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Letters to the Editor  |   March 2009
Response
Author Affiliations
  • William Evan Rivers, DO
    Rehabilitation Institute of Chicago Ill
Article Information
Osteopathic Manipulative Treatment
Letters to the Editor   |   March 2009
Response
The Journal of the American Osteopathic Association, March 2009, Vol. 109, 122-123. doi:10.7556/jaoa.2009.109.3.122
The Journal of the American Osteopathic Association, March 2009, Vol. 109, 122-123. doi:10.7556/jaoa.2009.109.3.122
In his historically significant and intriguing document, R. Kendrick Smith, MD, DO,1 quotes a passage from Carl McConnell, MD, DO, to explain his approach to osteopathic medical care. In the quotation, Dr McConnell emphasizes the assessment of “the tension of muscles, the status of glands, the flexibility of the vertebral joints, the mobility of the chest wall, and the vital response of viscera” in osteopathic diagnosis. Dr McConnell1 also asserts the importance of addressing the “edematous barrier of the involved lymphatic tissues” to “enhance drainage and leucocytic [sic] activity.” Thus, in our November 2008 article,2 we used the term “comprehensive lymphatic treatment”—that is, treatment that addresses the multiple factors that contribute to lymphatic flow.3 
To develop our protocol, we used the most recent edition of Foundations for Osteopathic Medicine3 for current and standardized descriptions of osteopathic manipulative treatment techniques. 
We caution the reader against making direct comparisons between Dr Smith's 1920 report1 and our recent study2 because of differences in purpose, research design, methods, and study populations—as well as different historical contexts. 
We collected subjects' heart rate measurements using a pulse oximeter, as stated in the “Methods” section of our article,2 but we did not record subjects' oxygen saturation levels. An analysis of heart rate measurements is noted in the final paragraph of our “Results” section.2 
We found no condition × time interaction effects for red blood cell count or differential leukocyte counts.2 Please refer to the Table for the requested data on these variables. 
Table
Short-Term Effects of Osteopathic Lymphatic Techniques: Red Blood Cell and Differential Leukocyte Counts by Condition and Time


Baseline Treatment Received

Measure, Mean (SD)

Postbaseline Measures, Mean (SD)

P Value*
Variable
20 min
50 min
80 min
Condition Effect
Time Effect
Condition × Time Effect
Red Blood Cell
    Count, million / μ L N 4.90 (0.23) 4.94 (0.22) 4.98 (0.25) 4.98 (0.22)
Y4.87 (0.19)4.91 (0.21)4.92 (0.21)4.97 (0.22)...< .001...
Basophils, % N 0.50 (0.52) 0.25 (0.45) 0.25 (0.45) 0.25 (0.45)
Y0.17 (0.38)0.25 (0.45)0.17 (0.38)0.25 (0.45).........
Eosinophils, % N 1.92 (1.44) 2.00 (1.12) 1.75 (1.05) 1.75 (1.05)
Y2.08 (1.50)2.00 (1.53)2.25 (1.54)1.83 (1.33).........
Lymphocytes, % N 32.42 (8.82) 32.42 (8.71) 33.08 (9.94) 33.83 (9.03)
Y33.42 (8.36)33.50 (7.62)33.33 (8.63)34.33 (8.53)....034...
Macrophages, % N 7.42 (0.99) 7.83 (1.40) 8.50 (1.97) 7.92 (1.50
Y7.67 (1.30)7.58 (1.16)7.58 (1.31)8.00 (1.53).........
Neutrophils, % N 57.75 (9.45) 57.50 (8.80) 56.58 (10.06) 56.08 (9.20)

Y
56.75 (8.67)
56.92 (8.79)
56.83 (9.52)
55.50 (9.70)
...
.001
...
 *Ellipses (...) indicate that the comparison is not statistically significant.
Table
Short-Term Effects of Osteopathic Lymphatic Techniques: Red Blood Cell and Differential Leukocyte Counts by Condition and Time


Baseline Treatment Received

Measure, Mean (SD)

Postbaseline Measures, Mean (SD)

P Value*
Variable
20 min
50 min
80 min
Condition Effect
Time Effect
Condition × Time Effect
Red Blood Cell
    Count, million / μ L N 4.90 (0.23) 4.94 (0.22) 4.98 (0.25) 4.98 (0.22)
Y4.87 (0.19)4.91 (0.21)4.92 (0.21)4.97 (0.22)...< .001...
Basophils, % N 0.50 (0.52) 0.25 (0.45) 0.25 (0.45) 0.25 (0.45)
Y0.17 (0.38)0.25 (0.45)0.17 (0.38)0.25 (0.45).........
Eosinophils, % N 1.92 (1.44) 2.00 (1.12) 1.75 (1.05) 1.75 (1.05)
Y2.08 (1.50)2.00 (1.53)2.25 (1.54)1.83 (1.33).........
Lymphocytes, % N 32.42 (8.82) 32.42 (8.71) 33.08 (9.94) 33.83 (9.03)
Y33.42 (8.36)33.50 (7.62)33.33 (8.63)34.33 (8.53)....034...
Macrophages, % N 7.42 (0.99) 7.83 (1.40) 8.50 (1.97) 7.92 (1.50
Y7.67 (1.30)7.58 (1.16)7.58 (1.31)8.00 (1.53).........
Neutrophils, % N 57.75 (9.45) 57.50 (8.80) 56.58 (10.06) 56.08 (9.20)

