Anybody else think OMM has some use?

[mwsapphire]

Hi everyone,

First year DO student here. Learning OMM in the pandemic setup has been challenging, but overall, I like OMM. I think it is useful for MSK pain ( for example, neck pain). The cranial stuff is BS, but some of it actually is useful for neck/back pain.

Am I the only one here? Like, yes , okay, I didn't get into an MD school, but I also don't hate OMM. It really does help my neck pain, for example.

Is this just me? I feel like we hate on OMM a little too much on here.

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[iforget2]

After finishing my OMM rotation, it'd be hard to argue against the improvement that some of the patients feel after an appointment of ME, BLT, counterstrain, and different articulatory techniques. I don't know how much of it is placebo or just time that the body needed to heal, but nearly all the patients who came in loved it and even were willing to pay out of pocket if their insurance company didn't cover OMM. I don't even think my preceptors believed in cranial or chapman's points though, which was a relief to me.

 

[Lawpy]

Yeah i think OMM has some benefits and should be an elective everywhere rather than a DO-only thing

 

[Hippocrates II]

The problem with OMM lies in the obscure diagnoses, ridiculous premises like chapmans/cranial, focus on unusual problems like fibular head flexion or radial head supination, how phases of the moon impact your diagnosis, etc. If OMM just focused on LBP/C-spine pain/etc. and realistic treatment modalities, I don't think anyone would have a problem with it. Instead, they put so much stock into this being our differentiator that they have to make it cumbersome and difficult beyond just simple stretches and massage techniques.

Also, while I absolutely hate people on here who just downplay other people's opinions because they're a year or two behind them, I will say that the suck of OMM really came to light end of first year / all of second year for me.

 

[hallowmann]

Hi everyone,

First year DO student here. Learning OMM in the pandemic setup has been challenging, but overall, I like OMM. I think it is useful for MSK pain ( for example, neck pain). The cranial stuff is BS, but some of it actually is useful for neck/back pain.

Am I the only one here? Like, yes , okay, I didn't get into an MD school, but I also don't hate OMM. It really does help my neck pain, for example.

Is this just me? I feel like we hate on OMM a little too much on here.

Its not just you. Plenty of people actually benefit from OMM. In fact we send people to PT for some VERY similar techniques that just have different names all the time. The issue really is that there is almost this air surrounding it that is feels very unscientific, both in the diagnosis and theory as well as history, and there are some techniques that really just don't make any sense, specifically cranial and Chapman's points.

I think there's also a question of the utility of having in medical school, when the vast majority of DOs will not use it with any regularity. I think that's a different conversation. There's historic stuff about degrees that affect what is taught all the time, so I just chalk it up to that and something I needed to learn to be a physician, and maybe even something that rarely comes in handy.

 

[Neopolymath]

Some great points have been posted already. I could write a long essay on this topic but for me it comes down to some really basic issues that I can't get past. Hallowmann, as usual, hits the nail on the head. Some OMM works. Of that OMM, who should learn it and how should patients receive it and why the hell are we learning the stuff that is clearly BS? If you think about these things, you will probably come to the conclusion many of us have. "Great, it works. What does that have to do with 90%+ of DO students and why is it something that DO leadership would die over instead of refine for the landscape of modern medicine and practice in 2021?"

- Some OMM works. We call that PT, OT, massage etc. (Are you seeing my point here? Let these people learn it and do it)
- The workflow of the modern physician makes OMM unlikely to be used by all but OMM specialists if nothing else but for time and money reasons.
- Why are we forcing all students to do it given almost no one uses it and PT, OT, and massage can do it better and with more focus?

There is more to it but basically, I believe that if you polled med students a small group of people hate everything about OMM but it's mostly related to the orgs that OMM represents (NBOME etc.). There is real hostility there that you might not be aware of as an M1 and I wouldn't piss on them if they were on fire, frankly. But I also believe that most people would tell you that OMM can work for some patients but needs to be an elective and emphasized about 10% of what it currently is. The majority don't have a beef with OMM directly. They have a beef with everything OMM represents that's wrong with DO education, our reputation, and the complete and utter disrespect of our time as trainees who will almost certainly be part of the huge (and growing) percentage of physicians who don't use OMM.

 

[mwsapphire]

Some great points have been posted already. I could write a long essay on this topic but for me it comes down to some really basic issues that I can't get past. Hallowmann, as usual, hits the nail on the head. Some OMM works. Of that OMM, who should learn it and how should patients receive it and why the hell are we learning the stuff that is clearly BS? If you think about these things, you will probably come to the conclusion many of us have. "Great, it works. What does that have to do with 90%+ of DO students and why is it something that DO leadership would die over instead of refine for the landscape of modern medicine and practice in 2021?"

- Some OMM works. We call that PT, OT, massage etc. (are you seeing my point here?)
- The workflow of the modern physician makes OMM unlikely to be used by all but OMM specialists if nothing else but for time and money reasons.
- Why are we forcing all students to do it given almost no one uses it and PT, OT, and massage can do it better and with more focus?

