Any student just not feeling OMM?

[sylvanthus]

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This is probably not a popular question to ask. But, I am curious if there are any other students out there that just do not enjoy OMM. I applied only to DO programs because I bought into the whole "osteopathic" philosophy. But, in reality, the only difference between allopathic and osteopathic medicine I am seeing is an added OMM component that, quite frankly, I am not really buying into. In fact, now, I would much rather spend the 7 hours a week on added physiology/anatomy or another course.

Perhaps it is the way my course is run. But, when our instructor discusses taking things to the "feather" edge and feeling the "ice cube melting" with little to no explanation about why things work I have a hard time believing many of these techniques are "evidence based." Add to that, the whole "cranial-sacral" therapy thing and I just find myself annoyed everytime we have OMM lab.

There are many in my class that seem to just go through the motions to get it done. Anyone out there with me? Any advice on sucking it up as this course is going to be 2 years long?

 

[Bacchus]

Hang in there. I'm getting bored too. Every lab I usually mumble I can't feel anything. Some techniques you probably won't ever use again or will use a different diagnostic test to ascertain the same diagnosis. Once we start learning treatment (which I'm assuming you aren't) it should get better. I at least hope so. It has its place, I'm not writing OMM off just yet.

 

[engineeredout]

Yeah I love hearing in OMM Lab:

"We don't actually know why indirect myofascial stretching techniques work. Actually we do but I don't feel like explaining it".

 

[ChiDO]

Wait till you get to do cranial...

 

[sylvanthus]

I'm sure OMM has its uses, but right now I am just annoyed at spending roughly 7 hours a week for 2 years on something I may or may not use "some" of.

 

[nlax30]

Yea, in the beginning it was easy to just go through the motions and personally I think a lot it depends on how the course is structured and taught. Our OMM dept head was terrific and was upfront about what OMM was good for and what it's not, especially when it came time to go through cranial it was presented more as here's what you need for the boards.

But with everything else the underlying pathophys was explained along with connections made to associated medical conditions so it seemed more like an extension of a clinical exam and msk pathophys class than some nebulous magic treatment explained vaguely.

Having a few rotations under my belt let me encourage you to take that lab time to at he very least become more adapt at actual physical exams and just practice getting a feel of what actual anatomy feels like under your hands before you're thrown out into the world and actually use your palpation skills regardless of if you're going to do OMM or not.... Just a good skill physicians need to be adept at.

The other thing is that during the first two years when you're basically just "working/practicing" on each other in lab all of you are pretty healthy to begin with so there is a lot of just going through the motions without having an actual dysfunction.

I'm on family medicine right now with a DO who does occassionally use OMM in the office if warranted and it has worked for what we've used it for. At the very least the doc is very comfortable with orthopedic complaints and can fairly easily determine if someone with hip pain just needs a shoe insert or if an ortho referal is needed. Other times we can do some soft tissue work and ice therapy to give the pt some instant relief (which he can bill for) and then send them out with some muscle relaxants or something.

Just the other day I had a pt who had some elbow pain that he was told by others as just being tennis elbow but wasn't getting better, even after a couple weeks of NSAIDs. Well he probably had that but he also had a radial head dysfunction and so I did some muscle energy and hvla with noticeable differences pre and post treatment and I less than a minute he was basically pain free and quite surprised at it, I was as well.

So there are definitely limits to it and what it's good for but just think of it as another tool and skill you have at your disposal.

 

[AMEHigh]

Having a few rotations under my belt let me encourage you to take that lab time to at he very least become more adapt at actual physical exams and just practice getting a feel of what actual anatomy feels like under your hands before you're thrown out into the world and actually use your palpation skills regardless of if you're going to do OMM or not.... Just a good skill physicians need to be adept at.
.

I agree with this. Yes, I'm somewhat not always into OMM and although I might never use techniques I think about how useful it is that I am palpating weekly. These skills will help us in the long run. I'd like to think that not a lot of schools get that opportunity so I'm going to try and be positive about OMM.

 

[Styria]

There are many in my class that seem to just go through the motions to get it done. Anyone out there with me? Any advice on sucking it up as this course is going to be 2 years long?

I think the most important thing to learn right now is palpation skills. You need them in order to use OMT effectively, especially when your exams switch over to diagnosing and fixing real dysfunction rather than hypotheticals.

Part of palpation involves recognition. Sometimes that requires patience; sometimes it just needs some assistance. When we learned the suboccipital release, I wasn't feeling anything, but one of the professors recognized it and came over to reposition my hands. I immediately started to feel the tissue texture changes under my fingers, and learning how that felt like made the whole rest of that soft tissue lab go better too.

