Welcome to YourOsteopath Newsletter
Every two months we will bring you the latest news from the osteopathic profession as well as up-to-date advice on health topics relating to osteopathy. It won't be too technical; it will be straightforward, informative and - we trust - useful. If you have questions about any of the treatments mentioned below, then just contact your Osteopath who will be pleased to help you. We hope you enjoy it.
Top Story
The new fit note regime comes into force on 6 April, with the traditional sick note being replaced by a more flexible system that will allow doctors to advise if a patient ‘may be fit for work'.
Under the new system, doctors will have the option to advise that their patient would be able to work, subject to the employer's agreement, if temporary changes such as reduced working hours or amended duties could be accommodated. The fit note focuses on what an employee may be able to do at work rather than what they cannot do.
The Government estimates that the fit note system could save businesses £240 million over the next 10 years.
Lord McKenzie, Minister for the Department for Work and Pensions said: The fit note will reduce the costs employers often have to bear when people are off sick for a long time. We know work is good for people's health. With the right support in place, employers and doctors can work with employees to help them get back to work sooner.
The new guidance has been created by the Department for Work and Pensions with the Royal College of General Practitioners, British Medical Association, CBI, Acas, Federation of Small Businesses, Chartered Institute of Personnel and Development, Association of British Insurers, British Retail Consortium and EEF, the manufacturers' organisation.
The Department of Work and Pensions said that making simple, practical adjustments to help people back to work at an earlier stage will benefit both the employer and the employee. This will prevent long-term sickness absences and will also ensure employers do not lose the expertise of their staff.
"Work plays a significant role in determining a person's health", said Dame Carol Black, National Director for Health and Work, "The fit note is a hugely important development which means that GPs will be encouraged to think about their patient's ability to work and provide more helpful information to patients to discuss with their employer. This is why the fit note is a win-win for both employees and employers."
www.dwp.gov.uk/fitnote
Osteopathy
The UK's General Osteopathic Council (GosC) publishes some interesting statistics about how osteopathy functions in the UK. Here are some selected highlights:
Osteopathic patients
Around 30,000 people currently consult osteopaths every working day.
54% of new patients are seen within one working day after contacting the osteopath; 95% are seen within one week.
Osteopathic training
Training to be an osteopath takes 4 years full-time or 5 years part-time.
Osteopaths must complete 30 hours of Continuing Professional Development per year.
Osteopathic treatment
Most osteopaths work in private practice. Treatment costs vary across the UK, but typically between £35 to £50.
Osteopathy remains principally a form of private healthcare with more than 80% of patients funding their own treatment.
Most major private health insurance policies provide cover for osteopathic treatment. In 2007, private health insurance accounted for 10.4% of payments for osteopathic treatment.
Osteopathic profession
There are currently 4,198 osteopaths on the UK Statutory Register of Osteopaths. Of these, 2,175 are male and 2,023 are female [correct as of 21 August 2009">.
The majority of osteopaths are aged between 31 and 50, although the profession includes all ages between 21 and 70.
The greatest number of osteopaths are to be found in England (85.2%). The rest are in Scotland (3.1%), Wales (2.2%), Northern Ireland (0.4%) and overseas (9.1%).
Public Awareness
Awareness of osteopathy currently stands at 83% amongst the UK adult population, according to a survey commissioned by the GOsC in 2006.
See more at www.osteopathy.org.uk
Case Study
The case: Ian, a 32 year old mechanical engineer, is suffering from pain in his right knee. The pain had started when he slid down a water flume holding his young daughter, and on hitting the water he was aware of a sharp pain in the centre of his knee joint. He immediately found great difficulty in walking and a few hours later noticed slight local swelling to the front and inside of his knee joint. He attended Accident and Emergency at the local hospital, where he was told that he probably had some minor ligament damage.
He was given a bandage support, some pain killers and advised that with rest he should be fine in a couple of weeks. Over the two weeks there was some improvement, but then things seem to plateau and the pain continued to limit his ability simply to get about. It was now two months since the accident, and his knee was still very painful. A friend suggested he try an osteopath.
The diagnosis: After taking a full case history and making an initial examination, his osteopath is able to diagnose that Ian had sprained the inner capsule area of his knee. The capsule is a tough fibrous membrane that protects and supports the joint. Damage to the inside is more common and usually less serious than to the outer part of the knee. Ian's osteopath tells him that his patella (knee cap) seems to have been close to dislocating at the angle he hit the water with his knee slightly bent and leg rotated to the outside. He had probably taken up this protective posture to keep his young daughter clear of the waters splash and impact. Unfortunately, the force at this angle had damaged the inner capsule area of his knee, and the supporting tendons and ligaments.
