Scientific Validity of OMM

[deleted771945]

Hello all. I'm getting ready for school and I'm wondering about OMM/OMT and how "true" or evidence-based it is relative to the other parts of medicine that we have to learn. Should I approach the subject with caution or treat it as equal to other classes? Which will make my life easier?

Thanks.

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[BobbyKoch]

Give it the bare minimum of your attention required to pass

 

[Goro]

Treat it as
1. A tax on you for lower GPA and/or MCAT
2. A means to have great palpation, surface anatomy, and human contact skills.
3. Suspend your disbelief and see if you can learn something useful.
4. A collection of many unproven claims

 

[DrZoidbergDO]

The muscle energy type stuff is somewhat interesting and useful, it's stuff like cranial and chapmans which are dumb AF

 

[Proudfather94]

I've heard a lot of it is useful especially for things like back pain. Honestly if it could prevent a patient from needing to go on pain medications or lower the amount they're taking it would be worth it to me.

 

[Goro]

The muscle energy type stuff is somewhat interesting and useful, it's stuff like cranial and chapmans which are dumb AF

Ahh yes, Chapman's points. They don't exist. Period.

Just smile and think of England when the subject is brought up.

 

[Sleepingdoc]

I've heard a lot of it is useful especially for things like back pain. Honestly if it could prevent a patient from needing to go on pain medications or lower the amount they're taking it would be worth it to me.

I have heard the same things/rumors about physical therapy/occupational therapy as well about all it is just trying to get patient to move when in general people are just lazy.

With regards to this reply above, I agree, when you start practicing there will be many people who come to your office for pain meds for general msk pain. If you could use other modalities to stop the pain, then yes its worth it.

 

[DOVinciRobot]

OMM teaches the cranial bones move… so…. Most of it’s not evidence based.

The stuff that is beneficial is functionally PT and makes up a very small percentage of what OMM actually is, and is only a useful tool for physicians in specific specialties such as sports med, FM who sees a lot of MSK complaints, etc.

 

[SurgDoc95]

It’s as goro said a tax on going DO. It’ll teach you to be less awkward doing a physical exam, gives you a better understanding of muscular and bone-y anatomy and is otherwise a time suck. That being said, with step and level 1 being pass/fail it’s less of a detriment to your ability to score high. It’s a great time for a free massage during the first semester if nothing else

 

[hellosnd]

My school cited papers... performed on dogs....

 

[DOVinciRobot]

My school cited papers... performed on dogs....

I’ll one up you. My faculty published papers on rats… with N values of less than 15…. Where greater than 5 rats died during the study and weren’t even included in the statistical analysis to manipulate the data…

 

[Goro]

I’ll one up you. My faculty published papers on rats… with N values of less than 15…. Where greater than 5 rats died during the study and weren’t even included in the statistical analysis to manipulate the data…

Lemme guess, this ended up in that monument of scientific journals, the JAOA?

 

[voxveritatisetlucis]

How does one massage a rat, anyway?

 

[Darrow O'Lykos]

My school cited papers... performed on dogs....

Properly aligning the sacrum = increased flexibility to lick one's own balls.

It's science.

 

[Lawpy]

When you graduate and start to practice you’ll see just how much bull**** a lot of “evidence based” medicine is.

Yeah it’s not just OMM. There’s a lot of crap in medicine that isn’t really scientifically backed and/or is driven by poor statistical analyses.

 

[hellosnd]

How does one massage a rat, anyway?

With osteopathic hands, anything is possible

 

[Osminog]

Most of osteopathy belongs in a museum. Some of it belongs in the curricula of physical therapy and chiropractic programs. None of it belongs in the curricula of modern medical institutions.

 

[MateoGM416]

Yeah it’s not just OMM. There’s a lot of crap in medicine that isn’t really scientifically backed and/or is driven by poor statistical analyses.

Examples?

