Osteopathy bases its claim to be placed at the level of a therapeutic science (medicine) on the fact that there exists a relationship (finite and definite) between a determined organ and the central nervous system. This relationship is ensured through the segmentation of the spinal nerves or through the neuro-vegetative nervous system by means of various ramifications.
Physicians (osteotherapists) argue that a disturbance of the vertebral mechanics can influence, through the intermediary of neurovascular circuits, the functioning of an organ. Doctors who have studied traditional osteopathy argue the opposite and refute this deliberately reductive and, in any case, archaic position.
Neuro-vegetative relationships (Sympathetic, parasympathetic)
A powerful musculature holds, supports and joins the vertebrae together, one above the other to form the vertebral longitudinal axis, rigid and flexible at the same time, able to support the trunk and ensure standing and balance . The muscles obey an automatic control mode. It is easy to imagine that each small vertebra stays in place thanks to the insertions of agonist and antagonistic muscles that allow flexion and extension movements. In addition, these vertebrae are connected by long muscles whose insertions can go to grip structures sometimes outside their neighborhood.
It is therefore not surprising that this localized vertebral blocking resonates on distant vertebral areas and gives rise to a misleading symptomatology, painful at a distance, the origin of which can remain unknown for a long time.
All manual medicine must analyze:
Why the repercussion on the vegetative nervous system and in particular on the nerve-nets which manage the functions of the organs makes it possible to understand the appearance of certain visceral disorders, often unsuspected, whose long-disproved mechanical origin is no longer in doubt.
How one has, indeed, refused to a disruption of the type subluxation or vertebral seizure the possibility of provoking a neuralgic pain associated with an attack by loss or insufficiency of nerve and vascular commands at the level of an organ or a tissue.
How one has, indeed, refused a disruption of the type subluxation or vertebral seizure the possibility of provoking a neuralgic pain associated with an attack by loss or insufficiency of nerve and vascular commands at the level of an organ or a tissue.
The osteopathic concept has, since Still, obviously evolved. He remains tributary – in spite of the convictions and personal feelings of his disciples however distant – from the certainty of their master to consider the human being as a masterpiece of nature.
The aphorisms of Still are numerous.
“The human body does not operate in separate units, but as a harmonious whole”
“The disease is caused by anatomical abnormalities that lead to physiological dysregulation”
“It is not up to the practitioner to heal the sick person. Its role is to adjust some or all of the system so that vital currents can spread there and irrigate the affected parts.
The state of health is therefore conditioned by a free circulation of body fluids. Any obstacle will be at the origin of stases leading to contractures, congestive, inflammatory and even infectious states. The accumulation of waste will change the terrain and promote the evolution of germs, as pointed out Claude BERNARD: “the microbe is nothing, the land is everything.”
Gérard SUEUR clearly tells us:
“Osteopathy is the therapy that consists of finding the anatomical elements that are no longer free in their own movements (or movements related to a general dynamic) and then treating them so that they cover their free physiological mobility.”
This lack of movement is expressed in the vocabulary of A.T. STILL, by a difference in temperature and texture of the tissues and by a disturbed positioning statics.
Except for certain accidents involving real bone movements requiring intervention by medical specialists, it is common to encounter, following trauma, disorders of the vertebral statics, imbalances of the pelvis, etc … abnormal tensions that settle in the fascio-musculo-aponeurotic system. As a result, the osteo-articular system will be hampered in its essential function: movement. This or that articulation will become hypo mobile, it will present neither displacement nor total blocking, it will present a restriction of mobility. Any articulation of the human body (vertebral column, pelvis, limbs, skull) may be affected by these mobility defects reflecting the abnormal tension exerted on it which osteopaths call somatic dysfunction. The importance of this somatic dysfunction is easily understood when we know that support tissues play an important role in the circulation of body fluids (blood, lymph, cerebrospinal fluid) and are places of exchange allowing cells to receive the substances they need to live, and drain the waste that clutters them.
The Faculties of Medicine recognize that whenever the joints or the walls of the body are subjected to a direct mechanical aggression, such as a blow, a fall, a sprain, etc., a more or less important inflammation develops in the tissues affected. The degree of inflammation depends on the one hand on the nature and severity of the trauma and on the other hand on the previous state of the affected tissue. We will see congestion, swelling and diffusion of blood fluids and cells of varying importance. A simple sprained ankle is a typical example of these various processes. The nature and origin of this inflammatory response is simple, since known physical forces are the cause.
Over time, this simple table of acute inflammation may be associated with chronic, infectious, sclerotic or other processes that will complicate the clinic. They have their own therapeutic solutions.
Perfect agreement between medicine and osteopathy:
The ideal would be, according to the severity of the lesions, to work in concert. On the other hand, this is done at the particular level, and the examples fortunately do not lack perfect harmony between medicine and osteopathy.
