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| {{Interventions infobox | |||
| | Name = Osteopathic manipulative medicine | |||
| | Image = | |||
| | Caption = | |||
| | ICD10 = {{ICD10PCS|7|7}} | |||
| | ICD9 = {{ICD9proc|93.6}} | |||
| | MeshID = D026301 | |||
| | OPS301 = | |||
| | OtherCodes = | |||
| | HCPCSlevel2 = | |||
| }} | |||
| {{Osteopathic Medicine}} | |||
| '''Osteopathic manipulative medicine (OMM)''', also known as '''osteopathic manipulative treatment (OMT)''', is the core technique of osteopathic medicine.<ref name=paradox/> It is based on a ] devised by ] (1828–1917) which posits the existence of a ]l continuity – a tissue layer that interlinks all parts of the body. Practitioners attempt to diagnose and treat "]" by manipulating the bones and muscles of a patient, so addressing a variety of ailments, most commonly ], but sometimes systemic conditions such as ] and ].<ref name=back-pain/><ref name=paradox/> | |||
| Research into OMM has generally not found it to be an effective therapy.<ref name=coch/><ref name=ernst-sr/><ref name=musculo-no/> Critics have characterized it as pseudoscience.<ref name=ident/><ref name=elephant/><ref name=ss/> | |||
| ==Origins and conceptual basis== | |||
| ] | |||
| ], ], ] was a 19th-century American physician and ] surgeon who founded ]. Following the loss of three of his children to ], Still became dissatisfied with contemporary medical practices and sought to further medical understanding and treatment.<ref>{{cite web| title = Andrew Taylor Still, The Father of Osteopathic Medicine| publisher = A.T. Still University - Museum of Osteopathic Medicine| accessdate = 2011-12-19| url = http://www.atsu.edu/museum/ats/index.htm}}</ref> Still claimed that human illness was rooted in problems with the ] system, and that hands-on manipulations could solve these problems and so effect a cure by harnessing the body's own self-repairing potential.<ref name=ident>{{cite journal|pmid=10179479|year=1998|last1=Guglielmo|first1=WJ|title=Are D.O.s losing their unique identity?|volume=75|issue=8|pages=200–2, 207–10, 213–4|journal=Medical economics}}</ref> Still's proposed treatment regime also included as strong dose of healthy living: he advocated abstinence from alcohol, and patients were forbidden from taking medicine.<ref name=paradox/> | |||
| Osteopathic medicine defines a concept of health care that embraces the concept of the unity of the living organism's structure (anatomy) and function (]). The ] (AOA) state that the four major principles of osteopathic medicine are:<ref>{{cite web|title=Statement of Healthcare Policies and Principles|url=http://www.osteopathic.org/inside-aoa/advocacy/Documents/aoa-healthpolicy-principles.pdf|publisher=American Osteopathic Association|accessdate=1 July 2012}}</ref> | |||
| # The body is an integrated unit of mind, body, and spirit. | |||
| # The body possesses ], having the inherent capacity to defend, repair, and remodel itself. | |||
| # Structure and function are reciprocally interrelated. | |||
| # Rational therapy is based on consideration of the first three principles. | |||
| These principles are not held by Doctors of Osteopathic Medicine to be ]s; they serve, rather, as the underpinnings of the osteopathic approach to health and disease.{{cn|date=February 2014}} | |||
| According to medical professor Joel D. Howell, OMT is based on the idea that a ]l continuity "links every part of the body with every other part"; a practitioner, through a "skillful and dexterous use of the hands" treats what was originally called "the osteopathic lesion", but which is now named "somatic dysfunction".<ref name=paradox/> The most commonly treated ailment is back pain, although some practitioners claim OMT can be used to treat a wide range of conditions.<ref name=back-pain>{{cite book|author=Vincent C, Furnham A |work=Complementary Medicine: A Research Perspective |url=http://books.google.com/books?id=Q_UnQNQPJ60C&pg=PA15 |year= 1997 |publisher=John Wiley & Sons |isbn=978-0-471-96645-6 |page=15 |entry=Manipulative Therapies: Osteopathy and Chiropractic}}</ref> It has been proposed as effective for treating diseases including asthma, ] and Parkinson's disease.<ref name=paradox>{{cite journal|doi=10.1056/NEJM199911043411910|title=The Paradox of Osteopathy|year=1999|last1=Howell|first1=Joel D.|journal=New England Journal of Medicine|volume=341|issue=19|pages=1465–8|pmid=10547412}}</ref> | |||
