General Interest

Is that a knot in my muscle?


54 year old Barbara has pain extending across the top of the shoulders, frequently extending into the neck. Is it a muscle? Is it a trapped nerve? Or is there something more complex going on?  Why didn’t it hurt six months ago?

Surely, the muscles are tight?

They may actually be a bit wound up actually, especially with a little bit of stress in your life.  Most of us have experienced a rush of adrenaline in the work place, at home or even crossing the road.  Adrenaline is great; it prepares your body to get moving by increasing your heart rate and your breathing so you can send more oxygen to your muscles.  The free-floating adrenaline also binds to your muscle spindles, increasing the resting tension so your muscles can burst into action. 

Most of the time though, we’re left not bursting into action but taking a deep breath and getting on with not moving.

But is all that tension going to make a knot?

One study specifically found there is no clear evidence of a strong relationship between increased electrical activity of muscles and the development of musculoskeletal disorders (2).  Keep in mind this was one study, and the definition of a musculoskeletal disorder might not include Barbara and her sore muscles across the top of her shoulders.

I can definitely feel a knot in there.

There is zero consensus about what that hard lump in the muscle actually is and ‘knot’ seems like a fairly innocuous word to all those other than knitters and sailors.  And just like knots in the real world, most are amenable to unwinding given the right intervention.

Bio (Body) Psycho (Brain) Social (Environment/Interaction) 

Like many things in the body and pain, the pathophysiological mechanisms remain unclear. We are always more than the sum of our parts and if we look at the risk factors above, you need to find out whether Barbara has stress in the workplace, disappointment in her job, her relationship, whether she has a cold, whether her dog just died and she’s stopped walking, whether her children left her with five grandchildren on the weekend? And then what is her ability to control any or all of these aspects of her professional and personal life?  

See the problem?  This is why a medical history is important, why Osteopaths ask a lot of questions, why we need to spend more than seven minutes with you to grasp how to help you out of pain.  We need to find out what’s tipped you from not even noticing that you’re a bit tight, to not being able to tolerate your shoulder discomfort a moment longer.  

Hopefully, it’s as simple as softening off the muscles, turning a computer to a better angle, taking some micro breaks in the workplace and heading out for a daily walk.

Let’s get back to Barbara...

Step One:

take a slow deep breath

drop your shoulders

release the tension

Step Two: 

get up from your desk occasionally

wave your arms around or run them quickly on the spot for ten seconds

smile at your colleagues and let them know you’re not crazy

Step Three:

Find some daily exercise that you love

Step Four:

Advise your children you can no longer care for all five grandchildren at once for an entire weekend.


Ratey, John J.,Hagerman, Eric. (2008) Spark :the revolutionary new science of exercise and the brain. New York : Little, Brown,


Westad C, Westgaard RH, De Luca CJ.   J Physiol. 2003 Oct 15;552(Pt 2):645-56. Motor unit recruitment and derecruitment induced by brief increase in contraction amplitude of the human trapezius muscle.

Morning, I'm Broken!

We all know we feel better physically, emotionally and psychologically if we’ve taken the time to exercise in the morning but how do we reduce the general ache and stiffness that many of us feel before we even get out of bed?

The main thing people consult an osteopath for is pain.  Pain in their low back, between their shoulder blades and in their neck.

But a frequent complaint in practice is people reporting a general feeling of stiffness or ache in all sorts of places when they try to leave their beds of a morning. So while the good news is you aren’t woken with pain in the night, the moans and groans start when you haul yourself out of bed. And it can be enough to wake your partner, or the dog.

Is there any research on this?

There was nothing focused in the literature about whether stiffness improves with exercise, and certainly nothing as specific as morning stiffness. Although this may be because no one asked the question in an original study (i.e. it wasn’t set as a specific outcome for the population being studied).      

An educated guess…

Waking with stiffness would be due mostly to your body trying to adapt to new behaviours or resting postures you’d get out of given the chance if you were awake.

