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Graphic of a certificate with a gold seal.Inside the border the text states.We provide Diplomate credentialing and education for the fields of medicine, chiropractic, acupuncture, physical, neuromuscular, and massage therapies. In addition to, information on assessment and treatment options for the manual medicine practitioners and the public they serve.
If you are legally responsible for the interpretation of symptoms and signs this site is for you.!
This consortium promotes evidence based comprehensive safe and effective health care delivery.!
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The term manual medicine was developed to serve as a collective name for any hands on technique whereby the practitioner/provider is attempting to create a physiological change within an individual who is experiencing dysfunction. It may be used as a stand alone treatment or employed as an adjunct to augment the affect of medications and surgery. Therefore, when you see a doctor manipulate a joint and/or a therapist, trainer, or nurse provide massage, you are witnessing manual medicine technique. For more about the evolution of manual medicine click here.
Pain is an adaptive response to dysfunction, therefore, prior to experiencing pain an individual experiences dysfunction of either the musculoskeletal system (soma), viscera, or psyche. Over the years, there have been numerous physiological models advanced to explain the mechanisms of pain. We have attempted to employ commonality of thought as it pertains to evidence based mainstream medicine as well as the concepts of the leading authors on the subject of pain. Regardless of the model, all pain involves nerve supply, whether or not, its referral is related to trigger points, reflex pain from diseased viscus, or exclusively related to the nerves. Nerve pain, or its counter part, loss of sensation, is usually described as sharp or lancinating, electrical or knife-like, numb or tingling. Throbbing pain is usually vascular in origin. Trigger point pain is usually described as deep, aching, or burning. However there are certain trigger points, which can produce sharp pain, as found in the Quadratus lumborum, or in the case of the Platysmas, numbness and tingling (paresthesia) may be exhibited.
Using shoulder pain as an example, the reader should note, that there may appear to be discrepancies between nerve supply and dermatome patterns. Spinal nerves C4 and C5 supply the Rhomboids and the Scalenes, yet, the dermatome referral pattern for a C4 or C5 radiculopathy references the back of the neck and the top of the shoulders. However, when that spinal nerve supply for whatever reason becomes dysfunctional, the muscles that are also supplied by that nerve, may develop trigger points and its deep aching referral pattern to the medial aspect of the shoulder blade. Therefore, a practitioner, when viewing nerve innervation, must not only look at the pain referral area but, also establish all the muscles which potentially could contribute to trigger point referral and could subsequently skew their findings based upon the subjective report of pain. Diseased viscus or organs may also cause atypical pain referral. This can be attributed to trigger point formation in the fascia surrounding the organ, or due to the neurologic differentiation during fetal development. This seems to be the most recognized reason that individuals, whom are experiencing a tubal pregnancy or prostate cancer, would experience shoulder pain, as referenced above. Therefore, if you exclusively use our dermatome charts, that shoulder pain will be caused by a radiculopathy at C7, T1, or T2. If you exclusively use the trigger point charts, that shoulder blade pain may be caused by the Rhomboids, or the Scalenes, among others. As the Scalenes and Rhomboids are both innervated by the Dorsal scapular nerve, which branch off from spinal nerves C4 and C5, wouldn’t a spinal nerve dysfunction at that level also be possible? There is no substitute for a comprehensive knowledge base, therefore, when reviewing this material you must consider dermatome patterns, trigger point referral patterns, and the possibility of a disease process. For those that are non-physicians this is intended to provide you with an overview of the complexities of pain management. You should note, that frequently it requires elaborate diagnostics established through radiographic, and/or laboratory findings, as well as instrumentation, to determine the cause of dysfunction. And without a physical examination and diagnostic testing, the reader may only infer that this is scientific food for thought, but certainly cannot be solely established to develop a course of treatment.
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