Which OMM techniques do you like or dislike?

[Red Beard]

We are getting close to the end of our MS1 OMM course. So far, I have had the most success treating and being treated with muscle energy techniques.

I'm really not a big fan of counterstrain or MFR. Even in our textbook they point out that counterstrain does nothing to address the underlying somatic dysfunction.

Haven't had any cranial yet. I am skeptical, but will wait to see what I see.

How about you?

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[Dr.Dicky]

I love the frog and the wheelbarrow...definitely keepers. Although the intra-rectal coccygeal release is working its way up to the top of my list.

 

[Sirius Black]

Cervical and thoracic HVLA is my fav, simply because there is nothing more satisfying than hearing that "pop". As for effectiveness, I've found that muscle energy works the best for the widest range of dysfunctions.

 

[DragonWell]

I love the frog and the wheelbarrow...definitely keepers. Although the intra-rectal coccygeal release is working its way up to the top of my list.

Bad...so bad...

Soft tissue, HVLA, ME are my faves.

We don't really do CS till next year, but based on the little we have done, I like it pretty good esp. for piriformis.

 

[Taus]

I'm mostly an HVLA/ME guy...I usually just use counterstrain when I'm trying to diagnose and there's a really tender spot segmentally....its kind of funny to watch people accuse you of moving your finger from the tenderpoint b/c they don't feel the pain anymore when you push

 

[blike]

Like: Kirksville crunch (hey, what can I say, I'm from KCOM), texas twist (not taught, learned from a 3rd year), HVLA cervicals ("the patients like the joint music" as one of our esteemed retired surgeons put it), lumbar roll (aka the million dollar roll).

Dislike: Cranial.

 

[cyclohexanol]

My wife is a big fan of long-axis cervical kneading, it seems to help with her cervicogenic headaches. So I guess I'll go with ST for my favorite.

 

[olliemctuffy]

I can't stand cranial, it should be removed from our curricula and the board exams. The evidence for it does not exist and the theories are bogus. It is embarrasing.

That said, I like using ME, ST, BLT and occassionally HVLA, particlularly for the T spine.

 

[surrender903]

I'm mostly an HVLA/ME guy...I usually just use counterstrain when I'm trying to diagnose and there's a really tender spot segmentally....its kind of funny to watch people accuse you of moving your finger from the tenderpoint b/c they don't feel the pain anymore when you push

them "hey thats not the spot"

me "nooooo you just are feeling better"

them "no no no thats not the spot anymore!"

me "..."

_____________________________________________

i prefer HVLA and counterstrain, but lymphatic techniques are very handy during the winter months.

 

[Jack Daniel]

It seems that DOs have developed some technique for every freaking muscle in, on, and around the pelvis. Before I would ever use some of these techniques on actual patients, I'll need to either change how I value these techniques or marry the patient.

 

[cyclohexanol]

After today's crapshoot of a dismal test, let me add posterior lumbar counterstrain as something I dislike... a lot.

 

[nvshelat]

I dislike counterstrain...Umm let me just put my finger there and lift up your leg... does that feel all better now?? Thanks, that'll be $150 please.

ME ain't bad - my fiance is an OT and they use it alot along with the PTs, they just call it something else. Cervical HVLA gave me a HA but I liked lumbar HVLA.

We do this thing at NYCOM called FPR, do you guys do that? It's like lazy mans counterstrain - this one you only have to hold for 3-5 sec but since you have a pillow involved, that magically makes it all better.

 

[Dr JPH]

Most common things I use (therefore I like)

1. Cervical HVLA
2. First rib Still technique
3. Thoracic/Lumbar HVLA
4. Sacral counterstrain
5. Visceral
6. OA decompression

 

[babyruth]

When treating older or difficult patients, you will end up using a lot of things you might dislike to get them relief. You basically need a large array of techniques under your belt. HVLA, ME, springing, modified BLT, and soft tissue work really well depending on the age. Last resort is FPR or MFR, especially on fibro patients. Do what your comfortable with first and then work outwards. Having a routine down also helps (i.e. sacrum up, or cranium down, etc.). I'm still trying to coordinate it into my schedule, especially hospital medicine where you are limited on time and acuity of care. I know several docs who refer out to chiropractors for their patients because of time, amount of treatments needed, and $ issues with their patients. There is also medical massage and acupuncture used with varying degrees of success.

 

[Fin-Nor]

Ligamentous articular strain, BLT, BMT or watever other name you want to call it
Counter strain
Fascial release
muscle energy
HVLA

it's a shame that majority of DO's only like HVLA or muscle energy.

 

[Taus]

Ligamentous articular strain, BLT, BMT or watever other name you want to call it
Counter strain
Fascial release
muscle energy
HVLA

it's a shame that majority of DO's only like HVLA or muscle energy.

It may have something to do w/ that fact that we learn OMM on relatively healthy patients in lab (ie each other) and those other techniques just don't seem like they are doing anything to our relatively healthy selves....vs. hvla/ME you can feel, see (or maybe even hear) some kind of result

Combine that w/ the fact that only a certain percentage of us will take the OMM training in years 3+4 seriously....and you get people who only feel comfortable w/ the stuff they liked or felt was useful in year 1+2

I'm only an M2...so hopefully I'll have some good opportunities to brantch out w/ my techniques on patients who are actually in pain in the next few years

though its not like any of us M1/2's know what drugs in a class we "like" or how we prefer to work up patients for whatever medical dx.....those will only come w/ experience....

