Review and write up by Stephanie Matthews. Proofreading and editing by Lee Jarvis, M.OMSc.
In another effort to present the effects and capacities of Osteopathic Manual Therapy, the CJO has begun what will be a regular series reviewing and summarizing Osteopathic journal articles. We hope to highlight the findings of these studies, while at the same time making them accessible to the average practitioner (including the many technical terms related to them). Each article will be summarized and specific scientific words not commonly used have either been defined in the write up, or explained using terms more familiar to the average reader. For this first instalment we begin with:
The effects of osteopathic manipulative treatment on pain and disability in patients with chronic low back pain: a single-blinded randomized controlled trial
Published on January 11th, 2024 in the Journal of Osteopathic Medicine by John M. Popovich, Jacek Cholewicki, N. Peter Reeves, Lisa A. DeStefano, Jacob J. Rowan, Timothy J. Francisco, Lawrence L. Prokop, Mathew A. Zatkin, Angela S Lee, Alla Sikorskii, Pramod K. Pathak, Jongeun Choi, Clark J. Radcliffe and Ahmed Ramadan.
See full article here.
The purpose of this Random Controlled Trial was to determine the effects of Osteopathic Manual Treatment on the pain and disability that is associated with chronic low back pain. Low back pain is familiar to most (whether you have experienced it or not) but “disability” in this context is in reference to how the sufferer can be in so much pain that they are incapable of typical daily physical exertion. This level of pain can interfere with the social life of the sufferer as well with their capacity to work, often leading to lost wages for the employee and lost productivity for the employer. This scenario, is where seemingly common pain can become a systemic problem when not well addressed in a large population. We can see this issue addressed though a growing amount of research being devoted to chronic low back pain both inside and outside the field of Osteopathy.
This study included approximately 80 participants who had non-specific chronic Low Back Pain. Participants were both male and female between the ages of 21 and 65 years old. “Non-specific” refers to participants being selected if their back pain was not the primary result of another disease or condition, as any disease would add complicating elements to the study. The study lasted for a total of 9-16 weeks depending on when the patients received treatment. This was a crossover study, wherein one group received immediate Osteopathic Manual Treatment and the other group received Osteopathic Manual Treatment after the first group had completed their treatment series. In this way, the delayed treatment group served as a control group (a “normal person” to compare to) within the study, but whose results after completing the treatment component are still meaningful data to be added to the study. Treatment sessions were approximately 30 minutes in duration and the physician administering treatment was able to use four treatment techniques of their choice including; high-velocity low-amplitude (HVLA) thrust, soft tissue, myofascial release, muscle energy, articulatory, and counterstain techniques. As an attempt to standardize the treatment process all participants received a mandatory one time HVLA thrust technique to the low back. Participants were not allowed to receive any other type of treatment outside of the study for the duration of the study period to ensure the Osteopathic Manual Treatment was solely responsible for the results.
The immediate Osteopathic Manual Treatment group received 3-4 treatment sessions in the first 4-6 weeks. The second, delayed Osteopathic Manual Treatment intervention group did not receive any treatment for the first 4-6 weeks. Pain was subjectively reported through an 11 point numeric rating scale. “No pain” was considered a 0 and “the worst pain imaginable” was considered a 10. There was a statistically significant (clinically meaningful) improvement in average pain experienced observed in this study. A reduction in average pain took approximately 3-4 Osteopathic Manual Treatment sessions over the course of 4-6 weeks, however anxiety scores were reduced after only 1 treatment session. According to the authors, this effect on anxiety is likely due the fact that chronic pain has a well-established link to depressive disorder as they share similar neurophysiological pathways. As Osteopathic Manual Treatment considers the whole-person while treating, it is possible for it to affect multiple mechanistic pathways involved in neuromuskuloskeletal conditions like chronic low back pain.
It is important to remember that the participating Osteopathic Manual Physicians were able to use any or all of the above listed treatment techniques to treat a patient. This is a better simulation of real-world Osteopathic practice, as a practitioner in a clinical setting often decides in real time what treatment approaches would work best on the patient right in front of them, at that exact moment. This should therefore result in varied outcomes of treatment depending on the choice of treatment technique, and the somatic dysfunctions found. It also means that no two treatments were exactly the same, another commonality of treatment in the real world.
The authors noted that, though there were some adverse events that occurred in the treatment process, these events were either not related to the Osteopathic Manual Treatment or they were insignificant in nature. An adverse event is an unintended negative outcome during or after the treatment. An example of a significant adverse event in this study is when a participant had Colitis during the study process. However, this colitis was shown to be unrelated to the Osteopathic Manual Treatment administered and therefore did not count on the list of adverse events. Of all the adverse events that were found to be related to Osteopathic Manual Treatment in the study, these were considered minor events; that being largely soreness following treatment that went away within one to two days.
The study’s first findings were primarily based on subjective pain reports, which although valid, is not an objective finding. Anxiety interestingly improved after only 1 Osteopathic Manual Treatment session, while pain reportedly took a longer period of time to improve, but nonetheless improvement was reported. The dose of treatment was not monitored during the study, however it is suggested by the authors that 6 Osteopathic Manual Treatment sessions have been shown to be necessary in order to obtain more significant improvement in pain.
The authors conclude by indicating that it can be said that Osteopathic Manual Treatment can reduce pain while also being very safe.