Doubts about OMM

[spiceylife]

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I have posted quite a bit under another userid, but I have created a second ID for the purposes of this question. I am quite identifiable under my usual id.

I am now an MS1 at an Osteopathic school. I love my school and my fellow classmates and I have no problems with my education except one. This OMM stuff looks and feels like bunk. Every time a teacher tells me how wonderful their patient feels after OMM, I want to ask if they offered them a happy ending.

I'm not saying that physical thereapy isn't useful, I just don't think it takes a doctor to do it. All the techniques that I have been studying look like pretty simple physical therapy (muscle energy and HVLA) or simple massage (bowstringing and longitudinal stretch). It might take a doctor to diagnose tennis elbow, but why (after giving a cortisone shot) doesn't he just prescribe daily or weekly massages and have a trained physical therapist or massage place on rolodex?

And the idea of teaching "philosophy" to medical students is quite annoying. What if one day a scientific study proves that the "rule of the artery" ISN'T supreme. What is this stuff about the body being a unit? Didn't Darwin already prove that the purpose of the body is to successfully procreate - not self-regulate.

Also, the AT Still worship bothers me. Why in the world do the philosophical/religious opinions of a not terribly rational man from the early 1900's matter to us in the treatment of patients? Aren't we supposed to be dedicated to science? Ok, the 1918 flu patients treated by DO's survived better. Wonderful - now what have you done for me lately? They were still working on viral theory in 1914. Maybe Osteopaths were better scientists than phlebotemists, but what recommendation is that today?

Look, I'm being really critical here and overstating my point a bit. I believe that DO's are as good of doctors as MDs. I believe that the education at osteopathic schools is wonderful and we are producing great physicians. I just think that the OMM education is a waste of time.

I am willing to be corrected. I am only an MS1 and may have a different opinion next year.

I recognize that this is an inflammatory post, and I am really not intending to be a troll. I hope that the admins will forgive my using a second ID to post this. I will reveal my identity to the admins if they request it and they can verify that I really am a DO student and a regular poster. I would just like to hear an answer to my challenge to Osteopathic orthodoxy without losing my career.

 

[J-Rad]

I am often ambivalent to many of the claims mad about OMM, yet am open to some modalities being helpful. My real response is more complicated than that, but I don't have the energy right now and I'm a lousy typists.

But here's an intersting letter to the editor from JAOA: http://www.jaoa.org/cgi/content/full/108/9/484

You aren't the only one with questions in re the 1918 pandemic.

I am also a bit curious about your paranoia on this item of questioning: you ask questions/put forth opinions here on SDN that have been rendered umpteen times before. I would venture that more people here agree with you to some degree between generally and strongly. Is there something about your school that actually makes you think that espousing these (commonly held and expounded upon) beliefs here would be career ending? How very sad. How fortunate for me that I trained at a school that employed these two (very good professors) http://faculty.une.edu/com/shartman/sram.pdf and at which, when introducing cranial to the students were actually respectful and open to the opinions of the above.

 

[spiceylife]

I am often ambivalent to many of the claims mad about OMM, yet am open to some modalities being helpful. My real response is more complicated than that, but I don't have the energy right now and I'm a lousy typists.

But here's an intersting letter to the editor from JAOA: http://www.jaoa.org/cgi/content/full/108/9/484

You aren't the only one with questions in re the 1918 pandemic.

I am also a bit curious about your paranoia on this item of questioning: you ask questions/put forth opinions here on SDN that have been rendered umpteen times before. I would venture that more people here agree with you to some degree between generally and strongly. Is there something about your school that actually makes you think that espousing these (commonly held and expounded upon) beliefs here would be career ending? How very sad. How fortunate for me that I trained at a school that employed these two (very good professors) http://faculty.une.edu/com/shartman/sram.pdf and at which, when introducing cranial to the students were actually respectful and open to the opinions of the above.

I apologize for repeating old arguments. I was not often in this forum before. I will do a more thorough search. I saw nothing with "doubts" and OMM in the title.

Edit:

Ok, I did another quick search and browsed through several threads and I'm not sure that what I said is quite the tired argument that you imply.

Firstly, I'm not just challenging cranial (that's pretty obviously herb-wife stuff) but I have a problem with having classes in a medical school that begin with "philosophy" and a pretty weak philosophy at that. This isn't exactly Kant or Descartes. Physicians should be scientists, not evangelists.

 

[bleeker10]

Besides cranial, my biggest issues with OMM lie in the naming of the treatments. I truly believe in and employ muscle energy when I can. I just hate that it's called muscle energy. Adding the word 'energy" makes it seem more hokey. HVLA at least has a cool sounding name haha. Same with BLT, even though I don't really like it.

 

[J-Rad]

Look, I know the search function isn't all that great (even the advanced search), but I'm going to just tell you that in the >8 years that I've been on this website, opinions similar to yours have been widely expressed and freely shared. I'm not criticizing you for having or posting them, but your level of paranoia is what intrigued me. Even the JAOA and The DO routinely print letters to the editor with such opinions (I was trying to dig up a particular older one from an ornery and eloquent writer, but couldn't find it. Sorry)

 

[st2205]

It's okay. If the endocrinologists were given four hours of the week the entire preclinical years you'd be getting the importance of that drilled into your head too. When you're on rotations you'll see you attendings with their own pet interests that's either the diagnosis or treatment for everyone. It's no different than OMM, except there's a department set up for it.

 

[thepoopologist]

OMM is out of the question in the hospital setting from what I've seen. Patients expect actual medicine practiced on them. The most useful aspect I've gleaned from it is it's made me far better with the physical exam than I would've been without those two years. I never gave much credit to the bull**** stories they spun in lecture, I mostly focused on practicing the techniques. A lot of OMM I never use but some of the stuff we were taught were exams you could find in a physical diagnosis book. I guess the moral of the story is that you'll eventually find some stuff useful, and others not so much. No you don't have to learn it well if you don't want to but you'd be kidding yourself to think that it's no benefit at all. The ones who enter OMM lab with that mindset are the ones who derive 0 skills vs some.

 

[randomusername]

I'm sitting here studying for my cranial midterm I have tomorrow, eating the worst tasting metaphorical pancakes of my life and figured I'd post.... If the intro stuff bugs you now, wait until you hit this stuff or Chapman's points. You're definitely not a lone voice of reason, as most of the people in my class seem to accept stuff like ME and HVLA but call total BS on stuff like cranial and find it ridiculous that we're not only taught the history and philosophy but that we're also tested on that stuff significantly.

