Monday, February 27, 2006

TMJ or Jaw Problems

The tempro-mandibular joint is located on each temporal bone just forward of the external auditory meatus or ear canal. Since the lower jaw is attached to the temporal bones via this joint it isn't any wonder that a displacement or mal position of these two temporal bones could cause joint pains to occur over a period of time.
The temporal bones have the capability to move and rotate like off centered wheels, (back and out, or forward and in), depending on the side affected. This displacement creates an environment for the TMJ joint to become irritated by the misalignment of these bones.
NCR has the ability to reposition these bones without surgery or medications. It is recommended that this procedure be coordinated with the patients' dentist as to maximize the positive affects of this treatment. Allergies: In the 1950's and 1960's Osteopathic doctors used a form of NCR for treating breathing and sinus problems. In anatomical terms NCR increases the diameter of the nasal passages which are made up of cranial/facial bones.
When moved/opened, these bones allow for more air to pass through the nasal passages, thus decreasing the congestion by increasing the volume of nasal air. More air equals dryer passages equal fewer bacteria with less tissue reactions to ingested air particles.

JAW PAIN and Osteopathic Manipulative Treatment

By Martha A. Simpson, D.O., M.B.A.
Assistant Professor of Family Medicine
Ohio University College of Osteopathic Medicine


Question: A few weeks ago I began having pain in my left ear. I thought it was an ear infection, and I went to the doctor. He said I had a TMJ disorder. Could you tell me what causes this and what I can do to get better? My doctor is sending me to an oral surgeon. Will I need surgery?

Answer: Temporomandibular joint (TMJ) syndrome is a painful condition that causes inflammation in the joint created by the temporal bone in the skull and the lower jaw bone (or mandible). As you can see, the term “temporomandibular” comes from combining “temporal” and “mandible” to make an adjective. Therefore, the abbreviation "TMJ" literally refers to the joint itself, although it is often used to refer to the disorder rather than the joint.

There are many things that can cause this problem. Teeth that don’t align properly -- “malocclusion” in medical lingo -- is a very common cause. Some people grind their teeth -- a condition called bruxism. This usually occurs at night and can lead to pain in the TMJ. Injury to the jaw or the side of the head can also cause TMJ syndrome. And, you can get arthritis in the TMJ, just like any other joint in the body.

The primary symptom is pain with opening and closing the mouth. This pain is usually worse in the morning and is just in front of the ear. This pain can radiate to the ear, cheek, neck or shoulder. Some people also complain that their jaw catches when they open their mouth. Some people have a grating or clicking sound in their TMJ when they eat.

Your doctor probably made the diagnosis of TMJ syndrome by feeling this joint with his fingers while you opened and closed your mouth. This is a technique we call palpation. He may have felt clicking or deviation of the jaw to one side when you opened your mouth. Also, he may have noted that you couldn’t open your mouth as wide as normal. You may have indicated that you felt pain when he applied slight pressure as he palpated the joint. And, depending on the results of this physical examination, he may have asked for an X-ray or MRI to aid in the diagnosis of your condition.

In most cases, TMJ syndrome can be treated with dietary modifications to eliminate very chewy foods, gum chewing and ice eating. Non-steroidal antiinflammatory drugs (NSAIDs) like ibuprofen are also very helpful as is moist heat to the area a couple of times a day for 10-15 minutes. Some people who grind their teeth or have pronounced malocclusion benefit from a dental appliance that prevents the jaw from closing completely. This has been shown to relieve the symptoms in over 70 percent of patients with TMJ problems. Some cases of TMJ syndrome respond very well to osteopathic manipulative treatment; so, if your physician is a D.O., you might ask if this manual medicine technique might be effective in your case. Fortunately, the odds are you probably won’t need surgery. Statistically, the need for this is rare; it is indicated in less than 5 percent of cases.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnosis and recommend treatment for any medical conditions. Past columns are available online at

Sunday, February 26, 2006

Olympics Gold Medalist uses an osteopathic doctor for sports injury treatments

Apolo injury flares up at Games

11:02 AM PST on Wednesday, February 22, 2006

Apolo Anton Ohno is being treated for a flare-up of a leg injury he sustained last fall, according to his father, Yuki Ohno.

According to Yuki Ohno, Apolo had been feeling fine until his first day on the practice ice in Torino. Yuki Ohno told Mimi Jung of KING 5 News that getting Apolo healthy has been his primary focus and that his son's recovery this past week has been "phenomenal." He calls it a "miracle" that Apolo's been feeling much better.

When Jung spoke with Apolo Ohno after his 1,000 meter final, Ohno told her he had a lot of pain in his legs and Yuki Ohno attributes some of that to the ankle and hamstring injury. Yuki Ohno has a blog on and in it he wrote in part:

"He needed to overcome his injury, stemming from the ankle, connecting his pelvis to his hamstring firing pattern that he was troubled with since Day 1 at ice training session in Torino. His osteopathic doctor, Dr. Lavine from Tacoma, Wash., has been with him all week to heal his injuries.

"It's just so demanding, he needs to heal extremely quickly in order to be back on the level he should be. But it's been moving positively and his status has been upgraded every 24 hours. Day-to-day the difference in his healing is taking an amazing turn!"

U.S. Speedskating is now acknowledging there is some kind of physical problem, but they're downplaying it, saying they don't want to give out a lot of information and give opponents an edge.

Ohno skates today (Wednesday) in the 500 meters and will race in the 5,000 meter relay.

Dozens of teens turn out for health conference, learn about Osteopathic Manipulative Treatment

Source:By LACHLAN MACLEAN/Times Herald correspondent
Vallejo Times Herald

Touro University medical students reached out Wednesday to help dozens of local teens on a host of health issues from drug use to eating disorders.
In their first Teen Life Conference, 150 students from Touro's schools of osteopathic medicine, pharmacy and health sciences used lectures and one-on-one discussions to highlight more than 15 prominent health issues. Among the issues were allergies and teen pregnancy.

The conference also offered a number of health screenings, including blood pressure checks, skin and eye examinations and body mass index evaluations.

About 70 students from Vallejo's Jesse Bethel, Hogan and Vallejo high schools and Mare Island Technical Academy milled around the booths and lecture hall, hands full of informational pamphlets and handouts.

Aaron Aquino, 17, a Jesse Bethel High School senior, said the conference was very informative.

"They taught us important stuff about staying healthy, especially about STDs and drugs," Aquino said. "More students should come next time, because they don't focus too much on these subjects in high school."

Event organizers Samantha Pecson and Melody Padilla had been working on the conference idea since last summer.

"I think it was a good turnout for our first event," Pecson said. "We're very excited, students are coming and getting involved, and you can really feel the volunteers' enthusiasm. We hope they will come again next year and bring even more people."

John Glover, chairman of Touro's school of osteopathic manipulative medicine, said that in addition helping the teens, the medical students were able to get valuable experience diagnosing and discussing maladies.

"The (Touro students) are getting experience treating real people with real problems, and getting a chance to apply what they've learned in class," Glover said. "It's a good contrast to the lectures and lab work."

Richard Hassel, Touro's vice president of administration, said the event was "awesome," and he was "thoroughly impressed" with the event's organization.

"Part of our curriculum is community involvement, and it is important that Vallejoans take advantage of the benefits of having a medical school in their community," Hassel said. "I'm so proud of these future doctors; they did this on their own initiative."

David Swedler, 25, a student doctor of osteopathic medicine, said it was "very rewarding" to participate in the first Teen Life Conference, and hopes the event will grow in the future.

"It was great to be able to pull together as a school and do something good for the education and wellness of the Vallejo community," Swedler said. "I think everyone involved got something valuable out of this experience."

DO vs. MD and MD vs.DO?


If you are like most people, you probably don't know the difference between a medical doctor, MD, and an osteopathic doctor, DO.

DOs and MDs are alike in many ways:

Applicants to both DO and MD colleges typically have a four-year undergraduate degree with an emphasis on science courses.

Both DOs and MDs complete four years of basic medical education.

After medical school, both DOs and MDs can choose to practice in a specialty area of medicine—such as psychiatry, surgery, obstetrics, or sports medicine—after completing a residency program (typically two to six years of additional training).

Both DOs and MDs must pass comparable state licensing examinations.

DOs and MDs both practice in fully accredited and licensed hospitals and medical centers.

Both are medical doctors; MD is specifically Doctor of Medicine and DO is Doctor of Osteopathic Medicine.

What Makes DOs Different?
DOs can perform surgery, child delivery, treat patients, and prescribe medications in hospitals and clinic settings.

DOs look at the "total person." Osteopathic physicians focus on preventive care. Instead of just treating specific symptoms or illnesses, they look at the whole body.

DOs receive extra training in the musculoskeletal system, which is comprised of the nerves, muscles, and bones. This training gives DOs a better understanding of how an injury or illness in one part of the body can affect another part of the body; therefore, DOs have a therapeutic and diagnostic advantage.

DOs use what is called osteopathic manipulative treatment (OMT). OMT is a technique in which the DOs use their hands to diagnose injury and illness, giving special attention to the joints, bones, muscles, and nerves. Manipulations improve circulation, which in turn, creates a normal nerve and blood supply, enabling the body to heal itself.

Saturday, February 25, 2006

The Osteopathic Approach to Seizures

by Viola Frymann, D.O., F.A.A.O., F.C.A.

Seizures may occur at any stage in life from newborn to old age. But the etiology or underlying cause may vary from patient to patient. Rare causes are organic brain diseases.

For the child who develops seizures such conditions may be ruled out by elector-encephalogram, (EEG) computerized tomography (C.T.) scan or magnetic resonance imaging (M.R.I.).

Another causative factor may be trauma, a head injury following a car accident, bicycle accident, football or other high speed sports mishaps, a fall from a tree, or even an upper bunk especially if there is a door knob or hard table obstructing the fall and causing a focal blow to the head.

Such injuries will be identified in the course of history-taking and confirmed in many instances by X-ray (C.T. or M.R.I.). A far more common traumatic factor, and far less easily identified injury may have occurred during the process of birth.

The nine months of pregnancy is arranged anatomically and physiologically to provide the utmost protection to the developing baby within the mother's abdomen.

The process of labor whereby the baby is delivered into this world is also designed to bring the baby into this world without injury.

However modern "civilization" with high heeled shoes, refined, processed flavored, colored foods, chemical solutions in place of wholesome healthy drinks of spring water, exposure to toxic chemicals in the workplace as well as the stresses on the job may all bring detrimental influences to the developing baby within mother's body.

The period of pregnancy may be a healthy, happy, joyous experience until the expected date of delivery draws near. Labor begins, or at least the contractions seem like labor. Contractions continue, somewhat erratically for a few hours or days only to reveal themselves as false labor. The baby in the womb has been compressed by the uterine contractions on his buttocks and sacrum (the large bone at the base of the spine), and his head may have been compressed as it was pushed into the pelvis before the birth canal opened to permit an easy passage.

On the other hand there may have been no false labor, and the real labor begins according to expectation. Then mother experiences severe back pain, which suggests that the baby has turned face forward instead of face backward.

Progress is retarded because this position makes passage through the birth canal more difficult. This is but one of the possible traumatic events that can occur during the birth process and affect the delicate musculoskeletal mechanism of the baby.

Perhaps you can see that your baby has a crooked or asymmetrical head, perhaps your baby throws his head back forcibly and screams. This is like a cramp in the neck, and it hurts! But these are indications that the delicate nervous system within the skull and spine has suffered some degree of trauma.

There are many degrees and varieties of trauma that may occur during the birth process. Ten percent of babies may suffer visible, obvious trauma. Ten percent of babies may be perfect with free physiological motion and function throughout. But about 80% of new born babies may have less visible, but nevertheless significant strain factors within their body mechanism.

Some of these produce microscopic injuries to areas of the brain which may manifest exteriorly as jerking of muscles, spasms in parts of the body with or without changes in consciousness, and even full seizures affecting the whole body.

Other children may vomit after many feeds or they may have been slow to learn to suck effectively, they may cry inconsolably, their muscle tone may be markedly increased, and tense or limp or flaccid. There are other signs that may appear later in childhood that indicate that microscopic injury may have occurred during the birth process, but in areas of the brain that do not come into full function at the time of birth.

The osteopathic physician is trained to identify these subtle changes in the musculoskeletal system and apply gentle manipulative skills to correct them.

In many instances the neurological problems can be profoundly benefited by such treatment. The earlier in life the treatment can be given the better the results.

The magnitude of the brain injury is also a factor in the degree of response. When a child is diagnosed as having a seizure disorder various diagnostic tests will be performed and in many instances anticonvulsant medication will be prescribed. Progress under osteopathic treatment will be measured by reduction in intensity and frequency of seizures and in positive changes in the EEG.

However the objective of treatment regardless of the intensity or severity or the problem is to enable this child to function at the maximum of his/her potential.

Friday, February 24, 2006

Using Osteopathic Manipulative Treatment (OMT) to Treat Torticollis

Source: Pin-Chieh Chiang

A few weeks ago, a special visitor came to my school: a 5-month-old infant with torticollis. Torticollis is a condition where the muscles of the neck are contracted, producing slanting and twisting of the head to one side. The baby smiled and sat on his mommy's lap while 40-plus medical students sat in a half circle around him. Even when my professor, Dr. Cislo, approached him, he didn't shy away.

Dr. Cislo did not touch the baby right away. Instead, she worked on making eye contact. She let the baby play with her scarf and fingers, while she slowly made physical contact starting at the extremities. All the while, she was getting the history and physical from the parents and giving us students a demonstration of the proper way to approach a baby.

For those of you who aren't familiar with OMT (osteopathic manipulative treatment), it involves using the hands to diagnose, treat, and prevent illness or injury. Dr. Cislo proceeded to treat the baby with OMT. "Babies," she said -- "you have to treat them wherever they are, can't just position them and expect them to stay still." She showed this by working around the baby and mother, changing positions and adapting to the baby as he was breastfeeding, getting burped, or just fussing around.

The baby cried during the treatments, and it was hard not to cringe for him. But Dr. Cislo is a professional and she would show the mom how little force she was using through each technique so as not to worry her. Just as Dr. Cislo was explaining, "You know the treatment works when the baby calms down, because his pain is released," the baby actually stopped crying. From that point on, he was much more compliant.

After the treatment, my classmates and I watched for the baby's reaction. He was being his smiling, bouncing self. Like any other infant, he was happily playing with his toes. It didn't seem remarkable… until the mother said, "That's the first time he's played with his feet." A few days later, the mother contacted Dr. Cislo to remark on how her baby has turned over for the first time and how he can tolerate his physical therapy sessions much longer now. The mother also mentioned the indirect effects such as the baby being more playful, staying awake longer, eating better, and using his left arm more.

That day, it was very inspiring to see my professor in her physician mode. I know that a lot of my professors are more than just the lecturer I normally get to interact with. It makes me look forward to rotations, to when I will get more chances like these to learn first-hand from my professors. It was also very awesome to be able to see OMT work outside of the classroom. Often in the laboratory setting, I rarely succeed in treating my partners with OMT. This is because most of the time my partners don't have any serious problems and also because I am still learning how to execute the techniques properly. Still, I definitely love all the concepts of OMT; otherwise I wouldn't be at an osteopathic school.

This isn't intended to be a comprehensive clinical study about the effects of OMT. But on that day, this mother and her beaming baby had nothing but thanks for Dr. Cislo's wonderful work.

Osteopathic Medicine plus Osteopathic Manipulative Treatment (OMT)

Source:Missouri Association of Osteopathic Physicians & Surgeons

Osteopathic Medicine plus Osteopathic Manipulative Treatment (OMT) resembles the old country song, "I was country when country wasn't cool."

Osteopathic medicine's philosophy was based on holistic medicine by its founder A. T. Still in 1892, long before managed care and hospital systems began to market the holistic approach to health care. And, the osteopathic philosophy has withstood the test of time and scientific scrutiny; it is more widely accepted now than any time in its over 108 years of existence.

In a time when medical advances, state-of-the-art surgeries, miracle drugs and alternative medicine steal the pages of most every publication, osteopathic manipulation is an effective part of medical care provided by osteopathic physicians. Not alternative medicine - but traditional medical care with an added dimension of health care, provided to osteopathic physicians' patients.

OMT: Hands-On Care

Osteopathic physicians (D.O.'s) provide you with all the best that medicine has to offer. Their knowledge and use of the latest medical technology, complemented by a hands-on diagnosis and treatment tool known as Osteopathic Manipulative Treatment, or OMT.

D.O.'s use OMT to diagnose, treat, and even prevent illness or injury.

Osteopathic Medicine: A Unique Philosophy of Care

The Big Picture

Osteopathic physicians (D.O.'s) take a whole person approach to care. They look for underlying causes for a disease; they consider your physical condition, plus mental and emotional factors.

The Musculoskeletal System

D.O.'s believe that all of the body's systems, including the musculoskeletal system, work together, and that disturbances in one system may impact function elsewhere in the body.

D.O.'s place particular emphasis on the musculoskeletal system, which comprises two-thirds of the body's mass; they use OMT to manually assess and treat illness or injury.

OMT and How It Can Work for You

OMT is predicated upon your osteopathic physician's (D.O.'s) knowledge of medicine. While manipulative medicine is commonly associated with physical ailments such as low back pain, this far-reaching treatment modality can also be used to relieve the discomfort or musculoskeletal abnormality associated with a number of disorders.

The osteopathic approach to treating many diseases includes medication and/or surgical intervention, plus manipulation. OMT can relieve muscle pain and can hasten your recovery from illness/injury by promoting blood flow through tissues.

Your Structural Exam


Through extensive osteopathic training in manipulative medicine, osteopathic physicians (D.O.'s) can detect changes in tissue, however small, that signal injury or impairment.


Using a variety of OMT techniques, your D.O. will apply manual forces to your body's affected areas to treat structural abnormalities, and will then apply specific corrective forces to relieve joint restrictions and misalignments.

Who Can Benefit From OMT

Through OMT, people of all ages and backgrounds have found relief from pain and dysfunction.

Osteopathic Medical Education

Osteopathic physicians (D.O.'s) complete four years of medical training at one of the accredited colleges of osteopathic medicine. The osteopathic curriculum is intensive and broad-based. It includes comprehensive training in the musculoskeletal system and use of OMT.

Upon graduation from osteopathic medical school, D.O.'s complete a one-year internship, rotating through all areas of primary care. Then, they complete a residency in one of the more than 120 specialty and subspecialty areas of medicine.

D.O.'s and M.D.'s are the only recognized, educated and trained physicians to provide comprehensive medical care and have unlimited practice rights in all fifty states.

For further information on the differences, refer to our web site brochure, "What is a D.O., What is an M.D."

Tuesday, February 21, 2006

WHAT IS A DO( Doctors of Osteopathic Medicine)?

Doctors of Osteopathic Medicine (DOs) are the legal and professional equivalents of Doctors of Medicine (MDs). They are licensed to practice medicine in all 50 states and use all conventionally accepted therapeutic modalities such as surgery, radiology, and drugs. They are eligible to enroll in all federal programs, managed care and insurance plans, serve as commissioned medical officers in all branches of armed services, and serve as public health officers, coroners, insurance examiners, and team physicians. In other words, they practice complete medicine and surgery. Only DOs and MDs can do this.

DOs represent about 5% of the country's physicians and provide care for approximately 10% of the patients. This is because higher proportions of osteopathic medical graduates enter into primary care residencies after graduation compared to their MD counterparts.

