A Hands-On Introduction to Osteopathic Manipulative Treatment & Acupuncture in a Case of Low Back Pain
Gautam J. Desai, D.O.
Physician Educator, Dept of Medical Affairs
Associate Professor, Dept of Family Medicine
Kansas City University of Medicine & Biosciences College of Osteopathic Medicine
Mary P. Guerrera, MD, FAAFP, DABMA Associate Professor, Dept of Family Medicine University of Connecticut School of Medicine W. Joshua Cox, D.O. Assistant Professor, Dept of Family Medicine Kansas City University of Medicine & Biosciences College of Osteopathic Medicine
This presentation was made possible by Grant Number 5 R25 AT000529-03 from the National Center for Complementary and Alternative Medicine (NCCAM) and the American Student Medical Association Foundation (AMSA Foundation) - its contents are solely the responsibility of the speakers and do not necessarily represent the official views of the NCCAM, the National Institutes of Health, or AMSA.
Review of 1999 National Ambulatory Medical Care Survey comparing DO’s v. MD’s when the dx was “musculoskeletal disorder”
Some differences seen in this study
DOs spent more time with patients,
DOs provided more manual and complementary therapies.
MDs ordered more diagnostic tests
MDs prescribed more medications.
Sun C, Desai G, Pucci D, Jew S: Management of Musculoskeletal Disorders: Does the Osteopathic Profession Demonstrate Its Unique and Distinctive Characteristics? Journal of the American Osteopathic Association , April 2004, vol 104, number 4
“ Integrative Medicine is healing oriented & emphasizes the centrality of the doctor-patient relationship. It focuses on the least invasive, least toxic, & least costly methods to help facilitate health by integrating both allopathic & complementary therapies. These are recommended based on an understanding of the physical, emotional, psychological, & spiritual aspects of the individual.”
Rakel D. Editor. Inegrative Medicine.Saunders:2003.p 5.
Since the 1997 NIH Consensus Panel on Acupuncture there have been >100+ Randomized Controlled Trials.
Results of Systematic Reviews: Ernst E. Editor. The Desktop Guide to CAM: an evidence-based approach. 2nd ed Mosby 2006, p 295. Positive Inconclusive Negative Chronic back pain Dental pain Fibromyalgia GI endoscopy Idiopathic HA Post-op N & V Oocyte retrval pn OA knee Addictions Lat Elbow pn Asthma Myofascial pn Bell’s palsy Neck pain Cancer pain OA Depression 1 dysmennrh Facial pain Sciatica Induc labor Surgical pain Inflam Rhem ds Stroke Insomnia Tinnitus Labor pain TMJ dysfunc RA Smoking Wt loss
“ Because of numerous methodological & other problems, the current evidence allows ample room for interpretations.”
Ernst E. Desktop Guide to CAM: An EB approach. 2ed. 2006, p.294.
Results of Controlled Clinical Trials of Acup by Country of Research: After Vickers 1998. Berman B. EMB & Medical Acupuncture in the 21st Century. Amer Acad Med Acup Symp. April 24-27,2003. Favoring Acupuncture Country Total trials Number % USA 47 25 53 China 36 36 100 Sweden 27 16 59 UK 20 12 60 Demark 16 8 50 Germany 16 10 63 Canada 11 3 27 Russia 11 10 91
“ Declines in adverse reports may suggest that recent practices, such as clean needle techniques & more rigorous acupuncturist training requirements, have reduced the risks associated with the procedure. Therefore, acupuncture performed by trained practitioners using clean needle techniques is a generally safe procedure.”
Stand at side of table, place cephalad hand over base of sacrum with fingers pointing toward feet, place other hand on the paravertebral muscles with fingers pointing toward head. Exert separating tractional force in directions fingers are pointing. Intermittent or sustained inhibition
Prone pressure with counter leverage
Stand at side of table, contact pt’s opposite side, grasp musculature with cephalad hand, apply anterior and lateral force. Contact ASIS with caudad hand and apply upward force. Use kneading or deep inhibitory pressure
Place dysfunctional area where it wants to go (indirect). Add a compressive or traction force and articulate it to where it doesn’t want to go, thus engaging the restrictive barrier (direct). Remove force and place pt back in neutral position. Reassess
Pt supine, stand on side of concavity (side of side bending component). Contact pt’s lumbar transverse process with cephalad index finger, supporting the muscles with palm, this is the monitoring hand. Grasp pt’s knee on same side with caudad hand and flex knee and hip until motion/relaxation felt at monitoring hand or approx 90 deg
Then move monitoring hand to knee, and caudad hand to leg around ankle. Induce internal rotation (pull lower leg lateral) and adduction by pushing knee medially. This sidebends toward concavity and rotates away - indirect (induces tissue relaxation)
Press down with 5 # pressure on knee toward the table in direction where monitoring hand had been. Maintaining compression, carry knee through neutral and then abduction and external rotation in articulatory manner. Pt’s leg brought back to extended, neutral supine position. Reassess.