On the plus-side, OMM is just something else you can bill for in the future and it's an easy way to impress the ladies if you happen to be single and a dude. 😉

 

[spiceylife]

Look, I know the search function isn't all that great (even the advanced search), but I'm going to just tell you that in the >8 years that I've been on this website, opinions similar to yours have been widely expressed and freely shared. I'm not criticizing you for having or posting them, but your level of paranoia is what intrigued me. Even the JAOA and The DO routinely print letters to the editor with such opinions (I was trying to dig up a particular older one from an ornery and eloquent writer, but couldn't find it. Sorry)

Sorry if I sound paranoid. Maybe I'm just being extra careful. My ID is closely associated with my school.

I was under the impression that this was a sacred cow - at least its treated religiously by several doctors here - but I'm glad to hear that it is barbedcued regularly.

 

[spiceylife]

OMM is out of the question in the hospital setting from what I've seen. Patients expect actual medicine practiced on them. The most useful aspect I've gleaned from it is it's made me far better with the physical exam than I would've been without those two years. I never gave much credit to the bull**** stories they spun in lecture, I mostly focused on practicing the techniques. A lot of OMM I never use but some of the stuff we were taught were exams you could find in a physical diagnosis book. I guess the moral of the story is that you'll eventually find some stuff useful, and others not so much. No you don't have to learn it well if you don't want to but you'd be kidding yourself to think that it's no benefit at all. The ones who enter OMM lab with that mindset are the ones who derive 0 skills vs some.

That's a good way to think about it. My school is traditional in not introducing you to patients for a long time and this is a good way to gain some skills.

 

[spiceylife]

Besides cranial, my biggest issues with OMM lie in the naming of the treatments. I truly believe in and employ muscle energy when I can. I just hate that it's called muscle energy. Adding the word 'energy" makes it seem more hokey. HVLA at least has a cool sounding name haha. Same with BLT, even though I don't really like it.

I think that you are right. I've tried the muscle energy stuff on a friend who has a knee restricted by Rheumatoid arthritis and he gained 4 to 5 degrees of extension in a few minutes. This sort of physical therapy can be useful. But the name sounds like it was invented by a guy in a brightly painted wagon selling Dr. HealAll's amazing healing wax.

 

[Bacchus]

So tell someone you're going to stretch them with their active participation?

 

[thepoopologist]

That's a good way to think about it. My school is traditional in not introducing you to patients for a long time and this is a good way to gain some skills.

It's either that or transfer to an MD, although I have to say OMM lab honestly helps, though not for the reasons they tell you.

 

[Ghost22]

Take what's useful, discard what isn't, move on. Don't get so bent out of shape, there's something to be gained from almost everything they have us do.

 

[spiceylife]

Take what's useful, discard what isn't, move on. Don't get so bent out of shape, there's something to be gained from almost everything they have us do.

But if I get bent out of shape, the OMM instructors can use a holistic approach to fix me.

 

[gocatgo]

I was holding my partner's head for 2 minutes during our Cranial practical exam, pretending I was feeling the 'CRI." I just couldn't feel anything except his respirations. Proctor knew I was totally faking and I failed that portion of the exam. Stupid cranial exam.

 

[DrWBD]

But here's an intersting letter to the editor from JAOA: http://www.jaoa.org/cgi/content/full/108/9/484

You aren't the only one with questions in re the 1918 pandemic.

Excellent article!

 

[MedicinaeDoctor]

It's either that or transfer to an MD, although I have to say OMM lab honestly helps, though not for the reasons they tell you.

you gotta tell us those reasons.

 

[LesBois88]

I can't speak for the previous poster- but OMM lab does help with some unrelated things.

Examples include rapid identification of external landmarks and MSK features. This is more relevant when doing procedures and perhaps in some specific rotations/residencies like PM&R.

 

[Arch Guillotti]

Friend, I have been on SDN almost since it started. Thoughts such as the ones you have posted have been thrown about on this board from the get-go and I'll bet there are many others that feel this way.

I hated OMM and I am about as un-osteopathic of a physician there can be (flame away if you wish).

I think some OMM is bunk (cranial, OA release etc). Some is useful (felt really good to get my back cracked when my thoracics were out of whack). I think a lot of it is very similar (if not identical) to physical therapy.

The 4 tenets of osteopathic medicine are just common sense IMHO.

Any physician can be holistic (or not).

Suck it up and before you know it OMM will be a distant memory.

I have posted quite a bit under another userid, but I have created a second ID for the purposes of this question. I am quite identifiable under my usual id.

I am now an MS1 at an Osteopathic school. I love my school and my fellow classmates and I have no problems with my education except one. This OMM stuff looks and feels like bunk. Every time a teacher tells me how wonderful their patient feels after OMM, I want to ask if they offered them a happy ending.

I'm not saying that physical thereapy isn't useful, I just don't think it takes a doctor to do it. All the techniques that I have been studying look like pretty simple physical therapy (muscle energy and HVLA) or simple massage (bowstringing and longitudinal stretch). It might take a doctor to diagnose tennis elbow, but why (after giving a cortisone shot) doesn't he just prescribe daily or weekly massages and have a trained physical therapist or massage place on rolodex?

And the idea of teaching "philosophy" to medical students is quite annoying. What if one day a scientific study proves that the "rule of the artery" ISN'T supreme. What is this stuff about the body being a unit? Didn't Darwin already prove that the purpose of the body is to successfully procreate - not self-regulate.

Also, the AT Still worship bothers me. Why in the world do the philosophical/religious opinions of a not terribly rational man from the early 1900's matter to us in the treatment of patients? Aren't we supposed to be dedicated to science? Ok, the 1918 flu patients treated by DO's survived better. Wonderful - now what have you done for me lately? They were still working on viral theory in 1914. Maybe Osteopaths were better scientists than phlebotemists, but what recommendation is that today?

Look, I'm being really critical here and overstating my point a bit. I believe that DO's are as good of doctors as MDs. I believe that the education at osteopathic schools is wonderful and we are producing great physicians. I just think that the OMM education is a waste of time.

I am willing to be corrected. I am only an MS1 and may have a different opinion next year.

I recognize that this is an inflammatory post, and I am really not intending to be a troll. I hope that the admins will forgive my using a second ID to post this. I will reveal my identity to the admins if they request it and they can verify that I really am a DO student and a regular poster. I would just like to hear an answer to my challenge to Osteopathic orthodoxy without losing my career.

 

[DrHogFan]

The 4 tenets of osteopathic medicine are just common sense IMHO.


Suck it up and before you know it OMM will be a distant memory.

