Osteopathy

The British Institute of Osteopathy was set up in 2002 and was built upon the great tradition of the osteopathic approach to therapeutics.

For any therapeutic to survive, it has to evolve to take account of the ever-changing clinical setting. This does not mean adopting the medical narrative and trying to make osteopathic technique fit – which I call ‘Osteolite’ – it means evolving the narrative to make it relevant in the modern clinical setting.

The current clinical setting is very different to the times of early osteopathy. Nowadays patients self-medicate, rarely now do patients understand the value of fever or rest and stress management. What we present here is a brief overview of where osteopathy has come from. This shows the roots of the pathway that has led directly to the new online course 
‘Fast Track to Better Practice’ and a new evolutionary narrative – drawing on our roots, to make those brilliant simple early ideas time now relevant.

The two first osteopathic principles were:

1. ’The rule of the artery is supreme and from its disturbance marks the second, minute and hour that disease starts.’ A T Still,

This led directly to:

2. Natural immunity to disease stems from structural integrity Quote from A T Still

Interesting to note that Still observed that the processes of disease involved disturbances in somatic factors, not distinctly external causes, and these revolutionary ideas lay at the heart of osteopathy’s founding principles.

Structural integrity also extends into the ability of the body to bring balance and homeostasis through all of its systems – like a Biome. This means that all structures are fit for function. In order to be able to adapt, the body has the capacity to adjust, within its best limits, to stay alive and vital. When we lose the ability to adapt and adjust – this is where osteopathy as a therapeutic can step in.
Osteopathic treatment is concerned with the process of restoring adjustment to the body by identifying and removing obstructions to health. (This does not mean the isolated cracking of joints, rubbing of isolated stiff bits or knots, which is Osteolite)

Some modern terms for the word adjustment might be ‘restoring homeostasis’ or allowing balance back to the body. Health and un-health are both natural phenomena and the body does not go wrong, it does the best it can to ‘go right’.

Not focusing on symptoms alone

Osteopathic treatment is about opening up the whole field of diagnosis and considers all the interactive relationships of the body. When we make a constitutional diagnosis, we look at the whole context of the presenting problem, instead of just focusing on the presenting symptoms.

For example, a patient with low back problems could have ‘viscero somatic referred symptoms’ which often occurs with constipation and menstrual disturbances. Attempting to treat the back pain alone with just painkillers denies the patient an opportunity to address the real causes. Any underlying issues thus not addressed, could develop into a chronic problem.

Just like in building work, a crack in a wall tells an Architect that the foundations may have slipped, putting a patch over the crack and doing nothing else is likely to make the crack spread. ’This is how the acute is turned into the chronic and ultimately the degenerative.

Howard Beardmore DO

Disease or un-health, normal or abnormal?

So the idea that ‘diseases’ are isolated entities, or pathologies, in their own right, is not always true. Early Osteopaths like Ernst Tucker DO felt that we needed a new diagnostic. He would classify deviations from health in terms of the clinical adaptations in the physiology through the neuro-endocrine system; rather than use the vocabulary of orthodox medicine which had become distorted, eclectic and confusing.
If we are to approach therapeutics from a constitutional perspective, we need a narrative that reflects how we make a diagnosis and treat our patients and understand the functions of the body as a biome. for example: Constitutionally the immune system is a waste recognition and excretion system, if we obstruct its efforts to keep us ‘clean’ we start to produce symptoms.

This is not pathology, it is normal immune system functioning like the oil warning lights coming on the dashboard, it is telling us to take action. We cannot just pull the light bulb out and expect a return to health!

Symptoms in the body can be explained as a physiological reaction to toxicity. This toxicity is effectively retention of our own waste products under the actions of chronic stress hormones, but can also be external poisonings from poor diet or toxic environment too.
In the new online course, a deeper discourse on the importance of the constitutional narratives on inflammation and immune function and health can be explored. Exploring the constitutional immune system

Tucker Wilson DO The Theory of Osteopathy 1936

‘There are two organized agencies for combating disease or for conducting the defense of the body against unfavourable influences – the nervous and endocrine systems’

Tucker DO, wrote a book called the ‘Endocrine Brain’ which attempted to reclassify diagnosis and describe conditions as neuro endocrine disturbances – rather than distinct and separate medical pathologies.

Although this was a step away from the restrictions of using medical language it still kept us tied to the idea that we needed to label presenting conditions as distinct and different. A true constitutional approach recognises that when the body is well adjusted it is well. When it is not well adjusted it is unwell. Naming the consequence/pathology is academically interesting but does nothing to help the patient in the final analysis.

