Immediate effects and associations between interoceptive accuracy and range of motion after a HVLA thrust on the thoracolumbar junction: A randomised controlled trial

BackgroundThere is paucity in the literature regarding the role of interoceptive accuracy (IAc) at predicting the effectiveness of osteopathic techniques which increase spinal mobility when directed specifically at the thoracolumbar junction (TLJ).AimsThe study aimed to explore whether a high velocity, low amplitude (HVLA) thrust of the TLJ would increase spinal mobility (measured through Range of Motion; ROM) and change IAc. Also, whether baseline IAc correlated with the post-ROM measures and change in ROM.Method21 asymptomatic participants were allocated into three conditions in a randomised order. These were; (1) a high velocity low amplitude manipulation of the TLJ; (2) sham (basic touch); and (3) a control (laying supine on a plinth). Before and following each intervention, the participants’ spinal ROM was measured using an Acumar digital inclinometer. In addition to this an ECG was used to measure their pre and post condition IAc.ResultsThere were significant increases in ROM for all condition, however, the HVLA thrust led to a significantly greater increase in ROM (p < 0.001) when compared to the control and sham. Baseline IAc was inversely associated with post-ROM but there was no association with change in ROM. The HVLA thrust did not significantly change IAc scores from pre to post intervention. Conclusions. HVLA thrust over the TLJ is a useful intervention for increasing spinal ROM. IAc maybe a useful predictor for intervention effectiveness of this technique and spinal area which could in the future be utilised by osteopaths as part of their diagnostics.     

原发性甲状旁腺功能亢进的骨骼X线分析(附36例报告)

本文分析了36例原发性甲状旁腺功能亢进的骨骼X线改变,认为主要的骨病征象可概括为指骨的骨膜下骨吸收、颅骨的磨玻璃样及颗粒状改变、骨皮质下的囊肿样改变和棕色瘤,骨的突起或肌腱韧带附着处的骨吸收,以及软骨下骨吸收。骨皮质下囊变的征象对鉴别诊断很有帮助。作者认为骨质疏松和反复泌尿系结石可提示甲状旁腺功能亢进的早期表现,应及时检查血钙磷以确诊。     

Studies on psoriatic osteopathy

Summary To demonstrate an as yet merely postulated generalized osteopathy in psoriatics, the serum calcium level, the alkaline phosphatase in the serum and the urinary excretion of hydroxyproline were evaluated in 24 patients with Ps and 24 patients with PA. Moreover, the bone bioptates from 25 patients with PA and 10 patients with Ps were examined histologically and measured morphometrically. The investigations provide evidence for the existence of a generalized latent osteopathy in terms of an elevated bone turnover rate without loss of bone volume (high turnover remodelling) in both patients with PA as well as those with Ps without arthritis. As a pathogenetically essential factor shared by dermatosis and osteopathy, latent vitamin D deficiency and/or D hormone resistance is discussed.     

Osteopathic treatment in patients with primary dysmenorrhoea: A randomised controlled trial

ObjectivesTo investigate the effectiveness of a series of osteopathic treatments in patients with pain due to primary dysmenorrhoea.Design and settingsMulti-centered randomised controlled trial with an osteopathic intervention group and an untreated (“waiting list”) control group.SubjectsWomen aged 14 years and older with a regular menstrual cycle, diagnosed with primary dysmenorrhoea.InterventionSix osteopathic treatments over a period of three menstrual cycles or no osteopathic treatment. At each treatment session, dysfunctional structures were tested and treated based on osteopathic principles. In both groups, pain medication on demand was allowed, but was documented.Outcome measuresPrimary outcome measures were average pain intensity (API) during menstruation, assessed by the Numeric Rating Scale (NRS), and days of dysmenorrhoeal pain exceeding 50% of NRS maximum (DDP). Main secondary outcome measure was health-related quality of life.ResultsA total of 60 individuals (average age 33 years) were randomised, seven patients dropped out. API decreased in the intervention group from 4.6 to 1.9 (95%CI = −1.9 to −3.5), and from 4.3 to 4.2 in controls (95%CI = −0.7 to 0.5); between group difference of means (BGDoM): 2.6, 95%CI = 1.7 to 3.6; p < 0.005. DDP decreased from 2.2 to 0.2 days in the intervention group (95%CI = −2.5 to −1.3), and from 2.3 to 1.9 in controls (95%CI = −1.0 to 0.2); BGDoM 1.5; 95%CI = 0.6 to 2.3; p = 0.002. A positive impact on quality of life (physical component score) could be observed in the osteopathic treatment group only.ConclusionsA series of osteopathic treatments might be beneficial for women suffering from primary dysmenorrhoea.     