Very true, but sadly they aren't actually practiced by MOST allopathic physicians as much as they are by MOST osteopathic physicians. We never claimed to know some secret formula that MD's don't, we just claim to practice it. There is more to being an osteopathic physician than OMT. A neurosurgeon can be just as osteopathic as a NMM fellow or sports med doc. In the end I understand one's doubts of OMM. But then again, you DID apply to an osteopathic school, so it should be no shock. I personally feel privileged to be equipped with these extra skills that I can use in ADDITION to prescribing medication or performing surgery. I think there are more and more MD clone osteopathic schools out there that teach OMM for the boards and that be it. I attend a traditional school, and have wonderful OMM professors who can and are happy to go into detail about why you do a certain technique, when, and what is happening in the body. And it makes sense to me, and I enjoy doing it. I'm not accusing anybody here, and I know it is a fact that this happens, but I feel like those who attend DO schools as back ups share these viewpoints towards OMM and osteopathic philosophy as the OP. I knew graduating college I wanted the DO after my name and knew what I was getting into. My advice to the OP is have am open mind, learn it for the boards, and no one is going to twist your elbow once your an attending, forcing you to perform OMT.

 

[sylvanthus]

You say you knew what you got into, but didn't you just start a couple months ago? Somehow, I don't think you are qualified to say all of the above. After the koolaid drinking and shiny new toy feeling fades, your tune may change

 

[DrHogFan]

You say you knew what you got into, but didn't you just start a couple months ago? Somehow, I don't think you are qualified to say all of the above. After the koolaid drinking and shiny new toy feeling fades, your tune may change

Actually I have worked closely for four years with osteopathic and allopathic physicians. My best friend is a 3rd year osteopathic student. Didn't and doesn't make me an expert by any means, but I DID know what I was getting into. I figure I had more than average knowledge for a premed as to what osteopathy is. I did not mean for my post to come across as flaming because that was not my intent. I was speaking to an OMS1 as an OMS1 that has had a different experience with my first few months.

 

[spiceylife]

Very true, but sadly they aren't actually practiced by MOST allopathic physicians as much as they are by MOST osteopathic physicians. We never claimed to know some secret formula that MD's don't, we just claim to practice it. There is more to being an osteopathic physician than OMT. A neurosurgeon can be just as osteopathic as a NMM fellow or sports med doc. In the end I understand one's doubts of OMM. But then again, you DID apply to an osteopathic school, so it should be no shock. I personally feel privileged to be equipped with these extra skills that I can use in ADDITION to prescribing medication or performing surgery. I think there are more and more MD clone osteopathic schools out there that teach OMM for the boards and that be it. I attend a traditional school, and have wonderful OMM professors who can and are happy to go into detail about why you do a certain technique, when, and what is happening in the body. And it makes sense to me, and I enjoy doing it. I'm not accusing anybody here, and I know it is a fact that this happens, but I feel like those who attend DO schools as back ups share these viewpoints towards OMM and osteopathic philosophy as the OP. I knew graduating college I wanted the DO after my name and knew what I was getting into. My advice to the OP is have am open mind, learn it for the boards, and no one is going to twist your elbow once your an attending, forcing you to perform OMT.

I didn't go to my school as a backup. I love it and I believe that it is producing great physicians. There is more to an osteopathic medical school than the legacy of AT Still and I doubt that the school selects its students by their devotion to OMM.

A few people have said that the Osteopathic tenets are just common sense, but I disagree. They sound like common sense, and I'm sure that they made sense to a parson's son in 1874, but, let's face it, they aren't science. A body doesn't have everything it needs to heal itself. They didn't know about any autoimmune or genetic diseases in 1892 - in fact - they hadn't even proved that viruses cause disease yet. The body isn't a unit dedicated to homeostasis - as a physical body, it is dedicated to preserving its genes. Allostatic load is metaphysics, not science. I even saw that one of my class notes was teaching the Holmes and Rahe stress load test. Come on, folks, can you get any softer and still call it science? Why don't we teach some sociological and economic "science" while we are at it.

I really came into this education with an open mind about OMM - I was excited to learn a set of skills that I could put into practice quickly. Yes, I've only been at this a couple of months, but I have a sensitive meter for nonsense and I smell snake oil.

 

[Tig2575]

You have a critical, skeptical, scientific mind. It's a shame that you're being bombarded in your first year with such pseudoscience. At my allopathic school in our second year, we had three hours of lecture on "herbal remedies" given by some doctor-in-title-only. The lectures were not evidence based in the slightest, and a huge number of my fellow students complained to our dean about being subjected to such bull**** in the guise of an academic institution. The lectures have since been removed from the next year class' schedule.

Personally, I don't know what my response would be to having such quackery being not only a part of the core curriculum, but an underlying principle of the degree I was working to attain. I think you've been given great advice when others have told you to ignore the crap that you do not believe in. I think, based on your posts, that you'll do a great job of tailoring your education in a purely scientific and sensible manner.

 

[Velocity]

The body isn't a unit dedicated to homeostasis - as a physical body, it is dedicated to preserving its genes. Allostatic load is metaphysics, not science. I even saw that one of my class notes was teaching the Holmes and Rahe stress load test. Come on, folks, can you get any softer and still call it science? Why don't we teach some sociological and economic "science" while we are at it.

I really came into this education with an open mind about OMM - I was excited to learn a set of skills that I could put into practice quickly. Yes, I've only been at this a couple of months, but I have a sensitive meter for nonsense and I smell snake oil.

Your thoughts on procreation are echoing those of the "selfish gene" theory, which I disagree with. To say that we exist purely to procreate is untrue. It is too simplistic to say that each individual exists purely to procreate. The clearest example can be seen in species like ants and bees, where members of the colony are completely sterile. Humans are different, but we also exist in social collectives. Some even hypothesize that this can explain why homosexuality is completely natural: you have members of the species that are not spending time and energy on procreation/fighting for mates, and who can help the collective as a whole. Just some thoughts unrelated to the main crux of your post.

That aside, I felt similarly to you a few months ago. Details regarding A.T. Still take on an almost religious tone to them. We go over various quotations that he said, learn all about his life (and get tested on it)... honestly, as a scientifically-oriented person, it seems a little bizarre to me. I don't know of any of my classmates who buy into it, though, so I just see it as a thing that we all have to get by. Take what you will from it, and ignore the rest (unless it's on a test).

 

[spiceylife]

Your thoughts on procreation are echoing those of the "selfish gene" theory, which I disagree with. To say that we exist purely to procreate is untrue. It is too simplistic to say that each individual exists purely to procreate. The clearest example can be seen in species like ants and bees, where members of the colony are completely sterile. Humans are different, but we also exist in social collectives. Some even hypothesize that this can explain why homosexuality is completely natural: you have members of the species that are not spending time and energy on procreation/fighting for mates, and who can help the collective as a whole. Just some thoughts unrelated to the main crux of your post.

That aside, I felt similarly to you a few months ago. Details regarding A.T. Still take on an almost religious tone to them. We go over various quotations that he said, learn all about his life (and get tested on it)... honestly, as a scientifically-oriented person, it seems a little bizarre to me. I don't know of any of my classmates who buy into it, though, so I just see it as a thing that we all have to get by. Take what you will from it, and ignore the rest (unless it's on a test).

