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Why OMM ?. William C. Simon DO New Medical health care. What is OMM?. Osteopathic manipulation is a treatment that attempts to improve joint range of motion and balance tissue and muscular mechanics. Improve function and decrease pain and suffering. What is OMM used for?. Headaches
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Why OMM ? William C. Simon DO New Medical health care
What is OMM? Osteopathic manipulation is a treatment that attempts to improve joint range of motion and balance tissue and muscular mechanics. Improve function and decrease pain and suffering
What is OMM used for? Headaches Back pain Shoulder dysfunction and pain Carpal Tunnel Syndrome Strains and sprains SOB Chest pain with rib dysfunction Colic Just to name a very few
OMM is used to treat: musculoskeletal pain conditions, such as back pain, shoulder pain, arthritis, and tension headaches . Some advocates of OMT believe that it has numerous other benefits, including: Upper respiratory infections Fibromyalgia Asthma Carpal tunnel syndrome Pneumonia Bronchitis Overall health and well-being
Evolution of Osteopathic Medicine Evolution of osteopathic medicine's mission and identity tookYears to evolve: 1892 to 1950 Manual medicine 1951 to 1970 Family practice / manual therapy 1971 to present Full service care / multispeciality orientation 1916-1966, Federal recognition Recognition by the US federal government was a key goal of the osteopathic medical profession in its effort to establish equivalency with its MD counterparts. Between 1916 and 1966, the profession engaged in a "long and tortuous struggle" for the right to serve as physicians and surgeons in the U.S. Military Corps
Years States Passed unlimited practice rights for DOs, equal to those of MDs • Early, 1901-1930 • Middle, 1931-1966 • Late, 1967-1989
Geographic distribution of osteopathic physicians as a percentage of all physicians, by state. <3% 3-5% 5-10% 10-15% 15-25
Osteopathic Medical Schools Midwest& Plains AT Still Kirksville, Des Moines COM, Kansas City COM, Michigan State, Midwestern Chicago, Ohio COM, Oklahoma State Northeast Lake Erie COM, New England COM, New York COM, Philadelphia COM, Touro Harlem, UMDNJ-SOM Southeast Lake Erie COM, Bradenton, Lincoln Memorial, North Texas COM, Nova Southeastern, Philadelphia COM Georgia, Pikeville KYCOM, Virginia COM, West Virginia SOM, William Carey COM West AT Still Arizona, Midwestern Arizona, Pacific Northwest, Rocky Vista, Touro California, Touro NevadaWestern Currently, there are now 26 accredited osteopathic medical schools offering education in 34 locations in the United States and 126 accredited US (MD) medical schools.
Osteopathic Schools In 1960, there were 13,708 physicians who were graduates of the 5 osteopathic medical schools. In 2002, there were 49,210 physicians from 19 osteopathic schools. Between 1980 and 2005, the number of osteopathic graduates per year increased over 250 percent from about 1,000 to 2,800. This number is expected to approach 5,000 by 2015.
Osteopathic Training The osteopathic medical school curriculum is clearly distinguished from allopathic medical education by its focus on osteopathic manipulative medicine (OMM), a hands-on therapy that is used to diagnose and treat illness and injury. OMM education usually occurs through year-long first and second yeartheoretical and skills courses, and through subsequent clinical experiences. OMM education is in addition to, and integrated with, medical training on current and emerging theory and methods of medical diagnosis and treatment.
Osteopathic Training and Trends Osteopathic medicine is considered by some in the United States to be both a profession and a social movement, especially for its historically greater emphasis on primary care and holistic health. However, any distinction between the MD and the DO professions has eroded steadily; diminishing numbers of DO graduates enter primary care fields, fewer use OMM, holistic patient care models are increasingly taught at MD schools, and increasing numbers of DO graduates choose to train in non-osteopathicresidency programs.
Trends in Osteopathic Primary Care Trends in primary care as a career choice of osteopathic medical students 4th year students-dark blue 1st year students-light blue
Total Number of DO’s in Residency Training Programs, by Year. Blue is DO residents in ACGME (MD) programs. Red is DO residents in AOA (DO) programs.
Manipulation in Practice A 2001 survey of osteopathic physicians found that more than 50% of the respondents used OMT on less than 5% of their patients. The survey follows many indicators that osteopathic physicians have become more like MD physicians in every respect —few perform OMT, and most prescribe drugs or suggest surgery as a first line of treatment.
Manipulation in Practice Recent studies show an increasingly positive attitude of patients and physicians (MD and DO) towards the use of manual therapy as a valid, safe and effective treatment modality. One survey, published in the Journal of Continuing Medical Education, found that a majority of physicians (81%) and patients (76%) felt that manual manipulation (MM) was safe, and over half (56% of physicians and 59% of patients) felt that manipulation should be available in the primary care setting. Although less than half (40%) of the physicians reported any educational exposure to MM and less than one-quarter (20%) have administered MM in their practice, most (71%) respondents endorsed desiring more instruction in MM.
