Value of manipulation

[completelysure]

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I was just hoping to start a new thread about the benefits and consequences of articular manipulation. I'm wondering how many pre-osteopathic students even know what manipulation is and what it's appropriate for. I'm sick and tired of pre-DO students applying because they failed to get into MD school. I also wonder if how many people realize that DOs are a more consummate doctor than the MD counterparts. The DO education is more complete.

 

[Hedwig]

What a great post!

I absolutely agree. Unfortunately, the osteopathic profession is plagued by bad publicity. They don't advertise well. Often they don't advertise at all. And when lies are told about DOs in the press, there's seldom a rebuttal. PR is everything.

As for reputation, if DO schools began accepting ONLY top candidates and the got the reputation for only taking the cream of the undergraduate crop, it would be a whole new ballgame.

Again, kudos to you. It's so refreshing to hear someone say what you did. Personally, I'm a post-bacc premed with a 3.97, tremendous activities, and a ton of clinical experience, and I'm only 21! I'm ONLY applying to osteopathic schools because, having seen firsthand the difference a DO makes, I could not see myself being an MD. DOs are absolutely the greatest people in the world. Bright, compassionate, and a hell of a lot more fun to be around on a day-by-day basis than MDs. I don't think my patients deserve any less!

 

[solie]

I don't know what it's like being in class with people who only applied DO because "they failed to get into MD school", because I'm not in med school until August. It seems to be a source of frustration for a lot of DO med students, though.
Is this because these "MD-challenged" students have some sort of chip on their shoulders? Do they trash talk the "DO philosophy" or OMT, or talk about how "if only I had gone MD..."? That WOULD be really frustrating for the rest of us who value the education we're receiving (or are about to receive) as exactly what it is--a medical education that will prepare us to be physicians (and good ones at that!).

Although my GPA's not quite as high as Hedwig's is, I think I could have gotten into an MD school, but I ONLY applied to DO schools, because I really want to be a DO. I don't have anything against people who applied to both DO and MD, in order to maximize their chances of ultimately becomming a physician. However, if the person who'll be sitting beside me in August is only there because they couldn't (for some reason) get into an MD school and acts like the privilege of becomming a DO is somehow second-rate, I'll be pretty frustrated, too. 🙁

I'm glad that I've experienced manipulation, both as a patient, and as an observer/shadower. It gives me that much more encouragement that I'll actually be able to help people at some point.

And completelysure, I agree with you about a "more complete" education--eventually I'll be trained in a method of treatment that most MDs just don't have. Does that make DOs "better" than MDs? Nope. But it sure doesn't make us any worse, either. 🙂

And one thing's for sure, getting accepted to a DO med school is definitely NOT an easy accomplishment. So, anyone who has gotten in should be really proud of themselves and what they've achieved, regardless of whether or not they applied to MD schools as well.

 

[Sweaty Paul]

The thread was to talk about the value of articular manipulation, not rehash the md do debate that seems to go on ad nauseum. The net result of four years of medical school at either a do institution or md institution results in the ability to practice medicine in all fifty states of the union in any specialty. Getting into either type of institution is difficult, and surviving them tough. Both sets of boards are unpleasant, and yet both groups must suffer them to be deemed qualified to matricualte into thier respective 3rd and 4th years. We all suffer, whether osteopathic or allopathic a large degree of academic abuse and the lawyers and insurance executives still make too much.

Now onto the articular med and its efficacy. OTM, or your schools acronym (OMM, OMT, OPP) are better terms than articular med as you will soon be learning. Articulatory techniques are another treatment modality in the aresenal of manipulative med (OTM, OMM, OMT, OPP). Articular techniques themselves work on range of motion (ROM) of the joint that is being treated or the muscle that is being treated, and they can be a powerful tool. Other aspects of OTM are of course the ever popular "Kirksville crunch", counterstrain (a personal favorite), indirect techniques, muscle energy, cranial, high velocity low amplitude techniques, low velocity moderate amplitude, etc. There are a lot.

There have been a number of studies done showing that manual med does help to tx musculoskeletal problems effectively and with fewer drugs. Anecdotally there has been a lot reported concerning somatic-visceral responses and positive tx. However, that is the rub, they evidence is anecdotal and requires evidenced based research to truly prove its efficacy isn't merely placebo. D.O.'s bragging about their unproven tx is what cause the quack labels (Never mind trad. medicine is replete with examples of unproven treatments or treatments with pharmaceutics that work with some unknown mechanism).

Personally I think that OTM has the ability to be a powerful tool in the D.O.'s bag-of-tricks and should be used when it will benefit the patient. I plan to use it when I am in the real world and away from school, however, I think as Osteopaths we have a long row to hoe to prove the efficacy of some of our treatment modalities and move them beyond the realm of the anecdotal.

