Approach to Low Back Pain – Osteopathy

Case

A man aged 42 years, who works as a police officer, presented with severe lower back pain, which he had experienced for 24 hours after spending the previous day helping his brother to move house. He had difficulty ambulating and most movements aggravated the pain. There were no lower limb symptoms and no red flags present on history or examination. He was otherwise well and was not taking any regular medications.

Osteopaths are registered health professionals who work mainly in private clinics and manage various musculoskeletal complaints.1 ..with major studies in anatomy, physiology, pathology, research methods, and osteopathic philosophy and technique. There are similarities with other manual therapies, such as chiropractic and manipulative physiotherapy, but the differences in underlying philosophy, approach to diagnosis, and frequency and duration of consultations provide distinctive practice styles to each discipline.

Osteopathic approach and philosophy

The osteopathic approach to patient care is characterised by holism and places emphasis on the reciprocal relationship between anatomical and physiological structures. The holistic approach also acknowledges psychosocial, environmental and ergonomic factors2 that influence pain and disability. To reach a diagnosis, osteopaths assess symptomatic tissues and other related areas of the body that may influence optimal biomechanical function. Treatment includes manual techniques and patient education.

Research and osteopathy

Although there is a paucity of high-quality research investigating the effectiveness of osteopathic management for many conditions, limited but growing evidence offers support for treatment of low back pain (LBP).3–7 Isolated manual techniques, such as spinal manipulation, have been most thoroughly examined by researchers, but seem to have only a modest benefit for LBP.8 An integrated treatment approach using an eclectic set of manual techniques and advice – as commonly used in osteopathic practice – may be of greater benefit in LBP and a number of randomised controlled trials (RCT) have found improvements in LBP after osteopathic treatment.3–7 Recent RCTs reported that osteopathic treatment was more effective than placebo for chronic LBP interventions,5 more effective than usual medical care for acute LBP,3 and helpful for LBP in pregnant women.4

Initial assessment

Initial osteopathic consultations are up to 60 minutes in duration. The consultation includes obtaining a case history and other relevant medical and health information,9 assessment of red flags10 and gaining patient consent for treatment. If a red flag is identified, patients are immediately referred to their GP for assessment, and in more urgent cases (eg. cauda equina syndrome) referred directly to hospital emergency units. The patient completes a self-report pain questionnaire (eg. visual analogue pain scale) and assessment of changes in activities of daily living (ADLs) to assess pain and functional disability.

The information provided in this case scenario suggests differential diagnoses of lumbar facet joint sprain, lumbar disc pathology or sacroiliac joint (SIJ) sprain. The osteopathic physical examination is informed by the case history and aims to support or exclude differential diagnoses.

Physical examination for the case presented

A physical examination would include the following:

• observation of standing posture
• active and passive range of motion of lumbopelvic, hip and thoracic regions
• occupation and ADL-oriented functional movement testing
• assessment of lumbar and thoracic segmental mobility and tenderness
• palpation of lumbar spine, abdomen and hip soft tissues
• orthopedic tests, including straight leg raise, active straight leg raise test and SIJ pain provocation tests.

Management strategies

Immediate (at initial presentation as stated in the case scenario)

For the case presented here, the osteopath would address restricted and painful areas identified in the examination. Treatment may involve mobilisation or articulation of lumbar and thoracic facet joints, soft tissue massage and stretching of lumbar and hip musculature, and the use of gentle isometric contraction techniques (‘muscle energy’) to encourage better motion, muscle recruitment and decrease pain.11,12 Gentle application of spinal manipulation may be used for the lumbar and/or thoracic spine,13 but suspected intervertebral disc pathology would be a contraindication. The patient would be advised to consult their general practitioner (GP) or pharmacist for appropriate short-term pain relief medications and advised to keep moving within pain limits.

An advantage of the osteopathic consultation is the time available to educate patients and discuss concerns. In this case, the osteopath would explain the likely cause and prognosis, and offer reassurance to the patient that nothing serious was evident, that most acute back pain resolves without the need for ongoing treatment or surgery, and that the patient should aim to be active and return to work as soon as possible.14 The osteopath would discuss sick leave for 2–3 days and schedule a review consultation.

