Still’s osteopathy – its roots and reason (6)

Fascia

In the first chapter of Still’s seminal work appears a very short but profound paragraph entitled ‘fascia’. Still’s comment that “the fascia is the ground in which all causes of death do the destruction of life” despite its absolutism sign posts an area of study that is only now being fully explored, so ahead of his time was the founder of his profession.

Fascia is now being hailed as an independent organ, whose complexity and importance to the organism as a whole is unsurpassed.

International Fascia Research Congress defines fascia as the dynamic mesenchymal tissue that unites every cell in the body and allows for fluid and tissue movement. Far from being just a band or sheet of connective tissue beneath the skin that attaches, stabilises, encloses, and separating muscles and other internal organs – fascia is the uniting element that allow the body to work as a whole organism.

This is where Still philosophy maintains it integrity, Still propounds that the body works as a single unit – and if the fascia is the uniting element, then it is fair to propose that it is the ground where all the causes of death do their destructive work, as they would undermine the unity of the whole. It is of course a bit excessive to say disease lives purely in the fascia, however if we see it as poetic licence aimed to inspire researchers and students alike it is truly prophetic.

People interested in further contemplation of the subject I append the fascinating youtube video “Strolling under the skin” for your edification.

 

Still’s Osteopathy – its roots and reasoning (5)

Principles

Midway through the first chapter Still reveals his underlying position, he is essentially a mechanist who encourages his students to become “master mechanics’ skilled at “adjusting the engines of life’.  He compares his extended version of anatomy to an ‘engineer’s hand book’ and defines the job of the osteopath to “go no farther than to adjust the abnormal condition, in which you find the afflicted. Nature will do the rest.”

Criticism of a mechanistic approach abound; how can a system as adaptive, dynamic and incomprehensibly complex as the human being be understood as purely mechanical? Its possible but the underlying notions of certainty can not be sustained. Complex systems provide us with probable outcomes not certain outcomes and this is where modern clinical science and fundamental osteopath diverge. There is no absolute treatment or answer to any complaint – there are probable outcomes to probable diagnoses; and there are a multitude of confounding environmental, physiological and psychological factors that often skew outcomes. However endeavouring to comprehend the complex human system in a functional way is primary to any approach and Still is right to point that out.

 

 

Still’s Osteopathy – its roots and reasoning (4)

The Osteopath an Artist

In a very short chapter Still promotes the need for medical practitioners to have a thorough and profound anatomical knowledge, a knowledge he believed that in the medicos of the time had “become sloppy and haphazard’. He wants his new practitioners to be anatomical artists whose anatomical knowledge was so ingrained that they held a picture of all the bodily structures in their minds. Later in the text Still makes it clear that physiological, histology, biochemistry and pathology should be considered branches of anatomy.

This of course begs the question – how good is the anatomical knowledge of our medical practitioners now? Does Still’s critique that it is sloppy and haphazard is hold true.

Sadly as recently as 2015 the British College of Surgeon (RCS) revealed they could not fill their training places with medical graduates because not enough of them met the minimum standard for anatomical knowledge. According to Turney writing in the RCS Annals in 2007 anatomical knowledge in the medical profession as been on the decline for the last 30 years.

Whether Osteopaths’ anatomical knowledge is of a higher standard is a moot point. Certainly at we had access to a wet labs and I was taught anatomy, physiology, histology, embryology, biomechanics and advanced visceral anatomy during my time at university. I believe Dr Raymond Blaich Osteopath in doing his pHd on this very topic and I eagerly await his results.

 

Still’s Osteopathy – its roots and reasoning (3)

 

Chapter 3 – Method of reasoning

Still’s disregard for the allopathic medical industry of the time is so profound that he claims to have “obtained a mental divorce from them”. So having divorced himself from the generally accepted medical practice of the time, Still determines to undertake two distinct pathways to establish his new medical practice – Osteopathy. The first being an exacting study of the structures and functions of the human body, and the second to use reason to establish the very principles that explain the underlying and unchanging nature of the function of those structures.

In this way Still establishes himself as both empiricist and rationalist, thus combining the major competing schools of philosophical thought at that time, much as Emmanuel Kant was endeavouring to do in the world of ethics. In short bringing deontological thought to the primarily experimentally based utilitarian practice of medicine.

