Anyone @ DO school refuse getting cervical adjustment in OMM?

[McDreamy123]

Just curious as to those at DO programs can you refuse to have cervical adjustment performed on you? I interviewed at both MD and DO programs this cycle, and liked everything about the DO programs except the OMM aspect. Granted, lumbar manipulation has some support in literature for treatment in lower back pain--but other than that not so much.

I ask this because of the proven link between cervical manipulation and vertebral artery dissection with stroke. Assuming most medical students cervical spine is in good shape why risk having other medical students learning the ropes while tweaking your cervical spine. This NIH article cites that cervical adjustment INDEPENDANTLY increases the risk of VAD with stroke six fold! Granted in the grand scheme of things this is still small chance, but if it happens to you, then once is too much! I almost went DO but was told that I would have to comply with OMM, but do you need to allow cervical adjustment on you? This seems like it could almost be a legal/ethical issue if a student pursued this. That was a huge turnoff to DO for myself. I.e. I would be cool with OMM performed on me but wouldn't want my cervical region touched.

Vertebral artery dissection and cerebellar infarction following chiropractic manipulation

Also recently a 34 year old woman was confirmed killed post cervical adjustment by the LA chief coroner due to VAD with stroke. I mean it seems insane to force cervical adjustment on students. Here is link discussing that incident.


Playboy Model Katie May Died After Chiropractor Ruptured an Artery in Her Neck, Coroner Says

---

Members don't see this ad.

 

[pericardium]

If you're going to refuse cervical HVLA, prepare to put up a fight against OMM faculty.

If you don't want cervical HVLA done on you, and you have an MD acceptance, don't go to DO school.

 

[McDreamy123]

If you're going to refuse cervical HVLA, prepare to put up a fight against OMM faculty.

If you don't want cervical HVLA done on you, and you have an MD acceptance, don't go to DO school.

This seems ridiculous to me. Don't you feel you should be able to opt out of cervical portion of OMM if you want to? Totally unethical in my opinion, and if something happened to a student I could see it having lawsuit and settlement ramifications.

 

[EmergDoc2B]

I refused HVLA on my neck and refused to perform it. I received a zero for that portion of the practical and still managed a C.
No one gave me **** about it and we moved on.

 

[EmergDoc2B]

If you're going to refuse cervical HVLA, prepare to put up a fight against OMM faculty.

If you don't want cervical HVLA done on you, and you have an MD acceptance, don't go to DO school.

Disagree about the HVLA being a deciding factor if youre set on D.O. Be prepared to voice your concern tactfully and you're good to go.

 

[Promethean]

You can allow people to do the set up for HVLA and not perform the thrust.
You can claim history of cervical disk issues and refuse on that basis.
You can simply refuse to have HVLA done on you. Without some contraindication, you might get hassled a little, but not so much.

HVLA of the cervical spine is safe when done right and on someone who doesn't have contraindications.

Almost always, when you hear of HVLA causing some kind of complication, the story will involve manipulation by a chiropractor and the technique involved placing the patient's neck into extension. If the procedure is performed with flexion or extension, the risk is higher. When kept in neutral in the sagittal plane, the risk of vertebral artery damage goes way down.

 

[Peach Newport]

They told us that the risk is really only there when you do HVLA on the neck when it's in extension... so we don't ever actually do the thrust on an extended neck.

 

[McDreamy123]

That is good to know one can opt out if they aren't comfortable with it.

 

[McDreamy123]

I refused HVLA on my neck and refused to perform it. I received a zero for that portion of the practical and still managed a C.
No one gave me **** about it and we moved on.

Yes, so you were punished by not partaking it seems though? That doesn't seem fair. You received a C in OMM or just on a practical? I guess it varies school by school, because I have been told my some DO students that you must partake in cervical HVLA unless you have injury precluding you from doing so.

 

[EmergDoc2B]

Yes, so you were punished by not partaking it seems though? That doesn't seem fair. You received a C in OMM or just on a practical? I guess it varies school by school, because I have been told my some DO students that you must partake in cervical HVLA unless you have injury precluding you from doing so.

Just the practical. This was absolutely fair because it's part of our curriculum and I chose to not take part. I was given the option and chose what I thought best.

 

[McDreamy123]

Just the practical. This was absolutely fair because it's part of our curriculum and I chose to not take part. I was given the option and chose what I thought best.

Cool, how did you do in OMM as a whole if you don't mind me asking? Also, do you feel like you faced any blowback from deciding not to participate? Thanks

 

[medstar11]

Just curious as to those at DO programs can you refuse to have cervical adjustment performed on you? I interviewed at both MD and DO programs this cycle, and liked everything about the DO programs except the OMM aspect. Granted, lumbar manipulation has some support in literature for treatment in lower back pain--but other than that not so much.

