Osteopathic Management Research Articles

Effectiveness of Osteopathic Manipulative Treatment on Hemodynamic and Pulmonary Response in Coronary Artery Bypass Graft Patients: A Meta-Analysis.

In the realm of cardiovascular care, the quest for innovative and holistic approaches to enhance patient outcomes persists. This study analyzes osteopathic manipulative treatment (OMT) and its potential impact on pain intensity, length of hospitalization, respiratory function, and hemodynamic response in patients undergoing coronary artery bypass grafting (CABG). OMT, with its emphasis on physical manipulation of the body's muscles and tissues, presents a potential treatment beyond the realms of conventional post-operative care. Google Scholar was used to identify four relevant articles for further review. RevMan 5.4 was utilized for meta-analytic evaluation in order to produce forest plots with associated standardized mean difference (SMD), confidence interval (CI), and heterogeneity (I²). Output from collection and analysis revealed statistically significant decreases in negatively viewed outcomes, including length of stay (SMD 0.39; 95% CI -0.02,-0.76; I² ≤ 0%) and pain control (SMD 1.67; 95% CI -1.34,-0.67; I² ≤ 94%). Parameters for respiratory function and hemodynamic response, including vital capacity (SMD 0.91; 95% CI 0.57,1.24; I² ≤ 96%) and maximal aerobic capacity (SMD 0.50; 95% CI 0.19, 0.82; I² ≤ 0%), showed a statistically significant increase. These findings suggest the incorporation of OMT as a viable adjunct for postoperative management in CABG patients, yielding favorable reductions in adverse outcomes such as length of hospitalization and pain. Moreover, it has demonstrated enhancement in maximal aerobic and vital capacity. This study suggests that the addition of osteopathic management to post-bypass standards can ultimately prevent certain morbidities associated with this specific patient population.

Osteopathic management of non-specific neck pain: Preliminary findings from a cross sectional study of Australian osteopaths

ObjectiveNeck pain is a highly prevalent condition that leads to considerable pain and disability. There is an economic cost to neck pain at both a personal and broader health system level. Neck pain may be classified as ‘non-specific’ neck pain (NSNP) when there is an absence of identifiable underlying disease or abnormal anatomical structure. Osteopaths play a role in the management of NSNP, but it is unclear how osteopaths specifically manage this condition. This study explores what osteopaths do for patients with NSNP. MethodsCross sectional design. Via an online survey. ResultsAll participants in this study reported applying soft tissue techniques, using exercise prescription, discussing physical activity levels, physical fitness, stress management, pain education and posture and ergonomics for patients with NSNP. Less than half of the osteopaths in this study reported using PROMs in clinical practice for the management of non-specific neck pain and only a small number completed continuing professional development (CPD) related to the clinical management of NSNP. ConclusionThis study demonstrates Australian osteopaths use a range of manual therapy techniques and education strategies in clinical practice for the management of NSNP in line with clinical practice guidelines. Implications for clinical practice•All osteopaths in this study reported applying soft tissue techniques, using exercise prescription, discussing physical activity levels, physical fitness, stress management, pain education and posture and ergonomics for patients with NSNP.•Less than half of the osteopaths in this study reported using PROMs in clinical practice for the management of non-specific neck pain.•Only a small number of Australian osteopaths completed continuing professional development (CPD) related to the clinical management of NSNP.

Osteopathic Management of Pediatric Feeding Disorder, Oral Aversion, and Growth Faltering: A Case Report

Abstract Growth faltering is a complex problem in the pediatric population and can result from multiple mechanisms, including inadequate caloric intake. Feeding difficulties are common among children with growth faltering and can present significant challenges for achieving adequate nutrition and weight gain, particularly when coupled with any degree of oral aversion. The patient in this case is a 21-month-old child with oral aversion, pediatric feeding disorder (PFD), and growth faltering who had failed to gain weight while receiving the standard of care. Upon transitioning his care to an osteopathic pediatrician, who incorporated osteopathic manipulative treatment (OMT) into his care, he demonstrated weight gain, which was sustained over the 8 months of this study. This case report demonstrates the potential benefit of OMT for children with PFD, oral aversion, and growth faltering.

