Osteopaths on the loose...

[Neuromuscular Therapist]

That study once again is not applicable if you ask me because - because anyone worth their salt will incorporate more than just one type of therapy, some soft tissue massage, maybe manipulation if deemed appropriate, with pilates, other exercise, or simply stretching instruction - seeing that is "real world" treatment we need to study more real world situations.

I completely agree. In my practice I use more than just one mode. In my practice I regularly use MET (Muscle Energy Technique), STR (Soft Tissue Release), Myofascial Release, Strain, Counter strain, Positional Release and Neuromuscular Technique, which is working to locate and de-activate Trigger Points. I use a mixture of techniques, according to the client in front of me, what their problem is and their needs.

[QUOTE=The problem with manual therapy is that no matter what you know regarding evidence, as a practitioner you are going to do the same thing because you have a limited scope of practice. There is no technology coming to help you out and you can't administer medicine or do surgery. So anyone in a manual therapy will cling tightly to their techniques as a holy grail. having said that I still think it is worth a full exploration to see exactly how beneficial it really is and this is a long way off.
[/QUOTE]

I don't quite see how manual therapy has a limited scope of practice? Yes, if you are doing manual therapy, then you are not performing surgery, however, within the scope of manual therapy there are lots of techniques that can be used - massage, deep tissue massage, myofascial release, soft tissue release, Trigger Point work, muscle energy technique, positional release, stain/counter strain, exercise advice, stretching, facilitated stretching and postural assessment.

[Pebble]

[quote=Neuromuscular Therapist;44706]I completely agree. In my practice I use more than just one mode. In my practice I regularly use MET (Muscle Energy Technique), STR (Soft Tissue Release), Myofascial Release, Strain, Counter strain, Positional Release and Neuromuscular Technique, which is working to locate and de-activate Trigger Points. I use a mixture of techniques, according to the client in front of me, what their problem is and their needs.

[\quote]

Muscle energy technique
Soft tissue release
Myofascial release
Positional release

Nice terms: do they simply describe what you do, or the impact in the body, if the latter any evidence base? How do you know that the muscle energy technique does something to the metabolism of the muscle, if so what how much, for how long etc?

[Neuromuscular Therapist]

[
Nice terms: do they simply describe what you do, or the impact in the body, if the latter any evidence base? How do you know that the muscle energy technique does something to the metabolism of the muscle, if so what how much, for how long etc?

Oh, sorry, but I thought you came here claiming to know something about osteopathy or osteopathic practice? Evidently I was wrong in my assumptions!! A lot of the techniques that I have mentioned are used routinely by osteopaths as part of their soft tissue work. They are also used regularly in sports massage practice and yes, there is an evidence base to back them up.

The aim of MET is firstly to inhibit the muscle and then to lengthen it so that you can then achieve more movement.

The aim of any manual therapy should be to locate short and tight muscles and use techniques/methods to lengthen them. Short and tight muscles will cause pain, so when the muscles are then lengthened the pain will be reduced because an overall muscular balance has been achieved.

[Don't drink the bongwater]

All different ways to poke, prod, press and stretch. Only theorized mechanisms of action and no particularly strong evidence as yet that any is more effective in a particular condition than another, but one again they are typically performed in concert with other techniques, so those studies would be practically worthless if done.

[Pebble]

Oh, sorry, but I thought you came here claiming to know something about osteopathy or osteopathic practice? Evidently I was wrong in my assumptions!!

Can't imagine where you got that idea. I am questioning the strength of evidence not claiming to be a practitioner. I am not a mechanic, but before I buy a car I want to know what it does, and whether it is better than the alternatives, ideally with independently verifiable data. The same holds for osteopathy or any other 'treatment'. Descriptions of what you believe you are achieving are fine, but not evidence.

