10000 massörer kan inte vara fel!

Fick Medicinsk kursforums nyhetsbrev idag och blev varse att Branschrådet nu har certifierat den 10000de massören. Ett pressmeddelande berättar hur

Certifierade massörer är den absolut största gruppen av
terapeuter i Sverige, med fler utövare än alla andra terapiformer tillsammans.

Vilket är nog en sanning med modifikation. För om jag förstår saken rätt har alla som går Naprapatutbildningen möjlighet att certifiera sig efter sitt första år. Där skulle man kunna räkna bort ungefär 1000 som gjort certifieringen men som nu jobbar som Naprapater. Sen har vi alla andra terapeuter som valt att certifiera sig som massör men som huvudsakligen jobbar med andra terapiformer eller som vidareutbildat sig efter certifieringen. Sist men inte minst kan man ställa sig frågan hur många som en gång certifierat sig och som valt att fortsätta att jobba som massörer. En på tio är en siffra som jag hört. Hård konkurrens om kunderna, överetablering av terapeuter, intresse och ork är nog de största anledningarna till att man väljer ett annat yrke. Men ändå envisas man med att påskina att

Arbetsmarknaden växer för certifierade massörer.

Ja, men utbudet av massörer är väldigt mycket större än efterfrågan. I min erfarenhet i alla fall. Flera stora utbildningsanordnare som trycker ut hundratals certifierade massörer varje termin och vart ska de ta vägen?

Vill man in på företagen har man riktigt hård konkurrens med starka aktörer som garanterat har en välslipad säljorganisation och en outsinlig källa av terapeuter att sätta in. Såklart kan man arbeta för dessa företag, det gör jag själv, men jag är tveksam till att man kan få ihop en full månadslön på det. De stora leverantörerna måste så klart vinna något på sitt arbete.

Så javisst, 10000 certifierade massörer låter jättebra. Men det känns som om massagebranschen, dvs branschorganisationer och utbildare, ständigt försöker haussa sig själv.

Bra om LB-P/SIJ-P

Research diary part 3

After reading through the document and some of the litterature I have decided to focus on the last part, where osteopathy is defined by the medical doctors on the comittee appointed by HSV. This is for me the most interesting part and I have to narrow down this project, I think there is enough to write about in this small text.

I will provide a translation:

Osteopathy, as well as several other therapeutic approaches such as chiropractics and homeopathy, was founded in the second half of the 1800s, partly as a reaction to the ineffective and counter-productive activity in the ordinary health care in the United States in those days. Most alternative medical disciplines are based on different philosophical ideas about nature, such as harmony and balance and sustainment of the body's self healing ability. They have not primary had a basis in science even though post-hoc attempts have been made to find parallels and seek mechanistic explanations for various disease processes. Several reviews have described the area, for example S. Singh & E. Ernst: Trick or Treatment. Alternative Medicine on Trial (2009).

The emphasis in osteopathic diagnosis and treatment usually lies in various symptoms or syndromes, ie clusters of symptoms, which one seeks to influence, rather than in organic disease diagnoses. In the case of osteopathy the basis is often that, quantitatively, the musculoskeletal system is the largest part of the organism and
therefore also affects other organ systems. For example, anomalies between the cranial bones would have an affect other parts of the body, and by manipulating the flat and tightly linked cranial bones one could get the remote effects; and vice versa it is indicated that pelvic floor massage could cure neck pain and headaches.

Another assumption is that the viscera would have ended up in the wrong position, which also could be affected by manual treatment. The large volume of osteopathic conditions resides in the back where osteopathy focuses on affecting faulty positions between bones and joints as well as disturbances in the function of the soft tissues. As for the musculoskeletal diseases, non-specific pain syndromes dominate the osteopathy as well as the regular outpatient and primary care activities. Aches and pains affect almost every human being during life.

