Osteopathic Manipulative Therapy with Dr. Teresa Kilgore

Osteopathic manipulative therapy, or OMT, is a treatment offered at MUSC Health that includes applying gentle pressure to manipulate muscles, soft tissues and joints in order to assist the body in its own self-healing processes. Theresa Kilgore, DO, is a doctor of osteopathic medicine as well as a general internist. In this episode, she talks about the philosophy behind OMT, its benefits, and what to expect during treatment.

“One of the basic tenets of OMT is this idea of flow. Restrictions cause a problem, and our whole focus is to anatomically release those restrictions with manipulative therapy to allow things to flow as they should.”
—Teresa Kilgore, DO

Topics Covered in This Episode

• Osteopathic medicine (OM) was developed in the 1800s by Dr. Andrew Taylor Still, who believed in the body’s natural ability to heal itself. Osteopathic physicians treat illnesses and injuries like all other physicians do, but Kilgore says they also believe that all the systems in the body work together and profoundly affect each other.
• A basic tenant of OM is the idea of flow–that good health is reliant on the natural influx of nutrients and the natural outflux of toxins. Kilgore says when this flow is restricted, both acute and chronic issues can develop.This applies to all systems of the body including muscular, nervous, endocrine, cardiovascular, lymphatic, respiratory and digestive.
• Osteopathic manipulative therapy (OMT) is the practice of returning these systems to their natural flow states. This includes a variety of techniques including manipulation and massage of muscle tissues, as well as traditional alignment techniques a chiropractor might use.
• Kilgore is a general internist in addition to being a doctor of osteopathic medicine and applies OMT techniques to patients as part of her general practice. OMT is commonly applied in instances of muscle spasms, back pain, herniated discs, pinched nerves, sinus issues, and respiratory issues, for example, though OMT is applicable to a wide range of conditions.
• While OM was less mainstream historically, it has become far more commonplace now as the medical world has itself become more integrative and holistic in approach.
• The field of OM also began expanding significantly due to an expected shortage in primary care physicians and the fact that so many doctors of OM do their residencies in primary care.
• OM has proven benefits for patients with respiratory issues, such as asthma, COPD and congestive heart failure. Additionally, studies are being done to measure the impact of OMT on those with COVID-19 and “long COVID.”

Read the Show Transcript

Erin Spain, MS [00:00:04] Welcome to Advance with MUSC Health. I'm your host, Erin Spain. This show's mission is to help you find ways to preserve and optimize your health and get the care you need to live well. Osteopathic manipulative therapy, or OMT, is a treatment offered at MUSC Health that includes applying gentle pressure to manipulate muscles, soft tissues and joints to help the body heal itself. Today's guest, Dr. Theresa Kilgore, is a doctor of osteopathic medicine and joins me today to talk about the benefits of OMT and what to expect during treatment.

Welcome to the show.

Teresa Kilgore, DO [00:00:44] I'm very happy to be here. Thanks for having me.

Erin Spain, MS [00:00:46] Physicians like yourself, osteopathic physicians, treat illnesses and injuries like all other physicians do. But they also believe that all the systems in the body work together and affect each other. Tell me about this approach.

Teresa Kilgore, DO [00:01:00] That's the basis for the philosophical difference when the school was developed, and this was back in the 1800s. And realizing that medicine back then really had some techniques that weren't great -- we gave arsenic and we did other techniques, bloodletting or things, that just were, you know, like not helpful. So we've certainly come a long way. But at that time, an M.D. who was Dr. Still — he was kind of a very spiritual guy and he was kind of like, you know, the human body is such a miraculous, wonderful thing that has the ability to heal itself. It is set up that way. We have so many measures within our body to maintain health and when there is disease or disease to heal itself. And so he really tried to focus on that.

