[tomtom]

That the Osteo cracked my back and neck every trip (and I felt better for a couple of hours after that) I saw as an added bonus...

The spinal manipulation is what scares me about osteos and chiropractors but then my sister in law is a nurse who loves to spread stories of doom and gloom about the times it goes horribly wrong. After I fell on my head a few years back I had some back and neck manipulation and having a bloke say 'try and relax' followed by a loud crack and a moment of panic while I check I'm not paralyzed didn't really work for me... It never provided anything more than very short term relief for me so I made my excuses and didn't book a repeat as soon as I could.

I had uncontrollable giggles when he was cracking my back on the first visit - I don't know why - and I suspect it was and unusual reaction! For my upper back (Thorasic spine - check me..) this does seem to free things up. The stuff on the neck? Meh... You can always ask them to not do it? The stretching/non spine cracking manipulation has been good for me too...

[Sloper]

The OP said 'osteo / physio', you just chose to focus on the one you consider to be a quack while ignoring the other.

And in reply to your ''evidential base'':

To once more quote the consultant neurosurgeon - your idea of the gold standard guy, this time on evidence based medicine:

Whilst you may well gain benefit from sessions with a professional physiotherapist, or other manipulative therapist (osteopath, chiropractor (his words)) it is essential that you develop your own programme. The aim is to maintain the range of movements in your spine - of the discs and of the multiple joints. ...  Stretching of the hamstrings and the rest of the body will then reduce the amount of movement required of the spine. This is very important and often neglected. Your physiotherapist may have taught you specific movements. However, the simplest programme and one which may be adequete is as follows:
..
[goes on to explain a very simple 'touch your toes and sideways/backwards bends]
..
Is this ''evidence based medicine''? No, and virtually no back pain treatments are, in the sense of the definitions fashionable today. But I was taught these stretches by my predecessor Mr John O'Connell when I was appointed consultant at St. Bartholomews in 1990. He had been the first surgeon to perform discetomy in Britain and I still encounter patients he saw in the 1950s who tell me they ''have been doing the stretches ever since and have been perfect''. This is evidence enough for me. Sadly he is no longer with us but I would have much enjoyed witnessing one of the modern zealots of evidence based medicine suggesting to Mr O'Connell that he didn't have any!


I too would enjoy watching you argue with someone like that for your gold-standard evidence-based medicine Sloper.

If something gives long-term relief of symptoms without causing further harm, that's a successful outcome. Whether it fits into an 'accepted' definition is less important.

You'd also probably expereince similar benefit from a blow job by a pretty girl, winning £10k on the lottery & etc but that doesn't mean they're 'curing' the cause of the sym,ptoms: there's a reasons why the acronym TEETH (tried everything else, try homeopathy) is widely recognised, it's a way of the doctor getting someone out of their surgery / off their list etc

there's a difference between physiotherapy which is well recognised and has a very strong evidence base and a form of Victorian hokum with good PR

[petejh]

I'm not clear what you're arguing against anymore - I'm not convinced you know what you're arguing against either.

If in doubt quote homeopathy, that'll distract from the point that you know approximately twat-all about what you're talking about.

[Sloper]

Sorry your half an hour is up.

[petejh]

Aww.. I was enjoying your consultation. What was that smell of bullshit all about - aromatherapy?

[Sloper]

  response.

If you believe in osteopathy then fine, but trying to dignify it with anything more than dogma and credo is very poor.

[petejh]

Is that icon supposed to be demonstrating a corrective exercise of yours?

[Jim]

I've had my back cracked a few times by an osteo and thought it was great.
Something that everyone is forgetting is old age, still young at 28 but your now past your best and its all downhill from here.
Keep meaning to give accupuncute a try one day to see if it helps with my back but too busy these days, I just MTFU and get on with it
 

[Boredboy]

but trying to dignify it with anything more than dogma and credo is very poor.

That's just not correct.

[Oldmanmatt]

Honestly.

