Letters to the Editor  |   July 2009
Author Affiliations
  • Reem Abu-Sbaih, DO
    New York College of Osteopathic Medicine of New York Institute of Technology, Old Westbury
    Assistant Professor of Osteopathic Manipulative Medicine/Neuromusculoskeletal Medicine
Article Information
Osteopathic Manipulative Treatment / Being a DO / Osteopathic Cranial Manipulative Medicine
Letters to the Editor   |   July 2009
The Journal of the American Osteopathic Association, July 2009, Vol. 109, 379. doi:
The Journal of the American Osteopathic Association, July 2009, Vol. 109, 379. doi:
To the Editor:  
I found the original contribution on cranial palpation pressures by Rafael Zegarra-Parodi, DO (England), MEd, and colleagues (2009;109:79-85) very disturbing. Osteopathy in the cranial field is not merely a “technique” or “therapy,” as indicated by the authors, but rather a medical treatment modality. Furthermore, it cannot be compared with cranial-sacral techniques, which are often performed by individuals who have no medical training. The process of applying osteopathic principles and practice involves a cohesive system of diagnosis, and osteopathic manipulative treatment (OMT) is different from any techniques performed by practitioners who are not trained in osteopathy in the cranial field. 
As an assistant professor of osteopathic manipulative medicine (OMM), I see the premise behind the kind of research described by Mr Zegarra-Parodi and colleagues as opposing the basic principles of OMM and osteopathy in the cranial field. One cannot measure nor “standardize” a quantifiable amount of pressure to use for a manipulative technique, as suggested by the authors. The main reason that osteopathic medicine is so effective is that the osteopathic physician continuously diagnoses as he or she treats the patient. The appropriate amount of force used must always be individualized for each patient during each treatment session. Safe and effective OMM is not something that can be performed or taught as a series of protocols or standardized techniques. 
It takes years of clinical practice—on top of the years of osteopathic medical training—to get a proper sense of how best to apply effective hands-on treatment for each patient in each case. This evolutionary process should not be taken so lightly by the editors of JAOA—The Journal of the American Osteopathic Association. 
Because the application of OMT is so individualized, it would be useful to conduct outcome studies comparing results obtained in treatment of patients with various ailments by osteopathic medical students and osteopathic physicians who have varying amounts of OMT experience.