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Application Of Osteopathic Treatment for Non-Pain–Related Discomforts of Pregnancy: A Literature Review
Abstract
Many osteopathic textbooks include treatment modalities and techniques that could improve frequently experienced ailments of pregnancy, such as nausea, vomiting, gastroesophageal reflux disease, constipation, and edema. However, there is little scientific evidence to support the use of osteopathy for these conditions, particularly among the pregnant population. The aim of this literature review is to identify and evaluate current evidence regarding the use of osteopathy in the management of common discomforts of pregnancy. Several search engines and journals were used to identify peer-reviewed articles written between 2003 and 2023. Eleven articles were included in total, including a variety of case reports, pilot studies, and journal articles. The results show that although osteopathy does appear to be safe to perform during the third trimester and its efficacy in the treatment of these conditions is promising, current evidence is insufficient to guide treatment protocols. Further research is needed to establish efficacy and determine osteopathic treatment regimens.
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Osteopathic manual treatment has been recommended as a non-pharmacological therapy for Gastroesophageal Reflux Disease (GERD). However, to date, no study has supported the effectiveness of this intervention with respect to the symptoms of the disease. Our goal was to assess the effect of an osteopathic manual technique for the lower esophageal sphincter on GERD symptoms, cervical mobility and on the C4 spinous process pressure pain threshold (PPTs).
Methods:
A randomized, double-blind placebo-controlled trial was performed. Sixty subjects suffering from GERD participated in this study and were randomly assigned to either an experimental group (EG) (n = 29), who received the osteopathic technique for the lower esophageal sphincter, or to a control group (CG) (n = 31), who received a manual contact, which mimicked the osteopathic technique without exerting any therapeutic force. Randomization was computer-generated, with allocation concealed by sequentially numbered, opaque, sealed envelopes. The GerdQ questionnaire was used to assess symptom changes the week after intervention. Cervical Range of Motion (CROM) and algometer were used to evaluate cervical mobility and PPTs before and after both treatments. Before-after between groups comparison (t-test) was used for statistical analysis of the outcome, with two measurement points (GerdQ), while repeated-measures ANOVA was used for those outcomes with four measurement points (CROM and PPT).
Results:
The application of the osteopathic manual treatment in subjects with GERD produced a significant improvement in symptoms one week after the intervention (p = 0.005) with a between-groups difference of 1.49 points in GerdQ score (95% CI: 0.47-2.49). PPT C4 improved in the EG after the treatment (p = 0.034; η2 = 0.048) (between-groups difference 8.78 Newton/cm2; 95% CI: 0.48-17.09). CROM also increased in the EG compared to the CG (p < 0.001; η2 = 0.108) (between-groups difference 33.89 degrees; 95% CI: 15.17-52.61).
Conclusions:
The manual osteopathic technique produces an improvement in GERD symptoms one week after treatment, cervical mobility, and PPTs. This may mean that osteopathic treatment is useful for improving symptoms of GERD.
Context:
By promoting the recirculation of tissue fluid, the lymphatic system preserves tissue health, aids in the absorption of gastrointestinal lipids, and supports immune surveillance. Failure of the lymphatic system has been implicated in the pathogenesis of several infectious and inflammatory diseases. Thus, interventions that enhance lymphatic circulation, such as osteopathic lymphatic pump treatment (LPT), should aid in the management of these diseases.
Objective:
To determine whether thoracic duct lymph (TDL) mobilized during LPT would alter the function of macrophages in vitro.
Methods:
The thoracic ducts of 6 mongrel dogs were cannulated, and TDL samples were collected before (baseline), during, and 10 minutes after LPT. Thoracic duct lymph flow was measured, and TDL samples were analyzed for protein concentration. To measure the effect of TDL on macrophage activity, RAW 264.7 macrophages were cultured for 1 hour to acclimate. After 1 hour, cell-free TDL collected at baseline, during LPT, and after TDL was added at 5% total volume per well and co-cultured with or without 500 ng per well of lipopolysaccharide (LPS) for 24 hours. As a control for the addition of 5% TDL, macrophages were cultured with phosphate-buffered saline (PBS) at 5% total volume per well and co-cultured with or without 500 ng per well of LPS for 24 hours. After culture, cell-free supernatants were assayed for nitrite (NO2-), tumor necrosis factor α (TNF-α) and interleukin 10 (IL-10). Macrophage viability was measured using flow cytometry.