Examples of the types of things that might cause stiffness in your neck:

Stomach sleeping

Bingeing on Netflix in bed with a laptop

Long long hours at a computer

Long drives on straight roads


Examples of the types of things that might cause stiffness in your low back:

See above


Examples of the types of things that might cause stiffness in your feet and achilles:

Standing for long periods (cooking, ironing, gallery walking)

New exercises or an increase to new exercises (skipping, golfing, new shoes)

Or just good old DOMS the day or two after a workout at the gym

What exactly will you be mobilising? 

There is no exactly about it….you’ll be mobilising nerves, muscles, tubes, connective tissue, all manner of fluids including sparking up your brain juices.

A word of caution in the mornings.

Your nervous system is a bit protective of itself when we first wake up, as anyone who has ever done yoga before 6am will attest. That burning tightness behind your knees is not your hamstrings it’s actually your sciatic nerve letting you know it does not appreciate being pulled quite so aggressively before the sun has even risen.

Give it a fortnight.

It might take a while to tell if your body is going to love a new regime but in the meantime you can reward your mornings with these mobilisations:


ACHILLES and FEET stiff when you stand on them in the mornings? 

Prancing with straight legs

Heel to toe

Holding onto the door frame squat


If your low back stiff in the mornings?

Try this series of movements: 

LB twist 


Knees to chest



Child Pose with Lateral Flexion 



UPPER BACK and NECK stiffness in the mornings?

Sidelying bow and arrow

Neck slider/shoulder shrugs




All our mobilisations will be available on our BLOG this month. 

So make yourself a morning routine that suits you.

Share these tips and tricks to put some spring in someone else’s step this August.  

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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.


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Not all pain is caused by tissue damage but there are many occasions when an ‘event' has caused someone to present with pain.  Pulling off a tight and sweaty crop top, lifting a heavy pot plant on a weekend clean-out, twisting an ankle during a netball match or landing awkwardly while trying to double bounce your kids on the trampoline.

Four weeks ago, a lovely mid-50s patient kicked a heavy box (that wasn't there before) on a night time bathroom break.  She had an x-ray the next day and there was no indication of a fracture and now she is presenting with pain in her toe joint one month later.  She is worried the toe may be fractured and the x-ray missed it and now her pain seems to expanding into other areas of her foot.    

As students we all learn about how long a tissue injury may take to heal.  But this information is infrequently passed on to the patients and I don't think we should underestimate the benefit in learning how long something might take to feel better. It is one of the active ingredients in therapeutic care that we can provide to patients with pain, along with reassurance.  Sometimes people don't want to hear that healing and resolution will take 'time' but I'm afraid that's one of the first things we need to accept.  


As an absolute minimum these are some common timelines for Tissue Healing:


Muscle Tear: between 2-12 weeks depending on the severity

Acute Tendinopathy: 4+ weeks

Degenerative Tendinopathy: 8+ weeks

Ligament: Between 2-12 weeks depending on the severity (and 12+ weeks if you've had surgical repair)

Internal Disc Derangement: 8+ weeks depending on severity and location

Bone fracture: 8+ weeks (depending on severity)

Bone bruising: 8+ weeks

Most Cartilage injuries: 4+ weeks

Bursa: 2-6 weeks (or on and on and on) depending on severity

Things that will impact tissue healing times (for better or for worse):

  • Underlying bony change (age related or previous injury) 
  • Anti-inflammatories
  • Progressing exercise too fast
  • No exercise
  • Sitting on your butt 9 hours per day
  • Eating great or crap food
  • Drinking alcohol
  • Drinking caffeine
  • Drinking sugary drinks
  • Age
  • Occupation
  • Values (have you got a big game to play?)
  • Beliefs (your father thinks you're weak)
  • Sleep or lack of...
  • Stress

Keep in mind we are talking about tissue healing times here and this is something completely different from whether you are experiencing pain or whether you have terrific or terrible function (read this entry here for more on the complexity of pain).

Back to our lovely mid-50s lady with sore toe. Potentially, when she kicked her toe into the heavy box, she didn't fracture the long bone but compressed the ends of two bones into each other essentially bruising the bone.  This bruised bone takes a lot longer to heal than a bruise to the skin and the soft tissue just below it and this means it may also hurt for longer.

