Physiological Regulation Through Manual Therapy This section was compiled by Frank M. Painter, D.C.
Make comments or suggestions to Frankp@chiro.org
FROM: Physical Medicine and Rehabilitation: State of the Art Reviews 2000; 14 (1)
OPEN ACCESS Eric A. Mein, MD, Douglas G. Richards, PhD, David L. McMillin, MA,
John M. McPartland, DO, MS, Carl D. Nelson, DC
From the Meridian Institute Virginia Beach,
Virginia (EAM, DGR,DLM,CDN) and
Department of Osteopathic Manipulative Medicine
Michigan State University College of Osteopathic Medicine
East Lansing, Michigan (JMM)CORRECTION AND REGULATION
Manual therapy can be divided into two distinct conceptual approaches to treatment: specific adjustments for correction of anatomic issues (structure) and adjustments for physiologic regulation (function). In recent years, the primary emphasis of most practitioners has been on finding structural problems associated with musculoskeletal issues and correcting anatomic findings ("lesions" and "subluxations"). Less emphasized has been the capability for manual therapy to regulate physiology, reestablishing equilibrium and balance among the various systems and processes of the body. Historically, however, the origins of both osteopathy and chiropractic can be traced to positive outcomes in the treatment of systemic dysfunction. A. T. Still, founder of osteopathy, used an "inhibition" technique (lying with his head in a sling) to relieve his own headaches; D. D. Palmer, founder of chiropractic, first treated a patient with a hearing impairment.
Recognition of the structure versus function choices within manual therapy dates to the early days of osteopathy. For example, Hazzard (1899), a prominent early osteopathic physician, acknowledges both of these approaches in his textbook Principles of Osteopathy:In our treatment of a spine there are two points which we may take into consideration; two objects which we may have in view. In the first place, we may wish to TREAT THE SPINE ITSELF [anatomical correction. In the second place, we may wish to REACH, BY TREATING THE CENTERS ALONG THE SPINE, THE VISCERA TO WHICH THESE NERVES RUN [physiologic regulation]. It is not always possible to disassociate these in your practice. [23]
The textbooks of the early 1900s emphasized regulation, [2, 5, 11, 19, 23, 30a, 51, 60] yet by 1991, Kuchera and Kuchera state: "The majority of DOs do not use manipulation. Many of those physicians who do so use it primarily for treating musculoskeletal complaints. They do not use manipulation for its homeostatic benefits [regulation] to the body's physiology." [30]
Johnston points out that there are aspects of osteopathic manipulation in which spinal segment dysfunction is not necessarily the focus for diagnosis and treatment. [25] These include direct manipulation of the visceral organs themselves, influencing cerebrospinal fluid flow, and adjustment of postural influences on visceral support systems. All of these are interventions that regulate physiology.
The general lack of awareness of regulatory techniques and effects can complicate the interpretation of research. For example, Balon et al. compared active and simulated chiropractic manipulations as an adjunctive treatment for childhood asthma. [4] They concluded that, because there were no significant differences in response to the active and simulated treatments, chiropractic spinal manipulation provides no benefit. However, the so-called simulated or sham treatment involved "soft tissue manipulation and gentle palpation to the spine, paraspinal muscles, and shoulders." Additional manipulations were applied to the head, ankles and feet, gluteal region, and occipital protuberance. "Low-amplitude, low-velocity impulses were applied in all these nontherapeutic contacts," in contrast to the standard high-velocity chiropractic manipulation.
Unfortunately, this simulated treatment resembles a traditional general osteopathic regulatory treatment. [17, 23] The Early American Manual Therapy website provides easy access to several such examples from the traditional manual therapy literatures. [32] Figure 1, which dates back to 1909, demonstrates such a technique. In the Balon study, both treatments produced positive effects. The authors note, "We are unaware of published evidence that suggests that positioning, palpation, gentle soft-tissue therapy, or impulses to the
musculature adjacent to the spine influence the course of asthma." [4] Richards et al. and Nelson et al. have, however, shown that there is substantial published evidence that such techniques are effective in regulating a large number of physiologic parameters. [41, 50]
FIGURE 1. Manipulation of the muscles in the back, in general treatment of the spine from A Manual of Osteopathy by Eduard W. Goetz, D.O., published in 1909. Soft tissue manipulation was often used by the early osteopaths for a wide range of systemic disorders. Typically, paraspinal massage and manipulation were included in the osteopathic general treatment format to improve nervous system coordination and drainages throughtout the system. This type of soft tissue technique is similar to the "simulated" (control) treatments given in a study for childhood asthma. [4] (From Goetz EW: A Manual of Osteopathy with the Application of Physical Culture, Baths and Diet. Cincinnati, Nature's Cure Company, 1909.)