There is more to it but basically, I believe that if you polled med students a small group of people hate everything about OMM but it's mostly related to the orgs that OMM represents (NBOME etc.). There is real hostility there that you might not be aware of as an M1 and I wouldn't piss on them if they were on fire, frankly. But I also believe that most people would tell you that OMM can work for some patients but needs to be an elective and emphasized about 10% of what it currently is. The majority don't have a beef with OMM directly. They have a beef with everything OMM represents that's wrong with DO education, our reputation, and the complete and utter disrespect of our time as trainees who will almost certainly be part of the huge (and growing) percentage of physicians who don't use OMM.

Thanks, I feel like it is less about hating OMM and more just hating how it's set up.
That last part made my soul hurt a little, I hope it's overstated...

 

[Neopolymath]

Thanks, I feel like it is less about hating OMM and more just hating how it's set up.
That last part made my soul hurt a little, I hope it's overstated...

I love your optimism but prepare to be disappointed lol. It's not an SDN trope. It's a very real and very unnecessary hurdle. Nothing like going to school to be a doctor and facing so much adversity from your own schools and professional organizations. You will see what I mean as you progress through training. Some people take a long time to get there but most people end up seeing why some of their classmates are so irritated even if they aren't as bothered themselves.

 

[mwsapphire]

I love your optimism but prepare to be disappointed lol. It's not an SDN trope. It's a very real and very unnecessary hurdle. Nothing like going to school to be a doctor and facing so much adversity from your own schools and professional organizations. You will see what I mean as you progress through training. Some people take a long time to get there but most people end up seeing why some of their classmates are so irritated even if they aren't as bothered themselves.

Oh I know that the NBOME gives us issues! I just meant that like..how bad is the DO bias at less uber places. That's all I was referring to. I am p cynical/ realistic when it comes to the NBOME. Tbh, my school is pretty realistic about being DO. ( For example, emphasizing that almost everyone should take the USMLE.) And that's it's harder to match a competitive specialty.

 

[Osminog]

I’m sick of hearing anecdotes about individual patients feeling better after being treated with OMM. Talk to the long-time clients of any homeopath, reflexologist, faith healer, etc., and you’ll hear the same exact things. If I’m going to consider the possibility that the effects of OMM treatment surpass the effects that stem from the placebo effect and the body’s natural recovery progress, I want to see large-scale, rigorous studies in reputable journals.

One might respond, “Sure, our only empirical evidence comes from small, horribly designed studies from the Journal of Osteopathic Medicine, a propaganda arm of the AOA—but we understand how OMM works in theory!” No. The mechanisms that are proposed to explain osteopathic theories and principles virtually all stem from reckless misapplications of science. Like many forms of quackery, osteopathy surrounds itself with a thin veil of technical, fancy-sounding terms and concepts in order to seem credible. It’s all just a facade, meant to cover up what is really an outdated, irrelevant brand of pseudoscience.

Osteopathy doesn’t make sense in theory, and there’s still no strong evidence that it works in practice. It would never even cross my mind to refer a patient to a physician who regularly performs OMM treatments. Scam artists and delusional mystics have no place in the medical profession.

 

[DrZoidbergDO]

Its not just you. Plenty of people actually benefit from OMM. In fact we send people to PT for some VERY similar techniques that just have different names all the time. The issue really is that there is almost this air surrounding it that is feels very unscientific, both in the diagnosis and theory as well as history, and there are some techniques that really just don't make any sense, specifically cranial and Chapman's points.

I think there's also a question of the utility of having in medical school, when the vast majority of DOs will not use it with any regularity. I think that's a different conversation. There's historic stuff about degrees that affect what is taught all the time, so I just chalk it up to that and something I needed to learn to be a physician, and maybe even something that rarely comes in handy.

If learning how to do basic PT techniques is the price I pay for being a doctor, I'll gladly make that payment. Besides, It's not like OPP is a particularly difficult class to pass with the smallest modicum of effort. I'm far from the smartest student, and even I can do decently with only a modicum of effort.

 

[mwsapphire]

I’m sick of hearing anecdotes about individual patients feeling better after being treated with OMM. Talk to the long-time clients of any homeopath, reflexologist, faith healer, etc., and you’ll hear the same exact things. If I’m going to consider the possibility that the effects of OMM treatment surpass the effects that stem from the placebo effect and the body’s natural recovery progress, I want to see large-scale, rigorous studies in reputable journals.

One might respond, “Sure, our only empirical evidence comes from small, horribly designed studies from the Journal of Osteopathic Medicine, a propaganda arm of the AOA—but we understand how OMM works in theory!” No. The mechanisms that are proposed to explain osteopathic theories and principles virtually all stem from reckless misapplications of science. Like many forms of quackery, osteopathy surrounds itself with a thin veil of technical, fancy-sounding terms and concepts in order to seem credible. It’s all just a facade, meant to cover up what is really an outdated, irrelevant brand of pseudoscience.

Osteopathy doesn’t make sense in theory, and there’s still no strong evidence that it works in practice. It would never even cross my mind to refer a patient to a physician who regularly performs OMM treatments. Scam artists and delusional mystics have no place in the medical profession.

I think you're being a little dramatic. I think OMM can be considered a watered- down form of PT that we learn on top of the rest of med school.