| ==Reception== | |||
| Initially, D.O.s were regarded by M.D.s as "cultists" whose treatments were rooted in "pseudoscientific dogma", and tensions between the two continued for many years.<ref name=ident/> | |||
| In 1988, ] classified osteopathy as one of the "paranormal" forms of alternative medicine, commenting that it has a view of disease which had no meaning outside its own closed system.<ref name=paranormal>{{cite journal |author=Skrabanek P |title=Paranormal health claims |journal=Experientia |volume=44 |issue=4 |pages=303–9 |year=1988 |month=April |pmid=2834214 |type=Review |authorlink=Petr Skrabanek}}</ref> | |||
| In a 1995 conference address the president of the ], Jordan J. Cohen, pinpointed OMT as a defining difference between M.D.s and D.O.s; while he saw there was no quarrel in the appropriateness of manipulation for musculoskeletal treatment, the difficulty centered on "applying manipulative therapy to treat other systemic diseases" – at that point, Cohen maintained, "we enter the realm of skepticism on the part of the allopathic world."<ref name=ident/> | |||
| In 1998 ] of ] posted a highly critical article online entitled "Dubious Osteopathic Practices", in which he said that the worth of manipulative therapy had been exaggerated and that the ] (AOA) was acting unethically by failing to condemn ]. The article attracted a letter from the law firm representing the AOA accusing Barrett of libel and demanding an apology to avert legal action.<ref name=ident/> In response Barrett made some slight modifications to his text, while maintaining its overall stance; he queried the AOA's reference to "the body's natural tendency toward good health" and challenged them to "provide with adequate scientific evidence showing how this belief has been tested and demonstrated to be true."<ref name=ident/> Barrett has been quoted as saying "the pseudoscience within osteopathy can't compete with the science".<ref name=ident/> | |||
| In 2004, the osteopathic physician ], a professor of ], wrote disparagingly of the "pseudoscience" at the foundation of OMT. In his view, "OMT will and should follow homeopathy, magnetic healing, chiropractic, and other outdated practices into the pages of medical history".<ref name=elephant>{{cite journal |journal=J Am Osteopath Assoc |author=] |year=2004 |volume=104 |issue=10 |page=407 |title=The Elephant in the Room: Does OMT Have Proved Benefit? |type=Letter |url=http://www.jaoa.org/content/104/10/405.full.pdf+html}}</ref> | |||
| In 1999, Joel D. Howell noted that osteopathy and medicine as practiced by M.D.s were becoming increasingly convergent. He suggested that this raised a paradox:{{quote|if osteopathy has become the functional equivalent of allopathy, what is the justification for its continued existence? And if there is value in therapy that is uniquely osteopathic – that is, based on osteopathic manipulation or other techniques – why should its use be limited to osteopaths?<ref name=paradox/>}} | |||
| In 2010, ] wrote that OMT was promoted as a special distinguishing element of DO training, but that it amounted to no more than "'extra' training in pseudoscientific practices".<ref name=ss>{{cite web|url=http://www.forbes.com/sites/sciencebiz/2010/10/29/second-thoughts-on-osteopathic-medicine|title=Second Thoughts On Osteopathic Medicine|last=Salzberg|first=Steven|date=27 October 2010|publisher=]|accessdate=18 September 2013}}</ref> | |||
| == Treatment == | |||
| ] (OMT) involves ] and ] of ]s, ]s, ]s, and ]e.]] | |||
