OMM and you

[Megalofyia]

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What exactly is OMM and how will it benefit me or my patients? When would OMM be used? Is is something that would be more used by a family practice doctor rather than someone who specialized?

 

[texdrake]

I am not a huge OMM person, but I will take a stab at your questions.

1. OMM is a physical therapeutic modality that allows DO's to help treat their patients. Its a combination of soft tissue (massage), reflexology, stretching, and most importantly manual manipulation (kind of like chiropractic care, actually chiropractic care developed from OMM).

2. It can benefit you because you can offer it to your patients where as an MD can not. A DO can DO everything an MD can and can also do OMM, an MD can not.

3. It can benefit your patients in a multitude of ways, just depends on what techniques you do. From improving posture, pain, or discomfort to enhancing circulation, breathing, and drainage. It really is hard to describe all it can do.

4. OMM can be used in a variety of settings and times, but is most commonly used when patients present with musculoskeletal symptoms, although it may be used even to relax a patient.

5. Most DO's are in primary care. So it is used more commonly there, but it is used by some specialists as well. Family practitioners and OMM specialist would be the two most common areas though.

6. Can it cure all? Hell no. In fact there are some things that I am taught that I know I will never utilize (tender points) or that I believe don't work (lymphatic pumps) but there are many that do and I will utilize as well. Everyone finds theire own niche within the spectrum of OMM. Mine isn't as prominent as some of my friends but I still see the need and the results of correctly utilizing the modality. The great thing about OMM is that it really doesn't take as long as people think it does and you can teach many techniques to your patients so they can help themselves or their family members, especially the stretching exercises.

Now memorize that...spew it back to me in an interview and I woudl probably accept you..... 😛

 

[Megalofyia]

Thanks for the great answer!

 

[Runtita]

OMM can be incredibly useful to the OB in relieving the weird stresses and angles which can develop in a woman's body from pregnancy-induced joint laxity and added weight. OMM can also align a pelvis, making childbirth less stressful.

I'll be the FIRST in line to say that OMM worked for me! I was SO uncomfy during my 1st pregnancy when I had an MD for an OB. Even massage therapy didn't help that much. I felt so medicalized. With my 2nd child, my OB was a DO, and I had a completely different experience- my comfort level was much greater (she did OMM on me throughout the pregnancy) and I had an easier (and drug-free) delivery.

OMM is also nice to know in pediatrics (for colic and other tummy symptoms) and in occupational rehab. I'm sure that there are countless specialties that could use OMM at one time or another.

 

[Ohiobuddhist]

While trying to avoid redundancy, I would also like to take a stab at this.

OMM is a way for the practitioner to use the patients body for both diagnostic purposes and treatment. It is probably most widely used in this country at the present time for musculoskeletal disorders. If you look at some of the history of osteopathy, you will see that it has been used effectively in clinical situations to relieve/cure a variety of illnesses. One problem modern day OMM faces is the lack of WIDELY PUBLISHED clinical studies. As an osteopathic student currently working on manipulative research, I would like to remind all of us that just because it isn't published in NEJM, that doesn't necessarily mean that there is "NO" research to "prove" osteopathic manipulation's usefulness. Enough of that rambling.

It has been my experience that one will use OMM only if they truly understand it and most importantly practice it. I don't want to go off on a rant here (sorry, Dennis), but I have been in an osteopathic school for over a year and listened to people bitch and moan about how they think they are wasting there time learning OMM and how they think it is useless, and how it lacks research. I know this happens at other institutions. Well, dammit, if you ask most of these people to find a simple somatic dysfunction in someone's thoracic spine and then ask them to diagnose it, you know what, they often can't even do that. And why, because we feel we are to busy learning other things to learn manipulation.

Now before I get flamed here for being one of those freaky UAAO kids, let me tell you that my first love is emergency medicine. I plan on using as much OMM as possible in my practice.

So a little tally here for everyon:
Positives:
1. OMM may actually make your patient feel better, perhaps we may never know why fully in some cases, but for some reason it works
2. OMM may actually cure someone's illness. In this current medical culture of "medical management" but too infrequently medical cure, we need to consider our options
3. People will pay you...and pay you well to do this stuff. I know some HMO, etc suck at this, but they're coming around. All our OMM docs have a wait list over 2 months long.
4. Compared to much of the crap we already have to learn in med school, OMM is actually pretty easy and in many cases more fun to study - this is not to say you can only focus on OMM. Approporiate use of OMM implies an incredible wealth of medical knowledge that only properly educated physicians (be that DO or MD - yes they can learn it too) possess.

OK, take a breather, and then read on, if you please.

