The Practice and Applied
Therapeutics of Osteopathy
Charles Hazzard, D. O.
DISLOCATIONS, DEFORMITIES, JOINT AFFECTIONS, ETC.
This class of troubles furnishes the Osteopath with
very numerous cases. The marked success of osteopathy in curing spinal
curvature; setting old dislocations; overcoming chronic pain, stiffness,
etc., in joints; overcoming the various effects of injuries to any part
of the body; curing synovitis, ankylosis, etc., makes this line of practice
a very satisfactory one.
The curing of spinal curvature without the use of
braces or mechanical appliances; the removal of plaster casts, jackets,
.splints, bandages, and all things of that kind, causing the natural resources
of the parts to be depended on, is a novel and successful feature of Osteopathy.
The setting of old dislocations is not much attempted
by other lines of practice. Great success is met in this line. It
is evident by a glance at the case reports that egregious blunders are
repeatedly made by the most skilled physicians in many cases of this and
similar sorts. "Tubercular joints," "ruptured ligaments," "fractured
bones," and various other serious conditions are often found by the Osteopath
to be partial or complete dislocations, slips, strains, etc., which are
CASES: A few typical cases of deformity, etc., in
each of the various parts of the body subject to these conditions are here
presented. Great numbers of these cases are upon record, but it will
be sufficient to confine this list to a few examples.
(1) A pronounced double lateral curvature, in a
young lady, involving the whole dorsal region, with single vertebral lesions
at 10th and 11th dorsal, and 4th and 5th lumbar. The spine was very
sensitive, but this condition was overcome by three or four treatments.
After twelve treatments the patient, considerably benefited, went away
upon a visit, remaining several months. Upon her return it has found
that the curvature and spinal condition were materially improved.
Seven more treatments cured the condition entirely.
(2) Double lateral curvature of girl of twelve.
The curvature was to dorsal; to the left from the 9th dorsal was cured
by four months treatment.
(3) A posterior curvature in the dorsal region,
in a young boy, general health was poor. After two weeks treatment
the spinal brace was removed, and after two months treatment the curvature
had entirely disappeared.
(4) Pott's disease of eighteen years standing, in
a young lady of twenty-eight. It came on gradually after a fall at
the age of eight, having developed to completeness in two years.
Casts were worn for two and a half years, during
which time two abscesses discharged, one just below the anterior superior
spine on the left, the other in the right limb just below the groin. For
years the abscesses would alternately heal and break. The posterior
angular projection involved the vertebral from the 4th dorsal to the sacrum,
the apex being at the 10th dorsal. She came under treatment at the
age of twenty-eight. Both abscesses were discharging freely; after
three months treatment a third abscess appeared, and the patient appeared
to grow worse. After this she began to improve and the curvature
began to yield. Two abscesses healed. Gradually the curvature,
was reduced until scarcely noticeable, and the 3rd abscess was nearly healed.
The general health was perfect. The patient's height had been increased
two and a half inches.
(5) A thyroid dislocation of the hip set in one
(6) A dislocation of the hip of three years standing;
the patient had been upon crutches ever since the accident producing the
injury. The hip was set in three treatments, and the patient had
no use for crutches thereafter.
(7) A dislocation of the hip of four years standing
in a case which had been thrown from a buggy.
The femur had been fractured at the same time. The hip was set
in three months treatment.
(8) Tuberculosis of the hip and spine, so-called,
in a girl of sixteen, of four years standing. The best physicians
had pronounced it tuberculosis of the hip. The hip was found to be
slightly dislocated downward and forward, and there was vertebral lesion
of the 3rd and 4th lumbar. The hip was set and the case entirely
cured in four months.
(9) A case diagnosed by the physician as hip joint
disease. The patient had been confined to his cot for ten months.
A partial dislocation of the hip was found and set in three months treatment,
curing the case.
(10) Partial dislocation of hip and knee joints.
The patient had worn a laced leather stocking from the ankle halfway to
the thigh for eleven months. He walked with a crutch. The case
had been diagnosed as "rupture of the internal lateral ligament of the
knee" by two prominent Chicago physicians. The dislocations were
set in nine treatments.
(11) A case which had been diagnosed as a "complicated
fracture of the neck of the femur," of five years standing. Specialists
had confirmed this diagnosis. The injured limb was three inches shorter
than the other. Osteopathically the case was diagnosed as a dislocation
and was cured.
(12) Tuberculosis of the knee, so-called, in a boy.
The joint was put in a cast. There was constant pain in it.
A slip of the hip joint was found, and its adjustment cured the case.
(13) Torticollis due to contraction of the sterno-mastoid
muscles. By four treatments the muscle was relaxed, and the condition
(14) Torticollis of many years standing, caused
by injury to the neck. The muscles were extremely rigid, and the
cervical vertebra were badly curved and twisted. There was constant
pain in head, neck, and eyes. The case was greatly relieved permanently
by the treatment.
(15) Injury of the knee and shoulder joints in a
bicycle accident. The knee condition had been diagnosed as rupture
of the ligaments. By three weeks treatments the shoulder and knee
were entirely cured.
(16) Tubercular knee in a boy six years old.