 

[Goro]

Hi everyone,

First year DO student here. Learning OMM in the pandemic setup has been challenging, but overall, I like OMM. I think it is useful for MSK pain ( for example, neck pain). The cranial stuff is BS, but some of it actually is useful for neck/back pain.

Am I the only one here? Like, yes , okay, I didn't get into an MD school, but I also don't hate OMM. It really does help my neck pain, for example.

Is this just me? I feel like we hate on OMM a little too much on here.

I've been helped by it, especially for shoulder, ankle and knee issues. Back and hips, more hit and miss, usually it seems due to who does the procedures.

 

[Cornfed101]

I’m sick of hearing anecdotes about individual patients feeling better after being treated with OMM. Talk to the long-time clients of any homeopath, reflexologist, faith healer, etc., and you’ll hear the same exact things. If I’m going to consider the possibility that the effects of OMM treatment surpass the effects that stem from the placebo effect and the body’s natural recovery progress, I want to see large-scale, rigorous studies in reputable journals.

One might respond, “Sure, our only empirical evidence comes from small, horribly designed studies from the Journal of Osteopathic Medicine, a propaganda arm of the AOA—but we understand how OMM works in theory!” No. The mechanisms that are proposed to explain osteopathic theories and principles virtually all stem from reckless misapplications of science. Like many forms of quackery, osteopathy surrounds itself with a thin veil of technical, fancy-sounding terms and concepts in order to seem credible. It’s all just a facade, meant to cover up what is really an outdated, irrelevant brand of pseudoscience.

Osteopathy doesn’t make sense in theory, and there’s still no strong evidence that it works in practice. It would never even cross my mind to refer a patient to a physician who regularly performs OMM treatments. Scam artists and delusional mystics have no place in the medical profession.

It’s pretty tough to do a double blind study on OMM because the physician will always know if they are doing it or not (hopefully)

 

[DrRedstone]

It's a great way to befriend nurses and other support staff.

 

[Osminog]

It’s pretty tough to do a double blind study on OMM because the physician will always know if they are doing it or not (hopefully)

Laymen can be randomly divided into two groups, with one group being taught how to correctly perform a particular OMM technique and the other being taught how to perform a sham technique. Without knowing if the technique they were taught was “real OMM” or not, they can perform the techniques on subjects.

 

[Ho0v-man]

Just stop trying to make it about influencing the nervous system and more about aches and pains and most people wouldn’t care.

 

[AnatomyGrey12]

Some great points have been posted already. I could write a long essay on this topic but for me it comes down to some really basic issues that I can't get past. Hallowmann, as usual, hits the nail on the head. Some OMM works. Of that OMM, who should learn it and how should patients receive it and why the hell are we learning the stuff that is clearly BS? If you think about these things, you will probably come to the conclusion many of us have. "Great, it works. What does that have to do with 90%+ of DO students and why is it something that DO leadership would die over instead of refine for the landscape of modern medicine and practice in 2021?"

- Some OMM works. We call that PT, OT, massage etc. (are you seeing my point here?)
- The workflow of the modern physician makes OMM unlikely to be used by all but OMM specialists if nothing else but for time and money reasons.
- Why are we forcing all students to do it given almost no one uses it and PT, OT, and massage can do it better and with more focus?

There is more to it but basically, I believe that if you polled med students a small group of people hate everything about OMM but it's mostly related to the orgs that OMM represents (NBOME etc.). There is real hostility there that you might not be aware of as an M1 and I wouldn't piss on them if they were on fire, frankly. But I also believe that most people would tell you that OMM can work for some patients but needs to be an elective and emphasized about 10% of what it currently is. The majority don't have a beef with OMM directly. They have a beef with everything OMM represents that's wrong with DO education, our reputation, and the complete and utter disrespect of our time as trainees who will almost certainly be part of the huge (and growing) percentage of physicians who don't use OMM.

This. And that last part really hits it on the head.

Thanks, I feel like it is less about hating OMM and more just hating how it's set up.
That last part made my soul hurt a little, I hope it's overstated...

Unfortunately it’s not overstated. OMM is a symbol for everything wrong with DO education. Despite an occasional poster accusing me as such, I am not a self hating DO. I am proud to be a physician. BUT. Yes, I now hate the entire DO system. I didn’t always, but the pandemic has really exposed just how much the leadership organizations don’t actually care about students, how they prop themselves up on the backs of students, and yes, the NBOME is public enemy number 1. The AOA isn’t any better. I have die hard classmates who consider themselves as true “osteopaths” who are completely disillusioned now after how things unfolded this last year. There is very real animosity burningand it’s far more widespread than it ever has been. It isn’t just SDN trope anymore.

OMM is a complete sham. A lie so that these organizations can prop themselves up and somehow a claim a necessary existence. Now are there parts of OMM that are real and have real benefit to patients? Yes. Muscle energy and soft tissue are largely PT. But as long as those few techniques that work get called “OMM” along with cranial, Chapman's points, etc then their efficacy is irrelevant when regarding all of it together. Because “OMM” means all of it together.

It’s not throwing the baby out with the bath water. It’s throwing out the small rubber duck with the dirty water from a large pool.

