omm internship

[applicant2002]

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I have a question about doing an omm fellowship. I don't know if fellowship is the right word. i'm not talking about where you do it in between your second and third year, I mean if you want to do it after you graduate.

so for example, if you do an osteopathic rotating internship, is there a fellowship in omm that you can do for one year--then go on to do the residency that you want to do (e.g family medicine or peds)?

the only reason that i've been thinking about this is because i would like to learn omm and then related it to my field during training.

so much of OMT is not about manipulating the spine, but about the sympathetic nervous system, muscles, and cranial. there is so much potential for application besides low back pain.

🙂 😀 😀 🙂

 

[DOSouthpaw]

yes, the Academy has a +1 program. You just tack it on the end of your regular residency. I don't know if you can tack it on the front of one or not. Whatever you do, make sure you put your hands on everyone of your patients during your internship and residency.

 

[minime]

Once you get into school and take part in OMT lab, you'll probably give the fellowship idea up.
I was gung ho about OMT and then I saw that the majority of what we are taught goes against basic logic and is really a bunch of quackery.

 

[DOSouthpaw]

It's probably because you aren't any good at it. If I couldn't manipulate worth a crap, it wouldn't work for me either. All the people in my class that think it's a bunch of crap do it as a defence mechanism to make up for lack of skill/practice etc...
We don't do this because it's easy, we do it because it makes the patient better, and puts us a step ahead of the MD's. The difference between a DO and a MD is that MD's use three fingers and we use ten. 😉

 

[bones]

hey all,
I gotta defend the OMM fellowship (since I'm a future fellow). I think that several of the schools teach OMM in a way that is less than ideal, but if you shadow docs that use primarily OMM you will quickly see what it does for patients. This experience is why I want to do it. Do try to keep an open mind until you see what a skilled OMM practicioner can do for patients.

now, southpaw, I do think you're being somewhat harsh. not everyone is born blessed with OMM skills, but anyone can learn how to be good with enough hands-on time.

bones

😎

 

[DOSouthpaw]

That's why I said skill/practice. I know I wasn't born with mad palp. skillz. I suggest Leon Chiatow's book on Palpation for anyone interested in getting good!

 

[DrQuinn]

My 2/10th of a dime...

I am a 4th year DO student, and will likely never use HVLA in my career... I don't mind the soft tissue stuff... but I'll explain why...

A) I work part time as a medical malpractice defense paralegal, and we had a case of a cervical HVLA gone wrong. -> vertebral artery dissection. There was absolutely no defense in that case, and we lost a lot of $ (and reputation).

B) I've seen a lot of DOs who DO practice a lot of OMM, and they are very haphazard in the way they use it (granted, these are people who are just FP trained, and I do not believe they did the OMM year). I've seen so many thoracic HVLAs, Kirksville crunches, etc on old osteoporotic kyphotic patients... and I've seen cervical HVLA done on the elderly without any thought to evaluate for the patency of the vertebral arteries (btw, those exams are horrible unsensitive and unspecific).

Q

 

[bones]

agreed, but what you are talking about is common sense, or the lack thereof. It speaks nothing of the efficacy of OMM when done correctly. For elderly, Still technique is the way to go if you want to go through an articular barrier. HVLA isn't all there is to osteopathy by a long shot, but when you go to FP docs that just might be all they ever learned how to do (again speaking to the lazyness of certain DO students in OMM class). Balanced ligamentus tension (or LAS), FPS/counterstrain, myofascial, and neuromuscular techniques also work quite well for serious musculoskeletal problems and have few if any complications.

HVLA is more like a last resort for really really stuck vertebrae in healthy patients- and then only if its done with skill and localization. with perfect localization for HVLA, there is nothing more than a small "click" as you pass through the barrier (you don't rotate or sidebend past the normal range of motion and almost no force is used) so with enough skill HVLA probably isn't contraindicated in the elderly either.

when you run into problems is when you have poorly skilled osteopaths doing HVHA- hard neck cracks without diagnosis or localization the way I've seen classical chiropractors do. That isn't what osteopathy is about. I know good chiropractors too, so I don't mean to generalize- but I believe that is the way they are taught, and thats what's dangerous. AND even with all the hack jobs out there, such dissections are quite rare (like one or 2 per year tops with millions of necks treated). just use common sense and don't be a hack job. and the chances are ~zero.

The advantage of OMM is that unlike in the MD offices I've spent time in, patients that enter with unbearable pain often leave virtually pain-free with no medications. Fast, easy, and permanent- the way patients like it. Of course, it isn't a cure-all, but we have all the MD tools for those with pain that is beyond our reach as well. Not to mention what we can do with autonomics, neuro feedback and performance rehab after injury.

good tools to have if you take the time to develop them.
😎

 

[DrQuinn]

Agreed. I am not arguing on the patient satisfaction in OMM... but I am concerned that a lot of DO students see FP's HVLA everyone (without trying soft tissue stuff) and think that it is 100% safe.

I approached one FP about his lack of non-HVLA techniques, and he said he "didn't have time to do that, HVLA is much quicker."