 

[culturekweenXx]

Even the basis of osteopathic diagnosis and treatment seems unfounded. Where’s the evidence that multiple practitioners can reliably find the same somatic dysfunction in a patient? That these dysfunctions actually palpably improve after treatment? That sidebending and rotational dysfunctions of the spine are in the same or opposite direction based on (insert factor here)?

 

[Ho0v-man]

Literally any spine surgery ever?

Scaminectomies

 

[Angus Avagadro]

From March 2020. I guess its worth reposting again.



Below is from a post I put up in January 2020. I believe it is worth reposting in this thread. These articles are from mainstream peer reviewed journals, some of the top in their specialty. Many more exist in the JAOA file. Noll, et al, has studies on pneumonia with N's in the 200's.

I have been listening to medical students trash OMM for a couple years now without any feedback. Remember pre meds read SDN and might actually think you know what you are talking about. It is not all pseudoscience. Mainstream journals aren't in the habit of publishing pseudoscience.
Annals of Internal Medicine: 2004, 141; 432-439
Manipulative Therapy in Addition to Usual Medical Care for Patients with Shoulder Dysfunction and Pain;
Gert J.D. Bergman, et al.
American Journal of Obstetrics and Gynecology, (ACOG Green Journal), Am J Obstet Gynecol 2010; 202:43.e1-08
Osteopathic Manipulative Treatment of Back Pain and Related Symptoms during pregnancy: a Randomized Controlled Trial
John C. Licciardone, D.O. et al.
Annals of Internal Medicine; 21 December 2004; Vol 141: Number 12; pp. 920-928.
A Clinical Prediction Rule to Identify Patients with Low Back Pain Most Likely to Benefit from Spinal Manipulation: A validation Study
Maj John D. Childs, PhD, et. al.
Annals of Thoracic Surgery: 2017 Jul;104(1): `45-152. doi: 10.1016/j.athoracsur.2016.09.110. Epub 2017 Jan18
Osteopathic Manipulative Treatment Improves Heart Surgery Outcomes: A Randomized Controlled Trial.
Racca V, et. al.
These are some articles published in peer reviewed mainstream journals showing positive correlations with OMT. These articles don't represent a cure for cancer or for the common cold, but suggest OMT was beneficial in their study and like anything, more work is needed. Students having trouble wrapping their arms around cranial and Chapmans points is understandable. Too many students have very firm opinions about OMT and should reserve them until they have actually treated patients, not classmates, with OMT. Once again, these mainstream journals are not in the habit of publishing pseudoscience. Whew, got that off my chest.....


In addition,for the enthusiasts of Evidence Based Medicine, in all reality, it is actually "Best" Evidence Based Medicine. In medicine, before one changes the parameters of their practice, data should be reproduced at other centers. It can be risky to change ones practice on a single peer reviewed article. Why do I say this? The Lancet, probably the most prestigious medical journal on the planet, published a paper suggesting that childhood vaccines appeared to have a role in Autism. We today, are still suffering from the fallout of that error with the ubiquitous anti vaxer movement. Perdue Pharma published data in in the New England Journal of Med if my memory is accurate, during the 90's that suggested one could not become addicted to opiates if they were taken while one was experiencing pain. We have seen the horrific results of that in the opioid epidemic. 250 to 300 drugs were taken off the market last year by the FDA. Good work, right? Except for the fact that the FDA, using Evidence Based Medicine, APPROVED them initially. Medical students, for all of the decades I was in med ed, have attempted to tell their trainers what they need to know, having never practiced medicine. I take it all with a grain of salt.

 

[DO2015CA]

OMM teaches the cranial bones move… so…. Most of it’s not evidence based.

The stuff that is beneficial is functionally PT and makes up a very small percentage of what OMM actually is, and is only a useful tool for physicians in specific specialties such as sports med, FM who sees a lot of MSK complaints, etc.

