This document summarizes a presentation given by David López Sánchez on spinal osteopathic manipulative therapy. It provides an overview of osteopathic philosophy which views the body as a single unified system. It describes assessment techniques for somatic dysfunction including asymmetry and tissue changes. Mechanisms of spinal manipulation are discussed such as restoring range of motion and reducing nociception. The document concludes that osteopathy aims to optimize health and stimulate self-regulation rather than simply treat diseases.
Spinal Osteopathic Manipulative Therapy (OMTh) Revisited by Manual Therapists 2014
1. Prof. David López Sánchez
Kinesiologyst; Chiropractor D.C.
Director of the Chiropractic Program
Central University of Chile
Director of Manual Therapy Diplomats
Saint Thomas University, Chile
The Spinal Osteopathic Manipulative
Therapy (OMTh): revisited by other
Manual Therapist
XX edition of International Disabled People’s Day.
International Scientific Symposium
20-23 March 2014. Zgorzelec, Poland.
2. Osteopathy: Art,
Science & Philosophy
Mind – Body – Spirit are a single unity
OMT is Hands-On Medicine
Structure and Function are reciprocally
related: Localized visceral stimulation
produces patterns of reflex response in
spinal segments related with somatic
structures (1,2)
The body is a system who heals itself and
capable of self regulation
1.- Beal, M.C.: “Viscerosomatic Reflexes: A Review.” Journal of the A.O.A.. 85, (12): 786-801, 1983.
2.-Louisa Burns, Viscero-Somatic and Somato-Visceral Spinal Reflexes. The Journal of The American Osteopathic
Association. 2000; 100(4);249-258. 2David Lopez Sánchez DC, PT
3. Asymmetry
Restricted Range of Motion
Tissue Texture Changes
Position of Elements
Restricted Motion Direction
Free Motion Direction
Skeletal structures
Myofascial structures (Tozzi, 2012)
Tissues: Vascular, Lymphatic and
Neural related elements (Langevin,
2006)
Somatic Dysfunction:
Diagnosis
Impairment
Disorder
Paolo Tozzi, Selected fascial aspects of osteopathic practice, Journal of Bodywork & Movement Therapies. 2012;16, 503-519.
Helene M. Langevin, Karen J. Sherman, Pathophysiological model for chronic low back pain integrating connective tissue and
nervous system mechanisms, Medical Hypotheses, 2006; 68,74-80.
3David Lopez Sánchez DC, PT
5. Manipulation:
Homeostatic Effects
•Free Nerve Ending
•Mechanoreceptors
Receptors
•Brain
•Dorsal Corn
Integrator •Muscle
•Vessels walls
•Glands
Efectors
Homeostasis & OMT:
Stable operating conditions in the internal inviroment
to maintain the physiological equilibrium
The response to the manipulative stimulus leads the changes.
ResponseOMT
5David Lopez Sánchez DC, PT
6. Intervertebral Somatic
Dysfunction
Fryer, Gary (2003) Intervertebral Somatic Dysfunction: A Discussion of the Manipulable Spinal Lesion. Journal of Osteopathic
Medicine, 6 (2). pp. 64-73. ISSN 1443-8461
The facilitated segment: There is
evidence of spontaneous
electromyographic (EMG) activity
and increased sympathetic output
at spinal levels associated with
clinically detected segmental
dysfunctions (Denslow 1947 & Korr,
1958).
A vertebral segment or spinal cord
level exhibits a pool of related
neurons that maintain a state of
partial excitation; then less afferent
stimulation is required to trigger
the discharge of impulses.
Muscle Inhibition;
Compensatory
Shortened and
Overactive muscles
Joint ROM restriction
Asymmetry
Increased Sympathetic
Output
Tissue Texture Changes
(Edema & fibrosis);
Circulatory Changes
(ischemia)
Increased Nociception
(Pain);
Altered gamma and
Alfa Activity
(Mechanoreceptors
hyperactivity)
Facilitated
Spinal Cord
Neurons
6David Lopez Sánchez DC, PT
8. Joint Dysfunction:
Deafferentation
• The loss of motor control in a joint
it can become restricted or
unstable.
• The Joint Dysfunction can alter the
mechanoreceptors Type I & II
discharge and limit their role on
the pain modulation, which results
in an increased nociceptor
feedback.
