The overall goal of these procedures is to help treat patients with pneumonia using osteopathic manipulative medicine. These methods help remove any restrictions that might be limiting thoracic cage mobility and lymphatic flow, and augment the body's ability to fight off infection by promoting the body's immune system. This is accomplished by first treating any restrictions to terminal lymphatic drainage at the thoracic inlet.
Treating first rib somatic dysfunctions can remove restrictions to lymphatic drainage and improve upper rib cage mobility. The second step is to help improve diaphragmatic mobility by treating the abdominal diaphragm and ensuring optimal excursion. Next, any rib restrictions along the thoracic cage are addressed by performing seated rib.
Raising this gently articulates the entire rib cage and helps improve rib motion to improve thoracic cage compliance and assists in maximizing pressure changes in the thoracic cavity with breathing. The final step is the thoracic lymphatic pump technique, which promotes circulation and lymphatic flow. Ultimately, osteopathic manipulative medicine has been shown to be a potentially helpful adjunctive treatment for patients with pneumonia.
Osteopathic medicine or OMM is a hands-on approach, which has helped patients pneumonia since the late 18 hundreds. OMM is a gentle procedure that could help remove musculoskeletal restrictions and promote the body's own self-healing mechanism. Treatment with osteopathic manipulative medicine is based on an understanding of the anatomy and physiology of the body.
Each of these techniques assess and address potential musculoskeletal restrictions or smack dysfunctions that if present could potentially prevent and delay the patient's ability to heal. Treatment with OMM helps remove any musculoskeletal restrictions that may be obstructing circulation or lymphatic drainage. Maximizes thoracic cage in diaphragmatic excursion assist in balancing autonomic tone and reducing visceral sematic facilitation and promotes lymphatic and circulatory flow with manual pump Techniques.
Visual demonstration of these methods is critical as the physician and patient positioning and instruction are difficult to learn. Observation of the techniques will assist with better understanding of the procedures. Begin by assessing RIB one motion.
Have the patient ly supine on the table and place a thumb on the posterior aspect of the patient's first rib, a second digit on the supraclavicular portion of the first rib and a third digit on the infraclavicular portion of the first rib. Then palpate for decreased excursion of the rib with inhalation to diagnose a rib one exhalation dysfunction. To treat an exhalation dysfunction stand on the opposite side of the rib dysfunction.
For example, if the patient has a left rib, one exhalation dysfunction, stand on the patient's right side. Then reach a hand under the patient and grasp the posterior aspect of rib one. Then apply traction in an inferior lateral direction.
Next, have the patient place the dorsum of their left wrist onto their forehead. Then the physician places a hand over the patient's wrist. Have the patient take a deep breath and hold.
The patient will hold the breath for three to five seconds while attempting to lift their head against the isometric resistance. At the same time, the physician provides further inferior traction on rib one posteriorly to engage the restrictive barrier. Repeat these steps three to five times while reengaging a new restrictive barrier.
After each repetition, following the last repetition, a final passive stretch should be performed further into the restrictive barrier. Then reassess rib one motion and check for signs of improvement. To assess inhalation dysfunction, sit at the head of the table while the patient lies supine.
Place a thumb on the posterior aspect of rib one, a second digit on the supraclavicular portion, and a third digit on the infraclavicular region. Then palpate for decreased excursion of the rib with exhalation. To diagnose a rib one inhalation dysfunction, monitor the head of the dysfunctional rib in the supraclavicular fossa.
With a thumb flex the patient's head forward with the opposite hand until motion is felt at rib one. In order to relieve the tension of the anterior caline muscles, now instruct the patient to exhale. As the patient exhales move rib one inferiorly into the restrictive barrier.
Instruct the patient to hold exhalation for three to five seconds while the patient is exhaling. Instruct them to push their head backwards against isometric resistance. When the patient inhales resist the natural tendency of the rib to move superiorly with inhalation.
Repeat these steps three to five times while reengaging a new restrictive barrier with each repetition By providing further coddle pressure with the thumb on the first rib. After the final repetition, a passive stretch should be performed further into the restrictive barrier. Then reassess the patient's rib motion to evaluate for any improvement.
Have the patient lie supine on the table and stand on either side. To assess thoracic cage motion bilaterally, the rib cages palpated while the patient inhales and exhales thumb tips should be placed inferior lateral to the xiphoid process and rest along the anterolateral cosal margin. Below rib seven, which corresponds to muscular attachments of the respiratory diaphragm, the remaining digits should rest along the inferior lateral border of ribs.
