Is OMT on Life Support?

[VA Hopeful Dr]

Absolutely agree with the above. EBM seems to be the new cult. In medicine, it's really not EBM, but Best Evidence Based Medicine to date, as new data continues to comes up. I have posted several references to OMM papers published in major peer reviewed journals in the past. Yet, people continue to claim there is no EBM to suggest OMM is effective . Chiropractor parking lots are full and people with OMM practices are quite successful. Why? Patients feel better when they leave the office. Yet, these same complainers would write a script for Adderall for someone with ADHD in 2 seconds. The last time I looked into it, there is no diagnosis in the DSM that has had more studies published about it than ADHD. Yet, the EBM has yet to suggest that long term outcomes, with respect to addiction, anti social behavior, graduation, etc., are improved with stimulants. The only benefit appears to be reduction in symptoms. So the patients feel better with OMM... AND ..stimulants, but one is quackery and the other is EBM? Sorry, but it can't be both ways.
/Rant over.

Congratulations, you win the "most wrong post" for this week.

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[Angus Avagadro]

Congratulations, you win the "most wrong post" for this week.

Care to elaborate? Or just want to throw bombs?

 

[VA Hopeful Dr]

Care to elaborate? Or just want to throw bombs?

I thought it was obvious, but fair enough. There is a significant amount of long-term data on the use of stimulants for treatment of ADHD.

 

[Angus Avagadro]

I thought it was obvious, but fair enough. There is a significant amount of long-term data on the use of stimulants for treatment of ADHD.

Well, to begin, ADHD has been studied extensively for over 35 yrs. There is also a significant amount of data to suggest that long term benefits are limited, or dont exist with respect to the issues I mentioned. Some patients are non responders to stimulant therapy. So, I'll have to wait for more reproducible data confirming the long term benefits. As I said earlier, it's Best Evidence to Date Medicine. I read one study not long ago suggesting the incidence of drug addiction might be reduced in treated patients. This I found interesting and hopefully more data will come confirming this. The main point of my comment is that OMT and stimulant use in ADHD both make "Symptoms" better. Long term benefits aren't as clear. One is considered quackery by many and the other is mainstream.

 

[VA Hopeful Dr]

Well, to begin, ADHD has been studied extensively for over 35 yrs. There is also a significant amount of data to suggest that long term benefits are limited, or dont exist with respect to the issues I mentioned. Some patients are non responders to stimulant therapy. So, I'll have to wait for more reproducible data confirming the long term benefits. As I said earlier, it's Best Evidence to Date Medicine. I read one study not long ago suggesting the incidence of drug addiction might be reduced in treated patients. This I found interesting and hopefully more data will come confirming this. The main point of my comment is that OMT and stimulant use in ADHD both make "Symptoms" better. Long term benefits aren't as clear. One is considered quackery by many and the other is mainstream.

Except again you're wrong, there is quite a bit of long term data about treating ADHD with stimulants.

 

[Mad Jack]

Osteopathic manipulative treatment (OMT) use among osteopathic physicians in the United States

Context Updated data on the use of Osteopathic Manipulative Treatments (OMT) by osteopathic physicians in the United States is overdue. This data would provide an up-to-date point of reference for evaluating the current use of OMT as a distinguishing feature of the osteopathic profession...

www.degruyter.com

Small sample size (~1,700)
78% reported using OMT on <5% of their patients
57% reported using OMT on 0% of their patients

Should DO curriculum and board exam subjects be re-evaluated?

The same could be said of any number of things taught in medical school, honestly. I'll never do anything related to surgery, and yet I still can remember all the time I put in learning to knot and suture. I'll never look at a pathology specimen, and yet I spent hundreds of hours learning clinical and anatomical pathology. Given the expansion in the number of DO graduates overall, 22% of the current number of DOs using OMT on >5% of patients still represents an enormous expansion in the number of people using OMT with any regularity and 43% using it with any frequency. There's over 170,000 osteopathic physicians and medical students compared to 31,000 in 1990. That's 37,400 regular practitioners of OMT and 73,100 total practitioners using OMT, representing an enormous expansion over the course of most of our lives.

