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Effect of osteopathic manipulation on gait asymmetry

  • Cherice N. Hill , M’Lindsey Romero , Mark Rogers EMAIL logo , Robin M. Queen and Per Gunnar Brolinson
Published/Copyright: November 18, 2021
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Journal of Osteopathic Medicine
From the journal Journal of Osteopathic Medicine Volume 122 Issue 2

Abstract

Context

Movement and loading asymmetry are associated with an increased risk of musculoskeletal injury, disease progression, and suboptimal recovery. Osteopathic structural screening can be utilized to determine areas of somatic dysfunction that could contribute to movement and loading asymmetry. Osteopathic manipulation treatments (OMTs) targeting identified somatic dysfunctions can correct structural asymmetries and malalignment, restoring the ability for proper compensation of stresses throughout the body. Little is currently known about the ability for OMTs to reduce gait asymmetries, thereby reducing the risk of injury, accelerated disease progression, and suboptimal recovery.

Objectives

To demonstrate whether osteopathic screening and treatment could alter movement and loading asymmetry during treadmill walking.

Methods

Forty-two healthy adults (20 males, 22 females) between the ages of 18 and 35 were recruited for this prospective intervention. Standardized osteopathic screening exams were completed by a single physician for each participant, and osteopathic manipulation was performed targeting somatic dysfunctions identified in the screening exam. Three-dimensional (3-D) biomechanical assessments, including the collection of motion capture and force plate data, were performed prior to and following osteopathic manipulation to quantify gait mechanics. Motion capture and loading data were processed utilizing Qualisys Track Manager and Visual 3D software, respectively. Asymmetry in the following temporal, kinetic, and kinematic measures was quantified utilizing a limb symmetry index (LSI): peak vertical ground reaction force, the impulse of the vertical ground reaction force, peak knee flexion angle, step length, stride length, and stance time. A 2-way repeated-measures analysis of variance model was utilized to evaluate the effects of time (pre/post manipulation) and sex (male/female) on each measure of gait asymmetry.

Results

Gait asymmetry in the peak vertical ground reaction force (−0.6%, p=0.025) and the impulse of the vertical ground reaction force (−0.3%, p=0.026) was reduced in males following osteopathic manipulation. There was no difference in gait asymmetry between time points in females. Osteopathic manipulation did not impact asymmetry in peak knee flexion angle, step length, stride length, or stance time. Among the participants, 59.5% (25) followed the common compensatory pattern, whereas 40.5% (17) followed the uncommon compensatory pattern. One third (33.3%, 14) of the participants showed decompensation at the occipitoatlantal (OA) junction, whereas 26.2% (11), one third (33.3%, 14), and 26.2% (11) showed decompensation at the cervicothoracic (CT), thoracolumbar (TL), and lumbosacral (LS) junctions, respectively. Somatic dysfunction at the sacrum, L5, right innominate, and left innominate occurred in 88.1% (37), 69.0% (29), 97.6% (41), and 97.6% (41) of the participants, respectively.

Conclusions

Correcting somatic dysfunction can influence gait asymmetry in males; the sex-specificity of the observed effects of osteopathic manipulation on gait asymmetry is worthy of further investigation. Osteopathic structural examinations and treatment of somatic dysfunctions may improve gait symmetry even in asymptomatic individuals. These findings encourage larger-scale investigations on the use of OMT to optimize gait, prevent injury and the progression of disease, and aid in recovery after surgery.

Keywords: biomechanics; injury risk; osteopathic postural assessment; somatic dysfunction

The use of manual medicine for the treatment of musculoskeletal complaints dates back to around 400 B.C. when Hippocrates utilized manipulation on the ancient Greek athletes [1]. Present-day osteopathic medicine focuses on the body’s unique ability to heal itself as well as the interrelationship between structure and function [1]. Osteopathic physicians may employ manual medicine techniques with the goal of restoring maximal, pain-free appendicular and axial skeletal joint movements. To accomplish this goal, a physician needs to be able to identify dysfunctional movement patterns and seek to correct the dysfunctional structure(s) leading to functional improvements.