Andrew Taylor Still, MD founded osteopathic medicine in the late 1800's in response to what he thought was poor medical practice at that time. He based osteopathic medicine on the following principles:

1) The structure of the body and its functions work together, inter-dependently.

2) The body systems have built-in repair processes which are self-regulating and self-healing in the face of disease.

3) The circulatory system provides the integrating functions for the rest of the body.

4) The musculoskeletal system contributes more to a person's health than only providing framework and support.

5) While disease may be manifested in specific parts of the body; other parts may contribute to a restoration or a correction of the disease.

The preparation and training of DOs is nearly identical to the training of MDs. Admission prerequisites and curricula are very similar. DOs can sit for the MD boards if they are interested in pursuing a MD residency after graduation.

The primary difference in their education is that DO students complete an additional 200-300 hours of training in osteopathic manipulative medicine (OMM). OMM is a modality used primarily to treat musculoskeletal problems and overlaps in its scope with physical therapy and manual medicine techniques. Also, DO schools place more emphasis on producing primary care physicians than do some MD schools. This means that during their clinical years, students at DO schools spend more time rotating through primary care specialties such as family medicine, pediatrics, obstetrics and gynecology, internal medicine, and psychiatry. Nevertheless, specialty training isn't out of the question for DOs. Many DOs seek and obtain residencies in surgical and non-surgical specialties.

Monday, February 20, 2006

What does "somatic dysfunction" mean?

[The following article was published in the San Diego Workers' Compensation Forum Newsletter. Osteopathic physicians frequently use the term "somatic dysfunction" to describe certain musculoskeletal diagnoses. This article was designed to explain this term to insurance adjusters and other Workers' Comp professionals.]
Patient A: 25 year-old male electrician presents with a stiff, sore neck of one day’s duration. Denies trauma. Spent previous day looking upward, pulling wires through ceiling. Started bothering him as he went to bed. Woke up not able to turn his neck.
Diagnosis: Neck sprain/strain (Somatic dysfunction: cervicothoracic junction)

Patient B: 20 year-old female visiting nurse slipped while descending staircase at a clients home. Managed to catch herself with the railing as she fell backwards, hence she did not actually strike the ground. No pain at the time, but within an hour or so, begins to feel sharp pain in the middle of the back associated with painful deep inspirations.

Diagnosis: Thoracic sprain/strain (Somatic dysfunctions: thoracolumbar junction and ribs)

Patient C: 35 year-old male construction worker bent forward to pick up a jackhammer that had been lying in a hole. Thought he felt a "tweak"/popping sensation as he stood up, but didn’t hurt. Next day, he begins experiencing aching in right side of his low back and finds he has some restricted movement in the region. No changes in his genitourinary or gastrointestinal systems, nor does he complain of radicular symptoms.

Diagnosis: Low back sprain/strain (Somatic dysfunction: lumbosacral region)

You know what a sprain/strain means – the patient did not sustain any bony injuries such as a fracture, i.e. a "soft-tissue" injury. But what about these "somatic dysfunction" diagnoses – is this doc trying to pad his bill?

No, in fact a Doctor of Osteopathic Medicine (D.O.) uses this term in an attempt to be more specific regarding their diagnoses. A sprain refers to a stretch-type injury of a ligament, whereas a strain refers to muscles and tendons. In the above mentioned examples, neither one of these mechanisms is responsible for the patients’ complaints. Rather, a mechanical restriction occurs first, which is usually followed by a reflex increase in muscle tone/spasm.

Allopathic physicians refer to this as "facet syndromes;" Chiropractors refer to them as subluxations. To osteopathic physicians, somatic dysfunction refers to impaired or altered function of related components of the somatic (body framework) system: skeletal, arthrodial, and myofascial structures, and related vascular, lymphatic and neural elements.

Recall the fact that humans are machines containing an internal skeletal supporting structure. The vertebral column contains 3 regional curves (cervical, thoracic, and lumbar), that can be easily visualized from the side. These curves are important because they help to cushion the discs and spinal cord from excessive or unexpected forces.

Sidebending a spine in its neutral posture (i.e. with curves intact) is generally well-tolerated and without ill-effects as the individual vertebral segments accommodate to the movement, as a group, and return back to their neutral postures once the movement is completed.

On the other hand, let’s say that there is a loss of normal curvature in a region when sidebending is attempted. The spinal mechanics are different. Rather than behaving as a group, a single vertebral segment must "give in" to allow for the segments above and below it to sidebend. [Try this simple experiment: fold an 8" x 11" piece of paper in half (so that it becomes 4" x 11"). Grasp the folded edge using the thumbs of both hands and attempt to bend the "spine" of the paper. You’ll observe that the paper must "kink" in order to promote bending.]

Incidentally, this "kink" doesn’t have to cause pain right away. In fact, the reflex mechanisms that kick in may not induce discomforts until 1-3 days later. Why the inspiratory rib discomforts seen with thoracic problems? This is because the rib heads articulate with the thoracic vertebral segments. If a particular segment is restricted in its motion, the adjacent rib will be affected, as well. Hence, a rib that is prevented from its normal inspiratory excursion causes pain (that often originates from the back and radiates anteriorly around the chest).

Finally, why bother using the term at all – isn’t sprain/strain still good enough for coding purposes? The reason has to do with a procedure called Osteopathic Manipulative Therapy (OMT). If a D.O. performs OMT as part of his/her overall treatment plan, a diagnosis of the appropriate regional somatic dysfunction needs to be included in order to support the need for this particular treatment modality (e.g. one wouldn’t code a laceration repair without a diagnosis of a laceration!).

Therefore, in summary, D.O.’s may list both the allopathic and osteopathic diagnoses as part of their assessments. The former to provide a sense of what is going on with the patient using conventional terminology, the latter to address billing documentation concerns.

So, what's the difference between Osteopathic and Chiropractic medicine?

Over the subsequent years, Still and the growing D.O. community integrated the Osteopathic principles and practices into their practice of medicine. That is, they would still use drugs or perform surgery if needed, but their general maxims were "Above all, do no harm." and "Keep it pure." In other words, D.O.'s were not defined by manipulation, rather, they were defined by their philosophy and manipulation/palpation happened to be a "really good tool" that was used. (In all honesty, D.O.'s didn't all agree that they wanted to do this; they were spurred on to do this by changes that were going on within the allopathic community, the Flexner Report on medical schools, etc.) D.C.'s, on the other hand, limited their practices strictly to manipulation, and did not teach "materia medicae" (essentially, medical therapeutics) in their schools at the time.

OK, back to the 1990's: Is there any difference between manipulation between a D.O. and a D.C.? Probably not. There are many different ways to mobilize joints and which technique is selected is more likely based upon the skill and comfort of the practitioner, not to mention the size/shape of the patient. I have chiropractic friends (who recently entered D.O. school incidentally) who would adjust me when I would need it using techniques very similar to mine.

How much manipulation training do D.O.'s receive? I can't quote the exact number of hours but they were a lot. In addition to our regular traditional medical school classes (anatomy, biochemistry, pharmacology, etc.), we would have at least one hour of Osteopathic Principles and Practices each day, for each semester that we were in classes. So generally, we spent longer times in school each day, in comparison to our M.D. colleagues.

What about holistic medicine? Do M.D.'s practice holistic medicine? As I noted, the concepts of structure and function being inter-related, etc. have all been pretty much accepted by the medical community nowadays, but whether or not most M.D.'s actually think about this is another matter. Philosophically, Osteopathy can be considered more closely aligned historically with Chinese medicine, which took a holistic approach. Allopaths (M.D.'s) philosophy stems way back to ancient Egypt where they used to have individual gods for different things. Body parts were sort of compartmentalized - there may have been a god to care for extremities, another for chest, etc.. This type of thinking does not lend itself as well to a holistic approach. The result today: the majority of D.O.'s practice primary care medicine and the majority of M.D.'s specialize.

Osteopathic Medicine Profession Overview


With 100 million patient visits to osteopathic physicians in the United States each year, it is clear that osteopathic medicine is gaining ever wider acceptance by the general public. Men and women holding the doctor of osteopathy, or D.O., degree can practice in a full range of medical specialties anywhere in the country. Most D.O.s, though, are in family medicine and the other primary care disciplines of general pediatrics, general internal medicine and general obstetrics and gynecology. To understand why this is so, it may help to understand a little about the profession's roots.

The osteopathic profession was begun in the late 19th century by Andrew Taylor Still; a man of strong passions, he was both a supporter of women's rights and an outspoken abolitionist. When the Civil War broke out, Still, not surprisingly, entered the Union Army to enlist in the fight to crush slavery and worked as a regimental surgeon. After a series of medical tragedies in his own family, Still dedicated himself to the study of the physical and mechanical structure of the human body.

In 1874 Still laid the cornerstone of osteopathic medicine by describing the principles and philosophy on which the profession was to be based. This philosophy viewed the human body as a single organism in which each part interacts with and influences every other part. D.O.s, therefore, are taught to treat each patient as a whole person, rather than focusing just on the area that is causing the immediate medical problem.

Osteopathic physicians are also specially trained to use a procedure called osteopathic manipulative medicine. This technique makes it possible for physicians, when appropriate, to use their hands to help diagnose illness and treat patients. By manually examining the patient, osteopathic doctors can detect subtle changes in the body's structure, with special emphasis on the joints, bones, muscles and nerves. By using direct or indirect pressure to move the muscles and bones, doctors often improve circulation and nerve response, helping the body heal itself.

What Still began was, in essence, a reform movement directed against the widespread abuses and inefficiencies of the health care of his time. Since then, osteopathic principles and manipulative techniques have become recognized as valid medical concepts which are as exciting now as they were a hundred years ago. This is because the osteopathic approach leads to a profoundly personal, "people-oriented" style of practice that today's medical students find very rewarding. During his or her medical education, the D.O. student learns to treat the person as well as the disease and is taught that the physician's role is to facilitate the body's own natural recovery mechanisms. It's not surprising that with this focus the majority of D.O.s become family doctors who provide the "grass roots" type of general health care so much in demand in the United States today.

Osteopathy and Osteopathic Manipulative Treatment Today

Osteopathy - Developed 130 years ago by physician A.T. Still, osteopathic medicine is one of the fastest growing healthcare professions in the U.S. and brings a unique philosophy to traditional medicine. With a strong emphasis on the inter-relationship of the body's nerves, muscles, bones and organs, doctors of osteopathic medicine, or D.O.s, apply the philosophy of treating the whole person to the prevention, diagnosis and treatment of illness, disease and injury.

Osteopathic manipulative treatment, or OMT, is hands-on care. It involves using the hands to diagnose, treat, and prevent illness or injury. Using OMT, your osteopathic physician (D.O.) will move your muscles and joints using techniques including stretching, gentle pressure and resistance.

Osteopathic Manipulative Medicine ( OMM )
What is it?

Started in 1874 by Dr. Andrew Still in the United States , Osteopathic medicine specializes in the spinal and joint health. Osteopathic therapy works with the natural healing abilities of the body and considers the whole person. Osteopathic physicians commonly treat the cause of the problem rather than focus only on symptom relief. The osteopathic approach is an emphasis on the person’s health instead of disease.

Osteopaths study the relationship between the structures and functions of the body. The approach considers the inseparable connection of the body’s functioning to the emotional and spiritual aspects of the person as well. At the core of Osteopathic Medicine is belief in the body’s innate ability to self- heal. The osteopath’s role is to find structural alterations and by manipulation, improve the structure and therefore the function. By restoring these, the whole body will maintain better overall health. Thorough knowledge of all systems of the body and training in the comprehensive osteopathic approach is the main difference between this and other forms of manipulative bodywork or therapy.

What can I expect?

The Osteopath will palpate and choose from a variety of techniques such as manipulation, casts, medication, or in severe situations, even surgery. Plans are made with you individually that will consider many aspects of your life. Most commonly, manipulation is part of every treatment plan. Manipulation is gentle and therapeutic. It may involve releasing restriction or dysfunction wit myofascial release, muscle energy (contracting your muscles), thrust techniques that cause “popping” sensations, or strain- counter strain (going into the position of strain).

What are the reported benefits?

The benefits list is as long as the types of dysfunction that can present in the body. Many people think that the benefits are isolated to back pain and injuries. However, Osteopaths specialize in treating the healthful functioning of the whole body.

How much does it cost?

Osteopaths practice in a huge variety of settings and environments so the cost will be influenced accordingly. They are licensed to practice the same scope of medicine as medical doctors so expect costs to be in a similar range.

What kind of training does my osteopath have?

Registered Osteopaths have a degree or diploma in Osteopathy. Osteopaths attend four-year osteopathic medical schools. In addition to traditional medical school, osteopaths receive 300-500 hours of structural diagnosis and hands-on treatment. Osteopaths are qualified to perform surgery and prescribe drugs. Many Osteopathic schools offer masters in public health, research, or education, or PhD’s, in combination with the Doctor of Osteopathy.

Myofascial Pain Syndrome (MPS) and Osteopathic Manipulative Treatment

Myofascial Pain Syndrome (MPS) is a is a painful musculoskeletal condition, a common cause of musculoskeletal pain. MPS is characterized by the development of Myofascial trigger points (TrPs) that are locally tender when active, and refer pain through specific patterns to other areas of the body. A trigger point or sensitive, painful area in the muscle or the junction of the muscle and fascia (hence, myofascial pain) develops due to any number of causes. Trigger points are usually associated with a taut band, a ropey thickening of the muscle tissue. Typically a trigger point, when pressed upon, will cause the pain to be felt elsewhere. This is what is considered "referred pain".

These factors can cause trigger points:

•Sudden trauma to musculoskeletal tissues (muscles, ligaments, tendons, bursae)
•Injury to intervertebral discs
•Generalize fatigue (fibromyalgia is a perpetuating factor of MPS, perhaps chronic fatigue syndrome may produce trigger points as well)
•Repetative motions; Excessive exercise; Muscle strain due to over activity
•Systemic conditions (eg, gall bladder inflammation, heart attack, appendicitis, stomach irritation)
•Lack of activity (eg, a broken arm in a sling)
•Nutritional deficiencies
•Hormonal changes (eg, trigger point development during PMS or menopause)
•Nervous tension or stress
•Chilling of areas of the body (eg, sitting under an air conditioning duct; sleeping in front of an air conditioner)

The fascia is a tough connective tissue which spreads throughout the body in a three dimensional web from head to foot without interruption. The fascia surrounds every muscle, bone, nerve, blood vessel and organ of the body, all the way down to the cellular level. Therefore, malfunction of the fascial system due to trauma, posture, or inflammation can create a binding down of the fascia, resulting in abnormal pressure on nerves, muscles, bones or organs.

This can create pain or malfunction throughout the body, sometimes with bizarre side effects and seemingly unrelated symptoms. It is thought that an extremely high percentage of people suffering with pain and/or lack of motion may be having myofascial problems; but most go undiagnosed, as the importance of fascia is just now being recognized.

Many of the standard tests, such as x-rays, myelograms, CAT scans, eletromyography, etc., do not show the fascia. (John Barnes, P.T., 1992)

Occassionally, trigger points produce autonomic nervous system changes such as flushing of the skin, hypersensitivity of areas of the skin, sweating in areas, or even "goose bumps." The trigger points cause localized pain, although TrPs can involve the whole body.

In three studies, the prevalence of myofascial TrPs among patients complaining of pain anywhere in the body ranged from 30% to 93%; (among patients with chronic craniofacial pain, 55%; and for lumbogluteal pain, 21%.)

The characteristic electrical activity of myofascial TrPs most likely originates at dysfunctional endplates of extrafusal muscle fibers. This dysfunction appears to play a key role in the pathophysiology of TrPs. (Simons 1996)

Subjective shortness of breath can be part of the myofascial pain syndrome of the levator scapulae muscle. In one study, 75 patients who reported neck pain & shortness of breath were examined. Trigger points were located and inactivated with acupuncture needles (dry needling). 68 of the 75 patients in the study reported that their shortness of breath and soreness were abolished immediately after inactivation of the TrPs. The other 7 patients needed a second trial of inactivation. Eliminating the trigger points eliminated the symptoms. (Journal of Muskuloskeletal Pain, 1996)

Like fibromyalgia, Myofascial Pain syndrome is an often misunderstood condition. Even today, some doctors either don't believe that MPS exists or they don't understand its symptoms and treatment.

Treatment of MPS can only begin after an accurate diagnosis is accomplished. Methods for managing this painful condition:

• Trigger Point Therapy {Myofascial release therapy, myotherapy, massotherapy (medical massage therapy)}
• Spray and Stretch technique (stretching of the muscles involved with a vapocoolant spray - a coolant is sprayed on the trigger point to lessen the pain and then the muscle is stretched. this is often done by a physical therapist.)
• Trigger Point Injections (local anesthetic,such as lidocaine, injected directly into the trigger points)
• Dry Needling (the use of a needle without injecting anything)
[TrP injections and dry needling mechanically disrupt the tirgger point. The use of lidocaine is no more effective, but it reduces the soreness afer injection. For MPS there is no role for injected steroids]
Osteopathic manipulation treatment
• Craniosacral Therapy
• Physical Therapy (hands-on)
• Exercise
• Improvement of nutrition
• Changing sleeping habits
• The use of tricyclic antidepressants in low doses
• Elimination of stress; Biofeedback; Counseling for depression that may result from this painful condition

An active trigger point when treated well or with rest will become latent (quiet, or not causing active symptoms). It can often resurface after trauma after acute overload or fatigue, or even sudden exposure to cold. Conversely, new trigger points may arise elsewhere, or at least become more sinificant as others become latent.

For MPS, you should see a doctor knowledgeable in chronic pain such as a physical medicine doctor (a physiatrist), or a neurologist. The diagnosis is made by the history and physical exam. There is no lab test nor imaging studies to confirm the diagnosis. A history of acute trauma or chronic overuse should be looked for.. On exam, there is typically restricted motion with pain of the affected muscle. Other medical problems need to be ruled out with imaging or other studies. For instance, if a patient presents with back pain, disc and other problems need to be ruled out.

Altered Pain Perception Accompanies MPS: A Danish study indicates that people with chronic myofascial pain perceive and transmit pain differently than people without the syndrome. As many as 72 percent of people with fibromyalgia may have trigger points associated with myofascial pain.
Source: "Qualitatively altered nociception in chronic myofascial pain," by L. Bendtsen, R. Jensen, and J. Olesen, Pain, 65 (1996), pages 259-264

Osteopathic Philosophy

Good Book:

Osteopathic Medicine:
Philosophy, Principles and Practice.

Published by Blackwell Science,
March 2001.

“At this late date many seem to forget that a basic discovery of Dr. Still was the fact of immunity…. The whole living structure (not just the backbone) which embraces function, or vice versa, is something more than just a sum of the parts; and the sum of the parts is not confined to one class of tissue, e.g. bones…. The practical everyday problem resolves itself into what the individual measure of the particular case is. It is not a composite collective one, but composite and unified, with multiplicity in unity. ”
JAOA , March 1935.

Sunday, February 19, 2006

AT Still Quotes


“A student of life must take in each part of the body and study its uses and relations to other parts and systems”

“...fascia and its nerves demand his attention first, and on his knowledge of the same, much of his success, and the life of his patients do depend.”

“No two or more organs can work perfectly when one is crowding on another.”

AT Still DO,MD.

Friday, February 17, 2006

Muscle Energy Technique


Founder: Mitchell Fred L. Sr., D.O., F.A.A.O.

Principles: A series of articular tests evidences articular hypo- and hyper-mobility due to muscular spasms and hypertonicity. Recourse to isotonic contractions against resistance modifies the muscle’s state of contraction and frees the articulation.