It is also dependent on where you go to school. My school was very heavily ME/CS. IIRC, we had 2 cranial labs and zero Chapman’s points ones but rather told to memorize the points for the comlex only. TBF, those faculty are no longer at my school and I have no clue what their replacements are teaching.

 

[PhD_to_DO]

Hello all. I'm getting ready for school and I'm wondering about OMM/OMT and how "true" or evidence-based it is relative to the other parts of medicine that we have to learn. Should I approach the subject with caution or treat it as equal to other classes? Which will make my life easier?

Thanks.

There is quite a bit of OMM/OMT that will leave you scratching your head. There are things that you’ll learn for which the evidence is sketchy at best. However, there are some things that have a strong evidence base and will be quite useful in practice. My wife bought me a massage table so that I can practice on her; I’ve seen her chronic back pain improve dramatically because of some of the techniques that I’ve learned. Ditto for my dad; he no longer takes toradol injections for hip and knee pain since he started biweekly OMM/OMT. You’ll really learn your surface anatomy/anatomical land marks and develop great palpatory skills.

Its an easy class and doesn’t take too many brain cells to pass but I know a student at another school who failed out of her program because she failed OMT twice. She said that she just couldn’t get into it and didn’t take it seriously. Don’t be her.

 

[Metamorphosis.DO]

The muscle energy type stuff is somewhat interesting and useful, it's stuff like cranial and chapmans which are dumb AF

Agreed. Chapmans and cranial are wildly fairytale land. It is disgraceful to the profession. It should be removed from the curricula of all schools and from boards. Wildly unscientific.

HVLA in my experience is not efficacious but is a nice party trick.

I’ve actually seen some anecdotal efficacy mostly in muscle energy (despite the stupid sounding name) and some in counter strain.

Learn good surface anatomy and palpation skills. It’s nice feeling so comfortable with different body habitus when you get to rotations. Also, saying a treatment is placebo is not condescending. If it works, let it work for the patient. If they want to get acupuncture (not by you) or use essential oils and it works, let them. It’s better than drugs/surgery. That doesn’t mean I don’t think that some modalities are anti scientific and should be removed, however.

 

[shaggybill]

One thing you'll learn quickly when you deep dive into the "evidence" behind a lot of modern medicine is that there is too much influence from the pharmaceutical industry, there is bias, and there is poor quality (44% risk reduction for statins, yeah right). OMT research carried out by OMT doctors has an inherent bias because it NEEDS to be beneficial to justify its existance. A lot of docs swallow research hook, line, and sinker because we need things to be black and white. We need a fast answer so we can move on to the next patient. We don't have time to question and prod.

Alright, taking my jaded self elsewhere.

 

[Jberto2018]

OMM is useful, but not enough to give it attention if you aren't going to be using it frequently. Cranial is fake, Chapmans points are fake. There are other examples also. I have had personal benefit with sacral, spinal, and msk manipulation. I think the most frustrating aspect of OMM is trying to figure out what is real and what is complete nonsense.
Older DO's need to come around to the fact that the younger generation doesn't buy into woo woo. Honestly it's crazy that licensed Doctors are allowed to be taught some of the stuff we are.....it's even more frustrating because we learn everything else an MD would, so by doing more we delegitimize ourselves to some degree. Very frusterating.

 

[macman]

Looks like I am in the minority here but here goes....

If you applied and were accepted at a DO school then my advice would be to excel in ALL subjects presented, whether that be microbiology or OMT

"how you do anything is how you do everything"

i.e. you are in professional school and should act and think like a professional, that may mean do things that aren't your favorite but always giving 110%

Yes, you may have some OMM professors that seem a little out there, but much of OMT is very similar to PT and chiro, which are very well accepted and studied modalities. There are many papers out there which presented reasonable evidence for spinal manipulation, particularly with regard to spine issues. The quality of the evidence does not tend to be very good because A it is very difficult to study low back pain and B it is even more difficulty to study physical modalities

The physical exam skills alone that you can gain from OMM/OMT make it worth your while to apply yourself

If you feel you cannot be bothered to apply yourself in all subjects then being a doctor may not be the best pathway for you, or you may have more maturing to do... I know that is a bit direct and harsh...

