Dunia Mardini, Nicole Peña, J. Talsma, Stacey L. Pierce-Talsma
{"title":"Osteopathic Cranial Manipulative Medicine: Frontal and Parietal Lift Techniques","authors":"Dunia Mardini, Nicole Peña, J. Talsma, Stacey L. Pierce-Talsma","doi":"10.7556/jaoa.2019.139","DOIUrl":"https://doi.org/10.7556/jaoa.2019.139","url":null,"abstract":"","PeriodicalId":16639,"journal":{"name":"Journal of Osteopathic Medicine Journal of Osteopathic Medicine","volume":"10 1","pages":"e44 - e45"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79329442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alexandria Caldwell, H. Qasimyar, Lisa Shumate, Michael P. Anderson, Amanda S. Cherry, Cheryl Bryant, A. Bax
Abstract Context Residents receive little parenting education despite its potential to improve parenting behavior and decrease child maltreatment despite the inclusion of parenting content on board certification examinations. Teaching residents how to discuss parenting and foster positive parent-child relationships is essential to treating the whole person in osteopathic pediatric medicine. Objective To improve pediatric and internal medicine–pediatric residents’ knowledge, confidence, and skills in providing parenting advice. Methods Four toddler parenting and discipline modules were developed. During continuity clinic, residents viewed and discussed modules with faculty. Residents completed a confidence and knowledge questionnaire before and after the curriculum, provided a self-report of use of skills learned, and completed a feasibility survey. Faculty also completed a feasibility survey. Results Forty-one of 61 residents (67%) participated in the study. Before participation, the median (interquartile range [IQR]) resident score for confidence in giving advice was 6.0 (4.0-7.0) (on a 10-point scale), increasing to 7.0 (6.0-8.0) for those completing 1 to 3 modules and 8.0 (8.0-9.0) for those completing 4 modules. Median (IQR) score on board-style questions was 8.0 (7.0-9.0) (on a 12-point scale) before participating in the modules and 8.5 (7.5-9.5) for those completing 1 to 3 modules and 9.0 (7.0-9.0) for those completing 4 modules after participation; the increase was not statistically significant. Nine faculty and 29 residents completed the modules and responded to the exit survey regarding feasibility and acceptability of the curriculum. On a 4-point scale (4 being excellent), sessions had an overall mean (SD) rating of 3.7 (0.5) by faculty and 3.5 (0.5) by residents. Most residents (27 [93.1%]) reported interest in more modules, and 28 residents (96.6%) reported using information learned from the modules during clinic visits. Conclusion Confidence delivering parenting advice increased among residents who completed the curriculum modules. Faculty and residents reported high feasibility ratings, and residents endorsed application of skills during clinic visits and interest in more modules.
{"title":"Structured Curriculum to Improve Pediatric Resident Confidence and Skills in Providing Parenting Advice","authors":"Alexandria Caldwell, H. Qasimyar, Lisa Shumate, Michael P. Anderson, Amanda S. Cherry, Cheryl Bryant, A. Bax","doi":"10.7556/jaoa.2019.124","DOIUrl":"https://doi.org/10.7556/jaoa.2019.124","url":null,"abstract":"Abstract Context Residents receive little parenting education despite its potential to improve parenting behavior and decrease child maltreatment despite the inclusion of parenting content on board certification examinations. Teaching residents how to discuss parenting and foster positive parent-child relationships is essential to treating the whole person in osteopathic pediatric medicine. Objective To improve pediatric and internal medicine–pediatric residents’ knowledge, confidence, and skills in providing parenting advice. Methods Four toddler parenting and discipline modules were developed. During continuity clinic, residents viewed and discussed modules with faculty. Residents completed a confidence and knowledge questionnaire before and after the curriculum, provided a self-report of use of skills learned, and completed a feasibility survey. Faculty also completed a feasibility survey. Results Forty-one of 61 residents (67%) participated in the