When Sloper and Sam agree on something, alarm bells should start ringing.

A little digging.

Make up your own minds.

I'll stick to proven medicine ,  ta very much 'n all.

Matt out.

 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1905885/

[tomtom]

Chiropractors get most of the bad press in that article...

[Oldmanmatt]

Chiropractors get most of the bad press in that article...

Ok.

One more.

Fundamentally they are similar in practice and treatment modality (manipulation). They differ, philosophically, in the expected outcomes of treatment.
An Osteopath might expect to treat pneumonia with chest massage, for example.
The Chiropractic method would expect the same result from spinal manipulation.

It is clear that there is little evidence base for either method.

There is a strong evidence base for Physiotherapy.

The later is also strictly regulated and subject to continuing and rigorous research and development.

The others?
Not so much.

[webbo]

One of the common forms of treatment done by Physios is Ultra sound. There is not a lot of evidence to say this has any effect.
I would rather go with the opinion of our trusts back health advisor/expert who is of the opinion that Physios should stop messing about with their machines and actually start using hands on treatment.

[Plattsy]

The neck cracking thing just makes me think of that tough guy in a movie. You know the guy who can kill you with a flick of your head.

People have suffered strokes due to incorrect manipulations (google for info). I'm not letting no one Steven Seagal my neck.

Pain relief is addictive and as chiro/osteo doesn't fix a problem it only alleviates it. It is a pretty good business model for repeat business don't you think.

Got a problem then address the source which will require work/pain/effort/sacrifice or take the Chuck Norris option.

[duncan]

One of the common forms of treatment done by Physios is Ultra sound. There is not a lot of evidence to say this has any effect.
I would rather go with the opinion of our trusts back health advisor/expert who is of the opinion that Physios should stop messing about with their machines and actually start using hands on treatment.

Most physios. I know stopped using ultrasound more than 20 years ago. There is evidence of small effects in animal models but trials in real people with muscle, tendon or ligament injuries suggest it does not matter if the machine emits ultrasound if the lights turn on. Use of ultrasound would be an indication to me of someone not keeping up-to-date with their practice or was consciously looking for a placebo effect.

Most health checks are worthless for the customer. They may well work well as income generation for the practitioner.

I can see how, theoretically, non-ideal movement could be a predisposing factor to injury, especially in people doing highly repetitive activities like runners or musicians. It's probably less important in climbers since our movement is so varied and it's certainly a small part of a big picture.

Who you choose to do your check is up to you. Physiotherapy courses require the highest academic qualifications to entry of all the movement-analysts you could choose and are pretty good about keeping clear of pseudoscience but, like any other profession, not all Physios. are equally good. Personal recommendation goes a long way.

Sloper, don't confuse manipulation mechanism (poorly understood, often misrepresented) with effect (small-moderate effect size in spinal pain, which makes it one of the better interventions on offer). It is a NICE recommended intervention.

Basically, what Pete said.

[kelvin]

One of the common forms of treatment done by Physios is Ultra sound. There is not a lot of evidence to say this has any effect.
I would rather go with the opinion of our trusts back health advisor/expert who is of the opinion that Physios should stop messing about with their machines and actually start using hands on treatment.

Hear hear.

After I had the big accident, I had maybe three physio sessions a day for the best part of six months (various body parts) and apart from the odd private session I paid for myself - the NHS basically rebuilt me to a point were I could work again.
After 10 months or so, the insurance claim against the other fella started to be processed and I had access to the world of insurance funded private physios. This was great for getting detailed scans of various other body parts the NHS hadn't focused on but I don't remember once, any of these physios actually getting properly physical - straight to the ultrasound machine and the bill is in the post. One actually looked at the scans of my knee, turned on the machine and set to without even touching my knee. Never went back there, he may well have been a decent physio but I had no confidence in him after that.
Only my little anecdote, it seemed to me that certain physios were too quick to press the button on the miracle machine.

