Volume 100, Issue 5

Progressive inhibition of neuromuscular structures (PINS) is a technique that can be included in the osteopathic manipulative treatment repertoire. It relies on knowledge of anatomy and neuromuscular physiologic features as well as on standard forms of osteopathic palpatory diagnosis and treatment. It is a variant of the inhibition technique that has been taught as an osteopathic manipulative technique for many years, and it bears some resemblance to other manual medicine techniques. The emphasis of the approach is the determination of the alteration of the tissues due to dysfunction, delivering treatment based on palpatory evaluation and patient feedback. Two related points are initially chosen, followed by a progression from one to the other. Relationships to similar techniques are also discussed. Theoretical as well as selected practical applications are presented.

This article describes a 73-year-old white man with a history of dizziness secondary to profound anemia who presented with a large basal cell carcinoma of the left front temple region. A multidisciplinary approach to the extirpation and reconstruction of this defect is presented with a review of histopathologic features and outcomes of basal cell carcinoma excision.

Several recent studies document the declining use of osteopathic manipulative treatment (OMT) in clinical practice. In this article, the authors contend that developing new teaching materials based on the mastery learning approach can augment time-tested methods of teaching OMT and help to stop or reverse this decline. The Spencer technique for shoulder manipulation is used to demonstrate the development and evaluation of OMT mastery learning materials. These materials could be developed as part of a progressive teaching sequence requiring increasing diagnostic acumen, palpatory skill, and therapeutic subtlety. Such a program could be used throughout osteopathic medical training and for continuing medical education to increase skills and confidence in the use of OMT.