THE EFFECT OF GLOBAL OSTEOPATHIC TREATMENT ON CHRONIC LOW BACK PAIN (2006)
SALLY A SHAW DOMP, unpublished thesis Canadian College of Osteopathy
Chronic low-back pain and disability continue to be a health care challenge, and the cause, predictors and treatment remain unclear. No one treatment has proven to be effective over another in long-term management. A primary premise of osteopathy is that structure governs function, i.e., removing the mechanical restrictions of all structures will improve function. This study evaluated whether osteopathic treatment on subjects with chronic low-back pain (CLBP) changed pain levels, function and endurance of the spinal stability muscles.
A within subject, repeated-measure study, using the subjects as their own control, was conducted. Forty subjects with chronic CLBP were admitted into the study, twenty-six completed the study without violating the study protocol. The mean age of the subjects was 42.92 +/- 8.30 years and the mean interval since onset of back pain was 12.88 +/-6.86 years. During the control phase (one month), the subjects continued with existing health care. During the treatment phase (one month), they received four osteopathic treatments at one-week intervals. Dependent variables were measured at baseline, following the control period, one week following the last treatment, and at four weeks following this last evaluation. The outcome variables were the Roland Morris disability index (RMDI), the visual analog scale (VAS) for pain, the SF 36 and a rating of satisfaction of care.
Results were analyzed using separate repeated measures ANOVA for each dependent variable. When significant differences were observed among values obtained at each assessment point, ‘a priori’ linear contrast analysis provided separate significant tests for changes observed across the baseline interval, and those observed across the treatment interval.
A significant change was seen on the RMDI during the treatment phase and this was maintained at five weeks post treatment. The change between baseline to post treatment (visit two to three) was a decrease of 3.7 and this change had a significance of p <0.001 and an effect size equal to 0.51. From baseline to follow up the change was maintained with a significance of p< 0.002 and an effect size equal to 0.33. VAS pain ratings of average over the last month showed a significant change from baseline to follow up (visit two to four) with a significance of p< 0.001 and an effect size equal to 0.37. A high level of subject satisfaction was obtained and thirty eight percent of the subjects reported a large improvement with treatment. No subjects reported an increase in symptoms with osteopathic treatment. There was no significant change in either the mental or physical summary scores of the SF 36. We could not detect any subject characteristics (i.e. age, exercise, health history or duration of symptoms) that predicted a positive change on the RMDI (MCID>5).
This study was unique in chronic low back pain studies as it evaluated global osteopathic treatment. Our subjects presented with numerous areas of restrictions and lesions that would partially account for changes in their posture and spinal mechanics possibly perpetuating their chronic pain condition. Key areas requiring treatment were lesions of the core link, (SBS, C0-C1, L5-S1), the spinal pivots (C5, T4, L3), L1-L2, lesions of the central fascial chain, the pelvis and both lower extremities.
