The practice of medicine and of osteopathy is an art, or skill in the application of definite rules and procedures. Such rules may, or may not, be based upon the accurate and logical interpretation of facts. If an art is based upon the logical interpretation of facts, which are understood and demonstratable, then the application of the word ‘science’ to the procedures is appropriate. Osteopathy is clearly an art. The clinical and practical value of osteopathic procedures is well established, but thus far there is insufficient research evidence or controlled clinical trials to produce incontravertible proof as to the validity of the theories which underlie it. This in no way invalidates the osteopathic approach.
Even if osteopathic principles cannot be scientifically proved, they do at least broaden the physician’s view, and help him to look at the whole picture of the patient and his environment, which is where the skill of the physician needs to be applied, rather than simply attacking symptoms. Much research has been done, which confirms and validates osteopathic principles, and this will be discussed in the chapter on research. The aim of this chapter is to set out the basic beliefs which underlie the practice of osteopathy.
The Basic Premises
The basic premises include:
- That the human body is an integrated unit in which structure and function are reciprocally and mutually interdependent.
- That through complex mechanisms and systems the human body is self regulating and self healing in the face of challenges and diseases (this is known as homeostasis).
- That optimum function of the body systems is dependent upon the unimpeded flow of blood and nerve impulses.
- That the musculo-skeletal system comprises a major system of the body, and that its importance goes far beyond that of providing a supportive framework.
- That there are components of disease within the structure of the musculo-skeletal system which are not only the manifestations of disease processes, but which are frequently important contributing, or maintaining, factors in disease processes. These may be local to, or distant from, such disease processes and are usually amenable to appropriate treatment
The recognition of the importance, in the overall economy of the body, of the musculo-skeletal system, its proneness to dysfunction, and the repercussions of such changes, and finally the recognition of the ability of therapy to normalize such dysfunction by one or more of a variety of manipulative procedures, represents the essence of osteopathy’s individuality.
The body is functional. Structure is the manifestation of function, for structure that does not allow function is pointless. If structure alters, so will function. In a self-regulating mechanism, such as the human body, adaptation and compensation to such structural changes takes place, but always at the expense of optimum, or perfect, function. Such alterations in function may remain within acceptable limits, and not produce noticeable symptoms, but as will be seen, if these changes occur in vital spinal areas, widespread effects may take place, distant from the area of dysfunction. Structure and function should not be thought of as separate entities, one is inconceivable without the other. The musculo-skeletal system comprises roughly 60 per cent of the structure of the human body, and it expends most of the energy of the body. It has been called the ‘primary machinery of life’ by Professor Irvin Korr , who points out that our personality and our individuality are demonstrated through the musculo-skeletal system. The organs of the body can be seen as secondary, supportive, machinery, which provides energy to meet the demands of the musculoskeletal system. It is more than just a framework which supports and contains the viscera of the body, but is the main dynamic component of the living body.
All healing systems recognize that there resides within the body an inherent capacity for adapting to and recovering from the stress and demands placed upon it. There are many mechanisms operating towards this end. The word homeostasis is often used to describe the complex interplay of systems and processes involved in health maintenance. The hormonal, circulatory, lymphatic, nervous and musculo-skeletal supplied by the nerves skeletal systems, all interact in the maintenance and recovery of health.
Distribution of Segmental Nerves e.g., If the roots of 1st sacral nerve are compressed pain is felt on outside of foot (the areas indicated are from the spinal level indicated by letter and number).
Professor Korr stands out as the leading scientific researcher into the osteopathic concept. He coined the phrase ‘Somatic component of disease’ as far back as 1948, to conceptualize the physical entity which had previously been called the osteopathic lesion. The manner in which the musculo-skeletal system can become involved in disease processes is varied. As we shall discover, the major area through which the musculo-skeletal system influences the body, in health and disease, is through the nervous system. The body of the patient responds, through the nervous system to stimuli from its countless internal sources, as well as from external sources. The responses are mediated through the nervous system. From the neurological viewpoint, osteopathic manipulative therapy is attempting to restore function to areas of the musculo-skeletal system that are responding to increased, or abnormal, stimulation and which are modifying nerve impulses from and to the various body structures and organs. There is no part of the body that is not inter-related with every other part, via the nervous system.
A little known recent development in neurological research has shown that nerves not only carry messages but actually have a trophic function. This means that substances are transported along nerve fibres, in both directions, at varying speeds. Most of these substances are proteins and some are fats. Many degenerative diseases would appear to result from abnormalities in the transportation of these apparently vital substances along nerve pathways. We have for too long thought of the nervous system as simply a network along which impulses and messages are conducted. The implications of the nerve tissues acting as a transportation medium for essential cell substances are far reaching.
