What defines OMT?

[MRSAful Fate]

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Last week I had a plenary session to prepare for my OMT rotation two months and the DO facilitating told us that our experiences on our OMM rotations would range from what we had done in lab to all cranial to purely "energy work." All of these docs advertise themselves as OMM specialists but they provide extremely different services, and much of what they do sounds like it would be completely foreign to what is taught in OP&P labs.

So what defines OMT? Where is the line? If I can somehow justify what I'm doing using the four principals can it be considered OMT? Without the standard of an evidence based approach is there anything stopping a DO from going out and making up random techniques (or manipulating chakras, laying hands on someone and "manipulating their energy fields", etc) and billing for OMT? How far down the rabbit hole does it go before you leave the OMT world? Having a bit of an existential crisis here...

 

[Textbookversion]

"energy work" sounds nutty

 

[babdoc]

From DiGiovanna's book: "Somatic dysfunction is an impaired or altered function of related components of the somatic parenthesis body framework) system: skeletal, arthrodial, and myofascial structures, and related vascular, lymphatic, neural elements." --pg. 16

Furthermore: "OMT is directed specifically at the treatment of somatic dysfunctions, which involve the body framework--joints, muscles, faster, tendons, and ligaments as well as blood vessels and the nerves that are involved with these structures" --pg. 77

Savarese's OMT Review states: "The goal of osteopathic treatment is to eliminate [somatic dysfunction], thus restoring symmetry. [...] In a direct treatment, the practitioner "engages" the restrictive barrier. [...] In an indirect treatment the practitioner moves tissues and/or joints away from the restrictive barrier into the direction of freedom." --pg. 8

So, to me, OMT acts in the realm of specifically palpable findings involving musculoskeletal structures as well as those structures that support them (i.e. lymphatics, nervous, and vascular). So, the buck stops there for me. I guess there's all that GI manipulation, etc. too, but that's probably not too far from the definitions that we are given in OMT coursework--if only tangentially related.

Beyond that, it seems these doctors are crossing over into other sCAM (supplements, complementary, and alternative medicine) modalities--coopting concepts from energy "medicine", reiki, etc. I believe you are hitting this point rhetorically. When you incorporate other techniques and concepts that do not follow standard definitions of Somatic Dysfunction and OMT, you pass beyond the scope of osteopathic treatment. Therefore, these methods should not pass for (or be billed as) OMT.

So, yeah. Basically it's all nutty.

 

[Instatewaiter]

So what defines OMT? Where is the line?

Quackery... OMT is defined by quackery

 

[se20001984]

Quackery... OMT is defined by quackery

👍👍👍👍👍

 

[Dharma]

🙄 Nice how the two opinions expressed above are coming from 2 individuals without any experience in OMT. (or is that another didn't- change-status "pre-med"?)

A good bulk of it is based in understanding of anatomy and physiology, structure and function. There are most definitely the whacked out topics, but this is not representative of the entirety. (Premeds: Refrain from passing judgement until you actually give it a chance if you plan on a D.O. school). And don't let the negative aspects shed similar light on the techniques and approaches that are effective.

OP: Structure and function. Stick to the basics. Know your anatomy and physiology well. Apply the techniques that demonstrate the understanding. Anything beyond that, may be going to the side of quack.

 

[NOsaintsfan]

Magic is a key element in any good OMT practice, along with a good supplier of energy crystals.

A background in voodoo and performing séances will serve you well.

Above is correct though, a good bit of OMT is based on anatomy and being able to understand the movement of the skeletal system on its various axis.

The rest is magic, mostly dark magic.

 

[babdoc]

Premeds: Refrain from passing judgement until you actually give it a chance if you plan on a D.O. school.

I'd add recommending a good literature search coupled with a dose of critical thinking and an understanding of what good research is. Everything in OMT lab is presented as being efficacious when it is not always so. Not totally dogging on OMT here, it's just important to know its role.

 

[Didierdrogba]

Quackery... OMT is defined by quackery

Not necessarily. Much of OMT is pretty legit, and is very similar to what PT's do, especially the musculoskeletal stuff. But other things.... yeah....

Either way, don't underestimate the power of touch!

 

[JGimpel]

MD with some Chiropractic and Physical/Massage Therapy added in and further enhanced by the DO sensing the Cranial Rhythmic Impulse from the patient's big toe through his shoe.

 

[Banned]

MD with some Chiropractic and Physical/Massage Therapy added in and further enhanced by the DO sensing the Cranial Rhythmic Impulse from the patient's big toe through his shoe.

I've managed to sense cranial impulse through Skype. You need to work on your HVLA high volume bs low aptitude ebm to really feel the chakras. Upgrading your steth to a high quality energy crystal is also very helpful.

 

[JGimpel]

I've managed to sense cranial impulse through Skype. You need to work on your HVLA high volume bs low aptitude ebm to really feel the chakras. Upgrading your steth to a high quality energy crystal is also very helpful.

Preach on, brother.

 

[Dharma]

I'd add recommending a good literature search coupled with a dose of critical thinking and an understanding of what good research is. Everything in OMT lab is presented as being efficacious when it is not always so. Not totally dogging on OMT here, it's just important to know its role.

