Research articles

 

 

 

 

 

 

 

 A summary of research articles can also be found here. There is also a comprehensive list of cranial osteopathic research findings.


 

 

Back pain


J. C. Licciardone, D. E. Minotti, R. J. Gatchel, C. M. Kearns, K. P. Singh

Published in The Annals of Family Medicine, 2013; 11 (2): 122 DOI: 10.1370/afm.1468

OMT patients did see significant improvement in pain, used less prescription medication and were more satisfied with their care.

Rubinstein SM, van Middelkoop M, Assendelft WJ, de Boer MR, van Tulder MW.

Published in Spine

High-quality evidence suggests that there is no clinically relevant difference between spinal manipulative therapy and other interventions for reducing pain and improving function in patients with chronic low-back pain. Determining cost-effectiveness of care has high priority.

Vaughan B, Morrison T, Buttigieg S, Macfarlane C, Fryer G. 

Published in Australian Family Physician 2014, Vol43, No.4, April 2014 Pages 197-198

This article forms part of our allied health series for 2014, which aims to provide information about the management approach of different allied health professionals, using the case example of uncomplicated, mechanical low back pain.

Cruser dA, Maurer D, Hensel K, Brown SK, White K, Stoll ST.

Published in the Journal of Manual and Manipulative Therapy, 2012 Feb; 20(1):5-15.

This study supports the effectiveness of osteopathic manipulative treatment in reducing acute low back pain in active duty military personnel.

Licciardone JC, Minotti DE, Gatchel RJ, Kearns CM, Singh KP.

Published in Annals of Family Medicine

The osteopathic manipulative treatment regimen met or exceeded the Cochrane Back Review Group criterion for a medium effect size in relieving chronic low back pain. It was safe, parsimonious, and well accepted by patients.

JC Licciardone, AK Brimhall and LN King

OMT significantly reduces low back pain. The level of pain reduction is greater than expected from placebo effects alone and persists for at least three months. Additional research is warranted to elucidate mechanistically how OMT exerts its effects, to determine if OMT benefits are long lasting, and to assess the cost-effectiveness of OMT as a complementary treatment for low back pain.

Licciardone JC, Kearns CM, Minotti DE.

The large effect size for OMT in providing substantial pain reduction in patients with chronic LBP of high severity was associated with clinically important improvement in back-specific functioning. Thus, OMT may be an attractive option in such patients before proceeding to more invasive and costly treatments.

Helge Franke, Jan-David Franke and Gary Fryer

Published in BMC Musculoskeletal Disorders 2014

Clinically relevant effects of osteopathic manipulative treatment were found for reducing pain and improving functional status in patients with acute and chronic nonspecific low back pain and for low back pain in pregnant and postpartum women at 3 months posttreatment. However, larger, high-quality randomized controlled trials with robust comparison groups are recommended.

Vismara L, Cimolin V, Menegoni F, Zaina F, Galli M, Negrini S, Villa V, Capodaglio P.

Published in Manual Therapy

Combined rehabilitation treatment including osteopathic manipulative treatment showed to be effective in improving biomechanical parameters of the thoracic spine in obese patients with chronic low back pain.

Williams NH, Wilkinson C, Russell I, Edwards RT, Hibbs R, Linck P, Muntz R.

Published in Family Practice

Aim: was to assess the effectiveness and health care costs of a practice-based osteopathy clinic for subacute spinal pain. A primary care osteopathy clinic improved short-term physical and longer term psychological outcomes, at little extra cost. Rigorous multicentre studies are now needed to assess the generalizability of this approach.

de Oliveira RF, Liebano RE, Costa Lda C, Rissato LL, Costa LO.

Published in Physical Therapy

The immediate changes in pain intensity and pressure pain threshold after a single high-velocity manipulation do not differ by region-specific versus non-region-specific manipulation techniques in patients with chronic low back pain.

Downie A, Williams CM, Henschke N, Hancock MJ, Ostelo RW, de Vet HC, Macaskill P, Irwig L, van Tulder MW, Koes BW, Maher CG.

Published in BMJ

While several red flags are endorsed in guidelines to screen for fracture or malignancy, only a small subset of these have evidence that they are indeed informative. These findings suggest a need for revision of many current guidelines.

Paul J Orrock and Stephen P Myers

One trial concluded similarity of effect between osteopathic intervention, exercise and physiotherapy and the other was similar in effect to a sham intervention. Further clinical trials into this subject are required that have consistent and rigorous methods.

Roger Chou, MD; and Laurie Hoyt Huffman, MS

Therapies with good evidence of moderate efficacy for chronic or subacute low back pain are cognitive-behavioral therapy, exercise, spinal manipulation, and interdisciplinary rehabilitation.In 1 study of primary care clinicians, 65% reported recommending massage therapy and 22% recommended, prescribed, or performed spinal manipulation .

Paul Posadzki & Edzard Ernst

Five RCTs suggested that osteopathy compared to various control interventions leads to a significantly stronger reduction of musculoskeletal pain.

 


 

Neck pain


Anita Gross, Pierre Langevin, Stephen J Burnie, Marie-Sophie Bédard-Brochu, Brian Empey, Estelle Dugas, Michael Faber-Dobrescu, Cristy Andres, Nadine Graham, Charles H Goldsmith, Gert Brønfort, Jan L Hoving, Francis LeBlanc. Editorial Group: Cochrane Back and Neck Group

Published Online: 23 SEP 2015 on Cohrane Library

Findings suggest that manipulation and mobilisation present similar results for every outcome at immediate/short/intermediate-term follow-up. Multiple cervical manipulation sessions may provide better pain relief and functional improvement than certain medications at immediate/intermediate/long-term follow-up. Since the risk of rare but serious adverse events for manipulation exists, further high-quality research is needed to guide clinicians in their optimal treatment choices.

