Forbes Osteopathic Medicine Article

[chicago5950]

http://www.forbes.com/sites/sciencebiz/2010/10/27/osteopaths-versus-doctors/

Does this piss anyone else off?

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[costales]

This was two years ago. The idiot created quite a firestorm, judging from the comments. He didn't even know there were DOs teaching MD students at his school. He did publish a half-assed retraction/apology two days later:
http://www.forbes.com/sites/sciencebiz/2010/10/29/second-thoughts-on-osteopathic-medicine/

 

[Bacchus]

And received a nice letter from the AOA president, haha.

 

[The kitchen sink]

http://www.forbes.com/sites/sciencebiz/2010/10/27/osteopaths-versus-doctors/

Does this piss anyone else off?

Interesting read, thanks for the post. He gets completely ripped in the comments so I'm sure he has learned his lesson.

Is it wierd I enjoy reading articles by misinformed people hating on the DO profession (as a DO candidate myself)?

Might I add, both articles were terribly written, in my opinion. I expected more well-informed writers from Forbes, jeez.

 

[rafman]

Its good to see that its not only the DO's that are upset and arguing against the article. I guess the stigma really is decreasing among the general population. Hopefully in the next 30 years or so, it'll be a thing of the past!!

 

[TriagePreMed]

There was a huge thread here. He definitely got destroyed for this.

 

[SpecterGT260]

2 things, the author typos to "OD". Dont do that if you want to write a criticism. On the other hand the author does not hide that MDs are often as guilty of quackery. I understand the frustration with the negative tone in the article but the info isnt inaccurate.

 

[TheOncoDOc]

http://www.huffingtonpost.com/larry-malerba/osteopathic-doctors_b_1460022.html

Here's another response to that same article.

 

[TriagePreMed]

http://www.huffingtonpost.com/larry-malerba/osteopathic-doctors_b_1460022.html

Here's another response to that same article.

How sad that he's a homeopath which basically gives credence to what Salzberg says.

 

[SoulinNeed]

How sad that he's a homeopath which basically gives credence to what Salzberg says.

Seriously. Added by the fact that he responded to a two year old article, it just gives more exposure to Forbes' BS.

 

[Socrates25]

There is still a vestige of the past in osteopathic manipulative therapy (OMT), which the American Osteopathic Association claims can treat such problems as asthma, sinus problems, and menstrual pain.

Please tell me this is NOT true.

 

[LSU Alex]

Please tell me this is NOT true.

Depends on your definition of "treat". Treat does not necessarily mean cure. I can't speak to the asthma stuff, but people commonly use massage to provide relief from sinus headaches and menstrual issues. They are, in effect, treating themselves. OMT for those specific issues is pretty much a jedi version of massage.

It's not going to cure it, but OMT will get you points with your lady friends for the attempt...

 

[DocEspana]

Please tell me this is NOT true.

That's totally true. As was said above me. Treat = improving symptoms, not curing. We learn how to augment albuterol, tylenol, and midol for asthma, sinus pain, and menstrual cramps. Its under the fields of improving respiratory effort by assuring there are no concurrent rib issues, sinus massage for drainage, and muscle massage for the cramping.

 

[DOWay]

Wow that author sounds so bitter! I wonder what his problem is/was with DOs.

 

[MedicinaeDoctor]

Depends on your definition of "treat". Treat does not necessarily mean cure. I can't speak to the asthma stuff, but people commonly use massage to provide relief from sinus headaches and menstrual issues. They are, in effect, treating themselves. OMT for those specific issues is pretty much a jedi version of massage.

It's not going to cure it, but OMT will get you points with your lady friends for the attempt...

now that's pretty awesome. i always seem to come across DO students complaining about OMT on sdn. if OMT helps treat so many different types of issues, what is it that turns DO students off about OMT? i'm guessing cranial, lack of application in their desired specialty, lower reimbursement, application itself of OMT is time consuming, the fact that OMM class takes time/effort away from other stuff, kinda out there professors of OMM, and that some people are just not good at it? am i close? if that's the case, OMT doesn't seem all that bad to me as people make it seem on sdn.

 

[Bacchus]

now that's pretty awesome. i always seem to come across DO students complaining about OMT on sdn. if OMT helps treat so many different types of issues, what is it that turns DO students off about OMT? i'm guessing cranial, lack of application in their desired specialty, lower reimbursement, application itself of OMT is time consuming, the fact that OMM class takes time/effort away from other stuff, kinda out there professors of OMM, and that some people are just not good at it? am i close? if that's the case, OMT doesn't seem all that bad to me as people make it seem on sdn.

Its because of the way it is taught. I understand we need (supposedly) the foundations of OMM. However, it is so much more helpful learning it from a clinician that isn't board certified in OMM and/or NMM but rather another specialty. I've had two lectures/demonstrations where a busy FP showed and told us how OMM was incorporated into practice in the office. I worked with a DO who did OMM on a fair number of people and she carried on her office visits while HVLA'ing necks, spines, or inominates. As she was further interviewing the patient and pain-stakingly typing into the EMR she'd have me do soft tissue or MFR. Its easy to incorporate simple tasks into the visit, but we aren't taught this way.