Agreed. But lack of current research does not necessarily negate efficacy. If anything it highlights the fact that what is needed is more quality research. Critical thinking should lend one the ability to see how many of these techniques could be quite effective in the right hands. There are a lot of variables at work in OMT (especially that of practitioner skill) so it is a difficult field to research. That said, this is no excuse to shy away from proper research.

 

[Kevin Baker]

Agreed. But lack of current research does not necessarily negate efficacy. If anything it highlights the fact that what is needed is more quality research. Critical thinking should lend one the ability to see how many of these techniques could be quite effective in the right hands. There are a lot of variables at work in OMT (especially that of practitioner skill) so it is a difficult field to research. That said, this is no excuse to shy away from proper research.

I don't disagree with this sentiment in the long run but based on my experience with OMT, lack of research isn't the main issue. The main issue is faculty trumping up poor research and making claims poorly supported in science, not supported in science, or worse, selecting only positive studies while ignoring the negative ones. Imo, OMT as currently taught isn't limited by research. It's limited by teachers who purposefully or ignorantly use bad science to advance a point. If that's the case, more research isn't the solution and could even be harmful. More knowledgable/less biased teachers, a change in culture, and advancement of critical thinking in both students and faculty should first be addressed. Then we can add on proper research.

 

[felix2929]

you have to do an OMT rotation? is this the norm?

 

[Dharma]

I don't disagree with this sentiment in the long run but based on my experience with OMT, lack of research isn't the main issue. The main issue is faculty trumping up poor research and making claims poorly supported in science, not supported in science, or worse, selecting only positive studies while ignoring the negative ones. Imo, OMT as currently taught isn't limited by research. It's limited by teachers who purposefully or ignorantly use bad science to advance a point. If that's the case, more research isn't the solution and could even be harmful. More knowledgable/less biased teachers, a change in culture, and advancement of critical thinking in both students and faculty should first be addressed. Then we can add on proper research.

👍 Solid points. What I have noticed are some major discrepancies between OPP professors in terms of utilization of and approach towards the OMT (and the subject of osteopathic medicine in general). There are those who tend towards the end of the spectrum you mentioned above (i.e. unsubstantiated claims and veering off the path of that which could be explained by basic anatomy and physiology), yet still there are the few (unfortunately, the minority) who keep it at a level that could be backed by current understanding of A&P, and in doing so practice techniques that are effective. The problem is that the former usually make up a bulk of faculty and those who become the "voice" of the osteopathic profession as a whole.

Regardless, some good ol' ME is good by me any day of the week when done with skill and could be a great tool for any physician working with musculoskeletal issues. We spent most of MS1 OPP working on muscle energy and I don't see anything outlandish about its principles or uses.

 

[n3xa]

you have to do an OMT rotation? is this the norm?

At our school it is. I think we may even have a longer OMT core rotation compared to other schools, but I'd have to check on that.

 

[Tizoc]

OMM rotations are entirely optional at our school.

 

[Styria]

From the NMM/OMM residency guidelines:

Emphasis must be placed on techniques (HV/LA), muscle energy techniques, articulatory techniques, myofascial release techniques, strain/counterstrain techniques, lymphatic drainage techniques, facilitated positional release techniques, still techniques, balanced ligamentous tension techniques, visceral manipulation, Osteopathy in the Cranial Field (OCF) and Chapman’s techniques.

The resident must have training in trigger point/tender point injections, peripheral nerve blocks, and joint aspiration/injection.

is there anything stopping a DO from going out and making up random techniques

Seriously, where do you think new techniques came from? Osteopaths apply principles and formidable palpation skills to their knowledge of anatomy and physiology. Those "random" techniques come from their problem-solving when they're faced with a dysfunction that won't release well or completely.

DOs are better at it than anyone - just listen to the non-physicians doing visceral manipulation talk about how fast and creative Barral (a French osteopath) is when coming up with new techniques. One of them was opening up the vertebral artery (they claimed a 40% increase in flow) by winding the arm and clavicle. And when the OMM-specialists get together at Convocation, they're always screwing around and trying to impress each other.

No, there's nothing stopping DOs from going out and making up random techniques, thank God. Hopefully you'll learn some things on your rotation that can't be found in books.

As for the "energy" side, you would have to show how "energy" relates to somatic dysfunction and physiology before you could call it OMM.

 

[MRSAful Fate]

Seriously, where do you think new techniques came from? Osteopaths apply principles and formidable palpation skills to their knowledge of anatomy and physiology. Those "random" techniques come from their problem-solving when they're faced with a dysfunction that won't release well or completely.

DOs are better at it than anyone - just listen to the non-physicians doing visceral manipulation talk about how fast and creative Barral (a French osteopath) is when coming up with new techniques. One of them was opening up the vertebral artery (they claimed a 40% increase in flow) by winding the arm and clavicle. And when the OMM-specialists get together at Convocation, they're always screwing around and trying to impress each other.

No, there's nothing stopping DOs from going out and making up random techniques, thank God. Hopefully you'll learn some things on your rotation that can't be found in books.

As for the "energy" side, you would have to show how "energy" relates to somatic dysfunction and physiology before you could call it OMM.

I see your point, however the line between scientific progress and flying by the seat of ones pants seems to be awfully grey here. Many techniques are not based on anatomy or physiology (cranial, Chapman's points) and others which are have pretty much no research behind them. The industry standard for quality control of OMT seems to be at the level of "this one guy did this and said it did something, so it's gotta be legit."