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How to Prepare to Demonstrate your OMT Skills Margaret Wilkins, DO, FACOFP How to Prepare to Demonstrate your OMT Skills Margaret Wilkins, DO, FACOFP

Objectives n Increase familiarity with osteopathic terminology n Provide tips on how to study Objectives n Increase familiarity with osteopathic terminology n Provide tips on how to study for the practical section of the Boards n Review case scenarios

Learning the Lingo n Somatic dysfunction – “impairment or altered function of the somatic Learning the Lingo n Somatic dysfunction – “impairment or altered function of the somatic system: Skeletal n Arthroidal n Myofascial n Vascular n Lymphatic n Neural n

Somatic Dysfunction n TART n Tissue texture changes n Asymmetry n Restriction n Tenderness Somatic Dysfunction n TART n Tissue texture changes n Asymmetry n Restriction n Tenderness

Tissue Texture Changes n Acute changes n Chronic changes n Erythema n Pallor n Tissue Texture Changes n Acute changes n Chronic changes n Erythema n Pallor n Warmth n Cold n Moist n Dry n Boggy / edematous n Ropy / fibrotic n Contracted muscle n Decreased tone

Somatic Dysfunction n Chapman’s Points Small (2 -3 mm) n Firm/nodular and tender n Somatic Dysfunction n Chapman’s Points Small (2 -3 mm) n Firm/nodular and tender n Paired anteriorly and posteriorly n Found bilaterally for paired organs n Rarely found midline n Represent a viscerosomatic reflex n

Somatic Dysfunction n Ganglion Cranial and spinal nerves pass through n Parasympathetic and sympathetic Somatic Dysfunction n Ganglion Cranial and spinal nerves pass through n Parasympathetic and sympathetic n Ones we normally treat n n Celiac n Superior mesenteric n Inferior mesenteric

Treatment n Direct vs. Indirect n Direct – into the restrictive barrier n Used Treatment n Direct vs. Indirect n Direct – into the restrictive barrier n Used in the chronic situation n Used in the outpatient setting n Indirect – away from the barrier n Used in acute pain n Employed in the hospital setting

Treatment n Passive vs. Active n Passive – we do the work n Active Treatment n Passive vs. Active n Passive – we do the work n Active – patient helps

Treatment n Muscle energy n Direct n Active Treatment n Muscle energy n Direct n Active

Treatment n Counterstrain – recently found to be the most effective long term treatment Treatment n Counterstrain – recently found to be the most effective long term treatment for pain n Indirect n Passive

Treatment n HVLA n Direct n Passive Treatment n HVLA n Direct n Passive

Preparing to Study n Three good books n The 5 minute OMM Consult n Preparing to Study n Three good books n The 5 minute OMM Consult n n n OMT Review n n n By Millicent King Channell and David Mason Paperback, great review of incorporating OMM into FP By Savarese, Capobianco and Cox Paperback, has review questions with explanations COMLEX Review: Clinical Anatomy and OMM n n By Modi and Shah Paperback, short descriptions

Studying n Find a partner n Practice what you know and use n Explain Studying n Find a partner n Practice what you know and use n Explain in words as you are performing

Format of the Practical Exam n There will be 3 testing stations n Spine Format of the Practical Exam n There will be 3 testing stations n Spine n Extremity n Family Practice / Viscerosomatic case

Studying Demonstrate your structural exam findings, especially key landmarks n Prepare 2 techniques per Studying Demonstrate your structural exam findings, especially key landmarks n Prepare 2 techniques per area of SD n Soft tissue / MFR n Muscle energy n HVLA n Counterstrain n Lymphatic drainage n

Areas of Somatic Dysfunction n Cranial 739. 00 n Pelvic 739. 5 n Cervical Areas of Somatic Dysfunction n Cranial 739. 00 n Pelvic 739. 5 n Cervical 739. 1 n Lower Extremity 739. 6 n Thoracic 739. 2 n Upper Extremity 739. 7 n Lumbar 739. 3 n Ribs 739. 8 n Sacral 739. 4 n Other 739. 9

Procedure Codes n Treat 1 -2 areas – 98925 n Treat 3 -4 areas Procedure Codes n Treat 1 -2 areas – 98925 n Treat 3 -4 areas – 98926 n Treat 5 -6 areas – 98927 n Treat 7 -8 areas – 98928 n Treat 9 -10 areas - 98929 * 25 Modifier!

Cases n Neck pain n 25 yo male stayed at his in-laws’ house and Cases n Neck pain n 25 yo male stayed at his in-laws’ house and they gave him the fattest, firmest pillow. Now c/o pain in his right neck with limited ROM. No paresthesias. n Structural exam findings? n Diagnoses? n Techniques?

OMT for Cervical SD n Soft tissue n Counterstrain n Muscle Energy OMT for Cervical SD n Soft tissue n Counterstrain n Muscle Energy

Cases n Wrist pain 47 yo transcriptionist c/o tingling in her fingers and pain Cases n Wrist pain 47 yo transcriptionist c/o tingling in her fingers and pain in wrist that radiates to her elbow. n Structural exam findings n n Diagnoses? n Treatment

Upper Extremity SD n Soft tissue n Muscle energy n HVLA to carpal bones Upper Extremity SD n Soft tissue n Muscle energy n HVLA to carpal bones

Constipation 5 month old presents with parent with hard, infrequent stools. No blood. Eating Constipation 5 month old presents with parent with hard, infrequent stools. No blood. Eating OK, in fact, eating lots of rice cereal. n Structural exam findings n n Diagnoses n Treatment

Viscerosomatic SD n Treatment – osteopathic MFR of ganglion n Reset autonomics – rib Viscerosomatic SD n Treatment – osteopathic MFR of ganglion n Reset autonomics – rib raising n Inhibition of Chapman’s points n Colonic stimulation n n Treatment Nutritional strategies n Discuss stimulation and medicine concerns n

Do’s and Don’ts n Do n n n Use familiar techniques Jot down your Do’s and Don’ts n Do n n n Use familiar techniques Jot down your thoughts on the case report Talk out loud as you examine and set up Appear confident! Remember other aspects of medical care: PT, meds, diagnostic studies n Don’t n n n Start talking about a technique or term that you can’t bring full circle Tell the examiner that you don’t usually do OMM Ask the examiner to teach you the technique Try to give more info than they are asking for Hurt your partner