You don't need to diagnose segment by segment or layer by layer to get your treatment modality. You use common sense and avoid contraindications or what makes you feel uncomfortable. If a 30 y/o comes in with LBP and you ruled out the red flags (via your regular ROS you do) you can continue talking to them while you do a quick crunch. You can do several of your ENT sequence steps while you tell the patient about follow up care, etc.

Unfortunately, the pillars of osteopathic medicine prevent this modality and thought process from entering the sacred halls of the OMM lab.

 

[LSU Alex]

now that's pretty awesome. i always seem to come across DO students complaining about OMT on sdn. if OMT helps treat so many different types of issues, what is it that turns DO students off about OMT? i'm guessing cranial, lack of application in their desired specialty, lower reimbursement, application itself of OMT is time consuming, the fact that OMM class takes time/effort away from other stuff, kinda out there professors of OMM, and that some people are just not good at it? am i close? if that's the case, OMT doesn't seem all that bad to me as people make it seem on sdn.

First, medical students like to b*tch about everything. Second, yes, it does take away from that renal final you need to study for, and there isn't a whole lot of evidence based medicine behind it all. I don't advocate the use of OMT; but if someone wants to do it and their pts get something out of it, more power to you. The way I see it is you are going to a DO school, so you signed up to learn OMT. Deal with it. If you pick something up that you like, put that club in your bag for later use.

You will actually find pts who seek out OMT... they swear by it. Good for them. I'll just refer them to a DO who practices in the dark arts.

 

[hopeinternist]

medicare-data-reveal-564-million-wasted-on-chiropractors-and-osteopathic-manipulation

Google the forbes article from today

he strikes again.. man this guy really hates DOs

 

[BorntobeDO?]

medicare-data-reveal-564-million-wasted-on-chiropractors-and-osteopathic-manipulation

Google the forbes article from today

he strikes again.. man this guy really hates DOs

Its the same guy? I was wondering that when I saw the link. Dude is fake news.

 

[CoomassieBlue57]

Vertebral artery dissection? That’s in the foot right? How should I know because I’m just derf hocus-pocus osteopathingy. Contraindications? Never heard of ‘em.

 

[cryhavoc]

This feels like libel. Anybody a lawyer?

 

[NurWollen]

Without having read the entire article, I've gotta say that for us DOs and DO students to be outraged, kind of smacks of "no one trashes us but us." It's easy to get outraged, especially given Salzburg's previous article. But the truth is, much of OMM is every bit as pseudoscientific as chiropractic. And many SDNers know that and talk about it here all the time.

Sent from my SM-G930V using SDN mobile

 

[cryhavoc]

Without having read the entire article, I've gotta say that for us DOs and DO students to be outraged, kind of smacks of "no one trashes us but us." It's easy to get outraged, especially given Salzburg's previous article. But the truth is, much of OMM is every bit as pseudoscientific as chiropractic. And many SDNers know that and talk about it here all the time.

Sent from my SM-G930V using SDN mobile

He’s basically saying we aren’t doctors. OMT is additional training, not substituted training. He’s making it sound like we don’t practice conventional medicine.

He also uses terrible historical examples to make us look bad, when you could find just as many terrifying historical examples of allopaths at work.

 

[DrfluffyMD]

He’s basically saying we aren’t doctors. OMT is additional training, not substituted training. He’s making it sound like we don’t practice conventional medicine.

He also uses terrible historical examples to make us look bad, when you could find just as many terrifying historical examples of allopaths at work.

Change allopath to “physicians”. I never understood why physicians were called “allopaths” etc.

 

[Chibucks15]

Change allopath to “physicians”. I never understood why physicians were called “allopaths” etc.

To differentiate from the other type of physicians that are out there...you know, cuz there's more than one path to being a physician

 

[DrfluffyMD]

To differentiate from the other type of physicians that are out there...you know, cuz there's more than one path to being a physician

It’s a degrading term coined by creator of homeopathy to refer to modern medicine.

Allopathic medicine - Wikipedia

Honestly I am not quite sure why SDN has it. Just say LCME students would be better than “allopathic” forums.

 

[cryhavoc]

It’s a degrading term coined by creator of homeopathy to refer to modern medicine.

Allopathic medicine - Wikipedia

Honestly I am not quite sure why SDN has it. Just say LCME students would be better than “allopathic” forums.

9/10 posts that have alphabet soup or acronyms make my eyes glaze over. No clue what they are talking about. Just to dissect the post often requires looking up ten different acronyms. Acronyms hardly are “useful” at easing communication at that point . . .

