Book Review  |   December 2009
First Aid for the COMLEX: An Osteopathic Manipulative Medicine Review: Second Edition
Author Affiliations
  • Francisco Laboy, III, DO
    Department of Neuromusculoskeletal Medicine/Osteopathic Manipulative Medicine, Philadelphia College of Osteopathic Medicine, Pennsylvania
Article Information
Book Review   |   December 2009
First Aid for the COMLEX: An Osteopathic Manipulative Medicine Review: Second Edition
The Journal of the American Osteopathic Association, December 2009, Vol. 109, 629-631. doi:
The Journal of the American Osteopathic Association, December 2009, Vol. 109, 629-631. doi:
First Aid for the COMLEX: An Osteopathic Manipulative Medicine Review: Second Edition—written by Zachary Nye, DO; John M. Lavelle, DO; Stockton M. Mayer, DO; and Rachel Laven, DO, and edited by Elise B. Halajian—is an excellent “just meat, no bone” review of osteopathic manipulative medicine (OMM) for the Comprehensive Osteopathic Medical Licensing Examination-USA (COMLEX-USA) Levels 1, 2, and 3. The authors are former teaching fellows at Midwestern University/Chicago College of Osteopathic Medicine in Downers Grove, Illinois, and current residents at various institutions. The editor is an OMM fellow at Midwestern. This team has produced a highly useful resource for osteopathic medical students who are preparing to take COMLEX-USA. 
The book is organized into five sections, consisting of 13 chapters, that cover the following topics: (I) “Guide to Efficient Examination Preparation,” (II) “OMT Fundamentals,” (III) “Regional and Systems-Based Assessment,” (IV) “Historical Highlights, Key Points, and Musculoskeletal Tests,” and (V) “Osteopathic Treatments and Techniques.” This organization—along with the easy-to-follow bullet-point format of information presentation, concise tables, and useful figures (including black-and-white illustrations and photographs)—make this book essential for time-conscious osteopathic medical students and osteopathic physicians who are sitting for the OMM component of a state licensing examination. Also useful are the end-of-chapter review questions (with answers), many of which resemble board-style questions in format and complexity. 
Section I starts with a discussion of the structure of COMLEX-USA for each of the four steps (Levels 1, 2-Cognitive Evaluation, 2-Performance Evaluation, and 3). In Table 1-1, a list of the percentages of examination content devoted to various topics provides for a quick review. A discussion of examination grading and mean scores is followed by a review of how osteopathic manipulative treatment (OMT) is integrated into COMLEX-USA. This section ends with a “Walk Through of Test Day,” which summarizes what to expect on the day of examination, such as a 50-minute orientation consisting of video and oral presentations and the timings of lunch and other breaks. After reading section I, osteopathic medical students should not have any surprises on test day. 
Section II provides a lightning-fast but thorough review of the basics of OMT. Explanations of somatic dysfunction and tissue texture changes, including acute and chronic palpatory findings, are addressed in bullet and table format. As in the rest of the book, several illustrations in this section stress important concepts. For example, Figure 2-2 summarizes the barrier concept by using simple traffic signs, such as a stop sign to represent an anatomic barrier and a railroad-crossing gate to represent loss of range of motion. 
Throughout the book, the authors present material in a variety of formats, including bullet points, tables, and illustrations. These different formats enable readers to acquire knowledge in the form they understand best. The authors also convey information using note points, located in the side margin of each page. For example, in section II, note points, bullet-point lists, and an illustration all address Fryette principles. Students can easily review these note points without stopping to look the topic up elsewhere, making the learning process extremely efficient. 
Section III is the “meat” of the book. The first chapter of this section presents regional diagnosis concepts, from occiput to sacrum, in a logical and intuitive manner. For each body region, the text discusses relevant anatomic information followed by material on range of motion and steps for segmental diagnosis and treatment. A good example of how the authors convey this information is their discussion on sacral mechanics, diagnosis, and treatment—a topic that is traditionally represented heavily on COMLEX-USA. The authors use a step-by-step diagnostic approach for both the sacral torsion model and the anterior-posterior sacrum model, including providing examples for each model with bullet points and figures. I have not seen another text, let alone another review book, that presents information on these two models of sacral mechanics so effectively. 
The second chapter of section III covers systems-based assessment in clinical medicine. For each system, the discussion begins with relevant anatomic information, then addresses visceral somatic reflexes. The section finishes with osteopathic medical considerations and treatment guidelines. The material on obstetrics is a prime example of how the authors' presentation of a topic works well. Table 5-1, “Contraindications of OMT in the Pregnant Patient Divided by Trimester,” is a perfect reference for studying for boards as well as for rounds on an obstetrics floor service. The discussion of trimester-specific chief complaints and related somatic dysfunctions is especially straightforward and easy to understand. 
The systems-based information provides osteopathic medical students with a high-yield review of clinical considerations of OMT for COMLEX-USA. However, this chapter at times reads a bit like a “cookbook” in that the succinct lists of diagnosis and treatment steps seem to be taken out of the context of osteopathic medicine. 
Section IV is a concise presentation of high-yield topics and key points for COMLEX-USA. I recommend that osteopathic medical students read this section the day before taking the examination. The text briefly reviews the viscerosomatic reflex, Chapman reflex, and Jones counterstrain tender points, then discusses the most common orthopedic tests that appear on COMLEX-USA. The tables and figures in chapter 6 are especially useful. Table 6-1 and Table 6-2 are chock-full of information that students need for the examination, such as locations of reflexes and tender points. In addition, several figures show locations of tender points. 
What I find most brilliant about the material in section IV is the list of orthopedic tests with descriptions and corresponding illustrations. These features will enable osteopathic medical students to achieve higher examination scores because orthopedics and OMM are integrated on COMLEX-USA. 
Section V wraps up the book by covering various OMT techniques according to body regions—cranial; cervical; thoracic, rib, and diaphragm; lumbar; sacrum and pelvis; extremity; and systemic. Techniques are well described and illustrated. This section is most useful for students who are preparing for the COMLEX-USA Level 2-Performance Evaluation and for osteopathic physicians who are sitting for the OMM component of the state licensing examination. 
The only caution I have for students about section V is that it is not meant to be an all-inclusive atlas of OMT techniques. Thus, confusion may occur if comparison is made between the techniques presented in this section and the techniques presented in individual colleges of osteopathic medicine. (On a sidenote, contrary to the photograph in Figure 13-2, gloves should be worn when performing all intraoral techniques with patients.) 
In summary, First Aid for the COMLEX: An Osteopathic Manipulative Medicine Review: Second Edition is a well-written, well-illustrated, and concise review book for COMLEX-USA that I recommend to any osteopathic medical student who is preparing to take any level of the examination. I also recommend this book to any osteopathic physician who desires a quick review of OMM or who is preparing to take the osteopathic practical component of a state licensing examination. The formula of integrating bullet-point descriptions, tables, and figures with the reinforcement of point notes gives this book an advantage over other available COMLEX-USA review books. 
 By Zachary Nye, DO; John M. Lavelle, DO; Stockton M. Mayer, DO; and Rachel Laven, DO; edited by Elise B. Halajian. 260 pp, $44.95. ISBN: 978-0-07-160025-5. New York, NY: The McGraw-Hill Companies; 2009.