2010: welcome to a brighter future as we enter the new year; now is one time to affirm a truly positive outlook, so here is one very good idea……reject the tedious, ultimately indigestible diet of fear, gloom and desperation that characterises the biased mainstream media (MSM). As you satisfy your addiction into what selectively passes for ‘news’, you risk jeopardizing your mental and emotional health, because you’re literally quite helpless to respond. In truth, look to your own community, the one that you know and can influence. This is where you can see and do good – literally. On the other hand the MSM news reinforces your sense of helplessness -  and that is indescribably unhealthy. We know ‘fear mongering injures civil society’ and we persist in battering ourselves into states of insensibility and cynicism, needing ever more disasters, cataclysms and news of ‘the end is nigh’. Such is one modern day addiction. Make no mistake; the more fearsome, the more sensational, the more troubling, the more you’re likely to listen, buy the paper, and see the ads. Instead, use your intelligence and wit to select, assess and evaluate the news. Go to the net. Look at different sources. Select, assess and evaluate. Once or possibly twice a week is perfectly sufficient to grasp the essentials.

The world is a fabulous place, full of opportunity and joy. Develop the habit of looking for positive things, surrounding yourself with positive people and projects, doing something new and interesting, rediscovering some of your passion and enthusiasm for life. Take one day, one moment, one hour, one step at a time. This is one of many routes leading to better health and well being.

Dunedin Osteopathic Clinic positively and distinctively offers you focused osteopathic care. The clinical goal is to have you diagnosed, comfortably functional and as pain free as possible within the shortest possible time. Our treatment is informed by research, evidence, experience and qualifications second to none. We think positively and we aspire to have you doing the same. Our pre-eminent aim is to save you time and therefore money; not to over-diagnose, over-treat or over-service your condition or indeed to foster clinical ‘dependence’. We believe in delivering the minimum amount of treatment for your maximum benefit, and providing you with the ability to manage future risk. And we believe in doing this collaboratively with you.

We wish you a positively prosperous and healthy 2010!

Bibliography

McGrath, MC. Osteopathic Treatment and TMJ pain dysfunction syndrome. (1991) New Zealand Register of Osteopaths Journal, vol 5.

McGrath, MC. (1993) Osteopathic Management of the degenerative hip joint. New Zealand Register of Osteopaths Journal, 1993: vol 6.

McGrath, MC. Review of the role of intra-abdominal pressure as a mechanism for the reduction of axial loading in the lumbar spine. New Zealand Register of Osteopaths Journal, 1990, 4:8–14. (abridged from dissertation for Postgraduate diploma in Biomechanics, University of Strathclyde, Glasgow. 1990)

McGrath, MC. Sacral stress fracture in a female distance runner. Journal of Osteopathic Education, 1994, 4(2):63-4.

McGrath, MC. New Zealand Osteopathic Snapshot Survey 1995. New Zealand Register of Osteopaths, May 1995.

McGrath, MC. Spina bifida occulta in the lumbosacral spine: anatomical observations of the posterior soft tissues related to radiological findings in cadavers. Thesis by research, submitted in fulfilment for the degree of Master of Science, anatomy, University of Otago, Dunedin, NZ. June 1998

Inaugural (1st ICAOR) international conference on Advances in Osteopathic Medicine Research, British College of Osteopathic Medicine, London. Accepted abstract (based on MSc (anat)(Otago) thesis: Spina bifida occulta of the lumbosacral spine: anatomical observations of the posterior soft tissues related to radiological findings in cadavers, May 1999.

New Zealand Acute Low Back Pain Guide October 2004 Accident Rehabilitation and Compensation Insurance Corporation (ACC), Wellington. Acknowledgements: Member of ALBP Guide developing Expert Panel and Osteopathic representative (since 1997).

McGrath, MC. A review of the physiology of cranial osteopathy: viewpoint. Journal of Osteopathic Medicine, 2003, 6(2):84-86.

International Conference (3^rd ICAOR) for Advances in Osteopathic Medicine Research, Victoria University of Technology, Melbourne. Anatomical evidence for sutural motion of the cranial bones.Review of the anatomical literature of the cranial bones and sutural biology; McGrath MC, Mercer S, Received  ‘best young researcher award’ .  Presentation highlighted the paucity of morphological and biological evidence for cranial bone movement, February 2002

McGrath, MC. Clinical considerations of sacroiliac joint anatomy: a review of function, motion and pain. Journal of Osteopathic Medicine, 2004, 7(1):16-24.

McGrath, MC. Tayles, N. Anatomical observations related to radiological findings in spina bifida occulta (SBO) of the lumbar spine. Journal of Osteopathic Medicine, 2004, 7(2):70-78.

