When OMM becomes dangerous

[siinew]

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You asked about my Verbal MCAT score and I told you I got a 12. I'd love to know your verbal score while you're busy insulting my verbal comprehension skills so I know whether or not to be hurt.

My last post on this topic, since the two of us going around and around in circles same thing over and over is certainly starting to be tedious to me, and I can only imagine its effect on anyone else reading it:

Since you volunteered your MCAT verbal score though, I should at least pay you the same courtesy: VR=13, with an S on the writing sample. It wouldn't matter if I had a 15 and you had a 6 or vice versa though. My statements about your lack of comprehension of someone else's posts you were trying to bash, however ineffectual that bashing may have been, were very valid. I'd say "go back and read them," but I think your time would be much better spent studying medicine.

 

[DropkickMurphy]

BTW DropkickMurphy, I realize that I didn't have all the historical facts accurate before, but the Kool-Aid analogy is mine. I'll expect quotation marks and a reference of my name next time.

Duly noted....I didn't mean to plagairize your condescension

 

[DropkickMurphy]

really no such thing as "wilderness" in the USA any more anyway

Let me drop you into certain parts of Alaska, Washington state, or Maine.....and I will see if you change your opinion.

Or are you saying that Hirudotherapy (leeches and bloodletting), which has been in use for at least a few decades to assist with (among other things) various aspects of surgery, is actually a left-over from flat-earth society times, and has no place in medicine?

Well, we realized that the idea that bleeding someone for anemia wasn't working so we stopped.....also all of your examples have proof to back up their efficacy. That is my point, not the origin of the practice, but the proof that it does what it is claimed to do- leeches to restore blood flow to reattached body parts has been proven to work, not because it was voodoo medicine and the shaman we trained under told us it worked but because when compared to other methods it improved outcomes.

even needing for some other reason to have an anti-inflammatory or antipyretic applied topically (ok, your kid is intensely sick with a high fever and can't keep anything down orally),

And they happen to have a congenitally absent anus and rectum, thereby precluding use of suppositories like any other reasonable medical provider would resort to.

I agree with your point that "extraordinary claims require extraordinary evidence" but unless you could prove that cranial is causing harm, I don't see how that negates the point of the post you were replying to (and the point of many posts on this thread). If it's not doing harm and a D.O. wants to use it on their patients, thereby perhaps even doing their own personal research into it as well, why would that possibly be a problem? Especially in the case of patients who actively are seeking out this type of therapy because they KNOW it works for them.

False hope is worse than no hope, and besides, if we wish to be considered professionals.....then shouldn't we be held to the same standards that allopathic docs are?

 

[DropkickMurphy]

When asked about OMM during interviews, be sure to let the adcoms know your opinion. I'm sure they will get a kick out of the Jim Jones comparison!

I differentiate between OMM and cranial, since one is at least plausible and the other is laughable at best and probably downright harmful to the reputation of osteopathy at worst. If I'm asked about OMM, I'll br

I would LOVE to have a DO interview after I have an acceptance in hand to see if I could argue my point (that we can't accept all aspects of OMM based on current evidence and that further research is needed) effectively enough to garner an acceptance.

BTW, I would love an allopathic school start offering an online "bridge" program for DO's to earn their MD degree just to watch the AOA hierarchy all collectively stroke out at once......

 

[the1doc]

Duly noted....I didn't mean to plagairize your condescension But correct me if I'm wrong but didn't you incorrectly attribute the Kool-aid to the Heaven's Gate people?

Yes, I attributed Kool-aid to Heaven't Gate. However, I WAS the first to compare the OMM faculty teaching cranial to the people saying, "just drink the Kool-aid." What can I say? It is a great analogy. I can see why you'd want to borrow it.😀

 

[DropkickMurphy]

Yes, I attributed Kool-aid to Heaven't Gate. However, I WAS the first to compare the OMM faculty teaching cranial to the people saying, "just drink the Kool-aid." What can I say? It is a great analogy. I can see why you'd want to borrow it.😀

I bow before the master. (No, not A.T. Still)

 

[the1doc]

I differentiate between OMM and cranial, since one is at least plausible and the other is laughable at best and probably downright harmful to the reputation of osteopathy at worst. If I'm asked about OMM, I'll br

I would LOVE to have a DO interview after I have an acceptance in hand to see if I could argue my point (that we can't accept all aspects of OMM based on current evidence and that further research is needed) effectively enough to garner an acceptance.

