Hello everyone and welcome to our second episode of the OMM Research Podcast!
Our panelists for this episode are Dr. Stephen Stacey and Dr. Alfred Amendolara.
In this episode, we are an article titled “Autonomic correlates of osteopathic manipulative treatment on facial functional mapping: an innovative approach based on thermal imaging” by Cerritelli et al. published in Scientific Reports. The article can be viewed at this link: https://www.nature.com/articles/s41598-025-92092-8
We are also looking at an article titled “COVID-19 mRNA vaccine immune response to the addition of osteopathic manipulative treatment with lymphatic pumps: a randomized controlled trial” by Martinez et al. published in Virus Research. The article can be viewed at this link: https://pubmed.ncbi.nlm.nih.gov/40669693/
Hope you enjoy and feel free to reach out to us at dotouchnet@atsu.edu!
[Music] Okay. Well, hello to you our listeners, the manipulated and the manipulators. Uh, welcome to the OM Research Podcast. The OMM research podcast is produced by DOTouchnet, a practice-based research network that focuses on osteopathic manipulative medicine research. Doouchet is based out of the AT still research institute, which is located at ATill University in Kirksville, Missouri. Please note that the views and opinions of the panelists in this podcast are personal to each panelist and do not reflect the views or opinions of at Still University. My name is Corey Lubring and I am the practicebased research coordinator uh for DO TouchNet and the host of the OMM research podcast. Uh before we get started, we also just want to remind our listeners that this podcast recording has video recorded with it and it can be viewed on the doouchet YouTube channel if you prefer to consume the episode in that medium. So, as always, we want to start off by uh introducing and welcoming our panelists for this episode. And we’re going to start off with Al. Hi, my name is Dr. Al Mandelara. I’m a first year resident at St. Luke’s uh University Health Network in Bethlehem, Pennsylvania. And I’m in neurology right now. And thank you for being with us today, Al. And then we would like to welcome uh Stephen. Hey, my name is Steve Stacy. I’m the director of osteopathic education for the Mayo Lacrosse Family Medicine Residency Program in Lacrosse, Wisconsin. And I am a an assistant professor of family medicine at Mayo Clinic. And thank you for being with us today, Stephen. And you welcome. And you both have brought some interesting articles that we’re going to be looking at today. And we’re going to be starting out with an article that Al has brought us on osteopathic manipulative treatment and facial functional mapping. So I’m going to pass it over to Al. Yeah. All right. So this uh paper is titled autonomic coralates of osteopathic manipulative treatment on facial functional mapping an innovative appro innovative approach based on thermal imaging. Um it’s by Saratelli at all. It was published in scientific reports in I believe March of 2025. Um so this paper is a uh crossover randomized control trial conducted on healthy adults uh where they compared OMT to a sham therapy in 37 individuals uh where they compared a baseline, a tactile treatment and a post treatment. um facial imaging. So they used thermal imaging cameras to attempt to measure autonomic parameters uh using something called seed correlation analysis. Um what their their main findings are is that the sham group exhibited an elevated warming effect on the cheeks, nose, and chin, but the OMT group had a in their words conspicuous cooling trend in the nose. So a little bit of a difference. Um the comparative analysis of their thermal maps and in addition to the seed correlation analysis that they did um in their words represents a significant advancement in our understanding of the physiologic mechanisms underlying OMT’s effect on the autonomic functions. So yeah, I think that’s a quick summary of it. So before we hop into discussion about the article uh bullet point for our listeners uh the the main high points you want to put out uh point out about this uh study. Sure. So for me uh a big positive about this study is that they are definitely attempting to dig into a little bit of the physiological mechanisms of OMT. That’s not something we see a lot and I think they have a good justification for doing that. Um I think their approach is is interesting. I usually or at least in my experience have seen this seed correlation analysis mostly used when interpreting uh brain imaging. So looking at neural networks uh within the brain. And so I I think it’s interesting that they’re they’re using this approach on thermal imaging of the face. um and other you know in other ways I think this was a generally thoughtfully designed study for the most part and then of course a couple quick bullet points for just caveats. Sorry to cut uh before we hop in Dr. Stacy. Yeah. So so some caveats to this. Uh I I don’t I’m not convinced that they convinced me that there’s a correlation between uh facial mapping, especially thermal facial mapping and the autonomic effects that they’re claiming to have. Their big conclusion is that uh this provides evidence of autonomic modulation from OMT techniques, but we don’t get a good sense of what OMT techniques are using. I don’t think we get a good justification for why those OMT techniques might impact the autonomic nervous system. And then truthfully, I I don’t see a good justification for why surface temperature necessarily directly correlates to autonomic nervous system activity as it relates to OMM’s stimulation of those kind of neural