osteopathic concepts

structure and function
The original osteopathic concepts and overall philosophy arose in response to perceived inadequacies of conventional medicine and were inspired by a functional interpretation of anatomy. The term osteopathy is somewhat misleading, but does allude to the notion that the skeletal system can be used to access and influence an organism’s self-regulation/ organisation. The founder of osteopathy was religious in the tradition of American romantics/naturalists, at odds with the popular Cartesian sentiments of his time, including structure-function dichotomy. He saw no real distinction between anatomical and physiological systems and hence treatment procedures have the capacity to influence overall physiological integration. Altered structural relationships influence function, and conversely function ultimately influences structure – structure and function are meshed together into a continuum.

An example of structure-function relationship that I frequently encounter in clinical practice relates to insidious/non-traumatic shoulder pain. Through orthopaedic testing and osteopathic assessment one can readily identify the painful tissues but the insidious onset alerts the osteopath to altered structural and functional relationships. Altered structural relationships cause suboptimal loading and movement patterns/function. Over time this has the potential to cause overuse of soft tissue structures. Osteopathic treatment in this instance would focus on facilitating tissue drainage, inflammation management and normalising structural relationships to improve overall shoulder girdle function. In most instances this would include assessing and treating pelvic and functional leg length dysfunctions. Osteopathic treatment is all about the overall context of presenting complaint, not merely the site of pain.

respiration
Osteopaths identify and treat a number of interrelated respiratory processes, structures and movements. Moreover we situate healthy (this constitutes more than simply being alive) respiration and the constant involuntary and unconscious movement of the entire body at the core of physiological and emotional health. Altered respiration, whether it is caused by anxiety, emotional or physical trauma, or respiratory dysfunctions like asthma, influence wellbeing. Respiratory dysfunction often contributes to and perpetuates apparent musculoskeletal problems as well as being central to problems like reflux and poor hepatic (liver) function and clearance.

pain and dysfunction
Musculoskeletal pain is the main reason that a patient ends up in my practice. Pain is a complex phenomenon and a common symptom of dysfunction. Pain perception is influenced by emotional, psychological, cultural and physiological factors. Given the same tissue injury, each individual responds differently. It is therefore unwise and insensitive to dismiss another persons pain or suffering by pejoratively situating it ‘in their head’.

When working with patients in acute or chronic pain it is critical to build their understanding of the basic physiology of tissue injury, pain processing and inflammation. In many situations I discuss with patients cognitive, emotional, respiratory and if necessary pharmacologic approaches to reducing pain and its sequelae. Sequelae include whole body responses that effect movement, posture, respiration, mental state, sleep and energy levels. Persistent pain can modify the way we process and experience pain – this change in pain processing is called sensitisation. In such instances the patient experiences pain and debility in the context of complete resolution (healing) of the initial tissue injury/damage.

In manual medicine provocation and reproduction of pain and other neurological phenomena can assist in tissue specific diagnosis. Reduction in pain is usually associated with improved function, both are invaluable outcome measures. The therapeutic relationship in manual medicine is informed and influenced by changes in pain and function, both which can be expressed in the form of a visual analogue scale/score. This creates a transparent, outcome-based approach that strips mystique from the osteopath and focuses on the patient’s response.

biomechanics and energy conservation
Altered biomechanics influence the economy and metabolic cost (energy) of movement and motion. Moreover biomechanical changes alter musculoskeletal relationships and distribution/transfer of force leading to premature and imbalanced wear and tear throughout related and compensating structures.

Treatment of old ankle and foot injuries or generalised rigidity in the pelvis leads to significant improvements in movement and energy conservation. Biomechanical restrictions, particularly of the legs and pelvis, frequently alter smooth transfer of momentum, reducing the economy of walking and running.  

connective tissue
Connective tissue permeates the entire musculoskeletal system and has a number of distinct characteristics that are relevant to the practice of osteopathic medicine. Connective tissue is made up of collagen and related molecules. It contains specific types of cells that synthesise collagen and mediate immune function. The density and physiological function of connective tissue varies enormously amongst individuals. Muscles, tendons and ligaments are composed of increasing proportions dense connective tissue. Connective tissue is therefore integral to and affected by biomechanical function, trauma and postural loads. Its mechanical properties can be defined in complex material engineering terms and indeed behaves like any other material when exposed to force. Under balanced loading conditions, connective tissue resists, stretches and recoils. Sudden or persistent abnormal/suboptimal loading can cause rupture, tears/creep and more subtle deformation. These processes are usually associated with inflammation and tissue repair/reorganisation. Although it is common for osteopaths to treat traumatic injuries, much of our work focuses on the subtle deformation associated with persistent occupational and postural patterns.

medicine, self-organisation, open systems, health and consciousness
Germ theory and heroic medicine have profoundly and positively affected human health and disease outcomes, and represent the most significant offerings of a modern medicine based on empirical and experimental methodology. The failings of the enlightenment project are however too numerous to mention. Failed, misguided and unnecessary surgery, adverse drug reaction/interactions, hospital-based infection and mishap and the neglect of preventative health strategies have contributed increasing public dissatisfaction with general and specialist practice. 

The failure to widely embrace a ‘biopsychosocial’ (and I would add ecological/environmental) model, in favour of a naïve molecular medicine (warmly supported by the big-pharmaceutical companies) has reinforced unsustainable notions that complex problems like depression, diabetes and asthma can be a treated with magical pharmacologic bullets. There is hope though, the functional medical revolution is building momentum, placebo is now a legitimate biological response, and general practitioners are appropriating the concept and brand of holism in the bland marketplace of inner-urban medical practice. Eventually medical education will embrace a nonlinear/open-system approach that better reflects the subject of their ministrations: a conscious and open biological system.

The dismissive and all too often arrogant tone of the physician as the agent of recovery and restoration of health is now widely challenged by web-mediated health consumer awareness. This cultural change will inevitably lead to better care and greater awareness of the conditions and factors that stimulate and support health rather than merely prevent disease.

neuroimmunoendocrine integration
The rule of the artery is supreme’. This phrase was coined A.T. Still, the founder of osteopathic medicine and resonates. Contemporary biomedical research is illuminating the subtle details and pathological idiosyncrasies that are the result of co-regulation of neurological, chemical, hormonal and immunological mediators. Formerly distinct and naïve systems have all but been demolished through the emergence of neuroimmunoendocrine integration. The emergent understanding of non-alcoholic fatty liver disease and metabolic syndrome in relation to fructose consumption stunningly exemplifies the benefits of an integrated approach to understanding normal and altered physiology.

amplification through movement
In osteopathic practice I have not found it generally adequate to simply treat a complaint, and find the prospect of patients on a schedule of so called ‘maintenance’ sessions rather dull. My approach is more engaged and active. The benefits of osteopathic treatment can be amplified and extended through the use of specific movement practices. Patients are unlikely to be very compliant with these approaches unless they are persuaded by the rationale and potential benefits. I teach patients a range of individualised and modified yogic poses, specific stretching and strength techniques and cognitive approaches to postural and movement patterns. This combination of approaches means that I see patients less frequently and that they can engage active techniques to manage and improve their particular issues.

soft tissue osteopathy and yoga
21 Neales St Kaleen Canberra Tel: 02 6255 5702