Y
56.75 (8.67)
56.92 (8.79)
56.83 (9.52)
55.50 (9.70)
...
.001
...
 *Ellipses (...) indicate that the comparison is not statistically significant.
×
Finally, the “Comment” section of our article2 notes that we did not confirm results of previous studies of hematologic effects of lymphatic techniques in healthy subjects.4,5 
Smith RK. One hundred thousand cases of influenza with a death rate of one-fortieth of that officially reported under conventional medical treatment [reprint of J Am Osteopath Assoc. 1920;19:172-175]. J Am Osteopath Assoc. 2000; 100:320-323. Available at: http://www.jaoa.org/cgi/reprint/100/5/320. Accessed March 3, 2009.
Rivers WE, Treffer KD, Glaros AG, Williams CL. Short-term hematologic and hemodynamic effects of osteopathic lymphatic techniques: a pilot crossover trial. J Am Osteopath Assoc. 2008;108: 646-651. Available at: http://www.jaoa.org/cgi/content/full/108/11/646. Accessed March 3, 2009.
Wallace E, McPartland JM, Jones JM III, Kuchera WA, Buser BR. Lymphatic system: lymphatic manipulative techniques. In: Ward RC, ed. Foundations for Osteopathic Medicine. 2nd ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2003:1056-1077.
Mesina J, Hampton D, Evans R, Ziegler T, Mikeska C, Thomas K, et al. Transient basophilia following the application of lymphatic pump techniques: a pilot study. J Am Osteopath Assoc. 1998;98:91-94.
Castlio Y, Ferris-Swift L. Effects of splenic stimulation on normal individuals on the actual and differential blood cell count and the opsonic index. Coll J (Kansas City). 1932;16:111-120.
Table
Short-Term Effects of Osteopathic Lymphatic Techniques: Red Blood Cell and Differential Leukocyte Counts by Condition and Time


Baseline Treatment Received

Measure, Mean (SD)

Postbaseline Measures, Mean (SD)

P Value*
Variable
20 min
50 min
80 min
Condition Effect
Time Effect
Condition × Time Effect
Red Blood Cell
    Count, million / μ L N 4.90 (0.23) 4.94 (0.22) 4.98 (0.25) 4.98 (0.22)
Y4.87 (0.19)4.91 (0.21)4.92 (0.21)4.97 (0.22)...< .001...
Basophils, % N 0.50 (0.52) 0.25 (0.45) 0.25 (0.45) 0.25 (0.45)
Y0.17 (0.38)0.25 (0.45)0.17 (0.38)0.25 (0.45).........
Eosinophils, % N 1.92 (1.44) 2.00 (1.12) 1.75 (1.05) 1.75 (1.05)
Y2.08 (1.50)2.00 (1.53)2.25 (1.54)1.83 (1.33).........
Lymphocytes, % N 32.42 (8.82) 32.42 (8.71) 33.08 (9.94) 33.83 (9.03)
Y33.42 (8.36)33.50 (7.62)33.33 (8.63)34.33 (8.53)....034...
Macrophages, % N 7.42 (0.99) 7.83 (1.40) 8.50 (1.97) 7.92 (1.50
Y7.67 (1.30)7.58 (1.16)7.58 (1.31)8.00 (1.53).........
Neutrophils, % N 57.75 (9.45) 57.50 (8.80) 56.58 (10.06) 56.08 (9.20)

Y
56.75 (8.67)
56.92 (8.79)
56.83 (9.52)
55.50 (9.70)
...
.001
...
 *Ellipses (...) indicate that the comparison is not statistically significant.
Table
Short-Term Effects of Osteopathic Lymphatic Techniques: Red Blood Cell and Differential Leukocyte Counts by Condition and Time


Baseline Treatment Received

Measure, Mean (SD)

Postbaseline Measures, Mean (SD)

P Value*
Variable
20 min
50 min
80 min
Condition Effect
Time Effect
Condition × Time Effect
Red Blood Cell
    Count, million / μ L N 4.90 (0.23) 4.94 (0.22) 4.98 (0.25) 4.98 (0.22)
Y4.87 (0.19)4.91 (0.21)4.92 (0.21)4.97 (0.22)...< .001...
Basophils, % N 0.50 (0.52) 0.25 (0.45) 0.25 (0.45) 0.25 (0.45)
Y0.17 (0.38)0.25 (0.45)0.17 (0.38)0.25 (0.45).........
Eosinophils, % N 1.92 (1.44) 2.00 (1.12) 1.75 (1.05) 1.75 (1.05)
Y2.08 (1.50)2.00 (1.53)2.25 (1.54)1.83 (1.33).........
Lymphocytes, % N 32.42 (8.82) 32.42 (8.71) 33.08 (9.94) 33.83 (9.03)
Y33.42 (8.36)33.50 (7.62)33.33 (8.63)34.33 (8.53)....034...
Macrophages, % N 7.42 (0.99) 7.83 (1.40) 8.50 (1.97) 7.92 (1.50
Y7.67 (1.30)7.58 (1.16)7.58 (1.31)8.00 (1.53).........
Neutrophils, % N 57.75 (9.45) 57.50 (8.80) 56.58 (10.06) 56.08 (9.20)

Y
56.75 (8.67)
56.92 (8.79)
56.83 (9.52)
55.50 (9.70)
...
.001
...
 *Ellipses (...) indicate that the comparison is not statistically significant.
×