 

[homeboy]

It may have something to do w/ that fact that we learn OMM on relatively healthy patients in lab (ie each other) and those other techniques just don't seem like they are doing anything to our relatively healthy selves....vs. hvla/ME you can feel/see/hear some kind of result

Combine that w/ the fact that only a certain percentage of us will take the OMM training in years 3+4 seriously....and you get people who only feel comfortable w/ the stuff they liked or felt was useful in year 1+2

I'm only an M2...so hopefully I'll have some good opportunities to brantch out w/ my techniques on patients who are actually in pain in the next few years

like: ME & soft tissue
dislike: basically everything else, particularly MFR, tenderpoints, and of course, cranial.

seriously, i don't get the "I love the pop" people. you're like the habitual knuckle-crackers.

 

[Jack Daniel]

...seriously, i don't get the "I love the pop" people. you're like the habitual knuckle-crackers.

Today we learned some HVLA techniques on the thorax. Got a nice pop while I was the patient. Felt pretty darn good. I might have to start seeking these people out.

 

[DragonWell]

It may have something to do w/ that fact that we learn OMM on relatively healthy patients in lab (ie each other) and those other techniques just don't seem like they are doing anything to our relatively healthy selves....vs. hvla/ME you can feel, see (or maybe even hear) some kind of result

Combine that w/ the fact that only a certain percentage of us will take the OMM training in years 3+4 seriously....and you get people who only feel comfortable w/ the stuff they liked or felt was useful in year 1+2

I'm only an M2...so hopefully I'll have some good opportunities to brantch out w/ my techniques on patients who are actually in pain in the next few years

though its not like any of us M1/2's know what drugs in a class we "like" or how we prefer to work up patients for whatever medical dx.....those will only come w/ experience....

I think the learning curve on indirect techniques is much longer too, and the findings are much more subtle. I don't think most people aren't putting in the time to develop these skills, at least during M1-2.

 

[yanky5]

Counterstrain rules. I don't like cervical HVLA since I don't think it's safe. They tell you it is safe but they cover up injuries that occur to pts sometimes.

 

[JohnDO]

I don't like cervical HVLA since I don't think it's safe. They tell you it is safe but they cover up injuries that occur to pts sometimes.

Evidence?

 

[Jamers]

Counterstrain rules. I don't like cervical HVLA since I don't think it's safe. They tell you it is safe but they cover up injuries that occur to pts sometimes.

Sure, you don't go popping someone with Downs but, in a healthy person, what harm could a well place technique cause?

Me: I am a cracking junkie, if I can hear it, I like it.

 

[Taus]

Counterstrain rules. I don't like cervical HVLA since I don't think it's safe. They tell you it is safe but they cover up injuries that occur to pts sometimes.

or they never listen to their profs and put the neck into extension before cranking it around....

 

[Red Beard]

Counterstrain rules. I don't like cervical HVLA since I don't think it's safe. They tell you it is safe but they cover up injuries that occur to pts sometimes.

The risk with HVLA has actually been studied in great detail, both from within and outside the osteopathic profession. The findings invariably point to a risk of serious complications with cervical HVLA somewhere on the order of 1:500,000 or less. Most studies suggest rates closer to 1:1,000,000 or less. These aren't just JAOA papers either. The point is that cervical HVLA, performed by a trained operator, and with the relevant contraindications taken into account, is one of the safest medical procedures there is.

As far as "they" covering up injuries to patients...I'm not sure how one would go about covering up life threatening cervical injuries.

 

[ShyRem]

Haven't done much HVLA yet (still MSI), but we do a TON of CS and ME techniques first year. Have done a few HVLA stuff. I think it depends a lot on who you're treating. My husband HATES HVLA, but really really loves the CS and ME stuff. There are some folks in class who are harder than all get out to pop, but they respond well to the other techniques. I will say that learning all those CS points drives me nuts.

 

[Taus]

Haven't done much HVLA yet (still MSI), but we do a TON of CS and ME techniques first year. Have done a few HVLA stuff. I think it depends a lot on who you're treating. My husband HATES HVLA, but really really loves the CS and ME stuff. There are some folks in class who are harder than all get out to pop, but they respond well to the other techniques. I will say that learning all those CS points drives me nuts.

forget the points.....just fold and hold around where it hurts...

 

[The_Sensei]

Techniques I like - None
Techniques I hate - All

I'm an anesthesiologist, though

 

[msgirl]

Counterstrain is awesome if you've ever actually had a Chapman's point. And it enables the patient to be functional. About it not correcting a somatic dysfunction--you do address the inapporiate gamma motor neuron firing. I'm telling you, sometimes the osteopathic clinical correlates sound like a bit of a stretch; this one is not. It really does reduce pain by 30% or better.

To me, HVLA is good if you do it correctly. If not, you cause way more problems than you fix (remember the cervical lab??). My favorites are ME and Still's techniques.

All of OMM requires that you understand what's going on with the body, and to me that's pretty awesome (not to mention the mark of a doc that's worth his or her salt).

 

[DORoe]

I am going to throw in a vote for Spencer technique. I have used it a lot and people really like it.

 

[RobbingReality]

Sacral Rocking- A cruel joke on unsuspecting victims