Neuromusculoskeletal Medicine/Osteopathic Manipulative Medicine (NMM/OMM)

What is an Neuromusculoskeletal Medicine/Osteopathic Manipulative Medicine
Pre-Doctoral Teaching Fellow?

The Neuromusculoskeletal Medicine/Osteopathic Manipulative Medicine Pre-Doctoral Teaching Fellowship Program is a twelve-month training program integrated within the student’s third and fourth clinical clerkship years. An additional year is added to the student’s osteopathic medical training to accommodate his/her clinical clerkship and fellowship obligations. The fellowship program affords students the opportunity to teach the science and art of osteopathic principles and practice (OPP). It also allows the interested student to practice and perfect his/her skills while working under supervision of experienced osteopathic physicians.

The goals of the fellowship program are to help develop future osteopathic physicians who:

• Have the ability to teach applications of osteopathic philosophy and principles in practice
• Have advanced skills in osteopathic diagnosis and manipulative treatment
• Contribute to advancing the discipline of neuromuscular medicine/osteopathic manipulative medicine through education, research and clinical practice

The NMM/OMM PDT Fellows are respected members of the teaching, research, and service team in COMP’s NMM/OMM Department. The position requires a strong commitment to the department faculty, peers, patients, and to the students who depend heavily upon the Fellows’ assistance and expertise.

Osteopathic History and Principles

Osteopathic medicine as we know it begins with Andrew Taylor Still, M.D. (1828 – 1917), who introduced its concepts in 1874. Still’s basic idea — that the human body was much like a machine, one that would function well if all its parts were in proper mechanical relationship — was unique compared to the medical thinking of the time.

Doctor Still believed that the human body should be studied as a whole, and that all elements of a person’s body, mind and spirit had to be incorporated into the total care of that person. He believed that the body had self-regulatory and self-healing powers, that the body contained within it all the substances necessary for maintaining health. When the body was properly stimulated, Still believed that these substances would also assist in recovering from illness. He did not view disease as an outside agent somehow inflicting itself on the body. Rather, disease was the result of alterations in the structural relationships of the body parts that led to an inability of the body to resist or recover from illness.

“Osteopathy is based on the perfection of Nature’s work. When all parts of the human body are in line we have health. When they are not the effect is disease. When the parts are readjusted disease gives place to health. The work of the osteopath is to adjust the body from the abnormal to the normal; then the abnormal condition gives place to the normal and health is the result of the normal condition.”

Still applied this philosophy to his medical practice with great success, while continuing to prudently utilize the medical and surgical approaches available to him. As a result of his years of study, and the application of his ideas to his practice, he was able to leave us with a set of general principles that are still central to the contemporary practice of osteopathic medicine.

• The human body is a unit, an integrated organism in which no part functions independently. According to this principle, abnormalities in the structure or function of one part of the body may unfavorably influence other parts, and eventually, the body as a whole.
• The body has an inherent capacity to maintain its own health and to heal itself. By extension, this principle implies that there must be adequate circulation to and from all tissues of the body, and there must be proper nervous system function in order to coordinate the actions of all of the body’s organs and systems.
• Structure and function are interrelated, and the musculoskeletal system can reflect changes in and can produce changes in other body systems. Still considered the human body to be a machine. He saw that the musculoskeletal system (bones, muscles, ligaments and connective tissues) was the largest collective system of the body, making up 60 percent or more of the body’s mass. Through careful study and experimentation, he was able to associate abnormalities in the structural system of the body with signs and symptoms of various diseases. He developed manipulative methods (now known as osteopathic manipulative treatment) to remove these structural abnormalities to alleviate the patient’s illness.
• Rational treatment is based upon integration of the first three principles into the total care of the patient. Thus treatment is based on the principles of body unity, self-regulatory and self-healing mechanisms, the somatic component of disease, the interrelationship between structure and function, and the appropriate use of manipulative treatment.

The Osteopathic View of Health and Disease

What an osteopathic physician does for a patient (aside from the use of osteopathic manipulative treatment) is often not different from what any physician might do when faced with a similar situation. What is different about the osteopathic physician is how he or she thinks about health and disease. The difference is found in the previously described philosophical concepts and principles of osteopathic medicine.

