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RecruitingNCT07193212Updated May 14, 2026

How Osteopathic Treatment Affects the Leg and Foot in People With Low Back Pain

An interventional study of Osteopathic Manipulative Treatment in Chronic Low Back Pain (CLBP), sponsored by Edward Via Virginia College of Osteopathic Medicine. Recruiting at 1 site in United States. Open to participants aged 18 Years to 65 Years. Per ClinicalTrials.gov, last updated 2026-05-14.

Sponsored by Edward Via Virginia College of Osteopathic Medicine · Not applicable, Interventional, and Treatment

From the registry’s dates

  • Started Nov 2025; still recruiting 1 year later.
Phase
Not applicable
Study type
Interventional
Enrollment
20
Allocation
Not applicable
Ages
18 Years to 65 Years
Sex
All
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Study summary

This pilot study will examine whether osteopathic manipulative treatment (OMT) can improve both physical and psychological aspects of chronic low back pain by focusing on the interconnected myofascial system of the back, legs, and feet. Twenty adults with chronic low back pain will receive four OMT sessions over 5-7 weeks. Before and after treatment, the investigators will measure muscle stiffness with ultrasound, plantar pressure during walking with a pressure plate, and patient-reported outcomes on pain, disability, sleep quality, stress, anxiety, depression, pain catastrophizing, and pain self-efficacy using surveys. By linking these objective and subjective measures, the study aims to provide early evidence of how OMT may influence musculoskeletal function, daily activity, and overall well-being, helping to guide future larger studies on treatment strategies for low back pain

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Conditions studied

  • Chronic Low Back Pain (CLBP)

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Keywords

  • chronic low back pain
  • myofascial systems
  • omt
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In context

Low Back Pain

2,922 studies on the registry are indexed under Low Back Pain; 580 are open to participants now.

This study's planned enrollment of 20 is below the median of 60 across 2,364 interventional studies indexed under Low Back Pain.

Browse Low Back Pain studies →

Lead sponsor

Edward Via Virginia College of Osteopathic Medicine is the lead sponsor of 24 studies on the registry; 5 are open to participants now.

Counted across the registry records on this site, refreshed daily.

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Who can participate

Ages eligible
18 Years to 65 Years
Sexes eligible
All
Accepts healthy volunteers
No

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

  • male and female subjects 18-65 years old
  • presence of chronic low back > 3 months duration or pain present > 50% of the time within the previous 12 months

Exclusion criteria

Exclusion Criteria:

  • prior surgery of the thoracic, lumbar or sacral spine, pelvis
  • diagnosis lumbar radiculopathy or pinched nerve in the neck
  • diagnosis of foot condition that alters gait
  • diagnosis of connective tissue or muscle disorders
  • diagnosis of cancer
  • previous spinal cord injury inflammatory arthritis and fibromyalgia
  • pregnancy
  • tobacco use
  • known diabetes or prediabetes
  • allergy to ultrasound gel (propylene glycol)
  • history of manual therapy treatment within the past 2 weeks
  • injection for pain within the past 1 month
  • currently taking muscle relaxers
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Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrollment
20 participants (estimated)

Study arms

  • Experimental
    OMT Treatment Group

    Other: Osteopathic Manipulative Treatment

Interventions

  • OtherOsteopathic Manipulative Treatment

    Osteopathic Manipulative Treatment (OMT) is a hands-on approach where a trained physician uses techniques such as gentle pressure, stretching, and guided movements to improve mobility, reduce pain, and support the body's natural healing. It focuses on the interconnectedness of muscles, joints, and fascia to restore balance and function.

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What researchers measure

Primary outcomes

  1. Stiffness of Low Back and Lower Extremity Muscles Assessed by Ultrasound Shear Wave Elastography

    Stiffness in the muscles of the low back and lower extremity will be quantitatively assessed using ultrasound shear wave elastography (SWE). SWE provides a non-invasive, reliable measure of tissue stiffness by calculating the shear wave speed (in meters/second) and corresponding elasticity modulus (in kilopascals). Regions of interest will be placed within target muscles and tissues (e.g., lumbar multifidus, thoracolumbar aponeurosis, hamstrings, gastrocnemius) and standardized acquisition protocols will be used to ensure reproducibility. This method allows for objective measurement of muscle stiffness rather than relying on subjective evaluation, thereby enhancing the validity of the outcome measure.

    Time frame: From baseline measures on Day 1 until the last OMT treatment, up to 6 weeks.

  2. Body sway normalized path length, area, and velocity.

    A triaxial accelerometer will be used to measure postural control. The sensor will be secured over the lower trunk and measurements will occur under six conditions: feet together eyes open, feet together eyes closed, single-leg stance on the right and left with eyes opened and eyes closed. An average of 3 trials per condition will be used for each stance with 1 minute rest between trials. Double leg stance trials will be performed for 30 seconds while single leg stance trials will be performed for 15 seconds. Normalized path length (NPL) of acceleration in the anteroposterior (AP) and mediolateral (ML) directions, and sway excursion area, and velocity will be determined.

