Osteopathy-64 in Biarritz and Urrugne, France

Cranio-sacral motion and the ideomotor effect

2011-04-12T00:49:00.000-07:00

In a number of coutries, Osteopathy is becoming or close to be a healthcare profession. This should be considered an honor. But this rise to more responsability asks for a deeper introspection about what is based on belief from what is based on facts. This is especially true for the cranio-sacral concepts of Osteopathy.

Until recently, osteopaths were claiming that they could feel with their amazing palpation the movement of the Cerebro-spinal fluid that was pulsing in the cranium. Later on a few researches have shown that was impossible. Quick, hurry a new theory ! Electro-magnetic pulse? Venous pulse? Contractibility of the dura mater ? Quantum healing? The only research showing some effect of cranial therapy on a body's rythm was done in 2002 on 23 participants. It shows an effect a smoothening of the Traube-Hering-Mayer pulsations with a cranial approach. This is a bit weak to validate the existency of cranial motion. More than 5 researches were done to see if 2 osteopaths were feeling the same rythm on the same patient. None of them were conclusive! Whilst all the evidences seem to show that cranial motion is non-existent, nonetheless a lot of osteopaths still practice and believe in cranio-sacral therapy and its concept.

Osteopaths do feel a movement, Are you saying that thousands of osteopaths are having palpatory hallucinations ?

Yes and no...

Have you heard of the "Ideomotor Effect" or "Ideomotor movement"

Ideomotor Movement

Ideomotor movement are movements that we'll induce without realizing it, just by imagining consciously or incousciously the same movements. This effect is the explanation for radiaesthesia, the pendulum, and the ouija board. It might also well be the explanation of cranial osteopathy.

extract from wikipedia:

"Scientific tests by the English scientist Michael Faraday, the French chemist Michel Eugène Chevreul, and the American psychologists William James and Ray Hyman have demonstrated that many phenomena attributed to spiritual or paranormal forces, or to mysterious "energies," are actually due to ideomotor action. Furthermore, these tests demonstrate that "honest, intelligent people can unconsciously engage in muscular activity that is consistent with their expectations".[2] They also show that suggestions that can guide behavior can be given by subtle clues (Hyman 1977).

Some alternative medicine practitioners claim they can use the ideomotor effect to communicate with a patient's unconsciousness using a system of physical signals (such as finger movements) for the unconscious mind to indicate "yes", "no" or "I'm not ready to know that consciously"."

The pendulum example:

Before you use a pendulum, you have to calibrate it. You have to be in "resonance" with it. To do so, you have to ask yourself a few "yes" questions and notice in which direction the pendulum is turning (let's say clockwise). Try now with a "no answer" question and the pendulum should rotate in the other direction (anti-clockwise). The pendulum is now calibrated and you can ask any yes-no questions and check in which direction it is rotating.
This s due to the ideomotor effect. your subconscious mind is creating slight movement that are giving momentum to the pendulum and making it turn in one way or the other.

This effect feels real enough for thousands of people to believe in the extraordinary power of the pendulum, to check the gender of a futur baby, find your keys, find some water etc etc...

This is the same effect than the ouija borad used during a seance.

Would it be possible that the osteopath is also a victim of his proprioceptive sensations?

Can we accept the fact that radiesthesists could fool themselves but we as osteopaths, couldn't be fooled by our sensations when our job is essensialy based on proprioception ? Are we so full of ourselves that we can imagine not be tricked by our own feelings ?

Dear cranio-sacral practitioner, next time you are on a non-lesionnal sphenoid ask yourself this question: "can I feel a right side bending or is it possible to feel a right side bending?" and you will notice that strangely enough the sphenoid will follow a right side bending after a few seconds!

It is surely really unpleasant to think that for the last 80 years we believed in the existence of an non-existing phenomenon! a phenomenon that we induce ourselves !

Our teachers we right when they were telling us to put some intention in our techniques because with intention this movement and the ideo-motor effect are magnified!

Why do so many practitioner still believe in the cranial motion and in the IVM?

Imagine the cerebral effort that we need to put ourselves through to acknowledge the fact that our belief system (cranial motion) we had for years was wrong. It is as hard for a god believer to believe tha there is no god, or an American to believe that Socialism is not evil. This change of belief is possible but is intellectualy very costly.

Just Imagine how hard it is for the therapist to admit to his patients that what he was telling them for years was wrong... The patients should be pleased about the progress of their osteopath, but definitely others might have the feeling of having been fooled around for years.

Why does an osteopath want to believe in an inherent cranio-sacral motion ?

1. Osteopathy defies science: “This movement exists, we know it and we can feel it but science is unable to prove it. Science has limits and cannot prove everything.” This statement helps showing the superiority of Osteopathy against the "evil" scientific based medecine.

2. “This movement is so fine that only the skillful osteopath is able to feel it." This allows the osteopath to "show off" about his extraordinary palpation skills. Let's be serious, is the movement we feel really around a few micrometers ?

3. It allows to see the body with a vital energy (the osteopathic Qi)

Is all cranial osteopathy to be discarded ?

This doesn't mean that cranial osteopathy isn't effective, it just say that there is probably no inherent mobility of the cranial bones, and that the therapist himself is responsible for the movement that he is feeling. The cranial therapist is the source of the IVM (involuntary mechanism). This theory would just so easily explain why 2 osteopaths will feel 2 different rythms on the same patient.

In fact the movement felt by the practioner would be an interaction between the motion that he is inducing with the ideomotor movements and the reaction of the patients' cervical restrictions and fascial tensions.

This rythmic movement is really relaxing and a great number of patient is drifting away within minutes. This cranio-sacral approach rocks rythmically the cranium and the neck of the patient which is truly relaxing and can get rid of persisstent musculo-skelettal tension.

Let's try to explain what the practitioner feels during the treatment with an ideomotor movement perspective:

1. The therapist induces a rythmic Flexion/Extension on the cranium, but the neck of the patient is tense. This initiated movement is in conflict with the neck tensions. The practiotioner believes that there is no or a poor cranial movement.
2. After a few direct or indirect techniques some of the neck tensions disappear and slowly when the practitioner induces these F°/E° movement the head of the patient offers less resistance. The Cranial mobility seems greater.
3. After a few more minutes the head and neck of the patient is much more relaxed. The body of the patient understand what the osteopath wants to induce as a movement and start following it. The osteopath analysed a much better cranial movement freed of cranial tensions!

Conclusion:

Too few researches seem to prove that there is a cranial motion taking place.

We can say "absence of proof is not proof of abscence" But is there not a moment were we could be wrong? Do we have to wait another century of unsuccessful researches or the last 70 years are enough ?

Isn't it logical to say that this inherent movement doesn't seem to exist until proof of its existency ? And if one day it is proven to exist, we will still congratulate osteopathy to have discovered it !

Wouldn't it be more reasonable to say that if the practitioner feels a movement and that no researches proves the existence of such movement therefore there is a great chance that this movement is induced by the osteopath himself ? Ideomotor effect is a known fact for the explanation of similar deceptive feelings. Thousands of people have been deceived by the ideomotor effect wouldn't it be unreasonable to think that no osteopath could be as well deceived by this effect ?
This could also explain why certain osteopaths believe they can test allergies or intolerance by palpating the cranium of their patients. Themselves or the patient restrain the movement when testing this or that type of allergen.

Something interesting is that osteopaths who don't believe in cranial osteopathy and IVM are under intense criticism because they undermine the profession, but wouldn't it be the opposite that should be true?

Remember that saying that Cranial motion is created by the practitioner doesn't mean that cranial osteopathy is ineffective. he fact that the osteopath himself is the power of the motion doesn't change much about cranial osteopathy.

If we go along with this ideomotor theory then it can explains a lot of researches. Osteopathy will show to be mature enough to be able to introspect and criticise itself. We also remove from the hands of a lot of detractors the stick they are hiting us with. What a great step towards a healthcare profession.

A bit of fun for Christmas!

2010-12-22T08:13:00.000-08:00

The reggae osteopath

The risk of cervical manipulation and the birthday paradox

2010-12-08T01:15:00.001-08:00

I have removed this post because of faulty reasoning on my part

Placebo within osteopathy

2010-11-26T12:05:00.001-08:00

We will try to exert self-criticism and bring the light on the subject of placebo effect within osteopathic treatments.

This article might be disturbing because it seems to reveal an important number of psychological manipulations. But if you look closer, you will see that this phenomenon exists everywhere: at school, in religions, in your local supermarket, at your doctor and of course at your osteopath! We use these techniques without realizing it, but being aware of it, allows you osteopath to increase the effect of the treatment.

The Placebo within osteopathy

It should be remembered that the patient in addition to be in pain, is in a bad mood, he is stressed, anxious to be vulnerable, does not understand what happens to him and might worry whether he will be able to work or even if he will ever recover.

This mindset parasites his ability to be positive and to improve. It is this aspect of the pain that the placebo effect will find its field of action.

The placebo effect is a psychosomatic effect. Therefore all the tricks that will increase the positivity or decrease the negativity towards the osteopath, osteopathy, and the point of view of the patient towards his own pain will have a positive effect on the patient.

We will attempt to define the main axes of the placebo effect during an osteopathic consultation.

1. The feeling towards osteopathy

to be recommended to see a specific osteopath: the mindset of a patient to whom it is recommended to see a specific an osteopath is totally different than one who is looking for the first osteopath in the yellow pages. The first one will allow himself to wait several days for an appointment while the second will rush at the following number if the therapist is not available in the afternoon. Having followed the suggestion of his friend, the future patient is already conditioned to see a skilled osteopath and know that he will receive a good quality treatment.

to make an appointment: this is one of the most important steps that the patient will do. He decides to be in charge of himself by coming to see an osteopath. Take such a decision shows that the patient has a "spark of desire" to get better. Because he wants to be there, the patient will generally be pro-active during treatment. The most difficult patients to treat are often patients whose appointment were booked by a third party without their full consent. They do not let themselves go and are not accommodating. They don't want to be here. They wait for only one thing, the end of treatment to tell their friend that the osteopathic treatment didn't change anything.

the duration of treatment: the fact that treatment lasts at least 30 minutes allows the patient to be listened to, to be understood in their suffering. Just this fact allows the patients to unwind, to let go and to have time to empty their "bag".

the cost of the consultation: The cost of the product also affects its efficiency! Some people claim that generics are not as effective, it could be because they are cheaper and thus their placebo effect is less. We interpret this as: "Generics are cheaper because they are of poorer quality" instead of "original medicines were excessively expensive". Similarly, the fact that a patient must pay for osteopathic treatment also contributes to a part of the placebo effect. Firstly because it's quite expensive (40-60 £) and secondly in France we do not usually pay for our health. It is obvious that the patient does not want to spend 40£ for nothing, so he will be into a state of mind "I want to get better." Moreover he will respect the treatment and will avoid the next few days to do anything "silly" that could "spoil" the treatment.

to get undressed: to see the patient in his underwear is important clinically but also it has another advantage. The fact that the patient undresses makes him more suggestible. If a patient tries to establish a relationship such as "parent-child" with the osteopath, then it is very important for successful treatment for this patient not to keep his trousers for example. The fact that he is in his underwear rebalance that relationship to "adult-adult". However, if a patient is shy and force your hand into a relation "child-parent", then after the observation/examination provide a cover, or allow them to keep their trousers, they will feel more at ease and this will certainly improve the response to the osteopathic treatment.

the principles of osteopathy: principles of osteopathy are simple and "speak" to the patient. They make sense. The patient can identify their problem as a matter of body mecanic. They self-suggest that osteopathy is the therapy that can help them.

2. The osteopath

the practice: is the practice inviting? nice, clear, clean? or is it dark, obscure and looks like a summoning place for dark magic ?

age: age is one factor that may work against the osteopath if he is young and be part of the factors "nocebo". If the osteopath is young and even competent, there's a good chance that the patient, even if he is getting better, will consider that an older ("more experienced") osteopath would have done better.Therefore e wil not be completely satisfied with the treatment.

gender: the gender of the osteopath has an important influence on the treatment. Some women prefer to be treated by women, others by men and vice versa. The fact that the patient consults a male or female practitioner is rarely innocent. When a patient expect to be treated by a female or male practitioner and found out that it is the opposite, it can be problematic. Sometimes the unexpected happens, and this turns out to be benificial: this is called

Cognitive Dissonance: Cognitive dissonance is a psychological concept developed by Leon Festinger in 1957 in his book "The failure of a prophecy." "Cognitive dissonance is an uncomfortable feeling caused by holding conflicting ideas simultaneously. The theory of cognitive dissonance proposes that people have a motivational drive to reduce dissonance. They do this by changing their attitudes, beliefs, and actions.^[2] Dissonance is also reduced by justifying, blaming, and denying. It is one of the most influential and extensively studied theories in social psychology".(wikipedia). The personal experience the following could be an example: one day I replaced an osteopath at the last minute and he had not had time to warn all patients. One of them was a woman who was violently raped three years previously and obviously this dreadful event was not digested. "She Might Be a little bit upset" he warned me ... When she saw me, she was obviously on the edge of canceling the appointment (perhaps the difficulty of trusting another man, a stranger, and to tell again her traumatic story) but she still accepted the treatment. We mostly worked with cranial and fascial approaches. The following week I heared that she has not felt that well for the last 3 years. Fascial treatment's effect or effect of cognitive dissonance?

