The Ailing Spine: A Holistic Approach to Rehabilitation

162 Pages·1991·5.1 MB·English

by  Univ.-Prov. Dr. Hans Tilscher

The
H. Tilscher
M. Eder
Ailing Spine
A Holistic Approach to Rehabilitation
With 76 Illustrations
and 20 Tables
Springer-Verlag
Berlin Heidelberg New York
London Paris Tokyo
Hong Kong Barcelona
Budapest
Univ.-Prov. Dr. HANS TILSCHER
Orthopadisches Spital, SpeisingerstraBe 109
A-1130 Wien, Austria
Univ.-Doz. Dr. MANFRED EDER
Schonaugasse 4, A-8010 Graz
Austria
Translated by JUDITH JABBOUR
Translation of "Der Wirbelsaulenpatient", 1989
ISBN-13: 978-3-642-48867-2
ISBN-13: 978-3-642-48867-2 e-ISBN-13: 978-3-642-48865-8
DOl: 10.1007/978-3-642-48865-8
Library of Congress Cataloging-in-Publication Data
Tilscher, H. (Hans) [Der Wirbelsaulenpatient. English]
The ailing spine: a holistic approach to rehabilitation / H. Tilscher, M. Eder. p. cm.
Translation of: Der Wirbelsaulenpatient. Includes bibliographical references.
ISBN-l3: 978-3-642-48867-2
1. Spine-Diseases-Treatment. 2. Holistic medicine.
I. Eder, Manfred, 1927- . II. Title.
RD768.T5513 1991 617.3'7506-dc20 90-10272 CIP.
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Preface
The subtitle of this book - A Holistic Approach to Rehabilitation -
underscores our fundamental point of view regarding spinal ailments.
The patient with his ailments should be at the focus of attention, yet the
subtitle combines two important elements, namely, "rehabilitation" and
"holistic approach." It is only by combining both concepts to show that
they do belong together that the door to successful treatment of persons
with vertebral problems can be opened. Holistic medicine does not
require an ideological classification of its own, but should be under
stood as a unified, optimal form of medicine which encompasses the
whole person: his health and his illnesses in all their aspects. Too often,
there is an automatic, senseless separation of the two concepts. Purists
in one or the other camp need to recognize the common ground and to
eliminate the barriers that have been erected by extreme positions and
attacks.
When we look back into history, we can see that there have always
been schools of medical thought that have promulgated one or another
direction. Evaluations and interpretations change in accordance with
our knowledge and the times themselves, but that which is most valu
able remains in end effect, forming the starting point for following gen
erations. It should be noted that the entire body of medical knowledge
had its beginnings in empiricism, whose ideas could not be confirmed
and supported until much later, parallel with the developments in
research technology. Today's universal medical knowledge is nothing
more than the sum of the experiences of yesterday's many physicians in
various areas as substantiated by their colleagues. However, we need
not yield completely to the objectivity of empiricism. Medicine does not
belong to that group of exact sciences such as physics, or chemistry, or
mathematics, in which the requirement that experimental and computa
tional proof be provided is taken for granted.
Many patients today express uneasiness about common medical
practices. These complaints are not unfounded. The reasons for this
feeling lie mainly in the exaggerated role that technology and faith in
medication play in today's medical practice. As valuable as scientific
knowledge and research and top technology may be - above all, in situ
ations of life or death - they do not provide a solid basis for assessing
chronic illnesses. To use these by themselves is misleading and results in
VI Preface
attributing too much importance to individual findings, while the multi
factorial nature of the pathogenesis often goes unnoticed, especially in
areas where the factors cannot be measured quantitatively. This is one
side of the coin. The other is the lack of personal contact between
patient and physician, compounded by the cold atmosphere created by
the use of impersonal machines. When we look beyond objective symp
toms and subjective complaints, there is an area where other distur
bances are at work that often go unnoticed. It is in this area that ther
apy will certainly fail if it is based solely on symptoms and signs. As a
result, any passing complaint that defies mechanical examination is
then classified as psychosomatic. This tendency is disastrous and un
justified.
How, then, can holistic medicine be put into practice? All that is
required is a rethinking of the values that have evolved out of various
schools of medical thought. We must begin by talking to patients and
must use inspection, palpation, and other physical examinations in
making a diagnosis. In setting up a therapy program, we must consider
the patient's life style, eating habits, elimination habits, diet, fasting,
and sweating, among other factors. Without exaggeration, we would
like to say that these methods have been among the tools of healing for
thousands of years and even today have not lost any of their impor
tance. They are, therefore, irreplaceable and should be used together
with those measures that scientific medical progress offers. We can say,
then, that holistic medicine is that medicine taught today in medical
schools, complemented and supported by tried and true methods of
inquiry and treatment which unjustly have been pushed into the sha
dows of scientific progress.
In the following pages we want to do nothing more than discuss
holistic medicine and how it can be used to treat persons suffering from
spinal ailments. Of course, the pathogenic factors that cause a healthy
person to be affected by spinal disorders continue to be the immediate
concern. How can we eliminate them by means of rehabilitation? How
can we prevent relapses? What individual therapies can be used that
will lead to a pain-free way of life?