Bischoffa A, Nürnbergera A, Voigta P, Schwerla F

Published in the International Journal of Osteopathic Medicine Volume 9, Issue 1, March 2006

A series of osteopathic interventions seems a promising therapeutic regimen for CNP sufferers. Further studies will have to demonstrate whether (a) these findings are reproducible and (b) positive long term outcomes can be achieved.

Fryer G, Alvizatos J, Lamaro J

Published in the International Journal of Osteopathic Medicine Volume 8, Issue 2, June 2005

Self-rated pain and disability significantly reduced during the course of osteopathic treatment, and reductions were evident regardless of the chronicity of the pain. This pilot study suggests that osteopathic treatment may be effective for the management of neck pain. Recommendations are made for further studies.

Haller H, Lauche R, Cramer H, Gass F, Rampp T, Saha F, Dobos G

Published in the Clinical Journal of Pain: May 2016 - Volume 32 - Issue 5 - p 441–449 doi: 10.1097/AJP.0000000000000290

 CST was shown to be specifically effective and safe in reducing neck pain intensity and may improve the functional disability and the quality of life up to 3 months after the intervention. Particularly in chronic and recurrent neck pain, CST may be a worthwhile treatment option in addition to standard medical care. Further studies with rigorous methodological designs and long-term follow ups are needed to confirm CST efficacy in neck pain treatment.

McReynolds TM, Sheridan BJ.

  Published in the J Am Osteopath Assoc Feb;105(2):57-68 2005

The authors found that, at one hour posttreatment, OMT is as efficacious as IM ketorolac in providing pain relief and significantly better in reducing pain intensity. The authors conclude that OMT is a reasonable alternative to parenteral nonsteroidal anti-inflammatory medication for patients with acute neck pain in the ED setting.

Genese JS

Published in the  J Am Osteopath Assoc Jul;113(7):564-7 2013

Whiplash injury is often caused by rear-end motor vehicle collisions. Symptoms such as neck pain and stiffness or arm pain or numbness are common with whiplash injury. The author reports a case of right facial numbness and right cheek pain after a whiplash injury. Osteopathic manipulative treatment techniques applied at the level of the cervical spine, suboccipital region, and cranial region alleviated the patient's facial symptoms by treating the right-sided strain of the trigeminal nerve.

Published in the Man Ther Jun 1 2010

Schwerla F, Kaiser AK, Gietz R, Kastner R. 2013

Moderate quality evidence supports this treatment combination for pain reduction and improved quality of life over manual therapy alone for chronic neck pain; and suggests greater short-term pain reduction when compared to traditional care for acute whiplash. Evidence regarding radiculopathy was sparse. Specific research recommendations are made.

Miller J, Gross A, D'Sylva J, Burnie SJ, Goldsmith CH, Graham N, Haines T, Brønfort G, Hoving JL 

Published in the J Altern Complement Med Jun;19(6):543-9 2013

Five (5) osteopathic treatments had a beneficial effect on the physical as well as the mental aspects of LWS and lives up to its claim of being a complementary modality in the treatment regimen of this condition. Based on these preliminary findings, rigorous randomized controlled studies are warranted.

 


 

Headaches

 

Anderson RE, Seniscal C.

Published in Headaches, 2006 Sep;46(8):1273-80.

The people in this study who did relaxation exercises and received 3 osteopathy treatments had significantly more days per week without headache than those who did only relaxation exercises.

Posadzki P, Ernst E.

Published in Complement Thera Med. 2012 Aug;20(4):232-9. doi: 10.1016/j.ctim.2011.12.001. Epub 2011 Dec 29.

The evidence that spinal manipulation alleviates tension type headaches is encouraging, but inconclusive. Further research is needed.

Chaibi A, Tuchin PJ, Russell MB.

Published in J Headache Pain. 2011;12(2):127-133.

The random controlled trials suggest that massage therapy, physiotherapy, relaxation and spinal manipulative therapy might be equally effective as propranolol and topiramate in the prophylactic management of migraine. However, these had many methodological shortcomings and therefore, future, well-conducted trials are needed.

Bronfort G, Assendelft WJ, Evans R, Haas M, Bouter L.

Published in J Manipulative Physiol Ther. 2001 Sep;24(7):457-66.

Manipulation appears to have a better effect than massage for cervicogenic headache. It also appears that spinal manipulation has an effect comparable to commonly used first-line prophylactic prescription medications for tension-type headache and migraine headache.

 


 

Pregnancy


Licciardone JC, Buchanan S, Hensel KL, King HH, Fulda KG, Stoll ST

Published in American Journal of Obstetrics and Gynaecology, 2010 Jan;202(1):43.e1-8.

Osteopathic manipulative treatment slows or halts the deterioration of back-specific functioning during the third trimester of pregnancy.

Jane Frawley, Tobias Sundberg, Amie Steel, David Sibbritt, Alex Broom, Jon Adams.

Published in Bodywork and Movement Therapies (available via Science Direct subscription)

Women are visiting osteopaths for help with common pregnancy health complaints, highlighting the need for research to evaluate the safety, clinical and cost effectiveness of osteopathy in pregnancy.

Pennick V, Liddle SD.

Published in Cochrane Database Syst Rev. 2013 Aug 1;8:CD001139. doi: 10.1002/14651858.CD001139.pub3.

Physiotherapy, OMT, acupuncture, a multi-modal intervention, or the addition of a rigid pelvic belt to exercise seemed to relieve pelvic or back pain more than usual care alone.