OSCAR (Osteopathic Single CAse Research) – Assessing the effect of standard and biopsychosocial osteopathic management for patients with non-specific low back pain: Protocol for a Single Case Experimental Design (SCED)

BackgroundOsteopathy has been shown to be effective in the management of chronic low back pain (LBP). Guidelines recommend biopsychosocial care for chronic, complex musculoskeletal conditions, including non-specific LBP. ObjectivesThis study has four aims: 1/to assess how patients with LBP improve after osteopathic treatment, both before and after an osteopath has completed a Biopsychosocial Pain Management course; 2/to assess if it is feasible and acceptable for osteopaths to receive weekly SCED data and use it to guide patient management; 3/to assess if it is acceptable for patients to submit daily data and discuss weekly summary with their osteopaths; and 4/to test feasibility for researchers in collecting, managing and storing large quantities of individual patient data. MethodsA multiple baseline single case experimental design trial with up to 10 UK osteopaths with more than 15 years in practice and 60 patients will assess how change occurs as a result of osteopathic treatment for patients with non-specific LBP of more than 12 weeks’ duration. Statistical analysis will assess the degree and rate of change between baseline, intervention and follow-up periods, and whether differences in effect are observed after the osteopaths have completed the biopsychosocial patient management training course. Primary outcomes will be the Numeric Pain Rating and Patient Specific Function Scales, measured daily at baseline and for 6 weeks during the intervention stage, and weekly or fortnightly during a 12-week follow-up period. EthicsThis research was approved by the University College of Osteopathy Research Ethics Committee.

Характеристика остеопатического статуса пациентов с метаболическим синдромом

Purpose of research: to assess the osteopathic status based on the study of the structure of somatic dysfunctions in patients with metabolic syndrome. Materials and methods. Clinical, biochemical and osteopathic examination of patients with metabolic syndrome (n = 33) aged 40 to 80 years was carried out. To fulfill the purpose of the study, an assessment of the somatic status, osteopathic examination in full, anthropometry, calculation of BMI, tonometry, determination of heart rate, pulse, ECG in standard leads, determination of glucose level and lipid spectrum in blood serum were carried out. Results. The study of the osteopathic status in these patients made it possible to reveal the dysfunction of organs and systems in the form of somatic dysfunctions, and to identify the most typical somatic dysfunctions for patients with metabolic syndrome. In this connection, the possibility of therapeutic and osteopathic management of patients with metabolic syndrome is determined.

Does instrumental delivery have an influence on the need for orthodontic treatment?

The objective of this comparative retrospective cohort performed on 202 patients was to evaluate the influence of instrumental extraction (forceps, suction cup, spatula) during delivery on the need for orthodontic treatment. Questionnaires on the type of delivery were distributed in three different structures. The need for treatment was assessed using the IOTN indicator (Index of Orthodontic Treatment Need). The groups were compared by statistical tests at the significance level of 5%. 202 patients were included (51 in the group « instrumental delivery », 151 in the control group). With an average IOTN of 3.3 in the « instrumental delivery » group versus 2.5 in the « non-instrumental delivery » group, the difference between the two groups is statistically significant (p = 0.00015). Since the need for orthodontic treatment is significantly higher in patients born by instrumental delivery compared to patients born without instrumental support, instrumental extraction is therefore a risk factor in orthodontics, diagnosis and orthodontic treatment may be indicated in these patients. In addition, provided that it is proven effective, early osteopathic management may be recommended.

