Applying Osteopathic Manipulative Medicine in Practice

[wahngjasnowy]

Hi everyone,

I've been reading more into osteopathic principles and find this additional approach to medicine both very intriguing and beneficial.

I have shadowed an MD (never a DO), and I've been wondering how DOs are able to apply the Osteopathic Manipulative Medicine (OMM) while seeing patients clinically. In particular, with the time constraints seen in clinical practice, are DOs really able to use OMM on a regular basis? Or clinically are DOs, to an extent, excluding this part of treatment?

I'd like to imagine that DOs could use OMM routinely, but it appears to be difficult.

Thank you to anyone who can help shed some light on this for me.

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[FutureCTDoc]

You can use OMM, however in many specialties it has limited utility. In IM, FP, OB/GYN you can make extensive use of OMM, as well as in Pain management, postoperatively and potentially in an OMM only practice.

 

[TriagePreMed]

You can use OMM, however in many specialties it has limited utility. In IM, FP, OB/GYN you can make extensive use of OMM, as well as in Pain management, postoperatively and potentially in an OMM only practice.

What about Neurologists? Seeing how physical tests are so important, I'd think OMM might be important.

 

[VeeTeeHokies]

What about Neurologists? Seeing how physical tests are so important, I'd think OMM might be important.

I'm with you on this, neurology is one of my interests and I have been pretty interested in how often a neurologist can employ OMM in practice. It always made sense to me that neurology should be one of the specialties in which OMM has readily available applications.

 

[NurWollen]

An ENT doc I shadowed said he doesn't use OMM in his practice but that he believes in its efficacy... he said he does use it on his family.

A family practice DO that spoke at our pre-med society said he had used it that same day on a patient with neck pain.

I guess it depends on the doctor.

 

[MedicinaeDoctor]

Add Physical Medicine and Rehabilitation to the list.

Also, keep in mind that a select few doctors practice their specialty during the majority of the week and spend a day of the week (or a few hours) doing OMT at a clinic.

I've read a few studies that states that Emergency Medicine can incorporate more OMT (mostly for acute ankle injuries and musculoskeletal issues), although judging from sdn, the majority of osteopathic EM doctors do not seem to use OMT routinely.

http://www.jaoa.org/cgi/content/abstract/104/1/15
http://www.ncbi.nlm.nih.gov/pubmed/14527076
www.jaoa.org/cgi/reprint/103/9/417.pdf

 

[VeeTeeHokies]

Add Physical Medicine and Rehabilitation to the list.

Also, keep in mind that a select few doctors practice their specialty during the majority of the week and spend a day of the week (or a few hours) doing OMT at a clinic.

I've read a few studies that states that Emergency Medicine can incorporate more OMT (mostly for acute ankle injuries and musculoskeletal issues), although judging from sdn, the majority of osteopathic EM doctors do not seem to use OMT routinely.

http://www.jaoa.org/cgi/content/abstract/104/1/15
http://www.ncbi.nlm.nih.gov/pubmed/14527076
www.jaoa.org/cgi/reprint/103/9/417.pdf

I'll second the point that EM docs don't use much OMT, there were a few DOs in the ER that I shadowed at and they mentioned that they rarely get to use OMT in the field.

 

[Element]

I've seen a DO convert SVT to NSR by applying pressure to the jugular vein/artery.


I think OMT is reserved for the McGyvers of Medicine.

 

[sylvanthus]

I've seen a DO convert SVT to NSR by applying pressure to the jugular vein/artery.


I think OMT is reserved for the McGyvers of Medicine.

That has nothing to do with OMM btw.

 

[Drrrrrr. Celty]

I'm with you on this, neurology is one of my interests and I have been pretty interested in how often a neurologist can employ OMM in practice. It always made sense to me that neurology should be one of the specialties in which OMM has readily available applications.

Hmm I'm curious to why you believe that.

 

[taylormade2006]

Hmm I'm curious to why you believe that.

In cases of nerve encroachment or entrapment, patients can get a lot of relief from manual therapies.

Regarding the ED scenario, I could see a patient coming in with some sort of pain and fearing a heart attack or other visceral problem. Having ruled out serious disease and diagnosing a musculoskeletal disorder, the doc may employ OMM as a treatment, but I don't know if the ER doc would actually do that or just discharge them.

 

[NurWollen]

I'm with you on this, neurology is one of my interests and I have been pretty interested in how often a neurologist can employ OMM in practice. It always made sense to me that neurology should be one of the specialties in which OMM has readily available applications.