I had friends in DO school who liked to party and said "7-O equals DO", i.e. just do enough to pass. they either didn't match or matched to poor residencies, and many are no longer docs

 

[Eric Harris]

Hello all. I'm getting ready for school and I'm wondering about OMM/OMT and how "true" or evidence-based it is relative to the other parts of medicine that we have to learn. Should I approach the subject with caution or treat it as equal to other classes? Which will make my life easier?

Thanks.

I am one of the DOs that regularly uses OMT. You have to use it to get good at it. I commonly treat carpal tunnel for mild to moderate cases that do not need surgery. I treat a lot of back pain. You can turn off hypertonic muscles to allow them to participate in PT. Unless someone has a simple acute issue, you usually need to incorporate PT. OMT is useful when it is correctly used.

 

[dabears505]

It's probably better than putting people on a bunch of meds or doing unnecessary surgery.

 

[MateoGM416]

The thing that blows my mind about osteopathy is that medical school curriculum is supposed to be so difficult to get into, so rigorous, and science-based but at the same time tries to convince us that stuff like chapmans' points exist. But of course some of OMM is clinically useful.

What happens though when DO students and schools eventually push back enough to say that a lot (if not most) of what distinguishes osteopathic medicine and allopathic medicine is hogwash? Are they just gonna start awarding MD degrees or is OMM that integral to the profession? Lol

 

[NontradICUdoc]

I have been using OMT on some of my patients and there are those that it does help and those that it does not. The literature is far behind in its evidence. There has been an increase in the amount of literature utilizing US for proof of concept for certain musculoskeletal procedures such as myofacial release and muscle energy. Of course, the proof is in the pudding, does the patient get relief from the treatment or not?

One advantage is the use of the palpatory skills that you will learn and it is an extra layer of anatomy to review, especially origins and insertions of tendons. Don't poo poo it as it will affect your grades.

 

[orthoPA81]

Rising OMS2 here. I’ll add that students who are the most miserable and complain about OMT are usually those that do poorly on written and practical exams.

It’s amazing how much more enjoyable it is when you learn it well and get rewarded. Whenever I find myself bitter about osteopathy material it’s because I’ve been slacking and my grades slip.

Only other thing I’ll add is I’ve used muscle energy on my wife for msk complaints and she feels much better.

 

[TragicalDrFaust]

There is very limited evidence that some modalities can address lower back pain. But there are inherent issues with studying OMM bc it’s difficult, maybe impossible, to make a control group where one does sham treatments.

I have trouble trusting OMM because the inter rater reliability is so low. Ie ask 10 docs get 11 answers.

But you really only need to do the bare minimum to pass at my school. I passed by cramming a day or two before the test first year and two or three days before the test second year.

At the same time I’ve appreciated learning OMM for the hands on anatomy lesson and palpation skills. It’s valuable to be comfortable touching patients.

My wife and other people around me often request OMM treatments and I oblige. Suboccipital inhibition and Spencer’s are favorites. They know my thoughts on it but seem to feel a benefit from it despite. As a rising OMS 3 I’m not sure how comfortable I would be telling patients it’s firmly evidence based but I would be open to suggesting it for certain MSK ailments if they were open to it.

I need to find the study where they did sham KNEE SURGERY and the placebo effect was strong enough that the majority of people felt a benefit from that. Anyone have it it handy?

As a future physician, rather than a phd, I think it’s ok to ask “does it work” rather than “why does it work” sometimes.

