Francesca Galiano
21/09/2022 - Last update 28/12/2022

Luca Cicchitti, Marta Martelli, Francesco Cerritelli | Year 2015

Chronic inflammatory diseases and osteopathy: a systematic review


Chronic inflammatory diseases

Type of study:

Systematic review with meta-analysis

Date of publication of the study’:



Purpose of the study

  • Objective: to evaluate the efficacy of OMT in case of medical conditions defined as chronic inflammatory diseases
  • Measured outcomes:
    primary: any outcome measuring the efficacy of OMT compared to standard of care and other therapies
    secondary: adverse effects of the OMT


  • Articles analyzed: 10
  • Search string: a combination of the following terms, free or as MeSH: osteopathic manipulative treatment, chronic inflammatory disease, bronchitis, pulmonary disease, chronic obstructive, asthma, pelvic inflammatory disease, prostatitis, otitis, vestibular neurotides, middle ear inflammation, neuropathy, polyradiculoneuropathy, chronic inflammatory demyelinating, myelitides, brain inflammation, inflammatory bowel disease, irritable bowel syndromes, gallbladder inflammation, gastritides, atherosclerosis, vasculitides, mediastinum inflammation, cardiomyopathy, arteritides, bone inflammation, arthritides, rheumatic disease
  • Criteria of inclusion:
    • Single-center and multicenter controlled randomized trials (RCT); quasi-RCT, interrupted time series, controlled before-after, observational, cohort, cross-sectional, case-control, case series and case report studies; studies including people with definite medical conditions like inflammatory diseases; studies with animal model; studies in English and carried out in any nation and environment (eg, hospital and private practice); use of gray literature, national trial register, web researching and conference proceedings.
    • OMT compared to: no treatment, sham treatment, standard of care, waiting list (the participants would receive OMT at the end of the study); OMT administered on its own or together with conventional therapies (drugs, counseling)
  • Criteria of exclusion: conference abstracts; studies not in English.

Characteristics of the studies

  • 6 RCTs
  • 1 study of laboratory
  • 1 pilot cross-over study
  • 1 observational study
  • 1 pilot case-control study
  • 2 studies on asthma
  • 3 studies on chronic obstructive pulmonary disease
  • 1 study on peripheral arterial disease
  • 3 studies on irritable bowel syndrome
  • 1 study on arthritis on an animal model
  • 7 studies have valued the adverse effects of OMT
  • Evaluation of the quality of te studies through the Cochrane methods
    • 1 study of low quality, 1 study of moderate quality and 7 studies of dubious quality


  • Number in the smallest study: 10 people
  • Number in the biggest study: 140 people
  • Total: 360 people and 26 animals

Interventions and evaluations

  • Sessions administered every 1 to 3 weeks over 1 to 6 months
  • Intervention duration from 10 to 60 minutes
  • OMT: various techniques, standardized or individualized (1 study did not provide details on this regard)
    • balanced ligamentous tension, Still’s, muscle energy, soft tissue, high-velocity low-amplitude, visceral, diaphragmatic release, rib raising, myofascial release, suboccipital decompression, thoracic inlet myofascial release, pectoral traction, thoracic lymphatic pump with activation, strain-counterstrain and craniosacral manipulation techniques
  • In the control groups: sham treatment (light touch applied to the same body parts as the OMT and/or passive mobilization), no treatment, waiting list


Primary outcomes:

  • Asthma: improvement of peak expiratory flow immediately after OMT in asthmatic children, although not statistically significant compared to the control group (light touch). On the other hand, no difference was observed between OMT and sham treatment in adult women with chronic asthma.
  • Chronic obstructive pulmonary disease: statistically significant improvements of pulmonary function measured through different parameters (eg, forced respiratory flow, residual volume, 6 minutes walking test) in favor of OMT (also when combined with pulmonary rehabilitation) compared to the control group (light touch). Nevertheless, a meta-analysis on these studies did not detect significant differences between OMT and sham treatment.
  • Peripheral arterial disease: OMT, combined with a program of lifestyle changes and pharmacologic treatment, statistically significantly improved the endothelial function at the end of the study compared to the beginning and the health status compared to the control group.
  • Irritable bowel syndrome: compared to standard care or sham treatment, OMT favored a statistically significant improvement in health, assessed through validated scales (eg, IBSQOL 2000 questionnaire and Functional Bowel Disorder Severity Index) or through various investigations on severity, pain, constipation, diarrhea and depression.
  • Arthritis: on animal models, OMT favored an improvement in movement, assessed according to different parameters, although not always reaching statistical significance.

Secondary outcome: 5 studies reported absence of adverse effects, whereas 2 studies reported reactions like soreness or muscle pain after OMT (in 1 of these studies, 4 people had palpitations, high blood pressure and soreness as side effects of sham treatment).


OMT appears to make an important contribution to the management of chronic inflammatory diseases, although larger and more robust studies are needed. In fact, OMT has often shown favorable effects that, however, have not reached the significance. In addition, many studies have reported little data in relation to participants, therapeutic setting and long-term outcomes (the last evaluations were made shortly after the last treatment). In this regard, several studies have reported few methodological features useful to understand if the researchers had adequately checked for any bias in the research. Consequently, to evaluate the clinical effectiveness of OMT more rigorous studies are needed, and, most of all, studies also considering a cost-benefit analysis, in order to involve stakeholders to favor a widespread use of OMT in the fields in which it proves to be effective.

The review of Osteopedia

By Marco Chiera

Strengths: f inclusion in the research of studies of gray literature or with several different sources; good description of the interventions of each study analyzed; assessment of the limits of the osteopathic literature and suggestions on how to improve it.

Limits: the pathologies analyzed have been a small part compared to the diseases that today are considered chronic inflammatory (although it is also true that there is still little research on these kind of diseases in the osteopathic field).

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