overview of global bio-mechanics - yet with a precise muscluo-skeletal diagnosis and tissues causing symptoms

A precise diagnosis, in musculo-skeletal terms, of the tissues causing symptoms is essential in good Osteopathy and good physical therapy, and musculo-skeletal medicine.

Further to my last blog, and emphasis on the importance of whole-body bio-mechanics (which is essential for good Osteopathy), and an understanding of the whole of the person, body mind and spirit, as Andrew Still, the founder of Osteopathy put it  -  I should also like to point out, that we also need a good musculo-skeletal diagnosis, good anatomical knowledge, logical clinical reasoning skills, and a precise diagnosis, in terms of the tissues causing symptoms.

These tissues causing the symptoms may not be only local (as physiotherapists often seem to think) but may sometimes (especially in a chronic case) also be (part of) a complex pattern of altered global bio-mechanics.  If this is the case, then in good Osteopathic treatment, we must address the entire pattern of the altered bio-mechanics, i.e. Osteopathic treatment of the whole body, not just perhaps the part that hurts.

Of course, this is not always so, and sometimes things are relatively straightforward, e.g. in a younger person perhaps, or a simple sports injury (but even here, sometime the entire body pattern, and the way a person uses their body has a significant influence).

For example, sometimes a medial collateral ligament strain of the knee, is just that - a medial collateral ligament strain.  Of course, there may be also other factors:  e.g. any muscle imbalance of the legs or pelvis, and/ or pelvic, sacral, or spinal torsion, as these factors can certainly influence the mechanical loading to the knee.

An understanding of, and a treatment plan aimed at also addressing the 'big picture', i.e. these global bio-mechanical influences, if present, can certainly lead to better treatment outcomes and faster recovery time from injury.  They may also even predict an area that might predispose to injury, and in treating this broader imbalance in global bio-mechanics help prevent injury.

For more on this, you might want to see:
http://www.christchurch-osteopathy-acupuncture.co.nz/osteopathy/principles.html

http://www.christchurch-osteopathy-acupuncture.co.nz/osteopathy/howManyTreatments.html


And as for Acupuncture, sure an understanding of the whole person is important, and we can give a constitutional treatment, and this can give better results, and promote general health and faster tissue healing.  Yet, even with acupuncture, it is also important sometimes to give specific treatment.  If there is knee pain, for example, then needling around the knee, perhaps both above and below also, is probably important.  Ans if it is, for example, a medial collateral ligament strain, then needling over the medial collateral ligament directly can help promote tissue healing, and collagen regeneration.

For more on this, you might want to see:

http://www.christchurch-osteopathy-acupuncture.co.nz/acupuncture/scientificBasis.html

http://www.christchurch-osteopathy-acupuncture.co.nz/acupuncture/acupuncture.html

modern osteopathy, acupuncture and integrated healthcare: towards an global understanding of health, not just a analytical reductionist understanding of dis-ease.

There is a Traditional Chinese Medicine and Acupuncture pattern of disharmony described as 'deficiency below and excess above', and any experienced clinician or acupuncturist may recognize this in many chronic diseases (e.g. chronic fatigue, hypertension, diabetes, heart-disease, etc) and in the older person.

There is the concept 'zang-fu' of paired organs in Traditional Chinese Medicine and Acupuncture, and after all, in physiology, this also makes perfect sense: e.g. the relationship of the heart and kidneys in haemodynamics, and regulating blood pressure (as well as rate and force of the heart's contractions and suction) through the kidney's control of water and electrolyte balance.  

The traditional acupuncture concept of the heart-kidney shao-yin axis does of course go way beyond the mechanical and haemodynamic action of these organs, and suggests neuroendocrine effects, altering mood, emotion, and mental states.  For in the traditional acupuncture paradigm, emotions are 'visceral' and organic, and have a physiological basis.  None would argue with this perhaps. 

Even modern osteopathy (e.g. John Pierre Barral) sees the visceral component as highly significant, and the 'tissue memory' (as John Upledger put it) storing 'emotional charge' locked away in the body.  Or as John Littlejohn (who studied with Andew Still, the founder of Osteopathy) said: 'The body is the graveyard of emotion'.  Any experienced clinician has an intuitive grasp of these truths, I would hope.  The early Chinese acupuncturists wrote of this in pre-Christian times, when Aristotle and Hippocrates were leaving some the early written European records.  In traditional acupuncture the specific emotions relating to each organ system were identified, in their integrated body-mind continuum world view. 

For more on this, see:

http://www.christchurch-osteopathy-acupuncture.co.nz/acupuncture/acupuncture.html

http://www.christchurch-osteopathy-acupuncture.co.nz/osteopathy/visceralOsteopathy.html


http://www.christchurch-osteopathy-acupuncture.co.nz/osteopathy/principles.html

Acupuncture: Traditional and Modern: Reflections on Acupuncture, Osteopathy, and the history of medical science

Acupuncture:  Traditional and Modern:  Reflections on Acupuncture, Osteopathy, and the history of medical science.