Still postulated that if we could establish through empirical facts the functional nature of the human body we could derive unchanging principles and a rational base for all treatment and management. This is arguably what makes Osteopaths different for every other forms of western medicine and is the very focus of this seminal text as will become clear as we progress through the work.

“The student of any philosophy succeeds best by the more simple methods of reasoning. We reason for needed knowledge only, and should try and start out with as many known facts as possible. If we would reason on diseases of the organs of the head, neck, abdomen or pelvis, we must first know where these organs are, how and from what arteries the eye, ear, or tongue is fed.”

 

 

Still’s osteopathy – its roots and reasoning (2)

Chapter 2

God and experience as the only source

In a very short section Still claims the only authors of his text are God and himself (his experience). This is because it would be “very foolish” to look for instruction or advice from any medical writers of a science as they know nothing of – the science of Osteopathy.

This statement is of course inadequate – no one wakes up one morning and starts providing a complex new form of philosophy and medicine that involves cracking people’s necks without precedents and influences. And there are many – in fact the practice of bone setting is even depicted in Egyptian hieroglyphs.  The English written tradition of bone setting reaches back into the 1600s and is well documented. Perhaps more interestingly the American indians, notably the Sioux, also practiced bone setting and Still does admit to having discussed health matters with JB Abbott and Indian agent.

I digress, what is important is to recollect that this is a philosophical text – so the philosophical precedents for Osteopathy also require investigation. Linking medicine and philosophical method was fundamental to ancient Greek medicine, so in this Still in the inheritor of a very long rational tradition.

Who exactly influenced Still isn’t clear in this text and as that is the focus of these blogs I will not dig further but to say the second chapter creates more questions than answers.

 

Still’s Osteopathy – its roots and reasoning

Introduction 

ATSTillIn this hopefully provocative set of blogs I will painstakingly examine A.T. Still’s seminal Osteopathic text “The philosophy of Osteopathy”.

My aim is to tease out the roots of our profession and openly discuss his original philosophical axioms with reference to the modern medical era.

Should we discarded Still work as out dated? or are there underlying truths about the human experience that still hold true?

Chapter 1 Medication is not medicine

To begin – even in the preface Still is immediately making his stance very clear, he is utterly opposed to drug driven medicine.

“When I saw others who had not more than skimmed the surface of the science, taking up the pen to write books on Osteopathy, and after having carefully examined their productions, found they were drinking from the fountains of (the) old schools of drugs, dragging back the science to the very systems from which I divorced myself so many years ago, and realized that hungry students were ready to swallow such mental poison, dangerous as it was, I became fully awakened to the necessity of some sort of Osteopathic literature for those wishing to be informed.” (Still, 1899)

It must be admitted here that Modern Osteopathy has long been wedded to the stand point Still was criticising here, due in large part to the profound success of antibiotics in the treatment of bacterial infections, such as cholera, typhus, syphilis, staphylococcus, etc and to a lesser extend to the efficacy of NSAIDs. However with the advent of antibiotic resistant strains of bacteria the time to rethink our adherence to medication driven medicine may have come again.

Still’s horror at medication was due primarily to the use of laudanum and alcohol in the era referred to as ‘heroic medicine’, during and after the American civil war when Still founded Osteopathy. However, Still’s concern for a medicine based on chemical compounds has found advocates in unexpected places in recent times as well.

Danish physician Dr Peter Gotzsche, medical researcher and co-founder of the Cochrane Collaboration, the world’s foremost organisation for the assessment of medical evidence, has stated that our most commonly used drugs, even when used as prescribed, are lethal and cause the death of over 100,000 American’s per year.

Gotzsche warns us off the following drugs; antidepressants as they don’t work, all psycho-active and anti-psychotic drugs for children or the elderly, non-steroidal anti-inflammatories for headaches, arthritis or muscular pain, chemotherapy and drugs for incontinence. A quick reminder here – Gotzsche is a co-founder of the Cochrane Collaboration; the world’s leading medical evidence assessors.

Pain is in the brain – part 1

According to the work of Dr Michael Moskowitz from the Department of Anaesthesiology and Pain Medicine from the University of California, brain scans indicates that pain is perceived in eight section of the brain; posterior cingulate, amygdala, insular, supplementary motor, prefrontal, anterior cingulata, somatosensory and posterior parietal.

In part 1 – I do a relatively brief investigation of the first four regions of the brain involved in pain and postulate how neurones involved in chronic pain might be able to be stolen back.