Andrew Taylor Still, D.O., the founder of osteopathy and osteopathic medicine, said, “The fascia is the place to look for the cause of disease and the place to consult and begin the action of remedies in all diseases” [2]. In accord, Gordan Zink, D.O., conceptualized and created a structural screening examination that focuses on fascial distortion throughout the body [2]. This systematic fascial distortion is considered common because it can be found in a large proportion of the population, among both symptomatic and asymptomatic people, thus it is appropriately named the “common compensatory pattern” [2]. Zink’s screening method is an efficient way to evaluate structure and function. It focuses on identifying the fascial preference at the transition zones, i.e., occipitoatlantal/atlantoaxial (OA/AA) junction, cervicothoracic (CT) junction, thoracolumbar (TL) junction, and the lumbosacral (LS) junction. These junctional areas are subject to the greatest soft tissue strain and are the areas where fascial function first changes. Zink believed that if a person had alternating fascial preferences, the fascial preferences are healthy and could compensate for stressors placed on the body [2]. This screening method can identify limb asymmetries and show a relationship with fascial preference present at the transition zones. Although no person is perfectly symmetric, identifying whether a person is in a compensated pattern could indicate an ability to produce proper movement mechanics.

Quantifying movement mechanics and associated movement asymmetry is an important part of assessing human locomotion, with gait being the most commonly assessed. Gait asymmetry can be defined as a difference in the behavior of the lower limbs during walking. Many researchers have discussed functional asymmetries with differential contributions to propulsion and control between limbs [3], [4], [5], [6], [7], [8], [9]. However, movement asymmetries, including those observed during gait, are more commonly associated with a higher risk of injury and pathology along with accelerated disease progression [10], [11], [12], [13], [14], [15], [16], [17], [18], [19].

Temporal, kinetic, and kinematic gait characteristics carry clinical importance as potential targets for interventions aimed at preventing injury, slowing disease progression, and maximizing recovery after injury or surgery. Gait asymmetries in many of these measures have been previously observed in clinical populations [20], [21], [22]. Asymmetries in temporal measures including stride, stance, and swing times may indicate protective compensatory movement patterns. Kinetic measures such as ground reaction force profiles and kinematic measures such as joint ranges of motion offer insight into resultant loading and joint movement patterns, respectively. Technologies such as gait mats, inertial measurement units, and in-shoe pressure insoles now enable the accessible and objective collection of these gait measures in a clinical environment. Therefore, objective gait assessment can now be incorporated in regular clinical evaluation and in response to clinical interventions. The ability to reduce gait asymmetries in these measures could carry impactful therapeutic implications.

Few studies have evaluated the use of manual therapies and their effect on gait asymmetry [23], [24], [25], [26]. Given the principles and philosophy behind osteopathic manipulation, it stands to reason that utilizing an osteopathic screening method like the common compensatory pattern and treating key areas of somatic dysfunction utilizing osteopathic treatment techniques may affect gait and reduce asymmetries, thereby reducing the risk of injury and the risk or progression of osteoarthritis. Previous studies did not utilize a standard whole-body osteopathic screening method and instead focused on screening and treatment of a limited area of the body such as the sacroiliac joint [23], [24], [25], [26]. Prior biomechanical analyses have not assessed temporal, kinetic, and kinematic variables along with an osteopathic evaluation [23], [24], [25], [26]. Additionally, a previous study of 100 healthy college-age participants found that females exhibit different structural characteristics including greater anterior pelvic tilt (+38.7%), femoral internal rotation (+101.1%), knee hyperextension (+168.9%), and knee valgus (+20.2%) compared to males [27]. In a previous study of 23 females during menses, there was a higher likelihood of somatic dysfunction in the lumbar spine (+39.1%), left innominate dysfunction (+9.0%), and posterior chapman points (+30.4%), which are smooth, palpable, organ-specific ganglioform contractions associated with underlying visceral dysfunction [28]. As such, sex is a crucial factor to consider in postural analyses and investigations of manual therapy effects. Therefore, the purpose of this study was to demonstrate whether osteopathic screening and treatment could alter movement and loading asymmetry during treadmill walking. We hypothesized that gait asymmetry would be reduced following an osteopathic manipulation treating identified dysfunctions in both males and females despite potential structural differences between sexes. This hypothesis was based on an expectation that osteopathic manipulation would decrease structural asymmetries, which would in turn reduce functional asymmetries during gait.

