The Somatic Connection  |   January 2013
Osteopathic Fascial Manipulation Reduces Low Back Pain and Increases Kidney Mobility
Author Affiliations
  • Michael A. Seffinger, DO
    Western University of Health Sciences College of Osteopathic Medicine of the Pacific, Pomona, California
Article Information
The Somatic Connection   |   January 2013
Osteopathic Fascial Manipulation Reduces Low Back Pain and Increases Kidney Mobility
The Journal of the American Osteopathic Association, January 2013, Vol. 113, 102. doi:
The Journal of the American Osteopathic Association, January 2013, Vol. 113, 102. doi:
Tozzi P, Bongiorno D, Vitturini C. Low back pain and kidney mobility: local osteopathic fascial manipulation decreases pain perception and improves renal mobility [published online ahead of print March 3, 2012]. J Bodyw Mov Ther. 2012;16(3):381-391. doi:10.1016/j.jbmt.2012.02.001.  
Manipulation of organs and their surrounding fascial connections has been promoted by osteopathic physicians since the founding of the profession. The American Academy of Osteopathy has been offering courses for physicians on these types of procedures since its founding 75 years ago. However, controlled clinical trials evaluating the efficacy of this approach are rare. Clinical researchers in Italy addressed this topic by using a well-designed study protocol. They focused on 3 objectives: (1) calculate and compare kidney mobility in asymptomatic individuals and those with low back pain (LBP) using real-time ultrasonography (US), (2) assess renal mobility, and (3) assess pain perception in participants with nonspecific LBP after osteopathic fascial manipulation (OFM). 
Researchers recruited 101 asymptomatic participants (30 women, 71 men; mean [standard deviation (SD)] age, 38.9 [8] years) who were evaluated with abdominal US screening. The distance between the superior renal pole of the right kidney and the ipsilateral diaphragmatic pillar was calculated in both maximal expiration (RdE) and maximal inspiration (RdI). The mean of the RdE:RdI ratios provided a kidney mobility score (KMS) in the cohort of asymptomatic participants. The same procedure was applied to 140 symptomatic participants (66 women, 74 men; mean [SD] age, 39.3 [8] years). This symptomatic cohort was divided into 2 groups: 109 were randomly assigned to the experimental (OFM) group and 31 to the control (sham therapy) group. Range of right kidney mobility for both groups was ascertained by calculating the difference between RdE and RdI values before and after each intervention. 
The ultrasonographer was blinded to group allocation. The osteopath who administered the OFM had 6 years of experience. The sham therapy, which consisted of light touch applied to the same areas as the OFM, was administered by an untrained layperson. Participants in both groups completed a Short-Form McGill Pain Assessment Questionnaire on the day of recruitment as well as on the third day after treatment. 
Factorial analysis of variance showed a significant difference (P<.05) in mean (SD) KMS in asymptomatic participants (1.92 [1.14] mm) compared with the KMS in those with LBP (1.52 [0.79] mm). For symptomatic participants, repeated measures analysis of variance showed a significant difference (P<.0001) between pre- and post-RD values of the experimental group compared with those found in the control group. Additionally, the pain scores were significantly lower (P<.0001) in the OFM cohort compared with those in the sham cohort. 
This pioneer study, using standard, validated instruments, demonstrated that participants with non-specific LBP had reduced range of kidney mobility during respiration compared with asymptomatic individuals. Osteopathic fascial manipulation applied to the thoracolumbar junction region improved kidney mobility and reduced pain perception over the short term compared with light touch sham therapy. 
   “The Somatic Connection” highlights and summarizes important contributions to the growing body of literature on the musculoskeletal system's role in health and disease. This section of The Journal of the American Osteopathic Association (JAOA) strives to chronicle the significant increase in published research on manipulative methods and treatments in the United States and the renewed interest in manual medicine internationally, especially in Europe.
   To submit scientific reports for possible inclusion in “The Somatic Connection,” readers are encouraged to contact JAOA Associate Editor Michael A. Seffinger, DO (, or JAOA Editorial Advisory Board Member Hollis H. King, DO, PhD (