Method: According to the ascertained articular problem, there is a specific position of correction where the patient is asked to effect three isotonic contractions against resistance supplied by the osteopath.

all types of acute and chronic articular hypomobility and hypermobility. This method is also indicated for children and is an excellent alternative to the generally more invasive classic manipulations.

Osteopathic Medicine Philosophy

Source: (c) 2000, 2001 June Leslie Wieder

In 1874, Andrew Taylor, M.D., became dissatisfied with the existing medical fields and the use of dangerous drugs and compounds for "curing" illnesses. Taylor believed that the body has an inherent ability to heal itself if its systems were in balance.

Taylor felt that a doctor could promote self-healing by minimizing obstructions to blood and lymph flow, and keeping the musculoskeletal system in alignment. He developed techniques to manipulate soft tissue and bone. His work was instrumental in laying the groundwork for osteopathy medicine.

Dr. William Sutherland enrolled in a unorthodox medical school in the late 1890s. Later, as an osteopath, he was intrumental in advancing and changing the concepts of "self-healing."

Dr. Sutherland's theory that the central nervous system was in "constant rhythmic motion" was later validated by advanced diagnostic equipment. This constant rhythmic motion was found to be essential for life and well being. He believed that a dysfunction in one area of the body would lead to a compromise of the entire structure of the body.

In "Five Components of the Primary Respiratory Mechanism," Dr. Sutherland summarized the working principles of osteopathy:

1. There is motion at the cranial sutures, the joints linking the 26 bones of the skull

2. There is expansion and contraction of the hemispheres of the brain

3. There is motion of the membranes covering the brain and spinal cord

4. There is a fluid wave within the cerebrospinal fluid that baths the brain and spinal cord

5. There is involuntary, subtle motion of the sacrum.

These principles are the basis of the treatment protocols of osteopathic medicine.

Osteopathic medicine is similar to traditional, or allopathic, medicine but it places a much greater emphasis on the role of normal body mechanics and the musculoskeletal system. One of the principles of osteopathic medicine is that the patient's illness and traumas are stored within the structure of their bodies

The osteopath is trained to palpate (touch) the body to detect tissue texture, flow of fluids, and motion of joints, and to seek out impairments caused by traumatic injuries and chronic or acute illnesses. The objective of the osteopathic physician is to restore the body to its normal or full function by applying a precise amount of force to promote movement of fluids, (a rhythmic flow of cerebrospinal fluid in the brain and spinal cord), decompress joints and bones , and increase tissue function.

The body is a unit where dysfunction in one areas can affect another area. For example, a disc problem in the neck can pull the legs and affect the way we walk. Treatment for the legs can significantly reduce the neck pain.

Osteopaths treat birth and pediatric problems such as palsy, colic, and learning disorders. They also treat neck and back problems such a headaches, sciatica, overuse syndrome and trauma.

Among the systemic problems successfully treated by osteopaths are, nerve problems, digestive disorders, infections,such as sinitus and colds, chronic ear infection, respiratory promblems such as asthma and allergies.


Ortho-Bionomy is a gentle non-invasive approach.that is osteopathically based. The practitioner uses gentle movements and positions of the body to facilitate change and reduce stress patterns. Arthur Lincoln Pauls, the creator, choose to work with the line of lease resistance. Ortho-bionomy means "a correct application of the natural laws of life."

During a session, tension points and restricted movements are located. Slight compression is applied while gentle rocking and holding an area until a release has occurred.

Ortho-Bionomy has been found to be effective for chronic pain, injuries, and structural imbalances.

Craniosacral Therapy

Dr. John E. Upledger who is an osteopathic physician and surgeon, developed therapies that he calls Craniosacral Therapy and Somato-Emotional Release. These therapies are based on the theories of William Sutherland. D.O.

Dr. Upledger's success is largely due to his extensive clinical research and his committment to look beyond conventional approaches. .He is considered one of the leading authorities in whole-body therapies.

Craniosacral is non-invasive, gentle approach. This technique was developed by an osteopath to balance the flow of the cerebralspinal fluid that circulates in a loop from the skull to the sacrum. This craniosacral system uses the menigeal system (the membranes of the brain and spinal cord) which constantly bathes the spinal cord and brain. The CSF is continuosly pumped in a rhythmic fashion with contraction and expansion.

Restrictions to the flow can result in a number of neuromuscular disorders and create chronic pain.

The practitioner first seeks to locate restrictions in the cerebrospinal fluid flow, which most often occurs in the skull and pelvis. Treatment consists of gentle pressure on bones and soft tissue from the head to the base of the spine to improve circulation of the cerebrospinal fluid. Sessions last up to one hour.

Most effective for treating head traumas, headaches, sinus congestion, TMJ, behavorial problems and neurological impairments. Used on infants who suffer from respratory and digestive disorders (colic) congenital, and genetic problems.

Myofascial Release


Myofacial release is an osteopathic term coined by Dr. Robert Ward John, Barnes, a physical therapist developed a system that evaluates the fascia by using osteopathic methods, craniosacral therapy, Structural Integration, and physical therapy.

Myofascial release is a gentle approach that identifies and releases constricted areas in the connective tissue surrounding nerves, muscles, and bones. The belief is that the connective tissue becomes constricted due to illness, stress, or injury.

Treatment consists of strokes and stretching called unwinding, which helps the practitioner find specific areas of trauma called still points. Sessions can be from 30 to 90 minutes. Myofascial therapists also teach the patient

stretching exercises to help them maintain their health.

Myofascial release relieves pain associated with muscle tightness, headaches, fibromyalgia, and scoliosis, and can help recovery from injury.

Myofascial therapy provides relief for chronic neck and back pain, and aids in the recovery of spinal cord injuries. It also is effective for traumatic stress syndrome and some disorders of the nervous system.



Osteopathic treatment concentrates on the relationship between the structure of the body - the skeleton, muscles, ligaments and connective tissue - and the way in which the body moves and functions. The literal meaning of the word osteopathy is 'bone disease' - a rather unfortunate term that does nothing to evoke the great benefits of this safe, natural system of diagnosis and treatment. To an osteopath, the body functions as a complete, working system, so any problems affecting its structure, upset the balance of our general health. For this reason, an osteopath will not simply want to ease the pain and stiffness in your neck, but also want to know what is causing that pain, which could be anything from physical injury to mental anxiety.

The therapy was devised in the 19th century by an American doctor, Andrew Taylor Still. He became disillusioned with medicine when three of his children died of viral meningitis. Still sought an alternative in the philosophy of Hippocrates, who claimed that the 'cure of disease lies within the body'. An interest in osteopathy developed through his belief that tension in muscles and misaligned bones places unnecessary strain on the body. This strain can be caused by any number of things, such as physical injury, bad posture, or by emotions such as anger and fear.

Whatever the cause, Still believed it could be eased by adjusting the framework of the body, so that all the systems within it would run smoothly and the body could heal itself. Of all the bone structures in the body, Still considered the vertebrae of the spine to be the most important. Still's reasoning was simple: the spine protects the spinal cord, a major part of the nervous system, and the nervous system penetrates every area of the body, controlling voluntary and involuntary movement and registering every sensation, from the most delicate smell, to tortuous pain. Still believed that anything interfering with the nervous system could resonate in every area of the body.

Osteopathy is not just about bones - easing muscular tension also plays a considerable part. This belief that a relaxed muscle will feel comfortable, is based on the physiological fact that muscles use up energy when they contract, wastes energy and makes muscles less elastic, and therefore more prone to becoming damaged. Tense muscles slow down the circulation and lymphatic systems, so that your body's growth and elimination processes are restricted. They inhibit heart function and can worsen the effects of common respiratory conditions, such as asthma.

Osteopathy is a hands-on therapy. Through touch, massage, manipulation and stretching techniques, an osteopath can diagnose and treat people with physical and emotional problems. Since osteopaths are concerned with the structural integrity of the whole person, there are no formally recognized specialities. However, some practitioners develop their expertise in specific fields, such as the treatment of children, elderly, sports injuries or pregnancy-related problems. Similarly, some osteopaths choose to concentrate on certain methods, such as cranial technique, which focuses on the patient's breathing and the nervous system, concentrating on diagnosing and correcting imbalances through gentle manipulation of the skull.

Other practitioners specialize in visceral techniques, in which the internal organs are manipulated by massaging the abdomen or working on the nerve centers along the spine. This form of osteopathy can improve the position of an organ, break down adhesions, ease congested tissue and improve muscle function. Osteopaths often liken their therapy to a three-legged stool; one leg represents the chemistry of the body, which relies on a healthy diet for strength; the second represents the physical structure of the body; and the third symbolizes emotion, mental and spiritual health. The seat is the influence of the heredity over the whole person. Just as the stool can't balance if one leg is broken, a person can't be healthy if one aspect of their health is affected. This is why an osteopath will treat every aspect when relieving a disease which appears to affect only one.

Muscular and joint pain, backache, sciatica, headaches, sports injuries, arthritis and rheumatism can all benefit from osteopathy. It can ease the discomfort of pregnancy and PMS and the gentle touch of pediatric and cranial osteopathy can benefit children, from easing colic to calming hyperactivity.

Wednesday, February 15, 2006

Website Pick of the Month!

Great Website!

Many Thanks to Wesley Beth Reiss, D.O. for an excellent website full of nice articles.



Cranial Osteopathy is a prominent sub-specialty of Traditional Osteopathic medicine, and was discovered, developed and taught by William Garner Sutherland, DO, starting with his own research in the early 1900s and continuing ceaselessly until his passing in 1954. He determined that there is a palpable movement within the body that occurs in conjunction with the motion of the bones of the head. This is a rhythmic alternating expansion and contraction motion in the cranium, independent of the rhythms of heart beat or breathing, which is part of the Primary Respiratory Mechanism (PRM). This motion exists in every cell of the body and can be felt and worked with in any part of the body by a trained physician. The aim is to free up restrictions in the PRM and allow the subtle natural rhythms of the central nervous system to express themselves in a balanced fashion.

Cranial Osteopathy is uniquely suited to treat problems related to the skull and brain, yet it can potentially affect any situation arising from disease or trauma in the body. Even an almost imperceptible alteration of the skull's natural configuration and movement in infants can lead to such disorders as colic, the inability of the baby to swallow, or frequent spitting up or delayed development. Trauma affecting this mechanism can lead in adults to low back problems, headaches, breathing and digestive disorders, joint pains, menstrual disorders and repetitive stress injuries such as tendinitis.


With the heightened awareness of cranial manipulation, it is vital to understand the distinctions between "Cranial Osteopathy" (also known as Osteopathy in the Cranial Field) and "craniosacral therapy." Only DOs, MDs, DDSs or DMDs have the comprehensive education to fully diagnose and treat patients - and to practice Cranial Osteopathy. In fact, Dr. Sutherland always emphasized that the cranial concept was only an extension of, not separate from, Dr. Still's science of Osteopathy.

Physicians with training in Cranial Osteopathy recognize that the PRM impacts every cell of the body, interfaces and guides the physiology of the entire body and is not restricted to the cranium, spinal cord, dura and sacrum. Osteopathic physicians do not separate the body into a somatic portion and a cranial portion but instead treat the body as a whole. When working on any one part, the physician is in contact with all parts. Therefore medical and scientific knowledge is essential when treating with Cranial Osteopathy and in-depth knowledge is acquired only with a comprehensive medical education.

Some of Dr. Sutherland's techniques have been isolated and simplified by John Upledger, DO in the 1970s to create what he calls "Craniosacral therapy." Claiming full credit for these techniques, Dr. Upledger states, "The requirements to do craniosacral therapy were dedication, compassion and sensitivity... not organic chemistry, neurology, materia medica or other science courses." The Upledger Institute is open to all licensed health care practitioners, though the majority of practitioners trained in "craniosacral therapy" are massage therapists, chiropractors, and physical and occupational therapists.

A final word on Cranial Osteopathy from it's discoverer, Dr. Sutherland...

"Have you ever had a thought strike you?

I have told many times of the thought that struck me before I graduated from the American School of Osteopathy. [In trying] to prove that motion between cranial bones in the living adult is impossible ... I gained knowledge not only of the articular mobility of the skull but also of the Tide and something within that I call the 'Breath of Life.' I do not consider this contribution of thought mine - I call it a guided thought.

The goal with your patients is to find the way to healthy function within the mechanism that they bring to you. Study the Life principle and come closer to understanding what I mean by the 'Breath of Life.' To the digger who will take time to dream and the dreamer who will wake up and dig, the science of osteopathy will unfold into a magnitude equal to that of the heavens."

Edgar Cayce and Osteopathic Medicine


Since age 21, Edgar Cayce (1877-1945) demonstrated the uncanny ability to put himself into a kind of self-induced sleep state by lying down on a couch, closing his eyes, and folding his hands over his stomach. This state of relaxation and meditation enabled him to place his mind in contact with what many believe to be all of time and space. From this state he could respond to questions as diverse as, "What are the secrets of the universe?" to "How can I remove a wart?" His responses to these questions came to be called "readings" and contain insights so intriguing and detailed that even to this day individuals have found practical help for everything from maintaining a well-balanced diet and improving human relationships to overcoming life-threatening illnesses and experiencing a closer walk with God.

Six decades ago this farmer from Kentucky, who became one of the most versatile and credible psychics ever known, was already emphasizing the importance of diet, attitudes, emotions, exercise, and the patient's role - physically, mentally, and spiritually - in the treatment of illness. As a result, he has been sometimes been called "the father of holistic medicine" and has been recognized for foreseeing the direction of health care.

Edgar Cayce was a strong proponent of Traditional Osteopathy above all other forms of medicine and manual therapy. Out of 14,000 total readings during his lifetime, he specifically recommended Osteopathy over 6,000 times, such as in this quote...

"There is no form of physical mechano-therapy so near in accord with nature's measures as correctly given osteopathic adjustments. Others may say what they may, but prove it by watching those who have them regularly, and who depend on them." (reading 1158-31)

For additional information on Edgar Cayce and the foundation that continues the research into his compelling work, please follow the link provided below.
Since age 21, Edgar Cayce (1877-1945) demonstrated the uncanny ability to put himself into a kind of self-induced sleep state by lying down on a couch, closing his eyes, and folding his hands over his stomach. This state of relaxation and meditation enabled him to place his mind in contact with what many believe to be all of time and space. From this state he could respond to questions as diverse as, "What are the secrets of the universe?" to "How can I remove a wart?" His responses to these questions came to be called "readings" and contain insights so intriguing and detailed that even to this day individuals have found practical help for everything from maintaining a well-balanced diet and improving human relationships to overcoming life-threatening illnesses and experiencing a closer walk with God.

Six decades ago this farmer from Kentucky, who became one of the most versatile and credible psychics ever known, was already emphasizing the importance of diet, attitudes, emotions, exercise, and the patient's role - physically, mentally, and spiritually - in the treatment of illness. As a result, he has been sometimes been called "the father of holistic medicine" and has been recognized for foreseeing the direction of health care.

Edgar Cayce was a strong proponent of Traditional Osteopathy above all other forms of medicine and manual therapy. Out of 14,000 total readings during his lifetime, he specifically recommended Osteopathy over 6,000 times, such as in this quote...

"There is no form of physical mechano-therapy so near in accord with nature's measures as correctly given osteopathic adjustments. Others may say what they may, but prove it by watching those who have them regularly, and who depend on them." (reading 1158-31)


by Wesley Beth Reiss, D.O., P.C.

If you get a deep cut in your finger, the attending doctor will disinfect, close, and bandage the wound. In a week the cut is mended. Did the doctor heal you? Actually, no. Your own body did. But the physician assisted - by setting the stage and removing obstacles that might interfere with your body's repair processes. In much the same way but with a larger scope, a physician who practices traditional Osteopathy (or Osteopathic Manipulative Medicine) removes the impediments to normal body functions and corrects the physical abnormalities that cause disease and inhibit recovery. This allows your own innate healing abilities to come forth and restore you naturally to optimal health.

Osteopathy is both a type of medical practice and a philosophy - interchangeable and inseparable. Practitioners have their knowledge solidly rooted in the nuance of anatomy, their guidance found in the unerring wisdom of the body, their partner in healing the elemental energies of life. Doctors of Osteopathy (D.O.s) are fully licensed physicians with credentials equal to M.D.s, who practice all phases of medicine, including writing prescriptions and performing surgery. However, they are trained to look at the whole person; mind, body, and spirit, rather than focus on diseased parts. They understand that the human body has a nearly unlimited power to heal and maintain itself, but sometimes needs assistance in removing obstacles that block it from achieving its full health potential.

D.O.s have learned how the body’s systems work together, and why a small physical disturbance in one area may greatly impact functions elsewhere. They are concerned with determining what is causing an imbalance in the body and why. Osteopaths have found that once the underlying causes have been diagnosed, treated, and removed, the body is then free to repair itself or to respond to other appropriate therapies more successfully.

History of Osteopathy

Traditional Osteopathy is an entirely American form of holistic medical care that was developed in the late 19th century by Andrew Taylor Still, MD. Dr. Still, a frontiersman and civil war physician, was dissatisfied with the crude and often toxic medicine of his day. By observing wildlife and the elegant relationship between structure and function, he originated a new system of medicine, which he called "Osteopathy." He noted that when adequately nourished and rested, the body can heal and maintain itself if all its parts are in their correct position and free to move within the normal range of motion. Dr. Still developed the first manipulating techniques in modern medicine, used to restore structure and function, and started treating his patients with this new concept in 1874. Owing to his ever-growing success and the demand that generated, he founded in his home town of Kirksville, Missouri the first Osteopathic college in 1892. 19 such colleges are now teaching Osteopathy nationwide.

The full benefits of Osteopathy were widely revealed during the Great Flu Epidemic of 1918. 500,000 deaths were seen in the United States from this disease, and those who were admitted to hospitals had an alarming fatality rate. However, patients treated by Osteopaths had only one sixteenth as high a fatality rate. Their mobilized immune system effectively fought the infection, while congestion in the lungs and other waste products from virus die-off were thoroughly drained.

One of Dr. Still's students, Dr. William Garner Sutherland, greatly expanded the science of Osteopathy by developing in the late 1930's the field of "Cranial Osteopathy." He found that the primary rhythm of the body, from which all other energy flowed, was revealed in the pulsing of cerebral and spinal fluids. This rhythmic pulse, not related to heartbeat, respiration, or any previously known cycles of the body, creates a coiling and uncoiling of the spinal cord that can be felt by a trained practitioner anywhere on the patient. Special osteopathic manipulation of the cranial bones and sacrum can then gently free up restrictions and balance this primary rhythm movement. The functioning of the central nervous system is improved, which then impacts the health of the entire body. His concepts and therapies were so unique, even to Osteopathy, that he worked for decades before they were finally accepted by his colleagues.

As Osteopaths struggled after WWII to gain equal recognition as MDs, their practices shifted as well in that direction towards conventional allopathic medicine. The manipulative techniques that made them special were all but lost. One of the few Osteopaths who steadfastly maintained the techniques and philosophy of traditional manipulation during this time was Dr. Robert Fulford, who helped bring back Dr. Still's and Sutherland's teachings to the newest generation of physicians. His own work included the development of the Fulford Percussor as well as a profound study of how Osteopathy affects and enhances the energy field of the body. Dr. Reiss had the privilege to train under Dr. Fulford, and more than any other physician, she models the principles of her practice after his work.

