In almost any profession the review of research can get overlooked by the practitioners of that profession. In healthcare, the vast majority of people work on the clinical side, working directly with the patient and Osteopathy/Osteopathic Manual Therapy (OMT) is no exception to this. Despite this, the efforts of researchers are invaluable to maintaining the proof of effect and validation of our work. It is unlikely that reading a single newly published study on an effective OMT clinical trial will make the way you do OMT in your office substantially different but these studies are essential in proving to the public, other fields of healthcare, insurance companies, and even the government that what we do is safe and effective.
Systematic Review and Meta Analysis are the highest tiers of study when considering academic studies. In this type of “study of studies”, a number of articles, each demonstrating proof for a similar concept, are combined together to create a greater proof. An individual random controlled trial (RCT) that shows evidence that a surgical method or drug reliably creates a useful effect is a good step towards proving the effectiveness of that method or pharmaceutical. However, any individual trial could have bias, unnoticed/undocumented errors, or irreproducible results and therefore cannot be the final say on effectiveness or safety. We must have reproducible results from a number of entirely independent sources to say with any kind of certainty that something is effective or not. As well, when we are able to combine a number of different sources, it can be specified who that treatment is best used for, what are the most common effects of the treatment, and how much of it is needed to generate a certain effect. This is a long and cumbersome process and certainly is part of the reason why science can be so slow. This process of review has however been proven to be far safer than small scale trials and far superior as compared to the days of the travelling tonic salesman (aka the “snake oil” salesman).
In this article I will briefly explain the more current systematic reviews of OMT that show evidence of effectiveness in their specific applications. I am not attempting to claim this as a systematic review of systematic reviews (another type of study that is exactly what it sounds like) as a study of such calibre is far beyond my qualifications and capacity. However, I do hope to show some currently and easily available systematic reviews of OMT with explanations in simple terms. This will hopefully act as an entry point should anyone wish to research the subject further or can be used as a quick reference for practitioners in the OMT field when asked for evidence on OMT applications. Full text links are provided for each article along with explanations for the reader’s comprehension. I am certain that the authors of the studies listed would be delighted to have you at least read the abstract (the summary at the top of the article) and quite possibly beside themselves should you read the entirety of the article (though do keep a dictionary handy as you read).
A necessary note: Because I live in Canada, I must state very clearly that I, as an Osteopathic Manual Therapist, do not/am not claiming to treat disease with Osteopathic Manual Therapy. These are largely reviews that take studies from many parts of the world and therefore phrasing in these articles may differ. For Canadian purposes I will say that we will take the claims made in these studies as the idea that they have been shown to help patients who have the related diseases/conditions. I am of the opinion that the capacity to help one’s patients live better is more than enough to continue to do the work of Osteopathy.
It should also be mentioned that there are other recent systematic reviews of OMT not included in this article. These reviews were omitted for the fact that they showed no evidence of effect in their specific areas of application. This is not an attempt to hide failure, only that this article is about what has been shown to have evidence/be possible to highlight what kind of patients can be helped with OMT.
Below is a list of some the systematic reviews of OMT that have shown beneficial effect to patients with diseases and conditions. A brief explanation and some criteria from each study are presented to be explained further on in this article.
Effects of spinal manipulation and myofascial techniques on heart rate
variability: A systematic review
By Amoroso Borges, et al. Full Text https://www.bodyworkmovementtherapies.com/article/S1360-8592(17)30249-8/abstract
This systematic review determined that the Sympathetic and Parasympathetic nervous systems could be influenced by OMT. 9 studies were included in the review which varied in quality. Some of the studies were weakened in quality as they lacked full documentation of methodology. Short term (immediately post treatment) and longer lasting effects were determined to be possible using OMT. In this review they were able to demonstrate some reliability of sympathetic or parasympathetic change with specific manipulation types to specific body regions.
Osteopathy for primary headache patients: a systematic review
By Cerritelli F, et al. Full Text https://pubmed.ncbi.nlm.nih.gov/28352200/
This systematic review showed a low level of evidence that OMT is effective in helping sufferers of headache and migraine. 5 RCT’s from numerous countries were included in the review. Between the 5 included studies there were 265 participants in total. Numerous different techniques, methodologies, frequencies of treatment, and lengths of treatment were utilized from study to study. OMT was found to reduce occurrences of headache per week, reduce severity, and reduce medication use. Some of the studies had significant results showing much stronger evidence of OMT effectiveness on headache and migraine; however, the small size of participants and risk of bias in the included studies reduced the reliability of the findings and so reduced the quality of evidence.
