What is Osteopathic Manipulation?

Damian Bundschuh is a DO, Doctor of Osteopathic Medicine, with a specialty in osteopathic manipulative medicine (OMM).

Osteopathic medicine is a complete system of medical care practiced by DOs. Medical doctors (MDs) and DOs are the only two fully unrestricted physicians in the United States, licensed to train and practice in any area of medicine. Roughly 1 out of 4 physicians in the United States is a DO, and rising.

Osteopathic manipulation is a type of physical bodywork administered by DOs in a medical context as a biomedical procedure. It is effective for the diagnosis, management, and treatment of problems involving the biomechanical system and overall body function.

In practice, patients see Dr. Bundschuh exclusively for osteopathic manipulative medicine service, where there is a hands-on diagnosis with osteopathic manipulative treatment, with the patient on the treatment table for the majority of the appointment time (typical new visit is 60-90 minutes, followups 45 minutes total).

The experience is not physical like a massage, but anatomic and medical (yes, generally relaxing!), with an emphasis on basic biomechanics, breathing, posture, symmetry, fluid drainage, and inherent motion. You will experience “good” hands.

Additional procedures available 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 are generally for patients suffering with arthritis, flairs of chronic pain, tendonitis, chronic sprains, or those not responding to osteopathic manipulation and supportive care.  

DOs & Osteopathic Medicine

DOs undergo additional training in anatomy and physiology of the musculoskeletal system compared to MDs, including osteopathic manipulation.

Traditional methods handed down from the American past integrated with medical science and biomechanical reasoning.

Osteopathic philosophy and theory includes important basic principles, such as “the body is a unit, structure and function are interrelated, and the body has self-healing vitality.” These principles inform the professional practice of medicine as a licensed physician, including medical decision-making, medical perspective, and treatment approach to patients that need help with pain, recovery, or from illness or injury.

DOs and MDs practice together in every area of medicine, including all medical and surgical sub-specialties, though DOs as a group tend to gravitate towards primary care, such as family medicine, internal medicine, pediatrics, OB/Gyn, and general surgery.

Manipulation In Depth

The actual application of manipulative medicine starts with diagnosis by checking movement of bones, joints, muscles, and soft tissue. This is based on examination and physical palpation: the medical term for a specific type of touch used for diagnosis, such as detecting direction of motion in a joint, tension in a muscle, or swelling from inflammation or edema.

This is a different type of interaction with the body than simple kneading. It is a gross oversimplification to say that manipulation is only just or simply cracking joints.

Osteopathic diagnosis is done with large or small motions by introducing a light gentle pressure against soft tissue or moving joints.

The body should also be checked for the presence of inherent internal motion at rest, which is breathing movement at large and small scales. Light touch, blending with the structures, and following any motion present allows the practitioner to evaluate the quality of inherent motion.

Biomechanical body parts tend to lose efficiency over time from stress or disease. The structure becomes asymmetric relative to the midline, such as a vertebra in the spine not rotating well by not turning as far to one side.

Asymmetry is not optimal, causing compensation and adaptation. Favoring the left or right side over long periods of time, even in miniscule amounts, will disrupt the efficiency of 3-dimensional movement — macro and micro.

Treatment Approach

The osteopathic way of treating the cause of pain or any symptom is not simply “working on” the twisted vertebrae or muscle spasm. (Though, sometimes it’s necessary in limited situations to use a stereotypical thrusting type of direct force that resets the joint with a crack, the expectation over time is that the body will need less direct force as tissue healing evolves, not more.)

Biomechanical problems aren’t presumed to always require direct force. The focus here is how the problem area relates to functioning of the entire body as a physical biomechanical system that adapts to daily stressors.

Sometimes problems are simpler, other times effects are spread throughout the soma, or aggravate diseases in other systems. Osteopathic manipulation is treating the particular bones, muscle, and palpable tissue relevant to the problem area and how those parts work together as a part of the whole.

The purpose of osteopathic manipulation is to restore normal motion. Motion and function improve with treatment using a variety of active and passive techniques and approaches.

The objective in all cases is to encourage natural physiology: the body’s innate ability to relax and return as a system to normal expected function, or at least optimize its capacity for dealing with stresses from disease and living life.

Scope of Practice

Osteopathic Manipulative Medicine 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 the diagnosis and care of musculoskeletal disorders.

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 more limited potential scope of practice than US DOs, so they are not considered fully licensed physicians in the United States.

OMM specialists are not the only DOs who can 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 doctors no longer have the time, resources, or institutional support 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.

Professional Associations

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 certifies members to the national board and promotes osteopathic manipulation through conferences, workshops, and publications.

The regional osteopathic organization Arizona Osteopathic Medicine Association (AzOMA) aids patients and DOs statewide with advocacy, resources, and education.

For more information, see the Reference page.