Spinal Osteopathic Manipulative Therapy (OMTh) Revisited by Manual Therapists 2014

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Health & Medicine

Published on March 13, 2014

Author: dalopezdalopez

Source: slideshare.net


In this presentation the author, David Lopez Chiropractor DC and Kinesiologyst (PT) from Chile expose about the different principles under the scope of the osteopathic manipulation of the spine. Dr. Lopez is director of the progran in Chiropractic for healh professional of the "Universidad Central de Chile" and director of the Diplomats in Manual Therapy of the "Universidad Santo Tomas de Chile. The interest is to review the fundamentals to understand the approach of the Osteopathy to the practice of the manual therapy and healthcare. This vision was exposed in Poland in the framework of an international symposium of Physiotherapy.

Prof. David López Sánchez Kinesiologyst; Chiropractor D.C. Director of the Chiropractic Program Central University of Chile Director of Manual Therapy Diplomats Saint Thomas University, Chile The Spinal Osteopathic Manipulative Therapy (OMTh): revisited by other Manual Therapist XX edition of International Disabled People’s Day. International Scientific Symposium 20-23 March 2014. Zgorzelec, Poland.

Osteopathy: Art, Science & Philosophy  Mind – Body – Spirit are a single unity  OMT is Hands-On Medicine  Structure and Function are reciprocally related: Localized visceral stimulation produces patterns of reflex response in spinal segments related with somatic structures (1,2)  The body is a system who heals itself and capable of self regulation 1.- Beal, M.C.: “Viscerosomatic Reflexes: A Review.” Journal of the A.O.A.. 85, (12): 786-801, 1983. 2.-Louisa Burns, Viscero-Somatic and Somato-Visceral Spinal Reflexes. The Journal of The American Osteopathic Association. 2000; 100(4);249-258. 2David Lopez Sánchez DC, PT

Asymmetry Restricted Range of Motion Tissue Texture Changes Position of Elements Restricted Motion Direction Free Motion Direction Skeletal structures Myofascial structures (Tozzi, 2012) Tissues: Vascular, Lymphatic and Neural related elements (Langevin, 2006) Somatic Dysfunction: Diagnosis Impairment Disorder Paolo Tozzi, Selected fascial aspects of osteopathic practice, Journal of Bodywork & Movement Therapies. 2012;16, 503-519. Helene M. Langevin, Karen J. Sherman, Pathophysiological model for chronic low back pain integrating connective tissue and nervous system mechanisms, Medical Hypotheses, 2006; 68,74-80. 3David Lopez Sánchez DC, PT

Spinal Osteopathic Manipulation: Forces Extrinsic Forces Adjusting Springing Traction Gravity Mechanical Systems Intrinsic Forces Muscle Contraction- Relaxation Respiration Homeostatic 4David Lopez Sánchez DC, PT

Manipulation: Homeostatic Effects •Free Nerve Ending •Mechanoreceptors Receptors •Brain •Dorsal Corn Integrator •Muscle •Vessels walls •Glands Efectors Homeostasis & OMT: Stable operating conditions in the internal inviroment to maintain the physiological equilibrium The response to the manipulative stimulus leads the changes. ResponseOMT 5David Lopez Sánchez DC, PT

Intervertebral Somatic Dysfunction Fryer, Gary (2003) Intervertebral Somatic Dysfunction: A Discussion of the Manipulable Spinal Lesion. Journal of Osteopathic Medicine, 6 (2). pp. 64-73. ISSN 1443-8461 The facilitated segment: There is evidence of spontaneous electromyographic (EMG) activity and increased sympathetic output at spinal levels associated with clinically detected segmental dysfunctions (Denslow 1947 & Korr, 1958). A vertebral segment or spinal cord level exhibits a pool of related neurons that maintain a state of partial excitation; then less afferent stimulation is required to trigger the discharge of impulses. Muscle Inhibition; Compensatory Shortened and Overactive muscles Joint ROM restriction Asymmetry Increased Sympathetic Output Tissue Texture Changes (Edema & fibrosis); Circulatory Changes (ischemia) Increased Nociception (Pain); Altered gamma and Alfa Activity (Mechanoreceptors hyperactivity) Facilitated Spinal Cord Neurons 6David Lopez Sánchez DC, PT