| According to the AOA, osteopathic manipulative treatment is considered to be only one component of osteopathic medicine and may be used alone or in combination with ], ], ], ], ], and ]. OMT techniques are not necessarily unique to osteopathic medicine; other disciplines, such as ] or ], use similar techniques.<ref name="aacom1">{{cite web|url=http://www.aacom.org/about/osteomed/Pages/default.aspx |title=What Is Osteopathic Medicine? |publisher=Aacom.org |date= |accessdate=2012-05-24}}</ref> OMT can be considered as a treatment for certain ] problems such as lower back pain.<ref>{{cite journal |first1=Sarah |last1=Cole |first2=Jeremy |last2=Reed |journal=The Journal of Family Practice |pmid=20544039|url=http://stg.jfponline.com/Pages.asp?AID=8612&issue=May_2010&UID= |year=2010 |title=When to consider osteopathic manipulation |volume=59 |issue=5 |pages=E2}}</ref> | |||
| ===Muscle Energy=== | |||
| {{Main|Muscle energy technique}} | |||
| Muscle energy techniques address somatic dysfunction through stretching and muscle contraction. For example, if a person is unable to fully ] her arm, the treating physician raises the patient's arm near the end of the patient's range of motion, also called the edge of the restrictive barrier. The patient then tries to lower her arm, while the physician provides resistance. This resistance against the patient's motion allows for ] of the patient's muscle. Once the patient relaxes, her range of motion increases slightly. The repetition of alternating cycles of contraction and subsequent relaxation help the treated muscle improve its range of motion.<ref name=DiGiovanna_83>{{Harvnb|DiGiovanna|Schiowitz|Dowling|2005|pp=83–5}}</ref> Muscle energy techniques are contraindicated in patients with fractures, ], ]s, ], severe ] or strains, severe ], severe ], ], severe illness, and recent surgery. | |||
| ===Counterstrain=== | |||
| {{Main|Counterstrain}} | |||
| Counterstrain is a system of diagnosis and treatment that considers the physical dysfunction to be a continuing, inappropriate strain ], which is inhibited during treatment by applying a position of mild strain in the direction exactly opposite to that of the reflex.<ref name=DiGiovanna_86>{{Harvnb|DiGiovanna|Schiowitz|Dowling|2005|pp=86–8}}</ref> After diagnosis of a counterstrain tender point, the identified tender point is treated by the osteopathic physician who, while monitoring the tender point, positions the patient such that the point is no longer tender to palpation.<ref name="counterstrain">{{cite journal |doi=10.1016/j.math.2011.10.001 |title=Strain counterstrain: Current concepts and clinical evidence |year=2012 |last1=Wong |first1=Christopher Kevin |journal=Manual Therapy |volume=17 |pages=2–8 |pmid=22030379 |issue=1}}</ref> This position is held for ninety seconds and the patient is subsequently returned to her normal posture. Most often this position of ease is usually achieved by shortening the muscle of interest.<ref name="counterstrain"/> The use of counterstrain technique is contraindicated in patients with severe osteoporosis, pathology of the ], and in patients who are very ill or cannot voluntarily relax during the procedure. | |||
| ===High-velocity, low-amplitude=== | |||
| High velocity, low amplitude (HVLA) is a technique which employs a rapid, targeted, therapeutic force of brief duration that travels a short distance within the anatomic range of motion of a joint and engages the restrictive barrier in one or more places of motion to elicit release of restriction.<ref name="aacom" /> The use of HVLA is contraindicated in patients with ] due to instability of the ] which may stem from ], and in pathologic bone conditions such as ], history of a ], ], osteoporosis, and severe cases of ].<ref name="Emergency">{{cite journal |first1=Raymond J. |last1=Roberge |first2=Marc R. |last2=Roberge |title=Overcoming Barriers to the Use of Osteopathic Manipulation Techniques in the Emergency Department |journal=Western Journal of Emergency Medicine |pmid=19718381 |pmc=2729220 |url=http://escholarship.org/uc/item/31547932 |volume=10 |issue=3 |year=2009 |pages=184–9}}</ref><ref name=Savarese_146>{{Harvnb|Savarese|Copabianco|Cox|2009|p=146}}</ref> HVLA is also contraindicated in patients with ] such as ]s, or disease of the ] or vertebral arteries.<ref name="Emergency"/> Patients taking ] or ]s, or who have local ] should not receive HVLA.<ref name="Emergency"/> | |||
