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.

Research Resources

To assist researchers, we have put together resource sheets that provide information on common research topics such as grant writing, preparing manuscripts, and data analysis. There will be more sheets added over time. A full list of resource sheets can be found at the bottom of this page.

Research News


Respiratory Physiotherapy for COPD: a review

Chronic Obstructive Pulmonary Disease (COPD) remains one of the most prevalent respiratory diseases worldwide and research into the role of allied health professionals such as physiotherapists around COPD is increasing. A systematic review by Leemans and team has investigated the cost effectiveness of respiratory physiotherapy (e.g., exercise training) for individuals with COPD. While only 11 studies were included in the final analysis (of which only four were interpreted as cost effective), the team noted that physiotherapy interventions had the potential to be cost effective, though further research is needed in the area.

Leemans, G., Taeymans, J., Van Royen, P., & Vissers, D. (2021). Respiratory physiotherapy interventions focused on exercise training and enhancing physical activity levels in people with chronic obstructive pulmonary disease are likely to be cost-effective: a systematic review. Journal of Physiotherapy. 67(4), 271-283

Cardiometabolic health improvements after high intensity interval training

A recent study published in the Journal of Exercise Science and Fitness has suggested that both high intensity interval training and moderate intensity continuous training both alone and alternating was able to improve cardiometabolic health in obese middle-aged men. 48 participants aged between 40-59 took part in the study, all of whom were previously inactive. The study was able to utilise a randomized control research design with free living conditions to better reflect everyday lifestyle habits. In addition to improvements in cardiometabolic health, the authors also noted an overall reduction in weight, waist circumference, BMI, and percentage fat in each of the exercise groups.

Poon, E. T. C., Little, J. P., Sit, C. H. P., & Wong, S. H. S. (2020). The effect of low-volume high-intensity interval training on cardiometabolic health and psychological responses in overweight/obese middle-aged men. Journal of Sports Sciences38(17), 1997-2004.

A review of manual palpation for low back pain assessment

A review in the Journal of Chiropractic & Manual Therapies has investigated the reliability and validity of manual palpation for the assessment of lower back pain. The research team identified 14 articles to be included in their evidence synthesis out of over 2000 articles originally identified. However, they were unable to find consistency in the assessments commonly used by manual therapists suggesting that reliability of these assessments varies greatly. As there was little consistency in the articles and little evidence is available on the validity of these assessments, more research is needed in the area to build a strong evidence profile for the use of palpation in the assessment of lower back pain.

Nolet, P. S., Yu, H., Côté, P., Meyer, A. L., Kristman, V. L., Sutton, D., Murnaghan, K., & Lemeunier, N. (2021). Reliability and validity of manual palpation for the assessment of patients with low back pain: a systematic and critical review. Chiropractic & manual therapies, 29(1), 1-20.

Advice giving for patients with lower back pain

Advice giving for patients with low back pain is often endorsed in best practice statements and clinical guidelines – but little is known about the extent of health promotion and what actual advice is given to patients who see manual therapists or acupuncturists. As such, a novel study by Osborn-Jenkins and team from the University of Southampton has described advice giving practices in physiotherapists, osteopaths, and acupuncturists in the UK. The results noted a broad scope of advice with majority of practitioners offering exercise advice.

Osborn-Jenkins, L., Roberts, L., Al-Abbadey, M., MacPherson, H., Stuart, B., Carnes, D., Fawkes, C., Yardley, L., Bradbury, K., & Bishop, F. L. (2021). Advice-giving practice in physiotherapy, osteopathy, and acupuncture for people with low back pain. Physiotherapy113, e164-e165.


GUIDELINES: Myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome: diagnosis and management

The UK National Institute for Health and Care Excellence (NICE) released updated guidelines on the diagnosis and management of myalgic encephalomyeltis/chronic fatigue syndrome

Overview | Myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome: diagnosis and management | Guidance | NICE

Respiratory Palpation in Osteopathic Manual Medicine

An article published in Cureas has noted the clear lack of literature in regarding palpation of the lower respiratory tree and the failure to demonstrate how to perform palpation of said area. The review article thus covers innervation of the respiratory tree, the mechano-metabolic weight of the passage of fluids and air in the respiratory tract, anatomical topography, and respiratory movements – illustrating hand placement for effective osteopathic assessment of respiratory structures such as the tracheal, bronchial, structures.

