Journal of Osteopathic Medicine

Abstract Literature describing the integration of osteopathic manipulative treatment (OMT) during prenatal care visits in a resident clinic setting are scarce. Concise and readily accessible resources reviewing OMT in pregnancy are limited. We sought to integrate OMT into routine prenatal care appointments in a family medicine resident clinic setting and create a concise resource for those performing OMT in pregnancy. Musculoskeletal (MSK) pain in pregnancy is common. Specifically, low back pain (LBP) often accompanies pregnancy and may negatively impact sleep, the ability to work, and the ability to complete daily tasks. Treatment options for LBP in pregnancy are limited due to the concern for fetal or maternal harm associated with pharmacologic options or invasive procedures. OMT is a low-risk intervention that has been demonstrated to improve back pain and reduce deterioration of back-specific function in pregnancy. Over a 12-month period, one resident physician offered OMT during routine prenatal care visits in a family medicine resident clinic. During the study period, we identified barriers to integrating OMT along with solutions. Barriers to integrating OMT were noted in three areas: clinic setup and logistics, attending physician awareness of OMT in pregnancy, and treating physician knowledge of OMT in pregnancy. OMT provides pregnant patients with additional treatment options and relief from MSK pain. This may reduce the number of patients with untreated MSK pain and benefit those who are unable to attend additional appointments outside of prenatal care due to financial or logistic barriers. OMT can be integrated into routine prenatal care visits in a training setting by providing complaint-specific OMT and determining how treatments can be performed for each unique examination room and table. Reviewing OMT in pregnancy with the attending physician prior to treatment, contraindications to OMT in pregnancy, and visualizing how treatments will be altered in pregnancy allows for smooth integration.

Travis D. Rath

Kyle R. Baum

Bradley D. Kamstra

Jennifer A. Schriever

Integrating osteopathic manipulative treatment into prenatal care visits in a family medicine resident clinic

将整骨手法治疗整合到家庭医学住院医师诊所的产前护理中

Abstract Context Medical students report high levels of perceived stress and burnout, especially during the preclinical years. The combination of physical stressors from poor posture, poor sleep quality, and mental stressors from the rigorous curriculum stimulates the sympathetic nervous system (SNS) to secrete cortisol. Previous studies have shown that persistent elevated cortisol levels are associated with negative health outcomes. Objectives We conducted an Institutional Review Board (IRB)-approved study to determine if regular osteopathic manipulative treatments (OMTs) could impact the stress levels of first-year osteopathic medical students (OMSs) at Touro College of Osteopathic Medicine (TouroCOM) Harlem campus by measuring physiologic stress through changes in weekly salivary cortisol levels, perceived emotional and psychological stress levels, and cognitive function. Methods We recruited 10 first-year OMSs who were not currently receiving external OMT outside of weekly coursework; other forms of external stress management, such as yoga or meditation, were not controlled for in this study. Utilizing a random number generator, the 10 student respondents were split into a control group that received no treatment and a treatment group that received 15 min of weekly OMT for 6 weeks. The treatment consisted of condylar decompression, paraspinal inhibition, and supine rib raising, which are techniques that are known to balance the SNS and parasympathetic nervous system (PNS). Cortisol levels were quantified by enzyme-linked immunosorbent assay (ELISA) cortisol immunoassay via salivary samples collected at the beginning of each weekly session, prior to treatment for the treatment group, at the same time of day each week. We also measured participants’ weekly subjective perception of stress utilizing the College Student Stress Scale (CSSS) and cognitive function utilizing the Lumosity Performance Index (LPI). We conducted a two-tailed, unpaired t -test as well as a U test for the cortisol levels, given the smaller sample size and potential for a nonnormal distribution. Results A lower cortisol level was correlated to a higher optical density (OD), the logarithmic measure of percent transmission of light through a sample; analysis of our data from the ELISA cortisol immunoassay showed an average weekly change in OD (∆OD) for the treatment group of 0.0215 and an average weekly ∆OD of −0.0044 in the control group. The t -test showed p=0.0497, and our U test showed a p=0.0317. Both tests indicated a statistically significant decrease across the weekly salivary cortisol levels in the treatment group utilizing a p&lt;0.05. An additional effect-size analysis supported our finding of a significant decrease in weekly cortisol levels in the treatment group, Cohen’s d =1.460. Based on the CSSS responses, there was no significant difference in perceived stress between the control and treatment groups (p=0.8655, two-tailed). Analysis of the LPI revealed no statistically significant difference in cognitive performance (p=0.9265, two-tailed). Conclusions Our study supports the claim that OMT that targets the SNS and PNS has a significant impact on cortisol levels. While the reduction in cortisol levels was statistically significant, the broader physiological impact remains unclear. Further research is necessary to determine whether this reduction translates to meaningful clinical benefits.