Our approach to the subject differs from that of other authors as a
result of our many years of experience with persons with spinal disor
ders. We hope that we have presented the material in a manner that
physicians and physical therapists will be stimulated to also pay atten
tion to the less appreciated disturbances and the reflex-therapeutic
methods that are practically indispensable for treating patients with spi
nal ailments.
We sincerely thank all those who in thought and substance have con
tributed to the realization of this book as well as the publishers for their
readiness to agree to all of the author's wishes and alterations despite
the resulting increase in production costs.
Vienna/Graz, September 1990 HANS TILSCHER
MANFRED EDER
Contents
1 Introduction. . . . 1
2 Pathogenic Factors 7
2.1 Unalterable Factors 8
2.1.1 Constitution .... 8
2.1.2 Congenital and Irreversible Changes. 11
2.1.3 Biometeorologic Disturbances 13
2.1.4 The M Factor. . . . . . . . 17
2.2 Alterable Physical Factors . 19
2.2.1 Pain .......... . 19
2.2.2 Statics and Posture . . . 23
2.2.3 Structural Disturbances 25
2.2.4 Metabolism . . . . . . 30
2.2.5 Focal Events . . . . . 35
2.2.6 Inflammatory Factors 51
2.2.7 The Psyche ..... . 53
2.3 Alterable Environmental Factors 55
2.3.1 Occupation and Work . 55
2.3.2 Sports ......... . 63
2.3.3 Common Noxae ... . 70
2.3.4 Iatrogenic Disturbances 73
3 Therapy . .... . 77
3.1 Manual Medicine 77
3.1.1 Diagnostics . . . . 78
3.1.2 Therapeutic Techniques 93
3.2 Therapeutic Local Anesthesia . 105
3.3 Methods of Therapy Via Skin Receptors . 115
3.4 Acupuncture . . . . 116
3.5 Physical Therapy . . . . 119
3.6 Therapeutic Riding .. 140
3.7 Dietary Rehabilitation . 142
4 Conclusion 151
References . . . . 153
1 Introduction
• Ehrenfel's Principle
"The whole is greater than the sum of its parts." • System Laws
and Cybernetics
• Stability and Sequential
Functioning
Ehrenfels' well-known principle is a suitable leitmotiv to the sequence • Reafference Principle
of ideas necessary for understanding complex medical processes. The and Control Loop
• Information Events
compilation of data, details, and statistics is an undisputed necessity,
in the Organism
but it begins to make sense only when, following a principle of order,
• The Spinal Column
these seemingly unrelated pieces are united in a functioning structure. as a System
In the past, energy and matter formed one's conception of the world. • L. D. Harmon's
Computer Image
Today, however, the actual cohesive element that permits a meaningful
synergism of energy and matter, the phenomenon of organization, is
just beginning to affect our ideas. The unity we are looking for and
whose structures we are analyzing consistently presents itself to us as a
system which follows regulated laws of an open order. The supporting
columns of this ordered system are the transmission of information and
circuit principles. For the fundamentals we are indebted to cybernetics
(Wiener 1969), the science of control mechanisms. Together with system
principles, it opens the way to knowledge that is so important and so
striking in its basic concepts that Maruyama (1978) referred to the intro
duction of biocybernetics, not incorrectly, as the greatest epistemologi
cal revolution in the West since the ancient Greeks. Thinking in systems
is both the key to biological complexes, including cybernetics, and the
basic thought behind this book.
In the area of medical problems we are confronted with extremely
complex systems. Their complexity depends not on the number of
related elements but on the variety of their connections (Wieser 1959).
Systems that survive must be flexible, capable of adapting and changing
themselves and, because survival means more than just merely vegetat
ing, must include development, growth, and evolution. Flexibility, not
only in subsystems but also in the supercomplexes of the systems of our
world, can be, in a somewhat simplified manner, compared to the
design of a circuit system. The circuit of a complex system is character
ized by the interdependence of its parts in a state of equilibrium of flow.
Its intelligent organization is its true secret. The equilibrium of flow in a
circuit encompasses the supersystem of the third order where, practi-
2 Introduction
cally speaking, medicine belongs. This third order can be described as
being ultrastable. It guarantees substitute switching to the subsystems,
should disturbances occur, in order to maintain the prescribed milieu of
the system as much as is possible. Putting into operation the necessary
compensatory mechanisms obeys the principle of sequenctial function
ing that links the ability to adapt with that to choose as the system
attempts to regain its former stability in the presence of the new vari
ables. This complete process - the synergism of feedback signals and
sequential functioning for stabilization purposes - is known as
homeostasis. The area where the regulating circuit acts together with its
feedback mechanism is summarized in Fig. 1.
The five main elements that constitute the path of activity in a circuit
are:
1. The Regulating Variable - It is the same as the real functional goal
of the system.
2. The Controller - Here the input is compared with the nominal
value based on the actual value. If necessary, the regulating frequency is
corrected by discharging impulses (output).
