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Introduction: This study examined the efficacy of manual therapy for pain and disability measures in adults with sacroiliac joint pain syndrome (SIJPS). Methods: We searched six databases, including gray literature, on 24 October 2023, for randomized controlled trials (RCTs) examining sacroiliac joint (SIJ) manual therapy outcomes via pain or disability in adults with SIJPS. We evaluated quality via the Physiotherapy Evidence Database scale and certainty via Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Standardized mean differences (SMDs) in post-treatment pain and disability scores were pooled using random-effects models in meta-regressions. Results: We included 16 RCTs (421 adults; mean age = 37.7 years), with 11 RCTs being meta-analyzed. Compared to non-manual physiotherapy (i.e. exercise ± passive modalities; 10 RCTs) or sham (1 RCT) interventions, SIJ manual therapy did not significantly reduce pain (SMD: −0.88; 95%-CI: −1.84; 0.08, p = 0.0686) yet had a statistically significant moderate effect in reducing disability (SMD: −0.67; 95% CI: −1.32; −0.03, p = 0.0418). The superiority of individual manual therapies was unclear due to low sample size, wide confidence intervals for effect estimates, and inability to meta-analyze five RCTs with a unique head-to-head design. RCTs were of 'good' (56%) or 'fair' (44%) quality, and heterogeneity was high. Certainty was very low for pain and low for disability outcomes. Conclusion: SIJ manual therapy appears efficacious for improving disability in adults with SIJPS, while its efficacy for pain is uncertain. It is unclear which specific manual therapy techniques may be more efficacious. These findings should be interpreted cautiously until further high-quality RCTs are available examining manual therapy against control groups such as exercise. Registration: PROSPERO (CRD42023394326). [ABSTRACT FROM AUTHOR]

Background/Objective: Short hamstring syndrome is common in the general population and can lead to impaired balance, function, and posture, and increased risk of injuries. Local treatments have obtained controversial results, so it is necessary to evaluate the effectiveness of other types of therapy such as osteopathic treatment. To evaluate the efficacy of osteopathic techniques in increasing the elasticity of the hamstring musculature in short hamstring syndrome. Methods: A systematic review of randomised controlled trials was conducted in PubMed, Medline, Cinhal, Scopus, WOS, SPORTDiscuss, and PEDro. The PEDro scale was used to evaluate the methodological quality and the RoB2 for the evaluation of biases. Results: A total of eight articles were selected. Most of the participants were assessed with the Active Knee Extension or Straight Leg Raise tests. The osteopathic techniques used were the muscle energy technique, suboccipital inhibition, and vertebral mobilisations. As for the control interventions, they mainly included passive stretching and placebo. Conclusions: The results suggest that osteopathic techniques are more effective than placebo or other interventions in increasing flexibility in adult patients with short hamstring syndrome. This effect can be explained by neurophysiological (Golgi apparatus, neuromuscular spindle activity, and Hoffmann reflex) and structural factors (dura mater, posture, and myofascial chains). Nevertheless, the evidence suggests that it would be beneficial to incorporate this type of treatment into flexibility improvement programmes. [ABSTRACT FROM AUTHOR]

Background/Objectives: Scoliosis is a condition that involves deformation of the spine in the coronal plane and commonly appears in childhood or adolescence, significantly limiting a person's life. The cause is multifactorial, and treatment aims to improve the spinal curvature, prevent major pathologies, and enhance aesthetics. The objective of this review was to determine whether high-velocity low-amplitude (HVLA) spinal manipulation is more effective than other treatments for children with idiopathic scoliosis (IS). Methods: The PubMed, Web of Science, Scopus and PEDro databases were searched for both clinical trials and cohort studies. Methodological quality was assessed via the PEDro scale (for clinical trials) and the Newcastle–Ottawa scale (for observational studies). The protocol of this systematic review was registered in PROSPERO (CRD42024532442). Results: Five studies were selected for review. The results indicated moderate improvements in pain and the Cobb angle and limited improvements in quality of life. Conclusions: HVLA spinal manipulation does not seem to have significant effects on reducing spinal deformity in IS patients, nor does it significantly impact quality of life. However, this therapy may have significant effects on reducing pain in these patients. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Traditional Medical Complementary Therapies is the property of Turkiye Klinikleri and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Salud, Ciencia y Tecnología is the property of Fundacion Salud, Ciencia y Tecnologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Cardiovascular diseases (CVDs) are the leading cause of death globally. Morbidity and disability related to non-fatal events are increasing exponentially. There are several symptoms that may arise after invasive therapeutic approaches such as coronary artery bypass graft (CABG), including chronic pain in anatomical areas connected to the mediastinum; these pains can be found not only initially after surgery but also years later. We present a case where non-specific neck pain (NNP), in a patient undergoing CABG five years earlier, was resolved with an osteopathic technique, working the pericardial area. To the knowledge of the authors, it is the first article illustrating an osteopathic approach with resolution of NNP, with a manual technique used on the pericardial area.