As I wasn't working much at the time, I tried googling ultrasound but there wasn't masses of stuff about it and I became convinced that the best use for it would be in the creation of a targeted near use raybeam gun for the assassination of Presidents - turn it up and hit them straight in the heart, with no one any the wiser as they fall to the floor dead. Assumed heart attack until much later and you'd be well away by then...

[petejh]

Chiropractors get most of the bad press in that article...

Ok.

One more.

Fundamentally they are similar in practice and treatment modality (manipulation). They differ, philosophically, in the expected outcomes of treatment.
An Osteopath might expect to treat pneumonia with chest massage, for example.
The Chiropractic method would expect the same result from spinal manipulation.

It is clear that there is little evidence base for either method.

There is a strong evidence base for Physiotherapy.

The later is also strictly regulated and subject to continuing and rigorous research and development.

The others?
Not so much.

Matt I get your skepticism and it's something I share. However, if you believe physiotherapy is one side of some well-defined imaginary 'quackery line in the sand' and the chrio/osteo sits on the other side, then I think you're either misinformed or unhelpfully dogmatic (i.e. Sloper). From what I can tell - and disregarding what the 'xyz' practioners may believe are the mechanisms behind the effect of the manipulation, the manipultive therapies all float around in the same nebulous area of knowledge and practice. Chrio/osteo/physiotherapy all have crossover in the area of manipulation and alignment. The most effective physiotherpaists in my experience are MACP qualified ones. This is all about musculoskeletal manipulation and how the body's neuromuscular system reacts to manipulation.

Very little of any form of preventative sports medicine is 100% proven to be effective.

The whole concept of alignment and imbalance is open to question - therefore physiotherapy could be said to be onboard an unproven bandwagon.

If you disagree with the beliefs behind why one form of 'xyz' manipulation works then I share your skepticism - I've encountered some totally whack beliefs among various physio/chiros.

Getting back to the OP's point - The person I get most benefit from for keeping my body healthy and in good shape and general all over fitness is someone who shows me exercises for keeping the kinetic chain toned up and strong, and who keeps me on track ensuring I perform the exercises with good form - i.e. good alignment (the unproven part of the concept). TRX and various other simple body-weight exercises for range of movement, strength and mobilty. It isn't rocket science but I never used to do any of it.
When I've been overdoing the climbing/training I see a good sports massage therapist to give the muscles a treat.

And the principle 'do no further harm' sits in context - it doesn't apply to surgery. 'Do less harm than good' is more accurate.

[tim palmer]

There is a strong evidence base for Physiotherapy

No there isn't, except for chest physio and possibly for stroke rehab

[psychomansam]

When I've been overdoing the climbing/training I see a good sports massage therapist to give the muscles a treat.

Feels great. Probably worth the money just for that. Very little evidence of any physical benefit.   

[petejh]

Spoken like a true armchair philosopher/critic who's read some studies, like this one: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2953308/
Which show no measurable benefit.

Imagine trying to live a life in strict accordance to a rule that states 'you must only adopt practices and beliefs that are proven beyond all doubt by scientific studies to be beneficial'. You'd be paralysed by indecision before you finished breakfast. In fact, breakfast would be an impossible choice of conflicting data. Don't you dare think about approaching the fingerboard - just lie on the bed and don't move, that way you won't risk breaking the rule.

Back on planet earth... People who regularly put a high load on their bodies find masage to be 'benefical'. without getting the force measurement apparatus; the range of movement measurments; the metabolite markers measured and various other parameters tested out both pre and post massage,  the definition of 'beneficial' is quite unscientific and instinctive.  Like much of life 

[slackline]

An Osteopath might expect to treat pneumonia with chest massage, for example.

Osteo == bones, what sort of weird causal pathway posits that manipulating the bones around the lungs will have any effect on bacterial/viral infections within the lung tissue (the underlying cause of pneumonia which is swelling of the lungs due to infection)?  A Cochrane Review concluded it is not efficacious.