I ask this because of the proven link between cervical manipulation and vertebral artery dissection with stroke. Assuming most medical students cervical spine is in good shape why risk having other medical students learning the ropes while tweaking your cervical spine. This NIH article cites that cervical adjustment INDEPENDANTLY increases the risk of VAD with stroke six fold! Granted in the grand scheme of things this is still small chance, but if it happens to you, then once is too much! I almost went DO but was told that I would have to comply with OMM, but do you need to allow cervical adjustment on you? This seems like it could almost be a legal/ethical issue if a student pursued this. That was a huge turnoff to DO for myself. I.e. I would be cool with OMM performed on me but wouldn't want my cervical region touched.

Vertebral artery dissection and cerebellar infarction following chiropractic manipulation

Also recently a 34 year old woman was confirmed killed post cervical adjustment by the LA chief coroner due to VAD with stroke. I mean it seems insane to force cervical adjustment on students. Here is link discussing that incident.


Playboy Model Katie May Died After Chiropractor Ruptured an Artery in Her Neck, Coroner Says

My only issue with your sources is one is >10 years old and they both have to deal with chiropractors and not OMM specifically. At my school they walk you through step by step because no one is comfortable with cervical to start. I am pretty sure we also signed something before school started saying we understand that we will be performing manipulation on each other so you would probably lose all the points for that section. I am not sure in my school if you would still manage a C or not just because it is also part of the final practical as well. I would say if you get into MD then go there. We were shown quite a large amount of evidence showing how safe cervical is but of course there is always rare cases that pop up.


Sent from my iPad using SDN mobile

 

[skeletor06]

We do cervical manipulation (soft tissue, myofascial release, etc.) but were never forced to do HVLA, or have it performed on us. We had to set up for it, but no one was forced to actually do anything they weren't comfortable with, or having it done on them if they don't want that.

I'm definitely not huge into OMM at all, but it's probably good to remember that chiropractors are not physicians. A quick Google search found that of the research that has been done on arterial dissection 2/2 manipulation, 158 cases and 24 deaths were by chiropracters as opposed to 10 cases and 2 deaths for DOs, at least says this: http://files.academyofosteopathy.org/CME/2012OMEDconvention/King_Presentation.pdf

 

[McDreamy123]

We do cervical manipulation (soft tissue, myofascial release, etc.) but were never forced to do HVLA, or have it performed on us. We had to set up for it, but no one was forced to actually do anything they weren't comfortable with, or having it done on them if they don't want that.

I'm definitely not huge into OMM at all, but it's probably good to remember that chiropractors are not physicians. A quick Google search found that of the research that has been done on arterial dissection 2/2 manipulation, 158 cases and 24 deaths were by chiropracters as opposed to 10 cases and 2 deaths for DOs, at least says this: http://files.academyofosteopathy.org/CME/2012OMEDconvention/King_Presentation.pdf

Ok, but to that I would ask how many cervical adjustments are DO's performing in practice versus chiros? My guess would be chiros perform at a much larger frequency thus explaining the greater number of incidents. Perhaps the % of risk of VAD is similar between chiros and do's. The % of prevalence would be more relevant to me than frequency of occurrence. Many do's don't even use OMM in practice so of course the # of incidents would be lower for them. And yes DO's are physicians, which is more the reason they should just dump OMM as most never use it in their practice.

 

[EmergDoc2B]

Cool, how did you do in OMM as a whole if you don't mind me asking? Also, do you feel like you faced any blowback from deciding not to participate? Thanks

I was an A-B student. No blowback at all and our OMM guys were pretty passionate about omm.
I was a good student and was very respectful when I approached them about it so I think that may have helped as well.

 

[skeletor06]

Ok, but to that I would ask how many cervical adjustments are DO's performing in practice versus chiros? My guess would be chiros perform at a much larger frequency thus explaining the higher number of incidents. Perhaps the % of risk of VAD is similar between chiros and do's. The % of prevalence would be more relevant to me than frequency of occurrence. Many do's don't even use OMM in practice so of course the incidence would be lower for them. And yes DO's are physicians, which is more the reason they should just dump OMM as most never use it in their practice.

Agree with your points, but I am pretty sure the type of manipulation we do is different, as well. Granted, I've never been to a chiropractor, but the OMM faculty at our school led us to believe that the HVLA that we do is different than that performed by chiropractors.

 

[dodobirddo]

Go to the MD school if you get in. OMM is a large part of any DO school. I don't see how you could refuse ALL cervical treatments. They are a large part of the curriculum. But I agree with the suggestions above, tell your partner you don't want cervical HVLA or ask them not to thrust on the practical. That's easier than becoming the problem child of the OMM department.

