OMM in Neurology

[c5212]

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Is OMM used by DO's in neurology/pain mgmt? If so, how frequently and (sorry for my ignorance) what does it do?

 

[JaggerPlate]

Is OMM used by DO's in neurology/pain mgmt? If so, how frequently and (sorry for my ignorance) what does it do?

Pain management and Neurology are two different fields. Most people in Pain Management do a residency in PM&R or Anes and then a fellowship in Pain Mgmt. I don't know if many people (or if you even can) go Neuro -> Pain Mgmt. I know PM&R is one of the most 'DO friendly' specialties out there, with many dual accredited residencies, OMM being taught in ACGME residencies, and even the chair of PM&R at Harvard is a DO. I've personally haven't heard a lot about OMM in Neurology ... my guess is that it doesn't get used a lot.

 

[wasvsdal]

How the eff do u expect a neurologist to MANIPULATE a damn nerve? Unbelievable! Let me predict your next question: Can I get a colonscopy from a cow in my farm?

haha jk jk...sike i honestly dont even know what OMM is. just a good ole troll, trollin around.

 

[chartero]

I think the OP asks an entirely reasonable question. Pain Medicine is also a recognized subspecialty of neurology, and psychiatry. Neuromuscular Medicine, also, is an ABMS subspecialty of both neurology and PM&R. Neuromusculoskeletal Medicine and Osteopathic Manipulative Medicine, an AOBMS specialty, is entirely separate, but the potential common ground seems obvious. (ABMS Specialties and Subspecialties; AOBMS Specialties and Subspecialties.)

Resources for further inquiry could include the American Academy of Osteopathy, neurology, neuroscience and NMM/OMM faculty in COMs, osteopathic residencies in neurology, PM&R and NMM/OMM, and literature searches.

 

[bleeker10]

Is OMM used by DO's in neurology/pain mgmt? If so, how frequently and (sorry for my ignorance) what does it do?

From a powerpoint in my OPP class, there isn't a single specialty where OMM can't be utilized to some point. Now that is completely debatable but there are a lot of things you can do with OMM in any practice. I would imagine with Neurology you could do things like suboccipital release, cervical traction, etc. Anything that manipulates the vertebrae, especially the cervical region would be beneficial to the patient. Can you use it for a stroke victim? I'm not sure but I don't see how there could be a lot of benefit to them. My advisor is a DO neurologist so the next time I see her I will ask her for you

 

[Bacchus]

True. Our DO pathologist said he doesn't use OMM but could to break up some rigor mortis.

 

[Bacchus]

OMM on the neural system can be done. By manipulating the muscular system you are directly affecting nerves and other associated factors. OMM on a neck could help alleviate herniation pain and thus help mobility, strength, etc. because the herniation would have otherwise been impeding the nerve.

 

[Ibn Rushd]

For what it's worth, I've shadowed an osteopathic neurologist and he never uses OMM.

 

[Kramerica]

Is OMM used by DO's in neurology/pain mgmt? If so, how frequently and (sorry for my ignorance) what does it do?

Here's what I found:
"Cranial Osteopathy – Inside the skull or cranium there is a covering over the brain, the dura, that continues down inside the spine to the tailbone or sacrum, protecting and supporting the central nervous system. This central nervous system controls the functioning of every organ, muscle and nerve in the body. Cranial Osteopathy is a systematic approach to patient diagnosis and treatment utilizing the body’s inherent third wave pulse, emanating from the central nervous system and the fluctuation of the cerebrospinal fluid. This is called the Cranial Rhythmic Impulse (CRI). This gentle, manual technique utilizes the CRI to treat the whole person, emphasizing the head and spinal regions."

 

[chartero]

There are a number of threads on cranial osteopathy (or just "cranial," or "craniosacral" therapy) archived on SDN; it's controversial, and just a subset of osteopathic tradition an OMM practitioner may or may not use.

