Letters to the Editor  |   May 2006
Manual Therapies
Author Affiliations
    Hartford Medical Group Hartford, Conn
Article Information
Osteopathic Manipulative Treatment / Physical Medicine and Rehabilitation
Letters to the Editor   |   May 2006
Manual Therapies
The Journal of the American Osteopathic Association, May 2006, Vol. 106, 304-305. doi:
The Journal of the American Osteopathic Association, May 2006, Vol. 106, 304-305. doi:
To the Editor:  
The medical education article by Brian A. Allee, DO, et al, in the December 2005 issue of JAOA—The Journal of the American Osteopathic Association was interesting (Allee BA, Pollack MH, Malnar KF. “Survey of osteopathic and allopathic residents' attitudes toward osteopathic manipulative treatment.” 2005;105:551–561). Besides noting that most current osteopathic residents do not participate in residency training programs sponsored by the American Osteopathic Association (AOA), the authors also suggest that osteopathic physicians (DOs) who are not family practitioners have a lesser need of using osteopathic manipulative treatment (OMT) than those who are in family practice. 
The lower likelihood of OMT use among many DOs outside of family practice is predictable and understandable, especially when one asks what the immediate need is for any kind of manual therapy to be performed by such specialists as endocrinologists, pathologists, and radiologists. My wife is a DO who is an anesthesiologist, and she does not practice OMT. However, as a practicing physiatrist (specializing in physical medicine and rehabilitation), I find that OMT is a valuable therapeutic tool. Therefore, I frequently use it with my patients. 
Allee et al pose a question asking whether allopathic physicians (MDs) should or could become proficient in manual therapy. They then argue that OMT helps “to maintain a clear distinction between DOs and MDs.” From my point of view, this argument is humorous because, when performed properly, manual therapy is not chiropractic, osteopathic, or orthopedic medicine—rather, it is basic anatomy and physiology.1 
A case in point: I was originally a practicing chiropractor. I then went to osteopathic medical school and served the first year of my postgraduate training in an AOA-approved program. Following this, I served a residence in physical medicine and rehabilitation in a large allopathic program in Baltimore, Md. Does this education and training mean that, as a practicing physician, I perform chiropractic manipulation, OMT, or orthopedic manual medicine?2 
The answer is that there is no clear distinction between practicing these forms of manual therapy. The good physician simply does what he or she medically and physically can for the best interest of the patient. 
My 26 years of clinical experience with manual medicine is best summed up as follows: The chiropractor performs no unique clinical service and, by definition, has no medical background. Manual therapy is not performed by MDs to any extent in the United States. Physiotherapists who do perform manual therapy are not physicians. Therefore, DOs are in the best clinical position to perform manual therapy for the patient.3 
Geiringer SR, Kincaid CB, Rechtien JR. Traction, manipulation, and massage. In: DeLisa JA, ed. Rehabilitation Medicine: Principles and Practice. 2nd ed. Philadelphia, Pa: JB Lippincott Co;1993 : 440–462.
Cyriax JH. Textbook of Orthopaedic Medicine: Diagnosis of Soft Tissue Lesions. Vol 1. 8th ed. London: Balliere Tindall; 1982.
Carbon, John R Jr. DOs have an edge in treating low back pain in primary care settings. The DO. May1997;38:13 ,16.