I never wanted cervical HVLA done on me, especially by a classmate who had never done it before.
No one will hold a gun to your head but unfortunately there is pressure to particupate in everything. At my school the grading of our OMM lab practical (which was half of our overall OMM grade) was subjective.

Medical students should be given the opportunity to consent to or refuse any treatment they are not comfortable with. We aren't guinea pigs, but unfortunately sometimes we are treated like them.

 

[skeletor06]

Go to the MD school if you get in. OMM is a large part of any DO school. I don't see how you could refuse ALL cervical treatments. They are a large part of the curriculum. But I agree with the suggestions above, tell your partner you don't want cervical HVLA or ask them not to thrust on the practical. That's easier than becoming the problem child of the OMM department.

I never wanted cervical HVLA done on me, especially by a classmate who had never done it before.
No one will hold a gun to your head but unfortunately there is pressure to particupate in everything. At my school the grading of our OMM lab practical (which was half of our overall OMM grade) was subjective.

Medical students should be given the opportunity to consent to or refuse any treatment they are not comfortable with. We aren't guinea pigs, but unfortunately sometimes we are treated like them.

Yeah, I don't think you could refuse all of them. But you're not going to catch a dissection from myofascial release. I know a lot of people who didn't want HVLA done, and the faculty didn't care at all. They taught us the setup and how one would do the thrust, and that was it. No worries.

 

[NurWollen]

.
Almost always, when you hear of HVLA causing some kind of complication, the story will involve manipulation by a chiropractor and the technique involved placing the patient's neck into extension. If the procedure is performed with flexion or extension, the risk is higher. When kept in neutral in the sagittal plane, the risk of vertebral artery damage goes way down.

That's what our OMM faculty told us as well. Seemed like they were just anxious to distinguish between chiropractors and DOs. Of course if you ask an OMM specialist, he'll say OMM>>>>>>>>>>>>>>>>>Chiropractic because DOs are more awesome.

They told us that the risk is really only there when you do HVLA on the neck when it's in extension... so we don't ever actually do the thrust on an extended neck.

Again, they say that, out of thin air. Any evidence at all to show that neutral position makes cervical HVLA safer?

 

[GUH]

At WesternU, you are definitely required to receive and perform cervical HVLA unless you have a specific contraindication. It sounds scary but there just isn't evidence that cervical HVLA performed by a DO in the neutral or flexed position is dangerous. Your being nervous about it is normal but it wouldn't get you out of anything at my school.

If you don't want to do or receive OMM, then go to an MD school.

 

[AlbinoHawk DO]

If you're not willing to do cervical HVLA or have it performed on you, don't go to a DO school. The stance of the AOA is that Cervical HVLA is safe, effective and chances of anything bad happening are less than adverse effects from taking 1 tylenol pill. Personally, I don't like HVLA, won't perform it on patients, but when it comes to OMM lab, I just bit the bullet on it.

 

[EmergDoc2B]

If you're not willing to do cervical HVLA or have it performed on you, don't go to a DO school. The stance of the AOA is that Cervical HVLA is safe, effective and chances of anything bad happening are less than adverse effects from taking 1 tylenol pill. Personally, I don't like HVLA, won't perform it on patients, but when it comes to OMM lab, I just bit the bullet on it.

respectfully disagree. I'm graduating from a D.O. program and did everything except perform HVLA or have it done to me. one tiny aspect of OMM does not define Osteopathic physicians and should not deter a future student from choosing this path to becoming a physician.

 

[SurgeDO]

I refused receiving or performing HVLA on anybody. I was even called to the front of the class to be the guinea pig patient to be adjusted by a "leading expert" in cervical HVLA. I refused.

you should never, ever, ever, ever, ever, EVER let any of those quacks touch your neck. there is absolutely no reason whatsoever to have that bull **** done to your neck. there was a student at my school who had a stroke (in the student's 20s). while the reason was never given, I'd bet my money that it was related to the cervical HVLA they were studying that week.

do not ever let them touch your neck.

 

[AlteredScale]

Just curious as to those at DO programs can you refuse to have cervical adjustment performed on you? I interviewed at both MD and DO programs this cycle, and liked everything about the DO programs except the OMM aspect. Granted, lumbar manipulation has some support in literature for treatment in lower back pain--but other than that not so much.

I ask this because of the proven link between cervical manipulation and vertebral artery dissection with stroke. Assuming most medical students cervical spine is in good shape why risk having other medical students learning the ropes while tweaking your cervical spine. This NIH article cites that cervical adjustment INDEPENDANTLY increases the risk of VAD with stroke six fold! Granted in the grand scheme of things this is still small chance, but if it happens to you, then once is too much! I almost went DO but was told that I would have to comply with OMM, but do you need to allow cervical adjustment on you? This seems like it could almost be a legal/ethical issue if a student pursued this. That was a huge turnoff to DO for myself. I.e. I would be cool with OMM performed on me but wouldn't want my cervical region touched.

