- Hello, and welcome to another
live broadcast with MedStar Health.
My name is Caryn Zengel,
and I'm joined today
by Dr. Ryun Lee, family medicine physician
at MedStar Medical Group at Mitchellville.
I'm really excited to
talk to Dr. Lee today
about osteopathic manipulative medicine.
What it is, how it benefits patients,
how does it differ from
chiropractic medicine,
and much more.
And we're even gonna do
a live demonstration.
So if you have any question for Dr. Lee,
please ask them in the comments.
Dr. Lee, thank you so
much for being here today.
- Thank you for having me.
- Of course. Before we get
started with some questions,
could you tell our viewers
a little bit about yourself?
- Sure. Hi everybody,
my name is Dr. Ryun Lee.
I'm in osteopathic family medicine
here at MedStar Medical
Group in Mitchellville.
I see pediatric and adult patients,
and I do osteopathic manipulative medicine
on my Friday afternoons.
- Thank you, so let's
get into some questions.
- Sure.
- So let's just tell
our viewers, what is it?
What is osteopathic manipulative medicine?
Say that ten times fast. (laughs)
- I know, it is a tongue twister.
So, osteopathic manipulative
medicine; OMM, for short,
is a type of therapy that was developed
to execute the osteopathic
philosophy of medicine.
And that philosophy states
that the body has systems,
like your cardiovascular system,
nervous system, musculoskeletal system,
that works together to help
bring balance and wellbeing.
And the philosophy also believes
that the body has the
capabilities to heal itself
and so what DOs, as myself, do is
to help promote that and
facilitate that direction.
- Great, thank you.
So, how does OMM differ
from chiropractic medicine?
- Yeah. So, I am a medical doctor.
I went to an osteopathic medical school,
did my medical training, residency.
You know, the normal medical doctor stuff.
Chiropractics go to chiropractic school
and do their training during
school and after school.
With chiropractic
medicine, they tend to use
a lot of thrust techniques,
like the cracking, as you will.
And DOs who do OMM can
also do thrust techniques,
but we also learned more
direct and indirect techniques
to help not only the bones and the joints,
but also muscles, fascia,
your blood vessels,
your lymphatic vessels, your organs.
- Okay, thank you, that was very helpful.
So can you discuss some of the more common
and not so common
disorders where you would
recommend OMM treatment?
- So I see a lot of my patients
who come see me for OMM,
I see them for neck pain
and back pain mostly,
but I do see some cases
where they have like
allergies, or sinusitis,
or headaches, or insomnia,
and I've treated them for that.
I've also treated other
patients with jaw pain
from TMJ, so I have helped
them out with that as well.
I don't see patients
who've had a recent injury
or fracture, for obvious reasons,
because I am working with my
hands to diagnose and treat.
So if you have a
fracture, I don't want to,
obviously, worsen the fracture.
- Okay. So we had a question from Anna.
She said, "My 90 year
old father has severe
curvature on his spine
and it's affecting his
neck causing him a lot of
pain around the sternum
and neck because his head weighs him down.
Could he benefit from OMM?"
- So, it sounds like,
what's her name? Katie?
- Anna.
- Anna. Sorry, Anna. It
sounds like Anna's father
has scoliosis which probably
has gotten worse from,
you know, from aging and
his bones getting weaker.
So this is Scoliosis Awareness Month,
so it's appropriate that
we talk about this today.
Scoliosis is an abnormal
curvature of your spine.
Normally your spine moves
forward and backwards,
but with scoliosis, it moves side to side
or it really accentuates
a curvature that you have.
So your thoracic, your
upper back, normally
it hunches backwards and
with what it sounds like
her dad is, it's really like this.
And yes, your head can be
heavy as it goes forward
and cause a lot of neck
pain and upper back pain.
With OMM, in that situation, it will be
more of like a palliative treatment.
I certainly won't be able to reverse
the severity of his curvature,
but I can certainly help to
try to relax the muscles,
try to help get a little
bit more range of motion,
try to open up his ribs,
and get a little more
motion in the sternum and the diaphragm.
- Thank you. So let's talk
about some of the benefits.
You've touched on a few of them,
so what are the benefits of this treatment
and how often would someone be treated?
- So the benefits of
OMM, is, you know, with
the philosophy to help
bring people back into
kind of like their balance or, you know.
So that would be, you
know, the goal of OMM.
In saying that, it's you know,
better function, better
mobility, reduction in pain.
