End of summer - reflecting on what's new and exciting?

Hermes - by Sasha Chaitow (2009)
Kai Galen Mitchell - grandson of the developer of MET - demonstrating longus colli technique

September already!
....the summer slipped away so quickly and I am using this posting to reflect on the high points - as well as some specific aspects of it.

It's been a very productive 3 months, cocooned in our Corfu paradise, working on revisions, as well as editing the Journal of Bodywork & Movement Therapies (JBMT), and starting work on chapters for 2 new books that I am co-editing (more about these below).
To be sure revisions continue unabated.
During the summer I completed the 3rd edition revisions for Palpation & Assessment Skills, as well as Modern Neuromuscular Techniques, and Fibromyalgia Syndrome - A Practitioner's Guide to Treatment.
I am now working on revising, for its' second edition, Clinical Applications of Neuromuscular Techniques, Volume 2, Lower Body (CANMT), with chapters whizzing back and forth between my co-author Judith DeLany and myself (Florida to Corfu and back, in a nanosecond!).
The new editions will be published either later this year, or early next - although the CANMT 2nd edition won't appear until the end of 2010.
New work in progress involves 2 multi-authored texts that I am coediting, one is on Chronic Pelvic Pain and the other on Fascia.....more about these in future blogs, as the work unfolds.
Revision demands the tedious requirement of re-reading everything I/we had written 5 or 6 years back (and CANMT is well over 500 pages long), looking for ways of updating text - and references....as well as adding new ideas, methods, evidence....and often new chapters contributed by experts on the particular topic.
Working approximately 10 hours a day, seven days a week, throughout the summer, has allowed this mountain of work to be completed on schedule.
This work rate is only possible for me because of the warm and loving environment created by my remarkable wife Alkmini, who manages everything - allowing my work-time to meld with time in the enchanting garden she has created, so that periods of leisure, walking, swimming, reading, fruit picking, dog-walking - interweave with the writing.
The other magic ingredient is my 2 hour siesta every afternoon....necessary when the work day starts at 4am, or thereabouts.

An exciting aspect of the process of revision and editing comes when new information emerges from data searches or contributed work - and a few such nuggets are described below.

Revising powerpoint slides for the series of conference presentations, and courses, that lie ahead over the next few months, is another part of the continuous process of keeping abreast of new developments in manual therapy and associated topics.....and there's more on this below as well.

The real crowning glory of this summer however - for me - has been watching the blossoming of my remarkable daughter's talents.
Having completed her Masters degree, in Western Esotericism, at Exeter University, last year (we attended her graduation in January) she has since then been lecturing (Athens and Strasbourg), organising a conference (University of Indianapolis, November 6/7 - see details on this link) in Athens - as well as preparing for an exhibition of her art, to coincide with the conference.
Sasha spent 3 weeks of August with us in Corfu, settling down to paint in the garden around 11pm...and finishing as the sun rose (as did I) between 4 and 5am.....she would then sleep till early afternoon, swim or socialize, then once more paint all night, in the company of troops of fat dormice, scavenging our great oak trees for acorns and bugs.
Apparently a steady stream of half-eaten acorns rained down all night - sometimes onto her, and sometimes plopping into the swimming pool.
I am posting just one example of her production, above - Hermes.
For more you need to visit her site......or find her on facebook, or come to Athens in November.

So what exciting new information emerged this summer?

1/ Earlier in the year I contributed a section to a publication by the German Osteopathic Association (Verband der Osteopathen Deutschland) Muscle Energy Technique History-Model-Research, celebrating the 60th anniversary of the birth of Muscle Energy Technique. Fred Mitchell Jr, son of the developer of MET, has said:

“Treating joint motion restriction, as if the cause were tight muscle, is one approach that makes possible restoration of normal joint motion. Regardless of the cause of restriction, MET treatment based on a ‘short muscle’ paradigm is usually completely effective in eliminating blockage and restoring normal range of motion, even when the blockage is due to non-muscular factors”

Now this is how I have worked for many years...but to have this sanctioned by one of the fountainheads of MET was reassuring.

2/ Mitchell also reported that Karel Lewit, the renowned Czech physician had modified early MET approaches, by showing that, “because segmental vertebral motions are coupled, if normal ROM can be restored [to a restricted spinal segment] in the coronal plane, normal motion will be restored in the other planes. Simplistically this means that a flexion, side-bending rotation restriction, taken to its' end of range, may be effectively released by using a light isometric contraction, in just one of those planes, side-flexion for example. This concept has been shown to be valid in recent studies, for example by Lenehan et al (2003)

3/ The association between manual treatment methods and the release in the body of analgesic and euphoria inducing chemicals, such as the endocannabinoids, has helped to explain much about the almost instant effects of some modalities. In this regard John McPartland's papers (2004)have been invaluable.

