Democratization of OMM?

[LukeWhite]

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I don't know a whole lot of OMM yet, but I've been struck by a few things while learning it so far:

1. Many of the more useful techniques are extremely simple and intuitive, so much so that a layman could learn them without much trouble at all.

2. There's VERY little public information on OMM techniques. One has to dig through journals or buy costly, low-print-run books to find the techniques. A quick internet search on techniques turns up creepily little.

The question, for all you grizzled veterans of the OMM scene, is this: Are my suspicions well-founded that this paucity of OMM information is directly related to its simplicity? If the techniques were common knowledge, it seems as if patients would do quite a lot more self-treatment, and the lucrative (often cash-only) OMM practices could take a significant hit.

Obviously there are some techniques, like HVLA, that probably wouldn't be too advisable for public consumption. But it seems that many are at least as safe and idiot-proof as aspirin. I walked my brother online through some muscle energy techniques for his wrist that would have cost him at least triple digits at a clinic; it seems likely to me that physicians could make this sort of thing public knowledge.

Time, perhaps, for "over-the-counter" OMM, gaining increased public recognition over the objections (and admittedly, at the expense of) of the specialists?

 

[Ohiobuddhist]

I'll agree that many OMT techniques are pretty easy and intuitive; however, knowing when to use which types of treatment and in what sequence to receive a desired outcome for more complicated problems eludes many osteopathic students and physicians. Nevertheless, many treatments, ME in particular can be learned by just about anyone for simple problems. There even used to be a program called (I think) "OMM for the masses" at my school to help educate folks about OMT and teach them some techniques. There is also the fact that the philosophies or principles underpinning some of the treatments may not be very complicated, but applying them to a specific lesion can be. For example, the phrase "place the vertebral segment in its position of physiological dynamic equilibrium (ease)" doesn't really sound hard until you try to teach it to your mom who probably will not have the palpatory skills necessary to achieve any result.

 

[Goofyone]

I totally agree.

The concepts couldn't be any more simple.

Even though I understand the concepts, I suck at OMM because I can't palpate very well.

I think I let one too many firecrackers explode in my hand as a kid.

 

[DrMom]

Originally posted by Ohiobuddhist
I'll agree that many OMT techniques are pretty easy and intuitive; however, knowing when to use which types of treatment and in what sequence to receive a desired outcome for more complicated problems eludes many osteopathic students and physicians...
...For example, the phrase "place the vertebral segment in its position of physiological dynamic equilibrium (ease)" doesn't really sound hard until you try to teach it to your mom who probably will not have the palpatory skills necessary to achieve any result.

I agree completely. Many techniques are simple, but you have to be able to feel and diagnose properly to have consistent success in treating them.

 

[Idiopathic]

Yes...many pathology concepts are simple also, and pharmacology, and histology...

 

[LukeWhite]

Originally posted by Idiopathic
Yes...many pathology concepts are simple also, and pharmacology, and histology...

Interesting that you should bring up those three.

Pathology: Mom notices her child has a fever.

Histology: Mom sees discolored skin.

Pharmacology: Mom administers Tylenol.

Osteopathic Manipulation: Mom...?

It's pretty obvious that we're not going to be teaching people to treat individual spinal lesions, but there's a lot that can be taught all the same, as others have wisely pointed out. People tend to be a lot smarter than they're given credit for.

As for the more advanced things, whether or not the layman has the training to grasp a complicated pathology concept, say, it's at least available to him. There's an almost complete and ubiquitous transparency in all the other clinical sciences, but OMM is kept on the down-low, when it would be far easier to teach people how to do a few simple OMM techniques properly than it's been to educate the public on the correct uses for aspirin, tylenlol, excederin, Benadryl, etc. etc.

The difference, of course, is that teaching the public how to use pharmaceuticals (and teaching the requisite histology, pathology, etc. needed to know they need them) is quite lucrative for certain interested parties. At least one reason OMM isn't taught is surely the same: keeping the "trade secrets" is good business for its practitioners. Both are instances of controlling the means of production, which has classically been justified in the name of protecting people from their own ignorance.

 

[Dr JPH]

Teach Mom the pedal lymphatic pump.

