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To the Editor:

Thank you for the two fine articles (J Am Osteopath Assoc. 2003;103(12):583-596, 577-582) that point to the importance and the unique difference osteopathic manipulative treatment (OMT) can have in the care of our patients. In the outstanding review of integrated neuromusculoskeletal release (INR), Jay B. Danto, DO, provides a thorough discussion of this approach, which can be effective for both inpatients and outpatients.

Screening and treating patients with somatic dysfunction without a treatment table can make this form of OMT user-friendly. The potential of the fascial trauma of cesarean delivery or hysterectomy (or any abdominal incision) to produce trigger points related to myofascial tension and stress is well known. Therefore, I have begun to use INR for my obstetric and postoperative patients. Certainly, the principles of INR are practical in the care of postoperative patients, as are the other osteopathic modes of therapy described in the article (ie, soft tissue manipulation, thoracic pump, strain, and counterstrain).

In the second article, the results of the study by Hollis H. King, DO, PhD, et al regarding the use of prenatal OMT indicate that the application of INR may be useful in obstetric patients, as these approaches are readily performed without need of a treatment table versus other potentially cumbersome techniques.

As the study by King et al showed improved outcomes in labor and delivery, I would encourage obstetricians and family physicians providing obstetric care to add INR to their antenatal, intrapartum, and postpartum arsenal. It is hoped that future prospective studies will also show that the use of OMT in obstetrics is more than a tradition, but a meaningful clinical difference in patient care.

Wausau, Wisconsin

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