 

[Metamorphosis.DO]

What happens though when DO students and schools eventually push back enough to say that a lot (if not most) of what distinguishes osteopathic medicine and allopathic medicine is hogwash? Are they just gonna start awarding MD degrees or is OMM that integral to the profession? Lol

I have wondered this as well. Asserting that DOs are more holistic is inaccurate. Truly, its time for a major facelift. Remove the quacky modalities of Chapman’s points, Cranial, most viscerosomatics, lymphatic, and some HVLA. Reduce the hours to 100 and focus on ME/CS with some HVLA primarily to treat back/neck pain and some nerve entrapment. Would that even set DOs apart? Not really. So again, do they switch to just awarding MDs? They did it in California a while ago.

having gone through the training, I kept an open mind and I’ve decided that I’ll likely use close to none of it. Maybe some in OB patients. Then again, doesn’t take a DO to perscribe some at home exercises.

 

[Spine MD]

Literally any spine surgery ever?

Hey now, let’s not leave out interventional pain; at least spine surgeons can stabilize a traumatic fracture or cut out some mets every now and then…

 

[JDWannabe]

I have wondered this as well. Asserting that DOs are more holistic is inaccurate. Truly, its time for a major facelift. Remove the quacky modalities of Chapman’s points, Cranial, most viscerosomatics, lymphatic, and some HVLA. Reduce the hours to 100 and focus on ME/CS with some HVLA primarily to treat back/neck pain and some nerve entrapment. Would that even set DOs apart? Not really. So again, do they switch to just awarding MDs? They did it in California a while ago.

having gone through the training, I kept an open mind and I’ve decided that I’ll likely use close to none of it. Maybe some in OB patients. Then again, doesn’t take a DO to perscribe some at home exercises.

With all that being said, I would say that there has been some good research showing lymphatic technique (splenic pump) works extremely well with improving antibody response post-vaccination. Additionally, I would propose that the efficacy of a technique is directly proportional to the skill level of the practitioner. I've used every technique taught on patients (and oftentimes combine multiple approaches simultaneously) with a noted improvement stated by each treated almost without exception.

 

[Darrow O'Lykos]

Are they just gonna start awarding MD degrees or is OMM that integral to the profession? Lol

It's what should happen, but most COCA schools can't (or won't) meet LCME standards, so they'll continue peddling the montra that osteopathy is in$eparable from clinical practice.

Any DO school that can't meet LCME standards should be closed IMO. The argument that they shouldn't be held to LCME standards because they don't have resources or because they are "primary care focused" is so problematic because it's essentially giving a soft affirmation that it's okay to train physicians at a standard beneath what is expected/required, or furthermore that it's okay to train primary care physicians at a substandard level. That's obviously not to say that DOs = substandard MDs, but the problem is that on one side, administrations are okay with perpetuating the story

I don't know if the LCME would ever consider it okay for MD schools to grant MS's in OMT (or if they even oversee dual degree paths at MD schools for MBAs, MPHs, etc.) , but if they would, that would be the perfect scenario. Let students opt in and out of it just as clinicians do. Stop arguing that it makes one set of board certified physicians more holistic than another, or that training in it is essential to treating patients.

 

[Angus Avagadro]

Examples?

The use of muscle relaxants for back pain/strain. Carisoprodol, Cyclobenzaprine,Metaxalone. All useless and addicting, but still prescribed today.

 

[LadyDustyBlue]

The use of muscle relaxants for back pain/strain. Carisoprodol, Cyclobenzaprine,Metaxalone. All useless and addicting, but still prescribed today.

Applying anything similar to PT (like OMM) prior to resorting to surgery that comes with it’s own traumas & risks sounds way better than putting a patient through potentially-unnecessary risk and cost. And true, we live in a country that also tends to prescribe medications patients can easily abuse.

From March 2020. I guess its worth reposting again.



Below is from a post I put up in January 2020. I believe it is worth reposting in this thread. These articles are from mainstream peer reviewed journals, some of the top in their specialty. Many more exist in the JAOA file. Noll, et al, has studies on pneumonia with N's in the 200's.