Finally, walking around with that sore toe can mean you may start to move through your foot differently avoiding the sore joint. You might weight bear more on the foot that doesn't hurt. Your whole body is invested in reducing the pain in your foot and so adapts to give your poor old toe the time and space to heal and recover.  Learning about this can help your anxiety around your sore toe and even reduce pain levels.  And of course manual and physical therapy provided by the Osteopaths at Fairfield Osteopathic Clinic can certainly diagnose, treat and provide education and advice to help reduce your pain and your anxiety about 'how long until this stops hurting'.

To make an appointment book online or call 9489 0981

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Sitting at the desk can be a real pain in the %$*&

It's one of the most common questions we get in the clinic - what is the best sitting posture?

To be honest, it would be ideal if we didn't sit as much of the day as we do, but given the society we live in it's going to be a while before we all get to go primal.  

We have all had a think about it and the overwhelming advice we give revolves around optimal sitting postures and reducing the amount of time you sit altogether.

So what can you do?

We all need to become big softies. Softening your neck, shoulders and upper back will go a long way to reducing pain and dysfunction around that area. 

Start by dropping those shoulders. 

Whether you sit, stand or kneel you're still going to get a sore neck and shoulders if those upper back, neck and shoulder muscles are working hard for hours on end. They have to work hard any time you have your arms out in front of you for long periods of time. For instance, when you are tapping at the keyboard, driving the car, crocheting, and then throw in the added tension that stress creates. A neat trick that seems to help is to tuck your elbows to your sides, this lets the shoulders relax a little more and keeps you mindful. Always try and rest the weight of your forearms on the desk or chair if you are sitting. 

Some other good ideas to help you soften through your upper back neck and shoulders include:

1) Breathe and Release - most people find it easier to drop the shoulders, soften and release on an exhale.

2) Driving - hold the wheel on the two lower quarters and let your shoulders rest when you are in a more relaxed stage of a drive. 

3) A Trigger - find a trigger during the work day to consciously soften through the trapezius and drop the shoulders, e.g. hanging up a phone call, sending an email, etc. 

I'm sure you've noticed the recurring theme is 'letting the shoulders drop'. 

If you are quite conscious of this over a period of three weeks, there is a sense of 'retraining' your brain to release your shoulders and neck tension automatically.

There are definitely more optimal sitting posture than others.

We have included some photos of the good, the bad and the plain ugly. Some sitting positions are extremely sloth-like but extremely comfortable, and that's ok. But always remember the more comfortable you are in the position the longer you can hold it - and that can be the problem. 

The thing about maintaining good "posture" or sitting more upright is that the "better" your posture the more energy intensive and the harder it is to hold so then you move away from that position - therefore it’s better for you. Moving more is better for you - it is that simple.

Other simple tricks for the desk jockey:

1. Stand to talk on the phone wherever possible

2. Look out the window at something small and distant (like a bird in the tree) - this is good for your eyes.

3. Have walking meetings outside wherever possible. Who said a meeting had to be sitting down?

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Blurred Lines of Health Care

Multiple x-ray.jpg

I felt the need to share the case of a patient I had recently.  The issue is not with the patient themselves but with the care they received from another practitioner.  

The mature gentleman in question had presented to me with a long history of knee pain. Due to that long history he had also developed some compensatory pain in the hip and low back as his overall function had diminished. Some treatment helped with the presenting complaint but the knee was still pretty bad. A quick consultation with the GP and it was agreed a specialist referral would be necessary. Turns out the knee was severely degenerated and he was a strong candidate for  knee replacement surgery.

The patient was not keen on surgery, which is fair enough. The recommendation is always to hold out for replacement surgery as long as possible and I support that wherever possible. He decided to get a second opinion from another manual therapist, a Chiropractor, that had been strongly recommended by a friend of his. This opinion was meant to see if any more could be done to prevent surgery. I would always encourage a client to seek further advice if they have any doubts at all.


