sore back/OMT

[Realchiro]

UHS03,

KC? Great place. Used to live there. Is Kelly's Westport still there?

As for your question: " Does chiropractic ever focus similarly on muscle spasm, or is joint dysfunction almost always considered the primary problem? It seems to me that DO's
and DC's use similar techniques, but they are aimed at treating different things. Is this
accurate?"

Absolutely. Spasms are addressed utilizing either myofascial techniques or in many cases the spasm ceases following CMT; depending on their location to the spine. The issue of joint dysfunction or muscle spasm occuring frist is one of regular debate. In a previous post, I outlined the mechanism of the so-called subluxation complex. In it, the spasm is typically considered a consequence to, or residual component of the complex. As for the techniques applied, yes there are many similarities, though the appplication and the desired results are probably different. True, we view the neural component as a key factor in addressing the CMT procedure. It could be considered the hallmark of our premise....\

Curious, do they still teach OMT of all spinal areas? Is the main goal of CMT for mobility?

great conversation

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[UHS03]

I just finished my first year, so I cannot speak as eloquently yet about OMT as some others may be able to. So far, we have learned to apply OMT to all areas of the spinal cord, from cervicals to sacrum. We have learned to address these areas using the high velocity maneuvers as well as muscle energy, strain-counterstrain, and simple soft tissue techniques. By far, I think the technique we have learned the least about applying is strain-counterstrain..perhaps that will be addressed next year.

So far as I have learned it, the primary goal of OMT is to restore normal range of motion. A large chunk of our classtime was spent learning how to evaluate range of mation, compare each side, and then treat the dysfunctional side. We have also spent time learning when NOt to do OMT, such as with acute whiplash patients. The biggest problem I have with the things we have been taught thus far is in it's application. What I mean is I'm not sure someone should be treated at all unless they are symptomatic. If a dysfunction is causing problems that interfere with a patients' quality of life, then by all means I think we should do what we can. I disagree that we should treat something simply because there is a restriction to the ROM, provided this is something previously unnoticed by the patient.

As far as the debate, what came first themuscle spasm or the joint dysfunction, I tend to believe it is the muscle spasm, unless trauma is involved. Admittedly, I have not really researched this out, it just makes more anatomical sense to me. This brings me back to my initial problem. Why is HVLA so popular among DO's when we are mainly taught that muscle spasm is the precipitating cause?

Realchiro, here in Missouri if I am not mistaken, I believe that the chiropractic lobby has attempted to pass legislation giving chiropracters prescription rights. These measures have failed to date, but I am curious what your position is on this. Do you support such legislation? I am not fluent in the actual bills that have been suggested, but I am curious if they involved, as a prerequisite to gaining prescription priveledges, additional classwork at chiropractic schools. You said earlier that it was a choice to stay out of the drug market which is why I am curious about your take on such legislation.


I'm glad you came here to student doctor. This is a discussion I have been avidly following and enjoying. I wish I was further along in my schooling so that I could add some more intelligent dialogue.


[This message has been edited by UHS03 (edited 05-25-2000).]

 

[Smile]

UHS03,

You mentioned you have learned to apply OMT to all areas of the "spinal cord." Please tell me you are not doing this!!!! Help!!

 

[UHS03]

Doh! I meant vertebral column, alhtough you never know what they'll come up with next

 

[Realchiro]

UHSO3,

Interesting. Could you elaborate on the muscle energy? I am familar with the other techniques you mentioned, but not this one.
Don't worry about being a little "green" in areas. I am a little old, since being away from the scolastic environment... rusty!

CMT (what we do) is also used for restoration of range of motion. It has a two-fold purpose, in some cases to restore ROM and in other cases to reduce or remove nerve pressure at the area of the IVF (intervertebral foramen). In fact, nerve interference is most commonly addressed. Afferent (sensory) and efferent (motor) nerves can be encroached at the nerve root by either disc, connective tissues and in a few cases, by osseous structures and subsequently from an inflammatory process of the prior.

As for treating something that has restricted ROM, but no symptomatology, consider one potential. If the symptom that is being observed, is pain, it is very common that a free nerve ending or pain fiber, which is intertwined within a spinal nerve bundle, may not be compressed and therefore a pain symptom may not be elicited. Therefore, consideration must be made to discern any positive ortho or neuro findings. Ie. changes in muscle strength, dermatome findings, deep tendon reflex changes and/or paresthesia.
In some cases emg can assist in determining nerve signal loss.

Acute whiplash should be addressed cautiously and a seasoned doctor can detect when it is appropriate. Many times, a few days must be given before CMT is used on the cervical region.

In the muscle or the joint dysfunction debate, I opt for muscle in many cases, but in cases of direct nerve involvement, at the IVF, I go with the joint dysfunction. I believe, in most cases, you cannot have one without the other, since they are both part of the same functional joint complex.

As for HVLA. I can't speak for DOs, but I have come to realize that if a muscle spasm will not respond, CMT (OMT) can interupt the spasm with a single treatment; frequently instantaneously.

