However it still makes a lot of sense to discuss some subject areas in more detail and to look at the specific concepts involved.
In a sense Osteopaths are trying to hold the middle ground between the strongly reductionist approach, that looks only at local symptoms and the strongly holistic approach that insists on a broad perspective, even when it is not that useful.
All the osteopaths in our practice will take a broad and holistic view of each patient they see. However, Osteopaths are individuals too, and, over the years, find certain areas of treatment are of particular interest to them.
In this section we outline the various areas in which each of us has a special interest.
Osteopaths have specialised in diagnostic touch from the start of the profession. We use the sense of touch, informed by our knowledge of anatomy, to work out if any areas of the body or movements of the joint feel tighter or more restricted than they should.
With the movement of joints in the arm, leg or spine this is fairly obvious. However, following the pioneering work of W.G. Sutherland, osteopathy began to focus on subtle rythmic movements palpable most easily within the cranium, but also present throughout the body. Sutherland‘s concepts are widely practiced and many osteopaths are convinced that cranial osteopathy is a very useful, safe and effective way of helping babies and children as well as adults.
The method has been controversial from the start, both within the osteopathic community and more widely. This controversy does not centre around issues of safety; even its detractors believe the approach to be safe, but concerns the lack of formal research based evidence for its effectiveness.
Many osteopaths around the world believe that in due course correctly designed and applied research will show dramatic results in favour of this method.
Many people think Osteopaths only treat low back pain - this is not the case by any means. We can help patients with all sorts of problems arising from the musculoskeletal system. Nevertheless, it is an area where Osteopathy is particularly effective and probably about half of our patients first come seeking help for low back pain.
It is often said that "80 per cent of back strains get better within 8 weeks, regardless of any treatment" (see "The Times", Body and Soul supplement, 17 January 2004). But who can afford to be incapacitated with low back pain for 8 weeks, and what about the other 20 per cent who cannot get better by themselves?
Diagnosis of the problem is the key to success in treating patients with low back pain, as there are a multitude of variables which contribute to the condition. In the first instance, care must be taken to spot any serious disease giving rise to the patient's pain, but, in most cases, low back pain makes life wretched, but is not life-threatening.
The lumbar spine is a complicated area, where damage to structures such as intervetebral discs, ligaments, tendons and muscles, with or without the involvement of nerve roots giving referred pain elsewhere, must all be considered. Some well-known causes of back pain are:-
Intervertebral disc damage
This is the so-called "slipped disc" - even though it doesn't slip anywhere. The disc is the shock absorbing pad which lies between each bone of the spine. Think of it as being a bit like a doughnut, with a gooey, liquid substance - the "nucleus pulposus" - in the middle, surrounded by rings of tougher fibres ("anular fibres"), and all encapsulated within a skin around the outside. In a so-called "slipped disc" - more correctly "herniated" or "prolapsed" disc, the tough rings of fibres develop a fissure or tear, allowing the liquid in the middle to seep outwards - a process which may well take years. The process is not painful because there are no nerves in the centre of a disc. Only when the liquid reaches the outer part of the disc, and causes a bulge within its skin, does it give back pain. As you may imagine, getting to the painful stage is often the 'last straw' in a process which has been going on for a long time - thus patients often feel they have done little or nothing to warrant such severe pain. If the process goes a step further, and the liquid bursts out of its skin, it may well hit a nerve root and pain will be felt acording to the area that nerve root supplies. At this stage the patient may well have raging leg pain ("sciatica", as it is often the sciatic nerve which is compressed).
Osteopathy can do much to reduce the abnormal compression of a disc and to relieve the pressure of a disc protrusion on nerve roots. If, however, the problem does not begin to resolve quite rapidly, or signs of nerve root compression are becoming worse, the Osteopath will refer you back to your General Practitioner, and surgery may, in a few cases, be necessary.
Facet Joint Locking or Strain
The spine is a segmental structure, permitting considerable flexibility. At every level there are two small joints. If a joint moves too far, or movement is poorly controlled by the muscles, a joint may strain or even lock, giving sudden, severe back pain. The back muscles may go in to spasm and movement becomes almost impossible. This problem can be quite frightening, but can be very simple for an Osteopath to sort out, by manipulating a joint so that its mobility is restored, the muscle spasm eases, and the pain goes as soon as any inflammation present has subsided.
However, patients problems are often more complicated than the paragraphs above suggest. It is more common for a combination of structures to be involved - say a facet joint lock, together with strain of the surrounding ligaments which try to support the spine. There may also be irritation of a nerve root emerging close to the joint, which then sends messages to the muscle group it supplies to over-contract, givng cramp-like symptoms. An Osteopath must also be looking for the underlying causes of the problem. For example, a disc may have become abnormally worn, and eventually prolapse, because another area of the back is too stiff and does not carry out its share of movement - this may be for reasons associated with the posture one has learned over the years, or even problems of development back in one's teenage years (known as osteochondritis of the spine or Scheurmann's Disease).
Stiffness and inflexibility of the spine are a common cause of recurring low back strain and pain. This may in part be genetic, it may be to do with previous damage to the area causing the ligaments and muscles to become shortened and tight, or may be to do with arthritic (degenerative) changes in the spine. Arthritis (sometimes called spondylitis) in the spinal joints, associated with abnormal or early wear, commonly causes significant stiffness and this decreased flexibility often leads to recurrent strains in the back. The resulting pain can, however, by successfully treated by Osteopathy, and mobility exercises will often help. Arthritis of the spine rarely leads to significant disablity, and patients who have been given this diagnosis should not be unduly worried (talk to an Osteopath about it!).