Short term (days to weeks)

Some improvement in symptoms would be expected due to the natural history of acute musculoskeletal conditions. Further manual therapy would be provided, advice given on ADLs, and approaches to return to work within a short period of time would be encouraged. Recommendations for alternative work duties may also be appropriate.

Medium term (up to 6 months)

It is unlikely that this patient would need treatment for more than a few weeks. In the case of other factors being present (ie. yellow, black or blue flags) or re-injury, treatment may include manual therapy, the focus being directed towards active treatment approaches, such as rehabilitation exercises. The implementation of additional outcome measures may be helpful for identification of patients requiring psychological intervention.

Long term (years, including prevention and maintenance strategies)

It is highly unlikely that the patient in this case would require long-term osteopathic treatment. Osteopaths encourage patients to invest time and effort into keeping muscles strong and joints mobile, either though occasional osteopathic manual treatment, ergonomic awareness, their own exercise and rehabilitation program, or a combination of all.

Conflict of interests: None
Provenance and peer reviewed: Commissioned; externally peer reviewed.

References

1. Burke SR, Myers R, Zhang AL. A profile of osteopathic practice in Australia 2010–2011: a cross sectional survey. BMC Musculoskelet Disord 2013;14:227. Search PubMed
2. Fryer G. Special issue: Osteopathic principles. Int J Osteopath Med 2013;16:1–2. Search PubMed
3. Cruser dA, Maurer D, Hensel K, Brown SK, White K, Stoll ST. A randomized, controlled trial of osteopathic manipulative treatment for acute low back pain in active duty military personnel. J Man Manip Ther 2012;20:5–15. Search PubMed
4. Licciardone JC, Buchanan S, Hensel KL, King HH, Fulda KG, Stoll ST. Osteopathic manipulative treatment of back pain and related symptoms during pregnancy: a randomized controlled trial. Am J Obstet Gynecol 2010;202:43–48. Search PubMed
5. Licciardone JC, Minotti DE, Gatchel RJ, Kearns CM, Singh KP. Osteopathic manual treatment and ultrasound therapy for chronic low back pain: a randomized controlled trial. Ann Fam Med 2013;11:122–29. Search PubMed
6. Vismara L, Cimolin V, Menegoni F, et al. Osteopathic manipulative treatment in obese patients with chronic low back pain: a pilot study. Man Ther 2012;17:451–55. Search PubMed
7. Williams NH, Wilkinson C, Russell I, et al. Randomized osteopathic manipulation study (ROMANS): pragmatic trial for spinal pain in primary care. Fam Pract 2003;20:662–69. Search PubMed
8. Rubinstein SM, van Middelkoop M, Assendelft WJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for chronic low-back pain: an update of a Cochrane review. Spine 2011;36:E825–46. Search PubMed
9. Orrock P. Profile of members of the Australian Osteopathic Association: Part 1 - The practitioners. Int J Osteopath Med 2009;12:14–24. Search PubMed
10. Downie A, Williams CM, Henschke N, et al. Red flags to screen for malignancy and fracture in patients with low back pain: systematic review. BMJ 2013;347. Search PubMed
11. Degenhardt BF, Johnson JC, Hagan C. Osteopathic manipulation reduces pain and improves quality of life. Int J Osteopath Med 2013;16:e11–12. Search PubMed
12. Greenman PE. Principles of Manual Medicine. 3rd edn. Philadelphia: Lippincott William & Wilkins, 2003. Search PubMed
13. de Oliveira RF, Liebano RE, Costa LdCM, Rissato LL, Costa LOP. Immediate effects of region-specific and non-region-specific spinal manipulative therapy in patients with chronic low back pain: a randomized controlled trial. Physical Therapy 2013;93:748–56. Search PubMed
14. Brooks P, March L, Bogduk N, et al. Evidence-based management of acute musculoskeletal pain. Australian Acute Musculoskeletal Pain Guidelines Group. Brisbane: Australian Academic Press, 2003. Search PubMed

This article originally appeared on racgp.org.au and was written by Brett Vaughan, Tracy Morrison, Della Buttigieg, Chris Macfarlane and Gary Fryer.