McGrath, MC. Zhang, M. Lateral branches of the dorsal sacral nerve plexus and the long posterior sacroiliac ligament. Surgical and Radiological Anatomy, 2005, 27(4):327-30.

McGrath, MC. Palpation of the sacroiliac joint: an anatomical and sensory challenge. International Journal of Osteopathic Medicine 9 (2006) 103 – 107 March 2006. doi: 10.1016/j.ijosm.2006.03.001

McGrath, MC, Zhang, M. Australia and New Zealand Association of Clinical Anatomists Conference (ANZACA) 3rd/4th September, 2005, Otago School of Medical Sciences, Dunedin, NZ.  Poster presentation : ‘The detailed morphology of the long posterior sacroiliac ligament’

Keynote address Australian Osteopathic Convocation, September 2007 Christchurch, NZ: Chronic Back Pain: The Sacroiliac Region: The Devil’s in the Morphological Detail’.

Dunedin Osteopathic Peer Group: organised, developed and run in the Department of Anatomy and Structural Biology, University of Otago, November 24^th, 2007: Review of SIJ morphology and motion, new morphological research in the posterior sacroiliac region, anatomy laboratory session of pelvis.

McGrath MC, Nicholson H, Hurst P. The long posterior sacroiliac ligament: a histological study of morphological relations in the posterior sacroiliac region. Joint Bone Spine. 2009 Jan;76(1):57-62. Epub 2008 Sep 25.(2008), doi:10.1016/j.jbspin.2008.02.015

Dunedin Osteopathic Peer Group: organised. developed and run in the Department of Anatomy and Structural Biology, University of Otago, May 24^th, 2008 Clinical and anatomical considerations of the thoracic outlet syndrome. A review of morphology and current clinical research at the superior thoracic aperture and anatomy laboratory session.

Dunedin Osteopathic Peer Group: organised. developed and run in the Department of Anatomy and Structural Biology, University of Otago, December 5th, 2009 Clinical and anatomical considerations of the shoulder joint: anatomical ‘hot spots’ at the shoulder. Lecture and lab.

McGrath MC The relationship between the long posterior sacroiliac ligament and the posterior sacrococcygeal plexus. Record number: 151710, Australasian Digital Thesis Program. Identfier: http://adt.otago.ac.nz./public/adt-NZDU20070824.142033

McGrath MC, Nicholson H. The sacral thoracolumbar fascia. Conference abstract: Fifth meeting Australia and New Zealand Association of Clinical Anatomists, November 27 – 28, 2008, University of Auckland Medical School. Clinical Anatomy 20:399 – 409 (2009)

McGrath MC, Nicholson H, Hurst P Le long ligament sacro-iliaque posterieur : etude histologique de ses rapports dans la region sacro-iliaque posterieure. Revue du rhumatisme, November 2008. doi: 10.1016/j.rhum.2008.02.022

McGrath MC, Composite sacroiliac joint pain provocation tests: a question of clinical significance. Published online 21.08.2009 International Journal Osteopathic Medicine, doi:10.1016/j.ijosm.2009.06.002

McGrath MC, Nicholson H, Hurst P.  Branch blockade of the dorsal sacral rami. Letter to the editor. Pain Medicine (acceptd for publication 2009)

SUSTAINABLE EXERCISE AND YOU.

‘Sustainable’ has rapidly become a nearly meaningless buzz-word, a ‘feel-good’ word that any self-respecting advertisement or promotion cannot afford to be without. Sheer usage and widespread indiscriminate application has seen it assume to a level of clichéd meaninglessness. Fortunately however, when applied to exercise, sustainability has much more to do with having fun and enjoyment than anything else, so we’ll use it here with a relaxed disposition and that in mind.

Oftentimes one can see people in the gym undertaking activity with a magazine in front of them. They might be on the static bike, cross trainer or treadmill. They amble along, barely appearing to breath, presumably secure in the belief that because they are moving in the gym, they are on a road to fitness. On the other hand they could be there just for the relaxation and social company. If it’s the latter that’s the case, then please bother to don’t read on.

So, without doing a great injustice to the gilt-edged intentions of those who profess to the intention of exercise, which are and who are indeed to be applauded, it is worth bearing in mind that the results of such low wattage endeavours are predictably dim. Of course, a magazine is a fabulous distraction in an otherwise dull environment. It possibly relieves not only the boredom but any process of insight that twigs to the idea that being there is nearly a complete waste of time. It is likely that there is only a limited engagement and focus upon the activity in question. And that if truth be known, the level of enjoyment is low. One wonders about the primary motivation. Whilst not a total waste of time, it is close to it, particularly when one considers the gym fees involved. Honestly, it would be cheaper to stroll around the park and enjoy the scenery.

