Osteopathic Treatment Q&A

The following is a letter I received with some common questions concerning osteopathic treatment:

Dear Dr. Dolgin,

Could you please explain to me exactly how an osteopath treats a patient (or helps a patient's body treat itself)? I read the paragraphs in your web site (thank you for putting up such a great site), but didn't get quite the answer I was looking for.

I understand how traditional Eastern doctors can "read" a patient's body through pulse--measuring strength and rate to determine the health of various organs. And I agree with what I've read on your web site about the body being interrelated. I could see how an osteopath could place his or her hands at the base of a patient's skull, or along the spine, and with a developed sensitivity say that there is stress in the parasympathetic nervous system. But how can an osteopath feel the fluids/energy etc. along the spine and say "There was an injury once behind your left shoulder,"... or "Something is going on in your right leg"? These are all actual statements made by an osteopath near me, and I don't understand how she can make those statements merely by cradling my head. Nor do I understand how she can help me overcome them by placing her hand under my coccyx.

...I am turning to you for the explanations I'm seeking. I hope you don't mind this too much. Can you help me?

...I, frankly, also expected someone to do manipulations more along the lines of rolfing and chiropractics.

Any insight you could share would be greatly appreciated...

Per your letter, I wish to refer you to an outstanding reference on Osteopathy which appears on the New York Times' best seller List, "Spontaneous Healing." I know many of your questions will be answered by the Harvard-trained MD, Andrew Weil, who authored the book.

Dr. Weil, who was also skeptical of Osteopathy, made an exhaustive study of this little known "hands-on" approach to healing. He wanted to determine whether there was any credence to the "miraculous" stories of "cure and recovery" reported to him by many of his patients and colleagues. After years of study, Dr. Weil has become an ardent supporter and continues to refer many of his "toughest" cases to osteopaths.

As for your specific questions, I am impressed with your desire to learn more and hope to demystify what takes place when a physician administers Osteopathic Manual Medicine.

Though a DO attends medical school the same number of years as an MD, he is taught more anatomy, specifically, osteopathic clinical anatomy. In addition, the "Cranial Osteopath" trains several additional years in anatomy and physiology to develop his/her palpatory senses (hands-on diagnostic training).

He/she has an "educated" sense of touch and can identify every part of the body and how it should feel under normal circumstances. That way, it is possible to identify dysfunction in the "living anatomy" (i.e. compression in bones, obstruction to cerebral spinal fluid, damage to tissues, etc.)

I am frequently asked how I can feel dysfunctional tissue in a leg, the back, or the pelvis, while my hands are on a patients head. At that point I ask my patient if he or she has ever driven a car with a manual transmission. They usually answer that they have at which point I ask them how they know that the car is in gear when they don't actually have their hands in the gear box.

I point out that they have their hand on an extension of the gear box and are shifting the gears generally by use of their sense of touch and position in space. This is precisely the way an osteopath does it. The shift lever is synonymous to fascia.

As you are aware, there is only one piece of fascia in the human body, albeit a large piece. It is circular and continuous with itself. I tell my patients to think of it as similar to one large piece of shrink wrap, covering all the organs, lining all the body cavities and encasing all parts of the body including muscle, nerves, blood vessels, and bones.

One can see how tension any part of this fascial envelope will be transmitted to all other parts, since it is literally one big piece of tissue.

Remember that fascia also has contractile elements in it as explained in any histology book. These contract in response to injury and a pattern can be imprinted in the body that way.

Please try an experiment: Take a piece of plastic wrap and tape one end of it to a stationary object and hold the other end in your hands, with the remaining corners held between your thumb and index fingers. Hold it with a slight amount of tension in the plastic and someone put a coin on it while your eyes are closed. After a while it will be easy to identify where and how far the coin is from your hands.

As for the injuries specific to your case, you mentioned your osteopath could feel an injury to your shoulder; however, her hands were no where near your shoulder at the time the diagnosis was made. The answer is simple. Fascia (connective tissue) extends from the top of the head to the bottom of your feet. Your osteopath could feel the fascia pulling from your shoulder at the time she was treating another part of your body.

With a state of chronic inflammation, tissue fibrosis occurs, that is fibrous tissue is deposited continually at the site of injury or altered structure. You can read about tissue changes with acute and chronic inflammation in any pathology book. Each has its own feel due to the distinct physiologic changes that it produces in the body. Due to this, a DO can frequently "date" an injury by the feel.

