The Legacy of Stanley Schiowitz, DO,...

The Legacy

of

Stanley Schiowitz, DO, FAAO

Dennis J. Dowling, DO, MA, FAAO

No Conflicts to declare

Graduated from high school at age 15

St. John’s University ages 15-18

AGE 18

“It’s time for the Dr. Moe Levy

Story”

Philadelphia College of Osteopathy

Graduated at age 22 in 1944

Apprenticeship with Moe Levy, D.O.

1944-1946

Stanley Schiowitz, D.O., F.A.A.O.

Private Practice in Brooklyn 1945 – 1977

Senior Attending Physician, Department of Family Practice, Interboro General Hospital, New York

1966 – 1977

DME Interboro Hospital 1971-1977

Past President NYSOMS

Stanley Schiowitz, D.O., F.A.A.O.Chair of NYCOM OPP Department 1977 – 1991

Stanley Schiowitz, D.O., F.A.A.O.

Robert G. Thorpe, D.O., F.A.A.O.

Eileen L. DiGiovanna, D.O., F.A.A.O.

Mary Hitchcock,, D.O., F.A.A.O.

Gary Ostrow, D.O

Andrew “jack” Tatom,, D.O

MY NYCOM “BROTHERS” and “SISTERS”

“I.O.”

First Rib

MONITOR

“Figure Four”

Physician’s monitoring arm must be more

cephalad

• Patient supine• physician stands on same side as dysfunction (typically an elevated rib)• physician uses the same sided hand to monitor rib (right hand monitors

right rib, left hand monitors left rib)• arm on same side is abducted slightly (10 degrees) and shoulder flexed to

approximately 90 degrees physician uses his other arm• physician exerts downward pressure towards the rib along the long axis of

the arm• monitoring arm acts as a fulcrum• a slight amount of increased shoulder flexion is introduced (this also

creates relative further internal rotation of the shoulder)• abduction is introduced• further internal rotation is introduced• return to neutral• reassess

First Rib

First Rib

“I.O.”“INSTANT OSTEOPATHY”

How Long? A few seconds

Basic Rules of F.P.R.• Diagnose

• Put region/joint into Neutral (flatten curves)• places joint into idling position

• Monitor continuously

• Add facilitating force (usually compression or torsion)• reduces proprioceptive and nociceptive “noise”

• Add freedoms in all three planes (Flexion/Extension, Sidebending, rotation)• reduces muscle spindle activity

• allows reduction of gamma gain

“If compression doesn’t work, try traction. If it doesn’t work going to

the right, go to the left. Simple philosophy.”

“Someday, someone will explain to me what the hell I am doing.”

• Hold position for five seconds

• Determine alteration of tissue tension

• Return to Neutral

• Reassess

• Barriers can then be challenged (“wiggle” “jiggle”)

• Reassess

Basic Rules of F.P.R.

“Any mechanical dysfunction in the body can affect any

other part of the body and therefore can affect any system of

the body (and vice versa). When treating a patient, never

treat them for a diagnosed medical condition. Treat the

musculoskeletal change, and if the patient feels better then

you are both lucky. Maybe it will help, maybe it won’t.”

Functional Technique?Harold Hoover, DO

1896 – 1966Functional Technique

1940s

Charles Bowles, DO(1904 - 1984)

William Johnston, DO, FAAOFunctional Technique

1970s

PASSIVE - INDIRECT

“Still’s Technique”Charles Hazzard, Ph.B., DO

The Practice and Applied Therapeutics of Osteopathy

Second Revised Edition1901

Richard Van BusKirk, PhD, DO, FAAO The Still Technique

1990s

Andrew Taylor StillThe Philosophy and

Mechanical Principles of Osteopathy

1902

How Long? A few seconds

• Hold position for five seconds

• Determine alteration of tissue tension

• Return to Neutral

• Reassess

• Barriers can then be challenged (“wiggle” “jiggle”)

• Reassess

Basic Rules of F.P.R.

“But, Stan, you never wrote

about challenging the barriers.

What gives?”

PASSIVE – INDIRECT & DIRECT

“I don’t treat the way I teach, I get down to

smaller and smaller motions.”

Still Technique

Facilitated Positional Release

Still Technique

Facilitated Positional Release

TWIN TECHNIQUES with DIFFERENT FATHERS

“Did Stan Schiowitz know that his FPR

was the third iteration of the Still

Technique?”

“No, he didn’t…”

“He knew that it was the

second.”

F.P.R.J Am Osteopath Assoc. 1990 Feb;90(2):145-6, 151-5.

Still TechniqueJ Am Osteopath Assoc. 1996 Oct;96(10):597-602.

A form of Myofascial Release• Counterstrain & Functional techniques are positional

techniques

• Facilitated Positional Release and Still technique rely on both the positional component and…

… a facilitating force

• They both start INDIRECT and then become DIRECT

• They are both very TIME EFFICIENT

“It is important to learn efficiency in time and effort. “

Contraindications

• Localized pathological tissue conditions• Infection

• Cellulitis

• Osteomyelitis

• Cysts

• Tumors

• Fracture

• Increase or significant alteration of symptoms

• Inability to tolerate position

Learned from Moe Levy, D.O. (his mentor):

1. Always do a complete H&P

2. Always do a rudimentary structural exam

3. Always use OMT whenever you can.

Type of Technique

• Passive - the patient does nothing

• Indirect - Treatment is directed primarily away from the barriers

• (Direct - barriers can be challenged afterwards)

• (Occasionally we ask the patient to do something [i.e. isometrics])

Dr. Schiowitz’s Legacy Dean NYCOM 1992-2002

• Had an Educational Consortium established more than a decade prior to most other COMs. Hospitals had to establish internships and residencies as well as rotations for students

• Many other of the literally thousands of alumnae, interns, and residents who have learned from Dr. Schiowitz have become leaders in the profession as well serving as medical directors, residency directors, deans, and professors.

• As the Dean of Allied Health at New York Institute of Technology from 1995 to 2000, Dr. Schiowitz oversaw the development of programs in nursing, physician assistants, occupation therapy, physical therapy, and nutrition; and a masters’ degree in business administration.

Stanley Schiowitz, D.O., F.A.A.O.

Robert G. Thorpe, D.O., F.A.A.O.

Eileen L. DiGiovanna, D.O., F.A.A.O.

Mary Hitchcock,, D.O., F.A.A.O.

Gary Ostrow, D.O

Andrew “jack” Tatom,, D.O

• NYIT-NYCOM OPP Department became the Stanley Schiowitz, DO, FAAO Department of Osteopathic Manipulative Medicine

• Dean Emeritus NYCOM 2002-2011

• Scott Memorial Lecturer (ATSU-KCOM)

• the Louisa Burns Memorial Lecturer (AOA),

• David Heilig Lecturer (PCOM).

• A.T. Still Medallion American Academy of Osteopathy

• Honorary Life Membership from the American Academy of Osteopathy

• Dale Dodson, D.O. Award.

• Distinguished Physician of the National Academies of General Practice

• 2005 inductee into AOA mentor Hall of Fame.

• The AOA Distinguished Service Award