OMT Overview

However, it was only statistically significantly higher at 25 weeks postvaccination. In a cohort of patients with carpal tunnel syndrome, OMT was associated with both symptomatic and electrodiagnostic improvement.50, 75

In a blinded, randomized, controlled trial (n = 14) comparing standard medical care with standard care plus OMT for hospitalized patients with pancreatitis, patients in the OMT group had significantly fewer days in the hospital (mean reduction, 3.5 days, P = .04).76

There were no significant differences in time to oral feeding or amount of pain medications between the groups. Based on the exclusion criteria, the reader can infer that the 2 groups were roughly equal in terms of disease severity; however, the authors did not specifically state that the treatment and control groups were comparable based on Ranson criteria, Acute Physiology and Chronic Health Evaluation scoring, or some other objective measure of disease severity.

Osteopathic manipulative therapy has been used as adjunctive therapy in the treatment of pneumonia since the early 1900s. The only large-scale study evaluating the efficacy of OMT against pneumonia was a case series that was collected during the 1918 influenza epidemic in the United States consisting of 6258 patients with influenza complicated by pneumonia.

The average mortality rate for patients treated in the usual fashion with the prevailing therapy was approximately 25%. The mortality rate for patients who were treated with OMT in addition to the usual prevailing therapy was allegedly 10%.77 The only randomized control trial of OMT in this same setting also revealed a favorable trend.

In this trial, the mean duration of leukocytosis, intravenous antibiotic treatment, and hospital stay were shorter in the patients treated with OMT compared with the control group who received either a sham treatment or no additional physical contact.

However, none of these differences were statistically significant, possibly owing to insufficient power from the small sample size. The only outcome measure that did reach significance was total time taking oral antibiotics while in the hospital.77

Osteopathic manipulative therapy provided acute benefits in a small group of patients with idiopathic Parkinson disease (IDP).78 Ten patients with IDP and 8 age-matched controls without IDP having similar physical conditions, underwent computerized gait analysis before and after a single session of OMT.

A separate group of 10 patients with IDP underwent a sham manipulative treatment. The patients did not know when the measurements for gait analysis were being taken, and were not aware of whether the treatment they were given was the sham treatment or OMT. Before motion analysis, all patients with IDP underwent a 12-hour medication washout period.

All patients with IDP had mild to moderate disease with a Unified Parkinson's Disease Rating Scale Motor Score average of 14.3; however, the study lacks a comparison table, so how well the groups were matched cannot be fully determined. Patients with IDP who were treated with OMT had statistically significant increases in stride length, cadence, arm swing, and maximum velocities of upper and lower extremities, compared with the control group without IDP.

Significant differences occurred only in patients with IDP who were treated with OMT and not in IDP patients who received a sham treatment, suggesting that the improvements were the result of OMT. The duration of this beneficial effect is unknown because patients were not followed up further.

The single report of OMT as an isolated treatment for episodic tension-type headache found a reduction in pain intensity immediately after the treatment, but the subjects were also not evaluated further.79

A controlled trial of chiropractic spinal manipulation did not show a positive effect on episodic tension-type headaches.80 Another similar trial did, however, find a beneficial effect of manipulation on cervicogenic headache.81

CONCLUSIONS

Osteopathic medicine is similar to allopathic medicine, but places a greater emphasis on the importance of the musculoskeletal system and normal body mechanics as central to good health. To support this emphasis, more basic research and controlled trials for the effectiveness of manipulation are needed.

GLOSSARY

Autonomic Innervation of Selected Viscera

Sympathetic fibers supplying the heart and lung and part of the esophagus originate in the first 5 thoracic segments.

Those supplying the pancreas, liver, stomach, and gallbladder arise in the 5th through 10th thoracic segments, and those supplying the small and large intestine and kidneys arise in the eighth thoracic to second lumbar segments.

Facilitation

Facilitation is the maintenance of a pool of premotor neurons or preganglionic sympathetic neurons in 1 or more segments of the spinal cord in a state of partial or subthreashold excitation; in this state less afferent stimulation is required to trigger the discharge of impulses.

It is also a neurophysiological theory regarding the neural mechanism of somatic dysfunction.

Somatic Dysfunction

Somatic dysfunction is the impaired or altered function of the skeletal, arthrodial, and myofascial structures and their related vascular, lymphatic, and neural elements.

The positional aspects of somatic dysfunction are described using 1 or more of 3 parameters: (1) the position of the body part as determined by palpation and referenced to its adjacent defined structures, (2) the direction in which motion is freer, and (3) the direction in which motion is restricted.

Somatic dysfunction is characterized by one or more of the following: vasodilatation, edema, tenderness, pain, constriction, asymmetry of motion, motion restriction, and changes in tissue texture. It may or may not be associated with organic disease.

Author/Article Information

From the Internal Medicine Service, US Army Medical Activity, Heidelberg, Germany.

Corresponding author: Emil Lesho, DO, CMR 442 Box 594, APO AE 09041-0501. Accepted for publication November 13, 1998.

Archives of Family Medicine,Vol. 8 No. 6, November/December 1999

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