Research into Osteopathy

Research into Osteopathy

Osteopathy is a common sense approach to physical wellbeing. Here you can find a list of some studies which show osteopathy research outcomes. The list will be added to periodically.

1) Fort Worth study into low back pain outcomes, USA and UK

Osteopathic manipulative treatment for low back pain: a systematic review and meta-analysis of randomized controlled trials. Licciardone JC, Brimhall AK, King LN. Osteopathic Research Center, University of North Texas Health Science Center, Fort Worth, TX 76107, USA. jlicciar@hsc.unt.edu BACKGROUND: Osteopathic manipulative treatment (OMT) is a distinctive modality commonly used by osteopathic physicians to complement their conventional treatment of musculoskeletal disorders. Previous reviews and meta-analyses of spinal manipulation for low back pain have not specifically addressed OMT and generally have focused on spinal manipulation as an alternative to conventional treatment. The purpose of this study was to assess the efficacy of OMT as a complementary treatment for low back pain. METHODS: Computerized bibliographic searches of MEDLINE, EMBASE, MANTIS, OSTMED, and the Cochrane Central Register of Controlled Trials were supplemented with additional database and manual searches of the literature. Six trials, involving eight OMT vs control treatment comparisons, were included because they were randomized controlled trials of OMT that involved blinded assessment of low back pain in ambulatory settings. Data on trial methodology, OMT and control treatments, and low back pain outcomes were abstracted by two independent reviewers. Effect sizes were computed using Cohen's d statistic and meta-analysis results were weighted by the inverse variance of individual comparisons. In addition to the overall meta-analysis, stratified meta-analyses were performed according to control treatment, country where the trial was conducted, and duration of follow-up. Sensitivity analyses were performed for both the overall and stratified meta-analyses. RESULTS: Overall, OMT significantly reduced low back pain (effect size, -0.30; 95% confidence interval, -0.47 - -0.13; P = .001). Stratified analyses demonstrated significant pain reductions in trials of OMT vs active treatment or placebo control and OMT vs no treatment control. There were significant pain reductions with OMT regardless of whether trials were performed in the United Kingdom or the United States. Significant pain reductions were also observed during short-, intermediate-, and long-term follow-up. CONCLUSION: OMT significantly reduces low back pain. The level of pain reduction is greater than expected from placebo effects alone and persists for at least three months. Additional research is warranted to elucidate mechanistically how OMT exerts its effects, to determine if OMT benefits are long lasting, and to assess the cost-effectiveness of OMT as a complementary treatment for low back pain'...

http://www.ncbi.nlm.nih.gov/pubmed/16080794?dopt=Abstract&holding=f1000,f1000m,isrctn

2) UK Beam Trial into Back Pain treatment outcomes

click to download the UK beam trial as a pdf.

