Osteopathy – Healthy.net

Otitis Media: Try osteopathy before grommets

What Doctors Don't Tell You — Fri, 23 Jun 2006 20:51:58 +0000

Acute otitis media is a painful and nasty disease of the middle ear in children, which doctors usually treat with courses of antibiotics. Unfortunately, this often offers only a short-lived reprieve, if any, and the child may sometimes have to undergo surgery to have grommets inserted if the problem keeps recurring. This is traumatic for the child and parents, so both will be interested in a study that discovered osteopathy offers a long-term solution.

Children who had three or four episodes of otitis media in the previous year were either assigned to routine care (mainly antibiotics) or to routine care plus osteopathy. Those in the osteopathy group needed less medical care and suffered fewer attacks than those just receiving standard treatment.

(Source: Archives of Pediatrics & Adolescent Medicine, 2003; 157: 861-66).

Osteopathic Manipulation

Leon Chaitow ND DO MRO — Wed, 06 Dec 2000 13:28:02 +0000

One purpose of osteopathic manipulative therapy (OMT) is to restore physiological motion to areas in which there is restriction or dysfunction. By restoring or improving function in the musculo-skeletal system, it is anticipated that all connected parts will benefit, whether these are other parts of the musculo-skeletal system or areas influenced via nerve or circulatory pathways. OMT is not aimed at specific disease processes but rather at normalizing the musculo-skeletal structures with a view to benefiting overall function and thereby maximizing the body’s homeostatic, self-regulating and healing activities.

There are a great variety of osteopathic manipulative methods. It is just as ridiculous to talk of manipulation, as though it is a specific entity, as it is to talk of medicine or surgery in the same terms. Just as the allopathic doctor, or surgeon, has a wide range of choice regarding medication or surgical procedure, so does the osteopathic practitioner have a wide range of choices regarding techniques and methods of manipulation.

Among the aims of manipulation are the restoration to normal of the supporting tissues such as muscle, ligaments, fascia etc. Then there is the normalization of movement and articulation, there is the use of reflex, mechanical, influence on the body as a whole.
Techniques can, roughly speaking, be divided into three groups:

Shows a soft tissue stretching technique in which the shoulder girdle muscles are lifted and stretched. It also simultaneously allows articulation of the shoulder joint.

Soft-tissue techniques. These are varied and involve any method that is directed towards tissue other than bone. Frequently soft-tissue techniques are used diagnostically, as well as therapeutically. Soft-tissue techniques may involve stretching movements across or along the lines of the muscular fibres and deep pressure techniques, as well as stretching and separation of muscle and other soft-tissue fibres, especially where muscles originate or insert into bony structures. Much soft-tissue manipulation involves working on fascia or connective tissues. These methods usually precede manipulation of the bony structures but can frequently achieve mobilization and normalization of joint structures on their own. This can result from the improvement of rigid or tense tissues, allowing a previously restricted joint to achieve a free range of motion.

A uniquely British contribution to this end was developed by the late Stanley Lief D.O., and it is in the use of this and other soft-tissue methods that attention is usually paid to the reflex areas that might influence the patient’s condition. These might range from simple trigger points to more complex reflexes, involving internal function (Chapman’s reflexes etc.). With soft-tissue techniques, diagnosis and treatment are often simultaneous. As the practitioner is palpating and assessing the tissue for signs of dysfunction, so is he treating and attempting to normalize what he finds.

A direct action method, very similar to those employed by chiropractors. It involves high velocity and low amplitude in its execution. The supporting couch may have a sprung section to allow for a rebound effect.

Direct Techniques. In these methods the practitioner attempts to overcome limitations to normal movement by taking the joint involved towards, or through, the restrictive barrier that is preventing normal motion. This might involve thrust techniques in which, after careful positioning of the hands in relation to the joint, a high velocity, low amplitude thrusting movement forces the bony articulation to move. There would be very little movement of the hands, or of the joint in question, in such a manipulation. A matter of only a centimetre or less of actual movement might take place, but at very high speed. This might be compared to trying to move a drawer that is jammed. Pushing slowly on it, however hard, will often fail to shift it, whereas a sharp tap at the appropriate angle releases it instantaneously.

This direct action, high velocity, low amplitude manipulation involves the precise localization of the forces required to allow correction of the particular dysfunction. This is achieved by means of rotation and sidebending of the patient’s spine, followed by the adjustment.

This direct action manipulation positions the patient so that by extending, side-bending and rotating the neck a locking of joint facets is obtained which localizes the forces preparatory to the high velocity, low amplitude thrust being delivered to the appropriate vertebrae (in this case the second thoracic vertebrae. )

A different direct method of OMT is known as articulatory technique. In this the restricted joint may be repeatedly taken through its free range, up to the point of restriction, in an attempt to gradually force a greater range of mobility, with more freedom of movement. This type of manipulation often employs leverage to achieve its aims, and, as always, the longer the lever the greater the force that can be applied. A knee joint, for example, may be mobilized by the joint itself being stabilized, whilst the lower leg is grasped at the ankle and taken through a range of movements. The lower leg thus becomes a lever, and depending upon the skill with which the leverage is applied around the fulcrum (the knee joint) a great deal of controlled force can be brought to bear on the motion barriers, or on restricted tissues and surfaces. This is essentially a low velocity (slow moving), high amplitude, type of manipulation.

This direct action technique enables the practitioner to use leverage to force into its correct anatomical position a posterior subluxation of the head of the fibula.

Muscle Energy Technique (MET) is a further method of applying direct action to a restricted area. With MET, however, it is the patient’s own forces which produce the manipulative effort. By placing a joint in a precise position, and calling on the patient to use a muscular effort in a particular direction, against a distinctly executed counter-force from the practitioner, it is frequently possible to achieve dramatic improvements in joint mobility. The skill in such a manouevre is in creating a balance of forces which can operate precisely on the restriction. In general terms MET involves placing the joint in question at the limit of its possible motion, in the direction in which it is most restricted. This position is maintained (not exaggerated) by pressure from the practitioner and, in a controlled manner, the patient then attempts to move the joint, by sustained effort, against the practitioner’s counterforce. No movement should take place during repeated short or long efforts of this type. After each such effort the joint should be reassessed, and if the range of movement has increased then the joint should be taken to this new limit before the next attempt. This method is virtually painless, and is suitable for self-use in many areas of the body (fingers or elbow, for example).

Indirect Techniques. These methods, rather than engaging and attempting (by whatever means) to overcome resistance, do the opposite. In counterstrain technique, for example, the part in question is moved by the practitioner away from the planes of restricted motion towards the planes of easier, unrestricted motion. There is a constant seeking for the position of greatest ease. At this point a mild degree of strain is introduced by the operator. This results in a reflex release of previously restricted tissues. The essence of this slowly performed technique is the introduction of the mild strain, whilst the joint is held in a position opposite to the direction in which there is a limitation of movement. It is essential that all movements are directed and controlled by the practitioner, as he eases the joint along the path of least resistance.

A further type of indirect technique is called functional technique. This also uses practitioner induced movement, whilst the area of dysfunction is constantly palpated. The joint is taken in all directions of ease (as opposed to directions of bind, which indicate irritation of tissues) gradually guiding towards the point of maximum ease. The palpating hand informs the practitioner when the affected area is least in distress. There is no further treatment at this point. The feedback from the distressed joint whilst in its state of ease is enough to begin normalization.

Shows the spontaneous release technique in which the affected part (in this case the low back) is carefully positioned in an exaggerated degree of the distortion already existing. This is maintained until there is a reflex release of spasm. No active manipulation is used at this usually acute stage.

Spontaneous release technique is a method ideally used when an area or joint is in lesion and is distorting its normal anatomical position. Often in low back problems, or neck conditions, there will be an obvious distortion. The individual might be in a stooped position or tilted to one side, or be unable to straighten a sidebent neck. This technique gently guides the affected part further into the direction of distortion. By exaggerating the lesion and holding the area in this position for several minutes, there is often a reflex release of muscular spasm and a resolution of the problem. This is a painless method.

Many techniques employ the assistance of the respiratory movements of the patient. It is a fascinating fact that as we breathe in and out, every part of the body moves. Perhaps some of the movement is very slight indeed, but it is palpable to the trained hand. For example, as we breathe in, the arms and legs rotate slightly outwards, and all the spinal joints move. The opposite (i.e. a return to the neutral position) takes place as we breathe out. Using this knowledge an osteopath will often synchronize attempts to move a joint with the phase or the respiratory cycle that will most aid the movement.

Combinations of direct and indirect techniques, sometimes preceded or followed by soft tissue methods, are often employed. Whether one method or another or a combination is needed, will be dictated by the individual case. The wide range of techniques available (and those described are by no means all) gives the osteopathic practitioner the ability to deal with musculo-skeletal problems and their ramifications.

A further area of manipulative effort is the use of cranial technique. This will be considered more closely in Chapter 11, but it is worth mentioning, in passing, that there does exist this specialized form of treatment which incorporates the cranial structures into the overall consideration of body mechanics. Cranial osteopathy attempts to normalize the bones of the head as well as influencing the circulation and fluid movements (cerebro-spinal fluid etc.) to, from and within the cranium. It attempts to balance what is known as the cranio-sacral mechanism. What this is and what its effects are will be dealt with in the appropriate chapter. The cranial concept and the techniques employed in correcting dysfunction in this area, have opened new vistas to the osteopathic profession. Birth injuries and many previously untreatable conditions have responded to cranial methods.

All osteopathic manipulation is aimed at accomplishing specific ends. Not only must the physiology of the area being treated be understood but the overall inter-relationship between it and the body as a whole needs to be considered. At the same time the manipulative techniques being employed must take into account the individual needs of the patient. When selecting the appropriate technique the practitioner visualizes the desired end result and the way in which this is most likely to be achieved. The choice will differ from patient to patient, and even in the same patient, from one visit to another.

The oldest maxim in osteopathy is ‘Find it, fix it, and leave it alone’. These are golden words.

Bodywork Masterclass Series-7:Muscles and Joints – Which Should Be Treated First?

Leon Chaitow ND DO MRO — Wed, 06 Dec 2000 13:28:02 +0000

Over the past 15 years I have been privileged to teach soft tissue methods in the UK and at chiropractic, osteopathic and massage schools throughout the USA, Scandinavia and Israel. More recently my teaching has formed a module in the new MA in Therapeutic Bodywork at the University of Westminster. Where chiropractors are concerned the vexed, sometimes highly charged question which forms the title of this article is never far from the lips of those attending, many of whom seem to have made up their minds in advance of asking the question.

I believe it is vital that all those treating musculoskeletal dysfunction have available a range of skills which can address both joint (intra-articular) restrictions and those of a soft tissue nature, or results will never be as good as they might be.

The Evolution of Musculoskeletal Dysfunction.

The normal response of muscle to any form of stress is to increase its tone.

Stress affecting musculoskeletal soft tissues produces hypertonicity, irritation and pain, and can include:

Acquired postural imbalances
‘Pattern of use’ stress (occupational, recreational etc)
Inborn imbalance (short leg, small hemipelvis, fascial distortion via birth injury etc)
The effects of hyper or hypomobile joints, including arthritic changes
Repetitive strain from hobby, recreation, sport etc (overuse)
Emotional stress factors
Trauma (abuse), inflammation and subsequent fibrosis
Disuse, immobilisation
Reflexogenic influences (viscerosomatic, myofascial and other reflex inputs)
Climatic stress such as chilling
Nutritional imbalances (vitamin C deficiency reduces collagen efficiency for example)
Infection

A chain-reaction of events may evolve as any combination of these or other stress factors demand increased muscular tone in those tissues obliged to compensate for, or adapt to them.

