PR IN C IPLE S
f
o
O S T E O PAT H Y
‘
AS
By D A I
R,
M E M BE R O F TH E F A C U LTY O F TH E
C OLL E G E O F O S T E O PA T H Y
18 98
F
E LLO W
-
D O
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PA CI F I C
1907
O F TH E S OU TH E R N C A L I F O R N I A
A CA DE M Y O F S CI EN C ES
P R ES I D E N T O F T H E C A L I F O R N I A S T A T E
B O AR D O F O ST E O PA TH I C E X A M I N E R S
19 0 1- 1 9 02
P R E S I DE N T O F
B OA RD O F
'
T H E C A L I F O R N I A S T AT E
M E DI CA L E XAM I NE R S
1 9 1 0 19 11
-
M E M BE R O F TH E A M E R I C A N
ASS O CIATIO N
O
ST E O PA TH IC
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R e w w d IZ/m z m ted
T5 im E di ti on
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LS E
ELS N
A N ELE S
P UB
B IR E L E Y a:
LO S
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G
BY
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P R IN TIN G c o
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CAL
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C O P Y R IG H T
D
LO S
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D
1 9 1 3 BY T H
A U TH O R
E
A IN L TA S K E R D O
A N G ELE S C A L IF O R NIA
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P R E FA C E
Thi s b o o k
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th e P ri n c ip le s o f O ste o p athy i s i n te n ded
n er s
as a m an u al fo r th e u se o f s t u de n t s an d pr ac titi o
Th ere has b e e n n o e ff o rt O n th e p art o f th e au th o r to do
m o re th an give a sh o rt te r s e e x p o s iti o n o f th e e ss e n ti al
f act s u n der lyi n g o ste o p athy
R e al izi n g f u lly th e g r e at
e ff o rt r eq u ired to ke ep p ac e with th e rap i d p r o gre s s o f
m edi c i n e i n ge n er al we h ave tried to i n cl u de i n o u r c h ap
ter s o n ly th at whi c h wi ll b e so l id f o o d fo r o u r re ade r s W e
h ave lo n g s i n c e l e ar n ed th at th e h u rri ed s t u de n t an d b u sy
pr ac titi o n e r h ave n o tim e to re ad lo n g di ss ert ati o n s o n
Ti m
e i s an e ss e n ti al f act o r i n c o ve ri n g th e
an y s u bj e c t
n e c e s sary s t u die s o f an o ste o p athi c c u rri c u lu m
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on
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der that the st u d e n t m ay re ad th e se c h apter s
i n te llige n t ly h e m u st h ave c o n c lu de d at l e ast te n m o n th s
H i s t o lo gy A n at o my an d P hy s i o lo gy
o f B i o lo gy
s t u dy
Th e s e s u bj e ct s f o rm th e b asi s o f th e sc i e n c e o f o ste o p athy
In
or
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th o r has kept i n t ou ch with the gr o wth o f o ste o
p athy fr o m ye ar to ye ar th r o u gh c aref u l p er u sal o f i ts pu b
li she d b o o k s an d p e ri o di cal s
The
au
.
The
te nt s o f thi s b o o k ar e the co n d e n s e d re su lt s
o f th e au th o r s s t u dy o f re c o g n ize d m edi c al te x t b o o k s o u
An at o my P hy si o lo gy H i s t o lo gy P ath o lo gy Bac teri o lo gy
an d Di ag n o s i s o f th e w o rk s o f th e f o u n d er o f O s te o p athy
D r A T S ti ll H azz ard R igg s H e n ry an d M c Co n n e ll ; o f
s i x ye ar s ex p e r i e n c e i n th e c l i n i cs o f th e P a c ifi c S c h o o l o f
O ste o p athy an d th e I n firm ary i n c o n n e cti o n with th i s
c o ll ege
an d si x ye ar s o f c o n ti n u o u s te ac hi n g tw o o f wh i ch
wer e dev o te d to An at o my an d P hy s i o lo gy an d th e rem ai n
;
co n
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PR E F A C E
8
i ng
c al
f o u r to Th e o ry
D i ag n o s i s
P r acti c e Of
an d
O s te o p athy
an d
P hy s i
.
TO e n u m er ate th e b o o k s fr o m wh o s e p age s f ac t s h ave
be e n g le an ed fo r c o rr o b o r ative te s ti m o ny c o nc er n i n g the
P ri nc ipl e s o f O ste o p athy i s imp o ss ib l e Bo o k s h ave b ee n
re ad an d l ai d as i d e an d wh at is h e re w ritte n may b e th e
re s u lt o f so m ethi n g whi ch cau ght th e au th o r s atte n ti o n
fo r a m o m e n t o n ly an d th e n be c am e a m averi c k
.
.
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’
‘
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The i llu str ati o n s
e lu c i d ate th e te x t h ave b ee n fu r
o ri e s an d C l i n i c s o f th e
n i s he d p ri n c ip ally by th e l ab o r at
P ac ifi c S ch o o l o f O s te o p athy
With o u t th e h e arty an d
e flfi c i e n h a i d o f my ass o c i ate s o n th e f ac u lt y o f th i s co ll ege
m u ch o f th e co nc i s e det ail o f th i s b o o k w o u l d h av e b e e n
i mp o s s ib l e I am i n debted to s eve r al o s te o p ath i c phy si
e i au s fo r dr awi n g s o f h i s t o l o gi c al ti s su e s wh i c h th ey had
prep are d d u ri n g th ei r c o ll ege w o rk Th ey ar e give n c re dit
u n der t hei r d r awi n g s
to
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The l arge nu mb er
e x c e lle n t ph o t o gr aph s o f m i c r o
p ati e n t s an d m o vem e n t s i s th e re su lt
sc O p i c s tr u c t u re s
A few o f th e ph o t o gr aph s
o f th e ski ll o f J O H u n t D O
were m ad e by M E S p erry D
w ho al so t o o k gre at
care t
o s e e th at we had th e b e s t o f ph o t o gr aphi c l e n s e s
with wh i ch to w o rk l am also gre at ly i n debted to C H
P h i nn ey D O an d J E S t u ar t D O fo r th ei r ac cu rate
d em o n str ati o n o f o ste o p ath i c m o vem e n t s
of
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M y th an k s
e x te n de d to M i s s L o ui sa B u r n s B S
fo r re adi n g th e m an u s c ript an d su gge sti n g co rre cti o n s
th e rei n al s o to M i ss G ertr u de S mith fo r p rep ari n g th e
m an u script fo r th e p ub li sh er
ar e
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D AI N L TA S K E R D
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PR E F A C E
9
PR E F A C E TO TH I R D E D I TI O N.
l o n g tim e has e lap se d s i n c e th e s e co n d editi o n o f
h i s b o o k w as s o l d o u t The pre s e n t e diti o n i s i n re ality
t
o o d as a
a n e w b o o k i n ste ad o f wh at is o rdi n ari ly u n der st
revi si o n The m ateri al wh i ch w as deve lo p e d fo r th e fir s t
an d s e c o n d editi o n s w as e n ti re ly d e s tr o ye d by th e dy n a
mi te e x plo si o if an d fi re whi ch wre cke d th e gre at e s t ab
li shm e n t o f the Lo s An g e l e s Tim es an d k i ll e d m o re th an a
s emp lo ye e s
sc o re o f i t
The d em an d fo r thi s b o o k h avi n g gr o w n s te ad i ly
m o re i ns i ste n t an d th e
ore i mp o rt an t fac t th at d u r in g
th e tim e s i n c e th e p u b li cati o n o f th e se co n d e diti o n th ere
has b ee n a gre at d eve lo pm e n t i n every ph ase o f o ste o p ath i c
tempt to p r o d u c e
te achi n g an d p r ac ti c e has l e d u s to at
an ed iti o n o f P ri n c ip l e s o f O s te o p athy wh i ch wi ll b e eve n
m o re u s ef u l to S t u de n t s an d p r ac titi o n er s th an o u r f o r m er
editi o n s
The e x p erim e nt al w ork d o n e i n th e lab o r at o ri e s o f
o u r c o ll ege s an d o i p r iv ate i n ve s tig at o r s
as we l l as th e
re c o r ded e x p eri e n c e s o f o u r p r actiti o n er s te n d m o re an d
mo re to su b st an ti ate th e P ri n cipl e s o f O ste o p athy as se t
fo rth i n o u r p r evi o u s editi o n s The fee li n g th at th i s b o o k
wi ll f u r n i sh ge n u i n e as si st an c e i n th e te ach i n g an d p r ae
ti c e o f o ste o p athy l e ad s th e au th o r to s e n d it f o rth with
th e b e li ef th at i ts i mp erfe cti o n s wi ll b e ki n d ly e x c u s ed by
i ts re ader s i n vi ew o f th e spi ri t o f g e n er o u s h e lpf u ln e s s
t o w ard all S ch o o ls o f m edi c i n e whi c h has b ee n m ade th e
re as o n fo r its ex i s te n c e
Ne ar ly every ch apte r i s In so m e degre e c h an ge d o r
co mp l ete ly rewritte n
S ever al n e w c h apter s o f p r acti cal
v alu e h ave b ee n adde d M u c h o f the m ateri al i n e ar ly
re lati n g to h i st o lo gy has
ch apter s o f th e f o r m er editi o n s
b e e n e lim i nate d
The writer wi s h e s to e x p re s s hi s gr atit u de to J o h n
Co m s t o c k fo r hi s v alu ab l e as s i st an c e i n i llu s tr ati n g th i s
editi o n
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T AB L E
OF
C O NT E NTS
27
C H A PT E R I—C aus e s o f D is e ase
N o r m al an d A b n o r m al— The I de al N o r m al—V ar iat i o n s i n
—
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I nt e r p r e t at i o n o f
e
s
to C
e e ce
c e cy
Ph e n o m e n a o f D i s e as e — F avo r abl e R e act i o n to E nvir o n m e nt
K n o w n C au s e s o f D i s e ase—The Te nac it y o f L if e— L e s i o n
D i s e as e A sso c iat i o n— R e m o v e the C au se O f D i s e as e — Pr e ve n
—
—
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tat v e
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R e s i st an c C au s e an d E ff e ct—C e ll R e l at i o n s— E x c e s siv e
of
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C e l l L i f e D e p e n de nt o n C i r
S i m u la o
Te n s i o n— S c i e n ti fi c Th e r ap e ut i c s—The
c u l at i o n—I nt e r c e ll u l ar
—
—
l
a
l
o
u
a
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o
e
Pr o bl e m as a Wh e N t r R c v r y E x tr i n s i c C au s e s o f
D i s e as e — I nh e r e nt R e cup e r at iv e P o w e r—D i stu r b e d Ti s su e R e
l ati o n s— The B i o l o g i c al R e lat i o n o f F u n c t i o n an d S tr u c t u r e
The Tr u e A r t o f H e ali n g
’
e
‘
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C H A PT E R
—Th
II
e
Le s i o n
as a
se
C au
D e fi n i ti o n— Char act e r i st i c s o f a L e s i o n— C las se s O f Le s i o n s
C au se s o f L e s i o n s—S e c o n dar y L e s i o n s E ff e ct o f V i o l e n c e o r
F at i g u e — F ailu r e o f A dap t at i o n
Ch e m i c al C au s e s o f S p i n al
L e s i o n s—The R e as o n fo r the P e r si st an c e O f a L e si o n— The
S e q u e n c e o f L e s i o n Ph e n o m e n a—V ar i at i o n s i n D e v e l o p m e n t
P alp at i o n o f a L e si o n— D e s cr ip ti o n— F i n d the L e s i o n— In sp e c
t i o n o f the B ac k— P alp at i o n o f V e rt e br al S tr u ctu r e s— H i st o r y
We i ght C arr y i n g an d Balan c
o f A c c i de n t—Tr au m at i c L e s i o n
i n g F u n ct i o n D i st u r b e d— L ac k o f Ph y s i o l o g i cal R e st—In fl u e n c e
—
i
n
n
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l
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S e gm e nt al C o o r di n at i o n
rv t
d I
on
C ir c u at o
E x am p l e o f F at i g ue —L o s s o f M u s c u lar To n e — E x p e r i m e nt al
L e si o n s— L o s s o f M o t i o n—N e c e s sit y fo r S tu dy o f S tru ct ur e
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—
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!
—
-
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C H A PT E R III—The Le si o n as an E ffe ct
55
A naly s i s o f the Cau s e s o f L e s i o ns— The Attr act ive n e s s o f the
Tr au m at i c L e s i o n Th e o r y— C las s i fi c ati o n o f L e s i o n s— E x am p l e s
o f S e co n dar y L e s i o n s— The S p i n al L e s i o n an O bj e c t iv e S y m p
—
—
i
fi
x
V sc e r al R e e e s P le ur i sy—C ar di ac L e si o n P att e r n s
to m
U nit y o f the B o dy
C H A PT E R IV—S pi n al H y p e rae s th e s ia an d M us cul ar Te nsi o n 5 9
S u bj e ct iv e S y m p t o m s—I rr it at i o n o f the S p i n al N e rv e s—S p i nal
Tr e at m e nt—C o ntr o l o f the B o dy by the N e rv o u s S y st e m —A
—
n
f
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u
s
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N e u r al g i a—V i s c e r al D i st u r b
C o c e pt o t e N rvo s S y t e
an c e D u e to D i st ur b e d N e rv e C o ntr o l—C o e x i st e n c e o f S p i nal
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-
T AB L E
Te n de r n e s s— S y mp t o m s
C O NT E N TS
OF
11
—
S p i n al Ir r i tati o né D u r at i o n o f Aff e c
t i o n s D u e to S p i nal Irr it at i o n— A ff e ct i o n o f the U p p e r C e rvi c al
R e g i o n— I rr it ati o n o f the L o w e r C e rvi c al R e g i o n— Irrit ati o n o f
th e U pp e r D o r s al R e g i o n— Irr i t at i o n o f th e L o w e r D o r s al
R e g i o n—I rr it at i o n o f the L u mbar an d S ac ral R e g i o n s—The
E ff e ct o f R e c u m b e n c y— I rr it at i o n o f S p i n al M arr o w Not Ne c e s
s ar i l y
D e p e n de nt o n D i se as e O f V e rt e brae — L at e r al Cu rvatu r e
— Tr e atm e n t— G an g li a o f the S ymp ath e ti c N e rve s— S ympt o m s
—
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r aci c S y m path e t i c G an g li a— S p i n al Tr e atm e nt H y p e r ae m i a
M u s cu l ar Te n si on—D i g it al E x am i n at i o n o f the S p i n al Ar e a
Th e Us e o f S p i n al M usc u l ar Te n s i o n i n D i ag n o s i s— C au s e o r
of
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C H A P TE R V—The S e g me ntati o n o f the Bo dy
1 1: e L e si o n as a G u i de i n D i ag n o s i s—The S p i n al S e g m e n t
11 1 y o f a S i n g l e N e rv e —A U n i lat e r al C e rvi c al S p i n al L e s i o n
:
—i r e at m e n t—I nvo lv e m e nt o f the C e ntr al N e rv e C e ll s— C e rvi c al
I n fl u e n ce
l\ i 1 S cl e s— E m br y o l o g y— S e g m e nt at i o n— Wi de s p r e ad
a S p i n al L e s i o n— A s so c i at i o n o f M u s c l e s I n n e rv at e d by the
o
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E ff e ct o f S e ct i o n i n g S i n g l e S p i n al N e rv e
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D e ve lo p m e nt al Ch an g e s i n M u s c l e s
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11
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C H A PT E R V I—The Ne r v o us S y st e m
The M e diu m o f C o m m u n i c at i o n— The Attr i bu t e s o f N e rv e Ti s
Irr it abi lit y— C o n du ct ivit y— Tr o ph i c ity
s u e — N e rv e an d M u sc l e
—
U n it y o f the N e rvo u s S y st e m — O th e r S y st e m s o f I n t e g r at i o n
— M e c han i c a1i r i tati o n—E ff e ct o n C o n du ctivit y—A ff r e nt an d
Eff e r e n t F i br e s— O r g ani at i o n o f the N e rv e B u n dle—I ntr a
S e g m e nt at i o n o f the S p i n al C o r d S e gm e nt al In
s p i n al F i b e r s —
—
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The S i mp l e R e fl e x —The
s
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to m C
te g
Pr o t e ctiv e R e act i o n s— E x am
S e n s o r y S i de o f the R e fl e x Ar c —
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F i b e r s to th e S y mp ath e t i c G an g li a—G an g li o n i c C o ntr o l— Thr e e
F i e l ds f o r R e c e p t i o n o f S e n so r y Imp r e s s i o n s— Pr o p r i o c e p ti v e
é
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Plu i s e g m e n tal
to
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L e s i o n s—L e si o n s Du e to F u n cti o n al F at i g u e
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1 14
C H A P T E R V II—The Ne rv o u s S y ste m ( C o ntinu e d)
—
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fl
x
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l
n
n
T
n
R
e
e
e
A g me t o e
C li n i c al I l lu str at i o n— I n sp e ct i o n
P at e llar Te n do n R fl e x — G astr i c S p i n al R e fl e x — S n sati o n
V i s c e r al S e n s at i o n— D e p e n de n c e o n O bj e c tiv e S ympt o m s
D e p th an d E x t e n t o f L e s i o n s— L e si o n P i ctu r e i n A u t o t o x e mi a
— L e s i o ns I n de p e n de nt o f S e gm e nt al R e fl e x e s— The L e s i o n as
C i r c u l at o r y I n t e
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—The I nt e r s cap ular R e g i o n—A C as e I llu str at i n g the Ci li o sp i nal
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A p p ar at u s— The H e ar t R e g u lati o n o f C o ntr act i o n—Co o r di
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C H A PT E R X—H i lt o n s Law
18 1
The Law S t at e d—M e th o ds o f S tu dy i n g A n at o m y—E x am p l e o f
H i lt o n s Law—The K n e e—O bj e c t o f su ch a D i str i buti o n—Uni
f o r m it y o f the Law—Pr e ci si o n O f N e rv e D i stri bu ti o n to M u s c le s
—I n di cat i o n s f o r the U s e o f Th e r ap e ut i c s— The U s e o f H i l
t o n s Law i n Ph y s i cal D i ag n o si s—C o m p ar i s o n o f M e th o ds
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O st e o path i c C e nt e r s
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S up e r i o r C e rv i c al G an gli o n—S u bo c cip i t al Tr i an g l e s—C e rvi c al
P le x u s—I nt e n sit y o f R e fl e x e s—The S p i nal A c c e sso r y—The
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The S p i n al C o lum n— The S p i n al L i g am e n t s— F l e x i bili t y— No r
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2 63
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S u blu x ati o n s
28 3
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S p i n o u s Pr o c e s s e s— N o rm al D o r s a1 M o v e m e n ts—F al s e L e s i o n s
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The Diag n o st i c V alu e o f Back ach e
C H A P T E R X V—
311
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a n s—R ach it i s— M al i g n ant G r o w th s—Ty ph o i d S p i n e — L u m bag o
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t e n s ity o f R e act i o n— L o c at i o n o f R e fl e x e s— R e fl e x P att e r n s
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Inh ib iti o n
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hi bi ti o n a N o rm al Attr i bu t e o f the C e n tr al N e rv o u s S y st e m
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hibi ti o n—M u sc u lar A ct ivit y—Thr e e Ch ar a ct e r i st i c s o f the N e rv
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t e r s A c t— O ve r s ti m u lati o n E q u al s I nh ibit i o n—The G u i de f o r
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3 71
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C H A PT E R XX—
402
M e th o ds O f Pr o c e du r e—R e lax ati o n O f the L at i s si m u s D o r s i
R e lax ati o n O f the Tr ap e i u s— R e lax ati o n o f the R horn b o i ds
The P e ct o r ali s M aj o r an d S e rr at u s M ag n u s— Q u adr at u s Lu m
bo r um— Er e ct o r S p i n ae —Tr e at m n t O f S imp l e K y ph o s i s—Lo
—
i
o
s
l
Th e P o s s i bl e V ar i e t y o f M o v e m e n t s
do s s U p pe r D r a
w h i ch W i ll S e c u r e the S am e R e s u lt s— The H e ad an d N e c k as a
L ev er— L o r do s i s o r K y ph o si s M ay A ff e ct a F u n ct i o n S i m il ar l y
—S p l e ni u s C ap iti s e t C o lli— K y ph o s i s U p p e r D o r s al—K y p ho
—
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l
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r
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s s
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A pp li c ati o n s o f a Pri n c ip l e — The U s e o f a F u l cr u m — C O o r di
—
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L at e r al
C o rr ct v e M v m t s D o r s al R o t at i o n—
o
D O No t C o p y
C u rv atu r e —K n o w H o w to A p p l y Pr i n c ip l e s —
M o v e m e nt s
R e du c t i o n o f S u blux at i o ns
C H A PTE R X X I—
443
L at e r al S u blu x at i o n s— L ux at i o n s o f the I n n o m i nat e B o n e s
A nt e ri o r R o t at i o n o f the I li u m— P o st e ri o r R o t ati o n o f the
I l i um
C H A PTE R XX II—Tre atme nt o f the C e rvi cal R e g i o n
471
To R ai s e the C l avi cl e —S u blux at i o n o f the C lavi c l e — Pr e p ar at o r y
Tr e at m e nt o f th e N e k Tr ap e i u s— S t e r n o l e i do —
m ast o i d
S c al e n i— S p l e n i u s C ap it i s e t C o lli—E x t e n si o n— R o t at i o n— The
—
4
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l
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H y o d B o e M y hy o d d H y g
S t e r n o th y r o i d an d
S te r n o h y o i d— I ntr i n si c M u s c l s O f the L ar y n x — The At l as
S i x th C e rvi c al—G e n e r al Pri n c i pl e U n de r l y i n g C o rr e c t iv e M o v e
m e n t s—The S i m p l e st F o r m o f C o rr e ct i o n— To r si o n an d C o u n
te r Pr e s su r e — R i g i di t y— The F av o r abl e P o s it i o n f o r C o rr e c t iv e
M o v e m e nt s
E x tr e mi ti e s
49 3
C H A PT E R XX III—
D i ag n o si s— C au s e s o f S t iff Jo i nt s—A n k y lo s i s— The S ap u lo
h u m e r al Arti cu lat i o n— E x ami n at i o n o f the B r ach ial P l e x u s
R e du cti o n O i D i s l o c at i o n s by Tr act i o n— R e du ct i o n o f D i slo c a
—
—
—
i
l
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t i o n s by L e ve r ag e E bo w D s o c t o
s
O ld D i s
e R ad
l o c at i o n s— M u sc l e s o f the L o w e r E x tr e m it y— Q u adri c e p s E x
—
—
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t e n s o r The A ddu ct o r G r o p D i s lo c ati o n o f the F e mu r
—
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—
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C H A P TE R XX IV—M an ipul ati o n fo r V as o mo t o r Ne rve E ff e cts 52 2
—
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INTR O D U C TIO N
.
