Efficacy of osteopathic manipulative treatment for low back pain in euhydrated and hypohydrated conditions

Participants

• Number: 19 people (8 female and 11 male)
• Criteria of inclusion: members of the Midwestern University of Downers Grove, Illinois; low back pain from 1 to 12 months, with somatic lumbar dysfunction
• Criteria of exclusion: previous diagnosis of musculoskeletal diseases, nerve root compression, unmistakable signs of neurological alteration during the physical evaluation, a history of spinal injury or surgery, malignant tumor, scoliosis, systemic inflammatory disorders, uncontrolled diabetes, urinary tract infections, pregnancy
• Groups of study: 2 groups obtained by randomization
  • Group 1: OMT, first in a hydrated status and afterwards in a dehydrated status, 8 people (4 female and 4 male, mean age 27.1 years
    • mean duration of low back pain: 4.7 months
  • Group 2: OMT, first in a dehydrated status and afterwards in a hydrated status, 11 people (4 female and 7 male, mean age 31.5 years)
    • mean duration of low back pain: 5.9 months

Interventions and evaluations

• Assessment of the basal hydration status by measuring body mass and urine specific gravity at the beginning of the study
• Evaluation of the hydration status by measuring body mass and urine specific gravity before treatment
• Evaluation of pain through VAS immediately before treatment, immediately after treatment and 3 days after treatment
• Evaluation of total number of somatic dysfunctions, of number of severe somatic dysfunctions and number of postural asymmetries in orthostatism through osteopathic structural evaluation
  • the severity of somatic dysfunctions was evaluated on the fifth lumbar vertebra, psoas and sacrum by the severity scale of somatic dysfunction of the Outpatient Osteopathic SOAP Note Form Serie
  • postural assessment in orthostatism was carried out on 8 areas: occipital condyles, acromion processes, lower corners of the shoulder blades, iliac crests, femoral heads, kneecaps, lateral malleoli and medial arches of the feet
• 1 30-minute session of OMT
• All the above interventions were repeated twice, after a week, putting the participants in two different conditions of hydration, namely hydration and dehydration
  • dehydration was defined as a body mass lower than basal body mass by 1% or as a specific urine gravity greater than 1.02
  • these two conditions were met through 36 hours of controlled water intake
  • the 36 hours in question elapsed in the days following the measurement of the basal hydration status and preceding the treatment
• OMT personalized on the basis of actual responses of the participants
  techniques applied: muscle energy, Still’s, thrust, counterstain, articular, soft tissue and myofascial release
• The structural evaluation and the OMT were administered by different physicians

Results

• Primary outcomes: OMT promoted a statistically significant reduction in pain immediately after treatment in both conditions. 3 days after treatment, the result even improved in the case of hydration. However, the difference between the two conditions (hydration and dehydration) was not statistically significant.
• Secondary outcomes: both the total number of somatic dysfunctions and the number of severe dysfunctions decreased statistically significantly after OMT in both groups. However, in the hydration status, OMT favored a sharper decrease in the total and severe dysfunctions number compared to the condition of dehydration, also in a statistically significant way In particular, while only 1 severe somatic dysfunction persisted in only 1 participant in the case of hydration, a good 25 serious dysfunctions persisted in the case of dehydration scattered amongst 13 participants.

  Finally, OMT favored the reduction of postural asymmetries only in case of hydration with a statistically significant result.

Discussion

OMT showed to promote better results, particularly by reducing somatic dysfunctions, severe somatic dysfunctions and postural asymmetries in case of hydration.
The interesting aspect of the study is that: on one hand, all participants reached the hydration or dehydration status on the basis of one of the two criteria (body mass or urine specific gravity); on the other hand, only 7 participants have reached the desired status on the basis of both criteria.
It follows that the circumstances in which the patients were treated were similar to the daily clinical practice: hardly, in fact, people with a status of perfect hydration or with a status of severe dehydration are treated.

The reason underlying the absence of a difference in pain reduction between the two states may depend on both the small sample and the hypothesis that, maybe, a greater state of dehydration is required to produce an actual difference.
Larger studies are needed, with placebo control groups, with more objective measurements than pain and osteopathic palpatory evaluation and with a follow-up over time.