Question about DO's philosophy on manipulation.

[MH]

Hey,

I am curious as to what exactly the Ostepathic profession's viewpoint and philosophy is on spinal manipulation. I have heard that it is decreasing in importance in osteopathic medicine but how is it propossed to work etc.? What benefit is it suppossed to provide to patients and how should it be used? Does anyone here know what the reasons, justifications etc. behind it? Is it essentially the same philosophy as chiropractors have?

I am planning on going to med school in a few years and I am trying to explore both osteopathic and allopathic schools. My fiance's father is a DO, but he is an OB/GYN and he says he has never used it.

Thanks

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[turtleboard]

But can your fiancee's father explain why OMT seems to work?

I've never studied OMT myself, but if you want a really great introductory book on it, Phillip Greenman, DO, of MSU College of Osteopathic Medicine wrote a classic book on OMT and the theory behind it.

Chiropractic, if you didn't know, is actually a derivative of Osteopathy, so many of the theories are very similar. What's different between the two professions, when it comes to spinal manipulation, is in their techniques.


Tim of New York City.

 

[MH]

He actually helps teach at MSU's program. They are from near Detroit. He really doesn't believe in it too much from what I can tell. I will see him next week. I'll try and get a little more out of him.

I guess I am coming from a somewhat skeptical point of view on it. I have a pretty strong orthopedic background (ATC/PT) and while I feel that manipulation can be beneficial in some cases such as certain orthopedic pathologies, I definately don't think that it can be the only treatment in itself. There is usually a reason someone is not in alignment. Just "popping" someone back in place isn't going to fix the problem. While the patient may feel better for a while, the problem will undoubtably return.

This is where ethically I have a problem with it. If nothing is done to correct the biomechanical deficits (in ortho problems), they will be coming back and the bill will keep on climbing. I find another post I read on this site saying that at least you can charge $200 an hour for it very disturbing. If that is the philosophy, I definately do not want to become a DO. Talk about a reason for escalating costs of health care! And if someone starts saying that spinal manipulation can cure cancer etc......I would start to have some even more serious doubts!!!

Once again, from my point of view, when someone can get manipulation at a cost of $200/hr with the insurance paying for it and a stroke patient is limited in the therapy that they can get because the HMO's won't pay for it, something is VERY wrong. That is what is wrong with health care right now.

While there are many things that may be somewhat subjective practice in the practice in physical therapy, including some manipulation, I think there is a huge effort to make it as objective as possible. They trend, at least in some of the better schools, is going away from the heat pack, ultrasound, massage routine to a more scientific based treatment.

I just want to know what the objective reasoning is behind spinal manipulation. While many "alternative" techinques should implemented along side "traditional" methods, I just find it hard to justify paying for something that can not be proven. I am not against the osteopathic way, I am just skeptical. I definately think that the philosophy of treating the whole patient instead of just body parts is extremely important and often overlooked aspect in medicine.

 

[UHS03]

I have a couple things to add here. First, osteopathic manipulation should be looked at as one part of the overall treatment. Using manipulation with medical therapies enhances the effectiveness of everything you do. I'll give an example. Your lymphatic system rids your body of excess fluid and waste by collecting it and returning it to your blood. The only things driving the lymphatic system are indirect "pumps" i.e. flexing muscles and such. If manipulation could be used to enhance the action of the lymphatics, getting drugs to target tissues, bioavailability of drugs, etc. is improved. Manipulative thereapy is complementary to medical therapy in this case.

For acute back pain, osteopathic physicians who choose to may try and use just manipulation to treat it. Others will use muscle relaxants plus manipulation, and others will disregard manipulation entirely. If acute back pain does not go away, or keeps coming back after a little while, we are not taught to just keep treating it and hook the patient into long term treatments (that's for chiropracters to do.) Some back pain can't be helped even by the best doctors. Some pain can be controlled quite well with drugs (but who wants to be on drugs the rest of their life..most people I know with chronic back pain just live with it.) Sometimes it takes surgery. We are fully licensed physicians and we know the indications/contraindications for manipulation, surgery, or whatever. I would be really suprised if I heard about some DO's that were stringing patients along on manipulation treatments for indefinite periods of time. If I heard about it, I would denounce it (as would most other DO students and DO's.)

I only wanted to add one other thing. While chiropractic and osteopathic may be similar in terms of treamtents, I believe they differ about what it is they think they're treating. Chiropractic believes all dysfunction arises from nerve impingement, etc. and when they treat dysfunctions, I believe they are aiming to relieve that nerve impingement. DO's focus much more on the musculoskeletal system. While we learn how the autonomic nervous system is involved in things, our goal is more to relieve muscle spasm usually. There is obviously much more than this, but I have gone on long enough. Basic difference between osteopathic and chiropractic manipulation: the pathology of the dysfunction. Also...one can use drugs and other complementary therapy, and one can't.