 

[Ohiobuddhist]

Another thought - I don't really know how well we are keeping manipulative techniques to ourselves. I'll agree that some books, such as Greenman and Kimberly can be hard to find, but if you spend ten minutes on Amazon, you can find a plethora of osteopathic texts written by european and american osteopaths alike that are often much better at explaining things than your school's respective guru(s).
Also, when I first started doing OMT last year I realized that much of it is very similar to Hatha yoga techniques, and god knows there are tons of people out there teaching yoga.

In the end, if it were really that easy to do, more docs might feel comfortable with it and actually use it. In a recent JAOA article, there was a high correlation between comfort with structural diagnosis skills and use of OMT in practice. In the end, you do what you know works, I guess.

 

[Goofyone]

I've got two words for you:

Pubic shotgun

 

[referee]

You give people as a mass too much credit. There is not a shortage of doctors because people go out and find the knowledge how to heal themselves. It should also be intuitive to not eat a big mac for breakfast, lunch, and dinner.

Docs are less likely to see people to want to, or will ever read the book on it. If the public were complient, there would be less obseity, heart disease, smoking induced cancer, STDs, and mass stupidity.

What are you going to do for the rest of the unhealthy population? I swear you have to be getting a nickel for every plug you give tylenol. What do you do for the women who claims chronic pain, wants a medical work excuse, and claims the pain relievers aren't working or upset her stomach too much to take them?

 

[DrMom]

Originally posted by lukealfredwhite
Interesting that you should bring up those three.

Pathology: Mom notices her child has a fever.

Histology: Mom sees discolored skin.

Pharmacology: Mom administers Tylenol.

Osteopathic Manipulation: Mom...?

I do know parents who have been taught basic OMT skills so that they can treat recurring problems in their kiddos. It certainly can be and is done on an individual basis, but I don't see broad teaching of OMT to the general public as ideal.

 

[LukeWhite]

Definitely admirable that parents should be taught specific maneuvers. I suppose that the techniques for cystic fibrosis could be grouped under this category too.

Of course, lots of people do things which are already more or less OMM (facilitated stretching in sports, for example.) I can definitely envision a more popular brand of OMM that shows more of a continuum between physician-only maneuvers and self-treatment.

Ref: I don't know that there really is such a thing as public noncompliance. Ultimately, it's all individual, and that's why we at the same time can have a recreationally overweight population that also is capable of understanding the subtle differences among a bewildering array of medications and procedures. The most you can do is to throw the information out in a simple format with clear relevance.

For the life of me, though, I still can't think of an instance in which giving the public LESS information about any procedure, medication, what have you, has led to good.

Thank you all for the responses. This has been pretty fascinating stuff. I'll be working on some copy for a website on OMM techniques and theory written for the general population over the next while. The intelligent and thoughtful responses have definitely helped to put it all in perspective.

Thanks again!

 

[referee]

I am not arguing semantics, people might have been a better choice of a word, and then leave off mass stupidity, and I am clearly referring to a group of individuals, that while can act as a group, have made individual decisions that have lead to obesity, heart disease, smoking induced cancer and STDs.

I will forgo including snide remarks in examples for the sake of confusion.

And, no, I don?t believe the ?population that also is capable of understanding the subtle differences among a bewildering array of medications and procedures?. That is why (and I will dare say most) people believe that while one is good, two is better. Most couldn?t tell the difference between Tylenol and Aspirin. They would take either for a pain, but which one should be given for a post-op patient?

Okay, you told them no aspirin, they understand it affects bleeding, so they reach for the Excedrin instead. Make it simpler, same patient, knows not to take drugs with aspirin for pain, but they get a migraine and by habit, take the ?headache medicine? because it?s not pain, it?s a headache.

In addition, smoking was one time recommended for maintaining health, as was eating a balanced diet including cakes and pies. How much drug research has come out false after additional testing? Phen-phen, grrrreat drug. At least OMM has a safer track record than the drug industry.

As a side note, I should mention that I am not condoning OMM as a cure-all for all diseases, nor am I discrediting all drugs, nor profit driven research, just want to avoid confusion. By the way, how many Tylenol pens do you have Luke?

To avoid digressing too far, a lot of athletes, especially high school, do not know the proper form for stretching let alone the ?recreational obese?. Start your website with stretching for dummies, evolve into OMT for dummies, and conclude it with doctoring for dummies.