Vertebral artery dissection and cerebellar infarction following chiropractic manipulation

Also recently a 34 year old woman was confirmed killed post cervical adjustment by the LA chief coroner due to VAD with stroke. I mean it seems insane to force cervical adjustment on students. Here is link discussing that incident.


Playboy Model Katie May Died After Chiropractor Ruptured an Artery in Her Neck, Coroner Says

There's a mixed bag of evidence in the literature most weighing in on the fact that one needs to consider the fact that a mild-moderate risk for dissection can occur with cervical spinal manipulation. Personally, I refuse to get it and it should be no issue to faculty that you do not wish to have it done on you. Here is a good review of reviews: The risk associated with spinal manipulation: an overview of reviews. - PubMed - NCBI

 

[AlbinoHawk DO]

respectfully disagree. I'm graduating from a D.O. program and did everything except perform HVLA or have it done to me. one tiny aspect of OMM does not define Osteopathic physicians and should not deter a future student from choosing this path to becoming a physician.

Well, maybe that's the case at your school. At our school it would be grounds for failing. The only way you can get out of it is if you have a medical contraindication. The reason I suggested not attending DO is because OP alluded to having the opportunity of going MD, which would be much less of a headache than explaining to the OMM department that you as a pre-med know better than them about medical treatment.

 

[DO2015CA]

Just curious as to those at DO programs can you refuse to have cervical adjustment performed on you? I interviewed at both MD and DO programs this cycle, and liked everything about the DO programs except the OMM aspect. Granted, lumbar manipulation has some support in literature for treatment in lower back pain--but other than that not so much.

I ask this because of the proven link between cervical manipulation and vertebral artery dissection with stroke. Assuming most medical students cervical spine is in good shape why risk having other medical students learning the ropes while tweaking your cervical spine. This NIH article cites that cervical adjustment INDEPENDANTLY increases the risk of VAD with stroke six fold! Granted in the grand scheme of things this is still small chance, but if it happens to you, then once is too much! I almost went DO but was told that I would have to comply with OMM, but do you need to allow cervical adjustment on you? This seems like it could almost be a legal/ethical issue if a student pursued this. That was a huge turnoff to DO for myself. I.e. I would be cool with OMM performed on me but wouldn't want my cervical region touched.

Vertebral artery dissection and cerebellar infarction following chiropractic manipulation

Also recently a 34 year old woman was confirmed killed post cervical adjustment by the LA chief coroner due to VAD with stroke. I mean it seems insane to force cervical adjustment on students. Here is link discussing that incident.


Playboy Model Katie May Died After Chiropractor Ruptured an Artery in Her Neck, Coroner Says

I don't think you know enough about OMM to make those statements about it not working. If you believe that you might as well not prescribe PT. We like to act like DOs have found the truth but it's a lot of isometric stretches. Having a friend in PT school, muscle energy and counter strain are in their toolbox. There are certain parts of OMM that causes people to lose their minds like cranial and visceral manipulation but a lot of the msk stuff has some merit to it

 

[DrMcLovin]

Im at a DO program and have never done or received cervical HVLA. I've never lost any points in OMM or had to explain myself. We were tested on knowing how to set it up, indications and contraindications

 

[starri]

We were only required to do the setup. I have rheumatoid arthritis, so with a pretty contradiction, no one said boo when I didn't want the thrust. Not when I didn't want to perform it.


Sent from my iPad using SDN mobile

 

[axiomofchoice]

Just for my information, how is HLVA different from what chiropractors do?

 

[GUH]

Just for my information, how is HLVA different from what chiropractors do?

I am not an expert on chiropractic but I don't think that their evaluation is the same as ours, such as the segmental diagnosis.

 

[Event_Horizon]

I dislike many parts of OMM as much as the next person, but if you are setting up cervical HVLA in a way that risks vertebral artery compromise, you are doing HVLA wrong. If your diagnosis is correct, you engage the barrier correctly, and the thrust is along the correct plane, than there should be no issue. HVLA should be gentle. This issue being discussed seems more about trusting other people to do it correctly, rather than cervical HVLA actually being dangerous.

 

[Promethean]

Just for my information, how is HLVA different from what chiropractors do?

Chiropractors use mechanical traction/distraction. As in, they have devices that do what we do with our hands. There is a table that you lay on, putting your head so that a couple of rubber stoppers rest at the base of your occiput, and there are other attachment points elsewhere. The table separates at certain points to create direct traction on your spine. The concept is that by stretching the vertebrae away from one another, they will reset themselves into the correct alignment when allowed to come back together. I don't like the idea of having a device cranking vertebral segments away from one another, as the machine can't feel when it is at a barrier that shouldn't be crossed.