Negatives:
1. You have to study more. Well, anyone who came to med school to not study is pretty screwed anyway.
2. You may have to accept that something works based on partial knowledge and hypotheses. How many drugs are prescribed daily that have unknown or partially unknown mechanisms - to say nothing of adverse effects.
3. You have to develop a sense that you may never have really used before - touch. Believe it or not, some people really suck at feeling things that are subltle, and it takes practice.
4. You might have to look for literature that is slightly outside of the typically accepted realm. Try reading some books by Chaitow, Thomas Myers (Anatomy Trains), or Schultz and Feitis (The endless web). Also, you will likely never see good literature on manipulative studies in JAMA or NEJM. Politics is politics people, and sometimes no matter how good the study, publishing space is limited. Try the JAOA, Spine, or maybe even the (god forbid) AAO journal.

So in the end, I am want to address some of the original poster's questions.
1. How will it benefit you or your patients - This depends on the patient's problem and the doctor's knowledge of OMM. There are those that think OMM is just for muscles, and it works great for muscles. There are also those that think OMM can relieve hypertension, endocrine disorders, and variable syndromes like irritable bowel syndrome. If you take time and learn the techniques and the underlying anatomy and physiology, it is probable that you may use OMM to help with these problems. It also helps if you have witnessed patients improve from these afflictions - you will be more likely to use it.
2. When is OMM used - see above, but I will incorporate the next question of "who uses it?" into my answer. Family docs use OMM more than anyone other than OMM specialists and maybe DO PM&R docs. However, specialists, who theoretically, should know a system better than anyone should be more than inclined to use OMM. The problem here is training. Most DO's who are specialists get their last OMM training in their second or third year of medical school, maybe into the fourth year if your curriculum allows. This means that all during their residency, which is probably done in an allopathic program, they will get no experience in OMM. This is a real shame. So you are forced to either rely on something you might have heard once in MS-1 and practiced twice or you can just forget about it and prescribe the pharmaceutical du jour. As a previous poster mentioned, OMM is widely applicable to peds and OBgyn. Read An osteopathic approach to children by Carreiro - wonderful book.

I hope that someone out there in DO or Pre-Do land finds this useful. I have been reading postings on this forum for 2 years or so and have been most disappointed with the degree of discussion regarding Osteopathic manipulation and principles. Since I finally got a little time, I thought I might finally add my two cents (or in this case $3.02) to the forum.

I agree with Texdrake, you will find yourself somewhere on the OMM spectrum. There are DO's in Europe who laugh at us for our weakness in manipulative skills - not that they have it all correct. There are MDs in this country (and I'm sure DO's too) that think all OMM is crap - I know this because I have read it on this forum. Somewhere along the line history will judge our profession's recent decisions. I listened to Norm Gevitz, author of The Do's, give a speech a year ago, during which he described the last generation of DO's. He said that DO's in the 70's, 80's, and 90's have had to forsake much of their OMM in the name of expansion. I would argue this a better alternative than the DO's in California who in the earlier half of the 20th century simply traded in their degree. I hope that soon we'll all be past this feeling of guilt that many of us have when we practice OMM. Osteopathy is embedded in medical society, and now many argue that we are no different than our MD counterparts. I argue that it's time for a renaissance in American Osteopathy. We must ride the wave that our predecessors have created into maistream medicine, but we must now regain our roots in osteopathy while strengthening them with as much evidence as possible. There is no way that OMM can be tested with placebo in a double-blind randomized, controlled study. It just can't be done. We must accept this and find other ways to prove that manipulation can do what we say it does. Remember, we are fighting a battle that many other groups believe is unimportant. There are hundreds of thousands of bodyworkers, rolfers, and accupressurists out there who practice everyday with loyal patients, and they seem only to be expanding. Few of them question if their techniques work. (Spare yourself the time of arguing with me here, I've already heard it.) This is a problem that we have created for ourselves. To whom are we trying to prove that OMM works? I would argue that it is ourselves. But, clinical medicine is now driven by evidence-based medicine published in so-called respectable journals. So, if we want others to follow the "banner of osteopathy" as old A.T. said, we need to dig in and do the work. So, if you're a skeptic, and you're in the DO family, I encourage you to go after that null hypothesis. I don't want to waste mine or anyone else's time, so if you can illustrate that certain beliefs and practices are not useful, by all means do it. What was A.T. Still himself, but a man of science?

My thanks to anyone who managed to make it to the end.🙂

 

[Megalofyia]

I must say thanks to these posts I am far more interested in OMM than I intentionally set out to be. Just shows you what can happen when you learn a little about something.
It looks like a subject I'd definitly want to learn more about so that I can form my own opinion.
Thanks again.

 

[Ohiobuddhist]

Glad to hear it.

 

[texdrake]

Damnit Ohiobuddist, that was outstanding. I think I had a tear in my eye. I am going to get the table out and start "cracking backs" as my uneducated friends say. In fact, I am going to copy and keep that post. Wow.