4/ How long should soft tissues be stretched to achieve optimal mobility? I have long taught a 30 second period of stretch, particularly where the tissues are indurated, fibrosed. Smith & Fryer (2008) decided to test the validity of this advice, compared with that offered by Philip Greenman DO - of a 5 second stretch......and guess what - both stretches (30 second and 5 second) appear to produce the same benefit!

“Both techniques appeared to be equally effective in increasing hamstring extensibility, and there appeared to be sustained improvement one week following the initial treatment. The findings suggest that altering the duration of the passive stretch component does not have a significant impact on the efficacy of MET for short-term increases in muscle extensibility”…. “both these post-isometric techniques were superior to passive stretching in this group of subjects” ... I will nevertheless cling to the longer stretch suggestion in my teaching/writing because the study involved asymptomatic individuals...and real-life usually involves individuals with both symptoms and associated soft tissue changes.

5/ Among the most interesting ideas that emerged this summer was the possible link between ligamentous responses to compression, and the effects of facilitated aspects of Strain/counterstrain.

In modern positional release methodology, a common facilitating feature involves compression – which slackens ligaments automatically - reflexively inhibiting associated muscles. Solomonow (2008) has reported that “Evidence supports the possibility that ligamento-muscular reflexes have inhibitory effects on muscles associated with that joint - inhibiting muscles that destabilize the joint or increasing antagonist co-activation to stabilize the joint…….Ligaments are functional (effective) under tension, or when stretched, and completely non-functional in compression or when shortened below their resting length.”

...and now for the rest of the year....

References

• Lenehan K et al 2003 The effect of MET on gross trunk of motion. Journal of Osteopathic Medicine, 6(1):13-18
• McPartland, J et al 2005. Cannabimimetic effects of osteopathic manipulative treatment. Jnl. American Osteopathic Association 105:283–2
• Smith M Fryer G 2008 Comparison of two MET techniques for increasing flexibility of the hamstring muscle group. Jnl. Bodywork & Movement Therapies 12(4):312-317
• Solomonow M 2009 J. Bodywork & Movement Therapies 13(2) 136-154

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fascia, water and bodywork (plus: Micro-tornadoes, hydrogenated diamonds & nanocrystals)

Gerald Pollack in his lab (see below for more on this amazing researcher)

This posting leans heavily on a number of articles written over the past few years, for the online magazines NaturopathyDigest, and its' sister publication MassageToday.
Articles include:

• The Amazing Fascial Web, Part I. May, 2005 (Vol. 05, Issue 05)
• The Amazing Fascial Web, Part II. June, 2005 (Vol. 05, Issue 06)
• Breathing Patterns, Connective Tissue and Soft-Shelled Eggs. October, 2005 (Vol. 05, Issue 10)

The 2^nd International Fascia Research Congress is rapidly approaching (October 27 to 30, 2009). This is to be held at the Free University, Amsterdam and so it seemed appropriate to return to some of the fascinating advances touched on in the earlier articles.

Fascia Congress

On the first morning of the Congress (Tuesday 27 October) I will be moderating a panel that aims to demonstrate a number of modalities to those attending who are research scientists, many of whom have little or no experience in manual therapy. Approximately 800 delegates are anticipated, and it if the pattern seen at the First Fascia Research Congress (Harvard Medical School Conference Center, Boston, November 2007) is repeated, a little under half will be researchers with the other half practitioners and therapists from various clinical background.

The panel will comprise expert clinicians who will demonstrate and explain current thinking as to the mechanisms involved, Neurodynamics ('neural flossing') - demonstrated by Michel Coppieters PT; Vibrational methods - demonstrated by Zachary Comeaux DO; High velocity low amplitude manipulation ('adjustment') - demonstrated by Geoff Bove DC; Structural Integration (Rolfing) - demonstrated by Robert Schleip PhD; Connective Tissue Manipulation (or CT Massage) - demonstrated by Stephanie Prendergast PT; and Positional Release Techniques (e.g. Straincounterstrain) - - demonstrated by myself.

There will be both video demonstrations of the methods, as well explanations by the expert presenters - and critically - questions for researches regarding mechanisms - particularly those linked to fascia. Ample time will be allowed for questions from delegates.

It should be fascinating!

Fascia related topics in archived articles

In this short posting I've added details of a few fascinating new pieces of fascia related research, and some links to spice this up – and although not always immediately apparent - this topic and the associate research, reflects directly on the work of all manual therapists.

