Naturopathic Physical Medicine: Theory and Practice for Manual Therapists and Naturopaths

579 Pages·2008·13.45 MB·English

by  Leon Chaitow ND DO

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Dedication
This book is dedicated to the naturopathic teachers and pioneers who inspired all those
involved in writing it, as well as to all students, educators and practitioners of naturopathy,
and their patients.
Authors and Contributors
Eric Blake ND MSOM Dipl Acupuncture 1. Physical medicine in a naturopathic context
National College of Naturopathic Medicine, (co-author)
Hydrotherapy Department Coordinating Supervisor and 2. Adaptation and the evolution of disease and
Academic Adjunct Faculty; Clinical Director, Holistic dysfunction (author)
Health PC, Portland, Oregon, USA 3. History of naturopathic physical medicine
3. History of naturopathic physical medicine (contributor)
(author) 4. Naturopathic physical medicine (contributor)
4. Naturopathic physical medicine (contributor) 5. Assessment and palpation: accuracy and reliability
8. Integrated naturopathic (manual) physical medicine issues (author)
protocols (contributor) 6. Assessment/palpation section: skills (author)
11. Naturopathic hydrotherapy (author) 7. Modalities, methods and techniques (author)
12. Electrotherapy modalities (author) 8. Integrated naturopathic (manual) physical medicine
protocols (author)
Hal Brown ND DC RAc
10. Naturopathic physical medicine approaches to
Naturopathic Physician and Acupuncturist, Vancouver,
general health enhancement and specifi c
BC; Department Chair and Instructor in Physical
conditions (author)
Medicine, Boucher Institute of Naturopathic Medicine,
11. Naturopathic hydrotherapy (contributor)
New Westminster, BC, Canada
Michael Cronin ND DAAPM
7. Modalities, methods and techniques (contributor)
10. Naturopathic physical medicine approaches to Practice specializing in Physical Medicine; Diplomate
general health enhancement and specifi c American Academy of Pain Management; Founding
conditions (contributor) President, Southwest College of Naturopathic Medicine;
Residency in Physical Medicine, National College of
Nick Buratovich ND
Naturopathic Medicine; Board member, Naturopathic
Professor, Department Chair – Physical Medicine,
Academy of Therapeutic Injection
Southwest College of Naturopathic Medicine, Tempe,
1. Physical medicine in a naturopathic context
Arizona, USA
(contributor)
1. Physical medicine in a naturopathic context
Brian Isbell PhD BSc ND DO
(contributor)
7. Modalities, methods and techniques (contributor) Head of Department, Department of Complementary
10. Naturopathic physical medicine approaches to Therapies, School of Integrated Health, University of
general health enhancement and specifi c Westminster, London, UK
conditions (contributor) 10. Naturopathic physical medicine approaches to
12. Electrotherapy modalities (contributor) general health enhancement and specifi c
conditions (contributor)
Leon Chaitow ND DO
Registered Osteopath and Naturopath, Honorary Fellow, Douglas C. Lewis ND
School of Integrated Health, and former Senior Lecturer Naturopathic Physician/Physical Medicine Practitioner,
University of Westminster, London, UK Seattle; Former Faculty and Chair of the Department of
x Authors and Contributors
Physical Medicine, Bastyr University, Kenmore, Paul Orrock RN ND DO MAppSc
Washington; President, Washington Senior Lecturer, Director of Clinical Education,
Association of Naturopathic Physicians, Seattle, Coordinator of Clinical Sciences (Osteopathy),
Washington, USA Department of Natural and Complementary Medicine,
7. Modalities, methods and techniques (contributor) Southern Cross University, NSW, Australia
8. Integrated naturopathic (manual) physical medicine 1. Physical medicine in a naturopathic context
protocols (contributor) (contributor)
11. Naturopathic hydrotherapy (contributor) 4. Naturopathic physical medicine (author)
12. Electrotherapy modalities (contributor)
David Russ DC
Benjamin Lynch ND
Chiropractic physician, Portland, Oregon, USA
Naturopathic Physician; President, Eco-Integration, Inc.
