Research

Standing Firm - Why it sometimes hurts to stand from sitting?

The sit-to-stand (STS) is a test used to measure lower-limb strength in older people or those with significant weakness (1). 

It is considered an easy, quick and fairly valid measure, which involves measuring the time taken to stand from a seated position a certain number of times, or recording the number of repetitions you can do in a given period (2).

The findings of recent studies suggest performance in this test is influenced not just by factors associated with strength, but also balance and mobility, and a vast array of psychological factors (1).

But what about when sit-to-stand hurts?

Low back pain can reduce spine, hip and pelvic floor motion due to conscious or unconscious guarding associated with pain (3). 

Multiple studies have shown there are changes in how energy is transferred between bone and soft tissue in the spine, pelvis, and legs associated with pain (4).  And that inefficient energy flow or transfer then places more demand from everything.  A cycle of back pain-altered biomechanics can start, creating more back pain. With all the changes in energy transfer and muscle power, everyday activities such as standing up from a sitting position can become difficult.  

Muscle coordination, balance and mobility are affected, and psychological factors start to play in and effect our beliefs and so the cycle continues (1).

Stopping the cycle can be easy. 

You just bypass your traditional route to standing and try something different altogether. 

Try these simple tips.  You may not need all of them:

RELAX before you start

WIDER STANCE - think SUMO wrestler

SLOW DOWN (TIMING) - move more slowly

HANDS ON KNEES

BREATHE OUT - this is a big one.  The less compression in the container of the torso the better. 


Many people are surprised they can suddenly sit-to-stand with no pain after weeks or months experiencing twinges and outright muscle spasms when trying to stand after sitting.  


After a few days of pain free sit-to-stand, you can try heading back to your old ways as there is rarely a “right” way to do something.  You can get up and down any way you choose, each one of them equally valid. 


As a lot of research shows, the way you do something does start to matter. If you always get up and down via your arm on the desk, leaning forward to create momentum, it means the strengths necessary to do it another way are waning. 

Can this help if I have pain elsewhere?


This can also break the cycle if you experience pain in hips, knees and feet.


references


1. J Gerontol A Biol Sci Med Sci. 2002 Aug;57(8):M539-43. Sit-to-stand performance depends on sensation, speed, balance, and psychological status in addition to strength in older people. Lord SR1, Murray SM, Chapman K, Munro B, Tiedemann A.


2. Exp Gerontol. 2018 Oct 2;112:38-43. doi: 10.1016/j.exger.2018.08.006. Epub 2018 Sep 1. The sit-to-stand muscle power test: An easy, inexpensive and portable procedure to assess muscle power in older people. Alcazar J1, Losa-Reyna J2, Rodriguez-Lopez C1, Alfaro-Acha A3, Rodriguez-Mañas L4, Ara I1, García-García FJ5, Alegre LM6. 

3. Explain Pain Supercharged G. Lorimer Moseley and David S.
Butler. Adelaide City West: NOI Group Publishers, 2017. ISBN: 978-0-6480227-0-1

4. Gary L. Shum, PhD, et al. Energy Transfer Across the Lumbosacral and Lower-Extremity Joints in Patients with Low Back Pain During Sit-to-Stand. In Archives of Physical Medicine and Rehabilitation. January 2009. Vol. 90. No. 1. Pp. 127-135.

Get Your Body Moving - 30 mobilisations for everybody

 

Let’s be honest people. We can’t always be as active as we want.

We find it inconvenient and at times impossible to answer the call for natural movement*. It’s hard to run across the grassy plains when we’ve only got a concrete path or it takes a two-hour train ride to get to a wilderness trek up the side of a mountain. And we have to be dedicated in searching out opportunities to squat, throw something, wrestle, dance, run, leap, climb or hang upside down off a branch.  

We need to do these things, but when we can’t, you can offer something else to your beautiful body. Something to nourish, so it can flourish! And so comes the concept of 30 ideas to mobilise your body.

WHAT THE HECK ARE MOBILISATIONS?