In a more direct manner dysfunction of the musculo-skeletal system can interfere with respiratory and circulatory function. Few people realize the importance of correct breathing. Not only is this function responsible for providing the body with oxygen but it is also an important means of eliminating waste products. The effect of respiration on the circulation of blood and lymph (through the glands) is profound. As the lungs expand and contract, the diaphram rises and falls, thus altering the relative pressure between the thoracic and pelvic areas. This pump-like action is essential if venous blood is to return efficiently to the heart for re-oxygenation. The heart pumps blood to the legs, but in order to return, the muscles of the lower extremeties need to be in use to produce the so-called ‘musclepump’ action, whereby as muscles contract they effectively squeeze the blood along the veins (which have no-return valves), and thus enable it to reach the pelvis where the diaphragmatic pump operates. If there is dysfunction in the spine which affects normal breathing, then the efficiency of blood and lymph circulation will be impaired. It is possible to appreciate, therefore, how such conditions as varicose veins and haemorrhoids can be improved by correction of body mechanics.
Unless structure is normal it cannot function normally and the consequences can be far-reaching. Goldthwait states in a criticism of the medical profession, of which he was a respected member:
Not only is little attention paid to differences in structure, but practically no consideration is given to what happens to the function of various organs, when the easily demonstrable malposition of them is considered. Is it not possible that much of what concerns chronic medicine has to do with the imperfect functioning of sagged or misplaced organs? Is it not possible that such sagging results in imperfect secretions, which at first are purely functional but if long continued may produce actual pathology? It would seem to be a matter of common sense to expect health with the body so poised or balanced that all the organs are in their proper position and the muscles in proper balance!
Korr  describes the manner in which the musculo-skeletal system most frequently becomes involved in disharmony:
Man’s musculo-skeletal system is an incomplete and imperfect—certainly an unstable—adaptation of a basic quadruped system to biped stance and locomotion. The components of a perfect cantilever bridge have been somewhat rearranged and modified by evolutionary process to form a less adequate skyscraper. There is no doubt that gravity is far more demanding of man’s resources than of other mammalian species. As a result, local postural stresses, asymmetries, myofascial (soft tissue) tensions and irritations, and articular and peri-articular (joint) disturbances have a particularly high incidence in man. Their probability, always high, increases with time. In man, therefore, gravity has become an environmental factor of great importance.
Korr recognizes that dysfunction may result from injury, but he believes that the main cause is the result of the body’s adaptation to erect posture. Individual habits, inherited factors, attitudes, occupations, the development of inborn asymmetries and defects will all add to the picture, as will such factors as obesity and pregnancy. He also points out that such symptoms and signs as pain, tenderness and muscular rigidity in spinal areas, may often result from other tissues or organs which are themselves diseased or under stress, affecting spinal tissue via the nervous system. He states: ‘Through the reciprocity of influences between visceral and somatic tissues (organs and body) via the central nervous system, visceral (organ) pathology produces disturbances in musculo-skeletal structures. This is recognized in the concept of the secondary, reflex osteopathic lesion and in the ‘splinting’ (muscular rigidity) associated with painful visceral (internal organ) syndromes.’
The Spinal Cord
The spinal cord is the source of most of the nerve supply to the body. Every organ and tissue receives some nerve supply which originates from the spinal cord. The cord is also the point of entry or reception of most of the information from the organs and tissues of the body. Impulses carrying information to the higher centres and the brain pass into and through the cord and are often ‘screened’ and organized and transmitted in, and by, tissues in the spinal cord. Everything that is happening to the body is constantly monitored and controlled via this vital pathway. Many automatic functions as well as conscious orders are either conveyed by or recoded and dispatched by the cord. Insofar as the musculo-skeletal system is concerned, Korr explains it thus: 
The spinal cord is the keyboard on which the brain plays when it calls for activity. But each ‘key’ in the console sounds not an individual tone’ such as the contraction of a particular group of muscle fibres, but a whole “melody’ of activity, even a ‘symphony’ of motion. In other words, built into the cord is a large repetoire of patterns of activity, each involving the complex, harmonious, delicately balanced orchestration of the contractions and relaxation of many muscles. The brain thinks in terms of whole motions, not individual muscles. It calls, selectively, for the pre-programmed patterns in the cord and brain stem, modifying them in countless ways and combining them in an infinite variety of still more complex patterns. Each activity is subject to further modulation refinement, and adjustment by the feedback continually streaming in from the participating muscles, tendons and joints.
