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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.
The osteopathic approach to treating depression in children and adolescents
Osteopathic Family Physician
Evidence confirms that children and adolescents can experience the whole spectrum of mood disorders and suffer from the significant morbidity and mortality associated with them. Effective treatment often relies on physicians developing advanced communication skills with their patients. Enhanced communication will help decipher the etiology of the patient’s depression and, in addition to serotonin-regulating medications, will optimize treatment. Osteopathic medicine offers an effective treatment model through osteopathic manipulative treatment (OMT) because of the inseparability of physical and mental health. Osteopathic medicine takes a holistic view in which somatic, visceral and psychological dysfunction are united. Thus, physicians who incorporate OMT into their practice will help treat psychopathologies, such as depression and its accompanying somatic dysfunctions. This paper discusses the epidemiology of depression, the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) depression criteria, screening algorithms, current treatment protocols, osteopathic considerations to treating depression, and lastly, OMT and its role in treatment.
(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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Understanding regional activation of thoraco-lumbar muscles in chronic low back pain and its relationship to clinically relevant domains
BMC Musculoskeletal Disorders
Altered regional activation of the lumbar extensors has been previously observed in individuals with low back pain (LBP) performing high-effort and fatiguing tasks. It is currently unknown whether similar alterations can be observed during low-effort functional tasks. Similarly, previous studies did not investigate whether side differences in regional activation are present in individuals with LBP. Finally, there is limited evidence of whether the extent of the alteration of regional activation is associated with clinical factors. Therefore, the aim of this study was to investigate whether individuals with LBP exhibit asymmetric regional activation of the thoraco-lumbar extensor muscles during functional tasks, and if the extent of neuromuscular control alteration is associated with clinical and psychosocial outcome domains.
21 participants with and 21 without LBP performed five functional tasks (gait, sit-to-stand, forward trunk flexion, shoulder flexion and anterior pelvic tilt). The spatial distribution of activation of the thoraco-lumbar extensor muscles was assessed bilaterally using high-density electromyography. For each side, the distribution of electromyographic (EMG) amplitude was characterized in terms of intensity, location and size. Indices of asymmetry were calculated from these features and comparisons between groups and tasks were performed using ANOVA. The features that significantly differed between groups were correlated with self-reported measures of pain intensity and other outcome domains.
Indices of asymmetry did not differ between participants with and without LBP (p > 0.11). The cranio-caudal location of the activation differed between tasks (p < 0.05), but not between groups (p = 0.64). Participants with LBP showed reduced EMG amplitude during anterior pelvic tilt and loading response phase during gait (both p < 0.05). Pearson correlation revealed that greater pain intensity was associated with lower EMG amplitude for both tasks (R<-0.5, p < 0.05).
Despite clear differences between tasks, individuals with and without LBP exhibited similar distributions of EMG amplitude during low-effort functional activities, both within and between sides. However, individuals with LBP demonstrated lower activation of the thoraco-lumbar muscles during gait and anterior pelvic tilt, especially those reporting higher pain intensity. These results have implications in the development or refinement of assessment and intervention strategies focusing on motor control in patients with chronic LBP.
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Temporal summation of mechanical pain prospectively predicts movement-evoked pain severity in adults with chronic low back pain
BMC Musculoskeletal Disorders
Biopsychosocial factors above and beyond pathoanatomical changes likely contribute to the severity of chronic low back pain. A pro-nociceptive endogenous pain modulatory balance (↓inhibition and ↑facilitation) may be an important contributor to chronic low back pain severity and physical function; however, additional research is needed to address this possibility. The objective of this study was to determine whether quantitative sensory tests of endogenous pain inhibition and facilitation prospectively predict movement-evoked pain and cLBP severity self-reported on a validated questionnaire.
One hundred thirty-four individuals with chronic low back pain were enrolled in this two-session study. During the first study session, temporal summation of mechanical pain and conditioned pain modulation were assessed at the lumbar spine to determine endogenous pain facilitation and inhibition, respectively. One week later, participants returned for a second study session whereby they reported their pain severity and pain interference using the Brief Pain Inventory-Short Form. Movement-evoked pain and physical function capacity were assessed upon completion of the balance, walking, and transition from sit to stand tests of the Short Physical Performance Battery.
Temporal summation of mechanical pain, but not conditioned pain modulation, significantly and prospectively predicted greater movement-evoked pain and poorer physical function on the Short Physical Performance Battery. Neither temporal summation nor conditioned pain modulation were significantly related to self-reported pain severity or pain interference on the Brief Pain Inventory-Short Form.
