The Principles of Osteopathic
A. S. Hollis, D.O.
THE BASIC PRINCIPLES OF OSTEOPATHIC PRACTICE
In presenting the following discussion of certain
fundamentals of osteopathic practice we shall attempt to make clear and
definite a few main thoughts that lie at the very foundation of our Science.
Unfortunately Osteopathy has frequently been judged by its opponents on
the ground of several misrepresented fundamentals and the claims of the
Science have been disregarded, because some of those fundamentals were
often apparently at variance with known anatomical facts. In every
new Science a difficulty, such as this one, is found, and it is only when
the basic ideas are stated with extreme accuracy and exactness that any
claim to scientific precision can be made for them. We shall attempt
herein to a state our ideas with as much clearness as possible, so that
whether or not out readers agree with the contentions put forward they
cannot but grasp the thoughts and follow the lines of reasoning.
The first conception that we wish to determine clearly
is the lesion. What is the lesion? How widely are we justified
in applying that term from the osteopathic viewpoint? Do the commonly
accepted ideas of the lesion clash with the Anatomy of the spine as we
know it? In answer to these and similar questions we would say that
an OSTEOPATHIC LESION is a condition which is found in the spine associated
with disease and serving as a causative factor of it. It is an abnormal
of the ligamentous and other articular structures of such a nature
that the movements between the vertebrae become perverted.
This definition is designed to emphasize the essential
nature of the condition which is under discussion, and this is that some
PERVERSION Of MOVEMENT is the MANIFESTING FACTOR in a lesion. This
perversion may be in the nature of an excessive amount of movement, though
this is rare, or it may be in the nature of a deficient amount, and this
is very commonly the case. Such a condition, namely a deficient amount
of movement between the vertebrae, is called RIGIDITY. Hence, RIGIDITY
is the essential feature of most osteopathic lesions. Now rigidity
between articular surfaces means that the ligaments and the synovial membranes,
etc., of the articulation in question have become thickened and perverted
in their nature to the extent that THEY limit the normal movement.
Hence the essential pathology of an osteopathic lesion is to be looked
for mainly in the articular structures themselves, though also we may look
for it in the ligaments that elsewhere bind the vertebrae together, such
as the common and the supraspinous ligaments. We need do scarcely
more than merely mention the fact after what has been already said, that
any "bony" lesion will be manifested by limitation of movement WITHIN THE
RANGE OF THE NORMAL MOVEMENT OF THE VERTEBRAE AFFECTED. We mention
this to combat the thought of the "dislocated" vertebra, that is to say,
the thought of a vertebra wrenched beyond its normal range of movement;
for as soon as such a "lesion" is found it is analogous to a dislocated
ankle and should be treated in a manner similar to such a condition.
A question naturally arises as to the causative factors
underlying the reduction of lesions, and on careful analysis we find that
we may accurately speak of two main types. These we might name: (a)
primary, (b) secondary. By a primary lesion we mean either one that
is developed spontaneously owing to a certain architectural weakness that
seems inherently to cling to man's spine, and this is due largely, in all
probability, to his upright position; or one that can be traced to some
trauma. A secondary lesion refers to a contracture of the musculo-ligamentous
structures of the back, owing to a toxic congestion that occurs concurrently
with acute troubles in the body. In a somewhat different sense, the
term "secondary" is often applied to lesions that occur in the neck and
back as a result of and to compensate for lesions lower down. Lesions
of such a nature, and they are common, will themselves remain corrected
only if their primary lesions be thoroughly worked upon and adjusted.
This is a strong argument for working from below upwards when giving a
treatment, which indeed should always be done. By working this way
these "secondary" lesions will often adjust themselves to a great extent.
The main point we would emphasize here is that an osteopathic lesion will
be manifested by a lessened degree of movement in the majority of cases;
these will always be SOME PERVERSION OF MOVEMENT and generally also some
tenderness will be found on attempted motion.
A thought that demands a word of explanation at this
point is: granted that such be the case, what does the Science of Osteopathy
suggest as a curative procedure? The answer is that osteopathic practice
aims to RE-NORMALIZE ABNORMAL TISSUES. We may use to advantage in
this connection the expression "adjustment," as being a fitting term to
express what Osteopathy aims to accomplish. What is meant by this
is that a certain normal standard is regarded as existent for every individual
spine, and that if there are found present variations from that standard
it is the work of the osteopathic physician to NORMALIZE those structures
and, thus to give free play to Nature and to Nature's processes.
