Osteopathy: Models for Diagnosis, Treatment and Practice 2nd Edition

179 Pages·2005·35.63 MB·English

by  Jon Parsons

v
Contents
ELSEVIER
CHURCHILL
LIVINGSTONE
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and contact' and then 'Copyright and Permission'. Forewords vii 14. Balanced ligamentous tension techniques 219
Preface ix
15. Visceral osteopathy 223
Cover photographs © Kampfner Photography Acknowledgements xi
Abbreviations xiii 16. Indirect approach technique: myofascial 233
First published 2006
Reprinted 2008 17. Functional technique 241
SECTION 1 Osteopathy and the osteopathic
18. Jones technique 245
ISBN 978 0 443 07395 3 lesion - a 1
19. Trigger points 249
British Library Cataloguing in Publication Data
1. What is osteopathy? Towards a definition 3 20. Chapman's reflexes 251
A catalogue record for this book is available from the British Library
2. The osteopathic lesion or somatic dysfunction 17
21. Soft tissue techniques 253
Library of Congress Cataloging in Publication Data
A catalog record for this book is available from the Library of Congress
SECTION 2 Osteopathic conceptual
SECTION 4 Clinical conditions 257
Notice models 41
Knowledge and best practice in this field are constantly changing. As new 22. Dysmenorrhoea 259
research and experienc~ broaden our knowledge, changes in practice, treatment 3. Structural concepts 43
and drug therapy may become necessary or appropriate. Readers are advised to 23. Irritable bowel syndrome 265
4. Tensegrity 71
check the most current information provided (i) on procedures featured or (ii) by
24. Asthma 271
the manufacturer of each product to be administered, to verify the recommended 5. Biotypology 83
dose or formula, the method and duration of administration, and contraindica 25. Low back pain 275
tions. It is the responsibility of the practitioner, relying on their own experience 6. The nervous system 107
and knowledge of the patient, to make diagnoses, to determine dosages and the 26. Headache 285
7. Psycholog ical considerations 137
best treatment for each individual patient, and to take all appropriate safety pre
27. Pregnancy 289
cautions. To the fullest extent of the law, neither the publisher nor the authors 8. The respiratory-circulatory model of osteopathic
assumes any liability for any injury and/or damage. care 159 28. Otitis media in the infant 295
9. The total osteopathic lesion 165 29. Sports injuries 299
Working together to grow
libraries in developing countries 30. Blood pressure 305
SECTION 3 Introduction to models of
www.elsevier.com I www.bookaid.org I www.sabre.org 31. Whiplash 313
and treatment 177
ELSEVIER Pn?,?,~~!?t Sabre Foundation 32. Geriatrics 317
The 10. General osteopathic treatment 181 33. Treatment planning 323
Publishers
policy is to use 11. Specific adjusting technique 189
34. Special isms in osteopathy 331
paper manufactured
www.elsevierhealth.com
from sustainable forests 12. Muscle energy technique 193
Printed in China I 13. Cranial osteopathy 201 Index 333
vii
Forewords
Having known both the authors as students it is a significant contribution to that much-needed body
great privilege to be asked to write a brief foreword of knowledge, charting, as it does, the historical
to this, their first book. Sadly, in spite of their both perspectives of osteopathy and its evolution into a
having been my students, I can make no claim healthcare profession that has a rational evidence
whatsoever for any of the wisdom contained base for its concepts and clinical practice.
within these pages. As the chapters progress the reader is given an
In the late 1970s I became aware that if osteopa overview of the major concepts in osteopathic
thy was to fulfill its potential in healthcare and thinking. The book traces these concepts from their
achieve any form of recognition from conventional historical roots too and describes how these are rel
medicine there needed to be universal and credible evant to current osteopathic practice and its
standards of undergraduate training underpinned emphasis on integration with emerging orthodox
by the principles of conventional anatomy, physiol concepts such as psycho-neuroimmunology. The
ogy and pathology. At that time anyone, irrespec book also describes how concepts such as tenseg
tive of their level of training, could set up and rity can be applied to the science of osteopathy and
practise as an osteopath. Training courses ranged are relevant to clinical practice.
from 4-year full-time programmes to merely a few The book manages throughout to achieve a sense
weekends' instruction in manipulation. This situa of holism and consistency of thought, bringing
tion meant that neither patients nor conventional together the different concepts and models of
medical practitioners could rely upon the safety osteopathic healthcare that have arisen within the
and competence of all members of the osteopathic worldwide osteopathic community. What emerges
profession. is a total concept of osteopathy, not only in terms of
Throughout the 1980s and early 1990s I was for somatic dysfunction but also integrating areas such
tunate to be able to assist the profession in coming as tensegrity and psychology. While destined to be
together to form a consensus on the needs of under a set text for all osteopathic students, this book also
graduate training and proper regulation, which has much to offer all practitioners of the
resulted in the passing of the Osteopaths Act 1993. mind/body therapies. I look forward with eager
The establishment of osteopathy as a statutory reg anticipation to the next offering from these two
ulated profession along the same lines as medicine innovative osteopathic thinkers.