Results:
Lymphatic pump treatment significantly increased TDL flow and the flux of protein in TDL (P<.001). After culture, macrophage viability was approximately 90%. During activation with LPS, baseline TDL, TDL during LPT, and TDL after LPT significantly decreased the production of NO2-, TNF-α, and IL-10 by macrophages (P<.05). However, no significant differences were found in viability or the production of NO2-, TNF-α, or IL-10 between macrophages cultured with LPS plus TDL taken before, during, and after LPT (P>.05).
Conclusion:
The redistribution of protective lymph during LPT may provide scientific rationale for the clinical use of LPT to reduce inflammation and manage edema.
The structural and physiologic changes in a woman’s body during pregnancy can predispose pregnant women to low back pain and its associated disability, as well as to complications of pregnancy, labor, and delivery. Anecdotal and empirical evidence has indicated that osteopathic manipulative treatment (OMT) may be efficacious in improving pain and functionality in women who are pregnant. Based on that premise, the Pregnancy Research on Osteopathic Manipulation Optimizing Treatment Effects (PROMOTE) study was designed as a prospective, randomized, placebo-controlled, and blinded clinical trial to evaluate the efficacy of an OMT protocol for pain during third-trimester pregnancy. The OMT protocol developed for the PROMOTE study was based on physiologic theory and the concept of the interrelationship of structure and function. The 12 well-defined, standardized OMT techniques used in the protocol are commonly taught at osteopathic medical schools in the United States. These techniques can be easily replicated as a 20-minute protocol applied in conjunction with usual prenatal care, thus making it feasible to implement into clinical practice. This article presents an overview of the study design and treatment protocols used in the PROMOTE study.
Background:
Few quality data exist on the safety of osteopathic manipulative treatment (OMT) during pregnancy. The Pregnancy Research on Osteopathic Manipulation Optimizing Treatment Effects (PROMOTE) study was a randomized controlled clinical trial that studied the application of an OMT protocol to manage pain and dysfunction in pregnant patients during their third trimester.
Objective:
To evaluate the safety of an OMT protocol applied during the third trimester of pregnancy by analyzing incidence of high-risk status and labor and delivery outcomes.
Methods:
In the PROMOTE study, 400 pregnant patients were randomly assigned to 1 of 3 study groups: usual care plus OMT (OMT), usual care plus placebo ultrasound treatment (PUT), or usual care only (UCO). The incidence of high-risk status of participants and outcomes of labor and delivery, including length of labor, fever in mother during labor, operative vaginal delivery, conversion to cesarean delivery, need for forceps or vacuum device, need for episiotomy, incidence of perineal laceration, meconium-stained amniotic fluid, and infants' Apgar scores, were analyzed.
Results:
Data from 380 participants were studied. High-risk status was less likely to develop in participants who received OMT (95% CI, 0.16-0.91; P=.03). The OMT protocol also did not increase risk of precipitous labor, operative vaginal delivery, conversion to cesarean delivery, need for forceps or vacuum device, need for episiotomy, incidence of perineal laceration, or meconium-stained amniotic fluid when compared with participants in the other 2 groups (P>.05). Of all other maternal outcomes examined, no difference was reported among the 3 treatment groups with the exception of incidence of prolonged labor in the OMT group. Participants receiving OMT had longer durations of labor than participants in the other groups (P=.002).
Conclusion:
These results suggest that the OMT protocol given during the third trimester of pregnancy as applied in the PROMOTE study is safe with regard to labor and delivery outcomes. The increased duration in labor in the OMT group needs further study. (ClinicalTrials.gov number NCT00426244).
Background: During the last 50 years, the efficacy of medication in the treatment of gastro esophageal
reflux disease (GERD) has increased with introduction of histamine 2 antagonists and proton pump
inhibitors. Surgical treatment is effective, but irreversibleand complications may occur. Is it possible to
develop an effective treatment procedure beside pharmaceuticals and surgery?
Objective: To describe Osteopathic Manual Therapy (OMT) techniques and investigate the effect in
patients suffering from GERD.
Design: The study performed as an open, single-centre, one-armed interventional trial.
