What Every MS-I Should Know About Learning OMM

JPHazelton said:

I am writing this post in order to better prepare incoming first year DO students for OMM lab and lecture. I am an undergraduate OMM Fellow at PCOM so I have the opportunity to participate in the education of underclassmen in the OMM course. This post contains my own personal suggestions and do not reflect PCOM or PCOM's OMM Department.


First...DOs and DONTs for OMM

DO take OMM seriously. This is a class that is graded just like Anatomy, Physiology and Pharmacology. You will also see OMM questions on the COMLEX (approximately 18% of the exam).

DO practice OMM in your spare time. Just as you would break out Netter to study Anatomy, break out your lab manual to study OMM. You absolutely cannot get better at this unless you put in the time and effort. If you want to become a surgeon you practice tying. If you want to become an anesthesiologist you practice intubating. If you want to become an osteopathic physician you practice OMM.

DO search out other modalities for learning OMM. Just because a certain professor explains something in a particular way, that doesnt mean you cant learn it a different way AS LONG AS YOU GET THE CONCEPTS. Some professors, just like some students, are more visually oriented and their lectures will appeal more to those students...the opposite is true for more concrete learners. Find which methodology works best for you and use it to you advantage.

DO NOT go through the motions with OMM. It is very easy to copy techniques from your lab manual or copy the movements of your instructors in order to make it look like you know what you are doing but if you do not understand the dynamic anatomy and physiology behind what you are doing then you have done nothing but waste your time.

DO NOT let OMM intimidate you. Some people pick it up quickly, others do not. Do not get discouraged if you are the one in your class who cannot palpate as well as your partner. Do not get discouraged if you cant get the technique correct right away. Time and practice will bring everyone to where they need to be.


Now, just some general points of advice:

- Use you instructors and OMM fellows. OMM is a subject that must be taught hands-on (no pun intended). Ask for help if you need it.
- Be careful asking upper classmen for advice unless you know that THEY know what they are doing. I cannot tell you how often I see MSIIs giving advice to MSIs that is absolutely wrong and will not only cause them to fail a practical, but can lead to them inadvertently hurting someone in the process.
- The development of you OMM skills is directly proportional to the amount of time you put into learning the subject.
- Learning anatomy really well will help you learn OMM and learning OMM really well will help you learn anatomy. These two subjects go hand-in-hand without question. In my experience some of the best clinical anatomists are also great at OMM.
- Take your time. Developing palpatory skills and comfort in performing techniques is not something you can get by reading a book. You need to practice, practice, practice...and be patient as your palpatory skills grow.
- Make models, draw pictures, use the anatomy lab, use anatomical models...whatever it takes to help your spatial mind become stronger.

I hope this has been somewhat helpful. If nothing else maybe this post will help ease the worry some of you have about OMM.

OMM is not like pharmacology or microbiology. You cannot simply study charts or sit in a study group discussing. You need to do, practice and most importantly, incorporate OMM into everything else you learn...it will make the most sense this way and, in turn, make the most of your osteopathic education.

Click to expand...

I couldn't have said it any better......well, maybe I could.

Seriously, though, JP speaks out of a great knowledge basis and is a great teacher. To those incoming and current MS's- listen to his advice.

And, don't hesitate to ask any questions about OMM. JP will be happy to answer them.

In closing, three words, "Practice makes perfect."

Chisel
PCOM MS III.75

I am also a 4th year...here's my input: you will like some techniques, and dislike others. You will want to use some in practice, and not others. When it comes to the real world, you can't know/learn them all (unless you plan on doing a HUGE amount of OMM in your practice) so for school/boards learn it all fairly well. When you are done, learn what you plan on using and learn it well. I don't do some modalities, but I know the types I like, and do them well.

I am an MS4 - here's my take...

Some people like it, some don't...by the end of your 3rd year, you will know if you'll ever use it while you are an attending. That being said - It's still going to be on AT LEAST THREE sets of comlex tests, not to mention that beloved PE.

Don't think schools don't fail people in OMM...it happens. About 6 people failed 3rd quarter OMM at KCOM during my 1st year and had to take that quarter again.

IMPORTANT - feeling things is a SUBJECTIVE thing. You may feel you are 100% right with your diagnosis...but whoever is checking you may totally disagree...even when you ask the instructor to show you what you did wrong..and they place your hands right were theirs were...you will still disagree - but, you aren't grading yourself..so what the instructor says is what the diagnosis is....

Get used to the fact that some people simply have the talent of OMM - regardless of whether you like OMM or not, you may suck at it. Me? I absolutely suck at it. I can "crack" people and do really good soft tissue and muscle energy - but I'm not one of those who can put my hands on people and know just what ails them....some people do that and I think it's fantastic...just don't be discouraged if you aren't one of them.

Practice for practicles...sometimes that IS just going thru the motions...it's going to be your biggest perceived waste of time when you have biochem and phys exams the same day of practicles....but...you gotta do it.

double elle said:

I am an MS4 - here's my take...

Some people like it, some don't...by the end of your 3rd year, you will know if you'll ever use it while you are an attending. That being said - It's still going to be on AT LEAST THREE sets of comlex tests, not to mention that beloved PE.

Don't think schools don't fail people in OMM...it happens. About 6 people failed 3rd quarter OMM at KCOM during my 1st year and had to take that quarter again.

IMPORTANT - feeling things is a SUBJECTIVE thing. You may feel you are 100% right with your diagnosis...but whoever is checking you may totally disagree...even when you ask the instructor to show you what you did wrong..and they place your hands right were theirs were...you will still disagree - but, you aren't grading yourself..so what the instructor says is what the diagnosis is....

Get used to the fact that some people simply have the talent of OMM - regardless of whether you like OMM or not, you may suck at it. Me? I absolutely suck at it. I can "crack" people and do really good soft tissue and muscle energy - but I'm not one of those who can put my hands on people and know just what ails them....some people do that and I think it's fantastic...just don't be discouraged if you aren't one of them.

