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Introduction: Allostatic load refers to the burden of chronic stress, which impairs physical and mental health. Interventions to reduce allostatic load, quantified by various biomarkers, are urgently needed. Preliminary evidence suggests that osteopathic manipulative treatment may lower allostatic load. However, the literature is heterogeneous due to the multitude of relevant biomarkers, which are often not classified as representing allostatic load. Objective: To summarise the evidence on the putative effect of osteopathic manipulative treatment on allostatic load biomarkers and identify knowledge gaps for future research. Methods: A scoping review will be conducted. PubMed, Cochrane, Embase and AMED will be searched from inception to presumable April 2023. The review will include interventional studies that investigate the effect of osteopathic treatment on allostatic load biomarkers (from pre- to post-intervention) in healthy subjects and clinical populations as well as in-vitro and animal models. Keywords: Osteopathic manipulative treatment; Allostatic load; Chronic stress; Biomarkers.

International audience; Introduction: This study explores the value of using motion analysis to evaluate cervical and jaw ROM on students with or without bruxism when comparing Osteopathic Manipulative Treatment (OMT) to sham in school settings. Methods: A feasibility study was run with 48 volunteer students from an osteopathic educational institution. Random sequence for allocation was generated using a 1:1 ratio and block size of four to either OMT or sham treatment (control group). The chosen motion outcomes of interest were the lateral jaw range of motion, jaw opening, cervical rotation and side-bending. ROM was measured averaging over three repeated movements at baseline, immediately after the 1st treatment, one week before the 2nd treatment, and immediately after the second treatment using video-based analysis with 15 body landmarks. Results: Repeated measures of joint motion at baseline showed high levels of reliability (ICC ranging from 0.953 to 0.985). Motion analysis detected clinically important differences between OMT and sham one-week posttreatment for jaw lateral ROM (3.3 degrees; p = 0.018) and cervical rotation ROM (12.0 degrees; p = 0.003) in participants with bruxism but not in those without. Magnitude of differences were increased for all parameters following the second treatment (lateral jaw movement; 4.8 degrees, p = 0.005; jaw opening; 5.5 degrees, p = 0.002; cervical side-bending; 9.2 degrees, p = 0.023; cervical rotation; 18.2 degrees, p < 0.001). Conclusion: Motion analysis is capable of detecting the effects of OMT on cervical and jaw ROM in students with bruxism but not without. Finally, the study showed the feasibility of introducing usual standards for clinical trials and sham treatment in an educational setting with students.

Background & Aims: The role of touch in managing psychiatric patients is controversial. The purpose of this pilot study was to determine the effectiveness of osteopathic manipulative treatment (OMT) in patients with anxiety and or depression. Methods: This was an 8-week pilot study comparing a treatment to a control group, each consisting of 10 randomly assigned adult participants with anxiety and or depression on psychotropics. No significant difference existed between groups for age or severity of disease. Participant responses for anxiety and depression were recorded weekly via a modified Generalized Anxiety Disorder 7 item (GAD-7) and Harvard National Depression Screening Day (HANDS) scales. 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. For statistical purposes, the data gathered from both groups were subdivided into two categories: depression and anxiety subgroups. The depression treatment group had a week 1 mean of 24.4 ± 11.2 (n=5) with a paired t-test showing significance at week 7 of 18.0 ± 10.9 (n=5), P = .00767 and week 8 of 15.2 ± 12.5 (n=5), P = .041.The anxiety treatment group had a week 1 mean of 26.0 ± 8.7 (n=5) with paired t-test significant at week 7 of 20.2 ± 10.7 (n=5), P = .019 and week 8 of 19.2 ± 11.1 (n=5), P = .00815.All patients in the treatment group showed significant improvements in their anxiety and depression levels compared to those in the control group, which worsened by week 8. Conclusions: Findings in this study indicate that OMT may be an effective adjunctive treatment modality for depression and anxiety.

Restoration of blood flow is critical to a blocked coronary blood vessel. With respect to the heart, two main procedures, coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) revascularize the area to prevent future blockages. Post-procedurally, bed rest iatrogenically produces non-life-threatening back pain.1,2 No exact guideline for the duration of post-procedural bed rest exists but recommendations range from 2 to 24 hours.1 However, research has shown that bed rest beyond 4 hours significantly increased the presence of post-procedural back pain.1,2 Osteopathic manipulative treatment (OMT) is the term ascribed to a number of categories of manual techniques used by osteopathic physicians to treat somatic dysfunctions, to complement conventional management in patient care. In this case report, we discuss a patient with post-procedural upper thoracic pain that resolves with OMT, demonstrating that OMT may play a useful post-PCI role in the care of patients who undergo stent procedures.

Context Patient-centered care is often considered a characteristic of osteopathic medicine, in addition to the use of osteopathic manipulative treatment (OMT) in such musculoskeletal conditions as low back pain. Objectives This study aimed to determine if patient-centered care or OMT are mediators of the clinical outcomes of osteopathic medicine in patients with chronic low back pain. Methods A comparative effectiveness study was conducted within the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation (PRECISION Pain Research Registry). Eligible patients met the diagnostic criteria recommended by the National Institutes of Health Task Force on Research Standards for Chronic Low Back Pain and completed four consecutive quarterly encounters between April 2016 and November 2020. The Consultation and Relational Empathy instrument for patient-centered care was used at the baseline encounter and OMT use was measured at the final encounter. The clinical outcome measures included low back pain intensity on a numerical rating scale (NRS) from 0 to 10, back-related functioning on the Roland-Morris Disability Questionnaire (RMDQ), and pain impact on the National Institutes of Health Minimum Dataset for Chronic Low Back Pain (NIH-MDS). A parallel multiple mediator model was used to compute the direct and indirect effects of osteopathic medicine in achieving each of the three clinical outcomes. Results The 404 study patients had a mean age of 52.2 years (standard deviation, 13.1 years) and 288 (71.3%) were female. The 88 (21.8%) patients treated by osteopathic physicians reported more favorable scores for patient-centered care (mean, 41.3; 95% CI 39.0–43.5) than patients treated by allopathic physicians (mean, 38.0; 95% CI 36.8–39.3) (p=0.02). Fifty-six (63.6%) patients treated by osteopathic physicians used OMT. The age- and sex-adjusted outcomes for patients of osteopathic vs. allopathic physicians across all four encounters were: mean, 5.4; 95% CI 5.0–5.7 vs. mean, 5.9; 95% CI 5.7–6.1 on the NRS for pain intensity (p=0.01); mean, 11.3; 95% CI 10.1–12.6 vs. mean, 14.0; 95% CI 13.3–14.7 on the RMDQ for back-related disability (p Conclusions This appears to be the first study to simultaneously address both patient-centered care and OMT as potential mediators of the effect of osteopathic medicine in treating chronic pain. Patient-centered care did not mediate the effects of osteopathic medicine and OMT only mediated outcomes relating to low back pain intensity. More research is needed to identify other aspects of osteopathic medicine that mediate its beneficial effects in patients with chronic low back pain.

