2017 Presentation Synopses

Session 1 - Biomechanics

Biomechanics - the study of the structure and function of biological systems - has always played a prominent role in osteopathy. However throughout the years its original concept and definition has been diverted toward a pure linear mechanistic approach, leaving behind key aspects relevant for the optimisation of clinical practice.  This session will explore a renewed vision of biomechanics making available to clinicians and researchers crucial elements useful for a significant improvement of the daily clinical scenario

Paul Bell BSc (Hons) Ost, DO

The research presented explores spinal biomechanical adaptations in elite level football players. Both recurrent and subsequent injuries pose a major problem for the sports medicine profession, but the mechanisms that underlie these injuries are often unclear. We will discuss spinal adaptive kinematic alteration following injury, its correlation with previous injury in the spine, pelvis and lower extremity and the potential effect this could have on future injury incidence. In addition, although functional movement analysis is widely used in the sports environment for injury prediction, its efficacy as an injury predictive tool is still unproven. Therefore we will explore the potential benefits of improving injury management by analysing functional sports specific tasks in the clinical environment, using marker-less 3D motion analysis techniques.

Dr. Walid SALEM PhD, DO

Dr. Carl Martin Todd PhD, MSc (Sport Med), BSc (Hons) Ost, DO, CSCS, Cert Ed.

Young athletes that perform regular intense training and sports competions have been shown to increase the risk of low back pain (LBP) and spinal pathologies, e.g. early disc degeneration. This may be the result of heavy loading in different planes to the spine, heavy training in young age, overuse injuries or from postural positions associated with particular sports that sustain heavy loads to the spine, at a young age. Throughout the past 20 years, several studies have reported on the spino-pelvic sagittal alignment values within young and aging populations. Whilst specific spinal pathologies have been shown to correlate with types of spinal curvature according to Roussouly et al. (2003), little is known about how pelvic or hip morphology may effect spinal alignment. Although a correlation between these regions due to their anatomical, morphological and functional proximities may exist; it is not fully understood how hip joint conditions such as whether Femoro-acetabular impingement (FAI) and sporting activities may affect the spino-pelvic sagittal alignment in young Elite athletes. The aims of this presentation are to highlight the results from clinical and radiological studies that compared the spino-pelvic sagittal alignment and the prevalence and correlation of back and hip pain in young Elites athletes to a non-athletic population. The athletes were young Elite skiers (n=75) and were all High School pupils (grades 1-4, between 16-20 years of age) as the control group (n=27) were first year High School pupils.

Session 2 - Touch

Given that the sense of touch plays a critical role in osteopathy, this session will explore the potential mechanisms by which stimulation of the skin senses can exert beneficial physiological and psychological effects, aiding growth and development. The session will review a class of low threshold mechanosensitive c-fibre, named c-tactile afferents, which respond optimally to gentle, slow moving touch are likely to play a direct and significant role in the efficacy of manual therapies. Then it will discuss the impact the type and quality of touch plays in therapeutic tactile interventions and in particular the neuroscience underpinning these effects will aid the development of more targeted, population specific interventions.

Dr. Francis McGlone PhD

In this talk I will pose the question 'why do we have a system of slowly conducting gentle touch responsive nerves in the skin?' and provide some evidence-based, and some speculative, reasons why such a system has evolved in social species.  A sense of touch is fundamental for an organism to detect its environment, but it also serves a second social/affiliative function that has, over evolutionary time, reached its zenith in human primates. Here we propose, and provide evidence, that a recently identified system of gentle touch sensitive nerves in the skin provide the neurobiological substrate for a 2nd touch system that encodes the emotional qualities of skin touch. These nerves – called c-tactile afferents (CT) - are hypothesised to play a fundamental and critical role in socialising the developing brain, and have led to our view of the skin as a social organ where gentle nurturing touch shapes the destiny of the social brain.

Dr. Jorge Esteves PhD, MA, BSc, DO

Touch plays a critical role in osteopathic diagnosis and care. Despite the growing evidence that osteopathy is effective in a range of clinical conditions and in specific clinical populations, its underlying biological correlates remain largely unknown. In this presentation, I will explore the potential mechanisms by which the stimulation of the skin senses can exert beneficial physiological and psychological effects, modulating pain, reducing allostatic load, and in promoting physical and mental wellbeing. In particular, I will argue that the c-tactile afferents, which respond optimally to gentle, slow moving touch are likely to play a direct and significant role in the efficacy of osteopathy.

