Notable OMM Publications for the Skeptics (such as myself)

[rjgennarelli]

I have the priviledge of being taught OPP/OMM by one of the selective few DO's at the forefront of neuromuscular medicine; fantastic physician/teacher/lecturer. I couldn't ask for anyone better. However, we are left with taking the instructor at his word when we ask 'how' these techniques work, and whether their respective theories are in fact sound. After reading "The DOs" by Norman Gevitz this summer, it has come to my attention that there is, in fact no scientific proof of the theories behind various OMM techniques (the AOA funded research twice in the 1900s, but failed to discover any kind of spinal "lesion"). Interestingly, OMM is statistically proven to benefit patients in the exact way they are designed to, and every so often I will see a cited journal article on SDN showing that an OMM technique has statistically proven benefits (usually this is p < 0.05).

This statistical proof is far too often overshadowed by OMM's theoretical lack of scientific proof. I propose we make a comprehensive list of journal articles that we (the students) find interesting, statistically significant or not (it is also important to know which techniques might have a lesser likelihood of success) and discuss what interesting value they may have. For those of you who may have some interesting articles OMM/OPP related, please post a link with a brief summary of the conclusion (if it is a clinical trial, please include the p-value). I will copy and paste them below.

Disclaimer: I am by no means an OPP/OMM enthusiast and have no intention of practicing OMM.

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[pattr]

Disclaimer: I am by no means an OPP/OMM enthusiast and have no intention of practicing OMM.

Why do you have so much interest in something you're not going to practice?

 

[Siggy]

Why do you have so much interest in something you're not going to practice?

Curiosity?

 

[se20001984]

The horse**** press

 

[Banned]

The horse**** press

lol

I'm guessing the majority of OMM studies you'll find published in JAOA, which is a pretty crummy excuse for a journal. I doubt mainstream, high impact journals are willing to put their necks on the line for the stuff that passes for "science" in OMM studies. Good luck with your search.

 

[sylvanthus]

lol

I'm guessing the majority of OMM studies you'll find published in JAOA, which is a pretty crummy excuse for a journal. I doubt mainstream, high impact journals are willing to put their necks on the line for the stuff that passes for "science" in OMM studies. Good luck with your search.

I wish you luck OP. I did an Omm rotation and we spent time each week going over the research. There are few, if any, good studies showing positive results save for maybe low back pain.

 

[se20001984]

OMT is in its own world- outside of science and logic


its has now focused on arbitrary diseases (which may or may not exist) such as lower back pain, gerd, headachs, chronic fatigue syndrome, etc etc

pretty where science cannot go- OMT is there.

keep being a skeptic! we are medical students NOT Ost....

 

[rjgennarelli]

I wish you luck OP. I did an Omm rotation and we spent time each week going over the research. There are few, if any, good studies showing positive results save for maybe low back pain.

Maybe you can post one or two?

 

[pattr]

Maybe you can post one or two?

... I don't get why you can't do this yourself, OP. just pubmed it. To get you started, here's a good one from the Annals of Family Medicine (NOT the JAOA) from just earlier this year.

Osteopathic Manual Treatment and Ultrasound Therapy for Chronic Low Back Pain: A Randomized Controlled Trial.

John C. Licciardone, DO, MS, MBA; Dennis E. Minotti, DO; Robert J. Gatchel, PhD; Cathleen M. Kearns, BA; Karan P. Singh, PhD

PURPOSE:
We studied the efficacy of osteopathic manual treatment (OMT) and ultrasound therapy (UST) for chronic low back pain.

METHODS:
A randomized, double-blind, sham-controlled, 2 × 2 factorial design was used to study OMT and UST for short-term relief of nonspecific chronic low back pain. The 455 patients were randomized to OMT (n = 230) or sham OMT (n = 225) main effects groups, and to UST (n = 233) or sham UST (n = 222) main effects groups. Six treatment sessions were provided over 8 weeks. Intention-to-treat analysis was performed to measure moderate and substantial improvements in low back pain at week 12 (30% or greater and 50% or greater pain reductions from baseline, respectively). Five secondary outcomes, safety, and treatment adherence were also assessed.