Introduction As the prevalence of drug-resistant infections continues to outpace the development of new antibiotics, we must explore all reasonable options for enhancing the effectiveness of existing anti-infectives. The emergence of novel pathogens without initial drug treatments or vaccines, typified by the severe acute respiratory syndrome coronavirus-2 pandemic, further underscores the need for non-pharmacologic adjunctive measures for infection management. Osteopathic manipulative treatment (OMT) may represent such an adjunct. Areas covered PubMed, CINAHL, Google Scholar, Cochrane databases and relevant chapters of major osteopathic texts were searched for animal experiments, case reports, observational studies, non-randomized, and randomized trials pertaining to infection, OMT, and the complications or safety of OMT. OMT was associated with one or more of the following: decreased bacterial colony counts in lung tissue; changes in immunologic profiles manifested by significant differences dendritic cells and levels of IL-8, MCP-1, MIP-1a, and G-CSF; shorter durations of IV antibiotics; decreased length of hospitalization; decreased rates of respiratory failure and death; decreased post-surgical lengths of stay; and enhanced patient satisfaction. Expert opinion Preliminary, lower-grade evidence suggests that OMT can improve some infection-related outcomes, and is safe. The role of OMT in infection management should undergo further controlled trials without delay.

Introduction: Based on the osteopathic principle that “structure and function are interrelated,” a kidney that is not moving optimally with respiration might be limited in its physiologic functions as well. The objective of this study was to determine if osteopathic manipulative treatment (OMT) affects craniocaudal renal mobility and if there are any correlations between renal mobility and blood pressure measurements. Methods: 33 healthy female participants were recruited. 25 participants were in the treatment group, and 8 in the control group. All participants’ blood pressures were recorded initially. All participants were then evaluated for craniocaudal renal mobility via ultrasound measurements using Mindray Z6 technology. The treatment group then received an OMT protocol, while the control group rested for 20 minutes. The ultrasound evaluation for renal mobility was then repeated on the participants, and a final blood pressure reading obtained (Touro College HSIRB #1799). Results: OMT significantly increased the mobility of the right kidney (P Conclusion: In this preliminary study, right kidney mobility increased and systolic and diastolic blood pressure measurements both decreased after OMT. Follow-up studies are warranted to further explore kidney mobility and its potential association with blood pressure measurements, as well as the effects of OMT on kidney mobility and blood pressure.

Objectives: To determine Lean management's ability to improve the efficiency of residents and increase osteopathic manipulative treatment (OMT) in a family medicine residency clinic. Methods: A Key Performance Indicator Board (KPI), a process of Lean management, was created in a residency clinic by various staff. Patient wait times were chosen for the quality measure and daily huddles took place to track progress. A “5-why” was conducted to determine the reasons for failure to meet goals. Faculty used this information to create the 5 “S” of Efficiency method to help residents improve timeliness in caring for complicated patients. Comparisons of the number of patient visits failing wait time goals and total OMT performed before and after the intervention was analyzed. Chi-square was used for statistical analysis and the p-value was set at 0.05. Results: Implementation of the 5 “S” of Efficiency method resulted in a significantly lower percentage of days failing the wait time goal in comparison to months before the intervention (p = 0.00001): the average percentage of failed days decreased from 43.1% to 10.4% with the intervention. Enacting Lean management also resulted in a significantly greater percentage of billed OMT billing codes (6.8% vs. 5.3%) (p = 0.03). Conclusion: This study indicates that the use of Lean may reduce patient wait times and lead to increased OMT use among family medicine residents. Use of Lean or the 5 “S” of Efficiency method may help other osteopathic programs attempting to improve care; however, further research is indicated.

Introduction: This study aims to investigate if proprioception is the mechanism through which osteopathic manipulative treatment (OMT) corrects somatic dysfunctions. OMT focuses on resolving structural asymmetry in the body that may interfere with physiologic function, including proprioception. Multiple theories have been proposed regarding the physiologic mechanisms of OMT and the effect on proprioception, with few studies objectively establishing a connection. Hypothesis: Significant change in measurements of proprioception was expected in the treatment group (OMT) over the 4-week period. Methods: For the study, 35 adults recruited from the Des Moines University community were randomized equally into treatment and control groups. For 3 weeks, the treatment group received weekly osteopathic structural exams (OSE) and OMT, while the control group underwent the same OSE but without treatment. Proprioception was assessed using force plate measurements collected during two-leg and single-leg tests prior to the first intervention, immediately after the first intervention, and 1 week after last intervention. Measurements included anterior-posterior sway, medial-lateral sway, average velocity, area, path length and time, which were analyzed with a linear model of mixed effects for repeated measures to account for the fixed effects (time and treatments), interaction effects and the random subject effects. Results: Over the 4-week period, significant differences were found for 4 measurements: two-leg eyes-open-path-length (p=0.0342), two-leg eyes-open-average-velocity (p=0.0334), single-right-leg eyes-open-average-velocity (p=0.0145), and single-right-leg eyes-closed-medial-lateral-sway (p=0.0488). Conclusion: Certain measurements of proprioception changed in an adult population over a 4-week course with 3 weekly OMT treatments. These results indicate OMT may be altering proprioception through the correction of somatic dysfunctions. Our results suggest a need for further research investigating the effects of OMT on proprioception in symptomatic populations and larger sample sizes.

Parkinson’s disease (PD) is a neurodegenerative disorder with motor symptoms including resting tremor, bradykinesia, cogwheel rigidity, and postural instability. Parkinson’s patients can also exhibit respiratory symptoms. The muscle rigidity associated with PD has been found to be highly correlated with the severity of pulmonary dysfunction. This case details the treatment of a 73-year-old PD patient who presented with acute dyspnea that resolved with application of osteopathic manipulative treatment (OMT). Treatment focused on addressing thoracic cage musculoskeletal restrictions, balancing autonomic flow, and improving circulatory and lymphatic flow. The patient’s respiratory symptoms were alleviated despite a lack of significant pulmonary function test changes immediately post-treatment. This case demonstrates the positive effect of integrating OMT for the treatment of pulmonary symptoms in PD.

Introduction Non-pharmacologic alternative therapies for pain have been around for a long time, some for hundreds of years. They have been used throughout history to treat many issues. Recent Findings Currently, alternative medicine is most frequently used to treat musculoskeletal pain, and between 59 and 90% of patients utilizing alternative therapies for chronic pain claimed they were helpful and can serve as an effective adjunctive for the treatment of chronic pain. Some examples of alternative therapies that will be discussed in this review include acupuncture, tai chi, osteopathic manipulation, and chiropractic care. Acupuncture, traditionally a Chinese practice, is becoming more popular across the world to attempt to relieve pain. It involves the placement of thin needles at various points in the body. The efficacy of acupuncture for pain is heavily debated. More research and discussion are necessary to determine the exact role it plays in the treatment of chronic pain. Tai chi is also a traditional Chinese practice that is often used as a form of meditation and for potential health benefits. Tai chi involves a series of complex movements such as squatting combined with deep breathing to achieve relaxation and pain reduction. Osteopathic manipulative treatment (OMT) is a technique used by both osteopathic physicians (DO) as well as other health professionals to manage a wide range of conditions in any given patient. The technique involves utilization and manipulation of the musculoskeletal system to achieve potential health benefits. OMT has been used as therapy for many issues but is commonly used for pain conditions. Summary Alternative therapies may serve as an effective adjunctive treatment modality for the management of chronic pain conditions. There has been a tremendous amount of research dictating the effectiveness of alternative therapies for chronic pain management. The purpose of this review is to provide a comprehensive evidence-based update of alternative therapy used for the management of chronic pain conditions.

