Letters to the Editor  |   March 2011
Osteopathic Manipulative Treatment in Developing Countries: A Call for Education and Research
Author Affiliations
  • Daria Szkwarko, OMS IV
    University of Medicine and Dentistry of New JerseySchool of Osteopathic Medicine, Class of 2012; Fogarty International Clinical Research Scholar 2010-2011, Eldoret, Kenya
Article Information
Osteopathic Manipulative Treatment
Letters to the Editor   |   March 2011
Osteopathic Manipulative Treatment in Developing Countries: A Call for Education and Research
The Journal of the American Osteopathic Association, March 2011, Vol. 111, 179-180. doi:
The Journal of the American Osteopathic Association, March 2011, Vol. 111, 179-180. doi:
To the Editor:  
In an editorial published in the March 2001 JAOA—The Journal of the American Osteopathic Association, Debra A. Smith, DO,1 urged us to expand our minds and consider the osteopathic medical profession 15 years into the future as a profession that had actively moved into the global arena. She challenged our institutions to “become official `WHO [World Health Organization] Collaborating Centers' and involve themselves in various WHO high-priority research projects around the world.”1 Dr Smith provided several inspiring ideas about how to unite our profession internationally and revolutionize healthcare delivery. Yet, in 2010, a PubMed search for osteopathic manipulative treatment (OMT) in developing countries yielded no results. 
The start of 2011 marked the end of the first Bone and Joint Decade, an initiative by the United Nations and the WHO to address the increasing burden of musculoskeletal conditions globally.2,3 Global health priorities are quickly shifting from infectious diseases to chronic diseases. As longevity increases and physical activity continues to decline in the developing world, the need for cost-effective interventions for individuals with musculoskeletal conditions is urgent. Musculoskeletal conditions rank eighth globally as a cause of disability-adjusted life-years.4 A WHO bulletin published in 2003 showed that the burden of musculoskeletal conditions is greatest in developing countries.5 The most common musculoskeletal condition leading to chronic pain is back pain, typically caused by osteoarthritis.6 
As I walk about the hospital grounds at the Moi Teaching and Referral Hospital in Eldoret, Kenya, I frequently see Kenyan patients, visitors, and healthcare workers with obviously painful somatic dysfunctions. Our allopathic counterparts have created elaborate organizations in this region of Africa to provide healthcare to such individuals, who are in great need. The medications and diagnostic tools that they provide—though extremely beneficial—always come with a price tag, and many of the innovative treatments are not affordable for most individuals. I cannot help but ask myself, where are the DOs? As osteopathic physicians and students, we have the knowledge and skills to not only manage patients' conditions with novel medicines and diagnostic procedures, but we have an additional skill (OMT) that can reduce pain and improve quality of life in a much more cost-effective manner than conventional allopathic treatments. 
Musculoskeletal conditions are likely to become an even more neglected problem for millions of individuals around the world in the future. There is no better time than now to create an osteopathic medical presence in global healthcare. In order to take the lead on tackling musculoskeletal problems in a cost-effective way, we should approach the opportunity in a stepwise manner. First, our osteopathic medical institutions need to create our own collaborations with medical schools and hospitals throughout the world to foster an educational exchange of knowledge. With such collaborations, we will have the opportunity to teach our distinct osteopathic skills to healthcare providers, as well as to learn from our international counterparts. 
To establish trust and greater understanding of our profession, it is also imperative to conduct research on the use of osteopathic medical techniques in developing regions. Research conducted on the use of OMT for patients with common medical conditions in developed countries has demonstrated the benefits of our unique skills. In particular, OMT has been shown in both the United States and the United Kingdom to be an effective modality for reducing low back pain in patients.7 The Osteopathic Research Center, at the University of North Texas Health Science Center in Fort Worth, has been recently founded to move our profession forward in musculoskeletal research. This center is training fellows who have interests in using OMT for treating patients with low back pain, and it is creating a national practice-based research network.8 There is no reason that this national initiative cannot act as a model for extending our efforts globally in the near future. 
As we enter a new decade and as the next generation of osteopathic health-care providers graduate, I hope that we hit the ground running with OMT in developing nations. We have a tremendous opportunity to help thousands of individuals around the world who continue to suffer because they cannot afford the medications necessary to ease their pain. It is time for us to take advantage of this opportunity and to not only help those in greatest need, but to also make our profession better known in all corners of the world. 
Smith DA. Going global with osteopathic medicine [editorial]. J Am Osteopath Assoc. 2001; 101(3):156-159. Accessed January 22, 2011.
Woolf AD. The bone and joint decade 2000-2010 [review]. Ann Rheum Dis. 2000;59(2):81-82. Accessed January 22, 2011.
Bone and joint decade's musculoskeletal portal. Bone and Joint Decade Web site. Accessed January 22, 2011.
Woolf AD, Brooks P, Akesson K, Mody GM. Prevention of musculoskeletal conditions in the developing world. Best Pract Res Clin Rheumatol. 2008;22(4):759-772.
Woolf AD, Pfleger B. Burden of major musculoskeletal conditions. Bull World Health Organ. 2003;81(9):646-656. Accessed January 22, 2010.
Brooks PM. The burden of musculoskeletal disease—a global perspective [published online ahead of print April 12, 2006]. Clin Rheumatol.. (2006). ;25(6):778-781.
Licciardone JC, Brimhall AK, King LN. Osteopathic manipulative treatment for low back pain: a systematic review and meta-analysis of randomized controlled trials [review]. BMC Musculoskelet Disord. 2005;6:43. Accessed January 22, 2011.
Licciardone JC. Time for the osteopathic profession to take the lead in musculoskeletal research [editorial]. Osteopath Med Prim Care. 2009;3:6. Accessed January 22, 2011.