By Laurie Melrose-Doering, Osteopath & Applied Kinesiologist
In osteopathy, there are probably as many notions of osteopathy as there are osteopaths. No two osteopaths will provide the exact same treatment. This is because the ways in which an osteopath can approach a treatment are so numerous.
Because osteopathy is so diverse, it is difficult to give a brief definition.
Fortunately, certain concepts underpin osteopathic practice, and I will list some of these below. I will not go into much detail because an in-depth explanation is beyond the scope of this article. If you are eager to know more, you can refer to this excellent book ‘Osteopathy: Models for Diagnosis, Treatment and Practice’ but please note that this is a book for osteopaths so may be a bit dry.
Some of the ideas that characterise osteopathy are the four osteopathic principles, the five conceptual models of patient care, and the patient-centred approach.
I think the best place to start is with the four osteopathic principles as outlined by the founder of osteopathy, Andrew Taylor Still. These are:
-the body is a whole (treatment of the knee may require consideration of the foot and ankle)
– structure and function are interrelated (decreased range of movement of the neck may be due to a restriction of a vertebral joint)
– the body has innate self-healing mechanisms (the self-healing is initiated by arterial blood, which brings nutrients and oxygen)
– treatment is based on the rationale of the above
Osteopathy also considers five conceptual models of patient care.
These five different models signify five different approaches to diagnosis and treatment – the models are ‘lenses’ through which the osteopath may view the patient.
The models are the biomechanical (postural), the neurological, the respiratory-circulatory, the metabolic-energy, and the behavioural (psychosocial).
The different systems covered by these models already hint at the vast breadth of osteopathy.
The biomechanical model addresses the musculoskeletal system, i.e. posture and motion.
This model receives a lot of attention from osteopaths. It considers increased energy expenditure (due to muscle tightness), altered proprioception, posture, changes in joint structure, and obstruction of neuromuscular function and altered metabolism (because structure and function are interrelated).
The aim is to remove restrictions, which the osteopath calls somatic dysfunctions, and to restore optimal musculoskeletal function.
Fortunately for us, the body is very clever and will compensate for postural imbalances. For example, if one leg is shorter, e.g. due to a previous injury, the body will compensate in the pelvis or with a functional scoliosis in order to keep the eyes horizontal.
Most of the time, the body can cope with a few compensations. However, if there are too many, there might be a breakdown in compensation which means the body will no longer cope with the dysfunctions.
This is when most patients book in to see an osteopath.
Whether the body is coping well or struggling with these compensations, the osteopath must find the primary problem and ‘fix’ it. Applied Kinesiology is a great diagnostic tool for such problems.
The neurological model is very closely related to the biomechanical model. This is because all muscles and joints are controlled by nerves.
Having studied the innervation and course of all nerves, I can help muscles and joints by treating nerve roots or peripheral nerves which may be impinged due to myofascial tightness or other issues.
For example, I can treat weak adductor muscles by releasing the obturator nerve, the nerve innervating the adductor group. But again, I must find out whether the muscle weakness is a result of a biomechanical issue, a neurological issue, or else.
Again, Applied Kinesiology muscle testing is a great diagnostic tool to unscramble these hidden problems.
A further example is, that I can treat the diaphragm via its neurological supply – the phrenic nerve or cervical nerve roots C3-5; I can treat the diaphragm mechanically via the muscle itself or its attachment points – the lower six ribs or the xiphoid process; or I can treat the diaphragm through its associated lymphatic points, which is an example of the next model, the circulatory-respiratory model.
This model focusses on the circulation of fluids – that is blood, lymph, and cerebrospinal fluid – as well as pulmonary and cardiovascular function.
The osteopath will look at the diaphragm and the rib cage, muscles associated with venous return such as the calf muscles or the pelvic floor muscles, the heart, lymphatics, and the cranium.
The importance of this model is not to be underestimated, because subtle imbalances of the cranial bones impact cerebrospinal fluid, i.e. CSF.
And because CSF protects and nourishes the central nervous system, osteopathic treatment of these subtle imbalances, e.g. a sphenobasilar dysfunction or a frontal compression, are very powerful and effective.
This model deals with some of the physiological and endocrinological consequences of stress. It leans heavily on Hans Selye’s model of adaptation to stress which is explained in this video from 06:28.
It is important that the osteopath takes the physiological repercussions of stress into account, as the effects on the body are widespread.
As well as osteopathic treatment of viscera, an osteopath may help the patient by giving advice on diet, exercise and coping mechanisms.
There is huge overlap between the metabolic-energy and the behavioural model. The former deals with the way in which stress impacts homeostasis; the latter places more emphasis on the psychosocial side, and how physical, emotional, and social health are inseparable.
Although psychotherapists, hypnotists, counsellors, and cognitive behavioural therapists are the gold standard here, any practitioner that builds up a therapeutic relationship – be it osteopath, herbalist, acupuncturist or other – has a role to play.
An osteopath or herbalist can pick up subtle cues that may indicate if a patient is stressed, such as muscular tension, elevated shoulders, costal breathing, being hyper-sensitive, not wanting to be touched, or finding it difficult to relax.
Taking a patient’s psychosocial aspect into account is so important because stress very often exacerbates symptoms – from low back pain to migraines to irritable bowel syndrome. And this is because psychosocial health impacts the other four models.
Furthermore, depression and a negative attitude (e.g. the feeling that one will not recover, not seeking help, being afraid of moving, or thinking nothing can be done) are strong predictors for poor outcome. Attitude may even be a reason for chronic pain. Although, this can also be the other way around – chronic pain impacting the psychosocial aspect.
As can be seen, all five models are related and interdependent. For example, a structural restriction – caused by dysfunction of muscles, joints or connective tissue – can compromise vascular or neurological structures which in turn would affect metabolic processes and behaviour. In my blog post about posture,I give a few examples of this.
This vast approach, with its many considerations, helps to explain why osteopaths treat such a wide range of conditions, such as arthritis, back pain, headaches, migraines, shoulder problems, joint pain, IBS, infantile colic, repetitive strain injuries and many more.
Wilfrid Streeter’s brilliant (and long) article provides insight into the thinking of the early osteopaths.
For more information on the history of osteopathy in the UK, you can read this article by the Institute of Osteopathy.
By Laurie Melrose-Doering, Osteopath & Applied Kinesiologist
