Visceral and obstetric osteopathy

349 Pages·2007·11.083 MB·English

by  Caroline Stone

©Elsevier Ltd 2007. All rights reserved.
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ISBN-13: 978-0-443-10202-8
ISBN-10: 0 443 10202 3
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Acatalogue record for this book is available from the British Library
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Notice
Neither the Publisher nor the Author assumes any responsibility for any loss or injury and/or
damage to persons or property arising out of or related to any use of the material contained in
this book. It is the responsibility of the treating practitioner, relying on independent expertise
and knowledge of the patient, to determine the best treatment and method of application for
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vii
Forewords
I have known Caroline for 20 years, initially as a Visceral manipulation permits patients to feel
postgraduate osteopath learning visceral manipu- better in their life and it is something that
lation, and later as someone who has enabled many osteopaths must include in their evaluation of
other osteopaths to grow and develop. I haveseen patients and their dysfunctions. In particular,
her evolve as a practitioner and as a teacher of vis- osteopaths have a special contribution to make in
ceral work and the osteopathic approach in gen- the field of gynaecology and obstetrics. To help a
eral; in bringing this to the broader profession, woman to have a child and for her to achieve this
she has made an indispensable contribution to in the best conditions is a chance that should be
osteopathy. open to all. We have certain unique keys to
As soon as we met, I felt she had very good improve factors around fertility, pregnancy and
hands and that she would do something special in delivery, and it is our duty to do it, as health and
the visceral field; indeed, she has made many function can be subtly but powerfully influenced
important contributions to the profession’s under- by the osteopath’s gentle, and knowing, ‘listening’
standing and appreciation of visceral manipula- touch.
tions within osteopathy, and how to help patients I commend this book to anyone wanting a
on many different levels, accordingly. deeper understanding of the osteopathic approach
In her teaching, Caroline integrates many dif- to healthcare, and applaud Caroline on her con-
ferent components and brings alive the concepts tinuing dedication and contribution to osteopathy.
of three-dimensional biomechanics in her inclusion
of visceral tensions, torsions and dysfunctions.
Just as importantly, she reveals the interaction Grenoble 2006 Jean-Pierre Barral
between anatomy and physiology, thereby illustrat-
inghow soft tissue, organ, fascial and other tissue
tensions can impact on homeostasis, function and Churchill said, ‘I always avoid prophesying
recovery from pathology and injury. This helps beforehand, because it is a much better policy to
osteopaths to approach the management, not only prophesy after the event has already taken place.’
of patients with musculoskeletal symptoms, but I wish hindsight were my assigned task; however,
also those with more complex visceral dysfunc- I was asked to write a ‘foreword’ and not a ‘back-
tions and disorders. This book is important for all word’. In concluding this foreword, therefore, I
those wishing to appreciate and incorporate work decided to be somewhat bold in my assessment of
within the visceral field to their osteopathic practice. this book. Please read on to understand why.
It will also help to guide those outside the profession My global foreword is simply this: Visceral and
towards an understanding of the osteopathic Obstetric Osteopathyis a valuable, clinically applicable
approach to patient care. text written without pretence. In it, the author easily
viii FOREWORDS
communicates her clinical expertise by translating are taught and valued. Interestingly, these
static anatomy into a palpable experience. reservations were not felt outside of the
Techniques are clearly and concisely written and Introduction. My overall summary: this part
follow directly from their anatomical descriptions. of the book is of an easily read, simplified
The elegance of the technique presentation in this discussion of commonly and less-commonly
book lies in the simplicity of the diagrams used to used osteopathic approaches constituting a
summarise them. nice background for the rest of the text.
Chapter details in this foreword could be broadly ■ Overview of individual systems (Chapters 4–8).
painted because there is a clarity in the overall This is the essence of the text and the reason
structure of the book. There are three parts to this to own it! Building on clear anatomic descrip-
book: (1) The Introduction and first three chapters tions, the simple-yet-elegant diagrams facilitate
are basically overview materials; (2) Chapters 4–8 acquisition of these often under-appreciated
are visceral-system specific and literally constitute clinical techniques. These are not chapters
the heart of this text; and (3) Chapters 9–10 contain written to validate the approach, rather they
the author’s clinical application perspective. are careful, clear descriptions of how to man-
ually contact and balance anatomy. For prac-
■ Introduction and Chapters 1–3. Don’t judge titioners wishing to learn for themselves the
the value of this text by its overview alone. value of integrating such techniques, this is
Aware of the impossibility of writing the place to start. While the sections are not
overview materials to please everyone, the exhaustive in their overall scope to influence
author wisely and simply states her perspec- visceral function (e.g., sternal techniques were
tive. The result is an interesting synopsis of absent and viscerosomatic approaches were
concepts and clinical-approach models as superficially addressed), the author’s intent
understood and/or postulated in her train- was fully met. The text excels in presenting
ing as an osteopathic professional. There is the manual approach to the viscera them-
little attempt to convince any healthcare selves in an unambiguous and complete fash-
practitioner (osteopathic or otherwise) with ion. Finally, I would also be remiss if I did
outcome studies about the value of upcom- not praise the author for including arterial,
ing techniques … but then that was never her venous and lymphatic vasculature as approach-
stated purpose. Note that the Introduction is able visceral structures.