• This has effects at the segmental
level and the cortex. The
manipulation could reverse these
effects acting at GDR’s level.
1.- Terrett and Terret, “Referred Posterior Thoracic Pain,” Chiropr J of Australia 2002; 32: 44
2.- Seaman DR, Winterstein JF. Dysafferentation, a novel term to describe the neuropathophysiological effects of joint
complex dysfunction: A look at likely mechanisms of symptom generation. J Manip Physiol Ther 1998;21(4):267-80
8David Lopez Sánchez DC, PT
9. David Lopez Sánchez DC, PT 9
Osteopathy & Tensegrity:
The Body as full integrated Unit
The body is a unit…with a architectural
network of omnidirectional viscoelastic
forces and rigid components distributed
an tied through a tensegrity system.
Thus the cranium content could be
affected by tensions transferred from the
related structures through the connective
and soft tissues. Under this model
secondary stresses can be the result of
the posture of the spine and any distant
change of tension within the
musculoskeletal system.
Graham Scarr. Helical tensegrity as a structural mechanism in human anatomy. International Journal of Osteopathic Medicine. March
2011 (Vol. 14, Issue 1, Pages 24-32.
10. Dentate Ligament Theory:
Cord Traction
10David Lopez Sánchez DC, PT
The Dentate Ligament connect the spinal cord and brain stem with dura
mater. Any misalignmet at level Occipito-Atlanto-Axial could be a factor of
direct traction on the spinal cord.
1) J Neurol Neurosurg Psiquiatría v.47 (4); 04 1984
2) The Origins of the Grostic Procedures. Jhon Grostic DC. ICA, 1978.
11. David Lopez Sánchez DC, PT 11
Dentate Ligament :
Role in Mielopathy
• In presence of a spondylotic bar, tensile forces acts over the spinal
cord from the dentate ligament causing traction and neural tissue
stress, this produces narrowing of small vessels and decreased local
microcirculation, thus consequentelly mielopathy.
David N Levine. Pathogenesis of cervical spondylotic myelopathy. Journal of
Neurology, Neurosurgery, and Psychiatry 1997;62:334-340
12. Dentate Ligament Theory:
Cord Traction
12David Lopez Sánchez DC, PT
Journal of Clinical Neuroscience 19 (2012) 1150–1153
Dentate Ligament before & after a meningiom of spinal cord resection.
The spinocerebellar tracts (proprioception) are located at the site of maximal
mechanical irritation, their irritation may cause hypertonicity and spasticity in
the muscles of the pelvic girdle and lower extremities
13. Somatic Dysfunction:
Cord & Neural Traction
13David Lopez Sánchez DC, PT
Atlas Dysfunction
Fernandez Noda et al. ‘Neck
and brain transitory vascular
compression causing
neurological complications’, J.
Cardiovasc Surg 1996; 37 (suppl.
1 to no. 6): 155-66).
The trigeminal nerve spinal
nucleus may be tractioned by a
lateral deviation and rotation of
the atlas.
14. Osteopathic Cavitation:
Joint Space Separation?
14David Lopez Sánchez DC, PT
• The separation of the zygapophyseal joints after manipulation has been
demonstrated with MRI.
• The observed gapping increases significantly over a tension of 8 kgs., the
facetary surfaces separates 4,7 mms with an audible cavitation. (Cramer G.,
2013, 2012, 2000).
Cramer Gregory DC. J Manipulative Physiol Ther. 2013 May; 36(4):203-17
15. 15
David Lopez Sánchez DC, PT
1.- Johnson, Gillian M. The sensory and sympathetic nerve supply within the cervical spine: review of recent observations. Manual
Therapy Volume: 9, Issue: 2, May, 2004, pp. 71-76.
2.- Spine. 15 January 2007 - Volume 32 - Issue 2 - pp 244-248. Friedrich, Klaus M. MD et als. High-Field Magnetic Resonance Imaging
of Meniscoids in the Zygapophyseal Joints of the Human Cervical Spine. Spine. 15 January 2007 - Volume 32 - Issue 2 - pp 244-
248.
3.- Engel R. & Bodguk N. The menisci of the lumbar zygapophysial joints. J. Anat. (1982) 135, 4, pp. 795-809 795.