    Time frame: From baseline measures on Day 1 until the last OMT treatment, up to 6 weeks.

Secondary outcomes

  1. Low back pain intensity and frequency.

    Low back and lower extremity pain intensity, and frequency measured by an NRS (intensity) and Likert scale (frequency).

    Time frame: From baseline measures on Day 1 until one week after the last OMT treatment, up to 7 weeks.

  2. Functional disability.

    The Roland-Morris Disability Questionnaire will be used to score functional disability.

    Time frame: From baseline measures on Day 1 until one week after the last OMT treatment, up to 7 weeks.

  3. Plantar Pressure Changes Assessed by EMED Pedobarographic Platform

    Plantar pressure distribution will be assessed using a validated EMED pedobarographic platform (Novel), which records dynamic foot pressures during gait. Outcome parameters will include peak pressure (kPa), pressure-time integrals, and center of pressure trajectory. Participants will walk barefoot at a self-selected pace across the platform, and standardized protocols will be used to ensure reproducibility. An average of 5 measures from each foot will be obtained.

    Time frame: From baseline measures on Day 1 until the last OMT treatment, up to 6 weeks.

  4. Pain self-efficacy score

    The pain self-efficacy questionnaire will be used to assess participants confidence in their ability to perform various activities and achieve goals despite experiencing pain, and its relationship to clinical response to treatment.

    Time frame: From baseline measures on Day 1 until one week after the last OMT treatment, up to 7 weeks.

Other outcomes

  1. Depression Assessed by Depression Anxiety Stress Scale-21 (DASS-21)

    Depression will be assessed using the Depression Anxiety Stress Scale-21 (DASS-21), a validated 21-item self-report questionnaire. The Depression subscale consists of 7 items, each scored on a 4-point Likert scale (0 = did not apply to me at all; 3 = applied to me very much, or most of the time). Scores are summed and multiplied by two to yield a final subscale score ranging from 0 to 42, with higher scores reflecting greater depressive symptoms.

    Time frame: From baseline measures on Day 1 until one week after the last OMT treatment, up to 7 weeks.

  2. Anxiety Assessed by Depression Anxiety Stress Scale-21 (DASS-21)

    Anxiety will be assessed using the DASS-21 questionnaire. The Anxiety subscale includes 7 items scored on a 4-point Likert scale (0-3). Subscale scores are summed and multiplied by two, yielding a final score from 0 to 42, with higher scores reflecting greater anxiety symptoms.

    Time frame: From baseline measures on Day 1 until one week after the last OMT treatment, up to 7 weeks.

  3. Stress Assessed by Depression Anxiety Stress Scale-21 (DASS-21)

    Stress will be assessed using the DASS-21 questionnaire. The Stress subscale consists of 7 items scored on a 4-point Likert scale (0-3). Subscale scores are summed and multiplied by two, yielding a final score from 0 to 42, with higher scores reflecting greater stress symptoms.

    Time frame: From baseline measures on Day 1 until one week after the last OMT treatment, up to 7 weeks.

  4. Impact of sleep quality on daily function

    The PROMIS Sleep-Related Impairment Short Form (8-item) will be used to assess changes in self-reported perceptions of daytime sleepiness, tiredness, and functional impairments related to poor sleep.

    Time frame: From baseline measures on Day 1 until one week after the last OMT treatment, up to 7 weeks.

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Study locations

1 of 1 sites recruiting
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References and documents

