Osteopathic Manual Therapy Research Articles

Effects of Osteopathic Manual Therapy on Hyperinflation in Patients with Chronic Obstructive Pulmonary Disease: A Randomized Cross-Over Study.

Osteopathic manual therapy (OMT) may reduce hyperinflation in patients with chronic obstructive pulmonary disease (COPD) by improving breathing mechanics. The aim of the study was to evaluate the immediate effects of OMT on hyperinflation in stable COPD patients with forced expired volume in 1s (FEV1) <50% predicted. Nineteen COPD patients of the median age 68 (IQR 63-72) years and the median FEV1 39.8 (IQR 33.4-46.6) % predicted were enrolled into the study. For the first session, patients were randomly assigned to either OMT or sham therapy. During the second session, the two groups of patients were crossed over. Pulmonary function and dyspnea were compared before and after both procedures. Neither pulmonary function nor dyspnea differed significantly before and after OMT or sham procedures. However, 36.7% and 47.4% patients achieved the minimally important difference for residual volume (RV) reduction after both OMT and sham therapy, respectively. Responders to OMT had a greater median (IQR) baseline sense of dyspnea compared to non-responders, assessed on a visual analog scale, of 7.0 (4.5-7.0) vs. 3.0 (0.0-5.0), p=0.040, respectively. Although OMT did not have an immediate effect on hyperinflation or dyspnea, a subgroup experienced a reduction in RV following OMT and sham therapy. Future studies are needed to identify the characteristics of responders.

Randomized Two-Dimensional between-Patient Response Surface Pathway Design with Two Interventional- and One Response Variable in Estimating Minimum Efficacy Dose

Background: The aim of this paper is to introduce and evaluate the RSP design with two interventional and one response variable exemplified by estimating minimum efficacy dose (MED) of osteopathic manual therapy (OMT) in treatment of gastroesophageal reflux disease (GERD). Methods: 15 GERD patients, divided in three design-level with three, five and seven patients. The study was performed as a randomized two-dimensional, between-patient RSP designed multicenter study with two interventional– and one response variable. The interventional variables “Number of OMT’s” and “Treatment Interval” with common response variable, formed two independent one-dimensional randomized between-patient RSP studies. The response variable was percent reduction in sum of the five GERD score from baseline. Three GERD patients were allocated on the first design level and given six OMT with five days’ interval. Based on results obtained in the first and second design level, five patients were included to the second design level and seven to the third. Results: The two-dimensional randomized between-patient RSP-design with the combined outcome procedure worked as expected. The percent reduction in GERD score increased with increasing number of OMT’s and time intervals. This increase leveled out after three to five OMT’s and three to four days between treatments. A clinical interaction between the two interventional variables was obtained. The estimated MED of OMT in treatment of GERD was three treatments with two days between treatments. Conclusions: The suggested two-dimensional, randomized between-patient RSP-design worked as expected and estimated MED of OMT in GERD patient sufficiently.

Study to findout the efficacy of osteopathic manual therapy in chest expansion in copd patients

Study to findout the efficacy of osteopathic manual therapy in chest expansion in copd patients

Osteopathic manual therapy in heart failure patients: A randomized clinical trial

BackgroundHeart Failure (HF) patients usually present with increased arterial resistance and reduced blood pressure (BP) leading to an impaired functional capacity. Osteopathic Manual Therapy (OMT) focused on myofascial release techniques (MRT) and in the balancing of diaphragmatic tensions, has been shown to improve blood flow in individuals using the resistive index (RI). However, its effects in HF patients have not been examined. PurposeTo evaluate the acute response of selected osteopathic techniques on RI, heart rate (HR), and BP in patients with HF. MethodsRandomized-controlled clinical trial of HF patients assigned to MRT (six different techniques with three aimed at the pelvis, two at the thorax, and one at the neck for 15 min) or Control group (subjects in supine position for 15 min without intervention). The RI of the femoral, brachial and carotid arteries was measured via doppler ultrasound while HR and BP were measured via sphygmomanometry before and after a single MRT or control intervention. ResultsTwenty-two HF patients equally distributed (50% male, mean age 53 years; range 32–69 years) (ejection fraction = 35.6%, VO2peak: 12.9 mL/kg−1 min−1) were evaluated. We found no intra or inter group differences in RI of the carotid (ΔMRT: 0.07% vs Δ Control:11.8%), brachial (ΔMRT:0.17% vs ΔControl: 2.9%), or femoral arteries (ΔMRT:1.65% vs ΔControl: 0.97%) (P > 0.05) and no difference in HR or BP (ΔMRT:0.6% vs ΔControl: 3%), (P > 0.05). ConclusionA single MRT session did not significantly change the RI, HR, or BP of HF patients.