Practice for practicles...sometimes that IS just going thru the motions...it's going to be your biggest perceived waste of time when you have biochem and phys exams the same day of practicles....but...you gotta do it.

Click to expand...

True. It is tough studying for all of the other subjects plus OMM. My advice, as I'm sure JP will back me up on, is to learn the techniques, don't just go thru the motions.

True that some people are good and some are amazing when it comes to OMM. You don't have to suck at OMM. Let's be realistic. We're all above average people or else we wouldn't be where we are today. You don't have to be a good palpator to be good at OMM. Larry Jones who is the founder of Counterstrain was never a good palpator. Hell, I'm sure that most people don't ever feel "the release", etc. But you can become good with the application of OMM.

Even if you learn OMM only to use it on your family and a few select patients in the future, you'll find that it is worth the time to know how/why it works. If you look at it as preparing for the tests just "so that you can pass", it will end up taking you longer to learn it each time you prepare.

You have the most time you'll ever have now while your in school. Why go thru the motions for every single exam (COMLEX and state boards included) when you can learn the material while you have lectures to accompany it and the faculty to help you, not to mention your classmates to hurt, I mean practice on.

Just my opinion.

Chisel

MGoBlueDO said:

Dr. Simmons books is good...www.drsimmons.net...I think its 25.00 or so. I wish I bought it my first year rather than just for the boards second year...it would have helped me understand the basic concepts a lot faster...

Click to expand...

If you have any serious interest in OMM and plan on using it in practice you shoul down both the SImmons and the Saverese book. There is significant overlap, of course, but very different styles and you will learn and retain more using them both. The Saverese book has ALOT of Qs in the back. Really having both is a good idea. The earlier in your education the better

double elle said:

IMPORTANT - feeling things is a SUBJECTIVE thing. You may feel you are 100% right with your diagnosis...but whoever is checking you may totally disagree...even when you ask the instructor to show you what you did wrong..and they place your hands right were theirs were...you will still disagree - but, you aren't grading yourself..so what the instructor says is what the diagnosis is....

Get used to the fact that some people simply have the talent of OMM - regardless of whether you like OMM or not, you may suck at it. Me? I absolutely suck at it. I can "crack" people and do really good soft tissue and muscle energy - but I'm not one of those who can put my hands on people and know just what ails them....some people do that and I think it's fantastic...just don't be discouraged if you aren't one of them.

Click to expand...

Im an MSIV at KCOM as well, and an OMM fellow.

so here's my take- while I agree not everyone born -should- be an osteopath- your skill is VERY much dependent on how much you put into it. The first years I watch who practice outside of class every week in many cases already have better hands than second years who love OMM and want to be good- but never really put in the time (much less the ones who only study for practicals). Many did NOT have a natural talent with this stuff when they started but are quickly becoming great.

To learn more advanced tools- such as diagnosis using visual cues or diagnosis across fascia or through distant joints, you need mentors who can show you how its done. nobody is born knowing that stuff, and it doesn't usually make its way into the curriculum.



My stock advice for incoming students and MS-1's who want to make the most of their osteopathic education- whether or not you want to be an OMM specialist:

1) Seek out mentors early and often. Watch for people who do what you want to do, and ask them how they do it- and work with them until you can.

2) Practice REGULARLY outside of class. make the time to get good at diagnosis- perhaps a weekly meeting, perhaps 10 minutes daily. Work with OMM fellows- in many schools we get paid work study to teach outside of class so many of us are approachable for tutoring (not only for remedial work- but for advanced training).

3) SHADOW in the clinic. most of your classmates are NOT sick and do NOT need much treatment, and this is all you get in class. The post treatment soreness of an un-localized treatment may be worse than the asymptomatic asymmetry that you tried to treat. - compare this to patients who go to see OMM specialists in the clinic. Worried about the subjectivity of diagnosis? wait till you see your first scoliosis patient (sidebent left you say?) and if they don’t need a metal rod in their back due to your work and the work of your attending- perhaps you can convince yourself that your time has been well spent. Whiplash? Chronic pain? Newborns with birth trauma? You need to see OMM in action to understand how to study it. Its not enough to memorize hand positions out of a book for patients like these.

4) Learn that anatomy!
Osteopathy is really all about anatomy, functional anatomy, physiology and a deep understanding of pathophysiology. If you don’t know these things, how can you possibly hope to find the source of a patient’s problems? If you don’t know the thoracic functional anatomy of respiration, pulmonary physiology and autonomic innervation, how are you going to treat things like asthma where abnormal resting autonomic tone of the lungs and restricted rib cage movement is often an important part of the -source- of the disease process? You need to be able to diagnose if it is hyper-parasympathetic, hypo-sympathetic, or purely restricted rib-cage mechanics (AND WHY) -and then treat the cause accordingly (also useful for choice of beta agonist vs ACh antagonist until the symptoms resolve completely). If you just pop their back where it hurts… really- what are the chances that your will entirely fix the source of the aberrant physiology with that? Zero.

Learning the mechanics of OMT and having good hands is important as an osteopath, but certainly far less important than understanding living anatomy, pathophysiology, and the philosophy of osteopathy. If you don’t know medicine or osteopathic philosophy and just study OMT you are really something of an overpaid chiropractor (and you’ll keep treating patients for the same things- since you don’t know enough to treat causes). If you know your medicine but don’t put in your time into learning osteopathic theory and OMT, it is very hard to justify having a DO vs an MD. As an osteopath you need to know it all, which unfortunately is very difficult. The rewards, I think, are worth it.
------
if you arent going to specialize in OMM- the more you know the less time you have to spend to come up with a good diagnosis and an effective treatment. keep that in mind.

That just about sums it up- good luck!

Thanks guys! This is very useful information. We'll have some good amt to look forward to this fall.

Is it o.k. to wear sweats or scrubs instead of shorts during omm lab. Also if you're not comfortable with having someone of the opposite sex working with you, is it o.k. to request to work with someone of the same sex.

Juniperbee said:

Is it o.k. to wear sweats or scrubs instead of shorts during omm lab. Also if you're not comfortable with having someone of the opposite sex working with you, is it o.k. to request to work with someone of the same sex.