[Acleron]

Can't imagine where you got that idea. I am questioning the strength of evidence not claiming to be a practitioner. I am not a mechanic, but before I buy a car I want to know what it does, and whether it is better than the alternatives, ideally with independently verifiable data. The same holds for osteopathy or any other 'treatment'. Descriptions of what you believe you are achieving are fine, but not evidence.

Quite clear, and perhaps nobody saw my question.

In your opinion, what is the best evidence that Sports and Remedial Massage is useful?

Is there any evidence, apart from the fact you do it, and it might be an inconvenience to you and your patient if you do not have any evidence for the treatment?

[Pebble]

A lot of the techniques that I have mentioned are used routinely by osteopaths as part of their soft tissue work. They are also used regularly in sports massage practice and yes, there is an evidence base to back them up.

Any chance of sharing some of this evidence, as requested by:

Quite clear, and perhaps nobody saw my question.

Is there any evidence, apart from the fact you do it, and it might be an inconvenience to you and your patient if you do not have any evidence for the treatment?

and

How do you know that the muscle energy technique does something to the metabolism of the muscle, if so what how much, for how long etc?

and

... have you compared the available database on physiotherapy to sports massage in properly conducted, randomised trials?

[Don't drink the bongwater]

Is there any evidence, apart from the fact you do it, and it might be an inconvenience to you and your patient if you do not have any evidence for the treatment?

Only un-scientific evidence I have for sports massage is that when I get sore legs or sore lower back and get a massage it feels great and I feel reduced (and many time completely absent) discomfort afterward. Until I go do something crazy and mess it up again, which happens a lot.

By the way Pebble, are you in the market for a therapist of some sort - I figured with the car analogy you might be hinting you have a niggle that needs tending to?
Based on that comparison, I'd really rather own a Honda or Toyota than a Jaguar considering reliability, but I bet someone with a far bigger wallet would think differently about the whole situation. In the end the market will decide and vote with their feet......

It might be a good opportunity to go for a "test drive" and then you can report back the experiences. Only thing is they tend not to give out free samples

[Pebble]

By the way Pebble, are you in the market for a therapist of some sort - I figured with the car analogy you might be hinting you have a niggle that needs tending to?
Based on that comparison, I'd really rather own a Honda or Toyota than a Jaguar considering reliability, but I bet someone with a far bigger wallet would think differently about the whole situation. In the end the market will decide and vote with their feet......

Sorry to disappoint, but as the evidence base that I have been able to access supports the Alexander technique, then physiotherapist guided exercise then simple analgesia - I have enough to be getting on with.

As for the cars, how one chooses the best may vary and indeed the depth of the pocket may be a deciding factor, but that does not mean that on any given parameter one cannot compare - e.g. social kudos.

[Acleron]

Only un-scientific evidence I have for sports massage is that when I get sore legs or sore lower back and get a massage it feels great and I feel reduced (and many time completely absent) discomfort afterward. Until I go do something crazy and mess it up again, which happens a lot.

I was advised to have a massage after strenuous exercise and felt worse. My conclusion was that anecodotal evidence is worthless. But if you have evidence for your conclusions, please supply it. Don't waste your time with anything else, just supply the most convincing evidence you have.

By the way Pebble, are you in the market for a therapist of some sort - I figured with the car analogy you might be hinting you have a niggle that needs tending to?
Based on that comparison, I'd really rather own a Honda or Toyota than a Jaguar considering reliability, but I bet someone with a far bigger wallet would think differently about the whole situation. In the end the market will decide and vote with their feet......

It might be a good opportunity to go for a "test drive" and then you can report back the experiences. Only thing is they tend not to give out free samples

Oh dear, a train wreck coming soon.

