OMM: Are you supposed to actually be able to feel stuff?

garrettp

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Despite now being a 2nd year DO student, I still have to make up all my somatic dysfunction findings. When an instructor asks me if I feel something subtle during lab, I just say yes, even though I can't actually feel anything. I can't feel the "texture of fascia" or the "release of tissue" or the "cranial rhythmic impulse." God knows I've tried. Also, the findings of my motion tests seem to all be dictated by whether I'm using my stronger arm or weaker arm, and I can never feel subtle bone movements underneath muscles and ligaments.

Even though I've been making up all of my diagnoses, whenever faculty members re-check them during labs or practical exams, they always say that I'm correct. This sometimes makes me wonder if I'm actually supposed to feel anything, or if this is all like just an elaborate psychological game that I'm oblivious to. My diagnoses are all just random or pre-prepared for convenience, and yet I've somehow had a 100% accuracy rate over the course of a gazillion labs and six practicals.

OMM is taken very seriously at my school, and it would be taboo to talk openly about my experience with my classmates. I honestly feel ashamed about my situation. I try to be an honest person with integrity in my daily life, and I don't think it's ethical to just "fake it 'til I make it." Unfortunately, my alternative to lying would probably be failing OMM and flunking out of med school. I sometimes feel like I'm living a lie and that I don't truly belong at a DO school, even though I've been having no trouble with any class besides OMM.

When you're doing OMM, are you supposed to accurately feel and assess most of the things they're talking about? When the faculty members carefully re-check and then accept all of my made-up diagnoses, are they playing a psychological game with me or are they being swayed by confirmation bias? If palpatory skills are supposed to become super effective and precise with practice, why are DOs with OMM/NMM fellowship training and decades of experience not immediately catching my BS? Am I out of the loop on something?
 
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Osteosaur

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I have never felt a thing. Especially not CRI.

'Tissue texture' you should be able to feel, but you're probably just overthinking it. Remember you're working on people who are already 'healthy'. Doing muscle energy (which is really just stretching) on an actually tight neck is another matter...
 
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drducky.

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Dont think we’re actually supposed to feel anything. Our faculty don’t even check if we found the correct diagnosis, just gotta go thru the motions.
 
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garrettp

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I have never felt a thing. Especially not CRI.

'Tissue texture' you should be able to feel, but you're probably just overthinking it. Remember you're working on people who are already 'healthy'. Doing muscle energy (which is really just stretching) on an actually tight neck is another matter...

So did you just "fake it 'til you made it" for the things you didn't feel? Is that a common experience? If most of my classmates are giving off a facade and are actually doing the same thing I'm doing, I'd feel a little bit better... though I still wish it wouldn't have to be this way.

The "tissue texture" point is definitely a good one. But it also sort of brings up the question... if med students are a generally healthy population, how are the faculty members able to discover dysfunctions worth treating in literally every structure they happen to look? And how would the students be expected to find somatic dysfunctions everywhere? Are we looking for what isn't actually there so that we'd be ready to find real dysfunctions on "unhealthy" patients, and it's all just hushed pretending? I feel like I'm missing something fundamental in this equation.
 

garrettp

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Dont think we’re actually supposed to feel anything. Our faculty don’t even check if we found the correct diagnosis, just gotta go thru the motions.

Thanks for the reply. Your faculty members let you fully perform a treatment on somebody for a diagnosis that they haven't re-checked? Ours have a policy where they have to re-check before we can treat what was found, to make sure that the treatment is necessary.

"Going through the motions" is pretty much exactly what I've been doing. I've been pulling and pushing and squeezing and poking in the right general locations on the body, but I'm not able to do much beyond that. Obviously, I can feel basic landmarks and big bones (like the scapula, ASIS, etc.), but that's about it. It just feels wrong to constantly lie about what I'm sensing when I'm palpating, and it feels extremely weird to have long-time faculty members re-check my diagnoses and confirm all of my made-up conclusions.
 
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Ho0v-man

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I mean you should be able to tell NSrRl L1-3 or something. Or just generally tight muscles because that’s real.

Beyond that? Nope. On one practical I “found” a cervical tenderpoint and set up the treatment the wrong way. The proctor started to grill me on it so I just said it was a maverick point. They then palpated and agreed with me lol. It’s dumb.
 
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MedDoc305

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Despite now being a 2nd year DO student, I still have to make up all my somatic dysfunction findings. When an instructor asks me if I feel something subtle during lab, I just say yes, even though I can't actually feel anything. I can't feel the "texture of fascia" or the "release of tissue" or the "cranial rhythmic impulse." God knows I've tried. Also, the findings of my motion tests seem to all be dictated by whether I'm using my stronger arm or weaker arm, and I can never feel subtle bone movements underneath muscles and ligaments.

