Foundations of Osteopathic Medicine

1158 Pages·2010·70.733 MB·English

by  American Osteopathic Association, Anthony Chila

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FOUNDATIONS OF
OSTEOPATHIC
MEDICINE
THIRD EDITION
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FOUNDATIONS OF
OSTEOPATHIC
MEDICINE
Published under the auspices of the American Osteopathic Association
THIRD EDITION
EXECUTIVE EDITOR
ANTHONY G. CHILA, D.O., ANN L. HABENICHT, D.O., F.A.A.O.,
F.A.A.O. dist, F.C.A. F.A.C.O.F.P.
Professor Professor, Department of Osteopathic Manipulative Medicine
Department of Family Medicine Chicago College of Osteopathic Medicine
College of Osteopathic Medicine Midwestern University
Ohio University Downers Grove, Illinois
Athens, Ohio
JOHN A. JEROME, PH.D., B.C.F.E.
Associate Professor of Clinical Medicine
SECTION EDITORS Department of Osteopathic Medicine
JANE E. CARREIRO, D.O. Michigan State University
Associate Professor and Chair East Lansing, Michigan
Department of Osteopathic Manipulative Medicine Pain Psychologist
University of New England Lansing Neurosurgery and The Spine Center
College of Osteopathic Medicine East Lansing, Michigan
Biddeford, Maine
MICHAEL M. PATTERSON, PH.D. (RETIRED)
DENNIS J. DOWLING, D.O., F.A.A.O.
Nova Southeastern University College of Osteopathic
Attending Physician and Director of Manipulative Medicine Medicine
Physical Medicine and Rehabilitation Department Fort Lauderdale, Florida
Nassau University Medical Center
East Meadow, New York FELIX J. ROGERS, D.O., F.A.C.O.I.
Director of Osteopathic Manipulative Medicine Assessment Downriver Cardiology Consultants
The National Board of Osteopathic Medical Examiners Trenton, Michigan
Clinical Skills Testing Center
MICHAEL A. SEFFINGER, D.O., F.A.A.F.P.
Conshohocken, Pennsylvania
Associate Professor
RUSSELL G. GAMBER, D.O., M.P.H. Family Medicine/Osteopathic Manipulative Medicine
Professor, Department of Osteopathic Manipulative Medicine Chair, Department of Neuromusculoskeletal Medicine/
University of North Texas Health Science Center at Osteopathic Manipulative Medicine
Fort Worth College of Osteopathic Medicine of the Pacific
Texas College of Osteopathic Medicine Western University of Health Sciences
Fort Worth, Texas Pomona, California
JOHN C. GLOVER, D.O., F.A.A.O. FRANK H. WILLARD, PH.D.
Professor and Chair Professor of Anatomy
Department of Osteopathic Manipulative Medicine Department of Anatomy
Touro University-California University of New England
College of Osteopathic Medicine College of Osteopathic Medicine
Vallejo, California Biddeford, Maine
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Library of Congress Cataloging-in-Publication Data
Foundations of osteopathic medicine. — 3rd ed. / published under the auspices of the American Osteopathic
Association; executive editor, Anthony G. Chila; section editors, Jane E. Carreiro . . . [et al.].
p. ; cm.
Rev. ed. of: Foundations for osteopathic medicine / executive editor, Robert C. Ward. 2nd ed. c2003.
Includes bibliographical references and index.
ISBN 978-0-7817-6671-5 (alk. paper)
1. Osteopathic medicine. 2. Osteopathic medicine—Philosophy. I. Chila, Anthony G. II. American
Osteopathic Association. III. Foundations of osteopathic medicine.
[DNLM: 1. Osteopathic Medicine—methods. WB 940]
RZ342.F68 2011
615.5’33—dc22
2010028827
DISCLAIMER
Care has been taken to confirm the accuracy of the information present and to describe generally accepted
practices. However, the authors, editors, and publisher are not responsible for errors or omissions or for any
consequences from application of the information in this book and make no warranty, expressed or implied, with
respect to the currency, completeness, or accuracy of the contents of the publication. Application of this informa-
tion in a particular situation remains the professional responsibility of the practitioner; the clinical treatments
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DEDICATION
This third edition of Foundations of Osteopathic Medicine is dedicated to two individuals who made very
significant contributions to the development of osteopathic medical research. Common threads bound their careers
together: dedication to better understanding of the scientific basis of osteopathic medicine; complementary relationship
in Basic Science and Clinical Science research; and sustained support of the research effort of the American Academy
of Osteopathy, an affiliate body of the American Osteopathic Association. Their respective years of passage span the
time between the release of the second and third editions of this text.
