Osteopathy, A Brief History
Osteopathy was founded in 1876 by Civil War surgeon Dr. A.T. Still. The conventional medicine of the time included the use of mercury, laudanum and leeches. Where pus was produced by the wound during surgery, it was thought that healing was taking place, whereas it is now known that pus is a sign of infection.
After the Civil War, Still became a farmer, building and maintaining his own equipment. He noticed that a cart wheel which was fitted well and greased allowed the cart to travel faster, made less noise and broke down less. This inspired the notion that the body is “an intricate machine which, if kept in proper adjustment, nourished and cared for, will run smoothly into an old useful age.” This formed the basis of Still’s philosophy.
Still had three children who died from Meningitis. He was unable to help them and watched each child die. As a response to his loss Still sought and learned new ideas about health. It is suggested that he drew inspiration from Native Americans and Chinese immigrants. Man’s dominance over nature is questioned by Still’s original philosophy. Medicine was viewed as secondary to the healing power of nature, where a person with healthy mind, body and spirit would enjoy abundant health!
This experienced battlefield surgeon founded Osteopathy based on the idea that the structure of the body has a profound impact on how the body functions. The body cannot be viewed just as a collection of separate tissues; rather dysfunction in one area affects other areas. This philosophy of the body being a single unit is underpinned by common sense, where the tendency of medicine is towards high-tech imaging, nano drugs, key-hole surgery and away from addressing the whole person, thus medicine can separate the person into tissues, organs or systems which can mean medicine cannot see the wood for the trees.
Modern Osteopathic training is UK Government regulated and university based, borrowing heavily from modern medicine, where osteopathic students study: Anatomy, Physiology and Pathology so that patients whom present with certain pathologies which can mimic musculoskeletal pain, are not ignored and treated as musculoskeletal pain. A good example of this is Angina Pectoris where the heart muscle is denied sufficient blood due to atherosclerosis, (arterial clogging by fatty substances including LDL or Low Density Lipoprotein, which carries cholesterol from the liver out to the cells where if it is not used the cholesterol can build up!), causing the heart muscle to release Adenosine and Bradykinin which irritate nerves traveling away from the heart that join the spinal cord in the upper back and mid neck, triggering the Anginal pain felt in the arms, chest and jaw. So a problem in the heart muscle has a knock-on affect in the spinal cord in the area which manages the arms, chest and jaw. This is a heart problem being felt distally, where no amount of massage or stretching can help the underlying heart problem. Osteopaths are trained to screen for these conditions.
In essence, Still’s Osteopathy started with the manipulation of joints and bones. Osteopathy later developed and moved closer to mainstream medicine. Today Osteopathy is highly regulated by UK law and is recommended by the National Institute of Clinical Excellence as a safe and appropriate modality for non specific low back pain. To practice as an Osteopath, practitioners need to be registered and have met the exacting requirements of the General Osteopathic Council’s Register of Osteopaths. Undergraduate training requires a minimum of four years full-time study.
Low Back Pain. What is it?
80% of us experience low back pain at some point in our lives. This pain can often resolve itself if the cause is removed. For instance, when you change your job and no longer perform bending or twisting tasks the cause is removed and your body heals itself. Low back pain occurs where the body’s ability to heal itself is outweighed by the damage being caused. The complexity of low back pain is in the variety of the sources of pain. People try to make sense of low back pain by using terms like Lumbago or Slipped Disc. Understanding low back pain requires the ability to pin-point where the pain where the pain travels to and what movements provoke the pain.
Sacroilliac Joint Pain:
Our body is drawn down by gravity and must resist this invisible force. To stand upright and walk requires a balance between stability and flexibility. The weight of our body presses down through the spine, into the sacrum, through the sacroilliac joints and down the legs. To maintain our upright posture while walking requires that the pain sensitive sacroilliac joints allow a small amount of movement. Restriction or excessive play in these important joints can give a deep local ache on the belt line either side of the spine, or opposite the joint over the hip.
