MDs learning OMT

[johnathanbarefoot25]

First of all, I am still in premed. Second, I would prefer a DO school but I have plans to work internationally and it would be better for me to go to an allopathic medical school. Can MD's learn OMT through a CE course after they graduate or is OMT strictly taught in an osteopathic medical school?

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[Chibucks15]

First of all, I am still in premed. Second, I would prefer a DO school but I have plans to work internationally and it would be better for me to go to an allopathic medical school. Can MD's learn OMT through a CE course after they graduate or is OMT strictly taught in an osteopathic medical school?

1) Do more research into international stuff. You'll have some increased trouble but not overly so with DOs unless you literally want to go live in another country and practice. Doctors without borders and stuff like that youll be good.

2) There are CE credits if I remember correctly but unless its really something you're passionate about, I doubt you'll want to add more courses and stuff onto an already exhausting journey

 

[sab3156]

First of all, I am still in premed. Second, I would prefer a DO school but I have plans to work internationally and it would be better for me to go to an allopathic medical school. Can MD's learn OMT through a CE course after they graduate or is OMT strictly taught in an osteopathic medical school?

Yeah you can learn it at some random schools that teach it.

But why not just read about this hocus pocus online? The vast majority of it is just pseudoscience that has no real clinical findings, and you can just read about it if you want to learn it. Go on youtube if you need to see stuff. Other than a few things like muscle energy and range of motion and whatnot, we make up our diagnoses during the lab practicals because these diagnoses don't exist and cannot be verified (such as cranial, chapman, etc.), and it's hilarious that people try to teach it. The "hands on" instruction that we got in our lab further demonstrated to us that these diagnoses and techniques are absolutely made up. Case in point - when we asked an OMM professor to "verify" our made up cranial diagnoses... guess what? He verified them. Even though we made them up. So yeah, just go on youtube and read about it online if you really feel the need to entertain yourself. Don't waste your time actually pursuing a course in it.

 

[ciestar]

Some schools have electives you can try to do as an M4.

 

[BorntobeDO?]

Just go MD, if you really want to do OMM later there are plenty of FM residency’s that incorporate it.

 

[Sardonix]

Go MD if possible. Take a $500-5000 course once you're a resident and still interested for some reason. DO is of course a fine option, but it is not first line given how the US medical system is set up.

 

[JSReed]

FWIW MD vs DO will not be an issue internationally. Maybe in Switzerland, but not in Malawi (I'm assuming you're looking more at LMICs). Know plenty of DOs who worked as clinicians in LMICs. That being said, MD over DO if you have the choice.

 

[Scrubs101]

My school offers weekend courses to MDs (or DOs wanting to refresh), theyre out there.

 

[fldoctorgirl]

we make up our diagnoses during the lab practicals because these diagnoses don't exist and cannot be verified (such as cranial, chapman, etc.), and it's hilarious that people try to teac

Well, that answers my question about how I'm going to BS my way through our next CPA with cranial 😵

 

[deleted831695]

Yeah you can learn it at some random schools that teach it.

But why not just read about this hocus pocus online? The vast majority of it is just pseudoscience that has no real clinical findings, and you can just read about it if you want to learn it. Go on youtube if you need to see stuff. Other than a few things like muscle energy and range of motion and whatnot, we make up our diagnoses during the lab practicals because these diagnoses don't exist and cannot be verified (such as cranial, chapman, etc.), and it's hilarious that people try to teach it. The "hands on" instruction that we got in our lab further demonstrated to us that these diagnoses and techniques are absolutely made up. Case in point - when we asked an OMM professor to "verify" our made up cranial diagnoses... guess what? He verified them. Even though we made them up. So yeah, just go on youtube and read about it online if you really feel the need to entertain yourself. Don't waste your time actually pursuing a course in it.

The MSK components of OMM are more than “a few things”. It’s the majority of OMM, and actually useful skills to pick up. Agreed that Chapman points and cranial are voodoo.

