Book Review  |   August 2009
The 5-Minute Osteopathic Manipulative Medicine Consult
Author Affiliations
  • Dennis J. Dowling, DO
    Osteopathic Manipulative Medicine Associates PC, Syosset, NY
Article Information
Book Review   |   August 2009
The 5-Minute Osteopathic Manipulative Medicine Consult
The Journal of the American Osteopathic Association, August 2009, Vol. 109, 401-464. doi:10.7556/jaoa.2009.109.8.401
The Journal of the American Osteopathic Association, August 2009, Vol. 109, 401-464. doi:10.7556/jaoa.2009.109.8.401
Osteopathic manipulative medicine truly cannot be practiced by following a “cookbook approach,” and the authors of The 5-Minute Osteopathic Manipulative Medicine Consult are in agreement. Millicent King Channell, DO, and David C. Mason, DO—both of the Department of Osteopathic Manipulative Medicine at the University of Medicine and Dentistry of New Jersey-School of Osteopathic Medicine in Stratford—emphasize this fact in the opening lines of the preface. However, to continue the metaphor, even the most experienced chef generally relies on recipes as the foundation for his or her art. Similarly, the authors present “recipes” to serve as a foundation for various osteopathic manipulative treatment (OMT) techniques. These recipes appear in a handy, easily transportable pocket format, increasing the usefulness of this resource for the busy clinical practice. 
In this book, the authors first set up various clinical diagnoses, suggesting a variety of physiologic findings that would be expected in the motor, sympathetic, and parasympathetic systems. The book next provides a list of related somatic dysfunctions common to such patients. Subsequently, the authors suggest relevant OMT techniques for 2-minute, 5-minute, and extended treatment times. 
While all osteopathic physicians have training in applying OMT—at least during their first 2 years of osteopathic medical school—not all DOs have had supervised clinical experience with this treatment modality. Given the nature of clinical encounters for osteopathic primary care and specialist physicians, the amount of treatment time available during patient visits for utilizing OMT is typically rather limited. The reasons most often given by osteopathic physicians for not treating patients with OMT are not enough time, lack of experience with OMT, and poor (or no) financial compensation for OMT.1,2 It is possible, however, to perform OMT in just a few minutes—with health benefits for the patient and financial compensation for the physician. An easily accessible OMT reference, such as this volume, that can be used to jog an osteopathic physician's memory would improve the likelihood of OMT being used in patient care. 
The 5-Minute Osteopathic Manipulative Medicine Consult has a simple, straightforward organization, covering 60 common clinical conditions. Among these conditions are ankle sprain, carpal tunnel syndrome, depression, fibromyalgia, hypertension, influenza, otitis media, pregnancy, restless leg syndrome, scoliosis, tachycardia, and urinary tract infection. After the physiologic findings and related somatic dysfunctions of each condition are described, the authors present three appendices with step-by-step instructions for OMT techniques (appendix 1), specialized tests (appendix 2), and summary charts (appendix 3). Also included are recommendations for International Classification of Diseases, Ninth Revision (ICD-9) codes3 to use when billing for osteopathic manipulative medicine. 
Appendix 1 presents OMT techniques—via written descriptions, photographs, and diagrams—by body section, including the head, the cervical, thoracic, and lumbar sections, the sacrum, and the upper and lower extremities. Techniques addressed in this appendix include auricular drainage, counterstrain, Galbreath treatment, high-velocity, low-amplitude (HVLA), Muncie technique, muscle energy, and myofascial release. 
The specialized tests in appendix 2—which is also organized by body section—include the compression and distraction (intervertebral foraminal encroachment) tests and the Valsalva test for the cervical spine; the hip drop (sidebending) and straight leg raising tests for the lumbar spine; the ASIS (anterior superior iliac spine) compression test as well as the seated and standing flexion tests for the pelvis; and the Apley's, Phalen's, and Yergason's tests as well as the patellar grind and valgus stress tests for the extremities. 
The summary charts in appendix 3 address such items as cranial holds, dermatomes, diagnoses, muscle motions, nerve impingements, and reflexes. 
As an example of the way that the authors handle each clinical diagnosis, the section on ankle sprain has a detailed listing of sympathetic findings (eg, “Increased tone-dilated arterioles of the muscles,” T10-L2 myofascial tenderpoints, tissue texture changes over transverse processes) and motor findings (eg, L4-S2 common fibular nerve impingement, inversion and eversion strain). Regarding other somatic dysfunctions associated with ankle sprain, the reader is directed to look for pes planus (“flat foot”) and certain tarsal, metatarsal, tibial, and fibular dysfunctions. 