Mobilisations are like dynamic stretching.  They sit somewhere in between rehab and lifting weights. It’s difficult to get any specific research to support this kind of movement but we can draw some conclusions based on evidence supporting early movement after surgery for hip and knee replacement (1) daily movement for acute low back pain rather than bed rest (2) safe movement following a car accident instead of a neck brace (3) and a long history of committed movement in multiple cultures (tai chi, qi gong, ceremonial dancing, prayer and worship).

We might even want to throw it out there that mobilisations might be useful for:

  • pain relief
  • early healing
  • micro breaks
  • preventing pain
  • preventing injury (I said maybe!!)

 

the dip in the couch

We can get attached to not moving. You know the feeling when you’ve succumbed to the dip in the couch or you’ve shaped your body to the back of your ‘ergonomic’ chair. Our bodies sometimes try to get us to move out of desperation before the thinking part of our brain even gets a say.  We crack our neck, stretch our back over the back of the chair or twist forcefully to one side. Take charge of your runaway body and acknowledge that alarm bell for what it is. 

Convert that animal instinct into something to nourish your cells in all your tissues, including your brain. Pump and stretch those clumping cells and provide them with the nutrition they need via blood supply using the mechanics of your own body.  Help juice up your joints, tendons, skin, brain cells, muscles, nerves, ligaments, organs and move those tubes that string them all together.

 

we've put together 30 great ideas to inspire the modern human to combat physical stagnation.

The rules to follow:

  • easy and painless
  • lots of repetitions (i can do it i can do it i can do a little bit more) 25-75 repetitions (1-3) sets/day
  • joyful, fun, no protocol, no commitment beyond maybe a few days
  • if you’ve tried to make it easier and it still feels bad (or pointless) then STOP

INSTA VIDEO SERIES

SEATED ROTATIONS

hip and back tightness/pain, neck stiffness, excessive sitting

STIR THE POT

neck stiffness/pain, upper back pain, shoulder pain

FOREARM MOBILISATIONS

arm and shoulder tightness and pain, desk worker

SIDE RAINBOW

side stiffness, hip and back tightness, shoulder pain

HIP RELEASE - KATY BOWMAN STYLE

hip and buttock tightness/pain

STANDING ROTATIONS

stiffness everywhere, excessive sitting

SEATED GLUTE STRETCH

hip pain , low back pain , improve hip mobility 

CHEST OPENING AND CLOSING

upper back, chest and shoulder tension

ALPHABET EXERCISE  - ARM SWINGS 

thoracic and shoulder tension, low back too

BEAR HUGS

more dynamic than chest openings, more arm wrap around, good for shoulder and upper back tension

ASSISTED SQUATS

low back, hips, knees and ankles

ANKLE TWIRLS

stiff ankles, fluid congestion, motion is lotion

CAT AND CAMEL

good for spinal mobility, ask practitioner if this is right for you

THREAD THE NEEDLE

thoracic and shoulder mobility, low back stiffness

THREAD THE NEEDLE (V.2)

thoracic and shoulder tightness, standing at the desk version 

CATH A BUTTERFLY

shoulder, hand, forearm and elbow

HIP DROPS

low back hips and pelvis

LOWER LIMB AND GLUTES

glutes, hips, hamstrings and calf

WAG THE DOG

lower back, hips and pelvis

LEG SWINGS

hip stiffness, low back, balance, positional awareness

DO THE SWIM

shoulders, upper back and neck

LEG SWING V.2

hips and low back 

THE LAWNMOWER

Upper back, lower back and shoulders

NECK MOBILISATION

write out no. 1-10 with your nose, for general neck stiffness

SHOULDER SWINGS

good for stiff shoulders - who would have thought!?

BOW AND ARROW STANDING 

shoulders, upper back and chest

FOOT AND ANKLE MOBILISATION

foot and ankle mobility

CHEST OPENINGS

chest, shoulders and upper back 

THE SHOVEL

general back and shoulder  - better without a real shovel!

DISCO TIME 

looking good ladies - dance your way to better movement!

THAT'S 30! PHEW!

References

(1) Guerra, Mark L., Parminder J. Singh, and Nicholas F. Taylor. "Early mobilization of patients who have had a hip or knee joint replacement reduces length of stay in hospital: a systematic review." Clinical rehabilitation 29.9 (2015): 844-854.

