Evidence Based Medicine

A welcome revolution is underway in medicine. Once accepted therapies, surgeries and medications are now being tested and reviewed and studied at length to ensure that what is being promised is actually being delivered (Prasad, et.al. “A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices.” Mayo Clinic Proceedings 88, no. 8 (August 2013): 790–98).

Generalised consent to treatment by some mythical all knowledgable practitioner is being replaced by the informed consent of intelligent well studied clients to undergo treatments that have high probabilities of success and known negative risks (Grady, et.al. “Informed Consent.” The New England Journal of Medicine 376, no. 9 (02 2017): 856–67).

A good deal of Osteopathic therapies are under review and many studies are being under taken to prove the efficacy of Osteopathic practice.

Soft tissue techniques are the focus of the work at this clinic and of all the therapies this is the one with the greatest evidence base. Piper, et al.’s systematic review of traffic injury management indicates that musculoskeletal injury of the extremities respond well to soft tissue therapy (“The Effectiveness of Soft-tissue Therapy for the Management of Musculoskeletal Disorders and Injuries of the Upper and Lower Extremities: A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.” Manual Therapy 21 (February 2016): 18–34).

High Velocity Low Amplitude (HVLA )adjustments have come under significant criticism as they may cause injury and aggravation when they are incorrectly or inappropriately administered. Although the attempts at systematic reviewing of HVLA have been compromised by method or numbers of participants, one recent study, July 2017, by Galindez et.al indicates that HVLA increases cervical range of motion, increases grip strength and lowers hypertension (“Effects of Cervical High-Velocity Low-Amplitude Techniques on Range of Motion, Strength Performance, and Cardiovascular Outcomes: A Review.” Journal of Alternative and Complementary Medicine (New York, N.Y.), July 21, 2017.)

The efficacy of Muscle energy techniques (MET) has also been questioned and at present no thorough systematic review has been possible due to a lack of adequate high quality studies. That said one randomised control trial indicates that it is more effective in the medium term at reducing tennis elbow pain than corticosteroids (Küçükşen, Sami, Halim Yilmaz, Ali Sallı, and Hatice Uğurlu. “Muscle Energy Technique Versus Corticosteroid Injection for Management of Chronic Lateral Epicondylitis: Randomized Controlled Trial With 1-Year Follow-up.” Archives of Physical Medicine and Rehabilitation 94, no. 11 (November 2013): 2068–74.)

Possibly the most criticised therapy at the disposal of the Osteopath is craniosacral therapy, which is occasionally practiced in this clinic. Again there are very few high quality studies allowing us to adequately critique this practice. However one review of the studies that do exist indicated that craniosacral therapy reduced pain and increased the participants quality of life/general well-being”(Jäkel, Anne, and Philip von Hauenschild. “A Systematic Review to Evaluate the Clinical Benefits of Craniosacral Therapy.” Complementary Therapies in Medicine 20, no. 6 (December 2012): 456–65.)