Robert Valencia

Gowtham Anche

Gabriela Do Rego Barros

Victor Arostegui

Henal Sutaria

Emily McAllister

Mary Banihashem

Mikhail Volokitin

Stressbusters: a plot study investigating the effects of OMT on stress management in medical students

压力克星：一项研究OMT对医学生压力管理效果的情节研究

Abstract Context Urinary incontinence (UI) in the powerlifting community has been a hot topic due to its noticeability during competition and the burden it places on female athletes who experience it. UI is even experienced in those we least expect: young, high-performing, females with no history of pregnancy. Current studies have utilized primarily survey methodology, thus there is a lack of clinical information on this topic. Furthermore, the top athletes are underrepresentedbecause previous surveys were open to anyone reporting themselves as a powerlifter, regardless of competition level. Objectives The objectives of this study were to determine whether UI in elite female powerlifters is correlated with any musculoskeletal diagnoses and to further evaluate potentially contributing factors for UI within this group. Methods Subjects underwent an osteopathic structural examination and then completed two surveys: the Incontinence Severity Index (ISI/Sandvik Test for Urinary Incontinence) and the Study Questionnaire. Results In total, there were 31 female participants, all of whom were in the top 2 % of powerlifters in the world between the ages of 20 and 30 years old (as of May 21, 2023) and reside in the United States. The survey results displayed a moderately positive relationship between age (rho=0.449, where rho refers to Spearman’s rho), history of pelvic floor examination (rho=0.413), and self-care practice with ISI (rho=0.340). Other survey information such as weight class, height, best total in competition, number of years training, average duration of training day, confidence in ability to contract pelvic floor muscles, history of abdominal or pelvic surgery, history of urinary tract infection (UTI), and sexual activity status all had rho values less than 0.300. With atlantoaxial (AA) rotation to the right, there was an increase in ISI score (p=0.009). Similarly, with AA rotation to the left, there was a decrease in ISI score (p=0.030). All patients with severe ISI had nonphysiologic sacral dysfunctions (p=0.051). Severe ISI-scored participants were more likely to yield a dysfunctional clavicle upon screening (p=0.027). There was a strong correlation between increasing severity of UI and findings of a restricted right clavicle and/or AA rotation to the right (p=0.010). In addition, there were only two individuals with both a restricted right clavicle and AA rotation to the right, and these two individuals both scored severe on the ISI (p=0.012). A pelvic diaphragm dysfunction was present in 74.2 % of the participants. Extension diagnoses of the lumbar spine were found in those with mild UI over those with severe UI (p=0.012). Most other diagnoses were largely unremarkable due to a wide distribution across all ISI scores. Conclusions Our study revealed a relationship between UI and somatic dysfunctions in this population. These findings may help providers, especially in the fields of primary care, sports medicine, and urogynecology, to expand treatment options for UI in this group in the future. Survey results yielded a positive relationship of moderate strength between age, history of pelvic floor exination, and engaging in leakage prevention practices with ISI. No survey category was found to have a relationship of high strength with ISI. These findings contribute to our knowledge on factors that do (or do not) contribute to incontinence severity.

Kloie D. Nutt

Michael Carnes

Laura Griffin

Gregory Rivin

Urinary incontinence in elite female powerlifters aged 20–30: correlating musculoskeletal exam data with incontinence severity index and survey data

20-30岁精英女性力量举运动员的尿失禁：肌肉骨骼检查数据与失禁严重指数及调查数据的关联

Forrest Bohler

J Osteopath Med

Addressing confounding factors in the match disparities between DO and MD seniors

解决DO与MD毕业生匹配差异中的混杂因素

Abstract This case report details the presentation, diagnosis, and management of a newborn Native American male with non-Herlitz junctional epidermolysis bullosa (JEB), a rare diagnosis specifically in the Native American population. Genetic analysis revealed a homozygous mutation in the COL17A1 gene. The management involved multidisciplinary care and highlighted the challenges in treatment, including pain management, wound care, and ethical considerations surrounding adoption within Indigenous communities. This case highlights the importance of tailored interventions and the need for further research into the genetic diversity and prevalence of epidermolysis bullosa (EB) among the Native American population.

