Osteopathic Research Articles

Effect of osteopathic visceral manipulation for individuals with functional constipation and chronic nonspecific low back pain: randomized controlled trial

Effect of osteopathic visceral manipulation for individuals with functional constipation and chronic nonspecific low back pain: randomized controlled trial

Effectiveness of Osteopathic Manipulative Treatment in Adults with Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis.

The aim of this systematic review and meta-analysis was to evaluate the effectiveness of the osteopathic manipulative treatment (OMT) in adults with irritable bowel syndrome (IBS). A literature resview was carried out on the following databases: PubMed, Embase, Cochrane, Cinahl, Scopus, PEDro and ClinicalTrials.gov. 350 articles were recovered. Eligibility criteria were evaluated by two independent reviewers, including randomized controlled trials (RCTs), quasi-RCTs, or ongoing RCTs with OMT compared to any kind of control in patients diagnosed with IBS. Six studies (five RCTs and one ongoing RCT) were considered eligible. Four RCTs were classified as some concerns and one as high risk of bias. In the meta-analysis, OMT compared to sham/no intervention showed statistically significant results for abdominal pain (effect size ES = -1.14 [-1.66, -0.62]; p < 0.0001) and constipation (ES = -0.66 [-1.12, -0.20]; p = 0.005). Instead, OMT was not superior to the control for the IBS symptoms measured with the IBS Severity Score and the Likert scale (ES = -0.34 [-0.83, 0.16]; p = 0.19), and diarrhea (ES = -1.20 [-2.84, 0.43]; p = 0.15). The quality of evidence was "low" for IBS symptoms in general for abdominal pain and constipation, while it was judged as "very low" for diarrhea. OMT turns out to be safe in the treatment of IBS without major adverse effects. OMT may be effective in IBS patients, however the results must be interpreted carefully due to the low methodological quality of the studies.

The Biomechanical Links Between Pelvic Floor Dysfunction and Testicular Pain: A Clinical Review

Chronic scrotal content pain affects 100,000 men in the United States annually. Up to 50% of these cases do not resolve by following conventional treatment algorithms and are deemed to be idiopathic. There is little peer-reviewed literature supporting the specific cause and effect relationship between pelvic floor dysfunction and chronic scrotal content pain. Additionally, the specificity of the physical exam in these types of patients is not present in the literature. Overall, the literature is deficient in proposed treatment algorithms that address the large number of cases that are deemed to be idiopathic. Patients presenting with chronic scrotal content pain may benefit from an osteopathic diagnostic and treatment approach. In these types of patients, we recommend osteopathic manipulative therapy (OMT) or pelvic floor manual therapy prior to surgical intervention. This conservative approach may reduce the large portion of cases that aredeemed to be idiopathic. The emphasis on structure and function within osteopathic medical education places osteopathic family physicians in a unique position to be able to properly diagnose and treat this type of pain. Since most cases of chronic scrotal content pain are initially addressed in the primary care setting, it is important for osteopathic primary care physicians to remain vigilant in considering musculoskeletal dysfunction when evaluating these types of patients. This clinical review is underscored by a unique case presentation of a male collegiate athlete who helps demonstrate the larger gap that is present in the literature on male pelvic floor and scrotal content pain.

Non-pharmaceutical management of chronic pain

Chronic pain is a complex and pervasive condition that challenges both individuals and healthcare systems. In light of concerns about overreliance on pharmacological interventions, non-pharmacological approaches have gained prominence in chronic pain management. This article explores the scientific basis and benefits of diverse non-pharmacological interventions, including physical exercise, manual therapies, cognitive-behavioral therapy (CBT), meditation, acupuncture, and herbal medicine, in alleviating chronic pain. Each intervention's mechanisms of action are elucidated, shedding light on their physiological and psychological effects. Physical exercise has emerged as a cornerstone of non-pharmacological pain management, offering benefits such as pain reduction, enhanced mobility, and improved quality of life. Mechanisms encompass endorphin release, anti-inflammatory effects, and central nervous system modulation. Manual therapies, represented by chiropractic manipulation, osteopathic manipulative treatment , and massage therapy, demonstrate significant pain relief through mechanisms involving joint mobilization, muscle relaxation, and neurophysiological responses. Cognitive-behavioral therapy (CBT) operates through cognitive restructuring, behavioral modification, and pain perception modulation. Meditation practices, such as mindfulness and meditation-based pain relief, cultivate mindfulness and promote emotional regulation, leading to reduced pain perception and improved overall well-being. Acupuncture, a traditional Chinese therapy, involves needling specific points to achieve pain relief through mechanisms like endorphin release, neural pathway modulation, and anti-inflammatory effects. Herbal medicine, with its rich pharmacopeia, contributes to pain management through anti-inflammatory, analgesic, and muscle relaxant properties. Mechanisms encompass modulation of neurotransmitters, prostaglandins, and ion channels. Collectively, these non-pharmacological interventions empower individuals to actively engage in their pain management and improve their quality of life.

