Osteopathy - biomechanically analysing the cause of injury including secondary effects.

What is the Origin of Osteopathy?
It is well to remember that the first drug to be manufactured was aspirin in 1899 by Bayer. Prior to that medical doctors had a more diverse role than today, dispencing herbal remedies and other plant drugs such as foxglove (1785) and morphine (1803), mineral drugs including large doses of heavy metals, tending, cuts and abrasions, stitching wounds, setting broken bones and performing Osteopathy. In the Hollywood Westerns, doctors are often referred to as "sore bones".

It is not surprising that in settling America lots of injuries occurred and new medical schools flourished. The first Osteopathic college was established by a medical doctor, Doctor Andrew Taylor Still, in 1892 in Kirksville Missouri. Unhappy with the way other doctors prescribed the medicines of the day to excess Still sought more holistic approaches. He rejected the idea that germs alone cause disease but that diseases where more common when bones moved out of place and disrupted the flow of blood or the flow of nervous impulses making the body more susceptible to disease. He therefore concluded that one could cure diseases by manipulating to restore the interrupted flow. Observing that the human body had much in common with the machines he worked on in earlier life, Still approached the study of the human body as one would approach the study of a machine. Over time and with his study of medicine he developed a series of specialised physical treatments for which he coined the name 'Osteopathy'.

Today Osteopathy is taught in 19 different medical schools in the United States and three universities in Australia.

What is the Difference between Osteopathy and Chiropractic?
Chiropractic was started just after Osteopathy by Danial David Palmer in 1897 in Davenport Iowa. In September 1895 D.D. Palmer, a magnetic and spiritual healer manipulated the forth or fifth dorsal vertebra in the upper back of a Negro janitor Harvey Lillard and claimed to restore his hearing fully after 17 years of deafness. D.D. Palmer coined the term 'Chiropractic' meaning to practise by hand with manipulating or adjusting spinal vertebra 'with one move'. In so doing he dispensed with the Osteopathic approach of first working with the supporting muscles and ligaments in conjunction with re-alignment of the musculo-skeletal system.

The Osteopathic treatment approach therefore provides a broad range of both direct (soft tissue massage, manipulation, muscular energy techniques, mobilisation, articulation, proprioceptor neuro-muscular facilitation and stretching muscle, myofascial release techniques) and indirect techniques (functional strain/ counter strain, posture, exercise, diet, supplements, visceral and constitutional) integrated to formulate the most effective approach indicated by the clinical diagnosis.

Therefore mainstream Chiropractic is more a system of joint release only while Osteopathy addresses the supporting tissue involvement prior to joint mobilisation and gentle manipulation.

What is the Difference between Osteopathy and Physiotherapy?
Where Physiotherapy is primarily a soft tissue modality using some hands on techniques and often incorporating machines such as ultra-sound and micro-wave, Osteopathy combines this soft tissue approach with biomechanical re-alignment through manipulation of the skeletal joints of the neck, spine, pelvis and all the joints of the limbs.

Osteopathy describes a musculoskeletal system, a system of muscles and bones working together to create movement at our joints, that muscles don't work independently of the skeleton and the skeleton doesn't work independently of the muscles, they work together.

Dysfunction is therefore both muscular and skeletal. To maximise the most efficient and fastest recovery Osteopaths believe that both aspects need to be addressed simultaneously.

What does the Training Involve / How Safe is Osteopathy?
Osteopathy is the fastest growing and safest allied health profession in Australia. Osteopaths are registered with every state medical board in Australia. Osteopaths like general practitioners are classified as primary care practitioners meaning they are trained and registered to diagnose and treat in Osteopathy. To be registered, Osteopaths must complete a science degree and a post graduate masters degree in Osteopathy, a total of five years full-time tertiary training. This involves a two year internship where real patients are treated in an out-patients clinic.

The training is broad and diverse and includes a wide range of techniques including neck, spinal and pelvic mobilisation, manipulation and balancing, cranial, cranio-sacral and sacro-occipital techniques including jaw or TMJ (tempro-mandibular joint) re-alignment, soft tissue massage, deep tissue massage, myo-fascial and neuro-muscular release techniques, trigger point therapy, stretching, strain / counter strain techniques and visceral techniques for constitutional problems of the cardio-vascular, gastro-intestinal, pulmonary, lymphatic and uro-genetal systems.

