Effects of Osteopathic Manipulation and Other Manual Manipulative Treatments on Cystic Fibrosis

Cystic fibrosis (CF) is a genetic disease that affects multiple organ systems, and symptoms include chronic cough, gastrointestinal (GI) malabsorption, exercise intolerance, and chronic pain. Examples of standard treatments are nebulizers, supplementary enzymes, chest percussive therapy, respiratory therapy, and lifestyle modifications. The purpose of the current review was to determine whether manual therapies, such as osteopathic manipulative treatment (OMT), in conjunction with standard treatments, provide symptom relief for patients with CF. PubMed was searched to identify studies investigating the role of manual medicine in the care of CF patients. Search terms included chiropractic, physical therapy, physiotherapy, osteopathic, manipulation, massage, and manual medicine. All terms were searched in combination with cystic fibrosis. Studies investigating only exercise or chest percussive therapy as adjunctive treatments were excluded. Eight studies were found that investigated manual therapies alone or in conjunction with exercise for treatment of CF symptoms. All studies reported improvement after manual therapy in 1 or more symptoms, such as posture, GI symptoms, peak airflow, anxiety, back or chest pain, or breathing. Study types included a case study, prospective observational studies, and randomized controlled trials. Most studies were small and statistically underpowered. In an inpatient/outpatient observational study of adults with CF, patients reported a significant reduction in pain after a single physiotherapy treatment, and inpatients also reported significantly improved breathing after treatment. In a randomized controlled trial involving adult CF outpatients, there was a significant improvement in chest and back pain scores between the OMT and control groups. Results of the current review suggested patients with CF can experience symptom relief after OMT and similar manual therapies. Patients subjectively reported improvement with manual therapies, and studies found statistically significant decreases in pain after a single treatment. However, larger studies with sufficient statistical power are needed to further define the role of manual therapies as adjunctive treatment for symptom relief in CF patients.