Osteopathic practitioners have responsibility to diagnose and refer patients as appropriate when the patient’s condition requires therapeutic intervention, which falls outside the practitioner’s competence. Both osteopaths and osteopathic physicians need to recognize when specific approaches and techniques may be contraindicated in specific conditions.

It is important to understand that a contraindication to osteopathic manipulative treatment in one area of the body may not preclude osteopathic treatment in a different area. Likewise, a contraindication for any specific technique does not negate the appropriateness of a different type of technique in that same patient. Absolute and relative contraindications for osteopathic manipulative treatment are usually based upon the technique employed. It is the responsibility of the osteopathic practitioner to discern which types of techniques are safe and appropriate in a clinical situation.

Techniques can be categorized as direct, indirect, combined, fluid and/or reflex based(26). Direct techniques, such as muscle energy, thrust and articulatory manoeuvres, pose different risks than indirect, fluid and reflex based techniques. There is scant data published that details which techniques should be avoided in specific conditions. An understanding of the pathophysiology of the patient’s condition and the mechanism of action of the technique have been used to establish biological plausibility for the absolute and relative contraindications listed.

Contraindications

Patient refusal or absence of informed consent is an absolute contraindication to the application of any technique or treatment. Significant adverse response to prior treatment or the initiation of any technique is an absolute contraindication to the completion of that specific technique.

2.1. Direct techniques

Direct techniques may be applied specifically to a joint or non-specifically to a body area. Direct techniques engage the restrictive barrier. Direct techniques may use thrust, impulse, muscle contraction, fascial loading, or passive range of motion to achieve the tissue response. Often an area that should not be treated using a direct technique may safely and effectively be treated using an alternative technique approach, e.g., indirect, fluid or reflex based.

2.1.1. Absolute contraindications to any direct technique (systemic conditions):

• suspected bleeding disorder
• prolonged bleeding times
• anticoagulant pharmacotherapy without recent evaluation of therapeutic level.
• clotting abnormalities
• congenital or acquired connective tissue diseases that result in compromised tissue integrity
• compromised bone, tendon, ligament or joint integrity as might occur in metabolic disorders, metastatic disease, and/or rheumatoid diseases

2.1.2. Relative contraindications to direct technique (systemic) osteoporosis osteopenia

2.1.3. Absolute contraindications to direct techniques specifically applied at the local site

• aortic aneurysm
• open wounds, skin derangement, recent surgery
• acute hydrocephalus
• hydrocephalus without diagnostic workup
• acute intracerebral bleed
• acute cerebral ischemia, including transient
• suspected cerebral arterial-venous malformation
• cerebral aneurysm acute abdomen
• acute cholecystitis with suspected leakage or rupture
• acute appendicitis with suspected leakage or rupture
• acute or subacute closed head injury
• acute intervertebral disc herniation with progressive neurological signs
• suspicion or evidence of vascular compromise
• suspected vertebral artery compromise
• known congenital malformation
• acute cauda equina syndrome
• ocular lens implant (early post-operative period)
• uncontrolled glaucoma
• neoplasm
• suspected or risk of bone compromise such as osteomyelitis, boney tuberculosis, etc.

2.1.4. Absolute contraindications to direct techniques specifically involving thrust or impulse applied at the local site:

• specific technique at the site of surgical internal fixation of the joint
• compromised bone or joint stability as might occur focally in neoplasm, metastatic disease, suppurative arthritis, septic arthritis, rheumatoid diseases, osteomyelitis, boney tuberculosis, etc.
• acute fractures
• boney or intramuscular hematoma or abscess

2.1.5. Relative contraindications to direct techniques using thrust or impulse at the local site:

• intervertebral disc herniation
• strained ligaments at the site
• acute acceleration-deceleration injury of the neck

2.2. Indirect, fluid, balancing, and reflex based techniques:

Indirect, fluid, balancing, or reflex based techniques may be applied specifically to a joint or non-specifically to a body area. These techniques do not engage the restrictive barrier. These techniques may include fascial and soft-tissue loading or unloading, hydraulic pressures, phases of respiration, cranial or postural adjustments as part of the application of the technique. Relative contraindications to indirect techniques usually concern the clinical-temporal profile of the problem.