Non-steroidal Anti-inflammatory Drugs and Osteopathic Manipulative Treatment for Pain Management in Patients With Osteoarthritis: A Literature Review.

The pathophysiology of osteoarthritis (OA) involves the destruction of articular cartilage and the overgrowth of bone with lipping and spur formation. Nerve endings in the joint capsule and adjacent tissues play a major role in the pain mechanisms of osteoarthritis. This often requires patients to seek pain control measures beyond over-the-counter drugs, such as local anesthetics. Osteopathic manipulation treatment (OMT) is a conservative, non-pharmacological treatment that can be used to help treat chronic pain associated with OA. Other non-pharmacologic therapies include weight loss, exercise, physical therapy (PT), and assistive devices. However, pharmacologic management may be added synergistically to control flares and maintain baseline activities of daily living. While oral non-steroidal anti-inflammatory drugs (NSAIDs) have been the mainstay of treatment for pain and inflammation associated with OA, they have a non-selective inhibitory action that often results in negative side effects when used chronically. The possibility of minimizing these complications through alternate treatments such as topical NSAIDs provides an opportunity for patients to receive adequate pain relief from OA without suffering unnecessary consequences. This literature review seeks to assess the state of research regarding topical NSAIDs and OMT as alternatives to the current gold-standard treatment of OA. The significant inclusion criteria consisted of articles that described the effects of OMT on OA or the use of topical NSAIDs such as Voltaren on OA. Due to the limited articles found, a qualitative analysis was performed, and the salient conclusions are outlined. Alternative pharmacological and non-pharmacological treatments, such as topical diclofenac gel and OMT, have shown promising results in the treatment of pain in OA. It is seen that a majority of patients achieve pain management using NSAIDs, acetaminophen, or topical analgesics. Both diclofenac sodium and OMT have individually been shown to be effective treatments of OA when compared to the use of oral NSAIDs. A holistic treatment approach that utilizes both topical diclofenac sodium and OMT may provide OA patients with an effective option to reduce their moderate to severe chronic pain with limited side effects. Further, high-quality randomized controlled trials are needed to identify whether synergistic effects occur when combining diclofenac sodium gel and OMT for pain relief in patients with OA.

Resolution of Stridor, Gastritis and Cephalgia in an Adolescent with Reflex Sympathetic Dystrophy Following Osteopathic Manipulative Treatment—A Case Report

Resolution of Stridor, Gastritis and Cephalgia in an Adolescent with Reflex Sympathetic Dystrophy Following Osteopathic Manipulative Treatment—A Case Report

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.

The Efficacy of Physical Therapy and Rehabilitation Approaches in Chronic Migraine: A Systematic Review and Meta-Analysis.