 

[Mad Jack]

Well, to begin, ADHD has been studied extensively for over 35 yrs. There is also a significant amount of data to suggest that long term benefits are limited, or dont exist with respect to the issues I mentioned. Some patients are non responders to stimulant therapy. So, I'll have to wait for more reproducible data confirming the long term benefits. As I said earlier, it's Best Evidence to Date Medicine. I read one study not long ago suggesting the incidence of drug addiction might be reduced in treated patients. This I found interesting and hopefully more data will come confirming this. The main point of my comment is that OMT and stimulant use in ADHD both make "Symptoms" better. Long term benefits aren't as clear. One is considered quackery by many and the other is mainstream.

There is mixed evidence with regard to long-term studies. ADHD tends to improve in a substantial number of patients, but those with persistent ADHD into adulthood seem to still benefit from treatment for ADHD. This likely means that the patients that have had significant baseline symptom improvement dilute the clinical improvements that are being made in the population that still has substantial clinical symptoms at baseline. This is likely why studies that examine treatment of adults with ADHD still show significant clinical benefit in functioning despite the endpoint of child studies not demonstrating same- the adults all have clinically significant symptoms at baseline while a percentage approaching just shy of half of the children will no longer have clinically apparent ADHD.

https://onlinelibrary.wiley.com/doi/10.1111/bcpt.12477

 

[Angus Avagadro]

There is mixed evidence with regard to long-term studies. ADHD tends to improve in a substantial number of patients, but those with persistent ADHD into adulthood seem to still benefit from treatment for ADHD. This likely means that the patients that have had significant baseline symptom improvement dilute the clinical improvements that are being made in the population that still has substantial clinical symptoms at baseline. This is likely why studies that examine treatment of adults with ADHD still show significant clinical benefit in functioning despite the endpoint of child studies not demonstrating same- the adults all have clinically significant symptoms at baseline while a percentage approaching just shy of half of the children will no longer have clinically apparent ADHD.

https://onlinelibrary.wiley.com/doi/10.1111/bcpt.12477

I'd like to thank @Mad Jack for adding the clarification.

 

[GotToGetThatGPAUp]

The dreamer in me hopes that the AOA would call for better studies on the efficacy of OMM, but the flip side is that the True Beleivers will say "we have to have MORE time for OMM/OMT!

Yup. An OMT Faculty member of mine pointed out that any OMT specialist in a decent area like Great Neck, NY could haul in as much as a dermatologist, and with less overhead. All you need is the OMM table, after all.

Ah Great Neck, I used to be a pool boy there during high school. No joke, I thought their pool houses were the actual homes the first week given the size.

I'm hardly surprised they're eating up OMM, probably paying out of pocket too.

 

[DOhio]

I would like to chime in here. I am not a great writer, but after reading the DO hate in this thread, I want to offer a bit of an anecdote for OMT, take it or leave it. I'm a family physician, a DO. been in practice about eight years now. I cannot say that I have been a great role-model for Osteopathy in that time. In fact, I've always struggled with the question, What is a DO? I am not entirely sure why I chose to pursue a DO degree instead of an MD, but it was probably my own insecurity and a perception of DO schools being easier to gain entrance. At this point, I honestly believe none of that was deserved. I went to a well-known private university for undergrad. I have a BS in a challenging science degree. My grades were good. My test scores including MCAT were good. I would probably have gotten into an MD school if I applied. Whatever the reason, I convinced myself to go the DO route, and that's what I did. Got in rather readily too.
As I age into my profession, I become increasingly convinced those feelings are all my own insecurities and not a reflection of what Osteopathy has to offer. They are not a reflection of my clinical education either, although I do have critisms there. In fact, I don't think I ever had a good example of classic Primary Care Provider who used OMT regularly while I was a student. I was never once asked, "what did you find on your osteopathic examination?" Perhaps that's why it was so difficulty for me to integrate the concept into my own practice. At this point, it's taken me eight years, but just this year, more and more I refer to myself as an Osteopathic Family Physician, and I say it out loud, and I say it with pride.
I'm not certain what changed. I think the moment was when my spouse had an episode of acute low back pain. She complained daily for about a month. Finally, she begged me to just try that "DO thing" you learned in school. I literally broke out med school notes. Without a table, I evaluated her on the carpet, found an actual somatic dysfunction (a sacral torsion with an L5 Type II dysfunction), and put together a treatment on the spot. She immediately felt better, and the next day the pain that was there for a month was gone, and didn't return. Since then I have slowly embraced OMM. At this point, I have added a structural evaluation to most of my office encounters. Most of those evaluations reveal somatic dysfunctions. I do OMT on most of them. I have had several absolutely stunning resolutions of problems using just OMT. Most patients have no idea what I'm doing. Many absolutely love it. Being a billable procedure, it adds a small, but real bump in RVU production as well. I am almost never behind schedule, at least compared to pre-OMT days.
Why didn't I do OMT before now? The two main barriers for me were worrying about time and not trusting my skill. I can tell you if you passed your OMM courses in school, you have all the tools you need to apply OMT quickly and effectively. It adds only a few seconds perhaps a couple minutes to do the structural evaluation. Applying OMT to specific key lesions takes a few minutes, almost always under five minutes, more likely one to two minutes. If a patient has complicated, chronically compensated patterns, you're not going to crack that nut in five minutes. Those patients would require very long sessions, thirty to sixty minutes, and you'd still be chasing the bouncing ball. But you can start. you knock over the first domino, and start to get the structure back to better position and restoring proper motion, and sometimes these things will start to unwind themselves at that point.
The OMT is such a small thing. It's not a way of life. It's not an entire medical practice. It's one more tool to use to help people overcome their problems. It's like 5% of what I do.
As I said, it's taken me eight years to get to this point. I don't expect everyone to be here, and some people may never agree with me, but I am coming to believe that Osteopathic distinctiveness is a wonderful opportunity to connect with patients through touch. An osteopath can understand a patient's problems from a perspective that the typical H&P will miss. It also offers a treatment somewhere between medicine and surgery done by their PCP at a regular office visit. Perhaps PT and chiro can also be effective, but OMT is not those things. I am a scientist by training. I fully embrace the EBM concept. More importantly, I am a physician. EBM does not cover the full scope of problems patients can have. At least, not yet.
So how do I now answer the question, "What is a DO?" Rather than answer with words, I SHOW patients what makes a DO unique.

