Osteopathic Manipulation of the Sphenopalatine Ganglia Versus Sham Manipulation, in Obstructive Sleep Apnoea Syndrom: A Randomised Controlled Trial

(1) Background: osteopathic manipulation of the sphenopalatine ganglia (SPG) blocks the action of postganglionic sensory fibres. This neuromodulation can reduce nasal obstruction and enhance upper airway stability. We investigated the manipulation of the SPG in 31 patients with obstructive sleep apnoea syndrome (OSAS); (2) Methods: Randomised, controlled, double-blind, crossover study. Participants received active (AM), then sham manipulation (SM), or vice versa. The primary endpoint was apnoea-hypopnoea index (AHI). Secondary endpoints were variation of nasal obstruction evaluated by peak nasal inspiratory flow (PNIF) and upper airways stability evaluated by awake critical closing pressure [awake Pcrit]), at 30 min and 24 h. Schirmer’s test and pain were assessed immediately post-manipulation. Tactile/gustatory/olfactory/auditory/nociceptive/visual sensations were recorded. Adverse events were collected throughout. (3) Results: SPG manipulation did not reduce AHI (p = 0.670). PNIF increased post-AM but not post-SM at 30 min (AM-SM: 18 [10; 38] L/min, p = 0.0001) and 24 h (23 [10; 30] L/min, p = 0.001). There was no significant difference on awake Pcrit (AM-SM) at 30 min or 24 h). Sensations were more commonly reported post-AM (100% of patients) than post-SM (37%). Few adverse events and no serious adverse events were reported. (4) Conclusions: SPG manipulation is not supported as a treatment for OSAS but reduced nasal obstruction. This effect remains to be confirmed in a larger sample before using this approach to reduce nasal congestion in CPAP-treated patients or in mild OSAS.

Effect of osteopathic manipulation on gait asymmetry

Context Movement and loading asymmetry are associated with an increased risk of musculoskeletal injury, disease progression, and suboptimal recovery. Osteopathic structural screening can be utilized to determine areas of somatic dysfunction that could contribute to movement and loading asymmetry. Osteopathic manipulation treatments (OMTs) targeting identified somatic dysfunctions can correct structural asymmetries and malalignment, restoring the ability for proper compensation of stresses throughout the body. Little is currently known about the ability for OMTs to reduce gait asymmetries, thereby reducing the risk of injury, accelerated disease progression, and suboptimal recovery. Objectives To demonstrate whether osteopathic screening and treatment could alter movement and loading asymmetry during treadmill walking. Methods Forty-two healthy adults (20 males, 22 females) between the ages of 18 and 35 were recruited for this prospective intervention. Standardized osteopathic screening exams were completed by a single physician for each participant, and osteopathic manipulation was performed targeting somatic dysfunctions identified in the screening exam. Three-dimensional (3-D) biomechanical assessments, including the collection of motion capture and force plate data, were performed prior to and following osteopathic manipulation to quantify gait mechanics. Motion capture and loading data were processed utilizing Qualisys Track Manager and Visual 3D software, respectively. Asymmetry in the following temporal, kinetic, and kinematic measures was quantified utilizing a limb symmetry index (LSI): peak vertical ground reaction force, the impulse of the vertical ground reaction force, peak knee flexion angle, step length, stride length, and stance time. A 2-way repeated-measures analysis of variance model was utilized to evaluate the effects of time (pre/post manipulation) and sex (male/female) on each measure of gait asymmetry. Results Gait asymmetry in the peak vertical ground reaction force (−0.6%, p=0.025) and the impulse of the vertical ground reaction force (−0.3%, p=0.026) was reduced in males following osteopathic manipulation. There was no difference in gait asymmetry between time points in females. Osteopathic manipulation did not impact asymmetry in peak knee flexion angle, step length, stride length, or stance time. Among the participants, 59.5% (25) followed the common compensatory pattern, whereas 40.5% (17) followed the uncommon compensatory pattern. One third (33.3%, 14) of the participants showed decompensation at the occipitoatlantal (OA) junction, whereas 26.2% (11), one third (33.3%, 14), and 26.2% (11) showed decompensation at the cervicothoracic (CT), thoracolumbar (TL), and lumbosacral (LS) junctions, respectively. Somatic dysfunction at the sacrum, L5, right innominate, and left innominate occurred in 88.1% (37), 69.0% (29), 97.6% (41), and 97.6% (41) of the participants, respectively. Conclusions Correcting somatic dysfunction can influence gait asymmetry in males; the sex-specificity of the observed effects of osteopathic manipulation on gait asymmetry is worthy of further investigation. Osteopathic structural examinations and treatment of somatic dysfunctions may improve gait symmetry even in asymptomatic individuals. These findings encourage larger-scale investigations on the use of OMT to optimize gait, prevent injury and the progression of disease, and aid in recovery after surgery.

