Great Dunmow Osteopathic Clinic

 

What is the difference between Osteopathy, Chiropractors and Physiotherapists?

 

This has to be the most frequently asked question when patients visit the practice and I will have an honest attempt at answering it.

In very simple terms and the treatment modality that concerns everyone is manipulation of the small joints in the spine. All physical therapists will manipulate but there is a subtle difference in how they go about it. This stems from what exactly the practitioner believe s he is achieving when he or she elects to use this treatment modality.

A woman's world article summed it up quite well.

Chiropractors tend to use more force to open the small joints in the spine producing cracking sounds.

Osteopaths warm the joint up more with soft tissue, muscle energy techniques. They use a gentler manipulation that also produces cracking sounds.

Physiotherapists generally don't manipulate they use massage and electrotherapies and exercise advice.

Having said all that some chiropractors behave very much like osteopaths and vice versa and some physiotherapists  have done post grad courses in manipulation. All will use soft tissue techniques, prescribe exercise and use electrotherapies. It really depends upon the individual practitioner and how they practice. The key for the patient is to find a practitioner who helps them achieve their reasonable treatment and health objectives.

Physical therapy has been with us since the time of Hippocrates and there are ancient Greek stone carvings depicting scenes of manual therapists at work.

Up until the 19th century there was little differentiation between medical practitioners; then in a small room in the University of Worcester UK, a small group of medical practitioners got together and formed the General Medical Council or GMC as we all know it.

This was done to protect the public from rogues and charlatans who would make all sorts of promises with out delivering very much. It brought the medical profession down and conscientious medical professional generated this format to bring the profession into shape. The medics were given the Medical Act 1858 from parliament and were then responsible for the profession ensuring academic institutions teaching medicine were up to scratch and medics practising medicine were appropriately qualified and followed logical practice governance to benefit their patients. This enabled the GMC to clear out the profession of all the deadwood. The aim being to establish the confidence of the public and most importantly do everything they could to ensure the public were safe from bad or dangerous practice.

At about this time in The USA there was a Military Surgeon Physician, Anatomist, Methodist preacher a philosopher named Andrew Taylor Still. He tragically lost 3 of his children  to Viral Meningitis and his first wife to pneumonia. He was able to secure the services of the finest medical supervision of the time, but it was to no avail, and his family perished which devastated Still.

This drove him to re- examine the philosophy of Allopathy/Orthordox medicine at that time which was a contentious thing to do but in the light of his experiences quite reasonable. He upset establishment medicine with his questioning of the accepted philosophies and principle of orthodox medicine at that time; not least from his own family who were all medics. His free thinking and ideas were contentious and challenging. The established medicine found all this self/clinical audit and reflection very uncomfortable particularly when they would try to prosecute him for malpractice and he would always point to the mortality rates for his patients in comparison to his allopathic colleauges of the time. The prosecution case was always dismissed leaving the Allopaths red faced and furious. He returned to his studies and eventually came up with a number of principals that he based his natural non invasive health care philosophy on and that was:

1. Profusion of tissue by blood and its good drainage were fundamental to tissue health.

2. The structure of the body governs its function, Anatomy and physiology are recipricol.

3. The body has the capacity to sustain a steady healthy state. Homeostasis 37  degrees celcius and 7.4 pH which is fundamental for the optimal function of physiology.

4. The body is a self healing mechanism; the body has a capacity to heal itself. (Blood clotting and Immunity.)

This list has been refined and added to over the years but these 4 principles create the foundation of his philosophy. This philosophy was also underpinned by a devout faith and acceptance of the Almighty creator(God) of all things, he felt humbled and reasoned that if the almighty had created it... it must have purpose which was for us to reveal.

He took his principles and applied them via manual therapies, care for his patients, good nutrition and rest. Dr Still coined the term Osteopathy in 1885 and today in the USA the Andrew Taylor Still University of Osteopathic medicine is a thriving  academic medical centre of education; that has been accepted by the Allopaths.

This is the first comparison we can make to highlight the difference and similarities between Chiropractics and Osteopathy. D. D Palmer was a beekeeper, teacher and grocery store owner and  reader of medical journals. He practised Alternative therapies including Magnetic healing, and Spiritulism ( indeed Still initially described himself as a Magnetic healer and lightining bonesetter until 1885 when he used the name Osteopath). Palmer raised his profile when he claimed he relieved a deaf man of his deafness by cracking his back and another man of his heart condition via spinal adjustments.....very grand claims to make and very difficult to substantiate or repeat I am sure(but a tremendously powerful marketing tool). Palmer coined the term Chiropractor in 1890. He spent time in jail for practicing medicine without a licence, but started a college of chiropractors in 1892.