BTW, I would love an allopathic school start offering an online "bridge" program for DO's to earn their MD degree just to watch the AOA hierarchy all collectively stroke out at once......

You bring up a great point. Most of us knew little to nothing (like siinew) about OMM and cranial when we matriculated at DO schools. I learned what I could, but I had no idea there would be so much focus on quackery (cranial and lymphatic). Now that I understand the anatomy, understand what the techniques are, etc, I believe that it is a very poor reflection on osteopathy. I know that many DOs/DO students feel the same way. Members of the cranial cult are quick to say, "then you shouldn't have gone to a DO school." That is a stupid assertion. Most of us lacked the background to make that type of decision. And DO schools definitely don't advertise cranial to potential students.

I think there needs to be an organized effort to get rid of cranial and other questionable techniques. Until the AOA is confronted about the issue by an organized group of students/doctors, it will continue to push cranial in the literature and curriculum. I realize that there is a long tradition of apathy and/or fear regarding this issue, but why has it continued as long as it has despite the fact that most students/DOs disagree with it? Has there ever been an organized effort among students to confront this issue?

 

[DropkickMurphy]

If there hasn't been, there will be once I get into school.

 

[FutureNavyDOc]

My last post on this topic, since the two of us going around and around in circles same thing over and over is certainly starting to be tedious to me, and I can only imagine its effect on anyone else reading it:

Since you volunteered your MCAT verbal score though, I should at least pay you the same courtesy: VR=13, with an S on the writing sample. It wouldn't matter if I had a 15 and you had a 6 or vice versa though. My statements about your lack of comprehension of someone else's posts you were trying to bash, however ineffectual that bashing may have been, were very valid. I'd say "go back and read them," but I think your time would be much better spent studying medicine.

Somehow I knew even if I said my verbal score was 16 you would have beaten me by 1. Not doubting your score, just ironic it was better than mine by 1. I did beat you by a letter on the most worthless part of the MCAT though. As we've both said it doesn't matter a lick in the grand scheme of things.

At least we finally agree on something, that my time is better spent studying medicine which is what I'm going to get back to right now.

 

[Dr JPH]

I think there needs to be an organized effort to get rid of cranial and other questionable techniques. Until the AOA is confronted about the issue by an organized group of students/doctors, it will continue to push cranial in the literature and curriculum. I realize that there is a long tradition of apathy and/or fear regarding this issue, but why has it continued as long as it has despite the fact that most students/DOs disagree with it? Has there ever been an organized effort among students to confront this issue?

Agree 100%

I know among Undergraduate OMM Fellows I am in the minority. Offering the cranial courses on campus as elective activities should be the extent.

I would elaborate on my feelings more but I have got myself in hot water on a number of occassions for my opinion on this.

So the1doc...perhaps our opinions on some things arent as different as we both may think.

BTW...AOA Convention was excellent.

 

[Dr JPH]

BTW....

When I do stand up for OMM I do NOT include cranial or any "cranial like" treatments, diagnoses or theories into my statements.

I focus on the structural basis for OMM...musculoskeletal and neurovascular influences for example.

 

[FutureNavyDOc]

BTW....

When I do stand up for OMM I do NOT include cranial or any "cranial like" treatments, diagnoses or theories into my statements.

I focus on the structural basis for OMM...musculoskeletal and neurovascular influences for example.

My apologies, JP, I had you pegged for an all-OMM is good OMM type.


My favorite comment I received from a classmate when I was lamenting on the absence of evidence supporting the claims about cranial goes as follows:

"How can you call yourself a DO student when you don't believe in cranial? I bet AT Still is rolling over in his grave."

When I reminded her Cranial came around several decades after AT's passing, she decided to leave the conversation.