For OMT techniques in cases of ankle sprain, the authors present options for 2-minute (eg, counterstrain), 5-minute (eg, counterstrain, HVLA, lymphatic drainage, myofascial release), and extended (eg, articulatory, counterstrain, HVLA) treatment. This listing makes it clear that counterstrain—which could easily be provided in less than 2 minutes—is not the only manual treatment option available. Regardless of whether a radiograph was ordered, a cast or splint applied, or a prescription for an anti-inflammatory drug given, the patient could still benefit from brief application of OMT and leave the office, clinic, or emergency department feeling better.4 
In the case of ankle sprain, the authors note that the level of evaluation and management coding for an office visit by an established patient (ie, 99213) could be supplemented with a -25 modifier code, indicating that a separately billable procedure—OMT—was performed on the same day of service. The authors also include the ICD-9 code for lower extremity somatic dysfunction (ie, 739.6) for use in patient assessment and billing. However, they fail to include the primary diagnosis ICD-9 code for ankle sprain (ie, 845.00), the prominent placement of which (ie, heading) would make completion of the billing form easier for the osteopathic physician. 
A few additional comments can be made about the clinical diagnosis text. Several of the clinical topics covered by the authors, including headache and hypertension, require more than one ICD-9 number, depending on the condition's etiologic factors and symptoms. The 5-minute and extended treatment options mentioned by the authors include some OMT techniques and body regions not included among the 2-minute options. However, almost any OMT technique could be performed within the 2-minute timeframe, and three or four OMT techniques could be completed during a 5-minute treatment session. The choice of techniques would depend mostly on the skills of the osteopathic physician and the comfort levels of the patient with the treatment. 
Additional clinical conditions could have been added to the text without significantly increasing the book's compact size. Some clinical concerns, such as sensory and symptom relationships, could have also been added to the text to further flesh out complicated aspects of certain diagnoses. 
Although the relative brevity of The 5-Minute Osteopathic Manipulative Medicine Consult prevents it from being the final resource on this matter, the book's format—with nearly all of the material on each clinical condition appearing on facing pages—facilitates quick scanning by the reader. The font size, however, may be too small for some readers. Most pages have plenty of “empty” space in which the text could have been enlarged for improved readability. Regarding the graphics, the diagrams and photographs featured in the book's OMT technique and specialized test sections are clear, simple, and immediately comprehensible. 
All things considered, The 5-Minute Osteopathic Manipulative Medicine Consult is a good effort and can be recommended to osteopathic residents and attending osteopathic physicians. Directors of residency training programs and osteopathic medical educators who are interested in incorporating OMT into training should make this book required reading—or they should consider purchasing it for osteopathic residents. 
Unfortunately, the available electronic version of this book ( may not be quite as easy to use as the book itself. When the reviewer attempted to access this material online, access required registration with the publisher and then entering a number from the scratch-off area on the inside front cover of the book. Once on the site, however, the index at the left side of the Web page was easily searchable. The illustrations, text, and other items loaded quickly and were easy to read. Readers should be aware that the online material is not available in a downloadable format, however. Instead, it must be accessed by signing on at the publisher's Web site each time one wants to view it. A downloadable version that could be placed on a personal digital assistant, iPhone, or other electronic device would be a great benefit to the busy osteopathic physician, resident, and student. 
In summary, The 5-Minute Osteopathic Manipulative Medicine Consult is a worthwhile book that, when properly used, could increase the clinical application of OMT. Expanded use of OMT would benefit patients, osteopathic physicians, and the osteopathic medical profession at large. This is not a book to read and place on the bookshelf. Rather, it belongs in the pocket of the laboratory coat or, at least, on the countertop in a nearby examination room. 
 By Millicent King Channell, DO, MA, and David C. Mason, DO. 314 pp, $52.95. ISBN-10: 0-7817-7953-7, ISBN-13: 978-0-7817-7953-1. Baltimore, Md: Wolters Kluwer/Lippincott Williams & Wilkins; 2009.
Spaeth DG, Pheley AM. Evaluation of osteopathic manipulative treatment training by practicing physicians in Ohio. J Am Osteopath Assoc. 2002;102:145-150. Accessed June 22, 2009.
Johnson SM, Kurtz ME. Conditions and diagnoses for which osteopathic primary care physicians and specialists use osteopathic manipulative treatment. J Am Osteopath Assoc. 2002;102:527-540. Accessed June 22, 2009.
Centers for Medicare and Medicaid Services, National Center for Health Statistics. ICD-9-CM Official Guidelines for Coding and Reporting. Washington, DC: US Government Printing Office; October 2008. Accessed June 22, 2009.
Eisenhart AW, Gaeta TJ, Yens DP. Osteopathic manipulative treatment in the emergency department for patients with acute ankle injuries. J Am Osteopath Assoc. 2003;103:417-421. Accessed June 22, 2009.