Patient expectations of manual and non-manual therapy within an osteopathic consultation: A cross sectional study

IntroductionPatient expectations of an osteopathic consultation can influence their evaluation of the effectiveness of osteopathic management. Throughout an osteopathic consultation practitioners' may use manual therapy (MT) and/or non-manual therapy (NMT). Currently, little is known regarding patient's expectations and preferences of osteopathic management. The aim of this study was to identify patients' expectations of their management within an osteopathic consultation, specifically in terms of the ratio of MT and NMT. MethodsNew patients to the Victoria University student osteopathic clinic were invited to complete a 5 question likert survey about their previous osteopathic experience; body region to be treated, and the expected ratio of MT to NMT during the consultation. ResultsOverall, Of the 161 participants, 85.7% expected a ratio of 75:25 or 50:50 MT to NMT (Q3), while 49% of participants were ‘extremely likely’ to ‘likely’ to attend a solely NMT consultation, if it were best practice for their condition (Q4). No significant difference was identified between responses to Q3 or Q4 when grouped according to the number of previous osteopathic consults, or gender. There was a positive, weak correlation between Q3 and Q4. ConclusionThe majority of participants expected their osteopathic consultation to consist mostly of MT. This study enhances osteopaths’ understanding of patient expectations, which can contribute to the formulation of improved education and management plans. Future research should focus on strategies on how to best align patient expectations of management with the broader evidence base.

Effects of non-manipulative osteopathic management in addition to physical therapy and rehabilitation on clinical outcomes of ankylosing spondylitis patients: A preliminary randomized clinical trial

IntroductionAnkylosing Spondylitis (AS) is reported to impair quality of life, physical and functional ability of patients. Rehabilitation and physical therapy is usually proposed to improve AS patient clinical conditions. Besides, an osteopathic management has not been extensively studied in the field of inflammatory diseases. = ObjectiveTo investigate the effects of osteopathic approach in addition to conventional rehabilitation management on clinical and functional outcomes among patients with AS. Equipment and methodsEighteen patients with AS were recruited to participate to a physical therapy and rehabilitation (PTR) program over an 18-week period. They were randomly allocated into two groups to complete PTR only or PTR combined with osteopathic management without manipulative techniques (OSTEO group). Thoracolumbar maximal isometric strength (for flexion, extension, lateroflexion, and axial rotation) and flexibility, functional index, pain intensity and quality of life (self-assessment questionnaires) were assessed before and after the protocol. ResultsSignificant improvements were observed for the OSTEO group in strength, flexibility, disease activity and pain compared to the PTR group. However the difference between groups did not reach statistical significance for all the post-intervention measures. No significant correlation was found between functional, disability data or pain intensity and disease duration for both groups. ConclusionThe results suggest that osteopathic management in addition to a physical therapy and rehabilitation program may be beneficial for individuals who suffer from AS. Further investigations are required using larger sample sizes to confirm these preliminary results.

Medical Infrared Thermography in back pain osteopathic management

ObjectivesThe objective of this study was to provide proof-of-concept for the use of Medical Infrared Thermography to verify both diagnosis and osteopathic management accuracy in back pain. MethodsA 50-year-old woman with acute back pain syndrome volunteered to participate in this study. ResultsPrior the treatment, thermal image reveals that in a sagittal plane, the inflammation extends from vertebra D8 to L3 with a maximum inflammation between vertebrae D10 to L1. Post-treatment, Medical Infrared Thermography only shows a slight inflammation along the lumbar furrow that does not induce pain in the patient. ConclusionMedical Infrared Thermography has made it possible to scientifically support the osteopathic approach to back pain, both in the initial diagnostic phase and in the validation phase of treatment effectivess.

Assessment of cervical stiffness in axial rotation among chronic neck pain patients: A trial in the framework of a non-manipulative osteopathic management

BackgroundCervical stiffness is a clinical feature commonly appraised during the functional examination of cervical spine. Measurements of cervical stiffness in axial rotation have not been reported for patients with neck pain. The purpose of this study was to investigate cervical spine stiffness in axial rotation among neck pain patients and asymptomatic subjects, and to analyze the impact of osteopathic management. MethodsThirty-five individuals (17 patients) were enrolled. Measurements were carried out for left-right axial rotation using a torque meter device, prior and after intervention. Passive range of motion, stiffness, and elastic-and neutral zone magnitudes were analyzed. Pain intensity was also collected for patients. The intervention consisted in one single session of non-manipulative osteopathic treatment performed in both groups. FindingsA significant main effect of intervention was found for total range of motion and neutral zone. Also, treatment by group interaction was demonstrated for neutral-, elastic zone, stiffness in right axial rotation, and for total neutral zone. Significant changes were observed in the clinical group after intervention, indicating elastic zone decrease and neutral zone increase. In contrast, no significant alteration was detected for the control group. InterpretationsStiffness characteristics of the cervical spine in axial rotation are prone to be altered in patients with neck pain, but seem to be relieved after a session of non-manipulative manual therapeutic techniques. Further investigations, including randomized clinical trials with various clinical populations and therapeutic modalities, are needed to confirm these preliminary findings.