Actually, I believe in creation (or biologos, or theistic evolution, or something like that, I'm not terribly concerned with giving it a name), but I recognize my belief as a religious - not scientific - one and would have a problem with a required course called "power of prayer".

 

[fiznat]

Some have it worse than others. We aren't getting tested on too much AT Still history (there was 1 question on the first test I think), but we still get our fair share of n=1 storytime in lecture, etc. I smell snake oil too, but I'm trying to keep an open mind.

We're doing muscle energy right now and I thought I'd look up the research on it. Heh. Here's an article I found in a recent issue of the International Journal of Osteopathic Medicine that does a pretty good review of the literature.

A quote from that article which pretty much sums things up (they're talking about muscle energy):

...With dubious reliability and validity for many tests of spinal and pelvic dysfunction, practitioners following an evidence-informed approach will be frustrated. Until we have tests with better clinical usefulness, the practitioner should use those tests with face validity and clinical utility based on experience, be cautious about making firm conclusions based on single clinical findings, and use a variety of tests that support a logical clinical reasoning process.

 

[costales]

My OMM class was kinda fun. There was stuff I didn't care about, but I learned specific techniques that were interesting and useful. Otherwise, it was the least of my worries in the curriculum and in the grand scheme of things.

 

[bones]

I have posted quite a bit under another userid, but I have created a second ID for the purposes of this question. I am quite identifiable under my usual id.

I am now an MS1 at an Osteopathic school. I love my school and my fellow classmates and I have no problems with my education except one. This OMM stuff looks and feels like bunk. Every time a teacher tells me how wonderful their patient feels after OMM, I want to ask if they offered them a happy ending.

I'm not saying that physical thereapy isn't useful, I just don't think it takes a doctor to do it. All the techniques that I have been studying look like pretty simple physical therapy (muscle energy and HVLA) or simple massage (bowstringing and longitudinal stretch). It might take a doctor to diagnose tennis elbow, but why (after giving a cortisone shot) doesn't he just prescribe daily or weekly massages and have a trained physical therapist or massage place on rolodex?

And the idea of teaching "philosophy" to medical students is quite annoying. What if one day a scientific study proves that the "rule of the artery" ISN'T supreme. What is this stuff about the body being a unit? Didn't Darwin already prove that the purpose of the body is to successfully procreate - not self-regulate.

Also, the AT Still worship bothers me. Why in the world do the philosophical/religious opinions of a not terribly rational man from the early 1900's matter to us in the treatment of patients? Aren't we supposed to be dedicated to science? Ok, the 1918 flu patients treated by DO's survived better. Wonderful - now what have you done for me lately? They were still working on viral theory in 1914. Maybe Osteopaths were better scientists than phlebotemists, but what recommendation is that today?

Look, I'm being really critical here and overstating my point a bit. I believe that DO's are as good of doctors as MDs. I believe that the education at osteopathic schools is wonderful and we are producing great physicians. I just think that the OMM education is a waste of time.

I am willing to be corrected. I am only an MS1 and may have a different opinion next year.

I recognize that this is an inflammatory post, and I am really not intending to be a troll. I hope that the admins will forgive my using a second ID to post this. I will reveal my identity to the admins if they request it and they can verify that I really am a DO student and a regular poster. I would just like to hear an answer to my challenge to Osteopathic orthodoxy without losing my career.

You are right to doubt. If I didn't have excellent mentors over the years I probably would have given up on it myself, despite me choosing the DO route specifically to master an alternative approach to patient care.

Unfortunately many of the schools treat Osteopathy as a religion- and expect belief based on thin or no evidence.. and try to make you "believers" by throwing you impressive sounding cases that they have heard about or had in their own practice, and you have no way to know if they made it up or embellished. This should trigger some skepticism- you'd be a fool if it didn't. Memorization of techniques and protocols designed to fix things (with no evidence that they do) was annoying as well... I felt like they were trying to make me a chiropractor or physical therapist, much as it sounds like you do.

This isn't "real" osteopathy... but it is the only version of it most DO's see. Ironically this isn't at all what AT Still tried to teach. Despite his face being on every wall and endless quotes of his taken out of context, it seems nobody has a clue what he was trying to say.

My sentiment about physical therapy is about the same as yours- it seems very useful as an adjunct, but should be practiced by non physicians. I also agree that most of the techniques of osteopathy are not much different than what a physical therapist might do. The emphasis of techniques and beliefs over biomechanics and pathophysiology is where OMM departments lose most students... It becomes a procedural art like physical therapy, or worse, a pseudoscience- instead of a branch of medicine based on knowledge and clinical reasoning. What I can do that a physical therapist cannot is I can diagnose things, and using the diagnosis I can reason to the cause- and then cure it in many cases. This occurs sometimes in one visit. I never prescribe a course of X treatments over X time, and I never follow protocols. I do my best to make the correct clinical diagnosis and cure or refer appropriately.

All I have to offer is cases of my own, though that is admittedly little to offer. I try to offer them as objectively as possible. My goal in sharing them isn't at all to make you a "believer" but rather to show you how OMM might be useful to you and to share my clinical rationale so that someone might replicate my success themselves. I do not think my process or results at all resemble physical therapy, even if some of the treatment mechanics are similar- but you can judge for yourself.

http://forums.studentdoctor.net/showthread.php?t=854642

There are hundreds more (and more every day) and they are highly reproducible, but they do not compensate for the complete lack of good standardized research we have produced thus far.

I humbly disagree that OMM is a waste of time- though your OMM class may be. I have nothing to reference but my own experience and the offer to show you what I mean if you are so inclined. I wish there were more, and maybe someday there will be. I encourage you to ask hard questions of your faculty, don't accept any explanations on faith.

This is spot on:
"be cautious about making firm conclusions based on single clinical findings, and use a variety of tests that support a logical clinical reasoning process."

 

[fozzy40]

I love these threads!

I will give you my opinions on this topic as an osteopathic physiatrist.

- OMM for all intensive purposes is a branch of the manual medicine tree. There are many other branches such as chiropractic medicine, massage therapy, etc. We all basically believe that the body functions as a unit and biomechanical restrictions/dysfunctions (aka somatic dysfunction) contribute to disease.
- OMM works when provided on the "right" patients but does have its limitations like any other treatment.
- Now what is the "right" patient to treat somatic dysfunction? No one knows. Osteopathic physicians, allopathic physicians, neurologists, chiropractors, physical therapists, orthopedic surgeons, and physiatrists do not know who to treat. Part of the problem is that no two patients have the exact same causes of back pain for example. From a research perspective, this makes designing studies difficult because of these confounding factors.
- I think where students (myself included initially) get lost is how dogmatic some of our instructors are about the treatments. I see spine and MSK problems 100% of my day and there is no "cure" for musculoskeletal problems. OMM can help you diagnose problems and allow you opportunity give some pain relief using manipulation so that they can participate in ACTIVE physical therapy. That being said, you kind of have to have people that teach it dogmatically initially so that you learn the techniques. Where I think what we fail is that the limitations are not emphasized as much as the benefits.