6. Assessment/palpation section: skills (contributor)
11. Naturopathic hydrotherapy (contributor)
10. Naturopathic physical medicine approaches to
Lisa Maeckel MA CHT general health enhancement and specifi c
Hakomi Therapist, Portland, Oregon, USA conditions (contributor)
7. Modalities, methods and techniques (contributor)
David J. Shipley ND DC
10. Naturopathic physical medicine approaches to
Naturopathic Physician, Tigard, Oregon, USA
general health enhancement and specifi c
6. Assessment/palpation section: skills (contributor)
conditions (contributor)
Pamela Snider ND
Carolyn McMakin MA DC
Executive and Senior Editor, Foundations of
President, Frequency Specifi c Seminars, Inc, Vancouver,
Naturopathic Medicine; Associate Professor, National
Washington; Clinical Director, Fibromyalgia and
College of Natural Medicine, Portland, Oregon, USA
Myofascial Pain Clinic, Portland, Oregon, USA
1. Physical medicine in a naturopathic context
12. Electrotherapy modalities (contributor)
(co-author)
Les Moore ND MSOM LAc
Matthew Wallden ND DO MSc Ost Med
Director, Integrative Medicine Department, Clifton
CHEK IV HLC III
Springs Hospital, New York, USA
11. Naturopathic hydrotherapy (contributor) CHEK Practitioner/osteopath/naturopath, Sports
Orthopaedics Spinal, Weybridge, Surrey, UK
Dean E. Neary Jr ND
1. Physical medicine in a naturopathic context
Associate Professor Chair, Physical Medicine
(contributor)
Department, Bastyr University School of Naturopathic
2. Adaptation and the evolution of disease and
Medicine, Kenmore, WA, USA
dysfunction (contributor)
7. Modalities, methods and techniques
5. Assessment and palpation: accuracy and reliability
(contributor)
issues (contributor)
10. Naturopathic physical medicine approaches to
9. Rehabilitation and re-education (movement)
general health enhancement and specifi c
approaches (author)
conditions (contributor)
Brian K. Youngs BSc(Lond) ND DO
12. Electrotherapy modalities (contributor)
Practitioner of complementary medicine, Harley Street,
Roger Newman Turner ND DO BAc
London, UK
Newman Turner Clinic, Letchworth Garden City, Herts,
7. Modalities, methods and techniques (contributor)
and Harley Street, London, UK
4. Naturopathic physical medicine (contributor) Jared Zeff ND
7. Modalities, methods and techniques (contributor) Adjunct Professor, Bastyr University of Natural Health
10. Naturopathic physical medicine approaches to Sciences, Seattle, Washington, USA
general health enhancement and specifi c 1. Physical medicine in a naturopathic context
conditions (contributor) (co-author)
Foreword
Our modern world suffers a tremendous burden of a whole, complex person, not as isolated parts. This
poor health and disease. The incidence of most chronic search has led to renewed appreciation of naturo-
degenerative diseases has increased in virtually every pathic medicine and the healing wisdom it offers.
age group during almost every decade of the past The growth and increasing sophistication of naturo-
50 years. Much of this suffering is unnecessary – as pathic medicine over the past few decades has been
research has now shown that a large body of healing phenomenal. The naturopathic precepts of the causes
wisdom, long the province of naturopathic medicine, of ill health and rules for healthful living, which were
has been missing from the health care system. once dismissed as faddism (and worse), are now
We have much to be grateful for in conventional becoming mainstream wisdom. Eating a whole foods,
medicine – almost miraculous advances in the treat- organically grown diet; avoiding endogenous and
ment of acute illness, trauma and life-threatening exogenous toxins; physical exercise and balance; stress
disease accomplished through dedication, intense reduction; healthy social relationships – all once dis-
research, and a huge investment of fi nancial resources missed – are now known as necessary for health.
(unfortunately to the exclusion of most other Over the past century, physical medicine has been
approaches to health care). Key to this advancement foundational to the formation and evolution of natu-
has been standardization of diagnosis, of therapy and, ropathic thought and practice. The huge expansion of
unfortunately, of patients. In addition, the advance- research into nutrition, lifestyle and physiology has
ment of this disease treatment model has apparently inspired in modern naturopathic medicine a much
necessitated isolation of diagnosis and treatment to greater orientation to metabolic approaches for the
distinct entities separate from the whole person. Con- promotion of health and treatment of disease. While
ventional medicine has developed standardized ther- this approach has much to offer, prescribing supple-
apies for standard diagnoses for specifi c conditions in ments and changing a patient’s diet do not correct
generic patients that are sometimes curative, often the neurological, muscular and vascular dysfunctions
highly effective in symptom relief, but not very effec- caused by musculoskeletal problems. Problems can
tive in promoting health, ignore the interactive range from mechanically impaired joints chronically
complexity of whole-person systems and are utterly releasing pro-infl ammatory chemical mediators that
incapable of recognizing how truly different each of cause health-damaging effects throughout the body
us is, starting at the cellular level. Worse, this reduc- to tissues being so poorly vascularized or their
tionistic isolation of attention and the lack of recogni- lymphatic drainage suffi ciently compromised that no
tion of each patient’s uniqueness is a primary cause amount of detoxifi cation or supplementation can
of the huge incidence of adverse drug reactions from restore normal function.
