Osteopathy Matters Blog by Laurence Kirk

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.

Frydman-Marom A, Levin A, Farfara D et al. Orally Administrated Cinnamon Extract Reduces β-Amyloid Oligomerization and Corrects Cognitive Impairment in Alzheimer’s Disease Animal Models. PLoS ONE 2011 ↩

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……………………………………………………………..

Feb 27 / admin

Vascular Claudication

still to come

http://www.manualtherapyjournal.com/article/S1356-689X%2808%2900136-7/abstract

Feb 27 / admin

Complex Regional Pain Syndrome

coming soon

The International Association for the Study of Pain(IASP)recommended some time ago that the old terms of ‘causalgia’ and ‘reflex sympathetic dystrophy’(RSD) be replaced with ‘complex regional pain syndrome’(CRPS). Type 1 CRPS is associated with trauma and equivalent to the old RSD whilst type 2 occurs in he absence of trauma and is similar to the old description of ‘causalgia’

http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WFG-4XBR4S2-1&_user=10&_coverDate=01%2F31%2F2010&_rdoc=1&_fmt=high&_orig=gateway&_origin=gateway&_sort=d&_docanchor=&view=c&_searchStrId=1657674047&_rerunOrigin=scholar.google&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=1850e772279c3981e7d08685a508e0f5&searchtype=a

Jan 31 / admin

Back to the Future

There has been an assumption, which appears to have some face value, that disability from low back pain (LBP) may be greater as a result of inactivity. A recent review has suggested that there is however only a weak link with acute LBP, but a demonstrable and significant correlation for chronic LBP¹

It may also seem self evident that a lifetime of relative inactivity could predispose to a greater risk of LBP. Waddell famously described LBP as a late 20th century epidemic and a healthcare enigma², and it shows no sign of letting up in the 21st century.

Given our increasingly sedentary lifestyles, a number of researchers have tried to investigate a potential direct ink between weakness in the lumbar paraspinal muscles and increased risk of LBP. A large scale Finnish study has recently demonstrated that in subjects with a mean age of just 21 years, lumbar paraspinal muscle weakness does not correlate with an increased predisposition to LBP³. Although the conclusion was that atrophy or infiltration of lumbar paraspinal muscles did not predict an increased risk of LBP, it will be interesting to look at the same subjects in 15 years time.

So, it would still seem prudent for all of us to continue to recommend structured activity and specific exercise for individuals with LBP when appropriate.

Jan 31 / admin

Deep Vein Thrombosis in Practice

Deep vein thrombosis(DVT) can present in clinical practice as apparent musculoskeletal pain. A thorough case history is vital and new predictive rules can aid in the recognition of DVT.

Patients with deep vein thrombosis(DVT) of the lower limb may present in osteopathic practice with symptoms which may feel, to them, rather like a muscle tear or even nerve pain.

The clinical features accompanying a DVT can often be somewhat variable. Since the 1990’s, Well’s criteria¹ have been used in an attempt to quantify those variables which make a diagnosis of DVT more likely. A recent research study has compared a new primary care rule with Well’s existing criteria and suggested that the new rule may be more reliable in clinical practice, in deciding whether ultrasonography and treatment is indicated. ²

Physical testing procedures such as Homan’s test for DVT appear to be out of favour as they are thought to be potentially risky as well as unreliable and non-specific ³ Nevertheless, it is important to remember that if in doubt, err on the side of caution before applying vigorous deep inhibition to a painful calf.

Wells Rule and the Primary Care Rule Scoring to Rule Out Deep Vein Thrombosis (DVT)
Variables	Wells Rule	Primary Care Rule
Male sex	–	1
Oral contraceptive use	–	1
Presence of active malignancy (in last 6 mo)	1	1
Immobilisation paresis/plaster lower ex.	1	–
Major surgery (last 3 mo)	1	1
Absence of leg trauma	–	1
Localised tenderness of deep venous system	1	–
Dilated collateral veins (not varicose)	1	1
Swelling, whole leg	1	–
Calf swelling ≥3 cm	1	2
Pitting oedema confined to the symptomatic leg	1	–
Previously documented DVT	1	–
Alternative diagnosis at least as likely as DVT	-2	–
Positive D-dimer result	–	6

Cutoff scores for considering DVT as absent	≤1	≤3

Wells et al: Lancet 1997; 350: 1795-1798. ↩
van der Velde et al; Comparing the Diagnostic Performance of 2 Clinical Decision Rules to Rule Out Deep Vein Thrombosis in Primary Care Patients; Ann Fam Med 9: 31 ↩
Joshua AM, Celermajer DS, Stockler MR.Beauty is in the eye of the examiner: reaching agreement about physical signs and their value. Intern Med J. 2005 Mar;35(3):178-87. ↩

Dec 31 / admin

Kindness Revisited

‘Kindness’ as a taught objective does not feature prominently, if at all, in the curricula or course outlines of many osteopathic or medical institutions.

This may seem anomalous, since as far as the recipient is concerned, kindness is one of the most notable qualities of an effective practitioner¹. We may be guilty of over emphasising the ‘cold’ scientific and quantitative elements of practitioner-ship at the expense of the ‘warm’ or more qualitative elements of human interaction.

In some quarters there even appears to be a perception that ‘kindness’ is somehow a weak, non-scientific and archaic quality far removed, in clinical education, from the cold acquisition of specific academic and clinical skills. But, as practitioners, we are aware that kindness is a powerful factor and acts to not only enhance the therapeutic relationship, but also benefits the ‘giver’. Indeed, Buddhist teaching has long advocated the merit of ‘metta’ a loving kindness and compassion. In addition, Professor Paul Gilbert has recently published ‘The Compassionate Mind‘ which, from a western psychotherapeutic approach, reinforces the very same notion that kindness and compassion do seem to confer benefits on both the giver and the receiver.

Clichéd as it may be, many of us feel that we have a genuine vocation to help others and have long recognised that there is much more to clinical effectiveness than the mantra of evidence based practice alone would imply. To paraphrase John Launer: “I’m not a clever osteopath, but I am a kind one.”²

Wishing you all a very Happy and Healthy New Year

W G Pickering: Kindness, prescribed and natural, in medicine. J Med Ethics 1997;23:116-118 ↩
John Launer: On kindness. Postgrad Med J 2008;84:671-672. ↩

Osteopathy Matters

Cinnamon for Xmas

The Veedee

Professional Regulation?

Respiratory Muscle Exercise and COPD

Osteopathy and NHS awareness

Vascular Claudication

Complex Regional Pain Syndrome

Back to the Future

Deep Vein Thrombosis in Practice

Kindness Revisited

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