, 1994). Patients were randomly GSK-3 inhibition allocated to treatment and these assignments were conveyed to treatment providers via opaque sealed envelopes. Neither patients nor outcome assessors were informed of treatment group assignments. Study procedures were approved by the Institutional Review Board at the University of North Texas Health Science Center and the trial was registered with ClinicalTrials.gov (NCT00315120) prior to implementation. The 230 patients in the OSTEOPATHIC Trial who were assigned to

receive active OMT were the focus of this study because data on biomechanical dysfunction were systematically recorded throughout the trial only in these patients. This cohort consisted of 115 patients who received active OMT and active ultrasound therapy, and another 115 patients who received active OMT and sham ultrasound therapy. Active ultrasound therapy was not efficacious

when compared with sham ultrasound therapy in providing improvements in LBP or secondary outcomes (Licciardone et al., 2013c). During each treatment session patients were examined for five biomechanical dysfunctions that are often present with persistent LBP (Greenman, 1996 and Kuchera, 2007). Non-neutral lumbar dysfunction was diagnosed by finding either restricted extension or flexion upon assessing the lumbar transverse processes with the patient in the seated or prone positions. Pubic shear dysfunction was diagnosed by finding the superior aspect of the pubic tubercle

higher on TSA HDAC mouse one side than the other in the horizontal plane with the patient in the supine position. Innominate shear dysfunction was diagnosed by finding the inferior aspect of the ischial tuberosity Sclareol lower on one side than the other or a dramatically inferior and slightly posterior inferolateral sacral angle on the side of the deep sacral sulcus with the patient in the prone position. Restricted sacral nutation was diagnosed by finding inability of either sacral base to nod forward across a transverse axis between the innominates with the patient in the prone position. Psoas syndrome was diagnosed by finding a psoas muscle tender point upon palpation in conjunction with suspected imbalance of the psoas muscles as determined by restriction during a sweeping motion of the hip capsule. These examinations were performed by each patient’s designated provider to give equal attention to all patients and to help maintain blinding throughout the study; however, the findings were used primarily to guide OMT delivery. Consequently, the presence or absence of these biomechanical dysfunctions was systematically recorded only for those 230 patients assigned to receive OMT.