 

[culturekweenXx]

Just stop trying to make it about influencing the nervous system and more about aches and pains and most people wouldn’t care.

More than half of my 2nd year OMM curriculum has focused on the effects on OMM on autonomic output and viscerosomatics, something that is blatant pseudoscience. How am I supposed to have any appreciation for the PT-esque aspects of OMM when I can't sit through a single lecture without heavy BS filters on?

 

[culturekweenXx]

This. And that last part really hits it on the head.

Unfortunately it’s not overstated. OMM is a symbol for everything wrong with DO education. Despite an occasional poster accusing me as such, I am not a self hating DO. I am proud to be a physician. BUT. Yes, I now hate the entire DO system. I didn’t always, but the pandemic has really exposed just how much the leadership organizations don’t actually care about students, how they prop themselves up on the backs of students, and yes, the NBOME is public enemy number 1. The AOA isn’t any better. I have die hard classmates who consider themselves as true “osteopaths” who are completely disillusioned now after how things unfolded this last year. There is very real animosity burningand it’s far more widespread than it ever has been. It isn’t just SDN trope anymore.

OMM is a complete sham. A lie so that these organizations can prop themselves up and somehow a claim a necessary existence. Now are there parts of OMM that are real and have real benefit to patients? Yes. Muscle energy and soft tissue are largely PT. But as long as those few techniques that work get called “OMM” along with cranial, Chapman's points, etc then their efficacy is irrelevant when regarding all of it together. Because “OMM” means all of it together.

It’s not throwing the baby out with the bath water. It’s throwing out the small rubber duck with the dirty water from a large pool.

It's almost funny how OMM faculty never draw any distinctions between techniques in term of evidence base or efficacy. We're expected to take MSK stretches and massage (used by a variety of professions and with a solid amount of research showing modest benefit) just as seriously as a modality based almost entirely on a book written by one dude in the mid-20th century

 

[Neopolymath]

I think you're being a little dramatic. I think OMM can be considered a watered- down form of PT that we learn on top of the rest of med school.

The crux of the issue is here: Even if I believe that it's a valid treatment and blah blah blah... Why should a 21st century medical student be forced to learn it (and spend a lot of dogmatic time on it) and not leave it to PT, OT, massage etc personnel?

Your statement is innocent, but politely, it's also very naive.

Time is a finite resource in medical school. It's a zero-sum game. If you are learning OMM then you are taking time away from studying medicine, research, hobbies, family. There is no getting around this fact.

Forget the pseudoscience of some of it. Should we really be forcing all DO students to deal with this when almost no one uses it when they aren't forced to by their school? The workflow of the modern physician and the specialization of roles in healthcare support the idea that we should abandon OMM (make elective) and let it live on via other healthcare professionals that we refer to. Teaching OMM in med school is like teaching bloodbanking, lab, and micro techniques to doctors because you think they still do all that stuff at the hospital and their office. The world has moved on.

Furthermore, essentially all DO students are future physicians not *osteopathic* physicians by both philosophy and employment necessity. Fundamentally, MDs and DOs are the exact same and no one is going out and getting an "osteopathic job" so employment is the same as well. OMM is not a prerequisite for becoming a physician aside from as an artificial requirement so old DO fatcats can abstract some money from us until they lose their jobs when we finally destroy the separate and parasitic DO orgs. So why should it be a requirement? Requirements to me mean that it is a core competency of the career. You can't argue it's a core competency when no one uses it and no one thinks differently than any modern MD.

So, yeah, in a long-winded way, some OMM is fine but who cares? I want my hours and hours back to spend with my family. I don't care if the tests were easy or whatever some people say to shrug it off.

 

[Lawpy]

Unfortunately, OMM must be necessary to justify the separation between the two degrees. I don't like it at all because i oppose dividing physicians when we need to be united. A compromise is to make OMM as an elective for MSK benefits (and get rid of the cranial crap) and dissolve AOA/COCA/NBOME, resulting in the full reconversion of DO schools into MD.

A lot of schools will shut down because LCME doesn't play around and has very strict standards. That will lead to problems/propaganda of worsening physician shortage.

Honestly, it's going to be a gradual process, with the ACGME/AOA residency merger being the first step.

 

[AnatomyGrey12]

Unfortunately, OMM must be necessary to justify the separation between the two degrees. I don't like it at all because i oppose dividing physicians when we need to be united. A compromise is to make OMM as an elective for MSK benefits (and get rid of the cranial crap) and dissolve AOA/COCA/NBOME, resulting in the full reconversion of DO schools into MD.

A lot of schools will shut down because LCME doesn't play around and has very strict standards. That will lead to problems/propaganda of worsening physician shortage.

Honestly, it's going to be a gradual process, with the ACGME/AOA residency merger being the first step.

It’s the inevitable end result IMO. The residency merger was merely the first step in a long, slow process. I suspect we will see such a merger during our careers.

