Osteopathic Manipulative Treatment Techniques Research Articles

Osteopathic Approach to a Patient with Recurring Low Back Pain following OMT results in Diagnosis of Underlying Gynecological Etiology: A Case Report

Abstract This case report describes the occurrence of acute low back pain, and the application of Osteopathic Manipulative Treatment techniques (OMT) initially resulting in resolution of the patient's presenting symptoms. When OMT is successful in resolving the patient's symptoms, this usually supports a musculoskeletal etiology; however, when confronted with recurrence of symptoms despite repeated successful resolution of these symptoms with OMT, the physician should suspect an organic etiology. This case demonstrates the importance of the osteopathic physician understanding viscerosomatic dysfunctions and the efficacy of the osteopathic approach to arriving at correct diagnoses. Of note, the osteopathic approach to a patient with recurring low back pain following OMT resulted in diagnosis of the underlying gynecological organic etiology for this patient's symptoms.

Osteopathic Manipulative Treatment During Post-operative Recovery: A Scoping Review.

Surgery is a common and often necessary treatment option for a wide range of medical conditions, with an estimated 40 to 50 million surgeries performed in the US alone each year. While the various types of surgeries performed may be effective in treating or managing different conditions, the post-operative period can be challenging for patients. Osteopathic manipulative treatment (OMT) is a hands-on approach to medical care that seeks to restore balance and harmony to the body from the lens of an interconnected mind, body, and spirit. Given the potential for adverse events in patients following surgical treatments, OMT may be a viable adjunct post-operatively to enhance patient care and recovery. The purpose of this scoping review is to evaluate the state of current research examining the effectiveness of OMT in improving outcomes in post-operative patients. Three hundred articles were collected; 53 duplicates were removed. Eleven independent reviewers evaluated all 247 articles. Thirty articles were identified, including nine in general surgery, six in cardiothoracic surgery, five in orthopedic surgery, four in spinal surgery, three in neurosurgery, and three others (otolaryngology, oral/maxillofacial, and gynecologic surgery). Post-operative patients were treated with various OMT techniques with myofascial release and muscle energy being some of the most common treatments utilized in all surgical fields. Many studies demonstrated the benefits of OMT usage including significant pain relief, improved and earlier bowel function, and decreased lengths of hospital stay. This study demonstrates how OMT can be effective in reducing post-operative pain, reducing the incidence of post-operative ileus, and shortening the length of stay. Further research into the utilization of OMT in post-operative patients should be considereda potential adjunct to surgical intervention, especially in vulnerable patient populations.

The Use of Osteopathic Manipulative Treatment for Treatment of Sore Throat, Headache, and Facial Pain: A Case Report

Abstract This case report describes the unusual occurrence of acute sinusitis without cervical lymphadenopathy and the application of Osteopathic Manipulative Medicine to treatment of the ensuing somatic dysfunctions. Osteopathic Manipulative Treatment techniques normalize the somatic dysfunctions and result in resolution of the patient’s presenting symptoms. Of note, normalization of the SBS torsion appeared to spontaneously resolve the sacral dysfunction in this patient.

Osteopathic manipulative treatment for concussions and postconcussive syndrome in athletes: a literature review.