 

[oldManDO2009]

all i can say is, "thank goodness for my 300+ hours spent learning OMM!!!"

now, when i have a pt. with an MI, i can thoughtfully include elevated 1st rib and T2 extended rotated sidebent right in my differential diagnosis!!!

kidney/prostate problems? type II lumbar segmental disorder OR sacral torsion!

headaches? vertical strain, horizontal strain, or SBS compression!!!

praises to a.t. still, our osteopathic god!

 

[Dr JPH]

My apologies, JP, I had you pegged for an all-OMM is good OMM type.

Accepted.

And I apologize for my "if you dont believe in OMM you are an MD-wannabe".

 

[danclear]

BTW....

When I do stand up for OMM I do NOT include cranial or any "cranial like" treatments, diagnoses or theories into my statements.

I focus on the structural basis for OMM...musculoskeletal and neurovascular influences for example.

I also realize that cranial is definitely what gives DOs a "voodoo" kind of approach to medicine. My personal opinion of cranial is this: it is an effective treatment modality, with its biomechanical and physiological mechanisms still largely unknown. The way a lot of us are taught that it treats this or does that is still completely speculative. I also don't believe that it should be included on our Boards, but what changing the AOA and NBOME's opinion on this is going to take some time.

I have seen cranial work very effectively in treating certain patients for headaches that were refractory to other treatment modalities. Keep in mind, this is by DOs that have been extensively trained in cranial osteopathy. At the same time, I have seen not as experienced DOs really jack up some people using cranial, myself included. So I think it is something that is effective, but you have to be rigorously trained before you can offer appropriate treatment. That said and done, most of these DOs I mention that are very good at cranial are very ungrounded to planet Earth when talking about what the hell they are doing.

In the future, the best thing that could happen to cranial is a physician that knows how to effectively communicate what the hell they are doing to their patient...and they can back it up with proper research. Meanwhile, I agree with most of your posts that this should not be integrated within our OMM curriculum at this time. I do think we should be made aware of it, such as a lecture presentation, and then students who are interested can elect to pursue a professional course.

 

[FutureNavyDOc]

Accepted.

And I apologize for my "if you dont believe in OMM you are an MD-wannabe".

Also accepted.

Anyone know the guitar cords to Kumbaya?🙂

 

[DropkickMurphy]

Also accepted.

Anyone know the guitar cords to Kumbaya?🙂

G Em G, G C D, repeat ad nauseum....

 

[the1doc]

Agree 100%

I know among Undergraduate OMM Fellows I am in the minority. Offering the cranial courses on campus as elective activities should be the extent.

I would elaborate on my feelings more but I have got myself in hot water on a number of occassions for my opinion on this.

So the1doc...perhaps our opinions on some things arent as different as we both may think.

BTW...AOA Convention was excellent.

Glad to hear you had a good time at the AOA convention. But let's be honest....did it have more to do with the AOA....or with Vegas?

I am sure that we have a lot more to agree on than disagree. I shouldn't have assumed that you supported cranial just because you are an OMM fellow. Personally, I think it is commendable that someone who has so much invested in OMM can be objective enough to openly disagree with cranial.

 

[Dr JPH]

Glad to hear you had a good time at the AOA convention. But let's be honest....did it have more to do with the AOA....or with Vegas?

Actually Ive been to Vegas many times. In fact, our (my fiancee and I) best friends live out there. But I did manage to attend a good number of lectures and I was also supporting many of my friends who were presenting posters at the research seminars.

Personally, I think it is commendable that someone who has so much invested in OMM can be objective enough to openly disagree with cranial.

Just as I hope that critics of OMM are able to see the value in many of the musculoskeletal uses of OMM.

 

[FutureNavyDOc]

Just as I hope that critics of OMM are able to see the value in many of the musculoskeletal uses of OMM.

I've presonally never been opposed to the use of OMM for musculoskeletal uses when appropriate. I've had posterior ribs popped back in more times than I want to count and have appreciated it greatly every time!

My personal opinion has always been to keep the first year of OMM (Sacrum up through Cervicals and OA) the same and either make the 2nd year optional or only 1 semester and cut out Cranial.

