Somatic dysfunction
Encyclopedia
In osteopathic medicine and osteopathy
, somatic dysfunction is the impaired or altered function of bodily structures (most often of the musculoskeletal system
, nervous system
, or lymphatic system
) treated by osteopathic manual technique (OMT)
.
can be used to detect a diminished range of motion.
The hallmark of a musculoskeletal somatic dysfunction diagnosis involves the detection of a "restrictive barrier" related to the structure in question. The language of "barriers" refers to the point at which a structure cannot move further in a given direction. For example, a natural "physiologic barrier" of the arm represents the farthest that a person can naturally move their arm before it cannot be comfortably moved further. The "anatomic barrier," then, is how far the arm can be pushed or pulled by an outside force before the arm becomes physically injured. A "pathological" or "restrictive" barrier represents the shortened range of motion to which the arm is confined because of an injury, spasm, or some other somatic dysfunction. The goal of treatment, then, is to restore the arm's range of motion (or that of whatever structure is in question).
Other types of somatic dysfunctions may include occlusions or mutilations of vasculature or lymphatic vessels, which can impair cardiovascular or lymphatic circulation. This may also occur secondary to organ pathology, a factor which theoretically allows the detection of visceral dysfunction by examining surface structures. It is by this explanation that Chapman's Points
are said to be used in identifying problems with deep tissue structures. A Chapman's Point
is an area of bunched tissue or vasculature that is said to occur as a result of fluid backup or another dysfunction at a portion of the vasculature more proximal to a pathological organ. For example, damage to an organ such as the appendix may cause lymphatic back-up that produces a palpable nodule in distal lymphatic vessels near the tip of the 12th (floating) rib. By feeling for this Chapman's Point, the physician may be able to noninvasively detect appendicitis. The evidence for these points remains controversial, though some studies suggest modest sensitivity and specificity for their use in diagnosis .
(causing a tissue texture change). Lymphatic drainage aids in clearing the infection while, conversely, resolution of the infection causes clearing of associated edema. Thus the physician attempts to aid the resolution of visceral disease by eliminating its associated manifestation in the musculo-skeletal system. The two reflex effects just discussed are generally referred to as the somatovisceral and viscerosomatic reflexes, and these are routinely encountered in regular clinical work. What is perhaps of particular interest is that it does not matter if the spinal lesion was caused by nociceptic (pain) inpulses from the organ, or by biomechanical forces. The result is the same...a reciprocal neurological phenomenon between the viscus and the vertebra wherein the status of the vertebra has been altered, which will generally persist in the absence of treatment, and will create trouble unless treated.
When this "vicious cycle" is broken by the application of osteopathic manipulation, a return to normal physiological status both in the spinal tissue and the organ tissue generally ensues except when complicated by the presence of major infection or significant physical trauma. The clinical picture will vary from patient to patient, but the phenomena are based on sound neurologial principles.
The founder of osteopathy, Dr. Andrew Still
, held that spinal lesion effects were based on the compromise of vascular supply not on neurological effects. In recent years, most osteopathic physicians agree that neurological effects are primary, while vascular changes may play some part.
(OMM), also called osteopathic manipulative treatment(OMT) has resulted in mixed conclusions. In a famous article published the New England Journal of Medicine
in November 1999, researchers concluded that osteopathic manipulative medicine and traditional drug therapy resulted in equivalent resolution of lower back pain in a nearly identical time frame. The difference was that those receiving osteopathic manipulative medicine required less pharmaceutical intervention. The advantage of osteopathic manipulative medicine was diminution of adverse drug reactions while the disadvantage was the greater amount of physician time required for each patient.
However, a meta-analysis of six randomized controlled trials of osteopathic manipulative treatment that involved blinded assessments of low back pain in ambulatory settings found from computerized bibliographic searches of MEDLINE, EMBASE, MANTIS, OSTMED, and the Cochrane Central Register of Controlled Trials, found that osteopathic manipulative treatment significantly reduces low back pain. It also concluded that the level of pain reduction is greater than expected from placebo effects alone and persists for at least three months.