Traction tables are also used by PT, but typically not for cervical traction.

Extension is a known cause of vertebral artery damage. People who go to hairdressers where they have their head extended backward into a sink for washing can get vertebral artery damage up to and including strokes just from that. Extending too far back, for too long, in a susceptible person is bad mojo. Chiropractors sometimes use extension in their cervical manipulation.

It isn't just my professors who have warned me about chiropractic. I've taken care of more than one patient that washed up on my stroke unit at the tertiary care center where I started my nursing career, who had had neck manipulation by a chiropractor. Virtually of the criticism of cervical HVLA that I've read references chiropractic cervical manipulation. If osteopathic cervical manipulation were discussed in those sources, I'd be intellectually honest enough to say as much.

If you google "cervical manipulation stroke risk," you get back page after page referencing chiropractors. My professors aren't a powerful enough cabal to redact all evidence of some secret epidemic of osteopathically induced strokes 2/2 HVLA. Rather, chiropractors do a lot more cervical HVLA than osteopathic doctors do, and one reason for that is that osteopathic physicians do not use "shotgun" techniques, but rather localize to the specific level they are treating. Also, osteopathic physicians do seek out specific level diagnoses based on palpation and motion testing and treat only what they find, rather than assuming that everyone has significant dysfunction. Thus, there are a lot of patients that the DO will determine will not benefit from cervical manipulation, where the chiropractor applies that modality to just about everyone. Finally, DOs are actually fully trained physicians, and will screen out many patients who have contraindications to HVLA. Again, chiropractors will HVLA everyone from 9 days to 99 years, and aren't as well educated on contraindications. I've known of one who did cervical HVLA on someone with Down's, for instance, and had no idea how risky that was.

Here is an article which is generally skeptical about cervical HVLA, which a student at my school posted to the class Facebook to justify their fear of using the technique. But, if you take the time to read it, it is all about how chiropractic manipulation is risky.

Neck Manipulation: Risk vs. Benefit

My take away from all that I've taken the time to learn about this topic is that:

HVLA of the cervical spine is only significantly dangerous if you do it to people who have contraindications, if you perform it incorrectly / with sloppy technique, and if you perform it in the absence of dysfunction. Done correctly, in the absence of arthritis, osteoporosis, disk degeneration, hyperlaxity, or congenital ligamentous anomaly, in neutral or *slightly* flexed position, for someone who has TART changes at the level being treated, it is a highly effective technique which brings significant pain relief and improved range of motion.

The worst figures I have seen indicate a serious complication rate of about 2 per million manipulations... and that is including numbers from chiropractors. Consider other treatment modalities. Heck, if you perform 1 million CT scans, 500-1000 of those folks will get cancer because of it. Other treatments for neck pain and motion restriction? I can't think of any pharmaceuticals that have only a 2 per million serious complication rate.

TL;DR -- People are afraid of cervical manipulation because humans suck at evaluating relative risk.

 

[AlteredScale]

Chiropractors use mechanical traction/distraction. As in, they have devices that do what we do with our hands. There is a table that you lay on, putting your head so that a couple of rubber stoppers rest at the base of your occiput, and there are other attachment points elsewhere. The table separates at certain points to create direct traction on your spine. The concept is that by stretching the vertebrae away from one another, they will reset themselves into the correct alignment when allowed to come back together. I don't like the idea of having a device cranking vertebral segments away from one another, as the machine can't feel when it is at a barrier that shouldn't be crossed.

Traction tables are also used by PT, but typically not for cervical traction.

Extension is a known cause of vertebral artery damage. People who go to hairdressers where they have their head extended backward into a sink for washing can get vertebral artery damage up to and including strokes just from that. Extending too far back, for too long, in a susceptible person is bad mojo. Chiropractors sometimes use extension in their cervical manipulation.

It isn't just my professors who have warned me about chiropractic. I've taken care of more than one patient that washed up on my stroke unit at the tertiary care center where I started my nursing career, who had had neck manipulation by a chiropractor. Virtually of the criticism of cervical HVLA that I've read references chiropractic cervical manipulation. If osteopathic cervical manipulation were discussed in those sources, I'd be intellectually honest enough to say as much.

If you google "cervical manipulation stroke risk," you get back page after page referencing chiropractors. My professors aren't a powerful enough cabal to redact all evidence of some secret epidemic of osteopathically induced strokes 2/2 HVLA. Rather, chiropractors do a lot more cervical HVLA than osteopathic doctors do, and one reason for that is that osteopathic physicians do not use "shotgun" techniques, but rather localize to the specific level they are treating. Also, osteopathic physicians do seek out specific level diagnoses based on palpation and motion testing and treat only what they find, rather than assuming that everyone has significant dysfunction. Thus, there are a lot of patients that the DO will determine will not benefit from cervical manipulation, where the chiropractor applies that modality to just about everyone. Finally, DOs are actually fully trained physicians, and will screen out many patients who have contraindications to HVLA. Again, chiropractors will HVLA everyone from 9 days to 99 years, and aren't as well educated on contraindications. I've known of one who did cervical HVLA on someone with Down's, for instance, and had no idea how risky that was.