Concussions are the most common type of traumatic brain injury (TBI) and can often occur in athletes. These injuries have many deleterious acute symptoms and can lead to the development of postconcussive syndrome (PCS). Osteopathic manipulative treatment (OMT) is a treatment option that may benefit patients with concussions and PCS. The objective of this review is to determine whether OMT can improve symptoms associated with concussions and PCS in athletes. A comprehensive literature review was conducted between August 2021 and March 2022 by two authors (Z.K.L. and K.D.T.) who searched the literature utilizing PubMed, Google Scholar, and Cochrane Library. Articles reviewed included case reports, case studies, randomized control trials, meta-analyses, and peer-reviewed journal articles. Search terms included concussion, postconcussive symptoms, osteopathic manipulative medicine, and manipulation. To be included into this study, articles must have included OMT from an osteopathic physician or manipulative techniques by nonosteopathic providers for patients with a concussion or PCS, and the insulting injury must have occurred in an athletic setting. No disagreements occurred between authors about what studies to include. However, we were prepared to come to a unanimous decision through discussion among the authors. A narrative synthesis was performed. No other data analyses were conducted in this study. Included in this review were nine articles including randomized control trials, retrospective review, case series, longitudinal, retrospective studies, and case reports. The literature shows the positive effects of OMT and manipulative techniques on symptom resolution after a concussion. However, most of the literature is qualitative rather than quantitative in nature, lacking in randomized control trials. There is a scarcity of high-quality studies evaluating the effectiveness of OMT on concussions and PCS. More research is needed to understand the degree of benefit for this treatment option.

The Virtues of Osteopathic Manipulative Treatments in Patients with Opioid Use Disorder

As America continues to face the opioid epidemic, numerous people have made great strides in receiving formal treatment for their opioid use disorder (OUD). This research seeks to examine the effects of providing osteopathic manipulative treatment (OMT) along with traditional OUD pharmacological methods in providing results for patients. By using prior research on OMT techniques, we were able to uncover how effective OMT can be in reducing the time and discomfort associated with seeking opioid recovery. Osteopathic manipulative treatment, in combination with traditional pharmacology, was associated with reduction of somatic pain, higher success with medication-assisted treatment and lower costs. This research also highlights the importance of OMT in the era of COVID-19 social distancing, as well as special considerations when treating those with trauma histories associated with their disorder. We argue the benefit of OMT in combination with pharmacological methods can be successful at reducing the overall burden of prior OUDs.

Effectiveness of osteopathic manipulative treatment in cardiovascular function: a systematic review protocol

The objective of this review is to investigate the short- and long-term effects of osteopathic manipulative treatment on cardiovascular function and its regulators in the nervous and endocrine systems. A variety of pharmacological and lifestyle-based treatments are used to prevent or treat vascular diseases, yet vascular disease underpins the top 2 causes of death worldwide. There is a need for more preventative and therapeutic interventions in the management and prevention of vascular disease that are compatible with existing interventions. Osteopathic manipulative treatment has shown promise as a non-invasive approach to improve cardiovascular function, but it is currently utilized mostly for alleviating musculoskeletal symptoms. A comprehensive summary of the evidence on the effectiveness of osteopathic manipulative treatment in cardiovascular function will assist clinicians and guide future research directions. This review will consider randomized controlled trials, non-randomized controlled trials, and crossover studies. Participants must have received osteopathic manipulative treatment intervention. Comparators will include passive or active controls, including controls for body position, touch, and other potential interventions for vascular disease. Cardiovascular, nervous-system, or endocrine-system outcome variables must be measured at least once after treatment. Adverse events will also be considered. Searches will be conducted in the following sources: MEDLINE, the Journal of Osteopathic Medicine , Embase, Scopus, ProQuest One Academic, MedNar, the International Journal of Osteopathic Medicine , and CINAHL. Studies available in English, without date restrictions, will be considered for inclusion. Relevant studies will be selected by 2 independent reviewers, critically appraised, and extracted using a tool customized for the details of the study. If meta-analysis is possible, evidence will be summarized using standard techniques with subgroup analyses providing more insight into particular osteopathic manipulative treatment techniques, time frame of the treatment, and duration of effects, among others. Certainty of findings will be presented using GRADE. PROSPERO CRD42021225838.

Osteopathic Manipulative Treatment and the Management of Headaches: A Scoping Review.