Osteopathy
Osteopathy and osteopathic medicine are often used interchangeably for the philosophy and system of alternative medical practice first proposed by A. T. Still MD, DO in 1874....
, somatic dysfunction is the impaired or altered function of bodily structures (most often of the musculoskeletal system
Musculoskeletal system
A musculoskeletal system is an organ system that gives animals the ability to move using the muscular and skeletal systems...
, nervous system
Nervous system
The nervous system is an organ system containing a network of specialized cells called neurons that coordinate the actions of an animal and transmit signals between different parts of its body. In most animals the nervous system consists of two parts, central and peripheral. The central nervous...
, or lymphatic system
Lymphatic system
The lymphoid system is the part of the immune system comprising a network of conduits called lymphatic vessels that carry a clear fluid called lymph unidirectionally toward the heart. Lymphoid tissue is found in many organs, particularly the lymph nodes, and in the lymphoid follicles associated...
) treated by osteopathic manual technique (OMT)
Osteopathic Manipulative Medicine
Osteopathic Manipulative Medicine is the application of the distinct osteopathic philosophy, structural diagnosis and use of Osteopathic Manipulative Technique in the diagnosis and management of the patient. OMM takes into account the physical and mental health of a patient, and how either aspect...
.
Diagnosis
Somatic dysfunction is diagnosed by physical examination. The osteopathic physician looks for symptoms commonly represented by the mnemonic device "TARt" (Tissue texture change, Asymmetry, Restriction, and Tenderness). The physician uses techniques such as layer-by-layer palpation and intersegmental range of motion testing to make the diagnosis. Diagnosis usually requires only the use of the physician's hands and fingertips, though instruments such as a goniometerGoniometer
A goniometer is an instrument that either measures an angle or allows an object to be rotated to a precise angular position. The term goniometry is derived from two Greek words, gōnia, meaning angle, and metron, meaning measure....
can be used to detect a diminished range of motion.
The hallmark of a musculoskeletal somatic dysfunction diagnosis involves the detection of a "restrictive barrier" related to the structure in question. The language of "barriers" refers to the point at which a structure cannot move further in a given direction. For example, a natural "physiologic barrier" of the arm represents the farthest that a person can naturally move their arm before it cannot be comfortably moved further. The "anatomic barrier," then, is how far the arm can be pushed or pulled by an outside force before the arm becomes physically injured. A "pathological" or "restrictive" barrier represents the shortened range of motion to which the arm is confined because of an injury, spasm, or some other somatic dysfunction. The goal of treatment, then, is to restore the arm's range of motion (or that of whatever structure is in question).
Other types of somatic dysfunctions may include occlusions or mutilations of vasculature or lymphatic vessels, which can impair cardiovascular or lymphatic circulation. This may also occur secondary to organ pathology, a factor which theoretically allows the detection of visceral dysfunction by examining surface structures. It is by this explanation that Chapman's Points
Chapman reflex points
Chapman reflex points, or Champman's points, are small, discrete tissue texture changes located just deep to the skin. The Chapman Point is an outward physical representation of internal dysfunction or pathology of an organ system. Chapman's reflexes are localized to consistent anatomic landmarks...
are said to be used in identifying problems with deep tissue structures. A Chapman's Point
Chapman reflex points
Chapman reflex points, or Champman's points, are small, discrete tissue texture changes located just deep to the skin. The Chapman Point is an outward physical representation of internal dysfunction or pathology of an organ system. Chapman's reflexes are localized to consistent anatomic landmarks...
is an area of bunched tissue or vasculature that is said to occur as a result of fluid backup or another dysfunction at a portion of the vasculature more proximal to a pathological organ. For example, damage to an organ such as the appendix may cause lymphatic back-up that produces a palpable nodule in distal lymphatic vessels near the tip of the 12th (floating) rib. By feeling for this Chapman's Point, the physician may be able to noninvasively detect appendicitis. The evidence for these points remains controversial, though some studies suggest modest sensitivity and specificity for their use in diagnosis .
