Osteopathic Manipulative Treatment

In a study of 183 people with neck pain , use of osteopathic methods provided greater benefits than standard physical therapy or general medical care. 12 Participants receiving OMT showed faster recovery and experienced fewer days off work. OMT appeared to be less expensive overall than the other two approaches; however, researchers strictly limited the allowed OMT sessions, making direct cost comparisons questionable. Another study evaluated a rather ambitious combined therapy for the treatment of chronic pain resulting from whiplash injury (craniosacral therapy along with Rosen Bodywork and Gestalt psychotherapy). 13 The results failed to find this assembly of treatments more effective than no treatment.

In a 14-week, single-blind study of 29 elderly people with shoulder pain , real OMT proved more effective than placebo OMT. 1 Although participants in both groups improved, those in the treated group showed relatively greater increase in range of motion in the shoulder. And, in a larger study of 150 adults with shoulder complaints, researchers found that adding manipulative therapy to usual care improved shoulder and neck pain at 12 weeks. 18

In a small randomized, placebo-controlled trial researchers used oscillating-energy manual therapy, an osteopathic technique based on the principle of craniosacral therapy, to treat 23 subjects with chronic tendonitis of the elbow (tennis elbow or lateral epicondylitis). Subjects in the treatment group showed significant improvement in grip strength, pain intensity, function, and activity limitation due to pain. These results however, are limited by the small size of the study and the fact that the therapist delivering the treatment could not be blinded. 17

Twenty-four women with fibromyalgia were divided into five groups: standard care, standard care plus OMT, standard care plus an educational approach, standard care plus moist heat, and standard care plus moist heat and OMT. 2 The results indicate that OMT plus standard care is better than standard care alone, and that OMT is more effective than less specific treatments, such as moist heat or general education. However, because this was not a blinded study (participants knew which group they were in), the results can’t be taken as reliable. In another study, 93 women (average age 53) with fibromyalgia were randomized to receive sham treatment or craniosacral therapy (one-hour sessions twice a week for 20 weeks). 19 The women in the craniosacral therapy group experienced a decrease in pain at 20 weeks, which persisted for at least one year. In another randomized trial, 94 people with fibromyalgia received either myofascial release or sham therapy for 40 sessions (20 weeks). 21 At the 6-month follow-up, the people in the treatment group reported less pain and more physical ability. But, only some of these results lasted until the 1-year follow-up.

A study of 28 people with tension headaches compared one session of OMT against two forms of sham treatment and found evidence that real treatment provided a greater improvement in headache pain. 3

A small randomized controlled trial with 63 patients compared two myofascial release techniques to a control group. Myofascial release treatments resulted in fewer headaches for the 4-week trial period compared to the control group. 22 Similar results were found in a randomized trial including 62 people with tension headache. The twice-weekly myofascial head and neck massages were associated with fewer headaches when compared to an ultrasound or waitlist. 26

OMT was tested for the prevention of migraines. Though they are both referred to as headaches, tension headaches and migraines have different trgigers. OMT is a reasonable treatment for tension headaches since it is associated with musculoskeletal tension but migraine causes are more often associated with changes in nervous system or chemical changes. However, in a randomized trial of 105 adults with chronic migraines (average 22.5 headaches per month), OMT with medication was associated with a significant reduction in rescue medication, migraine days per month, severity of pain, and functional disabilitycompared to sham OMT with medication and a control group taking medication only. Patients had eight 30-minute sessions using a combination techniques.27

OMT has shown some promise for the treatment of back pain , 4,5 including a randomized trial of 455 patients. The trial assessed the effects of 6 OMT sessions over 8 weeks compared to sham treatments. At 12 weeks, OMT was associated with moderate or substantial pain reduction compared to sham OMT. OMT also reduced the use of prescription pain medications. 25

However, one of the best-designed trials failed to find it a superior alternative to conventional medical care. In this 12-week study of 178 people, OMT proved no more effective than standard treatment for back pain. 6 Another study, this one enrolling 199 people and following them for 6 months, failed to find OMT more effective than fake OMT. 14 This study also included a no-treatment group; both real and fake OMT were more effective than no treatment.

A much smaller study reportedly found that muscle energy technique enhances recovery from back pain, but this study does not appear to have used a meaningful placebo treatment. 15

Researchers analyzed 4 studies investigating the benefits of manual therapy (including massage therapy, joint mobilization, and manipulation) for osteoarthritis of the hip or knee. 20 The results were inconclusive. Although one of the studies (involving 68 people) did find that massage therapy helped to improve pain and function, it was compared to no intervention rather than another treatment or a placebo.

Some studies have evaluated the potential benefits of OMT for speeding healing in people recovering from surgery or serious illness. The best of these studies compared OMT against light touch in 58 elderly people hospitalized for pneumonia. 7 The results indicate that use of osteopathy aided recovery.

In a much less meaningful study, OMT was compared to no treatment in people recovering from knee or hip surgery. 8 While the people receiving OMT recovered more quickly, these results mean very little, since, as noted above, any form of attention should be expected to produce greater apparent benefits than no attention.

A weak study suggests that OMT might also be helpful for people hospitalized with pancreatitis . 9

A small study found some evidence that OMT might be helpful for childhood asthma . 16

OMT showed improvement in 6-minute walk test distance in a small randomized trial of 20 patients with stable chronic obstructive pulmonary disease . Distance in patients in the OMT group improved on average by 72.5 meters compared to 23.7 meters for patients in the sham OMT group. 23

A systematic review found that osteopathic manipulation may be effective at managing urinary incontinence symptoms in women. A smaller subset found it may be as effective as pelvic floor training. Better structured studies need to be done to see if the benefits holds.28