Osteopathic Technic
Ernest Eckford Tucker
Principles of Osteopathy
    A brief summary of the principles of Osteopathy so far as they relate to the matter to be discussed in this book is a fitting introduction to it.
    Osteopathy rests on a very sure foundation.  Its philosophy rests on axioms; its practice on facts; its profession and its history on success.

    The axioms on which its philosophy is founded are:

    I. Everything composed of mechanical parts is subject to disorder among those parts.

    From this axiom there is no appeal.  There is no exception to it.  The solar system is not an exception, the eye of the beetle is not an exception, and the human body is not an exception.

    A corollary of this axiom is that the greater the number of parts, the more frequent should be disorder or lesion among them; and there are a great many different parts to the human body.

    II. If anything depends on the order, then that thing will be deranged by the disorder.

    In the human body, function and health depend on the order; and disease arises from the disorder.

    There is no appeal from this axiom, for the laws of mechanics are fundamental wherever they apply.

    These are two fundamental axioms on which the science is based.  But let us go further with the matter.  The human body is in all respects subject to the operation of law.  This is certainly axiomatic.  Where law does not operate logic is impossible.  If there be any parts not within the scope of law, then on those parts may we experiment.  If all parts are subject to law, then the only experimenting that is justified it the experimenting to discover those laws; and this experimenting should be performed on animals, not on human beings.  The only specific remedies that are possible are the specific laws that are violated.

    But if all parts of the human body are subject to the operation of law, then it follows as an axiom that the only possible cure for disease is the removal of causes; for to make any other attempt is to try to suspend the operation of law.

    Now there are only three possible kinds of causes of disease as there are only three possible causes for bad functioning in anything.  They are causes that relate to the mechanism, those that relate to the operation of it, and those that relate to the source of it.  In the human body, they are mechanical or structural disorder; functional strain or exhaustion; and hereditary weakness.  Every incidental cause of disease must come under one of these heads.  (It is possible to define them all as one—as structural, reckoning intracellular disorders as structural, though microscopic; but we preserve the distinction for convenience.)

    Of these three, heredity is not a cause of disease, but of only the weakness that allows disease.  Functional strain is sometimes fundamental as a cause, sometimes secondary.  If the strain exceeds the total strength given by normal heredity, then is it a fundamental cause of disease; if, however, it exceeds merely the existence of those facts ten men or even three men cannot possibly be mistaken.   There have been 10,000 men who bore testimony to the osteopathic facts.

    These facts are discovered in each individual case, and treatment is applied to them as found.  Each case contains its own evidence, and correction is directed to that evidence, not to any general formula of description, which may or may not apply in the individual case.

    The profession itself grew up on a basis of success.  Things do not belong wrong; when found wrong they were corrected—no other reason or excuse was necessary.  But this was followed by cure.  From the very first inadvertent experiment made by Dr. Still, the policy of correcting disorders was followed by good results, and was pursued only and solely for that reason.  Other men seeing the good results that followed this policy insisted on being trained in it.  From this beginning the school arose, and the profession was organized.  There is no appeal from success.  Things that succeed prove themselves true in relation with every law known and unknown that applies to them.

    The success of osteopathy is not absolute.  It does not acclaim to be the final revelation in the matter of healing.  It believes itself to be absolutely fundamental, however, a necessary basis for whatever else of good may be found in the healing art; and to be unshakable in principle and in logic. without vanity for itself or antagonism for others, but in a spirit of impersonal estimate, it sees itself as a real science of healing—i.e., the first; for surgery abandons the question of cure, and removes—saves, but does not cure; medicine counteracts. Stimulates and sustains, and cares for; but neither these nor any other science except osteopathy alone bases its practice solely on the principle of removing fundamental causes.

    Mathematics is an absolute science, in theory.  In the application thereof to individual problems it is no stronger than the technic of the person so applying it.  The same thing is true of Osteopathy.  The practical reality of the science is in its technic.

    That every physician’s technic is “different,” is his own individual development, is well known.  The only true contribution to the subject therefore is along the lines of conception of lesions, and the principles of technic, though much may be hoped for from merely comparison of the technical development of others.  Details of technic are here given to illustrate the principles that are set forth.  There is no though, as there is no possibility of exhaustive or complete presentation of such a subject.

