Osteopathic Manipulative Therapy in DO school

[vanbamm]

I am a chiropractic student and I was curious to know if your future DO's still take courses in manipulative treatment, and if you do, how extensive is it? My uncle is DO, doing internal medicine, and a lot of DO's really don't do it that much anymore, concentrating on areas where specialists are needed like MD's do. Thanks.

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[csmittyB]

I am a chiropractic student and I was curious to know if your future DO's still take courses in manipulative treatment, and if you do, how extensive is it? My uncle is DO, doing internal medicine, and a lot of DO's really don't do it that much anymore, concentrating on areas where specialists are needed like MD's do. Thanks.

I know I'm sounding like a jerk, but did you seriously create a thread asking if DO students still take courses in OMT?

To answer your question, yes, DO students take 2 yrs of OMT during med school. You are right, few practicing DO's use OMT.

 

[vanbamm]

It seems like they would stop emphasizing it so much since it isn't used and make it optional to those who may utilize it in the future seeing as most apply for residency in a specialty anyways where that knowledge is pretty useless and rarely if ever used. I was curious because there seems to be a skiff at times between DO's and DC's over manipulation and who is better blah ect. ect., meanwhile most DO's do not define themselves by it at all.

Not a jerk at all, I assume you are going to school to be a DO so it seems like a ridiculous question, just as if someone asked about my courses I would initially think it pretty trivial.

 

[JaggerPlate]

It seems like they would stop emphasizing it so much since it isn't used and make it optional to those who may utilize it in the future seeing as most apply for residency in a specialty anyways where that knowledge is pretty useless and rarely if ever used. I was curious because there seems to be a skiff at times between DO's and DC's over manipulation and who is better blah ect. ect., meanwhile most DO's do not define themselves by it at all.

Not a jerk at all, I assume you are going to school to be a DO so it seems like a ridiculous question, just as if someone asked about my courses I would initially think it pretty trivial.

1. Who says 'they' emphasis it so much? It depends on what school you go to. Some are very devout OMM peeps, others aren't. That seems like a pretty broad, blanket statement.

2. It is tested on the COMLEX steps, ergo, it needs to be taught in Osteopathic Medical Schools. If you want to argue about taking it off COMLEX, then that is a different story.

3. I don't see how medical knowledge is ever overtly useless. Especially knowledge that, from what I understand, can instill a good understanding of anatomy, comfortable palpation skills, and emphasis on neuromusculoskeletal function. Seems pretty universal. Now, I'm not going to call it a fix all, or aggravate those who have gone through school and don't believe in it, etc, but doesn't seem 'useless.'

4. No offense, but I really don't think there is a big tiff between DOs and DCs concerning this issue, not at least from DOs anyway. Manual therapy is a broad type of treatment, there is plenty of room for people who want to practice their specific branch of it.

5. DOs don't define themselves by it, from your point of view, because they aren't straight manual therapists. DOs are medical doctors who have additional training in manual techniques. DCs on the other hand are not medical doctors and receive strict training in manipulation. Hence, it would make far more sense for DCs to define themselves by their predominant form of treatment, compared to Osteopathic physicians who are fully licensed physicians and can CHOOSE to use manual therapy if/when it is appropriate (or they even care to).

6. Finally, there is a pretty wide range of people with regards to OMM. Some love it, some hate it, and a lot of people fall somewhere in between. Again, too bold of a blanket statement to assume DOs don't like it/want it or something as a whole.

 

[metalmd06]

3. I don't see how medical knowledge is ever overtly useless. Especially knowledge that, from what I understand, can instill a good understanding of anatomy, comfortable palpation skills, and emphasis on neuromusculoskeletal function. Seems pretty universal. Now, I'm not going to call it a fix all, or aggravate those who have gone through school and don't believe in it, etc, but doesn't seem 'useless.'

Jagger, love your optimism, but I couldn't help but laugh when I read this. Something we learned in OMM recently: the diaphragm is tethered to the hip through the psoas major muscle. You will NEVER learn that in anatomy lol.

 

[JaggerPlate]

3. I don't see how medical knowledge is ever overtly useless. Especially knowledge that, from what I understand, can instill a good understanding of anatomy, comfortable palpation skills, and emphasis on neuromusculoskeletal function. Seems pretty universal. Now, I'm not going to call it a fix all, or aggravate those who have gone through school and don't believe in it, etc, but doesn't seem 'useless.'