The are three keys to beneficial and sustainable exercise:

ENJOY!

DO THE WORK!

DON’T INJURE YOURSELF!

1.    Enjoy!

If you do, exercise is very much more likely to be sustainable. In other words, you’ll go back for more and you’ll feel a positive sense of enjoyment. Self-affirmation will build with results and a sense of relaxation will become apparent in association with doing an activity that engenders pleasure.

2.    Do the work!

Figure out how much exercise you need to do and do the work! Stop wasting your time and money in a gym, staring into space, reading magazines and generally distracting yourself from the purpose of being there. The scenery is arguably more pleasant and much cheaper in the park. Put your gym membership on hold, save the money and go for a stroll in the park instead.

3.    Don’t injure yourself!

There’s absolutely no sense in injuring yourself pursuing paid for recreational activity that is fun and relaxing. If you find yourself getting bored, seek the help of the professionals in the gym to liven up your program or adjust its goals. Accidents happen but in the context of the gym, a potentially highly controlled risk environment, these should be very limited. Help yourself by not getting too tired training, or training when you’re too tired. Take care of yourself; over-training, uninformed-training, no rest-days and training when sick are all big no-no’s. Also, training near people who are sick is inadvisable. Coughing and sneezing, the flu and illness just do not belong in the gym. Don’t take them there. Consider others and insist on the same. Use gloves when handling equipment and never touch your eyes or face during training. Always wash your hands first. Carry a hand towel to mop sweat. Finally, procure professional advice in helping design your enjoyable exercise schedule.

The Metabolic Equivalent (MET), is a physiological concept that expresses the energy cost of physical activity as a multiple of the metabolic rate at rest. It is a ratio of metabolic rate (rate of energy consumption) during a specific physical activity when compared against a reference rate of metabolic rate at rest, set by convention to 3.5 ml O2 . kg-1 . min-1 consumption, or an equivalent energy output of 1 kcal (or 4.184 kJ) . kg-1 . hr-1.

1 MET is considered as the resting metabolic rate obtained during quiet sitting with values indicative of physical activity ranging between 0.9 (sleeping) to 18 (running fast at 17.5 km/h). For example, should you weigh 55kg, your resting metabolic rate will be 55kcal per hour or 70kg, it will be 70kcal per hour at rest.

MET values of physical activities are able to provide a rough indication of the all important intensity of physical activities. They may be used as a practical means of expressing the intensity and energy expenditure of physical activities among people of different body weight. Actual energy expenditure (calories or joules) during a physical activity depends upon the person’s body mass. The same physical activity will be have different energy expenditure for persons of different weight. Smaller people require less energy at rest than larger people, and proportionally less energy to move than larger people. So MET’s enable a direct comparison to be made between individuals of different weights based on the activity pursued.  Consequently, heavy people require a larger exercise energy expenditure to achieve the same proportionate weight loss as a lighter person. This becomes of increasing relevance when the entire body weight is being moved less, such as when cycling or cross training.

Why then is ‘strolling in the park’  nearly a complete waste of time as far as the exercise benefit is concerned? Simply because the amount of energy expended is so small that it will be irrelevant in the wider picture. The exercise will need to be conducted for a very, very long time. Sustainability is a great issue here because, unless you’re getting an emotional reward, it is unlikely you’ll persist.

Given that one needs to burn 3500kcal to erase 0.45kg fat (1lb) it is a simple matter to calculate the energy expenditure required to lose a given amount of weight. Those numbers multiply out quickly and it soon becomes evident that the work required is quite large. The only way you’ll get to stick at it is if you hold all those exercise keys! It doesn’t matter what you do, only that you get to move with a measure of effort-related-intensity and that you persist at it, that you enjoy it and that it doesn’t wreck you one way or another.
So, make the difference to your life and your wallet by doing the work! Save yourself time and the money by actually making a physical effort.

Remember, find a physical activity that you enjoy, that is fun and doesn’t wear you down physically or mentally. It’s an activity that is more likely to be sustainable!

4.5 METS is classed lies between light and moderate exercise.

Here are some MET values associated with some everyday activities:

Lying quietly in bed = 1     MET
Walking slowly = 2.5     MET
Leisurely cycle = 3.5    MET
Slow swim  = 4.5    MET
Walking brisk = 4.5     MET
Vacuuming house  = 3.5    MET
Fast walk  = 8.0    MET
Jogging = 10.2 MET
Squash = 12    MET

4.5 MET is chosen here as an example, because it is representative of light to moderate activity and it provides an exercise context for possible targeted weight loss.