Osteopathy is a very safe, gentle and effective system because of the time taken in preparing the soft tissues prior to joint mobilisation and so safe it is used on children, the elderly, pregnant women and even new born babies.

What Type of Injuries / Conditions do Osteopaths Treat?
Osteopaths treat all musculo-skeletal injuries and dysfunction of every part of the body as well as visceral or constitutional problems. Osteopaths take a holistic approach to your problems with a bio-mechanical re-alignment and balancing emphasis in conjunction with a keen interest in your diet, nutrition, posture, exercise and lifestyle as these impact directly and indirectly on your health and wellbeing. They are wellness practitioners.

Injuries and dysfunction can occur from incorrect lifting, falls and sprains, horse, bike and car accidents, from sporting injuries, from bad posture or a bad work station at work, on the computer and from general slouching particularly in the car and relaxing at home.

Osteopaths treat all muscles and joints of the body including the neck, spine, ribs and pelvis, the hips, legs, knees, ankles and feet, the shoulder girdle, arms, elbows, wrists and hands and even the jaw or temporo-mandibular joint (TMJ). Below are a few examples of some of the conditions that Osteopaths treat.

• Jaw pain and dysfunction, clenching and grinding of your teeth
• Cranial Osteopathy
• Cervical or neck pain including whiplash injuries
• Headaches and migraines
• Thoracic or back pain including rib pain and sternum pain
• Lower back pain, pelvic pain, hip pain and gluteal or buttock pain
• Sciatica and referred pain, ITB pain
• Curvature of the spine, scoliosis and spinal dysfunction
• Subluxations, back strain, back injury, correct alignment and musculo-skeletal balance
• Frozen shoulder, shoulder girdle, stero-clavicular and acromio-clavicular pain
• Elbow pain, wrist pain, hand and finger pain
• Tennis elbow, golfers elbow and other sports injuries
• Knee pain, ankle pain, foot pain including plantar fasciitis and metatarsalgia, toe pain
• Sprained ankles including Achilles tendon pain
• Muscle spasm and cramps including dietary advice / magnesium supplementation
• Muscle and ligament strains and tears of arms and legs eg calf tears, hamstring tears
• Heat or ice, when to apply
• Lymphatic drainage, bloating, abdominal cramps and pain, constipation, sluggish bowel
• Postural correction, movement and exercise, how to sit, move and sleep with back pain
• Spinal analysis / spinal assessment, diagnosis and treatment or management plan
• Full medical report and treatment plan provided with all initial consultations
• Work cover assessment / treatment including RSI (repetitive strain injuries) from overuse
• Ergonomic assessment and advice
• Medico-legal reports, corporate assessments
• Pregnancy, neonatal and childcare treatment and advice
• Arthritis pain and stiffness relief, dietary and supplement advice
• Supplements to maximise healing and minimise injury especially sports nutrition

What Happens in an Osteopathic Session?
An initial Osteopathic session last for 30 to 40 minutes depending on the complexity of your problem. On arrival you will be asked to fill out a form with your relevant details.

Once you are with the Osteopath a full history is taken of your condition, your presenting symptoms and any signs or triggers you may have noticed which can be of great help in understanding the background to your problem. So that the Osteopath can examine you and then subsequently treat you, you may be asked to remove some of your clothing > Women are provided with a clean hospital gown.

The Osteopath then performs a full and thorough examination, may do various orthopaedic or neurological tests and examines any x-rays you may have with you. It may be necessary in some severe or complex cases to have x-rays taken before proceeding with treatment if you don't already have them. Once the Osteopath is satisfied with the examination and investigations a diagnosis is made. The diagnosis and treatment plan will be discussed with you before treatment commences.

The treatment approach has been mentioned above but will usually commence with a thorough soft tissue work up involving extensive therapeutic massage and various Osteopathic release techniques so that the joint restriction can be corrected more easily and more gently. The emphasis is to balance the musculo-skeletal system especially the pelvis and to mobilise any painful restricted spinal and peripheral joint.

Following the initial consultation a medical report is prepared listing the complaint history, the examination findings, the diagnosis, treatment plan, response to the initial treatment, advise on what to do and what not to do especially regarding work, sport, exercising, stretching and general movement and recommendations on how to get the most out of your treatment. You will be advised when to have your follow up treatment and given an idea as to how long it will take to correct your problem which will depend on whether your problem is a recent acute injury or a chronic complaint.