Material: Eighteen female and four male GERD patients, mean age and disease duration of 47.4 years
and 20.4 months, recruited from one single OMT practice.
Method: The patients received three to 12OMT interventions consisting of thoracic spine and diaphragm
mobilisation, traction of the cardia and posture correction. The interval between interventions was
one week and the effect recorded as “none,” “slight,” “moderate” or “good.” The presence of heartburn,
retrosternal pain, acid in the mouth, epigastric pain and tension or pain in the lower thoracic spine
recorded before and three month after the last treatment.
Results: The prevalence and total number of GERD symptoms were significantly reduced (p << 0.01)
and only two patients reported an unchanged situation. A “moderate” or “good” effect reported by 77.3
% of the patients. In 19 patients with extended thoracic kyphosis and reduced extension, 78.9 % reported
a “moderate” or “good” treatment effect. No differences detected between patients using and not using
additional GERD pharmaceuticals.
Conclusions: The results indicate a positive effect of OMT in the treatment of GERD.
Gastroesophageal reflux disease (GERD) is a chronic condition that affects a growing number of people and is currently among the most common disorders seen in clinical practice.
To develop a protocol for the management of GERD with osteopathic manipulative therapy (OMTh) applied to the diaphragm and esophagus, and to evaluate the protocol's effectiveness using the quality of life scale (QS-GERD) for the disease.
In this single-blinded prospective study, an OMTh protocol focusing on the diaphragm and esophagus was applied to a single patient, who had received a diagnosis of GERD 4 years previously. Outcomes were measured using the QS-GERD, which has a total possible score ranging from 0 to 45 (the lower the score, the better the quality of life) and a level of satisfaction from very satisfied to incapacitated. The OMTh protocol was applied at 3 sessions (initial session, second session 1 week after the first, and third session 2 weeks after the second), and the patient completed the QS-GERD 4 times (before the first session, before the third session, and 2 and 4 weeks after the third session).
The OMTh protocol was administered without adverse events, and the patient reported positive outcomes after the third session. The QS-GERD showed a score improvement from 13 of 45 to 4 of 45.
The results in the present report show that OMTh applied to the diaphragm and esophagus may improve symptoms of GERD and should be added to the somatovisceral approach to the care of patients with this condition.
The physiological changes that occur during pregnancy, including increased blood volume and cardiac output, can affect hemodynamic control, most profoundly with positional changes that affect venous return to the heart. By using Osteopathic Manipulative Treatment (OMT), a body-based modality theorized to affect somatic structures related to nervous and circulatory systems, we hypothesized that OMT acutely improves both autonomic and hemodynamic control during head-up tilt and heel raise in women at 30 weeks gestation.
One hundred subjects were recruited at 30 weeks gestation.
The obstetric clinics of UNTHealth in Fort Worth, TX.
Subjects were randomized into one of three treatment groups: OMT, placebo ultrasound, or time control. Ninety subjects had complete data (N=25, 31 and 34 in each group respectively).
Blood pressure and heart rate were recorded during 5min of head-up tilt followed by 4min of intermittent heel raising.
No significant differences in blood pressure, heart rate or heart rate variability were observed between groups with tilt before or after treatment (p>0.36), and heart rate variability was not different between treatment groups (p>0.55). However, blood pressure increased significantly (p=0.02) and heart rate decreased (p<0.01) during heel raise after OMT compared to placebo or time control.
These data suggest that OMT can acutely improve hemodynamic control during engagement of the skeletal muscle pump and this was most likely due to improvement of structural restrictions to venous return.
The treatment of gastroesophageal reflux disease may be clinical or surgical. The clinical consists basically of the use of drugs; however, there are new techniques to complement this treatment, osteopathic intervention in the diaphragmatic muscle is one these. The objective of the study is to compare pressure values in the examination of esophageal manometry of the lower esophageal sphincter (LES) before and immediately after osteopathic intervention in the diaphragm muscle. Thirty-eight patients with gastroesophageal reflux disease - 16 submitted to sham technique and 22 submitted osteopathic technique - were randomly selected. The average respiratory pressure (ARP) and the maximum expiratory pressure (MEP) of the LES were measured by manometry before and after osteopathic technique at the point of highest pressure. Statistical analysis was performed using the Student's t-test and Mann-Whitney, and magnitude of the technique proposed was measured using the Cohen's index. Statistically significant difference in the osteopathic technique was found in three out of four in relation to the group of patients who performed the sham technique for the following measures of LES pressure: ARP with P= 0.027. The MEP had no statistical difference (P= 0.146). The values of Cohen d for the same measures were: ARP with d= 0.80 and MEP d= 0.52. Osteopathic manipulative technique produces a positive increment in the LES region soon after its performance.
