Muscle energy technique is a form of manual therapy used to treat somatic dysfunction, such as pain and decreased range of motion. It engages the patient in contracting specific muscles against the resistance of the clinician.
On a recent crisp, sunny Saturday morning, Sara “Sally” Sutton’s kitchen radiated tantalizing aromas of her beef stew. Individually and in small groups, DMU osteopathic students began to arrive, calling, “Hello, Sally!” instead of knocking, as they shed shoes, backpacks and coats in the foyer. They knew what to do: set the table for lunch.
“I always forget – do the water glasses go on the right?” asks Emiko Ishihara, D.O.’14.
“Above the knife,” Sutton reminds her. She and nine DMU students and one undergraduate fill their bowls and sit around two festively set tables, helping themselves to salad, biscuits and Sutton’s homemade pickles and relish; dessert will come later. This gathering is much more than lunch among friends, however. It’s the prelude to hands-on instruction about osteopathic manual medicine (OMM), which for years Sutton has been providing once or twice a month in her home and on campus to groups of DMU students who learn about her from word of mouth.
Working with students and often behind the scenes, alumna Sara “Sally” Sutton has advanced osteopathic medicine and those who practice it.
Sutton, too, is much more than a meticulous teacher who’s passionate about students, osteopathic medicine and patient care, although those aspects alone make her special. She also has been a longtime national force in promoting muscle energy technique, a type of osteopathic manual diagnosis and treatment. For her ardent advocacy for the technique and years of teaching it with superb precision, Sutton was selected from more than 150 nominees as the American Osteopathic Association’s 2011 Mentor of the Year. She received the honor at the AOA’s Osteopathic Medical Conference and Exposition held last fall.
“Muscle energy diagnosis is basic for most of what we talk about in OMM and somatic dysfunction,” says Jose Figueroa, D.O.’95, a DMU assistant professor and clinician who had a rotation with Sutton early in his medical career. “Muscle energy technique is used worldwide, in part because of Dr. Sutton. She changed my life and changed the whole profession worldwide.”
A bit of history affirms Figueroa’s statement. Sutton was one of two female members of the Class of 1953 at Des Moines Still College of Osteopathy and Surgery, now DMU. While she downplays that – “I didn’t mind the teasing, but I greatly resented the profanity” spewed by male classmates – it was a time when women had few to no internship and residency opportunities. After she graduated, she borrowed her sister’s car to drive around northern Iowa to find a community that needed a doctor and had office space to rent. She started her first practice on Nov. 1, 1954, in Renwick, IA, where she provided general care, obstetrics and emergency medical services for more than nine years before moving to Fort Dodge, IA; there, her practice grew to nearly 8,000 patients.
“She was so thorough in her examinations. She looked at every part of a patient’s skin, in every hole and palpated every part of the body. Because of that, anything abnormal in a patient stood out like a sore thumb,” Figueroa says. “In her mind, that is the best preventive medicine you can have.
“Her idea of manipulation is that it’s integrative with medicine,” he adds. “There’s no distinction between OMM and medicine; OMM is medicine.”
Practice, preserve, promote
OMM principles In the late 1960s, Sutton attended a presentation at an osteopathic convention in Des Moines by Fred Mitchell Sr., D.O., who had developed muscle energy technique. Perhaps because he was a friend of her mentor and DMU faculty member Paul Kimberly, D.O.’40, he agreed to teach her the technique. She traveled several times to his Chattanooga, TN, practice to observe him.
“He had a full-time practice. He’d explain the technique, but he was so busy it didn’t work,” Sutton recalls. “I asked him to come to Iowa to teach a group of us.”
That “tutorial” took place in Sutton’s home in March 1970. Years later, one of the participants, Ed Stiles, D.O., recalled to Figueroa, “Fred Mitchell told me that if the tutorial didn’t work in her home, he was going to stop teaching the technique.”
“Muscle energy technique came about because of Mitchell,” Figueroa adds. “He was trying to promote it, but to do so, he needed Dr. Sutton.”