Wait, you might be too late, does webMD have a section on OMM?

 

[LukeWhite]

Ah, ref. I know you're just baiting me to take my mind off that nasty Clinical test tomorrow morning. Bless your heart.

With that said, I'm really not sure I follow your argument at all. So OTC drugs are too confusing for the general public, so we...shouldn't teach them OMM? I'm sure you were there the same time as I when we were given the lecture on how the less aggressive OMM is so very much safer than even Tylenol (which, I might add, I've no particular fondness for. I go straight for a darvocet-and-NoDoz cocktail of my own concotion.)

So athletes don't understand proper stretching techniques? Why not teach them? I'm not sure where the sarcasm in your suggestion gets its bite. It seems to make sense to me. Do we really think anyone's going to mess up myofascial release? And if they do, will it really matter?

Again, I just don't follow. You argue against the popularization of OMM techniques by citing the fact that it's safer than many OTC drugs and discredited health regimens. I wish I could respond more in depth, but I really just have no idea what you're getting at.

 

[referee]

The idea of generalizing OMM for public consumption, I fear, would lead the public to believe it is a simple, intuitive, home remedy. In doing so there would be, I think, several negative effects.

?1. Many of the more useful techniques are extremely simple and intuitive, so much so that a layman could learn them without much trouble at all.?
Why then, do we as D.O.s hang our white coat on the hook of osteopathy when it is such a simple, intuitive treatment?

?But it seems that many [osteopathic techniques] are at least as safe and idiot-proof as aspirin.?
How idiot-proof is aspirin? Once a treatment is treated the same as an OTC, abuse of such a treatment comes without a second though. I.e. one is good, two are better.

?Do we really think anyone's going to mess up myofascial release? And if they do, will it really matter??
Taking the athlete for example, his improper stretching only prolongs his healing time. Right, for some it might not matter, but for others, especially those pushing the envelope.

?So athletes don't understand proper stretching techniques? Why not teach them??
Most of these athletes have been taught, but yet, they are either non-compliant or interpreted the techniques incorrectly. As for the interpretation, take for instance the scan-tron forms we filled out. How many different ways were there for ?put your student id in the box?? How effective would OMM for dummies be?

Sometimes I just like to find some of your points and pick on them, but to summarize:

I don?t believe do-it-yourself OMM would be effective because of the ambiguity of the written word, and is best taught by physical example. Sometimes a little knowledge is the most dangerous thing.

Maybe OMM is not as invasive as many other techniques, but I would not want my patients reaggravating sprains and strains from learn-at-home OMM, just as I would not want them, while under my care for a condition, taking the latest OTC for that condition, in addition to my prescription without my knowledge, since the magazine add said it was okay.

Also, I like to argue for the sake of it, and it somewhat sounded to me, that you were trivializing the very thing that sets us apart as D.O.s.

 

[LukeWhite]

Certainly some valid points, and of course I always welcome the chance to debate these things; I was certainly hoping for some in starting the thread.

I'll address the point of trivialization first. In a sense, yes, I would like to see some of the things that set osteopaths apart trivialized insofar they're easy to do and can have value apart from a doctor's visit. I certainly wouldn't charge a patient $100 for repeated rounds of counterstrain if I thought he could do the same thing on his own time with a little training and a willing relative.

Speaking of counterstrain, did you know Strain-Counterstrain is (or was) a registered term owned by the company of the doctor who invented it? You can see the (R) in some glossaries, and a quick check of the US Patent/Trademark office backs it up. Seems Dr Jones, lovable country doctor to his simple farm-folk patients, had quite the business sense and wasn't willing to see his technique distributed to just anyone.

Personally, it seems to me that osteopathy would benefit quite a lot from a little popularization. If you ask any ten random people what OMM is, the odds are excellent that they won't know. This doesn't pose a direct problem for osteopathy because most DO's don't touch OMM with a ten-foot pole, and most OMM specialists have a steady and wealthy clientele.

There is, however, an indirect harm that comes with any little-known treatment. There's a critical mass below which that which sets DO's apart becomes less a sale point than a stigma or confining factor. The danger in keeping OMM too closely to one's heart is that patients will tend to associate you with that alone.