A splenic cyst causing a viscerosomatic reflex in the thoracic spine. A case report

IntroductionMusculoskeletal pain in the thoracic spine is a common complaint and often seen in the osteopathic clinic. An underlying cause may be pain originating from an internal organ referring to the segmental related somatic structures, i.e. a viscerosomatic reflex. A splenic cyst causing a viscerosomatic reflex in the thoracic spine is a rare but serious differential diagnosis for thoracic musculoskeletal pain that may be identified during routine osteopathic assessment and treatment.Case presentationA 36-year-old women was referred for osteopathy with pain in the thoracic spine as the main complaint. The pain was aggravated by twisting motions, prolonged standing and sitting. The physical examination identified hyperalgesia, hypertonic paraspinal muscles with trophic changes at T6-10 and hypomobility at T6-8. On palpation the diaphragm muscle was hypertonic. In the abdomen, a palpable mass was found in the left upper quadrant, which was suspected to be an enlarged spleen. A normal size spleen is not palpable; therefore, the patient was referred for further investigations. An X-ray and CT scan identified a splenic cyst of approximately 10 cm which was removed with a splenectomy as advised, leading to resolution of the thoracic pain.ConclusionA splenic cyst mimicking mechanical pain in the thoracic spine is rare; however, this case report highlights the importance of comprehensive history taking and screening of red flags, combined with careful physical examination of both musculoskeletal and visceral structures.     

The Portuguese osteopaths' attitudes towards a biomechanical or biopsychosocial model in the approach of chronic low back pain – A cross-sectional questionnaire-based survey

ObjectiveThis study investigated the Portuguese Osteopaths attitudes towards a biomechanical or biopsychosocial approach of care in patients with chronic low back pain (cLBP).MethodsA cross-sectional questionnaire-based survey of Portuguese registered osteopaths was composed using sociodemographic determinants, the Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS) and Pain Attitudes and Beliefs for Physiotherapists (PABS-PT). The HC-PAIRS assesses the attitudes and beliefs about the functional expectations of patients with cLBP, and the PABS-PT assesses the dominant model of care.ResultsPortuguese registered osteopaths (n = 103) had mean PABS-PT subscale scores of 29.6 ± 7.7 [CI95% 28.12–31.14] (biomechanical) and 22.9 ± 5.3 [CI95% 21.88–23.94] (biopsychosocial). The mean HC-PAIRS total score was 52.4 ± 9.0 [CI95% 50.66–54.16]. There was a strong and positive correlation between the HC-PAIRS and the PABS-PT biomechanical subscale (n (103) = 0.55, p < 0.001, and in PABS-PT a negative correlation between the biomechanical and biopsychosocial subscale scores (n(103) = -0.21, p = 0.028).ConclusionsPortuguese osteopaths tend to adopt a biomechanical model of care instead of a biopsychosocial model in the management of patients with chronic low back pain. They seem to agree that chronic low back pain was due entirely to tissue damage, indicating strong biomechanical beliefs about the pain that may ultimately influence their clinical decisions.     

Holism in Osteopathy – Bridging the gap between concept and practice: A grounded theory study

Background and objectivesThis study aimed to explore the meaning of holism to Osteopathic professionals and thus develop a theory to inform the gap between holism as a concept and its implementation in clinical practice.MethodsOsteopathic practitioners were purposively selected resulting in eight participants from eight clinics in different demographic regions of Melbourne, Australia. In depth interviews were conducted and data was analysed using grounded theory methodology.ResultsResults demonstrate that an understanding of holism in osteopathic health care (in education and clinical practice) required an “awareness of relationships”. The emerging theory relates concept and educational framework (i.e. both biomedical and holistic philosophical approaches), with the practice of holism and describes what holism means within the context of an individual treatment.ConclusionImplications are for osteopathic education to provide a balanced emphasis between holistic and biomedical frameworks and theoretical insight into understanding patients presenting with chronic health issues.