In a family practice or ER setting, OMM must be combined efficiently with the rest of the examination and treatment. Most of the time, the chief complaint and history will lead the student to a focused musculoskeletal exam in either the upper half or the lower half of the body.
Lower half of the body: screen leg length, sacrum (parasympathetics), lumbars, etc. (if time allows, think of the low back pain treatment sequence as a guide to areas that deserve evaluation in light of the patient’s complaint).
Upper half of the body: thoracics are a gold mine for a problem’s treatable (OMT) sympathetic manifestations; look for a rib dysfunction at the level of a thoracic dysfunction, too; superior thoracic aperture dysfunction (T1-2, associated ribs, sternum) affects lymphatic drainage for the whole body; Chapman’s reflexes can be quick for diagnosis and treatment; etc. Knowledge of sympathetic and parasympathetic innervations for viscera potentially related to chief complaint can guide the focus of inquiry for axial spine involvement. (E.g. If GERD is suspected, be particularly interested in thoracic segments 5 through 9 and associated rib linkage.) Choose two or three most likely locations of somatic dysfunction for evaluation in this setting. The number of areas treated will be dictated by the assessment of importance and time limits. Remember post treatment reassessment is part of any office visit.