Pharmacological treatment is the primary approach in chronic migraine (CM), although non-drug interventions such as physical therapy are used as adjunct treatments. We aimed to review the efficacy of physical therapy and rehabilitation approaches for CM and their impact on quality of life (QoL) and disability. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and included randomized controlled trials (RCTs) in adults with CM. The primary outcomes were changes in intensity, frequency, duration of headache, disability, and QoL. Methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) scale. Data synthesis and quantitative analysis were conducted on relevant studies. Seven RCTs were included in the narrative review, and five of them were eligible for quantitative analysis. Aerobic exercise (AE), osteopathic manipulative treatment (OMT), occipital transcutaneous electrical stimulation (OTES), acupressure, hydrotherapy, instrument-assisted soft tissue mobilization (IASTM), facial proprioceptive neuromuscular facilitation (FPNF), and connective tissue massage (CTM) were used in CM. AE combined with pharmacological therapy reduced the frequency, duration, and intensity of headache. OMT combined with medication improved QoL and reduced disability, intensity of pain, and migraine days per month. Hydrotherapy combined with medication also resulted in improvements in the intensity of headache, frequency, and overall QoL. IASTM and OTES reduced the intensity of headache, alleviated neck pain, and improved QoL, although there were conflicting findings following OTES alone on disability and intensity of headache. Both FPNF and CTM reduced the intensity of headache. Acupressure as an adjunct to medication did not show additional benefits on the intensity of headache and QoL. Quantitative analysis of the data showed that manual physical therapy combined with medication reduced the intensity of headache (p = 0.0796), and manual or AE combined with medication reduced the headache days per month (p = 0.047). A limited number of RCTs investigating the efficacy of physical therapy and rehabilitation approaches show promise in improving headache symptoms, reducing disability, and enhancing QoL in CM. Meta-analysis of the data also supported favorable outcomes for both intensity and headache days per month. Further research is needed to better understand the efficacy, optimal duration, and safety of physical therapy and rehabilitation approaches for CM, and to explore alternative interventions.

Treatment of early post-operative flexion contracture after total knee arthroplasty with osteopathic manipulations

Treatment of early post-operative flexion contracture after total knee arthroplasty with osteopathic manipulations

Effectiveness of Osteopathic Manipulative Treatment in Treating Symptoms of Irritable Bowel Syndrome: A Literature Review.

Irritable bowel syndrome (IBS) is a common gastrointestinal disorder that affects a patient for their entire life. Effective treatments for IBS are scarce, leading to an increased interest in alternative treatmentssuch as osteopathic manipulative treatment (OMT). OMT uses hands-on treatment to reduce pain through various methods. By focusing on visceral techniques, OMT can restore autonomic homeostasis and increase lymphatic flow. This literature review aims to investigate the efficacy of visceral OMT in reducing the severity of IBS symptoms. Five primary research studies were evaluated in this analysis. The concluding results show that visceral OMT effectively reduces the symptoms of IBS and improves patients' quality of life. Therefore, OMT should be considered an alternative therapy for treating IBS.

Effects of the Fourth Ventricle Compression Technique and Rib Raising Osteopathic Technique on Autonomic Nervous System Activity Measured by Heart Rate Variability in 35 Healthy Individuals.

BACKGROUND Fourth ventricle compression (CV4) is a cranial osteopathic manipulation technique for brain and cranial nerve function. Rib raising is an osteopathic technique that reduces rib restriction and conditions associated with sympathetic hypertonia. This study aimed to evaluate the effects of the CV4 and rib raising osteopathic techniques on autonomic nervous system activity, measured by heart rate variability, in 35 healthy individuals. MATERIAL AND METHODS The study involved 35 healthy participants, randomly divided into 2 groups. The experimental group received osteopathic therapy in the form CV4 and rib raising techniques for 30 min. The placebo group had a sham procedure performed using an ultrasound transducer for 20 min. The test of heart rate variability was conducted for 6 min, with participants in a seated position. RESULTS A significant decrease in heart rate values was observed in the experimental group (P=0.012), and an increase in the standard deviation of all the rib raising intervals parameter and a decrease in the high frequency% parameter was observed in the placebo group (P=0.035, P=0.048; respectively). There were no differences in other parameters between the groups. CONCLUSIONS The use of the CV4 technique and rib raising technique leads to a significant decrease in heart rate, which can be interpreted as increased parasympathetic activity; however, the use of these techniques did not affect the other parameters.