Today, Osteopaths comprise about 5% of all physicians in the U.S., but with their comprehensive training and personable orientation make up 15% of all rural doctors. Unfortunately only 1 out of every 10 Osteopaths nationwide actually use their traditional manipulative techniques as a primary modality. The remaining large majority, perhaps owing to the relative convenience, continue to put aside their holistic training and practice mostly conventional medicine identical to their allopathic MD counterparts. This ratio may be changing, as it has been reported that more medical students "see the writing on the wall" and are shifting their emphasis towards the ever-more-popular holistic approach of Traditional Osteopathy. Dr. Still's and Sutherland's work has also generated over the past century several "spin-off" therapies, including chiropractic and "craniosacral," which by their origin are limited to a small percentage of an Osteopathic physician’s training and full range of healing techniques.

How Osteopathy Works

Osteopathy has been defined as "a comprehensive system of diagnosis and treatment, based on the interrelationship of anatomy and physiology, for the study, prevention and treatment of disease." The entire body, if adequately nourished, functions to maintain, repair and heal itself to the best advantage if its structure and physiological functioning are in proper order.

Osteopathy emphasize the following four fundamental principles:

The human being is a dynamic unit of function.
The body possesses self-regulatory mechanisms which are self-healing in nature.
Structure and function are interrelated at all levels.
Rational treatment is based on these principles.

Doctors of Osteopathy understands that health will manifest to its fullest potential only when all parts of the body are in correct relationship to one another and free to move within their normal range of motion. They know that resistance to disease depends on normal blood and nerve supply. Such integrated totality emphasizes the fundamental need for the physician to consider the individual who has the diseases rather than the disease which has the individual - the principal approach being through proper normalization of the total body structure.

When putting these principles into action, they first find imbalances in the anatomy, often old and hidden, by touch. They then apply gentle manipulation to the bones, muscles, organs, and all connective tissue over the entire body to restore normal structure and remove restrictions. This enhances all circulatory systems, allowing the body’s own healing powers to better reach ailing areas. D.O.s also consider how all aspects of a patient’s life, including diet, exercise, physical and emotional stresses, genetic, and environmental and occupational issues, influence their overall state of health.

By combining natural therapies with a physician’s knowledge of western medicine, Traditional Osteopaths work to correct the true underlying cause of dysfunction. They can relieve pain, prevent disease, and speed recovery from nearly all medical problems. Often they can reduce or even eliminate the need for more intrusive therapies such as medication or surgery.

Osteopathy and Dentistry

Source: Dr. Farid Shodjaee
St. Laurent Dental Centre Ottawa, ON

Cranio-Dental Orthopedics

Dentists and Osteopaths are working together more and more nowadays. This makes great sense, because there is a fundamental relationship between proper, balanced movement in the face and mouth and in the rest of the body. In other words, there is a body attached to the head! The connection between the position of the teeth when the jaw is closed (OCCLUSION) and how osteopathy can influence this by working on the head and body as a whole is very complicated.

The Importance of Treatment

There are direct connections between the alignment of teeth, the symmetry of the joints, the curves of the spine, the levels of the shoulder blades and pelvis, and leg length.

You can see this for yourself if you wear an appropriate heel lift in your shoe for just a day; afterward there may be discomfort in the areas that are connected.

It is important for those who have malocclusion to have their whole bodies examined by an Osteopath. If the problems in the jaw are solved, then many other connected problems can also be helped. Among these are:

Breathing difficulties
Dteriorating eyesight
Hormonal problems
Painful teeth

Sometimes a common toothache may be due to a problem of restricted movement in the upper part of the neck. An over-stimulated nerve in this area irritates the nerve in the face.

Most people think that the skull and the face are made up of a bones that do not move. From the observation and work of skilled osteopaths, however, it is clear that the head is instead a dynamic and mobile structure. All the bones in the cranium are designed to move, or "breathe" slightly - the primary respiratory mechanism or PRM. The sutures joining the bones together are like movable hinges, allowing a gentle spreading; this gives a pumping action to the system, without which it will not work as it should.


Distortion of the Jaws (MALOCCLUSION)

In my practice I am concerned with the size, shape and relationship of your teeth so that they fit together properly. Underdeveloped or distortion of one or both jaws and therefore the teeth are well recognized in dentistry. Corrections must be done directly by developing the arches and straightening the teeth by various kind of braces.

We need our jaws to fit together well to have a healthy gums and teeth. The joints and the soft tissues that work the jaws also depend on this. If all is as it should be, we can talk, chew and grind without causing any problems.

he ligament that attaches the teeth to its socket is called the periodontal ligament. It is highly sensitive and richly supplied with nerve fibers. This is how we are aware of even the smallest variation of pressure on each tooth remember what it feels like to have a piece of celery string caught between your teeth! This sensitivity shows how important it is to have even contact between the teeth.

Signs of Malocclusion
There are a number of clear signs and symptoms that show problems in how a person’s jaw fits together. Among these are heavily worn teeth, shiny spots or grooves on fillings and teeth that are not straight in the jaw. The patient may also have had problems with broken teeth or fillings; clenching or grinding of teeth (especially at night); white lines in the mouth; and scalloped edges to the tongues.

Malocclusion can begin with a difficult birth, inherited problem of too many or too few teeth, a blow to the face or jaw or poor diet can also create difficulties. Even where it looks like a child may have inherited some problems, though, there are likely t be other factors that could benefit from osteopathic and dental treatment. Ideally, treatment should begin as soon as possible after the birth.

Birth Trauma and Malocclusion
It has been known for some time that many problems that dentists are called upon to deal with are developmental. and may in part be caused by difficulties during the birth of a baby. Osteopathic work with the primary respiratory mechanism has further recognized the significance of such trauma. The process of birth can sometimes compress the head, and such babies may have asymmetric faces and unusually high palates.

Some of the following symptoms in an infant or young child can suggest problems:

Behavioral or learning difficulties
Recurrent ear infections
Eye problems
Nasal symptoms
Difficulties in swallowing
Daytime tiredness
Habits such as breathing through the mouth, thumb-sucking, tongue-thrusting, biting the lips, sleeping only on one side of the face and early or late loss of baby teeth are signs of difficulties that must be treated as soon as possible. Osteopath and your dentist can work together to remedy the situation.

If the compression are treated early enough by an Osteopath the results may be twofold: immediate release of the restriction; and gradual remolding of the abnormalities in the structure of the jaws. The best insurance against future malcurvature of the spine and malocclusion is when the osteopath removes the restrictions in the newborn that prevent the normal movement of the primary respiratory mechanism (PRM) in the head.

Most people have not had the opportunity of this treatment by an Osteopath, and they develop malocclusion that now require some kind of orthopedics and/or orthodontic treatment preferably as a young child where there is still growth potential. Unfortunately if this malocclusion is not treated in children it will give rise to so many jaw and/or teeth problems in adulthood. Such as broken teeth, periodontal disease, severe worn dentition, jaw aches, headaches and many other related symptoms.

Other causes of Malocclusion

Direct trauma to the jaw and face can also cause problems. Falling forward on to the chin and blows to the jaw can distort the temporomandibular joints (TMJ) and compress the bones of the face and head. Having teeth out can also leave unwelcome forces between and inside the bones of the mouth and face, so if possible avoid having any teeth removed - unless it is absolutely necessary.

If some teeth are missing, or only one side of the mouth is used for chewing, an unequal and considerable strain is placed on one joint.

The cheek bones continue to grow throughout your life. So where a person’s teeth are all removed and dentures fitted, there may be bone loss in the face over a period of time. The dentures may therefore need to be built up to compensate for this. If the dentures are the wrong height, they may create an imbalance in the jaw muscles

Osteopathic Manipulative Treatment now witnessing a resurgence under western names in India.

Traditional techniques for joint and spinal manipulations are now witnessing a resurgence under western names in India.

Imagine this. You walk down the road. Overlook a banana peel, slip and fall. Result—a sprain. The next day a ball hits your child's knee while he is playing. Result—a broken leg and a brawl. The same day, your friend bends down to lift up his heavy suitcase. Result—a sudden and searing backache.

What do you do? You apply some ointment on your sprain, your kid wraps his knee in a plaster, and your friend, much to his chagrin, undergoes an operation. But why not opt for some traditional methods of treatment that could cure much better? Such as osteopathy and chiropractic?

Osteopathy is a technique that uses body massage and bone manipulation. Dorling's Pocket Medical Dictionary defines osteopathy as "a system of therapy based on the theory that the body is capable of making its own remedies against disease and other toxic conditions... (and) emphasizes the importance of normal body mechanics and manipulative methods of detecting and correcting faulty structure". Explains Dr Krishna Murari Modi, an osteopath based in Mumbai, India: "Apart from a clinical examination, osteopaths depend on palpatory diagnosis: the feel of the tissue, the feel of the muscle, the feel of movements at the intervertebral joint. X-rays cannot detect minor spinal changes. So, once the defect is detected, adjustments are done by positioning the patient in a specific manner and giving sharp, short jerks. The patient begins to feel immediate relief." Until recently, Dr Modi was the only osteopath in the country. "When I came to Mumbai in 1975 and started practicing, there was no one in the country who offered osteopathic treatment." Dissatisfied with the limitations of orthopedic treatments, he decided to learn osteopathy.

Osteopathy dates back to the early '20s. It was created by Dr Andrew Tailer Still, an Army surgeon who got disillusioned with conventional medicine when his three children died of spinal meningitis. In his book, Cure Aches and Pains through Osteopathy, Dr Modi quotes from Dr Still's autobiography: "I asked myself a serious question. In sickness, had God left man stranded in a world of guessing? To guess what the matter was? To guess what to give and guess what the result would be? I decided then that God was not a guessing God but a God of truth. All his works were harmonious. So wise a God had certainly provided remedies for all illness."

Dr Manjit Sehmby, a resident doctor at Dr Modi's health resort that offers naturopathy and osteopathy, explains: "Osteopathy offers a drug-free alternative to ailments such as migraines, spondylosis, shoulder pain, elbow pain, sprains and fractures. All these ailments occur mainly because we neglect our bodies. A bad posture accompanied by stress and tension gives rise to pain in the shoulder, the neck or the head." Backaches, however, are most common. Citing an example, Dr Modi says: "A lady who was two months pregnant suffered from severe backache. She was brought to me on a stretcher. The doctors opined that she should undergo abortion as she would not be able to bear the pain for the next seven months." But a few sittings with him and the pain disappeared.

A classic example of the wonders of osteopathy is the case of former Indian cricketer Dilip Vengsarkar. Dr Modi recalls: "In 1976, Vengsarkar had been suffering from severe back pain and was out of the game for nearly six months. Doctors suggested that he undergo a slip disc operation.

But he opted for osteopathy. After 6-8 sittings, he started playing again." A cricket fan himself, Dr Modi has recently written a letter to star Indian cricketer Sachin Tendulkar pointing out the benefits of osteopathy: "When Sachin was suffering from backache, he was given painkillers, laser treatments, and made to play. The best treatment is to allow him to rest."


Do not twist the body while turning. Instead, change the position of your feet and turn.
Just bending down and turning to one side should also be avoided.

When you want to lift any heavy object from the ground, do not stoop. Sit and lift the object.
Sleep on a hard bed covered with a carpet or a bed sheet.
Drink lots of water to flush the kidneys.

According to the doctor, osteopathy recognizes the structural abnormality of the spine and aims to normalize mechanical defects. But when this is not possible, it enables the body to adapt itself to structural weakness. "When we manipulate the spine," says Dr Modi, "we are not so concerned with putting the bone back into place as with removing the mechanical hindrance, if any, and restoring normal movements in the joints."

In osteopathy, manipulation is usually done in four ways. "The direct method," says Dr Modi, "involves applying pressure directly on the spine. Chiropractors generally use this maneuver. The second method is where the manipulation is done indirectly through levers formed by hands, shoulders, pelvis and legs. No pressure is exerted directly on the spine. Instead, the patient is properly positioned and the osteopath manipulates in all directions. In the semi-indirect method, pressure is applied to the manipulated segment with the help of the hand, knee or the chest. Another method involves exerting constant pressure in the cranial region."

Chiropractic, too, is a form of manipulative treatment. Says M.L. Kapoor, Mumbai-based chiropractor: "Chiropractic manipulations aim at removing disturbances within the nerves that stop proper circulation. And the pressure is usually applied with the help of knuckles." The healing power of nature then takes over, for, as Kapoor points out, chiropractic is essentially based on the philosophy of self-healing.

"However, chiropractic existed in India long before the West discovered it," reveals Kapoor. "It was passed on from the guru to the pupil for several generations." A retired government official, Kapoor learned this technique from his wrestling coach at Peshawar. After Partition, he came to Mumbai. Since then he has been treating people free. Chiropractic cures ailments ranging from sinus, headaches to slip disc and muscular dystrophy. "Though," qualifies Kapoor, "you cannot cure polio totally, people suffering from slip disc are plenty and chiropractic is a perfect cure for them." Kamini Mathur, a former patient, says: "I was suffering from a slipped disc. But a few sittings of chiropractic, followed by a strict diet regime, has made all the difference." Anuradha Waghdhare, a housewife, says: "I suffer from sciatica and have recently started chiropractic. Nonetheless, the pain has decreased tremendously."

Both chiropractic and osteopathy differ only in the form of manipulation—and in the fact that osteopaths are medically qualified.

But manipulation has been an age-old technique for setting bones. Bonesetters existed in almost all parts of the world. Even Sushruta, the legendary Indian surgeon, used manipulation on several occasions, recorded in his treatise on bone treatment, called Asthichikitsa.

An interesting tale goes that when Dr Corvisort, the physician-in-chief of Napoleon, was summoned to relieve the Emperor of lumbago, he asked Napoleon to disrobe and lie across a table. He then administered a well-aimed slap on his hips. The stunned Emperor turned in fury towards his doctor, but during this movement the painful contraction of his lumbar muscles disappeared.

The moral of the story? It only needs a twist or two from safe hands to keep yourself straight and running all your life.

Excellent Website for Osteopathic Medicine Treatments

Please visit:

Center for Sports and Osteopathic Medicine

An excellent website!

Many Thanks to Richard M Bachrach, D.O., FAOASM.

Somatic Dysfunction and Osteopathic Medicine

Source: Copyright © 1996-2003 Dr. Richard M. Bachrach
317 Madison Avenue, NY 10017 - 212-685-8113

I’m sure many of you have looked at the diagnoses on your itemized medical bill and expressed that very sentiment, perhaps in more colorful language. The problem may be twofold:

1. In the presence of pain and/ or fear, it is extremely difficult to absorb a lot of semi-technical information often couched in unfamiliar language.

2. We may occasionally be unable to find the specific key words to open the diagnostic doors for you.

What we have, in other words, is a failure of communication. This can be very upsetting to the therapeutic relationship. The following are some frequently used diagnostic terms in a neuromusculoskeletal practice and their explanations.

I Somatic dysfunction: impaired or altered function of the related components of the body framework, resulting in pain and abnormal motion, usually decreased. The term is used most commonly in this practice in reference to joint motion. However, somatic dysfunction involves changes in all tissues in the area: skin, muscles, ligaments, fascia, tendons, nerves, blood vessels, with or without radiation to a more remote site. Some of the most frequent areas of involvement in our practice:

A. Cervico-thoracic spine (neck and upper back) or lumbo-sacral spine (low back): There is a loss of normal movement between the vertebrae. This may be produced by abnormal muscle pulls resulting from trauma, chronic poor posture, stress, too little, too much or inappropriate exercise.

B. Sacroiliac joints: These are the large joints connecting the two halves of the pelvis to the sacrum (the triangular bone at the base of the spine). Motion at these joints is slight (according to some of our less enlightened colleagues, non-existent) but essential to the normal weight-bearing and movement functions. This condition is commonly caused by trauma and/or muscle imbalances and may produce pain in the buttock, low back, hip and/or thigh.

C. Trauma, abnormal muscle pulls and stresses may produce somatic dysfunction of any other body tissue.

II Psoas Dysfunction/Insufficiency Syndrome: Characterized by tightness of the primary hip flexor muscle, the psoas major, associated with forward tilting of the pelvis, tightness of the hamstrings and weakness of the abdominal and buttock muscles. This syndrome along with the ligamentous laxity associated with aging, injury and/or poor posture, commonly contributes to dysfunction at the sacroiliac joints, with consequent pain and disability. It may also be a precursor of:

III Intervertebral Disc Disease: Intervertebral discs are the cushions between the bodies of the vertebrae. They function as shock absorbers and enhance flexibility. The fibrous cartilaginous outer ring becomes frayed and stretched. The gelatinous nucleus within may push against it, bulge or protrude through it or even break through to press on one or more of the spinal nerves exiting the spinal canal between the vertebrae. This may produce radiating pain numbness or weakness in the involved leg. Long-standing disc disease eventually results in disturbance of normal mechanics with arthritic changes in the small spinal joints, thickening of ligaments and finally narrowing of the spinal canal through which the spinal nerves travel, a condition called:

IV Spinal Stenosis: characterized by back and/or leg pain occurring while standing or walking, and relieved by sitting. As the condition deteriorates, the distance the patient is able to comfortably walk becomes progressively shorter and the patient tends to lean forward. The pain will frequently cause early awakening from sleep. It is typically severe upon attempting to get out of bed in the morning

V Myofascial pain syndromes: Muscles, and, indeed, all cells, tissues and organs are lined, covered and invested with a tough connective tissue called fascia. Fascia is three-dimensional and is continuous throughout the body. Anything affecting fascia in one area is manifested to some extent in all body regions.

Repetitive micro-trauma (injury), unresolved single injury, inflammation, poor posture or maladaptive movement habits at play or at work, stress, lack of sleep or any combination of the above will produce tightness or abnormal contraction of skeletal muscles. The investing fascia becomes taut and bound down. Circulation to and from the muscles is decreased, resulting in the accumulation of the end-products of muscle metabolism, particularly lactic acid and potassium ions. Localized areas of muscle tenderness called trigger points are formed. These trigger points are extremely sensitive and fire impulses under the slightest provocation such as pressure and stretching, to distant tissues. This produces pain and consequent loss of motion at remote locations. Toxins accumulate, muscles and fascia tighten, pain increases. The myofascial pain cycle is perpetuated.

Shoulder Pain and Osteopathic Medicine
Copyright © 1996-2003 Dr. Richard M. Bachrach
317 Madison Avenue, NY 10017 - 212-685-8113

"I can’t close my bra in the back." "The pain in my shoulder is terrible when I turn on it in bed at night. "It hurts like hell when I try to put on my T-shirt, fuhgget about taking it off." "The pain starts in my shoulder and goes down my arm to the elbow." "Sorry, you’ll have to pick up the tab, I can’t get to my wallet."

These are typical of the things we hear from patients consulting us about shoulder pain. Most ailments afflicting the shoulder have a gradual, often imperceptible onset. We keep thinking it’s going to get better, but our range of motion decreases progressively because of our natural avoidance of moving into pain. Muscles and tendons shorten, joints tighten and movements are more limited, until daily activities become so difficult we finally have to scream for help.

The shoulder is not a biomechanically efficient joint, nor is it one single joint. The head of the upper arm bone (humerus) sits rather insecurely in an extremely shallow cup at the outer upper angle of the shoulder blade (scapula) called the glenoid fossa. Essentially, it is held in place by the muscles and ligaments attached to it. Extreme movements in any direction, but particularly overhead and/or to the back, subject those tethers to stretching which eventually results in slight tearing of ligaments and tendons. The body attempts to protect these structures and sets up a reaction called inflammation. The inflammatory response is associated with swelling due to increased blood flow, paradoxically further restricting motion and increasing pain.