Background/Objectives: Scoliosis is a condition that involves deformation of the spine in the coronal plane and commonly appears in childhood or adolescence, significantly limiting a person’s life. The cause is multifactorial, and treatment aims to improve the spinal curvature, prevent major pathologies, and enhance aesthetics. The objective of this review was to determine whether high-velocity low-amplitude (HVLA) spinal manipulation is more effective than other treatments for children with idiopathic scoliosis (IS). Methods: The PubMed, Web of Science, Scopus and PEDro databases were searched for both clinical trials and cohort studies. Methodological quality was assessed via the PEDro scale (for clinical trials) and the Newcastle–Ottawa scale (for observational studies). The protocol of this systematic review was registered in PROSPERO (CRD42024532442). Results: Five studies were selected for review. The results indicated moderate improvements in pain and the Cobb angle and limited improvements in quality of life. Conclusions: HVLA spinal manipulation does not seem to have significant effects on reducing spinal deformity in IS patients, nor does it significantly impact quality of life. However, this therapy may have significant effects on reducing pain in these patients.

Cardiovascular diseases (CVDs) are the leading cause of death globally. Morbidity and disability related to non-fatal events are increasing exponentially. There are several symptoms that may arise after invasive therapeutic approaches such as coronary artery bypass graft (CABG), including chronic pain in anatomical areas connected to the mediastinum; these pains can be found not only initially after surgery but also years later. We present a case where non-specific neck pain (NNP), in a patient undergoing CABG five years earlier, was resolved with an osteopathic technique, working the pericardial area. To the knowledge of the authors, it is the first article illustrating an osteopathic approach with resolution of NNP, with a manual technique used on the pericardial area. [ABSTRACT FROM AUTHOR]

Flexion contracture is an unwanted complication of total knee arthroplasty (TKA), occurring in 1.4 to 17% of patients, probably secondary to an abnormal distribution of forces across the prosthetic components with an increased load in the posterior aspect of the tibial plateau and the patellofemoral joint. Several studies have advocated that residual flexion contracture after TKA may improve with time; however, contradictory results have also been reported, especially in cases with more than 15° of severe post-operative flexion contracture. Nineteen patients (19 knees) who did not have a pre-operative flexion contracture and underwent TKA surgery between January 2014 and July 2014 by a single surgeon were included in the study. Patients treated with osteopathic manipulations showed a significant improvement compared to controls. The causes of stiffness during knee flexion are often unclear even if full extension is achieved intra-operatively. We believe that there is a direct correlation between pain and stiffness and flexion of the knee, observed when the patient assumes a flexed position due to pain. Since our study shows an improvement in both pain and stiffness with osteopathic manipulative treatment (OMT), we believe that this treatment modality may be beneficial to allow early rehabilitation. [ABSTRACT FROM AUTHOR]

Introduction. Stabilometry and baropodometry are currently the object of study in different health fields both at a preventive, diagnostic level, and as a method of treatment of different pathologies or imbalances. Osteopathic manipulative techniques applied to the foot sensor could modify the postural registers. Objectives. To analyze the modification of the stabilometric and baropodometric registers in the bipedal standing posture in healthy subjects after the application of the osteopathic manipulative technique of TUG of the scaphoid. Method. A randomized experimental study was performed with a sample of 36 subjects (intervention group n=17; control group n=19). The intervention group underwent an osteopathic scaphoid TUG intervention, while the control group was given a placebo. Before and after the intervention, both groups underwent a stabilometric and baropodometric analysis by means of a pressure platform using the standards of the Association Français de Pos- turologie. Statistical analysis was carried out with IBM SPSS Statistics, version 19.0 (Shapiro-Wilks test, analysis of Q-Q and Q-Q normality graphs without trend, Levene's test, ANOVA, Bonferroni correction and Cohen's d). Results. The inter- and intra-group post-intervention comparative analysis showed that there were no significant differences in the stabilometric and baropodometric variables studied, except for the support surface variable which showed significant intra-group results both in the control group (differences in the right foot p=0.02) and in the intervention group (left foot p=0.032), which suggests an anomaly or influence of some parameter not con- trolled in the study or in the measurement process. Conclusions. Osteopathic TUG manipulation of the scaphoid does not modify the stabilometric or baropodometric recordings in the bipedal standing posture in healthy subjects. [ABSTRACT FROM AUTHOR]

Gastroesophageal reflux disease (GERD) is a chronic condition resulting from a retrograde flow of part of the gastroduodenal contents into the esophagus. Generally, this reflux is linked to a malfunction of the lower esophageal sphincter. Studies involving manipulative therapies suggested an important role in the coadjuvant treatment for reflux, acting as a form of prevention and treatment. to carry out a systematic review of the literature regarding the treatment by means of manual techniques for GERD, aiming to evaluate the methodological quality employed in the studies, summarize the findings, analyze the effectiveness of the intervention and possible recommendation for clinical practice and/or indicate the need for further research. The study is characterized as a systematic review, with research conducted in the English and Portuguese languages, in the databases Bireme, Lilacs, PubMed, PEDro, Scielo, Cochrane and Google Scholar. We exctracted the manual therapy techniques used in the selected studies, and the reporting of the effectiveness of these interventions. The PRISMA reporting guidance was used to structure the review and the PEDro scale was used to evaluate the methodological quality of the included studies. A total of 6 clinical trials were found and included a total of 218 people analyzed by objective and subjective measures in the pre- and post-intervention phases. Regarding methodological quality, 3 studies had scores higher than 7, i.e. high quality, while one had a score of 4, and 2 had a score of 3, denoting low internal validity. The observed results show positive clinical effects for visceral manual therapy in the gastroesophageal reflux in adults. The research suggests the presence of favorable results with the use of manual techniques for the treatment of gastroesophageal reflux, seen in studies with high methodological quality, however, due to the small number, and other studies with a low score assigned by the PEDro scale, caution should be adopted and there is the need for further experimental studies. [ABSTRACT FROM AUTHOR]