Traditional Acupuncture has long used the inner and outer bladder lines, and also the Huatuo Jiaji points, 0.5 cun from the mid-line of the spine.   Very useful from a practical point of view for back pain, but also pertaining to the spinal nerves, and therefore able to influence the whole body and nervous system. 

No doubt the famous Chinese physician and acupuncturist Huatuo realized their importance, even though he didn't know the anatomical terms, as the ancient Chinese physicians didn't dissect cadavers, and were not anatomists, like their early European counterparts we beginning to become.  

Early recorded European records show that it was the ancient Greeks that began dissection and the study of anatomy, later followed by Romans such as Galen.  However the only cadavers they had access to were from convicted felons, and it the thought of being permanently crippled and maimed (as ghosts) in the underworld and the afterlife was a gruesome punishment for such criminals. Perhaps all serving as an additional deterrent, to help maintain law and order, and social harmony.

OK there might also have been a bit of grave-robbing  going on, as not doubt also happened in later centuries once medical schools were more widely established and bodies were in demand for dissection.  All together a gruesome subject  - and perhaps why a more civilized culture like ancient China did not resort to such barbarities.  After all, they knew how energy circulated in meridians the body  (from qigong practice and meditation) and were far more advanced in their own understanding of physiology in terms of qi and blood, yin and yang, excess and deficiency and so on.

To return to the Acupuncture points (and Chinese physicians such as Huatuo) the mechanism and action and underpinning neuroanatomy and physiology of these back points is now well understood.  Acupuncture here stimulates paraspinal muscle (spinalis, semi-spinalis, etc.) and their segmental spinal nerves, and feedback into the dorsal horns and associated spinal reflexes. 

One of the mechanisms of acupuncture is likely to be via alpha-delta fibres that inhibit the nocieceptive pathway in the dorsal horn of each vertebrae, and this segmental effect can influence visceral conditions, both for pain and disturbed autonomic reflexes.  The intermediate cells in the dorsal horns, by way of collateral terminals, also release the neurotransmitter enkephalin (which blocks pain transmission).

The somato-visceral reflexes involved here, pertain to underlying viscera (via the sympathetics and segmental vasomotor reflexes) and again these effects seemed to be well known to the ancient Chinese physicians and acupuncturists, as they noticed that acupuncture had benefits well beyond musculo-skeletal medicine.  They were effecting the nervous system itself, not just treating muscle and joint pain.  

Integration of modern and and ancient medicine can give a much better understanding.  Both world-views have a great deal to contribute.

For more on this see:
http://www.christchurch-osteopathy-acupuncture.co.nz/acupuncture/scientificBasis.html

different theoretical models underpinning these (apparently) two different types of acupuncture. Osteopathic principals and modern biomedical science

Reflections on integration of Traditional Chinese Acupuncture and Western Medical Acupuncture models

The obvious thing anyone notices here is the quite different theoretical models underpinning these (apparently) two different types of acupuncture.  Are they really different?  Well, that is the question.

So called Western Medical Acupuncture justifies its efficacy according to modern bioscience, and neurology and physiology.   I must admit this does make it easier for me personally, as an osteopath to integrate this acupuncture according to Osteopathic principles. 

However, this also generates food for thought and much reflection, about the type of (osteopathy or acupuncture) treatment given: specific, symptomatic and reductionist  -  versus a more global, integrative, whole-body, whole-person, mind-body-spirit approach.  These principles were those of Andrew Still and the early osteopaths.  The global model is also the principle of traditional acupuncture.

So the differences, as I see it, between the Traditional acupuncture and modern reductionist so called Western Medical Acupuncture models, have a close parallel between the classical osteopathic paradigm (e.g. Andrew Still, Littlejohn, John Wernham) and the more reductionist, orthopaedic, quick-fix kind of osteopathy  (or chiropractic or physiotherapy) as a simplification, a symptomatic treatment, 'only treat where it hurts' type of approach.

I would like to hope that perhaps the Western Medical Acupuncture model might have some scope for the richness and sophistication that we find in Traditional acupuncture.   OK, all beginners have to start somewhere. As beginners in acupuncture (as all clinicians were, once upon a time) we all started with basics, and gradually developed our clinical skills.  But why medics cannot go beyond this primitive cut-down western medical acupuncture model is beyond me.  Perhaps it is a lack of time, or commitment to further study. 

And also the Traditional acupuncture model has to be open to scrutiny, and rigorous evaluation of evidence base.  Indeed it already is, with vast amount of research, and universities in Korea, China, and Japan generating a lot also).  And also admittedly, I'm sometimes a little disappointed with my Traditional acupuncture colleagues, and there being not quite enough modern western biomedical science (a thorough grounding in anatomy, physiology, neurology, pharmacology, rheumatology, orthopaedics, etc) in their training courses.  Although I would like to hope that this is getting better.

So good to try to help integrate these tow models:  the historical richness and sophistication of traditional acupuncture, and modern western biomedical science.  Surely this is a win-win scenario for all.  Let the debate (and friction) continue.

For more on this, see:
http://www.christchurch-osteopathy-acupuncture.co.nz/acupuncture/traditionalDry.html

As naturopathic medicines (osteopathy, acupuncture, mindfulness-meditation, etc) seem more and more to be seeping into the mainstream . . .