tri de s h av e b ee n m ade d u ri n g th e p as t twe n ty
five ye ar s i n th e p r ac ti c e Of m edi c i n e The re lative p o s i
ti o n s f o rm er ly h e ld by dr u g th er apy an d su rgery h ave
b e e n co mp l ete ly rever s ed The co n c o cti o n s o f th e phar m o
C O po e i a with th ei r v ag u e an d u n c ert a i n e ff e c t s u p o n h u m an
ti ss u e s an d f u n c ti o n s n o l o n ger e n ti c e th e e ar n e st seeker
after m edi c al tr u th s to s p e n d a l ifetim e
e x p erim e n ti n g
with s u b s t an c e s whi c h ar e ab so lu te ly f o reig n to th e h u m an
b o dy
Th ere w as a ti m e n o t far aw ay wh e n th at p er so n
w ho tre ate d h u m an di s e as e s by m an ip u lati o n w ater di et
he ch ief o f
an d ge n er al hygi e n e w a s c o n s id ere d to b e t
imp o st o r s G O a litt l e f arth er b ac k i n th e hi st o ry o f m e di
u s e it w as me
c i n e an d we se e s u rgery di s h o n o re d b e c a
chan i c al
n o t my sti c al e n o u gh fo r th e p o n der o u s mi n d s
wh o s e f o rt it w as to d e al with s tr an ge s u b s t an c e s o f the
an i m al veget ab l e an d m i n e r al ki n gd o m s
—
D u ri n g all th e ye a r s i n wh i ch dr u g th er apy flo u ri s hed
th e re were a few re al s c i e n ti st s w ho dev o ted tim e an d
t al e n t s to th e str u ct u re o f o u r b o di e s an d th e f u n c ti o n o f
e ach p art D i s co veri e s c am e slo w ly alo n g the s e li n e s be
c au s e
th e m aj o rity o i m edi c al m e n were c o n c e n tr ati n g
th e ir e n ergie s o n ferreti n g o u t th e e ff e ct s o f dr u g s F act s
i n an at o my an d phy s i o lo gy wh i c h a r e s o p ate n t to u s at
thi s tim e rem ai n e d o b s c u re fo r c e nt u ri e s si mp ly b e c au s e
th ere w as n o th o u ght o f st u dyi n g th e f o rm an d acti o n o f
ti s su e s whi le all n at u re o u t sid e o f Ou r o w n b o di e s s eem e d
to b e a gr an d lab o r at o ry o f s p e c ifi cs fo r h u m an a i lm e n t s
I f o s te o p athy had bee n b o r n fif t
y ye ar s ag o it w o u ld
h ave die d b e c au se th e p o p u lar an d s c ie n tifi c mi n d s were
n o t i n a c o n diti o n to re c eive it
E ve n th e ti m e at wh i ch
G re at
s
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I N T R O D U CT I O N
18
it
r ely thi r ty fi v e ye ar s ag o w as h ardly ri pe
fo r th i s n e w d ep art u re i n m ed i c i n e
Twe n ty ye ar s e asi ly
co ve r th e p eri o d o f i t
s ac tive h i s t o ry
—
A S c i e ntifi c G r o wt h Th ere i s o n e d i sti n c tive p o i n t
ab o u t o s te op athy whi c h sh o u l d b e e sp e c i al ly emph as ized
I t i s n o t an empi ri c al sy stem ; n o thi n g i s d o n e o n th e c u t
I t has be e n d eve lo p ed i n a p u re ly se i e n
an d dry p lan
tifi c w ay
We might Ob s erve th e ac ti o n o f th e h u m an
b o dy i n h e alth an d di s e as e i n defi n itely with o u t s e c u ri n g
any
e x act d at a to p ass o n to th e n e x t ge n er ati o n O f o b
o k n o w th e s tr u c t u re o f th e b o dy . A
s e rve r s i i we f ai l t
phy si c i an m ay l e ar n m an y thi n g s i n an empiri c al w ay
whi ch ar e ve ry p o o r ass et s fo r s c i e n c e
The s tr an ge p art o f m edi cal h i s t o ry to th e m o de r n
i nve stig at o r i s th e fact th at di sco v e r l e s l n anat o my an d
phy si o l o gy whi ch ar e o f s u c h vit al i mp o rt an c e to th e s u c
c e s s fu l tre atm e n t o f h um an di s e as e s were l eft st o red aw ay
b etwe e n th e co ver s o i b o o k s n o t d eem ed o f any v alu e
e x cept to Wh et th e m i n d o f th e di lle tan te i n m edi c i n e
O ste o p athy as a di sti n c t s y s tem o f m ed i c i n e has
gr o w n to its p r ese nt p r o p o rti o n s at a t
i m e wh e n the o ld er
s c h o o l s o f m edi c i n e ar e m aki n g r adi c al c h an ge s i n th ei r
In sp ite
h e r ap e u ti c al p r o c e d u re s e g ser u m th er apy
t
o f all th e s e s o call e d sc i e n tifi c adv an c e s 1 n dr u g th er apy
o s te o p athy has m ad e
adv an c e i n t o p u b l i c f av o r
ste ady
th ereby sh o wi n g th at it i s f u l ly abl e to co mp e te w 1th th e
o l de r sy s tem s o f pr ac ti c e
D r A T S ti ll o f K i rk s
The F o u nde r o f O ste o pat hy
vi lle M o i s th e h o n o red f o u n d er o f th i s sy stem o f th era
H
i
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n
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rk
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re
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c
u
f
o
s
s
w
o
u
r
p
b o die s dire c tly an d th u s g ai n i n g an ac cu r ate k no w ledg e o f
ho w b o n e s lig am e nt s an d m u sc le s b lo o d ve ss e ls g lan d s
Th e n h e so u ght th at dep artm e n t
an d n e rve s ar e pl ac ed
an d l e ar n ed ho w
o f k no w l edge wh i c h we c all phy si o l o gy
th e se ti ss u e s act i n h e alth
H avi n g had p revi o u s t r ai n
i n g i n tre ati n g d i s e ase s by th e d r u g meth o d he w aS s lo w
to di s c ard th e o ld m eth o d fo r o n e whi c h had n ever b e e n
w as
b o rn
,
sc a c
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I NT R O D U CT I O N
19
trie d eve n th o u gh it had go o d s c i e n tifi c re aso n s b ack o f
i t Bu t th e sub s tit u ti o n di d t ake p lac e by d egree s u n ti l hi s
sy stem o f th er ap e u ti c s n o l o n ger dep e n d ed o n th e u se o f
dr ug s
I t seem s to b e a p o p u lar id e a th at it i s n e c e ssary fo r
th e f o u n der o f a sy stem to h ave a Cre ed o r st atem e n t o f
bel i ef We do n o t d o u bt bu t th at it i s g o o d fo r u s at tim e s
to try to pu t o ur b e li ef s i n writi n g n o t to f o rm a fi x ed
p os iti o n bu t j u st as th e ar ch ite ct dr aw s m an y p lan s to
gr ad u ally deve lo p hi s m e n t al pi c tu re s Th es e st atem e n t s
u s u ally c o n t ai n th e tr u th ab o u t o u r w o rk so far as we
k n o w it We can th u s se e ho w far we h ave ad van c ed
an d r ealiz e th at we h av e m u c h to l e ar n
D r S ti ll has fr o m tim e to tim e e x p re sse d th e re s u lt
th at i s th e o b s e rve d f ac t s u p o n wh i ch h e
o f hi s s t u di e s
In 18 74 D r S ti ll
has b ui lt hi s sy s te m o f th er ap e u ti c s
A di s t u rbed artery
s t ate d hi s Ob s e rv ati o n s as f o llo w s :
m ark s th e p e r i o d to an h o u r an d m i n u te wh e n di se as e
b egi n s to so w i ts s e ed s o f de str u cti o n in th e h u m an b o dy
Th at i n n o c as e c o u ld it b e d o n e with o u t a b r o ke n o r su s
p e n ded cu rr e n t o f arte ri al b lo o d whi ch by n at u re i s in
t en de d to s upp ly an d n o u ri sh all n erve s ligam e n t s m u s
b o n e s an d th e artery it s e lf
The
s ki n
c l es
r u l e o f th e artery m u st b e ab so lu te u n iver sal an d u n o b
o r di s e as e wi ll b e th e re s u lt
All
s tr u cted
n e rve s d ep e n d wh o lly u p o n th e arteri al sy s tem fo r th eir
q ualitie s s u ch as s e nsati o n n u triti o n an d m o ti o n eve n
t ho u gh by th e law o f re c ip r o c ity th e y f u r n i sh f o r c e n u
tr i ti o n an d s e n s ati o n to th e art ery it s e lf
—
i
i
D e fi n t on s
M an y d efi n iti o n s have bee n f o rm u late d
E ac h o n e te n d s to limit
th e w o r l d
an d p u b l i sh ed to
i n s o m e p arti c u lar
one s
o s te o p at hy
c o n c epti o n
of
A
defi n iti o n alw ay s l imit s th e thi n g defi n e d th eref o re n o
defi n iti o n o f o s te o p athy c an b e c o mp lete b e cau s e We ar e
de ali n g with a p ri n c ip l e th e u n ive rsality o f whi ch n o o n e
k n o w s Wh ere as l e s s th an seve n ye ar s ag o it w as th o u ght
th at o ste o p athy w as an e x c e ll e n t m et ho d o f tre ati n g
,
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I NT R O D U CT I O N
20
h r o n i c ai lm e nt s we n o w fi n d o ste o p ath s w o rki n g day
an d n ight at th e b ed s id e o f th e ac u te ly s i c k
Th u s d o e s it
s pre ad
an d be co m e th o r o u gh ly re c o g n ized as a sy stem
app li c ab l e to all di s e as e s
In o rd er to b ri n g b ef o re th e s t u de n t as f u ll an d c o m
p reh e n sive an i d e a Of th e sco p e o f o ste o p athy as p o s si bl e
Th e s e d efi n iti o n s h i ve
a s eri e s o f defi n iti o n s ar e q u o ted
be e n t ake n fr o m c u rre n t o ste o p ath i c li te r at u re an d ar e
c red ite d to th ei r r esp e c tive au th o r s
O n e o f th e sh o r t p ar agr aph s i n D r S ti ll s au t o
bi o gr aphy is s u ffi c i e n t to give a c le ar u n der st an d i n g o f hi s
“
The h u m an b o dy i s a m ac h i n e
i de a o f th e h u m an b ody
an d th at it m ay be r u n
r u n by th e u n s ee n f o r c e c all ed life
h arm o n i o us ly it i s n e c e ssary th at th ere b e l iberty o f b l o o d
th e ge n er ati n g p o i n t to de s
n e rve s an d arteri e s fr o m
c
,
.
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’
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ti n ati o n
”
.
The f o l lo wi n g d efi n iti o n i s
b e e n use d
“
i n th e A m eri c an S c h o o l p u b l i c ati o n s fo r a lo n g ti m e : O s
te o pathy i s th at s c i e n c e whi c h c o n s i s t s Of s u c h e x ac t e x
hau sti v e an d verifi ab l e k n o w l edge o f th e s tr u c t u re s an d
f u n c ti o n s o f th e h u m an m e chan 1s m an at o m
i c al p hy si o
lo gi cal an d p sy c h o lo g i c al i n c lu d i n g th e c h emi s try an d
phy s i c s o f i ts k n o w n e l em e nt s a
s has m ad e di sc o ver ab l e
withi n th e
c ert ai n o rg an i c law s an d rem edi al re s o u r c e s
b o dy it se lf by wh i c h n at u re u n der th e sc i e ntifi c tre atm e n t
pe c u li ar to o ste o p ath i c p r acti c e ap art fr o m all o rdi n ary
m eth o d s o f e x tr an e o u s artifi c i al o r m edi ci n al sti m u lati o n
an d i n h arm o n i o u s acco r d with i ts o w n m e c h an i c al p ri n
m o le cu lar activitie s an d m et ab o li c p r o c e s s e s m ay
c i ple s
re co ver fr o m di spl ac em e n t s di s o rg an i z ati o n s der an ge
m e n t s an d co n s e q u e n t di se as e an d reg ai n i ts n o rm al eq u i
”
libri u m o f f o rm an d f u n c t
i o n i n h e alth an d S tre ngth
M aso n W P re ssly A B P h D D j o
“
O ste O pathy i s th at s c i e n c e o f h e ali n g whi ch e m pha
n
s ize s
a
th
e
di
a
g
o s i s Of di s e a s e by phy s i c al m eth o d s
( )
with a vi ew to di s co ve ri n g n o t th e sympt o m s b u t th e c au s e s
Of di s e ase s i n c o n n e c ti o n with mi sp lac em e nt s o f ti s s u e
o ne
wh i c h
has
,
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I NT R O D U CT I O N
23
phy s i o lo gi st th at m ay no t be Of vit al i mp o rt an c e to
th e s c i e ntifi c o ste o p ath H e n c e a c o rre ct di ag n o si s b ased
u p o n s u c h k n o wl edge i s h alf th e b att l e
With o u t it se i e n
tifi c o ste o p athy i s im p o s sib l e an d th e p r ac ti c e is n e ce s
The de fi
s ar i ly h aph az ard o r m e re ly r o u ti n e m o vem e n t s
n i ti o n l ay s stre ss u p o n ( 2 ) rem o v al Of th e c au s e o f d i s e ase
A de r an ge d m e ch an i s m m u st b e c o rre c te d by m e c ham cal
m e an s spe c i fi c ally app li e d as th e m o st n at u r al an d o n ly
di re ct m eth o d o f p r o c ed u re Th i s w o rk i s n o t d o n e by
any o f th e m eth o d s o f o th er sch o o ls
After th e m e c h an i s m
has be e n co rre cted litt l e rem ai n s to b e d o n e to re s t o re
f u n cti o n bu t stim u lati o n o r i nhibiti o n o f c e rt ai n n erve
c e n te r s m ay
give temp o r ary rel i ef an d ai d n at u re The
adj u v an t s u s ed by o th er s c h o o l s s u ch as w ater diet e x e r
c i se
s u rgery
et
c
ar e th e c o mm o n h erit age o f o u r pr o i e s
si o n and s h o u l d b e re s o rte d to by th e o s te o p ath i f th ey ar e
”
E
i ndi cate d
R B o o th Ph D D O E x P r e s ide n t
or
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A O A
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O s te o p athy i s
th at s c i e n c e o r sy ste m o f h e al i n g whi ch
n s o f di ag n o s i s with a vi e w to di s c o ver
u si n g every m e a
i n g n o t o n ly th e sym pt o m s bu t th e cau s e s o f d i s e ase s
by sci e n tifi c m an ip u lati o n s Of the h u m an b o dy an d
s eek s
th e c o rre cti n g an d rem o vi n g o f all
o th e r phy s i c al m e an s
ab n o rm al iti e s i n th e phy s i c al re lati o n s o f th e c e lls ti s su e s
an d o rg an s o f th e b o dy p arti c u l arly th e c o rre c ti ng o f m i s
pl ac em e n t s o f o rg an s o r p a rt s th e re lax i n g o f c o ntr acted
ti ssu e s th e rem o vi ng o f o b str uc ti o n s to th e m o vem e nt s
th e rem o vi n g o f i n terfere n c e s with th e tr an s
o f fl u id s
mi s si o n O i n erve imp u ls e s th e n e u tr ali z ing an d rem o vi ng
o f septi c o r f o reig n s u b s t ance s fr o m th e b o dy ; th er eby r e
phy si o lo gi cal p r o c e s s e s thr o u gh th e re
st o ri n g n o rm al
e st abli sh m e n t o f n o rm al ch emi cal and vit al r e l ati o n s o f
th e c el l s ti ss u e s an d o rgans o f th e b o dy an d re s u lti n g i n
re st o r ati o n o f he alth thr o ug h th e au t o m ati c stim ul ati o n
an d free Oper ati o n o f th e i n h ere n t re s i s t an t an d rem e di al
”
f o r c e s withi n th e b o dy it s e lf
C M Tu r n er H u lett D O
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I NTR O D U CT I O N
O s te o p athy
.
