Am I a Candidate for Osteopathic Manipulative Medicine?

For those with chronic back, neck, head, shoulder, ankle, or foot pain, osteopathic treatment may not only help to relieve your pain but, in many cases, can help to avoid surgery. (Part 1)

What is Osteopathic Medicine?

Osteopathic manipulative medicine (OMM), sometimes called osteopathic manipulative treatment (OMT), is a comprehensive set of manual, or hands-on, maneuvers to help diagnose, prevent, and treat a range of conditions and injuries. The approach may also involve medication, noninvasive procedures, or, in extreme cases, surgery. Osteopathic medicine is typically provided by a Doctor of Osteopathic Medicine (DO); these doctors are licensed and trained in all areas of medicine but have specialized training in the musculoskeletal system.

Doctors of osteopathy typically work in conjunction with other physicians, such as part of a pain care team or clinic, for the most successful outcomes. This way, all aspects of a patient’s pain can be managed properly. Patients tend to seek out osteopathic medicine after conservative treatment methods, such as medications or physical therapy, have failed or to complement other ongoing therapies.

The National Institutes of Health considers osteopathic medicine to be among one of the top non-medication-based treatment options.1 And, according to the American Association of Colleges of Osteopathic Medicine,the field is growing, with more than 25% of medical students in the United States currently training to be osteopathic physicians.2


Osteopathic medicine is typically used to diagnose and manage several painful areas, including the back, neck, head, shoulder, ankle, and foot. (Image: iStock)


What Types of Pain Can Osteopathic Medicine Help?

Osteopathic manipulation is typically used to diagnose and manage several painful areas, including the back, neck, head, shoulder, ankle, and foot. In many cases, the goal is to help patients avoid surgery. In addition, OMM has been found useful in relieving headaches3 and mild upper respiratory infections.4

OMM can also be used to help avoid opioid use disorder (OUD, formerly called opioid addiction) or to help treat the disorder. By providing additional pain relief through OMM, a patient is often able to lower opioid doses or be tapered off completely.5

How Exactly Does OMM Work?

OMM is based on four basic principles:

  • The body is a unit; the person is a unit of body, mind, and spirit.
  • The body is capable of self-regulation, self-healing, and health maintenance.
  • Structure and function are reciprocally interrelated.
  • Rational treatment is based upon an understanding of the basic principles of body unity, self-regulation, and the interrelationship of structure and function.

To put this into perspective, the approach basically means that the mind, body, and spirit are all connected. For example, when people feel emotionally stressed, muscle tension in the body typically occurs. The body is treated as a single unit, with emphasis on the brain, muscles, and bones (ie, the neuro-musculo-skeletal system), with each part performing its own function via help from the others.

Physicians integrate these principles into their treatment approaches by seeing the body in a broader sense. This allows the physician to “think outside the box” and become more analytical to combat the problem at hand. After careful evaluation of the patient’s progress and goals, the physician will adjust the treatment plan as it fits the changing needs of the patient.

Using the example above, if muscle tension becomes chronic, it can cause pain. This ongoing pain may, in turn, damage the person’s mind or “spirit” and lead to increased levels of depression or anxiety. OMM works to indirectly cleanse that “spirit” by reducing the pain.

Osteopathic treatment manipulations tend to last less than 1 minute each and multiple manipulations are typically performed during an office visit. (Image: iStock)


Here’s how a typical osteopathic visit may go.

The physician will first ask questions about your pain and observe your body movements. Then, they will use their hands to evaluate any underlying structures to see if something is out of position. For instance, if you have back or neck pain, the doctor may palpate your spine and ask you to flex or extend the lower body. If a joint is involved, your range of motion for that joint will be tested.

Manipulation may be used to bring the dysfunctional area back to its normal position. This is done by allowing underlying structures to relax through direct pressure from the the physician, including moving the joint where it does not like to go and back again.

Manipulations tend to last less than 1 minute each, however, multiple manipulations are typically performed during an office visit.  

David Abend, DO, an assistant professor of osteopathic medicine at Rowan University in New Jersey, says he may also prescribe home exercises (such as pressing against the wall to straighten out the spine) depending on the individual case. Home-based regimens help to engage the patient in their own treatment and allow them to have more ongoing relief from their pain.

Hydration is also key, says Dr. Abend. Drinking water before and after sessions, and as part of your daily routine, will likely improve your outcome. 

Overall, the core goals of osteopathic manipulation are to improve circulation and mobility. “Circulation is the key to improve an area that lacks it, delivering essential nutrients,” explains Dr. Abend. “We also help with deconditioning by mobilizing and improving circulation to the area we treat, improving neurologic function as well.”

What Will OMM Be Like for Me?

It is important to remember that everyone’s experience with OMM may be different. For instance, physical manipulation for an older patient may be less aggressive than that for a younger patient. For a patient whose pain limits their ability, a doctor may take a slower approach to the therapy.

“In my practice, I offer weekly treatments,” shares Dr. Abend. “In the first 48 hours, it will feel like you just worked out for the first time in months. You may have been deconditioned and now you’re attempting to mobilize a joint, for instance.”

Keep in mind that OMM is typically an ongoing approach to pain management. It is not a matter of going to a few sessions and being done. “It takes time to properly align the dysfunctional area,” says Dr. Abend. Typically, you may be asked to attend one to three sessions per week at the beginning, coupled with home exercises, and then your treatment may change to monthly follow-ups for a period of time. “Overall, “this is a commitment,” he says.

If your OMM goal is to avoid a procedure or surgery, your osteopathic doctor should work closely with your specialist to track your progress. Imaging before and after treatments may be needed.

Physical therapy in comparison to osteopathic therapy involves more active patient participation and, in many cases, focuses on recovery following physical trauma. (Image: iStock)


How Does Osteopathic Medicine Differ from Chiropractic Therapy or Physical Therapy?

Chiropractors can perform manipulations that are similar to osteopathic manipulations, however, they are unable to prescribe medications or perform surgery.  

Although there are similarities with physical therapy as well, physical therapy tends to involve more active patient participation and, in many cases, focuses on recovery following physical trauma. OMM approaches, on the other hand, can be both active and passive (where the physician does the work, placing the body into position and performing manipulations) and take a whole-body unit approach.

Are There Any Risks?

Osteopathic manipulation offers a non-medication option for pain relief. However, many people tend to achieve the most benefit when using dual therapy - that is, a combination of OMM and prescribed medications.

It is not recommended to use OMM if you have a moderate to severe respiratory condition, such as with asthma, or breathing trouble. As with any physical manipulation, if the technique is performed improperly, it is possible to move a joint past its range of motion and cause damage. The frequency of this complication is rare. Shares Dr. Abend, who has been practicing OMM for roughly 30 years, this complication has yet to occur in his practice. (See Part 2 on OMM Techniques)

Will My Insurance Cover Osteopathic Treatment?

Yes, OMM is typically covered by insurance carriers but always check with your provider first.  

Dr. Abend adds, “Many insurance companies prefer that you go through 4 to 6 weeks of conservative treatment for pain, which may include anti-inflammatory drugs, muscle relaxants, physical therapy, and osteopathic muscle manipulation.” Your doctor should be able to provide the necessary documentation for such treatment.

To find an osteopathic doctor, check the American Academy of Osteopathy database.


Updated on: 05/04/20
Continue Reading:
Osteopathic Manipulative Medicine: Assessment and Techniques (Part 2)