Since the cord is housed in a structure, the spinal column, which is patently commonly in a state of dysfunction, it is not surprising to find the perfect harmony, as described by Korr, turning into discord and disorganization. The repercussions of joint dysfunction in the spine may be local or distant. Apart from local discomfort or pain, alterations may occur in the function of nerves and their impulses and trophic functions. Whether the impulses reaching the cord are from body tissue such as muscles, ligaments, joints, etc. (somatic impulses) or from organs such as the liver, spleen etc. (visceral impulses), or whether they arise from the brain or from within the nervous system itself, such changes may be manifested in the tissues of the spinal column. The nerve cells in an area of dysfunction may become over-excited and this allow for over-reaction to stimuli. Impulses which would normally produce a small response may call forth a major one, in terms of local activity or of rapid transmission onwards of such messages. It is as though the spinal ‘keyboard’, because of dysfunction, was responding with a far louder note than the soft striking of a particular key warranted. Consequently disharmony results. The overexcitability of specific areas, as a result of somatic dysfunction, is known as facilitation. Professor Michael Patterson explains it thus: 
One of the most important concepts of osteopathic philosophy and practice is that of the facilitated segment. Described in research writings of the profession over the past thirty years, the concept of the facilitated segment states that because of abnormal afferent or sensory inputs to a particular area of the spinal cord, that area is kept in a state of constant increased excitation. This facilitation allows normally ineffectual, or subliminal stimuli, to become effective in producing efferent output from the facilitated segment, causing both skeletal and visceral organs innervated by the affected segment to be maintained in a state of over-activity. It is probable that the ‘osteopathic lesion’ or somatic dysfunction with which a facilitated segment is associated, is the direct result of the abnormal segmental activity, as well as being partly responsible for the facilitation. Although the effects of the facilitated segment on various skeletal and visceral functions are well documented, little is understood about the genesis and maintenance of spinal facilitation. Even the question of why some traumas cause facilitation and others do not, remains unanswered.
Professor Irvin Korr is the researcher whose work has led to the describing of the phenomenon of the facilitated segment and its implications. In 1955 he wrote: 
Facilitation of the sensory pathways in the disturbed lesioned segments means that there is easier access to the nervous system—including the higher centres—through these segments. The lesioned segment is one through which environmental changes—especially noxious or painful stimuli—have exaggerated impact on man.
Facilitation of motor pathways leads to sustained muscular tensions, exaggerated responses, postural asymmetries, and limited and painful motion. Since the muscles have rich sensory as well as motor innervation, under these conditions, they and related tendons, ligaments, joint capsules etc. may become the sources of relatively intense and unbalanced streams of impulses.
The physiopathological effects of facilitation on local sympathetic pathways depend on the structures which are innerverted by those pathways; that is which viscera? which blood vessels? which glands?
The implications of an area, or areas, of the spine which is causing the various aspects of the nervous system to behave in an exaggerated manner is profound. Here is a major, perhaps the major, co-ordinating and organizing mechanism of the body, with responsibility for the defence and maintenance of life, behaving in an aberrant manner. Normally that part of the nervous system known as the sympathetic nervous system plays a vital role in organizing the adaptive and protective functions of the body. When there is sustained over-reaction on its part, damage to the organs involved, and disturbance of the entire body economy become likely. Whether or not disease results will also depend upon the total resources of the individual. Such factors as inherited tendencies, psychological balance, nutritional balance etc., all decide to some extent what physiological reserves the individual has. The facilitated segment and the havoc it causes may well be the decisive factor limiting the ability of the body to maintain itself in a disease-free state.
The work of men such as Professor Korr explains in scientific terms what the original precepts of osteopathy mean in practice. How structure and function inter-relate, how the musculo-skeletal system is capable of influencing the well-being of the body as a whole; and the implications of manipulative therapy in restoring normality. Manipulation is the means wherby areas of dysfunction are diagnosed, appraised and treated. Even when such treatment is aimed at relieving symptoms such as a backache or stiff neck, the result will be to normalize the physiological functions by reducing spinal dysfunction. Osteopathic manipulation is, therefore, best seen as a system rather than as a modality. It cannot be understood or assessed adequately outside of the context of the concepts of health and disease, from which it stems, as outlined in this chapter.
1. The Sympathetic Nervous system as Mediator Between Somatic and Supportive Structures. Lecture to Postgraduate Institute of Osteopathic Medicine 1970 (New York)
2. Essentials of Body Mechanics, Goldthwait, Brown, Swain and Kuhns. (J. B. Lippencott and Co.)
3. The Collected Papers of Irvin M. Korr. Published by The Academy of Applied Osteopathy 1979 (first published in the Journal of the American Osteopathic Association Vol. 54 1955)
4. Spinal Cord as Organizer of Disease Process. 1976 Year Book of the Academy of Applied Osteopathy.
5. A Model Mechanism for Spinal Segmental Facilitation by Professor Michael Patterson, 1976 Year Book of the Academy of Applied Osteopathy.
6. A Model Mechanism for Spinal Segmental Facilitation by Professor Michael Patterson, 1976 Year Book of the Academy of Applied Osteopathy.