Dr. Boggess (Medical Director)
Dr. Tony Boggess is a Physical Medicine and Rehabilitation (PM&R) physician, speaker, and writer who specializes in Nutritional and... read more
Physical Medicine Approaches
Osteopathic & Cranial
What is a Doctor of Osteopathy (DO)? A DO is a fully licensed physician and surgeon in the US, who completed 4 years of college, 4 years of medical school, and 4 or more years of postgraduate specialty training. We are similar yet distinct from our allopathic (MD) colleagues in that we also learn osteopathic principals and practice which is a “whole-person” system of evaluation and treatment designed to achieve and maintain health using manual modalities similar to, but distinctly different, from chiropractic, massage, and physical/occupational therapy.
Osteopathy (theory) maintains that much illness, pain and disability stems from an improper relationship between structure and function. Thus, DOs use Osteopathic Manual Medicine (OMM), a soft manual therapy to align the musculo-skeletal system correctly in order to reduce tension and improve physical and physiological functions. DOs learn that organ systems and bodily tissues, which rely on the musculo-skeletal frame for support, benefit from such treatment and the circulatory, lymphatic and other fluid systems associated with the body’s innate healing mechanisms function more efficiently after one or more treatments.
Cranial Osteopaths, are Doctors of Osteopathy (DOs) who, in addition to osteopathic manipulation, specialize in cranial manipulation. A set of highly regarded sub-techniques of osteopathic medicine referred to as Osteopathy in the Cranial Field (OCF), to be distinguished from “cranial-sacral healing” and various other techniques practiced by physical and massage therapists.
OCF (theory) maintain that subtle, coordinated, rhythmic movements of fluids and tissues related to micro movements in skull joints (or sutures) provide osteopathic access to diagnose and treat dysfunctions not only in and around the brain and spinal cord as they relate to the local dysfunction, but also throughout the entire body as they relate to the whole person. DOs that practice this form of manipulation have a highly refined sense of touch used to identify subtle disturbances as well as a gentle, yet verifiable way of balancing and correcting them. While OCF can treat any number of ailments, it is clearly helpful for dizziness, headaches, untoward effects of difficult deliveries on babies and children as well as any musculo-skeletal anomaly for which other osteopathic techniques are appropriate.
Cranial Rhythmic Impulse (CRI): The cranio-sacral system is considered the generator for Cranial Rhythmic Impulse, which along with the cardiovascular and respiratory impulses, is one of three life-maintaining impulses of the human body. The components that make up this system include the fine membranes that cover the brain and spinal cord, 22 skull bones divided into midline and paired bones, the sacrum (tail bone), and the cerebrospinal fluid (clear fluid derived from blood) that circulates around and bathes the brain and nervous system. Also via its subtle connections, its influence extends to the entire body via fascia or layers of connective tissue that encloses organs, nerves and muscles. Together, these structures pulsate in rhythmic fashion and where imbalance is detected in the CRI, there is strain in the system. Thus, OCF is used to both diagnose and treat patients.
The safe practice of this form of manipulation requires rigorous study in applied anatomy, physiology, embryology and pathology. Though the techniques seem simple enough, post-treatment reactions that speak to their profound effect on patients such as nausea, vomiting, headaches and outburst of crying do occur. Osteopathic medical schools require their students to understand only the basics of OCF, so most physicians who specialize in these techniques have hundreds of additional hours of study. While many non-medical persons claim adeptness in cranial-sacral manipulation, choosing one trained in the entire scope of medicine (DOs, MDs, and DMDs) is advantageous because extensive medical background is needed to apply these techniques comprehensively and safely.
In essence, we intervene, and then allow the body to heal itself—like watering dry grass, we add water in intervals and let nature do the rest. Because not all osteopathic physicians stick to their roots in manual medicine, one should inquire if OMM is part of any given osteopathic physician’s skill set.
OMM remains a significant part of my daily work with children and adult patients.
According to the National Institute of Health, there are currently more than 12 million adults in the U.S. that have, or are currently using acupuncture. Thousands of scientific studies have validated its effectiveness, and acupuncture is fast becoming one of the most sought after approaches by patients seeking alternative approaches to pain, mood, and many other functional conditions (see list below).