 

[Mad Jack]

medicare-data-reveal-564-million-wasted-on-chiropractors-and-osteopathic-manipulation

Google the forbes article from today

he strikes again.. man this guy really hates DOs

What is interesting to me is that I've spent a few weeks of time in an OMM clinic, and for many patients it was the only thing that provided them any relief. A lot of them were able to stop taking opioid medication and regained day-to-day function after failing years of conventional therapy. Yeah, it may be anecdotes of bone wizardry, but the results I saw were pretty damn good, and many patients were improved enough by a handful of treatments that they never needed to be seen again (again, after failing conventional therapy for months or years). So while OMM may not have a strong evidence base, from the clinic I was rotating at, I guarantee the treatments overall paid for themselves if you pooled all of the patients together (some obviously failed treatment, but any treatment will have nonresponders). Chiropractic care I've seen less than thrilling results with for most conditions, as it seems many chiropractors are more keen to sell supplements and treat the same thing over and over again than to favor an approach that actually fixes a problem for any length of time.

 

[cryhavoc]

What is interesting to me is that I've spent a few weeks of time in an OMM clinic, and for many patients it was the only thing that provided them any relief. A lot of them were able to stop taking opioid medication and regained day-to-day function after failing years of conventional therapy. Yeah, it may be anecdotes of bone wizardry, but the results I saw were pretty damn good, and many patients were improved enough by a handful of treatments that they never needed to be seen again (again, after failing conventional therapy for months or years). So while OMM may not have a strong evidence base, from the clinic I was rotating at, I guarantee the treatments overall paid for themselves if you pooled all of the patients together (some obviously failed treatment, but any treatment will have nonresponders). Chiropractic care I've seen less than thrilling results with for most conditions, as it seems many chiropractors are more keen to sell supplements and treat the same thing over and over again than to favor an approach that actually fixes a problem for any length of time.

I’ve met so many patients who only find relief from chronic pain from OPP. A lot of the techniques are basically physical therapy and even the ones that aren’t definitely provide human touch and placebo.

Better than being hooked on drugs for pain relief. Prescription pads aren’t the solution for all of life’s problems and sometimes create even more problems.

 

[Osminog]

What is interesting to me is that I've spent a few weeks of time in an OMM clinic, and for many patients it was the only thing that provided them any relief. A lot of them were able to stop taking opioid medication and regained day-to-day function after failing years of conventional therapy. Yeah, it may be anecdotes of bone wizardry, but the results I saw were pretty damn good, and many patients were improved enough by a handful of treatments that they never needed to be seen again (again, after failing conventional therapy for months or years). So while OMM may not have a strong evidence base, from the clinic I was rotating at, I guarantee the treatments overall paid for themselves if you pooled all of the patients together (some obviously failed treatment, but any treatment will have nonresponders). Chiropractic care I've seen less than thrilling results with for most conditions, as it seems many chiropractors are more keen to sell supplements and treat the same thing over and over again than to favor an approach that actually fixes a problem for any length of time.

This is the exact sort of thing that apologists for homeopathy say. You can't discount the placebo effect.

"Patients drank the wate... err, medication, and now they say they feel much better. Mainstream medicine failed them, but we pulled through."

 

[Mad Jack]

This is the exact sort of thing that apologists for homeopathy say. You can't discount the placebo effect.

"Patients drank the wate... err, medication, and now they say they feel much better. Mainstream medicine failed them, but we pulled through."

I mean, whatever you want to believe. All I'm saying is I've seen people come off opioids and that's ****ing life changing, and potentially life-saving.

 

[Mad Jack]

This is the exact sort of thing that apologists for homeopathy say. You can't discount the placebo effect.

"Patients drank the wate... err, medication, and now they say they feel much better. Mainstream medicine failed them, but we pulled through."

Spinal manipulative therapy for chronic low-back pain | Cochrane

And OMM isn't something for which there is no evidence- it is as effective as physical therapy, exercise, and other conventional treatments. Given that the CDC has recommended non-opioid therapy for primary management of chronic pain, it stands to reason that OMM, which is equally as effective as physical therapy and other primary modalities, is also acceptable as a primary treatment.

CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016 | MMWR

 

[Osminog]

Spinal manipulative therapy for chronic low-back pain | Cochrane

And OMM isn't something for which there is no evidence- it is as effective as physical therapy, exercise, and other conventional treatments. Given that the CDC has recommended non-opioid therapy for primary management of chronic pain, it stands to reason that OMM, which is equally as effective as physical therapy and other primary modalities, is also acceptable as a primary treatment.

From the article you linked: "However, it is less clear how [spinal manipulative therapy] compares to inert interventions or sham (placebo) treatment because there are only a few studies, typically with a high risk of bias, which investigated these factors."

You already admitted that OMM doesn't have a strong evidence base. Are you going to backpedal now?

 

[Mad Jack]

From the article you linked: "However, it is less clear how [spinal manipulative therapy] compares to inert interventions or sham (placebo) treatment because there are only a few studies, typically with a high risk of bias, which investigated these factors."

You already admitted that OMM doesn't have a strong evidence base. Are you going to backpedal now?

