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Chicago,Illinois
PastVicePresidentforHealthAffairsandDean UniversityofPikeville,KentuckyCollegeofOsteopathicMedicine Pikeville,Kentucky
RobertoCardarelli,DO,MPH,FAAFP
Professor,InterimChairandDivisionChief FamilyandCommunityMedicine UniversityofKentuckyCollegeofMedicine Lexington,Kentucky
JaneE.Carreiro,DO
Vice-PresidentofHealthAffairsandDean
ProfessorofNeuromusculoskeletalMedicine/OsteopathicManipulativeMedicineandFamilyMedicine CollegeofOsteopathicMedicine UniversityofNewEngland Biddeford,Maine
ConstanceCashen,DO,FACOS
ClinicalAssociateProfessorofGeneralSurgery OhioUniversityHeritageCollegeofOsteopathicMedicine Athens,Ohio
ProgramDirector,GeneralSurgeryResidencyProgram MercyHealthStVincentMedicalCenter ToledoSurgicalAssociates Toledo,Ohio
ThomasACavalieri,DO,FACOI,FACP,AGSF
Dean,OsteopathicHeritageEndowedChairforPrimaryCareResearchandProfessorofMedicine RowanUniversitySchoolofOsteopathicMedicine Stratford,NewJersey
DavidAConnett,DO,FACOFP
Vice-Dean ProfessorofFamilyMedicine CollegeofOsteopathicMedicineofthePacific WesternUniversityofHealthSciences Pomona,California
Chair,CommitteeoftheOsteopathicGraduateMedicalEducationDepartment,AmericanOsteopathicAssociation MihaiCovasa,PhD
AssociateProfessorofPhysiology CollegeofOsteopathicMedicineofthePacific WesternUniversityofHealthSciences Pomona,California
WilliamThomasCrow,DO,FAAO
ProfessorofOsteopathicManipulativeMedicineandFamilyMedicine Director,ResidenciesofFP/NMM,NMM/OMMandPlusOneNMM/OMM UniversityofNorthTexasHealthScienceCenter–TexasCollegeofOsteopathicMedicine Ft.Worth,Texas
GilbertE.D'AlonzoJr,DO
ProfessorofThoracicMedicineandSurgery LewisKatzSchoolofMedicine TempleUniversity
DeputyDirector,DivisionofPulmonaryandCriticalCareMedicine TempleUniversityHospital Philadelphia,Pennsylvania
Editor-in-ChiefEmeritus,JournaloftheAmericanOsteopathicAssociation
BrianDegenhardt,DO
AssistantVicePresidentforOsteopathicResearch Director,CenterofAdvancementofOsteopathicResearchMethodologies(CORM) ATStillResearchInstitute Kirksville,Missouri
WilliamHDevine,DO
DirectorofMedicalEducationandNMMPlusOneResidencyProgram
Director,PostdoctoralOMM ProfessorofOsteopathicManipulativeMedicine ArizonaCollegeofOsteopathicMedicine MidwesternUniversity Glendale,Arizona
DennisJDowling,DO,MA,FAAO
AttendingPhysician
DirectorofManipulativeMedicine PhysicalMedicineandRehabilitationDepartment DepartmentofFamilyMedicine NassauUniversityMedicalCenter EastMeadow,NewYork
DirectorofOsteopathicManipulativeMedicineAssessment Chairman,POCKETProject
TheNationalBoardofOsteopathicMedicalExaminers ClinicalSkillsTestingCenter Conshohocken,Pennsylvania
RobynDreibelbis,DO
AssistantProfessorofFamilyMedicine CollegeofOsteopathicMedicineofthePacific-Northwest WesternUniversityofHealthSciences Lebanon,Oregon
WalterC Ehrenfeuchter,DO,FAAO
ProfessorandChairmanofOsteopathicManipulativeMedicine PhiladelphiaCollegeofOsteopathicMedicine,GeorgiaCampus Suwanee,Georgia
DavidEland,DO,FAAO
ProfessorofOsteopathicManipulativeMedicine HeritageCollegeofOsteopathicMedicine OhioUniversity Athens,Ohio
MitchellLElkiss,DO,FACN,CSPOMM,FAAMA
ClinicalAssistantProfessor
DepartmentofNeurologyandOphthalmology CollegeofOsteopathicMedicine MichiganStateUniversity EastLansing,Michigan
AttendingNeurologist DepartmentofInternalMedicine Providence-StJohnHospital Southfield,Michigan
HughEttlinger,DO,FAAO
ProgramDirector,OsteopathicNeuromusculoskeletalMedicine StBarnabasHospital Bronx,NewYork
AssociateProfessorofOsteopathicManipulativeMedicine CollegeofOsteopathicMedicine NewYorkInstituteofTechnology OldWestbury,NewYork
YadiFernandez-Sweeny,PsyD,MS,CRNA
AssociateProfessor
Chair,DepartmentofBehavioralMedicineandPsychiatry CollegeofOsteopathicMedicineofthePacific WesternUniversityofHealthSciences Pomona,California
JMichaelFinley,DO
AssociateDean,GraduateMedicalEducation
AssociateProfessorofInternalMedicine ChiefAcademicOfficer,OPTI-West CollegeofOsteopathicMedicineofthePacific WesternUniversityofHealthSciences Pomona,California
WilliamFoley,DO,MSc
AssistantProfessor
DepartmentofFamilyMedicine UniversityofMassachusettsMedicalSchool ClinicalInstructor,TuftsSchoolofMedicine Boston,Massachusetts
Founder,BostonOsteopathicHealth Newton,Massachusetts
ChristianFossum,DO
PrincipalatNordicAcademyofOsteopathy Oslo,Norway
MarcelPFraix,DO,MBA,FAAPMR
AssistantDean,StrategicInitiative&PopulationHealth AssociateProfessor
Chair,ClinicalSciencesDepartment
Chair,DepartmentofPhysicalMedicineandRehabilitation CollegeofOsteopathicMedicineofthePacific WesternUniversityofHealthSciences Pomona,California
KathleenGibbons,DO
ChiefResidentforTraditionalRotatingInternshipandMedicalStudentEducation UniversityHospitals,RegionalHospitals RichmondHeights,Ohio
RebeccaEGiusti,DO
AssociateProfessorofNeuromusculoskeletalMedicine/OsteopathicManipulativeMedicineandFamilyMedicine Chair,DepartmentofNeuromusculoskeletalMedicine/OsteopathicManipulativeMedicine CollegeofOsteopathicMedicineofthePacific WesternUniversityofHealthSciences Pomona,California
ThomasGlonek,PhD
ProfessorofOsteopathicManipulativeMedicineattimeofcontribution CollegeofOsteopathicMedicine MidwesternUniversity DownersGrove,Illinois
JohnC.Glover,DO,FAAO
ProfessorofOsteopathicManipulativeMedicine CollegeofOsteopathicMedicine TouroUniversity–California Vallejo,California
ThomasAGoodwin,DO
AdjunctClinicalAssistantProfessor DepartmentofFamilyandCommunityMedicine HomerStryker,MDSchoolofMedicine WesternMichiganUniversity Kalamazoo,Michigan
MarilynRGugliucci,MA,PhD,AGHEF,GSAF,AGSF
ProfessorandDirectorofGeriatricEducationandResearch DepartmentofGeriatricMedicine UniversityofNewEnglandCollegeofOsteopathicMedicine Biddeford,Maine
MaryAnneMorelliHaskell,DO,FACOP
AssociateClinicalProfessorofOsteopathicManipulativeMedicineandPediatrics CollegeofOsteopathicMedicineofthePacific WesternUniversityofHealthSciences Pomona,California Privatepractice Coronado,California
KurtPHeinking,DO,FAAO
ProfessorandChairofOsteopathicManipulativeMedicine ChicagoCollegeofOsteopathicMedicine MidwesternUniversity DownersGrove,Illinois
ScottHelf,DO
AssistantDean,AcademicInformatics ChiefTechnologyOfficer
AssociateProfessorofSocialMedicineandHealthcareLeadership CollegeofOsteopathicMedicineofthePacific WesternUniversityofHealthSciences Pomona,California
JanT.Hendryx,DO,FAAO,FAAMA
ProfessorofFamilyMedicineandOsteopathicPrinciplesandPractice DirectorofIntegrativeMedicine LakeErieCollegeofOsteopathicMedicine Erie,Pennsylvania
KendiHensel,DO,PhD,FAAO
AssociateProfessorofOsteopathicMedicine TexasCollegeofOsteopathicMedicine UniversityofNorthTexasHealthScienceCenter,FortWorth,Texas
AssociateEditor,JournaloftheAmericanOsteopathicAssociation Chair,EducationalCouncilonOsteopathicPrinciples,AACOM President-elect(2018),AmericanAcademyofOsteopathy AmericanOsteopathicAssociationBureauofOsteopathicClinicalEducationandResearch
NatalieHollick,DO
PredoctoralTeachingFellowattimeofcontribution DepartmentofNeuromusculoskeletalMedicine/OsteopathicManipulativeMedicine CollegeofOsteopathicMedicineofthePacific WesternUniversityofHealthSciences Pomona,California
RobertWHostoffer,DO,LhD,FACOP,FAAP,FACOI,FCCP
AssociateProfessor CaseWesternReserveUniversity Cleveland,Ohio
ProgramDirector
ACGME,OsteopathicRecognition,Allergy/ImmunologyFellowship UniversityHospitals,ClevelandMedicalCenter Cleveland,Ohio
ClinicalProfessor HeritageCollegeofOsteopathicMedicine OhioUniversity Athens,Ohio
BoardofTrustees,AmericanOsteopathicAssociation
RaymondJHruby,DO,MS,FAAO(dist)
SeniorConsultantandProfessorofNeuromusculoskeletalMedicine/OsteopathicManipulativeMedicineandFamilyMedicine CollegeofOsteopathicMedicineofthePacific WesternUniversityofHealthSciences Pomona,California
JohnAJerome,PhD
AssociateProfessorofClinicalMedicine MichiganStateUniversityCollegeofOsteopathicMedicine EastLansing,Michigan
ClinicalDirector,PainClinic,PainManagementSpecialists,PLLC Lansing,Michigan
JohnMJonesIII,DO
ProfessorofClinicalMedicine FoundingChair,OsteopathicPrinciplesandPractice WilliamCareyUniversityCollegeofOsteopathicMedicine Hattiesburg,Mississippi
RoseJJulius,DO,MPH,DABAM
DeputyChiefMedicalOfficer
DepartmentofBehavioralHealthandIntellectualdisAbilityServices CommunityBehavioralHealth Philadelphia,Pennsylvania
BrianEKaufman,DO,FACP,FACOI
NewEnglandSportandSpine Wells,Maine MaineGeneralMedicalCenter Manchester,Maine
HollisHKing,DO,PhD,FAAO,ABIHM
ProfessorofFamilyMedicineandPublicHealth SchoolofMedicine UniversityofCaliforniaatSanDiego SanDiego,California
AlbertJKozar,DO,FAOASM,RMSK
AssociateProfessorofSportsMedicineandOsteopathicManipulativeMedicine Director,NeuromusculoskeletalMedicine-OsteopathicManipulativeMedicineResidencyandFellowship EdwardViaCollegeofOsteopathicMedicine Blacksburg,Virginia
SamuelLKrachman,DO
ProfessorofThoracicMedicineandSurgery LewisKatzSchoolofMedicine Director,SleepDisordersCenter,TuberculosisProgram DepartmentofPulmonaryMedicine TempleUniversity Philadelphia,Pennsylvania
MichaelLKuchera,DO,FAAO
ProfessorofOsteopathicManipulativeMedicine CollegeofOsteopathicMedicine MarianUniversity Indianapolis,Indiana
Secretary-GeneralofFédérationInternationaledeMédecineManuelle(FIMM)
StevenLam,DO
AssociateProfessorofFamilyMedicine CollegeofOsteopathicMedicineofthePacific WesternUniversityofHealthSciences Pomona,California
JudithOhLeonor,DO
PredoctoralTeachingFellowattimeofcontribution DepartmentofNeuromusculoskeletalMedicine/OsteopathicManipulativeMedicine CollegeofOsteopathicMedicineofthePacific WesternUniversityofHealthSciences Pomona,California
MartinSLevine,DO,MPH,FACOFP(dist)
InterimClinicalDean
ProfessorofFamilyandCommunityMedicine TouroCollegeofOsteopathicMedicine-Harlem NewYork,NewYork
AlyseFolinoLey,DO
AssociateProfessorofPsychiatry Director PsychiatryResidencyProgram DepartmentofPsychiatry CollegeofHumanMedicine CollegeofOsteopathicMedicine MichiganStateUniversity EastLansing,Michigan
JohnLicciardone,DO,MS,MBA,FACPM
ProfessorandExecutiveDirectoroftheOsteopathicResearchCenter
OsteopathicFoundationRichards-CohenDistinguishedChairinClinicalResearch DepartmentofFamilyMedicine UniversityofNorthTexasHealthScienceCenter–TexasCollegeofOsteopathicMedicine FtWorth,Texas EditorialBoardMember,JournaloftheAmericanOsteopathicAssociation
JamesALipton,DO,CSP-OMM,FAAO,FAAPMR,FAOCPMR
AdjunctClinicalTrackProfessorofPhysicalMedicineandRehabilitationandOsteopathicPrinciplesandPractice EdwardViaCollegeofOsteopathicMedicine Blacksburg,Virginia
KennethLossing,DO
PastPresident,AmericanAcademyofOsteopathy PrivatePractice SanRafael,California
BrianLoveless,DO
AssociateProfessorofNeuromusculoskeletalMedicine/OsteopathicManipulativeMedicineandFamilyMedicine CollegeofOsteopathicMedicineofthePacific WesternUniversityofHealthSciences Pomona,California
JedMagen,DO,MS
AssociateProfessor Chair,DepartmentofPsychiatry CollegeofHumanMedicine CollegeofOsteopathicMedicine MichiganStateUniversity EastLansing,Michigan
MaryAnnMagoun,DO
AssistantProfessorofNeuromusculoskeletalMedicine/OsteopathicManipulativeMedicineandPediatrics CollegeofOsteopathicMedicineofthePacific WesternUniversityofHealthSciences Pomona,California
LukasMartincek,DO
PredoctoralTeachingFellowattimeofcontribution DepartmentofNeuromusculoskeletalMedicine/OsteopathicManipulativeMedicine CollegeofOsteopathicMedicineofthePacific WesternUniversityofHealthSciences Pomona,California
PeterMichaelson,DO,PhD PrivatePractice Sebastian,Florida
MiriamVMills,MD,FAAP
ClinicalProfessorofOsteopathicManipulativeMedicine OklahomaStateUniversityHealthcareCenter CollegeofOsteopathicMedicine OklahomaStateUniversity Tulsa,Oklahoma
KennethENelson,DO,FAAO,FACOFP
ProfessorofOsteopathicManipulativeMedicine,FamilyMedicineandBiochemistry ChicagoCollegeofOsteopathicMedicine MidwesternUniversity DownersGrove,Illinois
NatalieANevins,DO,MSHPE
AssistantDean,ClinicalEducation
AssociateProfessorofNeuromusculoskeletalMedicine/OsteopathicManipulativeMedicineandFamilyMedicine CollegeofOsteopathicMedicineofthePacific WesternUniversityofHealthSciences Pomona,California
KarenJNichols,DO,FACOI
DeanandProfessor DepartmentofInternalMedicine ChicagoCollegeofOsteopathicMedicine MidwesternUniversity DownersGrove,Illinois
ClarenceLNicodemus,DO,PhD
AssociateProfessor
DepartmentofOsteopathicManipulativeMedicine MichiganStateUniversityCollegeofOsteopathicMedicine EastLansing,Michigan
DavidC Nieman,DrPH,MPH
Director,HumanPerformanceLab CollegeofHealthSciences
AppalachianStateUniversityandNorthCarolinaResearchCampus Kannapolis,NorthCarolina
DonaldRNoll,DO,FACOI
ProfessorofInternalMedicineandGeriatrics NewJerseyInstituteforSuccessfulAging RowanSchoolofMedicine Stratford,NewJersey
BobbyBNourani,DO
AssistantProfessorofFamilyMedicineandCommunityHealth SchoolofMedicineandPublicHealth UniversityofWisconsin Madison,Wisconsin
JudithAO’Connell,DO,FAAO,MHA
ClinicalProfessorofOsteopathicManipulativeMedicine HeritageCollegeofOsteopathicMedicine OhioUniversity Athens,Ohio
CEO,PainAlternatives,Inc. Beavercreek,Ohio
MichaelI.Opipari,DO,MACOI
ClinicalProfessorofMedicine
MichiganStateUniversityCollegeofOsteopathicMedicine EastLansing,Michigan AssociateDME
AuthorityHealthGMEConsortium Detroit,Michigan
RobertOrenstein,DO,FACP,FIDSA
AssociateProfessorofMedicine Chair,InfectiousDiseases MayoClinic,Arizona
Editor-in-Chief,AmericanOsteopathicAssociation
GeraldGuyOsborn,DO,MPhil,DFACN,DFAPA
AdjunctProfessorofPsychiatry DeBuskCollegeofOsteopathicMedicine LincolnMemorialUniversity Harrogate,Tennessee
DianePadre,DO
Osteopathicmedicalstudentattimeofcontribution CollegeofOsteopathicMedicineofthePacific WesternUniversityofHealthSciences Pomona,California
MichaelMPatterson,PhD,DO(Hon)
Professor,OsteopathicMedicine(Retired) DrKiranC PatelCollegeofOsteopathicMedicine NovaSoutheasternUniversity FtLauderdale,Florida
AugustineLPerrotta,DO
ClinicalProfessorofMedicine
MichiganStateUniversityCollegeofOsteopathicMedicine EastLansing,Michigan
BarbaraEPeterson,DLitt(Hon)
AmericanAcademyofOsteopathy Evanston,Illinois
KimPfotenhauer,DO
AssistantProfessor DepartmentofFamilyMedicine TouroUniversityCollegeofOsteopathicMedicine Vallejo,California
AndrewJPicca,DO
PredoctoralTeachingFellowattimeofcontribution DepartmentofNeuromusculoskeletalMedicine/OsteopathicManipulativeMedicine CollegeofOsteopathicMedicineofthePacific WesternUniversityofHealthSciences Pomona,California
DavidLRedding,DO
AssociateProfessorofNeuromusculoskeletalMedicine/OsteopathicManipulativeMedicineandFamilyMedicine CollegeofOsteopathicMedicineofthePacific WesternUniversityofHealthSciences Pomona,California
PaulR.Rennie,DO,FAAO
AssociateProfessor
Chair,DepartmentofOsteopathicManipulativeMedicine CollegeofOsteopathicMedicine TouroUniversity–Nevada Henderson,Nevada
FelixJRogers,DO,FACC,FACOI
DownriverCardiologyConsultants,PC Trenton,Michigan
SydneyPRoss,DO
KirksvilleCollegeofOsteopathicMedicine ATStillUniversity Kirksville,Missouri
JesusSanchezJr,DO,MSHPE
AssociateProfessorandVice-ChairofNeuromusculoskeletalMedicine/OsteopathicManipulativeMedicineandFamilyMedicine CollegeofOsteopathicMedicineofthePacific WesternUniversityofHealthSciences Pomona,California
BrentWSanderlin,DO
AssistantProfessor SchoolofOsteopathicMedicine UniversityofIncarnateWord SanAntonio,Texas
StephenMScheinthal,DO,DFACN,DFAPA
ProfessorandChairofPsychiatry SchoolofOsteopathicMedicine RowanUniversity Newark,NewJersey
HowardSchubiner,MD
ClinicalProfessorofInternalMedicine WayneStateUniversitySchoolofMedicine Detroit,Michigan
Director,MindBodyMedicineProgram DepartmentofInternalMedicine ProvidenceHospital
StJohn’sHealthSystemSouthfield,Michigan
MarkSchuenke,PhD
AssociateProfessor DepartmentofAnatomy CollegeofOsteopathicMedicine UniversityofNewEngland Biddeford,Maine
RichardAScott,DO
AssociateClinicalProfessorattimeofcontribution DepartmentofOsteopathicMedicineandOrthopedicSurgery MichiganStateUniversityCollegeofOsteopathicMedicine EastLansing,Michigan
MichaelASeffinger,DO
ProfessorofNeuromusculoskeletalMedicine/OsteopathicManipulativeMedicine CollegeofOsteopathicMedicineofthePacific WesternUniversityofHealthSciences Pomona,California
AssociateEditor,JournaloftheAmericanOsteopathicAssociation
NicetteSergueef,DO(Fr)
AdjunctAssociateProfessor DepartmentofOsteopathicManipulativeMedicine ChicagoCollegeofOsteopathicMedicine MidwesternUniversity DownersGrove,Illinois
HarrietHShaw,DO
ClinicalProfessorofOsteopathicManipulativeMedicine OklahomaStateUniversityCenterforHealthSciences StaffPhysician DepartmentofOsteopathicManipulativeMedicine OklahomaStateUniversityMedicalCenter Tulsa,Oklahoma
MichaelBShaw,DO
AssistantClinicalProfessorofSurgery OklahomaStateUniversity AttendingPhysician DepartmentofEar,Nose,andThroat SouthcrestHospital Tulsa,Oklahoma
AnitaShowalter,DO,FACOOG(dist)
AssociateDeanforClinicalEducation AssociateProfessorandChiefofWomen’sHealth CollegeofOsteopathicMedicine PacificNorthwestUniversityofHealthSciences Yakima,Washington
JayHShubrook,DO,FACOFP,FAAFP
ProfessorofFamilyMedicine DirectorofClinicalResearchandDiabetesServices TouroUniversityCollegeofOsteopathicMedicine Vallejo,California
AssociateEditor,JournaloftheAmericanOsteopathicAssociation BureauofOsteopathicClinicalEducationandResearch,AmericanOsteopathicAssociation
HarveyVSparksJr,MD
ProfessorEmeritus MichiganStateUniversity EastLansing,Michigan
SarahASprafka,PhD
DirectorofPredoctoralEducationattimeofcontribution CollegeofOsteopathicMedicine UniversityofNewEngland Biddeford,Maine
PaulRStandley,PhD
AssociateDean,CurricularAffairsandProgramEvaluation Professor,CollegeofMedicine UniversityofArizona Phoenix,Arizona
KarenMSteele,DO,FAAO
ProfessorEmeritus
WestVirginiaSchoolofOsteopathicMedicine Lewisburg,WestVirginia Founder,OsteopathicTreatmentforChildren Salem,Virginia
GeraldRThrush,PhD
AssociateDean,AcademicAffairs ProfessorofImmunology DepartmentofBasicMedicalSciences CollegeofOsteopathicMedicineofthePacific WesternUniversityofHealthSciences Pomona,California
LexC Towns,PhD
AssistantDeanforAcademicAffairs ProfessorofAnatomy ATStillUniversityofHealthSciences KirksvilleCollegeofOsteopathicMedicine Kirksville,Missouri
DatTrinh,DO
AssociateProfessor Chair,DepartmentofFamilyMedicine CollegeofOsteopathicMedicineofthePacific WesternUniversityofHealthSciences Pomona,California
JeffreyTsai,DO
ResidentPhysicianInternalMedicineResidencyProgram LarkinCommunityHospital PalmSprings,Florida
BethAValashinas,DO,FACOI
LakesidePhysiciansRheumatology Granbury,Texas
KevinD Valvano,DO
VCOM/VTPrimaryCareSportsMedicineFellowattimeofcontribution Instructor,DepartmentofFamilyMedicineandSportsMedicine EdwardViaCollegeofOsteopathicMedicine–VirginiaCampus Blacksburg,Virginia
RichardLVanBuskirk,DO,PhD,FAAO
PrivatePractice
Sarasota,Florida
VishwanathVenketaraman,PhD
AssociateProfessorofMicrobiology/Immunology CollegeofOsteopathicMedicineofthePacific WesternUniversityofHealthSciences Pomona,California
DeborahAWagenaar,DO,MS
AssociateProfessor
Director,MedicalEducationandGeriatricPsychiatryFellowship
DepartmentofPsychiatry MichiganStateUniversity EastLansing,Michigan
ElaineWallace,DO,MS,MS,MS
DeanandProfessor
DrKiranC PatelCollegeofOsteopathicMedicine NovaSoutheasternUniversity FortLauderdale,Florida
MichaelRWells,PhD
AssistantDean
ProfessorofStructuralMedicine CollegeofOsteopathicMedicine RockyVistaUniversity–SouthernUtah Ivins,Utah
JMichaelWieting,DO,MEd,FAOCPMR(dist),FAAOE
SeniorAssociateDean
ProfessorofPhysicalMedicineandRehabilitationandOsteopathicManipulativeMedicine DeBuskCollegeofOsteopathicMedicine LincolnMemorialUniversity Harrogate,Tennessee Chair,BureauofSpecialists,AmericanOsteopathicAssociation
FrankHWillard,PhD
ProfessorofAnatomy DepartmentofAnatomy UniversityofNewEngland CollegeofOsteopathicMedicine Biddeford,Maine
KendallLWilsonJr,DO
ClinicalProfessorofFamilyMedicine WestVirginiaSchoolofOsteopathicMedicine Lewisburg,WestVirginia
ShanShanWu,DO,MS
Allergy/ImmunologyFellow PulmonaryandCriticalMedicine UniversityHospital,ClevelandMedicalCenter Cleveland,Ohio
RobertD Wurster,PhD
ProfessorEmeritusofPhysiology SchoolofMedicine LoyolaUniversityMedicalCenter Maywood,Illinois
RajivLYadava,DO
DesPeresHospital StLouis,Missouri
CHAPTERREVIEWERS MarkSCantieri,DO,FAAO
ClinicalAssistantProfessor CollegeofOsteopathicMedicine MarianUniversity Indianapolis,Indiana
St.JosephRegionalMedicalCenter Mishawaka,Indiana
MemorialHospital SouthBend,Indiana
CEO,CorrectiveCare,PC Mishawaka,Indiana
BoardofTrustees,AmericanOsteopathicAssociation
ChelseaChung,DO
ResidentPhysicianinNeuromusculoskeletalMedicineattimeofcontribution
ChinoValleyMedicalCenter
Chino,California
WesternU-OPTI
CollegeofOsteopathicMedicineofthePacific WesternUniversityofHealthSciences Pomona,California
JayBDanto,DO
AssociateProfessor
Chair,DepartmentofOsteopathicManipulativeMedicine–JoplinCampus KansasCityUniversityofMedicineandBiosciences Joplin,Missouri
DuaneFoley,PhD
ProfessorofPhysiology
CollegeofOsteopathicMedicineofthePacific WesternUniversityofHealthSciences Pomona,California
ThomasFotopoulos,DO
AssociateProfessor
Chair,DepartmentofOsteopathicPrinciplesandPractice ArkansasCollegeofOsteopathicMedicine FortSmith,Arkansas
LisaHodge,PhD
AssociateProfessorofMolecularBiology&Immunology InstituteforCardiovascularandMetabolicDiseases Chair,BasicScienceResearch OsteopathicResearchCenter TexasCollegeofOsteopathicMedicine UniversityofNorthTexasHealthScienceCenter FtWorth,Texas
KayKalousek,DO
ProfessorofFamilyMedicine CollegeofOsteopathicMedicineofthePacific WesternUniversityofHealthSciences Pomona,California
MiklosPeterfy,PhD
ProfessorofBiochemistry CollegeofOsteopathicMedicineofthePacific WesternUniversityofHealthSciences Pomona,California
AdrianaPollak-Lazzaro,DO
AssociateProfessorofFamilyMedicine CollegeofOsteopathicMedicineofthePacific WesternUniversityofHealthSciences Pomona,California
AiraniSathananthan,MD,MSHS,FACE,FACP
AssociateProfessorofInternalMedicine/DivisionofEndocrinology,DiabetesandMetabolism CollegeofOsteopathicMedicineofthePacific WesternUniversityofHealthSciences Pomona,California
DeborahASeffinger,PhD
ClinicalPsychologist,FoundingDirector AdvancedPsychologicalAssociatesandWellnessCenter RanchoCucamonga,California
LiZhong,PhD
AssociateProfessorofPhysiology CollegeofOsteopathicMedicineofthePacific WesternUniversityofHealthSciences
FOREWORD AfterAndrewTaylorStillpassedawayin1917,theAmericanOsteopathicAssociation(AOA)HouseofDelegateswascreatedin1920togovern theprofessionandsetpoliciesfortheAssociationTheypassedaresolutionthattheATStillResearchInstitute,underthedirectionofLouisa Burns,DO,wouldpublishanupdatedversionofthemostpopulartextbookonosteopathicprinciplesinprint,addingcurrentscientificknowledge insupportofthephilosophyThebookwasreviewedbyalltheosteopathiccollegesforinputIn1922,thisconsensus-basedtextbookwas publishedbytheATStillResearchInstituteasarevisededitionoftheclassictextbookbyGD Hulettinitiallywrittenattheturnofthe20th centuryIntheearly1990s,theAOAagainlaunchedanambitioustextbookproject,whichresultedinthefirsteditionofFoundationsof OsteopathicMedicine,publishedin1997Sincethattime,thistextbookanditssecondandthirdeditions(2003and2011)havebeenthe evidence-basedprofession-wideconsensustextbookonosteopathicphilosophy,clinicalapplications,andresearchfortheAmericanosteopathic medicalprofession,andIamproudtohavebeenacontributingauthortothefirsttwoeditionsThis“centennial”fourtheditionwilltakethiseffortto newheights
TheosteopathicprofessionhasbeenthefastestgrowinghealthcareprofessionintheUnitedStatesoverthepasthalfcenturyManybelievedthe mergeroftheCaliforniaOsteopathicAssociationandtheCaliforniaMedicalAssociationintheearly1960sandtheresultinglossofoneofoursix schoolswouldspellthebeginningofthedemiseofosteopathicmedicineasadistinctprofessionInfact,theresultwasjusttheoppositeThe consequencesoftherecognitionofoureducationandtrainingopenedthedoorforatriplingofthenumberofschools,includingtheestablishment ofcollegesofosteopathicmedicineinpublicuniversitiesforthefirsttimeBeginningin1996,anotherperiodofsustainedgrowthbeganthat continuestothisday
Ibelieveourprofessionhasarrivedatanexus;aconvergenceofthreekeydevelopments theastoundinggrowthoftheprofession,the increasedpublicawarenessofosteopathicmedicine,andtheopportunitiesforexpansionofosteopathictrainingproducedbythecreationofa singleaccreditationsystemforgraduatemedicaleducation.DuringmytermasPresidentoftheAOA,Ihadtheopportunitytovisitmanyofthe34 collegesofosteopathicmedicine,nowlocatedon49campusesin32states.Ourstudentshaveanenthusiasmanddesirefortheirosteopathic trainingtocontinuethroughouttheireducationalpathway.ThecodificationofosteopathicprinciplesintheU.S.graduatemedicaleducation accreditationsystempresentsagreateropportunitytoexpandaccesstothattrainingthaneverbeforeandultimatelytoincreaseaccessto osteopathicmedicalcare;whatourpatientswant,whattheydeserve,andwhatallDOsaretrainedtoprovide.Withover100,000livingUSDOs, oneineveryfourmedicalstudentsenrolledinacollegeofosteopathicmedicine,andtheexpansionofosteopathicGraduateMedicalEducation (GME)forbothDOsandMDs,theneedforastandardtextbookonOsteopathicPrinciplesandPractices(OPP)andOsteopathicManipulative Medicine(OMM)hasneverbeengreater
OsteopathicmedicinewasbornanddevelopedinAmericaIntoday’sglobaleconomy,itisexperiencingworldwideexpansionAstheUS osteopathicprofessiontakesaleadershiproleinperson-centeredcare,thisbookwillhelpshapetheeducationthataccompaniesthatgrowthIn myexperienceasacareer-longteacherofOPPandOMM(bothwithinandoutsidetheUnitedStates),apastmemberofEducationalCouncilon OsteopathicPrinciples(ECOP),mentortoAmericanAcademyofOsteopathy(AAO)leaders,Deanofacollegeofosteopathicmedicine,and pastPresidentoftheAOA,Icanattesttothebrightfutureofosteopathicmedicineandtheimportanceofthisprofessionwideconsensustextbook tothatfuturePleaseenjoy!
PastPresident,AmericanOsteopathicAssociation Chicago,Illinois
PastVice-PresidentforHealthAffairsandDean
UniversityofPikeville,KentuckyCollegeofOsteopathicMedicine Pikeville,Kentucky
FOREWORD Tosaytherewouldn’thavebeenanyFoundationofOsteopathicMedicine(FOM)textswithoutHowardM.Levine,DO,probablyisn’thyperbole. Thefirsteditioneditor,RobertWard,DO,wrotethededicationtomyfather“whosevision,support,determination,persistence,andpoliticalskills
havebeeninvaluable”Myfatherthough,understoodheneededotherswiththeexpertisehedidn’tpossessSo,hethankedthepolitical leadership,thefundraisers,theeditor,theAmericanOsteopathicAssociation(AOA)staffwhospecializedineducation,andtheosteopathic physicianswhokeptthebook“osteopathic”Hisvisionwastocreateanauthoritativecomprehensivepublicationthatwouldhelpphysiciansand studentsreferenceallosteopathicphilosophyandpractice
IhavehadthegreatprivilegeofbecominganosteopathicphysicianIhavealsohadtheprivilegeofservingasthe115thPresidentofthe AmericanOsteopathicAssociationDuringtheascenttothatposition,IservedinmanyothercapacitiesWhilemyfatherservedaschairofthe BureauofResearchoftheAOA,hesawtheneedfortheFoundationstextIservedaschairoftheBureauofOsteopathicEducationand Research(BOCER)withMichaelSeffinger,DO(ExecutiveEditorofthisfourthedition)whenhedevelopedtheLowBackGuidelinesthattheAOA publishedintheAgencyforHealthcareResearchandQuality NationalGuidelineClearinghouseThoseAOAguidelinescontinuetoresidethere withalevel1aevidenced-basedgradeTheClinicalAssessmentProgram(CAP)wasledbyfoundingchairoftheBOCERandpastAOA President,GeorgeThomas,DO,developedbyRichardSnow,DO,anddisseminatedbyJosephMcNerney,DO,whileDrSeffingerandI continuedleadingtheBOCERwithSharonMcGill,MPH,AOAstaff
Theimpactofthoseprojectsonimprovingqualityofphilosophyandevidence-basedosteopathiccareandpatientaccesstothatcarewas immeasurableThearticlespublishedfromtheCAPdatademonstratedimprovedpatientoutcomesenoughformultipleinsurerstoincrease paymentstoosteopathicphysicianswhoparticipatedThousandsofpatientsdirectlybenefittedfrombetteroutcomesinalltheosteopathicfamily medicineandinternalmedicineresidencyprogramsthatparticipatedintheCAPprojects
Asanosteopathicfamilyphysicianfor35years,IhavepracticedwhilepreceptingthirdandfourthyearOsteopathicmedicalstudents,thirdyear medicalstudents,andosteopathicfamilymedicineresidentsTheFOMhasbeenagreatresourcethroughoutthattimeforteachingstudents, residents,andpatients,nottoforgetmyselfonosteopathicphilosophyandpracticeMyphilosophyofusingosteopathicmanipulativetreatment (OMT)oneverypatientoneveryvisitcamefrommyfather’sfather-in-law,DavidSteinbaum,DO(KCOM’30),whowasourfamilypatriarch Duringhisfirstnineyearsinpractice,DOswerelimitedtoonlypracticingmanipulationHewasabletobuildastrongpractice,andafterthelaw allowedfullpracticerightstoDOs,hecontinuedtouseOMToneveryoneThatwasthenormwhenmybrotherandIjoinedmygrandfatherand fatherinthatsamepracticeOnerulewasperforminglymphaticthoracicpumponallpatientsgettingimmunizationstoincreasetheirantibody titers
StudentsatourCollegesofOsteopathicMedicinewhileinOsteopathicManipulativeMedicine(OMM)traininglabregularlyaskhowisthis treatmentwe’relearningrelevant?ConstantremindersandreferralstoFoundationsofOsteopathicMedicineforachapterreviewonthesubject andrelevantarticlesintheextensivebibliographies,helpstomotivatethemtopracticetheOMMtechniqueslearnedinlab Iremindeveryonereadingandusingthistextbook,asIhavedonesoduringmypracticepreceptingstudentsandresidents,intheOMMlabasa tabletrainer,andduringeverygraduationspeech,whitecoatceremonyandCMElecture,topracticeuptoyoureducationandtraining.Every patientdeservestoreceiveOMT;weknowtheywillfeelbetterforit,sowhywouldn’tweDOit?PracticeOMT,proveit,publishit,andpromoteit!
Thankyou,Mickey,forthisfourthedition.
MARTINS.LEVINE,DO,MPH,FACOFP(DIST) PastPresident,AmericanOsteopathicAssociationInterimClinicalDean
ProfessorofFamilyandCommunityMedicine
TouroCollegeofOsteopathicMedicine-Harlem NewYork,NewYork
FOREWORD Asosteopathicmedicinehasgrown,andthenumberofnewschoolshasexpandedacrossthenation,theosteopathicprofessionhasstruggled withconsistencybetweenitseducationalinstitutionsThisisexemplifiedintheuniquelyosteopathiccomponentofthemedicalschoolcurriculum, osteopathicmanipulativemedicine(OMM)Someschools,withfacultyhighlyproficientincertainOMMtechniques,orwhohaddevelopedtheir owntechniques,couldfocustheircurriculumontheirpersonalizedapproachFacultyatotherschoolsmaynotbeasfamiliarwiththose techniques,andtherefore,theirstudentsalsowouldcontinuethatlackofexposureTheosteopathicprofessionrecognizedthataminimum commoncurriculumforOMMwasneeded,aswellasaconsensusontheterminologyanddefinitionsused ECOP,theEducationalCouncilonOsteopathicPrinciples,wasfoundedasanindependentorganizationin1969tobegintoaddressthese
concernsECOPjoinedtheAmericanAssociationofCollegesofOsteopathicMedicine(AACOM)in1974asacomponentcouncilThefirst objectivewastheOsteopathicglossary,withitsinitialeditioncompletedin1980
Asthenumberofosteopathicmedicalschoolshascontinuedtogrow,nowtoover40,theneedforconsistencyhasalsogrownThemissionof ECOPhasbeenfour-fold:
Toimprovetheteachingofosteopathicprinciplesandmethodsatosteopathiccollegesandpostgraduatecenters
Toencouragethefreeexchangeofideasandtheirapplicationinclinicaldiagnosisandtreatmentintotalhealthcare
Toencourageresearch,clinicalinvestigation,andeducationalprogramstoimprovetheteachingofosteopathicprinciplesandmethods
Toworktowardestablishingacommonlanguageofcommunicationforintra-professionalandinter-professionalcommunicationof osteopathicprinciplesandmethods
ECOPiscomprisedofarepresentativefromtheOMMdepartmentateachcollegeorschoolofosteopathicmedicineWemeettwiceayearand addressissuesincludingcontinuingrevisionandupdatingoftheGlossaryofOsteopathicterminology,publicationoftheTeachingGuidefor OsteopathicManipulativeMedicine,clarifyingOsteopathictermsintheSNOMEDdatabase,providingtechnicalstandardsforadmission, discussingaccreditationstandards,recommendingtestablematerialtotheNationalBoardofOsteopathicMedicalExaminers(NBOME),and proposingresolutionsfortheAmericanOsteopathicAssociation(AOA)HouseofDelegatesonpositionsintegraltotheuniqueteachingofOMM andOsteopathicPrinciplesandPractices(OPP)
AsECOPhasbecomeamoreorganized,productive,andrepresentativebody,ourproductsbecameatemplateforthisbook,andourmembers contributedassectioneditors,authors,orreviewers,andthestructureofthetexthasbeenpresentedanddiscussedatourmeetingsWesupport FoundationsofOsteopathicMedicine,FourthEdition,beingacollectionofourhistoryandphilosophicalapproachtopatientcareindifferent specialties,includingthefivemodelsofosteopathiccare
Frommyperspective,thistextbookrepresentsthefullspectrumofosteopathicprofessionalactivities,includingthefourpillarsofosteopathic medicine:philosophyandhistory,basicscience,clinicalapplications,andresearchThefoundationalpillarofosteopathicmedicineisits philosophy,whichincorporatesourviewontheinterrelationshipoftheinnermechanismsofthebody,aswellashowthebodyisinterrelatedwith themindandspiritTheseviewsaresupportedbyscientificobservationsAscanbeseeninthebasicscience,clinicalapplications,and researchsectionsofthistextbook,theosteopathicprofessionandosteopathicclinicalpracticestandsolidlyonascientificfoundationThe osteopathicprofessionhascontinuedtobecomemorescientificallyrigorous,usingtheevidencebasetodevelopnationalosteopathicclinical practiceguidelinesforuseofOMTinpatientswithlowbackpain,andincreasingthequalityofpublicationsintheJournaloftheAmerican OsteopathicAssociation
ECOP’sgoalisforthisfourtheditiontocontinuetoservetoincreasetheconsistencyofknowledgeprovidedtoourstudentsandtrulyprovidetheir osteopathicfoundation.WehavebeenproudtopartnerwithDr.Seffingertobringthiseditiontofruition.
KENDIHENSEL,DO,PHD,FAAO AssociateProfessor
DepartmentofOsteopathicMedicine
TexasCollegeofOsteopathicMedicine
AssociateEditor,JournaloftheAmericanOsteopathicAssociation Chair,EducationalCouncilonOsteopathicPrinciples,AACOM President-elect(2018),AmericanAcademyofOsteopathy
FOREWORD AsEditor-in-ChiefoftheAmericanOsteopathicAssociation,IhavethepleasuretointroducethisnewfourtheditionoftheFoundationsof OsteopathicMedicine.Thisfourtheditionisacollaborativeeffortofadiversegroupofbasicscienceandclinicalfacultyrepresentingseveral collegesofosteopathicmedicineandscholarlyclinicians,reflectingtheosteopathicprofession’scommitmenttoadvancingtheevidenceforour uniquecontributiontothehealthcaresystem.Thiscontemporarytext,editedbyDr.MichaelSeffinger,leadsthereaderonajourneythrough osteopathicmedicine,beginningwithitshistoricalandphilosophicalfoundation,throughitsscientificbasisanditsclinicalapplications.Unlike mosttextbooksofmedicine,thisoneisunique,approachingthemanagementofhealthanddiseasefromanosteopathicperspectiveItcanbe usedasareferencetextforstudentsofosteopathicmedicineorasapracticaltooltoteachtraineesintheclinicThebookcontainssectionson
uniqueareassuchasbiopsychosocial,lifestyle,andmusculoskeletalmedicineItpresentsandhighlightsresearchopportunitiesneededtogrow theprofessioninthenextdecadeAsourprofessionexpands,thistextprovidesthefoundationforDOsandnon-DOsinterestedinlearningthe toolsofosteopathicmedicine
ROBERTORENSTEIN,DO,FACP,FIDSA AssociateProfessorofMedicine Chair,InfectiousDiseases
MayoClinic,Arizona
Editor-in-Chief,AmericanOsteopathicAssociation
PREFACE TheFoundationsofOsteopathicMedicinetextbookrepresentsthecollectivevoiceoftheosteopathicprofession,foundedbyA.T.Still,MD,DO in1892.Ithasbeenover100yearssincethepassingofDr.Still,aneventthatforcedtheprofessiontodetermineitsowndestinywithoutits founderatthehelm.In1922,theosteopathicprofessionpublisheditsfirstnation-wideconsensus-basedtextbooktofirmly,andinwriting, establishthephilosophyoftheprofessionanddelineateitsup-to-datebasicsciencefoundationThistraditionwascarriedforwardinthefirstand successiveeditionsofthistextbookInitiatedbyaninformalproposalforanupdatedtextbook40yearsagobytheEducationalCouncilon OsteopathicPrinciples(ECOP),theprojectwasdirectedtowarddevelopmentofalongitudinalcurriculuminOsteopathicPrinciplesandPractice (OPP)Similartothe1922textbook,calledHulett’sPrinciples,whichwaseditedandupdatedbytheAmericanOsteopathicAssociation(AOA) ATStillResearchInstitute,theconceptandplanforthistextweredevelopedwithintheAOABureauofResearchItwastheBureau’sdecision totermthisactivitythe“OsteopathicPrinciplesTextbookProject”TheBoardofTrusteesandHouseofDelegatesoftheAOAprovidedfinancial supportforitsdevelopment,andtheprojectwaslaunchedinJuly1990UnderthepioneeringleadershipofExecutiveEditorRobertC Ward,DO, FAAO,thefirstandsecondeditionsofthistextappearedin1997and2003,respectivelyAnthonyGChila,DO,FAAO(dist),FCA,assumedthe roleofExecutiveEditorforthethirdeditionin2006anddidamasterfuljobatrestructuringtheentiretexttowardclinicalapplicationsto demonstratetheosteopathicthoughtprocessinpracticewhilecaringforpatients
IhavebeenassociatedwiththistextbookprojectsinceitsinitialoutlinewithinECOPin1984IworkedwithDrWardsincethattimeuntilhe handedoverthereinstoDrChila,thencontinuedasAssociateEditorandauthorunderDrChilaTheprocessofreviewandrevisionhasalways beencarriedoutinacarefulandthoughtfulmannerEacheditionincludednewandupdatedchapters,withalternatingfocusonspecialtyor population-basedpatientcarethencase-basedpatientcareReviewersofpreviouseditionsfavoredablendingofbothspecialty/populationand case-basedpatientcareexamplesofclinicalapplicationsofosteopathicprinciplesandpractices,whichledtothecombinedformatmakingup thefourtheditionAdditionally,colorphotosandillustrationsalongwithreformattingofthecontentwasundertakentofacilitateclarity,easeof reading,teaching,andlearningAsinpreviouseditions,recognitionisgiventoaddressingtheneedsofosteopathicmedicalstudentsand physicians,includingresidentsintrainingOtherhealthprofessionalswillalsofindthistextfoundational,wellreferenced,andclinicallyuseful However,themainaudienceforthetextbookremainsthefirstandsecondyearosteopathicmedicalstudentTheformatchosenemphasizesthe uniqueosteopathicapproachtothepatientsuchthatthereadercangraspthemeaningoftheterm“thinkingosteopathically”Theorganizationof thetextisgiveninthefollowingoverview
PARTI:FOUNDATIONS Section1:PhilosophyandHistoryofOsteopathicMedicine ThefirstchaptersetsthecornerstoneofthefoundationasitoutlinesosteopathicphilosophyasoriginallyespousedbyitsiconicfounderATStill, MD,DO,andexploresitsevolutionintoitscurrentdayexpressionTheroleoftheECOPindevelopingTheFiveModelsofOsteopathicCareis introducedandfurtherexpoundedinChapter23Thefivemodels(Biomechanical;Respiratory-Circulatory;Metabolic;Neurological;Behavioral) aredescribedinrelationtothethreestandardcomponentsofaphilosophyofmedicine(Health,Disease,PatientCare)Theexplicationof osteopathicphilosophybytherespectedscientistIrvinMKorr,PhD,ispreservedfromthefirstedition
Thehistorychapterhasbeenupdatedtoincludeeventsthathaveoccurredinthefirsttwodecadesofthe21stcenturyItpresentsthehistoryofthe osteopathicprofessionfromDrStilltoitsnationalandinternationalstatustodayItisorganizedintermsoftheprofession’sgrowthand developmentinthedomainsofpre-andpostdoctoraleducation,research,networking,statelicensureandregulation,diversity,specialtiesand hospitals,andinternationalexpansion
Section2:BasicSciences Thefivemodelsofpatientdiagnosis,treatment,andmanagementfrequentlyusedbyosteopathicphysiciansprovidethebackgroundforthis sectionChapters3–6constitutethebasicsciencefoundationfortheStructural/BiomechanicalModel;Chapters7–9,theRespiratory-Circulatory Model;Chapters10–14,theNeurologicalModel;Chapters15–17theMetabolicModel;andChapters18–20theBehavioralModelSeveralnew chaptershavebeenaddedthatarestateoftheartandtimely:TheRoleofInflammationinHealingandHomeostasis;Symbiosis:Ecologyofthe HumanMicrobiome;EnergyBalance:NutritionandExercise;andLifestyleMedicineInaddition,moreembryologyhasbeenaddedtothe anatomychapter
PARTII:THEOSTEOPATHICAPPROACHTOTHEPATIENT Thesechaptersfocusontheosteopathicapproachtopatientevaluation,diagnosisandtreatment,thatemphasizesapatientcentered,healthorientedphilosophy,andcompassionate,hands-oncareuniquetothisprofessionTheOsteopathicHistoryandPhysicalExaminationchapter combineselementsoftraditionalphysicalexaminationprocedureswithuniquelyosteopathicpalpatorydiagnosisofthemusculoskeletalsystem TheFiveModelsofOsteopathicPatientCareiselaboratedupontosetthestagefortheclinicalapplicationsinthelatterhalfofthetextbookThe intentofthechaptersinsectionsoneandtwoistodescribewhatismeantby“thinkingosteopathically,”throughbasicconstructs,examples,and casevignettes
PARTIII:APPROACHTOTHESOMATICCOMPONENT Theosteopathicstructuralexaminationisdetailedinthispart,aswellasregionalanatomyasabasisforunderstandingsomaticdysfunction Palpation,ScreeningExamination,SegmentalMotionTesting,andPosturalConsiderationscontinuetodefinefundamentalapproachesto patientassessment
NewchaptershavebeenaddedonInternalOrganAssessmentforVisceralMotionDysfunction;AssessingViscero-SomaticReflexesand Somato-SomaticReflexes,JonesTenderpoints,TriggerPointsandChapmanReflexes;andTheOsteopathicManipulativeTreatment
PrescriptionOsteopathicmanipulativetreatmentproceduresthataretaughtatallAmericanosteopathiccollegesasrecommendedbyECOP aredescribedfirst,followedbyothercontemporaryapproachesasexamplesofthewiderangeofOMTusedaroundthecountryAchapteron DynamicStrainwasadded,andtheFunctionalTechniquechapterwasrewritten
PARTIV:OSTEOPATHICCONSIDERATIONSINTHESPECIALTIES —POPULATIONMANAGEMENT ThechaptersinthissectioncombinetheclinicalapplicationsofosteopathicphilosophyandprinciplesthatwereintroducedinFOM2eand FOM3eusingbothspecialty/populationandcase-basedformatsOsteopathicconsiderationsinthespecialtyfieldsofOsteopathic NeuromusculoskeletalMedicine,PrimaryCare(FamilyMedicine,Pediatrics,GeneralInternalMedicineandGeriatrics),InternalMedicine Subspecialties(Rheumatology,CardiovascularMedicine,Pulmonology,Neurology,Oncology,andEndocrinology),PhysicalMedicineand Rehabilitation,Psychiatry,EndofLifeCare,ObstetricsandGynecology,Surgery(HEENT,Orthopedics,Generalsurgery)andSportsMedicine havebeenupdatedandreformatted
PARTV.RESEARCHINVESTIGATINGOSTEOPATHICPRINCIPLES Newlywrittenand‘stateofthescience’chaptersinResearchMethodsandEvidenceRelatingtoOsteopathicManipulativeTreatment,Efficacy andSafetyofOsteopathicManipulativeTreatment,andStrategicPlanforResearchonOsteopathicPrinciplesandPracticeshavebeenaddedto thisFOM4e
Overall,thefourtheditionofFOMhasbeencraftedwiththeexpressgoalofrevealingandexplainingthefoundationsofosteopathicmedicinefor facultyattheCollegesofOsteopathicMedicine,osteopathicmedicalstudents,osteopathicphysiciansinpostdoctoraltrainingprogramsandin practice,aswellasotherhealthcareprofessionalsthatareinterestedinunderstandingand/ordevelopinganosteopathicapproachtopatient care
MICHAELA.SEFFINGER,DO ExecutiveEditor
ACKNOWLEDGMENTS Iwasencouragedtostepuptothechallengeofrevisingthisprofession-widestandardtextbookbyrecommendationsandformalendorsements fromtheAmericanOsteopathicAssociation,AmericanAssociationofCollegesofOsteopathicMedicine(ECOP),theAmericanAcademyof Osteopathyand,mostinfluentially,theDeanoftheCollegeofOsteopathicMedicineatWesternUniversityofHealthSciences,PaulaMCrone, DOForthistremendousprofession-widesupportandtrust,Iamdeeplyhumbledandgrateful
ThisprojectcouldnothavebeencompletedwithoutDeanCrone’ssupportintheformofhercommitmenttoitscompletionandgenerous allocationoffacultyandstudenttimeandeffortoverthecourseofthreeyears(2015–2018)Overfortymembersofhercollegeparticipatedin variouscapacitiestobringthisprojecttofruitionSheisdirectlyresponsibleforspearheadingthelifestylemedicineprogramathercollegeunder theappointedleadershipofDrsRobynDreibelbisandMarcelFraix,whowereinstrumentalindevelopingthisnewsectionofFOM4eDean CronealsopromisedmywifethatIcouldworkonthetextbookaspartofmycontractattheCollegeofOsteopathicMedicineofthePacificat WesternUniversityofHealthSciencesandnotexpectorpressuremetoworkonitatnightoronweekendswhileattendingtofamilyduties
TheresearchassistantsintheDepartmentofNeuromusculoskeletalMedicine/OsteopathicManipulativeMedicinewerealsoindispensableat reformattingtheentiretextbooktocurrentstylesrecommendedbythepublisherandreviewersofpastvolumes
TheworkinvolvedinpreparationofthisfourtheditionwasadedicatedeffortbymanyindividualsfromallcornersoftheUnitedStatesofAmerica. Inaccomplishingtheirvarioustasks,allcontributedtoacohesiveproductrepresentinganotherlevelofdevelopmentforthistext.Grateful appreciationisextendedtothefollowing:
SectionEditors RayJHruby,DO,MS,FAAO(dist)
FrankHWillard,PhD
JohnLicciardone,DO,MS,MBA
TheartworkofWilliamAKuchera,DO,FAAO
EducationalCouncilonOsteopathicPrinciples(ECOP) ThisCounciloftheAmericanAssociationofCollegesofOsteopathicMedicine(AACOM)iscomprisedoftheDepartmentalChairpersons,or theirdesignees,responsiblefordeliveringthepartoftheosteopathicmedicalschoolcurriculumatthevariousCollegesofOsteopathicMedicine thatfocusesonosteopathicphilosophy,principlesandpractices,osteopathicpalpatorydiagnosis,andosteopathicmanipulativetreatment (OMT)Duringtheyears2013–2015,theFOMtextbookreviewcommitteeevaluatedandofferedrecommendationsforimprovementthatwere instrumentalindevelopingthefourtheditionTheexecutiveeditorupdatedECOPattheirsemiannualmeetingsduringthecourseofproductionof thisedition,andregularlyansweredquestionsandmaintainedcontinuousopencommunicationwithcouncilmembers,severalofwhomare chapterauthorsDuringthelifeoftheproject,atdifferenttimes,membersofECOPwerepresentedmaterialinpreparationandaskedfortheir commentandcritique.SpecialthanksforherinitiativeandleadershipinthisactivityisgiventoKendiHensel,DO,PhD,chairofECOP.
TheAmericanOsteopathicAssociation AdrienneWhite-Faines,ChiefExecutiveOfficer,AmericanOsteopathicAssociation
RobertOrenstein,DO,Editor-in-Chief,Publications,AmericanOsteopathicAssociation
CharlieSimpson,SeniorVice-President,ChiefCommunicationsOfficer,AmericanOsteopathicAssociation ContributorsandReviewers
ThistextbookrepresentsthebestofosteopathicmedicinescholarshipTheauthorsandreviewerswhocontributedtotheFoundationsof OsteopathicMedicinetextbookprojectoverthelastthreedecadesarewellknownandrespectedleaders,teachers,androlemodelsforthe osteopathicprofessionTheyofferedtheirtime,talent,expertise,andwisdomtothenextgenerationofosteopathicphysiciansandtothosewho aspiretounderstandandincorporateosteopathicphilosophy,principles,andpracticesintotheirapproachtopatientsofallagesandinalltypes ofclinicalscenariosCollectively,theypracticeosteopathicmedicineinallpartsoftheUnitedStatesandrepresentnumerousosteopathic institutionsandcollegesSeveraldevotetheireffortstotheAmericanOsteopathicAssociationintheformofparticipationontheBoardof Trustees,oneofitsBureaus,oraseditorsfortheJournaloftheAmericanOsteopathicAssociationTheymadethistextbookstateoftheartand scienceofosteopathicmedicineContributionstotheartworkandphotoscamefromseveralcollegesofosteopathicmedicineacrossthe countryAppreciationisextendedtotheauthors,theirpatients,andosteopathicmedicalstudentsatseveralcollegesofosteopathicmedicine acrossthecountrywhocontributedillustrationsandphotosSpecialappreciationisextendedtoTSMagoun,NajiMuwanas,andOranSutawho producednewillustrations;andEmilyBauer,MarinelleCamilon,JaredCox,BrittanyFernandez,RebeccaGiusti,ElanGreen,Mirza Hasanefendic,KimHecht,KyleHomertgen,RayHruby,BrianJohnson,JordonJohnstone,BrianLoveless,NimaJahanforouz,MaryAnnMagoun, AllenMcGrew,NatalieNevins,AnnNguyen,LukeRauch,TayaRoberts,SarahStrube,AndrewSumida,DallinTonks,LaurenVanWoy,Micah Wittler,andElaineYuwhocreatednewphotosforthisedition
SpecialThanks Iamdeeplygratefulforthelovingsupportfrommywife,Deborah(alsoknownasesteemedclinicalpsychologist“DrDebb”)Sheagreedto supportmycontractswiththepublisherandmydeanontheconditionImindmyfamilyresponsibilities(9children,17grandchildren,elderly
parents,andmycommitmenttoher),continuewithregularexercise,andmaintainahealthybalancedlifestyle(“youcan’twriteaboutitandnotlive it”)Shecarriedouthercommitmenttomethroughoutthisprojectwithunerringconsistencyanddevotion
CONTENTS Contributors■Foreword■Preface
Acknowledgments
PARTONE:FOUNDATIONS
MichaelA.Seffinger
SECTIONI:PHILOSOPHYANDHISTORYOFOSTEOPATHICMEDICINE
MichaelA.Seffinger
1.PhilosophyofOsteopathicMedicine
MichaelASeffinger,RaymondJHruby,FelixJRogers,FrankHWillard,JohnLicciardone,JohnMJonesIII,HollisHKing
2.HistoryoftheOsteopathicProfession
JohnMJonesIII,BarbaraEPeterson
SECTIONII:BASICSCIENCEFOUNDATIONS
FrankHWillardandMichaelASeffinger
BIOMECHANICALMODEL
3.Anatomy:GeneralandEmbryologicalConcepts
MarkSchuenke,LexC Towns,FrankHWillard
4TheFascialSystemoftheBody
FrankHWillard,ChristianFossum,PaulRStandley
5.Biomechanics
MichaelRWells,ClarenceLNicodemus
6InherentMotion,Rhythms,andOscillations
ThomasGlonek,NicetteSergueef,KennethENelson RESPIRATORY-CIRCULATORYMODEL
7.TissueRespirationandCirculation
HarveyV.SparksJr
8AnatomyandPhysiologyoftheLymphaticSystem
HughEttlinger,FrankHWillard
9.Anatomy,Mechanics,andPhysiologyofPulmonaryRespiration
FrankH.Willard,GilbertE.D’AlonzoJr,SamuelL.Krachman
NEUROLOGICALMODEL
10AutonomicNervousSystem
FrankHWillard,ArtworkbyWilliamAKuchera
11.NociceptionandPain
FrankHWillard,JohnAJerome,MitchellLElkiss
12.SomaticDysfunction,SpinalFacilitation,andViscerosomaticIntegration
MichaelMPatterson,RobertD Wurster
13.ThePhysiologyofTouch
FrankHWillard,JohnAJerome,MitchellLElkiss
14.ChronicPainManagement
MitchellLElkiss,JohnAJerome METABOLICMODEL
15TheRoleofInflammationinHealingandHomeostasis
GeraldRThrush
16.Symbiosis:EcologyoftheHumanMicrobiome
RobertOrenstein,MihaiCovasa,VishwanathVenketaraman
17EnergyBalance:Nutrition,ExerciseandTheMetabolicModel
MarcelPFraix,DavidC Nieman,RobynDreibelbis,RebeccaEGiusti
BEHAVIORALMODEL
18.BehavioralScience
A.Psychoneuroimmunology:BasicMechanisms
YadiFernandez-Sweeny,DavidABaron,RoseJJulius,FrankHWillard
B.LifeStages
YadiFernandez-Sweeny,JedMagen,AlyseFolinoLey,DeborahAWagenaar,SteveMScheinthal
19.BehavioralMedicine
AMind-BodyMedicine
YadiFernandez-Sweeny,HowardSchubiner
B.StressManagement
YadiFernandez-Sweeny,JohnAJerome,GeraldGuyOsborn
CSpiritualityandHealthCare
YadiFernandez-Sweeny,FelixJRogers
20.LifestyleMedicine
ALifestyleMedicine OsteopathicPerspectives
MarcelPFraix,DavidC Nieman,RebeccaEGiusti
B.EnvironmentalIssues
NatalieANevins
PARTTWO:THEPATIENTENCOUNTER
MichaelASeffinger
SECTIONI:THEOSTEOPATHICAPPROACHTOPATIENTCARE
MichaelASeffinger
21.TheOsteopathicPhysician–PatientRelationship
StevenLam,DatTrinh,DavidLRedding
22.OsteopathicHistoryandPhysicalExamination
JaniceUBlumer,RebeccaEGiusti,RaymondJHruby
23.TheFiveModelsofOsteopathicPatientCare
MichaelASeffinger,EdwinAmirianfar,MichaelLKuchera,JohnJerome
SECTIONII:DEVELOPINGANOSTEOPATHICMANAGEMENTPLAN
MichaelASeffinger
24.OsteopathicCase-BasedLearning,Problem-Solving,andEvidence-BasedMedicine
MichaelASeffinger
AAnOsteopathicApproachtoCase-basedLearning
NatalieANevins,ScottHelf,DianePadre,MatthewAlbright
B.ClinicalProblem-solving
SarahASprafka
CEvidence-basedMedicine
RobertoCardarelliandBrentWSanderlin
PARTTHREE:THESOMATICCOMPONENT
RaymondJHruby
SECTIONI:OSTEOPATHICSTRUCTURALEXAMINATION–IDENTIFYINGSOMATICDYSFUNCTION
RaymondJ.Hruby