WILLIAM L. JOHNSTON, DO, FAAO ALBERT F. KELSO, PHD, DSCI (HON)
February 17, 1921–June 10, 2003 November 19, 1917–January 29, 2009
It is with sadness that I announce the passing of William L. Johnston, It was with a great sense of loss that we inform you of the death of
DO, and commemorate his numerous achievements. As Editor-in- Albert F. Kelso, PhD. Dr. Kelso was more than just a colleague and
Chief of the American Osteopathic Association (AOA) and having fellow Academy member. Dr. Kelso received a Doctor of Philoso-
served on the AOA Bureau of Research, I have had the opportunity to phy degree from Loyola University Graduate School in 1959 and
work with truly outstanding people. Dr Johnston, with whom I collab- later received a Doctor of Science (Hon) from Kirksville College
orated for more than 20 years, was certainly one of those individuals. of Osteopathic Medicine in 1970. Dr. Kelso was also a student at
I consider Dr Johnston a mentor in the truest sense of the word. the Institute of Medicine in Chicago as well as the University of
He introduced me to research involving osteopathic principles and Chicago.
practice in a meaningful way. I met Dr Johnston at the Michigan State Beginning in the mid-40s, Dr. Kelso worked as a biology and
University College of Osteopathic Medicine (MSU–COM), East physiology instructor, professor, and department chair at George
Lansing, when I was a young physician assuming a new role as vice Williams College and the Chicago College of Osteopathic Medi-
chairman of the Bureau of Research. I was thoroughly impressed with cine. By 1975, he was involved in research serving as the director of
the breadth and depth of his understanding of osteopathic medicine, research affairs as well as a research professor in osteopathic medi-
particularly the focus he believed was needed in future research. cine. It was in 1974 when he fi rst became a research consultant on the
An outstanding teacher and, more important, an original and pro- AAO’s Louisa Burns Clinical Observation Committee where he still
found thinker, Dr Johnston was a professional who got things done. gave counsel until his passing. He was awarded the American Osteo-
Truly, he was an original and special man who deserves every accolade pathic Association’s 1981 Louisa Burns Memorial Lecture, “Plan-
that can be applied to such a professional. I am sure I am but one indi- ning, Developing and Conducting Osteopathic Clinical Research.”
vidual who will write a memoriam about Dr Johnston. Dr. Kelso was honored as the 2005 recipient of the ACADEMY
When I became the AOA’s Editor-in-Chief, I decided to name AWARD in recognition of his outstanding commitment to the
new members to JAOA’s Editorial Advisory Board. I needed a mentor osteopathic medical profession, supporting its philosophy, principles,
to guide my choices. I wanted someone who had the respect of the pro- and practices.
fession and who understood what is meant by osteopathic principles As a representative of the Association of Colleges of Osteo-
and practice at the deepest level. pathic Medicine, Dr. Kelso served on the National Society of Medi-
I found that the individual I needed was already on the Editorial cal Research in addition to serving as a representative to the Medical
Advisory Board. He was a go-to individual for many of my questions Legal Council of the Illinois State Medical Society, Medical Records
concerning osteopathic medicine. When he spoke at our Editorial and Right to Privacy through 1982. Dr. Kelso was an educational
Advisory Board meetings, the room became quiet and all attention consultant for the AOA’s Committee on Colleges and served on their
was directed toward him. Everything Dr Johnston said was meaningful Council of Osteopathic Educational Development. Since 1981, he
and important and sometimes enormously funny in the way he had of served as an editorial referee for the Journal of the AOA, and he was an
bringing reality to the table. associate editor of the defi nitive textbook, Foundations of Osteopathic
All in the osteopathic medical profession will miss Dr Johnston. Medicine, which was published in 1997.
I know that the faculty and students at MSU–COM will deeply miss Dr. Kelso was author or contributing author on several publica-
him. And I will personally feel the void left by one so large in knowl- tions and has many abstracts and papers printed in a variety of medi-
edge and personal responsibility. cal journals. He was a member of many notable professional societies
Dr Johnston’s family was blessed to have had his loving presence. I such as the American Academy of Osteopathy, American Osteopathic
am sure that he will remain fi rmly in their minds and deep in their hearts Association, American Physiologic Society, and the Illinois Society for
for the remainder of their lives and will most likely live on for genera- Medical Research.
tions to come. A fi ner, more dedicated osteopathic physician committed We know that his passing will leave a void not only in our lives but
to this profession, its research, and education would be diffi cult to fi nd. also in the hearts of all those who knew him.