The new research center at TCOM is a great start and will hopefully fullfill some our research needs. In addition, here at KCOM, one of our clinicians was the first to recieve an NIH grant to study the efficacy of OTM in the tx of the elderly with pneumonia. His initial study showed that pts receiving trad. pharmacologic tx and otm were released from the hospital a day-and-a-half to two days earlier than those treated with pharmaceuticals alone. If this second study shows the same he will hopefully get funding for a multi-center study and this will at last prove, in a very narrow arena, what the profession has been arguing; that structure and function are interrelated and that properly alinging the structure will allow the patient to recover more quickly.

Anyway, the long and the short is I think it will help. Even if it doesn't prove to help, our pts perception is that we are invested in their health, and that is worth the extra time to tx someone if you aren't doing any harm.

Sweaty 🙂

 

[mistirvr]

Well said, Sweaty!

-Melissa 🙂

 

[drcrafey]

I am a DC applying to med school and I have found that joint manipulation is a great tool. I have had great success with it, but you need lots of tools in your bag and know when to use them to make a great doctor!
Carl

 

[CaliforniaGirl]

Completelysure's post mentioned "wondering how many pre-osteopathic students even know what manipulation is and what it's appropriate for. I'm sick and tired of pre-DO students applying because they failed to get into MD school.".

I can understand this feeling because I too, after much research, chose to apply only to DO programs. However, after I spent some time in an OMM lab with students I felt a little differently. I met a few students who WERE disappointed MD applicants. These guys were NOT aware of, or even interested in OMT when they began school. But now, they are very grateful to have the opportunity to learn and utilize OMT. I got the feeling that later in their careers they would represent the field of osteopathy very well. I still understand how you feel, but just thought I'd share a different perspective. :wink:

 

[completelysure]

I am really happy with all the responses so far, thanks everyone. I am interested in the course of the discussion, that being more focused on the manipulation aspect. The osteopathic education is the single most comprehensive health education-period. However, at what point does this become an albatross insofar as it promotes the "jack of all trades, master of none" opinion. For example, DCs go to school for over 3 years to concentrate on articular and soft tissue manipulation. At the other end, MDs concentrate purely on pharmaceuticals and other surgical and diagnostic procedures. I guess the discussion I am willing to spurn is this: Is it better to be an MD and a DC or simply a DO? Should the DO education actually be longer than what it currently is.?

 

[Sweaty Paul]

Completelysure,

Just because you are graduated from a DO or MD school doesn't mean you are competent to practice medicine, it also doesn't mean that we are done learning. This is precisely the reasons that residencies exist, including those in manipulation.
Most courses you take in your medical school careers could be likened to a survey course in western history. You cover a lot, get the big picture, then go out and specialize. Whether you are specializing in FP, internal med, opthamology, or manipulation. The OTM training you recieve is not all the info you will need to know, rather it is a foundation on which to build.
Therefore, I think that the average D.O., who chooses to utilize OTM for some parts of their practice, are more than quailified. However, if manipulation is to be the cornerstone of their practice than doing a residency or fellowship in manipulation would be best. I say this because, though I enjoy learning and utilizing manipulation, I don't want to, nor do I plan to use it as my primary tx modality (I actually see myself in a specialty cardio, anesthesia, ENT). Subsequently, I would argue that the amount of education in OTM we get at D.O. schools has to be in balance with our other clinical courses such as Cardiology, Orthopedics, OB/GYN, Pulmonology, etc.
Yes, to be in balance will mean we spend more time with OTM, because it is a tactile skill. However, to assume that all that attend D.O. schools want to become manipulators is also incorrect. D.O.'s have the best of both worlds, since we can manipulate and medicate (and get paid for both) while providing the best care for our patients.

Sweaty

 

[deebird]

Ok, so for those of use who are not disappointed MD rejects, but instead joyful pre-osteopaths and that have a basic conceptual understanding of OMT but a limited grasp of the mechanical nuts-and-bolts aspects of it, what woulds't thee suggest as resource material to augment fervered preparation for matriculation? (i.e. easy reading for the summer when I'm actually able to sit still in spite of the excitement...)
DB.

 

[OldManDave]

My most fervent of recommendations -- RELAX and ENJOY your time off. For Christ's sake -- school will begin soon enough. In the beginning, you will be awestruck by the volume and pace you are expected to absorb material. However, as do the vast majority of those who matriculate, you get much much more efficient over time and then it just becomes a way of life.

So...do not...I repeat...DO NOT try to pre-study for med school thinking that it will make things less stressful or easier. Unlike the courses you took as an undergrad, the focus is very different. BioChem in Ugrad, is focused on the chemistry...in med school, the chem is there to a degree, but the focus is on how it fits into the life-sustaining biological process. Subsequent to that, you will introduce a disease process and see how it affects the original pathway.

Long story made short, no matter where you attend med school, your time will be consumed with learning. You will learn to maximize the quality of your free time in lieu of the quantity you have become accustomed to now. So do something outlandish that you can reflect upon when you're up late for the umpteenth day in a row studying for an exam block. You will thank yourself (and me) later for heading this advice.