Osteopathic physicians (DOs) comprise a growing portion of family physicians. In 2023, more DO seniors matched into family medicine than MD seniors, and nearly a quarter of US DO seniors matched into family medicine. Family medicine benefits from the osteopathic philosophy of whole-person care, though this provides challenges regarding research in family medicine. Notably, among students entering family medicine, MD students report an average of 2.4 research activities compared with 1.7 for DO students, marking the lowest values across specialties. There are multifarious reasons for the limited research exposure of osteopathic medical students, and 2 may be amenable to change. First, osteopathic trainees have relatively limited research exposure. Second, osteopathic manipulation training emphasizes techniques that are not compatible with current theories of anatomy and pathology. The reduced research emphasis among osteopathic trainees can be addressed by strategies that focus on enhanced research exposure and a cultural shift toward fearless reevaluation of these inconsistent beliefs. Improvements in research training and culture among osteopathic trainees (including medical students and residents) will directly benefit osteopathic medicine, family medicine, and patients., Competing Interests: Conflict of interest: None., (© Copyright by the American Board of Family Medicine.)

Abstract Background Despite the increasing use of osteopathy, a manipulative complementary and alternative medicine therapy, in the general population, its efficacy continues to be debated. In this era of evidence-based practice, no studies have previously reviewed the scientific literature in the field to identify published knowledge, trends and gaps in empirical research. The aims of this bibliometric analysis are to describe characteristics of articles published on the efficacy of osteopathic interventions and to provide an overall portrait of their impacts in the scientific literature. Methods A bibliometric analysis approach was used. Articles were identified with searches using a combination of relevant MeSH terms and indexing keywords about osteopathy and research designs in MEDLINE and CINAHL databases. The following indicators were extracted: country of primary author, year of publication, journals, impact factor of the journal, number of citations, research design, participants’ age group, system/body part addressed, primary outcome, indexing keywords and types of techniques. Results A total of 389 articles met the inclusion criteria. The number of empirical studies doubled every 5 years, with the United States, Italy, Spain, and United Kingdom being the most productive countries. Twenty-three articles were cited over 100 times. Articles were published in 103 different indexed journals, but more than half (53.7%) of articles were published in one of three osteopathy-focused readership journals. Randomized control trials (n = 145; 37.3%) and case reports (n = 142; 36.5%) were the most common research designs. A total of 187 (48.1%) studies examined the effects of osteopathic interventions using a combination of techniques that belonged to two or all of the classic fields of osteopathic interventions (musculoskeletal, cranial, and visceral). Conclusion The number of osteopathy empirical studies increased significantly from 1980 to 2014. The productivity appears to be very much in sync with practice development and innovations; however, the articles were mainly published in osteopathic journals targeting a limited, disciplinary-focused readership.

Fatigue is among the most common symptoms of the long-term effects of coronavirus (long COVID). This study aims to compare the effectiveness of osteopathic manipulative treatment (OMT) combined with physiotherapy treatment (PT) compared to PT alone on fatigue and functional limitations after two months post randomization in adults with long COVID. This is a study protocol for a two-arm, assessor-blinded, pragmatic randomized controlled superiority trial. Seventy-six participants will be randomly allocated to OMT + PT or PT. The PT includes usual care interventions including motor and respiratory exercises targeting cardiorespiratory and skeletal muscle functions. The OMT entails direct and indirect musculoskeletal, viceral and cranial techniques. Patients will be evaluated before and after a 2-month intervention program, and at 3-month follow-up session. Primary objectives comprise fatigue and functional limitations at 2-month post randomization as assessed by the fatigue severity scale and the Post-COVID Functional State scale. Secondary objectives comprise fatigue and functional limitations at 3 months, and the perceived change post-treatment as assessed by the Perceived Change Scale (PCS-patient). This protocol was registered (NCT05012826) and received ethical approval (38342520.7.0000.5235). Participant recruitment began in August 2021 and is expected to conclude in July 2023. Publication of the results is anticipated in 2023. [ABSTRACT FROM AUTHOR]

