Figure 1: The utility of osteopathic manipulative treatment (OMT) according to the potential relationships between somatic dysfunction and low back pain (LBP).

Mentions: The concept of somatic dysfunction raises some fundamental questions regarding its causal relationship to disease states and its responsiveness to OMT [2]. Is somatic dysfunction sufficient to cause a particular disease? Is somatic dysfunction necessary to cause a particular disease? The most likely and complex scenario occurs when the response to each of the previous questions is negative. For example, when considering low back pain as the "disease," this scenario leads to the 2 × 2 table presented in Figure 1. The following conclusions may thus be drawn: (1) OMT may not be indicated for all patients with low back pain; and (2) OMT may be useful in some patients with somatic dysfunction, but without low back pain. The first conclusion has important implications for establishing inclusion and exclusion criteria when designing clinical trials of OMT. The second conclusion suggests that OMT may be useful as a secondary preventive measure.

Licciardone JC - Osteopath Med Prim Care (2007)

Bottom Line: The intersection of these fundamental aspects of osteopathic medicine suggests that the profession may successfully adopt a generic strategy of "focused differentiation" to attain a competitive advantage in the health care arena.To help promote an osteopathic identity, "omtology" and its derivative terms are recommended in referring to the study of OMT.The osteopathic profession should adopt a coherent strategy for developing and promoting its identity.Failure to do so will likely ensure that osteopathic medicine remains "stuck in the middle."

Affiliation: Osteopathic Research Center, University of North Texas Health Science Center-Texas College of Osteopathic Medicine, Fort Worth, TX 76107, USA. licciar@hsc.unt.edu

Abstract: The growth and acceptance of osteopathic physicians as conventional medical practitioners in the United States has also raised questions about the distinctive aspects of osteopathic medicine. Although the use of osteopathic manipulative treatment (OMT) and a focus on primary care are most often cited as rationales for the uniqueness of osteopathic medicine, an osteopathic professional identity remains enigmatic.The fledgling basic osteopathic research efforts of the early and mid-twentieth century have not been sustained and expanded over time. Thus, there is presently a scarcity of basic mechanistic and translational research that can be considered to be uniquely osteopathic. To be sure, there have been advances in osteopathic clinical trials, particularly those involving OMT for low back pain. Meta-analysis of these low back pain trials has provided evidence that: (1) OMT affords greater pain reduction than active or placebo control treatments; (2) the effects of OMT are comparable regardless of whether treatment is provided by fully-licensed osteopathic physicians in the United States or by osteopaths in the United Kingdom; and (3) the effects of OMT increase over time. However, much more clinical research remains to be done. The planning and implementation of a large longitudinal study of the natural history and epidemiology of somatic dysfunction, including an OMT component, represents a much-needed step forward. Osteopathic medicine's use of OMT and its focus on primary care are not mutually exclusive aspects of its uniqueness. The intersection of these fundamental aspects of osteopathic medicine suggests that the profession may successfully adopt a generic strategy of "focused differentiation" to attain a competitive advantage in the health care arena. While there are both requisite demands and risks for the osteopathic profession in adopting such a strategy, these are reasonable in relation to the potential rewards to be attained. To help promote an osteopathic identity, "omtology" and its derivative terms are recommended in referring to the study of OMT.The osteopathic profession should adopt a coherent strategy for developing and promoting its identity. Failure to do so will likely ensure that osteopathic medicine remains "stuck in the middle."