 

[Rogue Synapse]

I've worked with a few DO neurologists and never seen OMM used or even talked about. However, it is often an integral part of PM&R, a very close cousin of neurology. There is very little/no literature on CRI being used for neurological therapy (or any other therapy for that matter). It would be interesting to see some well-controlled studies; it seems like an interesting methodology. Maybe one of you will publish the definitive study some day!

 

[Rogue Synapse]

OMM on the neural system can be done. By manipulating the muscular system you are directly affecting nerves and other associated factors. OMM on a neck could help alleviate herniation pain and thus help mobility, strength, etc. because the herniation would have otherwise been impeding the nerve.

Agree. Neurology includes the nervous system and muscles. If you have a myopathy or dystrophy, you go to a neurologist. So to the extent that OMM benefits muscles, it doesn't even need to include the nerve to fall into the field of neurology.

 

[futIDdoc]

There are a number of threads on cranial osteopathy (or just "cranial," or "craniosacral" therapy) archived on SDN; it's controversial, and just a subset of osteopathic tradition an OMM practitioner may or may not use.

Controversial in not really the word that should be used here. More like debunked, or hooey, or my favorite hogwash.

 

[jjmad1201]

Pain management and Neurology are two different fields. Most people in Pain Management do a residency in PM&R or Anes and then a fellowship in Pain Mgmt. I don't know if many people (or if you even can) go Neuro -> Pain Mgmt. I know PM&R is one of the most 'DO friendly' specialties out there, with many dual accredited residencies, OMM being taught in ACGME residencies, and even the chair of PM&R at Harvard is a DO. I've personally haven't heard a lot about OMM in Neurology ... my guess is that it doesn't get used a lot.

you can go into pain management from pm&r, anes, neuro and psy

 

[chartero]

It's rare but also possible to do pain fellowships from other primary specialties. On the Pain Medicine forum you can read about a pain fellowship based in the department of family medicine at John Peter Smith in Fort Worth; for PCPs the premise seems to be that it would almost always build on training in Sports Medicine.

 

[Back2School4DO]

I am a chiropractor that works in an office with a neurology diplomate. Having always been fascinated with the field, I plan to pursue a career as a neurologist. Within the past few years, a number of studies have been published investigating the neurophysiological effects of spinal manipulation. I was actually a subject in one while in chiro school that utilized H reflexes and F waves as variables pre and post lumbar manipulation. This particular study found that a temporary inhibition of alpha motoneuron excitablility was exhibited.

Another study utilized somatosensory evoked potentials to investigate any cortical response to the manipulation. The study found that the primary effect was inhibitory with cervical manipulation. This may offer some explanation as to why spinal manipulation is therapeutic to many chronic pain patients. (Yet another study found certain areas of the brain to be consistently hyperactive in chronic pain patients)

I actually designed a study while in chiro school that would utilize fMRI to objectively measure changes in cortical activity pre and post manipulation. Unfortunately a grant was not awarded. Maybe I'll have better luck as a D.O. neurologist.

With these and other studies in mind, I believe that D.O. neurologists that do not apply spinal manipulation as part of their treatment repertoires are not using every tool they have. I personally plan to keep spinal manipulation in my bag of tricks, and hopefully as the research progresses, more will do the same.

 

[Bacchus]

I am a chiropractor that works in an office with a neurology diplomate. Having always been fascinated with the field, I plan to pursue a career as a neurologist. Within the past few years, a number of studies have been published investigating the neurophysiological effects of spinal manipulation. I was actually a subject in one while in chiro school that utilized H reflexes and F waves as variables pre and post lumbar manipulation. This particular study found that a temporary inhibition of alpha motoneuron excitablility was exhibited.

Another study utilized somatosensory evoked potentials to investigate any cortical response to the manipulation. The study found that the primary effect was inhibitory with cervical manipulation. This may offer some explanation as to why spinal manipulation is therapeutic to many chronic pain patients. (Yet another study found certain areas of the brain to be consistently hyperactive in chronic pain patients)

I actually designed a study while in chiro school that would utilize fMRI to objectively measure changes in cortical activity pre and post manipulation. Unfortunately a grant was not awarded. Maybe I'll have better luck as a D.O. neurologist.

