The Therapeutic Pause in Osteopathy and Manual Therapy

The Somatosensory Integration Time

Louise Tremblay

• Éditeur: Handspring Publishing
• Année: 2015
• ISBN:
  9781912085415
• Édition: 1
• Sujet: Medicine
• Sous-sujet: Alternative & Complementary Medicine

Osteopathy, and Bowen therapy in particular, emphasises the importance of making therapeutic pauses during treatments. But it is not explained why a pause should be incorporated into the treatment session, just that it is important to do so. This book is based on research which attempted to understand and identify the physiology that might justify the inclusion of pauses during treatment. It also looked at how much the pause was used within osteopathic treatment in general.

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Speaking the language of the body

Man lives in a state of perpetual interaction with his environment. These interactions not only allow him to move around or react to particular kinds of stimulation, but they are required in order to regulate his internal environment. This requires a constant flow of afferent information, the integration of such information, and feedback response in order to maintain, amongst other things, the optimal state of tension/relaxation of muscle fibers according to the specific requirements and homeostasis in the body; this occurs thanks to the message flow between the various cells of the body. Along with the endocrine system, the nervous system is one of the body’s intercellular communication systems.

We communicate. The internal environment and the external environment communicate with the nervous system and the endocrine system, which in turn respond to the internal or the external environment. Where there are feedback messages we call this bidirectional communication.

Osteopathy is a manual therapeutic science founded on an in-depth knowledge of anatomy and physiology among other things. It solicits the body’s auto-regulation systems in order to restore harmonious functioning. Working with their hands, osteopaths act on the nervous system, affecting somesthesic afferences, which are the entrances for their influence on the entire body. The term somesthesia means body sensitivity (skin and internal) versus sensory functions (vision, hearing, smell and taste) (Laget, Encyclopédie Universalis, n.d.). For the patient, hearing ‘you should relax your arteries because they play an essential part in the normalization of the body,’ or seeing a ‘released’ artery will not solve his problem. The action of the osteopath on the patient is not at the visual or auditory level nor at the sense of taste or smell. Although a patient’s intellectual understanding is beneficial to treatment, it is not essential; evidence shows this, and osteopaths working on babies and animals will tell you so. This is somatosensory learning. And since the osteopath is seeking self-regulation systems, he must ‘speak’ the somatosensory language, a language that is perceived, understood and integrated by the central nervous system, which will in turn carry out the desired normalization. Through the somatosensory senses, we can set in motion the process of self-regulation.

We need therefore to understand the basics of how the nervous and endocrine systems work, how they communicate and in what way.

These two systems ensure the coordination of all functions of all body systems.

They are coordinated so that together they make up an integrated super-system called the neuroendocrine system:

–Specific parts of the nervous system stimulate or inhibit the release of hormones that can, in turn, enable or prevent the production of nerve impulses. The nervous system controls muscle contractions and glandular secretions.

–The endocrine system not only helps regulate the actions of smooth muscles, cardiac muscles and certain glands, it also affects just about every other type of tissue.

The nervous, immune and endocrine systems react to stimuli at different rates. In general, nerve impulses have an effect in a few milliseconds. Responses of the endocrine system are often slower than responses of the nervous system; ‘although some hormones act within seconds, most take several minutes or more (hours) to illicit a response’ (Tortora and Derrickson, 2009, p. 643). The effects of nervous system activation are generally briefer than those of the endocrine system.

The osteopath must listen to the body’s response if he wants to respect the principle of two-way communication. Although we know that the osteopath’s action is somatosensory, we do not really know what the response of the nervous system will be: motor, hormonal, or both? It is not in our ‘power’ to decide how the body will respond. This is also the principle of self-regulation: that is to say that even if the stimulus still comes from the environment (within or external to the body), regulation is by autonomous processes, inherent in the body, which are not controlled by the environment.

Although unable to decide on the nature of the nervous system’s response, the osteopath can still optimize it if he understands how the treatment center functions, the afferent and efferent pathways, nervous and hormonal.

