The Somatic Connection  |   April 2008
The Somatic Connection
Article Information
The Somatic Connection   |   April 2008
The Somatic Connection
The Journal of the American Osteopathic Association, April 2008, Vol. 108, 194-195. doi:
The Journal of the American Osteopathic Association, April 2008, Vol. 108, 194-195. doi:
Improved Infantile Postural Asymmetry After Osteopathic Manipulative Therapy
More than 40 years ago, Frymann reported an 88% incidence of asymmetric somatic findings and cranial somatic dysfunction among 1250 newborns—58% of whom were symptomatic and 30% were asymptomatic (J Am Osteopath Assoc. 1966;65:1059). A 2006 single-blind, randomized clinical trial by Philippi and colleagues—including two foreign-trained osteopaths—investigated the effectiveness of osteopathic manipulative therapy to improve structural asymmetry in infants.  
Infants with a gestational age of at least 36 weeks, post-term aged 6 to 12 weeks, with a diagnosis of postural asymmetry and no significant underlying disease, no predominant oblique body position masking the trunk curvature, and not undergoing any other treatment for postural asymmetry, were recruited in Mainz, Germany. To establish the degree of asymmetry using a standardized scale (4 points, no symmetry; 24, maximal asymmetry), 61 referred infants underwent neurologic and physical examinations. Of these infants, 32 (18 male, 14 female) met the inclusion criterion of a score greater than 12. 
Subjects were randomized to receive osteopathic manipulative therapy or sham therapy (touch only; 16 infants per group). Subjects received a weekly 45- to 60-minute intervention administered by an osteopath for 4 weeks. Asymmetry was measured using video-based scoring before the first treatment and 1 week after the final treatment by three independent, blinded, trained observers who demonstrated high interrater reliability. Five infants in the sham therapy group improved, 8 infants were unchanged, and 3 infants “deteriorated”; the mean (SD) improvement was 1.2 (3.5) points. In the osteopathic manipulative therapy group, 13 infants improved and 3 remained unchanged, for a mean improvement of 5.9 (3.8) points. The difference between groups was statistically significant (P=.001). 
The authors concluded that osteopathic manipulative therapy in the first months of life improves the degree of asymmetry in infants with postural asymmetry. They were unable to find predictive outcome measures in those infants that improved naturally (with sham therapy) or were nonresponders to osteopathic intervention. No complications or adverse events were reported, though some vegetative symptoms (eg, sleeping, crying) were transiently aggravated in some patients in both groups. Long-term follow-up to determine stability of improvement is warranted.—M.A.S. 
Philippi H et al. Dev Med Child Neurol. 2006;48:5-9  
Manipulation and Exercise: Best Noninvasive Treatments for Neck Pain
The Bone and Joint Decade 2000-2010 Neck Pain Task Force recently published results from its “best-evidence synthesis” on the use, effectiveness, and safety of noninvasive therapeutic treatments for patients with musculoskeletal neck pain and its associated disorders. The recommendations of the study were directed toward reducing the medical, social, and economic consequences of this common affliction. 
The task force systematically searched and appraised relevant articles published in scientific peer-reviewed journals between 1980 and 2006. Articles that evaluated various aspects of neck pain management (eg, risk factors, prevention, prognosis, rehabilitation) or that measured economic costs, health-care use, or safety were included. Studies on at least 20 subjects with neck pain or at risk for neck pain; whiplash-associated disorders (WADs); work-related injuries and strains; or neck pain of unknown etiology were also included, as were case series if judged to have special relevance to the Neck Pain Task Force report. Studies of patients with serious local pathologic conditions or systemic diseases were excluded. Of 31,878 citations screened, the task force analyzed 139 scientifically admissible articles on noninvasive interventions. Within this group of articles, there were 25 systematic reviews and one systematic review of systematic reviews. Seventeen studies (reported in 27 articles) focused on manual therapies for “nonspecific” neck pain or associated disorders—including one randomized clinical trial on osteopathic manipulative treatment (J Am Osteopath Assoc. 2005;105:57-68). 