Click to expand...

The specifics of dress code and partner selection depend on the school (KCOM is flexible on both questions, while i know at least a couple other schools are not). I suggest you get used to the idea of working with members of both sexes though- you will want exposure to as many body types as possible to improve your diagnostic skills.

Juniperbee said:

Is it o.k. to wear sweats or scrubs instead of shorts during omm lab. Also if you're not comfortable with having someone of the opposite sex working with you, is it o.k. to request to work with someone of the same sex.

Click to expand...

you are required to wear scrub pants and a srub top or t-shirt at OSU-COM, so no shorts anyway

you can easily be assigned to the same gender by request (in fact, i've been pretty much in this situation, regardless of my preference)----keep in mind that there are differences, especially in pelvic mechanics and anatomy between males and females, and you will need to spend time on both genders to be competent

Thank you JP and Mike from KCOM for this very thoughtful and appropriate thread.

My advice, being an MS-IV about to enter internship and residency.....

1. When you are an MS-I or MS-II, it can be hard to see the value of what you are learning. Have a little faith that if you are paying attention, you will see the magic of OMM work.
2. Go to allheart.com and buy a cheaper diagnostic set (since you will hardly use it anyway) and put the extra $$$ into either a spine or a skeleton model. This way, you can use the spine to see what is really going on. I wish I would have done that first year. I have one now and working on OMM is completely different.
3. Try and do a rotation with an OMM doc. Not just an FP who does OMM, but a C-SPOMM doc who does OMM full-time. You will learn a ton. I was afraid to do one because I never felt that my OMT was any good. What I have learned in two weeks is that, one, my skills are actually a lot better than I ever thought they were, and two, the doc can help you look at OMT and diagnosis/treatment a new way. It's unfortunate that we end up "segmenting" the body instead of seeing it for its interconnectedness.


If you need a good OMM rotation, check out Mt. Clemens General Hospital in MI. Dr. Dillard and Dr. Rennie are both full-time OMM docs, and are superb.

Juniperbee said:

Is it o.k. to wear sweats or scrubs instead of shorts during omm lab. Also if you're not comfortable with having someone of the opposite sex working with you, is it o.k. to request to work with someone of the same sex.

Click to expand...

In our labs you need to wear t-shirt and shorts to have full access to the body. And you absolutely need to get used to working with the opposite sex. You will have patients of the opposite sex so might as well get used to it. your classmates see you without your shirt on/half-naked in that class so you sort of get used to it.

Thank you so much for your advice.

I will be attending GA-PCOM in August, and with the class of 2009 being the pioneering class, how would you suggest for us to get extra exposure to OMM minus the fellows and upperclassmen.

ttpatel said:

Thank you so much for your advice.

I will be attending GA-PCOM in August, and with the class of 2009 being the pioneering class, how would you suggest for us to get extra exposure to OMM minus the fellows and upperclassmen.

Click to expand...

You will have the benefit of smaller classes and the OMM dept will be able to spend more time with you since they are not going to be teaching any 2nd years. Talk to the head of your dept, Dr. E, if you want to spend some more time on it. I would also try to shadow an OMM specialist (might be hard to find in Lawrenceville) with your free time. On another track you should look to get your local chapter of the Undergraduate American Academy of Osteopathy up to speed so as to be a rallying point for those of you willing to spend more time on their OMM development. The AAO convocation will be in Birmingham in the spring and it would be pretty convenient for your school to send a good sized contingent. I am the president of the UAAO at PCOM and will me making a trip down to speak to y'all in the fall about the UAAO and SGA creation process. Look forward to meeting you.

Juniperbee said:

Is it o.k. to wear sweats or scrubs instead of shorts during omm lab. Also if you're not comfortable with having someone of the opposite sex working with you, is it o.k. to request to work with someone of the same sex.

Click to expand...

I don't have the exact wording with me atm, but at AZCOM when you matriculate, you sign an agreement that you must work with both sexes and allow fellow students to crack you. It's not a big a deal. You lose a lot of self-consciousnss quickly and, like several people have said already, you're going to need to know how to work with anyone.

We have random partners for practicals. You have to be comfortable with male/female, short/tall, overweight/athletic, etc. It's actually pretty fun and the challenge of working with a new partner can be exciting.

FYI: for certain technics you can request that your partner adjust their methods here, but it rarely happens (e.g. inf. pelvic shear, thoracic pump).

I am an anesthesia resident; I went to an AOA internship. A few things I've noticed about OMM:

1) Most, but not all, OMM people are a little bit stranger than others. But they are almost all very nice and approachable.

2) To do well on the COMLEX, you need to know neuro and sacrum, but mostly your neuro which you can get from books, not practice.

3) It's kind of laughable on the COMLEX to go from a highly clinical question stem with an answer like spontaneous bacterial peritonitis to "Question 102. Patient steps off of from curb..." with an answer like superior shear.

4) There is no literature that shows that OMM does anything effective except possibly reduce the number of NSAIDS for low back pain. Rib-raising for pneumonia is would make everyone laugh at me at my MD hospital.

5) Do practice your OMM in school because it probably will be the last time you actually use it unless you're doing an OMM residency. You will see it again (very little - once a month) if you do an AOA residency.

6) One of my attendings (a DO) had pretty severe low back pain and tried the OMM clinic. He came back and told me, "they feed off of one another - one guys says he palpates this, the other guys says yeah, and it becomes a big spiral." His back pain never really resolved except with rest and NSAIDS, the most recognized treatment.

7) I'm glad I never bought any OMM books in med school like my some of my fellow students who ended up never even cracking them open.

8) A program director at my school once said at internship orientation, "Too bad we didn't score higher on the MCAT so we don't have to sit through this once a month [talking about the OMM lectures]

9) Back cracking and neck popping is flashy but it doesn't really solve anything.

10) You will see what I mean when you graduate med school.

11) Believe me, I wish there were more positive literature (not in JAOA) about OMM not just anecdotes and blind faith. Good quality studies is what the AOA should back.