Some of the key fascia related topics covered in earlier articles were :

• The presence of contractile smooth muscle cells (SMCs)/myofibroblasts) that are embedded in most connective tissues. For example SMCs have been located widely in connective tissues including cartilage, ligaments, spinal discs and lumbodorsal fascia (Ahluwalia 2001, Hastreite et al 2001)
• The facts that the extracellular matrix (ECM) plays a key role in the transmission of forces generated by the organism (e.g. muscle contraction) or externally applied (e.g. gravity, or by means of manually applied therapy).
• Cell-matrix adhesion sites appear to host a ‘mechanosensory switch’ as they transmit forces from the ECM to the cytoskeleton, and vice versa, triggering internal signals following mechanical stimulation, such as occurs in manual therapy (Chen & Ingber 1999).
• There appear to be forms of communication within the fascial matrix, for example caused by tugging in the mucopolysaccharides, created by twisting acupuncture needles (Langevin et al 2005)

German researchers, Robert Schleip et al ( 2005), note that:

“The ability of fascia to contract is further demonstrated by the widespread existence of pathological fascial contractures. Probably, the most well known example is Dupuytren disease (palmar fibromatosis), which is known to be mediated by the proliferation and contractile activity of myofibroblasts. Lesser known is the existence of similar contractures in other fascial tissues which are also driven by contractile myofibroblasts, e.g. plantar fibromatosis, Peyronies disease (induratio penis plastica), club foot, or – much more commonly – in the frozen shoulder with its documented connective tissue contractures. Given the widespread existence of such strong pathological chronic contractures, it seems likely that minor degrees of fascial contractures might exist among normal, healthy people and have some influence on biomechanical behavior.”

Anyone using myofascial release approaches, or acupuncture, should be able to appreciate the potential therapeutic implications of these discoveries.

Research involving fascia and water’s amazing crystalline properties

And more recently, even more evidence has emerged of the mysteries of fascia.

For example:

The behavior of water that interacts with protein in the human body is becoming clearer. Professor Martin Gruebele of the University of Illinois explains:

"Water in our bodies has different physical properties from ordinary bulk water, because of the presence of proteins and other biomolecules. Proteins change the properties of water to perform particular tasks in different parts of our cells."

He continued: "Water can be viewed as a 'designer fluid' in living cells.” For more on this topic click on this link

Sommer & Zhu (2008) note that interfascial water plays a key part in what is termed ‘protein folding’, the process necessary for cells to form their characteristic shapes – and that nano-crystals are a part of this process – and that these are influenced by light.

“In the course of a systematic exploration of interfacial water layers on solids we discovered microtornadoes, found a complementary explanation to the surface conductivity on hydrogenated diamond, and arrived at a practical method to repair elastin degeneration, using light.”

Leading researcher in this field, Pollack (2006), has shown that water can at times demonstrate a tendency to behave in a crystalline manner. He has discussed interfacial water in living cells known as vicinal water. Interfacial water exhibits structural organizations that differ from what is termed ‘bulk’ water. This ‘vicinal’ water seems to be influenced by structural properties that make up the cell. In discussion of one example of this, in relation to the water in a temperomandibular joint, Pollack says: “The combined data from three different methods lead to the conclusion that all or almost all of the water in the intact disc is bound water and does not have properties consistent with free or bulk water.”

Pollack also says:

"If you want to understand what happens in any system – be it biological, or physical, or chemical, or oceanographic, or atmospheric, or whatever – it doesn’t matter, anything involving water, you really have to know the behavior of this special kind of gel-like water, which dominates.”
Pollack’s water studies have led to amazing possibilities: that water acts as a battery, that this battery may recharge in a way resembling photosynthesis, that these water batteries could be harnessed to produce electricity. He discusses these ideas in a lecture now playing on UWTV: “Water, Energy and Life: Fresh Views From the Water’s Edge.”
For a fascinating insight into water research I suggest you download - or watch - this free video of Professor Pollack's recent address at the University of Washington. To do so click on this link:

Fascia, water and manual therapy

Several years ago Klingler & Schleip (2004) showed that the water content of fascia partially determines its’ stiffness, and that stretching, or compression, of fascia (as occurs during almost all manual therapies, causes water to be extruded (like a sponge) – making the tissues more pliable and supple. After a while the water is taken up again and stiffness returns, but in the mean time structures can have been mobilised and stretched more effectively and comfortably, than were they still densely packed with water.

•Klingler et al measured wet & dry fresh human fascia, and found that during an isometric stretch, water is extruded, refilling during a subsequent rest period

•As water extrudes during stretching, temporary relaxation occurs in the longitudinal arrangement of the collagen fibers

•If the strain is moderate, and there are no micro-injuries, water soaks back into the tissue until it swells, becoming stiffer than before

All this suggests that much manual therapy, and the tissue responses experienced, may relate to sponge-like squeezing and refilling effects in the semi-liquid ground substance, with its water binding glycosaminoglycans and proteoglycans.

