Osteopathy

Osteopathy is a distinct form of holistic medicine which identifies diseases and dysfunctions in the human organism with the aim of correcting them. It is a system of diagnosis and therapy based primarily on the biochemical functioning of the body with reference to its neurological and muscular-skeletal systems.

An understanding of the human body is not limited to the neurological and muscular-skeletal systems. Other systems play an equally important role. These include the gastro-intestinal, cardiological, respiratory, endocrine and genital/urinary systems. When the human body is in balance and in good working order, like a well-oiled machine it will function with minimal physiological damage, thus creating energy and a lust for life.

The most important principle in osteopathic medicine is that it gives credence to the complexities of the human organism and is sensitive to the patient as an integrated whole. This means that the osteopath investigates not only the individual’s somatic problems but also the biochemical and emotional aspects which impact on the individual.

The principles which govern osteopathic medicine are the following:

• The body is an integrated whole
• The structure and the functioning of the body are inextricably bound together
• The body possesses self-regulating mechanisms
• The body has the ability to repair itself
• Disease comes about when the body’s ability to defend itself is negatively impacted by environmental changes
• The efficient movement of bodily fluids is essential to the maintenance of health
• The nervous system is a vital factor in the regulation of bodily fluids
• Disease is not exclusively a manifestation of the patient himself. Other factors can play a part in the perpetuating of disease.

Osteopathic medicine offers the benefits of contemporary medical practices as well as traditional and historical medical techniques. Current technology is used whenever necessary to determine the nature of the patient’s problem. Osteopathy differs from other medical diagnostic techniques in that it explores and addresses the many aspects of a problem rather than simply a single dysfunction.

The taking of the medical history of the patient includes questions about all the factors which affect him or her. Pharmacological history, related health issues and the impact of family, professional and social life are seen as equally important in creating a full picture of the patient’s state of health.

Clinical methods include the use of blood pressure gauges, otoscopes, ophthalmological tests, neurological “hammers” and whatever other tests are indicated by the patient’s condition. The use of various clinical tests to determine the mobility of the joints and possible injury to muscular tissue play a role in diagnosis. In order to obtain the clearest view of the patient’s bodily structure, it is required that a minimum of clothing be worn (underwear) during examination and treatment.

X Rays and blood tests may be called for in the judgment of the osteopath and whenever there is recourse to the opinion of a consulting physician. It is often the case that the results of these tests are congruent with the original judgment of the osteopath. In only a few cases do these test results significantly influence the treatment. For example, if the osteopath concludes that the patient has a concavity in a disc based on symptoms and clinical tests, the treatment would be the same had it been verified by magnetic tomography.

What is of interest to the osteopath is the functionality of the patient’s whole body and not an isolated specific problem. It is well known that a diagnostic conclusion based on an X-Ray may differ up to 50% from a general clinical appraisal. An X-Ray may, for example, show significant decay in a joint whereas the patient suffers little or not at all from this posited condition. Thus it can be concluded that great discrepancies can exist between clinical and ‘real’ experience and the results of tests.

The American doctor Andrew Still is considered to be the founder of osteopathic medicine. In 1874 he developed the concept of outstanding or exceptional physical health and recognized the importance of treating of a disease within the context of the body as a whole.

Still was born in Virginia in 1828. From a young age, he followed in the footsteps of his father as a doctor. After studying medicine and practicing along with his father, he received his professional medical license in the state of Missouri. Later, in the early 1860’s, he continued his studies at the College of Medicine and Surgery in Kansas City and went on to practice as a surgeon in the army during the Civil War. After the war and the deaths of his three children from meningitis in 1864, Still concluded that the orthodox medical practices of his time were often unsuccessful and sometimes harmful. Thus, he dedicated the next ten years of his life to the study of the human body, searching for better methods to fight diseases.

His research and clinical observations lead him to believe that the muscular/skeletal system plays a crucial role in health and disease and that the body contains within itself all the elements necessary for the maintenance of health when they are properly mobilized. He believed that with the repairing of problems in the physical structure of the body through the practice of osteopathic techniques, the body would have the ability to function better and improve considerably. He went on to develop the idea of preventive medicine and the philosophy that the doctor/therapist must be devoted to the treatment of the whole body and not simply focus on the disease. Doctor Still established the first school of osteopathic medicine based on these principles in Kirksvale, Missouri in 1982.

