OMT in ER

[Doctor Bob]

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1. To call one of these spinal dysfunctions a subluxation is to grossly overstate how out of place these segments are. These are out of place to the degree of.... well.. have you ever seen someone (not a patient) complain that their neck feels stiff, then roll their head around and you hear their neck pop (like the popping of knuckles)? Well that's how far out they are... it's nothing life threatening.

2. Rather than get an indepth explanation of osteopathic manipulation from some guy online (and get all worried about nothing, conjuring up images of DOs going around paralyzing helpless post-MVA patients), take a CME course on it and learn more about it the proper way. Plenty of allopathic schools offer CME courses on OMT for MDs. Harvard (for example) does it every few years. The last one was 2007. http://cme.hms.harvard.edu/cmeups/pdf/00271286.pdf

3. As for the research... well you'll have to check with someone else for that. I don't use OMT and it was my worst grade every semester during medschool so I never took the time to go into the literature. When they taught me something that made intuitive sense (and I found effective when I used it), I took the time to memorize it. I promptly forgot the rest. But I'm sure the literature is pretty weak on the subject... DO schools aren't as research oriented as MD schools (although in the past 5-10 years that's beginning to change), MD schools don't care to do research on a modality they don't teach their students (although that too is changing as some allopathic schools are adding small primer classes on the subject), and the bulk of DOs doing a lot of the research tend to be the fringe that believe you can affect someone's heartrate by adjusting their cranial rhythmic impulse (I wish I was making that up).

Anyways, I find myself in an unusual situation, being on the side defending OMT since I'm so often on the other end, decrying how for the most part it is useless. Well it does have it's occasional use but the right modality should only be done in the right situation for the right indication and it's not something that should be done in the ED.

 

[samnite]

I was going to make a new thread but I'll just add on to this one since it is related to my question.

I'm planning to apply for Resolution 42 (DO in an allopathic residency) and have to present something related to Osteopathic medicine that could be useful in the ED.

Anyone else out there have to do this? What were some useful resources?

thanks

 

[docB]

I was going to make a new thread but I'll just add on to this one since it is related to my question.

I'm planning to apply for Resolution 42 (DO in an allopathic residency) and have to present something related to Osteopathic medicine that could be useful in the ED.

Anyone else out there have to do this? What were some useful resources?

thanks

Does something like this have to invoke OMT? You could say something about the holistic approach and the movement in EM to address more prevention, teachable moments and so on.

 

[EM2BE]

I was going to make a new thread but I'll just add on to this one since it is related to my question.

I'm planning to apply for Resolution 42 (DO in an allopathic residency) and have to present something related to Osteopathic medicine that could be useful in the ED.

Anyone else out there have to do this? What were some useful resources?

thanks

My best guess would be OMT on the back or suboccipital release. Don't know about research though. If it's not too much a stretch, I think you could do reduction of dislocated shoulders and using your OMT skills in doing that. Legg reduction maneuver for patients with anterior shoulder dislocations

 

[GeneralVeers]

My best guess would be OMT on the back or suboccipital release. Don't know about research though. If it's not too much a stretch, I think you could do reduction of dislocated shoulders and using your OMT skills in doing that. Legg reduction maneuver for patients with anterior shoulder dislocations

Or you could just do it the normal way.

 

[Apollyon]

Or you could just do it the normal way.

There's more than one "normal" way. If you're talking "brutane", you may also be talking sedation (and, if you're not, and not going intraarticular with lidocaine, then leave my shoulder out), and that's extra time. If I can put a shoulder back in painlessly, and not taking any more time than needed, then that's a way to go. The Legg method isn't any voodoo or bizarre stuff.

 

[GeneralVeers]

There's more than one "normal" way. If you're talking "brutane", you may also be talking sedation (and, if you're not, and not going intraarticular with lidocaine, then leave my shoulder out), and that's extra time. If I can put a shoulder back in painlessly, and not taking any more time than needed, then that's a way to go. The Legg method isn't any voodoo or bizarre stuff.

No argument. Though by OMT I assumed he meant some sort of external manipulation without pain meds or sedation.