Methods

Participants

Forty-two recreationally active adults between the ages of 18 and 35 were recruited. Exclusion criteria included a history of major lower extremity surgery, currently being under the care of a medical professional for any musculoskeletal disease or injury, and any lower-extremity injury in the past three months limiting physical activity for more than one day. Informed consent approved by the Institutional Review Board (IRB#2016-051) was obtained from the participants prior to study participation. The researcher explained the study, the associated risks, and what the participant would be asked to do before giving the participant additional time to read the consent form and obtaining the participant’s signature indicating consent to participate. This study is listed in the ClinicalTrials.gov registry (NCT04860999) in alignment with the Declaration of Helsinki.

Participant age and sex, as either male or female, was indicated by the participant. All participants completed an osteopathic postural assessment utilizing the screening technique of Dr. Zink [2] described above and a pre-manipulation biomechanical assessment in random order, followed by an osteopathic manipulation and a post-manipulation biomechanical assessment (Figure 1). Pre- and post-manipulation biomechanics were compared in a paired manner to enable each participant to act as their own control.

Figure 1: Testing protocol.
Figure 1:

Testing protocol.

Osteopathic assessment and manipulation

A single osteopathic physician who regularly utilizes manual medicine techniques in clinical practice completed a standard osteopathic assessment utilizing the Zink screening method for each participant (Figure 2). The Zink method was chosen as the screening method to enable a generalized screening with a focus on transition areas [2]. The postural assessment began by evaluating posture in the sagittal plane looking for tendencies of lordosis and kyphosis, followed by comparing leg and arm lengths between sides. Pelvic and sacral symmetry, along with symmetry at the LS, TL, CT, and craniocervical (OA) junctions, was assessed by comparing the relative locations of major landmarks on each side and performing common clinical tests. For each landmark, either the side that allowed the easiest rotation with applied force (right/left) or the relative prominence (whether the landmark is higher/lower) was recorded. If no asymmetry was observed, equal rotation or prominence was recorded. According to the Zink model, a patient is either in a compensated or decompensated state [2]. This is determined based on the rotation of the transition zones, which are OA, CT, TL, and LS. A patient is considered compensated if they follow the rotation pattern of rotation to the left/right/left/right or less commonly right/left/right/left. If the patient does not follow an alternating pattern, he or she is deemed decompensated.

Figure 2: Osteopathic postural assessment form.
Figure 2:

Osteopathic postural assessment form.

After the osteopathic postural assessment and pre-manipulation biomechanical assessment, the osteopathic physician administered an appropriate osteopathic manipulation utilizing standard techniques for those with somatic dysfunctions [1]. He focused on areas not following the typical pattern, and structures were in a more neutral, functional position following treatment. He utilized muscle energy for pelvic dysfunctions, high-velocity low-amplitude for the spine, articulatory for rib dysfunctions, and facilitated positional release for sacral dysfunctions [1].

Biomechanical assessment

Participants wore form-fitting shorts and Nike Zoom neutral cushioning athletic running shoes (Nike Inc, Beaverton, OR) provided by the lab to control for the effects of clothing and footwear on gait mechanics [29, 30]. Reflective markers were placed bilaterally on lower-extremity bony landmarks to track motion of the body segments during walking (Figure 3). Anatomic markers were placed on the first and fifth metatarsal head, medial malleolus, medial femoral condyle, and iliac crest. Tracking markers were placed on the: lateral malleolus; superior, inferior, and lateral calcaneus; lateral femoral condyle; anterior superior iliac spine (ASIS); greater trochanter; posterior superior iliac spine (PSIS); and L4/L5 vertebrae (Figure 3). Anatomic markers were removed after a static calibration trial was recorded.

Figure 3: Lower-extremity marker set utilized during biomechanical testing. The photos were taken with participant consent.
Figure 3:

Lower-extremity marker set utilized during biomechanical testing. The photos were taken with participant consent.

