Kitabı oku: «The Principles and Methods of Osteopathy. Part 1. Biomechanical Methods»

© I. A. Aptekar, 2020

ISBN 978-5-4498-7378-1 (т. 1)

ISBN 978-5-4498-7379-8

Created with Ridero smart publishing system

Osteopathy is an art that allows, using the

power of the Spirit, the Body and Mind, using your hands, to launch a therapeutic process under the guidance of Health.

…Unknown osteopathy…

This book is dedicated to James S. Jealous D.O., my teacher…

Preface

Osteopathy is based on understanding of integrity and unity of man and nature of which it is an integral part.

Internal filling of Osteopathy as an art and science depends on spiritual basis of the doctor – osteopath, the level of perception, the used model of the description of the world and the actual angle of “vision” in the process of perception. Especially in the cases when we think that we perceive integrity.

Often, our perception is directly dependent on which side we are looking at and which part we are holding on to. Just like in the known story about an elephant and blind sages.

Abbreviation DO is often decoded by many osteopaths not only as “doctor of osteopathy” but also as the motto Dig On. This is a direct call not to stop studying osteopathy, even when it seems that everything has already been studied, known and mastered.

The process of teaching Osteopathy as other types of human activities is universal. We go from unconscious ignorance and inability to unconscious knowledge and ability. We go through the stages of conscious ignorance and conscious actions until knowledge and ability are fixed on the reflex level.

Formation of professional competencies occur gradually being fixed at the level of reflexes and unconscious knowledge. No matter what we study – martial arts, dancing, singing, computer work, cooking steak – we go through one and the same stages. Any motional act is comprehended gradually in the process of constant mastery of the skill.

Originally we study principles and methods, and then go to the techniques and simple movements. We repeat them after our teachers trying not to miss anything. Copying their movements are repeated many times each, trying to achieve the sensations they are talking about, and the results we see watching their work.

This process continues for a long time. However much we would like to accelerate, we are still moving at the same speed as we are capable of. And consistently go through all the stages of studying and acquiring practical skills, developing both palpation and perception.

Starting basic training in the osteopathic school we think we’ll be able to quickly master osteopathy within 4 years. But it takes a lot longer before we realize that we are still at the beginning of the journey. Then we master methods and techniques seeking their perfect fulfillment, or we think we’ve already mastered them. At some point in learning and development there is a feeling that we can bring something of yourself into approaches and osteopathic techniques. And the techniques become personified, personal. We even begin to consider ourselves pioneers of something new and already see our images in the same row as the founding fathers of osteopathy.

Schools appear, new techniques are described, new words and word- combinations are uttered, and new meanings are formed. And only principles and methods remain unchanged. The principles of restoring the integrity of the human organism with the help of hands.

And three methods of osteopathy:

– Biomechanical, with its axial model of motion description and therapeutic force coming from the doctor – osteopath;

– Functional, in which the therapeutic force is the global functions of the whole body manifested in the form of global endogenous rhythms, whose action is aimed at achieving integrity and synchronic anatomical molecular and electromagnetic unity of the human body;

– Biodynamic, based on the principle of the unity of man and the world around him, with its therapeutic force coming from the outside and manifesting itself in the form of exogenous (ecological) rhythms; the Force having Intellect; Potency that heals unerringly; and Health always present.

All three methods exist simultaneously and represent a single and indivisible integrity. The choice of this or that method is determined by the diagnosis and depends on the effectiveness of “the dialogue” with the body and tissues. Division into methods is nominal and applies only to the period of basic training of osteopathy.

Consecutive study of the biomechanical method allows you to prepare a theoretical and practical basis for mastering the functional method. What, in turn, forms the basis for studying the biodynamic method.

But over time we suddenly realize and feel that in fact, osteopathy – it’s neither even the principles and methods of therapy nor the individual techniques. This is a way of life based primarily on spirituality and love for people. Otherwise, the system does not work.

And one day there comes a time when we no longer think about what kind of osteopathic help to apply in this or that case.

We just try to be:

– the most useful;

– neutral and calm;

– loving and benevolent;

– humble;

– respecting the wisdom of nature and the human body.

Of course, if after a session of osteopathic care you are asked what it was, then you will no doubt give an exhaustive answer about the osteopathic diagnosis, primary somatic dysfunction, therapeutic process, its sequence and end phase, up to the global rebalance.

At some point we find that the whole, having achieved neutrality and calmness, can easily restore any part of itself. While the part will never restore the whole. She simply does not enough potency for this. At this level of our life anatomy of the parts becomes less significant compared with anatomy of the whole.