So what would be the practical ramifications of teaching OMM to the masses? I think we'd end up with more business all around for osteopathy, and possibly even OMM specialists. The growing American obsession with nutrition certainly hasn't done anything to hurt the career or dieticians, and a public knowledge that many dysfunctions can be treated with some pretty simple techniques would not, in my opinon, dilute osteopathy at all.

Niches always want to keep theirs, which is certainly one of the reasons osteopathy's remained mainly a regional thing. If you want to see manipulative medicine NOT trivialized, precisely the way to do it is to increase awareness and use of it. The specialists hide it under a bushel to keep the cash-only money train rolling, and the majority of DO's downplay it completely--how often have you heard, "Oh, we're just like MD, but with a different philosophy"? Ensuring that osteopathy both grows and retains an identity that incorporates manipulative medicine is going to require the sort of evenhanded evangelism that, as best as I can tell, isn't practiced much today.

 

[Dr JPH]

First of all, let me say that this is a great discussion taking place.

Here's my quick and dirty POV:

I agree that teaching patients OMT, or an easy-OMT version of techniques, would not dilute osteopathy. Part of me thinks that it may even raise awareness in the skill thereby increasing the patient-based knowledge of the techniques and maybe even causing patients to more actively seek out professionals who do this for a living.

But remember...there are problems with teaching patients techniques if they don't understand the risks invovled. And certainly, few would understand the physiology behind it all. I have seen several classmates injured to the point where they need to be seen by an OMM doc because overzealous classmates (who, often times, do NOT understand the risks and do NOT understand the physiology) injured them while "practicing."

I would be interested in seeing what sort of project you are working on, luke. But again, I remind you...the majority of people who may have access to information about "Self OMT" can very well hurt themselves or others. You mentioned nutritionists...well, look at all the people out there busting up their kidneys on the Atkins diet because of all the positive "look at me!" press. Would you recommend this diet to your patients? I wouldn't. But some "authority" on dieting says its good and suddenly thousands of people are doing it.

I think your intentions are noble and your optimism refreshing. However, tread carefully.

 

[referee]

Can you validate for me, that most D.O.s "don't touch OMM with a ten foot pole"?

I would have to disagree that teaching our techniques to the public should be used to increase awareness.

Chiropractic, which doesn't really have any techniques for the public has experienced greater growth in the recent past than D.O.s have.

When seeing the success of chiropractic without teaching the public, and the potential harm caused by OMM from improperly trained, it would be more benficial to increase our awareness by some other means.

 

[Globus P]

Interesting posts, especially since this is between a couple of MS1s, with only 10 weeks into medical school.....its good to have opinions, but I think we still have much more to learn and to be exposed to (thank goodness) before we can formulate smart opinions of OMM and medicine.

 

[Dr JPH]

Originally posted by ToddE
Interesting posts, especially since this is between a couple of MS1s, with only 10 weeks into medical school.....its good to have opinions, but I think we still have much more to learn and to be exposed to (thank goodness) before we can formulate smart opinions of OMM and medicine.

👍

 

[LukeWhite]

To be honest, I don't hold all that much stock in the 1st year argument. It has its uses in delineating what one doesn't know, but is used far too often as a foil against what one DOES know. And, of course, it continues on up through the ranks--there will always be someone higher to inform you that you don't know all that much, and it'll more or less always be true.

But all that's obvious. The point is that talking about inexperience begs the question. If the basic techniques really do require ages of practical experience before they reach their threshhold of usefulness, then OMM would not be useful if popularized.

If, however, even a lowly first year can, with a little research outside of class, understand the principles behind a few basic techniques and successfully teach them to people with even less knowledge with good results, it seems as if crying MS1 misses the point.

Not to sound like a broken record, but there's a reflex in any discipline to protect knowledge from outsiders, and the two arguments always used to support it is that the public isnt' intelligent enough to deal with, and that those who would spread the knowledge Are Toying With Forces They Can't Possibly Comprehend. While fire may have its dangers, I'll maintain again that as far as I can tell, there's a vast chunk of OMM that's easy, intuitive, and can be done inexpensively outside of the doctor's office. Shying away from that out of a feeling that there's more to learn misses the point I think.

 

[muonwhiz]

Hey, I want to have some do it yourself OMM! Doggone it, I can't for the life of me reach back and do HVLA on my own T-10. I think I need at least one more arm and hand to have any shot at this! Do you know where I can get one?