(2) Hagen, Kåre B., et al. "The Cochrane review of bed rest for acute low back pain and sciatica." Spine 25.22 (2000): 2932-2939.

(3) Teasell, Robert W., et al. "A research synthesis of therapeutic interventions for whiplash-associated disorder (WAD): Part 2–interventions for acute WAD." Pain Research and Management 15.5 (2010): 295-304.

(4) Chan, Roxane Raffin, and Janet L. Larson. "Meditation interventions for chronic disease populations: a systematic review." Journal of Holistic Nursing 33.4 (2015): 351-365.

 

thank you for your inspiration:

How to do Joint mobility drills - Todd Hargrove

Mobilize! Dynamic joint mobility drills are an alternative to stretching - Paul Ingraham

Therapeutic Stretching - Eyal Lederman

Nutritious Movement - Katy Bowman

Daniel Wolpert - TED talk

 

 

There are devoted proponents for natural movement who have wonderful websites. Check them out: 

Mark Sisson, Katy Bowman, Phillip Beach

Jaws 42 - The Curse of TMD (Temporomandibular Joint Disorder)

 All credit of this image go to Steven Spielberg and novelist Peter Benchley. Also to Zanuck/Brown Productions and Universal Pictures.

All credit of this image go to Steven Spielberg and novelist Peter Benchley. Also to Zanuck/Brown Productions and Universal Pictures.

It has been nearly 42 years since the legendary movie "Jaws" was released. It was a cinema masterpiece of its time with bucket loads of suspense and horror that managed to scare everyone from swimming in the ocean for years afterward. Well, so I'm told. With the clever use of animatronics, images of bloody big dorsal fins and spooky music it left movie goers nursing tense and sore jaws from clenching their teeth through anxiety and fear. Segue complete. See that? Jaws and jaw pain? 

Jaw pain is a pretty common issue affecting 33% of the general population at some time in life (1). Of that population there seems to be more significant spike in the age range of 20-40 year olds, with a significant portion of that number needing to seek treatment from a health professional. Anxiety is a key contributor to jaw pain but it is not the only reason people experience pain in/around the jaw or temporomandibular joint (TMJ). We commonly refer to pain around the TMJ as Temporomandibular Joint Disorder or TMD. It is actually not one single disorder but representative of multiple sub groups of issues. They are typically categorised as muscle problems or joint problems.

WHAT CAN YOUR OSTEOPATH DO?

At Fairfield Osteopathic Clinic we take into account the whole person when dealing with the treatment of TMD. In other words we need to understand the underlying causal factors, which may range from mechanical joint factors, emotional stress or functional overuse issues (think Australian gum-chewing cricketer). There are also direct links between neck pain and TMD and any assessment will recognise the connection. There is plenty of evidence both clinically and through peer reviewed research to suggest that the neck and jaw are pretty tight in their relationship with one another (pardon the pun). One paper suggesting that 70% of TMD sufferers also experience neck pain (2). 

A worthy TMD assessment will always encompass an actual physical assessment of the muscles around the jaw and the joint movement itself. This will guide treatment options. As osteopaths we use lots of direct and indirect techniques to modulate pain, but without addressing underlying causal factors that impact the jaw then relief may not last for long. These irritating causal factors might include chewing gum, chewing meals on one side of the mouth, specific dental issues, night time bruxism or teeth grinding and habitual jaw clenching (a lot of people don't realise they clench until they actively relax their jaw muscles). There are simple relaxation exercises for the jaw that are easy to practice and master. Head down to the end of the BLOG for some ideas.

SELF MANAGEMENT 

Self management strategies are essential in dealing with any long term TMD. A large study published in November 2016 attempted to collate as much data on self management strategies and form a best practice management strategy for longterm TMD. These strategies include:

1. Education - a bit of positivity is a good start as pain is usually self-limiting. Understanding the anatomy and usual function of the TMJ complex and associated musculature can be helpful too. Other ideas include improved sleep hygiene (don't watch Jaws before bed), sensible and time-limited use of analgesia, avoidance of OTC splints bought without consultation with a dentist, limit caffeine usage, ‘doctor shopping’ won't help.

