By Lee Jarvis. Initial research completed by Cortney Zettler. Proofreading and editing by Sasha Wilde.
In this three-part series we intend to analyze some of the reasoning that Osteopathic Manual Therapy (OMT) uses to justify a full body treatment approach. In this first article we will review the early Osteopathic writings on a full body assessment and treatment. The second and third articles will focus on an overview of biomechanical relationships to movement and the multiple potential inputs of pain.
It is traditional in Osteopathic writing to start with the first principle of Osteopathy, “The body is a dynamic unit of function.” Though we certainly agree with this principle, we have decided to go with a different starting point. In the book Osteopathy, Research and Practice by Dr. Andrew Taylor Still, Dr. Still spends a considerable amount of the book explaining the treatment of patients with specific diseases. The book is divided by anatomic region and further divided into an explanation of each of the diseases of the region. This is followed by Dr. Still’s discussion regarding how Osteopathic assessment and treatment should be delivered to the patient with reference to specific diseases in question. Dr. Still covers numerous diseases and it is made clear that a full spinal assessment and treatment is conducted when approaching treatment of many of these diseases. For the purposes of completeness, we have gone through the book and counted the number of times where Dr. Still indicates that the Osteopathic practitioner should assess the majority of the spine or where he dictates a full spinal treatment for the given patient with the disease.
In certain passages, Dr. Still states outright to “explore the entire spine beginning with the atlas” (pg. 151). In many other passages, Dr. Still describes an assessment and/or treatment process that encompasses the entire body. As to not misrepresent the book, we erred on the side of caution in our count. If any entry had less than the majority of the spine represented (at minimum Atlas to Sacrum) it was not included.
It should be stated that an OMT full spinal assessment or treatment typically indicates working with the limbs (arms and legs) as well. When assessing or treating the spine, the entire arm and leg are often used as levers/leverage to move large and small regions of the spine. Utilizing the arms or legs to move the spine is what is often referred to in Osteopathy as “long leverage” as it is not just direct pressing on the spine (which is comparatively a “short lever”). During normal human movement, such as in ambulation, the arms and the legs act on or induce motion upon the spine. Therefore, the use of the arm or leg as leverage is an effective way for Osteopathic practitioners to encourage movement of the spine. As well, it is common in Osteopathic practice to “trace out” the spinal nerves and the vascular pathways from the spine and through the limbs, as these tissues share and influence nerve function and circulation. Direct spinal movement/mobilization certainly occurs in OMT, but usually does not make up the majority of the treatment (and sometimes is not used at all).
In Research and Practice there are 100 diseases explained and followed with a treatment approach. Of those diseases listed there are 33 occurrences in which Dr. Still indicates that the majority of the spine should be assessed and/or treated. Therefore, a substantial 33% of the treatments indicated full spinal assessment and/or treatment. Of these 33 occurrences the regions/ranges of spine indicated most often were:
- Occiput to Coccyx (9 times)
- Atlas to Coccyx (7 times)
- Occiput to Sacrum (7 times)
A few examples of notable, but not counted, occurrences included assessment and/or treatment from:
- Cervical to Lumbar Spine
- Atlas to Lumbar Spine (3 times)
These are notable due to the substantial range of the spine represented. Although they were not added to the final count, we hope the reader will agree they are still indicative of an osteopathic preference towards a full body treatment.
Some notable quotes indicating a full spinal assessment and treatment include:
“Thus the importance of perfect adjustment of every rib, and every vertebra from the head to the coccyx, or the work will fail to show perfection in place, form and function in some part of the body.” (pg. 71)
“My object is normality at every point of articulation of spine and ribs, from the atlas to the sacrum.” (pg. 147)
“I proceed to adjust from the abnormal to the normal all bones of the body from the sacrum to the atlas.” (pg. 183)
“I have found the cause of much of it in the impoverished condition of the whole sympathetic system from the atlas to the coccyx.” (pg. 197)
“…beginning my work with the coccyx and ending it with the atlas.” (pg. 197)
“I examine every bone and every joint from the occiput to the coccyx.” (pg. 205)
“This will follow the return of nutrition to its normal condition which depends upon an unobstructed nerve and blood supply to the spine from the occiput to the sacrum.” (pg. 224)
The above quotes are ideal for our argument, in that they illustrate Dr. Still’s emphasis on considering the whole spine, however, there are a greater number of descriptions in Research and Practice whereby Dr. Still explains assessment and treatment of the entire body in a sequential manner. This could be a “top to bottom” or “bottom to top” process but the explanation typically involves the majority of the spine, clavicle, ribs, pelvis, and the upper and lower limb. We should specify though, Dr. Still is not saying that every single part of the body receives the exact same amount of assessment and treatment, the amount of treatment delivered is always dependent on individual need. Dr. Still identifies key areas of anatomy that should be more thoroughly assessed, yet, he leaves it up to the skills of the practitioner to determine what needs to be done (and to move on if no treatment is required).
From this we can say that the earliest writings on Osteopathy, written by the founder himself, advocate for addressing the majority of the body in assessment and treatment. In the coming two articles we hope to explain some simple, modern rationales for exploration and treatment of the entire body.
References
Still, Andrew T. Osteopathy, Research and Practice. Kirksville, Author, 1910, archive.org/details/osteopathyresear00stiliala/page/n5/mode/2up.
Image retrieved from the Museum of Osteopathic Medicine.