appropriately prescribed medications. As the number of When we assert that we treat the whole person –
drugs prescribed per person has increased, so has the mind, body and spirit – we need to remember that the
incidence of adverse drug reactions and health- body includes more than just biochemical reactions.
damaging interactions. Its physical structures can have as much impact on
Widespread public dissatisfaction with the cost, side bodily health as nutrients and toxins. And, happily,
effects and limited health advancement that charac- they are amenable to intervention.
terize the dominant medical system has led to the Physical medicine is perhaps the most whole-person
search for a new medicine. Patients are looking for of all our therapies. Thinking back to my days as a
health care professionals who integrate the best of student, I remember one of Dr Bastyr’s wise admoni-
conventional and natural medicine and treat them as tions, ‘Always touch your patients; let them know you
xii Foreword
care.’ The application of physical medicine is in many ropaths, chiropractors, acupuncturists and physical
ways the most intimate of our therapies, where we as therapists have all contributed their expertise without
physical beings interact personally with our patients being limited by the boundaries of their professions
with healing intent. In this era of increasing deperson- and united by their passion for this healing wisdom.
alization and social isolation, this closeness to our Dr Chaitow is to be congratulated for bringing
patients is a welcome contrast to the 7-minute offi ce together such an outstanding group of leaders in
call. physical medicine to create such a valuable resource
In addition to the importance of this textbook in for clinicians.
advancing our understanding of physical medicine is
its role as another example of the emerging sophistica- Joseph Pizzorno Jr ND
tion of academic natural medicine. This excellent text- Author, Textbook of Natural Medicine
book was written by experts in all schools of natural Editor-in-Chief, Integrative Medicine,
medicine from all over the world. Osteopaths, natu- A Clinician’s Journal
Preface
Naturopathic physical medicine incorporates a wide cal/manual stimulation, delivered by physician/prac-
array of methods, techniques and modalities, many of titioner controlled soft-tissue, spinal and extremity
which are explored in this text, along with the evi- mobilization. Evidence is offered in the book of the
dence and rationale for their use in health care. As ways in which such treatment approaches can benefi -
explained in depth in this book, the use of physical cially infl uence neurological, circulatory and bio-
medicine in a naturopathic context may focus on the mechanical functions, as well as having positive effects
treatment and rehabilitation of musculoskeletal dys- on the individual’s psychological/emotional status.
function, or it may be employed in treatment of both In keeping with the naturopathic principle of fi rst
major and minor health problems in order to enhance do no harm, when mobilization with impulse (HVLA)
and encourage self-regulatory functions. is applied, it is with an appropriate (to the patient’s
It is important to note that naturopathic practitioners needs and current health status) degree of force,
in different states, provinces and countries practice designed to produce just suffi cient impulse to over-
physical medicine as part of their clinical care of come articular restriction and/or malposition. It is the
patients, in accordance with local laws and licensing application of such an extrinsically applied thrusting
regulations which are anything but uniform. For impulse that has attracted concern regarding safety
example, in North America and Canada naturopathic and competency.
education results in qualifi cation as licensed primary It is worth emphasizing that, by defi nition, HVLA
care naturopathic physicians through state or provin- impulse, or thrust, involves high velocity, not high force,
cial boards of medical examiners. delivered over a very small distance. This use of
In contrast, in Europe and Australia (as examples), velocity rather than force is an essential skill in HVLA
a naturopathic qualifi cation leads to a more limited delivery, only employed once an appropriate diagno-
scope of practice, unless additional qualifi cations sis has been made. Once a dysfunctional segment or
(DO, DC, PT, MD, etc.) are also held. To an extent joint has been identifi ed, specifi c HVLA techniques
these differences are refl ected in the physical medicine may be selected to achieve mobilization. The mechan-
(and other) methods utilized and, in some instances, ics of such applications include the use of long or
to the conditions treated. short levers, focused tissue tension with joint locking,
The continuum of manual methods employed in appropriate line of drive, and physician and patient
naturopathic clinical practice may (depending on positioning, all achieved with balance and control (see
licensing variations) incorporate both static and Chapter 7).
