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International Journal of Osteopathic Medicine
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International Journal of Osteopathic Medicine RSS feed: Current Issue. The International Journal of Osteopathic Medicine is a peer-reviewed journal that provides for the publication of high quality
research articles and review papers that are as broad as the many disciplines that influence and underpin the principles and practice
of osteopathic medicine. Particular emphasis is given to basic science research, clinical epidemiology and health social science in
relation to osteopathy and neuromusculoskeletal medicine. The Editorial Board encourages submission of articles based on both quantitative
and qualitative research designs. The Editorial Board also aims to provide a forum for discourse and debate on any aspect of osteopathy
and neuromusculoskeletal medicine with the aim of critically evaluating existing practices in regard to the diagnosis, treatment and management of patients with neuromusculoskeletal disorders and somatic dysfunction. All manuscripts submitted to the IJOM are subject
to a blinded review process. The categories currently available for publication include reports of original research, review papers,
commentaries and articles related to clinical practice, including case reports. Further details can be found in the IJOM Instructions
for Authors. Manuscripts are accepted for publication with the understanding that no substantial part has been, or will be published
elsewhere.
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Editorial Board
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Reporting new developments in sacroiliac imaging and lymphatic pump techniques
Pain perceived in the sacroiliac region is common in patients presenting to osteopaths. A range of hypotheses have been proposed to explain the origin of this pain and a variety of physical examination tests devised to identify relevant clinical dysfunction or injury. Physical examination of the SIJ can be broadly considered in two categories: (1) examination procedures that are intended to reproduce a patient?s familiar symptoms (?provocation tests?); and (2) procedures intended to detect joint dysfunction. Textbooks in osteopathy have tended to focus on evaluating the SIJ from the perspective of somatic dysfunction (rather than symptom reproduction) and describe the use of palpation and motion testing to evaluate joint range of motion, perceived quality of movement, tissue texture change, end feel and other characteristics. The findings of research into physical examination methods for SIJ dysfunction are not encouraging and raise doubts about the clinical utility of these procedures. Other approaches to SIJ assessment have been developed that rely less on palpation and more on the extent to which symptoms can be reproduced using combinations of procedures that ostensibly stress various structures. In reality practitioners tend to develop their own variations and idiosyncrasies and research into the practice of UK osteopaths suggests that practitioners combine components of both dysfunction and symptom reproduction in assessing the sacroiliac region. Careful consideration of the anatomy of the sacroiliac region reveals that both intra and extra-articular structures may be involved in symptom generation and it has been suggested that more localized pain may involve more superficial extra-articular structures. A particularly interesting development has emerged from the findings of anatomical studies that reveal a close relationship between branches of the dorsal sacral rami and myofascial structures of the sacroiliac region. In this issue of the journal Chris McGrath and colleagues present the findings of a ?proof of concept? study using Doppler ultrasound to provide images of the vascular signature of the dorsal sacral rami. They reason that if ultrasound is able to provide imaging of these delicate structures, that it might be developed as a useful tool to investigate entrapment neuropathy or other neurogenic causes of localised posterior pelvic pain.
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The dorsal sacral rami and branches: Sonographic visualisation of their vascular signature
Abstract: Objectives: The differentiation of potential pain generating structures in the sacro-iliac region remains a diagnostic challenge. The aim of this proof of concept study was to evaluate the feasibility of using Doppler ultrasound to image the vascular components of dorsal sacral rami and their associated medial and lateral branches. Using the vascular signature of the dorsal sacral arteries to identify the dorsal sacral rami could assist with the diagnosis and treatment of localisable, extra-articular, posterior sacro-iliac joint pain.Methods: The posterior sacral region was scanned in 30 healthy adults using an Acuson X300 ultrasound machine with 7.5 MHz high-resolution linear transducer in spectral Doppler mode to assess the feasibility of identifying and measuring the Resistive Index (RI) of the dorsal sacral arteries.Results: The vascular signature of the dorsal sacral rami and associated branches was identified in 62% of participants; S2 70%, S1 57% and S3 59%. More than two vascular signatures were recorded in 23 (76.7%) cases; in only two (6.67%) were no vascular signatures detected. Mean RI was 0.82 ± 0.11, increasing significantly (P < 0.05) at each caudal sacral level. No statistically significant difference in RI was observed between rami arteries and their branches or between genders.Conclusions: Doppler ultrasound may be useful in identifying the individual dorsal sacral rami (S1-3) and their associated branches. This may assist with selective imaging of the dorsal sacral rami and their branches in the diagnosis and treatment of chronic localisable pain in the posterior sacro-iliac region and facilitate investigation of the hypothesis of entrapment neuropathy in this region.
