An Osteopathic Approach to Diagnosis and Treatment 3rd Edition

703 Pages·2004·27.78 MB·English

by  Eileen L DiGiovanna

An Osteopathic Approach to
Diagnosis and Treatment

THIRD EDITION
An Osteopathic

Approach to

Diagnosis and Treatment

THIRD EDITION
Eileen L. DiGiovanna, DO, FAAO, Senior Editor
Professor Emerita Former
Chairperson
The Stanley Schiowitz, DO, FAAO Department of Osteopathic Manipulative Medicine
New York College of Osteopathic Medicine
New York Institute of Technology
Old Westbury, New York
Fellow of the American Academy of Osteopathy
Stanley Schiowitz, DO, FAAO, Senior Editor
Dean Emeritus
Former Distinguished Professor and Former Chairperson
The Stanley Schiowitz, DO, FAAO Department of Osteopathic Manipulative Medicine
New York College of Osteopathic Medicine
New York Institute of Technology
Old Westbury, New York
Fellow of the American Academy of Osteopathy
Dennis J. Dowling, DO, FAAO, Editor and Illustrator
Private Practice
Attending Physician & Director of Manipulation
Physical Medicine and Rehabilitation Department
Nassau University Medical Center
East Meadow, New York
Former Professor and Chairperson
The Stanley Schiowitz, DO, FAAO Department of Osteopathic Manipulative Medicine
New York College of Osteopathic Medicine
New York Institute of Technology
Old Westbury, New York
Fellow of the American Academy of Osteopathy
With 20 Contributors
ILLUSTRATED BY Dennis J. Dowling, DO, FAAO
LIPPINCOTT WILLIAMS & WILRINS

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2nd edition 1997 Lippincott 1st edition 1991
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Library of Congress Cataloging-in-Publication Data
An osteopathic approach to diagnosis and treatment / [edited by] Eileen L. DiGiovanna,
Stanley Schiowitz, and Dennis Dowling.—3rd ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 0-7817-4293-5
1. Osteopathic medicine. I. DiGiovanna, Eileen L. II. Schiowitz, Stanley. III. Dowling,
Dennis J.
[DNLM: 1. Osteopathic Medicine. WB 940 084 2004]
RZ341.0696 2004 615.5'33—dc22
2004015188
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01 02 03 04
Dedication

We dedicate this book:
To osteopathic students and physicians who share our belief that our hands are
channels of healing;
To colleagues and mentors who have expanded our understanding of osteopathic
manipulative medicine;
To our patients, who have taught us so much about the functioning of the human body,
mind, and spirit;
To our families, who give us the support that allows us to continue.
Preface to First and Second Editions

The instruction of students in the concepts and organizes currently taught concepts and tech-
principles of osteopathic medicine, as well as in niques into one comprehensive volume which
the skills of manipulative medicine, began in a might then serve as a reference for osteopathic
tiny frame building in Kirksville, Missouri, al- medical students, as well as practicing physi-
most 100 years ago today. Andrew Taylor Still cians. The result is a book, which presents an
was the founder and professor of that school. integrated method for both the diagnosis and
He wrote down many of his thoughts and ideas, treatment of somatic and visceral problems man-
which were later collected into the first books ifesting in the soma. We have also added an ex-
of this profession. tensive section on practical applications to serve
Since that time, only a few books have been as a demonstration of examples of osteopathic
published on osteopathy, with most of the edu- concepts integrated into the management of
cational process relying on personal instruction some commonly encountered conditions.
and demonstration. To add to this, much of the The osteopathic approach to diagnosis and
treatment is unique. We hope this text will make
information is scattered in obscure journals not
it more readily available to all osteopathic medi-
available to everyone. Those texts which are
cal students.
available are generally limited to one or a few
types of techniques. Eileen L. DiGiovanna, DO, FAAO
Our goal here has been to prepare a text that Stanley Schiowitz, DO, FAAO
VII
Preface to Third Edition

The osteopathic profession has continued to tical applications have been added to the text
grow, both in numbers of physicians and stu- along with many of the newly developed tech-
dents and in the understanding of osteopathic niques. Each section on a region of the body has
manipulative medicine, since the first publica- been enhanced with case histories illustrative of
tion of this text. The subject matter taught in the situations where osteopathic manipulative medi-
osteopathic colleges’ departments of osteo- cine is applicable to the patients’ needs.
pathic manipulative medicine has expanded to We have retained the material we feel is es-
meet the needs of the students as they prepare sential for practicing osteopathic physicians to
for practice. The methods of testing the students understand in order to best serve their
has evolved with heavier emphasis on case histo- patients’ treatment needs.
ries.
The editors have revised this edition to meet Eileen L. DiGiovanna, DO, FAAO
the needs of both teachers and students of osteo- Stanley Schiowitz, DO, FAAO
pathic manipulative medicine. Many more prac- Dennis J. Dowling, DO, FAAO
IX
Acknowledgments

We wish to acknowledge the able assistance given us in preparing this book by the editorial staff at
Lippincott William & Wilkins. And of course, thanks to our spouses, Joseph DiGiovanna, DO, Lillian
Schiowitz, and Fran Dowling for their support and allowing us the time to complete this project.
XI
Contents

SECTION I BASICS OF OSTEOPATHIC MEDICINE
1 Introduction .....................................................................................................
Eileen L. DiGiovanna
2 History of Osteopathy .........................................................................................
Eileen L. DiGiovanna
3 The Philosophy of Osteopathic Medicine ..........................................................
Dennis J. Dowling and David J. Martinke
4 Somatic Dysfunction ........................................................................................
Eileen L. DiGiovanna
5 General Anatomic Considerations ....................................................................
Stanley Schiowitz, Eileen L. DiGiovanna, and Nancy Brous
6 General Physiologic Considerations ....................................................................
Dennis J. Dowling and Paula D. Scariati
7 Structural Examination and Documentation ...................................................
Stanley Schiowitz and Dennis J. Dowling
8 Palpation ..........................................................................................................
Eileen L. DiGiovanna
9 The Role of Exercise in Osteopathic Management ...........................................
Stanley Schiowitz and Albert R. DeRubertis
SECTION II OSTEOPATHIC MANIPULATION
10 History of Manual Medicine ............................................................................
Eileen L. DiGiovanna
11 Goals, Classifications and Models of Osteopathic Manipulation ........................
Eileen L. DiGiovanna
12 Myofascial (Soft Tissue) Techniques ....................................................................
Toni Spinaris and Eileen L. DiGiovanna
13 Muscle Energy .................................................................................................
Dennis J. Dowling
xiii