I've nothing against proven holistic approaches to healthcare whereby nutrition, sleep, activity, posture etc are looked at in conjunction to understand the underlying causes of chronic problems but if thats what "Osteopathy" is (all problems have their aetiology in the musculoskeletal system and manipulating it will cure it) then its not very scientific.

It might have some utility in treating musculoskeletal problems.

[Sloper]

Spoken like a true armchair philosopher/critic who's read some studies, like this one: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2953308/
Which show no measurable benefit.

Imagine trying to live a life in strict accordance to a rule that states 'you must only adopt practices and beliefs that are proven beyond all doubt by scientific studies to be beneficial'. You'd be paralysed by indecision before you finished breakfast. In fact, breakfast would be an impossible choice of conflicting data. Don't you dare think about approaching the fingerboard - just lie on the bed and don't move, that way you won't risk breaking the rule.

Back on planet earth... People who regularly put a high load on their bodies find masage to be 'benefical'. without getting the force measurement apparatus; the range of movement measurments; the metabolite markers measured and various other parameters tested out both pre and post massage,  the definition of 'beneficial' is quite unscientific and instinctive.  Like much of life 

That's a whole heap of shit.  I'm not suggesting that everything we do must be backed by DBRCT, proven in the LHC etc, what I am saying is that paying good £££££ for something that has very limited provenance but very real risks isn't a great idea.

The idea thast 'manipulation' isn't well understood is as tru as the idea that magic isn't well understood either.

Plenty of things, like acupuncture 'work' as placebo and placebo is not wholly understood but we at least recognise that it is the placebo that works rather than the placing of needles in a particular spot that works.

Of course a good massage feels good, who'd dispute that? Do you pefrom better when you feel good? Of course you do. None of this is however relevant.

Personally I see the 'alternative' medicine brigade as being charlatans who dupe the gullible and this ranges from the almost amusing (Hopi ear candles) to the criminal selling of quack cures for serious illnesses.  Clearly you think osteopathy is in a special class, so do you want to buy come Accapi clothes?

In respect of the study you cite,  I seem to remember it being bad practice to conclude that 'more studies are needed' source Dr Goldacre B.

[psychomansam]

Spoken like a true armchair philosopher/critic who's read some studies, like this one: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2953308/
Which show no measurable benefit.

Imagine trying to live a life in strict accordance to a rule that states 'you must only adopt practices and beliefs that are proven beyond all doubt by scientific studies to be beneficial'. You'd be paralysed by indecision before you finished breakfast. In fact, breakfast would be an impossible choice of conflicting data. Don't you dare think about approaching the fingerboard - just lie on the bed and don't move, that way you won't risk breaking the rule.

Back on planet earth... People who regularly put a high load on their bodies find masage to be 'benefical'. without getting the force measurement apparatus; the range of movement measurments; the metabolite markers measured and various other parameters tested out both pre and post massage,  the definition of 'beneficial' is quite unscientific and instinctive.  Like much of life 

Someone has some rage I see!? I fucking love sports massage and would have it every week if I could afford it. There was no sarcasm in my above post, merely observation.

One important issue here is that you seem to be conflating two conditions:
1) The condition in which something has not been subjected to rigorous peer-reviewed studies
2) The condition in which something has been subjected to rigorous peer-reviewed studies and has not been found to be beneficial

It's an important distinction. The third condition worth mentioning here is much more certain and much rarer, since conclusive disproof is extremely difficult.
3) The condition in which something has been subjected to rigorous peer-reviewed studies and has been found to not be beneficial

And if, for some reason, my love of sports massage hasn't dispelled your pejorative accusations of being an armchair philosopher, bear in mind that while I find the debate over the efficacy of breakfast intriguing, I eat a large breakfast every day without remorse. If I try to do, well, anything really without having had breakfast, I get head-rushes, feel faint, weak and grumpy. I can just about manage a lie-in without breakfast, but even this can only last so long. If we go out for brunch, I tend to eat something beforehand since I'll otherwise be sullen, grumpy and poor company by the time I get fed. As I say, in this case it seems that pragmatic approach is the correct on.

