How do DOs feel about OMM?

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Blesbok

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I have heard varying things from varying people and I am just wondering how the majority of DOs view OMM.
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Blesbok said:
I have heard varying things from varying people and I am just wondering how the majority of DOs view OMM.
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I think many of the techniques are a great tool to have. However, due to time restraints (reimbursement) I don't think I will use it on a regular basis clinically. I suppose that is why most of the OMM docs are cash-only (takes a lot of time that insurance companies will reimburse relatively little for)
 
I like it, its fun, and makes for a decent adjunctive therapy. However, I rarely actually use it on patients, rather I use it on family, friends, and hospital staff. I really don't think I'll be using it on too many of my patients, given the field I am going into (Anesthesiology), but fully intend to maintain my skills on people close to me.
 
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Blesbok said:
I have heard varying things from varying people and I am just wondering how the majority of DOs view OMM.
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Just a med student, but so far I like it. Just like every medicine out there, there must be the right indications for therapy and you will have variation in response to treatment. If anyone goes in to DO school thinking it's miracle work, they will be disappointed. A lot of techniques are very similar to physical therapy and I it's fun to use on my family.
 
It's amazing how well it works on back pain. And so far, about half the attendings I had for 3rd and 4th year have asked me to work on them -- and they were grateful. If you want to use it and do it quickly, there's a book called the 5-minute osteopathic manipulative medicine consult. It'll give you several levels of treatment time - 2 minutes, 5 minutes, and something like 15 minutes, and the treatments you can do in that time that will be most effective.
 
I love it, my patients love it, and my family loves it.
 
JStub said:
I think many of the techniques are a great tool to have. However, due to time restraints (reimbursement) I don't think I will use it on a regular basis clinically. I suppose that is why most of the OMM docs are cash-only (takes a lot of time that insurance companies will reimburse relatively little for)
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I've heard lots of things about this cash only OMM docs, but I can never find websites. Does anyone have links? I figure these physicians would utilize the internet, and I'd love to check out their websites.
 
OMM is at the forefront of your mind all through 1st and 2nd year, and depending on your clinical situation, sparsely through 3rd and 4th years, but unless one enters an AOA residency (specifically , primary care) you're not going to see it. period.

OMM is a sort of Munchausen by proxy, and being in the osteopathic educational enclaves, you're bound to feel like this modality has its place in medicine. But upon entering the real world, where the absolute majority of providers (and patients) reside, one finds the futility of OMM.

now post your obligatory defense of OMM because it "worked for you" or you know some old lady with chronic pain who swears by it...I don't care, and neither does the rest of the medical community.

So maybe a higher percentage of patients / providers in Philly, Des Moines, and Michigan are aware of DOs and actively seek them for their manipulation skills. Terrific. But big picture, OMM is a fart in the wind.
 
homeboy said:
OMM is at the forefront of your mind all through 1st and 2nd year, and depending on your clinical situation, sparsely through 3rd and 4th years, but unless one enters an AOA residency (specifically , primary care) you're not going to see it. period.

OMM is a sort of Munchausen by proxy, and being in the osteopathic educational enclaves, you're bound to feel like this modality has its place in medicine. But upon entering the real world, where the absolute majority of providers (and patients) reside, one finds the futility of OMM.

now post your obligatory defense of OMM because it "worked for you" or you know some old lady with chronic pain who swears by it...I don't care, and neither does the rest of the medical community.

So maybe a higher percentage of patients / providers in Philly, Des Moines, and Michigan are aware of DOs and actively seek them for their manipulation skills. Terrific. But big picture, OMM is a fart in the wind.
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Dood, shut up! OMM worked for me, also - I know this old lady with chronic pain who swears by it.

:smuggrin:
 
The DO that I shadowed is in family medicine. He told me that OMM is used as much as YOU want to make use of it. He says the number of people he uses it on is declining over time, but there are still instances where he likes to whip it out: headache, neck/shoulder/back pain.

