California DO thrives as an OMM specialist in a hospital system

Alice I. Chen, DO, fell in love with osteopathic manipulative medicine (OMM) and osteopathic manipulative treatment (OMT) as a medical student at the A.T. Still University – School of Osteopathic Medicine in Arizona (ATSU-SOMA), where she completed an additional year of medical training as an undergraduate OMM and anatomy teaching fellow.

During that time, she says she was amazed by the body’s capacity for healing with skillfully applied OMT.

Wanting to learn more, Dr. Chen went on to St. Barnabas Hospital in the Bronx, New York, to complete a three-year osteopathic neuromusculoskeletal medicine (ONMM) residency. After residency, she began working at the renowned University of California San Diego (UCSD) Health System. There, Dr. Chen developed an inpatient OMM consultation service, where she now integrates osteopathic care into the care plans of all types of patients within the UCSD Health System.

Dr. Chen is board certified in osteopathic neuromusculoskeletal medicine (ONMM) and uses OMM/OMT on a daily basis to enhance the care of hospitalized patients, including those healing from complicated surgeries such as organ transplants and brain surgery.

Following is an edited Q&A with Dr. Chen.

Can you talk about your experience completing an osteopathic neuromusculoskeletal medicine (ONMM) residency?

Graduating from osteopathic medical school gives DOs the basic training necessary to practice OMT on our patients. However, while l graduated with the understanding of how to perform different osteopathic techniques, I didn’t feel like I knew how to fully apply osteopathic thinking and touch to real-life clinical situations.

Residency training with Hugh Ettlinger, DO at St. Barnabas Hospital really filled this gap for me. My residency training taught me how to perform an osteopathic structural exam in a variety of clinical situations and to think about how to understand somatic dysfunction patterns in the context of a patient’s health and disease state. It also provided this apprenticeship-like training where I was able to really hone my palpatory skills and learn how to apply OMT more skillfully on different patients.

My training was three years long. I was the last class to complete my ONMM residency pre-ACGME accreditation, so my training may be slightly different than what’s available now. My first year consisted of a traditional osteopathic internship, which included rotating between a variety of different specialties such as family medicine, hospital wards, emergency medicine, pediatrics, neurology, surgery, ICU, et cetera.

My second and third year of training focused on deepening my understanding of anatomy, physiology, biomechanics and traditional osteopathic philosophy, alongside learning how to integrate that with palpation, osteopathic diagnosis and applying OMT. So much of our medical training is focused on the potential mechanism of illness, about where things go wrong and how to fix it with time, pharmacotherapy and surgery.

ONMM residency training gave me this opportunity to witness and learn more about how the body heals after illness and injury. Through this experience, I felt like I witnessed the osteopathic tenets come to life. There is a somatic component to all disease processes and alleviating that can really help with recovery.

Can you share a patient story that illustrates the power of OMT?

I’ve been seeing a lot of patients after lung transplants recently, some after severe COVID infections. Something I have observed is the severe thoracic and ribcage somatic dysfunction present in these patients, likely in part from the surgery but seemingly also interrelated with their chronic lung pathology and respiratory issues prior to surgery. So after surgery, these patients now have these newly transplanted lungs, and they’re so grateful because they feel like they can breathe again.

Further restoring their rib cage motion, restoring their diaphragm motion and restoring their spinal motion helps them take even deeper breaths. It’s so rewarding when these patients say things like, “Wow, I haven’t taken a deep breath like this in decades.” When we restore ribcage motion and the moment the release happens, they immediately feel the pain relief and no longer need the same dose of pain medication and muscle relaxants. 

How do practicing DOs stay familiar with OMT, especially if they aren’t using it in the clinical setting like you are?

The most important part of OMM is obtaining an accurate somatic dysfunction diagnosis, before applying the OMT. Dr. Ettlinger, my residency program director, would remind us often – if you only have five minutes with the patient, then spend four minutes finding the correct diagnosis and spend one minute performing the technique.

