When people find out I'm a DO — a Doctor of Osteopathic Medicine — the most common question I get is: what's the difference? And when I mention that I offer osteopathic manipulative treatment, or OMT, the follow-up is usually: is that like chiropractic? The short answers are: quite a bit, and not exactly. But both questions deserve a real explanation — because OMT is one of the most versatile, underutilized, and genuinely helpful tools I have as a physician.
I've used it on patients alongside conventional medicine, and I've used it on patients where medication and surgery simply weren't the right answer — or hadn't worked. I've used it on adults managing chronic pain, and on children too young to take most medications. The range of what it can address is broader than most people expect.
What Is a DO — And How Is the Training Different?
A Doctor of Osteopathic Medicine (DO) is a fully licensed physician. DOs and MDs complete the same four years of medical school, the same residency programs, the same board exams in their specialties, and have the same prescribing rights and scope of practice in all 50 states. We work in every field of medicine — primary care, surgery, emergency medicine, pediatrics, psychiatry, and beyond.
The difference is one of philosophy and an additional layer of training. Osteopathic medical schools integrate at least 200 additional hours of hands-on training in osteopathic manipulative medicine into the standard medical curriculum. This training is built on the principle that the body's structure and function are deeply interconnected — and that supporting one supports the other. It shapes not just how DOs use their hands, but how we think about the whole patient.
- The body is a unit — a person is a combination of body, mind, and spirit
- The body is capable of self-regulation and self-healing
- Structure and function are reciprocally interrelated
- Rational treatment is based on understanding these principles
Osteopathic medical students now make up more than 25% of all US medical students, and approximately 56% of practicing DOs enter primary care — reflecting the field's core mission of whole-person, accessible medicine (AACOM, 2025).
So What Is Osteopathic Manipulative Treatment?
Osteopathic manipulative treatment — OMT, or sometimes called OMM (osteopathic manipulative medicine) — is a hands-on diagnostic and treatment approach in which a physician uses their hands to assess and treat the musculoskeletal system. This includes muscles, joints, tendons, ligaments, fascia, and the fluid and nerve pathways that run through them.
OMT is not one technique — it's a family of them. Depending on the patient, the condition, and what I find on examination, I may use soft tissue release, myofascial techniques, muscle energy techniques (where the patient gently resists my pressure), high-velocity low-amplitude thrusts, counterstrain, craniosacral work, lymphatic pump techniques, and more. Each approach is adapted to the individual — their age, their body, their condition, and what their body needs in that moment.
The goal is to reduce restrictions in movement, improve blood flow and lymphatic drainage, decrease pain, and support the body's own ability to heal and regulate — all without necessarily reaching for a prescription or a procedure.
How OMT Differs from Chiropractic Care and Physical Therapy
This is the question I get most often, and it's a fair one — there is overlap. All three involve hands-on care and can help with musculoskeletal pain. But the differences matter, both in scope and in how treatment decisions are made.
| OMT (DO) | Chiropractic (DC) | Physical Therapy (DPT) | |
|---|---|---|---|
| Medical license | Full physician license — can diagnose, prescribe, order labs, refer, perform procedures | Licensed for chiropractic care only — cannot prescribe medications | Licensed for rehab and movement therapy — cannot prescribe medications |
| Training | 4 years medical school + 200 additional OMT hours + residency (3–7 years) | 4 years chiropractic college after undergraduate coursework | 3-year Doctor of Physical Therapy graduate program after undergraduate |
| Primary focus | Whole body — structure, function, fluids, nervous system, visceral organs — integrated with full medical assessment | Primarily spinal alignment and nervous system via vertebral adjustment | Movement, rehabilitation, strength, and function — typically post-injury or post-surgery |
| Non-musculoskeletal conditions | Yes — lymphatic, respiratory, digestive, pediatric, and more | Limited — primarily musculoskeletal | Limited — primarily musculoskeletal and functional |
| Integrated with conventional medicine | Yes — OMT is one tool within a full medical visit; physician manages all aspects of patient health simultaneously | Separate from medical care; referral required for medications or advanced diagnostics | Typically requires a physician referral; does not prescribe or independently diagnose |
As the American Academy of Family Physicians notes, a key distinction is that osteopathic physicians apply OMT with comprehensive medical training across all body systems — allowing manipulative medicine to be adapted specifically to each patient in the context of their overall health. A DO can integrate examination findings — and also order the MRI, manage the medication, or refer to a surgeon — in the same visit.
Conditions OMT Can Help With
OMT is best known for musculoskeletal pain — and that's where the evidence is strongest. But the scope is broader than most people realize. Because the musculoskeletal system is connected to every other system in the body — circulatory, lymphatic, neurological, respiratory, digestive — OMT can support healing in conditions that go far beyond back pain.
The American Osteopathic Association recommends OMT as a frontline intervention for both acute and chronic non-specific low back pain at its highest evidence level (Level 1a). A systematic review found moderate-quality evidence that OMT significantly improves pain and functional status in acute and chronic low back pain, as well as postpartum back pain (Franke et al., 2014).
