Evidence Based Osteopathy Treatments
Imagine if your osteopath spent countless hours acquiring the knowledge and skills to decipher the unique characteristics of your specific conditions, then created a personalised plan to help you move better, feel better and get better.
At YouMove Osteopathy, that is exactly what we do!
Our Mount Eliza osteopaths have all learnt, at a post-graduate university level, how to analytically critique scientific research. Our osteopath’s all have Masters level qualifications which involved significant hours spent both applying and performing research.
Whilst “doing your research” to some people means a google search. Research really should be done through reading scientific journals or clinical studies. The truth is that most people don’t even do this. The real skill really comes after this. It is identifying meaningful research. Research studies that were performed well. Then, applying the right information to the conditions that present to us in the clinic.
Evidence based osteopathy treatments would suggest a treatment approach that only considers research, without any consideration for practical experience, or your individual preferences.
Evidence informed osteopathy treatments involves research conducted by your osteopath to create the best clinical strategies to achieve your optimal outcome. These strategies are then applied to you, as an individual, using a balanced mix of scientific research, practical experience, and your individual preferences.
The interchangeability of these two phrases often leads to the preference for evidence ‘based’ treatment, chosen for its simplicity. Nevertheless, our emphasis lies in evidence ‘informed’ treatment, acknowledging the crucial role of individual characteristics. Mastering the art of analysing and critiquing published research is a refined skill that takes years to develop, enriching the process with depth and expertise.
Evidence informed osteopathy is a pragmatic approach to clinical evaluation and therapeutic treatment incorporating:
The osteopath’s experience.
The individual preferences and characteristics of the person needing help.
The osteopaths at YouMove Osteopathy use their research analytical skills and clinical expertise when searching for information to help you get better. Then develop evidence informed treatments using their experience, the most appropriate scientific reports, and your individual needs.
How do Our Osteopaths use Evidence Informed Treatments?
We leverage our extensive experience and regular discussions with fellow osteopaths to inform our approach, integrating new research where necessary for individual cases. Conducting research after every client appointment isn't feasible, but we prioritize staying informed through continuous engagement with the field.
Here are some examples of recent research analysis conducted by our osteopaths and how they used the information to help their clients.
Does Sitting Posture Increase Pressure on the Lumbar Discs?
Kai presented to YouMove Osteopathy complaining of lower back pain. The clinical picture suggested that Kai’s pain was likely discogenic– that is, it’s likely related to a strain of an intervertebral disc in the lower back. Kai reports that his pain is worse when sitting for long periods of time.
For the past 50 years, researchers have been studying the effect of certain postures on disc pressure. Nachemson and Elfstrom concluded that sitting postures increased pressure on the disc. They measured the pressure on the discs in the lower back in different sitting positions (see the picture below). [i][ii] Research such as this lead many osteopaths and other musculoskeletal therapists to advise against sitting for long durations, as this poses greater risk to the lumbar disc. Especially, sitting and leaning forward.
However, in 2022, Jia-Qi Li and colleagues reviewed many studies that investigated different postures and lumbar disc pressure. They found inconsistencies in the findings of more recent studies. With some studies indicating similar values or contradictory conclusions in both postures. [iii]
Take home message:
Whilst sitting likely does induce higher loads on the lumbar spine than standing, to maintain good function of the lumbar spine and manage LBP symptoms, any prolonged posture should be avoided.
How this was integrated into the persons management:
We explained these findings to Kai, and worked with him to consider lifestyle modifications that could help minimise prolonged sitting.
In this case, Kai purchased a sit-stand desk that is quickly and easily modified from sitting to standing. This made a big difference.
We also introduced “exercise snacks” which involved Kai taking a regular break every 15 minutes, but only for a very short time of 30 seconds or 1 minute. In this exercise snack time, he would perform one of his prescribed exercises.
Kai asked his colleagues if they would be happy to take walking meetings and was surprised when his colleagues were thrilled with the idea. Kai also used air pods so he could move around whilst taking business calls.
Finally, we made sure that Kai’s downtime wasn’t contributing to the problem. Instead of spending Saturday mornings watching YouTube video’s, he would go for a walk and listen to a podcast instead.
Management of Pain in the Side of Your Hip
Jill presents with pain in the side of her hip. She thinks she might have bursitis. It hurts to lay on the effected side and is particularly sore after walking. Jill wants to walk the Camino Pilgrimage Walk in Spain next year.