The primary sources of injury are muscle weakness, imposing too great a stress on the less elastic tendons, and technique faults resulting in inappropriate muscle use in throwing or swimming, weight lifting or other such activities. A lax shoulder joint capsule also overstresses the muscles. Prior shoulder injury predisposes to tendinitis. A mighty football heave on a Sunday morning without warming up can take the place of a whole slew of repetitive injuries and cause significant shoulder damage.

A classic example is rotator cuff impingement tendinitis. This most common condition involves the supraspinatus muscle and tendon, which passes from the upper part of the back of the scapula, and passes laterally, underneath the acromioclavicular joint (another one of those shoulder joints) which connects the scapula to the collar bone (clavicle). The tendon is inserted into a prominence on the lateral aspect of the humerus, the greater tuberosity. This muscle (along with the infraspinatus) rotates the arm outwards and brings it away from the midline (abducts). When the arm is raised repetitively to the side and then above the head, the supraspinatus tendon may be compressed in a "tunnel" between the acromioclavicular joint, the ligaments forming an arch over the shoulder, and the humerus. This movement is obviously essential in swimming and tennis, and these two sports, along with football (quarterbacks), weight training and baseball are associated with a great frequency of incidence of rotator cuff injury. With increased repetitions, the tendon begins to fray just like a rope. Fluid and inflammatory tissue accumulates, further compressing it. Pain increases in intensity and movement range decreases. The muscle weakens. Finally, we realize, hopefully before endstage complete tear, that it won’t get better by itself.

What to do? First stop doing the things that make it hurt. Certainly, if you know what did it, stop that particular activity! At least for a while… until you can do it right. Ice, applied locally for 20 minutes every two to three hours, will be helpful. Aspirin, in the absence of sensitivity, two tablets every four hours, may do some good. Certainly don’t take aspirin or any of the so-called non-steroid anti-inflammatory medications if you have an ulcer or gastritis history or if you have been allergic to aspirin. Acetaminophen (Tylenol) is an excellent pain reliever but has no anti-inflammatory effect.

Inability to return to full active range of motion without significant discomfort, through your own efforts, will necessitate consultation with a physician. Persistent pain and restricted motion will result in shortening of muscles, tendons and ligaments leading to chronic shoulder pain and, frequently’ to what is known as "frozen shoulder". This, in turn, may require intensive, expensive and painful physical therapy. Physical therapy will include manual mobilization of the shoulder joint, passive and active exercises, ultra-sound and electrical stimulation. Corticosteroid injection with a local anaesthetic into the shoulder may be necessary to supplement more conservative therapy, but this is reserved for cases unresponsive to physical therapy and is not to be used with any frequency.

Another frequent cause of shoulder pain lies in the "joint" between the scapula and the rib cage. This is commonly due to muscular imbalances between the muscles that connect the scapula to the chest. These, in turn derive from aberrant movement patterns creating myofascial pain syndromes and their associated trigger points.

TREATMENT depends on the appropriate stretching and strengthening exercises, normalizing movement patterns and correcting other perpetuating factors such as poor posture. This is supplemented by OMT, physical therapy modalities, trigger point injection with local anaesthetic and, often, acupuncture.

Shoulder pain may be referred from the neck (cervical spine). This is frequently related to intervertebral disc arthritis, degeneration or herniation with consequent impingement on the nerve root or roots exiting the cervical spine between the vertebrae and innervating the skin and muscles of the shoulder. A further discussion of this topic will appear shortly

What can I do?

Learn the correct way to do what you do.

Keep in good aerobic and musculoskeletal condition.

Warm-up, stretch.

Play, then stretch again.

Listen to your body!

Have fun!

And if none of the above works, see us at the Center for Sports & Osteopathic Medicine. Sooner rather than later!

MYOFASCIAL Pain Syndromes

Copyright © 1996-2003 Dr. Richard M. Bachrach
317 Madison Avenue, NY 10017 - 212-685-8113

Repetitive micro-traumata (injuries), unresolved single injury, inflammation, poor posture or maladaptive movement habits at play or at work, stress, lack of sleep, or any combination of the above will produce tightness or abnormal contraction of skeletal muscles. The investing fascia becomes taut and bound down. Circulation to and from the muscles is decreased, resulting in the accumulation of the end-products of muscle metabolism, particularly lactic acid and potassium ions. Localized areas of muscle tenderness called TRIGGER POINTS are formed. These are extremely sensitive and will fire impulses (under the slightest provocation such as pressure and stretching), to distant tissues, producing pain and consequent loss of motion at remote locations. This causes the further accumulation of muscle toxins, more muscle and fascial tightness, more pain, etc., perpetuating the MYOFASCIAL PAIN cycle.

This is an extremely common cause of pain anywhere in the body: head, face, neck, shoulders, chest, arms, low back, buttocks, legs, feet, etc. To understand more about this ubiquitous problem, a few definitions and explanations are in order:

Fascia is a tough connective tissue lining, covering and investing muscles, and, indeed, all cells, tissues and organs. Fascia is three-dimensional and is continuous throughout the body. Anything affecting fascia in one area is manifested to some extent in all body regions.

Pain is an abnormal, unpleasant EMOTIONAL and sensory experience caused by actual or perceived injury. This results in the stimulation of nerve endings called nociceptors. These impulses are transmitted to the spinal cord and then to the brain where they register as pain.

Trigger points (TrP) are foci of hyperirritability in muscle, fascia or ligaments (connecting bone to bone as in joints). They are characterized by taut fibrous bands, a twitch response when stimulated, and constant areas of referred pain. The pain patterns thus produced are called myofascial pain syndromes. There are several types and locations of trigger points:

Active TrPs are always tender. They prevent full lengthening of the muscle and weaken it. Direct compression, stretching, or other sources of irritation such as accumulation of the toxic chemical products of muscle metabolism or lack of oxygen will ignite the TrP. From it, localized pain is produced in a specific area with associated autonomic changes. These may include increased or reduced skin temperature, sweating or dryness. The area of referred pain is often distant from the TrP.

Latent TrPs may not be painful to pressure, but result in muscle weakness and restricted motion. There are also secondary and satellite TrPs, the explanation of which is beyond the scope of this article.

Ligamentous TrPs are found in lax, stretched ligaments as a result of aging, trauma and/or poor posture, particularly those ligaments involved in the support of the axial (vertebral column and pelvis) or appendicular skeleton.

Periosteal TrPs are found on the surface of bone usually at the site of ligament or tendon attachment and related to tension on that area from stretched ligaments.

Alignment Or Postural Factors: Gravity in combination with aging, long term poor posture, and/or repeated injury causes laxity of the axial (trunk and pelvis) and appendicular skeletal ligaments. This is most relevant in the spine and pelvis. Tightness of the psoas major muscle combined with weakness of the abdominal muscles, particularly the pelvic attachment of the obliques and recti, combine to perpetuate a downward tilting of the pelvis and an increase in the lumbar lordosis. Thus, the ligaments connecting the pelvis to the vertebral column and to the lower extremities are stretched and their nociceptors depolarized, initiating the pain cycle. The same applies to the pelvic and low back muscles which now are tightened and ischemic.

Other Perpetuating Factors: include leg length disparity or pelvic tilt; hyperpronation (inward rolling of the foot); nutritional, metabolic, endocrine, postural and emotional factors as well as bacterial or viral infections or parasitic infestations.

Major Myofascial Pain Syndromes: The trigger points I have found most frequently related to pain complaints in our practice are located in the following muscles: iliopsoas, quadratus lumborum, gluteus medius, gluteus minimus, piriformis, hamstrings, trapezius, levator scapula, scalenus anticus.


Here are a few pointers to help you in your own pain management:

Passive stretching can be dangerous: "no pain no gain" is a rule with strict limitations. The inadequately trained person stretching you has no conception of your pain or tolerance. Stretch yourself or let a trained therapist help.

The presence of a TrP in a muscle can be suspected when stretching or attempting to strengthen a muscle group is either fruitless or results in aggravation of pain with the pattern being repetitive. Don’t attempt to stretch or strengthen a muscle with TrPs.

Any discomfort while stretching should be experienced in the belly of the muscle, NOT at the point of attachment to bone or in the tendon.

Remember: not everybody needs to stretch and not every muscle needs to be stretched. Older people with extremely lax ligaments may depend on hypertonic muscles to support unstable skeletal structures and may react poorly to attempts to stretch.

Treatment of myofascial pain syndromes consists principally of the following measures and is part of the program available at the Center for Sports and Osteopathic Medicine:

Identify and correct all possible perpetuating factors. Of particular importance are: correction of postural imbalances with short leg lifts; correction of faulty foot mechanics with orthotics.

Identify and treat all trigger points with ultra sound and low volt electrical stimulation, dry needling, injection with a local anaesthetic, acupuncture, spray and stretch with a topical local anaesthetic or any combination of the above.

Osteopathic manipulation, massage, soft tissue mobilization.

Re-establish normal, restorative sleep using muscle relaxants, L-tryptophan (if available), acupuncture or a combination of these.

Pain relief with medication ranging from acetominophen through non-steroid anti-inflammatories and aspirin to short term narcotics, if necessary.

Careful, appropriate stretching and strengthening are essential components of any successful treatment and rehabilitation program. Your physical therapist and I will be your guides in such a program.

Aerobic exercise, instituted carefully and progressed gradually to tolerance is vital to recovery and prevention of recurrence.

Osteopathic Manipulative Techniques

Source:From the American Academy of Osteopathy

The spectrum of osteopathic manipulation techniques focus on the principle that body structure and function are dependent on one another. When structure is altered via the musculoskeletal system, abnormalities occur in other body systems. This, in turn, can produce restriction of motion, tenderness, tissue changes and asymmetry (somatic dysfunction). Following are some of the manipulation procedures most commonly used by osteopathic physicians to diagnose and treat somatic dysfunctions:

Hands-On Contact

Health professionals universally acknowledge the value of the placing of hands on a patient. This essential component of the doctor-patient relationship has a great deal to do with the patient’s well being, whether he or she suffers from a cold or a terminal disease. When a DO examines a patient by auscultation of the chest or palpation of the abdomen or spine, the treatment already has begun.

Soft-Tissue Technique
This procedure is commonly applied to the musculature surrounding the spine, and consists of a rhythmic stretching, deep pressure and traction. Its purpose is to move excess tissue fluids (edema) and to relax hypertonic muscles and myofascial (fibrous tissue) layers associated with somatic dysfunction.

Myofascial Release
This procedure is designed to treat primarily the myofascial structures. In the use of direct myofascial release treatment (MRT), a restrictive barrier is engaged for the myofascial tissues; the tissue is loaded with a constant force until release occurs. In treating with indirect MRT, the dysfunctional tissues are guided along a path of least resistance until free movement is achieved.

Cranial Osteopathy
This is a specific approach within the osteopathic concept. It influences the structure and fluid surrounding the central nervous system, creating an impact on the total body and initiating the body’s inherent capacity to heal itself. Fascial connections throughout the body are contiguous with the linings around the central nervous system, including the dura and other structures. Practitioners of cranial osteopathy utilize a manual approach to accomplish these goals within the practice of osteopathic medicine.

Lymphatic Technique
This manual procedure is designed to promote circulation of the lymphatic fluids and can be used to treat various difficulties. One technique is pressure applied with the physician’s hands on the supine patient’s upper chest wall. When the force that is applied to the chest reaches its maximum on expiration, the physician’s hands are removed suddenly. This increases negative pressure of the chest to assist the body’s respiratory mechanism to move lymphatic fluids.

Thrust Technique (HVLA)
In this form of manipulation, the physician applies a high-velocity/low-amplitude thrust to restore specific joint motion. With such a technique, the joint regains its normal range of motion and resets neural reflexes. The procedure reduces and/or completely nullifies the physical signs of somatic dysfunction: tissue changes, asymmetry, restriction of motion and tenderness.

Muscle Energy Technique
In this manual technique, the patient is directed to use his or her muscles from a precise position and in a specific direction against Counterforce applied by the physician. The purpose is to restore motion, decrease muscle/tissue changes and modify asymmetry of somatic dysfunction.

This is a manual procedure in which the patient is moved passively away from the restricted motion barrier, towards the position of greatest comfort. At this point, passive, asymptomatic strain is induced.

Visceral Osteopathy
In this manual technique, the position of the organs of the body is determined by development and embryology. There is a specific freedom of motion to each organ. Restriction of this motion can cause disability of organ function as well as cause tissue changes at certain spinal levels (somato-visceral reflexes). These tissue changes can be used to diagnose visceral (organ) dysfunction. Treatment of visceral dysfunction can restore normal function of the organ system.

Osteopathic Medicine

Source: Anne Woodham,,181041_182353,00.html

Osteopathy concentrates as much on why there is a problem in the muscles and joints as on the problem itself explains Anne Woodham

Osteopathy - from the Greek osteon ('bone') and pathos ('suffering') - was developed in the late 19th century by an American army doctor, Dr Andrew Taylor Still, after his wife and three children died from meningitis. He believed that when the body was correctly adjusted, there would be less strain on the muscles and joints, all the systems would function smoothly and the body could heal itself naturally.

How does it work?
Osteopaths use touch and manipulation to diagnose and treat problems caused by misalignments of the muscles, bones, joints, ligaments and connective tissue that make up the musculo-skeletal system. In a healthy body, this framework supports and protects the organs, helping all body systems - nerves, circulation, digestion and hormones - to function at their best.
Physical and emotional stress, injury and poor posture can have a negative effect on the musculo-skeletal system. Pain creates muscle tension, which in turn creates more pain. Osteopathic techniques that range from soothing massage to high velocity mobilisation of joints help ease muscle tension, improve mobility and promote self-healing processes.

Osteopathy is a holistic approach, regarding your way of life and your mental and emotional state as important influences on total well-being. An osteopath will be as concerned about why a problem has arisen as with the problem itself. For example, is your back pain due to a lifetime of lifting heavy loads the wrong way?

Specialisations include cranial osteopathy, developed by an American osteopath, Dr William Garner Sutherland, in the 1930s. Practitioners use delicate touch around the skull and lower spine to ease tension believed to disturb the flow of cerebrospinal fluid. Cranial osteopathy is believed to be particularly successful for babies and young children and in treating problems following trauma and injury.

What can I expect?
After taking a thorough medical history, an osteopath asks about lifestyle and emotional health and carries out standard medical tests. You will probably be asked to undress to your underwear so that the osteopath can see as much of your body as possible, and to stand, sit and lie down on a special treatment table to study the way you hold yourself and move.

The osteopath will also ask you to bend this way and that while feeling your spine. Years of experience sensitise their fingers, so that by palpating (feeling) tissues, muscles and joints, and by testing temperature, tone, shape and response to movement, they can detect problem areas.

Treatment is tailored to individual needs. It may consist simply of massage and stretching techniques, or it may involve manipulation of the joints, taking limbs through their full range of movement. An abrupt high-velocity thrust, though painless, can cause the joint to 'click'. You may be positioned in such a way that tension from areas of strain or injury is released spontaneously. 'Muscle energy techniques' involve working against resistance provided by the practitioner in order to release tension.

What is it good for?
Osteopathy can help with back and neck pain, joint pain, sports injuries, frozen shoulder, sciatica, PMS and menstrual pain, headaches, insomnia, depression and digestive disorders. Cranial osteopathy is used to treat colic, sleeplessness and glue ear in children.

Monday, February 13, 2006

The Root of Reflexology and Osteopathic Medicine

By Christine Issel
Christine Issel, M.A., with her extensive background in reflexology spanning more than 30 years, consults and lectures on all aspects reflexology nationally and internationally. She is an author of Reflexology: Art, Science & History and with Sandi Rogers, Reflexognosy: A Shift in Paradigm. She is also the editor of Reflexology Today, the national news magazine of the American Reflexology Certification Board. In addition, she is an international lecturer, conference organizer, founder of reflexology associations and organizations, and serves as a director on several reflexology boards acting as a legislative advocate.
Reflexology Association of AmericaAdministration OfficeP.O. Box 26744Columbus, OH 43226-07441-740-657-1695 – office & fax
Copyright © 1999-2004 Reflexology Association of America. All rights reserved. This page was last updated on 02/12/06.

Many people confuse reflexology with massage, but they are two distinct modalities—each with its own strengths. Both, like many therapies (chiropractic, osteopathy, and other somatic practices), involve the use of the hands to apply specific techniques to the body thereby enhancing the well-being of the client.

From a historical perspective, reflexology is more akin to osteopathy in both theory and techniques than to massage. Osteopathy, developed by Andrew Taylor Still in 1874, believed in a direct relationship between disorders in joint movement and symptomatology. In addition, Still theorized that in some way the autonomic nerve reflexes were involved in metabolic changes in soft tissues. The goal of osteopathy is not to directly relieve organic diseases, but to improve the structural function, tone of muscles, relieve tension, and restore relaxation to the body. As osteopathic physician Dr. Myron Beal explains “…any constriction or congestions will interfere with the vital processes and normal functions of the body tissues. ...The zone of the spine from which the nerves emerge which are concerned with any particular organ or area of the body must be specially considered in osteopathic treatment.”1. Osteopathy is not normally used in the treatment of infectious diseases although it may be used in conjunction with other treatment because of its effect on the sympathetic nervous system, circulation and hormone secretion.

No doubt Eunice Ingham was introduced to these concepts, if not through her own interests and research, then during her work at the clinic of the Osteopathic Hospital in St. Petersburg, Fla., and her association with osteopath, Dr. Joe Shelby Riley in the mid-‘30s. She was also a guest lecturer in the 1950s at the American School of Osteopathy. Ingham refers to osteopathic and chiropractic concepts and research in Stories The Feet Have Told. Under a section titled ‘Osteopathic Concept’ Ingham writes, “A spinal lesion* means an abnormal pull on muscle tissue. If we can release the excessive tension by contacting a specific reflex in the feet, we are helping to bring about a correction of that spinal lesion.”2 In this statement Ingham combines two concepts fundamental to osteopathy and reflexology—lesions and reflexes.

Chapman’s Reflexes

Discovered by Dr. Frank Chapman D.O., Chapman’s Reflexes are painful points located all over the body that, when palpated, he felt could lead to the healing of disease. In An Endocrine Interpretation of Chapman’s Reflexes, 2nd editionFred Mitchell, D.O. writes, “Drs. Chapman and Owens were of the opinion that these reflexes were clinically useful in three principal ways: 1) for diagnosis; 2) for influencing the motion of fluids, mostly lymph; and 3) for influencing visceral [organ] function through the nervous system.”3

In general, Chapman’s Reflexes are found in soft tissue at various points along both sides of the sternum, the proximal head of humerus, distal and proximal clavicle, occipital ridge, cervicals, ribs, scapula, thoracics, lumbar, sacrum, coccyx, pelvis, pubis, fibula, and medial head of the tibia. When the condition involves an organ, the location where the autonomic nerve ganglion branches off the spinal column to the organ becomes one of the reflex points to be palpated.

According to Mitchell, “Chapman’s Reflexes is just a term given to these receptor organs because of the osteopath who discovered their diagnostic and therapeutic value in the location and treatment of disease.”4 Since Chapman’s Reflexes were located all over the body the impression given was that a reflex is an object or point on the skin. Leon Chaitow notes in Soft Tissue Manipulation that ‘reflexes’ go by many names: Janet Travell, M.D., and associates refer to them as trigger points; Myron Beal as viscerosomatic reflexes; Terence Bennet, D.C., as neurovascular points; M. Gutstein, M.D., as myodysneuric points; Irvin M. Korr, Ph.D., as facilitate segment and referred dysfunction; and in acupuncture they are tsubo points, yet all are discussing the same phenomena.

