Research

Efficacy

In a meta-analysis and systematic review of six randomised controlled trials of osteopathic manipulative treatment (OMT) that involved blinded assessments of lower back pain in ambulatory settings, it was concluded that OMT significantly reduces lower back pain, and that the level of pain reduction is greater than expected from placebo effects alone and persists for at least three months.

Mechanism

Another study, which aimed to identify cellular mechanisms at work during osteopathic treatment, was published in the Journal of American Osteopathic Association in December 2007. Data from this study suggest that fibroblast proliferation and expression/secretion of pro-inflammatory and anti-inflammatory interleukins may contribute to the clinical efficacy of indirect osteopathic manipulative techniques.

Safety

Safety concerns have been raised in relation to manipulative techniques used in osteopathic practice. ‘Neck cracking’, i.e. cervical high-velocity low-amplitude thrusting, has received particular attention in the popular media due to a possible risk of arterial occlusion and consequently of stroke. Although the existing data cannot provide a conclusive estimate of the cervical artery dissection risk researchers have stated that a stroke risk of about 1.3 per 100 000 chiropractic visits for individuals aged under 45 years, with a 95% confidence interval of 0.5–16.7 per 100 000 is a theoretically unbiased estimate. Although these data primarily concern chiropractic visits, both osteopaths and chiropractors may practice cervical manipulations.