Which DO schools do HVLA on the cervical region?

[Insert]

I was wondering what schools do HVLA on the cervical region. It seems kind of scary to think that someone who doesn't know what they're doing yet is manipulating your neck. Does your school do that or let you practice it?

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[DrMom]

We do it, but you can opt out of being a "pt" if you wish.

 

[DOtobe]

We do it, but you can opt out of being a "pt" if you wish.

Same for us at LECOM. Most people in my class did not mind having HVLA done on their necks, though. HVLA was explained to us fairly well, so we pretty much felt comfortable having our classmates manipulate us. (at least this was the case in the little area of the OMM lab I was in.)

And cervical HVLA is not that dangerous - just keep the person's cervical spine out of extension and you will be fine. I like doing cervical HVLA (and HVLA in general). I think it is the most direct way to treat a lesion.

Just my two cents' worth.

Edit: are there any DO schools that don't do HVLA of the cervical spine? I thought all schools learned it? 😕

 

[babyruth]

We do it at DMU. It's scary only the first day, but they prepare you so well that by then you know what barriers are and what to do. Remember, it's high velocity LOW AMPLITUDE--meaning that it is a small, quick, controlled thrust. We don't crack necks like some ninja movie or anything.

 

[docslytherin]

we do it here at KCOM too... we didn't learn it until 3rd quarter so we were familiar with barriers and thrust vectors and all of that necessary stuff. we also got a lot of lectures about safety and were watched very carefully by the faculty. if i remember correctly we were required to demonstrate an HVLA technique on our practical for the cervicals too... (we had to do that for the thoracic segments too).

 

[LukeWhite]

AZCOM does it, and I think it's fair game for practicals also. It was one of our first refresher labs this year.

 

[sophiejane]

You have to work pretty hard to hurt someone doing cervical HVLA. And this is coming from someone who was very skeptical at first.

As far as I know, all of the schools teach it.

 

[Insert]

Thanks for the responses. I'm pretty scared about HVLA on the neck. So if your partner does it and cracks your neck, isn't it possible that he or she misaligned some vertebrae causing you to have more problems rather than less.

Obviously at times it's difficult to diagnose which way a vertebrae is rotated and sidebent. What if they diagnosed it wrong and perform the procedure on a vertebrae that wasn't even misaligned but that was aligned. Then you gain a somatic dysfunction. Isn't all this possible?

Also if you do a search on neck manipulation you will see that it is quite possible to dissect by accident the vertebral artery causing stroke and even death. I'm starting to become weary of OMT particularly HVLA.

 

[delchrys]

there are schools that don't do cervical HVLA. my sister went to LECOM and said they do it there, but she indicated that there are programs that do not do it because of the danger associated with it.

 

[Doctor Peloncito]

there are schools that don't do cervical HVLA. my sister went to LECOM and said they do it there, but she indicated that there are programs that do not do it because of the danger associated with it.

You are more likely to seriously injure your neck looking into the back seat of your car than your are with cervical hvla.

 

[Paul1441]

Thanks for the responses. I'm pretty scared about HVLA on the neck. So if your partner does it and cracks your neck, isn't it possible that he or she misaligned some vertebrae causing you to have more problems rather than less.

Obviously at times it's difficult to diagnose which way a vertebrae is rotated and sidebent. What if they diagnosed it wrong and perform the procedure on a vertebrae that wasn't even misaligned but that was aligned. Then you gain a somatic dysfunction. Isn't all this possible?

Also if you do a search on neck manipulation you will see that it is quite possible to dissect by accident the vertebral artery causing stroke and even death. I'm starting to become weary of OMT particularly HVLA.

The neck is most vunerable in extension, mainly severe extension, and HVLA in the cervical is not done in extreme extension for this reason. The head is kept mainly on the table or in some flexion.