study. Before participation, the median (interquartile range [IQR]) resident score for confidence in giving advice was 6.0 (4.0-7.0) (on a 10-point scale), increasing to 7.0 (6.0-8.0) for those completing 1 to 3 modules and 8.0 (8.0-9.0) for those completing 4 modules. Median (IQR) score on board-style questions was 8.0 (7.0-9.0) (on a 12-point scale) before participating in the modules and 8.5 (7.5-9.5) for those completing 1 to 3 modules and 9.0 (7.0-9.0) for those completing 4 modules after participation; the increase was not statistically significant. Nine faculty and 29 residents completed the modules and responded to the exit survey regarding feasibility and acceptability of the curriculum. On a 4-point scale (4 being excellent), sessions had an overall mean (SD) rating of 3.7 (0.5) by faculty and 3.5 (0.5) by residents. Most residents (27 [93.1%]) reported interest in more modules, and 28 residents (96.6%) reported using information learned from the modules during clinic visits. Conclusion Confidence delivering parenting advice increased among residents who completed the curriculum modules. Faculty and residents reported high feasibility ratings, and residents endorsed application of skills during clinic visits and interest in more modules.","PeriodicalId":16639,"journal":{"name":"Journal of Osteopathic Medicine Journal of Osteopathic Medicine","volume":"38 1","pages":"748 - 755"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85383149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Osteopathic Manipulative Medicine Considerations in Pelvic Pain","authors":"S. Moloney, J. Talsma, Stacey L. Pierce-Talsma","doi":"10.7556/jaoa.2019.130","DOIUrl":"https://doi.org/10.7556/jaoa.2019.130","url":null,"abstract":"","PeriodicalId":16639,"journal":{"name":"Journal of Osteopathic Medicine Journal of Osteopathic Medicine","volume":"264 1","pages":"e42 - e43"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90644843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hallie Zwibel, Joanne DiFrancisco-Donoghue, A. Defeo, Sheldon C. Yao
Abstract Esports is gaining acceptance in the world of professional, collegiate, and high school athletics. However, there is a lack of information for osteopathic physicians about the health concerns and appropriate treatment of esports athletes. Because of the sedentary nature of the sport and accompanying poor posture, esports athletes are likely to have musculoskeletal injuries of the neck, back, and upper extremities. Additionally, these athletes may have metabolic disturbances resulting from light-emitting diode computer monitors as well as mental health concerns regarding gaming addiction and social behavior disorders. The authors explore the osteopathic physician's role in promoting health and reducing injury in this new gaming phenomenon.
{"title":"An Osteopathic Physician's Approach to the Esports Athlete","authors":"Hallie Zwibel, Joanne DiFrancisco-Donoghue, A. Defeo, Sheldon C. Yao","doi":"10.7556/jaoa.2019.125","DOIUrl":"https://doi.org/10.7556/jaoa.2019.125","url":null,"abstract":"Abstract Esports is gaining acceptance in the world of professional, collegiate, and high school athletics. However, there is a lack of information for osteopathic physicians about the health concerns and appropriate treatment of esports athletes. Because of the sedentary nature of the sport and accompanying poor posture, esports athletes are likely to have musculoskeletal injuries of the neck, back, and upper extremities. Additionally, these athletes may have metabolic disturbances resulting from light-emitting diode computer monitors as well as mental health concerns regarding gaming addiction and social behavior disorders. The authors explore the osteopathic physician's role in promoting health and reducing injury in this new gaming phenomenon.","PeriodicalId":16639,"journal":{"name":"Journal of Osteopathic Medicine Journal of Osteopathic Medicine","volume":"24 1","pages":"756 - 762"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76192803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Submitted February 22, 2019; revision received April 10, 2019; accepted April 15, 2019. A 67-year-old man presented with dyspnea and