12) I have nothing against OMM people at all. They are the real osteopaths, but they are a very, very rare species. Kudos to them.

TomasMay said:

1) Most, but not all, OMM people are a little bit stranger than others. But they are almost all very nice and approachable.

Click to expand...

agreed.

TomasMay said:

2) To do well on the COMLEX, you need to know neuro and sacrum, but mostly your neuro which you can get from books, not practice.

Click to expand...

Neuro, autonomics, cranial, and other random stuff from OMM are all tested on comlex, and none require hands on knowledge (it is a written test- so of course this is the case). That said, if you only study that which will give you a higher board score, you are not serving your patients or your future practice.

TomasMay said:

3) It's kind of laughable on the COMLEX to go from a highly clinical question stem with an answer like spontaneous bacterial peritonitis to "Question 102. Patient steps off of from curb..." with an answer like superior shear.

Click to expand...

agreed. laughable. except when you realize how much money you as an anesthesiologist can make in a pain clinic, and then when you realize that at best you can actually help about half of the patients that show up asking for help (and of those, the help is usually temorary). Some of these patients present with scenarios like the laughable one above (though more commonly an auto wreck or serious fall).. and most anesthesiologists waste a tremendous amount of time on these patients with little progress. I have had tremendous success on some of the worst pain clinic patients i've seen using OMM, and the improvements are permanent, unlike cortisone shots. Of course, success using OMM depends on the etiology of the pain- but the majority have serious musculoskeletal contributions.

TomasMay said:

4) There is no literature that shows that OMM does anything effective except possibly reduce the number of NSAIDS for low back pain. Rib-raising for pneumonia is would make everyone laugh at me at my MD hospital.

Click to expand...

This is blatantly false. There are literally hundreds of studies out there.
http://www.osteopathic-research.com/

I agree that many of them are poorly done, and that the JAOA is a laughable publication (I have done years of research myself, and JAOA is not up to snuff). There have been good studies taht have shown OMM to be more effective than NSAIDS for LBP and neck pain and it has been shown to decrease hospital stays in pneumonia patients by ~2 days. The problem is finding OMM docs from private practice that want to ditch a 300k-400k/year practice that is also a lot of fun to go do boring research for pennies, even if it would help the profession (those who end up in academics usually do not treat as clincially serious cases- and many dont know enough about research to put together an effective study).

TomasMay said:

5) Do practice your OMM in school because it probably will be the last time you actually use it unless you're doing an OMM residency. You will see it again (very little - once a month) if you do an AOA residency.

Click to expand...

This is true for some schools, and its very sad. It means that all those hours in lab were completely wasted for all of these students. I personally am planning on an allopathic Neurology residency and i will likely use my OMM daily (since i usually get instant improvement on migraines and certain types of nerve impingement neuropathies). Those who enter physiatry, orthopedics sports med, neurology and anesthesia (pain management) have the greatest need to master OMM of any specialties. FP's may only find it useful for about 20-30% of their patients- those who have musculoskeletal complaints, but this is still significant (i.e. daily use). Usually, however, students who never invest time in their osteopathic skill will never be good enough to help their patients- and will be forced to refer out or (more commonly) just leave their patient suffering, hoping that nature will eventually run its course over the next few weeks or months.

TomasMay said:

6) One of my attendings (a DO) had pretty severe low back pain and tried the OMM clinic. He came back and told me, "they feed off of one another - one guys says he palpates this, the other guys says yeah, and it becomes a big spiral." His back pain never really resolved except with rest and NSAIDS, the most recognized treatment.

Click to expand...

There are good and bad docs in every speciality. it sounds like he found some bad ones. Does this mean that if a surgeon takes out your gallbladder and you still have abdominal pain you will never go to any surgeon ever again? You might want a second opinion on the diagnosis first- and then find someone with the tools to correct it (i.e. possibly another surgeon, depending on the diagnosis).

TomasMay said:

7) I'm glad I never bought any OMM books in med school like my some of my fellow students who ended up never even cracking them open.

8) A program director at my school once said at internship orientation, "Too bad we didn't score higher on the MCAT so we don't have to sit through this once a month [talking about the OMM lectures]

Click to expand...

If you have no interest in learning osteopathic philosophy or osteopathic mechanical principles- you should have attended an MD school. It is a waste of your time to attend courses that will not benefit your career, and the pessimistic attitude hurts those in your class that seriously want to learn. If your numbers were not good enough to get into an MD school- you might as well make the most of the extra educational opportunities to develop your hands for patient care and learn to be a great osteopath. Many of us chose the DO route even with numbers that would have landed us in great MD programs- and are very glad we did. please dont regard osteopathy as a second-rate choice, nor go around in public places degrading our profession.

TomasMay said:

9) Back cracking and neck popping is flashy but it doesn't really solve anything.

Click to expand...

agreed. HVLA is a temporary fix at best when used by itself (when used unskillfully it can even be a real problem). If you want OMM to work, "popping" is probably not something you will do much of. I almost never use HVLA on my most serious cases, and have yet to use it in the hospital setting or on infants. We have hundreds of tools, and almost all work better than even perfectly localized HVLA for long term care (though it may feel good in the short run). Often chronic pain is more about fascial and muscular syndromes (or chronic bone wear or displacement secondary to these processes)- these are not people you want to be popping, unless you want even more pain and spasm.

TomasMay said:

10) You will see what I mean when you graduate med school.

Click to expand...

Unfortuately many will share your sentiment on graduation. This reflects a failure of education for integration of osteopathic theory and practice into mainstream medical knowlege (the job of your school) rather than a failure of osteopathic philosophy or practice itself. This failure is manefest in any schools where graduates are all essentially either MD's with a DO degree or OMM specialists with little to no medical knowledge (aka glorified overpaid chiropractors). Unfortunately, this is a rather widespread problem in our profession at the moment- and the new schools popping up every day do little to help the problems present at those schools that already exist (such as insufficient skilled osteopathic faculty).

