An Osteopathic Approach to Diagnosis and Treatment THIRD EDITION An Osteopathic Approach to Diagnosis and Treatment THIRD EDITION Eileen L. DiGiovanna, DO, FAAO, Senior Editor Professor Emerita Former Chairperson The Stanley Schiowitz, DO, FAAO Department of Osteopathic Manipulative Medicine New York College of Osteopathic Medicine New York Institute of Technology Old Westbury, New York Fellow of the American Academy of Osteopathy Stanley Schiowitz, DO, FAAO, Senior Editor Dean Emeritus Former Distinguished Professor and Former Chairperson The Stanley Schiowitz, DO, FAAO Department of Osteopathic Manipulative Medicine New York College of Osteopathic Medicine New York Institute of Technology Old Westbury, New York Fellow of the American Academy of Osteopathy Dennis J. Dowling, DO, FAAO, Editor and Illustrator Private Practice Attending Physician & Director of Manipulation Physical Medicine and Rehabilitation Department Nassau University Medical Center East Meadow, New York Former Professor and Chairperson The Stanley Schiowitz, DO, FAAO Department of Osteopathic Manipulative Medicine New York College of Osteopathic Medicine New York Institute of Technology Old Westbury, New York Fellow of the American Academy of Osteopathy With 20 Contributors ILLUSTRATED BY Dennis J. Dowling, DO, FAAO LIPPINCOTT WILLIAMS & WILRINS A Wolters Kluwer Company Philadelphia • Baltimore • New York • London Buenos Aires • Hong Kong • Sydney • Tokyo Acquisition Editor: Danette Somers Developmental Editor: Keith Donnellan and Nancy Winter Marketing Manager: Kathy Neely Project Manager: Bridget! Dougherty Typesetter: Maryland Composition, Inc. Printer: Edwards Brothers, Inc. Copyright © 2005 by Lippincott Williams & Wilkins 2nd edition 1997 Lippincott 1st edition 1991 Lippincott 530 Walnut Street Philadelphia, Pennsylvania 19106 351 West Camden Sreet Baltimore, Maryland 21201-2436 USA All rights reserved. This book is protected by copyright. No part of this book may be reproduced in any form or by any means, including photocopying, or utilized by any information storage and retrieval system without written permission from the copyright owner. The publisher is not responsible (as a matter of product liability, negligence or otherwise) for any injury resulting from any material contained herein. This publication contains information relating to general principles of medical care which should not be constructed as specific instruction for individual patients. Manufacturers' product information and package inserts should be reviewed for current information, including contraindications, dosages and precautions. Printed in the United States of America Library of Congress Cataloging-in-Publication Data An osteopathic approach to diagnosis and treatment / [edited by] Eileen L. DiGiovanna, Stanley Schiowitz, and Dennis Dowling.—3rd ed. p. ; cm. Includes bibliographical references and index. ISBN 0-7817-4293-5 1. Osteopathic medicine. I. DiGiovanna, Eileen L. II. Schiowitz, Stanley. III. Dowling, Dennis J. [DNLM: 1. Osteopathic Medicine. WB 940 084 2004] RZ341.0696 2004 615.5'33—dc22 2004015188 The publishers have made every effort to trace copyright holders for borrowed material. If they have inadvertently overlooked any, they will be pleased to make the necessary arrangements at the first opportunity. To purchase additional copies of this book, call our curtomer service department at (800) 638-3030 or fax orders to (301) 824-7390. For other book services, including chapter reprints and large quantity sales, ask for the Special Sales department. For all other calls originating outside of the United States, please call (301) 714-2324. Visit Lippincott Williams & Wilkins on the Internet: http://www.lww.com. Lippincott Williams & Wilkins customer service representatives are available from 8:30 am to 6:00 pm, EST, Monday through Friday, for telephone access. 00 01 02 03 04 Dedication We dedicate this book: To osteopathic students and physicians who share our belief that our hands are channels of healing; To colleagues and mentors who have expanded our understanding of osteopathic manipulative medicine; To our patients, who have taught us so much about the functioning of the human body, mind, and spirit; To our families, who give us the support that allows us to continue. Preface to First and Second Editions The instruction of students in the concepts and organizes currently taught concepts and tech- principles of osteopathic medicine, as well as in niques into one comprehensive volume which the skills of manipulative medicine, began in a might then serve as a reference for osteopathic tiny frame building in