A Challenging Case of Scleroderma: Diagnosis, Treatment, and Management

Scleroderma is a relatively rare autoimmune disorder that causes progressive hardening, tightening, and scarring of the skin, as well as internal organ involvement. This case study presents a 56-year-old African American female with diffuse cutaneous scleroderma who has had recurrent complications since 2017, including earaches and fingertip infections. The patient’s medical history, clinical course, diagnosis, and treatment options, including NSAIDs, low-dose corticosteroids, and methotrexate, are discussed. Osteopathic manipulative medicine is explored as a potential symptomatic treatment for scleroderma. Early diagnosis and chronic management for scleroderma patients are emphasized to avoid severe complications such as pulmonary hypertension, which can lead to cor pulmonale and right-sided heart failure. Further research is needed on prophylactic treatments for scleroderma complications and the potential link between multiple autoimmune disorders and increased susceptibility to scleroderma. This case study provides medical professionals with a better understanding of scleroderma and the available treatment options to improve patient quality of life.

Effects of a focused training on first-year osteopathic medical students' ability to incorporate point-of-care ultrasound in assessment of the anterior knee.

Patients frequently present to the outpatient clinic, urgent care, or emergency department with a painful, swollen knee. Differentiating the underlying etiology can be a challenge for both medical students and seasoned clinicians alike. Because this scenario can represent a time-sensitive emergency, developing skills to diagnose the underlying cause quickly and accurately is essential for proper management, whether the patient would benefit from osteopathic manipulation, prompt administration of antibiotics, or a more invasive procedure like joint aspiration or surgery. The objectives are to determine the effects of a focused ultrasound training on first-year osteopathic medical students' ability to identify normal sonographic anatomy of the anterior knee and to differentiate between three common pathologies: joint effusion, prepatellar bursitis, and cellulitis. First-year osteopathic medical students voluntarily participated in this cross-sectional study. The study protocol included a focused ultrasound training (online materials, brief didactic and single hands-on sessions) followed by a hands-on assessment. A written test and 5-point Likert scale questionnaire were administered before and after the focused training. Nine weeks later, students completed a follow-up written test. The proportion of students who correctly identified common pathologies on written tests before (pretest) and after (posttest) training and on the follow-up written test were compared utilizing the Fisher's exact test. A t test was utilized to compare data from the pretraining and posttraining questionnaires. Of 101 students completing the written pretest andpretraining questionnaire, 95 (94.1 %) completed the written posttest and posttraining questionnaire, and 84 (83.2 %) completed the follow-up written test. Students had limited previous experience with ultrasound; 90 (89.1 %) students had performed six or fewer ultrasound examinations before the focused ultrasound training. On written tests, students accurately identified joint effusion (22.8 % [23/101] pretest, 65.3 % [62/95] posttest, 33.3 % [28/84] follow-up test), prepatellar bursitis (14.9 % [15/101] pretest, 46.3 % [44/95] posttest, 36.9 % [31/84] follow-up test), and cellulitis (38.6 % [39/101] pretest, 90.5 % [86/95] posttest, 73.8 % [62/84] follow-up test). Differences were found between pretest andposttest for identification of all three pathologies (allp<0.001) and between the pretest and 9-week follow-up test for identification of prepatellar bursitis andcellulitis (both p≤0.001). For questionnaires, (where 1=strongly agree, 5=strongly disagree), the mean (standard deviation [SD]) confidence for correctly identifying normal sonographic anatomy of the anterior knee was 3.50 (1.01) at pretraining and 1.59 (0.72) at posttraining. Student confidence in the ability to differentiate joint effusion, prepatellar bursitis, and cellulitis utilizing ultrasound increased from 4.33 (0.78) at pretraining to 1.99 (0.78) at posttraining. For the hands-on assessment, 78.3 % (595 correct/760 aggregated responses) of the time students correctly identified specific sonographic landmarks of the anterior knee. When the evaluation combined real-time scanning with a prerecorded sonographic video clip of the anterior knee, 71.4 % (20/28) accurately identified joint effusion, 60.9 % (14/23) correctly diagnosed prepatellar bursitis, 93.3 % (28/30) recognized cellulitis, and 47.1 % (8/17) diagnosed the normal knee. Our focused training was effective at immediately increasing basic knowledge, as well as confidence of first-year osteopathic medical students when assessing the anterior knee with point-of-care ultrasound. However, spaced repetition and deliberate practice may be useful for learning retention.