Integrating osteopathic approaches based on biopsychosocial therapeutic mechanisms. Part 2: Clinical approach

The biopsychosocial mechanisms for therapeutic effect in an osteopathic treatment encounter for people with somatic pain were reviewed and discussed in Part 1 of this article. The author argued that both biological and psychosocial therapeutic mechanisms are potentially important in clinical practice, although the relative importance of these mechanisms differs depending on the person's presentation and the nature and chronicity of the involved pain. In Part 2, clinical implications of the differing processes of pain and therapeutic mechanisms of osteopathic techniques are discussed. A rationale is presented for osteopathic management based on an understanding of the likely biological and psychological factors present and for the complementary actions of manual therapy with a cognitive behavioural approach to pain and disability. Appropriate communication, reassurance, education, and empowerment can result in positive attitudes and behaviours to pain and complement the specific biological effects of osteopathic manipulative treatment. This article will aid the clinical reasoning process and provide guidance to osteopaths for treatment selection based on patient presentation and the likely biological and psychological factors involved in pain and disability.

Osteopathic management of chronic constipation in women patients. Results of a pilot study

Constipation is a common problem in western countries. The aim of this pilot study was to determine the effectiveness of osteopathic manipulative treatment (OMT) for the treatment of constipated women with functional constipation (FC) or defeation disorders (DD). Twenty-one constipated females referred to a tertiary center were recruited. A course of OMT, weekly for four weeks, was given. Clinical questionnaire, Bristol stool form scale and patients' subjective perception of constipation, bloating and abdominal pain, were recorded. Total and segmental colonic transit time (CTT) were performed before and after OMT. Eleven patients had FC and 10 DD, as defined by Rome III criteria. After OMT, the Knowless Eccersley Scott Symptom score (P=0.020), the oro-anal transit time (P=0.002), the right (P=0.005) and left (P=0.009) CTT had decreased while the stool frequency (P=0.005) and the Bristol Stool Form scale (P=0.003) had increased. After OMT, the intensity of constipation, and the Patient assessment of constipation symptoms score did not change but a decrease of abdominal pain, bloating, quality of life score and drug use was found. This study shows OMT has potential benefit for treating functional constipation in women. Further randomised trials are required to confirm these results.

Preliminary development of a complex intervention for osteopathic management of dysfunctional breathing

BackgroundBreathing retraining (BRT) is commonly used during osteopathic consultations as an adjunct to osteopathic manual therapy (OMT) for assessment and treatment of breathing-related dysfunction. Although BRT and OMT are widely recognised within osteopathy and other allied health disciplines, there are few descriptions of clinically applicable protocols in the literature. ObjectiveTo describe the development of a dual-protocol framework (BRT and OMT) for assessment and treatment of dysfunctional breathing. DesignDevelopment and evaluation of a complex intervention. MethodsCyclical, iterative processes of development, feasibility and piloting, evaluation and subsequent redevelopment were applied in the design of two conceptual protocols for BRT and OMT. ResultsThe resulting BRT protocol consists of progressive steps of breathing practice in three body positions (neutral, flexion, extension), followed by a guide for more advanced breathing challenges that can be tailored towards the individual. The OMT protocol provides a semi-standardised assessment and treatment plan, which details body regions for assessment of somatic dysfunction and a list of techniques that can be selected according to practitioner clinical judgement, based on patient presentation and preferences, and clinical context. ConclusionsHere we present a clinically applicable guide for a complex intervention entailing assessment and management of dysfunctional or abnormal breathing. Implementation of this protocol within the clinical setting is now recommended, along with ongoing development, and further randomised clinical trials assessing its efficacy, effectiveness, and acceptability.

