The Somatic Connection  |   October 2011
Osteopathic Therapy for Improving Postural Symmetry in Infants
Article Information
The Somatic Connection   |   October 2011
Osteopathic Therapy for Improving Postural Symmetry in Infants
The Journal of the American Osteopathic Association, October 2011, Vol. 111, 571-572. doi:10.7556/jaoa.2011.111.10.571
The Journal of the American Osteopathic Association, October 2011, Vol. 111, 571-572. doi:10.7556/jaoa.2011.111.10.571
Philippi H, Faldum A, Schleupen Aet al. Infantile postural asymmetry and osteopathic treatment: a randomized therapeutic trial. Dev Med Child Neurol. 2006;48(1):5-9. 

“As the twig is bent, so grows the tree.” —Alexander Pope

German researchers studied the effect of “osteopathic treatment” on postural asymmetry in infants. The study was conducted at the outpatient clinic of the University Children's Hospital in Mainz, Germany, from March 2002 to January 2003. A validated video-based rating scale for the assessment of infantile postural asymmetry, which was developed and published in 2004 by the first author, Heike Philippi, MD, was used in this study to measure outcomes (Philippi et al. Early Hum Dev. 2004;80:79-90). 
Sixty-one infants aged 6 to 12 weeks who were diagnosed as having postural asymmetry were referred from 19 pediatric practices in Mainz. Exclusion criteria were as follows: asymmetry scale score below 12 points; “significant” underlying disease; gestational age younger than 36 weeks; parents not familiar with the German language; any other treatment for asymmetry in the past or present; and predominant oblique body position masking the trunk curvature. The infants were evaluated using the standardized postural asymmetry scale developed by Dr Philippi, which ranges from 4 points (no symmetry) to 24 points (maximum symmetry). 
Thirty-two infants meeting the criteria of substantial postural asymmetry and gestational age of at least 36 weeks were enrolled in the study. The infants were randomly assigned to receive either osteopathic or sham therapy. The demographic and clinical characteristics of each group were virtually identical. 
The osteopathic therapy was performed by osteopaths who had experience in providing such therapy to infants. Each infant underwent therapy once a week, in a session lasting 45 to 60 minutes, for a 4-week period. Before the manipulative therapy at each session, diagnostic palpation was performed of each infant to assess tissue quality and mobility characteristics of the skull; the sacrum, iliac, and coccyx bones; and the thorax, sternum, diaphragm, and abdomen. From the descriptions in the article, osteopathic physicians would probably consider the manipulation procedures used in the study to be osteopathic manipulative medicine in the cranial field and balanced membranous tension. 
In the sham therapy group, the osteopaths placed their hands on the infants' bodies in the same areas contacted in the osteopathic therapy group, but no manipulation maneuvers were performed. For the infants' parents, who were present at all sessions, the difference between sham therapy and osteopathic therapy was unrecognizable. 
Parents, video scorers, and the physiotherapists and physicians who performed the baseline and final examinations were blinded to the group assignments for the duration of the study. The osteopaths, statistician, and study coordinator were unblinded. Each infant was scored for asymmetry at baseline and again at 4 weeks after the final therapy session. 
With sham therapy, 5 infants improved (ie, higher measurements on the asymmetry scale of at least 3 points compared to baseline), 8 infants remained unchanged (ie, measurements on the scale within 3 points of baseline), and 3 infants deteriorated (ie, lower measurements on the scale of at least 3 points compared to baseline). With osteopathic therapy, 13 infants improved, 3 remained unchanged, and none deteriorated. The average (standard deviation) improvement in the sham therapy group was 1.2 (3.5) points and in the osteopathic therapy group, 5.9 (3.8) points, representing a statistical significant of P=.001. 
The authors explain that the short intervention period of 4 weeks was chosen because validation of the asymmetry scale was limited to infants aged up to 16 weeks (and the oldest infants at baseline were aged 12 weeks). Nevertheless, the authors suggest that their results constitute evidence for the benefit of osteopathic therapy in infants with postural asymmetry. They cite other studies indicating that if uncorrected, the degree of asymmetry found in the infants in this study would likely result in persistent scoliosis, restricted head movements, asymmetric gait disturbances, and facial scoliosis with temporomandibular joint displacement. The authors clearly recognize the inadequacy of not administering appropriate therapy to young patients with diagnoses of torticollis, scoliosis, or plagiocephaly, and they suggest that osteopathic therapy would be appropriate treatment (provided that further research substantiates their findings). 
I discovered the Philippi et al study while preparing my review of the article by Pizzolorussa et al (Chiropr Man Therap. 2011;19[1]:15) for the present edition of “The Somatic Connection.” I was previously unfamiliar with the Philippi et al study—illustrating the deficiencies of literature searches and the need for readers to survey the reference sections of articles for studies that may have escaped categorization by the available search engines. 
From my perspective, it is helpful to know about the validation instrument for assessment of infantile postural asymmetry that is described in this study. In addition, this article stimulated an idea for a possible study project—the evaluation of infants of mothers who received prenatal osteopathic manipulative treatment, to determine if these infants have less postural asymmetry than controls.—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 (