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Osteopathic Manipulation for Back and Pelvic Pain

Online Health Chat with Dr. Fredrick Wilson

January 14, 2011


Introduction

Cleveland_Clinic_Host: Osteopathic manipulative therapy (OMT) is a system of evaluation and treatment designed to achieve and maintain health by restoring normal function to the body by balancing body structure with manipulation. Manipulation is the therapeutic application of manual pressure or force. Oftentimes, structural problems in the spinal column can affect the nerves that radiate out to the various organs, thus contributing to disease.

OMT is typically used to treat musculoskeletal disorders, such as low back pain, neck pain, pelvic pain, sports injuries, repetitive stress injuries, and tension headaches. While osteopathic and chiropractic techniques overlap, they are not identical. As a general rule, chiropractic manipulation uses direct thrust techniques on the spine (HVLA), while osteopathic practitioners - such as Dr. Wilson - use other, gentler techniques, as well as HVLA.

Fredrick Wilson, D.O. is Director of the Cleveland Clinic Solon Center for Spine Health. Dr. Wilson is an osteopathic medical specialist who treats patients with back and neck pain. He uses traditional conservative medical treatments and incorporates osteopathic spinal manipulation when appropriate. He has been on staff at Cleveland Clinic since 1997 and has been the Director of the Solon Cleveland Clinic Center for Spine Health since 2000. He is part of the teaching faculty for Cleveland Clinic medical spine fellows and internal medicine residents. He is also a Clinical Assistant Professor of Family Medicine for the Ohio University College of Osteopathic Medicine, where he teaches medical students, interns, and residents.

Cleveland_Clinic_Host: To make an appointment with Fredrick Wilson, D.O. or any of the other specialists in the Center for Spine Health at Cleveland Clinic, please call 216.636.5860 or call toll-free at 800.588.2264. You can also visit us online at www.clevelandclinic.org/spine.

Welcome to our Online Health Chat with Dr. Wilson. We are thrilled to have him here today for this chat. Let’s begin with the questions.


Understanding Osteopathic Manipulative Treatment

SBMom3: What is osteopathic manipulative treatment (OMT)?

Dr__Fredrick_Wilson: Osteopathic manipulative treatment is a form of treatment aimed at restoring function by balancing bones and soft tissue structures into their normal alignment.

Reader4567: Can you explain the basic principle behind osteopathic manipulation?

Dr__Fredrick_Wilson: Basically, manipulation attempts to balance structures that are out of balance. Once that happens, blood flow improves, and chemicals that can irritate the tissue are diminished.

HoleinOne: Who would benefit the most from osteopathic manipulation?

Dr__Fredrick_Wilson: OMT is typically used to realign vertebrae or other joints to reduce “mechanical pain,” so people with back pain benefit significantly from this therapy.

OMT also helps regulate organ function. All of the organs have information coming in and going back from the nervous system through a network of nerves that branch out from the spinal cord. When an organ is in a “disease state,” it sends more impulses back to the spine at the segment where its nerves meet the spinal cord. This spinal cord segment has many small nerves inside the spinal cord, whose activity is increased by the signals coming from the organ. The activity is then sent back to local small muscles and can cause muscle spasm and tenderness. In this way, organ dysfunction can cause back pain. So correcting some of the muscle spasms with manipulation can help increase blood flow to that diseased organ. Therefore, manipulation can have some benefits to help balance organ function.

hoover: Can anybody have OMT? Or are there some cases when it is not recommended?

Dr__Fredrick_Wilson: Manipulation should be avoided if the affected bone is broken or if a person has cancer, when the bones are very fragile. Care should be taken in cases of severe osteoporosis. Indirect, gentler methods may be used.

whistler: Can you please describe what some of the therapies entail? How many types of therapy are there?

Dr__Fredrick_Wilson: There are at least 10 different subtypes of manipulative therapy that are described in osteopathic textbooks. They all boil down to two general types: direct and indirect.

MortyRunning: What should I expect to during an OMT visit?

