I probably way over-prepared for the OMM portion of the test, but considering the expense of a fail, I wanted to minimize my chance of failing on the basis of something as silly as OMM. I also tend to go blank in high pressure, timed testing situations, so my prep method was to drill a few cookbook OMM routines for common complaints and then to basically regurgitate them when an appropriate case came up in Philly.
I did do a screening exam on almost every patient, but this usually consisted of little more than quick palpation of the back when auscultating the lungs, eyeballing their spinal curves, and assessing active ROM of the spine. Since others have passed without this, it's probably unnecessary, but again, my philosophy was why take chances, especially since they emphasize that it's an osteopathic test about Q10 minutes during the orientation...
A couple other small points:
Hand sanitizer is now provided in the rooms and is an acceptable (and time saving) alternative to washing hands.
Whatever technique you do, perform it "by the book", and always recheck after performing OMM, but note that they specifically state during orientation that the duration of some OMM treatments (ie counterstrain points) can be abbreviated due to the time constraints of the test. OMM done during the test does not actually have to reach a true therapeutic endpoint to be counted as correct.
OMM Screening Exam
-Observe AP curves for kyphosis, lordosis, scoliosis,
-Observe Active ROM,
-Palpate for hypertonicity, tenderness, viscerosomatic reflexes
Ie- T2-T7 for resp.
T5-9 for upper GI
T10-11 for mid GI
T12-L1 for lower GI
Sample Write Up for OMM Screening
OMM: AP curves WNL, No scoliosis, Lumbar/Thoracic Spine Active ROM WNL, No hypertonicity, spasm or tenderness in viscerosomatic reflex regions/ T2-7/ T5-9
The following were the OMM routines I drilled for each chief complaint. I mostly used ME, a little counterstrain, and threw in the occasional lymphatic technique.
OMM Exam/Tx for Low Back Pain
Ask pt to stand
-Observe AP curves, scoliosis
-Observe Active ROM of lumbar spine
-Check standing flexion
-Walk on Heels,
-Walk on tip toes
Ask pt to sit
-check patellar reflex
-check achilles reflex
-test muscle strength
-test sensation sharp, dull, 2-point, vibration, proprioception
-palpate thoracic paraspinal muscles
-palpate lumbar paraspinal muscles
-perform spinal segmental testing in thoracic, lumbar spine
-perform seated flexion test
Correct dysfunction with muscle eneregy
-salute rotation
-docs arm under for neutral, over for non-neutral
Ask pt to lay back supine
-check straight leg test
-ASIS Compression
-Flop
-Check ASIS
-Check Pubic Symphysis
Check Thomas Test
-tx psoas with muscle energy if needed
Check for Anterior Lumbar Tender Points
-check for anterior lumbar counterstrain points and treat if necessay
Ask pt to turn over prone
-Check PSIS
-check sacral base
-check ILA
-check sacral spring
-check sphinx test
-check for Piriformis counterstrain point and treat if necessary
-Tx Sacrum, Pelvis with ME
OMM for forearm (ie CTS)
Ask pt to sit
-palpate thoracic paraspinal muscles
-palpate thoracic spine, esp t2-t7
-tx with muscle energy
MFR of forearm
OMM for Cough/SOB
Ask pt to sit
-Observe AP curves, scoliosis
-palpate thoracic paraspinal muscles
-palpate thoracic spine, esp t2-t7
-tx with muscle energy
Ask pt to lie supine
-palpate and open thoracic inlet
-palpate cervical muscles for tension
-tx with muscle energy if needed
-cervical segmental diagnosis
-tx with muscle energy if needed
-palpate thoracoabdominal diaphragm
-redome if needed
-palpate ribs
-ME to ribs
Use Rib Raising in thoracic spine
OMM for Abdominal Pain
Ask pt to sit
-palpate thoracic paraspinal muscles
-palpate thoracic spine, esp t5-t9
-tx with muscle energy
Ask pt to lie supine
-palpate and open thoracic inlet
-palpate cervical muscles for tension
-tx with muscle energy if needed
-cervical segmental diagnosis
-tx with muscle energy if needed
-palpate thoracoabdominal diaphragm
-redome if needed
Use Rib Raising in thoracic spine
OMM for Headache
Ask pt to lie supine
-palpate and open thoracic inlet
-palpate cervical muscles for tension
-tx with muscle energy if needed
-OA decompression
-cervical segmental diagnosis
-tx with muscle energy if needed
-palpate over sinuses
-tx sinuses with efflurage/galbreath if needed
-tx trigeminal w/ inhibition supraorbital, infraorbital foramen, mental foramen
-palpate tmj
-tx with muscle energy if needed
-palpate thoracoabdominal diaphragm
-redome if needed
-screening exam over ribs
-tx with muscle energy if needed
OMM for Shoulder
Ask pt to sit
- -palpate thoracic paraspinal muscles
-palpate thoracic spine, esp t2-t7
-tx with muscle energy
-Spencer Technique
OMM for URI
Ask pt to lie supine
-palpate and open thoracic inlet
-palpate cervical muscles for tension
-tx with muscle energy if needed
-cervical segmental diagnosis
-tx with muscle energy if needed
-palpate over sinuses
-tx sinuses with efflurage/galbreath if needed
-tx trigeminal w/ inhibition supraorbital, infraorbital foramen, mental foramen
I hope this "guide" might help minimize some anxiety in future test takers.
The thing I found most difficult in preparing for this test was the lack of clear guidelines about exactly what we are expected to perform. It would be nice to have a more information about the specific skills we are responsible for in the Biomedical/Biomechanical Domain, but it seems that the NBOME has not chosen to share this information, so we are left to study USMLE CS books, get advice from students who passed, and guess about what they mean when they say this is a "osteopathic" test.
Good luck to all the future test-takers.
Good luck guys!
