**5.6 Manual physical therapy**

Manual physical therapy with an osteopathic approach (MPT-OA) entails palpation and receptive manipulation of body tissues to relieve restraints that limit mobility and health. Biomechanical, myofascial, and articular constraints can contribute to DV by altering alignment, distorting the pelvis, restricting mobility, and thus affecting pressures within the abdominal and pelvic cavities [73]. Altered pressure relationships can affect neurological, vascular, lymphatic, and hormonal functions. In the randomized controlled trial that involved 21 children with DV, it has been shown that children with additional 4 sessions of MPT-OA demonstrated better short-term results compared to children that had only standard treatment [73]. The authors speculated that MPT-OA treatment helped restoring more natural alignment and mobility which helped the abdominal and PFMs to function more efficiently. However this single-centre promising results should be confirmed by multi-centre randomized controlled trials in order to draw definitive conclusions of MPT-OA in children with DV.