The patient returned to my practice a couple of weeks later with a full spinal X-ray series - from head to bum basically. They wanted my opinion on this series of X-rays that the Chiropractor had ordered. The patient was particularly interested in my opinion of their neck X-ray. There was a little bit going on in the neck but nothing too sinister at all. I asked whether they currently had neck pain. The answer was a resounding "No". Turns out they hadn't had any neck pain at the time of the X-rays either. However the Chiropractor had pointed out a lot of areas of 'concern' that would need to be addressed in a series of treatments over the next YEAR! 

I'm sorry, but there was no pain and no clinical indication to X-ray anything above the knee in the first place. The Chiropractor may have valid reasoning in their own mind for pursuing a course of treatment on an asymptomatic neck but it's not good health care. 


A big problem with private practice health care is that it is about the practitioner's livelihood. There are mortgages, living costs and often large educational debts to pay for, as well as their own health care needs, and the list goes on. Many get into health care professions with the most noble of intentions only to find it is not that easy to make a living - not as easy or lucrative as many would think. There are numerous health care business coaches out there who wax lyrical about the money that can be made in private practice. Unfortunately, it is completely driven by increasing treatment for patients and this means they aren't always selling good health care in order to build those numbers. They are selling over treatment and dis-empowerment of the patient and that's not an equation we like too much.

A multitude of practitioners sign people onto treatments they don't need.  In fact Four Corners did an hour long expose of the billions wasted in unnecessary investigations and treatments within the medical system.

Instead of the public purse paying for treatments it is the patient's personal income that pays for unnecessary treatments and for what end?

Practitioners may unknowingly prescribe snake oil.  They have invested a lot in their careers and they may be dissatisfied with their earning potential or they may have chosen to ignore the evidence to everyone's peril.


HCF is a private health fund that sends us the data comparing the number of treatments we provide to their members compared to other Osteopaths in the area.  Providers at Fairfield Osteopathic Clinic provide 30% less treatment per person. I don't think it's limited to clients who are members of HCF!

And don't get me wrong, I don't think it's because we're more talented. I think it's because we take time to explain the complexities of pain, encourage clients to be insightful about their condition, and encourage an active care approach and more than anything empower our patients with the confidence and knowledge to help themselves on a daily basis.

Another thing we do is to ask what your goal is?  Most of the time it's simple things; to get a better sleep, to be able to run with no pain, etc. Not many people are aiming for one hundred percent.  There is no finish line or silver bullet.  Reducing pain and improving function is maddeningly provisional and a lot of the time we are just there to give you a better chance of doing it better the next day.

This is not something that works for every patient. Some people benefit hugely from therapeutic touch for lots of different reasons and they seek hands-on treatment much more often than others. As long as patient and practitioner have a clear understanding of the care plan going forward then that is entirely appropriate.


All practitioners at Fairfield Osteopathic Clinic look at the outcomes for our patients, not at the outputs on the books.  It's a terrible business model of course.  So please, unless it's an exercise program, don't sign on for anything that's going to take twelve months.

* For interest of privacy many details have been changed.


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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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The Massage "Affect" on Anxiety and Depression


I know many people feel that booking in for a massage is an indulgence.  They wait for a gift voucher from a loved one, or save up once a year for their birthday. 

Many benefits of massage are still disconcertingly uncertain but while everyone is discussing those, a somewhat proven benefit is its positive effects on mood (1).

Massage has been shown to:

    1.    reduce depression

    2.     reduce anxiety


How often have you noticed your neck pain is at it's worst when you're under a lot of stress?  It will build up and up until you finally lean over to pick up your toothbrush and 'bam' you can't move your neck.  

Anxiety is a potent factor in all types of pain.  And in the case of lower grade anxiety and depression, the kind we all seem to be living with every day, massage can make a valuable contribution to your well being.


Although the neurophysiological effects are complex, the simple negative cycle that emerges when people are depressed or anxious, is that it's hard for them to do anything when they feel miserable.  As you continue to feel miserable, this leads to doing less, which in turn, leads to feeling worse.  

