Osteopathy for Physical Injury

Most people experience some physical injuries throughout their life, from the gentle falls that accompany learning to walk to the scrapes and fractures that come with sports participation. As we age, accumulated joint damage, thinning bones, arthritis, and the effects of repetitive stress can take their toll as well. Osteopathy looks at the structure of the musculoskeletal system in order to diagnose a problem with the bones, muscles, or nerves. Allopathic treatments can range from simple first aid (ice packs and aspirin) to the medically sophisticated and intense (surgery, stitches, traction, artificial joints and bone grafts). In osteopathic medicine, manipulation techniques can also be used to restore the healthy structure of the musculoskeletal system, reduce pain, and possibly prevent future injury.

What Kinds of Osteopathic Treatments are Used for Physical Injury?

Doctors of Osteopathy (DOs) use many of the same methods to treat injury as an allopathic physician, such as prescription medication and surgery when necessary. DOs also use a variety of osteopathic manipulation techniques (OMTs), including:

• Functional manipulation techniques: These include articulation and thrust mobilization, techniques where the patient's joints are moved through the normal range of motion allowing the practitioner to assess damage that restricts movement. Spinal manipulation (sometimes called an "adjustment") is the application of controlled force on spinal joints to treat low back pain.

• Muscle energy techniques:Counterstrain is an osteopathic manipulation technique where a muscle or joint is moved to the most relaxed position or point of greatest comfort. Then a mild level of overstretching is applied to counteract and release the unhealthy muscular contraction. Massage techniques such as Swedish massage, deep tissue massage, and shiatsu focus on soft tissues to relax and ease muscles and muscle pain. Myofascial trigger point release (also called pressure point massage) uses deep finger pressure and hand strokes to focus pressure on knots in the muscles (the myofascial trigger points).

Common Physical Injuries that Benefit from Osteopathic Treatments

Osteopathic treatments for injuries to the musculoskeletal system, such as back pain, neck pain, joint pains, and carpal tunnel syndrome, as well as non-musculoskeletal conditions, have been studied. Based on those studies, osteopathic treatment provides relief as effectively as non-osteopathic treatments, especially for back and neck pain. There is additionally some evidence that patients who receive osteopathic treatments experience a degree of pain relief more quickly, and use fewer medications less often.

Doctors of Osteopathy (DOs) use Osteopathic Manipulation Techniques (OMTs) to treat back pain in numerous ways. They can apply pressure to muscles around the spine, called soft tissue techniques; direct their patient to engage their muscles from a certain position in resistance of the DO’s own force, a muscle energy technique; or they can swiftly and forcefully perform a thrust technique in order to regain range of motion and proper alignment. Osteopathic Manipulation Techniques (OMTs) can even be helpful for alleviating symptoms of sinus and some respiratory problems because they help drain the sinuses and open airways. OMTs used on the hands, arms and back can help carpal tunnel syndrome (CTS); menstrual pain and headaches can be relieved by other specialized OMTs. In some cases, osteopaths can help align a pregnant mother’s body when her organs are displaced by the growing fetus, creating a more healthy body alignment.

What are some Benefits of Osteopathic Treatments?

Pain reduction, stress reduction, and relaxation are generally the result of established Osteopathic Manipulation Techniques (OMTs). Research suggests osteopathic treatments, particularly those aimed at neck and back pain, are as effective as standard medical treatments. Osteopathic practitioners have a "whole person" view of their patients and spend more time with them, which may encourage patients' recovery. The cumulative effect of reducing pain and stress, and enhancing relaxation can promote sleep and the release of helpful chemicals (such as endorphins or serotonin).

What Risks are Associated with Osteopathic Treatments?

As with non-osteopathic treatments, there are side effects and potential risks associated with medical treatment:

• Patients may experience a short period (1-2 days) of increased pain, mild headaches or fatigue immediately following osteopathic manipulation. Side effects of massage therapy can include sensitivity to lotions or oils, bruising or swelling of tissues, and temporary discomfort or pain.

• Patients with broken or dislocated bones, infections or cancers of the bones or joints, recent joint surgery, osteoporosis, rheumatoid arthritis of the neck, damaged ligaments, or who take blood-thinning medications (for example, aspirin, coumadin or Warfarin) should not undergo osteopathic manipulation. Patients with blood clots, deep vein thrombosis or damaged blood vessels should avoid massage.

• On extremely rare occasions, patients who have undergone neck manipulation have experienced strokes or spinal injury. Also very rarely, patients who have been treated with spinal manipulation have experienced cauda equina syndrome (compression of nerves in the lower spinal cord). Pain, weakness, loss of feeling in the legs, and loss of bowel or bladder control can occur.

What is Osteopathy?

Osteopathy is a holistic conventional medicine approach that focuses diagnosis and treatment on the musculoskeletal system (the body's structure of bones, muscles, and nerves). More broadly, osteopaths look for "somatic dysfunctions," a functional impairment of the musculoskeletal system and the related blood vessels and lymphatic system. Osteopathic treatments can include medication, surgery, massage (of soft tissues), and specialized manipulations of bones and joints.

What is a Physical Injury?

Physical injuries are damage to the body caused by trauma, extremes of heat and cold, exposure to harmful levels of radiation, and electrical shocks. Damage caused by impacts to the body's bones and tissues from blunt force, stabbing or cutting, or crushing is called mechanical trauma. The resulting injuries may be temporary or permanent in nature, and may require multiple types of treatments. Severe injuries may also cause significant pain immediately, during treatment, and in the longer term (becoming chronic pain).

Additional Resources

American Osteopathic Association

National Institutes of Health: NCCAM Backgrounder: Get the Facts: Spinal Manipulation for Lower Back Pain

Barron M.C., Rubin B.R. (2007): Managing osteoarthritic knee pain. Journal of the American Osteopathic Association 107(Suppl 6): 21-27.

Bronfort G., Haas M., Evans R.L., et al. (2008): Evidence-informed management of chronic low back pain with spinal manipulation and mobilization. Spine Journal 8(1):213-225.

Cavalieri T.A. (2007): Managing pain in geriatric patients. Journal of the American Osteopathic Association 108(5):251-259.

Chou R., Huffman L.H. (2007): Nonpharmacologic therapies for acute and chronic low-back pain: A review of the evidence for and American Pain Society/American College of Physicians clinical practice guideline. Annals of Internal Medicine 147(7):492-504.

Cleland J.A., Glynn P., Whitman J.M., et al. (2007): Short-term effects of thrust versus nonthrust mobilization/manipulation directed at the thoracic spine in patients with neck pain: a randomized clinical trial. Physical Therapy 87:431–440.

Shen F.H., Samartzis D., Andersson G.B.J. (2006): Nonsurgical management of acute and chronic low back pain. Journal of the American Academy of Orthopedic Surgeons 14:477-487.

Wynne M.M., Burns J.M., Eland D.C., Conatser R.R., Howell J.N. (2006): Effect of counterstrain on stretch reflexes, Hoffman reflexes, and clinical outcomes in subjects with plantar fasciitis. Journal of the American Osteopathic Association 106(9):547-556.