The Use of Osteopathic Manual Therapy and Rehabilitation for Subacromial Impingement Syndrome: A Case Report

Rotator cuff dysfunction is common in athletes involved with overhead sports. Secondary subacromial impingement is a common cause of pain for patients with rotator cuff dysfunction. Exercise rehabilitation and manual therapy can be used in the treatment of subacromial impingement to decrease pain, increase functionality and support a return to activity. The current case report describes a 24-year-old patient with supraspinatus tendinosis and secondary subacromial impingement who was experiencing pain when playing tennis, and during daily activities involving overhead movements. Osteopathic manual therapy and rehabilitation was undertaken leading to significant improvements in pain and function over a six-week period. The current case report describes an evidence-informed approach to the management of subacromial impingement syndrome whilst incorporating a manual therapy technique, balanced ligamentous tension, that has received little attention in the literature.

The effect of visceral osteopathic manual therapy applications on pain, quality of life and function in patients with chronic nonspecific low back pain.

The efficacy of osteopathic manual therapy (OMT) applications on chronic nonspecific low back pain (LBP) has been demonstrated. However, visceral applications, which are an important part of OMT techniques, have not been included in those studies. The study's objective was to determine the effect of OMT including visceral applications on the function and quality of life (QoL) in patients with chronic nonspecific LBP. The study was designed with a simple method of block randomization. Thirty-nine patients with chronic nonspecific LBP were included in the study. OMT group consisted of 19 patients to whom OMT and exercise methods were applied. The visceral osteopathic manual therapy (vOMT) group consisted of 20 patients to whom visceral applications were applied in addition to the applications carried out in the other group. Ten sessions were performed over a two-week period. Pain (VAS), function (Oswestry Index) and QoL (SF-36) assessments were carried out before the treatment and on the sixth week of treatment. Both of the treatments were found to be effective on pain and function, physical function, pain, general health, social function of the QoL sub-parameter. vOMT was effective on all sub-QoL parameters (p<0.05). Comparing the groups, it was determined that the energy and physical limitations of the QoL scores in vOMT were higher (p< 0.05). Visceral applications on patients with non-specific LBP gave positive results together with OMT and exercise methods. We believe that visceral fascial limitations, which we think cause limitations and pain in the lumbar segment, should be taken into consideration.

Does Osteopathic Manipulative Treatment (OMT) have an Effect in the Treatment of Patients Suffering from Gastro Esophageal Reflux Disease (GERD)?

Background: During the last 50 years, the efficacy of medication in the treatment of gastro esophageal reflux disease (GERD) has increased with introduction of histamine 2 antagonists and proton pump inhibitors. Surgical treatment is effective, but irreversibleand complications may occur. Is it possible to develop an effective treatment procedure beside pharmaceuticals and surgery? Objective: To describe Osteopathic Manual Therapy (OMT) techniques and investigate the effect in patients suffering from GERD. Design: The study performed as an open, single-centre, one-armed interventional trial. Material: Eighteen female and four male GERD patients, mean age and disease duration of 47.4 years and 20.4 months, recruited from one single OMT practice. Method: The patients received three to 12OMT interventions consisting of thoracic spine and diaphragm mobilisation, traction of the cardia and posture correction. The interval between interventions was one week and the effect recorded as “none,” “slight,” “moderate” or “good.” The presence of heartburn, retrosternal pain, acid in the mouth, epigastric pain and tension or pain in the lower thoracic spine recorded before and three month after the last treatment. Results: The prevalence and total number of GERD symptoms were significantly reduced (p << 0.01) and only two patients reported an unchanged situation. A “moderate” or “good” effect reported by 77.3 % of the patients. In 19 patients with extended thoracic kyphosis and reduced extension, 78.9 % reported a “moderate” or “good” treatment effect. No differences detected between patients using and not using additional GERD pharmaceuticals. Conclusions: The results indicate a positive effect of OMT in the treatment of GERD.