At the same time palpation was thought to create a reflex action of some type. Like Chapman, Ingham uses the word reflex to describe a sensitive area while at the same time using it to also describe the physiological process produced by a reflex action. Explaining the results she obtained, Ingham writes, “Try this simple method of producing a reflex action (by manipulation) through the nerve endings on the soles of the feet.”5 Here she is indicating a reflex action. Then, like Chapman, she produced charts that illustrated where points could be palpated to reach various organs and called them reflexes, too.

Chapman himself stressed that results would come more quickly and be less painful by gentle, rather than strong, pressure to the reflex point. The actual time a practitioner worked on a particular reflex could last from 20 seconds to two minutes or more. Mitchell stresses that over-treatment fatigued the reflex arc and nullified the good effect produced. However, he also cautioned that inefficient or insufficient work produced poor results. While admonishing the student to remember the inter-relationship of organ systems, he recommended working the system in the sequence it is found. For example, “work the distal colon before treating the proximal colon.”6

The 2nd edition of Chapman’s Reflexes contains a foreword that suggests when studying reflex work, the student: 1) learn each reflex by location rather than by sense of touch; 2) learn reflexes by groups (systems) one at a time; and 3) learn to include the endocrine gland along with the nerve and blood supply concerned in the disturbance.8

All three of these points were adopted for reflexology by Ingham. The layout design is also very similar in Ingham’s and Chapman’s books. Each chapter covers a pathology and points to work are indicated.

Endocrine Link

Two different systems coordinate the working of the body. The nervous system works by using electrical impulses, while the endocrine system uses chemicals called hormones. Within the nervous system there are sensory neurons that carry nerve impulses from different parts of the body to the central nervous system. Some sensory neurons are directly triggered by stimuli while others are triggered indirectly by special cells or neurons called receptors.

Osteopathic theory concludes that if there is a lesion formed within the soft tissue of the spinal column then a stimulus by palpation will produce a reflex action that will in turn produce a physiological reaction to organs innervated from the autonomic nerve ganglia. To this Chapman linked receptors and the role they play with the endocrine system. Communication does take place within the receptors and this could be why Chapman was the first to link the endocrinology of the body to the concept of reflexes as an osteopathic principle. In her little known book, Zone Therapy, Its Application to the Glands and Kindred Ailments Ingham also utilizes this theory in her hypothesis of the mechanics of how reflexology works. “May we retain an open receptive mind for aid or suggestions in the scientific explanation of the relation of these nerve endings and their direct association with the tissues involved. Is it not possible that by way of the autonomics, the endoctrines [sic] [glands] are doubtless affected in such a way that a better synergism is brought about between the various important glands of this system.”8

Osteopathy’s Connection to the Feet

An interesting point to consider in Chapman’s work is that nowhere are the feet or hands involved as sites to be worked. However, we do know that sensory neurons are plentiful in the soles of the feet and palms of the hands. Dr. Joe Shelby Riley, may have reached this same conclusion and adapted Chapman’s concept, which he knew about through his own osteopathic training, to the feet and hands while coupling reflexes with Fitzgerald’s work with zones. Riley’s charts are the oldest which map the various ‘reflex’ points on the feet. Riley’s work was further refined, expanded and popularized by Ingham who worked as his assistant for several months during two successive winters in Florida prior to the publication of her first book.

With Chapman’s concepts in mind, the palpation to the receptors on the feet may support much the same principles. First, sensitivity in the soft tissue of the foot, [e.g. pain upon palpatory pressure] may affect the body as the fascia forms lesions and adversely affects biomechanical movement. Removal of articular lesions coupled with the hormonal activation triggering an endocrine response, stimulation to the circulatory and lymphatic systems, and all nervous systems makes reflexology a very powerful and wholistic therapy. Additionally, the proper alignment of the joints in Reflexognosy produces relief of tension to the segmental dysfunction of the dermatomes resulting in the relaxation of muscular tension and nervous throughout the body. The reduction of pain results as normalization of receptor activity moves toward normal muscle tone. The relaxation process will reverberate up the spinal column and through the autonomic nerve ganglia to the organs and other parts of the body due to the close ties between the central nervous system and the autonomic nervous system.

Ingham puts it more simply in Stories the Feet Have Told by saying, “If any degree of tenderness is found in those reflexes in that part of the foot relative to the spine, then by applying this form of compression massage to that area you will relax the muscle tension surrounding that vertebra.”9 In fact, the actual processes the practitioner has affected includes structural alignment which produces reduced tension on the fascia that may result in improved circulation and pain reduction, improving overall health.

Palpatory Terminology

Another link between reflexology and osteopathy is found in their terminology. Typically palpation involves both the use of light-touch and deep-touch to discover changes taking place in the skin and subcutaneous tissue. Light touch can either be passive, where the fingers rest lightly on the skin, or active whereby the fingers move from site to site. Beal writes, “In deep-touch, the fingers compress the skin surface, palpating through skin and subcutaneous tissues to the superficial muscle. Further compression leads to palpation of deeper muscles, fascia, and bone. Deep palpation utilizes forces of compression and shear. Compression is a force applied perpendicularly to the skin surface. Shear is a force applied parallel to the skin surface. In some instances, deep palpation combines both compression and shear in the exploration of deep tissue texture.”10

Note the use of the term compression. In Eunice Ingham’s statement above, she described her work as ‘the reflex method of compression massage’ before finally settling on the term reflexology. The term massage by Ingham is preceded with the adjective compression indicating she was not referring to Swedish massage. Her later use of the term reflexology implicates she considered the work to involve a study of the reflexes and reflex action. From this it is clear, the techniques and nomenclature employed by reflexologists are closely aligned with osteopathic principles and ‘reflexes,’ not those of massage, as some would claim. To reflexology osteopathy contributes:

• The terms, techniques and theories of reflexes, reflex action, lesions and compression;

• The importance of the autonomic nerve ganglion innervating the organs and endocrine system;

• Tactile skills and soft tissue manipulation of ‘reflexes’;

• A wholistic approach to illness through the study of the systems of the body utilizing touch.

While at first glance the opposite may seem true, osteopathic theory and techniques are certainly more akin to reflexology than massage in theory and techniques. Reflexologists simply concentrate their work on the feet and hands rather than the spine and trunk of the body.

Friday, February 10, 2006

Cranial Osteopathy

Source: 2006 Original Osteopathy, Santa Monica, California

Do the cranial bones move?

The controversy rages, as does one man struggle with his brother. The premise of cranial bone motion is central to Cranial Osteopathy. Our teachings, practices, and cured patients have relied on it for over sixty years.

Technically, it's no debate. The finest anatomy texts always illustrate the 28 cranial bones separately, with discussion on how they fit together, what their functions are, and so on. A reasonable person could deduce, that since the cranial bones are separate and distinct, there must be motion between them, preventing their fusion. In fact, four researchers, Frymann (1971), Michael and Retzlaff (1975), and Moskalenko (1980,'96,'98) have all shown that the cranial bones do, indeed, move. Frymann measured skull diameters on living human subjects. After extensive recordings, her studies showed that the cranial bones exhibit a rhythmic mobility that is different from the breathing rate. Michael and Retzlaff measured the cranial bone motion of squirrels. Their findings showed cranial bone motion with a rate of 5-7 cycles/minute that did not corresponded to heart rate or changes in venous pressure. Moskalenko used computer analysis of various physiological measurements to show cranial bone "fluctuations" of 6-14 cycles/minute. A fifth and sixth researcher, Heifetz and Weiss (1981), decided to temporarily increase the pressure inside the heads of two comatose patients. They injected solution into the brain. Guess what they found? The cranial bones move, spreading apart in response to the rising internal pressure. Six researchers, one conclusion.

So then, anyone who knows this research can not debate. Cranial bones move.

Cranial Osteopathy also contends that the brain and spinal cord have inherent motility. Cranial Osteopaths, collectively, since the 1940's have sensed this with their trained fingers. Seven studies, involving twelve researchers, have demonstrated brain and spinal cord motion. They range from observations on nerve cells moving rhythmically in tissue culture, to multiple MRI studies on humans, recording the brain actually moving, rhythmically and consistently, as it sits inside the living skull! Included, are the studies done by Greitz (1992), Enzmann & Pelc (1992), Poncelet et al. (1992), Feinberg & Mark (1987), Maier (1994), Miklis et al. (1994), Wolley & Shaw, and Clark & Hyden. All have demonstrated, in one way or another, the inherent motility of the brain and spinal cord.

The basic tenets, then, of brain, spinal cord, and cranial bone motion hold true.

So what about the efficacy of Osteopathy as applied to real patients? Does it work, with real life ailments?

The issue of something working or not is more complicated than it seems. I could barrage a man with information on how well something works, but if his heart is closed, then, for him, it will not work.

In the nine years I have spent honing my Osteopathic skills, I have seen, and continue to see results that astound me. Chronic ear infections cured. Herniated disks requiring surgery, healed. Chronic injuries, often aggravated for years, healed. And one of my favorites: injuries produced by other practitioners, reversed and cured. These have been some of my personal experiences in patient care. What follows is a bit of the existing research in print.

Osteopathy Means Fewer Ear Infections
A study published in Arch Pediatrics in 2003 showed that children with recurrent middle ear infections, who received Osteopathic manipulation, had fewer ear infections, needed less surgery (to place tubes), and had more normal hearing studies (tympanograms) than children who did not. "No adverse reactions were reported" in the study.

The article concluded that: "The results of this study suggest a potential benefit of osteopathic manipulative treatment as adjuvant [in addition to routine pediatric care] therapy in children with recurrent AOM [acute otitis media]; it may prevent or decrease surgical intervention or antibiotic overuse."

Osteopathy Means Fewer Drugs and Fewer Expenses to Back Pain Sufferers
A study in the New England Journal of Medicine in 1999 compared Osteopathic spinal manipulation with standard care for patients with low back pain. The "osteopathic-treatment group required significantly less medication (analgesics, antiinflammatory agents, and muscle relaxants) and used less physical therapy." The "differences in cost were significant."

This article concludes that: "Given the known and potentially serious adverse effects and costs or nonsteroidal antiinflammatory drug therapy, the achievement of equal outcomes in regard to pain relief, function, and satisfaction, with less use of medication and physical therapy, suggests an important benefit of osteopathic manipulative treatment; this type of treatment deserves careful examination through a formal cost-benefit analysis."

Osteopathic Treatment Results in Positive Gains in Children With Spastic Cerebral Palsy
A study published in the journal of Clinical Pediatrics in 2004 compared parental perceptions of 23 children, diagnosed with cerebral palsy, who were treated by osteopathic manipulation as compared to 19 children who were not (the control group). Over a twenty-four week course of therapy, "twenty-one of the 23 parents of the children in the osteopathic group reported improvement in their child during the course of the therapies."

Osteopathic treated group, specific parental comments:
"Improved 'dramatically' with walking, runs without holding onto furniture-age 32 months."
"Stood for the first time, climbs everywhere-age 34 months."
"Running for the first time; chases boys; very coordinated; kicked ball for first time-age 8 years."
"No surgery on his hips 'The orthopedist was stunned'-age 12 years."
"Able to use skateboard for the first time-age 12 years."
In the control group, however, only 2 of 17 parents reported "general but nonspecific improvement" in any area. "One child reported improvement in speech and in mood and the other reported improvement just in mood." On the other hand, "five children in the control group reported worsening of mood."

The basic conclusion: No intervention. No specific benefit.

These examples offer a glimpse, experienced by patients and researchers, of the bounty of benefits that Osteopathy offers.

The research supports us. The evidence is undeniable. The decision is yours.

Standring, S., Gray's Anatomy, 39th British Ed., Elsevier, 2005.
Gray, H. & Carter H.V., Gray's Anatomy, 15th Ed., 1901, Reprinted by Barnes & Nobles Books, 1995.
Jones, James H. (with contributions from Seffinger, Michael, D.O.) "The Controversy of Osteopathy in the Cranial Field: The Research Status the Primary Respiratory Mechanism," 2005.
Frymann, V.M. "A Study of the Rhythmic Motions of the Living Cranium", JAOA, Vol. 70, 1971, 928-945.
Michael, D.K., & Retzlaff, E.W., "A Preliminary Study of Cranial Bone Movement in the Squirrel Monkey", JAOA, Vol. 74, 1975, 860-864.
Moskalenko, Y. et al., "The Biophysical Organization of the System of Cerebral Circulation", Chapter 2, In: Biophysical Aspects of Cerebral Circulation, Pergamon Press, 1980, 41-42.
Moskalenko, Y., "Bioengineering Support of the Cranial Osteopathic Treatment", Medical and Biological Engineering and Computing, Vol. 34, Supplement 1, Part 2, 1996, 185-186.
Moskalenko, Y., "The Phenomenology and Mechanics of Cranial Bone Fluctuations", paper Presented at the Proceedings of the First Russian Symposium. St. Petersberg, Russia, May 27-29, 1998.
Heifetz, M.D., & Weiss, M., "Detection of Skull Expansion with Increased Intracranial Pressure", Journal of Neurosurgery, Vol. 55, 1981, 811-812.
Sutherland, W.G., The Cranial Bowl, Freeman Press, 1939.
Grietz, D., et al., "Pulsatile Brain Movements and Associated Hydrodynamics Studied by Magnetic Resonance Phase Imaging, the Monro-Kellie Doctrine Revisited", Radiology, Vol. 34, 1992, 370-380.
Enzmann, D.R., & Pelc, N.J., "Brain Motion: Movement with Phase-Contrast MR Imaging", Radiology, Vol. 185, (3), 1992, 653-660.
Poncelet, B.P. et al., "Brain Parenchyma Motion: Measurement with Cine Echo-Planar MR Imaging", Neuroradiology, Vol. 185, (3), 1992, 645-651.
Feinberg, D.A., & Mark, A.S., "Human Brain Motion and Cerebrospinal Fluid Circulation Demonstrated with MR Velocity Imaging", Radiology, Vol. 163, (3), 1987, 793-799.
Maier, S.E., et al., "Brain and Cerebrospinal Fluid Motion: Real Time Quantification with M-Mode MR Imaging", Radiology, Vol. 193, (2), 1994, 447-483.
Miklis, D.J., et al., "Oscillatory Motion of the Normal Cervical Spinal Cord," Radiology, Vol. 192, (1), 1994, 117-121.
Magoun, H., Osteopathy in the Cranial Field, 3rd Ed. The Journal Printing Company, 1976.
Millis, M.V. et al., "The use of Osteopathic Manipulative Treatment as Adjuvant Therapy in Children With Recurrent Otitis Media," Arch Pediatr Adolesc Med. 2003; 157: 881-866.
Anderson, Gunnar B.J. et al., "A comparison of Osteopathic Spinal Manipulation with Standard Care for Patients with Low Back Pain," The New England Journal of Medicine, 1999; 341: 1426-1431.
Duncan, B. et al., "Parental Perceptions of the Therapeutic Effect from Osteopathic Manipulation or Acupuncture in Children with Spastic Cerebral Palsy," Clinical Pediatrics, May 2004; 349-353.

Cranial Osteopathy Treats:


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  • Newborn irritability, colic, spitting up, poor suckle, ear infections.
  • Some developmental delay syndromes-especially if concomitant long labor, difficult labor, suction, forceps, induction, or "timed delivery" was present.
  • Plagiocephaly (misshapen head)
  • Childhood injuries, especially to the head.
  • Herniated disks, sciatica, back pain of all degrees. Any specific body pain.
  • Old injuries, fractures, sprains, strains.
  • Car accident related pain or derangements.
  • Migraine, headache, tinnitus, vertigo, TMJ.
  • Dental related or Post-orthodontic trauma leading to any of the above.
  • Injuries resulting from other practitioners.
  • Indigestion, constipation, asthma, and some forms of emotional shock.

What is Cranial Osteopathy? What does an Osteopath do?

Source:Original Osteopathy
2128 Pico Boulevard
Santa Monica, CA 90405
(310) 664 8818
[email protected]
Arash Jacob, D.O.
Specializing in traditional and cranial osteopathy
2128 Pico Boulevard, Santa Monica, CA 90405
(310) 664-8818

Your doctor sits with you. You start talking, explaining how you've come to be, sitting in front of him. He studies what you've pointed to, asking that the holes be filled. Birth details? Trauma? Falls? Orthodontia? Dental work? You answer. A careful study of the physical body is next. He looks, feels, and listens. The heart trumpet sounds. The belly melody plays. Roll call. Spine, hips, feet, shoulders, clavicles? Anyone out of line, causing trouble? All is noted. Now you lay on the treatment table. He rests his hands atop your head or feet and waits. Minutes pass. Skilled hands begin to feel. The body's speaks-revealing itself. Traumas unfold.

An old birth strain in the right leg tugs on the pelvis, twisting the spine, calling you. "Pay attention. I'm the cause of the low back pain you seek."

A shock to the sternum, heart, and ribs has twisted the chest, causing shoulder tightness, pain. "Help me with this and I'll free one shoulder, maybe two!" -the chest cries out. "That car accident did this to me."

This is the intimate communication we expose every day, with every patient. If you forgot a fall, or a trauma, nothing is lost. The body will testify on your behalf, telling all. Skilled hands can read this, verifying strain patterns that have caused your ailments.

And now your doctor will issue cure. Not with the drugs or surgery at his disposal, as his license allows. But in accord with the body's natural method of cure. So how does the body heal? At what pace? And with what texture? Can it heal overnight a trauma of years ago? Insanity!

It is with a calm, directed, healing potency that the body works. It is with that same potency that the Cranial Osteopath works-aiding it, stimulating it. He encourages that potency to treat old areas-traumas long forgotten or too difficult to overcome. He acts as the body's greatest helper. Could the forces that such hands apply ever overwhelm or overpower? No. The Cranial Osteopath applies, with his hands, only gentle to balanced forces, sometimes featherlike, sometimes firmer but always in response to the body's need, not his own. It is with this skilful understanding and meticulous execution that the Cranial Osteopath can help to remove tissue restrictions. The body can now begin healing the way it couldn't before, without strain, without hindrance.

The Benefits of Osteopathy

Source: Copyright © 1999, Dr. Claude Brodeur, Ph.D.
All rights reserved

The beginnings....
Medical practice was relatively primitive in the late 1800's when Dr. Andrew Taylor Still discovered what is now known as Osteopathy. Few drugs were then available. Morphia and quinine were commonly overused with disastrous results. The relationship of germs to disease was not established. The cellular structure of the body was not accepted. The nature of the immune system was unknown. Antibiotics were not yet available as such.

The discovery....
What did Dr. Still discover that became known as Osteopathy? Simply stated, the Osteopathic Doctor treats the faulty functioning of body structures such as joints, muscles and tendons. First, he determines where the fault is, then by means of proper manual manipulation releases the body’s own healing powers which then are able to restore the joints or tissue being treated to normal functioning. In the traditional practice of osteopathy the skilled Doctor uses therapeutic touch alone to locate the malfunctioning body part, then gently manipulates that body part using the right amount of pressure in the right place at the right time in the right way. In addition to the treatment of joint or tissue abnormalities, Osteopathic treatment may include advice about posture, work positions, inappropriate activity, nutrition and exercise, or discussion about emotional upsets.

