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Research and Evidence

Research within the osteopathic profession has taken place over a number of years; capacity in terms of research active osteopaths is steadily growing.

Research relevant to osteopathic treatment of musculoskeletal pain comes from a number of manual therapy professions.

 

A profile of osteopathic practice in Australia 2010-2011: a cross sectional survey.

Burke SR, Myers R, Zhang AL.

Published in BMC Musculoskeletal Disorders

In this study, Australian osteopaths mainly see patients with acute or sub-acute musculoskeletal problems which are predominantly spinal conditions. A significant proportion of these patients have one or more co-existing condition, largely of the cardiovascular and respiratory systems, along with mental health disorders. The majority of patients have a significant improvement within few treatments, with infrequent and minor adverse events reported. These findings should be tested through multi-centred pragmatic trials of osteopathic practice.

Effectiveness of manual therapies: the UK evidence report

Gert Bronfort, Mitch Haas, Roni Evans, Brent Leininger, Jay Triano

Published on PubMed

Spinal manipulation/mobilization is effective in adults for: acute, subacute, and chronic low back pain; migraine and cervicogenic headache; cervicogenic dizziness; manipulation/mobilization is effective for several extremity joint conditions; and thoracic manipulation/mobilization is effective for acute/subacute neck pain.

Following a review (by the UK government's independant Advertising Standards Authority  of the Bronfort et al Review in 2010) they accept that osteopaths may claim to help a variety of medical conditions, including:

• generalised aches and pains,
• joint pains including hip and knee pain from osteoarthritis as an adjunct to core OA treatments and exercise
• arthritic pain,
• general, acute & chronic backache, back pain (not arising from injury or accident)
• uncomplicated mechanical neck pain (as opposed to neck pain following injury i.e. whiplash)
• headache arising from the neck (cervicogenic) / migraine prevention
• frozen shoulder/ shoulder and elbow pain/ tennis elbow (lateral epicondylitis) arising from associated musculoskeletal conditions of the back and neck, but not isolated occurrences
• circulatory problems,
• cramp,
• digestion problems,
• joint pains, lumbago,
• sciatica,
• muscle spasms,
• neuralgia,
• fibromyalgia,
• inability to relax,
• rheumatic pain,
• minor sports injuries and tensions.

Spinal manipulative therapy for chronic low-back pain: an update of a Cochrane review.

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.

A ‘system based’ approach to risk assessment of the cervical spine prior to manual therapy

Alan J. Taylor, Roger Kerry

Published in International Journal of Osteopathic Medicine

Back Pain

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 physiotherap 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.

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.

Musculoskeletal Conditions during 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. 

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

This large randomised controlled trial identified that osteopathic treatment reduced the number of days of hospitalization and is cost-effective on a large cohort of preterm infants

T. Andreson, C. Bahr, C. Ciranna- Raab 

IJOM 16 (2), June 2013, 99-113

In this systematic review, osteopathy and other manual therapy approaches are tested in dental malocclusion. Evidence collected suggests osteopathy assisted realignment over alternative forms of manual therapy.

Headaches and Migranes

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.

Pain Management

Brisbane: Australian Academic Press, 2003.

Provides information on the management of acute pain, communication between clinicians and consumers, and the diagnosis, prognosis and interventions for acute low back, thoracic spine, neck, shoulder and anterior knee pain.

Other Research

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.

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.

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.

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.

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.

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.

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