Letters to the Editor  |   October 2008
Author Affiliations
  • Donald R. Noll, DO
    Academic Medicine Inc Kirksville, Mo
Article Information
Osteopathic Manipulative Treatment / Pulmonary Disorders
Letters to the Editor   |   October 2008
The Journal of the American Osteopathic Association, October 2008, Vol. 108, 542. doi:
The Journal of the American Osteopathic Association, October 2008, Vol. 108, 542. doi:
I wish to thank Drs Engel and Vemulpad for their thoughtful comments regarding our May original contribution.1 It is always gratifying to learn more about the research being conducted overseas on the use of manual techniques. 
It may be correct that persons with nonchronic conditions or healthy individuals are better choices for testing the immediate effects of osteopathic manipulative treatment (OMT). As we are all aware, the research that has been published in this area is so minimal that everything is open to speculation. However, the authors2 of one small study that was conducted with healthy subjects reported no changes in pulmonary function measures—except for a compensatory increase in tidal volume. This increase was thought to be related to lower respiratory rates in half of their 6 subjects.2 
Our study1 contributes to the literature by showing that a single multitechnique treatment session can cause immediate changes in pulmonary function in persons with chronic obstructive pulmonary disease, relative to a sham control—and that most of these changes were negative, suggesting an overall worsening of air trapping at 30-minutes posttreatment. It is also interesting to note that most patients in our study felt that they could breathe better when surveyed by telephone at 1-day posttreatment. Ambitious or not, our findings do show a demonstrable negative effect of OMT in patients with chronic obstructive pulmonary disease, though the clinical significance of these findings remains open to debate, and the long-term effects of OMT among such patients merit further investigation. 
Unfortunately, there is no consensus on the best study design for OMT research. The treatment protocol used in our study1 was intended to be as homogeneous as possible while retaining the ability to target specific somatic dysfunction. By allowing for treatment to focus on specific somatic dysfunction unique to the individual, the protocol more closely reflects actual clinical practice—though with the tradeoff of some treatment variability among patients. 
I wish to clarify that, for the standardized portion of the treatment protocol in our study, all subjects in the OMT group received the same seven standardized techniques. The standardized portion of the treatment session took approximately 15 minutes of each 20-minute treatment session. However, we did not intend to represent the results as though the intervention group was a completely homogeneous unit. 
It would seem logical that an elderly person would need more treatments than a younger person to achieve the same effect. Because chest wall stiffness is a known age-related change, we said only that this change could result in a population that is more responsive to OMT. However, until more research is conducted, determining which population is truly “more responsive” to OMT is merely a matter of speculation. 
Noll DR, Degenhardt BF, Johnson JC, Burt SA. Immediate effects of osteopathic manipulative treatment in elderly patients with chronic obstructive pulmonary disease. J Am Osteopath Assoc. 2008;108:251-259. Available at: Accessed September 23, 2008.
Ortley GR, Sarnwick RD, Dahle RE, Roode TD, Zink JG, Kilmore MA. Recording of physiologic changes associated with manipulation in healthy subjects [abstract]. J Am Osteopath Assoc. 1980;80:228-229.♦