 

[Buster Douglas]

I was wondering what schools do HVLA on the cervical region. It seems kind of scary to think that someone who doesn't know what they're doing yet is manipulating your neck. Does your school do that or let you practice it?

HVLA for the upper cervicals is not taught at PCSOM. We get good results with muscle energy, functional, and jones s/cs alone to not bother with the risks of cervical HVLA. The theory taught here is... the better sense you have of the barriers, the less force should be needed to induce change. If you really wanna learn how to crack the cervicals we've got enough DOs that'd be happy to teach us, but it is not a part of our curriculum. I don't think anyone would attempt to crack a neck if they didn't think it was necessary and/or if they were never taught the technique.

 

[raspberry swirl]

while many people may not choose to use cervical hvla, it is a quick, easy, and effective treatment for a number of problems. you can certainly get similar results from other techniques, but i think its unwise for it not to be taught . . . it may be the best option for a particular patient. its the fastest treatment, and as busy physcians, as sad as it is, it may be the only type of treatment you have time for on a particular day. it's also easy to learn and to perform cervical hvla in comparison to most other techniques, making it something that most students feel pretty comfortable with. even if you choose not to use it, your osteopathic education is incomplete without it. besides . . . its a neat party trick 😉

 

[Idiopathic]

You have to work pretty hard to hurt someone doing cervical HVLA.

I had a practical with someone who was neither prepared nor confident. I would not recommend this. They cannot relax themselves nor the patient, and it is of utmost concern that the patient be relaxed, or injury is a big possibility. I had trouble walking for a week afterwards 😉

 

[San_Juan_Sun]

You are more likely to seriously injure your neck looking into the back seat of your car than your are with cervical hvla.

I have a paper somewhere that describes the number of documented complications of cervical HVLA (things like vertebral artery dissection). The number was very, very low. The authors concluded that if proper assesment of contraindications is performed, cervical HVLA is very safe. However, it should be noted that the authors also said that the numbers may well be off, as self-reporting of complications could very easily be small.

 

[LukeWhite]

I have a paper somewhere that describes the number of documented complications of cervical HVLA (things like vertebral artery dissection). The number was very, very low. The authors concluded that if proper assesment of contraindications is performed, cervical HVLA is very safe. However, it should be noted that the authors also said that the numbers may well be off, as self-reporting of complications could very easily be small.

Heh, yes. I know of someone in our class last year who had some rather nasty complications from upper thoracic/lower cervical manipulation done by...well, better left unsaid. Maybe a freak accident, but I suspect these things are sort of common, and just aren't talked about much.

 

[DOctorJay]

I'm going to learn it tomorrow at UMDNJ!!!

-J

 

[San_Juan_Sun]

Heh, yes. I know of someone in our class last year who had some rather nasty complications from upper thoracic/lower cervical manipulation done by...well, better left unsaid. Maybe a freak accident, but I suspect these things are sort of common, and just aren't talked about much.

Did you hear the guy yelp in pain after someone did cervical HVLA on him in lab two weeks ago?

 

[LukeWhite]

Did you hear the guy yelp in pain after someone did cervical HVLA on him in lab two weeks ago?

Might have missed that--the gunshot-like staccato of my own vertebrae going CRACK CRACK CRACK was drowning out ambient noise.

 

[Doctor Peloncito]

HVLA for the upper cervicals is not taught at PCSOM. We get good results with muscle energy, functional, and jones s/cs alone to not bother with the risks of cervical HVLA. The theory taught here is... the better sense you have of the barriers, the less force should be needed to induce change. If you really wanna learn how to crack the cervicals we've got enough DOs that'd be happy to teach us, but it is not a part of our curriculum. I don't think anyone would attempt to crack a neck if they didn't think it was necessary and/or if they were never taught the technique.

Anyone who knows the man who is teaching you guys OMM will know why you don't need to learn cervical HVLA. However, even Dr. Stiles will say that HVLA is appropriate from time to time.