Functional components of the nervous system

The nervous system

On the structural level, the nervous system is divided into a peripheral system and a central system The peripheral system is made up of the somatic motor system, which includes the spinal and cranial nerves, and the autonomic nervous system (ANS), which is subdivided into the sympathetic system (which incites prompt reactions in the body), the parasympathetic system (which tends to protect and relax the body) and an enteric nervous system sometimes called ‘the second brain’ due to its independence from the central nervous system (CNS). Gershon (1998) provides a useful explanation of the enteric nervous system:

The enteric nervous system, uniquely, can escape from the functional hierarchy of the CNS. Technically, the enteric nervous system is a component of the peripheral nervous system, but it is so only by definition. The enteric nervous system does not necessarily follow commands it receives from the brain or spinal cord; nor does it inevitably send the information it receives back to them. The enteric system is not a slave of the brain but a contrarian, independent spirit in the nervous organization of the body. It is a rebel, the only element of the peripheral nervous system that can elect not to do the bidding of the brain or spinal cord.

The ANS is not completely peripheral because it is managed by centers located in the CNS, in particular the hypothalamus, which is the main regulator of the autonomic preganglionic neurons.

Together, the somatic motor system and the ANS constitute the total neural output of the CNS. The somatic motor system has one single function: it innervates and commands skeletal muscle fibers. The ANS has the complex task of commanding every other innervated tissue and organ in the body (Bear, Connors and Paradiso, 2007, p. 492).

From a schematic point of view, we could say that the central system is made up of the following (Fig. 1.1):

1. the spinal cord;

2. the brainstem, which is composed of the medulla oblongata, the pons, the cerebellum, and the mesencephalon;

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FIGURE 1.1

Organization of the nervous system

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3. the brain, which is composed of the diencephalon and the telencephalon, including:

– the thalamus, the hypothalamus;

– the basal ganglia, the limbic system and the cerebral cortex.

The nervous system carries out three functions (Fig. 1.2):

–The sensory system is responsible for conveying the information coming from the environment to the nerve centers, with help from the afferent neurons.

–The motor system is involved, through efferent neurons, in the transmission, toward effectors, of commands programed in the nerve centers.

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FIGURE 1.2

Functional components of the nervous system. Reproduced with permission from Waugh and Grant, Anatomy and physiology in health and illness. p. 138. Elsevier 2010.

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–As for treatment centers, they are made up of circuits composed mainly of interneurons, and their function is to process information and program reactions.

The nerve impulse

The nerve impulse that travels along the neurons is the basis of the information transmitted to the nerve centers for processing. These nerve impulses, which are passing through billions of nerve fibers, are not different from one another, regardless of the type of information they are transmitting. Why do we hear sounds through the ears and see objects or colors through the eyes, not the other way around? Simply because the difference between the messages is not created by the message itself, but by its destination. If a muscle is the destination, the muscle will contract or relax. If a gland is the destination, it will accelerate, slow down or stop secreting. If the destination is one part of the brain an image will appear, and if it is another part of the brain the message will be decoded as a sound. ‘Ultimately, says Godefroid, we would only have to rewire the nerves, connecting the optic nerve to the part of the brain that analyzes sound in order for the visual information captured by the eyes to be heard’ (Godefroid, 2008, p. 175).

The overall organization of the three main types of exit from the central nervous system is illustrated in Figure 1.3.

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Table des matières

• Dedication
• Title Page
• Copyright
• Contents
• Forewords
• Preface
• Acknowledgements
• Introduction
• 1. Speaking the language of the body
• 2. Allostasis and limbic touch to maintain homeostasis
• 3. Integration time in osteopathy
• 4. Integration time in other manual therapies
• 5. Conceptual analysis
• 6. Conclusion
• Appendix I Synaptic plasticity
• Appendix II Extraocular circadian phototransduction
• Appendix III Dr Guimberteau’s observations
• Appendix IV The CSF and collagenic fascial fiber
• Appendix V What the therapist can observe during and after a still point
• Appendix VI Encoding of tactile forces in the primary somatosensory cortex
• Afterword
• References
• Further reading
• Index