Omm

[applicant2002]

does anyone have any suggestions on how to improve OMM skills? I am having a lot of trouble palpating PSIS's on the standing and sitting flexion tests. i know this is early, but i am quite worried. i really want to be competent in OMM and i would greatly appreciate any and all imput.
i know i can study books for the boards, but i so want to be actually able to do OMM, not be a DO "want to be".
thank you for your thoughtfullness and kindness. all replies are greatly apprecitated.


thank you

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[DOSouthpaw]

I know this sounds bad, but try to pair up with someone in lab that has a ton of dysfunction. My partner has a really sore and hurt foot, therefore he walks kinda bent over. This kind of walking does wonders for his spine so every week I have all sorts of great "hard end feels" to palpate and treat.

As far as external landmark anatomy is concerned, you need to find someone who is "normal", meaning, not too thin, not too fat, and not too muscular, and then keep trying week after week. Don't get discouraged. It took me over a month of palpating to start to feel dysfunction in the spine, and now I'm doing a pretty good job of it.

 

[apgar7]

PSIS's are hard to find when you're first starting out, especially on people with "softer" bodies. What works for me is to first find the iliac crests with the palms of your hands and then rotate your thumbs 45 degrees toward the feet. This should land your thumbs pretty close to the PSIS's, but you still have to try to palpate them because you won't necessarily land exactly on them. Once you find them (they feel like small bumps), place your thumbs below them but pushing up against the bottom end of them. This allows you to accurately assess the heights of each relative to the other.

 

[njdevil]

lots of classmates, lot of patients, lots of practice...

 

[DOtobe]

I agree. Just keep on practicing. The more and more you practice palpation gets a lot easier.

 

[pink]

applicant,
one thing that works for me for the flexion tests is to have your patient lean forward slightly. this usually makes those PSIS's stick right out! i don't know if you've already tried that or not, but that's pretty much all the advice i have for you. also, i totally agree about finding the iliac crests first. that will help you get oriented. i really believe that confidence and patience will get you the skills you desire. best of luck!

 

[applicant2002]

thanks everyone


for the psis, i was told that there is a dimple right ? to it on the outer skin. So my ?: is the dimple right above the PSIS, or is the PSIS to the left or right?

Once again, thanks for all the help.

 

[DOSouthpaw]

The dimple is only there on thin people, and more so on women. Next time you're at the pool in the summer time, check out the ladies with the low riding bikinis and you'll see the dimples on each side...among other things. lol

 

[applicant2002]

but on people who have the dimple, what is the relation to the PSIS? (i've seen it on those who are not so skinny)

 

[PACtoDOC]

I have been somewhat disappointed in the OMM course in my first year now, and I am hoping it will somehow come to me in the next 18 months. I actually chose a DO school over an MD school because I wanted the skills but our school puts a decreased emphasis on it in the middle of all the other first year courses. And the problem I am really having is that the PhD faculty and clinical medicine faculty are on completely different pages when it comes to terms, definitions, and movements of the spine and extremities. You would think they all could sit down for a meeting and agree on commone terminology and the like. I find that it is frustrating going through the techniques without really knowing why we are doing them. We are just told to "do this to adjust the clavicle" but no one tells us why you would need to, or even what to look for in an abnormal patient. Most of us are clueless because we are forced to put OMM on the back burner and study it the night before, because we are so busy with anatomy, physio, histo, embryo, etc... Unfortunately I don't see how they could do it any other way though because this is not an MD school where they don't have to find the time for OMM. In reality, I hope in the future that the schools will come up with a "basic nuts and bolts" OMM and save the rest for people who want to specialize in OMM. Being inexperienced though I don't know what things they could leave out, but my guess is it could be these things like clavicle and foot dyfunctions. I wish there was more time to learn the OMM stuff but there just insn't. That's what makes a DO school all the harder for the first two years I suppose. I don't regret it though, because my knowledge of anatomy and landmarks will be way superior to an MD equal if nothing else.

And one last point that maybe some upperclassmen could comment on. Do you have TA's at your school who come around during class manipulating necks and backs without really diagnosing first? We have already had people who have been hurt from this, and I am nervous about getting to cervical where I have to donate my neck to my inexperienced partner. Can anyone comment?

 

[AthensfromCols]

I think it is very sad that you are learning to "treat" patients this early in the first year of OMT without having first been taught how to properly diagnose the areas you are treating.

The remainder of your OMT career will depend heavily on your accurate diagnose of the problem the patient as and subsequently treating the patient. Diagnosis is the first, and ultimately, most important part of that algorithm.

Maybe the reason the TAs are treating people without diagnosing them first is that your school doesn't seem to make a big deal out of accurate diagnosis before treating using OMT. It sounds like a shotgun approach that might work sometimes, but could ultimately lead to some sore necks and backs in the long run.

Good luck and I have decided that medical school is what you make it. If you choose to spend hours memorizing the pathways of biochemistry instead of learning the rules of OMT, that's a decision you will need to live with. I know at times it seems like OMT gets put to the backburner because it isn't as "high stress" as some of the other courses, but if you want to be good at it, make it a priority and find a partner you trust to practice with and learn the techniques of DIAGNOSIS and treatment together. In the end, you'll be very glad to have the initials D.O. after your name because you can affect immediate changes in patients with just a little bit of skill.