REFERENCES:
1 .[Reference deleted.]
2. Ashmore EF: Osteopathic Mechanics. Kirksville, MO, Journal Printing Company, 1915.
3. Bailey JH: Osteopathic Treatment of the Eye, Ear, Nose and Throat in Hay Fever, Asthma, Bronchitis, Catarrhal Deafness and Allied Conditions. Lecture 13. Osteopathic Treatment of Hay Fever. Philadelphia, John H. Bailey, DO, 1922.
4. Balon J, Aker PD, Crowther ER, et al: A comparison of active and simulated chiropractic manipulation as adjunctive treatment for childhood asthma. N Engl J Med 339:1013-1020, 1998.
5. Barber ED: usteopatny complete. Kansas City, MO, Hudson-Kimberly Publishing, 1898.
6. Beal MC: Viscerosomatic reflexes: A review. J Am Osteopath Assoc 85:786-801, 1985.
7. Beicastro MR, Backes CR, Chila AG: Bronchiolitis: A pilot study of osteopathic manipulative treatment, bronchodilators, and other therapy. J Am Osteopath Assoc 83:672-676, 1984.
8. Bowles CH: Functional technique: A modern perspective. J Am Osteopath Assoc 80:326-331,1981.
9. Burchett G, Dickey J, Kuchera M: Somatovisceral effects of osteopathic manipulative treatment on cardiovascular function in patients [abstract]. J Am Osteopath Assoc 84:74, 1984. 10. Callan JP: [Editorial]. JAMA 241:1156, 1979.
10a. Casale TB: The role of the autonomic nervous system in allergic diseases. Ann Allergy Asthma Immunol 51:423-429, 1983.
11. Davis AP: Neuropathy: The New Science of Drugless Healing Amply Illustrated and Explained. Cincinnati, OH, FL Rowe, 1909.
12. Downing JT: Observations on effect of osteopathic treatment on blood pressure. J Am Osteopath Assoc 13:257-259, 1914.
13. Feely RA, Castillo TA, Greiner JV: Osteopathic manipulative treatment and intraocular pressure. J Am Osteopath Assoc 82:60, 1982.
14. Fitzgerald M, Stiles E: Osteopathic hospitals' solution to DRGs may be OMT. The DO (Nov):97-101, 1984.
15. Frymann VM, Carney RE, Springall R: Effect of osteopathic medical management on neurological development in children. J Am Osteopath Assoc 92:729-744, 1992.
16. Gilliar WG, Kuchera ML, Giulianetti DA: Neurologic basis of manual medicine. Phys Med Rehabil Clin North Am 7:693-714, 1996.
17. Goetz EW: A Manual of Osteopathy (with the Application of Physical Culture, Baths and Diet). Cincinnati, OH, Nature's Cure Company, 1909.
18. Greenman PE, Mein EA, Andary M: Craniosacral manipulation. Phys Med Rehabil Clin North Am 7:877-896, 1996.
19. Gregory AE: Spondylotherapy Simplified. Oklahoma City, OK, Alva Emery Gregory, M.D., 1922.
20. Guthrie RA: Lumbar inhibitory pressure for lumbar myalgia during contractions of the gravid uterus at term. J Am Osteopath Assoc 80:264-266, 1980.
21. Guthrie RA, Martin RH: Effect of pressure applied to the upper thoracic (placebo) versus lumbar areas (osteopathic manipulative treatment) for inhibition of lumbar myalgia during labor. J Am Osteopath Assoc 82:247-251, 1982.
22. Harris JD, McPartland JM: Historical perspectives of manual medicine. Phys Med Rehabil Clin North Am 7:679-692, 1996.