GILBERT E. D’ALONZO, JR, DO
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CONTENTS
Contributors xi 16. Chronic Pain Management . . . . . . . . . . . . . . . . . . . . . . . 253
Preface xv Elkiss, Jerome
Foreword xvii
17. Psychoneuroimmunology—Basic Mechanisms . . . . . . . 276
Acknowledgments xix
Baron, Julius, Willard
18. Psychoneuroimmunology—Stress Management . . . . . . 284
PART I: FOUNDATIONS Jerome, Osborn
19. Life Stages—Basic Mechanisms . . . . . . . . . . . . . . . . . . . 298
Section 1
Magen, Ley, Wagenaar, Scheinthal
Overview of the Osteopathic Medical Profession 3
Section Editor: Michael A. Seffinger, DO, FAAFP
PART II: THE PATIENT ENCOUNTER
1. Osteopathic Philosophy . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Section Editor: Felix J. Rogers, DO, FACOI
Seffinger, King, Ward, Jones, Rogers, Patterson
2. Major Events in Osteopathic History . . . . . . . . . . . . . . . . 23 20. The Initial Encounter . . . . . . . . . . . . . . . . . . . . . . . . . . . . 315
Peterson Rogers
3. Osteopathic Education and Regulation . . . . . . . . . . . . . . 36 21. Public Health Aspects . . . . . . . . . . . . . . . . . . . . . . . . . . . 318
Bates Aguwa
4. International Osteopathic Medicine and 22. Musculoskeletal Component . . . . . . . . . . . . . . . . . . . . . . 323
Osteopathy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Gilliar
Carreiro, Fossum 23. Environmental Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . 331
Nevins
Section 2 24. Osteopathic Medicine within the Spectrum of
Basic Sciences 53 Allopathic Medicine and Alternative Therapies . . . . . . 335
McPartland
Section Editors: Frank H. Willard, PhD, and
John A. Jerome, PhD, BCFE 25. Clinical Decision Making . . . . . . . . . . . . . . . . . . . . . . . . 338
Cain
5. Introduction: The Body in Osteopathic Medicine— 26. Professionalism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 352
the Five Models of Osteopathic Treatment . . . . . . . . . . . 53
Hortos, Wilson
Willard, Jerome
27. Mind-Body Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . 359
6. The Concepts of Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . 56
Schubiner
Towns, Jacobs, Falls
28. Spirituality and Health Care . . . . . . . . . . . . . . . . . . . . . . 365
7. The Fascial Systems of the Body . . . . . . . . . . . . . . . . . . . . 74
Rogers
Willard, Fossum, Standley
29. Patient-Centered Model . . . . . . . . . . . . . . . . . . . . . . . . . 371
8. Biomechanics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Butler
Wells
30. Health Promotion and Maintenance . . . . . . . . . . . . . . . 377
9. Somatic Dysfunction, Spinal Facilitation, and
Osborn, Jerome
Viscerosomatic Integration . . . . . . . . . . . . . . . . . . . . . . . 118
31. End of Life Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 387
Patterson, Wurster
Nichols
10. Autonomic Nervous System . . . . . . . . . . . . . . . . . . . . . . 134
32. Evidence-Based Medicine . . . . . . . . . . . . . . . . . . . . . . . . 394
Willard
Cardarelli, Sanderlin
11. Physiological Rhythms/Oscillations . . . . . . . . . . . . . . . . 162
Glonek, Sergueef, Nelson
PART III: APPROACH TO THE SOMATIC
12. Anatomy and Physiology of the
Lymphatic System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191 COMPONENT
Ettlinger, Willard
Section Editors: Ann L. Habenicht, DO, FAAO,
13. Mechanics of Respiration . . . . . . . . . . . . . . . . . . . . . . . . . 206
Dennis J. Dowling, DO, FAAO, Russell G. Gamber, DO, MPH,
Willard and John C. Glover, DO, FAAO
14. Touch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221 Section 1
Willard, Jerome, Elkiss
Basic Evaluation 401
15. Nociception and Pain: The Essence of
Pain Lies Mainly in the Brain . . . . . . . . . . . . . . . . . . . . . 228 33. Palpatory Examination . . . . . . . . . . . . . . . . . . . . . . . . . . . 401
Willard, Jerome, Elkiss Ehrenfeuchter, Kappler
vii
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viii CONTENTS
34. Screening Osteopathic Structural Examination . . . . . . 410 C. Progressive Inhibition of Neuromuscular
Ehrenfeuchter Structures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 820
35. Segmental Motion Testing . . . . . . . . . . . . . . . . . . . . . . . 431 Dowling