RESULTS:
There was no statistical interaction between OMT and UST. Patients receiving OMT were more likely than patients receiving sham OMT to achieve moderate (response ratio [RR] = 1.38; 95% CI, 1.16-1.64; P <.001) and substantial (RR = 1.41, 95% CI, 1.13-1.76; P = .002) improvements in low back pain at week 12. These improvements met the Cochrane Back Review Group criterion for a medium effect size. Back-specific functioning, general health, work disability specific to low back pain, safety outcomes, and treatment adherence did not differ between patients receiving OMT and sham OMT. Nevertheless, patients in the OMT group were more likely to be very satisfied with their back care throughout the study (P <.001). Patients receiving OMT used prescription drugs for low back pain less frequently during the 12 weeks than did patients in the sham OMT group (use ratio = 0.66, 95% CI, 0.43-1.00; P = .048). Ultrasound therapy was not efficacious.

CONCLUSIONS:
The OMT regimen met or exceeded the Cochrane Back Review Group criterion for a medium effect size in relieving chronic low back pain. It was safe, parsimonious, and well accepted by patients.

http://www.annfammed.org/content/11/2/122.long

Happy reading.

 

[DocVapor]

1.
Mechanical strain applied to human fibroblasts differentially regulates skeletal myoblast differentiation.
Hicks MR, Cao TV, Campbell DH, Standley PR.
J Appl Physiol. 2012 Aug;113(3):465-72. doi: 10.1152/japplphysiol.01545.2011. Epub 2012 Jun 7.
PMID: 22678963 [PubMed - indexed for MEDLINE]
Related citations Remove from clipboard
Select item 21929819

2.
Cyclic strain upregulates VEGF and attenuates proliferation of vascular smooth muscle cells.
Schad JF, Meltzer KR, Hicks MR, Beutler DS, Cao TV, Standley PR.
Vasc Cell. 2011 Sep 19;3:21. doi: 10.1186/2045-824X-3-21.
PMID: 21929819 [PubMed] Free PMC Article
Related citations Remove from clipboard
Select item 19083676

3.
In vitro modeling of repetitive motion strain and manual medicine treatments: potential roles for pro- and anti-inflammatory cytokines.
Standley PR, Meltzer K.
J Bodyw Mov Ther. 2008 Jul;12(3):201-3. doi: 10.1016/j.jbmt.2008.05.006. Epub 2008 Jun 30. Review.
PMID: 19083676 [PubMed - indexed for MEDLINE] Free PMC Article
Related citations Remove from clipboard
Select item 18178762

4.
Modeled repetitive motion strain and indirect osteopathic manipulative techniques in regulation of human fibroblast proliferation and interleukin secretion.
Meltzer KR, Standley PR.
J Am Osteopath Assoc. 2007 Dec;107(12):527-36.
PMID: 18178762 [PubMed - indexed for MEDLINE] Free Article
Related citations Remove from clipboard
Select item 17996550

5.
Importance of strain direction in regulating human fibroblast proliferation and cytokine secretion: a useful in vitro model for soft tissue injury and manual medicine treatments.
Eagan TS, Meltzer KR, Standley PR.
J Manipulative Physiol Ther. 2007 Oct;30(8):584-92.
PMID: 17996550 [PubMed - indexed for MEDLINE]
Related citations Remove from clipboard
Select item 16585384

6.
In vitro biophysical strain model for understanding mechanisms of osteopathic manipulative treatment.
Dodd JG, Good MM, Nguyen TL, Grigg AI, Batia LM, Standley PR.
J Am Osteopath Assoc. 2006 Mar;106(3):157-66.
PMID: 16585384 [PubMed - indexed for MEDLINE] Free Article
Related citations Remove from clipboard

 

[Textbookversion]

Does it really matter if OMM is hogwash or not? Why is a physician provider doing manual medicine when DPT's exist, and cost less per hour?