It is well to remember that Osteopathy was founded on the premise that
Nature is striving for each one of her children to be well; health is normal,
and if not present there is but one reason, namely that somehow Nature's
attempted efforts are being thwarted or are not being afforded free play.
The striking feature of osteopathic practice is of
course the manipulative procedures employed, but if we associate the term
"adjustment" with Osteopathy, we must see that any methods which will harmonize
with Nature's efforts to produce normal conditions are strictly to be concluded
under the heading of the osteopathic principle. We must aim not only
to adjust the individual parts of the organism in order that harmony may
result within and without, but also we must adjust the organism
to its environment.
In correcting abnormalities in the organism the attempt
is made to drive away congestion, to dissipate and absorb excess tissue
that may have proliferated around the articulations of the vertebrate,
to stretch and otherwise normalize the capsules surrounding the articulations
of the vertebrae, and to reestablish generally a normal condition of the
In other words, to the extent that we "adjust" the
tissues of the vertebral column to the normal, are we employing the essential
feature of osteopathic practice. Many times in using manipulation
a "pop" is heard between the articular surfaces. This is due to the
separation of those surfaces and is not of supreme importance in itself.
In fact, the more strictly normal an articulation is the more readily,
frequently, it can be "popped." In other words, if a pop can not
readily be obtained between almost all the vertebrae, there are generally
but two explanations possible. One is that the line of force used
was not properly
applied, and the other is that the tissues so congested and the ligaments
etc., so thickened that the force applied was insufficient to cause a separation
of the articular surfaces. At this point we would simply mention
the fact that too frequent popping of vertebral articulations (and especially
of those in the neck) undoubtedly causes irritation and is itself productive
of considerable harm; also in some people there is present so lax a condition
of the connecting tissues that the vertebrae pop at the slightest provocation.
Many osteopathic movements do not produce a "pop," and in these cases the
force is applied directly in the line of the plane of the articulation
and the principle employed is analogous to that employed in breaking up
adhesions in one of the large joints of the body.
The exact mechanism whereby the osteopathic lesion
produces its effects upon the nervous system is hard to determine precisely.
Concerning two facts we may probably feel fully assured, and they are:
(a) that any trouble that may result from or be associated with osteopathic
lesions, is produced by some vascular changes occurring around nerve cells;
these cells being either in the cord itself or in the sympathetic ganglia;
(b) that direct pressure upon the nerve trunk or upon the blood
vessels in the intervertebral foramina is a negligible factor in the
production of disease. We are not in this latter connection denying
the possibility that the vessels may become contracted in size in the intervertebral
foramina; they may conceivably do so, but if they do, that condition is
produced by an irritation of their vasomotor cells, and not by direct pressure.
Classification of Lesions.
We are now ready to discuss somewhat more fully a
point that we have touched upon above, viz: The types of lesion that may
be found. Under this heading we have suggested the following
classification: Lesions may be (a) primary; (b) secondary. Primary
lesions may themselves be (1) traumatic, or due to extraneous force;
(2) idiopathic, or self-originating. Secondary lesions are reflex
from toxic conditions or inflammatory processes elsewhere in the body.
This latter type of lesion we will consider more fully when discussing
the relation of the lesion to acute diseases. About primary lesions
we may to advantage say a little right here. The term traumatic is self-explanatory,
though the lesions to which this term may be applied are comparatively
rare. However we see examples of this lesion especially in the Innominate
articulation. Indeed perhaps the majority of innominate lesions are
traumatic in origin, that is, the symptoms arising from them date from
some injury that was directly felt by that joint. The idiopathic
lesions form probably the large majority of lesions met with in clinical
develop in the spine because of its peculiar structure, and because
of a certain inherent architectural weakness existent in the spine of man
in his upright position. They are important because of the proximity
of the spine to the nervous system and by their presence oftentimes is
produced an irritation of the nervous system which may manifest itself
as a disease of some organ or part.