Muscle energy technique-like contractions and stretches almost certainly have similar effects on the water content of connective tissue, as do myofascial release methods, and the multiple force-loading elements of massage.

The speed with which research is uncovering the secrets of fascia is mind-boggling, and I hope to see you in Amsterdam to discover even more!

REFERENCES

· Ahluwalia, S., 2001. Distribution of smooth muscle actin containing cells in the human meniscus. Journal of Orthopaedic Research 19 (4), 659–664.

· Born, B., Kim, S.J., Ebbinghaus, S., Gruebele, M., Havenith, M. 2008 The terahertz dance of water with the proteins: The effect of protein flexibility on the dynamical hydration shell of ubiquitin Faraday Discussions 141, pp. 161-173

· Hastreite, D., et al., 2001. Regional variations in certain cellular characteristics in human lumbar intervertebral discs, including the presence of smooth muscle actin. Journal of Orthopaedic Research 19 (4), 597–604.

· Klingler W Schleip R Zorn A 2004 European Fascia Research Project Report. 5^th World Congress Low Back and Pelvic Pain, Melbourne, November 2004

· Langevin H Bouffard N Badger G et al 2005 Dynamic fibroblast cytoskeletal response to subcutaneous tissue stretch ex vivo and in vivo Am J Physiol Cell Physiol 288:C747-756

· Pollack G et al 2006 Water And The Cell. Springer

· Schleip R, Klingler W, Lehmann-Horn F 2005 Active fascial contractility: fascia may be able to contract in a smooth muscle-like manner and thereby influence musculoskeletal dynamics. Medical Hypotheses 65:273–277

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Schwartzenegger -vs - osteopathy: who will win the battle - Arnie or the DOs?

Strange happenings in California.
In his battle with a budget deficit, and his pledge to create 'smaller government' 'The Governator' has abolished the naturopathic licensing board (Bureau of Naturopathic Medicine) of the state, and has virtually merged this, under the aegis of the Osteopathic Medical Board of California.

This action has:
a/ pleased the naturopaths, as it more or less ensures the survival of the small profession (350 members or so) in that state, while:
b/ severely displeased the very large and powerful osteopathic profession - who see it as an affront to be stabled with NDs.

The major osteopathic organisation in California OSPC (Osteopathic Physicians & Surgeons of California), has issued this dramatic statement:

"Under the cloak of darkness, Governor Schwarzenegger has merged the Bureau of Naturopathic Medicine into the Osteopathic Medical Board of California (OMBC). OPSC is vigorously pursuing alternatives to overturn this legislation, including the possibility of litigation against the State of California. The legislation that merges naturopaths into the OMBC was included in the “emergency” budget bills on the very night that they were signed by the legislature, allowing no opportunity for opposition. Governor Schwarzenegger signed the legislation shortly afterwards.Under the legislation, two naturopaths will be seated as full members of the OMBC, and a nine person naturopathic committee will be created under the jurisdiction of the OMBC.
OPSC is vehemently opposed to this action, as naturopaths are not fully licensed physicians; this merger will only serve to confuse the public and possibly endanger patients. The merger is scheduled for implementation by October 23, 2009."

The OSPC states that it is actively planning to find legal ways of blocking this legislation.

Watch this space for further developments...........

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Is there more to osteopathy than muscle and joint dysfunction - the PAD evidence?

My previous posting about the possible value of chiropractic in treatment of childhood health problems, such as colic and earache, highlights an ongoing debate in my own profession - osteopathy.
This is less of an issue in the USA where osteopathic physicians operate as first-line physicians - treating all manner of health problems, with a mix of mainstream medical and traditional osteopathic approaches. Some DOs in the States have brilliant manipulative skills - probably second to none in the world - but sadly, the majority ignore those aspects of their training, and focus on allopathic (i.e. traditional, conventional) medical health care.

In Europe the story is very different, and in earlier postings I've tried to encourage a realisation of the potential of osteopathic healthcare, outside of it's proven track record in handling musculoskeletal pain and dysfunction...... for example by pointing to evidence from research showing just such benefits, as well as the history of osteopathic care during the great influenza pandemic of the early 20th Century..
In addition, in a March 2009 posting I outlined some of the evidence for the benefits of manual approaches to psychological and emotional problems.
In the United Kingdom, there is a lot of discussion within the profession - especially as we (along with all other health care professions) move towards a new government ordained initiative of revalidation.
For example, will it be acceptable to revalidation panels , for an osteopath to claim that the particular model of osteopathy being practiced deals with general health, or even psychological problems ......... as well as musculoskeletal dysfunction and pain?
Quite predictably, and appropriately, "where's the evidence", may well be the demand?
Please note that my repetitive focus on the wider benefits of osteopathic manual therapy is not meant to suggest that there is something necessarily superior in one mode of practice, as compared to another.
Reducing pain and improving function is pretty important - and to be praised when performed well.
It's just that I think (and there's more evidence below) that there is even more that could be achieved, if practitioners were of a mind to investigate the potentials.

