Research and Articles

At Osteopathy Australia, our aim is to build a strong evidence base for the work of osteopaths. This involves reviewing the available literature to highlight relevant research for members, particularly with regard to its significance in clinical practice. The articles below are regularly updated with new information.

July 2021

Decrease in sarcomere numbers in patients following stroke

Researchers at Northwestern University have recently found that stroke patients had a significant loss in sarcomeres along the length of the muscle, which hasn’t previously been demonstrated in humans. The team used MRI, ultrasound, and microendoscopy to measure functional parameters in stroke patients compared to healthy controls.

The study has implications for patients who experience abnormal amounts of muscle stiffness and tight joints following impairment – suggesting that changes in muscle structure may be part of the problem. Of further significance is that the study establishes the ability to investigate muscle adaptations in humans without being limited to tissue samples from a biopsy or measurements during surgery.

Adkins, A.N., et al. (2021) Serial sarcomere number is substantially decreased within the paretic biceps brachii in individuals with chronic hemiparetic stroke. PNAS. doi.org/10.1073/pnas.2008597118

A long-term look at graded exercise self-help to improve symptoms of chronic fatigue syndrome

Chronic fatigue syndrome (CFS) is a disorder characterised by persistent fatigue that causes dysfunction to daily life. There has been a growing body of evidence suggesting that patients with CFS may benefit from various forms of exercise therapy.

The GETSET trial – a randomised controlled trial of UK patients with CFS – aimed to assess graded exercise self-help (GES) alongside long-term health and economic outcomes. The study found that short-term fatigue reduction (at 12 weeks) was maintained at long-term follow-up (at 15 months) for participants assigned to the graded exercise program. However, no additional improvement was noted at the long-term follow-up. While additional research is still required in the area, trials such GETSET are an important initiative to determine long-term outcomes for patients who suffer from CFS.

Clark, L. V., McCrone, P., Pesola, F., Vergara-Williamson, M., & White, P. D. (2021). Guided graded exercise self-help for chronic fatigue syndrome: long term follow up and cost-effectiveness following the GETSET trial. Journal of Psychosomatic Research, 146, 110484. https://doi.org/10.1016/j.jpsychores.2021.110484

Explaining central sensitisation to patients reporting chronic unexplained musculoskeletal pain

Reconceptualising pain remains an important aspect when commencing rehabilitation services for patients with chronic unexplained pain. This is commonly achieved using patient education.

Pain physiology education has been shown to effectively change pain perceptions and improve health status in patients with musculoskeletal pain disorders. Patient education about central sensitisation and its role in chronic pain may be a particularly useful tool to help patients understand their pain. Central sensitisation (characterised by generalised or widespread pain hypersensitivity) provides an evidence-based explanation for some cases of chronic unexplained musculoskeletal pain.

Nijs, J., Paul van Wilgen, C., Van Oosterwijck, J., van Ittersum, M., & Meeus, M. (2011). How to explain central sensitization to patients with 'unexplained' chronic musculoskeletal pain: practice guidelines. Manual therapy, 16(5), 413–418. https://doi.org/10.1016/j.math.2011.04.005

Nijs, Jo & George, Steven & Clauw, Dan & Fernández-de-Las-Peñas, César & Kosek, Eva & Ickmans, Kelly & Fernández-Carnero, Josué & Polli, Andrea & Kapreli, Eleni & Huysmans, Eva & Cuesta-Vargas, Antonio & Mani, Ramakrishnan & Lundberg, Mari & Leysen, Laurence & Rice, David & Sterling, Michele & Curatolo, Michele. (2021). Central sensitisation in chronic pain conditions: latest discoveries and their potential for precision medicine. The Lancet Rheumatology. 3.10.1016/S2665-9913(21)00032-1. https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(21)00032-1/fulltext

A review of the validity of lumbo–pelvic landmark palpation

Osteopaths, alongside other manual therapists, often use palpation as part of a lower back or pelvic assessment. A recent review published in the International Journal of Osteopathic Medicine noted that, lumbo–pelvic landmark palpation, while common, has not achieved clearly established validity as a clinical tool. The authors further suggest a shift away from the over-reliance on landmark palpation in order to align manual therapy with practice guidelines.

Alexander, N., Rastelli, A., Webb, T.R., & Rajendran, D. (2020). The validity of lumbo-pelvic landmark palpation by manual practitioners: a systematic review. International Journal of Osteopathic Medicine. 39. 10.1016/j.ijosm.2020.10.008. https://www.journalofosteopathicmedicine.com/article/S1746-0689(20)30208-X/fulltext

Use of integrative and complementary healthcare services by people with spinal cord injury.

A recent descriptive study published in the Archives of Physical Medicine and Rehabilitation has depicted the use of complementary and integrative health services by people with spinal cord injury. The study suggests that patients may use at least one if not more complementary and/or integrative approaches. The implications for rehabilitation clinicians and the importance of open dialogue with patients is also discussed.

Coker, J., Berliner, J., Botticello, A., Bryce, T. N., Charlifue, S., Chen, D., Estrada, D., Monden, K. R., Taylor, H., Zafonte, R., & Zanca, J. M. (2021). Utilization of complementary and integrative healthcare by people with spinal cord injury in the Spinal Cord Injury Model Systems: A descriptive study. Archives of physical medicine and rehabilitation, S0003-9993(21)00400-7. Advance online publication. https://doi.org/10.1016/j.apmr.2021.04.023

The potential for osteopathy to regulate brain–heart modulation in chronic pain

A recent study published in Nature – Scientific Reports suggests that osteopathic treatment may be able to modulate brain–heart interactions. Cerritelli et al used cerebral blood flow (CBF) and heart rate variability (HRV) to demonstrate that patients receiving osteopathic treatment showed a decrease in CBF in some regions of the brain associated with pain. This change was also associated with changes in HRV parameters and a reduction in reported pain by the treatment group. The study begins to increase the knowledge base surrounding the neurobiological and physiological changes associated with osteopathic interventions for chronic pain.

Cerritelli, F., Chiacchiaretta, P., Gambi, F., Saggini, R., Perrucci, M. G., & Ferretti, A. (2021). Osteopathy modulates brain-heart interaction in chronic pain patients: an ASL study. Scientific reports, 11(1), 4556. https://doi.org/10.1038/s41598-021-83893-8

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