Osteopathic manipulative treatment in improving symptoms and quality of life in patients with Graves’ ophthalmopathy: A case report

BackgroundGraves' Disease (GD) is an autoimmune disorder, with ∼50% of GD patients developing Graves’ Ophthalmopathy (GO). Common presentations include lid retraction, exophthalmos, disfigurement, ocular pain, and pressure. Treatment of GD depends on disease severity, ranging from artificial tears to ocular surgeries. Patients with GO symptoms experience a decreased quality of life (QoL) and could benefit from additional treatment options. ObjectiveThis case report describes the use of osteopathic manipulative treatment (OMT) as an adjunct to standard care for a patient with symptomatic GO, and measurement of treatment response with a standardized QoL assessment tool. Clinical featuresClinical evaluation of a patient with GO showed clinical activity score to be 4 with oppressive feeling behind globes, hyperemia, and eyelid edema. Corneal displacement measured by Hertel exophthalmometer indicated increased proptosis. CT scan showed enlarged extraocular muscles bilaterally, with signs of edema in retrobulbar fat. Visual acuity and optic nerves were within normal limits. Intervention and outcomesThis case report demonstrates the use of OMT in long-term reduction of ocular pain and pressure by relieving orbital myofascial tension along with improving ocular circulation, in a patient with GO. Using the European Group On Graves’ Orbitopathy QoL questionnaire, the patient noted better quality of life (93, 81.3 for pretreatment visual and appearance scores, respectively, and 100, 87.5 for post-treatment visual and appearance scores, respectively) and perceived reduced exophthalmos. ConclusionsProviding OMT as a cost effective, non-invasive treatment option for GO symptoms could meet a significant need for GO patients and warrants further study.

Evaluation of the effects of osteopathic manipulative treatment associated with transcranial direct current stimulation in chronic nonspecific low back pain. A protocol for a randomised controlled trial

ObjectiveThis study aimed to investigate the effects of osteopathic manipulative treatment (OMT) combined with transcranial direct current stimulation (tDCS) in individuals with chronic nonspecific low back pain (CNSLBP). MethodsThis will be a randomized controlled clinical trial of three groups with blinded evaluators and participants. The study will be conducted at the at the Rehabilitation Center of the Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil. Participants72 participants of both sexes, with CNSLBP. InterventionParticipants will be randomly allocated into three groups, with 24 participants per group (Group 1: active tDCS + active OMT; Group 2: placebo tDCS + placebo OMT; Group 3: placebo tDCS + active OMT). Assessments will be conducted before and after the intervention protocol and 1 month after the end of the entire process. For tDCS, 10 sessions of 20 minutes over 2 weeks (5 sessions per week). OMT will be performed by an osteopath, with two consultations, one per week, before the first and sixth sessions of tDCS. Main outcome measuresThe primary outcome will be the visual analog pain scale, and the Roland Morris disability and EuroQol-5D quality of life questionnaires will be used as secondary. AnalysisThe statistical analysis will be calculated using linear mixed models and based on intention-to-treat. The level of significance will be set at α = 5%.

The effectiveness of disinfection protocols in medical school osteopathic manipulative medicine labs.

