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We aim to bring you interesting and helpful information about osteopathy and complementary medicine within Bristol and beyond.......

Tuesday 26 March 2013

Knee Cartilage Research Paper


From CHICAGO, Illinois — Patients with knee osteoarthritis and a meniscal tear who received physical therapy without surgery had good functional improvement 6 months later, and outcomes did not differ significantly from patients who underwent arthroscopic partial meniscectomy, a new clinical trial shows.
In the Meniscal Tear in Osteoarthritis Research (METEOR) trial, both groups of patients improved substantially in function and pain.
This finding, presented here at the American Academy of Orthopaedic Surgeons 2013 Annual Meeting and published online simultaneously in the New England Journal of Medicine, provides "considerable reassurance regarding an initial nonoperative strategy," the investigators report.
Patients with a meniscal tear and osteoarthritis pose a treatment challenge because it is not clear which condition is causing their symptoms," principal investigator Jeffrey Katz, MD, from Brigham and Women's Hospital in Boston, Massachusetts, told Mediscape Medical News.
"These data suggest that there are 2 reasonable pathways for patients with knee arthritis and meniscal tear," Dr. Katz explained. "We hope physicians will use these data to help patients understand their choices."
In an accompanying editorial, clinical epidemiologist Rachelle Buchbinder, PhD, from the Monash University School of Public Health and Preventive Medicine in Victoria, Australia, said that "these results should change practice. Currently, millions of people are being exposed to potential risks associated with a [surgical] treatment that may or may not offer specific benefit, and the costs are substantial."

These results should change practice.

The METEOR trial enrolled 351 patients from 7 medical centers in the United States. Eligible patients were older than 45 years, had osteoarthritic cartilage change documented with magnetic resonance imaging, and had at least 1 symptom of meniscal tear, such as knee clicking or giving way, that lasted at least 1 month despite drug treatment, physical therapy, or limited activity.
In this intent-to-treat analysis, investigators randomly assigned 174 patients to arthroscopic partial meniscectomy plus postoperative physical therapy and 177 to physical therapy alone.
The physical therapy in both regimens was a standardized 3-stage program that allowed patients to advance to the next intensity level at their own pace, Dr. Katz explained. The program involved 1 or 2 sessions a week for about 6 weeks and home exercises. The average number of physical therapy visits was 7 in the surgery group and 8 in the nonsurgery group.
Investigators evaluated patients 6 and 12 months after randomization. The primary outcome was the between-group difference in change in physical function score from baseline to 6 months, assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). At baseline, demographic characteristics and WOMAC physical function scores were similar in the 2 groups.
At 6 months, improvement in the WOMAC function score was comparable in the 2 groups. The mean between-group difference of 2.4 points was not statistically significant after analysis of covariance. There was also no significant difference between groups in pain improvement or frequency of adverse events.
METEOR: Mean Improvement in Osteoarthritis Index at 6 Months
Treatment Group
Mean Improvement (Points)
95% Confidence Interval
Surgery plus physical therapy
Physical therapy

There was 1 death in each group, and 8 patients in the nonsurgery group and 13 in the surgery group withdrew in the first 6 months of the study.
Patients in the nonsurgery group were allowed to cross over to the surgical group at any time. Within 6 months, 30% of patients did so.
"They were not doing very well," Dr. Katz said. His team is still analyzing the reasons these patients did not benefit from intensive physical therapy.
The 12-month results were similar to the 6-month results. In addition, by 12 months, outcomes for the crossover patients and for those in the original surgery group were similar.
Meeting delegate John Mays, MD, an orthopaedic surgeon practicing in Bossier City, Louisiana, who was asked by Medscape Medical News to comment on the findings, said most patients don't choose physical therapy. "In the real world, most people want a quick fix" and choose surgery, he noted.
Dr. Mays said he would have liked to have seen a group of patients who underwent surgery but did not receive postoperative physical therapy. He explained that his patients with osteoarthritis and meniscal tear rarely get physical therapy after arthroscopic meniscectomy; they most often do home-based exercises.
He added that "most insurance plans have limits on the number of physical therapy sessions they allow."
This study is funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Dr. Katz, Dr. Buchbinder, and Dr. Mays have disclosed no relevant financial relationships.

Monday 18 March 2013

Learning about Cranial Sacral Therapy

I was asked to escort Giles to Worcester a few weeks ago and observe his course on cranial osteopathic techniques. As a complementary therapist and a teacher myself I was keen to learn what cranial sacral therapy is all about and how it is done.

It was really facinating to watch how an osteopath prepares him/herself to treat and how they assess which movements to perform. I learnt a lot about the anatomy of the skull and the many ways in which it can be compressed and cause a range of problems.

This is a truly remarkable therapy, so gentle and yet so powerful with the results it can provide. I look forward to Giles developing this course for therapists like me!

Bronwyn Ward

Monday 4 March 2013

Vertical Reflex Therapy

Our reflexologist, Anne Brunton, is now an appointed tutor of Vertical Reflex Therapy (VRT); as a tutor, Anne will be involved in teaching the VRT techniques to qualified reflexologists across the country. 
Vertical Reflex Therapy is a versatile and acclaimed award-winning technique, developed by Lynne Booth.   VRT is a very brief reflexology treatment on the weight-bearing feet (or hands) and is now used extensively by reflexologists to enhance their classical reflexology treatments.  As it enables shorter treatments, it can be used to great effect with children, elderly people, in sports clinics and the workplace.  It can also be combined very effectively with other treatments such as physiotherapy and osteopathy.  Exceptional results may be obtained, often in a few minutes. 
As well as achieving really good results with sports injuries and mobility problems, Anne has also found the VRT techniques invaluable in helping with sub-fertility issues – several of her clients, who were waiting for IVF, have conceived quickly after using VRT endocrine techniques in combination with either Bowen or classical reflexology....or maybe, its just something in the Chandos Clinic water?!
For more information about Vertical Reflex Therapy, and how it may help you or your family and friends, see www.boothvrt.com.  
You can also contact our reflexologist, Anne Brunton, for more information on 0777 157 5837