TomasMay said:

11) Believe me, I wish there were more positive literature (not in JAOA) about OMM not just anecdotes and blind faith. Good quality studies is what the AOA should back.

Click to expand...

agreed. See my answer to #4 above. There is plenty of OMM literature, but very little of it is good. Fortunately you can see its success instantly and reliably when you shadow someone who has taken the time to develop their skill, and you can repeat their successes with your own hands.

TomasMay said:

12) I have nothing against OMM people at all. They are the real osteopaths, but they are a very, very rare species. Kudos to them.

Click to expand...

You bring to light some very valid and troubling topics that our profession is struggling with. I appreciate the post, and i hope i did not offend with my pointed replies. I am not saying every osteopath should be an "OMM guru". what i am saying is that every DO should learn to use their hands, it is critical for the diagnostic reasoning we use in medicine every day, and it can also be a very valuable first-line treatment tool for the vast majority of specialties- and it seems a waste to throw away such potential.

Woo-Woo! Great post!

sorry but OMM is silly ....it makes DO's look ridiculous....and why the hell dont Do's do more research,. have you ever read the New england journal.. i ve looked through it for years and barely ever see a single Do ever! how can Do's be taken serioulsy with cranial sacral. you cant fu***ckn help erebral palsy with palpating. wise up!!

tigger0821 said:

sorry but OMM is silly ....it makes DO's look ridiculous....and why the hell dont Do's do more research,. have you ever read the New england journal.. i ve looked through it for years and barely ever see a single Do ever! how can Do's be taken serioulsy with cranial sacral. you cant fu***ckn help erebral palsy with palpating. wise up!!

Click to expand...

Troll.

Moderators?

tigger0821 said:

sorry but OMM is silly ....it makes DO's look ridiculous....and why the hell dont Do's do more research,. have you ever read the New england journal.. i ve looked through it for years and barely ever see a single Do ever! how can Do's be taken serioulsy with cranial sacral. you cant fu***ckn help erebral palsy with palpating. wise up!!

Click to expand...

your posts make you look silly!

Perhaps you can't help someone with cerebral palsy, but you can sure help someone like me with hyperextension mobility syndrome - and the MDs can't do a darn thing to help me at all.

tigger0821 said:

sorry but OMM is silly ....it makes DO's look ridiculous....and why the hell dont Do's do more research,. have you ever read the New england journal.. i ve looked through it for years and barely ever see a single Do ever! how can Do's be taken serioulsy with cranial sacral. you cant fu***ckn help erebral palsy with palpating. wise up!!

Click to expand...

Learning OMM can aid DO's in more ways than one. The fact is, as we learn OMM we become very comfortable touching other people. Osteopathic Physicians touch their patients more than Allopathic Physicians. By placing a hand on a patients arm or shoulder is very comforting for them and provides a better patient/physician relationship. It shows compassion and caring. You can't just think about the disease when treating a patient, you must treat the WHOLE person. If I can calm and relax a patient by performing Cranial, which I can, then it's incredibly useful.

I personally enjoy treating patients with Cranial. I've treated many headaches and migranes very successfully. Next time you're suffering from a headache, maybe you can bite your tongue and find a talented DO to help you out.

BoneCruncherDO said:

Learning OMM can aid DO's in more ways than one. The fact is, as we learn OMM we become very comfortable touching other people. Osteopathic Physicians touch their patients more than Allopathic Physicians. By placing a hand on a patients arm or shoulder is very comforting for them and provides a better patient/physician relationship. It shows compassion and caring. You can't just think about the disease when treating a patient, you must treat the WHOLE person. If I can calm and relax a patient by performing Cranial, which I can, then it's incredibly useful.

Click to expand...

There is clearly much more to osteopathy than touching patients, and much more to cranial than relaxing patients, although these are nice side effects that make patients feel like they can trust us (i often get patients spilling their guts to me about things they wont tell anyone else involved in their healthcare).

The "relaxation" part of cranial may allow patients with chronic anxiety, insomnia or fibromyalgia to get some sleep for days or weeks, or ideally much more (by cutting their anxiety->spasm->sleep deprivation->more spasm->more anxiety cycle)... but this is really very little of what cranial is about.

Cranial osteopathy is a controversial subject for many due to our fuzzy understanding of its mode of action and its adaptation by many outside the profession (and even some inside the profession) with little medical understanding. We had a discussion about this on another forum if you are interested. I am happy to field questions, personal observations, thoughtful objections, and inane criticisms on the topic of cranial osteopathy there:

http://forums.studentdoctor.net/showthread.php?t=174060&page=6

Lets keep this forum here on topic though-> subjects of direct relevance to new first year students (cranial is a more advancted topic, no matter your opinion of it).

please read what i wrote on page 6 of that forum before putting in your 2 cents there. I covered a lot of information there to bring order to the madness. It would be more productive to the discussion if we were building on (or refuting) my points rather than repeating the same things.

thanks.

JPHazelton said:

I am writing this post in order to better prepare incoming first year DO students for OMM lab and lecture. I am an undergraduate OMM Fellow at PCOM so I have the opportunity to participate in the education of underclassmen in the OMM course. This post contains my own personal suggestions and do not reflect PCOM or PCOM's OMM Department.


First...DOs and DONTs for OMM

DO take OMM seriously. This is a class that is graded just like Anatomy, Physiology and Pharmacology. You will also see OMM questions on the COMLEX (approximately 18% of the exam).

DO practice OMM in your spare time. Just as you would break out Netter to study Anatomy, break out your lab manual to study OMM. You absolutely cannot get better at this unless you put in the time and effort. If you want to become a surgeon you practice tying. If you want to become an anesthesiologist you practice intubating. If you want to become an osteopathic physician you practice OMM.

DO search out other modalities for learning OMM. Just because a certain professor explains something in a particular way, that doesnt mean you cant learn it a different way AS LONG AS YOU GET THE CONCEPTS. Some professors, just like some students, are more visually oriented and their lectures will appeal more to those students...the opposite is true for more concrete learners. Find which methodology works best for you and use it to you advantage.

