Osteopathic Manipulative Therapy

What exactly is Osteopathic Manipulative Therapy (OMT)?

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OMT involves the physical movement of skin, bones, joints, and soft tissue in an effort to impact the surrounding organs and tissues. The goal of OMT is to improve movement, range of motion, and reduce pain or discomfort.  

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There is little or no doubt within the medical community that the body can be manipulated to produce changes in a persons physiology. For example, every MD and DO, while in medical school, learn the technique known as carotid massage. By using the fingers, a physician can massage the carotid artery of the neck of a patient. The gentle, yet effective massage, typically produces changes in the patient's heart rate and blood pressure by stimulating the vagus nerve. This technique is also used to help with identifying abnormal heart rhythms and may treat specific patients whose heart is beating too quickly.

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How does OMT differ from chiropractic manipulation?

 

OMT is performed by osteopathic physicians (DO) and few allopathic physicians (MD) with additional training. These physicians tend to have a much greater understanding of anatomy, physiology, and pathology of disease that their chiropractor counterparts. OMT includes more that just spinal manipulation. It also includes the treatment of extremities, abdominal complaints, respiratory conditions, and treatment of muscles and soft tissues.

 

Keep in mind that OMT is only one of the many methods of treatment used by osteopathic physicians.  Osteopathic doctors are also licensed to write prescriptions, perform surgery, and other medical services that chiropractors are unable to provide.

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What conditions can be treated using OMT?

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OMT has been found to benefit many medical conditions, including:

• Back pain

• Neck pain

• Shoulder pain

• Frozen shoulder

• Hip pain

• Wrist pain

• Ankle pain

• Carpal tunnel

• Sinus congestion

• Muscle spasms

• Muscle aches

• Headaches

• "Pinched" nerves

• Constipation

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Is OMT painful?

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OMT, when performed properly, should not be painful. Many patients experience a "release" during treatment, a sudden decrease in pain.

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What are some of the techniques used in osteopathic manipulation?

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The most well-known technique in osteopathic manipulation is High-Velocity Low-Amplitude (HVLA) techniques, also known as "thrust treatment". When using this technique, manipulation of a patient's spine or joints may produce noises like "cracks". People who have ever visited a chiropractor are familiar with similar techniques.

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Other techniques used in OMT include:

• Soft tissue techniques

• Myofascial release techniques

• Counterstrain techniques

• Muscle energy techniques

• Facilitated positional release techniques

• Techniques of Still

• Balanced ligamentous tension

• Visceral techniques

• Lymphatic techniques

• Articulatory and combined techniques, and

• Osteopathy in the Cranial Field

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Are physical exams done by osteopathic doctors different from allopathic doctors?

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Yes and no. The classical methods of physical examination are learned and practiced by all physicians (listening, touching, looking). Osteopathic physicians practicing OMT will often spend a little more effort on the musculoskeletal components of the exam. In the end, all physicians operate within the same medical model - diagnose and treat.  

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Can anyone be treated with OMT? What are the contraindications to OMT?

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One of the great things about osteopathic manipulation is that there are not any absolute contraindications to OMT as a whole. However, there are patients and conditions where a particular treatment is not appropriate. The same is the case for all other treatments in medicine. 

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For example, the muscle energy techniques require the patient to be able to participate and follow instructions during treatment. These techniques are unlikely to be successful if the patient is too young or has severe dementia.  

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A Brief History of Osteopathic Medicine

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The field of osteopathy was founded by Andrew Taylor Still, M.D., D.O., an American doctor in the 19th century. Dr. Still initially practiced medicine using the typical methods of the time period. Physicians at the time used treatments such as salves, plasters, and other oral medications. In fact, the wealth of medical knowledge possessed by the medical community today was only in its infancy. Over the course of his life, he decreased the use of medication, substituting drugs for manipulative treatments. Sometime in the 1880's, when he stopped using medications altogether to treat patients, he decided to refer to his new practice of medicine as "osteopathy".  

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The first osteopathic medical school was founded in 1892 as the American School of Osteopathy, follow by the establishment of the Philadelphia College of Osteopathic Medicine in 1898. Over the course of the next century, osteopathic education and the osteopathic profession would continue to expand. Today, there are more than 37 osteopathic medical schools in the U.S.. In addition, more than 20% of all graduating physicians in the United States are osteopaths. Osteopathic physicians are fully licensed to practice medicine and surgery in all 50 states.

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Research on Osteopathic Manipulation

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Below is a very small selection of research papers and articles. The biggest limitation surrounding research in osteopathic manipulation is the inability to conduct proper blinding for a study. The highest quality studies are randomized, double blinded, placebo controlled studies. Double blinded studies are ones that neither the doctor nor the patient know what the treatment may be. That's nearly impossible with manipulation for obvious reasons. Therefore, unfortunately, many of the research studies are criticized for being of "low-quality". Typically, the "low-quality" research is a result of that limitation.

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Dal Farra F, Risio RG, Vismara L, Bergna A. Effectiveness of osteopathic interventions in chronic non-specific low back pain: A systematic review and meta-analysis. Complement Ther Med. 2021 Jan;56:102616. doi: 10.1016/j.ctim.2020.102616. Epub 2020 Nov 13. PMID: 33197571.

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Bagagiolo D, Rosa D, Borrelli F. Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews. BMJ Open. 2022 Apr 12;12(4):e053468. doi: 10.1136/bmjopen-2021-053468. PMID: 35414546; PMCID: PMC9021775.

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Jara Silva CE, Joseph AM, Khatib M, Knafo J, Karas M, Krupa K, Rivera B, Macia A, Madhu B, McMillan M, Burtch J, Quinonez J, Albert T, Khanna D. Osteopathic Manipulative Treatment and the Management of Headaches: A Scoping Review. Cureus. 2022 Aug 9;14(8):e27830. doi: 10.7759/cureus.27830. PMID: 36110479; PMCID: PMC9462953.

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