In my earlier posting (April 2009), that asked whether osteopathy in the UK was in danger of losing its' soul, I offered a number of clear examples - for example of reduced hospital time and medication usage, when osteopathic care was combined with regular medical care, in (for example) treatment of pneumonia in the elderly, as well as in hospital care of patients with pancreatitis.
These and other examples highlighted the general benefit to health, in terms of reduced morbidity and mortality, of ensuring that the structures of the body were functioning optimally via use of osteopathic care.

New Italian evidence
And now new Italian research has added a further piece of evidence.
Rita Lombardini and colleagues (2009), at the University of Perugia, have conducted a study that assessed the effects of OMT (osteopathic manipulative treatment) of patients with peripheral artery disease (PAD) - and with symptoms of intermittent claudication.
This is the abstract of their paper:

"Peripheral arterial disease (PAD) is a manifestation of systemic atherosclerosis associated with impaired endothelial function and intermittent claudication is the hallmark symptom. Hypothesizing that osteopathic manipulative treatment (OMT) may represent a non-pharmacological therapeutic option in PAD, we examined endothelial function and lifestyle modifications in 15 intermittent claudication patients receiving osteopathic treatment (OMT group) and 15 intermittent claudication patients matched for age,
sex and medical treatment (control group). Compared to the control group, the OMT group had a significant increase in brachial flow-mediated vasodilation, ankle/brachial pressure index, treadmill testing and physical health component of life quality.

So, what were the ingredients of the OMT applied by these physiotherapists/osteopaths in Italy, 8 times in 5 months (total contact time 4 hours)?
They report:

"OMT protocol
At the start of each OMT session, the DO performed a structural examination of each patient to identify areas of somatic dysfunction,
defined as ‘‘impaired or altered function of related components of the somatic (body framework) system; skeletal, arthrodial, and myofascial structures; and related vascular, lymphatic and neural elements."
The somatic dysfunction of each patient was treated using one or more of the following OMT techniques: myofascial release,
strain/counterstrain, muscle energy, soft tissue, high-velocity low amplitude manipulation (thoracolumbar region, typically T10–L1), lymphatic pump and craniosacral manipulation.
All these techniques were considered safe even in view of the patients’ mean age and associated pathophysiology.
Techniques were chosen and listed by the DO at each session which lasted for approximately 30 min. During the study no patient
referred to any common side effects except for three who had transient muscle tenderness; no new pathologies developed."

I suggest that is is therefore reasonable to conclude that practitioners of osteopathy, and chiropractic, and physical therapy (since PTs now utilise almost identical procedures), are capable of far more than they may be aware of - and can offer safe, effective, complementary - or integrated - health care, over and above the attention they offer to musculoskeletal pain and dysfunction.

Reference:
Lombardini R et al 2009 The use of osteopathic manipulative treatment as adjuvant therapy in patients with peripheral arterial disease. Manual Therapy 14:439–443

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What's the truth about chiropractic for infants?

This post is the first for over a month, during which time I've been on the move in the UK, USA and Canada, teaching, seeing patients, and trying hard to remain focused, as the prospect of 3.5 months in Corfu (which I reached last week) loomed - just ahead - like a mirage of a cool oasis pool, to a thirsty desert traveller.
During this period a drama has been unfolding in the UK, as a major chiropractic organisation sued a journalist for libel. The BCA alleged that Simon Singh (writing in the Guardian newspaper) had alleged that chiropractic claims to successfully treat such conditions as ear infection and infant colic, were 'bogus'.
The original article is no longer available on the Guardian site (doubtless for legal reasons), but numerous pro and con commentaries exist that contain extracts.
An example of an anti-chiropractic view can be found on the Quackometer website.
A more balanced view can be found on The Times Higher Education website.
An initial court ruling found in favour of the BCA, awarding damages, and Singh has now announced that he intends to appeal this judgement.
The whole furore has hinged on the interpretation by the judge of the word 'bogus', rather than on any attempt to analyse whether the claims by chiropractors have any foundation.
Prominent personalities (Stephen Fry, for example) have rallied to Singh's defence, in the name of freedom of speech, while supporters of alternative, complementary and integrated health have been saddened by the failure of the process to allow intelligent analysis of the actual essence of the issue - can chiropractic care help conditions such as ear infection and infantile colic?

