Integrative Osteopathy

It’s More Than Just Manipulation

ObjectivesReview some basics

Learn to combine different options for treatment of common

conditions and improve outcomes

Treatment combining other modalities

Treatment from head to feet

Treatment changes over time

Techniques we have learned

Techniques we have learned

HVLA

Techniques we have learned

HVLAStrain/Counterstrain

Techniques we have learned

HVLAStrain/CounterstrainMyofascial Release

Techniques we have learned

HVLAStrain/CounterstrainMyofascial ReleaseCranial Sacral

Techniques we have learned

HVLAStrain/CounterstrainMyofascial ReleaseCranial SacralDirect/Indirect

Techniques we have learned

HVLAStrain/CounterstrainMyofascial Release Cranial SacralDirect/Indirect Muscle energy

Techniques we have learned

HVLAStrain/CounterstrainMyofascial ReleaseCranial SacralDirect/Indirect Muscle energyBalanced Ligamentous Tension

Techniques we have learned

HVLAStrain/CounterstrainMyofascial ReleaseCranial SacralDirect/Indirect Muscle energyBalanced Ligamentous TensionArticular Techniques

Treatment modalities you may not have learned

Acupuncture Prolotherapy Reiki Applied KinesiologyActivator

Think like an Osteopath!

Listen with your fingers!

TrustWhat YouFeel.

HEADACHES

Everything from migraine, tension, sinus or other multiple causes.

Cervical strains/arthritis TMJ, teeth problems Cranial lesionsTBI, Concussions

Cranial treatment

Gb 20 in a depression between the origins of SCM and Trapezius

Back painHeadaches Neck pain Neck stiffnessVertigo Tinnitus Hearing lossHypertension Vision problems

Cranial treatment using Bl 2 at the Supraorbital notch at the medial end of the eyebrow and Gb 14 on the foreheaddirectly above the pupil at midpoint of theeyebrow

Bl 2 and Gb 14Eye disorders. Eye disorders Dizziness. Dizziness Eyelid spasms. Eyelid spasmsHeadaches (frontal). Headaches (frontal)Nasal congestion. Facial muscle paralysis Common Cold. Ptosis

Neck pain causes

Muscle spasms

Strains/sprains

Somatic Dysfunctions

Arthritis/stenosis

Neck pain treatments

Triple warmer 17 point is locatedAt transverse process of C1Deafness, tinnitus Ear and eye disordersJaw (TMJ) disorders Parotitis and toothachesUsually very tender

Gv 16Just below External Occipital Protuberance at the base of theSkull

HeadacheNeck painNeck stiffness Suicidal tendencies Upper respiratory conditions Vertigo

Gv 14

Below the spinous

process of C7

Gv 14 below Spinous Process of C7

Asthma Respiratory disordersChest discomfort Neck stiffness Cough Spinal painDyspnea Shoulder painNeck pain Insomnia Hypertension

Thoracic pain causes

Muscle tightnessTrapsRhomboids

Somatic Dysfunctions

Rib Dysfunctions

Thoracic treatmentsTw 15 on the superior angle of the scapula

Neck pain and stiffness,Scapular, shoulder and arm painChest oppression Fever without sweating

Thoracic pain treatmentBack pain

Bl 11, 12 & 13(T1-3)Bladder points also Good for asthma, cough

Bl 16, 17 & 18 points at T6, T7 & T9Good for stomach and abdominal Issues

Lumbar pain causes

Spasms

Radicular symptomsBulging or herniated disk?

Strains/sprains

Arthritis/stenosis

Lumbar Treatments

Bl 22 at L1DiarrheaLumbar StiffnessLumbar PainUrine retention VomitingHeadache

Lumbar Treatments

Bl 23 at L2AsthmaPremature EjaculationImpotenceNocturnal EmissionsIrregular MensesLumbar PainKnee Disorders

Lumbar Treatment

Bl 24 at L3

AsthmaDysmenorrheaIrregular MensesHemorrhoidsLumbar PainLumbar Spinal Pain

Lumbar Treatment

Bl 25 at L4ConstipationDiarrheaLeg PainLeg ParalysisLumbar PainLumbar SpainSacral PainDysuria

Lumbar Treatment

Bl 26 at L5DiarrheaDysuriaLumbar PainSciaticaThirstFrequent Urination

Sacral pain causes

Locked SI joint

Sacroiliitis

Tendon strain

Pelvic imbalance

Sacral Treatments

Bl 27, S1Bl 28, S2 Bl 29, S3Bl 30, S4Lumbosacral PainLumbar StiffnessSciaticaLeg Weakness Anal Disease