I'm not backpedaling. I'm saying its evidence is as strong as anything for PT/exercise, per multiple studies. Comparing it against placebo is difficult, because the only way to have a proper placebo would be if it were double-blind, which is impossible unless you train someone completely to believe that they are providing effective treatment but you have in fact trained them in sham treatments, then set them up with patients that also believe they are providing effective treatments. Someone who is trained in OMM cannot just fake sham treatments reliably, because they will have subconscious bias due to the fact that they do not believe what they are doing to be working. That is why the "high risk of bias" exists: the only way for there to not be bias would be to completely train someone incorrectly through an entire medical and OMM education, then use them as a manual medicine placebo control.

This is a basic study design issue, and not the fault of OMM, but rather the fact that some studies are just extremely difficult to perform. As someone who spent many years in critical care, I can tell you that the issue is endemic not just to osteopathic medicine, but to many other areas as well. Orthopedics, for instance, has minimal evidence base for many of their procedures, and the evidence that exists has no or poor controls because performing sham surgery is both difficult and hard to ethically justify. Of the sham studies that have been done, placebo was found to be as effective as surgery in several cases (knee arthroscopy, for instance).
Surgery for Torn Meniscus in the Knee is Often Unnecessary, Ineffective, Misdirected
Why ‘Useless’ Surgery Is Still Popular

But I digress. As you progress further in medicine, you will realize that some things are unfeasible, or in some cases impossible, to study for a myriad of reasons, and that "evidence based medicine" is often based upon poorly designed studies (ARDSnet, anyone? If you want to fight me about it I'll gladly throw down, it was a poorly designed and controlled study, but it's standard of care because they showed 6cc was superior to supratherapeutic 12cc tidal volumes, while no intermediate volumes were studied or considered, and no group received oxygen protocol alone or volume therapy alone). OMM is but one of many things that fall into this bucket.

 

[Deecee2DO]

What is interesting to me is that I've spent a few weeks of time in an OMM clinic, and for many patients it was the only thing that provided them any relief. A lot of them were able to stop taking opioid medication and regained day-to-day function after failing years of conventional therapy. Yeah, it may be anecdotes of bone wizardry, but the results I saw were pretty damn good, and many patients were improved enough by a handful of treatments that they never needed to be seen again (again, after failing conventional therapy for months or years). So while OMM may not have a strong evidence base, from the clinic I was rotating at, I guarantee the treatments overall paid for themselves if you pooled all of the patients together (some obviously failed treatment, but any treatment will have nonresponders). Chiropractic care I've seen less than thrilling results with for most conditions, as it seems many chiropractors are more keen to sell supplements and treat the same thing over and over again than to favor an approach that actually fixes a problem for any length of time.

Chiropractic spinal manipulation is virtually identical to OMM, yet chiropractic gets trashed-on and OMM is seen as "effective". They are both HVLA. You would have seen the same results with a chiro doing spinal manipulation as you did in the OMM clinic. But, for some reason, because it is OMM and is in reference to DOs people may be more willing to open their eyes as seeing it as providing some sort of function in comparison to chiro. However, other than yourself, who has actually SEEN results from manipulation in the clinic and can give first-hand empirical knowledge on the subject, many of our medical student peers/colleagues/fellow SDNers repeatedly trash talk chiropractic manipulation despite having ANY experience with it at all. The purpose behind OMM and chiropractic manipulation as a safer and more cost effective alternative treatment for low back pain compared to surgery/opioid analgesics is to restore function/mobility within the joint complex, reduce capsular adhesion formation/inflammation and induce articular mechanotransduction via HVLA (essentially a different form of passive mobilization). This CAN be great for some patients as you have seen in the OMM clinic. However, like you also stated it is a lot more difficult to study manipulation from a research perspective because there are so many variables and it would be tough to perform studies in this arena (we do have some but it is not as comprehensively studied as much of the other medical research currently out there). If you take out the supplements and scam artist chiros trying to tell you they can cure your reflux and cancer and tell you that you have to be treated for life, you have chiropractic spinal manipulation (HVLA) which serves virtually the same exact purpose/function as OMM (HVLA). Source: I am a DO student who was previously a licensed chiro, so I have a great deal of background knowledge in manipulation and non-surgical MSK.

P.S. Thank you for your insight into the OMM clinic

 

[Deecee2DO]

Interesting read, thanks for the post. He gets completely ripped in the comments so I'm sure he has learned his lesson.

Is it wierd I enjoy reading articles by misinformed people hating on the DO profession (as a DO candidate myself)?

Might I add, both articles were terribly written, in my opinion. I expected more well-informed writers from Forbes, jeez.

As a DO student and previous licensed chiro, trust me I know what it feels like to hear and see misinformed people referencing/writing about stuff they think they know but haven't done any informed research on and trust what "everyone else" says. It is easy to jump on the bandwagon, but what many of those on SDN who trash alternative treatments (especially chiro spinal manipulation HVLA) who will be doctors or are already doctors are doing when we do this is completely disregarding what we are taught. When a patient comes in with an issue to see you as their physician, will you just dx them with what the previous doctor dx them with? I hope not since that would be incredibly negligent.

 

[cryhavoc]

This is the exact sort of thing that apologists for homeopathy say. You can't discount the placebo effect.