23
th at sc i e n c e wh i c h re aso n s o n th e
h u m an sy stem fr o m a m e ch an i cal as we ll as a ch emi c al
s t an dp o i n t
t aki n g i n t o c o n s id er ati o n i n its di ag n o s i s
h ere dity th e h abit s o f th e p ati e n t p ast an d p re s e n t ; the
hi s t o ry o f th e tr o u b l e , i n c lu di n g s ymp t o m s f alls str ai n s
i n j u r i e s t o x i c an d s epti c c o n diti o n s an d e s pe c i ally i n every
c as e a p hy s i c al e x am i n ati o n by i n s e c ti o n
p
p
ti
l
n
o
a
a
r
e
p
p
c u ss i o n
au s c u lati o n e tc
to dete rmi n e all ab n o rm al phy s i
c al Con d iti o n s
th e tre at me n t emph as izi n g sc i en tifi c m an ip
u lati o n to c o rre c t m e c h an i c al l e s i o n s
to s tim u late o r i n
b ibit an d reg u late n e r ve f o r c e an d c i r c u lat ory fl u id s fo r
th e re c up erati o n o f any di s e as e d p art u s i n g th e vit al f o r c e s
With i n th e b o dy ; als o th e h ab it s o f th e p atie n t ar e reg u
l ate d as to hygie n e ai r f o o d w ate r re st e x er c i s e s c lim ate
an d b ath s ; s u c h m e an s as hydr o p athy e l e c tri c ity m a ss age
an ti d o te s an d an ti s epti cs an d s u gge sti o n so m etim e s b ei n g
”
u s e d as adj u n c t s
C h as C R eid D O
The ab o ve defi n iti o n s h ave n e ar ly all be e n t ake n fr o m
th e J o u r n al o f th e A m e r i can O ste o p ath i c A sso c i ati o n
"
IS
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— Phys i cal di ag n o s i s i s an d al
Way s wi ll b e th e l e adi n g f ac t o r i n th e su cc e ss o f o s te o
T
o t ake h o l d o f an ai l i n g
hi
s abi l ity t
athi c p r ac titi o ne r s
p
c t o r i n it i s th e
hu m an b ei n g an d dete c t the di st u rbi n g fa
highe st att ai n m e n t o f the phy s i c i an O s te o p athy has d e
Bas
v e lO p e d the ar t o f p alp ati o n to a w o n derf u l d egree
h i s ar t o n a d efi n ite k n o w l edge o f s t r u ct u re an d
in g t
f u n c ti o n m ake s it th e ch i ef re l i an c e in di agn o s i s E very
phy si cal di agno s i s b egi ns wit h p alp ati o n an d p r o c ee d s with
au scu l ati o n an d per c u ss i o n an d n o t f ai l i n g to u s e c h emi c al
The s t u de nt
an d mi c r o s c o pi c al m et ho d s w he n n e c e s sary
mu s t l e ar n to u se hi s s e n s e o f t o u ch c o n ti n u ally i n f ac t
l e ar n to s e e with hi s fi n ger s A dd to thi s deve lopm e n t o f
t o u ch a t r ai n i n g i n chemi c al an d mi c r o s c o pi c al an aly s i s o f
an d we h ave a
an d e x c reti o n s o f th e b o dy
s e c r eti o n s
pr actiti o n er th o r o u gh ly e q u ipp ed to m ake an acc u r ate
s c i e n tifi c di ag n o si s
O ste o pathi c D i ag n osi s
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I N TR O D U CT I O N
24
— O ste o p athi c tre atm e nt i s
b ased o n th i s ki n d o f phy s i c al di ag no si s whi ch we h ave
It t ake s i n t o acc o u n t th e f ac t th at the
j u st d e s c rib ed
o rg an i s m
i s a sel f re c u p e r ati n g m e c h an i s m an d re q u i re s
p r o p e r f o o d p r o p e r s u rr o u n di n g s an d pe rfe c t ac tivity o f
eve ry ti s su e e sp e c i ally th e bl o o d Th us we divi de tre at
m e n t i nt o th re e divi s i o n s ( l ) m an ip u lati o n fo r th e pu r
p o s e o f c o rre cti n g th e m al p o s iti o n o f any ti ssu e wh eth er
th at ti s su e b e b o n e o r b lo o d ; ( 2 ) p r o p er fe edi n g i e
di eteti cs ; an d ( 3 ) p r o p e r s u rr o u n di n g s i e hygi e n e
I f th e c o n diti o n o f th e b o dy i s s u ch th at n o n e o f th e
th re e m eth o d s j u st m e n ti o n ed wi ll right th e di ffi c u lty i e
i f the re ar e br o ke n b o n es r u pt u re d m u scle s an d c o nn e c
tive ti s su e s o r f als e gr o wth s we c an th e n u s e su rgi cal
m e an s S u rgery i s a p art o f th e o ste o p athi c sy s tem j u s t
The c hi e f a ss u r an c e
as it i s o f all s y s te m s o f medi c i n e
li e s i n th e f ac t th at th e o s t e o p athi c sy s te m i s very c o n
i v e as reg ard s th e u s e Of th e k n ife
s e r v at
O ste o p athy i n c lu d e s all th o s e q u al iti e s whi c h m ake
s
u p a s u cc e ss f u l sy s tem ; i ts di ag n o s i s i s ac c u r ate an d it
n
l
i
n
tre atm e n t i s c o m
reh
e
n
ive
i
c
u
di
g
c
i
e
n
t
fi
c
m
n
ip
l
a
s
s
a
u
p
ti o n s sci e ntifi c d ieteti c s hygi e n e an d su rge ry
eri c an M o n th ly R eview
In a re c e n tarti c l e i n th e A m
R e vi ew s th e f o llo wi n g s e n te n c e s appe ar z W ith bu t
0 1
few e x c epti o ns the e ntire veget ab le and m i n er al ki n gd o m s
h ave give n u s litt le o f s p e c ifi c v alu e ; bu t sti ll u p to th e
pre s e n t day th e b u lk o f o u r b oo k s o n m ateri a m edi ca i s
m ade u p o f a d e sc ripti o n o f m an y v alu e le s s d r u g s an d
p rep ar ati o n s Is it n o t to b e dep lo re d th at v alu abl e tim e
s h o u l d be w as te d i n o u r s t u d e n t d ay s by c r ammi n g in t o
o u r h e ad s a lo t o f th er ap e u ti c b allast
Thi s i s p ro b ably th e m o s t re c e n t s t atem e n t o f th i s
ki n d i n th e p u b li c p r i n t s I t s u b st an ti ate s th e p o s iti o n
t ake n by th e o ste o p athi c c o llege s We fe el j u stifi ed i n
c laim i n g th at o ste o p athy t o d ay o cc u pi e s a p o siti o n whi c h
every o th e r sy stem o f m edi c i n e m u st c o m e to s o o n er o r
I t i s br o ad e n o u gh an d lib e ral e no u gh to ac c ep t
late r
O s t e o pat hi c
The r ape u ti c s
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I NT R O D U CT I O N
25
tr u th wh e rever dem o n str ated Its f o u n d ati o n s b ei n g lai d
i n th e b as i c s c ie n c e s an d i ts tre atm e n t n ever dep arti n g
fr o m th e f ac t s o f th e s e s c ie n c e s m ake it a sy stem o f lasti n g
w o rth an d c ap abl e o f addi n g an e n ti re ly n e w c o n c epti o n
Of th e ph e n o m e n a o f life to m edi c al lite r at u re
The f o rm ati o n o f th e n am e O ste o p athy ( fro m o s te o n
b o n e an d p ath o s s u ff eri n g ) s eem s to be as p erfe c t a de
s c riptive n am e as it i s p o ss ib l e to f o rm whi c h w o u ld c o ve r
The b o n e s ar e th e
th e b as i c p ri n c ip l e o f th e s c ie n c e
f o u n d ati o n u p o n wh i ch all th e s o ft ti s su e s ar e l ai d an d
th e o s te o p ath m ake s all hi s e x ami n ati o n s u si n g th em as
fi x e d p o i n t s fr o m wh i ch to e x plo re f o r f au l ty arran ge
m e n t l The n am e d o e s n o t m e an b o n e di s e as e bu t s i n c e
th e o ste o p ath fi n d s m an y di s e as e s re su lti n g fr o m i r r i t ati o n
du e to s l ight ly di sp l ac ed b o n e th e n am e i s u s e d i n th e
s e n s e o f di s e as e c au s ed by b o n e
W e do n o t co n s i der th at
all di s e a s e s a r e c au s ed by di s p lac e d b o n e bu t it i s a c au s e
whi ch has h eret o f o re be e n o ver lo o ked We re co g n iz e th at
th ere ar e m an y c au s e s o f di s e a se an d do n o t W i sh to b e
o o d a s tryi n g to fit f ac t t
u n der st
o th e o ry
bu t as a re s u lt
of
c e rt ai n f ac t s
thi s b asi c pri n c ip l e o f o ste o
p athy has b ee n m ad e c l e ar
W e b e lieve th at h e alth i s th e n at u ral S t ate an d th at
thi s co n diti o n i s b o u n d to b e m ai n t ai n e d s o lo n g as every
an d i ts c o n tr o ll i n g
c e ll has an u n i n terr u pte d b l o o d s u pp ly
Th eref o re th e fi r st e ff o rt Of th e
n erve i s u n di s t u rb ed
o b l o o d an d n erve
o rem o v e all o b str u c ti o n s t
o s te o p ath i s t
fe e li n g c e rt ai n th at wh en t he s e Ob str u c ti o n s ar e
s u pp ly
rem o ved h e alth wi ll f o llo w
H i lt o n i n hi s l e ctu re s o n
“
R e s t an d P ai n wh i c h ar e co n si d ere d m ed i c al clas si cs
has e x p re ss e d h im s e l f f o r c ib ly o n thi s s u bj e c t as f o llo w s :
I t w o u ld b e we ll I thi n k if the su rge o n w o u l d fi x u p o n
hi s m em o ry as th e fir s t p r o fe ss i o n al th o u gh t whi ch sh o u l d
ac c o mp an y him i n th e co u r s e o f hi s d ai ly o c c u p ati o n th i s
phy si o lo gi c al tr u th — th at n at u re has a co n st an t te n de n cy
to rep ai r th e i n j u r i e s to whi c h h er str u c t u re s m ay h ave
be e n su bj e c te d wh eth e r th o se i n j u ri e s b e th e re s ul t o f
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I N T R O D U CT I O N
26
f atig u e o r e x h au sti o n o f i n fl am m ati o n o r acc i de n t Al so
th at th i s rep ar ativ e p o wer be c o m e s at o nc e m o st c o n
di st u rbi n g c aus e has be e n rem o ved ;
spi c u o u s wh e n th e
th u s p re s e n ti n g to th e co n si der ati o n o f the phy s i c i an an d
s u rge o n a co n s t an t ly re c u rri n g an d so u n d p ri n c ip l e fo r hi s
”
g u id anc e in hi s pr o fe s si o nal p r acti c e
E ve ry sy ste m o f c u r i n g h u m an i ll s wh i ch i s b ase d o n
th e k n o w n fac t s o f anat o my an d p hy s i o l o gy wi ll l as t
b e cau s e it i s tr u e Wh e n sy stem s o f d r u g m e d i c at
i o n ar e
k n o w n o n ly as hi sto ry o s te o p athy will b e m i n i steri n g to
th e h u m an r ac e be c au s e it k n o w s no o th er p ath th an th at
whi ch le ad s to gre at e r tr u th s i n phy s i o lo gy an d anat o my
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PR I N C I PL E S
OF
O S T E O PA TH Y
C H A PTE R I
C AUS E S
No r m a
l
27
.
O F D IS EA S E
Abn o r m al — Ino rder to
.
th e w o rd ab
n o rm al with refere n c e to the s tr u c t u re an d f u n c ti o n o f l ivi n g
ti s su e s we m u s t h av e k n o w l edge o f th e no r m al No rm al i s
a w o r d h av i n g app are n tly as m an y i n terpret ati o n s a s th e
”
w o rd be au ty i e s t an d ard s to wh i ch th e s e w o rd s ar e
app l i ed di ff er
eve n as th e i n divi d u al s w ho u s e th em In
o r d e r th at w e m ake c l e ar wh at w e c o n c eive as n o rm al an d
it i s n e c e ss ary to call atte n ti o n to
ab n o rm al co n diti o n s
v ari ati o ns i n s tr uc t u re an d fu ncti o n whi c h sh o u l d be r e c o g
n iz e d as n o t b ei n g far e n o u gh rem o ved fr o m typ i c al c o n di
ti o n s to i n di cate th e e x i s te n c e o f a n ee d fo r co r r e ctive
i n te r f er e n ce
The Ide al No r mal — O u r fir s t s tep s i n th e ac q u irem e n t
o f a m edi c al e d u c at i o n ar e p r ac ti c ally all c o n c er n e d with
st
u dy o f t
he n o r m al
We di ss e ct b o di e s whi ch h ave b ee n
chan ged by di s e as e an d the ref o r e we c o m e i n c o n t ac t with
ab n o r m al ity
To co u n te r act t hi s we s t u dy de s c riptive an at
o m y an d i de alize o u r re al k n o w l edge wh i ch w a s o bt ai n ed by
di ss e c ti o n O ftti m e s o u r ide al has s u c h attrib u te s o f pe r fe c
ti o n th at no thi n g e v
e r c o m es u p to st an d ard an d h e n c e ap
p e ar s to us to b e defe ctive Thi s hyp er criti c al attit u de le ad s
to e x agge r ati o n o f th e i n te rp ret ati o n pu t u p o n sympt o m s
an d h e nc e l e ad s to m i s dire c te d e ff o rt s at co rre c ti o n
V ar i ati ons in S tr u ct u r e and F u ncti o n —W e n eed th ere
fo re fi r st o f all a f ai r ly go o d k n o w ledge o f th e v ari ati o n s i n
s tr u c t u re an d f u n c ti o n wh i c h m ay be re c o g n ized as c o n s i d
e r able dep art u re s fr o m typ e
bu t sti ll n o t ab n o rm al i n th e
s e n s e we u s e th at term wh e n s p e aki n g Of di s e as e
No ti s su e
an d
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u se
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PR I N C I PL E S
28
O ST E O PAT H Y
OF
in
th e b o dy is u nyie ld i n g an d h e n c e will ad apt it s e lf to eve n
a very m o d er ate f o r c e if th at f o r c e i s lo n g c o n ti n u ed
Thi s
is we ll i ll u str ate d by th e gre at C h an ge s wh i c h can b e pr o
du ce d i n th e alig n m e n t o f th e te eth u n d er co rre c tive b r ac i n g
A dapt ati o n —The c h an ge s i n s tr u c t u re whi ch ar e fr e
q u e n t ly re c o g n ized m ay be evid e n c e Of ad apt ati on i e th ey
h e b o dy s e ffo rt to m ai nt ai n i ts e x i s
ar e th e fi nal re s u lt o f t
te n c e at th e high e s t p o i n t o f e ffi c i e n cy o f whi c h it i s cap abl e
With th is th o u ght e ve r i n o u r m i n d s we m ay s afe ly Ob s erve
th e ch ar acte r o f s t r u ct u re s an d dr aw mo re j u st c on c l u si o n s
as to th e e x i s te n c e o f n o rm al o r ab n o rm al c o n diti o n s
No r m al H e alt h —P e o p l e u su ally s eek th e s ervi c e s o f a
phy s i c i an b e cau se th ey su ffe r s o m e d egre e o f di s com f o rt
Tr u e it is th at s o m e s eek a c o s m eti c e ff e c t bu t th i s m ay
h ard ly b e s eri o u sly c o ns i d ered No rm al h e alth m e ans a co n
diti o n wh erei n we ar e u n c o n s ci o u s o f b o di ly d i stre s s an d ar e
ab l e to do wh at is o rdi n ari ly c o u n te d as o u r s h are o f w o rk
This s tate o f b o di ly c o m f o rt u n de r th e o rdi nary s tre ss o f
l ab o r i s n o t n e c e s sari ly b ase d u p o n symm etry o f s tr u ct u r al
deve lo p m e n t i e ab s o lu te co n fo r m i ty to o u r ide al o f s tr u e
t u r al p erfe cti o n ;
—
E
i
ffi c e n cy
No rm ality fr o m the c r ad l e to
C o m f o r t an d
the gr ave s e em s to b e a p e r so n al eq u ati o n i e b o dily co m
f o r t u n der th e stre ss o f m o der at e phy s i cal an d m e n t al e x e r
ti o n I n c re ase o f phy si c al o r m e n t al e xer t
i o n e ith er thr o u gh
ad a pt ati o n p r o d u c e s i n c re as e d c ap ac ity o r th r o u gh f ai lu re
p r o d u c e s d e s tr u ctive c h an ge s Co m f o rt an d
o i ad apt ati o n
e ffi c i e n cy ar e th e re al attrib u te s o f n o rm ality I f th e s e ar e
pre s e nt i n aver age degre e th e re i s litt le li ke lih o o d o f a phys i
c i am b ei n g c o ns u l ted
The n o rm al o f any i n divi d u al
V ar i ati o n o f the No r m
al
v ari e s at di ff e r e n t p eri o d s o f life an d f o llo wi ng acc i de n t s o r
The phy s i c i an i s fre q u e n tly c on s u lted with
s evere i lln e s s e s
th e h o p e th at the n o r m al o f later ye ar s might b e r ai s e d to
th e degree c o n sc i o u s ly p o ss e ss e d at a f o rm e r tim e o r in th e
h o p e o f b ei n g re s t o red to th e no rm al whi c h e x i ste d previ o us
The n e w n o rm al s whi ch
to an ac c i de n t o r s evere i lln e ss
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PR I N C I PL E S
3O
O ST E O PAT H Y
OF
ph e no m e n a o u t o f i ts co mp ar ative v al u e with any o th er
gr o u p I t is h o pe d th at by p re s e nti n g as well as we ar e abl e
th e le si o n the o ry Of di s e ase we may b e abl e to sh o w p ath s o f
o a b etter i n terpret ati o n o f di s e ase
c o nve rge n c e l e adi n g t
ph e no m e na an d th u s th e tr u t hs wh i ch u n d erl i e th e l e s i o n
th e o ry will n o t be co m e di st o rted i nt o f an t asti c v ag arie s
We do n o t wi sh to be u n de r s t o o d as c l ai m i ng fo r o ste o p athy
th e di sc o very o f th e cau s e o f di se as e Th ere ar e m any
O s te o pathy bri n g s to
cau s e s wi d ely div erge n t i n ch ar ac ter
y o u r atte nti o n a c au s e freq u e ntly f o u n d an d o f su ffi ci e nt
de fi n ite n e s s to w arr an t c o n c e n trated atte n ti o n
,
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E nvi r o nm e nt— S i n c e
R
to
we ar e
m e ch an i s m s o f livi n g ti ss u e s o u r su rviv al dep e n d s u p o n r e
ac ti n g f av o r ably t
o e n vi r o n me n t
We fi n d th e el em e nt s ai r
light h e at an d co l d all aff e c t u s adver s ely at tim e s
They
be co m e de str o yer s o f b o dily co mf o rt an d e ffi c i e ncy w h e n
i nte ns ified Ch an ge s i n atm o sph e r i c p re s su re i n te n sifi ca
ti o n o f light i n c re as ed h e at o r co l d aff e c t u s s e r i o u s l y
i on
e act
F av o r ab l e
,
.
,
,
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,
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,
,
,
.
