OMT/OMM

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kp11 said:
I like doing HVLA and getting that "POP"... but Chapman's points? Not too sure.
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I'm pretty sure... lol.
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Well that really presses my small, hard, exquisitely tender, somewhat edamatous, mysteriously un-x-rayable, unultrasoundable, un-cat scanable, buttons.

Also, my advice....don't say "upper pole " in a really sarcastic manner with palpable malintent and the emphasis on the wrong syllable.

[Edit] also don't refer to OMT as "poke-ology" in front of some ubergunner.
 
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Interestingly, I think things get more "hokey" as time moves on and people added their own "techniques" to the osteopathic canon. HVLA and muscle energy? Sure, I can see how that might help. Counterstrain? Alright, I guess the hypothesis behind it is decent. Facilitated positional release? I'll pass. Craniosacral? No.

I actually enjoy learning muscle energy a lot as it's basically just an anatomy review with some stretching. So it's one of those things I might actually use. But I can virtually guarantee I'm never going to spend 90 seconds poking someone to see if they feel better.

Also, I think it's really interesting (see also: frustrating) that there's this "memorize specific techniques" attitude about OMM. Especially since Andy Still specifically told his student not to just copy instructions.
 
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Ophiuchus said:
Also, I think it's really interesting (see also: frustrating) that there's this "memorize specific techniques" attitude about OMM. Especially since Andy Still specifically told his student not to just copy instructions.
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He even refused to write down most of what he did. So almost nothing of what we do today comes from him. Even Still technique is a best guess based on a grainy video and eyewitness accounts.

Though if you talk to some of the more hard core OMM faculty, the older ones, they don't memories specific techniques either. They just kind it intuit their way around...
 
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For all of you preparing for the USMLE when did you start studying? when would you advise younger OMS 1 students to start studying?
 
anthony78001 said:
For all of you preparing for the USMLE when did you start studying? when would you advise younger OMS 1 students to start studying?
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Yesterday, Damnit! If you didn't start yesterday both your IAS and your EASand your distal SC are about to prolapse. Heck, you should start the day after you take ....no....the evening you get home from taking the MCAT.
 
So should I start working out to have awesome muscles when my hot classmates practice OMM on me?
 
Tired said:
You know the rule. Pics or it didn't happen.
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My class is good looking. @CrocodilePancake can attest. But realistically, that fades quickly in the OMM lab and there's little to no sexuality in it. You're feeling butts about 2 months in, and it's whatevs.
 
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Tired said:
Wow. Just... wow.

I gotta tell you, it's a little hard to take this seriously.
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This isn't nearly as bad as some of the voodoo **** we've learned this year. That video is actually taken from a PT school, which has adopted that treatment (as well as other techniques from OMT). I thought an Orthopod might be more open to stuff like this since you probably refer to PT all the time. I know PT deals more with strengthening, but still.
 
Tired said:
Wow. Just... wow.

I gotta tell you, it's a little hard to take this seriously.
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His treatment (in the video) is completely different than what I learned for the diagnoses he gave. It looked more like he was treating innominate rotation, albeit with a slightly different technique the we leared even for that. He also treated the wrong side with his first technique. He was supposed to do a standing flexion test to see if it was a left up shear or a right down shear.

Does everyone agree or does my school just do it completely differently?

It seems there's no right or wrong way to do OMM... it's about allegiance to the idea rather than consistency.
 
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NurWollen said:
His treatment (in the video) is completely different than what I learned for the diagnoses he gave. It looked more like he was treating innominate rotation, albeit with a slightly different technique the we leared even for that. He also treated the wrong side with his first technique. He was supposed to do a standing flexion test to see if it was a left up shear or a right down shear.

Does everyone agree or does my school just do it completely differently?

It seems there's no right or wrong way to do OMM... it's about allegiance to the idea rather than consistency.
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My take:

He was really only checking upshear/downshear of the pubic bone, not the entire innominate. A pubic shear is one of the possible components of a rotated innominate, so treating the way he did would be appropriate. Problem is that he didn't diagnose the entire innominate there, so we can't be sure he had the proper diagnosis to begin with.

C- for the video makers.
 
Tired said:
I'm open to manipulation in general. I think that some of the soft tissue work done with manipulation can provide excellent, usually temporary, relief from pain. PM&R and PT will do manipulation (or needling) for myofascial pain, and I'm very down with that, despite some eye-rolling from my colleagues.

Where I drop out is the concept that skeletal alignment can be altered with manipulation. I'll be totally honest, I have no idea what you guys mean "pelvic shear" or "innominate rotation" means. However, if it's what the plain reading of the terms suggests, I just don't believe it. Having spent a little time operating on bones connected by relatively immovable joints, I don't believe that you can alter the relationship between those joints with external pressure, either temporarily or permanently. Similar to the "BOOP" concept that chiropractics used to talk about, I'm not buying.

