Infantile colic is a poorly understood condition that affects between 8% and 40% of infants, usually those younger than 3 months. Foreign-trained osteopaths in the United Kingdom performed the first pragmatic, open, controlled, randomized clinical trial on the effect of osteopathic manipulative therapy on the signs associated with infantile colic. Infants, who were recruited by referral, were eligible for the study if they were no older than 12 weeks, had not previously received osteopathic treatment, exhibited signs of infantile colic, and had no signs or symptoms indicative of other disease. Signs of infantile colic were at least 90 minutes of inconsolable crying per day for at least 5 days in the past week, loud abdominal gurgling noises, knees drawn up to the chest, clenched fists, and backward bending of the head or trunk. 

Of the 44 screened infants, 28 (22 males; 6 females) met inclusion criteria and were randomly assigned to receive either osteopathic manipulation (including cranial manipulation) or no treatment (no sham therapy). Demographic characteristics of each group were comparable. All participants were seen once weekly for 4 weeks, with the same osteopath administering all interventions. Treatment in the manipulation group was applied according to individual findings from osteopathic structural examinations conducted at each visit. (It is unclear from the report what the findings were or what treatments were used.) In a daily diary, parents recorded the time the infant spent crying, sleeping, and being held or rocked. Two infants from the control group were withdrawn from the study as a result of worsening symptoms and the need for more intensive care. 

A statistically significant decrease in crying (P<.001) and increase in time spent sleeping (P<.002) occurred in the treated group. All 14 infants in the treatment group improved, 10 (71%) of whom required no further treatment after 3 weeks. Only 3 infants (21%) in the control group improved by 3 weeks, with a total of 7 (50%) improving by 4 weeks. These improvements, however, were not statistically significant. Although these findings are preliminary, they suggest that osteopathic manipulation can help reduce infantile colic. A larger, multi-site, sham-controlled study is warranted. —M.A.S. 

Hayden C et al. Complement Ther Clin Pract. 2006;12:83-90.  

Patients with frozen shoulder are commonly treated with manipulation under anesthesia to mobilize joints that are refractory to such treatment while the patient is awake. However, little evidence exists to prove the efficacy of this treatment modality for frozen shoulder, a condition that can take up to 3 years to resolve. 

A group of physiatrists and physiotherapists in Finland conducted the first randomized clinical trial evaluating the long-term (1 year) effectiveness of manipulation under anesthesia in patients with clinically verified frozen shoulder. A total of 125 patients with this condition, referred from three hospitals in southern Finland, were randomly assigned to the manipulation plus exercise group (n=65) or control (exercise only) group (n=60). The patients were supine for manipulation, during which the physicians flexed and abducted, then internally and externally rotated the subject's joint until it had normal or near-normal range of motion. A cracking sound was heard in manipulated shoulders, but no major complications were noted. Manipulation occurred only once, within 2 weeks of randomization. Pendulum exercises and stretching techniques were taught to each patient, who was instructed to perform the exercises daily. Outcomes measured included range-of-motion assessment by a blinded physiotherapist, pain and working ability scales, a modified Shoulder Disability Questionnaire, use of analgesic medications, and other therapy received for shoulder pain. Data were gathered at baseline and at follow-up examinations 6 weeks and 3, 6, and 12 months after randomization. 

One third of the patients were lost to follow up at 1 year. Although the patients in the manipulation group had improved shoulder mobility at the 6-week and 3-month follow-up, pain intensity and disability were similar between groups. At 1 year, only slight pain remained in both groups. The authors concluded that manipulation under anesthesia does not improve the effectiveness of an at-home exercise regimen. —M.A.S. 

Kivimäki J et al. J Shoulder Elbow Surg. 2007;16:722-726.  

Osteopathic physicians have characteristically promoted healthy dietary practices as a fundamental component of patient self-management. Increasingly, long-term follow-up studies of various diets have demonstrated the wisdom of this approach. Metabolic syndrome, affecting 47 million US adults, is defined by the presence of three or more of the following cardiovascular disease risk factors: abdominal obesity, high blood pressure, glucose intolerance, and elevated high-density lipoprotein cholesterol or triglycerides. It is also associated with increased risk of type 2 diabetes mellitus, cardiovascular disease, and mortality. 

The Atherosclerosis Risk in Communities study gathered survey data from 9514 adults during a 9-year period to determine the role of diet in the origin of metabolic syndrome. Unique to this study, researchers evaluated the effect of the whole diet pattern on subjects prospectively, rather than singling out specific foods or only one gender in a cross-sectional design as in other longitudinal studies. 

Researchers used a 66-item food frequency questionnaire and principal-components analysis to derive “Western” versus “prudent” dietary patterns. The Western diet consisted primarily of refined grains, processed meat, fried food, eggs, red meat, and diet soda. The prudent diet was predominantly fish, poultry, whole grains, fruits, cruciferous and carotinoid vegetables, and low-fat dairy products. 

Within 9 years, metabolic syndrome occurred in 3782 participants (40%). After adjusting for various demographic and behavioral characteristics, a Western dietary pattern was found to be adversely associated (18% increased risk) with the occurrence of metabolic syndrome. Individually, meat, fried food, and diet soda were strongly associated with the occurrence of metabolic syndrome, whereas dairy consumption was protective. No associations were found between the occurrence of metabolic syndrome and a prudent dietary pattern or, individually, whole grains, refined grains, fruits, vegetables, nuts, coffee, or sweetened beverages. —M.A.S. 

Lutsey PL et al. Circulation.. (2008). ;117:754-761.