Letters to the Editor  |   October 2010
Author Affiliations
  • To Shan Li, DO
    Department of Biomedical Sciences, West Virginia School of Osteopathic Medicine, Lewisburg
    Department of Osteopathic Principles and Practice, West Virginia School of Osteopathic Medicine, Lewisburg
Article Information
Osteopathic Manipulative Treatment / OMT in the Laboratory
Letters to the Editor   |   October 2010
The Journal of the American Osteopathic Association, October 2010, Vol. 110, 608-609. doi:
The Journal of the American Osteopathic Association, October 2010, Vol. 110, 608-609. doi:
We appreciate Dr Magoun's candid feedback regarding our June JAOA original contribution,1 and we believe that his assertion that “[t]here is no question that rib raising affects the sympathetic nervous system” actually supports the rationale behind our study. 
The aim of our study1 was to investigate the effects of rib raising on the autonomic nervous system on a more exact level using measurable biomarkers. The intent of our study was not to define the clinical scope of rib raising. Although rib raising is used for a number of indications, we chose to focus on its proposed physiologic effects on the autonomic nervous system because noninvasive methods for studying this system are available. The rib raising technique used in our study1 is identical to that described in Foundations for Osteopathic Medicine2 and Pocket Manual of OMT,3 and it is also consistent with procedures used in recent clinical efficacy trials, including the Multicenter Osteopathic Pneumonia Study in the Elderly (MOPSE).4 
Although Dr Magoun feels that our study1 dilutes traditional concepts of osteopathy, we believe that we are exploring and clarifying these concepts by expanding our understanding of them through scientific investigation of the physiologic response to manipulation. It is our hope that studies such as ours1 will provide a better understanding of not only the physiologic basis of osteopathic manipulative treatment (OMT), but also of individual differences in response to OMT—thereby facilitating the standardization and optimization of treatment protocols. 
In combination with clinical efficacy trials, a continued focus on basic research into the mechanisms behind OMT will further expand the scientific knowledge base for the role of OMT in the spectrum of modern osteopathic medical care. 
Henderson AT, Fisher JF, Blair J, Shea C, Li TS, Bridges KG. Effects of rib raising on the autonomic nervous system: a pilot study using noninvasive biomarkers. J Am Osteopath Assoc. 2010;110 (6):324-330. Accessed September 20, 2010.
Chapter 68. In: Ward RC, ed. Foundations for Osteopathic Medicine. 2nd ed. Baltimore, MD: Lippincott Williams & Wilkins; 1997: 1065.
Chapter 12. In: Essig-Beatty DR, Steele KM, Comeaux Z, Lemley WW. Pocket Manual of OMT: Osteopathic Manipulative Treatment for Physicians. Baltimore, MD: Lippincott Williams & Wilkins;2005 : 337.
Noll DR, Degenhardt BF, Fossum C, Hensel K. Clinical and research protocol for osteopathic manipulative treatment of elderly patients with pneumonia. J Am Osteopath Assoc. 2008;108 (9):508-516. Accessed September 20, 2010.