 

[Siggy]

Does it really matter if OMM is hogwash or not? Why is a physician provider doing manual medicine when DPT's exist, and cost less per hour?

Does it really matter if drugs are hogwash or not? Why is a physician provider writing prescriptions for chronic pain when NPs and PAs exist, and cost less per hour?


:-D

 

[Textbookversion]

Does it really matter if drugs are hogwash or not? Why is a physician provider writing prescriptions for chronic pain when NPs and PAs exist, and cost less per hour?


:-D

That's a horrendous argument. Not even worth responding to.

 

[Trogghunter]

The standard of fda approval for several...several drugs is 'more efficacious than placebo'. That's so messed up especially given cost and a/e.
Who doesn't get paid when manual medicine is used? Pharma. When there is a way to exploit manual medicine, we will see it as standard of care along with reps providing delicious lunch. I can't wait--i have great hands. I could probably replace an ultrasound machine with them.
You know how much a percussive vest costs? A lot. how effective is it? Not very. Is it part of CF treatment protocol? Yes. Who makes them? Not manual med docs.

 

[dozitgetchahi]

I can't wait--i have great hands. I could probably replace an ultrasound machine with them.

Wait, what?

So you're gonna palpate the uterus of a pregnant woman and tell her the gender of her child?

Special hands indeed...

 

[Banned]

Does it really matter if drugs are hogwash or not? Why is a physician provider writing prescriptions for chronic pain when NPs and PAs exist, and cost less per hour?


:-D

Drugs are totally hogwash. I suggest the next time you get surgery, refuse all anesthetics/antibiotics. Good luck.

 

[Oo Cipher oO]

Does it really matter if OMM is hogwash or not? Why is a physician provider doing manual medicine when DPT's exist, and cost less per hour?

So now we are limiting osteopathic physicians' scope of practice are we? Diagnose and treat but make sure to refer out if anyone needs some manual medicine? If you don't want to do it thats fine but don't tell me how I need to refer my patient if I have the training to help them.

It's not financially efficacious to do OMM from a physician stand point. It takes time you could be seeing other patients and you lose money in the long run. But if a physician feels its important enough to take the extra time who are you to tell them otherwise?

 

[Oo Cipher oO]

Drugs are totally hogwash. I suggest the next time you get surgery, refuse all anesthetics/antibiotics. Good luck.

Sarcasm is hard

 

[survivordo]

Baltazar, Gerard A., DO. "Effect of Osteopathic Manipulative Treatment on Incidence of Postoperative Ileus and Hospital Length of Stay in General Surgical Patients." The Journal of the American Osteopathic Association 111.3 (2013): 204-09. www.jaoa.org.

 

[rjgennarelli]

Alright give me a couple days guys i want to take a look at these articles and provide a little hand written summary of the conclusions. Thanks for the citations!

 

[Tekar]

You people make me laugh... DO's and OMS's with chips on their shoulders... keep that chip right where it's at.. I'll teach the MD's what I do when they ask me how the hell I turned off a headache they had no idea how to fix in about 10 minutes...and then I'll charge $350 an hour for my skill set my 8 year old son can feel, but you guys refuse to try. They'll tell everyone who'll listen to come see me... and they will cease being your patients.

When you reach the limits of your medical knowledge and have no idea which lab test to order next, shrug at your patients.. it'll help.. I promise.

OR... you could stop trying to find hope in medical journals and put your hands on patients...

 

[Textbookversion]

I turned off a headache they had no idea how to fix in about 10 minutes

is this real life

 

[jesspt]

You people make me laugh... DO's and OMS's with chips on their shoulders... keep that chip right where it's at.. I'll teach the MD's what I do when they ask me how the hell I turned off a headache they had no idea how to fix in about 10 minutes...and then I'll charge $350 an hour for my skill set my 8 year old son can feel, but you guys refuse to try. They'll tell everyone who'll listen to come see me... and they will cease being your patients.

When you reach the limits of your medical knowledge and have no idea which lab test to order next, shrug at your patients.. it'll help.. I promise.

OR... you could stop trying to find hope in medical journals and put your hands on patients...

