Osteopathic Medicine

By Karissa Scarabino, DO

When you find a sport you love, it can be difficult to slow down due to an injury – even when your body is warning you. A 35-year-old male patient who is an avid runner comes in to my office complaining of right hip pain that starts within the first mile of his run. He runs through snow, rain and yes, pain. He’s had the same nagging hip pain for a year and no matter what he does, it just doesn’t go away. He is frustrated, feeling he’s tried everything. Using my training as an osteopathic doctor, I listen to his history and learn that he is training for a marathon, and has been street running on the sloped pavement shoulder of the road. 

My examination confirms my suspicion, that he’s developed a leg length discrepancy. The most likely cause is the daily pounding he’s done running on the hard-pitched surface, which has caused a sacral base un-leveling, and hip imbalance that’s the cause of his pain. Through hands-on osteopathic treatment techniques and a heel lift precisely fit for him, I’m able to get him running without pain, with better performance and improved times.  

What is an Osteopathic Doctor and Osteopathic Manipulative Medicine? Andrew Taylor Still, MD served as an Army surgeon during the Civil War. His father was a Methodist preacher and a physician, so he had a sense of the mind-body-spirit philosophy at a young age. He was frustrated with the “cutting edge medical treatments” at the time, which included bloodletting and treating with heavy metals. He saw how these treatments caused more harm than good, and could often be worse than the diseases they were supposed to treat, many times resulting in injury and death. He had 11 children, three died of meningitis, one died of pneumonia, and his wife also died of pneumonia. Feeling medicine had failed him on a much deeper personal level, he searched for something more, knowing the practice of medicine could be better.

At this time, something called “bone setting” was coming about in Europe. Dr. Still saw how these hands-on treatments helped patients obtain good health and healing. By improving a person’s structure, you could improve their function. For example, he saw an elderly woman with emphysema hunched over with a big curve in her upper spine do very well with hands-on treatment. By treating her musculoskeletal system, including the restrictions in her diaphragms, she was able to stand taller and breathe easier. The treatments enhanced healing, maximized health, and helped her to have good quality of life. He saw various illnesses and dysfunctions treated this way including headaches, asthma, and irritable bowel syndrome, to name a few. 

He returned to the U.S. and went back into the anatomy lab to continue his study. He again saw the relationship of the nervous system to the internal organs. The sympathetic (fight or flight) nerve roots come off your upper (thoracic) and lower (lumbar) spine, and each level innervates different organs, while the parasympathetic (rest and digest) nerve roots come off your neck (cervical) and base of your spine (sacrum) to innervate different organs. This may be compared to the fuse box in your home where each switch powers a different room or area. Dr. Still recognized that if there was a dysfunction in a person’s internal organs, there was a palpable musculoskeletal change due to how it affected the corresponding nerve segment. He found that a trained physician could both diagnose and treat each patient with this knowledge. 

Dr. Still was very excited about this connection and saw how the hands-on treatments were helping so many people. He approached the leaders of the medical schools at that time, and presented his case on why and how these treatments should be taught to medical students, providing another skill set and “tool” in each doctor’s “toolbox.” This was not well-received and the majority thought he was crazy because he was thinking outside the norm. Dr. Still continued to plead his case for several years and after he realized he could not change their minds, gave up, and in 1892, started his own school of osteopathy in Kirksville, Mo. His first graduating class included five women. Dr. Still never intended to have a separate profession. He simply wanted to incorporate hands-on treatments into the medical school training at that time.

Now there are two separate medical schools, osteopathic (DO) and allopathic (MD), which means your doctor has either a DO or MD after their name. DOs learn the same basic science coursework as MDs, but also learn to diagnose and treat musculoskeletal aches and pains, as well as medical illnesses with their hands. The education recognizes the connection of mind-body-spirit and appreciates the importance of the interconnectedness of the muscular, skeletal and nervous systems. DOs can go into any medical or surgical specialty, with fewer than 10% practicing manual treatments.

The types of osteopathic manipulative treatment range from indirect to direct techniques. Treatment types include soft tissue techniques, myofascial releases, articulatory techniques, cranial osteopathy, lymphatic techniques, muscle energy techniques, and fascial distortion model techniques.

Anyone can benefit from OMT including newborns, infants, children and adults. OMT can be used to diagnose and treat a variety of conditions, including: sports pain and injures; concussion and post-concussion syndrome; infant issues such as feeding difficulties, torticollis and colic; recurrent ear infections in children; pregnancy-related and postpartum pain; menstrual pain; heartburn, reflux, constipation, and other digestive problems; temporomandibular joint (TMJ) pain; headaches and migraines; back-neck-joint pain; nerve pain, numbness and tingling; scoliosis; leg length discrepancy; carpal tunnel syndrome; respiratory problems (asthma, chronic obstructive pulmonary disease (COPD), bronchitis, pneumonia); and sinus problems.

While only about 10% of DOs practice OMT, patients who receive this treatment typically use less or no medications, and lessen or eliminate the need for injections or surgeries. 

Meet Dr. Scarabino at the Adirondack Sports Summer Expo to learn more about Osteopathic Medicine.

Is a leg length discrepancy the real cause behind your aches and injuries? 

As an osteopathic physician, I see a lot of patients suffering from aches and injuries from an unknown cause or patients that have never really returned to normal following a trauma or surgery. What I find in many cases is that the root cause of the problem is a leg length discrepancy.

Leg length discrepancy is a condition where the length of one leg is shorter relative to the other. It can occur in all ages. Most people have some degree of leg length inequality, on average less than 1.1cm, and usually patients easily compensate. However, it is also common to see these leg length discrepancies be pathological and cause pain. The leg length discrepancy causes sacral base un-leveling – the sacrum is the triangular-fused-bone located at the base of the low back in between the hips. The brain wants to remain level to the horizon. The body twists and contorts to make sure the eyes are level, which causes muscular strains and skeletal changes in the pelvis, lumbar spine, thoracic spine, neck and jaw. 

Lower extremity disorders associated with leg length discrepancy include: increased hip pain and degeneration; altered gait (limping); scoliosis; low back pain; knee injury; iliotibial band (ITB) syndrome; pronation and plantar fasciitis of the feet; asymmetrical strength in the lower extremity; increased disc or vertebral degeneration; headaches; neck/upper back pain; TMJ dysfunction and pain.

There are many different neuromuscular and traumatic causes of leg length discrepancies. LLD can be found in any competitive athlete and pretty much anyone who is active. I commonly see these discrepancies in the patients I treat, especially runners and walkers who run or walk outside on pitched roads, or hikers who walk on uneven terrain. This tends to put a painful strain in the pelvis that results in an acquired leg length discrepancy. I also see many patients who have had bone and/or joint surgeries and have not fully recovered, walking with pain and hitching to one side even when they have completed extensive rehabilitation programs.

As an osteopathic physician, I’ve been trained to diagnose and successfully treat leg length discrepancies. Gentle hands-on treatments help individuals struggling with acute and chronic pain return to health without the need for medications or surgical interventions.

Dr. Karissa Scarabino (drkscarabino@gmail.com) is a traditional Osteopathic Physician (DO), board certified in family medicine and osteopathic manipulative medicine. In 2017, she opened her own practice (osteopathichealthofsaratoga.com), specializing in OMM. She loves to spend time outdoors hiking, gardening, kayaking, and snowshoeing with her husband and puppy.