Even though I've been making up all of my diagnoses, whenever faculty members re-check them during labs or practical exams, they always say that I'm correct. This sometimes makes me wonder if I'm actually supposed to feel anything, or if this is all like just an elaborate psychological game that I'm oblivious to. My diagnoses are all just random or pre-prepared for convenience, and yet I've somehow had a 100% accuracy rate over the course of a gazillion labs and six practicals.

OMM is taken very seriously at my school, and it would be taboo to talk openly about my experience with my classmates. I honestly feel ashamed about my situation. I try to be an honest person with integrity in my daily life, and I don't think it's ethical to just "fake it 'til I make it." Unfortunately, my alternative to lying would probably be failing OMM and flunking out of med school. I sometimes feel like I'm living a lie and that I don't truly belong at a DO school, even though I've been having no trouble with any class besides OMM.

When you're doing OMM, are you supposed to accurately feel and assess most of the things they're talking about? When the faculty members carefully re-check and then accept all of my made-up diagnoses, are they playing a psychological game with me or are they being swayed by confirmation bias? If palpatory skills are supposed to become super effective and precise with practice, why are DOs with OMM/NMM fellowship training and decades of experience not immediately catching my BS? Am I out of the loop on something?
This actually makes me feel good to read. I'm a first-year, a couple of months into my OMM and I have not been able to feel a thing. First practical today and I am winging it.
 
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deleted1005514

Correct diagnosis is only worth one point on our checkouts and practicals...they care more about whether you’re in the right area using the right words and being confident. Plus you’re working on healthy 20-somethings, what do they expect you to find?

I asked a third year rotating in our class a question last week and he couldn’t answer it, if that makes you feel any better.
 

Osteosaur

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So did you just "fake it 'til you made it" for the things you didn't feel? Is that a common experience? If most of my classmates are giving off a facade and are actually doing the same thing I'm doing, I'd feel a little bit better... though I still wish it wouldn't have to be this way.

The "tissue texture" point is definitely a good one. But it also sort of brings up the question... if med students are a generally healthy population, how are the faculty members able to discover dysfunctions worth treating in literally every structure they happen to look? And how would the students be expected to find somatic dysfunctions everywhere? Are we looking for what isn't actually there so that we'd be ready to find real dysfunctions on "unhealthy" patients, and it's all just hushed pretending? I feel like I'm missing something fundamental in this equation.

yes. just go through the motions.

you're in medical school to learn medicine, don't stress over this.
 
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DO2015CA

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Correct diagnosis is only worth one point on our checkouts and practicals...they care more about whether you’re in the right area using the right words and being confident. Plus you’re working on healthy 20-somethings, what do they expect you to find?

I asked a third year rotating in our class a question last week and he couldn’t answer it, if that makes you feel any better.

3rd years are so inundated learning actual medicine that OMM knowledge slips out of your brain until you study for level 2 again. Rinse and repeat for lvl 3
 
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deleted1005514

3rd years are so inundated learning actual medicine that OMM knowledge slips out of your brain until you study for level 2 again. Rinse and repeat for lvl 3

That makes the look he gave me when I asked a question about Fryette’s make so much sense. It was an “oh crap, they expect me to know stuff!” look, lol. I totally get having knowledge squeezed out to make room for other stuff though.
 

iforget2

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I definitely felt the same way my 2nd year. To help with your faking, look up which dysfunctions for cranial/lumbar/lower extremety/etc is the most common or which ones are physiologic vs. pathologic. This way the diagnoses you conjure up are much more believable.
 
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Despite now being a 2nd year DO student, I still have to make up all my somatic dysfunction findings. When an instructor asks me if I feel something subtle during lab, I just say yes, even though I can't actually feel anything. I can't feel the "texture of fascia" or the "release of tissue" or the "cranial rhythmic impulse." God knows I've tried. Also, the findings of my motion tests seem to all be dictated by whether I'm using my stronger arm or weaker arm, and I can never feel subtle bone movements underneath muscles and ligaments.

Even though I've been making up all of my diagnoses, whenever faculty members re-check them during labs or practical exams, they always say that I'm correct. This sometimes makes me wonder if I'm actually supposed to feel anything, or if this is all like just an elaborate psychological game that I'm oblivious to. My diagnoses are all just random or pre-prepared for convenience, and yet I've somehow had a 100% accuracy rate over the course of a gazillion labs and six practicals.