DO NOT go through the motions with OMM. It is very easy to copy techniques from your lab manual or copy the movements of your instructors in order to make it look like you know what you are doing but if you do not understand the dynamic anatomy and physiology behind what you are doing then you have done nothing but waste your time.

DO NOT let OMM intimidate you. Some people pick it up quickly, others do not. Do not get discouraged if you are the one in your class who cannot palpate as well as your partner. Do not get discouraged if you cant get the technique correct right away. Time and practice will bring everyone to where they need to be.


Now, just some general points of advice:

- Use you instructors and OMM fellows. OMM is a subject that must be taught hands-on (no pun intended). Ask for help if you need it.
- Be careful asking upper classmen for advice unless you know that THEY know what they are doing. I cannot tell you how often I see MSIIs giving advice to MSIs that is absolutely wrong and will not only cause them to fail a practical, but can lead to them inadvertently hurting someone in the process.
- The development of you OMM skills is directly proportional to the amount of time you put into learning the subject.
- Learning anatomy really well will help you learn OMM and learning OMM really well will help you learn anatomy. These two subjects go hand-in-hand without question. In my experience some of the best clinical anatomists are also great at OMM.
- Take your time. Developing palpatory skills and comfort in performing techniques is not something you can get by reading a book. You need to practice, practice, practice...and be patient as your palpatory skills grow.
- Make models, draw pictures, use the anatomy lab, use anatomical models...whatever it takes to help your spatial mind become stronger.

I hope this has been somewhat helpful. If nothing else maybe this post will help ease the worry some of you have about OMM.

OMM is not like pharmacology or microbiology. You cannot simply study charts or sit in a study group discussing. You need to do, practice and most importantly, incorporate OMM into everything else you learn...it will make the most sense this way and, in turn, make the most of your osteopathic education.

Click to expand...

Hey,
Great Post!!!!! I agree with you.

ShyRem said:

Perhaps you can't help someone with cerebral palsy, but you can sure help someone like me with hyperextension mobility syndrome - and the MDs can't do a darn thing to help me at all.

Click to expand...

it's ok!

OMM is for those unable to think for themselves. The classes are taught as if AT Still is a divine being with omniscient powers. It is more of a cult, and if you are critical of it, you are dismissed as a non-believer. I don't doubt that SOME "somatic dysfunction" type lesions play a role in acute and chronic pain, but the inability of the AOA and OMM-happy students / DOs to critically analyze these practices for efficacy's sake is rediculous. You can site a handful of rinky-dink studies over the years, "OMM better than NSAIDS in LBP...", etc..., but they don't mean squat if they aren't dbl blind randomized controlled trials or systematic reviews of such trials.
More to follow when I catch up on sleep...

homeboy said:

OMM is for those unable to think for themselves. The classes are taught as if AT Still is a divine being with omniscient powers. It is more of a cult, and if you are critical of it, you are dismissed as a non-believer. I don't doubt that SOME "somatic dysfunction" type lesions play a role in acute and chronic pain, but the inability of the AOA and OMM-happy students / DOs to critically analyze these practices for efficacy's sake is rediculous. You can site a handful of rinky-dink studies over the years, "OMM better than NSAIDS in LBP...", etc..., but they don't mean squat if they aren't dbl blind randomized controlled trials or systematic reviews of such trials.
More to follow when I catch up on sleep...

Click to expand...

I couldn't agree more.

OMM will be the easiest course you take during your 2 didactic years and if you pay attention in class and put an hour into studying for the exams, there's no reason you shouldn't get A's.

OMM has helped people in the past, however, many of the claims about OMM are ridiculous and baseless.
Some examples of ridiculous claims I have heard over the past 2 years:

Doing OMM on every patient earns you an extra $180,000 a year.
The Cranial Technique CV IV can induce labor.
Cranial-sacral manipulation has been proven to be efficacious (yet when you ask for proof they have none).
A DO who doesn't do OMT isn't a full physician.


Don't believe the hype. OMM can help, but it is not the be-all-end-all of what a physician is, if it were, why not be a chiropractor? Don't get guilt tripped into believing everything they tell you in OMM either. Second guessing OMM and questioning it's validity doesn't make you any less of a DO or DO student, it just shows you have a brain and are able to think for yourself.

We stopped using leeches long ago to treat patients because they were never proven to work. OMM has not been proven to work yet it lingers, any intellectual person has no choice but to ask why?

I agree with Taus. This is how you should go through your entire medical education, pick up the things from every doc that will make you a better doc and leave the BS at their door.

Some interesting info...
The largest OMM course held yearly is a conference in Michigan at MSU-COM. The second largest, at Harvard. If you're a DO and have any interest at all in OMT this should make you mad. Another thing, PM&R has for years used what they call "manual medicine" which is basically OMM/PT and this is practiced all over the country by MDs. PM&R is typically a very DO friendly specialty because we're very familiar with the mskel system and how to treat with our hands.

If you don't buy into it entirely, fine but don't dismiss it as entirely false. My program doesn't shove it down our throats so I've been very fortunate to not hear some of the stuff you guys have. I've also been able to participate in OMT related research and our OMT chair conducts his own research projects year round. Oh that reminds me, it's impossible to conduct a double blind project when someone is actually using their hands for the treatment. You can use sham but the doc is obviously going to know what s/he did.

-J

I think probably the most interesting thing about this thread is that a future DO MS1 can see that OMM brings up controversy among med students! HAH!

That being said, a positive attitdue goes a long way toward your grade in OMM. And it will be amazing how much it will help you on your boards, because you will have a proportionately higher number of questions on the boards vs the difficulty in the subject.

Oh, and they are using leeches still for wound dehiscence.

homeboy said:

OMM is for those unable to think for themselves. The classes are taught as if AT Still is a divine being with omniscient powers. It is more of a cult, and if you are critical of it, you are dismissed as a non-believer. I don't doubt that SOME "somatic dysfunction" type lesions play a role in acute and chronic pain, but the inability of the AOA and OMM-happy students / DOs to critically analyze these practices for efficacy's sake is rediculous. You can site a handful of rinky-dink studies over the years, "OMM better than NSAIDS in LBP...", etc..., but they don't mean squat if they aren't dbl blind randomized controlled trials or systematic reviews of such trials.
More to follow when I catch up on sleep...

