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Am Fam Physician. 2019;99(4):214

Related article: Manipulative Therapies: What Works

Author disclosure: No relevant financial affiliations.

Musculoskeletal pain is common in primary care, and the evidence indicates that manual therapy is equally or more effective in treating pain and improving function vs. oral analgesics.1 Osteopathic manipulative treatment (OMT) at the point of care is a valuable modality that has the potential to decrease cost and improve pain/function in patients.2 As outlined in the related article, “Manipulative Therapies: What Works,”3 there are multiple applications for manipulative therapy in the primary care setting, all with a minimal adverse effect profile, but it is important to consider how OMT differs from other manual therapies.

OMT comprises a group of related techniques used to treat somatic dysfunction. The goals of applying manual medicine are to restore maximal, pain-free movement of the musculoskeletal system; enhance neuromuscular function; and improve biomechanical balance.4 The musculoskeletal system is essential to maintaining health because it encompasses the mechanical and connective tissues. This complex system not only provides the means for movement, but also interacts with most other organ systems to regulate and maintain health. Manipulation of this system through manual techniques may assist in the management of disorders outside of the musculoskeletal system, such as obesity, cardiovascular disease, diabetes mellitus, and other metabolic disorders.5

Some OMT techniques are similar to those used by chiropractors, physical therapists, and massage therapists, whereas others are unique to osteopathic physicians. Although there are similarities between OMT and chiropractic manipulative therapy techniques, osteopathic physicians generally incorporate the soft tissues surrounding and supporting the spine or joint for manipulative treatments, whereas chiropractors typically focus more on the osteoarticular structures.4 One of the main differences between osteopathic manipulation and other forms of therapy is that osteopathic physicians are trained to apply the underlying philosophy of osteopathic health care with comprehensive medical training in all systems of the body, thus setting the stage for manipulative medicine to be adapted specifically to each patient. The focus of treatment, therefore, goes beyond simple spinal alignment to dealing directly with the abnormal body physiology using an array of direct and indirect techniques.5 This individualized treatment plan is developed to fit the patient's unique needs and allows for facilitation of the body's self-healing and self-regulating mechanisms at the point of care.

Although it can be challenging to integrate OMT into practice, several training options exist for clinicians who are interested in incorporating these modalities to enhance treatment of musculoskeletal conditions in a holistic manner (Table 1). If you have the ability and motivation, integrating OMT into your practice can bring substantial rewards.

American Academy of Family Physicians Osteopathic Manual Manipulation Procedural Self-Study Package
American Academy of Osteopathy Continuing Medical Education (CME) Opportunities
American College of Osteopathic Family Physicians Video Library of Osteopathic Diagnostic and Treatment Techniques
Michigan State University College of Osteopathic Medicine Manual Medicine Series
University of New England College of Osteopathic Medicine Manual Medicine Series

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