Over-flexibility or instability of the spine can give rise to just as many problems. Many patients will remember being very gymnastic as a child, but, over the years, leaving physical activity behind them as the demands of daily life required more and more time. People like this often have rather elastic ligaments, permitting a big range of movement at joints, which is a bonus whilst the muscular strength is there to support the spine. But if activity decreases, adequate muscular support may also be lost, and repeated back injuries may result.
Research over the last few years has focussed more attention on sufferers of long-standing (chronic) or recurrent back pain and its causes. It has been found that patients like this often have an imbalance in the strength of the deep muscles of the back ("multifidus"), which stabilise one bone on another, and the longer, more superficial muscles (Erector Spinae"), which bring about the big movements of the spine. Correct co-ordination between the two may also be lost, so that the stability of one bone on top of another is poorly controlled, whilst the spine as a whole is being moved about - resulting in injury and further loss of strength in Multifidus and co-ordination. Rehabilitative exercise, such as Pilates, can be very useful in addressing this kind of damaging imbalance.
The causes - or rather the combination of causes which adds up to low back pain - are so varied - as varied as people themselves. In addition to considering tissue damage, an Osteopath must also consider a patient's ability to heal - do they, for example, suffer from other pathologies such as Diabetes which makes recovery less rapid, - the occupation they are undertaking, the physical demands of their home-life, their emotional stress which can affect the state of their muscles, and so on and so forth - the list is almost endless. This is why an Osteopath needs to take such a detailed history and undertake a thorough examination of the patient in the first instance, but also needs to re-evaluate and explore a patient's structure more thoroughly at each treatment session, adapting trreatment if necessary as changes begin to occur.
Cranial osteopathy can be very useful for adults as well as children.
Overall mobility is reducing throughout adulthood, both in the limbs and spine, and more extensively in the head (cranium). Despite the finding that the gaps between the many cranial bones (sutures) can tend to close over or fuse as we age, osteopaths believe tiny amounts of movement are preserved due to the slight flexibility of living bone.
Because of this gradual reduction in cranial movement we believe that headaches can become more likely or more severe and persistent symptoms after a head injury may be more likely.
A full case history of symptoms and medical history is taken. The osteopath will often be surprisingly interested in injuries that happened a long time ago; even birth trauma can be relevant at any age.
If appropriate, the examination commences and includes much of the mobility and postural assessment and observation that is common to any osteopathic assessment. What is different is the use of light touch, which feels like being cradled in the hands to identify areas of tightness in the body and in particular the head.
Treatment consists of a similarly light but more directed touch to begin to restore motion where possible.
After treatment adults may initially feel a little ‘light headed’. It is very rarely a problem as long as they are warned that it may happen. Another common reaction is to be slightly more sleepy afterwards and that same night. Again this is rarely a problem as long as patients are warned.
In adults the response to treatment is slower and more treatments may be required than in children. The osteopath will try to give some idea of how many treatments it is reasonable to try and agree to review the situation at the end of the course of treatment.
When a woman first hears that she is pregnant the birth can seem a very long time away. But those months will be packed with events as the baby grows and the mother’s body changes.
Osteopathy places a great emphasis upon how the body copes with the demands that life and posture place upon it. This means that osteopathy is an excellent treatment to have throughout the pregnancy.
So what is an Osteopath looking for when a woman comes for a check up early in her pregnancy, or even before she is actually pregnant?
We are essentially checking her musculoskeletal system, (her joints and muscles), to see if they are in good shape for the demands of the pregnancy and labour.
We are looking at her posture, gently palpating and moving her body to see if everything is mobile and relaxed.
We focus particularly upon the low back and pelvis, but the hips and the rest of the body are important as well.
As her posture changes during the pregnancy, due to the increasing size and weight of the baby and of course hormonal influences, the most important thing is simply to keep up!
The best time to discover that you have an area of tightness in the back, or an area that isn’t working as well as it should, may be before you are pregnant, or at least early on. It certainly isn’t good to find out late in the pregnancy with an episode of back or pelvic pain.
Though as Osteopaths we are well used to treating and helping women who have back and pelvic pain ‘out of the blue’ during pregnancy, we are keen to see women early and try to prevent problems.
There are no safety concerns about treating women during pregnancy, but even so we take extra care to make our treatment as gentle and careful as possible, particularly during the early weeks of the pregnancy when spontaneous miscarriage is more likely.
After the pregnancy we are keen to check the mother, (and of course the baby or babies), to help her body to get back to normal as soon as possible. If we are needed and mother or baby cannot travel, perhaps being confined to home or hospital, we will visit.
Whilst little formal scientific research has been undertaken into the effectiveness of osteopathy in childhood, the improvements we see in our young patients leaves us in no doubt that it can provide huge benefits.
Very light touch is used to identify any areas of tension and tightness in the body which can originate from birth or subsequent injuries or illnesses, and which can cause babies to become very distressed..
A similar light touch is used to correct these disturbances, though as children develop, some gentle techniques similar to those used with adults may be used. When treating babies, very light touch is used to identify areas of tightness or tension in the baby’s body.
If the treating Osteopath is concerned that there is a more serious problem going on, he/she will, of course, refer the baby back to their GP for conventional medical investigations.
Martyn Morgan is happy to talk to parents in advance to advise whether osteopathy is likely to be helpful in individual cases. (Tel: 0117 949 1290).