Recently discovering this post (by David Wolf -  thanks for this, only included here, so could comment more fully on it) on Facebook, I am struck by how we might be getting quite a different kind of medicine nowadays, or so it would seem. At least it's 'power to the patient' rather than more and more to pharmaceutical multinationals. All food for thought..

However, sadly I suspect such a doctor would never loose all their patients, as not everybody it seems, really wants to be proactive in their own healthcare and well-being. But at least doctors are saying the right things a bit more.  Well, let's hope so anyway. 

At least mainstream healthcare is changing. It always seemed to me that the greatest failure of the medical model is foster a 'culture of dependency'. And even the accountants realize that the implications for this are greater healthcare costs. All developed countries and struggling with higher and higher healthcare costs, as we live longer, but not necessarily any healthier.

All good that Naturopathic and traditional medicine (and here I could include Osteopathy,  Acupuncture, mindfulness-meditation, Qigong,  yoga and Traditional Chinese Medicine) seem to be seeping into the mainstream.  This would seem to be a win-win scenario for all:  especially individual patients, but also for the tax-payer.  OK, potential losers here might to a very limited extent be the pharmaceutical companies and their revenues, but they are such huge players, with so much influence, somehow I don't think most people will worry about this.

Of course,  pharmaceutical medicine has its place - do one would deny that (I hope).  The feedback I get from many of my patients, is not that they are necessarily unhappy with their doctors  - but only that in additions to their script for pharmaceutical drugs, their doctors (in the past, at least) have often offered little else.

So this is why perhaps we could call this 'power to the patient'.  After all,  isn't this a good thing.   With the advent of the internet, almost all educated people will go to their GP with a lot more questions.  Or I would certainly hope so.

For more on this please see my self-care / rehabilitation osteopathy page:
http://www.christchurch-osteopathy-acupuncture.co.nz/selfcare/selfcare.html

and my Naturopathy pages:
http://www.christchurch-osteopathy-acupuncture.co.nz/naturopathy/naturopathy.html


sorry  -  you'll probably have to copy an paste these links into your browser

osteopathy, mindfulness, compassionate non-judgemental awareness, presence and healing

Those who know me as an osteopath, many also by now begin to understand my love of poetry.
Carl Roger's  (the father of Humanistic psychology and 'client-centered' therapy) considered that the most important thing in the therapeutic relationship was simply to be 'fully present' with the client, and to listen fully, compassionately and non-judgementally.

Mindfulness seems to be mainstream, and everyone seems to have heard about it.  Once all the 'qi and blood' and biological energy we invest in our 'narrative mode' of anxieties and restless thinking is spared -  how much more of the body's resources might be available for tissue healing?  Something to reflect on perhaps.

http://www.christchurch-osteopathy-acupuncture.co.nz/painManagement/painManagement.html
http://www.christchurch-osteopathy-acupuncture.co.nz/selfcare/mindfulnessForHealth.html

Ryokan   (from  Sky Above:  Great Wind  The Life and Poetry of Zen Master Ryokan):

Past has passed away

Future has not arrived

Present does not remain

Nothing is reliable; everything must change.

You hold on to letters and names in vain

forcing yourself to believe in them.

Stop chasing new knowledge

leave old views behind.

Study the essential

and then see through it.

When there is nothing left to see through,

then you will know your mistaken views.

-------------------------------------------------------------------------------------------------------

And, seemingly on a very similar theme from Buddha:

One Who Has Had a Single Excellent Night

Let not a person revive the past

or on the future build his hopes;

For the past has been left behind

And the future has not been reached.

Instead with insight let him see

each presently arisen state.

Let him know that and be sure of it

invincibly, unshakeably.

Today the effort must be made.

Tomorrow death may come, who knows?

No bargain with mortality

can keep him and his hordes away.

But one who dwells thus ardently

relentlessly, by day, by night  -

It is he, the peaceful sage has said

who has had a single excellent night.

Bhaddekaratta Sutta 1211 - 1214  (Pali Cannon)

  

----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

and one more poem from Ryokan:

Delusion and enlightenment
two sides of a coin
Universal and particular
just parts of one whole

All day I read the wordless scriptures
All night I practice no-practice meditation
On the riverbank, a bush warbler
sings in the weeping willow
In the sleeping village, a dog bays at the moon
Nothing troubles the free flow of my feelings
But how can this mind be passed on?

mentoring for Osteopaths: self-reflective learning journal.

Having attended the Osteopathic Council Mentoring training last last weekend in Auckland  (28/02 to 01/03) I am now able to begin the mentoring process for overseas osteopaths entering NZ, wishing to gain full registration with the Osteopathic Council NZ.

The preceptoring (mentoring) process makes use of a reflective portfolio for osteopaths gaining full registration.  This is the same platform as the self-reflective learning journal that will soon be used for ongoing re-certification for all osteopaths in NZ.  Nurses, occupational therapists and other professions use a similar process.

NZ register of Acupuncture continuing professional development will continue to be based on courses or webinars, according to the number of hours.