The white coat: The white coat is the dress code of the medical profession. It is a very effective barrier between the patient and the therapist. It constantly reminds the patient that he is dealing with a health practitioner. It is a very effective tool for young osteopath who need the help of a barrier. But such a barrier may also be a hindrance in the therapist-patient relationship.

Do you have the "gift"?: Tring to show to your patients that you possess the "gift" can be a dangerous game and might be off the limits of ethics but it is a very powerful tool. The patient can be amazed and this effect makes him even more suggestible."The Gift" brings together different "extra-ordinary" abilities (magnetism, clairvoyance, radiesthesia ...). Whether it exists or not is not here the debate. But it is easy to pretend to have such a gift. It is said that some osteopaths can from a cranial hold are able to identify an old ankle injury for example. This can be done without this "gift". Here's how an unscrupulous osteopath could proceed: the patient lies on his back, then the osteopath performs a quick testing of the ankle (it takes 10sec and goes unnoticed). The osteopath locates a restriction, and then places his hands on the skull. After 3 minutes he can claim: "Ooh dear, you have a blockage in your right ankle, an old sprain maybe?". The effect is guaranteed ...

"Cold reading":(read full facts book of cold reading Ian Rowland) is the ability to understand and "read" a person but also to make him believe we can read him/her. Using such techniques can help the therapist to subdue the patient. The patient is impressed by the "abilities" of the osteopath and this will make him more suggestible. Such techniques should be used carefully ... here are some examples:

when the patient describes his pain, he will often simultaneously touch the place that hurts. Without looking directly at the patient, the osteopath can see with his peripheral vision where the patient shows his pain. This information can be restored later to impress the patient, "it is the right knee that hurts you? I saw it at your gate"
Trying to make "hits" by asking negative questions: eg "you didn't have any headaches recently, did you?" the Osteopath is almost certain to make a "hit". If the patient answers yes then it is a "hit" and if he says no, he was not wrong!
the use of "Barnum statements": These statements are sentences that are true for 90% of patients but will perceive as being personal. For example: "You do have a lot of stress at the moment between work and the family, don't you?"

Comparison with previous therapists: At the end of treatment it is legitimate to wonder whether if previous treatments that the patient had with other practitioners were similar to the treatment you just provided. This maneuver has two objectives: the first one is to get an idea of the approach of your colleagues and the second is to impregnate the patient with the quality of treatment that he just received.

3. Complex psychological pain patient

the vocabulary used has an influence: in the book "predictably irrational" the author talks about an experiment conducted to evaluate the influence of words on our mood. The experiment was conducted on two groups of people, who were asked to read and memorize a lists of words. In the first group, the words were related to slow, rest, calm... In the second group, the words were synonymous of speed, stress, excitement. At the end of their memory exercise, an experimenter was discreetly timing how long it took them to travel along the corridor to the elevator. You guessed it, people in the first group took longer than the second group to reach the elevator. let' go back to a session of osteopathy: our patient is stressed, tense, on edge, it is clear that a semantic related to nervousness is to be avoided, choose a language rather quiet, sedating and a calming vocabulary.

2. subjective pain: (...). The techniques of trigger points are as effective tools to help the patient perspective the degree of pain he feels normal. These techniques mimic the pain experienced

Subjectivity and suggestibility of an improvement: this part of the treatment takes place at the end of treatment or early treatment.

At the end of treatment: "Helping" the patient to feel changes in his/her body at the end of treatment is very important because it obliges the patient to recognize some efficacy of the treatment he has just received, this opens a door in accepting that some changes just happen and that it can get better in the future. Some patients, less suggestible, take care not to express their feelings.
At the start of second treatment: This moment is critical because the patient is not really sure what's better or not. Reevaluate the various movements or habits that were painful can give an idea of the improvement. Then ask him a percentage of improvement in order to show him the side of the "half full glass". The patient who tells you that there was no change (which is different from any temporary improvement) doesn't want to acknowledge the truth, or pays too little attention to his own body.

Body language: be aware of body language and know how to read it. It shows whether the patient is receptive or not and helps to see if an action we do is perceived positively by the patient or not. Once upont the time an expert on body language began a conference in the U.S. by criticizing American mores. After a few minutes he stopped and asked his audience to stay in their body postures and to observe each other. The vast majority had their arms crossed! Crossing your arms or legs are often signs of reserve, or disagreeing. If your patient is lying on the table and hold such a posture, it is likely that it can influence negatively on their responsiveness to the osteopathic treatment. Ask them to "uncross" their legs or arms. It is important for the practitioner to "break" any body language which is in conflict with the treatment.

The suggestion: the treatment can be assimilated to an induction of hypnosis. The patient is in an unusual position (lying naked in the hands of a therapist) and has run through a series of commands (get undressed, lie down, raise your leg, lie on the side ...). This makes him each time more and more suggestible at each one of your demands/commands. An experience told in "Petit traité de manipulation à l'usage des honnêtes gens" was the following: a group of students was asked to address passers for a little bit money. The result was not encouraging. Subsequently the experiment was repeated by asking them to first, ask the time and then ask for some money. They then increased massively their earnings! Acquiescence to the first suggestion makes the patient more conciliatory to the second suggestion ... During treatment it is not uncommon to repeat about 50 times, "you release, relax, let go ...." These suggestions are effective and temporarily break the state of tension and stress of the patient.

Anchors: Suggestions are often used with anchors. It's actually a Pavlovian reflex. It combines a suggestion with a visual stimulation, touch, smell ... For example you can lightly tap the shoulder of the patient when you ask him to perform movements: like this it combines the "tapping" to respond to a command . Then involve the "tapping" to the command "relax, let go ...." Subsequently You will just have to tap the body part that you want the patient to relax. This is very effective and helps to avoid repeating the same suggestions over and over. Another powerful anchor is the power of smell. Use a cream with a pleasant smell during your treatment. The patient will associate this odor with the feeling of relaxation and being looked after. The products with camphor are a good example.

correlations between feeling better and the osteopathic treatment: it is interesting to see how we are victims of our desire to find links between causes and effects between events that surround us. If a patient gets better after a treatment, even if it takes a week, provided that the osteopath said: "it will take several days to get better", then the patient will necessarily associate the fact that he is feeling better with the osteopathic treatment. Hasty conclusion ...

Giving exercices and recommandations: Giving exercises or recommending to place ice pack on the pain can extend the influence of treatment. The patient is following the suggestions of his osteopath (which are effective or not), he is conditioned to be in charge of himself and to have a positive attitude. These are also firewall in case the patient does not improve: the osteopath may ask: "If you did put some ice as I recommended it, your side effects would have been much less important. " The side effects or unresolved problems are not because of the osteopath but because of the patient.

Nutrition Recommendations: it works on the same principle as the previous examples.

Warning: Forgetting to warn patients of side effects they might experience is a major mistake. Because knowing that they could have side effects reassure them. If side effects are felt, then the osteopath was right. He really knows his job...

Conclusion

If therapy only works in the field of suggestion such as hypnosis or NLP, which is the field of the placebo effect, can call them placebo therapies? of course not, because their field of expertise is suggestion.

If we consider osteopathy as a therapeutic approach strictly manual and mechanical that only treats musculoskeletal dysfonction then in this case, the placebo has a huge role in therapeutic efficacy.

But if the definition of osteopathy is considered as a holistic therapy that comprises a comprehensive care of the patient, in this case osteopathy has no placebo effect since it has expanded its fields of action with that of field of suggestion!

The more a therapist is aware of psychological variables which can influence positively the patient the less the placebo effect is important in treatment.

Power Balance, Placebo Power

2010-09-13T01:29:00.000-07:00

Have you heard about the Power Balance Bracelet?

We tried it for you:

Well unless you still believe in Fairies, smurfs and super heroes I would not recommend it.

Take Care

English speaking osteopath in Biarritz and Urrugne, France

2010-04-20T23:16:00.000-07:00

Welcome to this blog!
This blog is dedicated to English speakers who are interested in Osteopathy.
Feel free to browse this website

If you happen to travel or live in the south west of France (Biarritz, St Jean de Luz/Urrugne) and you need an osteopath do not hesitate to contact me.

Take care,

Pierre

An osteopathic perspective of your office

2008-11-14T01:39:00.000-08:00

(You can find a french translation of this article Here)
I really wonder if I should write this post. In fact if you read this post you can be pretty sure that you will save hundreds of pounds in physiotherapy, chiropractic or osteopathy...

The aim is to give you a few advices to properly sit in front of your computer. Each time I read something about it, I have never been satisfied with the given answers.

Many of our patients work sitting in front of a computer. Because of poor advices, awareness, and common sense the worker quickly develop the "mouse syndrome" (I first heard this term from D. McGinn one of my teacher). In fact working behind a screen more than 8 hrs a day is become a new form of slavery. The office furniture quickly become a huge money making industry to promote ergonomic chairs, ergonomic tables, ergonomic keyboards, ergonomic mouse, erg... OK I think you understand. Well in fact for the advice I will give you, you will need: a decent size table, a decent chair (adjustable height), and a "grandma" cushion (not too small not too thick 40cm*25cm).

The Mouse Syndrome:

No it is not a state in which the patient develop a long tail, some fur and an increase appetite for cheese. The mouse syndrome is a series of signs and symptom that a typical office worker tends to develop.

-neck pain

-upper back pain

-shoulder pain

-headaches

-Thoracic outlet syndrome

-carpal tunnel syndrome

-Stress...

Analysis of the typical posture in an office:

Too often the employee slouch in his chair which because of its price is generally quite comfortable, but in fact wrongly comfortable. When you slough you:

-decrease your lumbar lordosis (decrease extension of low back) which feels good because you stretch some muscles but in fact you over stretch for 8 hrs a day your ligaments , capsules and discs of your low back.

-increase of thoracic kyphosis (flexion of mid back). This leads to a poor relaxed posture which compromise greatly the function of your diaphragm. In fact your diaphragm cannot contract properly because it sits on your abdominal organs. This obliges you to breathe with your upper chest and use breathing accessories muscles: scalenes, SCM and some intercostals muscles. The scalenes are muscles which are attached from the neck to the first ribs. Their contractions induce some tension in the neck and elevates the first rib: A fantastic cocktail for neck, shoulder and TOS !

-Increase of the neck extension, as the patient might have a bit of wear and tear in his neck this neck extension is precipitating some neck pain and headaches.

-Only the wrists or first third of the forearm is resting on the desk. By doing so you need to carry the weight of your arms and forearms. And which muscles do so ? your trapezius and levator scapulae muscle! Well known muscles for their tendency to give neck and shoulder pain !

-Tendency to use the mouse moving all the arm and shoulder. The shoulder is not made to do some precise movements but wide ones. if you try to do precise movement with your shoulder you need to contract all the muscles of the shoulder! Mouse Syndrome.

Analysis of a better posture at work:

So what is this secret posture ? well the secret of the pain free posture is... is... Arghhhh...

Only joking !

-Sit right back on your chair, not your back but your buttocks. Now lean forward and insert the grandma cushion down your low back. Now straighten up. How do you feel? if you have the good size cushion you should feel being straight without any effort. The cushion should be situated at the upper part of your low back, if this make sense. Don't try to force your shoulders to touch the back of the chair. Just sit straight.

-Now come closer to your desk, a bit more, a bit more. Be close enough from the desk to have 2 inches between your stomach and the desk.

-Your feet should be flat on the flour with a nice 90deg angle at your knees. Add a foot rest if your legs are too short.

-Now rest your two forearms on the desk, your keyboard should be at least 25 to 30 cm away from the edge of the desk. Adjust the height of your chair to feel your shoulder relaxed and your arms/forearms resting comfortably on the desk. You should be pretty comfortable in this posture and should feel your shoulder much more relax than earlier. In fact you don't carry the weight of your arms anymore, but the desk does it for you !

-The mouse is situated at the same level than your keyboard. Have your mouse sensitive enough so that you can run through the screen only using your wrist.

-The screen should be standing at least 45cm away from the edge of the desk. I would recommend a 17 or 19 inches flat screen.

Fantastic ! you now know the secret not to come back to see us that often!

Another recommendation would be to adopt a more abdominal breathing.

Try to breathe in for 3 sec and out for 3 sec, between the two hold your breath for 1 to 2 sec.

Each time you breathe in avoid to breathe with your chest but pushing out your abdomen. When you breathe out pull in your stomach and contract your abdominal muscles and pelvic muscles firmly, and when you breathe in just relax them. Doing this will promote a good breathing, a better digestion, a firmer abdo belt, decrease your stress and being more focus on your work !

