[Music]
let's talk about how we do an
osteopathic exam to a patient let's
check out our patients let's see what's
going on with an exam that's our stock
and trade that's what we do and every
exam starts with a chief complaint and a
history of present illness they start
from the patient coming in and saying
here's why I'm here
and in their own words they get to start
the visit and they get to guide where
it's going to focus the problem is a
chief complaint is subjective
it's what the patient thinks it's what
the patient learned from the internet
it's what they were told by their
friends they should focus on and it
isn't always what needs to be focused on
it's what we need to start it needs to
be addressed it needs to be taken
seriously it needs to be repeated so the
patient knows you're listening but we
also realize that subjective is
different and every time we get a
positive we ask more questions if
there's a pain what's the location
what's the quality of the pain what's
the chronology when did it start when is
it worse when it's it better what are
the Associated manifestations to it so
those are questions you ask for every
positive and then you develop a review
of each system so we're there headaches
involved are there pain symptoms are
there things that make it better or
worse you review each positive and you
get more of a picture and you round out
the complaint then once you've got some
good clear understandings of what's
going on you do an exam and the exam is
objective that's data we can take to the
bank it's data that we see that we are
determining that's coming from outside
the patient to either validate what the
patient said or give us another aspect
of what's going on that may be related
to what the patient said the Osteopathy
exam is a neuromusculoskeletal exam it
always includes a review of systems and
it starts from the time the patient
enters the room every osteopathic
examination
should be done in at least two positions
sitting and standing standing and
walking moving from side to side you're
not going to get a view of function
unless the person is functioning so it's
not just the structure of the body it's
not just anatomy but how that Anatomy is
affected by motion people complain
saying but but but it's so much easier
to look at it in one dimension and when
we do x-rays x-rays are anatomic we
actually take the weight off of somebody
to take the x-ray
well the chiropractor's don't
podiatrists don't they want to see the
anatomy in action and we can actually
request that we look at flexion and
extension views of the cervical spine
let's see the motion of it let's examine
it in activity and not just the anatomy
of it so the O n mm exam is a dynamic
exam it's an exam that starts from the
beginning of the interaction with the
patient watch the patient's stand up
watch the patient move and one of the
things I like to note and take a note in
my mind is is this function person
functioning comfortably do they look
comfortable or uncomfortable and it's
not just the look on their face it's the
fluidity of motion and I'm gonna
introduce FRA its laws here France laws
talk about motion for a body to be
efficient if you say Ben right you
rotate left you displace the force and
the weight amongst as much of the
vertebrae as possible and that means
that a person is healthy if somebody
can't use their muscles well and they
need to use their larger muscles they're
going to override some of the subfloor
movements and they'll siphon right
rotate right to use the larger muscles
to push up that's someone who's going to
look uncomfortable who's going to look
weak
and you know they've got problems that
are going beyond pain they may be
presenting with and it may be weak
muscles
it may be hypertrophied muscles
it may be nutritional it may be hormonal
or endocrine those are all things you
need to look at
so the musculoskeletal functioning
whether they're in neutral mechanics or
non neutral mechanics tells you a lot
and we have a 10-step exam as a way of
examining people that can give you all
the information you need to see if the
person will benefit from the treatments
we have to offer them because you don't
treat somebody without a diagnosis and
you don't diagnose somebody without
examining them and getting their history
and doing a physical
[Music]