Effects of Osteopathic Manipulation and Other Manual Manipulative Treatments on Cystic Fibrosis

Context: Cystic fibrosis (CF) is a genetic disease that affects multiple organ systems, and symptoms include chronic cough, gastrointestinal (GI) malabsorption, exercise intolerance, and chronic pain. Examples of standard treatments are nebulizers, supplementary enzymes, chest percussive therapy, respiratory therapy, and lifestyle modifications. Objective: The purpose of the current review was to determine whether manual therapies, such as osteopathic manipulative treatment (OMT), in conjunction with standard treatments, provide symptom relief for patients with CF. Methods: PubMed was searched to identify studies investigating the role of manual medicine in the care of CF patients. Search terms included chiropractic, physical therapy, physiotherapy, osteopathic, manipulation, massage, and manual medicine. All terms were searched in combination with cystic fibrosis. Studies investigating only exercise or chest percussive therapy as adjunctive treatments were excluded. Results: Eight studies were found that investigated manual therapies alone or in conjunction with exercise for treatment of CF symptoms. All studies reported improvement after manual therapy in 1 or more symptoms, such as posture, GI symptoms, peak airflow, anxiety, back or chest pain, or breathing. Study types included a case study, prospective observational studies, and randomized controlled trials. Most studies were small and statistically underpowered. In an inpatient/outpatient observational study of adults with CF, patients reported a significant reduction in pain after a single physiotherapy treatment, and inpatients also reported significantly improved breathing after treatment. In a randomized controlled trial involving adult CF outpatients, there was a significant improvement in chest and back pain scores between the OMT and control groups. Conclusions: Results of the current review suggested patients with CF can experience symptom relief after OMT and similar manual therapies. Patients subjectively reported improvement with manual therapies, and studies found statistically significant decreases in pain after a single treatment. However, larger studies with sufficient statistical power are needed to further define the role of manual therapies as adjunctive treatment for symptom relief in CF patients.

Osteopathic considerations for breastfeeding women

Extensive benefits of breastfeeding have been identified and although many women initiate breastfeeding, discontinuation is common when problems arise. In this article, the authors review the pertinent anatomy of the breast with osteopathic considerations to help osteopathic physicians identify myofascial, vascular, lymphatic, or innervation somatic dysfunctions to support the breastfeeding mothers’ long term breastfeeding goals, optimize breastmilk supply, and potentially prevent or treat problems that could interfere with lactation. Observations from the authors’ academic mother-baby osteopathic manipulation clinic are also included.

Crochet the Pain Away: A Case Study of Osteopathic Manipulation for Cervical Rib Induced Thoracic Outlet Syndrome

Background: Many people experience symptoms of thoracic outlet syndrome each year; one cause of these symptoms is the presence of cervical ribs. Cervical ribs have an estimated prevalence of 2% in the general population and 8.3% of those with thoracic outlet syndrome symptoms.1 Current treatment for thoracic outlet syndrome includes physical therapy and surgical resection. Techniques have been described for the treatment of thoracic outlet syndrome with osteopathic manipulation, but no specific treatment for cervical ribs was noted on a literature review. Case Presentation: 25-year-old healthy female presents with intermittent hand numbness and tingling along the C8 distribution that worsened with crocheting. She had also noted for many years the presence of a hard-supraclavicular mass on her left side. Palpation of this mass showed a bony protrusion that stopped 2 cm posterior to the clavicle on the left, but no mass noted on the right. Records review revealed an x-ray confirming cervical rib on the left. Results: After the treatment of surrounding dysfunctions without improvement in symptoms, the cervical rib was identified, manually isolated, and treated with direct myofascial release with respiratory assistance. This treatment provided immediate resolution of her symptoms. She remained asymptomatic for 10 days after treatment. A repeat treatment at two weeks resulted in resolution of her symptoms as far out as three months. Discussion: Cervical ribs are common in patients with thoracic outlet syndrome, and treatment for these patients typically includes physical therapy followed by surgical intervention for non-responders. We propose that OMT, with a focus on direct myofascial release, may be effective in alleviating symptoms for patients with cervical ribs. A limitation of this study is that it is a case report of one young active female. A larger study that includes various ages, activity levels, and both sexes would be more generalizable. Conclusion: Direct myofascial release is an effective technique for treatment of cervical rib induced thoracic outlet syndrome when myofascial restrictions are present.