Take Care,

Total Trans-generational Osteopathic Lesion

2008-09-08T11:24:00.000-07:00

In this post, we will try to see how our mind & body can be influenced from what we inherit from our family or relationships and how our body and mind could influence our family and relationships.

Again, I have to warn you that we will be doing a bit of "Osteopathic philosophy", most of the examples below are illustrative. I hope that you will not read these lines too severely and that you will enjoy your lecture as much as I enjoyed writing it.

I tried to classified these different interactions:

-Structure and Function our inherited DNA
-Our inherited family culture & diet

-Our inherited psychology and somatisation

Structure and Function, our inherited DNA:

In traditional chinese medecine they use the notion of Qi (chi). The Qi is the energy that animate you. A part of it is acquired by eating properly, doing sport, breathing properly (healthy lifestyle) and a part of it is innate or pre-natal, and this is the "Yuan Qi". This pre-natal Qi is given from the Qi of our parents: we can follow the same process, a part of it is aquired, and the other is issued from their respective Yuan Qi.

If we try to compare this chinese notion to our western point of view, it seems that our Qi at birth (mostly Yuan Qi) is the DNA that we inherit from our parents. This DNA relatively determines what we will become. From birth we are not equal physically, physiologically and neurologically and this thanks to our parents. If both of your parents are tall, there is a good chance that you'll be tall. if both of your parents are small, there is a pretty good chance that you will be small. Now if both of your parents have a "weak" heart, unfortunately there is a good chance that yours will be too. As our DNA predicts how our anatomy will develop, we can inherit from our parents, a big/small heart, big/small lungs, good/bad teeth(...). I remember a mother and her daughter who came to see me for some Osteopathic treatments, what amazed me was that both of them had the exact same left knee: both had an uncommonly excessive passive external rotation. Our DNA (partly) determines our anatomy and therefore our structure, we believe in Osteopathy that structure affects function, that means that our DNA package will partly influence our function and might lead us to certain weaknesses, functional or pathological problems.

Now something that I discovered recently (well not really discovered, i red it in a magazine of some sort) is that not all our DNA is used! in fact, certain part of it are expressed and others ignored. But what is really interesting is that the unexpressed parts of your DNA can express themselves under special circumstances, for example under a big stress or if you are facing a new environment.

One very interesting example is the one of the domestic pig. Some people may not like it but we are quite close genetically. A domestic pig has fine hair and a concave snout while a wild pig has thick coarse hair and a flat snout. The shape of his nose seems to be adapted for his alimentation. It has been noticed that a domestic pig if left in the Wild will see the shape of his snout changing and flatening. The crazy thing is that if you bring back this very same pig to a domestic life, his snout will change again and curves back to its initial state!

From a human point of view if we take 2 twins and that we place them in two different environments the expression of their DNA will be different. If one is sent in a rice field and the other one in Central London their morphology will adapt over time; one will develop strong low back muscles, and will probably suffer from osteoarthritis in his lumbar spine but will generally be very fit and strong physically while the other after spending years behind his computer will probably suffer from neck and shoulder pain and not being that fit physically. Their body morphology will be much different but their DNA the same. What changes is the expression of their DNA made to adapt their body to their need.

If we come back to the discussion about the Qi, this expression of the DNA could be part of this acquired Qi as well as a healthy lifestyle (which will affect the expression of your DNA).

Now, do we transmit this acquired Qi to our children at a pure DNA level ?

I don't know but I'd like to believe so.

In fact this would mean that the environment in which we evolve before having a child would facilitate the expression of the child's DNA for this specific environment from birth or even in-utero.

A bit lost ? So am I...

OK let's take an illustrative example:

hypothesis: is the environment in which our family evolve influence the expression of our DNA in-utero or at birth ? Will it influence our DNA selection over 3 to 4 generations?

Imagine that we have 4 pair of twins, 2 pairs of female and 2 pairs of male. their name are : F1, F2, and f1, f2. The name of the male twins are M1,M2 and m1, m2; now we match them with each other in order to obtain 2 groups of similar couples.

we obtain in the first group:

-couple 1:F1,M1 and couple 2: f1,m1

in the second group:

-couple 1: F2,M2 and couple 2 f2,m2

The first group will be sent in the country side and will have a rural type of life with some extra physical work while the second group is sent in town and lives an extremely urban life, no much sport, using cars to move around and a computer type of work.

In both cases the next generation of children are following the same type of lifestyle than their parents. Now these children are getting married to each other respecting their cast (children of (F1,M1) with the one of (f1,m1) and same thing in the second group).

Now at birth, having had 2 generations of parents being either in town or in the country side and having a very different type of life, are these children much different in terms of weight, strength, shape ? is the expression of their DNA more geared towards a physical lifestyle or cerebral one? are the children of the rural group more adaptable to a rural lifestyle than the children of the urban group?
I would like to believe so, but I am not sure about that. If anyone knows about this let me know, because this could mean that the function of our life could determine the DNA or its expression that we pass on !

Functions affects structure, which is another Osteopathic concept. It seems that there is something, some studies on diets have shown that if we have an "american style of diet" over 2 generation that it activates a "obesity gene" quite hard to get rid off giving a higher chance to our children to develop diabetes, HBP...We'll come back to this later. So far we have shown that the DNA will affect our anatomical development which in turn can favor us to suffer from such and such condition or problem, and there is a possibility that the lifestyle or "acquired Qi" of our parents influence on our DNA expression and possible structure, which in turn can also lead us to suffer from specific condition.

-Our inherited family culture and diet:

My mother once told me something that really surprised me:
"The other day I went to this restaurant where I ordered an andouillette (a kind of sausage made of porks' pieces which according to wikipedia and my girlfriend can have a taste of pork feces), each time I went to this restaurant with my parents they forced me to eating this, since then each time I go to this restaurant I was eating this plate, but I just realised that I don't like it at all!"

It impressed me because a lot of our comportment is automated and it is actually quite difficult to determine what is issue from our own choice (if any) and what is just a type of complicated pavlov reflex.
Here is just a quick series of illustrative examples:

-using the knife with the right hand

-having a cigarette with your coffee if you are a smoker

-yawning or caughing when someone else does

-have you notice that your mind anticipate automatic stairs? if the stairs are not working and you enter them, you seem to loose your balance forward and backward at the end of them.

-who do you sit next to in a bus, someone of the same sex or not?

-when you talk to a child or baby and are you having a baby talk? or when you meet someone for the first time is your voice of slightly higher tone?

-do you walk to work? do you always use the same pathways ?

-are you voting for the same political party than your parents?

-Are you following the same religion than your parents?

We constantly believe that we have a "free will" and our society relies on it, but sometimes I wonder if we really do have one...

Influence of the culture:

In Thailand for example, in the coutryside people tend to sit/squat. From the age of 10 months children imitates their parents and squat when they want to sit. For a westerner it is not necessarly easy to do so. First of all because we use chairs, but also anatomically it is not always possible. Exercise time! try to squat keeping you feet flat on the floor as low as you can. if you fall backward this means that you have either: tight calves, ankles or knee problems. What happens is that in Thailand the whole family will tend to sit that way and in their fifties there is a good chance that their knees will suffer from wear and tear. This sitting habit is deeply anchored in their culture and difficult to change (and why would we like to change it ?)

Muslims need to pray at least 4 times a day. During each prayer there is a succession of kneeling and flexion of the spine. One could argue that this ritual keeps them fit, but the repetitive full flexion of the knee and spine will change the structure of their body (function affects structure) and possibly make them more likely prone to suffer from specific "conditions".

Another example is the one of the toilets. Again in Asia and in under developped or developping countries you need to squat when you need to p**. In fact this position is really natural (not really practical), because when you squat you open your pelvic floor making it easy to pass motion. In"Europe" being a bit lazy and not being able to squat, we sit! Our pelvic floor is not fully relaxed/opened which means that we need to push a bit more to achieve our goal: great for hemorrhoids !

Influence of the Diet:

Diet could be one of the biggest and influential factor on our body function and DNA. It has been shown in the US that the typical Macdo diet modifies our DNA making our children more likely to develop obesity or diabetes for example. A "recent" research has shown that within 2 generation a healthy japonese family that emigrated to the USA started to develop these type of diseases when following a "junk food type" diet. The horrible thing is that being the diet of choice for "non-rich" people, your social status is directly liked with your health.

In Europe culturally, we tend to heavily rely on alcohol, coffee, milk, carbonated drinks: it is an affront to refuse such a drink, and you may be seen as antisocial. These drinks are perfect coktails for increasing stomach acidity which leads to some gastritis or ulcers. From a gross Osteopathic perspective, this means antalgic posture around the stomach/duodenum, decrease amplitude of the left hemi diaphragm, fixations of the ribs 5 to 8 on the left, elevated first ribs, shoulder, neck and upperback pain...

Talking about milk, have ever wonder what went through the mind of the first human who drunk some cow milk ??? Beurk !

Psychologically it has been demonstrated that children tend to imitate their parents: It means that if the parents demonstrate an interest in healthy food, sport, healthy lifestyle it is likely that the children will follow this way of life or at least be aware of it. But if the parents lives on junk food, they spoil all the chances to transmit to their children a healthy lifestyle, which in turns will fail to transmit it to their own kids. This unhealthy lifestyle will lead them to all sorts of complaints, symptoms and pathologies and as this way of life as been anchored since birth it is very hard to reprogram it.

Influence of our mind:

I am not a psychologist or a psychiatrist. The following examples are shorten/cut/exaggerated for us to understand it. I am sure that some of you, readers, will consider it as vulgarisation or maybe pub psychology. Fair enough, the aim is just to open a bit more our understanding to an often misregarded field.

In Osteopathy we tend to see and touch a lot of patients which gave us an interesting understanding and analysis of patients. There is often a link between the body and the mind of the patient. The director of a financial company will tend to have a rigid and stiff body, whilst someone who shows some flexibility and maleability at work will often have a flexible body. Look in the streets, some men will walk straight barely avoiding anyone, their are stiff in their postures, they are the big dominant bosses!;) Generally they are a "nightmare" to treat, meaning that they often present chronic condition (chronic low back) and as their body is stiff the full and long term recovery is often an illusion. Some big bosses can be less stiff or even relatively flexible, check on Utube Steve Jobs the Apple big boss, the way he moves clearly indicate a relative flexibility in his body and in his mind. But his job needs him to be creative, open to new technologies and concept; his mind need to be quite flexible.

The posture is also quite a good indicator of the type of person you are facing. Someone who is leaning forward tends to be ready for action, extraverted, outgoing constantly in motion, combative, assertive, dominant... The opposite is also often true, a lay back posture is quite often reflecting a lay back personnality, introvertion, shy, reserved, submissive, imaginative, scared... What happen is that these different type of posture will result in different and quite specific complains, for example: leaning always forward will make your back muscle work harder and you might develop some bilateral muscle stiffness of the low back while being lay back increase the extension of your lower vertebrae (L4-L5-S1) which will give more specific vertebral facets compression/pain. This is a very short example but the list is long, the body functions will be completely differently regarding the postures.

Now if we come back to their children, knowing that they tend to pick up these non-verbal communication expressions, they will themselves tend to imitate the posture of their parents which makes them prone to follow the same body functions and suffer from relatively the same type of pains and discomforts.

In a very interesting book that I read recently, the french title is "ces enfants malades de leurs parents" the literal translation would be " these children sick from their parents". In this book the authors talk about family secrets which are physical or emotional traumas that can happen to us and that we try to hide from our children. the first example is "anism". Anism is a condition in which when we need to defecate the anus contract instead of dilating. this leads to anal fissure, hemorrhoids, functional constipation and possibly low back pain. While anism can happen to anyone, it is predominant in children or adults that have been sexually abused in their childhood. More than 95% of abused children will suffer from anism. Be careful the opposite is not true. What is amazing it is that a mother who has been abused can unconsciously transfer this emotional trauma to her own children and themselves can develop this specific condition (and certainly other stress related conditions)!

Anniversary dates are also very important psychologically. I realised recently that christmas in my family was never not such a happy day: my grandmother once lost a child at christmas (family secret) and later on, my mother a husband. This example is unfortunately quite obvious, but if a patient lost his parents in a traggic accident at 12 for example, when his own children will turn 12 some changes may certainly occur in the psychological dynamic of this family.

Once a patient who consulted me was in her mid fifties and looked incredibly younger. She came to see me complaining of a low back pain that I related with her uterus. It happens that all her life she had a painful lower abdomen. She mentioned that she had her first periods quite late (at 16 or 17) and that she was a real Tom boy being young. In fact she had three older sisters and her parents desperately wanted a boy, but unfortunately she was a girl. One of her parent gave her a boy "nick name". Does the guilt of being a girl and betraying her parents could push her being a Tom boy? having her periods (female attributes) relatively late? having a symptomatic uterus (pain in her female parts)? I believe so and I actually read similar stories.

