OMM/OMT in Emergency Medicine

Discussion in 'Emergency Medicine' started by Dr JPH, Oct 4, 2002.

  1. Dr JPH

    Dr JPH Banned
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    I am a first year DO student at PCOM.

    I am interested in learning more about Osteopathic Manipulative Medicine/Therapy and the potential uses in the Emergency Department.

    Anyone have any interesting cases?
     
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  3. DocWagner

    DocWagner Senior Member

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    The most important thing to learn when learning OMM is that it is far MORE than manipulation.
    Sure, there are a few cases in which manipulation can be used, but it is quite honestly very rare. So it is the "osteopathic thinking" that can be quite useful. such as teaching a home exercise program or education to a LBP patient, or understanding many of the aspects of visceral-somatic reflexes. Most of all, it is the ability to "touch" and use physical diagnosis to your greatest advantage.
    These skills are actually absent in most DO EM docs/residents. But, if you are aware, then you can facilitate.
     
  4. Dr JPH

    Dr JPH Banned
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    Doc Wagner

    Thank you for your response. It is good to know that the skills I am learning in school will not be "wasted" should I decide to pursue emergency medicine.

    I still hope to hear of people who have used OMT in the ED.

    Josh
     
  5. soluentgreen

    soluentgreen Junior Member

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    I am in the middle of am EM rotation at a DO hospital. One of the studies the residents are launching are patient preferences in which hospital they present to for an acute exacrbation of asthma, depending on whether they recieve OMT or not. Pilot data is showing a preference for our ED because the patients feel OMT helps.
    This is just one example- I see OMT used quite often as a part of a comprehensive treatment of an ED patient. Ranging from back pain (quite common in the ED) to a congested pregnant female, your skills will definitely not go to waste.:clap:
     
  6. droliver

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    The point of the study is what?
     
  7. soluentgreen

    soluentgreen Junior Member

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    to see whether the OMT they recieve determines which hospital they present to. The area we are in has several hospitals within miles of each other, which gives the consumer quite a choice. Keep in mind, this is a pilot study..... they are still figuring out where to go with this data.
     
  8. Bleurberry

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    Is OMM taught in DO schools in such a way as to
    reduce it to a few techniques that hopefully furnish
    results? I'm reading Edward Rollin's books on
    cranial osteopathy based on the findings of Still and
    Sutherland and it seems to me that what's being pointed
    out is an attunement, almost a 6th sense awareness and
    sensability when with the patient, combined with a superior understanding of anatomy, fluids' movement, range of motion, and the behavior of involuntary mechanisms of the body. So I ask again,
    how is OMM applied in the ER? Are there ANY ER docs out there using OMM/OMT? What's the point of COM schools and their D.O. residencies if they aren't REALLY being taught how to apply OMM in the ER?
    Sounds like either I'm in for a rude awakening or a lot of D.O.s have bought into their inferiority complex's.
     
  9. TexPre-Med

    TexPre-Med Banned
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    Spent time in 3 ED's. D.O.'s were present in all 3. Never once seen or heard anything regarding OMM or OMT.

    However I have heard that 90% of all D.O.s don't use it anyway.

    Saw a D.O. in FW the other day and he didn't know what I had exactly, so he gave me 3 scripts to cover all avenues. Doesn't seem like osteopathic philosophy is used with many D.O.s.

    I think it is just what you make of it.
     
  10. EM2BE

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    I would add the use of OMT in migraine cases. Many times, you can feel a dysfunction if a person has a migraine. If they are drug seekers, you will probably be able to tell. Just my opinion, but if I had a migraine, and I knew I could get the OMT treatment if I went in, I would probably make the trip (given I don't have any friends around at the time). I have had some people that can almost cure the migraine.
     
  11. GeneralVeers

    GeneralVeers Globus Hystericus
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    Asthma and OMT? I call a BS alert on that one. :rolleyes:
     
  12. tkim

    tkim 10 cc's cordrazine
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  13. DropkickMurphy

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    Wow....what a blast from the past......seeing as JP just matched for a surgical residency...... :thumbup:
     
  14. DropkickMurphy

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    Agreed......but then again I was treated by a DO friend in the ED for a pulled muscle in my neck. Granted I had to ask/beg him to do it, but that's the ONLY time I've ever seen OMM used in any setting by any of the DOs I know.
     