 

[Angus Avagadro]

I would like to chime in here. I am not a great writer, but after reading the DO hate in this thread, I want to offer a bit of an anecdote for OMT, take it or leave it. I'm a family physician, a DO. been in practice about eight years now. I cannot say that I have been a great role-model for Osteopathy in that time. In fact, I've always struggled with the question, What is a DO? I am not entirely sure why I chose to pursue a DO degree instead of an MD, but it was probably my own insecurity and a perception of DO schools being easier to gain entrance. At this point, I honestly believe none of that was deserved. I went to a well-known private university. I have a BS in a challenging science degree. My grades were good. My test scores including MCAT were good. I would probably have gotten into an MD school if I applied. Whatever the reason, I convinced myself to go the DO route, and that's what I did. Got in rather readily too.
As I age into my profession, I become increasingly convinced those feelings are all my own insecurities and not a reflection of what Osteopathy has to offer. They are not a reflection of my clinical education either, although I do have critisms there. In fact, I don't think I ever had a good example of classic Primary Care Provider who used OMT regularly while I was a student. I was never once asked, "what did you find on your osteopathic examination?" Perhaps that's why it was so difficulty for me to integrate the concept into my own practice. At this point, it's taken me eight years, but just this year, more and more I refer to myself as an Osteopathic Family Physician, and I say it out loud, and I say it with pride.
I'm not certain what changed. I think the moment was when my spouse had an episode of acute low back pain. She complained daily for about a month. Finally, she begged me to just try that "DO thing" you learned in school. I literally broke out med school notes. Without a table, I evaluated her on the carpet, found an actual somatic dysfunction (a sacral torsion with an L5 Type II dysfunction), and put together a treatment on the spot. She immediately felt better, and the next day the pain that was there for a month was gone, and didn't return. Since then I have slowly embraced OMM. At this point, I have added a structural evaluation to most of my office encounters. Most of those evaluations reveal somatic dysfunctions. I do OMT on most of them. I have had several absolutely stunning resolutions of problems using just OMT. Most patients have no idea what I'm doing. Many absolutely love it. Being a billable procedure, it adds a small, but real bump in RVU production as well. I am almost never behind schedule, at least compared to pre-OMT days.
Why didn't I do OMT before now? The two main barriers for me were worrying about time and not trusting my skill. I can tell you if you passed your OMM courses in school, you have all the tools you need to apply OMT quickly and effectively. It adds only a few seconds perhaps a couple minutes to do the structural evaluation. Applying OMT to specific key lesions takes a few minutes, almost always under five minutes, more likely one to two minutes. If a patient has complicated, chronically compensated patterns, you're not going to crack that nut in five minutes. Those patients would require very long sessions, thirty to sixty minutes, and you'd still be chasing the bouncing ball. But you can start. you knock over the first domino, and start to get the structure back to better position and restoring proper motion, and sometimes these things will start to unwind themselves at that point.
The OMT is such a small thing. It's not a way of life. It's not an entire medical practice. It's one more tool to use to help people overcome their problems. It's like 5% of what I do.
As I said, it's taken me eight years to get to this point. I don't expect everyone to be here, and some people may never agree with me, but I am coming to believe that Osteopathic distinctiveness is a wonderful opportunity to connect with patients through touch. An osteopath can understand a patient's problems from a perspective that the typical H&P will miss. It also offers a treatment somewhere between medicine and surgery done by their PCP at a regular office visit. Perhaps PT and chiro can also be effective, but OMT is not those things. I am a scientist by training. I fully embrace the EBM concept. More importantly, I am a physician. EBM does not cover the full scope of problems patients can have. At least, not yet.
So how do I now answer the question, "What is a DO?" Rather than answer with words, I SHOW patients what makes a DO unique.