There is a boatload of evidence to support enjoyable movement and exercise to improve mood but how about not getting to the point of feeling miserable or trying to find someone to help you crawl out of that hole?

Most massage therapists are pretty nurturing types of humans.  They can provide a therapeutic support role through 'recovery' and encourage paced activity to incorporate self-management.


A leading researcher in this field is Christopher Moyer PhD who is a behavioural scientist primarily interested in the role of massage therapy on anxiety and depression or the human affect. 

I'll let him speak about the research he has accumulated on the subject about whether more massage is better:

"We made an interesting discovery concerning the effect of the treatment on the state of anxiety. When a series of massage therapy sessions was administered, the first session in the series provided significant reductions in anxiety, but the last session in the same series provided reductions that were almost twice as large. This pattern was consistent across every study we were able to examine, which strongly suggests that experience with massage therapy is an important predictor of its success, at least where anxiety is concerned. To put it another way, it is possible that the greatest benefits come about only when a person has learned how to receive massage therapy." (2)


You can all stop feeling guilty.  If you enjoy getting a massage then book one now and do something good for your mental health. Give yourself a pat on the back for being proactive about your wellbeing. Well done you!

(1) Christopher A. Moyer, PhD, Research Section Editor, IJTMB, Assistant Professor, Int Journal Therapeutic Massage and Bodywork. 2008; 1(2): 3–5. Published online 2008 Dec 15.

(2) Moyer CA, Rounds J, Hannum JW. A meta-analysis of massage therapy research. Psychol Bull. 2004;130(1):3–18.

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What is Osteopathy?

The word Osteopathy, along with the concept, was developed well over a hundred years ago. "Osteo" is clearly a derivation relating to "bone", but an Osteopath is much more than just treating bones.  I'm pretty sure if it was developed now, a whole team of branding and marketing specialists might come up with a better name.  It does have a fair bit to do with bones (as part of the overall musculo-skeletal system), but I don’t think there are many Osteopaths still out there who think we can use joint manipulation to cure serious disease.  So whilst many theories have been culled from the original concept, the manual side of Osteopathy has evolved to help people with pain and provide professional advice in their recovery from injury or surgery. 

A foundational principle, or perhaps the philosophy of Osteopathy, remains sound.  Historically, Osteopaths were trained to treat the body, mind and spirit.  In today’s speak, Osteopaths are trained to take a bio-psycho-social approach.  Bio (body) pscyhological (mind) social (spirit) is at the very foundation of how Osteopaths think.


We work with the body because we are manual therapists.  This means we use our hands, our eyes and our brain to assess your body and use a broad range of hands-on techniques and movement therapies in order to modulate your pain and help you move better.  Modulate in this context means to modify, hopefully in a positive direction, with the result being, you have less pain and movement is easier.


But where would we be without your brain, or ours for that matter.  Our brain works with your brain. This doesn't mean we’re psychologists but it does mean we’re good listeners and we recognise the person standing in our room has a brain, a mind, a long history of lived experience; possibly trauma, happiness, an education.  We work together with your brain, in countless ways, listening, discussing, educating and providing advice.  We might challenge your default or resting postures, and significantly, we will educate you about pain and this might challenge the way you think about your pain.


Osteopaths have historically also worked with your ‘spirit’.  This is the part that can make people feel we’re a bit ‘out there’, a bit ‘crystal healing’, a bit ‘woo’.  Once again, this aspect has an historical context. Osteopathy was developed when Science and Medicine didn't have answers for many horrible afflictions.  Using leeches and ‘bleeding’ people was common practice. 

Like medicine and the manual and physical therapy realm, Osteopathy has benefited from great leaps of understandings in Science over the last 100 years and especially research into neuroscience in the last 20 years.  

Most people’s experience of pain improves when you are provided with nurturing environments, good education about pain and why it’s there, empowering explanations, and the knowledge of how to change their pain.  This isn't pandering to the concept of a ‘spirit’ but it does recognise that people are complex creatures and appreciate being treated as humans.