Lastly, OMM is a great skill to learn no matter what field you go into. It teaches you think out of the box and treat the body as a unit. If you disagree that the body does not function as a unit, just give me an example of what you mean. True story...lady came into my office last Monday with episodic but rhythmic back pain. I did an abdominal exam and found an acute cholecystitis. She went to or for lap chole the following day. Do a pubmed search, gallbladder pain typically presents as abdominal pain and RARELY back pain. Out of the box.

OMM works if performed on certain patients but does have limitations.

 

[spiceylife]

There are many other branches such as chiropractic medicine, massage therapy, etc. We all basically believe that the body functions as a unit and biomechanical restrictions/dysfunctions (aka somatic dysfunction) contribute to disease.

That, I believe is my first problem with the teaching of this. "The body functions as a unit." That statement is so vague and unfalsifiable that it cannot qualify as science. In order to qualify as scientific, a hypothesis must be testable. That is not a statement of science, it is a statement of philosophy.

Also, it doesn't lead anywhere. If you say that the osteopathic physician looks for back problems not only in the back, but also in the feet and neck - that is great. But I'm trying to think of a physician who would not consider this possibility. Is there an MD orthopod who would claim that all back problems are localized in the back?

It looks to me like the OMM department makes vague sweeping statements that sound scientific to sell you on techniques that may or may not be effective. This approach is more appropriate for a vacuum cleaner salesman.

 

[spiceylife]

You are right to doubt. If I didn't have excellent mentors over the years I probably would have given up on it myself, despite me choosing the DO route specifically to master an alternative approach to patient care.

Unfortunately many of the schools treat Osteopathy as a religion- and expect belief based on thin or no evidence.. and try to make you "believers" by throwing you impressive sounding cases that they have heard about or had in their own practice, and you have no way to know if they made it up or embellished. This should trigger some skepticism- you'd be a fool if it didn't. Memorization of techniques and protocols designed to fix things (with no evidence that they do) was annoying as well... I felt like they were trying to make me a chiropractor or physical therapist, much as it sounds like you do.

This isn't "real" osteopathy... but it is the only version of it most DO's see. Ironically this isn't at all what AT Still tried to teach. Despite his face being on every wall and endless quotes of his taken out of context, it seems nobody has a clue what he was trying to say.

My sentiment about physical therapy is about the same as yours- it seems very useful as an adjunct, but should be practiced by non physicians. I also agree that most of the techniques of osteopathy are not much different than what a physical therapist might do. The emphasis of techniques and beliefs over biomechanics and pathophysiology is where OMM departments lose most students... It becomes a procedural art like physical therapy, or worse, a pseudoscience- instead of a branch of medicine based on knowledge and clinical reasoning. What I can do that a physical therapist cannot is I can diagnose things, and using the diagnosis I can reason to the cause- and then cure it in many cases. This occurs sometimes in one visit. I never prescribe a course of X treatments over X time, and I never follow protocols. I do my best to make the correct clinical diagnosis and cure or refer appropriately.

All I have to offer is cases of my own, though that is admittedly little to offer. I try to offer them as objectively as possible. My goal in sharing them isn't at all to make you a "believer" but rather to show you how OMM might be useful to you and to share my clinical rationale so that someone might replicate my success themselves. I do not think my process or results at all resemble physical therapy, even if some of the treatment mechanics are similar- but you can judge for yourself.

http://forums.studentdoctor.net/showthread.php?t=854642

There are hundreds more (and more every day) and they are highly reproducible, but they do not compensate for the complete lack of good standardized research we have produced thus far.

I humbly disagree that OMM is a waste of time- though your OMM class may be. I have nothing to reference but my own experience and the offer to show you what I mean if you are so inclined. I wish there were more, and maybe someday there will be. I encourage you to ask hard questions of your faculty, don't accept any explanations on faith.

This is spot on:
"be cautious about making firm conclusions based on single clinical findings, and use a variety of tests that support a logical clinical reasoning process."

I saw that thread several weeks ago and starting reading through it. I fear that the concepts discussed are a little advanced for me, and I may understand it more after a few months. I'll come back to it.

 

[fozzy40]

That, I believe is my first problem with the teaching of this. "The body functions as a unit." That statement is so vague and unfalsifiable that it cannot qualify as science. In order to qualify as scientific, a hypothesis must be testable. That is not a statement of science, it is a statement of philosophy.

Also, it doesn't lead anywhere. If you say that the osteopathic physician looks for back problems not only in the back, but also in the feet and neck - that is great. But I'm trying to think of a physician who would not consider this possibility. Is there an MD orthopod who would claim that all back problems are localized in the back?

It looks to me like the OMM department makes vague sweeping statements that sound scientific to sell you on techniques that may or may not be effective. This approach is more appropriate for a vacuum cleaner salesman.

Haha...orthopods are notorious for not looking for things other than the area that hurts. Not sure of your experience but I deal with it day in and day out. If you can't operate on it, they won't touch it our believe that it's a significant problem. Now I'm not saying except everything at face value. I'm saying not every situation is easy to test in an evidence based manner. We should continue to strive for it though.

I absolutely agree about creating a testable hypothesis is the basis of science.

1) Just as an exercise, create a testable hypothesis regarding low back pain and OMM for me.
2) Evidence based medicine is great! However, it doesn't always equate to good clinical conclusions. Plus, absence of proof does not mean that the treatment does not work. Check out my thread on my signature where I give many examples of this. Here is a fun example! To date, there is no randomized controlled trial that parachutes prevent injury or death. Anyone want to test that against placebo?🙂

 

[bones]

I love these threads!

I will give you my opinions on this topic as an osteopathic physiatrist.

- OMM for all intensive purposes is a branch of the manual medicine tree. There are many other branches such as chiropractic medicine, massage therapy, etc. We all basically believe that the body functions as a unit and biomechanical restrictions/dysfunctions (aka somatic dysfunction) contribute to disease.
- OMM works when provided on the "right" patients but does have its limitations like any other treatment.
- Now what is the "right" patient to treat somatic dysfunction? No one knows. Osteopathic physicians, allopathic physicians, neurologists, chiropractors, physical therapists, orthopedic surgeons, and physiatrists do not know who to treat. Part of the problem is that no two patients have the exact same causes of back pain for example. From a research perspective, this makes designing studies difficult because of these confounding factors.
- I think where students (myself included initially) get lost is how dogmatic some of our instructors are about the treatments. I see spine and MSK problems 100% of my day and there is no "cure" for musculoskeletal problems. OMM can help you diagnose problems and allow you opportunity give some pain relief using manipulation so that they can participate in ACTIVE physical therapy. That being said, you kind of have to have people that teach it dogmatically initially so that you learn the techniques. Where I think what we fail is that the limitations are not emphasized as much as the benefits.