clearly written from the perspective of a ■ Patient management: visceral and obstetric.
practitioner whose medical education and The last two chapters of the textbook were
permitted scope-of-practice are more limited clinically delightful and particularly appeal-
in her own country than in the USA. I there- ing. Some patient management scenarios
fore felt occasional reservations about the suggested much more care than I currently
historical or clinical perspectives presented. provide (or would have been willing to have
There are significant differences in American considered prior to reading this text); some
and non-American applications of osteo- scenarios suggested much less osteopathic
pathic care in part because ‘osteopathic med- care than I thought could be done and her
icine’ in the United States is practised by description didn’t change my opinion about
more than 60,0001complete physicians, includ- what I would do for my patients; and many
ing D.O. obstetricians and gynaecologists, scenarios I secretly applauded because I felt
internists, and family medicine specialists. we would have managed that patient with
Osteopathic medicine is therefore a much that condition in exactly the same fashion. As
less ‘contentious’ word in the United States, a clinical educator, the key appeal to this sec-
where residencies exist in these and other tion is that the scenarios that I interpreted as
fields, including NMM/OMM (neuromuscu- too much, too little or ‘just right’ are unlikely
loskeletal medicine/osteopathic manipula- to be the same ones that the reader identifies.
tive medicine) where many of the visceral Such food for thought can only serve to help
and homeostatic concepts noted in her text us to ‘dig on’ in our clinical understanding
Forewords ix
and to evolve in our respective arts and In conclusion and in my opinion, Visceral and
practices. Obstetric Osteopathy has the potential to be an
instrument of reformation … if not of a profession,
That brings me back to my foreword’s ‘brave’
at least of one practice at a time.
prophecy that this text has the potential to positively
Osteopathic founder, A. T. Still, M.D., D.O.
reform the healthcare we provide our patients.
said, ‘Know you are right and do your work
■ ‘Reform must come from within, not without.’ accordingly.’ In sharing anatomic fact and her
As an osteopathic practitioner, I thank clinical perspective, Caroline Stone has con-
Caroline Stone for this contribution to the structed a text that empowers the reader to con-
osteopathic profession. sider that possibility.
■ ‘Reform, that you may preserve.’ As someone
who has had a successful practice for over Michael L. Kuchera,
25 years, I thank this book for continuing to Philadelphia 2006 D.O., FAAO2
remind me to integrate new (and/or redis-
covered) science, philosophy and art into my
practice.
■ ‘If you try to make a big reform you are told you 12006 figures. Osteopathic medicine is the
are doing too much, and if you make a modest fastest growing segment of healthcare providers
contribution you are told you are only tinkering in the USA so numbers will increase significantly
with the problem.’ I don’t believe reform was after publication of this text.
on the author’s mind at all. Nonetheless, 2Dr Michael Kuchera and his father, William
intentionally or not, as an outside reviewer Kuchera, are also the authors of Osteopathic
and educator I want to go on record as saying Principles in Practice and of Osteopathic Considerations
that this book strikes a happy balance to do so. in Systemic Dysfunction(Greyden Press).
xi
Preface
Osteopathy is a great profession, and I have been approaches in the visceral and obstetric fields of
very happy to help actively promote and develop osteopathic healthcare.
it over the past 20 years. Establishing a firm basis Some of the techniques and approaches dis-
and enthusiasm for the practice of visceral cussed in Chapter 10 ‘Osteopathy and obstetrics’
osteopathy has been a huge part of my profes- may be subject to practice restrictions in the UK.
sional life; of this I am very proud. Osteopathic Readers and practitioners are advised to check
care for pregnant women and patients suffering current legal boundaries for practice in their
from a wide variety of ‘visceral’ problems need region/location. Their inclusion in this book does
not be complex or confusing. This book aims to not in itself infer practice rights.
help all practitioners, regardless of their individ-
ual approaches to patient care, to appreciate a
range of basic, advanced, subtle and integrated Mount Lawley 2006 Caroline Stone
xiii
Acknowledgements
In writing this book, I would like to thank the and helpful comments. Thanks also to Claire Wilson
following people who have all helped in a number and Gail Wright at Elsevier for their efficient and
of ways: Ray and Catherine Power for help with friendly work on this book.
illustrations; Julie Peipers for support; Amanda I would most like to thank my husband, Brad,
Heyes for lots of care, comments and treatment; and for his love and enthusiasm for this project, and our
other colleagues who have attended recent courses beautiful daughter Jasmine for her self-sufficiency
and offered great feedback. I would also like to and patience! Love also to our second child, who
thank Anne Cooper and Jenni Paul for their insights will arrive as this book nears publication.