 

[DOSouthpaw]

Just to straighten stuff out. Just as Buster said, we DO learn HVLA on the C-spine. What we do not practice in lab are long lever techniques of the c-spine and and HV/LA on the A/A and O/A.

That said, it does not mean we don't do it. By the time we learn HV/LA the students that actually practice are competent in the principles of spinal mechanics, palpation of the mechanics in the spine, and the barrier concept, so performing long lever HV/LA and techniques in the A/A and O/A are pretty simple. I mean, if you can do MET on the cervical spine and understand what you are doing, it doesn't take much more to figure out HV/LA

Later!

 

[Insert]

Did you hear the guy yelp in pain after someone did cervical HVLA on him in lab two weeks ago?

That's just wrong. I am having serious misgivings about learning cervical HVLA and OMT in general. I'm starting to think I should have gone to an allopathic school.

 

[LukeWhite]

Insert,

For all the bad things one could say about OMM (and I've said nearly all of them), it really *does* work. I was skeptical about the discipline, and have been pretty hostile towards accepting anything that doesn't have some solid evidence (cranial tides?).

All that said, OMM really does have a tremendous amount of utility. Some of it's quackery; the stuff that's not is absolutely invaluable, and should be taught everywhere. The trouble with OMM is that it's one of the few things in medicine that's really an *art*. Anyone can follow algorithms, but the two really common medical activities that seem to me to take an exceptional touch are critical synthesis of symptoms into a treatment plan, and OMM.

This isn't to excuse the people who do it badly, and obviously even the best can be overaggressive and do it poorly. But it has a lot of merit. Keep an open mind while at the same time insisting that you're taught based on evidence rather than tradition. The nature of the beast demands that a lot of this evidence may be experiential, but it will help you to separate the wheat from the chaff. I've seen about a dozen techniques I can envision myself using in general practice, and I think they'd be a big help. Some of the rest are too subtle for me to fully appreciate, and others are outright quackery. You'll have to sort them out for yourself, but I think you'll find as you continue that there are a few gems in that pile of creaky bones.

 

[Insert]

Insert,

For all the bad things one could say about OMM (and I've said nearly all of them), it really *does* work. I was skeptical about the discipline, and have been pretty hostile towards accepting anything that doesn't have some solid evidence (cranial tides?).

All that said, OMM really does have a tremendous amount of utility. Some of it's quackery; the stuff that's not is absolutely invaluable, and should be taught everywhere. The trouble with OMM is that it's one of the few things in medicine that's really an *art*. Anyone can follow algorithms, but the two really common medical activities that seem to me to take an exceptional touch are critical synthesis of symptoms into a treatment plan, and OMM.

This isn't to excuse the people who do it badly, and obviously even the best can be overaggressive and do it poorly. But it has a lot of merit. Keep an open mind while at the same time insisting that you're taught based on evidence rather than tradition. The nature of the beast demands that a lot of this evidence may be experiential, but it will help you to separate the wheat from the chaff. I've seen about a dozen techniques I can envision myself using in general practice, and I think they'd be a big help. Some of the rest are too subtle for me to fully appreciate, and others are outright quackery. You'll have to sort them out for yourself, but I think you'll find as you continue that there are a few gems in that pile of creaky bones.

I agree with what you said. I think some of the things I have learned so far would be useful but some things I would never do on a patient. I'm thinking right now I would only do some of the muscle energy and soft tissue techniques.

I am still skeptical on the articulatory and HVLA techniques.

 

[coreyw]

Thanks for the responses. I'm pretty scared about HVLA on the neck. So if your partner does it and cracks your neck, isn't it possible that he or she misaligned some vertebrae causing you to have more problems rather than less.

Obviously at times it's difficult to diagnose which way a vertebrae is rotated and sidebent. What if they diagnosed it wrong and perform the procedure on a vertebrae that wasn't even misaligned but that was aligned. Then you gain a somatic dysfunction. Isn't all this possible?