This sounds like the same argument that acupuncturists, reiki masters, etc. make when defending their practice. God forbid you look at the science and evidence supporting manual medicine. Just "...put your hands on patients."

 

[jesspt]

... I don't get why you can't do this yourself, OP. just pubmed it. To get you started, here's a good one from the Annals of Family Medicine (NOT the JAOA) from just earlier this year.

Osteopathic Manual Treatment and Ultrasound Therapy for Chronic Low Back Pain: A Randomized Controlled Trial.

John C. Licciardone, DO, MS, MBA; Dennis E. Minotti, DO; Robert J. Gatchel, PhD; Cathleen M. Kearns, BA; Karan P. Singh, PhD

PURPOSE:
We studied the efficacy of osteopathic manual treatment (OMT) and ultrasound therapy (UST) for chronic low back pain.

METHODS:
A randomized, double-blind, sham-controlled, 2 × 2 factorial design was used to study OMT and UST for short-term relief of nonspecific chronic low back pain. The 455 patients were randomized to OMT (n = 230) or sham OMT (n = 225) main effects groups, and to UST (n = 233) or sham UST (n = 222) main effects groups. Six treatment sessions were provided over 8 weeks. Intention-to-treat analysis was performed to measure moderate and substantial improvements in low back pain at week 12 (30% or greater and 50% or greater pain reductions from baseline, respectively). Five secondary outcomes, safety, and treatment adherence were also assessed.

RESULTS:
There was no statistical interaction between OMT and UST. Patients receiving OMT were more likely than patients receiving sham OMT to achieve moderate (response ratio [RR] = 1.38; 95% CI, 1.16-1.64; P <.001) and substantial (RR = 1.41, 95% CI, 1.13-1.76; P = .002) improvements in low back pain at week 12. These improvements met the Cochrane Back Review Group criterion for a medium effect size. Back-specific functioning, general health, work disability specific to low back pain, safety outcomes, and treatment adherence did not differ between patients receiving OMT and sham OMT. Nevertheless, patients in the OMT group were more likely to be very satisfied with their back care throughout the study (P <.001). Patients receiving OMT used prescription drugs for low back pain less frequently during the 12 weeks than did patients in the sham OMT group (use ratio = 0.66, 95% CI, 0.43-1.00; P = .048). Ultrasound therapy was not efficacious.

CONCLUSIONS:
The OMT regimen met or exceeded the Cochrane Back Review Group criterion for a medium effect size in relieving chronic low back pain. It was safe, parsimonious, and well accepted by patients.

http://www.annfammed.org/content/11/2/122.long

Happy reading.

This study is .......strange. Why compare OMM to US, when we have had good meta-analysis for years that shows that US does nothing for the conditions it is used to treat? And the take home message that I got was that sham OMM and real OMM resulted in essentially the same outcome.

 

[Tekar]

Yup. It's not voodoo. You're welcome to not believe me. Especially if you like beating your head against a wall with repeated failures in treatment for "migraine" and pointless referrals to Neurology even more clueless about how to treat them than the family practice docs. I'm quite certain your patients won't notice the difference.

Or you could keep an open mind and willingness to give things and honest effort before you blow them off, and you might just be able to treat people and help them find more health than they've seen in years.... it's your choice.

 

[Tekar]

I don't really need to be able to trust "science" to know that what I do works... There's plenty of physiology out there to talk about it, but since the practice of osteopathy involves living systems, it's a bit harder to study. Studying anatomy on cadavers is like studying trees on telephone poles. They're not the same.

Odd thing though... an MD radiologist working with NASA studying astronauts suffering with various neurological deficits presented his data that proved wide variety of concepts that osteopathy has had as its foundation for 100 years... He came to those who practice Osteopathy in the cranial field and asked them what is going on. It's not voodoo (and cranial is a vehicle for a concept, not the end all) Once you feel it and apply it with ridiculous results, you'll begin to question a lot of things you thought were true. Or you can decide to look for some pharmaceutical funded double blind placebo controlled trial done by spine surgeons conducting cervical fusions as being more efficacious than osteopathy... and then you can see an MRI of a cervical spine in motion and realize the fusion didn't do a damn thing to stop motion... the radiologists words, not mine...