Can I have Osteopathy on my private medical insurance?
Most private health funds give benefits for Osteopathic treatment. Reimbursement will depend on the insurer and the plan you have chosen. Contact the helpline of your insurance company who will explain the actual benefits and methods of claim for your individual policy. If your Health Fund is a member of HICAPS we can reimburse your benefit at City Clinic.

Muscle Energy Techniques (MET):
The principle is similar to PNF (post-neural facilitation) techniques. MET is used to re-correct proprioceptive information regarding joint position, and muscle tone. The physiological principle is based on neural reflexes which contract the agonist muscle, whilst simultaneously contracting antagonist muscles during joint movement. This allows the range of a joint or tissue to be extended post isometrically as the nervous system resets its proprioceptive information. Application of this technique is particularly useful during acute stages of pain and inflammation, and when manipulative techniques are contraindicated.

High Velocity Low Amplitude Techniques (HVLA) - Manipulation:
Manipulative techniques are based on the application of a rapid thrust to a joint in an attempt to improved range of motion and reduce pain. The joint itself is not taken beyond its anatomical range, therefore minimising the risk of injury. Such techniques are particularly useful in acute conditions when excessive soft tissue movement and mobilisation can exaggerate inflammation.

Articulation:
Has both a diagnostic and therapeutic component. Accessory joint play is vital for the normal congruency and function of healthy joints. Similarly muscle attachment in inflammatory conditions such as tendonitis is often effected by poor accessory joint movements. Articulatory techniques are particularly useful for restoring passive joint movements and avoiding inflammatory responses associated with gross passive movements or active muscular contraction.

Myofascial Release Techniques:
Myofascia or connective tissue has an integral function within the human body. Not only does it act as a protective mechanism enveloping all structures it serves as the medium in which our immune system flows. Lymph channels flow through the connective fascia pathways. Myofascia is prone to restriction and stasis in the same way that muscle tissue is. Myofascial techniques are similar in application to soft tissue massage with the exception to the time in which a release is achieved. The technique often takes 3-5 minutes to perform effectively. Restrictions in fascia manifest as joint restrictions and pain.

Functional Techniques:
Functional osteopathy or positional release utilises physiological properties existing within neural tissue. It aims at gently mobilising restrictions and creating a self awareness within the structure, allowing it to be repositioned or to relax. Proprioceptive reflex pathways are integral for the success of functional techniques. This is particularly useful with joint position and joint range restrictions and myofascia. By either engaging barriers directly or indirectly (i.e. towards a restriction or away from restriction) the body adapts to the change in stimuli. By taking the tissue into its ease position there is a reduction in afferent neural bombardment to the CNS which has the reciprocal affect on efferent stimuli. The end result is a reduction of neural tone, tissue spasticity and muscle spasm allowing joints to move freely.

Carpal Tunnel syndrome is caused by compression of the median nerve at the wrist. This nerve is responsible for sensation along the outer part of the hand and controls movement of some of the muscles in the hand. Clinically it is diagnosed with functional orthopaedic tests and where possible a nerve conduction study. Despite diagnosis, there is however other functionally related aggravating factors to consider.

Often patients with carpal tunnel have what is termed a secondary entrapment site. This may be at the neck (due to arthritic changes) or anywhere along the course of the nerve i.e. beneath a muscle belly, or between a ligament and bone. Effective management of the entrapment at the wrist must involve examination of other possible entrapment sites.

Myofascial tone of the effected limb is also restricted in patients with carpal tunnel. This reduces tissue elasticity and affects the pressure gradient between the nerve and surrounding structures adding to the compression.

Due to the compression the blood flow to the nerve is compromised, which further affects the nerve and aggravates the symptoms

Joint position and range is almost always reduced in patients with carpal tunnel. Restrictions and the wrist, elbow and spine must be addressed to restore normal functional capacity.

Osteopathic management of carpal tunnel is based on the above mentioned changes. Restoration of the functional capacity of the upper limb and neck give the patient the best chance of recovery.

Surgery is often recommended to patients with carpal tunnel syndrome and has a limited success rate for various reasons. One thing to consider is the scar formation post operatively and the carpal tunnel. The incision itself can cause a proliferation of scar tissue and over time can make symptoms return and even worsen.