Why osteopathic manipulative medicine belongs in the exam room: Reclaiming the art & science of OMM

Starting osteopathic manipulative medicine (OMM) training as a first-year osteopathic medical student can feel exciting, intimidating and sometimes uncertain. It is a skillset unique to your degree—one that blends anatomy, physiology and patient-centered care in ways that can’t be replicated with prescriptions or procedures alone.

The Osteopathic Oath calls on DOs to “keep in mind always nature’s laws and the body’s inherent capacity for recovery,” and OMM is one of the clearest expressions of that promise We wish to share some insights to help new students approach OMM with curiosity, confidence and an understanding of its scientific and clinical value as they prepare to step into that first lab session.

OMM and evidence-based medicine

Early in our training, we are taught that evidence-based medicine (EBM) is the gold standard. EBM combines the clinician’s expertise, the best available science, and the patient’s values to determine a treatment plan. The levels of the Evidence-Based Pyramid (EBM) is one way to organize the different types of evidence, with randomized controlled trials (RTCs) being the top tier of unfiltered information (see below).

It is necessary to understand that EBM is not limited to RCTs. Furthermore, EBM clearly illustrates and allows for—even encourages—what we call the “art of medicine,” as what occurs in a lab-controlled setting may not accurately translate to the real world.

OMM is no exception, and as we take into account the best available research, trusting that what we are taught in school (like everything else) is scientifically grounded, we will be better prepared as future DOs.

What the research says

A PubMed search for studies published in the year 2000 or later using the term: “‘osteopathic manipulative treatment’ OR ‘osteopathic manipulative medicine’” will yield 911 results at the time of writing this article. In our limited search through these results, a review documenting the biological effects following OMM was discovered. Interestingly, this study also notes that 72.1% of the present research consists of clinical trials, approximately 62% of which were RCTs.

Other results discussed the physiologic effects of various osteopathic treatments on the immunologic system, biomarkers, neurologic system and memory function, and cellular and molecular mechanisms. Although limitations exist in every research study, it is not difficult to find evidence to support the concept that OMM treatment can improve various conditions, and that, as the third tenet of osteopathic medicine states, “Structure and function are reciprocally interrelated.”

Multiple clinical examples highlight what the literature emphasizes as well. If a patient is not recovering after following the recommended academy guidelines, based on various consistent RTC studies, OMM provides a perfect low-risk next step in management. The following are high-yield, everyday examples of patient encounters where OMM serves as an effective adjunct to standard care:

Ear pain

A pediatric patient presents with ear pain. Standard management includes pain control and, if indicated, antibiotics. With fluid behind the tympanic membrane but no acute infection, observation is recommended. Gentle lymphatic drainage and balanced ligamentous tension are performed to promote eustachian tube drainage, resulting in symptom improvement and resolution of fluid without antibiotics.

Neck pain & tension headache

A student reports neck pain and headaches worsened by computer work. Standard measures include ergonomic advice, hydration and NSAIDs. OMM—suboccipital release, balanced ligamentous tension and myofascial release—reduces pain and improves cervical motion, and can be reinforced with posture correction exercises.

Postpartum pelvic pain

A postpartum patient experiences pelvic and low back pain during activity. Standard management involves gradual return to exercise, pelvic floor therapy and analgesics. OMM—gentle muscle energy and myofascial release—improves alignment and mobility, aiding recovery alongside rehabilitation exercises.

Irritable bowel syndrome—constipation

A patient with IBS-C continues to experience abdominal discomfort and infrequent bowel movements despite dietary fiber optimization, hydration and medication. OMM—gentle sacral rocking and pelvic diaphragm release—helps improve pelvic floor mobility and lymphatic flow. Symptoms ease and regular bowel habits are supported alongside ongoing medical management.

This list is by no means exhaustive, but it illustrates how integrated OMM can be in nearly every clinical encounter. Furthermore, our experience indicates that patients today are seeking out this skill set more and more.

Value of OMM becomes clearer with time

Some students do the bare minimum in OMM labs, assuming it won’t be useful later. Do not let that be you, because the priceless value of OMM becomes clearer with time, practice and patient feedback. So, approach OMM with curiosity, learn the anatomy, practice palpation and ask faculty about cases where OMM made a difference.

Have confidence in the skills you are taught as an osteopathic medical student; know that these skills are grounded in evidence and can help patients. Do not shortchange your future patients by not trying to see if there is something that OMM could address. Know that OMM often offers a highly safe and drug-free alternative to other treatments that come with risks.

As future DOs, our role is not to defend OMM uncritically, nor to abandon it hastily, but to stay curious, keep practicing, and continue to build the evidence base. In doing so, per the Osteopathic Oath, we “further the application of basic biologic truths to the healing arts and to develop the principles of osteopathy which were first enunciated by Andrew Taylor Still” and honor our unique degree.

Related reading in the Journal of Osteopathic Medicine:

Chronic pain outcomes among patients treated by osteopathic vs. allopathic physicians: A 36-month follow-up study

The process and outcomes of chronic low back pain treatment provided by osteopathic and allopathic physicians: A retrospective cohort study

Related reading in The DO:

How OMM solved a year-long mystery in 15 minutes

Sculpting a career: From fine arts to ONMM

How adopting OMT can improve both patient outcomes and physician satisfaction