Whether or not it is worth the time of a physician to do some of the long restrictor stuff that a PT can do is another issue though. My personal opinion is to let nurses do the nursing stuff, PT's do what they can do, and physicians do what no one else is qualified to do. With the forecasted shortage in physicians in the coming years, I think that as much as many docs and students (myself included) don't like it, that the most efficient use of time is to turf to other specialties that which can be turfed and have Docs worry about doing that which only docs can do first then do the other stuff.

 

[the1doc]

Just as I hope that critics of OMM are able to see the value in many of the musculoskeletal uses of OMM.

A chiropractor helped me out after I'd been in an MVA. That's why I had an open mind about OMM when I chose to go DO. I also had a PT who did an excellent job of helping me recover from a sporting injury.

Although there are many DOs (mostly OMM faculty) who try to put their musculoskeletal techniques above those of chiros and PTs, it's really the same stuff. Since I've always respected chiros and PTs for the work they do, it would follow that I can see the benefit in some uses of OMM.

Having said that, the problem with OMM is that it is currently a wastebasket for all things "anti-allopathic," including the shady, the unproven, and the downright quackery. That's why I feel that somebody (or somebodies) needs to take some initiative and force the leadership to take a critical look at the OMM curriculum and get it cleaned up. In its current state, it is a very poor reflection of what osteopathic medicine is.

 

[ohiovolffemtp]

I've been struck by the twists and turns in this thread. Many strongly beliefs are coloring replies and taking them on tangents. Only a few folks have recognized that the problem FutureNavyDoc reported was poor diagnosis. Perhaps the PCP's judgment was influenced by education that stressed OMM, perhaps not - wasn't there, can't know.

What I can say is that this sort of problem is not unique to DO's, or MD's, or allied health providers. I've seen it in patients I've picked up in nursing homes, urgent cares, doctors offices, etc. Many providers at all levels lose sight of potentially critical conditions because they look for conditions they see frequently. My experience as a field provider and an ACLS instructor for a teaching hospital & medical school is that there is also a very wide range of ability to deal with cardiac problems, especially with doc's who don't routinely manage these sorts of patients.

In their defense, I've yet to be to a PCP's office as either a responder or a patient where they had a functioning EKG - either a 3 lead or a 12 lead. So, they're not prepared to do the quick check that would pick up most AMI's. But, they can (and often do) recognize the potential and get the patient checked. That was this doc's mistake - not thinking broadly enough.

As for evidence supporting different therapies, all I can say is that there is much evolution. Look at ACLS: what was the original evidence behind many of the drugs, such as lidocaine? Is amiodarone better - or did it have extra funding to push the AHA to favor it? I'm not trying to resolve that issue here, only to illustrate that there is much to learn on all fronts. So, don't focus on a specific treatment as the problem, when poor diagnosis is the issue.

 

[MDDOWhatever]

I've been struck by the twists and turns in this thread. Many strongly beliefs are coloring replies and taking them on tangents. Only a few folks have recognized that the problem FutureNavyDoc reported was poor diagnosis. Perhaps the PCP's judgment was influenced by education that stressed OMM, perhaps not - wasn't there, can't know.

What I can say is that this sort of problem is not unique to DO's, or MD's, or allied health providers. I've seen it in patients I've picked up in nursing homes, urgent cares, doctors offices, etc. Many providers at all levels lose sight of potentially critical conditions because they look for conditions they see frequently. My experience as a field provider and an ACLS instructor for a teaching hospital & medical school is that there is also a very wide range of ability to deal with cardiac problems, especially with doc's who don't routinely manage these sorts of patients.

In their defense, I've yet to be to a PCP's office as either a responder or a patient where they had a functioning EKG - either a 3 lead or a 12 lead. So, they're not prepared to do the quick check that would pick up most AMI's. But, they can (and often do) recognize the potential and get the patient checked. That was this doc's mistake - not thinking broadly enough.

As for evidence supporting different therapies, all I can say is that there is much evolution. Look at ACLS: what was the original evidence behind many of the drugs, such as lidocaine? Is amiodarone better - or did it have extra funding to push the AHA to favor it? I'm not trying to resolve that issue here, only to illustrate that there is much to learn on all fronts. So, don't focus on a specific treatment as the problem, when poor diagnosis is the issue.