Irvin Kim Korr

Korr was very aware of Burns but Korr did his experiments upon human patients! Not vivisection, but using a method that tested the electrical skin resistance patterns on patients who had many varied visceral conditions. He demonstrated using dermatomal mapping how various visceral conditions could be recorded electrically and results could be repeated.

He made two really profound statements from his years of great work that certainly helped focus the attention on constitutional approaches to therapeutics rather than segmental observations.

Sustained sympatheticonia as a factor in disease – was a ground breaking theory, linking the various states of disease and lesioning as degrees of ‘sympathetic phenomena’.

2. Korr observed that although adjusting spinal lesioning had a profound effect on quite remarkable pathology, it was difficult to stabilise the adjustments. They would not ‘hold’.

Korr transformed our understanding of lesioning and it’s effects on the constitution but realised you had to do more than attempt to ‘correct’ lesions in isolation – osteolite!

Korr did focused on segmental lesioning, but made honest statements about the limitations of not approaching research from a constitutional perspective. This is may be why using a general treatment bodywork routine has a more stabilising/holding effect on lesioning because it adjusts arch relationships rather than segments. Diagnosing a segmental block and hitting it makes no sense for the patient.

Henry Fryette

‘Dare to be different, so many would rather be orthodox than right’

Fryette, another American Osteopath, gave us a context to understand how the spine moves as a whole, rather than segmentally. His work was extensive, self-reflective and honest. He knew spinal segments moved in groups, depending on the starting posture and devised classifications to describe how the spine lesioned into various compensatory patterns.

When Fryette did early experiments on cadavers observing spinal lesioning, he soon realised that there was no vertical loading and this perverted the results. It was only when he observed contextual movement in real subjects and then tested spinal movement; that he was able to correctly report how the spine moves when lesioned.

He saw spinal lesions as compensations, rather than just problems that needed solving.
Fryette gave us:

1. Segmental lesioning is necessary to allow movement in the rest of the spine.

2. Segments do not lesion in isolation. it is the pre-existing nature of the spinal arch relationships that determines how the spine moves in side-bending and flexion and extension

3. A contextual way to understand spinal lesioning

Again, whilst Fryettes work was ground breaking it was his final conclusions that were the most useful. It is a mistake to think we can treat spinal lesioning by identifying facet blocks and cracking them – without considering anything else. Fryette made some very useful observations about contextual movement but did not give us a rational for treatment.

Film 3 in the online course explores constitutional biomechanics and represents 23 years of thought process behind making stable adjustments. Making Biometric adjustments constitutionally

Early Osteopaths did not study disease

Studying or adopting the orthodox classification of the separateness of disease, borrows terminology from a different discipline to the constitutional approach and often leads to confusion.

If the original observations of A T Still of ‘natural immunity’ and ‘structural integrity’ were to mean anything, then physiology – or how the body works – had to be taught from a perspective that looked at the relationships, rather than the differences in the way the body worked. Physiology is a reflexive phenomenon not a set of isolated specialisms. It is capable of sharing stresses and strains to limit damage when we are under pressure.

Often in patients with chronic constipation we find a chronic cough, or poor skin conditions as the body tries to develop compensatory ways to eliminate waste. Do we stop the cough, put cream on the skin or deal with the underlying cause?

It is the narrative that you use that gives potency to the approach, not the technique’ and nowhere is this more important than in therapeutics.

Many excellent books were written by the A.T Still institute explaining the osteopathic philosophy on physiology, some of which still exist. There are no books on the philosophy of orthodox medicine, only books on protocols, ethics and legality.

They studied health

Studying health instead of disease made sense. If you logged all the physiological similarities in patients with gastrointestinal ulcers for example and those without the similarities in diet, posture, spinal lesions, habits, lifestyle etc would make it pretty obvious what the maintaining factors could be and even the cause.

This may look obvious and begs the question, why doesn’t orthodox medicine acknowledge or recognise this as a logical approach. If you look at orthodox medical training you will see that its tendency towards specialism, reductionism and symptomatic suppression is the problem. Most medical student’s introduction to training involves spending the first year dissecting a dead body to find out how it works! Considering we are working in the field of the living, why not start by studying life?

In the current Covid phenomena, no one seems to be studying people who ‘have it’ and then recover with no sequale? Where is the science in that? No one is studying people living with people who do not ‘catch it’, why not? Is it really that hard to convince medical science to study people who are well and vital?

