Osteopaths on the loose...

[SKIRRID5]

All this stuff about germs not being responsible for disease is, I believe, more or less what George Bernard Shaw believed. He was a celebrity, so it must be true!
I got this from a book well worth reading, if it's still around: The New Apocrypha, by the excellent SF writer, the late lamented John Sladek.

[filippo lippi]

I thought not, but NT might come up with something; I'm sceptical, but open to the possibility.

With the old PR I used to suffer a lot of sinus infections, at least one a year. The GP never once recommended massage, the anti-hystamines seem to do the trick quite nicely.

I live in hope...

[Neuromuscular Therapist]

Okay, you guys don't quite seem to have understood what I am saying.

This is to clarify the situation.

As a physical therapist and sports massage therapist, I work with musculo-skeletal problems. What I have found in my practice is that in some patients that I see who have musculo-skeletal problems also accompanied with either sinus problems or ear problems have found relief from these problems when I have worked on tight and shortened musculature in the areas of the neck and all the muscles in this area - upper traps, SCM, scalenes and the sub-occipital muscles.

No, an MD won't refer you for massage if you have sinus problems or ear problems. They will refer you for physical therapy or massage if you have muscular problems, such as neck or back problems and what I am saying is that some of these patients with neck and back problems also have sinus and ear problems and at times, when I have been working with the neck and around this area generally, once the tightness in these muscles and normal length has been restored the other problems sometimes resolve or lessen in severity too.

Not all patients with neck problems actually have sinus and ear problems, but in the ones who do, once some of this muscular tightness is removed, some of the other problems do seem to get better.

This is just what I have observed in my practice of physical therapy and sports massage.

If you have sinus or ear problems, then yeah, go see an MD and if you have muscular problems, then go see or get a referral to a physical therapist rather than a chiro. You can also see a DO instead.

[filippo lippi]

As a physical therapist and sports massage therapist, I work with musculo-skeletal problems. What I have found in my practice is that in some patients that I see who have musculo-skeletal problems also accompanied with either sinus problems or ear problems have found relief from these problems when I have worked on tight and shortened musculature in the areas of the neck and all the muscles in this area - upper traps, SCM, scalenes and the sub-occipital muscles.

No, an MD won't refer you for massage if you have sinus problems or ear problems. They will refer you for physical therapy or massage if you have muscular problems, such as neck or back problems and what I am saying is that some of these patients with neck and back problems also have sinus and ear problems and at times, when I have been working with the neck and around this area generally, once the tightness in these muscles and normal length has been restored the other problems sometimes resolve or lessen in severity too.

Not all patients with neck problems actually have sinus and ear problems, but in the ones who do, once some of this muscular tightness is removed, some of the other problems do seem to get better.

"Hearsay and conjecture are types of evidence."

As I thought, these conditions that generally get better on there own also get better when you've manipulated them, but you don't have any other proof that your manipulations have any effect.

[Croydon Bob]

As a physical therapist and sports massage therapist, I work with musculo-skeletal problems. What I have found in my practice is that in some patients that I see who have musculo-skeletal problems also accompanied with either sinus problems or ear problems have found relief from these problems when I have worked on tight and shortened musculature in the areas of the neck and all the muscles in this area - upper traps, SCM, scalenes and the sub-occipital muscles.

OK, that sounds possible. I've recently had toothache and at its worst my jaw, right ear and even eyeball all ached with it. Now that I've had a root-canal done, my jaw, ear and eye are fine.


I don't think that the two sides of this debate are really very far from each other.

[Neuromuscular Therapist]

"Hearsay and conjecture are types of evidence."

As I thought, these conditions that generally get better on there own also get better when you've manipulated them, but you don't have any other proof that your manipulations have any effect.

Firstly, I practice physical therapy and sports massage, so I DO NOT USE MANIPULATION as part of my practice. Chiropractors use manipulations, but I don't. Do you actually know the difference between these practices?

I use tests in my practice at the beginning and end of treatment to evaluate whether my work has been effective.

What I have put forward is not really meant to be evidence, but just what I happened to have noticed as part of my practice, in that once shortness and tightness in muscles has been released and muscular balance is achieved, some other problems that are thought to be unrelated can resolve.