and dentistry is, however, only the beginning of the
story. The profession now has a firm foundation Simon Fielding OBE DO
from which to realize its full therapeutic potential Founder Chairman of the General Osteopathic
and establish the coherent body of osteopathic Council and Trustee of The Prince of Wales's
knowledge and research essential for its future Foundation for Integrated Health
development. This book by Parsons and Marcer is a
viii FOREWORDS
This book is written at a crucial point in the still In the last decade, osteopathy has spread irre
young history of osteopathy and for this reason it sistibly around Europe, not only as a discrete
will remain as a milestone. approach to health and medicine for the benefit of
Preface
Osteopathy developed in the USA and was inte patients but also academically. A number of differ
grated progressively into the medical culture of ent groups have been active in this growth and the
that country. In its early infancy, JM Littlejohn European School of Osteopathy is considered to be
brought this young and fragile approach to health one of the main protagonists.
and medicine to Europe, where it has developed From its inception, the School has had a
and expanded independently. Today we have a European outlook, having a French, English and
duality in approach and understanding around very quickly a Belgian branch. From 1994 the net
Europe, but we must work together to create a work expanded and academic links developed pro
forum in which the successes of our osteopathic gressively so that new schools were helped to
efforts can be shared. structure themselves. 1998 saw the foundation of
The dynamic growth of our profession in Europe the Osteopathic European Academic Network
and throughout the world can be summarized by a (OSEAN), which aims to link these institutions.
discussion that took place between Viola Frymann The two authors of this book, Jon Parsons and
and myself in Colorado Springs, USA. She was Nicholas Marcer, have been active internationally The aim of this book is to attempt to explore some of case that many of the fundamental concepts that
arguing that when the 'osteopathic seed' is planted during the last decade and it is now a great privi the fundamental concepts to which an undergrad are expressed within this book are rooted in
in one country, there are always two trees that grow lege to see their ideas coming to light. uate student of osteopathy, or other manual therapeu 'English' or perhaps even 'Maidstone' osteopathy;
and fight for life. To my mind, when the osteo The real internationalization of osteopathy is just tic approach, will be exposed. We are relating these however, between the two of us, we have worked
pathic seed is planted in one country, the roots beginning and the next step will take place through concepts to the treatment and support of human extensively in Europe and the USA, and have been
spread in different directions; it is only when these cross-fertilization between the two sides of the beings. This creates certain difficulties, as the rich exposed to many other osteopathic paradigms.
roots are able to accumulate enough energy that the Atlantic. Research will be the medium to expand complexities of the human form and function are not Wherever possible, we have tried to incorporate
trunk can grow. this dialogue, as the research basis of our science easily pinned down and so the attempts to interpret or explain these varying views. We have also
We are at exactly this moment in the develop needs to be developed. these complexities for a therapeutic purpose are sought the advice of osteopaths throughout the
ment of osteopathy. In every country various edu often numerous and varied. osteopathic world. Any shortcomings are our own,
cational groups have formed and strengthened; on Renzo Molinari DO Within the osteopathic world specifically there are however, and are apologised for.
different continents diverse groups have structured Principal of the European School of Osteopathy a multitude of varied interpretations and percep The book has been structured in four sections:
the professional and educational aspect of our art tions, and though it is a relatively young profession,
Section 1 looks at the development of osteopathy,
and science. It is now time to work together on over time osteopathic concepts have been subject to
how we may define it, and then explores the idea of
developing the core of our profession. the interpretation and reinterpretation of many great
the osteopathic lesion (somatic dysfunction), as an
thinkers, and some less great! Each has added their
entity itself and within a more holistic perspective.
own perspective.
Section 2 addresses some of the conceptual mod
Different countries have also developed their
els that have been used, in an attempt to under
understanding in subtly different ways. Within
stand how functional or pathological problems
Europe there are shades of differences that occa
may be explained from an osteopathic perspective.
sionally appear so opaque that they severely limit
Section 3 discusses some of the models of diag
communication: one simple example of this is the
nosis and treatment, how they have arisen and
nomenclature utilized to classify somatic dysfunc
(where known) their underlying physiological
tion. In the USA, the allopathic/ osteopathic combi
rationale.
nation has further modified their contribution.