A gastrointestinal specialist is only able to describe ‘perversions’ that are local and distinct to the gastrointestinal tract (GIT). This is fine if there is an obstruction or an acute trauma injury; the advances in trauma surgery have saved many lives.

The osteopathic Lesion

The description is deliberately trans-dimensional and not definitive, because the constitutional osteopathic approach acknowledges all of the interdependent and symbiotic correlations that are continually part of the homeostasis or balance of health.

This is ostensibly about supporting the immune system’s function to negate the effects of toxaemia by re-establishing elimination, upbuilding, cleaning and repair.

This is infinitely variable, so it is impossible to be prescriptive about treatment. Every patient is a control of 1 and it is their obstructions and enervation’s that are the true field of therapeutic diagnosis, specific to them. Lesioning is as specific to them as the treatment required to restore them to health.

There can be no prescriptive treatment protocols for specific conditions – that is the biggest fallacy medicine throws at the patient. If you chase pathology you are chasing death. Seek what keeps us alive not what stops us dying! Howard Beardmore DO

Louis Pasteur or Antoine Bechamp?

It is an orthodox ‘notion’ that diseases are ’caused’ by germs and viruses based on the work of the 19th Century Frenchman Pasteur. Interestingly on his deathbed he is quoted as his last words to have said:

‘Bernard the germ is nothing the soil is everything’. Louis Pasteur – sourced from Bechamp or Pasteur E Douglas Hume 1923

However, another microbiologist called Antoine Bechamp at the time said:

‘If man goes down the therapeutic route of killing the germ it does not bode well for mankind for diseases are born of us and within us’ Antoine Bechamp. It is interesting to note that in John Lewis’s autobiography of A T Still he noted that Still had read the works of Bechamp and one wonders if, like Henry Lindlahr – Still recognised how close Bechamp was to the osteopathic understanding of health and Natural Hygiene?

Film 1 explores the background to the constitutional Osteopathic approach and how it has been evolved to make sense in a modern clinical setting. It traces our work back to Hippocrates, through A T Still to the current day. To know your roots is to know your work

The unhealth state is not abnormal

Susceptibility to the unhealthy state, is a natural consequence of a disturbed immune system and its cleaning functions. This usually leads to toxaemia, or the retention of waste.

The retention of waste in any tissue is naturally irritative and the consequent inflammation is a normal event. this is the stimulus that starts the cleaning process. This is followed by elimination, restoration and repair. When there is a focus of toxaemia, the whole body may get involved by way of a systemic fever and the process can be quite vitriolic.

Instead of classifying diseases as distinct and different, which other therapies do, early Osteopaths studied the similarities between the degrees of compensations that occur, as a reaction to toxemia. This compensatory process is a normal function of our immune system when health drifts towards the unhealthy state.

For example, when the kidneys get into trouble, the skin will start to excrete, to support – and the patient will smell of urine. If the liver starts to struggle, we see yellowing of the skin, this is not disease as such, it is supportive compensation; a normal immune system adaptation to keep us alive. It is not ‘deficiency in deodorant’

What a constitutional Osteopathic approach can therefore offer, is an alternative diagnostic narrative to the differential reductionist approach. What the Constitutional Osteopathic approach does not do is borrow a medical diagnosis and attempt to suppress the symptoms using different techniques.

For example, bronchitis is not ‘irritation of the bronchioles’ but is in fact cleaning of the lung!

But if we allow the constitution to do it’s work

The patient who is assisted to finish the cleaning with good therapeutic support, however, does not get a repeat performance. Unless, of course, the lung requires a new phase of cleaning or the patient lapses back into enervating habits.

Recovery from years of palliation takes time, effort and skilled mentoring and the practitioners who are still able to do this are becoming scarce. You cannot learn this kind of work on a modular course alone, with no mentored practice. At some point the osteopath in training, will experience managing a patient with a healing crisis and you will need a good narrative to be able to support the patient and understand what is happening.

Being a patient yourself is the best learning curve because it makes the learning real. If the patient is ever to believe they are in good hands the practitioner cannot have academic experience alone.

Health is the ability to adapt both in good times and bad

If the lymphatic and venous systems or the cleaning organs can’t cope then the nearest mucous membrane to the focus will go into overdrive. This is known as hyper-physiology. The constitutional Osteopath looks elsewhere for the failing, recognises the adaptation, removing obstructions to the flow of circulation and thus renders the compensating hyper-physiology unnecessary.