Also if you do a search on neck manipulation you will see that it is quite possible to dissect by accident the vertebral artery causing stroke and even death. I'm starting to become weary of OMT particularly HVLA.

Do you mean 'wary'?

The risk of injury or death from CVA associated a properly performed upper cervical HVLA manoeuvre on most patients is very small. But a risk remains. So yes, it is possible, but very unlikely.

Both the chiropractic and (at least outside of the US) osteopathic professions have been the subject of scrutiny and much media attention regarding this procedure. Yet, if the same cost-benefit analysis were applied to a host of other medical procedures, an upper cervical HVLA would rank quite low on the danger scale. Most media reports on the subject take it way out of proportion.

For an excellent review of the risks associated with upper cerical manipulation, see SAFETY AND EFFECTIVENESS OF CERVICAL MANIPULATION
Addressing the Gap Between Perception and Reality, The Chiropractic Report, May 2001 Vol. 15 No. 3, Editor: David Chapman-Smith LL.B. (Hons.)
http://www.chiropracticreport.com/samples/TCRMay2001.pdf

As to getting your partner to 'crack' your neck - I wouldn't recommend it. They're more likely to cause trauma to the ligamenture of the neck than to cause a CVA, but that ain't pleasant. Moreover, lacking the diagnostic and treatment skills of a trained manipulative therapist, they are unlikely to properly address the any cervical joint dysfunction. The 'cracking' may bring temporary relief because cavitation of joints corresponds with elevated beta endorphin levels... so you get a temporary 'high' or dose of the body's natural pain relievers.

Muscle energy technique has been shown to be as effective for the treatment of upper cervical joint dysfunction, so you're fairly safe with this procedure. A significant number of people feel uncomfortable with the HVLA technique, especially of the upper cervical area and so MET provides an effective and less 'shocking' alternative. Also, there are certain conditions that contrainidcate the use of HVLA or at least increase the risk of injury or death, especially on the neck.

 

[raspberry swirl]

oh please. just pay attention to your instructor, and have someone watch you and your partner the first time you do it. its not a big deal-- are you telling me you've never turned your head and cracked your neck?? people's necks get cracked every single day. with all the legal issues these days, if people were dying or having serious complications from it, i gaurantee you, we wouldn't be allowed to practice it willy-nilly in class. just make sure your partner isn't a *****.

 

[babyruth]

Thank you, well said.

 

[LukeWhite]

oh please. just pay attention to your instructor, and have someone watch you and your partner the first time you do it. its not a big deal-- are you telling me you've never turned your head and cracked your neck?? people's necks get cracked every single day. with all the legal issues these days, if people were dying or having serious complications from it, i gaurantee you, we wouldn't be allowed to practice it willy-nilly in class. just make sure your partner isn't a *****.

Gotta disagree slightly with this--the fact that schools have their students do it isn't prima facie evidence that it's safe. It's not as if the OMM departments have been doing large controlled trials on the...well, on anything about OMM. Let's accept the argument that OMM is as legitimate a specialty as anything--if so, why are we expected to be proficient by second year, when most students couldn't even handle a blood draw? Either the discipline's fuzzy or the science is iffy. Either way, the fact that we're doing it is no guarantee that it's A-OK.

Again, anecdotally though it may be, I personally know one person who had some pretty nasty complications from HVLA done by a highly qualified individual. This was out of a sample size of far less than our class size of 140, since not everyone had their necks adjusted by This Person Who Will Remain Unspecified.

I'm willing to buy that very serious complications are rare. I don't buy for a second that it's a perfectly innocuous procedure--people are more inclined to keep quiet about their bad experiences because there's no lasting damage (and therefore no lawsuit) and because physicians are generally extremely solicitous after making the situation worse.

