Clinical Research

Introduction

The effectiveness of OCF has been consistently demonstrated in a number of clinical studies. Research has been performed on treatment of the following conditions:

Otitis Media
Pregnancy, Labor and Delivery
Seizure disorders
Neurologic deficits
Learning problems
Dental problems
Normalization of Blood Flow
Normalization of Autonomic Function

Early Research

The earliest OCF Clinical Research is found in the text “Osteopathy in the Cranial Field” by Harold I. Magoun, DO.¹

Laughlin¹ charts reduced sweat production before and after application of the technique known as the compression of the fourth ventricle (CV4). This decrease in the activity of the sympathetic nervous system has also been demonstrated in more recent research.²

Magoun¹ also documents a substantial decrease of blood sugar and white blood cell count before and after application of the CV4.

Otitis Media

A difficult labor and delivery may alter the mobility of cranial structures, interfering with fluid drainage, and compromising healthy function of the ear. Understanding the usefulness of OCF in the treatment of Otitis Media requires a familiarity with the anatomy of the Temporal Bone (which houses the ear structures) and the Eustachian Tube.

Multiple studies^9-11 have demonstrated the successful treatment of Otitis Media with OCF. These studies showed improvement in health as measured by fewer ear tubes, improved tympanography (a measure of the movement of the ear drum and existence of fluid in the ear), and a significant reduction of the need for antibiotics in children suffering from recurrent ear infections (otitis media). As a result of these positive findings, plans for a multi-site clinical trial are in development.

Pregnancy, Labor and Delivery

Since the inception of the osteopathic profession pregnant women have been treated with Osteopathic Manipulative Treatment (OMT).

As early as 1911, studies¹³ on hundreds of women who received prenatal OMT were published. Shorter labors with fewer complications were reported.

In another study¹⁴ that included OCF, statistically fewer preterm deliveries and fewer cases of meconium-stained amniotic fluid (a sign of fetal distress) were noted.

A promising pilot study that awaits a larger follow-up was done by Gitlin and Wolf¹⁵ on women who were overdue to deliver and had not yet felt any uterine contractions. Eight women were treated using only a compression of the fourth ventricle (CV4). Positive results were demonstrated. Of the six women who completed the study, all began uterine contractions within 34 minutes with an average of 17.5 minutes.

Pediatrics

Trauma, including a difficult labor and delivery, can produce unfortunate clinical outcomes.

Frymann¹⁶ evaluated the cranial bone mechanics of 1250 newborns and found that 88% had identifiable cranial bone strain patterns.

Frymann further demonstrated the benefit of OCF in the treatment of children with learning problems,¹⁷ children with neurological deficits,¹⁸ and seizure disorders.¹⁹

Inspired by Frymann’s work, research was later done in Russia by Lassovetskaia on children with language and learning problems.²⁰ In this study, 96 children who received 6-12 weeks of OCF demonstrated significantly higher academic performance in virtually all categories, compared to their untreated classmates.

The OCF treatment of respiratory conditions such as asthma, pneumonia, bronchiolitis, and newborn diaphragm restrictions are described in the chapter on General Pediatrics in the Foundations for Osteopathic Medicine²¹. The authors discuss the applications of OCF in gastrointestinal disorders such as colic, gastroesphageal-reflux (GERD), constipation, and diarrhea.

A common finding in cases of infantile colic involves an impingement of the 10th cranial nerve (Vagus). This nerve passes through the jugular foramen (an opening between the occipital and temporal bones) and coordinates the peristaltic wave action (normal wavelike motion down the intestines) of the gastrointestinal tract. Pressure on the 10th cranial nerve can be caused by compression of the head during the birth process. Decompression of this region by gentle OCF can restore nerve function.

Dental Applications

Since teeth reside within cranial bones and are involved in cranial motion, it is not surprising that OCF has been successfully applied in the treatment of dental conditions.