 

[Jeff698]

I just read that article, at least the part that told me how to do it. I'll certainly give it a try but my guess is that by the time they reach me, it will have been out long enough to hurt like hell no matter what I do.

The article talks about this being able to be done at the scene. Perhaps that soon after the injury, any maneuver might work.

Take care,
Jeff

 

[samnite]

Does something like this have to invoke OMT? You could say something about the holistic approach and the movement in EM to address more prevention, teachable moments and so on.

I don't think it has to be OMT-related specifically. I just need to teach them about something related to Osteopathic medicine. DO Residents before me have discussed osteopathic methods to deal with dislocations (not sure if it was the Legg maneuver specifically though) in the ED.

Thanks for the advice.

My best guess would be OMT on the back or suboccipital release. Don't know about research though. If it's not too much a stretch, I think you could do reduction of dislocated shoulders and using your OMT skills in doing that. Legg reduction maneuver for patients with anterior shoulder dislocations

Nice link. I'll consider using it if it hasn't been done before by past residents in my program.

Speaking of the shoulder, do you think Spencer Technique would be something useful to know for EM residents? Maybe I could teach them about that....although it may seem like it would take a lot of time considering ED time constraints.

 

[EM2BE]

Nice link. I'll consider using it if it hasn't been done before by past residents in my program.

Speaking of the shoulder, do you think Spencer Technique would be something useful to know for EM residents? Maybe I could teach them about that....although it may seem like it would take a lot of time considering ED time constraints.

I never really learned what the Spencer Technique would be useful for other than improving ROM. I think it would take way too much time in the ED to perform. I remember just going through the motions in class and it was too long for me.

 

[soos]

I have seen it in the ER- it does work from backache to stopping someone from being intubated -

 

[GeneralVeers]

I have seen it in the ER- it does work from backache to stopping someone from being intubated -

Are you serious, or just a troll?

 

[Laryngophed]

Are you serious, or just a troll?

Or maybe, just maybe, a serious troll?

I worked in a small ED that was staff at least 50/50 with DOs and never once saw OMT used. I think it has a place, but I'm not certain that the ED is one of those places. Admittedly, I know little about the actual techniques, but I'm open to the idea that there is some credence to give to OMT.

 

[DrMom]

I have seen it in the ER- it does work from backache to stopping someone from being intubated -

I'd like to think you're just joking, but considering your other posts suggest you're in an OMM/NMM residency or fellowship I'm assuming you actually think that OMM can take someone at the verge of intubation and make them breathe well. As much as I support OMM in the appropriate setting, that concept is delusional.

 

[deleted65604]

I have seen it in the ER- it does work from backache to stopping someone from being intubated -

I try to fight my inborn arrogance, keep my mind open, and give new ideas a try (OK, I fail invariably). Then, somebody makes a statement like this and makes me lose complete faith in the DO system of teaching. I have known some great DOs, who are amazing physicians, and smart as a tack. Comments like this make me think that they are good docs despite their training, not because of it.

 

[DrMom]

Jarabacoa, please do not group DOs who ONLY do OMM with the rest of us. They get some weird Kool Aid in their residency/fellowship training that the rest of us avoid drinking. Fortunately, they are an extremely small subset of the DO world.

Again, I think OMM can do patients some good in appropriate clinical settings. I do not think it is a cure all or useful outside of the musculoskeletal realm and I don't think it is appropriate in the ER except in very, very rare occasions.

 

[Hamhock]

I do not think it is a cure all or useful outside of the musculoskeletal realm

Dr. Mom - would you please review my posts and those by Doctor Bob regarding "vertebral dysfunction" and give your opinion.

As each day passes, it is becoming harder and harder for me to consider OMM for even the "musculoskeletal realm" anything more than hogwash...

There must be something that I am missing for the many DOs I respect to swallow this...why aren't DOs asking the same questions I did above? And if they are, what are the answers? And if the answers show OMM to be chiro, then why aren't DOs denouncing OMM like chiro (I know, some may acutally believe in chiro)?