3. The Probe - It is located in the control system and registers the
actual value of the system.
4. Final Control - This acts as the regulating mechanism and output
receiver, balancing the actual value with the nominal value.
5. Feedback - The characteristic action of the circuit as a whole is the
retroactive effect from the starting point at the controller via the control
loop to its entrance under the reversal of the effect. Each positive suc
cessful piece of information at the starting point leads to an opposing
negative effect at the control's starting point that is characterized by
Fig. 1. Control Loop
Control Input
Controller Transport of
___ ----------{ ...... }i~---------___... / the Actual Value
Transport of
/ the Control Output
Probe
Introduction 3
negative feedback. We are dealing here with a situation where a nega
tive event has positive results. If the polar action does not take place,
then there is positive feedback and the resulting reaction leads to insta
bility in the system. Regulation then is distorted to such an extent that a
circuit catastrophe results from this see-sawing. In order to establish
basic stability in the circuits, D-constituents, or elements with differen
tial sensitivity, are switched on in between in complex systems. These
take into account not only the absolute values of disturbances, but also
the changes in velocity. In addition, the desired flexibility of complex
systems also requires a latitude variation of nominal values using cen
tral, superpostulated guidance with peripheral regulation accommodat
ing the central handicaps (follower controller). Extremely complex bio
logical systems are divided into numerous levels of guidance accord
ingly and follow a hierarchical principle that sets vital connections into
immediate action.
Biological systems exist as unstable equilibrium flows whose regu
lated state is maintained by homeostasis.
Integration of the above statements with the medical subject that fol
lows points up the fact that the nervous system (NS) is the most com
plex of all systems and stands out as the center of biocybernetic activi
ties. The basic elements of its organization lie in the principle of
reafference (Holst and Mittelstaedt 1950), according to which the suc
cessful feedback of individual output into a regulating center deter
mines its further progress. This is the concept of classical feedback
found in circuits. The series of impulses in the NS are always able to
choose from among diverse pathways and numerous possible connec
tions. Again and again, over and over, the NS must choose from differ
ent pathways and from different switching elements. The shaping of
nervous processes and of resulting action is not inflexible but change
able, and predictions about what goes on in the system are restricted to
the area of probability of a statistical order. We are able to identify
input and output, but for the inner processes we have to be satisfied
with the concept of "black boxes" used in cybernetics.
The possibility to observe physiological and pathophysiological reac
tions is substantially expanded, however, when in the functioning cir
cuit of material-energy and guidance, first suggested by Wolff (1967) as
an additional factor in vertebrological problems, time is included as the
4th dimension, so to speak.
A basis for communicating information is then created when the spa
tial order is linked with the temporal order to code the contents of a
message. However, the communication of information in the nervous
system makes use of only one single pathway, namely, the variations in
impulse frequencies. The patterns of communication are made up of all
of this as well as of the different speeds along the nerve pathways, indi-
4 Introduction
vidual kinds of fibers (A-, B-, C-fibers) that are definitely dependent on
a time factor. Furthermore, it is essential for the time factor that the
information content of a communication is not determined alone by the
all-or-nothing character of an individual impulse in a binary sense, but
that it dissolves itself into an analogous mechanism by means of
impulse series.
A further possibility for communicating information is the so-called
Electrotonus (Sherrington 1906; Adrian 1947). This refers to the con
stant presence of an electrical field that as the second level either pro
motes or hinders nervous activity across intensity fluctuations.
Stimuli prefer prestimulated pathways and sensitized synapses.
A further point that must often be used to explain the appearance of
pathological states is the preparation for a stimulus event using storage
and direction, with the former more spatially, the latter more temporally
oriented. Stimulus impulses prefer prestimulated nerve pathways, and
in the case of stimulated synapses, the level of stimulation declines only
slowly. Pathogenic patterns that establish themselves this way success
fully favor the same kind of action of otherwise subliminal secondary
stimuli. In addition, the stimulus level itself varies according to the
momentary state of the entire system, with the formatio reticularis func
tioning at the superpostulated level of direction when this is compared
with the events in a circuit. This appears to be especially true of the
tonal situation of the musculature.
Following this step-by-step explanation of the fundamentals of sys
tems behavior, of circuit events, of the information processes, and of the
neural action resulting from these, we would now like to turn to the spi
nal column (SC) and its appropriate place in this setting.
If we regard the SC as an organ and, as with any other organ, assign
it a particular kind of behavior in the sense of its being open not only to
other subsystems of participating individual structures but to the entire
human organism, we then have the intended basis for a biocybernetic
interpretation of vertebral disorders.
From the above we can conclude that irritations connected with the
SC gain in pathotrophy when they
- Exceed a certain intensity
- Confront a presensitized environment
- Accumulate along with other factors
- Strain the ability for compensation
This combination leads one only too easily to throw causes of disorders
and ultimate triggers together into the same pot, without giving thought
to the fact that the causes of the disorders have been existing for a long
time and have been subliminally active, whereas the triggers are only
the final impulses that have not reacted to compensation efforts on the