Context is everything!

These normal immune system compensations are what an orthodox approach calls ‘disease’ and it’s symptoms require suppressing. Effectively the suppression of cleaning is what turns an acute toxemia to a chronic one and finally a degenerative one. This is because the restorative part of the immune system is unable to complete repair.

Many so called ‘disease prodromes’ were thought to be the direct result of years of suppressive palliative treatments by early writers and you can see their point.

Personally I think this will bring us closer to ‘degeneration’ without any recourse to recovery because it is the accumulation of suppressed colds, influenza and immune system cleaning events that keeps us well; not disinfectant. The prevalence of chronic disease modern man is currently experiencing must be due in part to the unprecedented access to over the counter palliation. Without any ‘pathway’-cleaning/ healing events for the life of the patient – the body will just go straight to terminal illness. In the words of Antoine Bechamp on germ killing as a therapeutic approach:

“If man goes down the therapeutic route of killing the germ, it does not bode well for mankind’

Sourced The Eye of Bechamp by Hector Grasset 1913 translated by Jocelyn C Proby DO MRO.

Why randomised controlled trials (RCTs) don’t work

Orthodox medicine demands that any therapeutic has to satisfy the ‘gold standard’ of randomised controlled trials. There have been many failed attempts to do this with osteopathic treatments, an understanding of why these attempts will always fail needs to be discussed, because a lot of time is being wasted, with good intent; that could be put to better use.

One reason why randomised controlled trials or RCTs so often fail to produce any evidence to support alternative approaches to maintaining health is because RCTs were designed to test pharmaceutical interventions, only allowing one variable at a time. They were also about treating pathology, which Osteopaths don’t do. As was explained earlier, there is no disease as such, only obstructions to healing and repair.

How do you find a cohort of test subjects with exactly the same constitution, life story, diet, partner, job……… and then introduce a variable and test it? This alone is a total fallacy.

Because RCTs can only deal with one variable and the constitutional osteopathic approach is multifaceted, the osteopathic practitioner is forced to reduce his treatment to only one intervention – to fit the trial model. This is an immediate fail, what is the point of claiming to do ‘osteopathic research’ if you are not including all the variables as part of the study? Including all the variables is a core part of the true Osteopathic approach.

This effectively means that almost all the modern attempts at research on Osteopathy are not actually testing osteopathy, but they are proving the ineffectiveness of RCTs on testing the validity of symbiotic, multifaceted, constitutional approaches.

There is nothing more patient centered than a constitutional diagnosis.

What is a constitutional Osteopathic diagnosis based upon?

In the fields of osteopathic diagnosis, an osteopath considers factors that have led to the failure to adapt rather than stimulating or forcing the body to accept the state of unhealthy by suppressing symptoms.

This will involve doing an audit of many fields, including lifestyle, diet, posture, occupation, hobbies, sport, activity, rest cycles…………. In a sense unless we ‘diagnose’ from the total context of the patient, we are not making a constitutional diagnosis.

A patient, who has a slight twist in the pelvis, may produce symptoms of pain and swelling in the knee, as a referred strain. They may have a twist in the pelvis as a viscero somatic reflex reaction from their chronic constipation or uterine problems.

A reductionist approach would entail the patient visiting someone different for the knee, bowel/uterus, pelvic strain which might mean three or four different treatments.

Just treating the pain in the knee as an illness ignores the intelligence of the body’s feedback, saying ‘don’t use it’ and then may lead to ‘wearing’ of the knee structure. Rather like if the tracking is ‘out’ on your car the tyres will wear on the inside and just replacing the tyres will result in the strain being moved elsewhere.

The twist in the pelvis may be due to impaction in the bowel from a poor diet, which would move the centre of gravity producing a counter strain on the posture. There could be a myriad of reasons why the problem has presented symptoms in the knee and the key to a successful result depends on being deductive with reasoning rather than differential.

Constitutional resolution of this kind of case means no problems in all of those fields and would encompass one integrative constitutional diagnosis.
If you want to learn more about how to use Osteopathic principles in a modern clinical setting, why not go to film 2 Using Osteopathic Principles in a modern clinical setting

The positive way forward

It could be so much cheaper and easier if we had a health service, rather than a disease management service and everybody was taught how to maintain their health. Rather like – we are all expected to be responsible for our financial affairs. Then we would only need an acute A and E for accident care, obstructive childbirth and injuries sustained in warfare.

Schools would teach children how to stay well and the chronic health care budget would evaporate.