pathways. So um Al tell me a little bit here about uh kind of the rationale behind this. You know when I when I think of like thermal imaging and and body and stuff uh the the first thing that pops into my mind was a a scene from uh like ghost hunters where they were working with a psychic you know and everything and they were imposing their you know psychic medium onto a person to affect the body temperature and stuff. Uh so so it kind of feels just a little interesting to me that you know this thought that us doing you know hand manipulation on a people can’t actually affect you know the surface temperature that that is can be measured on a person. So give me a little more insight on that. So their justification is that there’s some evidence that that suggests that OMT can influence the autonomic nervous system in general. It can potentially uh influence release of pro-inflammatory cytoines and a general kind of have an anti-inflam inflammatory effect. Whether or not I I’m convinced by this I think is a bigger a bigger question than we have time for. But that at least is is their justification. I will say that um other research I’ve seen h has been generally directed towards heart rate variability. I I’ve read a number of papers on that. I I also think that maybe has a is a questionable metric to use for OMT. Sure. And its autonomic effects, but this this was a image that caught my eye, you know, that was shared in the article for one of their figures and I I thought this was really interesting. So, you were going to add something, Dr. Stacy. Please go ahead. Yeah, I think that there’s this age-old question of in a study, do you use protocolized OM or do you use physician directed OM based off of the somatic dysfunction findings that the clinician finds? And in a mechanistic study like this where you have certain techniques that are hypothesized to specifically modulate the autonomic nervous system. This seems honestly like an ideal time for protocolized OM because you’re really trying to to isolate a specific neurologic response to specific techniques versus then when you use sort of um you know physician directed OM you’re introducing a lot of variables into a system that famously reacts strangely to different variables. So, the autonomic nervous system is is an incredibly complicated process with a lot of inputs and a lot of outputs. And if you’re going to have a study where you’re going to try to convince me that the intervention is having some type of meaningful effect on that process, you’d really better convince me that the control that you’re doing or the sham is is really um inert. And I just haven’t seen that the sham that they came up with is going to 100% um isolate the effect only of the OMT and not things like how much the provider is having them move around the table, get up, get down, um how relaxed do they feel about having a gentle massage versus the the actual effect of the tissue manipulation itself. Yeah. And they can’t compliment them during it either. they might blush, you know, type of thing. So, exactly right. What’s the I think that’s actually a good point. Um, it is hard to know exactly how much this thermal imaging correlates to to autonomic activity. There’s some research out there that maybe suggests that it does, but you know, again, it’s it’s hard to say how convincing it is. And normally, I I don’t think that’s a problem. Uh, I like the fact that they’re using a relatively novel technique in an interesting way. Uh, but I I do wonder if they’re conclusions are a little bit overstated because there are some open questions with their both their methodology and their their approach to study design. Yeah, I do like that they are trying to advance our understanding of the physiological mechanisms underlying OMT’s effects on autonomic functions. That is something that we definitely need to see more of in the osteopathic literature as we build up foundational mechanistic um processes to determine what we ought to study and and how. Um, and I think that there are ways that you could restructure this study such that it provides more replicable and um, isol isolated data stuff that you can hang your hat on a little bit more versus this one was just a little bit noisy. Agree. So, what would you recommend? Oh, sorry. Go ahead. Overall, no. Overall, I I I enjoy this type of study because I I think it’s rare in osteopathic medicine, at least for me, in osteopathic research, to come across a study that I don’t necessarily entirely agree with, but I enjoy reading the science behind it. And and I think that someone sat down and designed this study and executed this study competently um with an eye towards advancing scientific knowledge, which I appreciate. And yeah, and I and I don’t want to I don’t want to overstate the uh the problems with the study. You know, certainly we need to see more research like this. Uh as with anything, there are ways that it could be done better. And you know, just mean this with uh with constructive feedback in mind, I suppose. And what what improvements or next steps or progress on this would you recommend? Uh Stephen, uh so one thing would be to um get a little bit more granular about which techniques you think would influence the autonomic nervous system and in what way and then try just doing those techniques because you’re looking at unconscious autonomic responses. So maybe you see if just sacral rocking has an unconscious autonomic response that could be measurable. and then you test a different technique and then a different technique and you you could you could look at a lot of different techniques