Magoun^22-24 provides several case studies and specific techniques for OCF treatment of individuals whose cranial strains involve dental considerations.

Lay²⁵ continued work in the dental sphere, providing more case studies involving temporal-mandibular joint (TMJ) dysfunction.

Baker²⁶ demonstrated widening of the dental arch of patients receiving OCF.Models of upper teeth over a six month period showed overall widening of 0.7 mm between molar teeth. It is common in the practice of orthodontics to move the upper molars up to 2 mm by dental appliances. However, in cases reported by Baker, the changes were brought about only by OCF.

Some dentists study and apply OCF within the scope of their practices. Dentists may become Associate Members of the Cranial Academy.

Effects of OCF on Vascular and Autonomic Nervous System Functions

Treatment with OCF has been effective in helping normalize function of both the nervous and vascular systems.

Huard²⁷ demonstrates that the “Venous Sinus Technique” (VST) helps restore optimal intracranial blood flow in the area of the cranial base (base of skull). The VST is a commonly applied procedure used in the treatment of congestive headaches and sinus congestion. Huard applied the VST to 39 subjects, with 39 others receiving light touch only, and another group of 39 subjects received no touch at all. Ultrasound technology was used to measure and record blood flow.

Cutler et al² showed statistically significant effects on the application of the CV4 in sleep latency (the length of time that it takes to go from full wakefulness to falling asleep) and the reduction of sympathetic nerve activity. In a controlled environment, healthy subjects went to sleep faster if the CV4 was applied compared to subjects who received only a light touch control protocol or no touch at all. Sympathetic nerve activity measured in the peroneal nerve (nerve of the lower leg) was also significantly reduced.

Giles et al^28,29 presents further evidence of the impact of OCF on body function. Statistically significant improvement in the heart rate variability (a function used to measure the health of the autonomic nervous system) was demonstrated in healthy human subjects. Osteopathic treatment was applied to the cervical spine with emphasis on the occipito-atlantal area (between the neck and base of skull) utilizing decompression, a common OCF technique. Heart rate variability was best when OCF was applied, compared with sham and time control conditions in an N=24 cross-over design.

Summary

The evidence presented to date provides a significant foundation for the use of OCF in clinical practice. As future studies emerge, and the body of evidence supporting the clinical practice of OCF becomes more compelling, it is our expectation that the clinical practice of OCF will find greater prevalence in the health care system.