Dr__Fredrick_Wilson: On the first visit, your medical history is reviewed and a physical exam is performed to diagnose the problem. Your doctor will thoroughly explain the manipulation technique before it is performed.

FYITMI: Does spinal manipulation hurt?

Dr__Fredrick_Wilson: After OMT, especially after the first visit, there can be some soreness for a day or two.

BryceAve: Are there health risks involved with osteopathic manipulative therapy?

Dr__Fredrick_Wilson: Usually, the risks are minimal, such as a little soreness. Rarely, a bone might crack with very aggressive techniques. The worst risk is when high-velocity techniques are used on the cervical spine by someone unfamiliar with the technique. Stroke is a very rare risk, occurring in 1 patient in 1 million cases.

manchester: Do you feel the effects of manipulation immediately or does it take time?

Dr__Fredrick_Wilson: The resolution of pain can be immediate post-manipulation, but it may also take time. It depends on how long the problem has existed. For an acute problem that has recently occurred, the resolution may be quick, and pain relief seen after one treatment. I have also seen patients who have had mechanical problems for years so that their bodies have learned to compensate. One adjustment will not fix these problems. The resolution could take weeks or months.

telly: Is pelvic physical therapy part of OMT? Which is better?

Dr__Fredrick_Wilson: I have patients do some exercises for pelvic dysfunction, but a physical therapist will provide additional exercises to strengthen this area. Both pelvic physical therapy and OMT can be effective.


OMT and Health Conditions

SnowWoman6: I have osteoporosis. Is OMT an effective treatment option for me?

Dr__Fredrick_Wilson: Indirect manipulative techniques can be used safely on osteoporotic patients.

Vivalasvegas99: Is osteopathic manipulation effective for post-operative spine care? If so, is it more effective than physical therapy?

Dr__Fredrick_Wilson: Physical therapy is important to strengthen muscles and improve range of motion, especially after surgery. Manipulation would not be used much until the tissues have healed.

shaker: Is OMT an effective treatment for back pain from fibromyalgia?

Dr__Fredrick_Wilson: In my experience, manipulation can relieve fibromyalgia pain for only a few days. I have found that aerobic exercise, heat, and the right medication are a more effective treatment for fibromyalgia. Cleveland weather (cold and damp) is particularly bad for fibromyalgia pain.

candy: My husband was in a car accident a few months ago. He still suffers lingering back pain and neck pain. It was recommended that he see a chiropractor. Which would be a better treatment for this type of injury, manipulation or chiropractic therapy?

Dr__Fredrick_Wilson: I know many patients who have seen chiropractors following this type of situation and have improved. I have also seen many patients in this situation where manipulation has helped. Physical therapy should also be considered.

kajr0210: Can OMT be used to relieve lower left pelvic ache (near the hip/joints)? I suspect the ache is musculoskeletal in nature. I also experience sciatica on right side.

Dr__Fredrick_Wilson: OMT can be used on the pelvic bones (innominates). The spine can also get a little twisted near the sacrum, so manipulation can balance the pelvis and sacrum, thus helping pelvic and hip pain.

12345: I have trigeminal neuralgia. Someone mentioned that success was seen with osteopathic manipulation. Have you seen any success?

Dr__Fredrick_Wilson: The only techniques for trigeminal neuralgia would be cranial manipulation. Though I have been exposed to it, I do not use it for that treatment, but there are osteopathic physicians who use it exclusively.

12345: Thanks for your reply. But, in your opinion, does it work? How would I find a practitioner who is adept at this therapy?

Dr__Fredrick_Wilson: I do not use a lot of cranial manipulation; therefore, I am not sure how successful it is. There is a Cranial Academy, which you could search and contact via the Internet. Those would be the individuals who practice cranial manipulation.

stevemc: I have seen three different chiropractors over the last seven years. It seems like I get relief for a while but I never get any better. The same spots in my spine need adjustment every time. Is there something different that you do that could help this, or are my back problems permanent?

