Spreading FDM as a Student and Resident
I was exposed to the Fascial Distortion Model (FDM) right after I was accepted to an osteopathic medical school. While I did not take my first full class until after my first year of school, I had enough exposure to FDM that I started using it on classmates who had musculoskeletal (MSK) complaints that hadn’t resolved with the techniques we were learning in class. I saw the benefit of having this additional training and attended all of the modules before graduating. I have had varying levels of success spreading the model during my clinical rotations as a student and now during residency.
One of my most impressive successes was during a neurology rotation at a military base. The physician had a large number of patients with MSK complaints who had failed previous treatments. He attempted to learn other tools such as acupuncture to help his patients, but that didn't help all of them. One of the first patients I saw with him had hip pain. Her history and hand gestures indicated a Folding Distortion. Acupuncture had not resolved the pain, and the physician asked if I had any other ideas. I provided a quick elevator pitch on FDM highlighting Folding Distortions and outlined the treatment. Both the physician and the patient felt like they had nothing to lose, and I treated her. After treating the Folding, the patient indicated an HTP. I explained HTPs and how they are treated (including that it would hurt). Still, the patient wanted to go ahead. After the treatment, the patient was able to walk with much more ease than she had arrived. The very next patient had also been treated with acupuncture on multiple occasions with minimal improvement, and the attending wanted to know what else could be done for the patient from an FDM perspective. After two of his patients who had failed previous modalities improved with their first encounter with FDM, he was sold. Through the course of the rotation, the attending learned the body language and the treatments indicated. In another instance, the attending told me he was just going to set up an acupuncture treatment so I could do some of the paperwork I had at the time. He was only in the room for 10 seconds before walking out and saying, "the patient did this," gesturing a Triggerband, "he needs you and FDM."
I also worked with a traditional osteopath who was curious about FDM and why I had taken multiple courses. She had read the book Why Does it Hurt? and thought FDM was an intriguing idea but did not like the fact that treatments could be painful. We were working on one of her long-time patients with lumbar and hip pain. The hip pain was easily treated, but the lumbar region has been less responsive to manipulation, and even trigger point injections hadn’t helped. They wanted me to palpate her lumbar spine to feel what they described as “gravel.” I recognized the gravel to be HTPs and CDs. I asked the patient to show me her pain, and she indicated bilateral HTPs that matched the palpatory findings, I explained what I believed the "gravel" to be. The patient was up for a trial of FDM, and the physician hesitated but agreed. Before treatment I had the patient perform a forward bend for a baseline. I treated three lumbar HTPs and retested. There was not a noticeable improvement in flexion, but the patient reported her back was pain-free. At this point, she described pain in her glute that was holding her back. She gestured towards it and laid on her side on the table with her knee bent, the perfect position to treat her Bullseye HTP. Following treatment, the patient stood up from the table to re-check. The attending asked her what she was doing standing up, and the patient replied that she was retesting to see where the pain was. Following treatment, the patient reported that she had more motion and felt better than she had for years. I was impressed that the patient quickly caught on to the test, retest procedure, while the practicing osteopath struggled with the concept so emphasized in FDM.
Utilizing FDM as a student or resident can be difficult due to variation between attendings and what they are comfortable with students/residents doing. I will provide a few pointers that I have used to present FDM to attendings. These can help, but they don't guarantee the attending will allow for FDM or any OMT to be used.
Have an elevator pitch - You should have one for FDM and OMT. Make it short and focus on what it is and how it can help patients. Modify it based on the attending and their background. Usually, when I describe FDM, I will include gestures that almost everyone alive has seen before. My standard pitch goes something like, "FDM is a form of osteopathic manipulation that relies on the patient's description and gestures to make the diagnosis and to treat accordingly." Then I demonstrate CDs, Triggerbands, HTPs, and Folding of the cervical spine, saying the gestures indicate different distortions and treatment is adjusted accordingly.
Carefully pick the patient - Often you only have one chance to validate FDM or OMT with your attending. Offer it on a patient that shows clear body language with corresponding palpatory findings. Also, the patient should be someone that is able to undergo the treatment without undue distress fr om the discomfort during treatment. It's bonus points if the patient has failed other therapies and the attending is scratching their head on how to help them .
Have a way to measure improvement - Compare the range of motion before and after. If the patient reports that they feel better after an FDM treatment, that is awesome. It's even better if there is a change that the attending can see. As much as we might try to deny it, sometimes seeing is believing.
I fully believe that the world needs FDM. It's a long process, and it really starts with us, those of us that have been trained in it. Spreading the word by showing results and helping people that have failed previous treatments. I hope that the attendings I described earlier will continue to learn about FDM and help their patients. Additionally, I hope this article can help students and residents to introduce their attendings to FDM, and help spread the Model.
The neurology attending was really put out one day after I treated two posterior cervical Triggerbands in a lady with an active migraine. Following the treatment, the patient took off her sunglasses and reported resolution of symptoms. After pondering for a while, the attending said, "She has failed abortive and preventive medications along with an occipital nerve block, and all it took was some
a---ole with a thumb." Let's spread the word and find more a---oles with thumbs.