Thanks for sharing your thoughtful post. Like any therapy, it's helpful when applied correctly. I have lots of anecdotes, but one I like is a family friend with severe arm and shoulder pain. They were a a good football player years ago so I knew they were not a baby. They told me they were sleeping in a recliner using a sling. I tested for Thoracic Outlet Syndrome and was astonished all the tests were positive. I had never seen a case before. I treated them and the symptoms completely resolved, much to both of our surprise. TOS is often caused by tight muscles and sometimes takes weeks to resolve with treatment. If you have such a patient in the office, they will tell anyone who listens what an astute doctor you are and will come to your office. Sadly, some of them are pretty tough patients, you know..allergic to everything. Thanks for sharing your experience.

 

[Niwrad]

I’d like to add something about cranial OMT.

I’ll start off by saying I’m a natural skeptic, but not dismissive either. I had gone in DO school without knowing much about MD/DO except “it’s basically the same” except DO has lower GPA requirements. In hindsight I realized my GPA was lower because of specifics of my major and school and probably would have qualified at MD schools.

I don’t think the cranial bones move either, and the CRI is unbelievably difficult to palpate, since the lung respiration is much more prominent and the given frequency of normal CRI is almost exactly the same as normal breathing.

However, I’ve seen something similar between how people (and myself) literally scratch their heads when trying to think and the movements and pressures with cranial OMT.

Perhaps the stimulation of certain points on the scalp helps improve symptoms like how people feel an impulsive urge to scratch their head when confronted with something intellectually challenging.

Cella M, Acella E, Aquino A, Pisa V. Cranial osteopathic techniques and electroencephalogram (EEG) alpha power: a controlled crossover trial. J Osteopath Med. 2022 Jun 8;122(8):401-409. doi: 10.1515/jom-2021-0257. PMID: 35675898.

I’ve copied the first result I found on pubmed that looks into the neurological effects from cranial OMT as measured by EEG.

This seems very promising and would also explain why, at least to me, why it’s not well studied as I have basically no knowledge of how to interpret an EEG aside from the absolute minimum for exams.

 

[DO2015CA]

Have to agree with macman. I would like to see the OMT curriculum reduced to MSK interventions, but there are data that support those interventions for MSK stuff. Cranial, Chapmans needs to be axed and everyone I think agrees on this. I have seen pts addicted to opioids get off them when tx with OMT--that's powerful and I think worth saving. Maybe there is a future where DO schools become (as if they are not already, but more officially) the model to produce primary care physicians, who will incorporate OMT in practice. The study reported about half of the respondents were in primary care, but it doesn't break down how they responded as far as percentage utilized. It did note that "lack of time" was the most significant barrier to performing OMT, and in primary care that makes perfect sense with our "move the meat" healthcare model.

This won’t be possible the way the healthcare system is progressing. We are becoming less time and more division of labor. If we start to truly value OMT then it would be more and more OMT only docs. Not added to primary care. It’s just as easy for pcp to refer to PT. And it’s cheaper.

 

[drusso]

Many DO's get "reconverted" to OMT when they get out in practice and discover that they can boost their RVU's for office visits by throwing in a little Strain-Counterstrain, etc especially if you're in a MSK-oriented specialty.

 

[Mr.Smile12]

FWIW: new 2022 video from PCOM on introducing people to OMT