The knee was swollen, and the temperature was 103 F. The case was
much benefited by three weeks treatment, and was well on the way to recovery.
The 10th and 11th dorsal, 1st, 2nd, 3rd, and 4th lumbar vertebrae were
(17) A long standing pain in the shoulder, which
had been examined and treated by eminent physicians both in Europe and
America without relief. Lesion was found in crowding together of
the 2nd and 3rd dorsal vertebrae. After one treatment the patient
suffered no further pain.
(18) Partial dislocation of the head of the humerus,
of some months standing, causing a painful condition which had been treated
as rheumatism. The case was cured by setting the bone.
(19) Fibrous ankylosis of the elbow-joint due to
being kept in splints too long after fracture of the humerus. The
condition was of eight weeks standing. By the treatment, use of joint
was gradually perfectly restored.
(20) Broken down arches of the feet in a man of
twenty-eight, due to rheumatism which had settled in the ankles.
The astragalus was markedly dislocated to the inner side. For two
years the patient had worn braces to support the arch of the instep.
By the treatment the bones were replaced and the arches were rebuilt into
their natural condition. The case was cured in six weeks.
OF DISLOCATIONS, DEFORMITIES, AND JOINT AFFECTIONS
While the treatment of each of these conditions will be
discussed separately, some general remarks apply to them collectively.
The mark success of Osteopathy in cases of this kind is largely due, at bottom
to an intimate knowledge of nerve and blood supply of the affected part, patience
and skill in manipulation, and the ability to relax, strengthen, or build up
tissues, open a joint and direct the circulation to it, and in all respects
to thoroughly prepare parts concerned to be returned to the normal state.
In the recent case this preparatory treatment does not take long. In the
chronic one, which represents a considerable majority of this class, this preparation
may necessarily extend over many months. It is here that patience and
skill play an important part. Often the preliminary work done in getting
all parts ready to be restored to normal is the most important and most distinctively
osteopathic part of the process. When parts are once prepared, as for
example in the setting of a hip, the final maneuver used to replace the bone
in position is practically the same as a surgeon would use for the purpose.
These remarks apply with almost equal force to both dislocations
and deformities. Yet in the latter case the correction of position of
bony parts is continually going on, pari passu with the process of the treatment.
In case of joint affections this process of treatment constitutes the whole
course of procedure, yet it not infrequently occurs that the replacing of a
slipped bony part is a portion or the whole of the treatment of a joint affection.
TREATMENT OF SPINAL CURVATURES AND OF POTT’S DISEASE: The
treatment of the various forms of spinal curvature and of Pott's disease are
upon much the same lines. In all the preliminary work as described is
of the utmost importance. It constitutes much of the course of treatment,
but bony parts are drawn and pressed back into place all the while.
Spinal curvatures are rarely painful, but when they are the
first step in the treatment is to carefully relax all spinal tissues, deep and
superficial; to increase or correct circulation in them; and in these ways to
gradually work out the soreness and to strengthen them.
In any case of curvature this sort of treatment constitutes
the first step in the procedure. To this end one may use any or all of
the treatments described under I, II, II, IV, and V, in Chap. II. In this
way the spine is gradually strengthened throughout; the muscles and ligaments
are given greater strength to hold the ground gradually gained, now and later,
in the form of the slow restoration of bony parts toward the normal position.
Likewise, during this process of treatment, the intervertebral
discs, which have been altered in shape by pressure atrophy, are gradually freed
of unequal pressure and are returned into proper shape by properly distributed
pressure and by the blood circulation.
After a short preliminary treatment, or at once if the case
allows, attention is directed to the replacement of bony parts. It is
a good rule in spinal curvatures to begin at the lowest vertebra involved and
make an attempt at each treatment to set it back into place. When this
has been accomplished, the while it is going on, the next vertebra, then the
next, and the next, and so on, is attempted. Much may be gained in this
Suspension of the patient in the osteopathic swing, or in
the special apparatus devised for the suspension of curvature patients, is a
great help to the practitioner in the treatment. By this device the weight
of the patient's body is used to help draw the bony parts back into place during
the various special treatments employed for that purpose. In this way
very rapid gains have been made in straightening the curve.
Various special movements may be successfully applied to
the reduction of the bony parts. The treatments described under VI, VII,
VIII, IX, X, X (a), XI, XII, XVII, AND XVIII, in Chap. II, may be used and combined
as desired. This style of treatment should be combined all the time with
that described as the first step in the process f treatment. The treatment
must be most persistent and assiduously applied, the practitioner using a considerable
degree of force to put parts back into place. But violence must be avoided.
During the course of the treatment all spinal braces, jackets,
casts, and artificial supports or corrective mechanisms of every sort are laid
aside, either gradually or at once as the patient may be able to do without
them. In this way one gets rid of their irritating local effects and of
their detrimental influence upon the general health, while at the same time
the parts are taught to depend upon their own strength, a matter essential to
Due attention must be given to complications and to the general
The practitioner must bear in mind the changed relations
assumed by the ribs both with respect to each other and with respect to the
vertebrae. Treatment must be applied during the course of treatment, to
the adjusting of these ribs. The various special methods described in
Chap. VII may be used.