Pain is this area is often associated with a combination of factors, including tendinopathy, bursitis, and gluteal muscle dysfunction. This is why we use the encompassing term of greater trochanteric pain syndrome (GTPS) rather than specifying one tissue.[iv]
Radiological findings for patients with side hip pain report variable incidence, with bursitis incidence ranging from 4% to 46% and gluteal tendinopathy ranging from 18% to 50%.[v]
An enlarged bursae is often referred to as bursitis. However, the trochanteric bursa is often thickened without showing typical signs of inflammation. Anomalies of the bursae are observed in similar proportions of symptomatic and asymptomatic hips (people without any hip pain at all have thickened bursae).[vi]
Sometimes corticosteroid injections are considered as a second line option for side hip pain when there is noteworthy bursitis present. However, this only provides short term relief (3-4 months). Cortisone injections make no difference to your outcome in the longer term (when reviewed 12 months later).[vii]
Gluteal tendon healing involves remodelling of the tendon cellular matrix to restore the normal structure and function of the tendon. During the healing process, the cells in your body will lay down new fibres in the tendon to help it repair. Through this process, the tendon becomes stronger and more resilient over time. Mechanical loading is one of the most important factors in tendon remodelling so recovery from tendon injury requires a careful management program.[viii]
Take home message:
Pain in the side of your hip is more complicated than having an inflamed bursa. Often the gluteal tendon is involved in the pain. We use the term greater trochanteric pain syndrome to encompass the many factors that can be contributing to pain in the side of your hip.
The management side hip pain is best split into two phases. The first being to settle the pain down and the second being to promote resilience in the tissues to help graduate you towards your goals.
How this was integrated into the persons management:
We started with some hands-on osteopathic treatment to help reduce pain and help Jill get moving again.
Jill also presented with plantar fascia pain in the opposite foot. So, we incorporated that into our management plan as its likely that offloading the opposite foot will increase pressure on her painful hip. Also, because who wants a sore foot? Nobody.
We also laid out a series of home-based modifications to help calm the pain down.
We had Jill reduce compression of the area by implementing a short-term reduction in laying on the affected side, sitting cross legged, standing lazily. We asked Jill to stop stretching the hip as this might be making things worse.
We told Jill that she can continue walking as complete rest won’t see an improved outcome. But we asked Jill to reduce the total distance in the short term, whilst we settle the pain down.
As Jill’s paid started to settle, we began the process of building resilience in the local tissues. Adequate loading helps to stimulate tissue repair and remodelling, which can improve the quality and strength of the gluteal tendons over time.
As Jill’s strength improved, we graduated her return to walking distances. 3 months in and Jill reports great results. Whilst she is not 100% pain-free yet, her level of pain has significantly reduced. She is confident in her hips capacity to tolerate walking and was stoked to report that she was able to walk 20km without any aggravation of her pain afterwards. For Jill, it now about “stability of symptoms, and increasing function.”
Management of a Calf Injury and Future Injury Prevention.
Having decided to hang up the football boots, Pancho set himself the task of completing the Melbourne Marathon. He bought himself a fitness watch and started running most days.
With a good base level of fitness from his football career, Pancho was off to a great start. He was running 10km on a weekend run, and totalling 25kms for the week. However, on one particular run, Pancho was crossing the road and as he stepped down off the gutter, he felt a sharp pain in his calf. Afterwards, he struggled to walk the 1km home. A week later, Pancho felt his calf has improved but it just felt “tight” and he came to see one of our osteopaths to see if some Dry Needling could help loosen his calf up a bit.
We could consider 100 variables as to why Pancho hurt himself. There is a very real likelihood that the eccentric force transmitted through his calf as he stepped off the gutter was unusually high. But Pancho’s calf was likely already fatigued and this stage of the run and he put himself at greater risk of injury by his rapid increase in weekly training load.
Tim Gabbett performed a wonderful review of the literature surrounding training load and injury risk.[ix] His paper demonstrated that excessive and rapid increases in training loads are likely responsible for a large proportion of non-contact, soft-tissue injuries. However, interestingly, training also develops physical qualities which protect against injury. So, reducing training load is also a risk. See the terrific illustration below for a great visualisation of this research:
The next important aspect of research that we must consider here, is how do we restore capacity into Pancho’s calf so that we can help him reach his goal of completing the Melbourne Marathon?
Unfortunately, research does not give us a specific recovery time for Pancho. After our assessment, we concluded that his pain was likely a soleus muscle strain without tendon involvement. A review of recovery times for this type of injury ranges from 9-81 days.[x]
Rather than provide a rehab plan for Pancho based on research-derived formulae. We tailor his progressions through each phase of his recovery by gauging his accomplishments in handling progressively higher calf loads and assessing his preparedness to advance.