hemoptysis for 2 days. His medical history included atrial fibrillation, anemia, chronic kidney disease, hypertension, and tobacco and alcohol dependence. Evaluation revealed atrial fibrillation with a rapid ventricular rate and absent breath sounds on the left lung. Computed tomography (CT) demonstrated left pleural effusion with complete atelectasis, opacification of the lung bronchi, and left-to-right mediastinal shift (image A). Echocardiography revealed a 7.8-cm hyperechoic extracardiac mass moving synchronously with the heart. Underfilling of the left ventricle was due to compression of the lateral and inferior ventricular walls (image B, video). Pathologic findings supported a diagnosis of primary metastatic adenocarcinoma of the lung. Pleural effusions and airway patency were managed with a catheter and radiation. Symptoms improved with palliative paclitaxel and carboplatin. Metastases to the heart are much more common than primary cardiac tumors and are generally associated with poor prognosis. Lung carcinoma is the most common cancer to metastasize to the heart and pericardium, and the most involved site is the pericardium. Cardiac metastases are often found in patients with advance stage of disease. The most important goals for management include palliative care and involvement of multidisciplinary teams of specialists. (doi:10.7556/ jaoa.2019.129)
{"title":"Extracardiac Lung Adenocarcinoma","authors":"Faiza Choudhry, Jelena Z Arnautovic","doi":"10.7556/jaoa.2019.129","DOIUrl":"https://doi.org/10.7556/jaoa.2019.129","url":null,"abstract":"Submitted February 22, 2019; revision received April 10, 2019; accepted April 15, 2019. A 67-year-old man presented with dyspnea and hemoptysis for 2 days. His medical history included atrial fibrillation, anemia, chronic kidney disease, hypertension, and tobacco and alcohol dependence. Evaluation revealed atrial fibrillation with a rapid ventricular rate and absent breath sounds on the left lung. Computed tomography (CT) demonstrated left pleural effusion with complete atelectasis, opacification of the lung bronchi, and left-to-right mediastinal shift (image A). Echocardiography revealed a 7.8-cm hyperechoic extracardiac mass moving synchronously with the heart. Underfilling of the left ventricle was due to compression of the lateral and inferior ventricular walls (image B, video). Pathologic findings supported a diagnosis of primary metastatic adenocarcinoma of the lung. Pleural effusions and airway patency were managed with a catheter and radiation. Symptoms improved with palliative paclitaxel and carboplatin. Metastases to the heart are much more common than primary cardiac tumors and are generally associated with poor prognosis. Lung carcinoma is the most common cancer to metastasize to the heart and pericardium, and the most involved site is the pericardium. Cardiac metastases are often found in patients with advance stage of disease. The most important goals for management include palliative care and involvement of multidisciplinary teams of specialists. (doi:10.7556/ jaoa.2019.129)","PeriodicalId":16639,"journal":{"name":"Journal of Osteopathic Medicine Journal of Osteopathic Medicine","volume":"49 1","pages":"772 - 772"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75909101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Pelvic malalignment is a somatic dysfunction that can lead to pelvic discomfort, despite normal genital examination findings. A 3-year-old girl presented with vulvar discomfort after a straddle injury sustained while riding a tricycle. The symptoms persisted despite standard medical treatment for vulvovaginitis and chronic vulvar irritation. An osteopathic structural examination revealed distortions of the bony pelvis, often associated with genitourinary complaints. After 5 osteopathic manipulative treatment sessions, the patient experienced significant relief. With persistent vulvar pain, somatic dysfunction should be considered in the differential diagnosis. A brief musculoskeletal examination of the pubic tubercles, iliac crest, and iliac spines can help to identify somatic dysfunction in a gynecologic patient with symptoms that are unresponsive to standard treatments.