3) American Osteopathic Association back pain cost effectiveness review

Background: Osteopathic manipulative treatment (OMT) is a distinctive modality commonly used by osteopathic physicians to complement conventional treatment of musculoskeletal disorders, including those that cause low back pain. Osteopathic manipulative treatment is defined in the Glossary of Osteopathic Terminology as: "The therapeutic application of manually guided forces by an osteopathic physician (US Usage) to improve physiologic function and/or support homeostasis that has been altered by somatic dysfunction. OMT employs a variety of techniques." Somatic dysfunction is defined as: "Impaired or altered function of related components of the somatic (body framework) system: skeletal, arthrodial and myofascial structures, and their related vascular, lymphatic, and neural elements. Somatic dysfunction is treatable using osteopathic manipulative treatment." Previous published guidelines have been based on literature reviews and meta-analyses of spinal manipulation for low back pain. They have not specifically addressed OMT and generally have focused on spinal manipulation as an alternative to conventional treatment. The purpose of this study was to assess the efficacy of OMT for somatic dysfunction associated with low back pain by osteopathic physicians and osteopathic practitioners trained in osteopathic palpatory diagnosis and manipulative treatment.
> Methods: Computerized bibliographic searches of MEDLINE, OLDMEDLINE, EMBASE, AMED, MANTIS, OSTMED (OSTMED.DR), and the Cochrane Central Register of Controlled Trials were supplemented with additional database and manual searches of the literature. Six trials, involving eight OMT vs control treatment comparisons, were included because they were randomized controlled trials of OMT that involved blinded assessment of low back pain in ambulatory settings. Data on trial methodology, OMT and control treatments, and low back pain outcomes were abstracted by two independent reviewers. Effect sizes were computed using Cohen d statistic, and meta-analysis results were weighted by the inverse variance of individual comparisons. In addition to the overall meta-analysis, subgroup meta-analyses were performed according to control treatment, country where the trial was conducted, and duration of follow-up. Sensitivity analyses were performed for both the overall and subgroup meta-analyses.
> Results: Osteopathic manipulative treatment significantly reduced low back pain (effect size, -0.30; 95% confidence interval, -0.47 to -0.13; P=.001). Subgroup analyses demonstrated significant pain reductions in trials of OMT vs active treatment or placebo control and OMT vs no treatment control. There were significant pain reductions with OMT regardless of whether trials were performed in the United Kingdom or the United States. Significant pain reductions were also observed during short-, inter mediate-, and long-term follow-up.
> Conclusions: Osteopathic manipulative treatment significantly reduces low back pain. The level of pain reduction is clinically important, greater than expected from placebo effects alone, and may persist through the first year of treatment. Additional research is warranted to elucidate mechanistically how OMT exerts its effects, to determine if OMT benefits extend beyond the first year of treatment, and to assess the cost-effectiveness of OMT as a complementary treatment for low back pain.

Address correspondence to Michael A. Seffinger, DO, Western University of Health Sciences College of Osteopathic Medicine of the Pacific, 309 E 2nd St, Pomona, CA 91766-1854. E-mail: mseffinger@...

4) Moskalenko and Frymann, technical study into the physical basis of cranial osteopathy

Read this interesting (but rather technical) paper about the scientific basis of the cranial mechanism

5) Overview of Research into the wider effects of manual therapy, Hollis King DO ed.

Clinical impact of manual therapy on physiologic functions and systemic disorders

6) Low Back Pain: Osteopathic Manual Therapy Appears to Help


Patients with low back pain may benefit from the treatment known as osteopathic manual therapy (OMT).

A new study suggests that the technique leads to clinically significant short-term pain relief for this population of patients.
The double-blinded, randomized controlled trial of 455 patients with low back pain is published in the March/April issue of Annals of Family Medicine. It examines whether OMT or ultrasound therapy (UST) is effective for the treatment of low back pain.
"The OMT regimen was safe, parsimonious, and well accepted by patients as demonstrated by high levels of treatment adherence and satisfaction with back care," authors note. "By contrast, UST was not efficacious in relieving chronic low back pain."
John Licciardone, DO, from Osteopathic Research Center, University of North Texas Health Science Center, Fort Worth, and colleagues randomly assigned patients to receive OMT (n = 230), sham OMT (n = 225), UST (n = 233), or sham UST (n = 222) for 6 treatment sessions during a course of 8 weeks.
By week 12, 50% (n = 114) of the OMT group and 35% (n = 79) of the sham OMT group reported substantial improvement (relative risk [RR], 1.41; 95% confidence interval [CI], 1.13 - 1.76; P = .002). Additionally, 63% of patients in the OMT group (n = 145) and 46% of those in the sham OMT group (n = 103) reported moderate improvement by week 12 (RR, 1.02; 95% CI, 0.86 - 1.20; P = .85).
By contrast, 44% of those in the UST group (n = 103) and 41% of patients in the sham UST group (n = 90) showed substantial improvement (RR, 1.09; 95% CI, 0.88 - 1.35; P = .43). In contrast, 55% of patients in the UST group (n = 128) reported moderate improvement in low back pain compared with 54% (n = 120) of patients in the sham UST group.
The authors note that the effects of osteopathic manual treatment in this study equaled or surpassed criteria set forth by the Cochrane Back Review Group for a medium-size effect for both moderate and substantial improvements in low back pain.
Some of the study's limitations include comorbid conditions, work disability, and co-treatments for low back pain, all of which patients self-reported.
"This study shows that OMT is efficacious for short-term pain relief when used to complement other co-treatments for chronic low back pain," the authors write.
Whether the treatments have monetary value is also in question, according to the authors.
"There are concerns that chronic low back pain is often managed with costly and invasive treatments of questionable efficacy and safety. Our results support efficacy and safety of OMT; however, they do not address its cost-effectiveness," the authors write.
The study was supported by the National Institutes of Health–National Center for Complementary and Alternative Medicine and the Osteopathic Heritage Foundation. The authors have disclosed no relevant financial relationships.

