The Stillpoint

I’ve been talking a lot lately regarding the difference a DO makes. I’ll have a page comparing different practitioners soon, but for now here’s one way of thinking about it.

When a patient comes in with a problem, the treatment from a medical perspective depends on making an accurate diagnosis. This means history taking, physical exam, and testing such as blood work or radiography.  When all of the pieces have been gathered, a named disease is proposed and the treatment ensues. An osteopathic treatment, though, depends less on what the name of the “disease” is and more on what is going on in the patient’s body. This leads to a personalized treatment which attempts to address the source of the problem, rather than managing the symptoms. An example is required here:

Let us say the patient has hip pain. History might give us worsening with activity, stiffness, limitation of range of motion, very tender if she lays on that side. No history of trauma or falls. Physical exam would tell us that there is a limp when the patient walks, with mild redness and some tenderness along the hip bone. Limitations of both flexion and extension of the hip.

Laboratory studies might include blood work to look for rheumatoid arthritis, gout, autoimmune diseases, or infection. A sample of the joint fluid might be taken for microscopic testing, and X-rays taken to look for obvious arthritis or degenerative changes.

Assuming all of those are negative (and they usually are), we might be left with a diagnosis of bursitis (in this case, the greater trochanteric bursa) which means that the hip is inflamed, leading to warmth, pain, and sometimes swelling. Treatment then would include rest, ice, anti-inflammatory medication, and possibly an injection of a steroid for further anti-inflammatory action.

The osteopathic difference lies our more intensive training in the musculoskeletal system coupled with an ability to diagnose and manipulate or treat problems with our hands. In the above case, I wouldn’t be satisfied with the diagnosis given, I would need to find why the patient’s bursa is inflamed. Simply giving an anti-inflammatory drug would not treat the cause of the bursitis in the first place. In most cases the motion of the joint in question is altered due to tension in the ligaments, muscles, or fascia surrounding the joint. Treatment aimed at those structures will restore normal movement of the joint and stop the inflammation. No anti-inflammatory medication, injections, or rest needed.

The body usually tries to stop inflammation by draining the area via the lymphatic system. Once the tensions around the joint are normalized, the normal drainage can take place, and the inflammation goes away. If there is recurrence, we need to address activities that the patient might be doing which are aggravating the bursa, and also look at their diet to remove potentially inflammatory foods.

The point here is not to say that only an osteopath will take the extra step and look for the cause (although that is often true today), but that our unique approach to the musculoskeletal system and its interactions with the other systems in the body is The Osteopathic Difference.

August 11th, 2008 | Category: Osteopathy | Subscribe to comments | Leave a comment | Trackback URL