The cervical zygapophysial joints and
their richly innervated meniscoids have
been well documented as source of neck
pain (1).
The High-Field MR image sequence is
best for the evaluation of the meniscoid
anatomy and pathology (2).
Meniscoids may become entrapped
between the articular cartilages of the
facet joints and OMT could release them.
OMT: Entrapped
Zygoapophysial Meniscoid
16. Spinal Manipulation:
ROM and Neurophysiological
Effects
16David Lopez Sánchez DC, PT
• K. Rodrigues DC. Active range of motion in the cervical spine increases after
spinal manipulation (J Manipulative Physiol Ther 2001;24:552-5).
• Fernández-de-las-Peñas, César et als. Immediate changes in radiographically
determined lateral flexion range of motion following a single cervical HVLA
manipulation in patients presenting with mechanical neck pain. Journal of
Osteopathic Medicine Volume: 8, Issue: 4, December, 2005, pp. 139-145.
• Herzog, PhD et al. Electromyographic responses of back & limb muscles
associated with spinal manipulative therapy. Spine 1999; 24(2): 146-153.
b. Peak load
d. Duration of the impulse
(relates to resonant frequency)
c. Rate of rise of applied load
a. Pre load
17. • Prolonged or repetitive activity of
dorsal horn neurons caused by
sustained noxious stimulation may
subsequently produces central
sensitization and may be involved in
the generation of referred pain and
hyperalgesia across multiple spinal
segments (Mira M, 2007).
• The systematic critical review of the
literature confirms an hypoalgesic
effect of spinal manipulative therapy
(SMT) on experimentally induced
pain provoked by pressure (Millan,
2012, Bronfort, 2010)
David Lopez Sánchez DC, PT 17
1.- Mira Meeus & Jo Nijs. Clin Rheumatol (2007) 26:465–473
2.- Millan et al.Chiropractic & ManualTherapies 2012, 20:26
3.-Bronfort, G. Chiropractic & Osteopathy 2010, 18:3
Osteopathic Manipulation (SMT):
Hypoalgesic
Effects
18. The OMT could not been seen only as an useful technique to restore the
segmental mobility. It can also intend to restore the vascular and neural and
homeosthatic functions of the tissues according the age, gender, lifestyles,
health and current somatic dysfunction of the patient.
David Lopez Sánchez DC, PT 18
Osteopathic Vision:
Health & Disease
From IAO:
Modern Principles of Osteopathy
2011.
19. David Lopez Sánchez DC, PT 19
Spinal
Osteopathic Manipulative Therapy:
Where are we now?
Osteopathy is a system of diagnosis and
treatment with a well differentiated philosophy
that practice a “whole person” approach in
healthcare (1).
Osteopathy does not declare to treat diseases or
illness, it optimizes patient health to stimulate
self-regulating processes (repair, anti-
inflammatory, immunity and defense
mechanisms, homeosthasis) (2).
1.- Glossary of Osteopathic Terminology. Prepared by (ECOP/AACOM). Revised April 2009
2.- International Academy of Osteopathy. Modern Principles of Osteopathy, 2011
20. David Lopez Sánchez DC, PT 20
Spinal Osteopathic Manipulative Therapy:
Summary
The manipulative therapy is essential for
osteopaths to restore and correct the
human biomechanical function.
Basic medical sciences, scientific research
and a clinical osteopathic reasoning are
used to explain and understand the
interaction between biomechanics and the
neural, musculoskeletal, circulatory and all
physiological system in a somatic
dysfunction.
Glossary of Osteopathic Terminology. Prepared by (ECOP/AACOM). Revised April 2009
WHO. Benchmarks for training in traditional / complementary and alternative medicine: benchmarks for training in osteopathy. 2010
21. David López Sánchez
Kinesiologyst; Chiropractor DC
E mail: consultas@dolordeespalda.cl
www.dolordeespalda.cl
Conference: “The Spinal Osteopathic Manipulative Therapy (OMTh): revisited by
other Manual Therapist” Poland, 2014
Conference: “Osteopathic Manipulative Therapy (OMTh) of Extremities: revisited
by other Manual Therapist”, Poland, 2014
XX edition of International Disabled People’s Day.
International Scientifique Symposium
20-23 March 2014. Zgorzelec, Poland.