Can you describe your Osteopathic training?

Every American DO receives a basic level of training in Osteopathic Manipulation and Osteopathic philosophy in medical school. I chose to expand greatly upon the limited compulsory curriculum in Osteopathic medical school by extending my learning outside of the classroom. I continually study anatomy to enhance my understanding of the human body, I have taken on the average about 100 hours per year of continuing medical and Osteopathic education classes since graduation from residency in 1988, and I academically study the history of Osteopathy and the wisdom of the early Osteopathic pioneers.

I learned the science of Osteopathy by extensively studying anatomy, medicine, and the Osteopathic principles that form the basis of this applied clinical philosophy. I learned the art of Osteopathy by mentoring, at different points in my career, with master Osteopaths. Real Osteopathy is not learned from a textbook or from a lecture. The essence of Osteopathy is passed on from teacher-to-student in the oral tradition and is not recorded in textbooks. True Osteopathy is transmitted from the hands of a teacher to the hands of the learner.

To be an effective Osteopath, one must become a life-long learner. I have devoted myself to the study of the human body and to ways in which holism can be restored by the use of Osteopathic Manipulation.

Have you ever practiced Family Medicine or have you always had a specialty practice in Osteopathy?

After completing my Family Medicine residency in 1988 I moved to Watsonville, California and worked as the young associate with an established Family Doctor, Sean Murphy, MD. I practiced the full spectrum of outpatient and inpatient Family Medicine, while incorporating Osteopathy with a small percentage of my patients. After a year and a half, my office was destroyed in the Loma Prieta earthquake of 1989. Dr. Murphy and I lost everything and had to close our office because our building was severely damaged. I then worked in an Urgent Care Clinic for 2 1/2 years and ultimately became their Occupational Medicine Director. During that post-earthquake interval I also worked as a part-time physician at the Santa Cruz County Jail and at the Veterans Clinic at Fort Ord in Monterey, California.

When did you leave Family Medicine and begin to practice Osteopathy as a specialty?

In 1992 I decided to leave allopathic Family Medicine and Urgent Care and took over the practice of a well-known Osteopath, Fritz Smith, MD. Dr. Smith had originally trained as an Osteopathic physician and later was one of the first American doctors to receive Acupuncture training in the 1970s. He incorporated Osteopathy and Acupuncture into an alternative medicine practice and developed the system of healing known as Zero Balancing. In 1992 I formally shifted my practice to one that specialized in Osteopathic Manipulative Treatment and alternative medicine.

Do all DOs utilize Osteopathic Manipulation?

Unfortunately, most DOs do not utilize OMT in their practices. In many ways Osteopathic Manipulation is a dying healing art in America. Surveys have shown that only 3-5 % of DOs use OMT on a regular basis in the United States. Most DOs practice identically to MDs and you cannot tell the difference between them. There is a strong, yet small, group of about 1000 American DOs who specialize in Osteopathic Medicine and utilize OMT on all or most of their patients. As of 2009 there were over 60,000 DOs in the United States but only a very small fraction offer Osteopathic Manipulation in their offices.

Do you use OMT?

YES! Every patient receives Osteopathic Manipulation either as the primary treatment or as a complementary treatment in my office. I specialize in Osteopathic Manipulative Medicine.

Do you use Cranial Osteopathy in your practice?

Almost every patient receives some form of Cranial Osteopathy in my practice. In my hands Cranial Osteopathy is both a form of diagnosis and a method of treatment. For some medical conditions Cranial Osteopathy is the primary method that I utilize to treat the complex anatomy of the cranium. Cranial Osteopathy is also a unique approach to treating the entire body and is a holistic expression of Osteopathy. It is important to note that Cranial Osteopathy is not separate from the whole of Osteopathy.

Do you use “visceral manipulation” in your practice?

I use a wide variety of approaches, including visceral manipulation. It is important to note that visceral manipulation is not really a separate Osteopathic technique. Visceral manipulation is the application of clinical Osteopathic philosophy and common Osteopathic techniques to the visceral field. Historically, application of Osteopathy to the visceral field was done by A. T. Still, the founder of Osteopathy.

Do you “crack” necks or backs?

I very rarely find that the high-velocity, low-amplitude thrusting manipulative techniques, that produce a popping sound, are helpful. Patients think that the “pop” does something. In my opinion the noise heard with certain forceful thrusting maneuvers doesn’t do anything, it is doesn’t fix or repair a problem. I was trained in this technique in medical school but my Osteopathic style has evolved and I have found that other more gentle approaches work much better.