Here is an article which is generally skeptical about cervical HVLA, which a student at my school posted to the class Facebook to justify their fear of using the technique. But, if you take the time to read it, it is all about how chiropractic manipulation is risky.

Neck Manipulation: Risk vs. Benefit

My take away from all that I've taken the time to learn about this topic is that:

HVLA of the cervical spine is only significantly dangerous if you do it to people who have contraindications, if you perform it incorrectly / with sloppy technique, and if you perform it in the absence of dysfunction. Done correctly, in the absence of arthritis, osteoporosis, disk degeneration, hyperlaxity, or congenital ligamentous anomaly, in neutral or *slightly* flexed position, for someone who has TART changes at the level being treated, it is a highly effective technique which brings significant pain relief and improved range of motion.

The worst figures I have seen indicate a serious complication rate of about 2 per million manipulations... and that is including numbers from chiropractors. Consider other treatment modalities. Heck, if you perform 1 million CT scans, 500-1000 of those folks will get cancer because of it. Other treatments for neck pain and motion restriction? I can't think of any pharmaceuticals that have only a 2 per million serious complication rate.

TL;DR -- People are afraid of cervical manipulation because humans suck at evaluating relative risk.

Can you cite the figure that says the incidence is 2 per million undergoing Cervical manipulation? If you're using the link above it's citing a 1996 study so would be nice to see a more to date study on it.

Beyond looking at the numbers, wouldn't you need to also consider the fact that CT causing cancer is quite progressive (meaning you're not going to gather enough mutations in a dose of CT to actually push something from CIS to actual malignancy) vs the sudden onset and high danger of a vertebral dissection that can be caused by this technique?

Are you planning to use OMM in your residency?


Sent from my iPhone using SDN mobile

 

[starri]

In addition to what's already been said, chiropractors also use a lot more force in their manipulations. For as satisfying at the pop after you successfully perform an HVLA, the chiropractic equivalent is unnervingly loud.

 

[hallowmann]

Don't go to a DO school. You have a general disregard for OMM that is very apparent, and I really can't imagine any reason you would prefer a DO school over an MD one given you have options to attend both and you hate OMM.

As far as cervical HVLA goes, I have performed it all of 2 times (one of those was with a half-hearted thrust during a practical) and I've had it done to me 3 times (2 during practicals). I strongly dislike it. I didn't stroke out. I let it happen to me the first time, because it was when we first learned it. I didn't like the way it made my neck feel. I let it happen to me the two other times, because I didn't want to mess with my partners' grades during practicals. I knew people who opted out, and most proctors and especially peers were receptive when others said they didn't want to perform the thrust, but it did result in points off during the practical, usually not enough to make the person fail that practical if other aspects were OK (most points were in the diagnosis and set-up, the thrust itself was only a few points).

If you don't feel comfortable with cervical HVLA, don't do it. I don't plan on using it at all in practice. There are plenty of other OMM techniques that I have no problem utilizing to accomplish similar goals.

I agree with what others have said with regards Chiropractors and extension.

respectfully disagree. I'm graduating from a D.O. program and did everything except perform HVLA or have it done to me. one tiny aspect of OMM does not define Osteopathic physicians and should not deter a future student from choosing this path to becoming a physician.

It doesn't, but if you read the OP's posts, their issue is with pretty much all of OMM, and they just happen to be saying that cervical HVLA is horribly dangerous/ethically or legally reprehensible. They don't seem to like the idea of OMM in general. In that context, I would not recommend that individual go to a DO school.

 

[EmergDoc2B]

I agree with the above if you "hate" omm look elsewhere. If you have a healthy skepticism but an open mind about omm, which I did entering school you will enjoy the experience of a Osteopathic education.

 

[McDreamy123]

Thanks for all the input guys/gals. I don't have a huge issue with OMM-- I was at one point interested in PT so I realize the benefits. Especially some for lower back pain individuals.

