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Is there more to osteopathy than muscle and joint dysfunction – the PAD evidence?

My previous posting about the possible value of chiropractic in treatment of childhood health problems, such as colic and earache, highlights an ongoing debate in my own profession – osteopathy.
This is less of an issue in the USA where osteopathic physicians operate as first-line physicians – treating all manner of health problems, with a mix of mainstream medical and traditional osteopathic approaches. Some DOs in the States have brilliant manipulative skills – probably second to none in the world – but sadly, the majority ignore those aspects of their training, and focus on allopathic (i.e. traditional, conventional) medical health care.

In Europe the story is very different, and in earlier postings I’ve tried to encourage a realisation of the potential of osteopathic healthcare, outside of it’s proven track record in handling musculoskeletal pain and dysfunction…… for example by pointing to evidence from research showing just such benefits, as well as the history of osteopathic care during the great influenza pandemic of the early 20th Century..
In addition, in a March 2009 posting I outlined some of the evidence for the benefits of manual approaches to psychological and emotional problems.
In the United Kingdom, there is a lot of discussion within the profession – especially as we (along with all other health care professions) move towards a new government ordained initiative of revalidation.
For example, will it be acceptable to revalidation panels , for an osteopath to claim that the particular model of osteopathy being practiced deals with general health, or even psychological problems ……… as well as musculoskeletal dysfunction and pain?
Quite predictably, and appropriately, “where’s the evidence”, may well be the demand?
Please note that my repetitive focus on the wider benefits of osteopathic manual therapy is not meant to suggest that there is something necessarily superior in one mode of practice, as compared to another.
Reducing pain and improving function is pretty important – and to be praised when performed well.
It’s just that I think (and there’s more evidence below) that there is even more that could be achieved, if practitioners were of a mind to investigate the potentials.

In my earlier posting (April 2009), that asked whether osteopathy in the UK was in danger of losing its’ soul, I offered a number of clear examples – for example of reduced hospital time and medication usage, when osteopathic care was combined with regular medical care, in (for example) treatment of pneumonia in the elderly, as well as in hospital care of patients with pancreatitis.
These and other examples highlighted the general benefit to health, in terms of reduced morbidity and mortality, of ensuring that the structures of the body were functioning optimally via use of osteopathic care.

New Italian evidence
And now new Italian research has added a further piece of evidence.
Rita Lombardini and colleagues (2009), at the University of Perugia, have conducted a study that assessed the effects of OMT (osteopathic manipulative treatment) of patients with peripheral artery disease (PAD) – and with symptoms of intermittent claudication.
This is the abstract of their paper:

“Peripheral arterial disease (PAD) is a manifestation of systemic atherosclerosis associated with impaired endothelial function and intermittent claudication is the hallmark symptom. Hypothesizing that osteopathic manipulative treatment (OMT) may represent a non-pharmacological therapeutic option in PAD, we examined endothelial function and lifestyle modifications in 15 intermittent claudication patients receiving osteopathic treatment (OMT group) and 15 intermittent claudication patients matched for age,
sex and medical treatment (control group). Compared to the control group, the OMT group had a significant increase in brachial flow-mediated vasodilation, ankle/brachial pressure index, treadmill testing and physical health component of life quality.

So, what were the ingredients of the OMT applied by these physiotherapists/osteopaths in Italy, 8 times in 5 months (total contact time 4 hours)?
They report:

OMT protocol

At the start of each OMT session, the DO performed a structural examination of each patient to identify areas of somatic dysfunction,
defined as ‘‘impaired or altered function of related components of the somatic (body framework) system; skeletal, arthrodial, and myofascial structures; and related vascular, lymphatic and neural elements.”
The somatic dysfunction of each patient was treated using one or more of the following OMT techniques: myofascial release,
strain/counterstrain, muscle energy, soft tissue, high-velocity low amplitude manipulation (thoracolumbar region, typically T10–L1), lymphatic pump and craniosacral manipulation.
All these techniques were
considered safe even in view of the patients’ mean age and associated pathophysiology.
Techniques were chosen and listed by the DO at each session which lasted for approximately 30 min. During the study no patient
referred to any common side effects except for three who had transient muscle tenderness; no new pathologies developed.”

I suggest that is is therefore reasonable to conclude that
practitioners of osteopathy, and chiropractic, and physical therapy (since PTs now utilise almost identical procedures), are capable of far more than they may be aware of – and can offer safe, effective, complementary – or integrated – health care, over and above the attention they offer to musculoskeletal pain and dysfunction.

Lombardini R et al 2009 The use of osteopathic manipulative treatment as adjuvant therapy in patients with peripheral arterial disease. Manual Therapy 14:439–443

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