The majority of individuals infected with SARS-CoV-2 have mild-to-moderate COVID-19 disease. Convalescence from mild-to-moderate (MtoM) COVID-19 disease may be supported by integrative medicine strategies. Integrative Medicine (IM) is defined as healing-oriented medicine that takes account of the whole person, including all aspects of lifestyle. Integrative medicine strategies that may support recovery from MtoM COVID-19 are proposed given their clinically studied effects in related conditions. Adoption of an anti-inflammatory diet, supplementation with vitamin D, glutathione, melatonin, Cordyceps, Astragalus and garlic have potential utility. Osteopathic manipulation, Qigong, breathing exercises and aerobic exercise may support pulmonary recovery. Stress reduction, environmental optimization, creative expression and aromatherapy can provide healing support and minimize enduring trauma. These modalities would benefit from clinical trials in people recovering from COVID-19 infection. [ABSTRACT FROM AUTHOR]

Chronic rhinosinusitis (CRS) is an inflammatory disease affecting the nasal cavity and paranasal sinuses. Diagnosis of CRS typically requires two of the following four symptoms to persist for a minimum of 12 weeks: anterior or posterior nasal drainage, hyposmia or anosmia, facial pain or pressure, or nasal obstruction. Additionally, diagnosis necessitates the visualization of inflammation on physical examination or diagnostic imaging. This review aims to compare the outcomes of CRS patients who undergo interventional treatment via functional endoscopic sinus surgery (FESS) to those who opt for noninterventional treatment with osteopathic manipulation. FESS is not the sole interventional method utilized for CRS, but it is the focus of this review since it is the gold standard surgical treatment, encompassing a variety of techniques. Although there is limited literature discussing the use of osteopathic manipulative treatment (OMT) to remedy CRS, some evidence indicates OMT can alleviate symptoms for individuals seeking non-surgical alternatives. Moreover, osteopathic manipulation for CRS may be beneficial for patients unresponsive to previous medical or surgical management. Pharmacologic treatment is typically the initial approach to CRS and is discussed briefly herein, though it largely falls beyond the scope of this review., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Klover et al.)

Muscle energy technique (MET) is a therapeutic technique involving active muscle contraction by the patient. The selection of particular techniques by osteopaths is underexplored. The aim of the study was to explore the practice profile of those Australian osteopaths who use MET often in their practice compared to those who do not use the technique often. A secondary analysis of data collected from 922 participants by a practice-based research network (PBRN) for the Australian osteopathy profession was performed. Frequency of use of MET on a 4 point scale: never , rarely , sometimes , and often were binary coded as less often and often. Inferential statistics were used to explore the associations between individual practice characteristics and the frequency of MET use. Adjusted odds ratios (OR) with 95% confidence intervals (CI) and p-values were calculated from regression modelling. Dichotomising participant responses resulted in less often (203, 20.5%) and often (788, 79.4%). There was a significantly greater proportion of male practitioners using MET compared to those practitioners who did not often use the technique (OR = 0.46; CI = 0.33, 0.63; p < 0.01). Australian osteopaths who often used MET were younger (36.3 vs 44.6 years old) and had fewer years in practice (9.9 vs 17.3 years) compared to osteopaths who used the technique less often. Osteopaths who reported that they often used MET were more likely to be male, often use counterstrain and more likely to use orthopaedic testing in patient examination. The study provides an insight into how Australian osteopaths practice, particularly their use of MET. • When the responses of 922 Australian osteopaths who participated in a practice-based research network were dichotomized according to usage of MET, the majority reported they use MET frequently. • MET and counterstrain appear to be used in combination for musculoskeletal patient care by Australian osteopaths. • Australian osteopaths who reported often using MET were more likely to see patients for low back pain, perform orthopaedic testing, use neurological cranial nerve testing, and refer for diagnostic imaging. • The practice characteristics of osteopaths who use MET often compared to those who do not reveal insight into different practice styles within the osteopathic profession. [ABSTRACT FROM AUTHOR]

Joint manipulation is generally used to reduce musculoskeletal pain; however, evidence has emerged challenging the effects associated with the specificity of the manipulated vertebral segment. The aim of this study was to verify immediate hypoalgesic effects between specific and non-specific cervical manipulations in healthy subjects. Twenty-one healthy subjects (18–30 years old; 11 males, 10 females) were selected to receive specific cervical manipulation at the C6-7 segment (SCM) and non-specific cervical manipulation (NSCM) in aleatory order. A 48h interval between manipulations was considered. Pressure pain threshold (PPT) was measured pre- and post-manipulation with a digital algometer on the dominant forearm. The SCM produced a significant increase in the PPT (P < 0.001) however no difference was observed in the PPT after the NCSM (P = 0.476). The difference between the two manipulation techniques was 37.26 kPa (95% CI: 14.69 to 59.83, p = 0.002) in favor of the SCM group Specific cervical manipulation at the C6-7 segment appears to increase PPT on the forearm compared to non-specific cervical manipulation in healthy subjects. [ABSTRACT FROM AUTHOR]

