JAOA • Vol 108 • No 5 • May 2008 • 234-235
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Osteopathic Manipulation: Promise for Infantile Colic
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Infantile colic is a poorly understood condition that affects between 8%
and 40% of infants, usually those younger than 3 months. Foreign-trained
osteopaths in the United Kingdom performed the first pragmatic, open,
controlled, randomized clinical trial on the effect of osteopathic
manipulative therapy on the signs associated with infantile colic. Infants,
who were recruited by referral, were eligible for the study if they were no
older than 12 weeks, had not previously received osteopathic treatment,
exhibited signs of infantile colic, and had no signs or symptoms indicative of
other disease. Signs of infantile colic were at least 90 minutes of
inconsolable crying per day for at least 5 days in the past week, loud
abdominal gurgling noises, knees drawn up to the chest, clenched fists, and
backward bending of the head or trunk.
Of the 44 screened infants, 28 (22 males; 6 females) met inclusion criteria
and were randomly assigned to receive either osteopathic manipulation
(including cranial manipulation) or no treatment (no sham therapy).
Demographic characteristics of each group were comparable. All participants
were seen once weekly for 4 weeks, with the same osteopath administering all
interventions. Treatment in the manipulation group was applied according to
individual findings from osteopathic structural examinations conducted at each
visit. (It is unclear from the report what the findings were or what
treatments were used.) In a daily diary, parents recorded the time the infant
spent crying, sleeping, and being held or rocked. Two infants from the control
group were withdrawn from the study as a result of worsening symptoms and the
need for more intensive care.
A statistically significant decrease in crying (P<.001) and
increase in time spent sleeping (P<.002) occurred in the treated
group. All 14 infants in the treatment group improved, 10 (71%) of whom
required no further treatment after 3 weeks. Only 3 infants (21%) in the
control group improved by 3 weeks, with a total of 7 (50%) improving by 4
weeks. These improvements, however, were not statistically significant.
Although these findings are preliminary, they suggest that osteopathic
manipulation can help reduce infantile colic. A larger, multi-site,
sham-controlled study is warranted. —M.A.S.
Hayden C et al. Complement Ther Clin
Pract. 2006;12:83
-90.[Medline]
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Manipulation Under Anesthesia Overrated?
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Patients with frozen shoulder are commonly treated with manipulation under
anesthesia to mobilize joints that are refractory to such treatment while the
patient is awake. However, little evidence exists to prove the efficacy of
this treatment modality for frozen shoulder, a condition that can take up to 3
years to resolve.
A group of physiatrists and physiotherapists in Finland conducted the first
randomized clinical trial evaluating the long-term (1 year) effectiveness of
manipulation under anesthesia in patients with clinically verified frozen
shoulder. A total of 125 patients with this condition, referred from three
hospitals in southern Finland, were randomly assigned to the manipulation plus
exercise group (n=65) or control (exercise only) group (n=60). The patients
were supine for manipulation, during which the physicians flexed and abducted,
then internally and externally rotated the subject's joint until it had normal
or near-normal range of motion. A cracking sound was heard in manipulated
shoulders, but no major complications were noted. Manipulation occurred only
once, within 2 weeks of randomization. Pendulum exercises and stretching
techniques were taught to each patient, who was instructed to perform the
exercises daily. Outcomes measured included range-of-motion assessment by a
blinded physiotherapist, pain and working ability scales, a modified Shoulder
Disability Questionnaire, use of analgesic medications, and other therapy
received for shoulder pain. Data were gathered at baseline and at follow-up
examinations 6 weeks and 3, 6, and 12 months after randomization.
One third of the patients were lost to follow up at 1 year. Although the
patients in the manipulation group had improved shoulder mobility at the
6-week and 3-month follow-up, pain intensity and disability were similar
between groups. At 1 year, only slight pain remained in both groups. The
authors concluded that manipulation under anesthesia does not improve the
effectiveness of an at-home exercise regimen. —M.A.S.
Kivimäki J et al. J Shoulder Elbow
Surg. 2007;16:722
-726.[Medline]
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Western Diet Associated With Metabolic Syndrome
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Osteopathic physicians have characteristically promoted healthy dietary
practices as a fundamental component of patient self-management. Increasingly,
long-term follow-up studies of various diets have demonstrated the wisdom of
this approach. Metabolic syndrome, affecting 47 million US adults, is defined
by the presence of three or more of the following cardiovascular disease risk
factors: abdominal obesity, high blood pressure, glucose intolerance, and
elevated high-density lipoprotein cholesterol or triglycerides. It is also
associated with increased risk of type 2 diabetes mellitus, cardiovascular
disease, and mortality.
The Atherosclerosis Risk in Communities study gathered survey data from
9514 adults during a 9-year period to determine the role of diet in the origin
of metabolic syndrome. Unique to this study, researchers evaluated the effect
of the whole diet pattern on subjects prospectively, rather than singling out
specific foods or only one gender in a cross-sectional design as in other
longitudinal studies.
Researchers used a 66-item food frequency questionnaire and
principal-components analysis to derive "Western" versus
"prudent" dietary patterns. The Western diet consisted primarily
of refined grains, processed meat, fried food, eggs, red meat, and diet soda.
The prudent diet was predominantly fish, poultry, whole grains, fruits,
cruciferous and carotinoid vegetables, and low-fat dairy products.
Within 9 years, metabolic syndrome occurred in 3782 participants (40%).
After adjusting for various demographic and behavioral characteristics, a
Western dietary pattern was found to be adversely associated (18% increased
risk) with the occurrence of metabolic syndrome. Individually, meat, fried
food, and diet soda were strongly associated with the occurrence of metabolic
syndrome, whereas dairy consumption was protective. No associations were found
between the occurrence of metabolic syndrome and a prudent dietary pattern or,
individually, whole grains, refined grains, fruits, vegetables, nuts, coffee,
or sweetened beverages. —M.A.S.
Lutsey PL et al. Circulation.2008
;117:754
-761.[Abstract/Free Full Text]
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Footnotes
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"The Somatic Connection" highlights and summarizes important
contributions to the growing body of literature on the musculoskeletal
system's role in health and disease. This section of JAOA—The
Journal of the American Osteopathic Association strives to chronicle the
significant increase in published research on manipulative methods and
treatments in the United States and the renewed interest in manual medicine
internationally, especially in
Europe.
To submit scientific reports for possible inclusion in "The Somatic
Connection," readers are encouraged to contact JAOA Associate
Editor Felix J. Rogers, DO
(fjrogers{at}aol.com),
or Michael A. Seffinger, DO
(mseffinger{at}westernu.edu
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