Background
Ultrasound is commonly used to assess musculoskeletal abnormalities. High-velocity, low-amplitude (HVLA) is an osteopathic manipulative treatment technique commonly used by osteopathic physicians. The Shaw et al study has shown the reliability of ultrasound in measuring the improvement of rotational symmetry of lumbar somatic dysfunction (SD) after the use of HVLA.
Objectives
The purpose of this study was to evaluate the use of ultrasonography as a reference tool to quantitatively assess the rotational symmetry of cervical SD after the use of HVLA.
Design
The study was separated into 2 phases: 1) cervical diagnosis and pretreatment imaging and 2) HVLA or cranial vault hold (CVH) and post-treatment imaging.
Method
Two physicians independently diagnosed each participant (N = 51) with an SD between levels C2–C7; the key SD (the segment with the most posteriorly rotated articular pillar (AP)) was chosen. Ultrasound imaging was performed immediately after diagnosis. Next, the participants were randomly distributed into a treatment group, in which the participants were treated with HVLA, and a control group, in which a CVH was performed on the participant. Members of the HVLA group were then reassessed to confirm the key SD had resolved. Ultrasound imaging was immediately performed at the level of the segment with the key SD after HVLA reassessment or CVH completion.
Results
Physician reassessment confirmed SD resolution in 25 of 25 HVLA participants and 0 of 26 control participants. There was no significant change in ultrasound-measured AP rotation for the HVLA group (M=.05680 cm, P=.179) or control group (M=.02384 cm, P=.160).
Conclusions
Despite a palpatory resolution of the cervical SD, ultrasound was not able to determine a statistically significant change in AP rotation in either the HVLA or the control group.
Obsessive-compulsive disorder (OCD) is a debilitating neuropsychiatric disorder that affects about one in 40 American adults and one in 100 American children. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the patient must have the presence of obsessions, compulsions or both. OCD can be covert in presentation and therefore requires physician vigilance with the diagnosis. The efficacy of the physician’s interviewing style is extremely important in OCD treatment because typically, long delays in diagnosis often occur and the shame associated with the disorder may inhibit discussion of the symptoms and treatment plans. In addition to serotonin-regulating medications, deciphering the etiology of the patient’s obsessions or compulsions is important. Thus, cognitive behavioral therapy supplemented with SSRIs is the true first-line therapy for OCD because it provides a synergistic approach of life discussions, habit training and medication.
Because of the inseparability of physical and mental health, osteopathic medicine offers an effective model for treatment through osteopathic manipulative treatment (OMT). In the holistic view of OMT, somatic, visceral and psychological dysfunctions are united. Thus, physicians who incorporate OMT into their practice can aid in the treatment of psychopathology, such as OCD.
In this article, we will discuss the epidemiology of OCD, the DSM-5 criteria for OCD, the current OCD treatments, the osteopathic approach and how it pertains to OCD treatment, and lastly, OMT and its possible role in treating OCD. Due to a lack of research on osteopathic manipulative medicine (OMM) treatments in OCD, we will also propose a possible study design for further investigation.
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