OMT, manipulation, counterstrain, and circulatory stasis are a few terms that were never incorporated into my medical school curriculum. They are all associated with osteopathic medicine, or D.O.’s. I never considered osteopathic medicine when I was applying for medical school, partly due to my ignorance of the specialty, and mostly due to the stigmata that D.O.’s aren’t real doctors. To clarify, the M.D. and D.O. educational curriculum are theoretially identical except that D.O. curriculum includes more training in musculoskeletal systems.

I’ve gotten the occasion to discuss medical cases with some osteopathic folks, and the experience was eye opening. The following is an excerpt from one of my first presentations. I was presenting a gentleman who had a hemidiaphragm weakness later found to due to demyelination disease:

Me: “Mr J is a 64 guy with Class III heart failure and emphysema who presented with SOB over the last week after experiencing some viral URI-like symptoms. He also has a-fib, liver di…”

OMT attending: “Yeah, yeah, what did the ribs look like?”

Me: <confused> “Well, he did had some asymmetrical inspirations. The right side was more sluggish. Lungs were crackly…”

OMT attending: “Which ribs were preferred? Inspiration? You think it’s pump, bucket, or caliper?”

At that point, one of the other residents, an osteopath, bailed me out by saying, “He’ll benefit from some treatment”.

Over the next hour, we performed some rib raising, muscle energy techniques, and diaphragm release/facilitations. The patient told us he felt symptomatically improved afterward. Several days later after I switched services, I believe the next team transferred him to UPenn.

Nuts. I guess OMT didn’t work in this case.

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