Lastly, OMM is a great skill to learn no matter what field you go into. It teaches you think out of the box and treat the body as a unit. If you disagree that the body does not function as a unit, just give me an example of what you mean. True story...lady came into my office last Monday with episodic but rhythmic back pain. I did an abdominal exam and found an acute cholecystitis. She went to or for lap chole the following day. Do a pubmed search, gallbladder pain typically presents as abdominal pain and RARELY back pain. Out of the box.

OMM works if performed on certain patients but does have limitations.

Agree with most of what you say, but my experience strongly disagrees with the "no cures" part you speak of. Cures (or remissions) are a daily component of a good OMM practice. This is the natural consequence of fixing the causes of symptoms that you see rather than (or in addition to) fighting the symptoms directly.

This could be as simple as disrupting a spinal cord reflex spasm of a muscle that has been causing neck pain for years. You could stretch or inject or use electrotherapy on the muscle regularly for months or years and maybe make incremental gains, or you could do a single counterstrain treatment and have it normalized for good after 90 seconds, with zero recurrence (or you could use Still technique or NFR and have it resolve in only a few seconds). To me, physical therapy is a waste of time for such a patient when OMM is so fast and effective. Same appears to be true of nerve impingement syndromes, migraines, shoulder impingement syndrome, plantar fasciitis, tennis elbow, trochanteric bursitis, psoas spasm and sacroilliac pain, among other conditions. One or two visits should in each of these cases result in permanent improvement or complete and permanent remission- depending on how good a job was done. I consider it a failure if I achieve anything less. If symptoms resolve for a few days but recur, I take that as a sign that my technique was good but my thinking was faulty and the wrong thing was treated. Back to the drawing board. Often a re-evaluation reveals the cause and permanent remission is then possible.

For strokes, spinal cord injuries or patients with major deconditioning- I think physical therapy is superior to OMM, as you dont want a physician spending the 1x1 time with a patient necessary to make the slow incremental gains with are a natural part of their recovery, and PMR docs are well trained to oversee physical therapists doing this work. A DO PMR physician has the unique opportunity to integrate the approaches and use either when it is most effective for a given patient. In my practice, i end up referring these patients for which PT will likely be more cost and time effective.

For patients where anatomic abnormalities are the major source of pain, an ortho or spine specialist referral may be far more effective than OMM. Straightening/stabilizing a compression fx or surgically mobilizing or replacing an anatomically fused joint is very important for some patients so they can have more normal function.

So yes- choosing the right patients for OMM is critical so you dont waste the patient's time and you don't waste your own time.

As for gallbladder disease- the back pain is pretty common actually- and sometimes the only complaint. Really weird is right shoulder pain as the primary complaint for gallbladder disease, and I have seen that a few times. The shoulder pain is referred from the diaphragm/phrenic nerve which shares C3-5 innervation with the ipsilateral shoulder- much in the way that an inferior wall MI could produce neck and left shoulder pain by irritating the left hemidiaphragm. I check the abdomen in cases where my shoulder exam is completely unremarkable despite significant local pain. A rigid tender abdomen then warrants an ultrasound. Resolution of the shoulder pain after appropriate surgery is diagnostic. The reason people think back pain/shoulder pain is so rare is that the pain goes undiagnosed and is treated with pain meds until the condition worsens to the point where they have abdominal cramping or tearing of the biliary system- and at that point the gallbladder isn't tied back to the pain regardless of the fact that the pain resolves after surgery.

 

[spiceylife]

2) Evidence based medicine is great! However, it doesn't always equate to good clinical conclusions. Plus, absence of proof does not mean that the treatment does not work. Check out my thread on my signature where I give many examples of this. Here is a fun example! To date, there is no randomized controlled trial that parachutes prevent injury or death. Anyone want to test that against placebo?🙂

Doctor, you have passed step 1 and 2, graduated medical school and completed a residency. Therefore, you have proven, beyond all doubt, that you are too intelligent to believe that argument is valid. I have not accomplished any of these things and therefore, might be too stupid to avoid a naegleri fowleri infection. I am bothered to believe that you believe that I could find a sophomoric statement like this convincing. Another possibility is that you are actually trying to prove the irrationality of OMM practitioners. But I will give you the benefit of the doubt and decide that you are busy treating patients and just tossed that off because it sounded cool.

 

[peppy]

I think we do need to keep in mind that AT Still was from an era when 'conventional' medicine had a lot of harmful quackery of its own and many people would indeed be better off allowed to heal on their own rather than taking some toxic patent medicine.
So, in the context of his era, I think AT Still had some very good ideas and did the best he could with the information he had at the time. Since I ended up going into psychiatry, I would liken him to Freud - I think most psychiatrists respect Freud for being a pioneer and giving a foundation to the rest of us, but the vast majority of psychiatrists no longer consider Freud's theories to be the pinnacle of psychiatric knowledge and have refined our understanding as new information has come about.

Unfortunately, it does seem to me like many OMM departments are stuck in the past and are not trying to adapt as more knowledge becomes available. It does seem very much like a religion, where "the truth" was revealed one day and now there is to be no questioning or refinement of our beliefs.
I think the reason that DO schools still teach things like cranial is because that topic IS a big one for COMLEX, but it would be nice if there was more discussion about if the evidence actually does support continuing to teach and test on such topics. I do wonder if things may get better once the new generation of DOs gets into leadership positions....

 

[spiceylife]

I do wonder if things may get better once the new generation of DOs gets into leadership positions....

By getting into the leadership position, the office-holder becomes financially interested in maintaining differences between DO's and MD's. Therefore the average DO is never represented by the leadership of the DO organizations, because the leaders represent the leadership.

 

[fozzy40]

Agree with most of what you say, but my experience strongly disagrees with the "no cures" part you speak of. Cures (or remissions) are a daily component of a good OMM practice. This is the natural consequence of fixing the causes of symptoms that you see rather than (or in addition to) fighting the symptoms directly.

I guess it depends on how you define "cure". Cure to me means no recurrence. MSK problems in my experience have a tendency to recur.