Dr__Fredrick_Wilson: Manipulation can have an acupuncture effect. Acupuncture helps by inhibiting the pain messages from reaching the brain. Manipulation can do that as well. Manipulation may not be the answer to your problem, as it is not “fixing” the cause of your pain. It should be reassessed by a medical spine specialist.

stevemc: Could OMT help atrial fibrillation?

Dr__Fredrick_Wilson: No. You should speak to a cardiologist.

master: I sit at a computer all day (8 to 10 hours). Can manipulation help take away or keep away the inevitable soreness and stiffness in my back, shoulders, and neck?

Dr__Fredrick_Wilson: This is more of a physical therapy issue and would involve more stretching, if it is just a muscle tightness issue. If a mechanical imbalance has occurred, that could be balanced with manipulation.

kajr0210: Is OMT used to treat nerve entrapment in the pelvic region?

Dr__Fredrick_Wilson: Yes. There is a condition called neuralgia paresthetica that is caused by a nerve getting pinched by a ligament in the pelvis. Manipulation can help to free this nerve.


More on OMT

Mcdaddy: How many OMT appointments are necessary to relieve my chronic low back pain?

Dr__Fredrick_Wilson: I tell my patients on their first visit that we will meet four times. If they are completely better or not better at all, we are finished with treatment. If they are somewhat better, we will continue until we get the patient as improved as possible.

bad_news: Can OMT cause damage for someone who has had a spinal fusion?

Dr__Fredrick_Wilson: There are two types of manipulation: direct and indirect. Direct techniques force the vertebrae to go where they do not want to go. Indirect techniques actually put the vertebrae where they want to go and hold them there for a period of time, allowing them to reset themselves to a more balanced position. I would use indirect, gentler techniques on the area where the spinal fusion surgery was performed.

Ohmyachingback10: I’ve read that general anesthesia is sometimes needed during manipulation procedures. Is this generally the case? When would this be used?

Dr__Fredrick_Wilson: Direct, high-velocity techniques used to be done sometimes on patients under anesthesia so they would be perfectly relaxed, and tense muscles would not get in the way. OMT under anesthesia is done less frequently today.

mastermind: Do you use manipulation therapy in conjunction with other medical therapies? Does one complement the other? Is it possible that they would contradict each other?

Dr__Fredrick_Wilson: Manipulation is another “tool in your belt” and can be used with other therapies. Other modalities include pain management blocks, TENS units, acupuncture, physical therapy, and medication. When I do manipulation, I am looking for “somatic dysfunction,” which is the imbalance. If I do not find somatic dysfunction, manipulation is not going to help.

mastermind: How do you determine if there is somatic dysfunction?

Dr__Fredrick_Wilson: Somatic dysfunction is determined by palpation and by range of motion testing.


Doctors of Osteopathic Medicine

theater: What is the difference between an MD and a DO?

Dr__Fredrick_Wilson: MDs and DOs take the same medical courses in medical school. DOs also take courses in manipulative therapy. Many DOs, once in practice, no longer use manipulation. Manipulation is another useful tool that can be used for treating pain.


Osteopathic Manipulation and Chiropractic

chambers: Would someone do osteopathic manipulation and chiropractic therapy at the same time, or do you choose one or the other? Can they enhance each other?

Dr__Fredrick_Wilson: In my experience, chiropractic manipulation for the most part is what is called HVLA technique - High Velocity Low Amplitude. That is where you force the vertebrae to go where they do not want to go and they "pop” into place. HVLA is one of the techniques performed by DOs as well. My understanding is that the DO has more indirect and gentler techniques. Since I am not a chiropractor, I cannot say that for sure.

Tracie6799: Do chiropractors perform spinal manipulation?

Dr__Fredrick_Wilson: Chiropractors perform direct manipulative techniques of spinal manipulation. Osteopaths can perform those techniques and indirect, gentle techniques.

candy: My husband was in a car accident a few months ago. He still suffers lingering back pain and neck pain. It was recommended that he see a chiropractor. Which would be a better treatment for this type of injury, manipulation or chiropractic therapy?