I would actually like to make a lot of use of it: my future vision is sports medicine, so I think that would be a great place to use it. I can help out people just like me that get overzealous and mess themselves up. It seems a lot of the time the injuries are self-healing, albeit slowly; OMM seems like it would be a good way of accelerating the healing process.
 
The DOs I shadowed used it often in their practices. Granted it was family medicine but what better place? Brown University Family Medicine Clinic actually has instituted a weekly OMM clinic for their patients. DO and MD residents alike are participating. Feel the love.
 
The problem with OMM is that you must be extremely capable and a fast diagnostician. Our preceptor in OMM lab is a FP getting an OMM fellowship. She practices in our medical office building. On average, she has 20 minutes per visit. Ideally, if she wants to use OMM she tries not to have it last longer than 7 minutes. In 7 minutes it can be rather hard to do a physical OMM exam, diagnose, and treat. The more time you spend on OMM the less time you have in the visit to address the patient's other concerns, or concerns that are found at the visit.
 
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Although it does take time (and then fast thinking and decisions), OMM sounds like it would be a fun and interactive method to incorporate. At least ideally, I would love to learn it well and use it frequently. It'll be a long time until I get to that point, though, so I will see what happens.

I do remember that I heard DO students tell me OMM is addictive. It's probably nice to do to yourself, after your neck, shoulders, and back ache from sitting in a chair for too long, studying and studying. ;)
 
You can definitely use it. If anything, it will be a "temporary" relief for symptoms until medication, surgery, etc can be used. However, several followup visits of OMM or a single visit can fix the problem. I'm glad you aren't writing it off. Its just sometimes that amount of time you have to use it is limited. I believe most people benefiting from long-term OMM here are referred to the OMM clinic.
 
I agree with most of the other posters. OMM is a useful tool in your bag of tricks, but it certainly is not the cure-all that some OMM professors might make you think.

I think the reason most DOs do not use OMM in practice is because they are simply not comfortable with it, and here's why: During your first 2 years, you practice extensively on your peers... who, with few exceptions, are healthy, average-sized young adults. When you're thrown into the hospital for your 3rd and 4th years, encountering 60 year-old morbidly obese patients with multiple medical problems, the last thing on your mind is whether or not they have a sacral torsion or pelvic shear. Sometimes it's a flat-out bad idea to do anything because you don't know their entire medical history. On top of that, most of the residents or preceptors won't really encourage you to perform OMM on patients, possibly because they are MDs or simply not comfortable with it themselves. So you skip anything OMM-related and do a focused physical exam (which is what you are supposed to do anyways).

The problem arises when you're in clinic and you come across a patient with lower back strain. You will rack your brain trying to think of what you can do for them osteopathically, and the last few years of not practicing it causes you to completeley blank out. Therefore you just agree with the attending that Percocet is the way to go.

So bottom line is, you have to find a way to keep it fresh in your mind throughout your clinical years. Doing an OMM elective is always helpful.
 
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Some residents and attendings held a panel here. They said they had more leeway with OMM treatment, if they could back up their ideas, with MD attendings vs. DOs. Reason was, the MDs were curious. Now, it was for a small majority of attendings and not all DOs are going to say no, but I thought it was interesting that those within the profession would give more "hassle" to fellow DOs than MDs would.

But, like you said, if the patient isn't a regular at your office, OMM could be detrimental. Let alone, trying to do OMM on a morbidly obese patient is just difficult like you mention. Some of the more muscular guys here give people problems. And, like you said, we're all pretty much normal when practicing so you aren't always sure if something is actually wrong.
 
ceftazidime said:
I think the reason most DOs do not use OMM in practice is because they are simply not comfortable with it,
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To some degree, maybe, but let's keep in mind there are over 800,000 practicing physicians in the country, less than 10% of whom are DOs.

Minus the paltry few that utilize OMM in practice, we're supposed to believe that the remaining majority are simply ill equipped to deal with the complexities of incorporating OMM into their practice or hospital setting?

That's a very generous assumption.

The more likely explanation: the majority simply could care less about it because the extent to which it will improve patient outcomes is negligible for the amount of time required...that, and most of it is bogus.