- Acute and chronic low back pain
- Neck pain and cervicogenic headaches
- Tension headaches and migraines
- Hip, knee, and shoulder pain
- Rib dysfunction and chest wall pain
- Sports injuries and repetitive strain
- Osteoarthritis — OMT may improve pain and mobility when no curative treatment exists (Cureus, 2024)
- Postural imbalances and scoliosis-related discomfort
- Pregnancy-related back and pelvic pain; postpartum recovery
Lymphatic pump techniques and rib cage mobilization can support drainage and airflow, making OMT a helpful adjunct for patients who haven't found full relief through medication alone.
- Chronic sinusitis and congestion
- Asthma — OMT may improve chest wall mechanics and respiratory function
- Recurrent upper respiratory infections
- Post-COVID respiratory stiffness and fatigue
OMT's influence on the autonomic nervous system, lymphatic flow, and craniosacral rhythm opens doors for conditions that conventional medicine may manage but not fully resolve.
- Chronic fatigue and fibromyalgia
- Hypertension — some evidence suggests OMT supports blood pressure regulation
- Digestive dysfunction including constipation and IBS
- Dizziness and vertigo with cervical involvement
- Anxiety and stress-related somatic symptoms
OMT techniques are adapted for the gentleness that infants and children require — there is no "cracking" or high-force manipulation used in pediatric OMT. A meta-analysis found moderate-quality evidence that OMT significantly reduces hours of crying in infantile colic (Castejón-Castejón et al., 2022). Research also suggests modest potential benefits for recurrent ear infections. Evidence in pediatrics is still developing — I always discuss this honestly with families.
- Infantile colic and excessive crying
- Recurrent ear infections (otitis media) — OMT may support eustachian tube drainage
- Breastfeeding difficulties related to latch or jaw tension
- Plagiocephaly (positional head flattening)
- Growing pains and postural issues in school-age children
- Sports injuries in adolescents
OMT works through a completely different mechanism than anything in a pill bottle — and for some patients, that's exactly what was missing.
OMT as Part of Whole-Person Care
What I find most meaningful about OMT is what it represents philosophically — not just physically. When I perform OMT, I am not treating a back or a sinus or a shoulder. I am treating a person. That means understanding what is happening in their body structurally, but also what's happening in their life, their sleep, their stress levels, their movement patterns, and their overall health.
OMT is most powerful when it's integrated — used alongside appropriate medications, lifestyle modifications, or referrals when needed. It is not an alternative to medicine. It is medicine, delivered through the hands.
In my practice, OMT is available as a standalone visit (no membership required) or as part of a DPC membership. Whether you're dealing with something acute or something chronic, something that just started or something you've been managing for years — it's worth a conversation.
Is OMT Right for You?
OMT is not for everyone, and every session starts with a thorough evaluation. There are contraindications — situations where manipulation would not be appropriate — and I assess for those carefully. But for many patients, especially those managing chronic pain, recovering from an injury, navigating a condition where medication isn't fully working, or simply wanting a more hands-on approach to their care, OMT is worth exploring.
If you're curious whether it might help your specific situation, the best first step is a conversation.
- American Association of Colleges of Osteopathic Medicine (AACOM); UPMC HealthBeat, "MD vs. DO," updated January 2025.
- American Osteopathic Association (AOA) — Tenets of Osteopathic Medicine (osteopathic.org).
- Roberts A, Harris K, Outen B, et al. "Osteopathic Manipulative Medicine: A Brief Review of the Hands-On Treatment Approaches and Their Therapeutic Uses." Medicines. 2022;9(5):33. doi:10.3390/medicines9050033. PMC9143587.
- American Academy of Family Physicians (AAFP). "Osteopathic Manipulative Treatment: A Primary Care Approach." American Family Physician, February 2019.
- Franke H et al. "Osteopathic manipulative treatment for nonspecific low back pain: a systematic review and meta-analysis." Chiropractic & Manual Therapies, 2014.
- American Osteopathic Association — Level 1a recommendation for acute and chronic non-specific low back pain. Referenced in ICOM, "What Is Osteopathic Manipulative Medicine?" 2025.
- Stoll V et al. "The Role of Osteopathic Manipulative Treatment in Osteoarthritis: A Scoping Review." Cureus, November 2024.
- PMC. "A Review on Osteopathic Manipulation in Patients With Headache." NIH / PMC, 2024.
- Castejón-Castejón M et al. "Osteopathic Treatment for Gastrointestinal Disorders in Term and Preterm Infants: A Systematic Review and Meta-Analysis." PMC, 2022.
- PMC. "Use of osteopathic manipulation techniques for management of acute otitis media in pediatric patients: a scoping review." PMC, 2025.
This post is for informational and educational purposes only and does not constitute medical advice. OMT is not appropriate for all conditions or all patients. Please consult a licensed physician to determine whether OMT is right for your specific situation.
Curious whether OMT could help your specific condition? Dr. Nelly offers osteopathic manipulative treatment — no membership required.