Osteopathic Manipulation in Patients With Chronic Asthma

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Table of Contents

Introduction
Aims of Study
Methodology Used by the Researchers
Results
Conclusion
Literature Review
Clinical Relevance
References

Introduction

Osteopathic manipulation is an alternative mode of medical therapy and is gradually gaining popularity and acceptance in the medical community especially in the United States and European nations (Bockenhauer et al. 2002). There are however no controlled trials and studies supporting its efficiency. Osteopathic manipulation principles are based on the interrelationship between body organs and their function and the belief in the bodys natural ability to heal itself.

This article seeks to criticise the application of osteopathic manipulation in the treatment of asthma patients. Several articles investigating the effectiveness of acupuncture as a treatment of asthma have generated conflicting results (Guyton & Hall 2009). Investigations by a group of researchers showed quantifiable improvement in bronchial response to histamine and asthma severity. This study was however limited to spinal thrusting, a technique applied by chiropractors.

Aims of Study

The study reported in this article seeks to critic the hypothesis that osteopathic manipulation techniques can be designed to increase respiratory motion. It also pinpoints the weaknesses of these techniques and their inefficiencies. The study is designed to collect both objective and subjective statistics before and after the application of four well-defined osteopathic manipulation therapy techniques. Benefits that would arise from multiple treatment sessions are sacrificed in a bid to exclude confounding factors.

The focus is on the intervention of osteopathic manipulation therapy in restoring normal functioning and compliance to the thoracic cage that is objectively measurable. Patients reports of asthma symptoms and progressive severity have also been monitored to establish any immediate or future change that can be associated with the therapy. The article also seeks to use thoracic vertebrae articulation to find a statistically viable improvement in hyper-reactivity explainable by the effect of treating viscerosomatic reflex areas and return to normal sympathetic nervous system response. Care should be taken to determine whether this therapy will have adverse effects on the patient.

Methodology Used by the Researchers

The researchers used a pre-test-post-test crossover approach where every patient was treated through osteopathic manipulation procedures in line with sham procedures on different dates at least a week apart. This way the patients would serve as their control. Patients underwent two cycles of the pre-test-intervention-post-test protocol. One of these cycles consisted of four recognized Osteopathic Manipulation procedures that included balanced ligamentous tension in the occipitoatloid and cardiothoracic junctions (Ziment 2008).

The examiner measured thoracic excursion at two different locations in 15 minutes before and after each intervention. This methodology ensured that the patients progress was closely monitored. The methodology however leaves a loophole in the sense that the patients condition and response to the therapy may fluctuate after some time (Ziment 2008). The environmental conditions such as humidity, temperature and oxygen concentration may also influence the results of this study (Szentivaneji & Goldman 2009).

A handheld peak-flow meter was used to measure and monitor the thoracic excursions and collect the patients subjective assessment of symptoms. Information as to whether the patients were going to receive osteopathic manipulation, or a sham was concealed from the examiners by the investigator. For thoracic wall measurements, patients were undressed and instructed to take in full inspiration followed by complete expiration. These points in the human body are hard to spot and will require specialized expertise. This procedure is also prone to error (Guyton & Hall 2009).

The osteopathic manipulation procedures took place in settings similar to those of subjects in the same position on the therapy table. Manual pressure was applied on the thoracic outlet region, the occipitoatloid and cervicothoracic junction and the epigastric region. Upper extremities were circumducted at the shoulder region through a passive motion at a partial range.

The researchers in this article chose to recruit patients from Brooklyn, New York. This was because patients from this population were likely to be familiar with osteopathic manipulation therapy. They held a belief that previously treated patients would be able to recognize sham procedures. This selection method is however not completely effective since there is a possibility that some of the patients may not have undertaken osteopathic manipulation therapy (Ziment 2008). Primary care physicians from community-based clinics were requested to recruit and refer all asthma patients who had attained the age of 18 diagnosed through their history and physical examination (Bockenhauer et al. 2002).