 

[Mad Jack]

Works great for my wife. Before I knew OMM muscle relaxants were about the only thing that provided her any relief. Counterstrain and suboccipital tension release work far better and faster and provide days of relief in one go without side effects

 

[Mad Jack]

After finishing my OMM rotation, it'd be hard to argue against the improvement that some of the patients feel after an appointment of ME, BLT, counterstrain, and different articulatory techniques. I don't know how much of it is placebo or just time that the body needed to heal, but nearly all the patients who came in loved it and even were willing to pay out of pocket if their insurance company didn't cover OMM. I don't even think my preceptors believed in cranial or chapman's points though, which was a relief to me.

I saw a lot of patients that had formerly been on high dose opioids but now were managed with only OMM. OMM dramatically improved and in some cases even saved the lives of these chronic pain patients

 

[drstranger]

So follow up question If DO schools get rid of OMM do they justify existence? we get rid of our one "distinguishing factor" (according to 90% of admissions interviews). Will DO school be able to admit that they are in fact the easy route, not really a unique route? I will say quality DO schools are still needed maybe not the amount we are currently building though, and some of the shady ones need to be investigated while also class sizes limited. will we just be MD* schools at that point??
Not trying to offend anyone and I know there are lots of anecdotes out there about people being accepted to MD and not DO but as far as just stats DO schools have lower average GPA/MCAT.

 

[AnatomyGrey12]

So follow up question If DO schools get rid of OMM do they justify existence? we get rid of our one "distinguishing factor" (according to 90% of admissions interviews). Will DO school be able to admit that they are in fact the easy route, not really a unique route? I will say quality DO schools are still needed maybe not the amount we are currently building though, and some of the shady ones need to be investigated while also class sizes limited. will we just be MD* schools at that point??
Not trying to offend anyone and I know there are lots of anecdotes out there about people being accepted to MD and not DO but as far as just stats DO schools have lower average GPA/MCAT.

They will become primary care producing community med schools. I suspect in the long run we see an even steeper split of DO schools producing primary care docs and MD schools will produce the specialists, even more than we see now.

 

[drstranger]

They will become primary care producing community med schools. I suspect in the long run we see an even steeper split of DO schools producing primary care docs and MD schools will produce the specialists, even more than we see now.

I wouldn't mind that honestly especially if they worked out a 3-year deal to streamline the process like some MD schools have with their primary care tracks.

 

[Neopolymath]

I saw a lot of patients that had formerly been on high dose opioids but now were managed with only OMM. OMM dramatically improved and in some cases even saved the lives of these chronic pain patients

That's truly great to hear. It still should probably just be taught to physical therapists and it would be the same or better because they can somehow magically do research and don't make excuses like DO people do. It would also be better for thousands of medical students who went to physician school not physical therapy school and will never ever do OMM without proverbial gun to head.

 

[Lawpy]

So follow up question If DO schools get rid of OMM do they justify existence? we get rid of our one "distinguishing factor" (according to 90% of admissions interviews). Will DO school be able to admit that they are in fact the easy route, not really a unique route? I will say quality DO schools are still needed maybe not the amount we are currently building though, and some of the shady ones need to be investigated while also class sizes limited. will we just be MD* schools at that point??
Not trying to offend anyone and I know there are lots of anecdotes out there about people being accepted to MD and not DO but as far as just stats DO schools have lower average GPA/MCAT.

I think uniting the degrees is more likely to happen than getting rid of OMM. OMM is here to stay. We just need to get rid of the pseudoscience/True Believer crap and strictly stick to MSK PT benefits

 

[Mad Jack]

That's truly great to hear. It still should probably just be taught to physical therapists and it would be the same or better because they can somehow magically do research and don't make excuses like DO people do. It would also be better for thousands of medical students who went to physician school not physical therapy school and will never ever do OMM without proverbial gun to head.

I'm glad I learned it, I use it pretty often on friends and family. Absolutely wish it wasn't on the boards though.

 

[Mad Jack]

I think uniting the degrees is more likely to happen than getting rid of OMM. OMM is here to stay. We just need to get rid of the pseudoscience/True Believer crap and strictly stick to MSK PT benefits

It would actually make me sad to see it go, as I think there's a lot of value in treating minor conditions with it. Given that the only other group adept in anything close are physical therapists that rarely interact with mostly healthy patients, OMM for more basic conditions would likely become a lost art

 

[Neopolymath]

It would actually make me sad to see it go, as I think there's a lot of value in treating minor conditions with it. Given that the only other group adept in anything close are physical therapists that rarely interact with mostly healthy patients, OMM for more basic conditions would likely become a lost art

So we start sending these people to physical therapy by adjusting our referral patterns.

 

[mwsapphire]

Works great for my wife. Before I knew OMM muscle relaxants were about the only thing that provided her any relief. Counterstrain and suboccipital tension release work far better and faster and provide days of relief in one go without side effects

That's nice ! I'm not sure what condition she has though. I do have some sort of long lasting neck pain that OMM soft tissue knocked clean out.
You're a third year resident now! I hope residency is treating you well.

 

[Mad Jack]

So we start sending these people to physical therapy by adjusting our referral patterns.

Yeah that'll never happen, insurance companies won't reimburse PT for primary care work

 

[Neopolymath]

Yeah that'll never happen, insurance companies won't reimburse PT for primary care work

Rubbing a back or wrist is not owned by primary care. The system can and will evolve. It has in most other ways.