HH King; MA Tettambel; MD Lockwood; KH Johnson; DA Arsenault; R Quist

Published in The Journal of the American Osteopathic Association, December 2003, Vol. 103, 577-582.

The case control study found evidence of improved outcomes in labor and delivery for women who received prenatal OMT, compared with women who did not.

Smallwood CR, Borgerding CJ, Cox MS, Berkowitz MR

Published in the International Journal of Osteopathic Medicine Vol 16 (3) pages 170-177 2013

OMT for the laboring woman should be considered as a treatment modality to facilitate a natural childbirth.

Hensela KL, Pacchiab CF, Smith ML

Published in the Complementary Therapies in Medicine Volume 21, Issue 6, December , Pages 618–626 2013

OMT can acutely improve hemodynamic control during engagement of the skeletal muscle pump and this was most likely due to improvement of structural restrictions to venous return.

Lavelle JM

Published in the J Am Osteopath Assoc Jun;112(6):343-6 2012

Through the viscerosomatic connection, the hemodynamic changes of the maternal body can be controlled, the duration of labor reduced, and the complications of labor avoided.

Hensel KL, Buchanan S, Brown SK, Rodriguez M, Cruser dA

Published in the American Journal of Obstetrics and Gynecology Volume 212, Issue 1, January , Pages 108.e1–108.e9 2015

OMT is a safe, effective adjunctive modality to improve pain and functioning during the third trimester.

Hastings V, McCallister Am, Curtis SA, Valant RJ, Yao S

Published in the Journal of the American Osteopathic Association, August 2016, Vol. 116, 502-509. doi:10.7556/jaoa.2016.103

Preliminary results demonstrate that OMT is efficacious for postpartum pain management. The lack of a control group precludes the ability to make causal claims. Future studies are needed to solidify OMT efficacy and generalizability.

American Osteopathic Association

Through the use of OMT, the number of patients reporting lower back pain decreased by 30 percent, abdominal pain by 17 percent and vaginal pain by 10 percent. This study shows that by combining osteopathic manipulation with other pain therapies, we can help new mothers get back on their feet quicker and improve their quality of life with their new infant.

Abbasi, Osman Z.; Zito, Patrick M.

Published in International Journal of Childbirth Education . Apr2013, Vol. 28 Issue 2, p76-78. 3p.

The female body undergoes a number of physiological and anatomical changes at various stages throughout pregnancy. These changes can cause a lot of discomfort and pain during pregnancy. There are not a lot of pharmacological options when carrying a child. However, Osteopathic Treatments offer a natural option that allows for the pregnant mother's body to heal itself with the guidance of a trained professional. This prevents unwanted side effects encountered with medication and can help solve a number of common complaints encountered throughout pregnancy.


 

Treating children

      Natalie M. Hayes, DO; Todd A. Bezilla, DO

      Published in The Journal of the American Osteopathic Association, October 2006, Vol. 106, 605-608.

      Osteopathic manipulative treatment appears to be a safe treatment modality in the pediatric population when administered by physicians with expertise in osteopathic manipulative treatment. Future studies should be prospective and include larger numbers of patients to document the safety of osteopathic manipulative treatment in this clinical application.

      Steele KM, Carreiro JE, Viola JH, Conte JA, Ridpath LC.

      Published in the Journal of American Osteopathic Association

      A standardized osteopathic manipulative treatment protocol administered adjunctively with standard care for patients with acute otitis media may result in faster resolution of middle ear effusion following acute otitis media than standard treatment alone.

      Mills MV, Henley CE, Barnes LL, Carreiro JE, Degenhardt BF.

      Arch Pediatr Adolesc Med. 2003 Sep;157(9):861-6

      The results of this study suggest a potential benefit of osteopathic manipulative treatment as adjuvant therapy in children with recurrent AOM; it may prevent or decrease surgical intervention or antibiotic overuse.

      F.Cerritelli, G.Pizzolorusso, C.Renzetti, V.Cozzolino, M.D’Orazio, M.Lupacchini, B.Marinelli, Alessandro A.C.Lucci, J.Lancellotti, S.Ballabio, C.Castelli, D.Molteni, R.Besana, L.Tubaldi, F.Paolo Perri, P.Fusilli, C.D’Incecco, G.Barlafante

      Published in PLOS ONE | DOI:10.1371/journal.pone.0127370

      Osteopathic treatment reduced significantly the number of days of hospitalization and is cost-effective on a large cohort of preterm infants.

      Bolin DJ.

      Published in the Pediatr Clin North Am. 2010;57(3):775-94.  PMID:20538156

      The application of manual techniques to pediatric athletic injuries has been considered alternative medicine. There are many injuries that are associated with loss of normal motion. Altered biomechanics can be readily identified and treated using manual methods. These include articular or thrust techniques, muscle energy, strain-counterstrain, and myofascial treatments, among others. Although there are few high-quality studies available, most available literature reports effectiveness of manual techniques in combination with therapeutic exercise for common pediatric motion restrictions.

      Tarsuslu T, Bol H, S¸ims¸ek IE, Toylan IE, Çam S

      Published in the Journal of Manipulative and Physiological Therapeutics Volume 32, Issue 8, October , Pages 648–653 2009

      Osteopathic methods were as effective as osteopathic methods in addition to medical care for both treatment groups. The results of this study suggest that osteopathic methods may be helpful as an alternative treatment in constipation. Additional advanced studies should be conducted.

      Lessard S, Gagnon I, Trottier N.

