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The Somatic Connection  |   May 2017
Addition of Osteopathic Visceral Manipulation to OMT for Low Back Pain Decreases Pain and Increases Quality of Life
Author Notes
  • University of California, San Diego School of Medicine 
Article Information
The Somatic Connection   |   May 2017
Addition of Osteopathic Visceral Manipulation to OMT for Low Back Pain Decreases Pain and Increases Quality of Life
The Journal of the American Osteopathic Association, May 2017, Vol. 117, 333-334. doi:10.7556/jaoa.2017.062
The Journal of the American Osteopathic Association, May 2017, Vol. 117, 333-334. doi:10.7556/jaoa.2017.062
Tamer S, Öz M, Ülger Ö. The effect of visceral osteopathic manual therapy applications on pain, quality of life and function in patients with chronic nonspecific low back pain. J Back Musculoskelet Rehabil. 2016:1-7. doi:10.3233/BMR150424 
Turkish researchers from the Department of Physiotherapy and Rehabilitation at Hacettepe University in Ankara, Turkey, compared the effects of osteopathic manipulative therapy (OMTh; manipulative care provided by foreign-trained osteopaths) procedures with those of visceral OMTh in patients with chronic nonspecific low back pain (LBP). Inclusion criteria for patients were nonspecific LBP for more than 12 weeks and no treatment received in the past 6 months. Exclusion criteria were patients with tumors, severe scoliosis, inflammation, radicular symptoms, motor and sensory deficits, or abdominal surgery in the past 6 months. 
Thirty-nine patients were randomly assigned to the OMTh (n=19) or visceral OMTh (n=20) group. No significant demographic differences were found between the groups. The OMTh techniques consisted of soft-tissue mobilization, muscle energy techniques, and mobilization for lumbar segment procedures. The visceral OMTh group received the OMTh procedures in addition to thoracic lymphatic pump, liver pump, pelvic floor, and respiratory diaphragm procedures. Also, according to the patients’ need, they received arterial, venous and neural techniques, lymphatic drainage, and fascial mobilization of visceral organs. Each patient received treatments twice per week for 5 weeks. Data were gathered at baseline and 6 weeks after the beginning of interventions. 
The outcome measures were pain visual analog scale for pain intensity and the Short Form-36 for quality of life, with subscales for physical functions, physical role limitations, general health, energy, social function, emotional role limitations, and mental health. Functional ability levels were measured on the Oswestry Function Scale. 
Both groups showed reduced pain intensity on the visual analog scale (P<.001) and functional ability on the Oswestry Function Scale (P<.001). For the visceral OMTh group, improvement on the Short Form-36 Health Survey was shown in all parameters, but the OMTh group did not improve in energy, emotional role limitations, mental health, or total mental health. Comparison of the 2 groups showed greater physical function (P=.028), energy (P=.034), and total physical (P=.025) score improvement in the visceral OMTh group. 
The researchers suggest that the interventions inhibited pain by reducing muscle spasms and sympathetic system activation. They surmise that the visceral procedures improved blood circulation throughout the body and eliminated congesting bodily fluids, thus explaining the additional benefits that the patients in the visceral OMTh group demonstrated. They also suggest that viscerosomatic segmental effects may have reduced pain and increased energy. These findings demonstrate the need for further examination of viscerosomatic interactions in musculoskeletal disorders.