Do I have an opinion?
Well it seems to me that health enhancement involves a variety of possible influences - including biomechanical.
A brief search of available, easy to access, data, on research into chiropractic and health enhancement (outside of the obvious biomechanical, musculoskeletal arena) brought me the following articles that might be pertinent, and some of which might well have been part of the BCA defence of their position. Indeed as Singh is appealing the case, there might eventually actually be consideration of the real, underlying, in fact critical, question - can chiropractic enhance general health, and thereby encourage resolution of apparently unrelated health problems?

A brief literature search, limited to the last 3 years, using key words 'chiropractic' and 'colic' and 'ear conditions' yielded a selection of studies and reports, including the following:

• Browning M Miller J 2008 Comparison of the short-term effects of chiropractic spinal manipulation and occipito-sacral decompression in the treatment of infant colic: A single-blinded, randomised, comparison trial Clinical Chiropractic 11(3:122-129.
• Di Duro J 2006 Improvement in hearing after chiropractic care: A case series Chiropractic and Osteopathy 14:2
• Hawk C Khorsan R Lisi A 2007 Chiropractic care for nonmusculoskeletal conditions: A systematic review with implications for whole systems research Journal of Alternative and Complementary Medicine 13(5):491-512
• Hipperson A 2004 Chiropractic management of infantile colic Clinical Chiropractic, 7(4):180-186
• Jamison J Davies N 2006 Chiropractic Management of Cow's Milk Protein Intolerance in Infants With Sleep Dysfunction Syndrome: A Therapeutic Trial Journal of Manipulative and Physiological Therapeutics 29(6):469-474
• Kingston H 2007 Effectiveness of chiropractic treatment for infantile colic. Paediatric nursing 19(8):26

The excellence or otherwise of these is not my focus, only the fact that they exist, which is enough to at least call into question Singh's blanket use of the word 'bogus', with its' connotations of fraud and deception.

The Hawk review paper (2007) contained a number of conclusions, amongst which were:
(1) The few reports of adverse effects of spinal manipulation for all ages and conditions were rare, transient, and not severe.
(2) Evidence from controlled studies and usual practice supports chiropractic care (the entire clinical encounter) as providing benefit to patients with asthma, cervicogenic vertigo, and infantile colic. Evidence was promising for potential benefit of manual procedures for children with otitis media and elderly patients with pneumonia.

The Jamison and Davies paper (2006) was also insightful, since it makes clear that the 'chiropractic treatment' offered dealt with the issue of cow's milk intolerance, with no mention of manipulation - only of a careful evaluation of possible dietary/invironmental influences that - if modified - might assist in health enhancement.
Singh seems to have failed to recognise that chiropractic is a health care profession, and that seeing a chiropractor does not necessarily mean that the patient will inevitably be manipulated.
This reminded me of a lecture I was asked to give on the subject of amino-acid nutritional supplementation, sometime in the mid-1980s, at Los Angeles College of Chiropractic, where I was a periodic visiting lecturer/tutor on soft tissue manipulation topics. Nutrition, lifestyle and general health maintenance was a major part of chiropractic training back then, and is today.

Since the judgement for the BCA has been appealed, it is to be hoped that at some stage the real issues will be evaluated in court.
Meanwhile the opportunity can be seen to exist for clarity to emerge as to just what chiropractic can offer in health terms, apart from its value in musculoskeletal care.

Conflict of interest note:
I am not a chiropractor, but have taught at some of the best chiropractic training colleges - and am happy to say that some of my best friends are DCs!

I once again apologise to blog readers for the lengthy gap in posts....caused by a tiring trip to the US and UK.
I am now back in blissful Corfu, where I am currently reviving!

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Osteopathic and naturopathic approaches to Influenza: Part 1

NOTE: Part 2 of this posting can be found by going to this link
http://massagemag.com/massage-blog/bodywork-blog/
A reality check this morning (Sunday Times, London) put into perspective the questionable severity of the impending pandemic:

• In the past week around 17 people have died from this strain of flu, allegedly caused by the H1N1 virus (aka Swine flu, or Mexican flu).
• In the same week approximately 5000 people have died from conventional, common-or-garden flu (and a further 35,000+ from AIDS!)

Yes I know, it's early days, and we may indeed see this turn into a devastating world-wide event - although to be sure it's not so long ago since we braced ourselves for the arrival of so-called Avian (aka bird) flu - linked to the H5N1 virus.
Will swine flu go the way of bird flu?

