Are you one of the many people who aren’t sure which anti-inflammatory they should take? Don’t worry, you’re not alone.

Turns out, they’re all pretty similar in terms of the amount of pain relief they provide.

“Most NSAIDs have comparable efficacy for most conditions, despite their different pharmacodynamic effects. The pharmacokinetic profile of different NSAIDs might confer varying risks and advantages for acute or chronic conditions that influence their selection.NSAIDs have well-recognised adverse effects, including cardiovascular, renal and gastrointestinal risks. While these risks vary between NSAIDs, all of them confer some increased risk. Proton pump inhibitors reduce upper gastrointestinal complications but not lower gastrointestinal ones. Other important precautions relate to pregnancy and hypersensitivity reactions.”

So your choice probably relates more to whether you have a cardiovascular condition, renal condition or gastrointestinal condition. As always, discuss with your GP or Pharmacist.

Source: https://australianprescriber.tg.org.au/articles/choosing-a-nonsteroidal-anti-inflammatory-drug-for-pain.html

I really enjoyed the Rhonda Patrick interview on the Diary of a CEO podcast recently. I plugged the youtube clip into Notebook LM and asked is to give me a summary. To save you the three hours I spent listening to it, here are ten key points from the provided sources:

• Dr. Rhonda Patrick is an anti-aging expert with a PhD in biomedical science, specializing in aging, nutrition, and metabolism, and is the founder of FoundMyFitness. She produces monthly science-focused podcasts exploring actionable strategies for enhancing longevity, cognitive performance, and physical health.

• Cardiovascular fitness is highlighted as the number one predictor of lifespan. The sources discuss how to improve cardiorespiratory fitness, including the Norwegian 4×4 training method, and warn about the death-related risks of being sedentary.

• Vitamin D deficiency is a significant concern, with 70% of the U.S. population being deficient, and this deficiency is linked to an increased risk of dementia. Magnesium is also mentioned as important for disease prevention, slowing aging, and boosting brain power.

• Creatine‘s effects on cognitive function and its link to cancer outcomes are discussed. The podcast also addresses the common question of whether creatine causes hair loss.

• Omega-3 fatty acids are presented as beneficial for mental health, depression, and longevity. The discussion also differentiates between Omega-3 supplementation and a high Omega-3 diet.

• Small daily habits can help reduce the risk of Alzheimer’s and cancer. The sources delve into what causes dementia and Alzheimer’s and explore whether multivitamins can improve cognitive performance.

• Mitochondrial health is identified as having a hidden link to aging and chronic disease. The podcast also touches upon how the body generates energy and the effects of vigorous training.

• Fasting strategies are explored, including specific fasting windows to achieve autophagy and the do’s and don’ts of intermittent fasting, along with its effects on sleep.

• Lifestyle plays a critical role in life expectancy and healthspan, potentially more so than genetics. This includes discussions on the impact of the keto diet, the use of exogenous ketones for cognitive repair, recommended superfoods, and the vital role of fiber.

• Other health-enhancing strategies covered include the benefits of red light therapy, traditional versus infrared saunas for reducing stress and improving mood, and understanding microplastics and how fiber can help in their elimination.

To watch the podcast podcast, click this link https://www.youtube.com/watch?v=JCTb3QSrGMQ

Let’s start by discussing what osteopathy is and what the underlying principles it is governed
by.
What is Osteopathy?
Osteopathy is a way of manual (hands-on) treatment of the body to improve its capacity to
function. Osteopaths uses a variety of techniques, both “Active” and “Passive” techniques.
Active techniques are where the patient primarily does the intervention, such as exercise
rehabilitation. While passive techniques are where the osteopath primarily does the
intervention and the patient less so. These techniques include soft tissue massage, joint
mobilisation and manipulation.
What are the principles of Osteopathy?
There are 4 principles of osteopathy:

1. The body is a unit:
    Mind, body, and spirit are interconnected.
    Physical health is influenced by mental and emotional well-being, and vice versa.
    Osteopaths consider all aspects of a person, not just the site of pain, when diagnosing
   and treating.
2. Structure and function are interrelated:
    How the body is built (structure) affects how it works (function), and vice versa. For
   example, restricted joint movement or poor posture can impair circulation, nerve
   function, and overall mobility.
    Osteopaths look for restrictions or imbalances in the body that may be affecting health
   or performance.
3. The body has the capacity to self-regulate and have self-healing mechanisms:
    The body has an innate ability to maintain health and recover from illness or injury.
    Osteopathic treatment aims to support and enhance these natural processes rather than
   override them.
4. Treatment should be based on the above three principles:
    Osteopaths use their knowledge of anatomy, physiology, pathology, and
   biomechanics to create individualised treatment plans.
    The goal is not just symptom relief, but to restore function, support overall health, and
   empower the patient.