Headaches have been studied and treated since nearly 7,000 BC because of their significant global impact. Current headache treatment modalities are various and have a wide variety of targets, but medications are the most common. Since conventional medical treatments have several side effects, alternative remedies such as osteopathic manipulative treatment (OMT) should be considered. OMT can assist in the management of various health conditions, such as low back pain, neck pain, and headaches. The purpose of this scoping review is to evaluate recent findings regarding the efficacy of OMT modalities in the management of headaches such as tension-type headaches (TTH) and migraines.This study was designed as a scoping review to gather evidence on the efficacy of OMT modalities in the management of headaches. Following PRISMA guidelines, four databases were used to search for articles published between 2010 and 2022 that reported the use of OMT and manual therapy for TTH and migraines. Databases used include Embase, PubMed, Medline, and Web of Science. The following keywords were used: treatment, therapy, Headache, migraine, craniosacral, muscle energy, myofascial release, trigger point, osteopathic, and manipulation. The initial search yielded 473 unique articles after removing duplicates. After screening based on the inclusion and exclusion criteria, and after further analysis, 15 articles were selected.Data reports of OMT and manual therapy efficacy and/or effectiveness in treating TTH and migraine were analyzed. Articles included were randomized control studies (13 of 15, 86.6%), one pilot study (one of 15, 6.7%), and one case series (one of 15, 6.7%), which were divided into TTH (nine of 15, 60%) and Migraine Headaches (six of 15, 40%). All articles reported significant headache improvement in at least one measurement. Of all treatments analyzed, single technique interventions (seven of 15, 47%) and multiple technique interventions (eight of 15, 53%) were identified. Among the techniques used, Myofascial Release was the most common (nine of 15, 60%).The articles presented provide evidence of the significant benefits of manual therapy. Because of the limitations of traditional medicine, OMT can be used either as an alternative or adjuvant therapy for headaches. Evidence suggests the positive impact it can provide on headache management, but the number of randomized control trials and population samples should be increased to support its recommendation. This demonstrates how different osteopathic techniques can provide therapeutic effects on TTH, MH, and potentially other types of headaches. A preference for myofascial release was observed, which can be due to the fast relief from the physiologic effect on tissue movement.This review study demonstrates the benefits OMT has on decreasing headache frequency, intensity, and duration in TTH and migraines. OMT has shown to be beneficial, especially for patients seeking alternative non-pharmaceutical and non-invasive treatments. Further studies are needed to evaluate the effects of different OMT techniques, and different combinations of treatments, on other types of headaches.

Inflammatory Biochemical Mediators and Their Role in Myofascial Pain and Osteopathic Manipulative Treatment: A Literature Review.

Chronic inflammatory pain conditions, specifically myofascial pain (MFP), account for an overwhelming percentage of office visits every day. The combination of the high cost of its treatment and frequent patient visits makes MFP a critical pathology to be investigated. Sharpening our understanding of the molecular mechanisms within MFP will expedite the enhancement of therapeutic approaches. Inflammation plays a critical role in the pathophysiology of MFP. The chief inflammatory mediators of interest in this review related to MFP are interleukin 1β (IL-1β), IL-6, and tumor necrosis factor-α (TNF-α). This review aimed to determine the impact of inflammatory mediators on fibroblasts and satellite cells, specifically their role in muscle injury and regeneration. Blocking pro-inflammatory mediators such as IL-1β, IL-6, and TNF-α in these cell types could prove to be an effective treatment for MFP. An osteopathic manipulative treatment (OMT) modality, specifically indirect counterstrain therapy, was investigated in the hopes of elucidating a reduction in particular cytokines. In addition, myofascial release (MFR) therapies (OMT modality) were explored as a potentially effective treatment through the acceleration of wound healing, stimulation of muscle regeneration, and decreased inflammation via altered fibroblast activity. Pharmacologic agents such as non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat MFP but have a higher adverse side effect profile compared to OMT therapy. The optimal management of MFP is likely multifactorial, and more treatment modalities must be explored.This literature review analyzed 17 peer-reviewed articles specifically related to MFP management and the role of inflammation in MFP. Chronic inflammation from other etiologies was excluded. Our aim was to elucidate the biochemical mechanisms underlying MFP and inflammation in an effort to promote the medical community's understanding of treatment modalities for this chronic condition. This study revealed that various OMT techniques such as MFR and counterstrain lead to changes on the cellular level in MFP. Discovering similar effects on biochemical inflammatory markers with non-pharmacologic treatment modalities was an exciting revelation and one that could potentially change the way physicians address pain management.

