Five Models of Osteopathic Medicine: Introduction

00:01 Osteopathic medicine is a philosophy.

00:03 It’s a world view. It’s a way of looking at patients and their problems.

00:08 And when you look at people, they don’t live their life on one level all the time.

00:12 You can be a father, a son, a spouse, and many of the things at the same time.

00:18 The same way with your illness. It may be musculoskeletal but have issues that are involved with your psyche or your breathing.

00:25 So the Educational Council in Osteopathic Principles back in the early 80’s, came up with a concept of dealing with people living their lives on multiple levels, and having problems that transverse multiple levels.

00:39 And when you get tested by the National Board of Osteopathic Medical Examiners, they want to know how you’re using the models to decide which therapeutic technique you’re going to use, how you’re going to use it, and how it fits into an explanatory model of health and illness.

00:54 We call this the Five Model Approach to Osteopathic Medicine.

00:59 So the models sometimes overlap, again, you can live your life in many different levels all at once.

01:04 And it is important to address this when you choose how you’re going to treat somebody, and how you’re going to think about their problems, and how you’re going to focus your attention as a provider caring for a human being.

01:17 So we came up with a five model approach of dealing with human beings, of looking at people living their lives in multiple ways, all at once.

01:27 The five models of manipulation are #1— the biomechanical model— basic mechanics of musculoskeletal movement, how much motion you have, and how much motion have you lost.

01:37 Then 2nd model is the neurologic model— looking at the sympathetics, para- sympathetics, autonomics, and the innervation of the musculoskeletal system and how the nervous system affects the body.

01:49 The 3rd system is the respiratory/ circulatory model— looking at how breathing is affected, how comfortably somebody is breathing, how their rib cage is moving, how that’s effecting their functioning, their breathing and heartbeat.

02:02 The 4th is a psychological model and how is their mental status, how is their functioning, how are they thinking and feeling, and how is their mood? That’s going to affect how somebody looks at their own health, how they interpret individual symptoms, and what that does to their exclamation of what’s going on, their explanation of their illness, and how it effects their being.

02:28 And the last model is the bioenergy model.

02:31 How is their energy? How is their mood? Are they sleeping? Are they eating? How are they interpreting their intervention and their approach and their place in the world? So those are the five models of manipulation.

02:45 And when somebody comes in with a complaint, they could say, “My neck hurts,” and that could be because their neck doesn’t move.

02:52 It could be because they’ve got a pinched nerve.

02:54 It could be because they didn’t sleep and they have no energy and they can’t wake up despite how much coffee they drink.

03:01 It may be that they’re depressed.

03:03 So you can have multiple levels, but if you’re going to address neck pain, and say they can’t move and they ask you, “How are you going to treat this?” You’d say well I’m going to use the biomechanic model and I’m going to make sure that they can’t twist more than 70°, I’m going to get them to go to 90°.

03:19 Or if you say, “You know they can move their neck and I don’t think they’re functioning well and they have tender points on their forehead, on their anterior chest wall, I’m going to look at the bioenergetic model to evaluate the patient for a fibromyalgia chronic fatigue or some other bioenergetic or somatic based syndrome and address it in that way.” Or you can say, “I’m going to mix a couple of different models lthough the treatments for each of those models will be the same." That’s why we have the models. It gives you a way of making a decision and choosing a path that will be philosophically consistent.

03:55 When you have somebody who comes to you with an issue, with a complaint that doesn’t fall into a specific issue— it’s not chest pain, it’s not shortness of breath— you want to start looking at where am I going to place this problem.

04:10 Do they have a somatic dysfunction? Do they have a psychological issue? Do they have an energy issue? Is it just normal variation in functioning and is the person aging and not accepting it? So we have to figure out where it fits and how we’re going to go with it and how we’re going to manage it.

04:26 Are we going to witness the patient’s symptoms? Are we going to intervene with the patient’s symptoms? Are we going to manage symptoms and somehow try to get them to a better place and when do we start applying the specific skills we learned in osteo- pathic manipulative therapy and treatments to their issue? And once we decide whether or not to do something with osteopathic manipulative treatment, what technique do you use? Do you use high velocity, low amplitude? Do you use muscle energy? Is it something that a counterstrain technique, and if you’re going to use counterstrain, how well does counterstrain work in the biomechanical model? It does. Is it the 1st choice? It could be.

05:08 But it’s one of the choices.

05:10 So with the manipulative prescription, how often is this person going to come for treatment? How often does this person want to come for treatment? How important is the therapeutic relationship to helping them get better? How much support do you give them? This all figures in to figuring out the amount of treatment and how long treatment, and what your goals are going to be? What the patient will accept, what the patient is looking for, and what’s within the community standard for providing care and support to the patients.

05:41 We also want to look at the risk- benefit considerations.

05:44 Some treatments will have downsides.

05:48 If somebody is older, do you want to do high velocity, low amplitude? If somebody has cancer, and they’ve got bone mets, what’s the risk of doing something direct versus indirect in your treatment techniques? So the five models helps you choose which way you’re going to go and your treatment.