 

[babyruth]

I understand your concerns, and if you have predisposing factors where you might be susceptible to complications, then you should just request ME from your partner. One of my lab partners only has one carotid artery and we are very cautious with that. Another was a gymnist and has a hypermobile spine, so we only do ME on her. If you fall into any of these categories, then I suggest you only have ME or MFR done on you. Most HVLA techniques that we do are 'softened' up before hand with soft tissue. Since most med students are young and healthy, we don't have any problems with these techniques. As always, the treatments, like any medical treatment, is taylolred to the individual. We don't just willy-nilly crack people's necks. Treatments should be limited to once a week or more, because you don't want the cervical ligature to become lax. Hence the reason that they tell you not to crack your own neck. One of our physician profesors believes that you shouldn't do any inocuos procedure to someone unless you have had it done on you (dilated pupils, DRE, pelvic, etc. etc.).

 

[DD214_DOC]

Do most schools allow you to opt out of being a patient for cervical HVLA? I have already screwed my neck up once and would prefer to not do it again.

 

[Insert]

oh please. just pay attention to your instructor, and have someone watch you and your partner the first time you do it. its not a big deal-- are you telling me you've never turned your head and cracked your neck?? people's necks get cracked every single day. with all the legal issues these days, if people were dying or having serious complications from it, i gaurantee you, we wouldn't be allowed to practice it willy-nilly in class. just make sure your partner isn't a *****.

JKDmed, I am sure you can opt out of it if you ask. I certainly will be doing that and even if they tell me to do it I'll just say I have neck problems.

Raspberry, you go right ahead and be your OMM partner's guinea pig in letting them do some HVLA on your neck. Given the fact that there is a possibility of having your vertebral artery dissected leading to stroke and even death is enough for me to not do it. You can't die from soft tissue techniques or articulatory techniques on the thoracics or lumbar.

There is a slight chance there could be a complication with HVLA on the neck. My philosophy is why risk it. Just so someone can improve their HVLA technique? I'll pass....

 

[Dr_sax]

Well if you go to LECOM you might not. To my knowledge, I do not believe on a practical you can pass on doing cervical HVLA. And this is why:

1) The docs believe it is safe and effective. They also believe that if you set the patient up properly, there is little to no chance of serious side effects.
2) The docs try and instruct everyone on how to properly do cervical HVLA to a point where they feel you understand the technique.

That being said, if you come into a practical saying you don't feel confident or comfortable doing it, they will say "well all you had to do was practice it-it's not hard"(which in reality the setup is one of the easiest to remember). Then, they fail you.

Good, bad, indifferent. It's what might happen.

 

[Doctor Peloncito]

Well if you go to LECOM you might not. To my knowledge, I do not believe on a practical you can pass on doing cervical HVLA. And this is why:

1) The docs believe it is safe and effective. They also believe that if you set the patient up properly, there is little to no chance of serious side effects.
2) The docs try and instruct everyone on how to properly do cervical HVLA to a point where they feel you understand the technique.

That being said, if you come into a practical saying you don't feel confident or comfortable doing it, they will say "well all you had to do was practice it-it's not hard"(which in reality the setup is one of the easiest to remember). Then, they fail you.

Good, bad, indifferent. It's what might happen.

We don't actually do any HVLA thrusts in our practicals. We set up the treatment and simulate the vector of the thrust.

 

[San_Juan_Sun]

We don't actually do any HVLA thrusts in our practicals. We set up the treatment and simulate the vector of the thrust.

We also have this option at AZCOM.

We also have to get permission and educate the "patient" about HVLA on our practicals. (Well, it actually depends on your grader.)

 

[Dr_sax]

At LECOM you diagnose and treat. Our testers require more than just an explanation.
I attempted a pretend thrust once and the doc snickered at me.
But take what I say with a grain of salt...LECOM is a "unique" institution.