Ian is just relieved that now there is a full diagnosis and something is actually being done to sort it.
The treatment: Ian's osteopath used direct soft tissue, articulation and manipulation techniques to try to stimulate healing in the affected area. He was given specific instructions on the things to avoid, that may delay his recuperation.
The outcome: After two weeks Ian noticed a significant improvement. At this time he was ready to be given some exercises to aid his recovery. A further month of treatment and he felt that real progress had been made. His pain was now occasional and not so disabling. It is now two months since Ian's last treatment and his knee is back to normal, he's back on the golf course, but not in the water flumes!
Body Talk
The word spondylolisthesis is derived from two parts- spondylo, which means spine, and listhesis, which means slippage. So quite literally, a spondylolisthesis is the forward slippage of one vertebra (the individual spinal bones) relative to the vertebra immediately beneath it. This slippage normally occurs in the lumbar spine (low back) just above the pelvis. The shift is normally graded from one to four:
Grade 1 - the least movement when there is a forward slippage of 25%.
Grade 2 - 50%
Grade 3 - 75%
Grade 4 - 100%
If the slippage is backwards it is known as a retrolisthesis, which are less common and tend to be less stable.
What is the cause?
Spondylolisthesis is found in around 3-6% of the population, and is approximately twice as common in men as women. Often the cause is unknown, and it is usually an incidental finding on an x-ray or scan, when the patient is being examined as a result of an unrelated condition.
The most common cause in young healthy individuals is spondylosis. This is when small micro-fractures occur in part of the vertebra allowing it to part, and the front piece to move forward, giving a spondylolisthesis. It is thought that this is normally associated with a genetic weakness within a specific part of the vertebra which under repeated mechanical stress eventually fractures. There is an increased incidence in young athletes, especially gymnasts, where there is excessive arching of the low back.
The gradual degeneration of the spinal joints with age is the other common cause of spondylolisthesis, where the wearing of the joint and the aging disc allow the forward slippage.
Congenital: You are simply born with it.
Trauma: Rarely a cause.
Pathological: Where a disease is present.
What are the symptoms?
Many people are symptom free.
Increased lordosis - the inward arch in your lower back.
Low back pain, especially after exercise, or during prolonged standing.
Pain or weakness on one or both lower extremities.
Hamstring tightness.
Change in gait, becoming waddling style, causing the abdomen to protrude.
Reduced control of bladder and/or bowel function.
Treatment
The treatment for spondylolisthesis can vary greatly depending on its severity and the individual involved. Generally the lower grades respond well to osteopathic treatment. Osteopaths cannot reduce the slippage of spondylolisthesis, but can stretch and articulate the area to improve spinal function and reduce or eliminate pain.
The dorsal or thoracic spine (upper back) can be treated to improve spinal mobility and therefore reduce the strain on the low back. Your osteopath can make a full assessment of the specific circumstances and the amount of lordosis present before treatment, which may involve self help techniques of muscle strengthening and stretching.
In higher grades of spondylolisthesis surgery may be the only answer. Usually only attempted when all else has failed, surgery needs to be considered on a risk-benefit assessment, as it is not always a success, and when unsuccessful can never be undone to try something else.
Healthcare in the News
BackCare, the charity for healthy backs, has launched a new quarterly journal featuring the latest news and research on coping with back pain. This first issue includes articles on various types of chronic and sudden back pain, testing and training lumbar spine muscles, and managing musculoskeletal problems. You can read it online at www.backcare.org.uk
The European Commission is investing €1.5 million into research on complementary and alternative medicine (CAM) over the next three years, reports The Osteopath magazine. The project, called CAMbrella, started in January 2010 and will create a network of European research institutes focusing on terminology, legal regulation, patients' needs, the role of CAM treatments in healthcare systems, and research methodology.
The Health & Safety Executive has a monthly feature on its website that aims to dispel common health and safety myths. This February they tackle the myth that there is nothing you can do about slips and trips and they don't really hurt anyone anyway. "Most slips and trips are preventable and many happen when spills aren't cleared up or clutter tidied away", says HSE, "Last year, there were four fatalities and more than 10,000 employees were seriously injured when they had a slip or trip at work. This results in broken bones and time off work, costing the economy around £800 million per year." www.hse.gov.uk