Eight through 10 instruct the patient to take a deep breath and then breathe all the way out. As the patient exhales, follow the diaphragm by pressing both thumbs posteriorly towards the table and cephalad hold this pressure on the diaphragm as the patient takes the next inhalation. Then during the next exhalation, a further cephalad motion of the diaphragm is applied within a reasonable means and not providing any excessive discomfort to the patient.
Continue to monitor the superior movement of the diaphragm. Repeat these steps for three to five respiratory cycles or until the diaphragm domes easily at the end of exhalation. Reassess by monitoring the diaphragm for improvement in excursion.
Assess respiratory motion examining the ribcage. This is done by palpating the chest wall motion during the breathing cycle or by motion. Testing the rib cage via translation.
In particular, assess specific ribs for individual restrictions that impede the motion of the entire thoracic cage. Begin by having the patient seated stand facing the patient with one foot behind the other and instruct the patient to cross their arms and then rest their elbows as seen here. The patient may also rest their head on their arms.
Now, reach underneath the arms of the patient. Finger pads should be positioned near the cost of transverse articulation at the level of ribs two to six. The finger pads are used as a fulcrum for extension of the patient's spine.
Lean back, shifting weight onto the rear foot and draw the patient forward. Providing anterior lateral traction of the rib angles. Extend the patient's spine by shifting weight posteriorly, thereby stretching the intercostal spaces and engaging the restrictive barrier.
Hold this position for one second and then release by transferring weight forward to the more anterior foot and allow the patient to spring back to a more upright position. Next, move finger pad placement down one rib level and repeat these steps. Continue this step by step down the patient rib levels until the lumbar region is reached.
Now, reverse the procedure by working back the rib cage until reaching rib two. Then determine successive treatment by reassessing rib motion of previously restricted rib levels. Position the patient's supine and stand at the head of the table.
The table should be adjusted to a comfortable height so that the patient's pectoral region can be easily reached. Assess thoracic cage motion by palpating for chest congestion and fogginess. Place both hands over the patient's pectoral region with the palms just distal to the clavicles and the thumbs at approximately 45 degrees to the sternum while the patient breathes normally provide a compressive force downward onto the chest cage.
Oscillate the degree of compression to produce a pump motion. Continue for approximately one minute or until adequate time passes for proper limp flow. Next, initiate respiratory cyst by instructing the patient to again inhale deeply and then exhale deeply.
During the exhalation phase, follow the chest wall down until exhalation is complete. This is repeated for three to five cycles each time further compressing the patient's chest wall inferiorly as the patient takes a final inhalation rapidly remove resistance from the patient's chest to allow for a sudden influx of error. Finally, reassess for improvements by palpating thoracic motion.
This figure demonstrates significant findings in randomized controlled trials comparing length of stay in pneumonia patients. Patients who underwent osteopathic manipulative treatment or physiotherapy had a shorter mean length of stay compared to patients who underwent conventional therapy. This figure demonstrates significant findings in randomized controlled trials comparing duration of antibiotics in pneumonia patients.
In two out of three studies, patients who underwent osteopathic manipulative treatment or physiotherapy had a shorter mean duration of antibiotic treatment compared to patients who underwent conventional therapy. After watching the video, you should have a good understanding of how osteopathic manipulative medicine can be applied to a patient with pneumonia. These techniques can help reduce musculoskeletal restrictions, which may impede the body's ability to heal.
The data presented also demonstrated the efficacy of OMM as an adjunctive tool for pneumonia. Prior to performing any osteopathic manipulative medicine procedures, it is vital to assess the risk and benefits for each technique and ensure that there are no contraindications to treatment such as bony fractures or risk of thromboembolic events. The techniques demonstrated are a sampling of potential techniques that we can utilize for a patient with pneumonia.
As long as the key principles of osteopathic manipulative medicine are applied, physicians may choose to utilize different osteopathic techniques which may be more effective for the patient depending on the situation. Through these OMM techniques, physicians can improve the ability of the patient's immune system to fight off infection and heal. These osteopathic manipulative medicine treatments and principles have also been shown to be effective when applied to other infectious or respiratory presentations such as otitis media, sinusitis, asthma, and COPD.
