Volume 112, Issue 7

Context: Somatic dysfunction is diagnosed by the presence of any of 4 TART criteria: tissue texture abnormality, asymmetry, restriction of motion, or tenderness. Objective: To measure the prevalence of somatic dysfunction in patients with chronic low back pain (LBP) and to study the associations of somatic dysfunction with LBP severity, back-specific functioning, and general health. Design: Cross-sectional study nested within a randomized controlled trial. Setting: University-based study in Dallas-Fort Worth, Texas. Patients: A total of 455 adult research patients with non-specific chronic LBP. Main Study Measures: Somatic dysfunction in the lumbar, sacrum/pelvis, and pelvis/innominate regions, including key lesions representing severe somatic dysfunction. A 10-cm visual analog scale (VAS), the Roland-Morris Disability Questionnaire (RMDQ), and the Medical Outcomes Study Short Form-36 Health Survey (SF-36) were used to measure LBP severity, back-specific functioning, and general health, respectively. Results: Severe somatic dysfunction was most prevalent in the lumbar (225 [49%]), sacrum/pelvis (129 [28%]), and pelvis/innominate (48 [11%]) regions. Only 30 patients (7%) had no somatic dysfunction in the lumbar, sacrum/pelvis, or pelvis/innominate regions. There were 4 statistically significant pairwise correlations for severe somatic dysfunction: thoracic (T) 10-12 with ribs; T10-12 with lumbar; lumbar with sacrum/pelvis; and sacrum/pelvis with pelvis/innominate. Having a key lesion in the lumbar region (ρ=0.80) or sacrum/pelvis region (ρ=0.71) was strongly correlated with the overall number of key lesions. There were no consistent demographic or clinical predictors of somatic dysfunction. The presence (vs absence) of severe somatic dysfunction in the lumbar region was associated with greater LBP severity (median VAS score, 4.7 vs 3.8, respectively; P =.003) and greater back-specific disability (median RMDQ score, 6 vs 4, respectively; P =.01). The presence (vs absence) of severe somatic dysfunction in the sacrum/pelvis region was associated with greater back-specific disability (median RMDQ score, 6 vs 5, respectively; P =.02) and poorer general health (median SF-36 score, 62 vs 72, respectively; P =.002). An increasing number of key lesions was associated with back-specific disability ( P =.009) and poorer general health ( P =.02). Conclusion: The present study demonstrates that somatic dysfunction, particularly in the lumbar and sacrum/pelvis regions, is common in patients with chronic LBP. Forthcoming extensions of the OSTEOPATHIC Trial will assess the efficacy of OMT according to baseline levels of somatic dysfunction.

Context: Knee bending during tests of lumbar forward bending (FB) may introduce confounding variability. Precluding bending at the knees has, therefore, long been standard protocol to produce valid and reproducible results. However, there is limited research on cervical spine bending as a confounding variable in whole trunk and lumbar FB. Objective: To examine the role of cervical spine bending on the range of whole trunk and lumbar FB. Methods: Participants were recruited from the faculty, staff, and student population of Nova Southeastern University's Health Professions Division. Each participant underwent 4 FB tests with varying cervical starting positions. Range of motion was measured for whole trunk FB and lumbar FB by using the fingertip-to-floor and double digital inclinometer techniques, respectively. Results: Two hundred thirty-six participants met the study criteria. Statistically significant differences were found in both whole trunk (6.96 cm) and lumbar (3.95°) FB range of motion when the cervical spine was backward bent after full spine FB ( P <.05). Statistically significant differences were also found in both whole trunk (15.72 cm) and lumbar (7.38°) FB when the cervical spine was backward bent before thoracolumbar spine FB ( P <.05). Conclusion: Cervical spine bending influences the ability of the trunk and lumbar spine to bend forward and is, therefore, a confounding variable during tests of whole trunk and lumbar spine FB.

Context: Complementary and alternative medicine (CAM) has grown into a huge health care industry in the United States, with 91.5 million people (38% of adults) using CAM in 2007. Given the increase in CAM use and the need for CAM education for health professionals, it is important to understand the baseline attitudes and beliefs of osteopathic medical students regarding CAM, as well as the factors that may have formed them. Objectives: (1) To determine osteopathic medical students' use of different CAM modalities. (2) To assess osteopathic medical students' attitudes toward CAM using a previously validated instrument. Methods: A previously validated, 29-item Integrative Medicine Attitude Questionnaire and a 10-item CAM Health Belief Questionnaire were administered to osteopathic medical students. Demographic and other data were collected on student use of and recommendations for CAM modalities as well as student awareness and use of primary CAM information resources. Results: Survey respondents were 635 osteopathic medical students from 7 osteopathic medical schools and additional locations in the United States. Osteopathic medical students demonstrated positive attitudes toward CAM use. A total of 527 osteopathic medical students (83.0%) self-reported the use of at least 1 CAM modality, whereas 69 students (10.9%) used just 1 CAM modality and 458 (72.1%) used 2 or more modalities. The most commonly used CAM modalities—meditation/yoga/relaxation/imagery, massage, and spirituality/prayer—were also most likely to be suggested to patients by osteopathic medical students. Sex, age, and the use of CAM modalities were significantly correlated with attitudes toward CAM modalities. Conclusion: Osteopathic medical students had a positive attitude toward CAM and had high levels of self-reported CAM knowledge and use. Osteopathic medical students who acquire professional training and have personal experience with CAM may be in a better position to discuss CAM with future patients.

Clinical research is increasingly conducted in real-world settings. Osteopathic practices represent natural laboratories for studying the distinctiveness of osteopathic medicine. The Osteopathic Research Center (ORC) recently developed a triadic paradigm for research consisting of the Consortium for Collaborative Osteopathic Research Development (CONCORD), its affiliated practice-based research network (PBRN), and the patient-centered research (PCR) fellowship program. The CONCORD-PBRN was certified by the Agency for Healthcare Research and Quality in 2011. The inaugural PCR fellowship class completed didactic training that year. Fellows increased their knowledge of research design and biostatistics following participation in the curriculum. In 2012, a card study of osteopathic palpatory findings and manual techniques will be conducted within the CONCORD-PBRN. The ORC plans to use a hub-and-spoke model to grow the CONCORD-PBRN. Further expansion of this triadic paradigm is dependent on funding streams to support the needed research infrastructure.

Pain is a common occurrence after tooth extraction and is usually localized to the extraction site. However, clinical experience shows that patients may also have pain in the head or neck in the weeks after this procedure. The authors present a case representative of these findings. In the case, cranial and cervical somatic dysfunction in a patient who had undergone tooth extraction was resolved through the use of osteopathic manipulative treatment. This case emphasizes the need to include a dental history when evaluating head and neck pain as part of comprehensive osteopathic medical care. The case can also serve as a foundation for a detailed discussion regarding how to effectively incorporate osteopathic manipulative treatment into primary care practice for patients who present with head or neck pain after tooth extraction.