Ernest Eckford Tucker
Causes of Osteopathic Lesions
The causes of Osteopathic lesions is a subject for
principles rather than for technic, except so far as it relates to recording
and to prevention, and as it relates to recording and to prevention, and
as it aids in forming a clear picture of the mechanics of lesions.
The causes of Osteopathic lesions are the thousand
forms of violence and strain to which the human body is subjected—to which
indeed man subjects it. Compared with animals these are as a thousand
to one. The business of the animal is to protect itself from such
things, and except in the comparatively rare occasions of its fights it
does so. The business of the human being on the other hand is to
harness and control the forces of nature, and the stress of this control
rests finally upon the mechanisms of his body. Nor is her body exempt,
for the stressful contact of human life with the forces it controls has
led to the great development of the human brain, with a consequent and
necessary enlargement of the female pelvis, to admit of its being born;
which enlargement is out of proportion, mechanically, is a mechanical weakness
with increased danger of lesion, and at a point that is the mechanical
axis of the body and more subject to strains than any other part.
Probably more than half of the women who have been examined by osteopathic
physicians in the last half century have had lesion of the sacro-iliac
Comparing the mechanisms of the animal body with
those of the human body, we find further reason for the large number of
lesions found in the human body. In the prone position of the framework
the force of gravity acts at one angle; in the erect position at ninety
degrees from this angle. The joints, the stresses, the weights and
pressures in the animal body were adapted for the horizontal position,
in which they have the greatest amount of protection that is possible along
with the necessary motion. In the erect position the angle is changed
enough to destroy completely many of these protective devices. For
instance the articular planes of the spine and those of the transverse
processes for the ribs are flat to the direction of gravitation in the
horizontal position, while in the erect position they are parallel to it,
and much more exposed as a consequence. The sacro-iliac articulation
also is not adapted for bearing the weight of the body and all of its muscular
efforts as well, but a large-9-in fact, the larger—part of this in animals
is borne by the forelegs; yet in the human subject this is first subjected
to extreme torsion from the erect position, it’s thrown off its balance
by the tilting of the pelvis, and then is forced to bear the strain of
the erect position and of all the effort put forth by arms and trunk as
And the human spine is derived from the animal spine.
Undoubtedly compensation is made for this change to the erect position—the
adjustment of structure to function is an automatic thing in higher animals—but
also that adjustment is never complete. The ages of heredity are
magnificent as compared with the race history of the human family.
Each individual passes again through an epitome of the evolution of its
race, re-enacting its race history, structurally as well s otherwise.
And though each individual is also re-created by its parents, under the
influence of their environment and efforts, yet the balance struck between
the forward reaching heredity and the backward reaching re-creation is
much nearer the present than the past. The mechanical devices of
the human body are still weak with reference to the erect position, the
position in which it mostly receives its strains and shocks. For
a further illustration, again comparing the animal with the human spine,
we find in the latter the joints of the lumbar region extended to the limit
until they are in effect telescoped, while those of the dorsal area are
correspondingly flexed—constantly in a state of semi-flexion, as compared
with the horizontal animal spine bearing its weight transversely.
In these positions it is put through an immensely wider range of motion
and under immensely increased mechanical strain.
This is the background against which must be drawn
the picture of the causation of mechanical lesions in the body.
There is always a force greater than the power of
any structure to resist. Even in animals osteopathic lesions are
found in plenty, as shown in the reports of the A. T. Still Research Institute.
In human beings they are merely more in proportion, as his mechanism is
somewhat perverted, and his use of it violent.
We think of these forces of disorder as being of
a violent character. And indeed the most serious lesions are caused
by external violence. But there is also much internal violence, and
there is also the prolonged warping force, whose effect is slow but none
the less serious; whose total is, as a matter or face, probably greater
than that of the other two combined. To these must be added forces
that weaken the mechanism itself.
We may classify the sources of lesions therefore
Internal strain (muscular).
In reference to external violence, it proves to be
not easy to get a clear record of the cause of a given disorder.