Ehrenfeuchter D. Functional Technique . . . . . . . . . . . . . . . . . . . . . . . 831
36. Postural Considerations in Osteopathic Diagnosis and Johnston
Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 437 E. Visceral Manipulation . . . . . . . . . . . . . . . . . . . . . . . 845
Kuchera Lossing
F. Still Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 849
Section 2
Van Buskirk
Osteopathic Considerations of Regions 484 G. Chapman’s Approach . . . . . . . . . . . . . . . . . . . . . . . . 853
Fossum, Kuchera, Devine, Wilson
37. Head and Suboccipital Region . . . . . . . . . . . . . . . . . . . . 484
H. Fulford Percussion . . . . . . . . . . . . . . . . . . . . . . . . . . 866
Heinking, Kappler, Ramey
Yadava
38. Cervical Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 513
Heinking, Kappler
39. Thoracic Region and Rib Cage . . . . . . . . . . . . . . . . . . . . 528 PART IV: APPROACH TO OSTEOPATHIC
Hruby PATIENT MANAGEMENT
40. Lumbar Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 542
Section Editors: Jane E. Carreiro, DO, Anthony G. Chila, DO, FAAO
Heinking
dist, FCA., and John C. Glover, DO, FAAO
41. Pelvis and Sacrum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 575
Heinking, Kappler 53. Elderly Patient with Dementia . . . . . . . . . . . . . . . . . . . . 873
Bates, Gugliucci
42. Lower Extremities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 602
Kuchera 54. Uncontrolled Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . 883
Morelli, Sanchez
43. Upper Extremities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 640
Heinking 55. Adult with Chronic Cardiovascular Disease . . . . . . . . . 889
Kaufman
44. Abdominal Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 660
Hruby 56. Adult with Chronic Pain and Depression . . . . . . . . . . . 903
Kuchera, Jerome
Section 3 57. Dizziness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 910
Shaw, Shaw
Osteopathic Manipulative Treatment 669
58. Child with Ear Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 918
TRADITIONAL APPROACHES Steele, Mills
45. Thrust (High Velocity/Low Amplitude) Approach; 59. Difficulty Breathing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 931
“The Pop” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 669
Foley, Ettlinger, D’Alonzo, Carreiro
Hohner, Cymet
60. Cervicogenic Headache . . . . . . . . . . . . . . . . . . . . . . . . . . 939
46. Muscle Energy Approach . . . . . . . . . . . . . . . . . . . . . . . . . 682
Hruby, Fraix, Giusti
Ehrenfeuchter
61. Large Joint Injury in an Athlete . . . . . . . . . . . . . . . . . . . 946
47. Myofascial Release Approach . . . . . . . . . . . . . . . . . . . . . 698
Heinking, Brolinson, Goodwin
O’Connell
62. Multiple Small Joint Diseases in an
48. Osteopathy in the Cranial Field . . . . . . . . . . . . . . . . . . . 728 Elderly Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 952
King Heinking, Lipton, Valashinas
49. Strain and Counterstrain Approach . . . . . . . . . . . . . . . . 749 63. Lower Extremity Swelling in Pregnancy . . . . . . . . . . . . 961
Glover, Rennie Tettambel
50. Soft Tissue/Articulatory Approach . . . . . . . . . . . . . . . . . 763 64. Low Back Pain in Pregnancy . . . . . . . . . . . . . . . . . . . . . . 967
Ehrenfeuchter Tettambel
51. Lymphatics Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . 786 65. Adult with Myalgias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 974
Kuchera Wieting, Foley
CONTEMPORARY APPROACHES 66. Acute Neck Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 979
52. Representative Models . . . . . . . . . . . . . . . . . . . . . . . . . . . 809 Seffinger, Sanchez, Fraix
Dowling 67. Rhinosinusitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 990
A. Balanced Ligamentous Tension and Shaw, Shaw
Ligamentous Articular Strain . . . . . . . . . . . . . . . . . 809 68. Abdominal Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 999
Crow Adler-Michaelson, Seffinger
B. Facilitated Positional Release . . . . . . . . . . . . . . . . . 813 69. Acute Low Back Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . 1006
Dowling Fraix, Seffinger
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