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.

Quantification of Motion Palpation.

The palpation of motions is at the heart of the practice of foreign-trained osteopaths. When practicing osteopathic manual therapy (care provided by foreign-trained osteopaths) in the cranial field or osteopathic cranial manipulative medicine, the palpation of small motions (several tens of micrometers) is a key process. However, to the authors' knowledge, the smallest detectable motion has not been identified. To quantify motion detection capacity by passive palpation. Participants were instructed to hold a mechanical device containing a micrometric actuator between their hands and report when they felt motion while 6 series of 27 random motions were generated by the actuator. After each series, if a participant succeeded or failed to detect motion with a confidence level of greater than 98%, the motions in the next series were set to a smaller or larger magnitude, respectively. After 6 series, the individual motion detection capacity was recorded. Statistical significance was set at P=.02. A total of 21 participants were selected, comprising 14 osteopaths and 7 nonosteopaths. The average performance of the sample was 148 μm. Thirteen participants (62%) perceived motions of 200 μm or less, and 7 participants (33%) detected motions of 50 μm or less with bare hands. Osteopathic training did not notably affect the performance. Osteopaths were twice as likely to claim detection of nonexisting motions than to miss existing ones, whereas nonosteopaths were equally subject to both types of errors. The data show human passive palpatory sensitivity to be in the range of several tens of micrometers. This range is comparable to that reported for calvarial motion (10-50 μm).

Can laypersons be trained to effectively deliver osteopathic manual therapy to patients with HIV?: a pilot study.

Osteopathic manipulative treatment (OMT) may provide added benefits to standard human immunodeficiency virus (HIV) and AIDS treatments. However, lack of access to trained OMT providers is a potential barrier to the widespread use of OMT in the management of HIV and AIDS. To determine the best time to measure the short-term impact of a brief OMT protocol on white blood cell counts in individuals with HIV and AIDS. Also, to explore recruiting and training laypersons to administer select osteopathic manual techniques. Participants were HIV-positive men aged between 18 and 65 years who had not undergone antiretroviral therapy in the past 12 months, had CD4(+) lymphocyte counts of 200 to 700 cells/mm(3), and had viral load levels of less than 100,000 copies/mL. Participants were randomly assigned to an OMT group or a control group; those in the OMT group recruited a layperson for training in osteopathic manual therapy. Participants in the OMT group received a 15-minute OMT protocol consisting of myofascial release of the thoracic inlet, pectoral traction, rib raising, thoracic pump, and abdominal pump. Participants in the control group engaged in conversation with the researcher for 15 minutes. Between-group differences for each white blood cell type were examined at varying time intervals after the protocols. Laypersons were trained to administer thoracic and abdominal pump techniques. They were tested by multiple choice examinations and by an independent rater for fidelity of administration. Twenty-one participants met the eligibility criteria. Of those, 18 returned for their study visit (OMT group, n=9; control group, n=9). An optimal time interval for measurement of white blood cell changes across the 5 cell types was not determined. However, P values for the 30-minute interval were consistently below 0.18 for neutrophils, eosinophils, and monocytes. Nine laypersons were trained in osteopathic manual therapy, 5 of whom scored 100% on initial completion of the multiple-choice examination; the remaining 4 laypersons scored 80% on the first try and 100% on the second try. All laypersons appropriately administered the manual therapy protocol. It is feasible to recruit and train laypersons to administer selected osteopathic manual therapy techniques with fidelity. Longitudinal studies on this concept are needed to examine patient outcomes and to evaluate the retention and fidelity of laypersons over time.