 

[sab3156]

The MSK components of OMM are more than “a few things”. It’s the majority of OMM, and actually useful skills to pick up. Agreed that Chapman points and cranial are voodoo.

Note that I said "few things" in reference to things that you can actually verify a "diagnosis" for (like some dude's arm being stuck in adduction) - not that these MSK treatments aren't made up voodoo. Things like BLT and the idea that you can offer permanent clinical treatment by stretching someone is still ridiculous and unproven.

 

[NurWollen]

Note that I said "few things" in reference to things that you can actually verify a "diagnosis" for (like some dude's arm being stuck in adduction) - not that these MSK treatments aren't made up voodoo. Things like BLT and the idea that you can offer permanent clinical treatment by stretching someone is still ridiculous and unproven.

Yeah, but even then I question some OMM MSK assessments. There's a difference between "a dude's arm being stuck in adduction" as in he literally can't move his arm away from his body, and "stuck in adduction" as in "I'm in OMM lab practicing on a healthy classmate and I have to pick a side and say it 'resists abduction" or something. Just like there's a difference between someone having their vertebral body displaced in an MVA and an OMM guy saying it's T3 FRSL

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[sab3156]

Yeah, but even then I question some OMM MSK assessments. There's a difference between "a dude's arm being stuck in adduction" as in he literally can't move his arm away from his body, and "stuck in adduction" as in "I'm in OMM lab practicing on a healthy classmate and I have to pick a side and say it 'resists abduction" or something. Just like there's a difference between someone having their vertebral body displaced in an MVA and an OMM guy saying it's T3 FRSL

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Agree 100%. These diagnoses are laughably irrelevant.

 

[Osminog]

Case in point - when we asked an OMM professor to "verify" our made up cranial diagnoses... guess what? He verified them. Even though we made them up.

This is the norm. As you know, OMM "diagnoses" have a lot to do with how you choose to position your hands and fingers, and with how you subjectively perceive small distances and movements. Instructors unconsciously adjust their hands and fingers when they're re-checking your "diagnosis" and end up accepting your findings solely due to confirmation bias; in other words, they usually want your findings to be correct, and so their brains will trick them into finding precisely what you supposedly felt or saw, even when you made it up. An OMM practitioner feels what he wants to feel and sees what he wants to see, because the standards for "diagnosis" are made to be as loose and subjective as possible—and this is how it's supposed to be by design. By only using palpation and observation, one can find all sorts of "somatic dysfunctions" that one would never be able to uncover through any objective scientific means. What seems like a completely flawed, broken methodology is what gives OMM a purpose in a world in which evidence-based medicine has largely taken over.

 

[deleted898021]

This is the norm. As you know, OMM "diagnoses" have a lot to do with how you choose to position your hands and fingers, and with how you subjectively perceive small distances and movements. Instructors unconsciously adjust their hands and fingers when they're re-checking your "diagnosis" and end up accepting your findings solely due to confirmation bias; in other words, they usually want your findings to be correct, and so their brains will trick them into finding precisely what you supposedly felt or saw, even when you made it up. An OMM practitioner feels what he wants to feel and sees what he wants to see, because the standards for "diagnosis" are made to be as loose and subjective as possible—and this is how it's supposed to be by design. By only using palpation and observation, one can find all sorts of "somatic dysfunctions" that one would never be able to uncover through any objective scientific means. What seems like a completely flawed, broken methodology is what gives OMM a purpose in a world in which evidence-based medicine has largely taken over.

Yet despite all this being true, we have faculty at our school who practice OMM and have family Med/omm clinics who are overbooked and banking. Some of the stuff does work and can be used to help people feel better no doubt. Some of it it’s just flat out BS tho

 

[fldoctorgirl]

Yet despite all this being true, we have faculty at our school who practice OMM and have family Med/omm clinics who are overbooked and banking. Some of the stuff does work and can be used to help people feel better no doubt. Some of it it’s just flat out BS tho

It "works" as a placebo. It's the same reason why people think they feel sick, take EmergenC, and automatically feel better. It's a lame defense when actual clinical trials have yielded no results that it significantly makes a difference.