Participants completed a 5 min walking trial at a set speed of 1.5 m/s. An 8-camera 3-D motion capture system (Qualisys, Gothenburg, Sweden) collected marker trajectory data (120 Hz). A fore-aft split belt instrumented treadmill (AMTI, Watertown, MA) collected tri-axial ground reaction forces (1,440 Hz). The first and last minutes of the trial were excluded to ensure consistent cadence.

Participants completed this biomechanical assessment twice: prior to osteopathic manipulation (pre-manipulation) and immediately after manipulation (post-manipulation). After the initial biomechanical assessment, markers on the L4/L5 vertebrae and PSIS were removed to enable the participant to lie supine on the testing table during the osteopathic assessment and/or manipulation. These markers, along with any additional markers knocked off during assessment or manipulation, were replaced prior to the post-manipulation biomechanical assessment. It should be noted that when markers were knocked off, the double-sided tape utilized to secure the markers to the body usually stayed in place, facilitating consistency in marker placement between biomechanical assessments. Additionally, all marker placement was completed by a single evaluator. Prior to the current study, repeatability of marker placement performed by this single evaluator was tested. Markers were placed with the same marker set utilized in the current study at two time points at least 30 min apart. At each time point, participants walked on the instrumented treadmill for 3 min while motion capture and force plate data were collected in the same manner described above. Interclass correlation coefficients were calculated on peak sagittal and frontal plane joint angles during the stance phase of gait between the time points. All correlations were found to be good, ranging from 0.89 to 1. Because the evaluator placed markers with high repeatability, needing to remove and replace markers between biomechanical assessments is not believed to have affected the results.

Data processing and statistical analysis

Motion capture and loading data were processed utilizing Qualisys Track Manager (Qualisys, Gothenburg, Sweden) and Visual 3D software (C-Motion, Bethesda, MD) and were filtered utilizing fourth-order, recursive Butterworth filters with cutoff frequencies of 7 and 15 Hz, respectively [31]. Ground reaction force was normalized to body mass [32], [33], [34], [35]. Visual 3D was utilized to identify heel-strike and toe-off events and to compute bilateral time series data, which was exported and utilized to calculate asymmetry in peak vertical ground reaction force, the impulse of the vertical ground reaction force, peak knee flexion angle, step length, stride length, and stance time. Heel-strike and toe-off timings were identified utilizing a force threshold of 25 N on ground reaction force magnitude, and heel-strike and toe-off timings were confirmed by visual inspection. Vertical ground reaction force, the impulse of the vertical ground reaction force, and peak knee flexion angle were identified during the stance phase of gait, defined from heel-strike to toe-off. The impulse of the vertical ground reaction force was defined as the area under the time-vertical ground reaction force curve. Asymmetry of each measure was quantified utilizing a limb symmetry index (LSI) [36]:

L S I = | X D − X N D | 0.5 ∗ ( X D + X N D ) ∗ 100 % ( 26 )

where an LSI of 0% reflects no asymmetry, and X D and X N D denote data for the dominant and nondominant limbs, respectively. Participants were asked to kick a soccer ball to identify their dominant lower limb. A two-way repeated-measures analysis of variance (ANOVA) model was run to evaluate the effects of time (pre/post-manipulation) and sex (male/female) on each gait asymmetry measure (α=0.05). Cohen’s d effect sizes were calculated when statistical significance was found with effect sizes 0.01<d≤0.2, 0.2<d≤0.5, 0.5<d≤0.8, and d>0.8 reflecting very small, small, medium, and large effect sizes, respectively [37, 38].

Results

Participants were 24.5 ± 3.9 years old (males, 24.2 ± 4.9 years; females, 24.9 ± 2.9 years), 1.8 ± 0.1 m tall (males: 1.8 ± 0.1 m; females: 1.7 ± 0.1 m), and weighed 72.8 ± 13.5 kg (males, 79.5 ± 14.6 kg; females, 66.6 ± 9.1 kg) on average (mean ± standard deviation).

Biomechanical findings

Means and standard deviations of each variable are shown in Table 1. Asymmetry of vertical ground reaction force and the impulse of the vertical ground reaction force decreased for males after osteopathic manipulation but did not change for females. No main effects or interactions were observed for asymmetry in peak knee flexion angle, step length, stride length, or stance time (Table 1).