 

[Tekar]

This sounds like the same argument that acupuncturists, reiki masters, etc. make when defending their practice. God forbid you look at the science and evidence supporting manual medicine. Just "...put your hands on patients."

It's not an argument. I don't need to defend what I do to anyone. My patients and results speak for themselves. Keep searching though.. I'm sure fundamental truths can be found in scientific journals funded by for-profit entities.

Funny thing about all those big bad "alternative" practitioners... people go to them and get results that western medicine physicians were too stupid to try.

 

[jesspt]

It's not an argument. I don't need to defend what I do to anyone. My patients and results speak for themselves. Keep searching though.. I'm sure fundamental truths can be found in scientific journals funded by for-profit entities.

Funny thing about all those big bad "alternative" practitioners... people go to them and get results that western medicine physicians were too stupid to try.

Here's something that wasn't funded by a for-profit entity. But, it is getting perilously close to actual science, so you're probably not interested:

http://ptjournal.apta.org/content/78/11/1175.abstract

The full pdf is free to all. My favorite part of the conclusion:

Another possibility is that craniosacral motion may be an
artifact of the examiners' imagination rather than a
measurable phenomenon

 

[Banned]

I don't really need to be able to trust "science" to know that what I do works... There's plenty of physiology out there to talk about it, but since the practice of osteopathy involves living systems, it's a bit harder to study. Studying anatomy on cadavers is like studying trees on telephone poles. They're not the same.

Odd thing though... an MD radiologist working with NASA studying astronauts suffering with various neurological deficits presented his data that proved wide variety of concepts that osteopathy has had as its foundation for 100 years... He came to those who practice Osteopathy in the cranial field and asked them what is going on. It's not voodoo (and cranial is a vehicle for a concept, not the end all) Once you feel it and apply it with ridiculous results, you'll begin to question a lot of things you thought were true. Or you can decide to look for some pharmaceutical funded double blind placebo controlled trial done by spine surgeons conducting cervical fusions as being more efficacious than osteopathy... and then you can see an MRI of a cervical spine in motion and realize the fusion didn't do a damn thing to stop motion... the radiologists words, not mine...

I don't wish to join the argument because I'm not a fan of OMM, but I would like to read more about the "MD radiologist working with NASA" study you mention. I've never heard of it and it sounds interesting.

Link/reference please?

 

[Banned]

Here's something that wasn't funded by a for-profit entity. But, it is getting perilously close to actual science, so you're probably not interested:

http://ptjournal.apta.org/content/78/11/1175.abstract

The full pdf is free to all. My favorite part of the conclusion:

I'm surprised they got funding! Good on them. Most people don't need a study to know that cranial is sketchy. There are a handful of OMM techniques I find useful, but cranial is just embarrassing.

 

[se20001984]

It's not an argument. I don't need to defend what I do to anyone. My patients and results speak for themselves. Keep searching though.. I'm sure fundamental truths can be found in scientific journals funded by for-profit entities.

Funny thing about all those big bad "alternative" practitioners... people go to them and get results that western medicine physicians were too stupid to try.

ya

 

[pattr]

This study is .......strange. Why compare OMM to US, when we have had good meta-analysis for years that shows that US does nothing for the conditions it is used to treat? And the take home message that I got was that sham OMM and real OMM resulted in essentially the same outcome.

They're using UST as an additional control/comparison group. If you look at the figures in the article they compare OMT to UST side by side and show UST does nothing while OMT has a significant effect. I think the authors would agree with you; UST shouldn't be used for LBP.

How can you come to the conclusion that sham=OMT when the results clearly show statistical significance in favor of OMT in both moderate and substantial clinical effect sizes (as recommended by the IMMPACT consensus trial), which was the whole point of the article?: "Overall, 145 (63%) OMT patients vs 103 (46%) sham OMT patients reported moderate improvement at week 12 (RR = 1.38; 95% CI, 1.16&#8211;1.64; P <.001). Similarly, 114 (50%) OMT patients vs 79 (35%) sham OMT patients reported substantial improvement (RR = 1.41; 95% CI, 1.13&#8211;1.76; P = .002)."