Dr__Fredrick_Wilson: I know many patients who have seen chiropractors following this type of situation and have improved. I have also seen many patients in this situation where manipulation has helped. Physical therapy should also be considered.


General Questions

stevemc: At my last doctors appointment, he said he has given up as to what to give me for pain relief. I have tried almost every prescription medication there is for fibromyalgia, arthritis, joint pain, and back pain. They either don't work or the side effects are worse than dealing with the pain. Do you believe in herbal and vitamin remedies for pain, and what would you recommend?

Dr__Fredrick_Wilson: Physical therapy should always be considered. Aerobic exercise and stretching has been proven to help fibromyalgia and pain symptoms. You could look into an anti-inflammatory diet to help diminish inflammatory pain.

JZImaging: I seem to have different areas from my neck down to my butt bone that hurt. I sometimes get knots in my neck the size of large gumballs. My lower back hurts when walking no matter what type of shoes I wear. I am only 44 years old and feel like I am falling apart. I have been actively moving and remodeling, and was wondering if it's possible that I got something out of whack that could be causing this pain? Maybe falling while I was moving things? I was in a car accident 20 years ago, so I’m not sure if something just never went back into place. Any info would help. Thanks.

Dr__Fredrick_Wilson: This is a very common description for fibromyalgia or myofascial pain. This is increased muscle tension and pain of the upper and lower back. Three things that generally help this type of pain include: aerobic exercise, dry heat, and certain medications.

baileyhdd: I have spinal stenosis in my lower back. Can this cause hip, calf, and foot pain?

Dr__Fredrick_Wilson: Absolutely. The stenosis can cause neurogenic claudication. Neurogenic claudication is a pressure on the nerves and vessels that travel with the nerves in an upright/standing/walking position that can cause pain all the way down the leg to the feet.

stevemc: I have had lower back pain and sciatica for years. Recently, the leg pain has gone away and moved into my groin and pelvic area. Does this mean the sciatica is getting worse, and should I be concerned?

Dr__Fredrick_Wilson: Sciatica can cause buttock or pelvic pain. But if the pain has moved out of the leg, that is indicating improvement.

stevemc: In 2003 I herniated a disc at C6-C7, causing left arm numbness and chest pain. I had fusion surgery in ‘06. I now have been diagnosed with thoracic outlet syndrome in my left arm. Is there anything I can do to open up the thoracic outlet?

Dr__Fredrick_Wilson: It depends on the cause. Manipulation can work on the first rib. By balancing the first rib, you can open up the area where the artery and vein travel, which can help open up the thoracic outlet. Physical therapy exercises are frequently done that may help.

smithvolt3: I have pain in my lower back. The chiropractor instructed me to no longer carry my wallet in my back pocket and also to sleep with a pillow between my legs. I have done both and one year later it helps. I still go for a minor adjustment about twice a year. I understand the wallet making my hips sit at a slant or downhill, but what does the pillow do?

Dr__Fredrick_Wilson: The pillow may keep the spine balanced without any curve during the sleeping hours. The pillow also helps diminish the torquing of the spine that would occur if a pillow was not used.

stevemc: Do inversion tables work for lower back pain or should they be avoided? Do you recommend traction?

Dr__Fredrick_Wilson: Inversion tables are more or less like traction. I tell patients that want to try an inversion table to make sure they have another person in attendance to help them on and off the table. The same is true with traction. It may help, it may not. Generally, you will know the first time it is used.


Closing

Cleveland_Clinic_Host: I'm sorry to say that our time with Fredrick Wilson, D.O. is now over. Thank you again Dr. Wilson for taking the time to answer our questions about Osteopathic Manipulation for Back and Pelvic Pain.

Dr__Fredrick_Wilson: I have enjoyed answering your thought-provoking questions. Good health to you all.


More Information
  • To make an appointment with Fredrick Wilson, DO or any of the other specialists in our Center for Spine Health at Cleveland Clinic, please call 216.636.5860 or call toll-free at 800.588.2264. You can also visit us online at www.clevelandclinic.org/spine.
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