OMM is taken very seriously at my school, and it would be taboo to talk openly about my experience with my classmates. I honestly feel ashamed about my situation. I try to be an honest person with integrity in my daily life, and I don't think it's ethical to just "fake it 'til I make it." Unfortunately, my alternative to lying would probably be failing OMM and flunking out of med school. I sometimes feel like I'm living a lie and that I don't truly belong at a DO school, even though I've been having no trouble with any class besides OMM.

When you're doing OMM, are you supposed to accurately feel and assess most of the things they're talking about? When the faculty members carefully re-check and then accept all of my made-up diagnoses, are they playing a psychological game with me or are they being swayed by confirmation bias? If palpatory skills are supposed to become super effective and precise with practice, why are DOs with OMM/NMM fellowship training and decades of experience not immediately catching my BS? Am I out of the loop on something?
If you have a sense of touch, you should be able to feel things that are actually there.

But unfortunately, I fear the True Believers are prone to tactile delusions.
 
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PapaGuava

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I feel like by the time every DO student reaches 2nd year or beyond, the explanation of OMM always begins like this (especially to first years) -

1600219062901.png
 
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Sardonix

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I feel like by the time every DO student reaches 2nd year or beyond, the explanation of OMM always begins like this (especially to first years) -

View attachment 318408

Was gonna say something witty, but the thread has peaked with this. That is 100% a mental image of me preparing to explain OMM to a colleague.
 
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calivianya

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I’ve always been pretty confident in my diagnoses.... except cranial. I can’t feel a thing. Totally doesn’t exist.

I feel like some people can’t feel things because they try too hard. I have a classmate I used to practice with who would really twist my arm significantly trying to test pronation/supination, really dig her thumbs into my back to test my lumbars/thoracics etc., and she always said she never felt anything. I sure as hell couldn’t relax because of the pressure she was adding, so I’m not surprised she didn’t feel anything.

I’m not saying that’s you for sure, but if the dysfunction is there, you really shouldn’t have to apply significant pressure to find it unless your partner is obese and the structure you’re looking for is below several thick layers of tissue.
 
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Angus Avagadro

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To OP, yes you should be starting to feel things. Practicing is essential between labs to develop your palpatory skills. I would bust the fake it till you make it types. They make up a diagnosis and memorize the treatment. I don't have a huge problem with this, they at least learned something. I would just give them a much different diagnosis and treatment to perform. The ones who study didnt have a problem, but the fake it types would crash and burn. But as many posters have noted, many instructors are happy you can regurgitate a diagnosis and demonstrate a correct treatment. Ask for some help, practice between labs, examine friends and family, and you will get better. Good luck and best wishes!
 
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elphie236

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Despite now being a 2nd year DO student, I still have to make up all my somatic dysfunction findings. When an instructor asks me if I feel something subtle during lab, I just say yes, even though I can't actually feel anything. I can't feel the "texture of fascia" or the "release of tissue" or the "cranial rhythmic impulse." God knows I've tried. Also, the findings of my motion tests seem to all be dictated by whether I'm using my stronger arm or weaker arm, and I can never feel subtle bone movements underneath muscles and ligaments.

Even though I've been making up all of my diagnoses, whenever faculty members re-check them during labs or practical exams, they always say that I'm correct. This sometimes makes me wonder if I'm actually supposed to feel anything, or if this is all like just an elaborate psychological game that I'm oblivious to. My diagnoses are all just random or pre-prepared for convenience, and yet I've somehow had a 100% accuracy rate over the course of a gazillion labs and six practicals.

OMM is taken very seriously at my school, and it would be taboo to talk openly about my experience with my classmates. I honestly feel ashamed about my situation. I try to be an honest person with integrity in my daily life, and I don't think it's ethical to just "fake it 'til I make it." Unfortunately, my alternative to lying would probably be failing OMM and flunking out of med school. I sometimes feel like I'm living a lie and that I don't truly belong at a DO school, even though I've been having no trouble with any class besides OMM.

When you're doing OMM, are you supposed to accurately feel and assess most of the things they're talking about? When the faculty members carefully re-check and then accept all of my made-up diagnoses, are they playing a psychological game with me or are they being swayed by confirmation bias? If palpatory skills are supposed to become super effective and precise with practice, why are DOs with OMM/NMM fellowship training and decades of experience not immediately catching my BS? Am I out of the loop on something?

with the exception of cranial movement you should actually feel the changes in the tissue. You actually do notice T6 FRrSr. It’s v subtle so the harder you look for something obvious the harder time you’ll have. Look for the position of your fingers. Is one of your thumb just slightly more posterior than then other one?Practice enough you’ll notice the difference even if you’re practicing on healthy med student. Most of us are mess up whether we realize it or not. Especially by the time you get to 2nd year lol. Now some of my classmates never get to that point and that’s ok. Just memorize the concepts and set up for your exams. You’ll make it through.

