Volume 112, Issue 9

Context: Little is known about the role that cytokines play in osteopathic manual treatment (OMT) of patients with chronic low back pain (LBP). Objective: To measure the baseline concentrations of interleukin (IL)-1β, IL-6, IL-8, IL-10, and tumor necrosis factor (TNF)-α in patients with chronic LBP; the correlations of these cytokine concentrations with clinical measures, including the number of key osteopathic lesions; the changes in cytokine concentrations with OMT; and the association of such changes with clinical outcomes. Design: Substudy nested within a randomized controlled trial of OMT for nonspecific chronic LBP. Setting: University-based study in Dallas-Fort Worth, Texas. Patients: Seventy adult research patients with nonspecific chronic LBP. Main Outcome Measures: A 10-cm visual analog scale, the Roland-Morris Disability Questionnaire, and the Medical Outcomes Study Short Form-36 Health Survey were used to measure LBP severity, back-specific functioning, and general health, respectively. Results: At baseline, IL-1β (ρ=0.33; P =.005) and IL-6 (ρ=0.32; P =.006) were each correlated with the number of key osteopathic lesions; however, only IL-6 was correlated with LBP severity (ρ=0.28; P =.02). There was a significantly greater reduction of TNF-α concentration after 12 weeks in patients who received OMT compared with patients who received sham OMT (Mann-Whitney U =251.5; P =.03). Significant associations were found between OMT and a reduced TNF-α concentration response at week 12 among patients who achieved moderate (response ratio, 2.13; 95% confidence interval [CI], 1.11-4.06; P =.006) and substantial (response ratio, 2.13; 95% CI, 1.07-4.25; P =.01) LBP improvements, and improvement in back-specific functioning (response ratio, 1.68; 95% CI, 1.04-2.71; P =.03). Conclusions: This study found associations between IL-1β and IL-6 concentrations and the number of key osteopathic lesions and between IL-6 and LBP severity at baseline. However, only TNF-α concentration changed significantly after 12 weeks in response to OMT. These discordant findings indicate that additional research is needed to elucidate the underlying mechanisms of action of OMT in patients with nonspecific chronic LBP.

Context: One of the goals of providing manipulative treatment such as osteopathic manipulative treatment (OMT) is to restore maximal, pain-free movement of the musculoskeletal system and to enhance neuromuscular function. Anecdotally, some athletes have reported that their athletic performance improves after manipulative treatment. Objective: To develop preliminary data to gain more understanding about the association between precompetition manipulative treatments provided to Division I football players and their athletic performance during each game for 2 consecutive football seasons. Methods: The study design was a retrospective cohort study. Participants were football athletes at Virginia Polytechnic Institute and State University (Virginia Tech). Board-certified osteopathic physicians who were trained in osteopathic manipulative medicine and sports medicine performed OMT and determined the type of OMT techniques used and the spinal segments treated. One chiropractor provided chiropractic manipulative therapy. Prior to each game, the athletes who elected to receive precompetition manipulative treatment (ie, OMT or chiropractic manipulative therapy) underwent a focused physical examination and received manipulative treatment on the basis of clinical findings. After each game, the coaching staff “graded” the players by using a standard coaching algorithm. Offensive players received a percentile score (0 to 100) and defensive players received a numeric score (>30 was considered “very good”). Results: A total of 1976 manipulative treatments were provided to 115 football players in 2 consecutive football seasons. Sixty-two offensive players received 985 manipulative treatments, and 53 defensive players received 991 manipulative treatments. Treatments were applied to the affected regions of the spine: cervical, thoracic, lumbar, and sacral sections. Mean (standard deviation) performance scores were 67.8% (22.8%) and 11.1 (9.9) points among offensive and defensive players, respectively. The correlation coefficients between the numbers of the manipulative treatments and the performance scores were 0.107 ( P =.407) among the offensive players and 0.218 ( P =.117) among the defensive players. Conclusion: Precompetition manipulative treatment was positively associated with improved performance among both offensive and defensive Virginia Tech football players. Although the associations between these 2 factors were relatively small and not statistically significant, we found positive correlations in performance of the offensive and defensive players.

Each year, more than 18 million adults in the United States receive manual therapies, at a total annual out-of-pocket cost of $3.9 billion. Although there is growing evidence supporting the efficacy of manual therapies, little is known about the mechanisms underlying these treatments. This lack of basic knowledge significantly limits the development of rational strategies for the use of these treatments and potentially hinders their acceptance by the wider scientific and health care communities. Many authors have hypothesized that manual therapies act by disrupting the pain-spasm-pain cycle, but relatively little experimental evidence has supported this hypothesis. The authors have tested this hypothesis and summarize their work on the biology of manual therapies.