Bordoni, B., & Escher, A. R. (2021). Palpation of the Respiratory System in Osteopathic Manual Medicine: From the Trachea to the Lungs. Cureus13(9), e18059.

Large analysis shows the high burden of musculoskeletal disorders for 195 Countries and Territories

Musculoskeletal disorders have an ever-increasing prevalence globally and can severely affect an individual’s quality of life. A study in the Journal of Arthritis & Rheumatology has provided an overview of the burden of musculoskeletal disorders in a global context. The researchers examined data from the Global Burden of Disease Study 2017 which covered musculoskeletal disorders such as (but not limited to) rheumatoid arthritis, osteoarthritis, neck pain, lower back pain. The team found that there were approximately 1.3 billion prevalent cases of musculoskeletal disorders around the world in 2017 and that the burden of these diseases tended to increase with age, was more common among females, and was higher in developed countries.

OCTOBER 2021: Journal Focus – Musculoskeletal Science and Practice

Issues in identifying serious pathology in Musculoskeletal care during and after COVID

Identifying serious pathology in musculoskeletal care is challenging at the best of times and the COVID 19 pandemic seems to have compounded the issue as consultations have moved online, limiting assessment and decision-making capabilities. A paper published in the Journal Musculoskeletal Science and Practice discusses the complexities of identifying serious pathology as well as clinical risk and management strategies.

Paling, C. (2021). The complex problem of identifying serious pathology in Musculoskeletal care: Managing clinical risk during the COVID pandemic and beyond. Musculoskeletal Science and Practice, 102379

A look at manual therapy techniques for migraine

Migraines are much more than just a simple headache and over 4 million Australians experience migraines at some point in time. Not only are they a literal pain, but they often lead to a significant reduction productivity. A study published in the Journal Musculoskeletal Science and Practice has suggested that Articulatory manual therapy may reduce pain intensity, disability, and medication intake in patients who suffer from migraines. The study also reported on short term sustained improvements in quality of life. However, a variety of articulatory techniques were used and thus the observed improvements could not be attributed to a singular technique.

Muñoz-Gómez, E., Inglés, M., Serra-Añó, P., & Espí-López, G. V. (2021). Effectiveness of a manual therapy protocol based on articulatory techniques in migraine patients. A randomized controlled trial. Musculoskeletal Science and Practice54, 102386.

Care seeking in adolescents with neck and low back pain

Neck and lower back pain are often associated with adulthood and more often with old age, however, there is an increasing prevalence of these conditions in younger individuals, but questions remain as to their care seeking behaviours and what may influence younger patients to seek care for neck and back pain. A study by Oliveira and team from the Universidade Estadual Paulista (UNESP) in Brazil noted that around 1/3 of adolescents in their study with neck or low back pain sought healthcare. They also found that adolescents were more likely to seek care for if they reported daily activity limitations due to their pain, had higher physical activity at school, or were encouraged to practice physical activity by others.

Oliveira, C. B., Pinto, R. Z., Damato, T. M., Lemes, I. R., Delfino, L. D., Tebar, W. R., & Christofaro, D. G. (2021). Daily activity limitations and physical activity encouragement influence adolescents seeking health care for neck and low back pain. Musculoskeletal Science and Practice54, 102385

Patient experiences regarding medication for sciatica

First line treatments for many forms of lower back pain, including sciatica, are often medications. A study in the Journal Musculoskeletal Science and Practice has explored sciatica patients experiences on medication, noting issues around cost, lack of effectiveness, side effects, and fear of addiction. Such findings have steady implications on healthcare practice and the use (and sometime over use/prescription) of medication for pain.


Patient focused care in musculoskeletal practice

Patient-centered care in musculoskeletal practice and rehabilitation remains a key feature in best practice and quality of care for individuals with chronic musculoskeletal pain. However, an article from the journal of Musculoskeletal Science and Practice which covers content from the 2021 World Physiotherapy Congress (online), has noted that clinicians may experience difficulties with integrating patient-centered care into their everyday practice. The article covers aspects like patient connections, shared decision making, self-management support, and implementation.