23. Hazzard C: Principles of Osteopathy, 3rd ed. Kirksville, MO, Charles Hazzard, 1899.
23a. Jackson KM, Steele KM: Osteopathic treatment of asthma: A literature review and call for research. Am Acad Osteopath J 9:23-27, 1999.
24. Jackson KM, Steele TF, Dugan EP, et al: Effect of lymphatic and splenic pump techniques on the antibody response to hepatitis B vaccine: A pilot study. I Am Osteopath Assoc 98:155-160, 1998. 24a. Jindal SK, Kant SK: Relative bronchodilatory responsiveness attributable to sympathetic and parasympathetic activity in bronchial asthma. Respiration 56:16-21, 1989.
25. Johnston WI, Hill JL, Sealey JW, Sucher BM: Palpatory findings in the cervicothoracic region: Variations in normotensive and hypertensive subjects. J Am Osteopath Assoc 79:300-308, 1980. 25a. Kaliner M, Shelhamer JH, Davis PB, et al: Autonomic nervous system abnormalities and allergy. Ann Intern Med 96:349-357, 1982.
25b. Kallenbach JM, Webster T, Dowdeswell R, et at: Reflex heart rate control in asthma. Chest 87:644-648, 1985.
26. Kaluza, Sherbin M: The physiologic response of the nose to osteopathic manipulative treatment: Preliminary report. J Am Osteopath Assoc 82:654-660, 1983.
27. Korr IM: The neural basis of the osteopathic lesion. J Am Osteopath Assoc 47:191-198, 1947.
28. Koff IM: The spinal cord as organizer of disease processes: The peripheral autonomic nervous system. J Am Osteopath Assoc 79:82-90, 1979.
29. Kuchera WA, Kuchera ML: Osteopathic Principles in Practice, 2nd ed. Columbus, OH, Greyden Press, 1994.
30. Kuchera ML, Kuchera WA: Osteopathic Considerations in Systemic Dysfunction. Kirksville, MO, KCOM Press, 199 1.
30a. Long EA: The Fundamental and Applied Principles of Osteopathy. Philadelphia, Frederick A. Long, 1938.
30b. Kumar SD, Emery MJ, Atkins ND, et al: Airway mucosal blood flow in bronchial asthma. Am J Respir Crit Care Med 158:153-156, 1998.
31. Mannino JR: The application of neurologic reflexes to the treatment of hypertension. J Am Osteopath Assoc 79:225-231, 1979.
32. McMillin DL: The Early American Manual Therapy Web site: http://www.members.visi.net/mcmillin/1998.
33. McPartland JM, Mein EA.: Entrainment and the cranial rhythmic impulse. Altern Ther Health Med 3:40-45, 1997.
34. Measel JW Jr: The effect of the lymphatic pump on the immune response: 1. Preliminary studies on the antibody response to pneumococcal polysaccharide assayed by bacteria] agglutination and passive hemagglutination. J Am Osteopath Assoc 82:28-31, 1982.
35. Measel JW, Kafity AA: The effect of the lymphatic pump on the B and T cells in peripheral blood [abstract]. J Am Osteopath Assoc 86:608, 1986.
36. Mein EA: Keys to Health: Holistic Approaches to Healing. New York, St. Martin's Press, 1994.
37. Mein EA: Overview of techniques and system approaches to manipulation. Phys Med Rehabil Clin North Am 7:731-747, 1996.
38. Miller CE: The lymphatic pump, its application to acute infections. J Am Osteopath Assoc 2:443-445, 1926.
39. Misischia PJ: The evaluation of intraocular tension following osteopathic manipulation. J Am Osteopath Assoc 80:750, 198 1.
40. Morgan JP, Dickey JL, Hunt HH, Hudgins PM: A controlled trial of spinal manipulation in the management of hypertension. J Am Osteopath Assoc 85:308-313, 1985.
41. Nelson CD, Redwood D, McMillin DL, et a]: Manual healing diversity and other challenges to chiropractic integration. J Manipulative Physiol Ther [in press].
42. Northrup TL: Manipulative management of hypertension. J Am Osteopath Assoc 60:973-978, 1961.
43. Owens C: An Endocrine Interpretation of Chapman's Reflexes. 2nd ed. Chattanooga, TN, Chattanooga Printing & Engraving, 1937.