Effects of osteopathic manipulative treatment vs. osteopathic cranial manipulative medicine on Parkinsonian gait.

Sixty thousand people are diagnosed with Parkinson's disease (PD) each year, making it the second most common neurodegenerative disorder. PD results in a variety of gait disturbances, including muscular rigidity and decreased range of motion (ROM), that increase the fall risk of those afflicted. Osteopathic manipulative treatment (OMT) emphasizes the central role of the musculoskeletal system, which could be ideal for addressing the somatic dysfunction associated with neurodegeneration in PD. The close anatomical relationship of structures implicated in PD within the skull and the increased frequency of strain patterns raise the question of whether osteopathic cranial manipulative medicine (OCMM) can improve gait performance by improving circulation to the affected nervous tissue. However, there have been few studies in recent years that explore the effects of a standardized OMT protocol on Parkinsonian gait characteristics, and there have been few studies that include OCMM techniques. This study aims to determine whether a single session of OMT or OMT+OCMM can improve the gait of individuals with PD by addressing joint restrictions in the sagittal plane and by increasing ROM in the lower limb. The following study is a two-group, randomized controlled trial in which individuals with PD (n=45) and age-matched healthy control participants (n=45) were recruited from the community. PD participants were included if they were otherwise healthy, able to stand and walk independently, had not received OMT or physical therapy (PT) within 30days of data collection, and had idiopathic PD in Hoehn and Yahr stages 1.0-3.0. PD participants were randomly assigned to one of three experimental treatment protocols: a 'whole-body' OMT protocol (OMT-WB), which included OMT and OCMM techniques; a 'neck-down' OMT protocol (OMT-ND), including only OMTtechniques; and a sham treatment protocol. Control participants were age-matched to a PD participant and were provided the same OMT experimental protocol. An 18-camera motion analysis system was utilized to capture 3-dimensional (3D) position data in a treadmill walking trial before and after the assigned treatment protocol. Pretreatment and posttreatment hip, knee, and ankle ROM were compared with paired t-tests, and joint angle waveforms during the gait cycle were analyzed with statistical parametric mapping (SPM), which is a type of waveform analysis. Individuals with PD had significantly reduced hip and knee extension in the stance phase compared to controls (32.9-71.2% and 32.4-56.0% of the gait cycle, respectively). Individuals with PD experienced a significant increase in total sagittal hip ROM (p=0.038) following a single session of the standardized OMT-WB treatment protocol. However, waveform analysis found no significant differences in sagittal hip, knee, or ankle angles at individual points of the gait cycle following OMT-WB, OMT-ND, or sham treatment protocols. The increase in hip ROM observed following a single session of OMT-WB suggests that OCMM in conjunction with OMT may be useful for improving gait kinematics in individuals with PD. Longitudinal studies over multiple visits are needed to determine the long-term effect of regular OMT and OMT+OCMM treatments on Parkinsonian gait characteristics.

Evaluation of osteopathic manipulative treatment in pain reduction in pregnant women during third trimester and postpartum: Review Article

Abstract The female body undergoes physiological changes during pregnancy that often lead to low back pain (LBP). To assess a non-pharmaceutical treatment option for LBP, a literature review was conducted comparing research trials using Osteopathic Manipulative Treatment (OMT) and its effect on LBP experienced in the third trimester and postpartum. Research studies using the Visual Analog Scale (VAS) to rate pain were used and the effects of OMT was analyzed. It was found that, compared to usual treatment for LBP, OMT provided significant relief of pain for patients. While research conducted in pregnant populations is limited, further research is required to assess OMT technique models on individuals and the effect on pain throughout pregnancy through the postpartum period.

Characteristics and treatment of geriatric patients in an osteopathic neuromusculoskeletal medicine clinic.

