While I maneuvered through my first block of medical school, I felt emboldened by how well my undergraduate studies and extracurriculars prepared me for the transition. After majoring in biomedical laboratory diagnostics with a concentration in medical microbiology, I was able to educate my peers on subjects like B cell and T cell maturation, the identification of high yield pathogens and the biomechanics of immunoassays.
My experiences as an EMT prepared me to succeed in the clinical skills domain of my medical program by minimizing any discomfort while efficiently gathering a medical history and assessing my patients. Furthermore, working as an autopsy assistant in the morgue equipped me with the professionalism and mental fortitude needed to scrupulously wield my scalpel in careful dissection of the donors who so graciously donated their bodies to my education.
With that being said, Osteopathic Manipulative Medicine (OMM) snuck in on its Trojan horse and presented me with a very unexpected challenge. Briefly, OMM is the practice of identifying and alleviating somatic dysfunction. This is done by manually manipulating structural components of the body such as bones, muscles, fascia, lymphatics and neurovasculature.
It operates on the principles that structure and function are reciprocally interrelated and that the body has an innate ability to self-regulate and self-heal. This all sounds intuitively constructive and simplistic in theory and on paper. However, as I attended OMM lab week after week, I found myself increasingly doubtful about the supposed diagnostic and healing benefits that our lectures and texts promised.
As aforementioned, my experiences as an EMT eliminated most of the uneasiness I used to have when palpating patients. So, imagine my frustration when I was ambushed by the betrayal of my hands when they failed to recognize the fascia, musculature and bony structures that textbooks claimed should lie just below the skin’s surface. I was constantly lost, the sensory nerve endings loitering uselessly in my fingertips, unable to differentiate bony landmarks under concealed sheaths of muscle.
My professor assisted me countless times in my desperate attempts to locate the transverse processes of vertebrae in order to assess thoracic asymmetries. He found them with ease and would place my hands directly under his, to no avail. As soon as he left to help another struggling student, my partner and I exchanged repudiating quips from beneath our N95s and face shields about how we will never use this “pseudo-medicine” in real practice.
As disenchanted as I was with OMM, I leaned into my struggle and apprehension. Reluctantly, I signed up for a local community volunteer event offering cardiovascular health screenings and Osteopathic Manipulative Treatment (OMT) at a community festival. I showed up with no intention of performing OMM and I quietly strung my stethoscope around my neck as I settled into a spot at the cholesterol and blood sugar screening table.
It was not long before the line of people seeking OMT exceeded our student doctors currently practicing at that station and I had to go help out. I chatted with my first patient and her family in an attempt to delay the anticipated awkwardness of prodding her back and making uncertain observations about her vertebrae and ribs. Eventually, I arrived at a few diagnoses — T4 through T7 were rotated right and side bent left and her neck resisted leftward rotation at C2.
I then treated these somatic dysfunctions accordingly, all the while explaining what I was doing and why. When I finished, she stood up and slowly contorted her neck and body, testing the waters to see if I had done more harm than good. I was pleasantly surprised to hear that she felt fantastic — more relaxed and loose with improved range of motion.
She was not the only patient to express gratitude after receiving osteopathic treatment that day. Another patient had been in a car accident years prior, resulting in significantly restricted mobility in his neck and lower back. After performing a few muscle energy and counterstrain techniques, a smile lit up his face as he told me that this was the first time he had been able to rotate his neck in months. He was overcome with relief and astonishment, as was I. “Thank you so much,” he said.
I spent the rest of my day doing OMM rather than cardiovascular screening. This led to me connecting with people on a much deeper level: a boxer with chronic sports injuries, a woman seven months pregnant with her second child, a lieutenant in the United States Army and a high school girl interested in pursuing a career in the medical field. Each one of them was more eager than the last to see what OMM is all about and open up about themselves and their lives. I recall feeling overcome with joy on how my profession was not only helping me provide a valuable service to others but also connecting me with members of my community in a profound way.
Though my early experience with OMM was tainted by skepticism, hesitancy and clumsiness, I have come to truly appreciate it now as part of my osteopathic education. OMM has tremendously enhanced my clinical lens, empowering me to notice minute details in individuals like their structural features, gait and strength — aspects that I previously was not privy to.
I now recognize how OMM helps medical students feel more comfortable interacting with patients and performing physical assessments, a key aspect to deriving an accurate diagnosis and initiating treatment. Finally, and perhaps most importantly, patients respond extremely well to this prompt, tangible treatment that we can offer “on the spot” in response to back pain, joint stiffness, constipation or even pneumonia.
They appreciate that doctors immediately demonstrate their understanding of the problem and begin a treatment regimen right away. This enhances patients’ trust in their physician which inspires adherence with recommended treatments and encourages patients to return for follow up, leading to better outcomes. While there may be some controversy and doubt surrounding the utility and efficacy of OMM in a clinical setting, I have found it to be a wonderful tool in my arsenal as a budding physician-in-training.