Muscles antagonistic to the hypertonic muscles become weaker (inhibited) – as may the hypertonic muscles themselves.
Stressed muscles develop localised areas of relative ischemia while simultaneously there will be a reduction in the efficiency of metabolic waste removal.
The combined effect of toxic build-up (largely the by-products of the tissues themselves) and oxygen deprivation leads to irritation, sensitivity and pain, which creates more hypertonicity and pain. This often becomes self-perpetuating.
Oedema may be part of the soft tissue response to stress.
If inflammation is part of the process fibrotic changes in connective tissue may follow.
Neural structures in the area may become facilitated, and so hyper-reactive to stimuli, often evolving into active ‘trigger points’, adding to imbalance and dysfunction.
Initially when stressed the soft tissues will show a reflex resistance to stretch and after some weeks a degree of fibrous infiltration may appear as the tissues under greatest stress adapt to the situation.
The tendons and insertions of the hypertonic muscles become stressed and pain and localised changes will manifest in these regions. Tendon and periosteal pain and discomfort start.
If any of the hypertonic structures cross joints, and many do, these become crowded and some degree of imbalance will manifest, as abnormal movement patterns evolve (with antagonistic and synergistically related muscles being excessively hypertonic and/or hypotonic) leading ultimately to joint dysfunction.
Localised reflexively active structures (myofascial trigger points) will emerge in the highly stressed,ischaemic, tissues, and these become responsible for the development of new dysfunction at distant target sites, typically inhibiting antagonist muscles.
Because of excessive hypertonic activity there will be energy wastage and a tendency to fatigue – both locally and generally.
Functional imbalances will occur, for example involving respiratory function, when chain reactions of hypertonicity and weakness impact this. ,
Muscles become involved in ‘chain-reactions’ of dysfunction as some muscles are used inappropriately as they compensate for other structures which are weak or restricted, leading to a loss loss of their ability to act synergistically or normally.
Over time the central nervous system accepts altered use patterns, as normal, complicating recovery since rehabilitation then requires a relearning process as well as more obvious structural and functional muscle and joint corrections.

Understanding Muscles

In order to make sense of patterns of soft tissue change it is necessary to conceptualise muscular function and dysfunction as being something other than a local event.

Irwin Korr stated the position elegantly and eloquently:

‘The spinal cord is the keyboard on which the brain plays when it calls for activity. But each ‘key’ in the console sounds not an individual ‘tone’ such as the contraction of a particular group of muscle fibres, but a whole ‘symphony’ of motion. In other words, built into the cord is a large repertoire of patterns of activity, each involving the complex, harmonious, delicately balanced orchestration of the contractions and relaxation of many muscles.The brain thinks in terms of whole motions, not individual muscles. It calls,selectively, for the preprogrammed patterns in the cord and brain stem, modifying them in countless ways and combining them in an infinite variety is still more complex patterns. Each activity is subject to further modulation refinement, and adjustment by the feedback continually streaming in from the participating muscles, tendons and joints.’

We must never forget the complex interrelationships between the soft tissues, the muscles, fascia and tendons and their armies of neural reporting stations, as we attempt to understand the nature of dysfunction and of what is required to achieve normalisation.

Postural Muscles – a factor to keep in mind

Research by Lewit, Korr, Janda, Basmajian, and others shows that muscles which have predominantly stabilising functions will shorten when stressed while others which have more active ‘moving’ or phasic functions will not shorten but will become weak (inhibited).

The muscles which shorten are those which have a primarily postural rather than phasic (active, moving) role and it is possible to learn to conduct, in a short space of time (ten minutes or so) an assessment sequence in which the majority of these can be identified as being either short or normal.

Janda informs us that postural muscles have a tendency to shorten, not only under pathological conditions but often under normal circumstances. He has noted, using electromyographic instrumentation, that 85 per cent of the walking cycle is spent on one leg or the other, and that this is the most common postural position for man. Those muscles which enable this position to be satisfactorily adopted (one-legged standing) are genetically older; they have different physiological, and probably biochemical, qualities compared with phasic muscles which normally weaken and exhibit signs of inhibition in response to stress or pathology.

Postural Muscles

Those muscles which respond to stress by shortening comprise the following:

Gastrocnemius, soleus, medial hamstrings, short adductors of the thigh, hamstrings,psoas, piriformis, tensor fascia lata, quadratus lumborum, erector spinae muscles, latissimus dorsi, upper trapezius, sternomastoid, levator scapulae, pectoralis major and the flexors of the arms.

Janda has also shown that before any attempt is made to strengthen weak muscles any hypertonicity in their antagonists should be addressed by appropriate treatment which relaxes them, for example by stretching using MET. Relaxation of hypertonic muscles leads to an automatic regaining of strength of their antagonists. Should the hypertonic muscle also be weak it commonly regains strength following stretch/relaxation.

Commenting on this phenomenon, chiropractic rehabilitation expert, Dr.Craig Liebenson states:

‘Once joint movement is free, hypertonic muscles relaxed, and connective tissue lengthened, a muscle-strengthening and movement coordination program can begin. It is important not to commence strengthening too soon because tight, overactive muscles reflexively inhibit their antagonists, thereby altering basic movement patterns. It is inappropriate to initiate muscle strengthening programs while movement performance is disturbed, since the patient will achieve strength gains by use of ‘trick’ movements’.

Where Do Joints Fit Into the Picture?

Janda has an answer to the emotive question when he says that it is not known whether dysfunction of muscles causes joint dysfunction or vice versa.

He points out however that since clinical evidence abounds that joint mobilisation (thrust or gentle mobilisation) influences the muscles which are in anatomic or functional relationships with the joint, it may well be that normalisation of the muscles’ excessive tone in this way is what is providing the benefit, and that by implication normalisation of the muscle tone by other means (e.g. Muscle Energy Technique – MET) provides an equally useful basis for joint normalisation. Since reduction in muscle spasm/contraction commonly results in a reduction in joint pain, the answer to many such problems would seem to lie in appropriate soft tissue attention.

Liebenson not unnaturally has a chiropractic bias, ‘The chief abnormalities of (musculoskeletal) function include muscular hypertonicity and joint blockage. Since these abnormalities are functional rather than structural they are reversible in nature….Once a particular joint has lost its normal range of motion, the muscles around that joint will attempt to minimise stress at the involved segment.’

After describing the processes of progressive compensation as some muscles become hypertonic while inhibiting their antagonists, he continues, ‘What may begin as a simple restriction of movement in a joint can lead to the development of muscular imbalances and postural change. This chain of events is an example of what we try to prevent through adjustments of subluxations.’

We are left then with one view which has it that muscle release will frequently normalise joint restrictions, as well as a view which holds the opposite, that joint normalisation sorts out soft tissue problems, leaving direct work on muscles for rehabilitation settings and for attention if joint mobilisation fails to deal with long-term changes (fibrosis etc).

It is possible that both are to some extent correct, however it is worth restating that once soft tissues have shortened and become fibrotic the degree of shortening they display is no longer under neurological control,a structural modification has occurred in the tissues and no amount of joint manipulation can ever restore normality. Some additional approach is vital.
What emphasis each practitioner gives to their prime focus – be it joint or be it soft tissues – the certainty is that what is required is anything but a purely local view, as Janda helps us to understand.

Before treating dysfunction there are many pertinent questions which need answering such as:

Which muscle groups have shortened and contracted?
Is the evident restriction in a specific soft tissue structure or joint related to neuromuscular influence (which could be recorded on an EMG reading of the muscle) or tightness due to connective tissue fibrosis (which would not show on an EMG reading). or both?
Which muscles have become significantly weaker, and is this through inhibition or through atrophy?
What ‘chain reactions’ of functional imbalance have occurred as one muscle group (because of its excessive hypertonicity) has inhibited and weakened its antagonists?
What joint restrictions are associated with these soft tissue changes – either as a result or as a cause of these?
Is a restriction primarily of soft issue or of joint origin, or a mixture of both?
How does the obvious dysfunction relate to the nervous system and the rest of the musculoskeletal system of this patient?
What patterns of compensating postural stress have such changes produced (or have produced them) and how is this further stressing the body as a whole, affecting its energy levels and function?
Within particular muscle areas which are stressed what local soft tissue changes (fascia etc) have occurred leading, for example, to myofascial trigger point development?
What symptoms, whether of pain or other forms of dysfunction, are the result of reflexogenic activity such as trigger points ?
In other words what palpable, measurable, identifiable evidence is there which connects what we can observe, test and palpate to the symptoms (pain, restriction, fatigue etc) of this patient?
And what, if anything, can be done to remedy or modify the situation, safely and effectively?
Is this a self-limiting condition which treatment can make more tolerable as it normalises?
Is this a condition which can be helped towards normalisation by therapeutic intervention?
Is this a condition which can not normalise but which can be modified to some extent, so making function easier or reducing pain?
What mobilisation, relaxation and/or strengthening strategies are most likely to be of assistance, and how can this patient learn to use themselves less stressfully following this?
To what degree can the patient participate in the process of recovery, normalisation, rehabilitation?

Fortunately, as a part of such therapeutic intervention well structured assessment protocols exist as do a vast range of Muscle Energy Techniques (MET), Positional Release methods (Strain/counterstrain – SCS) and Neuromuscular techniques (NMT) exist as means of achieving normality.

Osteopathy in Practice

Leon Chaitow ND DO MRO — Wed, 06 Dec 2000 13:28:02 +0000

Most patients consulting osteopathic practitioners will do so in the hope of obtaining relief from musculo-skeletal aches and pains. In the main, the low back and neck are the areas most likely to be involved, but all the joints and muscles of the body are possible sources of problems which may be helped by osteopathic care. A growing number of patients, however, do consult osteopaths about a wider range of health problems, and these might include such conditions as migraine headaches, tinnitus (noises in the head), dizziness, bronchial problems, asthma, functional cardiac problems, digestive problems and menstrual irregularities. The treating of these and other conditions by osteopathic methods can be surprisingly successful.

Photo: Courtesy Rehabilitation Products Limited.
An osteopathic treatment couch.

What Happens On Visiting an Osteopath

A typical visit to an osteopath can last from fifteen to forty-five minutes, depending upon the condition, and at the first visit the osteopath will take a case history and conduct a detailed examination and assessment of the spinal and other joints. Should the condition warrant it, x-ray pictures might be taken. In many cases the heart and chest will be examined, blood pressure taken and possibly other clinical tests performed or arranged (urine tests, blood tests, eye or ear assessments etc.) In these ways the osteopath arrives at a diagnosis as to the causes of the patient’s problems, or at least as to the possible musculo-skeletal involvement in whatever problem the patient is troubled with.

Treatment normally consists of preliminary soft-tissue manipulation. This might be local to the area of pain, or distant from it if the osteopath is attempting to influence the condition reflexly. Having stretched, relaxed and generally prepared the soft tissues, the osteopath will manipulate the appropriate joint or joints. As shown in Chapter 6, a variety of methods may be used at this stage. The age, condition, degree of pain and spasm etc. will all decide which is the most desirable approach.

Some forms of manipulation produce an audible snapping or popping sound. This is thought to result from the creation of a momentary vacuum between the joint surfaces as they are manipulated. Such sounds do not necessarily indicate that the manipulation has been successful, nor does the absence of such sounds mean that the treatment has failed to achieve mobility.

After treatment there is often immediate relief from pain and improved mobility. However, there may be a degree of transient discomfort, and in some cases a slight increase in pain may be felt for a day or so, especially in acute conditions. More usually there is a feeling of well-being. Some patients experience a marked degree of relaxation and a desire to sleep, and others feel a sense of exhilaration and energy.

Practitioners will explain the objectives of the treatment, and may well suggest a programme of home treatment to augment and support the osteopathic therapy. This could include exercise, dietary changes and relaxation. If the condition is a simple mechanical strain, then it would normally be correctable fairly quickly, and require no further attention. If, on the other hand, the condition is of a more chronic nature, then periodic maintenance treatment may be necessary to prevent a recurrence.

The frequency of osteopathic treatment can vary from very often, say every other day, to occasional, say every month or so. In chronic conditions the regular ‘maintenance’ treatment is likely to be at intervals of anything from once weekly to once in three or four months. There is a tendency for patients to be advised to have regular check-ups, two or three times a year, on the same basis as in dentistry. Since many minute musculo-skeletal changes often precede obvious problems by many months, this preventive approach can be of value. In the same way an increasing number of infants and growing children are taken for osteopathic assessments each year to ensure that problems are corrected before they become established.

