I'm a 4th year student, I came to a DO school interested and excited about OMM, but as I learned more and more about it I found it progressively less founded and less useful. I would often look up lecture citations only to come up greatly disappointed. Even more disappointing to read mainstream publications showing OMM resulted in worse outcomes than no OMM at all. Most students and attendings have a "conversion" story about how OMM worked on them. I personally have suffered from chronic low back pain from a traumatic accident. Pain is always on the right side. Despite dozens of classroom OMM sessions rarely if ever was a diagnosis made by fellow student or OMM attending which correlated to my symptoms. Never was a treatment applied other than bowstringing (simple massage) that relieved pain. Frequent were diagnosis on the left side or at other vertebral levels at which no symptoms were felt that is until after treatment was performed, at which point I did have pain sometimes lasting for days.
Personally I find that HVLA is useful only as a placebo factor because patients like the pop. Muscle energy and Counterstrain are useful in limited ways but often take more time than worth for the mild degree of benefit. Chapman's points, Viscerosomatic reflexes and sacral-cranial are utterly worthless beyond the placebo, "drink the kool-aid" effect.
From casual conversation with fellow students, I would estimate that >90% abhor OMM and find it nothing more than something to joke about.
The following is a summary of my issues with OMM
Research
1) Small participant numbers which are mostly osteopathic medical students (young, healthy, active, pro-active in self health, and believe in osteopathic medicine)
With the exception of military medicine this is not relatable to the general patient population (older, obese, comorbid, lesser self-direction, little understanding of osteopathic medicine). Modalities which worked reasonable well in class with a 23 yr old partner are a nightmare with a 58yr old obese patient with arthritis. often good research is not clinically relevant.
2) Judicial technique- most research lets physicians do whatever modalities they feel best in treating a specific diagnosis. This does not permit examination of various techniques to determine which ones are clinically effective and which are a waste of time.
3) Dogmatic themes and conclusions. There are countless osteopathic research articles that are negative in there findings which then conclude with a statement to the effect of "hopefully future research and advanced technology will be able to elucidate the mechanism of action of ___OMM technique. Never can a conclusion be the most obvious idea which is that there is no scientific foundation for ____method and its justification for clinical use is limited.
4) Much citations of scientific validity in OMM are improperly attributed. The Foundations book by Ward aka the Green Bible of OMM is considered to be the preeminent evidenced based text of OMM. Unfortunate, several citations (I have not done an exhaustive survey) are to papers that are out of print and only available by special archival request, some residing only in special collection of school libraries, some refer to articles which are poor studies all-around, and other poorly relate to the cited text.
Communication of Knowledge
1) MDs don't understand the terms and significance of OMM findings, thus when writing notes that may be read by MD attendings or colleges (more and more common as private practices are dying out) the importance of OMM findings are often not worth the time to write them.
2) If the methods of OMM are not legitimate enough for all doctors to understand and use then they are not legitimate enough to spend so much time in medical school learning
Joel D. Howell, M.D., Ph.D stated, The paradox is this: if osteopathy has become the functional equivalent of allopathy, what is the justification for its continued existence? And if there is value in therapy that is uniquely osteopathic that is, based on osteopathic manipulation or other techniques why should its use be limited to osteopaths?
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3) Physical therapists, Chiropractors, Massage therapists, and to some degree Neurologists, Sports medicine, and Orthopedic surgeons all have treatment modalities which are similar if not exactly the same as osteopathic therapies. Yet the therapies may all go by different names. Osteopathy's attempt to maintain a propriety hold on modalities has contributed to fragmentation and lack of coordinated care in cases where manual medicine may be seen as appropriate.
Pragmatism
Is OMM effective? - yes, sometimes, in the right patient with the right techniques.
Does this justify 1 day a week for 2 years and 1 month of clinical medicine plus private study time for class and boards. For a small group of student maybe yes; but for the 75% of DOs that never use it and another 19% that rarely use it.[ii].,.[iii]. maybe no. Most students who desire proficiency either do a fellowship or spend a significant amount of personal time performing OMM. Older doctors may disagree but the current model of education of speciality practice modalities is to gain that training in fellowships. This enables those that wish to perform OMM to gain those skills, DO or MD and those that have no interest or no applicability can focuses there time, energy, money on other medical skills. Perhaps in areas that more exemplify "osteopathic philosophy."
... Howell JD. The paradox of osteopathy. N Engl J Med. 1999;341:1465 1468.
..[ii]... Spaeth DG, Pheley AM. Use of osteopathic manipulative treatment by Ohio osteopathic physicians in various specialties. J Am Osteopath Assoc. 2003;103:1626..
..[iii]... Spaeth DG, Pheley AM. Evaluation of osteopathic manipulative treatment training ..by practicing physicians in Ohio. ..J Am Osteopath Assoc... 2002; 102(3):-145-150..