Publications

  • Berenshteyn Y, Gibson K, Hackett GC, Trem AB, Wilhelm M. Is standing balance altered in individuals with chronic low back pain? A systematic review. Disabil Rehabil. 2019 Jun;41(13):1514-1523. doi: 10.1080/09638288.2018.1433240. Epub 2018 Jan 30. PubMed 29382241 ↗
  • Wang H, Zheng J, Fan Z, Luo Z, Wu Y, Cheng X, Yang J, Zhang S, Yu Q, Lo WLA, Wang C. Impaired static postural control correlates to the contraction ability of trunk muscle in young adults with chronic non-specific low back pain: A cross-sectional study. Gait Posture. 2022 Feb;92:44-50. doi: 10.1016/j.gaitpost.2021.11.021. Epub 2021 Nov 19. PubMed 34823100 ↗
  • Park J, Nguyen VQ, Ho RLM, Coombes SA. The effect of chronic low back pain on postural control during quiet standing: A meta-analysis. Sci Rep. 2023 May 16;13(1):7928. doi: 10.1038/s41598-023-34692-w. PubMed 37193730 ↗
  • Ruhe A, Fejer R, Walker B. Is there a relationship between pain intensity and postural sway in patients with non-specific low back pain? BMC Musculoskelet Disord. 2011 Jul 15;12:162. doi: 10.1186/1471-2474-12-162. PubMed 21762484 ↗
  • Ryum T, Stiles TC. Changes in pain catastrophizing, fear-avoidance beliefs, and pain self-efficacy mediate changes in pain intensity on disability in the treatment of chronic low back pain. Pain Rep. 2023 Sep 13;8(5):e1092. doi: 10.1097/PR9.0000000000001092. eCollection 2023 Sep. PubMed 37719924 ↗
  • Ogunlana MO, Odole AC, Adejumo A, Odunaiya N. Catastrophising, pain, and disability in patients with nonspecific low back pain. Hong Kong Physiother J. 2015 Dec;33(2):73-79. doi: 10.1016/j.hkpj.2015.03.001. Epub 2015 Apr 16. PubMed 30930571 ↗
  • Xu C, Fu Z, Wang J, Wu B, Wang XQ. Differences and Correlations of Anxiety, Sleep Quality, and Pressure-Pain Threshold between Patients with Chronic Low Back Pain and Asymptomatic People. Pain Res Manag. 2022 May 17;2022:8648584. doi: 10.1155/2022/8648584. eCollection 2022. PubMed 35619991 ↗
  • Nguyen C, Boutron I, Zegarra-Parodi R, Baron G, Alami S, Sanchez K, Daste C, Boisson M, Fabre L, Krief P, Krief G, Lefevre-Colau MM, Rannou F. Effect of Osteopathic Manipulative Treatment vs Sham Treatment on Activity Limitations in Patients With Nonspecific Subacute and Chronic Low Back Pain: A Randomized Clinical Trial. JAMA Intern Med. 2021 May 1;181(5):620-630. doi: 10.1001/jamainternmed.2021.0005. PubMed 33720272 ↗
  • Murillo C, Falla D, Rushton A, Sanderson A, Heneghan NR. Shear wave elastography investigation of multifidus stiffness in individuals with low back pain. J Electromyogr Kinesiol. 2019 Aug;47:19-24. doi: 10.1016/j.jelekin.2019.05.004. Epub 2019 May 3. PubMed 31077992 ↗
  • Menz HB, Dufour AB, Riskowski JL, Hillstrom HJ, Hannan MT. Foot posture, foot function and low back pain: the Framingham Foot Study. Rheumatology (Oxford). 2013 Dec;52(12):2275-82. doi: 10.1093/rheumatology/ket298. Epub 2013 Sep 17. PubMed 24049103 ↗
  • McClinton S, Weber CF, Heiderscheit B. Low back pain and disability in individuals with plantar heel pain. Foot (Edinb). 2018 Mar;34:18-22. doi: 10.1016/j.foot.2017.09.003. Epub 2017 Sep 28. PubMed 29202429 ↗
  • Loffler M, Schneider P, Schuh-Hofer S, Kamping S, Usai K, Treede RD, Nees F, Flor H. Stress-induced hyperalgesia instead of analgesia in patients with chronic musculoskeletal pain. Neurobiol Pain. 2022 Dec 6;13:100110. doi: 10.1016/j.ynpai.2022.100110. eCollection 2023 Jan-Jul. PubMed 36561877 ↗
  • Licciardone JC, Gatchel RJ, Aryal S. Recovery From Chronic Low Back Pain After Osteopathic Manipulative Treatment: A Randomized Controlled Trial. J Am Osteopath Assoc. 2016 Mar;116(3):144-55. doi: 10.7556/jaoa.2016.031. PubMed 26927908 ↗
  • Anukoolkarn K, Vongsirinavarat M, Bovonsunthonchai S, Vachalathiti R. Plantar Pressure Distribution Pattern during Mid-Stance Phase of the Gait in Patients with Chronic Non-Specific Low Back Pain. J Med Assoc Thai. 2015 Sep;98(9):896-901. PubMed 26591401 ↗
  • Alsaadi SM, McAuley JH, Hush JM, Maher CG. Prevalence of sleep disturbance in patients with low back pain. Eur Spine J. 2011 May;20(5):737-43. doi: 10.1007/s00586-010-1661-x. Epub 2010 Dec 29. PubMed 21190045 ↗

Individual participant data

Plan to share: No

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Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on May 14, 2026, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
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Registry details

Key details

Study ID
NCT07193212
Lead sponsor
Edward Via Virginia College of Osteopathic Medicine
Responsible party
Sponsor
First posted
Sep 25, 2025
Start date
Nov 5, 2025
Primary completion
Sep 2026 (estimated)
Completion
Dec 2026 (estimated)
Last update
May 14, 2026

Study contacts

Daniel Cawley, DC, MS, MSHS
Contact
dcawley@vcom.edu
334-442-4105
Daniel Cawley, DC, MS, MSHS
principal investigator · VCOM

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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