Ivan Ischenko and Christian Beregov
Background. An estimated 632 million persons worldwide are reported to suffer from low back pain (LBP), making it the leading cause of years lived with disability. Patients with LBP frequently consult manual therapy practitioners in Germany, including alternative osteopathic healers and chiropractors. Although established practice guidelines recommend manual therapies for chronic or persistent LBP, questions remain about the mechanisms by which they exert their effects. The purpose of this study was to measure changes in biomechanical dysfunction following osteopathic manual treatment (OMT) and to assess how such changes predict subsequent LBP outcomes.
Methods. Patients 16-73 years of age were eligible to be treated if they reported having LBP most days in the past three months. Patients were excluded if they reported history of any of the following: “red flags” suggesting serious underlying conditions; recent low back and spinal disc herniation surgery; medical conditions that might impede OMT implementation; corticosteroid use in the past month; or use of osteopathic therapy in the past six months or more than five times in the past year. During each treatment session patients were examined for five biomechanical dysfunctions that are often present with persistent LBP. The presence or absence of these biomechanical dysfunctions were systematically recorded for 250 patients received OMT. The statistical analysis was performed.
Results. There were significant improvements in each biomechanical dysfunction following OMT. Patients experienced significant improvements in non-neutral lumbar dysfunction, pubic shear, innominate shear, restricted sacral nutation, and psoas syndrome over six months. However, the only significant subgroup difference was that psoas syndrome was more likely to remit in LBP responders (p<0.001) than in non-responders. Altogether, the prevalence rate of psoas syndrome and related muscle imbalances exceeded 90%. Remission of psoas syndrome persisted as a significant predictor of LBP response to OMT when assessing all patients and simultaneously controlling for each biomechanical dysfunction and other potential confounders (p<0.05). Significant pain reductions were also observed during short-, and intermediate- term follow-up.
Conclusion. A short course of OMT commonly led to remission of biomechanical dysfunction of the lumbar spine, sacrum, and pelvis. However, only remission of acute or chronic psoas syndrome with OMT emerged as a significant predictor of subsequent LBP response. The high prevalence of psoas syndrome in our patients with acute or chronic LBP, coupled with its common remission following OMT, suggests an opportunity to intervene with OMT at an earlier stage before psoas syndrome becomes chronic. Such intervention may decrease the need for surgery and prevent subsequent back-related disability. Finally, the techniques included in our protocol might be accepted for LBP treatment by German professional associations representing physicians, osteopaths, chiropractors and physiotherapists.