Craniosacral therapy for chronic pain: a systematic review and meta-analysis of randomized controlled trials
By Haller H, et al. Full Text https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-019-3017-y
This Systematic Review showed significant small to medium effects on patients suffering from pain. Craniosacral Therapy (CST) is at times limited to working on the cranial region exclusively, however, the studies used in this review also treated other parts of the body in some cases (many OMT practitioners regularly utilize CST as a component of OMT treatment). 10 studies were reviewed all of which were Random Controlled Trials (RCTs). Between these 10 studies this accounted for 681 patients’ various forms/regions of pain. The studies came from many different countries, studied numerous types of pain, utilized many different methods and/or techniques, and administered varying lengths and frequencies of treatments. Each technique and/or methodology showed different levels of success in reducing pain. Due to the small sample size of participants in the studies it could not be clearly stated what pain experiencing patient population CST would have the greatest effects on, what techniques/methods are best used, or what frequency of treatment would be required to generate the most beneficial effects.
Effectiveness of Osteopathic Manipulative Therapy for Managing Symptoms of Irritable Bowel Syndrome: A Systematic Review
By Müller, Axel, et al. Full Text https://doi.org/10.7556/jaoa.2014.098
This systematic review determined that there is evidence of short-term improvements of Irritable Bowel Syndrome (IBS) with OMT. The review involved 5 studies representing 204 patients. Numerous techniques and methodologies were used on multiple areas of the body amongst the studies with different levels of success but without consistency in application between the studies. As this is a small number of articles and number of patients it is not possible to be certain which patients will respond best to the applied OMT.
Effectiveness of an osteopathic treatment on the autonomic nervous system: a systematic review of the literature
By Rechberger V, et al. Full Text https://pubmed.ncbi.nlm.nih.gov/31653268/
This systematic review of 23 studies represents a moderate level of evidence that OMT has an effect on the Autonomic Nervous System (ANS). In these studies various OMT techniques and methods were performed on numerous body regions showing differing levels of effectiveness. Due to the small sample size, inconsistent methodologies, and inability to effectively match participants across studies there is no specific statement that could be made as to what OMT does to the ANS, how OMT affects the ANS, how frequently it needs to be administered to generate a consistent/lasting effect, and what patient population it could be most beneficial to.
Osteopathic Manual Treatment for Pain Severity, Functional Improvement, and Return to Work in Patients With Chronic Pain
By Rehman, Yasir, et al. Full Text https://doi.org/10.7556/jaoa.2020.128
This systematic review showed moderate quality evidence that OMT can reduce chronic pain. The type of pain specific to this review was chronic pain of numerous types (other than pain associated with cancer). It also showed that severity and disability related to pain can be reduced with OMT. Quality of life was also shown to increase with OMT. This review was based off of 16 RCT’s totalling 1158 participants between them. Due to the small sample size and inconsistent methods between studies it was not possible to determine what (if any) techniques/methods were resultant in greater or lesser effects. In this review the high risk of bias in some studies lowered the quality of the evidence.
Impact of osteopathic manipulative techniques on the management of dizziness caused by neuro-otologic disorders: systematic review and meta-analysis
By By Rehman, Yasir, et al. Full Text https://doi.org/10.1515/jom-2022-0119
This systematic review showed moderate evidence that OMT reduces the severity, frequency, and disability associated with dizziness. 12 studies were utilized for this review totalling 367 participants between all studies. In each study various different OMT techniques were used that were successful but not consistent amongst the studies. Based on the small sample size it is not clear which OMT techniques were more (or less) effective than others, however, articular work was better represented. The frequency of treatment necessary to reduce dizziness was also not established.
