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TO THE ERROR: In the article entitled, "Diagnosis and Management of Acute Low Back Pain,"1 the authors did not mention the role of osteopathic medicine in a multidisciplinary approach to managing this health care enigma. Therapeutic manipulation is only one component of the osteopathic medical philosophy; thus, it should be considered unique from the chiropractic manipulation that was included in the review.
In addition to conventional diagnostic methods, the osteopathic physician uses palpatory skills to diagnose barriers to joint range of motion and asymmetry within the musculoskeletal system. Fundamental to osteopathy is the recognition of the body's inherent ability to restore homeostasis. In addition to manipulation, the osteopathic physician will use various soft tissue techniques to relax contracted muscles.
In a recently published randomized, controlled trial,2 osteopathic medical care, which included conventional medicine (i.e., analgesics, nonsteroidal anti-inflammatory drugs, muscle relaxants and physical therapy) plus manipulative medicine, was compared with conventional medical approaches in the treatment of subacute low back pain (i.e., pain lasting longer than three weeks and less than six months). Patients in the osteopathic care group required less medication and physical therapy than those in the standard care group. These results correlated with a significant cost difference between treatment groups.
The guidelines' from the Agency for Health Care Policy and Research (now known as the Agency for Healthcare Quality...