Click to expand...

I half-agree with this post.

The OMM faculty at my school has a lot of overzealous, eccentric (I'd say borderline schizotypal personality disorder), unprofessional, not-very-academically-inclined DO's. They are great at OMM, don't get me wrong, but their interaction with the students suffers on MANY levels. For example, they do not lecture well, they write poor exams, they are subjective in their grading, and their eccentricities do nothing to dispel the "witchdoctor" feel that some students get when learning OMM.

The result of this is that many students come away from the class with negative sentiments (as obviously depicted in this thread). I know it was hard for me to learn from many of these professors.

Another problem with OMM is that we only practice on each other--and guess what, we're all fine. It's pretty rare to find a real somatic dysfunction unless you're already gung-ho pro-OMM and out looking for it on your own. Those that are not impressed with OMM, or are fence-sitters, are not going to be exposed to real somatic dysfunction and thus a major part of being "converted" to the practice of OMM is missing for those who need it most!

I agree with what has already been said about the shameful lack of evidence-based medicine for OMM. This needs to be improved on immediately.

Finally, my own piece of advice to new students reading this thread:

Don't buy Foundations in Osteopathy.

It's huge. It's expensive. It's an ugly shade of green color. And you really won't use it. You ought to be able to get the concepts well enough from your professors and the lab.

Just my opinion. If you're the type that wants to go light on texts, definitely skip that one.

DOctorJay said:

I agree with Taus. This is how you should go through your entire medical education, pick up the things from every doc that will make you a better doc and leave the BS at their door.

Some interesting info...
The largest OMM course held yearly is a conference in Michigan at MSU-COM. The second largest, at Harvard. If you're a DO and have any interest at all in OMT this should make you mad. Another thing, PM&R has for years used what they call "manual medicine" which is basically OMM/PT and this is practiced all over the country by MDs. PM&R is typically a very DO friendly specialty because we're very familiar with the mskel system and how to treat with our hands.

If you don't buy into it entirely, fine but don't dismiss it as entirely false. My program doesn't shove it down our throats so I've been very fortunate to not hear some of the stuff you guys have. I've also been able to participate in OMT related research and our OMT chair conducts his own research projects year round. Oh that reminds me, it's impossible to conduct a double blind project when someone is actually using their hands for the treatment. You can use sham but the doc is obviously going to know what s/he did.

-J

Click to expand...

One of the things that attracted me to Osteopathy was the attitude of looking for different ways to heal, starting with that which his least invasive. I agree that blind adherence is dangerous, but let's look for the positives. I'm going to be an MSI this summer. What parts of OMM do you find most reliable?

As for OMM at Harvard, do you mean Harvard Medical School? In Massachusetts? It sounds like an urban legend to me. Take a look for yourself

http://medcatalog.harvard.edu/

And let's hope that the pinhead who began a legitimate topic in a childish way has as little patient contact as possible.

As for OMM at Harvard, do you mean Harvard Medical School? In Massachusetts? It sounds like an urban legend to me. Take a look for yourself

http://medcatalog.harvard.edu/

Click to expand...

Check this link:

Harvard CME: Introduction to Osteopathic Manipulative Treatment

newbie04 said:

Check this link:

Harvard CME: Introduction to Osteopathic Manipulative Treatment

Click to expand...

a weekend course hardly makes an osteopath out of an MD... however yes- they have been pushing hard to integrate OMM into PM&R, since OMM training gives such an advantage in this field. only makes sense.

newbie04 said:

Check this link:

Harvard CME: Introduction to Osteopathic Manipulative Treatment

Click to expand...

Very cool. Thanks. I had no idea Spalding had an OMM department. And of course, the CME class is at the Fairmont Copley, one of the nicest hotels in Boston.

I have now been a practicing DO for the past 6 years. I can tell you without hesitation that you are doing your patients a tremedous disservice if you do not master OMT. If you ever have a patient walk through your door (and you will) that has been taking NSAIDS for back pain/HA daily for the past year you owe it to Dr. Still and every practicing DO to truly relieve this patient of the burden of that expense.

Fwiw, NSAIDS are about 100 times more dangerous than OMT and not even close to being as effective.

Remember, you are not MDs you are DOs. Be proud of it.

Oh and to the idiot that said this,

they don't mean squat if they aren't dbl blind randomized controlled trials or systematic reviews of such trials.

Click to expand...

There has yet to be a scientist that has any clue how you can do a controlled study on a manual therapy. As soon as you figure out how get back to us, ok champ?

HVLA said:

There has yet to be a scientist that has any clue how you can do a controlled study on a manual therapy. As soon as you figure out how get back to us, ok champ?

Click to expand...

So, in essence you are saying that manipulation can never be proven by evidence based medicine, so there's no sense lamenting the lack of research...right......
Well then, what's the point of all the so-called 'research' articles in the JAOA? The last one I read...which was utterly pathetic...was treating chronic otitis media with various soft-tissue techniques and cranial...on a sample size less than 10...you can't tell me one single spec of reproducible data can be extracted from a study analyzing 5 test subjects... The JAOA--the official 'research journal' of the AOA--is a joke.

But back to the meat of this thread...what every MS-1 should know about OMM: take it with a grain of salt.

It is close-minded thinking to brush aside OMM as completely useless (particularly since it is tested on boards), and I am not discounting whatever results OMM practicioners get from their work, but there is a substantial portion of manipulative medicine that is already covered by PTs, physiatrists, and chiropracters, and much of what's left is balderdash.

This is an interesting point that many people overlook...the notion that there is extreme overlap between OMT and various other professions. Tweaks here, minor set-up differences there...and voila...OMT is it's own entity.

