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The Somatic Connection  |   May 2014
OMT Improves Acute Hemodynamic Control in Pregnancy by Means of Improved Venous Return
Author Affiliations
  • Michael A. Seffinger, DO
    Western University of Health Sciences College of Osteopathic Medicine of the Pacific, Pomona, California
  • Justin Brohard, OMS III
    Western University of Health Sciences College of Osteopathic Medicine of the Pacific, Pomona, California
Article Information
The Somatic Connection   |   May 2014
OMT Improves Acute Hemodynamic Control in Pregnancy by Means of Improved Venous Return
The Journal of the American Osteopathic Association, May 2014, Vol. 114, 404-405. doi:10.7556/jaoa.2014.077
The Journal of the American Osteopathic Association, May 2014, Vol. 114, 404-405. doi:10.7556/jaoa.2014.077
Web of Science® Times Cited: 64
Hensel KL, Pacchia CF, Smith ML. Acute improvement in hemodynamic control after osteopathic manipulative treatment in the third trimester of pregnancy [published online August 30, 2013]. Complement Ther Med. 2013;21(6):618-626. doi:10.1016/j.ctim.2013.08.008  
For over a century, osteopathic physicians have been treating patients with pregnancy-related symptoms using osteopathic manipulative treatment (OMT).1 In an effort to better understand the effectiveness of OMT in these patients, much research has been conducted in this field. More recently, King et al2 reported that prenatal OMT has an impact on the occurrence of meconium-stained amniotic fluid and preterm delivery, and Licciardone et al3,4 found that OMT helps to prevent progressive back-specific dysfunction that typically arises during the third trimester of pregnancy. Related to this research, a recent study by Hensel et al revealed that OMT has an influence on hemodynamic stability and the cardiovascular changes that occur during pregnancy. 
Participants of the PROMOTE study (an unpublished clinical trial involving OMT and low back pain in pregnancy) were enrolled in the substudy of Hensel et al if they were between the ages of 18 and 34 years, in the 30th week of pregnancy, and did not satisfy any of the exclusion criteria, including history of syncopal episodes, abruptio placenta, placenta previa, pre-eclampsia, eclampsia, pregnancy-induced hypertension, vaginal bleeding, gestational diabetes, and current injury to the lower extremity. The participants were randomly assigned to 1 of 3 treatment groups: OMT, including standardized soft tissue, articulatory, myofascial release, and muscle energy techniques to the head, neck, abdominal diaphragm, back, pelvis, and pelvic diaphragm (n=25); placebo ultrasound (n=31); or time control (n=34). Baseline measurements were taken, including heart rate, mean arterial pressure, and heart rate variability, followed by a second set of measurements taken after a 5-minute period of head-up tilt or a 4-minute period of heel raises. After a 20-minute treatment period, the same measurements were taken again. 
The study revealed no significant changes between groups during the 5-minute head-up tilt period when comparing pretreatment and posttreatment measurements of all 3 variables (P>.36). However, when comparing the OMT group to the placebo ultrasound and time control groups during the 4-minute heel raise periods before and after treatment, the authors found a significant increase in mean arterial pressure (P=.02) and a significant decrease in heart rate (P<.01), indicating enhanced hemodynamic stability. The authors concluded that this impact is not a representation of a direct action on the autonomic nervous system, but rather a manifestation of improved venous return caused by OMT's removal of structural restrictions and somatic dysfunctions. Therefore, the OMT protocol used in this study may be beneficial in improving venous return in pregnant patients. 
References
Whiting LM. Can the length of labor be shortened by osteopathic treatment? J Am Osteopath Assoc. 1911;11:917-921.
King HH, Tettambel MA, Lockwood MD, Johnson KH, Arsenault DA, Quist R. Osteopathic manipulative treatment in prenatal care: a retrospective case control design study. J Am Osteopath Assoc. 2003;103(12):577-582. [PubMed]
Licciardone JC, Buchanan S, Hensel KL, King HH, Fulda KG, Stoll ST. Osteopathic manipulative treatment of back pain and related symptoms during pregnancy: a randomized controlled trial [published online September 20, 2009]. Am J Obstet Gynecol. 2010;202(1):43.e1-43.e8. doi:10.1016/j.ajog.2009.07.057. [CrossRef]
Licciardone JC, Aryal S. Prevention of progressive back-specific dysfunction during pregnancy: an assessment of osteopathic manual treatment based on Cochrane back review group criteria. J Am Osteopath Assoc. 2013;113(10):728-736. doi:10.7556/jaoa.2013.043. [CrossRef] [PubMed]