Musculoskeletal

Neck Pain

The studies referenced for this section compared OMM to 30mg Ketorolac injections and muscle relaxers. Ketorolac is a very strong Non-Steroidal Anti-inflammatory (NSAID) that can be given in an intravenously (IV) or intramuscularly (IM). It is said to be as effective as morphine without blunting your senses as opiates do. You would encounter this medication in the emergency room to manage pain or after surgery.

Muscle relaxers are supposed to help reduce the spasm in the muscles and in so doing decrease pain. They act on the nerves influencing the muscles at the level of the muscle itself, or in some cases at the spinal cord. They frequently make you sleepy and this limits their usefulness.

This comparison was done in an emergency room setting over a 3 week period of observation. The study found that OMM:

  • Was equally effective overall compared to ketorolac

  • Significantly better in reducing pain intensity

  • Is more effective than more effective than muscle relaxants

  • Is especially effective in reducing neck pain and spasms when combined with exercise, for pain that’s been present for over 2 weeks

  • All NSAIDs can raise blood pressure, cause bleeding in the GI tract, and impact kidneys. This limits the utility of these medicines in certain groups of patients. OMM is a viable alternative having been shown to be equally effective treating various musculoskeletal complaints, and can be used safely in patients with health issues such as: hypertension, history of ulcers or GI bleeds, or impaired renal function.

Low back Pain

The traditional medical approach to low back pain is: muscle relaxer, ibuprofen or similar, ice, rest, and maybe physical therapy.

This set of research literature agreed that whether OMM was used as a solo treatment or if it was added to the traditional interventions when it was included in a treatment plan, patients had

  • Decreased pain

  • Decreased need for physical therapy (PT)

  • Decreased use of medications

Research suggests there is an additive value to these treatments and that the most effective treatment cocktail of all is using all of these together as they work in a synergistic manner - sometimes it’s a “both, and” world.

Headaches

The two most common types of headaches are tension headaches and migraines. Tension headaches derive from muscle spasms in the neck and shoulders and wrap up and around the head toward the forehead often creating a band of tension or pain. Migraines originate within the blood vessels and tissue of the brain beginning as a vascular process and then expanding into an inflammatory process. Migraines are often associated with neurological symptoms such as nausea, light sensitivity, sound sensitivity and sometimes symptoms that mimic a stroke such as partial paralysis. There are often changes in vision (disco balls, blind spots, fireworks etc.) called an aura that alert a person the headache is impending.

OMM is effective in treating both types in different ways.

  • In moderate to severe headaches, OMM provided relief at the time of treatment, but was also found provide relief lasting days or weeks beyond the time of treatment.

  • Patients receiving OMM for tension headaches reported

    • Decreased frequency of headaches

    • Decreased pain intensity

    • Decreased use of over the counter (OTC) medications (Tylenol, Advil, Excedrin etc.)

    • Lower scores on the headache disability self-reporting form, meaning their lives were less interrupted (fewer days missed at work, fewer activities cancelled, greater enjoyment of life activities, and less worry about a headache necessitating cancelled plans and life activities)

    • Most importantly some of these improvements lasted months after the treatment period ended

Migraines

In this study migraine sufferers were given a single 50 min treatment once a week for 10 weeks.

On the HRQ and MIDAS (questionnaires to determine the severity of migraines and how much they affect a person’s daily functioning such as missing work showed improvement in multiple metrics:

  • Decreased severity of migraines

  • Fewer missed days at work

  • Decreased impact on life as a whole both work and private

  • Had fewer headaches overall

  • Self reported improvement in general quality of life

Fight or flight

Your body has two nervous systems. The sympathetic nervous system aka fight/flight/freeze and the parasympathetic nervous system aka rest and digest. We live on a continuum between fully relaxed in parasympathetic mode or totally keyed up sympathetic mode such as when you wake up feeling rested and realize it’s because you’re two hours late for work. The calming effect of the parasympathetic system originates in the brain and exits the skull, both as chemicals, as neurotransmitters, in the blood and as the vagus nerve.. The hyper-vigilant ready for action, fight for your life neurons arise near the spinal cord and act as the counterbalance. The balance of these two systems determines the function of the internal organs they share control of such as heart rate, breathing rate, digestion.

In modern society, chronic postures frequently create distortions and spasms at the base of the skull and in the neck. Injuries such as whiplash from car crashes compound this. The calming effect of the parasympathetic nervous system is impaired in its ability to contribute and only provides a fraction of what would normally be called for. This plays out as anxiety, insomnia, panic attacks, irritability, inability to relax and eventually depression. Structural problems have structural solutions.

When exposed to noxious or irritating stimuli, patients that had received OMM vs. sham touch or none at all were calmer and experienced less stress. (Sham touch is non-directed contact.)

Vertigo

This is another symptom that can come on after a car accident or traumatic brain injury (ex. concussion) or simply with age. The body determines where it is in space via a system of three semicircular canals of fluid in the bones of the temporal bone . They are oriented at 90 angles at each other along the S, Y, and Z axis of a coordinate plane and have small hairs that are hooked up with the nervous system. As we move our heads the fluid causes the tiny hairs to move with the current and our brain uses that to tell us where our body is in space. When the information reaching the brain doesn’t match from the various canals and/or eyes the result is vertigo.

  • After a single treatment, regardless of the underlying cause of the vertigo, patients had benefits both immediately after and one week later citing better balance and improved ability to function normally.

Works Cited

Migraines:

  • Voigt K, Liebnitzky J, Burmeister U et al. Efficacy of osteopathic manipulative treatment of female patients with migraine: results of randomized controlled trial. J Altern Complement Med. 2011 17(3): 225-230.

Vertigo

  • Friax M, Gordon A, Gram V, et al. Use of the SMART Balance Master to quantify the effects of osteopathic manipulative treatment in patients with dizziness. J Am Osteopath Assoc. 2013. 113 (5) 394-403.

Tension headache

  • Rolle G, Tremolizzo L, et al. Trial of Osteopathic Manipulative Therapy for Patients with Frequent Episodic Tension-Type Headache. J Am. Osteopath Assoc. 2014. 114 (9): 678-685

  • Hurwitz EL, Acker PD, Adams AH, et al; Manipulation and mobilization of the cervical spine: A systematic review of the literature. Spine. 1996. 21: 1746-1760.

  • Nisson N, Christiansen HW, Hartivgsen J. The effect of spinal manipulation in the treatment of cervicogenic headache. Journal of Manipulative Physiological Therapeutics. 1997. 20: 326-330.

Neck pain

  • McReynolds TM, Sheridan BJ: Intramuscular ketorolac versus osteopathic manipulative treatment in the management of acute neck pain in the emergency department: a randomized clinical trial. JAOA. 2005, 105 (2) 57-67.

Low Back pain

  • Seffinger MA, Hruby RJ. Illustrator Kuchera WA. Evidence Based Manual medicine: A Problem Oriented Approach, Saunders Elsevier, 2007, pages 80-83.

  • Licciardone JC, Gatchel RJ, Aryal, S. Targeting Patient Subgroups with Chronic Low Back Pain for Osteopathic Manipulative Treatment, J Am Osteopath Assoc. 2016. 116(3): 156-168, 144-155