Those would be some of
the benefits of OMM.
- And how often would someone be treated?
- So I do OMM on a weekly
basis, because I see patients,
my regular patients, the
other days of the week.
So, for me the frequency would be,
if I was to see somebody
on a more frequent basis,
it would be once a week,
but I determine that
based on what I feel that day.
If I feel like they have
a lot of dysfunction,
I would have them come
back maybe once a week.
But as we progress, and I see that
they're getting better and better,
we can extend it out to
every two or three weeks.
I have patients that come see
me every one or two months
for just like maintenance.
- Thank you.
So, from what I've read and understood
about OMM, all ages can
benefit from this treatment.
So can you share with us some examples
of you using this treatment on infants,
children, adults, geriatrics;
how you treat them differently.
- So OMM, yes, can be done for all ages,
even in infancy all the way
to the geriatric population.
In terms of infants,
children, and adolescents,
where their bones are still growing,
I tend to not do thrust
techniques on them,
but I can do the other techniques,
the more gentler, direct
and indirect techniques.
In the geriatric population,
it really depends
on how I view their frailty is
and just act accordingly.
- Thank you, so we got
some more questions in.
- Sure.
- Nita asks, "Could this
treatment benefit MS patients?"
- With MS, it's a neurological condition.
When I do OMM, I prefer
to do it in conjunction
with other therapies, so
obviously, needs to see
a neurologist, a physical therapist,
and even the alternative medications,
like seeing an herbalist
or an acupuncturist.
Or the chiropractor, too. I'm cool.
And in terms of a patient with the MS,
I would treat kind of based
on what their issue is
that's bothering them the most.
If it's spasticity, then
I can help them with that.
It's by all means not a cure,
but it's, again, whatever I
can to help them with symptoms.
I can definitely help them with that.
- Great. Thank you.
Audra asks, "Will insurance cover OMM?"
- Insurance does cover OMM,
but it depends on the insurance
in terms of how much they're gonna cover
and much like insurance companies cover
a certain amount of
sessions for acupuncture
or chiropractic work, they may also
set a limit on how many
sessions you can get for OMM
and sometimes insurance companies can
lump chiropractic and OMM as one.
So definitely check out and talk
to your insurance company
and see what the coverage is.
- Okay, great. Thank you very
much for all your questions.
We do have another one from Katrina.
After sitting for a
while, or once she gets up
from sleeping, her feet hurt.
Once she starts moving,
it feels better again.
Could she benefit from OMM?
- Yes, so that sounds like what
you have is plantar fasciitis.
And, yes, there are some techniques
that have been developed to help people
with plantar fasciitis,
but that's in addition
to you doing things at home such as
stretching your feet, putting ice,
wearing a night brace, taking
anti-inflammatory medication.
- Okay, great. Could
you show us a little bit
about how you do these techniques?
- Sure.
- Okay, so we're going to show you
a live demonstration right now on
how Dr. Lee performs ONM
- OMM.
- OMM. If you have any other questions
while we're doing this, please ask them
in the comments and we'll ask them
after we're finished. Okay.
- All right, so you can
slide down a little bit more.
Do you mind sliding the foot? Thank you.
So right now, I'm going
to work on Caryn's neck.
She has twin daughters,
that's a lot of carrying.
- (laughs)
- So, you can just relax your neck.
What I like to do first is, obviously,
diagnose and see what the
issues are that we have today.
So, I'm just kind of
pressing along the sides
of her spine and I feel that she has
restriction on the left side here
and all of these other
ones are pretty nimble.
Just like, right here, okay?
Then see kind of how her head turns
when it's neutral and
then checking out her AA.
And then when we do
that, you'll see she has
a little bit, it's hard for her to turn
on the right as opposed to the left.
And to help kind of relax the muscles
before I do any other further treatment,
I do a technique called soft tissue which,
basically, I'll be putting
my hands on the sides
of her neck where the
muscle is along the spine,
called the peraspinal
muscles, generally speaking.
And I'll just be, basically
it's like a deep tissue massage.
Down the sides, going in an upward,
down, forward, and up motion.
And this will help me prep
for other things that I am going to do.
Or if this feels good, then
we could just stop right here.
- It does feel good, but you
don't have to stop. (laughs)
- Moving down. And oftentimes
when people have headaches,
that start from the back
and move to the front,
there is these little muscles called
the suboccipital muscles
that are on the base
of the skull to the neck
that get really tense
so that brings the
headache kind of forward.