      Published in the Complement Ther Clin Pract Nov;17(4):193-8 2011

      These clinical findings support the hypothesis that osteopathic treatments contribute to the improvement of cranial asymmetries in infants younger than 6.5 months old presenting with nonsynostotic occipital plagiocephaly characteristics.

      Philippi H, Faldum A, Schleupen A, Pabst B, Jung T, Bergmann H, Bieber I, Kaemmerer C, Dijs P, Reitter B

      Published in the Dev Med Child Neurol Jan;48(1):5-9; discussion 4 2006

      We conclude that osteopathic treatment in the first months of life improves the degree of asymmetry in infants with postural asymmetry.

      Gemelli M, Ulbricht L, Romaneli EFR

      Published in the IFMBE Proceedings 41, pp. 1067-1070 2014

      Osteopathy has been effective to eliminate reflux symptoms suggesting that control group studies must be carried out on a statistically significant sample to assess the real relationship between osteopathy and acceleration of improvement of babies with GER.

      Hayden C, Mullinger B

      Complementary Therapies in Clinical Practice Volume 12, Issue 2, May , Pages 83–90 2006

      Treated infants also required less parental attention than the untreated group. In conclusion, this preliminary study suggests that cranial osteopathic treatment can benefit infants with colic; a larger, double-blind study is warranted.

      Gludovatz Petra Dipl. PT

      Though a relatively small number of test persons was included in the study, the results clearly indicate a positive effect of osteopathic methods on three months colic, particularly with regards to crying habits. This effect is expressed in absolute numbers as well as in statistical tendency.

      Guiney PA, Chou R, Vianna A, Lovenheim J

      Published in the J Am Osteopath Assoc Jan;105(1):7-12 2005

      OMT group showed a statistically significant improvement of 7 L per minute to 9 L per minute for peak expiratory flow rates. These results suggest that OMT has a therapeutic effect among this patient population. The authors suggest that more clinical trials are required to better demonstrate the effectiveness of OMT in patients with asthma.

      Pepino VC, Ribeiro JD, Ribeiro MA, de Noronha M, Mezzacappa MA, Schivinski CI.

      Published in the J Manipulative Physiol Ther Jan;36(1):57-65 2013

      The use of manual techniques on children with respiratory diseases seems to be beneficial. Chiropractic, osteopathic medicine, and massage are the most common interventions. The lack of standardized procedures and limited variety of methods used evidenced the need for more studies on the subject.

      Pizzolorusso G, et.al

      Published in Chiropractic and Manual Therapies 2011, 19:15

      In a population of premature infants, osteopathic manipulative treatment showed to reduce a high occurrence of gastrointestinal symptoms and an excessive length of stay in the NICU. Randomized control studies are needed to generalize these results to a broad population of high risk newborns.

      Accorsi A, Lucci C, Di Mattia L, Granchelli C, Barlafante G, Fini F, Pizzolorusso G, Cerritelli F, Pincherle M

      Published in the J Am Osteopath Assoc May;114(5):374-81 2014

      Participants who received OMTh had greater improvement in Biancardi-Stroppa Test scores than participants who received conventional care only, suggesting that OMTh can potentially increase performances of selective and sustained attention in children with ADHD. To confirm these findings, studies of larger and more diverse populations are warranted.

      Castellarina IB, Drysdalea I, Patelb V

      Published in the Journal of Osteopathic Medicine Volume 16, Issue 1, March , Pages e13–e14 2013

      The experimental hypothesis has been supported indicating a positive effect of Visceral Osteopathic Treatment (VOT) on the measured symptoms and behavioural patterns of Autistic children. This data indicates that the use of VOT on GI function may be of benefit to autistic children.

      Apoznanski TE, Abu-Sbaih R, Terzella MJ, Yao S

      J Am Osteopath Assoc Feb;115(2):110-4 2015

      A review of the literature highlights key pathophysiologic processes, management options, and musculoskeletal aspects of dacryostenosis. Physicians should consider osteopathic manipulative treatment in the management of dacryostenosis.


       

      Shoulder pain

       

      Gert JD Bergman, Jan C Winter, Maurits W van Tulder, Betty Meyboom-de Jong, Klaas Postema and Geert JMG van der Heijden

      Published in BMC Musculoskeletal Disorders 2010

      Manipulative therapy in addition to usual medical care accelerates recovery and is more effective than usual medical care alone on the long term, but is associated with higher costs.

      Brantingham JW, Cassa TK, Bonnefin D, Jensen M, Globe G, Hicks M, Korporaal C.

      Published in J Manipulative Physiol Ther. 2011 Jun;34(5):314-46. doi: 10.1016/j.jmpt.2011.04.002.

      This study found fair evidence for manual and manipulative therapy (MMT) of the shoulder, shoulder girdle, and/or the the full kinetic chain (FKC) combined with multimodal or exercise therapy for rotator cuff injuries/disorders, disease, or dysfunction. There is also fair evidence for MMT of the shoulder/shoulder girdle and the FKC combined with a multimodal treatment approach for shoulder complaints, dysfunction, disorders, and/or pain.

       


       

      Sinusitis

       

      Häfner S. Stadler M.

      Osteopathic interventions seem to induce positive changes in the symptomatology of CS (chronic sinusitis) with further improvement after cessation of therapy. Most aspects of the study protocol proved feasible, while likert scales used to assess aspects of quality of life should probably be replaced by a more sensitive instrument, taking into account generic as well as condition specific criteria.

      Méndez-Sánchez, González-Iglesias J, Puente-González AS, Sánchez-Sánchez JL, Puentedura EJ, Fernández-de-Las-Peñas C.