{"title":"Myofascial Release for Vulvar Pain and Pubic Shear After a Straddle Injury in a 3-Year-Old Girl","authors":"Maggie Dade, J. Broecker","doi":"10.7556/jaoa.2019.127","DOIUrl":"https://doi.org/10.7556/jaoa.2019.127","url":null,"abstract":"Abstract Pelvic malalignment is a somatic dysfunction that can lead to pelvic discomfort, despite normal genital examination findings. A 3-year-old girl presented with vulvar discomfort after a straddle injury sustained while riding a tricycle. The symptoms persisted despite standard medical treatment for vulvovaginitis and chronic vulvar irritation. An osteopathic structural examination revealed distortions of the bony pelvis, often associated with genitourinary complaints. After 5 osteopathic manipulative treatment sessions, the patient experienced significant relief. With persistent vulvar pain, somatic dysfunction should be considered in the differential diagnosis. A brief musculoskeletal examination of the pubic tubercles, iliac crest, and iliac spines can help to identify somatic dysfunction in a gynecologic patient with symptoms that are unresponsive to standard treatments.","PeriodicalId":16639,"journal":{"name":"Journal of Osteopathic Medicine Journal of Osteopathic Medicine","volume":"32 1","pages":"768 - 771"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84648089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Abel, P. Renz, S. Hasan, Richard J White, D. Dawodu, R. Wegner, R. Fuhrer
Abstract Prostate-specific antigen (PSA) levels are routinely surveilled after oncologic intervention in patients with prostate cancer. Occasionally, PSA levels are elevated because of factors unrelated to disease recurrence, such as herbal supplement use. False-positive PSA elevations may confound the clinical picture and subsequent decision-making processes, potentially leading to unnecessary diagnostic and therapeutic interventions. In this case report, a patient with low-risk prostate cancer who was treated with low-dose-rate interstitial brachytherapy presented several years after treatment with an erroneously elevated PSA level after taking an herbal supplement. This case highlights the importance of a holistic approach to patient care, whereby tactful assessment of the psychosocial and spiritual aspects of health led to the identification of an uncommon but potentially morbid entity.
{"title":"Alternative Medicine and Oncology: Erroneous Biochemical Failure Following Herbal Supplementation in Early-Stage Prostate Cancer","authors":"S. Abel, P. Renz, S. Hasan, Richard J White, D. Dawodu, R. Wegner, R. Fuhrer","doi":"10.7556/jaoa.2019.126","DOIUrl":"https://doi.org/10.7556/jaoa.2019.126","url":null,"abstract":"Abstract Prostate-specific antigen (PSA) levels are routinely surveilled after oncologic intervention in patients with prostate cancer. Occasionally, PSA levels are elevated because of factors unrelated to disease recurrence, such as herbal supplement use. False-positive PSA elevations may confound the clinical picture and subsequent decision-making processes, potentially leading to unnecessary diagnostic and therapeutic interventions. In this case report, a patient with low-risk prostate cancer who was treated with low-dose-rate interstitial brachytherapy presented several years after treatment with an erroneously elevated PSA level after taking an herbal supplement. This case highlights the importance of a holistic approach to patient care, whereby tactful assessment of the psychosocial and spiritual aspects of health led to the identification of an uncommon but potentially morbid entity.","PeriodicalId":16639,"journal":{"name":"Journal of Osteopathic Medicine Journal of Osteopathic Medicine","volume":"17 1","pages":"763 - 767"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91544442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Context Providing long-acting reversible contraception (LARC; eg, subdermal implants and intrauterine devices [IUDs]) can help mitigate rates of unintended pregnancy because they are the most effective reversible contraceptive methods. However, many varied barriers to LARC placement are reported. Medical education and training can be tailored if there is a better understanding of how barriers predict LARC referral and to predicting LARC placement. Objective To understand how a variety of key barriers to LARC placement are related to one another; to identify which of the barriers, when considered simultaneously, predict LARC referral and LARC placement; and to assess the barriers to LARC placement that persist, even when a major barrier, training, is removed. Methods We recruited providers (obstetricians and gynecologists, family physicians, pediatricians, internal medicine physicians, certified nurse practitioners, and certified nurse midwives) across the state of Ohio. Participants were compensated with a $35 Amazon gift card for completing an online survey comprising 38 Likert-type items, an 11-item knowledge test, LARC placement and referral questions, and demographic questions. We conducted data analyses that included correlations, odds ratios, and independent samples t tests. Results A total of 224 providers participated in the study. Long-acting reversible contraception knowledge, training, and provider concerns were correlated with one another. Training was found to positively predict placement and negatively predict referral when other barriers, such as knowledge and provider concerns, were considered simultaneously. Of providers who were trained to place implants, 18.6% (n=16) said they referred implant placement, and 17.4% (n=15) said they did not place implants. Of providers who were trained to place IUDs, 26.3% (n=26) said they referred IUD placement, and 27.3% (n=27) said they did not place IUDs. Those who referred placement and those who did not place LARCs reported greater barriers (in type and magnitude) to LARC placement than those who did place LARCs. Conclusion(s) Long-acting reversible contraception knowledge, training, and provider concerns about barriers to LARC placement were interdependent. Even when providers were trained to place LARCs, a significant portion referred or did not place them. Efforts to increase LARC placement need to address multifaceted barriers.