Osteopathic manipulative medicine (OMM) is an adjunctive treatment approach available to geriatric patients, but few studies provide details about presenting conditions, treatments, and response to osteopathic manipulative treatment (OMT) in that patient population. To provide descriptive data on the presentation and management of geriatric patients receiving OMT at anoutpatient osteopathic neuromusculoskeletal medicine (ONMM) clinic. Data were retrospectively collected from electronic health records (EHR) at a single outpatient clinic for clinical encounters with patients over 60years of age who were treated with OMT between July 1, 2016, and June 30, 2019. Records were reviewed for demographic information, insurance type, presenting concerns, assessments, regions treated, OMT techniques used, and treatment response. There were 9,155 total clinical encounters with 1,238 unique patients found during the study period. More women than men were represented for overall encounters (6,910 [75.4%] vs. 2,254 [24.6%]) and unique patients (850 [68.7%] vs. 388 [31.3%]; both p<0.001). The mean (standard deviation, SD) number of encounters per patient per yearwas 4.5 (4.0) and increased with increasing age by decade (p<0.001). Medicare was the most common primaryinsurance (7,246 [79.2%]), with private insurance the most common secondary insurance (8,440 [92.2%]). The total number of presenting concerns was 12,020, and back concerns were most common (6,406 [53.3%]). The total number of assessments was 18,290; most were neuromusculoskeletal (17,271 [94.5%]) and in the thoracolumbar region (7,109 [38.9%]). The mean (SD) number of somatic dysfunction assessments per encounter was 5 (1.7); the thoracic region was the most documented and treated (7,263 [15.8%]). With up to 19 technique types per encounter, the total number ofOMT techniques documented across all encounters was 43,862, and muscle energy (7,203 [16.4%]) was the most documented. The use of high-velocity, low-amplitude (HVLA) declined as age increased (p<0.001). The overall treatment response was documented in 7,316 (79.9%) encounters, and most indicated improvement (7,290 [99.6%]). Our results showed that geriatric patients receiving OMT at our clinic were predominately presenting for neuromusculoskeletal concerns associated with back, neck, and extremity conditions, consistent with national epidemiological data for this population. The most common OMT techniques were also consistent with those used nationally by osteopathic medical students and practicing physicians. Future longitudinal studies are needed to determine the length of time improvement persists and the overall health impact experienced by geriatric patients receiving OMT.

Characteristics and Management of Pregnant Patients From a Neuromusculoskeletal Medicine/Osteopathic Manipulative Medicine Clinic.

Osteopathic manipulative medicine (OMM) is considered beneficial in the treatment of pregnant women, but few studies have outlined the presenting complaints and diagnoses that warrant consideration and utilization of osteopathic manipulative treatment (OMT) in this population. To describe the characteristics of pregnant patients receiving OMM at a neuromusculoskeletal medicine (NMM)/OMM specialty outpatient clinic, for the purpose of identifying patients who would benefit from referral to NMM specialty clinics or to be considered for treatment by DOs in non-NMM specialty clinics. Electronic health records were reviewed from a single clinic for a 3-year period from October 2015 through September 2018 for patient encounters involving patients with an International Classification of Diseases 10th Revision code for pregnancy. Data regarding patient demographics, payment methods, presenting complaints, treatment modalities, regions treated, and assessment diagnoses were collected and analyzed. Records showed 465 clinical encounters with 194 pregnant patients (mean [SD] number of encounters per patient, 2.4 [2.0]). The most common presenting complaints involved the back (371; 55.4%), hip and pelvis (99; 14.8%), neck (62; 9.3%), and head (54; 8.1%). The most common clinical assessments were lumbar and thoracic spine neuromusculoskeletal diagnoses (420; 53.0%). There were 2604 somatic dysfunction assessments documented; lumbar (409; 15.7%) and sacral (396; 15.2%) somatic dysfunction were most commonly assessed. There were 2518 OMT techniques documented, and muscle energy was most frequently used (406; 16.1%). This data, which documents the most frequent presenting complaints of pregnant patients in an NMM/OMM clinic, may be used by clinicians to better understand the role of OMM as an obstetric adjunctive treatment approach and to identify conditions to investigate in future outcome studies.