Table 1:

Gait asymmetry (mean ± SD) measures and main and interaction effects for each variable.

Variable, LSI% Males Females Time Sex Time × sex
Pre Post Pre Post
Vertical ground reaction force 5.1 ± 2.2 4.5 ± 1.8 3.7 ± 0.7 3.7 ± 0.9 p=0.016* p=0.013* p=0.025*
d=0.180 a d=0.770 c
Vertical ground reaction force impulse 2.8 ± 0.9 2.5 ± 0.8 2.1 ± 0.5 2.12 ± 0.6 p=0.045* p=0.018* p=0.026*
d=0.189 a d=0.708 b
Peak knee flexion angle 7.7 ± 3.0 8.6 ± 3.5 9.2 ± 4.2 10.8 ± 6.0 p=0.072* p=0.12 p=0.657
Step length 2.6 ± 0.9 2.7 ± 0.8 3.2 ± 2.0 2.6 ± 1.1 p=0.325 p=0.329 p=0.275
Stride length 1.2 ± 0.5 1.0 ± 0.3 1.0 ± 0.5 1.1 ± 1.2 p=0.849 p=0.986 p=0.397
Stance time 1.8 ± 0.4 1.8 ± 0.4 1.7 ± 0.3 1.8 ± 1.1 p=0.736 p=0.763 p=0.505

  1. Effect sizes only reported with statistical significance. *p<0.05, avery small effect, bsmall effect, cmedium effect.

Osteopathic findings

All participants had somatic dysfunctions identified by the osteopathic structural examination and therefore completed a manipulation with the osteopathic physician. Although 25 participants (59.5%) followed the common compensatory pattern, 17 participants (40.5%) followed the uncommon compensatory pattern. Fourteen participants (33.3%) showed decompensation at the OA junction, while 11, 14, and 11 participants (26.2, 33.3, 26.2%) showed decompensation at the CT, TL, and LS junctions, respectively. Among the participants, 37, 29, 41, and 41 (88.1, 69.0, 97.6, 97.6%) had somatic dysfunction at the sacrum, L5, right innominate, and left innominate (Figure 4).

Figure 4: Observed somatic dysfunctions. (A) Zones of decompensation. (B) Participants following a common vs. an uncommon compensatory pattern. (C) Number of participants with a somatic dysfunction in the sacrum, L5, and innominates who followed the common compensatory pattern.
Figure 4:

Observed somatic dysfunctions. (A) Zones of decompensation. (B) Participants following a common vs. an uncommon compensatory pattern. (C) Number of participants with a somatic dysfunction in the sacrum, L5, and innominates who followed the common compensatory pattern.

Rib 1 dysfunction was experienced by 35/42 (83.3%) participants, 20/42 (47.6%) participants were found to have a synonymous long leg and dominant leg, and the long leg was associated with posterior innominate rotation for 15/42 (35.7%) participants. There was equal leg length in 3/42 (7.1%) participants, and 2/42 (4.8%) did not have a diagnosis regarding their leg length. 14/42 (33.3%) had OA and AA rotations in similar direction, and the lateral screening showed that the posture of 12/42 (28.6%) participants was deemed ideal despite being considered decompensated after utilizing the common compensatory screening.

Discussion

Gait asymmetries were reduced in males but not females following osteopathic manipulation. This reduction in gait asymmetry was observed despite the sample population being asymptomatic individuals. Study results suggest that osteopathic structural evaluation and osteopathic manipulation are important and could be utilized to reduce gait asymmetry despite the absence of symptoms reflecting functional impacts of somatic dysfunction. Additionally, the sex-specificity of observed results is interesting and may suggest that the drivers of dynamic gait asymmetries differ between males and females. It is also possible that the timing of the acute responses to manipulation may differ between males and females. Regardless of the cause for the sex-specificity of observed results, osteopathic manipulation in asymptomatic individuals may be more beneficial to reduce gait asymmetries in males than in females.

