FAQs

DOs/Osteopathic Medicine/Osteopathy and Cranial Osteopathy

What is a DO? Is a DO a “real doctor”? What’s the difference between a DO and an MD?
What is osteopathic manipulative medicine?

What is cranial osteopathy?

What conditions can osteopathic manipulative medicine treat?

Is osteopathic manipulative medicine the same as chiropractic? physical therapy? massage?

What’s the difference between a DO and a chiropractor (DC)?

Are cranial osteopathy and craniosacral therapy the same?

What’s the difference between a DO and a craniosacral therapist?

Dr. Lytle-Vieira is board certified in osteopathic manipulative medicine/neuromusculoskeletal medicine. What does that mean?

Treatment/Appointments

Will I see Dr. Lytle-Vieira or an assistant for my appointment?
Do you treat infants? Children? Elderly? Pregnant women?

How long does my appointment last?

What will happen during my appointment?

How many treatments will I need to get better?

How many times a week will I need treatment?

Can Dr. Lytle-Vieira prescribe medication? order blood tests? order x rays/MRIs, etc?

What services does Dr. Lytle-Vieira provide?

Does Dr. Lytle-Vieira participate with insurance?

Can Dr. Lytle-Vieira be my/my child’s primary care doctor?

What if I need to cancel my appointment or forget my appointment?

DOs/Osteopathic Medicine/Osteopathy and Cranial Osteopathy

What is a DO?  Is a DO a “real doctor”? What’s the difference between a DO and an MD?

Yes, a DO is a “real doctor”. A DO is a medical doctor, just like an MD. The DO and MD degrees are legal and professional equivalents.

There are only two types of fully licensed physicians in the United States—DOs and MDs. Both DOs (osteopathic physicians) and MDs (allopathic physicians) are complete physicians, with a full and unrestricted license for the unlimited scope and practice of medicine and surgery.

Some notable DOs are listed here.

The medical school and residency training of DOs and MDs is identical, with one notable difference. In addition to the standard medical school curriculum, DOs receive several hundred hours of training in hands-on manual medicine (called osteopathic manipulative medicine) and the body’s musculoskeletal system (bones, ligaments, connective tissues, muscles, joints).  DOs are taught how the musculoskeletal system and nervous system influences every other body system. MDs do not receive this hands-on manual medicine training.

For more information about DOs and their training, click here. For more information about osteopathic manipulative medicine (osteopathy) click here.

For more information about DOs versus MDs, click here.

What is osteopathic manipulative medicine?

Osteopathic manipulative medicine (OMM) is a hands-on whole body medical treatment that eliminates or reduces chronic pain and a wide variety of medical problems by treating the distorted anatomy and physiology that lead to illness.

Osteopathic medicine is the clinical application of the understanding of how the human body is built and how it functions as one unit of inter-related structure and function. For example, a physician specializing in OMM understands how a patient’s symptom of neck pain might be due to a problem in the neck, but also how other body structures could be playing a role as well. Neck pain might actually be caused by a problem in the shoulder, or the ribs or diaphragm (breathing muscle in the chest). Until you treat the real cause, you can treat the neck for years and never solve the problem (and never get relief for the patient).

For more information about osteopathic manipulative medicine click here.

What is cranial osteopathy?

Cranial osteopathy (also known as craniosacral treatment or osteopathy in the cranial field—OCF) is the clinical application of the osteopathic approach (anatomy, physiology, embryology, pathophysiology, and osteopathic philosophy) as they relate to the cranium (head) and sacrum (tailbone) and their relationship with the entire human body. Strains and dysfunctions can occur within the cranium and pelvis/sacral area just as they can anywhere else in the body, and can have far reaching negative effects on the whole body because the body is intimately connected anatomically.

The cranial concept was first described by William Garner Sutherland, DO, a student of AT Still, MD, the founder of osteopathic medicine.

