Meet Our Myofascial Specialist: Lloyd Chung

Lloyd Chung, RMT, is a 16 year specialist of myofascial release and cranial sacral Massage Therapy, recently adding Manual Osteopathy to his growing repertoire. He graduated from the Grant MacEwan College Massage Therapy program in June 2002 and became a member of the MTAA in 2003. Recently, Lloyd took a course at the National Manual Osteopathic College and is finishing his practical hours to become a Manual Osteopath.

Lloyd believes that massage should be seen as a tool that everybody should use to prevent pain and injury and maintain a healthier lifestyle, not just as a quick fix for pain and injuries.  He also believes that a therapeutic or deep tissue massage can be relaxing and doesn’t necessarily need to be painful. Manual Osteopathy will allow Lloyd to continue on his path of gently guiding and correcting the body towards less pain and better health.

Lloyd understands the unique nature of a client’s circumstance and health history. He is adept with adapting treatments to a client’s needs and comfort, working with an intuitive nature, but also applying orthopedic assessments for confirmation. Lloyd takes the time to explain his findings to support clients by helping them understand themselves more.

When Lloyd isn’t working or spending time with his wife, son and daughter, he enjoys playing trombone with the Festival City Winds or relaxing with a good book.

Lloyd is providing Manual Osteopathic Massage Therapy appointments as he completes the last of his qualification’s practical hours. These appointments are billed as Massage Therapy, and offer Manual Osteopathic theory and techniques at a discounted rate!

Manual Osteopathy: Health Care for the Whole Body

MANUAL OSTEOPATHY

The study of alignment, form and function, Manual Osteopathy is an advanced form of manual therapy using a range of techniques, such as joint mobilization, myofascial release, and soft tissue manipulation, to unwind the body and reset the nervous system.

The therapist assesses areas with postural problems, pain symptoms, compounded tension, weakness, and adhesions to address a variety of issues like joint and muscle pain, neural and organ dysfunction, limited range of motion, poor circulation, misalignment, and digestive issues.

This gentle therapy was developed to treat the body as a whole, because the body works and moves as a unit! Underlying issues are addressed to treat any compensation patterns that may be contributing to a chief complaint.

HOW DOES IT WORK?

In practice, a Manual Osteopath assesses the whole body, not limiting the examination and treatment to just the chief complaint. A Manual Osteopath takes in to account any reported symptoms of pain, discomfort or imbalance. For example, if a client is complaining of knee pain, the Manual Osteopath will assess the form and function of the knee, but will also look for any contributing factors within the body that may be a result or cause of dysfunction in the knee.
 
Once the Manual Osteopath has assessed the whole body they will use a combination of techniques, such as joint articulation, myofascial release, visceral manipulation, and cranial sacral techniques, as needed for each client. The treatment is clothed and the techniques can be administered with the client seated, standing or in a laying position, depending on the goal and treatment plan. The result is improving the overall functional biomechanics throughout the body which addresses a chief complaint, like knee pain, but also aims to improve other symptoms that seem unrelated, like poor digestion or headaches! Clients come out of their treatment plans with a better understanding of their body, it's posture and how to maintain good health beyond the treatment room!

INSURANCE

Check with your provider to see if your plan covers Manual Osteopathy. Insurance companies aren't offering direct billing at this time, but send in a request to your provider, and help us make that change!

Manual Osteopathy is covered by most insurance companies.

• Alberta Bluecross

• Benecaid

• Benefit Trust

• Claimsecure

• Chambers of Commerce

• Claimsecure

• Dejardins Financial Security

• Empire Life

• Imperial Life

• Johnson Inc.

• Johnson Group

• Manion Wilkins

• Maximum Benefit

• Medavie Bluecross

• National Life

• Nexgen

• Wawanesa

For information about which modalities we do have DIRECT BILLING with, visit this page.

More About Manual Osteopaths

"Manual Osteopaths focus on how the skeleton, joints, muscles, nerves, circulation, connective tissue and internal organs function as a holistic unit." Each client, condition and injury is unique so a Manual Osteopath will vary their treatments from person to person, making the experience completely tailored and progressive, addressing the needs of the client at the time.