According to the Zink model, 80% of the population should follow the common pattern of left/right/left/right rotation [2]. However, in this study, 40.5% of our population presented with the uncommon compensatory pattern. Because Zink’s model was developed based on personal experience and has not been scientifically or objectively tested, this model may deserve further evaluation and scrutiny to determine its utility as a model to utilize in clinical situations. Looking at the axial spine patterns, 5/17 (29.4%) who followed the uncommon pattern were considered compensated, whereas 2/25 (8.0%) who followed the common pattern were considered compensated. The typical pattern expected in a patient following the common compensatory pattern in the pelvic, sacrolumbar area is a left posterior innominate rotation, a left-on-left sacral torsion, and a right rotation of the lower lumbar spine [39]. A systematic review including nine studies determining the impact of artificial or naturally occurring leg length inequalities on pelvic torsion concluded that anterior innominate is typically associated with the shorter leg [40, 41]. However, 52.4% (22) of participants had a longer leg associated with an anterior/inferior innominate rotation. This discrepancy could be related to the method of screening. When a patient is supine, the person’s weight is on the heels and sacrum, which would allow the innominate to move freely and may eliminate the influence of the lower extremity on the pelvis. Conversely, when a person is screened in a prone position, the weight is on the ASIS, allowing the sacrum and spine to move freely. Clinically observed leg length could also relate to the axis of pelvis rotation, either the pubic symphysis anteriorly or the S2 level of the sacrum posteriorly. In this study, the osteopathic screening occurred while the patient was supine. The biomechanical screening occurred while the patient was upright and affected by gravity.

Weight and loading distribution can affect the development of somatic dysfunctions. Mahar et al. [42] found that simulated lower limb discrepancies of 10 mm were associated with more weight bearing through the longer extremity (n=14). In contrast, White et al. [43] found that more weight was distributed through the shorter extremity (n=20). In a study including 98 asymptomatic participants, Qureshi et al. [44] found that participants who exhibited a right anterior innominate rotation while standing bore more weight through their left lower extremity. Participants who exhibited a longer right leg in a standing position tended to bear more weight through the right lower extremity, whereas participants with a longer left leg bore more weight through the right (shorter) lower extremity. The authors theorized that the weight-bearing differences could lead to somatic dysfunctions of the pelvis, sacrum, and lumbar spine [44].

Another consideration is activity participation. Based on the clinical experience of the authors, when a person is involved in cutting or field sports, they are more likely to have more adductor loading resulting in the anteriorly rotated innominate limb being longer. If individuals are involved in activities like running, they will experience more psoas/hamstring loading, causing the anteriorly rotated innominate limb to appear shorter. Based on biomechanical principles, any differential load between sides is the result of an asymmetric gait pattern. Our findings suggest that osteopathic screening and manipulation have the ability to reduce certain parameters that contribute to gait asymmetry. This has the potential to reduce the differential loading that could reduce injury risk, decrease the progression of disease, or aid in postsurgical recovery.

Based on the screening method utilized, every patient was found to have somatic dysfunction in their innominate, sacrum, and spine. However, treatment of these somatic dysfunctions did not alter gait in females. A previous investigation has described females as having greater anterior pelvic tilt, femoral internal rotation, knee hyperextension, and knee valgus compared to males [27]. A systematic review including 17 studies found that there are also differences in strength, neuromuscular firing patterns, and tendon and ligament elasticity that can be affected by menses [45]. These differences may potentially partially explain the observed sex differences. In another review including 20 studies, Corso et al. [46] found evidence that spinal manipulative treatment in comparison to sham or other interventions did not enhance performance-based outcomes in an asymptomatic adult population. Currently, there have been no studies that we are aware of that document sex differences related to response to osteopathic manipulative treatment (OMT). This would be an area worthy of further study.