      Published in Journal of Manipulative and Physiological Therapeutics

      Patients with craniofacial pain and chronic rhinosinusitis who were treated with manual therapy demonstrated improvements in all outcome measures only after each treatment session. Our results suggest that manual therapy treatment could be considered as an appropriate alternative treatment of chronic rhinosinusitis.

       


      Carpal tunnel syndrome


       

      Taylor Burnham,Derek C. Higgins, DO; Robert S. Burnham, MD; Deborah M. Heath, DO

      Published in International Journal of Osteopathic Medicine

      Osteopathic manipulative treatment resulted in patient-perceived improvement in symptoms and function associated with carpal tunnel syndrome. However, median nerve function and morphology at the carpal tunnel did not change, possibly indicating a different mechanism by which osteopathic manipulative treatment acted, such as central nervous system processes.


       

      Pelvic pain

       

        Florian Schwerlaa, Petra Wirthwein, Michaela Rütz, Karl-Ludwig Resch

        Published in International Journal of Osteopathic Medicine

        A series of osteopathic treatments might be beneficial for women suffering from primary dysmenorrhoea.

         


         

        Ankle pain

         

        Loudon JK, Reiman MP, Sylvain J.

        Published in British Journal of Sports Medicine

        For acute ankle sprains, manual joint mobilisation diminished pain and increased dorsiflexion range of motion. For treatment of subacute/chronic lateral ankle sprains, these techniques improved ankle range-of-motion, decreased pain and improved function.

         


         

        Knee pain

         

        Hendry M, Williams NH, Markland D, Wilkinson C, Maddison P.

        Published in Family Practice

        Several physical, cognitive and contextual factors, and a typology of exercise behaviour were identified that could be addressed in primary care consultations. The importance of gyms and GP referral schemes for people who are exercising for the first time, and the high level of patient satisfaction associated with these were highlighted.

        Bachem S. Salzmann I. Schwartz U

        Although only 30 patients participated, the study presents a significant decrease of pain and improvement in quality of life. Because patients failed to achieve recovery in the conventional, more local focused proceeding, but experienced an important decrease of pain in the osteopathic, the whole body including way, our findings lead to the hypothesis, that knee pain is broadly influenced by different regions of the body. Therefore we conclude that osteopathy has beneficial effects in the treatment and accompanying of chronic knee pain.

        Haberl Franz-Josef

        Compared to the control group, the osteopathically treated test group showed a statistically significant increase in performance capability. The experimental group was able to increase performance capability by an average of approximately 4.5%. Measured performance increased by an average of 8% among female and 5.5% among male test persons compared to the control group. Treatment showed a sustained effect in three out of five achievement groups, with a further increase in performance levels between the third and the fourth test. One achievement group of the control group also increased performance in this period. Evaluation of questionnaires proved that neither of the two groups was able to accurately self evaluate their performance capability. Apart from the low number of participants, the results confirmed that osteopathic treatment is able to enhance performance capability and improves the sustained effect of training.

         


         

        Sciatica

         

        Burton, K. , Tillotson M. K., Cleary J

        Published in Eur Spine J (2000) 9 : 202–207

        This single-blind randomised clinical trial compared osteopathic manipulative treatment with chemonucleolysis (used as a control of known efficacy) for symptomatic lumbar disc herniation. By 12 months, there was no statistically significant difference in outcome between the treatments, but manipulation produced a statistically significant greater improvement for back pain and disability in the first few weeks. A similar number from both groups required additional orthopaedic intervention; there were no serious complications. Crude cost analysis suggested an overall financial advantage from manipulation. Because osteopathic manipulation produced a 12month outcome that was equivalent to chemonucleolysis, it can be considered as an option for the treatment of symptomatic lumbar disc herniation, at least in the absence of clear indications for surgery. Further study into the value of manipulation at a more acute stage is warranted.

         


         

        Elbow pain

        A. R. Stockard

        Published in The Journal of the American Osteopathic Association, September 2001, Vol. 101, 509-516.

        This article attempts to provide an overview of golf injuries to the elbow, with a concentration on incidence, proper diagnosis, adequate treatment (including rehabilitation), and prevention strategies.

         


         

        Hip and groin pain

         

        Hinman, R

        Published in J Physiother. 2014 Mar;60(1):56. doi: 10.1016/j.jphys.2013.12.005. Epub 2014 May 9.

        For people with hip and knee OA, manual therapy and exercise therapy supervised by physiotherapists can lead to reduced pain and improved physical function for up to one year, with no added benefit from combining these physiotherapy interventions.

        Pinto D, Robertson MC, Abbott JH, Hansen P, Campbell AJ; MOA Trial Team

        Published in Osteoarthritis Cartilage. 2013 Oct;21(10):1504-13. doi:10.1016/j.joca.2013.06.014. Epub 2013 Jun 27.

        Exercise therapy and manual therapy were more cost effective than usual care at policy relevant values of willingness-to-pay from both the perspective of the health system and society.

        Seffinger, M. A
        Published in The Journal of the American Osteopathic Association, January 2014, Vol. 114, 63. doi:10.7556/jaoa.2014.010

        It is likely that OMT effectiveness would be similar to the manual therapy effectiveness demonstrated in this study. Studies assessing the effectiveness of OMT for patients with hip or knee OA are warranted.

         

         


         

         

        Infants and Breastfeeding

         

         

        Fraval M

        Published in AAO Journal Summer 1998

        Following osteopathic treatment the pre and post feed fat estimations of breast milk were comparable with the fat estimations from babies who were breastfeeding normally.

