Realigning the JAOA to Sharpen Our Focus

To the Editor:

I feel compelled to reply to the letter in the June issue by Daniel K. Mangum, DO,¹ which was written in response to the November 2009 editorial titled “Realigning the JAOA to Sharpen Our Focus,” by Felix J. Rogers, DO.²

Dr Mangum¹ shares his opinion that the musculoskeletal system does not play a primary role in health and disease. He suggests that the osteopathic medical profession focus its manipulation skills primarily on back pain and—as I interpret his letter—also on fibromyalgia, headaches, and injuries. Dr Mangum¹ further suggests that we distance ourselves from claims that osteopathic manipulative treatment (OMT) may prevent diseases or modify illnesses. I may have misinterpreted Dr Mangum's letter,¹ but he seems to propose that OMT be reserved mainly for managing musculoskeletal-related problems because it is probably not helpful for other disease prevention or management.

As a full-time osteopathic physician who used OMT in most of my cases during my 15 years of practice, I can report that OMT definitely does modify existing illnesses and can prevent the development of more serious problems. Based on my experience, I would like to expand the list of conditions for which OMT can be successfully used. I will start with a list of conditions that are directly related to the musculoskeletal system—actually the neuromusculoskeletal system (in which I have board certification). I will then list diseases not usually associated with the neuromusculoskeletal system in which noticeable improvements from OMT can also sometimes be achieved.

I have witnessed improvement with the use of OMT to treat patients with the following neuromusculoskeletal conditions (listed roughly from head to toe):

• cerebral palsy

• Parkinson disease

• Bell's palsy

• trigeminal neuralgia

• migraines

• tinnitus

• dizziness

• temporomandibular joint disorder

• torticollis

• strabismus

• dental alignment issues

• herniated disk and stenosis of the cervical region

• frozen shoulder, shoulder pain, and related conditions (eg, impingement)

• lateral epicondylitis, ulnar neuropathy

• carpal tunnel syndrome

• rheumatoid arthritis, osteoarthritis, psoriatric arthritis

• multiple sclerosis

• polymyalgia rheumatica

• chest pain, rib pain

• postsurgical pain from open heart surgery

• pelvic pain, coccyx pain, pubic region pain

• herniated disk and stenosis of the lumbar region, spondylolisthesis symptoms

• sciatica

• osteoporosis-related pain

• ankylosing spondylitis pain

• scoliosis

• knee pain, knee sprains, Baker's cyst, torn meniscus, Osgood-Schlatter disease

• shin splints

• ankle sprain, foot sprains, torn Achilles tendon pain, heel spur pain

• postradiation pain

• growing pains

I have also witnessed noticeable improvements using OMT to treat patients with the following diseases and other problems seemingly not related to the neuromusculoskeletal system (listed alphabetically):

• abdominal pain

• anxiety

• asthma

• chronic obstructive pulmonary disorder

• common cold

• constipation

• cough

• Crohn's disease

• depression

• diverticular disease

• dysmenorrhea

• fatigue

• Guillain-Barre syndrome

• hemorrhoid pain

• high blood pressure

• hypersensitivity (ie, allergies)

• hypertension

• infant colic and reflux

• influenza

• insomnia

• irritable bowel syndrome

• leg edema

• Lyme disease symptoms

• lymphadenitis

• lymphedema

• mastitis

• otitis media

• pericarditis

• plagiocephaly

• pleural effusion

• pneumonia

• pregnancy problems (ie, postdates, breech)

• sinusitis

• sore throat

• ulcerative colitis

• urinary tract infection

• varicose vein pain

These lists are by no means exhaustive of all conditions for which I have used OMT with patients who reported feelings of benefits. Some of these conditions may not have been totally eradicated with OMT, but at least enough improvement was achieved so that a possibly more invasive or more expensive treatment was avoided, or a patient's quality of life was improved, or the severity of symptoms was reduced.

I realize that these lists represent only a single osteopathic physician's experiences and are anecdotal in nature. Nevertheless, the lists do seem to reflect the kinds of illnesses that osteopathic medical textbooks have taught us for many years and the kinds of conditions that we have long spoken of in the OMT laboratory.