In light of the COVID-19 pandemic, healthcare-associated infections have taken center stage. Healthcare has adjusted workflows to accommodate for more robust disinfecting regiments to help protect the community. This has resulted in the need for medical institutions to reevaluate the current disinfection protocols down to the student level. The osteopathic manipulative medicine (OMM) laboratory provides an optimal avenue for assessing the effectiveness of medical students' ability to clean examination tables. With OMM laboratories having a high level of interaction, adequate disinfection is important for the health and safety of students and teaching faculties. This study will evaluate the effectiveness of the current disinfection protocols in the medical school OMM labs. A cross-sectional, nonrandomized study was performed on 20 OMM examination tables utilized for osteopathic training. Tableswere chosen based on their close proximity to the podium. Close proximity was utilized as a criteria to increase the probability of utilization by students. The sampled tables were observed to ensure their use by students during class. Initial samples were collected in the morning after disinfection by Environmental Services. Terminal samples were collected after Osteopathic medical students utilized and disinfected the OMM examination tables. Samples were collected from the face-cradle and midtorso regions and analyzed utilizing adenosine triphosphate (ATP) bioluminescence assays with an AccuPoint Advanced HC Reader. This reader provides a digital readout of the quantity of light measured in relative light units (RLUs), which is directly correlated to the amount of ATP present in the sample, providing an estimated pathogen count. For statistical analysis, a Wilcoxon signed-rank test was utilized to find statistical differences in RLUs in samples after initial and terminal disinfection. The face cradle showed a 40 % increase in failure rate in samples after terminal disinfection when samples were compared after initial disinfection. A Wilcoxon signed-rank test revealed an estimated pathogen level for face cradle that was significantly higher after terminal disinfection (median, 4,295 RLUs; range, 2,269-12919 RLUs; n=20) compared to initial disinfection (median, 769 RLUs; range, 29-2,422 RLUs; n=20), z=-3.8, p=0.00008, with a large effect size, d=2.2. The midtorso region showed a 75 % increase in samples after terminal disinfection when samples were compared after initial disinfection. A Wilcoxon signed-rank test revealed that the estimated pathogen levels for midtorso were significantly higher after terminal disinfecting (median, 656 RLUs; range, 112-1,922 RLUs; n=20) compared to initial disinfecting (median, 128 RLUs; range, 1-335 RLUs; n=20), z=-3.9, p=0.00012, with a large effect size, d=1.8. This study suggests that medical students frequently failed to disinfect high-touch regions on examination tables, such as the midtorso and the face cradle. It is recommended that the current OMM lab disinfection protocol be modified to include the disinfection of high-touch regions in order to reduce the possibility of pathogen transmission. Further research should explore the effectiveness of disinfection protocols in clinical settings such as outpatient offices.

Quantitative ultrasound to assess efficacy of treatment for neck somatic dysfunctions: a feasibility study.

Neck pain is a common complaint in healthcare clinics. Although the pathogenesis of neck pain is often multifactorial, trapezius muscle dysfunction has been commonly linked to neck pain. Osteopathic manipulative treatment (OMT) has been demonstrated to be an effective treatment modality in treating trapezius muscle dysfunction and neck pain. However, there is a current lack of objective, quantitative measures to assess the effectiveness of OMT. Through previous research, ultrasound technology has been shown to be promising in its ability to quantify tissue changes both pre- and post-OMT. The objectives of this study are to evaluate the feasibility of shear wave elastography (SWE) in assessing upper trapezius muscles with pain and hypertonicity, as well as the changes in these muscles post-OMT for cervical somatic dysfunctions. After obtaining approval from the Rocky Vista University Institutional Review Board and written informed consent from participants, SWE and osteopathic assessments were performed on 22 adult participants with and without cervical spine somatic dysfunction. Participants with positive osteopathic assessments of tissue texture, asymmetry, restricted motion, and/or tenderness (TART) were treated utilizing OMT. Shear wave velocity (SWV, m/s) and shear wave velocity rate [SWVR = (SWV contraction- SWV relaxation)/ SWV relaxation] of the upper trapezius muscles with and without pain and hypertonicity, and before and after OMT, were examined utilizing a two-tailed t-test. SWV in muscle contraction and SWVR were significantly lower in muscles with pain compared to muscles without pain (p≤0.01). SWV in muscle contraction was also significantly lower in hypertonic muscles compared to normotonic muscles (p<0.01). Following OMT, SWV in muscle contraction and SWVR in muscles with pain and hypertonic increased significantly (p≤0.01). Overall TART score of all muscles with somatic dysfunction (SD) after OMT significantly decreased (p<0.01). SWV in muscle contraction and SWVR in hypertonic muscles were also significantly increased (p≤0.03), with an improvement index of 0.11 and 0.20. This study's results demonstrate the feasibility of utilizing SWE to evaluate somatic dysfunctions of the upper trapezius musculature and the efficacy of OMT for neck somatic dysfunctions.

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.

