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The Somatic Connection  |   January 2015
Osteopathic Manipulative Treatment Improves Clinical Response and Lowers Relapse Rates Among Patients With Chronic Low Back Pain
Article Information
The Somatic Connection   |   January 2015
Osteopathic Manipulative Treatment Improves Clinical Response and Lowers Relapse Rates Among Patients With Chronic Low Back Pain
The Journal of the American Osteopathic Association, January 2015, Vol. 115, 53-54. doi:10.7556/jaoa.2015.011
The Journal of the American Osteopathic Association, January 2015, Vol. 115, 53-54. doi:10.7556/jaoa.2015.011
Licciardone JC, Kearns CM, Crow WT. Changes in biomechanical dysfunction and low back pain reduction with osteopathic manual treatment: results from the OSTEOPATHIC trial. Man Ther. 2014;19(4):324-330. doi:10.1016/j.math.2014.03.004. 
Low back pain (LBP) is a common complaint encountered by osteopathic physicians. Kappler1 identified psoas muscle imbalance as a key component of dysfunction related to chronic LBP. Greenman2 then reported on 6 common somatic dysfunctions in patients with chronic LBP: (1) pelvic tilt and short leg syndrome, (2) nonneutral lumbar mechanics, (3) pubic shears, (4) innominate shears, (5) restricted sacral nutation, and (6) muscular imbalance. More recently, a randomized clinical trial3 found that the management of these 6 common dysfunctions with osteopathic manipulative treatment (OMT) correlated to the lowest rate of relapse among patients with chronic LBP. Several subgroup analyses of the data from this trial have since been published, with the current article being the most recent. 
Participants with high baseline pain severity scores have been shown to have a greater response to OMT than patients with low baseline pain.4 Therefore, in this subgroup analysis, patients with high baseline pain severity scores (n=186) were randomized into OMT (n=95) and sham therapy (n=91) groups to identify distinguishing characteristics that favored response to OMT. Low back pain was measured before each treatment session at weeks 1, 2, 4, 6, and 8, as well as at the 12-week exit visit using a 100-mm visual analog scale for pain. Patients who showed improvement at any time throughout the trial were termed initial responders. Initial responders who maintained their clinical improvement by the 12-week visit were deemed stable responders. Those who did not show any improvement throughout the trial were labeled nonresponders.  
The authors found that the proportion of time in which the patient experienced relief of LBP was higher in the OMT group (P<.001). In the OMT group, 62 patients (65%) were initial responders, and in the sham therapy group, 41 patients (45%) were initial responders (relative risk [RR], 1.45; 95% CI, 1.11-1.90). The OMT group had 42 stable responders, and the sham therapy group had 18 stable responders (RR, 2.12; 95% CI, 1.36-3.30). In the OMT group, 13 patients (24%) responded initially and then relapsed by the 12-week exit visit, and 18 patients (51%) in the sham therapy group relapsed (RR, 0.47; 95% CI, 0.26-0.83). The authors found that patients with psoas dysfunction who received OMT were less likely to experience relapses of LBP. This randomized controlled trial is the first, to our knowledge, to support Kappler's and Greenman's clinical approaches to patients with LBP. (doi:10.7556/jaoa.2015.011) 
Justin N. Brohard, OMS IV 
Western University of Health Sciences College of Osteopathic Medicine of the Pacific (WesternU/COMP)-Northwest, Lebanon, Oregon 
Michael A. Seffinger, DO 
WesternU/COMP, Pomona, California 
References
Kappler RE. Role of psoas mechanism in low-back complaints. J Am Osteopath Assoc. 1973; 72(8): 794-801. [PubMed]
Greenman PE. Syndromes of the lumbar spine, pelvis, and sacrum. Phys Med Rehabil Clin N Am. 1996; 7(4): 773-785.
Licciardone JC, King HH, Hensel KL, Williams DG. Osteopathic health outcomes in chronic low back pain: the OSTEOPATHIC Trial. Osteopath Med Prim Care. 2008; 2(5). doi:10.1186/1750-4732-2-5.
Licciardone JC, Aryal S. Clinical response and relapse in patients with chronic low back pain following osteopathic manual treatment: results from the OSTEOPATHIC Trial. Man Ther. 2014; 19(6): 541-548. doi:10.1016/j.math.2014.05.012. [CrossRef] [PubMed]