The Effect Of Osteopathic Manual Therapy On Arterial Circulation In Patients With Peripheral Arterial Disease
Condition: Peripheral Arterial Disease; Osteopathy in Diseases Classified Elsewhere
MeSH terms: Peripheral Arterial Disease; Peripheral Vascular Diseases
Study type: Interventional

Summary: 
      Peripheral artery disease (PAD) is a chronic atherosclerotic process that causes narrowing of
      peripheral arterial vessels in the lower extremities. Osteopathic manual therapy (OMT) is one
      of the new treatment options for various pathologies. The aim of this study was to
      investigate the effect of OMT on arterial circulation in patients with PAD.
    

Detailed description: 
      Peripheral arterial disease (PAD) is a chronic, atherosclerotic process in the lower
      extremities that causes narrowing of the peripheral arteries. It has a prevalence of up to
      10% worldwide, this rate rises to about 30% in patients over 50 years of age. Atherosclerosis
      is characterized by intimal lesions called atheromas or atheromatous or fibrous fatty plaques
      that protrude into the vascular lumen, weakening the underlying environment. In
      atherosclerotic disease of the lower extremities, arterial stenoses cause a gradual reduction
      of prolonged blood flow, which manifests clinically as pain and tissue loss. Many patients
      with PAD are asymptomatic. The earliest symptom of the disease is pain while walking and is
      known as intermittent claudication (IC). If IC left untreated, it can cause pain at rest,
      tissue loss, or gangrene. Risk factors for peripheral arterial disease can be listed as age,
      gender, ethnicity, smoking, diabetes, hypertension, hyperlipidemia, chronic kidney failure.
      Understanding the underlying pathophysiological mechanisms of atherosclerosis and the finding
      of intermittent claudication in PAD is essential to be aware of the whole process and
      recommend prevention and treatment strategies. Patients with a diagnosis of PAH should
      receive a comprehensive treatment program, including structural exercise and lifestyle
      modification, to reduce cardiovascular ischemic events and improve functional status. All
      treatment plans should include aggressive modification of risk factors. This includes smoking
      cessation, weight loss, diet, hyperlipidemia, hypertension, diabetes, homocysteine,
      inflammation, antiplatelet medication, exercise. Recently, manual therapy methods have also
      been used.

      Andrew Taylor Still, founder of osteopathic manual therapy (OMT), was born on August 6, 1828,
      in Jonesville. He developed a strong belief in God as the perfect creator of all things.
      Because of this, he had the belief that all creation, including the human body, is perfect.
      He stated that a perfect body can heal itself and will contain the necessary tools for this.
      In OMT, 5 models are used to treat the person: biomechanic, respiratory-circulatory,
      metabolic-energy, neurological and behavioral. The circulatory model is concerned with the
      maintenance and enhancement of the extracellular environments through the delivery of oxygen
      and nutrients and the removal of cellular waste products. In this model, the clinical goal is
      to identify and eliminate key tissue stresses that impede the flow or circulation of body
      fluids to positively impact tissue health. The circulatory model is one of three levers used
      in the treatment of systemic dysfunction. In this model, coordinated OMT allows to improve
      homeostasis. These effects are known to be caused by nitric oxide (NO). Salomon et al.
      concluded that mechanical stimulation of excised neural and vascular tissue stimulates NO
      release, based on the data they obtained in their laboratory. Stimulation of muscle structure
      within physiological limits by manual techniques causes NO synthase enzyme activation,
      followed by NO release in a short time. The effect of NO, which is released in a short time,
      can cause a longer-term physiological mechanisms, especially in vascular structures. NO
      regulates by reducing endothelial and immunocyte activation and adhesion, thereby performing
      vital physiological activities including vasodilation. This can act as a positive feedback
      mechanism that causes the amount of blood flow to increase. As a result of NO-induced
      vasodilation, the organism has the potential to protect itself from microorganisms and
      physiological disorders such as hypertension. Vasodilation modulated by NO also reduces
      endothelial dysfunction. There are studies in the literature reporting that manual therapy
      interventions contribute to the systemic circulation, but only one study in which OMT was
      applied in patients with PAH was found. In this study, patients' ABI, functional performance,
      quality of life and some blood parameters were evaluated. No data was performed on arterial
      diameter and flow in the affected extremity. Considering the NO-induced vasodilator effects
      of OMT, it can be thought that it may increase circulation and change arterial diameter and
      flow in patients with PAD. Purpose of this study, to investigate the effect of osteopathic
      manual therapy on arterial circulation in patients with PAD.
    

Intervention name(s): Osteopathic Manual Therapy
Intervention type(s): Other
Intervention description(s): Occipital release, supraclavicular release, sternum mobilization, omentum minus release, liver pumping, diaphragm mobilization, grand maneuver for 3 minutes, general osteopathic manual therapy of the hip, knee and ankle was applied to each extremity for 90 seconds for a total of 3 minutes
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: 28 Patients were included. All of the patients included in the study were informed about the process. Voluntary consent was obtained from the patients participating in the study. 14 of the patients were randomly assigned to the osteopathic manual therapy group (OMTG) and 14 to the control group (CG).
Masking: Double (Participant, Investigator)
Primary purpose: Treatment
Keywords: peripheral arterial disease; osteopathic manual therapy; artery diameter; arterial flow