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King HH, Mai J, Morelli Haskell MA, Wolf K, Sweeney M. Effects of osteopathic manipulative treatment on children with plagiocephaly in the context of current pediatric practice: a retrospective chart review study. J Osteopath Med 2024; 124:171-177. [PMID: 37999741 DOI: 10.1515/jom-2023-0168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/17/2023] [Indexed: 11/25/2023]
Abstract
CONTEXT Deformational plagiocephaly (DP) is on the rise in pediatric patients. The current standard of care recommended for management is repositioning with possible addition of cranial orthoses. However, strong data are lacking to support these recommendations. Osteopathic manipulative treatment (OMT) is another treatment option for DP that is also lacking evidential support. OBJECTIVES This retrospective chart review study investigated the effects of OMT at restoring a more symmetrical cranial bone configuration in children with DP. METHODS A retrospective chart review was performed on medical records of patients with a diagnosis of DP from three private practices over a 4-year period from September 2017 to December 2021. Inclusion criteria were diagnoses of DP by a referring physician and aged 10 months or less at the time of initial evaluation and treatment. Patients were excluded if they had confounding diagnoses such as genetic syndromes or severe torticollis. A total of 26 patients met these criteria, and their records were reviewed. The main outcome reviewed was anthropometric assessment of the cranium, mainly the cranial vault asymmetry index (CVAI). RESULTS Participants demonstrated a mean CVAI - a measure that determines the severity of DP - of 6.809 (±3.335) (Grade 3 severity) at baseline, in contrast to 3.834 (±2.842) (Grade 2 severity) after a series of OMT treatments. CVAI assessment after OMT reveals statistically significant (p≤0.001) decreases in measurements of skull asymmetry and occipital flattening. No adverse events were reported throughout the study period. CONCLUSIONS The application of OMT has shown potential benefit for reducing cranial deformity in patients with DP.
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Affiliation(s)
- Hollis H King
- University of California San Diego School of Medicine, Center for Integrative Medicine, San Diego, CA, USA
| | - Julie Mai
- Osteopathy's Promise to Children, San Diego, CA, USA
| | | | - Kimberly Wolf
- Osteopathic Manipulative Medicine Department, Touro University California College of Osteopathic Medicine, Vallejo, CA, USA
| | - Megan Sweeney
- Osteopathy's Promise to Children, San Diego, CA, USA
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King HH. Cervical Osteopathic Manipulation Shown to Affect Median Nerve Function. J Osteopath Med 2018; 118:348. [DOI: 10.7556/jaoa.2018.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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King HH. Osteopathic Manipulation Shown to Improve Upper Airway Stabilization. J Osteopath Med 2018; 118:348a-349. [DOI: 10.7556/jaoa.2018.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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King HH. Fibromyalgia Symptoms Reduced by Osteopathic Manipulative Medicine and Gabapentin. J Osteopath Med 2018; 118:349-350. [DOI: 10.7556/jaoa.2018.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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King HH. It Makes a Difference What You Are Thinking When You Touch Someone Clinically. J Osteopath Med 2018; 118:50-51. [DOI: 10.7556/jaoa.2018.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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King HH. CSF Flow Has a Significant Respiratory Component. J Osteopath Med 2018; 118:52-53. [DOI: 10.7556/jaoa.2018.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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King HH. Cervicogenic Somatic Tinnitus Significantly Reduced by Physical Therapy. J Osteopath Med 2017; 117:666-667. [PMID: 28973185 DOI: 10.7556/jaoa.2017.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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King HH. Intervertebral Herniation Pain Reduced by Inpatient Manual Therapy and Traditional Korean and Chinese Medicine. J Osteopath Med 2017; 117:668-669. [DOI: 10.7556/jaoa.2017.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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King HH. Addition of Osteopathic Visceral Manipulation to OMT for Low Back Pain Decreases Pain and Increases Quality of Life. J Osteopath Med 2017; 117:333-334. [PMID: 28459483 DOI: 10.7556/jaoa.2017.062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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King HH. Benefit of OMT in Patients Who Underwent Heart Surgery. J Osteopath Med 2017; 117:332-333. [PMID: 28459482 DOI: 10.7556/jaoa.2017.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Tang MY, King HH. Effectiveness of OMT and OCMM for Temporomandibular Disorders. J Osteopath Med 2017; 117:334-335. [DOI: 10.7556/jaoa.2017.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Tang MY, King HH. Manual Therapy Lowers Psychological Aggravations in Patients WIth Tension-Type Headache. J Osteopath Med 2017; 117:59-60. [DOI: 10.7556/jaoa.2017.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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King HH, Cayce CT, Herrin J. Thermography Examination of Abdominal Area Skin Temperatures in Individuals With and Without Focal-Onset Epilepsy. Explore (NY) 2016; 13:46-52. [PMID: 27876238 DOI: 10.1016/j.explore.2016.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Indexed: 12/16/2022]
Abstract
