National Osteopathic Conference -Auckland 2017 presentation slide produced by Dr Iain Bell.
Iain is a Musculoskeletal Physician who graduated from Otago in 1990 (with distinction), and holds post graduate Diplomas in Musculoskeletal Medicine and Sports Medicine, FRNZCGP, and FAFMM. He is currently completing a Masters in Health Science (Pain and Pain Management).
I am regularly asked what is the difference between an osteopath and a chiropractor; or a physiotherapist and an osteopath. The usual scripted answer is philosophy; and osteopaths do have an axiomatic set of principles that guide their work. However, thats not what really sets osteopaths apart. Chiropractors, physiotherapists and osteopaths all have five years of university training, each is taught the same clinical assessment skill, special orthopaedic assessments, neurological assessments, and simple active, passive and active resisted range of motion assessments. What differentiates an osteopath as a manual therapist can be summed up in two words; palpatory assessment – they focus of their examine is by touch.
This is not to say that chiropractors, physiotherapists don’t touch people or use this sense to assess but osteopaths from their very first class are taught to focus on their palpatory assessment. Osteopaths are taught to assess TART; texture, asymmetry, range of motion and tenderness in a very palpatory way. Texture and tenderness are obviously about touch sensation but osteopaths are interested in how the range of motion feels; its end feel, the quality of the movement in their hands and the feeling of symmetry in the tissues under their hands. Over many years of practice the hands of the osteopath become palposcopes capable of perceiving the integrity of bones and ligaments, the quality of the vascular perfusion of tissues, the neurological integrity as well as the tonicity of muscles and tendons. Studies indicate that after 20 years of practice something extraordinary seems to happen to osteopaths – their bookings and earns suddenly increase substantially (Orrock, PJ 2009, ‘Profile of members of the Australian Osteopathic Association: part 1 – the practitioners’, International Journal of Osteopathic Medicine, vol. 12, no. 1, pp. 14-24.). What is the driver behind this profound change hasn’t been thoroughly teased out but palpatory knowledge must be high on the list of causes.
The same is true of treatment as well as assessment, chiropractors, adjustment trained physiotherapists and osteopaths are all trained to stretching, massage, adjust and perform muscle energy techniques and they all have access to and prescribe exercise regimes – what differentiates the professions is the focus. What is important? Cavitating joints? The exact degree of movement a joint ? Or how it feels to move for both the practitioner and the patient. For the experienced and well regarded osteopath the answer is the last of these. It is their aim above all to assist their patient to find pain free movement as a basis for their recuperation and prolonged quality of life.
Neck pain, headaches and radiating pain in the arms requires a thorough history and clinical examination, and Laurie enjoys these aspects of his practice. A good quality history allows the client time to explain their complaint in detail. Laurie has also tutored in clinic assessment and his knowledge of clinical, neurological, orthopaedic testing is of a university standard.
Diagnosis may also require referral for imaging and Laurie likes to work with general practitioners to ensure that these test are thorough and affordable for the patient.
Neck pain can be divided into primarily musculoskeletal causes, neurological causes, and combination neurological-musculoskeletal. Differentiating between the primary cause of the complaint requires experience and a good knowledge of the structures involved. Laurie has been working on bodies for 20 years and his knowledge allowed him to graduate as the graduate of the year.
Lower back pain (LBP) is suffered by a large majority of people in our society, and it can and does ruin the quality of their lives. There are a host of pathologies that have been implicated in acute lower back pain; everything from cancer to spinal stenosis, from disc herniation to reactive arthritis. Being able to differentiate between these diagnostically is absolutely imperative for appropriate referral and correct treatment and management. That is where osteopaths, physiotherapists and exercise physiologists working together with radiologists have such a vital role to play.
However lower back pain isn’t just restricted to individuals with identifiable pathologies, in fact a great many cases of lower back pain have no identifiable pathological cause and are referred to as simple mechanical lower back pain. Of all the interventions exercise has the strongest evidence base, and Laurie prescribes exercises and stretches for this condition. That said a great deal of study is going in to the relief of lower back pain, particularly chronic LBP and where more exact identification of the specific somatic dysfunction is possible, adjustment and soft tissue treatments, may well be highly cost effective. Larger studies to prove this are underway.
Laurie encourages clients to read the guidelines for the management of lower back pain and to stay active, stay warm and well hydrated.
In Lismore the prevalence of knee pain and injury is significant due to the age of the residents, the large number of people involved in sports and the increasing number of full knee replacements (FKR) being undertaken by the populous.
Correct diagnosis is vital and a thorough knowledge of the anatomy and biomechanics of the knee provides clients with appropriate referral, good quality treatment and a doable and fun exercise program. Apart from fulfilling the requirement of the Osteopathic Masters in anatomy and physiology with high distinction, Laurie has also tutored in both these subjects.
Patients are encouraged should they have ever suffered knee pain or are involved in sports that place their knees at risk to read the information at the following link. basic-knee-injury-prevention.
The journey back to wholism or to be most reasonable the journey back to integrated systems management is perhaps the most important faced by medical science.
Huge distinct silos of knowledge and expertise exist now. No one individual can hope to integrate all the knowledge and know how, so referral mechanism exist to allow a patient to access these complexities. However none of these areas actually exist in isolation from the whole. Rheumatology and dietary information, optometry and cardiovascular medicine are intimately woven together. Dealing with them in isolation may deny the patient the opportunity to understand the fully physiological mechanism involved and lead to treatment of symptoms rather than cause.
In our examination of the epistemology of science you may have noticed a profound similarity between the limitations of the pattern apprehending mechanism of our senses and the reductive practices used in the scientific method.
In science we reduce what is already reduced by the limitations of our senses to find cause and to discover constituents parts to the objects we perceive.
Although all this reduction seems troubling at first it has served us well, through reductive methods by eliminating variables we have discovered the constituent parts to substances that the ancients believed were singular like air, now we know that air consists of nitrogen, oxygen, argon, carbon dioxide, hydrogen and a few other gases and we have even worked out how to seperate these constituents and use them for a host of different specific tasks.
This is the rub, this is the most important part of the equation, the reintegration of the knowledge of the unique constituent back into the complex whole so that knowledge is useful.
It is for this reason scientists use live animal testing because they want to test the effect of therapies on the complexity which is life.
In health science it is not so much the reductive element of research that’s important – it’s the reintegration of the therapy back into the complex whole that is important.
It’s is easy dissect a living creature but sowing it back together so it’s still living is how we discriminate between a surgeon and butcher.
Increasingly science is desperate to test therapies in the most complex and wholistic way they can because it’s the only way they can be proven safe.