Osteopathic decapitation: Why do we consider the head differently from the rest of the body? New perspectives for an evidence-informed osteopathic approach to the head

The osteopathic management of the head was initially founded on a biomechanical model which has since proved to be highly controversial. The current call for the evidence-informed practice of osteopathy, and the level of critical reasoning we expect from our students, are no longer compatible with Sutherland's ideas on cranial osteopathy.Meanwhile, an interesting field has developed called tissue mechanics. This may provide osteopaths with useful evidence to develop a treatment model of the head that fits better with current knowledge. Biomechanics is not limited to kinematics to the human body. It includes tissue mechanics that aims to describe the way living tissues distort under different types of loading. It has been extensively applied to understand the role and development of cranial sutures and the distribution of stresses and strains over the skull.Even though it is among the hardest materials in the body, bone distorts during normal function and more obviously during trauma. Bone tissues undergo stresses and strains when loaded, like any other material, and cranial bones are no exception to this rule.In this article we review the mechanical properties of the cranial bones and sutures and highlight the fact that the muscles are the main cause of cranial bone deflections. Muscle contraction is now recognized to be one of the principal causes of bone loading and this is true for the head: apart from in the case of traumatic events, a large amount of research into the mechanical properties of cranial bones and sutures confirms that muscle contraction is the main cause of skull deflection.

Osteopathic management of an adult patient suffering from trigeminal neuralgia after a post-operative Arnold Chiari type 1 decompression: Case report

Osteopathic management of an adult patient suffering from trigeminal neuralgia after a post-operative Arnold Chiari type 1 decompression: Case report

Profile of members of the Australian Osteopathic Association: Part 1 – The practitioners

Objectives The Research Council of the Australian Osteopathic Association (AOA) identified the need to gather data about the members of the Association as well as ‘who’ and ‘what’ they treat in order to guide strategic planning in research. Methods A census of two parts was sent to members of the AOA ( n = 656). Part 1 focussed on the practitioners and part 2 on the patients. Surveys of specific groups in the osteopathic profession in New Zealand and the United Kingdom as well as earlier Australian surveys were obtained for comparative and temporal analysis. Results The response rate was 52% of the sample population. The gender was split evenly, and the majority practice was a 32–40 h working week in one (59%) or two (33.8%) locations. They consult an estimated average of 40 patients a week (25% are new patients). In their diagnostic practice, physical examination was considered mostly in the orthopaedic and neurological systems, with a limited consideration of other systems. Referrals for diagnostic investigation were mostly for plain-film radiology. The estimated use of therapeutic modalities had soft tissue, muscle energy, non-high velocity articulation/mobilisation and high velocity manipulation consistently used, with a broad spread of others. Nutritional supplements, exercise and diet/lifestyle changes were all prescribed. Questions about inter-professional relationships revealed that practitioners refer to GPs 68.5% “occasionally” and 19.2% “frequently”, masseurs 48.2% “occasionally” and 19.3% “frequently”, naturopaths/herbalists 43.4% “occasionally” and 12.0% “frequently”, and podiatrists 47.5% “occasionally” and 9.8% “frequently”. Referrals were almost exclusively from other patients (96.1% frequently), whilst it was estimated by the respondents that GPs refer occasionally (47.9%) or frequently (17.4%). The sample placed importance on, and attended, continuing education activities, and reported that the most important professional issues were the public and health practitioners' perception/ignorance of osteopathy followed by the need for evidence into the efficacy of osteopathic management. Conclusions Part 1 of the survey of a sample of the members of the AOA revealed details of their qualifications and commitment to continuing education. The characteristics of respondents' practice within a multidisciplinary network, and the utilisation of the diagnostic skills of primary care were revealed. The importance of certain issues facing the Australian osteopathic profession were identified.