2. Self exercise therapy - gentle stretches for the jaw muscles and relaxation exercises, which are best explained by your osteopath.

3. Heat treatment - usually heat for sore jaw muscles is best. Ice treatment is best avoided due to the sensitivity of the nerves that innervate the area (remember ice-cream headaches)

4. Self massage therapy - there are very simple self massage techniques for the main jaw muscles and upper neck muscles. Again these are best explained in person as a little goes a long way.

5. Diet and Nutrition  - it's important to establish a pain-free diet for at least three weeks. That means avoiding excessive chewing or hard-to-chew foods. In other words TMD sufferers may need to establish a "soft diet" until sensitivity decreases.

6. Parafunctional behaviour - this is the tricky one. There are often habits that irritate the jaw that we seem to not have as much control over e.g. grinding teeth or jaw clenching during sleep, which is called nocturnal bruxism. This may require some other modalities of therapy or medication to help. Reflecting on coping strategies for stress and anxiety may be pivotal to changing some of these nocturnal habits (3).

EASY EXERCISE

Stand in front of a mirror.

Hold your palms gently on the side of your face - covering your cheeks.

Let your lower jaw fall into your hands. In other words relax it and let it go all loose.

Now practice that again without using yours hands on your face. Make as long a face as possible. 

If you are having trouble mouth the sound "Bah". It lets your lower jaw fall open. Repeat that until you get a sense of your jaw relaxing.

If you practice this in the mirror then when you are at work throughout the day you can put your hands on your face and use that as a trigger for your face and jaw to relax. You are creating awareness around the difference between tension and ease. 

Good luck and don't hesitate to make a booking to see us if things are a bit out of control.

 

References

1. Wright, Edward F., and Sarah L. North. "Management and treatment of temporomandibular disorders: a clinical perspective." Journal of Manual & Manipulative Therapy 17.4 (2009): 247-254.

2. Silveira, A., et al. "Jaw dysfunction is associated with neck disability and muscle tenderness in subjects with and without chronic temporomandibular disorders." BioMed research international 2015 (2015).

3. Durham, Justin, et al. "Self‐management programmes in temporomandibular disorders: results from an international Delphi process." Journal of Oral Rehabilitation 43.12 (2016): 929-936.

 

 

 

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Bridging the Gap on Men's Health

If you hadn't noticed it's Movember and Men's Health is in the spotlight. In particular Mental Health, Prostate Cancer and Testicular Cancer. Three aspects of Men's Health that contribute significantly to men's mortality. The saddest part of this statistic is that they are, to a great extent, preventable causes of death with early intervention.

In the course of my career I have taken many a phone call from the wife or partner of a man to make a booking on their behalf. Often unbeknownst to the man! This gives a small insight into men's health behaviour that is quite curious. Men will often avoid seeking attention for health related issues. 

Why don't men ask for health help?

A study from the International Journal of Consumer Behaviours (1) found some interesting reasons why men do not seek health care assistance when they clearly should. These were broken down into broad themes that included:

1. Health-seeking behaviour was seen as a more female trait and not one associated with male self-reliance (I think this might be code for "I'm too scared to find out what's wrong with me")

2. Expressions of underlying fear and fatalism (at least they're being honest!)

3. Feelings of disconnection from health providers (talking about how I feel with a stranger is just not cool)

There is no good age to be a man

At the pointy end, the life expectancy of a man is on average 4.5 years less than a woman. 

Perhaps more alarming, across the lifespan, just being a man means you're more likely to die than a woman.  And that's in all major age groups!  This is in part due to men being biologically driven to partake in more risky behaviour (with sometimes devastating consequences). However the stark difference across the lifespan points more directly at men's lack of attention to detail in maintaining their own health and well-being (2).

