Hello Medhatters!
For those of you who did not know, I am currently (as of 2018) an OMS-1 student at Kansas City University. As an osteopathic medical student, this means I am not only learning all about medicine in the traditional sense, but also learning how to manipulate the body through osteopathic treatment and manipulation (called OMT or OMM) to learn to treat disorders of the body.
If you are looking into medical school and are undecided if you should go the MD or DO route, hopefully this helps clear things up a bit for you. If you are just curious or just starting out your research on medical school and medicine, I hope this sheds some light for you as well!
What is Osteopathy?
Osteopathy is the philosophy of knowing the structure and function of the body and being able to use this knowledge to aid in the health and healing of the body. This practice looks at the host, (or patient) as a whole, instead of individually looking at just the problem area. In combination of seeing the patient as a whole + treating the disease/illness = overall improvement in health. By using our hands to feel and use OMM, we can help accomplish this! And this is generally how osteopathy operates.
How is this used in practice?
According to AACOM.org, “Osteopathic medicine provides all of the benefits of modern medicine including prescription drugs, surgery, and the use of technology to diagnose disease and evaluate injury. It also offers the added benefit of hands-on diagnosis and treatment through a system of treatment known as osteopathic manipulative medicine. Osteopathic medicine emphasizes helping each person achieve a high level of wellness by focusing on health promotion and disease prevention.”
You can also check out the link above for more information on the American Association of Collages of Osteopathic Medicine's website.
So, we still learn how to do surgery (in residency if that’s what you choose to go into), prescribe medications, and learn all about disease processes just like MD students do, but we add learning how to do OMM. OMM is used to treat things such as tight muscles, to treat a fancy term described as somatic dysfunction (which is anything that is unequal or off from the normal for the patient that can be treated by OMM more-or-less), poor circulation of lymph or blood flow, etc. In my first semester, most of what we have learned so far is finding if one side is unequal to another, or finding a very tight muscle and learning to fix it or cause it to relax. (This has been great for my tight neck and back!)
Now, OMM doesn’t treat everything. There are many types of techniques that have both general and very specific contraindications (or makes that treatment inadvisable to performing it on that patient). There are also many different types of treatments that we learn. So if one doesn’t work, there could be many others that may work.
However, if none of the options are recommended to be performed on a patient, or they aren’t working/the patient cannot tolerate them well or isn’t understanding the directions well, we need to look into the more “traditional” method. In this scenario, an osteopathic physician would treat the disease itself (so your typical medical measures such as medication, surgery, etc) as the patient would be unable to handle OMM without potentially causing more of an issue. But as a whole, if we can integrate OMM in combination with medically treating the issue, the patient should overall have improved health.
Honestly, I think this has a lot of appeal. Think of how many patients who do not want to undergo surgery, take pain medications, or muscle relaxants when they can come get a few second to a few minute treatment on their problem area(s). Its much less of a cost, much less invasive, and has immediate effects if it is indicated and safe to do OMM.
As a side note; just because an osteopathic physician is trained in a more wholistic fashion, doesn't mean many of us are also well versed or trained in holistic medicine. Some providers will know a lot about supplements and alternatives in that sense. But we do not get additional teaching on this. This has to be a side interest for any physician to learn. Some physicians may also learn things such as acupuncture or massage therapy to help assist with OMM. But again, not every provider will undertake this!
4 tenants of Osteopathic Medicine
There are 4 tenants of osteopathic medicine that we abide by. They are brought up many times (at least during our first year) and are listed as follows:
- The person is a unit of body, mind, & spirit
- The body is capable of self-regulation, self-healing, and health maintenance (Meaning may leave it to fix itself. However if having a fracture & displaced arm, interventional treatment is needed to help itself heal)
- Structure and function are reciprocally interrelated
- Rational treatment is based upon understanding & implementing the other 3 tenants
History of Osteopathy
Osteopathic medicine all started with this guy ——>
A.T. Still.