Harrison H. Fryette believes that in osteopathy,
“the notions of physio dynamics are, in fact, the privileged instruments of any etiological research in a patient.In fact, the originality of the osteopathic concept lies in the understanding and the evaluation of the essential role played by certain somatic modifications characteristic, known as somatic dysfunction in the process of the disease, both in its etiological phase and in its period of state, osteopathic diagnosis and therapy are a natural result of this understanding, whereas physical medicine represents only an amalgam of techniques, bathed in conventional concepts.This unit of concept is not found in physical medicine. “
The osteopathic profession remains very grateful to Dr. Louisa BURNS for the long research she has done on the tissue and circulatory changes that occur after artificial trauma of the spinal or other joints.
She was able to demonstrate that as a result of these musculoskeletal injuries, there were certain simple inflammatory changes whose amplitude was generally directly proportional to the severity of the injury. The conclusions drawn from this research on animals are generally considered by the osteopathic profession to be applicable to humans.
In general, this trauma to a part of the musculoskeletal system affects a joint, either directly, if the point of impact coincides with the joint itself, or through one or more bones that form this joint. As a result, the muscles, tendons, ligaments and joint capsule are usually affected and are the site of an inflammatory response.
When a constraint is applied to a joint in a direction that does not coincide with the direction of the normal axis of that joint (for example a lateral stress against the knee joint), the muscles and the supporting ligaments experience asymmetrical trauma.
In extreme cases, muscles and ligaments that experience maximal impact can tear, causing dislocation. In less severe cases, where there is no tearing of the supporting tissues, some structures will still be more affected than others on one side or part of the joint.
As a result, there will be more tension, contraction and inflammation in some muscles and ligaments.
Consequently, therefore, the joint at rest will be maintained in an abnormal and forced position, often at the extreme of one of its physiological amplitudes. This fixation at the limit or near the limit of one of the amplitudes, and this, at rest, obviously constitutes an abnormal position for the articulation, a position which implies that the members which compose it, take anomalous positional or dynamic relationships.
The inflammatory reaction of the supporting tissues of the joint, the tensions, the asymmetrical contractions of the muscles, the articular capsule and the ligaments, the anomalous positional relations in static and finally, the mobility restrictions, represent the modifications which characterize all the osteopathic pathologies of the musculoskeletal system. Abnormal stresses will exert on the supporting tissues while the loads will be irregularly distributed on the bearing surfaces.
The term “osteopathic lesion”, which we can now use, is used in the context of this type of pathology and always refers, in the context, to an articular problem of either the limbs or the spine.
The osteopathic lesion and its pathology have been described here as post-traumatic phenomena followed by an inflammatory reaction; but there are pathological conditions, which give a clinical image similar to that described above for the osteopathic lesion, and which follow a reflex or functional muscle contraction or spasm.
These states represent reflex manifestations of functional or organic visceral diseases, or somatisations of psychic problems.
They can occur in any muscle of the thoraco-abdominal complex (rigidity of the lower right quarter in appendicitis, of the upper right quadrant in cholecystitis, epigastric tension in the ulcer …);
But the most common reflex tensions are those found in the para vertebral muscles, and they will generally be found at the spinal stages situated in segmental relation with the diseased viscera.
These reflex voltages are rarely symmetrical and they therefore cause traction on one side of the vertebral joint. Mobility is then affected, resulting in positional disturbances similar to those described above for post-traumatic injuries.
The affected joint will have a restricted range of motion and become irritable during trauma, even the slightest.
These musculoskeletal pathologies, although generally neglected by other medical schools, are of great importance to the osteopath.
They are primarily articular tissue disorders and can only be detected by practitioners who have received osteopathic training. Congestion and tension can only be determined by palpation, they are not seen on X-ray.
Likewise, mobility restrictions are mainly determined by the palpatory evaluation of joint mobility.
Positional disturbances are minor and are, for the most part, not demonstrable on X-ray, the latter form of diagnosis being mainly able to assess the bone structure, to detect hypertrophies or dystrophies, or degenerative or neoplastic phenomena.
In physiology, it has long been recognized that every phase of the life process acts only within the context of the entire organism.
The function unit is total
Stimulation or artificial suppression of a single function modifies, to a certain extent, all physiology temporarily or permanently.
Clinicians are beginning to accept that the body’s responses to nociceptive agents are complex and affect many phases of the body’s activity.
The body reacts as a unit to trauma, infectious processes, psychic shocks, nutritional problems, chemical toxins and nociceptive physical agents.
The reactions of the body to these different etiological factors are similar: local or general circulatory changes, activation of the adrenocortical system and other endocrine tissues, activation of the vegetative nervous system and the thermoregulatory system, etc. These are just intrinsic reactions to different kinds of stress, and Selye included them in what he called the “general adaptation syndrome”.
Through his work, we now know that the body’s reactions to stresses of a very different nature are fundamentally similar.