Manipulation in Practice Another small study examined the interest and ability of MD residents in learning osteopathic principles and skills, including OMM. It showed that after a 1-month elective rotation, the MD residents responded favorably to the experience
OMM vs Standard Medical Treatment Study A Comparison of Osteopathic Spinal Manipulation with Standard Care for Patients with Low Back Pain Gunnar B.J. Andersson, M.D., Ph.D., Tracy Lucente, M.P.H., Andrew M. Davis, M.D., M.P.H., Robert E. Kappler, D.O., James A. Lipton, D.O., and Sue Leurgans, Ph.D. N Engl J Med 1999; 341:1426-1431November 4, 1999
OMT Study They performed a randomized, controlled trial that involved patients who had had back pain for at least three weeks but less than six months. They screened 1193 patients; 178 were found to be eligible and were randomly assigned to treatment groups; 23 of these patients subsequently dropped out of the study. The patients were treated either with one or more standard medical therapies (72 patients) or with osteopathic manual therapy (83 patients). They used a variety of outcome measures, including scores on the Roland–Morris and Oswestry questionnaires, a visual-analogue pain scale, and measurements of range of motion and straight-leg raising, to assess the results of treatment over a 12-week period.
OMT Study Results Patients in both groups improved during the 12 weeks. There was no statistically significant difference between the two groups in any of the primary outcome measures. The osteopathic-treatment group required significantly less medication (analgesics, antiinflammatory agents, and muscle relaxants) (P< 0.001) and used less physical therapy (0.2 percent vs. 2.6 percent, P<0.05). More than 90 percent of the patients in both groups were satisfied with their care.
Cervical Manipulation and Stroke Risk Stroke with cervical manipulation is estimated to be 1 in 400,000 to 1 in 5.8 million NCMIC Chiropractic solutions concluded: “the incident of stroke in the population as a whole is no different, with about 2 per 100,000 anually, than those who received manipulations of the neck.”
Cervical OMM Neck strains Headaches Sinus Problems Stiff neck Arm numbness
Thoracic Manipulation SOB with ribrelease Chest pains (not cardiac related unless stable) Upper back pains Shoulder pains Lots of people have pains in this area from purses, backpacks and leaning over to do daily work
Lumbar Manipulation Majority of back issues Sciatica Radiculitis Abdominal pain Usually spasms are cause for most pain Obesity is a contributal cause Related to daily activities such as lifting, twisting, stooping and bending
Obesity, Back Pain and Workers’ Comp Obesity was particularly linked to workers’ comp claims for falls, slips, lifting, exertion, back pain, and injuries to the hand, wrist, knee, hip and ankle! Physically demanding jobs carry the greatest risks!
Obesity, Back Pain and Worker’s Compensation • Medical costs per 100 workers • Normal BMI: $7,500 (18.5-24.9) • Overweight: $13,300 (25.0-29.9) • Mildly Obese: $ 19,000 (30.0+) • Moderately Obese: $23,000 (>40) • Severely Obese: $51,000 (>50) • Researchers found that the number of workdays lost was almost 13 times higher, medical costs 7 times higher and indemnity claims costs were 11 times higher among the heaviest employees compared to those of normal weight
Back Pain is a Leading Cause of Work-Loss Days 83 million days of work are lost each year due to back pain Back pain is a leading cause of work-loss days as well as work limitations. Adults with back pain spend almost 200 million days a year in bed! A larger proportion of back pain patients report feeling sad, worthless or hopeless.
Proportion of Adults with and without Back Pain Who are Working
Median Annual Earnings of Adults With Work Limitations Due to Back Pain, by Age
Adults With and Without Back Pain Using Various Health Care Services
Health Care Expenditures for Adults With and Without Back Pain
Effects of Back Pain on Retirement With Back Pain Without back pain
Cost of Back Pain In 2005 Americans spent $85.9 billion looking for relief from back and neck pain, through surgery, doctors’s visits, xrays, MRI’s and medications. This is up from $52.1 billion in 1997. According to the JAMA, that money has not helped reduce the number of sufferers; in 2005, 15% of U.S. adults reported back problems, up from 12% in 1997
Cost of Back Pain Researchers at the University of Washington and Oregon Health Science University compared national data from 3,179 adult patients who reported spine problems in 1997 to 3,187 who reported them in 2005 and found that inflation adjusted costs increased from $4,695 per person to $6,096.
Chiropractic Cost-Effectiveness Blue Cross Blue Shield of Tennessee conducted a study in 2010 that took place over a 2 year period. 85,000 BCBS subscribers in the insured study population had open access to MDs and DCs through self-referral, and there were no limits applied to the number of MD/DC visits allowed and no difference in co-pays. Thius this study reveals what happens when Chiropractic and Medical services compete on a level playing field.
Chiropractic Cost-Effectiveness The researchers compared the costs of low back pain care initiated by a DC with care initiated through a MD or DO. They found that costs for the DC group were 40% lower. Even after factoring in the severity of the conditions with which patients presented, costs when a DC initiated care were 20% lower than if a MD/DO initiated care.
Who does Manipulation? • Osteopaths are trained to do manipulation • Only a small percentage do OMM • Chiropractors are trained to do manipulation • Most DCs do some form of manipulation • Physical Therapists are trained to do manipulation • Are now PhDs wanting more indivdual practice rights • Massage Therapists-some do types of manipulation • Others such as DOM, Naturopaths and Homeopaths have manipulation traiing
How long does it take to do OMM? It takes anywhere from 1 minute to 30-40 mins depending on the treatment, method and extent. HVLA is usually fairly quick Strain-counterstrain usually takes 1 to 3 mins per area Cranial usually takes 5-10 mins depending on findings and areas Visceral takes about 5 min
