how does OMT help allegeries/asthma?

Discussion in 'Medical Students - DO' started by Dr Sum Day, Nov 14, 2002.

  1. Dr Sum Day

    Dr Sum Day SDN Lifetime Donor
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    Can any you DO extraordinaires explain the mechanism behind the treatment of allergies and/or asthma via OMT? tks. I am truely interested in this :D
     
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  3. Kevin3Ford

    Kevin3Ford Junior Member

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    Great question! Unfortunately, I don't buy it. From what I understand the mechanism behind it is the ANS. By placing someone in a position (say a modified slump test position) and mobilizing the vertebrae/costovertebral joint you increase/decrease sympathetic nervous system activity. A recent study published in the Journal of Manual and Manipulative Therapy showed that there was a decrease in temperature in the lower extremity on the side that this technique was performed on. The problem is that the sample size was too small. Why do people even do research if the methods are out of whack and will not give statistically significant information.

    I haven't seen any research about allergies, but I understand the anatomy and I don't buy it. I'm open to opinions and would also like someone to teach me how this can happen. If it works, then publish it so we can all learn.

    Sincerely,

    Kevin Ford, SPT, CSCS
     
  4. PACtoDOC

    PACtoDOC 1K Member

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    I am a DO student, but I am not about to say that I am convinced that there are any good OMM skills that can help with allergies. OMM is great for musculoskeletal disorders but I am probably never going to be convinced that it helps with things like allergies. Asthma on the other hand can be affected by muscle spasms or somatic dysfunction of the thorax, and thus OMM might be helpful here. My guess is that all this will be disproved or proved in the next 10 years and we will all start seeing MD schools start to slightly incorporate the useful OMM techniques. Then in 10 more years the AMA will probably make an offer to the AOA that they cannot refuse, and we will all be simply MD's. I could care less, because my title will always be the same thing, simply "doc". I kind of hope the DO and MD merger does not take place because chose this path to be different. I look forward to doing an allopathic residency and showing my MD resident buddies how to do some OMM. I think you will see that I am right though, but we will just have to wait to see. My guess is that once it finally happens, you will only be hearing chiropractors say that they can cure "everything" with manipulation. OMM definitely has its place, but a limited one.
     
  5. UHS2002

    UHS2002 Senior Member

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    In the last 6 months JAOA (Journal of the American Osteopathic Association) published a study concluding that there was no demonstrable improvement in asthma patients treated with OMM.
     
  6. minime

    minime Member

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    I'm with UHS2002, when the research is there me and the rest of the 92% of DO's that don't use OMT will start using it.
     
  7. fozzy40

    fozzy40 Senior Member

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    What type of condition or disorder is OMM effective? Furthermore, has there been any researched to validate it? Thank you.

    Fred
     
  8. AthensfromCols

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    Wow, guys. Such cynicism from DO medical students. I'm disappointed...

    I chose to become a DO based on the philosophy that the body can inherently heal itself. The use of manipulation is aimed at that goal. The body cannot heal itself if it is not operating at maximal efficiency. When you find somatic dysfunction, it isn't just affecting the body's musculoskeletal system, it also affects lymphatic flow, blood supply to muscles and organs, and nervous system stimulation in the region involved (or in referred areas). Using manipulative techniques to diagnose and treat these areas will allow the body to return to a more homeostatic environment and will allow a more maximal efficiency. This leads to improved abilities to heal.

    The "problem" with OMT is that it is hard to quantify results and the techniques are not always standardized from one doc to another. If you want to see how effective OMT can be, spend some time with a doc who does OMT as a major part of his/her practice. The proof is in the pudding, as they say, and the patients who could not walk without severe pain and discomfort a month ago and can now stand upright and walk without much pain are the real testaments to the benefits of OMT. I've even seen a woman with chronic asthma who received OMT every 3 months who was able to go off her asthma medicine except in acute crises.

    OMT does work, guys. Give it a chance. Learning the techniques and theories only gives you one more tool to use to treat patients. And those who benefit from it when nothing else seems to provide relief will be thankful that you didn't write it off early in your careers....
     
  9. fozzy40

    fozzy40 Senior Member

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    I didn't mean to sound skeptical. It is the osteopathic philosophy that drew me to this school of thought. However, every person that I talked to has stated that, "It just works." I realize that OMM may not work with every patient, just like certain medications don't work for everyone. I simply wanted to know if there has been any documentation on OMM efficacy for certain disorders. Believe me when I say that my glass is half full!!

    Fred:)
     
  10. BrooklynDO

    BrooklynDO Senior Member

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    Just to put my two cents in - its very hard to quantify omm results in scientifically valid studies because there are factors involved such as skill that really dont apply to drug testing. Alsol, a very sick person may not respond as well to omm for things like allergies as an otherwise healthy person may. Like someone here said...you learned it, so keep it in mind as a possible tool. Just cause your not a surgeon doesnt mean you dont send someone to surgery if medical treatment didnt work...
     
  11. LovelyRita

    LovelyRita Blade Slinger

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    ...Seems that palpating/acupressuring infraspinatus works. Anyone else have this experience?
    M.
     
