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OMT Minute  |   June 2020
Osteopathic Manipulative Treatment for Low Back Pain
Author Notes
  • From 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 Stacey Pierce-Talsma, DO, 11 Hills Beach Rd, Biddeford, ME 04004. Email: spiercetalsma@une.edu
     
Article Information
Neuromusculoskeletal Disorders / Osteopathic Manipulative Treatment / Pain Management/Palliative Care / Low Back Pain
OMT Minute   |   June 2020
Osteopathic Manipulative Treatment for Low Back Pain
The Journal of the American Osteopathic Association, June 2020, Vol. 120, e84-e85. doi:https://doi.org/10.7556/jaoa.2020.067
The Journal of the American Osteopathic Association, June 2020, Vol. 120, e84-e85. doi:https://doi.org/10.7556/jaoa.2020.067
  
Osteopathic Manipulative Treatment for Low Back Pain
eVideo. In this video, prone pressure with counterleverage and the sacroiliac joint articulatory technique are demonstrated.
Low back pain (LBP) is a frequent presenting complaint, affecting at least one-quarter of US adults and serving as a leading cause of disability.1-2 Most LBP is categorized as nonspecific, in which there is no identifiable cause.2 Acute or subacute LBP typically improves over time. If nonpharmacologic treatment is preferred, heat, massage, acupuncture, and spinal manipulation including osteopathic manipulative treatment (OMT) may offer some relief.1,3 
OMT is an effective tool for diagnosing and managing musculoskeletal LBP,3 and it has been reported to reduce pain levels and improve function in patients with LBP, including pregnant and postpartum patients.35 An observational study demonstrated decreased pain medication use and an association with decreased work absenteeism in patients who received OMT for LBP.6 
LBP is a common reason a patient will present for OMT.4 Anatomic areas to assess for somatic dysfunction may include the erector spinae (iliocostalis, longissimus, and spinalis), multifidus, iliopsoas, and quadratus lumborum muscles. Additional assessment may include the motion of L5 and the sacroiliac joint, a synovial and fibrous joint that transmits the weight of the body to the pelvis and is thought to be innervated by the dorsal rami of L5-S2.7 Other anatomic regions to assess and treat commonly include local and distant regions, such as the thoracic, pelvic, rib, and lower extremity regions.6 
Soft tissue and articulatory techniques may be beneficial to patients with LBP. In this video, we demonstrate prone pressure with counterleverage and the sacroiliac joint articulatory technique.8-10 
Prone treatments to the pelvic region are not recommended for elderly patients with osteoporosis.8 Performing soft tissue or articulatory treatments over acute strains or sprains, fractures or dislocations, joint instability, pathology (neurologic, vascular, or unknown origin), cancer, or infection is contraindicated.8 OMT is generally safe and well tolerated in patients with LBP, with few minor adverse events.4 
Using OMT to manage somatic dysfunction may help decrease the overuse of imaging, opioids, invasive interventions, and surgery in patients with LBP.2 Partnering with patients in a mind, body, and spirit approach may help to address lifestyle issues such as smoking, obesity, and depression, which are known to increase the risk of LBP.2 Encouraging exercise and providing education may also help mitigate LBP recurrences.2 The treatments performed in this video are not intended for any specific clinical condition but are only 1 aspect of the diagnosis and treatment plan an osteopathic physician may use to address the whole patient. 
Acknowledgment
We thank Jeff Reedy for video contributions. 
Resources
Qaseem A, Wilt TJ, McLean RM, Forciea MA; Clinical Guidelines Committee of the American College of Physicians. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017;166(7):514-530. doi: 10.7326/M16-2367 [CrossRef] [PubMed]
Maher C, Underwood M, Buchbinder R. Non-specific low back pain. Lancet. 2017;389(10070):736-747. doi: 10.1016/S0140-6736(16)30970-9 [CrossRef] [PubMed]
Clinical Guideline Subcommittee on Low Back Pain. American Osteopathic Association Guidelines for osteopathic manipulative treatment (OMT) for patients with Low Back Pain. J Am Osteopath Assoc. 2010;110(11):653-666..
Franke H, Franke JD, Fryer G. Osteopathic manipulative treatment for nonspecific low back pain: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2014;15:286. doi: 10.1186/1471-2474-15-286 [CrossRef] [PubMed]
Licciardone JC, Kearns CM, Minotti DE. Outcomes of osteopathic manual treatment for chronic low back pain according to baseline pain severity: results from the OSTEOPATHIC Trial. Man Ther. 2013;18(6):533-540. doi: 10.1016/j.math.2013.05.006 [CrossRef] [PubMed]
Prinsen JK, Hensel KL, Snow RJ. OMT associated with reduced analgesic prescribing and fewer missed work days in patients with low back pain: an observational Study. . J Am Osteopath Assoc. 2014;114(2):90-98. doi: 10.7556/jaoa.2014.022 [PubMed]
Vleeming A, Schuenke MD, Masi AT, Carreiro JE, Danneels L, Willard FH. The sacroiliac joint: an overview of its anatomy, function and potential clinical implications. J Anat. 2012;221(6):537-567. doi: 10.1111/j.1469-7580.2012.01564.x [CrossRef] [PubMed]
Nicholas A, Nicholas E. Atlas of Osteopathic Techniques. 2nd ed. Lippincott Williams & Wilkins; 2012:80,109,531.
DiGiovanna E, Schiowitz S, Dowling D. An Osteopathic Approach to Diagnosis and Treatment. 3rd ed. Lippincott Williams & Wilkins; 2005:243.
Nelson K, Glonek T. Somatic Dysfunction in Osteopathic Family Medicine. 2nd ed. Wolters Kluwer; 2015:198-199,222-223.
  
Osteopathic Manipulative Treatment for Low Back Pain
eVideo. In this video, prone pressure with counterleverage and the sacroiliac joint articulatory technique are demonstrated.