Careful, don't mess with the soapbox that NavyDOc and a few others have been so carefully working on constructing here, by actually addressing the real issue like you just did. 🙂

 

[drusso]

You bring up a great point. Most of us knew little to nothing (like siinew) about OMM and cranial when we matriculated at DO schools. I learned what I could, but I had no idea there would be so much focus on quackery (cranial and lymphatic). Now that I understand the anatomy, understand what the techniques are, etc, I believe that it is a very poor reflection on osteopathy.

The physiologic basis for treatment of the lymphatic system, myofascial release, and even counter-irritation of nociceptors of the cranial sutures has **MORE** scientific evidence for a putative mechanism of action than muscle energy or HVLA. You can't separate manual techniques that "work" from those that "don't work." It's not that specific. Manual medicine is a very blunt instrument.

It never ceases to amuse me that while DO students blast OMM as being "unscientific" several other areas of healthcare and research are becoming interested in it. Physical therapists are working to expand their scope of practice and spending millions of dollars lobbying state and federal lawmakers so that they can be independent practitioners of manual medicine. Why?? Because there is patient demand for this kind of treatment. Headache specialists are getting very interested in trigemino-cervical sensitization and the pathogenesis of migraine. Frank Willard (the neuroanatomist from UNECOM) is now a featured speaker at all pain society meetings.

I don't know why COM's don't do a better job of packaging OMM to students. I think that as you get further along in your training and see just how unscientific most of medicine is you'll appreciate the things you're learning in your OMM courses--especially when you start interacting with MD students. It sort of pays dividends over time...you'll see.

 

[siinew]

The physiologic basis for treatment of the lymphatic system, myofascial release, and even counter-irritation of nociceptors of the cranial sutures has **MORE** scientific evidence for a putative mechanism of action than muscle energy or HVLA. You can't separate manual techniques that "work" from those that "don't work." It's not that specific. Manual medicine is a very blunt instrument.

It never ceases to amuse me that while DO students blast OMM as being "unscientific" several other areas of healthcare and research are becoming interested in it. Physical therapists are working to expand their scope of practice and spending millions of dollars lobbying state and federal lawmakers so that they can be independent practitioners of manual medicine. Why?? Because there is patient demand for this kind of treatment. Headache specialists are getting very interested in trigemino-cervical sensitization and the pathogenesis of migraine. Frank Willard (the neuroanatomist from UNECOM) is now a featured speaker at all pain society meetings.

I don't know why COM's don't do a better job of packaging OMM to students. I think that as you get further along in your training and see just how unscientific most of medicine is you'll appreciate the things you're learning in your OMM courses--especially when you start interacting with MD students. It sort of pays dividends over time...you'll see.

But... but.... GMO-For-Life, oops, I mean FutureNavyDOc has already made it abundantly clear what the real "facts" are in this matter, and the guy who carries suppositories on wilderness outings to the deepest, darkest depths of Maine (DropKickMurphy) even backs him up. Sorry buddy, but your dose of open-minded reality and clear thinking is going to have to take a backseat to the howling rage of the village idiots on this one.

 

[Shinken]

I think that as you get further along in your training and see just how unscientific most of medicine is you'll appreciate the things you're learning in your OMM courses--especially when you start interacting with MD students.

Yes. It always makes me chuckle inside everytime someone complains about OMM and how "nobody can explain how it works yet they teach it" and then on wards, I hear about a drug being used an go to my ePocrates PDA program to see its mechanism of action. You guessed it, "mechanism of action unknown." They use the drug because it works. But when we use OMM because it works, we're quacks. Go figure.

 

[FutureNavyDOc]

The physiologic basis for treatment of the lymphatic system, myofascial release, and even counter-irritation of nociceptors of the cranial sutures has **MORE** scientific evidence for a putative mechanism of action than muscle energy or HVLA. You can't separate manual techniques that "work" from those that "don't work." It's not that specific. Manual medicine is a very blunt instrument.

More evidence? Where is this evidence everyone always claims exists but never can prove?