K no w n Cau se s o f D i se ase —Che mi c al p oi so n s s u ch as
l e ad ar s e n i c m e r c u ry ph os ph or u s c arb o n m o no x ide an d
ot
h e r g as e s ar e cau s e s o f p r o f ou n d i n j u ry The o rgan i c
p o i s o n s alco h o l Op i u m m o rphi n e c o cai n e f o o d p o i s o n s
s n ake ve n o m s au t o i n t o x i c ati o n s pl ay n o s m all p art i n c au s
i n g b o di ly di sco mf o rt an d i n e ffi c i e n cy
The veget ab le o r
n
i
m
i a c l aim ab u n d an t re co g n iti o n as
n
u
a
n
a
f
gi
b
a
ter
s
s
d
c
g
c au s e s o f di s e as e
P r o t o z o a ar e p r o pe r ly l i sted as c au s e s
fo r h ave we n o t th e w o n d erf u l di s co ve ri e s c o n c er n i n g m a
lar i al fever s l e epi n g s i c k n e s s am o ebi c dy s e n tery an d yel l o w
feve r ; s u ffi c i e n t sc i e n tifi c achi evem e n t s to st ar tl e th e w o rld
The fl u ke c e s t o d e an d r o u n d w o rm i n fe c ti o ns h ave l o n g
be e n re c o g n ized c au s e s o f di s e ase Add to th e fo rego i n g all
th o s e adve r s e co n diti o ns i mp o s ed by th e n at u re o f o u r
c r o wde d e x i s te n c e i n c iti e s
n o i s e an d u n re s t
s u rfeit and
p o verty fati g u e an d w o rry it is littl e to b e w o n dered at th at
we fi n d o u r s elve s s e ar c hi n g alm o st hy s teri cally fo r so m e
th i n g to ai d u s to su rvive it all
,
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PR I N C I P L E S
OF
O ST E O PAT H Y
31
L i fe —It i s m arve lo u s ho w o u r b o di e s
ad apt th em s e l ve s to all th e vi c i ss it u d e s o f e n vi r o n m e n t s u r
vive th e e ff e c t s o f i n o rgan i c an d o rg an i c p o i so n s i nv asi o n s
Of b acte r i a o r p r o t o z o a m ai n t ai n e x i ste n c e i n S pi te o f de fi
c i e n t f o o d an d r e s t
The te n ac ity o f li fe i n h u m an ti ss u e s
th e ad apt ati o n s an d co mp e n s ati o n s th at ar e d e ve lo p ed ar e
w o rthy th e pe n o f s o m e s c i e n tifi c ge n i u s w ho has the liter ary
abi l ity to m ake th e l aym an h ave f aith i n n at u r al l aw
—
—
Le si OnD i se as e As s o c i ati o n
With all th e se cau s e s o f
di s e as e we m ay we ll ask Ou r s e lve s wh at re lati o n th e sp i n al
o r o th er j o i n t l e s i o n has
I t w o u l d b e di ffi cu lt to fi n d any
di s e as e p r o c e ss th at d o e s n o t e x h ib it a S pi n al o r o th er j o i n t
l e s i o n i n th e s e n s e we o s te o p ath s r e co g n ize Thi s co i n
c i de n c e o f di s e as e an d s pi n al o r o th e r j o i n t l e s i o n d o e s n o t
n e c e s sari ly i n di cate a seq u e n c e o f eve n t s s t arti n g i n th e le
As s c ie n ti st s r at he r th an s p e c i al p le ader s fo r a th e o ry
si o n
we w ant to k n o w th e s ig n ifi can c e o f thi s as so ci ati o n I t i s
o u r ai m t
o dev o te th e p age s f o l l o wi n g t
o an an aly s i s O f thi s
le s i o n di s e as e asso c i ati o n
We ai m to write h e lpf u lly an a
ly z i n g o u r f ail u re s th at we m ay k n o w o u r we ak n e ss e s an
aly z i n g c ur s u c c e s s e s s o th at we m ay m ake o u r so l i d p ri n
c i l e s m o re wi de ly re c o g n ized
p
—
m
i
e
o
v
h
a
s
e
R
No gre at am o u n t o f
e t e C au s e o f D s e
an aly si s o f th e v ari o u s c au s es o f di s e as e i s re q u ired b ef o re
“
”
we r e al iz e th at to rem o ve th e cau s e we m u st do so m ethi n g
m o r e th an tre at i n divid u al m emb e r s o f s o c i ety There is a
ph as e o f m e di cal p racti c e wh i ch re q ui re s u s to vi ew th e g o o d
o f th e c o mm u n ity r ath er th an an y p o rti o n o f it
S o m e l ive s
ar e s ac rifi c e d be cau s e we h av e n o c u re fo r th e i n divid u al
W e cu r e th e c o m m un ity th e r ac e by sac rifi c i n g the i n divid
u al
P u b li c h e alth re q u ire s wh at s e e m
o b e c r u e lty t o w ard
s t
th e i n divid u al fr o m wh o s e di s e as e we mu st be pr o te cted
P r e v e nti v e M e di ci n
e — A s fa st as cau s e s o f c e rt ai n di s
e as e s hav e b ee n dem o n s tr ated
p lan s fo r preve n ti o n t ake
pre c ede n c e o ver tre atm e nt Of th e i n divi d u als w ho s u ff e r fr om
th o s e di s e as e s
Th u s a n e w c lass Of phy si c i an s is devel o p ed
i e th o s e tr ai n e d to co p e with th e p r o b l em s o f p reve n tive
The Te naci ty
of
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PRI N C I PL E S
32
O ST E O PAT H Y
OF
m edi c i n e r ath er th an m eet th e e x ige n ci e s o f tre ati n g i n
divi d u al p ati e n t s I t is th e n e c e ssari ly ag gre ss ive adv an ce
o f p reve n tive m e di c m e wh i c h ar o u s e s an t ag o n i sm an d s o c i al
di s co rd NO o n e c o u ld s u cc e s sf u lly c o nte n d th at all p reve n
tive m eth o d s th u s far e n f o r c ed ar e sati s f ac t o ry Th e n to o
it i s n o t p o s sib l e to d em o n str ate q u i ck ly to all th e m emb er s
S acri
of a c o m m u n ity th e n e c e s s ity fo r c ert ai n p r o c ed u re s
fi ce o f th e i n divi d u al b e it ever s o s light fo r th e g o o d o f th e
wh o le i s n o t agree ab le to th e vi cti m o r hi s fri e n d s Alt ho
we ar e d eve lo pi n g m eth o d s p ri m ari ly appl i cab le to th e i n
divi d u al r ath e r th an s ervi n g th e aggre ss ive p u rp o se s o f p re
v e n ti v e m edi c i n e th at whi c h m ake s th e i n divi d u al an e ff i
c i e n t m embe r o f s o c i ety s u b s erve s p u b l i c h e alth
D i s e ase s m an if est th em s elve s by c e rt ai n
S y m pto m s —
phe n o m e na whi c h ar e de s ig n ated as sympt o m s S ympt o m s
Thi s i s m ad e evi
ar e ab n o rm al d egre e s o f n o rm al re ac ti o n
d e n t by th e f ac t th at so m e s ympt o m s repre s e n t s ub an d
o th er s s u p er n o rm al f u n c ti o n i n g
The su pe r n o rm al f u n c ti o n
i n g repre s e n t s a re ac ti o n o n th e wh o l e f av o ra b leto re co very
wh ere as th e sub n o rm al re ac ti o n i s n o t f av o r ab le S i nc e th e
s ympt o m s repr e s e n t ph as e s o f re ac ti o n o r n o n —
re acti o n i n
ti ss u e s th e e ffo rt pu t f o rth by th e b o d y as a wh o l e to r e
c o ver
i s i n p r o p o rti o n to the e n e rgy c o n t ai n ed i n i ts cel ls
In a re s tri c te d s e n s e th e c au s e Of di s e as e i s i n th e c e ll s o f th e
Th ey c o n t ai n th e st o re d e n ergy
b o dy
i e
po
te n ti al
e n e rgy
W he n thi s p o te n t ial e n ergy is r e
l e ased by so me f o r c e o r stim u lu s we h ave ki neti c e nergy
P o te n ti al e n ergy d o e s n o t tr an s fer it s e lf s p o n t an e o u sly i n t o
ki n eti c e n ergy with o u t fi r s t b ei n g affec te d by so me o th er
f o r c e whi ch m ay b e c alled a sti m u l u s The am o u n t o f po
te n ti al e n e rgy c o n verted i n t o ki n eti c i s n o t pr o p o rti on al to
the am o u n t o f th e s tim u lu s u s ed to i n iti ate th e p r o c e s s Al l
s t o red
e n e rgy i e p o te n ti al e n ergy , re q u i re s a c ert ai n
s tre n gth o f s ti m u lu s to st art th e p r o c es s o f c o n ver s i o n i n t o
ki n eti c Whe n th i s s tr en gth o f sti m u lu s i s k n o w n it is cal led
th e n o rm al Th ere ar e u s u ally s eve r al ki n d s o f s tim u li e ach
o n e h avi n g a v aryi n
g degre e o f i nte n sity F o r e x amp le th e
'
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O ST E O P A T H Y
P R I N C I PL E S O F
33
p o te n ti al e n ergy i n a m u scl e fib er wi ll b e c o n v e r te d i n to k i
n eti c e n ergy as a re s u lt o f m e c h an i c al th erm al c h emi c al o r
e lec t ri c al s tim u li C ert ai n am o u n t s o f e ac h o f the s e sti m u l i
ar e re qu i red to i n iti ate th e c h an ge i n th e f o rm o f e n e rgy
—
l
A No r m al S ti m u u s
Th e p o te n ti al e n e rgy i n a m u sc l e
fiber has a c ert ai n degre e o f re s i s t an c e to sti m u fi A d efi n ite
n y o n e o f th e f o u r f o rm s o f s tim ul i n amed is
am o u n t o f a
Th i s de fi
n e c e s s ar y to c au s e th e m u s c l e fibe r to c o n tr ac t
n i te am o u n t whi c h i s c ap ab l e o f stim u lati n g th e m u s c l e to
an av e r ag e co n tr ac ti o n i s c al le d the n o rm al sti m u lu s an d
th e acti o n Of th e m u s c l e i s call ed th e n o rm al c o n tr acti o n I f
th e m u s c le s ho u ld c o n tr ac t m o re vig o r ou sly th an u s u al i n
re s p o n s e to th i s n o rm al s tim u lu s th e r es i stan c e o f th e po
The
e n ti al e n e rgy o f th e m u sc l e fiber i s b e lo w no rm al
t
v ary
s tre n gth Of s tim u lu s an d di s c h arge o f e n ergy may
gre at ly i n th ei r p r o p o rti o n s with i n n o rm al l im it s bu t th ere
ar e we ll m arked l i n e s ab o v e o r b e lo w W
hi c h re s i st an c e is
sp o ke n o f as ab o v e o r b e l o w n o rm al
A Chan g e o f R e s i s t an c e —W h e n the re s i s t an c e o f th e
p o t enti al e n ergy i s b e lo w n o rm al a n o rm al sti m u lu s cau s e s
to o gre at ah e ff e ct th at i s to o m u c h po te n ti al e n ergy i s
tr an s fe rred i n t o ki n eti c e nergy W h e n th e r es i st an c e o f th e
p o te n t ial e n e r gy i s n o rm al an d th e s tim ul u s ab o ve n o rm al
t here al so r es u lt s an e x c e ss iv e di s ch arge o f p o te n ti al e n ergy
The ref o re e x c e s sive d i sc h arge re s u lt s fr o m lo were d r e s i s
t an c e o r i n c re as e Of s tim u lu s R e s i s t an c e i s a q u ality Of th e
c e ll p r o t o pl as m
The Sti m u lu s i s an e x te r n al f o r c e
The
c e ll dep e n d s o n p r o pe r s u rr o u n di n g s i n o rder to m ai n t
ai n i ts
re s i s tanc e to e x te r nal sti mu li s u c h as b ac teri a The s tre n gth
o f b ac teri a m a
n
r
n
b
e
i
re
e
d
de
re
ed
by
th
e
t
re
a
l
so
c
a
s
o
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a
s
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o
f the i r
'
s u r r o u n di n g s
Cau s e
.
.
—A fter p te n ti al e n ergy
bee n
ch an ged i n t o ki n eti c e n ergy thi s latter m ay ge n er ate m o re
p o te nti al e n e rgy an d th i s als o m ay b e c o n vert ed i n t o ki n eti c
Th u s c au s e i s c o n ve rted i n t o e ff e c t an d e ff e c t i n t o c au s e
Thi s i s an e n d l e s s ch ai n Wh e n s u c h a p r o c e ss i s b ey o n d th e
no r m
al
as i n th e b o d y wh e n E
v aryi n g sympt o m s p re s e n t
E ff e ct
an d
o
has
,
.
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‘
"
,
PR I N C I PL E S
34
O ST E O PAT H Y
OF
th em se lve s th e r ap e u ti c e ffo rt s m u st b e c o n c e n tr ate d o n
so m e p arti c u l ar refl e x i n o rd e r t
o bre ak th e ch ai n
C e ll R e lati o n s — The re lati o n s o f a c e ll with i ts fe llo w s
th at is i ts str u c t u r al re lati o n s ar e th e b asi s u p o n whi c h i ts
re s i st an c e i n large me as u re d epe n d s Th e ref o re anythi n g
wh i ch di s arr ange s i ts n o rm al re lati ons wi ll i n all p r o b a
bi li ty
ch an ge
i ts re s i st an c e to s tim u li
A ll th e r ap e u ti c
m eth o d s wh i c h ai m at le s s e n i n g th e to o r apid co n ver s i o n o f
p o te nti al i nt o ki n eti c e n ergy th at i s i n c re as i n g c ell re s i s t
an c e m u s t s e e th at co rre c t s tr u c t u re i s att ai n ed
—
In c as e s wh ere alm o s t c o m
E x ce ss i v e S ti m u l ati o n
e
h
ti
o
n
o f p o te n ti al e n e r gy has re s u lted fr o m lo w
l
e
e
x
a
u
t
s
p
ered re si st an c e an d we fi n d th at eve n i n c re as e d stre n gth o f
r uct
u r al f au l t
stim u l u s f ai ls to ev o ke a re s p o n s e th e s am e s t
We k n o w th at s tim u lati o n wh e n e x c e ss ive
m ay e x i s t ;
p ass e s i nt o i nh ibiti o n P e rh ap s it i s tr u e r to s t ate th at o ve r
ac tivity o f a c e ll l e ad s to e x h au s ti o n o f i ts p o te n ti al e n ergy
The s t age o f e x h au s ti o n i n th i s s e n s e i s c o n so n an t with i n
hi bi ti o n
As an e x am p l e : In c as e o f str u c t u r al c h an ge s i n
th e lo we r d o r s al regi o n th e re m ay re s u lt a ch an ge i n r e
s i st
an c e i n th e s e c ret o ry an d c o n tr ac ti l e c e lls o f th e i n te s
ti n e s du e to ch an ged b lo o d s u pp ly Di arrh o e a re su lt
s fo r a
tim e f o llo wed by c o n stip ati o n A t th e begi n n i n g O f the
r apid c o n ver s i o n o f p o te n ti al i n t o ki n eti c e n er gy th e m u s c l e s
fe e l te n s e A fter th e co ns t i p ati o n o r p eri o d o f e x h au s ti o n
s et s i n th ey ar e fl abby
S t r u c t u r al D e f e ct s — S tr u c t u r al defe c t s m ay re s u lt i n
Th ey als o ac t as s tim
lo we red re s i s t an c e i n gr o u p s o f c e lls
u l i to s e t fre e th e p o te n t
i al e n erg y i n th e s e c e ll s In m any
o yi e ld t
o we ak s tim u li
cas e s we n o te o n ly a p re di s p o s iti o n t
“
”
Th i s i s th e c on diti o n i n i n divi d u als w ho ar e f ai r ly We ll
bu t c an n o t e n d u re an y o f the n o rm al s ti mu li i n ave rage
am o un t
Th ey c ann o t e x er c i s e free ly with o u t a bad r e ac
ti o n A slight ly h e av 1 e r m e al th an u su al th e e x c item ent du e
”
to th e p re s e n c e o f m an y p e o p le a r o u s e s sympt o m s
Th ei r
phy si o l o gi cal p r o c e sse s ar e e asily p erve rte d by n o rm al s tim
u li b e cau s e a st r u ct u r al de fe ct eith er di r e c tly o r i n dire ctly
,
.
'
.
,
,
,
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-
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'
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PR IN C I PL E S
OF
O ST E O P A T H Y
35
de c re as e d c e ll re s i s t an c e C as e s o f lo wered re s i st an c e
o h er e dity
s u pp o s ed t o b e du e t
s h o u l d b e c aref u lly e xam
i n e d fo r str u c t u ral defe c t s
I t i s n o t im pr o b ab le that many
“
i
r
o
an anc e s t o r i s wr o n g ly acc u s ed o f tr an s mitti n g a
e
d
s
p
p
”
siti o n
W hi le c e ll r e si s t an c e rem ai ns be lo w no rm al all e x
ter n al s tim u li s u ch as atm o sphe ri c c h an ge s an d the pre s e n c e
o f b ac te ri a e v
e n i f i n o n ly n o rm al am o u n ts m ay c all f o rth
“
”
s ympt o m s o f d i s e as e
—
e
ll
e
e
e
r
l
L
if
D
t
i
i
i
d
ivi
d
e
n
n
n
c
a
t
o
n
T
h
e
n
u
a
l
d
o
C
u
C
p
he b o dy d ep e n d 0 11 th e su pp ly o f n o u ri s hm e n t
c e ll s o f t
b r o u ght to th e m by th e c i r c u lati n g fl u id s o f th e b o dy The
pr o t o p lasm o f th e c e lls i s a c o mp l e x ch emi c al s u b st an c e
mad e up Of an e n o rm o u s n u mber Of co mp l e x m o l e c u l e s
The s e m o l e c u l e s o n ac c o u n t o f th e lo o s e n e s s o f c o mbi n a
ti o n o f th eir at o m s r eq u i re s u ffi c i e n t c r u d e m ateri al b r o u ght
to t hem to m ai n t ai n th e p r o p e r a t o mi c te n s i o n
U p o n th i s
te ns i o n i s bas e d th e re s i st an c e to no rm al o r ab n o rm al stim u li
The n e c e ss ary f o o d fo r c e ll p r o t o p l as m i s br o u ght to th e
c e lls by b lo o d an d ly mph
S i n c e c e ll p r o t o p las m i s e n ti re ly
d ep e n de n t u p o n th e c ir c u lati n g m e di a an y di st u rb an c e o f
th e se m e di a c hai i g e s th e m et ab o li s m o f th e c e ll an d h e n c e
a c h an ge i n re si s t an c e re s u lt s Thi s re s i s t an c e m ay b e v arie d
by f ai lu re o n eith er the ar te r i al o r ve n o u s s id e o f the ge n e r al
c ir c u lati o n
re s u lti n g i n c h an ged ly mph c ir c u lati o n The
co n s t an t rem o v al o f k at ab o l i c p r o d u c t s i s Of as m u c h i m
p o rt an c e as th e c o n st an t re n ew al o f m ate ri al fo r an ab o l i s m
—
t
i
I n tr ac e llu lar te n s i o n i e th e
In r ac e l lu l ar Te ns o n
c o h e s ive n e ss o f th e at o m s Of e ac h m o l e c u l e i s d ep e n de n t o n
lymph ati c c i r c u lati o n ; thi s u p o n arteri al an d ve n o u s c i r c u la
ti o n I f th ere i s ab n o rm al v ari ati o n i n any o f the s e c ir c u la
t o ry fl u id s th ere re s u lt s a ch an ge i n r e s i s tan c e o f th e c e lls
Th e ref o re a n o rm al s tim u l u s m ay pr o v o ke to o gre at a tr an s
fere nc e o f p o te nti al i n t o ki n eti c e n ergy an d th u s i n iti at e a
ran s fere n c e s Of o n e f o rm o f e n ergy i n t o a11
c hai n of s u c h t
A s a r u l e th e ki n eti c e n ergy whi c h re s u lt s fr o m th e
o th er
rel e as e o f p o te nti al e n e rgy i n e x c e ssive am o u nt s act s as a
ill m o re p o te nti al e n ergy and so o n to
o r el e as e st
sti mu l us t
has
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PR I N C I PL E S
36
OF
O ST E O PAT H Y
th e p o i nt Of e x h au s ti o n o f th e s u pply o f s u ch st o re d e n ergy
Th i s ch an ge i s e x em p lifie d i n th e s erie s o f symp t
o m s wh i c h
E ach lib erati o n Of a ne w su pp ly
app e ar i n m an y di s e as e s
o f e n ergy give s ri s e t
o a n e w sy stem
I f th e p o te n ti al e n
n d e x c e ss ive s e c reti o n re s u lt s ; if i n m u s
e r g y re s id e s i n a g la
The w ay i n whi ch th e ki n eti c
c
c l e e x c e ss ive c o n tr ac ti o n e t
en ergy i s m an ife s ted d ep e n d s u p o n th e m an n er i n whi ch its
p o te n ti al e n e rgy i s st o red The s e c reti o n o r th e
c au s e i e
o l ib er ate s ti ll m o re po
c o n tr ac ti o n m ay ac t a s a s ti m u lu s t
te n ti al e n ergy
.
.
.
‘
1
,
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,
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,
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,
.
—Th er ap e u ti c m eth o d s b e c o m e
s c i e n tifi c j u s t i n p ro po rti o n as they ar e b as ed o n th e k n o w n
cti o n o f th e ti s s u e s an d th e e x ac t c au s e o f
str u c t u re an d f u n
th e di s t u rb ed c o n diti o n Of th e ti ssu es i e th e d i s e as e The
e ff o rt to d evel o p s c i e n tifi c th er ap e u ti cs has l ed to v ari o u s
he
w ay s Of lo o ki n g at th e p r o b l em W e h ave m e n ti one d t
f act th at e ach c as e o f i lln e ss i s a p r o b lem with tw o u n k n o w n
q u an titi e s i e th e c au se o f th e i lln e ss an d th e re acti o n po w
The c au s e i n m an y
er i e th e re s i s t an c e o f th e i n divid u al
i ns t an c e s m ay b e s u ffi c i e n t ly wel l k n o w n to go ver n th e
m eth o d Of tre at me n t at l e as t th e tre atm e n t appe ars sci e n
The p o ss ib l e we ak p o i n t
ti fi c i f we th i n k o n ly o f th e c au s e
i n th e p lan o f tre atm e n t i s th e f ac t th at n o c o n sid e r ati o n has
b ee n p ai d to th e e x i s te n c e o f th e s e co n d u n k n o w n q u an tity
i e th e re si s t an c e o f th e ti s su e s to th e di se as e as we ll as to
th e tre atm e nt The tre atm e n t o f typh o i d feve r by i n te sti n al
an ti s epti cs app e ar s s c i e n tifi c be c au s e it app e ar s to bri n g th e
c au s e o f typh o i d an d th e m e an s o f d e str o yi n g it i n p r o p er
re lati o n The tre atm e n t has n o t pr o ve n s u cc e ss f u l be c au s e
o f th e s e c o n d u n k n o w n q u an tity an d b e c au s e th at wh i c h i s
de s tr u ctive to th e c au s e i s likewi s e de str u c tive to th e ti ss u e s
S c i e n tifi c The rape u ti cs
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.