[This message has been edited by UHS03 (edited 11-16-2000).]

 

[drusso]

Here's an excellent review article about osteopathic medicine and OMT. It also reviews the scientific literature dealing proposed mechanisms of action of manipulation. It used to be available for free viewing from the AMA website, but no more. Anyway, do your best to find it at a local university/medical school library:

Emil P. Lesho, DO. An Overview of Osteopathic Medicine. Archives of Family Medicine. 8;477-484, November/December 1999.

 

[Smile]

To MH,

I too was a PT w/ an orthopedics background before coming to osteopathic medical school (I am now a first year.) While I had learned and used many osteopathic techniques regularly at my job (w/o even knowing they were osteopathic), I too was slightly skeptical of some of the claims OMT makes on certain treatments before coming to school. But I came here w/ an open mind and after just 12 weeks, there are some really interesting things I am learning which I didn't know before and see more and more the value of OMT, but also with its limitations. You and I have a great advantage on this OMT thing, because we come from a different mind-set to treating patients and understand manual therapy from a different point of view (more scientific/objective, as you mentioned it, or more symptom-reproducing, as i was primarily taught). However, as one of my old professors told me, I will only become good if I take all philosophies I have learned and will learn (between PT, OMT, and anything else that might come along the way) and then come up w/ my own rationale and thought process for treatments using manual medicine. We will have a much greater perspective, since we have something to compare to. Finally, if all else fails and you don't agree w/ one word of OMT theory, then you will always have your PT licensure and can incorporate that into your medical practice!

 

[MH]

Good replies everyone.

I am no trying to knock the DO philoshophy by any means, so I hope nobody took offense. I am just trying to get a better idea on whether or not it is something that I can see my self believing in and planning my career around.

I agree with UHS03 in many aspects and I think that many of those reasons sound very good. While I may be somewhat biased, the one thing that I am afraid of is similar in many ways to your back pain example. Nowhere in your statement was anything about rehabilitation mentioned.

Now I will play devil's advocate for a bit! I hate to admit say it on this board, hopefully Smile will back me up on this, but sometimes physicians (DO or MD) are not the best ones to diagnose injuries such as these. When conventional treatment such as meds, rest etc. aren't working, or in conjunction with those, I hope that doctors DO or chiropractors, just don't start "popping" things. PT's many times are much more qualified to determine what the exact cause of back pain is for example. Not "medical problems" that need a "medical diagnosis" such as fractures, tumors, etc. More of movement disorders etc. which is often the cause of low back pain that there seems not to have a clear reason why it is occuring. That is what PT's do, and for some. There is a usually are biomechanical reason as to why these structures are out of place (some muscles too short, others too long, muscle weakness, faulty movement patterns etc.) So in some respects I definately feel that the whole body approach is vital to determining many causes of pathology, not only orthopedic.

I just hope, or maybe just wish, that doctors would more often realize that health care is a team approach, and other health professionals could be utilized better. Many times physicians, not all and I actually think DO's may actually be better at it, are too caught up in the "I am a Dr. so I know more" approach. I will get off of my podium now. Sorry for that. That is me preaching to all the future physicians and current physicians out there. If the ultimate goal is the best health care possible for our patients, we all need to lose the ego's. No offense to anyone, just food for thought from one perspective.

Now, on to other things! Smile could you give me some info on how you went about making the transition from PT to med school. Looking back on my previous post I didn't mean to imply that I am a licensed PT yet (I am a licensed ATC though), I am still in PT school. I am sorry if that was misleading in anyway, that is just the perspective that I am coming from. While I will be a ATC/PT, I very much want to go to med school. Most people think I am nuts. I had a post on the pre-allopath board about my situation. that is where the basis of many of my questions are coming from. And that is also where some of the dilemma that I am in is coming from.

I decided late in my undergrad career that I wanted to go to med school. I was lacking two prerequisites, and I didn't want to jump the gun and just quit on PT school and spend two years taking the classes and applying and then possibly not getting into med school, seeing as I had already applied and gotten in to PT school. Did you get any negative reactions for your decision to go from med schools? Did you go to a Master's program or a BA/BS? If you went to a Master's program, how did you get your referances after being out of undergrad for so long? I am kind of worried about asking my faculty here. While to some it may seem that I am indecisive, I am very firmly committed to going to med school. I just wanted to make the best decision for me and my fiance at the time and it turned out to be PT school. But now, I wish I had gone the other direction. Not that I do not enjoy what I am doing, but there is just so much more that I want to do. Any advice that you have would be appreciated. You are the first PT that has gone on to med school that I have had some contact with. Thanks.