The Pathokinesiological Dysfunction produces neurophysiological Dysfunction The Neurophysiological Dysfunction produces Pathokinesiological Dysfunction Intervertebral Somatic Dysfunction: Cause or Effect? 7David Lopez Sánchez DC, PT

Joint Dysfunction: Deafferentation • The loss of motor control in a joint it can become restricted or unstable. • The Joint Dysfunction can alter the mechanoreceptors Type I & II discharge and limit their role on the pain modulation, which results in an increased nociceptor feedback. • This has effects at the segmental level and the cortex. The manipulation could reverse these effects acting at GDR’s level. 1.- Terrett and Terret, “Referred Posterior Thoracic Pain,” Chiropr J of Australia 2002; 32: 44 2.- Seaman DR, Winterstein JF. Dysafferentation, a novel term to describe the neuropathophysiological effects of joint complex dysfunction: A look at likely mechanisms of symptom generation. J Manip Physiol Ther 1998;21(4):267-80 8David Lopez Sánchez DC, PT

David Lopez Sánchez DC, PT 9 Osteopathy & Tensegrity: The Body as full integrated Unit The body is a unit…with a architectural network of omnidirectional viscoelastic forces and rigid components distributed an tied through a tensegrity system. Thus the cranium content could be affected by tensions transferred from the related structures through the connective and soft tissues. Under this model secondary stresses can be the result of the posture of the spine and any distant change of tension within the musculoskeletal system. Graham Scarr. Helical tensegrity as a structural mechanism in human anatomy. International Journal of Osteopathic Medicine. March 2011 (Vol. 14, Issue 1, Pages 24-32.

Dentate Ligament Theory: Cord Traction 10David Lopez Sánchez DC, PT The Dentate Ligament connect the spinal cord and brain stem with dura mater. Any misalignmet at level Occipito-Atlanto-Axial could be a factor of direct traction on the spinal cord. 1) J Neurol Neurosurg Psiquiatría v.47 (4); 04 1984 2) The Origins of the Grostic Procedures. Jhon Grostic DC. ICA, 1978.

David Lopez Sánchez DC, PT 11 Dentate Ligament : Role in Mielopathy • In presence of a spondylotic bar, tensile forces acts over the spinal cord from the dentate ligament causing traction and neural tissue stress, this produces narrowing of small vessels and decreased local microcirculation, thus consequentelly mielopathy. David N Levine. Pathogenesis of cervical spondylotic myelopathy. Journal of Neurology, Neurosurgery, and Psychiatry 1997;62:334-340

Dentate Ligament Theory: Cord Traction 12David Lopez Sánchez DC, PT Journal of Clinical Neuroscience 19 (2012) 1150–1153  Dentate Ligament before & after a meningiom of spinal cord resection.  The spinocerebellar tracts (proprioception) are located at the site of maximal mechanical irritation, their irritation may cause hypertonicity and spasticity in the muscles of the pelvic girdle and lower extremities

Somatic Dysfunction: Cord & Neural Traction 13David Lopez Sánchez DC, PT Atlas Dysfunction Fernandez Noda et al. ‘Neck and brain transitory vascular compression causing neurological complications’, J. Cardiovasc Surg 1996; 37 (suppl. 1 to no. 6): 155-66). The trigeminal nerve spinal nucleus may be tractioned by a lateral deviation and rotation of the atlas.

Osteopathic Cavitation: Joint Space Separation? 14David Lopez Sánchez DC, PT • The separation of the zygapophyseal joints after manipulation has been demonstrated with MRI. • The observed gapping increases significantly over a tension of 8 kgs., the facetary surfaces separates 4,7 mms with an audible cavitation. (Cramer G., 2013, 2012, 2000). Cramer Gregory DC. J Manipulative Physiol Ther. 2013 May; 36(4):203-17