  12. AviatorDoc

    AviatorDoc fizz ee at' rist

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    I have been interested in manipulation research for a little bit, so I did a PubMed search and came up with the following.

    By and large, the medical community accepts OMT as a legitimate treatment of low and mid back pain. This is shown time and again in osteopathic and allopathic journals. In fact, manipulation is mentioned in "Spine" the presumptive authority in spinal neurosurgery.

    If you look into osteopathic research by itself, there have been few solid, randomized studies. One of them is on asthma. OMT (I believe rib raising) was compared to a placebo (a sham treatment) and was found to significantly affect the FEV of the pts, but not the Vmax. The study was not double-blind, but the pts were used as their own controls, as the groups were switched after a time. I have not actually read the whole paper, so I don't know how well the methods were developed.

    The mechanism of action is that rib raising supposedly increases the sympathetic tone, thus acting like a mild beta-agonist and opening the airways. I'd like to see testing on the actual CA levels before & after, but so far, this hasn't been done, as far as I can tell.

    (Abbreviations: OMT: Osteopathic manipulative treatment (duh), FEV: Forced Expiratory Volume, Vmax: Maximum velocity of expiration, CA: Catecholamines.)
     
  13. PACtoDOC

    PACtoDOC 1K Member

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    The problem at our school is that we get very little training these days in OMM. Its more like a cursory survey of OMM, and those like me that want to learn it well have to practice it a lot outside class. When we are in lab, we often are only there for an hour or two and may learn 3-4 techniques. If we don't pick it up then, thats all she wrote!! We later have a practical quiz which is more like a one on one tutorial session. I just cannot seem to feel what it is I am supposed to be feeling. I understand the concepts, and practice it on my wife a lot, but I just can't feel the movements I am supposed to with any accuracy. We are in cervical right now and I have a lot of trouble assessing segmental motion. IS it just me, or does this come later?

    Matt
     
  14. Dr JPH

    Dr JPH Banned
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    I can feel intersegmental movements quite well. Just takes practice. Start off on thinner people.

    As far as OMM research, I have read a great deal about this.

    It seems that for every study that concludes that OMM is equal to or better than a conventional treatment, there is a study that says the opposite.

    More research is being done with OMM.

    On a personal not, I have found OMM to be quite helpful for my musculoskeletal problems. I don't have asthma or anything like that, but a friend of mine claims to breath a bit easier after some treatments...no long term benefits are evident, but 1-2 days worth of comfort.

    I have seen (and experienced) relief from nasal congestion with OMM.

    Can OMM cure diseases? I have no idea.

    Undoubtedly it can improve ROM for sedentary patients and improve blood flow throughout the body.

    More research needs to be done, but more importantly, more DOs need to begin using OMM.

    I have no problems with people who don't believe in it or never want to use it. I have several classmates like this.

    Personally, I feel my training as a DO will allow me to be a better diagnostician, at least as far as neuromusculoskeletal issues are concerned.
     
  15. bones

    bones Osteopathic Physician
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    I'm sorry to hear you're having such problems. To some degree this may vary from school to school, but even here in Kirksville you gotta be proactive if you want to be really good.
    My suggestion is to seek out your professors and ask to shadow them as they see patients. Good teachers will give you a trial by fire and test your diagnostic skills on each patient that comes in, and help you catch things you've been missing. This way you can see the big picture and relevance of some of the techniques you learn, and the outcomes for patients that benefit from them. You will most likely find that the OMM that is taught in class is QUITE different than OMM that is used by specialists. Diagnosis is often made by quick visual screen of posture, a history, and very brief physical screen- and treatment revolves around treating the "key" lesion- something that is difficult to teach in class and wont be on the boards as such. You'll also find that no two specialists are the same, and while you might hate the way someone practices or the model in which you were taught (and thus generalize to all of OMM), but you might really like the next specialist you follow. Its worth looking around a little.

    The issue with testing OMM in double blind efficacy studies is that its just not a great treatment modality for this kind of research. Imagine trying to do double blind efficacy studies for surgery- its not easy to do. Too much relies on the skill of the surgeon/OMM specialist, and faking treatment can't be done "blind," nor can it really be done by someone outside the field who could be blind to expected efficacy- since skill level is quite important for success (unlike acupuncture, for example, where needles can be placed in designated spots by a lay-person).

    The majority of research in OMM thus far is outcome-based. not ideal, but at least it is something.

    I have only had limited exposure thus far to OMM for asthma and allergy patients but general autonomic tone can change quite a bit over the course of a treatment and I wouldn't be suprised if you see some improvement for chronic asthma (ask your docs if they've had luck with this, and have them show you what they do). With things like allergies though I wouldn't expect more than a temporary fix, since these are usually environmentally mediated. You can still use your DO preventative routine- look carefully in the history for environmental exposure to chemicals at work or home, and maybe talk about an air purifier if its pollen or dust.

    If all else fails, stick with the meds PRN :cool:

    cheers,
    bones
     

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