 

[LukeWhite]

Originally posted by muonwhiz
Hey, I want to have some do it yourself OMM! Doggone it, I can't for the life of me reach back and do HVLA on my own T-10. I think I need at least one more arm and hand to have any shot at this! Do you know where I can get one?

Ah, another AZCOMmer out of the woodwork! That's two posts of mine in a row you've misinterpreted, muon. But I'm sure you're quite as terribly busy with finals as we all are and can't be troubled to read those pesky original posts:

Originally posted by lukealfredwhite
Obviously there are some techniques, like HVLA, that probably wouldn't be too advisable for public consumption.

I won't go around casting epithets like elitist, but there's a definite undercurrent of snideness many osteopaths use in protecting their turf. Underdogs can't afford snobbery.

 

[referee]

To me, the attempt to STATE that much of osteopathy is so intuitive anyone can accurately understand and utilize it, such that the experience of the practitioner need not be a factor, is an attempt at self-justification to satisfy, for what I can only guess to be, the rationalization of OMM for his or her own hubris.

If there is not research to prove it, it must be so simplistic that ANY human?s innate ability to reason is justification to prove its effectiveness.

How in the matter of 10 weeks is such a realization in the simplicity of OMM come to light after going unnoticed through the annals of time in western and eastern medicine?

Is OMM so simplistic MS-1s can accurately purpose, with a level of competency as practicing physicians, the normal process of education and training can be circumvented, in such a way that an MS-1 can again be competent to make recommendations for the public welfare without an M.P.H., D.O., or M.D. after his or her name?

I am trying not to be condescending, okay, maybe I am.

How do you believe that most D.O.s wouldn?t touch OMM with a ten foot pole?

 

[referee]

Luke, I don?t mean to trivialize the subject with rhetorical questions or be condescending to make an ad hominem attack, but alas, this is the anonymity of the internet, and I find it some what amusing that you might not know who is who from AZCOM based on our ID?s. To simply say that I disagree with your conclusion that OMM can be given to the masses based on the faulty premise that most of OMM is so intuitive anyone can adequately understand and utilize with minimal training, would lead to a much shorter discussion.

 

[LukeWhite]

Originally posted by referee
How do you believe that most D.O.s wouldn?t touch OMM with a ten foot pole?

I think it's pretty self-evident. The vast majority of DO's have nothing to do with OMM, some for reasons more noble than others. The pathologists aren't going to have much use for it; others neglect it because they don't consider it efficient, effective, or simply because they'd rather not stand out. Whatever the reasons, it's pretty much a foregone conclusion that most DO's will not be using OMM in their practices.

Originally posted by referee
Is OMM so simplistic MS-1s can accurately purpose, with a level of competency as practicing physicians, the normal process of education and training can be circumvented, in such a way that an MS-1 can again be competent to make recommendations for the public welfare without an M.P.H., D.O., or M.D. after his or her name?

I'd answer with a qualified, though certain yes. Some OMM is highly technical, as we've already discussed, and takes years for a mastery of both theory and practice. Much of it is not. It's been adopted effectively by chiropractors, massage therapists, naturopaths, etc. etc. While some of these professionals are highly experienced, some aren't. Many of these techniques can be learned effectively in an afternoon course.

I'm not arguing that experience has no bearing on outcome. I'm arguing that there's no bright line below which the simple therapies are ineffective. Obviously if you have the choice, you'll have a doctor take your blood pressure, measure your blood sugar levels, do the therapy for your child with cystic fibrosis. Yet we consistently teach people to do these things on the theory that though they may not be as skilled, there's an overall good if the public can do these things.

So no, I can't propose these things with the level of a practicing physician. That's pretty self-evident. I can, however, propose them with certainty beyond a reasonable doubt that there's more good to be gained than harm to be done by teaching people how to more effectively treat themselves.

Originally posted by referee
To me, the attempt to STATE that much of osteopathy is so intuitive anyone can accurately understand and utilize it, such that the experience of the practitioner need not be a factor, is an attempt at self-justification to satisfy, for what I can only guess to be, the rationalization of OMM for his or her own hubris.

