The Ability of Osteopathic Structural Evaluation to Assess Gait
Condition: Osteopathic Manipulation; Postural; Defect; Somatic; Functional Disturbance
Study type: Interventional

Summary: 
      Movement and loading asymmetry have been associated with injury risk for a variety of both
      acute and chronic musculoskeletal injuries. In addition, asymmetric movements have been
      identified as compensatory strategies to allow for ambulation in a variety of post-operative
      populations. Osteopathic physicians have been assessing both structure and function through
      the use of structural evaluation techniques along with postural assessment that can identify
      somatic dysfunction. However, no studies have identified the ability of an osteopathic
      structural evaluation and postural assessment to identify potential movement disorders and
      loading asymmetry. Therefore, the primary objective of this study is to determine the acute
      impact of an osteopathic manipulation on restoration of side-to-side symmetry during walking
      gait in participants who are categorized as having lower extremity dysfunction. We enrolled
      51 participants who are pain-free and without a history of major orthopaedic injuries that
      required surgical intervention. Each subject completed an osteopathic structural evaluation
      and postural assessment along with an osteopathic manipulation. All participants completed
      instrumented gait analyses before and after the osteopathic manipulation using a motion
      capture system and an instrumented treadmill to determine the participant's movement and
      loading asymmetry during walking.
    

Detailed description: 
      Following recruitment and the completion of informed consent, each subject had a standard
      osteopathic postural assessment. This assessment was completed by a single experienced
      osteopathic physicians who uses manual medicine techniques in clinical practice as well as
      teaching these techniques to osteopathic medical students.

      Following the osteopathic exam, all participants completed an initial biomechanical
      assessment in the Kevin P. Granata Biomechanics Lab at Virginia Tech. All subjects wore form
      fitting shorts and a shirt, plus a pair of athletic shoes (Nike Pegasus, Nike Inc, Beaverton,
      CO) all of which was provided for them to use during testing. Patients had retro-reflective
      markers attached at specific locations on both lower extremities to track segmental motion
      level walking. Three-dimensional coordinate data was collected using a 8-camera motion
      capture system at a sampling rate of 120 Hz (Qualysis, Sweden). Ground reaction forces were
      collected using an instrumented treadmill with a sampling rate of 1440 Hz (AMTI, Watertown,
      Massachusetts). Each subject completed a standing trial followed by 2 walking trials.
      Participants completed 5 minutes of continuous steady state walking at 1.5m/s on the
      instrumented treadmill. Participants then completed a second 5 minute walking trial at their
      self-selected speed on the instrumented treadmill. During both 5 minute walking trials, data
      was collected simultaneously from the motion capture system and the instrumented treadmill
      from minute 1 through minute 4 in order to avoid collection during the beginning and end of
      the trial.

      After the initial biomechanical examination, osteopathic manipulation was performed on
      participants in the Dysfunction group. The osteopathic manipulations were focused on treating
      the asymmetric postural dysfunction that was identified by the initial functional structural
      evaluation. The manipulation consisted of typical time-honored osteopathic treatments
      directed at the identified somatic dysfunction(s). These techniques were clinically directed
      and include: soft tissue, muscle energy, high velocity low amplitude, low velocity high
      amplitude as well as facilitated positional release as indicated.

      After the osteopathic manipulation, participants completed the same walking assessment for a
      second time. This immediate post-biofeedback testing was completed using the same protocol as
      the baseline assessment previously described.

      All osteopathic assessments and manipulations were completed by a single experienced
      osteopathic clinicians and the biomechanical assessments was completed by a second individual
      using a standard set of directions.
    

Intervention name(s): Osteopathic Manipulative Treatment
Intervention type(s): Procedure
Intervention description(s): The osteopathic manipulations focused on treating the asymmetric postural dysfunction that was identified by the initial functional structural evaluation. The manipulation consisted of typical time-honored osteopathic treatments directed at the identified somatic dysfunction(s). These techniques were clinically directed and include: soft tissue, muscle energy, high velocity low amplitude, low velocity high amplitude as well as facilitated positional release as indicated.
Intervention model: Single Group Assignment
Intervention model description: Participants underwent an osteopathic structural examination and osteopathic manipulation. Participants completed a biomechanical assessment prior to and following the osteopathic manipulation to evaluate the effect of osteopathic manipulation on gait asymmetry.
Masking: None (Open Label)
Primary purpose: Basic Science
Keywords: gait; assessment; manipulation; asymmetry; osteopathic