We would here again call attention to the necessity
of distinguishing between the initiating primary lesion and any that may
be present as compensatory to it. These latter will never respond
to treatment until the former are thoroughly adjusted.
OSTEOPATHY IS NATURE'S METHOD OF CURING DISEASE,
and we find therefore that the logical scope of osteopathy includes all
diseases rationally curable by Nature’s own processes. The osteopathic
physician is entitled to use, in addition to his manipulations, common
sense aids, such as the enema, dietetics, antidotes, hot and cold water,
etc., but these do not constitute any essential feature, of his especial
curative methods. The surgeon realizes the value of anaestheties and employs
them, but an anaesthetic is not any special possession of the surgeon.
An osteopathic physician who refuses to give or advise an enema occasionally
is as foolish as a surgeon would be to refuse to allow a patient to take
an anaesthetic because this latter was not strictly along the line of his
The scope of Osteopathy is very broad and it is easily
seen by following the line of thought suggested that acute diseases rationally
fall into the field of osteopathic practice, for it is universally recognized
that normally an acute disease is self-limited and the up-to-date physician
trusts to this fact almost exclusively while employing ordinary hygienic
procedures. Those procedures we are as entitled to use as is the
medical man and hence even if our peculiarly specific work, the osteopathic
manipulations, was of no avail, we should at least be as well equipped
as is the medical practitioner. That the osteopathic manipulations
are of GREAT and STRIKING value we will attempt to prove a little later
in this article. Except in a very few acute diseases the pathology
in the early stages is such as readily to be dissipated by natural means,
and to the extent that this can be done, excellent results will follow.
Pathology and Prognosis.
The next thought that we would suggest for consideration
is the relationship that the pathology of a disease bears to the prognosis
of that disease, and in this connection we wish to quote from an article
by the writer in the Bulletin of the Atlas and Axis Clubs for October,
1912. We reproduce the following excerpts:
"It has been well said that Pathology determines
the Prognosis of Disease, and that the limits of every therapy are set
with absolute precision by the Pathology of Disease. By this we mean
that in diseases causing structural changes in the organism, the possibility
of cure is determined by the extent of those changes and by the degree
to which Nature can compensate for them. Underlying this thought
is one that is of great importance; indeed upon its validity the very rationale
of therapy depends. We refer to the apparent EXTRAVAGANCE AND PRODIGALITY
with which in most cases Nature has provided the various tissues of our
"Surgically and experimentally it has frequently
been demonstrated that the human body can maintain an unimpaired functional
integrity with one kidney extirpated, with one ovary or one testicle removed,
or with a portion of the stomach or a section of the intestine taken out.
We know that in a healed tubercular process of the lung, the cure is brought
about by the complete obliteration of the involved portion of the lung,
with its transformation into solid nonfunctioning connective tissue.
If it was not for the compensating mechanism within our bodies, which is
dependent entirely upon this apparent prodigality of Nature, no cure of
an organically involved structure would be possible. In a word, it
is the fact that Nature has provided in most parts of the human body tissue
in excess of that needed for bare functional necessities that enables that
body to react to organic disease at all.
"In many diseases that are 'cured' by some therapy
we find on close investigation that the functional integrity of the part
that was involved has been restored, though the anatomical relations are
perverted and permanently disturbed. Indeed this is found in the
majority of diseases in which structural changes have been wrought.
It is this phase of the curative process that is dependent upon the prodigality
of Nature mentioned above. Nature thereby is able to draw on the
excess functional tissue and thus to reestablish a physiological integrity.
"The diseases that are OSTEOPATHICALLY CURABLE we
believe are coextensive with the limits of Nature's ability to react to
a pathological process, which means that this class includes every disease
in which the pathological process has not advanced to such a stage as to
be beyond Nature's own reactive power. In other words we believe
that this class includes all diseases in which Nature has not been perverted
beyond her limits of compensation. What is curable from Nature's
standpoint is curable from the standpoint of Osteopathy, for we look upon
them as synonymous.
"From this standpoint it might be asked why Osteopathy
is powerful in combating disease. We know, from clinical experience,
that there is developed around the articulations of the vertebrae a tissue
perversion either antecedent to or concomitant with disease of the organism
elsewhere. This tissue perversion is manifested by impaired mobility
of the spine, and the restoration of a normal degree of movement between
the articulations means that the tissues have been normalized in this region.