[Don't drink the bongwater]

Seeing we like to cut to the pleasantries around here:

Here's another approach I used to find highly useful - the centralization principles of Robin McKenzie - there's more than a little bit of lit supporting this idea too. Best of all you can teach people and they can help themselves...

http://www.mckenziemdt.org/libResear...fm?section=int

[Acleron]

Seeing we like to cut to the pleasantries around here:

Here's another approach I used to find highly useful - the centralization principles of Robin McKenzie - there's more than a little bit of lit supporting this idea too. Best of all you can teach people and they can help themselves...

http://www.mckenziemdt.org/libResear...fm?section=int

OK, I made an assumption that the best evidence would be cited. Your ref lists 35 refs each less than an abstract. So searching for the first ref I find: Overview Supportive Studies: McKenzie Method of Mechanical Diagnosis and Therapy (MDT). This is also a paper that has ten refs, none of which gives any real data. The idea of asking for your best evidence was so that we could discuss that evidence. Out of all those refs, could you supply one that is published in a reasonable journal and supports, say, the McKenzie method.

[Pebble]

Here's another approach I used to find highly useful - the centralization principles of Robin McKenzie - there's more than a little bit of lit supporting this idea too. Best of all you can teach people and they can help themselves...

http://www.mckenziemdt.org/libResear...fm?section=int

Thanks for this. Quite a bit to work through, so I will probably bite off just one section to try and get the original information to report back on. Superficially, the impression is of little evidence of signficant benefit from the better conducted trials, but general support for the exercise/posture based approach rather than passive (massage) approach.

[Don't drink the bongwater]

OK, I made an assumption that the best evidence would be cited.

I'll save you the trouble.

Spine. 2006 Apr 20;31(9):E254-62.

The McKenzie method for low back pain: a systematic review of the literature with a meta-analysis approach.

Machado LA, de Souza MS, Ferreira PH, Ferreira ML.
Universidade Federal de Minas Gerais, Belo Horizonte, Brazil. lmac3689@mail.usyd.edu.au
STUDY DESIGN AND OBJECTIVES: Meta-analysis of randomized controlled trials to evaluate the effectiveness of the McKenzie method for low back pain (LBP). SUMMARY OF BACKGROUND DATA: The McKenzie method is a popular classification-based treatment for LBP. The faulty equation of McKenzie to extension exercises (generic McKenzie) is common in randomized trials. METHODS: MEDLINE, EMBASE, PEDro, and LILACS were searched up to August 2003. Two independent reviewers extracted the data and assessed methodologic quality. Pooled effects were calculated among homogeneous trials using the random effects model. A sensitivity analysis excluded trials reporting on generic McKenzie. RESULTS: Eleven trials of mostly high quality were included. McKenzie reduced pain (weighted mean difference [WMD] on a 0- to 100-point scale, -4.16 points; 95% confidence interval, -7.12 to -1.20) and disability (WMD on a 0- to 100-point scale, -5.22 points; 95% confidence interval, -8.28 to -2.16) at 1 week follow-up when compared with passive therapy for acute LBP. When McKenzie was compared with advice to stay active, a reduction in disability favored advice (WMD on a 0- to 100-point scale, 3.85 points; 95% confidence interval, 0.30 to 7.39) at 12 weeks of follow-up. Heterogeneity prevented pooling of studies on chronic LBP as well as pooling of studies included in the sensitivity analysis. CONCLUSIONS: There is some evidence that the McKenzie method is more effective than passive therapy for acute LBP; however, the magnitude of the difference suggests the absence of clinically worthwhile effects. There is limited evidence for the use of McKenzie method in chronic LBP. The effectiveness of classification-based McKenzie is yet to be established.

BTW, shall I pdf all papers in future and deliver them to your inbox or do you deem references acceptable? I'd have assumed going with the systematic reviews first was obvious....

Try this link: http://www.sciencedirect.com/science...617754529d2b3a

[Pebble]

Don't drink the Bongwater,

Thanks for those links, save the trouble of going through the background data, which was rather tedious as the original link mixed many articles of variable quality together. In the same issue is an excellent overview of the evidence base for all the therapies discussed, and I have to say it is quite depressing, some evidence of superiority here and there but all much of a muchness I think with one or two clear rubbish approaches.

http://www.sciencedirect.com/science...a60e76fd9fcdb0