I wrote quite a lot about psychological factors, but how are they related to Osteopathy ? In fact many of our patients' complaints are "stress" related. Even if we can find a symptomatic tissue causing pain and some osteopathic findings predisposing and maintenaing this particular symptom, Stress is often there, increasing the sensibility of the body or somatised in the tissues. Being aware of different reasons that can affect a patient as a whole make us open our mind and allow us to grasp a bit more the concept hollistic therapy.

Influence of Reincarnation ?

The first time I heard about this concept was while reading a book from Dr J. Upledger an american Osteopath. He describe a diagnosis and treatment received from JP. Barral (well known french Osteopath). Barral could apparently feel that Upledger was suffering from a spasm of the left ureter (little duct which goes from the kidney to the bladder). The thermal diagnosis revealed that this pain was more than 100 years old ! The only incident that Upledger could recall was being "stabbed" in a previous lifeliving as a farmer. Souvenir that he accessed a while ago during a previous regression hypnotic session.

I have an immense respect for both of these practitioners but I am still a bit dubitative about that one !

Lately I came across a book about reincaration written by a "medium" Joan Grant and a medical Psychiatrist Dr Denys Kelsey. In this book Denys explained how he became a firm believer in reicarnation and how he could, using hypnosis, successfully regress a patient to a previous life in order to treat certain symptoms affecting the same patient in his actual life. A major trauma in a previous life could apparently influence our behaviour in our actual life. I am not THAT open minded for the moment, give me another few years...

Let us try to find reasons in our actual life for the moment.

Psychology of the Tissue

2008-01-05T18:24:00.000-08:00

Let me tell you two little stories as an introduction to this post :

The first one is, from what I remember, coming from a book written by Bernard Weber.
There is a farmer trying to push his donkey into a box and his son is observing them. The donkey doesn't really want to go into the box, infact it doesn't want to be forced into the box. The father pushes the donkey even harder, but the harder he pushes the harder the donkey resists from being pushed. The son starts laughing at the scene. After a while the father, frustrated and irritated by the obstinence of the "stupid" donkey and by the laughing of his son, shouts at him : "you do it if you think you can !"
The son approaches the donkey and pulls his tail. The effect is immediate, the donkey jumps forward into the box...

The second one was told to us (a group of students) from Mr Colum Gregory (Osteopath, teacher/Tutor at the ESO).
Mr Gregory was at that time a student practicing at the ESO teaching clinic under the supervision of a senior tutor clinic, Mr Gez Lamb.
Colum was in a room with a patient and was trying desesperately to "crack" her T9 (a thoracic vertebrae) but it was really restricted. Gez Lamb finally came in the room and told him to unwind T9 using one of the legs as a leverage... (dear reader, if you are not an osteopath please acknowledge that such a technique is as irrationnal as it is obscure for you to understand). Mr Gregory did so and after a few moment the patient started crying excessively. This is what we call a good somato-emotionnal release. Colum asked her what happened and she replied that she remembered a particular incident that had happened during her childhood when some boys attached her to a tree and were particularly nasty with her.
This T9 restriction couldn't be forced to shift with a HVT or a LVT technique, fascial unwinding was THE technique to use to release this restriction with this particular patient.

While we could have forced the donkey into the box by pushing it with a tractor or "cracked" this patient's vertebrae with the help of a professionnal wrestler, a different approach adapted to the patients particular needs seemed to have worked and done the trick.
We are constantly confronted in practice with multiple choices of techniques we can use on one patient and on one particular restriction.
On certain patients a structural adjustment will have fantastic results, while others will react by tensing up even more.
On certain patients deep tissue massage relaxes the contracted muscle whilst with others the muscle will contract even more.
On certain patients the cranial approach will have almost miraculous effects whilst others will take you for a quack.

Is it possible that for any patient's restriction there is one specific approach which will be the most effective with the less side-effects ?
Which one needs to be used ? GAT, GOT, HVT. LVT, Recoil, BLT, direct/indirect cranial approach, MET, PNF, A/P work, Unwinding, Strain/counter Strain, Trigger point inhibition, dry needles, Functionnal techniques...
Is there a reason why a patient may react better with a certain type of technique or approach ?

I believe there is one, and the reason could be explained due to the Psychology of the Tissue.

Psychology of the Tissue

What is a Tissue ?

I will employ this term to express living structures such as bones, ligaments, muscles, capsules, tendons, arteries, nerves, cells, fasciae...

If we want to talk about a "psychology of the tissue" we need to accept the fact that a tissue holds a memory. Memories of past experiences are an essential part of the psychology of an individual or a tissue.

Tissues have memory :

There are some debates about it. Some state that the memory resides exclusively in the brain and some others believe that the memory is also localised in the tissue itself at a cellular level. This memory is very important as it will influence the psychology and the comportement of the tissue. I would say that there are 3 major memory mechanisms, and certainly many more.

The somato-psychologic, the psycho-somatic and the somatic-somatic memory (please note that I use the term somatic in its broader sense including the visceral sphere).

The somato-psychologic memory:

When we hurt ourselves some afferent information coming from the injured area is sent to the brain. A part of this information analyses the type and quality of the pain felt while another part is sent to our limbic system where the brain will attach an emotion to this pain (in which circumstance this injury happened) and will compare it to previous similar injuries.

let's give some examples :

Let's take two similar injuries which happened to two different individuals :Imagine a soldier on a battlefield who whilst carrying and saving the life of one of his team mates, twisted his ankle. Now imagine another random person who whilst on stage live on TV, missed a step and twisted his ankle, and by this action, embarrassed himself in front of million of spectators. During a treament the practitioner will certainly notice this injury. Asking about the cause of this trauma will awaken a sense of pride and self-confidence to the ex-soldier whilst it will awaken a deep sense of shame to the other patient. The internal chemical secretion and the immediate reaction of these two patients will be totally different.
Imagine now a widower who just lost his wife. Every single one of his friends came to him and whilst putting their hand on his shoulder asked him : "How do you feel?" or "How are you?" This scene is repeated 100 times. It creates a deep anchor mixed with a pavlov reflex between the sensation of feeling the hand of a friend on his right shoulder, the sentence "how do you feel?" and the deep sadness. Six months later our widower starts recovering slowly. One of his friend innocently put his hand on his shoulder and asks him :"How are you?" Unconsciously, a voice will say : " I was feeling fine until you reminded me I lost my love 6 months ago by reactivating this anchor..." Internally the chemical reaction will lower his mood for the day.

It is interesting to note that this somatico-psycological link will have in return an influence on the soma.

The Psycho-somatic memory :

This is maybe one of the most well-known links. The effect on the body from this type of link is very important. It is often classified as "stress". Stresses influence our body function greatly , by playing with our cardio-vascular system, our respiratory system, digestive system, immunity system, mental health and will also influence the musculo-skelettal system.

In practice we mainly percieve it through the musculo-skelettal, digestive and respiratory system. From my experience constant repetitive stressful situations tends to manifest itself by a general increase of the muscle tone. It means that generally muscles are more tense than usual. A good victim and barometer of the stress level is the diaphragm; stress generally holds the diaphragm in expiration limiting the expansion of the thoracic cage. Other good indicators of the stress level are the stomach and duodenum as well as the upper back and neck muscles (trapezius, levator scapulae, SCM, scalenes...). The way I would explain it, is that when the diaphragm is held in expiration, the thoracic spine is forced in a kyphotic posture. This kyphotic posture induces the posterior muscle chain (thoracic erector spinae, trapezius...)to contract constantly in order to maintain a relative balance. The lack of diaphragmatic expansion forces the accessory muscles of the respiration to increase their tonus. These muscles are the SCM and the scalenes. Their contraction allows the breathing to take place in the upper chest by raising the upper ribs. Another interesting effect of the kyphotic posture is that the shoulders rolls inward thus compromising their biomechanic.

In short the main complains of a stressed person are upper back pain, neck pain, headache, shoulder pain and thoracic outlet syndroms. Stress increases stomach and duodenum acidity thus resulting in gastritis or ulceration. The fact that these organs suffer can make the patient adopt the above posture. I can't say if these organ are always the direct/indirect cause of this adaptative posture.

We lost the track here ... where were we ? yes, we were talking about the psycho-somatic memory. So, is there a memory in there ?

Of course there is ! when the patient is clearly stressed because of his job, his symptoms don't go away as soon as he leaves his office. After a whole life of perpetual stress, the patient can become really rigid and his muscles really fibrotic.

Another example could be if you were involved in a car accident. I can promess that the first time you will get back into a car you will realise that your whole body is more tense than usual.

In fact this psycho-somatic memory can be more specific. if you had suffered from a relatively serious injury or trauma, months after the incident you will over protect the affected area. This over protection is accomplished by facilitating the contraction of protective muscles. The muscular tone is increased from a constant neurological firing. After years of over-stimulation the muscles become fibrotic.

This is how powerful is this psycho-somatic memory/reflex.

The somato-somatic memory :

Can a tissue have a memory by itself without involving the brain ?

Some may disagree but I will say : " Yes, of course !"

The memory will not be the same type of memory stored within the brain, but the memory will be a structural/mechanical memory on a cellular level.

After a whiplash, a repetitive trauma, an injury the structure of a tissue will be affected and that is a form of memory. If you suffered from a broken radius in your childhood, 40 years later an Xray will reveal an extra calcification; this is a structural memory of a trauma. If you suffer from a complete tear of a ligament, the memory is there, the ligament is gone.

Infact mechanical/chemical changes will take place around an injury which in the long run may affect the local vascularisation, the tone of the muscles and ligaments. Generally a sensation of density can be felt by the practitioner over an old injury. Dr John Upledger calls it : "kyst of residual energy".

This is where the concept of tensegrity take its place.(i'll come back later to this point in another post)

So far we have seen that :

1. to a physical trauma is attached to an emotion and a memory of this trauma

2. a "memory" of a mental trauma or stress can affect the physical body

3. a "memory" of a previous trauma can make us overprotective of the injured area

4. a physical trauma will affect the structure and therefore the function of the affected area, this is a structural/functional "memory" of an injury.

From these we can deduct that each traumatised or injuried area will be unique because of the unique psychological/structural/functional "memory" associated with it.

As each traumatised or injured area is unique we can understand that they will behave and react differently to the same external stimulus. Two different injured/traumatised areas will react differently to the same type of technique (same stimulus). Each "osteopathic lesion" has its own psychology.

If you have been brave enough to read until this point, you deserve a tea break...

Different bodytype, different psychology

The notion of different body types is a concept. I will discuss the bodytypes described by Sheldon. Sheldon distinguished three main bodytypes coming fom the three types of embryological tissues known as endoblast, mesoblast and ectoblast. Each one of these groups is associated with specific physical and psychological attributes.

-the ectomorph : is roughly a predominance of the element of restraint, inhibition, and of desire of concealment. Cerebrotonic people shrink away from sociability as from too strong a light. They "repress" somatic and visceral expression, are hyperattentional, and sedulously avoid attracting attention to themselves. Their behaviour seems dominated by the inhibitory and attentional functions of the cerebrum, and their motivational hierarchy appears to define an antithesis to both the other extremes.

In fact the ectomorph is not a physically strong individual. To "survive" in the world he cannot rely on his physical body but on his intellect. The ectomorph type has a tendency to intellectual over-stimulation and introspection.

The ectomorph is tall, long, thin, introverted, inhibited, quiet, serious...

-the mesomorph : is roughly a predominance of muscular activity and of vigorous bodily assertiveness. The motivational organisation seems dominated by the soma. These people have vigour and push. The executive department of their internal economy is strongly invested in their somatic muscular system. Action and power define life's primary purpose.

The mesomorph relies on his physical body and he is a man of action. He tends to be competitive, dominating and power seeking. They enjoy physical team sport.

The mesomorph type is muscular with large bones and strong ligaments. He is assertive, risk taking, adventurous.

-the endomorph : in its extreme manifestation is characterised by a general relaxation, love of comfort, sociability, conviviability, gluttony for food, for people and for affection. the viscerotonic extreme are for people who 'suck hard at the breast of mother earth' and love physical proximity with others. The motivational organisation is dominated by the gut and by the function of anabolism. The personality seems to centre qround the viscera. The digestive tract is king and its welfare appears to define the primary purpose of life.

The endomorph relies more on his digestive system. Life is not only about hunting and thinking but is also about eating and enjoying it ! The endo is a "bon vivant" as we will say in french.

The endomorph type is a social, loving, friendly, lively person and has a tendency to put weight on.

Osteopathic approach of the bodytypes

The following idea is easier to expose with the ectomorph and mesomorph type. Tom Dummer was using the functional/structural terms: Structural for mesoblastic constitution and functional for ectoblastic and endoblastic constitution.

In Osteopathy structural type of techniques are really effective on mesomorph patients while ectomorphs tend to react better to the functional techniques. Of course sometimes a functional approach is better to be used with a restriction of a mesoblastic patient and vice-versa.