To “point-form” the above, we can say that OMT is capable of:
- Pain reduction
- Headache and migraine pain reduction
- Reducing sympathetic expression
- Reducing the severity, frequency, and disability associated with dizziness
- Creating short-term improvements in sufferers of IBS
If you are not familiar with Osteopathic research you will have likely noted the use of the words “low” or “moderate” in regards to the evidence level in some of these reviews. Other reviews simply stated a generalized admission of evidence of the effectiveness of OMT in the review. You may have also been confused or dismayed by the lack of words such as “high”, “exceptional”, or “transcendent”. This want of acknowledgment for the profession is entirely understandable, as practitioners of Osteopathy we want everything we do to be completely proven and 100% effective at all times. This is a wonderful idea but very unrealistic as there is substantial external influence and nuance to all therapeutic methods that make any treatment method less than 100% reliable.
A point was made to state in every study explanation that the amount of studies included were low in size (in comparison to other healthcare fields that also produce systematic reviews). As well, when read in full it is shown that the reviews excluded many studies due to low quality. Unfortunately, based on the speed with which Osteopathic studies are being produced, as well as how they are being conducted, validating OMT’s specific uses is very difficult. This is not to say that Osteopathy can’t be of significant benefit, but we do not yet have enough data to support when it can be best used. Unfortunately, in regards to the quality of studies, even though some studies show the benefit of OMT, the way they are carried out lowers the validity of their evidence and they cannot be included in the systematic review. It could very well be that were these studies better conducted they would be a great source of evidence for OMT, however, because the results could be attributed to other factors, the findings cannot be trusted as a reliable source. I’m sure every researcher would agree that large sums of money could rapidly increase the speed of production and greatly increase the quality of OMT studies being produced, but this is unlikely to occur anytime soon.
It is also worth noting that based on the systematic reviews listed, OMT is doing more than just pain reduction. This is worth noting because OMT is often considered by the general public to be for body pain treatment only, but it is clearly doing more than just that. For this and other reasons, it is the author’s opinion that it is very likely we are not looking at the final list of what OMT can help with. I am very hopeful that much more OMT research is produced and we can add many more specific patient populations that can be helped with OMT in the near future.
References
Amoroso Borges BL, Bortolazzo GL, Neto HP. Effects of spinal manipulation and myofascial techniques on heart rate variability: A systematic review. J Bodyw Mov Ther. 2018 Jan;22(1):203-208. doi: 10.1016/j.jbmt.2017.09.025. Epub 2017 Oct 3. PMID: 29332747.
Cerritelli F, Lacorte E, Ruffini N, Vanacore N. Osteopathy for primary headache patients: a systematic review. J Pain Res. 2017 Mar 14;10:601-611. doi: 10.2147/JPR.S130501. PMID: 28352200; PMCID: PMC5359118.
Haller H, Lauche R, Sundberg T, Dobos G, Cramer H. Craniosacral therapy for chronic pain: a systematic review and meta-analysis of randomized controlled trials. BMC Musculoskelet Disord. 2019 Dec 31;21(1):1. doi: 10.1186/s12891-019-3017-y. PMID: 31892357; PMCID: PMC6937867.
Müller, Axel, Franke, Helge, Resch, Karl-Ludwig and Fryer, Gary. “Effectiveness of Osteopathic Manipulative Therapy for Managing Symptoms of Irritable Bowel Syndrome: A Systematic Review” Journal of Osteopathic Medicine, vol. 114, no. 6, 2014, pp. 470-479.
Rechberger V, Biberschick M, Porthun J. Effectiveness of an osteopathic treatment on the autonomic nervous system: a systematic review of the literature. Eur J Med Res. 2019 Oct 25;24(1):36. doi: 10.1186/s40001-019-0394-5. PMID: 31653268; PMCID: PMC6814098.
Rehman, Yasir, Ferguson, Hannah, Bozek, Adelina, Blair, Joshua, Allison, Ashley and Johnston, Robert. “Osteopathic Manual Treatment for Pain Severity, Functional Improvement, and Return to Work in Patients With Chronic Pain” Journal of Osteopathic Medicine, vol. 120, no. 12, 2020, pp. 888-906.
Rehman, Yasir, Kirsch, Jonathon, Wang, Mary Ying-Fang, Ferguson, Hannah, Bingham, Jonathan, Senger, Barbara, Swogger, Susan E., Johnston, Robert and Snider, Karen T.. “Impact of osteopathic manipulative techniques on the management of dizziness caused by neuro-otologic disorders: systematic review and meta-analysis” Journal of Osteopathic Medicine, vol. 123, no. 2, 2023, pp. 91-101.