  15. HunterGatherer

    HunterGatherer HunterGatherer
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    I spent some time in an osteo ED last summer. I saw one doctor do some OMT on a patient complaining of neck shoulder pain. the doctor said he might or might not combine some drug treatment based on the patients response to OMT. Only time I saw it in the ED.
     
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  17. fuegorama

    fuegorama Senior Member

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    General-
    Last year I would have totally been on page with you. However, I spent a couple of rotations w/ an FP/OMM guy that while not making me a "believer" did widen my perspective. Over a 6 month period I observed a chronic steroid kid (7yo) go from running a chronic gauntlet of acute exacerbations and hospitalizations to a prn albuterol user. He was being treated by this doc 2x/ month using soft tissue stuff that I really didn't understand.
    Below you can find a partial informal reponse from him when I asked about the basis for his treatment.


    "Treatment of the cervical spine in, essentially any respiratory condition, should include undressing the upper cervical segments which has a direct effect upon inhibition of the vagal nerve. Along with this, addressing any facilitated segments in the upper thoracic region and ribs will decrease the sympathetic drive to the upper respiratory tract. As a brief review, increased parasympathetic outflow or tone to the upper respiratory tract results in a relative bronchial constriction and production of profuse secretions. Complicating this are the facilitated upper thoracic segments which will cause vasoconstriction of the lung tissue itself. This may result in hypoperfusion of the lung tissue itself and influence the pulmonary portion of the immune system. Along with this, the hypersympathetic activity, over time, can lead to epithelial hyperplasia resulting in an increase in bronchial epithelium and goblet cells. The direct effect of this is more mucus production which tends to become thick, profuse and tenacious. The parasympathetic response primarily involves the vagus nerve which can limit normal diaphragmatic excursion resulting in a low volume breathing at a rapid rate. Flattening of the diaphragm obviously decreases volume displacement and pressure gradient not to mention decreasing lymphatic flow resulting in "congestion of tissues". Clinically I have noticed predominant rib restriction of the third and fourth ribs although I cannot give you any specific scientific or anatomic reasoning for this. I can say however that generalized rib raising does have a direct effect upon the hypersympathetic activity as well as compliance of the chest wall."

    Restrictions of movement and limitations in fluid outflow are frequent foci of osteopathic tretament. I would argue that many pharm. modalities also attempt to relieve these dysfunctions.
    Can most DOs remedy asthma with some 'rib raising'? Nope.
    I do think that all physicians can benefit from being mindful of other philosophies and therapies. Whether these should or could be incorporated in your pratice is dependent on your training and your personal perspective.
     
  18. GeneralVeers

    GeneralVeers Globus Hystericus
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    Not to discount your experience, but anecdotal evidence can be provided for almost any argument, regardless of validity. Can we really modify sympathetic outflow by massaging the soft tissues? I'm not going to say that we can't, but it seems a rather dubious concept. I'd like to see some actual Class I evidence that directly links these two events.
     
  19. EctopicFetus

    EctopicFetus Keeping it funky enough

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    This stuff has all been gone over ad nauseum on here. The best studies for OMM I have seen is that something like 5-10 mins of OMM is as good as an aspirin.. Thats great and all but not a good use of a docs time.
     
  20. DrMom

    DrMom Official Mom of SDN
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    I've used OMM for low back pain, rib pain (ie: from coughing, pneumonia, asthma), and occasionally for a tension HA. I don't always use it in these patients...depends on presentation and how much time I have.
     
  21. fuegorama

    fuegorama Senior Member

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    True dat.
    Here we have the downfall of most manipiulative therapies. While there is some documentation of positive outcome following manip., the ns for these studies are so small as to automatically discount the studies' quality.
    Why are they small and far between?
    A. The funding for non-pharm/device research is nonexistent. Why research what can't be sold.
    B. Studies like these typically are pursued in smaller osteo. friendly environments. The lack of endowment/IOH/NIH funding leads to the outcomes of part A.
    C. Laziness. The OMM leaders I have rotated with have admitted their lack of desire to publish what they see in clinic. They simply would rather spend their time with patients or read the latest monograph on 'the long tide'.