It means that HVT/LVT ("cracking") techniques, GAT (general articulation techniques), deep soft tissue work, General Oteopathic treatment are the techniques of choice with the mesomorph patients.Whereas ectomorph patients have a good response with indirect functional techniques, Balance ligament tension techniques, gentle innhibition, fascial techniques, cranio-sacral treatment...

It also means that ectomorphs react a bit too much to structural techniques while the mesos are wondering what you are trying to achieve by touching their head lightly!

We said in the previous chapter that different bodytypes had different psychological profiles; let's make a comparison between the techniques used and the psychological profiles of these two groups.

Mesomorph :

gross psychological profile: vigorous, aggressive, competitive, dominating

type of technique: GAT, HVT, LVT, deep STW.

Ectomorph :

gross psychological profile: (hyper)sensitive, intellectual, introspection, inhibited

type of technique: gentle inhibition, functional techniques, BLT, cranial, fascial unwinding...

I don't know if we read the same thing but it appears to me that there is a disturbing correlation between the psychological profile and the technique used. I would even say that the technique used for each profile is the best psychological way to communicate manually with the tissue of the patient. Structural approach imposes a certain state to the tissue whilst the functional one listens and discusses with the body of the patient.

Now let's take a typical mesomorph patient : a rugby player or a marine soldier. How would you convince them about something ? How will you convince them to win a game or to fullfill their mission ? Will you use a diplomatic or an authoritative speech ? that's right an authoritative one : you will give orders, you will shout at them and you will have to be more dominating than they are. The structural techniques are authoritative, strong, "aggressive", dominating...

What about a typical ectomorph patient : a chess player or a computer "geek". How would you convince them ? How will you convince them that they should change their tactiques or their programs ? Will you use an authoritative or a diplomatic speech ? Of course a diplomatic speech will be the best approach in order to convince them step by step of the need to change their point of view ! The functional techniques listens to the tissues, follows their logic and gently influences them.

We saw in a previous chapter that tissues had a "memory" and a "psychology". Wouldn't it be logical that our osteopathic techniques were psychological manual techniques ? In this case each technique will be a specific psychological manual tool to communicate with the traumatised tissue of the patient. It would mean that one technique would be more suitable than another according to the psychological profile of the injured tissue...

In the next chapter we will try to give a psychological definition to the most common osteopathic techniques.

Psychological explanation of osteopathic techniques (Chapter in construction)

This part is HIGHLY subjective and I invite anyone to comment on it

In Osteopathy we treat the hypomobilities, the restrictions. We said that a traumatised tissue (a somatic dysfunction) had a certain psychology. In fact a traumatised tissue is "stuck" in a certain behaviour pattern (a way of thinking) because of a previous stimulus (trauma).

For a easier understanding we will say that the tissue thinks "A" when it is traumatised (traumatised=osteopathic lesions). The aim of a successful treatment is to bring this traumatised tissue which thinks "A" to a balance relaxed and open state of mind where it will think "B".

Let's try to understand and analyse the most common type of techniques :

The Structural techniques:

HVT: these are the "cracking techniques". Manual description of the technique :With this type of techniques we impose a quick and "violent" stretch against the restriction of the somatic dysfunction in order to gap the joint. A "crack" sound is usually synonyme of a successful maneuver. Within a few minutes the joint has gain a significant gain in its range of movement. Psychological description of the technique : we give an order to the joint by imposing a point of view exactly opposite to his. You think "A" and I order you to think "B"and I impose you "B", no discussion.

GAT (general articulation technique): Manual description : there is a notion of repetition with this techniqne. The aim is to mobilise a restriction by going against it. generally the grip is relatively firm in order to focus a "six degree of liberty"type of movement on the specific area and you . The technique is progressive, a slight pain/discomfort can be felt. It allows to smoothen up the restriction thus improving the mobility of the joint, especially fibrotic joints. Psychological description : there is a notion of repetition and progression in this technique while being in safe hands (the firm grip). It looks to me as if there was a coach encouraging, stimulating, brain-washing and overcoming a negative thought "A" to bring it to a point of achievement "B".

The Recoil (from the Mechanical Link, Paul Chauffour) : this is quite interesting one . Manual description : after 300 to 400 tests the practitioner finds THE primary lesion of the body and exert a recoil (a kind of precise flick) against the barrier of the restriction, and and you quickly remove your fingers from any contact with the body. Psychological description : the effect of a recoil could be like, questioning in a few words the patient about a deep rooted psychological conflict that he is victim of, bringing this thought from the unconscious to the conscious. eg: "did you accept the death of your father ? " the fact that your hands are not in contact anymore means that you don't want to listen to the reply, letting the patient to deal on his own with this issue. if the tissue thinks "A" the recoil could tell it : What about "B" ?

The functional techniques :

Indirect cranial/fascial and Balance ligament techniques : Manual description : the aim and philosophy of these techniques is to move toward the lesion in order to arrive at the still point. The still point is a point of relative calm (the eye of the tornado) where tensions are balanced. It induces a lack of proprioception coming from this area, the body react by changing the muscle tone or tensions in order to regain some afferent informations. The aim is to move from still point to still point until a balanced fluidic movement is felt. Psychological description: In these type of techniques the aim is certainly not to go against the will of the thought but to encourage it. The tissue thinks "A" ok, show me the idea, the concept, why are you like this ? why do you think "A"? why ? why again ? I don' judge you, i am not against you, I want you to show me why you think "A", what does it involve. Sometimes we don't really believe in it but we follow an idea (A) just to be in confrontations with others. The fact that others try to confrontate us on this idea make us react even more. this is the exemple of the donkey at the beginning of the post, the Donkey doesn't mind to get into the box, it doesn't want to be forced into ! or we could give another example : you need to leave and ask your child to come but he refuses to let go of his toy. Either you force him to let go of his toy and to come (big tantrum) otherwise you can say ok you want to stay here ? stay here but me, I am leaving. By leaving the child to what he thinks he wants, you avoid the confrontation, the child realises that he was looking for a confrontation not really being alone. As he sees you leaving, he quickly realises that he needs to follow you.

Another way to see it : if some one has a short sighted point of view on a particular subject, "A". Instead of contradicting it, you ask the reason why. Try to get to the bottom of his "A" point of view. There is a moment where the root of the idea "A" has no logical value. As soon as you will get to this unlogical root of the problem, the patient will logically analyse that it is unlogical. This realisation will start unwinding the whole misconception about this "A" idea leading the tissue toward a more balance "B" way of thinking.

Functional technique: Manual description : Our starting position is "in" the restriction and the aim of a well executed technique is to arrive to the opposite position of the joint without avoiding any conflict with the restriction of the lesion : "follow the ease, avoid the bind". Psychological description : the tissue thinks "A" and by using a step by step agreement we bring the point of view of the tissue to "B".

MET (isometric): manual description : we find the motion barrier of a muscle or a joint and ask the patient to push against our resistance with 30 % of his force. After maintaining the isometric resistance for 5-7 secondes, we ask the patient to relax. After 2-3 seconds we stretch the muscle/joint until the next motion barrier. This process is generally effectuated 3-4 times. Psychological description : This technique feels like you ask the traumatised tissue to express its "A" thought while you remain still. After the "A" thought is expressed then you conter-attack with a gentle opposite "B" view (stretch). The fact that your resistance remains still may express that you don't accept the "A" argumentation given by the tissue.

The concentric MET could express encouragement to the tissue we want to strengthen. The Eccentric MET could challenge the tissue we want to work on.

Fascial unwinding : Manual description : the practitioner contacts the tissue to unwind. It can be a fascia, a muscle, a joint, a limb or even the whole body ! The aim is give a positive feedback to the proprioception to the tissue to unwind allowing it to express itself. The patient may have the sensation that the practitioner is moving his arm (for eg) while in fact the practitioner just follow the movement that the arm of the patient wants to express. The fascial unwinding may look like a "Neurologic Symphony" as the movement described are very smooth and intriguing. You can adapt this technique to the whole body and relive a certain traumatic event such as a fall in the stairs, a repetitive fascial trauma (repetitive hammering for eg) or even re-live your birth! Psychological description : it is a sort of encouragement to the expression of a trauma by "mirroring" the information received.

The explanations that I give are purely coming from my own interpretation. If you disagree or have another "psychological explanation", I'll be happy if you could comment on this post.

Conclusion

As two different osteopathic lesions have a different cause and a different memory, the chance that they react the same to the same technique is inexistent. This can explain why a mesomorph may react better with a functionnal technique on certain of his somatic dysfunctions and visa versa with an ectomorph.

It is possible that there is more than a single psychological blockage with a traumatized tissue. This could be the reason why sometimes you need to use different techniques to relax a tension, eg : deep STW, functional inhibition and HVT.

It could explain why such studies to check if spinal manipulations are effective in acute lowback pain are failing. Maybe that some of the acute facet lock shouldn't be manipulated because it is not the "psychological" way to convince them to relax ! (Of course other reasons may certainly interact with the study : please report to the post "lower back pain, an osteopathic perspective")

It could also explain the example that I give at the beginning of the post. This patient reacted so much with a fascial unwinding technique because it was the technique needed to express this tension.

It is, I think, very hard to know which exact technique to use on which patient, and this comes from a practitioners experience, skill and an open mind; this is the art of Osteopathy. If the somatic dysfunction doesn't release with a technique , I urge you not to persist but maybe to communicate with it in a different way.

From my belief a very good Osteopath should succeed to detect and understand the causes of the patient's complaint and at the same time he should know which technique needs to be used to get the best release from this particular restriction.

Man versus Machine

2007-11-16T21:17:00.000-08:00

I have been asked a few times : "How come your treatment can be effective if you don't use any machines ?".

How fantastic are these machines ! They make some noises, vibrate, send some electric shocks, alter your magnetic field and boost your cellular regeneration ! They are widely use by physiotherapists and other physical therapists.

You may know these machines by the name of TENS, Ultrasound, Sonic wave..

The US and TENS are not really effective

Human kind loves these types of gadgets and tends to rely blindly on it, while their effectiveness is in fact relatively approximative.

TENS (Transcutaneous Electric Nerve Stimulation) does not seem to do much better than a placebo (http://intl.elsevierhealth.com/e-books/pdf/135.pdf)

UltraSound does not do any better, it has been used for more than 35 years in the treatment of musculo-skeletal pain and studies clearly shows that it is not more effective than a placebo treatment (http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=11444997&dopt=AbstractPlus&holding=f1000%2Cf1000m%2Cisrctn).

The machine : a good excuse

These machines are an answer to the inhability of the conventionnal medical field to deal with the dysfunctions of the body classified as musculo-skeletal problems.

The therapist uses the machine as an "excuse" for not being able to help the patient :

"I use the best machine for your pain and yet you do not get better... You really suffer from a chronic problem !"

It sounds much better than saying :

"I can't help you, I don't know what is going on, and my therapeutic competency is really questionable as you are not getting any better".

The machine is used symptomatically

If these machines really help to relax a muscle or an organ, their lack of effectiveness on treatment could rely on the fact that their are not used at the right place ! As we have seen in the previous posts treating the symptom is rarely effective compared to treating the cause. If the patient complains of a chronic knee pain caused by an old ankle injury it might be more interesting and effective to use the US on the ankle rather than on the knee for example.

The machine will always be obsolete, the hand will never be

In 10 years time the most modern machine will look like a prehistoric equipment, and 10 years later it will be the same for the latest model.

The human hand has been used for thousands of years and is still not obsolete ! Far from it ! More and more people seek massages, and other manual therapies.

The Human Hand has fantastic abilities

The hand is able to massage, to drain, to push, to pull, to vibrate, to twist, to be firm, to be soft, to warm up, to cool down, to feel and to adapt to the patient' s body response.

The hand is the part of the body which is the most represented in the cortex (in the brain) this means that it is one of the most sensitive and precise part of your body. It can detect variation of temperature as little as 0.1 Cdeg.

J.P. Barral (One of the most talented Osteopath) says : "The hand is at the Osteopath what the nose is at the Oenologue". It is recognised that wine testers can differenciate and recognise different vignards and different years of production. The Osteopath with a bit of experience can easily pick up old injuries and with more experience can even date them.

The Hand cares the Machine does not

Physical contact is very important. I do believe that during the treatment an Osteopathic hand talks to the patient's body. A treatment is a real physical communication between the patient and the practitioner.

Does the hand of a serial killer around your neck will feel the same than the hand of your lover ? Certainly not ! The "ruffness", stiffness, heavyness, "speedness", clumsyness (actually if it is a real serial killer he may not be that clumsy), coldness(...) will clearly give you a different feeling.

The hand of the practitioner cares about you but the machine does not.

The human hand is definitely winning this contest, no appeal !

Frozen Shoulder or Adhesive Capsulitis

2007-11-12T06:30:00.000-08:00

This is a very annoying, painful, and debilitating long term condition.

The Shoulder is made of 4 joints : the gleno-humeral joint, the acromio-clavicular joint, the sterno-clavicular joint and the scapulo-thoracic "joint".