 

[Angus Avagadro]

I believe some former DO FM residencies are required to develop curricula for MD residents to teach them OMM. I'm not sure when this will happen, but heard it will. So if an MD wants to learn OMM, apply to one of these residencies with OMM certification.

 

[Goro]

It "works" as a placebo. It's the same reason why people think they feel sick, take EmergenC, and automatically feel better. It's a lame defense when actual clinical trials have yielded no results that it significantly makes a difference.

Best placebo I've ever had, and I am very skeptical by nature. My guess is that at a minimum, the human touch does something positive.

 

[DO2015CA]

It "works" as a placebo. It's the same reason why people think they feel sick, take EmergenC, and automatically feel better. It's a lame defense when actual clinical trials have yielded no results that it significantly makes a difference.

If you think that then quit referring your patients to PT if it’s ALL bs. Muscle energy and counterstrain are woefully similar to modalities PT use for muscle imbalance

 

[fldoctorgirl]

Best placebo I've ever had, and I am very skeptical by nature. My guess is that at a minimum, the human touch does something positive.

If you think that then quit referring your patients to PT if it’s ALL bs. Muscle energy and counterstrain are woefully similar to modalities PT use for muscle imbalance

I don't disagree with either of you. My issue with OMM is more with the things that are super pseudo-sciency, like cranial and Chapman's. I'm sick of my instructors putting up "studies" with 10 participants that showed how much better they were after OMM. Muscle energy is actually something I like, as it makes sense for the most part. It still doesn't change my opinion that a lot of the efficacy of it is from a placebo effect, but that's just my personal opinion.

 

[JSReed]

Many countries do not recognize DO or allow them to practice

Yea...from a humanitarian/development perspective, most of the countries you're going to work in aren't really going to care. Most of them are hurting for clinicians as is. As someone who used to get paid to run these types of programs, I'm decently confident in saying this.

 

[Sleepingdoc]

It "works" as a placebo. It's the same reason why people think they feel sick, take EmergenC, and automatically feel better. It's a lame defense when actual clinical trials have yielded no results that it significantly makes a difference.

There is a difference between prescribing NSAID's/steroids/opioids for every kind of musculoskeletal pain vs people finding relief while doing OMT.. If you believe that pain is real, pain relief is real too.. and plenty of patients find pain relief with OMT, so i wont dismiss it as a placebo.

 

[fldoctorgirl]

There is a difference between prescribing NSAID's/steroids/opioids for every kind of musculoskeletal pain vs people finding relief while doing OMT.. If you believe that pain is real, pain relief is real too.. and plenty of patients find pain relief with OMT, so i wont dismiss it as a placebo.

Agree to disagree.

 

[DO2015CA]

I don't disagree with either of you. My issue with OMM is more with the things that are super pseudo-sciency, like cranial and Chapman's. I'm sick of my instructors putting up "studies" with 10 participants that showed how much better they were after OMM. Muscle energy is actually something I like, as it makes sense for the most part. It still doesn't change my opinion that a lot of the efficacy of it is from a placebo effect, but that's just my personal opinion.

You are in the middle of spring semester 2nd year. It’s stressful and you hate your life but don’t throw the baby out with the bath water. I won’t use it and I will firmly say Chapman/cranial is ridiculous but to say all OMM is garbage is too far. ME and CS are classified as OMM

 

[Cornfed101]

It "works" as a placebo. It's the same reason why people think they feel sick, take EmergenC, and automatically feel better. It's a lame defense when actual clinical trials have yielded no results that it significantly makes a difference.

Isn't part of the issue that you can't do a double-blind study of OMM? The physician is always going to know if they are doing it or not...

 

[Osminog]

You are in the middle of spring semester 2nd year. It’s stressful and you hate your life but don’t throw the baby out with the bath water. I won’t use it and I will firmly say Chapman/cranial is ridiculous but to say all OMM is garbage is too far. ME and CS are classified as OMM

There is no baby in the bathwater. OMM is complete garbage, and ME and CS are garbage too.

