Welcome

I do hope this blog will be a useful resource for students, colleagues and those with an interest in osteopathy and manual medicine. I will update the blog from time to time with additional resources and observations which are either noteworthy or curious in themselves or contribute to the promotion of health, the scope of practice and the osteopath’s role in the wider healthcare context.
You will also find information relating to student workshops and CPD courses, based on small groups with PBL and practical content.
Kind regards
Laurence Kirk



Top Blogs

Apr 16 / admin

Cracking News

Joint Cavitation

Researchers at the University of Alberta have been investigating the phenomenon of ‘joint cracking’ . They were able to visualise changes on an MRI and for the first time showed a sudden increase in contrast on a T” weighted image immediately after the crack released gas within the joint. This may mean that fluid is being drawn across the joint surface and could account for some of the benefits associated with manipulation. Pardon the pun, but the mechanisms of joint manipulation are multi-faceted and may include both local and central effects i.e. mechanical and neurological/psychological. Previous posts on this blog have focused on the mechanisms of joint manipulation, but thankfully it looks like these  researchers are hoping to  continue to investigate the process.

Oct 23 / admin

Cervical Manipulation and stroke

20121030-160246.jpgIn progress………….

Assessing the risk of stroke from neck manipulation: a systematic review.

Haynes MJ, Vincent K, Fischhoff C, Bremner AP, Lanlo O, Hankey GJ (2012) Int J Clin Pract. 66 (10), 940-7.

Background:  Strokes, typically involving vertebral artery dissection, can follow cervical spinal manipulative therapy, and these types of stroke occur rarely. There is disagreement about whether a strong association between neck manipulation and stroke exists. An earlier systematic review found two relevant studies of association that used controls, which also discussed the limitations of the two papers. Our systematic review updates the earlier review, and aims to determine whether conclusive evidence of a strong association exists. Methods:  PRISMA guidelines for systematic reviews were followed, and the literature was searched using a strategy that included the terms ‘neck manipulation’ and ‘stroke’ from the PubMed, Embase, CINAHL Plus and AMED databases. Citations were included if they met criteria such as being case-control studies, and dealt with neck manipulation and/or neck movement/positioning. Papers were scored for their quality, using similar criteria to the earlier review. For individual criteria, each study was assigned a full positive score if the criterion was satisfied completely. Results:  Four case-control studies and one case-control study, which included a case- crossover design, met the selection criteria, but all of them had at least three items in the quality assessment that failed to be completely positive. Two studies were assessed to be the most robustly designed, one indicating a strong association between stroke and various intensities of neck movement, including manipulation, and the other suggesting a much reduced relative association when using primary care practitioners’ visits as controls. However, potential biases and confounders render the results inconclusive. Conclusion:  Conclusive evidence is lacking for a strong association between neck manipulation and stroke, but is also absent for no association. Future studies of association will need to minimise potential biases and confounders, and ideally have sufficient numbers of cases to allow subgroup analysis for different types of neck manipulation and neck movement.

Cervical manipulation and the myth of stroke.

Murphy DR (2012) Med Health R I. 95 (6), 176-7.

Should we abandon cervical spine manipulation for mechanical neck pain? No.

Cassidy JD, Bronfort G, Hartvigsen J (2012) BMJ. 344 ( ), e3680.

Apr 30 / admin

Resveratrol and Disc Repair

A number of recent studies have shown that resveratrol, a naturally occurring polyphenol compound found in red grapes and Japanese knotweed, may have great  potential for the treatment of nucleus pulposus mediated pain.  The studies have demonstrated some startling anti-inflammatory and anti ageing/catabolic effects effects on cells tested in the laboratory and anti-inflammatory effects in living subjects.1, 2, Apoptosis is the term used to describe programmed cell death, it appears that resveratrol may have the potential to block or retard this process.3

The dosage requires to have an effect is not clear as yet, although the concentration of resveratrol in the introduced invasive weed Japanese knotweed is higher than that in red grapes. It would be inadvisable to consume large amounts of either as, without processing, the Japanese knotweed would have a unfortunate laxative effect.