    My own school is taking a different tac on this. One of our strong faculty members has published a pretty great text about osteopathy for peds, and has several studies published in JAMA and others regarding OMM in treatment of AOM. With the backing of some names in Boston there is right now a fairly large program studying manipulation and OM. It should have the power and parameters needed to make it a class I study. I'm interested to see how it turns out.
     
  22. beyond all hope

    beyond all hope Senior Member

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    Not an osteopath myself, but if OMM is a gentle massage (not bone-cracking like chiropracty, which can actually cause disease) than how can it hurt? Heck, who wouldn't want a massage in the ED?

    I agree with the General: we need more studies. However, if OMM has been used safely for fifty years, and doesn't involve any aggressive maneuvers that might hurt a patient, and could potentially help, I say go for it.

    Most of medicine is actually not evidence-based. As long as it's an accepted practice in the medical community and doesn't have much chance of risk, I treat. E.g. Bronchodilators for viral syndrome 'bronchitis', even if the patient isn't wheezing.
     
  23. hyperbaric

    hyperbaric Cool under pressure.

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    Agreed. And another minimal risk treatment of questionable efficacy? Physiotherapy.
     
  24. DrQuinn

    DrQuinn My name is Neo
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    I'm an asthmatic myself, and once, during OMM lab as an M2, I asked the professor to do some cervical stuff on me (more muscle energy and countertraction). I was at a bit of a wheeze at the time, and didn't have my inhaler on me. After about 4-5 minutes, my symptoms went away completely.

    Q
     
  25. Red Beard

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    OP date 10-04-2002 07:34 AM
    You must have had to reach waaaaaaay up something, and around the corner, to find this... that's a lot of digging just for some troll material.:laugh:
     
  26. corpsmanUP

    corpsmanUP Senior Member

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    I went to a DO school because for me it came down to an MD school where I didn't feel I would fit in as well (2 years each in 2 separate cities...not good for my kiddos). The Do school I went to was a state school and was the same price as all my state MD schools. So it was a personal choice and I don't regret it.

    I found quite a bit of OMM to be useful in the sense that it strengthened the patient-physician relationship and often seemed to bring some amount of relief. General- ask your new classmate David D (one of your incoming interns) to teach you some of the cool stuff that OMM offers. I found though about 60% of OMM to be useless and so counterintuitive that I couldn't imagine it working (cranial, indirect techniques, and anything that relied upon an examiner/practitioner to be able to "feel the problem and diagnose it"). But the 40% that did work was probably similar to some of the things massage therapists and chiros use.

    Do I plan to use OMM in the ED....short answer, probably not. Mostly because I think the place for OMM is in the treatment of chronic musculoskeletal disorders. It is way too easy to do something to a patient you have seen once in the ED and have it come back on you a couple of years later when someone finds some true pathology in their complaint that brought them to the ED the year before. Then it becomes easy to place blame on the ED doc. Long term patient-physician relationships are environments where OMM is best used. I am not saying OMM would not benefit patient's acutely, but I AM saying that it is much easier for a patient to be willing to sue someone they barely know, and quite easy (right or wrong) to link an OMM treatment with a condition diagnosed later that likely was not nailed down in the ED.

    And since reimbursement for it is not good, then why do it?

    And FYI, I do believe acute asthma can benefit from OMM, but it is still something I am probably not going to do.
     
  27. The White Coat Investor

    The White Coat Investor AKA ActiveDutyMD
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    I'm an MD. I had a patient complain to me the other day about upper back pain. He said it felt like he needed to have it popped. So I pushed on his back and it popped. He said it felt better. I discharged him. Then I had to decide whether or not to document what I did to him and how, seeing as how I am not credentialed to perform manipulative treatment. Does that count?
     

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