Ayah A. Ibrahim

Macken Yrun-Duffy

Rochelle D. Almario

Jordyn R. Mullins

Scott S. Cyrus

Non-Herlitz junctional epidermolysis bullosa in a Native American newborn

美洲原住民新生儿中的非Herlitz型交界性大疱性表皮松解症

Endometriosis is defined as the presence of endometrial-like glands and stroma outside of the uterus. There are three types of endometriotic lesions: superficial or peritoneal endometriosis, ovarian endometrioma, and deep infiltrating disease. Endometriosis not only occurs in the pelvis but also can be found in extrapelvic sites such as the gastrointestinal tract, upper abdominal viscera, genitourinary tract, abdominal wall, diaphragm, and thoracic cavity. After thorough history and physical examination is performed, imaging, such as ultrasound or magnetic resonance imaging (MRI), should be obtained if there is high suspicion for deep-infiltrating endometriosis to better assess visceral involvement. Endometriosis can be suspected based on symptoms, physical examination findings, and imaging. However, a definitive diagnosis requires histopathologic confirmation. Treatment options include expectant, medical, and surgical management. Endometriosis is largely a quality-of-life issue, and treatment should be tailored accordingly with empiric medical therapy frequently utilized. Medical management focuses on symptom improvement. Surgical management with excision of endometriosis is preferred over ablation or fulguration of endometriotic lesions. In the case of deep or extrapelvic endometriosis, treatment with a multidisciplinary team with experience in the treatment of advanced-stage endometriosis is essential to minimizing morbidity and increasing long-term success.

Jordann-Mishael Duncan

Ritchie Delara

Gina Ranieri

Megan Wasson

Management of endometriosis: a call to multidisciplinary approach

子宫内膜异位症的管理：呼吁多学科方法

Abstract Context Runners often experience acute/chronic pain due to pre-existing structural somatic dysfunction and/or acquired various overuse injuries of the lower extremity, specifically affecting the ligaments, tendons, muscles, and bones. Common structural and function dysfunctions include but are not limited to patellofemoral pain syndrome (PFPS), Achilles tendonitis, iliotibial band syndrome (ITBS), ligamentous and muscle tears, muscle sprains/strains, stress fractures, pes planus, plantar fasciitis, and shin splints. Objectives The purpose of this study is to assess the correlation between acute and chronic pain, overuse injuries, and observational and palpatory findings upon evaluation to establish common trends of somatic dysfunctions and determine possible etiology of the pain/injury. Methods A total of 103 individuals were recruited (54.4% female, 45.6% male) aged 23–67 years old who consistently run at least 1 mile each week. They were categorized based on their weekly mileage – Novice (1–5 miles per week), Moderate (6–15), Advanced (15+) – with the intention to have a diversity of running types and to assess the data at various levels of commitment to running. The average was 7.8 miles/week with the range at 1 to 28 miles per week. The subjects included Touro students and individuals in the community. A history was collected through an anonymous survey on the individual’s running habits, chronic/acute injuries, and any other relevant medical information. Data analyzing investigators were blinded to subjects’ identifying information. Additionally, an osteopathic assessment was performed by two student investigators for reliability purposes and conducted under supervision by a board-certified osteopathic physician. Results Analysis of the data suggested an existing correlation between the number of somatic dysfunctions and years of running. A slight correlation was found between somatic dysfunctions and miles per week, sports injuries, time per week, and lower extremity pain. Finally, statistical correlations were also identified between the presence of pes planus and limb length discrepancy with three distinct muscular hypertonicities. Conclusions Runners’ pains and injuries of the lower extremity are complex, and injury treatment and prevention is equally multifaceted. An association was found between both pes planus and limb length discrepancy with lower extremity muscle hypertonicity, suggesting the interrelated nature of these somatic dysfunctions. The survey concluded that many runners continue to run in pain and/or after significant injury but do not necessarily capitalize on existing support such as fitted shoes, custom arches, and osteopathic treatment that may help to minimize their risk of or treat injury. The intention of the research is to bring awareness to practitioners to the most common somatic dysfunctions such that they can recommend runners to obtain gait analyses and/or osteopathic treatments, which may not only alleviate injuries faster but also prevent future injury.

Abbreviation	J. Osteopath. Med.
Journal Impact	1.37
Quartiles(Global)	MEDICINE, GENERAL & INTERNAL(Q2)

ISSN	2702-3648
h-index	58

Publication Information	Publisher: Walter de Gruyter GmbH，Publishing cycle: ，Journal Type: journal，Open Access Journals: No
Basic data	Year of publication: 2021，Proportion of original research papers: 89.61%，Self Citation Rate:7.10%， Gold OA Rate: 97.89%

Journal of Osteopathic Medicine

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Integrating osteopathic manipulative treatment into prenatal care visits in a family medicine resident clinic

Stressbusters: a plot study investigating the effects of OMT on stress management in medical students

Urinary incontinence in elite female powerlifters aged 20–30: correlating musculoskeletal exam data with incontinence severity index and survey data

Addressing confounding factors in the match disparities between DO and MD seniors

Non-Herlitz junctional epidermolysis bullosa in a Native American newborn

Stressbusters: a plot study investigating the effects of OMT on stress management in medical students

Management of endometriosis: a call to multidisciplinary approach

Non-Herlitz junctional epidermolysis bullosa in a Native American newborn

An osteopathic assessment of lower extremity somatic dysfunctions in runners

Addressing confounding factors in the match disparities between DO and MD seniors