Adhesive capsulitis or "frozen shoulder" is a retraction and stiffening of the capsule of the gleno-humeral joint. This retraction limits anatomically the range of movement of the G/H joint and therefore limits the shoulder itself.
While all movement are severely impaired, the most limited ones are the abduction, the internal rotation and flexion.

It affects predominently women at the menauposal age. People with diabetes, stroke, lung disease, rheumathoid athritis and heart disease, are at risk. History of a fall or a physical/emotionnal trauma in the previous year is not unusual.

The good news is :

-the recovery is generally good, you should be able to recover more than 90 % of the range of movement.
-it is very unlikely to develop twice on the same shoulder
-women are more often affected than men (good news for us ;))

What is the evolution of the condition and how long does it last ?

There are three stages in this condition :

the first stage is called the freezing stage :

This stage last from 6 weeks to 9 months. Insidiously the shoulder becomes stiffer and the range of movement is more limited. The patient may feel some pain at night and with any movement involving the affected shoulder. Some discomfort may arise all around the shoulder (neck, upper back, and down the arm) as the three other shoulder joints try to compensate for the lack of movement and pain from the "freezing" joint.

the second stage is the frozen stage :

The shoulder is now stiff and the range of movement is limited but does not get any worse . During the first part of this stage the shoulder is still quite painful. Slowly the pain decreases unless extreme range of movements are reached but the stiffness remains. This stage lasts for a period between 6 weeks to nine months. At that point muscle pain and tension are clearly felt all around the neck and shoulder area due to compensation/adaptation.

the third stage is the defreezing stage :

At last the shoulder is slowly becoming more mobile. By the end of this stage you should recover at least 90% of the range of movement with adequate physical therapy. This stage lasts for 5 to 26 months.

What are the common conventionnal treatments ?

-Cortico-steroid injections are applied locally. The aim is to reduce the inflammation but after a temporary relief the pain comes back and the movement is still restricted.

-Use of anti-inflammatories, parcetamol, muscle relaxant. This does not improve the mobility of the shoulder it merely masks the symptoms and long term use is not advisable.

-Manipulation under aenesthetic : the aim is to stretch and force the shoulder to move while asleep. As your shoulder is generally excruciating as soon as you arrive at the limit of the movement I do not dare to imagine how traumatising it is for the tissue and the surrounding structure. Risk of tearing the capsule exists, which enhances the presence of scar tissue and therefore limits the movement of the shoulder even more in the long run.

The outcome is uncertain, if you choose to have it done you need to be regular and disciplined with the following up physiotherapy treatments

-Physiotherapy : the physio will give you different exercises, may mobilise the shoulder and use various "machines" on the shoulder (TENS, sonic wave, electro-stimuation... welcome to the 21st century !)

What can I expect from osteopathic treatment?

As each Osteopath is different and they practice differently, I will describe the way I approach and "treat" frozen shoulder.

In general I believe that pain should be avoided at all cost !

Because as soon as the pain is experienced all the muscles protecting the shoulder will tense up and this will definitely not help the patient to relax and recover some mobility.

While the treament approach of the shoulder itself will depend on what stage the patient is at, the aim is first of all to treat and realign the rest of the body : rebalancing the pelvis, improving the mobility of the spine and treating any dysfunctional organs. The organs will have a great influence on the mobility of the ribs and diaphragm as well as on the posture of the patient. The biomechanic of the shoulder being greatly influence by the thorax it would be foolish to hope a good recovery without treating this part of the body.

The osteopathic approach of the shoulder itself :

Beginning of the first stage :

At the beginning of the first stage the restriction is relatively minor and the pain bearable. It is often misdiagnosed as a rotator cuff syndrom or as osteoarthritis of the acromio-clavicular joint.

I do believe that mobilisation of the glenohumeral joint at that point is benificial as long as it is not too painful. It is important to quickly restore a maximum of mobility through the other joints of the shoulder.

The complex first rib and clavicle is vital as the brachial plexus and artery might be slightly impinged (thoracic outlet syndrome) which can perturb the neuro-vascular activity around the G/H joint. Increasing the mobility of this area improves any slight "thoracic outlet syndrome".

The biomechanic of the clavicle is crucially important and needs to be restored to its "normal" state. It is important to understand that the sterno-clavicular joint is the only real joint linking the shoulder to the body !

Deep soft tissue massage is helpful to release the muscular tension emanating from the compensation pattern ; we may insist on the trapezius, levator scapulae, rhomboids, supraspinatus, infraspinatus, subscapularis and of course the pectoralis major and minor.

After a few treatments, the shoulder should improve and the condition avoided. It is true that as the condition is avoided it is hard to know if it really was a "beginning of frozen shoulder".

Middle of first stage to middle of second stage :

The patients often come to see an Osteopath at that stage of the condition, because they generally tried with poor results the conventionnal therapy. At that moent the pain is very bad and the limitation of movement is severe.

This is a long and fastidious stage. It is difficult to know how much the treatment is helpful because there are often tiny or no improvement. The patient may report some ease in the intensity of the pain, or improvement in the sleep pattern, but the mobility of the shoulder stays more or less the same. Some patient find it benificial enough for coming once a week. I want to believe that the treatment helps to shorten this period of the condition

The treatment will focus on the structures cited above but mobilisation will be avoided because of the pain it will create. The aim is to calm down the inflammation. Once the inflammation stopped we move to the next step of the treatment.

Middle of second stage to end of third stage :

At the middle of the second stage the shoulder is limited in its range of movement but free of pain. The recovery is coming at last !

During that period the Osteopathy can clearly helps the recovery. As well as using the techniques described above we can now use a combination of Muscle Energy Techniques (MET) and gentle mobilisation. The MET is a type of stretch applied after a gentle isometric contraction of a muscle. This technique gently stretches the G/H joint while respecting its integrity. The mobilisation techniques gently explore the joint mobility.

At that stage we can clearly notice some improvement between two treatments.

Conclusion

A frozen shoulder will definitely take time to recover fully It is frustrating for the patient as well as for the practitioner.

While the help from osteopathy is relevant straight at the beginning of a frozen shoulder and after the middle part of the second stage, it is hard to know how effective it is during the "painful-freezing" and "painful-frozen" part. A recent study has shown that physiotherapy mobilisations and stretches of the shoulder during this period actually increases the length of recovery. Remember that pain should be avoided at all cost...

Do not hesitate to use your arm within the pain free range of motion and keep any type of stretches for the later stage. An alternance of hot and cold pack might help (30 min hot, wait 15 min, then 30 min cold...) and position the pack all around the shoulder. you can repeat this procedure 2-3 times a week.

The Low Back Pain : an Osteopathic perspective

2007-09-02T05:13:00.000-07:00

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

"Low back pain is our daily bread", Mr D. Triana ( a teacher)was telling us. Actually I think he was saying that about nearly every type of complaints...

"You are as old as your back is" mentionned a brazilian tatooist.

In the UK, low back pain is one of the most common reason for time lost from work. The NHS spends more than 1 billion GBP/year and lost of productivity and sickness benefits cost the taxpayer another 20 billion GBP/year.

In this post, I'll expose the Osteopathic perspective of a low back pain, explaining different reasons that can cause this discomfort and what can be done to prevent it.

A quick anatomy review :

The low back comprises 5 lumbar vertebrae (L1 to L5), the sacrum, the coccyx (tail bone), 2 iliac bones which, with the sacrum constitutes the sacro-iliac joints. All of these bones are held together with rather thick ligaments (eg : ilio-lumbar, sacro-iliac, ischio-coccygeal ligament...)
Between each vertebrae there are discs which are composed of two parts : a liquid part in the middle, the nucleus and a fibrotic part which surrounds it the "annulus fibrosus".

A lot of muscles are present in the low back, long and short one :

The long one are generally attached to different bones or fasciae and will have an important postural "role"(eg : psoas, piriformis, QL, thoraco-lumbar fascia, gluteus...)
The short ones are little muscles which are attached from one vertebrae to another. These are the ones that if in spasm will "lock" a vertebrae and create an osteopathic lesion. if an "intertransversarii" muscle on the right gets into spasm between L2 and L3 then L2 will side bend on the right. To counteract this, a bigger muscle, the left Quadratus Lumborum will contract to counter balance and neutralise the lumbar spine.

AN OSTEOPATHIC PERSPECTIVE :

Facet lock /Somatic dysfunctions :

This is the essence of Osteopathy : the "Osteopathic lesion" (please report to previous post for a definition). This concept is really interesting at a vertebral level. After a trauma, a compensation or a visceral dysfunction (...) little muscles attached to the vertebrae will spasm. Often this reflex mechanism aims at protecting the surrounding structures by limiting the movement of the vertebrae. What seems to be beneficial on a short term is quite pathogenic on the long run : as this reflex has difficulties to relax it creates a series of compensations which in return makes a lot of muscles to work harder and put strain on different surrounding structures. A vertebral lesion might be described as follow : L2 is in Flexion, Left side bending , Right rotation. This means that this vertebrae moves easily in these directions but poorly in the opposite directions.

Pelvic imbalances :

The pelvis is crucially important : this is where the ascending forces (from the legs) and the descending forces ( from the spine) interact with each other. Each articulation of the pelvis (both Sacro-iliac joint and the pubic symphysis) needs to be relatively free. It will help the pelvis to adapt and compensate forces interacting at that place. Over time and traumas, some of the joints of the pelvis tend to become restricted. They often do so by adopting an excessive pattern.

The coccyx (also known as the "tail" bone ) is a very important little bone : we can compare it to the "rudder" of the spine. Any fall on it will restrict its movement and will heavily compromise the biomechanic of the pelvis and therefore the biomechanic of the whole body.

The most common pelvic patterns :

-anterior rotation of one of the ilium
-posterior rotation of one of the ilium
-upper slip of one of the ilium
-inflare or outflare of an ilium (opening or closing)
-the sacrum will be described through its flexion/extension, side bending and rotation
-the coccyx will be mostly described through its flexion/extension and side-bending

Example of a common pelvic pattern :

Anterior tilt of the right ilium associated with a flexion, left rotation and left side-bending of the sacrum.

A "healthy" pelvis is not necessary a balance pelvis, but a pelvis in which all the joints are mobile. If the pelvis is rigid, one has more chance to injured a ligament, a muscle or a disc as the transmission of the force will be quicker and the adaptation poorer.

The Visceral Sphere :

The organs are very important and have a great influence on the musculo-skeletal system. The medical field acknowledge that in acute cases one may feel some reffered pain from an organ but it seems to completely forget that a dysfunctional organ can also give some musculo-skeletal pain and greatly affect the posture of a patient.

There are different ways an organ can affect the complaint of a patient :

- imagine a patient with a spastic colon; the colon is attach on the psoas and on the diaphragm. If the colon tenses up, the psoas may react the same way and the diaphragm will see its amplitude decreases. In the case of the ascending colon, the patient might complain of a low back pain on the right side from the sacro-iliac joint to the lower ribs.

-In the case of a ptosis of the stomach (or hook shape stomach) the patient will adopt an increase flexion of the upper thoracic. One way of preserving the balance can be for the lumbar erector spinae muscles to contract in order to pull back the body of the patient. The low back muscles will work more than needed and the patient will complain of a tired low back at the end of the day.

-Other organs can affect the low back such as the kidneys, the duodenum, small intestine, uterus, ovaries, sigmoid, prostate... The influence of an organ can be mechanic, fluidic or neurologic (and psychologic ?)

-Don't forget that the diet (food, liquid, drug intake) is very important and may influence greatly an organ and therefore the body.

-Scars may also inluence the posture and therefore influence on a low back pain (see post on scar and posture)

Ascending Chain :

Ascending chain is a term which designs any osteopathic lesions coming from below (in this case the leg) which will influence a compensation above. A short leg, a long one, a flat foot, an old knee injury(...) are factors which will influence on our gate and therefore on our pelvic pattern. Again, an excessive pelvic adaptation increases greatly our chances to develop a low back pain.

Descending Chain :

Descending chain is the opposite. It is a lesion coming from above which will affect below. An old fractured clavicle will limit the range of movement of a shoulder. The gait of the patient might be affected as the arm does not swing as it should during the walk. A scoliotic pattern of the spine is developped which will affect the low back and the pelvis of the patient.

Some Osteopaths claim that a TMJ problem (jaw joint) or dental problem can create a low back pain. Why not !? Personnally I never met such a case, maybe I should say : I never diagnosed such a case. I am certainly still too narrow minded in my osteopathic approach.

Any Osteopathic lesions will increase the biomechanical stress on the body. It is believed amongst Osteopaths that such stress on the long run make muscles, joints, ligaments work harder than they should. After years of poor compensations, one is more likely to develop some wear and tear: some osteoarthritis. Increasing the mobility of the body, reduces the mechanical stress which affects it and over the years "should" decrease the severity of osteoarthritis (the "should" is there as I am not aware that any studies have been done to verify this ascertion).

