Osteopathic manipulation treatment versus therapeutic exercises in patients with chronic nonspecific low back pain: a randomized, controlled and double-blind study

Participants

• Number: 38 people (28 female and 10 male)
• Criteria of inclusion: age between 30 and 59 years, diagnostic of chronic nonspecific low back pain with intermittent or persistent lumbar pain with intensity greater than 30 mm on VAS for at least 3 months.
• Criteria of exclusion: fractures or dislocations of the spine, ligament tears, muscle breakdown, skin tears, sacroiliitis, vertebral osteomyelitis, infections, herniated disk with radicular symptoms, radicular disorders, cauda equina syndrome, tumor, visceral referred pain, red flags for low back pain, difference of length between the two lower extremities superior to 20mm.
• Gruppi di studio: Groups of study: 2 groups obtained by randomization
  • Group 1: OMT, 20 people(16 female and 4 male, mean age 46 years)
  • Group 2: physical exercise, 18 people (12 female and 6 male, mean age 50.1 years)

Interventions and evaluations

• Assessment of pain through VAS, disability through ODI, fear of movement through TSK and depression through BDS at the beginning of the study and after the last intervention
• Evaluation of the usual level of physical activity through Baecke questionnaire at the beginning of the study
• 5 weekly sessions of OMT of 30-45 minutes each and 10 sessions of physical exercise twice a week
• OMT: articulatory and myofascial techniques
• Physical exercise: therapeutic exercises for low back pain
• OMT performed by a physiotherapist with a diploma  in osteopathy
• Physical exercise performed by three physiotherapy students trained and supervised by an experienced physiotherapist
• People were asked not to undergo physiotherapy, take any medication or follow other treatments during this study
• During each visit, the practitioner investigated if the person had followed these directions: if not, the person would be excluded from the study

Results

• Primary outcomes: after the intervention, both groups saw a statistically significant decrease in pain intensity measured with VAS compared to the beginning of the study. The OMT group had a starkly greater decrease compared to the group with physical exercise (-49mm vs -18mm) in a statistically significant manner.
• Secondaru outcomes: both groups saw a decrease in disability measured by ODI compared to the beginning of the study in a statistically significant manner. The OMT group had a starkly greater statistically significant reduction compared to the group with physical exercise (-10 vs -4).
  With regard to depression, measured through BDS, the groups did not show statistically significant differences, even though at the beginning of the study the OMT group saw a statistically significant decrease of depression.  The same result as depression was obtained in fear of movement, measured through TSK.
• Further analysis: the decrease of pain was positively correlated, and in a statistically significant way, to the reduction of disability (strong association), of fear of movement (moderate association) and of depression (moderate association).

Discussion

OMT proved to be able to drastically reduce chronic nonspecific low back pain and other related parameters such as disability, fear of movement and depression. On the contrary, physical exercise induced minor effects compared to OMT, or even no effects like in the case of fear of movement and depression. 

The consequences OMT had on pain seem to have positively affected the other outcomes, which highlights the importance of considering both people and pathological conditions from a biopsychosocial point of view. 

The positive effects of OMT could depend on the reduction of muscular tensions and on an improvement of articular mobility, which induced a greater ease of movement, and, therefore, less fear, disability and depression.The authors hope that this study will promote a wider use of osteopathy as this type of treatment is not really expensive and has no side effects.