So OMM is marginally equally effective to treat LBP...so what. Is it more cost / time efficient to Rx some pain meds, which the pt can take PRN, or schedule daily / weekly / monthly appointments which are undoubtedly MORE expensive & schedule disrupting?

I love reading all these starry-eyed posts my pre-meds and MS1+2s about how they plan to incorporate OMM into their practice...kind of like how we all just fell in love with the "holistic" notion of patient care prior to DO school interviews..."treating the patient, not the disease."

Can't believe the AOA is still peddling this crap.
 
Interesting sidenote:
for the past several months, I've had this crunching sound / feeling in my neck every time I turn past a certain rotational degree (to the left). I'm either getting early arthritic change, or all that neck popping crap is coming back to haunt me.

I'm sure the OMMophiles in the crown would simply vote for more neck popping.
 
I use OMM everyday in my office. Granted it's not on every patient but I do have a following who come in regularly for their back adjustment. Now I am more prone to use HVLA since it is fast and you can do the whole spinal column in 5 minutes granted the person is relatively normal size. I have the patient lay on hot packs (like they use in PT) for 10 minutes while I'm seeing another patient to loosen them up first, then I don't have to work so hard. You can fix most problems with about 5 maneuvers. It's the old ladies who need muscle energy or those chronica paraspinal muscle spasms that eat up your office time. Patients love it. They come back week after week. Keep you from writing tons of narcotic scripts too.
 
homeboy said:
To some degree, maybe, but let's keep in mind there are over 800,000 practicing physicians in the country, less than 10% of whom are DOs.

Minus the paltry few that utilize OMM in practice, we're supposed to believe that the remaining majority are simply ill equipped to deal with the complexities of incorporating OMM into their practice or hospital setting?

That's a very generous assumption.

The more likely explanation: the majority simply could care less about it because the extent to which it will improve patient outcomes is negligible for the amount of time required...that, and most of it is bogus.

So OMM is marginally equally effective to treat LBP...so what. Is it more cost / time efficient to Rx some pain meds, which the pt can take PRN, or schedule daily / weekly / monthly appointments which are undoubtedly MORE expensive & schedule disrupting?

I love reading all these starry-eyed posts my pre-meds and MS1+2s about how they plan to incorporate OMM into their practice...kind of like how we all just fell in love with the "holistic" notion of patient care prior to DO school interviews..."treating the patient, not the disease."

Can't believe the AOA is still peddling this crap.
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My sentiments exactly :thumbup:
 
I guess another thing to ask, when I get to interviews, is to ask which maneuvers of OMM are taught and how they are taught.

For example, reading around on here I saw that some schools do not want to teach HVLA. Also, the DO I shadowed said he wished that the techniques were taught more clinically, rather than "this is technique X, and this is how you do it here, here, and here." Granted, he graduated from DO school 10+ years ago, so it could be different now.

Are the OMM techniques taught to students with their clinical applications in mind? That'd be nice to know.

As for ability to use OMM, my DO said that, for example, he avoids using HVLA on the elderly, which obviously makes sense. I guess you use it when you can, and don't if it's a higher chance you'll just hurt them instead. He likes using counterstrain the most, due to the fact that you can't hurt people with it.
 
homeboy said:
Can't believe the AOA is still peddling this crap.
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Yup. There are only so many hours in a day, and every hour spent studying back cracking is an hour you won't be able to spend learning real medicine. As the body of knowlegde of real medicine grows, COCA will have to adjust the amount of OMM in the curriculum - or turn out inferior physicians.

Fortunately, when you get out in the real world, you forget OMM pretty quickly.
 
homeboy said:
So OMM is marginally equally effective to treat LBP...so what. Is it more cost / time efficient to Rx some pain meds, which the pt can take PRN, or schedule daily / weekly / monthly appointments which are undoubtedly MORE expensive & schedule disrupting?
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Have you worked with many drug-seeking patients yet? They are MUCH MORE schedule-disrupting than a once-a-month OMM treatment would be, and on top of that, they are the bane of every PCP's existence.