Primary care physicians, especially in family medicine, are more prone to use osteopathic manipulative treatment (OMT) than other specialists; however, barriers to OMT use exist. The purpose of this study is to evaluate if the frequency of OMT use in a family medicine outpatient setting is influenced by having posters promoting OMT in exam rooms and waiting rooms. Methods: OMT posters were placed in two of four offices in an academic family medicine practice. Offices without posters served as the control group. Billing patterns were examined for the five months prior to and after poster placement. Report parameters included: age, gender, ethnicity, CPT code for OMT and somatic dysfunction ICD-10 codes. Results: Data before and after poster placement were compared. Results showed a positive correlation between posters advertising OMT and OMT use. There was a 6.5% increase in OMT use in the offices that had posters advertising OMT. Conclusion: This research showed that placing OMT posters in select family medicine offices resulted in an increase in OMT use. Possibilities for this increase include patients becoming more aware of the benefits of OMT and/or simply reminding osteopathic physicians of the benefits of OMT. Increased OMT utilization could lead to a decrease in pain medication prescribing and an increase in functionality through conservative measures.

Mastitis affects breastfeeding mothers everywhere and management obstacles often lead to cessation of breastfeeding. Breastfeeding mastitis is commonly managed with antibiotics despite lack of clear infectious etiology. With the emerging problem of antibiotic resistance, novel managements are required. We present the case of a 34-year-old woman with 6 pregnancies and 3 children (gravida 6, parity 3) who had 5 cases of mastitis within 6 months treated with multiple courses of antibiotics. The patient underwent with osteopathic manipulative treatment (OMT) to the affected breast over 2 sessions and was taught how to perform self-myofascial release. Techniques are shown in an accompanying Supplemental Video. As of this report, the patient had been symptom free for 1 year. Future research, including a clinical trial of OMT, is required to determine whether osteopathic physicians can effectively manage recurrent lactational mastitis.

Vulvodynia is chronic perineal pain in women. Repercussions of this disorder can have a negative effect on women's health and lifestyle. The origin is often multifactorial, including pelvic and lower extremity somatic dysfunctions. If left untreated, these somatic dysfunctions can directly alter ligamentous tension on the pelvic floor and surrounding regions, resulting in perineal pain. Management of vulvodynia must be individualized due to the multifactorial etiology and complicated structure and function of the pelvic floor muscles. The authors present a case of vulvodynia in which osteopathic manipulative treatment was an effective management technique.

PajorKacper, Szpyt Justyna, Turoń-Skrzypińska Agnieszka, Rotter Iwona. Effectiveness of craniosacral therapy in musculoskeletal pain disorders.Journal of Education, Health and Sport. 2020;10(9):915-926. eISSN 2391-8306. DOI http://dx.doi.org/10.12775/JEHS.2020.10.09.112 https://apcz.umk.pl/czasopisma/index.php/JEHS/article/view/JEHS.2020.10.09.112 https://zenodo.org/record/4062203 The journal has had 5 points in Ministry of Science and Higher Education parametric evaluation. § 8. 2) and § 12. 1. 2) 22.02.2019. © The Authors 2020; This article is published with open access at Licensee Open Journal Systems of Nicolaus Copernicus University in Torun, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author (s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non commercial license Share alike. (http://creativecommons.org/licenses/by-nc-sa/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 23.09.2020. Revised: 30.09.2020. Accepted: 30.09.2020. Effectiveness of craniosacral therapy in musculoskeletal pain disorders Kacper Pajor1, Justyna Szpyt1, Agnieszka Turoń-Skrzypińska2, Iwona Rotter2 Students’ Science Club of Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University in Szczecin, ul. Żołnierska 54, 70-204 Szczecin, Poland Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University in Szczecin, ul. Żołnierska 54, 70-204 Szczecin, Poland Address for correspondence Kacper Pajor, e-mail: kontakt@kacperpajor.pl Abstract Introduction Craniosacral therapy is becoming more and more popular among therapists around the world. Its activity is based on primary respiratory mechanism (PSM), a natural craniosacral rhythm consisting of two phases: flexion and extension. During therapy, the therapist, using appropriate manual techniques performed with minimal force, restores the physiological craniosacral rhythm, restores the mobility of the cranial sutures and affects the mobility of the central nervous system. Due to not fully understood mechanisms of action and controversial foundations, the effectiveness of craniosacral therapy is often questioned. Purpose The purpose of this research review is to determine the effectiveness of craniosacral therapy on musculoskeletal pain disorders. Material and methods The PubMed database was searched using "Craniosacral therapy" for clinical trials and randomized clinical trials. Studies with other forms of therapy or placebo, conducted on newborns and older than 15 years and were excluded. These exclusions narrowed the search results to 5 works. Results Each study reported statistically significant improvement in at least one type of perceived pain in intervention group. In all studies, in at least two of the assessed tests (assessing pain and functionality), the difference between the result before the therapy and the result achieved after the therapy improved more for the group undergoing craniosacral therapy.Moreover, a review of studies showed insufficient level of research explaining the physiological foundations of craniosacral therapy. Conclusions 1. Craniosacral therapy can effectively reduce pain of musculoskeletal origin and increase the functionality of patients. 2. The mechanisms responsible for the effectiveness of craniosacral therapy and its theoretical foundations require further research. Keywords: craniosacral therapy, manual therapies, osteopathic manipulative treatment

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.

Context Asthma is a common chronic obstructive lung disease with increasing prevalence and economic burden. The effect of osteopathic manipulative treatment (OMT) has been studied in patients with several lung diseases, including asthma; however, no clinical trials have studied effects beyond the immediate time period in adults with asthma using spirometry. Objective To examine the immediate, intermediate, and long-term effects of OMT on objective pulmonary function and subjective quality of life in asthmatic adults. Methods Twenty-five adults with asthma were recruited from the Des Moines University community. Standardized Asthma Quality of Life Questionnaire (AQLQ(S)) surveys and spirometry measures including forced expiratory volume in one second (FEV1), forced vital capacity (FVC), the FEV1/FVC ratio, and peak expiratory flow (PEF) were collected at baseline. Spirometry testing was performed immediately after and 3 days after each of 3 weekly standardized OMT sessions. Spirometry and AQLQ(S) surveys were collected again 4 weeks after the final OMT session. Spirometry results were analyzed using a repeated measure, linear mixed-effect model, and survey results were analyzed using paired t-tests. Results The study demonstrated statistically significant changes to the spirometry results, including the PEF and FEV1/FVC ratio. The PEF measurements increased 3 days after the first treatment and remained elevated through the completion of the study. The FEV1/FVC ratio decreased by 0.01 at 4 weeks post-OMT compared to baseline. There were no significant differences observed in the immediate, intermediate or long-term FEV1 and FVC measurements post-OMT. However, there was a significant increase in the overall score and all 4 domains of the AQLQ(S), including Symptoms, Activity Limitations, Emotional Function, and Environmental Stimuli. Conclusion The results of this pilot study suggest that OMT may improve the quality of life in adults with asthma. Spirometry testing revealed a significant change in some measures of pulmonary function and participants reported an improvement in asthma-specific quality of life. The authors suggest that, in combination with preventive measures and pharmacologic therapy, OMT may offer additional benefit in the treatment of adults with asthma. The results also suggest a need for further study of the effects of OMT on respiratory function in asthmatic adults.