As a hands-on approach to patient care diagnosis and management, osteopathic manipulative medicine (OMM) can be utilized to modulate the autonomic input to the gastrointestinal system. Palpatory findings of tissue texture changes at predictable body regions may correspond to visceral dysfunction related to the gastrointestinal (GI) system.1 Osteopathic manipulative treatment (OMT) of the viscero-somatic segment or viscero-visceral reflex can remove the feedback related to the somatic or visceral component, thereby affecting nociceptive facilitation at the spinal or visceral level and helping to restore autonomic balance.1,2
The purpose of this thesis is to describe an evaluation and treatment protocol to address somatic and visceral dysfunction found in many patients with impaired gastrointestinal function. A retrospective analysis of 5 patients will be outlined using the evaluation and treatment protocol. The safety of an OMT evaluation and treatment protocol as applied to address gastrointestinal function and as outlined in the current literature will also be addressed.
Background
Long-term Proton Pump Inhibitor use is associated with low response rates and the risk of adverse events.
Objective
The objective of this study was to assess the effectiveness of Osteopathic Treatment in patients with Gastroesophageal Reflux Disease (GERD).
Methods
This study was a randomized controlled trial with a series of osteopathic interventions and an untreated control group. Patients in the osteopathic group (OG) received 4 osteopathic treatments within a time of eight weeks. The control group (CG) did not receive any osteopathic treatment. Primary outcome parameters were gastrointestinal symptoms, assessed by means of the Reflux Disease Questionnaire (RDQ). Secondary outcome parameters were Quality of life with regards to GERD symptoms, assessed by means of the Quality of Life in Reflux and Dyspepsia (QUOLRAD) questionnaire, medication use and osteopathic dysfunctions.
Results
Seventy patients were randomized. RDQ mean scores decreased statistically significantly in the OG but did not change in the CG; however, these data cannot be interpreted due to a large number of incorrectly completed questionnaires. The between group difference of the changes for the QOLRAD score was statistically significant 0.69 [95%CI = 0.35 to 1.0]. At week 20, changes in the QOLRAD of the OG were sustainable. Medication use decreased substantially in the OG whilst it remained the same in the CG.
Conclusion
A series of osteopathic treatments might potentially be beneficial for patients suffering from GERD. Future studies should include longer follow-up times and establish the clinical significance of results by introducing a global rating of change measurement.
Background and aims:
Constipation is a common problem in western countries. The aim of this pilot study was to determine the effectiveness of osteopathic manipulative treatment (OMT) for the treatment of constipated women with functional constipation (FC) or defeation disorders (DD).
Methods:
Twenty-one constipated females referred to a tertiary center were recruited. A course of OMT, weekly for four weeks, was given. Clinical questionnaire, Bristol stool form scale and patients' subjective perception of constipation, bloating and abdominal pain, were recorded. Total and segmental colonic transit time (CTT) were performed before and after OMT.
Results:
Eleven patients had FC and 10 DD, as defined by Rome III criteria. After OMT, the Knowless Eccersley Scott Symptom score (P=0.020), the oro-anal transit time (P=0.002), the right (P=0.005) and left (P=0.009) CTT had decreased while the stool frequency (P=0.005) and the Bristol Stool Form scale (P=0.003) had increased. After OMT, the intensity of constipation, and the Patient assessment of constipation symptoms score did not change but a decrease of abdominal pain, bloating, quality of life score and drug use was found.
Conclusions:
This study shows OMT has potential benefit for treating functional constipation in women. Further randomised trials are required to confirm these results.
