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Osteopathic Manipulative Treatment for Low Back Pain

  • Vimala Ponna , Joel Talsma and Stacey Pierce-Talsma
Published/Copyright: June 1, 2020
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Journal of Osteopathic Medicine
From the journal Journal of Osteopathic Medicine Volume 120 Issue 6

Osteopathic Manipulative Treatment for Low Back Pain

eVideo. In this video, prone pressure with counterleverage and the sacroiliac joint articulatory technique are demonstrated.

Low back pain (LBP) is a frequent presenting complaint, affecting at least one-quarter of US adults and serving as a leading cause of disability.1-2 Most LBP is categorized as nonspecific, in which there is no identifiable cause.2 Acute or subacute LBP typically improves over time. If nonpharmacologic treatment is preferred, heat, massage, acupuncture, and spinal manipulation including osteopathic manipulative treatment (OMT) may offer some relief.1,3

OMT is an effective tool for diagnosing and managing musculoskeletal LBP,3 and it has been reported to reduce pain levels and improve function in patients with LBP, including pregnant and postpartum patients.3–5 An observational study demonstrated decreased pain medication use and an association with decreased work absenteeism in patients who received OMT for LBP.6

LBP is a common reason a patient will present for OMT.4 Anatomic areas to assess for somatic dysfunction may include the erector spinae (iliocostalis, longissimus, and spinalis), multifidus, iliopsoas, and quadratus lumborum muscles. Additional assessment may include the motion of L5 and the sacroiliac joint, a synovial and fibrous joint that transmits the weight of the body to the pelvis and is thought to be innervated by the dorsal rami of L5-S2.7 Other anatomic regions to assess and treat commonly include local and distant regions, such as the thoracic, pelvic, rib, and lower extremity regions.6

Soft tissue and articulatory techniques may be beneficial to patients with LBP. In this video, we demonstrate prone pressure with counterleverage and the sacroiliac joint articulatory technique.8-10

Prone treatments to the pelvic region are not recommended for elderly patients with osteoporosis.8 Performing soft tissue or articulatory treatments over acute strains or sprains, fractures or dislocations, joint instability, pathology (neurologic, vascular, or unknown origin), cancer, or infection is contraindicated.8 OMT is generally safe and well tolerated in patients with LBP, with few minor adverse events.4

Using OMT to manage somatic dysfunction may help decrease the overuse of imaging, opioids, invasive interventions, and surgery in patients with LBP.2 Partnering with patients in a mind, body, and spirit approach may help to address lifestyle issues such as smoking, obesity, and depression, which are known to increase the risk of LBP.2 Encouraging exercise and providing education may also help mitigate LBP recurrences.2 The treatments performed in this video are not intended for any specific clinical condition but are only 1 aspect of the diagnosis and treatment plan an osteopathic physician may use to address the whole patient.

From Touro University College of Osteopathic Medicine-CA in Vallejo.
Financial Disclosures: None reported
Support: This video was produced by Touro University College of Osteopathic Medicine-CA.

*Address correspondence to Stacey Pierce-Talsma, DO, 11 Hills Beach Rd, Biddeford, ME 04004. Email:

Acknowledgment

We thank Jeff Reedy for video contributions.

Resources

1. QaseemA, WiltTJ, McLeanRM, ForcieaMA; Clinical Guidelines Committee of the American College of Physicians. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017;166(7):514-530. doi:10.7326/M16-2367Search in Google Scholar

2. MaherC, UnderwoodM, BuchbinderR. Non-specific low back pain. Lancet. 2017;389(10070):736-747. doi:10.1016/S0140-6736(16)30970-9Search in Google Scholar

3. Clinical Guideline Subcommittee on Low Back Pain. American Osteopathic Association Guidelines for osteopathic manipulative treatment (OMT) for patients with Low Back Pain.J Am Osteopath Assoc. 2010;110(11):653-666.Search in Google Scholar

4. FrankeH, FrankeJD, FryerG. Osteopathic manipulative treatment for nonspecific low back pain: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2014;15:286. doi:10.1186/1471-2474-15-286Search in Google Scholar PubMed PubMed Central

5. LicciardoneJC, KearnsCM, MinottiDE. Outcomes of osteopathic manual treatment for chronic low back pain according to baseline pain severity: results from the OSTEOPATHIC Trial. Man Ther. 2013;18(6):533-540. doi:10.1016/j.math.2013.05.006Search in Google Scholar PubMed

