Letters to the Editor  |   July 2006
Cochrane Library's Summary of Review on Manipulative Treatment Misleading, Cheats Readers
Author Affiliations
    Foster, RI
Article Information
Neuromusculoskeletal Disorders / Osteopathic Manipulative Treatment / Pain Management/Palliative Care / Physical Medicine and Rehabilitation / Low Back Pain
Letters to the Editor   |   July 2006
Cochrane Library's Summary of Review on Manipulative Treatment Misleading, Cheats Readers
The Journal of the American Osteopathic Association, July 2006, Vol. 106, 426-427. doi:
The Journal of the American Osteopathic Association, July 2006, Vol. 106, 426-427. doi:
To the Editor: In its “Cochrane for Clinicians” section, the February 1, 2005, issue of American Family Physician presented a summary of a review from the Cochrane Library on low back pain and spinal manipulative therapy. The article, “Spinal Manipulative Therapy for Low Back Pain,” is written by Katherine Margo, MD, in the Department of Family Practice at the University of Pennsylvania at Philadelphia.1 
Although two of Dr Margo's references have “osteopathic manipulation” in the title,2,3 none of the six citations are to articles published in JAOA—The Journal of the American Osteopathic Association. One referenced text concludes: “There was no evidence that manipulation was better for any subgroup of low back pain.”2 The other reference concludes: “Osteopathic treatment for chronic pain found that therapy was as effective as sham treatment.”3 These conclusions mislead both physicians and nonphysicians. 
The past and present of our profession include many superb osteopathic physicians (DOs) who specialize in osteopathic manipulative treatment (OMT) of the back. In the words of Louisa Burns, DO, regarding spinal somatic dysfunction: “If severe, the pain may be pronounced and thus lead to early treatment, let us hope, by an efficient osteopathic physician.”4 In the more recent writings of George W. Northup, DO, “somatic dysfunction of the synovial joints, particularly of the spine, is increasingly recognized as a cause of pain and malfunction of the musculoskeletal system itself...the reputation of the osteopathic medical profession was first built on its ability to treat back pain effectively with manipulation...its application requires skill and clinical judgment.”5 Dr Northup also noted that many manipulative maneuvers “involve either intersegmental joint traction or placing the joint in such a position that the joint lock is released. Clinical experience teaches every physician willing to learn such helpful personal observations.”5 Recall your favorite moment in OMM (osteopathic manipulative medicine) while at school or, more recently, while offering OMT at state and national American Osteopathic Association (AOA) conferences. Who relieved your musculoskeletal back pain and made you feel better? 
If the Cochrane Library does not include the most respected journal of the osteopathic medical profession, then the Cochrane Library's readers are being cheated out of a more thorough and critical analysis of the subject. 
Are osteopathic physicians involved in gathering information for databases or at least advising audiences of the limitations of the databases? The AOA should verify that Cochrane, MEDLINE, and other “accepted” databases include at least the past 25 years of the JAOA's 100-plus years of articles supportive of OMT—especially for back pain. 
Let's face it: OMT has helped countless patients (beyond anecdotally).6 Osteopathic physicians who specialize in OMM are recruited by their MD counterparts in physical and rehabilitation medicine to be an integral part of the team at rehabilitation hospitals, such as Spaulding Rehabilitation Hospital in Boston, which has a DO on staff. I do not accept Cochrane's conclusion that no subgroup of patients with low back pain derives benefit from OMT. 
The spectrum of knowledge should be broad based and presented honestly—something we should demand every day from ourselves, authors, and editorial staff. 
Margo K. Spinal manipulative therapy for low back pain [review]. Am Fam Physician. 2005;71:464–465. Available at: Accessed April 19, 2005.
Williams NH, Wilkinson C, Russell I, Edwards RT, Hibbs R, Linck P, et al. Randomized osteopathic manipulation study (ROMANS): pragmatic trial for spinal pain in primary care. Fam Pract. 2003;20:662 –669.
Licciardone JC, Stoll ST, Fulda KG, Russo DP, Siu J, Winn W, et al. Osteopathic manipulative treatment for chronic low back pain: a randomized controlled trial. Spine. 2003;28:1355 –1362.
Burns L. Somatic sensory impulses and vertebral lesions. J Am Osteopath Assoc. 1921;20(111):601 –606.
Peterson B. A compilation of the thoughts of George W. Northup, DO, on the philosophy of osteopathic medicine. J Am Osteopath Assoc. 1998;98:53 –57.
Korr IM. The facilitated segment: a factor in injury to the body framework. Osteopathic Annals. 1973;1(2):10 –18.
Kimberly PE. Formulating a prescription for osteopathic manipulative treatment. J Am Osteopath Assoc. 1980;79:506 –513.