Evo Terra (Host): Chronic pain can impact your quality of life and zest for doing the things you love most. Today, we're talking to Dr. Jackson Chen from Trinity Health of New England Medical Group to explore a hands on technique serving as an alternative to pain medication.

 This is Transforming Your Health from Trinity Health of New England. I'm Evo Terra. Dr. Chen, welcome to the program.

Jackson Chen, DO, FAAO: Thanks for having me.

Host: So you are a DO and that is a doctor of osteopathy. You want to talk about the difference between being a DO and an MD ?

Jackson Chen, DO, FAAO: Right, so a DO is a doctor of osteopathy, but an MD is your traditional allopathic medical doctor. That's what they're known for and stand for. So the difference between the two is, I mean, we both go to four years of medical school and then residency training afterwards and even take similar board exams.

The difference mainly is that DOs are taught an additional course of medicine where we do manipulation with our hands. And some DOs actually do more training, and do some fellowships like myself who do specializing in manipulation as it is. Not all DOs, actually do OMT, but they actually learn about it.

And I've actually taught some MDs in CME courses, which is continue medical education, just to teach them about certain techniques that we can do that they can also provide for certain patients too.

Host: Got it. Curiosity, which came first between the DOs and the MDs?

Jackson Chen, DO, FAAO: MDs. So primarily the founding father, father, his name was Andrew Taylor Still. Back in the 1800s, he thought that, you know, he didn't really agree with traditional medicine and medicine wasn't really as advanced as it is today. Some of the main epidemics that occurred was cholera, smallpox, and tuberculosis. And the traditional medicine that were used at the time was bloodletting, mercury, or alcohol based compound pharmacotherapy.

These are essentially poisons in a nutshell. And he didn't agree with the use of this treatment for all patients. But he wanted to find a different method. So he created the whole idea of osteopathy, which is the study of the bone because that's the foundation of the human anatomy.

So what he ended up doing was he created a whole field where you focus more on holistic approach. So you're looking at the body as a whole and the body as a unit. And treating the person as a whole.

Host: Got it. Thanks for that background. I think that will be helpful as we get into this conversation with, with lots of big words. And in fact, let's start at the top and get those big words out all at once. What is osteopathic manipulative or neuromuscular skeletal medicine, gosh, and isn't there a shorter way for us to say those things? What are these things?

Jackson Chen, DO, FAAO: So they're basically, it's a field where you use certain principles to kind of help augment the body. The things that you usually find in a person is what we call somatic dysfunctions. Somatic dysfunctions in a nutshell is just impaired or altered function of any part of the body, in the skeletal and myofascial plane.

And you can use the certain techniques that you learn in school and even combinations of techniques to actually treat those things.

Host: Got it. So let's talk about when it's right, what types of conditions would OMT be best for?

Jackson Chen, DO, FAAO: So classically speaking, we're more trained in if someone has neuropathic pain or musculoskeletal pain. So, say you have carpal tunnel. In a sense, carpal tunnel syndrome, you have pain that's shooting down your hands bilaterally. Typically speaking, the retinaculum, which is a part of the wrist, if it gets too tight, it can compress on the median nerve and that can cause numbness and tingling.

So what we do is we try to improve that myofascial plane by doing different techniques that can kind of augment that nerve from being impinged. Now, there's other things that we could do too. Headaches is another one, where the thought is if you have muscle tightness in your neck, you can treat that muscle in a sense to prevent it from exacerbating any future headaches as it is. So those are the most common ones that you would usually treat. I can keep going.

Host: No, I think that's a good understanding, right? And I want to make a distinction. I need you to help me that. So you mentioned the word impingement, right? And, and that's a word that I know because I possibly have, well, I certainly have some impingement and we'll see how bad it is with my rotator cuff in my shoulder, which as I understand it is actually a tear in the muscle. Is OMT something you could do for muscle tears?

Jackson Chen, DO, FAAO: So, no.

Host: Yeah, I assumed not,

Jackson Chen, DO, FAAO: There's a limit to osteopathic medicine, but it's classically ideal for people who don't want to pursue surgery or are not a good candidate for surgery. Now, if you tore your rotator cuff, yeah, pretty much, you probably need to have an orthopedic surgeon to get involved and repair it.

However, if some people have like, when they're young, they may not want to do surgery cause it may cause more surgeries in the future. Those are people who we could tentatively actually utilize osteopathic manipulative therapy to kind of improve their range of motion and also to strengthen them. And honestly, we actually use our techniques to kind of, the way I can best explain it, improve someone's range of motion while physical therapy strengthens their whole joint as it is. So it's in conjunction with physical therapy that's helpful in that sense.

Host: Got it. Got it. Who's a good candidate for this? Not everyone, obviously, we've talked about that, needs this therapy. So who is the right person for OMT?

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Jackson Chen, DO, FAAO: I think the right person would be someone who wants to pursue some form of therapy without seeing or going through surgery as a procedure for the most part. And it really comes down to case by case practice. Example is someone who comes in with TMJ dysfunction. The people that probably sees TMJ problems the most with TMJ pain, it's probably dentists, honestly, and they usually don't know what to do with these patients.

So if they let me see the patient, I can basically identify which muscles, there's the temporalis muscle and the masseter muscles are two common ones that can cause tightness in the clenching of the jaw. And that usually is something we work on in terms of the muscle manipulation to kind of get it to feel better.

That's like one example, but it really comes out in case by case. I think everyone should at least be evaluated for OMT at the very least. But if someone's obviously needs surgery, like they have a torn rotator cuff or just need surgical interventions. Yeah, absolutely. I think probably need to go down that direction.

