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1.  Lymphatic Pump Treatment Repeatedly Enhances the Lymphatic and Immune Systems 
Lymphatic Research and Biology  2013;11(4):219-226.
Background: Osteopathic practitioners utilize manual therapies called lymphatic pump techniques (LPT) to treat edema and infectious diseases. While previous studies examined the effect of a single LPT treatment on the lymphatic system, the effect of repeated applications of LPT on lymphatic output and immunity has not been investigated. Therefore, the purpose of this study was to measure the effects of repeated LPT on lymphatic flow, lymph leukocyte numbers, and inflammatory mediator concentrations in thoracic duct lymph (TDL).
Methods and Results: The thoracic ducts of five mongrel dogs were cannulated, and lymph samples were collected during pre-LPT, 4 min of LPT, and 2 hours post-LPT. A second LPT (LPT-2) was applied after a 2 hour rest period. TDL flow was measured, and TDL were analyzed for the concentration of leukocytes and inflammatory mediators. Both LPT treatments significantly increased TDL flow, leukocyte count, total leukocyte flux, and the flux of interleukin-8 (IL-8), keratinocyte-derived chemoattractant (KC), nitrite (NO2−), and superoxide dismutase (SOD). The concentration of IL-6 increased in lymph over time in all experimental groups; therefore, it was not LPT dependent.
Conclusion: Clinically, it can be inferred that LPT at a rate of 1 pump per sec for a total of 4 min can be applied every 2 h, thus providing scientific rationale for the use of LPT to repeatedly enhance the lymphatic and immune system.
PMCID: PMC3875196  PMID: 24364845
2.  Lymphatic Pump Treatment Increases Thoracic Duct Lymph Flow in Conscious Dogs with Edema Due to Constriction of the Inferior Vena Cava 
Lymphatic Research and Biology  2010;8(3):149-154.
Osteopathic lymphatic pump treatments (LPT) are used to treat edema, but their direct effects on lymph flow have not been studied. In the current study, we examined the effects of LPT on lymph flow in the thoracic duct of instrumented conscious dogs in the presence of edema produced by constriction of the inferior vena cava (IVC).
Methods and Results
Six dogs were surgically instrumented with an ultrasonic flow transducer on the thoracic lymph duct and catheters in the descending thoracic aorta and in IVC. After postoperative recovery, lymph flow and hemodynamic variables were measured 1) pre-LPT, 2) during 4 min LPT, 3) post-LPT, in the absence and presence of edema produced by IVC constriction. This constriction increased abdominal girth from 60 ± 2.6 to 75 ± 2.9 cm. Before IVC constriction, LPT increased lymph flow (P < 0.05) from 1.9 ± 0.2 ml/min to a maximum of 4.7 ± 1.2 ml/min, whereas after IVC constriction, LPT increased lymph flow (P < 0.05) from 7.9 ± 2.2 to a maximum of 11.7 ± 2.2 ml/min. The incremental lymph flow mobilized by 4 min of LPT (ie, the flow that exceeded 4 min of baseline flow), was 10.6 ml after IVC constriction. This incremental flow was not significantly greater than that measured before IVC constriction.
Edema caused by IVC constriction markedly increased lymph flow in the thoracic duct. LPT increased thoracic duct lymph flow before and after IVC constriction. The lymph flow mobilized by 4 min of LPT in presence of edema was not significantly greater than that mobilized prior to edema.
PMCID: PMC2958464  PMID: 20863267
3.  Lymphatic Pump Treatment Mobilizes Leukocytes from the Gut Associated Lymphoid Tissue into Lymph 
Lymphatic Research and Biology  2010;8(2):103-110.
Lymphatic pump techniques (LPT) are used clinically by osteopathic practitioners for the treatment of edema and infection; however, the mechanisms by which LPT enhances lymphatic circulation and provides protection during infection are not understood. Rhythmic compressions on the abdomen during LPT compress the abdominal area, including the gut-associated lymphoid tissues (GALT), which may facilitate the release of leukocytes from these tissues into the lymphatic circulation. This study is the first to document LPT-induced mobilization of leukocytes from the GALT into the lymphatic circulation.
Methods and Results
Catheters were inserted into either the thoracic or mesenteric lymph ducts of dogs. To determine if LPT enhanced the release of leukocytes from the mesenteric lymph nodes (MLN) into lymph, the MLN were fluorescently labeled in situ. Lymph was collected during 4 min pre-LPT, 4 min LPT, and 10 min following cessation of LPT. LPT significantly increased lymph flow and leukocytes in both mesenteric and thoracic duct lymph. LPT had no preferential effect on any specific leukocyte population, since neutrophil, monocyte, CD4+ T cell, CD8+ T cell, IgG+B cell, and IgA+B cell numbers were similarly increased. In addition, LPT significantly increased the mobilization of leukocytes from the MLN into lymph. Lymph flow and leukocyte counts fell following LPT treatment, indicating that the effects of LPT are transient.