The P r o b l e m
as a
W hole —The d evel o pm e n t
o f sc i e n
th er ap e u ti cs i s evi d e n t ly n o t e as ily acc o mp l i sh ed eve n
wh e n we k n o w th e c au s e o f di s e ase Th ere ar e th o s e w ho
tre at di s e as e s an d th o s e w ho tre at i n divid u als i e th o se
w ho att ac k cau s e s with l itt l e reg ard fo r th e re ac ti o n s o f th e
tifi
c
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PR I N C I PL E S
38
OF
O ST E O PAT H Y
b u i ldi n g its p o rti o n o f s c i e n ti fi c th er ap e u ti cs b as e d u p o n
a k n o wle dge o f c au s e s an d re ac ti o n s
E x t r i ns i c C au se s o f D i s e ase — The c au s e s o f di s e as e
previ o us ly m e n ti o n e d i e e n vi r o n m e n t al co n diti o ns po i
ar e al l e x te rnal i n fl u e n c e s i n th e s e n s e
s o n s p ar as ite s e tc
th at th ey ar e n o t a p art o ff n o r m al ti ssu e str u ct u re s The
i s ar e a p art
c au s e s n o te d e s p e c i ally i n o s te o p athi c d i ag n o s
o f th e s tr u c t u re o f th e b o dy
The s tr u ct u r al rel ati o ns ar e
t ly altere d to c o m pe l th e b o dy to re ac t 0 11 i ts o w n
s u ffi c ie n
s tr u c t u r al i mb alan c e
I n he r e n t R e cu pe r ati v e P o w e r — S i nc e it hasi nh ere n t r e
i v e p o we r to o ve r c o m e the e ff e c t s o f e x te r n al caus e s
c u pe r at
o f di s e as e th ere i s n o d o u bt bu t t hat it u su ally S u rvive s lo
c t u r al l e sio n s o f thi s i n h ere n t char a c te r I t a
d apt s
c ali z e d str u
it s e lf as we ll to i n t er n al str u c tu r al c o n diti o n s as to d i s e as e s
p r o d u c ed by o th e r c au s e s W e h ave n o te d th e n e c e s si ty o f
a n o rm al m o l e c u lar i n tr ac el l u lar te n s i o n i n o rde r to m ai n
t ai n th e e ffi c ie n cy o f th e c e ll also th e n e c e ss i ty fo r p r oper
re lati o n s b etwe en th e c e lls an d th e c ir c u lati ng fl u id s Any
e lati o n ship co m
s tr u c t u r al f au lt whi c h i n terfe re s with th i s r
p e l s th e b o dy to re ac t to thi s f au lt ei th er i n a w ay to co rr e ct
it o r i f it th re at e n s th e life o f the wh o l e b o dy get ri d O i lt
W e s e e i n the s e re acti o ns j u s t Su c h ph e no m e n a as We ex
hibi t i n o u r s o c i al re lati o n s i e a s i c k m emb er o f th e c om
m u n ity c au s e s n o gre at re acti o n i n th e b o dy p o lit ic u n ti l hi s
i ll n e ss m e nac e s th e wh o le p e o p le
—
e
l
D i s t u r b e d Ti ssu e R ati o n s O s te o p athy emph asi ze s
th e di st u rb an c e s i n ti s s u e re lati o n s I t s ee s i n the s e b o t h
p redi sp o si n g an d e x c iti n g cau s e s of di s e ase ; predi s p o s i n g i n
th at ti s s u e re s i s t an c e to o u t s id e i n fl u e nc e s i s we ake n ed ; e x
c iti n g i n th at i n m an y i n st an c e s the re ac ti o n s t ak e o n th e
I n j u rie s ar e so ve r y freq u e n t
c h ar ac ter o f ac u te di s e as e s
th at th ere i s s c ar c e ly an i n d ivi d u al w ho has n o tpu tthe str u e
t u r al ti ss u e s to a severe te s t Th e s e str ai n s u s u ally o f s u ffi
o p r o d u c e lo c al di s tre ss an d h e ali n g re ac ti o ns
c i e n t s everity t
l e ave th ei r i n fl u e n c e s an d i f a l on g ti me fo r h e ali n g w as r e
q u i red pe rh ap s i n fl u e n c ed th e ge n er al s t ati c s o f th e b o dy
is
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P RI N C I PL E S
The Bi o l o g i c al R e l ati o n
The
O ST E O PAT H Y
OF
of
F u n c ti o n
39
S t r u ct u r e
an d
.
th o r d o e s n o t lo o k u p o n th e so call ed o s te O pathi c le
s i o n as b ei n g an evide nc e th at s tr u c t u re d etermi n e s f u n c ti o n
bi o lo gi c ally co n s idered The s tr u c t u r al L
e si o n i s an i n ter
r u pti o n o f th e bi o lo gi c a1 c o n c ept th at f u n cti o n f ashi o ns th e
Thi s i n te r r u pti o n di s tu r bs f u nc ti o n bu t th e b i o
s tr u c t u re
l o gi cal law is su re to ass ert it s e lf i n th e re c u p er ative pr o c e s s
”
l ivi n g ti s su e s ar e alw ay s be
S i n c e bi o lo gy has n o s t ati cs
i n g reb u i lt to s erve th e f u n c ti o n whi ch b ro u ght the m i n t o
bei n g Thi s abi lity to re pai r an i nj u red ti ss u e an d m ak e it
i s th e
s e rv e th e s p e c i al f u n c ti o n fo r wh i c h it w as i n te n d ed
f o u n d ati o n fo r ad apt ati o n an d c o m pe n sati o n th o s e phe
mo m e n a wh i c h we s e e e x h ibite d by th e b o dy in s o m any
f o rm s i n i ts str u gg l e to s u rvive
au
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The Tr u e Ar t Of H e al i n g— If we
t dy th e s e ph e
n o m e n a u n d er s t an d wh at Nat u re i s tryi n g to do a ss i st ac
In n o c as e c an
th e n we ar e i n d e e d phy s i c i an s
co r di n g ly
app e ar i n th e f o rm o f di s e as e whi c h w as n o t p re
an ythi n
g
p re s e nt i n th e b o dy as a p re di s p o siti o n ; e x te r n al
v i o u s ly
fo r c e s ar e ab l e m ere ly to m ake thi s p redi sp o s iti o n app are nt
Wh e n th e phy si c i an by th o r o u gh Ob s e rv ati o n an d i n ve s ti
h
i
n
e
co n diti o n s th at i n fl u e n c e a give n p re di s
k
o
w
a
t
o
n
s
t
g
p o siti o n i n a de fi nit e w ay wh e n h e i s s c i e n tifi c ally tr ai n ed
an d has a tr u e c o n c epti o n o f hygi e n e an d i s at o n c e phy s i
c i an an d n at u r al i s t th e n h e i s ab l e to c u re di s e as e by u s e o f
th e very sam e f o r c e s whi c h s erve to c re ate o r alter th e hu
m an c o n s tit u ti o n In t hi s S imp l e s e n s e th ere i s a tr u e ar t Of
”
he ali n g
c an s u
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PR I N C I PL E S
4O
O F O ST E O PAT H Y
CH AP TE R
IL
TH E LE S IO N A S A CAU S E
.
— The p r in c ip le s o f O ste o p athy t ake th ei r n at
” '
“
The
th e le s i o n
u r al b egi nn i n g i n th e c o n s i der ati o n o f
“
w o rd le s i o n i s u se d by O Ste O patli s to d e sig n ate s o m eth i n g
”
“
m o re th an an i nj u ry h u rt o r w o u n d i n any p art O f th e b o dy
A
n
ff
u
n
c
l
d
tr
t
r
h
e
wh
i
h
e
t
th
e
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o
u
u
u
a
l
a
n
a
c
c
s
c
c
s
(
y
)
g
Th e re m ay be
ti o nal ac tivity o f any ti s s u e i s c all ed a l e s i o n
s tr u c t u r al ch an ge s
ab n o r mal d eve lo p m e n t wh i c h ar e very
evid e n t top alp ati o n bu t do n o t aff e ct fu n c ti o n al ac tivity an d
th e re f o re ar e n o t l e s i o n s A l e si o n i s n o t o n ly a str u c t u r al
bu t s u c h a c h an ge a s i n fl u e n c e s f u n c ti o n de tr i
c h ange
ally
m e nt
Fig 112 i llu str ate s a stru ct u r al ch ange wit ho ut
detrime nt al i nfl ue nc e o n f uncti o n while Fig 1 13 il lustr ate s a
The rel ati o n o f th e s e str u ct u r al le s i O n S to the
ru e l e s i o n
t
m edi a Of co m mu n i cati o n an d e x ehang e n erve s an d bl o o d
ve ss e ls i s b e li eved to b e th e c hi ef e le m e nt ac tiv e i n pr o
Thi s i s th e
du c in g an d m ai n t ai n i n g f u n c ti o n al di so rd er s
c e n tr al p ri n c i l e o f o s te o p ath i c p r ac ti c e
p
—
L e s i o n s m ay b e p re s e n t i n
Char ac t e r i s ti cs o f a L e si o n
o s t e as ily re c o g n ized i n
an y ti ss u e bu t th ei r e x i s te n c e i s m
b o n e l ig am e n t an d m u s c l e D i s lo cati o n s a n d s u b lux ati o ns
scl e s co n
o f b o n e s th i c ke n ed lig am e n t s an d c o n tr ac te d m u
A tr u e l e si o n i s usually
i tu te th e u s u al v ari eti e s o f l es i o n s
st
p alp ab l e ; th e f u n cti o n al d i st u rb an c e i s rel ate d anat o m i cal ly
an d phy s i o lo g i cally ; th ere i s hyp er ae sth e s i a at th e p alp ab l e
Th e s e th re e co n diti o n s co ns tit ute th e Char ac teri sti cs
are a
Its p alp a
o f th e l e s i o n as it i s d e s ig n ated by th e o s te o p ath
bility m ay v ary bet w e e n very wide lim i ts ; th e l o cati o n o f th e
s tr u ct u r al ch an ge an d f u n cti o n al d er an gem e nt m ay b e d i r e c t
D e fi n i ti o n
4
.
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P R I N C I PL E S O F O ST E O PA TH Y
41
dire ct th e hyp er ae s th e si a di sti n ct o r i n di sti nc t ; sti ll
the di agn o sti c i an is j u stifie d i n c e n teri n g atte n ti o n u p o n th e
l e s i o n if a re as o n ab l e am oun t o f as so c i ati o n can b e dete c ted
or
in
,
,
.
—
i
L
o
n
s
L e s i o n s acc o r di n g to o ste o p athi c
es
Class e s o f
the o ry m
fir st ch ange i n s iz e o f
ay b e o f tw o c lass e s i e
ti ss u e s ; se co n d ch an ge i n p o siti o n G e n e r ally spe akin g a
o o ver c o m e th an a ch an ge
c h an ge i n si z e i s far m o re di ffi c u lt t
i n p o s iti o n be cau s e th e f o rm er i s a re su lt o f m o re pr o f o u n d
Ti ss u e s m ay i n c re as e in s iz e as th e re su lt o f c i
c h ang e s
fo r ts to rep air i nj u ry e g th e f o rm at i o n o f callo u s i n b o n e
o r thi c ke n i n g o f l ig am e n t s f o llo wi n g a s pr ai n
.
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-
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L e si o n s —The c au s e s o f le si o ns f all u n der tw o
ge n er al divi s i o n s : F ir st vi o l e n c e ; s e co n d f ai lu re to r e ac t to
e nvi ro n m e n t In th e fir s t divi s i o n all th e l e s i o n s ar e p r i m ary
i n char acte r i e th e vi o le n ce im m edi ate ly c h ang e s th e r el a
ti o ns o f str u ct u re an d thi s ch an ge b e co m e s an o b st r u cti o n
I f th e l e s i o n i s no t co r
to vit al ac tivity o f th e b o dy fl u i d s
r e ct
e d by th e re c u p er ative p o wer o f th e b o dy i tse lf o r by o u t
th e ch an ge i n p o s iti o n i s very apt to be co m e
s i de e ff o rt s
The i nj u ry r e su lt s i n t hi ck
co mpli c at ed by a c h an ge i n s ize
—
he li g ame n
s o r o th er fib r o u s ti ss u e s
t
e n i ng o f t
C au s e s o f
,
,
.
.
.
,
,
,
.
/
,
.
“
.
L e si o ns —The s e c o n d divi s i o n o f l e s i o ns i s a
very large o n e Th e s e l e si on s deve lo p as an evide n c e o f th e
fai lu r e o f th e o rgan i s m to b e co m e p erfe ct ly ad apted to i ts
f o o d c lo th i n g lab o r o r ge n er al e nvir o n m e n t They ar e
th eref o re s e co n d ary i n ch ar act e r an d m us t b e re c o gn ized as
Obj e c tive sympt o m s o f o n e f u n c ti o nal der an gem e n t whi l e
at the s am e tim e th ey Op e r ate p r im arily to c au s e f u n c ti o n al
d e r an ge m en t e l sewh ere Th u s th ey m ay b e rem o ve d by
m an i pu latio n an d c e ase to ac t as an ac ti v e cau se o f f u n c
ti o n al c h an ge bu t wi ll ret u r n ag ai n s o l o n g as e n vir o n
m e nt al f o r c e s ar e o verwh elm i n g
E ff e ct o f V i o l e n ce o r F at i gu e —The fir s t d ivi s i o n o r pri
m ary l e s i o n m ay re su lt fr o m s u dde n vi o l e n c e o r fr o m a f o r c e
In o th er w o r ds a
c o mp ar ative ly we ak b u t lo n g co n ti n u ed
l e si o n m ay b e dev e lo p ed i mm edi ately u n der gre at f o r c e o r
S e co n dar y
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PR I N C I PL E S
42
OF
O ST E O P A T H Y
l wly as th e re su lt o f gre at f atig u e An e x ampl e of a l e s i o n
d eve lo pi n g u n de r f atig u e i s no ted i n th e fau lty p o s iti o ns as
s u me d by th e b o dy f o llo wi n g p r o l o n ged e ffo rt o r i n p erf o rm
i n g c ert ai n t ask s
—
i
F ai l u r e o f Ada
h
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ti
o
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T
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o n dar y l e si o n s m ay re s u lt fr o m f ai lu re to re ac t p r o pe rly t
o
;
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i n g ai r m ay b e th e sam e at v ari o u s ti m e s bu t th e ch ar acter
o f th e c loth i n g m ay n e c e s s it ate a gre ater e ff o rt at ad apt ati o n
Th e re m u s t b e su dde nn e ss i n th e ch ange o f tem pe r at u re o r
C lo thi n g i n o rde r t
o pr o d u c e th e l e s i o n i e
th e re sp on s ive
n e s s o f th e ti ss u e s m u s t b e o ver t
The fir s t e ff e ct o f
ax ed
f ai lu re o f ad apt ati o n i s th e co ntr acti o n o f m u scl e and ac
The di s t o rti o n o f th e b o ny s tr ue
c o mp an yi n g s e n s iti ve n e ss
t u re i s c ons e q u e n t o n th e c o n t rac ti o n O r di nari ly if th e
the ad aptive f o r c e s o f th e o rg an i sm
s h o c k i s n o t to o gre at
wil l e x ert s u ffi c ie n t p o we r to co rre c t th e co n diti o n bu t
wh e n th e e n v i r o n m e n t i s n o t s u it abl e th e le s i o n m ay be
c o m e pe r m an e n t
H u mi dit y o r e le ctri c al c o n diti o n s o f th e
atm o s ph ere m ay o p er ate to p r o d u c e th e s e l e s i on s
—
f
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i
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C he m c a C
p
th at th e s e l e s i o n s h ave be e n di sco ve re d c o i nc i de n t with v i s
We m ay th eref o re s afe ly assu m e th at f o o d
c er al di so rder
wh i ch i s to o di ffi cu lt o f di ge s ti o n o r th e u s u al f o o d t ake n
d u ri n g f atig u e m ay ac t ch em i cally to p r o d u c e spi n al le si o n s
In thi s i n s t an c e th ey ar e c ert ai n ly o bj e c tiv e s ympt o m s o f
vi sc e r al d i s e ase b u t as st ated b ef o re th ey m u st b e p rim ary
To rem o ve s u c h a l e s i o n by man
c au s e s o f o th e r di so rd er s
i pu lati o n i s h e lpf u l to th e o rg an i sm bu t th e p ati e n t m us t
k n o w th at di eteti c i n di s c reti o n s o r e ati n g wh e n f atig u ed w as
th e re al st arti n g p o i n t o f th e di s e as e H ere is w he r e di e te ti c
an d hygie n i c k n o wl edge m u st b e a p o rti o n Of th e phy si c i an s
th er ap e u ti cs I f th e p o i nti n g o u t o f s tr u ct ur al change s as a
re su lt o f f u nc ti o nal di s t u rb an c e du e to i n di sc reti o n s i n e at
i n g an d o th e r appetit e s wi ll le ad p ati e nt s to s impl er l ivi n g
th e phy s i c i an m ay fe e l th at h e has p erf o rm e d a d u ty m o re
v alu ab l e to th e p ati e n t th an th e rem o v al Of his s e c o n d ary
s o
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P RI N C I P L E S O F O S T E O P A TH Y
le s i o ns
Th e r e
43
d ou bt bu t th at th e r e m o v al o f a
prim ary le s i o n du e to vi o l e n c e i s abso lu te ly e ss e n ti al bu t
Wh e n we m ai n t ai n th at all l e s i o n s m u st b e rem o ve d bef o re
fu n Cti o nt
c an right it s e lf we b e c o m e ab s u rd
F u rth erm o re
if we c o n te n d th at a s tr u c t u r al l e s io n an t e d at e s all f u n c
ti o n al di st u rb an c e s w e m ake o f l if e a s eri e s Of acc i de n t s i n
ste ad O f a f o r c e g o ver n ed by fi x ed law s
—
h
e
r
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f
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o
r
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e
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i st
i o n The q u e s
The R eas n
t e P
e o a L
ti On ari Se S why d o e s th e m u s c u la r co n tr ac ti o n p er s i st after
?
