Physical Modalities/Manipulations Taught in Osteopathic Medicine

Dec 30, 2009
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Hi, I was hoping some current osteopathic medical students could help me out with a unique situation. I'm a non-trad seriously possibly applying to med school in the next 3-4 years, depending on how some of my personal medical problems go.

I'm specifically posting this because of my unique circumstances. I have two friends from undergrad who are DO students now and I know that the main difference between allopathic and osteopathic medicine is that in the latter their is a more patient-centered approach and DO students are required to learn, practice, and perform when necessary on patients physical modalities/manipulations on different body parts for various ailments.

My situation is this. I was planning on improving my GPA and applying to only allopathic schools because I have had a chronic low back problem for many years. I have gone through multiple spine surgeries and had a low lumbar spinal fusion last year. Unfortunately, I am still having severe radiculopathy down my right hip, leg, and foot and most likely will be having more surgery. My neurosurgeon has high hopes and a optimistic prognosis but just thinks its going to take more time to recover then both he and my neurologist initially thought and that with another surgery and medications I could live an almost normal pain-free life. I have even asked him about my possible future in medicine despite my back troubles and he said sure you can. That is when I found out that my neurosurgeon himself had two spinal fusions and he is a neurosurgeon, which gave me incredible motivation despite my pain. I mean if a little person can be a pediatric critical care doctor, then I can work in medicine too. Though my surgeon did recommend that I do allopathic school, NOT because it is better than osteopathic, but because you don't have to bend and twist your body to practice and perform physical modalities/manipulations in allopathic school like you do in osteopathic.

Because of my lumbar spinal fusion, I have limited mobility/flexibility now in my low back and cannot do much physical manipulations or repetative bending at my waist or lifting up of patients without hurting my back. I can lift weights up to no more than 20-30 lbs (like a arm, head, or leg) but lifting a whole patient or large body section is out of the question without seriously hurting my back.

My friends in DO school recommended I talk with several of you on here in that I think that I will not be able to physically perform the modalities/manipulations DO students have to practice and perform. The sad part is, my GPA is more competitive for osteopathic rather than allopathic school, without some serious work and possibly SMP but I would be extremely affraid to take the chance of being in the middle of a DO program and do a physical modality/manipulation that could throw my back out.

Now I'm not saying that you don't have to bend or physical do things in an allopathic program, but because of the physical modality/manipulations requirement for osteopathic students, you have to do much more physical bending, etc in a osteopathic program than you do in allopathic program.

I wanted to get all of your thoughts and advice on if you concur with the assessment given by my DO friends and physician's opinions because as you know, med school, whether osteopathic or allopathic, is a extremely life changing/altering, challenging, and difficult but rewarding experience and I have a unique situation that most non-trad pre meds do not have. I actually originally had a interest in becoming a physical therapist but when my back problem started 6 years ago I had to forgo choosing that as a career because of how physically demanding it is, but I still really want to work in medicine because I'm people oriented, have had plenty of personal patient experience myself that I would have empathy for any case that came my way in my career, but want to make sure that I remain realistic of my diability but also optomistic that I don't have to give up on my dreams. I really have a interest in primary care internal medicine.

I want to find out if because of my physical spinal mechanical changes if allopathic school would be a better goal to shoot for then osteopathic because of the physical modalities/manipulations requirements?

Sorry for the long winded post but I wanted to give you as much information as possible so that you can give me the most informed decision possible and you guys would know better than anybody else I could ask since you yourselves are going through osteopathic school right now. Let me know if there is any other information you would like to know before giving me advice. I welcome and would appreciate your thoughts and guidance in this matter.
 

Styria

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Would you be able to perform CPR?

The OPP instructors occasionally refer to very small women they've worked with who are skilled at OMT and could treat much larger men. There are various ways to spare your back and prevent fatigue (and even people without a fused lumbar spine need to avoid that), and the better you get at positioning the patient, the less force you'll need.

For the lumbar roll, you do have to bend your back (or at least at the waist) to get over the patient, but the actual thrust is from bending your knees and dropping your weight on them rather than an act of bending further. I don't know about other HVLA.

You would certainly be able to do muscle energy, counterstrain, FPR, etc. But you should talk to the course instructors about what is needed, it's a better source than SDN. You can find E-mail addresses for them on various school websites.
 
Dec 30, 2009
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Would you be able to perform CPR?

The OPP instructors occasionally refer to very small women they've worked with who are skilled at OMT and could treat much larger men. There are various ways to spare your back and prevent fatigue (and even people without a fused lumbar spine need to avoid that), and the better you get at positioning the patient, the less force you'll need.

For the lumbar roll, you do have to bend your back (or at least at the waist) to get over the patient, but the actual thrust is from bending your knees and dropping your weight on them rather than an act of bending further. I don't know about other HVLA.