 And another one anyone who has neck injuries or back injuries, I think it's worth trialing these with manipulation, but sometimes you may need to get a neurosurgeon involved, but a lot of people who fear going to neurosurgery because they think they might end up having more chronic pain, I think those are ones that should benefit from seeing us too to see if we can provide any improvements with their pain.

Host: Well, let's walk through the process. I mean, I know what physical therapy is cause I went through with them with my other shoulder that was bad. But what would happen, well, just give me the process of what does an OMT session look like? What do we got to do?

Jackson Chen, DO, FAAO: Perfect. So if someone's coming to see me because their primary doctor referred you to me, or even I am a primary care doctor myself, uh, would like to see a patient. And they're coming in, for example, with sciatica. I think that's a pretty common thing that everyone knows about, and essentially that symptom is pain that radiates down your legs, even like a sharp, numbing pain that can do that.

There are more than just the back issues, so a lot of people assume sciatica is caused from nerve impingement in the back, and that could be one reason, but other considerations is some common ones, psoas syndrome and piriformis syndrome. And psoas and piriformis muscles are actually muscles that can impinge on the sciatic nerve.

So understanding just the anatomy is so important when you're doing osteopathic manipulation, where if I were to look at someone as a whole, I can kind of figure out, is there something that's bothering them that's impinging on certain parts that are making them cause these symptoms? So let's say that they did have a tenderness where I pushed in their gluteal region, it's very likely it's the piriformis muscle that's in spasm, and that can easily pinch on the nerve and that could actually mask the actual spinal issue. So not everyone who has like lumbar stenosis, actually, I mean, there are other ways you can have sciatica. It's not just lumbar stenosis is what I'm trying to get at. If that makes any sense.

Host: Yeah, yeah it does. So once you've identified this, what do you do? What are you manipulating?

Jackson Chen, DO, FAAO: So once you identiy identify the muscle itself or identify what's wrong with the patient in terms of the somatic dysfunction, you try to make it better.

So let's say in the sense, the piriformis muscle itself is tight. And it's tender when you push on it. What you do is you can bring the muscle into a position where it can relax, or you can do the opposite, actually stretch the muscle on purpose and have the patient push the muscle back into what it's supposed to do, and that itself can actually cause the muscle to relax even faster. And these are muscle, known as muscle energy and counter strain techniques, as it is.

Host: So you're pushing things around to get back to where it was. So that automatically tells me we're not talking anesthesia. We're not talking any sort of procedure really, other than it being manipulated. Why doesn't it just slip right back out?

Jackson Chen, DO, FAAO: The reason why people have pain with these muscle tightness is because there are receptors in the actual muscles itself. And if it's stretched too far or it's too tight, as in it's too spastic; it can trigger the pain itself. So what you do is you actually reset the length of the actual muscle so that it actually doesn't fire that pain signal to your brain, essentially. And usually we like to see people in doing these sessions at least three times before we make the decision, is this working for you or not?

Host: Not necessarily a one time fix, it may take multiple sessions, sure.

Jackson Chen, DO, FAAO: Right someone who has chronic back pain for like 10, 20 years, you're not going to fix it in one session as it is.

Host: Oh that would be nice.

Jackson Chen, DO, FAAO: Yeah, right. What I would say is, after three different sessions, if people find it improvement, then yeah, I've done my job. Even if it's a significant, like, half, 50 percent reduction in pain. Then great, I did something that can help the patient. But I usually don't like to waste time either, so if I need to get additional imaging or get a specialist involved, I will do that as well.

Host: Let's say someone's interested, first time they've heard about this, they've got these chronic conditions that they've been medicating and whatever, but they say, I want to try this. I want to try this. What are the first steps that someone should do that thinks maybe this is the right kind of treatment for me?

Jackson Chen, DO, FAAO: So I think it's the mindset. You have to have the mindset that you want to get better. You have the mindset that you don't want to just depend on medications, because I also have some patients that just want medications to just take away the pain, but you need people who are proactive about their health, and they actually want to take control of it, because those are the candidates that actually do really, really well with it.

And once they are like referred to see me, I usually explain to them, like, what I think is causing them to have this issue. And then I will do some techniques to see if that helps, and if they find it helpful, great. But if they don't find it helpful, then I wouldn't want to waste their time, and we'll find the correct specialist for them.

Host: Right. Yeah. That makes sense. Anything else you want to add that we didn't cover already? We've covered a lot of ground, so no is an okay answer, but if there is something else you want to talk about, now is the time.

Jackson Chen, DO, FAAO: Just know that OMT, there's a lot of different terminologies, unfortunately. There's OMM, which is Osteopathic Manipulative Medicine. OMT, as we talked about, Osteopathic Manipulative Treatment. OPP, which is Osteopathic Principle and Practice. And Neuromusculoskeletal Medicine, which is exactly what we talked about.

So, these are all interchangeable. They all mean the same thing, just different DO schools come up with different terminologies. I don't know, they just had one uniform terminology for the whole thing as it is, but it is what we do.

Host: Alright, I think that is a good place to end the conversation. Dr. Chen, thank you for all of the great information today.

Jackson Chen, DO, FAAO: Of course. Thank you for having me.

Host: Once again, that was Dr. Jackson Chen, an Osteopathic Physician with Trinity Health of New England Medical Group. For more information or to book an appointment, call 1 833 CU NOW. That's 1 833 C U Y O U NOW or visit trinityhealthofne.org/primarycare. And if you found this podcast episode helpful, please share it on your social channels and check out the full episode library for topics of interest to you.

I'm Evo Terra, and this has been another episode of Transforming Your Health from Trinity Health of New England. Thanks for listening.