1
Introduction
CHAPTER CONTENTS Considering the whole 5
Where is the problem? 7
Basic concepts of visceral and obstetric
Tissue awareness and interpretation 7
osteopathy 1
Overview of patient assessment 7
Visceral osteopathy 2
Obstetric osteopathy 2 Basic components of visceral osteopathy 9
Osteopathic medicine 3
Points to remember in visceral osteopathy 9
Definitive osteopathic tenets 4
About this book 10
The field of visceral and obstetric osteopathy is not ■ postpartum pelvic problems, including
new but is increasingly popular and relevant in pelvic floor injuries
current patient-oriented healthcare systems in ■ headaches and TMJ pain
which the body’s inherent self-regulating and self- ■ ENT problems
healing mechanisms are increasingly recognized ■ developmental, feeding, sleeping and other
and valued therapeutically. problems in babies and children.
Osteopaths themselves are also keen to maintain
Any or all of the above problems may benefit from
and develop their scope of practice and as general
the application of visceral osteopathy, even if the
and professional awareness of the potential of
symptoms arise within the musculoskeletal system
osteopathic care is reawakened, practitioners are
(and the patient has no accompanying visceral
more enthusiastic than ever to explore the human
symptoms or disorders). In other words, although
dynamic in increasingly three-dimensional and
a visceral approach can be used when patients
integrative ways.
present with visceral symptoms, it is also helpful
Osteopaths see a variety of patients complaining
when there are only musculoskeletal symptoms of
of many problems, including but not limited to:
biomechanical origin.
■ low back and neck pain
■ repetitive work-related injuries or strain
■ effects of trauma such as whiplash BASIC CONCEPTS OF VISCERAL AND
■ asthma and other breathing problems OBSTETRIC OSTEOPATHY
■ colic and irritable bowel syndrome
■ postoperative pain and adhesion problems Visceral osteopathy is a way of exploring those
■ back, joint and soft tissue pain during tensions of the body that reside within the organs
pregnancy and associated tissues, with the aim of improving
2 VISCERAL AND OBSTETRIC OSTEOPATHY
overall movement, lessening any barriers to better For most patients and presentations, a variety
function and allowing the body’s own self-healing of tensions, torsions, stresses and strains are appar-
and self-regulating mechanisms to function more ent throughout the whole of the body and the
optimally. Any problem within the body may osteopath often applies a combination of treatment
have a visceral component. to ‘old injuries’ or sites of infection/inflammation
These types of factors can be present in people and fresh or recent problems and traumas.
with no symptoms of visceral disease, in much Osteopaths are aiming to interact with the physio-
the same way that many of the biomechanical/ logical functions within the body and to promote
musculoskeletal tensions and restrictions present health and better function by removing irritating
in someone with, for example, low back pain are factors and barriers to the homeostatic self-
not in themselves always symptomatic. regulating mechanisms of the body. Better movement
Obstetric care by osteopaths centres around is considered the key to this process, and visceral osteopa-
allowing the woman to accommodate her preg- thy is at its simplest the study of movement within the
nancy as comfortably and physiologically as pos- visceral systems and related tissues and structures.
sible, with the aim of reducing or removing stress
and strain not only for the mother and for labour,
OBSTETRIC OSTEOPATHY
but for the developing baby as well.
Osteopathy in these contexts is an understand- Many women and many health practitioners
ing of how three-dimensional anatomy relates to consider that much of the pain and discomfort
physiological function and how manual treat- associated with pregnancy and birth is ‘part of
ments can help restore optimum functioning and one’s lot’ and not really amenable to treatment.
improve healing. Most women experience physical problems and
often the majority wait for the end of pregnancy to
bring relief to their suffering. This does not have
VISCERAL OSTEOPATHY
to be the case, as many of the problems associated
Visceral osteopathy is a field concerned with: with pregnancy can be managed or alleviated
using an osteopathic approach.
