The AAO Journal, 2025/06, 35(2):28. doi: 10.53702/i2375-5717-35.2.13, type of study: ,obs,

Full text    (https://aaoj.kglmeridian.com/view/journals/aaoj/35/2/article-p13.xml)

Keywords:

lumbar spine [65]
observational study [246]
OMT [3925]
osteopathic manipulative treatment [3946]
short-lever technique [1]
side-bending [1]
thoracic spine [98]

Abstract:

Hypothesis: Translation of lumbar and thoracic vertebrae can be visualized on ultrasound during short-lever side-bending technique. Research Design: Osteopathic literature doesn’t include adequate evaluation of in vivo testing of spinal somatic dysfunction corroborated with modern imaging. Through collection of normative data, our objective was to determine if the thoracic and lumbar vertebrae moved into side-bending when applying the short-lever side-bending technique, and to determine the force required to induce side-bending. Methods: Physicians skilled in osteopathic manipulation identified four vertebral segments in a prone subject: one normal and one Type 2 somatic dysfunction in the lumbar and thoracic regions. Subjects were free of debilitating conditions of the spine. The short-lever side-bending technique was applied per Atlas of Osteopathic Techniques by Drs. Nicholas. As ultrasound is routinely used in spinal evaluation, a transducer was positioned longitudinally, monitoring changes in intertransverse space during translations in both phases. In the unblinded phase, physicians were allowed to observe the ultrasound screen. Physicians replicated applied forces on loadpad sensors after each translation, ranging from 14-117N for successful translations. Twelve physicians completed 16 attempts each, totaling 192 attempts across phases. Results: Only 13/192 translation attempts induced side-bending. Successes didn’t vary significantly with variable physician experience, translation direction, vertebral dysfunction, or vertebral level. There was no relationship between success rate and force application. Conclusions: Physicians were unable to consistently induce side-bending using the short-lever approach on ultrasound. The few successes were likely due to chance. The short-lever technique, as demonstrated in the Nicholas manual, is not effectively visualized on ultrasound in living subjects. Instruction using this technique should be reconsidered. Limitation: evaluation time permitted only one subject per physician.