Osteopathic support for a survivor of gastric cancer: A case report

This case study describes an osteopathic approach to improving the quality of life of a survivor of gastric cancer. An older male patient received eight consultations over a period of 10 months, some three years after his cancer diagnosis and treatment. Osteopathic management included manual treatment to improve musculoskeletal mobility, cranial osteopathic treatment to release tension in the deeper fascia, discussion of dietary strategies and advice and education about the origin of his symptoms due to a total gastrectomy and cancer chemotherapy. After treatment his physical symptoms were reduced. His neck pain was reduced. Nausea and discomfort after eating disappeared. Frequency of diarrhoea, breathlessness and fatigue were improved. He gained weight and resumed social activities. This case study illustrates how osteopathy can play a role in the supportive care of cancer patients after their conventional treatment; a wide range of systemic and musculoskeletal symptoms fall within the scope of osteopathic knowledge and problem-solving skills. The training of osteopaths as primary health care practitioners equips them with a high level of knowledge in pathology and differential diagnosis. Osteopathic consultations provide time to engage in complex problems that may benefit from a holistic approach. The touch and body work involved in osteopathy can help the patient come to terms with altered body image and to talk openly about anxieties. The Hay approach to diet appeared to be valuable in improving the quality of life for this particular patient after his gastrectomy.

442 Wide-dynamic range neurons sensitization and spinal manipulative therapy: A rationale for osteopathic management of neuropathic pain?

European Journal of PainVolume 11, Issue S1 p. S196-S196 442 WIDE-DYNAMIC RANGE NEURONS SENSITIZATION AND SPINAL MANIPULATIVE THERAPY: A RATIONALE FOR OSTEOPATHIC MANAGEMENT OF NEUROPATHIC PAIN? R. Zegarra-Parodi, R. Zegarra-Parodi Directeur Du Département Recherche Du CEESO, Paris, FranceSearch for more papers by this author R. Zegarra-Parodi, R. Zegarra-Parodi Directeur Du Département Recherche Du CEESO, Paris, FranceSearch for more papers by this author First published: 16 January 2012 https://doi.org/10.1016/j.ejpain.2007.03.457Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume11, IssueS1June 2007Pages S196-S196 RelatedInformation

The effect of osteopathic treatment on people with sub-chronic and chronic neck pain: A pilot study