[00:01:45] I think one of the basic tenets also is this idea of flow. And if you just think in general, any system in nature, there has to be flow of toxins out and good nutrients and oxygen and health giving nutrients and needed materials in. It has to be going. If it's stagnant or it stops, there's death. That's really what death is going to be. And so this whole idea that the artery brings nutrition and oxygen to our body, veins help release it, but also the lymphatics, the lymphatic system is every tissue in every cell within our body that kind of removes some of these toxins. It's also a huge part of our immune system. And so that also needs to be part of it. And it's not something that's really focused on in other aspects of medicine. But we learn a lot and study techniques to help with this.

[00:02:44] And then even the idea of nerves and innervation. So nerves, arteries, veins, lymphatics are all key. They go through every part of our body and a healthy muscle has to have a healthy nervous system. You know, it all has to go together. So the whole basis, I think, of our training is a little more anatomy and physiology in this integrated system and saying if there are restrictions to flow of any of those things, restrictions to arterial flow, you can get a stroke or a heart attack or ischemia in any part of the body. Restrictions to lymphatics and venous problems, you're going to get edema and pressure on the skin and breakdown and wounds, you know, and things can't heal when there's a lot of swelling or edema. And same things if nerves are pinched, right? We've all had experience where we've sat on a nerve for a while or in a position and we get that numbness, tingling, or we've pinched a nerve severely or had a herniated disc that's pinched a nerve. So that's restriction, restriction of that nerve impulse. So any restrictions cause a problem, and our whole focus is to anatomically release those restrictions with some of this manipulative therapy to allow things to flow as they should.

Erin Spain, MS [00:04:01] This manipulative therapy. Walk me through what it's like as a patient. When do you typically see patients that would come to you and seek out this type of therapy?

Teresa Kilgore, DO [00:04:11] Sometimes it's specifically for a problem where they're having acute injury. You know, if they had a back injury recently and they're having that kind of acute pain, then there's usually a lot of muscle spasm. And then we would use kind of soft tissue techniques, kind of gentle things, because sometimes when it hurts so bad, you don't want to move around a lot or get pulled or pushed. Sometimes we do some very gentle, tender point releases where you take that muscle that's in spasm, put it into its most short and relaxed position, and hold it just until it resets itself and gets soft again. Usually that will allow you then to do some other stretching kind of techniques. So those might be some of them. Sometimes we see acute injury like that that we can do some treatments with, other times it's chronic and then we can tell the difference. So when I touch areas, say in your back that have spasm, if it's a chronic area, it'll feel ropey and hard. It's been there a long time. It's got some fibrosis and some scarring in there because it's a recurrent problem. If it's new, it will usually feel warm and tender and what we call boggy, almost spongy, when a muscle just had an injury to it or something like that. So you can kind of feel those differences. And we treat them with, like I said, some of these soft tissue techniques, some of these what we call indirect techniques which are tender point releases. There are some other doctors with integrated medicine and some D.O.s that would perhaps use injection into some of those areas. I don't. There are techniques when sometimes people just have chronic neck or back pain. And then when you think of chiropractic alignment type treatments, we learn those as well. And then I'd say another technique is muscle energy. I tend to use that a lot, and that is where you bring the muscle that's restricted or maybe even the segments of the spine that are a little restricted because of the muscles that are tight. And we bring them to the point where it is tight and restricted, and then we use the opposite muscles to kind of bring it back and allow them to relax because, you know, we're kind of symmetric, right? And so when one muscle is stretched, the other muscle relaxes. So we try to do some of those, what we call muscle energy techniques and all of those work. And again, it's just based on how the body functions.

Erin Spain, MS [00:06:33] Now, is this typically a one time treatment or are you coming back again and again for this therapy, depending on your condition?

Teresa Kilgore, DO [00:06:42] I'm a general internist, so I see people that'll come in with high blood pressure and diabetes and hypertension, and then they may have arthritis and then they also may have this incident that happens or a chronic, longstanding kind of injury that acts up every now and again. So I would treat them with whatever technique I think could help if they're having pain right now or have had it recently, if they're simple enough techniques, I'll do the technique and then I'll show their family members this kind of stretching technique, and then they can do that at home. There are some techniques for sinuses. We do those techniques sometimes for people with chronic sinus pressure. So we can do some of those techniques. They work well with children, with eustation tubes or earache problems. So those kinds of things. I'll show the person what I'm doing and maybe their partner can do that if this is a chronic problem for them. So they would probably only come back when they had an exacerbation.

