Source: http://www.annfammed.org/cgi/content/full/4/2/182
From its inception, the osteopathic profession has been smaller in numbers than its allopathic counterpart and has worked hard to secure its place in American medicine. Over the past 100 years or so these efforts have produced a profession that is highly competent and growing, with 23 colleges of osteopathic medicine at present and more in development. This growth phase has coincided with other sweeping changes in the financing of American medicine that have led to mergers and acquisitions of hospitals that have all but eliminated many hospitals that were previously osteopathic. This has reduced the options for graduates of osteopathic medical schools to acquire internships and residencies in osteopathic hospitals.
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Tuesday, March 28, 2006
Monday, March 27, 2006
Myofascial Therapy
Myofascial Therapy uses subtle stretching to lengthen and loosen restrictions on the facial system and is beneficial to patients in pain due to falls, auto accidents, and chronic syndromes.
Most practitioners and patients today use the term "myofascial therapy" as a generic term to describe physical treatment methods applied to skeletal muscles and their connective tissues. These tissues, as a anatomical and function unit are referred to as "myofascia" or "myofascial tissues."
The earliest use of the term myofascial therapy appears to have been in the 1950s by an osteopathic physician in Beverly Hills, California. Travell and Simons, in the famous Trigger Point Manual, used the term sparingly. In the early 1990s, Dr. John C. Lowe used the term in 20 or so articles published in chiropractic publications. He also promoted use of the term in seminars across the USA. Soon, other writers and practitioners within chiropractic and massage therapy followed suit.
The term "myofascial therapy" originally referred to the diagnosis and treatment of myofascial trigger points. During the 1990s, however, some practitioners and patients began using the term in a more generic sense. They began using the term to refer to most any form of bodywork in which practitioners address their patients' soft tissue problems. Accordingly, some people use the term to refer to different types of massage, rolfing, and neuromuscular technique (Europe) or therapy (USA). As long as the practitioners of the different approaches address their patients' myofascial tissues, the term seems to properly apply.
Most practitioners and patients today use the term "myofascial therapy" as a generic term to describe physical treatment methods applied to skeletal muscles and their connective tissues. These tissues, as a anatomical and function unit are referred to as "myofascia" or "myofascial tissues."
The earliest use of the term myofascial therapy appears to have been in the 1950s by an osteopathic physician in Beverly Hills, California. Travell and Simons, in the famous Trigger Point Manual, used the term sparingly. In the early 1990s, Dr. John C. Lowe used the term in 20 or so articles published in chiropractic publications. He also promoted use of the term in seminars across the USA. Soon, other writers and practitioners within chiropractic and massage therapy followed suit.
The term "myofascial therapy" originally referred to the diagnosis and treatment of myofascial trigger points. During the 1990s, however, some practitioners and patients began using the term in a more generic sense. They began using the term to refer to most any form of bodywork in which practitioners address their patients' soft tissue problems. Accordingly, some people use the term to refer to different types of massage, rolfing, and neuromuscular technique (Europe) or therapy (USA). As long as the practitioners of the different approaches address their patients' myofascial tissues, the term seems to properly apply.
Myofascial Release
Myofascial Release is a very specialized Fascial Release Technique focusing on treating scar tissue in the superficial and deep fascia of the body. Fascia is a very densely woven connective tissue covering and interpenetrating every muscle, bone, nerve, artery and vein as well as all of our internal organs including the heart, lungs, brain and spinal cord. The fascia is a specialized system of the body that has an appearance similar to a spider's web or a sweater and is actually one structure that exists from head to foot without interruption.
Each part of the entire body is connected to every other part by the fascia, like the yarn in a sweater. In the normal healthy state, the fascia is relaxed and wavy in configuration. It has the ability to stretch and move without restriction. When we experience physical trauma, scarring, or inflammation, however, the fascia loses its pliability. It becomes tight, restricted and a source of tension to the rest of the body. Trauma, such as a fall, whiplash, surgery or just habitual poor posture over time and repetitive stress injuries have a cumulative effect on our body. The fascia can exert excessive pressure, producing pain or restriction of motion. They affect our flexibility and stability, and are a determining factor in our ability to withstand stress and strain.
Myofascial Release focuses on the fascial tissues that surround muscle, bone, nerves, arteries and veins. Restrictions of these tissues can be (caused by trauma, surgery and/or stress). Once fascial restrictions have been identified, the therapist will apply a gentle force and follow the fascial tension three dimensionally with their hands to the restrictive barrier. This three dimensional fascial barrier is held with a constant gentle force until a release is felt. During the release, the patient and therapist can feel heat, vibration, pulsation and can even reproduce the symptoms.
Once the release is complete, the heat, vibration, pulsation and pain will diminish and there will be a sense of lengthening and relaxation in the tissues. The therapist can then go through several layers of fascial restrictions until the tissues around that structure relax. After a successful treatment, patients will experience decreased pain, muscle spasm, fascial tension, joint stiffness and swelling. There will be improved postural alignment, mobility, flexibility and range of motion.
Even though the patient may feel they are experiencing less of their initial pain and are moving better after a treatment, they may still feel aches in their body for several days afterwards as their body adjusts to the changes. This reaction quickly goes away with subsequent treatments and does not occur with every patient.
Since fascial restrictions occur due to trauma, we look at each person as a unique individual and each case is different. Depending on the individual, it may take one or several sessions to get the desired response, especially if their symptoms have persisted for months or years. This gentle, manual technique treats the whole person, emphasizing the muscles, bones, nerves, arteries and veins.
Myofascial Release is very effective for treating the following conditions;
• Migraine Headaches
• Chronic Neck and Back Pain
• Whiplash
• Sports Injuries
• Hip, knee & ankle pain
• Shoulder, elbow, wrist & hand pain
• Orthopedic Problems
• Fibromyalgia
• Temporomandibular Joint
• Emotional Difficulties
• Stress and Tension-Related Problems
• Post-Surgical Dysfunction
Each part of the entire body is connected to every other part by the fascia, like the yarn in a sweater. In the normal healthy state, the fascia is relaxed and wavy in configuration. It has the ability to stretch and move without restriction. When we experience physical trauma, scarring, or inflammation, however, the fascia loses its pliability. It becomes tight, restricted and a source of tension to the rest of the body. Trauma, such as a fall, whiplash, surgery or just habitual poor posture over time and repetitive stress injuries have a cumulative effect on our body. The fascia can exert excessive pressure, producing pain or restriction of motion. They affect our flexibility and stability, and are a determining factor in our ability to withstand stress and strain.
Myofascial Release focuses on the fascial tissues that surround muscle, bone, nerves, arteries and veins. Restrictions of these tissues can be (caused by trauma, surgery and/or stress). Once fascial restrictions have been identified, the therapist will apply a gentle force and follow the fascial tension three dimensionally with their hands to the restrictive barrier. This three dimensional fascial barrier is held with a constant gentle force until a release is felt. During the release, the patient and therapist can feel heat, vibration, pulsation and can even reproduce the symptoms.
Once the release is complete, the heat, vibration, pulsation and pain will diminish and there will be a sense of lengthening and relaxation in the tissues. The therapist can then go through several layers of fascial restrictions until the tissues around that structure relax. After a successful treatment, patients will experience decreased pain, muscle spasm, fascial tension, joint stiffness and swelling. There will be improved postural alignment, mobility, flexibility and range of motion.
Even though the patient may feel they are experiencing less of their initial pain and are moving better after a treatment, they may still feel aches in their body for several days afterwards as their body adjusts to the changes. This reaction quickly goes away with subsequent treatments and does not occur with every patient.
Since fascial restrictions occur due to trauma, we look at each person as a unique individual and each case is different. Depending on the individual, it may take one or several sessions to get the desired response, especially if their symptoms have persisted for months or years. This gentle, manual technique treats the whole person, emphasizing the muscles, bones, nerves, arteries and veins.
Myofascial Release is very effective for treating the following conditions;
• Migraine Headaches
• Chronic Neck and Back Pain
• Whiplash
• Sports Injuries
• Hip, knee & ankle pain
• Shoulder, elbow, wrist & hand pain
• Orthopedic Problems
• Fibromyalgia
• Temporomandibular Joint
• Emotional Difficulties
• Stress and Tension-Related Problems
• Post-Surgical Dysfunction
Saturday, March 25, 2006
Advocates for the American Osteopathic Association (AAOA)
Advocates for the American Osteopathic Association (AAOA)
The Advocates for the American Osteopathic Association (AAOA) is a non-profit organization whose members are related to osteopathic physicians. Its goal is to support public health and educate physicians through a wide range of programs.
Here are some interesting stats from their website
- D.O.s (we) also have additional training that focuses on the body’s structure and function, and its ability to help heal itself.
- .O.s (we) believe all parts of the body are interrelated and a problem in one system might impact the function elsewhere in the body.
- D.O.s (we) combine our philosophy of treating the root of the problem with an understanding of the body’s ability to help heal itself.
- The distinct group of physicians emphasizes prevention and wellness.
- Some D.O.s also practice Osteopathic Manipulative Treatment or OMT. This is a technique in which D.O.s use their hands to help diagnose and treat an injury or illness. It is a non-invasive therapy that can be used with or sometimes in place of medication or surgery. OMT helps treat structural abnormalities allowing the physician to relieve joint restrictions and misalignments. Unlike massage therapy, OMT is deeper technique that addresses musculoskeletal problems. It is an added expertise that D.O.s can offer patients.
- In recent years, more and more colleges of osteopathic medicine have opened to fill the demands of students who want to study osteopathic medicine. Right now, there are 20 colleges of osteopathic medicine across the country.
- D.O.s account for about 18 percent of all family physicians.
- D.O.s make up 15 percent of the total physician population that practice in towns of 10,000 people or less.
- D.O.s provide a distinctive field of medicine that fills people’s demand for patient-focused care.
- Just like M.D.s, D.O.s must attend four years of medical school, and complete an internship and residency program. D.O.s take State board exams and are licensed by the State.
- Other than M.D.s, D.O.s are the only other group of physicians in the United States to licensed to perform surgery and prescribe medication.
- Like M.D.s, D.O.s are complete physicians. That means the medical care D.O.s (we) provide includes performing surgery, delivering babies, and prescribing medication.
- The D.O. philosophy of patient care focuses on the whole person, not just a specific illness or injury. This distinct approach has been the foundation of our medical education for approximately 130 years.
- The philosophy of patient-focused care allows D.O.s to provide comprehensive health care, while making the patient fell well cared for.
Wednesday, March 22, 2006
Whiplash and Osteopathic Manipulative Treatment
Whiplash is a term used to describe an injury most commonly occurring to the neck region. The actual mechanism behind such an injury is that of a rapid acceleration and deceleration occurring within moments of each other. This is usually a result of a rear end collision. This can also be the mechanism of injury behind some types of low back injury if a lap type seat belt is worn. It is, therefore, not really limited to the neck region at all. For the purpose of this article the neck will be used for an example.
In the neck, the inertia of the head is in direct contrast to the sudden movement of the body, causing the hyperextension of the neck with a reflex shortening of the muscles on the front of the neck and throat. This reflex shortening is one of the many ways the body attempts to protect us.
The exact mechanism of injury is variable from person to person although the hyperextension - hyperflexion feature is consistent. Often there is a side bending or a rotational component involved which tends to complicate the injury and create a cascade of symptoms that can hardly be explained by the seemingly insignificant "fender-bender."
Symptoms experienced by the injured person can be immediately experienced or they can come on gradually taking a few days, weeks or months to manifest completely. The injured party may even perceive themselves to be uninjured initially, having a few symptom-free days. A whiplash of the neck region rarely, if ever, results in symptoms exclusively at the neck, rather the entire body will experience the repercussions of the injury.
In Osteopathy it is believed that the head and upper neck dictate to the rest of the body; housing the brain and spinal cord. Rolin Becker (1997, Life in Motion, Rudra Press, Portland, Oregon) states that the total body physiology "from the soles of the feet to the top of the head is subjected to the whiplash energies and all of the body physiology is influenced by the accident."
In Osteopathy there are four axioms or philosophical concepts, and they are: 1/that the body is a functional unit - which means that an injury to the neck will be experienced and adapted to by the rest of the body in order to retain function.
2/ structure governs function and function governs structure - which suggests that a physiological change (change in function) will become a structural change and visa versa. 3/ the body is auto regulating - which describes both the self-healing ability of the body and the ability of the entire body to adapt and compensate for any injury or changes to continue to enable function. 4/ the role of circulation is absolute (this was originally stated as" the role of the artery is absolute") - this suggests that without adequate circulation we can not nourish our cells and our tissues - and without adequate circulation we are unable to carry away toxic metabolic waste products. The effects of whiplash typically begin with a shock, which in a motor vehicle accident, may be evident from the moment of the impact i.e. not having seen the car coming or a perception of slow motion and slow reaction to the accident while it was occurring. This shock is not limited to one's emotions, rather it is the response of the central nervous system to an overwhelming amount of incoming stimulus. Our organs, in this situation, are also responsive ensuring that our vital organs (heart, lungs) remain functional by rushing blood to these organs specifically. This causes congestion and further injury to the function of the organ, with all the best intention. This shock will usually wear off within a few hours or days only to be replaced by stiffness, pain, swelling and maybe a loss of function i.e. turning the head or constipation or both. Effects will also vary if the injured driver/passenger was stopped or moving.
Common complaints following whiplash are:
a.. muscle spasm and pain at the neck, shoulder or chest region
b.. laryngitis from the overstretch of the larynx, pharynx and front of the throat muscles
c.. muscle weakness and full body exhaustion
d.. a stiff neck and/or back with a loss of range of motion
e.. pain at the shoulder or chest region which may accompany bruising from the shoulder harness portion of the seatbelt
f.. blurred vision or double vision
g.. ringing in the ears
h.. headaches to varying degrees sometimes accompanying jaw pain or eye pain or nausea
i.. numbness or tingling into one or both hands and arms or even into the face
j.. dizziness or light headedness
k.. mood swings with or without depression, although depression is fairly common following an accident
l.. low back pain
m.. a change in bladder or bowel function due to the lap portion of the seatbelt
n.. constipation or diarrhea
o.. leg or knee pain if the knee hit the dashboard or if the foot was planted on the brake or accelerator in preparation of the impact
This list is representative of a sample of physical experiences following a whiplash injury. By no means is it intended to suggest that these are the only possibilities, rather just the most common complaints. In a severe injury, the symptoms could include head injury or coma, shooting pains, numbness and tingling, neurological compromises of any sort, paralysis and may accompany what appears to be a virus or flu-like symptoms.
In the neck, the inertia of the head is in direct contrast to the sudden movement of the body, causing the hyperextension of the neck with a reflex shortening of the muscles on the front of the neck and throat. This reflex shortening is one of the many ways the body attempts to protect us.
The exact mechanism of injury is variable from person to person although the hyperextension - hyperflexion feature is consistent. Often there is a side bending or a rotational component involved which tends to complicate the injury and create a cascade of symptoms that can hardly be explained by the seemingly insignificant "fender-bender."
Symptoms experienced by the injured person can be immediately experienced or they can come on gradually taking a few days, weeks or months to manifest completely. The injured party may even perceive themselves to be uninjured initially, having a few symptom-free days. A whiplash of the neck region rarely, if ever, results in symptoms exclusively at the neck, rather the entire body will experience the repercussions of the injury.
In Osteopathy it is believed that the head and upper neck dictate to the rest of the body; housing the brain and spinal cord. Rolin Becker (1997, Life in Motion, Rudra Press, Portland, Oregon) states that the total body physiology "from the soles of the feet to the top of the head is subjected to the whiplash energies and all of the body physiology is influenced by the accident."
In Osteopathy there are four axioms or philosophical concepts, and they are: 1/that the body is a functional unit - which means that an injury to the neck will be experienced and adapted to by the rest of the body in order to retain function.
2/ structure governs function and function governs structure - which suggests that a physiological change (change in function) will become a structural change and visa versa. 3/ the body is auto regulating - which describes both the self-healing ability of the body and the ability of the entire body to adapt and compensate for any injury or changes to continue to enable function. 4/ the role of circulation is absolute (this was originally stated as" the role of the artery is absolute") - this suggests that without adequate circulation we can not nourish our cells and our tissues - and without adequate circulation we are unable to carry away toxic metabolic waste products. The effects of whiplash typically begin with a shock, which in a motor vehicle accident, may be evident from the moment of the impact i.e. not having seen the car coming or a perception of slow motion and slow reaction to the accident while it was occurring. This shock is not limited to one's emotions, rather it is the response of the central nervous system to an overwhelming amount of incoming stimulus. Our organs, in this situation, are also responsive ensuring that our vital organs (heart, lungs) remain functional by rushing blood to these organs specifically. This causes congestion and further injury to the function of the organ, with all the best intention. This shock will usually wear off within a few hours or days only to be replaced by stiffness, pain, swelling and maybe a loss of function i.e. turning the head or constipation or both. Effects will also vary if the injured driver/passenger was stopped or moving.
Common complaints following whiplash are:
a.. muscle spasm and pain at the neck, shoulder or chest region
b.. laryngitis from the overstretch of the larynx, pharynx and front of the throat muscles
c.. muscle weakness and full body exhaustion
d.. a stiff neck and/or back with a loss of range of motion
e.. pain at the shoulder or chest region which may accompany bruising from the shoulder harness portion of the seatbelt
f.. blurred vision or double vision
g.. ringing in the ears
h.. headaches to varying degrees sometimes accompanying jaw pain or eye pain or nausea
i.. numbness or tingling into one or both hands and arms or even into the face
j.. dizziness or light headedness
k.. mood swings with or without depression, although depression is fairly common following an accident
l.. low back pain
m.. a change in bladder or bowel function due to the lap portion of the seatbelt
n.. constipation or diarrhea
o.. leg or knee pain if the knee hit the dashboard or if the foot was planted on the brake or accelerator in preparation of the impact
This list is representative of a sample of physical experiences following a whiplash injury. By no means is it intended to suggest that these are the only possibilities, rather just the most common complaints. In a severe injury, the symptoms could include head injury or coma, shooting pains, numbness and tingling, neurological compromises of any sort, paralysis and may accompany what appears to be a virus or flu-like symptoms.
