2026 Poster Presentations
P510: OSTEOPATHIC MANIPULATIVE TREATMENT (OMT) AFTER VESTIBULAR SCHWANNOMA RESECTION: METHODS AND FRAMEWORK FROM A RECENT RETROSPECTIVE STUDY
Alice I Chen, DO; Anna Mercer, DO; Tasha Loader, DO; Rick A Friedman, MD, PhD; Marc S Schwartz, MD; UC San Diego Health
Introduction: A recent retrospective study found that incorporating osteopathic manipulative treatment (OMT) into the acute postoperative care of patients after vestibular schwannoma resection was associated with a shorter hospital length of stay and lower daily opioid consumption over time.
Objective: To describe the methodology of OMT as applied in this cohort and provide a reproducible framework for future investigation.
Methods: OMT was delivered by physicians board-certified in Osteopathic Neuromusculoskeletal Medicine with focused residency training in the application of inpatient OMT. OMT is a physician-directed, hands-on treatment distinct from other forms of manual therapy. It involves gentle manual contact and positioning informed by anatomy, physiology, palpatory diagnosis, and clinical judgment. In the hospital setting, these approaches do not involve any thrusting, joint articulation, or force to mobilize tissue or bony structures. Rather, techniques were guided by a balanced tension model: joints or tissues in which tension is diagnosed are percisely positioned into its neutral, minmal tension zone and held with a controlled, low-magnitude force at a precise contact point, allowing the region's intrinsic micro-movements to gradually release the strain.
Treatment was individualized to each patient’s clinical course and generally organized into three components.
1. Autonomic regulation and surgical stress support: Treatment often began with gentle contact using minimal force, comparable to pressure used when palpating a pulse. The intent was to reduce muscular guarding and to support returning to physiologic homeostasis after the acute stress of surgery.
2. Whole-body musculoskeletal mobility: Intraoperative positioning and soft tissue dissection can contribute to postoperative musculoskeletal strain, including but not limited to neck, shoulder, and back discomfort. The second treatment component addressed tissue tension in body regions remote from the craniotomy, including the diaphragms, spine, ribcage, and associated myofascial structures, with the aim of reducing tissue strain, supporting respiratory–circulatory function, and facilitating early mobility.
3. Lymphatic and venous drainage support: The third component emphasized improving tissue motion in regions important for fluid return. Motion of the pelvic and respiratory diaphragms and ribcage contribute to the pressure gradients that support venous and lymphatic return, and treatment of these regions sought to restore that function. Lymphatic drainage was further supported by addressing restrictions at the thoracic inlet and cervical soft tissues, where lymphatic channels converge into the central venous system.
Safety and Individualization: Direct contact with incisions, craniotomy margins, drains, and graft sites was strictly avoided. If discomfort occurred, techniques were immediately modified or discontinued. No adverse events related to OMT were reported in the retrospective study.
Conclusion: This description elucidates a rationale behind the OMT applied in patients recovering from vestibular schwannoma resection. Delivered by physicians with advanced training in anatomy, palpatory diagnosis, and inpatient populations, this approach may serve as a safe, non-pharmacologic adjunct to postoperative management. Beyond hospital stay and opioid use, future studies can examine whether OMT can help address persistent pain, vestibular dysfunction, dizziness, balance issues, and headache syndromes, common sequela after this surgery that can potentially impact long-term quality of life.