Given my own history of disc injuries, I will be conducting a small scale, non randomised or controlled study on myself- watch this space for further information!

  1. Wuertz K, Quero L, Sekiguchi M, Klawitter M, Nerlich A, Konno S, Kikuchi S, Boos N (2011)Descriptive and mechanistic investigation of the anti-inflammatory and anticatabolic effect of resveratrol in intervertebral discs (IVDs) in vitro and of the analgetic effect in vivo. Spine (Phila Pa 1976). 36 (21), E1373-84.
  2. Wang D, Hu Z, Hao J, He B, Gan Q, Zhong X, Zhang X, Shen J, Fang J, Jiang W (2012) Age (Dordr). ( ), .SIRT1 inhibits apoptosis of degenerative human disc nucleus pulposus cells through activation of Akt pathway.
  3. Li X, Phillips FM, An HS, Ellman M, Thonar EJ, Wu W, Park D, Im HJ The action of resveratrol, a phytoestrogen found in grapes, on the intervertebral disc.(2008) Spine (Phila Pa 1976). 33 (24), 2586-95.
Mar 24 / admin

Aspirin

ongoing …………Use of aspirin, but not other non-steroidal anti-inflammatory drugs is associated with decreased prostate cancer risk at the population level.

Veitonmäki T, Tammela TL, Auvinen A, Murtola TJ (2012) Eur J Cancer. ( ), .

Non-steroidal Anti-inflammatory Drugs and Endometrial Cancer Risk in the VITamins And Lifestyle (VITAL) Cohort.

Brasky TM, Moysich KB, Cohn DE, White E (2012) Gynecol Oncol. ( ), .
Aspirin in prevention of sporadic colorectal cancer: current clinical evidence and overall balance of risks and benefits.

Effects of regular aspirin on long-term cancer incidence and metastasis: a systematic comparison of evidence from observational studies versus randomised trials.

Algra AM, Rothwell PM (2012) Lancet Oncol. 13 (5), 518-27.

Rothwell PM (2012) Recent Results Cancer Res. 191 ( ), 121-42.

In addition to longstanding evidence from observational studies, evidence from randomised trials of the effectiveness of aspirin for chemoprevention of colorectal cancer has increased substantially in recent years. Trials have shown that daily aspirin reduces the risk of any recurrent colorectal adenoma by 17 % and advanced adenoma by 28 %, and that daily aspirin for about 5 years reduces incidence and mortality due to colorectal cancer by 30-40 % after 20 years of follow-up, and reduces the 20-year risk of all-cause cancer mortality by about 20 %. Recent evidence also shows that the risk of major bleeding on aspirin diminishes with prolonged use, suggesting that the balance of risk and benefit favours the use of daily aspirin in primary prevention of colorectal and other cancers. Updated clinical guidelines are currently awaited.

Feb 27 / admin

The Tuning Fork and Fracture Assessment: Myth or Magic?

I was stimulated to write about the use of the tuning fork in osteopathic practice following comments by a colleague, who referred to its use in fracture diagnosis as ‘an urban myth’. However, in spite of this, he did still use the tuning fork in his own practice(albeit in conjunction with auscultation)

The humble tuning fork has been used for many years as a rather ‘low tech’ method of confirming suspicions of the presence of bony fracture.

Although the use of the tuning fork has been questioned by some as it is somewhat lacking in evidence, if shown to be sufficiently reliable, sensitive and specific it would be a very cost effective addition to clinical examination.

There is very limited literature available for review, but a small sampling reveals, for example, a 1997 study using the tuning fork for tibial fracture diagnosis which stated:

The tuning fork test(TFT) is not sensitive enough to rule out a stress fracture on the basis of a negative test. However, in a setting in which there is a moderate to high pretest likelihood of stress fractures, such as military installations with new basic training recruits, it may be reasonable to avoid the cost and delays associated with nuclear imaging by instituting treatment for tibial stress fractures without obtaining a bone scan when the TFT is positive.

