TERRANCE MANNING II, ND, RMSK
SAMUEL G. OLTMAN, ND
Whether one is a primary-care naturopathic physician in a state with a limited scope or a long-time naturopathic prolotherapist practicing in a state with a broad scope, there is a need within health care for a specialty society regarding diagnosis and treatment of musculoskeletal complaints. In order to fill this need and serve our profession, a group of naturopathic physicians practicing in this field from various jurisdictions have established the Naturopathic Orthopedic Medicine Academy (NOMA) as a non-profit naturopathic specialty society. This group aims to serve our profession by informing our providers with updates in diagnosis and treatment of musculoskeletal dysfunction, outlining standards and guidelines for interventions, and providing training opportunities to comply with state board requirements.
A Natural Fit
As a general category, musculoskeletal pain and dysfunction is one of the most common problems encountered at the primary care level. Perennially, joint pain/arthritis and low back pain are among the top 5 chief complaints seen clinically.1
As naturopathic physicians, we are well equipped to help these patients. The 6 principles of naturopathic medicine provide an excellent framework to address all of the various levels through which pain can manifest. Our modalities bolster this philosophical approach and demonstrate excellent efficacy, including dietary/lifestyle changes, botanical medicine, physical medicine, energy/spiritual healing, and many more. When other more conservative measures fail and we move up the Therapeutic Order, various forms of injection therapies are powerful tools.
Whether applied systemically (intravenous therapies with vitamins and minerals) and/or locally (prolotherapy) to treat a patient’s musculoskeletal dysfunction and pain, these therapies are more complex and require post-graduate training and continuing education. Injection therapies (prolotherapy, platelet-rich plasma, adipose tissue, bone marrow aspirate, nerve hydrodissection, neuroprolotherapy, etc), when employed safely, ethically, and from an appropriately trained practitioner, can provide profound pain relief and durable healing for patients. Regenerative injection therapies are specifically a naturopathic therapy (vis medicatrix naturae), as they work with our body’s natural physiology to improve tissue health, relieve pain, and increase function.
A Place to Congregate
The primary goals of NOMA are as follows: to bring together and collate the existing body of knowledge and expertise within our profession through a combination of in-person events and published case studies; and to train and educate both new and experienced physicians in the art and science of prolotherapy and its family of orthopedic injection modalities.
Much like our colleagues in various other specialty groups (oncology, pediatrics, gastroenterology, etc), orthopedic and musculoskeletal medicine practitioners need a place to congregate for in-depth specialty knowledge. The role of a collegial community where members are continually learning and elevating their own practice is crucial for the profession and good for patients. NOMA will be the meeting place for anyone wanting to increase their knowledge and/or refine their skills in orthopedic medicine. While this will be largely in the context of injection therapies, due to the higher risk and technical nature of the procedures, it will not exclusively be an injection organization and there will be space for all modalities that provide pain relief in accordance with our principles. Members will benefit from access to collective knowledge, video tutorials, a national directory, and exclusive specialty workshop offerings.
Workshops & Residency Development
Currently, there is no standard training available for naturopathic physicians to clearly demonstrate safety and competency when delivering orthopedic injections. There are very few naturopathic physicians who have completed multi-year residencies specifically focused in this field, and availability of these residency opportunities are few and far between and vary year to year if offered. For these reasons, naturopathic physicians have relied on direct mentorship, conferences taught by conventional medicine specialty societies (eg, American Association of Orthopedic Medicine, Hackett Hemwall Patterson Foundation, etc), and/or sales representatives offering device/technique training. Unfortunately, the mentorship method lacks uniformity, the conferences do not provide sufficient hands-on training or direct certification, and trainings offered by sales representatives have inherent conflicts of interest and are not standardized. Due to our state-by-state licensure differences, understanding of scope of practice and setting a national professional standard is admittedly difficult and is often cited as the reason why established conventional organizations do not certify naturopathic physicians.
NOMA aims to remedy this by offering top-quality, in-person, hand-on training workshops for all skill and experience levels that abide by consensus guidelines for safety and efficacy. While there may be multiple right ways to deliver injection therapies, there are certainly wrong ways, and the future of our profession within the injection therapy specialty relies on all naturopathic physicians continually elevating their level of competency. Like our profession in general, we are continually under attack from actors who would revoke our scope given the chance, and the more we are able to demonstrate high levels of skill and training, the better we will be able to preserve our place within the field. We have the depth of expertise and individual skill to be the leaders in the field of prolotherapy and regenerative injection therapy. NOMA aims to bring it all together and propagate the highest level of care through training, education, and residency development.
We are currently enrolling for membership and for our first workshop, “Prolotherapy of the Lower Extremity,” on October 22-24, 2021. To join our email list, learn more about who is a part of NOMA, our workshop offerings, and why you should join us, visit www.nomacademy.org.
Reference
St Sauver JL, Warner DO, Yawn BP, et al. Why patients visit their doctors: assessing the most prevalent conditions in a defined American population. Mayo Clin Proc. 2013;88(1):56-67.