 

[Mad Jack]

That's nice ! I'm not sure what condition she has though. I do have some sort of long lasting neck pain that OMM soft tissue knocked clean out.
You're a third year resident now! I hope residency is treating you well.

I'm in a state of learned helplessness that makes residency more bearable by the day!

And she just has hypertonicity in her neck muscles from poor posture and ergonomics. When she minds things well her muscles don't get all irritated but if she gets lax about it I've gotta fix her

 

[Mad Jack]

Rubbing a back or wrist is not owner by primary care. The system can and will evolve. It has in most other ways.

Treating a patient's presenting complaint is absolutely primary care. If a patient comes to you for neck pain that you can fix in 90 seconds but you charge them for a visit just to refer them to a PT, you haven't improved care or made it cheaper, you've just delayed care and made it more expensive

 

[Neopolymath]

Treating a patient's presenting complaint is absolutely primary care. If a patient comes to you for neck pain that you can fix in 90 seconds but you charge them for a visit just to refer them to a PT, you haven't improved care or made it cheaper, you've just delayed care and made it more expensive

MDs send them to PT. Better make all of them learn OMM since it is costing the system so much. The vast majority of DOs send these people to PT because they don't do OMM. Hell, I personally know an OMM doc that sends his back pain patients to PT even though he does OMM on them in his office.

Sure, fix the nursemaid elbow in 30 seconds. Things that need to be "fixed" over and over can definitely go to PT.

 

[Hippocrates II]

I personally would not mind OMM if it were cut down to a 1/4 of what it currently is, and then the few things we were taught were done well/clearly. I don't have an issue with being taught how to treat garden-variety LBP/neck pain/whatever. In my eyes, that's not much different than being taught how to generally manage BP, diabetes, etc. even if that won't be your focus as a physician. You can make the case that that should just be referred out to PT, but I personally wouldn't have an issue with having a generalized approach to treating this. Problem is, we learn so much obscure nonsense that I laughably do not even know how to treat common conditions because my mind is so bogged down with sacral torsions, cranial whatevers, and so on. We could cut the class down from a longitudinal 2-year course into something much smaller, become more effective at actually treating common conditions, and cut out the pseudoscience that delegitimizes this degree.

Of course, I would rather just get rid of it altogether, but this would be a good start.

 

[Mad Jack]

MDs send them to PT. Better make all of them learn OMM since it is costing the system so much. The vast majority of DOs send these people to PT because they don't do OMM. Hell, I personally know an OMM doc that sends his back pain patients to PT even though he does OMM on them in his office.

Sure, fix the nursemaid elbow in 30 seconds. Things that need to be "fixed" over and over can definitely go to PT.

Most of the MDs don't even send them to PT, they hand them ibuprofen or muscle relaxers and call it a day. 3 months later, same problem. Okay, go to PT

Back pain is probably one of the lower yield issues you'll hit that OMM can address in a single visit. Shoulder, neck, and cervicogenic headaches are where it is at. Most PTs also aren't the best at addressing this sort of thing, and will focus on stretching, ergonomics, or other modalities rather than manual treatment. Ergonomics is huge, but without dealing with the underlying issue the pain is likely to continue for some time.

The question remains, if you can fix a problem quickly and easily, why wouldn't you? Especially in primary care, where you're kind of viewed as the person to address as much as possible (unless you're a hack that turfs everything).

 

[Lanhaines Elsetion]

I used it on my FM rotation every day with decent results. BLT, MFR, and spencer's were quick and worked well. I went to a few full length treatment sessions myself before the pandemic (45min-ish) and it had some long term relief of my neck pain and stiffness. They used BLT, MFR, CS, and HVLA on me.

 

[ciestar]

Most of the MDs don't even send them to PT, they hand them ibuprofen or muscle relaxers and call it a day. 3 months later, same problem. Okay, go to PT

Back pain is probably one of the lower yield issues you'll hit that OMM can address in a single visit. Shoulder, neck, and cervicogenic headaches are where it is at. Most PTs also aren't the best at addressing this sort of thing, and will focus on stretching, ergonomics, or other modalities rather than manual treatment. Ergonomics is huge, but without dealing with the underlying issue the pain is likely to continue for some time.

The question remains, if you can fix a problem quickly and easily, why wouldn't you? Especially in primary care, where you're kind of viewed as the person to address as much as possible (unless you're a hack that turfs everything).

I send everyone to PT lol
Limit that NSAID use

 

[bones]

Hi everyone,

First year DO student here. Learning OMM in the pandemic setup has been challenging, but overall, I like OMM. I think it is useful for MSK pain ( for example, neck pain). The cranial stuff is BS, but some of it actually is useful for neck/back pain.

Am I the only one here? Like, yes , okay, I didn't get into an MD school, but I also don't hate OMM. It really does help my neck pain, for example.

Is this just me? I feel like we hate on OMM a little too much on here.