Please help, HH

 

[DrMom]

HH, if you go into the Osteopathic forum you will find that many of the explanations given for how various methods of OMM work are being questioned by the students. I don't have the time, interest, or energy to describe what he meant by vertebral dysfunction and I honestly don't think it is necessary to do so. Look at it this way, for most DO students OMM is simply something you have to sit through 3 hrs/week during MS1/2 and do a 2 week rotation in during MS3 so that you can be a physician.

As I said, I do support OMM in the right arena. There are methods of OMM that I think are hogwash, but others that truly appear to help. We had 2 PTs in my med school class and they stated that much of what we were learning in OMM was the same as what they learned in PT school. Only one method of OMM is remotely similar to chiro, so I don't really understand why so many people even in the DO world describe OMM as similar to chiro. I tell people that it is much like physical therapy.

 

[GeneralVeers]

As I said, I do support OMM in the right arena. There are methods of OMM that I think are hogwash, but others that truly appear to help. We had 2 PTs in my med school class and they stated that much of what we were learning in OMM was the same as what they learned in PT school. Only one method of OMM is remotely similar to chiro, so I don't really understand why so many people even in the DO world describe OMM as similar to chiro. I tell people that it is much like physical therapy.

If some of the methods are "hogwash" then why doesn't the DO community purge itself of those questionable methods and only teach the techniques with some scientific or therapeutic evidence? They have always been sensitive to criticism about their qualifications, but things like "vertebral dysfunction" tend to just give critics more ammunition to discredit them.

 

[DrMom]

The people teaching OMM are the ones that think it all works, so that's why we can't get rid of the silliness. These are the same ones that teach that OMM can keep someone from requiring intubation.

 

[Hamhock]

The people teaching OMM are the ones that think it all works, so that's why we can't get rid of the silliness. These are the same ones that teach that OMM can keep someone from requiring intubation.

If you disagree with this "silliness", which your last post implies you do, why did you state in an earlier post:

"I don't have the time, interest, or energy to describe what he meant by vertebral dysfunction and I honestly don't think it is necessary to do so."

I understand not having the time, but to state that you "honestly don't think it is necessary" is very different than saying: "Yes, this vertebral dysfunction identified by the 'hands of a DO' is BULL****"...very little time, interest, or energy was required of me to type this...of course, I believe in that statement (nearly completely).

Why not admit it openly? Or, take the time to explain it and present the research?

Again, I am honestly asking for information, not a fight. I am likely to be in a position that has influence regarding applicants to allopathic residencies in the future. Until the past three or so months, I had always thought I would consider MD and DO applicants nearly equally. However, my readings on SDN, in a few journals, and elsewhere are creating a viewpoint of educational imbalance that my "liberal" self would not like...UNLESS, the evidence states otherwise.

Please help.

HH

 

[DrMom]

There isn't any good research out there, quite honestly. The portions of OMM that I have chosen to use (on friends and family, since I don't use it at work with very rare exception) are very similar to physical therapy techniques. If you don't have any issues with physical therapy, then you wouldn't have issues with much of OMM.

And, again, OMM is a very small portion of what we're taught. The rest is the same as you were taught.

 

[Hamhock]

There isn't any good research out there

And, again, OMM is a very small portion of what we're taught. The rest is the same as you were taught.

I so hope I won't ruin further discussion on this topic (especially from DOs -- please, please, contribute), but I COMPLETELY disagree with the idea that the "rest is the same as you were taught".

Admittedly, much of my education regarding 'scientific theory' and 'logic' was not from "med" school, but college and the "dinner table"...I'm gonna say: 'we're' not "taught" the "same as you were taught". Please don't insult my [post-secondary] education or family (yes, going WAY out on a two-carbon limb here):

Vertebral dysfunction diagnosed by the 'hands of a skilled DO'? ...please, don't force me to continue

HH

 

[JaggerPlate]

If you disagree with this "silliness", which your last post implies you do, why did you state in an earlier post:

"I don't have the time, interest, or energy to describe what he meant by vertebral dysfunction and I honestly don't think it is necessary to do so."

I understand not having the time, but to state that you "honestly don't think it is necessary" is very different than saying: "Yes, this vertebral dysfunction identified by the 'hands of a DO' is BULL****"...very little time, interest, or energy was required of me to type this...of course, I believe in that statement (nearly completely).