Treatments for pregnancy-related lumbopelvic pain: a systematic review of physiotherapy modalities.

To explore the effect of physiotherapeutic interventions on pregnancy-related lumbopelvic pain. Data sources: MEDLINE, Cochrane Central Register of Controlled Trials, PEDro, CINAHL, AMED, and SCOPUS databases were searched up to December 2014 for studies written in English, French, German or Scandinavian languages that evaluated physiotherapeutic modalities for preventing and treating pregnancy-related lumbopelvic pain. For lumbopelvic pain during pregnancy, the evidence was strong for positive effects of acupuncture and pelvic belts. The evidence was low for exercise in general and for specific stabilizing exercises. The evidence was very limited for efficacy of water gymnastics, progressive muscle relaxation, a specific pelvic tilt exercise, osteopathic manual therapy, craniosacral therapy, electrotherapy and yoga. For postpartum lumbopelvic pain, the evidence was very limited for clinic-based treatment concepts, including specific stabilizing exercises, and for self-management interventions for women with severe disabilities. No specific adverse events were reported for any intervention. No meta-analysis could be performed because of study heterogeneity. The levels of evidence were strong for a positive effect of acupuncture and pelvic belts, but weak for an effect of specific exercises. Caution should prevail in choosing other interventions for pregnancy-related lumbopelvic pain.

Osteopathic Manual Treatment and Ultrasound Therapy for Chronic Low Back Pain: An Illustration of Osteopathic Semantic Confusion

Osteopathic Manual Treatment and Ultrasound Therapy for Chronic Low Back Pain: An Illustration of Osteopathic Semantic Confusion

The effect of cranial osteopathic manual therapy on somatic tinnitus in individuals without otic pathology: Two case reports with one year follow up

The following case reports present the effect of treating proposed cranial bone dysfunctions on chronic somatic tinnitus, following head trauma, with one year follow up. Both cases were suffering from chronic tinnitus on the right side without any otic pathology or temporomandibular dysfunctions. Temporary and limited effects of medications and other treatments on their persistent tinnitus had a negative effect on their social interactions and quality of life. Both patients were considered to demonstrate marked sphenoid, temporal and occipital bone dysfunctions, based on manual cranial treatment. Active tender points were also identified with intra-oral palpation and examination on the lateral pterygoid muscle on the right side.Manual therapy of the cranial bones for restoration of normal alignment and cranial rhythm and myofascial release technique to deactivate tender points on the lateral pterygoid had a significant effect on reducing the persistent tinnitus in both patients. At one-year follow up, both patients reported significant improvement in their quality of life and social interactions without recurrence of their tinnitus symptoms. The findings of this study suggest that cranial manual therapy and myofascial release technique could be a potential treatment for somatic tinnitus in patients with no otic pathology or temporomandibular disorders.

Osteopathic intervention in chronic non-specific low back pain: a systematic review

