My introduction to the world of manual therapy was not an accident. My father was a nurse/manual therapist/massage therapist without an education, who worked in a local hospital and learned the art of manipulation from his friends. He knew how to help people with pain and headaches. He really enjoyed his work. Growing up, I never thought about becoming a doctor, nor did I have any desire to practice any kind of therapy, but I was amazed at how happy it made my father to successfully treat his patients. I helped him sometimes with treatments, and he really liked that I was there with him. Whenever there was an opportunity, he took me on house calls. Very proudly, he told me that one day I would become much better than him, because I have a good hands and a good touch.
In 1990, I moved to the United States and eventually met my future wife. I shared with her my fatherís dream that someday I would become a manual therapist. We got married, and I worked in a night club. But I realized that it was not the life for me. So, I went into college to improve my English and decided to start massage therapy school.
In 1996, I had just graduated from the Chicago School of Massage Therapy, and I went on a house call to Glencoe, a nice suburb north of Chicago. My client was 50-year-old woman with a long history of severe headaches, whose daughter had given her a gift certificate for a massage for her birthday. After the massage, her headaches were much improved. In fact, she asked me to come to her house five more times in the next two weeks for massages. Her neurologist called me in about month and congratulated me the good results. In next six months, the neurologist referred many patients to me, with great results. A year later, she suggested that I learn as much as possible about upper body treatment for headaches.
During the next three years, I took as many continuing education classes as I could at the Upplager Institute (cranio-sacral therapy), the St. John Pain Relief Institute, and the McKenzie Institute. My treatments results for pain and headaches become much better, and I became very busy. But something was still missing in my practice. I saw that other providers, such as Doctors of Osteopathy, also had good results using their techniques to help pain and headache patients. I decided to go to the Osteopathic Collage of Ontario, and it changed my life. Using osteopathic manual therapy (OMT), my results with headache patients became almost uniformly successful, and my back and neck related treatments improved as well. I learned from Dr. Steve Sanet, an American-trained osteopathic physician. He told me, “You need to practice and use OMT with every patient.” I observed him doing things that I could not explain. It was obvious to me that he had his feet on the ground with regard to the fundamental science. In the blink of an eye, Dr. Sanet inspired me to practice osteopathic therapy as I do now.
After graduation, I did my internship, became even more highly motivated, and treated practically everyone from friends to patients to nurses and co-workers. The bigger the patientís problem, the more I enjoyed it. By the time I completed my internship, I already had a patient base of people who knew me and wanted me to treat and care for them. I told them, “If you have a pain, headache, or migraine, call me right away, and I will do my best to see you that day. If you are not better after treatment, I will not take your money.”
Part of my practice is older people with “chronic arthritis,” and part is younger people with “poor posture,” who are overworked, underpaid, and stressed. In my “arthritis” patients, I see back, neck, shoulder, and hip painóthings you commonly think of as being treated with manipulation. Then there are the “poor posture” types, who are usually younger, mostly women, between the ages of 20 and 60. I also see some children with headaches, a lot of patients with headaches and migraines, and middle-aged women with severe neurological painófibromyalgia, neck, lower back, and shoulder pain. People who show up at my door have often run out of other options and hope that I can help. I always tell them that if we see some improvement after a few treatments, then I will continue. Otherwise, I will not. Very often, I find it is possible to do something to improve their lives. My headache/migraine patients love me, as they almost always do better after my treatments.
I do not try to sell osteopathic manual therapy, or get into long speeches of why it should work. It isnít relevant whether my patients believe in my philosophy or principlesóitís about whether I am going to do something beneficial for them or not. If you can get results, especially when others have not, you donít have to look very far to get patients. The “headache/migraine patients” are a perfect example. Every time they see different doctor, they are diagnosed with a different type of headache. They donít fully understand what I do and call me a chiropractor. It is useless to explain the difference to them, but they pay for my results. If I help the problem, then they open their wallets, pay me, come back, and refer their family members and friends. They donít care what degrees are hanging on my wall. However, if their neck is bothering them, and I donít help it, then they are not coming back.
I did not hang my diplomas on the wall for a long time. Eventually, my children had them framed and gave them to me on my birthday. I hang anatomical charts so I can explain to my patients the anatomy of their pain. Once in a while, I get an older person who asks, “You are a doctor, arenít you?” I smile and respond, “Not as far as I know.” But I never lie and never guarantee that I will fix a problem. Instead, I ask, “Why are you here?” Most of the time, it is because they had been to many other therapists and physicians without relief. So, I say, “Then, how about you give me a chance?” Logic tinged with a little humor is the best way to overcome fear.