The medical and osteopathic diagnosis are not opposite the one with the other. The medical diagnosis gives an idea of the state of the painful structure while the osteopathic diagnosis tries to understand the reason of this problem. While the allopathic approach will concentrate on the symptom, the osteopathic approach tries to "treat" the cause.

Recognition of Osteopathy in France

2007-08-15T19:32:00.000-07:00

At last Osteopathy is recognized in France !
It took more than 30 years for this recognition, yes... that's France. It takes time to change things.
Generally I believe that this is a good thing for Osteopathy to move towards regulation and medical acceptance. But there are a few points that are a bit bitter, unfair, obscure....

1. The Formation:

In France most schools provide an Osteopathic syllabus with a minimum of 5-6yrs of studies and practice. In general the number of hours accumulated is between 4500 and 5000hrs. In the UK, where Osteopathy is recognized as a primary health care profession, schools provide the same number of hours of teaching/practice but it is "compressed" into 4-5 years of syllabus.

From the official article concerning the syllabus of Osteopaths in France you need : 2030 hrs of studies! What a move from the Ministry of Health for the safety of the patients and to promote the competence of the future Osteopaths!

Why is this ? I believe that the lobby from the medical field was important : In France to become a GP you undertake a 9 years course. How as a doctor can you accept that another person can become qualified as a medical practitioner by studying for a mere 5-6 years ? How is it possible to accept that a profession that was so criticised (osteopathy) may now need more study than physiotherapy (3-4 years)? This is simply unacceptable : this is why it is necessary to cut the number of hours of the course to destroy the competence and the validity of Osteopathy.

Osteopathic Schools in France apparently decided not to follow the minimal course structure and agreed on a common programme spread over 5 years. Well done !

2. Restriction of certain manipulations :

With the regulation of Osteopathy in France came some restrictions concerning certain manipulations. It is forbidden for an Osteopath to practice :

-gyneco-obstetrical manipulations :
Personally I do not practice internal techniques (yet), but some Osteopaths do, and they have had good track record of success or various problems related to that area of the body. I do use external techniques on uterus, ovaries and coccyx. I believe that a lot of my female patients' complaints (lower back pain, hip pain, even headaches or neck pain) are often related to this area (eg :see article on scar/posture). The fact that I can palpate and feel any anatomical abnormalities (eg : cysts) helps me to refer the patient for some additional investigations and therefore enhances the safety of the patient.

-"touchers pelviens" : that's a good one! The translation is "pelvic touch". Well the pelvis is a wide area, it comprises : the sacrum and coccyx, the 2 ilium's, and a whole bunch of ligaments and muscles (sacro-iliac lgts, ischio-coccyx lgt, obturator membranes...). If there is ONE area that EVERY Osteopaths check and touch this is the ONE ! Any biomechanic's disturbances of the pelvis is likely to create some problems. Again not checking the pelvis leads to a poor osteopathic diagnosis and poor treatments...

-"cervical manipulations" must be recommended by a GP : It means that if anything happens during the manipulation the Doctor is responsible. There is a myth amongst some doctors that there is grave danger in this type of manipulation. In fact the risk is extremely low between 1/1000000 to 1/1500000 death per manipulations against 500/1000000 for taking NSAID (anti inflammatory) (see article on cervical manipulations). It is more dangerous to self prescribe and take NSAID for a neck pain...

Personally if I was a GP, I would not sign a lot of these letters : I would not put my career in the hands of a potential "death grip ninja" as I couldn't possibly vouch for every individual Osteopath...So you imagine how many referrals we will get through this route..

In most of the schools we start practicing cervical manipulations from the second year of study. We practice this techniques at least for 2 years before using it in clinic, under supervision of a trained Osteopath.
Some Doctors in France claim to be Osteopaths or to be able to manipulate the spine after a course, and can practice these techniques with force and extreme range of movement training directly on their patients. Don't worry ! they are Dr's, They know what they are doing ! In who's hands are you the safest ? This is your choice...

-There are also restrictions for treatments of pregnant women and babies under 6 months. Again a Dr. must refer the patient to the Osteopath. Why not, even if I still believe that an Osteopath should be competent enough to treat these types of patients.

3. Different types of Osteopaths ?

In France we have three major groups of Osteopaths:
-the Osteopaths-Osteopaths
-the Physio-Osteopaths
-the Doctor-Osteopaths

The Doctor-Osteopaths :
Generally he is s GP who became osteopath after a part-time course. The type of course here is really important. The most serious part-time course consists of 6 weeks a year over 6 years (1100 hrs + extensive homework) but some others are ridiculously short (few hundred hours). It is important to know if the Dr is a full time or part time practitioner, as the more you practice the better you are.

The Physio-Osteopaths :
The physiotherapist is in France a "masseur-kinesitherapeute". The courses taken to become Osteopaths are generally the same as above (serious or less serious). Now once they have their diploma either they leave their initial title of "kine" and become full time Osteopath or they keep their original title of "kine" and call themselves "kine-osteo".

I have a lot of respect for the "kine" who have abandoned their title to become Osteopaths. Some of my teachers followed this route and are fantastic Osteopaths. They exposed themselves to difficulties by carrying the Osteopath title to prosecution from Dr's, for illegal practice of medicine.

On the other hand "kine-osteo" use the title of "kine" to receive patients from Doctors : that way the patient does not pay for the treatments (because it is covered by the french NHS) and the practitioner can keep his practice busy... Ethically this is a bit dubious.

-The Osteopaths-Osteopaths :
This type are only practicing Osteopathy and their course lasted at least 5 years. They usually have the title DO (diploma in Osteopathy).
These are the Osteopaths I would recommend fr you to see, if you have any "osteopathic problems". The price is higher than a physiotherapy treatment (45 to 60 euros) and it is not covered by the Securite Sociale, the"french NHS". They are generally registered at the ROF (registre des Osteopathes de France) or at the UFOF (Union Federale des Osteopathes de France).

It is of course the patient who decides which practitioner to choose. Keep the one you feel comfortable with but keep in mind that in France the NHS is largely in debt. We are not used to paying for our own health but is it such a bad thing to pay for it ? To a certain extent, wouldn't it make us more responsible for our own health?

http://www.osteopathie-france.net/Groupe/pdf/Osteo_decret-formation.pdf
http://www.osteopathie-france.net/Groupe/pdf/Osteo_decret-DCE.pdf

What can Osteopathy treat ?

2007-08-11T01:07:00.000-07:00

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

Nothing at all...

In Fact Osteopathy does not treat anything but helps the patient to treat himself. The Osteopath just sign-posts the patient's body towards a different route of adaptation. In short, helping the body to improve itself.

In general, I would say that Osteopathy can "treat" or help with dysfunctions of the body :
"Dysfunction" could be described as a state between health and disease.

Untreated dysfunctions can lead the body toward uneconomical way to adapt a certain pattern. Uneconomical through a mechanical, physical, physiological, energetic (calories) point of view. It is a bit like driving around with a Porsche forgetting to remove your handbrake ! You can expect a poor acceleration, overuse of the brakes and high fuel consumption.
On the long term the body will be more exhausted and this can lead to potential illnesses (eg : infections) or premature ageing (eg : osteoarthritis).

While Osteopathy focusses mostly on the dysfunctions of the body certain pathologies can also be helped or improved (to a certain extent) ; certain types of asthma, gastritis, endomitriosis, Crohn's... Even if A.T. Still reported to treat cases of dysentery, it is unreasonable nowadays to prefer Osteopathy to an allopathic approach for the treatment of any types of infections, diseases or cancers.

"Osteopathy has no limit, only Osteopaths have some" this is a sentence from Idon'trememberwho, and I find it particularly true.

I have met a few people telling me about there symptoms during casual conversations and they say that Osteopathy can't help it because they saw an Osteopath and their problem didn't get any better. I would say that this Osteopath couldn't help you, how many have you tried ? Because you know there are as many different Osteopath(ies) than there are different Osteopaths. That's right, no Osteopath will practice the same way another one does !

The following list includes a series of patients' complaints or symptoms that I could help with :

Common complaints :
-whiplash injury
-neck, shoulder pain/sprain
-lowback pain/spain
-"disc" problem
-"sciatica"
-Thoracic outlet syndrome, carpal tunnel syndrome
-Headaches, migraine
-Temporo-mendibular joint pain
-hip, knee, ankle, foot pain/sprain
-complaints due to wear and tear (osteoarthritis)
-sport injury
-Repetitive strain injury
-gastritis
-IBS
-infantile colic
-stress

Less common complaints :
-Crohn's disease (decrease reoccurence of crisis, improve digestion and stress)
-endomitriosis (in certain cases helped with pain and associated symptoms eg : lowback pain/headaches)
-asthma (mostly with stress or effort induced asthma decrease of frequency and seriousness of attacks)
-kidney stone
-Bell's palsy (helped to recover but need more patients to say how much the treatments help)
-hemiplegia (might help the recovery after the attack, but mostly decrease the aches and pain caused by spastic muscles and body imbalances)
-paralytic syndromes (see above)
-ankylosing spondylitis
-frozen shoulder
-trigeminal neuralgia

These are cases I have treated over the years where I believe my osteopathic treatments have been helpful in the recovery.

Of course not all complaints are "treatable" and when there are not, it is important to check the reasons that could interfere with the improvements. These maintening factors can be due to daily activities, diet, intoxications, lack of sport, poor posture, psychological barriers or underlying pathologies. In this case your Osteopath is able to refer you to the appropriate consultant or to another Osteopath who may have another method of treatment.

How Scars influence your posture

2007-07-10T20:36:00.000-07:00

(You can find a French translation of this article Here)

Surgeries are not always useful or needed but they do save millions of lives every year.

While allopathic medecine "saves" your life, it brings little attention to the consequence of such a procedure. I don't talk here about the risk inherent to a surgery but about the "post traumatic adaptation" of your body.

My first clinical experience with such a case was when I was an Osteopathic student at the ESO teaching clinic. I was treating Mr G., 67yrs old, for some chronic low back pain. Mr G. couldn't stand for more than 30 minutes without experiencing pain in both thighs. This was a good excuse to avoid the boring food shopping with his wife. He was playing golf twice a week, while the walking and the swing were more supportable than standing still, at the end of the game and for the following few days his back was particularly stiff.
The treatment that I was providing were mostly based on deep massages, mobilisation of the spine, hips, knees... Mr G. was feeling some relief from it and was coming back every 3 weeks for a maintenance treatment.
One day, my Osteopathic tutor (Miss Celine Meneteau) entered the treatment room and asked me : "What is the scar your patient does have on the front ? Did you ever stretch it ?" Effectively the patient had a peritonitis 20 years ago and a subsequent 20 cm scar on his abdominal wall, and "no" I never worked on it, and never thought that it could be of any significance regarding my patient symptoms.
I did indeed stretch this scar as well as providing the usual treatment.
3 weeks later, Mr G. reported that he could not escape any more the shopping with his wife because he could stand more than 2hrs and half without any pain. His swing improved of 60 yards (obviously with the same club !).

"Post traumatic adaptation" :
Obviously an open wound is an experience a bit painful. The following weeks after the surgery, the patients will tend to protect their scar adopting an antalgic posture. The aim of this antalgic posture is to decrease the tension around the painful area.
In the case of a Csection, for example, the patient will bend forward and avoid to straighten up or to arch backward. Slowly the patient recovers from her surgery and can sraighten up a bit more, but compare to her initial posture she is now leaning forward. Why is this ? because there are some scar adhesions !
When an abdomen is cut open, you cut different layers of skin, muscles, fasciae... when the healing process takes place, scarring tissues create adherences between these different layers. What was once upon the time smooth, sliding, elastic healthy tissues are now fix, congested, non-elastic ones. This is the beginning of a long chain of problems...

Let's continue with our new mother who just had a Csection :
The first symptoms will be a sensation of heavyness on the lower abdomen, increase frequency of urination, bloating sensation.
Few months later low back pain starts being an issue and can be associated with pain/cramps in the calves. Of course carrying a child is not helping, but the tension of the scar obliges the mother to constantly lean forward. To compensate this imbalance, the extensors muscles of the spine constantly contract to prevent her from falling forward. At the same time when she leans forward, her gravity centre moves forward as well. This increases the pressure at the distal end of her feet. More tension by the calves muscles is needed to bring back the gravity centre. Guess what ! it gives pain/cramp/stiffness in the calves !

Exercise Time, let's have a try :
Please stand up, flat feet on the floor, bend forward a bit then grab an inch of skin underneath your belly button. Now straighten up (gently) stop as soon as you feel uncomfortable in your lower abdomen. As you cannot straighten up completely, you should be able to feel some contraction in your low back muscles. Slowly you will feel your posture shifting forward, and an urge to push down with your toes, now you feel more tension in your calves . Well done ! if you are a man you just discover the post traumatic adaptation of a Csection!
If you continue this little exercise, You will notice that if you want to look straight you have to extend a bit more your neck. On the long term it increases the compression on the facets of the cervical spine which leads to neck pain, spondylosis, headaches...

