Articles On Manual Therapy

General Treatment:
Essential in Lesions of Fixation and Immobilization, Precedes Specific Adjustment

E. C. Unverferth, D.O.
The Osteopathic Profession
May, 1941

To understand the value of the general osteopathic treatment it is necessary to consider two general types of lesions, and the frequency with which they occur in the human body.

McManis has differentiated between lesions of fixation and immobilization on the one hand, and lesions of subluxation on the other, as follows:

"When a spinal joint has become more or less rigid and fixed in a position somewhere within the normal range of movement of the articulating facets of the joint, it is not a subluxation.  It is a spinal (fixation) lesion.

"When the articulating facets have, by traumatism, been forced beyond their normal range of movement and the joint has become fixed in that position, then we have a subluxated joint."

Disregarding other classifications of osteopathic lesions, we will adhere in this brief discussion to lesions of subluxation and lesions of fixation and immobilization.  It is the realization of the fact that lesions of fixation and immobilization are so much more numerous than lesions of subluxation that has shown so clearly the value and importance of the general treatment.

For it is in lesions of fixation and immobilization that the general treatment is of greatest importance, and with this in mind we have found during the past year that we could treat successfully manipulative measures alone conditions which we formerly evaded or treated at best only in a haphazard fashion, such as hay-fever, asthma, various allergic conditions, goiter, and various gynecological conditions.

MacDonald, McCole, Gamble and others have pointed out that lesions of fixation and immobilization far outnumber lesions of subluxation, and that in the aggregate, lesions of subluxation constitute but a very small number of all the lesions that come to an osteopathic physician.  And so rather than feeling apologetic for the use of the general treatment as many of us have done because we felt our knowledge of specific treatment was inadequate, we should make much more of general treatment than we have done in the past.  We should, however, have always before us a specific aim and objective in the use of the general treatment.

In any consideration of its value, it is well for us to consider first of all what constitutes a general osteopathic treatment.  We quote from An Analysis of The Osteopathic Lesion by McCole,  page 104:

"To make a complete spinal examination, each area of the spine must be examined for range of articular movement.  The examination usually is coincident with what is practically a spinal treatment.  Each time as treatment is repeated, observations as to how the facets are seated and observation of the range of motion and of the condition of the different structures tell the physician of the conditions with which he has to deal.  In other words, osteopathic examination necessarily largely accompanies treatment.  In most cases, both general treatment of the whole spine and specific adjustment to certain points is given for the following purposes:

1. To learn by palpation and adjustment the general condition of the spine.
2. To determine the patient's level of vitality and powers of reaction.
3. To locate specific spinal lesions.
4. To stimulate the patient's circulation.
5. To produce a condition of euphoria.
6. To stimulate directly the receptors in spinal tissue.
7. To normalize the stimulation to the receptors by removing the lesion.
8. To remove tension in muscles of the joint.
9. To return ligaments to flexibility.
10. To remove local edema and its pressure in the canal of the intervertebral foramen.
11. To restore normal irritability of nerve cells in spinal segments involved.
12.  To relieve postural stress.

We heartily commend the above quotation for close study to all those who have not yet completely mastered the art of specific subluxation adjustment.  Always bear in mind, of course, the two major objectives of general treatment, first, the normalizing of the hemopoietic system. and second, the adjustment of the machinery of elimination.

We feel that the greatest value of the general treatment lies not in its application to the many abnormal conditions to which the human body is heir, nor in the treatment of disease, but in the fact that it can be used with the utmost propriety by the physician who has not yet mastered the art of skillful, specific, adjustive treatment.

No matter what our definition of Osteopathy, or our concept of its scope, there is right now the greatest need for intensive training in that phase of Osteopathy which sets it apart from all other branches of the healing profession, i.e., technic.  That difference in which we justly take such pride should prove sufficiently demanding to create a post-graduate college, the purpose of which would be to perfect this truly characteristic phase of our work which is, we believe, such an improvement on older methods.

We still consider specific adjustment the acme of perfection in osteopathic technic.  We still believe that just to the extent that the physician can skillfully apply specific adjustment in his general treatment, just to that extent will he be a more capable physician.  We do maintain, however, that until we master specific adjustment and, what is more important, the ability to make a specific description of a lesion, it is better to stick to intelligent general treatment, always with definite objectives in mind.  Our own personal ideal is to learn more and more of specific adjustment to apply in our general treatment, hoping to gain that decree of skill by which we shall find the definite point, and make that specific correction which will induce the change from pathology to physiologic function, as some are now able to do.

Technic is an art and, like any other art, can be taught.  A child is taught to play the piano, a boy is taught carpentry, blacksmithing, or some other trade.  Soldiers are taught to march and execute drills.  True, some individuals cannot be taught and are sent back to the awkward squad where some perhaps learn a little and others nothing.  However, that does not prove that the art cannot be taught but merely that certain individuals lack the ability to learn.  Such persons, of course, should be discouraged from entering a profession where a high degree of manual dexterity must necessarily be combined with a high degree of cerebration.

Critics there are who say we must work out our own technic and not blindly ape another.  But surely if we possess intelligence enough to work out and develop our own technic we must possess enough gumption to do better than blindly ape some one else.  We must accept and adapt from others only that which we can use ourselves in the light of our own experience.  And if we will do this we can proceed much more rapidly toward a technic properly applied.  As stated before, some kind of clearing house, a postgraduate college, if you please, should be established in which skillful training of this kind may be obtained.

Those among us who still feel inadequate in specific technic should always remember the efficacy of general treatment.  Dr. A. T. Still, who, no doubt, was Osteopathy's foremost artist in the application of specific adjustment, nevertheless strongly urged general treatment.  In his book, Research And Practice, he gives detailed instruction for the general treatment of measles, diphtheria, pertussis, influenza, erysipelas, mumps, chickenpox, smallpox, cholera, malaria, scarlet fever, and many other diseases.  In fact, in reading Dr. Still, we come to the conclusion that he used general treatment in all abnormal conditions of the body except those of recent traumatic origin.  Surely if Dr. Still found general treatment of such great value, we should feel free to use it without feeling apologetic.

Remember that the body functions always as a unit and never as a series of parts.  To quote again from McCole:

"It is of basic importance in Osteopathy to remember that while we speak of anatomic parts of the body, such division has advantages for purpose of description only.  The important fact is that life is carried on by the body, its muscles, nerves, glands, acting as a whole.  The osteopathic concept is not built about parts as parts, but about the functional capacity of the body as a whole."


We recommend the general treatment unreservedly, especially in the absence of superior ability in specific adjustment.  Give general treatment intelligently, always with the proper specific objectives in mind.  In our own work we have found the following two major objectives to be most important:

1. The normalization of the hemopoietic system.
2. The adjustment of the mechanisms of elimination.

Dr. Still, in his Research and Practice, has pointed the way.  If to the general treatment outlined there is added from time to time all that can be learned of specific adjustment as it is indicated in the general treatment, our success will be progressive and its limit of accomplishment boundless.