A 2005 article concluded, that although it should not be regarded as definitive, a simple tuning fork may assist in diagnosing leg pain in the athlete

a 2006 study in Emergency Medicine also concludes that the tuning fork may be a useful addition to clinical practice.

A well known website aimed at providing a practical resource for General Practitioners also recommends the use of a tuning fork, again with the proviso that a negative test should not be regarded as indicative of the absence of a fracture:

In addition a large scale NHS research project is about to start, indicating a resurgence in interest in the technique.

Obviously more research is still needed, as with many other physical examination procedures. However, when used appropriately, I believe the tuning fork to be potentially useful in practice.

A brief summary of pertinent points:

  • There appears to be consensus on the use of a frequency of 128hz
  • The tuning fork test should not be used as the sole means of diagnosis of a potential fracture, i.e. any competent practitioner will start with a full case history followed by a physical examination and evaluate all of this information before making any conclusions.
  • A negative test may be unreliable but if the test is positive alongside additional factors consistent with possible fracture then the result should not be ignored and within the context of osteopathic practice should be assumed to indicate a possible fracture, triggering appropriate referral.
Dec 1 / admin

Cinnamon for Xmas

Christmas is looming and ‘mix up Sunday’ for baking the traditional Christmas cake, and allowing it to mature, has already been and gone.  Cinnamon features widely in both traditional  spiced drinks and cakes and pastries. It has a distinctive festive taste but recent research has indicated an unexpected possible side benefit from regular consumption.

A study carried out at Tel Aviv University appears to indicate that the beta protein tangles which accumulate in the brain, eventually leading to Alzheimer’s disease, are modified and untangled when afflicted mice are fed an extract of cinnamon bark 1 The cinnamon extract resulted in improved cognitive ability, when given to the afflicted mice, so much so that their performance was close to the unaffected control group.

Finding a drug or medication which has the ability to remove or modify these tangles has been the ‘Holy Grail’ of Alzheimer’s research, if the research is transferable to human populations it will be truly remarkable that an ancient and now everyday spice might hold an answer to a distressing and otherwise untreatable condition.

It might be interesting if a human population, which traditionally consumes large amounts of cinnamon as part of their normal year round diet,  could be identified and shown subsequently to have a dramatically reduced incidence of Alzheimer’s.

It’s probably far too early to raise hopes,  and like many substances, excessive consumption of large amounts of cinnamon, e.g in capsules, may be harmful. (Some types of cinnamon also contain coumarin and other substances which can be toxic to the liver if consumed in large regular amounts). Used as it has been for thousands of years, in small amounts as a spice, it is safe. So we can all in the meantime enjoy our mulled wine and stollen,  and raise a glass to the potential power of cinnamon.

Nov 30 / admin

The Veedee

'VeeDee' Mechanical vibrator, London, England, 1900-1915
I’ve been collecting and displaying a few old and curious historical  devices previously used in the treatment of musculo-skeletal(MSK) pain.   The ‘Veedee’ vibratory massager, produced around the turn of the 20th century by J.E. Garratt, 96 Southwark Street, London S.E., was not only used for MSK pain but also claimed to treat colds, digestive complaints and flatulence through ‘curative vibration’.
The name is thought to be a foreshortening of  Veni Vidi Vici’. (I came, I saw, I conquered), presumably with reference to pain and illness.

The device was very fashionable for a time, however, when applied as in the illustration left, it requires a considerable amount of effort to maintain any vibration and the sensation itself is somewhat unpleasant. I do not intend to re-introduce it into my practice!

The device was marketed around the world. An interesting and amusing article relating to its use and the type of ailments that exponents advocated it for can can be found by visiting this page at the National Archive of Australia and viewing a newspaper report of a demonstration in Adelaide in 1914.