If I have erroneously conveyed even the slightest hint of regret for choosing to go to med school, that was not my intent. I have never worked so hard or loved being challenged so much. The things in life you must work hardest for are usually the best.

 

[Sweaty Paul]

I have got to go with OMD on this people. Don't worry about pre-studying anything whether OTM, biochem or anatomy. You will not likely learn the material in a way that you will be able to employ it to your benefit wherever you attend.

This is especially true with OTM where you really need to practice the skills and each school has their own methodology to learning otm.

Like OMD said, you should go out and have fun.

Sweaty

 

[deebird]

Forgive me, gentlemen, for it appears that my post was a bit misleading. My 'fervered preparation' will tend more toward packing, looking for an apartment, finding/earning $, etc., and will indeed include much celebrating, outdoor adventures and like... I will take your sage advice to heart. Thanks, DB

 

[Kimya]

Hello everyone,

I had another question about manipulation. I've been shadowing some DO's because I've been learning more about the field and it's philosophy, which I like more and more. The DO's I shadowed mentioned that, although they appreciated the background that manipulation gave them, they just couldn't use it in daily practice because of time constraints and because of insurance reimbursement (family practice physicians). This was a frustration in both HMO setting and group practices. So how can you get better coverage for this as a treatment tool so that it can be more effectively utilized in daily practice?

 

[Boomer]

•••quote:•••Originally posted by deebird:
•Ok, so for those of use who are not disappointed MD rejects, but instead joyful pre-osteopaths and that have a basic conceptual understanding of OMT but a limited grasp of the mechanical nuts-and-bolts aspects of it, what woulds't thee suggest as resource material to augment fervered preparation for matriculation? (i.e. easy reading for the summer when I'm actually able to sit still in spite of the excitement...)
DB.•••••I'd say get the bule OMT review book by Savarese. You'll need it come time for the COMLEX, plus I've found that it helps with weekly studying as well.

It's not that in-depth of reading, but it should at least introduce you to some of the terminology you'll hear in the class.

Still though, I agree with those above....take it easy and don't get too uptight about it...they'll throw it all at you when you get there.

 

[Sweaty Paul]

Kimya,

Never having practiced I can't with certainty answer your question. However, during my preceptorship the doctor I followed used manipulation on his patients daily. That isn't to say that everyone who came to the office got a manipulative treatment; however, some came only for a treatment, while others were given a treatment as part of their therapy for wellness. The doc I followed had over 13,000 visits to his clinic last year (he's the only doc) so manipulation can be done, but it does take time. Like anything, if you want to use it you will despite the extra time that it might take.

As for billing and reimbursement, I haven't a clue, though I know that there are codes for manipulation.

Sorry I couldn't be more helpful.

Sweaty

 

[Ben01]

•••quote:•••Originally posted by completelysure:
•I am really happy with all the responses so far, thanks everyone. I am interested in the course of the discussion, that being more focused on the manipulation aspect. The osteopathic education is the single most comprehensive health education-period. However, at what point does this become an albatross insofar as it promotes the "jack of all trades, master of none" opinion. For example, DCs go to school for over 3 years to concentrate on articular and soft tissue manipulation. At the other end, MDs concentrate purely on pharmaceuticals and other surgical and diagnostic procedures. I guess the discussion I am willing to spurn is this: Is it better to be an MD and a DC or simply a DO? Should the DO education actually be longer than what it currently is.?•••••Better take a look at this article before you decide that Chiropractic is a legitimate medical science/art:

<a href="http://www.chirobase.org/01General/skeptic.html" target="_blank">http://www.chirobase.org/01General/skeptic.html</a>

lots of other interesting articles on the main page:

<a href="http://www.chirobase.org/" target="_blank">http://www.chirobase.org/</a>

 

[completelysure]

To say that chiropractic is not a legitimate science is to also imply that osteopathic manipulation is not legitimate. Both methods are sorely lacking in scientific validation, but both have come a long way in providing evidence beyond anecdotal. In the future, I hope both chiropractic and osteopathy will endeavor to show the clinical utility and the pitfalls entailed in manipulative therapy. I hope that a pre-osteopathic student is not trying to denigrate a procedure that may be an integral part of his or her future curriculum.

 

[IlliniDC2B]

Please refrain from using the site chirobase.org to base your thoughts on Chiropractic, that is the most biased website on earth ran by Dr Barrett MD... And in general alot of it is false or mis represented...I actually read somewhere that it is being taken to court for false info on the web.(something like that)...

Anyway...I think manipulation is very helpful for all types of problems..it is a tool but not the only tool....

 

[Freeeedom!]

<a href="http://www.quackwatch.com" target="_blank">www.quackwatch.com</a> has spent many hours...long and hard fighting and exposing fraud. It even has interesting points about Osteopathic medicine, which I commented to Dr. Barrett about. There IS a slant towards antichiropractic, but chiropractors have painted themselves into a corner for DECADES!

Back to the topic...yes, manipulation is a valuable adjunct to other forms of medical treatment.