PM me if you are sincere and have a question about omm. most people on SDN have very little basis for an opinion either way on OMM, including DO students and DOs in practice. I specialize in it, and serve as a residency director for ONMM (the ACGME board specialty for omm specialists) use it on almost 100% of my patients, and teach
residents and accept 3rd and 4th year students for their omm rotations.
Think of it this way- if you train your hands and mind well enough, you should be able to make many diagnoses from history and physical exam alone, ordering imaging or labs just to verify. Many skilled older IM docs do this. If you add to this a knowledge of biomechanics you should be able to find any biomechanical causes of chronic symptoms. If you have tools to reverse biomechanical causes of symptoms, it is a no- brainer to use those tools to help your patients, and shouldn’t be that surprising when the patients symptoms go into permanent remission when the cause of symptoms is removed.

unfortunately, omm is taught in a manner that turns off a lot of the strongest students. These are the same people most likely to successfully unlock its potential and change lives. Asking hard questions is excellent. Poking holes in complicated models should be encouraged. To get the best results you need to know a lot of medicine, a lot of anatomy, and have very good palpatory skills. This isn’t emphasized in omm class at many of the schools. Lots of room for improvement there.

most of our referrals come from MDs, including rheumatologists, orthopedic surgeons, ER docs, neurosurgeons, and pain clinics. They appreciate what we do for their hardest patients that have failed surgery, are trying to get off disability, or for whom they are seeking a conservative approach. No matter your specialty as a DO you can offer these tools if your skills are good enough. Frequently a single rotation during medical school can get you the foundation you need- but you will need to apply what you learn through residency. Osteopathic Recognition is now offered for most acgme residencies, and this is how you can develop these skills directed towards the specialty of your choice.

 

[mwsapphire]

MDs send them to PT. Better make all of them learn OMM since it is costing the system so much. The vast majority of DOs send these people to PT because they don't do OMM. Hell, I personally know an OMM doc that sends his back pain patients to PT even though he does OMM on them in his office.

Sure, fix the nursemaid elbow in 30 seconds. Things that need to be "fixed" over and over can definitely go to PT.

But why not just have doctors who know a little PT? Like what are you so bitter about? If anything you can bill for it and make even more money ( not the reason why you should do it but it's even prgamatic in that way).

Most of the MDs don't even send them to PT, they hand them ibuprofen or muscle relaxers and call it a day. 3 months later, same problem. Okay, go to PT

Back pain is probably one of the lower yield issues you'll hit that OMM can address in a single visit. Shoulder, neck, and cervicogenic headaches are where it is at. Most PTs also aren't the best at addressing this sort of thing, and will focus on stretching, ergonomics, or other modalities rather than manual treatment. Ergonomics is huge, but without dealing with the underlying issue the pain is likely to continue for some time.

The question remains, if you can fix a problem quickly and easily, why wouldn't you? Especially in primary care, where you're kind of viewed as the person to address as much as possible (unless you're a hack that turfs everything).

Yes to all of this! Makes me proud to be a DO student. Yes, some of OMM is fluff, but the neck/back pain and headache stuff is real!
I had chronic tension headaches as a teen ( pretty much still do, but they are more managable). They were so bad when I was 16 that I literally thought they would ruin my life...sometimes I think about what a little OMM may have done. ( I actually mentioned this HA thing in one of my secondaries lol).

 

[Chicken Bone]

After finishing my OMM rotation, it'd be hard to argue against the improvement that some of the patients feel after an appointment of ME, BLT, counterstrain, and different articulatory techniques. I don't know how much of it is placebo or just time that the body needed to heal, but nearly all the patients who came in loved it and even were willing to pay out of pocket if their insurance company didn't cover OMM. I don't even think my preceptors believed in cranial or chapman's points though, which was a relief to me.

Stuff like muscle energy is not a placebo, many of the techniques are just a fancy name of some PT or rehab techniques. I think muscle energy is just a fancy name for PNF exercise. Other things like slapping or cupping are used routinely by message tech. PTs also learn these techniques and use them in on daily basis. Many of these techniques won't do anything chronically but it is good for an acute release this is why patients like it. just like people visit PT frequently.

 

[Osminog]

unfortunately, omm is taught in a manner that turns off a lot of the strongest students. These are the same people most likely to successfully unlock its potential and change lives. Asking hard questions is excellent. Poking holes in complicated models should be encouraged. To get the best results you need to know a lot of medicine, a lot of anatomy, and have very good palpatory skills. This isn’t emphasized in omm class at many of the schools. Lots of room for improvement there.

It's not a matter of how OMM is taught. Strong students are turned off by the fact that OMM isn't evidence-based and its "complicated models" don't make sense. And they're turned off by the fact that some charlatans (thankfully a minority of DOs) are peddling this 19th century pseudoscience as legitimate medicine—thereby abusing the trust of the public and contributing to the stigma against physicians with the DO degree.

If you want strong students to be interested in OMM instead of just pursuing a DO degree as a backdoor into medicine, then fight for higher quality research inquiries into its effectiveness. Osteopathy will only make the transition from alternative medicine to mainstream medicine if it becomes evidence-based.

 

[Chicken Bone]

But why not just have doctors who know a little PT? Like what are you so bitter about? If anything you can bill for it and make even more money ( not the reason why you should do it but it's even prgamatic in that way).