Erin Spain, MS [00:07:39] You're fairly new to MUSC Health. You have been a D.O. for as you mentioned for some time. What's it like when new patients come in and maybe they've never seen a D.O. before, they've never had this type of manipulative therapy done? What's the reaction like to your patients? What do they say to you?

Teresa Kilgore, DO [00:07:55] Sometimes I'll say I'm a D.O. and these are some techniques that I use, but other times I'll just say, well, this is what is going on, and I do have something I can do today that can help with that. It's a gentle sort of technique. And I'll tell them, you know, what it's supposed to do. And the feedback is, you know, sometimes they feel remarkably better. Sometimes it's like, oh, well, at least I got the pain from a ten down to a seven or a seven down to a four, you know? So it's like we've made some improvement. And then typically, you know, if it's an inflammatory kind of thing. So even if I've done that and it's a chronic back issue, they're still going to get on steroids if they can take those, right, the anti-inflammatory medicines.They may need a muscle relaxer for a few days just to really get out if they're tight and they've really injured a muscle like a bad strain. So they're still going to do all those same therapies on top of it. I think it's really just that we've got some additional tools to use that are both used to evaluate what's going on as well as to treat.

Erin Spain, MS [00:08:57] The word holistic comes up a lot with OMT because you do look at diet, exercise, mental health, sleep, all these different approaches when working with a patient.There is also something called lifestyle medicine that's out there now as a specialty. What's the difference? Do you think there's a lot of similarities there between lifestyle medicine and your approach?

Teresa Kilgore, DO [00:09:17] I think that, again, saying that this came back in the 1800s, this was something new and probably provocative back then. And it was interesting into the 50s and 60s. It was really almost — a lot of the D.O.s were like, no, I don't I don't want to make waves. I'm the same as an M.D. I just have a different degree. And then as we started to kind of realize how much we had to offer, and I think the key was that the rest of society was also changing. A lot of people were looking at Eastern health treatments, alternative treatments, integrative treatments, all those terms. I think everybody D.O., M.D., are much more holistic in their approach because they realize it makes sense. You're not treating one system or one organ. You're treating the whole body. Because our training has always been focused on that and the curriculum has been set to that bar, it's just something that we've done perhaps longer. But I think everybody is kind of getting on board because they realize how important it is and how much it impacts, right? So when I have a lot of external emotional stressors and my sympathetic nervous system is really jacked up, then that's affecting my breathing. You know, they'll have a lot of tightness in their thoracic spine and it'll decrease how well their diaphragm moves, so they won't take good, deep breaths. We get all tense in our shoulders, our backs and our bellies. So all of that can affect these areas. And you get chronic pain related to those as well. And so we're figuring that out. And, you know, we're kind of coming around to figuring out. We're all becoming much more integrated that way. And I think there's even all those things with, you know, meditation and mindfulness, all those things are helpful because it's body awareness. And so it makes us pay attention to what's happening in our body, particularly perhaps when we're having external stressors or even internal emotional things that we're dealing with.

Erin Spain, MS [00:11:24] People are going to be seeing more physicians with a D.O. behind their name instead of an M.D. because the field is growing. Tell me about what's happening right now in your field.

Teresa Kilgore, DO [00:11:35] I think we've really had a big expansion of the medical schools. I think one of the big things, if you recall a lot of the studies that were done, we really needed a lot of primary care physicians. We felt years ago, even a decade or two ago, they were realizing that as our population ages, preventive medicine is important. Primary care, who really does most of that was a needed area and that we might have a shortage. And so the D.O.s, because we are very preventive focused, I would still say the majority of our graduates do residencies in primary care. So that's family medicine, internal medicine, Pedes and OBGYN, as opposed to a lot of the M.D. graduates who tend to do their residencies in specialty areas. So it's just a trend. I'm not saying it's all an all or nothing, but that tends to be a trend. So we're really in areas, I think, that have been needed. And so therefore our schools have been able to grow and there have been a lot more. Now it's close to, you know, one in four figuring out that this is an alternative to medical education in America. There are plenty of schools, D.O. and M.D., for their training and they can do whatever specialty they want. We are all boarded by the same state boards for licensing. Our residencies since 2020 have all been combined. Prior to that, it was a mix, and then as of 2020, they were completely-- there's just one body that oversees the residency training, and that's all D.O.s and M.D.s together.