Acupuncture and Seasonal Allergies

Symptoms of running nose, sneezing, and watery itchy eyes that recur during specific parts of the year (especially Spring and Fall) are a cause of much suffering of a large segment of the U.S. population. Millions of dollars are spent on medications and the allergy shots for the treatment of seasonal allergies.

Western medicine views seasonal allergies as a form of immediate hypersensitivity reaction which occurs when anti-bodies produced by lymphocytes interact with airborne particles such as pollen. Western medicine describes the locations of lymphocytes in addition to being in the blood stream as also in Peyer's patches in the gastrointestinal tract, spleen, lymph nodes, and bone marrow. Interestingly in my practice of acupuncture the Spleen, Stomach, and Large Intestine meridians are utilized a great deal. One sees an interesting overlap of Western and Chinese medical thought. Also, Chinese medical thought sees sweets as being harmful to the Spleen (Chinese sense of the Spleen) function. In my practice sweets are often a major factor in the persistence and intensity of seasonal allergy symptoms.

I find it gratifying to treat seasonal allergies with acupuncture. There is often a quick response. Often patients get some relief during the first visit while lying on the exam table with their acupuncture needles in place. Patients are asked to score their nose stuffiness on a zero to ten scale. Zero meaning no stuffiness at all and 10 being the worst possible stuffiness for the patient. A score may be determined before and after the acupuncture treatment. Patients can also determine the effectiveness of acupuncture treatment by tracking the number of sneezes per day and the number of itching episodes around their eyes. After an initial series of treatments, patients come in for further treatments on an as needed basis. Some patients come back in once or twice a year for a booster while others may come more often. In general, patients do better if they avoid sugar and milk in their diets. They have better and longer lasting responses. I have seen many patients who failed medication and allergy shots respond to acupuncture. Patients continue with whatever standard treatments they are currently undergoing while getting acupuncture treatments. Most patients end up significantly reducing or eliminating their dependence on allergy medications.

There are many different ways of performing acupuncture, for example TCM (Traditional Chinese Medicine), Japanese, Korean, French Energetics, Worsley 5 Elements, ear, hand, etc. In choosing an acupuncturist the specific style a practitioner uses is not so important as the success rate a practitioner obtains with whatever style they use. Prospective patients should speak with the acupuncturist and inquire about past experience in treating seasonal allergies and their success rate.

In conclusion, it is my opinion that acupuncture is an excellent treatment option for seasonal allergies.

this article originally appeared on medicalacupuncture.org and was written by  Patrick J. LaRiccia, M.D.


 

Massage Therapy With Our Student Massage Therapist

Tristen Threefingers, Student RMT

Offering therapeutic and relaxation treatments to help people get back in to balance with movement, function and sense of ease!

Our passionate student massage therapist, Tristen Threefingers, has returned to Reset Wellness to complete her second year practicum with Makami College. In early 2017, Tristen provided our clients with effective care and treatment, making a strong impact in the quality of life and health in our community. Her contribution to the clinic's environment and team had her being praised wide and far.

Tristen provides Massage Therapy treatments at Reset Wellness as a registered student Massage Therapist with the City of Edmonton and CRMTA. Since she hasn't graduated from her program yet, (not until April 2018), and her treatments cannot be claimed through insurance, but are offered at a discount rate--serving as an option for people who do not have insurance coverage or have none left!

Tristen is highly professional, up beat, caring and thorough. She specializes in deep tissue treatments, sports massage and hot stone massage. She enjoys tackling challenges and learning from them, and would like to further her skills in neuromuscular and orthopedic treatments. She is committed to sharing her knowledge and talent with individuals to relieve pain, stress and anxiety, and restore balance and harmony. 