Dermatology programs seeking osteopathic recognition under the new single graduate medical education (GME) accreditation system are required to demonstrate osteopathic competencies within their teaching curriculum. Although the Accreditation Council for Graduate Medical Education has put forth guidelines to obtain osteopathic recognition, ambiguity lingers regarding specialty-specific content that would fulfill these requirements. To date, there are no set curriculum guidelines addressing osteopathic principles within the field of dermatology. In this article, we review the existing literature surrounding key competencies and propose a dermatology-focused educational model, “DERMS (Direct, Empathy, Restore, Mobilize, Senses) DO 5,” to encourage the teaching of osteopathic competencies within GME training programs. Our proposed curriculum model addresses the 5 osteopathic care models and applications of osteopathic manipulative treatment within the realistic realm of dermatology.

Background Pisa syndrome (PS) is a clinical condition frequently associated with Parkinson's disease (PD). It is characterized by a trunk lateral flexion higher than 10 degrees and reversible when lying. One pathophysiological hypothesis is the altered verticality perception, due to a somatosensory impairment. Osteopathic Manipulative Treatment (OMT) manages fascial-system alterations, linked to somatic dysfunctions. Fascial system showed to be implicated in proprioceptive sensibility. Objective The aim of the study was to assess OMT efficacy on postural control in PD-PS patients by stabilometry. Methods In this single-blinded trial we studied 24 PD-PS patients, 12 of whom were randomly assigned to receive a multidisciplinary physical therapy protocol (MIRT) and sham OMT, while the other 12 received four OMT plus MIRT, for one month. The primary endpoint was the eye closed sway area assessment after the intervention. Evaluation of trunk lateral flexion (TLF) with DIERS formetrics was also performed. Results At one month, the sway area of the OMT group significantly decreased compared to placebo (mean delta OMT - 326.00±491.24 mm2, p = 0.01). In the experimental group TLF showed a mean inclination reduction of 3.33 degrees after treatment (p = 0.044, mean d = 0.54). Moreover, a significant positive association between delta ECSA and delta TLF was observed (p = 0.04, r = 0.46). Discussion Among PD-PS patients, MIRT plus OMT showed preliminary evidence of postural control and TLF improvement, compared to the control group.

Introduction. Many published studies have examined the effects of osteopathic manipulative treatment (OMT), but none has evaluated its role in treating collegiate athletes. The authors examined collegiate athletes’ perception of OMT. Methods. A cross-sectional survey of a convenience sample of 592 collegiate athletes was conducted from two universities in the midwestern United States during August-September 2019. The athletes completed a 12-item survey during pre-participation physical evaluations at their respective institutions. Main outcome measures included pain, need for pain medication, stress and anxiety associated with injuries, and overall satisfaction with the OMT in recovery and return to sports. Fisher’s exact test was used to evaluate association between the variables. Results. The participation rate was 80.6% (477/592). Slightly fewer than 7% (31/477) of the athletes were familiar with OMT. Eighteen of the 31 athletes (58.1%) had received osteopathic manipulation as part of a treatment plan for injury. Of these athletes, 94.4% (17/18) reported a decreased need for pain medication and 83.3% (15/18) had reduced stress and anxiety related to their injury. One in three of them expressed interest in receiving osteopathic manipulation as a treatment option for an injury. The athletes reported general satisfaction with OMT in their recovery and return to sports. Conclusion. The findings demonstrated the interest and benefits of OMT among collegiate athletes. This evidence supported previous findings about perceived efficacy of OMT in treating patients regardless of injury and diagnosis. Future studies need to establish causal relationship among OMT, stress and anxiety, pain, and use of pain medications.

BACKGROUND: Professional musicians frequently suffer from musculoskeletal complaints and disorders (MCD), which can be treated by osteopathic manipulative treatment (OMT). The aim of this systematic review was to evaluate the effectiveness and efficacy of OMT in adult musicians. METHODS: A systematic literature search included the electronic databases PubMed/MEDLINE, Medpilot, EBSCOhost, BioMedCentral, OSTMED-Dr, osteopathic-research.com, PEDro, hand searches, and contact to European osteopathic academies. Interventional and observational studies published between January 1999 and January 2019, of professional or amateur musicians who were either healthy or had MCD treated by OMT, were included. The quality of the randomized controlled trials (RCTs) was assessed by the Physiotherapy Evidence Database (PEDro) Scale ranging between 0 and 10 points. RESULTS: Only 5 studies were identified investigating OMT in musicians, including 1 RCT (cross-over design), 3 clinical controlled trials, and 1 case report. The internal validity of the RCT was assessed as 6 points. OMT was reported to have a positive impact on healthy singers, improving phonation time, voice quality, and voice range. It also improved the cervical range of motion in violinists. No adverse events were observed, although only the cross-over RCT reported partly an assessment of adverse events. CONCLUSIONS: The evidence for OMT in adult musicians is very limited. Prospective controlled clinical trials investigating OMT in musicians are required.

To determine effectiveness of osteopathic manipulative treatment combined with stretching and strengthening exercises in the cervical region on pain and disability in individuals with non-specific chronic neck pain.90 adults with non-specific chronic neck pain were randomized to either exercises group (EG, n = 45) or osteopathic manipulative treatment associated with exercises group (OMT/EG, n = 45). The primary outcomes were obtained by the use of Numeric Pain-Rating Scale (NPRS), Pressure Pain Threshold (PPT) and Neck Disability Index (NDI). Secondary outcomes included range of motion (ROM) for cervical spine rotation, Fear-Avoidance Beliefs Questionnaire Work/Physical Activity (FABQ-W/PA) and Pain-self efficacy at two different moments: baseline and 4 weeks after the first treatment. Techniques and dosages of OMT were selected pragmatically by a registered osteopath. Generalized Estimating Equations model (GEE), complemented by the Least Significant Difference (LSD) and the intention-to-treat analysis, was used to assess the clinical outcomes.Analysis with GEE indicated that OMT/EG reduced pain and disability more than the EG alone after 4 weeks of treatment with statistically significant difference (p 0,05), as well as cervical active rotation was significantly improved (p = 0.03). There were no between-group differences observed in Pressure Pain Threshold (PPT) measure, Fear-Avoidance Beliefs Questionnaire and Pain-self efficacy.The association between OMT and exercises reduces pain and improves functional disability more than only exercise for individuals with non-specific chronic neck pain.