Exploring the Effects of Osteopathic Manipulative Treatment on Autonomic Function Through the Lens of Heart Rate Variability.

The osteopathic community has long hypothesized that the autonomic nervous system (ANS) represents one of the putative substrates through which osteopathic manipulative treatment (OMT) can improve body functions that have been altered by musculoskeletal alterations. Heart rate variability (HRV) is an important physiological measure of cardiac ANS activity. Emerging evidence suggests that OMT is associated with HRV changes that (i) are indicative of a larger cardiac vagal modulation, (ii) are independent from the part of the body needing treatment, (iii) occur even in the absence of musculoskeletal alterations. Yet, many questions remain unanswered, the duration of these effects and the specificity of HRV responses to different OMT techniques being perhaps the most critical. Therefore, this paper discusses prospects for future applications of HRV for the study of the influence of OMT on ANS function. Moreover, based on existing studies and preliminary data on the effects of OMT on HRV in specific pathological (hypertension) and physiological (stress exposure and recovery from sport competition) conditions that are commonly associated with increased sympathetic and/or decreased vagal activity, we propose that HRV analysis could be exploited to evaluate the effectiveness of OMT as a preventive or complementary strategy in clinical and non-clinical conditions characterized by ANS imbalance.

An Osteopathic Modular Approach to Asthma: A Narrative Review.

Asthma is among of the first ailments documented in the existing academic literature as being successfully managed with osteopathic manipulative treatment (OMT) techniques. Time-efficient and well-tolerated OMT techniques have been gradually added to the literature to manage this increasingly prevalent disease. In this narrative review, the authors discuss previously-published literature describing the history, diagnosis, and management of asthma related to osteopathic principles and practices and OMT application. They also present current and newly-approved medical managements, including biologics and inhaled corticosteroids. This article also includes supplemental videos showcasing OMT techniques for asthma management, which were developed by the authors based on recommendations indicated in the literature.

Rib Somatic Dysfunction Among General Surgical Patients.

Upper abdominal or chest pain, tenderness, or sensation of the presence of a mass may lead to general surgery (GS) service referral. These symptoms may be related to rib somatic dysfunction (SD). To describe rib SD in the GS setting and help build a foundation for additional osteopathic manipulative treatment (OMT) research in surgical care. The authors retrospectively reviewed and analyzed the electronic medical records of patient encounters in a GS outpatient clinic or private office in Bronx, New York. Included patients had emergency department or inpatient GS consultations with the diagnosis of rib SD (ICD-9 739.8 or ICD-10 M99.08) initially made by the GS service from February 1, 2016, to January 31, 2019. Six-month follow-up data were also reviewed. Twelve patients had rib SD as the underlying cause of their chief concern upon presentation to the GS service. Only 1 also had an underlying operative GS disease. The GS service treated 11 patients (91.7%) with OMT; 1 patient refused OMT. Time spent on OMT ranged from 5 to 30 minutes, with a median of 10 minutes and a mean (SD) of 12.7 (9.05) minutes. The OMT techniques used included balanced ligamentous tension, counterstrain, muscle energy, myofascial release, rib-raising, and soft tissue. All patients who received OMT demonstrated improvement, and 3 patients required osteopathic manipulative medicine/neuromuscular medicine follow-up. Rib somatic dysfunction may contribute to patient referral to a GS service, and OMT performed by general surgeons may help provide optimal surgical care.

Osteopathic Considerations for the Pregnant Patient with COVID-19.