Many patients speak of their problems in terms of ‘bones being out of place’. They therefore expect these to be replaced or ‘put back’ by manipulation. Such ideas are largely inaccurate and over-simplistic. Whilst slight changes in position may take place, the essence of osteopathic manipulation is the restoration of mobility between joint surfaces. Correction of positional lesions tends to be achieved by normalizing the soft tissues that are supporting, binding and holding the bones in their particular positions. Some individuals have hypermobile joints due to congenital or acquired ligamentous weakness. Such joints can become unstable and, far from requiring manipulation, may need stabilizing by improvement of the tone of the soft tissues. This is sometimes achieved by injecting a sclerosing agent which ‘tightens’ the supporting tissues.

The ‘Slipped Disc’

The commonest diagnosis with which patients arrive at an osteopaths door (in the UK) is that of a slipped disc. Very few doctors have studied the mechanics of the spine with the degree of detail required of the qualified osteopath. The most common diagnosis given in cases of acute low back pain is that of a ‘slipped disc’. The symptoms vary, but usually involve stabbing pain on movements, and often one-sided spasm of the lumbar muscles; there is great difficulty in standing erect, and there may be pain down one or both legs. These symptoms are usually present in a true case of prolapsed intervertebral disc, but may be present in any other conditions. How is one to know?

A detailed history of the onset will often enable a correct diagnosis to be made and with details of the past medical history and a careful physical examination, it is possible to confirm or rule out the diagnosis of a slipped disc, with a great degree of certainty.

For the unfortunate individual suffering from a strained sacro-iliac joint, who is told by his doctor that he is suffering from a ‘slipped disc’, life becomes very irksome. He may be put to bed for anything up to six weeks, and then put into a corset. He may find himself in a plaster cast or in some cases an operation is suggested. If the patient is really suffering from a prolapsed disc ,the period in bed or wearing the corset would rest the area and enable a degree of repair to take place, but if the trouble is a strain of the sacro-iliac joint these treatments would be worse than useless.

The disc that it supposed to slip is a tough cartilaginous ring that is firmly attached to the vertebrae above and below it. This contains an inner pulpy mass, the nucleus pulposis. When through strain or an injury a tear appears in the cartilage, the inner material can protrude. This will cause spasm in the surrounding musculature and if there is pressure on nerves in the area then there will be acute pain. The disc does not, indeed cannot ‘slip’. There can be a rupture, or a herniation, and thus the misnamed ‘slipped disc.’

Cross Section of:
1. Vertebral Bodies Showing:

2. Disc in healthy state.

The effect of long-term unnatural wear on the disc is to reduce the elasticity of the disc as a whole and to produce a narrowing, degenerative change. Thus the ability of the disc to act as a shock-absorber becomes reduced. This results in stiffness and loss of mobility and possibly pain. It is therefore apparent that anything that can be done to prevent this all too common degeneration is highly desirable.

Once a disc has herniated there is no way of ‘putting it back.’ Anyone who claims to replace a ‘slipped disc’ is, without doubt, not being accurate. It is possible, with manipulation, to ease the pressure on the disc, then with gentle exercise and care the slow repair can take place. In rare cases surgery may be needed to remove the extruded pulp, but I would suggest that surgery should never be resorted to before an osteopath has been consulted.

Cross Section Showing: 1. Prolapsed Disc

2. Pressure on Nerve Root. Such a condition would produce sciatic pain if this occurred in the Lumbar Spine.

Whether short-term painful joint problems, or long-term general health conditions are the reason for consulting an osteopath, the way the individual uses his body will to a large extent determine whether or not recurrence of the problem takes place. For this reason it is vital that after correction of areas of dysfunction, the patient be instructed in the correct use of the body and in appropriate exercises. Many osteopaths also advise their patients on correct nutrition and in this way provide a comprehensive health care service.

Cross Section of Spine showing:
1. Prolapsed Disc;

2. Bone Degeneration.

Other Complaints Which Osteopathy May Help

Without attempting to cover all the possible disease states that osteopathic manipulative therapy might be able to help. I list below a selection of examples with the idea of giving some idea of osteopathy’s possibilities.

Allergic Conditions

The treatment of causes rather than symptoms is of first importance, and a lot of attention will need to be given to both the nutritional and stress related aspects of the problem. There are, though, quite often cases where osteopathic manipulation can help. In asthma, for example, areas of dysfunction may be found around the second thoracic vertebra, and there are always restrictions in the normal range of movement of the ribs. Such structural problems may be improved or corrected by osteopathic treatment, but if nothing is done about the underlying hormonal, nutritional and stress factors there is a strong likelihood that the allergy will reappear.

In most cases of allergy there is a degree of adrenal gland dysfunction (inadequate adrenaline production in response to repeated stress arousal, for example) or liver dysfunction (inadequate production of anti-hystamine in response to allergic hystamine production). Both these organs can be to some extent adversely affected over a period of time by mechanical disorders in the spine, and spinal correction through osteopathic manipulation can sometimes bring about an improvement of function.

Arthritis

The localized degenerative changes to joints which are collectively labelled osteo-arthritis or osteo-arthrosis is afflicting the majority of people over 35 who live in industrialized countries, and the term ‘wear and tear’ adequately describes the joint damage which results from the misuse of the postural and weight-bearing joints such as the spine, hips, knees etc.

In the early stages of such wear and tear, when disability is first becoming apparent in the form of stiffness, discomfort and slight limitation of movement, it is possible through osteopathic manipulative treatment to halt, and perhaps even reverse, the initial damage to the soft tissues which precedes the actual joint surface damage.

Even in cases of existing osteo-arthritic conditions, improvement may be brought about through osteopathic treatment in terms of improved mobility, the lessening of pain, and possibly the slowing down of the degenerative process. This is especially likely in spinal regions such as the neck and upper thortic spine and the lower back and pelvic joints which are those most abused by bad postural habits. Osteopathic treatment cannot undo the damage already done, however, but it can often minimize the effects by increasing the degree of mobility in all but extremely advanced cases.

Bronchitis

Chronic or acute obstruction of the breathing passages may yield to osteopathic manipulative therapy, although the causative factors must also be dealt with, and it is not suggested that structural factors play a major part in the background to bronchitic conditions. Osteopathic treatment in the spinal, chest and diaphragm areas can improve respiratory function and seems to speed the elimination of obstructing mucus. Apart from the mobilizing of the structure of the chest, such as ribs and their articulations with the spine and sternum, there are specific osteopathic methods such as the ‘thoracic pump’ and the ‘diaphragmatic coming’ techniques which may help.

Constipation

When the problem results from an over-contracted or spastic bowel, osteopathic treatment may assist in normalizing the condition, in conjunction with a restructured diet to include a high degree of fibre.

Digestive Complaints

Osteopaths find that there is frequently a spinal element involved in digestive dysfunction, whether the condition involves over- or under-supply of acid, or over- or under-supply of enzymes, or increased or decreased blood supply, to particular regions of the digestive organs. Osteopathic treatment is non-specific in such conditions, and usually areas of spinal dysfunction will be found in the mid and lower thoracic areas. The normalizing of these, together with dietary changes, can alleviate the problem.

Headaches

There are a great variety of causes of what are generally termed headaches, but one of the main causes of the common headache is tension in the neck and back of the skull and this is found to be particularly amenable to osteopathic treatment. Also, a definite reduction in frequency and intensity of pain was found to result from the osteopathic normalization of the cervical spine when research into migraine was conducted at the British College of Naturopathy and Osteopathy in the early 1970s.

Many headaches of less obvious origins may respond to a combination of cranial, cervical and upper thoracic normalization, but it would be wrong to assume that all headaches can always be relieved by osteopathy. In my own experience, however, I have found that some headaches of many years duration have yielded to just one treatment session.

Heart Conditions

Generally the improvement of mobility in the thoracic spine and chest region after osteopathic manipulation seems to enhance the heart’s function and in turn the blood is more efficiently oxygenated.

References have been made in Chapter 7 to the results of research into the possibility of a musculo-skeletal connection in cases of cardiac disorder, and the correction of spinal dysfunction by osteopathic manipulative therapy is claimed to reduce the chances of cardiac distress.

A frequent finding is that of what has come to be called ‘false angina’. In this condition all the classical symptoms of angina occur (pressure in the chest, breathlessness, pain in one or both arms etc. ) but they fail to respond to drug therapy. In many such cases there is found to be an upper thoracic lesion which responds to simple manipulative techniques with a consequent disappearance of the symptoms.

Hiatus Hernia

This distressing condition involves a bulging upwards, through a gap in the diaphragm, of part of the stomach. Osteopathy’s normalizing treatment of the structures to which the diaphragm attaches itself can be of great assistance, and there are also soft tissue manipulations which can be applied direct to the diaphragm, the muscles of the abdomen and the stomach itself. By thus improving the mechanics affecting the diaphragm, as well as the other factors involved in the problem, the distressing symptoms of hiatus hernia may be minimized. Other factors, such as obesity, bad posture, stress and poor nutrition, must not be overlooked, but osteopathy can in a number of cases be decisive in relieving symptoms and helping to correct the mechanical strain which allows the initial upwards displacement of the stomach.

Hypertension

If high blood pressure is the result of tension then osteopathic manipulative therapy can have a very beneficial effect on the condition. Both research and clinical experience shows that the normalization of spinal and general mechanics seems to have a stabilizing effect on the systolic and diastolic readings for a number of weeks. It is not suggested, though, that osteopathy should be used as the major method for treating hypertension, but such treatment can be a useful additional therapy.

Menstrual Problems

Dramatic improvements in menstrual function, in terms of regularity, less pain and discomfort, and shorter periods, have been achieved through the normalization of dysfunction of the lumbo-sacral area of the spine. There are many possible contributory factors in menstrual problems. Some of these are hormonal, others emotional, and others involve nutritional imbalances. However, in many cases the cause of the problem lies in mechanical and postural factors. In some cases there is a marked increase in the angulation of the lumbar spine causing a hollow, or ‘sway’, back and this can result in the pelvic organs being literally tilted forward and crowded into the lower pelvis. This can be helped toward a more normal position by osteopathic treatment.

Sciatica

If there is a pain radiating down the leg, then it may be the result of some degree of nerve root irritation involving the sciatic nerve. Some forms of this condition are not amenable to osteopathic care; for example, when the nerve is actually inflamed (neuritis). However, in the majority of cases of sciatica the nerve is irritated and not inflamed (neuralgia) and in many such cases removal of the cause of the irritation by osteopathic treatment relieves the pain. The cause may lie in the low back or in the pelvic or buttock regions. In acute cases it may be the result of a prolapsed disc, in which case osteopathy may be of only limited value.

Tinnitus

This intensely aggravating condition, which involves a ringing, buzzing or hissing sound in the ears, can be relieved by cranial manipulation.

Childhood Ear Infections

Janet Zand LAc OMD — Wed, 06 Dec 2000 13:28:02 +0000

Every year, over 10 million children in the United States are treated for ear infections. Chances are that by the time a child reaches the age of six, he will have suffered otitis media, an infection of the middle ear. Ear infections are most common in children between the ages of six months and three years.

The ear is a complex structure that consists of three sections: the outer, middle, and inner ears. The outer ear is the part we see. It is the external canal that picks up the vibrations from sound and transmits them through the eardrum to the middle ear. The middle ear contains three small bones that take these vibrations into the inner ear, which contains the nerve endings that make hearing possible. The inner ear is also involved in maintaining balance.

The middle ear is connected to the nasal cavity and the throat by means of a I passageway called the eustachian tube. This allows excess secretions from the middle ear to drain away from the ear and into the nose and throat. If the eustachian tube is not draining properly, these secretions build up in the middle ear, with the result that pressure in the ear rises and the ear becomes painful and, often, infected.

Young children are more likely than others to develop middle ear infections because in infants, the eustachian tube is oriented more horizontally than vertically, making drainage more difficult than it is in older children. Fluids can collect and become blocked, creating an ideal environment for bacterial growth.

