“What kind of doctor are you?”
“I’m a DO, Doctor of Osteopathic Medicine, specialty Osteopathic Manipulative Medicine (OMM).
Manipulation is a type of bodywork where the physician introduces light gentle or deep pressure to bones, joints, muscles, and more to treat bio-mechanical problems that produce pain and affect distant parts of the body. Traditional methods handed down from the American past intermingle with medical science and bio-mechanical reasoning.
Osteopathic medicine is a complete system of medical care administered by DOs. Including medical doctors (MDs) they are the only two fully unrestricted physicians in the United States with potential licensure in any area and practice of medicine. Roughly 1 out of 4 physicians in the United States is a DO. DOs and MDs practice together in every area of practice, including all medical and surgical sub-specialties, but DOs as a group tend to gravitate towards primary care, such as family medicine, internal medicine, pediatrics, OB/Gyn, and general surgery.
We also undergo additional training in anatomy and physiology of the musculoskeletal system, including osteopathic manipulation, a distinct evaluation and treatment method that uses the physician’s hands to improve how the body parts–joint, muscle, soft tissue, everything–work together.
This is based on examination and physical palpation: the fancy medical term for a specific type of touch for diagnosis, such as detecting motion in a joint or tension in a muscle. Sometimes a part of the body on one side isn’t working well bio-mechanically and stands out compared to the other side, such as noticing that one of the vertebra in the spine doesn’t turn as far to one side, there’s a big tight muscle attached to it, and the area is tender and painful. (most would agree that this is a problem that needs to be fixed)
The osteopathic way of treating a cause of pain such as this involves not simply “working on” the twisted vertebrae or the muscle spasm right at the area of pain, but to discover how those bones and muscles are affecting the rest of the body, treating each area as we go so that the whole system works as efficiently as possible.
From my perspective, here’s a good basic question I often ask myself in this type of scenario: what bone is the muscle attached to at the other end, and is it moving in a normal healthy manner or stuck in a certain position? Also, what if that bone is an integral part of anatomy, such as a rib involved with breathing? That could have meaningful consequences if someone has pneumonia or asthma and the rib couldn’t move well because of muscle spasm. Asymmetry is not optimal, causing compensation and adaptation throughout the entire spine, effecting posture, weight distribution, and 3-dimensional movement.
These types of questions come from osteopathic philosophy and theory. Basic principles include “the body is a unit, structure and function are inter-related, and the body is capable of self-healing.”
In practice, patients see me almost exclusively for osteopathic manipulative medicine service, where there is hands-on diagnosis and treatment with you on the treatment table for the majority of the appointment time (typical new visit is 60 minutes, followups 45 minutes total). The experience is not sensual like a massage, but anatomic and medical (yes, generally relaxing!), with an emphasis on basic bio-mechanics, breathing, posture, symmetry, fluid drainage, and inherent motion. You will experience “good” hands.
Additional procedures for more intense needs include various types of injections: steroids for joints and inflammation, viscous gel for knees, muscle trigger points, superficial nerve blocks, and prolotherapy (soft tissue regeneration with sugar water). These aids for generally for patients suffering from arthritis, flair of chronic pain, tendonitis, non-responders, etc.
See below for more information about the DO profession and OMM specialty.”
Damian Bundschuh, D.O.
Scope of Practice
Osteopathic Manipulative Medicine (OMM) refers to the art and science of diagnosis and treatment of patients using osteopathic manipulation, versus the actual treatment called Osteopathic Manipulative Treatment (OMT) or osteopathic manipulation. Neuromusculoskeletal medicine (NMM) refers to the clinical practice and specialty of caring for diseases, syndromes, and ailments of the connected system of bones, muscles, soft tissue, nerves, and organs.
Residencies and board certification in osteopathic manipulation formally designate the specialty of osteopathic manipulation as NMM/OMM to describe the integration of osteopathic manipulation with physical diagnosis and treatment. Only US-trained osteopathic physicians can enter NMM/OMM residencies and fellowships or receive board certification. Osteopaths from Europe and other countries have a different training emphasis and are not considered fully licensed physicians in the United States.
OMM specialists are not the only DOs who practice osteopathic manipulation. Any DO, if lawfully licensed, has the legal and medical authority to diagnose osteopathic dysfunction and treat it with osteopathic manipulation. This includes family physicians, pediatricians, internists, obstetricians, surgeons, etc. Some DO family physicians, in keeping with the osteopathic approach to prevention, practice manipulation or have special dedicated office hours for certain patients.
However, in today’s busy practice environment, many family doctors no longer have the time or resources to spend on manipulation, referring their patients to the growing numbers of OMM specialists. Additionally, a small population of medical doctors and dentists take post-graduate courses in osteopathic medicine and treat with manipulation.
The education for OMM is structured similarly to other residency programs. After 4 years of college and 4 years of osteopathic medical school, the residency starts with a one year traditional rotating internship. The osteopathic intern is required to spend one month holding responsibility in all major areas of hospital medicine and clinical medicine, such as: general surgery, OB/Gyn, emergency medicine, ICU, pediatrics, family medicine, trauma surgery, internal medicine, plus electives. This year is intended to give the intern very broad exposure to all areas of patient care. The final two years are focused on OMM.
Depending on the program, OMM residents spend time evaluating and treating patients with osteopathic manipulation in all areas of inpatient and outpatient care: medical/surgical floors, out-patient clinics, emergency room, intensive care, pediatrics, post-partum mothers and newborn babies, and nursing home. Residents may also have teaching responsibilities at local colleges of osteopathic medicine or conferences.
A one-year fellowship is offered at some institutions to graduates of other residency programs, such as family medicine, physical medicine and rehabilitation, or pediatrics. This one-year training opportunity allows the physician to earn extra training in osteopathic manipulation and become board certified in more than one specialty. This is a similar process to the fellowship and board certification of sports medicine, for example, which requires the fellow to first complete a residency in a different specialty.
The American Osteopathic Association (AOA) is the largest professional organization for DOs, a counter-part to the American Medical Association (AMA). The AOA advocates for the profession in Washington, provides support in handling financial and medicolegal issues, and publishes the Journal of the American Osteopathic Association–a professional peer-reviewed academic journal. The NMM/OMM specialty has a sub-organization within the AOA, the American Academy of Osteopathy (AAO), that promotes osteopathic manipulation through conferences, workshops, and publications. For more information, see the Reference page.