 

[babyruth]

The reason that the risk is so low is because we are talking about millimeters here, not centimeters like the chiropractors have been known to perform. Our techniques are fine-tuned by that time, hence the reason they let you do thoracics and stuff earlier on.
All medical treatments carry some sort of risk, whether it is drawing blood or doing a coloscopy, deciding when this risk is that substantial is up to you. But my opinion is that if someone can't do it to you just because you don't want to, then you shouldn't have the freedom of doing it on someone else. I guess what I am trying to say is, fair is fair.

And when you get into lab, most people find the treatments to be awesome and worthwhile and want them from their fellow students.

 

[Dr_sax]

The reason that the risk is so low is because we are talking about millimeters here, not centimeters like the chiropractors have been known to perform. Our techniques are fine-tuned by that time, hence the reason they let you do thoracics and stuff earlier on.
All medical treatments carry some sort of risk, whether it is drawing blood or doing a coloscopy, deciding when this risk is that substantial is up to you. But my opinion is that if someone can't do it to you just because you don't want to, then you shouldn't have the freedom of doing it on someone else. I guess what I am trying to say is, fair is fair.

And when you get into lab, most people find the treatments to be awesome and worthwhile and want them from their fellow students.

Well said.

 

[LukeWhite]

The reason that the risk is so low is because we are talking about millimeters here, not centimeters like the chiropractors have been known to perform. Our techniques are fine-tuned by that time, hence the reason they let you do thoracics and stuff earlier on.
All medical treatments carry some sort of risk, whether it is drawing blood or doing a coloscopy, deciding when this risk is that substantial is up to you. But my opinion is that if someone can't do it to you just because you don't want to, then you shouldn't have the freedom of doing it on someone else. I guess what I am trying to say is, fair is fair.

And when you get into lab, most people find the treatments to be awesome and worthwhile and want them from their fellow students.

In theory, yes. In practice, it's the rare student who, when doing cervical HVLA for the first time, will have finely-tuned techniques. There are some in my class who haven't executed a successful thoracic HVLA; while it may have been a prerequisite *in theory* for going at the neck, in practice this wasn't the case. I'd be very surprised if AZCOM were alone in this.

It seems to me that we're far closer to chiropractors than we are to the stereotypical modern physician when practicing OMM. This isn't necessarily a bad thing, but it does imply a lower standard of evidence and competence. If we did all medicine the way we do OMM, we'd have MS-2's delivering babies and doing lumbar punctures after a five-question quiz on the subject that morning.

Again, this isn't to say that we shouldn't be learning OMM this quickly or with such a low standard of knowledge and technique, only that OMM is hardly the hard science that so many of its proponents make it out to be when discussing its safety.

 

[gioia]

In theory, yes. In practice, it's the rare student who, when doing cervical HVLA for the first time, will have finely-tuned techniques. There are some in my class who haven't executed a successful thoracic HVLA; while it may have been a prerequisite *in theory* for going at the neck, in practice this wasn't the case. I'd be very surprised if AZCOM were alone in this.

It seems to me that we're far closer to chiropractors than we are to the stereotypical modern physician when practicing OMM. This isn't necessarily a bad thing, but it does imply a lower standard of evidence and competence. If we did all medicine the way we do OMM, we'd have MS-2's delivering babies and doing lumbar punctures after a five-question quiz on the subject that morning.

Again, this isn't to say that we shouldn't be learning OMM this quickly or with such a low standard of knowledge and technique, only that OMM is hardly the hard science that so many of its proponents make it out to be when discussing its safety.

Luke's posts provoke another tangential thought regarding OPP: WHY do we have to learn SOOO many techniques in such a SHORT period of time? We have covered loads of material from diagnostics to counter strain to muscle energy to myofascial release to soft tissue treatments to knee HVLA. I switch partners every week and am hard pressed to find many fellow students who even know the amount of pressure to apply and vector to use. How can it be possible to develop ANY of these techniques and become proficient? OMM is an art and I feel like I have a beautiful sketch pad with a box of pastels and no talent to make it look pretty.