This one I'm not sure I quite follow, unless you're saying that I'm going about this to satisfy some sort of ego trip. I'm sure this ties into the message you sent me asking whether DO was my first choice. I'll repeat: It was, and I chose not to go MD for very specific reasons. I have nothing to justify; I'm at the school I prefer above the others learning the philosophy of medicine I prefer above the others. One of my reasons was the belief that medicine should be as little stratified as possible. A second: Physicians are principally teachers, and treatment by the physician is a last resort when teaching has failed.

This is, as best as I can tell, more or less the crux of traditional osteopathy. If it's not, I'm in the wrong place, and hopefully you can direct me to the proper forum.

Dr. Still didn't found the profession on manual medicine; he founded it on the conviction that the body is whole and self-regulating. OMM is a means to that end, and it seems sort of odd to suggest that a desire to popularize OMM is inconsistent with osteopathy. While I don't have conversations with the old guy, I'm pretty sure someone can find a few quotes backing this up in his autobiography. I have a few, but it's interesting reading in its own right:

http://www.meridianinstitute.com/eamt/files/still3/st3cont.html

 

[LukeWhite]

Originally posted by referee
Luke, I don?t mean to trivialize the subject with rhetorical questions or be condescending to make an ad hominem attack, but alas, this is the anonymity of the internet, and I find it some what amusing that you might not know who is who from AZCOM based on our ID?s. To simply say that I disagree with your conclusion that OMM can be given to the masses based on the faulty premise that most of OMM is so intuitive anyone can adequately understand and utilize with minimal training, would lead to a much shorter discussion.

That it would, and I actually have a fairly good guess of who's who, since I know less than a handful of folks in class who referee on the side, but I do hate jumping to conclusions, and so don't.

Ad hominem attacks don't bother me; I for one chose my screenname so that when I have to make them, or any other argument besides, people can trace me back and ask me about it.

But anonymity has its uses for some, and I'm gratified to see so many AZCOMmers chiming in--even the always-eloquent muon (who still, unfortunately, hides behind the veil.) Osteopathy benefits from frank discussion about where it's heading. Like any vibrant and growing philosophy, there are bound to be nasty little differences of opinion, and if people feel that they can more effectively express opinions without letting the whole world know their name and location, then anonymity's served a useful role in furthering the profession.

 

[muonwhiz]

Luke! Get a sense of humor! I STILL (no pun intended) want another arm so that I can do intuitive OMM on myself! Since you seem to already know everyone's identity by magic, I need not reveal myself further.

 

[LukeWhite]

Originally posted by muonwhiz
Since you seem to already know everyone's identity by magic

Do you actually read the posts, or do you find that a random sample of words works just as well for you?

Anyhow. Too much AZCOM sniping. Back to the point! Is teaching OMM to patients a hubristic affront to the dignity of the profession or a potentially effective means of better preventive health and public appreciation of osteopathy?

Interesting answers so far from all; I'd love to hear more!

 

[LukeWhite]

A little more fuel on the fire:

A few people mentioned the widespread availability of books detailing the principles of OMM as evidence that the techniques aren't kept close to the vest.

How much does the book recommended on the "osteopathic students" section of SDN cost on Amazon?

http://www.amazon.com/exec/obidos/t...bookstor/104-4033560-9935905?v=glance&s=books

$200! That's what I think they call in the business world a high barrier to entry.

 

[Robz]

looked to me like the paperback was 39.95.

 

[LukeWhite]

Originally posted by Robz
looked to me like the paperback was 39.95.

True enough (though the $200 one was a mass market paperback--the "cheap" version of paperbacks) The $35 one is on Amazon's really-hard-to-get-a-hold-of list, though (Notice the 4-6 week delay). Generally it indicates a very limited supply.

Admittedly, there ARE other books available, some of which more or less on par with standard textbook costs. But there's definitely a far narrower market. Some of it is surely due to the fact that there just aren't that many DO's in need of instruction. But that begs the question of whether there should be more, whether that instruction should be restricted solely to DO's, and why there isn't a free and easily accessible resource for the stuff like there is for most every other medical science.

 

[muonwhiz]

That was very mean spirited, Luke. I hope that you were just having a bad day. Despite this, I wish you well in your finals.

 

[DoctorInSpace]

Maybe I'm jumping in at the wrong time, but these are my thoughts on OMM. I'm not responding to any post in particular, just the overall discussion of OMM.