        Monaco A, Cozzolino V, Cattaneo R, Cutilli T, Spadaro A

        Published in the Eur J Paediatr Dent Mar;9(1):37-42 2008

        The study group showed a significant improvement of maximal mouth opening and maximal mouth opening velocity compared with no-intervention group.

        G. Olivi, A. Signore, M. Olivi

        Published in the Eur J Paediatr Dent Vol 13/2-12 p101-106 2012 

        Early intervention is advisable to reduce the onset of alterations correlated to the ankyloglossia. A multidisciplinary approach to the problem is advisable. Collaboration with the speech therapist, thephysiotherapist/osteopath is fundamental to complete the therapeutic approach.

        Lund GC, Edwards G, Medlin B, Keller D, Beck B, Carreiro JE

        Published in the J Am Osteopath Assoc Jan;111(1):44-8 2011

        During the OMT course, the twins' nipple feeding skills progressed to full oral feeding, which allowed them to be discharged to home without placement of gastrostomy tubes. The authors also review the literature and discuss the development of nipple feeding in premature newborns and infants and the use of OMT in the management of nipple feeding dysfunction.

        Herzhaft-Le Roy J, Xhignesse M, Gaboury I

        Published in the J Hum Lact. 2017 Feb;33(1):165-172. doi: 10.1177/0890334416679620. Epub 2016 Dec 27.

         This study is one of the first to bring together lactation consultants and osteopaths to address infants with biomechanical sucking difficulties. Findings support the hypothesis that the addition of osteopathy to regular lactation consultations is beneficial and safe.


         

        Treating women

        Riepler-Reisecker, I

        On the basis of the statistical results it has been proven beyond any doubt that it is possible to influence hormonal dysbalances of women by givingthem osteopathic treatment. Function of organs in the lesser pelvis is improved by a harmonisation on the structural, cranial and visceral levels and congestive pain symptomatology is considerably reduced.

        von Schneider-Milo, U

        The present study shows a significant change in the perceived pain and in some domains of health-related quality of life indicating that osteopathic treatment can be an acceptable tool in the treatment of endometriosis-related pain. Nevertheless, more research to understand the connection between pain in endometriosis patients and osteopathy is needed.

        Daraï C , Deboute O, Zacharopoulou C, Laas E, Canlorbe G, Belghiti J, Zilberman S, Ballester M, Darai E

        Published in European Journal of Obstetrics & Gynecology and Reproductive Biology Volume 188, May 2015, Pages 70–73 doi:10.1016/j.ejogrb.2015.03.001

        Our results support that OMT can improve QOL of patients with DIE and colorectal involvement. Moreover, this pilot study can serve to determine power calculations for future randomized trials.

        Franke H, Hoesele K.

        Published in J Bodyw Mov Ther. 2013 Jan;17(1):11-8. doi: 10.1016/j.jbmt.2012.05.001. Epub 2012 Jun 17.

        The findings of this systematic review and meta-analysis are promising and encouraging to conduct larger, rigorous osteopathic intervention studies for female urination disorders. Future studies should compare the osteopathic treatment with established standard procedures in the control group.

         


         

        Post surgery

         

        Bertelli DF, de Oliveira P, Gimenes AS, Moreno MA.

        Published in Am J Phys Med Rehabil Aug 2013;92(8):697-703

        The treatment protocols promoted reductions in volume values, suggesting that both techniques could be used to help reduce lower limb edema among this population. Nevertheless, the best results were obtained with MLD.

        Kim BJ, Ahn J, Cho H, Kim D, Kim T, Yoon B

        Published in the International Journal of Osteopathic Medicine November 2014

        Post-surgical physical disability improved more with OMT rehabilitation than the exercise programme. Residual leg pain decreased with OMT and exercise. Post-operative low back pain decreased in the OMT group and the exercise group. Patients in both groups required less frequent use of medication and were highly satisfied with the rehabilitation interventions. No side effects or complications from any intervention were reported.

        Crow WT, Gorodinsky L,

        Published in the International Journal of Osteopathic Medicine Vol 12 (1) pages 32-37, 2009

        OMT patients had a significantly shorter length of stay than the no treatment group

        Baltazar GA, Betler MP, Akella K, Khatri R, Asaro R, Chendrasekhar A.  

        Published in the J Am Osteopath Assoc Mar;113(3):204-9, 2013

        Osteopathic manipulative treatment applied after a major gastrointestinal operation is associated with decreased time to flatus and decreased postoperative hospital LOS.

        Goldstein FJ, Jeck S, Nicholas AS, Berman MJ, Lerario M

        Published in the J Am Osteopath Assoc Jun;105(6):273-9, 2005

        Administration of postoperative OMT enhanced pre- and postoperative morphine analgesia in the immediate 48-hour period following elective TAH, demonstrating that OMT can be a therapeutic adjunct in pain management following this procedure.

        Jarski RW, Loniewski EG, Williams J, Bahu A, Shafinia S, Gibbs K, Muller M

         Published in the Altern Ther Health Med Sep;6(5):77-81, 2000

        Patients receiving osteopathic manipulative treatment in the early postoperative period negotiated stairs earlier and ambulated greater distances than did control group patients.

         


         

        Foot pain

         

        Wynne MM, Burns JM, Eland DC, Conatser RR, Howell JN

        Published in the J Am Osteopath Assoc Sep;106(9):547-56 2006

        Clinical improvement occurs in subjects with plantar fasciitis in response to counterstrain treatment. The clinical response is accompanied by mechanical, but not electrical, changes in the reflex responses of the calf muscles. The causative relation between the mechanical changes and the clinical responses remains to be explored.

