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Dec 28, 2022

Journal Watch: NEW Study Supports Proposed Mechanism of Osteopathic Manipulative Medicine (OMM) for Managing Low Back Pain

By Dr. David Norton

Osteopathic Manipulative Medicine (OMM) is often used to treat low back pain, but the underlying mechanisms of Osteopathic Manipulative Medicine and its short and long-term effects on pain is debated.

In this study published in the prestigious journal Nature, Cerritelli et al. used MRI to investigate the effect of OMM on the brain (using regional cerebral blood flow (rCBF)) and the autonomic system (using heart rate variability (HRV)). The autonomic nervous system is a system that works to maintain the body's internal homeostasis. This system commonly referred to as the fight-or-flight system responds differently depending on the stress, but measuring such a complex system is challenging.

In this study, 32 right-handed patients were divided (randomized) into either 4-weekly session of OMM (n=16) or a sham manual therapy (n=16). The authors found that OMM changed blood flow to areas of the brain associated with pain perception, impacted heart rate variability and pain perception in patients with low back pain.

The authors hypothesized that OMM effects pain by impacting the brain and autonomic system thereby reducing an overall inflammatory effect on tissues. This study highlights the complex relationship between brain perfusion, heart rate variability and pain the the low back, and suggests that Osteopathic Manipulation Treatment has the ability to modulate these systems reducing pain and improving overall clinical state.


This paper demonstrates that osteopathic manipulative medicine can changes cerebral blood flow to areas of the brain involved in pain and impact the autonomic system, providing a possible neurobiological mechanisms for Osteopathic Manipulative Medicine for low back pain.


Cerritelli, F., Chiacchiaretta, P., Gambi, F. et al. Osteopathy modulates brain–heart interaction in chronic pain patients: an ASL study. Sci Rep 11, 4556 (2021).

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