That is all I am saying, no more and no less.

[Graham Lappin]

What I have put forward is not really meant to be evidence, but just what I happened to have noticed as part of my practice, in that once shortness and tightness in muscles has been released and muscular balance is achieved, some other problems that are thought to be unrelated can resolve.

That is all I am saying, no more and no less.

Neuromuscular Therapist - I take your point that you are not trying to make any outrageous claims but very often our intuitions can be misleading - it's science that shows our instincts are not always correct. The immediate problem is that there is no known mechanism by which the ear is directly linked to musculo-skeletal system and so the claim that treating one can effect a therapy in the other immediately rings alarm bells. There can of course be indirect links, a feeling of well-being after a massage for example but that is so general it could apply to virtually anything. For a direct association to be true, it would have to overturn a lot of scientific and medical evidence, which would make it an extraordinary discovery. Extraordinary claims require extraordinary evidence and so in all likelihood, the association you see is a perception of a pattern that is not really present.

Have a look at the short clip on You Tube http://www.youtube.com/watch?v=WCW8ocazmEM just as an illustration of how the mind can see associations that are not necessarily real.

I assume from what you have said that you are not a believer in subluxations and similar?

[Neuromuscular Therapist]

I AM NOT A CHIROPRACTOR.

I am however a physical therapist and a sports massage therapist and by definition, I work with the muskulo-skeletal system, that includes muscles and fascia.

No, I don't believe that subluxations exist.

There is an indirect link between the ear and muscles via and SCM attaching to the mastoid tip.

I know everything that you are saying - I have not been in practice for the last 20 years without learning a thing to two, but I do take notice of what my patients tell me. I do listen and this is what they have told me when they have come back after some treatments. That is all I was saying.

[Graham Lappin]

No, I don't believe that subluxations exist

I didn't think you did but I was just checking

There is an indirect link between the ear and muscles via and SCM attaching to the mastoid tip.

Not quite what I meant. What I was saying is that there is no mechanistic reason why treatment on, for example, the gastrocnemius muscle could have a therapeutic effect on the ear. (I just use these as example to illustrate the point, by the way. I am not saying you have made such a claim).

I know everything that you are saying - I have not been in practice for the last 20 years without learning a thing to two

I think you are somewhat thin ice with this one. I have been a clinical research scientist for 25 years but speaking from this authority does not automatically make me right.

but I do take notice of what my patients tell me. I do listen and this is what they have told me when they have come back after some treatments.

This is fine as far as it goes but this is exactly what homeopaths, acupuncturist etc quote to support their beliefs. What you are saying is intuition. Many discoveries started with intuition but it is then a matter of advancing the intuition into a testable hypothesis. I am just making the point that taking this approach, it is so easy to get misled into the wrong conclusion.

That is all I was saying.

From this I take it that you have made the observation and you don't really want to extrapolate the conclusion too far, which is something we can both agree upon.

[Don't drink the bongwater]

Well, I am an osteopath, at least I used to be (got bored to be honest, probably a pretty poor career choice for someone like me with a low tolerance for repetition and listening to patient complaints). This discussion is pretty funny, there are quacks out there that are osteopaths, but I don't think any more than any other health professions. I think craniosacral therapy is crap and I think any chiro who thinks they can cure "disease" is fooling themselves, to put it nicely. You won't get a bigger skeptic of the manual therapy profession than me, and I actually know what I am talking about when it comes to what is dogma and what isn't and I have pretty strong viewpoints on a lot of manual therapy practice in general.

However I have to say that practicing manual therapy, when done well and applied to the right cases, is very effective, for back pain, neck pain etc. Sure there are some unscrupulous bastards, but they are, at least in my experience in osteopath circles fairly few and far between (but I can name the one that I think are dodgy). But as there are less numbers of osteopaths overall as opposed to say, GP's, a few bad apples can spoil the barrel quick smart.