OBJECTIVE The aim of this study was to examine the effect of osteopathic manipulative treatment (OMT) on anaerobic performance and lactate clearance in male athletes. METHODS This study was a double-blind, randomized, sham-controlled and crossover trial. Fourteen male athletes were volunteered to participate this study. All subjects visited to laboratory 3 times in total: familiarization session, test session 1, and test session 2, respectively. At the beginning of the study, the subjects were randomly divided into 2 groups: In sessions 1 and 2, (a) 30-minute OMT or sham treatment before Wingate anaerobic cycling test (WAnT), (b) 30-second WAnT test, and (c) 10-minute OMT or sham therapy between 5th and 15th minutes of passive rest after WAnT was applied to all subjects, respectively. In both groups blood samples were taken at rest and 5, 15 and 30 minute after the WAnT for the determination of lactate concentrations. RESULTS There was no significant differences in WAnT parameters such as peak power, mean power and fatigue index between the OMT and sham treatment. Blood lactate levels were significantly higher 5, 15 and 30 minute after the WAnT when compared to the rest and were lower 15 and 30 minute after the WAnT when compared to 5 minute after the WAnT in both groups (P < 0.05). In addition, blood lactate concentration was significantly lower in OMT than sham treatment at 15 and 30 minute after the WAnT (P < 0.05). CONCLUSIONS This study suggests that OMT may improve lactate clearance while not affecting anaerobic performance in athletes.

The purpose of this study was to evaluate the efficacy and feasibility of a 4-week planned osteopathic manipulative treatment intervention on the improvement of neurocognitive and behavioral symptoms usually associated with fetal alcohol spectrum disorder. Thirty-two symptomatic children without fetal alcohol spectrum disorder aged 3–6 years with low level of attention from two schools and an osteopathic center were recruited in a prospective randomized pilot study in an osteopathic manipulative treatment group [osteopathic manipulative treatment (OMT)] or a control group (standard support measures). Neurocognitive maturity test results for attention (A), iconic memory (IM), spatial structuration (SS), and visual perception (VP) were recorded at baseline and post-intervention. No adverse effects were communicated and there were no dropouts. A significant increase in neurocognitive assessments was observed in children in the OMT group at post-treatment. Intergroup post-intervention statistical differences were found for A, SS, and IM were p = 0.005, p < 0.001, and p < 0.001, respectively; no differences were seen for VP (p = 0.097). This study shows that a 4-week osteopathic manipulative treatment intervention may be a feasible and effective therapeutic approach for neurocognitive and behavioral symptoms usually present in fetal alcohol spectrum disorder, justifying more studies on children affected by this condition.

Background: Osteopathic manipulative treatment (OMT) is a patient-centred, whole-body intervention aimed at enhance the person’s self-regulation. OMT interventions are focused on somatic dysfunctions (SD) that can be defined as an altered regulative function associated with inflammatory signs palpable in the body framework in different body regions. The conceptual model that sustains SD, as well as its usefulness for the osteopathic profession, is still being discussed by the osteopathic community. Understanding the role and the application of SD is the aim of this scoping review. Methods: A literature search was carried out through the main biomedical databases: Pubmed (Medline), Cochrane, Central (Cochrane), Embase, PEDro and Scopus. Grey literature was considered via Google Scholar and the Osteopathic Research Web. The review was prepared by referring to the “Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews” (PRISMA-ScR). Results: A total of 37,279 records were identified through database searching and other sources. After the duplicates were removed, 27,023 titles and abstracts were screened. A total of 1495 full-text articles were assessed for eligibility. The qualitative synthesis included 280 studies. Conclusions: Treating SD is an important part of osteopathic practice that varies from country to country. SD should be considered as a clinical value that assists in the clinical assessment and guides the decision-making process of osteopathic practitioners. Further studies should be designed to better understand why and how to choose the different assessment and intervention modalities to approach SD and to evaluate new osteopathic models.

Objectives Fibromyalgia (FM) is a chronic pain syndrome characterized by a large variety of symptoms. Evidence suggests that an alteration of central nervous system processing of pain could be involved. The purpose of this study is to analyze clinical records of patients affected by FM who underwent osteopathic manipulative treatment (OMT), predominantly based on a myofascial release approach (MFR). Methods This retrospective study considered records of 21 FM patients with moderate or severe functional impact, who consented to OMT in addition to their usual care. The assessment considered the following measures: FIQ (functional status), SF36 (quality of life), VAS (pain), TSK (kinesiophobia) and PSQI (quality of sleeping). Patients were preliminarily assessed over a 1 month run-in phase, then after 1, 2 and 4 months; a 1 month follow-up was also considered. Results After one month, 71% of patients reported a decrease in functional impact and scores remained stable until follow-up (from 69.8 to 52.37, p≤0.001). Overall, after four months, patients improved their quality of life, with a score ranging from 33.47 to 42.6 (p≤0.05). We also observed a reduction of pain (p≤0.05). Conclusions A series of OMT sessions based on MFR could play a therapeutic role in improving functional status, pain and quality of life over a period of 4 months.

Background: Despite the prevalence of abdominal adhesions after a caesarean section, there exist few postoperative treatment approaches which specifically target adhesions or establish their connection with chronic lower back pain (cLBP). Aims: To investigate if the osteopathic approach of treating adhesions after a caesarean section reduces existing cLBP symptoms and alleviates associated pain. Methods: The subjects received two 30-minute treatments with a one week pause between treatments. The intervention group A (n=18), those who received osteopathic treatment, were compared to a control group B (n=16), who received scar treatment using traditional physiotherapy. The evaluation of subjective (pain intensity with a numeric rating scale, or NRS) and objective (symptom evaluation using the Oswestry Low Back Pain Questionnaire) parameters was accomplished using questionnaires before and after the treatments. Results: Pain intensity reduced clinically relevant in group A by MA21=-2.6; SDA21=1.33 on the NRS. The average Oswestry Disability Index (ODI) in group A decreased from M1=18.3%; SD1=7.8 to M2=6.2%; SD2=6.2. In group B, the decrease from M1=19.1%; SD1=11.1 to M2=14.0%; SD2=10.1 was significantly smaller (p=0,005). Conclusions: Postoperative adhesions could cause cLBP. Treatment of adhesions using oste-opathy results in a significant reduction of pain symptoms for cLBP. Due to the sample size calculation, further studies addressing adhesions and chronic lower back pain would be rec-ommended. Keywords: peritoneal adhesions; visceral adhesions; caesarean section; chronic lower back pain (cLBP)

Concussions are a form of mild traumatic brain injury, which are caused by trauma to the head or body. Symptoms of concussion can include headaches, dizziness, imbalance, and difficulty with concentration, which can persist for weeks, months, or even years after the event. This case report details the treatment of a 17-year-old girl suffering from postconcussion symptoms, which prevented her from full participation in school for 2 months after the injury. The patient’s symptoms greatly improved with the application of osteopathic manipulative treatment (OMT). Treatment focused on balancing and restoring proper proprioceptive input, addressing musculoskeletal restrictions, and improving circulatory and lymphatic flow. Posttreatment, the patient was able to return to full activities at school. This case demonstrates the positive effect of integrating OMT into a case of postconcussion syndrome.