NATURE WANTS US TO BE WELL and she is able to function perfectly, provided
she is not taxed beyond her capacity for reaction. By restoring normal
movement in the spine we give Nature, in very many cases of disease, the
necessary assistance to enable her to combat the condition successfully."
The line of thought that we have been following naturally
leads us to the determination of the relation that must exist between the
osteopathic lesion and acute and chronic diseases. We would also
discuss briefly the relationship that Osteopathy bears to Surgery.
Osteopathy and Acute Diseases.
There are many factors that cooperate in the production
of disease in its acute stages; for example, if we take a concrete instance
of Typhoid Fever, it is well known that there are several such causative
factors at work. The age of the patient, the season of the year,
the dietary habits, previous mental or physical strain, the typhoid bacillus,
etc., all are important as factors to be taken note of. It is true
that an idiopathic lesion is very frequently present as a cause of the
rundown nervous system,
but it need not necessarily be so.
The disease itself is manifested by a series of effects.
Indeed every disease presents a fairly typical picture, upon which the
average practitioner bases his diagnosis. The "effects" are looked
upon as "symptoms" of the disease, though to what extent they are really
so will be seen in a moment. Suffice it for the present to say that
an abundance of toxin is produced by the infection and that the majority
of symptoms are symptoms of toxic poisoning.
What then is the relationship that exists between
Osteopathy and an acute infection? It is this: Many of the symptoms
that are commonly regarded as symptoms of the disease are in reality symptoms
of a secondary osteopathic condition which arises owing to the toxic infection
and which by its persistence maintains that infection by preventing a free
elimination of the toxin. This secondary condition is placed midway
between the "cause" and the "effect," and it is this factor that the osteopathic
physician works upon. A "good treatment" will relieve very materially
many of the symptoms of the disease, because many of the symptoms are really
effects of the secondary osteopathic condition. Thus the aching will
be eased, fever will be mitigated, the bowels will be regulated, etc.
Thus the osteopathic physician is able to handle
acute diseases better than a medical physician because not only can he
employ the same hygienic methods that this latter physician employs, such
as the enema, the bath, dietary restrictions, rest, etc., but also he has
it in his power to combat an extremely important secondary causative factor
that the medical man is ignorant of. If we glance at the "circle
of causes" as represented in the accompanying diagram we may ask which
of them a medical man can attack? Can he affect the age of the patient,
the season of the year, the previous dietary habits, the mentally or physically
rundown condition present, or the typhoid bacilli? The answer is
obvious, and indeed his inability to combat the majority of these factors
has driven him to attempt to overcome the last mentioned. The failure
of attempted "sera" is too well known to need comment in this connection.
The osteopathic physician, then, is from every standpoint as well equipped
to handle acute infections as is the medical man, and from the standpoint
of his own specialty he has a lever that raises him into a class entirely
by himself. We wish it to be clearly understood that Osteopathy does
not claim that typhoid fever is caused by a displaced vertebra or by a
slipped rib, but it claims that such a factor oftentimes causes sufficient
irritation to the nervous system to produce a rundown condition, which
is well known to be a necessary forerunner to such disease, and it further
asserts that as a result of the accumulation of toxins in the organism
a secondary reflex contraction of the spinal muscles occurs; it is this
latter factor which the osteopathic physician attempts to combat, because
he realizes that many of the apparent symptoms of the "fever" or "infection"
are in reality symptoms of the secondary osteopathic lesion. Moreover,
if there was present a deep-seated lesion at the outset of the infection,
the continued treatments during the siege of the fever will generally remove
it by the time the patient is about again.
Osteopathy and Chronic Diseases.
With some slight adaptations we can apply a
line of thought similar to that used in the case of the acute diseases,
when we consider the relation that exists between Osteopathy and
chronic diseases. In this latter discussion, however,
we shall find that the primary traumatic or primary idiopathic lesion
in many cases plays a far more striking part than it played in connection
with the acute eases. In some chronic conditions practically
the only causative factor is the osteopathic one; in this class
we would include most cases of sciatica, many cases of headache
and neuralgia, etc. In these instances the symptoms are the
direct results of the osteopathic cause. In other chronic
diseases there is a more complex "circle of causes," and it is these
diseases we will consider for a moment. The accompanying
cut represents these different relations diagrammatically.
