Uses Of Osteopathic Manipulative Treatment.

Because osteopathic treatment promotes homeostatic balancing and normalized function for the entire system, most pathological states may benefit to some degree from this approach. However, certain conditions in particular lend themselves to an osteopathic approach.
Indications

MUSCULOSKELETAL CONDITIONS
Osteopathic manipulation is often the treatment of choice for musculoskeletal conditions, particularly those involving trauma to the soft tissues, sprains and strains, range of motion restrictions, pain, impingement of nerves, and related areas. Most busy osteopathic practices see many patients with complaints of lumbar and cervical pain, both chronic and acute, localized and radiating. Some of this pain is caused by somatic dysfunction and some is secondary to nerve impingement, either discogenic or further along the route of the nerve. Manipulation is indicated in most of these situations with a few exceptions, one being in which extensive surgery has been performed and the effects of massive scar tissue impede osteopathic efforts and in emergencies, such as sudden loss of bowel and bladder function. However, even postsurgical cases often derive benefits arising from improved systemic function. Another key factor as with any approach is that of patient compliance. Reinjury of any kind must strictly be avoided.

Extremity pain, such as thoracic outlet syndrome, certain types of carpal tunnel syndrome in which repetitive motion reinjury can be avoided for a while, frozen shoulders, shoulder pain, and hip, knee, ankle and many types of foot pain seem to respond well.
Headaches of many kinds, with the exception of classical migraines (especially in their full-blown state), lend themselves to osteopathic treatment, as do sinusitis, temporomandibular joint dysfunctions, and closed-head injuries (with proper surgical consultation, of course).

CHILDHOOD CONDITIONS AND PREGNANCY
Although more research is needed, children with otitis media who have undergone many trials of antibiotic treatment with the infections always returning seem to respond well to OMT (24). The infections disappear, and the patients often avoid further antibiotics and tubes. In addition, the author has seen excellent response in patients with acute and chronic vertigo. In both of these conditions, cranial manipulation is useful.
Children diagnosed with attention deficit disorder and hyperactivity often benefit from an osteopathic cranial approach, as do many patients labeled developmentally delayed (25, 26 and 27).

Pregnant women respond especially well to gentle osteopathic treatment. It provides them with a relatively low pain pregnancy and is excellent physiological and anatomical preparation for delivery (28). Because most neonatal problems (e.g., colic, respiratory and upper respiratory problems, failure to suckle) can be treated in one to two visits, the author usually recommends mothers to bring in their newborn with these conditions. Issues such as plagiocephaly (i.e., misshapen heads) are best dealt with as early as possible and respond to direct cranial molding techniques.

HYPERSYMPATHETIC SYNDROMES, RESPIRATORY DISORDERS, AND OTHER CONDITIONS
One of the most valuable uses of OMT is in dealing with frank hypersympathetic syndromes, such as ileus. Until recently, standing orders were common at most osteopathic hospitals for preoperative and postoperative OMT for many surgical patients to prevent ileus. A clinical study demonstrating the value of such treatment for prevention of ileus was conducted at the osteopathic hospital in Waterville, Maine (29).

Although there are few formal studies conducted, I have found a number of conditions that are frequently helped with OMT. OMT is often helpful, for example, in respiratory disorders, such as asthma, pneumonia, and pulmonary sarcoidosis. Some data were collected on this in the 1918 influenza epidemic, which was in the preantibiotic era. American osteopathic clinics and hospitals reported a mortality rate of 0.25% for flu and 10% for the sequela of pneumonia compared with the allopathic rates of 9.8 to 27% for flu and 26 to 73% for the sequela of pneumonia at that time. Even now with antibiotics, OMT helps respiratory function in these conditions and can be a useful adjunct treatment (30, 31 and 32).

Other conditions that I have found responsive to osteopathic treatment include radiation fibrosis, hepatitis, mononucleosis, anterior chest wall pain, angina, amblyopia, neuritis, Bell's palsy, epilepsy with an unknown focal source, and whiplash.
There are also many conditions in which OMT may be a useful adjunct. Some of these are dental equilibration, swallowing disorders, tinnitus, stabilization of arrhythmias, infertility of unknown cause, gastroesophageal reflux, colitis, and stroke rehabilitation. OMT can also be helpful with the pain of cancer.

Contraindications
OMT is not recommended in certain conditions. Examples are cancer, nutritional problems, emotional problems, continuing repetitive trauma, or conditions of a psychosocial etiology.
With the exception of thrust technique, there are few contraindications (33). Obviously in muscle energy, an active technique, the patient must be able to follow commands adequately. Contraindications to thrust include fractures at the site of thrust, increase of pain or neurological symptoms while positioning the patient, severe rheumatoid arthritis, and metastatic cancer at the site of the thrust. Relative contraindications include carotid bruits in cervical thrust, advanced osteoporosis, acute spasms, and advanced mechanical motion restrictions (e.g., in certain types of arthritis).