        Batt J, Neeki MM 

        Published in the J Am Osteopath Assoc Nov;113(11):857-61 2013

        The authors present a case of a 24-year-old woman with left foot pain that began after an inversion injury obtained while running. The pain minimally improved with nonsteroidal anti-inflammatory medications. Clinical examination revealed a relatively normal foot with palpable changes in the bony structures at the midfoot consistent with a tarsal subluxation. Cuboid reduction was performed using high-velocity, low-amplitude manipulation, after which the patient reported immediate and near-complete pain relief. The authors also review mechanisms of injury, clinical findings, and treatment modalities for patients with tarsal subluxation.

         


         

        Jaw pain

        Cuccia AM, Caradonna C, Annunziata V, Caradonna D

        Published in the Journal of Bodywork and Movement Therapies Vol 14 (2) pages 179-184 2010

        The two therapeutic modalities had similar clinical results in patients with TMD, even if the use of medication was greater in CCT group. The OMT group required significantly less medication (non-steroidal medication and muscle relaxants). Our findings suggest that OMT is a valid option for the treatment of TMD.

        Tuncer AB, Ergun N, Tuncer AH, Karahan S

        Published in the Journal of Bodywork and Movement Therapies Volume 17, Issue 3, July , Pages 302–308 2013

        Our results suggest that a four-week period of MT–HPT has a clinically significant effect on both pain and pain-free maximum mouth opening in patients with TMD.

        Monaco A, Cozzolino V, Cattaneo R, Cutilli T, Spadaro A

        Published in the Eur J Paediatr Dent Mar;9(1):37-42 2008

        The results of this study suggest that OMT can induce changes in the stomatognathic dynamics, offering a valid support in the clinical approach to TMD. Multifactorial genesis of chronic disorders is also confirmed.

         


         

        Fibromyalgia

        Castro-Sánchez AM, Matarán-Peñarrocha GA, Arroyo-Morales M, Saavedra-Hernández M, Fernández-Sola C, Moreno-Lorenzo C.

        Published in the Clin Rehabil Sep;25(9):800-13 2011

        Craniosacral therapy improved medium-term pain symptoms in patients with fibromyalgia.

        Gamber RG, Shores JH, Russo DP, Jimenez C, Rubin BR

        Published in the J Am Osteopath Assoc Jun;102(6):321-5 2002

        Significant findings between the four treatment groups on measures of pain threshold, perceived pain, attitude toward treatment, activities of daily living, and perceived functional ability were found. All of these findings favored use of OMT. This study found OMT combined with standard medical care was more efficacious in treating FM than standard care alone. These findings need to be replicated to determine if cost savings are incurred when treatments for FM incorporate nonpharmacologic approaches such as OMT.

        Degenhardt BF, Darmani NA, Johnson JC, Towns LC, Rhodes DC, Trinh C, McClanahan B, DiMarzo V.

        Published in J Am Osteopath Assoc Sep;107(9):387-400 2007

        Concentrations of several circulatory pain biomarkers were altered after OMT. The degree and duration of these changes were greater in subjects with chronic LBP than in control subjects without the disorder.

         


         

        Digestion

        da Silva RC, de Sá CC, Pascual-Vaca ÁO, de Souza Fontes LH, Herbella Fernandes FA, Dib RA, Blanco CR, Queiroz RA, Navarro-Rodriguez T.

        Published in the Dis Esophagus Jul;26(5):451-6 2013

        Osteopathic manipulative technique produces a positive increment in the lower esophageal sphincter region soon after its performance.

        Attali TV, Bouchoucha M, Benamouzig R

        Published in the J Dig Dis Dec;14(12):654-61 2013

        This study suggests that visceral osteopathy improves short-term and long-term abdominal distension and pain, and also decreases rectal sensitivity in IBS patients.

        Hundscheid HW, Pepels MJ, Engels LG, Loffeld RJ.

        Published in the J Gastroenterol Hepatol Sep;22(9):1394-8 2007

        Osteopathic therapy is a promising alternative in the treatment of patients with IBS. Patients treated with osteopathy overall did better, with respect to symptom score and QOL.

        Florance BM, Frin G, Dainese R, Nébot-Vivinus MH, Marine Barjoan E, Marjoux S, Laurens JP, Payrouse JL, Hébuterne X, Piche T 

        Published in the Eur J Gastroenterol Hepatol Aug;24(8):944-9 2012

        Osteopathy improves the severity of IBS symptoms and its impact on quality of life. Osteopathy should therefore be considered for future research as an effective complementary alternative medicine in the management of IBS symptoms.

        Müller A, Franke H, Resch KL, Fryer G 

        Published in the J Am Osteopath Assoc Jun;114(6):470-9  2014

        The present systematic review provides preliminary evidence that OMTh may be beneficial in the treatment of patients with IBS. However, caution is required in the interpretation of these findings because of the limited number of studies available and the small sample sizes.

        Brugman R, Fitzgerald K, Fryer G

        Published in the International Journal of Osteopathic Medicine Vol 13 (1) pages 17-23 2010

        Participants reported an improvement in the overall severity of constipation, symptoms and quality of life. Further investigation of osteopathic treatment of constipation is recommended using larger sample sizes and a randomized controlled design.

         


         

         

        Sleeping

        Cutler MJ, Holland BS, Stupski BA, Gamber RG, Smith ML

        Published in the J Altern Complement Med Feb;11(1):103-8. 2005

        Cranial manipulation, specifically the CV4 technique, can alter sleep latency and directly measured MSNA in healthy humans. These findings provide important insight into the possible physiologic effects of cranial manipulation. However, the mechanisms behind these changes remain unclear.