References

Magoun HI. Osteopathy in the cranial field, 2e. Kirksville, MO: Journal Publishing Company; 1966:112-113.
Cutler MJ, Holland BS, Stupinski BA, et al. Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans: a pilot study. J Altern Complement Med. 2005;11(1):103-108.
Feely RA. (Ed.) Clinical cranial osteopathy: selected readings. Indianapolis, IN: The Cranial Academy; 1988.
King HH. (Ed.) The collected papers of Viola M Frymann, DO: legacy of osteopathy to children. Indianapolis, IN: American Academy of Osteopathy; 1998.
King HH. (Ed.) Proceedings of international research conference: Osteopathy in Pediatrics at the Osteopathic Center for Children in San Diego, CA 2002. Indianapolis, IN: American Academy of Osteopathy: 2005.
Magoun HI. Entrapment neuropathy in the cranium. J Am Osteopath Assoc. 1968;67:643-652.
Magoun HI. Entrapment neuropathy of the central nervous system: Part II. Cranial nerves I-IV, VI-VIII, XII. J Am osteopath Assoc. 1968;67:779-787.
Magoun HI. Entrapment neuropathy of the central nervous system: Part III. Cranial nerves V, IX, X, XI. J Am Osteopath Assoc. 1968;67:889-899.
Mills MV, Henley CE, Barnes LLB, et al. The use of osteopathic manipulative treatment as adjuvant therapy in children with recurrent acute otitis media. Archives of Pediatrics & Adolescent Medicine. 2003;157:861-866.
Steele KM, Kukulka G, Ilker CL. Effect of osteopathic manipulative treatment on childhood otitis media outcomes. Poster presented at the American Osteopathic Association 102 Annual Meeting and Scientific Seminar 1997 (Oct) grant # 94-12-400.
Degenhardt BF, Kuchera ML. Osteopathic evaluation and manipulative treatment in reducing the morbidity of otitis media: a pilot study. J Amer Osteopath Assoc. 2006;106:327-34.
Still AT. The philosophy and mechanical principles of osteopathy. Kansas City, MO: Hudson-Kimberly Publishing Co; 1902.
Whiting LM. Can the length of labor be shortened by osteopathic treatment? J Am Osteopath Assoc. 1911;11:917-921.
King HH, Tettambel MA, Lockwood MD, Johnson KH, Arsenault DA, Quist R. Osteopathic manipulative treatment in prenatal care: A retrospective case control design study. J Am Osteopath Assoc 2003;103(12):577-82.
Gitlin RS, Wolf DL. Uterine contractions following osteopathic cranial manipulation. J Am Osteopath Assoc. 1992;92(9):1183 [Abst]
Frymann VM. Relation of disturbances of craniosacral mechanisms to symptomatology of the newborn: study of 1,250 infants. J Am Osteopath Assoc. 1966;65:1059-1075.
Frymann VM. Learning difficulties of children viewed in the light of the osteopathic concept. J Am Osteopath Assoc. 1976;76:46-61.
Frymann VM, Carney RE, Springall P. Effect of osteopathic medical management on neurologic development in children. J Am Osteopath Assoc. 1992;92:729-744.
Frymann VM. The osteopathic approach to the child with a seizure disorder. In King HH. (Ed) Proceedings of international research conference: Osteopathy in Pediatrics at the Osteopathic Center for Children in San Diego, CA 2002. American Academy of Osteopathy, Indianapolis, IN, 2005;89-96.
Lassovetskaia L. Applications of the osteopathic approach to school children with delayed psychic development of cerebro-organic origin. In King HH. (Ed.) Proceedings of international research conference: Osteopathy in Pediatrics at the Osteopathic Center for Children in San Diego, CA 2002. Indianapolis, IN; American Academy of Osteopathy, 2005:52-59.
Centers S, Morelli MA, Vallad-Hix C, Seffinger M. General Pediatrics. In Ward RC (Ed.) Foundations for osteopathic medicine, 2/e. Philadelphia; Lippincott, Williams & Wilkins, 2002:305-326.
Magoun HI. Osteopathic approach to dental enigmas. J Am Osteopath Assoc. 1962;62:34-42.
Magoun HI. Dental equilibration and osteopathy. J Am Osteopath Assoc. 1975;74:115-125.
Magoun HI. The dental search for a common denominator in craniocervical pain and dysfunction. J Am Osteopath Assoc. 1979;78:83-88.
Lay EM. The osteopathic management of tempormandibular joint dysfunction. In Gelb H. (Ed.) Clinical management of head, neck and TMJ pain and dysfunction; a multidisciplinary approach to diagnosis and treatment. Philadelphia; W.B. Saunders Co, 1985.
Baker EG. Alteration in width of maxillary arch and its relation to sutural movement of cranial bones. J Am Osteopath Assoc. 1971;70:559-564.
Huard Y. Influence of the venous sinus technique on cranial hemodynamics. In King HH. (Ed.) Proceedings of international research conference: Osteopathy in Pediatrics at the Osteopathic Center for Children in San Diego, CA 2002. Indianapolis, IN; American Academy of Osteopathy, 2005:32-36.
Giles PD. Effects of cervical manipulation on autonomic control. Unpublished Master’s Thesis University of North Texas Health Science Center, Fort Worth, TX 2006.
[Giles PD, Smith M, Hensel K. Effects of cervical manipulation on autonomic control. Submitted for publication, J Compl Altern Med.]

RESEARCH