Early osteopathic theory and practice, and the work of the medical intuitive Edgar Cayce suggested that the abdominal areas of individuals with epilepsy would manifest "cold spots." The etiology for this phenomenon was thought to be abdominal adhesions caused by inflammation and viscero-somatic reflexes caused by adhesions or injury to visceral or musculoskeletal system structures. Indeed, until that advent of electroencephalography in the 1930s, medical practice regarding epilepsy focused on abdominal neural and visceral structures. Following two hypotheses were formulated to evaluate any abdominal temperature phenomena: (1) an abdominal quadrant division analysis would find one or more quadrants "colder" in the focal-onset epilepsy group (ICD9-CM 345.4 and 345.5) compared to controls. (2) Total abdominal areas of individuals with focal-onset epilepsy wound be colder than a control group. METHODS Overall, 50 patients with the diagnosis of focal-onset epilepsy were recruited from the office of the Epilepsy Foundation of Florida and 50 control subjects with no history of epilepsy were recruited through advertising to the public. Under controlled room conditions all subjects had infrared thermographic images made and recorded by Med-Hot Model MH-731 FLIR equipment. RESULTS There were no significant demographic difference between experimental patients and control subjects, though the control group tended to be younger and more often male; however, these were controlled for in all analyses. In the quadrant analysis, there were significant differences in that more epileptic patients had colder left upper abdominal quadrant temperatures than the control group (66.8% versus 44.9%; P = .030). In the total abdominal analysis, however, there were no significant differences. DISCUSSION The results support the hypothesis that individuals with focal-onset epilepsy have colder abdominal areas. If substantiated in further research, present study results will require further examination of the mechanisms of action for epilepsy, and suggest the need for re-examination of older formulations of abdominal epilepsy, including the place of abdominal injury, inflammation, and adhesions in epileptic pathology. The concept of somato-visceral and viscero-somatic neurological interactions is one of the possible mechanisms underlying the "cold spot" findings and warrants further consideration.
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Affiliation(s)
- Hollis H King
- University of California San Diego School of Medicine, La Jolla, CA.
| | | | - Jeph Herrin
- Flying Buttress Associates, Charlottesville, VA
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King HH. Manual Therapy and OMT May Be of Benefit in the Management of Somatosensory Tinnitus. J Osteopath Med 2016; 116:684-5. [DOI: 10.7556/jaoa.2016.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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King HH. Manual Therapy Shown To Improve Diabetic Foot Ulcer Healing. J Osteopath Med 2016; 116:685-6. [DOI: 10.7556/jaoa.2016.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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King HH. Japanese Massage Improves Shoulder Range of Motion in Elderly Patients With Late-Stage Parkinson Disease. J Osteopath Med 2016; 116:683-4. [PMID: 27669073 DOI: 10.7556/jaoa.2016.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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King HH. Manual Therapy Technique Shown Beneficial for Osteoarthritis of the Hip. J Osteopath Med 2016; 116:490. [DOI: 10.7556/jaoa.2016.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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King HH. Eye Contact, Appetite, and Vomiting Improved in Children With Autism Spectrum Disorder After Visceral Osteopathic Technique. J Osteopath Med 2016; 116:324-5. [DOI: 10.7556/jaoa.2016.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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King HH. Postural Balance and Gait Improved With an Osteopathic Intervention in a Special Needs Population. J Osteopath Med 2016; 116:325-6. [PMID: 27111788 DOI: 10.7556/jaoa.2016.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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King HH. Significant Benefit Shown After Lumbar Disk Surgery Rehabilitation by Inclusion of Osteopathic Intervention. J Osteopath Med 2016; 116:326. [PMID: 27111789 DOI: 10.7556/jaoa.2016.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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King HH. Viola M. Frymann, D.O., F.A.A.O., Internationaly Recongnized And Pioneering Osteopathic Physican, Dies At 94 In San Diego, California By Dr. Hollis King, D.O., PhD. J Bodyw Mov Ther 2016. [DOI: 10.1016/j.jbmt.2016.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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King HH. As the Twig Is Bent, so Grows the Tree—Part 6: In a Multicenter Study, OMTh Shortens Length of Stay in the Neonatal Intensive Care Unit. J Osteopath Med 2016; 116:60-1. [DOI: 10.7556/jaoa.2016.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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King HH. As the Twig Is Bent, so Grows the Tree—Part 5: In a Single Hospital, OMTh Shortens Length of Stay in the Neonatal Intensive Care Unit. J Osteopath Med 2016; 116:59-60. [DOI: 10.7556/jaoa.2016.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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King HH. As the Twig Is Bent, so Grows the Tree—Part 7: Severe Temporal Bone Restriction in Children Is Risk Factor for Acute Otitis Media. J Osteopath Med 2016; 116:61. [DOI: 10.7556/jaoa.2016.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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King HH. Ultrasound Measurement of Vertebral Artery Blood Flow Before and After High-Velocity, Low-Amplitude Thrust Therapy. J Osteopath Med 2015. [DOI: 10.7556/jaoa.2015.