“Take a deep breath. Exhale.”
I did exactly as I was told. I was lying facedown on the examination table in the middle of Osteopathic Manipulative Medicine Lab, a space on campus exclusively dedicated to the principles and practice of osteopathic manipulative medicine (OMM). Here, osteopathic medical students could gain hands-on experience with the human body by not only diagnosing one another’s musculoskeletal systems, but also treating one another’s musculoskeletal dysfunctions. But to be honest, as I lay there on the table, I was skeptical if the following technique — or any of the techniques we had learned so far — were going to result in any improvement or therapeutic benefit.
Just a few days ago, I had developed a sudden onset of severe pain medial to my left scapula. I assumed that my constant studying had tensed up my muscles, but no number of warm compresses or ibuprofens could make the discomfort go away. And so I had walked into OMM Lab, not as a first-year student doctor but as a patient with a complaint who needed evaluation. I asked a third-year student to examine my back, prompting her to make me lie facedown on the examination table. She positioned her thenar eminences on my area of pain and applied a compressive force downward.
“Alright. Take another deep breath and exhale.”
As I breathed in and breathed out one final time, she thrust downward and — crack! I let out a gasp. Slowly sitting upright, I bent my back in various positions. My aching pain was gone. “How did you do that?”
She gestured to a skeleton model that hung nearby. “Every body is different,” she said, “but I think it was a combo of your muscle hypertonicity and posterior rib angle.”
Since the beginning of the school year, I had struggled with OMM. How can you palpate a musculoskeletal dysfunction? What is a tissue texture change? How does one part of the body affect the whole? In that moment, I felt the pieces of my education beginning to align and reveal a greater picture.
Founded in the late 19th century by Dr. Andrew Taylor Still, osteopathic medicine was conceptualized as a response to allopathic medicine. Dr. Still — trained as an allopathic physician himself — eschewed the orthodox medical principles of his time, instead advocating in favor of preventive medicine and the body’s ability to function and heal itself. He proposed that the human body functioned as a whole, with the neuromusculoskeletal system playing an integral role in health and well-being. A musculoskeletal dysfunction within the body, for example, could potentially be ameliorated through physical touch and manipulation of the body’s bones, musculature, nerves, and lymph.
The training of osteopathic physicians (DOs) is therefore distinct from their allopathic counterparts (MDs) in its additional emphasis on the neuromusculoskeletal system and the manual manipulation of the body — and yet, recent reports indicate that these principles are rarely put into practice. A 2003 survey, for example, determined that 75% of DOs never or rarely use osteopathic manipulative treatment (OMT) on their patients. Another study published earlier this year in the Journal of Osteopathic Medicine concluded that nearly 57% of DOs do not use OMT on their patients at all.
Today, DOs hold the same privileges as MDs in all 50 states. The differences between the two groups have become virtually negligible over time, with one in four medical students in the United States attending an osteopathic medical school. The recent transition to a single accreditation system for graduate medical education, with both DO and MD residencies now merged into a single process, has only rendered the boundaries between these identities more porous. With all of these developments, I cannot help but wonder: What now separates osteopathic training from allopathic training?
I suppose I started seeking the answer well before becoming an osteopathic medical student.
“We have an extra tool in our toolkit,” Dr. Q had said to me years ago when I first saw osteopathic medicine in practice. Long before I entered medical school, I was just a medical scribe in my local ED. I worked with various physicians — DOs and MDs — and managed clinical information via the EMR. One evening, I watched as Dr. Q evaluated a patient who had arrived with a complaint of back pain. After a thorough examination and review of labs, Dr. Q determined that the issue was likely musculoskeletal in nature. In a matter of seconds, and with the patient’s consent, Dr. Q placed his hands on the patient and performed OMT.
I was shocked for multiple reasons — not only did the patient express tremendous relief, but I had also forgotten that Dr. Q was trained as a DO. He always walked around the ED with a badge that declared “MD” in bold letters, providing no indication of his osteopathic training. But when prompted, Dr. Q spoke proudly of his professional and educational backgrounds. “OMM Lab was my favorite part of medical school,” he told me and the other scribes. “It’s a whole different way of looking at the human body. You learn that the body isn’t standardized — every body is different. Plus, it’s super fun to practice and learn with one another.”
This hands-on aspect of osteopathic training, I believe, is perhaps its greatest distinguishing factor from allopathic training. In the learning environment of OMM Lab, students are physicians as much as they are patients: not only do we examine and diagnose one another, but we are also examined and diagnosed by others. This set-up is wholly distinct from scenarios involving standardized patients, or specially trained actors who simulate a clinical case for the edification of medical students. Encounters with standardized patients — a requirement for both osteopathic and allopathic medical training — allow trainees the opportunity to develop their history taking and physical examination skills in a controlled setting.
The beauty of OMM Lab and osteopathic medicine, however, lies in its very lack of standardization: there are no actors, no scripts needed at all. Students come as they are in their own bodies, using the power of physical touch and practicing their palpatory skills on one another. And in doing so, we discover that no two bodies are the same: there is no standardized patient with a standardized body. To assume so would not only fail the patient, but also limit our own perspective as physicians and the myriad ways in which we can provide care to the human body.
Do you have a background in osteopathic medicine? Share how you use OMM in your daily practice.
Saljooq Asif, MS is a second-year medical student at New York Institute of Technology College of Osteopathic Medicine. He is also a Lecturer in the Program in Narrative Medicine at Columbia University, where his scholarship focuses on the broader health humanities in relation to narrative ethics, racial justice, popular culture, and more. He is a 2021-2022 Doximity Op-Med Fellow.
Illustration by April Brust