Possibly, but not until a huge amount of economic damage has been done to whole economies (Mexico) and to numerous industries (travel, entertainment, catering, farming etc) with a balancing vast increase in profits for various drug houses (and face-mask manufacturers).
It's just a few days since my last post but I feel somewhat exercised by the whole influenza hysteria that's been bombarding us from all sides for the past 10 days - and am moved to use part of this gloriously sunny Corfu afternoon, to offer a few thoughts and references.
As the title suggests there is a part 2 of this post - because I am using this topic to also involve a second blog, written under the umbrella of Massage Magazine:Chaitow's Bodywork Blog, where I have expanded on the information provided in this post.
Before setting about the highlighting of possibly useful, hopefully interesting, information about osteopathic and naturopathic perspectives on influenza in general, and pandemics in particular, I want to mention a news report that caught my eye today (London, Sunday Times).
This represents a variant on the old idea that a dog biting a man has limited newsworthiness, whereas when a man bites a dog ... that's news!

The headline was:

Man infects pigs with swine flu on farm in Canada

The story informs us that a farm worker in Canada has infected a herd of pigs with swine flu, the first documented case of the virus being passed from humans to animals.
The herd of pigs tested positive for the H1N1 virus after the worker returned from Mexico with the disease.
The herd has been quarantined...... and both the man and the 200 pigs are recovering.

Osteopathy and the great flu pandemic of 1918
As mentioned above...there is more information on this topic in my other blog.
I strongly recommend a diligent read through of an article written in 2007 by two leading American osteopathic physicians (Raymond Hruby and Keasha Hoffman), entitled: "Avian influenza: an osteopathic component to treatment"
This carefully crafted article includes a summary of the data (see below) as well as the methodology employed - various manual modalities that enhance immune function and increase resistance.
They note:
"The known data regarding the success of DOs [Doctors of osteopathy] treating influenza were gathered from the 1918 Spanish influenza pandemic and was first presented by R. Kendric Smith, MD, in a paper in which he described the "osteopathic conquest of disease in which medicine has failed" [Smith 1920]. Doctor Smith reported that the mortality rate for a total of 110,120 patients with influenza treated by 2445 DOs was 0.25%. Mortality due to influenza in patients receiving traditional medical care, however, was estimated to be 5% to 6%. Patients with pneumonia treated with standard medical care had a mortality rate estimated at 33% overall, and as high as between 68% and 78% in some large cities. Of 6258 patients cared for by osteopathic physicians the death rate due to pneumonia was 10%.
In a paper delivered at the American Osteopathic Association meeting in Chicago in 1919, Riley [1920] reported similar low rates of morbidity and mortality from influenza in patients under the care of DOs, in large cities such as New York and Chicago. This information suggests that DOs achieved a high success rate in the treatment of patients during the 1918 Spanish influenza pandemic. This may have been due in part to their use of an additional effective therapeutic method – osteopathic manipulative treatment (OMT)."

Hruby and Hoffman are NOT suggesting that these methods alone should be employed currently - nearly 100 years later - but that they do deserve to be incorporated into management of both influenza and pneumonia.
There is abundent evidence of the usefulness of osteopathic approaches in pneumonia, in where marked reduction in antibiotic use as well as far shorter hospital stays, resulted from introduction of OMT (osteopathic manipulative treatment). [Noll et al 2000]
Hampton et al (2003) - and others - have shown that aspects of immune function are improved, albeit for a short time, after the osteopathic treatment methods are used.
I touched on some of the evidence in my April 9th post, in this blog, which asked whether osteopathy in the UK was 'losing its' soul?

And also....
Other aspects of defence against possible infection - particularly related to viruses - should include consideration (and implementation - if you're convinced) of naturopathic methods, such as :

• Forms of hydrotherapy that have been shown in clinical trials to improve resistance to infection
• Supplementation, with vitamin D in particular

I'll have expanded on these, and other, topics, as well as the idea of osteopathic preventive methods, in my other blog.

Conspiracy?
Without wishing to raise the possibility of a conspiracy theory, linked to the prospects of mammoth profits for pharmaceutical companies associated with anti-flu medication, and ultimately of course mass vaccination products - a question raised by a reader in The Sunday Times (Sven, from Stuttgart), does strike a chord:
"I would really like to know more about ties between WHO officials and certain parts of the pharmacological industry? "

Hmmmm
...and by the way, go to you-tube to see an instructive clip from a US Congressman on the topic of 'the pandemic'