The training....
Dr. Still, the founder of Osteopathy, insisted that any Doctor practicing Osteopathy must have a thorough knowledge of anatomy and a keen understanding of the difference between normal and abnormal. He theorized that a healthy heart and lungs are essential for general good health and that the Osteopath’s job is to help the patient achieve a healthy blood and nerve supply. Dr. Still placed great importance on the lymphatic system, which is needed to flush away impurities as they accumulate in our tissues.

The practice....
While both Chiropractic and Osteopathy include techniques for correcting abnormal spinal conditions through manipulating the joints, Osteopathy goes a step further. In addition to treatment of the joints, it includes the adjacent muscles, fascia and ligaments making up each spinal vertebra. Osteopathic Doctors claim that their practice is more concerned with the pelvic rather than the neck region. Traditionally, the Osteopath relies more on the sense of touch than x-ray evidence for diagnosing spinal derangement. Finally, Osteopathic treatment is more rhythmical and gentle than Chiropractic.

More unique features....
Only Osteopathy specializes in the manipulation of the fascia. The fascia sheath, a thin fibrous sleeve, permeates, divides and subdivides all parts of the body surrounding muscles, arteries, veins and lymphatics, and supports a network of nerves around those body tissues. Pain and other symptoms will arise in the organ or part of the body next to the affected fascia, whenever fascia become trapped, bruised, overstretched or lack nutrition,. Manipulation of the fascia can often bring about great cures.

The Applications....
What health problems are amenable to Osteopathic treatment? The complaints most commonly helped by Osteopathic treatment are low back pain and sciatica. The treatment is to improve blood flow, relax muscles, free any joints that are not moving properly, thereby restoring normal nerve activity. Osteopathic treatment has been particularly effective for so-called "slipped discs," arthritis in the low back or hip, and pain down the leg, commonly known as sciatica.

Many conditions respond favorably to Osteopathic treatment, such as neck, upper back pain, pain in the upper limbs (including shoulder, elbow, wrist and hand), migraine and headaches. Osteopathic treatment can help patients in the early stages of osteoarthritis of the hip, and can often restore movement or at least, in the case of the more advanced stages of osteoarthritis, reduce pain and swelling in arthritic patients awaiting surgery.

The limitations....
There are several medical conditions where Osteopathic treatment should not be used, or should be used in limited circumstances, or in conjunction with other treatments, such as active infections, fractures, bone disease, cancer, gross structural deformities, and severe general medical conditions such as gross high blood pressure or heart attack, vascular disease like thrombosis, neurological conditions with nerve damage, spinal cord damage, and severe prolapse of an intervertebral disc.

Osteopathy and exercise....
Osteopathic Doctors are taught to recognize the importance of exercise and posture for health. Exercise needs to be relevant to the patient’s age, state of health and aims in life. As we age, body tissues are less flexible. It is best to begin exercising gradually, increasing to a level that does not overstrain the heart and lungs. It is wise for middle-aged or older persons to see a Medical Doctor or Osteopath before starting an exercise program.

The role of posture in health....
Poor posture can result in poor circulation and weak muscles, backache, headache and many other distressful symptoms. Good posture includes knowing the best way to stand, walk, sit and rise from a chair, how to lift heavy objects, the best work positions for different jobs, and how to relax. For instance, the most relaxed and least pressured position for the spine, known is the semi-Fowler position, that is, lying down on your back with feet raised on a cushion or stool with the knees at 90 degrees. Do this for ten minutes every day or after strenuous activity or when you feel stiff and sore.

One of the best posture training programs is the Alexander Technique. Many actors, actresses, dancers and musicians take this training to enable them to maintain more relaxed control of their bodies while performing what is very demanding work. Learning the Alexander techniques involves one-to-one teaching. Courses are available in most large cities. Posture training is also available as part of Yoga training, Tai Chi, and Feldenkrais.

New developments....
Cranial Osteopathy has more recently become a specialization within the practice of Osteopathy. It is the name given to the Osteopathic manipulation of the skull bones. Problems such as headaches, high blood pressure, skin rashes, pain in the face, problems with the teeth, heart complaints, stomach ulcer and irritable bowel syndrome can have their origin in slight pressure on nerves originating in the skull. This kind of treatment should be performed only by highly skilled and specially trained operators, and then only after careful assessment.

Osteopathy and conventional medicine....
Be aware that some Osteopaths are also MD’s. In addition to specialized training in Osteopathy, they receive the regular training of a medical doctor and would be eligible for licensing to practice as such. This would permit them to prescribe medication and perform surgery in addition to the manual manipulation of a more traditional osteopath. Osteopaths who also practice "conventional" medicine are more common in the United States. I have myself been successfully treated for sciatica by an osteopath practicing what I call traditional or classical osteopathy.

Recommended reading....
Touch of Life, by Dr. Robert C. Fulford, is an excellent introduction to the practice of Osteopathy. Ninety-one-year-old Dr. Fulford has spent more than fifty years successfully treating patients whom conventional medical treatment failed to help. This is a delightful book to read, containing Dr. Fulford’s many observations on life, health and healing gleaned from his many years of practice. The book is written in plain, readable language. Dr. Fulford presents surprising insights on herbs, homeopathy, vitamins, and diet, concluding his book with some basic stretching and breathing exercises designed to enhance our own healing powers. It’s a book you will want to read, reread and share with your family and friends. Dr. Fulford’s book, Touch of Life, is published by Pocket Books of New York City, 1997.

Osteopathic Manipulation Gets Patients Moving After Surgery


Thirty-eight patients assigned to osteopathic manipulation on the second through the fifth days following surgery were able to climb stairs an average of 20% sooner than 38 others who had similar surgeries but did not receive such treatment (4.3 days vs. 5.4 days). According to the study, on the third day following surgery, the patients receiving manipulation walked an average of 43% farther than those who were not treated. Further investigation by Healthnotes Newswire prompted the study’s principal investigator to amend the finding to a significantly higher 57%. Both of these findings were statistically significant. Manipulation-treated patients also needed less pain medication than untreated patients, though this difference was not statistically significant. The researchers who evaluated stair-climbing and walking abilities and pain-medication use were not told which patients were receiving manipulation therapy.

In most ways, modern osteopathy is barely distinguishable from conventional medicine. However, when osteopathic medicine began over a century ago, its focus was a manipulation-based treatment that was unrelated to conventional medicine. Although “old-fashioned” osteopathy focuses on the use of physical manipulation, the nature of these manipulations is quite distinct from chiropractic treatments. Through the years, some osteopathic physicians have continued to use osteopathic manipulation in addition to using drugs and surgery. Today the practice of including osteopathic manipulation is once again becoming more popular. Findings from the current study suggest that osteopathic manipulation speeds recovery in patients who have just had surgery to the knee or hip.

Some common illnesses treated with Osteopathic Manipulative Treatment

Cheryl L. Howard, D.O.

Also read what patients had to say!

Pediatric Problems
Colic, Plagiocephaly, ADD, Down Syndrome, Spitting Up, ADHD, Sucking Difficulty,
Delayed Development, Birth Trauma, Cerebral Palsy, Hip Dysplasia and Learning

Pregnancy Problems
Back Pain, Groin Pain, Digestive Upset, and Edema

Somatic Pain
Neck Problems, Back Problems, Sciatica, Headaches, Migraines, Joint Pain
Syndromes, Hip and Leg Pain, Traumatic Injuries, and Overuse Syndromes

Respiratory Ailments
Asthma, Allergies, Bronchitis, Pleurisy

Systemic Problems
Neurologic Syndromes, Insomnia and Fatigue, Anxiety and Depression, Digestive
Disorders, Genitourinary Problems, Chronic Infectious Disease, Head Trauma,
Post Concussion Syndrome, and Seizures

Ear, Nose and Throat Problems
Chronic Ear Infection, Recurrent Sore Throat, Frequent Colds, Sinusitis

Malocculsions, TMJ, and Orthodontic related problems

Strabismus, Visual Somatic Dysfunction, Visual Strains, Phorias and Binocularity

Tuesday, February 07, 2006

Sports Injuries, Athletic Healthcare and Osteopathic Medicine

Source: Caroline Stone Osteopathy Clinic, Mount Lawley

Sports Injuries and Athletic Healthcare

Every sport is different, and every sportsman and woman has their own unique physique, with which they aim to use in a particular way for each individual sport. Sports such as golf, swimming, tennis, horse-riding and so on all require the body to be used in different ways, and each place strain in particular parts of the body. Hence some sports have common injuries such as tennis elbow or shin splints in runners, and if your own body does not twist or bend or work in quite the right alignment which is optimum for that sport, then you may experience additional strains and injuries as a result.

Treating sports people requires knowledge of how the body works as an integrated unit, and an awareness of how different sports require different movements throughout the body. Sports people need to be assessed carefully, so that any restrictions or tensions within their mechanical framework can be addressed, allowing them to operate more freely in their chosen sport, and thereby reduce injury occurrence, and also improve injury rehabilitation.

This approach is affective whether you play sports informally in the backyard with the kids, go to the gym once a week, or are a dedicated professional needing to be at optimum fitness and functioning on a daily basis.

Osteopaths are experienced in assessing the whole body, and integrating treatment so that all maintaining factors are considered and addressed wherever possible. Thus osteopathic management of sporting injuries is often more successful than other approaches. Osteopaths can also advise on exercise programmes and can work with other healthcare professionals in an intensive rehabilitation programme as required.

What to do for a sports injury

Joints and Muscles

This is the most well known area for osteopathic care. Whether your problem is repetitive strain injury from work, spinal problems from gardening, sports or lifting, whiplash and other traumatic incidents, sporting problems, or just as a result of the stresses and strains of normal life, osteopathy is often able to help. Many types of chronic and acute problems can be helped, and recovery is often quicker and more long lasting than with other types of care. Osteopaths deal with the very young to the very old and with problems in all parts of the body.

Prevention is definitely better than cure!

Your Osteopath can provide a number of stretching exercises and routines that will specifically assist you with avoiding injury through muscle and joint strain. In addition, depending on your sport and individual needs, your Osteopath can provide advice on lifestyle to assist you in both performance and recovery.

Osteopathic treatment involves manual techniques, including soft tissue stretching, mobilisation and manipulation, which is like a tune up for strained muscles, joints and spine. This creates a positive influence on your circulatory and nervous systems. In turn this can have a flow on effect to the rest of the body by improving elasticity and mobility. These hands on methods are gentle, safe and effective.

Out of Breath?
Whether you are aware that you suffer from a breathing disorder or not, it is important, particularly in sport, that you ensure your diaphragm is performing optimally and the rib cage mechanics are functioning correctly. This is highlighted when the body is under stress to perform and the respiratory rate is elevated. Your Osteopath can assess your structure and assist in maintaining good breathing function.

Breathing Disorders and Osteopathic Medicine

Source: Caroline Stone Osteopathy Clinic, Mount Lawley


People suffering from breathing disorders often have many tensions and restrictions in their ribcage. Whether they suffer from asthma, chronic bronchitis, reduced breathing from old rib fractures, emphysema or some other chronic respiratory problem, osteopathy can help. This is achieved by improving the elasticity of the ribcage, easing muscle tension to reduce respiratory fatigue, and helping the person cope with their condition more readily. Breathing exercises, rib stretching and postural advice can be given which helps to maintain better respiratory function alongside treatment. It is not always possible to resolve the underlying condition which may be related to other diseases or allergies, for example, but a better quality of life can be achieved and sometimes a reliance on medication can be reduced. Osteopathic management with respiratory disorders may be done in conjunction with your G.P. or other healthcare professionals.

As one of the most common presenting conditions to Osteopaths is asthma the information below may be invaluable.

Why are osteopaths interested in asthma?
Asthma is a common and sometimes debilitating respiratory disorder which can affect people of all ages. About one in ten Australians suffers from asthma at some time during their lives.

Sufferers experience breathing difficulties, wheezing, discomfort or pain in the chest, tightness in the chest, and sometimes coughing, shaking and vomiting as well. Each suffer's experience is individual, and not all asthma attacks are the same. There are common features though, and each asthma sufferer has to some degree mechanical changes in their rib cage, tension and fatigue in the respiratory muscles (including the diaphragm), poorer movement in the spine, neck and shoulder girdle and often, tension in the head and jaw.

These changes only serve to complicate the picture of each person's asthma, whether it is allergic (and triggered by pollen or what or dairy products, for example) or non-allergic, and triggered by physical exercise or stress, for example.

Osteopaths are interested in asthma, as they can detect these physical changes, and help to alleviate them over time. Keeping the chest, lungs, respiratory muscles and surrounding areas of the spine, shoulders, neck and throat freer and more elastic seems to help in lessening the asthma to some degree, and may also help to reduce the need for some asthma medication, on occasion.

Does Osteopathy replace conventional medical treatment?
No. Osteopaths recognize the important role of anti-inflammatory medication, antibiotics and broncho-dilators in the treatment of asthma, especially in acute attacks. Osteopaths can work in conjunction with other health care professionals with the long-term aim of decreasing the patient's dependence on medication.

Osteopaths work through all of the body, as they consider that restrictions in many parts of the spine, legs, pelvis shoulders and neck can all affect the lungs, rib cage and breathing muscles. Osteopaths release tension and poor function throughout to reduce load on the respiratory system, and thus help the body to cope more effectively with the asthma condition. They use gentle techniques to:

make the chest and ribs move more effectively
releasing the diaphragm and other muscle used for breathing
improving circulation and drainage in the chest, to help with inflammation and function

Other areas of management include the formulation of an individual exercise program, with emphasis on breathing exercises and the avoidance of aggravating factors. Your Osteopath may also provide(s) advice on diet, posture and lifestyle which may be of benefit.

"How Osteopathic Medicine Sees Disease, What It does to Heal Us"

How does Osteopathic Medicine treat us? Why is it unique?

See this article.

What does a myofascial release treatment feel like?


The pressure can range from very gentle touch to deeper pressure. The pressure should never be beyond your tolerance and it is important to give feedback to your practitioner during the treatment.

Some patients may experience a slight tingling or burning sensation in the skin, which is perfectly normal and safe. Others may feel a gentle to deep stretch on the area being treated.

The treatment can last from 15 minutes to over an hour. It is performed by a qualified practitioner who has studied this advanced work.

The techniques help to reorganize and lengthen the tight tissue allowing for better movement and health.

Myofascial release was specifically designed to relax the fascia throughout the whole body. And because tension in fascia can affect and cause pain in other areas, your therapist may treat other areas of the body to positively effect your treatment outcome. For example, your practitioner may work on the hips and low back to help reduce tension in the neck which in turn can cause headaches. This is the benefit of a whole body approach that makes myofascial release such an effective treatment.

Because each patient is different the number of treatments required may vary, however a general rule is that you should notice a change in your condition with the application of myofascial release. Your practioner will discuss your treatment plan and projected outcome with you during your first session.

Osteopathic Manipulative Treatment and Fibromyalgia Treatment

Source: What Treatment Seems Most Effective in Treatment of Fibromyalgia
(Part 4) ©
Leon Chaitow , D.O.

Osteopathic medicine, from which both SCS (Strain/Counterstrain) and Muscle Energy Technique (MET) derive, has conducted many studies involving Fibromyalgia, including:

1. Doctors at Chicago College of Osteopathic Medicine let by Drs. A. Stotz and R. Keppler measured the effects of osteopathic manipulative therapy (OMT - which includes SCS and MET) on the intensity of pain felt in the diagnostic tender points in 18 patients who met all the criteria for Fibromyalgia.

Each had six visits/treatments and it was found over a one year period that 12 of the patients responded well in that there tender points became less sensitive (14% reduction in intensity as against a 34% increase in the six patients who did not respond well) Most of the patients, the responders and the non-responders to OMT, showed that there tender points were more symmetrically spread after the course (using thermographic imaging) than before. Activities of daily living were significantly improved and general pain symptoms decreased overall.

2. Doctors at Texas College of Osteopathic Medicine selected three groups of Fibromyalgia patients, one of which received OMT, another had OMT plus self-teaching (learning about the condition and self-help measures) and a third group received only moist-heat treatment. The group with the least reported pain after six months of care was that receiving OMT, although some benefit was noted in the self-teaching group.

3. Another group of doctors from Texas tested the difference in results involving 37 patients with Fibromyalgia of using a/

drugs only (ibuprofen, alprazolam) or b/ OMT plus medication c/ a dummy medication (placebo) plus OMT or d/ a placebo only. The results showed that drug therapy alone resulted in significantly less tenderness being reported than did drugs and manipulation or the use of placebo and OMT or placebo alone.

Patients receiving placebo plus manipulation reported significantly less fatigue than the other groups. The group receiving medication and OMT showed the greatest improvement in their quality of life.

4. 19 patients with all the criteria of Fibromyalgia were treated once a week for four weeks at Kirksville, Missouri College of Osteopathic Medicine using OMT. 84.2% showed improved sleep patterns, 94.7% reported less pain and most patients had fewer tender points on palpation.

Sunday, February 05, 2006

Osteopathic Manipulative Treatment: Established Patient Example Part III

SOAP Note - Established Patient Example

Patient continues to experience achy and dull pain in the right lower cervical region, particularly with extension of the neck. It continues to radiate into the right lateral arm. He has experimented with some different positions of his car seat, which he feels has been helpful. He has tolerated the Lodine well and states that overall he fees somewhat improved. Further work history reveals improper placement of video screen at computer station and lack of wrist rest at keyboard.

B/P 126/64

Pulse 64

Respirations 18

Cardiac and pulmonary exam again negative. DTRs are +2/4 in the upper extremities bilaterally. No weakness or atrophy in the upper extremity. Tl and T3 are again rotated right with right 3rd rib dysfunction and hypertonicity of the right rhomboid muscles. The lower cervical segments are again sidebent left with tightness of the short restrictor muscles on the right. The lumbar spine is in better balance today with level sacral base. X-rays taken in the office today reveal an uncovertebral osteophyte at the C5-6 level on the right, causing mild foraminal narrowing. Radiologist report pending.

1. Somatic dysfunction - cervical, thoracic and costal, with secondary muscular

Hypertonicity. 728.8, 739.1, 739.2, 739.8

2. DJD cervical spine, 721.0

3. Mild cervical nerve root irritation 353.2

Secondary to #1 and 2 above.

1. OMT to above areas with good mobilization.

2. Continue Lodine,

3. Recommend changes in work station configuration,

4. Re-evaluate in 1 week.


Evaluation/management; established patient 99214-25

OMT three body regions; cervical, thoracic, ribs 98926

Osteopathic Manipulative Treatment: New Patient Example Part II


SOAP Note - New Patient Example

Patient presents with a chief complaint of achy, dull pain in the upper thoracic and lower cervical region, radiating into the posterolateral right arm. Patient has been having stiffness in the morning since then. He states the onset was two days ago, after golfing in cold weather. The symptoms have been gradually increasing since that time. The symptoms are aggravated while driving and working at his computer station; relieved when lying down. He denies anesthesias, parasthesias or weakness in the right fingers, hand or forearm. He has taken Tylenol with minimum relief.

PSH: Denies.

PMH: Noncontributory.

SH: Patient owns an insurance agency and spends several hours per day at a computer keyboard.

FH: Negative for rheumatologic problems.

Present Medications: Tylenol. No known drug allergies.

ROS: Cardiac, pulmonary and GI all negative

B/P 122/70

Pulse 64

Respirations 18

Weight 167

Heart has a regular rate and rhythm with no murmurs. Lungs are clear to auscultation bilaterally. Neurologic DTRs are +2/4 in the upper and lower extremities bilaterally. Sensation is intact and there is no evidence of weakness or atrophy in the upper extremities.