Findings suggest that a pro-nociceptive pain modulatory balance characterized by enhanced pain facilitation may be an important driver of movement-evoked pain severity and poor physical function in individuals with chronic low back pain.
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Osteopathic manipulative treatment of herpes zoster ophthalmicus/postherpetic neuralgia
Cureus
Herpes zoster (HZ) and herpes zoster ophthalmicus (HZO) are the result of reactivation of varicella-zoster virus (VZV) from a dormant condition. Although HZ symptoms typically subside after a few weeks, HZO and postherpetic neuralgia (PHN) can persist at least 90 days after the appearance of the HZ rash. Presently, there is no gold standard for a disease-modifying therapy for postherpetic neuralgia and the current treatment is focused on early intervention and management of symptoms and dermatological complications. In the present case, a 74-year-old Caucasian male initially developed severe right-sided eye pain and headache. He was diagnosed with HZO and treated with acyclovir, but later developed swelling over the right eye and skin rash over the right side of the forehead and face. He presented to the office after the acute manifestation of the infection disappeared, but the headache and scalp hypersensitivity persisted and increased. Osteopathic manipulative treatment (OMT) included correction of cranial strains, inhibition, myofascial release, balanced ligamentous tension, and facilitated positional release. In one week, the patient reported a reduction in pain from 10/10 to 2/10. Two weeks later, he reported complete resolution of his initial symptoms. There are a limited number of cases that illustrate the benefit of OMT in diminishing pain and associated symptoms in different types of neuralgias. OMT ensures the restoration of normal anatomical structure and associated function through correcting somatic dysfunction, normalization of blood supply, muscle tone, and lymphatic drainage, therefore, providing pain relief. Better documentation of case reports and more research in this area would greatly benefit the medical community. The present case demonstrates the successful treatment of PHN with OMT. OMT can be successfully used as an adjunct therapy in cases of HZ and PHN.
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Manipulative therapy of sacral torsion vs. myofascial release in patients clinically diagnosed posterior pelvic pain: A consort compliant randomized controlled trial
The Spine Journal
Chronic low back pain represents a health care problem with substantial costs. It is generally accepted that approximately 10% to 25% of patients with persistent chronic low back pain may have pain arising from the sacroiliac joints.
This study aimed to analyze the effects of manipulative therapy of sacral torsion versus myofascial release on disability, pain intensity, and mobility in patients with chronic low back pain and sacroiliac joints.
Sixty-four patients (mean ± SD age: 51 ± 9; 60% female) with chronic low back pain and sacroiliac joints comprised the patient sample. No participant withdrew because of adverse effects.
Self-reported disability (primary), pain intensity, scale of kinesiophobia, quality of life, isometric endurance of trunk flexor muscles, and lumbar mobility in flexion were assessed at baseline, pos-treatment and one month follow-up.
Participants were randomly assigned to a sacral torsion manipulation group or myofascial release group, receiving a total of 12 sessions (once weekly).
ANCOVA did not showed a statistically significant difference between groups for disability (95% CI -2.40−1.90, p=0.177). Effect sizes were large in both groups at both follow-up periods. Similar results were achieved for all secondary outcomes (p˂0. 05). The linear model longitudinal analyses showed significant improvements in both groups over time for all outcomes with the exception of fear of movement (manipulative: minimum within-groups change score 1.91, p˂0.001; myofascial: 1.66, p˂0.001).
Manipulative and myofascial release therapy in patients with clinically diagnosed sacroiliac joints syndrome resulted in a similar short term benefits on patient reported disability. Both groups experienced similar decrease in the intensity of pain over time, although no clinically meaningful effects were demonstrated in either group.
(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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Indirect treatment of coccygodynia with low thoracic spine and costotransverse joint mobilizations: A case report
Journal of Orthopaedic & Sports Physical Therapy
Coccygodynia is an uncommon disorder characterized by localized pain in the coccyx. Coccygodynia treatments include local remedies; however, there is a gap in the literature regarding the effects of indirect manual treatments to relieve persistent coccygodynia.
A 29-year-old man presented with a diagnosis of coccygodynia that had not resolved with pelvic physical therapy. The patient reported persistent pain in the coccygeal region and reproduction of symptoms with cervical and thoracic flexion. Manual joint mobilizations to the thoracic spinal segments and the costotransverse joints were performed with the patient in unloaded (supine) and loaded (sitting) positions, and while in neural tension.
The patient had complete resolution of coccyx pain, with continued relief 3 months later.
This case demonstrates the use of manual therapy to the thoracic spine to relieve coccygodynia. These findings led us to think more globally about potential contributing factors to symptoms of coccygodynia. (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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