It is a bit difficult to practice a type of therapy that is generally unfamiliar to most of my patients; work independently; and deal with insurance issues, third parties, or lawyers. These circumstances can cause confusion to arise between me and a patient. However, patients are becoming more resourceful. They are coming in looking for someone to help them after looking at a bunch of information (both good and bad) on the Internet. In the old days, patients just went to the doctor or therapist and did whatever they saidóno questions, no arguments.
Advertising dollars drive a lot of medicine. In 2003, the National Institute of Health published a statement that 90% headaches are tension type and the other 10% are unknown. For some reason, medication is still the most common treatment of choice. But the truth is, if 90% of headaches are tension type (with a musculoskeletal basis), then a good examination by an osteopathic physician, chiropractic physician, or neuromuscular therapist should be performed before drugs are prescribed.
Medical insurance will pay for all kinds of tests, from x-rays to MRI, which drive the cost of exams to thousands of dollars. Meanwhile, a simple osteopathic, chiropractic, or neuromuscular exam may cost between $100 and $300. For example, a McKenzie physical therapy evaluation is far superior to MRI, and helps the therapist treat the patient with much success. A PT evaluation can cost $200, but an MRI in hospital can cost $4,000 and still will not tell the therapist how to treat the patient.
Working in the hospital, I saw a patient who had a simple rib dislocation after shoveling snow end up in the hospital for chest pain for two or three days, with a cost to insurance of $25,000. But the doctor never placed his hand on the patientís ribs to see if the area was sensitive to touch for possible rib dislocation. I saw a patient with a migraine headache admitted to the hospital. He had a full neurological exam, MRI, CT scan, and moreóyet nobody asked if he had a history of any kind of headaches, jaw problem, or neck pain. I saw another patient who had seen a doctor for years and complained about headaches getting stronger and stronger. The doctor never asked if the patient was sleeping on his stomach (which can cause severe stress on the neck)óbut every time the patient came back for a doctor visit, the doctor increased his pain medication. Around 50% of my patients complain about headaches/migraine. Almost all of them are on antidepressant medication, and have to see the doctor every three months. These patients are receiving very little hands-on evaluation or help. A caring physician should know if pain is mechanical in nature or if headaches have a neuromuscular base. Medication should not be the only treatment.
When I was working with group of doctors, I treated a lot of the doctors, using osteopathic manual therapy for every one of them. During the course of treatment, I became friendly with many of them. Some of them would joke that manipulation was “real” medicine. I also treated many of their wives, children, friends, and patientsóbut some of them never referred any of their patients. One day, one of them came in all bent over, unable to stand up straight, and asked me to take a look at his back. I laid him down on the table and proceeded to fix him. I asked him to avoid certain movements, especially tennis, his favorite sport. He called me the next day and told me that he had played his best game ever. Doctors are the worse patients.
When a therapist who have never incorporated osteopathic manual therapy into their practice asks me to teach them techniques, I always start with the simplest ones. My mantra is, “Less is more.” If a therapist uses the techniques and gets positive results, it is a revelation, and they will use them again. But if I show them something complicated, they may become unsure and probably will not try it. Or if they get a bad result, they probably will never do manual therapy again. The danger with that is they may become either anti-OMT, or indifferent to it. There is a deep bond established with a patient through your hands. If you are a doctor or therapist who listens, and who puts your hands on a troubled patient, you have done a great thing for them.
I had a patient come to me, referred by a physician, who had stage 4 lung cancer. He said he had a few months left to live, so I asked him why he was coming to me. He said, “I have a pain in my mid-back, and postnasal drip that is keeping me awake at night.” I asked myself, “Why are we trying to do anything? In a few months, he will be dead.” But he wanted to enjoy his final few months. I treated him, and at a follow-up visit, he said that his postnasal drip was better and his mid back had pain decreased. He thanked me and left. All I did was work on his neck, to take some pressure off his sinus area. His cough improved, and with it, his back felt less stressed.
Around the world, osteopathy is huge and uses a non-medical modelóno prescribing, no surgeries. People who go to an osteopath know that they going to get manipulated. The whole world touches except in the Western world. Unfortunately, in the United States, doctors donít feel comfortable with a hands-on approach.
I think that most physicians are caring, and they do the type of evaluations that they were taught in school. I understand the need to teach medical students everything, as they must thoroughly understand the science to avoid doing something wrong. But there is also the need to bring it all back into perspective. If they become a family physician, there will be a waiting room full of patients, and maybe the best they can do is a bit of hands-on treatment.
My message to every physician is simple: No matter what your specialty, find a few minutes to put your hands on your patients and try some simple techniques. You will find that touching translates to care. It is not a placebo, it tells the patient that you really care about them. The funny thing is that once you do treat a patient, you start to care about them and become vested in their care. It will translate to personal and professional success and satisfaction.
Michael Pys NMT, Dipl. OMT
Hands-On Solutions to Headaches and Pain
2150 Pfingsten Rd. Suite 2200
Glenview IL 60025