OMT for Low Back Pain Relief

Effect of OMT on Low Back Pain

• A systematic review and meta-analysis focused on osteopathic manipulative treatment for non-specific lower back pain.
• The study reviewed literature for randomized clinical trials on generalized low back pain, measuring improvements in pain and functional status.
• Out of 307 studies, 15 met the criteria, with 10 investigating OMT effectiveness for non-specific low back pain, 3 for pregnancy-related pain, and 2 for postpartum pain.
• Moderate quality evidence suggests OMT significantly relieves pain and improves function for non-specific and postpartum low back pain.
• Results for pregnancy-related pain were similar, though evidence quality was lower.
• OMT reduces pain and improves function in acute and chronic low back pain, including non-specific, pregnancy-related, and postpartum pain.
• Studies analyzed used the Cochrane risk of bias tool, examining modalities like general OMT, myofascial release, and cranial/visceral manipulation.
• OMT was more effective than control interventions in reducing pain and improving functional status.
• Myofascial release was more effective than control-only, reducing pain and increasing functional ability, with benefits persisting into follow-up visits.
• Myofascial release showed superior improvement in pain relief and increased functional status compared to cranial and visceral manipulation.

Effect of OMT on Gastroesophageal Reflux Disease (GERD)

• A study by Silva and Group measured lower esophageal sphincter pressure after OMT in GERD patients.
• The diaphragm was treated to balance muscle tone, with manometry used to check lower esophageal sphincter pressure changes.
• Esophagus passes through the diaphragm at the T10-T12 level.
• Lower esophageal pressure was measured before and after OMT on 38 patients, 16 receiving OMT, 22 receiving sham OMT.
• OMT statistically increased lower esophageal pressure directly after treatment.

Effect of OMT on Irritable Bowel Syndrome (IBS)

• An Italian Air Group study examined short-term and long-term effects of visceral osteopathy on IBS.
• 31 patients with refractory IBS were enrolled in a randomized, crossover, placebo-controlled study.
• The effect of OMT was measured on IBS-related depression, diarrhea, abdominal distension, and abdominal pain.
• Visceral osteopathy was associated with significant amelioration of diarrhea, abdominal distension, and abdominal pain.
• Patients' mood didn't change much, but rectal pain decreased, possibly due to diarrhea improvement.
• Improvements lasted over one year after initial study enrollment.
• Visceral osteopathy offers short-term and long-term benefits for relieving pain and symptoms related to IBS.

Meet Max

• Max is 42 years old, a truck driver.
• He visited the family medicine clinic complaining of low back pain.

Prevalence of Low Back Pain

• 45% of the general population experiences low back pain each year.
• 60-84% of men will experience low back pain at some point in their lives.
• Approximately 13 million doctor visits this year will be due to low back pain.
• Low back pain ranks as the third most common reason for surgery and the fifth most common reason for hospital admission.

Differential Diagnosis of Low Back Pain

• Can be divided into acute (less than three months duration) or chronic (more than three months duration).
• Mechanical low back pain is caused by muscle strain, ligament sprain, disc herniation, lumbar spinal stenosis, spondylolisthesis/spondylolysis, vertebral compression fractures, and traumatic injuries.
• Non-mechanical low back pain can be caused by infection, inflammation, and cancer.
• Non-localized low back pain may be psychological or referred from visceral/retroperitoneal causes.

Max's Medical Visit

• Max explains that he's had low back pain for a week since finishing a delivery.
• Bending forward makes it better.
• He feels it in the groin, high on his left leg, especially after long drives.
• Max denies loss of bowel/bladder control, numbness in genitals/thighs, weight changes, night sweats, or pain radiating down his legs.

Physical Exam & Diagnostic Clues

• Max's answers rule out cauda equina syndrome, cancer with spinal metastasis, and radicular pain.
• Max has normal muscle strength and deep tendon reflexes; straight leg raise test is negative.
• Pain is triggered when the doctor pushes on the anterior pelvis.
• Max has a stooped posture, and pain is alleviated by bending forward, suggesting spinal stenosis or psoas spasm.
• Max drives 12-16 hours daily with infrequent stretching.