The Philosophy of Osteopathy By VIOLA M. FRYMANN, D.O.
THE ARTICLE BELOW IS A TOP FAVORITE OF THE AUTHOR AND THANKS THE AUTHOR VIOLA M. FRYMANN, D.O. FOR WRITING THIS WONDERFUL ARTICLE.
Osteopathy is only in its infancy, it is a great
unknown sea à and as yet we are only
acquainted with its shore-tide.1
By VIOLA M. FRYMANN, D.O.
A.T. Still wrote these words 80 years ago, yet they are almost as true today as they were then. The mechanical principles on which osteopathy is based are as old as the universe,2 but they tend to be displaced by more spectacular modern concepts based on man-made machines of diagnosis and treatment.
Osteopathy embraces all that is encompassed by the word "life the tangible and the intangible, the visible, the microscopic, the ultramicroscopic, and the invisible, the here and the hereafter, man and his Creator. But unlike so much that has been written on philosophy, the philosophy of osteopathy is eminently practical. It provides a plan of action for the solution of human problems; it provides a purpose for life here and an objective for the life that lies ahead. It recognizes that "principles govern the universe.3 The law of cause and effect provides the explanation for disease and health. Disease is the effect of a change in the parts of the physical body. Disease in an abnormal body is just as natural as is health when all parts are in place. Life and matter can be united, and that union cannot continue with any hindrance to free and absolute motion.4 Motion is the first and only evidence of life. We know life only by the motion of material bodies.5 All motion is matter in action.6
Osteopathy is the law of mind, matter, and motion.7 A philosophic discussion of this definition was developed and presented at the Kirksville College of Osteopathic Medicine with some trepidation in 1972,8 but the enthusiastic interest it evoked, particularly among the students and younger members of the profession, has encouraged further research into its practical application. As long ago as 1892, Still expressed the hope that "the osteopath will take up the subject and travel a few miles farther toward the fountain of this great source of knowledge and apply the results to the relief and comfort of the afflicted.9
The basic principles of osteopathy will therefore be cited as they were originally expressed and interpreted as the expanding concepts of today.
THE INTERDEPENDENCE OF STRUCTURE AND FUNCTION
Disease is the result of anatomical abnormalities followed by physiological discord.10
THE UNITY FUNCTION
The human body does not function in separate units but only as a harmonious whole.13
THE BODY PRODUCES ALL SUBSTANCES FOR FUNCTIONING IN HEALTH
The body constitutes the shop in which all substances pertaining
to the physical makeup are manufactured.17
THE BODY HAS THE POWER TO OVERCOME DISEASE
To make the sick well is no duty of the operator, but to adjust a part or whole of the system that the rivers of life may flow in and irrigate the famishing fields.20
CIRCULATION OF HEALTHY BLOOD IS FUNDAMENTAL TO WELL-BEING
The artery and its nerves must deliver constantly on time and in quantity sufficient: the venous system and its nerves must perform their function and allow no accumulations. These two demands are absolute.21
THE POTENCY OF THE CEREBROSPINAL FLUID
The cerebrospinal fluid is the highest known element that is contained in the
human body and unless the brain furnishes this fluid in abundance, a disabled condition of the body will remain.22
THE LAW OF CAUSE AND EFFECT
As the beautiful works of nature stand today, and in all times past, fully able by the evidence it holds before the eye and mind of reason, that all beings great and small come by the law of cause and effect, are we not bound to work by the laws of cause, if we wish an effect?30
We must conclude that, man is a builder, guided by wisdom to the fullest and most satisfactory proof that life is the essence of wisdom in action in all nature, and man is life and mind without beginning of days or end of time.33
BIBLIOGRAPHY
1. Still, A. T. Philosophy of Osteopathy. Reprinted by Academy of Applied
Osteopathy. 1946.
2. Still, A. T. Philosophy of Osteopathy. Reprinted by Academy of Applied Osteopathy. 1946.
3. Ibid., p. 17.
4. Still, A. T. The Philosophy and Mechanical Principles of Osteopathy. Kansas City, Mo.: Hudson-Kimberly, 1902, p. 250.
5. Ibid., p. 255.
6. Ibid., p. 256.
7. Still, A. T. Autobiography, Kirksville, Mo., 1987.
8. Frymann, V. M. Scott Memorial Lecture, 1972. The law of mind, matter and motion. Yearbook of the American Academy of Osteopathy, 1973, pp. 13-22.
9. Still, A. T. The Philosophy and Mechanical Principles of Osteopathy, p. 258.
10. Still, A. T. Osteopathy Research and Practice, p. 10.
13. Truhler, R. E. Doctor A. T. Still in the Living. 1950, p. 140.
17. Still, A. T. Osteopathy Research and Practice. P. 49.
20. Truhler, R. E. Doctor A. T. Still in the Living. P. 69.
21. Still, A. T. Osteopathy Research and Practice, p. 175.
22. Still, A. T. Philosophy of Osteopathy, p. 39.
30. Still, A. T. Philosophy of Osteopathy, p. 22.
33. Still, A. T. The Philosophy and Mechanical Principles of Osteopathy, p. 258
Osteopathy is only in its infancy, it is a great
unknown sea à and as yet we are only
acquainted with its shore-tide.1
By VIOLA M. FRYMANN, D.O.
A.T. Still wrote these words 80 years ago, yet they are almost as true today as they were then. The mechanical principles on which osteopathy is based are as old as the universe,2 but they tend to be displaced by more spectacular modern concepts based on man-made machines of diagnosis and treatment.
Osteopathy embraces all that is encompassed by the word "life the tangible and the intangible, the visible, the microscopic, the ultramicroscopic, and the invisible, the here and the hereafter, man and his Creator. But unlike so much that has been written on philosophy, the philosophy of osteopathy is eminently practical. It provides a plan of action for the solution of human problems; it provides a purpose for life here and an objective for the life that lies ahead. It recognizes that "principles govern the universe.3 The law of cause and effect provides the explanation for disease and health. Disease is the effect of a change in the parts of the physical body. Disease in an abnormal body is just as natural as is health when all parts are in place. Life and matter can be united, and that union cannot continue with any hindrance to free and absolute motion.4 Motion is the first and only evidence of life. We know life only by the motion of material bodies.5 All motion is matter in action.6
Osteopathy is the law of mind, matter, and motion.7 A philosophic discussion of this definition was developed and presented at the Kirksville College of Osteopathic Medicine with some trepidation in 1972,8 but the enthusiastic interest it evoked, particularly among the students and younger members of the profession, has encouraged further research into its practical application. As long ago as 1892, Still expressed the hope that "the osteopath will take up the subject and travel a few miles farther toward the fountain of this great source of knowledge and apply the results to the relief and comfort of the afflicted.9
The basic principles of osteopathy will therefore be cited as they were originally expressed and interpreted as the expanding concepts of today.
THE INTERDEPENDENCE OF STRUCTURE AND FUNCTION
Disease is the result of anatomical abnormalities followed by physiological discord.10
THE UNITY FUNCTION
The human body does not function in separate units but only as a harmonious whole.13
THE BODY PRODUCES ALL SUBSTANCES FOR FUNCTIONING IN HEALTH
The body constitutes the shop in which all substances pertaining
to the physical makeup are manufactured.17
THE BODY HAS THE POWER TO OVERCOME DISEASE
To make the sick well is no duty of the operator, but to adjust a part or whole of the system that the rivers of life may flow in and irrigate the famishing fields.20
CIRCULATION OF HEALTHY BLOOD IS FUNDAMENTAL TO WELL-BEING
The artery and its nerves must deliver constantly on time and in quantity sufficient: the venous system and its nerves must perform their function and allow no accumulations. These two demands are absolute.21
THE POTENCY OF THE CEREBROSPINAL FLUID
The cerebrospinal fluid is the highest known element that is contained in the
human body and unless the brain furnishes this fluid in abundance, a disabled condition of the body will remain.22
THE LAW OF CAUSE AND EFFECT
As the beautiful works of nature stand today, and in all times past, fully able by the evidence it holds before the eye and mind of reason, that all beings great and small come by the law of cause and effect, are we not bound to work by the laws of cause, if we wish an effect?30
We must conclude that, man is a builder, guided by wisdom to the fullest and most satisfactory proof that life is the essence of wisdom in action in all nature, and man is life and mind without beginning of days or end of time.33
BIBLIOGRAPHY
1. Still, A. T. Philosophy of Osteopathy. Reprinted by Academy of Applied
Osteopathy. 1946.
2. Still, A. T. Philosophy of Osteopathy. Reprinted by Academy of Applied Osteopathy. 1946.
3. Ibid., p. 17.
4. Still, A. T. The Philosophy and Mechanical Principles of Osteopathy. Kansas City, Mo.: Hudson-Kimberly, 1902, p. 250.
5. Ibid., p. 255.
6. Ibid., p. 256.
7. Still, A. T. Autobiography, Kirksville, Mo., 1987.
8. Frymann, V. M. Scott Memorial Lecture, 1972. The law of mind, matter and motion. Yearbook of the American Academy of Osteopathy, 1973, pp. 13-22.
9. Still, A. T. The Philosophy and Mechanical Principles of Osteopathy, p. 258.
10. Still, A. T. Osteopathy Research and Practice, p. 10.
13. Truhler, R. E. Doctor A. T. Still in the Living. 1950, p. 140.
17. Still, A. T. Osteopathy Research and Practice. P. 49.
20. Truhler, R. E. Doctor A. T. Still in the Living. P. 69.
21. Still, A. T. Osteopathy Research and Practice, p. 175.
22. Still, A. T. Philosophy of Osteopathy, p. 39.
30. Still, A. T. Philosophy of Osteopathy, p. 22.
33. Still, A. T. The Philosophy and Mechanical Principles of Osteopathy, p. 258
Patient positioning and spinal locking for lumbar spine rotation manipulation.
Source: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11527452&dopt=Abstract
High velocity low amplitude (HVLA) thrust techniques are widely used by many manual therapists to treat low back pain. There is increasing evidence that spinal manipulation produces positive patient outcomes for acute low back pain. HVLA thrust techniques are associated with an audible release in the form of a pop or cracking sound that is widely accepted to represent cavitation of a spinal zygapophyseal joint. This audible release distinguishes these techniques from other manual therapy interventions. When using long lever HVLA thrust techniques spinal locking is necessary to localize forces and achieve cavitation at a specific vertebral segment. A critical factor in applying lumbar spine manipulation with minimal force is patient positioning and spinal locking. A knowledge of coupled movements of the lumbar spine aids an understanding of the patient positioning required to achieve spinal locking consistent with maximal patient comfort and cooperation. Excessive rotation can result in pain, patient resistance and failed technique. This masterclass presents a model of patient positioning for the lumbar spine that minimizes excessive use of rotation to achieve spinal locking prior to the application of the thrust.
Read more
High velocity low amplitude (HVLA) thrust techniques are widely used by many manual therapists to treat low back pain. There is increasing evidence that spinal manipulation produces positive patient outcomes for acute low back pain. HVLA thrust techniques are associated with an audible release in the form of a pop or cracking sound that is widely accepted to represent cavitation of a spinal zygapophyseal joint. This audible release distinguishes these techniques from other manual therapy interventions. When using long lever HVLA thrust techniques spinal locking is necessary to localize forces and achieve cavitation at a specific vertebral segment. A critical factor in applying lumbar spine manipulation with minimal force is patient positioning and spinal locking. A knowledge of coupled movements of the lumbar spine aids an understanding of the patient positioning required to achieve spinal locking consistent with maximal patient comfort and cooperation. Excessive rotation can result in pain, patient resistance and failed technique. This masterclass presents a model of patient positioning for the lumbar spine that minimizes excessive use of rotation to achieve spinal locking prior to the application of the thrust.
Read more
Tuesday, March 21, 2006
Muscle Energy Treatment for the Osteopathic Physician
Authored by
Richard Hallgren, Ph.D.
Department of Physical Medicine & Rehabilitation
Department of Osteopathic Manipulative Medicine
Clinical Content Presented by
Philip Greenman, D.O., FAAO
Department of Osteopathic Manipulative Medicine
College of Osteopathic Medicine
Michigan State University
--------------------------------------------------------------------------------
Overview
Michigan State University College of Osteopathic Medicine has developed video content that you can download to your Mac or PC, sync to your iPod, and then replay at your convenience. If you have been looking for a practical way to review muscle energy treatment protocols for your practice, prepare for the COMLEX boards, or just to review for an exam, we think that you will find these materials to be just what you have been looking for.
--------------------------------------------------------------------------------
Content:
Muscle Energy Treatment for the Pelvis -- iPod Video
Muscle Energy Treatment for the Cervical Spine -- iPod Video
Muscle Energy Treatment for the Lumbar Spine -- iPod Video
Muscle Energy Treatment for the Thoracic Spine -- iPod Video
Muscle Energy Treatment for the Rib Cage Spine -- iPod Video
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If you have questions, you can contact Dr. Hallgren by email.
This product is intended for instructional use only. It is not designed for clinical or diagnostic purposes. The authors, producers, and publishers of these materials shall not be held liable for any loss and/or injury arising from the use of information and procedures contained in these programs.
Richard Hallgren, Ph.D.
Department of Physical Medicine & Rehabilitation
Department of Osteopathic Manipulative Medicine
Clinical Content Presented by
Philip Greenman, D.O., FAAO
Department of Osteopathic Manipulative Medicine
College of Osteopathic Medicine
Michigan State University
--------------------------------------------------------------------------------
Overview
Michigan State University College of Osteopathic Medicine has developed video content that you can download to your Mac or PC, sync to your iPod, and then replay at your convenience. If you have been looking for a practical way to review muscle energy treatment protocols for your practice, prepare for the COMLEX boards, or just to review for an exam, we think that you will find these materials to be just what you have been looking for.
--------------------------------------------------------------------------------
Content:
Muscle Energy Treatment for the Pelvis -- iPod Video
Muscle Energy Treatment for the Cervical Spine -- iPod Video
Muscle Energy Treatment for the Lumbar Spine -- iPod Video
Muscle Energy Treatment for the Thoracic Spine -- iPod Video
Muscle Energy Treatment for the Rib Cage Spine -- iPod Video
--------------------------------------------------------------------------------
If you have questions, you can contact Dr. Hallgren by email.
This product is intended for instructional use only. It is not designed for clinical or diagnostic purposes. The authors, producers, and publishers of these materials shall not be held liable for any loss and/or injury arising from the use of information and procedures contained in these programs.
Wednesday, March 15, 2006
NEWSWEEK MAGAZINE Error:Richard Jadick DO: Osteopathic Physician and War Hero
Newsweek magazine has a cover article titled: “He Saved 30 Lives in One Battle…Hero MD The Amazing Story of the War’s Most Fearless Doctor.”
Unfortunately, Newsweek identified Dr. Jadick as an MD, not the DO he is, who graduated from the New York College of Osteopathic Medicine.
I urge Newsweek to inform its readers that there are two types of physicians in the US – DOs and MDs – and cease using “MD” as a synonym for all physicians.
Unfortunately, Newsweek identified Dr. Jadick as an MD, not the DO he is, who graduated from the New York College of Osteopathic Medicine.
I urge Newsweek to inform its readers that there are two types of physicians in the US – DOs and MDs – and cease using “MD” as a synonym for all physicians.
Tuesday, March 14, 2006
What is Osteopathic Medicine?
If your physician has a D.O. after his or her name then you are being treated by an osteopathic physician. D.O.s (doctors of osteopathic medicine) and M.D.s (allopathic physicians) are the only two types of physicians that are licensed by state and specialty boards in this country to perform surgery and prescribe medication. D.O.s practice in all branches of medicine and surgery from psychiatry to obstetrics, from geriatrics to emergency medicine. The majority are primary care physicians practicing in the areas of general or family practice, internal medicine, OB/Gyn and pediatrics. D.O.s represent 5.5% of the total U.S. physician population including military physicians. By the year 2000, it is expected that 45,000 osteopathic physicians will be in practice in the U.S. Although D.O.s and M.D.s practice side by side in the community and have parallel medical education, there are differences that make D.O.s unique.
The founder of osteopathy, Andrew Taylor Still, was a minister and an M.D. In the early 1870's Still became disillusioned with the practice of medicine and the misuse and toxicity of the drugs common to the day. He founded a philosophy of medicine that dates back to Hippocrates, the father of medicine. Since it was based on anatomy, he called it osteo-pathy (osteon is Greek for bone). This osteopathic philosophy is based on the premise that a patient's history of illnesses and physical traumas are written into the body's structure, that all of the body's systems work together in unity, and that disturbances in one system may impact function elsewhere in the body. It recognizes the body's innate self-healing ability and focuses on the musculoskeletal system as a key element of health. Dr. Still developed a system of hands-on care, called Osteopathic Manipulative Therapy (OMT) to restore the body's normal function. These techniques (which include cranial sacral therapy, myofascial release and many others) are applied with a precise amount of gentle force. They promote circulation of the bodily fluids (venous, arterial and lymphatic), eliminate dysfunction in the motion of the tissues, and release compressed or misaligned bones, joints and nerves. These hands-on treatments essentially 'set' the body to heal itself. Osteopathic philosophy also stresses preventive medicine, proper eating, and keeping fit.
D.O.s complete four years of medical training at one of the sixteen osteopathic medical schools in this country. They are responsible for the same course work as their allopathic (M.D.) colleagues and in addition they spend 300-500 hours in the study of the musculoskeletal system and the art of Osteopathic Manipulative Therapy (OMT). OMT is used in concert with the doctor's knowledge of medicine to diagnose, treat, and prevent illness. While manipulative medicine is commonly associated with physical ailments such as low back pain, this far-reaching modality can also be used to relieve the discomfort of musculoskeletal abnormality associated with a number of disorders. And when appropriate OMT can be used in conjunction with (or in place of) medication or surgery.