I think that OMM is like any other medical treatment, and should be studied and regulated like anything else. I have found that there aren't a whole lot of studies done on different osteopathic techniques, which might give a little more credibility to those who disbelieve, but I'm a believer anyway. I plan on using OMM in my own practice, and hope to do an OMM fellowship at my school.

As far as making OMM more user friendly for non-physicians.......we can each teach our patients certain techniques that they can do themselves, especially post-mastectomy patients and the like. Our professors have actually said several times that certain techniques are easy to teach people to do on family members or themselves. I don't feel that this would eliminate the need for osteopathic manipulation by a physician---just helps to empower the patient somewhat.

Each one of us will decide for ourselves whether we want to use OMM in our practice or not, whether we believe in its usefullness, if we want to teach it to others, etc.

Yes, I'm an M1, with only 13 weeks now of OPP/OMM, but I chose to go to a DO school specifically for OMM. My opinion may be premature, but I'm really into OMM right now. I dont' think that will change, but we'll see.

 

[stomper627]

You guys make it sound as if OMM is such a hard thing to do....yet you as MSI are doing it within your first month of medical school....at which time you have such a great understanding of it. Right. And such a great understanding of medicine. Right.
Lets face it. Most of OMM is very simple....and the post about althetes is very correct. Ask any college athlete who worked with ATCs or CSCSs what muscle energy is. Sure it may be called something else (PNF) and not used to "correct dysfunctions", but it is still the same thing.
Counterstrain? Well anytime Im in the most comfortable position, Ill feel better....especially for musculoskeletal issues.
HVLA? How many times do you see people crack their own necks? Or how many of us had our "backs cracked" by each other as kids? Or how about when Im warming up on the bench, and my back cracks? But my favorite........is how we learned the correct technique in HVLA manipulation of the fingers. Yes, we learned how to correctly "pop" knuckles.
I think OMM is a great thing....for musculoskeletal issues (especially for us bodybuilders). Beyond that, there few uses.

stomper

 

[coreyw]

Self-manipulation (HVLA) is often apt to make the joint dysfunction, and associated discomfort and pain worse, not better. It should generally be advised against and advice given on how to relieve the discomfort and pain in between visits to the doctor.

In attempting 'crack' their own back or neck the patient often ends up moving the segment above or below the fixated vertebra (which may be hypermobile as a result of the adjacent hypomobile joint), providing some temporary relief as beta-endorphins flood the system, but actually aggravating the problem (or at least failing to successfully address it).

Many patients who undergo a well-tailored course of SMT (and have the fixated joints freed up) find the need to 'crack' their neck, back, sacro-iliac, etc. tends to subside. Simple self-mobilisation techniques (and basic strengthening/stretching) exercises are complementary to good physician-delivered OMM.

It is very tempting to 'crack' joints when pain and discomfort, often aggravated by stress, present themseves... sometimes several times a day (speaking from personal experience).

As to finger joints... the correct way to pop 'em is correct because it places less wear and tear on the joint capsule, and hence results in less pain and a shorter recovery period. You could take a 'harm minimisation' approach to your patient's 'addiction' joint popping by instructing them in the correct way to temporary relieve discomfort... but it won't address the underlying problems (including stress).

(The mother of an infant might, for instance, be taught to gently massage around the lower thoracic to help improve vertebral mobility and relieve the symptoms of colic, and I've read of DOs instructing mothers to encourage eustachian drainage to help alleviate otitis media.)

And let's not forget the psychosomatic benefits that may result from therapeutic touch by the physician... relaxation, improved immune response, etc.

Anyone can 'crack' joints willy-nilly, but it takes more than an afternoon to become a good manual therapist and skilled neuromusculoskeletal diagnostician. A good doctor will, on the other paw, encourage self-empowerment and self-control by the patient over their own health.

British, New Zealander and Australian osteopaths spend three to ten times as long as their American counterparts studying OMM... and even they aren't perfect.

best wishes,
Corey

 

[LukeWhite]

These are fantastic insights.

DoctorinSpace: Are there particular techniques that your profs have said work better for friends and families than others? I'm particularly interested in the techniques that they feel people can do effectively on themselves, without a trained partner.