People who just go through the motions have no idea how much they're short-changing themselves. Slow down. Go find some actual dysfunction. Your classmates have been hunching over books for hours. Their necks and shoulders ache and some have spinal curves. There are counterstrain tender points available and they might even be able to point right to them. Your athletic classmates have knee and other injuries in their pasts. The idea that everyone is young and fit is laughable. Besides, once you know what normal feels like, abnormal will jump right out at you. And then you'll learn what it feels like when the tissue eases up and will be able to recognize that too.

Other palpation stuff:
-Feel free to use your whole hand. In addition to getting you fully onto the pads of your fingers (which are more sensitive than the tips anyway), your palm is great at contours.
-"Feather's edge" means the point where the restriction is just starting. For now, move your partner all the way into the restriction, where you can definitely feel it, then back off slightly to where you just can't, but would if you went forward again.
-Ask others to confirm what you're feeling, and ask if you can palpate too if they've found something on someone else.
-If you've found something, check it again in other modalities you might have learned (i.e., the Styles Screen, which is dynamic (moving the patient), vs. just poking at the back while they're static) just to see how it would feel if you'd found it in them.
-Get treated by the physicians there so you know how things are supposed to feel when they're done right to you.

 

[ShyRem]

First year and most of second, I couldn't feel crap. I mean like almost nothing. Some stuff, yeah. Others... not a chance. Third year I was at a place where real patients came to see the med students every week. So every week we had patients to ourselves. And by the middle of third year, I was feeling stuff I had never felt before. Stuff my OMT professors were explaining back in first and second year that I said "yeah... BS".

And still there's stuff that I'm like "yeah... ummm.... no." It's definitely a technique that needs a lot of practice, preferably on real live patients with real honest problems. I have noticed that my classmates who did no OMT third year were faking it, but when they had pain most of them came to me to "fix" them.

Is it a cure-all? nope. But it works really well for MSK issues. Try and keep an open mind.

 

[Bacchus]

If nothing, we're getting good palpatory skills out of the deal. The boundary of touching a patient is being destroyed pretty quickly. Plus, its made me feel more comfortable and less uptight about my body.

 

[bleeker10]

What's really frustrating is when you have different profs/preceptors disagreeing with each other because there may be 5 different ways to diagnose something. It's also frustrating when you ask if you are diagnosing something correctly, like OA F Rr Sl and the teacher says "well it can vary in practice and what you get for a diagnosis is right, but on the test it has to be rotation and side bending to opposite sides for the OA joint". Makes me wonder how much of this diagnosis is legit and how much is made up. I do like OPP lab though and doing treatments so far is interesting and fun. I'm hoping it gets a lot better next semester and next year once we get into more treating of dysfunction.

 

[Bacchus]

What's really frustrating is when you have different profs/preceptors disagreeing with each other because there may be 5 different ways to diagnose something. It's also frustrating when you ask if you are diagnosing something correctly, like OA F Rr Sl and the teacher says "well it can vary in practice and what you get for a diagnosis is right, but on the test it has to be rotation and side bending to opposite sides for the OA joint". Makes me wonder how much of this diagnosis is legit and how much is made up. I do like OPP lab though and doing treatments so far is interesting and fun. I'm hoping it gets a lot better next semester and next year once we get into more treating of dysfunction.

Ditto on the, "Well... for boards and this class..." Take C2-C7 for example. We diagnosed a girl Type-1 when its supposed to be Type-2. It turned out, she had a bind... and I made my first diag, but it goes to show...

 

[rddoms]

Wait for the sacral portion. You are going to love the 'disappearing hand trick', and you will surely be comfortable with your partner after that!

 

[toothless rufus]

I thought I'd like it, but I cannot stand it.It sucks my soul out of my eyes. I want to forget it all and not have to relearn it again (and again) for board exams. Especially CS. It's annoying to me, and I simply can't be bothered with it. I think there's some useful MSK stuff, but I'll probably never use it. Guaranteed.

 

[wingbowlchamp3]

i'd say at least 60% of pcom students don't buy into omm. they study an hour before the practical in a panic and then never use those techniques again. the issue is with how it's taught. it wasn't until last month on an fp rotation that i saw a full omm treatment from start to finish. he was treating musculoskeletal complaints too...not an mi, kidney stones, etc.

you'd be dumb not to at least use omm for musculoskeletal stuff. even simple stuff like soft tissue and myofacial release can really help aches and pains. people who teach it just get too carried away with their arguments about what something is named (as someone else mentioned) and don't teach anything practically.