Structural Exam: T1 is rotated and sidebent right. C6 and 7 are sidebent left. T3 is rotated right with posterior displacement of the right 3rd rib. There is pain at the end point of range of motion of these areas. There are acute tissue texture changes and muscular hypertonicity in the upper right thoracic and lower cervical paravertebral muscles. Extension of the neck reproduces the patient's symptoms. The lumbar spine is sidebent left with secondary right rotation and significant restriction at the thoracolumbar and lumbosacral junctions. The sacral base declines to the right. 1.) Examination of the shoulders revealed negative impingement test, a negative drop arm test. 2.) The rotator cuff had normal motion both active and passive.

1. Somatic dysfunction - cervical, thoracic, costal, lumbar, sacral 739.1, 739.2, 739.4, 739.8.

2. Mild cervical nerve root irritation secondary to #1 above; suspect DJD. 353.2

1. OMT to above areas with excellent response.
2. Rx - Lodine 400mg to be taken one b.i.d. with food.
3. Recheck 1 week for signs and symptoms persist.


Evaluation/management; new patient 99204-25

OMT five body regions; cervical, thoracic, lumbar, sacrum, ribs 98927

Osteopathic Manipulative Treatment: Established Patient Example Part II


SOAP Note - Established Patient Example

Patient ambulating, non-smoker with chief complaint of deep cough and with occasional vomiting, x three weeks. Onset nasal congestion; hoarseness; cough; low grade temperature (100-101 degrees). Almost dry cough with occasional clear sputum. Pain in center chest with coughing and no radiation of chest pain. Patient did have right rib pain with deep inspiration and cough. Cough worse in PM with occasional insomnia. Occasional slight chills and sweats.

Temperature = 100 degrees; blood pressure = 120/80; pulse = 92; respiration = 18. Chest- diffuse insp. rales (fine and course). Heart - RRR without murmur. H& ENT - nasal congestion with TMs non--injected; pharynx-injected with cervical lymphadenopathy. Abdomen - non-tender, no splinting, negative Lloyds. Structural exam - resp diaphragm amplitude diminished with lateral rib restrictions R>L.

Sternal tenderness with palpation



Tentorium restricted with CRI

1. Pheumonia, prob mycoplasma 483.0

Somatic Dysfunction - head cervica, 739.0, 739.1, 739.2, 739.8, 739.9 thoracic, lumbar, rib cage, abdomen regions
3. Strained anterior cervical fascia

Treatment plan - Erythromycin 250 mg qid x 2 wks

Tessalon Perles: Two tablets q 6-8 hrs prn

Lab - CxR, CBC with diff, cold agglutinins

OMT - head, cervical, thoracic, lumbar, rib cage, abdomen regions (soft tissue and HVLA)

Lymphatic pump; rib raising

Call in 24 hrs; return in one wk for re-eval.


Evaluation/management; established patient 99214-25

OMT, five to six body regions 98927

Osteopathic Manipulative Treatment: Established Patient Example


SOAP Note - Established Patient Example

Patient is here for re-evaluation. He states that the pain has decreased in his low back and that he can get around better. He states that he has no radiation of pain into his legs. He does state that he feels stiff and achy if he tries to do his normal daily activities. He is still taking aspirin with some relief.


Tenderness with palpation and stretch of the erector spinae muscles
Pain with extention and rotation left of L5
Pain along with right SI joint with sacral extension
No muscle spasms noted with active or passive range of motion
Negative neurological exam of lower extremities
1. Lumbosacral sprain/strain; improving 846.0

2. Somatic dysfunction - lumbar, sacral; improving 739.3 and 739.4

1. OMT (appropriate techniques used*), applied to the lumbar and sacral regions

2. Instructed on proper posture when lifting

3. Increase home activities gradually and to tolerance

4. Follow up if improvement does not continue


Evaluation/management; established patient 99213-25

OMT two body regions; lumbar/sacral 98925

*See AOA Glossary of Osteopathic Terminology for appropriate techniques

Osteopathic Manipulative Treatment: New Patient Example


SOAP Note - New Patient Example

A patient complains of low back pain that began 3 days ago after he lifted a heavy object. Cannot straighten up when walking. Pain with change of position. Denies radiation of pain; it stays along the low back and waistline. Denies areas of numbness. Comfortable when lying down. Aspirin helps some. Has used heat with some help. No prior history of back pain or injury. Denies allergies. Medical/surgical history is unremarkable.


Tenderness noted over lumbar and sacral regions
Inability to extend lumbar spine when standing
Flexion posture when standing
Muscle spasms noted in paraspinals of the lumbar region
Decreased range of motion of lumbar spine and sacrum was noted on active and passive motion testing
Neurological exam normal
1. Lumbosacral sprain. 846.0

2. Somatic dysfunction - lumbar, sacral 739.3 and 739.4

1. OMT (appropriate techniques used*), applied to the lumbar and sacral regions

2. Continue aspirin

3. No lifting, bending or twisting

4. Follow up in two days to reevaluate patient progress


Evaluation/management; new patient 99203-25

OMT two body regions; lumbar/sacral 98925

*See AOA Glossary of Osteopathic Terminology for appropriate techniques.

Protocols For Osteopathic Manipulative Treatment (OMT)

Source: Notes Contributors
The development of this document by the American Osteopathic Association was prompted by the growing need among non-osteopathic peer reviewers and entities for guidance in the appropriate frequency and uses of osteopathic manipulative treatment (OMT). While these materials provide a framework, they are not absolute rules and should not be used to set absolute restrictions or other restrictions criteria that would override an osteopathic physician's professional judgment on case management. As with all medical treatments, patients may present with a broad variety of complicating factors and physicians should be afforded sufficient latitude to apply varying treatment styles and approaches to patient care.
The use or omission of any of the techniques described herein for the purposes indicated herein should not be construed as adherence to the standard of care or failure to adhere to the standard of care. Finally, these materials are only a basic reference and can not substitute for the education and training of an osteopathic physician.
Use of the enclosed guidelines, accompanied by proper documentation from the physician, should provide the reviewer with the information necessary to make an accurate determination. For further information please consult the osteopathic profession’s standard textbook: Foundations for Osteopathic Medicine, Robert C. Ward, DO, FAAO, Executive Editor, (Copyright 1997, Williams and Wilkins)

Osteopathic physicians utilize all recognized medical procedures and available technologies to provide comprehensive health care to their patients. The osteopathic profession is recognized by its distinctive philosophical approach. 1,2,19,33,34,39 This approach led to unique contributions by the osteopathic profession in the development of techniques used in osteopathic manipulative treatment, and by their integration into a physician-directed management of the total patient. 3.4 Osteopathic manipulative treatment involves the use by the physician of manual procedures to optimize patient health and function. 5,6,32 It should be emphasized that osteopathic manipulative treatment is a distinctive medical procedure and should not be confused with services provided by non-physicians. 7 Osteopathic manipulative treatment is a general term currently encompassing approximately twenty-five different types of physician-performed manipulative treatment. 19 Osteopathic manipulative treatment (OMT) is defined in the "Glossary of Osteopathic Terminology", the profession-wide accepted resource for osteopathic terminology, which is published by the American Osteopathic Association.

Structural Dysfunction
Structural diagnosis involves the use of expanded observation and palpatory examination of the neuro-musculoskeletal system with its venous, lymphatic and pulmonary interactions, 8, 9, 10,11, 12, 13, 14, 15, 25 as part of evaluation of the entire patient. The goal is to identify the presence of significant impediments to health and well being in the entire patient through an understanding of the interrelationships between the musculoskeletal system and all other systems of the body. 16,17 This includes but is not limited to the identification of somatic dysfunction and related visceral disease/dysfunction. 10,32, 38, 35 The performance of the history and physical examination of a patient should not be viewed as an isolated examination of the musculoskeletal system since many organ systems are examined. 18 The definition of somatic dysfunction is correlated with the entire patient as follows:
Impaired or altered function of related components of the somatic (body framework) system; skeletal, arthrodial and myofascial structures;and related vascular, lymphatic and neural elements. 19 21, 25, 36, 37, 38
During the process of diagnosis of altered structural function, somatic dysfunction is identified by one or more of the following physical findings: asymmetry of related parts of the musculoskeletal system, range of motion abnormalities, tenderness and/or tissue texture abnormalities.20, 21 Alteration in the range of motion may be exhibited by either restricted or increased motion. Alterations in quality and range of motion are the most common and often most significant findings indicating the presence of somatic dysfunction. 33, 39 Pain or tenderness or their provocation can be of assistance in the diagnosis but their provocation is not diagnostic in and of itself. Somatic dysfunction is also made clinically relevant by interpreting the effects of personal injury history 19, 22, 23, 24, 25, 33, 39

OMT Case Management
Osteopathic manipulative treatment involves the same principles utilized in diagnosing and treating any disease. This diagnosis must be specific. Once an accurate diagnosis is made, the physician will determine the appropriate techniques and treatment. It is not usually appropriate to create a "treatment plan" for OMT. Several different treatment techniques may be integrated for use in the same patient. Adjunctive modalities may be employed in the total case management of the patient's condition.
The choice of osteopathic manipulative technique is based on multiple factors. These include the age and physical condition of the patient, and the effectiveness of previous forms of treatment. The physician must also keep in mind his or her own experience and expertise in each of the treatment methods, and must choose those that can be performed effectively. Due to the complex interrelations of body systems, and the body's innate ability to make compensatory changes during each treatment, tissues both adjacent to and remote from the area of primary involvement may require concomitant treatment.
The three key components of an E/M service: history, examination and medical decision making are essential in the decision making process and management of the patient prior to the performance of subsequent OMT. Therefore it is appropriate for an E/M service to be performed at each follow-up patient encounter. An appropriate significant, separately identifiable E/M service, documented according to the E/M Documentation Guidelines should be provided and reported. This is all necessary in determining: If additional OMT needs to be provided and if so, 1) What body regions need to be treated, 2) What OMT technique(s) should be utilized, and 3) If OMT needs to be augmented with other medical services/ procedures.

Basic Treatment Concepts
A. Patients who present with a dysfunctional somatic component to their condition may benefit from OMT.
B. The primary goal of using OMT is to enable the patient to return to health and optimize function.
C. OMT should be performed at the appropriate effective frequency as determined through the on-going process of medical evaluation and management.
D. OMT should be performed for the minimum appropriate duration. This can be defined as that duration of time from the initiation of treatment which will result in continued improvement, and where additional treatment will not further benefit the patient.
E. Subsequent treatments may be an appropriate response to unstable or recurrent conditions as part of the overall management of the patient's condition. Every attempt is made to reach maximum improvement of the patient and OMT should be coupled with other appropriate medical and/or surgical interventions. Occasionally, less frequent, periodic treatment may be utilized effectively to help continue maximum medical improvement. The frequency of such treatment should be consistent with the phase of the patient's disease or dysfunctional process as determined by on-going evaluation and management of the patient's condition. 26
Some stabilized conditions that acutely decompensate may require reinstitution of OMT. 27
Subsequent evaluation and management in conjunction with OMT is appropriate for patients with long term conditions. 28, 29
Passive physical medicine modalities should be combined with an active treatment program which emphasizes progressive exercises with a decreasing frequency of passive treatments. The modalities provided should be appropriate to the individual patient's presenting problem and their response to prior treatment. Prolonged application of physical rnedicine modalities beyond the acute phase of treatment should be limited in frequency and number of modalities utilized and should not be utilized as the sole form of treatment.

OMT Parameters
The guidelines below are meant to be used as a basic reference for appropriate osteopathic manipulative treatment. They are not intended to set restrictive criteria that would override an osteopathic physician's good judgment in comprehensive case management. Most patients should fall within the parameters below and there should be sufficient latitude for physicians with varying treatment styles and approaches. Some patients have additional factors which complicate successful completion of treatment. Among these factors are the severity of the illness, duration or chronicity of the condition, as well as the existence and extent of comorbidities. 30
Acute, Post-acute and Chronic refer to the phase of illness determined by the time elapsed from the onset of symptoms. Date of injury, diagnosis, acute exacerbation or surgery must be taken into consideration. 31
Initial refers to the interval during which OMT is first utilized by a particular physician in the treatment process regardless of the phase. The initial use of OMT may occur through its use by the primary treating physician in the acute illness, or it may be first used in subsequent phases of the illness through appropriate referral. Patients are treated more frequently during the first several encounters regardless of the phase of the illness, with a subsequent decrease in treatment as appropriate.
Subsequent refers to the treatment period following the initial interval of treatment by a particular physician within an illness phase, and as continuing treatment through subsequent phases patient's progress to recovery or maximum medical improvement.
Treatment of Recurrent Problems: If a patient has multiple recurrent episodes related to their original complaint within one year, it should not be classified or treated as an acute problem. In this circumstance, it would be classified as a recurrent problem and secondary assessment and treatment methods should be used with an emphasis on active therapy and prevention strategies. Additional treatment may be necessary if repeated efforts to withdraw from treatment results in significant deterioration of clinical status. Patients with recurrent problems may require additional evaluation and interventions for psychosocial and ergonomic factors which may be contributing to the recurrent nature of the problem. A history of previous episodes of similar complaints should be considered as well as possible contributory factors such as chronic pain, depression, alcohol/substance abuse, smoking and extreme obesity. Supervised changes in physical activity and lifestyle should also he considered.
The routine scheduled provision of osteopathic manipulative treatment (OMT) would not be considered appropriate in the absence of acute or chronic problems.

Thursday, February 02, 2006

Osteopathic Treatments Effective in Managing Childhood Asthma

Source: © Mary Anne Morelli D.O., F.A.C.O.P. , Osteopathic Center for Children

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Note: The below article is copyright by Mary Anne Morelli D.O., F.A.C.O.P. and we thank her for this wonderful article.

During my first year of medical school I experienced the benefits of osteopathic manipulation for asthma. As a child, I hadsignificant difficulties with allergies and asthma. Gradually my symptoms lessened as I matured. But even in college and medical school I struggled with frequent upper respiratory illnesses.In medical school, the extra time I spent in the anatomy lab preparing for exams triggered asthma symptoms. This proved to be frustrating as I needed more energy, not less. Fortunately, I had been paired with a second-year student with a keen interest in Osteopathic Manipulative Treatment (OMT).He treated me and to my surprise the feelings of shortness of breath dissipated. I was relieved to find that I no longer needed inhaled medication. Furthermore, despite the continuing intensity of medical school, the frequency of my upper respiratory infections began to abate. Having suffered for many years from the aggravating effects of asthma and allergic sensitivities I experienced the benefits of OMT first hand. How I wish my family had been introduced to the benefits of OMT when I was a child!Rather than merely suppressing symptoms, osteopathic medicine addresses the underlying disturbances in the body's mechanisms. In asthma, medications are prescribed to cause dilation of the bronchioles. However, through properly applied manipulation, the body can be stimulated to release its own supply of these same chemicals. Proper circulation is absolutely necessary for effective function of the lungs. The arteries supply nutrition to vital organs and tissues in the body, while its counterpart returns the deoxygenated blood back to the heart through the veins. Osteopathic manipulation strengthens these vital pathways while removing road blocks to the body's natural healing process.Have you ever tried to take a deep breath with your rib cage locked? It is very difficult. Another goal in the osteopathic treatment of asthma is to create free motion in the rib cage and thoracic diaphragm. Osteopathic techniques to enhance drainage of the lymph nodes also help the immune system with its housecleaning tasks. OMT can also be effective when a child has taken a hard fall. Many times a fall to the tailbone will trigger an asthma attack in a child. This is due to the relation of the tailbone to the "primary response mechanism" . Making sure the sacrum (tailbone) is moving properly is very important in successfully treating asthma.Nutrition happens to be one of the best weapons in the prevention of asthmatic episodes. There is a clear relationship between poor nutrition and bronchial difficulties caused by asthma.A healthy diet should include fresh fruits, vegetables, nuts, seeds, and whole grains. Vitamin C, bioflavinoids, ginger and tumeric help reduce inflammation. Foods that promote inflammation such as fried foods, junk food, smoked or barbecued foods, and partially hydrogenated foods should be avoided as well as mucus-forming foods including milk, sugar, refined flour, and most dairy products. It is important to read labels and avoid all chemicals and additives. Do you know that modified wheat starch contained in many cereals and processed foods is "modified" by six chemicals all of which can cause allergies and asthma? Food is one of our best medicines-- use it wisely!

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

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

Osteopathic Medicine and End-of-Life Care


In 1998, there were some 34.5 million Americans age 65 and older. By 2030, that number is expected to double to about 70 million people, or 20 percent of the US total population.
As the average life expectancy in the US increases and the number of older Americans continues to rise, more and more adults, their families, and healthcare professionals are addressing the many issues and decisions surrounding “end-of-life” care and support.

End-of-life care encompasses a wide range of topics, from complementary and conventional acute pain management, to addressing social, cultural, and religious differences and sensitivities. It also involves counseling and other forms of support for patients and their caregivers, discussions about the costs related to end-of-life care, insurance coverage, advance directives for final stages of life care and treatment, and more. Helping Americans understand the choices they have and making life better for those who are dying are important parts of complete and compassionate medical care. This includes not only medical treatments, but responsiveness to the social, spiritual, and ethical needs and sensitivities of patients and their families. In short, the medical community plays a vital role in helping patients and families during the final stages of life.

Osteopathic physicians (DOs) treat the entire person, not just symptoms, and are particularly well-equipped to provide the terminally ill with the types of treatment and guidance that allow them to experience the same quality of care at the end of their lives as they have had throughout their lives. Among the core end-of-life care principles recently adopted by DOs nationwide was “recognizing death as the legitimate end-point to the human life cycle.”

“Osteopathic medicine is a comprehensive and hands-on type of medical care that takes into account all facets of a person’s state of health,” said Paul A. Martin, DO, the 2003-2004 president of the Ohio Osteopathic Association. “It is that unique and compassionate approach to patient care has made DOs the physician of choice for many.” Dr. Martin, a family physician in Dayton, said osteopathic medicine’s whole-person medical approach to care helps ensure optimal health for patients, not only through prescriptions, medicines, surgery, and other traditional measures, but also by utilizing a unique, distinctive tool called osteopathic manipulative treatment (OMT).

In 1874, a Missouri physician first described osteopathic medicine “a form of medicine that evolved around the belief that the body has intrinsic healing abilities.” Dr. Andrew Taylor Still and his unique medical viewpoint surfaced at a time when traditional medical practices were more often the problem, not the solution. Dr. Still had grown to distrust the quality of traditional medicines, many as harmful as the diseases themselves. As a result, he rejected the use of then-popular medical “cures,” such as leeches and mercury.

Today, DOs are involved in every branch of medicine. They care for the uninsured and the underserved. They perform brain surgery and deliver babies. And, they have contributed to the latest medical technology, including gene therapy and DNA coding for diagnostic purposes. Nationwide, there are more than 46,000 DOs who collectively treat more than 100 million patients annually. Approximately 64 percent of all DOs practice in primary care areas, such as family medicine, internal medicine, and pediatrics. In Ohio, which has the third largest number of DOs in the nation, following Pennsylvania and Michigan, 11 percent of all physicians are DOs. Of family physicians in Ohio, 34 percent are DOs.

The Ohio University College of Osteopathic Medicine (OU-COM) in Athens is one of 20 osteopathic medical schools in the nation. It was established in 1975 by the Ohio General Assembly which mandated that a high percentage of the College’s graduates would be family physicians who practice in underserved areas.

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