A patient in a motor vehicle accident doesn't realize that their body reads like a road map to the osteopath because of the trauma locked into the tissues. Each injury creates a pattern in the body which is unique, depending on the amount of force and direction that force was applied to the tissues.

One physician explained to his patient, who was in extreme pain after a car accident, that her tissue structure could be compared to the following scenario: Before the accident, the tissues felt smooth – like the side of a wax milk cartoon. But, after the accident, the tissues felt irregular just like those in a slightly compressed or damaged wax cartoon. In fact, the crush pattern in a carton demonstrates the type, magnitude, and direction of forces applied to it as reflected by the wrinkles in the milk carton. The same holds true for human tissue.

The pathological force can be to a discrete part of the body (arm, leg, head, etc.) or to the whole body (inertial injury, such as an auto accident). Each of these has a different palpatory sensation. If the forces of an injury are strong enough, they are literally imprinted on the body tissues. If the injury is not too large, the body treats out the pathology with no need for assistance, otherwise it will remain.

The Osteopath's "sense of touch" actually feels the dysfunction in the tissues. Physicians monitor tissue tension, tissue texture, and different waves of tissue motion, among other things.

Each physician will perceive his sense of touch in a slightly different manner than his colleague. One physician may sense tissue texture very well, another may be best at sensing motion, and yet another may be good at judging position. Some DOs feel how fluid waves generated by the CNS travel down the body, others judged static or dynamic tension in the body. Each one of us feels things in a slightly different manner and relies on a different combination of these senses to make clinical decisions.

DOs are taught to treat the tissue dysfunction that they find on palpatory exam. Dr. Still, who founded osteopathy, would teach anatomy in great detail and make sure his students trained their sense of touch. He rarely taught treatment techniques to them. He reasoned that one cannot anticipate the myriad of problems that he or she could encounter as a physician. Some do truly defy description with words.

By learning general principles of treatment a physician can easily create several ways to treat a problem. Most of the more advanced DOs are trained in this manner and really do not rely on techniques.

I will describe some common ways of approaching treatment:

A physician can create a counterforce along the same plane in the same direction as the pathological forces.

Compression or traction in precise amounts (and for the correct period of time) can be used to balance the tension in the body.

The fluids, membranes, bones and/or CNS can be engaged to treat an area by working with them.

A practitioner can help the body treat itself by positioning the area the body is working on and the level it is working at (bones, CNS, fluid, and/or membranes) by positioning body parts to affect it. Through fascial continuity this can be done from any part of the body, though most easily done on the part being treated.

You can move fluid through the body with a very light touch as there is continuity of fluid throughout the body. Bones are connected to fascia or derivatives of fascia and fascia is connected to the CNS; the CSF runs between layers of the meninges (derived from and continuous with fascia). Any one of these can and will affect all the others.

As the CNS goes through its rhythmic motion it gently pulls and lets go on all parts of the body. This motion is vital and basic to life and explains how the body treats itself. It is this mechanical motion that provides the force with which the body begins to treat itself.

This motion helps distribute fluids and this is responsible for nourishing nerves and the structures they run to. Structural problems cause tissue contraction and create added tension in the body. This will pull on the fascia and CNS and essentially pull the whole body towards itself. The effect of this is to direct more of the rhythmic motion towards the pathological area. This will enhance the motion in that area and the body will essentially direct more of the motion or "pulling " towards this in an effort to release the tension. This creates motion that is different than normal and it occurs around a certain axis or fulcrum. By changing the state around the fulcrum, the physician can get the pathology to release.

I have simplified diagnosis and treatment in order to easily explain them. Keep in mind it is more complex than this and there are more factors to consider.

Like most patients, Mr. Bernstein, you may expect more "force" in treatment likening it to "Rolfing" or "Chiropractic." Osteopathy is not similar to either of these. It is an interesting side note, that both these are offshoots of osteopathy, their philosophy only bears a superficial resemblance to it and concern only part of the osteopathic philosophy applied in a specific manner.

The nation's leading osteopaths aren't concerned about putting force into your body, but, rather taking the force out.

I just put case histories on my web site and you might be interested in reading them to understand a little more about the normal course of treatment.

In summation, I would encourage you to read the chapter on Osteopathy in "Spontaneous Healing" for further information. And, keep in mind, deep cure takes time. It may not take place in two or three sessions. Your osteopath has trained many years and endured a great deal of prejudice and skepticism to provide you with a service many patients have found invaluable.

Thank you for your interest.

Best Wishes,

Eric J. Dolgin, DO