 

[San_Juan_Sun]

Luke's posts provoke another tangential thought regarding OPP: WHY do we have to learn SOOO many techniques in such a SHORT period of time? We have covered loads of material from diagnostics to counter strain to muscle energy to myofascial release to soft tissue treatments to knee HVLA. I switch partners every week and am hard pressed to find many fellow students who even know the amount of pressure to apply and vector to use. How can it be possible to develop ANY of these techniques and become proficient? OMM is an art and I feel like I have a beautiful sketch pad with a box of pastels and no talent to make it look pretty.

At AZCOM, the OMM cirriculum was tweaked a bit for the class of 2007. The first quarter was mainly devoted to learning diagnostic/palpatory skills. The rationale given by the docs was basically "How can you fix something if you don't know the problem?"

After this period, we were given different techniques sequentially and applied them to several regions as the year went by. At the time, it sure seemed like an avalanch of material for such a short amount of time (usually 3-4 hours per week).

This year, we are seem to be doing an extensive review of the techniques we learned last year. We are also applying techniques to various conditions, I guess you could say we are getting a little more specific in our focus. Later in the year, we'll learn cranio-saral technique, and then get ready for boards.

I don't know what school you go to, but the idea at AZCOM seems to be:
1) learn to diagnose effectively
2) learn basic techniques and their applications
3) focus OMM technique on specific problems/dysfunctions

It seems that there is quite a bit of vaiation in how schools teach OMM. I'd be interested in hearing how other schools approach teaching OMM.

 

[coreyw]

Luke's posts provoke another tangential thought regarding OPP: WHY do we have to learn SOOO many techniques in such a SHORT period of time? We have covered loads of material from diagnostics to counter strain to muscle energy to myofascial release to soft tissue treatments to knee HVLA. I switch partners every week and am hard pressed to find many fellow students who even know the amount of pressure to apply and vector to use. How can it be possible to develop ANY of these techniques and become proficient? OMM is an art and I feel like I have a beautiful sketch pad with a box of pastels and no talent to make it look pretty.

I sympathise with you. Non-US osteopathic students spend three to ten times as much time in a five-year course to cover OMT. (Depending on which US school you compare it to.)

But then again, you wouldn't go to an Australian osteo with a skull fracture. And they get no hospital-based training.

Gioia, in an ideal world, how much more time would like to spend studying OMT? I guess what I'm asking here is: Is there any other subject you would safely sacrifice for more time on OMT or does it just come down to specialising later on?

 

[babyruth]

Our curriculum at DMU is 2 full years of training, similar to AZCOM's. You learn to first be comfortable with your palpatory skills and build up to something like cervical HVLA.

Yes, it is an art form; but an art form that does require practice. Even if you are only able to sketch with your pastels and are not a Monet, this is sufficient enough to be comfortable treating patients. If you don't feel confortable enough with your skills to do HVLA, then I suggest you don't do them.

As to comparing OMM to delivering babies, we get tons of more practice with these techniques than you do preparing for your OB-GYN rotations. My point is that HVLA is just another very effective tool in your tool box that you can use. Again, the reason that you learn so many techniques is so that you can cater to the individual patient. I feel more comfortable treating someone with OMT right now than I do starting an IV or delivering a baby, because there really isn't any practice that can prepare you for those things. Take advantage of what your school is offering you now, or I think that you will regret it later.

 

[LukeWhite]

I'm not sure it's a matter of more time (I don't know where we'd get it--if a year were added on to the program, fellowship style, I'd have gone allopathic) as a matter of fewer techniques.

SJS gave a good synopsis of how things are at AZCOM--whirlwind first year, while second year seems to be refining and targeting some of the techniques. That's dandy, and could be worse, but what would have been *better* would to have devoted first year to mastery of several key techniques.