15 David Lopez Sánchez DC, PT 1.- Johnson, Gillian M. The sensory and sympathetic nerve supply within the cervical spine: review of recent observations. Manual Therapy Volume: 9, Issue: 2, May, 2004, pp. 71-76. 2.- Spine. 15 January 2007 - Volume 32 - Issue 2 - pp 244-248. Friedrich, Klaus M. MD et als. High-Field Magnetic Resonance Imaging of Meniscoids in the Zygapophyseal Joints of the Human Cervical Spine. Spine. 15 January 2007 - Volume 32 - Issue 2 - pp 244- 248. 3.- Engel R. & Bodguk N. The menisci of the lumbar zygapophysial joints. J. Anat. (1982) 135, 4, pp. 795-809 795.  The cervical zygapophysial joints and their richly innervated meniscoids have been well documented as source of neck pain (1).  The High-Field MR image sequence is best for the evaluation of the meniscoid anatomy and pathology (2).  Meniscoids may become entrapped between the articular cartilages of the facet joints and OMT could release them. OMT: Entrapped Zygoapophysial Meniscoid

Spinal Manipulation: ROM and Neurophysiological Effects 16David Lopez Sánchez DC, PT • K. Rodrigues DC. Active range of motion in the cervical spine increases after spinal manipulation (J Manipulative Physiol Ther 2001;24:552-5). • Fernández-de-las-Peñas, César et als. Immediate changes in radiographically determined lateral flexion range of motion following a single cervical HVLA manipulation in patients presenting with mechanical neck pain. Journal of Osteopathic Medicine Volume: 8, Issue: 4, December, 2005, pp. 139-145. • Herzog, PhD et al. Electromyographic responses of back & limb muscles associated with spinal manipulative therapy. Spine 1999; 24(2): 146-153. b. Peak load d. Duration of the impulse (relates to resonant frequency) c. Rate of rise of applied load a. Pre load

• Prolonged or repetitive activity of dorsal horn neurons caused by sustained noxious stimulation may subsequently produces central sensitization and may be involved in the generation of referred pain and hyperalgesia across multiple spinal segments (Mira M, 2007). • The systematic critical review of the literature confirms an hypoalgesic effect of spinal manipulative therapy (SMT) on experimentally induced pain provoked by pressure (Millan, 2012, Bronfort, 2010) David Lopez Sánchez DC, PT 17 1.- Mira Meeus & Jo Nijs. Clin Rheumatol (2007) 26:465–473 2.- Millan et al.Chiropractic & ManualTherapies 2012, 20:26 3.-Bronfort, G. Chiropractic & Osteopathy 2010, 18:3 Osteopathic Manipulation (SMT): Hypoalgesic Effects

The OMT could not been seen only as an useful technique to restore the segmental mobility. It can also intend to restore the vascular and neural and homeosthatic functions of the tissues according the age, gender, lifestyles, health and current somatic dysfunction of the patient. David Lopez Sánchez DC, PT 18 Osteopathic Vision: Health & Disease From IAO: Modern Principles of Osteopathy 2011.

David Lopez Sánchez DC, PT 19 Spinal Osteopathic Manipulative Therapy: Where are we now?  Osteopathy is a system of diagnosis and treatment with a well differentiated philosophy that practice a “whole person” approach in healthcare (1).  Osteopathy does not declare to treat diseases or illness, it optimizes patient health to stimulate self-regulating processes (repair, anti- inflammatory, immunity and defense mechanisms, homeosthasis) (2). 1.- Glossary of Osteopathic Terminology. Prepared by (ECOP/AACOM). Revised April 2009 2.- International Academy of Osteopathy. Modern Principles of Osteopathy, 2011

David Lopez Sánchez DC, PT 20 Spinal Osteopathic Manipulative Therapy: Summary  The manipulative therapy is essential for osteopaths to restore and correct the human biomechanical function.  Basic medical sciences, scientific research and a clinical osteopathic reasoning are used to explain and understand the interaction between biomechanics and the neural, musculoskeletal, circulatory and all physiological system in a somatic dysfunction. Glossary of Osteopathic Terminology. Prepared by (ECOP/AACOM). Revised April 2009 WHO. Benchmarks for training in traditional / complementary and alternative medicine: benchmarks for training in osteopathy. 2010

David López Sánchez Kinesiologyst; Chiropractor DC E mail: consultas@dolordeespalda.cl www.dolordeespalda.cl Conference: “The Spinal Osteopathic Manipulative Therapy (OMTh): revisited by other Manual Therapist” Poland, 2014 Conference: “Osteopathic Manipulative Therapy (OMTh) of Extremities: revisited by other Manual Therapist”, Poland, 2014 XX edition of International Disabled People’s Day. International Scientifique Symposium 20-23 March 2014. Zgorzelec, Poland.

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