What's worse is that their condition is almost completely iatrogenic. Prescribing a pain med is quick and easy and will get the patient out the door. Sucks when they get narcotic bowel syndrome and have to be admitted to the hospital for detox. Sucks even worse when you get sued for prescribing a fentanyl patch that ends up killing them. To me, regular OMM or a PT referral just sounds a lot more cost-effective in the long run.
 
Also, I think having OMM is nice as one of those more conservative treatments. Of course prescriptions have their use, but if you can try to treat it with something that has no side effects (well, do HVLA wrong, that's another story) but MOSTLY no side effects, why not?

And drugs are quick but they can do stuff to you. Even milder stuff like NSAIDs commonly can make you nauseous. For example, my mom and dad get upset stomach from NSAIDs even with stuff like omeprazole or other stomach protectors, although they help a bit. So having non-pharmaceutical methods are nice as alternatives.
 
In certain situations OMM may be a good choice, lower back pain, joint pain. However I'm waiting for decent controlled studies on the issue. There seems to be decent evidence for the lower back pain, but I am really leery about doing cervical spine manipulation due to the risk of stroke. I doubt that I will integrate most of this into practice beyond the medical school and osteopathic residency years. However in learning to do this I've heard it's great in improving and cultivating palpation skills.
 
I might not remember much of head and neck, but you'd have to yank quite hard on someone's neck to either occlude blood to the brain or prevent drainage from it. Not to mention, OMM isn't being done on the c-spine with enough force to separate the spinal column.
 
Now granted my sample size of medical schools is 1, but what drives me nuts about OMM/OPP as a class is not the manipulation techniques or lectures on pelvis, cspine, or whatever. Its the seemingly random ass lectures that are tossed in between lectures on sacral motion that have absolutely nothing to do with ANYTHING. We go from pelvic shear to TENSCAM or random lectures on the benefits of exercise, without even any of the science/physio to back it up, its more like we're getting a seminar that would be given to anyone on the street.

Then the worst part is, we're tested on minute details of the randomness while you're trying to keep anatomy in your head.

Is it similar in other schools?
 
No... we have an OMM lecture which is the pre-lab for the OMM lab. In addition, we have clinical lectures mixed in to give us clinical examples of OMM usage.

Our first written exam is the second week of November. Unfortunately, rumor has it the exam is tortuous and extremely difficult. The writers of the exam also write for the COMLEX and give us the same style of questions.
 
Aren't there many pharmacotherapeutics used for altnerative pathologies then what they were invented for? Not all these uses are tested, if I remember correctly. A lack of pharm-anything, since I'm a first year, isn't helping me in the way of examples.
 
Yet we still use them. I'm not an OMM chanter and sometimes leave lab extremely disillusioned because I'm "not feeling anything" but I atleast recognize that the techniques can help people despite not being proven effective through clinical research.
 
Bacchus said:
Aren't there many pharmacotherapeutics used for altnerative pathologies then what they were invented for? Not all these uses are tested, if I remember correctly. A lack of pharm-anything, since I'm a first year, isn't helping me in the way of examples.
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The term you are looking for is "off-label use". And yes, there are MANY drugs that are used this way. Not every indication can have a double-blinded, placebo-controlled trial built around it. There is a lot of investment of time, resources, and $$ that must go into proving anything. We sit on the shoulders of those who came before us, but never think about how much work went into proving that "x" is the treatment of choice over "y".

Going to back to the topic of the thread, when it comes to OMM, there truly may not be a whole lot of evidence to back it up. I've always wondered why there aren't more studies with larger sample sizes than, say, 10. I understand that the studies are operator-dependent and therefore difficult to standardize, but seriously there needs to be a stronger focus on evidence-based medicine if the AOA wants to keep peddling the benefits of OMM.

On the other hand, there is no harm from OMM in my opinion, because what is the alternative? An increase in the pt's pain meds? Referral to Neurosurgery or Pain Management? Of course, there are indications for the above, but if OMM is working for a patient and they are improving, even if it's just a placebo effect, then why stop?