These do not occur in the presence of the physician; often they occurred
years before. All that he can note is the effect. Classifying
of these accidents and shocks with a view to prevention is not possible
yet. We find a rather curious thing, namely, that people do not often
remember even the serious accidents that are responsible for the more serious
of these disorders. The reason for this is doubtless that they have
not been taught to associate disease with disorders, i.e., with such accidents.
That which is a daily observation with the osteopathic physician is as
yet a novel and a strange doctrine to the people in general.
The greatest number of violence lesions comes probably
from falls; next ranks accidents of various kinds, and then blows, as blows
on the neck. A rather frequent cause of lesions is the playful habit
of pulling a chair from under someone about to sit down. In the resulting
shock the sciatic ligament is tensed by the position so that the elastic
yielding of the sacrum is less, the spine is strained forward compressing
the discs so that the full unrelieved shock from the descending weight
of the trunk comes against the sacro-iliac joint. This is especially
liable to produce serious lesion if one side strikes first, as the descent
of the opposite side then brings strong leverage action to bear on the
articulation. The suddenness of the shock will the more easily cause
a lesion, just as the quick pressure is more effective in correction, because
there is less time for the distribution of the pressure through the elastic
medium of the tissues; which in the one case acts to cause, in the other
to correct, the lesion—according to the direction of the force.
It is the sudden, violent shocks that cause the radical
lesions. Let us make an examination of the mechanics of the joint
in relation to such violence.
In the first place we have solid structures, bones,
bound together by flexible material; and these solid structures move on
each other. They move on each other, and they remain in contact while
doing so. In such a case one of two things must necessarily be true
of that flexible material which holds them together—either it must be elastic,
or it must be fastened at the center of motion of the bone that moves,
and move radially as it moves. Otherwise no motion would be possible
without tearing the material. Both of these things are true, as it
happens. There is one kind of ligament that is strong and very slightly
elastic, which acts radially; and another kind that is quite elastic, not
radial in its motion. Also it is evident that this binding material
does not keep the two bones from passing beyond their normal limits of
motion—it merely holds them at a constant distance while they do so.
It is not their function to limit them otherwise. That they do so
limit them is due to the fact that beyond the point of normal motion the
surface of the bone is no longer smooth or no longer permits of radial
motion. Beyond the limit of normal motion therefore the angle of
the surfaces to each other is changed, and the function of the joint as
such is destroyed. It is under those circumstances that it remains
in false position as a lesion. It may be very lightly held at first,
but the factors that hold it as a lesion are likely to increase as time
goes on and it is uncorrected; for it seems to be the fact that recent
lesions are far easier to correct and remain corrected more easily than
those of some standing.
It is the muscles, which act for the most part parallel
to the plane of the joint surfaces, that should constitute the protection
of the joint against lesion. Muscle is really a powerful thing.
Consider the leverage of the elbow through which the biceps acts—attached
about an inch from the center of the joint, or fulcrum, the lever is from
fifteen to eighteen inches long; to lift ten pounds in the hand requires
about one hundred and fifty pounds of force when the forearm is horizontal.
So of the other bones in the body in proportion to leverage. Their
power is adequate to protect joints normally.
It is when they are overpowered by the other leverages
of the body itself or are taken off their guard that lesion is mostly produced,
or when coordination of the body’s movements is faulty or slow.
It can be seen from this how necessary it is to have
the patient relax when correction is attempted. With relaxation complete,
the correction of lesion is often unbelievably easy with proper technic,
except in long standing or in extreme lesions.
The theory of the immunity of drunken men from hurts
in falling is probably incorrect, when it states that this is due to his
muscles being all relaxed. It is difficult to relax voluntarily—it
is the business of muscles to contract to protect joints. What does
happen is that the muscular reaction is slow, so that the shock of the
fall is widely distributed—as it would not be if the muscles were completely
relaxed, nor of course if they were violently contracted under the influence
of fright. The falling of a dead body differs by immense degrees
from that of a drunken man. In stage falls also there is probably
never complete relaxation—it would probably be found impossible to drill
the nervous system so thoroughly as to make it possible; but it is possible
by training to over come the element of fright which brings on over-contraction
with increased danger, and to secure enough relaxation to allow the distribution
of the shock.