"Patients drank the wate... err, medication, and now they say they feel much better. Mainstream medicine failed them, but we pulled through."

But people who practice homeopathy or chiropractics aren’t able to asses the patient as a normal physician as well. Run labs, imaging, exam, etc.

Patient comes in with back pain.

Doctor runs every test imaginable and cannot come up with a cause.

The doctor has a few choices. Pain medication (potentially addicting), handing him off to a another professional or telling them it is all in their head.

Enter the osteopathic physician. He does muscle energy, which is basically physical therapy. The patient feels better. Like someone isn’t just writing him off. And he isn’t getting addicted to pain medication.

Just seems like a winning situation all around.

The issue with the homeopath is he or she isn’t usually qualified to rule out all other causes before diving into alternative medicine. They want to dive in right off the bat or just don’t have the qualifications.

As for traditional medicine, we tried back surgery and it is largely ineffective, and we tried pain drugs that ruined lives and health.

So to completely dismiss the additional training, not substituted training (still can do everything else), is not fair.

This journalist is not assessing the osteopathic physician fairly at all.

 

[Mad Jack]

Chiropractic spinal manipulation is virtually identical to OMM, yet chiropractic gets trashed-on and OMM is seen as "effective". They are both HVLA. You would have seen the same results with a chiro doing spinal manipulation as you did in the OMM clinic. But, for some reason, because it is OMM and is in reference to DOs people may be more willing to open their eyes as seeing it as providing some sort of function in comparison to chiro. However, other than yourself, who has actually SEEN results from manipulation in the clinic and can give first-hand empirical knowledge on the subject, many of our medical student peers/colleagues/fellow SDNers repeatedly trash talk chiropractic manipulation despite having ANY experience with it at all. The purpose behind OMM and chiropractic manipulation as a safer and more cost effective alternative treatment for low back pain compared to surgery/opioid analgesics is to restore function/mobility within the joint complex, reduce capsular adhesion formation/inflammation and induce articular mechanotransduction via HVLA (essentially a different form of passive mobilization). This CAN be great for some patients as you have seen in the OMM clinic. However, like you also stated it is a lot more difficult to study manipulation from a research perspective because there are so many variables and it would be tough to perform studies in this arena (we do have some but it is not as comprehensively studied as much of the other medical research currently out there). If you take out the supplements and scam artist chiros trying to tell you they can cure your reflux and cancer and tell you that you have to be treated for life, you have chiropractic spinal manipulation (HVLA) which serves virtually the same exact purpose/function as OMM (HVLA). Source: I am a DO student who was previously a licensed chiro, so I have a great deal of background knowledge in manipulation and non-surgical MSK.

P.S. Thank you for your insight into the OMM clinic

The problem is, HVLA is generally one of the lowest-yield techniques in OMM. It provides short-term relief. The clinic that I observed had an approach that basically tried to normalize all of the soft tissue related to a complaint, and also approached lifestyle and other factors that led to the complaint in the first place. HVLA essentially functioned as an adjunctive treatment used on maybe one in ten patients, since most of the time HVLA performed in isolation will merely move something into a proper position only to be moved back later by the dysfunctional muscle and other tissue that moved it out of alignment in the first place. Treating the cause of dysfunction would often cause things to normalize on their own with no direct manipulation required. Hence why I'm not a big fan of chiropractic medicine- it's essentially treating a symptom but neglecting the problems that often created the symptom in the first place. Worse still, every chiropractor in my area has a reputation as a snake oil salesman that pushes useless supplements on their patients for hundreds or even thousands of dollars a month in useless pills.

 

[DrfluffyMD]

The problem is, HVLA is generally one of the lowest-yield techniques in OMM. It provides short-term relief. The clinic that I observed had an approach that basically tried to normalize all of the soft tissue related to a complaint, and also approached lifestyle and other factors that led to the complaint in the first place. HVLA essentially functioned as an adjunctive treatment used on maybe one in ten patients, since most of the time HVLA performed in isolation will merely move something into a proper position only to be moved back later by the dysfunctional muscle and other tissue that moved it out of alignment in the first place. Treating the cause of dysfunction would often cause things to normalize on their own with no direct manipulation required. Hence why I'm not a big fan of chiropractic medicine- it's essentially treating a symptom but neglecting the problems that often created the symptom in the first place. Worse still, every chiropractor in my area has a reputation as a snake oil salesman that pushes useless supplements on their patients for hundreds or even thousands of dollars a month in useless pills.

Can you briefly explain to me how are chiro manipulation and osteopathy differ?

 

[Mad Jack]

Can you briefly explain to me how are chiro manipulation and osteopathy differ?

Chiropractic manipulation is entirely focused on "subluxations" as the cause of various diseases. It focuses entirely on bones being out of place as the cause of disease and accompanying symptoms. Osteopathic medicine of the manipulative variety is different, as something being out of place or dysfunctional can be either the cause or the effect of something- only by analyzing the whole patient history and doing a full history/physical and evaluation can you determine what is going on and how best to approach it. Chiropractors don't know how to evaluate soft tissue in the slightest, while a great deal of osteopathic treatment is focused on muscle, fascia, etc. Basically it's a single-system, single modality approach versus a multi-system, multiple modality approach. Plus, you know, DOs also have all that regular medicine as well.