Osteopathy, including cranial osteopathy, is part of the practice of medicine and requires formal medical training (either DO or MD) and a high degree of skill. Cranial osteopathy is primarily learned by apprenticeship, with teacher and student working one-on-one with patients in a clinical setting.

Cranial osteopathy can be enormously beneficial in treating a wide variety of medical conditions, including musculoskeletal/orthopedic, respiratory, obstetric and gynecologic, rheumatologic, neurological, digestive, and many problems in infants and children. For more specifics, see the next question below.

What conditions can osteopathic manipulative medicine treat?

Osteopathy is helpful for a wide variety of medical conditions, but below are some examples.

General: improved joint flexibility, decreased muscle spasms/cramping, improved circulation, and easier recovery from pregnancy, trauma/surgery, sports injuries

Musculoskeletal/Orthopedic Problems: joint pain (low back/neck/knee/shoulder/hip/foot/wrist, etc), sports injuries, fibromyalgia, frozen shoulder, scoliosis, herniated discs/sciatica, headaches (including migraines), torticollis

Respiratory Problems: asthma, allergies, sinus problems

Ob/Gyn (obstetric and gynecologic) Problems: painful periods, pelvic pain, groin pain, joint pain (low back, hip, neck, upper/mid back, etc) pain of pregnancy, heartburn in pregnancy, morning sickness in pregnancy

Rheumatologic Problems: fibromyalgia, arthritis (including rheumatoid)

Neurological Problems: herniated discs/sciatica, carpal tunnel syndrome, migraines/headaches, Parkinson’s, tinnitus, vertigo

Digestive (Gastrointestinal) Problems: GERD (acid reflux disease), IBS (irritable bowel syndrome), chronic constipation, chronic diarrhea

In infants and children: chronic ear infections, allergies, colic, feeding problems, sleeping problems, constipation, learning problems, walking problems, “sensory integration” problems, plagiocephaly, scoliosis, torticollis, Down’s syndrome

Is osteopathic manipulative medicine the same as chiropractic? physical therapy? massage?

No.  Osteopathic treatment is very different from these other “hands on” modalities. Osteopathic manipulative medicine is a specialty within the practice of medicine and therefore requires a formal medical education that leads to a license for the practice of the unlimited and complete scope of medicine and surgery (DO or MD).

“Osteopathy is about taking care of sick people, not cracking a bunch of bones”– James Jealous, D.O.

Osteopathic training involves an understanding of the integrated nature (structure and function) of the WHOLE human body, including the cranium. For example, understanding the influence of the shoulder girdle on the neck, or the influence of the respiratory (thoracic) diaphragm on the hips through the psoas muscle. These are uniquely osteopathic concepts and principles.

The goal of osteopathic treatment is not defined by biomechanical “alignment” or “symmetry”, nor is it about following a standardized protocol or stroking sore muscles. The goal of an osteopathic treatment is to assist the normal functioning of all body parts and systems.

For more information about osteopathic manipulative medicine, click here.

What’s the difference between a DO and a chiropractor (DC)?

“Osteopathy is about taking care of sick people, not cracking a bunch of bones”– James Jealous, D.O.

The differences between a DO and a chiropractor are significant. The biggest differences are the level of training, scope of practice, and treatment approach and philosophy.

A DO is a fully licensed medical doctor, licensed to practice the unlimited and complete scope of medicine and surgery. In contrast, DC’s are not licensed medical doctors and are not licensed to practice the full spectrum of medicine and surgery.

DOs specializing in osteopathic manipulation integrate conventional medical diagnosis and treatment with their osteopathic diagnostic and treatment skills, providing a 360 degree approach to diagnosing and treating each patient.

DOs specializing in osteopathy are trained to solve medical puzzles using osteopathic principles and practice. They are trained to understand anatomical relationships (for example how a problem with the twelfth rib could affect the thoracic (respiratory) diaphragm and influence asthmatic symptoms.  DOs are trained to feel how the entire patient is functioning physiologically.