References
Hampton D, Evans R, Banihashem M: Lymphatic pump techniques induce a transient basophilia.J Osteopath Med (Australia) 2003, 6:41
Noll D Shores J Gamber R et al 2000 Benefits of osteopathic manipulative treatment for hospitalized elderly patients with pneumonia Jn Am. Ost Assoc. 100(12):776 -782
Riley GW. Osteopathic success in the treatment of influenza and pneumonia. JJn Am. Ost Assoc. 2000;100:315–319. [August 1919. Reprinted in JAOA] Smith RK. One hundred thousand cases of influenza with a death rate of one-fortieth of that officially reported under conventional medical treatment. JAOA. 1920;20:172–175. [Reprinted in: Jn Am. Ost Assoc, 2000;100:320–323]

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The nonsense of "evidence based medicine": Meet PieMan

Its the 1st of May, and today in Corfu it's been intermittently blustery and baking.
Alkmini busied herself making a traditional wreath, constructed from leaves and flowers, gathered as we wandered through the spring abundence of our garden and orchard.
Then it was back to work to complete a tedious task, trawling through revision of page-proofs for the 3rd edition of Fibromyalgia Syndrome(FMS): A practitioner's Guide to Treatment, due out early next year.
Sasha's back in Athens .... teaching, translating, painting, organising a conference .....so we wont have the joy of her company as we did last Mayday - see her last year's effort above!

The essential procedure of proof-reading involves numerous simultaneous areas of focus - looking for typos; ensuring that captions to illustrations actually match the pictures they describe; being sure not to miss the cryptic "see page 000" messages, that require identifying what page 000 actually is in the manuscript, so that cross referencing takes the reader to the right page; marking carefully in the text where the publishers should place icons to inform the reader that an accompanying video clip is available to demonstrate the particular topic (for example autogenic training relaxation, or breathing rehabilitation, or a specific manual method of treatment)..... and so on and on, through the 400+ pages.
And then it was done....and ready for electronic transmission back to Edinburgh, chapter by chapter, via the wondrous technology, we now work with so casually.
Because of excessive pressure on the local network I avoid using email attachments and simply upload to the excellent "yousendit" website

One of the most important processes in revising a text such as this is to supply validation - as far as it exists - for the numerous therapeutic methods discussed. Of course, individual chapters authored by others (see below) require that this task falls to their attention as they produce their particular focus on this widespread condition.

• What are the possible causes of FMS?
  
• What methods have been shown to be useful in treating FMS?
  
• The link between FMS and CFS; Manual methods of treating FMS
• Differential diagnosis & the use of dry needling for FMS (Jan Dommerholt and Tamer S. Issa)
• Integrated medicine and FMS
  
• Hydrotherapy and FMS (Eric Blake)
• Therapeutic Touch and FMS (Pat Winstead-Fry and Rebecca Good)
• Acupuncture and FMS (Peter Baldry)
• Microcurrent and FMS (Carolyn McMakin)
• Cognitive Behavioural approaches to FMS (Paul Watson)
• Metabolic rehabilitation (i.e. thyroid) and FMS (John C. Lowe)
• Fibromyalgia and the endocannabinoid system (John M. McPartland)
• ....and more

For those chapters that I am responsible for (those above with no author name) this task is fascinating.
Key words inserted into various data bases yield literally thousands of pieces of research, through which it is important to search for up-to-date information that might be useful to the reader of the book.
Meet Brian Kaplan's Pieman
Thinking about this brought my mind to the current efforts of a colleague with whom I work as part of the New Medicine Group, when I am in London - Brian Kaplan MD.
Brian - a fellow ex-South African - is a fascinating practitioner - who employs, among other approaches, homeopathy and Provocative Therapy (a form of psychotherapy).
He's brilliantly outspoken in his antipathy to the demands of mainstream medical science, who - he points out with gusto - have not looked at their own seriously deficient lack of evidence for many of the methods used regularly by GPs and specialists alike.
Look at the pieman chart above - and you'll see that, based on evidence published by the British Medical Journal, current orthodox, mainstream, medicine can claim that there is 'good evidence' that roughly 13% of what it does is useful.
For the rest, the proportions of commonly used medical treatment, that is supported by good evidence, looks like this:

• 23% is likely to be beneficial
• 8% is a trade-off between benefits and harm
• 6% is unlikely to be beneficial
• 4% is likely to be ineffective or harmful
• 46% is of "unknown effectiveness"

So, the next time you hear an 'expert' saying that alternative, complementary or integrated medicine has no foundation, and is based on little or no evidence - think hard about who is saying this, and why?
For my part, having spent many months trawling 'the evidence' in relation to FMS, I know with certainty that much can be done to help sufferers....I've seen, and reported the documentation!

So my Mayday rambling blog post has taken us from the making of wreaths in the garden in Corfu, to my revision blues, and the coming of pieman (via Brian Kaplan's efforts)

I hope it's been amusing, illuminating - and wish someone would comment as to which....

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