Health behaviour change and the time it takes

One of the major benefits of seeing an osteopath at Fairfield Osteopathic Clinic is the time we take with our patients. An initial consultation is usually around one hour and all subsequent consults are around 30mins. There is always opportunity to get to know the patient in front of us. Of course we'll take a detailed medical history and perform the appropriate physical examination. But more than that it is chatting to the patient about their life, family, work, hobbies, exercise routine, friendships - all the stuff that makes them who they are. Obviously this doesn't all happen in one consultation, it will often take a while to build a therapeutic relationship with a patient and trust is not something that can be afforded lightly.  Often this chat can reveal something about them that needs a little more attention. This might work a little better with men who are more reserved about revealing too much about their health history. 

So a shout out to the men out there. Don't put that appointment off  with the osteopath because you think that it's not "manly" to see someone about your aches and pains. This goes double for those things that you should see the GP about e.g. a spot that has changed on your skin, a lump that has developed somewhere it shouldn't, or you just aren't feeling your "manly" self. 

Taking ownership of your health

Influencing health behaviour's is usually a pretty subtle science, even as a health professional. In recent times initiatives like Movember have done terrific work in highlighting the need for men to take ownership of their health. Likewise the RUOK group have done great work in clearing the lines of communication to help men (and women) open up about struggles with mental health. Always keep in mind that your health professional is a confidential source for anyone to talk about their health problems. As osteopaths we always are aware of our professional boundaries and scope of practice and will refer you on as necessary.

(1) Buckley, Joan, and Seamus Ó Tuama. "‘I send the wife to the doctor’–Men's behaviour as health consumers." International Journal of Consumer Studies34.5 (2010): 587-595.

(2)http://www.ausstats.abs.gov.au/ausstats/subscriber.nsf/LookupAttach/4102.0Publication30.06.104/$File/41020_MensHealth.pdf

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The "cost" of bulk billing?

This might be controversial but I think it needs to be discussed. I have been prompted to write about the cost of health care services due to a recent increase in referrals from other health practitioners. This is great and we always welcome new referrals but it has presented a dilemma or two.

Many of the the new referrals come to us through the Chronic Disease Management Program (subsidised by Medicare) and the presenting patients are often surprised that we don't bulk bill our services. I think this is because most come from Bulk Billing GP practices and are used to not paying much (if anything) for medical services. Also, we have recently had a lot of people walk in off the street or ring on the phone to seek advice for their presenting complaint without actually making an appointment. As most will appreciate the latter is difficult to manage as we definitely do not like to consult on the phone or diagnose and treat in the waiting room.

There are many financial reasons we don't bulk bill but fundamentally we don't do it as it devalues the therapeutic relationship. Everyone should be entitled to health services and we offer concessions where possible but getting something for nothing seems to be an increasingly popular mentality when it comes to health.

There is a very big elephant in the room when it comes to bulk billing for service. A recent article in the Sydney Morning Herald noted the trend for poorer quality health care as the cost to the patient reduces. This is due to GP time management as it does not become cost effective to see patients for more time when they are being bulk billed. At Fairfield Osteopathic Clinic we will not sacrifice time with patients. Hence, we will not bulk bill. 

There have been suggestions regarding modifying Medicare payment processes and this may have been what the failed Federal Coalition Government Medicare Co-payment plan tried to address. The bottom line is those practitioners that choose to provide longer consults and spend more time gathering history and performing examinations/treatment should not be penalised.

We will always try and keep the cost of our consultations competitive for the business we are in. This is always a delicate balancing act.  Osteopathy Australia our national association continue to lobby for more provisions through Medicare for Osteopathic services so that we can provide that care to more patients patients from broader socio-economic backgrounds.

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Five tips for a better night's sleep.

Sleep is a tricky topic.  How many hours should we get? Seven, eight or nine?  What has been the impact of television/screens/ipads?  Should we sleep more like our ancestors in two big chunks (Bi-modal sleep)?  

The overwhelming response from most people would be that they'd really just like a bit more of it.  

Here's my top five tips to get a better night's sleep:

1. Stop unhealthy habits before bed

Finish eating or drinking at least two hours before you try to lie down.

Get off that computer or off the couch at least one hour before bed - seriously.

Check any nighttime medications* don't have caffeine in them.

2.  Clear your bedroom of unhelpful items (make a checklist) 

Get a blackout curtain if a street light shines in (it's not just for toddlers).

Is your room too warm or too cold?