The osteopathic structural exam can provide us with some valuable information about a patient. So, even if a DO forgets how to perform a technique, at least complete a structural exam. The presence of TART – tissue texture change, asymmetries, restriction in range of motion, temperature changes – will provide insight and information into a patient’s concern.

If you’re in a clinic and have time, try a basic technique you learned in medical school. The worst that can happen is that it doesn’t work. However, if you know that there is a structural restriction in the same area as their pain, you know that they might benefit from OMT, and can refer them someone who specializes in OMM/OMT.

Here’s another example. Let’s say a patient presents to the ED with chest pain and it’s kind of a mixed clinical picture and you’re not sure if it’s cardiac or gastrointestinal. Perform a structural exam of the thoracic back, just run your hands down the back left side of the thoracic region, just lateral to the spinous processes.

If there’s an acute viscerosomatic reflex – sometimes described as boggy, warm tissue texture changes – at T1 to T5 vs T5 to T8, that might give you a clue if it’s cardiac versus gastric. If it’s more upper thoracic, it might be wise to order a cardiac work-up versus if it’s a mid-thoracic, you would consider GI differentials.

Understanding the structural exam in the context of a patient’s presentation makes us better diagnosticians, and more accurate diagnosis leads to better treatments.

How does OMM thrive in a hospital system?

Most physicians – DOs and MDs – care deeply about their patients and want to help them get well. OMT works and when physicians and other health care providers see their patients get better with OMT, they want to know if OMT can help their other patients too.

Our current understanding of health and illness is incomplete. The osteopathic perspective, studying the mind-body-spirit and structure-function relationships, provides insight into another piece of the puzzle. An important part of OMM is anatomy and physiology, so when other physicians ask me what I do, I speak about the anatomy and physiology.

For example – a post-lung transplant patient with severe acute pain may have pain secondary to manipulation of the ribcage from the clam-shell approach. When the ribcage gets manipulated like that, there is severe somatic dysfunction of the ribcage, thoracic region, diaphragm, et cetera, that results.

When we treat that physical trauma and restore physiologic motion, these patients immediately feel better. They feel like they can take a deeper breath; their pain improves. That is why this OMM service is thriving here at UCSD. We’ve been able to help patients feel better, regain function more quickly, request less medications and actually get some rest. Nurses and other doctors also notice that their patients feel better, and then ask us to see more of their patients.

You’re involved in UCSD’s acoustic neuroma program. How are you incorporating OMT as a treatment modality?

UCSD has an internationally renowned acoustic neuroma treatment program. There’s a wonderful and very skilled neurotologist and neurosurgeon – the two of them perform microsurgical resections of acoustic neuromas and have excellent outcomes. We also have a neuro specific critical care unit (NCCU). When I started the hospital service, one of the NCCU attendings and these surgeons were among the first supporters of OMM. This team observed that many patients after craniotomies often complained about neck pain and jaw pain. It made sense to them that prolonged surgical positioning for the tumor resection might result in musculoskeletal strain that could cause this pain, and that OMT could address this.

They started to refer some of their postoperative patients to me. The patients loved it. These patients were telling their medical team stuff like, “Oh my gosh, this OMT is so amazing, and it really helped with my pain,” or “I feel so much more relaxed and calmer now.” One patient even made a video where she talks about receiving OMT as being the point in which she felt like she really started to heal. It really caught the attention of these surgeons and we’re a routine part of their postoperative care now.

It’s been a blast talking to you about your passion for OMT. Can you leave us with some final thoughts to close this interview?

Studying and practicing traditional osteopathic medicine has been one of the most rewarding and meaningful things that I’ve done in my life, thus far. OMM/OMT has a profound ability to help and heal others and with the current state of the world, I think we could all use some healing. I love my job and I love what I do.

I feel like I help other people in a meaningful way, and I just want more people to realize the potential of how osteopathic medicine can help our fellow humans on earth. And I want to emphasize, it’s never too late to go to AAO convocation or to take a basic cranial course or biodynamic phase course!

Related reading:

What this DO says the osteopathic profession can do to encourage more DOs to do OMM

Interested in specializing in OMM? Here’s what you need to know