Only continuously studying and developing osteopathy as art and science one can be the most useful and effective.

The world around us is a mirror which reflects our internal state. And if we want to change the environment we need to start with ourselves. It is for this reason that the osteopaths are in constant development, cognition of themselves, and the world around them. In medical practice the areas of application in osteopathy are limited only by the professionalism of the doctor – osteopath.

Aptekar I.

…There is a claim that is on June 22, 1874, at the age of 46,

A.T. Still publicly formulated the three main principles of his philosophy and thereby derived the formula of osteopathy:

– The Structure controls the function.

– The Body is a single whole.

– The Body has mechanisms of self-regulation and self-healing…

Osteopathy was discovered by Dr. Still. He did not claim to have created it. He came to understand that osteopathy is a word used to describe the laws of nature, placed in a person before his birth. These laws, known and unknown, are what we call Osteopathy.

James S. Jealous D. O.

Chapter 1 Osteopathic Activity

The Subject of the osteopathic activity is the restoration of the integrity of the human body with the help of hands.

Osteopathy (osteopathic medicine) is practical philosophy, science and art.

Speaking about the definition of osteopathy it should be noted that the following formulation, which is reflected in the clinical recommendations approved by the professional association of osteopaths “RoSA”, is now generally accepted.

Osteopathy is a holistic manual medical system of prevention, diagnostics, treatment and rehabilitation of somatic dysfunction consequences that entail health disorders, aimed at restoring the natural abilities of the body to self-correction.

Specific object of the therapeutic effect of a doctor – osteopath is somatic dysfunction.

The basis of osteopathy is fundamental sciences such as anatomy of the living body, embryology, biochemistry, physics, biomechanics, neurophysiology and many others. And when there are questions about the evidence base of osteopathy, we understand that the answers lie in the study of the above sciences and their laws.

Moreover, in the processof studying osteopathy, we must remember that the people who discovered it were deeply religious and spiritual. Osteopathy is now integrated into official medicine. In the process of integration, it is necessary to minimize risks of simplification and emasculation of the substantive part of osteopathy, to preserve its integrity.

Osteopathy evolves evolutionally on the basis of a holistic, predictive, personally oriented system of maintaining human health, as well as diagnosis, prevention and treatment of somatic dysfunctions, leading to a violation of the body’s ability to self-correction and self-recovery.

Osteopathy is not divided into parts. Crushing on the cranial, structural and visceral sections of osteopathy is appropriate only in the process of basic training.

Narrow specialization in the form of cranial, visceral and structural osteopaths leads to a violation of the integrity of osteopathy and distortion of osteopathic activity. Osteopathy is indivisible system. We study principles and methods, anatomy and biomechanics of a living body, fundamental sciences that lie at the basis in order to unite the separate parts into practical, integrated system of diagnostics and therapy, which we call osteopathy.

In the first years of training in the osteopathic school all our attention is focused on the biomechanical method and palpation with the principles (basics) of perception. In the future, we develop perception and master the functional method.

And only when the first two methods are mastered, their application becomes an integral part of the work of the osteopath. And he learned to perceive not only the manifestations of endogenous functions but also exogenous (ecological) rhythms, you can go to the third method of osteopathy – biodynamic.

Thus, the task of the biomechanical method is the restoration of the biomechanical unity of the organism; the functional method allows you to restore functional unity, and unity of the organism and biosphere of our planet is restored with the help of the biodynamic method.

Understanding this process is the basis of training osteopath physician throughout his life.

Health and somatic dysfunction

Health, according to the definition of the World Health Organization (WHO), is the state of complete physical, mental and social well-being and not merely the absence of diseases and infirmity.

On the other hand, according to WHO, from the point of view of health statistics, health is understood as the absence of identified disorders and diseases, and at the population level – the process of reducing the process of mortality, morbidity and disability.

In both cases, health is considered a condition in which there is no disease (or diseases).

For doctors – osteopaths, health has its manifestations for manual palpation and perceptive diagnostics. Osteopaths determine health not by the absence of disease, but by its manifestations.

It is for this reason that Sill’s assertion “… an osteopath is looking for health…, every person can find a disease…” is filled with practical meaning for Osteopaths.

The official health care system has now focused on finding and effective prevention of diseases. Perhaps, for this reason, “somatic dysfunction” has been distinguished by osteopaths as an anatomic morphological substrate, some health manifestation, of self-correction and self-restoration; mechanisms of adaptation that are implemented to maintain homeostasis at the stage before the onset of the disease, at the stage of pre-illness.