This is also where the
vagus nerve comes out
so this is kind of treating the muscles
and also the nerves that
I mentioned earlier.
- Just putting my hands,
and this is kind of
like a release, like an
inhibition technique,
so I'm just holding
here, just chilling here,
until I feel the release
of the suboccipital muscles
on both sides of her neck.
- This is a direct technique,
but it's a gentle technique.
(chuckles)
And it really depends on the
person how long I wait here.
- What's the longest you've waited?
- Maybe like 30 seconds to a minute.
- You can double that
for me, because I've got
two kids putting stress
on my neck. (chuckles)
- So what I'm going to do next is work on
her rotation restriction that she has.
A lot of the techniques that
I use is called muscle energy.
It works on isometric contraction.
So I know that sounds really foreign,
but what it is, and I'll give
an example with her AA joint.
I'll turn her at her restriction,
which is around here.
I'm gonna hold her to her chin,
so that she has something
to kind of push me against.
And I'm locking out her
other cervical spine
and just working on the AA
and so, Caryn, I'm gonna
ask you to turn your head
to the left and we're
gonna hold it like that
for five seconds and this
is isometric contraction
where she's turning, but it's
not like you're pumping iron.
It's not like you're
working on your biceps.
And then you're going to relax,
and then when she stops, I can turn her
a little bit further.
And so we're going into
like a new barrier,
working towards her anatomic barrier
and not the physiologic barrier
which is where her restriction was.
Okay, turn your head again to the left.
Hold it there for five seconds.
And relax, and then when you relax,
she can turn a little bit further.
Can you feel that?
- Mmhmm.
- Okay, and then turn again.
And relax. Stretch. Okay.
After we do a technique,
we always recheck.
This is helping me
practice for my (mumbles).
And then now, she has a little bit more
restriction on this side, because I
stretched her out on this side.
So we'll do this side again.
Okay, and turn to the right.
And relax.
And turn to the right.
Okay, good, now we'll check one more time,
and hopefully it's even now. Yep.
And there we have it.
- Wow, thank you!
- Muscle energy is what I like to use
as a technique for the
majority of my techniques.
For thrust, it's cool to kind
of hear that cracking sound,
but you know, I'm kind of a small frame.
Some of my patients are bigger than me
so it's a little bit hard to do that,
but I can always get satisfaction
when I do muscle energy.
- Okay, hopefully that
was helpful for you guys.
Let's see, it looks like
we have another question.
So if you wanna come back up here,
we have two more questions
and then we'll wrap up.
This one was from Caroline, so,
wow, I can already feel, I feel great.
Thank you. (laughs)
This is from Caroline, "Does this benefit
patients with osteoporosis,
osteoarthritis?"
So she asked about osteoarthritis,
she asked about osteoporosis,
if this would help with that.
- So osteoporosis is a
condition where your actual
density of your bone has been diminished
because of menopause or
you being on steroids
or some sort of medications
that can deplete
the calcium and the
vitamin D in your bones.
So, OMM to my knowledge, won't make your
calcium and vitamin D
go back into the bones,
so I guess the short answer is, "no."
but if me doing these therapies,
I am working on, especially
with muscle energy,
I'm having you push against me
which is pushing on your muscles,
pulling on your muscles,
that's on your bones.
The treatment for osteoporosis
is weight bearing exercise,
so that's kind of like a weight bearing,
resistance exercise.
So the short answer is "no,"
but if you have other aches and pains
then I can help you that way.
- She also asked about
rheumatoid arthritis.
What about that condition?
Would OMM help with that?
- Rheumatoid arthritis is
an autoimmune condition
where there's antibodies that
gets produced in your body
and that's attacking your joints.
So with that condition
you have deformities
and inflammation in your
small and large joints.
I can't reverse the process
of rheumatoid arthritis,
but I can, again, kind of like MS,
help with the pain and try to help
keep the mobility as full as possible.
But rheumatoid arthritis
is a whole body condition,
so we'll have to target
every time I see you
with where you want me to work that day.
- Well, thank you very much.
- Thank you.
- This was very helpful and that's all
the questions we have right now.
If you would like to make
an appointment with Dr. Lee,
we'll include a link to do
that in the Facebook post.
Thank you very much for joining us today,
and thank you for your time.
- Thank you for having me.
We hope you have a great day. Thanks!