    Neither description nor illustration can convey a proper concept of any individual technic.  The sooner we abandon that effort the better.  Individual instruction, with supervision and correction to insure the carrying out of the individual’s conception of his technic is the only practical method, certainly is the ideal method.

    Description, however, is necessary to lead to a scientific development of the subject, a discussion of dangerous and faulty methods and a definition of principles of technic.

    In applying these principles to individual cases, that is, in cultivating his individual technic, the physician must consider the feelings of the patient.  That technic is best which makes the most successful compromise between pleasing the patient and promptly correcting the lesions.  The latter only is our problem here, and our purpose is to develop as clear a mental picture of the mechanics and the principle of technic as possible.  The matter of adjusting this to the susceptibilities of patients is the personal problem of the operator.

Osteopathic Anatomy
    For a better understanding of the nature of lesions and the mechanics of reduction, some understanding of anatomy from the osteopathic point of view is desirable.  In the rest of this preface a summary of the important points that are brought out here and there in the text is brought together.  This subject might be called rational anatomy as distinguished from descriptive anatomy.

    Bones bear always pressure.  Bone will form automatically from pressure, and adapts itself automatically to the pressure that bears upon it.  The shape of every minutest bone in the body therefore is an expression of the forces of pressure acting on it.

    For illustration, the sacrum, composed of the five vertebrae included between the iliac, has become solidified into one bone and greatly enlarged from the pressure exerted by those iliac.  It is curved because as the body bends the great erector spinae muscle draws at different angles.  The tension of this great muscle is opposed by the great sciatic ligament and other ligaments and is transformed by them into pressure against the sacrum in line with its axis.

    The rounded skull sustains pressure from muscles, the occipito-frontalis and the temporal muscles, but chiefly it sustains atmospheric pressure; as in fact do all bones.  (In some birds, where there is great and rapid change in this pressure as the bird rises and descends in flight, the bones are hollow and communicate with the air.)

    All muscles are so attached as to bring pressure on the bones they move.  Muscle is attached in reality to periosteum, which encircles the bone, so as to bring pressure on its opposite side.

    All joints therefore bear pressure.  Nature does not endure tension on joints.  Muscles are relayed across joints, criss-crossed as it were, bringing always pressure to bear on them.

    This pressure is always perpendicular to the face of the joint.  For if it were not the joint would simply slide to the limit of its motion in the direction of the diagonal pressure, and stay there.

    An expression of this simple law is seen in the fact that joints on the same bone are always at right angles to each other.  The shoulder faces inward, the elbow faces forward.  But it is very conspicuously evident in the vertebrae and ribs, where the joints are close together.  The reason is very easily seen.  Given any one joint, motion is transmitted, which means that pressure is transmitted, parallel to the face of the joint.  All vertical pressure is taken up by the opposing face, and the parallel pressure or motion is transmitted.  A second joint therefore will have its face perpendicular to the first; and a third joint will be perpendicular to both of the other two, like the corner of a box.  If there is a fourth joint, it is a cartilaginous joint, like the cartilages of the ribs  or the intervertebral discs; and is parallel to the line of intersection of the planes of two of the other joints.

    In the vertebrae, the facets for the ribs are at right angles to each other and to the surfaces of the articular processes; reckoning the latter as one joint; while the muscles in the bone they move is brought to a focus and is tendinous.)  For instance, the ligaments of the spinous processes do not run vertically from one to the other, but converge toward the articular processes, radially to the vertical motion of each spinous process.

    Where ligament is stretched as the vertebra moves normally, it is of the yellow elastic variety; as in the ligamentum nucha and the posterior longitudinal ligament of the spine.

    This radial arrangement of ligaments makes it possible to exceed the normal range of motion with slight stretching of the fibres of the ligament; it helps to maintain the lesion when an angular position has been assumed in lesion; and it gives rise to the popping sound when such lesion is corrected.

    A ligament which is radial to one motion of a vertebra acts as a restraining force in motion of another character, and thus acts also to change the direction of the motion—to produce “secondary” motions.  This fact assumes some importance in the following study of motions and lesions.

    The bone and muscle arrangements of the body are all levers, of great variety and of wonderful symmetry and sequence.  Of these the joints are the fulcra; the part between the joint and the attachment of muscle is the power arm, the rest is the work arm; the muscle supplies the power.  Where ligament acts as a restraining force it becomes part of the fulcrum, producing a double fulcrum with shifting of the axis of motion.

These leverages must be used to get control of parts in lesion.