Yes to all of this! Makes me proud to be a DO student. Yes, some of OMM is fluff, but the neck/back pain and headache stuff is real!
I had chronic tension headaches as a teen ( pretty much still do, but they are more managable). They were so bad when I was 16 that I literally thought they would ruin my life...sometimes I think about what a little OMM may have done. ( I actually mentioned this HA thing in one of my secondaries lol).

No reason in my opinion. because PT wasn't there (maybe) when osteopathy was created. essentially, nowadays, what is useful in omm is PT or rehab techniques, they just have a fancy name. i can confirm this because of my undergrad background and also was told by PTs directly. I think we need to learn this just because DO schools want us to preserve a tradition that's all

 

[Osminog]

Stuff like muscle energy is not a placebo, many of the techniques are just a fancy name of some PT or rehab techniques. I think muscle energy is just a fancy name for PNF exercise. Other things like slapping or cupping are used routinely by message tech. PTs also learn these techniques and use them in on daily basis. Many of these techniques won't do anything chronically but it is good for an acute release this is why patients like it. just like people visit PT frequently.

The fact that PTs use a technique doesn't mean that it's evidence-based. Likewise, the fact that some patients "like" a technique doesn't mean that it's evidence-based. The evidence for the effectiveness of muscle energy is extremely weak. Up to this point, studies investigating the effectiveness of ME have been of abysmal quality—tiny samples, no tracking of long-term outcomes, poor design, high risks of bias, etc.

There's no question that stretching exercises, in general, have value. It's been pretty clearly demonstrated, for example, that long-term stretching can extend range of motion in many cases. What hasn't been proven is that the muscle energy technique is effective at treating cases of muscular "somatic dysfunction," or that the procedural intricacies of the muscle energy technique make it more effective than just having your spouse tug on your limb for a few minutes. We don't even have strong reason to believe in the legitimacy of "somatic dysfunction" diagnoses in the first place, since there have been so few studies on inter-examiner reliability of osteopathic diagnosis and virtually no effort among osteopaths to find objective physical measurements that consistently correspond to their subjective palpatory/visual findings.

 

[Allosteopath]

It's not a matter of how OMM is taught. Strong students are turned off by the fact that OMM isn't evidence-based and its "complicated models" don't make sense. And they're turned off by the fact that some charlatans (thankfully a minority of DOs) are peddling this 19th century pseudoscience as legitimate medicine—thereby abusing the trust of the public and contributing to the stigma against physicians with the DO degree.

I'm not one to argue with the sentiment that there evidence based medicine is largely the most useful tool physicians have to make decisions, but I really do feel the need to point out that EBM does in fact itself have limitations in some circumstances. Of course this largely is due to some practical restraints that make it very difficult to study increasingly narrow populations. EBM works in averages, and in that way it excludes individuals and potentially uniquely arising issues (which are not necessarily related to OPP, but could be any other diagnosis). So yes, its great at forming a general guidelines, but it can have limited utility if for whatever reason a patient doesn't fit the mold.

I have said before that OMM doesn't lend itself to great research, nor do I truly expect high quality research on OMM to start pouring of DO schools across the nation. Thats a true and fair criticism.

Now you may be scoffing at the thought from your perspective where patients are being blindfolded and forced against their will into OPP treatments that have no EBM to back them despite this not being a prerequisite for offering the service. I certainly can see that physicians being disingenuous about the healing powers of OMM being an unethical practice. But I do not think that there is anything unethical or disdainful about a DO offering a treatment which has some unproven or limited potential (even if unlikely) to help a patient, so long as they are completely openly discussing the limited research with the patients. Its not like you need to be deceitful to get people who are willing to give anything a shot after all else has failed. Even if they decline the treatment I don't imagine that it would be tremendously upsetting for most DOs, because they have lots of other things to be doing anyway. Is it not the goal for a physician to alleviate suffering of the individual in your exam room? Or is it just to follow EBM as complete gospel without consideration for the patient.

For that reason, think that there can be an argument to be made about OMM's usefulness in practice. Will it work for everyone? Certainly not, and in fact this may be the majority. Will some people find it therapeutic mentally and feel some alleviation of their symptoms? Yes, If you improved someone's subjective experience of life, and their own interpretation of well-being and symptoms would that be considered alleviation of suffering? I think so.

The issue is this sort of thinking doesn't exactly fit the mold of EBM. Counterpoints probably include thoughts like "its just placebo yadda yadda yadda", and that may be a fair point to raise, but if you gave the patient true informed consent, that argument kind of falls apart.

The Caveat.
I don't think there is anything inherently wrong with my interpretation of what I think OMM's utility could be from my perspective. However, I do get disconcerted at my peers who blindly accept all of the teachings in OMM as being supported by good evidence, or as just factual information without giving some thought to what it means, what poor quality evidence looks like or what ethical use of OMM would entail. I also think there is something to be said about the fidelity to bringing EBM as the first and foremost for your patients, because you absolutely CANNOT miss a finding because you've been caught up in your cervical soft tissue techniques leading to delayed care for life or limb threatening conditions. The goal isn't to be a snake oil salesman, its do do your best to alleviate suffering.