Frequently Asked Questions

FAQ

What is a DO?

In the United States, DO stands for Doctor of Osteopathy or Doctor of Osteopathic Medicine. There are two ways to become licensed to practice medicine and surgery in the United States. One way is to become a DO. The other way is to become an MD. Both DOs and MDs have an unlimited license to practice medicine, surgery, and obstetrics. American DOs are trained in all aspects of western medicine and receive additional training in Osteopathic Manipulation and in Osteopathic philosophy.

 

What is Osteopathic Manipulation?

Osteopathic Manipulation or Osteopathic Manipulative Treatment (OMT) is the unique hands-on manual medicine utilized by DOs. There are over a dozen different Osteopathic techniques. Each DO resonates with one or more of these techniques and then applies them in an individualized way for each patient. 

 

Is a DO a “real” doctor?

American trained DOs have the same unlimited license to practice medicine, surgery, and obstetrics as do MDs. American DOs can order lab and x-ray tests, prescribe medications, deliver babies, work in hospitals, and perform surgery just like MDs. American DOs practice in all the same medical and surgical specialties and subspecialties as MDs. After Osteopathic medical school, DOs and MDs enroll in all residencies together and train as equals, side-by-side.
 

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 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 read the medical literature extensively, with the goal of keeping up with the latest in medical advances. I have taken on average over 50 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.


Are you Board Certified?

I am Board Certified in Osteopathic Manipulative Medicine. I became Board Certified in Osteopathic Manipulative Medicine in 1994 and continue to actively maintain this specialty certification. I became Board Certified in Family Medicine, through the American Board of Family Medicine, in 1988 and maintained this credential until 2017. I became a Fellow in the American Academy of Family Physicians in 1995.


How long is a typical office visit?

The initial consultation is 60 minutes and all follow-up office visits last for 30 minutes.


What should I wear to an office visit?

An Osteopathic Treatment is done with the patient fully clothed. I can make any clothing situation work. But, if you can, dress in loose comfortable clothing.


What if I am sick with a cold or flu, should I come for my office visit?

YES! If you have a cold or flu, I will evaluate you from a medical perspective, make a diagnosis, determine if you do or do not need antibiotics, determine if you do or do not need a lab test or x-rays, and treat you with Osteopathic Manipulation. OMT is a powerful intervention that stimulates the immune system, decrease symptoms (cough, congestion, etc.), and helps your body get better faster.


What percentage of your practice is Osteopathic Manipulation?

I have a specialty practice in conditions that can be helped with Osteopathic Manipulation Treatment or OMT. Every patient receives a medical evaluation and medical diagnosis, by me as a physician. And I utilize Osteopathic Manipulation in 100% of my practice. Osteopathic Manipulation is used either as the primary treatment or as a complementary treatment for many medical conditions in my office.


What age group of patients do you see?

I see a wide spectrum of patients ranging from children beginning at about 5 years old to seniors. I treat men and women, young patients and older individuals. 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 had a patient who called us resort doctors. We are often the doctors of last resort to many patients who have lost hope within the medical system. 


How many office visits do I need to get better if you treat me using Osteopathic Manipulation?

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. For chronic conditions, a patient may require a team approach to manage rather than “cure” a problem.


Do you “crack” necks or backs?

I do not find that twisting, high-velocity, low-amplitude thrusting manipulative techniques, or approaches 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. A noise 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.


Do you use Cranial Osteopathy in your practice?

Every patient who gets Osteopathic Manipulation also 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. Visceral manipulation is the application of clinical Osteopathic philosophy and common Osteopathic techniques to the abdomen and pelvis.


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. 


Do you utilize herbs or supplements in your practice?

Yes, I compliment 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.


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 2020 there were over 70,000 DOs in the United States but only a very small fraction offers Osteopathic Manipulation in their offices.


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 Osteopathic Manipulative Medicine.

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 South America 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 might utilize herbs, vitamins, supplements, homeopathic remedies, or acupuncture. 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 medications. 


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

Physical therapists have a limited license and usually require 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 inanimate machines cannot reproduce that power.


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 Manual 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 helpful. 


Do you do Trigger Point injections?

I used to inject trigger points in the early 1990s. I trained with Janet Travel, MD, one of the founders of medical trigger point injection technique and used this intervention extensively during the 2 ½ 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 was highly skilled and had extensive experience but found that it only offered temporary symptomatic relief. I did thousands of trigger point injections. I don’t believe that this system works very well. It almost never got rid of a pain problem and it does not initiate a therapeutic process in a patient.


Do you perform regenerative medicine such as stem cell injections, prolotherapy, or platelet injections?

No. I do not utilize injection therapy of any kind in my practice.


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.


Do you do Dry Needling in your practice?

No. I do not do dry needling. I do not believe that dry needling is therapeutically helpful. In fact, I think that dry needling can often make musculoskeletal problems worse. The needles commonly cause bleeding into the muscle or subcutaneous tissue and the technique is very different than acupuncture. I do not recommend this invasive form of “treatment.”


Do you suggest that I get cupping therapy for my muscle and fascia problem?

No. Cupping causes bruising and the blood that enters the subcutaneous space causes inflammation and scar tissue formation. Also, I do not suggest that patients receive Graston technique or Gua Sha instrumentation. I find that they cause more harm than good. There is no good evidence that any of these invasive techniques are helpful.


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 only massage therapy. American DOs are required to attend four years of college, four years of Osteopathic medical school, and a minimum of 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. The vast majority of Craniosacral Therapists are practitioners of massage therapy. 

I do not do Craniosacral Therapy. I am an Osteopathic 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.


Osteopathic Manipulation is the only organized form of manual medicine that is taught to fully licensed physicians beginning in medical school. 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.

 

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

Allopathic medicine is the term used to describe the practice and philosophic approach of MDs. Allopathy is what we call western medicine, orthodox medicine, modern medicine, or standard medicine. It distinguishes the work of MDs. 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.


COPYRIGHT © 2020 STEVE PAULUS, DO, MS - ALL RIGHTS RESERVED.


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