Question:

In a multicentric, randomized, controlled intervention study it was investigated how the common disease Low Back Pain (LBP) can be treated meaningfully. Osteopathy, as well as the therapy with a strength training for the lumbar back muscles, aim at improving lumbar back pain. Since both therapies work with different approaches, it is interesting to see how pure strength training has an impact on LBP compared to a combination of strength training and osteopathy. The MedX LE is a specially developed training device for the isolated strengthening of the lower spinal musculature, which was used in the study as a training and analysis device. The study defined the following measurement parameters: lumbar muscle strength, pain, lumbar spine mobility, and general well-being (SF-36).

Experimental plan:

A total of 49 women at an average age of 50.2 years and 41 men at an average age of 48.2 years participated. These were divided into 3 groups of 30 patients each. The non-randomized control group (K) received 18 appointments HIT training to strengthen the lumbar spinal muscles with the Med X LE. In the second group (P), 18 appointments HIT training for strengthening the lumbar musculature with the Med X LE were combined with 4 parallel osteopathic treatments (at 40 min each). The third group (S) first received 4 osteopathic treatments (at 40 min each) and then 18 appointments HIT training to strengthen the lumbar musculature with the Med X LE. Patients in groups P and S were randomized by lot.

Results:

With each treatment method, the strength was increased, the pain reduced, the mobility improved and the general well-being increased. Comparing the groups with each other, group S's effects on strength, pain and general well-being were the clearest. As far as the increase in strength is concerned, the increase at 0 ° CI (41 to 56) averaged 7 lbs (3.18 kg) and at 72 ° CI (26 to 42) also averaged 7 lbs (3.18 kg) more than in Group P. A greater improvement of the mobility of the lumbar spine could be achieved compared to group K, but not compared to group P.

Discussion:

The study showed that group S achieved the best results. The additional expenditure of time incurred by the patient in this group due to the longer duration of treatment seems worthwhile. The serial intervention with an initial osteopathic treatment proved to be very positive for the patients, as their mostly dysfunctional joints and the associated soft tissues were therapeutically assisted in salutogenesis. The subsequent training was therefore better tolerated in the serial group.

Keywords:

Osteopathy, Low Back Pain (LBP), HIT Training, Strength, Mobility, Pain, Med X LE, Zebris WinSpine.

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Background

The lymphoedema is a condition affecting more than 120,000 individuals in Germany most of which are females. Patients quality of life is fundamentally reduced by compression stockings, a bulky, misshapen appearance, symmetric or asymmetric swellings as well as the development of cutaneous conditions. Manual Lymphatic Drainage (MLD) combined with Complex Physical Therapy (CPT) is the current Golden Standard treatment. Aiming at a greater amount of relief for the aforementioned patients, a combined treatment of MLD and various fasica techniques (FT) was applied. The FAUL (German: Faszien und Lymphe "fascia and lymphs") trial was used to determine if and how such a combination of MLD and FT can be effective.

Methods

The FAUL trial is a multicentric, randomised, controlled, blinded clinical trial which examined three groups regarding a suspected improvement in the effectiveness of treatment and a loss of volume in lymphoedema patients if MLD and FT are combined. One of three participating treatment centres administered standard MLD treatment to the first trial group, whilst the remaining two administered a combined therapy of FT and MLD, with FT marking the first phase of the session in the second trial group and the last phase of the session in the third trial group. The trial was conducted with 99 participating patients at treatment centres in Bad Berleburg and Pommelsbrunn. A perometer was used to determine the volume in millilitres (ml) of the extremities affected before, partly during, and at the end of patients stationary residence.

Results

Considering the Primary Endpoint of this trial (loss of volume in ml), no significant evidence could be determined effect-wise. However, as the Secondary Endpoint of this trial, an effect could safely be determined in a loss of volume in % of the MLD control group in comparison to the interventional groups.

Conclusion

An increase in volume loss through a combined therapy of MLD and FT cannot be proven by the data on hand. The Golden Standard treatment described above will remain the norm for lymphoedema patients.

Keywords

Lymphoedema; fascia therapy; manual lymphatic drainage; combination of fascia therapy and manual lymphatic drainage

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Background

By means of the "two-scales test" (ZWT) and computer-assisted static posturography (CSP) this study examines the question, whether a particular pain localization or any possibly existing dysfunction of the stomatognathic system affects balance and weight distribution. Another aim of this study was to examine the validity of the "ZWT".

