How to Prevent Falls and Slips

Dr. Jed Downs discusses common causes of falls and slips as aging sets in, and exercises and ideas for therapy that can help with balance issues. As we age fear of falling becomes more realistic. After age 65 there is an approximate one in 5 chan...
http://madison-manual-medicine.com/prevent-falls-and-slips/

Differential diagnosis of back pain

Dr. Jed Downs explains different forms of back pain, the body systems involved with each, and general thoughts about treatments that may help with each. Back strain: This terminology implies that muscles in the back were either too weak for the d...
http://madison-manual-medicine.com/differential-diagnosis-of-back-pain/

What to Expect in an Osteopathic Exam

What Can I expect in an Osteopathic Exam?

We will ask all patients for their medical history.  There will be a focus on past trauma, including past surgical trauma, as well as on active medical conditions and symptoms.

There will be a visual scan to assess for postural symmetry and balance as well as for possible lines of tension.

There will be an examination for structural asymmetry and for asymmetric motion, both in terms of range of motion as well as quality of movement.

The hands on exam includes general myofascial ‘listening’:  a technique in which the examiner places his or her hands on the patient, feels for lines of tension and uses touch receptors in both hands to triangulate or localize what is likely the strongest restriction in the patient’s body at that particular moment.  It also includes local myofascial ‘listening,’ in which the provider places his or her hands on the anterior midline of the body from the neck to the pubic bone and feels for a pull or draw within the tissues to more precisely localize any restrictions.  These examination techniques provide important information regarding tension impacting the three-dimensional structure of the human body.  If indicated, there are also local myofascial listening techniques for the legs and arms.  

The techniques are useful regardless of whether restrictions are present in the connective tissue supporting organs or the connective tissue attaching to the spine, limbs or head.

The examination will not be limited to the area of the primary patient complaint or discomfort.  The area of discomfort will be examined but structures distant from a site of pain can be responsible for tension that in turn causes an individual’s pain.  Pain should be looked upon as more of a billboard, advertising that something is wrong, rather than a road map telling the patient or the provider where the problem is.  This is sometimes confusing for patients, so a few examples are in order. 

• A chronic restriction in an ankle after an ankle sprain might alter gait and be responsible for lines of tension going up the leg, which in turn can cause inflammation, wear and breakdown, or pain up the extremities to include knee pain, shin splints, hip pain, low back or pelvic pain.  
• A fall on the buttocks may cause mechanical problems with the pelvis and low back with associated pain, but the shockwave traveling up the spine and body can impact the base of the skull and its attachments to the upper neck.  Twisting forces, forces on the outstretched arm used to try to break the fall, may all play an active role in a patient’s symptom complex.  Forces involved in trauma can also cause alteration in the position of solid organs such as the liver or a kidney.  The tension from a shift in the position of a kidney may then lead to flank pain, bladder irritability, or irritable bowel symptoms.  A shifted liver may pull on the pelvis contributing to back pain or to the diaphragm and chest wall which can lead to a side stitch when exercising or shoulder and or upper back pain.
• A patient may present with complaints of low back pain without recognized trauma. Surgical intervention for a hysterectomy, an ovarian cyst or an appendectomy can cause contracted scar tissue that then pulls on internal connective tissue that in turn has attachments to the spine.  Until the effects of the scar tissue are addressed, the back pain cannot be treated with long term success.

The osteopathic examination and treatment process is all about detecting and treating altered tension that may be leading to or contributing to the patient’s symptom complex.  Restoring appropriate structural relationships improves fluid and mechanical flow within the body and reduces tension on nerves, which can normalize reflexes and diminish pain.

A Brief History of Osteopathy

Osteopathy began as the brainchild of Andrew Taylor Still.
Still served as a Hospital Steward and surgeon in the Union Army during the Civil War. After the death of three of his children from spinal meningitis, he concluded that the medicine of his day was potentially harmful and often ineffective. He took a ten year hiatus from his practice and explored the insights of native healers as well as the implications of anatomic structure on function and health. He promoted the idea of treating the underlying structural problems not just symptoms and developed treatments based on an in-depth understanding of the structure of the body and how these structures interrelate with one another. After restoring balance to structural relationships, he found the body better able to recover from disease and injury. In other words, as mechanical balance and relationships were restored a patient was better able to return to function, health, and strength.

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Fundamentals of osteopathic medicine

Dr. John Jed Downs, an osteopathic physician from Madison Manual Medicine discusses the fundamentals of osteopathic therapy, including general history, diagnostic techniques and maninpulative techniques used in therapy.

There are a number of terms that get bandied around which are largely synonymous when it comes to osteopathic manipulative therapy. Other terms that may be used include osteopathic manual therapy, osteopathic manipulative medicine, and osteopathic manual medicine. It is a pity that more people are not familiar with the terms. Osteopathy was developed in this country in the 1870’s and has been taught continuously in the US since 1892. It was developed as a complete form of medicine that was an alternative to the crude surgeries without anesthetics and the toxic drugs of the day. Current practitioners of osteopathic treatment techniques consider it a form of complementary or integrative medicine and do not seek to invalidate medical advancements that occurred during the past century.

Osteopathic manipulative medicine holds these underlying tenets:

The body is an integrated unit of mind body and spirit.

The body possesses self regulatory mechanisms and has the inherent capacity to defend, repair and remodel itself.

Structure governs function and function governs function

Rational therapy is based on consideration of the previous principles.

Traditional osteopathy as practiced internationally adds an additional tenet:
The rule of the artery is supreme.

This is understood to mean that fluid flow within the body is critical. Impediments to arterial, venous, lymphatic, spinal fluid and other flows within the body are impediments to optimal function and optimal health.

With these truths in mind, the practitioner uses his/her hands to identify the regions in the body where blockages or restrictions exist to fluid flow, blockages or restrictions of mechanical movements of the joints. These blockages may be due to trauma, be it physical, surgical or emotional, postural habits, ergonomics, repetitive or cumulative trauma, or birth trauma as either the infant or the mother. These blockages are referred to as lesions or somatic dysfunctions and can be found almost anywhere. They may occur as a result of shock waves that hit distal to a site of injury, for example falling on one’s buttocks will send a wave up the spinal structures to the neck and skull. They may be due to shearing forces between tissues during rapid acceleration or deceleration events between organs or structures of different densities. Unfortunately, it may not be possible to identify all the root causes for a symptom complex.

After finding somatic dysfunctions, the practitioner mentally maps them and prioritizes the dysfunctions, before and during the ongoing treatment process. The treatment process is controlled by the practitioner’s hands and body. Depending on the quality of the tissues in terms of texture, mobility and subtle rhythmic motions, the provider selects the appropriate technique needed to restore movement and function to a target region. She/he then observes changes in response to the initial treatment before continuing on to treat other regions. Depending on the provider’s assessment and prioritization of the patient’s body’s needs for improved health and function, she/he may not end up directly treating the area of pain or region of lost motion.

Osteopathic treatment techniques include treatments that go into the ease of tissues which allow the body to unwind or untie itself in relation to dysfunction. Techniques include direct techniques in which tissues are put on stretch, others in which the nerves and muscles are hopefully retrained, and yet other techniques that are designed to break down a restriction, osteoarticular techniques, that may or may not be associated with popping or cracking.

The examination is comprehensive and looks for impacts of restrictions on nerves, arteries, lines of gravity, the autonomic nervous system, and the capacity of the head to express movement associated with spinal fluid circulation. The spine, ribs, joints of the extremities, interfaces between organs or the insides of cavities (chest & abdomen) and joints of the skull may all need to be examined and treated in the pursuit of better health and improved function.