From an OMS-IV
 

Firkin

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if med students are a generally healthy population, how are the faculty members able to discover dysfunctions worth treating in literally every structure they happen to look?

BINGO! Yes, our faculty ALWAYS find a dysfunction in the specific area that allows them to teach the day's topic. Without fail. And sometimes they find the opposite dysfunction (i.e. T7 is now suddenly rotated left when 5 minutes ago it was supposedly rotated right) on the same student "patient" later in the same session, because even they can't keep track of all the things they supposedly found. So if you don't find something that allows you to demonstrate the skill being taught, just fake it. If you do happen to find something, then go with that. And don't feel guilty or like a fraud. This is a game that has been going on for years, and unfortunately it's a game that you are being forced to play to get to where you want to be. Don't feel a moment of guilt over this
 
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Cornfed101

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I think the thoracic and innominate dysfunctions are fairly easy to feel even on healthy people. Everyone has messed up hips.
 
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I don't feel anything either but whatever. I just go through the motions. Testing on healthy people seems pointless and without an actual sick person to be able to compare and contrast, it all seems like guess work to me. I make my diagnosis and suddenly the teachers agrees as well. My partner does the same exact thing. COVID has made things even worse as we have halved our OMM labs and are expected to learn by videos. Whatever.
 

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>90% of DOs never do OMM again post-graduation. Spending time trying to learn something that's fake and not evidence based is a detriment to your medical education. Learn enough to pass the exams and spend the rest of your time learning actual medicine so you can better care for real patients in your future practice.
 
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Firkin

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The more generous way to think of your faculty always finding a dysfunction on a healthy student is: they are modeling for you how you need to perform when you do your in-person Performance Evaluation to demonstrate your physical exam/OMT skills. You will be demonstrating on model patients so it does involve pretending. Pretending now helps you to prepare for when you need to pretend on that exam.
 
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bigindian4891

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The people in our class who had the most trouble with OMM the first two years thought it was all fake/didnt even try to learn it/didnt care/I should have gone to an MD school. These students then had to spend extra time before exams and boards to relearn the material over and over again.

I feel like if you are trying to learn it, that should be good enough. Even if you dont feel ANYTHING, at least understand the concepts the first time. Sure, cranial is very fishy, but my attending in the outpatient office let me do all the back pain workups based on my knowledge of msk, which came directly from OMM. I try to stress this to the younger students. The people who outright refuse to learn it struggle the most.
 
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Scrubb

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No. The inter-rater and intra-rater reliability are both very poor. Ever asked multiple faculty about the same dysfunction and they give you exact opposite findings? Or you just make up a segmental diagnosis and they magically agree with you. Yeah...

Don’t trouble yourself over OMM. Just memorize the mnemonics and whatnot and move on.
 
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If you can't feel the pulsation of blood rushing back to the counterstrain tender point on a student partner who has nothing wrong with them after you held them in the position of ease for 90 seconds, then you are not a bone wizard. Pack your bags, and move on.
 

Prehealth1011

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My favorite was Cranial. You and your partner taking turns to nap while pretending to feel the CRI.

We don't need wellness lectures. Nap time is built into our curriculum.
 
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FutureDoctor5000

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NOBODY cares about omm, unless your one of the 1% of DO’s that do an omm residency or are stuck at a osteopathic recognition site/residency. It doesn’t really even exist for the outside world. I tried to explain it to patient and he straight up told me that’s fake “chiropractor stuff”.and tbh I couldn’t agree with him more. We are physicians and if patients wanted omm they can just go to chiropractors. Don’t do it/talk about unless as mentioned your in a omm clinic/residency.
 
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DO2015CA

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NOBODY cares about omm, unless your one of the 1% of DO’s that do an omm residency or are stuck at a osteopathic recognition site/residency. It doesn’t really even exist for the outside world. I tried to explain it to patient and he straight up told me that’s fake “chiropractor stuff”.and tbh I couldn’t agree with him more. We are physicians and if patients wanted omm they can just go to chiropractors. Don’t do it/talk about unless as mentioned your in a omm clinic/residency.

lol @fake chiropractic as if chiro itself isn’t fake too
 
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Deecee2DO

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OP, I'm a former licensed chiro and an M3 so my "hands", so to speak, are pretty good when it comes to manual medicine so trust me on this. To answer your question-no matter what your osteopathic OMM wizard instructors tell you you can't and will never feel a thing lol. Its all BS
 
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