Ventilation weaning is a key intensive care event influencing preterm infants’ discharge from a neonatal intensive care unit (NICU). Osteopathic manipulative treatment (OMT) has been recently introduced in some Italian NICUs. This retrospective cohort study tested if OMT is associated with faster non-invasive ventilation (NIV) weaning. The time to NIV weaning was assessed in very preterm and very low birth weight infants who either received or did not receive OMT. The propensity score model included gender, antenatal steroids, gestational age (GA), birth weight (BW), and Apgar score 5′. Out of 93 infants, 40 were included in the multilevel survival analysis, showing a reduction of time to NIV weaning for GA (HR: 2.58, 95%CI: 3.91 to 1.71, p < 0.001) and OMT (HR: 3.62, 95%CI: 8.13 to 1.61, p = 0.002). Time to independent ventilation (TIV) was modeled with GA and BW as dependent variables and OMT as the factor. A negative linear effect of GA and BW on TIV was shown. OMT exposure studied as the factor of GA had effects on TIV in infants born up to the 32nd gestational week. Preterm infants exposed to OMT were associated with earlier achievement of NIV weaning. This result, together with the demonstrated OMT safety, suggests the conduct of clinical trials in preterm infants younger than 32 weeks of GA.

Osteopathic principles and philosophy suggest the use of osteopathic manipulative treatment (OMT) to restore, augment, or facilitate lymphatic fluid flow to maintain body fluid balance, and/or to stimulate immune system responses to aid in the recovery from illness and maintain normal body defense mechanisms. This review provides an osteopathic view of the role of the lymphatic system in health and disease, with an emphasis on the use of OMT to alleviate somatic dysfunctions (SD) that inhibit the optimum function of the lymphatic system. The current evidence base is reviewed for the use of OMT to assist in restoring or augmenting lymphatic system function to help patients recover from illness and maintain health and wellness. An overview is provided on how osteopathic principles and philosophy relative to the immune system are applied in practice. A literature search was conducted using databases such as Medline, PubMed, Ostmed-DR, and Scopus, focusing on osteopathic approaches to the lymphatic system. Keywords used included osteopathic manipulative medicine, OMT, and lymphatic manual treatment or therapy. Current osteopathic textbook information was also surveyed. There is support for the application of osteopathic principles and OMT for certain conditions that involve the lymphatic system. More prospective research is needed.

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Background and purpose of the study: Esophageal atresia (AE) is a congenital anomaly that affects the normal development of the esophagus in neonates. The timely surgical approach allows its resolution, but long-term morbidities in adolescents show neurological developmental abnormalities and musculoskeletal deformities. The goal in this preliminary study is to investigate the recovery of the range of the right upper limb movement and on the rise of the anthropometric parameters through the osteopathic manipulative treatment, which, by acting on the connective system has a trophotropic effect documented. Materials and Methods: 5 children with type III AE were included in the study. 6 OMTs were performed in 4 months. At each treatment, the following were assessed height, weight, BMI and ROM in elevation of the right upper limb. OMT has been applied to improve scar, larynx, rib cage, and sternum mobility. Results: in the statural growth there was an average change of 2.3 cm in 4 months and in the ROM of the upper limb there was an average increase of 8° in 4 months. There were no significant changes in weight and BMI. Conclusions: This preliminary study suggests that it is a viable option to be further researched. In addition, the study provides potentially valuable evidence that the osteopathic manipulative treatment could benefit the increase in anthropometric parameters and the mobility of the right upper limb of children operated on for AE. In light of the results, new studies to evaluate the effectiveness of OMT in post surgical treatment of congenital malformations of the thorax can be considered in the future.

INTRODUCTION Low back pain is the most common type of global disability and annually costs the United States over two billion dollars. Opioids have been used to reduce low back pain, although current evidence concerning efficacy is lacking. Sacroiliac joint dysfunction (SIJD) is estimated to be a primary pain source of low back pain in between 10 and 25% of affected patients. The primary objective of this study was to evaluate the rate of SIJD identified through osteopathic techniques in a convenience sample of patients seeking low back pain treatment. The secondary objective was to assess prevalence of low back pain and SIJD among different age groups, and genders. METHODS Retrospective chart reviews were completed the adult patients who had received osteopathic manipulative treatment for low back pain at Family Health and Wellness Center in Essexville, MI from January 2018 through June 2019. The prevalence of patients with SIJD was identified during reviews of osteopathic procedural documentation for patients seeking low back pain treatment. Data regarding patients’ age, sex, and treatment modalities were also extracted. Descriptive statistics consisting of frequencies and percentages were calculated. RESULTS A total of 84 patient records were reviewed. A total of 51 (60.7%) patients seeking low back pain treatment were diagnosed with SIJD identified by osteopathic providers. This included patients with both lumbar and sacral diagnoses simultaneously. SIJD alone accounted for 26 (31%) of patients seeking treatment. Female patients were more likely to have SIJD involvement than males. Forty one (48.8%) treated patients were between 45-64 years old. Muscle Energy Technique was documented to be the most used for 68 (81%) patients. In addition, techniques tended to move from direct to indirect for older patients. DISCUSSION Our study demonstrated that SIJD appeared to contribute to low back pain in 51 (60.7%) of low back pain cases identified using osteopathic techniques. This is much greater than the previously reported percentages of 10 to 25%. One possible confounding influence included varied resident screening and reporting of sacral dysfunction. Since multiple areas of the body can be treated at one time, our current procedure notes did not allow for distinguishing between which types of modalities were used on each region or capture residents’ preferred treatments. CONCLUSIONS Although further studies are needed, our results suggest that knowledge of SIJD’s impact on low back pain could lead to improved patient outcomes such as decreased medical costs and opioid use.

Context Updated data on the use of Osteopathic Manipulative Treatments (OMT) by osteopathic physicians in the United States is overdue. This data would provide an up-to-date point of reference for evaluating the current use of OMT as a distinguishing feature of the osteopathic profession. Objective To determine the prevalence of OMT use, barriers to its use, and factors that correlate with increased use. Methods The American Osteopathic Association (AOA) distributed its triannual survey on professional practices and preferences of osteopathic physicians, including questions on OMT, to a random sample of 10,000 osteopathic physicians in August 2018 through Survey Monkey (San Mateo, CA). Follow-up efforts included a paper survey mailed to nonrespondents one month after initial distribution and three subsequent email reminders. The survey was available from August 15, 2018 to November 5, 2018. The OMT questions focused on frequency of OMT use, perceived barriers, and basic demographic information of osteopathic physician respondents. Statistical analysis (including a one sample test of proportion, chi-square, and Spearman’s rho) was performed to identify significant factors influencing OMT use. Results Of 10,000 surveyed osteopathic physicians, 1,683 (16.83%) responded. Of those respondents, 1,308 (77.74%) reported using OMT on less than 5% of their patients, while 958 (56.95%) did not use OMT on any of their patients. Impactful barriers to OMT use included lack of time, lack of reimbursement, lack of institutional/practice support, and lack of confidence/proficiency. Factors positively correlated with OMT use included female gender, being full owner of a practice, and practicing in an office-based setting. Conclusion Our data suggest that OMT use among osteopathic physicians in the US continues to decline. Barriers to its use appear to be related to the difficulty that most physicians have with successfully integrating OMT into the country’s insurance-based system of healthcare delivery. Follow-up investigations on this subject in subsequent years will be imperative in the ongoing effort to monitor and preserve the distinctiveness of the osteopathic profession.

