Q&A: OMM pioneer and longtime advocate for osteopathic medicine shares tales from a 50-year career

It is a pleasure to introduce you to Edward Stiles, DO, FAAODist. He has spent his entire medical career advancing osteopathic medicine. He is no stranger to the evolution and forward progress of osteopathic manipulative medicine (OMM).

With an impressive pedigree that started with his receiving the mentorship of George Andrew Laughlin, DO, the grandson of A.T. Still, DO, MD, as well as notable OMM specialists Fred Mitchell Sr., DO, and Phillip Greenman, DO, Dr. Stiles’ history in the profession dates back to the A.T. Still University Kirksville College of Osteopathic Medicine (ATSU-KCOM) Class of 1965.

Following his graduation, he completed his internship at Waterville Osteopathic Hospital in Maine. Years later, he revolutionized the profession by establishing the first hospital-based osteopathic manipulative treatment (OMT) services there. Through this Waterville OMT Hospital program, he was able to create the first five-level OMT coding system with Medicare.

From the late ‘70s to the late ‘90s, Dr. Stiles had several roles at various colleges of osteopathic medicine, such as chair of osteopathic principles and practice (OPP) at Oklahoma State University College of Osteopathic Medicine. Since 1997, he has been involved with the University of Pikeville Kentucky College of Osteopathic Medicine. He was the founding chair of their OPP department until 2005 and now is a professor and director of osteopathic medicine at Pikeville Medical Center.

Do not let his years in the business fool you; he is still fighting for the osteopathic profession in Kentucky and beyond until this day. Let’s rumble with one of the biggest living legends in OMT and get a glimpse into the mind of Dr. Stiles.

What was your path to osteopathic medicine and how was training in the ‘60s?

I got into osteopathic medicine when I was a pharmaceutical rep for Pfizer. I was a rep in Maine and sat in lot of waiting rooms in doctors’ offices. I would sit in DOs’ waiting rooms and hear patients rant and rave about OMT and I thought, ‘Wow, these doctors are doing something right.’ I decided to go to medical school, and I knew that I wanted to be a GP. Through my Pfizer experience, I had seen a lot of musculoskeletal issues, so I said, ‘I’m going the osteopathic route.’

In the early ‘60s, there were five DO schools and only 15,000 DOs in the entire country. You were taking a risk going into osteopathic medicine then. This was during the time California was completing the merger between DOs and MDs. I ended up going to ATSU-KCOM and graduating in 1965.

You were trained and mentored by A.T. Still’s grandson, Dr. Laughlin. Tell us about this mentorship.

Dr. Laughlin was amazing. I met him my first year [of medical school], because a group of five of us in my class were disenchanted with the way osteopathic medicine was being taught. We started a study group, and we went to several of the DO specialists in Kirksville and said, ‘We understand you integrate OMT into your practice. We would like you to spend an evening with us and teach us what you do.’ These DOs said, ‘Sure,’ and after several of them taught us, one of them said, ‘You guys need to meet Dr. George Laughlin,’ and we said, ‘Who’s he?’ They responded, ‘Well, he is one of Dr. Still’s grandsons.’

We were given the opportunity to meet him and that changed my career, because he mentored me for 20 years and what he did was serve as a role model on how A.T. Still treated.

Many common OMT techniques in use today were not taught in DO schools back in the ‘60s. Muscle energy, strain/counterstrain and functional positional release had not been developed.

I watched Dr. Laughlin do this very gentle manipulation and get unbelievable results. People were coming to him from all over the Midwest. Dr. Laughlin couldn’t really describe what he was doing, so I thought, ‘I have to figure this out, because this shouldn’t be lost.’

The way he was teaching me was really significant. He just said, ‘Take the ‘doodad’ where it wants to go.’ No one was talking about barriers and direct and indirect techniques in those days, so basically, Dr. Laughlin was saying to take it indirectly to the balance point and then fine-tune it to get as relaxed as possible, then add compression and the somatic dysfunction will self-release. When I saw that, it just blew me away.

You’ve been practicing medicine for over 50 years. Share with us a story from your journey that resonated with you.

In 1973, at Waterville Osteopathic Hospital, I established the first hospital-based OMT service in the country. About 10 months after I started that OMT program, the head of Medicare in Maine called me and said, ‘What’s this diagnosis ‘somatic dysfunction’?’ At the time, DOs were using the diagnosis ‘somatic dysfunction,’ but nobody [insurance companies] would give us codes for OMT reimbursement.

Since I was an OMT service provider and consultant at the hospital, I always told my staff to put in one of the top five diagnoses ‘somatic dysfunction’ on any consult that I did. I asked the head of Maine’s Medicare, ‘Why are you calling me?’ and he said, ‘You realize you’re saving us a lot of money,’ and I said, ‘What are you talking about?’ and he said, ‘Whenever a diagnosis comes up with ‘somatic dysfunction,’ the length of stay, the number of complications and the amount of drugs used is far less in Waterville Osteopathic Hospital than any of the surrounding hospitals, so you’re saving us a lot of money.’

He asked what I needed from Medicare to continue my work and I said, ‘Give me code numbers.’ After several meetings with the Medicare staff, we developed the first five-level OMT coding system with Medicare. At that moment, the Medicare codes validated my hard work and my mentors Dr. Laughlin’s and Dr. Mitchell’s hard work for osteopathic medicine. Through my data, we had a profound effect on Medicare and eventually, the other insurance companies accepted the coding system. It all started in Waterville, Maine, in a little ole 80-bed osteopathic hospital.

At Lincoln Memorial University, we are taught the Stiles’ Osteopathic Screen. How was this screen developed?

Dr. Mitchell was the biggest influence on this screening technique. He was the father of muscle energy. Several of my mentors also had an osteopathic screen, including Dr. Laughlin and Perrin T. Wilson, DO.

Most couldn’t really break it down to the fundamentals to make it teachable and attainable to osteopathic medical students. Therefore, I said, ‘Here are three big mentors of mine that all do a screen and I got to try to figure out what’s going on here and what they are doing.’ I took the screening techniques and applied a problem-solving aspect and I decided to try and organize them and expand them in order for it to be teachable for first- and second-year medical students.

What I stressed was that my mentors were really applying the third law of spinal mechanics. If you apply the third law, you will restrict, so you’ll get a physiological lock. If you spring diagonally across three planes at each segment, there should be some joint play, but where there’s dysfunction, there isn’t joint play. There’s a hard end feel. That’s your area of greatest restriction. That’s the whole basis of the screen. Over the years, many people have told me the thing that they learned in their career that changed their practice, more than anything else, was finding the area of greatest restriction and sequencing.

What advice or words of wisdom would you want to carry forward to the current and future practitioners of osteopathic medicine?

First, Paul Kimberly, DO, and Dr. Mitchell used to say to me, ‘Learn the principles and get them to work for you. Then, you work smart and not hard.’ Also, I think the tensegrity concepts of biomechanical design and mechano-transduction are powerful truths that support osteopathic medicine. All the tensegrity research being done worldwide ultimately supports osteopathic medicine. Tensegrity got me into the complex sciences, and this gives us concepts and language to bring osteopathic medicine into the 21^st century.

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