Effects of Osteopathic T9–T10 Vertebral Manipulation in Tonsillitis: A Randomized Clinical Trial

This study aimed to determine whether osteopathic manipulation of the T9–T10 vertebrae improves the evolution of tonsillitis. A randomized, stratified, controlled clinical trial with blinded patients, evaluator and data analyst was performed. The patients in the control group (CG) underwent a “sham” manipulation. A high-speed, low-amplitude technique was applied to the T9–T10 vertebrae in the osteopathic manipulative group (OMG) patients. The number of days needed to resolve the tonsillitis was significantly lower (p = 0.025) in the OMG (2.03 ± 0.95 days) than the CG (2.39 ± 0.82 days). Additionally, the number of episodes of tonsillitis after the treatment decreased significantly more in the OMG (0.8 ± 1.88 episodes/year in total) than the CG (2 ± 2.12) (p = 0.005). In the OMG, 60.8% had no recurrences of tonsillitis, compared to 22.5% of the CG, in the following year (χ2 (1) = 15.57, p < 0.001). No patients reported adverse effects. It has been concluded that during an episode of tonsillitis, the number of days to resolution was significantly lower after the application of an osteopathic manipulation of the T9–T10 vertebrae, compared to a sham manipulation. The number of subsequent year tonsillitis episodes was greatly reduced in both groups, significantly more in the OMG than in the CG patients.

Osteopathic medicine for fibromyalgia: a sham-controlled randomized clinical trial

Background: Patients with fibromyalgia (FM) frequently resort to osteopathic or chiropractic treatment, despite very weak supporting evidence. We aimed to assess the efficacy of osteopathic manipulation in FM in a properly controlled and powered randomized clinical trial. Methods: Patients were randomized to osteopathic or sham treatment. Treatment was administered by experienced physical medicine physicians, and consisted of six sessions per patient, over 6 weeks. Treatment credibility and expectancy were repeatedly evaluated. Patients completed standardized questionnaires at baseline, during treatment, and at 6, 12, 24, and 52 weeks after randomization. The primary outcome was pain intensity (100-mm visual analog scale) during the treatment period. Secondary outcomes included fatigue, functioning, and health-related quality of life. We performed primarily intention-to-treat analyses adjusted for credibility, using multiple imputation for missing data. Results: In total, 101 patients (94% women) were included. Osteopathic treatment did not significantly decrease pain relative to sham treatment (mean difference during treatment: −2.2 mm; 95% confidence interval, −9.1 to 4.6 mm). No significant differences were observed for secondary outcomes. No serious adverse events were observed, despite a likely rebound in pain and altered functioning at week 12 in patients treated by osteopathy. Patient expectancy was predictive of pain during treatment, with a decrease of 12.9 mm (4.4–21.5 mm) per 10 points on the 0–30 scale. Treatment credibility and expectancy were also predictive of several secondary outcomes. Conclusion: Osteopathy conferred no benefit over sham treatment for pain, fatigue, functioning, and quality of life in patients with FM. These findings do not support the use of osteopathy to treat these patients. More attention should be paid to the expectancy of patients in FM management.

Treatment Modalities for Notalgia Paresthetica Including OMT

Background: Notalgia paresthetica (NP) is a type of neuropathy associated with pruritus, dysesthesias and sometimes pain. Most etiologies stem from trauma and entrapment of cutaneous branches of the upper thoracic nerves. Objectives: We report a case of NP treated with osteopathic manipulative therapy (OMT) along with a review of previous treatment modalities performed per the literature. Methods: A comprehensive literature search using PubMed was performed on NP and its treatment. Keywords used include notalgia paresthetica, treatment, osteopathic manipulation, neuropathy and pruritus. Results: Our patient reported a 30% reduction in severity of pruritus after receiving OMT, with full intention of following up in office for additional treatment. Conclusion: OMT monotherapy or combination treatments may prove to be efficacious with little to no added risk.