Mr Oliver RussellOsteopath

The Osteopathic Clinic

Hamilton

14:00 - 16:00 WS #21: Osteopathy

14:00 - 16:00 WS #28: Osteopathy (Repeated)

Mr Martin LambertOsteopath

Love Your Bones Osteopathy

Ex President

Osteopathic Council New Zealand

GP conference Rotorua 2019

Osteopathy: Part of the healthcare jigsaw?

Martin Lambert – thanks to Jonathan Lloyd Paine

–Voltaire

“The art of medicine consists in amusing the patient while nature cures the disease.”

In the Beginning….

Osteopathy in NZ

Self regulation 1970s

ACC Treatment Provider status 1980s

HPCA Act 2003 – Statutory Regulation

Osteopathy in NZ today

SAFE?

Quacks?

❖ Treated by an osteopath

❖ Referred to an osteopath

❖ Haven’t a clue what they do

Sensory Body

Input Output

Soma

Helpful; Varied, Compound movements, MindfulAberrant;Heavy, Repetitive, Sedentary Muscle specific Reflexive.

Psyche

Helpful; Engaged, Stimulatory, Reactive, Mindful, Relevant, ValuedAberrant;Mundane, Valueless, Conditioned, Insult, Fear, Anxiety,

Motor control, Balance, Dexterity, Endurance, Power, Pain, Nociception,

Enjoyment, Stimulation, Attention, Passion, Self worth, Esteem, Meaning

Contextuality

❖ Simple sprain

❖ Major pathology

❖ Context

❖ Why now?

❖ Why me?

Osteopathic Philosophy❖ The body is a unit, and the person represents a

combination of body, mind and spirit.

❖ The body is capable of self-regulation, self-healing and health maintenance.

❖ Structure and function are reciprocally interrelated.

❖ Rational treatment is based on an understanding of these principles: body unity, self-regulation, and the interrelationship of structure and function.

❖ Patient Centred Care

About Osteopaths New ZealandOsteopaths New Zealand was formed as a professional association in March 2013

Osteopaths New Zealand is a clear voice advancing Osteopathic Healthcare in New Zealand.

We:

❖ Support the professional needs of New Zealand Osteopaths

❖ Promote the benefits of Osteopathic healthcare to New Zealanders

❖ Actively represent the Osteopathic profession in the healthcare environment

intermission

Archetypal postures

Assessment of functions

Archetypal postures as assessmentassessment

The Full

Squat

Toe Sitting

Drinking Posture

Toes Back Kneeling

Cowboy posture

Side Saddle Posture

Long Sitting

cross legged posture

Cobbler’s Pose

Lying Down

❖ Supine

❖ Prone

❖ Side-lying

W Sitting

intermission

Case Histories

The Bait

A 35 year old fit and well plumber injured his back at work 18 months ago.

He has had ongoing central lower lumbar pain, worse on sitting that restricts his exercise and work capacity and requires occasional analgesics.

He has had no neurological or red flag symptoms.

He has been seen by a specialist and undergone normal lumbar x-rays and MRI scan, and diagnosed with mechanical back pain.

Discuss?

Examination & Considerations

Osteopathic concepts

What is health?❖ Healthy expression of normal bodily activity

❖ Health is the level of functional and metabolic efficiency of a living organism. In humans it is the ability of individuals or communities to adapt and self-manage when facing physical, mental or social changes. – Wikipedia.

❖ Nixon function curve

❖ Somatic dysfunction

Function and influences of L4/5 L/S complex

❖ Function

❖ Transmit force to and from trunk and Lex

❖ To allow for diverse, rolling pelvic motion

❖ Visceral support

❖ Neurological protection and support

❖ Flexion extension with a small amount of rotation

❖ Hips

❖ LEx

❖ Meninges/spinal ligamentous complex

❖ Spinal curves

❖ Diaphragms

❖ Abdominal, gluteal, spinal, hips(especially flexors), LEx, Uex and cervical musculature

❖ Thorax

❖ Cervical spine

❖ The body as a unit

The Pelvis

❖ “One way to view the architecture of the human skeleton is to see it as a

tripod with the sacrum at the centre of the tripod.

❖ In this view the third leg is raised over the other two and functions as a

tension spring and shock absorber”

❖ Anne L. Wales

AAAARGGG ME SHIP BE GETTING BATTERED ⚔️💀☠️⚡️💥❗️⚔️💀☠️⚡️💥❗️

FASCIA& tensegrity

AAAARGGG ME SHIP BE GETTING BATTERED ⚔️💀☠️⚡️💥❗️⚔️💀☠️⚡️💥❗️

Blood supply

❖ Function around arterial paths

❖ Drainage

❖ Paraspinal venous plexus

❖ Diaphragms

❖ Blood pressure

Viscera

❖ Fascia directly with uterus, bladder, rectum, prostate, pelvic floor

❖ Autonomics (to organs and blood vessel)

❖ Blood flow

Psychosocial and emotional factors

❖ Recognise when to refer, when to just listen

Diagnosis

TREATMENT

Tools of the trade

❖ Rose quartz

❖ Rainbows

❖ Fairy dust

❖ Potions

❖ Ancient spells

❖ Water memory

❖ Ritual

❖ Anti-vaccine rhetoric

Techniques❖ Best application to get the

required change from a specific tissue that is best for their age, body type and health.

