Osteopathy

Osteopathy is both a philosophy and system of first proposed by Andrew Taylor Still MD in 1874. Its practitioners are known as osteopaths.

The system is based on recognition that the body is not just a mechanical and thus physical system, but is also a functional system and that form and function are closely integrated.  There is also far more emphasis on the concept of healing as opposed to treatment – there is for example recognition that  the body has the ability to heal itself; that many illnesses are functionally based and only manifest later as form based illness and that it is the role of the osteopathic practitioner to facilitate the process of healing.  The principles of osteopathy are

• The body is an integrated unit of mind, body, and spirit ("Man is a Triune" – A.T. Still).
• The body possesses self-regulatory mechanisms, having the inherent capacity to defend, repair, and remodel itself.
• Structure and function are reciprocally inter-related.
• Rational therapy is based on consideration of the first three principles.

It is worth adding that a number of qualified doctors in conventional medicine are also practising osteopaths, however, qualifications in osteopathy are not dependent on your being a doctor.  Osteopathy is regulated.  There are a number of international osteopathic and osteopathic medical associations, statutory regulators, recognised qualification levels and exams, and universities/medical schools offering osteopathic and osteopathic medical education, known as the Osteopathic International Alliance (OIA).

We will first take a look at osteopathy and then home in on the techniques of osteopathy in subsequent sections on this website– especially Craniosacral osteopathy.  In this I will be concentrating on the healing techniques used, because exactly the same principles and techniques used for healing are used to invoke a spiritual experience

A summary of the techniques and how they relate is shown below – I have only included those that are related to spiritual experience, there are far more related to healing in general.

The principles of osteopathy

Osteopathic treatment revolves around what are called ‘Somatic dysfunctions’.  A somatic dysfunction is an impaired or altered function in a part of the body.  It is identified using the 4 ‘TART’ symptoms:

• T = tissue texture change;
• A = asymmetry;
• R = restriction of motion;
• T = tenderness.

T : Tissue texture change

Osteopaths use palpation to ‘feel’ what may be wrong in someone’s body.  The quality of tissue texture is classified as a ‘palpatory finding’ and changes are searched for mostly around the paravertebral muscles. Muscle is assessed at both the superficial (skin) layer and at deeper (muscle) layers. The texture is dependent on the state the tissue is in; acute or chronic loads result in different texture changes. Three pointers are used in assessment:

• The  tone of the tissue tells the osteopath something about the vitality of the tissue. Healthy tissue and joints are elastic. This means that they can restore their equilibrium after they have been compressed, distorted or elongated. The human body has a remarkable capacity for self-restoration or ‘homeostasis’  - the ability of the body to detect changes and activate mechanisms that handle them. After prolonged loads on the (soft) tissues of the body, homeostatic control can be lost,  and the flexibility and vitality of the tissues decrease.

• The troficity/trophicity of tissues is defined as ‘the body's innate inclination to replenish its depleted supplies of nutriment’ and it can change. This is an acute process, as tissues gets congested. In chronic situations they become spongy and inelastic. After chronic stress on the tissue there is increased collagen production and a decrease in elastic fibers. These changes make tissue more fibrous. Palpating them they feel thick or as a cord. An example of extreme fibrotic tissue is scar tissue .

• The muscular tonus tends to be revealed  in the deeper layers.  When there is an imbalance  - a muscular dysfunction  - the muscle feels hypertonic or hypotonic.

Both in acute as well as chronic tissue changes, there is sympathetic hyperactivity.

Initially this hyperactivity creates vasoconstriction and sweat secretion, but in acute somatic dysfunction, where inflammation is present, there can be vasodilation and the tissue will feel warm. So warmth is an indicator of the severity of the dysfunction.  With experience and practice an osteopath can feel the tissue changes and not only determine whether there is a somatic dysfunction, but also whether it is acute or chronic.

A : Asymmetry

Asymmetry is mainly found by inspection of the body. Although simple observation and visual inspection is used to detect asymmetry, palpation is again used to determine the types of asymmetric changes that have taken place.  Three ways are used to inspect the asymmetry:

• Asymmetry of the body in general -  the osteopath  looks at the posture of the person.

• Asymmetry in a body region – the osteopath observes and then performs palpatory searches for any asymmetry in the shape of the head, thorax, abdomen, pelvis or discrepancy in leg length.

• Asymmetry of a body segment:  - the osteopath specifically observes if there is any  asymmetry in a vertebrae joint or the difference between the left and right side of the ‘processus transversus’ in a vertebrae.

R : Restriction of motion

Both the quality as well as the quantity of movement a person is able to perform is inspected and evaluated.

A somatic dysfunction can reveal itself in three different ways: first by the position of the vertebrae itself (evaluated by manual palpation); second by the directions of free movement a person is capable of, and third by the directions in which their movement is restricted.

• Restrictions in the range of movement are generally observed when the patient is walking, sitting or is in standing position. When the patient changes his or her position or when they bend forward, they are observed and evaluated for the range of movement of the vertebrae (axial system) and pelvis.

• The regional restrictions in range of motion are determined by observing fascial restriction. There are four major fascial attachment points in the body; the atlanto-occipitale region, the ‘thoracic inlet’ or cervico-thoracic region, the thoraco-lumbal region and the lumbo-sacrale region.