Manual Osteopaths will ask a client about their current problem and symptoms. Questions related to their health history, past symptoms, any medications, as well as any factors that may appear to have no direct correlation to the problem. Thorough examinations are conducted, like orthopaedic or neurological tests, postural assessments and activities or exercises, that will determine how best to manage a condition.

Manual Osteopaths may also provide education and recommendations to help a client manage their condition between appointments. Most Manual Osteopathic treatments are gentle and should not cause undue discomfort. If a client's injuries do require hands-on treatment of painful and tender areas, their Manual Osteopath will exercise care to make the client as comfortable as possible.

What To Expect from an Osteopathic Treatment

If you are a new patient:

After taking an extensive case history, we do an initial structural assessment and perform motion tests and any necessary neurological and orthopedic tests. We may request other investigations if necessary for diagnosis.

We assess the range and quality of motion in joints and soft tissues and look at your general structural/ postural pattern.

The reason for taking a comprehensive case history and performing an initial assessment is to judge whether it is safe for us to use particular osteopathic techniques with you, and whether osteopathic treatment is appropriate.

We are interested in what has worked for you previously, and whether you have treatment preferences.

We can explain the treatment plan, and gain your consent before treatment. You should let us know immediately, even during the treatment, if you would like to change or stop and discuss the treatment we are giving you.

Your Osteopath will then explain to you what they have found and how they would like to approach the treatment, as well as explain what you may expect, any risks involved, and gain your consent for treatment .

The Osteopathic Treatment:

The treatment itself can vary practitioner to practitioner, but all will involve a hands-on approach.  Osteopaths have a wide variety of manual techniques they use to treat various complaints. They include:

• Massage (soft-tissue releases)
• Stretching
• Articulation (joints are passively taken through their range of motion by the osteopath)
• Muscle Energy Techniques (used to lengthen tight, contracted muscles)
• Counterstrain (releases tight muscles by positioning the affected muscle in a shortened position to stretch the opposing muscles)
• Manipulations (short, quick, precise low-amplitude movements used to improve range of motion at the joint)
• Functional Techniques (gentle mobilisation of joints)
• Visceral Techniques 
• Osteopathy in the Cranial Field

At the end of the treatment, your Osteopath will reassess the initial movements that you performed so that we can see how effective the treatment has been. Your Osteopath may organise a return consultation and may give you some stretches and exercises to do at home to help speed up your recovery or improve your body's function. We may be able to give you advice about suitable physical activity during this recovery period.

We have special pillows so that our pregnant patients can lie comfortably.

For your Osteopathic Consultation:

Bring:

•  X-rays, scans and results of investigations
• Private Health Insurance card /Workcover/Motor Vehicle claim numbers/ EPC form/ DVA referral form and card

Wear:

• Comfortable clothes. Depending on the Osteopathic Practitioner and the area of concern, some disrobing may be required, but at all times you will be draped with towels and/or provided with a gown to ensure you feel comfortable during the treatment. 

Time:

• Allow 5-10 minutes extra for your initial consultation to fill in your information sheet.
• Initial consults last 45-60 minutes
• Followup treatments run for 30-45 minutes

How many Treatments Will I Need?

The number of treatments needed depends on how long you have had the problem, how severe it is, and how your body responds to treatment. 

Like any other form of therapy/treatment, occasional unwanted reactions may occur.  These usually don't last long, but if you would like your osteopath to talk to you about what is happening, please ring us. 

On average, people have between 3 to 6 Osteopathic treatments for good results. However, you may only need 1 or 2 visits.

This article originally appeared on fremantleosteopathy.com.au

Approach to Low Back Pain – Osteopathy

Case

A man aged 42 years, who works as a police officer, presented with severe lower back pain, which he had experienced for 24 hours after spending the previous day helping his brother to move house. He had difficulty ambulating and most movements aggravated the pain. There were no lower limb symptoms and no red flags present on history or examination. He was otherwise well and was not taking any regular medications.