(By the way, I am only talking about musculoskeletal pain as an indication for OMM. If you are using OA decompression to lower someone's BP rather than prescribing Metoprolol, that's a problem)
 
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Bacchus said:
Yet we still use them. I'm not an OMM chanter and sometimes leave lab extremely disillusioned because I'm "not feeling anything" but I atleast recognize that the techniques can help people despite not being proven effective through clinical research.
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How do you know they can help people if they are not proven effective through clinical research? Regarding off-label use, it is obviously not ideal, but if there is pharmacodynamic theory to support it, it might have some basis. Much of OMM is based on hypothesis that is unsupported anatomically, so I don't think that excuse flies very well, personally.

There is no downside to prescribing a homeopathic remedy either (after all, it's just water), and the placebo effect can work there too, but that does not make it a valid treatment modality.
 
Blesbok said:
I have heard varying things from varying people and I am just wondering how the majority of DOs view OMM.
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I am the only DO in my allopathic radiology residency program....when my back hurts(like now)...i wish there was another DO in my program.

Vince
 
netter45 said:
evidence based practice......
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:thumbup: my sentiments exactly. I've found myself growing more and more frustrated with OMM during the start of my second year. Firstly, they really have nothing new to show us yet. Most of what we have done for the first 2 months is review, which, is perfectly fine by me since the boards are coming up. However, that just shows me there isn't that much more to it. On top of that, the new stuff we have learned this year begins and ends with BLT, which in my opinion is total utter BS. I volunteered recently to have my neck treated with BLT during a lab session by the school's BLT and palpation guru. He stopped the treatment when he felt a release, but I sure as hell didn't feel it. In fact, I felt the same when as when I got on the table. I'm becoming more and more convinced that much of OMM is a placebo. I've said it before, the techniques that have a physiologic backing such as muscle energy, counterstrain and FPR work. I've experienced them work. Everything else I've learned, including HVLA, is either complete BS or palliation.

Going back to the original point, if there was more research and more evidence that this stuff worked, then I would have more conviction and care more. Show me that BLT or addressing a chapman's point at a VSR helps to improve end organ function, then I'll be more interested. Also, I keep hearing about suboccipital release working to normalize SVT. Has anyone seen a paper on this? Can you direct me to it, because I won't beleive it until I see it.
 
Lokhtar said:
How do you know they can help people if they are not proven effective through clinical research. Regarding off-label use, it is obviously not ideal, but if there is pharmacodynamic theory to support it, it might have some basis. Much of OMM is based on hypothesis that is unsupported anatomically, so I don't think that excuse flies very well, personally.

There is no downside to prescribing a homeopathic remedy either (after all, it's just water), and the placebo effect can work there too, but that does not make it a valid treatment modality.
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As stated above, although this is not ideal, not every single treatment has been proven to work through clinical research. This includes medications, invasive procedures, and OMM, yet they are still used because clinicians have had the personal experience of seeing patients improve with their treatment. If you work with a physician that performs OMM regularly and effectively, you will see how their patient's pain and overall quality of life has improved compared to those at a pain management clinic receiving monthly cortisone injections and increases in their pain medications.

Regarding pharmacodynamic theory as support for clinical use, there are numerous medications for which we do not know the specific mechanism of action. For example, how does hydroxyurea work exactly? We don't know, but it's FDA-approved for sickle cell and ET. Furthermore, how do we know the correct dosage and duration of treatment for say, antibiotics for MRSA bacteremia in a patient with a prosthetic joint? We don't, but 14-21 days has seemed to work so we go with that. Up until fairly recently, the role of nitric oxide in vasodilation was unknown, yet nitroglycerin had seemed to work effectively to relieve angina long before that, so its use was continued. Oftentimes, the personal experience of treatment efficacy comes before elucidation of its exact mechanism and the clinical research to support it. This is what the art of medicine boils down to, and if everything could be done stricly through evidence-based protocols, there would be no need for physicians.