Upper Extremity

Strains/Sprains/Tendonitis

Overuse Injuries

Arthritis

Carpal Tunnel Like Symptoms

Treating ShouldersLung points: Good for Asthma and breathing Problems

Lung 2Lung 1

Shoulder Treatment

Si 10 Good for arm motor impairmentArm pain and weaknessShoulder joint pain and soft tissueInjuries and scapular pain

Si 11Arm pain, scapular and Shoulder pain, asthma and elbow pain

Si 12Shoulder and scapular injuries

Elbow Treatment

Ht 3Arm pain and numbness, radiance pain,Headaches, neck stiffness

Pc 5Arm pain, chest pain, elbow problems,agitation, anxiety

Pc 6asthma, arm pain, cardiac pain, chestdiscomfort, palpitations, elbow problems

Elbow Treatment

Li 4arm pain,headaches,Respiratory disorders,ToothacheLi 11Neck stiffness, hivesShoulder pain, elbowProblems, arm pain, htn

Wrist TreatmentPc 7Cardiac Conditions, Nausea,Wrist Pain, Palpitations

Pc 6Cardiac Conditions, Palpitations,Throat infections, Wrist pain, Surgical Pains

Wrist and Hand Treatment Li 4Headaches, arm pain, all ailments of the face and head

Tw 4Arm pain, Wrist pain and soft Tissue joint pains, deafness and eye disorders

Lower Extremity

Hip bursitis

Knee OA/bursitis

Ankle strains/sprains

Foot pains

Ankle Treatment

Gb 40Ankle conditions, leg painNeck pain, muscle cramps

Lv 4Ankle conditions, lumbar Pain, hernia and genital pains

Knee Treatments

Lv 7 medial knee pain and swellingand inflammation Lv 8 leg pain, knee disorders, medialThigh painGb 33 knee disorders, leg numbness and paralysis

Abdominal TreatmentsAbdominal Reflex Points:

Abdominal tissue changes, temperature difference, and palpable tender areas associated with low back pain. They are usually located on the same side as the back pain.

Why do manipulation?

It helps patients feel better faster

Reduces need for medicines

Patients like it and seek out providers that do it

You can get paid to do it

Why do manipulation?A recent study shows manipulation increases substance P, neurotension, oxytocin and therefore may play a role in pain and inflammatory disorders.

It modulates various biochemical markers such as interleukins and cortisol which may also have benefits on pain and inflammation.

What is the Cost of Back Pain?

According to Ohio State University Spine Research Institute, the cost of low back pain is over $100 billion a year. The cost of just “over exertion” is estimated to be $14.2 billion to businesses each year. Research also estimates that the average cost of a workers comp low back injury is $40,000-$80,000 per case.

Reimbursement averages for OMM

1-2 regions. 5-6 regionsBCBS: 52.23 BCBS: 72.54-96.87 Aetna: 27.83 Aetna: 52.91Medicare: 24.26 Medicare: 46.09

3-4 regions 7-8 regions BCBS: 75.75 BCBS: 115.09Aetna: 40.53 Aetna: 49.50-

Treatments change over time

What has changed?

What has changed?

We have gotten older

What has changed?

We have gotten olderPatients have gotten older

What has changed?

We have gotten olderPatients have gotten older Patients have gotten bigger

What has changed?

We have gotten olderPatients have gotten older Patients have gotten biggerTechniques tend to evolve

What has changed?

We have gotten olderPatients have gotten older Patients have gotten biggerTechniques tend to evolveDiagnosis is more dependent on diagnostic testing instead of physical exam findings

Treatment Demonstrations

Anatomy of the Neck

Evaluation of Head and Neck

MotionRotation Flexion Extension Segmental Side BendingA-O Motion

Upper Extremity

Anatomy of the Shoulder

Evaluation of Upper Extremities

Areas of TendernessJoint Motion Strength Radicular Symptoms

Anatomy of the Forearm & Wrist

Thoracic Spine

Thoracic Spine Evaluation

Segmental Motion Somatic Dysfunctions Muscle TightnessRib Dysfunctions Kyphosis

Anatomy of the Upper Back

Lumbar Spine EvaluationSegmental MotionRotation Muscle Tightness/spasmsSomatic Dysfunctions

Lumbar Spine Anatomy

Disk Anatomy

Sacral and Pelvic

Sacral and Pelvic Evaluation

Sacral Motion flexion/extension/rotationPiriformis SyndromeSacroiliitis Muscle Spasms

Anatomy of the Pelvis

Lower Extremity

Lower Extremity Evaluation

RadiculitisSciatica Bursitis Arthritis Joint MotionFibular Head Dysfunction

Visceral

Visceral Evaluation

Breathing Problems Diaphragm IssuesConstipationAbdominal Pains

Questions?