Osteopathic treatment is a systematic therapy including a large range of somatic manipulation techniques as well as hydrotherapy and therapeutic exercise.

Techniques employed depend on the sex, age, general state of health and the pathological dysfunction of the patient. Another issue is the ultimate goal of the therapy. Each patient receives a therapy which is personally designed for him/her (individualized treatment). If the patient does not feel comfortable with certain techniques, the osteopath has access to a choice of other equally effective techniques.

The execution of a technique requires an adroitness and skill of feeling and touching acquired by lengthy practical training.

The implementation of these skills allows the osteopath to assess somatic dysfunction. Such dysfunctions include asymmetry, a reduction of the full range of motion, hypersensitivity, and changes in muscular texture and structure.

Osteopathic techniques include the following:

• Soft Tissue Techniques – create a distention or a straining in the myo-facial muscle and the connective tissues. The purpose is to relax the superficial muscles of the peritoneum and to lessen the trauma to wounded tissue. It also aids in effecting the cohesion of fragmented fibrous tissue. In all cases, it promotes a general tonic stimulation. This helps with the normal flow of bodily fluids (blood, lymph), decreasing the accumulation of potentially harmful substances. The process also makes it possible to identify those areas of the body which are dysfunctional.

  There are six soft tissue techniques: movement (effleurage), petrissage or localized pressure, tapotement (tapping), impact (percussion), friction and vibration.

• Neuromuscular techniques – include many soft tissue techniques used for diagnosis and therapy. The purpose of these techniques is generally the same as those described above. The difference is that these combine deep pressure with passive distention. This has the advantage of decreasing pain and altering changes in the problem area. These techniques create a wide range of movement and re-establish equilibrium, affecting specific neural structures and reflexes (somato-visceral, visceral-somatic, somato-somatic).

  Neuromuscular techniques are used when soft tissue techniques fail to solve the problem, prove contraindicative, or when a more rapid treatment is necessary. This may obtain in cases of sensitive skin or certain mental conditions. Like other techniques, these help to prepare an area of the body for further manipulation, mobilization or realignment

• Muscle energy techniques – release and distend muscular fibers, re-establishing the harmony or synchronicity between various muscle groups. They also improve mobility in the case of neuromuscular limitations.

  The patient is required to undergo mild spasms and to relax muscles in opposition to the resistance applied by the osteopath. Muscle energy techniques make use of the energy of the voluntary spasms of the muscles. It is an energy-based technique in that it makes use of the patient’s own strength. These techniques promote muscular relaxation and the activation of the Golgi tendon reflexes. Sometimes it is too painful to apply certain techniques directly to the site of the complaint, so the same technique is used to affect the same spot by applying it to an opposing group of muscles (indirectly).

  Muscle energy techniques involve post- isometric relaxation and stretching as well as post-isometric relaxation and reciprocal inhibition.

• Strain/counter strain techniques – permit the muscles to adjust to a physiological strain or extension. The body is restored to a state of release or muscular relief. The aim of this technique is the neurological balancing of muscular tissue.

  The osteopath knows the particular trigger points of pain or tension points which require therapy. Shifts in the body resulting in sensory changes (taking one or one and a half minutes) induce relaxation. The strain/counter strain technique seems very gentle and pleasant but it is quite effective in decreasing pain, muscular strain and stress and stiffness in nearly all parts of the body. It is an “indirect” or subtle technique.