With these and other studies in mind, I believe that D.O. neurologists that do not apply spinal manipulation as part of their treatment repertoires are not using every tool they have. I personally plan to keep spinal manipulation in my bag of tricks, and hopefully as the research progresses, more will do the same.

Do you think its going to be hard to get rid of the DC mindset and adopt OMM?

 

[Back2School4DO]

Do you think its going to be hard to get rid of the DC mindset and adopt OMM?

Sorry for the delayed reply. Haven't been home much.

If you are referring to the philosophical "subluxation" state of mind, I couldn't accept it from the beginning. There were many "principles" we were forced to memorize that were just silly and have been disproven by current research.🙄

Spinal manipulation is what it is regardless of who performs it. It works very well when performed with skill, and the research is beginning to show this. How it works is more complicated than previously thought, and no profession at the moment has the complete answer. As a result, chiropractic is trying to adopt an evidence based mindset, much to the chagrin of the old school subluxation based chiros. Who knows if the profession will ever get out of the dark ages completely.

Regardless of what osteopathic school tries to teach me about spinal manipulation, I will take it with a grain of salt. My life has revolved around how to manipulate the spine in various creative ways for the past few years, so I doubt what they say will be groundbreaking. I let research be my guide as to when and how to utilize it, and I suggest you do to. If you are not already familiar with it, add Pubmed to your favorites and use it often. It certainly kept my head in the right place during school, and will help you too.

 

[facetguy]

Do you think its going to be hard to get rid of the DC mindset and adopt OMM?

What does that mean?

 

[scummie]

I've seen OMM used for treating a concussion before. The DO apparently had been treating the patient for this over several visits, but I wasn't exactly sure what she was doing.

 

[Lokhtar]

I've seen OMM used for treating a concussion before. The DO apparently had been treating the patient for this over several visits, but I wasn't exactly sure what she was doing.

How the hell do you 'treat' a concussion? You hit your head, some braincells die....not much you can do about that.

Do you mean the headache/sleep problems/etc you might get from a concussion? If she was massaging his head, I'd venture a masseuse would be a better person to do that and her time might be better spent elsewhere....

 

[Bacchus]

What does that mean?

If you mutter chiropractor at my school, the OMM faculty will gut you. There is distinct differences and the approach to treatment between the two is different.

Just going off what I've soaked in.

 

[facetguy]

If you mutter chiropractor at my school, the OMM faculty will gut you. There is distinct differences and the approach to treatment between the two is different.

Just going off what I've soaked in.

DOs refer me patients regularly, so my experience has been different. Don't buy into the whole "chiropractors kill people" myth that still apparently gets perpetuated even among academics. Even if you end up not doing much manual therapy yourself, having a trusted DC to refer to will prove helpful to you and your patients.

 

[Back2School4DO]

It sounds like your OMM faculty has not let go of the old school mindset. Evidence based manual practitioners use their hands to achieve similar goals, regardless of the profession (DC, DO, PT). The traditional approaches were different, but few of the original theories postulated by D.D. and A.T. have been supported by research. It's not their fault. They were just working with what they had at the time.

It annoys me when doctors continue to quote theories by the founders, and neglect the current work being published in JMPT and Chiro and Osteo. While in school, we had some guest speakers that claimed "subluxations" were the underlying cause of all serious disease.

Your faculty probably thinks that all chiros still believe that crap. The fact is, a majority of newly licensed chiros understand their limitations, and focus on how to use their hands to alleviate pain and dysfunction.

I'm with facetguy. There is a good chance that I will get too busy to provide the manual care that I can now. When this happens, I will co-manage with a reputable chiro due to my understanding of the benefits of those therapies. Sure I will take care of the simple segmental dysfunctions, but more involved cases will be co-managed.

Don't let old school thinking cloud your logic. I understand that you're not in the field yet, but you will find that a good chiro (or other skilled practitioner of spinal manipulation) is a wonderful ally to have in the future.