The Somatic Connection  |   October 2011
Osteopathic Manipulation May Be Beneficial in the Treatment of Patients With Chronic Sinusitis
Article Information
The Somatic Connection   |   October 2011
Osteopathic Manipulation May Be Beneficial in the Treatment of Patients With Chronic Sinusitis
The Journal of the American Osteopathic Association, October 2011, Vol. 111, 569-570. doi:10.7556/jaoa.2011.111.10.569
The Journal of the American Osteopathic Association, October 2011, Vol. 111, 569-570. doi:10.7556/jaoa.2011.111.10.569
Lee-Wong M, Karagic M, Doshi A, Gomez S, Resnick D. An osteopathic approach to chronic sinusitis. J Aller Ther. 2011;2(2): 109. doi:10.4172/2155-6121.1000109. 
Researchers led by Mary Lee-Wong, MD, of Beth Israel Medical Center in New York City reported on the use of an “osteopathic manipulative treatment” protocol to treat individuals with chronic sinusitis. (Although the authors used that term in their article, this review uses “osteopathic manipulation”—without “treatment”—because osteopathic physicians did not apply the manual therapy in the study.) This article was selected for review because of the area of research and the beneficial outcomes reported, as well as the opportunity to consider broader issues in the arena of osteopathic manipulation and manual medicine. 
The pilot project by Lee-Wong et al included 16 patients with chronic sinusitis who requested complementary treatment for their pain and were offered osteopathic manipulation. Each of the 15 patients who accepted the offer received 1 osteopathic manipulation session, which comprised 6 maneuvers lasting 3 minutes each (for a total of 18 minutes of treatment). The 6 procedures were based on descriptions from a standard osteopathic medical text (DiGiovanna et al1) and are well described in the article. 
The primary outcome measure was a self-reported sinus pain/congestion symptom rating scale ranging from 0 (no pain) to 5 (very severe pain). The average pretreatment score for the 15 participants was 3.07. Immediately after the osteopathic manipulation protocol, the average score was 2.33, representing a statistical difference of P=.0012. On the scale of improvement in sinus symptoms, 1 patient reported complete improvement, 11 reported moderate improvement, and 3 reported minimal improvement. Only 4 patients reported discomfort (classified as minimal) with the manipulation procedures. 
The authors point out that there was no control group in their study and that further research is needed. However, I believe that the paucity of certain details in this article raises additional questions. The histories of the patients with regard to how long they had “chronic sinus pain/congestion” are not reported—though such information is essential to evaluate the severity of symptoms in the patients. The implication of the study is that traditional treatment for sinusitis had failed for these patients. Yet, data on complete patient histories would have provided a better understanding of how typical these patients were in relation to normative data for chronic sinusitis sufferers. 
The authors also make the statement that “current homeopathic therapies embody osteopathic medicine which is gaining acceptance among the healthcare communities in United States,” citing an article by Johnson and Kurtz from JAOA—The Journal of the American Osteopathic Association.2 The authors were inappropriate to associate current homeopathic therapies with osteopathic medicine in this context, and it appears as if they may have meant to say “complementary therapies” instead of “homeopathic therapies” (as they do later in their discussion). 
I communicated these concerns to the lead author via telephone in September 2011 and obtained further details. She indicated that the patients in the study were resistant to conventional treatment and adverse to receiving additional pain medication. She also confirmed that the intent of mentioning homeopathy was to emphasize the complementary nature of that therapy, as viewed by the editors of the Journal of Allergy & Therapy. 
The lead author—an allopathic physician who studied osteopathic manipulative treatment (OMT) during her postdoctoral training in sessions presented by US-trained DO faculty—indicated that she administered the manipulation in the study. The descriptions of the manual procedures used in the study appear to be classic osteopathic medical practice procedures as presented in 1 of the finer texts on OMT.1 
Although some osteopathic physicians may object to a non-DO performing osteopathic manipulation, I believe it was entirely appropriate for the MD in the study to use osteopathic manipulation—and even to use the American Medical Association's Current Procedural Terminology codes for billing for OMT (though the application of manipulation in the study was on a gratis basis as part of research). The procedures used in the study's protocol would seem to be low-risk applications of osteopathic manipulation and manual medicine that required minimal skill and training and involved no cranial or axial skeleton contacts. 
Despite the lack of DO involvement, as well as the lack of data on long-term effects of the treatment, the fairly immediate beneficial outcomes suggest a level of osteopathic manipulation efficacy that is worthy of further study. I can confirm from my own practice that the osteopathic manipulation protocol used in the study is indeed efficacious for patients in the early stages of sinus congestion and sinus pain. 
That the beneficial results reported in the study were obtained by an MD applying osteopathic manipulation should make no difference in considering the data. Sinusitis is among the most common patient presentations encountered in general and family practice—and it is worthy to note that an MD interested in OMT has taken the initiative of conducting research on the use of osteopathic manipulation for patients with this condition. 
This study may be an example of how osteopathic manipulation procedures that are readily available in the literature are being used by healthcare practitioners other than osteopathic physicians, residents, and students. My own review of various books and training programs on OMT, manual medicine, and manual therapy suggests that of all the professions that use manual methods in healthcare, the osteopathic medical profession produces the best results and should be considered the “gold standard” for manual medicine and manual therapy. 
The study by Lee-Wong et al is useful in bringing attention to the application of osteopathic manipulation to the treatment of patients with chronic sinusitis—an application routinely used by many osteopathic physicians. In addition, the article raises important interprofessional issues. For example, there may be advantages for the osteopathic medical profession in opening the door to more opportunities for MDs to learn and apply osteopathic manipulation. The study suggests that osteopathic manipulation is the pinnacle of manual medicine and therapy, and it is very likely that osteopathic manipulation techniques will be copied by other manual practitioners. 
Perhaps there is a place for osteopathic physicians in teaching and working with allopathic and nonphysician manual therapy practitioners to improve their skills within the context of their certifications. In July 2002, this issue was addressed by the AOA House of Delegates in a position paper,3 which noted that it is ethical for osteopathic physicians to teach “manual therapy/techniques” but not “osteopathic medicine” to non-DOs. 
For me, reviewing the article by Lee-Wong et al has been an opportunity to encourage an interprofessional dialogue that will enhance the public acceptance of the services of all professionals who use their hands in healthcare.—H.H.K. 
   “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 Michael A. Seffinger, DO (, or Editorial Board Member Hollis H. King, DO, PhD (
DiGiovanna EL, Schiowitz S, Dowling DJ, eds. An Osteopathic Approach to Diagnosis and Treatment. 3rd ed. Baltimore, MD: Lippincott Williams & Wilkins; 2005.
Johnson SM, Kurtz ME. Conditions and diagnoses for which osteopathic primary care physicians and specialists use osteopathic manipulative treatment. J Am Osteopath Assoc. 2002;102(10):527-540. [PubMed]
American Osteopathic Association position paper on teaching osteopathic philosophy, osteopathic manipulative treatment, and manual therapy. In: AOA Membership Directory 2006-2007. Chicago, IL: American Osteopathic Association; 2006:136-137.