2.2.1. Absolute contraindications to indirect, fluid, balancing, or reflex based techniques applied at the local site

• acute hydrocephalus without diagnostic workup
• acute cerebral bleed
• acute intracerebral vascular accident
• suspected cerebral arterial-venous malformation
• cerebral aneurysm
• suspected acute peritonitis
• acute appendicitis or other visceral disease with suspected leakage or rupture
• recent closed head injury with suspected internal derangement

2.2.2. Relative contraindications to any indirect, fluid, balancing, or reflex based technique applied at the local site

• metastatic disease
• neoplasm
• acute closed head injury

Príspevok Indications and contraindications of osteopathic treatment je zobrazený ako prvý na Cadan Institute.

• The human being is a dynamic unit of function, whose state of health is influenced by the body, mind and spirit;
• The body possesses self-regulatory mechanisms and is naturally self- healing;
• Structure and function are interrelated at all levels.

Osteopathy incorporates current medical and scientific knowledge to apply these principles to patient care. Scientific plausibility and evidence-based outcomes have a high priority in patient treatment and case management. Osteopathy recognizes that each patient’s clinical signs and symptoms are the consequences of the interaction of multiple physical and non-physical factors. Osteopathy emphasizes the importance of the patient-practitioner relationship in the therapeutic process.

Osteopathy provides a broad range of approaches to the maintenance of health and the management of disease. It embraces the concept of the unity of the individual’s structure (anatomy) and function (physiology); as such osteopathy is a patient centered system of health care, rather than disease centered.

Essential components of osteopathy are structural diagnosis and osteopathic manual treatment. Osteopathic treatment was developed as a means to facilitate normal self-regulating/self-healing mechanisms in the body by addressing areas of tissue strain, stress or dysfunction which may impede normal neural, vascular and biochemical mechanisms.

The practical application of the philosophy is described by several models of structure-function relationships that osteopathic practitioners use to influence the gathering of diagnostic information and the interpretation of the significance of neuromusculoskeletal findings in the overall health of the patient. As such osteopathy is not limited to the diagnosis and treatment of musculoskeletal problems, nor does it emphasize joint alignment and radiographic evidence of structural relationships. Osteopathy is more concerned with the manner in which the biomechanics of the musculoskeletal system are integrated with and support the entire body physiology.

Although manual techniques are used by various manipulative professions the unique manner in which osteopathic manipulative techniques are integrated into patient management, as well as the duration, frequency and the choice of technique are distinctive aspects of osteopathy. Osteopathic manipulative treatment (OMT) employs many types of manipulative techniques including spinal thrust, and impulse techniques as well as very gentle techniques.

Refining a structural approach: application and treatment

This course has been created to explore and refine the application of structural technique, with particular reference to high velocity low amplitude (HVLA) manipulation applied to all areas of the axial skeleton. It will be predominantly practical based to give you plenty of opportunity to practice and develop the skills.

More details

At an undergraduate level, techniques are taught as if a particular technique can be applied in the same way and be effective on all patients. In reality this is not the case, each will require small adaptations in order to be effective. Our aim is to explain the logic and rationale behind each of the techniques, so from a point of understanding you will be able to make these specific adaptations and thus improve your abilities in this area.

All the thrust techniques utilised within this course will be ‘soft locking’ techniques. These are techniques based on the ‘floating field’ concepts of tensegrity and involve a minimal locking method utilising precise application. This improves both the comfort of application for the patient and possibly more importantly, the safety of the technique.

Our starting point is your aims, level and experience. We will draw on your exiting skills and understanding in both the direct and indirect fields of osteopathy and work together to tailor the practical application to your individual needs. So, whether you are an experienced manipulator looking to refine your skills or are largely practicing with the indirect approaches (or are a relative novice) and want to learn how to apply HVLA, we will be able to accommodate this.

As well as addressing the refinement of specific techniques we will explore different variations of the techniques and discuss the when or why one should apply a particular technique rather than another for you to gain a greater confidence in the domain of structural osteopathy.

Though the structural field is the main emphasis of this course, many of the concepts discussed will be relevant within any of the osteopathic modalities of treatment.

The course will be limited to a small group (14 participants) in order to fulfil our aim of improving every aspect of your structural work.

Indicative Content

During practical part, we will explore a range of soft locking HVLA techniques and their variations ( as below).