{"title":"How Long-Acting Reversible Contraception Knowledge, Training, and Provider Concerns Predict Referrals and Placement","authors":"C. Thompson, J. Broecker, Maggie Dade","doi":"10.7556/jaoa.2019.122","DOIUrl":"https://doi.org/10.7556/jaoa.2019.122","url":null,"abstract":"Abstract Context Providing long-acting reversible contraception (LARC; eg, subdermal implants and intrauterine devices [IUDs]) can help mitigate rates of unintended pregnancy because they are the most effective reversible contraceptive methods. However, many varied barriers to LARC placement are reported. Medical education and training can be tailored if there is a better understanding of how barriers predict LARC referral and to predicting LARC placement. Objective To understand how a variety of key barriers to LARC placement are related to one another; to identify which of the barriers, when considered simultaneously, predict LARC referral and LARC placement; and to assess the barriers to LARC placement that persist, even when a major barrier, training, is removed. Methods We recruited providers (obstetricians and gynecologists, family physicians, pediatricians, internal medicine physicians, certified nurse practitioners, and certified nurse midwives) across the state of Ohio. Participants were compensated with a $35 Amazon gift card for completing an online survey comprising 38 Likert-type items, an 11-item knowledge test, LARC placement and referral questions, and demographic questions. We conducted data analyses that included correlations, odds ratios, and independent samples t tests. Results A total of 224 providers participated in the study. Long-acting reversible contraception knowledge, training, and provider concerns were correlated with one another. Training was found to positively predict placement and negatively predict referral when other barriers, such as knowledge and provider concerns, were considered simultaneously. Of providers who were trained to place implants, 18.6% (n=16) said they referred implant placement, and 17.4% (n=15) said they did not place implants. Of providers who were trained to place IUDs, 26.3% (n=26) said they referred IUD placement, and 27.3% (n=27) said they did not place IUDs. Those who referred placement and those who did not place LARCs reported greater barriers (in type and magnitude) to LARC placement than those who did place LARCs. Conclusion(s) Long-acting reversible contraception knowledge, training, and provider concerns about barriers to LARC placement were interdependent. Even when providers were trained to place LARCs, a significant portion referred or did not place them. Efforts to increase LARC placement need to address multifaceted barriers.","PeriodicalId":16639,"journal":{"name":"Journal of Osteopathic Medicine Journal of Osteopathic Medicine","volume":"47 1","pages":"725 - 734"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78387961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Elaine Lee, S. Moloney, J. Talsma, Stacey L. Pierce-Talsma
Submitted June 6, 2019; accepted August 5, 2019. T ension-type headache (TTH) is estimated to affect 65.6 million people in the United States, exceeding the number of those affected by migraine. It is categorized as episodic, frequent episodic, or chronic, with significant disability and resistance to medical management associated with the latter types. The pain associated with TTH is commonly bilateral and is often described as a dull, band-like sensation around the frontal, temporal, and suboccipital regions of the head; the neck may also be affected. Tension-type headache is most commonly triggered by mental stress and muscle tension, which suggests a mind-body-spirit connection that may be optimally treated with an osteopathic approach. Superficially, the posterior neck is covered in deep cervical fascia. This fascia attaches at the midline to the external occipital protuberance, nuchal ligament, and the seventh cervical spinous process. It then spreads laterally to envelop the trapezius muscle before attaching to the scapula. The deep muscles of the posterior neck include the splenius, iliocostalis, longissimus, semispinalis, and multifidus. As a group, these muscles are extensors and rotators of the head and cervical spine, and they may become hypertonic and overactive in chronic forward-head positions. The suboccipital muscle group comprises the rectus capitis major and minor and the obliquus capitis superior and inferior, attaching to the occiput, atlas, and axis, and it may play a role in headache by exerting tension on the dura mater through myodural bridges. Innervation to the posterior head and neck is provided by the cervical spinal nerves, with a large area of the posterior head receiving its sensory innervation from the