You would certainly be able to do muscle energy, counterstrain, FPR, etc. But you should talk to the course instructors about what is needed, it's a better source than SDN. You can find E-mail addresses for them on various school websites.
Yes CPR is fine. I actually just took a CPR and First Aid course several months ago and had no problem doing CPR since I can kneel down to do it, and it only puts a slight/minor bend in the low back. Same thing if a patient is on a gurney you can kneel above them. Its surprising, bending at the knees, takes tremendous pressure/tension off the sciatic nerve! You wouldn't think it but you do.

Thank you so much for responding though. I was getting worried because so many osteo students looked at this but didn't leave any advice. I did not think of speaking to course coordinators but that is a really great idea.

Plus, I forgot to mention, there is a possibility that my fusion hardware is causing some discomfort/decreased flexibility and I'm going to be talking to my surgeon about possibly removing some of it and having the bone graft site smoothed out. If he agrees that I could get some benefit from this, I might be able to get less pain and more flexibility back to my lumbar/sacral area. I noticed that if I bend far enough, or even squat at the knees, I get this terrible poking pain on either side my incision that shoots to my abdomen/genitals. I didn't have that pain before the surgery and the only thing that is different is the hardware so I'm hoping having some of it out will be my saving grace.

Thanks again
 

Styria

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The Educational Council on Osteopathic Principles is an AACOM council dealing with curriculum and how osteopathy is taught in the colleges. There aren't any individual E-mail addresses on that page, but it will give you some idea who to look up to ask.

If you do matriculate in an osteopathic school, have the department chair (or whoever he recommends) do a history and physical on you to determine what techniques you cannot be a safe patient model for. You'll still have to learn and demonstrate those techniques yourself, but won't be expected to let someone HVLA your lumbar spine that way. It's better to be clear up front than to refuse something later.
 

pianoman511

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Most of OMM is pretty adaptive, meaning there is more than one way to do a given technique. I would be more concerned with 3rd and 4th year rotations. Your body will take a beating, being on your feet for hours on end. Especially surgery, where often the student is the one holding the retractor for 4 hours. In that case, the surgeon might not feel like he has to give you a break.
 

BobBarker

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97% of students and all of the non-omt faculty don't give a crap about omt. You'll be fine. Nobody has ever failed an omt course for any reason other than lack of attendance. You don't think there has ever been a paraplegic DO student?
 

bones

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Hello! Perhaps I can offer a non-student opinion.

Osteopathy is a mental art first, physical second.

As specialists we see patients with severe chronic back pain and radiculopathy every day in clinic. Many of these patients are status-post spinal fusion surgeries. Some patients have permanent improvement in their pain and numbness after even one visit. Of course, results do vary based on both the mechanical cause of the symptoms and the skill and training of the practitioner- and I do refer some patients to surgery. There are also certainly several patients I've seen status post surgery that had no relief from surgery who were completely relieved after only a single OMM treatment- they key is getting the diagnosis right... Thus, it is not OMM itself you should be wary of- but rather an inexperienced student trying to practice on you.

If you have the will to learn- you will succeed. In DO school they will likely teach you their favorite 4 or so techniques (high velocity, muscle energy, counterstrain and balanced ligamentus tension/Indirect are the most commonly emphasized), some of which may be a challenge to do the way they teach most students- but if you do a little extra work to modify them (you may work with a OMM fellow on this) it shouldnt be a problem for you. Some of the techniques that they do not teach you that I use on most patients require minimal physical force or effort (facilitated positional release, neurofascial release). Thus your long term success will only be dependent on how much work you put into your training. To be safe, I would let your department chair for OMM know about your condition after your admission and work with them to accommodate your training in school.

There are indeed some DO schools where OMM is de-emphasized, usually due to a lack of vision by the administration or a lack of skilled OMM faculty (a few of the new schools only have 1 or 2 full time OMM board certified faculty, and sometimes they get questionably skilled or questionably professional physicians to fill these positions since credible skilled OMM docs are in very short supply). These schools may allow you to get through with little to no skill, as one of the prior posts implies. If you make the effort to get a professional education- I would recommend you avoid these schools as their other academics may be just as poor. A good gauge is to see how happy students are, how proud they are of their school, and how proud they are to be a DO student. Check all three of these things on your interviews very carefully.

When MDs ask you why you're a DO- you want a good answer- not just that your grades weren't good enough to be an MD. Those I know who are good at OMM are not ashamed of their DO title, no matter what the original reason they went DO. I definitely see others who are ashamed. I get more than half my consultations from MD's, and I've been told by many MD's that they wish they were taught even half of the musculoskeletal knowledge we get, and yet we have DO's that dont even take advantage of whats in front of them. You're paying for the education- get the most out of it you can.


To summarize- if you truly are interested in osteopathy and you have the will to go above and beyond to learn OMM- go for it. You will succeed, and you may even help others with symptoms like your own some day- and you will have a lot of sympathy for what your patients are going through. If you just want to be a doctor and you're considering the DO route for grade reasons- fight and struggle to get your grades up and really try to give it your all to go to MD school- if you dont make it, you can still succeed as a DO- but you should make the most of the education you get.

hope that helps!
Michael
 
Dec 30, 2009
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Thank you all for your ideas and suggestions. I greatly appreciate you taking the time out to answer my concerns.