I have no issue getting OMM adjustments performed on me, but just don't want any cervical adjustments done to myself. Also, I would not feel comfortable thrusting on someone else's cervical spine, just out of of morals --- if I am not cool with it done to me i am not going to do it to someone else. At the DO interviews I had they made us sign a contract acknowledging if we attend we had to participate in OMM, BUT there were not specifics as to how much we had to participate. Literally I have no problem with OMM except I don't want anyone thrusting on my cervical spine, and in turn I would not be willing to adjust someone else's cervical spine. Trying to figure if this would be an issue. It seems it wouldn't based on the posts above ! So thanks for the input

 

[Petypet]

I am a DO and I hate OMM. I did not let anyone crack my neck. Further I never cracked anyone's neck stating I didn't feel comfortable thrusting. There is no evidence it helps and there documented are risks. Just state you have a contraindication, say you have downs syndrome or RA which are absolute contraindications.Osteopaths are all about anecdotal evidence and I have seen 2 cases of vertebral artery dissection from manipulation. Further, there is no evidence that "segmental diagnosis" eliminates the risk of cracking someone's neck. Lastly, there is no evidence that manipulating on someone's neck after "diagnosing" makes it safer. Some of the times I have seen HVLA done they end up cracking areas that were not the "diagnosed" location. Oh whoops I got the whole C spine with that one.

Don't let the OMM crap preclude you from going to a DO school because 95% of us fake it till we make it and never use it past step 3.

 

[AlteredScale]

Thanks for all the input guys/gals. I don't have a huge issue with OMM-- I was at one point interested in PT so I realize the benefits. Especially some for lower back pain individuals.

I have no issue getting OMM adjustments performed on me, but just don't want any cervical adjustments done to myself. Also, I would not feel comfortable thrusting on someone else's cervical spine, just out of of morals --- if I am not cool with it done to me i am not going to do it to someone else. At the DO interviews I had they made us sign a contract acknowledging if we attend we had to participate in OMM, BUT there were not specifics as to how much we had to participate. Literally I have no problem with OMM except I don't want anyone thrusting on my cervical spine, and in turn I would not be willing to adjust someone else's cervical spine. Trying to figure if this would be an issue. It seems it wouldn't based on the posts above ! So thanks for the input

A lot of my classmates done agree with or are hesitant to perform HVLA. The other stuff (besides cranial and chapmans points) are pretty decent things to learn.


Sent from my iPhone using SDN mobile

 

[Drrrrrr. Celty]

Look at this MS0 having hopes and aspirations, like living.

But on a more serious note, I've had HVLA done to my neck. If someone knows what they're doing then you're probably safe. But most people including me mostly just set up and show that they can do the technique.

But realistically of the many stupid things you likely do in your life currently, HVLA probably is the least likely to kill you.

 

[NontradCA]

This seems ridiculous to me. Don't you feel you should be able to opt out of cervical portion of OMM if you want to? Totally unethical in my opinion, and if something happened to a student I could see it having lawsuit and settlement ramifications.

Actually my school does do this. And for the exact same reason you stated. OPs not crazy.

 

[hallowmann]

Thanks for all the input guys/gals. I don't have a huge issue with OMM-- I was at one point interested in PT so I realize the benefits. Especially some for lower back pain individuals.

I have no issue getting OMM adjustments performed on me, but just don't want any cervical adjustments done to myself. Also, I would not feel comfortable thrusting on someone else's cervical spine, just out of of morals --- if I am not cool with it done to me i am not going to do it to someone else. At the DO interviews I had they made us sign a contract acknowledging if we attend we had to participate in OMM, BUT there were not specifics as to how much we had to participate. Literally I have no problem with OMM except I don't want anyone thrusting on my cervical spine, and in turn I would not be willing to adjust someone else's cervical spine. Trying to figure if this would be an issue. It seems it wouldn't based on the posts above ! So thanks for the input

This post is pretty different than this statement in the OP:

...I interviewed at both MD and DO programs this cycle, and liked everything about the DO programs except the OMM aspect...

This statement makes me think you don't like OMM... because you basically said you didn't.

If you have another choice, and didn't like the "OMM aspect" of DO schools, don't go DO. Seems pretty simple to me, since that's the only appreciable difference barring school-to-school variability across all med schools.

 

[McDreamy123]

This post is pretty different than this statement in the OP:



This statement makes me think you don't like OMM... because you basically said you didn't.

If you have another choice, and didn't like the "OMM aspect" of DO schools, don't go DO. Seems pretty simple to me, since that's the only appreciable difference barring school-to-school variability across all med schools.

No, a DO school I got into was in a much more desirable location closer to family and also where my partner had a job. Yes, I am skeptical of OMM as many are, and many DO's are themselves. Just don't want to be forced into participating in cervical OMM as I am not okay with that. Could never live with myself if I gave someone a VAD, and likewise if I allowed someone to do it to me and something happened. If one is healthy I see no reason to be getting it done on them.

 

[sabsaf123]

Don't go to a DO school. You have a general disregard for OMM that is very apparent, and I really can't imagine any reason you would prefer a DO school over an MD one given you have options to attend both and you hate OMM.