In addition, this is one of the largest clinical trials done on OMT. It also supported the notion that OMT patients take less prescription medication for their pain (also statistically significant).

 

[jesspt]

They're using UST as an additional control/comparison group. If you look at the figures in the article they compare OMT to UST side by side and show UST does nothing while OMT has a significant effect. I think the authors would agree with you; UST shouldn't be used for LBP.

How can you come to the conclusion that sham=OMT when the results clearly show statistical significance in favor of OMT in both moderate and substantial clinical effect sizes (as recommended by the IMMPACT consensus trial), which was the whole point of the article?: "Overall, 145 (63%) OMT patients vs 103 (46%) sham OMT patients reported moderate improvement at week 12 (RR = 1.38; 95% CI, 1.16–1.64; P <.001). Similarly, 114 (50%) OMT patients vs 79 (35%) sham OMT patients reported substantial improvement (RR = 1.41; 95% CI, 1.13–1.76; P = .002)."



In addition, this is one of the largest clinical trials done on OMT. It also supported the notion that OMT patients take less prescription medication for their pain (also statistically significant).

My bad. I just quickly looked at the abstract, and have not accessed the full text article. but the following phrase sticks out to me:

Back-specific functioning, general health, work disability specific to low back pain, safety outcomes, and treatment adherence did not differ between patients receiving OMT and sham OMT.

 

[pattr]

My bad. I just quickly looked at the abstract, and have not accessed the full text article. but the following phrase sticks out to me:

Back-specific functioning, general health, work disability specific to low back pain, safety outcomes, and treatment adherence did not differ between patients receiving OMT and sham OMT.

Yeah those first three (functioning, health, disability) were all measured by survey/questionnaires. The primary outcome was pain. The authors acknowledge that in the conclusion:

In conclusion, the OMT patients achieved moderate to substantial improvements in low back pain, which met or exceeded the Cochrane Back Review Croup criterion for a medium effect size. The OMT patients also reported less frequent concurrent use of prescription drugs. They did not, however, report corresponding improvements in back-specific functioning, general health, or work disability.

I don't know if you're going to significantly change functioning, health, or disability in 12 weeks with any treatment for chronic LBP, though... so definitely need longer follow-up studies to see whether these indicators can be improved with OMT.

 

[Instatewaiter]

I'll teach the MD's what I do when they ask me how the hell I turned off a headache they had no idea how to fix in about 10 minutes...and then I'll charge $350 an hour for my skill set my 8 year old son can feel, but you guys refuse to try. They'll tell everyone who'll listen to come see me... and they will cease being your patients.

Does your massage come with a happy ending? I hear that's pretty good for headaches. Probably better than OMM. You should do a double blinded study. Then you'll really put the manual maniupulation into OMM.

I don't really need to be able to trust "science" to know that what I do works...

What?

since the practice of osteopathy involves living systems, it's a bit harder to study. Studying anatomy on cadavers is like studying trees on telephone poles. They're not the same.

Well that's just bullsh.t. Cardiology involves living systems but guess what, we have thousands of real (and well designed) trials.

an MD radiologist working with NASA studying astronauts suffering with various neurological deficits presented his data that proved wide variety of concepts that osteopathy has had as its foundation for 100 years...

It sounds like you made this up. I'm starting to believe you are trolling us.

 

[Tizoc]

Does your massage come with a happy ending?

OMM = Oriental Massage Methods

 

[pattr]

You people make me laugh... DO's and OMS's with chips on their shoulders... keep that chip right where it's at.. I'll teach the MD's what I do when they ask me how the hell I turned off a headache they had no idea how to fix in about 10 minutes...and then I'll charge $350 an hour for my skill set my 8 year old son can feel, but you guys refuse to try. They'll tell everyone who'll listen to come see me... and they will cease being your patients.

