Saturday, April 28, 2007

Structural, Visceral, Cranio-sacral Osteopathy ?

You can find a french translation of this article Here.

It is a sensitive thing to divide Osteopathy in different systems as any of these systems are inter-related. Some Osteopaths will even say that no such thing exist as "Structural Osteopathy", "Visceral Osteopathy" or "Cranial Osteopathy". I never really understood why. Maybe because from this notion comes the notion of "Cranial, Structural or Visceral" Osteopath and this can't be, because an Osteopath is not supposed to be specialised but to be holistic.

I do believe that we are all coming from different background and graduated from different schools which may differ from there lectures' content. Therefore we all practice differently and may have more affinities for one technique or another, for one field or another... Some Osteopaths may get a Master from the OCC, UK (Osteopathic Children Clinic) and I will certainly describe them as more "specialist" than I am in treating babies and children.
At the same time if I meet an Osteopath describing himself as a Cranial Osteopath, I would immediatly feel irritated/intrigued.

In the UK a great majority of osteopaths (from what I believe) are more focussed on the "structural and cranial field". In France maybe more on the "visceral and cranial field".

"Structural Osteopathy" :
is aiming at restoring movement through the Musculo-skeletal system (joints, muscles, fasciae, ligaments, capsules ...) by a combination of techniques. It may involve some "HVT/LVT" of the spine (the famous "cracking techniques"), articulation of joints, deep massage, trigger point inhibition, stretch, fascial unwinding...

"Visceral Osteopathy" :
is aiming at restoring the mobility and motility through the different organs of your body. This may sound strange but an organ can easily be the cause of a lowback, neck, shoulder (...) pain. It will do so by changing the posture of the patient (adoption of an antalgic posture) or by directly referring pain to an area of the body (liver/right shoulder, kidney/lowback pain...). The Osteopath will then mobilise, stretch, inhibit, unwind(...) the concerned group of organs. I do believe that at least 60% of the patients ' complaints do have a deep visceral cause. This means that if left untreated their symptoms are more than likely to reoccur.

"Cranial Osteopathy" :
is aiming at restoring the mobility and rythm through the bones of the cranium, spine and sacrum. This cranial rythm pulses between 10 to 12 cycles per minute and is believed to be the core mechanism of all the body functions. This is the approach of choice to treat babies (colic, reflux...), stress, anxiety, headaches(...). Cranial Osteopathy is still quite controversial even amongst osteopaths but is fast becoming a therapy in its own right.

Seeing, feeling, understanding and treating the body through these three fields make Osteopathy an effective holistic therapy.

Tuesday, April 10, 2007

What is Osteopathy ?

(You can find a french translation of this article here)

Osteopathy is a manual therapy which was developed at the end of the nineteenth century by Dr Andrew Taylor Still in the US. Dr Still based his discipline on 4 main principles :
- "Life is movement" : therefore any structures that are not moving in your body, are deteriorating or "dying".
- "The Structure governs the function" : and vice versa. If the structure of your body is affected so will be its function (a broken elbow results in a poor elbow motion for example). The opposite is also true : if you spend your life time lifting bricks, you will develope strong, fibrotic back muscles and probably degenerative discs and spondylosis in your lumbar vertebrae.
-"The rule of the artery is supreme" : blood flow is essential to our body and if any structures (muscles, joints, fasciae...) are stiff, rigid these will impair a good vascularisation which will lead to further deterioration.
-A.T. Still believed as well in the "self-healing mechanism of the human body", and that the Osteopath was not treating the patient, but was in fact sign-posting the patient's body towards a better way to "self-heal".

For an Osteopath, the aim of the treatment is to find the "restrictions" of your body and to mobilise them : "Find it, fix it and leave it alone".

"Restrictions" have many different names such as : "Osteopathic lesions", "Hypomobilities", "Somatic dysfunctions" (pseudo-medical term), "subluxations" (chiropractic term). They result from any micro/macro-traumas, environmental factors, diet, pathologies or simple adaptations.
The most important ones are called primary lesions and they will be responsible for a series of compensations called secondary lesions. Very often, the patients' complaints are secondary lesions. This is why a symptomatic approach is rarely effective on the long term ; because the primary lesion is still there and will recreate the same series of adaptations and therefore the same symptoms !
The Osteopath will tend to focus his treatment on finding and treating the primary lesion. By doing so, he's treating the cause of the symptom rather than the symptom itself.

OK, by re-reading myself it looks a bit confusing, let's give an example : A patient comes complaining of a low back pain, the case history reveals a fractured ankle 10 years ago. The patient had an Xray revealing some wear and tear at L5S1. He has been advised to have some physio (ultrasound, massage ...) on his back and to take some painkillers. Few month later the back pain is still pesistent with some gastritis (thanks to the NSAID). The Osteopath will test all the body and find some major restriction on his ankle. For 10 years the patient has been walking with a slight limp which developed an excessive compensation pattern through his pelvis and lumbar spine. As long as nothing is done to improve the mobility of his ankle no improvement can be expected for his back. His ankle restriction is his "Primary lesion", and the L5S1 joint the "Secondary lesion". The Osteopath will then mobilise his ankle as well as probably, knee, hip then low back and within few treatments we can expect a long term improvement.

Thursday, April 5, 2007

Another Osteopath in Malaysia

That's it ! Another Osteopath in Malaysia Kuala Lumpur ! It took me 9 months to get my work permit. The main problem being that I was only 26, one year short for the Ministry of Health guidelines.

Everything started in December 2005 when my girlfriend and I went to do some volunteer work in Thailand, Surin (thanks to Starfish ventures ). There I worked within the rehabilitation department of Surin Public Hospital, directed by Dr Noi, and Dr Lee. The language barrier was a real challenge. By the end I succeeded to communicate on a basic level with the patient ( lie on your back : "none niai", lie on your tummy : "none kwam ") but of course my tone and accent were rarely precise enough and often instead of saying : "sit down" ("nang") I was actually saying : "cinema". You can imagine that certain patients were a bit confused... Dr Noi and Dr Lee had a lot of patience with me and were helped me out when going through the case history of each patient.

Too often in Europe we practice osteopathy in a private practice having no or very little indirect communication with any doctors or specialists, and working there really allowed me to be in contact with physiotherapists, acupuncturists, radiologists, orthopaedists as well as seeing more "challenging patients' complaints"
Once Dr Noi told me : "you know here, in thailand, in public hospital we are paid really little, we do our job with passion , whereas in private hospital they do the job for money, do it quickly and by quantity..." I know that in France it is definively the opposite, but i found that this statement was true at least in their department.

So a few months later we went to renew our visa in Kuala Lumpur, Malaysia . I visited the KLCC and discovered a medical center. I came in looking like a typical tourist (shorts, converse, camera, sunglasses) and got my first interview !