Stomper: I'd love to hear more about your experiences with manipulation in athletics. Is this sort of thing passed on mainly via word of mouth, or are there more formal sessions where coaches walk through the processes with the team?

corey: Keen insights. I agree that most HVLA in particular is something we wouldn't want people doing without extensive training. I'd be interested to hear more about osteopaths in the Commonwealth--since OMM is their primary modality, I imagine there's a bit more of a tradition of thought behind what is and isn't fit for public consumption.

My personal view, again, is that there should be a continuum, with some techniques easily done by all, some better done by physicians but harmless and possibly helpful in the hands of interested patients, and the ones that could potentially cause serious damage if done by anyone but the highly trained.

It sounds like we're getting closer to what fits where, and even starting to include things not traditionally regarded as OMM. Which brings up another question: Should OMM be distinct from other forms of manual medicine, or should we wave that banner a little more broadly and make manual medicine in general, and not only that developed by osteopaths, our focus?

 

[DoctorInSpace]

Luke,

So far, the techniques that we have been encouraged to share with our patients and their families are effleurage and petrissage (especially for anyone who has lymph nodes removed, such as post-mastectomy patients), some of the soft tissue techniques (especially of the back), and mesenteric lift of small intesine and cecum. The last one is especially useful for babies apparently, although I imagine anyone with bowel trouble would find it useful. I was taught by a doctor YEARS ago certain ways to massage my abdomen for proper flow. So when we learned the mesenteric lifts, i was pleased and nicely surprised.

Not all OMM is appropriate for untrained people to perform on one another. But it is our job to educate and empower our patients, just like we would do with smoking cessation and diabetes. Everything in moderation, and good judgment should be used at all times. We are bound to do no harm, and teaching people techniques that would cause harm is just as bad. Some techniques are more benign than others.

Anyway, I hope that helps. I love OMM and look forward to learning more of it.

 

[LukeWhite]

DiS,

That's excellent info, thanks! Just out of curiosity, was the doctor who taught you the abdomen technique an MD or DO?

 

[buggs]

Originally posted by coreyw
(The mother of an infant might, for instance, be taught to gently massage around the lower thoracic to help improve vertebral mobility and relieve the symptoms of colic,

Any data supporting that?

 

[coreyw]

re data on spinal manipulation for infantile colic:

See: Wiberg JMM, Nordsteen J and Nilsson N. 'The Short-Term Effect of Spinal Manipulation of in the Treatment of Infantile Colic: A Randomized Controlled Trial with a Blinder Observer.' J Manipulative Physiol Ther, 1999:22(8):517?522.

Also, for a good review, see The Chiropractic Report online at http://www.chiropracticreport.com/samples/nov99.pdf

NB I'm not suggesting that mothers perform SMT on their infants. However, gentle paraspinal massage may be of help in alleviating the child's colicky symptoms in conjunction with professional treatment.

I'm led to believe that some families have traditionally dealt with colicky kids in something like this fashion - stretching baby over their lap and gently rubbing his or her back.

 

[tempest_fugit]

Hello,

There is a DO out there teaching an osteopathic technique to non-DO students. And yes, the workshops are more expensive than the general lay person can afford. However, non-DO lay and health related practitioners are encouraged to show patients gentle, non-invasive techniques, for example for a mother to use on her child.

His name is John Upledger, and the website is www.upledger.com. This is an unpopular topic with many DO's in practice, who consider Upledger a traitor. I took some of the classes before I got in med school because it was the only avenue available to me to learn the techniques.

Techniques are called CranioSacral Therapy, and it is a treatment modality employed by some massage therapists and physical therapists. Some nurses also learn the techniques. But there were also MD's and DO's in the workshops, as well.

If general OMM techniques are barely accepted, how many of you have had classes dealing with Cranial techniques, and the work of William Sutherland?

Hope this helps a bit,
Tempest

 

[DoctorInSpace]

That's excellent info, thanks! Just out of curiosity, was the doctor who taught you the abdomen technique an MD or DO?

Actually, it was a chiropractor (GASP!!). This particular chiropractor is into a lot of non-traditional modalities, like far eastern medicine, chinese herbal remedies, accupressure and accupuncture, as well as being a licensed nutritionist. I'm actually trying to see if NSU will allow him to take part in our alternative medicine course.

Sorry I didn't reply sooner......