Get rid of your shining alarm clock.  No one needs to see the time in neon.

Turn off your mobile phone.  I mean it.

Children and pets are warm, nurturing creatures but they don't always need to share the bed with you.  We often get shoved into a cold corner of the bed to accommodate them.  Restore your boundaries.

Is your mattress more than 8-10 years old?  It might be time for an upgrade.

Do you love your pillow? (see my post on pillows)

Covers too heavy or restrictive?

Spouse or partner that is restless, noisy, or generates too much heat - um, acceptance?

Some medical conditions❡ interfere with sleep.

3.  Do you love a daytime nap?

Do not daytime nap for more than 45 minutes

No napping after 3 pm

4. Exercise

A few surprises.  A 2010 (1) study found people with no previous sleep difficulties slept better the night following exercise.  But for people who had been diagnosed with insomnia, a fairly comprehensive study from 2013 (2) found people had to exercise daily and consistently for up to four months before there was a measurable benefit.

Put simply:

Consistently do a bit more physical activity during the day.

Expose yourself to bright light on waking – tell your body it's daytime.

Expose yourself to bright light in the afternoon to keep your body awake longer.

5.  Consistency of sleep habits 

Wake up at the same time every day - almost the hardest one to implement for anyone, especially an insomniac.

Develop a flexible before bed routine.  It might include a warm shower or bath, meditation or a calming book.

In-bed routines - breathing techniques, progressive muscle relaxations (that's a whole other BLOG)

Reduce fluid consumption in the evening to avoid the need to wee all night.

 

(1) Aerobic exercise improves self-reported sleep and quality of life in older adults with insomnia. Sleep Med. Oct 2010; 11 (9): 934-940. Kathryn J. Reid, PhD, Kelly Glazer Baron, PhD, Brandon Lu, MD, Erik Naylor, PhD, Lisa Wolfe, MD, and Phyllis C. Zee, MD, PhD

(2) J Clin Sleep Med. 2013 Aug 15;9(8):819-24.  Exercise to improve sleep in insomnia: exploration of the bidirectional effects.  Baron KG1, Reid KJ, Zee PC.

 

* Some medications that can interfere with sleep:

  • Antihistamines: Benadryl (daytime drowsiness)
  • Sympathomimetic Amines: bronchodilators and decongestants
  • Antihypertensives and Beta blockers: Clonidine, Aldomet, Reserpine (daytime drowsiness)
  • Steroids: Prednisone, dexamethasone
  • Thyroid medications:
  • Anti-epileptics and antipsychotics (daytime drowsiness)
  • Parkinson medications: (daytime drowsiness)
  • Stimulants for ADHD
  • Anticholinesterase drugs for Alzheimer's
  • Antidepressants: Prozac, Fluoxetine
  • Analgesics: opiates, Tramadol, Ultram
  • Chemotherapeutics: (nausea and vomiting)
  • Diuretics: (frequency at night)

 

❡ Some medical conditions that can interfere with sleep:

  • Respiratory disorders
  • Cardiovascular disorders
  • Gastrointestinal disorders
  • Musculoskeletal pain and dysfunction (Book Online)
  • Diabetes
  • Renal disorders
  • Prostate problems and small bladder causing urinary frequency
  • Cancer
  • Dementia
  • Dental disorders
  • Restless leg syndrome or Periodic Limb Movement Disorder (PLMD)
  • Fibromyalgia (alpha wave intrusion)

NOTE: People who do shift work have special challenges as they consistently interrupt their diurnal rhythms.  It is outside the scope of this post.

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Referrals from Dr Google

Why Dr Google isn’t always enough.

A colleague of mine in Canberra recently saw a teenage girl whose mother had noticed a curve in her spine.  Her mother was worried and took her daughter to her GP.  She was diagnosed with a Scoliosis and referred for X-rays.  The X-rays suggested the curve was so pronounced she was a candidate for bracing and/or surgery and the GP referred her to Canberra Hospital. Due to the nature of a regional hospital, Canberra didn’t have anyone appropriate to help the girl and sent her away. Unfortunately, they didn’t provide any further referral advice.

