The Somatic Connection  |   March 2015
Recognizing the Value of Manual Therapy Interventions in Women's Health: An Interim Report
Author Affiliations
  • Hollis H. King, DO, PhD
    University of California, San Diego School of Medicine
Article Information
The Somatic Connection   |   March 2015
Recognizing the Value of Manual Therapy Interventions in Women's Health: An Interim Report
The Journal of the American Osteopathic Association, March 2015, Vol. 115, 172-173. doi:
The Journal of the American Osteopathic Association, March 2015, Vol. 115, 172-173. doi:
Web of Science® Times Cited: 1
The 3 research publications reviewed in this installment of The Somatic Connection, along with research reviewed in previous installments,1-5 highlight the growing evidence base for the benefits of osteopathic manipulative treatment (OMT) and osteopathic manipulative therapy (manipulative care provided by foreign-trained osteopaths) for women. If we include research from other health care professions that use hands-on therapy (eg, chiropractic, physical therapy) that has been reviewed in The Somatic Connection6-14 and previously published in The Journal of the American Osteopathic Association,15-19 the list is substantial enough to warrant special recognition of the benefit of OMT and manual therapy in women's health. 
Perhaps the foremost contribution of OMT and manual therapy to women's health is intervention during the prenatal period. Intervention early in pregnancy has the potential to reduce morbidity associated with labor and delivery, such as preterm delivery and meconium-stained amniotic fluid,17 as well as reduce mortality rates in child birth.19 Preventing these types of complications could substantially reduce health care costs. Further research on these topics could form the basis for health policy changes in prenatal care. The improvement in hemodynamic control,6 reduction of labor duration,18 and reduction in pain during the late stages of pregnancy has been shown in osteopathic,4,15,20 massage,14 and chiropractic12 research. 
The literature has reported that up to 50% of women experience primary dysmenorrhea.21 In addition to the studies22,23 reviewed in this installment of The Somatic Connection, osteopathic,16 chiropractic,13 and physical therapy2 research articles have reported a significant reduction of the symptoms of primary dysmenorrhea after manual therapy. Urinary tract symptoms and pelvic pain have also been reduced with manual therapy1,3 and physical therapy,6-8 the findings of which have also been reviewed in this section. 
Research has also associated improvement in breast health with physical therapy9 and massage therapy.10 One report even described reduced depression symptoms in pregnant women after yoga and massage.11 
This overview is not a systematic review and meta-analysis suggesting proof, but rather an interim report describing the growing body of research suggestive of benefit in this area of women's health. It is my hope that this commentary stimulates more osteopathic research and practice in women's health issues. 
The mission of The Somatic Connection is to report and elucidate trends in manual therapy research across professions and around the world. Where applicable, we relate such research to osteopathic manual medicine research, and we will continue to review important research in this area that is at the heart of our profession. Readers are encouraged to send suggestions for research to be reviewed in The Somatic Connection to the section's editors at or 
   Editor's Note: This month's installment of “The Somatic Connection” features 3 articles on women's health issues. A commentary by section editor Hollis H. King, DO, PhD, on the benefits of manual therapy for women's health is included after the summaries.
de Almeida BS, Sabatino JH, Giraldo PC. Effects of high-velocity, low amplitude spinal manipulation on strength and the basal tonus of female pelvic floor muscles. J Manipulative Physiol Ther. 2010;33(2):109-116. [CrossRef] [PubMed]
Molins-Cubero S, Boscá-Gandía JJ, Rus-Martínez MA. Assessment of low back and pelvic pain after applying the pelvis global manipulation technique in patients with primary dysmenorrhea: a pilot study. Eur J Ost Clin Rel Res. 2012;7(1):29-38.