That's not to say, of course, that I wouldn't in fact benefit from a radical change of diet including a reduction or removal of breakfast. It may be that doing so would, in the long run, cause my body to adapt and adjust to the new diet and improve my overall health (I could do with losing a stone). In fact, if there was strong and unequivocal evidence in this direction, I might well give it a go. 

Also, I should probably say I've been helped substantially by sports physiotherapists. Full body check-ups are still a bad idea.

[petejh]

I'm genuinely baffled how it comes across that I have 'the rage'? I don't. I'm answering your point that you think there's very little evidence of any physical benefit from sports massage.

Also, I should probably say I've been helped substantially by sports physiotherapists.

For Sloper's benefit, can you define more accurately how you benefitted? Do you have some scientific evidence? No -  well, you may as well have gone for one of Sloper's aforementioned blow jobs or a winning lottery ticket, for the same effect, going with Sloper's tone of argument.

Calorie restriciton will give you years of extra healthy life btw. Or then again it might not.

Slopes- I'm baffled how you keep saying balls like: 'Clearly you think osteopathy is in a special class, so do you want to buy come Accapi clothes?' and expect anyone to take you seriously. I think only you could misconstrue what I'm saying to that extent.

Full body check-ups are still a bad idea.

Do you actually understand what sort of check the O.P. is suggesting? It wasn't a full body check in many people's understanding of the term.
 

[Oldmanmatt]

Spoken like a true armchair philosopher/critic who's read some studies, like this one: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2953308/
Which show no measurable benefit.

Imagine trying to live a life in strict accordance to a rule that states 'you must only adopt practices and beliefs that are proven beyond all doubt by scientific studies to be beneficial'. You'd be paralysed by indecision before you finished breakfast. In fact, breakfast would be an impossible choice of conflicting data. Don't you dare think about approaching the fingerboard - just lie on the bed and don't move, that way you won't risk breaking the rule.

Back on planet earth... People who regularly put a high load on their bodies find masage to be 'benefical'. without getting the force measurement apparatus; the range of movement measurments; the metabolite markers measured and various other parameters tested out both pre and post massage,  the definition of 'beneficial' is quite unscientific and instinctive.  Like much of life 

Someone has some rage I see!? I fucking love sports massage and would have it every week if I could afford it. There was no sarcasm in my above post, merely observation.

One important issue here is that you seem to be conflating two conditions:
1) The condition in which something has not been subjected to rigorous peer-reviewed studies
2) The condition in which something has been subjected to rigorous peer-reviewed studies and has not been found to be beneficial

It's an important distinction. The third condition worth mentioning here is much more certain and much rarer, since conclusive disproof is extremely difficult.
3) The condition in which something has been subjected to rigorous peer-reviewed studies and has been found to not be beneficial

And if, for some reason, my love of sports massage hasn't dispelled your pejorative accusations of being an armchair philosopher, bear in mind that while I find the debate over the efficacy of breakfast intriguing, I eat a large breakfast every day without remorse. If I try to do, well, anything really without having had breakfast, I get head-rushes, feel faint, weak and grumpy. I can just about manage a lie-in without breakfast, but even this can only last so long. If we go out for brunch, I tend to eat something beforehand since I'll otherwise be sullen, grumpy and poor company by the time I get fed. As I say, in this case it seems that pragmatic approach is the correct on.

That's not to say, of course, that I wouldn't in fact benefit from a radical change of diet including a reduction or removal of breakfast. It may be that doing so would, in the long run, cause my body to adapt and adjust to the new diet and improve my overall health (I could do with losing a stone). In fact, if there was strong and unequivocal evidence in this direction, I might well give it a go. 

Also, I should probably say I've been helped substantially by sports physiotherapists. Full body check-ups are still a bad idea.

Are you me today?