Erin Spain, MS [00:13:09] Well, speaking of 2020, the beginning of the COVID-19 pandemic, we were learning a lot about the body and how it reacted to COVID-19. And there were a lot of folks with multiple symptoms in their bodies after having long COVID, for example. Do you think OMT, the manipulative therapy, could be used to help some of these folks with long COVID?

Teresa Kilgore, DO [00:13:30] Yeah, so I focused some of the things we were talking about earlier on musculoskeletal complaints. But like I said, we do have techniques that help with edema and fluid movement. And the other aspect is pulmonary disease. So not just sinus things that I talked about, but we also have techniques that we do use with our chronic asthma patients, our chronic COPD patients who have exacerbations, and our patients who have chronic congestive heart failure, like if they're stable from a heart standpoint, but now they still have some breathing issues we can help with all that. Those same techniques can be used in these patients with any chronic lung illness like COVID and long COVID. There were techniques and studies that were done during the influenza pandemic in 1918, the Spanish flu. And those patients who were treated, you know, they didn't have a lot to treat, but those who did have OMT had a shorter recovery period from their illness. And a lot of those patients did go on to have what we call bronchiolitis, like abnormal airways, and produced a lot of secretions in their airways throughout their life after the damage from that. And I think that's what we're going to see, too, is that we're going to have this long term damage to their lungs and that the body can heal, but it won't ever get totally back to normal. These airways are so damaged by this virus. And so we need to make sure that the congestion in their lungs doesn't prohibit them from breathing, that they have good diaphragm movement, that their airways are open and relaxed and that their rib cage -- we have what we call rib raising. So it's kind of a technique to relax those muscles. There are tiny little muscles in between our ribs. And also our ribs attach to our spine that help open and relax. So there's normal movement and then techniques that decrease that congestion in the lungs. We call them lymphatic pump techniques for the lungs. So absolutely, they do feel better. They can breathe deeper. I think these are things that will be helpful for these patients.

Erin Spain, MS [00:15:46] If someone listening is interested in seeing you at MUSC Health or another D.O. and experiencing this type of therapy, tell me, where are you located and how can people seek out care?

Teresa Kilgore, DO [00:15:56] We're at 2001 Laurel. It's the Laurel Street Medical Pavilion at MUSC, and there are a lot more D.O.s within the MUSC system that are primary care and a lot of specialists. So what I've seen over the years in the state of South Carolina is that there are many more D.O.s who are in the residency programs at MUSC. So they may not be in the internal medicine, but they're in the subspecialty like in some of the fellowships, we call that. So after the residency training they'll do their fellowships. So we see a lot more in endocrine and GI and cardiology. So as I've met some of the other physicians and gone to some conferences, I see a lot more D.O.s and it's really great just, I think, to have that good mix that patients can see and be seen by and treated by.

Erin Spain, MS [00:16:45] What do you do to optimize your health and live well?

Teresa Kilgore, DO [00:16:48] Well, a lot of it for me is healthy eating, a little bit more plant-based. You know, I do still like to eat meat. My diet includes that. Certainly exercise on a regular basis. So, you know, I like to play tennis, so I try to do that once a week if I can, and then do walking. I get massage therapy, too. And I think just the biggest thing is this idea that we need to take time for ourselves, and we're such a hurried society that taking that time to just quiet your mind.

Erin Spain, MS [00:17:25] Thank you so much for being on the show today. We appreciate all of this insight.

Teresa Kilgore, DO [00:17:29] Great. I enjoyed it. Thank you.

Erin Spain, MS [00:17:36] For more information on this podcast, check out Advance.MUSCHealth.org