 

[Lawpy]

What is interesting to me is that I've spent a few weeks of time in an OMM clinic, and for many patients it was the only thing that provided them any relief. A lot of them were able to stop taking opioid medication and regained day-to-day function after failing years of conventional therapy. Yeah, it may be anecdotes of bone wizardry, but the results I saw were pretty damn good, and many patients were improved enough by a handful of treatments that they never needed to be seen again (again, after failing conventional therapy for months or years). So while OMM may not have a strong evidence base, from the clinic I was rotating at, I guarantee the treatments overall paid for themselves if you pooled all of the patients together (some obviously failed treatment, but any treatment will have nonresponders). Chiropractic care I've seen less than thrilling results with for most conditions, as it seems many chiropractors are more keen to sell supplements and treat the same thing over and over again than to favor an approach that actually fixes a problem for any length of time.

This is why I'm hoping OMM will become an elective adopted by many schools, and the DO degree gets reintegrated into MD. I can see the benefits of OMM to patient outcomes. I just don't see why OMM has to be unique to DOs.

 

[AnatomyGrey12]

I just don't see why OMM has to be unique to DOs.

Neither do we Lawp, neither do we. I don’t even see why it’s part of undergraduate medical education.

 

[Deecee2DO]

Chiropractic manipulation is entirely focused on "subluxations" as the cause of various diseases. It focuses entirely on bones being out of place as the cause of disease and accompanying symptoms. Osteopathic medicine of the manipulative variety is different, as something being out of place or dysfunctional can be either the cause or the effect of something- only by analyzing the whole patient history and doing a full history/physical and evaluation can you determine what is going on and how best to approach it. Chiropractors don't know how to evaluate soft tissue in the slightest, while a great deal of osteopathic treatment is focused on muscle, fascia, etc. Basically it's a single-system, single modality approach versus a multi-system, multiple modality approach. Plus, you know, DOs also have all that regular medicine as well.

with all due respect did you attend chiropractic school? were you a previous chiropractor? you may have no idea how much training chiropractors get in soft tissue and musculoskeletal diagnosis/ treatment. Youre suggesting in your post that chiros dont perform a comprehensive physical examination or hx. This is just wildly false. A chiro doesnt just see a patient lay him or her down and just start pounding on them haha i cant believe people think this. Its not your fault youre just misinformed. chiropractors do not base everything off subluxations. subluxations don't exist. Chiro students get more training in MSK and nonsurgical ortho than DO students, more biomechanics more gait diagnostics etc. ( I know this because I've worked in the field with both many DOs and DC's in multidisciplinary practices across the country and trained with both ive Dx and Tx hundreds of MSK conditions, I've gone through chiropractic training and a DO student now and have intricately compared DO curricula versus DC curricula i've also worked with both DOs and DC's who were on the Olympic medical team so I've seen both from an MSK perspective at the most elite levels of sports medicine and clinical MSK). Yes DO students get wayyy more training in medicine (cards, GI, path pharm etc), but literally most if not all chiros training is to treat and diagnose MSK conditions that dont require surgical intervention. people have a skewed perception of what chiropractic training is it's not just hocus-pocus subluxations. take a look at a chiropractic curriculum. most if not all chiropractors use soft tissue like myofascial release/active release technique in conjunction with HVLA. it's a matter of somatosomatic reflex, joint restrictions simply cause the muscles around them to become hypertonic this will cause myofascial adhesion formation which should be manipulated and addressed along with the restrictions and capsular adhesions within the joint complex. Chiropractors dont just do HVLA, MOST chiros will do soft tissue as well. Getting good results requires soft tissue work, addressing biomechanical deficits (in particular muscular imbalances like gluteal inactivation, age related multifidi atrophy from fat infiltration, core instability, subtalar overpronation, flexor hallucis longus inactivation, hallux rigidus leading to a poor windlass mechanism, hallux valgus which can all lead to gait abnormalities etc in low back pain-this is called a comprehensive approach and looking at the body as a system not just "pounding on subluxations" as people may think, chiros look at biomechanics too). This isnt just about HVLA. Most chiros address all of this. This is how info about chiros gets a bad rep because people that have little experience with it start informing people about it when their information is grossly incorrect only further contributing to a negative outlook on chiros You are giving @DrfluffyMD incorrect information about chiro. I take it as already a medical student or a physician that you already have a preconceived notion of your view on chiropractic and nothing anyone will say will change your position on it but i challenge many who may not have the experience about it to be open-minded to taking some knowledge from someone or others who do have knowledge about it in the sense that we are speaking (HVLA soft tissue chiro training MSK Tx and Dx). Dont get me wrong there are some kooky chiros out there but there are bad apples in every profession. What I am saying is if you are willing to be open to OMM and soft tissue I then challenge you to be open to what a chiro does (HVLA/soft tissue). I hope you can take this as an informative post not a combative one as I dont want to start an argument just want to inform

