Volume 105, Issue 10

The thoracic pump and the abdominal pump are osteopathic manipulative (OM) lymphatic pump techniques frequently used by osteopathic physicians to treat patients with infections (eg, pneumonia, otitis media). Although there is a widely accepted belief among the osteopathic medical profession that increasing lymphatic flow is beneficial, no measurements of lymph flow during osteopathic manipulative treatment have been reported. The authors surgically instrumented five mongrel dogs to record lymphatic flow in the thoracic duct (TDF) and cardiac variables during three intervention protocols. After recovery from surgery, canine subjects were placed in a standing-support sling, and TDF, cardiac output, mean aortic blood pressure, and heart rate were recorded during two randomized 30-second sessions of manipulative intervention using the osteopathic thoracic pump and abdominal pump techniques on two successive days. Lymph flow in the thoracic duct increased from 1.57±0.20 mL·min -1 to a peak TDF of 4.80±1.73 mL·min -1 during abdominal pump, and from 1.20±0.41 mL·min -1 to 3.45±1.61 mL·min -1 during thoracic pump. Lymph flow in the thoracic duct and cardiac variables were also recorded for canine subjects during physical activity (ie, treadmill exercise at 3 miles per hour at 0% incline). During physical activity, TDF increased from 1.47±0.33 mL·min -1 to 5.81±1.30 mL·min -1 . Although cardiac variables did not change significantly during manipulative intervention with lymphatic pump techniques, cardiac output and heart rate did increase during physical activity. The authors conclude that physical activity and manipulative intervention using thoracic pump and abdominal pump techniques produced net increases in TDF ( P <.05).

The tenets of osteopathic medicine first described by Andrew Taylor Still, MD, DO, in 1874 constituted the first scientific approach to manual techniques affecting the lymphatic system. Since then, many developments in manual techniques for the lymphatics have followed. Modern research in osteopathic medicine continues to add to the body of scientific knowledge about the lymphatic system, and recent studies point the way toward more efficacious uses of manual techniques for the lymphatics.

Context: Establishing reliable palpatory tests continues to be a critical, yet elusive, step in osteopathic medical research and evidence-based clinical practice. Objective: The authors investigated the interobserver reliability of common osteopathic palpatory tests used to evaluate the lumbar spine. Design and Methods: Subjects (N=119) were recruited from the faculty, staff, and students of Kirksville (Mo) College of Osteopathic Medicine (KCOM) of A.T. Still University of Health Sciences. Three osteopathic medical examiners residency trained in neuromusculoskeletal medicine initially evaluated lumbar segments on subjects from one subgroup (n=42) in a blinded assessment. The examiners performed palpatory tests of tenderness and tissue texture changes, as well as—in three planes—vertebral positional asymmetry and motion asymmetry. Kappa statistics (κ) were used to evaluate interobserver reliability. Following a period of consensus training, subjects from another subgroup (n=77) were evaluated in a blinded assessment for those palpatory tests that seemed most likely to produce reliable findings. The interobserver reliability was then re-evaluated. Results: During the initial evaluation of interobserver reliability, κ ranged from -0.02 to 0.34, within the poor-to-fair reliability range. Following consensus training, reliability improved, rising into the moderate range for tissue texture changes (κ=0.45) and into the substantial range for tenderness assessments (κ=0.68). Reliability for positional asymmetry in the transverse plane (κ=0.34) and rotational motion asymmetry (κ=0.20) were improved but remained in the fair range. Conclusion: The authors concluded that consensus training improved the interobserver reliability of common osteopathic palpatory tests of the lumbar spine. In two of the four tests that were studied—tissue texture and tenderness—acceptable κ values for clinical tests were achieved after consensus training.

Context: Coronary artery bypass graft (CABG) surgery is a common procedure for patients with coronary artery disease. The physiologic effects of postoperative osteopathic manipulative treatment (OMT) following CABG have not been documented previously. Objective: To determine the effects of OMT on cardiac hemodynamics post-CABG surgery. Design: Pilot prospective clinical study (N=29). Setting and Patients: Treatment subjects (n=10) undergoing CABG surgery were recruited for postoperative OMT. The primary assessment compared, pre-OMT versus post-OMT, measurements of thoracic impedance, mixed venous oxygen saturation (SvO 2 ), and cardiac index. Records of control subjects (n=19) who underwent CABG surgery—but who did not receive OMT—were assessed for SvO 2 and cardiac index at 1 hour and 2 hours postsurgery. Intervention: Immediately following CABG surgery (≤2 h), OMT was provided to subjects to alleviate anatomic dysfunction of the rib cage caused by median sternotomy and to improve respiratory function. This adjunctive treatment occurred while subjects were completely anesthetized. Results: A post-OMT increase in thoracic impedance ( P ≤.02) in OMT subjects demonstrated that central blood volume was reduced after OMT, suggesting an improved peripheral circulation. Mixed venous oxygen saturation also increased ( P ≤.005) after OMT. These increases were accompanied by an improvement in cardiac index ( P ≤.01). Comparisons of postoperative measurements in OMT subjects versus those in control subjects revealed statistically significant differences for SvO 2 ( P ≤.005) and cardiac index ( P ≤.02) between the two groups. Conclusion: The observed changes in cardiac function and perfusion indicated that OMT had a beneficial effect on the recovery of patients after CABG surgery. The authors conclude that OMT has immediate, beneficial hemodynamic effects after CABG surgery when administered while the patient is sedated and pharmacologically paralyzed.

Editor's note: This article was first published in the August 2005 issues of The DO magazine and JAOA and will be republished periodically, as space allows, as a public service announcement to AOA members.