This method of treatment applies to SCOLIOSIS, LORDOSIS,
KYPHOSIS, and their combinations.
In case of POTT's DISEASE the same general plan of treatment
is followed. In case the destructive process in the bones and discs has
ceased, and cure by deformity has followed by bony ankylosis of the vertebrae,
one cannot straighten the spine, but much may be done to correct the general
health. Yet, as in the case reported above (see case reports), it often
happens that after years of deformity the spine has been materially straightened.
In this disease the destructive processes can be quite stopped
often, or greatly limited; general health is bettered, and pain is relieved.
In these cases thorough attention to the general health is
necessary. Also bowels, kidneys, liver, and skin must be kept well stimulated
to aid in carrying off the septic products of the disease. In case of
the appearance of abscess, it must be drained when it has come to a head.
Such quantities of pus cannot be absorbed, and the abscess should not be allowed
to break. After drainage the abscess may be entirely healed by the treatment.
Various swerves in the spine, or departures from the normal
curves, are frequently met with. They are often called curvatures, but are not
properly so regarded. Yet they may predispose to curvatures. They
may be readily righted by the treatments given above.
Pott's disease requires a long and patient course of treatment.
This is often true of the ordinary curvatures, but very frequently a single
month, or a few months, of treatment will show surprising results.
The TREATMENT OF DEFORMITIES proceeds upon much the same
general plan of treatment as described for curvatures. All the surrounding
parts must be relaxed, strengthened and prepared by a course of treatment directed
to the complete restoration of circulation to the parts and tissues involved.
When the preparation is completed the practitioner proceeds by exaggeration
of lesions, traction, pressure, rotation, etc., applied to the bony part to
force it back into place.
It often happens that in apparent deformity of a bony part,
as of a joint, while pain and abnormal position and condition of the tissues
is apparent at the joint, the real cause may be an obstruction in the nerve
and blood supply of the joint somewhere above or at the spine. Thus apparent
deformity of a knee has with much frequency been found to be due to a luxation
of the hip joint or of spinal vertebrae.
A deformity, as an enlargement of a joint, may be not real
but apparent by reason of atrophy of the surrounding tissues. Then the
cause must be sought elsewhere for the wasting of the tissues. But the
surrounding tissue often waste in cases of joint disease or deformity.
It sometimes happens, as in the case of "hysterical joints"
that there is no real diseased condition of the suspected.
Muscular and ligamentous deformities are often the results
of some preceding or existing disease. In such cases treatment must be
made accordingly. Locally one must direct treatment to the affected tissues
to relax and restore them.
On the other hand these muscular and soft tissue deformities
are surprisingly often found to be due to a vertebral lesion, or other lesion,
at the origin or in the course of the nerves supplying the part. In such
case the treatment must embrace the removal of lesion as the real cause, and
corrective work upon the deformed tissues. It sometimes happens in the
treatment of these cases that the spinal lesion is treated to the exclusion
of the local treatment upon the affected part, or that treatment is mistakenly
directed to a spinal lesion not responsible for the condition. One will
learn that he must judge of the relative importance of treatment directed to
one situation or the other.
Sometimes a minute luxation of a joint itself is the cause
of the trouble.
In cases of deformity due to deposits in and about joints,
as in chronic rheumatism, the circulation is built up and kept stimulated to
absorb the deposit. In such cases it is necessary to adapt some motion
to thoroughly stretching or spreading the joint in order that the renewed blood
supply may freely circulate in the joint
Various special treatments applicable to the treatment of
deformities will be found described in the general treatments for the upper
and lower limbs.
The TREATMENT OF DISLOCATIONS is fully described in Chap.
Concerning the TREATMENT OF JOINT AFFECTIONS little need
be added to what has been said in describing the treatment of deformities (see
also the treatment of rheumatism.) Pain in a joint is often to be due to a spinal
lesion or to a lesion in a related joint. A very common occurrence is
to discover the cause of a so-called tubercular knee, or of a swelling or synovitis
of the knee joint, in a luxation of the hip joint.
In all cases of joint affections one must look closely for
lesion to nerves or vessels supplying the joint from the origin down, and remove
it as the cause of the trouble. To this must be added local manipulation
of the joint and its parts in order to correct proper circulation.
Plaster casts and bandages are at once removed to aid in
securing freedom of blood circulation.
One must not forget that apparently very serious disease has often been found
by osteopaths to depend upon a slight slip of the bones or cartilages of the
joint affected. Treatment, upon the principles laid down will usually
suffice to slip these back into place.
In strains, sprains, and inflammations of a joint one must
free the local and the connected circulation to take down the inflammation.
If applications are used, hot are better than cold.
In chronic affections it is usually necessary to treat from
the spine out to the joint in question, besides removing all bony lesions, adjusting
all tissues, etc.
Moderate use of a joint is usually advised, at discretion.
The use builds up a natural condition.
Cases of bony ankylosis are incurable without breaking. Ligamentous ankylosis
may be cured. If any motion at all exists in a joint there is good reason
for belief that it may be increased, possibly fully restored.