Will also explore the challenging aspect of treatment planning and holistic approach, looking at models that will support you in understanding patients and his/her problems (different osteopathic concepts, elements of PNI, differentia diagnosis etc), which will give you, as a therapist, the greatest possibility to be able to reflect retrospectively on what went as expected and what did not, which should assist your future development as an osteopath.

• Cervical
• Cervical ‘wheel’ (Supine) – direct and indirect
• Sitting cervical
• Prone cervical
• Occiput /C1 – direct and indirect
• Cervico thoracic / CD
• Prone (from the side and from the head with modifications for vertebrae and upper ribs)
• Side lying CD (both upper thoracic and upper rib application)
• Thorax
• Dog [supine] thorax technique (for ribs and vertebrae)
• Lift techniques both vertebra and ribs ( for C/D, upper thoracic, and low thoracic and lumbar both sitting and standing)
• Lumbo sacral
• Lumber sideroll – direct and indirect with modifications for lumbar spine, iliosacral (anterior/posterior and outflair) and sacroiliac or sidelying sacrum
• Sacral toggle
• Leg tug (for S/I, L/S, and lower extremity)

Jon completed his osteopathic training at the ESO (1989) and an MSc in Osteopathy (2004) Jon is a qualified lecturer with a PGCHE and an MA in education research and is a senior fellow of the Higher Education Academy (HEA), He has been working in osteopathic education since 1989 and has taught throughout Europe on a regular basis at both undergraduate and postgraduate levels since then. Having worked at the European school of Osteopathy for 25 years he has been working purely freelance for the last five years. Recently he is the cofounder of the Institute for Postgraduate Osteopathy (IPOE). He is the co-author of Osteopathy: Models for Diagnosis, Treatment and Practice. Currently he divides his time equally between osteopathic practice and lecturing.

Príspevok Philosophy of osteopathy je zobrazený ako prvý na Cadan Institute.

In the United States, osteopathic medical education is similar to allopathic medicine education, but includes integration of osteopathic philosophy and principles, and training in osteopathic manipulative treatment procedures throughout all phases of pre- and postdoctoral education. American-trained osteopathic physicians are primary care and primary contact health care providers, and practice in all medical and surgical specialties and subspecialties. They are eligible for full licensure for medical and surgical practice in many countries.

As osteopathic medicine spread to other nations, the scope of practice and training evolved according to the prevailing geopolitical forces. Economic, political and health system factors influenced the mechanism by which individual countries regulated the training and practice of osteopathic practitioners. As a result there are two principal models of osteopathic practice which are described by the international osteopathic profession as „osteopaths“ and „osteopathic physicians“. Both serve as primary contact health care providers.

Príspevok History of osteopathy je zobrazený ako prvý na Cadan Institute.

Osteopathic practitioners use their understanding of the relationship between structure and function to optimize the body’s self-regulating, self-healing capabilities. This holistic approach to patient care and healing is based on the concept that a human being is a dynamic functional unit, in which all parts are interrelated and which possesses its own self-regulatory and self-healing mechanisms. One essential component of osteopathic health care is osteopathic manual therapy, typically called osteopathic manipulative treatment (OMT), which refers to an array of manipulative techniques that may be combined with other treatments or advice, for example on diet, physical activity and posture, or counselling. The practice of osteopathy is distinct from other health-care professions that utilize manual techniques, such as physiotherapy or chiropractic, despite some overlap in the techniques and interventions employed. As a hands- on approach to patient care, osteopathy has contributed to the body of knowledge of manual therapies and complementary and alternative medicine.

Osteopathy is practised in many countries throughout the world. In some countries, manual therapists use osteopathic techniques and claim to provide osteopathic treatment, although they may not have received proper training.

This document presents what the community of practitioners, experts and regulators of osteopathy considers to be adequate levels and models for training osteopathic practitioners, as well as for dispensers and distributors. It provides training benchmarks for trainees with different backgrounds, as well as what the community of practitioners of osteopathy considers being contraindications for safe practice of osteopathy and for minimizing the risk of accidents. Together, these can serve as a reference for national authorities wishing to establish systems of training, examination and licensure that support the qualified practice of osteopathy.

Príspevok Osteopathy je zobrazený ako prvý na Cadan Institute.