LPT mobilizes leukocytes from GALT, and these leukocytes are transported by the lymphatic circulation. This enhanced release of leukocytes from GALT may provide scientific rationale for the clinical use of LPT to improve immune function.
PMCID: PMC2939849  PMID: 20583872
4.  Osteopathic Manipulative Treatment of Back Pain and Related Symptoms during Pregnancy: A Randomized Controlled Trial 
To study osteopathic manipulative treatment (OMT) of back pain and related symptoms during the third trimester of pregnancy.
Study design:
A randomized, placebo-controlled trial was conducted to compare usual obstetrical care (UOBC) and OMT (UOBC+OMT), UOBC and sham ultrasound treatment (UOBC+SUT), and UOBC only. Outcomes included average pain levels and the Roland Morris-Disability Questionnaire (RMDQ) to assess back-specific functioning.
Intention-to-treat analyses included 144 subjects. The RMDQ scores worsened during pregnancy; however, back-specific functioning deteriorated significantly less in the UOBC+OMT group (effect size, 0.72; 95% CI, 0.31-1.14; P=.001 vs. UOBC only; and effect size, 0.35; 95% CI, −0.06-0.76; P=.09 vs. UOBC+SUT). During pregnancy, back pain decreased in the UOBC+OMT group, remained unchanged in the UOBC+SUT group, and increased in the UOBC only group, although no between-group difference achieved statistical significance.
Osteopathic manipulative treatment slows or halts the deterioration of back-specific functioning during the third trimester of pregnancy.
PMCID: PMC2811218  PMID: 19766977
osteopathic manipulative treatment; pregnancy; back pain; physical functioning; randomized controlled trial
5.  Assessment of calvarial structure motion by MRI 
Practitioners of manual medicine/manual therapy (MM/MT) who utilize techniques thought to have some impact upon and move the solid structures of the human head have been criticized for lack of evidence of cranial bone motion. The present study utilized magnetic resonance imagery (MRI) technology to address the question of whether or not inherent (non-operator initiated) calvarial structure motion can be assessed.
Subjects: Twenty healthcare professionals, (physicians, nurses, medical students, pharmacists) between the ages of 24 and 52 were recruited. Seven females (ages 25-47, mean age 36.7) and 13 males (ages 25-53, mean age 31.2) volunteered. Technology: MRI scans were acquired at 450 ms per slice, in a 1.5 Tesla Signa Excite HD closed MRI system. The same scan prescription was repeated serially every 45 seconds to obtain eight serial slices for each subject. Image analysis was accomplished using ImageJ software (ImageJ 1.33 u National Institutes of Health, USA). Data from all eight images for each of the 20 subjects were analyzed to determine the two images with the largest differences in the parameters measured.
Difference values for the measures of area, width, height, major axis, and feret were statistically different whereas the measures for perimeter and minor axis were not. However, only the difference values for area were both statistically different (p < 0.003) and exceeded the resolution threshold of 0.898 mm/pixel.
The statistically significant difference value for area is suggestive of inherent motion in calvarial structures, and adds to the body of evidence supportive of biomechanically measurable calvarial structure motion in general. That the total intracranial area appeared to expand and recede was consistent with theory and prior studies suggestive of calvarial structure motion due to intracranial fluid volume changes.
The use of MRI technology was able to demonstrate calvarial structure motion at a level exceeding the resolution threshold, and provides a means for further research on phenomena related to the cranial concept. It may be just a matter of time until increased resolution of MRI technology and image analysis provide the ability to examine more detailed areas of specific cranial bone motion.
PMCID: PMC2743699  PMID: 19732453
6.  OSTEOPAThic Health outcomes In Chronic low back pain: The OSTEOPATHIC Trial 
Osteopathic manipulative treatment (OMT) and ultrasound physical therapy (UPT) are commonly used for chronic low back pain. Although there is evidence from a systematic review and meta-analysis that OMT generally reduces low back pain, there are no large clinical trials that specifically assess OMT efficacy in chronic low back pain. Similarly, there is a lack of evidence involving UPT for chronic low back pain.
The OSTEOPAThic Health outcomes In Chronic low back pain (OSTEOPATHIC) Trial is a Phase III randomized controlled trial that seeks to study 488 subjects between August 2006 and June 2010. It uses a 2 × 2 factorial design to independently assess the efficacy of OMT and UPT for chronic low back pain. The primary outcome is a visual analogue scale score for pain. Secondary outcomes include back-specific functioning, generic health, work disability, and satisfaction with back care.
This randomized controlled trial will potentially be the largest involving OMT. It will provide long awaited data on the efficacy of OMT and UPT for chronic low back pain.
Trial registration
, NCT00315120
PMCID: PMC2386783  PMID: 18439282

Results 1-6 (6)