At my school (and I’m sure at many other D.O. schools) we have to learn about what happens leading up to this main point, but basically after the Civil War (in which A.T. Still was a general in the battle of Westport; which is now a bar scene/district in Kansas City), he went back to his farm to live a “normal” life. 10 years after the war, in 1874, he “flung his banner into the breeze” (don’t ask me what that means because I still have no idea) which basically meant he decided to pursue his idea of osteopathy. At the time that he was a farmer, he was also the town’s physician and a Methodist church pastor.
When he spread the word and his idea about osteopathy, he was formally removed from the Methodist church and basically outed from his town. This is all still occurring in 1874.
Additionally in 1874 the first osteopathic technique was recorded. By 1875 A.T. Still officially moved his family to Kirksville, MO and he continued to work as a traveling physician in rural MO (since ya know, he was run out of his town and he had to keep making money).
Side note; Kirksville, MO ends up being where A.T. Still University (a DO school, obvi) will be in the future.
By 1885, Still coins the term “osteopathy”. Which doesn’t seem like a big step now but we use it daily in DO school.
In 1886 he becomes busy enough to stay in Kirksville and be the town’s physician.
It took until 1892 to open his first school, coined American School of Osteopathy (which will later become A.T. Still University). By 1900 it becomes the largest school of the healing arts.
Prior to A.T. Still passing away in 1917 he ends up publishing several books based on his research, his techniques, and his autobiographies.
How DO’s treat: the approach
Now, I don’t have a ton of practice in this yet and we haven’t really learned to integrate this into our PCM courses, SP encounters, or future patients. But so far in my first semester, we learn how to do an isolated exam and then to treat what we’ve learned so far (when in our osteopathic labs only).
From how we’ve been taught so far, it’s by far easiest to ask if there are problem areas for us to look at (because let’s be real, you don’t normally do a full body exam to find something. The patient tells you what’s bothering them!). Then we assess if its symmetric/even to the other side or not, tense, or more rotated/prefers one side.
Usually if you look hard enough though you can find something to treat. Or you don’t have to look hard at all. I mean, there is that too lol.
When assessing we look for TART. Which stands for tissue texture changes, asymmetry, range or motion, and tenderness. If there is any one of these, or more than 1 of these, it is worth looking into more to decide to treat. Then we pick a technique and “try” to fix the problem area with the limited number of treatment types we’ve been taught. I say “try” because 1) I’m a first year and I’m still trying to figure out what I’m feeling and 2) it may work for many patients but not be the best technique for that particular patient & their problem. Or 3) they need a combination of a couple of different types of treatments.
So far I have learned how to do soft tissue techniques (similar to some types of massage), lymph flow improvement, muscle energy, articulations, and I’m currently learning counterstrain!
We will eventually learn how to pop (called HVLA), BUT, that is not everyone’s cup of tea. It certainly isn’t mine. But popping isn’t the only technique we learn or that DO’s use. In fact, I would say counterstrain and muscle energy would be more widely used to treat.
From my understanding, by the time we have boards we have to do a full “SP” encounter (for more information on my PCM course check out my What is the PCM Course at KCU post) and do an osteopathic examination/TART screening, and a treatment for that area.
Since we aren’t there yet in our first semester, we don’t have to worry about trying to do an osteopathic exam or a treatment for the person’s issue. I’m sure we will start to learn how to do that by the end of our first year or the beginning of our second year.
Again, we integrate OMM like we would with any other treatment. So, if you have an elbow that bothers you and a physician recommends rest, ice, ibuprofen, and reducing activity, a D.O. physician may also do an OMM treatment to help the body move healing along at the elbow joint as well.
Lastly, if you go into a specialty where OMM doesn’t really integrate well, or you choose not to use OMM, that is okay too!
As always, let me know what you liked, didn’t like, or what you would like to see next in the comments below!