As a soon to be Emergency Medicine resident, I doubt I will use much OMM in the department. If something went wrong, I would have nothing to back me up.

Q

 

[bones]

heh, well, he might not have had time to LEARN non-HVLA techniques, but actually DOING them often doesn't take much more time, if any (with the exception of old-school counterstrain, but FPS is essentially counterstrain without the 90 second wait).

you are right though, ER is one of the more difficult environments for OMM, but if nothing else, its good to have the OMM diagnostic skills to go with H&P so you can catch simple things before doing tons and tons of expensive tests.

ahem, coming from personal experience... I was the 4-year-old patient that got the $1000+ workup for chest pain. of course they couldn't find anything wrong. that darn chest pain bothered me for several years and gave me trouble sleeping. only when it was re-aggrivated in OMM lab by a partner doing sloppy sternal techniques did I figure out what the problem was. A freakin rib! 🙄 A DO with a clue woulda gotten that right away and fixed it- if they were thinking osteopathically. I recall it hurting to breathe deeply, but nobody ever asked me that... and what did I know about that stuff at 4?

OMM is also apparently helpful for pneumonia and post-op treatment (NOT HVLA!). Probably lots of other things you see in the ER too. HVLA however might be your least-useful OMM tool unless you are a guru b/c those folks probably wont take thrusts well. I wish some folks out there would get it in gear with research so we can quote some studies- but patients appear to do MUCH better post-omm for some conditions. well, I guess I'll have my say in a couple of years- but all us who like OMM need to get our research muscles going.

btw... any applicants with research experience and an interest in OMM should EMPHASIZE this in your app- your chances of getting in will likely shoot through the roof.

bones

 

[DOSouthpaw]

Cervical HVLA was the hot topic at this year's AAO convocation. The profession is really having a problem with people doing HVLA on the C-spine because it is usually HVHA. It was reported that you have a higher chance of dying from taking a dose of Tylenol then you would having a vert. art. disection during a HVLA on the c-spine. But I'm sure since you have seen a discection, and not a freak Tylenol death, you're probably going to stick with the Tylenol..don't blame you there.

This is the deal...most of whom we as students see cracking people are those people from what we know as the "Lost Generation". Those DO's who all they learned was very non specific, High Velocity-High Amp techniques. They were working with the "Gotta put this back into place" model that Chiropractors use. Hopefully, most of the schools (at least mine is) are going Old School and teaching the stuff that works. If you localize properly, all a HVLA technique should require is a fast jab with your thumb, and that is on any vert., C-L spine. Sacrum is a little different.

But why even use HVLA? You have to work the thing all up against the barrier...that's hard work. Take it to the area of greatest ease, add theraputic compression, and let the lesion unwind. It's so much easier, a whole lot more powerful and intergrated that HVLA, and it's patient/old person friendly.

Personally, the only time I do HVLA is when someone specifically asks for it, and even then I make sure I localize as precise as possible, no shotguns here, I'm using a rifle with a scope.

If you're in the ER, don't give up on OPP, use it and you'll see the effects. Treat the area of greatest restriction on everyone. I'm not talking about having a 1 hour OMT session with everyone. Screen down the spine, find the area of greatest restriction, treat it indirectly, and move on to the next patient. Just doing that will make a huge impact. Later!

 

[DOSouthpaw]

Just one more quick thing. Our OMT chair used to be the OMT doc at Waterville Hospital in Maine. He did a study and found that patients that were treated with OMT were released .5-1 day earlier than those who were not treated with OMT. Show an insurance co that, and you have an instant job over any MD...unless they can manipulate. whooo hoo!

 

[bones]

was it a well-controlled study? where was it published? thas something I'd like to see. 😎

 

[DOSouthpaw]

I'm sure it was published in a journal somewhere. I found out about it in Norman Grevit's book "The DO's in America" Just look in the index for Waterville and it'll be there. I think it was back in the 70's. That would be a good place to start. We're trying to get something similar going right now with three groups
1) Standard Care
2) Standard Care + Non-Specific OMT (ex. I'm going to do rib raising on every patient with a lung problem or a shoulder technique on everyone with shoulder problems)
3) Standard Care + Sequenced OMT (ex. I'm going to screen every patient and treat the area of greatest restriction no matter what they're diagnosed with and no matter where the restriction is located.)

This way we can prove that chasing pain is not the way to go. Every patient is unique and must be treated where the tissues tell you to treat no matter what their condition is.

 

[bones]

well, let us know if you find it. Personally I was hoping for something published in the last 5 years in a reputable journal. studies like that warrant repetiton anyway.

I appreciate your efforts, but be careful of using words like "prove" when you're talking about research, as it makes some people's hair prick up. as best we can, we need to be indifferent about results- and words like "prove" makes it sound like there is an agenda. Additionally, the best we can hope for is a significant difference- that still doesn't prove anything- it only tells us what is likely to be true (assuming the methods are solid). I know I'm nit-picking... but this is all stuff to keep in mind when presenting to our skeptical MD bretheren.

We need to be skeptics ourselves first.

good luck with the study, and be sure to tell us what you find.