In summary, the authors recommended the following: 
  • For WADs, combine educational videos, mobilization, and exercises
  • For other neck pain, use manual therapy and supervised exercise interventions, low-level laser therapy, or acupuncture
  • No particular course of care (long vs short, early vs late) with any intervention improves the prognosis for whiplash or other neck disorders, but high rates of healthcare use can slow recovery from whiplash
  • Episodes of care should not last longer than 6 to 8 weeks with any one or combination of noninvasive interventions
The study also recommended that future research efforts focus on the design and evaluation of neck-pain prevention strategies in the community and workplace. The study of noninvasive interventions for patients with acute non-traumatic neck disorders, disorders with radicular symptoms, and cervicogenic headache were also suggested.—M.A.S. 
Hurwitz EL et al. Spine. 2008;33(suppl 4):S123-S152  
Further Insight Into Viscerosomatic Reflexes
In 1953, Louisa Burns, DO, reported on the etiologic factors of heart disease and provided clinical data from around the United States documenting its association with somatic dysfunction in the upper cervical spine (J Am Osteopath Assoc. 1953;52:369-372). Recent research indicates that not only do cardiopulmonary afferents affect spinal cord activity at the C1 and C2 spinal segments, but they also affect neural transmission of sensory information from distal spinal cord segments (ie, the lumbar spine). 
Zhang, Chandler, and Foreman at the University of Oklahoma Health Sciences Center in Oklahoma City performed experiments on 33 anesthetized male Sprague-Dawley rats. The researchers stimulated cardiopulmonary sympathetic afferents (CPSA) and vagal afferents and observed the extracellular effects on C1-C2 descending propriospinal neurons to lumbar spinal segments. Extracellular action potentials were recorded from C1-C2 neurons whose axons were antidromically activated from T12-L2 spinal segments. Using noxious (pinch) and innocuous (brush and tap) mechanical stimuli from the head, neck, abdomen, back, or limb regions, the researchers mapped the somatic receptive fields in the C1 and C2 spinal segments. Carbon-filament glass microelectrodes were used to record extracellular potentials of single propriospinal neurons in the C1-C2 spinal gray matter. 
More CPSA than vagal afferents excited or inhibited some, but not all, of these neurons. Also, CPSA stimulation excited more neurons with excitatory somatic fields than did the vagal stimulation. Although neurons in lamina V of the spinal cord responded to both CPSA and vagal stimulation, most neurons in lamina X responded only to CPSA stimulation. The researchers concluded that CPSA and vagal afferent activation from the heart or lungs modulates C1-C2 spinal cord propriospinal neurons that in turn moderate somatosensory information from distant spinal segments. Based on the latency of C1-C2 spinal segments' response to stimulation, the researchers postulated that the autonomic afferents relay their information to C1 and C2 spinal segments before stimulating the brain. Although this article is 5 years old and uses a rat laboratory model, it provides insight into the complexity of spinal reflexes and contributes to the osteopathically oriented and clinically relevant knowledge in this field.—M.A.S. 
Zhang J et al. Brain Res. 2003;969:53-58.  
 “The Somatic Connection” highlights and summarizes important contributions to the growing body of literature on the musculoskeletal system's role in health and disease. This section of JAOA—The Journal of the American Osteopathic Association strives to chronicle the significant increase in published research on manipulative methods and treatments in the United States and the renewed interest in manual medicine internationally, especially in Europe.
 To submit scientific reports for possible inclusion in “The Somatic Connection,” readers are encouraged to contact JAOA Associate Editor Felix J. Rogers, DO (, or Michael A. Seffinger, DO (
 Editor's Note: Robert D. Foreman, PhD, a coauthor of the referenced article, has been studying spinal cord reflexes for the past 25 years. Dr Foreman and other internationally renowned scientists and clinicians shared their research and proposed future research inquiries in this field of study at the International Research Symposium on Somato-Visceral Interactions and Autonomic Mechanisms of Manual Therapy. The conference was held at the Osteopathic Research Center in Fort Worth, Tex, from March 31, 2008, to April 1, 2008.