Osteopathic Principles, Practice, and Manipulative Treatment
Core concepts
Osteopathic principles emphasize body unity, structure-function interrelationships, self-regulation and self-healing, and treatment based on these principles. Somatic dysfunction is impaired or altered function of somatic components-skeletal, arthrodial, and myofascial structures-and related vascular, lymphatic, and neural elements. The exam expects TART: Tissue texture abnormality, Asymmetry, Restriction of motion, Tenderness. Document the region and somatic dysfunction rather than a vague disease label. Know Fryette mechanics: Type I neutral group curves have sidebending and rotation opposite; Type II nonneutral single segments have same-side sidebending and rotation. The five models are biomechanical, respiratory-circulatory, neurological, metabolic-nutritional, and behavioral. OMT includes HVLA, muscle energy, counterstrain, myofascial release, lymphatic, visceral, cranial, and facilitated positional release. Contraindications include fracture or dislocation, active infection, bleeding disorder, malignancy at the site, severe osteoporosis, unstable spine, and cauda equina. Traps include confusing the restrictive barrier with the physiologic barrier, overdiagnosing somatic dysfunction as visceral disease, missing red flags, and using HVLA when a contraindication exists.
Worked example
A patient has one lumbar segment sidebent and rotated to the same side, with tender paraspinal tissue and restricted extension. This is Type II nonneutral dysfunction because it is a single segment and rotation and sidebending are same-sided. Rule of thumb: document TART, segment, and direction; screen red flags before treatment.