Jagger, love your optimism, but I couldn't help but laugh when I read this. Something we learned in OMM recently: the diaphragm is tethered to the hip through the psoas major muscle. You will NEVER learn that in anatomy lol.

I tried to preface the fact that I'm naive/inexperienced the best I could. I think my main thesis with that point was that it's kind of hard to call a whole sect of knowledge 'worthless.' I mean, even if you think back to something you learned in OMM that you found absurd or didn't match what we know of modern anatomy ... the fact that you remembered it or realized how wrong it was could jog your memory/lead to a better conclusion based off that jumping point. Ya know? Trust me though, I will always defer to those who know what's up (ie med students). However, I may eat these words ... but I am excited and optimistic about OMM!!!

 

[metalmd06]

I tried to preface the fact that I'm naive/inexperienced the best I could. I think my main thesis with that point was that it's kind of hard to call a whole sect of knowledge 'worthless.' I mean, even if you think back to something you learned in OMM that you found absurd or didn't match what we know of modern anatomy ... the fact that you remembered it or realized how wrong it was could jog your memory/lead to a better conclusion based off that jumping point. Ya know? Trust me though, I will always defer to those who know what's up (ie med students). However, I may eat these words ... but I am excited and optimistic about OMM!!!

Not a bad perspective to have. I would say that about 70% of the OMM I have learned has direct correlation to anatomical/neurological/physiological truths. However, the remaining 30% makes me go, "huh?" This is the stuff that is going to be rote memorization for the COMLEX, and thus is not really going to be a memory jogger (for me at least). It will be easy for me to remember and internally rationalize referred pain and viscerosomatic reflexes, or that muscle energy disengages the muscle spindle. However, I think I will find it harder to remember exactly why disengagement of a rib head in BLT might clear up a VSR, or I might forget that treating a hip dysfunction might improve motion of the diaphragm. But hey, you never know, maybe the more outlandish things will stick out? I'll tell you after the boards, lol.

 

[Styria]

However, I think I will find it harder to remember exactly why disengagement of a rib head in BLT might clear up a VSR

The sympathetic chain ganglia lie in front of the ribs. Rib raising pushes on them too.

 

[metalmd06]

The sympathetic chain ganglia lie in front of the ribs. Rib raising pushes on them too.

Ok, so the anatomic correlation is there. However, how does simply pressing on a paravertebral ganglia work to normalize tone, physiologically? Futhermore, if the induced motion is supposed to be millimeters, does that really affect the function of the ganglia? This is the way I attempt to rationalize OMM treatments. For this specific one (BLT), I have yet to find satisfactory answers.

 

[sylvanthus]

I agree with the above, it seems that a rationale for a lot of OMM techniques is simply "because things are attached to each other." It seems to me that many techniques make about as much sense as treating a stubbed toe by pulling on the ear. Well, they are attached to each other distantly.

I think it is difficult for many DO students to grasp how things work when the reason given is because "they are attached to each other".

 

[facetguy]

Something we learned in OMM recently: the diaphragm is tethered to the hip through the psoas major muscle. You will NEVER learn that in anatomy lol.

The more we learn about the fascial system, the more we realize that the concept of muscle origin/insertion isn't everything, functionally speaking at least.

 

[vanbamm]

there are always multiple fronts.

 

[Styria]

The whole issue with the diaphragm and the Iliopsoas I think would cause one to really scratch their head when you think about how they are connected. ... [verbiage]

Why are you going through somersaults? The medial arcuate ligament of the diaphragm goes around the psoas. They touch, even if the fascia lets them slide past each other. Try flexing a leg to your chest, or flexing and externally rotating it to get it up there without it physically interfering with the abdomen's movement. It feels less easy for me to breathe that way, though I'm working on a full stomach.

 

[vanbamm]

I understand the position of the medial arcuate ligament, and that it is more likely to cause GI disorders if there is some ailment because of its relationship to the celiac ganglion right behind it which serves those organs, BUT that you are right that this ligament also is found overlying the fascia of the psoas major. The anatomical function of the iliopsoas and diaphragm oppose each other, and yes so there is gliding, and so yes, you discovered the missing link that places point A into contact with point B.
Standing upright, this is no problem. Bending over or crouching does create some resistance. Inhale=diaphragm down and iliopsoas moves back to accomodate the organs and make room for everything being compressed (with the pelvic floor which lowers, and abdomen which extends). Now trying to pull your leg to your chest on a full stomach.. I just hope you don't have GERD.