Some common illnesses treated with OMT include:
Pediatric Problems: Colic, Spitting Up, Sucking Difficulty, Delayed Development, Birth Trauma, Cerebral Palsy, Learning Disorders
Somatic Pain: Neck Problems, Back Problems, Sciatica, Headaches, Joint Pain Syndrome, Traumatic Injury, Overuse Syndrome
Systemic Problems: Neurologic Syndromes, Digestive Disorder, Genito-Urinary Problems, Chronic Infectious Disease, Head Trauma, Post Concussion Syndrome, Seizures
Ear Nose Throat Problems: Chronic Ear Infection, Recurrent Sore Throats, Frequent Colds, Sinusitis
Respiratory Illness: Asthma, Allergies, Bronchitis, Pleurisy
Pregnancy: Back Pain, Groin Pain, Digestive Upset, Edema
Like many great scientists and forward thinkers, Dr. Still was scorned by the medical community at the time. But his treatments were effective and physicians came from far away to study with him. In 1892 Dr. Still opened the first school of osteopathic medicine in Kirksville, Missouri, now called the Kirksville College of Osteopathic Medicine. He died in 1917, but his legacy of osteopathy lives on. Here is a small list of his credits:
Was the first to identify the human immune system and develop a system for stimulating it naturally.
Was the first to welcome women and minorities into medical school.
Predicted that this nation would have a major drug addiction problem within the century if physicians did not stop over-prescribing addictive drugs.
Warned that women were far too often the victims of needless surgeries.
Believed that physicians should study prevention as well as cure.
Believed that disease in one body part affected all other parts.
In summary, osteopathic physicians provide all of the best that medicine has to offer. They can specialize in every recognized area of medicine and are trained to take a whole-person approach to medical care, not just focusing on a diseased or injured part. They look for underlying causes for disease rather than simply treating symptoms. And they consider the mental and emotional factors that contribute to illness. Their knowledge and use of the latest medical technology is complemented by their application of a hands-on diagnosis and treatment tool known as OMT (Osteopathic Manipulative Therapy). This holistic approach is well suited for the expanding healthcare needs of our community as we move into the next millennium.
For more information about osteopathy, contact the American Osteopathic Association at (312) 202-8000. Or online at www.aoa-net.org or www.osteohome.com.
Karen L. Mutter, D.O., founder of the Integrative Medicine Healing Center in Clearwater FL, practices holistic internal medicine utilizing the tools of modern medicine in concert with complementary modalities to facilitate the body's self-healing ability. (727) 524-0900
The founder of osteopathy, Andrew Taylor Still, was a minister and an M.D. In the early 1870's Still became disillusioned with the practice of medicine and the misuse and toxicity of the drugs common to the day. He founded a philosophy of medicine that dates back to Hippocrates, the father of medicine. Since it was based on anatomy, he called it osteo-pathy (osteon is Greek for bone). This osteopathic philosophy is based on the premise that a patient's history of illnesses and physical traumas are written into the body's structure, that all of the body's systems work together in unity, and that disturbances in one system may impact function elsewhere in the body. It recognizes the body's innate self-healing ability and focuses on the musculoskeletal system as a key element of health. Dr. Still developed a system of hands-on care, called Osteopathic Manipulative Therapy (OMT) to restore the body's normal function. These techniques (which include cranial sacral therapy, myofascial release and many others) are applied with a precise amount of gentle force. They promote circulation of the bodily fluids (venous, arterial and lymphatic), eliminate dysfunction in the motion of the tissues, and release compressed or misaligned bones, joints and nerves. These hands-on treatments essentially 'set' the body to heal itself. Osteopathic philosophy also stresses preventive medicine, proper eating, and keeping fit.
D.O.s complete four years of medical training at one of the sixteen osteopathic medical schools in this country. They are responsible for the same course work as their allopathic (M.D.) colleagues and in addition they spend 300-500 hours in the study of the musculoskeletal system and the art of Osteopathic Manipulative Therapy (OMT). OMT is used in concert with the doctor's knowledge of medicine to diagnose, treat, and prevent illness. While manipulative medicine is commonly associated with physical ailments such as low back pain, this far-reaching modality can also be used to relieve the discomfort of musculoskeletal abnormality associated with a number of disorders. And when appropriate OMT can be used in conjunction with (or in place of) medication or surgery.
Some common illnesses treated with OMT include:
Pediatric Problems: Colic, Spitting Up, Sucking Difficulty, Delayed Development, Birth Trauma, Cerebral Palsy, Learning Disorders
Somatic Pain: Neck Problems, Back Problems, Sciatica, Headaches, Joint Pain Syndrome, Traumatic Injury, Overuse Syndrome
Systemic Problems: Neurologic Syndromes, Digestive Disorder, Genito-Urinary Problems, Chronic Infectious Disease, Head Trauma, Post Concussion Syndrome, Seizures
Ear Nose Throat Problems: Chronic Ear Infection, Recurrent Sore Throats, Frequent Colds, Sinusitis
Respiratory Illness: Asthma, Allergies, Bronchitis, Pleurisy
Pregnancy: Back Pain, Groin Pain, Digestive Upset, Edema
Like many great scientists and forward thinkers, Dr. Still was scorned by the medical community at the time. But his treatments were effective and physicians came from far away to study with him. In 1892 Dr. Still opened the first school of osteopathic medicine in Kirksville, Missouri, now called the Kirksville College of Osteopathic Medicine. He died in 1917, but his legacy of osteopathy lives on. Here is a small list of his credits:
Was the first to identify the human immune system and develop a system for stimulating it naturally.
Was the first to welcome women and minorities into medical school.
Predicted that this nation would have a major drug addiction problem within the century if physicians did not stop over-prescribing addictive drugs.
Warned that women were far too often the victims of needless surgeries.
Believed that physicians should study prevention as well as cure.
Believed that disease in one body part affected all other parts.
In summary, osteopathic physicians provide all of the best that medicine has to offer. They can specialize in every recognized area of medicine and are trained to take a whole-person approach to medical care, not just focusing on a diseased or injured part. They look for underlying causes for disease rather than simply treating symptoms. And they consider the mental and emotional factors that contribute to illness. Their knowledge and use of the latest medical technology is complemented by their application of a hands-on diagnosis and treatment tool known as OMT (Osteopathic Manipulative Therapy). This holistic approach is well suited for the expanding healthcare needs of our community as we move into the next millennium.
For more information about osteopathy, contact the American Osteopathic Association at (312) 202-8000. Or online at www.aoa-net.org or www.osteohome.com.
Karen L. Mutter, D.O., founder of the Integrative Medicine Healing Center in Clearwater FL, practices holistic internal medicine utilizing the tools of modern medicine in concert with complementary modalities to facilitate the body's self-healing ability. (727) 524-0900
General Description of Osteopathic Manipulative Treatment
http://www.pain-free-back.com/omm.html
Osteopathic Manipulative Treatment (OMT) is a hands-on system of diagnosis and treatment, designed to improve health and resolve symptoms by aligning the structures of the body and facilitating mobility. Circulation in the body (blood, lymphatic fluids, CSF, and in the nervous system) is thereby improved, and this enhances the body's ability to maintain its own health. As the structure of the body improves, so does its function.
OMT is provided by a D.O., Doctor of Osteopathy. D.O.s are fully trained and licensed physicians, who graduate from 4-year medical schools, complete post-graduate training programs, and must maintain their license by receiving continuing medical education. D.O.s practice in all specialties of medicine and are licensed in all 50 states of the US. D.O.s also practice in Canada and Europe.
Indications for Osteopathic Manipulative Treatment
Osteopathic Manipulative Treatment can be very effective in treating spinal and joint difficulties, arthritis, digestive disorders, bladder and menstrual problems, and chronic pain and illness. Strain/sprains, sciatica, back pain, tendinitis, headache, behavioral problems, colic in infants, dental problems, and symptoms related to fibromyalgia are all appropriate for an OMT consultation.
By aligning the structure of the body, the circulation and thus the overall health of the body improves. So function can usually be improved, whatever the main health problem is.
History of Osteopathic Medicine
Osteopathic Medicine, or Osteopathy, was first described and developed by Dr. Andrew Taylor Still. Dr. Still was a civil war physician who sought to improve the medicine of his time. He developed a new system of manual diagnosis and treatment, calling it osteopathy. In this system, the functioning of the body is corrected by making manipulative changes to the structure. Dr. Still founded the first school of osteopathy in Kirksville, Missouri in 1892.
Through the years osteopathic medicine continued to grow and develop as a profession, and additional schools were opened. Eventually all 50 states approved licenses for osteopathic physicians. Currently there are 21 accredited osteopathic medical colleges in the United States.
Osteopathic Philosophy
Osteopathic philosophy states that: 1. the body is a unit, and all regions and areas of the body affect one another. 2. structure and function are interrelated, and 3.the body has self-regulating, self-healing mechanisms.
Osteopathic Manipulative Treatment - Techniques Described
There are many different types of osteopathic manipulative treatment, all of which have the same goal of aligning the structure of the body, in order to bring about improvements in health and functioning as discussed above. The three main types of osteopathic manipulative techniques are: Soft Tissue, Direct Osteopathic Techniques, and Indirect Osteopathic Techniques.
Soft Tissue Techniques include stretching, kneading, and inhibition. These involve pressure being applied to muscles and soft tissue, with the goal being relaxation of muscles, and thus improved circulation and function.
Direct Osteopathic Techniques include Muscle Energy. This involves the patient flexing a muscle against the physician's pressure, then relaxing their muscles while the physician coordinates the treatment to release tension and increase the range of motion of a region.
Indirect Osteopathic Techniques include Cranial Osteopathy, Indirect
Treatment, and Jones Strain/Counterstrain
Cranial Osteopathy involves working with an inherent motion in the body. There is a cyclical motion involving the nervous system and the cranial bones which can be palpated by trained physicians. Through light-touch manipulation, restrictions and asymmetries in the bones of the cranium can be improved or resolved. This improvement in symmetry and motion of the cranial bones allows improved motion of the cranium, better circulation and nerve function, and thus improved health.
Indirect Treatment or myofascial release, involves holding a musculo-skeletal structure in a position of ease, balancing it in three planes of motion, and continuing to make minute positional correction until the tissues around that structure relax. After a successful treatment, alignment and mobility are improved. Local findings such as muscle tension, and symptoms such as pain, can have an immediate change or may take more time to resolve.
Jones Strain/Counterstrain involves positioning a part of the body so that a tender point will be pain-free, holding that position for a period of time, and allowing the tissues to relax. The mechanism behind this technique is that the shortening of the muscle sends a signal to the brain causing the muscle contraction to be reduced.
Osteopathic Manipulative Treatment (OMT) is a hands-on system of diagnosis and treatment, designed to improve health and resolve symptoms by aligning the structures of the body and facilitating mobility. Circulation in the body (blood, lymphatic fluids, CSF, and in the nervous system) is thereby improved, and this enhances the body's ability to maintain its own health. As the structure of the body improves, so does its function.
OMT is provided by a D.O., Doctor of Osteopathy. D.O.s are fully trained and licensed physicians, who graduate from 4-year medical schools, complete post-graduate training programs, and must maintain their license by receiving continuing medical education. D.O.s practice in all specialties of medicine and are licensed in all 50 states of the US. D.O.s also practice in Canada and Europe.
Indications for Osteopathic Manipulative Treatment
Osteopathic Manipulative Treatment can be very effective in treating spinal and joint difficulties, arthritis, digestive disorders, bladder and menstrual problems, and chronic pain and illness. Strain/sprains, sciatica, back pain, tendinitis, headache, behavioral problems, colic in infants, dental problems, and symptoms related to fibromyalgia are all appropriate for an OMT consultation.
By aligning the structure of the body, the circulation and thus the overall health of the body improves. So function can usually be improved, whatever the main health problem is.
History of Osteopathic Medicine
Osteopathic Medicine, or Osteopathy, was first described and developed by Dr. Andrew Taylor Still. Dr. Still was a civil war physician who sought to improve the medicine of his time. He developed a new system of manual diagnosis and treatment, calling it osteopathy. In this system, the functioning of the body is corrected by making manipulative changes to the structure. Dr. Still founded the first school of osteopathy in Kirksville, Missouri in 1892.
Through the years osteopathic medicine continued to grow and develop as a profession, and additional schools were opened. Eventually all 50 states approved licenses for osteopathic physicians. Currently there are 21 accredited osteopathic medical colleges in the United States.
Osteopathic Philosophy
Osteopathic philosophy states that: 1. the body is a unit, and all regions and areas of the body affect one another. 2. structure and function are interrelated, and 3.the body has self-regulating, self-healing mechanisms.
Osteopathic Manipulative Treatment - Techniques Described
There are many different types of osteopathic manipulative treatment, all of which have the same goal of aligning the structure of the body, in order to bring about improvements in health and functioning as discussed above. The three main types of osteopathic manipulative techniques are: Soft Tissue, Direct Osteopathic Techniques, and Indirect Osteopathic Techniques.
Soft Tissue Techniques include stretching, kneading, and inhibition. These involve pressure being applied to muscles and soft tissue, with the goal being relaxation of muscles, and thus improved circulation and function.
Direct Osteopathic Techniques include Muscle Energy. This involves the patient flexing a muscle against the physician's pressure, then relaxing their muscles while the physician coordinates the treatment to release tension and increase the range of motion of a region.
Indirect Osteopathic Techniques include Cranial Osteopathy, Indirect
Treatment, and Jones Strain/Counterstrain
Cranial Osteopathy involves working with an inherent motion in the body. There is a cyclical motion involving the nervous system and the cranial bones which can be palpated by trained physicians. Through light-touch manipulation, restrictions and asymmetries in the bones of the cranium can be improved or resolved. This improvement in symmetry and motion of the cranial bones allows improved motion of the cranium, better circulation and nerve function, and thus improved health.
Indirect Treatment or myofascial release, involves holding a musculo-skeletal structure in a position of ease, balancing it in three planes of motion, and continuing to make minute positional correction until the tissues around that structure relax. After a successful treatment, alignment and mobility are improved. Local findings such as muscle tension, and symptoms such as pain, can have an immediate change or may take more time to resolve.
Jones Strain/Counterstrain involves positioning a part of the body so that a tender point will be pain-free, holding that position for a period of time, and allowing the tissues to relax. The mechanism behind this technique is that the shortening of the muscle sends a signal to the brain causing the muscle contraction to be reduced.
Osteopathic Manipulative Treatment for Chronic Low Back Pain
Spine 28(13):1355-1362, 2003. © 2003 Lippincott Williams & Wilkins
Methods
A randomized controlled trial was conducted at the University of North Texas Health Science Center at Fort Worth to study the efficacy of OMT for chronic nonspecific low back pain. Subjects were recruited from January 2000 through February 2001 using advertising in local newspapers and referrals from university-based clinics and other local physicians. Subjects with constant or intermittent, nonspecific low back pain for at least 3 months composed the target population. The research protocol was approved by the Institutional Review Board of the University of North Texas Health Science Center.
A clinical research technician performed a brief telephone screening of recruitment responders. Screened subjects were excluded from participation if they were younger than 21 years or older than 69 years, had any of six possible underlying causes of low back symptoms in their history (spinal osteomyelitis, spinal fracture, herniated disc, ankylosing spondylitis, cauda equina syndrome, or cancer, excluding nonmalignant skin cancer), had undergone surgery involving the low back within the preceding 3 months, had received workers' compensation benefits within the preceding 3 months or were potentially involved in litigation relating to back problems, were pregnant, had ever been a patient at the trial clinic site, were an employee of the trial clinic site, or had received spinal manipulation for back pain within the preceding 3 months or on more than three occasions during the preceding year.
Eligible screened subjects were subsequently interviewed by the clinical research technician, who explained the research protocol and obtained verbal and written informed consent. These participating subjects then underwent a more thorough clinical assessment adapted from the Clinical Practice Guideline on Acute Low Back Problems in Adults.[5] This baseline assessment included a focused medical history and physical examination, including neurologic evaluation, performed by a predoctoral osteopathic manipulative medicine fellow. Subjects with "red flags" for any of the six aforementioned underlying causes of low back symptoms were identified, given appropriate recommendations for follow-up evaluation, and excluded from further participation. The red flags for each of the six conditions were as follows[5]:
spinal osteomyelitis: intravenous drug use, urinary tract infection, or skin infection within the preceding year, or corticosteroid use of more than 3 months duration within the preceding year
spinal fracture: spinal trauma within the preceding year or corticosteroid use exceeding 3 months duration within the preceding year
herniated disc: history of leg pain radiating below the knee, history of persistent numbness or weakness in the leg or legs, or history of claudication
ankylosing spondylitis: morning back stiffness in persons younger than 40 years
cauda equina syndrome: history of bladder dysfunction, saddle anesthesia, or fecal incontinence
cancer: history of previous cancer, excluding nonmalignant skin cancer, unexplained weight loss of at least 10 pounds or 5% of body weight within the preceding year, or no relief of low back symptoms with bed rest for persons older than 50 years.
Because approximately 12% of ambulatory patients with back pain have symptoms of sciatica or leg pain without neurologic compromise related to lumbar disc herniation,[5] the authors sought to include such subjects in the trial. However, to minimize the likelihood of including subjects with a lumbar disc herniation, subjects with sciatica were included only if they tested negative for all of the following: 1) ankle dorsiflexion weakness; 2) great toe extensor weakness; 3) impaired ankle reflexes; 4) loss of light touch sensation in the medial, dorsal, and lateral aspects of the foot; 5) ipsilateral straight-leg-raising test (positive result: leg pain at <60°); 6) crossed straight-leg-raising test (positive result: reproduction of contralateral pain).
