The authors surgically instrumented five mongrel dogs to record cardiac variables and lymphatic flow in the thoracic duct (TDF) during three intervention protocols: physical activity and two lymphatic pump techniques. Lymph flow in the thoracic duct increased from 1.57{+/-}0.20 to a peak TDF of 4.80{+/-}1.73 mL{middle dot}min-1 during abdominal pump, and from 1.20{+/-}0.41 to 3.45{+/-}1.61 mL{middle dot}min-1 during thoracic pump. During physical activity, TDF increased from 1.47{+/-}0.33 to 5.81{+/-}1.30mL{middle dot}min-1. The authors conclude that physical activity and manipulative intervention produced net increases in TDF (P<.05). The authors indicate the need for additional studies designed to examine the optimal duration of osteopathic manipulative treatment using thoracic and abdominal pump techniques, the most effective rates of compression using these techniques, and the optimal combination of lymphatic pump treatments.
The authors studied the interobserver reliability for osteopathic palpatory tests that are commonly used to evaluate the lumbar spine. Three residency-trained examiners specializing in neuromusculoskeletal medicine conducted palpatory tests on 42 subjects. Kappa statistics ({kappa}) were used to evaluate the initial interobserver reliability of these tests. After a period of consensus training focusing on those tests most likely to produce reliable findings and be applied in clinical practice, interobserver reliability was reevaluated with 77 subjects. The authors found that consensus training was effective in improving the interobserver reliability of tests for tissue texture and tenderness, producing clinically acceptable {kappa} values.
This study describes the immediate effects of postoperative osteopathic manipulative treatment (OMT) on cardiac hemodynamics after coronary artery bypass graft surgery, while patients remained sedated and pharmacologically paralyzed. Assessments of blood distribution (thoracic impedance), oxygen content of blood (mixed venous oxygen saturation), and cardiac output (cardiac index) all demonstrated the immediate physiologic benefit of OMT. Based on this pilot study, the authors conclude that OMT has immediate, beneficial hemodynamic effects following coronary artery bypass graft surgery.
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.
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.
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