How important is OMM?

[sean]

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I have followed this board for a while now and I am struck by the seeming lack of interest in the OMM part of a DO's training. Is OMM not a central part of a DO's training based upon a central ideal that the body has the ability to heal itself and that the manipulation aids this healing?

 

[Popoy]

It's important enough for me, that's why I choose to go to DMU where they have fellowship program which I hope to qualify for. What else do others think?

 

[kidterrific]

The fellowship is awesome, from what I hear. You pull it off, and you're one of the best in the nation. But you have to talk to all the applicants during interviews and answer the same questions every day for months!

The OMM guys during my intervew @ DMU were cool as hell. They helped me relax. I hope they're still around when I get there.

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KidT
[email protected]

 

[lotus]

OMM is one of the main reasons I like
osteopathy. Otherwise I dont' think it
is that different from going to an
allopathic school. The philosophy is
holistic. I think osteopathic students
have a huge advantage over allopaths, as
they are trained in both the best of the
more reductionist bio mechanical model of
allopathic medicine and they have insight
and experience with a more 'alternative'
holistic philosopy. Doctors who can bridge the two realms are going to be able to offer
patients a much wider range of care.

 

[Kent Ray]

From my experience OMM is rarely used in the clinical situation. Two main reasons.
1. Lack of research. One article in the New England Journal of Medicine does not prove or disprove all of OMM. Although DMU is an excellent place to learn OMM, none of the faculty are involved in clinical research. This is a huge obstacle in our way, unless we prove what we do is beneficial and cost effective then OMM can never be taken seriously.
2. Time. A busy general practice will only allow you to see a patient every 15 min or so. This is not enough time to use OMM. There are some who use OMM all the time in their office and they are compensated well.
3. Quackery. One bad apple can spoil the bunch. Several physicians make the claim that cranial manipulation can decrease the morbidity of migraines, post nasal drip... How can they say this without research to back it up.
I believe that OMM probably does work but I need proof. We will promote ourselves and our profession much more than the AOA ever could if we increase our research efforts in and outside the study of OMM.

 

[Billie]

I agree that to promote ourselves better we must have more research in OMM. I think a lot of docs though go on anecdotal evidence, i.e. what their patients say. If it works for their pt, then they will continue that tx. I, for one, feel that effleurage (spelling - sorry!) does clear my sinuses. Can I prove this scientifically? No, but I know it works on me much better than any ol' Claritin.

Billie

 

[sean]

I guess this is where things get a little fuzzy for me. If you don't use OMM, how would your practice be any different than that of an MD. Please, I am not trying to get into the MD vs DO thing. Is the concern about whether the technique actually works or just whether the practitioner is any good at the manipulation?

 

[drusso]

Manipulation is a psychomotor skill. It takes time to learn and requires practice to be good. It's not rocket science and it's not a panacea. It is simply a good modality for short-term (and some times long-lasting) relief of musculoskeletal pain syndromes. It also doesn't have to take very long to do if you are efficient---also it can pay quite well if you know how to bill and how to play the right games with insurance companies so that you get reimbursed for what you do.

A lot of older D.O.'s don't practice it because of the fear of being labelled a quack. Thirty years ago D.O.'s were just barely breaking into top allopathic medical centers. The quickest way to lose credibility among a bunch of M.D.'s when you're a D.O. in a heavily allopathic setting is to start talking about things like manipulation--which the vast majority of M.D.'s know nothing about and are probably not very interested in hearing about anyway.

Still, in my opinion, there is a resurgence of interest in manipulation these days. I am approached more and more frequently by M.D. attendings with questions about manipulation. I, myself, have even manipulated M.D. attendings! Let me tell you, there is nothing like a quick Kirkesville crunch on the OR table after spending 2 1/2 hours trying to pin a recalitrant hip...

I've met more than a few M.D.'s who have taken classes in OMM at Michigan State, NYCOM, etc. I routinely hear physical therapists talk about muscle energy and myofascial release treatments (both osteopathic manipulative techniques). Slowly, but surely, more quality research is appearing on the efficacy of manipulation too. NIH's center for complementary and alternative medicine is interested in all sorts of "body-work" therapies ranging from massage to rolfing, chiropractic, and osteopathy.

I think that learning OMM also teaches good physical exam/musculoskeletal medicine skills. I did a rehab medicine rotation and was amazed at some of the things that I learned as a second-year osteopathic medical student were only just barely being introduced to second and third-year PM&R residents.

Anyway, OMM is a good modality to learn and know. It has its place. Ultimately, you'll be a fine physician with or without it.

--Dave

[This message has been edited by drusso (edited April 26, 2001).]