44. Patriquin DA: Viscerosomatic reflexes. In Patterson MM, Howell JN (eds): The Central Connection: Somatovisceral/Viscerosomatic Interaction. 1989 International Symposium. Athens, OH, American Academy of Osteopathy,
1992, pp 4-18.
45. Patriquin DA: Chapman's reflexes. In Ward RC (ed): Foundations for Osteopathic Medicine. Baltimore, Williams & Wilkins, 1997.
46. Paul RT, Stomel RJ, Broniak FF, Williams BB Jr: Interferon levels in human subjects throughout a 24-hour period following thoracic lymphatic pump manipulation. J Am Osteopath Assoc 86:92-95, 1986.
47. Purdy WR, Frank JJ, Oliver B: Suboccipital dermatomyotomic stimulation and digital blood flow. J Am Osteopath Assoc 96:285-289, 1996.
48. Radjieski JM, Lumley MA, Cantieri MS: Effect of osteopathic manipulative treatment on length of stay for pancreatitis: A randomized pilot study. J Am Osteopath Assoc 98:264-272, 1998.
49. Reilly HJ, Brod RH: The Edgar Cayce Handbook for Health through Drugless Therapy. New York, Macmillan, 1975.
50. Richards DG, Mein EA, Nelson CD: Chiropractic manipulation for childhood asthma. N Engl J Med 340:391-392, 1999.
51. Riggs WL: A Manual of Osteopathic Manipulations and Treatment. Elkhart, IN, New Science, 1901.
52. Rogers JT, Rogers JC: The role of osteopathic manipulative therapy in the treatment of coronary heart disease. J Am Osteopath Assoc 76:71-81, 1976.
53. Rost A, Rost J: Introduction to Regulation Thermography. Stuttgart, Hippokrates, 1987.
54. Sato A: Reflex modulation of visceral functions by somatic afferent activity. In Patterson MM, Howell JN (eds): The Central Connection: Somatovisceral/Viscerosomatic Interaction. 1989 International Symposium. Athens, OH, American Academy of Osteopathy, 1992, pp 53-76.
55. Schmidt RF: Neurophysiological mechanisms of arthritic pain. In Patterson MM, Howell JN (eds): The Central Connection: Somatovisceral/Viscerosomatic Interaction. Indianapolis, American Academy of Osteopathy, 1992, p 135.
55a. Shah PKD, Lakhotia M, Mehta S, et al: Clinical dysautonomia in patients with bronchial asthma. Chest 98:1408-1413, 1990.
56. Sleszynski SL, Kelso AF: Comparison of thoracic manipulation with incentive spirometry in preventing postoperative atelectasis. J Am Osteopath Assoc 93:834-845, 1993.
57. Song LZ, Schwartz GE, Russek LG: Heart-focused attention and heart-brain synchronization: Energetic and physiological mechanisms. Altem Ther Health Med 4:44-52, 54-60, 62, 1998.
58. Stanton DF, Mein EA (eds): Manual Medicine. Physical Medicine and Rehabilitation Clinics of North America, vol. 7, no. 4. Philadelphia, WB Saunders, 1996.
59. Stiles E: Manipulative management of chronic lung disease. Osteopath Ann 9:300-304, 1981.
60. Tasker DL: Principles of Ostepathy. Los Angeles, Baumgardt, 1903.
61. Van Buskirk RL: Nociceptive reflexes and the somatic dysfunction: A model. J Am Osteopath Assoc 90:792-809, 1990.
61a. Wallace E, McPartland JM, Jones JM 3d, et al: Lymphatic system: Lymphatic manipulative techniques. In Ward RC
(ed): Foundations for Osteopathic Medicine. Baltimore, Williams & WiWns, 1997, pp 941-967.
62. Wolf AH: Osteopathic manipulation in eye, ear, nose, and throat disease. In American Academy of Osteopathy Yearbook. Indianapolis, AAO, 1962, pp 133-140
Return to NON-MUSCULOSKELETAL DYSFUNCTION
Since 6-07-2006
| Home Page | Visit Our Sponsors | Become a Sponsor |
Please read our DISCLAIMER |