Franke H, Hoesele K. Osteopathic manipulative treatment (OMT) for lower urinary tract symptoms (LUTS) in women. J Bodyw MovTher. 2013;17(1):11-18. [CrossRef]
Licciardone JC, Buchanan S, Hensel K, King HH, Fulda KG, Stoll ST. Osteopathic manipulative treatment of back pain and related symptoms during pregnancy: a randomized controlled trial. Am J Obstet Gynecol. 2010;202:43.e1-43.e8. [CrossRef]
Hensel KL, Pacchia CF, Smith ML. Acute improvement in hemodynamic control after osteopathic manipulative treatment in the third trimester of pregnancy. Complement Ther Med. 2013;21(6):618-626. [CrossRef] [PubMed]
Tu FF, Holt J, Gonzales J, Fitzgerald CM. Physical therapy evaluation of patients with chronic pelvic pain: a controlled study. Am J Obstet Gynecol. 2008;198(3):272.e1-272.e7. [CrossRef]
Anderson R, Wise D, Sawyer T, Nathanson BH. Safety and effectiveness of an internal pelvic myofascial trigger point wand for urologic chronic pelvic pain syndrome. Clin J Pain. 2011;27(9):764-768. [CrossRef] [PubMed]
FitzGerald MP, Payne CK, Lukacz ES, et al.  Interstitial Cystitis Collaborative Research Network. Randomized multicenter clinical trial of myofascial physical therapy in women with interstitial cystitis/painful bladder syndrome and pelvic floor tenderness. J Urol. 2012;187(6):2113-2118. [CrossRef] [PubMed]
Jahr S, Schoppe B, Reisshauer A. Effect of treatment with low-intensity and extremely low-frequency electrostatic fields (Deep Oscillation) on breast tissue and pain in patients with secondary breast lymphoedema. J Rehabil Med. 2008;40(8):645-650. [CrossRef] [PubMed]
Billhult A, Lindholm C, Gunnarsson R, Stener-Victorin E. The effect of massage on immune function and stress in women with breast cancer—a randomized controlled trial. Auton Neurosci. 2009;150(1-2):111-115. [CrossRef] [PubMed]
Field T, Diego M, Hernandez-Reif M, Medina L, Delgado J, Hernandez A. Yoga and massage therapy reduce prenatal depression and prematurity. J Bodyw Mov Ther. 2012;16(2);204-209. [CrossRef] [PubMed]
Peterson CK, Mühlemann D, Humphreys BK. Outcomes of pregnant patients with low back pain undergoing chiropractic treatment: a prospective cohort study with short term, medium term and 1 year follow-up. Chiropratic Man Ther. 2014;22:15. [CrossRef]
Hondras MA, Long CR, Brennan PC. Spinal manipulative therapy versus a low force mimic maneuver for women with primary dysmenorrhea: a randomized, observer-blinded, clinical trial. Pain. 1991;81(1-2):105-114.
Field T, Figueiredo B, Hernadez-Reif M, Diego M, Deeds O, Ascensio A. Massage therapy reduces pain in pregnant women, alleviates prenatal depression in both parents and improves their relationships [published online October 2, 2007]. J Bodyw Mov Ther. 2008;12(2):146-150. doi:10.1016/j.jbmt.2007.06.003. [CrossRef] [PubMed]
Guthrie RA, Martin RH. Effect of pressure applied to upper thoracic (placebo) versus lumbar areas (osteopathic manipulative treatment) for inhibition of lumbar myalgia during labor. J Am Osteopath Assoc. 1982;82(4):247-251. [PubMed]
Boesler D, Warner M, Alpers A, Finnerty EP, Kilmore MA. Efficacy of high-velocity low-amplitude manipulative technique in subjects with low-back pain during menstrual cramping. J Am Osteopath Assoc. 1993;93(3):203-208; 213-214. [PubMed]
King HH, Tettambel MA, Lockwood MD, Johnson KH, Arsenault DA, Quist R. Osteopathic manipulative treatment in prenatal care: a retrospective case control design study. J Am Osteopath Assoc. 2003;103(12):577-582. [PubMed]
Whiting LM. Can the length of labor be shortened by osteopathic treatment? J Am Osteopath Assoc. 1911;11:917-921.
Jones M. Osteopathy and obstetrical mortality and stillbirth and infant mortality: symposium on osteopathy in obstetrics chaired by S.V. Robuck, DO. J Am Osteopath Assoc. 1933;33:350-353.
Hensel KL, Buchanan S, Brown SK, Rodriguez M, Cruser dA. Pregnancy Research on Osteopathic Manipulation Optimizing Treatment Effects: the PROMOTE study [published online July 25, 2014]. Am J Obstet Gynecol. 2015;212(1):108.e1-108.e9. doi:10.1016/j.ajog.2014.07.043. [CrossRef]
Dawood MY. Primary dysmenorrhea: advances in pathogenesis and management. Obstet Gynecol. 2006;108(2):428-441. [CrossRef] [PubMed]
Schwerla F, Wirthwein P, Rütz M, Resch KL. Osteopathic treatment in patients with primary dysmenorrhea: a randomized controlled trial. Int J Osteopath Med. 2014;17:222-231. doi:10.1016/j.ijosm.2014.04.003. [CrossRef]
Molins-Cubero S, Rodríguez-Blanco C, Oliva-Pascual-Vaca A, Heredia-Rizo AM, Boscá-Gandía JJ, Ricard F. Changes in pain perception after pelvis manipulation in women with primary dysmenorrhea: a randomized controlled trial [published online March 25, 2014]. Pain Med. 2014;15(9):1455-1463. doi:10.1111/pme.12404. [CrossRef] [PubMed]