and and see which ones maybe have the biggest response. You could also um do a better job at explaining the exact techniques that you are using and just really convincing the reader that you did absolutely everything in your power to make these two situations as 100% the same as you could. And it’s just hard to see that that was done. And Al, your recommendations? Yeah, I actually So, this seems like the perfect study for a positive control. My biggest problem with their conclusions and the methodology here is I I see this I I think their statistical analysis is reasonable. I you know I I think it’s reasonably powered for a sort of basic science paper despite the fact that they call this a clinical trial. Okay. I have some I disagree that this is really a clinical trial. But um I think they have a reasonable sample size for what they’re doing, but I I don’t know I don’t know what the positive like what is what is our hypothesized positive outcome for this. And so without a a positive control, we have kind of a negative control in the sham, but without a positive control, I have a hard time uh rationalizing what exactly is happening to me. I look at their results and I say, “Okay, so one spot on their face was a slightly different temperature.” But does that mean that we’ve influenced the autonomic system? I and I I can’t I can’t answer that based on the data here. Or is it how they were positioned on the table? And if we had found the opposite like maybe the nose had been warmer instead of cooler would we have also concluded yes it modulates the autonomic nervous system. So exactly exactly we have no yard stick by which to measure this body essentially. Yeah we need probably some more definitive pre hawk hypothesizing. Yeah. All right. Well wonderful article. Thanks for the summary and breaking that down for us. And uh as before we move on to the next article, we do again want to just remind people that you can view this on the doouchet. That’s doo-t. YouTube channel uh with the video included with this episode, if you would like to listen to us there. And don’t forget if you are enjoying this uh episode and our future and past episodes, uh please feel free to like and subscribe uh to the art to the podcast so you can continue to follow along as we break down research as it comes out in uh the field of OMM. And Stephen has brought us a another uh teaser here, brain teaser uh that has to do with OMT working with the COVID mRNA vaccine response. Yes, the title is CO 19 mRNA vaccine immune response to the addition of osteopathic manipulation treatment with lymphatic pumps. a randomized controlled trial by Eric Martinez at all published in the journal virus research in September 2025. The research question they were trying to answer is in patients being immunized for CO 19 does addition of OMT at each vaccination result in increased anti-SARS Kovv2 spike protein antibbody titers compared with usual care and the findings to report are the OMT group showed significantly increased anti-SARS KV2 spike protein antibbody titers at 3 weeks versus controls. All right. So what what are the the main high points bullet points that you want to you know highlight for this? Um so I think as OM studies go again this one is reasonably well done. Uh definitely some things that we can nitpick about how it could have been done better and that’s going to be true for nearly any study. So that’s not unique to this trial. But I do commend the authors for um for being ambitious in the question that they asked. Um, one one aspect about the question that they ask, you know, they set up decently well some of the um, primary studies that were done to justify that this is the question that they decided to ask. You know, sometimes I think of, pardon the analogy, but I sometimes think of OM as kind of like hot sauce, right? where some people there are just some people out there that try to put it on everything and other people are like wait a minute why is hot sauce going on this right and so there are some things I’m I’m a hot sauce on everything guy for sure u but you know even if you’re not a hot sauce on everything guy if you’re going to be like how much hot sauce is the right amount for te for you know tacos like people can get on board with like okay you’re putting hot sauce on tacos I get it then there are some studies where it’s like we’re going to see how much hot sauce is right for ice cream and you’re like uh you know like I mean okay I can see like the sweet and spicy but you got to convince me that this is going to be the right thing to do versus some other studies are like let’s test how much hot sauce is right for baby formula and you’re like that just seems irresponsible. So this one, this one’s more of like I would say an ice cream, right? Where it’s like, you got to sort of convince me that there’s some reason why I should even expect that an external force applied to the body is going to modulate the immune response to an mRNA vaccine. And so they set up some uh some prior research and they said basically there’s been uh you know a general osteopathic hypothesis which okay nice and vague but then they show that it’s supported by preclinical animal studies and small human pilot trials. Um they don’t really have any basic science rationale which is a bit of a weakness but I just don’t know that any of that has even been done. So that’s skipping some steps on on the pathway of science. But um but they they are I would say appropriately tepid about what they say the prior studies have done where they’re basically saying um you know these these were small studies they we