         


         

        Asthma and respiratory tract infections

        Mehl-Madrona L, Kligler B, Silverman S, Lynton H, Merrell W

        Published in Explore (NY) Jan-Feb;3(1):28-36. 2007

        Acupuncture and/or craniosacral therapy are potentially useful adjuncts to the conventional care of adults with asthma, but the combination of the two does not provide additional benefit over each therapy alone.

        Bockenhauer SE, Julliard KN, Lo KS, Huang E, Sheth AM

        Published in the J Am Osteopath Assoc Jul;102(7):371-5; discussion 375 2002

        Measurements of both upper thoracic and lower thoracic forced respiratory excursion statistically increased after osteopathic manipulative procedures compared with sham procedures. Changes in peak expiratory flow rates and asthma symptoms were not statistically significant.

        Lee-Wong M, Karagic M, Gomez S, Wilson A, Resnick D

        Published in The Internet Journal of Asthma, Allergy and Immunology 7:2 2008

        Patients treated for acute asthma exacerbation with nebulizer treatment followed by osteopathic treatment (rib raising maneuver) showed significant improvement in their overall breathing. Unfortunately, lack of a control group in which there would be nebulizer treatment plus no osteopathic treatment makes it uncertain whether this OMT treatment had more than a placebo effect. However, since more patients request alternative therapies more research in OMT techniques should be considered. Offering osteopathic treatments as adjunct to traditional asthma treatment in an acute setting appears to have no adverse effects and may have psychological benefits.

        Noll DR, Degenhardt BF, Morley TF, Blais FX, Hortos KA, Hensel K, Johnson JC, Pasta DJ, Stoll ST.

        Published in the Osteopath Med Prim Care Mar 19;4:2 2010

        ITT analysis found no differences between groups. PP analysis found significant reductions in LOS, duration of intravenous antibiotics, and respiratory failure or death when OMT was compared to CCO. Given the prevalence of pneumonia, adjunctive OMT merits further study.

        Saggio G, Docimo S, Pilc J, Norton J, Gilliar W.

        Published in the J Am Osteopath Assoc Mar;111(3):143-7 2011

        This study demonstrates the positive effect of OMT on sIgA levels in persons experiencing high stress. Results suggest that OMT may then have therapeutic preventive and protective effects on both healthy and hospitalized patients, especially those experiencing high levels of emotional or physiological stress and those at higher risk of acquiring upper respiratory tract infections.

        Creasy C, Schander A, Orlowski A, Hodge LM

        Published in the Lymphat Res Biol Sep;11(3):183-6 2013

        Our data demonstrate that LPT may protect against pneumonia by inhibiting bacterial growth in the lung; however, the mechanism of protection is unclear. Once these mechanisms are understood, LPT can be optimally applied to patients with pneumonia, which may substantially reduce morbidity, mortality, and frequency of hospitalization.

        Hodge, LM

        Published in Int J Osteopath Med. 2012 Mar; 15(1): 13–21. doi: 10.1016/j.ijosm.2011.11.004

        This short review highlightsclinical and basic science research studies that support the use of Lymphatic Pump Techniques to enhance the lymphatic and immune systems and treat pneumonia, and discusses the potential mechanisms by which LPT benefits patients with pneumonia.

        Mueller, DM

        Published in the J Am Osteopath Assoc. 2013 Sep;113(9):703-7. doi:10.7556/jaoa.2013.036.

        Use of osteopathic manipulative treatment with vaccination, antiviral therapy, and chemoprophylaxis has potential to save lives and reduce complications. The present article describes the role of osteopathic manipulative treatment in the management of influenza and highlights current issues surrounding the use of antiviral therapy.

         

         


         

        Stress and sleep

        Mulcahy J, Vaughan B

        Published in the Journal of Evidence-Based Complementary & Alternative Medicine 2014 October ; vol. 19, 4: pp. 235-246

        The most frequently experienced sensations of osteopathy in the cranial field patients were "relaxed," "releasing," and "unwinding." Satisfaction With Life and Meaningfulness of Daily Activity were positively associated with Patient Perception Measure-Osteopathy in the Cranial Field scores. Negative associations were observed between the Patient Perception Measure-Osteopathy in the Cranial Field and depression. Psychometric properties of the Patient Perception Measure-Osteopathy in the Cranial Field require further testing. The observed associations of Satisfaction With Life and depression with patients' perceptions of osteopathy in the cranial field treatment needs to be tested in larger clinical manual therapy cohorts.

        Giles PD, Hensel KL, Pacchia CF, Smith ML

        Published in The Journal of Alternative and Complementary Medicine. 2013 February, 19(2): 92-96

        These data support the hypothesis that upper cervical spine manipulation can acutely affect measures of heart rate variability in healthy individuals.

        Henderson AT, Fisher JF, Blair J, Shea C, Li TS, Bridges KG.

        Published in J Am Osteopath Assoc 2010 Jun;110(6):324-30

        The results of the present pilot study suggest that SNS activity may decrease immediately after rib raising, but the hypothalamic-pituitary-adrenal axis and parasympathetic activity are not altered by this technique. Salivary alpha-amylase may be a useful biomarker for investigating manipulative treatments targeting the SNS. Additional studies with a greater number of subjects are needed to expand on these results.

        Cutler MJ, Holland BS, Stupski BA, Gamber RG, Smith ML

        Published in the J Altern Complement Med 2005 Feb;11(1):103-8.

        The current study is the first to demonstrate that cranial manipulation, specifically the CV4 technique, can alter sleep latency and directly measured MSNA in healthy humans. These findings provide important insight into the possible physiologic effects of cranial manipulation. However, the mechanisms behind these changes remain unclear.