How specifically is much of OMM based on "hypothesis that is unsupported anatomically"? Which specific techniques are you talking about here?
If this is true, yet the majority of techniques are also used by physical therapists on a regular basis, then how can physical therapy be an accepted and well-recognized modality of treatment?
 
Three facts:
1. A Lancet review of OMT for low back pain said that it exhibited at best the same efficacy as NSAIDs and noted that the key element of treatment is time for recovery (http://cme.medscape.com/viewarticle/572783)
2. At least some OMT is totally bunk since, as someone noted above, the proposed mechanism isn't possible given our modern knowledge of anatomy (see cranial therapy, http://www.chiroandosteo.com/content/14/1/10)
3. OMT, like all other therapies, is potentially harmful. The study in #1 cites vertebral artery dissection as the most common serious adverse effect.

And three opinions:
B. Given the equally efficacious option of an over-the-counter pill with few side effects or 2.2 trips to the osteopath per week (and the respective costs), what would you choose?
B. The credibility of all of OMT is, IMHO, thrown into serious question when, against all reason, its proponents and practitioners continue teaching the stuff in #2 above
C. "It's difficult to get a man to understand something when his salary depends on his not understanding it" --Upton Sinclair
 
ollantaytambo said:
Three facts:
1. A Lancet review of OMT for low back pain said that it exhibited at best the same efficacy as NSAIDs and noted that the key element of treatment is time for recovery (http://cme.medscape.com/viewarticle/572783)
2. At least some OMT is totally bunk since, as someone noted above, the proposed mechanism isn't possible given our modern knowledge of anatomy (see cranial therapy, http://www.chiroandosteo.com/content/14/1/10)
3. OMT, like all other therapies, is potentially harmful. The study in #1 cites vertebral artery dissection as the most common serious adverse effect.

And three opinions:
B. Given the equally efficacious option of an over-the-counter pill with few side effects or 2.2 trips to the osteopath per week (and the respective costs), what would you choose?
B. The credibility of all of OMT is, IMHO, thrown into serious question when, against all reason, its proponents and practitioners continue teaching the stuff in #2 above
C. "It's difficult to get a man to understand something when his salary depends on his not understanding it" --Upton Sinclair
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A couple of thoughts. Regarding effectiveness of OMT, or any manual therapy for that matter, you need to describe each specific technique, as OMT is a very broad term. If vertebral artery dissection is the most common serious adverse effect, then it's incredibly safe. Saying that a patient could simply take an OTC medication instead of pursuing a manual therapy program for something like low back pain suggests a lack of understanding of low back pain.

As for the Sinclair quote, we could apply that to much of medicine.
 
ceftazidime said:
How specifically is much of OMM based on "hypothesis that is unsupported anatomically"? Which specific techniques are you talking about here?
If this is true, yet the majority of techniques are also used by physical therapists on a regular basis, then how can physical therapy be an accepted and well-recognized modality of treatment?
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Primary respiratory mechanism used as a basis for cranial for example.
 
facetguy said:
A couple of thoughts. Regarding effectiveness of OMT, or any manual therapy for that matter, you need to describe each specific technique, as OMT is a very broad term. If vertebral artery dissection is the most common serious adverse effect, then it's incredibly safe. Saying that a patient could simply take an OTC medication instead of pursuing a manual therapy program for something like low back pain suggests a lack of understanding of low back pain.

As for the Sinclair quote, we could apply that to much of medicine.
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1st bold: Interesting argument. A classmate of mine recently approached the OMM faculty at my institution seeking to do efficacy research on specific techniques just as you say, and he was told it would not be a good study because OMT is a holistic approach to treatment. I'm not exactly sure how to interpret that, but I think they mean that each case differs, perhaps in subtle ways, but just enough that limiting the practitioner to only one treatment would not reveal the benefit of OMT treatment as a whole.

Also, I do not need to describe each specific technique in order to cast doubt on the academic rigor of the authoritative proponents of OMT. I can cite one example of absurdity - like cranial therapy - and thus undermine the weight of all of their claims about OMT. More simply stated, if they continue to propogate plainly impossible claims about one therapy, why should we believe their judgment about any therapies?