There is zero empirical evidence that “tender points,” the conceptual basis of CS, exist in any meaningful, objective sense, let alone that they can be accurately detected in a replicable way by poking arbitrary parts of the patient’s body or looking for “tissue texture changes.”

Regarding ME, here’s what the 2015 Cochrane Systematic Review of ME concluded: “The quality of research related to testing the effectiveness of MET is poor. Studies are generally small and at high risk of bias due to methodological deficiencies. Studies conducted to date generally provide low‐quality evidence that MET is not effective for patients with LBP. There is not sufficient evidence to reliably determine whether MET is likely to be effective in practice. Large, methodologically‐sound studies are necessary to investigate this question.”

If it is one day determined through rigorous, unbiased research (hopefully published outside the trash bin known as JAOA) that certain muscle energy or counterstrain techniques actually work, then we will need to abandon osteopathic pseudoscience and seek out the real mechanisms behind why they work—but we are not at this point yet.

 

[Osminog]

Isn't part of the issue that you can't do a double-blind study of OMM? The physician is always going to know if they are doing it or not...

You can teach a random untrained person how to do basic OMM techniques and how to do sham manipulation techniques, and not tell
them which ones are real and which ones are not. (As a safeguard, you can consult with an OMM practitioner to be sure that the sham manipulation doesn’t significantly overlap with any real technique.) That way, neither the treater nor the treated is aware of whether the control or the actual treatment is being administered, making it double blind.

Also, a number of medical devices can be used to put osteopaths’ claims to the test, though there appears to be a very strong resistance against the use of technology to investigate OMM.

 

[DO2015CA]

There is no baby in the bathwater. OMM is complete garbage, and ME and CS are garbage too.

There is zero empirical evidence that “tender points,” the conceptual basis of CS, exist in any meaningful, objective sense, let alone that they can be accurately detected in a replicable way by poking arbitrary parts of the patient’s body or looking for “tissue texture changes.”

Regarding ME, here’s what the 2015 Cochrane Systematic Review of ME concluded: “The quality of research related to testing the effectiveness of MET is poor. Studies are generally small and at high risk of bias due to methodological deficiencies. Studies conducted to date generally provide low‐quality evidence that MET is not effective for patients with LBP. There is not sufficient evidence to reliably determine whether MET is likely to be effective in practice. Large, methodologically‐sound studies are necessary to investigate this question.”

If it is one day determined through rigorous, unbiased research (hopefully published outside the trash bin known as JAOA) that certain muscle energy or counterstrain techniques actually work, then we will need to abandon osteopathic pseudoscience and seek out the real mechanisms behind why they work—but we are not at this point yet.

Then do not refer to PT. I’m not arguing for a physician to be doing OMM. I went to school to be a physician not a therapist. DOs are not unique. PT uses many of the less extreme modalities

 

[Angus Avagadro]

There is no baby in the bathwater. OMM is complete garbage, and ME and CS are garbage too.

There is zero empirical evidence that “tender points,” the conceptual basis of CS, exist in any meaningful, objective sense, let alone that they can be accurately detected in a replicable way by poking arbitrary parts of the patient’s body or looking for “tissue texture changes.”

Regarding ME, here’s what the 2015 Cochrane Systematic Review of ME concluded: “The quality of research related to testing the effectiveness of MET is poor. Studies are generally small and at high risk of bias due to methodological deficiencies. Studies conducted to date generally provide low‐quality evidence that MET is not effective for patients with LBP. There is not sufficient evidence to reliably determine whether MET is likely to be effective in practice. Large, methodologically‐sound studies are necessary to investigate this question.”

If it is one day determined through rigorous, unbiased research (hopefully published outside the trash bin known as JAOA) that certain muscle energy or counterstrain techniques actually work, then we will need to abandon osteopathic pseudoscience and seek out the real mechanisms behind why they work—but we are not at this point yet.

