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DO vs MD, is there really a difference?
A doctor of osteopathy (DO), like an allopathic physician (MD), attends four years of medical school which consists of two years of in class learning followed by two years of clinical rotations. DO receives additional training in osteopathic manipulative treatment (OMT) during their first 2 didactic years which is a form of passive treatment using manual maneuvers comprising of a wide variety of allied health disciplines.
In practice, some DO’s don’t OMT. This is mostly contingent on the specialty or subspecialty that they choose. Many DO’s that are in musculoskeletal specialties such as pain management, sports and spine, or practices focused solely on osteopathic manipulative treatment are typically the best at performing this hands-on training.
Other than the OMT, MDs and DOs have equal training.
OMT is a hands on treatment that consists different massage therapy techniques (myofascial release), Proprio-Neuro-Facilitation stretching or PNF, Counterstrain, Facilitated positional release (FPR), and Balanced Ligamentous Techniques (BLT).
Chiropractic techniques are also taught, particularly high velocity low amplitude (HVLA) techniques classically referred to as “cracking the back, neck, etc.. Further still, some OMT practitioners are well-versed in Craniosacral Therapy, which is another indirect approach that is extremely helpful to a select patient population and requires a precise touch on the part of the practitioner.
This has been found to be useful in the treatment of chronic headaches and some other conditions as well. Thus, a DO practicing OMT has a wide arsenal of hands-on treatments that they can perform on a patient that can supplement or even substitute for treatments given by other allied health professionals such as massage therapists, physical therapists and chiropractors.
Overall, OMT is a safe treatment that has few side effects, mostly consisting of temporary discomfort.
Treatment is different for every patient depending on their dysfunction. Often, patients can get lasting relief. Other times, they need maintenance treatments on a monthly or bi-monthly basis depending on their level of activity. The effectiveness of OMT is practitioner dependent, so finding a practitioner that practices often is key for best results.
I tried Physical Therapy in the past, but it wasn’t helpful. Should I re-consider?
Not all physical therapists are created equal! The same is true for any profession, including physicians. Not all physical therapists use the same approach.
To make sure you’re care is great, get with a specialist who is trained across many different specialties.
You’re your own individual and having the right therapist will be the difference between success and failure.
Part of a therapists’ job is to make therapy exciting while understanding your needs.
If you don’t feel connected with your therapist, this does not mean that you will necessarily fail physical therapy.
TRY ANOTHER THERAPIST!
Where do I get lab work and X-Rays done?
Laboratory work is done at an outside facility such as Quest or LabCorp. Of course, many other facilities are able to perform laboratory work as long as they have a prescription order.
This includes clinic labs and hospitals. If you have already completed lab work, upload the results in your Patient Portal.
Trigger Points and Trigger Point therapy?
Trigger points are also known as “muscle knots”, which form in the muscle tissue, usually resulting from chronic injury. They happen when one section of the muscle tissue becomes tight, and it pulls the rest of the tissue. This is where the “knots in my (enter body part)” comes from.
People try self-treatments like massage canes, lacrosse balls, and foam rollers but most times this only provides temporary relief.
Trigger point therapy is needle based therapy where the needle (without a syringe or injectable) is used to manipulate the muscle tissue. The goal is to start some muscle twitching, which is thought to deactivate the trigger point.
Sometimes anesthetics, anti-inflammatory, steroid or homeopathic medications are injected into the area for further relief.
“Dry Needling,’’ follows a similar principle with some minor differences.
There is no medication in the needle, and electric stimulation is sometimes used. It can help heal the muscle by helping stimulate its contraction.
Trigger point therapy is a safe treatment that can provide temporary or long-lasting relief.
Botox For My What?
Botox has been used for years in cosmetic treatments. It blocks muscle activity and often lasts for several months.
Turns out that the Botox is useful in treating other (painful) conditions caused by excessive muscle activity. This includes spasticity, which is when a muscle becomes extremely tight, resulting in dysfunction. It can be found in many neurologic conditions.
Spasticity can result in chronic pain, most commonly in the upper back muscles and facial muscles which may contribute to chronic headaches.
It is not unheard of to hear of Botox injections into the diaphragm to help with chronic hiccups and into the urinary bladder for spastic hyperctive bladder resulting in urinary incontinence.
Patients often see relief during this time, and then return for periodic re-injection.
Unfortunately it may become ineffective over time in a certain patient population.
Overall it is a safe treatment.
What Is A Physiatrist?
A physiatrist is a specialty-trained physician who completed a 4 year residency in physical medicine & rehabilitation, and the standard 4 years of medical school.
Specialties focus on patients with musculoskeletal and orthopedic injuries including sprains, strains, arthritis, fractures, and the related post surgical care.
Physiatrist are trained to work with patients with catastrophic injuries such as
-traumatic brain injuries
-spinal cord injuries with paraplegia or tetraplegia
-cardiac and cancer rehabilitation
-amputation and follow up care
A physiatrist wears many hats, and their expertise is invaluable!
They are also trained to work with conditions often treated by neurologists, such as multiple sclerosis (MS), Parkinson’s, and muscle spasticity.
Like neurologists, Physiatrists are also trained in nerve conduction studies (NCS) and Electromyography (EMG) exams, which are helpful in the diagnosis and treatment of various neurologic and muscular diseases.
With the additional years of experience Physiatrists have seen it all and have a great understanding of what the next steps will be.
Some Physiatrists will undergo fellowship training in a sub-specialty related to traumatic brain injury (TBI), spinal cord injury (SCI), pain management, Sports and Spine, and cancer rehab.
Numbness, tingling or may be experiencing weakness?
It may be nerve damage. An EMG/nerve conduction study can be done to help you understand what is going on.
A nerve conduction study is performed by a neurologist or a physiatrist, that consists of being hooked up to electrodes and undergoing minor electric pulses in order to test different nerves in the arm, hand, foot and leg as well as other areas if needed.
The speed of the nerve conduction is typically measured and compared to others to see if there is a discrepancy. Data is tabulated at the end of the exam and synthesized into an impression.
An electromyogram (EMG) is the second part of the exam and usually only performed by the doctor (neurologist or physiatrist) and involves a small needle being injected into various muscles. The insertional activity of the needle is first measured by a special machine that is hooked up to the needle. Some muscle diseases would show a change in the insertional activity. The patient is then instructed to contract the muscle that the needle is in and the activity inside the muscle is measured by the needle electrode as the patient is contracting their muscle. Data is obtained from this as well.
At the end of the exam, both the nerve conduction studies and EMG results are tabulated and formed into a diagnostic impression. Overall, it is a mild to perhaps moderately uncomfortable procedure but often tolerated by most people well.