NICE Guidelines - massage & osteopathy

Much has been made of the latest NICE Guidelines for Treatment of Low Back Pain, particularly in the massage and osteopathy fields. The full guidelines can be found here but to summarise:

The 4 Principles of Management for all Patients are described as:

1. Keep diagnosis under review at all times
2. Promote self-management/advice
3. Offer drug treatments as appropriate
4. Offer a range of alternative treatments including exercise, acupuncture and manual therapy.

Manual therapy is then further identified:

The manual therapies reviewed were spinal manipulation, spinal mobilisation and massage. Collectively these are all manual therapy. Mobilisation and massage are performed by a wide variety of practitioners. Manipulation can be performed by chiropractors and osteopaths, as well as by doctors and physiotherapists who have undergone specialist postgraduate training in manipulation.

So that's pretty conclusive, patients suffering from low back pain can and should be referred for massage and osteopathy, amongst other treatments. The guidleines recommend up to 9 treatments over up to 12 weeks.

This has got to be good news for both fields of treatment, hasn't it? The question is, how are we practitioners going to make our presence felt? Should the GPs be actively looking for us or should we target them? And how responsive will GPs be to sending patients off for manual therapy as opposed to physiotherapy or drug treatment?

What do you all think?

Hope with anatomy revision

The second year exams are but a few weeks away and we're all getting into the tough revision that we're got to endure, so it was good to see that no matter how poorly prepared I feel, there are others out there who know even less!

A team at King's College London found public understanding of basic anatomy has not improved since a similar survey was conducted 40 years ago. Less than 50% of the more than 700 people surveyed could correctly place the heart, BMC Family Practice says.Under one-third could place the lungs in their correct location, but more than 85% got the intestines right.

There are concerns that a poor grasp of anatomy could potentially compromise patient care.

http://news.bbc.co.uk/1/hi/health/8092930.stm

Now treating in 2 venues!!

I'm very excited to announce that I'm now offering professional sports massage in two prime locations in Nottingham City Centre. Tuesday appointments will now be taken at Elite Martial Arts, based at the High Pavement Business Centre in The Lace Market, Nottingham. This new facility is directly opposite the famous Pitcher & Piano pub, so is in a perfect location for those based in the city centre.

Thursdays will still be at Bushido MMA, the number 1 location for MMA, BJJ and Muay Thai boxing in Nottingham. Home of the Rough House Team featuring some of the best MMA fighters out of the UK including Dan "The Outlaw" Hardy, Paul "Semtex" Daley, Jim Wallhead, Lee Livingstone and many more, it has established itself as a top martial arts training location in the East Midlands.

Appointments are available from 6pm on Tuesdays and Thursdays, with other times and home visits available on request. If you would like to book an appointment at one of these great facilities, give me a call on 07990 548519.

Chest pain, coughing up blood...

... I think you've got a tree growing in your lung!!

Saw this amazing news article today about Artyom Sidorkin, a 28 year old Russian chap who presented to his local hospital with agonising chest pain and hemoptysis (coughing up blood). Convinced that he had lung cancer, he was taken to x-ray which showed what appeared to be a tumor. Straight into surgery where a section of his lung was removed and biopsied.. to reveal a 5cm spruce tree!!

Apparently he had inhaled a seed which then took root in his lung and began to grow! Read the full story here: http://tinyurl.com/cng9pw

And here's a nice little picture!

Footballer's Ankle

Whilst in clinic this week, I observed a young man being treated for neck and shoulder pain, alongside which he had a suspected Footballer's Ankle.

What is Footballer's Ankle?
This is a pinching or impingement of the ligaments or tendons of the ankle between the bones, particularly the talus and tibia. This results in pain, inflammation and swelling.

A common cause of anterior impingement is a bone spur on anklebone (talus) or the shinbone (tibia). Repeated kicking actions can cause the anklebone to hit the bottom of the shinbone, which can lead to a lump of bone (or bone spur) developing. This bone spur may then begin to impact on the soft tissue at the front of the ankle, causing inflammation and swelling.

The condition is most common in athletes who repeatedly bend the ankle upward (dorsiflexion), such as footballers, hence the name.

What are the symptoms?
- pain and tenderness over anterior ankle joint
- pain on dorsiflexion and plantar flexion
- band of pain across anterior ankle when kicking a ball
- palpable bony lump on distal tibia or superior talus

How can it be treated?
- soft tissue techniques to stretch muscles crossing the ankle to relieve tension
- mobilisation of ankle joint
- steroid injection to tackle inflammation
- surgery to remove bony spurs

Ref: http://www.sportsinjuryclinic.net/cybertherapist/front/ankle/footballersankle.htm & http://www.simonmoyes.com/trt_ankle_football.php

New testimonial!

Just received this really nice testimonial from one of my clients:

I have a huge thank you to say to you for giving me the confidence to allow someone to treat me for my back problem. Without you I would not be where I am today. I am still being treated for my back problem at an oesteopath in Belper but am down to monthly treatments now. Thanks for your support. If I lived closer to Nottingham I would still be making appointments with you today.

Without sounding overly sentimental, this kind of comment really does make it all worthwhile - Thank you.

Muscle a day #2: Omohyoid

Revising the triangles of the neck at the weekend, I realised that I knew very little about omohyoid, an important muscle which defines some of the sub triangles of both the anterior and posterior traingles. So here's some more information:

Omohyoid
This muscle is an infrahyoid muscle found in the anterior neck, deep to sternocleidomastoid.

Attachments
Upper border of scapula and occasionally superior transverse scapular ligament (crossing scapular notch).
Lower border of hyoid bone, lateral to insertion of sternohyoid.

Innervation
Ansa Cervicalis (C1-C3) (branch of cervical plexus)

Action
Depresses, retracts, and steadies hyoid bone

Notes:
The omohyoid has 2 bellies connected by a tendon and is one of the infrahyoid muscles. It passes anteriorly and superiorly from the scapula, passing behind sternoclediomastoid where it takes a steep redirection superiorly towards its attachment to the inferior hyoid.

The central tendon is attached to the first rib and clavicle by the deep cervical fascia.