Method

81 subjects with musculoskeletal pain were examined during different starting positions. The results of the "ZWT" were compared with the results of the CSP. The CSP served as the gold standard. In addition, the participants completed a questionnaire that shed light on their preferred chewing side and/or a possibly existing Cranio Mandibular Dysfunction (CMD). The "ZWT" was tested for sensitivity and specificity. The differences between the starting positions were only analyzed with the CSP.

Results

The "ZWT" shows a low sensitivity (0.37) and a high specificity (0.93) in the detection of unbalanced load of the lower extremity. The 95% area from the center of presure of subjects with lumbar discomfort exhibited the largest area (measured in mm2). The 21 subjects whose preferred chewing side was right showed no significant shift in the body"s center of gravity with the mouth closed and with eyes closed (p = 0.22). The 13 subjects whose preferred

chewing side was left also showed no significant displacement of the body"s center of gravity under the same conditions (p = 0.31). However, regardless of the conditions, a slight tendency could be observed to shift the weight to the left leg if the preferred chewing side was right, and to shift the weight to the right leg if the preferred chewing side was left.

Conclusion

The "ZWT" can be used conditionally with patients with lumbar discomfort, as this subgroup displays the greatest characteristics of fluctuation. To verify a correlation of one's preferred chewing side to specific postural characteristics, further studies with more homogeneous subgroups are required.

Keywords

Posturography; "two scales test"; CMD; Musculoskeletal;

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Background

In the daily routine of physical therapeutic work, simple and quick ways of testing are required to come to a diagnosis in an efficient manner. The Meersseman test is such an indicator for testing for temporomandibula disorder (TMD), a malfunction of the mandibular joint that causes a number of symptoms with a high impact for the patient. These symptoms include head, tooth & facial aching as well as limited ability for opening of the jaws, and cracking and grinding of the temporomandibular joint (TMJ). However the validity of the Meersseman test has never been proven in a clinical study.

Method and Material

A clinical study with 25 probands (16 in the test group, 9 in the control group) has been conducted. The Meersseman test was interpreted using the CROM instrument for measurement of the cranial range of motion. The results where validated based on condylographic test results and evaluated with the receiver operater curve (ROC) method.

Conclusion

The majority of the hypothesis could not be validated by the results of the condylographic measurements. The results of the total difference of the quantity for both jaw joints of jaw opening, protrusion and mediotrusion movements as well as the maximum distance of start and endpoint for the jaw opening movement did not show a correlation to the result of the Meersseman test. Nor could the analysis of maximum speed within the jaw opening and the special finding be connected to the Meersseman test results.
The analysis of the difference of start- and endpoint, however, showed a positive result with an AUC of 0.72 within the ROC. Further analysis via a scatter diagram showed the Meersseman test will turn positive in a deviation of 0.4mm and more. This indicates the test might be more suitable for muscular coordinative dysfunction, which is an assumption worth elaborating in further studies.

Keywords

TMD; Meerseeman-Test; Condylographie; Osteopathy

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Background

The rare disease HSP (Hereditary Spastic Paraplegia) is a neuro-logical disease which leads to spastic changes mainly in the lower extremities. As a standard therapy for the patients Physiotherapy is used for preservation of the available functions. In this study this kind of therapy was compared to Osteopathy.

Method

This study is a prospective intervention study compared between Osteopathy and the comparison group Physiotherapy. 18 persons took part in the Osteopathy group and five in the Physiotherapy. Because of the measurement before and after the intervention by Spastic Paraplegia Rating Scale (SPRS) only the effect of both methods of treatment could be determined.

Results

The average of the differences between measurement 1 and 2 in the osteopathic treatment was 21,6 and from the physiotherapeutic medication 27,4. Statistics were provided within the Osteopathy and the Physiotherapy group. In the study the point value of the SPRS in the Osteopathy group decreased about 3,0 with a state kind divergence of 1,9. This change was highly significant (p>;0.0001) different from zero. The Physiotherapy improves the point value about 1,6 with a state kind divergence of 2,1. This change was statistical not significant due to the low number of test persons. There could not be proven a significant difference between Osteopathy and Physiotherapy.

Conclusion

In summary it can be said the Osteopathy showed a short-term effect. It was the Osteopathic treatment measured with SPRS, while the control group Physiotherapy showed no short-term effect after the intervention. There was no difference between the two groups.

Keywords

Hereditary Spastic Paraplegia (HSP); Osteopathy; Spastic Paraplegia Rating Scale (SPRS)

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Background

Developing interdisciplinary teams is one of the most often formulated demands in the German health system. This has also been clearly emphasized in a report of the expert advisory council of the Federal Ministry of Health. But how do German osteophaths face this theme?