A chiropractor has not completed residency training or board certification in a medical specialty and has not been trained in osteopathic principles and philosophy. The California Board of Chiropractic Examiners states that “a duly licensed chiropractor may manipulate the spinal column and other joints of the human body and in the process thereof a chiropractor may manipulate the muscle and connective tissue related thereto”.

For more information about DOs versus DCs, click here.

Are cranial osteopathy and craniosacral therapy the same?

No.

Craniosacral therapy (CST) was trademarked by John Upledger, D.O. in the 1980’s to teach lay people osteopathic concepts and techniques. While CST is based on cranial osteopathy as developed by William Garner Sutherland, D.O., Upledger developed his own approaches and techniques to create protocols that would be safe for non-physicians to perform. While these simplified techniques are intended to be safe, craniosacral therapists are not trained or licensed to make medical diagnoses, formulate treatment plans for patients, or to adjust and develop their approaches in response to the unique needs of each patient. While some CST practitioners may be highly skilled, it is advisable to seek out a licensed physician specializing in cranial osteopathy whenever possible.

Craniosacral therapy is a “gentle soft touch therapy” requiring no medical training. Practitioners can practice with as little as one four day course.

For more information on cranial osteopathy versus craniosacral therapy, click here.

What’s the difference between a DO and a craniosacral therapist?

The difference is significant. The most important differences are the level of training, scope of practice, and treatment approach and philosophy.

A DO specializing in osteopathy works very accurately and precisely on complex levels of the patient’s nervous system, anatomy, physiology, and development–integrating the WHOLE of the patient. A complete medical education  and training in osteopathic principles is necessary for this 360 degree approach and is simply not available to craniosacral therapists, who are not medical doctors and therefore are not trained to take a medical history, do a physical exam,  or reach a diagnosis and individualized treatment plan for each patient.

Physicians specializing in osteopathy spend thousands of hours in training to be able to practice this unique form of medicine. Osteopathy is a lifelong learning apprenticeship with the human body in the context of a medical practice. It is not something you can learn in a weekend or even a few years.

In contrast, craniosacral therapy is a “gentle soft touch therapy” requiring no medical training. Practitioners can practice with as little as one four day course.

For more information on this topic, please click here.

Dr. Lytle-Vieira is board certified in osteopathic manipulative medicine/neuromusculoskeletal medicine. What does that mean?

Having a DO or MD degree does not mean that physician is qualified to practice in a specific medical specialty, for example: radiology, pediatrics, dermatology. Board certification is a voluntary process whereby a DO or MD takes written, practical, and oral examinations to demonstrate expertise in a particular medical specialty.  Upon successful completion of these exams, the physician has shown their competency in that particular area and is then called “board certified”. In the United States, board certification is considered the “gold standard”, showing the highest level of competency/credentials in a particular medical specialty.

Treatment/Appointments

Will I see Dr. Lytle-Vieira or an assistant for my appointment?

100% of your visit will be spent one on one with Dr. Lytle-Vieira. Only one patient is in the office at a time. We do not double book appointments.

Do you treat infants? Children? Elderly? Pregnant women?

Yes. Dr. Lytle-Vieira treats patients of all ages and diagnoses, including newborn infants, children, pregnant women, elderly, and everything in between!

How long does my appointment last?

The first appointment lasts approximately 60 minutes for adults, infants, and children. Follow up visits last approximately 30 minutes for adults, infants, and children.

This is all one on one time with Dr. Lytle-Vieira.

What will happen during my appointment?

After reviewing your medical history with you, Dr. Lytle-Vieira will perform a traditional medical physical exam, followed by hands on osteopathic examination and treatment. You will lay fully clothed on the treatment table while the doctor feels different parts of your body. This may include any body region, including but not limited to your head, neck, chest, back, pelvis and legs/arms.

Dr. Lytle-Vieira will gently and precisely use her hands to work with your body to resolve areas of strain and dysfunction and encourage normal body function.  Treatment is generally very relaxing– in fact it is not uncommon for patients to fall asleep.