Osteopaths are registered health professionals who work mainly in private clinics and manage various musculoskeletal complaints.1 ..with major studies in anatomy, physiology, pathology, research methods, and osteopathic philosophy and technique. There are similarities with other manual therapies, such as chiropractic and manipulative physiotherapy, but the differences in underlying philosophy, approach to diagnosis, and frequency and duration of consultations provide distinctive practice styles to each discipline.

Osteopathic approach and philosophy

The osteopathic approach to patient care is characterised by holism and places emphasis on the reciprocal relationship between anatomical and physiological structures. The holistic approach also acknowledges psychosocial, environmental and ergonomic factors2 that influence pain and disability. To reach a diagnosis, osteopaths assess symptomatic tissues and other related areas of the body that may influence optimal biomechanical function. Treatment includes manual techniques and patient education.

Research and osteopathy

Although there is a paucity of high-quality research investigating the effectiveness of osteopathic management for many conditions, limited but growing evidence offers support for treatment of low back pain (LBP).3–7 Isolated manual techniques, such as spinal manipulation, have been most thoroughly examined by researchers, but seem to have only a modest benefit for LBP.8 An integrated treatment approach using an eclectic set of manual techniques and advice – as commonly used in osteopathic practice – may be of greater benefit in LBP and a number of randomised controlled trials (RCT) have found improvements in LBP after osteopathic treatment.3–7 Recent RCTs reported that osteopathic treatment was more effective than placebo for chronic LBP interventions,5 more effective than usual medical care for acute LBP,3 and helpful for LBP in pregnant women.4

Initial assessment

Initial osteopathic consultations are up to 60 minutes in duration. The consultation includes obtaining a case history and other relevant medical and health information,9 assessment of red flags10 and gaining patient consent for treatment. If a red flag is identified, patients are immediately referred to their GP for assessment, and in more urgent cases (eg. cauda equina syndrome) referred directly to hospital emergency units. The patient completes a self-report pain questionnaire (eg. visual analogue pain scale) and assessment of changes in activities of daily living (ADLs) to assess pain and functional disability.

The information provided in this case scenario suggests differential diagnoses of lumbar facet joint sprain, lumbar disc pathology or sacroiliac joint (SIJ) sprain. The osteopathic physical examination is informed by the case history and aims to support or exclude differential diagnoses.

Physical examination for the case presented

A physical examination would include the following:

• observation of standing posture
• active and passive range of motion of lumbopelvic, hip and thoracic regions
• occupation and ADL-oriented functional movement testing
• assessment of lumbar and thoracic segmental mobility and tenderness
• palpation of lumbar spine, abdomen and hip soft tissues
• orthopedic tests, including straight leg raise, active straight leg raise test and SIJ pain provocation tests.

Management strategies

Immediate (at initial presentation as stated in the case scenario)

For the case presented here, the osteopath would address restricted and painful areas identified in the examination. Treatment may involve mobilisation or articulation of lumbar and thoracic facet joints, soft tissue massage and stretching of lumbar and hip musculature, and the use of gentle isometric contraction techniques (‘muscle energy’) to encourage better motion, muscle recruitment and decrease pain.11,12 Gentle application of spinal manipulation may be used for the lumbar and/or thoracic spine,13 but suspected intervertebral disc pathology would be a contraindication. The patient would be advised to consult their general practitioner (GP) or pharmacist for appropriate short-term pain relief medications and advised to keep moving within pain limits.

An advantage of the osteopathic consultation is the time available to educate patients and discuss concerns. In this case, the osteopath would explain the likely cause and prognosis, and offer reassurance to the patient that nothing serious was evident, that most acute back pain resolves without the need for ongoing treatment or surgery, and that the patient should aim to be active and return to work as soon as possible.14 The osteopath would discuss sick leave for 2–3 days and schedule a review consultation.