The American Academy of Osteopathy (AAO), of which Sutton was then an officer, asked her to document Mitchell’s technique. She completed a set of workbooks with Mitchell’s son, Fred Mitchell Jr., D.O.
“Muscle energy is one of the most universal techniques we have – it’s gentle, effective and time-efficient,” says Richard Schuster, D.O., a DMU assistant professor and clinician. He met Sutton at a conference in 2004. “She changed how I looked at muscle energy in a half-hour of working with her. She has such a desire to teach others. Sally is a gem.”
“Working with a legend”
Back in Sutton’s home that recent Saturday, after the tables were cleared, leftovers put away and the dishwasher was loaded, she and the students descended to the lower level, where four OMM treatment tables allow them to practice in pairs and groups. Elizabeth Abbas, D.O.’14, donned a gown; classmate Jeff Ebel practiced techniques under Sutton’s watchful eye. The group was preparing to treat a teenager who’s been plagued by gastrointestinal issues since birth; a previous treatment by the group already had given the teen some relief.
“She really makes the OMM part applicable to providing care,” Ebel says of Sutton. “She makes you focus on what you’re feeling for. You realize you’re working with a legend.”
That goes beyond her OMM expertise, the students say. The way she has treated patients throughout her career also inspires. “She doesn’t want us to forget to care about our patients,” says Alexis Beinlich, D.O.’14. “They say there’s pressure to limit exams to 15 minutes per patient. Really? Sally has established a full life treating patients the way she wants.”
Among the many physicians Sutton has inspired is Sasha Fach, D.O.’10, who’s now in the second year of a three-year family medicine residency through the University of Minnesota in Mankato. She was one of “Sutton’s students” during her DMU days.
“She was very adamant about doing a thorough history, a physical exam and a structural exam. Now I use pretty much the entire exam technique she used on her patients,” says Fach, who won DMU’s 2010 Ram’s Head Award for best individual performance in OMM by a graduating senior. “My goal is to integrate OMM into my daily family medicine clinic practice just as she did.”
While she’s dignified and soft-spoken, Sutton’s deeply principled approach to OMM reflects an unmistakable passion for it.
“Dr. Sutton wholeheartedly believes in osteopathy. She is able to help students see how important manipulation is in understanding the whole body,” says DMU Board of Trustees member Susan Beck, D.O.’84, FACOS, a surgeon with Katzmann Breast Center in Clive, IA, and Surgical Affiliates in Des Moines. “She’s an educator who imparts knowledge and learning and also passes on an infectious curiosity and passion. That’s what changes the world.”
During the session at her home, Sutton guides Ebel’s hands as he practices manual techniques on Abbas while the other students observe.
“The ultimate goal with these groups of students is not only to teach the skills, but to integrate them into overall practice,” Sutton says. “I love the students, but I also want to perpetuate the art of touch.”
A Renaissance woman, indeed
Sara “Sally” Sutton is one of Iowa’s only two Fellows (FAAO) of the American Academy of Osteopathy (AAO), an earned postdoctoral degree conferred by the academy.
She’s the only physician in Iowa to receive the Andrew Taylor Still Medallion of Honor, the highest honor given by the AAO.
She served on the DMU Board of Trustees for 22 years and on the DMU faculty for five.
She served as director of the Health Manpower Recruitment Corp. of North Central Iowa, which was key in bringing physicians to rural communities.
Sutton also founded and served as president of the Fort Dodge, IA, Fine Arts Association and the Fort Dodge Choral Society, which is still active more than 40 years later.
One of the many reasons she is a champion for osteopathic medicine: She contracted scarlet fever in the sixth grade, which forced her and her mother into quarantine in their home’s second floor; their family physician, a D.O., visited them every day, climbing a ladder from the outside of the house to avoid contaminating other family members.
She credits her undergraduate years as a music major for her sensitivity to touch as an OMM provider. “I know how to dot my I’s and cross my T’s from choral music,” she says. “I think I apply that in treatment.”
She’s the author of Dr. Sally’s Cookbook, a collection of more than 800 recipes “with and without sin.”