These six neurologic tests allow detection of most clinically significant nerve root compromises resulting from L4-L5 or L5-S1 disc herniations, which together make up more than 90% of all clinically significant radiculopathies attributable to lumbar disc herniations.[5] All eligible subjects then received an osteopathic structural evaluation performed by a predoctoral osteopathic manipulative medicine fellow to identify areas of somatic dysfunction that might potentially be associated with low back pain, and to develop an initial treatment plan for these areas.[10]
At the baseline assessment, data were collected on each subject's age, gender, race and ethnicity, marital status, education, occupation, type of insurance coverage, and comorbid medical conditions within the preceding 3 months. The Medical Outcomes Study Short Form-36 Health Survey (SF-36) was used to measure the self-reported health status of the subjects. The SF-36 is a valid and reliable instrument widely used to measure generic health status, particularly for monitoring clinical outcomes after medical interventions.[11, 12] The SF-36 provides data on health concepts using the following scales[11]: physical functioning, role limitations because of physical problems, bodily pain, general health, vitality, social functioning, role limitations because of emotional problems, and mental health.
Each subject's overall perception of back pain was assessed using a 10-cm horizontal visual analog scale. Findings have shown that the data derived from such written scales among patients with chronic low back pain are normally distributed, even when the scales are used without verbal instructions.[13] Pain at the two extremes of this scale was labeled as "not noticeable at all" and "worst pain possible." During clinic visits, OMT and sham manipulation subject responses to this scale were collected before treatment was received. The scale was scored by a blinded clinical research technician using a standard ruler.
Functional status and disability resulting from back pain were measured with the Roland-Morris Disability Questionnaire.[14] This questionnaire is short and simple to complete, and appears to be well suited for studies involving patients with mild to moderate disability.[15] Empirical research suggests that the Roland-Morris Disability Questionnaire poses fewer problems involving blank or multiple responses than either the Oswestry Disability Index or the Jan van Breemen Institute pain and functional capacity questionnaire, and therefore may be the preferred instrument for assessing change over time in patients with low back pain.[16] Additional data specific to back pain also were collected on the number of current cotreatments using a checklist of 12 possible treatments, current medication use, the number of lost work or school days within the preceding 4 weeks, and global satisfaction with back care as measured by Likert scale responses. Together, the trial data include the five domains of patient-based outcomes recommended for evaluating the treatment of spinal disorders[17]: 1) generic health status, 2) pain, 3) back-specific function, 4) work disability, 5) back-specific patient satisfaction.
After baseline assessment and data collection, the subjects were assigned randomly to one of three treatment groups in an approximate 2:1:1 ratio: OMT, sham manipulation, or no intervention as a control condition. The intent of this allocation strategy was to enroll comparable numbers of subjects receiving OMT and not receiving OMT, and subsequently to combine the sham manipulation and no-intervention control groups should no statistically significant differences be observed between the latter groups.
Randomization was performed using sequential sealed envelopes prepared by the clinical research technician before enrollment of the subjects. The treating predoctoral osteopathic manipulative medicine fellows subsequently opened the sealed envelopes and recorded the allocation of subjects as they entered the trial. The osteopathic manipulative medicine fellows responsible for the baseline assessments, structural evaluations, initial treatment plans, randomization, and OMT and sham manipulation interventions all were third- or fourth-year medical students in the process of completing an additional year of medical training devoted entirely to osteopathic theory and practice. All the trial personnel, with the exception of these fellows, were blinded to treatment group assignments throughout the trial.
Osteopathic and sham manipulation subjects were treated for a total of seven visits over 5 months, including visits 1 week, 2 weeks, and 1 month after baseline assessment, and then monthly thereafter. Each subject in these two groups was to receive his or her assigned treatment at all seven visits regardless of previous treatment responses. The 6-month visit was designed to collect exit data and did not include any treatment. Follow-up data on the SF-36 scales, visual analog scale for back pain, Roland-Morris Disability Questionnaire, and global satisfaction with back care were collected using each at the 1-, 3-, and 6-month visits. Data on back-specific cotreatments, current medication use, and lost work or school days were collected at the 1- and 6-month visits. No-intervention control subjects provided these data on the same timetable as the OMT and sham manipulation subjects, but did so through postal questionnaires instead of during a clinic visit.
The following protocol was used for OMT treatments. The OMT sessions lasted 15 to 30 minutes, and the OMT was performed by predoctoral osteopathic manipulative medicine fellows. The techniques included one or a combination of the following: myofascial release, strain-counterstrain, muscle energy, soft tissue, high-velocity-low-amplitude thrusts, and cranial-sacral. The OMT was aimed at somatic dysfunction in the low back or adjacent areas.
Because this trial was intended to assess the efficacy of OMT as practiced in actual clinical encounters, the research protocol allowed for discretion in OMT interventions and techniques across subjects and time.[10] Two cohorts of predoctoral osteopathic manipulative medicine fellows provided baseline structural evaluations and treatments for 3-month intervals on a rotating basis during the trial. A 1-hour trial-specific training session for new and returning fellows was provided by an osteopathic manipulative medicine specialist every 3 months to facilitate consistent protocol implementation throughout the trial, including the provision of both OMT and sham manipulation techniques.
Sham manipulation subjects received "treatments" according to the same protocol guidelines and timetable described previously for OMT subjects. These sham treatments included range of motion activities, light touch, and simulated OMT techniques. The latter consisted of manually applied forces of diminished magnitude aimed purposely to avoid treatable areas of somatic dysfunction and to provide minimal likelihood of therapeutic effect. The third group received no trial interventions. All the subjects, regardless of group assignment, were allowed to receive usual or other low back care to complement the trial interventions, with the exception of other OMT or chiropractic manipulation. Data were collected on each subject's use of cotreatments throughout the trial including prescription and over-the-counter medications, physical therapy, massage therapy, hydrotherapy, transcutaneous electrical nerve stimulation, spinal and epidural injections, acupuncture, herbal therapies, and meditation.
Baseline demographic and clinical characteristics were summarized using descriptive statistics. Analysis of variance was used to test for differences among the groups in continuous variables, and the 2 test was used for dichotomous or categorical variables. Crude SF-36 data were transformed and standardized using recommended procedures.[11] The Roland-Morris Disability Questionnaire was scored as the sum of positive responses on each of its 24 items.[14] The Likert scale responses for global satisfaction were transformed by assigning relative weights to each of the possible response options. Repeated measures analysis of variance[18] was used to identify significantly different changes over time among the treatment groups in each of 14 primary outcomes: eight SF-36 health scale scores, visual analog scale score for back pain, Roland-Morris Disability score, number of cotreatments, current back pain-specific medication use, lost work or school days related to back pain, and global satisfaction with back care. Outcomes for which baseline data were collected were tested for significance using the treatment group by time interaction term. For a given outcome, such analysis compares the cumulative experience of the treatment groups to the relevant point in time. The treatment group main effects were used to test for significance related to global satisfaction with back care because it was not possible to collect baseline data for this variable. The 2 test was used to identify differences among the treatment groups in the percentages of subjects currently using medication for back pain.
The numbers of subjects receiving OMT and not receiving OMT (the latter including the sham manipulation subjects and the no-intervention control subjects combined) to be included in the trial to achieve a power of approximately 80% in detecting moderate to large differences between groups were determined using the SF-36 scales. The latter were used because they comprised the majority of primary outcomes, and because extensive data were available to estimate sample sizes for a repeated measures design.[11] All hypotheses were tested at the 0.05 level of statistical significance. Data management and analyses were performed using the SYSTAT software package (Systat Software, Richmond, CA).
Methods
A randomized controlled trial was conducted at the University of North Texas Health Science Center at Fort Worth to study the efficacy of OMT for chronic nonspecific low back pain. Subjects were recruited from January 2000 through February 2001 using advertising in local newspapers and referrals from university-based clinics and other local physicians. Subjects with constant or intermittent, nonspecific low back pain for at least 3 months composed the target population. The research protocol was approved by the Institutional Review Board of the University of North Texas Health Science Center.
A clinical research technician performed a brief telephone screening of recruitment responders. Screened subjects were excluded from participation if they were younger than 21 years or older than 69 years, had any of six possible underlying causes of low back symptoms in their history (spinal osteomyelitis, spinal fracture, herniated disc, ankylosing spondylitis, cauda equina syndrome, or cancer, excluding nonmalignant skin cancer), had undergone surgery involving the low back within the preceding 3 months, had received workers' compensation benefits within the preceding 3 months or were potentially involved in litigation relating to back problems, were pregnant, had ever been a patient at the trial clinic site, were an employee of the trial clinic site, or had received spinal manipulation for back pain within the preceding 3 months or on more than three occasions during the preceding year.
Eligible screened subjects were subsequently interviewed by the clinical research technician, who explained the research protocol and obtained verbal and written informed consent. These participating subjects then underwent a more thorough clinical assessment adapted from the Clinical Practice Guideline on Acute Low Back Problems in Adults.[5] This baseline assessment included a focused medical history and physical examination, including neurologic evaluation, performed by a predoctoral osteopathic manipulative medicine fellow. Subjects with "red flags" for any of the six aforementioned underlying causes of low back symptoms were identified, given appropriate recommendations for follow-up evaluation, and excluded from further participation. The red flags for each of the six conditions were as follows[5]:
spinal osteomyelitis: intravenous drug use, urinary tract infection, or skin infection within the preceding year, or corticosteroid use of more than 3 months duration within the preceding year
spinal fracture: spinal trauma within the preceding year or corticosteroid use exceeding 3 months duration within the preceding year
herniated disc: history of leg pain radiating below the knee, history of persistent numbness or weakness in the leg or legs, or history of claudication
ankylosing spondylitis: morning back stiffness in persons younger than 40 years
cauda equina syndrome: history of bladder dysfunction, saddle anesthesia, or fecal incontinence
cancer: history of previous cancer, excluding nonmalignant skin cancer, unexplained weight loss of at least 10 pounds or 5% of body weight within the preceding year, or no relief of low back symptoms with bed rest for persons older than 50 years.
Because approximately 12% of ambulatory patients with back pain have symptoms of sciatica or leg pain without neurologic compromise related to lumbar disc herniation,[5] the authors sought to include such subjects in the trial. However, to minimize the likelihood of including subjects with a lumbar disc herniation, subjects with sciatica were included only if they tested negative for all of the following: 1) ankle dorsiflexion weakness; 2) great toe extensor weakness; 3) impaired ankle reflexes; 4) loss of light touch sensation in the medial, dorsal, and lateral aspects of the foot; 5) ipsilateral straight-leg-raising test (positive result: leg pain at <60°); 6) crossed straight-leg-raising test (positive result: reproduction of contralateral pain).
These six neurologic tests allow detection of most clinically significant nerve root compromises resulting from L4-L5 or L5-S1 disc herniations, which together make up more than 90% of all clinically significant radiculopathies attributable to lumbar disc herniations.[5] All eligible subjects then received an osteopathic structural evaluation performed by a predoctoral osteopathic manipulative medicine fellow to identify areas of somatic dysfunction that might potentially be associated with low back pain, and to develop an initial treatment plan for these areas.[10]
At the baseline assessment, data were collected on each subject's age, gender, race and ethnicity, marital status, education, occupation, type of insurance coverage, and comorbid medical conditions within the preceding 3 months. The Medical Outcomes Study Short Form-36 Health Survey (SF-36) was used to measure the self-reported health status of the subjects. The SF-36 is a valid and reliable instrument widely used to measure generic health status, particularly for monitoring clinical outcomes after medical interventions.[11, 12] The SF-36 provides data on health concepts using the following scales[11]: physical functioning, role limitations because of physical problems, bodily pain, general health, vitality, social functioning, role limitations because of emotional problems, and mental health.
Each subject's overall perception of back pain was assessed using a 10-cm horizontal visual analog scale. Findings have shown that the data derived from such written scales among patients with chronic low back pain are normally distributed, even when the scales are used without verbal instructions.[13] Pain at the two extremes of this scale was labeled as "not noticeable at all" and "worst pain possible." During clinic visits, OMT and sham manipulation subject responses to this scale were collected before treatment was received. The scale was scored by a blinded clinical research technician using a standard ruler.
Functional status and disability resulting from back pain were measured with the Roland-Morris Disability Questionnaire.[14] This questionnaire is short and simple to complete, and appears to be well suited for studies involving patients with mild to moderate disability.[15] Empirical research suggests that the Roland-Morris Disability Questionnaire poses fewer problems involving blank or multiple responses than either the Oswestry Disability Index or the Jan van Breemen Institute pain and functional capacity questionnaire, and therefore may be the preferred instrument for assessing change over time in patients with low back pain.[16] Additional data specific to back pain also were collected on the number of current cotreatments using a checklist of 12 possible treatments, current medication use, the number of lost work or school days within the preceding 4 weeks, and global satisfaction with back care as measured by Likert scale responses. Together, the trial data include the five domains of patient-based outcomes recommended for evaluating the treatment of spinal disorders[17]: 1) generic health status, 2) pain, 3) back-specific function, 4) work disability, 5) back-specific patient satisfaction.
After baseline assessment and data collection, the subjects were assigned randomly to one of three treatment groups in an approximate 2:1:1 ratio: OMT, sham manipulation, or no intervention as a control condition. The intent of this allocation strategy was to enroll comparable numbers of subjects receiving OMT and not receiving OMT, and subsequently to combine the sham manipulation and no-intervention control groups should no statistically significant differences be observed between the latter groups.
Randomization was performed using sequential sealed envelopes prepared by the clinical research technician before enrollment of the subjects. The treating predoctoral osteopathic manipulative medicine fellows subsequently opened the sealed envelopes and recorded the allocation of subjects as they entered the trial. The osteopathic manipulative medicine fellows responsible for the baseline assessments, structural evaluations, initial treatment plans, randomization, and OMT and sham manipulation interventions all were third- or fourth-year medical students in the process of completing an additional year of medical training devoted entirely to osteopathic theory and practice. All the trial personnel, with the exception of these fellows, were blinded to treatment group assignments throughout the trial.
Osteopathic and sham manipulation subjects were treated for a total of seven visits over 5 months, including visits 1 week, 2 weeks, and 1 month after baseline assessment, and then monthly thereafter. Each subject in these two groups was to receive his or her assigned treatment at all seven visits regardless of previous treatment responses. The 6-month visit was designed to collect exit data and did not include any treatment. Follow-up data on the SF-36 scales, visual analog scale for back pain, Roland-Morris Disability Questionnaire, and global satisfaction with back care were collected using each at the 1-, 3-, and 6-month visits. Data on back-specific cotreatments, current medication use, and lost work or school days were collected at the 1- and 6-month visits. No-intervention control subjects provided these data on the same timetable as the OMT and sham manipulation subjects, but did so through postal questionnaires instead of during a clinic visit.
The following protocol was used for OMT treatments. The OMT sessions lasted 15 to 30 minutes, and the OMT was performed by predoctoral osteopathic manipulative medicine fellows. The techniques included one or a combination of the following: myofascial release, strain-counterstrain, muscle energy, soft tissue, high-velocity-low-amplitude thrusts, and cranial-sacral. The OMT was aimed at somatic dysfunction in the low back or adjacent areas.
Because this trial was intended to assess the efficacy of OMT as practiced in actual clinical encounters, the research protocol allowed for discretion in OMT interventions and techniques across subjects and time.[10] Two cohorts of predoctoral osteopathic manipulative medicine fellows provided baseline structural evaluations and treatments for 3-month intervals on a rotating basis during the trial. A 1-hour trial-specific training session for new and returning fellows was provided by an osteopathic manipulative medicine specialist every 3 months to facilitate consistent protocol implementation throughout the trial, including the provision of both OMT and sham manipulation techniques.
Sham manipulation subjects received "treatments" according to the same protocol guidelines and timetable described previously for OMT subjects. These sham treatments included range of motion activities, light touch, and simulated OMT techniques. The latter consisted of manually applied forces of diminished magnitude aimed purposely to avoid treatable areas of somatic dysfunction and to provide minimal likelihood of therapeutic effect. The third group received no trial interventions. All the subjects, regardless of group assignment, were allowed to receive usual or other low back care to complement the trial interventions, with the exception of other OMT or chiropractic manipulation. Data were collected on each subject's use of cotreatments throughout the trial including prescription and over-the-counter medications, physical therapy, massage therapy, hydrotherapy, transcutaneous electrical nerve stimulation, spinal and epidural injections, acupuncture, herbal therapies, and meditation.
Baseline demographic and clinical characteristics were summarized using descriptive statistics. Analysis of variance was used to test for differences among the groups in continuous variables, and the 2 test was used for dichotomous or categorical variables. Crude SF-36 data were transformed and standardized using recommended procedures.[11] The Roland-Morris Disability Questionnaire was scored as the sum of positive responses on each of its 24 items.[14] The Likert scale responses for global satisfaction were transformed by assigning relative weights to each of the possible response options. Repeated measures analysis of variance[18] was used to identify significantly different changes over time among the treatment groups in each of 14 primary outcomes: eight SF-36 health scale scores, visual analog scale score for back pain, Roland-Morris Disability score, number of cotreatments, current back pain-specific medication use, lost work or school days related to back pain, and global satisfaction with back care. Outcomes for which baseline data were collected were tested for significance using the treatment group by time interaction term. For a given outcome, such analysis compares the cumulative experience of the treatment groups to the relevant point in time. The treatment group main effects were used to test for significance related to global satisfaction with back care because it was not possible to collect baseline data for this variable. The 2 test was used to identify differences among the treatment groups in the percentages of subjects currently using medication for back pain.
The numbers of subjects receiving OMT and not receiving OMT (the latter including the sham manipulation subjects and the no-intervention control subjects combined) to be included in the trial to achieve a power of approximately 80% in detecting moderate to large differences between groups were determined using the SF-36 scales. The latter were used because they comprised the majority of primary outcomes, and because extensive data were available to estimate sample sizes for a repeated measures design.[11] All hypotheses were tested at the 0.05 level of statistical significance. Data management and analyses were performed using the SYSTAT software package (Systat Software, Richmond, CA).