There were a few limitations in this study. Measurements were taken while walking on a treadmill, which may lead to more cautious gait patterns. Additionally, the use of a split-belt instrumented treadmill required participants to stay in the center of the treadmill to enable separation of forces beneath each foot during processing. Many participants unintentionally shifted from the center at several points during the walking trials and were asked to correct this shift, as necessary. This feedback briefly disrupted the natural gait pattern and may have impacted results, although the analysis of 3 min of gait data is believed to have minimized the impact of these brief interruptions. To maintain evaluation consistency, a single osteopathic physician completed all osteopathic assessments and manipulations. However, this may limit study external validity since screening results were not confirmed by another osteopathic physician. To further evaluate the external validity and robustness of these study results, a similar study or studies with larger and more diverse sample populations (by age, activity level, degree of dysfunction, pathology, race, ethnicity, etc.) would be warranted. Although the literature supports reliability with repeat marker placement, it is still possible that marker placement was not identical between biomechanical assessments. The study was done on asymptomatic, healthy individuals of a limited age range; as such, the generalizability of results is limited. However, it was interesting to find statistically significant effects of osteopathic manipulation in asymptomatic individuals. It can be speculated that if effects were observed in this population, it is likely that effects would also be observed in an older, symptomatic population. Similar studies with older participants and those with known musculoskeletal pathologies would be worthwhile.

Conclusions

Patients with postural asymmetry will have altered body mechanics, which can increase the risk of injury, musculoskeletal disease, and degenerative joint disease progression. Osteopathic manipulation reduced gait asymmetries in males but not females. This sex-specificity of the observed effects of osteopathic manipulation on gait asymmetry is worthy of further investigation. Study results did not support Zink’s model, suggesting that the model may deserve further evaluation and scrutiny to determine whether it is a useful model to utilize in clinical situations. Osteopathic structural examinations and treatment of somatic dysfunctions may improve gait symmetry even in asymptomatic individuals. These findings encourage larger-scale investigations on the use of OMT to optimize gait and prevent injury, reduce the progression of disease, and aid in recovery after surgery.

Corresponding author: Mark Rogers, DO, Department of Family and Sports Medicine, Edward Via College of Osteopathic Medicine, 2265 Kraft Drive, Blacksburg, VA 24060-6360, USA, E-mail:

Funding source: Edward Via College of Osteopathic Medicine's Intramural REAP n/a

Award Identifier / Grant number: V0051

Acknowledgements

We would like to acknowledge Alex Paulini and Leila Kamareddine for their assistance with the biomechanical data processing.

  1. Research funding: The current study was funded by a grant from the Edward Via College of Osteopathic Medicine (VCOM, Blacksburg, VA, USA) awarded to Robin M. Queen, P. Gunnar Brolinson, and Mark Rogers (VCOM Intramural REAP award V0051).

  2. Author contributions: All authors provided substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; all authors drafted the article or revised it critically for important intellectual content; all authors gave final approval of the version of the article to be published; and all authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  3. Competing interests: None reported.

  4. Informed consent: All participants in this study provided written informed consent prior to participation.

  5. Ethical approval: This study was reviewed and approved by the Edward Via College of Osteopathic Medicine Institutional Review Board (IRB#2016-051).

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Received: 2021-05-03
Accepted: 2021-08-20
Published Online: 2021-11-18

© 2021 Cherice N. Hill et al., published by De Gruyter, Berlin/Boston

This work is licensed under the Creative Commons Attribution 4.0 International License.

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https://doi.org/10.1515/jom-2021-0046
Keywords for this article
biomechanics; injury risk; osteopathic postural assessment; somatic dysfunction
Creative Commons
BY 4.0

Articles in the same Issue

  1. Frontmatter
  2. General
  3. Original Article
  4. A comparative study of the effectiveness of an osteopathic primary care sports medicine led intervention on performance in men’s collegiate lacrosse players
  5. Medical Education
  6. Original Article
  7. AOA ophthalmology and otolaryngology program closures as a model to highlight challenges of maintaining GME in high need areas
  8. Neuromusculoskeletal Medicine (OMT)
  9. Original Article
  10. Effect of osteopathic manipulation on gait asymmetry
  11. Brief Report
  12. Cranial manipulation affects cholinergic pathway gene expression in aged rats
  13. Pediatrics
  14. Case Report
  15. Pediatric unilateral knee swelling: a case report of a complicated differential diagnosis and often overlooked cause
  16. Public Health and Primary Care
  17. Brief Report
  18. Glycemic control is associated with lower odds of mortality and successful extubation in severe COVID-19
  19. Clinical Image
  20. Tracheobronchial cast
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