Most patients consulting osteopathic practitioners will do so in the hope of obtaining relief from musculo-skeletal aches and pains. In the main, the low back and neck are the areas most likely to be involved, but all the joints and muscles of the body are possible sources of problems which may be helped by osteopathic care. A growing number of patients, however, do consult osteopaths about a wider range of health problems, and these might include such conditions as migraine headaches, tinnitus (noises in the head), dizziness, bronchial problems, asthma, functional cardiac problems, digestive problems and menstrual irregularities. The treating of these and other conditions by osteopathic methods can be surprisingly successful.
Photo: Courtesy Rehabilitation Products Limited.
An osteopathic treatment couch.
What Happens On Visiting an Osteopath
A typical visit to an osteopath can last from fifteen to forty-five minutes, depending upon the condition, and at the first visit the osteopath will take a case history and conduct a detailed examination and assessment of the spinal and other joints. Should the condition warrant it, x-ray pictures might be taken. In many cases the heart and chest will be examined, blood pressure taken and possibly other clinical tests performed or arranged (urine tests, blood tests, eye or ear assessments etc.) In these ways the osteopath arrives at a diagnosis as to the causes of the patient’s problems, or at least as to the possible musculo-skeletal involvement in whatever problem the patient is troubled with.
Treatment normally consists of preliminary soft-tissue manipulation. This might be local to the area of pain, or distant from it if the osteopath is attempting to influence the condition reflexly. Having stretched, relaxed and generally prepared the soft tissues, the osteopath will manipulate the appropriate joint or joints. As shown in Chapter 6, a variety of methods may be used at this stage. The age, condition, degree of pain and spasm etc. will all decide which is the most desirable approach.
Some forms of manipulation produce an audible snapping or popping sound. This is thought to result from the creation of a momentary vacuum between the joint surfaces as they are manipulated. Such sounds do not necessarily indicate that the manipulation has been successful, nor does the absence of such sounds mean that the treatment has failed to achieve mobility.
After treatment there is often immediate relief from pain and improved mobility. However, there may be a degree of transient discomfort, and in some cases a slight increase in pain may be felt for a day or so, especially in acute conditions. More usually there is a feeling of well-being. Some patients experience a marked degree of relaxation and a desire to sleep, and others feel a sense of exhilaration and energy.
Practitioners will explain the objectives of the treatment, and may well suggest a programme of home treatment to augment and support the osteopathic therapy. This could include exercise, dietary changes and relaxation. If the condition is a simple mechanical strain, then it would normally be correctable fairly quickly, and require no further attention. If, on the other hand, the condition is of a more chronic nature, then periodic maintenance treatment may be necessary to prevent a recurrence.
The frequency of osteopathic treatment can vary from very often, say every other day, to occasional, say every month or so. In chronic conditions the regular ‘maintenance’ treatment is likely to be at intervals of anything from once weekly to once in three or four months. There is a tendency for patients to be advised to have regular check-ups, two or three times a year, on the same basis as in dentistry. Since many minute musculo-skeletal changes often precede obvious problems by many months, this preventive approach can be of value. In the same way an increasing number of infants and growing children are taken for osteopathic assessments each year to ensure that problems are corrected before they become established.
Many patients speak of their problems in terms of ‘bones being out of place’. They therefore expect these to be replaced or ‘put back’ by manipulation. Such ideas are largely inaccurate and over-simplistic. Whilst slight changes in position may take place, the essence of osteopathic manipulation is the restoration of mobility between joint surfaces. Correction of positional lesions tends to be achieved by normalizing the soft tissues that are supporting, binding and holding the bones in their particular positions. Some individuals have hypermobile joints due to congenital or acquired ligamentous weakness. Such joints can become unstable and, far from requiring manipulation, may need stabilizing by improvement of the tone of the soft tissues. This is sometimes achieved by injecting a sclerosing agent which ‘tightens’ the supporting tissues.
The ‘Slipped Disc’
The commonest diagnosis with which patients arrive at an osteopaths door (in the UK) is that of a slipped disc. Very few doctors have studied the mechanics of the spine with the degree of detail required of the qualified osteopath. The most common diagnosis given in cases of acute low back pain is that of a ‘slipped disc’. The symptoms vary, but usually involve stabbing pain on movements, and often one-sided spasm of the lumbar muscles; there is great difficulty in standing erect, and there may be pain down one or both legs. These symptoms are usually present in a true case of prolapsed intervertebral disc, but may be present in any other conditions. How is one to know?
A detailed history of the onset will often enable a correct diagnosis to be made and with details of the past medical history and a careful physical examination, it is possible to confirm or rule out the diagnosis of a slipped disc, with a great degree of certainty.