Significance
The physical manifestation of somatic dysfunction is frequently associated reciprocally with visceral illness, generally related to the vertebral level associated with the organ in question. E.g., T-6 (the sixth thoracic vertebra) is associated with the stomach. Similarly, the resolution of either can aid in the resolution of the other. For example, an infection may be associated with edemaEdema
Edema or oedema ; both words from the Greek , oídēma "swelling"), formerly known as dropsy or hydropsy, is an abnormal accumulation of fluid beneath the skin or in one or more cavities of the body that produces swelling...
(causing a tissue texture change). Lymphatic drainage aids in clearing the infection while, conversely, resolution of the infection causes clearing of associated edema. Thus the physician attempts to aid the resolution of visceral disease by eliminating its associated manifestation in the musculo-skeletal system. The two reflex effects just discussed are generally referred to as the somatovisceral and viscerosomatic reflexes, and these are routinely encountered in regular clinical work. What is perhaps of particular interest is that it does not matter if the spinal lesion was caused by nociceptic (pain) inpulses from the organ, or by biomechanical forces. The result is the same...a reciprocal neurological phenomenon between the viscus and the vertebra wherein the status of the vertebra has been altered, which will generally persist in the absence of treatment, and will create trouble unless treated.
When this "vicious cycle" is broken by the application of osteopathic manipulation, a return to normal physiological status both in the spinal tissue and the organ tissue generally ensues except when complicated by the presence of major infection or significant physical trauma. The clinical picture will vary from patient to patient, but the phenomena are based on sound neurologial principles.
The founder of osteopathy, Dr. Andrew Still
Andrew Taylor Still
Andrew Taylor Still is considered the father of osteopathy and osteopathic medicine. He was also a physician & surgeon, author, inventor and Kansas territorial & state legislator. He was one of the founders of Baker University, the oldest 4-year college in the state of Kansas, and was the founder...
, held that spinal lesion effects were based on the compromise of vascular supply not on neurological effects. In recent years, most osteopathic physicians agree that neurological effects are primary, while vascular changes may play some part.
Research
Research in somatic dysfunction and the use of osteopathic manipulative medicineOsteopathic Manipulative Medicine
Osteopathic Manipulative Medicine is the application of the distinct osteopathic philosophy, structural diagnosis and use of Osteopathic Manipulative Technique in the diagnosis and management of the patient. OMM takes into account the physical and mental health of a patient, and how either aspect...
(OMM), also called osteopathic manipulative treatment(OMT) has resulted in mixed conclusions. In a famous article published the New England Journal of Medicine
New England Journal of Medicine
The New England Journal of Medicine is an English-language peer-reviewed medical journal published by the Massachusetts Medical Society. It describes itself as the oldest continuously published medical journal in the world.-History:...
in November 1999, researchers concluded that osteopathic manipulative medicine and traditional drug therapy resulted in equivalent resolution of lower back pain in a nearly identical time frame. The difference was that those receiving osteopathic manipulative medicine required less pharmaceutical intervention. The advantage of osteopathic manipulative medicine was diminution of adverse drug reactions while the disadvantage was the greater amount of physician time required for each patient.
However, a meta-analysis of six randomized controlled trials of osteopathic manipulative treatment that involved blinded assessments of low back pain in ambulatory settings found from computerized bibliographic searches of MEDLINE, EMBASE, MANTIS, OSTMED, and the Cochrane Central Register of Controlled Trials, found that osteopathic manipulative treatment significantly reduces low back pain. It also concluded that the level of pain reduction is greater than expected from placebo effects alone and persists for at least three months.