As the mother was a client of my colleagues, she asked if she could review her daughter’s situation.  My colleague assessed her, read the report, looked at the X-rays and agreed with the findings.  Your garden variety Scoliosis* is rarely anything to be concerned about but this girl’s Scoliosis was very pronounced and due to her age, was at risk of progressing with potentially serious side effects.  My colleague knew, in this case, her place wasn’t in providing hands-on therapy or exercise advice.  The young girl didn’t have any pain. She reassured both the parent and young patient she would look into what the protocol was from this point.  

The Mishits

My colleague completed a Google search of her own.  The initial hits were private clinics offering exercise therapy from physiotherapists and spinal alignment from chiropractors. Either of these methods, even with the fanciest websites, and expensive treatment programs weren’t offering much for a spinal curve that could impact the long-term health of this young girl.  As an Osteopath interested in the evidence behind making decisions in clinic she dug a little deeper and started to search journal articles and systematic reviews about Scoliosis.  

Good advice, and therefore opinion, should change as new research enters the fold; exercise, bracing and surgery were all still in the offing but they were used for different grades of Scoliosis.  And she was no closer to finding an expert who could help this young girl with her choices.  

The Resolution

Many health professionals, especially Osteopaths, often work in isolation.  For a whole lot of reasons it can be hard to communicate with other health professionals.  It’s called cross-referral. 

My colleague rang me to discuss the situation.  I followed up her phone call by speaking to a friend who is a paediatrician at the Royal Children’s Hospital in Melbourne.  She suggested sending her to a big centre in Sydney to see a paediatric orthopaedic surgeon for assessment and advice.  Her advice emphasised consulting a bigger centre as even bona fide specialists are prone to working in isolation. They might have forgotten to keep up with the evidence and then you can be right back where you started.

There are also particular ways to take an X-ray of a Scoliosis that give a more accurate measure of the curve.  A big centre will organise this and it may mean this girl is not in as dire situation as her report suggests.  That’s worth knowing.

Occasionally, especially when it comes to making decisions about our health, we find ourselves at a loss, and we turn to Google for advice.  As magical as Google is, it doesn’t always cough up the best evidence-based advice.  There are a lot of people with something to sell, trying to make their living on the WWW.  

There are also some amazing people, who have studied a long time and continue to gather the evidence, and question the current dogma in support of what they do.  They may not have as much time to construct websites and complete digital marketing strategies that mean they’re ‘top of the pops’ on a Google search.  What they do have is more than an opinion.  In the case of this young girl, she was best off to navigate the fragile behemoth that is our amazing public health system.  My colleague, an Osteopath, has the skills, contacts and strategy to help her navigate the system, interpret the advice and provide reassurance.  She will also be there to help rehabilitate her after intervention with movement advice or provide pain relief - should she need it.  

My take home point

The health professional you visit, whether it’s your GP, Osteopath, Maternal and Child Health Nurse, Naturopath or Dentist, should be interested in providing advice and treatment based on current best practice, science and research.  

Times have changed and will continue to do so.  The healthcare/medical sphere is continuing to evolve.  As a consumer, it is in your best interest to seek out the professionals that are interested in treating you in this manner because then your healthcare complaint will be managed with the most current information available - NOT ‘this is how we’ve always done it’.  

The Osteopaths at Fairfield Osteopathic Clinic are all university trained in their area of expertise.  They know their limitations. They have the skills to navigate the healthcare system and will better equip you in your journey.  As Osteopaths we also have more time to provide this extra support you require ….. GP’s are VERY busy people.


(1) Epidemiology of adolescent idiopathic scoliosis.  Markus Rafael Konieczny, corresponding author Hüsseyin Senyurt, and Rüdiger Krauspe. J Child Orthop. Feb 2013; 7(1): 3–9.

* Very few humans on this planet have ‘perfect’ alignment.  Millions of people have Scoliosis (1) - a sideways curvature of the spine - with no undue stress or strain placed on any part of our bony structure, or the muscles and ligaments that attach to it.

Extra information

The Internet is an amazing resource, full of information and misinformation. This is a great link that questions the value of opinion:   http://theconversation.com/no-youre-not-entitled-to-your-opinion-9978