Ann Fam Med. 2013;11:122-129. Full text

6) This section is a long list of references which we have not checked from http://www.craniosacral.co.uk/research


Children and CST
Amiel-Tison C, Soyez-Papiernik E. Cranial osteopathy as a complementary treatment of postural plagiocephaly. Archives de Pédiatrie. 2008;15 Suppl 1;S24-30.
Cozzolino V, La Mola E, Ciardelli F, et al. Impact of OMT on reducing length of stay in a population of pre-term infants. International Journal of Osteopathic Medicine.2010;13(3):119
Gillespie BR. Case study in paediatric asthma: the corrective aspect of craniosacral fascial therapy. Explore (NY). 2008;4:48-51.
Gillespie BR. Case study in attention-deficit/hyperactivity disorder: the corrective aspect of craniosacral fascial therapy. Explore (NY). 2009;5:296-8
Hayden C, Mullinger B. A preliminary assessment of the impact of cranial osteopathy for the relief of infantile colic. Complementary Therapies in Clinical Practice.2006;12:83-90..
Lim KW. Infantile colic: A critical appraisal of the literature from an osteopathic perspective. International Journal of Osteopathic Medicine. 2006;9:94-102.
Lucassen PLBJ, Assendelft WJJ, van Eijk JThM, et al. Systematic review of the occurrence of infantile colic in the community. Archives of Disease in Childhood.2001;84:398-403
Lucassen P. Colic in infants. Clinical Evidence. 2010;02:309 Madeline LA, Elster AD. Suture closure in the human chondrocranium: CT assessment. Radiology. 1995 ;196:747-756
Mills MV, Henley CE, Barnes LL, et al. The use of osteopathic manipulative treatment as adjuvant therapy in children with recurrent acute otitis media. Archives of Paediatric and Adolescent Medicine. 2003:157(9):861-6.
Sergueef N, Nelson KE, Glonek T. Palpatory diagnosis of plagiocephaly. Complementary Therapies in Clinical Practice. 2006;12(2):101-10.
Steele KM, Viola J, Burns E et al. Brief report of a clinical trial on the duration of middle ear effusion in young children using a standardised osteopathic manipulative medicine protocol. Journal of the American Osteopathic Association. 2010;110(5):278-84
Wahl RA, Aldous MB, Worden KA et al. Echinacea purpurea and osteopathic manipulative treatment in children with recurrent otitis media: a randomised controlled trial. BMC Complementary Medicine. 2008;8:56
Wyatt K, Edwards V, Franck L, et al. Cranial osteopathy for children with cerebral palsy: a randomised controlled trial. Archives of Disease in Childhood. 2011 Jun;96(6):505-12. Epub 2011 Feb 24.
Vandenplas Y, Denayer E, Vandenbossche T, et al. Osteopathy may decrease obstructive apnea in infants: a pilot study. Osteopathic Medicine in Primary care.
Vohra S, Johnston BC, Cramer K, et al. Adverse events associated with pediatric spinal manipulation: a systematic review. Pediatrics. 2007;119(1):e275-83.
CST Technique
Degenhardt BF, Kuchera ML. Osteopathic evaluation and manipulative treatment in reducing the morbidity of otitis media: a pilot study. Journal of the American Osteopathic Association. 2006;106(6):327-324.
Drengler KE, King HH. Interexaminer reliability of palpatory diagnosis of the cranium. Journal of the American Osteopathic Association. 1998;98:387
Green C et al. A systematic review of craniosacral therapy: biological plausibility, assessment reliability and clinical effectiveness. Complementary Therapies in Medicine. 1999; 7(4):201-7)
