Original research| Volume 99, ISSUE 9, P1720-1729, September 2018

Osteopathic Manipulative Treatment Including Specific Diaphragm Techniques Improves Pain and Disability in Chronic Nonspecific Low Back Pain: A Randomized Trial



      To investigate the effects of an osteopathic manipulative treatment (OMT), which includes a diaphragm intervention compared to the same OMT with a sham diaphragm intervention in chronic nonspecific low back pain (NS-CLBP).


      Parallel group randomized controlled trial.


      Private and institutional health centers.


      Participants (N=66) (18-60y) with a diagnosis of NS-CLBP lasting at least 3 months.


      Participants were randomized to receive either an OMT protocol including specific diaphragm techniques (n=33) or the same OMT protocol with a sham diaphragm intervention (n=33), conducted in 5 sessions provided during 4 weeks.

      Main Outcome Measures

      The primary outcomes were pain (evaluated with the Short-Form McGill Pain Questionnaire [SF-MPQ] and the visual analog scale [VAS]) and disability (assessed with the Roland–Morris Questionnaire [RMQ] and the Oswestry Disability Index [ODI]). Secondary outcomes were fear-avoidance beliefs, level of anxiety and depression, and pain catastrophization. All outcome measures were evaluated at baseline, at week 4, and at week 12.


      A statistically significant reduction was observed in the experimental group compared to the sham group in all variables assessed at week 4 and at week 12 (SF-MPQ [mean difference −6.2; 95% confidence interval, −8.6 to −3.8]; VAS [mean difference −2.7; 95% confidence interval, −3.6 to −1.8]; RMQ [mean difference −3.8; 95% confidence interval, −5.4 to −2.2]; ODI [mean difference −10.6; 95% confidence interval, −14.9 to 6.3]). Moreover, improvements in pain and disability were clinically relevant.


      An OMT protocol that includes diaphragm techniques produces significant and clinically relevant improvements in pain and disability in patients with NS-CLBP compared to the same OMT protocol using sham diaphragm techniques.


      List of abbreviations:

      FABQ (Fear-Avoidance Beliefs Questionnaire), HADS (Hospital Anxiety and Depression Scale), LBP (low back pain), MCID (minimal clinically important difference), NS-CLBP (chronic nonspecific low back pain), ODI (Oswestry Disability Index), OMT (osteopathic manipulative treatment), PCS (Pain Catastrophizing Scale), RMQ (Roland–Morris Questionnaire), SF-MPQ (Short-Form McGill Pain Questionnaire), VAS (visual analog scale)
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