Download OMM in the ED - The American College of Osteopathic Emergency

Treatment Suggestions for
Common ED Complaints
Chest Pain
• Inhibition for ribs (highest yield will be superior
rib in the group-pain decreases respiration, decreasing motion of rib)
• Diaphragmatic release
• Rib raising
• Functional treatments to thoracic spine •
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Pneumonia Gentle articulatory technique to the ribs and
spine Rib raising (supine lateral traction and
passive range of motion to inhalation and
exhalation) Lumbocostal arch release (external
arcuate liga- ment release by lateral traction to
12th ribs)
Direct diaphragm release
Direct sternal release
Thoracic duct release Condylar decompression
(possible vagal involve- ment), CV4
• Gentle fascial release to hip and sacroiliac
Kidney Stones
• Occipitoatlantal and cranial base
decompression and release
• Still technique for somatic dysfunction of thoracolumbar junction/thoracic diaphragm
• Thoracolumbar (T10-L2) paraspinal inhibition
• Rib raising
• Counterstrain of anterior myofascial tender
Psoas muscle spasm treatment
•
L umbar/sacral/pelvic soft tissue articulation
and/or decompression and release
Sources:
American Osteopathic Association. Foundations for Osteopathic Medicine. 2nd ed. Lippincott William & Wilkins; 2002.
Savarese, RG. OMT Review. 3rd Ed. OMT Review; 2003.
Treatment Suggestions for
Common ED Complaints
SOB/Palpitations
• Rib raising
• Thoracic spine-muscle energy
• Thoracic spine-myofascial release
• Cervical spine-suboccipital release
• Thoracic inlet-myofascial release
• Thoracic outlet-myofascial release
• Lymphatic pump techniques
Back Pain • Proposed treatment sequence: Leg restrictors,
pubes, superior innominate upslip (shear),
lumbar spine, sacrum, innominate, iliopsoas
• Direct- HVLA, muscle energy, articulatory
• Indirect-Strain counterstrain, functional
methods
• *Look for back pain red flags before treating*
[such as paresthesias, bowel/bladder
incontinence, neurologic deficit, insidious
onset, constitutional symptoms]
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Pelvic Pain
Cranial techniques
OA condylar decompression
HLVA to the cervical, thoracic, and lumbar
spine
Muscle energy to the sacrum and pelvis
Articulatory techniques to the feet
Pelvic diaphragm release
Pedal pump
OMM in the ED
Sympathetic
Innvervations
T`1-T4: Head and neck
T1-T4: Heart
T1-T6: Lungs
T5-L2: GI Tract and Pelvis
T5-T9: Upper GI, Liver, Duodenum, Pancreas
T10-T11: Small Intestine, Right Colon,
Adrenals, Gonads, Kidney’s, Upper Ureter
T12-L2: Left Colon, Pelvis, Lower Ureter,
Bladder, Genetalia
Parasympathetic
Innervations
CN III, VII, IX -> head
CN X ->heart, lungs, trachea, liver, gallbladder, esophagus, stomach, pancreas, spleen,
kidneys, small intestine, ascending and
transverse colons.
S1-3 ->sex organs, external genitalia, bladder and its sphincters
*No parasympathetic innervation of the
extremities
Cranial Nerve Lesions
C5: Weakness of the deltoid. Numbness of the
shoulder. Biceps reflex diminished or absent.
C6: Weakness of the biceps brachii. Biceps brachii reflex diminished or absent. Numbness over
the thumb.
C7: Weakness of the triceps brachii. Triceps brachii reflex diminished or absent. Numbness of
the index and middle fingers.
C8: Weakness of the interossei (tested by having
patientspreadfingersagainstresistance). Reflex
Numbness of the ring and little finger.
Lumbar Nerve Lesions
L4: Pain over the low back, hip, posterolateral
thigh, and anterior leg. Numbness of the anteromedial thigh and knee. Weakness and atrophy of
the quadriceps. Knee jerk reflex diminished.
L5: Pain over the sacroiliac joint, hip, lateral
thigh, and leg. Numbness of the lateral leg and
web of the great toe. Weakness with dorsiflexion
of the great toe and foot with difficulty walking
on heels, foot drop possible. Atrophy is minor.
Uncom- mon to have changes in reflexes (if
present, absent or diminished posterior tibial
reflex)
Compiled by Cara Norvell, DO
Images:
The Ohio Univeristy Heritage College of Osteopathic Medicine
S1: Pain over the sacroiliac joint, hip, posterolateral thigh, and leg to heel. Numbness in the
back of the calf, lateral heel, lateral foot, and
lateral toe. Weakness with plantar flexion of the
foot and great toe with difficulty walking on the
toes. Atro- phy of the gastrocnemius and soleus.
Ankle jerk reflex diminished or absent.