Manual therapy and the evidence base

So let’s recap, the world is to complex to understand fully, despite this lack of understanding we can’t default to believing in nothing, as that’s impossible. We are free to choose our beliefs but those choices are determined by the complexity of our psycho-neurological mechanism and its perceptions.
The psycho-neurological mechanism is a pattern perceiver and projector that has evolved to allow us to understand enough to exist in an incomprehensibly complex world.
The social and health sciences accumulate repeated patterns in an attempt to differentiate between irrelevant correlations and causes. Due to the incomprehensibly complex nature of existence the results of these data gatherings only provide us with probabilities.
Alas much of health science still withdraws to reductionism in an attempt to defy complexity. The perfect example being the cocaine and rats experiments. The scientists place rats in a cage with a feeder that feed cocaine and one that provided food. The rats consumed the cocaine until they died. The same experiment was conducted with a fully laid out rat wonder world with wheels and sexual patterns and play grounds and the rats ignored the cocaine. Thus re-defining the causes of cocaine addiction.
The favourite form of reductionism being heralded at the moment is Randomised Control Trials (RCTs). These and the large scale reviews of these RCTs form the basis of evidence based medicine. RCTs suit drug assessment – because a single drug can be administered alongside a placebo by doctors who don’t know what they’re administering to people who don’t know what they’re taking – is it drug or placebo. And a simple answer can be provided.
Manual medicine is in comparison much more complex. People touch each other – heaven forbid – and they touch each other a lot and the full complexity of human interaction takes place. Each individual’s touch is modulated by the touch of the touched and this effects the touch of the toucher in a constant feed back mechanism. The state of mind and body of both weave together and the techniques become unreduceable. Much work has been done to attempt to bring reductive science to manual therapies but none with much success – because this way of assessing manual therapy is fundamentally flawed.
Osteopathy Australia is presently working on an outcome centric project that will hopefully provided a more complex assessment of the effectiveness of Osteopathic treatments and we look forward to their final results.

The fragile analytical base of science

The accumulation and assessment of data is critical to the way we think and behave around health care, but science is much more than just a grouping of probabilities based on empirical accumulations and aggregations of data.
Science like all of our communications is based on a shared language; a shared maths and a shared set of meanings to the words we use.
Empirical science is underpinned by a huge body of analytical knowledge.
Often this underlying and presumed knowledge base isn’t so shared. The reasons and examples for our shared confusion fill our world to bursting; some deliberate, some due to incompetence and some simple human error.
So despite all our elaborate and peer reviewed efforts to ensure drugs don’t make it on to the market that arent safe we still hear about drug companies coughing up millions in fines and recalling medications.
Health care is complex and as such a conservative approach seems to make a lot of sense. Is that new treatment, surgery or drug safe – have you researched the research into it? Have you grilled your medico about the studies related to it. Are there other options?
Manual therapies are often referred to as conservative therapies, because they’ve been long practiced and don’t pretend to be much more than just encouraging our musculoskeletal bodies to function normally.
Sometimes that’s enough to get the body back to doing what it evolved to do.

The freedom paradox

The primary aim of science is to ascertain causal links. So that if a snooker ball hits another snooker ball on the felt of pool table under normal coastal gravitational conditions at a specific angle with a specific spin on the balls the two balls will be caused to deflect in specific predictable ways.
Social and clinical sciences are different as the number of variable involved are astronomically larger however we generally agree that all behaviours and clinical outcome are caused. Ironically we also believing we are free to behave in any way we choose.
These two ideas are contradictory.
We are either free or we are caused? We can’t be both.
And this is the next great paradox.
The second paradox, the paradox of freedom – we are free to do what we choose but having done so we can describe the thoughts that determined that choice

Pattern presumption

Although it is true that the human mind is a pattern apprehending mechanism, perhaps more importantly we are also pattern projectors.
As we look around ourselves it is estimated that we see less than 5% of what’s actually there, the rest is the projection of what our minds expects to be there. We live in this presumptive world. As an example Our dependence on parental care has meant that regions of our brain are given over to facial recognition and we project facial imagery on to cloud formations and the moon and rock surfaces etc.
What is real and what presumed?

Complexity and surrender

Admitting defeat at the hands of life’s complexity, though necessary, is inadequate. Humans are by definition reasoning apes and to merely mutter something about letting your complexity deal with the greater complexity, for all its poetry, is a paltry offering.
First and foremost we must bow our heads to the greatness of that which we desire to comprehend. For it is to great too comprehend. Let us marvel at it instead.
The feeling of the zephyr on our cheek, the delicate dance of palm fronds in the breeze and join with it. The complexity is so beautiful to us.
And then from this new humble stand point let us use our failing senses and flawed thinking, our instruments to find patterns and meaning in it.

The overwhelming nature of complexity

All honest seekers of understanding are eventually overwhelmed by complexity. This is painful as it requires a us to leap reason and accept we are without the mental apparatus to comprehend the world we live in or even the body we inhabit. We can only accept it and live in the moment by letting our complexity live in the complexity.
To combat the pain of this loss I used paradoxes to reassure my mind of its limited function. As it often still likes to think it’s in control. My favourite paradox is this – There is no such thing as nothing. So even the word nothing is something and as a consequence isn’t nothing. So although I think I believe in nothing – that’s impossible. Even that very thought isn’t nothing. There is no such thing.

Ankle and wrist pain

Laurie prides himself on his anatomical knowledge, and in the management of ankle and wrist pain this knowledge is invaluable in the diagnosis, timely referral and appropriate treatment of these joints.

In Lismore and surrounds hosts a strong sporting community, and as such ankle and wrist injuries are common yet strangely few people contemplate how an Osteopath might be able to help management these issues.

The traumatic injury to the wrists and ankles that can happen in football (whatever the code) can cause fractures, ligamentous sprains, muscle strains, nerve impingements and infections in and around the joint. Being able to differentiate between these clinically and refer for appropriate imagery when appropriate is all within the osteopath’s remit. Good quality management of wrist and ankle injuries requires the correct diagnosis.

Once significant pathologies have been eliminated from the diagnosis of wrist and ankle pain, Laurie itemises the muscular guarding and range of motion limitations and addresses these directly. See modalities and techniques for treatment details. Treatment is always followed by home treatment, exercise and stretch prescriptions.

It you are interested in a thorough break down of the present science regarding ankle assessment and treatment please have a look at the clinic key recommended by Osteopathy Australia. (!/content/medical_topic/21-s2.0-1014958?scrollTo=%23refInSitu20090)

myofascial 2 low res

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