Hutting, N., Caneiro, J. P., Ong’wen, O. M., Miciak, M., & Roberts, L. (2021). Patient-centered care in musculoskeletal practice: key elements to support clinicians to focus on the person. Musculoskeletal Science and Practice, 102434.

Upper limb neurodynamic tests for cervical radiculopathy

An article published in the journal of journal of Musculoskeletal Science and Practice discusses the use of Upper Limb Neurodynamic Tests (ULNT) in the diagnosis of neuropathic conditions. The research team utilised a diagnostic accuracy study design involving 109 individuals with suspected cervical radiculopathy. The findings noted that ULNTs when used singularly were not effective however when used in conjunction, they may yield higher clinical utility and may rule in or rule out cervical radiculopathy.

Grondin, F., Cook, C., Hall, T., Maillard, O., Perdrix, Y., & Freppel, S. (2021). Diagnostic accuracy of upper limb neurodynamic tests in the diagnosis of cervical radiculopathy. Musculoskeletal Science and Practice55, 102427.

The use of manual therapy for chronic neck pain

An invited commentary published with the JAMA Network Open discusses the use of manual therapy as non-pharmacological treatment option for chronic neck pain.

Fritz, J. M. (2021). East or West—Manual Therapy as a Viable Nonpharmacologic Option for Chronic Neck Pain. JAMA Network Open4(7), e2114784-e2114784.

A case series on osteopathic interventions via telehealth in a paediatric population.

Over the course of the Covid-19 pandemic, certain aspects of healthcare delivery have been forcibly shifted from its rigid system to that of online telehealth. While for some disciplines, the shift was simpler, for other disciplines it was a challenge. As noted by a study by Kramer and team from the Pheonix Children’s Hospital in Arizona (USA), the delivery of manual therapies such as osteopathy via telehealth was a unique challenge as such therapies are typically provided physically, in-person, by a trained osteopath. However, the small case series observed that it was possible to see improvement in patient symptoms even via telehealth treatment. While it is important to note that the authors trialled the telehealth interventions with a considerably small number of patients and parents who were familiar with the techniques being used, the case series still reflects the capability of osteopathic care being applied in a safe and effective manner via telehealth.

Kramer, J. L., & De Asis, K. (2021). Osteopathic interventions via telehealth in a pediatric population: a retrospective case series. Journal of Osteopathic Medicine.

DNA changes associated with exercise

A study published in Molecular Metabolism has discussed the changes in skeletal muscle gene expression following exercise training. It is well known that regular physical exercise improves overall health, but information surrounding the mechanisms for these improvements continues to grow. Health changes associated with physical activity are partially driven by adaptations in muscle tissue and of notable significance, the study concluded that skeletal muscle enhancers were significantly enriched following endurance exercise training. As stated by the authors, the study provides insight into the mechanisms mediating the positive effects of exercise on platelet biology as well as cardiovascular, cognitive, and renal function.

Williams, K., Carrasquilla, G. D., Ingerslev, L. R., Hochreuter, M. Y., Hansson, S., Pillon, N. J., & Barrès, R. (2021). Epigenetic rewiring of skeletal muscle enhancers after exercise training supports a role in whole-body function and human health. Molecular metabolism53, 101290.


Considerations of mandatory Covid jabs for high-risk workers

An article published in the Medical Journal of Australia covers medico-legal considerations relating to mandatory vaccinations of high-risk workers such as healthcare workers.

Kevat, D. A., Panaccio, D. C., Pang, S. C., Dean, J. M., Farmer, C. C., & Mahar, P. D. (2021). Medico-legal considerations of mandatory COVID-19 vaccination for high risk workers. The Medical journal of Australia215(1), 22–24.e1.

A look into soft-collar use in the rehabilitation of whiplash-associated disorders

Whiplash and whiplash associated disorders are a common occurrence following motor vehicle accidents. A review published in the journal of Musculoskeletal Science and Practice covers the potential use of soft collars for whiplash associated disorders. The four randomised control trials reviewed all favoured an active approach and/or act-as-usual approach to treatment over soft-collar treatment. However additional research investigating soft collar use in combination with active rehabilitation is still needed.

