movement and tenderness, and it can exist in a wide array of illnesses and disorders. If somatic dysfunction exists, then an osteopath directs treatment towards the cause of that dysfunction (5). A key consideration is what makes this particular presentation special, the osteopathic belief being that no two cases are the same and that each case must therefore be treated on its own merits (8). Pragmatically speaking, this also requires an osteopath to follow the tradition of luminaries such as John Martin Littlejohn, Arthur Smith, T. Edward Hall and John Wernham and to reassess and re-evaluate the patient each time he or she is treated.

TABLE 1: OSTEOPATHIC TECHNIQUES USED IN SPORTS CARE Commonly used techniques

Articulation: low-velocity movement of a joint using moderate to high amplitude to increase the range and quality of movement while increasing local vascularisation

Functional release and myofascial release: continuous passive palpatory technique involving feedback from tissues to allow repositioning to a position, which allows a “release”

High-velocity thrust: high-velocity articulatory technique that combines two or more component vertices to allow “joint separation” in a specific direction

Inhibition/release: application of steady pressure to soft tissues to reduce reflex activity and produce relaxation

Lymphatic drainage: various stretching, pumping and effleurage-type treatments to encourage fluidity within the lymphatic system

Minimal-leverage thrust: moderate- to high-velocity articulatory technique that requires precise positioning of the joint to allow “joint separation” with very minimal force

Muscle energy: active and actively resisted movements used against a defined resistance. May be isotonic, isolytic, isometric, eccentric or concentric

Soft tissue massage: massage-type treatment focusing on direction of technique, tissue tension and joint position

Strain–counterstrain: controlled passive movement using a positionally induced mild strain and release of tissue to reset nerve fibres that are inducing and maintaining tension

From undergraduate and postgraduate lectures given by Professor L Hartman, T Aldridge and D Tatton to students at the British School of Osteopathy, London

8

Osteopathic treatment modalities are primarily hands-on and include soft-tissue treatment, joint articulation, myofascial release techniques, strain–counterstrain and neuromuscular inhibition techniques (Table 1). Osteopaths also use joint manipulation techniques (where appropriate), which involve a high-velocity, low-amplitude thrust to a joint. Advice on posture and exercise may be provided to aid recovery, promote health and prevent symptoms from recurring (8).

Other treatment approaches Neurocryotherapy: high-pressure carbon dioxide gas at –78°C is applied to bring the surface skin temperature down to 4°C and induce thermal shock

Dry needling: use of needles to effect biomedical changes in trigger points and provide intramuscular stimulation to reduce spasm, alter pain levels and encourage healing

Ultrasound: produces sound waves that target damaged tissue and, through vibration, provide energy at a cellular level to aid repair and recovery

OSTEOPATHIC TRAINING AND PRACTICE The General Osteopathic Council (GOsC; www.osteopathy. org.uk) regulates the practice of osteopathy in the UK. By law, all osteopaths practising in the UK must have completed rigorous training and be registered with the GOsC. Students of osteopathy follow a four- or five-year degree course, during which they study anatomy, physiology, pathology, clinical diagnosis, nutrition and biomechanics (6). In addition, they undergo a minimum of 1000 hours of clinical training. Qualification now takes the form of a bachelor’s degree in osteopathy (BSc (Hons), BOst or BOstMed) or a master’s degree in osteopathy (MOst). The clinical skills associated with good differential diagnosis are regarded as a vital constituent of these courses: the majority of patients see their osteopath before attending any other healthcare professional, and so the osteopath’s role is often one of primary care, with the osteopath having to make an accurate assessment in order to differentially diagnose whether, for example, the chest pain they are seeing is a simple intercostal muscle strain, a costo-chondral injury, a pneumothorax or a myocardial infarction. The GOsC sets the standards of osteopathic education and requires qualified osteopaths to update their training throughout their working lives, a process known as continuing professional development (CPD). The Osteopathic Sports Care Association (OSCA; www.osca.org.uk) is the membership organisation for osteopaths with a special interest in sport. Founded in 1995, OSCA is Europe’s largest sports-care association for complementary medical practitioners. Increasingly, leading clubs are realising that a small

team of therapists, providing different and complementary skills, can work together to create a very efficient and effective support structure. Associations such as OSCA and, for physiotherapists, the Association of Chartered Physiotherapists in Sports Medicine (ACPSM), provide career pathway guidance, standards and educational opportunities for their members to develop their skills (9). These associations also act as a conduit for players and coaches who wish to find details of locally based therapists. However, anecdotal observation also suggests that as the requirements of athletes become more sophisticated, a combined therapy approach is increasingly being seen as desirable, providing an opportunity to access the benefits of each specialisation – and getting better quicker is, after all, what it’s all about. The term “sports care” in OSCA, as opposed to “sports

medicine”, was chosen to reflect the importance that is made in osteopathic treatment to consider all aspects of an athlete’s presentation – cognitive, emotional, spiritual and physical (10). As such, prevention is a large part of this work, and the association promotes treatment and advice before involvement in sporting events such as the London Marathon.

sportEX medicine 2009;42(Oct):7-12