But no disrespect intended, and definitely not trying to put-down OMM or DOs in general. I have a nearly non-existent understanding of the subject; just making a general statement of my beliefs on a concept that some people have used to explain the effects of manipulation.
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No offense taken. Terms like "pelvic/pubic shear" sound just as weird to most of us as they do to you.
 
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Tired said:
I'm open to manipulation in general. I think that some of the soft tissue work done with manipulation can provide excellent, usually temporary, relief from pain. PM&R and PT will do manipulation (or needling) for myofascial pain, and I'm very down with that, despite some eye-rolling from my colleagues.

Where I drop out is the concept that skeletal alignment can be altered with manipulation. I'll be totally honest, I have no idea what you guys mean "pelvic shear" or "innominate rotation" means. However, if it's what the plain reading of the terms suggests, I just don't believe it. Having spent a little time operating on bones connected by relatively immovable joints, I don't believe that you can alter the relationship between those joints with external pressure, either temporarily or permanently. Similar to the "BOOP" concept that chiropractics used to talk about, I'm not buying.

But no disrespect intended, and definitely not trying to put-down OMM or DOs in general. I have a nearly non-existent understanding of the subject; just making a general statement of my beliefs on a concept that some people have used to explain the effects of manipulation.
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Yeah, I have very mixed beliefs about OMM.

Like... I'm positive the bones of the skull don't move (or at least shouldn't). Nor am I 100% convinced that the radial/fibular head or innominates really ever get too far from where they should be.

I tend to actually believe HVLA sometimes works for the back. If someone is laying prone, I usually start an assessment by running my fingers vertically along both sides of the spine and in many people, I do tend to feel little "road-bumps." Whether that's paravertebral musculature or the joints themselves, I'm unsure, but it generally resolves with some manipulation.

And whether or not it does what it's supposed to, when done by someone experienced, it does feel good. So at least it has the "therapeutic touch" aspects to it.
 
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NurWollen said:
His treatment (in the video) is completely different than what I learned for the diagnoses he gave. It looked more like he was treating innominate rotation, albeit with a slightly different technique the we leared even for that. He also treated the wrong side with his first technique. He was supposed to do a standing flexion test to see if it was a left up shear or a right down shear.

Does everyone agree or does my school just do it completely differently?

It seems there's no right or wrong way to do OMM... it's about allegiance to the idea rather than consistency.
Click to expand...

Yea, never seen that method. Based on what I've learned he seems to have chosen the most "invasive" way possible to correct it.
 
Ophiuchus said:
Yeah, I have very mixed beliefs about OMM.

Like... I'm positive the bones of the skull don't move (or at least shouldn't). Nor am I 100% convinced that the radial/fibular head or innominates really ever get too far from where they should be.

I tend to actually believe HVLA sometimes works for the back. If someone is laying prone, I usually start an assessment by running my fingers vertically along both sides of the spine and in many people, I do tend to feel little "road-bumps." Whether that's paravertebral musculature or the joints themselves, I'm unsure, but it generally resolves with some manipulation.

And whether or not it does what it's supposed to, when done by someone experienced, it does feel good. So at least it has the "therapeutic touch" aspects to it.
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Definitely agree with this one. It's unfortunate that many of the quackier aspects of OMT gets all the attention. I definitely believe many techniques in OMT are beneficial to patients, especially because many are also used by other professions under different names. I just wish that DO's as a whole would work together to produce more research regarding different OMT techniques and weed out the crazier theories and therapies (lookin at you cranial). It would really go a long way to lend credibility to manipulation as a whole.
 
NeuroSpeed said:
Speaking from personal experience, during clinicals, beware any rotations with a strong drug rep presence.
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They are exceptionally good at what they do, right down to remembering your favorite donut.
 
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meliora27 said:
Until there is objective evidence that "these


I had a outpt rotation that would often have 2 reps a day, one would bring breakfast, and one would bring lunch. It was a delicious and money saving month.
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If at some point you get annoyed with them pitching, say, a new nausea drug, you could just respond, "dude, I'll just rub of his celiac ganglion (through his abdominal wall and every major abdominal organ) and he'll be good to go."
 
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NurWollen said:
If at some point you get annoyed with them pitching, say, a new nausea drug, you could just respond, "dude, I'll just rub of his celiac ganglion (through his abdominal wall and every major abdominal organ) and he'll be good to go."
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This was at a somewhat rural DO FP office. Amount of OMT/OMM seen that month = ZERO.
 
NontradCA said:
@DrEnderW , OMT should be added to firecracker. What do you think?
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It is!