Facts about DOs.
Although osteopathic medicine started out as a drug-free approach to the practice of medicine, the vast majority of doctors of osteopathic medicine will prescribe medication as needed.
By combining all other medical and surgical therapies with osteopathic manipulative treatment (OMT), doctors of osteopathic medicine (DOs) offer their patients more--a comprehensive approach to health care--because they are taught to treat the whole person, rather than just a single condition.
Most DOs select careers in primary care--such as family practice, internal medicine, or pediatrics, while others practice specialties such as obstetrics and gynecology, surgery, and emergency medicine. Many practice in rural and low-income areas.
Andrew Taylor Still, DO, MD, the father of osteopathic medicine, developed the specialty in 1874 after becoming disillusioned with the practices of medicine in 1874. He wanted to reform the practice of medicine but ended up developing a new branch of it altogether.
Your DO will address various lifestyle factors during diagnosis and/or treatment, such as stress, diet, exercise and posture.
Osteopathic manipulative treatment (OMT) is considered extremely safe but is unadvisable for certain conditions, including bone cancer, bone or joint infection, a protruding disk or osteoporosis. OMT is not advisable if you've had spinal-fusion surgery.
One form of OMT is cranial sacral osteopathic manipulation; this approach involves OMT applied to your head using gentle, rhythmic pressure. If this is something that interests you, ask for the specialist in this area.
By combining all other medical and surgical therapies with osteopathic manipulative treatment (OMT), doctors of osteopathic medicine (DOs) offer their patients more--a comprehensive approach to health care--because they are taught to treat the whole person, rather than just a single condition.
Most DOs select careers in primary care--such as family practice, internal medicine, or pediatrics, while others practice specialties such as obstetrics and gynecology, surgery, and emergency medicine. Many practice in rural and low-income areas.
Andrew Taylor Still, DO, MD, the father of osteopathic medicine, developed the specialty in 1874 after becoming disillusioned with the practices of medicine in 1874. He wanted to reform the practice of medicine but ended up developing a new branch of it altogether.
Your DO will address various lifestyle factors during diagnosis and/or treatment, such as stress, diet, exercise and posture.
Osteopathic manipulative treatment (OMT) is considered extremely safe but is unadvisable for certain conditions, including bone cancer, bone or joint infection, a protruding disk or osteoporosis. OMT is not advisable if you've had spinal-fusion surgery.
One form of OMT is cranial sacral osteopathic manipulation; this approach involves OMT applied to your head using gentle, rhythmic pressure. If this is something that interests you, ask for the specialist in this area.
Osteopathy
Osteopathy is a healing art, which appreciates the beauty and wholeness of the human being and his/her connection to the natural world. The vision of a Civil War surgeon, Dr. A.T. Still, Osteopathy flourished in the late 1800's and early 1900's, and is again expanding both in the United States and internationally.
Dr. Still's insights were quite radical for his time. One of the most penetrating studies of living anatomy ever done combined with exceptional life experiences led Dr. Still to a transcendent understanding of health and disease. He then applied this understanding to a method of working with the neuromusculoskeletal system that has been shown repeatedly to alleviate patterns of injury and illness.
The Science
Osteopathy is a unique blend of Science and Art. The osteopathic doctor spends years of in-depth study of anatomy,physiology,biochemistry,pathology,embryology, pharmacology and all body systems. The science of each of these disciplines is explored and analyzed both in the classroom and in the clinical setting. The Osteopath emerges from medical school a fully trained physician.
The Art
Meanwhile, alongside this intensive scientific training, the Osteopath spends many more hours learning to understand and feel the living, dynamic, functioning human body, and its living, breathing musculoskeletal, fascial and fluid systems. We are taught to have thinking, seeing, feeling, knowing fingers. We are encouraged to sit still and learn to respect the essential ebb and flow of the body's homeostatic mechanism (the system that maintains our body's health). We then work with that mechanism using a gentle, thorough hands-on treatment to balance structures that are disturbed or strained by injury or illness and to increase circulation to all areas of the body. That circulatory impulse allows nourishment and repair of body tissues and cleansing through the lymphatics of the byproducts of metabolism. Healing is thus permitted and enhanced.
This comprehensive approach is referred to as Cranial Osteopathy, because it includes the manipulation of the cerebrospinal fluid. This fluid bathes the brain in the cranium (head), the spine, and the sacrum (tailbone), and its circulatory force reverberates through all living tissue.
Advanced Training
As we Osteopaths learn to listen to our hands, we are usually attracted to a teacher or teachers with whom to "apprentice". The many layers of sensation to which we are exposed requires the patient, wise teachings of those who have gone before to lead us through and learn to interpret what we experience. As we grow in the art of cranial osteopathy, the potential for healing grows also.
This training is a lifelong inquiry into a deep ocean of study. Advanced training and experience have taught me that the answer to many chronic health problems
is best sought from within the patient's body. One of our basic principles is that the body is a self-healing mechanism with wisdom installed from the embryonic
beginning. An osteopathic physician seeks to reestablish the pattern of health and eliminate superimposed patterns of disease and dysfunction without exposing the patient to undue risk. So strong are the forces within that we can usually count on them to see us through both minor and major episodes in our journey through life. They inspire awe in those who study health.
Osteopathy is a healing art, which appreciates the beauty and wholeness of the human being and his/her connection to the natural world. The vision of a Civil War surgeon, Dr. A.T. Still, Osteopathy flourished in the late 1800's and early 1900's, and is again expanding both in the United States and internationally.
Dr. Still's insights were quite radical for his time. One of the most penetrating studies of living anatomy ever done combined with exceptional life experiences led Dr. Still to a transcendent understanding of health and disease. He then applied this understanding to a method of working with the neuromusculoskeletal system that has been shown repeatedly to alleviate patterns of injury and illness.
The Science
Osteopathy is a unique blend of Science and Art. The osteopathic doctor spends years of in-depth study of anatomy,physiology,biochemistry,pathology,embryology, pharmacology and all body systems. The science of each of these disciplines is explored and analyzed both in the classroom and in the clinical setting. The Osteopath emerges from medical school a fully trained physician.
The Art
Meanwhile, alongside this intensive scientific training, the Osteopath spends many more hours learning to understand and feel the living, dynamic, functioning human body, and its living, breathing musculoskeletal, fascial and fluid systems. We are taught to have thinking, seeing, feeling, knowing fingers. We are encouraged to sit still and learn to respect the essential ebb and flow of the body's homeostatic mechanism (the system that maintains our body's health). We then work with that mechanism using a gentle, thorough hands-on treatment to balance structures that are disturbed or strained by injury or illness and to increase circulation to all areas of the body. That circulatory impulse allows nourishment and repair of body tissues and cleansing through the lymphatics of the byproducts of metabolism. Healing is thus permitted and enhanced.
This comprehensive approach is referred to as Cranial Osteopathy, because it includes the manipulation of the cerebrospinal fluid. This fluid bathes the brain in the cranium (head), the spine, and the sacrum (tailbone), and its circulatory force reverberates through all living tissue.
Advanced Training
As we Osteopaths learn to listen to our hands, we are usually attracted to a teacher or teachers with whom to "apprentice". The many layers of sensation to which we are exposed requires the patient, wise teachings of those who have gone before to lead us through and learn to interpret what we experience. As we grow in the art of cranial osteopathy, the potential for healing grows also.
This training is a lifelong inquiry into a deep ocean of study. Advanced training and experience have taught me that the answer to many chronic health problems
is best sought from within the patient's body. One of our basic principles is that the body is a self-healing mechanism with wisdom installed from the embryonic
beginning. An osteopathic physician seeks to reestablish the pattern of health and eliminate superimposed patterns of disease and dysfunction without exposing the patient to undue risk. So strong are the forces within that we can usually count on them to see us through both minor and major episodes in our journey through life. They inspire awe in those who study health.
Conditions for which Osteopathic Manipulative Medicine (OMM/OMT) is well suited:
http://www.herrpaul.com/
Adults:
Musculoskeletal conditions, especially
those related to injury
Head and face pain
Chronic sinusitis
Post-concussion syndrome
(minor closed head injury)
Noncardiogenic (not originating in the heart)
chest pain
Chronic abdominal and pelvic pain
Temporomandibular joint (TMJ) syndrome
(pain in the joint and muscles of the jaw)
Anxiety, tension
Carpal tunnel syndrome
(nerve entrapment syndromes)
Neuromuscular and rheumatic
conditions, including fibromyalgia
and arthritis
Chronic lung disease (by increasing
breathing capacity by freeing up
muscles/fascia)
Women:
Dysmenorrhea (painful menstruation),
especially with low back pain
Headaches, back pain, pelvic and
sciatica pain in pregnant women
Children:
Recurrent ear infections
Headaches (chronic)
Spasticity
Learning / Behavioral disorders
Infants:
Sucking and swallowing disorders
Colic, irritability
Positional plagiocephaly (flattened
head from sleeping in one position)
Club feet, in-toeing ("pigeon toed")
Developmental delay
Adults:
Musculoskeletal conditions, especially
those related to injury
Head and face pain
Chronic sinusitis
Post-concussion syndrome
(minor closed head injury)
Noncardiogenic (not originating in the heart)
chest pain
Chronic abdominal and pelvic pain
Temporomandibular joint (TMJ) syndrome
(pain in the joint and muscles of the jaw)
Anxiety, tension
Carpal tunnel syndrome
(nerve entrapment syndromes)
Neuromuscular and rheumatic
conditions, including fibromyalgia
and arthritis
Chronic lung disease (by increasing
breathing capacity by freeing up
muscles/fascia)
Women:
Dysmenorrhea (painful menstruation),
especially with low back pain
Headaches, back pain, pelvic and
sciatica pain in pregnant women
Children:
Recurrent ear infections
Headaches (chronic)
Spasticity
Learning / Behavioral disorders
Infants:
Sucking and swallowing disorders
Colic, irritability
Positional plagiocephaly (flattened
head from sleeping in one position)
Club feet, in-toeing ("pigeon toed")
Developmental delay
Osteopaths (the other 'real' doctors) to convene
Mary Beth Faller
The Arizona Republic
Mar. 8, 2005 12:00 AM
Hundreds of family physicians will gather at Phoenix Civic Plaza next week for their annual convention, discussing such typical medical topics as headaches, diabetes treatment and nutrition.
Though "real" doctors in every sense, they don't carry the credentials M.D. after their names, but D.O.
So what makes this group, the American College of Osteopathic Family Physicians, different from "regular," or allopathic, family physicians?
In many ways, they are similar. Both groups attend medical school and are licensed to perform surgery and prescribe medicines. If you have the flu, you're likely to get similar treatment from either.
The difference is more in the focus.
"Training for an osteopathic doctor focuses tremendously on the various interrelationships in the body, and we learn to treat patients not as a series of symptoms, but as a whole person," says Scott Steingard, an osteopathic family physician in Phoenix. "We're also concerned with things that affect them in their daily life.
"That's not to say that other doctors don't do that, but the uniqueness of osteopathic medicine is that the focus is to look right at that."
Osteopathic medical schools also emphasize training for primary care, especially in underserved rural areas. About 3 percent of all doctors in Arizona are osteopaths and half of them are in primary care, according to the Arizona Osteopathic Medical Association.
Osteopathic medicine was founded in 1874 by Andrew Taylor Still, a Missouri physician who was disillusioned by the medical practices of the time. He believed there was a strong correlation between the musculoskeletal system and the organs of the body, a principle stressed in osteopathic training today. D.O.s practice the technique of osteopathic manipulative treatment, or OMT, a hands-on treatment of gentle pressure, stretching and resistance. The goal of OMT is to restore the body to a neutral pattern, according to Steingard, who says that not every D.O. performs manipulation.
"The beauty is that we have the advantage of every modality: medicine, surgery, nutrition, manipulation - everything is at our disposal," he says. He uses OMT on about half of his patients.
Because chiropractors, who do not go to medical school, also practice a form of manipulation, there's a lot of confusion between the two practices.
"We've done a poor job of promoting our profession," Steingard says.
Like many people, Janalee Hagen was a bit skeptical of osteopathic doctors.
"My mother-in-law went to one for years, and I thought, 'What the heck are you doing?' " says the Phoenix resident.
But after unsatisfactory experiences with M.D.s and recommendations from relatives, Hagen, 58, decided to try an osteopath.
When she pulled a muscle in her back, her D.O. performed manipulation on her. "I thought, 'OK, this is nice.' And it felt much better," she says.
"I don't think I would ever go back to a regular doctor. Now my whole family goes."
A small study conducted in Maine and published in the Journal of the American Osteopathic Association in 2003 compared patients who visited osteopaths with those visiting allopaths, and concluded that D.O.s scored higher is such areas as using patients' names, discussing emotions and family life, and better explaining the cause of a disease.
Many people consider osteopathy as "alternative" medicine, although it's not.
"Patients come in and ask about (alternative treatments)," Steingard says. "There's a certain expectation that I know what it is because I'm a D.O., so I keep abreast of new treatments all the time."
Many D.O.s are members of the Arizona Medical Association, says Andrea C. Smiley, communications director. "Their medical training is very similar," she says. "We think highly of them."
To find an osteopathic doctor, visit the Arizona Osteopathic Medical Association Web site at www.az-osteo.org or call (602) 266-6699.
The Arizona Republic
Mar. 8, 2005 12:00 AM
Hundreds of family physicians will gather at Phoenix Civic Plaza next week for their annual convention, discussing such typical medical topics as headaches, diabetes treatment and nutrition.
Though "real" doctors in every sense, they don't carry the credentials M.D. after their names, but D.O.
So what makes this group, the American College of Osteopathic Family Physicians, different from "regular," or allopathic, family physicians?
In many ways, they are similar. Both groups attend medical school and are licensed to perform surgery and prescribe medicines. If you have the flu, you're likely to get similar treatment from either.
The difference is more in the focus.
"Training for an osteopathic doctor focuses tremendously on the various interrelationships in the body, and we learn to treat patients not as a series of symptoms, but as a whole person," says Scott Steingard, an osteopathic family physician in Phoenix. "We're also concerned with things that affect them in their daily life.
"That's not to say that other doctors don't do that, but the uniqueness of osteopathic medicine is that the focus is to look right at that."
Osteopathic medical schools also emphasize training for primary care, especially in underserved rural areas. About 3 percent of all doctors in Arizona are osteopaths and half of them are in primary care, according to the Arizona Osteopathic Medical Association.
Osteopathic medicine was founded in 1874 by Andrew Taylor Still, a Missouri physician who was disillusioned by the medical practices of the time. He believed there was a strong correlation between the musculoskeletal system and the organs of the body, a principle stressed in osteopathic training today. D.O.s practice the technique of osteopathic manipulative treatment, or OMT, a hands-on treatment of gentle pressure, stretching and resistance. The goal of OMT is to restore the body to a neutral pattern, according to Steingard, who says that not every D.O. performs manipulation.
"The beauty is that we have the advantage of every modality: medicine, surgery, nutrition, manipulation - everything is at our disposal," he says. He uses OMT on about half of his patients.
Because chiropractors, who do not go to medical school, also practice a form of manipulation, there's a lot of confusion between the two practices.
"We've done a poor job of promoting our profession," Steingard says.
Like many people, Janalee Hagen was a bit skeptical of osteopathic doctors.
"My mother-in-law went to one for years, and I thought, 'What the heck are you doing?' " says the Phoenix resident.
But after unsatisfactory experiences with M.D.s and recommendations from relatives, Hagen, 58, decided to try an osteopath.
When she pulled a muscle in her back, her D.O. performed manipulation on her. "I thought, 'OK, this is nice.' And it felt much better," she says.
"I don't think I would ever go back to a regular doctor. Now my whole family goes."
A small study conducted in Maine and published in the Journal of the American Osteopathic Association in 2003 compared patients who visited osteopaths with those visiting allopaths, and concluded that D.O.s scored higher is such areas as using patients' names, discussing emotions and family life, and better explaining the cause of a disease.
Many people consider osteopathy as "alternative" medicine, although it's not.
"Patients come in and ask about (alternative treatments)," Steingard says. "There's a certain expectation that I know what it is because I'm a D.O., so I keep abreast of new treatments all the time."
Many D.O.s are members of the Arizona Medical Association, says Andrea C. Smiley, communications director. "Their medical training is very similar," she says. "We think highly of them."
To find an osteopathic doctor, visit the Arizona Osteopathic Medical Association Web site at www.az-osteo.org or call (602) 266-6699.
Osteopathic Philosophy and Complete Care.
Osteopaths recognise and maintain that the human body possesses its own healing powers and defence mechanisms by which it can overcome and adapt to any stresses of life, either physical or other. It can only do this efficiently, however, when it has adequate nutrition and a sound structural integrity. This ability to heal is shown in an obvious way when a bone fracture occurs. Even if left to itself, the bone would eventually heal by itself, although modern medical techniques and interventions can help it to heal in better alignment. Osteopathy itself is just such an intervention, in that it is used to direct the body's own healing powers onto the right road. In other words, when the body has lost its structural integrity, osteopathy can help to restore it and thus promote healing.
The concept of the body as an integrated unit means that all areas of the body are interrelated and have effects on each other. Thus an area where there is a dysfunction not only causes problems or pain in that localised area, but can also lead to pain and other problems in remote sites of the body via the systems of blood and lymph circulation and nerve pathways. For example, if a person sustains a simple injury to a foot, which causes them to limp, this can lead to an imbalance in the pelvis, which in turn leads to a curvature in the spine. From there a dysfunction in the joints of the spine can occur, causing muscle tension and inflammation and impingeing on the spinal nerves. This can go on to cause a whole legion of problems in the areas which are supplied by the nerves. These can also include problems with internal organs such as the lungs, bowels, bladder, womb, etc. It can be easily seen why an osteopath will need to look at the whole body! This concept also extends to include psychological factors. It is astounding what a dramatic effect a state of mind can have on physical symptoms. Stress, fear, anger, worry, etc can all cause physical problems and the osteopath will need to take these factors into account.