I have been listening to medical students trash OMM for a couple years now without any feedback. Remember pre meds read SDN and might actually think you know what you are talking about. It is not all pseudoscience. Mainstream journals aren't in the habit of publishing pseudoscience.

Annals of Internal Medicine: 2004, 141; 432-439
Manipulative Therapy in Addition to Usual Medical Care for Patients with Shoulder Dysfunction and Pain;
Gert J.D. Bergman, et al.

American Journal of Obstetrics and Gynecology, (ACOG Green Journal), Am J Obstet Gynecol 2010; 202:43.e1-08
Osteopathic Manipulative Treatment of Back Pain and Related Symptoms during pregnancy: a Randomized Controlled Trial
John C. Licciardone, D.O. et al.

Annals of Internal Medicine; 21 December 2004; Vol 141: Number 12; pp. 920-928.
A Clinical Prediction Rule to Identify Patients with Low Back Pain Most Likely to Benefit from Spinal Manipulation: A validation Study
Maj John D. Childs, PhD, et. al.

Annals of Thoracic Surgery: 2017 Jul;104(1): `45-152. doi: 10.1016/j.athoracsur.2016.09.110. Epub 2017 Jan18
Osteopathic Manipulative Treatment Improves Heart Surgery Outcomes: A Randomized Controlled Trial.
Racca V, et. al.

These are some articles published in peer reviewed mainstream journals showing positive correlations with OMT. These articles don't represent a cure for cancer or for the common cold, but suggest OMT was beneficial in their study and like anything, more work is needed. Students having trouble wrapping their arms around cranial and Chapmans points is understandable. Too many students have very firm opinions about OMT and should reserve them until they have actually treated patients, not classmates, with OMT. Once again, these mainstream journals are not in the habit of publishing pseudoscience. Whew, got that off my chest

 

[Goro]

Isn't part of the issue that you can't do a double-blind study of OMM? The physician is always going to know if they are doing it or not...

You can teach a random untrained person how to do basic OMM techniques and how to do sham manipulation techniques, and not tell
them which ones are real and which ones are not. (As a safeguard, you can consult with an OMM practitioner to be sure that the sham manipulation doesn’t significantly overlap with any real technique.) That way, neither the treater nor the treated is aware of whether the control or the actual treatment is being administered, making it double blind.

Also, a number of medical devices can be used to put osteopaths’ claims to the test, though there appears to be a very strong resistance against the use of technology to investigate OMM.

One can easily do a study on OMT. Take a technique with a known indication (say, acute bronchitis), and then do said technique. Compare outcomes to a technique not indicated, and of course, standard treatments.

I have noted that a number of my OMM/OMT colleagues are hesitant to test their techniques, probably for fear of finding that they don't work. Well, medicine says you simply throw that out and try something else.

 

[Angus Avagadro]

One can easily do a study on OMT. Take a technique with a known indication (say, acute bronchitis), and then do said technique. Compare outcomes to a technique not indicated, and of course, standard treatments.

I have noted that a number of my OMM/OMT colleagues are hesitant to test their techniques, probably for fear of finding that they don't work. Well, medicine says you simply throw that out and try something else.

Noll and colleagues have published several pneumonia studies with N's in the 100's. I didn't mention any of them because they were in the JAOA and my point was to show OMT studies in mainstream MD medical journals.

 

[deleted707454]

Learn as much as you can about what OMM entails before committing yourself to that education pathway. Watch this video and conduct a literature review of the data of osteopathy in the cranial field. Would you seek this treatment (and pay for it accordingly) for yourself or your family members?

This is a single example of the many fringe entities of OMM and cranial, along with Chapmans reflexes, are the two most common cited pseudoscientific components to the curriculum. But a lot of the less fringe treatment modalities as well as osteopathic diagnostic criteria are similarly devoid of validity.