6. PrinsenJK,HenselKL,SnowRJ. OMT associated with reduced analgesic prescribing and fewer missed work days in patients with low back pain: an observational Study. J Am Osteopath Assoc.2014;114(2):90-98. doi:10.7556/jaoa.2014.022Search in Google Scholar PubMed

7. VleemingA, SchuenkeMD, MasiAT, CarreiroJE, DanneelsL, WillardFH. The sacroiliac joint: an overview of its anatomy, function and potential clinical implications. J Anat. 2012;221(6):537-567. doi:10.1111/j.1469-7580.2012.01564.xSearch in Google Scholar PubMed PubMed Central

8. NicholasA, NicholasE.Atlas of Osteopathic Techniques.2nd ed. Lippincott Williams & Wilkins;2012:80,109,531.Search in Google Scholar

9. DiGiovannaE, SchiowitzS, DowlingD.An Osteopathic Approach to Diagnosis and Treatment.3rd ed. Lippincott Williams & Wilkins; 2005:243.Search in Google Scholar

10. NelsonK, GlonekT.Somatic Dysfunction in Osteopathic Family Medicine. 2nd ed. Wolters Kluwer; 2015:198-199,222-223.Search in Google Scholar

Received: 2020-02-15
Accepted: 2020-03-30
Published Online: 2020-06-01
Published in Print: 2020-06-01

© 2020 American Osteopathic Association

Articles in the same Issue

  1. SURF
  2. Lumbar Diagnosis and Pressure Difference Variance
  3. OMT MINUTE
  4. Osteopathic Manipulative Treatment for Low Back Pain
  5. LETTERS TO THE EDITOR
  6. Influence of Research on Osteopathic Medical Student Residency Match Success
  7. ORIGINAL CONTRIBUTION
  8. How Trainees Finance Their Medical Education: Implications of Higher Education Act Reform
  9. Choosing Primary Care: Factors Influencing Graduating Osteopathic Medical Students
  10. BRIEF REPORT
  11. Empathy in Medicine Self and Other in Medical Education: Initial Emotional Intelligence Trend Analysis Widens the Lens Around Empathy and Burnout
  12. ORIGINAL CONTRIBUTION
  13. Implied Evidence of the Functional Role of the Rectus Capitis Posterior Muscles
  14. REVIEW
  15. The Role of Sphenobasilar Synchondrosis in Disease and Health
  16. CLINICAL PRACTICE
  17. Partnering With Patients to Reduce Firearm-Related Death and Injury
  18. SPECIAL COMMUNICATION
  19. Buying Time: Using OMM to Potentially Reduce the Demand for Mechanical Ventilation in Patients With COVID-19
  20. CASE REPORT
  21. Integrating Osteopathic Manipulative Treatment and Injections in the Diagnosis and Management of a Hip Labral Tear
  22. CLINICAL IMAGES
  23. Graves Orbitopathy
https://doi.org/10.7556/jaoa.2020.067

Articles in the same Issue

  1. SURF
  2. Lumbar Diagnosis and Pressure Difference Variance
  3. OMT MINUTE
  4. Osteopathic Manipulative Treatment for Low Back Pain
  5. LETTERS TO THE EDITOR
  6. Influence of Research on Osteopathic Medical Student Residency Match Success
  7. ORIGINAL CONTRIBUTION
  8. How Trainees Finance Their Medical Education: Implications of Higher Education Act Reform
  9. Choosing Primary Care: Factors Influencing Graduating Osteopathic Medical Students
  10. BRIEF REPORT
  11. Empathy in Medicine Self and Other in Medical Education: Initial Emotional Intelligence Trend Analysis Widens the Lens Around Empathy and Burnout
  12. ORIGINAL CONTRIBUTION
  13. Implied Evidence of the Functional Role of the Rectus Capitis Posterior Muscles
  14. REVIEW
  15. The Role of Sphenobasilar Synchondrosis in Disease and Health
  16. CLINICAL PRACTICE
  17. Partnering With Patients to Reduce Firearm-Related Death and Injury
  18. SPECIAL COMMUNICATION
  19. Buying Time: Using OMM to Potentially Reduce the Demand for Mechanical Ventilation in Patients With COVID-19
  20. CASE REPORT
  21. Integrating Osteopathic Manipulative Treatment and Injections in the Diagnosis and Management of a Hip Labral Tear
  22. CLINICAL IMAGES
  23. Graves Orbitopathy
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