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.
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 ↩
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.
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.
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still to come
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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……………………………………………………………..
]]>http://www.manualtherapyjournal.com/article/S1356-689X%2808%2900136-7/abstract
]]>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
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
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