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SPORTS MEDICINE OSTEOPATHY IN SPORT
presented, we must always consider both the interrelationship between the body’s various systems and the way that the function and structure of all parts of the neuromusculoskeletal system may be predisposing, maintaining or reacting to that injury.
EVIDENCE FOR THE USE OF OSTEOPATHY IN SPORT The use of manual medicine, or joint manipulation, for the treatment of athletic injuries dates back thousands of years. Hippocrates was well known for his use of manipulation with the ancient Greek athletes around 400 BC (8). This tradition has continued, and the contribution of osteopaths within in the sporting arena is growing rapidly. An osteopathic approach to the injured athlete is, we
believe, a unique one. Optimal sport performance is broadly viewed as being dependent on an efficient musculoskeletal system. The body, including the cardiovascular and pulmonary systems, has to be fine-tuned to the high and variable demands placed on the musculoskeletal system (11). The athlete is subject to the biomechanical, strength and flexibility demands of his or her particular sport, and to gravitational challenges (12). The ultimate goal of osteopathy, therefore, is to go beyond aiding the relief of immediate symptoms. It is instead directed towards strengthening homeostatic and protective mechanisms of the body so there can be optimal healing and better resistance to breakdown in the future (5). Ever since Still first proposed osteopathy, the same core beliefs are fundamental to the way osteopaths work – namely that, in addition to the complaint with which we are
Cross-fibre soft- tissue massage of the thoracic erector spinae muscles
In today’s evidence-based medicine, studies of the use of osteopathic techniques for the treatment of sports injuries are limited, despite its widespread use, and have tended to focus on the effect of osteopathic treatment on the general public rather than being directed specifically towards the treatment of athletes. There is clearly a need for further investigation (12). The majority of evidence concerning osteopathy can be found from studies investigating lower back pain. This is the symptom for which the highest numbers of patients consult osteopaths (13) and is also a common complaint among athletes. Research into the management of back pain, although providing positive feedback (14–16), has generally concentrated more on acute rather than chronic conditions. In 2004, the UK Back Pain, Exercise and Manipulation
Reinforced soft- tissue massage of the cervical erector spinae muscles
(UK BEAM) randomised trial looked at how a package of care involving one or a combination of treatment approaches could improve lower back pain in patients (17,18). The study’s authors concluded that the combination of spinal manipulation and exercise was more beneficial than when the treatments were used in isolation and when compared with “best care” offered through general practice. A growing body of evidence for spinal manipulation prompted Licciardone and colleagues to conduct a systematic review and meta-analysis (19). The authors concluded from their meta-analysis that osteopathic manipulative therapy significantly reduced lower back pain. Research into the use of osteopathic treatment on the sort of peripheral joint injuries seen in athletes includes work undertaken by Eisenhart and colleagues, which showed that there was an immediate advantage (in terms of reduced oedema and pain) and a delayed benefit to adding osteopathic techniques in the treatment of acute ankle injuries (20). Stockard’s review of elbow injuries in golf showed osteopathic manipulative treatment to be effective in some cases of lateral epicondylitis (21), and case reports for the treatment of iliotibial band syndrome and sacro-iliac joint dysfunction in athletes also report osteopathic manipulative treatment to be beneficial (22,23).
In the absence of further research, anecdotal feedback also has a role to play. For example, a specific repeated biomechanical overload may predispose to injury and such problems certainly do appear to respond to a combination of judiciously provided treatment, “regular exercise” and “adequate rest”, and this results in “timely recovery from injury” (24). The experience of tens of thousands of athletic individuals who return to osteopaths repeatedly for treatment of their various injuries, and who recommend fellow athletes, should also be taken into account when reviewing the benefits of osteopathy within the sporting world.
INTEGRATION OF OSTEOPATHS INTO THE SPORTS MEDICINE TEAM Many of the benefits of working in the sports-care world are obvious. Although it can be demanding, at elite level it also offers the possibility to travel to interesting and unusual destinations with a motivated and motivating group of sports-