To do this, we need to consider the variance of load placed onto the calf with different exercises. Research performed by one group looked at calf activity during cycling,[xi] another who looked at calf activity in differing types of gym-based exercises,[xii] and finally, another group, who looked at calf activity in runners.[xiii]
Finally, we need to consider the longer-term injury risk. This is high after calf injuries.[xiv]
We also came across an interesting read which looked at the qualitative practices and perspectives of expert sports clinicians.[xv] Now, this type of research doesn’t hold super strong value from a technical research perspective. However, we believe it remains important to learn from experts who have vast experience in the field. People who have worked hands-on, in direct care with people who have injuries. Not just looking at a series of statistics on a computer screen. Besides, there remains a mountain of area in musculoskeletal healthcare where more research is needed before we have the complete picture. Arguably, it will never be possible to completely rely on research-based care in musculoskeletal management.
Take home message:
Osteopaths are all university trained to consider the research and apply this to the management of their clients. In this case, we take our in depth understanding of load management, and injury risk, and apply that to Pancho’s calf recovery.
We hear people refer to their problem as “tight” all the time. I go into detail on my thoughts about the use of this word on THIS BLOG. Ultimately, I believe that people use this word to describe a low grade level of soreness that they don't feel is severe enough to warrant a more aggressive term such as sharp, or tearing, they can still move their body without severe pain limiting them, and the best descriptive word that explains their pain experience is the word- tight.
How this was integrated into the persons management:
Early management included the application of kinesiology tape which Pancho reported improved the tight feeling.
We educated Pancho on his condition, explaining that it is likely the tight feeling he is experiencing is due to a low-grade muscle strain in his calf. We outlined a management plan that would likely see the best outcome for him. Both in his return to running, and in reducing the risk of future injury.
Pancho had an ankle injury on the same side many years ago. There remained a reduction in ankle mobility, so we improved this with some mobilization techniques. This should help to enable the calf to perform through its full range of motion.
Yes, we did some myofascial dry needling to his calf.
Cycling caused less pain than walking for Pancho, so our loading program started with cycling and unweighted ankle range of motion. We progressed to walking when he could manage this, and soon introduced a double, then single leg heel raise. Soon, Pacho could tolerate some pogo jumps, though it took him a little longer to be able to tolerate single leg hopping. Next, we had Pancho running at a slower pace (6min/km). Once he could manage 5kms at 6min/km we had him progress to interval training (2 x 800m, 5 x 400m). We move Pancho towards managing his own running progressions after this with a strong push towards a slower graduation of weekly increases in running distance.
Osteopathy is Both a Science and An Art
Osteopathy is a healthcare profession that helps people affected by injury, illness, or disability through movement and exercise, manual therapy, education, and advice. It is both a science and an art, combining scientific knowledge and evidence-based practice with a personalized and creative approach to patient care. Here's how it embodies both aspects:
Scientific Foundation: Osteopathy is grounded in a thorough understanding of human anatomy, physiology, and biomechanics. Practitioners must have a comprehensive grasp of the musculoskeletal, neurological, and cardiopulmonary systems, as well as the effects of different diseases and injuries on these systems. Osteopaths apply evidence-based techniques and treatment modalities, relying on scientific research and clinical trials to inform their practice.
Evidenced-Based Practice: Osteopaths base their treatments on scientific evidence and clinical research. They integrate the latest findings from research and studies to develop and adapt treatment plans for their patients. This approach ensures that interventions are effective and supported by scientific data, enabling osteopaths to provide the best possible care for their patients.
Application of Techniques: Osteopathy involves the application of various therapeutic techniques, exercises, and modalities. While the scientific knowledge provides a framework for treatment, the art of osteopathy lies in the application of these techniques in a way that is tailored to each patient's unique needs. Osteopaths must use their clinical judgment and creativity to customize treatment plans that are specific to the individual, considering their personal goals, preferences, and lifestyle.
Patient-Centred Care: Osteopathy is an art in the sense that it requires understanding the individuality of each patient. It involves building a strong rapport with patients, understanding their concerns, and collaborating with them to set achievable goals. Osteopaths often need to employ empathy, communication, and interpersonal skills to motivate patients and facilitate their active participation in the recovery process.
Problem-Solving and Adaptation: Osteopaths often encounter complex cases where standard treatments may not suffice. In such situations, they must rely on their creativity and critical thinking skills to devise innovative solutions and adapt treatment plans to suit the unique needs of each patient. This adaptive and problem-solving approach is a manifestation of the artistic aspect of osteopathy.
In essence, the science of osteopathy provides a solid knowledge base and evidence-driven framework, while the art of osteopathy lies in the individualized application of this knowledge, the empathetic approach to patient care, and the creative problem-solving required in complex cases. This duality makes osteopathy a dynamic and holistic discipline that addresses both the physical and emotional well-being of patients.