 

[Mad Jack]

with all due respect did you attend chiropractic school? were you a previous chiropractor? you may have no idea how much training chiropractors get in soft tissue and musculoskeletal diagnosis/ treatment. Youre suggesting in your post that chiros dont perform a comprehensive physical examination or hx. This is just wildly false. A chiro doesnt just see a patient lay him or her down and just start pounding on them haha i cant believe people think this. Its not your fault youre just misinformed. chiropractors do not base everything off subluxations. subluxations don't exist. Chiro students get more training in MSK and nonsurgical ortho than DO students, more biomechanics more gait diagnostics etc. ( I know this because I've worked in the field with both many DOs and DC's in multidisciplinary practices across the country and trained with both ive Dx and Tx hundreds of MSK conditions, I've gone through chiropractic training and a DO student now and have intricately compared DO curricula versus DC curricula i've also worked with both DOs and DC's who were on the Olympic medical team so I've seen both from an MSK perspective at the most elite levels of sports medicine and clinical MSK). Yes DO students get wayyy more training in medicine (cards, GI, path pharm etc), but literally most if not all chiros training is to treat and diagnose MSK conditions that dont require surgical intervention. people have a skewed perception of what chiropractic training is it's not just hocus-pocus subluxations. take a look at a chiropractic curriculum. most if not all chiropractors use soft tissue like myofascial release/active release technique in conjunction with HVLA. it's a matter of somatosomatic reflex, joint restrictions simply cause the muscles around them to become hypertonic this will cause myofascial adhesion formation which should be manipulated and addressed along with the restrictions and capsular adhesions within the joint complex. Chiropractors dont just do HVLA, MOST chiros will do soft tissue as well. Getting good results requires soft tissue work, addressing biomechanical deficits (in particular muscular imbalances like gluteal inactivation, age related multifidi atrophy from fat infiltration, core instability, subtalar overpronation, flexor hallucis longus inactivation, hallux rigidus leading to a poor windlass mechanism, hallux valgus which can all lead to gait abnormalities etc in low back pain-this is called a comprehensive approach and looking at the body as a system not just "pounding on subluxations" as people may think, chiros look at biomechanics too). This isnt just about HVLA. Most chiros address all of this. This is how info about chiros gets a bad rep because people that have little experience with it start informing people about it when their information is grossly incorrect only further contributing to a negative outlook on chiros You are giving @DrfluffyMD incorrect information about chiro. I take it as already a medical student or a physician that you already have a preconceived notion of your view on chiropractic and nothing anyone will say will change your position on it but i challenge many who may not have the experience about it to be open-minded to taking some knowledge from someone or others who do have knowledge about it in the sense that we are speaking (HVLA soft tissue chiro training MSK Tx and Dx). Dont get me wrong there are some kooky chiros out there but there are bad apples in every profession. What I am saying is if you are willing to be open to OMM and soft tissue I then challenge you to be open to what a chiro does (HVLA/soft tissue). I hope you can take this as an informative post not a combative one as I dont want to start an argument just want to inform

What most chiropractors do versus what they learn are very different things. Chiropractors, at least in my area, are known for generating high visit counts with minimal improvement and high ancillary sales in homeopathic nonsense and supplements. They're also the core of the local anti-vaccine crowd. So like, I guess I don't care what they learn, police your field and weed out snake oil salesman and the anti-vaxx crowd or I'm going to continue to view every chiropractor that doesn't personally prove me wrong as a member of the notorious crowd present in my local area.

 

[Deecee2DO]

What most chiropractors do versus what they learn are very different things. Chiropractors, at least in my area, are known for generating high visit counts with minimal improvement and high ancillary sales in homeopathic nonsense and supplements. They're also the core of the local anti-vaccine crowd. So like, I guess I don't care what they learn, police your field and weed out snake oil salesman and the anti-vaxx crowd or I'm going to continue to view every chiropractor that doesn't personally prove me wrong as a member of the notorious crowd present in my local area.

People in your town is a small sample. would you take a study with a small sample size and trust it in clinical medicine as the ultimate source of evidence? probably not. Just because the DCs in your town do this doesnt mean thats what all chiros do. There are less OMM DOs than non-OMM practicing DOs just as there are less MSK practicing DCs that dont use "subluxation based" chiro althought there is still a very large population of DCs that practice MSK and ditch the subluxation crap. An experience based on a small group in your town to dictate your view on an entire profession with thosands of clinicians is questionable. And you cant say that zero OMM DOs use "OMM and manual medicine can help systemic issues" because they do its on the front page for the AOA website for the entire osteopathic medical profession. Do I think that all OMM DOs are quacks now? Heck no because I know thats just some practitioners and would be incredibly naive of me. Just because you personally havent seen what many chiros do in MSK doesnt mean that they dont and certainly you then shouldnt be giving advice or information about chiro and what it is to others solely based on "what i have seen chiros do in my town". Ask others who have been in the profession (preferrably a DC, DO-theres are clinicians out there with both degrees, i mean heck ill be one) or spend time in an MSK practice with both practitioners before informing others about chiro like you did in the OMM clinic (this was great info). It is similar to a pre-med giving out information about matching AOA ENT because he spent some time around some MD ENTs offices in his town