How would you describe your style of
Osteopathic Manipulation?

I have a very eclectic Osteopathic style. I use a wide variety of techniques to help patients achieve a greater expression of health and holism. I don’t have a cookbook approach and do not utilize the same treatment plan for every patient. Sometimes my treatment approach is very subtle. At other times it can be more physical. Osteopathic Manipulative Treatment is not painful. My goal is not to find the painful areas and push on them or make them worse. The goal of an Osteopathic Treatment is not to “pound down the high spots” or “fill in the holes.”

Several features determine my way of treating, the amount of physical pressure that is necessary, or the category of touch that is required. The age of the patient, the size of the individual, their gender, their overall medical condition, and the complexity of the dysfunction that is being addressed all weigh into the complex decision process that determines a holistic Osteopathic Manipulative Treatment.

For a more detailed description regarding my unique style of Osteopathic Treatment go to the Osteopathy link.

Are you Board Certified?

I became Board Certified in Osteopathic Manipulative Medicine in 1994 and continue to actively maintain this specialty certification. In 1988 I became Board Certified in Family Medicine. I maintained my Family Medicine Board Certification until 2002. I decided to not renew my Family Medicine Board Certification in 2002 because I had stopped offering primary care services to my patients, I no longer worked in a hospital environment, and my practice became more specialized with an orientation toward treating conditions that can be helped using Osteopathic Manipulation.

What age group of patients do you see?

I see a wide spectrum of patients of all ages ranging from newborn babies and children to older adults. I frequently see three generations within the same family.

What type of medical conditions do you treat?

Because I am a fully licensed physician and have extensive Family Medicine experience, I treat a wide variety of patients with a diverse range of medical conditions. I commonly see patients with serious medical conditions that have seen many different medical or surgical specialists and have not been helped. My wife Bonnie Gintis, DO has a patient who calls us resort doctors. We are the doctors of last resort to many patients who have lost hope within the medical system.

Osteopathic Treatment can be used as the singular or primary treatment for a particular problem or injury, or it can be used as complementary treatment.

Go to the CASE HISTORY section of this website and it will offer an extensive list of the variety of diseases, injuries, problems, or disorders that I treat using Osteopathic Treatment.

Do you treat athletes or do Sports Medicine?

I have many athletes in my practice and treat a wide spectrum of problems associated with recreational athletes as well as high-level college and high school competitors. My goal in the treatment of athletic injuries is to pragmatically get the individual back to playing their chosen sport. In my treatment approach, I incorporate a focused exercise prescription, Osteopathic Manipulation to correct structural imbalances, and suggest an appropriate rest phase to allow proper healing.

Do you teach patients exercises or recommend certain exercises?

Yes, for conditions that can be helped with exercise I will teach, recommend, or encourage patients to participate in their own health care by doing a home exercise program. There are many injuries or medical conditions that can be cured by exercise. Or at the very least, the problem can be managed more creatively by incorporating the proper exercises. I consider exercise to be like a prescription. I will carefully identify the specific forms of exercise that each patient needs and help them custom design a program that works for them as an individual.

How many office visits do I need to get better?

Every patient is different and every problem is different. There is no way to tell you in advance how many treatment sessions will be required. I need to listen carefully to your entire history, perform a thorough medical and Osteopathic examination, and then integrate this data into a diagnosis. Once a diagnosis is determined, then we discuss how best to treat you as an individual. I don’t have a cookbook approach and do not utilize the same treatment plan for every patient. It is my goal to assist each patient’s natural ability to self-heal so they can learn to access their own internal resources for long-term personal care.

In general, it is safe to say that acute problems usually respond more rapidly to Osteopathic Treatment and can resolve in 2-3 treatments. While chronic issues take longer and improvement unfolds in a layered manner. The treatment plan for chronic medical problems is diverse and may require patience as healing opens up in a gradual way.

What is the difference between an American DO and a DO trained outside of the United States?

In the United States, DOs have an unlimited license to practice medicine, surgery, and obstetrics. We have the same training as MDs, but have additional training in Osteopathic philosophy, anatomy, biomechanics, and in OMT.

Outside of the United States interest in Osteopathy philosophy and Osteopathic Manipulation is expanding exponentially. The vast majority of DOs in Canada, the UK, the rest of Europe, Australia, New Zealand, and in Brazil have a limited license to exclusively practice Osteopathic Manipulation and are not fully licensed physicians. The training of non-American DOs is very diverse with some having full-time three or four year schools and some being part-time schools.