What separates alternative medicine from the mainstream within traditional medicine is that the latter seeks to, in a scientific way, confirm or disprove hypotheses in unbiased, controlled trials, which is infrequently done within the alternative-medicine, including osteopathy. Altogether, osteopathy can not be considered to be resting on a scientific basis.

Osteopathy has a strong position in the UK but especially in the United States, where osteopaths in some states are entitled to also operate conventional medical care. In most European countries chiropractic dominates. In Sweden naprapathy dominates, which is essentially a domestic phenomenon. The various manual schools have more similarities than differences in the sense that they are using different variations of mechanical methods to influence the musculoskeletal system.

Overall they are widespread with significant demand; about 40 percent of the population seek alternative medicine annually. Thus, alternative medicine is an important factor, both economically and socio-politically. The demand for alternative medicine is surprisingly big when you consider that there is not much pointing to that manual medicine should have a greater impact than what you would expect from pure placebo. A contributory explanation for the perceived effects is "regression towards the mean", that is to say that most diseases have a fluctuating natural course, that you seek treatment when it hurts the most and that therefore there is a high probability that an improvement occurs over time, regardless of treatment.

One of the major reasons why alternative medical therapies are so popular may be due to dissatisfaction with the ordinary health care. Several of the patients seeking treatment from osteopaths have previously sought treatment in the conventional health care system, but have not been satisfied. The patients have not received a clear and understandable diagnosis. At the osteopath one often gets a concrete explanation for what is wrong. Also, patients often do not feel cared for and able to talk about their problem at the general practitioner. At manual therapists, they are thoroughly examined. The treatment is very clear and usually a series of contacts are made, during which an empathetic dialogue is held. The engagement of the operator of, for example, osteopathy is rarely a problem. It is unusual that the patients receiving manual therapy have any serious or progressive disease. It is not infrequently a question of marginal lifestyle improvements in terms of reduced pain.

Overall, it can be stated that alternative medicine, including osteopathy, largely lives on the shortcomings of regular medical health care, rather than on well documented scientific treatment principles. The high demand for consultations with for example osteopaths, means that such activities can not or should not be easily dismissed, as long as it does not put the clients' health in danger or is conducted in an uncontrolled manner. But the education of its practitioners must be carefully examined according to quality demands and level of higher education.

I have yet to read through this text in more depth and would also like to have the translation proof-read before I continue. But some things stick out at a first glance.

The text totally unreferenced apart from Ernst & Singh's book Trick or Treatment and even here this information is slightly distorted. So it is hard to say where most of the statements are coming from. Also the text seems to define what osteopathy is not more than anything else.

Futhermore what starts off as a definition of osteopathy turns into a discussion about the antagonistic relationship between alternative and traditional medicine.

I would like to research more into who exactly wrote this text and what sources of information has been used. Perhaps by contacting the authors.

Comic relief

Det var dags för det stora teoretiska slutprovet på SCOM och alla elever var otroligt stressade inför det prov de skulle utsättas för. Utom två som faktiskt kände sig så säkra på sina kunskaper att de bestämde sig för att gå ut och dricka lite öl kvällen innan provet. Lång kväll blev sen natt och de två studenterna blev ordentligt berusade, till den grad att de försov sig till sin stora tentan dagen efter.

De behövde så klart hitta på en ursäkt och ge ett giltigt skäl för att få skriva tentan så fort som möjligt. "Vi var på väg till skrivningen och fick punkteringen på motorvägen, därför blev vi så försenade." förklarade de för studierektorn.

Man kom överens att de skulle få skriva tentan redan dagen därpå, men studierektorn ville att de skulle sitta i separata rum när de skrev. Fine tyckte studenterna som tog sina prov och satte sig i sina respektive rum.

Fråga 1: Vilka nervrötter bidrar till plexus brachialis? (5 poäng)

"Ha, är det så här lätt rakt igenom kommer det här gå som en dans" tänkte de båda.

Fråga 2: Vilket däck fick ni punktering på? (95 poäng)