Home » How to Study for OMM (Osteopathic Manipulative Medicine) Questions

How to Study for OMM (Osteopathic Manipulative Medicine) Questions

An osteopathic medical school student studying for OMM questions in front of a laptop.


Osteopathic practice, principles, and manipulative medicine is a large part of each COMLEX exam and one of the major differences between Step and COMLEX exams. A common struggle for students is figuring out how to effectively study the high-yield topics of OMM. For COMLEX Level 1-3, OMM or OMT questions comprise a minimum of ~11%. That equates to roughly 30-50 questions per exam which can be easy points if you study right.



When to Start Studying OMM Questions


In an ideal world, you would be able to review OMM topics each week to help with spaced repetition and avoid cramming. See our COMLEX Level 2 study plan for an example of this. However, it is common for OMM to be left on the back burner until other questions in the question bank are complete.


At the very minimum, I recommend at least a week to review high-yield OMM topics. This includes finishing up question bank OMM questions, reviewing treatment modalities, and memorizing Chapmans points, counterstain positions, and sympathetic levels.


Many students choose to take COMLEX after Step to have a couple days to cram in OMM. If you are trying to decide which test to take first take a look at this blog post: Should You Take COMLEX or Step First?



How to Study for the OMM Section in COMLEX Exams


There are an endless number of resources to utilize for OMM. Unfortunately, each resource tends to have slightly different information which can make studying frustrating. Popular resources to use include: OMT Review aka “The Green Book” by Dr. Savarese, Online MedEd (OME), and OMG-OMT. Try to explore different resources early on and then when dedicated comes choose 1 or 2 resources so you don’t overwhelm yourself.


Like any topic for board exams practice makes perfect! Although UWorld is a popular choice for doing practice questions, incorporating a “D.O. question bank” such as ComQuest or TruLearn can get you familiar to COMLEX-style questions and practice OMM questions. The NBOME also has practice OMM questions under the OMT Comat section. These are a must before test day as the same questions often show up on the actual exam day.


If you use Anki, making cards for OMM topics can be helpful to incorporate into your daily study schedule. Good topics to make cards for would include viscerosomatic levels, Chapmans points, tenderpoints, and axes of different cranial strain patterns.



Resources to Use for OMM Questions


As mentioned above, popular resources to use include “The Green Book,” OMG-OMT, and OME. If you want to utilize the resources the NBOME will base their questions on, a list of textbooks is listed on the NBOME website:


OMT textbooks may seem daunting, so you can certainly get all the information you need from other more concise resources. If you are a video person, OMG-OMT, OME, and DirtyMedicine may be helpful options. For treatments, The Pocket Manual of OMT is concise and covers more than enough treatments for test day.


The Green Book is helpful for understanding concepts in OMM, treatments, and can easily be read over a couple days.


Try to explore these resources early on, choose 1 or 2 that work for you and stick with it!



High Yield Topics for OMM Questions


There are so many topics in OMM or OMT it is hard to pinpoint exactly what to focus on. A common pitfall is to study every single treatment you were taught. This is unnecessary and can waste time. Try to focus on the general concepts of each treatment. For example, understand in ligamentous articular strain (LAS) you disengage, exaggerate, then balance rather than studying how to do LAS for every body part. 




Cranial will likely show up on every COMLEX exam. High-yield topics in cranial include the 5 components of the primary respiratory mechanism, knowing the different strain patterns, how the strain will feel in your hands/which way your pinky and index fingers move, and which axes different strains move about.


Sacrum and Pelvis


Take out the drawing board for this one! You will likely be asked how to diagnose shears and torsions. Other important concepts include how the sacrum nutates/counternutates in relationship to cranial flexion/extension. Know how to interpret the spring test, sphinx test, and how to determine the diagnosis of L5 from a sacral diagnosis and vice versa.




The BITE pneumonic will be your friend! (the key rib is the bottom rib in inhalation somatic dysfunction and top rib in exhalation somatic dysfunction). Know which ribs are caliper, bucket handle and pump handle ribs. Review how to treat anterior and posterior tender points. Another high-yield topic is which muscles are activated when doing muscle energy. 


General Principles


It goes without saying, but memorize your Chapman’s points, sympathetic levels, and counterstrain positions. Understand which treatments target the sympathetic nervous system (rib raising, abdominal plexus release, ganglion releases) and which target parasympathetic (suboccipital release and sacral rocking). Know which treatments are direct vs. indirect including lymphatic and soft tissue techniques. 


OMT can feel like a lot to study for but finding a couple of resources that you find helpful and not waiting til the last minute to review can make these questions a breeze on test day and be easy points to boost your score!


For more COMLEX help consider enlisting the help of a 1-on-1 Elite Medical Prep COMLEX Level 1, 2 or 3 tutor. Schedule your complimentary consultation to learn more about how Elite Medical Prep can help you succeed!

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