Osteopathic principles and practice emphasize the importance of the musculoskeletal system as a major component in patient well-being. With OMT, physicians are able to affect the motion of this system, maximizing it and, as a result, improving overall function.
The respiratory system's high level of dependence on the musculoskeletal system is demonstrated most dramatically in the paralytic state induced by many poisons that halt respiration by completely disabling the musculoskeletal system. Suffocation follows even though the lungs themselves are completely healthy.
Similarly, when a person has broken ribs, respiratory function is compromised to an extent that correlates directly with the number of ribs broken. Although one broken rib is an inconvenience, several adjacent fractures in the ribs can be life threatening. It follows that if the muscles and bones of the thorax are working optimally, they can serve the complex process of respiration most efficiently. If these structures are inhibited, respiration suffers.
The therapeutic goal of OMT is maximization of physiologic motion of the musculoskeletal system. Just as an athlete stretches and exercises prior to competition in an effort to “loosen up” and achieve “peak” performance, so too the musculoskeletal system works most efficiently when barriers to motion are removed. Given the interdependent relationship that exists between the respiratory system and the musculoskeletal system, it seems that—by increasing physiologic motion of thoracic structures—OMT is a helpful addition to the list of treatment modalities available to clinicians treating patients with respiratory conditions, including asthma.
This study demonstrates that OMT may significantly improve pulmonary function for pediatric patients with asthma. The design of a randomized controlled trial increases the validity of the study significantly. The mean increase of PEFs for children with asthma who were in the OMT group for this study was 13 L per minute; patients in the control group showed no improvement at all. We therefore propose the use of OMT in treating pediatric patients with asthma as it is a safe, noninvasive, cost effective means of enhancing treatment for patients with this disease.
Although we are encouraged by the results of our study, we also recognize its limitations, one of which is the fact that several different osteopathic physicians performed OMT for patients in the OMT group. Because OMT skills and the OM techniques used may vary tremendously among individual practitioners, another variable may have been introduced inadvertently. To correct for this variable, future studies might instead make use of one osteopathic physician.
Additionally, although group assignment was masked (ie, single blind), physician assessment was not. The physicians who were responsible for measuring and recording patient PEFs were not blinded as to the study group to which patients were assigned (ie, OMT or sham procedure). Thus, physicians might have unconsciously affected patient PEFs with subtle acts of encouragement or discouragement. The use of blinded physicians (or a blinded respiratory technician) in measuring and documenting PEFs may correct for this confounding variable.
Finally, although PEFs have been used to estimate pulmonary function in patients with asthma, full pulmonary function spirometry would provide researchers with a better indication of the exact physiological aspect of pulmonary function that has been altered by OMT.