Acupuncture stems from Chinese medical philosophies dating back at least 3000 years. The modality involves inserting one or more hair-thin needles into the skin at specific points along energy channels or meridians that carry “life energy” or qi (chi). By placing needles in prescribed points, the practitioner seeks to accentuate or diffuse qi and thereby restores balance to the system. Likewise, the manner in which qi flows undisturbed through the body marks health and vitality, and any obstruction to its flow is linked to present or future “dis-ease.”
Medical Acupuncturists, are licensed physicians (MD or DO) who acquired additional training and certification in evidence-based acupuncture and Traditional Chinese Medicine (TCM). In addition to using traditional medicine, our understanding of the Chinese Medicine paradigm allows us to prescribe herbs and recommend diet and lifestyle changes in a safe and comprehensive way. In addition, as a PM&R physician I frequently place needles at key neuroanatomical trouble points. It is my conventional medical background in neuroanatomy and physiology in this case that allows me to understand how needle insertion stimulates nerves to produce neurotransmitters that positively impact hormones, pain signaling, circulation, and overall well-being in a variety of ways.
In the last 25 years, acupuncture and Chinese medicine has gained wider acceptance by conventional medicine due to growing research proving its efficacy in problems such as pain, mood disorders, addictions, fatigue syndromes, hormonal and menstrual problems, digestive disorders, migraine and stress related headaches, skin diseases, allergies, and many other conditions. Thus, some insurance companies will reimburse for it when prescribed and/or performed by a licensed physician.
Frequently asked Questions:
Is Acupuncture Painful?
Acupuncture needles do not cause pain like getting an injection or taking blood. Acupuncture needles are very fine and flexible, measuring about the diameter of a thick hair. While many patients experience needling differently, most report a slight non-painful sensation at the time of insertion. Some feel nothing whatsoever. Rarely there may be slight soreness at the site of needle insertion, which usually goes away in minutes.
Is Acupuncture Safe?
Our office uses single-use, sterile packaged acupuncture needles. While there is theoretical risk of infection anytime skin is punctured, I have never observed it as such. In fact, one of the great perks of acupuncture is its relative lack of side effects compared to conventional medications and modalities.
What Should I Expect During Treatments?
Most people receive acupuncture either lying on their back. Lights are dimmed and sometimes I’ll instruct patients to perform conscious breathing exercises during the waiting period while needles are “working.” I may use electrical stimulation, which adds additional benefits. Sometimes you may go home with gold or platinum stay-in needles in the ears, which fall out on their own in 3-5 days. Otherwise, I will guide you to relax and teach you how to receive maximum benefit from acupuncture by giving appropriate instruction both during and after treatments.
How Many Treatments Will I Need?
Each patient is unique as is the number and frequency of treatments required. As a rule a treatment plan may require 3-5 weekly visits before results are evaluated. Some symptoms are relieved after the first treatment. Otherwise, Frequency, duration and number of treatments are dependent on the character and severity of the illness. Chronic conditions usually take more visits. Acute ones take fewer. And everyone can benefit from an occasional preventative treatment.
Will Insurance Pay For Acupuncture?
Fortunately some insurance companies pay for acupuncture when performed or prescribed by a licensed physician (MD or DO). However, it is ultimately up to each patient to know the details of their insurance coverage. Following your initial consultation, you will be given the appropriate diagnosis and procedure codes which will assist you when calling your insurance company. If we participate with your insurance, we are happy to bill for our services, but we do not pre-certify or argue denials, and patients are ultimately responsible for paying for services rendered after 60 days of non-payment by insurance.
What Are Non-Insurance Fees For Acupuncture?
If we do not participate with your insurance, or you do not have acupuncture coverage, you can elect to have acupuncture Fee-For-Service.
Our Fee Schedule:
Needle Acupuncture with Electrical Stimulation – $85
Needle Acupuncture without Electrical Stimulation -$75
Non-invasive Acupuncture/ ETPS (for children) – $25 to $65
Auricular/Ear Acupuncture (stay in needles) – $35
Acupuncture Allergy Treatments – $65
As always, feel free to contact us with any additional questions you may have.