For the unfortunate individual suffering from a strained sacro-iliac joint, who is told by his doctor that he is suffering from a ‘slipped disc’, life becomes very irksome. He may be put to bed for anything up to six weeks, and then put into a corset. He may find himself in a plaster cast or in some cases an operation is suggested. If the patient is really suffering from a prolapsed disc ,the period in bed or wearing the corset would rest the area and enable a degree of repair to take place, but if the trouble is a strain of the sacro-iliac joint these treatments would be worse than useless.
The disc that it supposed to slip is a tough cartilaginous ring that is firmly attached to the vertebrae above and below it. This contains an inner pulpy mass, the nucleus pulposis. When through strain or an injury a tear appears in the cartilage, the inner material can protrude. This will cause spasm in the surrounding musculature and if there is pressure on nerves in the area then there will be acute pain. The disc does not, indeed cannot ‘slip’. There can be a rupture, or a herniation, and thus the misnamed ‘slipped disc.’
|Cross Section of:|
1. Vertebral Bodies Showing:
|2. Disc in healthy state.|
The effect of long-term unnatural wear on the disc is to reduce the elasticity of the disc as a whole and to produce a narrowing, degenerative change. Thus the ability of the disc to act as a shock-absorber becomes reduced. This results in stiffness and loss of mobility and possibly pain. It is therefore apparent that anything that can be done to prevent this all too common degeneration is highly desirable.
Once a disc has herniated there is no way of ‘putting it back.’ Anyone who claims to replace a ‘slipped disc’ is, without doubt, not being accurate. It is possible, with manipulation, to ease the pressure on the disc, then with gentle exercise and care the slow repair can take place. In rare cases surgery may be needed to remove the extruded pulp, but I would suggest that surgery should never be resorted to before an osteopath has been consulted.
|Cross Section Showing: 1. Prolapsed Disc||2. Pressure on Nerve Root. Such a condition would produce sciatic pain if this occurred in the Lumbar Spine.|
Whether short-term painful joint problems, or long-term general health conditions are the reason for consulting an osteopath, the way the individual uses his body will to a large extent determine whether or not recurrence of the problem takes place. For this reason it is vital that after correction of areas of dysfunction, the patient be instructed in the correct use of the body and in appropriate exercises. Many osteopaths also advise their patients on correct nutrition and in this way provide a comprehensive health care service.
|Cross Section of Spine showing: |
1. Prolapsed Disc;
2. Bone Degeneration.
Other Complaints Which Osteopathy May Help
Without attempting to cover all the possible disease states that osteopathic manipulative therapy might be able to help. I list below a selection of examples with the idea of giving some idea of osteopathy’s possibilities.
The treatment of causes rather than symptoms is of first importance, and a lot of attention will need to be given to both the nutritional and stress related aspects of the problem. There are, though, quite often cases where osteopathic manipulation can help. In asthma, for example, areas of dysfunction may be found around the second thoracic vertebra, and there are always restrictions in the normal range of movement of the ribs. Such structural problems may be improved or corrected by osteopathic treatment, but if nothing is done about the underlying hormonal, nutritional and stress factors there is a strong likelihood that the allergy will reappear.
In most cases of allergy there is a degree of adrenal gland dysfunction (inadequate adrenaline production in response to repeated stress arousal, for example) or liver dysfunction (inadequate production of anti-hystamine in response to allergic hystamine production). Both these organs can be to some extent adversely affected over a period of time by mechanical disorders in the spine, and spinal correction through osteopathic manipulation can sometimes bring about an improvement of function.
The localized degenerative changes to joints which are collectively labelled osteo-arthritis or osteo-arthrosis is afflicting the majority of people over 35 who live in industrialized countries, and the term ‘wear and tear’ adequately describes the joint damage which results from the misuse of the postural and weight-bearing joints such as the spine, hips, knees etc.
In the early stages of such wear and tear, when disability is first becoming apparent in the form of stiffness, discomfort and slight limitation of movement, it is possible through osteopathic manipulative treatment to halt, and perhaps even reverse, the initial damage to the soft tissues which precedes the actual joint surface damage.
Even in cases of existing osteo-arthritic conditions, improvement may be brought about through osteopathic treatment in terms of improved mobility, the lessening of pain, and possibly the slowing down of the degenerative process. This is especially likely in spinal regions such as the neck and upper thortic spine and the lower back and pelvic joints which are those most abused by bad postural habits. Osteopathic treatment cannot undo the damage already done, however, but it can often minimize the effects by increasing the degree of mobility in all but extremely advanced cases.