Activity that holds the keys of sustainability is exercise that provides the means of realising the goals of weight loss, health and fitness, mental and emotional well being. The choice of an activity is only limited by imagination. If you’re having difficulty, enlist the help of others, whether friends or professionals to help you think creatively about exercise to make it sustainable.

Getting the right help; this is vital when you are struggling with back pain. Osteopathic manipulative treatment reduces both medication requirements and physiotherapy requirements. It is an appropriate and effective intervention in selected conditions and patients. Primarily, manipulation is effective for neuro-musculoskeletal (somatic) pain. Expertly applied manipulation from an osteopath relieves somatic dysfunction and ease pain and restriction but it remains crucial that the underlying cause of the dysfunction is identified and managed appropriately. At Dunedin Osteopathic Clinic, the application of Focused Osteopathic Care is about specificity of treatment, identification of underlying cause and future self-management.

Manipulation is one of the oldest approaches humankind have used to relieving pain and distress. Osteopathic medicine brings the science of contemporary health care and diagnosis to this tradition. Osteopathy represents the first systematic and scientific utilisation of manipulation within the medical domain, beginning in the late nineteenth century. Both chiropractic and physiotherapy borrowed from osteopathic medicine, coming somewhat later.

‘Millions of patients with back pain seek manual therapy involving spinal manipulation in addition to, or as an alternative to, conventional treatment that includes physical therapy, surgery and medications. In contrast to the chiropractic approach that focuses on the nervous system and advocates adjustments to the spinal vertebrae, osteopathic medicine utilizes manual therapy in combination with standard treatment methods, and focuses on the need to optimize blood circulation to maintain and restore health. Leurgans, etal (N Engl J Med 341:1426, 1999) compared standard care to osteopathic care in 155 patients who had had low back pain for at least three weeks but less than six months in a randomized, controlled trial’.

‘Outcomes of treatment were assessed over a 12-week period using the Roland-Morris and Oswestry questionnaires, a visual-analogue pain scale, and measurements of range of motion and straight-leg raising. Greater than 90% of patients in both groups expressed satisfaction with their method of care and changes in the primary outcomes did not differ significantly. However, the use of medications, including nonsteroidal antiinflamatory drugs (NSAIDs) and muscle relaxants, was significantly higher (p<0.001) in the standard care group (n=72) when compared to the osteopathic treatment group (n=83). Additionally, the standard care group utilized physical therapy more frequently than the osteopathic care group (2.6% vs. 0.2%, p<0.05)’.

‘These data suggest, that while both standard care and osteopathic care are equally effective when comparing clinical outcomes of pain relief and function, patients receiving osteopathic care use less medication and physical therapy reducing both costs to the patients and potentially serious side effects from the use of NSAIDs’.

Ref. Johns Hopkins Arthritis Centre http://www.hopkins-arthritis.org/arthritis-news/1999/spinal_manipulation.html

Getting the right help at Dunedin Osteopathic Clinc.

Now that we’re over the ‘new’ year syndrome and most ‘resolutions’ quite likely to have evaporated, here are some self-help, prevention-orientated , health ‘golden rules’ that bear endless reiteration, as they are often the kind of self-help rules instantly forgotten once read. They are worth copying down and turning into a fridge magnet. They are also rules that help underpin a robust psychology and physiology, help build resilience and are manifestly common-sense. Furthermore, these rules have developed out of scientific studies that have endeavoured to establish characteristics associated with a longer, more healthy life.

Rule One: Eat a regular breakfast (see Rule Six).

Rule Two: Get six to eight hours sleep.

Rule Three: Maintain a prudent weight.

Rule Four: Don’t smoke and if you do, try and give-up or at least keep it to less than 5 cigarettes a day. Never carry a packet about with you, anymore than you’d necessarily carry a bottle of whiskey about with you. To do so arguably indicates addiction for which professional help is required. Smoking is a cumulatively damaging, dose-dependent activity!

Rule Five: Regular exercise. You need to cumulatively ‘pant’ for half and hour most days! A stroll just doesn’t cut it!

Rule Six: Eat fresh foods from the four food groups (whole grains, vegetables, fruit, legumes).

Rule Seven: Light alcohol consumption, no binge drinking and a certainly a few days off.

Rule Eight: Effective management of stress and anxiety. Develop nuturing, supportive, ‘non-toxic’, non-dependent personal relationships. Watch your occupational stresses and anxieties. Balance your stress with counter-point (see blog).

Reminding yourself of these key golden rules rules throughout the year is a wise prevention health strategy that in our view beats the often evanescent new years resolution.