Context Nationwide Children’s Hospital (NCH) has a large pediatric residency program with 43 residents in the categorical pediatric program and 10 residents in the Internal Medicine-Pediatrics (IM-Peds) program per class. Of the 43 categorical pediatric residents, four are in the osteopathic recognition track (ORT) and continue their osteopathic education throughout residency. There is currently a lack of data examining the effect of an ORT, and specifically a pediatric ORT, on a residency program. Objective To evaluate the impact of an ORT osteopathic recognition track on an overall residency program’s perceptions of osteopathic manipulative treatment (OMT) and to evaluate allopathic (MD) resident perception of osteopathic educational sessions. Methods An anonymous survey was conducted in June 2017 and distributed to 141 residents (both categorical and IM-Peds) to gather baseline information regarding perceptions and knowledge of OMT. Based on the initial results, a four-part case-based educational series was implemented during the 2018–2019 academic year to teach osteopathic principles to MD residents. A second survey was distributed following each session. Results For the initial survey, 59 (41.8%) residents responded. Survey results demonstrated that resident perceptions of OMT as an efficacious treatment option increased after starting their residency at NCH (p=0.04), and 25 of 43 (58.1%) MD residents stated an interest in learning OMT skills. A total of 140 attendees were present at the four educational sessions. One hundred and thirty-eight residents (98.5%) found the educational sessions beneficial and 132 (94.2%) stated they would refer a patient for OMT. Conclusion ORT residents make a significant impact on their colleagues’ perceptions and knowledge of OMT. This study suggests that further efforts to highlight the clinical applications of OMT in pediatric patients would be welcomed by residents.

Bell's palsy (BP) occurs when the facial nerve (CN VII) is swollen, inflamed, or compressed, resulting in facial weakness or paralysis; etiology is unknown. BP patients often succumb to a decreased quality of life due to the inability to make facial expressions, increased sensitivity to auditory stimuli, and dysregulation in tear and saliva production. Despite conventional examination and therapy options, the syndrome is majorly regarded as idiopathic and left unresolved for many patients. In this case of a patient with BP, treatment with osteopathic manipulative treatment (OMT) which focused on restoring a normal structure-function relationship resolved the patient’s symptoms. The osteopathic manipulative procedures utilized findings from an osteopathic structural exam and addressed those somatic dysfunctions with OMT. The authors report that the patient's symptoms improved after the application of OMT and without the use of pharmaceuticals. The results of the case study suggest that treating BP with OMT can rapidly improve symptoms and can be used without or concurrently with other treatment modalities, if applicable. Patient’s consent for this case report was obtained in written and verbal form.

Herein is a description of the experience of the author, who is an MD, who was trained in performing osteopathic manipulation after practicing general allopathic pediatric medicine for 8 years. In the ensuing 28 years, her experience using it liberally for a wide variety of conditions convinced her that early use of OMT in children could reverse or prevent any number of common pediatric maladies, in a non-invasive, and cost-effective manner.

Background: Chronic low back pain (CLBP) is a frequent cause of disability and it represents a medical, social and economic burden globally. Therefore, we assessed effectiveness of osteopathic interventions in the management of NS-CLBP for pain and functional status. Methods: A systematic review and meta-analysis were conducted. Findings were reported following the PRISMA statement. Six databases were searched for RCTs. Studies were independently assessed using a standardized form. Each article was assessed using the Cochrane risk of bias (RoB) tool. Effect size (ES) were calculated at post-treatment and at 12 weeks’ follow up. We used GRADE to assess quality of evidence. Results: 10 articles were included. Studies investigated osteopathic manipulative treatment (OMT, n = 6), myofascial release (MFR, n = 2), craniosacral treatment (CST, n = 1) and osteopathic visceral manipulation (OVM, n = 1). None of the study was completely judged at low RoB. Osteopathy revealed to be more effective than control interventions in pain reduction (ES: -0.59; 95% CI: -0.81, -0.36; P < 0.00,001) and in improving functional status (ES: -0.42; 95% 95% CI: -0.68, -0.15; P = 0.002). Moderate-quality evidence suggested that MFR is more effective than control treatments in pain reduction (ES: -0.69; 95% CI: -1.05, -0.33; P = 0.0002), even at follow-up (ES: -0.73; 95% CI: -1.09, -0.37; P < 0.0001). Low-quality evidence suggested superiority of OMT in pain reduction (ES: -0.57; 95% CI: -0.90, -0.25; P = 0.001) and in changing functional status (ES: -0.34; 95% CI: -0.65, -0.03; P = 0.001). Very low-quality evidence suggested that MFR is more effective than control interventions in functional improvements (ES: -0.73; 95% CI: -1.25, -0.21; P = 0.006). Conclusion: Results strengthen evidence that osteopathy is effective in pain levels and functional status improvements in NS-CLBP patients. MFR reported better level of evidence for pain reduction if compared to other interventions. Further high-quality RCTs, comparing different osteopathic modalities, are recommended to produce better-quality evidence.

This randomized, controlled, double-blinded study related the effect of osteopathic manipulative treatment (OMT) of the temporomandibular joint (TMJ) and the orthostatic posture using the molar shim (MS) as a postural adjustment factor. Twenty individuals classified with temporomandibular disorder (TMD) were randomly assigned to a treated group (TG, n = 10) and placebo (PG, n = 10). The independent variables were: MS and OMT of the TMJ. The dependent variables were: DC-TMD data; local pressure pain using algometry; and orthostatic posture assessed by the distribution of plantar pressures (baropodometry), in the evaluation periods before and immediately after the interventions. Results: pain did not show a statistically significant difference after the interventions. However, when comparing the Effect Size (ES) between the groups in the post-intervention moment, a moderate relationship was observed for the left trapezius muscle (0.51) and right and left TMJ (0.41 and 0.54 respectively). When correlating the pain and percentage of anteroposterior postural dislocation variables, a significant moderate inverse correlation was observed in the post-intervention moment. The results of the MS pointed to a significant decrease (p ≤ 0.05) of the average peak pressure (Medium P) during the use of the MS (503.4 ± 44.1 kgf/cm2) and after performing the OMT (516.5 ± 49.6 kgf/cm2), both for the TG compared to the pre intervention moment (519.3 ± 42.9 kgf/cm2). There is a correlation between TMJ and orthostatic posture. OMT of the TMJ influences orthostatic posture. The MS can be added to the evaluative context of TMD.