Chronic or acute obstruction of the breathing passages may yield to osteopathic manipulative therapy, although the causative factors must also be dealt with, and it is not suggested that structural factors play a major part in the background to bronchitic conditions. Osteopathic treatment in the spinal, chest and diaphragm areas can improve respiratory function and seems to speed the elimination of obstructing mucus. Apart from the mobilizing of the structure of the chest, such as ribs and their articulations with the spine and sternum, there are specific osteopathic methods such as the ‘thoracic pump’ and the ‘diaphragmatic coming’ techniques which may help.
When the problem results from an over-contracted or spastic bowel, osteopathic treatment may assist in normalizing the condition, in conjunction with a restructured diet to include a high degree of fibre.
Osteopaths find that there is frequently a spinal element involved in digestive dysfunction, whether the condition involves over- or under-supply of acid, or over- or under-supply of enzymes, or increased or decreased blood supply, to particular regions of the digestive organs. Osteopathic treatment is non-specific in such conditions, and usually areas of spinal dysfunction will be found in the mid and lower thoracic areas. The normalizing of these, together with dietary changes, can alleviate the problem.
There are a great variety of causes of what are generally termed headaches, but one of the main causes of the common headache is tension in the neck and back of the skull and this is found to be particularly amenable to osteopathic treatment. Also, a definite reduction in frequency and intensity of pain was found to result from the osteopathic normalization of the cervical spine when research into migraine was conducted at the British College of Naturopathy and Osteopathy in the early 1970s.
Many headaches of less obvious origins may respond to a combination of cranial, cervical and upper thoracic normalization, but it would be wrong to assume that all headaches can always be relieved by osteopathy. In my own experience, however, I have found that some headaches of many years duration have yielded to just one treatment session.
Generally the improvement of mobility in the thoracic spine and chest region after osteopathic manipulation seems to enhance the heart’s function and in turn the blood is more efficiently oxygenated.
References have been made in Chapter 7 to the results of research into the possibility of a musculo-skeletal connection in cases of cardiac disorder, and the correction of spinal dysfunction by osteopathic manipulative therapy is claimed to reduce the chances of cardiac distress.
A frequent finding is that of what has come to be called ‘false angina’. In this condition all the classical symptoms of angina occur (pressure in the chest, breathlessness, pain in one or both arms etc. ) but they fail to respond to drug therapy. In many such cases there is found to be an upper thoracic lesion which responds to simple manipulative techniques with a consequent disappearance of the symptoms.
This distressing condition involves a bulging upwards, through a gap in the diaphragm, of part of the stomach. Osteopathy’s normalizing treatment of the structures to which the diaphragm attaches itself can be of great assistance, and there are also soft tissue manipulations which can be applied direct to the diaphragm, the muscles of the abdomen and the stomach itself. By thus improving the mechanics affecting the diaphragm, as well as the other factors involved in the problem, the distressing symptoms of hiatus hernia may be minimized. Other factors, such as obesity, bad posture, stress and poor nutrition, must not be overlooked, but osteopathy can in a number of cases be decisive in relieving symptoms and helping to correct the mechanical strain which allows the initial upwards displacement of the stomach.
If high blood pressure is the result of tension then osteopathic manipulative therapy can have a very beneficial effect on the condition. Both research and clinical experience shows that the normalization of spinal and general mechanics seems to have a stabilizing effect on the systolic and diastolic readings for a number of weeks. It is not suggested, though, that osteopathy should be used as the major method for treating hypertension, but such treatment can be a useful additional therapy.
Dramatic improvements in menstrual function, in terms of regularity, less pain and discomfort, and shorter periods, have been achieved through the normalization of dysfunction of the lumbo-sacral area of the spine. There are many possible contributory factors in menstrual problems. Some of these are hormonal, others emotional, and others involve nutritional imbalances. However, in many cases the cause of the problem lies in mechanical and postural factors. In some cases there is a marked increase in the angulation of the lumbar spine causing a hollow, or ‘sway’, back and this can result in the pelvic organs being literally tilted forward and crowded into the lower pelvis. This can be helped toward a more normal position by osteopathic treatment.
If there is a pain radiating down the leg, then it may be the result of some degree of nerve root irritation involving the sciatic nerve. Some forms of this condition are not amenable to osteopathic care; for example, when the nerve is actually inflamed (neuritis). However, in the majority of cases of sciatica the nerve is irritated and not inflamed (neuralgia) and in many such cases removal of the cause of the irritation by osteopathic treatment relieves the pain. The cause may lie in the low back or in the pelvic or buttock regions. In acute cases it may be the result of a prolapsed disc, in which case osteopathy may be of only limited value.
This intensely aggravating condition, which involves a ringing, buzzing or hissing sound in the ears, can be relieved by cranial manipulation.