BackgroundChronic Non Specific Low Back Pain (CNSLBP) is a common, complex and disabling condition that has been present for longer than three months and is not caused by a serious pathology. Osteopaths are health practitioners who commonly diagnose and treat CNSLBP patients using a complex set of interventions that includes manual therapy. The study aimed to complete a Systematic Review of clinical research into osteopathic intervention in CNSLBP using a rigorous assessment of study quality.MethodsThe literature was searched to August 2011 using the following databases: AMED, CINAHL Plus, Cochrane Central Register of Clinical Trials, MEDLINE Plus, EMBASE, MANTIS, OSTMED, PEDro, ScienceDirect. Multiple search terms were used in various combinations: osteopathy/osteopathic, osteopathic manipulative technique, OMT, Spinal Manipulative Therapy, SMT, clinical trial, back pain, chronic back pain. The inclusion criteria were papers that: reported clinical trials; had adult participants; tested the effectiveness and/or efficacy of osteopathic manual therapy intervention applied by osteopaths, and had a study condition of CNSLBP. The quality of the papers was assessed using the Cochrane Back Review Risk of Bias criteria. A meta-analysis would proceed if the studies had adequate clinical and methodological homogeneity.ResultsInitial searches revealed 809 papers, 772 of which were excluded on the basis of abstract alone. The remaining 37 trial papers were subjected to a more detailed analysis of the full text, which resulted in 35 being excluded. The two remaining trials had a lack of methodological and clinical homogeneity, precluding a meta-analysis. The trials used different comparators with regards to the primary outcomes, the number of treatments, the duration of treatment and the duration of follow-up.ConclusionThere are only two studies assessing the effect of the manual therapy intervention applied by osteopathic clinicians in adults with CNSLBP. One trial concluded that the osteopathic intervention was similar in effect to a sham intervention, and the other suggests similarity of effect between osteopathic intervention, exercise and physiotherapy. Further clinical trials into this subject are required that have consistent and rigorous methods. These trials need to include an appropriate control and utilise an intervention that reflects actual practice.

The effect of osteopathic manual therapy on the vascular supply to the lower extremity in individuals with knee osteoarthritis: A randomized trial

Osteopathic principles guide treatments, one of which is the rule of the artery is absolute. Objectives of this study were to determine if selected osteopathic techniques (fascial releases along the arterial pathway and balancing of diaphragmatic tensions) were able to influence the vascular supply, dynamic balance, knee range of motion (ROM) and symptoms. Methods: Thirty subjects with radiographic confirmed knee osteoarthritis were randomly assigned to one of two groups: 1) osteopathic evaluation combined with treatment (treatment group); 2) osteopathic evaluation alone (no treatment group). Outcome measures were recorded before and after each osteopathic session: ultrasound/Doppler recordings of the resistive index (RI) of the superficial femoral artery (SFA), active knee flexion ROM, step test for balance and the visual analog scale (VAS) symptom rating. A two factor mixed model Analysis of Variance (ANOVA) for group (evaluation vs. treatment) with repeated measures (pre versus post test) was employed to test for main effects and all interactions for each dependent variable (alpha = 0.05). Results: The RI reduced significantly (p < 0.008) from pre to post test in the treatment group only. Significant pretest/posttest main effects were found for ROM, balance and symptom rating (p < 0.05). Conclusion: The significant difference in RI provides evidence for the benefits of specificity within osteopathic techniques, and reveal the vascular supply to the leg was affected by the fascial releases and will possibly influence some of the pathophysiological factors of an arthritic knee.

Pudendal nerve entrapment in a bareback rodeo cowboy: A case study

The case of a 31 year-old bareback rodeo cowboy who suffered from pelvic floor pain and spasm is presented. The clinical care pathway for this case was not simple and in fact, misdiagnosed for months prior to seeking the care of an osteopathic manual therapist. The pelvic floor muscle spasm was presumably caused by pudendal nerve entrapment even though there were no diagnostic tests such as EMG to confirm it. The entrapment was thought to be from the abdominal viscera (mesentery and sigmoid colon) being adhered to peritoneal tissue in the small pelvis. Treatment consisted of four consecutive days of osteopathic manual therapy treatment due to special patient availability and circumstances. The treatment focused on a release of the root of the mesentery and ischial intraosseous lesions, the release of the sigmoid colon from posterior abdominal wall and iliopsoas muscle, myofascial release of the thoraco-lumbar fascia, and myofascial release of pelvic floor musculature including balancing of three diaphragms, and harmonizing the primary respiratory mechanism within the cranial-sacral system. The etiology is thought to occur due to the sport's natural ptosis forces on the viscera. The patient returned to bareback riding without any issue and on follow-up five years later, did not report any symptoms.