Under normal circumstances, the body’s own self-regulatory and self-healing mechanisms are able to counteract these stressors and thus maintain health. However, should stressors accumulate to the point where these mechanisms are overwhelmed, the body’s inherent tendency toward health is weakened. Continuation of this process over time leads to the signs and symptoms of illness. The osteopathic physician recognizes that these signs and symptoms are not the illness itself, but are only the outward signs of the illness. The illness is the result of the stressors’ impact on the body’s systems. Treatment must be directed toward the stressors, as symptomatic treatment alone will not guarantee the restoration of health.

Medicine has classically been preoccupied with internal organs (viscera), but life as we experience it does not consist of the sum total of the activity of one’s viscera. Life is much more than that. Life is what we see each other do, and the human being is not just a biological entity that performs functions such as vasodilatation and peristalsis. The human being also runs, works, plays music, and is creative. In all of these activities the body as a whole or in part moves. Thus human life is expressed through movement, and the movement that is expressed is carried out by the musculoskeletal system. This musculoskeletal system is the machinery by which even our thoughts and wishes are carried out, by which even our highest intellectual activities are communicated to others and turned into action. Thus, from the osteopathic point of view, the musculoskeletal system is the primary machinery of life.

 If this is so, then what about the viscera, those internal organs with which medicine is always so concerned? Again, from the osteopathic point of view, their role is supportive in nature. They are the secondary machinery of life. The viscera are not less important, but rather are put into a different perspective. Their role is to care for and maintain the primary machinery, which means that they are concerned with providing nutrients, oxygen and other such materials, disposing of waste products, and providing defense and repair mechanisms for the body. In other words, the viscera are concerned with regulating the internal environment in which the cells of the primary machinery carry out their function. From moment to moment, the viscera bring into harmony all the functions necessary to meet the current demands of the primary machinery, the neuromusculoskeletal system.

We use the term ‘neuromusculoskeletal’ system, because it is through the nervous system that the primary and secondary machinery communicate and maintain the body’s state of dynamic equilibrium. We are particularly interested in the autonomic nervous system, and most particularly in the sympathetic portion of the autonomic system. While all parts of the nervous system are important in the body’s ability to function, the sympathetic system provides the most direct anatomical link between the soma and the viscera, since it has fibers that reach every tissue in the human body. Thus, the role of the autonomic nervous system is given more importance in the osteopathic physician’s approach to the patient.

The primary and secondary machinery communicate with each other by way of the nervous system, and especially through the sympathetic nervous system. When all goes well, and proper communication is maintained, the body is said to be in a state of wellness or homeostasis. But when illness occurs in an internal organ, the neural connections between that organ and its related body wall region experience a continued heightened state of activity known as facilitation. Likewise, when an injury to the soma occurs, these same neural connections can result in a facilitated state that results in visceral symptoms, even though the problem is not primarily in the viscera.

When this happens, standard medical practice focuses on and treats the visceral aspects of the problem. However, the osteopathic physician knows that the somatic component of any given illness is at least as important as the visceral aspect. Furthermore, the osteopathic physician knows that the somatic component can be accessed through palpation and treated with osteopathic manipulative methods. This not only helps to alleviate symptoms, but also improves blood supply, nerve function and immune response in the affected viscera, thus optimizing the body’s self-regulatory and self-healing mechanisms. The patient is in a better position to recover with perhaps little or no intervention with drugs or surgery, and is more capable of maintaining an improved state of health over a long period of time. This is the rationale for stressing the importance of the interrelationship between structure and function, and for the use of osteopathic manipulative methods as part of the total care of the patient.

NMM/OMM Research Dept

• American Academy of Osteopathy
• The Cranial Academy
• Sutherland Cranial Teaching Foundation
• Journal of the American Osteopathic Association
• American Osteopathic Association
• Osteopathic Physicians and Surgeons of California
• Best of the Web – Osteopathy
• The Osteopathic Heritage Foundations