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Osteopathic lymphatic pump techniques to enhance immunity and treat pneumonia
Abstract: Pneumonia is a common cause of morbidity and mortality worldwide. While antibiotics are generally effective for the treatment of infection, the emergence of resistant strains of bacteria threatens their success. The osteopathic medical profession has designed a set of manipulative techniques called lymphatic pump techniques (LPT), to enhance the flow of lymph through the lymphatic system. Clinically, LPT is used to treat infection and oedema and might be an effective adjuvant therapy in patients with pneumonia. The immune system uses the lymphatic and blood systems to survey to rid the body of pathogens; however, only recently have the effects of LPT on the lymphatic and immune systems been investigated. This short review highlights clinical and basic science research studies that support the use of LPT to enhance the lymphatic and immune systems and treat pneumonia, and discusses the potential mechanisms by which LPT benefits patients with pneumonia.
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Anterior hip pain ? Have you considered femoroacetabular impingement?
Abstract: Anterior hip pain is a frequent presentation in both primary care and musculoskeletal practice. Common diagnoses of anterior hip pain include iliopsoas tendinopathy and bursitis, snapping hip syndrome, osteoarthritis of the hip and sacro-iliac joint dysfunction or spinal referred pain. More potentially serious conditions including inguinal hernias, avascular necrosis of the femoral head and psoas abcess all need to be considered.One cause of anterior hip pain is femoroacetabular impingement (FAI). Here follows a short review of the typical clinical presentations, imaging features and management options of FAI. The possible role of osteopathy in the management of this condition will also be briefly discussed.
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Research and treatment bulletin
Jesse Mason, Private practice, Auckland, New Zealand Low back pain (LBP) is a highly prevalent condition and is notoriously difficult to accurately diagnose. Practitioners treating people with LBP face the challenging task of identifying a source, or sources of symptoms from a wide variety of possibilities. Effective treatment may rely on specific diagnosis, tools or techniques that provided consistently reliable information. Two recently published articles1,2 explore identification of two different types of LBP: pain that is due to tissue injury, termed nociceptive pain, and pain that arises from the nervous system, termed neuropathic pain (NP).
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Re: Groin pain in sacral insufficiency fracture. Avoiding delayed diagnosis
We read with interest the case study by Ungaro et al., which was published in the latest edition of the IJOM. The authors? highlight important issues with regard to the consideration of alternative and potentially serious diagnoses should a patient fail to respond in a timely manner to osteopathic treatment. This serves as a reminder to us all to be on guard continually during our encounters with patients, and to be prepared to re-evaluate a diagnosis when a patient is not improving or worsening. In particular, it is not infrequent in the emergency department to see elderly women who have had pain after apparently innocuous injuries (or indeed there may be no history of antecedent trauma at all), who turn out to have insufficiency fractures.
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Re: Groin pain in sacral insufficiency fracture. Avoiding delayed diagnosis
Thank you for the interest you have shown in our paper. Your comment is quite correct and is a useful elucidation of the subject. As you mention, scintigraphy, and in particular the H sign, are well-documented in the Literature, and discussed in the study which we cite in the bibliography. The lack of discussion of scintigraphy in our paper is due in part to the tone we wanted to give to the article, and to the circumstances that osteopaths who are not medical doctors face in Italy.
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[R-DO.org]
