Osteopathic Manipulative Medicine (OMM) and Osteopathic Manipulative Treatment (OMT) fall under a larger category called Osteopathic Principles and Practice that encompasses the philosophies, history and concepts related to osteopathic medicine. While OMM is the medical care that Doctors of Osteopathic Medicine (DO) provide to patients that includes diagnosis and treatment of somatic dysfunction – or, when aspects of the body's structure, such as the musculoskeletal, nervous or lymphatic systems, are impaired – OMT is the category of the manual techniques used to treat the somatic dysfunction.
In this Q&A with Lauren Noto-Bell, DO, FNAOME, an associate professor, clinician and faculty member in the PCOM Department of Osteopathic Manipulative Medicine, we learn ways that DOs may treat patients with a whole-person approach to care by utilizing health strategies that don't just combat illness and disorder, but work to prevent it, too.
In osteopathic practice, somatic dysfunction is determined by the criteria of tissue texture abnormality, asymmetry, restriction of motion and tenderness (TART) in the body, and if these criteria can be positively affected by OMT. Dr. Noto-Bell clarifies that OMT does not treat conditions, but “in the correct clinical context, the techniques of OMT treat the existing somatic dysfunction which may assist any appropriate medication, surgery, lifestyle changes or exercise.”
A common example of how OMT can help somatic dysfunction is in the case of an exacerbation of the lung condition called chronic obstructive pulmonary disease (COPD). “The patient's medical condition of COPD is the underlying pathology, and DOs may use techniques of OMT to help with the secondary somatic dysfunctions that are associated with COPD,” says Dr. Noto-Bell.
In a worsened case of COPD, the musculature next to the spine can become tight and tender, and may reflex out to the thoracic spine via neurological pathways. Dr. Noto-Bell says that “using OMT, DOs can treat the somatic dysfunction of the thoracic spine to get the restricted movement of the ribs to move with more ease. Though the restricted movement of the spine is secondary to the chronic medical problem, intervening on the rib movement can help in balancing the neurologic pathways that cycle back to the lungs. Ultimately, employing OMT can help to improve their primary medical condition a bit more quickly than they would otherwise.”
Even DOs who don't regularly utilize OMM and OMT with their patients still practice with a whole-person care approach – it is an integral aspect of the education taught at any college of osteopathic medicine. Dr. Noto-Bell reminds us that the principles of osteopathic medicine recognize that the body is a functional unit, and that if any sort of disruption occurs in one aspect of a person's life – whether internal to them or external from their environment – it will have an impact on the rest of their health and wellbeing.
Osteopathic physicians believe that structure and function are interrelated, so if there is a problem with the structure of the body, the patient will have altered function because of that disrupted structure. To illustrate this idea, Dr. Noto-Bell explains how a DO might treat a patient with a fractured hip.
“A fractured hip will not be fixed with OMT, because that TART is not somatic dysfunction – that requires surgery. But the osteopathic surgeon will still practice with the whole person in mind, and will recognize that this patient will not be able to walk properly unless the surgeon accounts for proper anatomic alignment and functional impact after the surgery, and they may also address patient concerns about rehabilitation and recovery time,” she says.
Another tenet of osteopathic medicine recognizes that the body has an inherent capability for self-regulating, self-correcting and self-maintaining, and it is this homeostasis that our bodies are trying to achieve all day long. “If something goes awry in that innate ability to correct itself, then a DO may intervene with medication, surgery, physical therapy, psychological therapy or possibly OMT.”
Dr. Noto-Bell says that DOs approach the patient with a different perspective.
“If a patient comes in with neck pain, some physicians may immediately begin treatment by addressing only the symptoms of neck pain by suggesting an X-ray or writing a prescription for a muscle relaxant. An osteopathic physician may instead begin by asking the patient about their lifestyle – do they have poor posture, or do they sit at a desk all day for work?” Dr. Noto-Bell says the DO is “in a good position to recognize that the patient's neck pain might be coming from poor postural mechanics from prolonged periods of sitting, and may begin treatment by working to correct their posture with some exercises, physical therapy or OMT.”
Even if the DO doesn't begin with OMT or another physical modality approach, as osteopathic physicians, they are adept in recognizing that it's not just the neck that's the problem – the neck pain is likely secondary to something else, like poor posture.
Regardless of the specialty they go into, a DO may find good use for OMM/OMT in their practice. Dr. Noto-Bell says that even in a psychiatric setting, osteopathic physicians can intervene on a patient's experience with OMT because some techniques can be useful in calming down a heightened neurological system.
“In the throes of an anxiety attack, for example, they may have medication to stabilize their mood or keep neurotransmitters balanced, and they may also utilize self-directed techniques like breathing exercises and visualization. But there are also manual OMT techniques that can help to calm down the nervous system.”
Dr. Noto-Bell explains that touch can be therapeutic in and of itself, by activating receptors that release ‘feel-good’ chemicals in the body, which have body-wide effects, like decreasing blood pressure, heart rate, pain sensitivity and anxiety. “Very simply stated, OMT is a precisely-delivered therapeutic touch that targets the dysfunctional structure, so that components of the nervous system are freed of tension or obstructions, allowing the nervous system to function in a more optimally-balanced way.”
© 2024 Philadelphia College of Osteopathic Medicine