Intervertebral Disc Pain:
An estimated 30% of us have a disc bulge in our lower backs and feel no pain or symptoms what-so-ever. As we age these gel filled discs of connective tissue naturally tend to dry out, thin down and degenerate giving little cracks or fissures. Discs provide help to manage bending, compression, torsion and shear between the bones of the back. They do not act as a shock absorbers.
What can go wrong?
Discs become thinner, allowing the bones to move closer together, with the additional problem that with thinning the ligaments, tendons and muscles that join the bones appear over-long leading to that section of the back to become unstable. Your body responds to instability by building more bone, like castle buttresses, which in time can lead to bony spurs forming which can compress nerves, vessels or tendons.
With disc thinning and drying the twenty two concentric rings of the outer disc can sustain cracks whereby the gel-sugar inner can squeeze out, giving a bulge (prolapsed, herniated or just bulged). This extrusion then pushes into nerves, ligaments or blood vessels causing compression and inflammation which in time can lead to a variety of pain presentations! Sometimes this can cause nerve pain which seems to radiate down into the leg.
What To Do?
Discs hate the combination of bending forward and twisting, especially from a seated position. If you sit at a desk all day or drive a lot, consider how you move while in your job. The greater the pressure pressing into the disc the more likely is a protrusion out from the inside of the disc. As we age the inner gel solidifies, so a diet that provides enough water will help limit this degeneration. Most prolapsed discs bulge out backwards and to the side, hence why discs hate forward bending, as the inner gel is squeezed backwards against the spinal nerves. So consider reversing the daily seated posture with McKenzie exercises, where you lie in a comfortable face down or prone position with a cushion under your chest giving a gentle backward bend, encouraging the gel to press away from the spinal nerve. Like all exercises please do not continue if you feel pain.
End Plate Fracture
The top and bottom of the disc is known as the end plate which can fracture. The inner gel can bulge up or down often leading to Schmorl’s nodes. End plate fractures cause localised back pain after a fall, or where a lot of lifting and bending has been done without preconditioning, like the first Spring digging session in the garden. The endurance of the spinal muscles gives-out and the end plate takes the load! In the laboratory and from the evidence of patients whom report an audible “pop” as the end plate fractures. End plate fracture with the up / down bulge of disc gel can cause nerve root compression by the immediate loss of disc height, where the vertebral foramina is partially closed giving the symptoms of true herniation.
Recently the news has told us of back pain caused by an autoimmune response to degenerative changes in the disc. The inner gel of the disc was never designed to come out. When it does your body launches an attack upon it as if it were a foreign body! Thus with an influx of Neutrophils and other white blood cells you get pain from inflammation giving you back ache.
Ligaments connect bones to other bones and have a role in limiting the mobility of joints. Research states that two ligaments in your back produce pain: the Interspinous and Iliolumbar ligaments. Each ligament then has certain movements which provoke pain. The Interspinous ligament stops the spinous processes from over-seperating, and will report pain when you bend forward, this pain will initiate as you progressively bend forward and then cease as you continue. Pain can be local to the spine and also perceived as referred pain down into the lower limbs. The Iliolumbar ligament connects the lowest Lumbar vertebra to the pelvis and resists spinal rotation, forward and side bending: this when pressed on directly, will report tenderness. Some research suggests that other structures may be responsible for tenderness over the area. These include: the LIA Lumbar Intermuscular Aponeurosis, the lumbrosacral joint or the muscles of the back.
Facet Joint Pain:
In-between each bone in the spine you have a gel filled disc, with two little facet joints set just behind the disc which act primarily as little rails that limit the movement in the bones. An additional role of the facet joint is allowing us to know where we are in space, like when you wake-up in the pitch dark, but you can still touch your nose! This positional sense derives from joints having nerves within them which if compressed can elicit localised pain. If the facet joint becomes arthritic then the boney growth can impinge on spinal nerves
People use their contractile tissues to move and stabilize their body. Muscles can move joints phasically and also stabilize joints. The deep Psoas hip flexor muscle has a dual role, where the posterior portion stabilizes the Lumbar spine and the anterior portion bends the hip. Some muscles have further roles to play, the Psoas is one such muscle. It has in addition to its moving and holding roles the Mighty Psoas has the following additional roles, From Professor Jo Ann Staugaard-Jones: