Osteopathic Manipulative Treatment: Suboccipital Release

Excerpt

Acute musculoskeletal pain is 1 of the most prevalent complaints in inpatient and outpatient settings. Many patients receive pharmacologic treatment for these complaints. Osteopathic manipulative treatment (OMT) allows providers to have another treatment option that is easily accessible. OMT involves manual manipulation of muscles and fascia to reduce pain and tension and help facilitate the body's restorative functions. Somatic dysfunction is defined as an imbalance within the musculoskeletal system. Osteopathic physicians are often taught to look for such imbalances through tissue texture changes, spinal alignment asymmetry, limited joint range of motion, or tenderness. Most osteopathic physicians are taught the mnemonic TART to look for these changes related to somatic dysfunctions. Acute findings can include edema, erythema, and sharp pain.

Chronic findings can include ropy texture and cool skin. These findings on the physical exam can correlate to visceral-somatic reflexes, which are visceral dysfunctions presenting as somatic findings. A typical example of this is in cholecystitis; there are typically spinal changes around the region of T5-9 due to gallbladder irritation. These reflexes have been extensively studied and mapped out for the entire spine. Some regions of note include T1-5 for the head and neck, T2-7 for the lungs, and T5-9 for the gallbladder and small intestine. Understanding how the viscero-somatic reflexes occur gives osteopathic providers a clue where to look for somatic dysfunctions based on the patient's symptoms.

OMT involves multiple techniques to help treat symptoms and restore proper body functions. Direct techniques, such as muscle energy, require more physical force and active patient participation. Yet, there are also indirect techniques that are more gentle. Technique choice should depend on the provider's experience and the patient's demographics and clinical picture. Older patients or patients with more co-morbidities tend to respond better to indirect techniques. The overall goal of using OMT for patients is to allow the body to regulate itself, decrease pain, and improve joint mobility.

Headaches are a common complaint that could benefit from OMT, specifically suboccipital release. Headaches are among the leading health problems in the world. The majority of headaches are primary, which include tension and migraine headaches. Tension-type headaches have been hypothesized to be due to compression of the greater occipital nerve. These types of headaches are best treated with NSAID medications. Migraines are also common headaches characterized by unilateral pulsating pain that lasts up to 3 days. Migraines classicly are accompanied by nausea, light sensitivity, and noise sensitivity. There has been extensive research regarding treatment options for headaches. Triptans are the first line for abortive treatment of migraines. Other medications, such as amitriptyline, beta-blockers, and topiramate, have been used to prevent migraines. Research has shown that non-pharmacologic therapies have reduced pain severity for patients. Therefore, OMT is another viable option for providers to allow for more individualized treatment plans. Research has also been performed on using local anesthetics to treat acute headaches. The most commonly studied is the greater occipital nerve block. This includes injecting lidocaine or bupivacaine into the greater occipital branch of the suboccipital nerve. This has been shown to decrease the intensity of acute headaches and improve patient comfort.

Neck pain is also 1 of the most commonly treated conditions using OMT. Neck pain is often non-traumatic and non-specific. It is estimated that upwards of 70% of adults experience neck pain in their lifetime. Neck pain can range from musculoskeletal strain and age-related structural changes in the spine to a symptom of a system-wide neurologic condition. Since primary care physicians see most patients with neck pain, it is imperative to have multimodal treatment options. It has been recommended to try conservative treatments such as NSAIDs, heat, ice, and strengthening. Therefore, OMT allows another non-invasive treatment option for patients with this complaint.

The suboccipital release is a relatively easy technique for providers to help with musculoskeletal complaints such as neck pain and headaches. This technique is also versatile and can help regulate the autonomic system in the body due to manipulation of the occipital-atlanto region. This technique has been noted to regulate the parasympathetic rather than the sympathetic system, which is targeted by most osteopathic treatments. Studies have shown that this technique has improved the range of motion and balance in the lower extremities of healthy and patients with pre-existing conditions due to the connection of the fascia along the entire body.