elements of OMT.pptx

Dpt

1. Elements of OMT Dr Ayesha Anwer Ali

2. OMT Evaluation A. Screening exam: An abbreviated exam to quickly identify the region where a problem is located and focus the detailed examination . B. Detailed exam: 1. History: Narrow diagnostic possibilities; develop early hypotheses to be confirmed by further exam; determine whether or not symptoms are musculoskeletal and treatable with OMT. - Present episode - Past medical history - Related personal history - Family history - Review of systems

3. 2. Inspection: Further focus the exam. - Posture - Shape - Skin - Assistive devices -ADL 3. Tests of function: Differentiate articular from extra articular problems; identify structures involved (see Chapter 3).

4. 4. Palpation - Tissue characteristics - Structures 5. Neurologic and vascular examination C. Medical diagnostic studies: Diagnostic imaging, lab tests, electro-diagnostic tests, punctures

5. D. Diagnosis and trial treatment Through the physical examination the therapist correlates the patient's signs with their symptoms. A relationship between musculoskeletal signs and symptoms suggests a mechanical component to a problem that should respond well to treatment by manual therapy. The constellation of signs and symptoms revealed during the physical examination indicates the nature and stage of pathology and forms the basis of a treatment plan.

6. Screening exam The screening examination is an abbreviated exam intended to quickly identify the region of the body where a problem is located The screening exam leads to one of the following three things: » A diagnosis may be made if the physical signs are obvious, correlate well with the history and confirm your initial impressions; » Further detailed examination may follow if insufficient data is collected and a diagnosis cannot be made; » Contraindications to further examination or treatment may be uncovered and lead you to refer the patient to an appropriate specialist.

7. Components of screening examination History Inspection Active and passive movements Resisted movements Neurological and vascular examination

8. Components of detailed examination Components of the detailed examination 1. History 2. Inspection 3. Tests of function (see Chapter 3) 4. Palpation 5. Neurological and vascular examination

9. Symptoms (chief complaint) » Location: anatomical site or area of symptoms » Time: behavior of symptoms over a twenty-four hour period. » Character: quality and nature of symptoms » Influences: aggravating and alleviating factors » Association: related or coincidental signs and symptoms » Irritability: how easily symptoms are provoked and alleviated » Severity: degree of impairment and pain

10. History and course of complaint (chronology): Trace the chronology of relevant events leading up to the present episode. » Date of onset » Manner of onset: sudden, traumatic, or gradual » Pattern of recurrence: previous manner of onset; related events; duration, frequency, and nature of episodes » Previous treatments and their effect

11. OMT treatment A. To relieve symptoms 1. Immobilization 2. Thermo-Hydro-Electro (T-H-E) therapy 3. Pain relief mobilization (Grade I - IISZ) (see Chapter 5) 4. Special procedures B. To increase mobility 1. Soft tissue mobilization a. Passive soft tissue mobilization b. Active-facilitated soft tissue mobilization 2. Joint mobilization (see Chapter 5) a. Relaxation mobilization (Grade I - II) b. Stretch mobilization (Grade III) c. Translatoric manipulation

12. 3. Neural tissue mobilization 4. Specialized exercise C. To limit movement 1. Supportive devices 2. Specialized exercises 3. Increasing movement in adjacent joints D. To Inform, instruct, and train

13. Treatment to relieve symptoms Symptom control treatments can be indicated for both hypermobile and hypo mobile joint conditions and in the presence of nerve root findings. Use symptom control techniques when: » severe pain or other symptoms (for example, an empty end feel) interfere with biomechanical assessment of the joint.

14. » end-range-of-movement treatment is contraindicated or cannot be tolerated (e.g., in certain stages of disc pathology) » inflammatory processes, disc pathology, or increased muscle reactivity around a symptomatic joint decrease gliding movement and restrict functional movement without structural soft tissue shortening (e.g., in the presence of normal muscle length or a normal or even a lax joint capsule)

15. Immobilization With some clinical conditions, immobilization is appropriate and necessary for a prescribed time. Selecting the correct general or specific immobilization method as well as timing when and how long to immobilize is important to the success of treatment. Acutely severe, painful and inflammatory conditions, instabilities, and recent post-surgeries may benefit from a prescribed duration of immobilization.

16. Specific immobilization methods such as the use of casts, splints, braces, and taping can be used to protect a joint while the patient continues to function. A cervical collar, lumbar corset, back belt, or tape application can limit movement of the affected spinal region (i.e., local immobilization) and may even provide pain-relieving decompression at the same time. Crutches can also limit movement and provide symptom-relieving decompression

17. Thermo-Hydro-Electro (T -H-E) therapy The judicious use of various forms of cold, heat, water, or electrotherapy can be an effective means to modulate pain, enhance relaxation, and reduce swelling. Integrated with manual therapy, modalities are used in preparation for mobilization and afterwards to prevent or limit treatment-related soreness. As with all treatments, selecting the correct technique, and determining when and how long to use it, is critical.

18. Soft tissue mobilization Whether or not a particular technique is viewed as soft tissue mobilization depends on the viewpoint of the clinician Soft tissue treatments can affect many structures including joints, nerves and blood vessels. The intention is to change soft tissues; assessment is made by monitoring soft tissues. The clinician continuously monitors tissue response and instantaneously modifies treatment.

19. Passive soft tissue mobilization During passive soft tissue mobilization (STM) the patient does nothing but relax while the practitioner provides all the movement and force. However, this approach may not be effective if the patient has difficulty relaxing while they are passively moved. There are many forms of passive STM, including classical massage, functional massage ( Evjenth ), and friction massage ( Cyriax ).

20. Active-facilitated soft tissue mobilization 1.Contract-relax followed by passive physiological lengthening of soft tissues (muscle stretching). Following a muscle contraction there is a brief period of relaxation when the muscle can be more easily stretched. During the relaxation phase, the practitioner stretches the soft tissues by moving muscle attachments maximally apart and holding them there This kind of passive stretching can be uncomfortable and even painful in the stretched tissues, but should not increase the patient's primary symptoms.

21. This kind of passive stretching can be uncomfortable and even painful in the stretched tissues, but should not increase the patient's primary symptoms. 2. Contract-relax followed by passive accessory mobilization of soft tissues. Following a muscle contraction there is a brief period of relaxation when the muscle can be more easily mobilized. During the relaxation phase, the muscle can be passively moved in a variety of ways depending on how the muscle responds. The practitioner times the soft tissue mobilization to take full advantage of the relaxation period.