Christensen, S., Rasmussen, M. B., Jespersen, C. L., Sterling, M., & Skou, S. T. (2021). Soft-collar use in rehabilitation of whiplash-associated disorders - A systematic review and meta-analysis. Musculoskeletal science & practice55, 102426. Advance online publication.

A commentary on the osteopathic body-mind-spirit tenet

An article published in the International Journal of Osteopathic Medicine discusses the clinical relevance of the body-mind-spirit (BMS) tenet in contemporary osteopathic practice. The authors noted a focus on osteopathy’s potential for “evidence-informed person-centred” practice but highlighted the lack of definition and associated clinical practices of the body-mind-spirit tenet and in turn propose the development of an evidence-oriented framework that integrates core features of the BMS tenet.

Zegarra-Parodi, R., Esteves, J., Lunghi, C., Baroni, F., Draper-Rodi, J., Cerritelli, F. (2021). The legacy and implications of the body-mind-spirit osteopathic tenet: A discussion paper evaluating its clinical relevance in contemporary osteopathic care.

Patients’ interpretation of the consent process before manual therapy of the cervical spine

Ongoing informed consent is a considerably important topic in modern medical and health practice. Researchers from the United Kingdom have noted that patients undergoing manual therapy may perceive a power divide in addition to other influences which may affect their perception and experience of consent prior to treatment. The authors concluded that a need for additional reflection and training was needed on existing communication strategies and current consent practices.

Reed, M., Thomson, P. (2021). “Who am I to disagree?” A qualitative study of how patients interpret the consent process prior to manual therapy of the cervical spine. International Journal of Osteopathic Medicine, 40; 4-13.

The rise of percussive massage treatments

Handheld percussive massage devices are rapidly gaining popularity in both professional and non-professional athletic circles. A study by Konrad and team at the University of Graz, Mozartgasse, Austria has discussed the acute effects of using a percussive massage device on plantar flexor motion and performance. 16 male athletes took part in the study which found an increase in range of motion following use of the percussive massage device however, no change was noted in maximum voluntary contraction. It should be noted that little research is available on the use, safety, and efficacy of percussive massage devices. While presumably rare, a case study published in the Physical Therapy and Rehabilitation Journal noted a patient with rhabdomyolysis following ongoing use of a percussive massage device emphasising the need to further evaluate the safety and effectiveness of these devices.

Konrad, A., Glashüttner, C., Reiner, M. M., Bernsteiner, D., & Tilp, M. (2020). The Acute Effects of a Percussive Massage Treatment with a Hypervolt Device on Plantar Flexor Muscles' Range of Motion and Performance. Journal of sports science & medicine.

Chen, J., Zhang, F., Chen, H., & Pan, H. (2021). Rhabdomyolysis After the Use of Percussion Massage Gun: A Case Report. Physical therapy101(1), pzaa199.

Muscle stretching and massage for the treatment of chronic neck pain.

As the prevalence of neck pan continues to increase worldwide, research in the area is ever increasing and aims to both prevent and/or support interventions and treatment options for the large number of people who suffer from the condition. A randomised single blind study from the Kırşehir Ahi Evran University in Turkey has investigated the effects of Sternocleidomastoid (SCM) muscle stretching and massage on pain, endurance, disability, range of motion, and kinesiophobia in individuals with chronic neck pain. The study utlilised 60 participnats, with a 50:50 split of between the SCM and control groups. Authors noted improvements in pain, disability, range of motion and endurance, suggesting that stretching and massage applied to the SCM-muscle, together with conventional physio, may reduce pain and disability, while increasing range of motion and endurance in those with chronic neck pain.

Büyükturan, B., Şaş, S., Kararti, C., & Büyükturan, Ö. (2021). The Effects of Combined Sternocleidomastoid Muscle Stretching and Massage on Pain, Disability, Endurance, Kinesiophobia, and Range of Motion in Individuals with Chronic Neck Pain: A randomized, single-blind study. Musculoskeletal Science and Practice, 102417.

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.

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.

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.

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.

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.

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.

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.

Research Resources

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