Articles On Manual Therapy

Technic Of A General Treatment

Mary L. LeClere, D.O.
The Journal of Osteopathy
June, 1922

 

I believe in the general treatment. My experience as demonstrated on my own body as well as on patients is that the results of a lesion are never confined to the local area of the lesion, but that a lesion anywhere results in tissue tension along pretty much the whole extent of the spinal column.  I believe that if our correction of the specific lesion is to hold, we must correct this general tension which, in its turn, will produce imbalance.  I believe that though the general treatment takes longer, it need not be repeated so often and the patient can afford to pay more for each treatment he gets.

I have been asked to describe my typical general treatment.  I might reply that there is no such thing as a typical general treatment.  Each patient is a law unto himself, and the treatment must be adapted to his particular needs and characteristics.  Sometimes a movement which works splendidly on most patients and get no results at all on the particular patient in hand.  Then I have to try another.  In general, however, I give a general treatment in this manner:

First I seat the patient and by inspection and palpation determine so far as possible what are the lesions and the spinal condition generally.  From this I make a tentative diagnosis only, for I consider that lack of normal movement is the final and unvarying proof of lesion.  A man's spine may be as crooked as the letter "S", yet if he has normal movement in all the joints, he is a well man.  On the other hand a rigid joint always makes trouble.

My treatment contains diagnosis, relaxation, and specific correction all in one and the same maneuvers.  To me relaxation does not mean muscle massage.  Tissue tension is too deep a matter for that.  Not only does "tissue tension" mean contracture of superficial and deep muscles, but also and more important, of the ligaments of the joints.  There is also involvement of the intervertebral disk and joint surfaces.  I am told by one of our research workers that in the production of the lesion the capsular ligament is always involved, that muscular contracture is always secondary.

In relieving tissue tension along the spine we must think of these deep tissues and realize that no massage can directly reach them.  We do reach them directly however, when we move the joint.  Movement is the normal stimulus to which, during the life of the organism the tissues about a joint have learned to respond.  If, due to direct or reflex irritation, the tissue tension interferes with normal joint movement, these tissues are deprived of their normal stimulus and deteriorate.  Circulation stagnates around a stiff joint and thus adds to the trouble.  In time adhesions occur about the joint.  Either relaxation or adjustment consists in putting the joints through their normal movements.

Usually I take the neck first.  Dr. Ashmore in her book, "Osteopathic Mechanics" says, "A certain amount of massage may be helpful in relaxation of contracted muscles but the preferred method is a stretching of the tissues by putting the neck through the normal movements of the cervical area, flexion, extension, rotation, and sidebending.  The osteopath should have in mind separation of the origin and insertion of each muscle [and ligament].  In this way a direct longitudinal pull is given to the muscle [and ligament] which tends to overcome its contraction.  The separation must be effected slowly, for all hurried, jerky movements defeat their own purpose, relaxation."  Gower states that slow tonic contractions of a muscle occur when its points of attachment are suddenly approximated.  Therefore in order to obtain relaxation, not only must the points of attachment be separated gradually but they must also be approximated again gradually.  Blessed is the osteopath who is temperamentally slow.  He escapes the necessity of learning to move slowly.

Patient lies on back.  (1) Operator supports the occiput with right hand.  Left hand against lamina of second cervical acts as a fulcrum.  Extend and at same time sidebend head toward left.  Move fulcrum down to lamina of third and repeat extension and sidebending.  Repeat all the way down the neck.  Then reverse position of hands and extend and sidebend to the right.  (2) Operator supports occiput with right hand.  Place left hand against lamina and transverse process.  Flex and sidebend head to left.  Moving fulcrum, repeat all the way down the neck.  Reverse position of hands then flex and sidebend toward right.  The patients find these movements very comforting.  The osteopath whose attention is concentrated on joint movement acquires considerable skill in detecting undue rigidity in any joint during these movements.  (3)  Rotate chin toward left.  Strongly flex the neck, putting the posterior tissues on a stretch, feeling for movement between the spinous processes.  Then rotate chin toward the right and strongly flex the neck, again feeling for movement between the spinous processes.  All three of these movements tend to correct lesions as well as relax tissues.  If lesions still remain, now is the time to use stronger specific corrective movements.