Others surely have better numbers and perspective than I do, but I suspect that most DO's who practice OMM rely on at the most five or ten core techniques. Given the very few DOs who do any manipulation at all (and the horror stories about experienced practitioners who can't do simple thoracic HVLA safely) it seems like the core focus of OMM in the first two years should be the master of diagnosis and simple treatment.

Those interested in more should be able to pursue more, be it through the heavily subsidized five-year plan that most schools have via fellowships, careful choice of externships, or even a residency. Many will respond that we shouldn't complain, as this is what we knew we were getting into with osteopathy. I'd respond that osteopathy should be practical *and* practice-able above all else, and while that might take the form of more time, it would be better if it took the form of fewer techniques.

 

[babyruth]

Are you counting S/CS techniques? Because then these number in the thousands. But if you don't count counterstrain, you have a few core techniques that are usually modified in some form or fashion to fit the patient (prone, supine, etc.). I agree that these techniques are many, but your curriculum should spend the time reviewing them so that they are second nature. You should already have developed the ones you like or dislike by the end of the first year. Then you should start refining one or two back-up techniques to use instead. Does your school require and encourage you to give full body treatments? This might be helpful because it helps you to practice and remember what you learn, like you have to do with anything you learn in medical school. Complaining about the amount of techniques that you have to remember is like complaining that there are too many drugs for you to remember or too many bones that you have to know the name of. Some things in medicine you just have to know, and by going the osteopathic route, this is one of them.

Another thought is that the reason that there are so many techniques is because they are usually refinements from old techniques. People have decided that certain things might work better than others, so it's good that they are still trying to hone this skill.

 

[LukeWhite]

Complaining about the amount of techniques that you have to remember is like complaining that there are too many drugs for you to remember or too many bones that you have to know the name of. Some things in medicine you just have to know, and by going the osteopathic route, this is one of them.

This is surely something on which reasonable people can disagree. I'm of the opinion that it's better to teach students to do a few things well that they're certain to do than many things haphazardly that they almost certainly won't do.

OMM is still in the GP days of yore, trying to cram all medical information into the school years. Specialization's certainly no absolute good, but it does allow for the possibility of not having to learn every technique under the sun. For those such as you who want that full scope of OMM, there are fellowships, clerkships, residencies. I maintain, though, that we'd have a lot more docs performing OMM if we focused on a mastery of the basics.

Perhaps schools don't do this because they know that DO students increasingly want nothing to do with osteopathy once they're out the door, and want to make sure that they get the training in while they can? I suspect this is the case, and suggest that this might be countered by easing up a bit on the OMM Iron Fist that is the AOA. A little more transparency and flexibility would go a long way to keeping docs in the fold, where they truly can refine and develop their techniques.

Dr Still, tear down this wall!

 

[gioia]

This is surely something on which reasonable people can disagree. I'm of the opinion that it's better to teach students to do a few things well that they're certain to do than many things haphazardly that they almost certainly won't do.

OMM is still in the GP days of yore, trying to cram all medical information into the school years. Specialization's certainly no absolute good, but it does allow for the possibility of not having to learn every technique under the sun. For those such as you who want that full scope of OMM, there are fellowships, clerkships, residencies. I maintain, though, that we'd have a lot more docs performing OMM if we focused on a mastery of the basics.

Perhaps schools don't do this because they know that DO students increasingly want nothing to do with osteopathy once they're out the door, and want to make sure that they get the training in while they can? I suspect this is the case, and suggest that this might be countered by easing up a bit on the OMM Iron Fist that is the AOA. A little more transparency and flexibility would go a long way to keeping docs in the fold, where they truly can refine and develop their techniques.

Dr Still, tear down this wall!

I am in total agreement with LUKEWHITE. With manipulation, the knowlege comes from the repetitive development of familiar techniques. We have a full two year program and spend a minimum of three hours a week just in lecture. I love it. But I also spend more time trying to keep the terminology straight than I have time do develop palprebral skills. Maybe this feeling stems from the knowlege that I have had excellent therapy in the past and want to share that with others.