In any given year, approximately 130 million babies are born worldwide. Previous research has shown that pregnant women may be more severely affected and vulnerable to contracting emerging infections, making them a particularly high-risk population. Therefore, special considerations should be given to treatment methods for pregnant women with COVID-19. In this narrative review, the authors evaluate scholarly journal articles and electronic databases to determine what is known about the pathophysiology of COVID-19 in pregnancy and the associated mortality rate. Osteopathic manipulative treatment techniques to mitigate the underlying pathology were identified, and modifications for use in pregnancy and the critical care setting are described.

Ultrasound Shear Wave Elastography to Assess Tissue Mechanical Properties in Somatic Dysfunction: A Feasibility Study.

Diagnosis of somatic dysfunction is based on subjective palpatory osteopathic assessments. This subjectivity has posed a challenge for researchers in studying osteopathic medicine. The development and use of radiological imaging techniques to objectively confirm or quantify muscle tissue stiffness associated with somatic dysfunction could be of benefit in osteopathic clinical practice, training, and further research. To investigate the feasibility of ultrasound shear wave elastography (SWE) to quantify muscle tissue stiffness in somatic dysfunction before and after osteopathic manipulative treatment (OMT). In this prospective study, we assessed lumbar spine somatic dysfunction in 20 adult patients before and after a single OMT session using standard osteopathic palpatory assessments by osteopathic physician faculty members in the Department of Osteopathic Principle and Practice at Rocky Vista University College of Osteopathic Medicine (Utah campus). Shear wave velocity (SWV, m/s) was measured in lumbar paraspinal muscle tissue using a commercial ultrasonography scanner on all participants immediately before and after OMT. In this study, OMT techniques targeted the iliocostalis lumborum and included the articulatory technique, balanced ligamentous tension, facilitated positional release, high-velocity, low-amplitude technique, muscle energy, myofascial release, and the Still technique at the discretion of the osteopathic physician. The difference in SWV between muscle tissues with and without dysfunction, and differences in SWV of dysfunctional tissue before and after OMT were examined using unpaired and paired t tests, as appropriate. The correlation between SWV measurements and osteopathic assessments was examined by the Spearman rank correlation. Intra- and interobserver reliability was analyzed using intraclass correlation coefficient. The difference in SWV between muscle tissues with and without somatic dysfunction was significant before OMT (mean [SD], 1.93 [0.44] vs 1.69 [0.19]; P=.03) and was not significant after OMT (mean [SD], 1.69 [0.19] vs 1.53 [0.31]; P=.05). The difference in SWV in the same tissue with somatic dysfunction before and after OMT was significant (mean [SD], 1.93 [0.44] vs 1.52 [0.3]; P<.001). The SWV value highly correlated with manual osteopathic assessments (r=0.72). Intra- and interobserver reliability for performing SWE in somatic dysfunction was good (intraclass correlation coefficient >0.80). The results of this study show that ultrasound SWE can objectively assess muscle tissue stiffness for diagnosis of somatic dysfunctions and for muscle tissue stiffness changes after OMT.

Clinical Efficacy of Mesenteric Lift to Relieve Constipation in Traumatic Brain Injury Patients.

Patients with severe traumatic brain injury (TBI) often have multiple autonomic disturbances that interfere with normal gastrointestinal motility. Many of the pharmacologic agents used in the intensive care unit (ICU) also adversely affect gastrointestinal motility. The body is further subjected to excessive levels of sympathetic discharge in states of traumatic injury and extreme stress, which can interfere with the proper absorption of fluids and nutrients. To determine whether mesenteric lift, an osteopathic manipulative treatment technique, is effective in relieving constipation in patients with TBI who are intubated in the ICU. This retrospective medical record review examined the effect of mesenteric lift on intubated patients with significant TBI who were unable to have a bowel movement within 72 hours of admission. The primary endpoint was the return of normal bowel function within 24 hours. A control group consisted of intubated patients with TBI during the same period who did not receive mesenteric lift. Of patients who received mesenteric lift, 77% experienced bowel movements (n=27 of 35), compared with 36% (n=16 of 44) in the control group (P=.01). The application of mesenteric lift to intubated patients with severe TBI in the intensive care unit significantly increased patients' ability to resume normal bowel function and expel waste.

