The Somatic Connection  |   October 2012
OMT and Obesity: A Timely Topic
Article Information
The Somatic Connection   |   October 2012
OMT and Obesity: A Timely Topic
The Journal of the American Osteopathic Association, October 2012, Vol. 112, 656-657. doi:10.7556/jaoa.2012.112.10.656
The Journal of the American Osteopathic Association, October 2012, Vol. 112, 656-657. doi:10.7556/jaoa.2012.112.10.656
Vismara L, Cimolin V, Menegoni F, et al. Osteopathic manipulative treatment in obese patients with chronic low back pain: a pilot study. Man Ther. 2012;17:451-455.  
With frequent references in the popular media to the current epidemic in obesity, it is timely to describe research related to the application of osteopathic manipulative therapy (OMTh) to manage low pack pain in obese patients. Researchers at the Orthopaedic Rehabilitation Unit of the Istituto Auxologico Italiano in Piancavallo, Italy, used spinal angles, a visual analog scale (VAS), the Roland Morris Disability Questionnaire (RMDQ), and the Ostwestry Low Back Disability Questionnaire (OQ) as outcome measures in a pilot study with obese women as participants. 
Twenty-one obese women (body mass index >30) were randomly assigned to 2 groups. The first group received ten 45-minute sessions of specific exercises (SE). The second group also received 10 sessions, which consisted of the same 45-minutes of SE plus OMTh (SE+OMTh). The OMTh was “targeted to the patient's clinical picture” and comprised high-velocity, low-amplitude thrust techniques to the thoracic spine, cranial OMTh techniques, and myofascial release techniques. Participants were selected if they complained of chronic low back pain of more than 6 months duration. Exclusion criteria were secondary low back pain, osteoporosis, osteoarthritis, or neurologic conditions that would preclude physical exercise; any cardiovascular conditions diagnosed by means of a treadmill stress test; and any respiratory or psychiatric conditions. 
The kinematic data were obtained by a 6-camera optoelectronic motion analysis system, which had been used in previous studies1,2 by these same researchers. Markers were placed on each participant to measure in the sagittal plane forward bending motion from S1 to T1, anterior pelvic tilt from the posterior superior iliac spine to the anterior superior iliac spine, lumbar movement from S1 to L1, and thoracic movement from L1 to T1. The kinematic, VAS, RMDQ, and OQ measures were taken at the beginning of the study and after the final SE and SE+OMTh sessions. 
There were no differences between the SE and SE+OMTh groups for age and body mass index. Two participants did not complete all the sessions, resulting in 8 in the SE+OMTh group and 11 in the SE group for final analysis. The only statistically significant improvement for the kinematic analysis was seen in the SE+OMTh group for the thoracic range of motion from L1 to T1. Both groups showed statistically significant improvement in self-reported pain (VAS), functional ability (RMDQ), and reduced disability (OQ). However, the SE+OMTh group had substantially greater improvement in VAS, RMDQ, and OQ scores than the SE group. 
The authors made comments that are typical for a pilot study; they stated that no generalizations could be made for clinical practice and that larger clinical trials are needed. An interesting observation was made about the possible “placebo effect” of the SE+OMTh group caused by the increased time the patients had in contact with the OMTh intervention provider. In the authors' opinion, such an effect might have influenced the VAS, RMDQ, and OQ data, but it was unlikely to have affected the spinal mobility as assessed with the kinematic measures. 
This study was selected for review because of the timely topic—obesity—and because of the technology used in the kinematic outcome measures, which may be of interest to other osteopathic researchers. The article's introduction provides a good discussion on the relationship between obesity and chronic low back pain, which may provide impetus for further research on this topic. Of note, the OMTh protocol was individualized according to each participant's apparent somatic dysfunction. This procedure raises a perennial question for manual therapy research: how is the protocol defined? I support a protocol like the one used by Vismara and colleagues. However, one must recognize that this type of protocol leaves such a study open to critical questions including “What did you actually do?” and “Can the study be replicated accurately?” At this point in the development of manual therapy research, it is better to proceed with a generally defined protocol that is provided by an experienced osteopathic physician or an osteopath, which was the case in this study. It is also worthy to note that cranial OMTh techniques were used along with the high-velocity, low-amplitude thrust and myofascial release techniques. This inclusion is suggestive of the efficacy of a broad-based manual therapy protocol and reminiscent of the protocol used in the study published in JAOA—The Journal of the American Osteopathic Association in 2011 that showed improvement in balance in healthy elderly patients who received osteopathic manipulative treatment.1 —H.H.K. 
Menegoni F, Vismara L, Capodaglio Pet al. Kinematics of trunk movements: protocol design and applicaition in obese females. J Appl Biomech Biomed. 2008;6:178-185.
Vismara L, Menegoni F, Zaina Fet al. Effect of obesity and low back pain on spinal mobility: a cross sectional study in women. J Neuroeng Rehab. 2010;7(1):3. [CrossRef]
Lopez D, King HH, Knebl JA, Kosmopolous V, Collins D, Patterson RM. Effect of comprehensive osteopathic manipulation treatment on balance in elderly patients: a pilot study. J Am Osteopath Assoc. 2011;111(6):382-388. [PubMed]