From the above it can be seen that the proper structure of the musculoskeletal system is extremely important to the body's ability to heal injuries. Structural integrity of the various components of the musculoskeletal system, comprising the spine, joints, bones, muscles, ligaments and other connective tissues, is essential in order that the body's natural defences have the best chance to do their work. If this integrity is impaired by imbalances and misalignments the person will have less resistance to the stresses and strains of everyday life and this can lead to ill health. This is where the osteopath's tenet of "Structure Governs Function" arises and this is the basis of an osteopathic treatment.
Dr Andrew Taylor Still was the founder of osteopathy. He discovered its benefits by accident when he was a child of ten years. He used to suffer with excruciating headaches from which he could get no relief. One day he tied a rope covered in a towel across a gap between two trees and lay down with his head and neck resting on it. He fell asleep and found when he woke up that his headache had entirely disappeared. He later realised that he had inhibited the nerves at the back of the skull and improved the blood flow.
He was in fact a medical doctor, but became disillusioned with allopathic medicine when three of his children died in an outbreak of meningitis, and he was unable to do anything. He began studying the human body and formulated the belief that the human body has an innate ability to heal itself and that poor health could result from restrictions in the musculoskeletal framework. Because the nerves and blood vessels must pass through or around muscle, bone and other connective tissues, any structural imbalance can, indeed, have widespread effects on the whole body. Through this relationship, osteopathy can sometimes help with conditions such as migraine, irritable bowel syndrome asthma and sinusitis, to name just a few.
The concept of the body as an integrated unit means that all areas of the body are interrelated and have effects on each other. Thus an area where there is a dysfunction not only causes problems or pain in that localised area, but can also lead to pain and other problems in remote sites of the body via the systems of blood and lymph circulation and nerve pathways. For example, if a person sustains a simple injury to a foot, which causes them to limp, this can lead to an imbalance in the pelvis, which in turn leads to a curvature in the spine. From there a dysfunction in the joints of the spine can occur, causing muscle tension and inflammation and impingeing on the spinal nerves. This can go on to cause a whole legion of problems in the areas which are supplied by the nerves. These can also include problems with internal organs such as the lungs, bowels, bladder, womb, etc. It can be easily seen why an osteopath will need to look at the whole body! This concept also extends to include psychological factors. It is astounding what a dramatic effect a state of mind can have on physical symptoms. Stress, fear, anger, worry, etc can all cause physical problems and the osteopath will need to take these factors into account.
From the above it can be seen that the proper structure of the musculoskeletal system is extremely important to the body's ability to heal injuries. Structural integrity of the various components of the musculoskeletal system, comprising the spine, joints, bones, muscles, ligaments and other connective tissues, is essential in order that the body's natural defences have the best chance to do their work. If this integrity is impaired by imbalances and misalignments the person will have less resistance to the stresses and strains of everyday life and this can lead to ill health. This is where the osteopath's tenet of "Structure Governs Function" arises and this is the basis of an osteopathic treatment.
Dr Andrew Taylor Still was the founder of osteopathy. He discovered its benefits by accident when he was a child of ten years. He used to suffer with excruciating headaches from which he could get no relief. One day he tied a rope covered in a towel across a gap between two trees and lay down with his head and neck resting on it. He fell asleep and found when he woke up that his headache had entirely disappeared. He later realised that he had inhibited the nerves at the back of the skull and improved the blood flow.
He was in fact a medical doctor, but became disillusioned with allopathic medicine when three of his children died in an outbreak of meningitis, and he was unable to do anything. He began studying the human body and formulated the belief that the human body has an innate ability to heal itself and that poor health could result from restrictions in the musculoskeletal framework. Because the nerves and blood vessels must pass through or around muscle, bone and other connective tissues, any structural imbalance can, indeed, have widespread effects on the whole body. Through this relationship, osteopathy can sometimes help with conditions such as migraine, irritable bowel syndrome asthma and sinusitis, to name just a few.
About Muscle Energy Technique
Muscle Energy Technique is a direct hands-on therapy originally developed by Dr. Fred Mitchell, Sr., Osteopathic Physician, and continued by Dr. Fred Mitchell, Jr. It utilizes the patient's own gentle muscle contractions and body positioning to normalize joint motion.
When a joint doesn't have full structural potential, its function will never reach full potential no matter how many muscles are massaged!
Muscle Energy Technique can be used to treat most joints in the body, including the intervertebral joints, in a gentle, soft, safe, and effective manner. It may be an alternative to high velocity thrust techniques, which many practitioners are not licensed to perform or that may be contraindicated.
Who Benefits from Muscle Energy Technique
People who are restricted in their movements. Conditions include back pain, headache, scoliosis, sciatica, "one leg longer than the other", "one hip higher than the other", and "one shoulder higher than the other".
People who have experienced trauma lately or in the past may also benefit.
In general, most everyone can benefit from this method.
When a joint doesn't have full structural potential, its function will never reach full potential no matter how many muscles are massaged!
Muscle Energy Technique can be used to treat most joints in the body, including the intervertebral joints, in a gentle, soft, safe, and effective manner. It may be an alternative to high velocity thrust techniques, which many practitioners are not licensed to perform or that may be contraindicated.
Who Benefits from Muscle Energy Technique
People who are restricted in their movements. Conditions include back pain, headache, scoliosis, sciatica, "one leg longer than the other", "one hip higher than the other", and "one shoulder higher than the other".
People who have experienced trauma lately or in the past may also benefit.
In general, most everyone can benefit from this method.
Monday, March 13, 2006
Osteopathic Medicine and Autism.
Introduction
Autism has increased in both incidence and prevalence by between
10 and 50 fold for the past ten to twenty years. This is cause for
grave concern as such a sudden increase suggests that it is not due
to genetic influences but rather environmental influences of one sort
or another. As child neurology residents twenty years ago, we rarely
saw cases of autism. Today I have almost 30 cases in my own
practice with other colleagues reporting as many as 200 cases in
theirs. In 1984 it was calculated that by the time a clinician becomes
aware of a causal association between exposure and disease or
becomes aware of an increase in incidence, the odds ratio is already
at least ten.? Within the past twenty years we have had a dramatic
increase in the introduction of multiple vaccines, multiple toxins,
multiple allergic syndromes, as well as shift geared toward fairly
aggressive interventionist obstetrics.
With the advent of the MMR vaccine there has been a significant
concurrent jump in incidence and prevalence of autism.?-? There has
also been an additional increase in incidence following the
administration of the hepatitis B vaccine in the perinatal period, which
is strongly suggestive of a cohort effect.4 We have seen a marked
increase in the familial incidence and prevalence of autism as well.
Many studies have attempted to discover a genetic etiology;
however, for a genetic influence to create an epidemic would be
against the basic laws of nature. A familial cause on the other hand,
ie. a shared risk factor from the environment, has tremendous
biologic coherence.5 A recent case report of a twin pair discordant for
autism in which one twin was subjected to the standard vaccine
schedule while the other did not receive vaccines until later, should
shed strong light on this issue as one twin is autistic, the other is
not.43 There are reports within the Osteopathic literature dating
back to the 1930s, of cranial distortion contributing to altered
cerebral function and osteopathic treatment restoring children to
normal or to markedly improved level of function.6-17 While these
reports have largely been ignored by mainstream medical practice,
many of these issues have, in fact, been discussed in books on
Osteopathic Medicine and especially in books on Cranial
Osteopathy.18-19
Within the alternative medicine environment there are additional
issues which bear directly upon Autistic Spectrum Disorders. Large
numbers of children have been studied following aggressive allergy
elimination treatment (NAET) with quite remarkable success.20
Additionally children have been treated homeopathically using both
isopathy to reverse and ameliorate vaccine side effects, as well as
with the more classical approach of a constitutional remedy. Multiple
studies have addressed themselves to rehabilitative efforts including
L.E.A.P., Lovaas, P.A.C.E., T.E.A.C.H., The Princeton Early Autism
Program and similar A.B.A. programs.21-22 Many of these programs
have demonstrated considerable success given certain circumstances.
One of the several common threads running through all of these
reports is that the earlier intervention is initiated with these children,
the better the chance for improvement and possible recovery.
Until now no one has systematically investigated the presence or
absence of cranial distortions and cranial and intra-cranial strain
patterns and their possible relationship to autism. In this paper I
report on twenty-five children who have been studied and treated
osteopathically. The majority of children in this study have been
exposed to highly integrated forms of treatment and rehabilitation
utilizing some or all of the following: cranial osteopathic techniques,
homeopathy, vitamin and herbal supplementation, lipid
metabolism,44 allergy elimination, behavior modification, auditory
integration, sensory integration, and extensive OT, PT and speech
rehabilitation. In no case was a single intervention by itself ("a
magic bullet") found to have had a significant level.
Methods:
Charts were reviewed from 25 consecutive children seen with a
diagnosis on the Autistic Spectrum meeting current DSM4
classification and diagnostic requirements (Table 1). There was one
case of Asperger's and three children who demonstrated autistic
characteristics but did not meet the requirement for diagnosis. There
were 8 girls and 17 boys. The ratio was approximately 2 boys for 1
girl. The mean age at first visit was 4.4 years. The median age at
first visit was 3 years. 15/25 of the children were ages 3 years or
less. Three of the children were siblings or twin pairs. 24/25 had
received Hep B vaccine; 23/25 had received the DPT/OPV/MMR. 1/24
with a clear onset within two weeks of MMR (ie. from typically
developing to autistic).
Results:
22/25 children demonstrated a characteristic common cranial
distortion. This distortion was characterized by compression and/or
restriction of the left middle cranial fascia. In all cases there was an
over-lying hyper-flexion type of pattern at the spheno-basilar
synthesis. This resulted in tension on the falx such that the falx was
pulled down exerting compression on the corpus callosum. The
tentorium was likewise flattened causing compression and decreasing
the space available for growth of the cerebellar vermis. The left
middle cranial fossa was restricted with significant restriction through
the left frontal temporal sphenoidal articulations extending down
through the spheno-temporal articulation into the spheno-sqamous
or SS Pivot. Over-lying compression was uniformly noted to involve
the left zygoma. Additionally, bi-lateral alanto-occipital (condylar)
compression was noted in all of the children studied (25 of 25). In
all 25 children the sacrum was markedly restricted and in 22/25 a
marked sacral torsion was noted. In all cases primary diaphragmatic
dysfunction was noted and the pulmonary diaphragm was noted to
be out of phase with the other two diaphragms. Compressions
through the left and right innominate were ubiquitous.
Decreased function through left and right lumbo costal arches was
also uniformly noted. In the other three children one exhibited a
severe torsion at the spheno-basilar symphysis as well as
spheno-basilar symphysis compression. The other two children
demonstrated a severe lateral strain (parallelogram deformity) with
significant plagiocephaly.
On an energetic level additional distortions were noted in all cases
which significantly compromised the overall health and functioning of
each child. In 22/25 children the posterior anterior energy flow
through the midline of the body was diverted at the level of the sella
tursica with a deviation approximately 90 degrees to the left. In
25/25 cases the motion of the third ventricle was significantly
impaired, as was the inherent motion of the central nervous system.
In 25/25 children the ignition system through the third ventricle was
also significantly impaired. In 25/25 children the energetic notochord
was found to be foreshortened of its normal length.
Outcome to Date:
15/25 children are communicating in sentences of 4 words or more,
initiating social contact and demonstrating spontaneous imaginative
play. 1/25 is fully mainstreamed and recovered. 11/25 are in
regular preschool, kindergarten or grade school with some
assistance. 13/25 are in special school programs for autistic
children.
Homeopathy:
11/25 children were treated with isopathy using preparation of
standard vaccines.
10/11 responded markedly to treatment with hepatitis B. 11/11
responded to treatment with MMR. 6/6 responded to treatment with
DPT. It should be noted that the majority of the children required
isopathic/homeopathic treatment for multiple vaccines. Following the
most isopathic/homeopathic treatment a clear increase in cognitive
function and socialization was noted. While some of the responses
were quite impressive, in no instance did this treatment lead to a
miraculous recovery.
Discussion:
At the onset of this discussion I want to emphasize once again that
no "magic bullet", no single treatment alone was found to
significantly ameliorate or reverse the effects of autism. Instead, in
all cases an individualized, well thought out and integrated approach
was required to move these children along the road to improvement
and recovery. It appears that some interventions paved the way by
having the effect of allowing subsequent interventions to be better
tolerated and more effective.
The cranial distortions which were identified were remarkably
consistent, even in siblings and twins (ie. the same distortion
patterns were found with the sib or twin). While it is tempting to
immediately look for a genetic component, there is clearly another
possibility to be considered that is far more consistent with an
epidemic event. It has long been known that pelvic distortions in the
mother result in similar distortion in the child who passes through the
birth canal. It has also been known in osteopathic literature and
teaching that interventionist obstetrics utilizing epidural anesthesia
and pitocin with forceps and vacuum extractors often results in cranial
distortion. Unfortunately, it is also documented that these
distortions are frequently NOT self-correcting. These non-physiologic
cranial distortions create an ongoing cerebral irritability usually
diagnosed as irritable baby syndrome, colic, difficulty sleeping, etc.
One has only to look at the older generation born prior to
approximately 1940 when these obstetrical interventions were far
fewer. In this older generation, heads are regular in shape and only
very rarely distorted. One measure of cranial base distortion is
regularity of teeth. The population rarely required orthodontic
intervention to straighten their teeth, yet they have relatively straight
teeth. The teeth phenomenon is a simple one in that teeth grow
either regularly or irregularly in response to intra-cranial distortions.
When in the late 1940s there was this marked change in obstetric
practice in the United States, a change from natural delivery to
obstetric interventionist delivery of children, this change to a large
degree, resulted in a epidemic of cranial distortions. When there is a
distortion of the maternal pelvis, the perinatal head which comes
through is basically liquid or gelatinous and takes on the form of that
pelvis – much like dough coming through a cookie cutter. If
you push dough through a cookie cutter you get remarkably
reproducible cookies. The same thing happens to siblings coming
through the same birth canal. This may account, at least in part for
the familial but not genetic concordance of autism in siblings. When
one changes or alters the maternal pelvis by osteopathic treatment
geared to returning that pelvis to normal or to "neutral", the next
sibling delivered takes on a very different head shape than prior
siblings delivered through an altered pelvis.23 This is reproducible in
case after case.
All of the above studied children were treated in Cranial Osteopathy.
This treatment was not geared just to the cranio-sacral mechanism.
Cranial Osteopathic treatment addresses the entire system, not just
the membranes. In addition to the membranes, it addresses the
bones, the cartilage, the fluid, the entire dynamic of the individual.
It seeks the health within the system and to enhance that "health"
to bring about clinical improvement.24 By so doing, these cranial
restrictions can be alleviated. Once these restrictions are released
the brain has an opportunity to grow in its intended fashion.
Common observations after treatment include, "my child is calmer,
sleeps better, falls asleep easier, is less irritable, etc". It appears
that the earlier these children are treated and the restrictions
released, the better the chance for significant progress. Again
however, it must be understood that removing these restrictions does
only that: remove restrictions. In addition to the brain, the entire
system must then be rehabilitated with any number of reasonable
and appropriate interventions.
There are numerous studies that address the neuro-immunologic
aspect of brain and its effect on the system in general; this effect
includes the immunologic environment of the body.25-26 We have
known osteopathically that restoring the system to neutral, ie.
removing restrictions, has a dramatic effect upon the neuro-immune
system, as well as on allergy, infections and other aspects of
immunological function. Going through allergy elimination
treatments (to food as well) may allow these children to do much
better and be more receptive to other interventions. There are
simple non-invasive allergy elimination techniques which do not
require blood drawing, scratch testing or shots which are very
effective in dramatically reducing allergies in over 80% of children.29
When these allergies are aggressively treated the children often
gradually come off their very restricted self-induced diet and the
variety of food intake improves dramatically. This may also
significantly and positively effect cognitive function.30-31
Additionally, both isopathic and homeopathic treatment may also be
important components in ideally reversing, but at least, in markedly
decreasing the negative effects of some vaccines. In terms of
vaccine issues, we use both isopathy/homeopathy and allergy to the
specific vaccines in our office with treatment effective success. While
these children following a homeopathic or allergy treatment regime
may have a brief 2-5 day period of irritability, following this mild
aggravation these children almost uniformly demonstrate a
noticeable jump in cognitive and/or social function. Paul Herscu uses
a combination of constitutional homeopathy and osteopathic
treatment also with positive results.32 Titus Smits of the Netherlands
uses an isopathic Kentian approach to vaccine treatment.33
The cranial osteopathic lesion, as described in the result section, has
a clear impact on cognitive and behavioral function as demonstrated
by improved clinical function. This distortion also may have a
marked impact on neurotransmitter function. Numerous reports have
appeared in the literature addressing the issue of altered
neurotransmitters and especially serotonin in autistic children.34-36
The cerebellar abnormalities involving cerebellar vermis have their
clinical correlates.37-40 In these autistic children, there is a
deficiency in rapidly orienting resources to an attended visual spatial
location. This also effects arousal and attention in addition to
coordination and retention in the acquisition of normal social
communication skills. Following release of the tentorium and
providing adequate space for growth of the cerebellar vermis, many
of these children so treated demonstrate marked improvement in
social skills, orientation, and receptivity to speech and occupational
therapy. The need is still present to be taught, re-educated and
rehabilitated in social interactions, but at least now that is physically
easier to accomplish. Reduction of pressure or release of pressure
upon the corpus callosum allows for reintegration of the two cerebral
hemispheres. Release of pressure surrounding the temporal lobe
now allows for appropriate growth of the temporal lobe and all of its
concomitant speech centers. Once this key restriction is removed,
the temporal lobe is available for aggressive speech therapy and
rehabilitation. There have been multiple reports of asymmetric brain
activity of reversed pattern of lateralization of brain activity for
language and motor imitation, as well as other priatal lobe
dysfunction.41-42 This, I believe, is in compensation for the left
sided brain compromise. Once these restrictions are relieved, these
children begin to demonstrate a sometimes dramatic and marked
increase in eye contact, initiation of social interaction and eventually
speech.