As for gallbladder disease- the back pain is pretty common actually- and sometimes the only complaint. Really weird is right shoulder pain as the primary complaint for gallbladder disease, and I have seen that a few times. The shoulder pain is referred from the diaphragm/phrenic nerve which shares C3-5 innervation with the ipsilateral shoulder- much in the way that an inferior wall MI could produce neck and left shoulder pain by irritating the left hemidiaphragm. I check the abdomen in cases where my shoulder exam is completely unremarkable despite significant local pain. A rigid tender abdomen then warrants an ultrasound. Resolution of the shoulder pain after appropriate surgery is diagnostic. The reason people think back pain/shoulder pain is so rare is that the pain goes undiagnosed and is treated with pain meds until the condition worsens to the point where they have abdominal cramping or tearing of the biliary system- and at that point the gallbladder isn't tied back to the pain regardless of the fact that the pain resolves after surgery.

Again, I depends on what you define as "common." 80% of my patients I see per day have back pain. About 100% of them do not have gallbladder disease. Based on that, gallbladder disease is not in my "top 5" differential and I don't consider it common.

 

[fozzy40]

Doctor, you have passed step 1 and 2, graduated medical school and completed a residency. Therefore, you have proven, beyond all doubt, that you are too intelligent to believe that argument is valid. I have not accomplished any of these things and therefore, might be too stupid to avoid a naegleri fowleri infection. I am bothered to believe that you believe that I could find a sophomoric statement like this convincing. Another possibility is that you are actually trying to prove the irrationality of OMM practitioners. But I will give you the benefit of the doubt and decide that you are busy treating patients and just tossed that off because it sounded cool.

Check out the thread in my signature.

 

[bones]

Doctor, you have passed step 1 and 2, graduated medical school and completed a residency. Therefore, you have proven, beyond all doubt, that you are too intelligent to believe that argument is valid. I have not accomplished any of these things and therefore, might be too stupid to avoid a naegleri fowleri infection. I am bothered to believe that you believe that I could find a sophomoric statement like this convincing. Another possibility is that you are actually trying to prove the irrationality of OMM practitioners. But I will give you the benefit of the doubt and decide that you are busy treating patients and just tossed that off because it sounded cool.

I think you're a little early in the training process to shoot off an opinion like this. He is correct that not everything that isn't proven is false. That is common sense to anyone. You may be taking issue with "Evidence based medicine is great! However, it doesn't always equate to good clinical conclusions."

He is actually correct about this as well. For example, read about thalidomide http://en.wikipedia.org/wiki/Thalidomide
Yes- it is a sedative that was fairly effective for morning sickness in controlled scientific studies. if you jumped on the EBM bandwagon and gave it to all your pregnant women you'd be sorry a few years later. Educated common sense must corroborate what is found to be statistical truth.


Beta blockers are effective in double blind trials at lowering blood pressure. and a systolic blood pressure of 140 may be 50% more likely to stroke than a patient with 120. Does that automatically mean you follow evidence based medicine and put your 95 year old patient taking coumadin (blood thinner) with osteoporosis on a beta blocker to get it to 120 to reduce their stroke risk? there are many docs that would without thinking due to EBM.

The risk of passing out and breaking a hip (50% mortality) or hitting their head (likely to cause a lethal brain bleed while on coumadin) may trump the stroke odds on this one, and quality of life plays a factor too. If the beta blocker makes it so they are tired all the time and cant exercise or stay awake to talk to their family, you need to consider these factors as well.

In the end medicine is an art as well as a science. Evidence based medicine is wonderful to validate or disprove what we believe to be true, but you cannot rely on it to make good decisions in the absence of common sense and a good understanding of what is most likely true based on your best judgement (even if it hasn't been fully proven yet). Where the EBM model falls on its face is when docs follow guidelines without this common sense and end up succeeding in reducing strokes but doubling or tripling the risk of mortality for their patient- but since EBM wasn't asking the question about mortality the prescribing doc and their patient are both blissfully ignorant of the risks.

 

[spiceylife]

I think you're a little early in the training process to shoot off an opinion like this. He is correct that not everything that isn't proven is false. That is common sense to anyone. You may be taking issue with "Evidence based medicine is great! However, it doesn't always equate to good clinical conclusions.".

I was referring to his parachute quote, not to his opinions about Evidence Based Medicine. Having doubts about OMM does not automatically turn me into a believer in the newest fads in treatment. As you say, I am too early in my education to have very many opinions.

My problem is that the argumentative technique he used is sophomoric and unworthy of a full-trained doctor. Having doubts about the religious tone of OMM training is not equivalent to deciding when to prescribe Beta-blockers or how much trust to place in EBM. As physicians we must be dedicated to science - that doesn't mean that we have to jump on every new bandwagon that calls itself scientific. EBM may prove to be a great advance in medical treatment, or it may be just a defense against lawsuits. I'll have a more educated opinion in a few years.

But I still have enough education to notice when a treatment is based on little or no science at all.

 

[bones]

I guess it depends on how you define "cure". Cure to me means no recurrence. MSK problems in my experience have a tendency to recur.

Again, I depends on what you define as "common." 80% of my patients I see per day have back pain. About 100% of them do not have gallbladder disease. Based on that, gallbladder disease is not in my "top 5" differential and I don't consider it common.

I agree with your definition of "cure", and I stand by my statement. every day I have patients who go into permanent remission for musculoskeletal problems, its not something special about me personally- its what any DO with the right training can do, but few have this training, and its not what you get in class at any of the schools I am aware of. Most OMM docs dont know their medicine, or their biomechanics, or how fascial planes relate to each other. Most dont even know their anatomy very well. Very little of this is integrated effectively into the OMM classes at schools.

To get permanent success with OMM you need effective screening methods and a good working knowledge of the many causes for each of the conditions you aim to treat. For any given patient there is usually only one of those many causes- and you need to find it or you wont be successful.


As for the gallbladder issue- I think I wasn't clear what I meant. probably less than 1% of back pain is gallbladder disease, but most with gallbladder disease has back pain on the right side, and maybe a certain percentage have back pain before they even have abdominal pain (i don't know exactly how common this is). No, it wouldn't even be close to your top 5 reasons for back pain. I see a few each year that come to me for back pain or shoulder pain without abdominal pain and I drop them that diagnosis. I imagine most don't get seen or are misdiagnosed until their abdomen starts hurting- so whatever the figure is, it is probably underrecognized.

 

[bones]

I was referring to his parachute quote, not to his opinions about Evidence Based Medicine. Having doubts about OMM does not automatically turn me into a believer in the newest fads in treatment. As you say, I am too early in my education to have very many opinions.

My problem is that the argumentative technique he used is sophomoric and unworthy of a full-trained doctor. Having doubts about the religious tone of OMM training is not equivalent to deciding when to prescribe Beta-blockers or how much trust to place in EBM. As physicians we must be dedicated to science - that doesn't mean that we have to jump on every new bandwagon that calls itself scientific. EBM may prove to be a great advance in medical treatment, or it may be just a defense against lawsuits. I'll have a more educated opinion in a few years.