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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King HH. Bodywork Shown to Reduce the Symptoms of Chronic Constipation and Improve Quality of Life. J Osteopath Med 2015. [DOI: 10.7556/jaoa.2015.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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King HH. Manual Therapy Improves Pulmonary Function Acutely. J Osteopath Med 2015. [DOI: 10.7556/jaoa.2015.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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King HH. Advances in Biomechanical Examination of Cervical Spine Manipulation. J Osteopath Med 2015. [DOI: 10.7556/jaoa.2015.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Hodge LM, Creasy C, Carter K, Orlowski A, Schander A, King HH. Lymphatic Pump Treatment as an Adjunct to Antibiotics for Pneumonia in a Rat Model. J Osteopath Med 2015; 115:306-16. [DOI: 10.7556/jaoa.2015.061] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract
Background: Lymphatic pump treatment (LPT) is a technique used by osteopathic physicians as an adjunct to antibiotics for patients with respiratory tract infections, and previous studies have demonstrated that LPT reduces bacterial load in the lungs of rats with pneumonia. Currently, it is unknown whether LPT affects drug effcacy.
Objective: To determine whether the combination of antibiotics and LPT would reduce bacterial load in the lungs of rats with acute pneumonia.
Methods: Rats were infected intranasally with 5×107 colony-forming units (CFU) of Streptococcus pneumoniae. At 24, 48, and 72 hours after infection, the rats received no therapy (control), 4 minutes of sham therapy, or 4 minutes of LPT, followed by subcutaneous injection of 40 mg/kg of levofoxacin or sterile phosphate-buffered saline. At 48, 72, and 96 hours after infection, the spleens and lungs were collected, and S pneumoniae CFU were enumerated. Blood was analyzed for a complete blood cell count and leukocyte differential count.
Results: At 48 and 72 hours after infection, no statistically significant differences in pulmonary CFU were found between control, sham therapy, or LPT when phosphate-buffered saline was administered; however, the reduction in CFU was statistically significant in all rats given levofoxacin. The combination of sham therapy and levofoxacin decreased bacterial load at 72 and 96 hours after infection, and LPT and levofoxacin significantly reduced CFU compared with sham therapy and levofoxacin at both time points (P<.05). Colony-forming units were not detected in the spleens at any time. No statistically significant differences in hematologic findings between any treatment groups were found at any time point measured.
Conclusion: The results suggest that 3 applications of LPT induces an additional protective mechanism when combined with levofoxacin and support its use as an adjunctive therapy for the management of pneumonia; however, the mechanism responsible for this protection is unclear.
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King HH. OMT—and Placebo—Shown Effective in Reducing Pain During Pregnancy. J Osteopath Med 2015. [DOI: 10.7556/jaoa.2015.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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King HH. Dramatic Reduction in Menstrual Pain After Osteopathic Manipulative Therapy. J Osteopath Med 2015. [DOI: 10.7556/jaoa.2015.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Affiliation(s)
- Lee Kenyon
- Western University of Health Sciences College of Osteopathic Medicine of the Pacific-Northwest, Lebanon , Oregon
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King HH. “ As the Twig Is Bent, so Grows the Tree”: Part 4. J Osteopath Med 2014. [DOI: 10.7556/jaoa.2014.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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King HH. Manual Therapy Effects in Patients With Cervicogenic Dizziness. J Osteopath Med 2014. [DOI: 10.7556/jaoa.2014.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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King HH. Dose-Response Research in Chiropractic Care and Possible Comparisons With OMT. J Osteopath Med 2014. [DOI: 10.7556/jaoa.2014.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Schander A, Padro D, King HH, Downey HF, Hodge LM. Lymphatic pump treatment repeatedly enhances the lymphatic and immune systems. Lymphat Res Biol 2014; 11:219-26. [PMID: 24364845 DOI: 10.1089/lrb.2012.0021] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Osteopathic practitioners utilize manual therapies called lymphatic pump techniques (LPT) to treat edema and infectious diseases. While previous studies examined the effect of a single LPT treatment on the lymphatic system, the effect of repeated applications of LPT on lymphatic output and immunity has not been investigated. Therefore, the purpose of this study was to measure the effects of repeated LPT on lymphatic flow, lymph leukocyte numbers, and inflammatory mediator concentrations in thoracic duct lymph (TDL). METHODS AND RESULTS The thoracic ducts of five mongrel dogs were cannulated, and lymph samples were collected during pre-LPT, 4 min of LPT, and 2 hours post-LPT. A second LPT (LPT-2) was applied after a 2 hour rest period. TDL flow was measured, and TDL were analyzed for the concentration of leukocytes and inflammatory mediators. Both LPT treatments significantly increased TDL flow, leukocyte count, total leukocyte flux, and the flux of interleukin-8 (IL-8), keratinocyte-derived chemoattractant (KC), nitrite (NO2(-)), and superoxide dismutase (SOD). The concentration of IL-6 increased in lymph over time in all experimental groups; therefore, it was not LPT dependent. CONCLUSION Clinically, it can be inferred that LPT at a rate of 1 pump per sec for a total of 4 min can be applied every 2 h, thus providing scientific rationale for the use of LPT to repeatedly enhance the lymphatic and immune system.
