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What is Osteopathic Manual Therapy for Low Back Pain? Does it work?

osteopathic manual therapy for low back pain relief effectiveA new study published this month suggests that osteopathic manual therapy for low back pain offers significant benefit to patients but what is OMT and why is it helpful? To understand the potential of osteopathic manual therapy it is important to first appreciate how this field of medicine came about, starting with the actual meaning of ‘osteopathic.’ The origin of this word is two Greek words, ‘osteone’ meaning structure and ‘pathos’ meaning pain. Together the term connotes a natural medicine that looks at how anatomy and physiology, the structure and function of the body, are interrelated and the cause of spinal stenosis, low back pain and other ailments.

What is Osteopathy?

Osteopaths are trained to understand the connections between the body’s tissues, fluids and systems and to apply manual therapy to correct dysfunctions in these. The aim is to rectify underlying problems rather than simply treat a symptom and it is this that makes osteopathic manual therapy a particularly attractive option for those with chronic back pain. Many therapies, such as analgesics and non-steroidal anti-inflammatory drugs (NSAIDs), mask the pain but do nothing to address the cause of low back pain and, as such, need to be used over and over with all the potential risks that implies. Osteopathic manual therapy is intended to restore proper function to improve mobility, allow tissues to heal by removing pressure and inhibiting factors and allow the body to balance itself without the need for invasive procedures such as back surgery.

How Does Osteopathic Manual Therapy Work for Low Back Pain?

Those trained in osteopathic manual therapy are taught to be incredibly sensitive to minor fluctuations in the anatomy of patients and to detect subtle disturbances in tissues and rhythms/movements of the body. Sensitive palpation skills mean that a hands-on session with a good osteopath can reveal issues hidden even on diagnostic imaging because they are able to assess the body in motion. A key tenet of OMT is that structure governs function, meaning that the proper flow of blood, lymph and nerve signals is at the mercy of structural integrity.

Restoring Structure to Restore Function

Where the bones, connective tissue, spinal discs, muscles and organs of the body lose their proper form, become brittle or calcified, are torn, fractured or displaced, the result can be trapped nerves, obstructed blood flow, or improper drainage of lymph and resulting immune system problems and infection. Low back pain caused by structural issues may respond to painkillers to numb the resulting functional symptoms but without correcting the problem with the bones, ligaments, muscles or spinal discs the symptoms will simply continue.

Restoring Function to Restore Structure

Just as mechanical problems can precede functional issues involving the nerves and body fluids, changes in these can themselves impact the structural elements of the body. Infection, low nutrient levels, poor tissue oxygenation and nervous system disorders and/or stress can lead to things like loss of bone density and resultant fracture, brittle dehydrated discs that rupture or herniate, ischaemia and the death of tissue and bone, and infection that destroys nerve cells or enters the spinal cord. Ensuring proper function is essential to allowing the body to heal itself.


OMT for Low Back Pain

Osteopaths focus, then, on assessing a patient’s symptoms, diagnosing, and treating structural disorders causing pain and mobility issues. The problem of low back pain may be connected to the spine itself or it could be an issue with peripheral joints or nerves causing an altered gait or posture. Similarly, low back pain may be due to visceral organ disease or illness, nervous system problems, musculoskeletal or circulatory issues. By manipulating the joints and organs with gentle movements, osteopaths can encourage a return to proper structure and function in some patients. They will usually also prescribe specific exercises, dietary and lifestyle modifications to augment this manual therapy and harness the body’s healing capacity.

Problems Osteopaths Treat

Osteopathic manual therapy for low back pain can be a cost-effective treatment and it may also be of benefit in other spinal disorders causing neck pain, spinal stenosis and thoracic spine pain, as well as in peripheral and vascular disease. Whiplash, neck pain and headaches, and arthritis pain are all conditions that osteopaths frequently encounter and work with patients to relieve symptoms by restoring proper structure and function in all aspects of the body.

New Evidence for OMT in Low Back Pain Relief

Unfortunately, the very nature of osteopathic manual therapy as it is centered on the individual patient makes it difficult to assess as part of a clinical study. However, there have now been at least a couple of fairly rigorous trials that concluded that osteopathic manual therapy is effective for low back pain relief. The latest study, involving some 455 patients with low back pain who were randomly allocated to ultrasound treatment or osteopathic treatment or sham versions of both therapies found that OMT for low back pain resulted in clinically significant short-term pain relief whereas ultrasound therapy and sham therapy did not.

Osteopathy Safe and Effective Back Pain Relief Treatment

Publishing their results in the Annals of Family Medicine, John Licciardone, DO, from Osteopathic Research Center, University of North Texas Health Science Center, Fort Worth, and colleagues concluded that OMT was safe, effective and well tolerated by patients who were satisfied with the back pain relief they achieved and were happy to stick with the therapy. In the group of patients having osteopathic treatment for low back pain (230 patients), half reported substantial improvement by week 12 and some 63% reported at least moderate improvement by that time, compared to just 35% and 46% in the sham OMT cohorts. The patients had six treatment sessions over a course of eight weeks. In the UST groups, 44% reported substantial improvement, compared to 41% in the sham UST group, and 55% reported moderate improvement in the UST group versus 54% in the sham group by week 12.

Avoiding Back Surgery with Osteopathy

Although the conclusions appear fairly well-founded there were clear limitations due to the patients’ other medical conditions, work disability, and the treatments they were already receiving for low back pain. However, the results were significant and suggest that it may be more cost-effective, less risky and of more benefit to those with low back pain to have osteopathic manual therapy to complement other back pain treatments rather than resorting to surgery or higher doses of drugs for pain relief.

References

W.J. Assendelft, et al., ‘Spinal Manipulative Therapy for Low Back Pain: A Meta-Analysis of Effectiveness Relative to Other Therapies,’ Annals of Internal Medicine 138 (2003), pp. 871-81

UK BEAM Trial Team. UK back pain exercise and manipulation (UK BEAM) trial—national randomised trial of physical treatments for back pain in primary care: objectives, design and intervention. BMC Health Serv Res 2003;3: 16.

John C. Licciardone, Dennis E. Minotti, Robert J. Gatchel, Cathleen M. Kearns, Karan P. Singh, Osteopathic Manual Treatment and Ultrasound Therapy for Chronic Low Back Pain: A Randomized Controlled Trial, Ann Fam Med. 2013;11:122-129.

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