■ the three-dimensional dynamics of body
Osteopathic care for pregnant women, pre- and
biomechanics (including musculoskeletal,
postnatally, focuses on helping the mother’s struc-
myofascial, connective tissue and organ
ture (spine, joints and soft tissues) to cope with the
structures)
increasing demands of the pregnancy. It helps to
■ reflex activity in the central and peripheral
alleviate some of the pains and problems associ-
nervous systems
ated with changes in posture, weight bearing, and
■ neuroemotional–immune links
the stretching of various ligaments and tissues
■ effective circulation and drainage of all the
that support the uterus. It also helps to prepare the
body fluid systems and tissues.
body and pelvis for labour and delivery, may have
Apatient does not need to present with a visceral a role to play during labour and helps the woman
problem (e.g. irritable bowel or hiatus hernia) for recover from the traumas and strains imposed
a visceral approach to be relevant. Many cases of during the birth process (be that ‘natural’ delivery
musculoskeletal pain can be helped by releasing or ‘caesarean’). Osteopaths can help in managing
asymptomatic problems within various organs existing spinal and joint problems during preg-
and body tissues. Also, just because someone has nancy, aiming to reduce the impact that the preg-
presented with some sort of visceral symptom nancy has on the disc disease or ligamentous and
does not mean that the primary treatment is applied muscular strain problems, for example.
to those organs. It could be equally if not more Obstetric osteopathy also aims to make the
important to consider the surrounding or related space available for the developing baby as ‘com-
musculoskeletal system components. Visceral fortable’ as possible, thus potentially reducing
approaches within osteopathy are merely another mechanical stress on the baby during pregnancy.
tool for the osteopath to utilize when managing a This may have many effects, including giving space
whole variety of patient presentations. for the baby to freely rotate and move around
Introduction 3
within the uterus, and get into an optimum posi-
Consequently, osteopaths consider that a nor-
tion for labour and birth. Improving the mechan-
mal part of medical management of pathology
ics of the joints and muscles of the pelvis in
and disease should be restoring or improving
particular is also thought to help ensure that the
movement in all body tissues where possible,
birth canal is as accommodating as naturally possi-
as they believe that this will aid physiological
ble. This is thought to reduce the risk of injury not
recovery.
only to the mother but also to the baby. There is also
a large field of study called paediatric osteopathy
which is concerned with the osteopathic manage-
ment of problems from birth through infancy and If movement is restored, communication
childhood to early adulthood, which is not fully between parts is more efficient, fluid circulation
addressed in this book. and drainage improve, irritating signals are
Intrapartum care is also an area of practice in reduced and the body’s homeostatic and immune
osteopathy. Here, the osteopath is legally a ‘birth mechanisms can operate more effectively, thus
partner’ to the labouring woman and does not restoring health and better function.
have medical control of the situation. Their role The term ‘osteopathic medicine’ is a con-
is to support the mother and offer whatever tentious one, as it has often been interpreted as
osteopathic services all parties (including the meaning that osteopaths are working outside
midwifery and obstetric carers) agree upon, with their scope of practice. Osteopaths have histori-
the aim of reducing strain in labour and poten- cally defended the use of their principles in the
tially improving birth processes and outcomes for management of health and disease issues, as sup-
the mother and child. This is an area of special plementary care, complementary care or alterna-
interest and not one that all osteopaths would tive care, depending on the situation. Providing
routinely offer. the pathological nature of conditions is under-
stood and appropriate considerations made, for
example in terms of techniques used, forces
OSTEOPATHIC MEDICINE
applied and ethics and legalities observed, then
Using osteopathy as part of a management system osteopathic management can provide sometimes
for the very sick, the diseased or those with a quite marked relief of symptoms associated with
weakened immune system is not contraindicated, those conditions. Not only that, but the impact on
nor is (as mentioned above) its use in natural con- physiological processes may enable the body to
ditions such as pregnancy or during labour. utilize its own self-regulating and healing mecha-
Osteopathic medicine is a term used to describe nisms more effectively, and thus may contribute in
how osteopaths view health and disease, and how some way to the resolution of ill health. Osteopaths
they consider that effective and efficient move- contend that treating the person, rather than the
ment in all body tissues, structures and fluid cir- disease, leads to improved outcomes on more levels
culations contributes to health and balanced than simple application of disease-oriented therapy
homeostatic function. Osteopaths consider that alone.
irritations in tissues and nerves and barriers to Whilst part of their work is aimed at symptom
effective fluid circulations are all related (in part) management, through the link between move-
to movement and biomechanical restrictions in ment and physiology and the way that osteopaths
the body tissues (including muscles, joints, con- consider that movement restrictions impact on physi-
nective tissues, organs, blood vessels and so on). ologyand hence reduce tissue health and function-
ing, there is some consideration of the potential
Osteopaths consider that there is a biomechani- aetiological impact of the movement restrictions
cal component to pathological processes and on pathological development and progression.
disease, and that examination of the body’s tis- Hence osteopaths also theorize that some of their
sues for movement disorders should form part management addresses pathological change. This
of any general medical screening procedure. is an area where the evidence base for osteopathic
concepts is currently small.