Various treatment approaches are used, including myofascial, muscle energy, counterstrain, balanced ligamentous/membranous tension, lymphatic, and cranial osteopathy.

How many treatments will I need to get better?

There is no hard and fast rule because each patient’s response to treatment is unique, but many issues can be resolved or significantly improved in one to three visits.  Generally, more severe, chronic/long standing issues require more visits than acute/mild issues.

How many times a week will I need treatment?

Dr. Lytle-Vieira’s goal is to help her patients get so well that they rarely (if ever) need to see her. She rarely treats patients weekly.

In general, patients are seen more frequently when first beginning treatment and as their body heals, fewer visits are needed. For example, a new patient that is 50% improved after 2 visits might return in 4-6 weeks if needed.

Frequency of treatment is always based on the patient’s needs and unique response to treatment coupled with the evolving diagnostic information gleaned during examination and treatment.

Dr. Lytle-Vieira recommends that patients return a few times a year for health maintenance (“tune up”), or sooner if they have dental work, get pregnant, or have trauma such as a car accident, fall, or surgery.

Can Dr. Lytle-Vieira prescribe medication? order blood test? order x rays/MRIs, etc?

Yes. As a licensed medical doctor, Dr. Lytle-Vieira can prescribe any medication, or order blood tests or any radiologic imaging. However, she rarely prescribes medication and is judicious in ordering tests that expose patients to unnecessary radiation. Dr. Lytle-Vieira feels that using drugs is phenomenally counterproductive when the real problem is a dysfunction within the anatomy/biomechanics and physiology/function of the body system. Drugs are also expensive and cause side effects.

What services does Dr. Lytle-Vieira provide?

In addition to osteopathic manipulation, Dr. Lytle-Vieira can offer assistance in important lifestyle components such as using Food As Medicine/nutrition, sleep, breathing exercise, movement, and mind/body medicine.

Does Dr. Lytle-Vieira participate with insurance? What about Medicare?

Yes, but only certain insurance plans. Dr. Lytle-Vieira is currently an in-network provider for some Blue Shield of California plans and some Anthem Blue Cross plans. Prior to scheduling an appointment, patients with Blue Shield or Anthem insurance must verify with their insurance plan that Dr. Lytle-Vieira is in-network for their specific insurance plan.

Dr. Lytle-Vieira does not accept Medicare. (Dr. Lytle-Vieira has opted out of Medicare). All patients with Medicare wishing to see Dr. Lytle-Vieira pay her fee in full at the time of each visit. This fee is 100% out of pocket, and is not reimburseable by Medicare. All Medicare patients must also sign the ABN (Advanced Beneficiary Notice) found on our website under “patient forms”, which states the patient understands they are entering into a private contract with Dr. Lytle-Vieira that is outside the Medicare system.

For those patients with insurance plans that the doctor is not contracted with, payment is required in full at the time of each visit. These patients (except Medicare patients) will receive  a “superbill”  at the end of each visit to submit to their insurance for reimbursement. Reimbursement varies from 0- 100%, depending on your insurance plan.

Will Dr. Lytle-Vieira be my/my child’s primary care doctor?

No. While Dr. Lytle-Vieira is a complete physician, licensed to practice the full spectrum of medicine in the state of California, her practice is a specialty practice devoted to consultation for osteopathic manipulative treatment.  As she is a specialist, not a primary care provider, her practice does not include the primary management of medical conditions of a chronic nature, routine blood work, “screening”/checkups, or prescription or supervision of long term chronic medications. Dr. Lytle-Vieira is not on call and does not admit patients to the hospital. She strongly recommends that you have a primary care physician/pediatrician for your/your child’s routine medical care and/or long term medication/healthcare needs.

What if I need to cancel my appointment or I forget my appointment?

Due to the nature of her practice, the doctor requires 24 hours notice for appointment cancellations. Full payment is due for any cancellation not made at least 24 hours in advance.

The doctor sets aside a significant amount of time for each patient visit. We ask for your cooperation in keeping your scheduled appointments.