Most children outgrow ear infections as their bodies mature and the structure
of the inner ear changes. As a child grows, the eustachian tube begins to curve
downward, allowing fluids to drain more easily. When the eustachian tube develops
its characteristic mature curve, fluids drain readily and infections are less
of a problem. When fully mature, the eustachian tube has a pronounced downward angle
(see illustrations below)

Figure A: Infant

Figure B: Older Child

Structure of the Ear: In infants, the eustachian tube extends almost horizontally from the middle ear to the nasal cavity and the throat. (figure A) As a child grows, the eustachian tube develops a downward curve. (figure B)

Ear infections are often a complication of a common cold or other upper respiratory infection, such as infection of the adenoids, tonsils, or sinuses. They are sometimes accompanied by coughing, runny nose, sore throat, and, occasionally, vomiting and diarrhea. Depending on the cause of the infection, a fever may be present.

A child who can talk will be quick to tell you, “My ear hurts!” Babies and toddlers will “tell” you by pulling or tugging on their ears, by rubbing or hitting their ears, or by fussing and crying. A young infant may simply be irritable or run a high fever for no apparent reason.

Another common symptom of ear infection, which your child may not have the words to express, is a feeling of fullness and pressure. This is caused by the excess fluid pushing against the eardrum. Your child may have a slight hearing loss in the affected ear. In most cases, this is temporary. However, if ear infection and hearing loss occur repeatedly, they can cause long-term problems. According to the American Academy of Pediatrics, recurring ear infections with hearing impairment may slow speech and learning development, even if there is no permanent hearing loss.

After initial treatment, if your child does not improve within twenty-four hours, call your doctor again. The risk of a permanent hearing loss increases if an ear infection is not properly treated or does not respond to treatment promptly. It may be necessary to try another treatment.

Emergency Treatment for Ear Infection

If your child experiences a sudden, severe pain, with drainage from the ear, it can mean that he has a perforated eardrum. When the buildup of pressure finally causes the drum to rupture, the relief from pressure can actually cause a dramatic lessening of the pain. Even if your child seems to be feeling better, take him to the doctor right away for an examination.

If your child experiences fever, chills, dizziness, or a serious hearing loss, call your doctor. These signs indicate that the infection may have worsened or traveled to the inner ear, requiring prompt medical attention.

Another potential, and
extremely serious, complication is meningitis. If your child complains of a
severe headache, stiff neck, and lethargy, contact your physician immediately
(see Meningitis).

Conventional Treatment

Antibiotics, such as amoxicillin, Bactrim, Septra, Augmentin, Ceclor, Suprax, and Pediazole, are commonly prescribed for ear infections. Most children with a first-time infection feel significantly better within forty-eight to seventy-two hours after starting a course of antibiotics, but it is important for them to continue taking the medication for the full course to be certain all infection is gone. Your health care provider will want to see your child once the full course of antibiotics is completed, to make sure the infection has cleared. Because many ear infections persist even after the symptoms have eased, it’s important to keep follow-up appointments.

While antibiotics are a common treatment for ear infections, parents should be aware that a study done in the Netherlands compared children with ear infections who were treated with antibiotics to a control group who were given a placebo. Although the antibiotic group improved somewhat faster, it is interesting to note that there was little difference between the two groups in long-term outcome.

Some ear infections may not respond to the first medication prescribed. If your child doesn’t seem to be improving after four or five days, talk with your doctor. Another of fice visit and evaluation, and possibly a change of medication, may be required.

An analgesic, such as acetaminophen (Tylenol, Tempra, and others) can help to relieve the pain of an ear infection and also bring down fever.

Note: In excessive amounts, this drug can cause liver damage. Read package directions carefully so as not to exceed the proper dosage for your child’s age and size.

If your child’s ear infection is related to sinus or nasal congestion, an antihistamine and/or a decongestant may be prescribed. Antihistamines often cause sleepiness, so if your child can’t sleep because of the discomfort, your doctor may recommend one. Research has not shown these medications to be helpful in actually curing ear infections, however.

Frequent ear infections are the most common reason for childhood surgery. If your child has had more than three ear infections within a six-month period, with resulting documented hearing loss, surgery may be recommended. Myringotomy is one of the most common operations performed in the United States. In this procedure, performed under general anesthesia, a physician inserts tiny plastic tubes into the middle ear to allow drainage of the fluid that is not draining, as it should, through the eustachian tube. Once in place, the tubes do not hurt. Your child should not even be aware of them. If infected tonsils or adenoids are causing recurring ear infections, your doctor may recommend tonsillectomy or adenoidectomy. Reports of long-term outcomes for these treatments are contradictory, however.

Some doctors prescribe a steroid, prednisone, for children with chronic ear infections. Steroids are powerful drugs with potentially serious side effects and are not suitable for long-term use. If your doctor recommends this, discuss in detail his or her reasons for thinking that this is the appropriate treatment for your child.

Dietary Guidelines

Keep your child well hydrated. If you are breastfeeding, do so frequently. Offer an older child plenty of spring water, soups, herbal teas, and diluted fruit juices.

Eliminate dairy foods. Dairy foods thicken and increase mucus, making it more difficult for an infected ear to drain.

Nutritional Supplements

For age-appropriate dosages of nutritional supplements, see Dosage Guidelines for Herbs and Nutritional Supplements.

Lactobacillus acidophilus or bifidus is valuable for a child who is taking antibiotics, who has chronic ear infections, or who has an ear infection with a stomachache. In addition to killing infectious bacteria, antibiotics strip the body of necessary friendly bacteria in the intestinal tract Replace the friendly bacteria by giving your child lactobacilli (either 1/4 teaspoon of powder, 1 teaspoon of liquid, or half of the contents of a capsule), once daily, two hours after administering the antibiotic.

Vitamin C and bioflavonoids are helpful for an ear infection. They are both mildly anti-inflammatory. Give a child over four years old one dose, six times daily. Select a product that contains mineral-ascorbate-buffered vitamin C but no sugar. For younger children, purchase a vitamin-C supplement made specifically for infants and toddlers.

Zinc boosts the immune response and helps reduce infection. Give your child zinc-based lozenges, two to three times daily, as needed, for a total of one dose of zinc a day.

Note: Excessive amounts of zinc can result in nausea and vomiting. Be careful not to exceed the recommended dosage.

Herbal Treatment

For age-appropriate dosages of nutritional supplements, see Dosage Guidelines for Herbs and Nutritional Supplements.

Echinacea and goldenseal herbal combination formula is important for clearing any type of infection. Echinacea is antiviral; goldenseal is antibacterial and soothes irritated mucous membranes. Both herbs stimulate the immune system. The liquid extract is the preferred form. Give your child one dose, every two hours, while the infection is acute. After his symptoms have eased, give him one dose, three times daily, for one week.

Note: You should not give your child echinacea on a daily basis for more than two weeks at a time, or it will lose its effectiveness.

Garlic is an antibacterial that can help heal an ear infection. Choose an odorless form of garlic capsules; with the smell missing, children don’t usually object to it. Your child can either swallow the capsule whole or take it dissolved in soup or hot water. Follow the age-specific dosage directions on the product label. Or heat a fresh garlic clove in olive oil and, with your child lying on his side, put one or two drops of warm (not hot) oil into the affected ear.

Mullein oil is a traditional Native American remedy used to reduce swelling and inflammation. Gently heat mullein oil to slightly above body temperature and, with your child lying on his side, put one or two drops into the affected ear. The heat feels comforting, while the mullein goes to work on the problem.

Homeopathy

The symptom-specific remedies listed here should work quickly. If your child’s pain does not subside within twenty-four hours, call your physician.

If your child has a fever, a red face, dilated pupils, and hot and moist skin, give him Belladonna. This is for a child with a throbbing earache that is relieved by resting with the head elevated. Give this child one dose of Belladonna 30x or 9c, two to three times daily, for one day.

For an earache that occurs with teething, give Chamomilla. The Chamomilla baby is crying, angry, obstinant, whiny, and irritable, but is comforted when carried around. Often he has one red cheek and one pale cheek with hot, moist skin, and his pain is intolerable. Give him one dose of Chamomilla 12x, 30x, 6c, or 9c, three times daily, for one to two days.

If your child has a fever along with an ear infection, give him Ferrum phosphoricum. This homeopathic preparation can be given together with another symptom-specific remedy. Give up to four doses of Ferrum phosphoricum 12x or 6c, thirty minutes apart.

Kali muriaticum helps relieve nasal congestion and swollen glands. It will benefit the child with a blocked eustachian tube that has affected his hearing. Give one dose of Kali muriaticum 12x or 6c, three times daily, for one to two days.

For a child who has a moderate fever and an earache that comes on gradually, use Pulsatilla. An important symptom that distinguishes a Pulsatilla child is the desire for cold; this child wants to be in fresh air-near a window or outdoors-and feels better with a cold compress. Give this child one dose of Pulsatilla 30x or 9c, three times daily, for one to two days.

Mercurius dulcis often works if other remedies have failed. Give your child one dose of Mercurius dulcis 12x or 6c, three times daily, for two days.

If none of the above remedies seems right for your child, a homeopathic combination earache remedy may be helpful.

If your child has ear surgery with a myringotomy and tube placement, give him one dose of Arnica 30x or 9c, three or four times daily, for two days. Arnica helps reduce inflammation surrounding the tube and also helps the body adjust to the tube’s presence.

General Recommendations

The pain of an earache is caused by pressure as the congested middle ear pushes on the eardrum. To promote drainage, prop your child at a 30-degree angle.

Prepare and use one of the herbal oil ear drops recommended under Herbal Treatment, above. A drop or two of warm oil on the eardrum helps relax and anesthetize the membrane, lessening the pain.

If your child cannot tolerate ear drops, apply a warm compress. If the warmth is comforting, use that knowledge to guide you in choosing an appropriate symptom-specific homeopathic remedy. Some children seem to feel better with a cold compress. Experiment with hot and cold to see what helps. If your child doesn’t like the warmth, give him homeopathic Pulsatilla.

If your child has an ear infection, avoid taking him on airplane flights. A child with an earache or upper respiratory infection will be very uncomfortable traveling by air. Air travel does not necessarily injure the ear or increase your child’s risk of developing an ear infection, but the change of air pressure in the cabin on takeoff and landing can greatly increase the pain. If you must fly with a child who has an ear infection, it may be worthwhile to give him nasal decongestant drops, along with acetaminophen, before takeoff.

Prevention

Do not expose your child to cigarette smoke. Studies show that children who live in households with one or more smokers suffer more ear infections than those from smoke-free households.

Do not give your baby a bottle to suck on while he is lying flat on his back. This position allows fluid to drain directly into the middle ear. Instead, hold or prop your infant at a 30-degree angle.

Massaging your child’s ear can help keep the eustachian tube open. Using gentle pressure, draw a line along the back of the ear and down the back of the jawbone. Gently push and release the flap of skin in front of the ear several times. You can also massage your child’s ear by placing the fleshy part of your palm, just belong your thumb, over your child’s ear, and rotating the ear in all directions.

Use an elimination diet to determine if food allergies are contributing to the problem. Cow’s milk tops the list of common troublemakers. Other common allergens worth deleting for a child with recurring ear infections include eggs, wheat, corn, oranges, and peanut butter.

If your child is subject to recurring ear infections, do not expose him to common irritating allergens such as pet dander. Down comforters and pillows are another possible source of trouble. Items like carpets, draperies, and stuffed toys all collect dust and are possible offenders as well.

Minor bupleurum is a Chinese herbal formula that helps to strengthen resistance to infection. It can be very helpful in preventing the recurrence of ear infections. Give your child 3 to 5 drops, five days a week, for one month. Discontinue it for three weeks, then resume giving 3 to 5 drops, five days a week, for another month. Discontinue it for another three weeks. Repeat this regimen for a six-month period.

Note: Minor bupleurum should be used as a preventive only. It should not be given to a child with a fever or any other sign of an acute infection.

If your child suffers from repeated ear infections, give him 1/3 tube of homeopathic Anas barbariae (available as a product called Oscillococcinum), once a week, during the month or two he is most susceptible to infection.

In some cases, chiropractic care and cranial-sacral work may be helpful for a child with recurrent ear infections.