When you reach the limits of your medical knowledge and have no idea which lab test to order next, shrug at your patients.. it'll help.. I promise.

OR... you could stop trying to find hope in medical journals and put your hands on patients...

Does your massage come with a happy ending? I hear that's pretty good for headaches. Probably better than OMM. You should do a double blinded study. Then you'll really put the manual maniupulation into OMM.

What?

Well that's just bullsh.t. Cardiology involves living systems but guess what, we have thousands of real (and well designed) trials.

It sounds like you made this up. I'm starting to believe you are trolling us.

I don't see how what you're doing is any less "trolling" than what he is doing. I also don't understand why some MDs get so trollish when they talk about OMM. You guys learn physical manipulations in school too... remember the treatment for nursemaid's elbow? Or the stretches you teach patients for lateral/medial epicondylitis? Or what about the carotid massage? the Dix-Hallpike and Epley maneuvers for BPPV? The Neer's test, Spurling's test, etc.... I could go on forever. These are things that are commonly used in primary care, PT, and PM&R.

OMM is no different than those... just applied to all the joints/muscles in the body (most commonly the axial spine). It's not like neuromuskuloskeletal OMM is so out there conceptually. I'm sure the MDs that have seen it or practiced it can understand the utility of it.

And to compare the evidence bases of OMM and cardiology is completely inappropriate. The funding and stakeholders, not to mention how many or the type of patients they each respectively affect, are completely different between the two fields... it's not just about how "well-designed" the research is.

 

[kedrin]

Yeah those first three (functioning, health, disability) were all measured by survey/questionnaires. The primary outcome was pain. The authors acknowledge that in the conclusion:



I don't know if you're going to significantly change functioning, health, or disability in 12 weeks with any treatment for chronic LBP, though... so definitely need longer follow-up studies to see whether these indicators can be improved with OMT.

There are so many confounders when you look at less prescribed drug use for OMT recipients. There were different drugs used between tx groups, different drugs between each patient, non prescript drug use was somehow "calculated out". I just do not see how this allows you to make a generalized statement that OMT reduces the amount prescription drug use when the drugs themselves are not a control in the study.

 

[pattr]

There are so many confounders when you look at less prescribed drug use for OMT recipients. There were different drugs used between tx groups, different drugs between each patient, non prescript drug use was somehow "calculated out". I just do not see how this allows you to make a generalized statement that OMT reduces the amount prescription drug use when the drugs themselves are not a control in the study.

So you're going to force all the patients in the study to only have access to the same standardized drug regimen for 3 months despite different individual pain tolerances and different baseline pain levels? Look, I get your point. It's a weakness. In the study's defense, however, in Table 3 you can clearly see that rates of other LBP co-treatments (including non-prescription drugs) during the study did not differ between the two groups.

And the study only makes the gross statement of whether or not the patients reported using Rx drugs during the study period (all or nothing). It didn't define any gradients in amounts of drugs used.

A total of 31 (13%) OMT patients vs 46 (20%) sham OMT patients reported using prescription drugs for low back pain during the study (use ratio = 0.66,- 95% Cl, 0:43-1.00, P-.048). The statistical significance of this finding persisted after simultaneously controlling for all other co-treatments.

 

[Textbookversion]

I don't see how what you're doing is any less "trolling" than what he is doing. I also don't understand why some MDs get so trollish when they talk about OMM. You guys learn physical manipulations in school too... remember the treatment for nursemaid's elbow? Or the stretches you teach patients for lateral/medial epicondylitis? Or what about the carotid massage? the Dix-Hallpike and Epley maneuvers for BPPV? The Neer's test, Spurling's test, etc.... I could go on forever. These are things that are commonly used in primary care, PT, and PM&R.

OMM is no different than those... just applied to all the joints/muscles in the body (most commonly the axial spine). It's not like neuromuskuloskeletal OMM is so out there conceptually. I'm sure the MDs that have seen it or practiced it can understand the utility of it.