i
th e p r o p er ch an ge s n h abit s h av e bee n m ade
Thi s q u e s
ti o n can n o t b e an swere d at p re s e n t S c ar c e ly o n e Of u s wi ll
v o lu n t ari ly m ake th e c h an ge i n h abit s u n ti l f o r c ed to do S O
by f ai l u re o f th e b o dy to re s p o n d to o u r dem an d s M an y
thi n g s Of a s o c i o lo gi cal ch ar ac te r ar e at w o rk to c o m pe l pe o
i
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p
Vi ewe d fr o m thi s s t an dp o i n t th e pr ac ti c e
u n hygi e n i c ally
The o rigi nal irrit a
o f m edi c i n e i s a pr o b l em i n so c i o lo gy
ti o nwhi c h cau s e s th e t e n s i o n p r o b ab ly cau s e s m o re Or l e s s
—
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Of ti s su e whi c h b e co m e s a fi x ed co n diti o n m ai n t ai n i n g the
l e s i o n i e , i t i s a p o rti o n o f th e l e s i o n
—
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P
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o
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The S e q u e n ce o L
W e h ave c o n
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er
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m u sc u lar c o n tr ac ti o n an d su b lu x ati o n Th ey h av e bee n
c o n s idered i n thi s o rder m ere ly o n acco u n to f hi s t o ri c al ref
ere n c e In o ste o p athi c p r ac ti c e th ey ar e rever s ed W e n o te
fir s t the s tr u c t u re th e n th e te n s i o n wh i c h acc o mp an i e s th e
e rae s th e s i a
c h an ge i n s tr u c t u re th e n th e hy p
—
l
m
e
n
t
It i s n o tu n c o mm o n to fi n d
V ar i ati o ns i n D e v e o p
S o m et im e s th e s e
c h an ge s fr o m th e u su al f o rm s o f th e b o n e s
b e ve ry de c eptive bu t wh e n an alyze d with
c h an ge s m ay
refere n c e to th e e x i s te n c e o f f u n c ti o n al di so rder i n th e a re a
Of th ei r n o rm al i n fl u e n c e an d th e p re s e n c e o f hyp er ae sth e s i a
i
the y w ill b e re c o g n i zed as m o rph o lo gi c al c h an ge s du e to
L e si o n s whi ch m ight h ave bee n active at a
n at u r al c au s e s
fo rm e r tim e ar e so m eti me s n o n ac tive o n ac co u n t o f law s o f
I f th e
acc o m m o d ati o n whi ch ar e alw ay s ac tive i n th e b o dy
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P R I N C I PL E S
44
OF
O ST E O P A T H Y
bo d y has su c ceed ed i n re c u pe r ati n g fr o m th e e ff e cto i th e s e
le s i o ns it i s u nwi s e to di st u rb th e m
AS an e x ampl e o f an
acco mm o d ated l e s i o n we m ay m e n ti o n th e fo r mati o n o f : a
n e w s o c ket fo r th e h e ad o f th e fe m u r f o l l o wi n g di sl o cati o n
Th e re ar e v ari ati o n s i n d evel o p m e n t all th r o u gh th e b o dy
an d e ac h phy s i c i an sh o u l d s trive to b e c o me ac q u ai n te d with
th em
—
n
The fir st S ig n o f a l e s i o n i s
e
s
o
P alpati o n o f a L i
th e ch an ge i n str u ct u re i s felt Ac
alp ati o n i e
n o ted by p
fli c i e n t evi
o wh at we h ave j u st s ai d th i s i s no t su
c o rdi n g t
d e n c e of th e e x i ste n c e o f a n active l e s i o n I t m u st b e ac
F ir s t tr y to el imi n ate th e ap:
co mp an i ed by o t he r S ig n s
p are n t e x i ste nc e o f th e le s i o n by h avi n g th e p ati e n t assu me
di ff ere n t p o s iti o ns
S e c o n d n o te wh eth er th e b o n y l an d
m ark s i n th at are a v ary fr o m th e n o rm al Th ird n o te
wh eth er th e l e s i o n c au s e s th e p ati e n t to assu m e any s p e c i al
F o u rth te s t th e amp l it u de o f m o v e m e nt i n th e
attit u d e
I f th ere
s e x te n t
arti c u lat i o n to d eterm i n e th e ch an ge s i n i t
i s p e rfe c t fl e x ibi lity it i s s c ar c e ly p r o b ab le th at a l e si o n e x
is ts fo r an ac tive l e s i o n l s q u i te i n co n ce i vabl e with o u t te n
F ifth fe e lflo f th e s o ft p ar ts o f th e j o i n t m u scl e s an d
si o n
No t e any swe lli n g o r ch an ge i n t emp er a
c onn e c tive ti ss u e s
t u re S i x th i n sp e c t th e s u rf ac e as to co lo r an d te x t u re
O rdi n ari ly an e x am
S eve n th te s t se n s ibi lity by p re ss u re
i n ati o n o f th e b o dy fo r l e s i o n s c o n s i s t s i n co mprehe n s ive
p alp ati o n wh i ch n o te s sy nch r o n ou s ly th e e x i ste nc e o f p o s i
ti o n al c h an ge te n s i o n temp e r at u re s we lli ng an d s e n s itive
The e x i s te n c e o f te n s i o n i s s u ffi c i e n t evide nc e o f d e
n e ss
Whe n vi o le n c e i s th e c au se o f th e le
c r ease o f fl e x ibi lity
o c o rre c t s tr u c t u r e di re c t ly
Wh e n th e
si o n it i s n e c e s sary t
o s s e o u s l e s i o n i s th e re s u lt Of m u sc u l ar te n s i o n du e t
o refl e x
o th e vi ewp o i n t o f th e
s tim u lati o n m eth o d s diff e r acc o rdi n g t
phy si c i an S o m e m an ip u late fo r di re ct red u cti o n o th e r s r e
lax m u sc le s an d th u s rem o ve th e cau s e o f th e o ss e o us le s i o n
The re al ly c o mp reh e n s ive p lan s h o u l d t ake i n t o acco u n t th e
he te ns i o n whi c h o ccasi o ns th e o ss e o u s l e si o n
c au s e o f t
H avi n g d o n e thi s th e phy si c i an m ay m anip u late th e l e s i o n
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PR I N C I PL E S
46
O ST E O PAT H Y
OF
p r acti c ally all p e o p le s i ck o r we ll I t rem ai ns th ere fo re
n e c e ss ary th at we add to th e s e phy s i c al c h an ge s s o m eth ing
o f a d eterm i n i n g c h ar a c te r i n o rd er t
o re co g n iz e an active
le s i o n
Te n d er n e s s to p re ss u re i s the de te r m i ni n g S i g n
H avi n g lo cated a le s i o n 1 e an o ss e o u s devi ati o n with m u s?
c u lar te n si o n an d te n d er n e s s i n th e s am e spi n al s egm e n t s
we can n o w pr oc e ed to analyz e it with refere n c e t o it s e x
i s te n c e as c au s e o r e ff e c t
ertebral l e s i o n j u st
The s pi n al v
n o te d m ay
i nv o lve tw o o r m o re ve rteb r ae wi th t hei r at
tac he d ti s s u e s
S o m e o b s e rver s c laim th at a l e si o n o f a
S i n g l e vertebr a i s r are
S i n c e o s te o p athy has fo s tere d th e
vi ew t hat s tr u c t u re aff e c t s f u n c ti o ni n p re fe r e n c e to th e r e
ve r se th e au th o r fee ls j u s tifi ed so lely by hi st o r i cal c o n sid e r
ati o n s i n b egi nn i n g al l an aly s e s o f l e s i o n s fr o m th at vi ew
It i s c an did ly u n de r s t o o d th at i n d o i n g th i s th e
p o i nt
auth o r i s n o t h o l di n g a bri e f fo r e ith er s i de o f any c o n tr o
v e rsy whi c h c i r c l e sab o u t th e q u e sti o n wh eth er th e egg p re
c ede d th e c h i c ke n o r th e rever s e
H i s to r y o f Acci de nt—In an y c as e u n de r e x ami n ati o n
th e di ag n o sti c i an d e s i re s to u n co ver th e hi s t o ry Of th e l e s i o n
“
"
Is
h e n c e th e m o st -dire c t q u e st i o n p o ss ib l e i s as ked i e
”
th e re any h i st o ry o f acc i de n t ?
I f a hi s t o ry o f accide n t is
give n h avi n g di re c t b e ari n g o n th e l e si o n u n de r co n s id era
ti o n th e n we ar e q u ite j u stified i n b e li evi n g it to b e th e p ri
m ary c au s e o f di st u rb ed f u n c ti o n F o r e x amp le a p ati e nt
wh e n attempti n g to alight fr o m a s tre et car j u st b ef o re it
f o u n d hi s f o o ti ng i n s e c u re an d he n c e cl u n g to th e
st o pp ed
h an d r ai l o f th e car with o n e h an d in an e ff o rt to pr o te c t
h im s e lf The f o rw ard m o ti o n o f th e c ar ro t ated h im an d
wr en ch e d his b ack H e w as ab le to g o to his h o m e with ou t
fee li n g m o re th an a s e n s e o f we ak n e ss an d p ai n i n th e a rea
The n e x t m o r n i ng h e w as
o f th e d o r s o l u mb ar arti c u lat i o n
q u ite u nab le to ri s e E x am i nati o n S h o we d gre at m u scu lar
te ns i o n i n th e m u sc le s c o n tr o lli n g th e m o vem e n t o f th e
twe lfth d o rsal an d fir st lu mb ar P r e ss u r e o n th e S pi no us
p r o c e sse s o f th e se ve rtebr ae cau sed i nte nse p ai n The b owel s
b e cam e co nsti pated an d th e cut ane o us ar e as su pp li ed by the
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PRI N C I PL E S
OF
O ST E O P A THY
'
47
twe lfth d o r s al an d fir st lu mb ar pai r s o f S pi nal n erve s g ave
s o m e su bj ec tiv e sympt o m s o f be i n g di s t u rbe d
Th i s cas e
re c o vered i n a few we ek s u n der th e i n fl u e n c e o f ho t p ack s to
the i n j u red are a re s t i n b ed an d after ac u te s o re n e s s ab ated
o
o
n
T
a
s
s
ive
m
ti
hi s c ase fo r m an y y e ar s has had att ac k s
p
“
”
lu mb ag o
of
Th e s e att ac k s u s u ally f o llo w chan ge s i n th e
we ath er an d s o m e e x e rti o n bey o n d the o rd i nary The le s i o n
alw ay s e x hibit s i ts o ld c h ar ac teri s ti c s viz
te n d er n e ss m u s
nd lo ss o f m o ti o n i n th e arth r o di al j o i n t s b e
c u latr igidi ty a
twe e n th e t w
e lfth d o r s al an
d fir s t lu mb ar U s u ally an o s te o
p ath i c tre atm e n t to e st ab li sh re lax ati o n an d m o vem e n t i s
s u ffi c ie n t t
o s e cu re r api d re c o very
—
Tr au m ati c L e si o n
W e h ave in thi s cas e a co n diti o n
Th i s i s a
o th e re s u lt s o f a s pr ai n e d wri s t o r an k l e
s im i lar t
hat no o n e w o u ld
o r ig i n t
cas e o f su c h
thi n k o f it fr o man y o th er st an dp o i n t The le s i o n i s a ch ar
ac te r i s ti c o n e derived i n a c h ar ac teri sti c m ann er an d f u l fi ll s
I t is f air ly
o u r c lass i c al pi c t u re o f lo c al ize d s pi n al i n j u ry
mi l d i n i ts di st u rb an c e o f f u n c ti o n o f th e n erve s fr o m th e i n
j u red are a It Was re c o vere d fr o m to s u ch an e x te n t th at th e
p ati e n t has co n si dere d h im s e lf we ll e x c ept at s u ch time s as
the fo rm er ly i n j u red ti ss u e f ai l ed to f u n c ti on p r o p er ly u n der
Th ere has n ever be e n co m
so m ewh at u n u su al c o n diti o n s
i
T
re
very
f
n
ti
o
n
n
th
e
a
rti
c u lati o n
h
i
s i s evi
l
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u
c
c
e
t
p
“
de n c e d by p arti al lo s s o f fl e x i o n an d e x te n s i o n h e n c e th e
”
i s alw ay s app are n t to th e tr ai n ed s e n s e o f t o u c h
l e si o n
Thi s l e s i o n p re s e n t s th e s am e c h ar ac te ri s ti c s so co mm o n ly
n o ted i n p eriph er al j o i n t s whi c h h ave b ee n s p r ai n ed an d r e
i o n I t i s u su ally m any
c o v e r e d f r o m with p arti al lo s s Of m o t
m o nth s b ef o re th e p o i n t o f att ac hme n t o f a s tr ai n e d lig a
m e n t i s fre e fr o m s e n s itive n e ss to pre ss u re o r te n si o n
W e i ght Car r y i n g an d Balan c i n g F u ncti o n Di s t u r b e d
W i th an i n j u ry o f thi s ch ar ac ter lo c ate d wh ere it has a
w e i g ht,c ar r y i n g an d b alan c i n g f u n c ti o n to pe rf o r m f o rmi n g
p art o f th e p r o te ctive c o veri ng o f th e S pi n al c o r d an d i ts
m embr an e s as we ll as b ei n g a p art Of th e w all o f a vi sc er al
y the re ar e m any far re ach i n g i n fl u e nc e s wh i ch may b e
cavi t
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PR I N C I PL E S
48
OF
O ST E O PAT H Y
ttrib u ted to it The rigi dity wh i ch nat u re m ani fe sts fi r st
as a p r o te c tive re ac ti o n 1 e
to p reve n t m o ti o n i n th e i n
j u red p art wi ll b e m ai nt ai n ed as a co ns t ant f act o r in any
c as e o f j o i n t i n j u ry wh i c h h e als with a p arti al ret u r n o f m o
ti o n By thi s i s m e an t th at b ef o re the m o ti o n o f the j o i n t
re ach e s i ts li mit th e m u s c l e s ass u m e th e f u n c ti o n o f lig a
m e nt s s o as to p r o te c t th e we ake n ed l ig am e nt s Thi s ac
ti o n Of th e m u sc le s we no te as a p r o te c tive rigidity whi ch
he i n fl u e n c e o f p ass ive m o ti o n m ay b e ab s e n t bu t r e
u n de r t
app e ar s wh e n th e j o i n t i s p u t th r o u gh i t
s v o l u n t ary f u n c
tio nal te s t s
Th u s th e f act th at the l e si o n u n der di scu ssi o n
i nv o lve s str u c t u re s fo rm in g a part of th e we ight carryi ng
an d b alan c i n g m e c h an i s m o f th e bo dy m ake s it m o r e di fli
c u lt o f re co very
In o rde r to p r o t e ct it fr o m m o ve m e n t
rigi dity e x i s t s i n s egm e n t s j u s t ab o ve an d be lo w it A l e s i o n
at th e p o i n t m e n ti o n e d wi ll te n d to p r o d u c e a s tr aight s pi n al
co l u m n b e ca
u s e it i s S it u ate d at t
h e j u n c t i o n o f tw o c u rve s
th e d o r s al p o steri o r an d th e l u mb ar an teri o r Any e x ag g e r a
ti o n o f th e s e c u rve s n e c e s sit at e s gre ate r mo vem e n t i n thi s
j o i n t Th eref o re i f thi s j o i n t b e i nj u re d an d i ts m o ve m e nt
limite d th ere i s gre ate r rigidity i n b o th c u rve s i n o r de r to
p r o te c t th e i njiIr e d j o i n t th r ou gh wh i c h th ei r co mp e n sati n g
m o vem e n t s Op er ate The te n si o n Of the p o s te ri o r spi nal
m u sc le s i s m et by c ou n te r b alan c i n g co n tr acti o n o f th e p s o as
m agn u s th e di aph r agm an d th e ab d o m i nal m u sc l es The
t en s i o n o f th e di aph r agm re su lt s in le ss e n e d re spir ati on The
te ns i o n Of th e abd o m i n al m u scl e s s u btr act s o n e f act o r i n th e
m ai n t e n an c e o f b ow e l ac ti o n L e ss e ned o x yge nati o n an d
e limi n ati o n ar e th u s p o s sib l e re sult s o n a p u rely m e ch an i cal
b as i s To co mpe ns ate fo r the s e de c re as e s th e wh o l e b o dy
m et ab o l iz e s at a slo we r r ate an d with o u t th e sy mp ath eti c
i y i ty
n erv o u s sy s tem i s vig o r ou s th e de c re as e i n vi s c e r al act
on
s o o n m ake s it s e lf s o app are n t th at th e p atie n t m ay b e C
Th u s it app e ar s th at a spi n al
s i de r e d c o n s tit u ti o n ally i ll
l e s i o n m ay i n fl u e n c e b o dy m et ab o li s m adver s e ly as a re su lt
The
u r al h e ali n g re ac ti o n as m an ife s te d i n rigidity
o f th e n at
de c re as e o f rhythmi c al m ov em e nt i n th e w alls o f th e abd o
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O F O S TE O PA TH Y
PR I N C I PL E S
men
49
th o r ax i s th e i mm edi ate c o n s eq u e n c e o f spi n al rig
Th e s e f u n c ti o n s ar e l e ss i n terfere d with wh e n th e
i di ty
weight c arry i n g f u n cti o n o f th e s pi n e i s l e as t call ed u p o n
h e n c e th e h o riz o n t al p o s iti o n i s n at u r ally ass u m e d to le ss e n
f
a
n
f
o r c o mp e n s at o ry te n si o n s
i
get
rid
th
e
d
em
d
n
o
n
a
d
a
p
L ack o f P hy s i o l o gi c al R e st—W h i le th es e i n ju rie s ar e
ac u te we n o te e as i ly th e c o mp e n s at o ry re acti o n s j u st de
b u t n o d o u bt th e m aj o rity o f s u ch case s fee l the
sc rib ed
n
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o
n
om
i
e
c e ss ity an d h e n c e try to ad apt th em
r
e
o
e
c
c
ss
p
b o r th r o u gh h o u r s m o re th an s u ffi ci e n t to pr o
s e lve s to la
d u c e a f atig u e aki n to s i ck n e s s The l e s i o n d eve lo p s a chr o
r r ath er has n ever had a c h an c e t
h
e
a
l
n
d
er
th
e
n i cit
o
o
u
y
be n ig n i n fl u e n c e o f phy s i o lo g i c al re st Thi s ch r o n i c le s i o n
n e c e ss it ate s p erm an e n t c o mp e n s at o ry ch an ge s su c h a s we
h ave n o ted Thi s p atie n t de ve lo p s p eri o di cal dige stive we ak
e s o f f ati g u e H e vi s it s a do c
n e s s sy n c hr o n o u s with hi s ti m
s u ff e r s m an y thi n g s o f m an y phy s i
to r an d fr o m th e n o n
”
Th r o u gh tim e an d th e c o mp e n s at o ry c h an ge s i n
c i an s
thi s p ati e n t s b o dy the o ri gi n al l e si o n an d i ts s ig n ifi can c e ar e
The e ff o rt m
ade to c o rre c t o r p all i ate th e di
lo s t to vi ew
i
d
i
t
rb
a
c e pr o b ab ly has n o refere n c e to an ythi n g
e
t
s
s
v
e
n
u
g
I t i s s u ch cas e s as the s e
bu t th e p r o m i n e n t sympt o m s
wh o s e h i st o ry o f tr au m ati c
s u ff e ri n g fr o m c hr o n i c i lln e s s
l e s i o n i s di s c o vere d by th e o s te o p athi c e x ami n ati o n whi ch
h av e give n p re s tige to o s te o p athi c th er ape u t i c s The tre at
m e n t give n by th e o s te o p ath to th i s o ld l e s i o n ree stab li sh e s
m o vem e nt i n th e j o i n t an d th eref o re th e c o mp e ns at o ry te n
si o n s i n th e b ac k ab d o m e n an d ch e s t ar e l e s s e n ed
I n fl u e n ce o n C i r cu lati o n an d I nn e rv ati on — H avi n g th u s
f o llo wed th e m e ch an i c al i n fl u e n c e o f thi s tr au m ati c l e si o n
thr o u gh so m e o f its c o mpe n sati on s we can with pr o fit t u r n
o u r atte n ti o n to th e far m o re s u bt l e i n fl u e n c e s u p o n c i r c u l a
t i o n an d i nn e rv ati o n The tr au m a u n de r co n s id er ati o n has
b e e n suffi c i e n t in s o me d egre e to r u ptu r e ti s s u e c o nti n u ity
an d th eref o re r eq u i re s i n c re as e o f c i r c u lati o n fo r rep ai r
The swe lli n g o ccas i o n e d by the c o n g e s ti o n o f th e c ir c u la
ti On bei n g u n der th e s p i n al appo n e u r o si s d o e s n o t evid e n c e
an d
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PR I N C I PL E S
50
OF
O ST E O PAT H Y
i ts
p re se nc e by a lo caliz ed t u m ef acti o n S o m e fiber s o f an
i n tri n si c s pi nal m u sc l e i e o n e o f th e fifth l ayer acco rdi n g
to G r ay s gr o u pi n g has be e n i nj u re d h e n c e o u r rep ai r i n
fl amm ati o n i s de ep s e ate d
The de epe r s e ated th e l e s i o n
th e m o re p re s su re wi ll b e e x erte d o n the br an ch e s o f n erve
t r u n k s em e rgi n g fr o m th e i nt ervertebr al c anal an d th e m o re
l ikelih o o d wi ll th ere b e th at the p ati e n t wi ll co mp lai n o f
s o m e sympt o m s o f a c h ar ac ter w hi c h m i ht b e i n terp rete d
g
as o f c e n tr al o rigi n e s p e c i ally if bi later al
The s u bj e c tive
sympt o m s
p ai n an d p ar ae sth e si a i n th e are a o f c u t an e o u s
di s trib u ti o n o f th e twe lf th d o r sal n erve ar e u su ally u n i lat
er al h e n c e sh o wi n g th at th e les iOn cau s e s a p e riph er al n e u
riti s o r at l e a st a p re ssu re o n th e n erve s u ffi c ie n t to cau se
th e b r ai n to regi ste r as th o u gh th e p e riph er al di s trib u ti o n
o f thi s n e rve w as i rrit ate d
—
n
A s egm e n t o f the s p1nal c o rd
g
t
o
or
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ti