| ===Myofascial release=== | |||
| {{Main|Myofascial release}} | |||
| Myofascial release is a form of ] used to treat ] and the resultant pain and restriction of motion. Treatment requires continual palpatory feedback to achieve release of myofascial tissues.<ref name="aacom">{{cite web|title=Glossary of Osteopathic Terminology, November 2011 Edition|url=http://www.aacom.org/resources/bookstore/Pages/glossary.aspx|publisher=]|pages=30–31|accessdate=1 July 2012}}</ref> This is accomplished by relaxing contracted muscles, increasing circulation and lymphatic drainage, and stimulating the ] of muscles and overlying ].<ref name=DiGiovanna_80>{{Harvnb|DiGiovanna|Schiowitz|Dowling|2005|p=80}}</ref> | |||
| ] is the ] component of the ] that provides support and protection for most structures within the human body, including ]. This soft tissue can become restricted due to ], overuse, trauma, infectious agents, or inactivity, often resulting in pain, muscle tension, and corresponding ].<ref name=DiGiovanna_81>{{Harvnb|DiGiovanna|Schiowitz|Dowling|2005|pp=80–1}}</ref> Although fascia and its corresponding muscle are the main targets of myofascial release, other tissue may be affected as well, including other connective tissue.<ref name=DiGiovanna_80 /> | |||
| ===Lymphatic pump treatment=== | |||
| {{See also|Lymphatic pump}} | |||
| Lymphatic pump treatments are manual techniques which encourage ] flow in the ]. Lymphatic pump treatment techniques increase lymph flow through the external application of forces to the ], abdomen, ], legs, and over the ] and the ].<ref name="lymph">{{cite journal |doi=10.1258/ebm.2011.011057 |title=Lymphatic pump treatment enhances the lymphatic and immune systems |year=2011 |last1=Hodge |first1=Lisa M |last2=Downey |first2=H Fred |journal=Experimental Biology and Medicine |volume=236 |issue=10 |pages=1109–15 |pmid=21865405}}</ref> The first modern lymphatic pump technique was developed in 1920, although osteopathic physicians used various forms of lymphatic techniques as early as the late 19th century.<ref name=Origins_Lymphatics>{{cite journal |first1=Bruno J. |last1=Chikly |title=Manual Techniques Addressing the Lymphatic System: Origins and Development |journal=The Journal of the American Osteopathic Association |pmid=16314678 |url=http://www.jaoa.org/cgi/pmidlookup?view=long&pmid=16314678 |year=2005 |volume=105 |issue=10 |pages=457–64}}</ref> Research shows that two types of lymphatic techniques, the thoracic pump and the pedal pump, are both safe for patients with ], and do not raise ].<ref>{{cite journal |first1=Dennis |last1=Cramer |first2=Dan E. |last2=Miulli |first3=Jennine C. |last3=Valcore |first4=Jon William |last4=Taveau |first5=Nguyen |last5=Do |first6=Daniel S. |last6=Hutton |first7=Gayatri |last7=Sonti |first8=Elijah |last8=Wogu |first9=Caroline F. |last9=Boorman |title=Effect of Pedal Pump and Thoracic Pump Techniques on Intracranial Pressure in Patients With Traumatic Brain Injuries |journal=The Journal of the American Osteopathic Association |pmid=20430911 |url=http://www.jaoa.org/cgi/pmidlookup?view=long&pmid=20430911 |year=2010 |volume=110 |issue=4 |pages=232–8|displayauthors=4}}</ref> | |||
| Research in animal models has demonstrated that lymphatic pump techniques produce a strong, short-term increase in the flow of lymphatic fluid, and stimulate the mobilization of immune cells in the lymphoid tissue of the gastrointestinal tract, from both the ] and ]; preliminary research in humans suggests that lymphatic pump techniques may be able to improve the immune response to vaccinations.<ref name="lymph"/> Relative contraindications for the use of lymphatic pump treatments include fractures, ]es or localized infections, and severe bacterial infections with ] higher than {{Convert|102|F|C}}.<ref name=Savarese_126>{{Harvnb|Savarese|Copabianco|Cox|2009|p=126}}</ref> | |||
| ==Effectiveness== | |||