Why not admit it openly? Or, take the time to explain it and present the research?

Again, I am honestly asking for information, not a fight. I am likely to be in a position that has influence regarding applicants to allopathic residencies in the future. Until the past three or so months, I had always thought I would consider MD and DO applicants nearly equally. However, my readings on SDN, in a few journals, and elsewhere are creating a viewpoint of educational imbalance that my "liberal" self would not like...UNLESS, the evidence states otherwise.

Please help.

HH

Hamhock,

I've been following this thread for a while, and I finally feel like saying something. First, and foremost, let me state that I am still technically a pre-medical student, but I'm beginning medical school (DO) at the end of the Summer (so take my opinion with this in mind). Frankly, I'm disturbed by the comments you've made regarding a position of power in an ACGME program and flaunting a DO bias on the internet. Furthermore, I think it's even a bit stranger that you would base this opinion on a few articles and some anonymous posts on an internet message board?

This, in my opinion, is worsened by the fact that Dr Mom, who, to my knowledge, went through an AOA residency program is explaining to you that a lot of these "questionable" techniques and beliefs are held by a small, fringe outlier. She stated earlier in the thread that she doesn't even see OMM performed in her AOA EM residency, and I think this is the opinion and information that needs to be analyzed, not a thread started by an anonymous pre-medical student, who created identical threads in various other forums. Furthermore, it seems like you're a resident at a program that is currently training various DO residents. Have you worked with these residents? Do you not trust the judgment of the program director who selected these students? Do you not think the fact that they have earned a spot in the same program as you demonstrates a general equivalence in education and skills??

If I'm out of my league here, I understand. I just think it's a tad odd, and potentially unprofessional and unethical to state that you will be in a position to discriminate against DOs, and will chose to do so based on anonymous banter on SDN? Especially when, from what I can gather, you work with DO residents in your program every day?

 

[pianoman511]

I so hope I won't ruin further discussion on this topic (especially from DOs -- please, please, contribute), but I COMPLETELY disagree with the idea that the "rest is the same as you were taught".

Admittedly, much of my education regarding 'scientific theory' and 'logic' was not from "med" school, but college and the "dinner table"...I'm gonna say: 'we're' not "taught" the "same as you were taught". Please don't insult my [post-secondary] education or family (yes, going WAY out on a two-carbon limb here):

Vertebral dysfunction diagnosed by the 'hands of a skilled DO'? ...please, don't force me to continue

HH

It does seem as if your argument is that DO schools have a different basic science curriculum is based on the fact that they teach OMM ???

I am studying right now for the COMLEX and while the questions may be worded differently, the material is similar if not identical to the USMLE. In fact, a good portion of my class will be taking both exams. In looking at the performance data from 2008, 81% of first time test takers from DO schools passed the USMLE versus 94% from MD schools. That being said, 17,000 MD students took the exam versus 1,500 DO students.

Many DO schools laud the "whole person" teaching strategy, but in most cases basic science and systems curriculum are similar (again, if not identical) to their MD counterparts. In fact, there are many faculty members formerly from MD schools or those who go and teach at MD schools later in their careers. Like any other schools - there are good professors and bad professors.

Please continue the discussion of OMM. In my two years of learning OMM, vertebral dysfunction is perhaps one of the easiest to "see"/explain to those who are not familiar with OMM. That being said, it is something that a first year medical student evaluating the spine will not necessarily be able to appreciate the first time that it is done. I can't really comment on the utility since there have been many studies that end up refuting one other, but I do know that my classmates and I practice on each other regularly and can see benefits (especially after long hours of studying). In addition, it is one of the more logical diagnostic and treatment modalities in OMM.

I would consider asking some of the practicing physicians who enroll in a post-MD OMM course (such as the one being offered at Harvard) what they think about OMM...

 

[corpsmanUP]

I'm have never been good at OMT. I don't think it has a place in the ED to be honest. I've pretty much lost all my palpatory skills anyway. I don't know anyone who does it and bills for it.