Free
OMT Minute  |   October 2019
Osteopathic Manipulative Treatment for Allostatic Load Lowering
Author Notes
  • From the Touro University College of Osteopathic Medicine-CA in Vallejo. 
  • Financial Disclosures: None reported 
  • Support: This video was produced by Touro University College of Osteopathic Medicine-CA. 
  •  *Address correspondence to Victor Nuño, 1310 Club Dr, Mare Island, Vallejo, CA 94592-1187. Email: victor.nuno@tu.edu
     
Article Information
Osteopathic Manipulative Treatment
OMT Minute   |   October 2019
Osteopathic Manipulative Treatment for Allostatic Load Lowering
The Journal of the American Osteopathic Association, October 2019, Vol. 119, e38-e39. doi:https://doi.org/10.7556/jaoa.2019.118
The Journal of the American Osteopathic Association, October 2019, Vol. 119, e38-e39. doi:https://doi.org/10.7556/jaoa.2019.118
  
Osteopathic Manipulative Treatment for Allostatic Load Lowering
eVideo. Victor Nuňo, DO, demonstrates the use of lumbar high-velocity, low-amplitude and upper thoracic facilitated positional release to lower biomarkers of stress.
Emotional and physical stress can have both protective and damaging effects on the human body.1 These stressors activate the sympathetic nervous system and hypothalamic-pituitary-adrenal axis, releasing catecholamines and glucocorticoids, mediating the function of multiple organ systems. This physiologic, allostatic response is essential for survival on a short-term scale. However, chronic stimulation and overproduction of stress hormones can produce pathophysiologic states.1,2 
The osteopathic manipulative treatment (OMT) for allostatic load lowering (ALL) study and recent safety literature suggests that OMT may be a safe and effective method of modulating physiologic markers of allostatic load.3,4 Osteopathic manipulative treatment has been shown to increase secretory immunoglobulin A5 and β-endorphin levels,6 while decreasing inflammatory and neuropathic mediators such as 5-hydroxytryptophan,6 5-hydroxyindoleacetic acid,6 anandamide,6 and tumor necrosis factor α,7 and improve respiratory rate8 and heart rate variability.9 
The autonomics, biomechanics, circulation, and screening examination (ABCs) of osteopathic medicine provide a framework for incorporating OMT by addressing autonomic innervation, biomechanics, and circulation to diagnose and treat somatic dysfunction and facilitate homeostasis.10 Additionally, a screening examination encourages global considerations of the patient beyond the obvious chief complaint or the specific region of somatic dysfunction.10 
The OMT techniques used to treat somatic dysfunction can have overlap related to the ABCs. For this demonstration 2 examples will be covered: lumbar high velocity low amplitude and upper thoracic facilitated positional release (video). 
Viewed through the lens of the ABCs, high velocity, low amplitude of a facilitated L1 or L2 segment can improve autonomic tone by addressing the sympathetic chain ganglia, biomechanical restrictions by increasing range of motion, and circulation by releasing the crural attachments to increase diaphragmatic excursion. 
The second technique, upper thoracic facilitated positional release, can also be used to treat multiple ABCs, such as improving autonomic tone by addressing sympathetic chain ganglia, biomechanical restrictions by removing restriction of motion in the thorax, and circulation by alleviating fascial restrictions associated with the thoracic inlet. 
Techniques that focus on optimizing the ABCs, may be effective in diagnosing and treating somatic dysfunction associated with increased allostatic load. Using OMT as a treatment modality to lower allostatic load may help to facilitate homeostasis and decrease the accelerated risk of disease in the majority of patients who experience stress in their daily lives.4-9 
Acknowledgments
We thank Jeff Reedy for contributions in video production and editing, Allison Siu, OMS II, for serving as the model in the video, and Carrie Janiski, DO, for her assistance in editing. 
References
McEwen BS. Allostasis and allostatic load: implications for neuropsychopharmacology. Neuropsychopharmacology. 2000;22(2):108-124. [CrossRef] [PubMed]
Juster RP, McEwen BS, Lupien SJ. Allostatic load biomarkers of chronic stress and impact on health and cognition. Neurosci Biobehav Rev. 2010;35(1):2-16. doi: 10.1016/j.neubiorev.2009.10.002
Seffinger MA. The safety of osteopathic manipulative treatment (OMT). J Am Osteopath Assoc. 2018;118(3):137-138. doi: 10.7556/jaoa.2018.031 [CrossRef] [PubMed]
Nuño V, Siu A, Deol N, Juster RP. Osteopathic manipulative treatment for allostatic load lowering. J Am Osteopath Assoc. 2019;119(10):646-654. doi: 10.7556/jaoa.2019.112
Saggio G, Docimo S, Pilc J, Norton J, Gilliar W. Impact of osteopathic manipulative treatment on secretory immunoglobulin A levels in a stressed population. J Am Osteopath Assoc. 2011;111(3):143-147. [PubMed]
Degenhardt BF, Darmani NA, Johnson JC, et al Role of osteopathic manipulative treatment in altering pain biomarkers: a pilot study. J Am Osteopath Assoc. 2007;107(9):387-400. [PubMed]
Licciardone JC, Kearns CM, Hodge LM, Minotti DE. Osteopathic manual treatment in patients with diabetes mellitus and comorbid chronic low back pain: subgroup results from the OSTEOPATHIC Trial. J Am Osteopath Assoc. 2013;113(6):468-478. [PubMed]
Bhilpawar PP, Auroa R. Effects of osteopathic manipulative treatment in patients with chronic obstructive pulmonary disease. Indian J Physiother Occup Ther. 20137(1):196-201.
Henley CE, Ivins D, Mills M, Wen FK, Benjamin BA. Osteopathic manipulative treatment and its relationship to autonomic nervous system activity as demonstrated by heart rate variability: a repeated measures study. Osteopath Med Prim Care. 2008;2:7. doi: 10.1186/1750-4732-2-7. [CrossRef] [PubMed]
Nuño V, Peña NJ, Hughes TNF, Cuny LAM, Pierce-Talsma SL. Teaching osteopathic principles and practice: easy as ABCs. AAOJ. 2018;28(2):34-38.
  
Osteopathic Manipulative Treatment for Allostatic Load Lowering
eVideo. Victor Nuňo, DO, demonstrates the use of lumbar high-velocity, low-amplitude and upper thoracic facilitated positional release to lower biomarkers of stress.