• Mobilization – involves a mild involuntary movement of the surfaces of the joints. It activates a variety of mechanical sockets. There are two ways to achieve the therapeutic result; one creates a continuous stressing of one joint’s surface and the mobilization of another; the other technique mobilizes both joint surfaces. When applied to the spinal column, this is referred to as spinal mobilization. The purpose here is the improvement of the kinetic range of the joint, the reduction of muscular spasms, and the alleviation of neurological difficulties as well as pain or discomfort around the joint..
• Manipulative techniques – involve a rapid thrust of movement to correct the mobility and of a specific joint. Thus the joint regains a greater range of movement and the neural reflexes are re-adjusted. This technique also decreases and counteracts such dysfunctions as hypersensitivity, asymmetry, limitations in movement, and abnormalities in the structure or texture of soft tissue. This manipulation is characterized by a clicking sound which is thought to be related to particles of blisters in the liquid in the joint (meniscoid theory). Common side effects are generally mild to medium in their intensity. They include local reflex disturbances, headache and fatigue.
• Lymphatic pump techniques – cause an increased flow of lymphatic fluids via the thoracic duct and the cistern chili to fight common infections. The lymphatic system is part of the immune system. It is believed that an increased flow of lymphatic fluids is beneficial because it filters out inflamed substances and their by-products from the spaces between the tissues. Use of the lymphatic pump helps to prevent or alleviate swelling, coughing, infection of the upper respiratory system or the stagnating effects of a long bed confinement.

  Lymphatic pump techniques include thoracic and abdominal pumping as well as the “Miller technique” which involves a rapid, rhythmic pressure on the upper thoracic wall (upper chest) as well as pumping applied to the soles of the feet and the diaphragm.

  These techniques are contraindicated in cases of weakened bones, osteoporosis, and trauma (including surgery) of the thorax.

• Cranial Techniques – are the mildest, gentlest osteopathic treatments. They require a high level of expertise to be administered successfully. The osteopath places his hands on parts of the cranium to examine them and to provide therapeutic intervention in the biorhythmic pattern of motion in the cranium.

  This technique is used on the spinal column on the sacrum and wherever else it is needed. The purpose of this technique is to readjust or regulate the physiology of the body by restoring a balanced flow of blood and other bodily fluids.

  This technique is used fairly often. It produces good results in children, older patients and those patients who respond best to gentle intervention. In spite of positive empirical evidence, the exact mechanical or therapeutic functioning of this technique has not been determined.

• Visceral techniques – encourage physical mobility, the tone and actions of the organs (liver, lungs, stomach, intestines, etc.) as well as their connective tissue to improve their functioning. It has been documented that visceral techniques relieve restrictions as well as imbalances between the functioning of the organs and all the systems of the body involving blood vessels, nerves and the peritoneal chambers. The osteopath exerts a medium strength pressure on the area above the organ being treated.

Some schools of osteopathy employ new techniques such as “harmonic” techniques. These involve the repeated movement of a part of the body. The goals of this treatment are the same as those described above.

All these techniques are contraindicated in cases of acute illness, fractures, wounds, cancer and any situation in which they would cause pain.

Hydrotherapy employs many techniques. Those used principally by the osteopath are the following:

• Liquid compresses – The application of warm and cold compresses (towels, ice packs) as necessary with an insulating layer of cotton or toweling.
• Warm compresses – The application of warm or hot compresses (including hot water bottles) insulated by a layer of cotton or toweling.

These compresses are used in osteopathic treatment for the relief of pain impacting on the nervous system, the alleviation of inflammation, the stimulation of blood circulation and metabolism and the relaxation of muscular tension and acute spasms.

The choice of technique is a function of the patient’s problem, his/her state of health and goal of the treatment.

Osteopathic exercises are simple therapeutic exercises that can easily be performed at home or modified for the patient’s work space should this prove practical or desirable.

The exercises are divided into two categories:

• Dilation – the involuntary (passive) stretching of a single muscle or a muscle group. The practical purpose of these exercises is relaxation of the muscles and peritoneum. They also increase joint mobility and consequently relieve pain.
• Strengthening – a recurrent isometric and prolonged isotonic movement of a part of the body to effect an increase in muscular strength and stamina. It also improves joint stabilization and the prevention of further damage.

The osteopath also makes use of such therapies as dry acupuncture, herbal remedies, nutritional medicine, psychotherapy, etc. The use of these therapies is a function of the osteopath’s particular orientation and beliefs as well as the scope of his scientific knowledge and advanced studies. Thus, the osteopath selects these treatments based on his personal expertise and philosophical frame of reference.