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The National Center for Complementary and Integrative Health recommends that research be judged on the merit of scientific findings rather than on the basis of professional degrees held by investigators.
In this spirit, the American Academy of Osteopathy provides OsteoBlast citations that are likely to be of interest to AAO members. The AAO offers these items from peer-reviewed journals without comment, and it endorses neither the research nor the advertisements contained in OsteoBlast.
Manual treatment for kidney mobility and symptoms in women with nonspecific low back pain and urinary infections
The Journal of the American Osteopathic Association
Recent studies have suggested a connection between low back pain (LBP) and urinary tract infections (UTI). These disturbances could be triggered via visceral-somatic pathways, and there is evidence that kidney mobility is reduced in patients suffering from nonspecific LBP. Manual treatment of the perinephric fascia could improve both kidney mobility and LBP related symptoms.
The objective of this study was to assess whether manual treatment relieves UTI and reduces pain in patients with nonspecific LBP through improvement in kidney mobility.
Records from all patients treated at a single physical therapy center in 2019 were retrospectively reviewed. Patients were included if they were 18 years of age or older, had nonspecific LBP, and experienced at least one UTI episode in the 3 months before presentation. Patients were excluded if they had undergone manipulative treatment in the 6 months before presentation, if they had one of several medical conditions, if they had a history of chronic pain medication use, and more. Patient records were divided into two groups for analysis: those who were treated with manipulative techniques of the fascia with thrust movement (Group A) vs those who were treated without thrust movement (Group B). Kidney Mobility Scores (KMS) were analyzed using high resolution ultrasound. Symptoms as reported at patients’ 1 month follow up visits were also used to assess outcomes; these included UTI relapse, lumbar spine mobility assessed with a modified Schober test, and lumbar spine pain.
Of 126 available records, 20 patients were included in this retrospective study (10 in Group A and 10 in Group B), all of whom who completed treatment and attended their 1 month follow up visit. Treatments took place in a single session for all patients and all underwent ultrasound of the right kidney before and after treatment. The mean (± standard deviation) KMS (1.9 ± 1.1), mobility when bending (22.7 ± 1.2), and LBP scores (1.2 ± 2.6) of the patients in Group A improved significantly in comparison with the patients in Group B (mean KMS, 1.1 ± 0.8; mobility when bending, 21.9 ± 1.1; and LBP, 3.9 ± 2.7) KMS, p<0.001; mobility when bending, p=0.003; and LBP, p=0.007). At the 1 month follow up visit, no significant statistical changes were observed in UTI recurrence (secondary outcome) in Group A (−16.5 ± 4.3) compared with Group B (−20.4 ± 7) (p=0.152).
Manual treatments for nonspecific LBP associated with UTI resulted in improved mobility and symptoms for patients in this retrospective study, including a significant increase in kidney mobility.
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Immediate decrease of muscle biomechanical stiffness following dry needling in asymptomatic participants
Journal of Bodywork and Movement Therapies
Biomechanical muscle stiffness has been linked to musculoskeletal disorders. Assessing changes in muscle stiffness following DN may help elucidate a physiologic mechanism of DN. This study characterizes the effects of dry needling (DN) to the infraspinatus, erector spinae, and gastrocnemius muscles on biomechanical muscle stiffness.
60 healthy participants were randomized into infraspinatus, erector spinae, or gastrocnemius groups. One session of DN was applied to the muscle in standardized location. Stiffness was assessed using a MyotonPRO at baseline, immediately post DN, and 24 hours later. The presence of a localized twitch response (LTR) during DN was used to subgroup participants.
A statistically significant decrease in stiffness was observed in the gastrocnemius, the LTR gastrocnemius, and the LTR erector spinae group immediately following DN treatment. However, stiffness increased after 24 hours. No significant change was found in the infraspinatus group.
DN may cause an immediate, yet transitory change in local muscle stiffness. It is unknown whether these effects are present in a symptomatic population or related to improvements in clinical outcomes. Future studies are necessary to determine if a decrease in biomechanical stiffness is related to improvement in symptomatic individuals.
(This is a hyperlink to the abstract for this article. To view the full article, you will need to log in to the journal's website.)
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Extrapolating beyond the data in a systematic review of spinal manipulation for nonmusculoskeletal disorders: A fall from the summit
Journal of Manipulative and Physiological Therapeutics
The purpose of this article is to discuss a literature review — a recent systematic review of nonmusculoskeletal disorders — that demonstrates the potential for faulty conclusions and misguided policy implications, and to offer an alternate interpretation of the data using present models and criteria.