Short term (days to weeks)

Some improvement in symptoms would be expected due to the natural history of acute musculoskeletal conditions. Further manual therapy would be provided, advice given on ADLs, and approaches to return to work within a short period of time would be encouraged. Recommendations for alternative work duties may also be appropriate.

Medium term (up to 6 months)

It is unlikely that this patient would need treatment for more than a few weeks. In the case of other factors being present (ie. yellow, black or blue flags) or re-injury, treatment may include manual therapy, the focus being directed towards active treatment approaches, such as rehabilitation exercises. The implementation of additional outcome measures may be helpful for identification of patients requiring psychological intervention.

Long term (years, including prevention and maintenance strategies)

It is highly unlikely that the patient in this case would require long-term osteopathic treatment. Osteopaths encourage patients to invest time and effort into keeping muscles strong and joints mobile, either though occasional osteopathic manual treatment, ergonomic awareness, their own exercise and rehabilitation program, or a combination of all.

Conflict of interests: None
Provenance and peer reviewed: Commissioned; externally peer reviewed.

References

1. Burke SR, Myers R, Zhang AL. A profile of osteopathic practice in Australia 2010–2011: a cross sectional survey. BMC Musculoskelet Disord 2013;14:227. Search PubMed
2. Fryer G. Special issue: Osteopathic principles. Int J Osteopath Med 2013;16:1–2. Search PubMed
3. Cruser dA, Maurer D, Hensel K, Brown SK, White K, Stoll ST. A randomized, controlled trial of osteopathic manipulative treatment for acute low back pain in active duty military personnel. J Man Manip Ther 2012;20:5–15. Search PubMed
4. Licciardone JC, Buchanan S, Hensel KL, King HH, Fulda KG, Stoll ST. Osteopathic manipulative treatment of back pain and related symptoms during pregnancy: a randomized controlled trial. Am J Obstet Gynecol 2010;202:43–48. Search PubMed
5. Licciardone JC, Minotti DE, Gatchel RJ, Kearns CM, Singh KP. Osteopathic manual treatment and ultrasound therapy for chronic low back pain: a randomized controlled trial. Ann Fam Med 2013;11:122–29. Search PubMed
6. Vismara L, Cimolin V, Menegoni F, et al. Osteopathic manipulative treatment in obese patients with chronic low back pain: a pilot study. Man Ther 2012;17:451–55. Search PubMed
7. Williams NH, Wilkinson C, Russell I, et al. Randomized osteopathic manipulation study (ROMANS): pragmatic trial for spinal pain in primary care. Fam Pract 2003;20:662–69. Search PubMed
8. Rubinstein SM, van Middelkoop M, Assendelft WJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for chronic low-back pain: an update of a Cochrane review. Spine 2011;36:E825–46. Search PubMed
9. Orrock P. Profile of members of the Australian Osteopathic Association: Part 1 - The practitioners. Int J Osteopath Med 2009;12:14–24. Search PubMed
10. Downie A, Williams CM, Henschke N, et al. Red flags to screen for malignancy and fracture in patients with low back pain: systematic review. BMJ 2013;347. Search PubMed
11. Degenhardt BF, Johnson JC, Hagan C. Osteopathic manipulation reduces pain and improves quality of life. Int J Osteopath Med 2013;16:e11–12. Search PubMed
12. Greenman PE. Principles of Manual Medicine. 3rd edn. Philadelphia: Lippincott William & Wilkins, 2003. Search PubMed
13. de Oliveira RF, Liebano RE, Costa LdCM, Rissato LL, Costa LOP. Immediate effects of region-specific and non-region-specific spinal manipulative therapy in patients with chronic low back pain: a randomized controlled trial. Physical Therapy 2013;93:748–56. Search PubMed
14. Brooks P, March L, Bogduk N, et al. Evidence-based management of acute musculoskeletal pain. Australian Acute Musculoskeletal Pain Guidelines Group. Brisbane: Australian Academic Press, 2003. Search PubMed

This article originally appeared on racgp.org.au and was written by Brett Vaughan, Tracy Morrison, Della Buttigieg, Chris Macfarlane and Gary Fryer.