This page intentionally left blank. CChhiillaa__FFMM..iinndddd iiii 88//66//22001100 88::1122::4444 PPMM FOUNDATIONS OF OSTEOPATHIC MEDICINE THIRD EDITION CChhiillaa__FFMM..iinndddd ii 88//66//22001100 88::1122::4444 PPMM This page intentionally left blank. CChhiillaa__FFMM..iinndddd iiii 88//66//22001100 88::1122::4444 PPMM 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 CChhiillaa__FFMM..iinndddd iiiiii 88//66//22001100 88::1122::4444 PPMM Acquisitions Editor : Charles W. Mitchell Product Manager : Jennifer Verbiar Designer : Steven Druding Compositor : SPi Technologies Third Edition Copyright © 2011, 2003, 1997 Lippincott Williams & Wilkins, a Wolters Kluwer business. 351 West Camden Street Two Commerce Square, 2001 Market Street Baltimore, MD 21201 Philadelphia, PA 19103 Printed in China All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. To request permission, please contact Lippincott Williams & Wilkins at 530 Walnut Street, Philadelphia, PA 19106, via email at [email protected], or via website at lww.com (products and services). 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. 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Lippincott Williams & Wilkins customer service representatives are available from 8:30 am to 6:00 pm, EST. 9 8 7 6 5 4 3 2 1 CChhiillaa__FFMM..iinndddd iivv 88//66//22001100 88::1122::4477 PPMM 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 CChhiillaa__FFMM..iinndddd vv 88//66//22001100 88::1122::4477 PPMM This page intentionally left blank. CChhiillaa__FFMM..iinndddd vvii 88//66//22001100 88::1122::4477 PPMM 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 CChhiillaa__FFMM..iinndddd vviiii 88//66//22001100 88::1122::4477 PPMM 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 CChhiillaa__FFMM..iinndddd vviiiiii 88//66//22001100 88::1122::4488 PPMM