OMM exposure and PM&R

[bbbmd]

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Ive met many DO's-to-be that have interviewed or have rotated thru my program. From speaking with them, I am impressed by the # of applicants there are from the DO schools this year. I know that OMM exposure varies from program to program. This question is for the current residents around the nation--> How does your program incorporate OMM training/exposure into your residency program? OMM is not currently part of the core competencies (to my knowledge, correct me if I am wrong), but definitely an integral part of musculoskeletal medicine and "Physical Medicine" in general. How are your programs getting M.D.'s up to par with the basic principles without having any exposure to it in the past? Are the MD's open to learning these principles (I would assume so)? This is just out of curiosity as I see a great influx of DOs into the specialty. I'd like to hear some discussion on this from both DO's and MD's as this trend will probably influence the future of our specialty.

 

[Finally M3]

One of the faculty at UM is an allopath who pursued OMM training. You get outpatient experience/exposure with him. Also, there is a weekend seminar/training session re OMM that he runs for the residents.

At the very least, as an allopath, I would be interested in exposure/familiarization...

 

[drusso]

You likely get exposure in OMM in your residency from fellow residents, attendings, or therapists. There are also many continuing educational courses in manual medicine.

--DR

 

[paz5559]

Ive met many DO's-to-be that have interviewed or have rotated thru my program. From speaking with them, I am impressed by the # of applicants there are from the DO schools this year. I know that OMM exposure varies from program to program. This question is for the current residents around the nation--> How does your program incorporate OMM training/exposure into your residency program? OMM is not currently part of the core competencies (to my knowledge, correct me if I am wrong), but definitely an integral part of musculoskeletal medicine and "Physical Medicine" in general. How are your programs getting M.D.'s up to par with the basic principles without having any exposure to it in the past? Are the MD's open to learning these principles (I would assume so)? This is just out of curiosity as I see a great influx of DOs into the specialty. I'd like to hear some discussion on this from both DO's and MD's as this trend will probably influence the future of our specialty.

I mean no disrespect, and I ask this in the most respectful of tones, but let me suggest that the appropriate tangential issue, given the continued influx and influence of a large number of DO's into the field of PM&R, is SHOULD OMM be taught, should it be an integral part of our training, and should it be one of the core competencies, or should that be left to the DO's to pursue?

The problem lies in the paucity of evidence-based medicine. Given a typically stated placebo effect of 35-40% in most low-back modalities, "it works in my experience" without any further statistical investigation consigns the techniques to the speculative group that includes prolotherapy and craniosacral therapy - some theoretical basis, but as of yet, unproven.

On the other hand, its use in areas outside of the neuromuscular area (ie. otitis media, hypertension, Parkinson's disease, CHF) consigns it to the domain of Chiropractors who tout their "spinal hygiene and wellness" programs that claim to impact generalized immune and endocrine function, and thus place the entire enterprise into the realm of charlatans and true believers

 

[bbbmd]

Ok, so I took the SAE and there was a few questions that had an OMM tone. Im an MD so I dont know if "muscle energy" is OMM or not (I know what it is but do not know if that is in the realm of OMM or PT). Im interested in learning more, at least to be confident with the indications for manipulation (even with a lack of HARD science evidence) so that I can identify and refer out if needed. We are having an OMM workshop at my program in a week and I was not sure how to use this info in my practice as an MD in the future. After the SAE, I think that what I learn at the workshop may actually help me out on the BOARDS and future SAEs.

 

[PTOSIS]

muscle energy is indeed OMM, and in my opinion (i am an MSII) the best OMM modality there is.

 

[DigableCat]

Ok, so I took the SAE and there was a few questions that had an OMM tone.

I noticed that too...a little unfair if you ask me.😡 Not everyone gets exposure to DO techniques and if I miss out on getting the Elkins Award this year because of that I'm gonna be hella pi$$ed. 😉

 

[DOctorJay]

I noticed that too...a little unfair if you ask me.😡 Not everyone gets exposure to DO techniques and if I miss out on getting the Elkins Award this year because of that I'm gonna be hella pi$$ed. 😉

pick up the green OMM review book. it'll give you the basics of all the techniques and some understanding of OMM. you won't get any hands on skills from it obviously but I'm sure it'll help with some of the questions.

-J

 

[drusso]

I mean no disrespect, and I ask this in the most respectful of tones, but let me suggest that the appropriate tangential issue, given the continued influx and influence of a large number of DO's into the field of PM&R, is SHOULD OMM be taught, should it be an integral part of our training, and should it be one of the core competencies, or should that be left to the DO's to pursue?

The problem lies in the paucity of evidence-based medicine. Given a typically stated placebo effect of 35-40% in most low-back modalities, "it works in my experience" without any further statistical investigation consigns the techniques to the speculative group that includes prolotherapy and craniosacral therapy - some theoretical basis, but as of yet, unproven.

On the other hand, its use in areas outside of the neuromuscular area (ie. otitis media, hypertension, Parkinson's disease, CHF) consigns it to the domain of Chiropractors who tout their "spinal hygiene and wellness" programs that claim to impact generalized immune and endocrine function, and thus place the entire enterprise into the realm of charlatans and true believers

I think that the thing to keep in mind is that essentially all of the common manual medicine techniques used by PT's (strain/counter-strain; muscle energy; etc) were developed within the osteopathic profession. As physiatrists, it's helpful to know the lingo and how these techniques are used in order to make a more comprehensive physical therapy prescription.

Since many patients independently seek chiropractic care and many are actually REFERRED by primary care physician for chiropractic manipulation, as non-operative musculoskeletal specialists, I think that it's important that physiatrists know when spinal manipulation may be useful (acute, uncomplicated low back pain in the abscence of radicular features), for how long (less than 12 visits max), and when manipulation is *CONTRAINDICATED.*

As for the shadey behavior and questionable practices of some chiropractors, well that's a whole separate discussion. I do find it amusing that there is fairly compelling historical evidence that Daniel Palmer was an osteopathic "drop-out" from Kirksville and set up his own school just across the border in Davenport. Hmmm...

 

[drvlad2004]

I found that throughout my interviews, the programs that was bent heavily towards musculoskeletal medicine would try to integrate OMM in their curriculum. At NUMC, they have OMM lectures and clinic incorporated into the training along with an OMM specialist on staff. UVa might be another program that incorporates some OMM. The larger and more inpatient-based programs seemed to steer clear of OMM such as NYU and Cornell-Columbia. Altogether, the incorporation of OMM into PM&R training is dependent on the residents. As a DO, you need to bring your OMM knowledge and skills into your training program and help teach others as well. For instance, a recent grad at Boston U. brought her OMM skills with her and has continued to teach fellow residents and faculty on how they can use OMM into practice.