Many practitioners, whether medical or manual, still practice within a biomedical model in which they tend to treat just the anatomical aspects of a problem.  “Here take some ibuprofen”, “You need to see me forever every four weeks to be truly healthy”, “Let’s strengthen your core to really solve the problem”, “Stand up straight”.  They often ignore the other human aspects that might be contributing to the problem, including the most important part that runs every single aspect of our mind and body, our brain. 

And we don’t forget the basics either.  We are very qualified to rehabilitate post-surgical or post-injury movement dilemmas. That's our bread and butter.

At Fairfield Osteopathic Clinic, our Osteopaths meet with you for up to an hour the first time you come in, in order to grasp the whole picture. 

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Michael Clarke's Back

Anyone who was watching the cricket yesterday would have seen the incident that led to Michael Clarke leaving the field with severe back pain. For the uninitiated Michael Clarke is the captain of the Australian Cricket team. The last week or so may have been, quite probably, the most traumatic and stressful period of his life so far. Recently there was the tragic injury, while batting, and subsequent death of Australian cricketer Philip Hughes. Phil Hughes happened to be a very close friend of Michael Clarke. A sad event all round and our condolences go to family, friends and the cricketing community at large.

I won't presume through this Blog to know exactly what is happening with Michael Clarke's lower back. I've heard it all from the commentators and journalists - disc degeneration, disc prolapses, sprained sacroiliac joints, pars interarticularis fracture - and the list goes on. No doubt he has a team of specialists giving their two cents on what is wrong and what he can do about it. What interests me is how such an innocuous incident could lead to a flare up of a pre-existing complaint.

The previous week Phil Hughes was felled by a bouncer while batting for NSW. Without going into detail it was a tragic and unfortunate accident that ultimately ended his life. Yesterday, while facing up to the Indian pace attack in the first Test Match of the summer Michael Clarke was travelling along quite well. He has recently altered his batting technique to take pressure off his "niggly" low back and hamstrings and it seemed to be working well. The Indian bowler at the time bowled a bouncer at Michael Clarke (which was a pretty ordinary ball putting the batsman under little pressure at all) to which he flinched to instinctively get out of the way. Wham-Oh! His back went into spasm and he was unable to continue.

Michael Clarke was under pressure - emotionally and physically. He was carrying a "niggly" lower back and hamstring problem. Suddenly a bouncer comes at him at 140km/hr and his brain says "ALERT, ALERT!" There is a reflex tensioning of the body and the messages from the brain to the lower back were greatly exaggerated. Here is a perfect storm for aggravating a pre-existing problem. Stress, anxiety and physical duress can all impact on the DANGER signals to the brain and the way the brain interprets that danger. It is quite likely Michael Clarke has not done any further "damage" to his lower back, and honestly I hope he is not being told how "damaged" his lower back is as it does not directly equate to a persons pain experience one iota.

Michael Clarke is an impressive captain to bravely go out and face that red ball under such stress and I'm sure will bounce back and hopefully be better for it. In fact, I think he just got a century.

What is the difference between an Osteopath, Physiotherapist and Myotherapist?

written by Mark Cooper


This is one of the most common questions from new patients in my daily practice. People sense I'm not going to laugh at their naivety and out it pops halfway through the first treatment.  My answer always errs on the side of caution as I don't really know what happens in other clinics. My answer is occasionally long winded as it's all about Philosophy, Philosophy, Philosophy.

Philosophy is one of those words that sometimes throws people. We know philosophers are intellectuals, thinkers or academics but ultimately, philosophy is just a theory or attitude that acts as a guiding principle for behaviour. That's what separates the individual disciplines, and of course, that's what separates individual practitioners and results in the treatment you'll receive.  

I think an example is in order. 

George, a 39 year-old office worker, saw the sun shining on the weekend and realised his deck needed some serious maintenance.  He bought some Cutek-CD50 deck cleaner and he started in, on his hands and knees, scrubbing the sucker. It took longer than anticipated. His knees were raw but it was his left shoulder that kept him up that night, throbbing uncomfortably into the early hours of the morning.  Upon waking, it was heavy, sore and he couldn't lift his arm above his head.  He realised thousands of repetitive movements that he had never done before might have resulted in some pain.