Example: Fryette's Laws were literally taught as medical gospel at my school. And for a set of "Laws," repeat motion studies in radiographic imaging and cadaver models have failed to show any evidence of these "Laws."

Diagnoses of somatic dysfunction is the emphasis in OMS1. Studies even among expert OMM practitioners have consistently had low inter examiner reliability. In one study of OMM practitioners, a wedge was placed under a subject's heel (unknowingly to the practitioner). Sometimes the left, sometimes the right, sometimes neither and so on... Then the practitioners were evaluated for their ability to detect this 5mm change. All levels of experience level weren't able to consistently detect this. When you're assessed in OMM ability in DO school, you're diagnosing asymptomatic medical students and getting graded on a faulty premise.

Note that your grades and advancement in medical education are dependent on whether or not your DO examiners agree with your findings. If they disagree with your perception of the bones' orientation, you will score low or won't pass altogether. Its not like they pull out calipers and have numeric values for this. It is all eyeballed and ballparked, and it can come down to their word against yours.

Osteopathic treatments are the emphasis OMS2, where you're graded on whether not the condition improves. Some treatment modalities you get graded on are "sleight of hand" akin to the above video (BLT, CS, soft tissue...). And after a treatment is performed, your grade depends on the same conundrum as above.

Always give the professors the benefit of the doubt, but if you happen to fall on their bad side (say, from being critical in any way of principles in OMM), you might join the small ranks of students who all of a sudden find it difficult to pass OMM labs. There have been students dismissed from DO school solely from their OMM performance. OMM professors are often not taken seriously by the other academic faculty, and they could jump at a chance to regain their lost footing at the expense of a student.

OMM education within DO schools vary so much- some are a complete breeze and others are a lot more difficult. Most students end up jumping through the hoops just fine, but still no way to predict your aptitude for ballparking and eyeballing bone alignment by seeing and feeling with your hands.

90 to 95% of DOs do not do manipulations. I think the frequency at which its practiced speaks for its clinical utility and efficacy. It is nonetheless a pathway to physician, but at least be well informed about it.

Last note... for all my preclinical courses, there was a textbook (e.g. Robbins, Bates, etc.) which are time honored by the majority of medical institutes and usually a great reliable foundation of which the course content is based from. What was the textbook for the osteopathic medicine course at my DO school? A spiral bound Microsoft Publisher document in Comic Sans font compiled by the OMM department at the school, with (generally) n=6 sample size JAOA studies from 50 years or more ago.

 

[deleted947265]

First of all, I am still in premed. Second, I would prefer a DO school but I have plans to work internationally and it would be better for me to go to an allopathic medical school. Can MD's learn OMT through a CE course after they graduate or is OMT strictly taught in an osteopathic medical school?

DO degree is recognized in many countries outside the US. Probably not as many as MD.

Are you sure you really that deadset on OMT? You can learn about of the techniques by just reading the textbooks, they're on Amazon and whatnot. OMM ranges from physical therapy to abject quackery. Source: Read the textbooks.

 

[Goro]

I fully agree that there are multiple unproven claims in omm/omt, as well as some pseudo-scientific Notions.

But in response to just one of your points, it actually takes work to fail an OMM/OMT class, despite the subjective grading of the faculty.

As I like to point out, having to take OMM/OMT at the minimum, is a tax on your inability to get into an MD School. The pathway still allows people to be doctors.

 

[Benjamin87]

First of all, I am still in premed. Second, I would prefer a DO school but I have plans to work internationally and it would be better for me to go to an allopathic medical school. Can MD's learn OMT through a CE course after they graduate or is OMT strictly taught in an osteopathic medical school?

We have an MD that is currently following the second year's curriculum in OMM while she practices family medicine at a nearby hospital part-time (or maybe full-time, I don't know really). She said she was interested in learning it from DOs she did her residency with, and applied for her current position. I think other DO schools offer similar opportunities to those interested. Hope that answers your question! PM me or reply back if you want to know anything else. Good luck with your future studies too!

 

[alprazoslam]

I would have paid you to learn my OMT