Background: Despite the increasing use of osteopathy, a manipulative complementary and alternative medicine therapy, in the general population, its efficacy continues to be debated. In this era of evidence-based practice, no studies have previously reviewed the scientific literature in the field to identify published knowledge, trends and gaps in empirical research. The aims of this bibliometric analysis are to describe characteristics of articles published on the efficacy of osteopathic interventions and to provide an overall portrait of their impacts in the scientific literature. Methods: A bibliometric analysis approach was used. Articles were identified with searches using a combination of relevant MeSH terms and indexing keywords about osteopathy and research designs in MEDLINE and CINAHL databases. The following indicators were extracted: country of primary author, year of publication, journals, impact factor of the journal, number of citations, research design, participants' age group, system/body part addressed, primary outcome, indexing keywords and types of techniques. Results: A total of 389 articles met the inclusion criteria. The number of empirical studies doubled every 5 years, with the United States, Italy, Spain, and United Kingdom being the most productive countries. Twenty-three articles were cited over 100 times. Articles were published in 103 different indexed journals, but more than half (53.7%) of articles were published in one of three osteopathy-focused readership journals. Randomized control trials (n = 145; 37.3%) and case reports (n = 142; 36.5%) were the most common research designs. A total of 187 (48.1%) studies examined the effects of osteopathic interventions using a combination of techniques that belonged to two or all of the classic fields of osteopathic interventions (musculoskeletal, cranial, and visceral). Conclusion: The number of osteopathy empirical studies increased significantly from 1980 to 2014. The productivity appears to be very much in sync with practice development and innovations; however, the articles were mainly published in osteopathic journals targeting a limited, disciplinary-focused readership. [ABSTRACT FROM AUTHOR]

Osteopathic manipulative treatment (OMT) is a therapy used by osteopathic physicians in various medical settings. Postoperatively, OMT can be utilized to optimize the body's function and recovery. This meta-analysis examines the efficacy of OMT in reducing the length of postoperative hospital stays. Given the significant implications of prolonged hospitalization for both patients and healthcare resources, research strategies to safely shorten this period are crucial. This meta-analysis examined five select studies that measured the length of hospital stay in postoperative patients who received OMT compared with postoperative patients who did not. A random effects model was applied in our statistical analysis to account for heterogeneity due to variations in surgical procedures, hospitals, and patient populations. Individually, three studies reported statistically significant reductions in hospital stay for OMT patients, while two did not. This meta-analysis, comprising five studies and 519 patients, found a mean difference of -2.37 days in favor of OMT; however, this finding did not reach a statistical significance (P = 0.06). The substantial heterogeneity observed (heterogeneity tau 2  = 6.75, chi 2  = 34.6, df = 4, P < 0.00001, I 2 = 88%) suggests that clinical dissimilarities among the five studies may have resulted in our inconclusive findings. While OMT shows promise in postoperative care, further research with standardized protocols and more homogenous patient populations is needed to assess its true impact., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Henwood et al.)

Patellofemoral pain syndrome (PFPS) is among the most common causes of musculoskeletal pain in the United States. It is defined as retropatellar or peripatellar pain that is reproduced with functional activities that load the patellofemoral joint in a flexed position, such as stair climbing or squatting. While it presents in both adolescents and adults, it is commonly found in physically active individuals, such as athletes and military recruits. Exploring the role of osteopathic manipulative treatment (OMT) in PFPS is of particular interest given the absence of a definitive treatment and the poor long-term prognosis associated with PFPS. This meta-analysis includes three studies exploring the use of OMT to reduce pain in patients suffering from PFPS and exploring the efficacy of OMT as a primary intervention. In these studies, pain assessments, pre-treatment, and post-treatment follow-up of at least 30 days were performed using a 10-cm visual analog scale (VAS). The mean difference in pain between OMT and no treatment (NT) groups using the random effects model was -3.95 (-6.39; -1.50) with a p<0.01, suggesting OMT resulted in significant knee pain reduction in those with PFPS. A measure of heterogeneity, known as I 2 , was found to be high at 97%, which suggests caution should be taken when interpreting the overall results. Given the lack of definitive treatment and the poor long-term prognosis for PFPS, the authors suggest OMT provides an effective option for pain relief in patients with PFPS. Further research is needed to provide results that may be more clinically applicable or valuably interpreted., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Delgadillo et al.)

The article reviews the anatomical path of the phrenic nerve and its anastomoses, with the most up-to-date knowledge reported in the literature. We have briefly reviewed the possible phrenic dysfunctions, with the final aim of presenting an osteopathic manual approach for the treatment of the most superficial portion of the nerve, using a gentle technique. The approach we propose is, therefore, a theory based on clinical experience and the rationale that we can extrapolate from the literature. We hope that the article will be a stimulus for further experimental investigations using the technique illustrated in the article. To the authors' knowledge, this is the first article that takes into consideration the hypothesis of an osteopathic treatment with gentle techniques for the phrenic nerve., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Bordoni et al.)

