Don't rule out ART of Osteopathic Manipulative Treatment

http://www.aafp.org/fpr/20000400/07.html
April 2000 • Volume 6 • Number 4
BY SHARON DENT
Las Vegas FP Report is published by the AAFP News Department.
Copyright © 2000 by American Academy of Family Physicians.


Martin Offenberger, M.D., left, of La Habra, Calif., practices osteopathic manipulation techniques with Charles MacDougall, M.D., of Plano, Texas, at AAFP's course on the musculoskeletal system.
Allopathically trained physicians often dismiss manipulative medicine as an unproven alternative therapy, but research is beginning to show it can help patients regain range of motion and overall health.

"For example, manipulation in the acute setting has been shown to be an effective modality in low back pain," said Dennis Cardone, D.O., assistant professor and director of a sports medicine fellowship in the family practice department at the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick. Cardone presented sessions on manipulative medicine techniques at the Office Procedures and Management of the Musculoskeletal System CME course Feb. 21-25.

He referred to the November 1999 New England Journal of Medicine, which featured results from a large study of patients with low back pain, comparing the use of traditional treatments alone with the use of those treatments augmented with osteopathic manipulation. The study found that manipulation decreased the need for pain medication and physical therapy.

Even some of the most basic, easy-to-learn techniques can have a dramatic impact on patient health, said Cardone. "It's not a panacea, it's not a cure-all, but when mixed in with the other modalities, it's effective," he said. "And it's definitely been shown that a physician's touch -- laying on of hands -- has healing powers unto itself."

Participants practicing the techniques on each other at the CME course frequently expressed surprise at the improvements they felt in their own bodies. "I heard people say that they never felt so relaxed, the muscles never felt so relaxed, they definitely felt an increase in their range of motion and the popping sensation wasn't as scary as they thought it might be," said Cardone.

He shared three fundamental osteopathic philosophies with attendees:

The body doesn't function as a collection of separate parts but as an integral unit.

An abnormality in the structure of any body part can lead to abnormal function, either at that body part or at some other location in the body. Therapeutic manipulation may be used to correct mechanical disorders of the body.

There are somatic components to disease that not only are manifestations of disease but also can contribute to ongoing physical problems.

Manipulation is indicated in patients with a somatic dysfunction -- a problem somewhere in the musculoskeletal system usually causing muscle pain or motion restriction, Cardone said. Specific criteria determine whether a patient has a somatic dysfunction. Just remember the ART of diagnosis:

Asymmetry -- Palpation of a joint with somatic dysfunction reveals that the bone involved is asymmetric with respect to its normal position and to the position of bones contiguous to it.

Restriction of motion -- A joint is restricted or meets an abnormal barrier in one or more planes of motion. Motion in the opposite direction is normal or free.

Tissue texture changes -- The soft tissues around the joint (skin, fascia or muscle) undergo palpable changes. Acute and chronic somatic dysfunctions present different tissue texture changes (see chart below).

If you suspect a somatic dysfunction, said Cardone, consider referring the patient to an osteopathic physician who practices manipulative medicine (not all D.O.s do it). Or better yet, learn how to do it yourself. Cardone emphasized that the techniques don't need to take much time: "A very focused treatment on a specific area takes just five minutes."

Where can you get training in manipulative medicine? The AAFP will offer clinical seminars and procedures workshops at the Scientific Assembly Sept. 20-24 in Dallas. Assembly information will be mailed to all members in May. Or attend next year's musculoskeletal system CME course; look for details in a fall mailing.