Unexpected Resolution of Chronic Hyposmia Following Osteopathic Manipulative Treatment Applied with Area of Greatest Restriction and Sequencing: A Case Report

Abstract Hyposmia, decreased olfactory sensation, is a disease process that may have a variety of etiologies. Osteopathic Manipulative Treatment (OMT) can address structural and functional components of the underlying cause of hyposmia. An Osteopathic Structural Exam (OSE) is utilized to help identify important somatic dysfunctions, through various types of screening mechanisms. One such screen, the Area of Greatest Restriction (AGR) screen, acknowledges the role of tensegrity in musculoskeletal function by seeking to address the key somatic dysfunctions contributing to the patient's allostatic load and, therefore, their chief complaint, while ignoring compensatory somatic dysfunctions. The following case demonstrates a positive outcome of chronic hyposmia resolution while implementing the AGR screen during OMT for a chief complaint of chronic hip pain. The patient was a 20-year-old female complaining of moderate chronic hip pain. Immediately following her third OMT appointment the patient noticed relief of previously undisclosed hyposmia. We propose that utilizing the AGR screen to guide OMT management contributed to the unintended positive outcome of hyposmia resolution by decreasing the somatic tension, altering biotensegrity, and lowering the total somatic allostatic load, thus impacting lymphatic drainage and tension on the cranial dura, sphenopalatine ganglia and vidian nerves. This demonstrates that even if OMT is utilized for a specific complaint, when the whole body is screened and somatic dysfunctions are prioritized such that allostatic load decreases, other unintentional benefits can result.