OMT
Dan Lynch, SAAO Member WCUCOM
OMT can be very rewarding when it works and frustrating when it doesn’t. I’m convinced that there are a few simple ideas which determine the success of a treatment. It takes more than knowledge to treat a somatic dysfunction; you have to practice at it, and since there are so many eager first years out there, I’d like to explain what I’ve learned and use as a guide myself which keeps me from getting stumped. I hope others modify my advice to suit their style to make their practicing OMT easier, more effective, and more enjoyable
1) Learn the principles first.
Learning the fundamentals, or principles, of a treatment modality provides a framework to learn the steps of each individual treatment. For example, you could learn every counterstrain treatment by memorizing this: “when treating the counterstrain point for the piriformis you must first stand on the side of the dysfunction, then with the patient in a prone position, and so on.” But it’d be more effective to understand the fundamentals first: you are going to place the patient in a position of ease, which is normally comfortable and the muscle in question is at its shortest, hold it for 90 seconds (120 for ribs), then passively return the patient to the neutral position; which stretches the muscle and ceases the nociceptive reflex. Sure, the individual steps are important, but by learning the fundamentals and applying them you begin practicing the art of osteopathic medicine.
2) Think about what your desired end result is, and then just DO it!
When asked about how to best perform a certain treatment, A.T. Still – and many of the other founding osteopathic physicians – would respond with a phrase akin to "I just find out what needs to be done and do it." Let’s use HVLA as an example to explain this. Let's say that you have correctly diagnosed a thoracic spine somatic dyfunction as T6 extended, rotated and sidebent right. So now you need to decide what needs to be done. Well, if it is T6 ERrSr, then it needs to be placed back into its normal position by flexing it, and rotating and sidebending it to the left. Instead of planning out exactly what what needs to be done, do it by feel. You will most likely have to try this during lab or with a friend before you completely understand it. To start, “zone out” or look away from the patient. By doing this you bring your mind's attention not to what you are seeing, but to what you are feeling. You will soon be able to tell the difference between where the segment is (ERrSr), and what needs to be done to get it back to neutral (FRlSl). After practice the process begins look like this in your mind: "hmm, that doesn't feel right.. It feels like it needs to be put back in place by doing this... ahh, there, that's better." Obviously, its not that simple, but it is something you can strive for.
3) Breathe and be confident.
Too often, OMT fails because of the practitioner's low confidence. This could be low confidence in their skill, or lack of confidence in the efficacy of the treatment. When you find that you are having trouble treating a certain somatic dysfunction, the first thing to do is step back and take a deep breath. Chill out. Clear your mind. Choose to have your focus on either your hands or your words, but not both. Start fresh. Then you can reassess the situation and what technique you would like to use to fix the dysfunction that is proving to be your kryptonite. Then you have to strive to remain confident in your ability. I have often told my peers who have come to me with help on a certain technique to "step back, take a deep breath and just fix the problem.” Just DO it. If you approach a somatic dyfunction feeling that it is going to be difficult, you will lose confidence and fail. The trick is to approach it knowing that it can be corrected. Whether it is corrected in one session, or with a certain technique, the fact of the matter is that it can be corrected. Once you have come to this conclusion you can begin to relax and conquer your fear failure.
To put it simply:
When you are performing OMT on a patient remember your fundamentals, figure out what needs to be done, take a deep breath, approach the patient and confidently do what needs to be done. Believe in your skillset and your experience.
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