Breathing retraining and manual therapy (MT), delivered independently or together, influence autonomic activity, and improve symptoms in patients with chronic conditions. This study evaluated the effects of breathing retraining and osteopathic MT on cardiac autonomic measures and breathing symptoms during spontaneous breathing in healthy active adults. Participants (n = 18) received breathing retraining and four, weekly manual therapy sessions, randomised to start immediately, or after 6-week delay. Heart-rate (HR) variability was assessed as a 7-day average of waking 6-min electrocardiograms, using time (logarithm of root-mean-square of successive differences; LnRMSSD) and frequency domain (logarithm of high-frequency; LnHF) measures. Recordings were taken before, one week following intervention or delay, and then following the later intervention for those with delayed starts. Changes were compared between those who received and had yet to receive the intervention, and before and after treatment for the whole cohort. Following the intervention, HR-variability measures increased 4% overall (Effect Sizes: 1.0–1.1) for the whole cohort. Between-group analyses showed that the immediate-start group increased more than the delayed start group: LnRMSSD 0.27 (0.02–0.52; 95%CI) ln.ms, and LnHF 0.41 (−0.01–0.84) ln.ms2 for immediate start; compared with LnRMSSD −0.09 (−0.29–0.11) ln.ms, and LnHF −0.19 (−0.59–0.22) ln.ms2 (P = 0.02–0.03 for interaction) for delayed start. Resting HR decreased following intervention in the whole cohort (Effect Size −0.8; P = 0.02). A 6-week osteopathic treatment consisting of breathing retraining and MT is beneficial in raising HR-variability compared to no treatment, and may induce favourable (parasympathetic over sympathetic) autonomic modulation. ACTRN12614001119684. [ABSTRACT FROM AUTHOR]

Copyright of Manuelle Medizin is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The impact of high-velocity, low-amplitude (HVLA) manipulations on the behavior of sacroiliac joint (SIJ) mobility in individuals submitted to an osteopathic intervention has not been sufficiently investigated. Furthermore, there is no standard agreement on the description of the acute effects of HLVA with regards to the mobility of the SIJ through three-dimensional motion analysis. The purpose of this study was to analyse possible alterations in the mobility of the SIJ pre- and post-manipulation of the ilium bone in healthy men. Thirty healthy male patients aged between 18 and 35 years were examined and divided into two groups: manipulation (MN) and placebo (PL) groups. SIJ movement was assessed through a three-dimensional motion analysis system before and after osteopathic manipulation of the anterior ilium bone, during hip flexion. Statistical analysis was performed using the Kolmogorov-Smirnov normality test, and Fisher's exact test was used to observe associations of interest in the mobility of the SIJ. Finally, the t -test was used to analyse values of mobility of the SIJ pre- and post-manipulation (p < 0.05). Non-significant differences were observed in SIJ mobility. In MN the means were pre-manipulation right SIJ 39.98 mm ± 10.82 [CI - 29.16–50.8] and post- 42.85 mm ± 27.17 [CI – 15.68–70.02] with p = 0.61. Pre-manipulation left SIJ 41.73 mm ± 15.34 [CI 10.89–82.99] and post- 39.97 mm ± 14.70 [CI - 24.67-54.07] with p = 0.39. HVLA does not alter the mobility of SIJ under these conditions. Further studies under different conditions, with patients that report pain, are required to fully understand the behavior of the SIJ after HVLA manipulation. [ABSTRACT FROM AUTHOR]

Low back pain (LBP) is a worldwide public health problem. The flexion-distraction technique (FDT) has been considered to treat LBP. However, the adequate dosage and the treatment effects are not clearly understood. This feasibility study aimed to assess the effects of different exposure times with 5 and 10 min of the FDT on the L5-S1 distance and pressure pain threshold (PPT) of patients with chronic LBP. A two-arm, examiner-blinded, randomized controlled feasibility trial with participants with chronic LBP enrolled in an outpatient clinic. Participants were randomly assigned to FDT-T5 (5 min) or FDT-T10 (10 min). The distance between the L5 lamina and the sacral promontory, and the PPT at the L5 spinous process was measured before and immediately after FDT. Ultrasound imaging was used to measure L5-S1 distance, and the pressure algometry examined the PPT. Pre- and post-intervention data were compared between two groups by two-way analysis of variance (ANOVA) for repeated measures. We also calculated the intra- and inter-rater reliability of the L5-S1 measurement. Seventeen participants [10 (58.8 %) females, mean age 45 (±12) years] completed all procedures. Improvements in the intervertebral space [FDT-T5 mean change = 2.65 (95 %CI 1.45, 3.85) mm; FDT-T10 mean change = 1.88 (95 %CI -1.86, 5.63) mm] and decreases in PPT values [FDT-T5 mean change = −0.55 (95 %CI -1.35, 0.26) Kgf; FDT-T10 mean change = −0.79 (95 %CI -1.92, 0.34) Kgf] were observed, although there was no significant difference between the two groups for the distance between the L5 lamina and the sacral promontory (p = 0.595) or the spinous process L5 PPT (p = 0.672) after the intervention. Good reliability values were found for inter- and intra-rater measurements ranging between ICC = 0.81 to ICC = 0.88). In this feasibility trial, both groups showed an increased distance between L5-S1 and decreased the PPT in the L5 spinous process, indicating greater pain sensitivity after the intervention. These quantitative methods may measure distance and pain in definitive studies. • This is the first study to compare the distance between the L5 lamina and the sacral promontory after the flexion-distraction technique (FDT) using ultrasound imaging (USI). • The present study could not determine the effect of a particular time of exposure to FDT (FDT-T5 or FDT-T10 min). • Both groups (FDT-T5 and FDT-T10 min) increased the lumbar distance, corresponding to mobilization of the lumbar region. • Both groups presented decreased values of PPT in the L5 spinous process immediately after the technique. • A single session of FDT showed improvements in the distance between L5 and S1 and reduced L5 pressure pain threshold in the feasibility study. [ABSTRACT FROM AUTHOR]