If your child suffers from recurring earaches, your physician may recommend a daily low dose of antibiotic to suppress any possible developing infections. If your doctor advises this, discuss it thoroughly to find out why he or she considers it an appropriate treatment for your child. A child on such a regimen will need to be seen by the doctor every month or so. He will also need to take yogurt or a lactobacillus acidophilus or bifidus supplement every day to counteract the effect of the medication on his digestive system. This approach may be effective in a few particularly intractable cases, but it runs the risk of creating antibiotic-resistant organisms and inhibiting the development of the body’s own natural resistance. It is better to consider and try all other options before agreeing to give your child a daily dose of antibiotics. It may not be presented as such, but this is an extreme-and not necessarily health-promoting-type of treatment.

Dosage Guidelines

Diet

Herbal Medicine

Homeopathy

Bach Flowers

Acupressure

From Smart Medicine for a Healthier Child by Janet Zand, N.D., L.Ac., Robert Rountree, MD, Rachel Walton, RN, ©1994. Published by Avery Publishing, New York. For personal use only; neither the digital nor printed copy may be copied or sold. Reproduced by permission.

The Principles of Osteopathy

Leon Chaitow ND DO MRO — Wed, 06 Dec 2000 13:28:02 +0000

The practice of medicine and of osteopathy is an art, or skill in the application of definite rules and procedures. Such rules may, or may not, be based upon the accurate and logical interpretation of facts. If an art is based upon the logical interpretation of facts, which are understood and demonstratable, then the application of the word ‘science’ to the procedures is appropriate. Osteopathy is clearly an art. The clinical and practical value of osteopathic procedures is well established, but thus far there is insufficient research evidence or controlled clinical trials to produce incontravertible proof as to the validity of the theories which underlie it. This in no way invalidates the osteopathic approach.

Even if osteopathic principles cannot be scientifically proved, they do at least broaden the physician’s view, and help him to look at the whole picture of the patient and his environment, which is where the skill of the physician needs to be applied, rather than simply attacking symptoms. Much research has been done, which confirms and validates osteopathic principles, and this will be discussed in the chapter on research. The aim of this chapter is to set out the basic beliefs which underlie the practice of osteopathy.

The Basic Premises

The basic premises include:

That the human body is an integrated unit in which structure and function are reciprocally and mutually interdependent.
That through complex mechanisms and systems the human body is self regulating and self healing in the face of challenges and diseases (this is known as homeostasis).
That optimum function of the body systems is dependent upon the unimpeded flow of blood and nerve impulses.
That the musculo-skeletal system comprises a major system of the body, and that its importance goes far beyond that of providing a supportive framework.
That there are components of disease within the structure of the musculo-skeletal system which are not only the manifestations of disease processes, but which are frequently important contributing, or maintaining, factors in disease processes. These may be local to, or distant from, such disease processes and are usually amenable to appropriate treatment

The recognition of the importance, in the overall economy of the body, of the musculo-skeletal system, its proneness to dysfunction, and the repercussions of such changes, and finally the recognition of the ability of therapy to normalize such dysfunction by one or more of a variety of manipulative procedures, represents the essence of osteopathy’s individuality.

The body is functional. Structure is the manifestation of function, for structure that does not allow function is pointless. If structure alters, so will function. In a self-regulating mechanism, such as the human body, adaptation and compensation to such structural changes takes place, but always at the expense of optimum, or perfect, function. Such alterations in function may remain within acceptable limits, and not produce noticeable symptoms, but as will be seen, if these changes occur in vital spinal areas, widespread effects may take place, distant from the area of dysfunction. Structure and function should not be thought of as separate entities, one is inconceivable without the other. The musculo-skeletal system comprises roughly 60 per cent of the structure of the human body, and it expends most of the energy of the body. It has been called the ‘primary machinery of life’ by Professor Irvin Korr [1], who points out that our personality and our individuality are demonstrated through the musculo-skeletal system. The organs of the body can be seen as secondary, supportive, machinery, which provides energy to meet the demands of the musculoskeletal system. It is more than just a framework which supports and contains the viscera of the body, but is the main dynamic component of the living body.
All healing systems recognize that there resides within the body an inherent capacity for adapting to and recovering from the stress and demands placed upon it. There are many mechanisms operating towards this end. The word homeostasis is often used to describe the complex interplay of systems and processes involved in health maintenance. The hormonal, circulatory, lymphatic, nervous and musculo-skeletal supplied by the nerves skeletal systems, all interact in the maintenance and recovery of health.

Distribution of Segmental Nerves e.g., If the roots of 1st sacral nerve are compressed pain is felt on outside of foot (the areas indicated are from the spinal level indicated by letter and number).

Professor Korr stands out as the leading scientific researcher into the osteopathic concept. He coined the phrase ‘Somatic component of disease’ as far back as 1948, to conceptualize the physical entity which had previously been called the osteopathic lesion. The manner in which the musculo-skeletal system can become involved in disease processes is varied. As we shall discover, the major area through which the musculo-skeletal system influences the body, in health and disease, is through the nervous system. The body of the patient responds, through the nervous system to stimuli from its countless internal sources, as well as from external sources. The responses are mediated through the nervous system. From the neurological viewpoint, osteopathic manipulative therapy is attempting to restore function to areas of the musculo-skeletal system that are responding to increased, or abnormal, stimulation and which are modifying nerve impulses from and to the various body structures and organs. There is no part of the body that is not inter-related with every other part, via the nervous system.

A little known recent development in neurological research has shown that nerves not only carry messages but actually have a trophic function. This means that substances are transported along nerve fibres, in both directions, at varying speeds. Most of these substances are proteins and some are fats. Many degenerative diseases would appear to result from abnormalities in the transportation of these apparently vital substances along nerve pathways. We have for too long thought of the nervous system as simply a network along which impulses and messages are conducted. The implications of the nerve tissues acting as a transportation medium for essential cell substances are far reaching.

Correct Breathing

In a more direct manner dysfunction of the musculo-skeletal system can interfere with respiratory and circulatory function. Few people realize the importance of correct breathing. Not only is this function responsible for providing the body with oxygen but it is also an important means of eliminating waste products. The effect of respiration on the circulation of blood and lymph (through the glands) is profound. As the lungs expand and contract, the diaphram rises and falls, thus altering the relative pressure between the thoracic and pelvic areas. This pump-like action is essential if venous blood is to return efficiently to the heart for re-oxygenation. The heart pumps blood to the legs, but in order to return, the muscles of the lower extremeties need to be in use to produce the so-called ‘musclepump’ action, whereby as muscles contract they effectively squeeze the blood along the veins (which have no-return valves), and thus enable it to reach the pelvis where the diaphragmatic pump operates. If there is dysfunction in the spine which affects normal breathing, then the efficiency of blood and lymph circulation will be impaired. It is possible to appreciate, therefore, how such conditions as varicose veins and haemorrhoids can be improved by correction of body mechanics.

Unless structure is normal it cannot function normally and the consequences can be far-reaching. Goldthwait[2] states in a criticism of the medical profession, of which he was a respected member:

Not only is little attention paid to differences in structure, but practically no consideration is given to what happens to the function of various organs, when the easily demonstrable malposition of them is considered. Is it not possible that much of what concerns chronic medicine has to do with the imperfect functioning of sagged or misplaced organs? Is it not possible that such sagging results in imperfect secretions, which at first are purely functional but if long continued may produce actual pathology? It would seem to be a matter of common sense to expect health with the body so poised or balanced that all the organs are in their proper position and the muscles in proper balance!

Korr [3] describes the manner in which the musculo-skeletal system most frequently becomes involved in disharmony:

Man’s musculo-skeletal system is an incomplete and imperfect—certainly an unstable—adaptation of a basic quadruped system to biped stance and locomotion. The components of a perfect cantilever bridge have been somewhat rearranged and modified by evolutionary process to form a less adequate skyscraper. There is no doubt that gravity is far more demanding of man’s resources than of other mammalian species. As a result, local postural stresses, asymmetries, myofascial (soft tissue) tensions and irritations, and articular and peri-articular (joint) disturbances have a particularly high incidence in man. Their probability, always high, increases with time. In man, therefore, gravity has become an environmental factor of great importance.

Korr recognizes that dysfunction may result from injury, but he believes that the main cause is the result of the body’s adaptation to erect posture. Individual habits, inherited factors, attitudes, occupations, the development of inborn asymmetries and defects will all add to the picture, as will such factors as obesity and pregnancy. He also points out that such symptoms and signs as pain, tenderness and muscular rigidity in spinal areas, may often result from other tissues or organs which are themselves diseased or under stress, affecting spinal tissue via the nervous system. He states: ‘Through the reciprocity of influences between visceral and somatic tissues (organs and body) via the central nervous system, visceral (organ) pathology produces disturbances in musculo-skeletal structures. This is recognized in the concept of the secondary, reflex osteopathic lesion and in the ‘splinting’ (muscular rigidity) associated with painful visceral (internal organ) syndromes.’

The Spinal Cord

The spinal cord is the source of most of the nerve supply to the body. Every organ and tissue receives some nerve supply which originates from the spinal cord. The cord is also the point of entry or reception of most of the information from the organs and tissues of the body. Impulses carrying information to the higher centres and the brain pass into and through the cord and are often ‘screened’ and organized and transmitted in, and by, tissues in the spinal cord. Everything that is happening to the body is constantly monitored and controlled via this vital pathway. Many automatic functions as well as conscious orders are either conveyed by or recoded and dispatched by the cord. Insofar as the musculo-skeletal system is concerned, Korr explains it thus: [4]

The spinal cord is the keyboard on which the brain plays when it calls for activity. But each ‘key’ in the console sounds not an individual tone’ such as the contraction of a particular group of muscle fibres, but a whole “melody’ of activity, even a ‘symphony’ of motion. In other words, built into the cord is a large repetoire of patterns of activity, each involving the complex, harmonious, delicately balanced orchestration of the contractions and relaxation of many muscles. The brain thinks in terms of whole motions, not individual muscles. It calls, selectively, for the pre-programmed patterns in the cord and brain stem, modifying them in countless ways and combining them in an infinite variety of still more complex patterns. Each activity is subject to further modulation refinement, and adjustment by the feedback continually streaming in from the participating muscles, tendons and joints.

Since the cord is housed in a structure, the spinal column, which is patently commonly in a state of dysfunction, it is not surprising to find the perfect harmony, as described by Korr, turning into discord and disorganization. The repercussions of joint dysfunction in the spine may be local or distant. Apart from local discomfort or pain, alterations may occur in the function of nerves and their impulses and trophic functions. Whether the impulses reaching the cord are from body tissue such as muscles, ligaments, joints, etc. (somatic impulses) or from organs such as the liver, spleen etc. (visceral impulses), or whether they arise from the brain or from within the nervous system itself, such changes may be manifested in the tissues of the spinal column. The nerve cells in an area of dysfunction may become over-excited and this allow for over-reaction to stimuli. Impulses which would normally produce a small response may call forth a major one, in terms of local activity or of rapid transmission onwards of such messages. It is as though the spinal ‘keyboard’, because of dysfunction, was responding with a far louder note than the soft striking of a particular key warranted. Consequently disharmony results. The overexcitability of specific areas, as a result of somatic dysfunction, is known as facilitation. Professor Michael Patterson explains it thus: [5]

One of the most important concepts of osteopathic philosophy and practice is that of the facilitated segment. Described in research writings of the profession over the past thirty years, the concept of the facilitated segment states that because of abnormal afferent or sensory inputs to a particular area of the spinal cord, that area is kept in a state of constant increased excitation. This facilitation allows normally ineffectual, or subliminal stimuli, to become effective in producing efferent output from the facilitated segment, causing both skeletal and visceral organs innervated by the affected segment to be maintained in a state of over-activity. It is probable that the ‘osteopathic lesion’ or somatic dysfunction with which a facilitated segment is associated, is the direct result of the abnormal segmental activity, as well as being partly responsible for the facilitation. Although the effects of the facilitated segment on various skeletal and visceral functions are well documented, little is understood about the genesis and maintenance of spinal facilitation. Even the question of why some traumas cause facilitation and others do not, remains unanswered.