I have been listening to medical students trash OMM for a couple years now without any feedback. Remember pre meds read SDN and might actually think you know what you are talking about. It is not all pseudoscience. Mainstream journals aren't in the habit of publishing pseudoscience.
Annals of Internal Medicine: 2004, 141; 432-439
Manipulative Therapy in Addition to Usual Medical Care for Patients with Shoulder Dysfunction and Pain;
Gert J.D. Bergman, et al.
American Journal of Obstetrics and Gynecology, (ACOG Green Journal), Am J Obstet Gynecol 2010; 202:43.e1-08
Osteopathic Manipulative Treatment of Back Pain and Related Symptoms during pregnancy: a Randomized Controlled Trial
John C. Licciardone, D.O. et al.
Annals of Internal Medicine; 21 December 2004; Vol 141: Number 12; pp. 920-928.
A Clinical Prediction Rule to Identify Patients with Low Back Pain Most Likely to Benefit from Spinal Manipulation: A validation Study
Maj John D. Childs, PhD, et. al.
Annals of Thoracic Surgery: 2017 Jul;104(1): `45-152. doi: 10.1016/j.athoracsur.2016.09.110. Epub 2017 Jan18
Osteopathic Manipulative Treatment Improves Heart Surgery Outcomes: A Randomized Controlled Trial.
Racca V, et. al.
These are some articles published in peer reviewed mainstream journals showing positive correlations with OMT. These articles don't represent a cure for cancer or for the common cold, but suggest OMT was beneficial in their study and like anything, more work is needed. Students having trouble wrapping their arms around cranial and Chapmans points is understandable. Too many students have very firm opinions about OMT and should reserve them until they have actually treated patients, not classmates, with OMT. Once again, these mainstream journals are not in the habit of publishing pseudoscience. Whew, got that off my chest.....


In addition,for the enthusiasts of Evidence Based Medicine, in all reality, it is actually "Best" Evidence Based Medicine. In medicine, before one changes the parameters of their practice, data should be reproduced at other centers. It can be risky to change ones practice on a single peer reviewed article. Why do I say this? The Lancet, probably the most prestigious medical journal on the planet, published a paper suggesting that childhood vaccines appeared to have a role in Autism. We today, are still suffering from the fallout of that error with the ubiquitous anti vaxer movement. Perdue Pharma published data in in the New England Journal of Med if my memory is accurate, during the 90's that suggested one could not become addicted to opiates if they were taken while one was experiencing pain. We have seen the horrific results of that in the opioid epidemic. 250 to 300 drugs were taken off the market last year by the FDA. Good work, right? Except for the fact that the FDA, using Evidence Based Medicine, APPROVED them initially. Medical students, for all of the decades I was in med ed, have attempted to tell their trainers what they need to know, having never practiced medicine. I take it all with a grain of salt.

The history on the opiates prescription and only finally restrictions are being made is, indeed a scary thought too.

 

[butidontwantto]

Like others have said, some of it is useful. Cranial, chapman points, and faculty making claims that it can cure autism is where it loses me....

 

[Angus Avagadro]

Applying anything similar to PT (like OMM) prior to resorting to surgery that comes with it’s own traumas & risks sounds way better than putting a patient through potentially-unnecessary risk and cost. And true, we live in a country that also tends to prescribe medications patients can easily abuse.



The history on the opiates prescription and only finally restrictions are being made is, indeed a scary thought too.

Applying manual medicine prior to surgery is useful. The Euros don't operate on radicular back pain unless you are in a diaper, i.e., Cauds Equina Syndrome. They are socialists and patients can take several months off to rehab. Roughly 85% of herniated disc's will heal. Takes about 6 weeks to several months. We operate so people can get back to work sooner, but the incidence of Failed Back( failure to respond to surgery or rehab) is the same for either approach.

