Somatic dysfunction possible linchpin to osteopathic back treatment

Aug 14 2012

By Lucy Piper, Senior MedWire Reporter

Somatic dysfunction, particularly in the lumbar and sacrum/pelvis regions, is common in patients with chronic lower back pain and contributes to poor functioning and general health, results from the OSTEOPATHIC Trial show.

"This study demonstrates that, relative to low back pain, somatic dysfunction is a valid diagnostic tool for patients with chronic low back pain," lead author John Licciardone (The Osteopathic Research Center, University of North Texas Health Science Center, Fort Worth, USA) told MedWire News.

Of 455 adults with chronic lower back pain studied, about half (49%) had severe somatic dysfunction, based on the presence of the four TART criteria ‑ tissue texture abnormality, asymmetry, restriction of movement, and tenderness.

Such dysfunction was seen mainly in the lumbar (49%), sacrum/pelvis (28%), or pelvis/innominate regions (11%). Indeed, only a few patients (7%) had no somatic dysfunction in these areas.

Patients with severe somatic dysfunction in the lumbar region had greater low back pain severity than those without, with median scores on a visual analog scale of 4.7 versus 3.8. In addition, they had greater back-specific disability, as measured on the Roland-Morris Disability Questionnaire (RMDQ), with scores of 6 versus 4.

Back-specific disability was also increased in patients with severe somatic dysfunction in the sacrum/pelvis region, who scored a median of 6 on the RMDQ versus 5 for those without dysfunction. Their general health was also impaired, with median scores on the Medical Outcomes Study Short Form-36 Health Survey of 62 versus 72.

As reported in the Journal of the American Osteopathic Association, having severe somatic dysfunction in any anatomic region correlated with the overall number of key lesions and both back-specific functioning and general health deteriorated as the number of key lesions increased.

These findings "reinforce somatic dysfunction as a credible diagnostic tool that also provides a baseline measure to help gauge treatment success using OMT [osteopathic manipulative treatment] when combined with other treatment outcome measures," Licciardone explained.

"These findings confirm part of what osteopathic physicians and osteopaths have been saying for years, that the goal is to identify somatic dysfunction, treat it with OMT, and patients get better."

Forthcoming extensions of the OSTEOPATHIC Trial will now assess whether somatic dysfunction improves with OMT and whether alleviation of somatic dysfunction results in reduced pain, and improved functioning and general health.

Licciardone concluded: "While this study may not change physicians' perceptions of OMT, the data do bring credibility and validity to the uniquely osteopathic concept of somatic dysfunction, which may help physicians be more open to other osteopathic concepts and treatments."

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