Professor Irvin Korr is the researcher whose work has led to the describing of the phenomenon of the facilitated segment and its implications. In 1955 he wrote: [6]

Facilitation of the sensory pathways in the disturbed lesioned segments means that there is easier access to the nervous system—including the higher centres—through these segments. The lesioned segment is one through which environmental changes—especially noxious or painful stimuli—have exaggerated impact on man.
Facilitation of motor pathways leads to sustained muscular tensions, exaggerated responses, postural asymmetries, and limited and painful motion. Since the muscles have rich sensory as well as motor innervation, under these conditions, they and related tendons, ligaments, joint capsules etc. may become the sources of relatively intense and unbalanced streams of impulses.
The physiopathological effects of facilitation on local sympathetic pathways depend on the structures which are innerverted by those pathways; that is which viscera? which blood vessels? which glands?

The implications of an area, or areas, of the spine which is causing the various aspects of the nervous system to behave in an exaggerated manner is profound. Here is a major, perhaps the major, co-ordinating and organizing mechanism of the body, with responsibility for the defence and maintenance of life, behaving in an aberrant manner. Normally that part of the nervous system known as the sympathetic nervous system plays a vital role in organizing the adaptive and protective functions of the body. When there is sustained over-reaction on its part, damage to the organs involved, and disturbance of the entire body economy become likely. Whether or not disease results will also depend upon the total resources of the individual. Such factors as inherited tendencies, psychological balance, nutritional balance etc., all decide to some extent what physiological reserves the individual has. The facilitated segment and the havoc it causes may well be the decisive factor limiting the ability of the body to maintain itself in a disease-free state.

The work of men such as Professor Korr explains in scientific terms what the original precepts of osteopathy mean in practice. How structure and function inter-relate, how the musculo-skeletal system is capable of influencing the well-being of the body as a whole; and the implications of manipulative therapy in restoring normality. Manipulation is the means wherby areas of dysfunction are diagnosed, appraised and treated. Even when such treatment is aimed at relieving symptoms such as a backache or stiff neck, the result will be to normalize the physiological functions by reducing spinal dysfunction. Osteopathic manipulation is, therefore, best seen as a system rather than as a modality. It cannot be understood or assessed adequately outside of the context of the concepts of health and disease, from which it stems, as outlined in this chapter.

1. The Sympathetic Nervous system as Mediator Between Somatic and Supportive Structures. Lecture to Postgraduate Institute of Osteopathic Medicine 1970 (New York)

2. Essentials of Body Mechanics, Goldthwait, Brown, Swain and Kuhns. (J. B. Lippencott and Co.)

3. The Collected Papers of Irvin M. Korr. Published by The Academy of Applied Osteopathy 1979 (first published in the Journal of the American Osteopathic Association Vol. 54 1955)

4. Spinal Cord as Organizer of Disease Process. 1976 Year Book of the Academy of Applied Osteopathy.

5. A Model Mechanism for Spinal Segmental Facilitation by Professor Michael Patterson, 1976 Year Book of the Academy of Applied Osteopathy.

6. A Model Mechanism for Spinal Segmental Facilitation by Professor Michael Patterson, 1976 Year Book of the Academy of Applied Osteopathy.

Osteopathic Treatments Effective in Managing Childhood Asthma

Mary Anne Morelli DO FACOP — Wed, 06 Dec 2000 13:28:02 +0000

During my first year of medical
school I experienced the benefits of osteopathic
manipulation for asthma. As a child, I hadsignificant
difficulties with allergies and asthma. Gradually my
symptoms lessened as I matured. But even in college and
medical school I struggled with frequent upper respiratory
illnesses.

In
medical school, the extra time I spent in the anatomy lab
preparing for exams triggered asthma symptoms. This proved
to be frustrating as I needed more energy, not less.
Fortunately, I had been paired with a second-year student
with a keen interest in Osteopathic Manipulative Treatment
(OMT).

He treated me and to my surprise the feelings of shortness
of breath dissipated. I was relieved to find that I no
longer needed inhaled medication. Furthermore, despite the
continuing intensity of medical school, the frequency of my
upper respiratory infections began to abate. Having suffered
for many years from the aggravating effects of asthma and
allergic sensitivities I experienced the benefits of OMT
first hand. How I wish my family had been introduced to the
benefits of OMT when I was a child!

Rather than merely suppressing symptoms, osteopathic
medicine addresses the underlying disturbances in the body’s
mechanisms. In asthma, medications are prescribed to cause
dilation of the bronchioles. However, through properly
applied manipulation, the body can be stimulated to release
its own supply of these same chemicals. Proper circulation
is absolutely necessary for effective function of the lungs.
The arteries supply nutrition to vital organs and tissues in
the body, while its counterpart returns the deoxygenated
blood back to the heart through the veins. Osteopathic
manipulation strengthens these vital pathways while removing
road blocks to the body’s natural healing process.

Have you ever tried to take a deep breath with your rib cage
locked? It is very difficult. Another goal in the
osteopathic treatment of asthma is to create free motion in
the rib cage and thoracic diaphragm. Osteopathic techniques
to enhance drainage of the lymph nodes also help the immune
system with its housecleaning tasks. OMT can also be
effective when a child has taken a hard fall. Many times a
fall to the tailbone will trigger an asthma attack in a
child. This is due to the relation of the tailbone to the
“primary response mechanism” . Making sure the sacrum
(tailbone) is moving properly is very important in
successfully treating asthma.

Nutrition happens to be one of the best weapons in the
prevention of asthmatic episodes. There is a clear
relationship between poor nutrition and bronchial
difficulties caused by asthma.

A healthy diet should include fresh fruits, vegetables,
nuts, seeds, and whole grains. Vitamin C, bioflavinoids,
ginger and tumeric help reduce inflammation. Foods that
promote inflammation such as fried foods, junk food, smoked
or barbecued foods, and partially hydrogenated foods should
be avoided as well as mucus-forming foods including milk,
sugar, refined flour, and most dairy products. It is
important to read labels and avoid all chemicals and
additives. Do you know that modified wheat starch contained
in many cereals and processed foods is “modified” by six
chemicals all of which can cause allergies and asthma? Food
is one of our best medicines– use it wisely!

Asthma can also be triggered by
airborne substances. Asthmatic attacks are commonly
triggered by smoke, high pollen counts, vacuuming, dust,
animal hairs, and mold growth. Using a hepa filter on all
filtering machines, keeping your windows closed from 5
a.m.to 10 a.m. during high pollen count periods, and
vacuuming with a sealed system with a hepa filter attached
will reduce exposure. Routine cleaning and dusting of
bedding reduces build up and the invitation for an airborne
substance to trigger an asthmatic episode.Washing sheets in
hot water kills dust mites and cleaning with vinegar or a
10% bleach solution will prevent mold growth.

Osteopathic Manipulative Therapy is an effective means of
treating and managing asthmatic conditions for children.
Coupled with a strong nutritional and environmental program
I have seen amazing transformations in health– for all
family members.

Osteopathic Research

Leon Chaitow ND DO MRO — Wed, 06 Dec 2000 13:28:02 +0000

A lot of research has been undertaken in the osteopathic field. Some relates to the way the musculo-skeletal system influences general body health and function; that is the actual changes that occur—especially in the spinal region—and the consequences of these changes. This area of research has produced great insight into the physiology and pathology of the body, whilst other research has been concerned with attempts to validate osteopathic diagnostic and therapeutic measures. This has helped to establish more clearly what is, and what is not, valid in these fields but, as with so much of research, more questions are raised as others are answered.

A major area of research was identified in the late 1930’s by Dr J. Denslow, who began testing spinal dysfunction by means of pressure meters and electro-myographs (recorders of muscular contraction and relaxation). He was able to show that the areas of dysfunction required a smaller stimulus to produce muscular changes than in normal areas of the spine. In this way he demonstrated for the first time the accuracy of what had previously been the osteopath’s subjective assessment through palpation that something was wrong in a particular area.

Having established that thresholds were low in areas of dysfunction, further research was needed to work out why this was so and to analyse the implications. Fortunately for osteopathy this task was undertaken by Professor Irvin M. Korr Ph.D., a biochemist and leading researcher into osteopathy, who showed that when a spinal segment was in this state of over-excitability it could be stimulated, or activated, by pressure or irritation from other apparently normal segments, even some distance above or below it. When the area of dysfunction was anaesthetized it could no longer be made to respond by local pressure, but would still respond to normal segments, above or below it, being pressed. At the time such troubled segments were termed ‘facilitated segments’.

Professor Korr realized that pressure was, in general terms, an unnatural test of body response, and he therefore introduced other stimuli to the subject being tested, such as sudden loud noise, painful stimuli, or verbal stimuli (embarrassing questions or faked bad news). In all cases the ‘facilitated segments’ (the areas of lowered threshold) were the first to show a reaction, and the muscular overactivity in such regions was the last to cease when the subject relaxed. This work was reported by Korr and his associates in 1947, and he described the process as being ‘like a neurological lens which focused irritation upon the lesioned segment and magnified its responses.’ [1]

Investigations were then made into what was happening in such segments to the sympathetic nervous system, and the possible ramifications in the body as a whole. This involved mapping the patient’s skin surface for variations in electrical resistance and temperature. This produced a visual record of the sympathetic nervous system behaviour, as reflected by sweat gland activity and blood flow, under the skin, of any given area at a particular moment in time.

This system has been superceded by infra-red photography as well as by the use of sophisticated electronic apparatus which simultaneously measures eight different spinal segments. All this has proved that there exists a correlation between the lesioned segment (area of somatic dysfunction) and the abnormal behaviour of motor and sympathetic nerves that are segmentally related to the lesioned area.

Patterns of Dysfunction
Over the years Korr began to establish consistent patterns of sympathetic nerve function disturbances and specific organ diseases, especially where pain was a major factor, such as pancreatitis, peptic ulcer, gall bladder disease, menstrual pain, colic, kidney stones etc. Often students who had volunteered for assessment were noted as having patterns of dysfunction which later would show up as a specific disease pattern.

Professor Korr admits that much work in this field remains to be done, but he states that when a condition of chronic facilitation exists in a spinal segment, ‘We cannot say that this 24-hours-a-day state of alarm results in illness on a definite one-to-one basis. We can only say that these disturbed segments are relatively vulnerable, that the probability is higher. Whether or not it becomes clinically significant depends upon the person we are dealing with and all the circumstances of his life, past, present and future. Here is where other unfavourable circumstances in the patient’s daily life may tip the balance; here is where an abnormal stress response will tend to find the earliest and most severe expression.’ [2]

In addition to this line of research Professor Korr has done much work on the trophic function of nerves (concerning the nutrition of the tissues). Nerves not only conduct impulses but supply proteins and other substances to the tissues and organs with which they connect. These substances are essential for the maintenance and self-repair of the tissues, and they influence their total function. In considering the implications of this, Korr states that any factors that interfere with this aspect of nerve function may contribute towards disease. He says:

Such factors could include disturbances (e.g. emotional stress) in descending impulse traffic from higher centers, impulse traffic in sensory pathways from various parts of the body, nutritional factors, drugs, toxicological agents, viral insults, changes in the chemical environment of the neurons and their axons (nerve cells) and, of course, the mechanical stresses and large forces exerted on and generated by the myofascio-skeletal tissues through which the nerves pass, and the accompanying chemical changes in these tissues. It seems likely that the efficacy of manipulative therapy may occur in part through alleviation of some of these detrimental factors.