A very small percentage of non-American DOs are medical doctors who attend Osteopathic school, outside of the United States, after receiving their MD degree and then practice Osteopathy and medicine similar to Osteopathically-oriented American DOs.

Do you practice Homeopathy?

I do not integrate Homeopathy into my practice. I have great respect for homeopathic medicine and if a patient requires this category of complementary medicine, then I refer to a homeopathic physician who specializes in this healing art.

Are you a Naturopath?

No, I am an Osteopath and a physician who attended Osteopathic medical school. Naturopaths attend Naturopathic school and receive an ND or Naturopathic Doctor degree. Naturopaths have a limited license to practice “natural medicine” and do not have the breadth of western medical training that MDs or American DOs have. They utilize herbs, vitamins, supplements, homeopathic remedies, and assist patients in treating medical conditions in an ambulatory care setting. NDs have training in nutritional counseling and some have additional instruction in manual therapy techniques. In some states, NDs have the legal ability to prescribe some simple medications and do injections.

Do you utilize herbs or supplements in your practice?

Yes, I complement my work as an Osteopath by using herbs, vitamins, or natural supplements that have been proven to be helpful in the treatment of certain conditions. I study the natural medicine scientific literature to find the most appropriate supplements that can help my patients. I have found that many patients take too many supplements, take them for the wrong reasons, or take too low of a dosage. I work with patients to find the best and lowest cost supplements that realistically work for that individual. Because I am a residency trained Family Physician with extensive experience in prescribing medications, I will review a patients herb and supplement list for potential interactions with prescription medications in order to prevent dangerous reactions.

What is the difference between a DO and a physical therapist or PT?

Physical therapists have a limited license and must have a physician’s (DO/MD) prescription to see a patient in order to get reimbursed by an insurance carrier. In some settings they can function autonomously and have the legal ability to see patients independent of a medical referral. Technically they are not licensed to make a formal medical diagnosis. They have special training in exercise, physical rehabilitation, and therapeutic methods of treating the musculoskeletal system. They frequently use additional modalities such as ultrasound, cold/heat, diathermy, and electro-stimulation. Some physical therapists have received additional manual therapy training.

Do you use modalities or machines in your practice?

I do not use any modalities like hot or cold packs, ultrasound, TENS units, electrical stimulation, cutaneous laser therapy, or any therapeutic machines in my office. I believe that the hands-on work of Osteopathic Manipulation is dependable, potent, and highly therapeutic. I believe that human touch is an incredibly powerful healing agent and that power cannot be reproduced by inanimate machines.

What is the difference between the manual therapy of PTs and Osteopathic Manipulative Treatment?

Many PT schools have traditionally offered training in massage and soft-tissue techniques. In the early 1980s, several American DOs began offering courses to PTs in OMT. A few Osteopathic medical schools also began to offer post-graduate Osteopathic manual therapy courses to PTs. The most common types of manual therapy techniques utilized by PTs are based on an Osteopathic model; however they do not practice Osteopathy. PTs do not incorporate Osteopathic philosophy into their work and frequently use OMT as a technique-driven modality rather than an integrated holistic approach.

Do you utilize massage in your practice?

I do not employ a massage therapist in my office and I do not perform massage therapy techniques. DOs are not massage therapists; we are physicians who incorporate OMT into a medical practice.

Do you do Trigger Point Therapy?

I do not use Trigger Point Therapy in my practice and it is not a formal part of Osteopathic Manipulation. Trigger Point Therapy is a technique often used by massage therapists, physical therapists, or Chiropractors. It involves isolating tender points in the muscles and then applying pressure to attempt muscle relaxation. I don’t believe that Trigger Point Therapy works. It is a painful procedure and I do not believe that “pounding down the high spots” or “smoothing out the bumps” is therapeutically creative.

Do you do Trigger Point injections?

I used to inject trigger points in the early 1990s. During my residency I trained with one of the founders of medical trigger point injection technique and used this intervention extensively during the 2 1/2 years when I worked in an Urgent Care Clinic. In this setting, I had a very high patient volume so I did not have time to offer OMT. I did thousands of trigger point injections. I don’t believe that this system works very well. I was highly skilled and had extensive experience but found that it only offered temporary symptomatic relief. It almost never got rid of a pain problem and it did not initiate a therapeutic process in a patient.

Sometimes when you treat you find a tender spot and hold it for some time. Are you doing Acupressure?

