The Five Osteopathic Models

Rationale, Application, Integration - from an Evidence-Based to a Person-Centered Osteopathy

Christian Lunghi, Giampiero Fusco, Ray Hruby, Paulo Tozzi

• Publisher: Handspring Publishing
• Year: 2017
• ISBN:
  9781909141698
• Edition: 1
• Topic: Medicine
• Subtopic: Alternative & Complementary Medicine

Far from being simply a sequence of techniques, as practised in many countries osteopathy is an independent primary health care system based on principles applied through a manual practice: a unique profession that takes care of the whole person through the application of five models (biomechanical, neurological, respiratory-circulatory, metabolic, and behavioral). These conceptual models of the relationship between structure and function allow osteopaths to evaluate treatment with the aim of promoting health rather than curing disease.

This book is intended as a manual for both students and osteopathic professionals interested in exploring the principles, objectives, origins and application of the five osteopathic models, from traditional concepts up to a modern vision, based on evidence and critical thinking. The selection criteria and rules for the application of each model, with their limitations and potential, are examined, to enable the reader to understand the rationale behind their use in a comprehensive, holistic and patient-centered practice.

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SECTION

Person-centered osteopathic medicine

From tradition to innovation through critical thinking supported by evidence

CHAPTER 1 Osteopathy: a practice based on tradition, research, critical thinking, and art

CHAPTER 2 Adaptive local response: somatic dysfunction

CHAPTER 3 General adaptation syndrome: biological fluids, involuntary rhythms, and fascial compensation schemes

Christian Lunghi

INTRODUCTION

It has often been said that osteopathy is not a simple application of techniques, but a complete structured medicine, based on principles of application through a manual practice.¹ However, currently, worldwide, there seems to be a general disagreement within the osteopathic community on what the great osteopathic principles should be and how they should be applied clinically,^1,2 resulting in possible controversy when it comes to making a choice about, for example, which technique is best suited for a given patient.

This section aims to revisit the traditional osteopathic principles and their application in the light of a modern vision, supported by evidence and reinforced by critical thinking (see Chapter 1). These fundamentals are the essence of what makes osteopathy a unique profession that takes care of the person, centering treatment on health. The treatment is then focused on the adaptive capacities of the person treated, which are expressed through the functions of the hypothalamic–pituitary–adrenal (HPA) axis of the sympathic-adrenergic system (SAS), and of the reflexes manifested on corporeal tissues from eventual overload of the regulatory systems. The osteopath observes the individual adaptive mode, trying to understand if this happens locally through somatic dysfunction (SD), or through functional alteration of the components of the somatic system in relation to each other as muscular-skeletal-fascial, vascular, lymphatic, and neural aspects (see Chapter 2); or if this is affected by factors that have a general effect on large parts of the body and are detectable in the fascial compensation schemes (FCS) and on the assessment of the dynamics of fluids and involuntary rhythms (DyFIR) (see Chapter 3).

Through knowledge of anatomy and physiology, the osteopath will try to interact with the tissue changes related to overloading of the self-regulating systems, with repercussions on neuropsychological, respiratory, circulatory, postural-biomechanical functions and the global economy of the body, so as to correct no longer sustainable dysfunctional patterns and changes of the individual chronobiology. The functions that can interact with the individual adaptive capacity represent five conceptual models of assessment of the relationship between structure and function, as well as activation forces which are based on biomechanical, neurological, circulatory-respiratory, metabolic-energetic, and biopsychosocial clinical approaches.³ The osteopath, through the application of a decision-making process, selects the best mode of interaction with the person, proceeding sometimes with specific local approaches directed to the clinically relevant SD, sometimes with adaptogenic approaches aimed at balancing FCS and/or dynamics of fluids and involuntary rhythms (DyFRI). All this brings to light osteopathic manipulation as a medicine centered on the person, based on holistic principles and the global application of structure/function models, aimed at promoting health rather than curing disease (see Chapter 1).

References

1. Rogers FJ. Advancing a traditional view of osteopathic medicine through clinical practice. J Am Osteopath Assoc. 2005;105(5):255–9.

2. Fryer G. Call for papers: an invitation to contribute to a special issue on osteopathic principles. Int J Osteopath Med. 2011;14(3):79–80.

3. Educational Council on Osteopathic Principles (ECOP). Glossary of osteopathic terminology. Chevy Chase, MD: American Association of Colleges of Osteopathic Medicine (AACOM); 2009.

Osteopathy: a practice based on tradition, research, critical thinking, and art Christian Lunghi

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Synopsis

The “osteopathic principles” are crucial in defining the peculiar characteristics of osteopathy. However, the lack of sharing and embracing of these principles within the practice community has made these fundamentals vague and undeveloped; moreover, the lack of recognition of these principles in their application during practice has not helped to distinguish osteopathy from other health professions that likewise place anatomy, physiology, and holism at the base of their work. In this chapter, by observing the traditional principles and contemporary scientific evidence we have drawn a hypothesis of rational treatment based on these principles. There emerges an osteopathy based on salutogenesis: a traditional medicine, which, evolving on an anthropological basis, centers its work on the person. The text also attempts to answer questions related to the mechanism of action and clinical effectiveness of osteopathy in many areas of health: from pediatrics and gynecology to sports medicine and geriatrics, and so on. However, in order to outline the actual indications of osteopathic treatment, additional protocols are necessary to study the mechanisms of action of osteopathic manipulative treatment, its clinical efficacy, the reliability of palpatory procedures, the cost/benefit ratio, as well as the person’s individual perception with respect to its discomfort, its adaptive capacity, and the osteopathic treatment received.

From reflections on the above principles there emerges a concept of adaptive health; consequently, the discomfort is considered a deficiency of the dynamic interaction within and between adaptive systems and is recognizable in the alterations of the relationship between structure and function, before the damage of the single system. The treatment has the objective of interacting with the adaptive biomechanical function, respiratory, circulatory, metabolic, and energetic, as well as psychological. Hence, the osteopath proceeds with either specific local approaches addressed to the clinically relevant somatic dysfunction, or with global adaptogenic approaches addressed to the balancing of the “fascial compensation schemes” and/or “dynamics of fluids and involuntary rhythms.”

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Introduction: osteopathic principles and their applications

Osteopathy is based on the manual contact during the phase of evaluation and treatment of the patient with respect to the relationship between body, mind, and spirit in conditions of both health and disease.

The osteopath focuses his or her intervention on the structural and functional integrity of the organism and the inherent tendency of the body toward self-regulation. Osteopaths use a wide range of therapeutic manual techniques aimed at improving physiological functioning and/or supporting homeostasis that has been altered by somatic dysfunction (SD), indicated in the International Statistical Classification of Diseases and Related Health Problems by the code M99,¹ namely a feature compromised or altered by somatic components in relation to each other.^2,3

Osteopathic manipulative treatment (OMT) uses a series of manual techniques that can be combined with other treatments or modifications related to lifestyle. Osteopathy is a manipulative approach to patient care that has contributed to the body of knowledge of manual therapies and complementary and alternative traditional medicine. Osteopathic practice is distinct from other health care professions which use manual techniques, such ...

Table of contents

• Cover
• Title Page
• Copyright
• Contents
• Dedications
• Editors and authors
• Preface to the English edition
• Preface to the Italian edition
• Abbreviations
• Section 1: Person-centered osteopathic medicine
• Section 2: The osteopathic models
• Index