Can laypersons be trained to effectively deliver osteopathic manual therapy to patients with HIV

Can laypersons be trained to effectively deliver osteopathic manual therapy to patients with HIV

Osteopathic manual therapy versus conventional conservative therapy in the treatment of temporomandibular disorders: A randomized controlled trial

Temporomandibular disorders (TMD) is a term reflecting chronic, painful, craniofacial conditions usually of unclear etiology with impaired jaw function. The effect of osteopathic manual therapy (OMT) in patients with TMD is largely unknown, and its use in such patients is controversial. Nevertheless, empiric evidence suggests that OMT might be effective in alleviating symptoms. A randomized controlled clinical trial of efficacy was performed to test this hypothesis. We performed a randomized, controlled trial that involved adult patients who had TMD. Patients were randomly divided into two groups: an OMT group (25 patients, 12 males and 13 females, age 40.6+/-11.03) and a conventional conservative therapy (CCT) group (25 patients, 10 males and 15 females, age 38.4+/-15.33). At the first visit (T0), at the end of treatment (after six months, T1) and two months after the end of treatment (T2), all patients were subjected to clinical evaluation. Assessments were performed by subjective pain intensity (visual analogue pain scale, VAS), clinical evaluation (Temporomandibular index) and measurements of the range of maximal mouth opening and lateral movement of the head around its axis. Patients in both groups improved during the six months. The OMT group required significantly less medication (non-steroidal medication and muscle relaxants) (P<0.001). The two therapeutic modalities had similar clinical results in patients with TMD, even if the use of medication was greater in CCT group. Our findings suggest that OMT is a valid option for the treatment of TMD.

Treatment of Carpal Tunnel Syndrome With Medical Acupuncture

ABSTRACT Background: Conservative management plays an important role in the treatment of carpal tunnel syndrome. Non-surgical options include physical and occupational therapy, splints, steroid injections, yoga, carpal bone mobilization, and anti-inflammatory drugs. Clinical experience demonstrates that acupuncture should be considered among these treatments as it may provide symptomatic relief to patients with this disorder. Objective: To demonstrate an acupuncture protocol for the treatment of carpal tunnel syndrome. Design, Setting, and Patients: Seventeen patients with electrodiagnostically confirmed carpal tunnel syndrome treated by a solo medical acupuncture practitioner for carpal tunnel syndrome. Patients were seen between 1998 and 2007 at the practitioner's New York office. Intervention: Needling of PC 6, PC 7, TH 5, and Baxie 1 and 2 points. Most patients additionally received osteopathic manual therapy. Main Outcome Measure: Patient-reported symptom relief. Results: Twelve of 17 patients had pa...

The Autonomic Nervous System Activity and Osteopathic Manipulation

The Osteopathic medical profession generally accepts that Osteopathic manual therapy (OMT) can be used to influence sympathovagal balance. However, there is little quantitative data evaluating this relationship. This study tested the hypothesis that cervical myofascial release increases vagal modulation of heart rate. The protocol lasted 30 minutes. Changes in body position were incorporated into the study to facilitate interpretation of autonomic tone measures. The protocol consisted of studying 17 human subjects in three positions; 10 min - horizontal, 10 min - 50 deg head-up, and 10 min - horizontal. Each subject was studied three times (control, sham, OMT) separated by at least one day. The OMT (cervical myofascial release) was applied while subjects were head-up. Sympathovagal balance was assessed by using spectral analysis of heart rate variability. In the control group, head-up tilt increased heart rate and the LF/HF ratio. The ratio increased from 1.45±0.23 (mean±SE) to 4.85±0.60 reflecting an increase in sympathetic and decrease in vagal tone. Sham treatment was not distinguishable from the control group. OMT caused a significant decrease in LH/HF ratio. The ratio decreased from 4.85±0.6 to 1.80±0.35. The results support the hypothesis that OMT can be used to modulate vagal tone. This study was approved by the institutional IRB; all subjects signed consent forms prior to participation in the study.