We Aim to Give You the Absolute Best Results Possible
A good osteopath spends a lot of time keeping up to date with current research and applying it. A great osteopath genuinely cares about you; they take the time to listen intently and assess thoroughly so they can uncover hidden factors contributing to your condition, then deliver unique individualised treatments aimed at helping you feel better while you get better.
We are happy to answer any questions you have and discuss your individual needs. If you’re searching for a tailored osteopathic treatment plan to help with your condition, contact YouMove Osteopathy or book an appointment online.
[i] Nachemson, A., & Elfström, G. (1970). Intravital dynamic pressure measurements in lumbar discs: A study of common movements, maneuvers and exercises. Scandinavian Journal of Rehabilitation Medicine. Supplement, 1, 1–40. [ii] Nachemson, A., & Morris, J. M. (1964). In vivo measurements of intradiscal pressure: Discometry, a method for the determination of pressure in the lower lumbar discs. The Journal of Bone and Joint Surgery. American Volume, 46, 1077–1092. [iii] Li, J. Q., Kwong, W. H., Chan, Y. L., & Kawabata, M. (2022). Comparison of In Vivo Intradiscal Pressure between Sitting and Standing in Human Lumbar Spine: A Systematic Review and Meta-Analysis. Life (Basel, Switzerland), 12(3), 457. https://doi.org/10.3390/life12030457 [iv] Dzidzishvili, L., Parrón Cambero, R., Mahillo Fernández, I., & Llanos Jiménez, L. (2022). Prognostic factors of trochanteric bursitis in surgical-staged patients: a prospective study. Hip International: The Journal of Clinical and Experimental Research on Hip Pathology and Therapy, 32(4), 530-536. [v] Reid, D. (2016). The management of greater trochanteric pain syndrome: A systematic literature review. Journal of Orthopaedics, 13(1), 15-28. [vi] Woodley, S. J., Nicholson, H. D., Livingstone, V., Doyle, T. C., Meikle, G. R., Macintosh, J. E., & Mercer, S. R. (2008). Lateral hip pain: findings from magnetic resonance imaging and clinical examination. Journal of Orthopaedic & Sports Physical Therapy, 38(6), 313-328. [vii] Brinks, A., van Rijn, R. M., Willemsen, S. P., Bohnen, A. M., Verhaar, J. A., Koes, B. W., & Bierma-Zeinstra, S. M. (2011). Corticosteroid injections for greater trochanteric pain syndrome: a randomized controlled trial in primary care. Annals of family medicine, 9(3), 226–234. [viii] Thomopoulos, S., Parks, W. C., Rifkin, D. B., & Derwin, K. A. (2015). Mechanisms of tendon injury and repair. Journal of orthopaedic research : official publication of the Orthopaedic Research Society, 33(6), 832–839. [ix] Gabbett TJThe training—injury prevention paradox: should athletes be training smarter and harder?British Journal of Sports Medicine 2016;50:273-280. [x] Pedret, C., Rodas, G., Balius, R., Capdevila, L., Bossy, M., Vernooij, R. W., & Alomar, X. (2015). Return to Play After Soleus Muscle Injuries. Orthopaedic journal of sports medicine, 3(7), 2325967115595802. https://doi.org/10.1177/2325967115595802 [xi] Sanderson, D. J., Martin, P. E., Honeyman, G., & Keefer, J. (2006). Gastrocnemius and soleus muscle length, velocity, and EMG responses to changes in pedalling cadence. Journal of Electromyography and Kinesiology, 16(6), 642-649. https://doi.org/10.1016/j.jelekin.2005.11.003 [xii] Bezerra de Azevedo, J. O. N. A. T. A. S., Massaroto Barros, B. R. U. N. A., Rosa dos Santos, L. E. P., Biasotto-Gonzalez, D. A., Fidelis de Paula Gomes, C. A., Baker, J. S., ..., & Politti, F. (2023). Activation of triceps surae during exercises on leg press, Smith and seated calf raise machines. Journal of Physical Education & Sport, 23(8). [xiii] Kyröläinen, H., Avela, J., & Komi, P. V. (2005). Changes in muscle activity with increasing running speed. Journal of sports sciences, 23(10), 1101-1109. [xiv] Green, B., & Pizzari, T. (2017). Calf muscle strain injuries in sport: a systematic review of risk factors for injury. British journal of sports medicine, 51(16), 1189-1194. [xv] Green, B., McClelland, J. A., Semciw, A. I., Schache, A. G., McCall, A., & Pizzari, T. (2022). The Assessment, Management and Prevention of Calf Muscle Strain Injuries: A Qualitative Study of the Practices and Perspectives of 20 Expert Sports Clinicians. Sports medicine - open, 8(1), 10. https://doi.org/10.1186/s40798-021-00364-0