| A 2013 ] reviewed six randomized controlled trials which investigated the effect of four types of chest physiotherapy (including OMT) as adjunctive treatments for pneumonia in adults and concluded that "based on current limited evidence, chest physiotherapy might not be recommended as routine additional treatment for pneumonia in adults."<ref name=coch>{{cite journal |doi=10.1002/14651858.CD006338.pub3 |title=Chest physiotherapy for pneumonia in adults |journal=Cochrane Database of Systematic Reviews |year=2013 |last1=Yang |first1=M |last2=Yuping |first2=Y |last3=Yin |first3=X |last4=Wang |first4=BY |last5=Wu |first5=T |last6=Liu |first6=GJ |last7=Dong |first7=BR|pmid=23450568 |issue=2 |pages=CD006338 |editor1-last=Dong |editor1-first=Bi Rong |volume=2}}</ref> | |||
| A 2013 systematic review of the use of OMT for treating pediatric conditions concluded that its effectiveness was unproven.<ref name=ernst-sr>{{cite journal|doi=10.1542/peds.2012-3959|title=Osteopathic Manipulative Treatment for Pediatric Conditions: A Systematic Review|year=2013|last1=Posadzki|first1=P.|last2=Lee|first2=M. S.|last3=Ernst|first3=E.|journal=Pediatrics|volume=132|pages=140–52|pmid=23776117|issue=1}}</ref> | |||
| A 2011 systematic review found no compelling evidence that osteopathic manipulation was effective for the treatment of musculoskeletal pain.<ref name=musculo-no>{{cite journal |author=Posadzki P, Ernst E |title=Osteopathy for musculoskeletal pain patients: a systematic review of randomized controlled trials |journal=Clin. Rheumatol. |volume=30 |issue=2 |pages=285–91 |year=2011 |month=February |pmid=21053038 |doi=10.1007/s10067-010-1600-6 |type=Systematic review}}</ref> A 2013 systematic review found insufficient evidence to rate osteopathic manipulation for chronic non-specific low back pain.<ref name=chronic>{{cite journal |author=Orrock PJ, Myers SP |title=Osteopathic intervention in chronic non-specific low back pain: a systematic review |journal=BMC Musculoskelet Disord |volume=14 |issue= |pages=129 |year=2013 |pmid=23570655 |pmc=3623881 |doi=10.1186/1471-2474-14-129 |type=Systematic review}}</ref> | |||
| ===Earlier research=== | |||
| A 2005 systematic review of OMT's use in treating asthma concluded: "There is insufficient evidence to support the use of manual therapies for patients with asthma."<ref>{{Cite journal |doi=10.1002/14651858.CD001002.pub2 |title=Manual therapy for asthma |journal=Cochrane Database of Systematic Reviews |year=2005 |last1=Hondras |first1=Maria A |last2=Linde |first2=Klaus |last3=Jones |first3=Arthur P |editor1-last=Hondras |editor1-first=Maria A |pmid=15846609 |issue=2 |pages=CD001002}}</ref> | |||
| ==See also== | |||
| * ] | |||
| * ] | |||
| * ] | |||
| * ] | |||
| * ] | |||
| * ] | |||
| == References == | |||
| {{Reflist|2}} | |||
| == Further reading == | |||
| * American Association of Colleges of Osteopathic Medicine (2011); ''''. | |||
| * {{cite web |author=Crislip M |title=Pump it up: osteopathic manipulation and influenza |url=http://www.sciencebasedmedicine.org/pump-it-up-osteopathic-manipulation-and-influenza/ |date=4 October 2013 |publisher=Science-based Medicine |accessdate=February 2014}} | |||
| * {{cite book|last1=Savarese|first1=Robert G.|last2=Copabianco|first2=John D.|last3=Cox|first3=James J.|title=OMT review|year=2009|publisher=|isbn=978-0967009018|ref=harv}} | |||
| * {{cite book|author=Smith JC |work=Pseudoscience and Extraordinary Claims of the Paranormal: A Critical Thinker's Toolkit |entry=Manipulative and Body-based Practices|url=http://books.google.com/books?id=ojd1sdVUydwC&pg=PA342 |year=2009 |publisher=John Wiley & Sons |isbn=978-1-4443-1013-9 |page=342}} | |||
| * {{cite book|last1=DiGiovanna|first1=Eileen L.|last2=Schiowitz|first2=Stanley|last3=Dowling|first3=Dennis|title=An osteopathic approach to diagnosis and treatment|year=2005|publisher=Lippincott Williams and Wilkins|location=Philadelphia, PA|isbn=978-0781742931|edition=3rd|ref=harv}} | |||
| * {{cite book|last=Ward|first=Robert C.|title=Foundations for Osteopathic Medicine|year=2002|publisher=Lippincott Williams & Wilkins|location=Philadelphia|isbn=0-7817-3497-5|edition=2nd}} | |||
| {{Osteopathic medicine3}} | |||
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