Aug 31 / admin

Professional Regulation?

A number of us have recently received emails asking us to consider whether the General Osteopathic Council should continue as our regulator.

An alternative option put forward is to emulate the Physiotherapists, and a number of other professions, under the banner of the Health Professions Council. Each profession retains autonomy and protected title, and in addition has a professional body to act in their member's interest, and/or, as in the case of the Chartered Society of Physiotherapy, and the British Medical Association as a trade union.
What is best for our future?

The HPC currently regulates the following 14 professions. Each of these professions has one or more ‘protected titles’. Anyone who uses one of these titles must register with the HPC. To see the full list of protected titles please see: www.hpc-uk.org/aboutregistration/protectedtitles/

Arts therapists
Biomedical scientists
Chiropodists / podiatrists
Clinical scientists
Dietitians
Occupational therapists
Operating department practitioners
Orthoptists
Paramedics
Physiotherapists
Practitioner psychologists
Prosthetists / orthotists
Radiographers
Speech and language therapists

The Government has published a number of command papers making clear their views.  A short summary follows., with my italics for emphasis :
1. The Command Paper, ‘Enabling Excellence – Autonomy and Accountability for Healthcare Workers, Social Workers and Social Care Workers’ sets out the Government’s proposals on how the system for regulating healthcare workers across the United Kingdom and social care workers in England, should be reformed to sustain and develop the high professional standards of our health and social care staff and to continue to assure the safety of those using services and the public.
2. The Coalition Agreement set out a clear agenda for reducing bureaucracy and the regulatory burden. Compulsory and centralised statutory regulation is not necessarily the most effective or efficient way of ensuring high quality care and we will ensure that regulation of the health and social care professions is delivered in a fashion that is demonstrably proportionate, accountable, consistent, transparent and targeted.
3. The aim of the Command Paper is to achieve that balance: ensuring that professional regulation is proportionate and effective, imposing the least cost and complexity consistent with securing safety and confidence for patients, service users, carers and the wider public.

The following table may be of interest to many.

Regulator Annual Expenditure Number of registrants Fees
General Chiropractic Council 2,635,000 2,607 £1000 practising, £100 non-practising
General Dental Council 24,042,000 94,023 £576 Dentists

£120 Dental Care Professionals

General Osteopathic Council 2,848,000 4,250 £350 year 1

£500 year 2

£750 thereafter

Non-practising is 50% of normal fee

General Medical Council 80,617,000 239,309 £410 with license

£145 without

General Optical Council 4,019,000 24,295 £219 for registrants

£20 for students

General Pharmaceutical Council 15,900,000 58,664 £261 pharmacist

£142 Pharmacy technician

General Social Care council 18,696,000 100,882 £30 social Workers

£10 students

Health Professions Council 15,004,000 205,311 £76
Nursing and midwifery Council 36,738,000 665,599 £76
Pharmaceutical Society of Northern Ireland 847,000 2,060 £372

Source: Data about the numbers of registrants and fees charged has been obtained from the CHRE or the relevant regulatory body. The above expenditure figures have been drawn from the latest available annual review for each body.

Mar 31 / admin

Respiratory Muscle Exercise and COPD

still to come

Mar 31 / admin

Osteopathy and NHS awareness

Draft

A recent article in the Journal of Clinical Audits has attempted to gauge attitudes, knowledge and opinions on a variety of complementary and alternative medical(CAM) approaches including osteopathy. Staff at St Georges and Kingston Hospitals in London were asked to complete a questionnaire.

Top was acupuncture which scored highly in terms of the percentage rating effectiveness and also in those wishing to undertake training, ( at 71% and 38% respectively) Osteopathy was in third place with  only 55% rating osteopathy as effective and of interest was that reflexology was rated second with 58% regarding it as an effective therapy, in spite of the lack of any substantive evidence base .

The study of course was limited to a relatively small number(n=375) of both doctors and nurses in just two London hospitals.

to be continued……………………………………………………………..

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