We are so excited to have her back with us and hope to see you booking your appointment with her!

Student RMT Massage Therapy Pricing

30 minutes for $35
60 minutes for $55
90 minutes for $75
 

What is Therapeutic Massage?

Therapeutic Massage

Therapeutic massage seeks to obtain a therapeutic benefit. While therapeutic massage is often relaxing, the end goal of the session or series of sessions is not relaxation.

Therapeutic goals can vary considerably between massage therapists and clients. In some cases, massage is recommended by a health professional and may be performed as part of a larger treatment plan. For example, someone attending physiotherapy for an injury might have regular therapeutic massage to loosen muscles, improve muscle tone, and increase their flexibility. Likewise, therapeutic massage can be used to supplement wound care, cancer care, and a variety of other treatments.

People can use therapeutic massage as a standalone treatment. Some people, such as athletes, labourers or stressed out even office workers, receive regular therapeutic massage to keep themselves in good physical condition.

People of all ages can benefit from therapeutic massage when it is performed by a competent and fully qualified remedial massage therapist. Massage is also suitable for people with disabilities, expecting mothers, and people in treatment for medical conditions, although some special precautions may need to be taken to protect the health of the client.

Basic therapeutic massage techniques are derived from a variety of massage styles. Your massage therapist will tailor your massage techniques depending on your needs. If you are unsure whether or not massage is appropriate for you, please call us at PhysioWorks for individualised advice.

How Does a Therapeutic Massage Help You?

Therapeutic Massage is a combination of Relaxation Massage and Remedial Massage to not only relax your whole body but at the same time, work through some of the muscle issues or “tight spots” you may be experiencing.

Massage therapy may also improve your circulation, which enhances the delivery of oxygen and nutrients to muscle cells and helps remove waste products or reduce swelling. These circulatory effects of massage may have value in the treatment of some inflammatory conditions, such as arthritis.

Massage therapy induces a relaxation response, which lowers your heart rate, breathing rate, and blood pressure; plus boosts your immune system; and generally decreases the physical effects of stress.

These effects suggest that massage may be helpful for a wide range of conditions.

What Conditions Benefit from a Therapeutic Massage?

Massage therapy helps your body in numerous ways. Massage can relax muscle tissue, which may lead to decreased joint and nerve compression, increased joint and muscle range of motion. This commonly results in less pain and improved function.

Therapeutic massage benefits the following conditions:

• Stress
• Anxiety
• General Wellbeing
• High Blood Pressure
• Arthritis
• Low Immunity
• Minor injuries

When are the Best Times for a Therapeutic Massage?

The best time for a therapeutic massage is when you feel yourself getting worked up or when you are just not feeling your best.

Others find a regular therapeutic massage every month or two to be a great dose of prevention therapy. We even have some highly stressed patients who have weekly massages just to cope with daily life.

What Duration is the Best Therapeutic Massage?

If you have never had a therapeutic massage before or it has been quite some time since your last massage then your initial treatment should ideally be for 60 to 90 minutes so that the therapist can work through those tired muscles at an even pace to minimise any possible soreness the following day. 

If you are a more regular massage recipient, your massage therapist will guide you as to the direction that works best for you and your muscles.

What Massage Frequency Works Best?

Everyone needs differ depending on your lifestyle. As a guide, regular therapeutic massages work best when on a 4 to 6-week basis. This is because your muscles need to keep relaxed and moving through their full available range. Otherwise, they become “creatures of habit”. If tense is how they are most often, that’s what they will consider normal. And… we all know what that leads to… tight muscles, stress, and pain!

For optimal results and less potential for muscle soreness the day post-massage, having a regular massage will keep your body from not only reacting to the positive change we are trying to provide, but it can also retrain your body to help itself and provide you with a better healthier you.

For advice specific to your therapeutic needs, please ask your massage therapist how regularly they feel that you should have a massage to function optimally.

This article originally appeared on physioworks.com.au and was written by Jodie Woulfe