 

[Bacchus]

i'd say at least 60% of pcom students don't buy into omm. they study an hour before the practical in a panic and then never use those techniques again. the issue is with how it's taught. it wasn't until last month on an fp rotation that i saw a full omm treatment from start to finish. he was treating musculoskeletal complaints too...not an mi, kidney stones, etc.

you'd be dumb not to at least use omm for musculoskeletal stuff. even simple stuff like soft tissue and myofacial release can really help aches and pains. people who teach it just get too carried away with their arguments about what something is named (as someone else mentioned) and don't teach anything practically.

As a first year, the one hour practice resonates with me. For both palpation and now our second exam, intersegmental motion testing, I've practiced about an hour each. Does that make me a good DO? Probably not, and Dr. Alex would probably shun me if he knew... which I'm sure he does.

I have to somewhat disagree however with not seeing OMM done to the full effect. We're always invited to use the clinic to shadow for a day to see OMM done. Plus, as a patient at the clinic you have to go through the motions. You can't just walk in, from what I've been told, and say can I have some HVLA on my C- and L-spines.

I don't like, however, that if we have a dysfunction or complain of pain, etc. we're told to come to the clinic while in lab. I have seen a handful of techniques done since the first week of school but have mostly heard, "Come over to the clinic." I understand the need for a complete history, but also know that we're all relatively healthy and a few questions and techniques can get the problem fixed fairly quickly. Plus, its a learning experience for my groupmates.

 

[WDeagle]

Do some schools really spend more than 7 hours a week on OMT? I think the average for me is 1.5 hour lab a week. Alot of the times we're not even doing OMT, we're learning other clinical stuff. I always felt like OMT would really make alot of sense untill you're seeing a bunch of patients and treating them all. I figure if you really want to be good at OMT you need to do a residency in it.

 

[nlax30]

We had 1 hr of lecture and 2 hrs of lab each week, and lecture was basically just going through more background theory/pathophys of what we'd be doing in lab later that week.

We don't have a student clinic or anything like that so we'd all just grab one of the faculty during lab to work on us if we had an actual complaint, which worked out well because they were good about working on us there and it gave everyone else to see some actual treatment and maybe a different technique. Usually a small group would end up gatherin around whoever was getting worked on so it would turn into a mini lecture.

 

[voitokas]

I feel you, Sylvanthus, and I wonder how much of it is just how it's taught, and how much of it is endemic to the osteopathic tradition. Have you read through "Foundations of the Ost. Trad." yet?👎 I assume all DO students are required to buy it - but most of it is presented in a very non-scientific way. It reads much like Creationist Science, really, and this is very disappointing to a scientist. If there are techniques that really do work, I may miss them, since I'm just classifying everything in my head as "memorize for comlex, but not for medicine". I'm just glad that OMM is only a couple of hours a week!

I bought into the DO philosophy too - and I still do - but I haven't seen any of it in class... maybe it comes from working with DO's on rotations?

Staying hopeful🙂

 

[sylvanthus]

"I bought into the DO philosophy too - and I still do - but I haven't seen any of it in class... maybe it comes from working with DO's on rotations?"


This is the thing that is the most frustrating, in general, to me. I have seen little in the way of the DO philosophy save for some manipulations with marginal benefits. Ahh well, guess we just have to get through school and practice how we want. I am just disappointed in the smoke and mirrors trick that is the DO philosophy.

 

[ShyRem]

It is strictly dependent on the physician you shadow. Some do well with the philosophy, some not so much. Some are fanatics of the worst kind.

 

[ModernChemistry]

It's moving way too slow at my school... I want to learn some HVLA now!

 

[wingbowlchamp3]

We're always invited to use the clinic to shadow for a day to see OMM done.

maybe that should be a requirement in first year at pcom. my impression was getting a day set-up wasn't easy. i never had a reason to go over there as a patient either so i lost that opportunity to see omm in the real world as well.

i just got tired of hearing all the somatic dysfunction talk and treatment of visceral stuff without any emphasis on omt for musculoskeletal complaints. dr. kuchera had a great reputation as a teacher but his lectures scare me away. i figured out on my own that i would use omt for aches and pains which made it easier to practice the techniques and maybe remember them beyond the practical.

 

[Bacchus]

maybe that should be a requirement in first year at pcom. my impression was getting a day set-up wasn't easy. i never had a reason to go over there as a patient either so i lost that opportunity to see omm in the real world as well.

i just got tired of hearing all the somatic dysfunction talk and treatment of visceral stuff without any emphasis on omt for musculoskeletal complaints. dr. kuchera had a great reputation as a teacher but his lectures scare me away. i figured out on my own that i would use omt for aches and pains which made it easier to practice the techniques and maybe remember them beyond the practical.

One thing I did appreciate is the merger of anatomy and OMM. Granted, Coughlin is the only professor actively involved in OMM from that department. Kuchera has only lectured us once or twice and I don't have the privilege of having him in my lab so I haven't interacted too much with him.