The Somatic Connection  |   October 2015
Osteopathic Manipulative Therapy Shows Promise for Improving Postdiskectomy Recovery
Author Notes
  • Western University of Health Sciences College of Osteopathic Medicine of the Pacific, Pomona, California 
Article Information
The Somatic Connection   |   October 2015
Osteopathic Manipulative Therapy Shows Promise for Improving Postdiskectomy Recovery
The Journal of the American Osteopathic Association, October 2015, Vol. 115, 629-630. doi:10.7556/jaoa.2015.129
The Journal of the American Osteopathic Association, October 2015, Vol. 115, 629-630. doi:10.7556/jaoa.2015.129
Kim BJ, Ahn J, Cho H, Kim D, Kim T, Yoon B. Rehabilitation with osteopathic manipulative treatment after lumbar disc surgery: a randomized, controlled pilot study. Int J Osteopath Med. In press. doi:10.1016/j.ijosm.2014.11.003. 
Lumbar diskectomy is a common treatment for patients with low back pain because it can help reduce physical disability and relieve nerve root pain compared with other nonoperative treatments.1,2 However, many patients report continued physical disability and low back and leg pain after surgery. An interdisciplinary team of surgeons and a British-trained osteopath in South Korea published a prospective randomized controlled pilot trial to determine the feasibility and potential benefit of using osteopathic manipulative therapy (OMTh; manipulative care provided by foreign-trained osteopaths) as an integral component of a postdiskectomy rehabilitation program. 
Inclusion criteria were patients aged 20 to 65 years who underwent lumbar microdiskectomy to manage low back pain and who experienced leg pain resulting from a herniated disk. The exclusion criteria were revision or combined surgery, pregnancy, metastatic disease, or mental disorder. 
Thirty-three participants were randomly allocated to either the OMTh group (n=16) or the exercise program group (n=17). Two to 3 weeks after the patients underwent lumbar microdiskectomy, they returned to the hospital for their first rehabilitation session. Both interventions consisted of eight 30-minute sessions performed twice per week for 4 weeks. All patients were prescribed anti-inflammatory medication, analgesics, and muscle relaxants by the surgeons. The OMTh intervention was performed by 2 foreign-trained osteopathic students supervised by a British-trained osteopath. This group received a standardized OMTh protocol including soft tissue, myofascial release, muscle energy, progressive inhibition of neuromuscular structures, osteopathic cranial manipulative medicine, and rib raising techniques. The exercise group also followed a protocol focused on stretching, strengthening, and Pilates exercises. 
Outcome measures were assessed at baseline (2-3 weeks after surgery) and a week after the final rehabilitation session (7-8 weeks after surgery) using the Roland-Morris Disability Questionnaire and a visual analog scale. Postsurgical physical disability improvement was statistically significant in the OMTh rehabilitation group at 54% vs 26% in the exercise group (P<.05). Residual leg pain decreased by 53% in the OMTh group and 17% in the exercise group (P>.05), and residual low back pain decreased by 37% in the OMTh group and 10% in the exercise group (P>.05). In addition, patients required less frequent use of medications in the OMTh group (P>.05). 
The authors concluded that OMTh as a postsurgical rehabilitation intervention after lumbar microdiskectomy is a feasible and potentially beneficial approach for improving physical function and residual back and leg pain, decreasing the frequent use of medications, and leading to overall patient satisfaction. A larger, randomized controlled trial using sham therapy is warranted. The use of OMTh as a postsurgical rehabilitation intervention after knee and hip arthroplasty has been shown to be a feasible approach for improving postoperative care.3,4 This study further supports its utility as an adjunct therapy and a potential standardized protocol for postsurgical rehabilitation. 
Weinstein JN, Lurie JD, Tosteson TD, et al. Surgical versus nonoperative treatment for lumbar disc herniation: four-year results for the Spine Patient Outcomes Research Trial (SPORT). Spine (Phila Pa 1976). 2008; 33(25): 2789-2800. doi:10.1097/BRS.0b013e31818ed8f4. [CrossRef] [PubMed]
Gibson JN, Waddell G. Surgical interventions for lumbar disc prolapse: updated Cochrane Review. Spine (Phila Pa 1976). 2007; 32(16): 1735-1747. [CrossRef] [PubMed]
Jarski RW, Loniewski EG, Williams J, et al. The effectiveness of osteopathic manipulative treatment as complementary therapy following surgery: a prospective, match-controlled outcome study. Altern Ther Health Med. 2000; 6(5): 77-81. [PubMed]
Licciardone JC, Stoll ST, Cardarelli KM, Gamber RG, Swift JN Jr, Winn WB. A randomized controlled trial of osteopathic manipulative treatment following knee or hip arthroplasty. J Am Osteopath Assoc. 2004; 104(5): 193-202. [PubMed]