He went to work, and by 3pm, he was Googling 'shoulder pain' 'Fairfield' and 'relief'. He wasn't really sure what he needed but it wasn't a footy injury and he winced at the thought of someone massaging it.  Google brought up Fairfield Osteopathic Clinic and he remembered his sister saying she'd seen an osteopath and thought they were awesome. Even better, as he considered himself tech savvy, he could book online for that day. Done. His shoulder felt better already.

What happened in the treatment?

He travelled up Station St, Fairfield and found himself in the waiting room.  Mark Cooper, shook his hand and in the consultation room Mark took a thorough case history which included much detail about the "deck incident" as well as his previous medical history. George was extremely anxious about his shoulder pain as his neighbour had recently had a shoulder operation for long standing shoulder pain that did not go well. This is where the reassurance of George began.

From that point on George was in good hands. Examination included some orthopaedic tests for his shoulder that were necessary to gather what muscles/joints/soft tissues/nerves were ringing alarm bells.  With a diagnosis in-hand George was treated with hands-on techniques that aimed at reducing pain so that George could confidently move his shoulder uninhibited. In short, there was a complete bio (body) psycho (brain) social (environment) approach to George's pain.

George was NOT told there was an imbalance of the strength of his muscles around his upper back and shoulders, or that his spine was out of alignment leading to restriction of the nerves coming from the neck to the shoulder which were now inflamed. Unfortunately, these kinds of poor diagnoses and explanatory models of pain and injury still exist and they don't help George one bit!

What would another practitioner do?

Okay, so what would the physiotherapist have done differently. The question, equally might be, what would an osteopath at another practice in Northcote have done as it might be just as different. Can you sense me stalling?  

Physiotherapists may do less hands-on treatment, they historically like heat-packs* and ultrasound, although that's changing.  You'll get exercises and advice. They know, like us, that this particular injury will get better on its own, so you don't need much intervention as long as you keep on moving it. Many physiotherapsists (not exclusively) tend to over-complicate some injuries and you might find yourself being referred into Pilates (at their clinic) or buying a theraband for a set protocol of exercises. 

A Myotherapist allies itself with remedial massage therapy and focuses on musculo-skeletal health. They will be able to help relieve your pain by working on the muscles around the shoulder. Some have a degree in Allied Health that takes four years, which is as long as physiotherapists train.  This doesn't mean their training is similar. Physiotherapists are supported in their education by hospital placements.  Osteopaths train for five years, although outside the hospital system.  

This is a big, messy discussion that covers diverse debates around contentious topics including clinical reasoning, capabilities and competencies, sandstone universities versus private institutions, vested interest and education as a commodity.  The most skilled, educated and compassionate Myotherapist may be more than equal to a complacent Physiotherapist or Osteopath. This is true in a variety of professions.  


* Hey, I like heat packs as much as the next person but it's much cheaper to use them at home.

No references today, as this particular BLOG is full of anecdote and opinion.

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Why Blog?

Navigating the manual therapy BS

As Osteopaths, we meet people like you who live with pain every day.  We are passionate about how manual therapy can help relieve your pain.  We are also passionate about the science of why you have pain, when it’s normal, why it’s there and how it got there.  We know that we can educate you about pain, and in combination with some treatment you will live with less pain in your life.  Don’t just take it from us, a study in 2003 showed that if you are educated about pain in combination with your therapy then you have better outcomes (1). 

We’ve been procrastinating about blogging for several years.  There is so much information out there.  And we realised so much misinformation.  Our aim is to write on topics informed by quality peer reviewed scientific literature.

There will be a mix of information on the blog.  Much of it will be informed opinion, some of it educated speculation, and I’m sure at times it will be anecdotes about the body’s, maybe your body’s, amazing capacity for recovery.

1. Moseley, G. L. (2003b). Joining forces - combining cognition-targeted motor control training with group or individual pain physiology education: A successful treatment for chronic low back pain.  Journal of Manual and Manipulative Therapeutics, 11, 88-94.