Title

Measuring the Effects of Osteopathic Manipulative Treatment on Range of Motion in Subjects with Postural Asymmetries in the Posterior View: A Potential Implication for People with Lateral Spinal Curvatures

Date of Award

2015

Degree Type

Thesis

Degree Name

Master of Science (MS)

First Advisor

Kerin M Claeson, PhD

Second Advisor

Lauren Nolo Bell, DO

Third Advisor

Donald Allison, DO

Abstract

Poor posture is a part of most people's lives whether they are aware of it or not. While correcting a postural asymmetry has options, many interventions are painful, inconvenient, and/or socially stigmatized. For instance, back braces and surgery are typical ways to improve posture when the underlying problem is a spinal lateral curvature. However, Osteopathic Manipulative Treatment (OMT) is potential noninvasive treatment for postural asymmetries and therefore has the potential to correct spinal lateral curvatures. My thesis research is centered on testing whether or not OMT improves range of motion and/or changes the overall shape of subjects with postural asymmetries. The research I am conducting seeks to test the efficacy of OMT on improving range of motion in persons with postural asymmetries using morphometric shape analysis. Morphometries is able to detect differences in shape and pieces out the principle components of the shape (e.g., length, width, or other); therefore it has the potential to determine whether OMT changes the shape of an individual's back. In my project, I am analyzing pre and post OMT treatment digital photographs taken of patients who received treatment in 2014 as part of joint study with the Department of Bio-Medical Sciences and the Department of Osteopathic Manipulative Medicine at PCOM. Photographs were taken of the backs of subjects after OMM clinicians palpated and then placed landmarks on specific bony-loci, which were then interpreted by the morphometries programs. The morphometric shape analysis program enables us to visualize treatment progression through graph and statistical analysis. I present the results here on subjects who have completed nine treatments, specifically analyzing range of motion indicated by the Adams Forward Bending (AFB) Test and by side bending to the left. The AFB test is a forward flexion exam that is used in order to predict postural asymmetries associated with scoliosis and spinal lateral curvatures. Once a rib hump or asymmetry is visually predicted by the clinician a radiograph is taken and the degree of curvature is confirmed by the gold standard called the Cobb Angle. I could not analyze the image changes in rib humps for this study because there were not enough examples of subjects who completed this portion of the trial. However, I could analyze side-bend range of motion. The results for Bony landmark palpations showed the greatest change in shape when comparing groups of subjects from a sham protocol and a treatment protocol, before the first day of treatments and after the ninth day of treatment. The first five Principle Component Analysis (PCA) Eigenvalues accounted for 84.674% indicating that landmarks five, six, seven, and ten had the most variation. Those landmarks represented body specific landmarks that relate to postural asymmetry on the patients posterior view in comparison to their spinal column. In addition to PCA analysis, a warp analysis was done which shows the energy bends in the data and the same landmarks were indicated to shift the greatest amount. Furthermore, and analysis of shape as a function of the subject group was performed using the Canonical Variates Analysis (CVA). Results of the CVA indicated that the treatment group had the largest change shift in morphospace on the graph, while sham did not shift as much. This may indicate that treatment subjects had a larger shape variation, which I interpret as an increase in range of motion. The same analyses were performed for semi-landmarks, which traced the silhouette of the backs of subjects. Results for bide bend left indicate that the semi data show that a majority of the shape change occurred around semi landmarks 31-41, which were on the left side of the trunk of the subject, the side the subject turned on. Landmark 31 was located on the left hip and 41 was under the left armpit region. These results may present an increase in range of motion for side bending to the left since these semi landmarks where indicative of the left side of the subjects. The CVA also showed a large shift in morphospace for OMT treated subjects as opposed to sham subjects.

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