How do Doctors of Osteopathic Medicine (DO) treat somatic dysfunction?

Osteopathic Treatment of Somatic Dysfunction

Doctors of Osteopathic Medicine (DOs) treat somatic dysfunction through osteopathic manipulative treatment (OMT), which involves hands-on techniques to diagnose, treat, and prevent illness or injury by addressing impaired or altered function in the body's structural framework.

Understanding Somatic Dysfunction

Somatic dysfunction is defined as "impaired or altered function of related components of the somatic (body framework) system: skeletal, arthrodial and myofascial structures, and their related vascular, lymphatic, and neural elements" 1. It is diagnosed through palpatory findings using the TART criteria:

• Tenderness
• Asymmetry
• Restricted motion (most commonly identified finding)
• Tissue texture changes

Assessment Process

The osteopathic approach to assessment involves:

1. Structural examination - Performed in 98.4% of patient visits 2
2. Palpatory diagnosis - Identifying areas of somatic dysfunction through TART findings
3. Motion testing - Assessing the quality and quantity of movement in affected regions
4. Tissue assessment - Evaluating changes in tissue texture, temperature, and tone

The "Variability Model" represents a newer perspective on somatic dysfunction assessment, focusing on movement variability within the neutral zone as an indicator of the body's adaptability 3.

Common OMT Techniques

Based on research, the most commonly used OMT techniques include 2:

1. Cranial techniques (14.5%)
2. Myofascial release (13.7%)
3. Muscle energy (13.6%)
4. Counterstrain (13.3%)

These four techniques account for more than half of all OMT provided.

Treatment Approach by Anatomical Region

Treatment approaches vary based on the anatomical region affected:

Head Region

• Pediatric patients are significantly more likely to receive OMT to the head compared to adults (adjusted OR 9.53) 2
• Cranial techniques are frequently employed
• Focus on addressing cranial restrictions and improving cerebrospinal fluid flow

Spine and Thorax

• Common areas for somatic dysfunction
• Treatment may include muscle energy, myofascial release, and HVLA (high-velocity, low-amplitude) techniques
• Aims to improve respiratory function and spinal mobility

Extremities

• Geriatric patients more likely to receive structural examination (adjusted OR 1.83) and OMT (adjusted OR 1.62) in the lower extremities 2
• Focus on improving joint mobility and reducing pain
• Counterstrain and articulatory techniques often used

Pelvis and Sacrum

• Female patients more likely to receive structural examination (adjusted OR 2.44) and OMT (adjusted OR 2.11) in the sacrum and pelvis 2
• Treatment focuses on normalizing sacral mechanics and pelvic alignment

Clinical Application and Effectiveness

OMT has shown effectiveness for various conditions:

• Low back pain: Meta-analysis shows significant pain reduction (effect size -0.30) compared to control treatments 1
• Chronic pain management: OMT integrates with biopsychosocial models and patient education to create personalized treatment plans 4
• Functional disorders: Addresses underlying somatic dysfunction that may contribute to functional limitations

Treatment Principles

The osteopathic approach to treating somatic dysfunction is guided by several principles:

1. Body unity: Treating the person as a whole, not just isolated symptoms
2. Structure-function relationship: Addressing structural issues to improve physiological function
3. Self-regulation: Enhancing the body's inherent capacity to maintain and repair itself
4. Rational treatment: Using evidence-informed techniques appropriate to the specific dysfunction

Treatment Protocol

A typical OMT protocol for somatic dysfunction includes:

1. Identify key dysfunctions through palpatory examination
2. Prioritize treatment areas based on primary vs. secondary dysfunctions
3. Select appropriate techniques based on:
   • Patient factors (age, condition, preferences)
   • Tissue characteristics (acute vs. chronic)
   • Practitioner expertise
4. Apply techniques in a logical sequence (often proximal to distal)
5. Reassess after treatment to evaluate effectiveness

Clinical Considerations

• Treatment frequency typically ranges from weekly to monthly depending on chronicity and severity
• Acute conditions may require more frequent treatment initially
• Integration with other treatment modalities often produces optimal outcomes
• Patient education about posture, movement patterns, and self-care is essential

Pitfalls to Avoid

• Focusing solely on symptomatic areas without addressing contributing dysfunctions
• Overtreatment (treating too many areas in one session)
• Neglecting to reassess after treatment
• Failing to consider psychosocial factors that may contribute to or perpetuate somatic dysfunction

OMT represents a distinctive approach to patient care that complements conventional treatments by addressing structure-function relationships in the body, with demonstrated effectiveness for conditions like low back pain and other musculoskeletal disorders.