It should be noted that the definition of somatic dysfunction is currently still under discussion. The most commonly used definition in the clinical guidelines entitled “Osteopathic diagnosis and Somatic dysfunction” is presented below.

Somatic dysfunction is a functional disturbance manifested by biomechanical, rythmogenetic and neurodynamic components.

You can also say that it is a reversible dysfunction manifested as a violation of micro- and macro- mobility.

Another definition suggests that somatic dysfunction is a functional disorder which manifests itself as a complex of biomechanical, hydrodynamic and neural changes. And all these statements are true in their own way.

For a more complete understanding of the term “somatic dysfunction” it is necessary to understand what is actually meant by the words “soma” and “function”. And if we use the word combination “somatic dysfunction”, then it is necessary to define the concept of the “somatic function”.

If somatic dysfunction manifests itself in a violation of the dynamic neutrality and human integrity, then the somatic function is expressed by integrity and neutral calmness.

Somatic dysfunction leads to desynchronization of internal processes of human vital activity and its relationships with the environment, which is resulting in a violation of the organism’s adaptation manifested.

Somatic function of the person, in its turn, is manifested by dynamic mechanisms of self-organization of all body systems, ability to complete compensation and adaptation to environmental influences. The effectiveness of these processes underlies the manifestation of biological and social functions of man.

Function (functio – execution, fulfillment) is a phenomenon that depends on another phenomenon and changes as this other phenomenon changes.

In the case of the human body, the function is an arbitrary or involuntary reaction of the organism in response to the influence of the external environment. This response is an adaptation to maintain the constancy of the internal environment. This is an adaptation. Violation of function is nothing but a violation of adaptation, as a result of which the system of maintaining of homeostasis can be broken.

Thus, functional impairment is a violation of the mechanism of adaptation in the process of vital activity of the organism in the changing external environment. The causes of any functional disorder lie outside the affected organ, organ system and are associated with a modified regulation of the function.

The search for the cause and its identification, the understanding of the entire pathogenic chain of the formation of somatic dysfunction should be considered not at the level of inference, but as a result of palpatory and perceptual research, a consistent study of the damage fields – both primary and secondary, that resulted from the implementation of adaptation mechanisms.

A functional disturbance, or a violation of adaptation, can be local, regional, but it is always global. And it contains all components of the homeostasis system, including neural, biomechanical and hydrodynamic.

The rhythmogenic component of dysfunction can be initiated by any of the above disorders. Naturally, this applies to the entire process of the appearance of rhythmic activity, beginning with the elaboration of rhythm, its carrying out and reaction to it from the whole body. At the same time, we must understand that the development of rhythm is not an end in itself of any function.

The purpose of the function is to adapt effectively. Functional activity has its manifestations. And with reference to the functional activity of the organism, this can be various oscillatory fluctuations of a rhythmic nature. Rhythm as a characteristic of a wave oscillation has certain parameters that allow judging the state of a function.

Thus, the view that somatic dysfunction is primarily is a global violation of the adaption of the entire body, the entire soma, finds its confirmation. This is a violation of the integrity of the body. Violation of synchronous functioning of all organs and systems as a whole, and not in the form of separate anatomical formations.

That is why, speaking of somatic dysfunction in pediatric practice, we primarily mean a global violation of the whole.

For the same reason, in working with children under 3—5 years of age, we use a biomechanical method exclusively for diagnostic purposes. And the therapeutic component is in the field of the functional and biodynamic model of perception.

Knowledge of all the sections of the human’s body’s anatomy, physiology and biodynamics allows the doctor – osteopath not only to understand the interrelations of the whole, but also to find the causes of violations of these interrelations. And, more significantly, in these violations find elements of health and create conditions for its growth and development as a whole.

Functional impairment, or somatic dysfunction, is manifested at the biomechanical level by a change in the state of biomechanical unity; at the functional level – a violation of the synchronous implementation of functions relative to each other and relative to global body functions; at the biodynamic level – a violation of the integrity of the organism and its habitat (mother Nature), of which it is a part.

In osteopathy, it is customary to distinguish three models of perception, or three methods: biomechanical, functional and biodynamic.

One of the reasons for the conditional division is not so much in the level of impact on which the osteopathic physician works, but in the level of perception that he is capable at the moment.

