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Osteopathic Manipulative Therapy Shows Promise for Improving Postdiskectomy Recovery

  • Dickran Altounian and Michael A. Seffinger
Published/Copyright: October 1, 2015
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Journal of Osteopathic Medicine
From the journal Journal of Osteopathic Medicine Volume 115 Issue 10

Kim BJ, Ahn J, Cho H, Kim D, Kim T, Yoon B. Rehabilitation with osteopathic manipulative treatment after lumbar disc surgery: a randomized, controlled pilot study. Int J Osteopath Med. In press. doi:10.1016/j.ijosm.2014.11.003.

Lumbar diskectomy is a common treatment for patients with low back pain because it can help reduce physical disability and relieve nerve root pain compared with other nonoperative treatments.1,2 However, many patients report continued physical disability and low back and leg pain after surgery. An interdisciplinary team of surgeons and a British-trained osteopath in South Korea published a prospective randomized controlled pilot trial to determine the feasibility and potential benefit of using osteopathic manipulative therapy (OMTh; manipulative care provided by foreign-trained osteopaths) as an integral component of a postdiskectomy rehabilitation program.

Inclusion criteria were patients aged 20 to 65 years who underwent lumbar microdiskectomy to manage low back pain and who experienced leg pain resulting from a herniated disk. The exclusion criteria were revision or combined surgery, pregnancy, metastatic disease, or mental disorder.

Thirty-three participants were randomly allocated to either the OMTh group (n=16) or the exercise program group (n=17). Two to 3 weeks after the patients underwent lumbar microdiskectomy, they returned to the hospital for their first rehabilitation session. Both interventions consisted of eight 30-minute sessions performed twice per week for 4 weeks. All patients were prescribed anti-inflammatory medication, analgesics, and muscle relaxants by the surgeons. The OMTh intervention was performed by 2 foreign-trained osteopathic students supervised by a British-trained osteopath. This group received a standardized OMTh protocol including soft tissue, myofascial release, muscle energy, progressive inhibition of neuromuscular structures, osteopathic cranial manipulative medicine, and rib raising techniques. The exercise group also followed a protocol focused on stretching, strengthening, and Pilates exercises.

Outcome measures were assessed at baseline (2-3 weeks after surgery) and a week after the final rehabilitation session (7-8 weeks after surgery) using the Roland-Morris Disability Questionnaire and a visual analog scale. Postsurgical physical disability improvement was statistically significant in the OMTh rehabilitation group at 54% vs 26% in the exercise group (P<.05). Residual leg pain decreased by 53% in the OMTh group and 17% in the exercise group (P>.05), and residual low back pain decreased by 37% in the OMTh group and 10% in the exercise group (P>.05). In addition, patients required less frequent use of medications in the OMTh group (P>.05).

The authors concluded that OMTh as a postsurgical rehabilitation intervention after lumbar microdiskectomy is a feasible and potentially beneficial approach for improving physical function and residual back and leg pain, decreasing the frequent use of medications, and leading to overall patient satisfaction. A larger, randomized controlled trial using sham therapy is warranted. The use of OMTh as a postsurgical rehabilitation intervention after knee and hip arthroplasty has been shown to be a feasible approach for improving postoperative care.3,4 This study further supports its utility as an adjunct therapy and a potential standardized protocol for postsurgical rehabilitation.

Western University of Health Sciences College of Osteopathic Medicine of the Pacific, Pomona, California

References

1. Weinstein JN ,LurieJD,TostesonTD,et al.. Surgical versus nonoperative treatment for lumbar disc herniation: four-year results for the Spine Patient Outcomes Research Trial (SPORT).Spine (Phila Pa 1976).2008;33(25):2789-2800. doi:10.1097/BRS.0b013e31818ed8f4.10.1097/BRS.0b013e31818ed8f4Search in Google Scholar PubMed PubMed Central

2. Gibson JN ,WaddellG. Surgical interventions for lumbar disc prolapse: updated Cochrane Review.Spine (Phila Pa 1976).2007;32(16):1735-1747.10.1097/BRS.0b013e3180bc2431Search in Google Scholar PubMed

3. Jarski RW ,LoniewskiEG,WilliamsJ,et al.. The effectiveness of osteopathic manipulative treatment as complementary therapy following surgery: a prospective, match-controlled outcome study.Altern Ther Health Med.2000;6(5):77-81.Search in Google Scholar

4. Licciardone JC ,StollST,CardarelliKM,GamberRG,SwiftJN Jr,WinnWB. A randomized controlled trial of osteopathic manipulative treatment following knee or hip arthroplasty.J Am Osteopath Assoc.2004;104(5):193-202.Search in Google Scholar
Published Online: 2015-10-01
Published in Print: 2015-10-01

© 2015 American Osteopathic Association

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

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https://doi.org/10.7556/jaoa.2015.129
Creative Commons
BY-NC-ND 4.0

Articles in the same Issue

  1. SURF
  2. Effects of Stem Cell Treatment in Human Patients With Peyronie Disease
  3. IN MY VIEW
  4. Interstate Medical Licensure Compact: Pernicious Myths and Inescapable Facts
  5. ORIGINAL CONTRIBUTION
  6. Accuracy and Adequacy of Computed Tomography–Guided Lung Biopsies: Experience From a Community Hospital
  7. Quantification of Motion Palpation
  8. REVIEW
  9. Non–Vitamin K Antagonist Oral Anticoagulants: The Clinician’s New Challenge
  10. CASE REPORT
  11. Peroneus Longus Rupture at Its Origin Managed With Platelet Rich Plasma
  12. THE SOMATIC CONNECTION
  13. 2b or not 2b: The State of the Evidence for Myofascial Release
  14. Lymphatic Vessels Found in the Brain—Osteopathic Considerations
  15. Osteopathic Manipulative Therapy Efficacious for Patients With Chronic Migraines
  16. Ultrasound Measurement of Vertebral Artery Blood Flow Before and After High-Velocity, Low-Amplitude Thrust Therapy
  17. Osteopathic Manipulative Therapy Shows Promise for Improving Postdiskectomy Recovery
  18. Bodywork Shown to Reduce the Symptoms of Chronic Constipation and Improve Quality of Life
  19. CLINICAL IMAGES
  20. Extensive Case of Subcutaneous Emphysema
  21. IN YOUR WORDS
  22. Filling an Open Spot
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