I cannot answer the lobbying issue, but I will try to find out and get back to you. I know that in Florida, they have OTC prescription rights. I am in the middle on the prescription issues. I really don't want the added headache or responsibility that comes with Rx. When I have serious injury cases, I have a working relationship with a GP, who I can send to for NSAIDS, then continue CMT treatment at my office. There are times when I would appreciate having the ability to provide the patient with some immediate pain relief. That and anti- inflammatories are the only that I would entertain.... As I stated earlier, our profession chooses to stay out of medicine and has not considered any options previosuly. There are some small groups, within the profession, that seek prescription rights. This is fairly new and not necessarily representative of the main body of our profession. Just as I am sure there are Osteopaths and Osteopathic medicine people, we have our factions....

Do you engage in extraspinal OMT? ie. appendages?

Great discussion.

 

[ewagner]

I don't mean to jump in, but Muscle Energy is virtually the exact same thing as PNF (proprioceptive neuromuscular fascilitation) used in orthopedics and neuro-rehab in Physical Therapy...predating muscle energy in osteopathy (they don't tell us that, but I know the history).
SO, if you are familiar with the concepts of PNF, except for the patterns, then you will get the jist of muscle energy.

Is OMT performed on the extremities...you know the answer to this!! You know, as well as I, that manual medicine is VERY similar the world around (except for theory). SO yes, OMT is done the extremities and it is done in PT and in CMT. THe techniques may be slightly different, but all the same aspects are there. Low velocity vs high velocity vs high amplitude vs low amplitude vs stretch(myofascial) vs spray and stretch vs compression vs distraction on and on and on.

It is only HOW and WHEN they are applied that one sees the difference in OMT, CMT, and PT techniques. I think that is fair to say.

 

[Realchiro]

ewagner,

Thanks. Just to be sure, the PNF is muscle challenging to encourage facilitation? Blance board, toggle board, etc? May be the same thing as I may understand in different terms..... We utlize the spray and stretch with flouri methane as well....

I wasn't sure OMT was still used on extremities. Is the protocal the same for OMT on extremities; joint mobilization?

How about mechanical flexion distraction of the spine?

good conversation

 

[ewagner]

PNF, well that is a very detailed subject, but it really isn't the use of balance.
It was first developed as a way to promote muscular synergistic movements in stroke patients, TBI, CHI etc. As an example, post stroke , the pattern of ulnar deviation, clenched fist, wrist flexion, arm adduction, elbow flexioin becomes the easiest for the patient to perform, and therefore the patient may use the same pattern for feeding, dressing etc. PNF uses those patterns to strengthen the patient, then automatically reverses the pattern to strengthen the antagonists.
It is also used in advanced forms in balance (ie rolling out of bed, kneeling and all fours). It was then adapted to meet some orthopedic needs in the "contract relax" format...which is where DO's began to use them and adapt them to their own needs.

Regarding extremity manipulation/mobilization, any and all of the techniques are used to normalize function. Ie, if the inferior capsule of the shoulder is adhered, then inferior mobilizations (over a long period of time)are used to increase the movement to facilitate inferior glide in abduction of the shoulder. Now, I know that some old school DO's use some other techniques in a thrusting fashion to gain some bits of motion...but I don't think that could possibly work. We have been taught some things that I simply don't believe based upon numerous research studies on shoulder mechanics and post surgical rehab. BUt that is another story.

 

[Realchiro]

UHSO3,

I inquired about your question of lobbying efforts of the Missouri DCs. The doctors in our forum said that there was no type of activity to their knowledge in this matter.
I had my doubts, since Mo schools hold a pretty strong control over the state issues and any of that type of activity...

BTW, the largest consensus of the board has very good respect for DOs.... Just thought you would like to know.


ewagner,

I understand now. Thank you for explaining the detail. Very much PT material....

interesting conversation

 

[UHS03]

Realchiro,

Thanks for checking on that. I guess I was mistaken. I knew I read somewhere about this happening, but I couldn't remember if it was in MO or not. I may have confused it with the bills that the pharmacy lobby has attempted to pass. Sorry about mymistake, but thank you for checking.

 

[Realchiro]

OHSO3,

In case you are interested in more of what we do, you may want to take a tour. We have a school, at the corner of Rockhill & Meyer. Call ahead with the registar's office to set up an appointment. Though the funding for some facilities is lacking, and not that impressive, I think you will find the school impressive, never the less.....

 

[ewagner]

Realchiro,

If you would like to see our school, UHS is located on Independence Ave by I35 and is open while we study for the USMLE and COMLEX step 1 examinations. As a matter of fact, I am in room 419 of Leonard Smith Hall and I will give you a personal tour and you can see what goes into the preparation of step 1 board examinations.

Happy Memorial Day!

 

[Realchiro]

ewagner,

Thanks for the invitation, and naturally my invitation is open to you as well, but I am on the east coast, so it would be difficult. Also, I have to plan several days, in advance, to close the office. Perhaps, I will fly up there sometime and take you up on the offer. I would be interested. Have a good holiday. I will be golfing and then invited to a pool cookout. Check out the school. For a facility that receives no outside funding, it isn't bad.