Limited evidence exists concerning the long-term follow-up of pain management in individuals with coccydynia. This study aimed to examine the effectiveness of combining manipulation and exercise as a treatment approach for patients with coccydynia, while also assessing its long-term outcomes. Six months follow-up of a randomized controlled trial. This study was conducted in a private hospital. The control group (n = 23) received exercise alone, while the experimental group (n = 23) received both exercise and manipulation. All participants performed exercises three days a week for four weeks, and the manipulation sessions were conducted once a week for a total of four sessions. Pain levels were assessed using the Visual Analog Scale (VAS), coccydynia symptoms were evaluated using the Paris questionnaire, and pain-related disability was measured with the Oswestry Disability Index (ODI). Forty-six participants were enrolled in the study. No statistically significant differences were observed in the demographic characteristics between the two groups (p > 0.05). However, participants in the manipulation group showed a statistically significant improvement in pain, symptoms, and ODI scores compared to the control group, both immediately after treatment and at the 6-month follow-up (p < 0.05). This study demonstrates that the combination of exercise and intrarectal manipulation over a four-week period significantly reduced pain, coccydynia-related symptoms, and disability scores in chronic coccydynia patients. However, no therapeutic superiority was observed in the long-term follow-up of six months. [ABSTRACT FROM AUTHOR]

SARS-CoV-2 is a disease with global impact, and in the United States alone, approximately 20 % of children have had SARS-CoV-2. Long-COVID affects a significant number of children and adults with an incidence reported as high as 57 % for a SARS-CoV-2 sequelae. Currently, a gold standard treatment has not been identified for long-COVID. There have been pathologic mechanisms of action proposed for long-COVID, but this is complicated by the wide variety of symptom manifestations. The goal of this case report is to demonstrate and discuss the application of osteopathic manipulative treatment (OMT) and osteopathic principles and practices (OPP) in a patient with long-COVID headache. In our case report we describe a child with long-COVID headache of 12-months duration with high somatic dysfunction burden found on cranial osteopathic structural examination. OMT was utilized to treat a patient with long-COVID headache and may have resulted in its resolution. This case suggests that OMT and OPP may play a role in the treatment of patients with long-COVID headache. • Our case report highlights OPP as a potential treatment option that may be complimentary to other treatments for pediatric patients experiencing long-COVID headache. • Our case report emphasizes the significance of individualized treatment plans, as osteopaths provide in a tailored fashion to each patient based upon their unique history and physical exam findings. • Our case report utilizing OMT promotes a non-pharmacological intervention and fosters opportunities for interprofessional collaboration. • Our case report sparks interest in further research and clinical trials to investigate the efficacy of OMT in pediatric long-COVID cases and its potential application in a broader range of post-viral syndromes. [ABSTRACT FROM AUTHOR]

Objectives: To determine the short-term effects of a modified Flexion-Distraction (FD) technique in comparison with a high-velocity low-back spinal manipulation (HVLA-SM) protocol on patients suffering from chronic low-back pain (CLBP).Design and Methods: A randomized controlled trial. The sample was composed of 150 patients suffering from CLBP, who were randomly assigned to either a FD (n = 75) or a HVLA-SM (n = 75) group. The variables used to study pain were the scores of the Visual Analogue Scale (VAS) and the Pressure Pain Threshold (PPT) on trigger points (TrPs) of the quadratus lumborum. In addition, the Oswestry Disability Index (ODI) was used to measure disability, and Schober's test and the Finger Floor Distance test (FFDT) to measure changes in low-back spine motion. An Analysis of Covariance (ANCOVA) was used to measure group effect, and Number Needed to Treat (NNT) for effect size.Results: Greater improvements occurred in the FD group, with a statistically significant group effect (p < 0.001) for all outcome variables. The ETA2 value was larger than 0.100 in the Schober's and FDD tests, larger than 0.200 in the case of ODI and PPT, and larger than 0.300 for VAS. OR = 0.07 [IC 95% = 0.03 to 0.18] and NNT = 2.08 [IC 95% = 1.64-2.84) yielded improved values for the FD group.Conclusion: For patients suffering from CLBP, greater improvements in pain and function were observed in the group receiving the modified FD treatment than in the HVLA-SM group. [ABSTRACT FROM AUTHOR]

Background and Objectives: The techniques directed to the cranial field in osteopathy are the most questioned due to the lack of scientific evidence. In osteopathic practice, manual palpation is essential and, therefore, measuring reliability is fundamental. The objective of this study is to assess the precision and objectification of an educational model in cranial osteopathy based on experience. Materials and Methods: A reliability study was conducted in a cadaver skull where a strain gauge was placed on the sphenobasilar synchondrosis (SBS) of the base of the skull. Three cranial osteopathic techniques (lateral compression, anteroposterior compression, and compression maneuver of the mastoids) were performed 25 times by osteopaths with different degrees of experience (5–10 years, 1–5 years, 15 years of experience. Data were analyzed to check for inter- and intra-observer reliability using intra-class correlation coefficients (ICC). Results: Reliability in osteopaths with 5–10 years’ experience (observer 1 and observer 2) performing all three techniques was higher (p < 0.001) than the osteopath with >15 years’ experience. Little or no reliability were observed in osteopaths with less experience. Conclusions: The experience of the osteopaths determines the reliability and effectiveness of the cranial techniques, a fundamental part in objectifying these techniques. This model can help implement objective training in cranial osteopathy formation.