motion palpation, as well as a wide variety of soft The effi cacy of mobilization with impulse (HVLA
tissue techniques, joint articulation, mobilization thrusting) has longstanding and current validation
without impulse (joint play), as well as mobilization from both the osteopathic and chiropractic profes-
with impulse. Mobilization with impulse is also sions (see Chapters 7 and 10, in particular). HVLA
referred to as high velocity, low amplitude (HVLA) issues relating to safety are commonly directed to cer-
thrust technique and, because of concerns as to safety, vical spine manipulation, and these safety concerns,
this modality is deserving of some explanation in naturopathic practice, are covered in some detail in
(Hurwitz et al 2005). Chapter 7. Safety concerns exist in the realm of the
Naturopathic manipulation (including HVLA) is knowledge of potential risk, precautions, complica-
directed towards correcting imbalances in structural tions, reactions and contraindications, as much as in
integrity, commonly manifested as joint fi xation/ the realm of technique application. In naturopathic
restriction and/or malposition, by means of mechani- educational programs that provide instruction in
xiv Preface
naturopathic physical medicine and naturopathic • To improve the body’s capacity to cope with
manipulation, including HVLA usage, the topics of adaptive demands via, as examples, enhanced
risk, precautions, complications, reactions and contra- biomechanical, circulatory and/or neurological
indications are studied in depth. These topics are not functions
only covered in specifi c classes on naturopathic • To safely modulate the patient’s presenting
manipulation but are also included in other aspects of symptoms – without adding to existing
the curriculum which deal with pathology and dys- adaptive overload.
functional conditions involving the musculoskeletal
Naturopathy considers that the body heals itself,
system and general systemic function, including
unless damage, dysfunction and degeneration are too
classes in diagnostic imaging. The naturopathic
advanced. Even then, functional improvement, or a
student, practitioner and practicing physician usually
delaying of further decline, may be possible. In all
focuses on whole body issues and restoration of
these objectives, use of naturopathic physical medi-
health, and so the training in physical medicine,
cine methods rely for effi cacy on intrinsic, endoge-
including naturopathic manipulation, is taught within
nous, innate, homeostatic, self-regulatory forces.
that context. Naturopathic manipulation using HVLA
All naturopathic therapeutic interventions, includ-
techniques is seldom employed in isolation but as part
ing naturopathic physical medicine methods, are
of a process designed to restore maximal pain-free
therefore focused on encouraging these processes.
movement of articulations, restoration of postural
balance, systemic functionality and facilitation of the
self-regulatory mechanisms of the body.
In a recent study of licensed Canadian naturopathic
physicians there was a strong indication that core
Nick Buratovich, Paul Orrock, Leon Chaitow –
naturopathic manipulation skills were adequate and
and all the other co-authors, contributors and internal
thorough (Verhoef et al 2006).
reviewers responsible for this book.
Similarly, a recent American Association of Naturo-
pathic Physicians (AANP) Position Paper reminds us
that naturopathic manipulative treatment, as part of
naturopathic physical medicine, has historically been
an integral part of the practice of naturopathic medi-
cine, and has been included in naturopathic medical
education and licensure since the early 1900s. That
References
Position Paper states that naturopathic medical
education prepares naturopathic physicians to safely
Buratovich N, Cronin M, Perry A et al 2006 AANP
and competently perform and practice naturopathic
Position Paper on Naturopathic Manipulative Therapy.
physical medicine and naturopathic manipulation
American Association of Naturopathic Physicians,
(Buratovich et al 2006).