Each of these regions is responsible for a number of things other than just pain and by encouraging people to engage these other actions and perceptions chronic pain can be down regulated; or as Dr Moskowitz puts it – we can steal back our neurones.

So lets break them down these regions of the brain and start a discussion on how we can help people free themselves from persistent pain.

  1. Anterior cingulate has been referred to as the default mode network of the brain, it is most active when we are daydreaming or in a state of wakeful rest. It is involved in episodic memory retrieval and pain perception (Buckner, Andrews-Hanna, & Schacter, 2008)

Could we daydream our way to a pain free state? Is this section of the brain utilised in meditation? Certainly thinking happy thoughts fits the bill. Not such an easy thing to do when you are in chronic pain.

2. Amygdala is a distinct part of the anterior temporal lobe and a vital part of the limbic system, and is active in memory, decision making and emotional reactions. Larger in men than women, and it is hypothesised it is a critical in evaluating the environment for potential dangers (Amaral, 2006).

As a consequence if we could provide people with a change of environment we might be able to change the focus of the amygdala from pain perception to other risk assessments.

3. The insular cortex is part of the cerebral cortex involved in a wide range of functions from emotional state to homeostasis; these include motor control, self-awareness, cognition, perception and interpersonal interactions, and it is theorised that it is responsible for offering a sense of spiritual certainty; removing all fear of uncertainty (Gschwind & Picard, 2016).

Perhaps this part of the brain could explain why people stubbornly hold onto the belief that the pain is in the tissues that have long since healed?

So many options for treatment here. Interpersonal interaction – changing your friends or how your friends talk to you, learn a new activity, catch your negative self talk, practice positive affirmations, even find religion?

4. Supplementary motor is a part of the cerebral cortex involved in the control of movement and it neurones project directly into the spinal cord. It has been hypothesised that it is involved in control of movement including postural stabilisation, bilateral coordination and sequential movements – and the perception of pain (Graziano & Aflalo, 2007).

This section of the brain is thought to initiate movement independent of external stimuli, and consequently could be a good place to reduce central sensitisation. There are a any number of balance related exercises from simply stating on one leg to standing on a board on a roller. A complex and repeated pattern of these could steal back some vital pathways. Again remember I’m only hypothesising here – all of the management ideas are experimental.

 

 

Drugs for lower back pain. Think again.

National Osteopathic Conference -Auckland 2017 presentation slide produced by Dr Iain Bell.

Iain is a Musculoskeletal Physician who graduated from Otago in 1990 (with distinction), and holds post graduate Diplomas in Musculoskeletal Medicine and Sports Medicine, FRNZCGP, and FAFMM. He is currently completing a Masters in Health Science (Pain and Pain Management). 

Lower back pain

Lower back pain (LBP) is suffered by a large majority of people in our society, and it can and does ruin the quality of their lives. There are a host of pathologies that have been implicated in acute lower back pain; everything from cancer to spinal stenosis, from disc herniation to reactive arthritis. Being able to differentiate between these diagnostically is absolutely imperative for appropriate referral and correct treatment and management. That is where osteopaths, physiotherapists and exercise physiologists working together with radiologists have such a vital role to play.

However lower back pain isn’t just restricted to individuals with identifiable pathologies, in fact a great many cases of lower back pain have no identifiable pathological cause and are referred to as simple mechanical lower back pain. Of all the interventions exercise has the strongest evidence base, and Laurie prescribes exercises and stretches for this condition. That said a great deal of study is going in to the relief of lower back pain, particularly chronic LBP and where more exact identification of the specific somatic dysfunction is possible, adjustment and soft tissue treatments, may well be highly cost effective. Larger studies to prove this are underway.

 

Laurie encourages clients to read the guidelines for the management of lower back pain and to stay active, stay warm and well hydrated.

http://www.aafp.org/patient-care/clinical-recommendations/all/back-pain.html

Study finds singing stops sleep apnea

The science is in – you don’t need bit of plastic in your mouth or some other weird contraptions; chances are you just need to sing to get a good nights sleep.
And if like me you think a dying raven makes more tuneful noises – sing in the shower, sing in the car (if your’e alone).
“Sing. Sing a song. Make it simple; to last your whole life long
Don’t worry if it not good enough for anybody else to hear, just sing…sing a song”