Neurophysiologic effects of spinal manipulation in patients with chronic low back pain

<p>Abstract</p> <p>Background</p> <p>While there is growing evidence for the efficacy of SM to treat LBP, little is known on the mechanisms and physiologic effects of these treatments. Accordingly, the purpose of this study was to determine whether SM alters the amplitude of the motor evoked potential (MEP) or the short-latency stretch reflex of the erector spinae muscles, and whether these physiologic responses depend on whether SM causes an audible joint sound.</p> <p>Methods</p> <p>We used transcranial magnetic stimulation to elicit MEPs and electromechanical tapping to elicit short-latency stretch reflexes in 10 patients with chronic LBP and 10 asymptomatic controls. Neurophysiologic outcomes were measured before and after SM. Changes in MEP and stretch reflex amplitude were examined based on patient grouping (LBP vs. controls), and whether SM caused an audible joint sound.</p> <p>Results</p> <p>SM did not alter the erector spinae MEP amplitude in patients with LBP (0.80 ± 0.33 vs. 0.80 ± 0.30 μV) or in asymptomatic controls (0.56 ± 0.09 vs. 0.57 ± 0.06 μV). Similarly, SM did not alter the erector spinae stretch reflex amplitude in patients with LBP (0.66 ± 0.12 vs. 0.66 ± 0.15 μV) or in asymptomatic controls (0.60 ± 0.09 vs. 0.55 ± 0.08 μV). Interestingly, study participants exhibiting an audible response exhibited a 20% decrease in the stretch reflex (p < 0.05).</p> <p>Conclusions</p> <p>These findings suggest that a single SM treatment does not systematically alter corticospinal or stretch reflex excitability of the erector spinae muscles (when assessed ~ 10-minutes following SM); however, they do indicate that the stretch reflex is attenuated when SM causes an audible response. This finding provides insight into the mechanisms of SM, and suggests that SM that produces an audible response may mechanistically act to decrease the sensitivity of the muscle spindles and/or the various segmental sites of the Ia reflex pathway.</p

Tradition of Osteopathic Medicine Dermatology: A Specialty That Exemplifies the Osteopathic Medical Profession SPECIAL COMMUNICATION

Even though the tradition of osteopathic medicine is based in primary care, more osteopathic graduates than in the past are pursuing subspecialties within medicine. Some claim that medical specialties, such as dermatology, compromise osteopathic principles and philosophy. However, the authors contend that dermatology exemplifies the ideals expressed by Andrew Taylor Still, MD, DO, and explain how osteopathic manipulative treatment and the principles of osteopathic medicine can be applied to dermatologic disease and patient care. J Am Osteopath Assoc. 2011;111(5):335-338 S ince its inception, osteopathic medicine has focused on primary care areas such as pediatrics and family practice. However, as osteopathic medicine has grown, so has its expansion into the medical and surgical specialties. From cardiology to orthopedic surgery, osteopathic medicine has embraced the need for specialists within the medical community. Even so, some argue that the trend toward specialized medicine has been at the expense of osteopathic principles and practice. 1 In particular, we have observed that the specialty of dermatology has been criticized for lacking osteopathic distinction because of the misconception that dermatology is a narrowly focused field in which osteopathic manipulative treatment cannot be used. In the present article, we elucidate how dermatology is a complex specialty that incorporates osteopathic principles into its approach to patients and exemplifies the legacy of osteopathic medicine. Tradition of Osteopathic Medicine In 1892, Andrew Taylor Still, MD, DO, founded osteopathic medicine as a solution to his frustration with the medical system during his time. He formed the term osteopathy by combining 2 Greek roots-osteon-for bone and -pathos for suffering-to convey his belief that physiologic dysfunction could be traced back to a disruption in the musculoskeletal system. 2 Central to osteopathic medicine are the following 4 major principles, 3 which have governed the osteopathic medical profession to this day: 1. The body is a unit, and the person represents a combination of body, mind, and spirit. 2. The body is capable of homeostasis, self-healing, and health maintenance. 3. Structure and function are interrelated. 4. Rational treatment is based on an understanding of these principles: body unity, self-regulation, and the interrelationship of structure and function. In addition to these principles, osteopathic medicine also uses physical manipulation, known as osteopathic manipulative treatment (OMT), within the greater context of osteopathic manipulative medicine as a means to treat patients with various diseases. 3 Dermatology as an Osteopathic Medical Specialty Dermatology is younger than most specialties within osteopathic medicine. For example, organizations such as the American Osteopathic College of Radiology, founded in 1941, 4 and the Osteopathic College of Ophthalmology and Otorhinolaryngology (now the American Osteopathic Colleges of Ophthalmology and Otolaryngology-Head and Neck Surgery), founded in 1944, 5 were uniting specialists in osteopathic medicine before the American Osteopathic College of Dermatology (AOCD) was established in 1957

The Importance of the Posterolateral Area of the Diaphragm Muscle for Palpation and for the Treatment of Manual Osteopathic Medicine

The eupneic act in healthy subjects involves a coordinated combination of functional anatomy and neurological activation. Neurologically, a central pattern generator, the components of which are distributed between the brainstem and the spinal cord, are hypothesized to drive the process and are modeled mathematically. A functionally anatomical approach is easier to understand although just as complex. Osteopathic manipulative treatment (OMT) is part of osteopathic medicine, which has many manual techniques to approach the human body, trying to improve the patient’s homeostatic response. The principle on which OMT is based is the stimulation of self-healing processes, researching the intrinsic physiological mechanisms of the person, taking into consideration not only the physical aspect, but also the emotional one and the context in which the patient lives. This article reviews how the diaphragm muscle moves, with a brief discussion on anatomy and the respiratory neural network. The goal is to highlight the critical issues of OMT on the correct positioning of the hands on the posterolateral area of the diaphragm around the diaphragm, trying to respect the existing scientific anatomical-physiological data, and laying a solid foundation for improving the data obtainable from future research. The correctness of the position of the operator’s hands in this area allows a more effective palpatory perception and, consequently, a probably more incisive result on the respiratory function. </jats:p