The capital element in the field of osteopathy and several other manual therapy methods, is the somatic dysfunction (SD), a functional imbalance that can involve different tissues and mechanisms in its genesis and maintenance. The main challenges found in the clinical scope are to understand the interaction, hierarchy, and relevance of the SD. Several manual tests are available to functionally evaluate the SD, each one with its applicability to analyze the different parameters of the SD. The so-called inhibitory tests are a category of functional manual tests that can be added to the diagnostic context of the SD. It is a particular type of test in which the evaluator applies manual mechanical stimuli to dysfunctional tissues and assesses the biological responses that occur simultaneously with the application of the stimulus. Its use can consider biomechanical and neurological principles in such a way that different conditions can be analyzed. The objective of this article is to review well-established knowledge and recent scientific discoveries about the SD and its local and global repercussions, in an attempt to offer ideas that can be applied to better understand the mechanisms that imply the use of inhibitory tests as complementary clinical diagnostic tools. It will be discussed some of the possible mechanisms involved in the physiology of the inhibitory tests, their practical applications in some distinct conditions, as well as new proposals of utilization based on the sensitization of metameric related structures under a dysfunctional state.

Osteopathic manipulative treatment (OMT) has been found to be effective in the context of premature infants. Nonetheless, no studies have investigated the immediate effects of OMT on heart rate variability (HRV). As altered HRV reflects poor or worsening newborn’s clinical conditions and neurodevelopment, should OMT improve HRV fluctuations, it could become a relevant intervention for improving the care of preterm newborns. Therefore, this study aimed to evaluate whether OMT could affect HRV. The study was carried out at the Buzzi Hospital in Milan. From the neonatal intensive care unit, ninety-six preterm infants (41 males) were enrolled and were randomly assigned to one of two treatment groups: OMT or Static Touch. The infants were born at 33.5 weeks (±4.3) and had a mean birth weight of 2067 g (±929). The study had as primary outcome the change in the beat-to-beat variance in heart rate measured through root mean square of consecutive RR interval differences (RMSSD); other metrics were used as secondary and exploratory analyses. Despite the lack of statistically significant results regarding the primary outcomeand some study limitations, compared to static touch, OMT seemed to favor a parasympathetic modulation and improved HRV, which could reflect improvement in newborn’s clinical conditions and development.

Objectives: It is unclear whether osteopathic manipulative treatment (OMT) affects gastric myoelectric activity (GMA), an index of gastric motility. We hypothesized that OMT significantly alters power spectral density (PSD) analyses of electrogastrography (EGG) recordings, an index of GMA, compared with time control OMT. Design: GMA data were obtained from nine subjects before and after OMT and time control on separate days in a cross-over design. Fifteen-minute EGG recordings were obtained before and after each intervention and after a water challenge (WC). Percent power in the normogastric range (PPN) was estimated from PSD analyses. Absolute percent change of PPN and dominant frequency (DF) from baseline to postintervention and baseline to post-WC was computed and compared using two-way repeated-measures ANOVA. Results: OMT altered PPN versus time control (time control: 5.3% ± 1.2%; OMT: 24.5% ± 4.5%; p = 0.015). WC altered PPN compared with time control (post-time control ΔPPN: 5.3% ± 1.2%; post-drink ΔPPN: 30.3% ± 7.2%; p

Objectives: In this study, we aimed to compare the efficacy of osteopathic manipulative treatment (OMT) to exercise treatment in the knee osteoarthritis (OA). Patients and methods: A total of 100 patients (9 males, 76 females; mean age 54.8 +/- 8.5 years; range, 40 to 70 years) with Stage II-III bilateral knee OA enrolled to the study and randomized into two groups between January 2015 and June 2015. Group 1 performed exercise and received OMT and Group 2 performed exercise alone. We assessed the clinical parameters with Western Ontario MacMaster Questionnaire (WOMAC) pain score, WOMAC joint stiffness score, WOMAC physical function score, Visual Analog Scale (VAS) and 50-m walking time. All patients were assessed at the beginning of the study, just after the treatment, and four weeks after the treatment. Results: There was no significant difference between groups in terms of physical examination and clinical assessment parameters before treatment. Functional improvement (p

Background Coccydynia is a disorder associated with pain/discomfort at the base of the spine. The role of osteopathic manipulative treatment (OMT) in chronic coccydynia as well as for low back pain (LBP) and radicular pain (RP) associated with coccydynia, has not previously been investigated. This study seeks to analyse the effects of OMT on chronic coccydynia compared to physical therapy and pharmacological treatment (PTPT). The secondary objective is to analyse the effect of OMT on LBP and RP associated with coccydynia. Methods Clinical records of 50 patients were examined. These patients (aged 39.94 ± 15.34 years, BMI 21.22 ± 3.15) who complained of chronic coccydynia were assessed 3 times: before any treatment (t0), after PTPT (t1) and after OMT (t2). Patients were treated with PTPT during the first 3 months and then referred by physicians to osteopaths to receive 3 sessions of OMT over a period of 5 weeks. The outcome measurements were made by a visual analogue scale (VAS 0–10 cm) and the Oswestry Low Back Pain Disability Questionnaire. Results Before starting OMT treatment, patients showed a stable condition of coccydynia (mean VAS values from 7.1 to 6.5 p = 0.065) and a slight but significant reduction in disability (mean OD values from 17.7 to 14.5 p = 0.017) after PTPT. After the 3 sessions of OMT, all subjects gained a successful reduction in pain (mean VAS values from 6.5 to 1.2, p ≤ 0.001) and demonstrated a higher significant reduction in disability (mean Oswestry scale values from 14.5 to 2.5, p Conclusions This case series shows that OMT elicits a positive benefit for pain relief and reduction in disability in patients complaining of coccydynia (with or without LBP and RP associated with coccydynia). Therefore, OMT could be considered as a valid therapeutic approach for treating chronic coccydynia. Nevertheless, further research is required to test the hypothesis and to better determine the benefits of OMT.

Osteopathic manipulative treatment (OMT) has been reported to reduce significantly low back pain (Licciardone et al. 2005). However, the mechanics by which osteopathic treatment may produce an incr...

Objectives To describe the effects of osteopathic manipulative treatment in patients affected by Multiple Sclerosis (MS). Design and setting This is a pilot study involving 20 MS patients attending the IRCCS Neurolesi “Bonino-Pulejo”, Messina, Italy. Intervention The clinical evaluation was performed before starting rehabilitation treatment (T0) and after 8 weeks of treatment (T1). The CG sample undergo a conventional rehabilitation training (CRT), 5 times/week for 60 min (for a total of 40 sessions), the EG performed the same CRT (but with a different frequency, i.e. 3 times/week, for a total of 24 sessions) and a specific OMT 2 times/week for 60 min (for a total of 16 sessions). Main outcome measures We analyzed the scores recorded in the following main scales: Expanded Disability Status Scale (EDSS), 10 m walking test (10mWT), Hamilton anxiety rating scale (HRS-A), and the Fatigue severity scale (FSS). Results Our data showed a reduction in the FSS score for the EG (40 ± 1,41 at T0 vs 37 ± 2,32 at T1; p = 0.04) but not in the CG (41 ± 2,41 at TO vs 39 ± 2,6 at T1) with an intergroup difference p Conclusions Our data raise idea that OMT might be useful in rehabilitative setting in MS patients, with particular regard to anxiety and fatigue.