❖ Direct

❖ Soft tissue (massage), traction, articulation, strain/counter-strain, muscle energy, HVLA (clicking)

❖ Indirect

❖ Balance ligamentous tension (BLT), fascial unwinding, muscle balance

Which technique?

❖ It depends

❖ What ever technique is best to get the change in the tissue or system of mechanics we have diagnosed

Management

Exercises and Strapping

❖ Variety of exercise techniques from many different sources

❖ Strapping

❖ Passive stretches

Archetypal postures

❖ Postures of sitting that shaped our evolution

❖ Get on the floor

Neural drives

Neuroplasticity

❖ www.neuroplastix.com

Referals

❖ Pain Clinic

❖ Pilates

❖ Physiotherapy

❖ Acupuncture

❖ Specialists (eg Anglesea Clinic Sports Medicine)

❖ Surgeons

❖ Psychiatrists and counsellors

❖ Yoga

❖ Pool work

Follow up and ongoing treatments

❖ It depends

❖ Rarely more than weekly

❖ Phone and email support

❖ Review if no change especially after 3 treatments and refer if necessary

intermission

Osteopathy & Children

What to expect

❖ Technique types

❖ Treatment of children

❖ Case histories

❖ How we could work together better

❖ Questions and general grilling

❖ Quick escape

Treatment of Children

“You can’t treat a child like an adult, but you can treat an adult like a child”

Dr J Jealous

Assessment

❖ Case history

❖ Including: General health, birth, pregnancy, conception, medical, health book stats, bowel/bladder motions, feeding, sleeping, distress, temperament, first breath/scream/feed, apgar

❖ Check up (not as proficient as yours – always having to refer to charts):

❖ Age specific

❖ Including: Hips, fontanels, bony/anatomical landmarks, asymmetry, tongue, lips, latch, suckle, weight, length, head circumference, ears, spine, temperature, O2 saturation, tone, skin colour, hair, reflexes, facial motion, neck and body movement, Heart rate and BP

❖ If any concerns – Refer to midwife, Plunket, GP or hospital, appropriately

Diagnosis

❖ Health

❖ Tissue lesion

❖ Dysfunction

❖ Restriction

❖ Tension

❖ Un-physiological motion

❖ Tissue causing symptoms

❖ Look for a cause

❖ Apply to the case history and symptoms

❖ Form a working diagnosis

Lesions

❖ Primary

❖ Secondary

❖ Tennis elbow – not common in the paeds wards

Follow ups

❖ It depends

❖ Regain health, provide support but without endless treatments and the associated cost

❖ Growth spurts (7-10 days, 2-3 weeks, 4-6 weeks, 3 months, 4 months, 6 months and 9 months)

❖ Phone and email support

Of particular interest in babies

❖ Diaphragms

❖ Thorax

❖ Breathing

❖ Midline structures

❖ Mandible

❖ Spine especially OA complex and cranial base

Diaphragms

Pressure gradients

Fluid dynamics

Digestion

Poos and wees

Oesophagus valve

Breathing

Venus and lymphatic return

Birth process

Breathing

❖ Passive / active

❖ Diagnostic and assessment

❖ State of health

❖ Fluid dynamics etc

Thorax

❖ Respiration – shared with abdomen

❖ Integration of movement neck, arms, pelvis

❖ Foundations for neck and head

Midline structures

❖ CNS

❖ Notochord

❖ GIT

❖ Fascia

❖ Mediastinum

❖ Umbilicus

Mandible

❖ A mechanical doorway to the inner ear

❖ Treatment of the throat, anterior cervical fascia, jaw or midline structures can help ear drainage

❖ Tongue/lip ties either pre or post release

❖ Relates mechanically very closely with the OA complex

❖ Via the mediastinum, Sibson's plexus and the thorax generally to the diaphragm, especially the central tendon

❖ Otitis media is more likely to occur in children that are not breast fed for at least 3-6 months

The OA complex and cranial base

❖ Compression/restriction through OA and occipital condyles

❖ Nerves, especially: C1, upper cervical fibres to the vagus and Hypoglossal

❖ Torticollis

Case History 1

❖ Released tongue tie (grade 2 tongue, grade 3 up lip) female 2 week old. Diagnosed by midwife, cut by dentist.