Section 4 consists of several case histories that
As a result of the above considerations, there are
attempt to integrate the first three sections by
many differing perceptual and practical approaches
demonstrating the processes involved in analysing
utilized, often with tension arising between the
several conditions from an osteopathic perspective.
apparently differing schools of thought. It is with this
situation in mind that we draw in this book on Though there was a combined input in all sec
founding principles in an attempt to facilitate under tions logistics dictated that Sections 1 and 2 were
standing in a relative newcomer to osteopathy. predominantly written by Jon Parsons and Sections
We were both trained at the European School 3 and 4 by Nick Marcer. It is hoped that the slight
of Osteopathy in Maidstone, England. As we are difference in writing styles is not too off-putting,
all influenced by the osteopathic paradigm in but it does allow us as individuals to express the
which we developed, it is almost certainly the concepts that are most important to each of us.
x PREFACE xi
Throughout this book we have made much use with the advances in science, perhaps appear to be
of conceptual models. Many may feel that this is naIve or lacking in scientific gravitas or simply
inappropriate, criticizing the fact that people are incorrect. We have done this as we feel that it is Acknowledgements
too varied to conform to models; or that a particu important to understand the concepts that underpin
lar model is too reductionist in its conception with the foundation of osteopathy and that have been
regard to the whole that is a person. Both these and the springboard for development of the more recent
the many other arguments that could be put for interpretations, to gain a more complete under
ward have validity; however, it must be understood standing of osteopathy.
that these, as with all principles, are not to be fol Though we have attempted to offer much infor
lowed slavishly but are there rather as a support mation, as is so often the case with osteopathy the
designed to facilitate the comprehension of the answers are not always obvious and it may be that
complexities of the human form and its function for in some sections you will come away with more
the neophyte body worker. Through application, questions than answers. That being said, we hope
the inherent strengths and weaknesses of each that you find this book helps you take the first steps
model will become apparent, and clinical experi on the exciting, confusing and rewarding osteo
ence will then remodel each individual's under pathic path.
Our greatest thanks must go to my wife, Alison, for Fran<;:ais, Paris; College of Osteopaths, London;
standing.
We have also discussed models originated by Maidstone and Fribourg Jon Parsons her patience, support and understanding (JP), and The Academy of Children's Development, St
some of the early osteopathic innovators which, Nicholas Marcer to Holly my daughter (NM). Petersburg; Skandinaviska Osteopatskolen,
Others who have contributed greatly, some both Gothenburg; Norwegian Osteopathic School, Oslo;
intellectually and emotionally, are Phil Austin, Instituto Superiore d'Osteopatia, Milano; Russian
Christian Fossum, Celine Meneteau, Renzo Academy of Osteopathic Medicine, St Petersburg;
Molinari, Lizzie Spring, Caroline Stone, Frank Wiener Schule fUr Osteopathie, Vienna;
Willard, Jane Carreiro and Margaret Gamble. Osteopathie Schule Deutschland, Hamburg,
For those brave souls who read the early drafts, Stuttgart, Bremen and Kassel; University of New
Lynne Pruce, Hedi Kersten, Rob Thomas and England, College of Osteopathic Medicine, Maine,
Steven Bettles. USA.
And all of the students and faculty and staff at Heidi Harrison of Butterworth-Heinemann for
the European School of Osteopathy for the last 20 commissioning us originally and with Elsevier,
years, who have nurtured us as individuals, as Mary Law and Mairi McCubbin for their patience
osteopaths and as teachers. Similarly, the students and Gail Wright for quietly and efficiently making
and faculty of all of the schools in which we have order out of the chaos.
taught and learnt, notably College International Finally, we would like to thank Ewan Halley for
d'Osteopathie, St Etienne; College Osteopathique jumping in at the eleventh hour and saving the day!
