A hands-on approach to low back pain

By Elizabeth Boyle 

Sept. 30, 2011

You’re not alone if you’ve ever sought health care for back pain. The ailment is the number two reason Americans visit their physicians. It’s also the focus of a new Ohio University Heritage College of Osteopathic Medicine study that looks at manual therapy, a common strategy used to treat the ubiquitous problem.

Despite the widespread use of manual therapy―including osteopathic manipulation treatment (OMT)―the researchers say little is known about the processes that take place when it’s applied. Funded by a $94,000 American Osteopathic Association grant, the team of researchers from the medical school and the College of Health Sciences and Professions will work to understand both neurological and biomechanical responses in patients who receive manual therapies for low back pain.

“By understanding the mechanisms underlying these treatments, we can help with the development of strategies for how, when, and what type of manipulation should be used in treating individuals with this kind of pain,” said principal investigator Brian Clark Ph.D., associate professor of physiology at OU-HCOM and director and principal investigator of the Ohio Musculoskeletal and Neurological Institute (OMNI).

The project follows a series of recent OMNI studies on manual therapy. The most recent investigation, published in BMC Musculoskeletal Disorders in July, focused on what happens during spinal manipulation that results in a “pop” sound during treatment. It found a 20 percent decrease in a subject’s low back muscle stretch reflexivity if the therapy resulted in an audible sound. The finding could indicate that manipulation lessons the spasm effect experienced by some back pain patients, Clark said.

Building on that study, this latest project looks at a form of manual therapy in which a physician mobilizes soft tissue to alleviate pain. The researchers will conduct two experiments on both healthy individuals and those with chronic low back pain.

The first experiment will help the researchers understand neurological changes that may happen with treatment. It uses a noninvasive brain stimulation device housed at OMNI to measure the cortical and stretch reflex excitability of each subject. After the initial testing, each subject will undergo a manual therapy session administered by co-investigator Stevan Walkowski, D.O., an assistant professor in the department of family medicine who specializes in manual medicine. Immediately following the therapy, each subject will undergo another test to observe any neurological changes.

The second experiment will take place in the lab of co-investigator and Associate Professor of Physical Therapy James Thomas, P.T., Ph.D. Each subject will be seated in a specially designed device that pulls him or her in one of six random directions. Sensors placed on the subject’s torso allow Thomas to measure the reflexive responses of the back and stomach muscles to the various unexpected motions both before and after a manual therapy session delivered by Walkowski.

Thomas, who is also an OMNI principal investigator, said that many low back pain patients become injured when responding to unexpected events or sudden movements. This experiment will help the researchers understand whether manual therapy helps normalize an individual’s reaction to unanticipated challenges to their trunk.

“Back pain has a staggeringly negative impact on our society in terms of medical expenses, disability and individual suffering,” Clark said. “This work will provide critical information on the biology of these therapies used to treat it.”