 

[FarmerToDoctor]

It’s as goro said a tax on going DO. It’ll teach you to be less awkward doing a physical exam, gives you a better understanding of muscular and bone-y anatomy and is otherwise a time suck. That being said, with step and level 1 being pass/fail it’s less of a detriment to your ability to score high. It’s a great time for a free massage during the first semester if nothing else

I legit fell asleep in lab one time when we were doing craniofacial lymphatics. It felt like my entire face was getting a great massage.

 

[FarmerToDoctor]

CS/ME may have some validity and demonstrate immediate relief/improvement in your patients. Study it enough just so that you don't fail it (1-3 hours/week). Some of the topics are pretty far out there. I do not plan on utilizing any of it on my patients once I start residency.

Despite what others have said, Chapman Points are the gold standard of modern medicine

 

[Cath Up]

From March 2020. I guess its worth reposting again.



Below is from a post I put up in January 2020. I believe it is worth reposting in this thread. These articles are from mainstream peer reviewed journals, some of the top in their specialty. Many more exist in the JAOA file. Noll, et al, has studies on pneumonia with N's in the 200's.

I have been listening to medical students trash OMM for a couple years now without any feedback. Remember pre meds read SDN and might actually think you know what you are talking about. It is not all pseudoscience. Mainstream journals aren't in the habit of publishing pseudoscience.
Annals of Internal Medicine: 2004, 141; 432-439
Manipulative Therapy in Addition to Usual Medical Care for Patients with Shoulder Dysfunction and Pain;
Gert J.D. Bergman, et al.
American Journal of Obstetrics and Gynecology, (ACOG Green Journal), Am J Obstet Gynecol 2010; 202:43.e1-08
Osteopathic Manipulative Treatment of Back Pain and Related Symptoms during pregnancy: a Randomized Controlled Trial
John C. Licciardone, D.O. et al.
Annals of Internal Medicine; 21 December 2004; Vol 141: Number 12; pp. 920-928.
A Clinical Prediction Rule to Identify Patients with Low Back Pain Most Likely to Benefit from Spinal Manipulation: A validation Study
Maj John D. Childs, PhD, et. al.
Annals of Thoracic Surgery: 2017 Jul;104(1): `45-152. doi: 10.1016/j.athoracsur.2016.09.110. Epub 2017 Jan18
Osteopathic Manipulative Treatment Improves Heart Surgery Outcomes: A Randomized Controlled Trial.
Racca V, et. al.
These are some articles published in peer reviewed mainstream journals showing positive correlations with OMT. These articles don't represent a cure for cancer or for the common cold, but suggest OMT was beneficial in their study and like anything, more work is needed. Students having trouble wrapping their arms around cranial and Chapmans points is understandable. Too many students have very firm opinions about OMT and should reserve them until they have actually treated patients, not classmates, with OMT. Once again, these mainstream journals are not in the habit of publishing pseudoscience. Whew, got that off my chest.....


In addition,for the enthusiasts of Evidence Based Medicine, in all reality, it is actually "Best" Evidence Based Medicine. In medicine, before one changes the parameters of their practice, data should be reproduced at other centers. It can be risky to change ones practice on a single peer reviewed article. Why do I say this? The Lancet, probably the most prestigious medical journal on the planet, published a paper suggesting that childhood vaccines appeared to have a role in Autism. We today, are still suffering from the fallout of that error with the ubiquitous anti vaxer movement. Perdue Pharma published data in in the New England Journal of Med if my memory is accurate, during the 90's that suggested one could not become addicted to opiates if they were taken while one was experiencing pain. We have seen the horrific results of that in the opioid epidemic. 250 to 300 drugs were taken off the market last year by the FDA. Good work, right? Except for the fact that the FDA, using Evidence Based Medicine, APPROVED them initially. Medical students, for all of the decades I was in med ed, have attempted to tell their trainers what they need to know, having never practiced medicine. I take it all with a grain of salt.