The most interesting aspect of FSM, in my opinion, is that it hails as the “homeopathy of electrical stimulation.” While the subtle healing aspects of the modality remain to be fully elucidated, the approach is clearly beneficial and well regarded among many professional sports teams for its ability to selectively heal tissues and physical conditions. It stands as one of the most promising and interesting physical medicine adjuncts we use in our office. We recommend it to patients after minor accidents as a preventative measure and for all musculoskeletal/pain conditions in general. However, we also know it does much more in the way of stimulating healing on many levels. Nevertheless, it is FDA approved for the same conditions as all electrical stimulation (TENS) devices, and its more subtle healing effects remain undefined (at least for now.)
What is Microcurrent?
A faint (almost homeopathic) electric impulse measured in millionths of an amp. By comparison a typical stimulator device (i.e. TENS unit) produce in the milliamps, which is a 1000 times greater. Live cells and tissues generate a current in the microamp range, so it stands to reason there is value in using electrical stimulation devices that deliver closer to this subtle range. While you may not feel the impulse, its effects are profound. Why?
“Living matter is highly organized and exceedingly sensitive to information conveyed by coherent signals…”
“Each cell, tissue and organ has an ideal resonant frequency that coordinates its activities.”
-James Oschman, PhD Dover, NH
Microcurrent therapy is safe and has been in use for over a century and was quite popular before drugs and surgery became the standard of medical care in the United States.
(Read this provocative letter to Dr. Merk, early founder of the American Medical Association, and owner of his own drug company, to understand why these technologies were essentially lost to medical education.)
How does Microcurrent help?
“Microcurrent increases the production of ATP, your own chemical energy, by up to 500%. It also increases protein synthesis and waste product removal.” -Cheng, 1987
As a physiologic modality that increases ATP (energy) production within the cells and tissues, FSM can impact any given tissue’s healing rate. The almost immediate response to the correct microcurrent such as let down of muscle tension and myofascia holding patterns in seconds; scars softening; trigger points desensitizing; swelling reduced, suggest mechanism involving the immune and nervous system are also at play. In many situations changes seen with patients with just a few weeks of treatment and are profound and long lasting and often permanent.
Why Frequency Specific?
Specific frequencies seem to induce specific effects on cells and other tissues that resonate with those frequencies. For example there is a specific frequency for nerves, a different frequency for muscles, another for tendons, etc. The “frequency specific” aspect of treatment is as important as the microcurrent itself. Thereby impacting positively cells, muscles, tendons, and nearly every tissue in your body depending on the settings. In addition to each tissue having its own unique frequency, there are specific frequency for tissue conditions such as inflammation, scars, loose connective tissue, et cetera. The automated units we use in the office and for home rentals, run through any number of custom tailored programs automatically. Animal research confirms that the frequency to reduce inflammation reduces inflammation by 62% in a mouse model. Prescription drugs reduce inflammation by 45% in the same mouse model by comparison. .
How do “specific frequencies” help?
It is hypothesized the frequencies work via biologic resonance. A high pitch sound can shatter a glass when it resonates with its crystalline structure. Microcurrent frequencies seem to be able to resonate with biologic tissue when chosen correctly. Once the tissue is “re-set” it seems to stay in its healthy configuration, baring no new insults, with basic nutritional support, et cetera.
Any known side effects or risks?
There is no record of any permanent harm caused by Frequency Specific Microcurrent, though adjustment and healing reaction may occur due to tissue and blood flow changes and the related release of long stored waste and metabolic products. Some people have similar reaction after a massage but the reaction after microcurrent tends to be stronger. Post reactions, which are actually a good thing, may include nausea, fatigue, drowsiness, or a temporary increase in pain or a flu-like feeling. This can start approximately 90 minutes after treatment and may last from 4 to 24 hours, mitigated by intensive hydration protocols which we will instruct you on. While reaction can occur, not everyone has them, and they have no real bearing on the efficacy of your treatment in general.
FSM is rarely used across the brain, in the presence of pacemakers, or during pregnancy. (Just in case.)
Of course, an important consideration is the misuse of microcurrent for a condition more appropriately addressed by a different method (i.e. misdiagnosed cancer, anatomical anomaly, et cetera). That is why it is a good idea to see a licensed doctor, and more importantly one proficient in anatomy and physical medicine.
Feel free to contact our office if you have any questions.