Session 3 - Placebo

The placebo effect is a multifaceted neuropsychobiological phenomenon influencing  patient’ response to both real and non-real treatment. Non-real or placebo treatment is an “inert” treatment, better defined as an intervention lacking of the active or specific principle to be tested. Placebo treatment is able to influence remarkably outcomes through several neuropsychobiological systems. Although it has been argued the strategic use of placebo to improve outcomes in real clinical scenarios, in research context the placebo phenomenon has an ambivalent value. The aim of the session will be to review the research evidence and contextualise this evidence in the clinical context.

Dr. Antoni Morral PhD, PT

When we apply a physical or pharmacological treatment, there are many things that may explain the clinical improvement experienced by a patient. The drugs or physical agents applied are important, but we must also add other elements in the context of the patient-therapist relationship.  Scientific evidence has proved that the placebo effect exists. This is a true biopsychosocial phenomenon produced by the context in which an intervention is carried out. Biases aside, placebo and nocebo responses are changes in patient’s symptoms, due to their participation at the therapeutic meeting, with its rituals, symbols and interactions.  This multitude of signals inherent in any intervention, are perceived and interpreted by patients and can create positive or negative expectations.

Francesco Cerritelli, PhD(c), MS, DO

Placebo, defined as “false treatment,” is a common gold-standard method to assess the validity of a therapy both in pharmacological trials and manual medicine research where placebo is also referred to as “sham therapy.” The aim of the present systematic review was to report how and what type of sham methods, dosage, operator characteristics, and patient types were used in osteopathic clinical trials and, eventually, assess sham clinical effectiveness. A systematic Cochrane-based review was conducted by analyzing the osteopathic trials that used both manual and nonmanual placebo control. Pragmatic searches were conducted on 8 databases up to December 2015. Two independent reviewers conducted the study selection and data extraction for each study. The risk of bias was evaluated according to the Cochrane methods. A total of 64 studies were eligible for analysis collecting a total of 5024 participants. More than half (43 studies) used a manual placebo; 9 studies used a nonmanual placebo; and 12 studies used both manual and nonmanual placebo. Data showed lack of reporting sham therapy information across studies. Risk of bias analysis demonstrated a high risk of bias. High heterogeneity regarding placebo used between studies, lack of reporting information on placebo methods and within-study variability between sham and real treatment procedures suggest prudence in reading and interpreting study findings in manual osteopathic randomized controlled trials (RCTs). Efforts must be made to promote guidelines to design the most reliable placebo for manual RCTs as a means of increasing the internal validity and improve external validity of findings.

Dr. Marco Annoni PhD

The use of placebos in clinical settings brings about a plethora of  complex ethical issues. As a converging series of empirical studies has demonstrated, placebo can be clinically effective and are still widely used by health-professionals. However, ethical guidelines tend to categorically prohibit the use of placebos as they require deception. In this talk I will synthetically outline the ethics of using placebos in clinical settings, presenting: the ethics of deceptive placebos; the ethics of placebos without deception; and the ethics of inducing placebo responses without resorting to physical interventions.

Patrick van Dun, MSc, DO

Healthcare systems are increasingly faced with the challenge to spend the healthcare budgets wisely. Therefore, in decisions on reimbursement, priority should be given to treatments that offer value for money. It is increasingly shown that osteopathic care is effective in improving the health status of patients with different conditions. But do they also show value for money? And how do they compare with other interventions in healthcare? This presentation will provide some answers to these questions. Low back and neck pain are frequent health problems and represent a major medical, social and economic burden including healthcare utilization, absence from work, impact on activities and quality of life. I will present results of a health economic evaluation study (HEVO) conducted to assess the value for money of osteopathic care in addition to usual care for two conditions, low back and neck pain compared to usual care alone.  A decision tree model considering a one-year time horizon was applied. The analysis occurred from a health insurance perspective only, considering direct medical costs. The health effects were expressed as quality-adjusted life years (QALYs) and the results were expressed in the form of an incremental cost-effectiveness ratio (ICER). The uncertainty around input parameters was addressed applying scenario analyses and one-way sensitivity analyses.

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