Effect of osteopathic visceral manipulation for individuals with functional constipation and chronic nonspecific low back pain: randomized controlled trial

Functional constipation is the infrequent or uncomfortable passage of hard stool often resulting from repeated voluntary attempts to hold stool due to non-defecation. Thus, it is a functional gastrointestinal disorder without structural and/or organic lesions or even physiological changes. In addition to compromising the quality of life, functional constipation also seems to favor the presence of pain. Specifically for low back pain, a longitudinal cohort study has shown that women with pre-existing gastrointestinal symptoms have an increased risk of developing low back pain. Therefore, a therapeutic alternative that may address the need to understand these two clinical conditions, functional constipation and low back pain, is osteopathic visceral manipulation (OVM). The aim of the present study was to investigate the effect of OVM on pain intensity and disability in individuals with functional constipation and chronic nonspecific low back pain. The hypothesis tested is that OVM produces a significant decrease in pain intensity and improves lumbar function in individuals with functional constipation and chronic nonspecific low back pain. This study is a randomized controlled trial with a blinded assessor. Seventy-six volunteers with functional constipation and chronic nonspecific low back pain were randomized to two groups: OVM and sham OVM. The primary clinical outcome was pain intensity measured using a numeric rating scale (NRS) and disability measured using the Oswestry Disability Index (ODI). The secondary outcomes were electromyographic signals measured during the flexion-extension cycle, the finger-to-floor distance during complete flexion of the trunk and the Fear-Avoidance Beliefs Questionnaire (FABQ). All outcomes were determined after six weeks of treatment as well as three months after randomization. The OVM group reported a reduction in pain intensity after six weeks of treatment and at the three-month evaluation (p <.0002) and the sham group reported a reduction in pain intensity after three-month evaluation (p <.007). For the ODI was also found in the OVM group six weeks after the end of treatment (treatment effect = −6.59, 95% CI: −12.01 to −1.17, p =.01) and at the three-month evaluation (treatment effect = −6.02, 95% CI: −11.55 to −0.49, p =.03). Significant differences were also found for paravertebral muscle activity during the dynamic phases (flexion and extension) six-week evaluations. Treatment led to reductions in pain and improvements in function at the post-intervention and follow-up evaluations as well as a change in thoracolumbar paravertebral muscle activity during flexion and extension of the trunk after six weeks of treatment. Studies should be conducted that add OVM to physical exercise treatment for patients with chronic nonspecific low back pain and functional constipation, since physical exercise is recommended by guidelines for the treatment of chronic nonspecific low back pain and to assist in improving functional constipation.