25PalpatoryExaminationSkillsandExercisesforDevelopingtheSenseofTouch
WalterC Ehrenfeuchter
26.ScreeningandRegionalOsteopathicStructuralExaminations
WalterC Eherenfeuchter,RaymondJHruby,RebeccaEGiusti
27OsteopathicSegmentalExamination
WalterC Ehrenfeuchter,RaymondJHruby
SECTIONII:REGIONALANATOMICALBASISFORSOMATICDSYFUNCTION
RaymondJHruby
28DescriptiveandFunctionalRegionalAnatomy
KurtPHeinking,RaymondJHruby,MichaelLKuchera
A.HeadRegion
KurtPHeinking
BCervicalRegion
KurtPHeinking
C.ThoracicRegion
RaymondJHruby
DRibCage
RaymondJHruby
E.LumbarRegion
KurtPHeinking
FPelvis
KurtPHeinking
G.UpperExtremity
KurtP.Heinking
HLowerExtremity
MichaelLKuchera
I.AbdominalRegion
RaymondJHruby
29.PosturalConsiderationsinOsteopathicDiagnosisandTreatment
MichaelLKuchera
SECTIONIII:VISCERALANDSOMATICINTERRELATIONSHIPSINSOMATICDYSFUNCTION
MichaelASeffinger
30.InternalOrganAssessmentforVisceralMotionDysfunction
KennethLossing,RebeccaEGiusti
31.AssessingforViscerosomaticReflexesandSomatosomaticReflexes,JonesTenderPoints,TriggerPoints,andChapman Reflexes
MichaelLKuchera,HughEttlinger,MichaelASeffinger
SECTIONIV:TREATINGSOMATICDYSFUNCTIONWITHOSTEOPATHICMANIPULATIVETREATMENT
RaymondJHruby
32.TheOsteopathicManipulativeTreatmentPrescription
RaymondJHruby
SECTIONIVA:EDUCATIONALCOUNCILONOSTEOPATHICPRINCIPLESOSTEOPATHICMANIPULATIVETREATMENTMODULES
RaymondJHruby
33.SoftTissue
WalterC Ehrenfeuchter
34MuscleEnergy
WalterC Ehrenfeuchter
35.High-VelocityLow-Amplitude(HVLA)Thrust
RebeccaE.Giusti,RaymondJ.Hruby
36MyofascialRelease
JudithAO’Connell
37.Strain/Counterstrain
JohnC Glover,PaulRRennieIllustrationsByWilliamAKuchera
38.OsteopathicCranialManipulativeMedicine
HollisHKing
39LymphaticDrainageProcedures
MichaelLKuchera,ElaineWallace
SECTIONIVB:EXAMPLESOFOTHERCONTEMPORARYOSTEOPATHICMANIPULATIVETREATMENTMETHODS
RaymondJHruby
40.AdditionalOsteopathicManipulativeTreatmentApproaches
A.AcutelyIllorHospitalizedPatients;OsteopathicConsiderationsandApproachesUsingOMT HughEttlinger
B.ArticulatoryProcedures
WalterC Ehrenfeuchter
C.(A.T.)StillTechnique
RichardLVanBuskirk
DBalancedLigamentousTensionandLigamentousArticulatoryStrain
WilliamThomasCrow
E.AModernApproachtoChapmanReflexPoints
ChristianFossum,MichaelLKuchera,WilliamHDevine,KendallLWilsonJr
FDynamicStrain
JanTHendryx
G.FacilitatedPositionalRelease
DennisJDowling
H.FulfordPercussion
RajivLYadava
I.FunctionalTechnique
DavidEland
JProgressiveInhibitionofNeuromuscularStructures(PINS)
DennisJDowling
K.VisceralManipulation
KennethLossing
PARTFOUR:OSTEOPATHICCONSIDERATIONSINTHESPECIALTIES POPULATIONMANAGEMENT
MichaelA.Seffinger
41OsteopathicConsiderationsinNeuromusculoskeletalMedicine
A.OsteopathicNeuromusculoskeletalMedicine
BrianLoveless,RaymondJHruby,NatalieANevins
B.DiagnosisandTreatmentofSomaticDysfunctioninthePatientwithLowBackPain
KurtPHeinking,MichaelLKuchera
42OsteopathicConsiderationsinPrimaryCare
JayHShubrook,KimPfotenhauer
A.OsteopathicConsiderationsinFamilyMedicine
JayHShubrook,KimPfotenhauer,MichaelASeffinger,JesusSanchezJr,MarcelPFraix,PeterMichaelson BOsteopathicConsiderationsinPediatrics
MaryAnnMagoun,AndrewJPicca,JudithOhLeonor,NatalieHollick,LukasMartincek,KarenMSteele,MiriamVMills,MaryAnneMorelli Haskell,JesusSanchezJr
C.OsteopathicConsiderationsinGeneralInternalMedicine
DonaldRNoll,BrianEKaufman
DOsteopathicConsiderationsinGeriatricMedicine
DonaldRNoll,ThomasACavalieri,BruceBates,MarilynRGugliucci,JeffreyTsai
43.OsteopathicConsiderationsinInternalMedicineSubspecialties
FelixJ.Rogers
AOsteopathicConsiderationsinRheumatology
JMichaelFinley,JMichaelWieting,WilliamFoley,KurtPHeinking,JamesLipton,BethAValashinas
B.OsteopathicConsiderationsinCardiovascularMedicine
FelixJ.Rogers
C.OsteopathicConsiderationsinPulmonology
GilbertED’AlonzoJr,SamuaelLKrachman,WilliamFoley,HughEttlinger,JaneECarreiro
D.OsteopathicConsiderationsinNeurology
MitchellLElkiss,KurtPHeinking,RaymondJHruby,MarcelPFraix,RebeccaEGiusti
E.OsteopathicConsiderationsinOncology
MichaelIOpipari,AugustineLPerrotta,DavidRBeatty
FOsteopathicConsiderationsinEndocrinology
MichaelASeffinger
44.OsteopathicConsiderationsinPhysicalMedicineandRehabilitation
MarcelPFraix,JMichaelWieting,JamesALipton
45OsteopathicConsiderationsinPsychiatry
TimothyEBlumer
46.OsteopathicConsiderationsinEnd-of-LifeCare
KarenJNichols
47OsteopathicConsiderationsinObstetricsandGynecology
A.Obstetrics
AnitaShowalter
B.Gynecology
AnitaShowalter
48.OsteopathicConsiderationsinSurgery
A.OsteopathicConsiderationsinPatientswithHead,Eyes,Ears,Nose,andThroatDisorders
ShanShanWu,RobertWHostoffer,KathleenGibbons,HarrietHShaw,MichaelBShaw BOsteopathicConsiderationsinOrthopedics
RichardAScott,KurtPHeinking,MichaelLKuchera
C.OsteopathicConsiderationsinGeneralSurgery ConstanceCashen,SydneyPRoss,ChristinaBohr
49OsteopathicConsiderationsinSportsMedicine
A.AnOsteopathicApproachtoSportsMedicine PerGunnarBrolinson,AlbertJ.Kozar,KevinD.Valvano
B.ProlotherapyforKneePainwithEnthesopathy
BobbyBNourani
C.OsteopathicApproachtoDiagnosingandTreatingSomaticDysfunctionintheExtremities
MichaelLKuchera,KurtHeinking,PerGunnarBrolinson,ThomasAGoodwin
PARTFIVE:RESEARCHINVESTIGATINGOSTEOPATHICPRINCIPLES
JohnLicciardone
50.ResearchMethodsandEvidenceRelatingtoOsteopathicManipulativeTreatment
JohnLicciardone
51EffectivenessandSafetyofOsteopathicManipulativeTreatment
MichaelLKuchera,MichaelASeffinger,DavidBoesler,DavidAConnett
52.StrategicPlanningforResearchonOsteopathicPrinciplesandPractices
BrianDegenhardt
GLOSSARY
INDEX
PARTONE Foundations MichaelASeffinger
