Studies Find Osteopathic Manipulative Treatment (OMT) Improves Chronic Low Back Pain

Studies Find Osteopathic Manipulative Treatment (OMT) Improves Chronic Low Back Pain

Studies published in the Journal of the American Osteopathic Association conclude that osteopathic manipulative treatment (OMT) reduces pain and improves function for people with chronic low back pain.  Study participants with the worst pain and highest degree of disability gained the most from OMT.

Two studies from a randomized double-blind, sham-controlled trial were used to determine how effective six OMT sessions over an eight week period were for people with low back pain.  Recovery was measured after 12 weeks using assessments including pain severity and functional status.  A total of 455 men and women between the ages of 21 and 69 with low back pain for at least three months were included in the trial.

The initial study was sought to measure whether OMT aided in recovery and the second study was intended to identify which participants benefited the most from the treatments.

The researchers from the University of North Texas Health Science Center in Fort Worth found that participants with baseline disability scores of 17 or greater (scale 1-24) experienced substantial benefit, and those with initial scores of 7 or greater experienced moderate benefit.

Substantial benefit was defined as experiencing a 50% or more improvement the baseline pain and disability assessment.

“Subgrouping patients according to chronic low back pain intensity and function appears to be a simple strategy for identifying patients who can attain substantial improvement with OMT. From a cost and safety perspective, OMT should be considered before progressing to more costly or invasive interventions,” said John C. Licciardone, DO, MS, MBA.

The study concluded, “The OMT regimen was associated with significant and clinically relevant measures for recovery from chronic LBP. A trial of OMT may be useful before progressing to other more costly or invasive interventions in the medical management of patients with chronic low back pain.”

The study can be found here: http://jaoa.org/article.aspx?articleid=2498824

Authored by: Staff

There are 6 comments for this article
  1. CathyM at 10:58 am

    I have an osteopathic doctor who ironically never does OMT on me – we tried it the first couple times I saw her, and it made my pain dramatically worse!! I don’t know if she got discouraged or if the medical codes no longer allow her to bill for that (in a general clinic) but I have my best relief from acupuncture and massage, neither of which are covered by insurance (and I have to drive 45 minutes one way for the acupuncture, which often “undoes” the good work on my spine before I get home). I agree with the first comment that we must be cautious about suggesting any alternative method as “the” method for general help – individuals have different issues, and I think these options should be available but not in place of medications which have been proven to help (if that is the case). That’s why we get our medical help from doctors not receptionists – it’s a skill/art that takes lots of training and is best done individually for individuals! 😉 I actually think a range of methods in combination works best – but I will be dead long before insurance or government pays for such a comprehensive treatment (conversely, organ transplants are becoming routine, and costs tens of thousands more than these pain relief methods!) It’s such a waste of potential…

  2. Cerys at 3:43 pm

    BTW, the picture shows neck manipulation. Research suggests higher incidence of stroke, particularly a kind of dissection known as VBA, after neck manipulation.

    As far as low back manipulation, the study authors noted several flaws not mentioned in the article. Some 20-25% of study subjects (not entirely randomly chosen) showed improvement), meaning the flip side result is 75%-80% did NOT respond. Also, researchers “discarded” over half the potential study pool – for reasons I didn’t see listed. With that in mind, I think it’s improper to suggest OMT results in substantial improvement in LBP patients overall.

    OMT may be a pain management tool in specific LBP patients, but a blanket endorsement is not supported by this study. I think most of us have tried “all conservative measures,” so it seems reasonable to consider it, particularly in subacute and early-chronic timelines. But to suggest intense LBP is relieved, or that the majority of LBP patients will respond, that’s a reach.

    Blanket statements can cause a lot of roadblocks to care. Stating that “XYZ helps 123” only serves to alienate those for whom XYZ does NOT work. I think the better approach is to state that OMT is a first-line therapy in SOME cases of LBP, and maybe quite reasonable early in a persons LBP timeline. Also, be aware that the study authors’ believe that meeting a pain threshold predetermined by them is, to them, a “cure”.

    Like many in the realm of pain management for back issues, my spine is compromised at multiple sites. Manipulation of any one part impacts the rest – yet those who practice manipulative techniques tend to forget. So do insurance codes. In the study, the median threshold of intensity and dysfunction is well below what I experience on a regular basis (so I’m pretty sure I wouldn’t have been a test subject). But concluding that OMT “improves” LBP creates an expectation that I “should” a) be prescribed that therapy; and b) benefit from it. And that’s a problem. Thankfully, my spine specialist understands. When he’s on vacation… that’s another matter.

  3. TIm at 6:15 pm

    I was hit by a car when I was 13 years old. I had a broken right leg, blood clot on left knee, broken nose and a concussion. I was unable to walk for 3 months. All this back in 1968 and I don’t if physical therapy was a luxury or my parents could not afford it. I was “lame” when I was finally able to walk again. All those injuries have now come to haunt me in my old age. ALIF 360, total hip replacement and on my 3 year old hip I have the worst case of piriformis syndrome my PT has ever seen.
    The physical adjustments I get twice a week are wonderful. It is not chiropractic stuff. These are subtle adjustments to my pelvis and deep tissue massage. I have had the dry needling after hip replacement and it worked wonders on my thigh. I have actually been able to reduce my morphine use and rarely take the break thru medication.
    I have transitioned to the “fitness center” and my energy has increased.
    I have moderate to severe OA and get LESI’s and injections into my shoulder and L4-S1 about twice a year.
    I despise chiropractic work and for me it seemed to irritate my joints. This PT hands on is different.
    The only thing I cannot get relief for is right piriformis pain, spasm and ache. My walking is very limited.

  4. Stephen S Rodrigues MD at 8:34 am

    32 years and these the answers to pain problems from the archives of medicine;

    The ONLY treatments for “the most common location of pain is in muscles” are in Hands-on Physical Therapy PT.

    What is hands-on PT?

    The archives of medicine is a treasure trove of some of the most important treatments which I have re-discovered all of which help to restore you body back to wellness. All focus energy into the muscular system so tissues can heal from inside.
    Massage, Tissue release; strain and counterstrain; spray and stretch and Joint and Spinal Manipulations.
    Thin intramuscular needling options, Dry needling, GunnIMS, Chinese, Japanese, French Energetic and various other “Acupuncture Disciplines.”
    Hypodermic intramuscular needling options, Wet Needling aka Tender Point Stimulative Needling, Tendon and Ligament Injections.

    The barriers are biases, misunderstanding and mis-education.

    NONE of these options can do any harm or damage.

    They do hurt but that is simply how it works and is normal and not harmful.

  5. Osteopath Twickenham at 4:22 am

    Consistency is key. We tend to revert back to bad habits in posture after we have been realigned. A constant work in progress.

    “I find that seeing my chiropractor regular helps me so much for a few days. He does very soft tissue massage as he is careful because I have had a hip replacement. Problem is some of my illnesses confine me to home so I can’t see him as often as I would like and the other being that medicare only covers so many sessions. Even if I could afford to go once a week it would make such a difference in the quality of my life”

  6. Marty at 3:53 am

    I find that seeing my chiropractor regular helps me so much for a few days. He does very soft tissue massage as he is careful because I have had a hip replacement. Problem is some of my illnesses confine me to home so I can’t see him as often as I would like and the other being that medicare only covers so many sessions. Even if I could afford to go once a week it would make such a difference in the quality of my life