We participated in a chiropractic meeting (Global Summit) that aimed to perform a systematic review of the literature on the efficacy and effectiveness of mobilization or spinal manipulative therapy (SMT) for the primary, secondary, and tertiary prevention and treatment of nonmusculoskeletal disorders. After considering an early draft of the resulting manuscript, we identified points of concern and therefore declined authorship. The present article was developed to describe those concerns about the review and its conclusions.
Three main concerns were identified: the inherent limitations of a systematic review of 6 articles on the topic of SMT for nonmusculoskeletal disorders, the lack of biological plausibility of collapsing 5 different disorders into a single category, and considerations for best practices when using evidence in policy-making. We propose that the following conclusion is more consistent with a review of the 6 articles. The small cadre of high- or moderate-quality randomized controlled trials reviewed in this study found either no or equivocal effects from SMT as a stand-alone treatment for infantile colic, childhood asthma, hypertension, primary dysmenorrhea, or migraine, and found no or low-quality evidence available to support other nonmusculoskeletal conditions. Therefore, further research is needed to determine if SMT may have an effect in these and other nonmusculoskeletal conditions. Until the results of such research are available, the benefits of SMT for specific or general nonmusculoskeletal disorders should not be promoted as having strong supportive evidence. Further, a lack of evidence cannot be interpreted as counterevidence, nor used as evidence of falsification or verification.
Based on the available evidence, some statements generated from the Summit were extrapolated beyond the data, have the potential to misrepresent the literature, and should be used with caution. Given that none of the trials included in the literature review were definitively negative, the current evidence suggests that more research on nonmusculoskeletal conditions is warranted before any definitive conclusions can be made. Governments, insurers, payers, regulators, educators, and clinicians should avoid using systematic reviews in decisions where the research is insufficient to determine the clinical appropriateness of specific care.
(This is a hyperlink to the abstract for this article. To view the full article, you will need to log in to the journal's website.)
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The addition of thoracic mobilization to aerobic exercise did not alter autonomic function and pain pressure threshold acutely in assintomatic young people: A randomized controlled trial
Journal of Bodywork and Movement Therapies
The objective of this study was to analyze the influence of acute aerobic exercise (AE) plus thoracic mobilization in pain perception and autonomic nervous system response in healthy adults.
Forty-eight asymptomatic adults were allocated into one of three groups: 1) Aerobic Exercise (AE), 2) Aerobic Exercise + Mobilization (AE+M), and 3) Placebo. Participants from groups AE and AE+M ran for 5 minutes on a treadmill with a 75-85% of age-predicted heart rate. Participants from AE+M group also received a rotatory thoracic passive accessory intervertebral mobilization at T4 after running. Participants from the Placebo group received placebo mobilization. We mesured the autonomic system modulation through Heart Rate Variability (HRV) (time-domain, frequency-domain, and non-linear variables). We measured Pressure Pain Threshold (PPT) with a handheld digital algometer.
While aerobic exercise increased the sympathetic outflow and reduced the HRV, the addition of vertebral mobilization to exercise had no further effect on autonomic system modulation. There was no change in PPT in any group. Besides, there was no correlation between HRV and PPT.
Thoracic mobilization did not increase the sympathetic response induced by aerobic exercise. Moreover, exercise alone or exercise plus thoracic mobilization did not change the PPT.
(This is a hyperlink to the abstract for this article. To view the full article, you will need to log in to the journal's website.)
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Osteopathic medicine for fibromyalgia: A sham-controlled randomized clinical trial
Therapeutic Advances in Musculoskeletal Disease
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.
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.
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.
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.
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Rehabilitation and return to sport of a high-level track and field athlete with low back pain — a case report
Physiotherapy Theory and Practice
Low back pain is prevalent among elite athletes with initial high levels of physical activity. Currently, there is a lack of evidence describing the optimal management strategy of high-level track and field athletes presenting with low back pain.
This case report describes the clinical management and return-to-sport strategies of a male high-level track and field athlete presenting with low back pain in an outpatient physiotherapy clinic. Mechanical diagnosis and therapy (MDT) served as an important tool in the clinical management of the athlete. Patient-Specific Function Scale (PSFS), an 11-point scale (0 = unable to perform activity to 10 = able to perform activity at preinjury level), was used during three activities: hammer throw, squats and getting socks and shoes on.
Eight weeks after initial consultation (15 weeks after the index injury), the athlete returned to sport and competition at national championship-level. PFPS scores at final consultation: hammer throw – 10/10; squats – 10/10 and getting socks and shoes on – 10/10.
In combination with modern rehabilitation strategies, MDT provided the opportunity to engage the athlete as an active collaborator, which is in accordance with current clinical guidelines and best practice. (This is a hyperlink to the abstract for this article. To view the full article, you will need to log in to the journal's website.)
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