Osteopathy and Infectious Diseases

The novel coronavirus (COVID-19) is not the first pandemic that the global community has had to overcome. At the beginning of the last century, another new disease emerged that rapidly developed into a global pandemic – the Spanish flu (influenza). It is considered one of the most devastating global health crises, claiming approximately 50 million lives. In Europe alone, 2,300,646 people died, mostly between the ages of 20 and 40. The mortality rate (averaging approx. 2.5%) varied between areas with high population density, which are associated with larger communication and transport networks, and remote, rural, more isolated areas. Despite all efforts to prevent the spread of the Spanish flu, which included the closure of public spaces, social distancing, and the construction of new hospitals, the pandemic spread rapidly. To assist in containing the pandemic, the American School of Osteopathy, based in Kirksville, Missouri, recruited all its graduates (2,445 osteopaths) to treat influenza patients. In total, 110,122 people suffering from the Spanish flu were treated with osteopathic manipulative treatment (OMT). Additionally, health data was recorded and published in many different publications. Thus, after the pandemic, it was shown that patients treated by osteopathic physicians and osteopaths had lower morbidity and mortality rates compared to patients treated with the standard medical care of the time. Another publication also reported low rates of pneumonia in patients under regular care of osteopathic physicians during the time of the Spanish epidemic. However, these results should be treated with caution, as scientific standards at the time lacked standardization in research methods and criteria. Nonetheless, Hruby and Hoffman rightly pointed out that the application of OMT by osteopathic practitioners was likely related to the high success rates of osteopathy during the Spanish flu and that OMT certainly played an important role in recovery.  Now, more than a century later, the world is once again facing a major challenge – the fight against COVID-19. Today, we have new tools at our disposal, such as genomic sequencing, antivirals, testing, and vaccinations, yet we still rely on proven containment approaches (quarantine, strict hygiene standards, and social distancing). The aim of a recently published historical literature review was to investigate which OMT techniques were administered to affected patients during the 1918 Spanish flu pandemic, in order to provide today’s osteopaths with a range of techniques. The results are discussed below.

Osteopathic Principles and Approaches

Osteopathic treatment always focuses on the patient and not the disease. This principle applies today just as it did then. The main goal of osteopaths during the Spanish flu was to prevent the further spread of influenza in the body by attempting to maximize the patients’ health potential. OMT was administered to improve general physiological functions and included the release of muscular blockages and the correction of bony lesions. Furthermore, treatments were used to support the respiratory, circulatory, and lymphatic systems, as well as those influencing the autonomic nervous system, the endocrine, and the metabolic systems. Table 1 lists the techniques applied to the musculoskeletal system during the Spanish flu. The various approaches aimed to release the thoracic inlet (myofascial release), address the head (frontal and maxillary lifting) and the neck region (soft tissue techniques), and release tension in the thoracic area (pectoral traction and rib raising techniques, diaphragmatic doming, and muscle energy techniques).

Table 1: Osteopathic approaches for musculoskeletal regions

Table 2 shows the systemic approaches used to improve and maximize coordinated body functions (i.e., respiration, circulation, lymphatics, neurology, metabolism, and behavior). Furthermore, a range of lymphatic approaches were used (e.g., thoracic, hepatic, splenic, abdominal, and pedal lymphatic pumps, as well as mandibular drainage).

Table 2: Osteopathic systemic approaches

Recent research with high methodological and scientific standards has investigated the effectiveness of OMT as an adjunctive treatment for hospitalized patients with pneumonia and produced impressive results. A significant reduction in the length of hospital stay (in both adults and the elderly) as well as the duration of intravenous antibiotics was observed. Furthermore, respiratory failure or death occurred less frequently. Despite these initial findings, much research is still necessary before OMT can be recommended as a treatment approach during a flu epidemic! The techniques presented, which were used during the Spanish influenza pandemic, are not fully applicable to the current situation due to a lack of methodological standards. However, they represent a springboard for new, evidence-based studies and should be used for an effectiveness review of OMT in respiratory infections (Baroni et al. 2021).LiteratureBaroni F, Mancini D, Tuscano SC, et al. Osteopathic manipulative treatment and the Spanish flu: a historical literature review. J Osteopath Med. 2021;121(2):181-190