Migraines?

 

[jbairddo]

I have known ped DO's who used OMM, many FP's manage to integrate it into their day, good ER doc's can do it, but the problem in the ER is that even though it lends itself to the treatment of acute injuries, it may be looked down upon in MD hospitals (although that is getting better), there may be a lack of time and some doc's worry about malpractice risk. As a diagnostic tool it works well and for many common medical conditions it works great including headaches of the tension or migraine type. It is very effective in acute pulmonary problems especially if there is a lot of rib dysfunction from coughing. The biggest issue is reimbursement, and whether OBama care will pay for it remains to be seen. DO's are kind of losing their identity and finding trainers who use this stuff and can pass it on to those with sponge like brains who truly can appreciate how beneficial it can be is the bigger problem. Good luck guys

 

[Trogghunter]

OMM is amazing and can treat a wide variety of ailments unlike specific medications and surgery. For example, tension headaches and migraines can be treated with OMM rather than prescribing ibuprofen for an extended period of time. Many maladities dealing with muscular movement, arthrological problems, and nervous/vascular constriction, etc. are prime for OMM. A study of OMM is essential to a comprehensive understanding of treating the human body.

 

[TallScrubs]

I shadowed a FP D.O. and he used OMT quite often. He would almost always use it with back or neck pain and whenever patients asked to be adjusted.

However, we had a resident D.O. who spent an extra year doing an OMM fellowship and she used it for a lot more. She didn't use as much HVLA as the other doc.

 

[VeeTeeHokies]

I've seen a DO convert SVT to NSR by applying pressure to the jugular vein/artery.


I think OMT is reserved for the McGyvers of Medicine.

Funny you said this, I told the DO that I shadowed that he is the MacGyver of medicine. He got quit the kick out of it haha.

Hmm I'm curious to why you believe that.

A lot of the OMM that I saw was in FP and it was largely used to treat pain. Pain is a signal conducted by nerves in response to stimuli of some sort. Neurologist = physician of the nervous system. I can definitely see some patients referred to a neurologist with complaints of pain that a DO neurologist may discover is caused by problems within the skeletal or muscular system, than can then be treated with OMM. Also one of the most commonly used OMM treatments (I unfortunately don't know what it's called, but it's the one where the doc puts his hands under the neck and head of the patient and massages as the head slowly falls down to the table) has a wide array of uses, and I'm pretty sure one of them is migraines.

In cases of nerve encroachment or entrapment, patients can get a lot of relief from manual therapies.

Regarding the ED scenario, I could see a patient coming in with some sort of pain and fearing a heart attack or other visceral problem. Having ruled out serious disease and diagnosing a musculoskeletal disorder, the doc may employ OMM as a treatment, but I don't know if the ER doc would actually do that or just discharge them.

The ER DOs that I met told me that OMM is most beneficial for patients who receive it in many visits over time. Since ER docs don't have regular patients (except the frequent flyers, which are usually there for other reasons, such as drugs or heart/lung problems) they can't employ it as they see fit. ERs are also typically teeming with patients and they don't have a lot of time to administer such treatments.

Migraines?

Yes, as mentioned above.

 

[JaggerPlate]

Good thread boys ... keep the discussion going! I love talking about OMM.

 

[wahngjasnowy]

Thanks everyone for the many responses to this thread! It's good to see that osteopathic medicine CAN actually be used routinely in the clinical setting. I was starting to fear that the stuff DO students are taught would to an extent be rendered unusable within clinical settings, but I can see that it's not!

I have known ped DO's who used OMM, many FP's manage to integrate it into their day, good ER doc's can do it, but the problem in the ER is that even though it lends itself to the treatment of acute injuries, it may be looked down upon in MD hospitals (although that is getting better), there may be a lack of time and some doc's worry about malpractice risk. As a diagnostic tool it works well and for many common medical conditions it works great including headaches of the tension or migraine type. It is very effective in acute pulmonary problems especially if there is a lot of rib dysfunction from coughing. The biggest issue is reimbursement, and whether OBama care will pay for it remains to be seen. DO's are kind of losing their identity and finding trainers who use this stuff and can pass it on to those with sponge like brains who truly can appreciate how beneficial it can be is the bigger problem. Good luck guys

I think the time constraints may apply the most pressure to DO docs, but do you think that malpractice is more of a risk because people are just not familiar with OMM? If a DO was sued for malpractice, they would probably have to defend themselves just like an MD doc would, though, so maybe not.

Thanks again everyone for the great discussion.