It is said that early chiropractics was very similar to osteopathy which may give some validity to the story Palmer may have been a student of Dr Still but never stayed to do the full course preferring to set up his own college with his son at exactly the same time that Still founded his college in Kirksville Missouri in 1892.

 Dr Still was rigourous and driven even obsessed by his practice and insisted that his students had full command of at least 90% of Grays Anatomy Text book, before allowing them to enter the clinic where patients were treated. Still never taught technique but was insistent that his students apply their knowledge of anatomy. Dr Still would demonstrate treatment but not teach technique and this maybe why Palmer went off to do his own thing..........who knows? One of Still's first students was a chap called John Martin Littlejohn who then came to London and set up the British school of Osteopathy. He taught a chap named John Wernham whose protégé was Tom Dummer who brought the Paris School of Osteopathy to Maidstone in Kent which was the beginning of The European school of Osteopthy at Boxley my old college!

Our physiotherapy cousins were first introduced when 4 nurses working in London set up the first physical rehabilitation unit in a London Hospital. This was in 1892.

It took till 1993 for the osteopathic profession to galvanise and follow the process of lobbying Parliament supported by The Prince of Wales and Princess Royal and the late Princess Diana for us to secure the Osteopath Act 1993. The formation of the General Osteopathic Council who oversee the profession in the same way as the GMC was critical to this process being successful.

The process of validation of the Osteopathic profession is now used as a model for other profession wishing to seek Statutory regulation to follow, due to the rigour of the process.The Chiropractors indeed followed the Osteopaths lead shortly after this.

The physios haven't as they predominantly are a subset specialisation of  nursing and don't see the need to be a separate profession the only issue about this is that whilst physios seen through the NHS will be qualified Private Physios will not necessarily have to be, as the title Physotherapists is not a legally protected title. They do belong to a health professional council. Another crucial difference is that Physiotherapists are not trained to diagnose. Ultimately they will always defer to Medical doctors for diagnosis of musculoskeletal problems.

As time goes by and the provision of health care has evolved in this country the NHS a leviathan of a bureaucracy has emerged heavily promoted by the Politicians but consistently under funded; raising patient expectation and failing to deliver on number of levels. A beautiful ideal but unworkable in practice. The livelihood of very sophisticated business people and X - politicians who fill their coffers with giant pharmaceutical companies loot, rely on its very existence.

Meanwhile on the front line the poor patient is not cared for. Post code NHS, Deaths as a result of neglect. An altruistic work force contractually gagged by insidious bureaucratic jargon and threats.

Osteopaths generally wish not to be involved in such a monster preferring to give candid, accurate advice and best treatment possible for their patients; including referral to medical colleagues when necessary. We have retained our freedom to speak honestly, openly and truthfully, we have demonstrated this in external audits of competence.

 

 

 

 

 

 

 

Back pain is a broad area and the reasons for it are multiple. The back pain you want to come and see  me about is mechanical back pain and this, I will be able to deal with for you,educate you comprehensively so that you can self manage effectively.

The analogy I use is a simple one and that is the spine and body (that is the thorax and abdomen or core) are like a land rover coil spring. Things are fine when we are young and trauma free, however, introduce a trauma or shock into the equation and lay on the effects of of gravity and the mechanical integrity of your spine and core will be compromised laying the seeds of a potential show stopping back injury. The problem with falls and traumas like whiplashes, physical viloence, playing contact sports, motor cross and horseriding, 5 aside football on astro turf or gym halls, it is like putting a large spring clamp onto the land rover spring. Continuing to live without the bounce in your spine puts your spine under COMPRESSION.

This compression changes the way in which your spine functions no longer a supple spring but now a fixed lever like a crowbar. Try taking a nail out of a piece of wood with a chain and now with a crowbar. You have to exert a lot more force with a chain than the crow bar, in fact it is easy with a crowbar and that is because it is easy to generate enormous force with a lever. This in very simplistic language is what is happening with your spine when it is under compression.

Ok if my spine is under compression if I hang upside down and have mechanical traction it will right its self?

 Yes it will help to a degree but there is no way of gauging how the tissues are responding and know precisely the effective duration for traction from one individual to the next(there is no empathy for the tissue). Osteopaths are best positioned to helping you when you have a restricted spinal mechanic. You need to have enough treatment to be effectivley treated but not too much so the problem is exacerbated and not too little so that you are left with the underlying mechanical restriction. Whilst your back may stop hurting you will  left in a vunerable situation with a mechanically restricted spine with the  potential (when moving in an unguarded manner) will generate a more serious injury. You are then  a chronic patient who will always have back problems that can be managed to a point but may deteriorate to a state where you are a chronic disabled back pain sufferer. Going to a pain clinic on huge amounts of medication.