Summary
I have reported a reproducible common consistent pattern of cranial
and intra-cranial distortion in a majority of children so studied with
autism. Once these restrictions are aggressively treated
osteopathically and aggressive rehabilitative efforts are applied,
significant positive results can and do occur with these children. It is
also extremely important to note that these restrictions are treatable
manually; this is not a surgical problem. It is also clear that the
earlier these children are diagnosed and treated, the better the
possibility for a positive outcome. Ideally I like to see children under
three years of age, but we have accomplished positive results with
children entering treatment at four and five years of age. I have two
children who have responded favorably with, at least a significant and
noticeable increase in function with the initiation of treatment at age
seven. At present, I have no experience with any older children. It
should also be noted that the positive effects of the release of
cranial restrictions can be gradual and it may take several series of
treatments for noticeable changes. Unfortunately, some parents take
their children out of treatment prematurely because of temporary
worsening of behaviors (a not unusual phenomena while the
treatments are processing) or because of the unrealistic expectation
that cranial osteopathy was going to cure their child and nothing
more was needed. I cannot stress enough the need for an
integrated approach based on the needs of the individual child.
Is this osteopathic cranial strain pattern the cause of autism? Most
certainly not. From examination of photographs of siblings and
parents of these children similar strain patterns have been noted.
Most autism is, in the greatest majority of cases, of multi-factorial
causation. When there is a cranial strain pattern such as I have
described, the brain is irritable. In the presence of this increased
irritability, the brain becomes far more susceptible to outside adverse
influences such as vaccines, toxins, etc. The reports of the Missouri
cohort following hepatitis B initiation in 1991 are suggestive of a
vaccine component. The multiple reports of MMR vaccination and the
subsequent increase in autism following, and with a delay of up to 4
years, are suggestive of MMR as a possible component. The
multiple studies which have proposed or which have found new
carpets in the prenatal period to be a significant risk factor suggests
an additional component supporting adverse environmental issues.
There may be some genetic aspects which contribute to an increased
susceptibility to develop autism given certain exposures. Is genetics
the sole cause? Perhaps in very rare circumstances, but generally
that has little biological coherence. One simply does not see an
epidemic increase of any disease process solely based on genetics,
and we have a clear epidemic of autism occurring at this time. It is
important to note that with the exception of the recent California
Study, all of the other studies of epidemiology of autism examine
populations that antedate current time by approximately 10 years or
more. One would expect, given the dramatic clinical increase in
autism – PDD and related disorders that epidemiologic studies
performed over the next several years will indeed confirm this
epidemic increase.
One thing that is absolutely clear is that autism is not a behavioral or
psychiatric disorder. Autism is a neurologic, physical, chemical,
physiologic neuro-chemical disorder that results in primary cerebral
dysfunction and with secondary abnormal behavior. It is vital that, in
addition to our current treatments of these children, we aggressively
investigate the causes for this epidemic with an ultimate view to
eliminating the contributing factors. What a blessing to have even
that hope.
REFERENCES:
1Lavine, L., Hauser, WA. 1984 unpublished.
2State of California. California Health and Human Services Agency.
Dept of Developmental Services. Changes in the population of
persons with Autism/PDD in California's Developmental Services System:
1987 through 1998. A report to the Legislature: March 1, 1999.
3(B. Rimland, pers. comm. 1999).
4Missouri School Cohort, 1999.
5Susser, M. 1973. Causal thinking in the health sciences: concepts and
strategies of epidemiology. 3rd ed. New York: Oxford UP.
6Arbuckle, B.E. Cranial birth injuries. Academy of Applied Osteopathy
yearbook 1945:63
7Arbuckle, B.E. Early cranial considerations. JAOA 48(2):315-320.
8Arbuckle, B.E. Effects of uterine forceps upon the fetus. JAOA
54(5)#9:499-508.
9Frymann, V.M. Relation of disturbances of craniosacral mechanisms
to symptomalogy of the newborn: a study of 1,250 infants. JAOA
65(10):1059-1075.
10Fryman, V.M., (1976) Trauma of birth. Osteopathic Annals
4(22):8-14.
11Frymann, V.M., R.E. Carney, et al. Effect of osteopathic medical
management on neurologic development in children. JAOA
92(6):729-744.
12Wales, A.L. Cranial diagnosis. Journal of the Osteopathic Cranial
Association 1948:14-23.
13Sutherland, W.G. Bent Twigs: compression of the condylar parts of
the occiput. Teachings in the science of osteopathy. Ed. A.L. Wales.
Rurda Press, 1990, 107-117.
14Lippincott, R.C. Cranial osteopathy. AAO yearbook
1947:103-111.
15Sutherland, W.G. (1943) The Cranial Bowl. JAOA 48(4):348-53.
16Woods, R.H. 1973. Structural normalization in infants and
children with particular references to disturbances of the central
nervous system. JAOA 72(5):903-08.
17Frymann, V.M. Learning difficulties of children viewed in the light
of osteopathic concept. JAOA 76(1):46-61.
18Sutherland, A.S., and A.L. Wales, eds. 1967. Contributions of
thought: collected writings of William Gamer Sutherland 1914-1954. The
Sutherland Cranial Teaching Foundation.
19Sutherland, W.G. (1939) The cranial bowl: a treatise relating to
cranial articular mobility, cranial articular lesions, and cranial technique.
Free Press, 1994.
20(D.S. Nambudripad. pers. comm. 1999) Publication in progress.
21Matson, J.L., D.A. Benavidez et al. 1996. Behavioral treatment of
autistic persons: a review of research from 1980 to the present.
Research in developmental disabilities 17(6):433-465.
22Dawson, G., ed. 1989. Autism: nature, diagnosis and treatment.
New York. Guilford Press
23A. Wales, pers. comm. 1999. My own pers. experience.
24Jealous, J.1997. Conservations: healing and the natural world.
Alternative therapies 3(1):68-75.
25Rapin, I., and R. Katzman, 1998. Neurobiology of autism.
Annals of neurology 43(1):7-14.
26Bauman, M.L., R.A. Filipek and T.L. Kemper. 1997. Early infantile
autism. International review of neurobiology 41:367-386.
27Bristol, M., D.J. Cohen et al. 1996. State of science of autism:
report to the National Institutes of Health. Journal of autism and
developmental disorders 26(2):121-154.
28Smalley, S.L. and F. Collins. 1996. Brief report: genetic, prenatal
and immunologic factors. Journal of autism and developmental
disorders 26(2):195-198.
29Ibid 9. D.S. Nambudripad.
30Speer, F., ed. 1970. Allergy of the nervous system. Springfield:
Charles C. Thomas pub.
31Ibid 9. D.S. Nambudripad.
32(P. Herscu, pers. comm. 1999).
33(T. Smits, pers. comm. 1999).
34Chugani, D., O. Musik et al. 1997. Altered serotonin synthesis in
the dentatothalamococrtical pathway in autistic boys. Annals of
Neurology 42(10)#4:666-669.
35Cook, E.H., Jr., 1996. Brief report: pathophysiology of autism:
neurochemistry. Journal of autism and developmental disorders
26(2):221-225.
36Ernst, M., A.J. Zametkin, et al. 1997. Low medical prefrontal
dopaminergic activity in autistic children. The Lancet 350(8):638.
37Courchesne, E., J. Townsend, et al. 1994. The brain in infantile
autism: posterior fossa structures are abnormal. Neurology
44:214-223.
38Piven, J., E. Nehme, et al. 1992. Magnetic resonance imaging in
autism: measurement of the cerebellum, pons, and fourth
ventricle. Biologic Psychiatry 31:491-504.
39Courchesne, E., R. Yeung-Courchesne, et al. 1988. Hypoplasis of
cerebellar lobules VI-VII in infant autism. New England Journal of
Medicine 318:1349-1354.
40Courchesne, E. 1999. Correspondence re: an MRI study of
autism: the cerebellum revisited. Neurology 52:1106.
41DeLong, G.R. 1999. Autism: new data suggesting new hypothesis:
views and reviews. Neurology 52:911-916.
42Rapin, I. 1999. Autism in search of a home in the brain.
Neurology 52:902-904.
43Manning, Anita. 1999. Vaccine-autism link feared. USA Today,
16 Aug. 99.
44Kane, P. 1997. Peroxisomal Disturbances in Autistic Spectrum
Disorder. Journal of Orthomolecular Medicine 12(4):207-218.
Autism has increased in both incidence and prevalence by between
10 and 50 fold for the past ten to twenty years. This is cause for
grave concern as such a sudden increase suggests that it is not due
to genetic influences but rather environmental influences of one sort
or another. As child neurology residents twenty years ago, we rarely
saw cases of autism. Today I have almost 30 cases in my own
practice with other colleagues reporting as many as 200 cases in
theirs. In 1984 it was calculated that by the time a clinician becomes
aware of a causal association between exposure and disease or
becomes aware of an increase in incidence, the odds ratio is already
at least ten.? Within the past twenty years we have had a dramatic
increase in the introduction of multiple vaccines, multiple toxins,
multiple allergic syndromes, as well as shift geared toward fairly
aggressive interventionist obstetrics.
With the advent of the MMR vaccine there has been a significant
concurrent jump in incidence and prevalence of autism.?-? There has
also been an additional increase in incidence following the
administration of the hepatitis B vaccine in the perinatal period, which
is strongly suggestive of a cohort effect.4 We have seen a marked
increase in the familial incidence and prevalence of autism as well.
Many studies have attempted to discover a genetic etiology;
however, for a genetic influence to create an epidemic would be
against the basic laws of nature. A familial cause on the other hand,
ie. a shared risk factor from the environment, has tremendous
biologic coherence.5 A recent case report of a twin pair discordant for
autism in which one twin was subjected to the standard vaccine
schedule while the other did not receive vaccines until later, should
shed strong light on this issue as one twin is autistic, the other is
not.43 There are reports within the Osteopathic literature dating
back to the 1930s, of cranial distortion contributing to altered
cerebral function and osteopathic treatment restoring children to
normal or to markedly improved level of function.6-17 While these
reports have largely been ignored by mainstream medical practice,
many of these issues have, in fact, been discussed in books on
Osteopathic Medicine and especially in books on Cranial
Osteopathy.18-19
Within the alternative medicine environment there are additional
issues which bear directly upon Autistic Spectrum Disorders. Large
numbers of children have been studied following aggressive allergy
elimination treatment (NAET) with quite remarkable success.20
Additionally children have been treated homeopathically using both
isopathy to reverse and ameliorate vaccine side effects, as well as
with the more classical approach of a constitutional remedy. Multiple
studies have addressed themselves to rehabilitative efforts including
L.E.A.P., Lovaas, P.A.C.E., T.E.A.C.H., The Princeton Early Autism
Program and similar A.B.A. programs.21-22 Many of these programs
have demonstrated considerable success given certain circumstances.
One of the several common threads running through all of these
reports is that the earlier intervention is initiated with these children,
the better the chance for improvement and possible recovery.
Until now no one has systematically investigated the presence or
absence of cranial distortions and cranial and intra-cranial strain
patterns and their possible relationship to autism. In this paper I
report on twenty-five children who have been studied and treated
osteopathically. The majority of children in this study have been
exposed to highly integrated forms of treatment and rehabilitation
utilizing some or all of the following: cranial osteopathic techniques,
homeopathy, vitamin and herbal supplementation, lipid
metabolism,44 allergy elimination, behavior modification, auditory
integration, sensory integration, and extensive OT, PT and speech
rehabilitation. In no case was a single intervention by itself ("a
magic bullet") found to have had a significant level.
Methods:
Charts were reviewed from 25 consecutive children seen with a
diagnosis on the Autistic Spectrum meeting current DSM4
classification and diagnostic requirements (Table 1). There was one
case of Asperger's and three children who demonstrated autistic
characteristics but did not meet the requirement for diagnosis. There
were 8 girls and 17 boys. The ratio was approximately 2 boys for 1
girl. The mean age at first visit was 4.4 years. The median age at
first visit was 3 years. 15/25 of the children were ages 3 years or
less. Three of the children were siblings or twin pairs. 24/25 had
received Hep B vaccine; 23/25 had received the DPT/OPV/MMR. 1/24
with a clear onset within two weeks of MMR (ie. from typically
developing to autistic).
Results:
22/25 children demonstrated a characteristic common cranial
distortion. This distortion was characterized by compression and/or
restriction of the left middle cranial fascia. In all cases there was an
over-lying hyper-flexion type of pattern at the spheno-basilar
synthesis. This resulted in tension on the falx such that the falx was
pulled down exerting compression on the corpus callosum. The
tentorium was likewise flattened causing compression and decreasing
the space available for growth of the cerebellar vermis. The left
middle cranial fossa was restricted with significant restriction through
the left frontal temporal sphenoidal articulations extending down
through the spheno-temporal articulation into the spheno-sqamous
or SS Pivot. Over-lying compression was uniformly noted to involve
the left zygoma. Additionally, bi-lateral alanto-occipital (condylar)
compression was noted in all of the children studied (25 of 25). In
all 25 children the sacrum was markedly restricted and in 22/25 a
marked sacral torsion was noted. In all cases primary diaphragmatic
dysfunction was noted and the pulmonary diaphragm was noted to
be out of phase with the other two diaphragms. Compressions
through the left and right innominate were ubiquitous.
Decreased function through left and right lumbo costal arches was
also uniformly noted. In the other three children one exhibited a
severe torsion at the spheno-basilar symphysis as well as
spheno-basilar symphysis compression. The other two children
demonstrated a severe lateral strain (parallelogram deformity) with
significant plagiocephaly.
On an energetic level additional distortions were noted in all cases
which significantly compromised the overall health and functioning of
each child. In 22/25 children the posterior anterior energy flow
through the midline of the body was diverted at the level of the sella
tursica with a deviation approximately 90 degrees to the left. In
25/25 cases the motion of the third ventricle was significantly
impaired, as was the inherent motion of the central nervous system.
In 25/25 children the ignition system through the third ventricle was
also significantly impaired. In 25/25 children the energetic notochord
was found to be foreshortened of its normal length.
Outcome to Date:
15/25 children are communicating in sentences of 4 words or more,
initiating social contact and demonstrating spontaneous imaginative
play. 1/25 is fully mainstreamed and recovered. 11/25 are in
regular preschool, kindergarten or grade school with some
assistance. 13/25 are in special school programs for autistic
children.
Homeopathy:
11/25 children were treated with isopathy using preparation of
standard vaccines.
10/11 responded markedly to treatment with hepatitis B. 11/11
responded to treatment with MMR. 6/6 responded to treatment with
DPT. It should be noted that the majority of the children required
isopathic/homeopathic treatment for multiple vaccines. Following the
most isopathic/homeopathic treatment a clear increase in cognitive
function and socialization was noted. While some of the responses
were quite impressive, in no instance did this treatment lead to a
miraculous recovery.
Discussion:
At the onset of this discussion I want to emphasize once again that
no "magic bullet", no single treatment alone was found to
significantly ameliorate or reverse the effects of autism. Instead, in
all cases an individualized, well thought out and integrated approach
was required to move these children along the road to improvement
and recovery. It appears that some interventions paved the way by
having the effect of allowing subsequent interventions to be better
tolerated and more effective.
The cranial distortions which were identified were remarkably
consistent, even in siblings and twins (ie. the same distortion
patterns were found with the sib or twin). While it is tempting to
immediately look for a genetic component, there is clearly another
possibility to be considered that is far more consistent with an
epidemic event. It has long been known that pelvic distortions in the
mother result in similar distortion in the child who passes through the
birth canal. It has also been known in osteopathic literature and
teaching that interventionist obstetrics utilizing epidural anesthesia
and pitocin with forceps and vacuum extractors often results in cranial
distortion. Unfortunately, it is also documented that these
distortions are frequently NOT self-correcting. These non-physiologic
cranial distortions create an ongoing cerebral irritability usually
diagnosed as irritable baby syndrome, colic, difficulty sleeping, etc.
One has only to look at the older generation born prior to
approximately 1940 when these obstetrical interventions were far
fewer. In this older generation, heads are regular in shape and only
very rarely distorted. One measure of cranial base distortion is
regularity of teeth. The population rarely required orthodontic
intervention to straighten their teeth, yet they have relatively straight
teeth. The teeth phenomenon is a simple one in that teeth grow
either regularly or irregularly in response to intra-cranial distortions.
When in the late 1940s there was this marked change in obstetric
practice in the United States, a change from natural delivery to
obstetric interventionist delivery of children, this change to a large
degree, resulted in a epidemic of cranial distortions. When there is a
distortion of the maternal pelvis, the perinatal head which comes
through is basically liquid or gelatinous and takes on the form of that
pelvis – much like dough coming through a cookie cutter. If
you push dough through a cookie cutter you get remarkably
reproducible cookies. The same thing happens to siblings coming
through the same birth canal. This may account, at least in part for
the familial but not genetic concordance of autism in siblings. When
one changes or alters the maternal pelvis by osteopathic treatment
geared to returning that pelvis to normal or to "neutral", the next
sibling delivered takes on a very different head shape than prior
siblings delivered through an altered pelvis.23 This is reproducible in
case after case.
All of the above studied children were treated in Cranial Osteopathy.
This treatment was not geared just to the cranio-sacral mechanism.
Cranial Osteopathic treatment addresses the entire system, not just
the membranes. In addition to the membranes, it addresses the
bones, the cartilage, the fluid, the entire dynamic of the individual.