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S
C
s aff ere n t fibe r s
c o o rdi n at e s th e i mp u ls e s re ac h i n g it o ve r i t
h e n c e in th e c as e o f o u r l e si o n th e b o mb ardm e n t o f th i s
s egm e n t with imp u l s e s fr o m th e i n j u red ti ss u e as we l l as
fr o m th e n e r ve s s u bj e c ted to p re ssu re as a re s u lt o f th e r e
p ai r i n fl amm ati o n wil l c au se e ff er e n t i mp u l se s to b e s e n t to
s o m ati c an d s p lan ch n i c are as s u ppl i e d fr o m thi s s egm e n t
Th e s e o u tg o i n g i mp u l s e s ar e i n fl ue nc i n g m o ti o n se c reti o n
n u triti o n whi ch ar e pr o b ab ly di s t u rb ed i f th e s e n s o ry n e r ve
i mp u ls e whi ch c alls f o rth th e re ac ti on IS a di st u rbed o n e
I t i s h ard ly pr o b ab l e th at re ac ti o n s o f th e ki n d h ere m e n
ti o n e d te n d to rem ai n ac tive withi n o n e spi n al s egm e n t
The n e rve c e n ter s i n v o lve d ar e v erti c al i e e xte n d th r o u gh
s an d h e n c e
o ur
re ac ti o n s te n d to
o n e o r m o re s egm e n t
A s s o o n as V i s c er al ac tivity i s di s t u rbe d by v as
S pre ad
o mot
e r c h an ge s a tr ai n o f refl e x e s o f a c o mp e n s at o ry ch ar
ac ter ar e i n iti ated an d wit ho u t we h o l d firmly i n m i n d th e
he p r o b able
ch ar ac te r an d l o c ati o n o f th e l e s i o n an d r e aliz e t
as w el l as p o ss ibl e co mp e n s at o ry re ac ti o ns o f a m e ch an i cal
c i r c u l at o ry an d ne rv o u s c h ar ac ter d ep e n de n t u p o n it we ar e
q u ite apt to b e l e d astr ay by th e b o ld n e ss with wh i c h so m e
c r o wd s i t
s w ay
i
n t o th e f o re
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P R I N C I PL E S
O ST E O P A T H Y
OF
51
gr o u n d o f o u r atte n ti o n The p e r s i s te n c e with whi ch m any
o f th e o l d er o s te o p ath s h ave w o rked u p o n th e l e s i o n an d r e
f u se d to b e l e d aw ay i n fr u it l e s s e ff o rt s to p alli ate sy m p
t o m s has co n trib u ted m u c h to th e su c c e ss o f th ei r s ch o o l
E x am pl e o f F ati gu e
A n o th er p h as e o f th e le s i o n as a
te n ab l e c au se o f di s e as e i s f o u n d i n th o s e c as e s wh o s e s tr u c
t u re s u ff e r s o n acc o u n t o f f atig u e o r eff ort to b e co m e
ad apte d to p o s iti o n
W e wi ll t ake tw o le s i o n s c o m m o n ly
m u s c u lar te n s i o n with a v ari ab l e am o u n t o f
ass oc i ate d i e
di st o rti o n o ver th e splan chn i c a r e a an d m u s c u lar te n si o n
ce n tere d o ver o n e o r all o f th e u pp er three c ervi cal vert a
b r ae A b o o kkeep e r f atig u e s his b ac k m u scl e s by hi s po s i
ti o n The e ff o rt to s e e cl e ar ly e s p e c i ally if th ere i s any i n
i s i o n o r o f th e c o o rdi n ati n g p o wer o f th e
tr i n si c defe c t o f v
o c c u lar m u s c l e s re q u ire s c o mp e n s at o ry ac ti o n o f th e c ervi c al
m u s cl e s to m ai n t ai n th e h e ad i n the m o s t f av o r ab l e p o s iti o n
fo r s eei n g T he f atig u e re s u lti n g fr o m m an y h o u r s o f thi s
c o mp e n s at o ry e ff o rt s u pp l em e n ted by o the r eve n t s o f d ai l y
“
”
l ife p r o d u c e s a s o—
c all e d
b o n y l e s i o n u s u ally ab o u t the
s e c o n d o r third c ervi c al o r eve n a s l o w as th e f o u rth d o r sal
By c arryi n g th e weight o f th e h e ad f o rw ard o f the c e n ter o f
th e b o dy th e str ai n o n th e e x te n s o r c ervi c al m u sc l e s i s e as ed
he s h o u l der s d ep re s s i ng th e th o r ax
so m e wh at by r o u n d i n g t
s h o rte n i n g th e di s t an c e b etwe e n th e e n d o f th e s ter n u m
c o s t al ar ch e s an d t
h e p e lvi c brim th u s r e lax i n g the abd o m
i n al m u s c l e s an d p e rm itti n g gas tr o an d e n ter o pt o s i s Thi s
saggi n g o f th e s t o m ac h an d b o we l m u s t b e ch e c ked if po s
h e n ce th e e x te n so r m u s cl e s o ver th e s p lan ch n i c are a
si b l e
c o n tr ac t to m ai n t ai n th e n o rm al ere c t attit u de b u t f ai l eve n
tu ally be cau s e th e b o dy i s n o t p l ann ed to su s t ai n th e weight
o f th e h e ad i n a p o s iti o n co n s t an t ly o ff th e c e n ter o f th e
b o dy Thi s i llu s tr at e s th e grad u al deve lo pm e n t o f le si o ns
du e to e ff o rt s o f ad apt ati o n
—
s
s
o
s
l
r
T
o
n
e
Lo
L o ss o f t o n e i n m u scl e s wi ll
f M u cu a
allo w th o s e ti ss u e s to wh i ch th ey ar e att ach e d to yi e l d to
th e f o r c e o f gr avity an d h e n c e l e s i o n s wi ll be pr o d u ce d A s
e x amp l e o n e o f my s u rgi cal cas e s c o mp lai n ed bitter ly o n
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PR I N C I PL E S
52
O F O S TE O PA TH Y
th e th i rd day afte r a hy ste re ct o my O f p ai n i n th e b ac k an
d
at th e l o we r e n d o f th e abd o m i n al w o u n d
I n sp e cti o n o f th e
w o u n d sh o wed no thi n g u n u su al The c o u r s e o f th e p ai n
w as e x ami n ed an d it w as f o u n d to f o ll o w th e co u r s e o f th e
twel fth d o r sal n er ve The fe eb le n e s s o f th e p at
i e n t allo wed
all her ti ss u e s to s ag with th e re s u l t th at th e right twe lfth
rib lay ag ai n st th e tr ans ver s e p r o c e ss o f th e fir st l u mb ar v e r
te br ae
A p re s su re th u s e x erted o n th e twe lfth d o r sal n erve
p r o d u ce d p ai n i n th e are a o f i ts di strib u t io n A small pad
o f g auze an d co tt o n s u ffi c ie n t to keep th e rib aw ay fr o m th e
tr ans ve r s e p r o c e ss fo r a few d ay s u n ti l ge n er al b o dy n u tri
ti o n re as s erte d i ts t o n i c e ff e ct w as s u ffi c i e n t fo r rel ief
As h e ret o fo re s t ate d it i sn t th e ac u te l e si o n s o e as ily
re co g n ized th at has c on trib u ted s o m u ch pr e stig e to O ste
hy
o pat
I t i s th e le s i o n h avi n g b e e n o ver lo o ke d o r m i s
t r e ated an d co ns ide re d a n eg ligib le q u an t ity as a c au sative
fact o r
E x pe r i m e ntal L e si o n s —As a f o u n d ati o n fo r better c li n
i c al o b s erv ati o n an d u n der st an di n g e x p erim e n t s h ave b e e n
he P hy s i o lo g i
c o n d u c ted n ot ably by D r L o u i sa Bu r n s i n t
ll ege o f O s te o p athy Lo s
c al L ab o r at o ry o f th e P ac ifi c C o
An ge l e s an d by D r C ar l M M c Co nn e ll o f C hi cag o Th e s e
e x p eri m e n t s c o n s i sted i n p r o d u c i ng artifi ci al l e s i o n s o n s m all
an i m al s u s u ally d o g s an d n o ti n g th e im m edi ate an d rem o te
e ff ect s th e n ki lli n g th e an i m als an d m aki n g a caref u l p ath
Dr
o l o gi c al s t u dy o f th e c h an ge s in th e l e s i o n ed ti s s u e s
M c Co nn e ll s de sc ripti o n o f th e m ann e r i nwh i c h h e p ro d u c e d
“
e x p erim e n t al l e si o ns i s as f o l lo w s : The p r o d u cti o n o f th e
l e si o n is a si mpl e bu t stil l very imp o rt an t m atter I t can
n o t be p e rf o rm e d su c c e s s f u l ly i n a h aph az ard m an n e r
S tri c t
atte n ti o n to th e th o r ou gh re lax ati o n o f ti s s u e s ab o u t th e
fie l d o f Op e r ati o n an d defi n ite app li c ati o n o f m e ch an i cal pr 1n
A fte r s el e cti n g a h e althy an im al ( a
c ipl e s ar e dem an de d
s u rgi c al an e s th e s i a i s
s m al l o r m ed i u m s ize d o g i s b e s t )
i n stit u ted Co mpl ete re lax ati o n u n d er an asthe si a i s n e c e s
F o llo wi n g th i s f u rth er re lax ati o n o f th e are a o f i n
s ary
te n d ed o p er ati o n by tr ac ti o n is e s s e nti al fo r e a se o f l e si o n
.
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PR I N C I PL E S
54
OF
O ST E O P A T H Y
te n de r ; o th er s do no t and sh o rtly sh o w n o app are n t i ll e f
fe c ts
L ate r o n a n u mb e r p re se nt m o re o r l e s s sy stemi c dis
The
tu r banc e s d ep e n di n g u p o n th e l o c ality o f th e l e s i o n
p eri o d s o f o b serv ati o n h ave ranged fr o m thre e to eighty
d ay s th at is th e t
im e fr o m p r o d u cti o n o f th e l e si o n to
”
au t o p s y
—
M
o
o
s
f
o
n
The m o ve ab le vertebr al an d co st o
L s o
ti
vertebr al arti c u lati o ns ar e ar tho dial i e g lidi n g h e n c e any
c h an ge i no n e o f th e s e arti c u lati o n s s h o rt o f di s l o c at i o n IS
i n a n o rm al di re c ti o n
In o th e r w o rd s th e l e s i o ns w hi ch
w e re c o g nize ar e p arti al fi x ati o n s h e n c e it i s n t th e p o siti o n
whi c h c o n stit u te s th e les i o n so m uc h as i t i s th e lo ss Of m o
ti o n i e th e lo s s o f f u n cti o n an d th e e x aggerated m u scu
lar c o n tr ac t
i o n whi ch ma1n ta1n s th e fi x ati o n an d th e ch ar ac
te r o f th e i nj u ry wh i ch i s the c au s e o f th e s e ch an ge s
—
r
r
B as e d o n th i s i de a
Ne c e s s i ty fo r S t u dy Of S t u c t u e
~
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,
,
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,
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,
,
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,
’
,
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,
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‘
.
wh at th e l e s 1o n 1 8 we m u st s t u dy th e no rm al st ru c t u re
an d f u n c t i o n o f eve ry verteb ral an d c o s t o verteb r al arti c u la
ti o n s o th at we m ay re c o gn ize n o t o n ly the co mp e n sat o r y
he im m e di ate gr o u p aff e cte d bu t als o tho s e
c h an ge s o n t
wi de sp re ad c o m pe n s ati o n s o f a me ch an i cal C i r c ul at o ry an d
n erv o u s c h ar ac te r wh i c h a r e part o f every re par ative and
u dy
S i n c e p ath o l o gy i s th e st
ad aptive e ffo rt o f th e b o dy
o f th e p erve r s i o n s o f th e n orm al we c an n o t u nd er s t an d
wh at th e b o dy IS tryi n g to do i n any give n cas e with ou t
t aki n g i n t o acc o u n t th e s u cc e s s e s an d f ai lu re s o f c o mp e ns a
ti o n as ar e m ad e evide n t by thi s div 15 1o n o f m edi cal sc i e n c e
of
,
-
,
-
,
,
.
'
'
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'
-
.
PR I N C I PL E S
OF
O ST E O P A T H Y
C H A P TE R I I I
55
.
TH E LE S IO N A S A N E F F E C T
.
An aly s is
—As p revi o us ly
L
n o te d th e i n s p e c ti o n o f th e vertebr al an d p ar avertebr al ti s
s u e s i n al m o st all c as e s o f i lln e s s i n v o lvi n g th e tr u n k o f th e
b o dy wi ll sh o w p hys i c al s ign s Of c o mp e n s at or y re acti o n s
“
”
The s e phy s i c al signs we call le si o n s
Th ey s e em to b e
i de n ti c al i n c h a r acter with th o s e wh i c h we n o te d as tr au
mati c l es i o n s i e th ere i s d evi at i o n i n o ss e o u s alig n m e n t
m u sc u lar c o n t r ac ti o n an d hyp er aes th e s i a I t m ay b e i m pos
o s e c u re fr o m th e p ati e n t any h i s t o ry o f tr au m a as the
s ib l e t
fo u n d ati o n o f thi s l e s i on th er ef o r e tw o e x p lanati o ns ar e
o p e n to u s ; eith e r we m u s t wi l f u l ly h o l d t
o the hyp o th e s i s
th at a t r au m a di d o c c u r o f s o light im m ed i ate e ff e c t as to
e scap e th e n o ti c e o f the p ati e nt o r u s e th e fact so f anat o my
an d phy s i o lo gy to b u i l d u p a r ati o n al th e o ry o f n o rm al r e ac
ti o n s I t i s m u ch e as i e r to de c lare tr au m a as th e cau s e th an
an alyze th e pr o te c tive re ac ti o n s o f th e b o dy
Thi s f ac t has
le d the e x p o n e n t s o f the v ari o u s f o rm s o f spi nal a dj u s tm e n t
to e x plai n e v e r
l
e s io n by c lai mi n g an o b sc u re t r au m a as th e
y
c au s e
S i n c e n o o n e eve r g o e s th r o u gh l ife with o u t m an y
s l ip s f al ls an d o th e r str ai n s whi c h c an b e c all e d t
o mi n d it
i s e asy fo r th e p atie n t to b e c o n vi n c e d th at so m e rem o te e x
r
i
n
i
f
e
c
o
n
i
n
thi
ki
d
f
t
th
e
f
d
ti
th
e
e
e
s
s
a
c
o
u
n
o
n
r
l
a
f
o
a
l
p
tr o u b le
The At tr acti v e n e s s O f the Tr aum ati c L e si o n The or y
The th e o ry th at an o b sc u r e t rau m a i n; th e s p i nal ti ss u e s is
th e e ss e nti a
l an d ade q u ate c au s e o f b o di ly di so rder s i s cap
It has so
ti vatin g b o th to th e phy s i c i an an d the p ati e n t
defi
ite
e
em
e
n t s whi ch ar e evi de n t b o th t o th e m i n d
n
n
l
a
m y
of
C au se s
the
of
e si o n s
.
,
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i
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:
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_
PR I N C I PL E S
56
O F O ST E O PAT H Y
th e phy si c i an an d o f th e p atie nt The phy s i ci an s palpat
i ng fi n ge r fe el s th e ch an ge i n o s se o u s alig n m e n t an d m u sc u
lar t o n e
The p ati e nt re c o g ni ze s th e di ff ere nc e in se ns itive
n e ss betwe e n th i s l e s i o n are a an d th o s e o u t s i de th e l e s i o n
anip u lati o n h avi n g fo r i ts ai m th e co r
i n fl u e n c e S p e c ifi c m
re cti o n o f alig n m e n t in th e le si o n ed are a give s so fre q u e ntly
al m o st i ns t an t s e n s e o f reli ef th at it i s n o w o n der phy si Ci ai i
an d p ati e n t be c o m e co n vi n c e d th at th e hyp o th e si s o f tr au m a
i s co rre c t
U n der th e i n fl u e n c e o f s u ch a th e o ry as t hi s o ur
ith st atem e nt s te n di n g
o s te o p ath i c liter at u re i s well s pi c ed W
The
to b e l ittl e th e i n fl u e n c e o f all o the r c au s e s o f d i s e ase
write r wi sh e s to emph as i ze th e fact th at l e s i o ns c an be di
n
n
d
e
co
a
rim
a
ry
a
d
ry
s
e
v i de d i n t o tw o gre at c l ass e s i
p
The fir st c l a
s s i s m ade u p o f th o s e o f trau ma t i c o r i g i n an d
ar e u n d o u bte dly c au s e s o f di s o rd er i n th e i r are as o f i n fl u
The s e c o n d c lass i s m ade u p o f th o s e le si o ns wh i c h
e n ce s
ar e phy s i c al s ig n Of th e b o dy s e ffort s at ad apt ati o n an d
c o mp e n s ati o n
A give n 1e 5 1o n c an b e
Classifi cati o n o f Le si o ns
ry o r s e c o n d ary o n ly a fte r c aref u l s t u dy Of
c l ass ed as p rim a
all th o s e f ac t or s w hi c h con s tit u te th e h i s t o r y an d sympt o m
V i sc e r al l e s i o ns cau s e m u scu lar co n
ot
ol o gy o f th e case
tr acti on s i n th e spi nal are a f r o m whi ch th ey re c e i ve th eir
l n erve co mm u n i cati o n s Th ey also cau s e p ai n
c e reb r o s p i n a
i n are as o f high er s e n s ibi lity c u t an e o u s are as with wh i c h
th ey ar e as so c i ate d by i nn e rv ati o n fr o m the sam e s egm e n t
c ti o n s o f
Th e s e referre d p ai n s an d c o n tr a
o f th e s pi n al c o rd
o b e re co g n ize d by sp e c i al i st s
S pi n al m u scl e s ar e begi nn i n g t
i n p u lm o n ary dige s tive an d re n al di se as e s Th ere has b ee n
he
nO w e ll o rd ered e ff o rt to c o o rdi n ate th e fac t s wh i ch li e a t t
fo u ndati o n o f th e s e ph e no m e na I t i s h o p e d th at w e ay
m ak e fo r o u r stu de nts a begi nn i n g i n thi s w o rk by wh at
i s to f o l l o w
—
P
e
o
n
AS e x ampl e s o f var
s
E x am pl e s o f S e c o n dar y L s i
o th e l e s i o n
i o u s se co n dar y le Sio nS w
e wi l l c all atte n ti o n t
ph e no me na f o und u sually to be sy n ch r o no us with e nvo lv
ment s o f so m e o f th e organs o f th e b o dy R ath er th an rush
’
of
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-
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-
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'
m
.
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.
‘
'
.
P R I N C I P L E S O F O ST E O PATH Y
i n t o an analys i s o f le s i o n s we deem it m o re to th e s t u de nt S
i n tere s t to h av e a c l e ar p i c t u re o f the ph e n o m e n a we de sire
naly z e later o n
O u r pr ac titi o n e r s w ho ar e dev o ti n g
to a
m uch tim e i n tre ati n g th e eye re co g n i ze th at i n di s e ase s o f
the eye an d orbit al ti ss u e s th ere ar e p o i nts i n th e n e c k whi ch
A l o n g with the te n de r n e s s
ar e r are ly free fr o m te n der n e ss
the se
are f o u n d m u sc u l ar c o n tr ac ti o n an d m
alal ig n m e n t
c o mp l eti n g o u r tri n ity o f l o c al ize d l e s i o n ph e n o m e n a
S u ch
le s i o n s m ay be l oc ated as lo w as th e s e co n d d o r sal
—
v
t
o
m
r
m
u
i
a
n
b
e
c
t
e
S
s
L
i
D
i
t
b
l
e
o
n
O
s
The S pi na
j
p
y
an c e o f c i r c u lati o n i n the t o n s i l i s ass o c i at ed with s p i nal 1e
Thes e l e s i o n s v ary i n nu mb er an d e x te nt acc o r di ng
S i o ns
to wh eth er th e di s e as e p r o c e ss i s S imp l e an d de c idedly l o cal
o r i s o f e n o u gh s ev erity to p r o d u c e co n s tit u ti o n al symp t o m s
The s pi n al l e s i o n s m u ltip ly an d i n
su c h a s c hi ll fever , e tc
te ns ify i n pr o p o rti o n to th e e x te n t an d S everity o f th e di s
Thi s i s th e c as e no m att e r i n what
tu r ban ce o f th e b o dy
s appe ar
o rgan o r ti s s u e o u r o rigi n al di s t u rb an c e m ad e i t
J u s t as th e Sympt o m co mp l e x v arie s acc o rdi n g to th e
an c e
s eve r i ty o f adi s e as e S O th e s p i n al l e s i o n s p r o p o r ti o n t he m
s e lve s i n l i k e m an n e r Th eref o re i n thi s s e n s e sp i n al le s i o n s
ive evi de n c e O f di s
ar e p hy s i c al S ig n s : o bj e c tive an d s u bj e c t
he s Of n erve s f ro m
tu r banc e i n ti ss u e s i n n erv ated by br an c
he s am e s egm e n t o f th e S p i n al co rd
t
V i sce r al R e fl e x e s —E ach vi scu s o r lo cal ize d ti ssu e
m u c o u s o r s er o us m embr an e s te n d to e s
s uc h as g lan d s
t
abli sh refl e x l e s i o n s i n th e S p i n al are a ti ss u e s whi ch ar e
s u pp l i ed with n erve s fr o m th e s ame S p i n al c o rd s egm e n t as
th ey th em se lve s ar e s u pp lie d In p r o p o r ti o n to th e am o u n t
o f c o mp e n sat o ry as s i s t an c e r eq u ired by an y o rgan o r ti s su e
fr o m th o s e p art s o f th e b o dy o rd i narily c alled u p o n fo r su ch
as
s i st an c e
o u r S p i n al l e s i o n i n c r e as e s i n e x te n t an d i mte n
o n e x amp l e o f th e f or eg o i n g th e st o m ach
mm
A
o
a
s it
S
c
y
m ay fail to do i ts w o rk th o r o u gh ly an d th u s thr o w added
w o rk o n th e s m all i n te sti n e an d i ts rel ated g lan d s l ive r an d
p anc r e as I f th e s e ar e s o mewh at o vert ax ed by th ei r c o m
n
a
ff
o
r
s
o
c
e
rt
p
i
l
e
i
wh
i
h
repre
e
ted
th
e
n
o
r
o
s
u
S
l
s
n
e
a
t
s
n
y
p
,
.
