Somatic dysfunction

Abstract: Background: Osteopathic manipulative treatment (OMT) is a distinctive modality commonly used by osteopathic physicians to complement conventional treatment of mus culoskeletal disorders, including those that cause low back pain. Osteopathic manipulative treatment is defined in the Glossary of Osteopathic Terminology as: “The therapeutic application of manually guided forces by an osteopathic physician (US Usage) to improve physiologic function and/or support homeostasis that has been altered by somatic dysfunction. OMT employs a variety of tech niques.” Somatic dysfunction is defined as: “Impaired or altered function of related components of the somatic (body framework) system: skeletal, arthrodial and myofas cial structures, and their related vascular, lymphatic, and neural elements. Somatic dysfunction is treatable using osteopathic manipulative treatment.” Previous published guidelines have been based on literature reviews and metaanalyses of spinal manipulation for low back pain. They have not specifically addressed OMT and generally have focused on spinal manipulation as an alternative to con ventional treatment. The purpose of this study was to assess the efficacy of OMT for somatic dysfunction asso ciated with low back pain by osteopathic physicians and osteopathic practitioners trained in osteopathic palpatory diagnosis and manipulative treatment. Methods: Computerized bibliographic searches of MED LINE, OLDMEDLINE, EMBASE, AMED, MANTIS, OSTMED (OSTMED.DR), and the Cochrane Central Reg ister of Controlled Trials were supplemented with addi tional database and manual searches of the literature. Six trials, involving eight OMT vs control treatment compar isons, were included because they were randomized con trolled trials of OMT that involved blinded assessment of low back pain in ambulatory settings. Data on trial method ology, OMT and control treatments, and low back pain outcomes were abstracted by two independent reviewers. Effect sizes were computed using Cohen d statistic, and meta-analysis results were weighted by the inverse variance of individual comparisons. In addition to the overall metaanalysis, subgroup meta-analyses were performed according to control treatment, country where the trial was conducted, and duration of follow-up. Sensitivity analyses were performed for both the overall and sub group meta-analyses. Results: Osteopathic manipulative treatment significantly reduced low back pain (effect size, -0.30; 95% confidence interval, -0.47 to -0.13; P=.001). Subgroup analyses demon strated significant pain reductions in trials of OMT vs active treatment or placebo control and OMT vs no treat ment control. There were significant pain reductions with OMT regardless of whether trials were performed in the United Kingdom or the United States. Significant pain reductions were also observed during short-, inter mediate -, and long-term follow-up. Conclusions: Osteopathic manipulative treatment signif icantly reduces low back pain. The level of pain reduction is clinically important, greater than expected from placebo effects alone, and may persist through the first year of treatment. Additional research is warranted to elucidate mechanistically how OMT exerts its effects, to determine if OMT benefits extend beyond the first year of treatment, and to assess the cost-effectiveness of OMT as a comple mentary treatment for low back pain.

Abstract: Burns and WellsOriginal Contribution Muscle energy technique is an established osteopathic manipulative intervention often used to treat somatic dysfunctions of the spine. There are little objective data to demonstrate its efficacy, however. To determine the efficacy of this osteopathic manipulative technique, the authors compared active cervical range of motion among asymptomatic young and middle-aged adults (n=18) before and after this treatment protocol, comparing those results against matched control subjects (n=14) who received sham manipulative treatment. Range of motion was measured in three planes (flexion/extension, lateral bending, rotation) on all subjects (N=32) using a motion- analysis system. Multiplanar gross cervical motion restric- tions were diagnosed in this asymptomatic population. In the treatment group, cervical long restrictor muscles were treated with the muscle energy technique in the sagittal, frontal, and horizontal planes. The control group had relative restrictions addressed by means of a sham manipulative treatment protocol in which the barriers to motion were not challenged therapeutically. The muscle energy technique produced a significant increase in overall regional cervical range of motion in the treat- ment group (approximately 4 degrees) when compared with control subjects (P.001). Significant differences were also observed in the magnitude of change in the three planes of movement (rotation, P.002; lateral bending, P.01), with flexion/extension being the least affected (P=.2). These data demonstrate that the applica- tion of the muscle energy technique can produce acute increases in the active cervical range of motion in asymp- tomatic subjects. I n the revised Glossary of Osteopathic Terminology,1 the term somatic dysfunction is defined as "impaired or altered func- tion of related components of the somatic (body framework) system: skeletal, arthrodial, and myofascial structures, and related vascular, lymphatic and neural elements." Somatic dysfunction of the cervical region of the spine often results in increased muscle tension, sensitivity changes (eg, tender- ness), asymmetry, and restriction of range of motion. Although many symptoms of somatic dysfunction, such as sensitivity changes, are subjective and are reported by patients, asymmetry and tissue tension can be found through palpa- tory examinations and, to a certain extent, by mechanical measurements. However, the restriction of range of motion, both active and passive, can be easily measured by conven- tional means.