And to compare the evidence bases of OMM and cardiology is completely inappropriate. The funding and stakeholders, not to mention how many or the type of patients they each respectively affect, are completely different between the two fields... it's not just about how "well-designed" the research is.

MSK manipulation IS TOTALLY DIFFERENT THAN CRANIAL WANKERY.

 

[rjgennarelli]

I would like to request a forum mod delete irrelevant argumentative posts so that this thread may stay on topic. This is not the place for bashing OMM. If you wish to discredit it, then cite journal articles which prove its lack of function.

 

[Textbookversion]

I would like to request a forum mod delete irrelevant argumentative posts so that this thread may stay on topic. This is not the place for bashing OMM. If you wish to discredit it, then cite journal articles which prove its lack of function.

I have one of these so I don't need journal articles:

Not pictured: fused cranial sutures.

 

[sylvanthus]

I would like to request a forum mod delete irrelevant argumentative posts so that this thread may stay on topic. This is not the place for bashing OMM. If you wish to discredit it, then cite journal articles which prove its lack of function.

No the burden of proof is on the believers to prove it does work, not for people to prove it doesn't. You don't market a new drug or treatment by saying "prove it doesnt work."

 

[Styria]

Odd thing though... an MD radiologist working with NASA studying astronauts suffering with various neurological deficits presented his data that proved wide variety of concepts that osteopathy has had as its foundation for 100 years... He came to those who practice Osteopathy in the cranial field and asked them what is going on. It's not voodoo (and cranial is a vehicle for a concept, not the end all) Once you feel it and apply it with ridiculous results, you'll begin to question a lot of things you thought were true. Or you can decide to look for some pharmaceutical funded double blind placebo controlled trial done by spine surgeons conducting cervical fusions as being more efficacious than osteopathy... and then you can see an MRI of a cervical spine in motion and realize the fusion didn't do a damn thing to stop motion... the radiologists words, not mine...

I was there. That was a great lecture, but I got the feeling Dr. Harshfield had no idea his audience palpates and treats cranial bones, membranes, and the CNS rather than just doing HVLA on the cervical spine. He let me copy his flash drive, and there are videos on there of a chiropractor grappling people's heads and whacking on their necks with an Activator, with accompanying fluoroscopy. Even the cranial people who use HVLA probably would have been pretty offended if he'd played that for us!

 

[Jwalker]

double blinded cranial !
http://www.ncbi.nlm.nih.gov/pubmed/20430912

 

[Lawgiver]

FDA approves drugs all the time where the how mechanism is not understood.Why are hands on therapies always looked at with extra scrutiny?

 

[Petypet]

double blinded cranial !
http://www.ncbi.nlm.nih.gov/pubmed/20430912

29 patients in the osteopathic journal with an impact factor of 0. Something to keep in mind with this journal.

FDA approves drugs all the time where the how mechanism is not understood.Why are hands on therapies always looked at with extra scrutiny?

But show us a drug that is approved that doesn't have significant journal publications demonstrating efficacy and safety. OMT is only shown to work in the aforementioned osteopathic journal. I am not even sure this journal is peer reviewed....

 

[DrEnderW]

There's no point talking about OMM pubs in the JAOA. If supporters of OMM want the practice to gain greater acceptance in the medical community, they need to publish in legitimate IF rated journals read by all physicians.

I don't think people realize how sketchy it is only publishing OMM in one in-house journal with an IF of zero.

 

[DocVapor]

There's no point talking about OMM pubs in the JAOA. If supporters of OMM want the practice to gain greater acceptance in the medical community, they need to publish in legitimate IF rated journals read by all physicians.

I don't think people realize how sketchy it is only publishing OMM in one in-house journal with an IF of zero.

Amen! Been preaching this for years.

 

[wjs010]

So, I'm not sure about that move where you lay down and have restricted cervical rotation. So you turn your head and just look with your eyes in the opposite direction. Wtf is that ?

Btw, one of the FAAO dudes at my school said it was hard to do clinical trials research for OMM because it's like , okay, the control group is not getting OMM and the other is... Lol