Treatment Plan

• The doctor diagnoses a spasm in Max's iliopsoas muscle due to prolonged sitting.
• The doctor recommends physical therapy, stretching, and muscle heat therapy.
• A muscle relaxer is offered as an option, along with OMT.

OMT Approach

• The OMT plan focuses on balancing autonomics, treating lymphatics, and targeting somatic dysfunction (psoas spasm).
• The plan includes tibial brushing to the sympathetic chain, lymphatic treatment for the low back, and strain-counterstrain for the psoas muscle.

Follow-Up & Advice

• The doctor schedules a follow-up in two weeks and advises Max to stretch every two hours while driving.

Understanding Gastroesophageal Reflux Disease (GERD)

• GERD occurs when gastric contents reflux into the esophagus, irritating the lining.
• GERD symptoms include gastric burning, cough, laryngitis, asthma, and dental erosions.
• Large meals with spicy food, chocolate, caffeine, mint, and citrus can trigger symptoms.

Diagnosis of GERD

• Trial of a proton pump inhibitor to see if symptoms improve.

GERD Diagnosis & Treatment Plan

• The doctor diagnoses GERD.
• The plan involves esomeprazole and osteopathic manipulation.
• Osteopathic manipulation can increase lower esophageal sphincter tone to prevent acid reflux.

Sympathetic & Parasympathetic Innervation Relative to GERD

• Sympathetic innervation to the stomach from T5 to T9 regulates blood flow and inhibits gastric secretion.
• Parasympathetic innervation via the vagus nerve affects gastrin secretion, which stimulates gastric acid production.

Lymphatic Drainage & Treatment Approaches

• Lymphatic drainage from the stomach travels through gastric and gastromental lymph nodes.
• Lymphatic treatment approaches include treating Sibson's fascia, the diaphragm, or performing a mesenteric release.

Somatic Dysfunction & Additional Considerations

• Consider Chapman’s points at the fifth intercostal space on the left, which corresponds to stomach acidity.
• Treat the celiac ganglion with ventral inhibition.

Overview of Irritable Bowel Syndrome (IBS)

• IBS is a GI disorder causing intermittent bowel pain, bloating, diarrhea, and constipation.
• IBS symptoms begin in the late teens or early 20s and tend to fluctuate.
• IBS is a common complaint in family medicine settings.

Patient Conversation

• Recommending a FODMAP diet, cyclobenzaprine, and osteopathic manipulation.

Physical Exam & Lab Findings

• Physical exam reveals normal bowel sounds.
• Lab results are typically negative.

Holistic Osteopathic Treatment Approach

• Dietary & Lifestyle: FODMAP diet, regular exercise, and peppermint oil.
• Standard of care: Antispasmodics for constipation.

Osteopathic Goals for IBS Treatment

• Remove restrictions to gut motility.
• Improve lymphatic flow to reduce inflammation.

Strain Counterstrain of Lower Pole L5 (LPL5)

• The tender point is located on the ilium, just inferior to the PSIS.
• Pain established as "10 out of 10" then hip/knee flexed to 90 degrees
• Internally rotate and adduct the hip to reduce pain (ideally to zero).
• Hold for 90 seconds, then slowly return to neutral.

Still Technique of the Suboccipital Muscles

• Diagnose hypertonic suboccipital muscles.
• Place fingers inferior to occiput, cradle head, flex head to muscle relation
• Introduce traction and extend the head, translating C1 anteriorly with fingers.

Cisterna Chyli Pump – Thoracic Duct Technique

• Used for swelling, edema, or abdominal distension
• The patient lies supine. The physician stands at the side of the table
• Apply posterior-directed vibratory force to the abdomen just below the costal margin
• Continue until fluid decongestion is perceived