xiii
Abbreviations
AACOM American Association of Colleges of GIT gastrointestinal tract
Osteopathic Medicine GOT general osteopathic treatment
AC anterocentral (anterior central) GST general systems theory
ACTH adrenocorticotropin hormone HPA hypothalamic-pituitary-adrenal
ANS autonomic nervous system HVLA high velocity low amplitude
AP anteroposterior HVT high velocity thrust
ASIS anterior superior iliac spine IBS irritable bowel syndrome
ASO American School of Osteopathy IL interleukin
BLT balanced ligamentous tension IVM involuntary mechanism
C cervical L lumbar
BMT balanced membranous tension LC locus ceruleus
CAT computer assisted tomography L/S lumbosacral
CCP common compensatory pattern LVHA low velocity high amplitude
CNS central nervous system MET muscle energy technique
CRF corticotropin-releasing factor MRI magnetic resonance imaging
CRH corticotropin-releasing hormone NIM neuroimmunomodulation
CRI cranial rhythmic impulse NMDA N-methyl-d-aspartate
CSF cerebrospinal fluid NMT neuromuscular technique
D dorsalsyn thoracic NO nitric oxide
D/L dorsolumbar NSAIDs non-steroidal anti-inflammatory
ECM extracellular matrix drugs
EEO Ecole Europeenne d'Osteopathie NRS easy normal rotation sidebending
EFO Ecole Fran<;:aise d'Osteopathie lesion
ESO European School of Osteopathy PA posteroanterior
ERS extension rotation sidebending PC posterocentral (posterior central)
lesion PGI paragigantocellularis
ESR electrical skin resistance PMS premenstrual syndrome
FRS flexion rotation sidebending lesion PNI psychoneuroimmunology
GOsC General Osteopathic Council of PNS peripheral nervous system
Great Britain PSIS posterior superior iliac spine
GAR general adaptive response PSNS parasympathetic nervous system
GAS general adaptation syndrome PRM primary respiratory mechanism
GAT general articulatory treatment PRT progressive relaxation training
GHRH growth hormone-releasing PVN paraventricular nucleus of the
hormone hypothalamus
xiv ABBREVIATIONS
RTM reciprocal tension membrane SRR stress resistance resource Parasympathetic Sympathetic
S sacral T thoracic
SAM sympathetic adrenal axis TBA total body adjustment Spinal cord
levels
SAT specific adjusting technique T/L thoracolumbar
SBS sphenobasilar symphysis TMJ temporomandibular joint
SCS strain counterst rain TOL total osteopathic lesion Cranial
nerves
SI sacroiliac TRH thyroid-releasing hormone
SNA sympathetic neural axis WDR wide dynamic range (neurone) (GIT)
Gastro
SNS sympathetic nervous system
intestinal
Heart Larynx
tract
and and
down to
lungs pharynx
leflcolic
flexure
GIT
Pelvic
up 10
urogenital
leflcolic
organs
flexure
Pelvic splanchnics '-----'-"-----"
The autonomic nervous system: (left) parasympathetic outflow; (right) sympathetic outflow. The basis of osteopathic medicine lies in
an understanding of the autonomic nervous system. All practitioners of osteopathy should have their own image of the autonomic
nervous system firmly imprinted in their own central nervous system to refer to during every treatment. This converts the lay bone
setter into the osteopath.
1
SECTION
steopathy and the
osteopathic lesion - a
developing concept
This section introduces the term osteopathy
SECTION CONTENTS
and reviews some of the numerous attempts
1. What is osteopathy? Towards a
at the difficult task of defining what it
definition 3
actually is. It explores the precepts originally
2. The osteopathic lesion or somatic
conceived by Andrew Taylor Still, the founder
dysfunction 17
of osteopathy, and their role in underpinning
and informing the practice of osteopathy. It
also reflects briefly on the historical
development of osteopathy itself.
The osteopathic lesion, or somatic dysfunction,
is used as a vehicle to explore the variety of
ways of perceiving osteopathy. This section
also includes an attempt to draw some
parallels between the varieties of models used,
to minimize the confusion that can arise when
communicating with osteopaths grounded in
differing conceptual models.
What is osteopathy?
Towards a definition
INTRODUCTION
CHAPTER CONTENTS
The concept of osteopathy came to Andrew Taylor
Introduction 3
Still, the founder of osteopathy, at 10 o'clock on
A brief history of the origins of osteopathy 6
22 June, 1874.1 He describes it as a revelation; it is
Andrew Taylor Still (1828-1917) 7
not uncommon for innovators or inventors to
Subsequent developments 7
describe the moment of comprehension in this way
Still's founding principles 9
and this is often referred to as the 'eureka princi
Still's political platform 13
ple'. After years of study .and background work, the
Summary 13
ideas suddenly coalesce at a particular point in
References 14
time, a revelation so significant that the individual
can recall the actual time that it occurred. Another
interpretation is that it was more a 'point of deci
sion' than a revelation. At this point, Still's cumula
tive experience enabled him to decide that he
would 'reform' current medical practice by intro
ducing a system of therapeutics which would utilise
'natural forces' in the process of healing, rather than
'poisonous chemical agents'.
Whether it was a eureka 'experience', or a point
of decision, Still certainly possessed an appropriate
background. He is reported to have had an interest
in anatomy from his childhood, and he worked as a
Frontier doctor during the American Civil War.
This experience, combined with a deep dissatisfac
tion with the current practice of medicine, would
have contributed to the development of his ideas.
His original conception was founded on the
importance of anatomy and its relationship to
the 'flow of natural forces' in the body. As he
became more pragmatic, these 'natural forces' even
tually developed into his ideas on 'the rule of the
artery', 'venous liberty' and later 'nerve force'. The
anatomical relationship matured into the theory