IfYouKnew,
Yes, I am going to do GMO tours for my entire life, all the way until death.
Is it supposed to be an insult that part of my navy career may be spent taking care of the very Marines who are the first to put themselves in harms risk in defense of our nation? You sound like your hero Senator Kerry

 

[siinew]

More evidence? Where is this evidence everyone always claims exists but never can prove?



IfYouKnew,
Yes, I am going to do GMO tours for my entire life, all the way until death.
Is it supposed to be an insult that part of my navy career may be spent taking care of the very Marines who are the first to put themselves in harms risk in defense of our nation? You sound like your hero Senator Kerry

Don't worry. Thanks to folks like Kerry, by the time you're ready to roll, we'll probably be pulling out anyway. But still... nice gesture on your part. Much appreciated.

 

[drusso]

More evidence? Where is this evidence everyone always claims exists but never can prove?

I think that you need to do a little research on the topic.

 

[FutureNavyDOc]

Don't worry. Thanks to folks like Kerry, by the time you're ready to roll, we'll probably be pulling out anyway. But still... nice gesture on your part. Much appreciated.

The end of my internship year will be in summer 2009, which means we will have a new president in power for many months by then. That combined with then recent political developments make me fairly confident we'll be out of Iraq... at least in our current capacity by then. But who knows where we'll be by that point in time!

My thoughts are that we should invade some place tropical like the coast of Mexico, we could even call that a counter-invasion!



drusso,
I'm not the one claiming the research exists. If it exists, then it should be easy to provide proof of it in links and journal references. In my 2 1/2 years of Osteopathic med school, I'm yet to see such proof!

It is the responsability of those making the claims to prove themselves, it is not the responsability of those who do not believe to prove it is not so. Otherwise, docs would spend their entire lives wasting time to refute every claim made by every chirporactor, homeopath, or other snakeoil salesman.

 

[Shinken]

It is the responsability of those making the claims to prove themselves, it is not the responsability of those who do not believe to prove it is not so. Otherwise, docs would spend their entire lives wasting time to refute every claim made by every chirporactor, homeopath, or other snakeoil salesman.

This is an often-quoted argument, but almost always not used properly.

Yes, you're correct in that the burden of proof rests with whoever is trying to prove a therapeutic modality works.

However, when that modality has already been proven via published studies in the literature, the burden of researching the studies rests with whoever is looking for the proof. Surely you don't expect to just sit back and have other people log on to the Cochrane Library, do a search, and e-mail you the results, right? The proof is out there (the burden of proof has already been satisfied!), now it's the duty of the people seeking the proof to pull out the study, read it, and accept it (if the study is valid and well-executed). You just can't sit back and claim that it's other people's responsibility to do that.

By the way, a good place to start is the osteopathic medicine journal club thread at the top of the osteopathic forum. Plenty of studies that prove and disprove some modalities of manual therapy.

 

[homeboy]

This is an often-quoted argument, but almost always not used properly.

Yes, you're correct in that the burden of proof rests with whoever is trying to prove a therapeutic modality works.

However, when that modality has already been proven via published studies in the literature, the burden of researching the studies rests with whoever is looking for the proof. Surely you don't expect to just sit back and have other people log on to the Cochrane Library, do a search, and e-mail you the results, right? The proof is out there (the burden of proof has already been satisfied!), now it's the duty of the people seeking the proof to pull out the study, read it, and accept it (if the study is valid and well-executed). You just can't sit back and claim that it's other people's responsibility to do that.

By the way, a good place to start is the osteopathic medicine journal club thread at the top of the osteopathic forum. Plenty of studies that prove and disprove some modalities of manual therapy.

Yea.......I am a little doubtful of anyone who says, "It has been proven, just search the literature!" as opposed to actually citing journals.

Yes, some manipulation has been 'proven'...but not specifics. In the BMJs Clinical Concise Medicine annuals, they list manipulation as a "probably beneficial" for LBP. Few studies specify what exact 'manipulations' are performed, by whom, and to what standard. Ie, manipulation is a 'catch all' that emcompasses all forms of hands-on manipulative modalities.
I'm guessing the op isn't opposed to the application of manipulation to various patients for various problems by competent physicians; he's addressing the mentality that often accompanies the gun-ho OMTers.

