Can anyone guess or tell me which is the most commonly used OMT technique by DOs (regardless of specialty)? Do FP's use some very often? If so what is it called?
Muscle Energy & Counterstrain are the most commonly used techniques in a primary care setting, since they have no contraindications for any patient population. These techniques are used by Physical Therapists as well.
From what i've seen so far in the clinic the young docs like HVLA of course. Kirksville and the like. I've only worked with a few DO residents who were in a mixed md/do FP program and therefore didn't have much guidance in from older DOs. I myself am partial to muscle energy, soft tissue, and indirect techniques. (although who can resist how gratifying a good kirksville crunch can be).
Where source are you using for this...that has not been what I have seen. I would think still tech., BLT/LAS, and/or MFR to be even safer than ME. Being a direct tech., I would not use ME on RA pts. and anyone with ligamantous (sp.) laxity/etc.
Muscle energy is not containdicated in those patients you have listed. HVLA is. And the source I am using is myself. When I have spent time shadowing or doing early clinicals, I most commonly see ME & CS. The most common somatic dysfunction we have seen is either a muscle restriction or a tender point. Although HVLA is commonly used as well, it has those contraindications that you mentioned, and as you know there is a high percentage of elderly in the patient population. (On a side note, let's assume soft tissue is always done prior to these other techniques---especially HVLA.)
1) To the best of my knowledge there are no research tested indications/contraindications for any OMT tech. That being said, it is widely accepted that you do not do HVLA on pt.'s with osteoporosis (or anything else that weakens bone structure, Mult Myeloma, Cancer mets, etc.), or any condition which may comprimise stabilizing soft tissues, esp. ligaments (pt.'s with RA,Down's, others). This information, although not widely researched as far as I have seen (if someone has a source on this please interject) is in all prominent DO OMM/OMT texts and considered to be acceptable and safe assumptions. Beyond that there is some gray area, and if you want to explain to a jury why your elderly pt. with RA has a spinal cord injury from aggressive ME thats your call . 2) As far as ME goes-I think you may need to rethink your logic. It is certainly a Direct tech. Yes, the pt. pushes away from the barrier, but the physician pushes them towards it and engages the restrictive barrier a total of four times (there is variation in the way this is taught but I am sticking to the standard way for discussion). Your school may teach something non-conventional that I'm not aware of. For COMLEX and by all widely accepted standards it is a DIRECT tech. My source for this is every OMM text published today Seriously though- DMU lecture notes (a bit dusty on my bookshelf) 9/1/2000- "Muscle energy is a direct, active technique developed by Fred Mitchell, Sr., D.O." Same lecture: "An indirect tech. involves the dysfunctional component being moved away from the motion barrier." If you think DMU lecture notes are a crappy source to quote (which they may be but thats all thats handy at the moment) ask your OMT chair or take a peek in a textbook on OMM/OMT for a classification of techniques i.e. direct vs. indirect (some are both [like Still tech.] but not ME), active/passive, intrinsic/extrinisic forces. This does come up on boards.
On the first part, I'm just going off of what I heard in lecture and have read in textbooks. I agree with you on the second part.
agreed...i cured my dad's headache in about 5-10 min. with this technique last night. if you can't tell i am very proud of myself. TUN-COM OMS-1
I have not really seen Counterstrain because docs don't really like waiting the 90 seconds... I've seen more ME and HVLA than the functional techniques, even on the elderly. Of course our OMM guy uses all kinds of techniques, but he still does not use S/CS unless that is the only thing that he can get to work on the patient.
Way to go Cardiotonic. You can work on me after anatomy Wed. I always have a headache with this cadaver.
Exactly, except that mine is a modified technique. The operator stands midline facing the patient and stabilizes the patient's popliteal fossa bilaterally with the operator's acromion processes. The finger pads are wrapped around the ischial tuberosities and the operator induces full innominate rotation posteriorly in the patient until a restriction in the tissues is felt. With respiratory cooperation this is one heck of a technique and there is a marked increase in both diaphragm excursion and patient satisfaction!
My favorites Cervical = Counterstrain Thoracic = HVLA Lumbar = ME (Never know who may have a L4/L5 facet tropism or Spondylolysis) Sacrum/Pelvis = ME/Joint mobilization using muscle force Etremeties = ME or a Script for PT
hey guys, i did add a Poll on the SDN OMTguru blog. It would be nice if everyone answered it just to see where we stand. dont take it twice!!! thanks for all the answers. It really helped me out. Visit Today for OMM/OMT News: http://www.studentdoctor.net/blogs/omtguru/