This paper reviews the current literature to examine what elements of osteopathic medicine can be used in psychiatry. The aim of this study was to use the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to conduct a systematic review of studies describing the efficacy of osteopathic manipulative medicine (OMM) in treating psychiatric problems directly and indirectly. The authors searched the databases PubMed, PsycINFO, and CINAHL (Cumulative Index to Nursing and Allied Health Literature), reviewing peer-reviewed articles from 1980 to April 2023. The literature demonstrates that OMM has a positive effect on psychiatric symptoms indirectly when treating certain medical conditions, such as chronic pain, fibromyalgia, and irritable bowel syndrome; however, there are many limitations on these studies, and further research is required prior to making firm recommendations. The evidence is lacking for osteopathic manual medicine being used directly to treat psychiatric conditions. This review demonstrates that in some populations, such as individuals with chronic pain, fibromyalgia, and irritable bowel syndrome, OMM could be considered by an osteopathic psychiatrist as an adjunct treatment. More research should be conducted in this area due to the many limitations in the available studies but current research suggests that the use of OMM by osteopathic psychiatrists could be beneficial for some patient populations., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Bowes et al.)

Spheno-occipital synchondrosis (SOS) is the joint regarded as the most important foundation for understanding cranial osteopathy and craniosacral therapy. SOS is the origin of the primary respiratory mechanism (PRM), a movement between the posterior surface of the body of the sphenoid bone and the anterior surface of the base of the occipital bone. From the PRM perspective, an alteration of the position between the two bone surfaces would create cranial and/or craniosacral dysfunction. These positional alterations of the SOS (in adults and children) would determine specific and schematical movements of the bones of the entire skull, whose movements are recognizable by palpation by trained operators. PRM expression is influenced by other elements, such as movement of the cranial bones, inherent movement of the central nervous system, cyclic movement of cerebrospinal fluid (CSF), mechanical tension of the cranial meninges, and passive movement of the sacral bone between the iliac bones. The article reviews the most up-to-date information on the evolution of cranial sutures/joints and meninges in adulthood, the fluctuations of the CSF, brain, and spinal mass movements. Research should reconsider the motivations that induce the operator to discriminate the palpable cranial rhythmic impulse, and probably, to rethink new cranial dysfunctional patterns., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Bordoni et al.)

Background A number of clinical reasoning models, including hypothetico-deductive, pattern recognition and narrative reasoning have been identified in both novice and experienced medical, nursing and allied health professionals. The aim of this project was to explore clinical reasoning in osteopathy from the perspectives of both experienced practitioners and novice practitioners. Methods Data were collected via semi-structured interviews that encouraged practitioners to reflect on the clinical reasoning processes they used in response to two case studies. Interviews were transcribed and analysed to identify key themes. Results Two themes emerged: (1) that experienced and novice osteopaths demonstrated different approaches to clinical reasoning, and (2) that experiential findings (e.g. from observation and palpatory findings derived from having direct contact with the patient) were integral to clinical reasoning in osteopathy. Conclusion The results of this study suggest that clinical reasoning in osteopathy is similar to that of other health professions in that deep understanding of clinical applications and clinical experience were key factors in developing sophisticated clinical reasoning processes. However, clinical reasoning in osteopathy, unlike many other health professions, relies on experiential findings resulting from direct observation and palpatory contact with the patient. Clinical reasoning that relies on subjective experiential findings requires further investigation. [ABSTRACT FROM AUTHOR]

Copyright of Manuelle Medizin is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Fisioterapia Brasil is the property of Atlantica Editora and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The skin is a complex organ, a system that influences and is influenced by the body system, with different skin layers always mechano-biologically active. In the presence of a lesion that damages the dermis, the skin undergoes sensory, morphological, and functional alterations. The subsequent adaptation is the formation of scar tissue, following distinct and overlapping biological phases. For reasons not yet fully elucidated, some healing processes lead to pathological scars, from which symptoms such as pain, itching, and functional limitations are derived. Currently, there is no gold standard treatment that fully meets the needs of different scars and can eliminate any symptoms that the patient suffers. One such treatment is manual medicine, which involves direct manual approaches to the site of injury. Reviewing the phases that allow the skin to be remodeled following an injury, this article reflects on the usefulness of resorting to these procedures, highlighting erroneous concepts on which the manual approach is based, compared to what the current literature highlights the cicatricial processes. Considering pathological scar adaptations, it would be better to follow a gentle manual approach., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Bordoni et al.)