Lots of what seems to work in manual therapy has inadequate evidence behind it in general. Funnily enough though, most of my lecturers at Osteo school (at least for anatomy, physiology, pathology, clinical diagnosis, neuro etc etc) were practicing MDs and I remember one of them, a well renowned GP, saying a large bulk of what the average GP does on a daily basis has pretty sketchy evidence tied to it (I believe the figure 75% was tossed about). This always struck me as pretty high, and I don't believe that is a published figure (I have searched but nada), but an interesting note from someone in the field.

It's funny how people think manual therapy professions don't know jack - I can't speak on behalf of physio's or chiros, but the osteopathic profession bases everything on conventional medical diagnosis first and foremost and in musculoskeletal examination they are highly proficient. When I was practicing, I picked up, through routine patient workup, 5 cases of various cancers that were missed by family GPs, two pretty serious cases of DVTs and a couple of other interesting bits and bobs that stuck out like dog's balls to me - but apparently not the local physician practices, not bad for a quack. Now all I did was conduct a routine history, physical and followed up with some indicated diagnostic radiology tests on the side - so I'm buggered if I know what the GP was doing. If there were cases where I couldn't figure out what was going on and help someone out pretty quickly, I referred them off to someone better equipped.

I hate practitioners of any kind who think they can bring peace to the middle east with a quick crack of the back.

[bindeweede]

Ddtb,

You mentioned manual therapy several times. Could you explain in a bit more detail what that is exactly? Sorry to be tedious. You see, this confuses me...

You won't get a bigger skeptic of the manual therapy profession than me, and I actually know what I am talking about when it comes to what is dogma and what isn't and I have pretty strong viewpoints on a lot of manual therapy practice in general.

However I have to say that practicing manual therapy, when done well and applied to the right cases, is very effective, for back pain, neck pain etc.

[Mongrel]

DD - I accept that a minority of osteopaths and chiropractors don't follow the wackier side of things but is there anything, at the end of the day, that separates them from a good physiotherapist?

[Blue Wode]

Funnily enough though, most of my lecturers at Osteo school (at least for anatomy, physiology, pathology, clinical diagnosis, neuro etc etc) were practicing MDs and I remember one of them, a well renowned GP, saying a large bulk of what the average GP does on a daily basis has pretty sketchy evidence tied to it (I believe the figure 75% was tossed about). This always struck me as pretty high, and I don't believe that is a published figure (I have searched but nada), but an interesting note from someone in the field.

The following might be of interest to you:

It’s a sad moment for British medicine when the chair of the NHS Alliance, Dr M Dixon, states that ‘only 10% of what doctors do in primary care is evidence-based’.1 The actual evidence shows that the figure is around 80%!2 But even if the 10% figure were correct, this would not lend itself, as Dr Dixon does, to the integration of more unproven treatments into the NHS. We first need to ensure that a therapy generates more good than harm and only subsequently should we consider it for general use. This course of action is not ‘integrated medicine’ but follows the principles of ‘evidence-based medicine’.

http://www.medicinescomplete.com/journals/fact/current/fact0902a09n06.htm

In recent years the claim that only 20% or less of standard Western medicine is evidence-based has been repeated widely by health professionals and others. [1]

This assertion is perhaps most often made by proponents of unproven (‘alternative’ and ‘complementary’) therapies with the implication that, if true, it might somehow justify the integration of any number of unconventional modalities with a similar dearth of supporting scientific evidence into main-stream medical practice.

It should be immediately noted that this line of reasoning is an example of the logical fallacy tu quoque (‘you did it too’): one party cannot criticize another because both parties are guilty of the same ‘sin.’ While this argument may be without merit, it is often made and widely held to be valid. Therefore, the authors of this paper have attempted to identify the sources of, and examine the evidence for, the ‘20% or less’ claim.

-snip-

In 1991, Dr David Eddy, at a conference in Manchester, UK, claimed that only 15% of medical practice was based on any evidence at all. He apparently based this sweeping conclusion entirely on his studies of treatments for just two specific conditions: arterial blockage in the legs and glaucoma.[10] Subsequently, Dr Eddy’s claim, rather than the much more conservative OTA ‘armchair estimate,’ has been widely cited as a criticism of mainstream medicine.

-snip-

Regardless of the origin or intent of the original assessments, critics of the ‘10 to 20%’ claims were originally unable to refute them because no solid evidence existed either in favor of or against them. That situation has changed in recent years. A growing body of evidence now exists regarding the extent to which medical practice is evidence-based.