Characteristics and Treatment of Pediatric Patients in an Osteopathic Manipulative Medicine Clinic.

Osteopathic manipulative medicine (OMM) is recognized as an adjunctive medical approach for the treatment of pediatric patients, but few studies have detailed the pediatric conditions that prompt the use of osteopathic manipulative treatment (OMT) or the types and frequency of OMT used. To present descriptive data of pediatric patients receiving OMT from a neuromusculoskeletal medicine/OMM outpatient clinic. Data were drawn from electronic health records from a single outpatient specialty clinic for pediatric clinical encounters involving OMT that took place between January 1, 2014, and December 31, 2016. Encounter notes and billing records were reviewed for demographic information, presenting complaints, clinical assessments, somatic dysfunction assessments, OMT techniques used, and payment method. Data were categorized by patient age and analyzed. Five hundred thirty-seven pediatric patients (321 girls, 216 boys) received OMT during the study. These patients accounted for 1688 clinical encounters (1106 for girls, 582 for boys). Mean (SD) number of encounters was 2.7 (1.3) encounters for boys and 3.5 (1.1) encounters for girls. A higher percentage of patients younger than age 2 were boys, while a higher percentage of patients older than age 2 were girls (both P=.005). Musculoskeletal complaints and assessments were the most common for children aged 6 years and older; misshapen head, feeding difficulties, and colic were the most frequently reported for children younger than 6 years. There were 8557 somatic dysfunction assessments documented; thoracic and cervical somatic dysfunction were most commonly assessed. There were 8485 OMT techniques documented, and myofascial release was most frequently used. Encounters with self-pay patients (n=72) involved fewer somatic dysfunction assessments (P<.001) than encounters with patients using private insurance (n=1060) or Medicaid (n=542). The electronic health records reviewed in the current study revealed descriptive data of pediatric patients presenting to an OMM clinic; these data were rarely documented in previous literature. They may be used by clinicians to better understand the role of OMM as a pediatric adjunctive medical approach and to identify conditions to target for future outcome studies based on common presenting complaints.

Effect of Osteopathic Obstetrical Management on the Duration of Labor in the Inpatient Setting: A Prospective Study and Literature Review.

Several studies have investigated the effects of osteopathic manipulative treatment (OMT) on labor duration, but the outcomes remain ambiguous. Confounding the relationship between OMT and labor duration is the lack of standardization between treatment settings, gestational ages at the time of treatment, OMT techniques, and overall obstetrical management principles from foundational and modern osteopathic approaches. To evaluate the effect of OMT on labor duration when applied in tandem with standard obstetrical management in the inpatient setting. This pilot prospective observational study was conducted from June 2017 through September 2017. All patients who received OMT as part of their labor management were included. These patients were matched with controls who did not receive OMT. The OMT protocol involved once-daily administration of suboccipital decompression, thoracic inlet release, rib raising, paraspinal inhibition, and sacral inhibition. Obstetrical decisions regarding labor management were made by 1 senior attending osteopathic obstetrician. Labor management as well as OMT was carried out by osteopathic obstetricians in the OMT group, whereas allopathic obstetricians carried out labor management in the control group. A total of 100 patients were enrolled. Fifty patients who underwent adjunctive OMT in addition to standard labor management were matched to controls who received standard labor management only. Each group was represented by an ethnically diverse population. The mean (SD) labor duration for patients receiving OMT was significantly shorter than the labor duration for controls (11.34 [6.62] hours [range, 1.1-27.0 hours] vs 16.57 [4.39] [range, 1.0-58.8 hours], respectively; P=.03). All other measures studied did not achieve statistical significance. Pregnancy and labor present many musculoskeletal and neurovisceral challenges to obstetrical patients and, to the authors' knowledge, this is the first study to present an effective, efficient, and feasible approach to intrapartum osteopathic obstetrical management in the inpatient setting to reduce labor duration.