[This message has been edited by MH (edited 11-16-2000).]

 

[Kristi]

Just to alleviate some of your concerns...the first thing we started learning in manipulative medicine was palpation. We learned to feel each layer between the skin and bone, and "popping" is by far the least of the techniques that we learn--I think it's just the most recognizable. Palpation is key in diagnosis and in an osteopathic education. Our hands will be the best diagnostic tools we have. Hope that helps in your understanding of osteopathy. Feel free to post any further questions or concerns...every day I'm more and more glad I chose this path, because I think I'd be missing something if I hadn't.

 

[MH]

I was not meaning popping as a catch all term for what osteopath's do. I was just using that for a lack of a better term off hand while I was writing it. Oh, and I just edited the message too, I didn't mean to say that PT's or other health professionals could replace doc's, they just are different specialties with different training and all should be utilized to provide the best health care possible.

 

[DDuncan]

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QUOTED TEXT:

When conventional treatment such as meds, rest etc. aren't working, or in conjunction with those, I hope that doctors DO or chiropractors, just don't start "popping" things. PT's many times are much more qualified to determine what the exact cause of back pain is for example. Not "medical problems" that need a "medical diagnosis" such as fractures, tumors, etc. More of movement disorders etc. which is often the cause of low back pain that there seems not to have a clear reason why it is occuring. That is what PT's do, and for some. There is a usually are biomechanical reason as to why these structures are out of place (some muscles too short, others too long, muscle weakness, faulty movement patterns etc.)
--------------------------

What you have described is an osteopathic approach. DO's do not just do "cracking and popping". Many of the old DO's used alot of this, but we are now taught a lot of soft tissue & muscle techniques. Many patients will choose a DO over a chiro due to these differences in treatment options.

Derek

 

[MH]

Not to just harp on this subject, but what kinds of soft tissue and muscle techniques. I am just trying to see if this will fit into my own philosohies and beliefs. Again, I am not trying to talk it down in any way, I am just trying to learn about it. I am kind of tough to convince I guess........but if this is the career path I want to pursue, I think it is pretty important and relavant.

 

[dostudent]

MH

Whether you are willing to admit it or not, your philosophies match osteopathy. Osteopathic medicince was founded by Dr. A.T. Still M.D. in 1874 because he disagreed with the medicine of that time, the bombardment of the body with external substances in hopes a cure would occur. The goal of Osteopathic medicine is to treat the person and not just the disease. We recognize that the whole body is inter-related and we study that relationship. There is more to patient care than writing a prescription to mask the symptoms, there is healing the patient. At most allopathic schools you will get very little if any on nutrition, vitamins, exercise programs, etc. We have specific classes on these subjects. I am in a club that studies herbal therapy, because it is becoming more important to patient care. As a first year, we are constantly reminded of the team approach to medicine. (our class is 65% medical - i.e. PT, RN, EMT, Paramedic, PharmD, PA, RN-P)

Now I could sit here for hours on end explaining to you the musculoskeletal techniques I have learned thus far and how I use them now to treat others, but you're just going to have to trust me. It works. At first I too was a bit skeptical, but I am learning it and using it and it works.

I started D.O. school because I strongly believe in the osteopathic philosophy of treating patients. I have never regretted that choice.

 

[Smile]

MH,

Sorry it took me a few days to get back to you (finals!) Anyhow, to answer your questions, I received a BS in PT from undergrad. (The program has since changed to an entry-level MS program). I did begin at an advanced degree MS program but didn't complete it upon applying to medical school. So, I practiced PT for a couple of years before deciding on medical school. For references, I just gathered old professors (with whom I was still in touch) and co-workers (PT's and physicians). As far as any negative reactions, I didn't find any. In fact, it was just the opposite: all the schools I interviewed at looked at my experience very favorably and as an asset. The transition hasn't been too difficult. Going to school is almost like a full-time job except that you bring home work with you! Other than not receiving a nice paycheck every 2 weeks and not having to deal with insurance companies on a daily basis, becoming a full-time student once again wasn't hard to get accustomed to.

I hope I have answered some of your questions. Feel free to ask any others. My only advice is that if you really want to go to medical school, do all you can to do it. You will not regret the decision. It is tough to get in, and it is tough once you're in, but it will be a lifetime of satisfaction that in my opinion you will not find in any other profession.