There may also be segmental restriction  - that is, restriction in the motion of joints.  When there is a somatic dysfunction of a joint, the range of movement is restricted by an apparent  ‘restriction barrier’ ; movement is often still within the medically normal range, but the elasticity of the joint is lost and can be felt in this ‘restriction barrier’.

T : Tenderness (sensitivity)

If the patient pulls back or shows discomfort when palpatory pressure is applied to a part of their body, that is an indicator of sensitivity. The test is intended to be objective, however, the response of the patient is, in a way, subjective, because it depends on the individual’s sensitivity and their threshold for pain.

Tenderness differs from pain. Pain is a totally subjective cortical perception of nociceptive input reported by the patient in the absence of palpatory stimulus.

You can see that the skill of the osteopath is key in all four types of diagnostic testing.  The osteopath needs considerable practice to both help heal and to diagnose a dysfunction of tissues and articulations in the first place.

Physiological explanation of a somatic dysfunction

Why are all these changes taking place?  What is the cause these somatic dysfunctions?  Most explanations in osteopathy for somatic dysfunction were once based on one of following three proposed mechanisms:

• Changes in the circulation of the body fluids  - Zink’s model (1977) proposed that abnormalities in lymphatic circulation, caused by a decrease in oxygen and nutrient input and decreased toxin removal by the body, negatively influenced the mobility of fascial and articular tissue. But, circulatory and lymphatic changes don’t provide an explanation for the musculoskeletal restrictions and visceral dysfunctions. As such it is now recognised that circulatory changes are an effect of the dysfunction not a causative factor.

• Changes in the connective tissue - Burns showed that somatic dysfunctions are accompanied by microscopic haemorrhages, oedema and inflammation in the connective tissue of the affected joints and muscles. He proposed that those changes were responsible for the restriction in motion in specific joints and the accompanying  pain. Later, it was surmised that tissue is connected at deeper levels of the body and any restriction in the connective tissue in one place could thus affect the whole body and be responsible for secondary somatic dysfunctions and postural changes.  But, again it was pointed out that this theory cannot account for the segmental nature of somatic dysfunction or its autonomic and visceral effects.

• Neurological changes  - Korr (1975) used a neurological model to explain somatic dysfunction. Korr stated that:

“ Only the nervous system can react in such a short time, which is typical for the origin of a somatic dysfunction and its release through manipulation”

He stated that somatic dysfunctions always occur in the same segment of the body that is innervated by a musculoskeletal restriction.  He also suggested that the mobility restrictions are caused by the chronic shortening of muscles. These in turn, cause over stimulation of motor neurons. Although not all Korr’s theory has stood the test of time, it is the nervous system that is thought to play the most fundamental role in somatic dysfunction.

Nociception and pain

Although pain can exist in the central nervous system without peripheral stimulus, it is mainly the result of stimulation of peripheral receptors, namely the nociceptors.  Not all stimulation of peripheral nociceptors is experienced as pain. The central nervous system is able to control nociceptive input, and this control takes place within the spinal marrow and brain.

Whenever any form of external stimulation takes place, the message is delivered to the brain by spinal neurons.  The brain, as part of the autonomic response, then sends signals back to the body and the signals are strongest  in those organs and muscles that are innervated by the same spinal segment as the original stimulation.  Two responses are key:

• Nociceptor input attracts musculoskeletal reactions that are designed [in theory anyway] to decrease the noxious stimuli through reflexes.

• Nociceptor input can also have a significant effect on the immune system, thus immunological responses can also be expected.

The ‘Van Buskirk (1990) Model’ [see over the page]  is often used to explain how the nociceptor plays a crucial role in the existence and/or maintenance of a somatic dysfunction.  Although this model is hypothetical, the explanation of the anatomical and physiological relationships between the musculoskeletal (parietal), visceral and autonomic system is important from an osteopathic point of view.

Osteopathy works, whichever particular school of osteopathy is used by using trigger points.

The osteopath first heals those parts of the body that are causing pain and disease.  This then means you are free of nervous sensations and can relax for the next stage.

The particular very gentle manipulation is then used to home in on very specific trigger points which are capable of giving you an experience. 

The mechanism is however, LOW INTENSITY and this is key.

High intensity stimulation can cause damage, whereas low intensity can heal and also provide profound experiences.

Observations

For iPad/iPhone users: tap letter twice to get list of items.

• 'Alternative' medicine and treatment for children in Italy
• Chris Astill Smith & James - 'Diagnostic Session'
• Lymphatic pump treatment repeatedly enhances the lymphatic and immune systems
• Osteopathic manipulative treatment for nonspecific low back pain: a systematic review and meta-analysis
• Osteopathy and dental pain
• Osteopathy and IBS
• Osteopathy and obesity
• Osteopathy and premature babies
• Parkinson's disease forum - Reiki and massage
• Standard osteopathic manipulative treatment acutely improves gait performance in patients with Parkinson's disease
• Still, Andrew Taylor - A definition of osteopathy
• Still, Andrew Taylor - The benefits of activity
• Still, Andrew Taylor - The reason for disease
• Still, Andrew Taylor- The objective of a doctor