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So many songs we forgot to play


Recent research reported at Science Daily:

Narrow focus on physical activity could be ruining kids’ playtime

While public health authorities focus on the physical activity benefits of active play, a new study from the University of Montreal reveals that for children, playing has no goal — it is an end in itself, an activity that is fun, done alone or with friends, and it represents “an opportunity to experience excitement or pleasure, but also to combat boredom, sadness, fear, or loneliness.” “By focusing on the physical activity aspect of play, authorities put aside several aspects of play that are beneficial to young people’s emotional and social health,” explains Professor Katherine Frohlich of the university’s Department of Social and Preventive Medicine, who supervised the study. “Play is a way to achieve various objectives, including the improvement of physical health and the development of cognitive and social aptitudes. Obviously, we…

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Evidence base for manual therapy.Give us a break!

I get annoyed by this insistence that there is an evidence base before you treat. I do agree that eventually there needs to be favourable evidence.However I think musculoskeletal medicine has not the kind of funds available to it as does that of Big Pharma and therefore it will take far longer to start to reach conclusions about our treatments.

I have a great example of what I mean.If I went to the medical establishment and said I have been using a box with a mirror on the outside and a patient puts their painful hand in the box, moves their non painful hand, looks at the reflection of the non painful hand and this appears to help to reduce the pain in the painful hand,the medical establishment would say this is the ultimate example of snake oil.However the renowned neuroscientist v s Ramachandran has been using this technique as a way of treating phantom and non phantom pain and neurological weakness (Stroke).It is based on recently discovered mirror neurones and appears to have some validity.However the reason it works is now being questioned and might be due to a crossed reflex .This may mean a bizzarre idea has effect but not due to the effect of mirror neurones but something else altogether.Now if something as strange as that can have positive therapeutic value why not being assessed,massaged,stretched,manipulated,given lifestyle,exercise and ergonomic advice and a thought through prognosis work?.

V s Ramachandran will be able to bring together a group of highly experienced researchers who will test his ideas out.Also they will have the knowledge and skills in producing strong peer reviewed evidence.

Osteopaths in the UK are a very small group and we work hard just to produce a living wage.We now have a research facility but it will take years before a view can be taken.Also everybody seems to think we are only useful as manipulators and research often looks at this element of treatment rather than looking at a whole treatment which brings together the elements stated above.To me it is far more useful to know if a treatment works rather than an element of a treatment that in reality lasts seconds.Sure it is useful to break down elements to see in time what is useful and what isn’t but at this moment surely it is more useful to look at the validity of a whole treatment than a part.Otherwise it can be like saying 4 roast potatoes makes a Sunday roast!.

It is our responsibity to prove our use but please give us a break.

How does manual therapy work?

I have been practising osteopathy long enough now to notice not is all it seems.We attend college(4 years full time) and learn lots of things to do with our discipline,such as anatomy,physiology,neurology,orthopaedics and pathology .We attend clinics where we are taught various techniques to create a hands on application of our theoretical knowledge.We then go out and try to make a living.

But all is not as it seems.I felt early on that successful outcomes were often not what you did on the table ,but rather whether the patient liked you,felt comfortable,trusted you and wanted you to get them better.

Some of my best results have been through what I have said rather than what I did.

There is a lot of evidence to back this up.

Sham treatment often is as good or nearly as good as real treatment.A study has shown all therapies tend to get about the same results,gutting when you compare my education against somebody that has trained over a few weekends.

It seems it depends on whether the patient invests in the treatment.This would appear to set off some sort of neurological and hormonal cascade that results in patients feeling improvement and once improvement is felt I believe that the bridge has been crossed and the body can stick to that healing pathway.Its just the nudge that is required.This can be physical such as a click to the low back or a good explanation of why that person is experiencing the pain they have and to give ressurance where appropriate.

Sometimes it can be complicated and you may not be able to find the key.I feel this is where experience counts.Without wanting to sound up myself I think you start to get a feel for what kind of patient you are dealing with.Some need information,some the click,rub,stretch.Some need you to work out their lifestyle and suggest small but positive ways they can change their own patterns of behaviour.Some require to acknowledge their emotional pain.I also worked under  a principal who had a “sergeant major” approach to his patients ,telling them off and this too could bring results.I think this may be because he was very self assured(a cocky git) and this probably had a comforting effect on the patient.