What is Evidence Based Practice (EBP)?
Evidence based practice (EBP) is a systematic approach to decision-making that utilizes the
best available evidence, including research findings, clinical expertise, and patient values, to
guide practice. It involves integrating these elements to make informed decisions that lead to
improved outcomes.

1. Best available research evidence:
    This refers to clinically relevant research from studies with minimal bias, like
   randomized controlled trials.
2. Clinical expertise:
    This encompasses the knowledge, skills, and experience of the healthcare
   professional.
3. Patient expectations and preference:
    Acknowledging and incorporating the patient’s preferences and circumstances into
   the decision-making process.

With the terms defined, here is what we know of osteopathy as an evidence-based approach
in treating patients.
When it comes to treating musculoskeletal dysfunctions like back pain and neck pain,
osteopathy does have research backed evidence to support it.
Back Pain
According to research published in BMJ Open and The Lancet, manual therapy including
spinal manipulation and mobilisation can be an effective part of a multi-modal approach for
managing back pain.

A 2020 systematic review showed that osteopathic manipulative treatment significantly
improved pain and disability in patients with chronic low back pain. When combined with
exercise and education, these treatments are especially beneficial.
Neck Pain
Neck pain, often caused by poor posture, stress, or prolonged sitting, responds well to manual
techniques like joint mobilisation, soft tissue massage, and muscle energy techniques, all
commonly used in osteopathy. Studies indicate short-term improvements in pain and range of
motion, especially when patients stay active and involved in their treatment.
It should be noted that in some of the research conducted on the benefits of different manual
therapy techniques, both active and passive techniques are not categorised specifically as
“osteopathy” only, “chiropractic” only or “physiotherapy” only techniques; meaning
provided with the correct training and expertise, any technique can be performed by any
practitioner within their scope of qualification.
While there is evidence for osteopathic treatment for back and neck pain (or at least active
and passive manual techniques), lets shift focus onto some other conditions that research does
not have a strong evidence in its effectiveness but anecdotal evidence through Clinical
Expertise have seen patients benefit.
Headaches and Migraine
Headaches and migraine are common presentations in the clinic. Some tension-type and
cervicogenic headaches are linked to musculoskeletal dysfunction in the neck and upper
back. Osteopaths may use gentle manual therapy to release tension in these areas, which can
reduce headache frequency and intensity. Migraine management through osteopathy still
lacks strong research evidence and should be approached cautiously, but this is where an
experienced osteopath can use their expertise to help using a variety of techniques.
Pregnancy
Pregnancy-related pain often comes with musculoskeletal discomfort. Think ligament laxity
through shifting hormonal changes, pelvic girdle pain, sciatica, and lower back tension.
Osteopathic treatment during pregnancy has been shown in small studies to improve
functional outcomes and reduce pain, potentially making pregnancy more comfortable
without medication. Anecdotally, patients may find these symptoms worsen during the
second and third trimester and passive techniques during this time has been very helpful in
easing discomfort.
Patient Preferences is the last pillar of EBP model. This is something an osteopath can find
out before the commencement of any treatment. A written and verbal consent should be given
and the osteopath must adhere to such requests. For example, if a patient has had some ill
effects from a manipulation from previous treatments or has fears after hearing from friends
or family who suffered poor outcomes after said technique, the osteopath must take this into
consideration to weigh up the risk versus reward of performing such technique. This is why
an osteopath with extended clinical experience and expertise in a variety of techniques is so
important.

Cranial and Visceral Osteopathy

A word on a less common and perhaps “old school” branch of osteopathy. Both cranial and
visceral osteopathy have much less scientific backing. While some practitioners and patients
swear by their effectiveness, large-scale and high-quality clinical trials haven’t consistently
shown strong evidence for these methods.
Cranial osteopathy, also known as craniosacral therapy, is a specialised area of osteopathy
that focuses on the delicate movements and structures of the skull and its surrounding tissues.
Osteopaths practicing cranial osteopathy use a highly developed sense of touch to identify
and address restrictions or imbalances in the cranial bones, meninges, and cerebrospinal fluid.
This approach aims to enhance the body’s self-healing mechanisms and improve overall well-
being.
Visceral osteopathy is a manual therapy technique within osteopathy that focuses on the
internal organs (viscera) and their relationship with the musculoskeletal system. It involves
gentle manipulations to improve organ mobility, release tension in fascial tissues, and address
potential restrictions that may contribute to various musculoskeletal or digestive issues.

Conclusion
Is osteopathy evidence based? In short, it depends…
While manual (active and passive) techniques such as joint mobilisation, soft tissue massage
and spinal manipulation along with exercise prescription and education have shown to be
beneficial, there is currently less evidence to support Cranial and Visceral branch of
osteopathy.
Ultimately, any form of treatment for best patient outcomes must be through the three pillars
of Evidence-Based Practice; the intersection of best available research evidence, clinical
expertise of the treating osteopath while considering patient expectations and preferences.