In the matter of the prevention of lesions in falls
and accidents therefore the proper thing would seem to be first never to
allow a joint to be moved to its extreme limit, and to keep the position
and motions of the body always securely under the control of its muscles.
Direct blows on joints are responsible for lesions
of ribs quite frequently, of the cervical vertebrae at times, and of the
sacrum rarely. Any severe shock will, however, be distributed through
the body, decreasing as it spreads, until it finds articulations whose
planes are parallel to its force; then if sufficient force is left, lesion
may be produced.
By internal violence is meant contracture of muscle
under some pathological force. As said, this contractile forace may
be very great and may last for long periods. With such a contracture
existing in some muscle, then even normal movement of the part may cause
it to overpower the muscles opposing it on the opposite side of a joint,
and to produce lesion. A familiar instance is the ordinary “crick
in the neck,” in which certain cervical muscles are contractured under
the shock of cold, by nerve shock reflected from the thermic centers in
the cervical cord; at the lower end of this contractured muscle lesion
of the rib to which it is attached will commonly be found.
The subject of warp lesions is a very vast one.
Probably every occupation that is at all monotonous or mechanical has its
typical warp. Very great benefit would come to the public from a
statistical study of this matter with a view to prevention. Many
of these have been commented on. Most important of these are the
sitting position, and the position in sleeping. High heels exact
a toll in human life and health whose total would be astounding could it
be reckoned. The high heel takes tension off of the rear thigh muscles,
and so allows the pelvis to assume a steeper angle; throwing the sacro-iliac
ligament off of its plumb, leading to lesion of this joint; stretching
the anterior spinal tissues and telescoping the articulations in the rear.
It is not uncommon to find the spine bent into a series of antero-posterior
curves, with lesions at various points. These may be corrected but
will appear at other points in a short time if the deformity of the shoes
is not corrected.
The mechanics of the warp lesion are practically
the same as those of the major force lesion. Instead of the sudden
violence overcoming the protective action of muscle and ligament there
is the gradual stretching of them. The mechanical positions and relations
that are assume are the same except that there is less tension in the stretched
ligaments; less indentation; greater ease in correction at first; but there
is probably much less tendency to spontaneous correction.
When, however, a lesion resulting from warp has stood
for some time it is probably quite indistinguishable from a major-force
The border-line between a normal state with muscles
relaxed at the limit of motion of any joint, and a warp with stretched
tissues, is very faint. So also is the border-line between a warp
and a warp lesion in which normal position is not assumed for mechanical
reasons. The latter distinction is not important in technic.
Weakening of the ligaments of the whole body occurs
in conditions of thyroid insufficiency. Weakening of ligaments of
individual joints is likely to occur in connection with vaso-motor disturbance
reflected from some internal abuse; in which case it occurs around the
specific center for that organ and is due to the inflammation congestion
and swelling of the ligaments.
There are certain points of natural mechanical weakness
in the body. Every mechanism has its structurally weakest point.
Mechanically weak points exist wherever a small part joins a large part.
Such points are found in the human body at the juncture of the spine with
the pelvis, with the reinforced chest box, at both upper and lower ends,
and with the cranium.
Mechanically weak points occur where the angle of
motion changes abruptly. These are found at the sacro-lumbar joint,
at the eleventh dorsal, the seventh cervical (heavily reinforced) at the
axis and atlas.
Mechanically exposed points exist at the ends of
the attachments of large muscles or of any muscles subject to strain, as
those of the shoulder, the scalene, the pectoralis minor.
Danger points exist where articulations are small
and motion slight, when strain, even well distributed strain, includes
them; as the upper dorsals, the last ribs.
Physiologically exposed points exist at the centers
for organs frequently strained or abused, as the organs of internal secretion;
these are the third cervical, the second to fourth dorsals, the seventh
and eighth dorsals, the eleventh dorsal.
A physiologically weak point exists in the sacro-iliac joint
in females near parturition, for the ligaments are functionally congested and
softened to make dilatation and adjustment easy.