Go you your settings under account details and select the OMM section. Use the traditional website for this. Let me know if that doesn't work, my interface/options may be different than the standard one.

It's a little primitive but still decent. I haven't personally used it a ton. I would love to get some changes made during this next year once I'm through Step 1.
 
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DrEnderW said:
It is!

Go you your settings under account details and select the OMM section. Use the traditional website for this. Let me know if that doesn't work, my interface/options may be different than the standard one.

It's a little primitive but still decent. I haven't personally used it a ton. I would love to get some changes made during this next year once I'm through Step 1.
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Yea it seems a little......restricted. Needs an adjustment. When did you stop using FC?
 
NontradCA said:
Yea it seems a little......restricted. Needs an adjustment. When did you stop using FC?
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Just recently at 4 weeks from my Step 1 date to focus on UWorld and NBME/COMSAEs.

I used it essentially daily up until then. Will start Step 2 in July.

And yeah, the OMM definitely needs some work, I agree. Hopefully it will be a great resource for keeping chapman/CS points and all the VSR stuff fresh soon. It could be a great tool.
 
DrEnderW said:
Just recently at 4 weeks from my Step 1 date to focus on UWorld and NBME/COMSAEs.

I used it essentially daily up until then. Will start Step 2 in July.

And yeah, the OMM definitely needs some work, I agree. Hopefully it will be a great resource for keeping chapman/CS points and all the VSR stuff fresh soon. It could be a great tool.
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At this point, how satisfied are you with your decision to utilize it fully this past year?
 
NontradCA said:
At this point, how satisfied are you with your decision to utilize it fully this past year?
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Extremely satisfied. I actually wish I did more - I focused a lot on school material still through 2nd semester M2 and could have afforded more board prep and FC.

I got a 600 on COMSAE D about 10 weeks out from my date without studying (no idea on the actual correlation accuracy) and I attribute that to sustained review with FC. There were tons of kids in my class getting below the 475 cutoff even 4+ weeks after that. I passed an exam 5 months out with only about 70% M2 covered so I definitely think the repeat exposure to early M2 and also M1 material helped. Highly recommend getting a routine down.
 
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ImageUploadedBySDN Mobile1434073101.475921.jpg

Hey guys, I finally found this Chapman's point that everyone is talking about.
 
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I'm so glad I'm done with 1st year OMM( all of the spine from cervical to sacral, as well as rib and pelvic). I hear 2nd year OMM is weirder but easier. Anything to spend less time in that class. It's just not for me. Techniques aren't bad... I feel like I'm pretty skilled in them, but I can't get past the diagnosis.
 
NeuroSpeed said:
Don't worry, you aren't alone. I can definitely feel some things and think OMM does help at times, though I doubt I will be doing much of it in my field. When we were going over lectures for our one (maybe 2?) cranial labs, I was like "This is BS, who could feel that?". Then when we got in lab I could actually feel the CRI, on multiple people.

I got ridiculed for even saying I could feel it, even though I am I not convinced that it is actually what they say it is, or that it means something. And I would probably never use cranial. But after having felt it myself, I try to remind people that just because they personally can't feel something, it doesn't mean it isn't there.
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I don't know what you were feeling either (if you felt something). You thinking you felt something may ironically be placebo effect as well (all OMM is good for). If you did feel something it was probably fluctuations of the CSF. We know this happens. We have seen it on MRI. You feeling that is definitely a possibility. Things that are not possibilities are being able to feel these pulsations and glean any diagnostic data from them (in contrast to heart or lung sounds). And you certainly will not be able to affect these pulsations in a direct manner. And finally but most importantly you are absolutely not feeing flexions/extensions/rotations/ and what not of skulls bones that do not do these actions. Sphenobasilar synchondrosis? Mother f-cing lochness monster.

Cranial is a joke. Cervical HVLA is a joke and ABSOLUTELY DANGEROUS. Soft tissue and myofascial release feels good (duh, it's a massage); it just has no proven clinical data. Same goes for most of the HLVA, and muscle energy stuff.
 
jw3600 said:
I don't know what you were feeling either (if you felt something). You thinking you felt something may ironically be placebo effect as well (all OMM is good for). If you did feel something it was probably fluctuations of the CSF. We know this happens. We have seen it on MRI. You feeling that is definitely a possibility. Things that are not possibilities are being able to feel these pulsations and glean any diagnostic data from them (in contrast to heart or lung sounds). And you certainly will not be able to affect these pulsations in a direct manner. And finally but most importantly you are absolutely not feeing flexions/extensions/rotations/ and what not of skulls bones that do not do these actions. Sphenobasilar synchondrosis? Mother f-cing lochness monster.