❖ (G2P2) Brother is 3 no complications but poor feeding and often distressed. 6/52 “constant” crying then decreased very gradually until 7 months gromits at 4

❖ Unremarkable birth or pregnancy, no family history (father’s mother joked about him being a ”a real pain to breast feed. Eventually took the bottle)

❖ Reflexes present, no asymmetries, body check up unremarkable

❖ Sleep no pattern yet, still demand feeding – 1.5 hrs-2.5hrs per feed, 1-4 hours between

❖ Examination showed restriction midline through the submandible, ant neck fascia, retro strernal tightness, upper rib breathing, C1 compression/restriction

❖ Treatment, advice to parents re winding, thoracic articulation and submandibular work, refer to lactation consultant re routine and feeding

❖ After the first ttt mother reported easier latching and ’happier’ baby. After lactaion consultant and exersises VMB. After 2nd ttt much easier baby. ”everyone more relaxed”

❖ 2 consultations phone support as necessary checkup next growth spurt (3/12)

Case History 2

❖ First seen in NICU 1/12 old girl born @ 30/52

❖ (G2P2) One elder sibling aged 2y.o., no problems c/o. Mother diabetic.

❖ Pregnancy good no problems until stopped moving at 30/52. Emergency c-sect after scan and adrenalin shot. Suffered brain bleed on the left esp into 3rd and lateral ventricles. Swelling reduced w tap skull. Remove 10ml of blood/csf on day 16.

❖ At the time was at 25 percentile body size. 2/52 prior to consultation viral infection w apnoea. NICU. Had upper borderline temps prev 6/7. high temperature meant less feeding.

❖ Feed 2-3x1/7 breast then EBM. Diagnosed possible reflux (gaviscon). Breathing good (except infection) since day 2.

❖ Good pooing – reg. occasional vomit/spill. Grumpy from 8pm onwards with difficulty settling through the night. Sleeps on mother.

❖ Plagiocephaly w flattening R temporal/parietal/squamous occiput.

❖ Cerebral palsy suspected.

Case history 2 continued

❖ Home after 1/12. difficulty feeding and pooing 1x6/7. Feeding every 3/24 for 3/24

❖ Return 1/12 later w difficulty feeding and very poor wt gain. Sedation and naso-endoscopy followed by Ph study. X-ray guided Naso-duodenal feeding tube. All had to be left nostril. Had R sided shunt due to “collapse during surgery”. Reflux –ve.

❖ Coughed up naso-duod tube few days later. Return 2/52 later for Mic-Key Button.

❖ Wt starts to increase though still choking on solids

❖ Osteopathy: First saw patient in NICU round 1. noted lots of compression and restriction in the OA complex and submadibularmidline. Breathing rapid and mid – lower thorax with little or no abdominal involvement. Tightness retro-sternal.

❖ Treatment aimed and increasing the range of motion in these tissue and improving thoracic respiration.

❖ The mother reported baby felt much easier – most notably after the first treatment. More relaxed and slept easier.

❖ Now Baby is much happier and alert as the food starts to do its magic and her health improves.

Osteopathy in NICU

❖ Find a place where we can be useful

❖ Learn more

❖ Make a difference

❖ More research

❖ Happening already with the medical community in many places throughout the world and in New Zealand

Barnet Hospital

❖ At the request of medical staff and patients, we provide osteopathy for premature infants at Barnet hospital’s Starlight Neonatal Unit. Premature infants have many difficulties and most will have difficulty breathing. Much of our work on the neonatal units involves assessment and osteopathic treatment of premature infants’ breathing, helping the chest, ribs and spine to move freely. This involves highly specialised and very gentle osteopathic techniques.

❖ The babies seem to respond well to osteopathy and to benefit from touch, movement and osteopathic treatment. We believe that babies who receive osteopathy require less medication, leave special care sooner and have better longer term outcomes. There is evidence for reduced duration of stay, and we are planning to conduct a large research project into this and longer term outcomes.

❖ The Osteopathic Children’s Centre, London

Papers

❖ 'Several biological speculations could be addressed to explain the present results.

❖ Preterms have been demonstrated to have higher levels of pro-inflammatory substances and a sustained increase of autonomic tone. OMT has been shown to produce a parasympathetic effect as well as anti-inflammatory action. Although OMT findings were reported on different study samples, a 'neuro-biological' hypothesis could be theorized. Osteopathic manipulations could reduce the release of cytokines and the sympathetic activity creating a cascade of biological and neurological events, currently understudied in newborns, that modulate the inflammatory and autonomic nervous system mechanisms’

❖ Efficacy of an Osteopathic Treatment Coupled With Lactation Consultations for Infants' Biomechanical Sucking Difficulties.

❖ Herzhaft-Le Roy J, et al. J Hum Lact. 2017.

Research

❖ A lot of research has got us to this point and a whole heap more will get us beyond it.

❖ Nation Council for Osteopathic Research at Barts School of Medicine and Dentistry, London

❖ The Osteopathic Children’s Centre, London

❖ Italy

❖ The research is good but not faultless

❖ Paediatrician in USA Dr Greg Lund

❖ Longitudinal studies – more possible with health apps and medical software

Any questions?

Find your local Osteopath at

www.osteopathsnz.co.nz