The second, no less significant reason is that a violation of adaptation mechanisms with the subsequent formation of somatic dysfunction can occur at the level of biomechanical interactions, or at the level of functional interactions of a part with respect to the whole, or at the level of interaction of a person and the surrounding world, of which he is a part.

From the point of osteopathy, man is not a collection of parts in the form of bones and joints, fasciae, muscles, ligaments, internal organs and body fluids. This is a holistic functional unity. It is a system that is in a continuous, balanced and synchronized movement of all its parts and components.

All movements of the human body (internal and external) have qualitative and quantitative characteristics and are one of the manifestations of its functional activity. All functions of the body are aimed at maintaining homeostasis in the process of interaction with the external environment.

Global movement of the whole

On the one hand, we observe the mobility of the whole body from the point of view of the biomechanics of anatomically resolved arbitrary and involuntary movements.

On the other hand, in the process of perceptive diagnostics, the global mobility of the human body is felt as a holistic vibration of a certain force, frequency and amplitude. It can be felt under the hands.

The origin of this movement can be explained by the superposition and synchronization of local, regional and global manifestations of the functions of all parts and systems of our organism.

What we perceive at hand in the process of perception and palpation, in this case is one of the manifestations of the living integrity of the human body – the system, integral not only in relation to itself, but also in relation to the surrounding world.

What do we actually perceive in the process of the perceptive diagnostics? The manifestation of life? Mobility? Involuntary, available, present movements? Fluctuations, wave rhythms as manifestations of various functions?

Perceptually, we can “observe” that local rhythms are synchronized with respect to global endogenous rhythms. And global fluctuations of the whole body, in turn, are synchronized with respect to exogenous (ecological) rhythms.

The function of a single cell, tissue, organ, systems of organs in itself, apart from the body, has neither meaning nor sense. As it has no meaning and sense a violin without strings, a bow, a musician, who is proficient in it, and a place where he can realize his skills.

Violation of synchronicity of interaction between parts of the body leads to a functional and biomechanical violation. The ability of the human body to adapt to changes and to interact effectively with the surrounding world is changing.

The volume of functional mobility decreases, qualitative characteristics of arbitrary and involuntary movements change toward limiting and increasing the volume of the elastic barrier. Somatic dysfunction develops as a manifestation of the function of health.

Sanogenetic reactions of the body, aimed at maintaining homeostasis, go beyond the limits of physiological comfort, forming clinical manifestations of somatic dysfunctions. As a result, the immune and autonomic nervous systems are weakened.

Sanogenetic manifestations of their functioning, arising in the process of adaptation to changing environmental conditions, cease to be physiological, forming a pathogenetic reaction.

The body adapts but with certain losses. Accumulating, the pathophysiological reactions (adaptations) of the body require additional “attention”, additional adaptations.

Thus, secondary somatic dysfunctions are formed often with clinical manifestations. Correction of secondary somatic dysfunctions is nothing more than symptomatic therapy. Solving current problems does not remove the basic lesion, but more often significantly improves the patient’s condition.

In cases when adaptation mechanisms are weakened, “internal doctors” cannot timely correct violations. Initially, there is a functional deformation, then a functional disorder. Without clinical manifestations. They appear in the future forming a disease.

Disease is a variant of adaptation of the organism to changing environmental conditions that has gone beyond the limits of the functional norm.

Disease is a manifestation of health, the struggle of the organism for its functional integrity, for survival.

Therefore, our task is not only to eliminate, if possible, the primary etiological factor of osteopathic lesion and somatic dysfunction, but also to create conditions under which self-correction of the organism and control mechanisms will function in the normal physiological mode.

Osteopathic lesion is a complex of functional reactions of the body as a response to the direct action of exogenous factors.

The lesion field is a complex of reactions of the organism in the process of its adaptation to the damaging exogenous factor. The lesion field has its own boundaries, the center (fulcrum).

Thus, somatic dysfunction is a manifestation of health in the form of physiological organism’s reactions in response to osteopathic lesion.

The main role of the doctor – osteopath is manifested in many respects not only in the diagnosis and correction of osteopathic damage (lesion) and somatic dysfunctions, but also in the prevention of violation of functional unity, the vital integrity of the human body, dysfunctional changes in the immune and autonomic nervous systems. All that breaks the functional connection with the outside world of which we are a part.

The subject of studying osteopathy is human health and its adaptation to environmental changes as well as the conditions for the formation of health, its preservation and development. And in case of lesion – prevention, diagnosis, correction of functional disorders that entail a violation of health. Including we are talking about the prevention of the formation of biomechanical disorders in the form of somatic dysfunctions.