 

[stoic]

Ok, I'm going to go ahead a play the devil's advocate here. For the record, I'm pre-DO. Anyways, it seems to me that publishing research in AAO, Spine, Etc., really isn't good enough. If OMM is as great as some people claim it to be, the someone somewhere needs to spend the time and money doing a big @$$ study that the AMA, NEJM, Etc., can't ignore. As osteopathic physcians, if the modality provides such benifits to so many patients then practitioners owe it to ALL patients (being treated by MD's and DO's) to do everything in thier power to bring OMM into standard care for every patient. Further, there seems to have been little effort to establish the pathophysiology of somatic dysfuntion. I don't understand why animal models haven't been devoloped to test the basic tennets behind OMM. I'm definately not saying OMM doesn't work (I've got an aunt MD and an who's brother is a DO they're both in family practice and the MD really wishes she could use OMM on low back pain) But this isn't the middle ages anymore, it's really not acceptable to just say that a treatment works due and leave it at that. I feel the same way about a lot of meds on the market. There will always be a place for OMM, but it will never be more accepted until more is understood about what it fixes and how it does it.

That said, I really believe there are more reasons that OMM to go DO. Most of the people I've met who are DO's or pre-DO's seem to be a little more laid back the the MD people (I know... dangerous generalization... please don't kick me). DO's really emphasize the psycho-social model of disease as well as the importance of healthy living and disease prevention. Finally, DO's themeselves seems to be really have a sense of community about the profession.

 

[jkhamlin]

Here is a personal account of how OMM has benefited me and why I would rather be a DO adapted from my post in another thread about choosing DO over MD:

My wife had an injury at work dislocating some ribs causing her to have difficulty breathing. At the emergency room, the lone DO was off that day, and all the MDs there wanted to do was narc her up (with Ativan) and send her home in hopes it would correct itself in a few weeks. If not, they would recommend surgery. We refused such a preposterous treatment, and went to an urgent care which fortunately had two DOs on that day. A DO resident fixed the dislocation in a totally non invasive manner in about 3 minutes. He prescribed Flexeril and a couple of days rest. She recovered quickly, and went back to work. Months later, this same DO resident stitched up a laceration that my daughter received at day care. He could do everything an MD could do and things an MD could not do, and he was only a second year FP resident. Most importantly, he used the most effective and least invasive treatments available with modern medicine, the only difference is which type of doctor those treatments are available to.

 

[Ohiobuddhist]

I will keep this much more brief than my earlier post. To address daveswafford, there have been studies since the early-mid twentieth century performed that help to describe the pathophysiology of somatic dysfunction. I would recommend the collected works of I.M. Korr, the imminent physiologist of osteopathy. The problem with osteopathic research has been and is today that you can only get it at osteopathic institutions. I urge you to try to find any really scientific information about OMM anywhere on line or at your local library. You can get full-text of the AAO journal online and that's about it. Recently, a database has been compiled that allows researchers in osteopathic medicine to look at what others have published as well as what is currently being worked on. But even this is somewhat chunky and doesn't offer text of the articles. Check it out anyway: http://ostmed.hsc.unt.edu/ostmed/index.html

Also, another interesting thing about pathophysiology of disease - any disease. I am in a case-based curriculum, so all I do is spend time reading text and journals. The more you read about a disease, the more you find out that when it comes to the microscopic/biochemical particulars of any disease, be it Somatic dysfunction or sepsis, there are quite often a lot of little holes to be filled in. Robbins path may fill those wholes with one piece of data, while other path books present different theories. But, at some point, we have to admit to ourselves that there is still a lot we don't know about the diseases we think we really do understand.

There was mention of other ways in which DOs are distinct. I urge you all to read the study entitled Do osteopathic physicians differ in patient interaction from allopathic physicians? An empirically derived approach. by Timothy S Carey MD, MPH, et al. It appears in the current issue of the Journal of the American Osteopathic Association. This study could drive osteopathic medicine into the next millenia. Problem: Look where it is published. JAOA. I like JAOA. But I bet only those of us who are DO students or DOs have ever actually seen a copy of this magazine. This study was very well-designed. My only criticism is sample size, which probably could have been larger and might have ensured publication in a larger journal, but who knows. I still hold that politics is politics. If you are interested in DO medicine, find this article: July 2000, VOL 103 N.7. To my knowledge, you can't get it online anywhere - big suprise.

Just a side note. I am doing research on OMM, and we have recently had an MD PM&R specialist come to our facility to consult on some techniques (not OMM). He has been most impressed with what we have shown him and stated that he wishes the DOs he worked with still did manipulation. DOs in PM&R who don't do OMM - can you believe it. What do they do? The MD really wants to learn the OMM. So a message to my DO student colleagues - don't waste a perfectly good opportunity that some people will never have, just because you think something is dumb, or needs more research. Learn the damn technique, then research it. I think we have the cart before the horse at a lot of institutions.

Well, I had hoped this response would be shorter. I guess this is what happens when they give me a minute to breathe away from my books.

 

[Runtita]

Ohiobuddhist,

I wanna be just like you when I grow up!

-hee!