Assessment and Management of Somatic Dysfunctions in Patients With Patellofemoral Pain Syndrome

Abstract

Context Patellofemoral pain syndrome (PFPS) is one of the most common determinants of knee pain. The causes of PFPS are multifactorial, and most treatment approaches are conservative. There are many kinds of therapy for this syndrome, which are based on building strength, flexibility, proprioception, and endurance. Training is functional and progression is gradual. Our hypothesis is that total-body osteopathic manipulative therapy (OMTh; manipulative care provided by foreign-trained osteopaths) focused on the management of somatic dysfunctions could be useful for managing the pain of patients with PFPS. Objective To investigate the effect of OMTh on pain reduction in patients with PFPS. Methods This pilot study was randomized, controlled, and single-blinded with 2 months of follow-up. Qualified participants were randomly assigned to 1 of 2 groups: OMTh group or placebo group. Each participant received either 4 sessions of OMTh or 4 sessions of manual placebo intervention that consisted of passive touching without joint mobilization in a protocolled order. A visual analogue scale (VAS) was used to assess general knee pain, peripatellar pain, pain after prolonged sitting, pain during the patellar compression test, and pain during stair ascent and descent. Pain assessment was performed before the baseline (T0), second (T1), third (T2), and fourth (T3) sessions, and follow-up (T4) was performed 8 weeks after T3. Results Thirty-five participants were enrolled the study. The VAS score was significantly reduced and clinically relevant in the OMTh group after each treatment and after 2 months of follow-up. The change in the VAS score before each treatment indicates that the most improved areas at T1 compared with T0 were lumbar and sacral with improvements in 83% and 40% of patients, respectively. At T2 compared with T1, the most improved areas were cervical and sacral with improvements found in 58% and 36% of patients, respectively. The number of dysfunctions that were diagnosed decreased during the baseline to T3 period (40% change). The correlation analysis showed significant results for the dysfunction and the compression test at T2 (P=.01, ρ=0.543). Conclusion Significant differences in VAS scores were found between the OMTh and placebo groups. These findings underline how OMTh can lead to reduced pain in patients with PFPS.

Response to a letter to editor from Hohenschurz-Schmidt et al

“…As Hohenschurz-Schmidt correctly pointed out, a pilot is "a future study conducted on a smaller scale," and including some consideration of the clinical importance of these preliminary findings will, in fact, justify the development and assessment of more complex intervention programs [1]. Regarding their concern that readers unfamiliar with the "required methodological standards of clinical trials" [1] might assume that the described osteopathic intervention resulted in a high level of evidence or a recommendation for the treatment of the patellofemoral syndrome, we are confident enough that limitations we acknowledged in the appropriate section of our article and our fairly cautious conclusions [2] will guide readers' understanding. Our report might, at most, complement recent evidence [6] demonstrating a positive effect of osteopathic treatment (when compared with exercise protocol) for reducing knee pain in runners with PFPS [6].…”

“…We are grateful to Hohenschurz-Schmidt and colleagues [1] for their interest in our brief report on the potential effects of osteopathic manipulative therapy (OMTh) in patients with patellofemoral pain syndrome (PFPS) [2] and for their valuable effort to enhance the rigor of research in osteopathic medicine.…”

Vertigo and Balance Disorders – The Role of Osteopathic Manipulative Treatment: A Systematic Review

“…Osteopathic Manipulative Treatment (OMT) is a whole-body intervention that is mainly focused on normalizing somatic dysfunctions [24-26] found in different regions of the body [27]. To date, osteopathic research has mostly been concerned with various clinical conditions such as musculoskeletal and neurological disorders [28-32].…”

Performing and interpreting randomized clinical trials

“…Many academic journals have made it mandatory to use reporting guidelines and to register trial protocols prior to recruitment to assure research integrity [4]. In this letter, we discuss a trial published in the Journal of the American Osteopathic Association in 2020 [5] to illustrate some major considerations in designing, interpreting, and reporting a randomized, placebo-controlled trial of osteopathic manipulative therapy (OMTh) and highlight some possible sources of confusion regarding the interpretation of pilot trials.…”

“…Tramontano and colleagues [5] published a pilot randomized, placebo-controlled trial reporting on management of patients with patellofemoral pain syndrome (PFPS) based on an assessment of "somatic dysfunction". Notably, the authors assessed osteopathic interventions in a disorder other than low back pain, and there are several commendable aspects of their placebo control design, which is notoriously difficult for nonpharmacological interventions [6][7][8].…”