Washington DC
It is worth re-emphasizing that HVLA is not a part
of the training of naturopathic practitioners in Europe Hurwitz E, Morgenstern H, Vassilaki M, Chiang L 2005
or Australia, and is employed by naturopathic practi- Frequency and clinical predictors of adverse reactions
tioners in those countries only if the ND also holds a to chiropractic care in the UCLA neck pain study. Spine
qualifi cation as an osteopath, chiropractor or physical 30:1477–1484
therapist, or as an appropriately trained medical Verhoef M, Boon H, Mutasingwa D 2006 The scope of
practitioner. naturopathic medicine in Canada: an emerging
Over and above the issue of safe HVLA usage, natu- profession. Social Science and Medicine 63(2):409–417
ropathic physical medicine employs a wide range of
methods, modalities and techniques, including hydro-
therapy and electrotherapy, and a plethora of manual,
movement, rehabilitation and re-education approaches,
all designed and employed to achieve one of three
objectives:
• To reduce adaptive demands via, as examples,
modifying patterns of use including improved
mobility, stability, balance, posture and/or
respiratory function
Acknowledgments
My profound thanks go to those who were active in the Sincere thanks also to the editorial team at Elsevier,
compilation of this book. Thanks to my co-authors – particularly Claire Bonnett and Claire Wilson for their
Eric Blake, Paul Orrock, Pam Snider, Matt Wallden and consistent and good natured help; and not forgetting
Jared Zeff; to the contributors and internal reviewers – Sarena Wolfaard, who embraced the concept of this
Hal Brown, Nick Buratovich, Michael Cronin, Brian book from the outset, and provided support through-
Isbell, Doug Lewis, Ben Lynch, Lisa Maeckel, Carolyn out its evolution.
McMakin, Les Moore, Dean Neary, Roger Newman On a personal level, as so often in the past, my grati-
Turner, David Russ, David Shipley and Brian tude goes to Alkmini, for creating a warm, supportive
Youngs . . . and of course to the author of the Foreword, and loving environment in which to write, on the
Joseph Pizzorno, whose inspirational work over the beautiful island of Corfu.
past 25 years has helped to launch and sustain naturo-
pathic medicine’s renaissance in North America.
1
Leon Chaitow ND DO,
Jared Zeff ND, Pamela Snider ND
With contributions from:
Nick Buratovich ND Physical Medicine
Michael Cronin ND
in a Naturopathic
Paul Orrock ND DO
Context
Matthew Wallden ND DO
In order to appreciate the meaning of the term naturo-
CHAPTER CONTENTS pathic physical medicine (NPM), it is fi rst necessary to
have an understanding of just what naturopathic medi-
The naturopathic profession 1 cine is (Lindlahr 1913); see Box 1.1.
Naturopathic medicine 2
The naturopathic profession
The vis 2
International perspective 3
Naturopathic medicine is a worldwide profession with
Allopathic medicine – a comparison 4 concentrations in the USA, Germany, Canada, UK,
Psychoneuroimmunology – towards a Australia and India. In these countries, naturopathic
broader allopathic model? 4 medicine functions, or is legally defi ned, as a primary
health care profession whose practice incorporates health
Example 1 6
promotion and the prevention, diagnosis and treatment
Example 2 7
of acute and chronic disease. There are marked scope of
Example 3 7
practice and training differences among various regional
Complexity 8
and global traditions (Standish et al 2005).
The healing power of nature and a In the USA and Canada naturopathic doctors (NDs) are
therapeutic order 8 trained as general practice family physicians. This is
Underlying principles of the therapeutic order 11 intentional and consistent with naturopathic principles of
Derivation – naturopathy’s antecedents 12 practice. Naturopathic doctors (and practitioners in coun-
tries where licensing and scope of practice are not as full
Naturopathic physical medicine 13
as in the USA where a broad medical scope of practice
Core components 13
prevails in many states) are trained to assess and treat
Features of naturopathic physical medicine 13 disease from a whole person perspective, taking into
The meaning of symptoms 14 account not only the presenting pathology but also
Pain and the mind 14 deeper causes and collateral relationships with other
Beyond biomechanical dysfunction 14 systems of the body (Standish et al 2005).
Boon et al (2004) report that:
Are all ‘natural’ modalities necessarily
naturopathic? 15 Naturopathic medicine is a licensed health care profession
Objectives and methods 15 in twelve US states (Alaska, Arizona, Connecticut,
Non-naturopathic manual methods 16 Hawaii, Maine, Montana, New Hampshire, Oregon,
Utah, Vermont, Washington, California), Puerto Rico and
What methods and modalities form
four Canadian provinces (British Columbia, Manitoba,
naturopathic physical medicine? 16
Ontario and Saskatchewan) (Hough et al 2001, American
Avoiding adaptive overload 18
Association of Naturopathic Physicians 2007). In most
states and provinces where naturopathic medicine is not
regulated, individuals call themselves naturopaths
(whether or not they have been trained at a school for
naturopathic medicine) because the term naturopathic
medicine is not a restricted term in all jurisdictions. The