-snip-

Evidence for evidence-based practice includes those listed in the box (q.v.).

• 96.7% of anesthetic interventions (32% by RCT, UK)[13]
• approximately 77% of dermatologic out-patient therapy (38% by RCT, Denmark)[14]
• 64.8% of ‘major therapeutic interventions’ in an internal medicine clinic (57% by RCT, Canada)[15]
• 95% of surgical interventions in one practice (24% by RCT, UK)[16]
• 77% of pediatric surgical interventions (11% by RCT, UK)[17]
• 65% of psychiatric interventions (65% by RCT, UK)[18]
• 81% of interventions in general practice (25.5% by RCT, UK)[19]
• 82% of general medical interventions (53% by RCT, UK)[20]
• 55% of general practice interventions (38% by RCT, Spain)[21]
• 78% of laparoscopic procedures (50% by RCT, France)[22]
• 45% of primary hematology–oncology interventions (24% by RCT, USA)[23]
• 84% of internal medicine interventions (50% by RCT, Sweden)[24]
• 97% of pediatric surgical interventions (26% by RCT, UK)11
• 70% of primary therapeutic decisions in a clinical hematology practice (22% by RCT, UK)[25]
• 72.5% of interventions in a community pediatric practice (39.9% by RCT, UK)[26]

More…
The evidence for evidence-based medicine Complementary Therapies in Medicine (2000), 8, 123–126

http://www.veterinarywatch.com/CTiM.htm

[Mojo]

I think any chiro who thinks they can cure "disease" is fooling themselves, to put it nicely. You won't get a bigger skeptic of the manual therapy profession than me, and I actually know what I am talking about when it comes to what is dogma and what isn't and I have pretty strong viewpoints on a lot of manual therapy practice in general.

However I have to say that practicing manual therapy, when done well and applied to the right cases, is very effective, for back pain, neck pain etc. Sure there are some unscrupulous bastards, but they are, at least in my experience in osteopath circles fairly few and far between (but I can name the one that I think are dodgy). But as there are less numbers of osteopaths overall as opposed to say, GP's, a few bad apples can spoil the barrel quick smart.

What do you think of the GOsC's claims that osteopathy can treat ear infections and asthma, among other conditions, and "help children suffering from cerebral palsy or Down's Syndrome"?

[Don't drink the bongwater]

Ok, manual therapy - general term for all who practice anything with a hands-on-body application (either massage, manipulation etc). It's a way to throw everyone in the same bucket from one respect, which is valid because there is overlap in the execution of some of the techniques.

I have to take exception with: "I accept that a minority of osteopaths and chiropractors don't follow the wackier side of things" as grossly inaccurate (of osteopaths) in my experience. I'd actually argue in the opposite direction that most of the osteopaths I know are legit and working hard to help people, making care-based decisions. Yeah, sure I know some whose practice decisions are driven by cash first (I can name them on one hand), and I think they undeservingly give everyone a shitty reputation.

What separates an Osteopath from a good physio you ask? (I'm conveniently ignoring the chiro side of things because I wasn't one)
Well, there are similarities and differences and it is not cut an dried. One way of explaining - that is bound to piss some people off, though I long ago stopped caring about who I offend on this matter - is the level of diagnostic ability. Physios are good at recognizing musculoskeletal problems, osteos are historically rooted in being medical practitioners (in the US) and this has most certainly filtered through to today's osteopath. Knowledge of pathology, clinical diagnosis, lab diagnostics and radiology is heavily emphasized, which means that not only can many of them figure out what they are treating, but more importantly they can figure out what they shouldn't treat, and to refer these people to the appropriate specialty. This is also the biggest problem with osteopathy as a profession IMO, as you know what you are dealing with in many cases, but can't do a damn thing about it (which is still better than the chiros who purport to cure "disease" my manipulating a subluxation if you ask me) - making you realize you should either go back to medical school or just have remained blissfully unaware and gone into finance and law in the first place. Bottom line to ask yourself: are you happy with the service you get from your physio? If so, keep it up.