Increased incidence and severity of somatic dysfunction in subjects with chronic low back pain

Department of Osteopathic Manipulative Medicine, Kirksville College of Osteopathic Medicine-A.T. Still University, 800 W Jefferson St, Kirksville, MO 63501-1443, USA.
The Journal of the American Osteopathic Association 09/2008; 108(8):372-8.
Source: PubMed


Patients with back pain make more than 14 million office visits per year to US physicians. Many of these patients have chronic low back pain (LBP) and are assumed to have more somatic dysfunction than those without chronic LBP.
To investigate incidence and severity of somatic dysfunction of four lumbar vertebral segments (L1-L4).
Sixteen subjects with chronic LBP and 47 subjects without chronic LBP were each evaluated by two blinded examiners using reliable osteopathic palpatory tests. The incidence and severity of somatic dysfunction for each test were then analyzed within and between the study groups. Results: Resistance to anterior springing (P<.001) and tenderness (P=.002) were found at significantly greater incidence in the chronic LBP group than in the non-LBP group, but there were no significant differences between groups for incidence of tissue texture changes or static rotational asymmetry. Significantly greater severity of tissue texture changes (P=.006), static rotational asymmetry (P=.008), resistance to anterior springing (P<.001), and tenderness (P=.001) were observed in the chronic LBP group than in the non-LBP group.
When compared with non-LBP subjects, chronic LBP subjects had overall greater severity for each of the four elements of somatic dysfunction evaluated, as well as greater incidence of resistance to anterior springing and tenderness. Somatic dysfunction is more severe in individuals with chronic LBP than in individuals without chronic LBP.

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    • "This concept has caused the profession to lose part of its monistic vision (Lee, 2005), by implying a direct link between SD and symptoms and diseases, which in reality corresponds to a biomedical model (Leigh, 1994) The concept of SD is clinically relevant, particularly in its association with LBP and its prevalence in a clinical setting (Licciardone et al, 2005b) but a clear distinction should be made between clinical evidence and scientific evidence for the concept of SD. SD is more prevalent in subjects with chronic LBP than in subjects without chronic LBP (Snider et al, 2008), and specific OMT is provided on a test-dependent basis for each patient. Patient agreement should also be obtained, and patient values and expectations for the outcome of the OMT should be acknowledged. "

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