Before leaving the neck, I carefully feel for movement in the occipito-atloid articulation and if necessary do specific corrective work there.

While the operator still stands at the head of the table, it is a good time to raise the ribs, a procedure which Dr. Burns tells us is very important in order to stimulate circulation through the marrow of the ribs where red blood cells are formed.  Patient still lies on his back.  He reaches up his arms above his head and clasps operator around the waist.  Operator draws back slightly.  The pull on the pectoral muscles lifts the ribs in front.  Operator assists this action by reaching forward, slipping his fingers under the posterior angles of the ribs, his thumbs under the anterior borders, pushing down on the posterior angles and lifting up on the ribs anteriorly.

While the patient is still on his back, palpate for the liver, and, if necessary, do abdominal work.

Patient turns on side.  I put the upper dorsal vertebrae (first to sixth) through their normal movements, using what Dr. Ashmore, in "Osteopathic Mechanics" calls the "head-leverage movement."  Patient lies on right side.  Operator stands facing him.  Operator slips left hand under patient's head.  The thumb of operator's right hand is placed against the spinous process of each vertebra in turn in order to localize the movement, while the fingers of the same hand feel for movement between that spinous process and the one below.  Operator rotates patient's head slightly toward left then sidebends toward left slowly, until tension is overcome.

The addition of a quick jerk now elicits a pop.  Done more slowly the joint is moved without the pop.  Personally, I prefer to move joints without popping them as I think that a movement which elicits a pop is not a normal movement.

Besides who ever knows definitely just which joints popped?  I find that most patients are made happy when I explain to them that the pop is not necessary.

Always feel for movement in each separate joint.  If you do not get it, shift the position of your patient slightly, and try again.  I have little patience with the operator who just treats and trusts to luck that he has moved the joints.  If a joint is in lesion and therefore does not move, this same movement given a little more strongly may now be used for specific correction.  If the lesion is rotation with spinous process toward the left, now is the time to rotate it back toward the right.  For relaxation of the lower dorsal and lumbar areas, I use a modification of what Dr. Ashmore calls the "sidebend rolling movement" in "Osteopathic Mechanics."  Patient is stilon right side in position of slight side-bending.  The side-bending is obtained by placing a pillow under the shoulder and by the position of the legs.  The right leg, the one underneath, lies straight on the table; the left knee is flexed and the left leg lies in front of the right.  Operator faces patient and places the elbow of his right arm strongly against patient's left hip to immobilize it, the fingers of his right hand are used to localize and to feel for movement.  Operator's left hand is placed against patient's left shoulder.  By pressing against shoulder he rotates the patient's trunk backward.  It will be found that each spinous procees in turn moves to the right of the one below.  If one does not move, that joint is in lesion.  This same movement may be used for specific loosening.

Now have patient he on left side and repeat the "head-leverage" and "sidebending" movement, this time sidebending and rotating in the opposite direction.

Now your patient is relaxed, much of your specific corrective work is done and you know exactly which joints are rigid and which have normal movement.  All this has not taken more than ten to twenty minutes, depending on how much specific loosening you have had to do and also depending on the degree of skill to which you have attained.  Any specific work which may still remain to be done will be only a matter of a moment.

I find the "side-bend rolling" movement very satisfactory for relaxing and diagnosing mobility in the lumbar joints but prefer another method for diagnosing and loosening lower dorsals (third to twelfth).  Patient seated on stool, right hand resting on left shoulder, head dropped forward on arm.  Operator stands to left and slightly behind patient, his left arm under patient's right arm, his left hand grasping patient's right shoulder.  He rotates patient toward the left.  Fingers of operator's right hand localizing and feeling for movement between the spinous processes.  Reverse position and rotate in opposite direction.  This movement is also good for specific loosening in this area.

I have been asked whether after a few treatments I would then confine my work to specific areas.  I believe that as long as there are specific lesions still needing correction, there is some secondary tissue tension along the entire spine that had better be restored to normal each time.  At least no on can know that there is none until he has tested for it and the act of testing for it corrects it.