Hanten WP, Dawson DD, Iwata M, et al. Craniosacral rhythm: reliability and relationships with cardiac and respiratory rates. Journal of Orthopaedics and Sports Physical Therapy. 1998;27;213-218
Hartman SE. Cranial osteopathy: its fate seems clear. Chiropractic & Osteopathy. 2006, 14:10 , 2006
Hartman SE, Norton JM. Interexaminer reliability and cranial osteopathy. The Scientific Review of Alternative Medicine. 2002;6(1):23-34
Melsen B. Time and mode of closure of the spheno-occipital synchondrosis determined on human autopsy material. Acta Anatomica. 1972;83:112-118
Upledger JE. The reproducibility of craniosacral examination findings: a statistical analysis. Journal of the American Osteopathic Association. 1977;76:890-899. 2008;2:8.
Nelson KE, Sergueef N, Lipinski CM, et al. Cranial rhythmic impulse related to the Traube-Hering-Mayer oscillation: comparing laser-Doppler flowmetry and palpation.Journal of the American Osteopathic Association. 2001 Mar;101(3):163-73.
Norton JM. A challenge to the concept of craniosacral interaction. American Academy of Osteopathy Journal. 1996;6(4):15-21
Okomoto K, It J, Tokiguchi S, et al. High-resolution CT findings in the development of the sphenooccipital synchondrosis. American Journal of Neuroradiology.1996;17:117-120
Pick MG (1994) A preliminary single case magnetic resonance imaging investigation into maxillary frontal-parietal manipulation and its short term effect upon the intracranial structures of an adult human brain. J Manipulative Physil Ther 17: 168-73
Rogers JS, Witt PL, Gross MT, et al. Simultaneous palpation of the craniosacral rate at the head and feet: intrarater and interrater reliability and rate comparisons.Physical Therapy. 1998;78:1175-1185
Sahni D, Jit I, Neelam A, et al. Time of fusion of the basisphenoid with the basilar part of the occipital bone in northwest Indian subjects. Forensic Science International. 1998;98:41-45
Sergueef N, Nelson KE, Glonek T. The effect of cranial manipulation on the Traube-Hering-Mayer oscillation as measured by laser-Doppler flowmetry. Alternative Therapies in Health and Medicine. 2002;8(6):74-6
Moran RW, Gibbons P. Intraexaminer and interexaminer reliability for palpation of the cranial rhythmic impulse at the head and sacrum. Journal of Manipulative and Physiological Therapeutics. 2001;24(3):183-90.
Moskalenko IuE, Vainshtein GB, Riabchikova NA, et al. Interhemisphere asymmetry of the CSF dynamics and biomechanical properties of the skull. Ross Fiziol Zh Im I M Sechenova. 2010;96(10):1005-13.
Nelson KE, Sergueef N, Glonek T. Recording the rate of the cranial rhythmic impulse. Journal of the American Osteopathic Association. 2006;106(6):332
Wirth-Patullo V, Hayes KW. Interrater reliability of craniosacral rate measurements and their relationship with subjects’ and examiners’ heart and respiratory measurements. Physical Therapy. 1994;74:909-920-.
Effectiveness of CST
Arnadottir TS, Sigurdardottir AK, Is craniosacral therapy effective for migraine? Tested with HIT-6 Questionnaire, Complementary Therapies in Clinical Practice (2012),dx.doi.org/10.1016/j.ctcp.2012.09.003
B Isbell and S Carroll (2007) The effectiveness of craniosacral treatment Fulcrum issue 41: 2-5. Also docs.craniosacral.co.uk/12
Curtis P, Gaylord SA, Fauort KR, Coble R, Suchindran C, Coeytaux RR, et al. (2011), Credibility of low-strength static magnet therapy as an attention control intervention for a randomized controlled study of craniosacral therapy for migraine headaches. J Altern Complement Med. 17:711e21.