As far as cervical HVLA goes, I have performed it all of 2 times (one of those was with a half-hearted thrust during a practical) and I've had it done to me 3 times (2 during practicals). I strongly dislike it. I didn't stroke out. I let it happen to me the first time, because it was when we first learned it. I didn't like the way it made my neck feel. I let it happen to me the two other times, because I didn't want to mess with my partners' grades during practicals. I knew people who opted out, and most proctors and especially peers were receptive when others said they didn't want to perform the thrust, but it did result in points off during the practical, usually not enough to make the person fail that practical if other aspects were OK (most points were in the diagnosis and set-up, the thrust itself was only a few points).

If you don't feel comfortable with cervical HVLA, don't do it. I don't plan on using it at all in practice. There are plenty of other OMM techniques that I have no problem utilizing to accomplish similar goals.

I agree with what others have said with regards Chiropractors and extension.



It doesn't, but if you read the OP's posts, their issue is with pretty much all of OMM, and they just happen to be saying that cervical HVLA is horribly dangerous/ethically or legally reprehensible. They don't seem to like the idea of OMM in general. In that context, I would not recommend that individual go to a DO school.

Is the procedure really that dangerous? As an incoming student is this something to be genuinely worried about?

 

[jw3600]

I hate OMM and I am at a DO school. I am near the top of the class for grades and boards. Never did one HVLA cervical in lab or practicals. Never had one done to me at school (I've let a few friends do it messing around at home). Got all As or A-s in OMM. You 100% can despise OMM, fake your way through it, and still be an extremely successful medical student.

 

[hallowmann]

No, a DO school I got into was in a much more desirable location closer to family and also where my partner had a job. Yes, I am skeptical of OMM as many are, and many DO's are themselves. Just don't want to be forced into participating in cervical OMM as I am not okay with that. Could never live with myself if I gave someone a VAD, and likewise if I allowed someone to do it to me and something happened. If one is healthy I see no reason to be getting it done on them.

Skepticism is one thing, but like I said from the sound of your posts it sounds like you have already made an opinion about OMM and stated that it may work only for LBP, when in reality, you're speaking only of spinal manipulation (i.e. not all of OMM). If that characterization is wrong, then my bad.

Honestly though, if you can go MD, I'd still do that. Unless your SO is your spouse with a child/children, you can probably do the long-distance thing that many of us have had to suffer through until they find a job in the area. Now I'm all about staying close to family and having a good support system, but what's the point of handicapping yourself when you don't have to?

Go MD and save the $1200 additional you'd spend on another pair of board exams on multiple roundtrip flights back home.

Is the procedure really that dangerous? As an incoming student is this something to be genuinely worried about?

Not really. I personally dislike it being done to me. Even when it was done by a reputable NMM doc, I hated it and if anything it made me hurt more.

That said, I'm not comfortable with doing it because I don't see the value, given the even extraordinary low likelihood of an adverse event, but possibility nonetheless. There are other techniques you can do, and honestly, you should be able to release a lot of people by simply putting them in the treatment position along with respiratory assist.

 

[DrPatriot]

We have the option to refuse it at my program. On a practical you just do all the steps up to the actual velocity and get everything positioned correctly and then if the other student wants to opt out of it you just verbalize what you would do. I like this approach

OMM is a waste of time though

Sent from my A1-840FHD using SDN mobile

 

[DOFOSHO]

Just curious as to those at DO programs can you refuse to have cervical adjustment performed on you? I interviewed at both MD and DO programs this cycle, and liked everything about the DO programs except the OMM aspect. Granted, lumbar manipulation has some support in literature for treatment in lower back pain--but other than that not so much.

I ask this because of the proven link between cervical manipulation and vertebral artery dissection with stroke. Assuming most medical students cervical spine is in good shape why risk having other medical students learning the ropes while tweaking your cervical spine. This NIH article cites that cervical adjustment INDEPENDANTLY increases the risk of VAD with stroke six fold! Granted in the grand scheme of things this is still small chance, but if it happens to you, then once is too much! I almost went DO but was told that I would have to comply with OMM, but do you need to allow cervical adjustment on you? This seems like it could almost be a legal/ethical issue if a student pursued this. That was a huge turnoff to DO for myself. I.e. I would be cool with OMM performed on me but wouldn't want my cervical region touched.

Vertebral artery dissection and cerebellar infarction following chiropractic manipulation

Also recently a 34 year old woman was confirmed killed post cervical adjustment by the LA chief coroner due to VAD with stroke. I mean it seems insane to force cervical adjustment on students. Here is link discussing that incident.


Playboy Model Katie May Died After Chiropractor Ruptured an Artery in Her Neck, Coroner Says

Cervical HVLA killed a woman. Wait until cranial, you may just kill yourself.

 

[Roxas]

Cervical HVLA killed a woman. Wait until cranial, you may just kill yourself.

You probably just didn't appreciate the motion hard enough

 

[SurgeDO]