Why then is Osteopathy powerful in combating any
such disease when there are so many causes operative? For this reason:
Anything that will BREAK INTO the "Circle of causes" will tend to give
Nature the necessary boost for her curative and reactive processes.
There is no factor known today in the medical world that is so POWERFUL
TO BREAK THIS CIRCLE AS THE REMOVAL OF THE OSTEOPATHIC LESION. Remember
always the osteopathic physician does not cure any disease, he REMOVES
OBSTRUCTIONS to Nature's operations. NATURE IS THE GREAT PHYSICIAN.
This last fact explains why it is that in some few cases methods other
than osteopathic seem to accomplish good results: in those cases the factor
utilized was stronger than the osteopathic factor in breaking into the
"circle of causes." However the strength of Osteopathy lies in the fact
that IN THE MAJORITY OF DISEASES THE MOST POWERFUL LEVER THAT IS KNOWN
FOR BREAKING INTO THE "CIRCLE OF CAUSES" IS THE REMOVAL OF THE OSTEOPATHIC
LESION. In this last statement lies the secret of the success of
Osteopathy and Surgery.
Some osteopathic physicians seem to regard Surgery
as almost a criminal procedure, and this attitude has somewhat biased the
medical profession against Osteopathy, because the value of Surgery in
selected cases is known positively and to assert dogmatically that all
Surgery is butchery can do nothing but expose the ignorance of the person
making the statement. In considering the relation of Osteopathy to
Surgery we would call attention to the fact that Surgery embraces both
a constructive and a destructive phase. For example, no one will
deny that a surgeon is in his rightful sphere when he sets a broken arm
or a dislocated wrist; indeed the principle underlying such work is the
same as the principle underlying Osteopathy, namely the restoration to
normal of abnormally affected structures. Now there are many surgical
operations that aim to correct conditions exactly similar in principle
to the broken arm, as when a surgeon repairs a hernia or suspends a uterus.
The principle underlying such operations is the principle underlying osteopathic
mechanics and as such must be given due credit by the osteopathic physician.
The other side of surgical practice is the phase of "destructive" Surgery,
and here again we will find no difficulty in brining about a reconciliation
between its principle and the principle of Osteopathy. "Destructive"
Surgery aims to remove some structure that, either by its advanced pathology,
or by its complete collapse has proved itself to be beyond the power of
Nature to combat unless some radical assistance be forthcoming. There
are some processes which can advance so far as to become analogous almost
to a condition of poisoning, that is to say something drastic has to be
done to combat the process. Under the first heading mentioned above
we would include such conditions as virulent cancers, under the second
a prolapsus uteri warranting complete hysterectomy. Surely no one
would cavil at conservative surgery of this type, for whether constructive
or destructive, the principle it is built upon is essentially osteopathic.
Briefly recapitulating we would say that the osteopathic
lesion is essentially a tissue-perversion involving the musculo-ligamentous
structures around the articulations of the spine, and manifesting by an abnormal
mobility, which is generally in the line of a lessening of the movement; that
lesions are primary or secondary and if primary they may be traumatic or idiopathic,
whereas if secondary they are reflex from toxic irritation; and that Osteopathy
attempts to correct "lesions" by a gradual restoration to normal of abnormal
condition. We would also urge that a "popping" of an articulation is indication
of the setting of a lesion and that the only sign that a lesion has been set
is that a normal condition has replaced an abnormal one. It is also important
to remember that the limits of the osteopathic therapy are determined by the
pathology of the disease under consideration, and that no pathological condition
that Nature cannot handle can be handled by Osteopathy or by any other therapy,
save perhaps by Surgery. In acute diseases by our treatments we improve
elimination and thus enable Nature to combat the toxin of the infection more
readily; in chronic diseases the removal of the osteopathic lesion presents
the MOST IMPORTANT lever that is known today to break into the "circle of causes"
and thus to combat the symptoms or effects and enable a remedy to be obtained.
Finally, Osteopathy has no quarrel with conservative Surgery, whether it be
constructive or destructive in nature, for at the last analysis the principle
underlying such Surgery is essentially the osteopathic dictum of "adjustment."