It cannot be coincidence that when somebody crawls into your room you often find that within the past few months they have lost a loved one or been made redundant,had a marriage break up etc.This “somatization”I believe is often underlying acute onsets and may well lead to chronic pain.This is tied into the stress hormone cortisol which has been seen to become pro inflammatory instead of its usual anti inflammatory state in the body.It can also stop the brain and spinal cord turning off the volley of messaging coming from the injured area.Remember pain is in the brain.Depressives and highly stressed people heal slower from cuts and musculoskeletal pain.

So manual therapists generally learn this through experience.Colleges I feel think this somehow beneath them to teach but  I feel needs to be taught thoroughly as I am sure our successful outcomes would increase markedly.


Muscles.What therapists like and don’t.

This one goes out to all manual therapists.In a very Nick Hornby way give me your top 5 most worked on muscle groups.

Mine would be:-

1 Trapezius surely everyones favourite !.Never met anyone who didn’t need a bit of work on it.

2 Erector spinae ,well I am an an osteopath after all

3 Glut max. I know Medius is far trendier but always needs attention with low back pain I feel.

4 Trickier now.Well  I’m going to say scalenes.Always helps neck pains I feel.

5.As a group rotator cuff .Anyone else find the mixture of supraspinatus and teres minor irresistable?.

Next top 5 tender areas.

1 ITB brings water to my eyes thinking about it.

2 Lat head gastrocnemius.I don’t know why but there you go.

3.Glut medius.Always a few juicy trigger points.

4.Adductors.Perhaps derverves to go up the list but just thought of it.

5.Psoas.Or is it my palpation technique ?.

Let me know your views.

Next most overlooked muscles.

1 Lat Dorsi.Even though i spend a lot of my practice life working on it it never enters my diagnostic thoughts.

2.Deltoid .Again big powerful muscle but don’t you just prefer it to be the rotator cuff.

3.Abdominals.well they are on the front aren’t they.


5.Serratus posterior.we love anterior but its namesake never gets a look in

Now the muscles I think are important that nobody else seems to.Or am i wrong?.

1. Splenius Capitis.Could be on my tender list but i feel is important in neck problems.

2 Tibialis Posterior.Oh those fallen arches.

3.Pec major/minor.Those office workers with protracted shoulders.Stretch,stretch,stretch!.

4.Whilst on the subject those inhibited rhomboids/lower trapezius need a bit of engaging.

5.The deep flexors of the neck.You just cannot get to them apart from with absurdly long needles(never had the guts to use).But feel need strengthening regularly.

Manual Therapies -the time to merge?

I am an osteopath who practises acupuncture.I like to give exercise and ergonomic advice.I use a vibrogym in my practice for rehab and loan out weights,wobble boards and therabands for use at home.

I think this is now common  throughout manual therapists.What are the differences between therapies?.This is something you are regularly asked by patients and generally fudge a response.The truth is that there may be a chiropractor or physio who is closer to my methods than a fellow osteopath.we all tend to borrow from one another and we would surely be foolish not to use techniques that are coming out of a different profession but have  good evidence for effectiveness.

So is it time to bring all manual therapies under one umbrella of say”The society of manual therapists”.I think so but feel that I would not be in the majority in my response.

This is because there are misunderstandings and jealousies between professions.Also there would be a lot of colleges doing themselves out of work.

But from a patient perspective it makes sense.They would have a much better idea of what they will be getting from an appointment.

Of course there are many varied techniques available but as we seek better truth through research as to what works and what doesn’t surely we will all be singing from the same sheet.

The education would become less geared towards the differing philosophies and more geared to useful treatments.

For example we learn in great detail the history of osteopathy and forget to teach modern ideas of biomechanics .

So here starts the revolution.Well David Butler(an Australian physio) said it first on NOIgroup,but articulated something I have always felt.