Moreover, for Selye, every organ and every vital function of the body participates in these two fundamental conditions of life, which are adaptation and resistance.
The originality of the osteopathic school lies in the incorporation into this concept of the fundamental role played by the musculoskeletal tissues (joints, muscles, tendons, ligaments, cartilages and joint capsules) and the nervous system in the pathological processes.
Osteopathy recognizes the consistency with which musculoskeletal tissues are attacked, directly or by reflex, whenever the body is stressed or shocked. The term “somatic components of the disease” has been used to express this constancy of musculoskeletal tissue affection.
These somatic components of the disease can be post-traumatic and constitute the main pathological factor in the affected subject. On the other hand, they may be the result of emotional or visceral disorders.
The medullary impact of the visceral or locomotor system pathologies is a hyper-irritability of the metameric spinal stages with the affected tissues or, in other words, their maintenance in a subclinical state ready to unload under the slightest influence. .
These neurophysiological changes and dislocation are the cornerstone of osteopathy.
They are responsible for many variations in homeostasis, visceral rhythm, general resistance and adaptability, and can potentially influence any visceral function. This neurophysiological imbalance, in addition to the direct orthopedic consequences of the osteopathic lesion, is capable of conditioning or modifying the body’s response capacities to aggressions of any type.
The osteopathic experience has shown that the expert and specific application of forces intended to normalize the structural and functional relationships, releases tensions in the muscles, ligaments and joint capsules, any structure having an important role in the maintenance of the pathology of the lesion. The relaxation of these persistent tensions can sometimes be obtained quickly or in few treatments. In other cases (again depending on the duration of the pathology, the muscle tone of the individual, previous diseases etc …), several treatments will be necessary before the function and tone of the affected region are normalized. An effective treatment eliminates any muscle or joint discomfort, local or general.
At the same time, the sensitive “stimulus” emitted by the affected tissues is reduced in volume and frequency, which reduces the irritability of the medullary center in a metameric relationship. As more normal reflex activity is restored, the distant or close effects of the injury regress.
Although osteopathy does not claim that the osteopathic lesion is the main etiological factor in all these pathologies, it must nevertheless be considered as a field factor or, in other words, a sensitizing and predisposing factor, of significant importance. basic clinical.
In this regard, Alan STODDARD recalls:
“That a vertebral osteopathic lesion is a condition in which the mobility of a vertebral joint is altered, with or without modification of the reciprocal positions of the adjacent vertebrae. When there is a modification of these positions, it is always within the fields of the normal movement of these articulations. “
Without doubt, the one who works “outside” these fields be he a surgeon, a vertebrotherapist or osteotherapist but he is certainly not an osteopath!
As a worthy representative of STILL’s osteopathy, JC ALLIRAND obviously approves and rightly incites his readers, if not to seek the most appropriate definition of the term manipulation, at least to establish a distinction between the various currents which advocate it. use.
Joint manipulation in the medical field is the art of giving a joint a new positioning in space. This term of manipulation is thus improperly used since it can also mean that we play the normal range of motion or that we force a joint beyond its limits.
The term “adjustment” is more precise and shows that the act must be specifically adapted to the joint in question. But only the Anglo-Saxons use it, which seems to show from the beginning that the method as well as the word have not been understood by us and is the cause of bitter and sectarian struggles.
John Guymer BURTON, a pupil of LITTLEJOHN, former President of the Association of British Osteopaths, recommended to his students:
To accept “germ theory” in the causality of the disease only to a certain extent, because microorganisms can only produce a disease if the natural forces of resistance and immunity, as well as the faculties elimination of metabolic points, have been diminished or suppressed.
To demonstrate that structural lesions and dietary errors predispose the body to microbial infections. Recent experiments in immunology have confirmed the correctness of A.T. Still concerning the natural immunity that every human being possesses provided that his blood circulation is not impeded. It is the best defence against infections.
These studies have shown that bacteria contain bacteria that destroy germs, bacteriolysins that dissolve them, agglutinins that delay their movements, antitoxins that neutralize their poisons, and opsonins that make them easier to “digest” with. the white blood cells responsible for their destruction.
“It is possible that germs determine the nature of the disease; but prior to any infection, there must be, and there is in fact, a primary agent or cause which, by its harmful interference with normal innervation and vascularization, has diminished the vitality or resistance of the affected area, thus predisposing to microbial invasion “
(P.H … Woodall, “Osteopathy”).
If the human machine is perfectly adjusted and properly nourished, it will remain relatively disease-free, last longer, and function more efficiently.
Osteopaths were the first practitioners to recognize the frequency of inequalities of the lower limbs and the repercussions that this entailed in the vertebral statics in the first place, then in the organs and viscera by interposed fasciae.
Thus, certain functional disorders of the cardiorespiratory, digestive and genitourinary systems (palpitations, extrasystoles, nervous tension disorders, aerophagia, gastritis, etc.) can find relief thanks to osteopathic care.