Sometimes I will find a local tender spot and use it as a way of monitoring the response of the tissues to something else that I am doing. Usually when I am monitoring a tender spot, I am using an indirect technique to shorten a muscle to assist it in organizing a new neurologic input that will cause relaxation of a dysfunctional region. OMT is not Acupressure and has no relationship to this manual form of Chinese Medicine.

What is the difference between a DO and a massage therapist?

A massage therapist has a limited certification to perform massage. In California it now takes 500 hours of training to receive your certification in massage therapy. American DOs are required to attend four years of college, four years of Osteopathic medical school, and three years of residency training before going into practice.

What is the difference between a DO and a
Chiropractor or DC?

Chiropractors are independent health care practitioners with a limited license to practice spinal manipulation and other forms of manual therapy. Unlike DOs or MDs, they cannot prescribe medications, admit patients to the hospital, or perform surgery. The philosophy and manipulative techniques used by Chiropractors are very different than that of Osteopaths.

Do you do Craniosacral Therapy?

Craniosacral Therapy (CST) is a trademarked name of a type of hands-on therapy developed by an Osteopath named John Upledger, DO. Dr. Upledger believed that there were too few DOs who utilized Osteopathic Manipulation in America and he developed a simplified version of Cranial Osteopathy and named it “Craniosacral Therapy.” He wanted to make some form of Osteopathy available to the masses so that people who needed hands-on work could receive care. There are no prerequisites to taking a Craniosacral Therapy course. Anyone can take their courses. I took the first two CST courses in the early 1990s out of curiosity. I was the only physician in my courses. Most “students” were massage therapists or Chiropractors. However, over half of my classes were attended by non-health care related individuals such as ministers, teachers, social workers, real estate agents, and several retired individuals with varied backgrounds.

I do not do Craniosacral Therapy, I am an Osteopath and a physician. I do Osteopathy. CST is derived from Cranial Osteopathy but it does not include the core principles of Osteopathy. The DO training to become skilled in Cranial Osteopathy is much more rigorous than that of CST.

Do you do “bodywork”?

Bodywork is a generic term utilized in alternative medicine that is used to describe many different techniques that are used to provide healing or relaxation through physical manipulation or touching. Manual manipulation of the body can be achieved in many ways depending on what type of therapy is being used. This generic term applies to many different types of therapies and treatments, and commonly includes massage, manual therapy performed by physical therapists, Rolfing, Feldenkrais method, Trager approach, Alexander Technique, Chiropractic, Zero Balancing, Ortho-Bionomy, acupressure, Shiatsu, Reiki, polarity therapy, foot reflexology, etc.

Osteopathy is the only organized form of manual medicine carried out by physicians in the United States. Usually, DOs are not included in the general listing of “bodyworkers.” Because we are Osteopaths and physicians our work tends to fall into the separate category of Physical Medicine. The training of American DOs is comparable to that of MDs and is dramatically more extensive than that of bodyworkers. I prefer to not be grouped, specifically or generally, with bodyworkers.

Do you utilize Acupuncture in your practice?

I do not integrate Acupuncture or Chinese Medicine into my practice. I have great respect for Chinese Medicine and if a patient requires this category of complementary medicine, then I refer to an Acupuncturist who specializes in this healing art.

In the past I had integrated Acupuncture into my medical practice, In 1992 I graduated from the two year UCLA physician training program in Acupuncture and then completed two years out of a four year Five Element Acupuncture training program in San Diego. In 1996 I relinquished the Acupuncture part of my practice because it was taking me too far away from Osteopathy and medicine. I find Chinese Medicine of great value for certain conditions and continue to refer to Acupuncture specialists when indicated.

You have used the term allopathic medicine to answer some of these questions, what is it?

Allopathic medicine is a 19th Century term originated by Samuel Hahnemann to describe the practice and philosophic approach of regular doctors or MDs. Allopathy is what we now call western medicine, orthodox medicine, modern medicine, or standard medicine. It is currently used to distinguish the work of MDs vs. DOs, or MDs vs. alternative medicine practitioners. As a term, allopathic medicine has a variable degree of acceptance in the MD community.

What is an OD?

An OD is a Doctor of Optometry. Doctors of Optometry have a limited license to evaluate problems relating only to the eye, perform eye exams, fit glasses and contact lenses, perform vision therapy, and in some states are trained to prescribe a few simple medications. Osteopathic physicians can be confused with Doctors of Optometry only because their professional initials, OD and DO are in reverse, we can sometimes be confused by the public.