And a question if anyone out there has the answer: have there been any studies comparing osteopathic manipulation to chiropractic manipulation? I think I remember reading something along those lines...

 

[Taus]

Dr. Russo has never been one to bs around on here.... Im sure he could point you in the right direction for latest research on manual medicine if you ask him

 

[FutureNavyDOc]

Dr. Russo has never been one to bs around on here.... Im sure he could point you in the right direction for latest research on manual medicine if you ask him

Dr Russo,
Please point me in the right direction.




I did some research and found an article from the Journal of Manipulative and Physiologic Therapeutics which found that "patients with tension-type headaches receiving manipulation alone did notobtain significant positive effects versus control subjects with regards to daily hours of headache, pain intensity or daily analgesic use"

Cronfort G et al: Efficacy of spinal manipulation for chronic headache: a systematic review. Journal of Manipulative and Physiologic Therapeutics 2001;24(7):457.

 

[scpod]

"patients with tension-type headaches receiving manipulation alone did notobtain significant positive effects versus control subjects with regards to daily hours of headache, pain intensity or daily analgesic use"

The studies must be out there. An article in the Annals of Internal Medicine http://www.annals.org/cgi/content/full/138/11/I-33compared 39 studies on low-back pain and concluded that "Spinal manipulation was more effective than sham therapy and therapies already known to be unhelpful. However, it was no more or less effective than general practitioner care, pain killers, physical therapy, exercise, or back school."

 

[drusso]

Unfortunately, I don't have the time to post as much as I used to...in order to better understand the physiologic and scientific basis of manual treatment you need to get away from "brand-names" such as osteopathic, chiropractic, physical therapy, etc and get into the nitty-gritty of neurophysiology of counter-irritation, biomechanics of connective tissue, etc. DC's, DO's, PT's do very little meaningful research, but they try.

One interesting and emerging area is the analgesic properties of nitric oxide, arterial vasodilation, and physical modalities and exercise: Might this explain the "rule of the artery is supreme?"

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15289898&dopt=Abstract

Another interesting area is the cellular basis of protein synthesis, stretch, and physical strain: Might this help us understand the basis of myosfascial "compensatory patterns?"

http://www.jaoa.org/cgi/reprint/106/3/157.pdf

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16618703&query_hl=14&itool=pubmed_DocSum

Finally, some recent studies confirm that peripheral stimulation of nerves can modulate CNS circuits. This has *HUGE* implications for those of us in pain medicine, but also harkens way back to IM Korr and the "facilitated segment."

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16730124&query_hl=10&itool=pubmed_docsum

Science doesn't happen over night. It takes decades and sometimes hundreds of years to move from systematic observation to hypothesis testing. Medicine is complex. The MSK system is one of the most poorly understood systems in the human body. Locomotion is complex. Our understanding of pain is simplistic at best. So, you can see how jumping ahead to RCT's of manual medicine is frought is difficulties.

I have been where many of you are now. I sat in class rooms and OMM labs and listened to a lot of "osteopathic fairy tales." I did a lot of eye rolling too. Believe me, there are quacks and zealots in every part of medicine not just DO schools. Though it does seem that one unintended consequence of osteopathic schoools' selecting for "holistic minded" practitioners is a greater tolerance for the lunatic fringe...that's lamentable, but ultimately okay.

Still, the thing to appreciate about fairy tales is that while the details are invented or false, usually "the moral of the story" is true. For example, at my school we seemed to spend an inordinant amount of time addressing "the lymphatics." I remember as a medical students running around the ICU's at our community osteopathic hospital "balancing the membranes" and "treating the ribs" and doing all kinds of hokey-pokey things that certainly didn't harm, but I wasn't always convinced exactly "helped" either. This stimulated some students to really take the bull by the horns and try to address the mechanisms of these treatments in a rigorous way:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16314677&query_hl=18&itool=pubmed_docsum

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=11213665&query_hl=23&itool=pubmed_docsum

Ultimately, this is how the profession will answer these questions. Not by repeatedly beating each other up and bemoaning "the lack of evidence."

 

[Taus]

thanks for the reply Dr. Russo....I didn't mean to put you on the spot...but I knew you'd be able to provide a better (and more realistic) response then most on here