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Affiliation(s)
- Artur Schander
- 1 Department of Molecular Biology and Immunology, University of North Texas Health Science Center , Fort Worth, Texas
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King HH. Myofascial Release Increases Effectiveness in Management of Chronic Low Back Pain. J Osteopath Med 2014. [DOI: 10.7556/jaoa.2014.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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King HH. Patients With Magnetic Resonance Imaging–Verified Lumbar Disk Herniations Benefit From Chiropractic High-Velocity, Low-Amplitude Spinal Manipulative Therapy. J Osteopath Med 2014. [DOI: 10.7556/jaoa.2014.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Affiliation(s)
- Hollis H. King
- University of Wisconsin School of Medicine and Public Health, Madison
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Licciardone JC, Kearns CM, King HH, Seffinger MA, Crow WT, Zajac P, Devine WH, Abu-Sbaih RY, Miller SJ, Berkowitz MR, Dyer R, Heath DM, Treffer KD, Nevins NA, Aryal S. Somatic Dysfunction and Use of Osteopathic Manual Treatment Techniques During Ambulatory Medical Care Visits: A CONCORD-PBRN Study. J Osteopath Med 2014; 114:344-54. [DOI: 10.7556/jaoa.2014.072] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract
Context: Osteopathic manual treatment (OMT) of somatic dysfunction is a unique approach to medical care that may be studied within a practice-based research network.
Objective: To measure patient characteristics and osteopathic physician practice patterns within the Consortium for Collaborative Osteopathic Research Development–Practice-Based Research Network (CONCORD-PBRN).
Design: Cross-sectional card study.
Setting: Eleven member clinics within the CONCORD-PBRN coordinated by The Osteopathic Research Center.
Patients: A total of 668 patients seen between January and March 2013.
Main Study Measures: Patient age and sex; primary diagnoses; somatic dysfunction as manifested by tenderness, asymmetry, restricted motion, or tissue texture changes; and use of 14 OMT techniques. Results were stratified by anatomical region and adjusted for clustering within member clinics. Clustering was measured by the intracluster correlation coefficient.
Results: Patient ages ranged from 7 days to 87 years (adjusted mean age, 49.2 years; 95% confidence interval [CI], 43.3-55.1 years). There were 450 females (67.4%) and 508 patient visits (76.0%) involved a primary diagnosis of disease of the musculoskeletal system and connective tissue. Structural examination was performed during 657 patient visits (98.4%), and 649 visits (97.2%) involved OMT. Restricted motion and tenderness were the most and least common palpatory findings, respectively. Cranial (1070 [14.5%]), myofascial release (1009 [13.7%]), muscle energy (1001 [13.6%]), and counterstrain (980 [13.3%]) techniques were most commonly used, accounting for more than one-half of the OMT provided. Pediatric patients were more likely than adults to receive OMT within the head (adjusted odds ratio [OR], 9.53; 95% CI, 1.28-71.14). Geriatric patients were more likely than adults to receive a structural examination (adjusted OR, 1.83; 95% CI, 1.09-3.07) and OMT (adjusted OR, 1.62; 1.02-2.59) within the lower extremity. Females were more likely than males to receive a structural examination (adjusted OR, 2.44; 95% CI, 1.44-4.16) and OMT (adjusted OR, 2.11; 95% CI, 1.26-3.52) within the sacrum and OMT within the pelvis (adjusted OR, 1.79; 95% CI, 1.12-2.88). Intracluster correlation coefficients for the 4 most commonly used OMT techniques ranged from 0.34 to 0.72.
Conclusion: This study provides proof of concept of the feasibility of studying osteopathic medical practice on a national level by developing and growing the CONCORD-PBRN.
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