Introduction Neck pain is a common problem in the general population and can be severely disabling and costly for the individual. 1 Cote P. Cassidy J.D. Carroll L. The Saskatchewan Health and Back Pain Survey: the prevalence of neck pain and related disability in Saskatchewan adults. Spine. 1998; 23: 1689-1698 Crossref PubMed Scopus (631) Google Scholar , 2 Cote P. Cassidy J.D. Carroll L. Kristman V. The annual incidence and course of neck pain in the general population: a population based cohort study. Pain. 2004; 112: 267-273 Abstract Full Text Full Text PDF PubMed Scopus (432) Google Scholar The aim of this study was to investigate if osteopathic management of people with neck pain would reduce their perceived pain and disability. Design Single cohort pilot study. Methods Participants: Seventeen subjects with neck pain (mean age 34.8 [SD=11.9] years, 7 males, 10 females). Subjects had a mean duration of symptoms of 168.8 weeks (SD=292, range: 4–1040). Intervention: A four-week course of osteopathic treatment at the Victoria University Osteopathic Medicine teaching clinic. Outcome measures: McGill pain questionnaires (MPQ), visual analogue scales (VAS), and Neck Disability Index (NDI) were completed prior to the initial treatment and after treatments on weeks 2 and 4. Results Analysis with repeated measures ANOVA revealed statistically significant differences between pre and post scores for the MPQ (F2,32=17.35, P=0.001), VAS (F1.62, 25.92=36.01, P<0.001) and NDI (F2,32=14.63, P<0.001). Pre–post effect sizes were large for MPQ (d=1.28), VAS (d=1.57) and NDI (d=1.12). Further testing using paired t tests revealed these differences to be significant between all time periods for the MPQ, and between the pre-treatment and 2 weeks and pre-treatment and 4 week periods for the VAS and NDI. When the cohort was subdivided into a sub-chronic (symptom duration less than 52 weeks) and chronic group (symptoms longer than 52 weeks), similar significant differences were found for both groups. Conclusion Self-rated pain and disability significantly reduced during the course of osteopathic treatment, and reductions were evident regardless of the chronicity of the pain. This pilot study suggests that osteopathic treatment may be effective for the management of neck pain. Neck pain is a common problem in the general population and can be severely disabling and costly for the individual. 1 Cote P. Cassidy J.D. Carroll L. The Saskatchewan Health and Back Pain Survey: the prevalence of neck pain and related disability in Saskatchewan adults. Spine. 1998; 23: 1689-1698 Crossref PubMed Scopus (631) Google Scholar , 2 Cote P. Cassidy J.D. Carroll L. Kristman V. The annual incidence and course of neck pain in the general population: a population based cohort study. Pain. 2004; 112: 267-273 Abstract Full Text Full Text PDF PubMed Scopus (432) Google Scholar The aim of this study was to investigate if osteopathic management of people with neck pain would reduce their perceived pain and disability. Single cohort pilot study. Participants: Seventeen subjects with neck pain (mean age 34.8 [SD=11.9] years, 7 males, 10 females). Subjects had a mean duration of symptoms of 168.8 weeks (SD=292, range: 4–1040). Intervention: A four-week course of osteopathic treatment at the Victoria University Osteopathic Medicine teaching clinic. Outcome measures: McGill pain questionnaires (MPQ), visual analogue scales (VAS), and Neck Disability Index (NDI) were completed prior to the initial treatment and after treatments on weeks 2 and 4. Analysis with repeated measures ANOVA revealed statistically significant differences between pre and post scores for the MPQ (F2,32=17.35, P=0.001), VAS (F1.62, 25.92=36.01, P<0.001) and NDI (F2,32=14.63, P<0.001). Pre–post effect sizes were large for MPQ (d=1.28), VAS (d=1.57) and NDI (d=1.12). Further testing using paired t tests revealed these differences to be significant between all time periods for the MPQ, and between the pre-treatment and 2 weeks and pre-treatment and 4 week periods for the VAS and NDI. When the cohort was subdivided into a sub-chronic (symptom duration less than 52 weeks) and chronic group (symptoms longer than 52 weeks), similar significant differences were found for both groups. Self-rated pain and disability significantly reduced during the course of osteopathic treatment, and reductions were evident regardless of the chronicity of the pain. This pilot study suggests that osteopathic treatment may be effective for the management of neck pain.

Anatomical observations related to radiological findings in spina bifida occulta of the lumbosacral spine

Abstract Background: Anecdotal osteopathic clinical experience suggested that spina bifida occulta (SBO) might adversely be complicating the presentation and prognosis of acute and chronic low back pain, yet the finding of spina bifida occulta (SBO) in anteroposterior lumbosacral radiological examinations is usually regarded as an innocent radiological finding. Review of the literature indicated that lumbosacral SBO is associated with an increased incidence of posterior intervertebral disc herniation. Aims and Objectives: The aim of this anatomical study was to examine the null hypothesis that SBO of the lumbosacral spine is not associated with variations in the expected appearance of the overlying posterior soft tissues. Materials and Methods: Thirty-six cadavers were initially available for radiological study. Eight cases of SBO were radiologically identified and dissected. Four further cadavers were selected as dissection controls on the basis of having a normal radiographic appearance of the lumbosacral spine. Comparisons were drawn between the soft tissues of the lumbosacral region of SBO cases and the controls. Discussion: SBO of the lumbosacral spine is associated with variation of the expected appearance in the overlying posterior soft tissues. A rationale is discussed that links altered anatomy, vertebral mechanics and accelerated degeneration of the related intervertebral disc. These biomechanical and clinical rationales are further offered as a reason for the classification of SBO as a reportable radiological finding. This rationale provides a theoretical explanation for the clinical differences noted in the routine osteopathic management of low back pain complicated by the presence of SBO. Conclusions: The results suggest that there are variations in the superficial soft tissues of the lumbosacral spine associated with the radiographic finding of SBO.