It seeks the health within the system and to enhance that "health"
to bring about clinical improvement.24 By so doing, these cranial
restrictions can be alleviated. Once these restrictions are released
the brain has an opportunity to grow in its intended fashion.
Common observations after treatment include, "my child is calmer,
sleeps better, falls asleep easier, is less irritable, etc". It appears
that the earlier these children are treated and the restrictions
released, the better the chance for significant progress. Again
however, it must be understood that removing these restrictions does
only that: remove restrictions. In addition to the brain, the entire
system must then be rehabilitated with any number of reasonable
and appropriate interventions.
There are numerous studies that address the neuro-immunologic
aspect of brain and its effect on the system in general; this effect
includes the immunologic environment of the body.25-26 We have
known osteopathically that restoring the system to neutral, ie.
removing restrictions, has a dramatic effect upon the neuro-immune
system, as well as on allergy, infections and other aspects of
immunological function. Going through allergy elimination
treatments (to food as well) may allow these children to do much
better and be more receptive to other interventions. There are
simple non-invasive allergy elimination techniques which do not
require blood drawing, scratch testing or shots which are very
effective in dramatically reducing allergies in over 80% of children.29
When these allergies are aggressively treated the children often
gradually come off their very restricted self-induced diet and the
variety of food intake improves dramatically. This may also
significantly and positively effect cognitive function.30-31
Additionally, both isopathic and homeopathic treatment may also be
important components in ideally reversing, but at least, in markedly
decreasing the negative effects of some vaccines. In terms of
vaccine issues, we use both isopathy/homeopathy and allergy to the
specific vaccines in our office with treatment effective success. While
these children following a homeopathic or allergy treatment regime
may have a brief 2-5 day period of irritability, following this mild
aggravation these children almost uniformly demonstrate a
noticeable jump in cognitive and/or social function. Paul Herscu uses
a combination of constitutional homeopathy and osteopathic
treatment also with positive results.32 Titus Smits of the Netherlands
uses an isopathic Kentian approach to vaccine treatment.33
The cranial osteopathic lesion, as described in the result section, has
a clear impact on cognitive and behavioral function as demonstrated
by improved clinical function. This distortion also may have a
marked impact on neurotransmitter function. Numerous reports have
appeared in the literature addressing the issue of altered
neurotransmitters and especially serotonin in autistic children.34-36
The cerebellar abnormalities involving cerebellar vermis have their
clinical correlates.37-40 In these autistic children, there is a
deficiency in rapidly orienting resources to an attended visual spatial
location. This also effects arousal and attention in addition to
coordination and retention in the acquisition of normal social
communication skills. Following release of the tentorium and
providing adequate space for growth of the cerebellar vermis, many
of these children so treated demonstrate marked improvement in
social skills, orientation, and receptivity to speech and occupational
therapy. The need is still present to be taught, re-educated and
rehabilitated in social interactions, but at least now that is physically
easier to accomplish. Reduction of pressure or release of pressure
upon the corpus callosum allows for reintegration of the two cerebral
hemispheres. Release of pressure surrounding the temporal lobe
now allows for appropriate growth of the temporal lobe and all of its
concomitant speech centers. Once this key restriction is removed,
the temporal lobe is available for aggressive speech therapy and
rehabilitation. There have been multiple reports of asymmetric brain
activity of reversed pattern of lateralization of brain activity for
language and motor imitation, as well as other priatal lobe
dysfunction.41-42 This, I believe, is in compensation for the left
sided brain compromise. Once these restrictions are relieved, these
children begin to demonstrate a sometimes dramatic and marked
increase in eye contact, initiation of social interaction and eventually
speech.
Summary
I have reported a reproducible common consistent pattern of cranial
and intra-cranial distortion in a majority of children so studied with
autism. Once these restrictions are aggressively treated
osteopathically and aggressive rehabilitative efforts are applied,
significant positive results can and do occur with these children. It is
also extremely important to note that these restrictions are treatable
manually; this is not a surgical problem. It is also clear that the
earlier these children are diagnosed and treated, the better the
possibility for a positive outcome. Ideally I like to see children under
three years of age, but we have accomplished positive results with
children entering treatment at four and five years of age. I have two
children who have responded favorably with, at least a significant and
noticeable increase in function with the initiation of treatment at age
seven. At present, I have no experience with any older children. It
should also be noted that the positive effects of the release of
cranial restrictions can be gradual and it may take several series of
treatments for noticeable changes. Unfortunately, some parents take
their children out of treatment prematurely because of temporary
worsening of behaviors (a not unusual phenomena while the
treatments are processing) or because of the unrealistic expectation
that cranial osteopathy was going to cure their child and nothing
more was needed. I cannot stress enough the need for an
integrated approach based on the needs of the individual child.
Is this osteopathic cranial strain pattern the cause of autism? Most
certainly not. From examination of photographs of siblings and
parents of these children similar strain patterns have been noted.
Most autism is, in the greatest majority of cases, of multi-factorial
causation. When there is a cranial strain pattern such as I have
described, the brain is irritable. In the presence of this increased
irritability, the brain becomes far more susceptible to outside adverse
influences such as vaccines, toxins, etc. The reports of the Missouri
cohort following hepatitis B initiation in 1991 are suggestive of a
vaccine component. The multiple reports of MMR vaccination and the
subsequent increase in autism following, and with a delay of up to 4
years, are suggestive of MMR as a possible component. The
multiple studies which have proposed or which have found new
carpets in the prenatal period to be a significant risk factor suggests
an additional component supporting adverse environmental issues.
There may be some genetic aspects which contribute to an increased
susceptibility to develop autism given certain exposures. Is genetics
the sole cause? Perhaps in very rare circumstances, but generally
that has little biological coherence. One simply does not see an
epidemic increase of any disease process solely based on genetics,
and we have a clear epidemic of autism occurring at this time. It is
important to note that with the exception of the recent California
Study, all of the other studies of epidemiology of autism examine
populations that antedate current time by approximately 10 years or
more. One would expect, given the dramatic clinical increase in
autism – PDD and related disorders that epidemiologic studies
performed over the next several years will indeed confirm this
epidemic increase.
One thing that is absolutely clear is that autism is not a behavioral or
psychiatric disorder. Autism is a neurologic, physical, chemical,
physiologic neuro-chemical disorder that results in primary cerebral
dysfunction and with secondary abnormal behavior. It is vital that, in
addition to our current treatments of these children, we aggressively
investigate the causes for this epidemic with an ultimate view to
eliminating the contributing factors. What a blessing to have even
that hope.
REFERENCES:
1Lavine, L., Hauser, WA. 1984 unpublished.
2State of California. California Health and Human Services Agency.
Dept of Developmental Services. Changes in the population of
persons with Autism/PDD in California's Developmental Services System:
1987 through 1998. A report to the Legislature: March 1, 1999.
3(B. Rimland, pers. comm. 1999).
4Missouri School Cohort, 1999.
5Susser, M. 1973. Causal thinking in the health sciences: concepts and
strategies of epidemiology. 3rd ed. New York: Oxford UP.
6Arbuckle, B.E. Cranial birth injuries. Academy of Applied Osteopathy
yearbook 1945:63
7Arbuckle, B.E. Early cranial considerations. JAOA 48(2):315-320.
8Arbuckle, B.E. Effects of uterine forceps upon the fetus. JAOA
54(5)#9:499-508.
9Frymann, V.M. Relation of disturbances of craniosacral mechanisms
to symptomalogy of the newborn: a study of 1,250 infants. JAOA
65(10):1059-1075.
10Fryman, V.M., (1976) Trauma of birth. Osteopathic Annals
4(22):8-14.
11Frymann, V.M., R.E. Carney, et al. Effect of osteopathic medical
management on neurologic development in children. JAOA
92(6):729-744.
12Wales, A.L. Cranial diagnosis. Journal of the Osteopathic Cranial
Association 1948:14-23.
13Sutherland, W.G. Bent Twigs: compression of the condylar parts of
the occiput. Teachings in the science of osteopathy. Ed. A.L. Wales.
Rurda Press, 1990, 107-117.
14Lippincott, R.C. Cranial osteopathy. AAO yearbook
1947:103-111.
15Sutherland, W.G. (1943) The Cranial Bowl. JAOA 48(4):348-53.
16Woods, R.H. 1973. Structural normalization in infants and
children with particular references to disturbances of the central
nervous system. JAOA 72(5):903-08.
17Frymann, V.M. Learning difficulties of children viewed in the light
of osteopathic concept. JAOA 76(1):46-61.
18Sutherland, A.S., and A.L. Wales, eds. 1967. Contributions of
thought: collected writings of William Gamer Sutherland 1914-1954. The
Sutherland Cranial Teaching Foundation.
19Sutherland, W.G. (1939) The cranial bowl: a treatise relating to
cranial articular mobility, cranial articular lesions, and cranial technique.
Free Press, 1994.
20(D.S. Nambudripad. pers. comm. 1999) Publication in progress.
21Matson, J.L., D.A. Benavidez et al. 1996. Behavioral treatment of
autistic persons: a review of research from 1980 to the present.
Research in developmental disabilities 17(6):433-465.
22Dawson, G., ed. 1989. Autism: nature, diagnosis and treatment.
New York. Guilford Press
23A. Wales, pers. comm. 1999. My own pers. experience.
24Jealous, J.1997. Conservations: healing and the natural world.
Alternative therapies 3(1):68-75.
25Rapin, I., and R. Katzman, 1998. Neurobiology of autism.
Annals of neurology 43(1):7-14.
26Bauman, M.L., R.A. Filipek and T.L. Kemper. 1997. Early infantile
autism. International review of neurobiology 41:367-386.
27Bristol, M., D.J. Cohen et al. 1996. State of science of autism:
report to the National Institutes of Health. Journal of autism and
developmental disorders 26(2):121-154.
28Smalley, S.L. and F. Collins. 1996. Brief report: genetic, prenatal
and immunologic factors. Journal of autism and developmental
disorders 26(2):195-198.
29Ibid 9. D.S. Nambudripad.
30Speer, F., ed. 1970. Allergy of the nervous system. Springfield:
Charles C. Thomas pub.
31Ibid 9. D.S. Nambudripad.
32(P. Herscu, pers. comm. 1999).
33(T. Smits, pers. comm. 1999).
34Chugani, D., O. Musik et al. 1997. Altered serotonin synthesis in
the dentatothalamococrtical pathway in autistic boys. Annals of
Neurology 42(10)#4:666-669.
35Cook, E.H., Jr., 1996. Brief report: pathophysiology of autism:
neurochemistry. Journal of autism and developmental disorders
26(2):221-225.
36Ernst, M., A.J. Zametkin, et al. 1997. Low medical prefrontal
dopaminergic activity in autistic children. The Lancet 350(8):638.
37Courchesne, E., J. Townsend, et al. 1994. The brain in infantile
autism: posterior fossa structures are abnormal. Neurology
44:214-223.
38Piven, J., E. Nehme, et al. 1992. Magnetic resonance imaging in
autism: measurement of the cerebellum, pons, and fourth
ventricle. Biologic Psychiatry 31:491-504.
39Courchesne, E., R. Yeung-Courchesne, et al. 1988. Hypoplasis of
cerebellar lobules VI-VII in infant autism. New England Journal of
Medicine 318:1349-1354.
40Courchesne, E. 1999. Correspondence re: an MRI study of
autism: the cerebellum revisited. Neurology 52:1106.
41DeLong, G.R. 1999. Autism: new data suggesting new hypothesis:
views and reviews. Neurology 52:911-916.
42Rapin, I. 1999. Autism in search of a home in the brain.
Neurology 52:902-904.
43Manning, Anita. 1999. Vaccine-autism link feared. USA Today,
16 Aug. 99.
44Kane, P. 1997. Peroxisomal Disturbances in Autistic Spectrum
Disorder. Journal of Orthomolecular Medicine 12(4):207-218.
3 Common OMT Techniques
Source:http://www.md-do.org/NewOMMBoard%20Review02-REV.htm
Muscle Energy: (Golgi tendon organ reflex). (Direct method). A pull on the tendon sends signal from the Golgi tendon organ to spinal cord. At the spinal cord inhibitory interneurons synapse with alpha motor neurons causing a reflex relaxation of the muscle. When tension on a tendon becomes extreme the inhibitory effect from the organ can become so great it causes a sudden relaxation of the entire muscle. Golgi tendon organs respond to rate and changes in muscle tension. Summary: Activation of large myelinated group 1b afferent fibers from tendon insertion reflexively inhibits alpha motor neuron to muscle spindle. Buzz: Golgi, alpha motor neurons, tension/force, direct technique. Primary source: Kuchera and Kuchera, OPP
Counterstrain: Decrease gamma gain: "...stop inappropriate proprioceptor activity... shortening the muscle that contains the malfunctioning muscle spindle by applying a mild strain to its antagonist." (Jones) This is an indirect technique that employs the Muscle spindle reflex. This reflex responds to rate and changes of intrafusal fiber length. Hypershortening the extrafusal fibers by bringing the origin and insertion of the muscle mass closer together, decreases the length of the intrafusal fibers and relaxes them. This relaxation phase is followed by a slow return to neutral in order to allow the CNS to reset the gamma gain activity in the spindle to a new lower level. The end result of counterstrain on the muscle spindle fibers is a turning down of the gamma gain. Remember: Position of ease, slow return after 90 seconds. Red herrings: C3 posterior put into flexion. C4 anterior put into extension, inion put into flexion, lower pole L5 put into flexion. Key words: proprioceptor, gamma gain. Note: FPR also employs the muscle spindle reflex. Primary source: Kuchera and Kuchera, OPP
HVLA: Can involve both the Golgi tendon organ and muscle spindle reflex. HVLA may produce changes in muscle tension and length of muscle spindles.
1. Thrust activation initiates so much afferent input into the CNS, causing the CNS to turn down the gamma gain to the muscle spindles, which relaxes the tight muscle mass.
2. During a thrust the tension on the tight muscle firmly pulls on the tendon. This activates the Golgi tendon receptors, which in turn causes a reflex relaxation to that tight muscle.
3. The stretch of the extrafusal fibers of the tight muscle pulls on the Golgi tendon receptors, which will cause a reflex activation to inhibit the contraction of the same muscle.
4. HVLA of 1/8” to 1/4” of forceful stretching of a contracted muscle may produce such a barrage of afferent impulses from the spindles to the CNS causing the CNS to respond by sending inhibitory impulses to the gamma gain cell bodies. This turns down the gamma gain activity to the spindles, thus relaxing the muscle mass via a central inhibitory reflex. Kuchera and Kuchera, OPP
Muscle Energy: (Golgi tendon organ reflex). (Direct method). A pull on the tendon sends signal from the Golgi tendon organ to spinal cord. At the spinal cord inhibitory interneurons synapse with alpha motor neurons causing a reflex relaxation of the muscle. When tension on a tendon becomes extreme the inhibitory effect from the organ can become so great it causes a sudden relaxation of the entire muscle. Golgi tendon organs respond to rate and changes in muscle tension. Summary: Activation of large myelinated group 1b afferent fibers from tendon insertion reflexively inhibits alpha motor neuron to muscle spindle. Buzz: Golgi, alpha motor neurons, tension/force, direct technique. Primary source: Kuchera and Kuchera, OPP
Counterstrain: Decrease gamma gain: "...stop inappropriate proprioceptor activity... shortening the muscle that contains the malfunctioning muscle spindle by applying a mild strain to its antagonist." (Jones) This is an indirect technique that employs the Muscle spindle reflex. This reflex responds to rate and changes of intrafusal fiber length. Hypershortening the extrafusal fibers by bringing the origin and insertion of the muscle mass closer together, decreases the length of the intrafusal fibers and relaxes them. This relaxation phase is followed by a slow return to neutral in order to allow the CNS to reset the gamma gain activity in the spindle to a new lower level. The end result of counterstrain on the muscle spindle fibers is a turning down of the gamma gain. Remember: Position of ease, slow return after 90 seconds. Red herrings: C3 posterior put into flexion. C4 anterior put into extension, inion put into flexion, lower pole L5 put into flexion. Key words: proprioceptor, gamma gain. Note: FPR also employs the muscle spindle reflex. Primary source: Kuchera and Kuchera, OPP
HVLA: Can involve both the Golgi tendon organ and muscle spindle reflex. HVLA may produce changes in muscle tension and length of muscle spindles.
1. Thrust activation initiates so much afferent input into the CNS, causing the CNS to turn down the gamma gain to the muscle spindles, which relaxes the tight muscle mass.
2. During a thrust the tension on the tight muscle firmly pulls on the tendon. This activates the Golgi tendon receptors, which in turn causes a reflex relaxation to that tight muscle.
3. The stretch of the extrafusal fibers of the tight muscle pulls on the Golgi tendon receptors, which will cause a reflex activation to inhibit the contraction of the same muscle.
4. HVLA of 1/8” to 1/4” of forceful stretching of a contracted muscle may produce such a barrage of afferent impulses from the spindles to the CNS causing the CNS to respond by sending inhibitory impulses to the gamma gain cell bodies. This turns down the gamma gain activity to the spindles, thus relaxing the muscle mass via a central inhibitory reflex. Kuchera and Kuchera, OPP
OMT and Sports Injury Treatment and Reversal
Osteopathic Manipulative Treatment is well known for treating many forms of sports injury.
For example:
1. Recently a speed skater at the olympics was recovered to 100% good health by the use of OMT.
See the full article here:
http://www.injuryreversal.com/cases/index.php
From golfers, basketball players to baseball players OMT has shown efficacy in treating numerous injuries.
For example:
1. Recently a speed skater at the olympics was recovered to 100% good health by the use of OMT.
See the full article here:
http://www.injuryreversal.com/cases/index.php
From golfers, basketball players to baseball players OMT has shown efficacy in treating numerous injuries.
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