greater occipital nerve (dorsal ramus of C2), third occipital nerve (dorsal ramus of C3), and the lesser occipital and great auricular nerve (ventral ramus of C2). The trapezius and semispinalis capitis muscles are pierced by the greater occipital nerve as it courses superiorly to transmit sensory innervation from the posterior scalp. It is postulated that compression of the greater occipital nerve, facilitated by the hypertonic trapezius and semispinalis capitis, causes referred pain to the dura mater by a convergence of afferents from the trigeminal nerve and the greater occipital nerve in the dorsal horn of C2. Sensory innervation to the face occurs primarily via the 3 divisions (ophthalmic, maxillary, and mandibular) of the trigeminal nerve. Although the pathogenesis of TTH is not well understood, current theories implicate cervical myofascial trigger points, forward head posture, restrictions in cervical mobility, and referred pain. Somatic dysfunction of the muscles of the neck or suboccipital region may contribute to headache via tissue texture changes, restriction of motion, referred pain, and tenderness. A review of the literature shows improvement in pain, frequency, and headache disability index scores wi
{"title":"Osteopathic Manipulative Treatment Considerations in Tension-Type Headache","authors":"Elaine Lee, S. Moloney, J. Talsma, Stacey L. Pierce-Talsma","doi":"10.7556/jaoa.2019.096","DOIUrl":"https://doi.org/10.7556/jaoa.2019.096","url":null,"abstract":"Submitted June 6, 2019; accepted August 5, 2019. T ension-type headache (TTH) is estimated to affect 65.6 million people in the United States, exceeding the number of those affected by migraine. It is categorized as episodic, frequent episodic, or chronic, with significant disability and resistance to medical management associated with the latter types. The pain associated with TTH is commonly bilateral and is often described as a dull, band-like sensation around the frontal, temporal, and suboccipital regions of the head; the neck may also be affected. Tension-type headache is most commonly triggered by mental stress and muscle tension, which suggests a mind-body-spirit connection that may be optimally treated with an osteopathic approach. Superficially, the posterior neck is covered in deep cervical fascia. This fascia attaches at the midline to the external occipital protuberance, nuchal ligament, and the seventh cervical spinous process. It then spreads laterally to envelop the trapezius muscle before attaching to the scapula. The deep muscles of the posterior neck include the splenius, iliocostalis, longissimus, semispinalis, and multifidus. As a group, these muscles are extensors and rotators of the head and cervical spine, and they may become hypertonic and overactive in chronic forward-head positions. The suboccipital muscle group comprises the rectus capitis major and minor and the obliquus capitis superior and inferior, attaching to the occiput, atlas, and axis, and it may play a role in headache by exerting tension on the dura mater through myodural bridges. Innervation to the posterior head and neck is provided by the cervical spinal nerves, with a large area of the posterior head receiving its sensory innervation from the greater occipital nerve (dorsal ramus of C2), third occipital nerve (dorsal ramus of C3), and the lesser occipital and great auricular nerve (ventral ramus of C2). The trapezius and semispinalis capitis muscles are pierced by the greater occipital nerve as it courses superiorly to transmit sensory innervation from the posterior scalp. It is postulated that compression of the greater occipital nerve, facilitated by the hypertonic trapezius and semispinalis capitis, causes referred pain to the dura mater by a convergence of afferents from the trigeminal nerve and the greater occipital nerve in the dorsal horn of C2. Sensory innervation to the face occurs primarily via the 3 divisions (ophthalmic, maxillary, and mandibular) of the trigeminal nerve. Although the pathogenesis of TTH is not well understood, current theories implicate cervical myofascial trigger points, forward head posture, restrictions in cervical mobility, and referred pain. Somatic dysfunction of the muscles of the neck or suboccipital region may contribute to headache via tissue texture changes, restriction of motion, referred pain, and tenderness. A review of the literature shows improvement in pain, frequency, and headache disability index scores wi","PeriodicalId":16639,"journal":{"name":"Journal of Osteopathic Medicine Journal of Osteopathic Medicine","volume":"8 1","pages":"e40 - e41"},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91293819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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