 

[Mad Jack]

People in your town is a small sample. would you take a study with a small sample size and trust it in clinical medicine as the ultimate source of evidence? probably not. Just because the DCs in your town do this doesnt mean thats what all chiros do. There are less OMM DOs than non-OMM practicing DOs just as there are less MSK practicing DCs that dont use "subluxation based" chiro althought there is still a very large population of DCs that practice MSK and ditch the subluxation crap. An experience based on a small group in your town to dictate your view on an entire profession with thosands of clinicians is questionable. And you cant say that zero OMM DOs use "OMM and manual medicine can help systemic issues" because they do its on the front page for the AOA website for the entire osteopathic medical profession. Do I think that all OMM DOs are quacks now? Heck no because I know thats just some practitioners and would be incredibly naive of me. Just because you personally havent seen what many chiros do in MSK doesnt mean that they dont and certainly you then shouldnt be giving advice or information about chiro and what it is to others solely based on "what i have seen chiros do in my town". Ask others who have been in the profession (preferrably a DC, DO-theres are clinicians out there with both degrees, i mean heck ill be one) or spend time in an MSK practice with both practitioners before informing others about chiro like you did in the OMM clinic (this was great info). It is similar to a pre-med giving out information about matching AOA ENT because he spent some time around some MD ENTs offices in his town

Not my town. My area. Which is a cachement of around a million people, with dozens of shady chiros.

 

[Deecee2DO]

Not my town. My area. Which is a cachement of around a million people, with dozens of shady chiros.

Maybe someday you will be a bit more open-minded. Until then think what you please I guess

 

[Deecee2DO]

But people who practice homeopathy or chiropractics aren’t able to asses the patient as a normal physician as well. Run labs, imaging, exam, etc.

Patient comes in with back pain.

Doctor runs every test imaginable and cannot come up with a cause.

The doctor has a few choices. Pain medication (potentially addicting), handing him off to a another professional or telling them it is all in their head.

Enter the osteopathic physician. He does muscle energy, which is basically physical therapy. The patient feels better. Like someone isn’t just writing him off. And he isn’t getting addicted to pain medication.

Just seems like a winning situation all around.

The issue with the homeopath is he or she isn’t usually qualified to rule out all other causes before diving into alternative medicine. They want to dive in right off the bat or just don’t have the qualifications.

As for traditional medicine, we tried back surgery and it is largely ineffective, and we tried pain drugs that ruined lives and health.

So to completely dismiss the additional training, not substituted training (still can do everything else), is not fair.

This journalist is not assessing the osteopathic physician fairly at all.

all chiros licensed in all 50 states can run labs, perform a comprehensive physical exam and order imaging just fyi. It is literally insane how misinformed some people are lol what do people think chiros do pop and pray? lmao they perform a comprehensive phys exam and take a hx just like your medical doctor would they order blood work and imaging (MRI CT Radiographs) when necessary and are trained as such. Ive had a few younger male patients with chronic low back pain present to the clinic as a DC myslef before med school and following taking a comprehensive Hx performing a physical exam and interpreting my own radiographs suspected AS (Ankylosing Spondylitis) I ordered HLA-B27 labs with ESR and CRP and MRI for increased sensitivity for sacroliliitis and based on hx, physical exam, labs and imaging dx them with AS only to refer them to rheumatologists for treatment. This was not common I would see this in practice as AS is not nearly as common as chronic mechanical low back pain but just to make a point here

 

[DrfluffyMD]

What most chiropractors do versus what they learn are very different things. Chiropractors, at least in my area, are known for generating high visit counts with minimal improvement and high ancillary sales in homeopathic nonsense and supplements. They're also the core of the local anti-vaccine crowd. So like, I guess I don't care what they learn, police your field and weed out snake oil salesman and the anti-vaxx crowd or I'm going to continue to view every chiropractor that doesn't personally prove me wrong as a member of the notorious crowd present in my local area.

So along your line of reasoning, what do most DO learn and what most DOs do are different also? Does your post mean it’s ok for me to simply view DOs as inferior physicians with lesser test scores who couldn’t get into med school versus fully train physicians with a unique knowledge and training in MSK conditions (which is what I currently believe)?

 

[Deecee2DO]

So along your line of reasoning, what do most DO learn and what most DOs do are different also? Does your post mean it’s ok for me to simply view DOs as inferior physicians with lesser test scores who couldn’t get into med school versus fully train physicians with a unique knowledge and training in MSK conditions (which is what I currently believe)?

Although i dont believe the same as you here regarding DOs being inferior physicians in MSK Im with you on the topic of @Mad Jack 's poor argument