can’t really conclude much by them. Therefore we’re doing a bigger better study. It’s like okay I’ll buy that. So before my mind starts going down which scientific pathway brings me the hot sauce on ice cream, what what are the main caveats that you want to point out uh you know for this study? Yeah. So they had um so I guess let’s first understand exactly what was going on here. So they had um 104 adults which met their which exceeded their um power calculation for how many people that they thought that they would need to randomize to find a difference. Um 91 completed the vaccination series and they each person was tested with uh with COVID titers um before and then serially throughout the the study as they got the first um Fiser COVID 19 vaccine plus the um plus the second in the series and then a booster later on. Some got the booster, some didn’t. Um, so they’ve got a nice subject flow diagram so you can see like who who made it, who didn’t. Um, they had, I think, some pretty appropriate exclusion criteria. You know, people who were immune compromised, people who couldn’t get OM for some reason. Um, pregnant and breastfeeding, I don’t know, had to be an exclusion, but a lot of IRBs get sort of jumpy about that, so I don’t blame them for for excluding that. Um, so, uh, overall, I think that worked out pretty well. um you know if you’re going to fall so there are a couple of things where I think it could have been a stronger more compelling argument that the OMT was the thing making the difference. So their control is basically nothing and it would have been nice to see some type of control that patients thought of as an active control just to exclude the power of somebody knowing that they are in a trial where something is being done and I don’t know why that should necessarily affect immune titers but then again I also don’t know why exactly um a lymphatic pump might affect immune titers either what is an immune tighter that’s not a a phrase that I’ve heard before it basically just looks at how much of the antibbody is present in the blood Okay. I think that would just, you know, I don’t know why they couldn’t just say that they had to use fancy word like tighter, but you know. Yeah. Well, see, that’s why medical school is so expensive is because you learn about 20 new $10 words every day and you got to pay for all of them. Yeah. I didn’t go to medical school just to call it the belly button. Now I have to call it the umbilycus. Oh, that’s a fancy word. I still call it the belly button sometimes. So, um, so kind of, you know, break break down, um, you know, the what were they doing that like when you said there was a a blank control just just a flat control? Were these people getting immunized at all or were they just like, yeah, you know, so the the intervention was the OMT itself. Everybody was getting immunized. So, it was really to see how did OMT modulate the response to immunization. And so everybody got everybody who was in the active treatment group got OMT at the index visit for the immunization plus another visit 24 hours later. Um and they they did have a protocolized OMM where they spent exactly 5 minutes with exactly one minute per treatment on each of five regions that were um meant to target the um the uh lymphatic system. Al, what jumped out to you about this study? Yeah, so I think there were a few things they have. I I think they start out with good intentions. Um, and it’s generally well welldesigned on the the front end, but their their solid sample size is is very rapidly eroded. Um, right off the bat, they limit their primary analysis to to COVID naive patients, uh, which I think is reasonable given what they’re looking for, but it’s a bit of a bait and switch. We end up with, uh, less than half of our actual sort of uh, stated power. Um, I think our COVID naive individuals uh, you end up with an N of 51. uh the full ho uh full cohort ended up with an N of 92. And it just, you know, to me it confuses the analysis a bit and they seem to uh to jump back and forth in in between who they’re comparing when. Uh and and really I I think the differences are a bit too sporadic for me to to take these to heart. So for instance, the IGG titers um changes from baseline are are significantly different at 3 weeks when everybody is compared. Um the area under the curve for the uh anti-SARS kov to spike protein IGG titers are significantly different at the 13th week. Um, and then the it just when then when they look at the naive group, it’s different again at the third week, but less significantly different. Um, yeah, there’s just a bit of variability in how they did their analysis, which I I don’t love. And there’s, you know, there are definitely a lot of variables that they are counting here and and reporting which ones, you know, expresses significant versus insignificant. Um, you know, so my main conclusion from this, I don’t this one, let’s just say it doesn’t change my practice, right? I’m not necessarily going to start doing OMT on all of my vaccinated patients based off of the results of this trial. But I think if I were somebody that was reviewing somebody’s grant proposal to do a bigger better study with more solid methodology uh and more patience um you know if they used this as as the background and said you know here’s what we learned from this and we want to like I could I could see this as being very positive in terms of uh moving forward with the research direction. I’d really want to see these findings replicated by other researchers at other locations. Um, and you know, and I don’t think we’re holding OM to a higher standard than