2nd bold: I didn't say taking a pill would cure back pain, I pointed to the Lancet review which indicates that taking a pill is just as effective as OMT, neither of which work particularly well to cure back pain.
 
ollantaytambo said:
1st bold: Interesting argument. A classmate of mine recently approached the OMM faculty at my institution seeking to do efficacy research on specific techniques just as you say, and he was told it would not be a good study because OMT is a holistic approach to treatment. I'm not exactly sure how to interpret that, but I think they mean that each case differs, perhaps in subtle ways, but just enough that limiting the practitioner to only one treatment would not reveal the benefit of OMT treatment as a whole.
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Manual therapy, OMT in this example, can vary practitioner to practitioner. So, for research purposes, it is helpful to limit the intervention to one specific technique. In the real world, a variety of techniques will often be employed which, while not fitting neatly into a narrowly-focused clinical trial, can be effective nonetheless. That said, it is this heterogenicity that can make it difficult for, say, an MD to get his/her arms around. Gaining trust in an individual manual practitioner helps solve this problem.

ollantaytambo said:
Also, I do not need to describe each specific technique in order to cast doubt on the academic rigor of the authoritative proponents of OMT. I can cite one example of absurdity - like cranial therapy - and thus undermine the weight of all of their claims about OMT. More simply stated, if they continue to propogate plainly impossible claims about one therapy, why should we believe their judgment about any therapies?
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I guess there's some truth to that. But would it be the same if your patients questioned your judgement when, for example, Vioxx was pulled from the market for killing people, even though you presribed it to them on many occasions?

ollantaytambo said:
2nd bold: I didn't say taking a pill would cure back pain, I pointed to the Lancet review which indicates that taking a pill is just as effective as OMT, neither of which work particularly well to cure back pain.
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Cure probably isn't the best term to use when dealing with LBP, I agree.
 
ollantaytambo said:
1st bold: Interesting argument. A classmate of mine recently approached the OMM faculty at my institution seeking to do efficacy research on specific techniques just as you say, and he was told it would not be a good study because OMT is a holistic approach to treatment. I'm not exactly sure how to interpret that, but I think they mean that each case differs, perhaps in subtle ways, but just enough that limiting the practitioner to only one treatment would not reveal the benefit of OMT treatment as a whole.

Also, I do not need to describe each specific technique in order to cast doubt on the academic rigor of the authoritative proponents of OMT. I can cite one example of absurdity - like cranial therapy - and thus undermine the weight of all of their claims about OMT. More simply stated, if they continue to propogate plainly impossible claims about one therapy, why should we believe their judgment about any therapies?

2nd bold: I didn't say taking a pill would cure back pain, I pointed to the Lancet review which indicates that taking a pill is just as effective as OMT, neither of which work particularly well to cure back pain.
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I know there was a small study recently done at my institution to assess whether OMT was efficacious in improving PFTs. The findings were said to be statistically insignificant.
 
OMM sounded good on paper, but ended up being a paper tiger.
 
facetguy said:
I guess there's some truth to that. But would it be the same if your patients questioned your judgement when, for example, Vioxx was pulled from the market for killing people, even though you presribed it to them on many occasions?
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No, it wouldn't be the same, provided I stopped prescribing Vioxx after evidence emerged that it carried CV risks. The point is that as evidence-based practitioners we use the best information available to inform our judgments. We're not always right, but we don't ignore facts in order to promote dogma.
 
OMM seems to be the price to pay for not getting into your state school. I find it to be nothing but BS that does nothing but take away time from studying the important aspects of medicine.

Just remember that less than 5% of DOs use manipulation, so chances are you will never use it. If you like it good for you, but most of us are here to become medical doctors.

I speak as a 1st year medical student that wishes he would have gotten into his state MD school. I should have waited another year so I didn't have to deal with the cultish atmosphere of the OMM department.

Ahh well, I only have to deal with it for a couple years. I just felt like ranting on here.
 
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