More recently it has been shown that the flow of material along nerves is a two-way traffic. The retrograde transport is seen as a means of communication, or feedback (literally) between the nerve cells and the cells they supply. Korr states:

Any factor that causes derangement of transport mechanisms in the axon or that chronically alters the quality or quantity of the axonally transported substances, could cause the trophic influence to become detrimental. This alteration in turn would produce aberrations of structure, function and metabolism, thereby contributing to dysfunction and disease.
Almost certainly to be included among these harmful factors is the deformation of nerves and roots, such as compression, stretching, angulation and torsion, that are known to occur all too commonly in the human being, and that are likely to disturb the
intra-axonal [nerve cell process] transport mechanisms, intraneural [nerve cell] micro-circulation [circulation in the smallest blood vessels] and the blood-nerve barrier. Neural structures are especially vulnerable in their passage over highly mobile joints, through bony canals, intervertebral foramina [apertures], fascial layers [fibrous tissue beneath the skin] and tonically contracted muscles (for example, posterior rami [branches] of spinal nerves and spinal extensor [stretching] muscles.) Many of these biochemically induced deformations are, of course, subject to manipulative amelioration and correction. [3]

As Paul Thomas D.O. states:

This appears to be a part of the long sought answer to the question of exactly how the nerves influence the structures innervated, with respect to metabolism, development, differentiation, regeneration, and trophicity in general. The treatment of an organ through its innervation is an element in present manipulative therapy. The new information regarding neural function may lead to specific improvements in technique. [4]

This knowledge, plus the segmental facilitation research of Korr and his associates, gives a scientific basis for the claims of osteopathic medicine; i.e. that dysfunction of the musculo-skeletal framework of the body can have profound effects on the health of the individual.

Research Into Diagnostic Methods
Research into the ability of osteopathic diagnostic methods to elicit accurately such dysfunction has also been carried out and evaluated. Between 1969 and 1972 over 6,000 patients admitted to Chicago Osteopathic Hospital were part of just such a clinical investigation. Visual and palpatory observations made by attending osteopathic physicians were recorded and analysed in relation to the health problems of the patients. The findings showed a clear link between the spinal area, diagnosed by the examining practitioner as being involved, and the corresponding diseased organs of the patient. The conclusion was: ‘The somatic findings in over 6,000 cases of hospital patients support the osteopathic theory of viscero-somatic (internal organs and the body) relationships.’ [5]

In clinical situations a variety of findings over the years have tended to validate the osteopathic concept. One such investigation related to the study of the relationship between disorders of the pelvic and thoracic organs, and spinal findings. It was ascertained that the following three palpable findings occurred in statistically significant numbers of tests:
Restricted intervertebral motion occurring alone.
Restricted intervertebral motion occurring in combination with abnormal vertebral position.
Restricted intervertebral motion occurring in combination with abnormal paravertebral musculature.

The cases assessed were of uncomplicated disorders of the heart, aorta, bronchii and lungs (86 cases) and disorders of the female genitalia (101 cases).

Research was carried out in 1965 at Los Angeles County Osteopathic Hospital into the effects of osteopathic care of children with pneumonia. [6] Here 239 cases of various types of pneumonia in children over a three year period were analysed. The results showed that there was a favourable comparison with results of treatment in non-osteopathic institutions of a similar nature.

Around the same time research was also conducted into the possibility of a musculo-skeletal connection in cases of cardiac disorder, and the results yielded strong evidence of such a correlation. [7] Palpatory, and x-ray findings, as well as prior fluoroscopic and E. C. G. readings, showed that a majority of the 150 patients in the tests had associated asymmetrical spiral aberrations and corrective spinal treatment was consistently found to be followed by varying degrees of relief from cardiac symptoms. These changes were reflected in objective clinical and laboratory tests.

More recently, in 1981, doctors at Riverside Osteopathic Hospital in Trenton, Michigan, undertook an investigation to establish the existence of a viscero-somatic reflex that could be easily detectable and which would correlate with the presence of athero-sclerotic coronary artery disease. In all, 88 consecutive cases, each suggesting coronary disease, underwent cardiac catheterization, and within one week of this, each patient in turn was given standard osteopathic musculo-skeletal evaluation (pain, range of movement, soft tissue texture etc.) by an examiner unaware of the results of the cardiac catheter probe. The results showed a correlation between coronary atherosclerosis and abnormalities of range of motion and soft tissue texture in the fourth and fifth thoracic and the third cervical intervertebral segments. [8]

At the same time research at the Philadelphia College of Osteopathic Medicine demonstrated that there occurs a definite, measurable and significant drop in the intraocular pressure following osteopathic manipulative therapy. [9] This is of great significance to patients with chronic open angle glaucoma.

Such research efforts are constantly being undertaken to establish the value of osteopathic treatment, and the fundamental and far-reaching results obtained by Professor Korr and others, as well as the cumulative evidence of many groups and individuals in the clinical field, have gone a long way towards this end already.

1. “The Neural Basis of the Osteopathic Lesion’, The Journal of the American Osteopathic Association 47: 191-198 (1947).

2. ‘The Trophic Function of Nerves and Their Mechanisms’, The Journal of the American Osteopathic Association 72:163-171 (1972).

3. ‘The Spinal Cord as Organizer of Disease Processes’, The Journal of the American Osteopathic Association, Vol. 80, No. 7, page 458.

4. Osteopathic Medicine, Hoag, Cole and Bradford (McGraw Hill 1969).

5. ‘A Clinical Investigation of the Osteopathic Examination’, Kelso, Larson and Kappler, The Journal of the American Osteopathic Association, Vol. 79, No. 7, page 460.

6. ‘Pneumonia Research in Children at L.A.C. Osteopathic Hospital’, Warson and Percival, Yearbook of the Academy of Applied Osteopathy, 1965, page 152.

7. ‘A Somatic Component in Heart Disease’, Richard Koch D.O., The Journal of the American Osteopathic Association, May 1961.

8. ‘Palpatory Musculo-skeletal Findings in Coronary Artery Disease: Results of a Double Blind Study’, Cox, Rogers, Gorbis, Dick and Rogers, The Journal of the American Osteopathic Association, July 1981.

9. ‘Evaluation of Intraocular Tension Following Osteopathic Manipulative Therapy’, Paul Misischia D.O., The Journal of the American Osteopathic Association, July 1981.

Birth Trauma: The Most Common Cause of Development Delays

Viola Frymann DO FAAO FCA — Wed, 06 Dec 2000 13:28:02 +0000

In at least 80% of children with developmental delays,
including attention deficits and autism, there is a history
of traumatic birth. In each diagnosis there are
manifestations of various aspects of cerebral dysfunction,
which in simple terms mean that the brain is not functioning
as efficiently as it should.

The
brain is contained within the bony skull, which at the time
of birth is designed to accept the temporary compression of
the birth canal, and expand fully when the baby cries
immediately after birth. The lower end of the central
nervous system is located within the sacrum, the large bone
forming the back of the pelvis. This, too, is designed to
absorb the compressing forces of the contracting uterus, and
then be restored by bodily movements after birth. The
vertebral column protects the spinal cord connecting the
head and the pelvis.

Problems of labor and delivery may compromise these
structural areas and thus disturb the nervous system within,
thus interfering with its physiological development. Any of
the following could be problematic:

False labor before real labor began

Premature rupture or leakage of membranes

Induction or acceleration of labor by use of
medication

Presentation of baby in other position than face
down

Very long (>18 hours) or very rapid (<3 hours) labor

Epidural anesthetic

Forceps or vacuum extraction

Cord around the baby’s neck one or more
times

Severe slowing of baby’s heart

Period of uterine inertia, i.e. contractions stopped
or slowed

Cesarean section delivery because of lack of
progress

The condition of the newborn baby or infant can also
provide evidence of the health of its nervous system. Signs
of potential difficulty:

Delay in sucking of more than 24-48 hrs.

Vomiting or spitting up after feeding

Arched back or throwing head back when held on
shoulder or side

Asymmetrical motion of arms or legs

Spells of inconsolable crying

Lack of sequence or missing stages in motor
development going from: rolling over, crawling flat on
floor, creeping on hand and knees, cruising around
furniture, and walking at approximately one year

Any of these signs in the baby suggest that some areas of
the central nervous system have been comprised. It is true
that sucking may be established in a day or two or more, and
that vomiting may stop in a month or two. The arching of the
back and extension of the head may be less obvious when
progression is made to standing and walking, but then
toe-walking may be apparent.

Children of school age who manifest problems may already
have been subject to a variety of medicinal interventions.
They may also have perceptual dysfunction’s that
interfere with visual and auditory skills. These children
are in dire need of structural treatment to restore the
musculoskeletal integrity of the whole body.

A comprehensive osteopathic approach with precise,
gentle, restorative manipulative therapy can help these
children immeasurably. The general level of well-being, as
well as neurological function, will significantly improve.
Adjunct therapies, such as vision and auditory, tutoring and
a well-balanced diet of whole, natural foods with carefully
selected supplements will then be far more effective.

Structural dysfunction resulting from birth trauma can be
corrected early so that neurological development progresses
satisfactorily. Then academic, behavioral and developmental
problems can be averted by establishing or restoring optimal
anatomic-physiologic integrity. Therapeutic measures can
teach a child how to use the body efficiently. When you have
your next baby, have an osteopathic physician provide a
though evaluation during the newborn period. This is the
essence of prevention.

What is Osteopathy?

Leon Chaitow ND DO MRO — Wed, 06 Dec 2000 13:28:02 +0000

If you have ever had an aching back, stiff neck, tennis elbow, ‘gammy’ knee or some such affliction of the body, then the chances are that you have sought the help of, or have been advised by someone to go to, an osteopath for relief. If, however, you have, or have had, a more serious health problem such as asthma, migraine headaches, angina pains, digestive disturbances (to name but a few examples), then it has probably not occurred to you that the condition might have some of its origins in a dysfunction of some mechanical component of the body, the musculo-skeletal system. You would, therefore, probably not have taken such a problem to an osteopath practitioner. Surprising as it may seem, many such ‘illnesses’ are often the end result of biomechanical changes in the structure of the body which are amenable to osteopathic treatment. This theme will be elaborated on in later chapters, and some of the fascinating research that has been done in a wide range of health problems will be detailed. At this stage, the idea of osteopathy offering help to conditions other than the more obvious aches and pains may seem a strange one. In order to understand the concept of osteopathy, and what its real potentials are, it is necessary to examine its roots and subsequent development.

Osteopathy is a system of health care which recognizes that the self-healing, self-regulating ability of the body is dependent upon a number of factors, including favourable environmental conditions (internal and external), adequate nutrition and normal structural integrity. It utilizes generally accepted methods of diagnosis, as well as certain specialised ones developed to facilitate accurate structural assessment. It places special emphasis upon the importance of body mechanics, and uses manipulative techniques to detect and correct, faulty structure and function.

In many people’s minds, especially in the U.K., osteopathy is equated mainly with the treatment of spinal and other joint pains and problems. This limited care concept is largely an historical accident. As indicated above, the osteopathic profession sees itself as being relevant to a wide range of health problems, and not simply limited to the treatment of musculo-skeletal derangements.
Since the turn of the century, when the first American-trained osteopaths established themselves in practice in the U.K., they have filled a gap that existed (and to a large extent still exists) in medical practice. Doctors tended to regard musculo-skeletal problems as relatively unimportant, and manipulation as, at best, an unknown quantity and, at worst, valueless.

Side view of a normal spine showing the natural curves.

In the U.S.A., the gradual evolution of osteopathy has been towards its original goal of providing a complete health-care system, dealing with all of man’s ailments, and utilizing all those accepted therapeutic methods which coincide with its belief in the necessity for treating the patient as a whole, rather than simply treating symptoms. This concept of treating the ‘whole’ man deserves closer scrutiny. Disease may be stated to be the result of a disparity between the capacities, resources and responses of the individual, and the demands and circumstances made by his life. Disease can be seen to be a phase in the natural history of the individual, whose unique nature responds to his own particular environment. The individual’s inheritance, capacities, resources and demands, and, therefore, his adaptations and responses, are unique to him. Illness, the level of health, predispositions, resistance, responses, adaptations etc. to all the elements of his environment, are a culmination of an individual’s life, up to that point. The apparent similarities between diseases in different individuals, and the ability to classify diseases, are testimony to the fact that the body can respond in only a limited number of ways to an infinite variety of events and factors. The patient’s illness should, therefore, not be seen to be a disease, or aberration, of an organ or process alone, but as part of an illness in his total being. The patient with angina is not ill because of his angina, but has angina because he is ill. It is consideration of the whole picture of the patient’s uniqueness, and his relationship with all his complex environmental factors, that provide the background for the total health care that osteopathy seeks to offer. This, of course, includes consideration of the largest body system, the musculo-skeletal system. The methods of care also include its own distinctive approach to the normalizing of musculo-skeletal dysfunction, osteopathic manipulative therapy (O.M.T.).