The critique from students is absolutely warranted. Having been through it I strongly disagree with you. The most shameful part of OMT that is usually not found in other non-evidence based treatments is the dogma, and that's what causes students to (very reasonably) throw out the baby with the bath water. You can't teach me reasonable PT-like mechanisms and stretching exercises that all have a basis in reality... alongside cranial sacral rhythm and non-resectable, non-visualizable lumps of tissue, and tell me they're all supported and real. That results in a loss of credibility and a lack of interest. Students don't lack an ability to wrap their heads around cranial and chapman's points- they aren't real. An entire field of OMT instructors/practitioners banding together and pretending like they exist is extremely harmful to the parts of OMT that have value, and to the DO degree. There's definitely some value in aspects of OMT but ignoring all nuance and accepting the pseudoscientific treatments in it -which is how it is currently taught and ostensibly practiced- is inconsistent with solid reasoning.

The ideal move would be to export OMT to PT and chiropractics in my opinion. It doesn't make sense to have a subset of physicians that have spent 300 extra hours in palpatory/muscle energy/stretching exercises. That should obviously come later in training for people that are specifically interested in those topics, if at all, in medical training. The next best thing would be to eliminate historical artifacts that have not withstood the test of time- namely Chapman's points, cranial stuff, tender points, and focus on treatments that actually appear to have some efficacy and a reasonable pathophysiologic/mechanistic theory behind them.

 

[Angus Avagadro]

The critique is absolutely warranted. Having been through it I strongly disagree with you. The most shameful part of OMT that is usually not found in other non-evidence based treatments is the dogma, and that's what causes students to (very reasonable) throw out the baby with the bath water. You can't teach me reasonable PT-like mechanisms and stretching that has a basis in reality... alongside cranial sacral rhythm and non-resectable, non-visualizable lumps of tissue, and tell me they're all supported and real. That results in a loss of credibility. Students don't lack an ability to wrap their heads around cranial and chapman's points- they aren't real. An entire field of OMT instructors/practitioners banding together and pretending like they exist is extremely harmful to the parts of OMT that have value, and to the DO degree.

I never said the critique was unwarranted, and your disagreement is welcomed. OMM complaints mostly occur in an echo chamber without rebuttal. So I rebutted. Med students like to tell instructors what they need to know without ever treating patients. Secondly, just what did I post that was inaccurate? As far as observational medicine, Traditional Chinese Medicine(Barefoot Doctors) has 2,000 years of observation. My old Chief went to China and witnessed a c section done entirely under accupuncture. So dont believe your lying eyes? Acupuncture follows no anatomic pathways, but has enough evidence that insurance pays for it. Insurers pay for OMT also. I have seen PTs perform HVLA, not very well, so why then do they do it? Chiropractors parking lots aren't empty. People wouldn't spend their hard earned cash if they didn't feel better. You don't need to do a double blinded randomized trial to suggest its raining outside. As far as your comments about non evidence based OMT, you appear to discount the evidence based peer reviewed journal articles I referenced. But I get it. Once in your heart, it is hard to change, even when presented with facts. I didn't post to change minds or argue. Just to be the dissenting voice in an echo chamber. Pre meds read these forums and might believe OMM has no value.

 

[Lawpy]

Any DO school that can't meet LCME standards should be closed IMO. The argument that they shouldn't be held to LCME standards because they don't have resources or because they are "primary care focused" is so problematic because it's essentially giving a soft affirmation that it's okay to train physicians at a standard beneath what is expected/required, or furthermore that it's okay to train primary care physicians at a substandard level. That's obviously not to say that DOs = substandard MDs, but the problem is that on one side, administrations are okay with perpetuating the story

I agree. I also hate the implied notion of DO = primary care and MD = specialty because there’s great doctors in both. I know brilliant and amazing PCPs who went to top schools, and I know great surgeons who are DOs. The barrier needs to disappear even if it means underperforming DO schools are forced to close