In this case, if you just manipulate the spine or massage the back you cannot expect any improvement but a symptomatic short term relief. As soon as you will start working on this scar as well as opening the anterior fascial chain, the change in the posture will be tremendous and this will lead to a great improvement of the symtoms.

Patients who had a masectomy and suffer from shoulder pain on the same side few years later, Patients who had an appendicectomy as a child and now you suffer from some sacro-iliac pain on the right side, patients who had a Csection or a hysteretomy and complain from low back pain or neck pain, did you ever think it could come from this old scar ? If it sounds familiar don't hesitate to contact your nearest osteopath or another competent therapist.

Different Osteopathic approaches of diagnosis and treatment :

2007-07-06T22:16:00.000-07:00

In this post I'll try to explain different modalities of Osteopathic treatment.

The two extreme ways of treatment are the minimalist approach and the other one is the maximalist approach. The minimalists will tend to push the diagnosis at the extreme and the treatment at its minimum, while the maximalists will tend to treat and diagnose at the same. The ratio in % I give is purely indicative.

Mechanical link (95% diagnosis, 5% treatment) :

Paul Chauffour and Eric Prat developed this approach in which they are looking for the Primary lesion and treat it, hoping for a decompensation of all Secondary restrictions.
They divide the body in 8 different unities :

-the spine and pelvis
-the anterior thorax
-the limbs (arms and legs)
-the cranium
-the viscerae (organs)
-the cardio-vascular system
-the intra-osseus lines of force
-the skin

Each of these unities will reveal one or two major restrictions. So which one is the one to treat ? Paul and Eric use the "inhibitory balance" to find out : if you apply a gentle pressure on two dominant restrictions the adaptation will soften under your fingers while the predominant lesion will still be dense. After finding the major restriction, the "Primary Lesion", you treat it with a "recoil" technique ( a swift flick of your thumb). The major restrictions found earlier should have soften, if not, then treat again the most dominant one. Each treatment comprises of around 350 to 400 tests and only 1 to 3 recoils !!!

This example of treatment has been reported to me by 3 of my colleagues who where watching a "mechanical link" demonstration :
The patient was having some pain in the right shoulder if he abducted his shoulder to more than 90 degrees. The Primary lesion was a spasm of the right femoral artery ! After correction of this spasm with a recoil, the patient could lift his shoulder without any pain or restriction.
This sounds incredible ? this is just one example. Even chronic cases seem to respond as well from this type of treatment.

This approach fits perfectly with A.T. Still statement : "find it, fix it, leave it alone..."

Gilette's approach (80% diagnosis, 20% treatment) :

This protocol of treatment has been developed by a Chiropractor (Gilette) but been presented to us during our osteopathic course by an Osteopath Mr Desjardins. Even if I am not so keen on chiropractic in general, I must say that I find this approach quite interesting.

The "philosophy" of this approach is that the pelvis is the major area of compensation between the descending forces of the upper body and the ascending forces coming from the legs. Therefore if the pelvis is not able to compensate then problems occur.

The diagnosis is fairly straight forward :
specific diagnosis of the pelvis pattern
-gross mobility testing of the thoracic spine
-testing of the occiput-atlas joint

The treatment is fairly straight forward :
-specific stretches of the pelvic ligaments
-mobilisation of the major group in restriction of the thoracic spine (HVT/Staircase)
-the occiput-atlas is seen as a barometer of the spine ; if after the previous corrections it is still restricted then manipulation of this level will be needed.

The pelvis and the thoracic spine is then reassessed.

With this methods you can treat a patient in less than 20 minutes. Mr Desjardins told us that it was the most effective type of treatment he ever practiced. Some of my colleagues use it and are convinced of its effectiveness.

Personally I still hope that I am a bit more than just a pelvis and a spine... But if you want to keep your practice simple and be able to see more than 80 patients a week this is certainly the way !

The Three Unities (75% diagnosis, 25% treatment) :

I have learned this approach from David McGinn at the CIDO. But I am still confused about who was the original author of this approach (dear colleagues please help me out with this one).

The aim of this method of diagnosis is to divide the body in three unities :

-Unity 1 : this is the locomotion unity, involving the lumbar spine from L3, the pelvis and the legs
-Unity 2 : this is the action and balance unity, involving the arms, the head and the cervical spine down to T4
-Unity 3 : this is the vital unity as well as the junction between the two other unities. It comprises the thoracic spine, upper lumbars as well as all the ribs.

Global tests permit to know quickly if a unity is involved or not. If a unity is involved then specific testing will reveal the predominant Osteopathic lesions.
As a general rule the Primary lesion should be found in all positions (standing, sitting, prone, supine, sidelying) and its correction should result in an increase of mobility of the other secondary restrictions.

I find this method of diagnosis really interesting and relatively minimalist. From your findings you can use the type of treatment you want. The major reproach I can think of is that the visceral and the cranial systems are not really integrated. A few other tests are needed for the diagnosis to be a bit more precise.

My Osteopathic Approach (40% diagnosis, 60% treatment):

I generally spend a good 15 min of the treatment (out of 40 mins) to test and diagnose a chain of tension to work on. The method of practice will change according to the body morphology. The fitter the patient is, the more precise the diagnosis will be and the more minimalist the treatment will be. If the patient is not as fit as he could be, the treatment will tend towards a maximalist approach (GOT approach, see below).

My assessment is based on the "Three Unities" (see above) while integrating fully the visceral system.

The treatment will generally be focused first on the visceral system, which removes the major part of the musculo-skeletal restrictions. After a reassessment I treat the remaining Osteopathic lesions from bottom to top.

I generally keep the cranial approach towards the end of the treatment unless I have found that area to be the main focus of my treatment (eg :TMJ, stressed patient, emotional trauma...).

The General Osteopathic Treatment (10% diagnosis, 90% treatment) :

Also known as Total Body Adjustment, the GOT, as practiced in the UK, has been introduced by John Martin Littlejohn and his student John Wernham. GOT is the British classical Osteopathy.

It is a routine of treatment based on 10 different principles :

routine
rhythm
rotation
mobility
motility
articular integrity
coordination
correlation
stabilization
mechanical law

The aim of the treatment is to literally "shake" your body by mobilizing every one of your joints from head to toe. It may be associated with some HVT ("cracking" techniques) through the spine. By mobilizing the whole body, an harmonization of all structures takes place. It improves the plasticity and elasticity of the tissues therefore enhances the adaptability of the body to its surrounding environment.

One may argue that the diagnosis is 100% part of the treatment, as the GOT practitioner diagnoses and treats at the same time. This is true, but this is the case for any type of techniques, because 90% of the treatment is spent in treating the patient, GOT is the most maximalist Osteopathic approach.

Of course these are not the only way to treat a patient, but the most well-known, or interesting that I have met during my Osteopathic Journey. Every Osteopathic practitioners evolve between a more minimalist or maximalist approach depending on the patient they treat.

Is cervical spine manipulation dangerous ?

2007-06-25T00:22:00.000-07:00

Yes Cspine manipulation is dangerous, but not that dangerous...

The risk is about 1/1.5million. It seems quite a lot but in fact you have more chances to die being struck by lightning !

Taking pills (NSAID) may seem safer, but in fact 16000 deaths a year in the US alone are attributed to the use of these painkillers. This gives a ratio of 500/1m people dying from gastric bleeding from taking anti-inflammatories. I won't even start to talk about liver intoxication associated with paracetamol.

So what is dangerous about it ?
in fact the danger comes from the rupture of the cervical artery or from a migration of atherothrombosis during the cervical manipulation which leads to a CVA or death.
Caution must be taken with :

patients suffering from High Blood Pressure (walls of arteries are more rigid and/or presence of cholesterol)
patients suffering from high cholesterol
patients suffering from hyperlaxity or connective tissue disorder (eg: Marfan syndrome)
patients suffering from vertebral atery occlusion syndrome

At a more practical level the aim is to reduce the number of cervical manipulation. And believe me a painful neck is not necessarly a neck to be manipulated !!! I've been horrified to hear patients telling me that they were seeing their therapist up to 3 times a week to have their neck manipulated.

The cause of your neck pain may not come from your neck !
This little test can be performed on yourself or on your patient. The patient sits on the table and you ask him to look over the right and left shoulder, check the rotation and ask the patients to notice when they feel the pain. Now, place your hands underneath the diaphragm and gently lift it up (liver, stomach...) and ask your patient to rotate his head again. Any change in the rotation or in the pain indicate that there is probably no need to manipulate the Cspine, the problem is coming from somewhere else. Yes this may sound odd but a gastritis, an anterior tilt of the liver, a Csection scar... can create neck pain.

Is it a problem if I "crack" my neck myself ?
It is not such a problem if you manage to do it at the right spot ! Often we tend to manipulate the part which is painful and this is not necessarly the right vertebrae or part of the body to manipulate. By moving the vertebral joint you will make it looser, if you manipulate it too often this joint will become hypermobile. To stabilize it, muscles will contract, this is painful and you feel the urge to crack it again... a splendid vicious circle. In other words, if you keep "cracking" the same vertebrae I seriously doubt that this is the right one to move and this will cause you other problem on the long run.

(http://en.wikipedia.org/wiki/Spinal_manipulation#Risks_of_upper_cervical_manipulation
http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=3239547&dopt=Abstract
http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=8583176&dopt=Citation
http://www.bmj.com/cgi/content/full/316/7146/1724)

Physiotherapy, Chiropractic, Osteopathy: What to choose ?

2007-06-24T07:56:00.000-07:00

The patient is often confused between these three therapies and doesn't know what to expect from these different approaches.

Physiotherapy : the physiotherapist is a specialist in rehabilitation. After an injury (fracture, surgery, CVA...) the physio will rehabilitate the patient with massages, mobilisations, ultra-sound, exercises or even teach a patient to use crunches. His approach is generally symptomatic and his recommendations are often statisticly based (eg : in chronic low back pain a series of 3 push ups, 5 sit ups and 7 pulls of the right ear lobe improve the symptom by 47% over a period of 7 weeks. Please don't try this at home, this is just an illustrative example !!!).

Why is this ? I believe that physiotherapists are the right hand of the medical field and have been formed to fit the medical way of thinking. Therefore anything they do must be proven effective and safe, even merely effective is fine as long as it is safe.

The problem is that proving something is hardwork, time consuming, money consuming, and often another study will few months later proves the opposite to be true. A study is often too specific or too global to be constructive.

This approach avoid to talk about the "Unicity" of the patient. It does mean that if two patients complain from the "same" areas or symptoms they will be given the same treatment regardless the root of the problem which is not necessarly the same. The outcome of the treatment is therefore not as effective as it could be : it does not address the root of the problem but the treatment is as safe as it can be.

Chiropractic : Here is a joke for you ... what is the difference between a chiropractor and an osteopath ? 60 000 $ a year.

Chiropractic has been developed in the US at the end of the 19th century by Dr Palmer. Chiropractors claims that the source of our problems comes from the nervous system. Therefore corrections of "subluxed" vertebrae tend to lead us towards balance and recovery. Chiropractors will use spinal manipulations, ultra-sounds, massages, TENS, or other "high-tech" equipments. Often the massage, US, TENS(...) is given by a PA (physician assistant), then here comes the Chiropractor who will manipulate the spine. The chiropractor may need to see you up to 3 times the first week then will decrease the frequency of the treatments.

Personnally I am far from convinced that a back pain necessarly comes from a "subluxed" vertebrae but if you believe that the key of your problem comes from your spine, well then go for it. If you are not getting any better then make your next stop the Osteopath ;)

Osteopathy : Any traumas, injuries, sugeries, infections you had in the past are affecting your body in some way today by creating some restrictions and series of compensations. After a while your body cannot compensate any more, you bend forward to pick up a pen and "click", a vertebrae moved a bit too much and you just suffer from an acute facet lock. Now, is it just a vertebrae or a whole pattern of compensations, interactions, fascial connections, visceral dysfunctions, nutritions(...) that is responsible for your agony ? I would like to believe that we just need to correct a vertebrae, as it would make the work a bit easier, but the human is a little bit more complicated.

Generally an Osteopath will spend between 30 and 40 min with you and only you. During that time at least 40% of the treatment is spent in diagnosis in order to understand where the problem is coming from, this allows a more accurate treatment.

Osteopaths only use their hands, as machines tend to be imprecise and often scare the patient.

Personally I will never see a patient more than once a week and rarely more than 3 times the first month. Some Osteopaths are even reluctant to do more than one treatment every other week. (for some more details about the treatment content please check the other posts !)

What ever therapist you see do no hesitate to try different ones and stick with the one you feel the most appropriate. If you do not feel any improvement after 2-3 sessions, look for another approach or opinion.

Structural, Visceral, Cranio-sacral Osteopathy ?

2007-04-28T06:58:00.000-07:00

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.

What is Osteopathy ?

2007-04-10T23:14:00.000-07:00

(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.

Another Osteopath in Malaysia

2007-04-05T03:39:00.000-07:00

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 !