It is not possible to separate osteopathic practice from the theories that produced it. Osteopathy is not just a mechanistic approach to disease but a sincere and effective system which attempts to remove the causes of ill-health and seeks to reinforce the basic curative force which lies within the body itself. The belief was originally expressed over a hundred years ago by Andrew Taylor Still, the originator of Osteopathy, whose life and work will be considered in the next chapter. The concept of many of the causes, and therefore of the remedies, lying within the body itself, has a long history. For as long as man has existed on earth, disease and injury have existed with him.

Treatment of disease was, in prehistory, assigned to practitioners of one or another healing method. The cause of disease was ascribed, by many, to outside forces which were thought to enter the body of the sufferer. Treatment in such case was aimed at driving out such evil or morbid influences. Other practitioners blamed aberrations within the body, or soul, of the victim, for the disease process, and treatment was then designed to normalize the causative disturbances. These two divergent philosophies, the outside or inside cause, exists side by side for centuries.

In the fourth century B.C. a rational system of healing was introduced by the great Greek physician Hippocrates. He taught that illness was often caused by quite simple things, such as eating the wrong food or by living in unhygienic conditions. He therefore recognized that the apparent causes of disease could originate from external or internal factors. However, I believed also that the body itself, through the healing efforts of its own nature, was the means of recovery. ‘It is our natures that are the physicians of our diseases’.

He stressed that the physician should assist the ability of the body to overcome disease by removing causative factors, and by encouraging the healing effort, but never to meddle with, or hinder nature’s attempt towards recovery. Thus the school of thought that followed Hippocrates’ teaching emphasized the study of health of man as a whole integrated unit; relating the whole man to his environment. Within that framework the causes of ill health were to be found.

Other schools of thought, however, continued to focus attention on the disease process itself, as an entity, largely ignoring the patient. The history of medicine ever since has been highlighted by proponents of one or other of these schools of thought. Through the ages we find the theoretical battle raging, which is more important, the diseased or the disease? It is true to say that the Hippocratic concept has been more honoured, but the rival philosophy has been more practiced.

Osteopathic theory and practice are firmly in line with the concepts of Hippocrates. The patient is considered and treated as a whole. Founded as it was in this tradition, osteopathy is patient orientated rather than disease orientated. It has utilized structural diagnosis and manipulative therapy as part of its philosophy and practice, and therefore as part of total patient care, not confining it to painful conditions of the musculo-skeletal system alone.

In essence the original concept of osteopathy held that:

Within the human body there exists a constant tendency towards health. If this capacity is recognized, and if treatment takes its relevance into account, then the prevention and normalization of disease processes is enhanced.
The structure of the body is reciprocally related to its function. By this it is meant that any change in structure will alter some aspect of function and, conversely, any alteration in function will result in structural changes.
Health is the primary area to be studied in attempting to understand disease.
The musculo-skeletal system, which incorporates the bones, ligaments, muscles, fascia etc. forms a structure which, when disordered, may affect the function of other parts and systems of the body. This might be the result of irritation or abnormal response of the nerve and/or blood supply to these other organs or parts.
The body is subject to mechanical disorder and is therefore capable of mechanical correction.

Discussion of these concepts will be found in the chapter dealing with osteopathic theory.

There is a growing awareness of the value to general health of an integrated, mechanically sound, musculo-skeletal system. The scientific rationale for this becomes clearer with research. Clinically, however, osteopaths have long realized the positive effects of manipulative therapy on health. It is necessary to keep in mind two essentially different roles filled by Osteopathic practitioners in their work. One is that of providing limited care to patients with joint pains and strains. The other is the total health-care of patients, with any of the myriad ills of mankind. There is also a further extension of osteopathic care, in areas in which no other form of healing offers much help. This is the more recent application of osteopathic principles and methods to the structures (bones, reciprocal tension membranes, fluid fluctuations etc.) of the skull, especially of infants. As will be described in the chapter on Cranial Osteopathy. These methods, when successfully applied to such problems as cerebral palsy and spasticity of the newborn, can produce results bordering on the miraculous. In its limited application (joint injuries, postural stresses etc.) osteopathy is a most effective system for the treatment of musculo-skeletal derangements.

Osteopathy Compared

Confusion exists in both public and medical minds as to the distinction between osteopathic and other forms of physical treatment. Because other systems utilize manipulative methods on their approach to the patient it is often assumed, even by apparently knowledgeable individuals, that there really is not very much difference between osteopathy and, for example, physiotherapy or chiropractic. Nothing could be further from the truth, and a brief examination of some of the other systems with which osteopathy is often confused should help to clarify the differences.

Chiropractic
Osteopathy and chiropractic differ in three main areas. These are the philosophical or theoretical aspects, the technique and the training. Osteopathy has a basic philosophical viewpoint from which have developed the specialized diagnostic and therapeutic measures, including osteopathic manipulative technique.

Chiropractic originally placed great emphasis on the idea that spinal joints, when misplaced (subluxated), could impinge upon nerves and thus cause disease elsewhere in the body. Chiropractors tended to focus attention on the spinal and pelvic structures, employing elaborate x-ray procedures in their analysis of subluxations. Treatment tended to be by specific high velocity thrust techniques, often employing a rebound effect from complex, sprung treatment couches.

Over the years chiropractic has tended to take more and more interest in joint dysfunction as related to back and neck pain, rather than in the general treatment of ill health. A survey in Australia, Canada and the U.K. indicated that 90 per cent of patients attending chiropractors do so for treatment of low back and neck pain. Chiropractic techniques have also changed over the years, to the point where many practitioners employ similar functional and leverage techniques to osteopaths. In the same way, many osteopaths have incorporated thrust techniques usually associated with chiropractic.

In the U.S.A. osteopathy has become an accepted (in law) alternative system to orthodox medicine, employing its own unique methods as well as what it considers useful from the orthodox system, in the treatment of all forms of ill health. Chiropractic is more limited in its legal position, its range of application and in its range of methods. It is certainly true to say, though, that in treatment of neck and back conditions the difference between the two systems has become blurred. The training of an osteopath in the U.S.A. takes seven years and a full licence is granted to graduates. A four year training which is undertaken to achieve a chiropractic doctorate leads to a limited licence (no surgery, drug prescription or the right to sign death certificates etc.)

Historically the two professions grew out of similar roots, but they have evolved to the point where their similarities are to be seen only in the relatively narrow areas of pain and dysfunction in the back and neck. Their differences become very apparent in their consideration of general health care.

Manipulative Therapy

This has grown out of the tradition of remedial massage and bonesetting. Whilst utilizing techniques which resemble osteopathic manipulative therapy and chiropractic, manipulative therapists regard their work as being aimed at the physical normalization of joint and muscle dysfunction, with the objective of improving mechanical function. No attempt is made to relate the methods to broader aspects of body function or ill health; indeed such ideas are actively discouraged by the leaders of this profession, which sees itself as a system subsidiary to medicine, in contrast to osteopathy which sees itself as an alternative.

Most of the work of these therapists involves massage, with manipulation only being used when considered absolutely necessary. There are no full time training facilities for such practitioners who are, as a rule, physiotherapists or masseurs drawn to these methods. Some are skillful and competent, but their narrow view as to the value and application of manipulation, together with their limited approach to bodily dysfunction, distinguishes them from the osteopathic practitioner.

Bonesetters
There are still some ‘bonesetters’ about, especially in remote rural areas. These are, frequently, gifted healers carrying on an unwritten tradition of learned and acquired skills which go back into prehistory.

In England, there was for many centuries a tradition of bonesetters. Many of these undoubtedly skilled practitioners had no formal medical training. In the early eighteenth century a Mrs Mapp achieved a great following and was consulted by many doctors.

In 1867 Sir James Paget, an eminent physician, warned his fellow doctors: ‘Few of you are likely to practice without having a bonesetter for a rival; and if he can cure a case which you have failed to cure, his fortune will be made and yours marred.’

The fame of Herbert Barker, an unqualified bonesetter, was so great that he was eventually knighted for his services. He was hounded by orthodox medicine and all contact between Barker and doctors was forbidden on pain of expulsion from the profession; this, despite his continual stream of successful cases. In his old age Barker demonstrated his techniques to a group of orthopaedic surgeons in London, a final admission of his genius.

Manipulation, as practiced by bonesetters, was a relatively simple matter of pushing or pulling restricted joints, to achieve ease of movement. Sometimes great force was used and frequently damage was caused by excessive violence. The difference between such methods and their total lack of any coherent or systematic use differentiates them from osteopathy.

Massage

Massage has a long history, but not until the nineteenth century was a systematic approach developed by P. H. Ling in Sweden. A school of medical gymnastics was founded, and this promoted the use of ‘scientific’ massage. Many variations exist. Some methods are remedial, being aimed at the restoration of function lost during surgery or because of enforced bed-rest (accidents, strokes etc.), or through advancing age. Other methods are used to encourage function in birth injuries or disease-damaged (polio) patients. Massage techniques are also used in gaining general relaxation and circulatory improvements.

Osteopaths utilize specialized soft-tissue techniques which bear a superficial resemblance to massage. Both deal with the soft tissues. The osteopath is either preparing the area for subsequent manipulation or dealing reflexly with problems distant from the area being treated. The U.K. trained osteopath might use a system developed in England known as neuro-muscular technique. In the U.S.A a similar deep soft tissue method was developed by the late Ida Rolf. Both these method have some similarities with the specialized German method of connective tissue massage (Bindesgewebsmassage) which uses deep finger and thumb strokes to achieve local and reflex effects Rolfing aims at releasing deep tissue contractions and thus encouraging postural and structural reintegration, and psychological ‘release’ from emotions which are tied into muscular stress patterns. Neuro-muscular technique, rolfing and connective tissue massage are all specialized soft tissue methods, bearing little in common with what is normally, thought of as massage.

Physiotherapy

In orthodox medicine the remedial gymnast and masseur of old has been replaced by the physiotherapist of today. This profession is an adjunct of the dominant medical system, and it incorporates a variety of modalities such as exercise, massage and manipulation. Traction and some forms of hydrotherapy also form part of the physiotherapist’s methods. In other words anything that can usefully be employed in treating the physical body, to enhance its function, or to minimize its dysfunction especially as related to the muscles and joints, is incorporate’ into physiotherapy. There are, of course, other rehabilitative aspects and therapeutic ones (such as encouraging normality after injury or surgery, and assisting in respiratory function in asthmatics.)

In the main, however, physiotherapists deal with the vast range of rheumatic diseases with the modalities outlined. Their use of manipulation tends to be confined to a limited range of specific techniques which are applied to the neck and low back areas. The techniques employed are usually direct action ones where joints are forced through a range of motion.
Doctors of physical medicine and orthopaedic surgeons tend to limit their sphere of interest to the mechanics and pathology of the musculo-skeletal system. This is a large and vital area, but from the osteopathic viewpoint it is important, not only in itself, but because of the ramifications that dysfunction in any of its constituent parts may have on the overall economy of the body and on specific organs and functions.

As we shall see in the unfolding of the history and current practice of osteopathy, as important as manipulative methods and specialized osteopathic diagnostic methods are to the science of osteopathy, it has always been recognized that care of the ‘whole’ man requires the integration and use of all methods and measures which contribute to well-being. This was made clear in the charter of the first College of Osteopathy in 1892. The aim then was stated to be ‘To establish a college of osteopathy, the design of which is to improve our present system of surgery, obstetrics and treatment of diseases generally, and to place the same on a more scientific and rational basis and to impart knowledge to the medical profession’. A reforming role was seen as being the essential part osteopathic medicine would play. The subsequent history and the success of the profession especially in the country of its birth, against extraordinary odds, is fascinating. Before we touch on this, however, a man of extraordinary vision deserves our attention; Andrew Taylor Still.