IAMMM academy conference Rovinj 2017

by Dr. Wouter Schuller, MD, MSc Epidemiol Free University of Amsterdam, Netherlands

I recently returned from the Academy conference in Rovinj In very good spirits.
Having never been to Croatia, the stunning beauty of Rovinj was heartwarming, as was the great food, the good coffee, the company of enthusiastic colleagues, and even the morning swims in the rather cold Mediterranean Sea.
Indeed, a beautiful venue for a conference with a splendid view of the old town and harbor from the conference hall itself.

While the show was certainly stolen by the venue, this should not deter our attention from the scientific program. This was the fourth conference that I have attended, and the quality of the program has been improving over the years. It is a huge compliment to the organizers for putting together this tremendously interesting program. It is still a struggle to get a sound scientific basis for musculoskeletal medicine.
A lot of research will be necessary to find out which MSK interventions are beneficial for patients, and to find out what mechanisms might explain their effect.
Research is also indispensable to find recognition for the profession of MSK medicine and to be able to position our profession within the group of professionals concerned with the treatment of locomotor disorders.
To be able to do research at all, though, it is necessary to have connections with university networks, and to have access to research facilities.

The presence of speakers and attendees from various universities around the world showed that interest in MSK medicine, and the possibilities to undertake MSK research are increasing.
This was clearly reflected in the quality of the research presented.
I do hope that we will be able to continue this development. Although the possibilities to do research might be increasing, there is still an awful lot of research that needs to been done.
And, although the enthusiasm in the academy is stimulating, to do proper research will need a lot of investment in terms of developing expertise, finding funding opportunities, and of course conducting studies.
Compared to other professionals in the treatment of the locomotor system we are a small group of enthusiasts, and it is therefore necessary that we continue to cooperate, and be both critical and supportive to each other.

After attending this conference I am confident that we can further develop MSK research, and I am already looking forward to the next conference in Zurich.
When science and beautiful nature unite.

by Prof. Berit Schiøttz-Christensen, MD, PhD Aarhus University, Denmark

The 9th IAMMM Academy Conference took place in the beautiful area of Rovinj in the southern part of Croatia.
Researchers from most of Europe, Israel and the United States joined the meeting leaving the impression that Manual Medicine is alive.
The manual skills are appreciated by the patients, and most of the attendants believes that MM is effective. But how does it actually work?

We learned about how to measure pressure when manipulating the cervical spine, and how much the pressure is - which is far less than expected.
We learned how important the inter-observer reliability in regards to standardized examination and treatment – and that the IAMMM protocol for reproducibility studies can be successfully utilized in daily practice outside university hospitals.

Functional anatomy is the cornerstone of MM. We were introduced to the movement pattern in the spinal canal both with and without nerve-entrapment.
The movement can be visualized on MRI, but the clinical importance must be proven. Neuromuscular efficiency of the trunk muscles is important as well in defining the functional state of the muscles. Studies defining the normal reference and describing age-related values were presented. These have to be taken into consideration when using neurophysiological measures for diagnostic purposes.
Despite more focus on reliable tests and an increasing use of MRI the group of back pain patients used in these tests are too heterogeneous leading to uncertainty about the results of the treatment given in MM.
We need more specific diagnostic tools. MRI can be one tool but the systematic description of the scans has to be summarized leading to more robust measures, which is validated in the normal population and into different LBP-populations.

For treatment acupuncture, as well as medication and exercise, is used. NSAIDS and opioids have been used for decades, but for the time being effect and adverse advents are debated in favor of non-pharmacological activities as prescribed by the medical doctor and supported by the physiotherapists.

In MM we focus on individualized treatment including different modalities. To be able to document what disciplines have been used and to estimate the effect and side-effects of MM, it is time to standardize the evaluation using a combination of PRO´s (patient reported outcomes) and register based organizational information.

We should start by focusing on the treatments described in the Clinical Guidelines, as these goals are interesting for those who pay for the hospital based treatment.
Afterwards the patient perspective is valuable, as many patients pay for their own treatment and they will be interested in knowing more about what they can expect when being treated by experts of MM.