Kirksville, Missouri, al- medical students, as well as practicing physi- most 100 years ago today. Andrew Taylor Still cians. The result is a book, which presents an was the founder and professor of that school. integrated method for both the diagnosis and He wrote down many of his thoughts and ideas, treatment of somatic and visceral problems man- which were later collected into the first books ifesting in the soma. We have also added an ex- of this profession. tensive section on practical applications to serve Since that time, only a few books have been as a demonstration of examples of osteopathic published on osteopathy, with most of the edu- concepts integrated into the management of cational process relying on personal instruction some commonly encountered conditions. and demonstration. To add to this, much of the The osteopathic approach to diagnosis and treatment is unique. We hope this text will make information is scattered in obscure journals not it more readily available to all osteopathic medi- available to everyone. Those texts which are cal students. available are generally limited to one or a few types of techniques. Eileen L. DiGiovanna, DO, FAAO Our goal here has been to prepare a text that Stanley Schiowitz, DO, FAAO VII Preface to Third Edition The osteopathic profession has continued to tical applications have been added to the text grow, both in numbers of physicians and stu- along with many of the newly developed tech- dents and in the understanding of osteopathic niques. Each section on a region of the body has manipulative medicine, since the first publica- been enhanced with case histories illustrative of tion of this text. The subject matter taught in the situations where osteopathic manipulative medi- osteopathic colleges’ departments of osteo- cine is applicable to the patients’ needs. pathic manipulative medicine has expanded to We have retained the material we feel is es- meet the needs of the students as they prepare sential for practicing osteopathic physicians to for practice. The methods of testing the students understand in order to best serve their has evolved with heavier emphasis on case histo- patients’ treatment needs. ries. The editors have revised this edition to meet Eileen L. DiGiovanna, DO, FAAO the needs of both teachers and students of osteo- Stanley Schiowitz, DO, FAAO pathic manipulative medicine. Many more prac- Dennis J. Dowling, DO, FAAO IX Acknowledgments We wish to acknowledge the able assistance given us in preparing this book by the editorial staff at Lippincott William & Wilkins. And of course, thanks to our spouses, Joseph DiGiovanna, DO, Lillian Schiowitz, and Fran Dowling for their support and allowing us the time to complete this project. XI Contents SECTION I BASICS OF OSTEOPATHIC MEDICINE 1 Introduction ..................................................................................................... Eileen L. DiGiovanna 2 History of Osteopathy ......................................................................................... Eileen L. DiGiovanna 3 The Philosophy of Osteopathic Medicine .......................................................... Dennis J. Dowling and David J. Martinke 4 Somatic Dysfunction ........................................................................................ Eileen L. DiGiovanna 5 General Anatomic Considerations .................................................................... Stanley Schiowitz, Eileen L. DiGiovanna, and Nancy Brous 6 General Physiologic Considerations .................................................................... Dennis J. Dowling and Paula D. Scariati 7 Structural Examination and Documentation ................................................... Stanley Schiowitz and Dennis J. Dowling 8 Palpation .......................................................................................................... Eileen L. DiGiovanna 9 The Role of Exercise in Osteopathic Management ........................................... Stanley Schiowitz and Albert R. DeRubertis SECTION II OSTEOPATHIC MANIPULATION 10 History of Manual Medicine ............................................................................ Eileen L. DiGiovanna 11 Goals, Classifications and Models of Osteopathic Manipulation ........................ Eileen L. DiGiovanna 12 Myofascial (Soft Tissue) Techniques .................................................................... Toni Spinaris and Eileen L. DiGiovanna 13 Muscle Energy ................................................................................................. Dennis J. Dowling xiii
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