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A functional approach to assessment, diagnosis and osteopathic manipulative treatment (OMT). Delivering OMT within the context of evidenced based medicine (EBM).
What is it?
A functional approach to OMT is an extremely subtle method in application yet profound in its effect of influencing joint mobility. It utilises palpable information to diagnose and treat disturbances to motion at mobile segments. Immediate compliance or resistance to passive movement tests is considered rather than joint position. Since minimally invasive it may be utilised with acute, frail, elderly or young patients, where direct approaches may be contra-indicated or premature.
How does it work?
Historically the work of Professors Korr and Denslow in the 1940’s was part of early scientific investigation of the “facilitated segment”. Current neurobiology has come a long way in explaining both peripheral and central sensitisation of the nervous system. Now we face many questions regarding OMT in an environment of clinical uncertainty.
Palpable signs of motion restriction and altered tissue tension are used to identify altered segmental function suggestive of increased afferent nerve input as a source of facilitated synaptic transmission. A traditional function approach aims to reduce the afferent input to the spinal cord, thereby interrupting the feedback loop that maintains “segmental facilitation”.
There is evidence against palpatory accuracy, segmental movement and mechanisms of effect from manual techniques. What can we learn from current neurobiology and pain science to explain the effects and positive outcomes from OMT such as a Functional approach? What contextual effects come into play and how do we ethically enhance them?
How to apply it?
A functional approach utilises 6 vectors of motion (3 rotary and 3 translational) plus respiration to influence segmental motion. The rationale is to reduce afferent input to the reflex arc and thereby reduce the facilitation that is compromising a neuromusculoskeletal complex. What else is going on while we are delivering such procedures?
The focus is on “function” rather than “joint out of place”. By assessing initial compliance or resistance to motion tests, palpatory skills become sensitive to tissue responses. What are we actually noticing here?
There will be explanation of theory and rational of a functional approach and where this fits in the spectrum of evidence for OMT and the biopsychosocial approach.
About the course leader
Michael Mulholland DO MSc Med (Pain Mgt)
Michael Mulholland graduated in Osteopathy from the Pacific College of Osteopathic Medicine, Sydney Australia 1985 and has worked in private practice in Sydney since qualification. He subsequently went on to study Pain Management obtaining his MSc from the University of Sydney in 2015.
He has been teaching and examining in Australia since 1987. He lectures and examines regularly in Europe and South America. Michael developed and teaches an evidenced based, distance education module through University of Sydney, which is part of a postgraduate medical course in chronic pain management.
Michael was an advisor to NSW Osteopaths Registration Board during a review of Osteopaths Act 2000-2001 and other policies 2006-2010. He was president of the Australian Osteopathic Association 2001-2002, president of World Osteopathic Health Organisation (WOHO) 2003-2008 and on the board of Directors, Osteopathic International Alliance (OIA) 2009 – 2015.
He was “Expert adviser”, World Health Organisation (WHO) on “Guidelines for safety and training in Osteopathy” 2004 -2007. Published as Osteopathy Benchmarks 2010.
Michael was on the board of directors of the Australian and New Zealand Osteopathic Council (ANZOC) 2008 – 2013 and chair 2008- 2011 which is the accrediting authority of university programs teaching osteopathy and assessment of overseas qualified osteopaths.
He is currently a member of Osteopathy Australia Pain Management Clinical Practice Guidelines development team, a member of the Australian Society of Lifestyle Medicine and the chair of the Steering Committee Osteopathy Strategy Australia (OA) 2020-2030.