Bottom line? Take from OMM what your gut tells you. Be open, but not a sucker. There's alot of crap mixed in (eg. cranial) that has no business in the medical profession, and there's other stuff that I'm sure is beneficial.
You will rarely encounter students who talk bad about OMM, unless it is behind closed doors. Particularly at DMU, be careful what you say...the 'thought police' may call you into the Dean's office (seriously). Some 1st and 2nd yrs don't like what is being said on forums like these...heaven forbid people would think for themselves and express their opinions...but the most popular opinion is not always the most vocal.

homeboy said:

So, in essence you are saying that manipulation can never be proven by evidence based medicine, so there's no sense lamenting the lack of research...right......
Well then, what's the point of all the so-called 'research' articles in the JAOA? The last one I read...which was utterly pathetic...was treating chronic otitis media with various soft-tissue techniques and cranial...on a sample size less than 10...you can't tell me one single spec of reproducible data can be extracted from a study analyzing 5 test subjects... The JAOA--the official 'research journal' of the AOA--is a joke.

Click to expand...

Hey, just because there's no research supporting something doesn't mean it's not true!

For example, there's no research that says that 3 boxes of Krispy Kreme's a week prevents cancer, but a guy on my floor freshman year believed it and he's 24 and STILL doesn't have cancer

In all seriousness, the only reason there isn't more research into Cranial is the same reason that people who believe terrorists are nice people don't invite them over for dinner= they don't want to be proven wrong!

Regarding the study with n=5, I can do a study of 5 people and prove just as reliably as the JAOA study did that all people in America are 6' or taller black males. Does that make it so?

homeboy said:

But back to the meat of this thread...what every MS-1 should know about OMM: take it with a grain of salt.

Click to expand...

So true!

homeboy said:

It is close-minded thinking to brush aside OMM as completely useless (particularly since it is tested on boards), and I am not discounting whatever results OMM practicioners get from their work, but there is a substantial portion of manipulative medicine that is already covered by PTs, physiatrists, and chiropracters, and much of what's left is balderdash.

This is an interesting point that many people overlook...the notion that there is extreme overlap between OMT and various other professions. Tweaks here, minor set-up differences there...and voila...OMT is it's own entity.

Click to expand...

The most useful time to know OMM and Cranial is when you're taking COMLEX Steps 1-3 and when you're taking exams over OMM.

Good point about the overlap, I know a 2nd year PT and she has learned every technique we learned for cervicals (sans HVLA) and about 20 more in the past month. Why should physicians spend time doing what others are qualified to do when there's already a physician shortage?
Why not let the PT's, Chiro's, and the like do that stuff and have physicians concentrate on real medicine?

homeboy said:

Bottom line? Take from OMM what your gut tells you. Be open, but not a sucker. There's alot of crap mixed in (eg. cranial) that has no business in the medical profession, and there's other stuff that I'm sure is beneficial.
You will rarely encounter students who talk bad about OMM, unless it is behind closed doors. Particularly at DMU, be careful what you say...the 'thought police' may call you into the Dean's office (seriously). Some 1st and 2nd yrs don't like what is being said on forums like these...heaven forbid people would think for themselves and express their opinions...but the most popular opinion is not always the most vocal.

Click to expand...

Definitely beware the DMU thought police and their ongoing witch hunt! A buddy of mine was called in to the Dean's office because someone anonymously told the dean that he was posting things on here critical of OMM and Cranial. The guy had never been on the website until the dean pulled it up to show him!

Besides, even if he was the one posting the thoughts about Cranial and OMM, what difference does it make? Is this not still America? Do we not still have the First Amendment Right to Free Speech? OR did we give that up when we signed on the dotted line to enter Osteopathic Med School?

Whoever it complaining to the dean like a little 2nd grader, grow up. If you have such a problem with what people are saying on here, get a username and come on here and defend your holy grail or grow a spine and confront the person directly. I guess now I'm confused how spineless people can be so outraged about negative comments made about OMM since by virtue of being spineless, most core OMM techniques won't work on them.


Well, I guess it's time for me to sit back and wait for the DMU thought police to read this and call the Dean so I can go in for my meeting

I don't even know what the purpose of the whiners calling the Dean is, do they think they can intimidate people to prvent them from expressing their thoughts? This isn't 1955 in Alabama. Pathetic attempts at intimidation will only strengthen the resolve of the masses.

Besides, if DMU won't kick people out who are caught cheating, do you really think they'd attempt to kick someone out for thoughts posted on an "anonymous" chatboard that isn't even affiliated with the school? Good luck

JPHazelton said:

I dont know how or why this thread took such a mean spirited turn. It seems that the anti-OMM people like to take every opportunity to ridicule and the pro-OMM people feel a need to defend it to the death even if it means arguing incessently (sp?)

Thanks

Click to expand...

my point was not to 'bash' OMM, but if the thread is titled 'what every MS-1 should now about OMM,' I would think that would include everything, good and bad.
it's a little unfair to label anything not pro-OMM as 'mean spirited.'

if your idea of an 'untainted thread' is one that is entirely 100% non-critical of OMM, you're looking for a 'bias' thread, not an 'untainted' one.

JPHazelton said:

I was referring to the language and tone used in the above posts, not the message they were meant to convey. I dont care what anothers opinions are, but I do feel it unecessary to express those opinions in a negative way. Open discussion is quickly crushed when people begin to put down others with differing ideas. For instance, saying that OMM is for people who cant think for themselves. Statements like that certainly dont lead to positive informative dialogue.

Click to expand...

understandable, and that quote from my post a few back is perhaps one i should have reworded.

FutureNavyDOc said:

For example, there's no research that says that 3 boxes of Krispy Kreme's a week prevents cancer, but a guy on my floor freshman year believed it and he's 24 and STILL doesn't have cancer

Click to expand...

Definitely beware the DMU thought police and their ongoing witch hunt! A buddy of mine was called in to the Dean's office because someone anonymously told the dean that he was posting things on here critical of OMM and Cranial. The guy had never been on the website until the dean pulled it up to show him!

Click to expand...

And here I thought I was the heretic at large.

That quackwatch website is operated by a Psychiatrist that was permanently stripped of his license for patient endangerment.