References
Licciardone, J. C., Kearns, C. M., Minotti, D. E., & Tatman, L. H. (2020).
Osteopathic manipulative treatment for chronic low back pain: A randomized controlled
trial.
Journal of the American Osteopathic Association, 120(8), 529–538.
https://doi.org/10.7556/jaoa.2020.088
Foster, N. E., Anema, J. R., Cherkin, D., Chou, R., Cohen, S. P., Gross, D. P., … & Maher, C.
G. (2018).
Prevention and treatment of low back pain: evidence, challenges, and promising directions.
The Lancet, 391(10137), 2368–2383. https://doi.org/10.1016/S0140-6736(18)30489-6
Franke, H., Franke, J. D., & Fryer, G. (2014).
Osteopathic manipulative treatment for nonspecific low back pain: A systematic review and
meta-analysis.
BMC Musculoskeletal Disorders, 15, 286. https://doi.org/10.1186/1471-2474-15-286

Miller, J., Gross, A., D’Sylva, J., Burnie, S. J., Goldsmith, C. H., Graham, N., … & Kay, T.
M. (2010).
Manual therapy and exercise for neck pain: A systematic review.
Manual Therapy, 15(4), 334–354. https://doi.org/10.1016/j.math.2010.03.008
Licciardone, J. C., Aryal, S., & Singh, K. P. (2010).
Osteopathic manipulative treatment for chronic low back pain: A randomized controlled
trial.
The Journal of the American Osteopathic Association, 110(10), 646–656.
Green, C., Martin, C. W., Bassett, K., & Kazanjian, A. (1999).
A systematic review of craniosacral therapy: Biological plausibility, assessment reliability
and clinical effectiveness.
Complementary Therapies in Medicine, 7(4), 201–207. https://doi.org/10.1016/S0965-
2299(99)80003-9
Guillaud, A., Darbois, N., Monvoisin, R., & Pinsault, N. (2018).
Effectiveness of visceral osteopathy: A systematic review of the literature.
European Journal of Osteopathic Research, 7, 1–10.

Written by Dr Marcus Ng (Osteopath) M. Osteo, B App Sc (Osteo Studies), B. Sc (Anat.)

Our Osteopath, Marcus Ng, shares the best way to get out of bed when you are suffering from acute low back pain.

When it comes to acute low back pain, regardless of how it started, it is often a great source of anguish just to get out of bed. You’re either poorly rested from a sleepless night or just in a lot of pain and stiffness trying to get out of bed. 

The good news is, I have a simple tried and tested method to get you out of bed to get you on the road to recovery. 

My name is Marcus and I’ve been an osteopath for over 10 years and this is how I teach my patients the best way to get out of bed when they have acute low back pain, regardless of the underlying tissue injury.

Step 1:

You just woke up, you either feel the stiffness or pain or you remember you felt it prior to falling asleep. Without doing too much, all I want you to do is to roll on the side of the bed that you want to get out of bed. 

Step 2:

Once in the side-lying position. Use ONLY your arms (and upper body strength) to push yourself up in the half-sitting position. 

You want to avoid any big swinging movements where you are bracing or holding your breath or using your legs to create leverage. You are only to use your arms to push yourself up. This is very important!

WHY?

When you brace or use momentum to swing you put a lot of pressure through your low back. This bracing causes… 

a) a huge contraction through the deep trunk stabilising muscles without having sufficiently prepared for the work;

b) an increase in abdominal pressure can cause added pressure to disc or nerves that are getting pinched or irritated.

Step 3:

You may drop your legs to the edge of the bed and get on the your buttocks. From here I want you slow and gently shift your weight left and right on to each of your sitting bones, back and forth. Aim for more subtle movements. You’re going to do this for about 10-15 seconds.

WHY?

This is to warm up those trunk stabilising muscles to prepare them to do work for the first time of the day.

Step 4:

Now it’s time to stand up. When you begin to stand up, make sure you stand straight upright and have a tight butt squeeze at the top of it. 

WHY?

When we stand up, we use our low back, gluts AND hamstrings so we want to make sure all those other muscles are contributing to this big movement. If your low back has been compromise we want to make sure those other big muscle groups are contributing to the work.

Congratulations, you are now officially out of bed; and with the added walk to the bathroom and a hot shower, hopefully, you’ve successfully avoided triggering any major bouts of pain in the low back. This allows the nervous system to be in a calm state and therefore likely to keep you in this state. 

Conversely, if we trigger the nervous system with sudden, forceful moments, there’s a good chance the nervous system will be heightened and that will only perpetuate the pain. 

So next time you or someone you know with low back pain are struggling to get of bed, be sure to share this useful tip with them!