But I still have enough education to notice when a treatment is based on little or no science at all.

okay I misjudged you- sorry about that 😛

The OMM classes at most schools are a total disaster of misconceptions and untested theories expected to be memorized and accepted as gospel. What I consider real osteopathy is a philosophical approach to seeing patients which incorporates as much science and modern EBM as possible to problem solve in a dynamic way- to get to the root of a problem, and fix the problem at its source with minimally invasive and maximally effective means.

EBM is the principle reason medicine isn't still pushing leeches and mercury on patients. It is wonderful. It is not to be used without educated common sense however, and just because something hasn't yet been tested doesn't mean it cant be true. Fox's point about the parachute was just a graphic way to demonstrate how scientific studies haven't covered everything.

Outcomes like what I've seen my mentors get and now what I get are very difficult to explain except by the effectiveness of what we do (unless you think I'm lying, which i can see is more plausible to some- but happens to be untrue). EBM has not caught up with what we do at all, and I dont have time to run the thousands of studies that need to be done all by myself. They need to be done, but we need to train DO's in research methodology to make this happen. Most DO schools have a pitiful review of how to read primary literature and how to write research papers. This is an area for future improvement in our schools.

I would be happy to know other explanations for what I see in clinic- especially if they involve me being wrong about anything I think i understand. I would have patients laugh in your face if you told them their improvement was all in their head or placebo- though that doesn't make them or me correct in our assessments. Many of these guys are simple farmers or storeclerks and they come to me by physician referral not expecting anything, not even sure what I do- and having suffered for years- and some leave after 20 minutes symptom free... that doesn't happen often in the non-DO world.

This is what I love most about my specialty and my practice- changing lives every day- giving people normal function again after years of suffering- often after they have lost all hope of being normal again. The bewildered looks on their faces when they realize they are better. That changes to joy on the 2-3 week follow up when they are still symptom free and realize they are likely to be symptom free from that point on. Don't get me wrong, I cant help everyone, and there are many things I simply refer. As I continue learning though, my odds improve each month that passes. Things that would have bewildered me a year ago are easy fast visits now. This is what DO's can be with the right training. I urge you and others reading this not to give up just because class sucks. Seek out successful mentors to find out what is possible.

 

[Galenus]

this is an awesome thread people. In addition to the points made above, I would add that AT Still was NOT a scientist. He may have started his movement during the time of phlebotomy, but almost at the exact same time in the 1860's, Louis Pasteur published his work proving the germ theory. If you read AT Still's book - published in the 1910's - he still doesn't acknowledge the germ theory. He claims to believe in them but then states that they can only take hold when there is some sort of somatic disfunction and describes what a worm or fungus would do to already dead tissue. How can a medical school put a photo up of a man who spent 50 years of his life denying a basic, provable, medical fact? It's like someone denying the existence of DNA today....

The AT Still worshiping must stop.

 

[spiceylife]

This is what I'd like to see in OMM class - A close association between anatomy and OMM. The OMM instructors ought to be present in our anatomy labs - helping us dissect and explaining the motions of the body internally when it is manipulated.

For example, I see a lot of OMM talk about fascia, but no one has explained what they are talking about. Is it possible for fascia to become twisted in a direction that the associated muscle is not designed to handle? If so, show that to me on a cadaver, or at least draw a cartoon illustration. Give me a coloring book showing somatic dysfunction - not at a zoom-out view 10 feet away - I mean show how the levator scapula muscle becomes strained and how it could be put into a position of ease. Show me what whip lash looks like - tell me which fascia's are involved - what may be strained or torn.

That would be science. Describing "counter-strain" without telling me what is physically happening to the patient is patent-medicine.

 

[spiceylife]

Now that I'm thinking about it, I'm wondering why none of this research has been done. Take a patient who has been under the care of a OMM specialist and is willing to donate his body. Now study the OMM notes and make measurements on the cadaver. Do special staining on the muscles and fascia to discover the differences. Does the right subscapularis have a different percentage of Type IIb muscle than the left? Is the right leg REALLY longer? Have the histology and pathology department go over the body microscopically. Have the anatomy department count the ligament attachments of the shoulder, back, thorax, abdomen... Measure the muscle bulk. Your living notes give you texture, temperature, turgor, supposed assymetry, your after-death study should give you TNF-alpha presence, count of lymph nodules and generating centers.

The DO schools started getting science facult in 1910 - it is now 2011 - that's 1 century. Why hasn't any of this been done yet? What is this - I'll marry you once I'm financially able?

 

[Bacchus]

This is what I'd like to see in OMM class - A close association between anatomy and OMM. The OMM instructors ought to be present in our anatomy labs - helping us dissect and explaining the motions of the body internally when it is manipulated.

For example, I see a lot of OMM talk about fascia, but no one has explained what they are talking about. Is it possible for fascia to become twisted in a direction that the associated muscle is not designed to handle? If so, show that to me on a cadaver, or at least draw a cartoon illustration. Give me a coloring book showing somatic dysfunction - not at a zoom-out view 10 feet away - I mean show how the levator scapula muscle becomes strained and how it could be put into a position of ease. Show me what whip lash looks like - tell me which fascia's are involved - what may be strained or torn.

That would be science. Describing "counter-strain" without telling me what is physically happening to the patient is patent-medicine.

This is a very good point and I wonder how many schools actually correlate the two. Our faculty, one member of it really, always said OMM professors should be allowed into the lab. Other faculty would love to be invited, too. Story goes, our head of cardiology would love to be in lab when dissection of the CV system occurs but when he proposed this/or said hi to the head of the lab, he got a "Who are you?" There's a big disconnect between the departments at schools. Happens at the undergraduate level and will happen at the graduate level. It's unfortunate, because our first lab actually had an OMM professor in it pointing out some landmarks before we skinned the back of our bodies but we didn't see an OMM professor after that.

 

[spiceylife]

This is a very good point and I wonder how many schools actually correlate the two. Our faculty, one member of it really, always said OMM professors should be allowed into the lab. Other faculty would love to be invited, too. Story goes, our head of cardiology would love to be in lab when dissection of the CV system occurs but when he proposed this/or said hi to the head of the lab, he got a "Who are you?" There's a big disconnect between the departments at schools. Happens at the undergraduate level and will happen at the graduate level. It's unfortunate, because our first lab actually had an OMM professor in it pointing out some landmarks before we skinned the back of our bodies but we didn't see an OMM professor after that.

I'm checking with a highly regarded PhD at our school about research of this to see what he replies. This may be worth pursuing.

 

[fozzy40]

My problem is that the argumentative technique he used is sophomoric and unworthy of a full-trained doctor.

Seriously? Take a joke youngin' and like I said check out the thread in my signature. I give plenty of "full-trained" doctor material that is "worthy" of your experienced eyes.