Osteopathic Manipulative Treatment in Patients with Anxiety and Depression: A Pilot Study, Part 2

Abstract Background &amp; Aims This is part 2 of an original study with a focus on pain. The role of touch in psychiatry is debatable; the purpose of this pilot study was to determine the effectiveness of osteopathic manipulative treatment (OMT) in treating pain in patients with comorbid anxiety and/or depression. Methods The study was an 8-week prospective, experimental, randomized, controlled pilot study to examine the effects of OMT as an adjunctive treatment of chronic anxiety and depression and pain. The study compared a treatment group to a control group, each consisting of 10 randomly-assigned adult participants with anxiety and/or depression on psychotropics, with a focus on pain. All patients were assessed and evaluated weekly using a musculoskeletal screening assessment which included the Numeric Rating Scale (NRS-11) to grade the level of pain or discomfort. From the initial cohort (n=20), a complete database was achieved for 16 of the patients. Statistical analysis was performed using RStudio. Results Of the 16 patients who successfully participated in the study, 6 received OMT, and 10 were part of the control group. Statistical analysis of pain treatment group data revealed a week one mean of 7.0 ± 2.4 (n=6) with a paired t-test showing significance as early as week three 5.7 ± 2.1 (n=6), P = 0.025* and thereafter. Analysis of pain control group data revealed a week 1 mean of 6.4 ± 1.8 (n=10) with paired t-test significant at weeks 6 through 8. All patients in the treatment group showed significant improvements in their pain levels in half the time compared to those in the control group. Conclusions Findings in this study indicate that OMT may be an effective adjunctive treatment modality for alleviating pain in patients with comorbid depression and anxiety.

Osteopathic Manipulative Treatment of Chronic Pelvic Pain due to High-Tone Pelvic Floor Dysfunction

Context: Chronic pelvic pain syndrome (CPPS) is a complex pain syndrome that affects 15%–30% of people of childbearing age (~10–20 million, US). Etiologies range from musculoskeletal conditions and visceral disease to neurological and psychological disorders. The interplay of many systems and disorders can manifest into a complex pathophysiology that is difficult to diagnose and treat. Dysfunction of the musculoskeletal system is often involved in patients with CPPS, either as the cause of pain or the result of underlying disease or dysfunction. Hypertonicity of pelvic floor muscles, myofascial trigger points, and dysfunctional shortening of the levator ani group of muscles contribute to the structural and functional abnormalities involved in CPPS. Osteopathic physicians are in a unique position to directly address this somatic dysfunction with a nonpharmacologic, nonsurgical approach: osteopathic manipulative treatment (OMT).Objectives: The purpose of this article is to review the literature on manual treatment efficacy for high-tone pelvic floor dysfunction (HTPFD) and the standardization of diagnosis to provide rational, medically based treatments. The second purpose is to elucidate the steps that the medical, and specifically the osteopathic profession can take to standardize pelvic floor evaluation, diagnosis, and treatment in the primary care setting.&#x0D; Methods: A search was conducted on the US National Library of Medicine’s PubMed database for studies involving manual therapy treatment for HTPFD. The authors excluded studies that described manual therapy interventions aimed at increasing pelvic floor muscle tone in patients with urinary incontinence and/or pelvic organ prolapse.Results: For perspective, the initial search using the keywords “chronic pelvic pain syndrome” led to 2,281 publications since 1974; the addition of “osteopathic” led to 10 results since 2009. The search for “high-tone pelvic floor dysfunction” led to 30 publications since 1992; the addition of “osteopathic” yielded no results. To evaluate the efficacy of manual therapy for HTPFD, the search was expanded to include any manual therapy protocols. While the consensus in the literature is that manual treatment for chronic pelvic pain (CPP) is efficacious, the finding is limited by the lack of a comprehensive protocol to appropriately diagnose and treat the patient. The authors propose a system to standardize the assessment of a patient with CPP in the primary care setting by an appropriately trained physician so that pelvic floor dysfunction is recognized, properly diagnosed and treated, or referred to specialized care.Conclusion: The literature supports that manual therapy is an effective treatment for CPP, and as primary care providers, osteopathic physicians are uniquely placed to recognize and treat patients with HTPFD, providing an empathetic, patient-centered approach. Standardization of the diagnosis and manual treatment of HTPFD is required to assess and monitor patients systematically. Development of an advanced training program for clinicians to learn diagnostic approaches and OMTfor the pelvic floor should be required since the techniques addressing the pelvic floor musculature are often not included in traditional training.