Method and Material

In the current study German osteopaths had been asked for their opinion about interdisciplinary teamwork. The participants initially were asked whether and how they already cooperate with any faculties in general. What was their opinion about cooperating with other faculties in general and what did they think about the advantages and difficulties that may occur.

Conclusion

The created questionnaire had been sent out online and anonymously to 5132 German osteopaths. Finally 915, i.e. 18 % response rate, had been returned fully filled in and the data were analysed. It revealed that most of the participating osteopaths indeed are very open-minded about interdisciplinarity in the health system and are interested to get a platform which could simplify the interdisciplinary teamwork. They see great chances to improve the treatment and thus gaining better therapy results.
The results of this research study can be assumed to be an overview of the topic. Detailed research in this particular field as well as many others would be very appreciated.

Keywords

Interdisciplinarity; Osteopaths; Germany; Teamwork

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Background

Asthma is a relative common disease (5% of adults). The main symptoms, such as difficulty in breathing and cough, reduce the quality of life of the affected persons. Asthma is treated symptomatically with medications from the doctors. This study has the target to work out, if osteopathy can improve the lung-function in case of asthma, if the symptoms can be reduced and if the patients need less medications.

Method

This study is a prospective, experimental, clinical case study with 19 patients. The study can be viewed as pilot study. It examines the impact of an osteopathic treatment on the lung function (measured by spirometry and peak-flow-meter) and the symptoms of the patient (examined with an Asthma Diary about 4 weeks), as well as the consumption of medications (Asthma Diary). The observation period is 4 weeks. The lung function is checked directly before and after the intervention, the asthma diary is performed for 4 weeks. There are 2 interventions, one in the beginning of the second week, the second in the beginning of the third week. The first week is the control week.

Results

No significant statement could be taken about the lung function directly before and after the treatment. The peak flow rate was tended to be worse. The FVC worsened after the 1st Intervention even significantly (p=0,03). The vital capacity, however, shows a positive trend directly before and after the intervention, but not significant (p=0,03). The lung function (measured with the peak flow meter) about 4 weeks improved significantly (p=0, 01). The symptoms improved as well in the period of 4 weeks (0,03). No significant statement can be made in case of the use of medication. But also the medication has a trend to decrease.

Conclusion

The results of this study are promising. Because this study can be seen as a pilot study, because N was too small, there could be follow larger studies, with a greater number of cases. The development of lung function and symptoms in the weeks after the interventions show an improvement with a significant result. This study therefore has a more long-termed success of the osteopathic treatment of bronchial asthma. A short-termed success could possibly be detected in patients with an acute asthma attack, which is difficult to make. Looking ahead osteopathy could be added to medications.

Keywords

Bronchial Asthma; Osteopathie; Osteopathic Treatment; Lung Function

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Background:

Myofascial pains belong to the most frequent pain syndromes of patients who visit our therapeutic institutions. Pain, which has its origin in musculature and fascia is called myofascial pain.

The term "myofascial pain syndrome has a general and a special meaning which should be separated from each other as Simons and Travell described it. The general meaning is defined as a local muscle pain syndrome, with its origin in the soft tissue (eg. muscles and fascia) and accompanied with muscular pain. The second meaning is a specific myofascial pain syndrome caused by trigger points. The clinical study "Efficiency of V- Actor vibration therapy in case of a myofascial pain syndrome of masticatory muscles refers to the general meaning of a local muscle pain syndrome, whereat painful point musculature can be in place without a typical transmitted pattern for active trigger points.

Method

The study considers the question how far a V-actor subfield vibration therapy of the Storz Medical Company is able to mitigate pain perception or appreciation of a patient who suffers myofascial pain syndrome of masticatory muscles.
Furthermore the study should bring perceptions how far subfield vibration therapy can be an alternative to manual techniques in case of myofascial pain syndrome of masti-catory muscles.

Already implemented was a comparing benefit assessment based on a randomized study with a control group. Three measuring instruments were used in the study: A questionnaire to capture afflictions in routine functions of the masticatory organ, the visual analogue scale to capture pain intensity and a functional analysis of measuring mandibular movements.

Results

The results of the study show, that the therapies have a positive influence on the pain threshold. A significant difference between intervention and control group could not be find out. The applied therapies do not achieve a radical success in sense of absolute absence of pain. But for sure, they are in the position to contribute a good therapy result in context with other therapies.

Keywords

TMD; myofascial pain syndrome; V-Actor; vibration therapy; Osteopathy

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