Andrew Taylor Still, MD, DO, stated in his autobiography, “I have never failed on a case of asthma to date, and after eighteen years' practice can say that for asthma Osteopathy is king.”³ I believe that osteopathic medicine may have been much more effective in Dr Still's time because of the following reasons: All food was completely organic. All meat and dairy animals were naturally raised and grass-fed, and the milk was raw. The air, water, and fish were virtually unpolluted (compared with today), without vast amounts of endocrine disruptors, heavy metals, and other harmful chemical contaminants. Most people had adequate amounts of exercise, because they performed physical labor rather than sat in front of televisions or computers all day. Although life expectancy has increased and medical care has advanced since Dr Still's time, I believe that patients of that earlier era may have responded more favorably to OMT because they had more natural nutrition sources and less exposure to chemical pollutants.

In my practice, I have noted that some patients are more difficult to treat with OMT alone when they are in poor immune and nutritional states. I have found that the addition of proper nutrition (including vitamins and minerals), probiotics, bioidentical hormone replacement, detoxification, homeopathy, and certain modern medications, when necessary, will often make a patient's response to OMT more dramatic. For example, patients with various conditions sometimes respond favorably to only nutritional changes—highlighting why a holistic osteopathic physician needs to look at all aspects of a patient, without expecting OMT to be a cure-all.

I have observed particularly magnificent results with the use of OMT for treating patients with back pain. In fact, I concur with Dr Mangum¹ on this point. The success of OMT for this condition was noticed in 1999 by the New England Journal of Medicine in one of the most frequently cited published articles on OMT.⁴ Despite this success, conducting academic research in OMT is still nearly impossible without obtaining a huge amount of support and financial resources—and these resources are usually not available. Even research involving surveys and chart reviews can be costly and time consuming.

Although OMT research may not be reported on the evening news, osteopathic physicians are quietly getting the job done. Information on the benefits of OMT is spread mostly by word of mouth among patients who have experienced these benefits for themselves. Quite of bit of published research besides the previously mentioned New England Journal of Medicine study⁴ has supported benefits from OMT. (I've listed just a few selected examples of this research in the reference list.^5–9) However, I have found that even if improvements in treatments are proven over and over again in the literature, many years may pass before such treatments become widely implemented, and if the literature results are not advertised, taught, or routinely tested, they may simply be ignored.

Based on my interactions with colleagues who also have family practices dedicated to OMT, I believe that their experiences with OMT have probably been similar to mine. I am not a faith healer, though I do have faith and I pray for my patients. I give God credit for any help that I have provided over the years to alleviate patients' suffering. I also give credit to Dr Still, who gave us this brave profession. I believe that all osteopathic physicians are “osteopathic” in some way and have learned something unique that stays with them from the early days of schooling—even if they do not often use OMT. That is why I would never change the initials of our DO degree.

I wrote this letter in an attempt to help prevent “the death of osteopathy”¹⁰ from occurring anytime soon. Whenever OMT becomes more limited in use, it comes that much closer to extinction. We must continue to teach osteopathic medical students that the truth about OMT can be found in individual patient experiences. Such patient experiences—rather than research that is difficult to fund and carry out—form the basis of most medical progress.

I believe that if modern osteopathic medical practice and residency training placed more of an emphasis on being holistic and on including OMT, improved nutrition, and other integrative practices in patient encounters, the general public would gain a better understanding of the benefits of OMT and osteopathic medicine. I also believe that a more widespread use of OMT would greatly decrease healthcare costs.

I welcome hearing of the experiences of other osteopathic physicians who regularly use OMT in their family practices. Furthermore, I suggest that an OMT survey of osteopathic physicians—specifically specialists in osteopathic manipulative medicine—be conducted. This survey, which I would be willing to lead with assistance from the American Osteopathic Association, would list numerous diseases, each of which the respondent would rate in terms of successful outcome from OMT. This kind of study could be conducted in the form of an e-mail survey that would take perhaps 10 minutes to complete. The survey results could help us quantify the effects of OMT on diseases that are not usually associated with osteopathic manipulation.