Those patients found to have had a change in asthma medication in the past 4 weeks, concomitant diagnosis of congestive heart failure, cancer, cirrhosis, renal failure and expectant mothers were however excluded from the research since it was believed that they were likely to face complications that would confound data. Ten eligible individuals were used in the research. The patients volunteered to participate in the research and signed a consent agreement. It is however hard to establish this since patients are vulnerable and can be easily manipulated (Ziment 2008).

Results

After carefully administering osteopathic manipulation therapy, no complications were recorded. Some patients reported having felt relaxed after both osteopathic manipulation and sham procedures. Two of the patients reported light-headedness after osteopathic manipulation. However, complications might arise days or even months after administering osteopathic manipulation procedures. The patients reaction should be monitored closely over a long period to ascertain that the patient has been fully treated.

Patients showed increased respiration motions after undergoing osteopathic manipulation procedures as compared to sham procedures. Upper thoracic excursion significantly increased with osteopathic manipulation while no increase was noted on the application of sham procedures. This is evidence that osteopathic procedures are more reliable than sham procedures. It is however hard to tell how long these effects will last. Repeated administration of these procedures would mean extra costs being incurred by the patient.

Subjects reported improved ease in breathing after receiving both osteopathic manipulation and sham procedures. The difference between the two was of no statistical significance. Ease in breathing is also a feeling hence not tangible. This implies that improved breathing cannot be used as a measure of osteopathic manipulations success.

Conclusion

Osteopathic manipulation procedures showed desirable results on patients. Such results included improved ease of breathing, increased respiratory motion and reduced complications. As a result of this, osteopathic manipulation procedures are preferable as compared to sham procedures. Focus however must be put on the availability of these services. It is also not surprising that these services are expensive and out of reach of low and middle-income patients.

Literature Review

The study reported in this article seeks to test the hypothesis that osteopathic manipulation procedure is a viable treatment for asthma patients. Osteopathic manipulation therapy aims to affect therapeutic responses through three distinct physiological mechanisms. At first, physicians attempt to restore full compliance to the thoracic cage aimed at increasing the patients respiratory motion. Asthma patients suffer from respiratory exacerbation resulting in overuse injury to the respiratory system. Osteopathic manipulation helps release such strains (Szentivaneji & Goldman 2009).

The second physiological mechanism intends to affect the response of the patient autonomic nervous system function. Study shows branches of the nervus vagus provides parasympathetic intervention to pulmonary structures and diaphragm. Though considered helpful, these procedures are not present in many developing countries and are limited to the privileged few.

Finally, osteopathic manipulation can facilitate lymphatic flow to and from the bronchus. Tissues at times become oedematous and metabolic waste accumulates when the lymphatic flow is inhibited. This adversely affects cellular functions causing diseases. Osteopathic Manipulation Therapy can be used to release strains in the myofascial and lymphatic vessels.

Despite the numerous benefits associated with osteopathic manipulation, this form of therapy also has some shortcomings. Some measures of the therapys success are not quantifiable. Some patients reportedly feel lightheaded after therapy. It is however not possible to tell how lightheaded one feels. This makes one question the success of the therapy.

Osteopathic manipulation therapy is also not very popular, especially in developing countries. Therapy can only be fully adopted as a success if it has been widely tested and proven to produce consistent results. Many costly activities are also involved making the service unaffordable to many. This therapy should thus be offered widely to win over peoples support.

Clinical Relevance

Osteopathic manipulation therapy is gaining popularity among members of society especially in European countries and the United States. Research has shown that this therapy is complication-free and can help treat respiratory disorders such as asthma. Although used on small scale, osteopathic manipulation has shown great potential and can turn out to be a preferable treatment for such ailments.

References

Bockenhauer, S et al. 2002, Quantifiable effects of osteopathic manipulative techniques on patients with chronic asthma, JAOA, vol. 102 no. 7, pp. 371-375.

Guyton, H & Hall, G 2009, Medical physiology, Free Press, New York.

Szentivaneji, A & Goldman, A 2009, Vagotonia and bronchial asthma, Thomas Learning, South Carolina.

Ziment, I 2008, Alternative therapies for asthma, Free Press, New York.

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