other types of treatments by insisting that that that’s what needs to be done before we broadly recommend practice change. Um, so I I think this is worth doing more studies on to find out. And then we, you know, we look at the ones with the with the lowest risk of bias, pull those together, see what we come up with. You know, there there may be some there there or maybe we find out that this study was the fluke and it actually doesn’t do anything. Again, I I’m not really um I’m not really down on the promise of OM to be helpful if this indication doesn’t really pan out at the end of things cuz I’m not usually putting hot sauce on ice cream anyway. Right. Well, I I think one of the the weaknesses of their conclusion I this is interesting from a mechanistic standpoint uh if this has some uh immune modulatory effects, but really their their main findings are strongest in uh COVID naive individuals. Um which begs the question, what population would this actually be effective in? because generally we’re not getting IGG titers on every patient walking in the door interested in in an O in a COVID vaccine or or really most other vaccines. Um so I think there is a question of if if this is only effective in a fairly narrow population. Yeah. And they did they did study the clinical outcomes as well. Um right honestly in that I see the the numbers as being too small to make I agree clinical conclusions. Um, again, hypothesis generating. Would love to see this uh done again by other researchers. See how well it replicates if at all. And then, you know, maybe we find out that this is a really cool thing that we ought to be doing. Or maybe we find out that this study over, you know, this study was just sort of a fluke and and it found too much of a difference. I don’t know. But that’s the cool thing about science is we can figure that out. And so Stephen, uh to kind of piggy back off what you said before with like you know if it if someone came to you with this was like their grant you know final study type of thing like what do you see as like being the next steps like something on that bigger scale that kind of you know redresses this? Yeah. So I’d want to see this as a multic-enter study. I would love to see a uh a more robust control. I would love to see whether patients knew they were in the control group or the treatment group. Um and then really looking at clinical outcomes would be the most defining thing here would you know so people don’t walk around saying hey have you checked out my immune titers they care whether or not they get sick and so that’s so immune titers are an example of a diseaseoriented outcome or a dough versus how long I’m spending sick is an example of patient oriented evidence that matters or a poem And so I’d like to see more poem oriented um end points. And they do have that a little bit here. It it doesn’t quite get to the level of of really being clinically convincing, but you know, to be fair, that’s not necessarily what the authors were going for either. So I I view this as a trial that I’m glad they did it. Um I’d like to see more, but if no more is done, I don’t know that this necessarily needs to change clinical practice. and Al so I’m going to dissent on that a little bit. I I think that OMT needs more uh more thought towards objective measures. Uh there I I agree that the clinical outcomes are are an important component and I would like to see to more of that but the results that they display here for their clinical outcomes are in my opinion uh useless. the the n is simply too small and I have to I I have no other data to compare it to. So, it makes it really hard for me to interpret that. And I personally I it’s refreshing to see a trial that is actually focusing on an objective outcome measure. And I I would like to see them stick with that because really before in my opinion before we get to the patient oriented outcomes with OMT, we need to have a foundation of in physiology and pathology and objective measures. And while IGG may not be all that clinically relevant for the patient, I think it does let us start from a foundation of saying we know this is doing something physiologically in the body. Um yeah so I don’t think it needs to be I don’t think it needs to be either or you know it can for sure be a yes and we can we can gather the objective data and have more people involved in the trial such that subjective data rises above the level of you know n equals 10 in two groups right well thank you both for uh joining us as our panelists this week with these articles uh for those of you listening please make sure that you follow us on your favorite podcast platform If you want to hear more of us breaking down research, uh sitting in our chairs and talking like we know everything, uh which we don’t. Uh but nonetheless, uh you know, just kind of breaking down what’s happening in research right now and just, you know, raising some questions and and talking about what we’d like to see next. And if you want to get involved in the conversation with us, uh feel free to hop in the comments section of YouTube for this video, pose any comments or questions that you have there and we’ll uh be seeing about if we can address those, you know, either offline or online in a future episode. Uh if you want to catch more about what we’re doing here in DOTNet, you can always go to our website which is doo-.net which is doodouch.net and find out more of what we’re doing here uh within our practicebased research network. Al Steven, thank you both for being with us again this week and uh we will see you all next time. Ciao. Yeah. Adios. [Music]
