Dr. William Dao
Director & Osteopath
History & Principles Of Osteopathy
Manual Therapy VS Exercise Therapy
My Holistic application of Osteopathy
Osteopathy: A brief history
Osteopathy was founded back in the late 1800s by Dr. Andrew Taylor Still in Kirksville, Missouri in the USA. With his father being a surgeon, Still's development of Osteopathy was sprouted by his desire to achieve positive health outcomes without the need for invasive surgeries and harmful medications which during those times, often made people sicker. Still was interested in how the bodily systems worked in unison for overall health, hence the formation of his principles:
The body is a unit
The body is possesses self-regulatory & healing mechanisms
Structure and function are reciprocally interrelated
Osteopathic treatment is anchored by the above points
These foundation principles were created many years ago, however are extremely applicable when it comes to how Osteopath's do their jobs in the present day, especially as more emerging evidence promotes the delay and even complete avoidance of elective surgeries for common musculoskeletal conditions such as disc bulges because they are shown to be no more effective in reducing pain and disability in them medium and long term despite offering better short term relief (Gugliotta et al., 2016).
If you've visited numerous Osteopaths in Australia, chances are your experiences are uniquely different dependant on who you see. I like to think of Osteopaths and other manual therapists as being on a scale of sorts, ranging from being completely "hands on" with minimal prescription of active measures such as exercise rehabilitation, whilst some practitioners do minimal (if any) manual therapy and heavily focus their consultations around movement and exercise, often these practitioner's are labeled as "hands off".
So what approach is best?
Well, it depends. Using the example I gave above relating to back surgery for disc bulges. The treatment approach chosen by a therapist is dependant upon their and your objectives as the patient. Is it a short or long term goal? How much risk is involved in each journey? Let me explain further:
1. Short term pain relief: Surgery is more effective in reducing pain within the 6 weeks following, but the surgery itself carries significant risks. Add to this potential financial strain, time off work and time spent in hospital.
2. Long term pain relief: Conservative measures (education, graded exercise program and manual therapy) is likely to be more effective at the 6-12 month mark, but the patient is likely to be in a higher degree of pain for the first 6 weeks compared to somebody who undergoes surgery.
The Manual therapy Vs Exercise therapy debate draws many similarities to the surgical vs non-surgical debate, in which "hands on" Osteopathy is great for improving pain/function in the SHORT TERM, but has its limitations in creating long term change. Conversely, somebody in acute pain may really struggle to perform any movement/exercise therapy and therefore not get the best result form their consultation. In my opinion, the therapist needs to shift where they sit on this spectrum to best address the clients needs at that given time. Somebody in acute pain does not need to "strengthen" anything immediately, conversely a recurring muscle strain cannot be simply "loosened up or rubbed out".
"Best care to me combines short term symptomatic relief with accompanying education and reassurance with long term strengthening and self management strategies"
1. History taking
In the treatment room, I first and foremost let you tell your pain story. Specifically, your pain experience, how it's affecting your day to day life and your goals of seeking help. After this, I will help you understand what is happening under your skin, further exploring your injury and medical history to build a true picture of you and your health.
After the initial history taking we will complete a movement assessment and special tests to identify your problem areas which relate to your presenting complaint.
image: example of a movement test: hip hinge
Once potential muscle tightness, joint restrictions and painful points are identified, we will utilise "hands-on" techniques such as muscle massage/stretching, joint movement/manipulation and dry-needling to decrease pain and improve function
. image: massage, a technique used to reduce pain and tightness of muscles
4. Exercise Rehab/Movement Strategies
After hands-on treatment, it is likely that you will be prescribed specific, tailored at home or gym based exercises utilising elite gym facilities within 'The Gym Jh' to further build upon the effects of treatment helping you work toward your treatment goals. To monitor your rehabilitation progress, we may utilise the app 'Physitrack' which is provided to you at no extra cost.
image: 'The Gym jh' rehab equipment access for The Osteo Room clients
image: 'Physiapp' which we use to track rehab exercises
5. Management Plan
To wrap up the consultation, we will sit together to write up and agree upon a Management Plan which will summarise your working diagnosis, how long we expect your recovery to be, what is to be done to get you there and who else in the healthcare system might be enlisted to help us for example your Family Doctor or Imaging house.
Thanks for your time in reading. I hope that you've learnt a little bit more about Osteopathy and how we like to do things at The Osteo Room. For more information head to our website or get in touch via e-mail: Hello@theosteoroom.com.au
Gugliotta, M., da Costa, B., Dabis, E., Theiler, R., Jüni, P., & Reichenbach, S. et al. (2016). Surgical versus conservative treatment for lumbar disc herniation: a prospective cohort study. BMJ Open, 6(12), e012938. doi: 10.1136/bmjopen-2016-012938