Harrison RE, Page J Multipractitioner Upledger Craniosacral Therapy: Descriptive outcome study 2007 – 2008. Journal of Alternative and Complementary Medicine.Volume 17. Issue 1 2011: 13 – 17.
Jäkel A, von Hauenschild P. A systematic review to evaluate the clinical benefits of craniosacral therapy. Complement Ther Med (2012),dx.doi.org/10.1016/j.ctim.2012.07.009
CST and Neurology
Castro-Sanchez A.M, Guillermo A Matara´ n-Pen˜ arrocha, Labraca N.A, Quesada-Rubio J.M, Granero-Molina J Moreno-Lorenzo C. A randomized controlled trial investigating the effects of craniosacral therapy on pain and heart rate variability in fibromyalgia patients. Clinical Rehabilitation. 2011; 25: 25–35
Linda A. Gardner, PhD, RN; Laura K. Hart, PhD, RN; and M Bridget Zimmerman. PhD “Craniosacral Still Point Technique Exploring its Effects in individuals with Dementia”. Journal of Gerontological Nursing. Vol 34. No. 3, 2008 www.slackjournals.com/article.aspx?rid=26916
Greenman PE, McPartland JM. Cranial findings and iatrogenesis from craniosacral manipulation in patients with traumatic brain syndrome. J Am Osteopath Assoc.1995; 95(3):182-188.
Lancaster DG, Crow WT. Osteopathic manipulative treatment of a 26 year old woman with Bell’s palsy. J Am Osteopath Assoc. 2006;106:285-9
Milnes K, Moran RW. Physiological effects of a CV4 cranial osteopathic technique on autonomic nervous system function: A preliminary investigation. International Journal of Osteopathic Medicine. 2007;10(1):8-17 41
Raviv G, Shefi S, Nizani D, Achiron A Effect of craniosacral therapy on lower urinary tract signs and symptoms in multiple sclerosis. Complement Therapy Clinical Practise. 2009 May;15(2): 72-5.
Miscellaneous
Leach J. Osteopathic support for a survivor of gastric cancer: A case report. International Journal of Osteopathic Medicine. 2008;11:106-11
Mehi-Madrona L, Kigler B, Silverman S, Lynton H, Merrell W, “The impact of acupuncture and craniosacral therapy interventions on clinical outcomes in adults with asthma”. Explore (NY). 2007 Jan-Feb; 3(1) :28-36 www.ncbi.nlm.nih.gov/pubmed/17234566/.
Vohra S, Feldman K, Johnston B, et al. Integrating complementary and alternative medicine into academic medical centers: experience and perceptions of nine leading centers in North America. BMC Health Services Research. 2005; 5:78.
Case histories reported by Journalists
This is what is known as anecdotal evidence, being specific to that client and that therapist and as such cannot be generalised to the population as a whole. Such case studies are of value in providing positive evidence and giving a sense of how effective CST treatments can be should larger scale trials be proven to support such effects.
Literature Searching
Below are useful links for literature searching.
National Council for Osteopathic Research - www.brighton.ac.uk/ncor/
PubMed - www.ncbi.nlm.nih.gov/pubmed/
The Medical Research Council - www.mrc.ac.uk/Ourresearch/index.htm
The Cochrane Collaboration – Complementary Medicine www2.cochrane.org/reviews/en/subtopics/22.html
Science Direct Database www.sciencedirect.com/science/journal/15508307/
If you have any research funding suggestions or any other comments please email the Research Group Chairman at dellis26@btinternet.com.
CSTA Research Group Latest Revision: March 2013