The objective of my treatment is to maintain optimal mechanical integrity to your spine. The consequence of this is that you can continue to condition effectively which allows you to pursue your physical activities, whether that is work ,sports, or just being able to travel and see friends and family. It will allow you to participate in life fully.

Yes but why does it hurt?

When the spine and core are under compression and they generate this excessive leverage force, the force is applied to the soft tissues and intrinsic tissues of the spine like the discs.

These tissues under shear compression and torsion will rip tear, as they tear cells are broken open and enzymes and proteins held within the cell walls are let lose into neibourighing tissues. These enzymes and proteins attack your tissues that they are prevented from doing when they are intracellular. This triggers the inflammatory response which is the the swelling oedema to splint the joints and serve the tissues with the material to heal. You may even rupture capillaries and venuoles and this is red blood leaking ito the soft tissues near your spine. Ever filled a ballon with water, how heavy it gets how easy it is to burst. Think of a fire hose with high pressure water flowing through it, this is how the soft tissues around our spine will become after injury (you cannot compress fluids). This is why its usually a bit better when you go to bed but first thing it the morning you are as stiff and sore as the proverbial board. This means you are vunerable to further exacerbation of your injury.

If its just inflammation why don't i just take ibprofen?

It will help if you are not an unfortunate soul who cannot take NSAID because of allergic intolerance. It is the mechanical restriction that is the cause of the injury so NSAID are fab initially (about as good a regular cold packs) but they won't remove the causative problem, so if you are an interested GP get much better results for your patients prescribing them the usual medication and send them to an osteopath who will get them back to full function far quicker. (Beam report 2004). Secondly it is precisely that uncompromised fuction that allows the effcient use of the muscle pump to squeeze the intrinsic tissue like a giant sponge to normalise the fluid content of the tissue. Optimising profusion and the most important aspect osteopathically promoting drainage of the tissue to irrigate the tissue and establish optimal healing of that tissue. This needs to be monitored and guided as sometimes people feel alot better and can re injury because they mistakenly believe they are "cured"... a very strong and misleading word.

The most important bit of information for you the patient is to understand that Osteopaths are rigourously trained to identify the difference between back pain of a mechanical nature and back pain which is the manifestation of pathology ( Red and Yellow flags).

Back pain derived from metabolic,infectious, inflammatory, neoplastic or genetic origins need medical attention first, before osteopaths would then be happy to try to work with whatever mechanical aches and pains you may also have.

What do you mean by metabolic?

Conditions such as Osteoporosis, Osteomalacia, Diabetes, Pagets these conditions need medical supervision and have medical treatments which are effective and it is important that that you the patient are aware of this and follow a treatment course. In these situations osteopathy helps palliative but works in conjunction with allopathy.

Infectious?

Conditions such as bacterial meningitis, osteomyelitis need antibiotics and hospitalisation.

Inflammatory?

Rheumatoid arthritis, Poly Myalgia Rheumatica, SLE, Sarcoidosis, conditions like these need medical supervision and osteopaths can in alot of case help palliate symptoms

Neoplasia?

Multiple myeloma, Bone tumors, abcesses need referral and treatment. 

Genetic?

Hereditary, congenital problems. Alot of the time these conditions are just the way you are and there is no allopathic treatment, but that is not saying you will not suffer from musculoskeletal related problems and you can be helped by osteopathy to relieve those symptoms. Your osteopath will find it useful to have as full an understanding of any genetic disorders as possible in order to define in what ways they will be able to help in your case.

To summarise, if you have back pain by all means book to see the osetopath. It is agood palce to start and you can be confident that if your condition is mechanical or systemic in origin the osteopath can guide you to the right treatment for your condition.

Osteopathyis a therapeutic approach to natural health care based on the philosophy that good bodily structure and functional fluidity are the means to optimal health.

Manual techniques are the main form of treatment, including manipulation and soft tissue massage of the head and body. These techniques are intergrated and applied as appropriate to the diagnosis of your particular problem, to treat the symptoms and promote the natural healing of the body.

Osteopaths are recognised as a discrete clinical discipline, just like medicine an Dentistry, by th UK Government and Judiciary. This is largely due to the breadth and depth of our training which covers all aspects of anatomy and physiology. So, whilst our speciality is biomechanics, we are equipped with comprehensive clinical diagnostic skills.

Our approach to diagnosis and treatment is firstly to interpret a patient's biomechanical patterns to detect asymmetrical anatomy and potential injury sites. We can often explain why you sustained the damage or injury in the first place.Through treatment, we then look to normalise structure, optimise the function and fluidity, and promote your healing potential.

We also work with other health care providers, e.g. doctors and surgeons, to manage and treat any other medical conditions you may have, to maximise your health

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