To the Editor:

    The conclusion reached by Balon et al. is based on the finding that there was no significant  difference between low-velocity, high-amplitude chiropractic manipulation and a "simulated" chiropractic treatment involving low-velocity, low-amplitude manipulation. Regarding the rationale for this simulated treatment, the  authors state, "We are unaware of published evidence that suggests that positioning, palpation, gentle soft-tissue therapy, or impulses to the musculature adjacent to the spine influence the course of asthma." Although this may be true of the chiropractic literature, the manipulations used for the simulated treatment are those typical of osteopathic manipulative therapy, and there is substantial research on the effect of these types of manipulations on physiologic functioning, including respiration. Examples include the report by Howell et al. (1) on osteopathic systemic therapy for chronic obstructive lung disease and the report by Purdy et al. (2) on the systemic effects of manipulation of the neck. Kuchera and Kuchera (3) and Stanton and Mein (4) provide detailed discussions of techniques and mechanisms.

    Balon et al. found that both forms of treatment resulted in improvement in symptoms, decreased use of medication, and improvement in the quality of life. Although the relevant statistical data are not provided, an examination of the reported data suggests that these improvements were likely to have been significantly different from the base-line findings in both groups.

    Thus, the most that can be concluded from the study is that chiropractic spinal treatment is not  significantly better than a rather crude form of osteopathic soft-tissue treatment. Concluding, as the authors do, that the improvement in both groups was simply due to a placebo effect is not justified, since the physiologic effects of manipulations similar to the simulated treatment are well documented.

Douglas G. Richards, Ph.D.
Eric A. Mein, M.D.
Carl D. Nelson, D.C.

Meridian Institute
Virginia Beach, VA 23454

References

1. Howell RK, Allen TW, Kappler RE. The influence of osteopathic manipulative therapy in the management of patients with chronic obstructive lung disease. J Am Osteopath Assoc 1975;74:757-60.

2. Purdy WR, Frank JJ, Oliver B. Suboccipital dermatomyotomic stimulation and digital blood flow. J Am Osteopath Assoc 1996;96:285-9.

3. Kuchera M, Kuchera WA. Osteopathic considerations in systemic dysfunction. Kirksville, Mo.: KCOM Press, 1991.

4. Stanton DF, Mein EA, eds. Manual medicine. Phys Med Rehabil Clin North Am 1996;7.