Osteopathic Manipulative Treatment in Low Back Pain
/Osteopathic Manipulative Treatment (OMT) or Osteopathic Manipulative Medicine (OMM) has been around since the 1870s when Andrew Taylor Still established the healing art of osteopathy. Since this has been around for so long you might expect OMT to be a part of mainstream medicine but you could say the same thing about acupuncture which has been around for much longer. Osteopathy and the Colleges of Osteopathic Medicine have been expanding and growing quickly over the past 10-20 years so more people are more aware of what an Osteopathic Physician can do. Still, many do not. What I would like to do over a series of posts is to explain the benefits of OMT to help pass on this information. If you are interested in learning more about what OMT consists of and what type of schooling a person must complete to become a DO (Doctor of Osteopathy) please check out my website at www.healthyhedgehog.com where those items are explained.
Before we get in to the topic of low back pain I want to explain why you may not have seen much about OMT before. We as a society of scientists in the medical world want to have hard evidence something works or at the least have a group of specialists who agree on the way we should be practicing medicine. To do so, we rely on studies to show that something works or does not work. When it comes to modalities like OMT and acupuncture this can be difficult and I will explain why.
There are several types of studies that can be performed but the gold standard study for anything in medicine is the randomized controlled double blinded study (I hope I didn’t just lose you with that). This means that all participants are randomly selected in to a group that gets the intervention or the group that does not (the control group). Usually a computer program identifies who goes in which group (randomizing). So the participants and the people who are providing the services do not know who is in which group (this is what double blinded means). Now, let’s think about that in terms of an intervention like OMT or acupuncture. We have developed ‘sham’ practices as controls but those still consist of some type of activity to the participant. In some cases a ‘sham’ treatment is not utilized but the control group of participants will get the standard treatment – medications, ice, rest, exercises. Each time we step further away from the gold standard, this makes the study appear weaker.
On top of all of that, studies need to have enough participants to show if a change is due to the intervention or not. A lot of studies are just small ones because recruiting, money, time, and many other things play a role in how many participants you can get. So sometimes a change may be seen but if the study only has a hand full of participants this information may not be so helpful. Also a study may only be for two weeks or go longer to a couple of months. Finding the ‘perfect’ timing to know when a person might respond to an intervention is difficult.
Then we fall in to the worst trap of all – trying to pick the few maneuvers of all of the ones in all of OMT and try to standardize those across all of the providers performing it. This means that the people who came up with the study pick a group of manipulative techniques, teach them to all of the providers in the study who will perform them and try to standardize this across all of the providers so they do everything exactly the same way. The problem is there are so many different maneuvers that can be used, each DO has her preferred techniques, and each person may respond differently. This can make it difficult to standardize a list of techniques that will work for all people with a specific condition. Also, something like low back pain can be due to lots of different causes so one technique may work for one person because it helps with that specific type of issue but may do nothing for someone who has the low back pain due to something completely different. So some studies have shown no improvement with OMT while others do but they use different manipulative techniques, the cause of the underlying issue may differ, and so on. I think you can start seeing the issues at hand with trying to do studies on OMT.
Now, I want to move forward and talk about low back pain since it is a major contributor to pain and disability in the United States for many people. Low back pain can last anywhere from just a few minutes at a time to months and years. Studies have been performed on the utilization of OMT for low back pain with varying results of course. I have picked low back pain as the first one to talk about since it actually does have a nice large study about it and several smaller ones over the years that have been analyzed. I will not bore you with the details of the studies but will give you the basic information that comes from them. If you want to learn more about the actual studies, send me an email at coach@healthyhedgehog.com and I will gladly share that information with you.
Overall studies have been completed on people with acute (less than 4 weeks), subacute (4 weeks to 3 months), and chronic (more than 3 months) pain and even looked at specific groups like military recruits, pregnant women, and postpartum woman. Some studies that support OMT have shown improvement in pain intensity and back specific function (able to get back to regular activities). Other studies have shown that patients who receive OMT utilize less pain medication than those that do not. Women who are pregnant and develop low back pain may benefit from OMT throughout their pregnancy. Women who develop low back pain after delivery may also benefit from OMT.
OMT is not a magic fix for low back pain. But if you or someone you know has low back pain this may be a modality to consider especially if contemplating epidural steroid injections, facet injections, or surgery. OMT is non-invasive and less expensive than those treatment options. Even if you are not considering such invasive procedures but your pain just is lingering, OMT is an option to try.