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Michigan State University

Osteopathic Recognition Resource Library: Inpatient Medicine

Purpose: to provide links to journal articles that can be used for journal clubs in any specialty to support the milestones for OR.

OMM for Inpatient 1

Case Study

A 68 year-old female with a history of combined-type congestive heart failure is admitted directly from the clinic because of a recent 10-pound weight gain, 2+ bilateral lower extremity edema, and acutely worsening dyspnea.  During her admission exam, she is satting 90% on room air, has rales in the bilateral lung bases, is borderline tachycardic, and her blood pressure is elevated.  She has a negative D-Dimer, her EKG shows no evidence of MI, and her troponins are negative, but her BNP is over 1800.  Your osteopathic exam demonstrates significant TTAs diffusely from T1-6, she has sluggish and shallow rib motion during breathing, a tight left thoracic outlet, and she has assymetrical tightness in the L diaphragm.  In addition to starting oxygen and ordering 40 mg IV Lasix, you release her thoracic outlet and diaphragm and initiate rib raising, pedal and thoracic pumps.  In six hours, having diuresed two liters, she is breathing with little oxygen support and her leg edema is visibly decreased.  
You repeat OMT treatment late that evening and in the next morning. When you check on her again later that day, she is no longer on oxygen, her weight and legs are back to normal, she's participating in PT without dyspnea, and her somatic dysfunctions have resolved almost completely.
Readings (all are in pdf below, except Greenman Ch. 15, which is linked remotely)
  • Foundations Volume 2, Chapter 21 “General Internal Medicine” 
  • Greenman Chapter 8 (Principles of Muscle Energy),15 (Rib Cage Techniques) [This is a very large file (56Mb), and will take a few minutes to download]
  • Henderson AT, Fisher JF, Blair J, Shea C, Li TS, Bridges KG. Effects of rib raising on the autonomic nervous system: a pilot study using noninvasive biomarkers. J Am Osteopath Assoc. 2010 Jun;110(6):324-30. 
  • Johnson SM, Kurtz ME. Conditions and diagnoses for which osteopathic primary care physicians and specialists use osteopathic manipulative treatment. J Am Osteopath Assoc. 2002 Oct;102(10):527-32, 537-40. 
  • Noll DR, BF Degenhardt, TF Morley, FX Blais, KA Hortos, K Hensel, JC Johnson, DJ Pasta, ST Stoll. Efficacy of osteopathic manipulation as an adjunctive treatment for hospitalized patients with pneumonia: a randomized controlled trial. Osteopathic Medicine and Primary Care 2010, 4:2. 
  • Shubrook JH Jr, Dooley J. Effects of a structured curriculum in osteopathic manipulative treatment (OMT) on osteopathic structural examinations and use of OMT for hospitalized patients. J Am Osteopath Assoc. 2000 Sep;100(9):554-8.

Questions for Case 1

1. Which of the following is a correct pairing of non-thrusting osteopathic treatments and their desired effects?

    a. Rib raising articulates each rib to improve rib cage motion and stimulate the parasympathetic chain ganglia.
    b. Suboccipital decompression uses traction to increase flexion at the occipitoatlantal and atlantoaxial joints, improving function by releasing tension around the vagas nerves.
    c. Soft tissue techniques use massage, stretching and kneading to apply direct stimulatory pressure that will relax the musculature.
    d. Pedal pump is used to rock the patient in a superior-inferior motion to stimulate lymphatic drainage.
    e. Doming the diaphragm and thoracic inlet release use rapid removal of the of the hands from the chest during deep inhalation to stimulate lymphatic drainage.
2. According to Noll et al, the results of MOPSE supported which of the following statements regarding the efficacy of OMT in the inpatient setting?
    a. Hospital length of stay increased with the use of OMT.
    b. By PP analysis, the decreased death rate among patients receiving OMT was not statistically significant, because 0.006 is less than 0.05.
    c. Patients receiving OMT required shorter duration antibiotic therapy than patients receiving Conventional Care Only, but required more than those who had sham (Light Touch) therapy.
    d. Patients with Pneumonia, while they reported lower pain levels on a Likert scale, were more likely to die after receiving OMT.
    e. Patients who did not receive OMT were more likely to have poor outcomes, including shorter lengths of stay, shorter intravenous antibiotic courses, and decreased probability of death.

Case 2

Case Study
  • Foundations Volume 2 Chapters 51 "The Abdominal Region", 69 "Visceral Manipulation", 71 "Treatment of the Acutely Ill Hospitalized Patient"
  • Greenman Chapter 10 
  • Kuchera, Osteopathic Considerations for Upper GI Disorders 
  • Knott EM, Tune JD, Stoll ST, Downey HF. Increased lymphatic flow in the thoracic duct during manipulative intervention. J Am Osteopath Assoc. 2005 Oct;105(10):447-56. 
  • Licciardone JC, Gamber RG, Russo DP. Quality of life in referred patients presenting to a specialty clinic for osteopathic manipulative treatment. J Am Osteopath Assoc. 2002 Mar;102(3):151-5. 
  • Pomykala M, McElhinney B, Beck BL, Carreiro JE. Patient perception of osteopathic manipulative treatment in a hospitalized setting: a survey-based study. J Am Osteopath Assoc. 2008 Nov;108(11):665-8. 
  • K Washington, R Mosiello, M Venditto, J Simelaro, P Coughlin, WT Crow, and A Nicholas. Presence of Chapman reflex points in hospitalized patients with pneumonia J Am Osteopath Assoc, Oct 2003; 103: 479 - 483.

Case 3

Case Study


  • Foundations Volume 2, Chapter 60 "Neuromusculoskeletal and Myofascial Release" 
  • Greenman Chapter 11 
  • Crow W.T., L. Gorodinsky. Does osteopathic manipulative treatment (OMT) improve outcomes in patients who develop postoperative ileus: A retrospective chart review. International Journal of Osteopathic Medicine 12 (2009) 32-37. 
  • Danto JB Review of integrated neuromusculoskeletal release and the novel application of a segmental anterior/posterior approach in the thoracic, lumbar, and sacral regions. J Am Osteopath Assoc. 2003 Dec;103(12):583-96. Comment: J Am Osteopath Assoc. 2004 Apr;104(4):146. 
  • Noll DR, Johnson JC, Brooks JE. Revisiting Castlio and Ferris-Swift’s Experiments on Direct Splenic Stimulation in Patients With Acute Infectious Disease. JAOA Vol 108 • No 2 February 2008 71-9. 
  • Radjieski JM, Lumley MA, Cantieri MS. Effect of osteopathic manipulative treatment of length of stay for pancreatitis: a randomized pilot study. J Am Osteopath Assoc. 1998 May;98(5):264-72. 
  • Kate R. Meltzer and Paul R. Standley. Modeled Repetitive Motion Strain and Indirect Osteopathic Manipulative Techniques in Regulation of Human Fibroblast Proliferation and Interleukin Secretion. J Am Osteopath Assoc, Dec 2007; 107: 527 - 536.