A 27-year-old white female patient with unremarkable medical history who was experiencing her first pregnancy visited an osteopathic manipulative medicine clinic complaining of 8 weeks of progressively worsening severe nausea and vomiting in pregnancy (NVP). An osteopathic structural examination revealed multiple areas of somatic dysfunction, including cervical, thoracic, pelvic, and cranial diaphragms. Osteopathic manipulative treatment (OMT) was performed based on somatic dysfunction, after which the patient reported resolution of nausea and vomiting. Based on the Pregnancy-Unique Quantification of Emesis and Nausea (PUQE) index and the patient's Hyperemesis Impact of Symptoms Score (HISS), the patient reported 50% and 41% decreases of nausea and vomiting, respectively, after the first treatment and 58% and 68% overall decreases, respectively, after the second treatment. This case study suggests that OMT is a valuable treatment for patients with severe NVP.
Functional gastrointestinal disorders (FGIDs) describe patients who present with symptoms that arise from the gastrointestinal (GI) tract yet have failed to be explained by a standard GI work-up. Somatic findings at midthoracic levels correspond to localized visceral dysfunction such as decreased peristalsis and vasoconstriction. The somatovisceral concept suggests that osteopathic manipulative treatment (OMT) provides relief by normalizing the autonomic tone. There are few reports in the literature that provide examples of successful treatment of FGID by OMT. This case describes a patient with postprandial nausea and vomiting who was successfully treated with OMT.
Background: Conventional medical treatment for constipation typically consists of dietary modification, increased fluid intake and exercise frequency, but many people do not respond to these interventions. Osteopathic treatment is claimed to restore normal function to the digestive system and related somatic structures and may provide an effective treatment for constipation. Objective: To examine the effect of osteopathic manipulative treatment for people with chronic constipation over a four week period. Methods: Six participants (mean age 48.5 ± 14.1 years) with chronic constipation were treated utilising a semi-standardised osteopathic treatment. Each participant was examined and treated six times over four weeks. Treatment outcomes were measured pre-treatment, during and one week following the treatment period using validated outcome measures specific to bowel function. Results: Following treatment there was a significant improvement in the severity of their constipation (p < 0.01), overall symptom improvement (p < 0.01), improved colonic transit times (p < 0.01) and overall quality of life (p < 0.01). Conclusion: Participants reported an improvement in the overall severity of constipation, symptoms and quality of life. Further investigation of osteopathic treatment of constipation is recommended using larger sample sizes and a randomized controlled design. Crown
During pregnancy, women may experience one or more of a wide variety of discomforts. Every pregnancy is different; discomforts felt during one pregnancy may not appear in another. Most discomforts experienced during pregnancy are thought to be the result of abundant hormonal changes. As pregnancy progresses, other discomforts are attributed to physical changes associated with the enlarging uterus. Selected discomforts of pregnancy are presented with suggestions for clinical management. Nurses can do something to decrease discomforts associated with pregnancy.
Introduction: During pregnancy, a woman’s body is challenged by significant physiological and biomechanical changes which can adversely affect normal function, mobility and quality of life. These changes may also contribute to co-morbid conditions accompanying pregnancy. Osteopathic manipulative medicine (OMM) is theorized to facilitate the body’s adjustment to the physiological and biomechanical demands of pregnancy and improve the outcomes of pregnancy, labor and delivery. Thus, this dissertation research was designed to examine the possible effects of an acute regimen of OMM on the autonomic and hemodynamic control mechanisms and gait and mobility function in women during the third trimester of pregnancy.Methods: Two studies were performed with 60 women at the 30th week of pregnancy. Study 1: The hemodynamic and autonomic (heart rate variability) responses to head-up tilt with and without engagement of the muscle pump via toe raising were assessed before and after a regimen of either randomly assigned OMM, sub-therapeutic placebo ultrasound, or a timecontrol. Study 2: Assessment of a cadre of gait parameters and functions was performed before and after application of the same randomized treatment regimens.Results: In Study 1, the response to tilt was not affected by OMM or placebo ultrasound, however, the systolic blood pressure response to toe raising was increased after OMM and was accompanied by a lower heart rate and enhanced vagal control of heart rate. In study 2, there were no statistically significant differences between groups at baseline. In addition, there were no statistically significant differences between pre-and post-treatment values for any spatiotemporal gait parameters. However, improvements in stride width and base of support trended toward significance.Conclusions: These data suggest that OMM improved hemodynamic control during engaging of the skeletal muscle pump that was most likely due to improvement of structural impediments to venous return. The gait data fail to elucidate a significant effect of OMM on gait parameters during the third trimester of pregnancy.