Cranial is a joke. Cervical HVLA is a joke and ABSOLUTELY DANGEROUS. Soft tissue and myofascial release feels good (duh, it's a massage); it just has no proven clinical data. Same goes for most of the HLVA, and muscle energy stuff.
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I may be misinterpreting your post, but you seem pretty worked up about what I thought was a fairly innocuous couple statements. And thanks for demonstrating perfectly my point (Placebo effect, really?).
 
NeuroSpeed said:
I may be misinterpreting your post, but you seem pretty worked up about what I thought was a fairly innocuous couple statements. And thanks for demonstrating perfectly my point (Placebo effect, really?).
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Emotions do not translate well on the internet. I'm cool as a cucumber. Was there a part from my post you did not know what I mean? (Being serious, not confrontational).
 
wjs010 said:
I'm so glad I'm done with 1st year OMM( all of the spine from cervical to sacral, as well as rib and pelvic). I hear 2nd year OMM is weirder but easier. Anything to spend less time in that class. It's just not for me. Techniques aren't bad... I feel like I'm pretty skilled in them, but I can't get past the diagnosis.
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If your school is anything like mine, then don't get too excited. OMM at my school is cumulative. I've heard from my second year friends that sometimes on their practical exams they get asked to demonstrate techniques learned during the first month of med school.
 
jw3600 said:
Emotions do not translate well on the internet. I'm cool as a cucumber. Was there a part from my post you did not know what I mean? (Being serious, not confrontational).
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No I think you were pretty clear in your post about your points, you just used some phrases and caps that made me unsure about your emotion level. Thanks for the reply. Trust me I'm not one of those OMM fans, and I more agree than disagree with much of what you said, but I don't lean quite as far over to the "OMM is useless/bad/dangerous" end of the spectrum as you do. I'm more open minded about it, but definitely want much more quality research (not the usual trash published in JAOA) done on OMM so that we might eventually be able definitively drop it into either the useful bucket or the trash bucket.
 
Ibn Alnafis MD said:
If your school is anything like mine, then don't get too excited. OMM at my school is cumulative. I've heard from my second year friends that sometimes on their practical exams they get asked to demonstrate techniques learned during the first month of med school.
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We go pretty slow through the material so I don't think we'd have time to do that. Then again I wouldn't be surprised. On the last day of school (last week) all of us thought we had nailed the practical, and almost ALL of us were back for remediation at the same station. They brought is back to **** with us because it was the last day.
 
People don't think OMM be like it is, but it do.
 
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wjs010 said:
We go pretty slow through the material so I don't think we'd have time to do that. Then again I wouldn't be surprised. On the last day of school (last week) all of us thought we had nailed the practical, and almost ALL of us were back for remediation at the same station. They brought is back to **** with us because it was the last day.
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That's a bummer, but it's not as bad as bringing nearly one third of the students back to remediate the Clinical Performance Exam during their dedicated boards prep time.
 
Ibn Alnafis MD said:
That's a bummer, but it's not as bad as bringing nearly one third of the students back to remediate the Clinical Performance Exam during their dedicated boards prep time.
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Haha I was there! Last year it was 2/3 of the class so you could say we had it easy this year.
 
GUH said:
Haha I was there! Last year it was 2/3 of the class so you could say we had it easy this year.
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Damn. That is something to keep in mind when studying for the CPE. The last thing I want is to compromise my boards studying plan.
 
I guess my experience is a little different. While I'll agree that Cranial and Chapman's are BS. For the most part, I thought the stuff I learned first year is pretty useful.

I don't know much about other school, but at the one I went to they hammered in basic anatomy. In terms of boards, MSK and anatomy is one of my strongest section with the least amount of studying. Several classmates agree, even the ones that dislike OMT.
 
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DrZed said:
I guess my experience is a little different. While I'll agree that Cranial and Chapman's are BS.
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Your experience doesn't sound much different at all. Cranial and Chapman's really seem to be the theories that taint OMM for most people.
 
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DrZed said:
I guess my experience is a little different. While I'll agree that Cranial and Chapman's are BS. For the most part, I thought the stuff I learned first year is pretty useful.

I don't know much about other school, but at the one I went to they hammered in basic anatomy. In terms of boards, MSK and anatomy is one of my strongest section with the least amount of studying. Several classmates agree, even the ones that dislike OMT.
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Define useful. I think most non kool aid drinkers feel the same way. Cranial, Chapmans, and some other stuff are horse manure. The other more reasonable stuff may or may not provide some relief with little downside. OMM is like suggesting a nap to a patient. It may or may not make them feel better but probably won't hurt.

As for cervical HVLA, venture into the Emergency Medicine forums. There is a literally a discussion right now about how several physicians agree they see a couple vertebral artery dissections a year with history of recent chiropractor/HVLA adjustments.
 
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