.
,
.
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.
’
.
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,
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,
,
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,
_
,
e
,
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,
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,
P R I N C I PL E S
58
O F O S TE O PA TH Y
t m ach e x te n d s f u rth e r d o w n o ve r th e S pi n al are as fr o m
w hi ch th e live r an d p an c re as re c e i ve a p o rti o n o f th eir i n
n e rv ati o n
S u ch e x amp l e s as thi s can b e re co g n ize d i n a
m aj o rity o f cas e s
P l e u ri sy — D i seas e p r o c e s se s i n th e l u n gs pr o d u c e
o their i n te n s ity
S p i n al l e s i o n s o f v ari o u s ki n d s acc o rdi n g t
P le u ri sy pr o d u c e s so gre at c o n tr ac
an d d e str u c tive n e ss
ti o n i n re s pi r at o ry m u s c l e s whi c h ac t p arti c u lar ly o n th e
rib s lyi n g o ver th e i n fl am e d are a th at fri cti o n o f th e pl e u r al
hy s i ci an s
s u rf ac e s at thi s p o i n t i s re d u c ed to a mi n i m u m
P
t aki n g th ei r pl an fr o m thi s n at u r al co mp e n sat or y c o ntr ac
ti o n freq u e n t ly rei n f o r c e n at u r al effo rt s by str appi n g o v er
th e co n tr acted ar e a w ith adh e s ive The th o r ax ad apt s its e lf
to th e s t
ate o f i ts c o n te n t s h e n c e wh e n a p o r ti o n o f th e l u n g
i s d e s tr o ye d th e an te r o p o s ter i o r di am ete r o f th e ch e st i s le S
The verteb r al an d co s to vertebr al ar
s e n ed i n p r o p o rti o n
ti c u lati o n s e n te r i nt o thi s ad aptive p r o c e ss an d h e nc e e x
hi bi t d e c ide d l e s i o n ph e n o m e na
—
In c as e O f h e art l e s i o n s th e
C ar di ac L e si o n P at te r n s
s o
,
.
.
.
.
,
.
,
,
.
,
'
,
.
,
-
-
-
.
.
b o dy is c alle d u p o n to m ake e x t ens ive co mp e nsat o ry r e ac
ti o n s an d h e n c e o u r spi n al le s i o n ph e no m e na m ay b e lim ited
e n d i n p ro p o r
to th e are a o f th e h e art s i nn erv ati o n o r e x t
ti o n as th e h e art s c on d iti o n i n v olve s th e p u lm o nary ci r cu
lati o n th e p o rt al c i r c u lati o n o r the ki d n ey
’
,
’
.
,
o f the Bo dy
—
D i se ase p r o c e ss e s i n th e p elvi c
U n ity
vi s
c er a p r o d u c e th ei r ch ar ac teri s ti c spi n al l e s i o n ph e n o m e na
j u s t as th e th o r ac i c an d abd o m i n al o rgan s The p o i nt we
de si re to em ph as iz e i s th at th e u n ity o f the b o dy is e x empl i
fi e d by th e S pi n al l e si o n ph e n o m e na
NO o rg an o r ti ssu e
c an o r d o e s s u ff e r i n j u ry with o u t o th e r ti ss u e s bei n g d r afte d
to c o mp e n s ate fo r i ts co n diti o n S O as to m ai nt ai n n o t o n ly
e x i ste n c e bu t th e m o st sati sfact o ry l ife o f whi c h th e o rgan
i s m i s cap ab le
I f th e S p i n al le si o n i s vi ewe d no t o n ly as a
p o ssib le c au s e bu t al so as a q u ite p r o babl e e ff e ct o f ti ssu e
di st u rb an c e e l sewh ere we wi ll appre ci ate m o re f u lly th e
m ann e r in wh i ch th e b o d y S trive s to l ive up to i ts be s t
.
.
.
,
.
,
,
,
.
PRI N C I PL E S
O F O S TE O PA TH Y
C H A PTE R IV
S PI NA L
59
.
HYP E R A E S TH E S I A A ND MU S CUL AR
TE NS I O N
.
O s te o p ath s
th e fir st o r o n ly phy s i c i ans w ho
have : u s ed th e S pi n e as a m e an s o f di ag n o s i s as well as an
are au p o n whi c h to c o n c e n t rate th er ap e u ti c m et ho d s
I t is
i n tere sti n g an d i n st ru c tive to n o te th e s tep s i n th e d evel o p
me n t o f th e k no w ledge o f spi n al co n dit i o n s an d o f the i n di ca
t i o ns Of rem o te f u nc ti o n al di st u rb an c e s whi ch ar e r egi s t e r ed
th ere
—
o
m
s
S u bj e ctive sympt o m s p r e c ede
S u bje cti v e S y m pt
It
an y attempt to di sco ver o bj e c tive evi de n c e s o f di s e ase
w as e ar ly n o te d by phy s i c i an s th at p ati e n t s co u l d n o t b e r e
Thi s l ed to e f
l ied u p o n to n terpr e t th ei r o w n sympt o m s
f o rt s to di sc o ver sympt o m s wh i ch Were i n d ep e n de n t o f the
n
l
on w o u l d nat u r ally
m
f
e
o
s
a
a
p
er
epti
P
p
ti
i
n
t
i
e
r
c
t
c
a
S
e
t
p
p
he are as c o mpl ai n e d o f by the p ati e n t
S i nce
be u sed at t
n c e o f o n ly th e peri ph er al are as o f
he b rai n take s c o g n iz a
t
di s trib u ti o n o f s e n so ry n erve s i n ste ad o f th e wh o l e co u r se
Of th e n er ve fib er s the phys i c i an might s ti ll be mi s led i n ap
o n b e c au s e h e w o u l d b e largely g o ve r n ed by
yi
n
g
p
l
p
a
ti
l
a
p
th e pati e n t s s e n s o ry i mp re ssi o ns P alp ati o n m ade wit h ref
ere nc e to a r e al iz i n g s e ns e o f th e di strib u ti o n an d f u ncti o no f
the n e rv o u s s y s tem be c o m e s a m o re s ati s f ac t o ry m e an s o f
di ag no s i s A S th e k n o w le dge o f th e n erv o us sy ste m i n
w as call ed m o re an d m o re to the spi n al
t o f i ts re lati o n s to th e gre at n erv o u s m ass
c o lu m n o n a
cco u n
with i n it P alp ati o n o f th e S pi n al co l u m n dem o nstr ated
the e x i s te n c e o f s e n s itive are as asso c i ated wit h vi sc er al o r
theref o re hyp er ae sth eti c are as ar e th e fi r st
o th er di so rde rs
ar e
no t
'
.
.
.
.
g
s
i
.
’
.
.
,
'
,
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’
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,
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PR I N C I PL E S
60
O F O S TE O PA TH Y
di ag no sti c p o i nt s m e nti on ed i n m e di c al liter at u re i n r eg ard
to th e S pi n al l e si o n
S u c h hyp er ae sth eti c are as were co n
s ide r e d as evide n c e o f S pi n al i rrit ati o n ; th at i s i r r it ati o n o f
th e S pi n al co rd
I r r it ati o n o f the S pi n al Ne r v e s —The fi r st refere n c e
to s pi n al i r r it ati o n w hi c h I h ave f o u n d i s c o n t ai n e d i n a
“
m o n o gr aph e n tit led A Tre ati s e o n Ne u r algi c Di s e as e s
D ep e n de n t o n I rrit ati o n o f th e S p i n al M arr o w an d G an gl i a
Of th e S ymp ath eti c Nerve by Th o m as P r i dg in Te al e 18 3 4
H e q u o te s a l etter fr o m M r R P P l ayer to th e ed it o r o f
th e Q u arter ly J o u r n al o f S c ie n c e O n Irrit ati o n o f th e
d ate d D e c e mb e r 10 18 2 1 as f o ll o w s :
I
S pi n al Nerve s
t ake the lib erty to su bm it to y o u r n o ti c e a p ath o l o gi cal
f ac t wh i c h has n o t to th e b e st o f my k n o wl edge be e n
ge n er ally rem arked an d at te nti o n to whi ch S O far as my
o w n e x p e ri e n c e g o e s
p r o m i s e s s o m e di mi nu ti o n o f th o s e
di ffi c u lti e s with whi c h th e h e ali n g ar t has to co nt en d
M o s t m edi c al p r actiti o n er s w ho h ave atte n d ed to th e sub
n
a
u
t
o
f
s
pi
a
l
di
s
e
s
e
m
s
t
h
a
ve
Ob
s
e
rve
d
th
a
t
i
t
m
e
c
s
s
j
y
p
t o m s fre q u e n t ly re s emb l e v ari o u s an d dis s imil ar m aladi e s
an d th at c o m m o nly eve ry f u n c ti o n o f every o rg an i s i m
p aired wh o s e n erve s o rigi nate n e ar th e s e at o f the di so r de r
The o cc u rre n c e o f p ai n i n di s t an t p art s fo r cibly att racted
my att en ti o n an d i n d u c ed fre q u e n t e xami nati o ns o f the
S pi n al co l u m n ; an d afte r so m e ye ar s atte n ti o n I co n s i de r e d
my s e lf e nab l e d to s t ate th at i n a gre at n u mbe r o f di s e ase s
m o rb id sympt o m s may be di s co vere d ab o u t th e o rigi n s o f th e
n e rve s wh i ch p r o c e ed to th e aff e c te d p art s o r o f th e S pi nal
br anch e s whi ch u n ite ; an d th at i f th e S pi n e b e e x ami n e d
m o re o r l e s s p ai n wil l co m m o n ly b e fel t by the p ati e nt o n
th e app l i cati o n o f p re ssu re ab o u t o r b etwee n th os e v e r te
br ae fr o m wh i ch su ch n erve s em erge
“
—
e
Thi s s p i nal aff e c ti o n may pe r
S pi n al Tr e atm n t
h ap s b e co n s i dered as th e co n se q u e nc e o f di s eas e s bu t O f
n
m
o
e
a
ti
fy
s
a
s
i ts e x i ste n c e at th eir co mm e n c em e n t an
y
y
h i ms e lf ; an d thi s c ir c u m s t anc e c o mb i n ed with th e s u cc e s s
whi ch has atte n d ed th e empl o ym e n t o f t o pi cal appl i cati o n s
,
.
,
.
,
,
.
.
.
.
,
,
,
,
,
,
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_
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’
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PR I N C I PL E S
62
O F O S TE O PA TH Y
whe n we co ns i d er ho w v arie d ar e th e f u ncti o ns o f th e dif
fe r e n t n e rve s an d ho w d ive r sified th e ti s s u e s an d o rg an s to
whi ch th ey ar e di strib u ted
“
To th e atte n ti ve o bs e r v e r o f di s e as e s n e u r algi c aff e c
ti o ns u n de r th e m o re e x te n ded s ig n i fi c ati o n m u st repe at
p re se n t th em s elve s The S ki n fo r i n st an c e, m ay b e
e dly
th e s e at o f every degre e o f e x alted o r di m i n i sh ed s e ns i
bi l i ty fr om the s l ighte s t u n e as i n e s s to th e m o st ac u te su f
s ibil ity
fe r i n g an d fr o m th e m o s t trivi al dimi n u ti o n o f s e n
—
sympt o m s n o t de
to th e c o m pl ete o b literati o n o f fee li n g
p e n d e n t u po n di s e as e aff e c ti n g th e di ff ere n t ti s su e s o f th e
p art b u t s o le ly r e fe r able to a mo r bi d c o n diti o n o f th e se n
ti e n t n e rve s The v o l u n t ar y m u s c le s m ay i n like m an n er
i n di cate i n a v ari ety o f w ay s a m o rbi d c o n d iti o n o f th e
n erv e s with wh i c h th ey ar e s u pp l i ed
Th ey m ay b e aff e c te d
with we ak n e s s sp asm s trem o r s o r a v ariety o f o th e r dis
o rde re d s t ate s i n c lu de d with i n t
he tw o e x tre me s O f c o n
The i nv o lu n t ary m us c l e s m ay h ave
v u ls i o n an d p ar aly s i s
th e h ar mo ny o f th ei r ac ti o n s i n terr u pte d fr om a mo rbi d
c o n diti o n o f th eir n e rve s ; th e h e art m ay
b e aff e c ted with
p alpit ati o n ; thef v e r m ic u lar m o ti o n o f th e st
o m a ch o r th e
p eri st alti c ac ti o n of the in te s ti n e s m ay b e s u bj e ct to i rreg
u lar i t
T
h
n
n
n
e
ibi
ity
Of
th
e
i
ter
r
m
like
e
s
l
n
a
o
a
a
s
l
s
y
g
y
wi s e be aff e c ted th e h e art th e s t o m ach th e i n te sti n e s
be i n g th e s e at o f p ai n refer ab le to th ei r n erve s an d i nde
pe n d e n t o f i nfl am m ati o n o r an y alte r ati o n o f str u c t u re
The s ec reti on s m ay al so u n de rgo alter ati o ns b o th i n q u an
tity an d q u ality fr o m a p erverte d age n cy o f th e n erve s
u p o n whi c h they dep e n d
S u c h i s a very imp erfe c t re c it al
o f th e v ari o u s m o rbi d aff e c ti o n s wh i ch m a
be
i
l
ded
n
c
u
y
u n d e r th e te rm Ne u r al gi a an d S O fre q u e n t i s th eir o c c u r
re nc e th at th ey m u st b e f am i li ar to eve ry pr actiti o n er Th ey
ar e h o weve r o fte n p erpl e x i n g i n th ei r tre atm e nt an d n o t
u n fre q u e ntly e x h au s t th e p atie n c e o f th e affl i c ted s u ff ere r
an d als o o f th e m e di c al atte nd an t
“
The d i ffi c u lty an d e mb arr as sm e n t wh i ch h ave atte n de d
th e di ag no s i s an d tre atm e nt o f th e se aff e c ti o n s I am i n
'
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'
,
,
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'
,
'
'
'
"
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PR I N C I PL E S
O F O S TE O PA TH Y
63
b e li eve has pri n c ip ally ari s e n fr o m mi st aken view s
hei r p ath o lo gy Th ey h ave too Ofte n b ee n reg arde d as
of t
ac t u al di s e as e s o f th o s e n erv o u s fi lam e n t s wh i c h ar e the
imm edi ate s e at o f the n e u r al gi a i n s te ad o f b ei n g c o n s i d
ered as sympt om ati c o f di s e as e i n th e larger n erv o u s m ass es
—
n
fr o m whi c h th o s e fi lam e n t s ar e d erived ; h e c e the tre at
me n t has too freq u e n t ly b ee n i n e ff e c t u ally applie d to the
s e at o f n e u r al gi a ; i n ste ad o f b ei n g dire cte d to th e m o re
rem ote an d l e ss o bv i o u s s e at o f di s e as e
“
I t i s n o w p retty ge n er ally admitted as a p ath o lo gi c al
th at di s e as e o f th e larger n erv o u s m ass e s as th e
ax i o m
br ai n an d S p i n al m arr o w i s n o t so m u ch evi n c e d by phe
n Om e n a i n th e im m edi ate s e at o f di s e as e as i n th o s e m o re
rem o te p art s to whi c h th e n erve s ari s i n g fr o m th e di s e as ed
p o rti o n ar e di s trib u ted In th e m o re s evere f o rm s o f di s
e as e th i s p ri n c ip l e i s re adi ly adm itted an d re c o gn ized
Whe n fo r in stan c e o n e —
h al f o f th e b o dy sh all h ave lo st i ts
s e ns ibi lity an d th e c o r re s p o n di n g m u sc l e s th eir p o wer o f
ac ti o n
th e S ki n an d th e m u sc le s ar e n o t regarded as the
s e at o f di s e as e
bu t th e br ai n i s imm edi ate ly r e f e r r e d to
In th e s l i ghte st f o r ms o f di s e as e o f th e br ai n an d s p i n al
m arr o w s u ch as do n o t co mp lete ly o b literate bu t m ere ly
i mp air o r p ervert th e f u n c ti o n s o f th e n erve s— s u ch as do
n o t p ar alyze th e s e n ti e n t an d m u s c u lar p o wer s o f th e p art
bu t pr o d u c e we ak n e s s trem o r s s p asm s e tc i n th e m u s
c u lar s y stem
an d n u mb n e ss an d p ri c ki n g s p ai n s an d o ther
m o rbid fee li n gs i n th e n erve s o f s e n s ati o n thi s imp o rt an t
p ri n c ip l e whi c h as s tri c t ly o bt ai ns as i n th e fo rm er i n s t an c e
is t
o o Ofte n e n tire l y o ver lo o ke d ; an d a n u m er o u s clas s o f
co mp lai n t s o f very freq u e n t o cc urre n c e
ar e reg arde d as
n erv o u s o r s p as m o di c di s e as e s o f th e p art aff e c ted i n s te ad
o f bei n g c o n s id ered as ac t u al di s e as e s o f th at p o rti o n o f
th e b r ai n an d S p i nal m arr o w fr o m wh i ch the n erve s o f the
art ar e de rive d
p
Vi sce r al D i st u r b an c e D u e to D i s t u r b e d N e rv e C o n t r o l
The sam e p ath o lo gi c al p ri n c ip l e i s I be l i eve e q u ally
app l i c ab l e to th e s ym path eti c sy s tem o f n e rve s ; alth o u gh
c li n e d
to
,
.
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"
'
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-
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‘
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PR I N C I PL E S
64
O F O S TE O PA TH Y
i t m ay be di ffi c u lt to e st abli sh thi s Opi n i o n by act u al e x
o
r
i
m
m
u
o
n
u
n
n
yet
I
thi
k
it
b
e
re
ted
p
well
gr
d ed
e
e
t
n
a
a
s
p
y
wh i ch wil l j ustify u S i n reg ardi ng th e n erv o u s
an alo gy
m ass e s o f th e gan g li o n i c sy stem as be ari ng th e sa m e rel a
ti o n to th e n e rve s d erive d fr o m th em as th e large n e rv o u s
m ass e s o f th e c e rebr o s p i nal sy stem b e ar to th eir re s p e c tive
H e nc e m an y n erv o u s aff e cti o n s o f th e vi sc er a o u ght
n erve s
n o t b e co n si d ere d as di s e as e s o f th e vi scer a th e m s elve s b u t
di s e as e i n thos e p arti c u l ar g an g li a
of
as
s ympt o m ati c
wh e n c e th ei r n erve s ar e de rived
,
,
,
-
.
.
i t
o f S pi n al Te n de r n e ss
I n flu e n c ed by
su ch c o n s i der ati o n s
I h ave fo r a few ye ar s b ee n i n th e
h abit o f tre ati n g m any o f th e se n erv o us aff e c ti o ns as dis
e as e s o f s o m e p o rti o n o f th e s pi n al m arr o w or g an gl i a ; an d
h ave b ee n s till f u rth er c o n firm e d i n my Opi n i o n by the
freq u e n t an d al m o st u n if o rm c o e x i s te n c e o f te n d e r n e ss
o n p re s s i n g s o m e p o rti on o f th e vertebr al c o l u m n an d th e
c ir c u m st an c e s o f th e te n d er p o rti o n o f th e s pi n e b ei n g i n a
p arti c u l ar s it u ati o n wh e re th e n erve s o f th e aff e cte d p art
o r i g i n ate
Co
-
e x s e nc e
.
,
-
-
.
3
.
S y m pt o m s o f S pi n al Ir r i tati o n
The s ympt o m s o f
s pi n al i rrit ati o n c o n si s t i n an i n fi n it e v ari ety o f m o rbid
.
f u n c ti o n s o f th e n e rve s o f s e nsati o n an d vo l iti o n wh i ch
h av e th ei r o rigi n i n th e s pi n al m arr o w an d th e p art s i n
wh i ch th e s e m o r bi d fu n c ti o n s ar e e x h ibited o f co u r s e be ar
r e fe r e n c e t
o th e di s trib u ti o n o f th e s pi n
al n erve s
“
The m o rbid s t ate s o f s e ns ati o n i n c lu d e every v ari ety
fr o m th e s li ghte st d evi ati o n fr o m th e he alth y s e ns ibi l ity o f
any p art
to th e m o st p ai n f ul n e u r al gi c aff e c ti o ns o n th e
o n e h an d
an d to c o mp l ete n u mb n e ss o r l o ss o f fe el i n g o n
th e o th er ; i n clu di n g p ai n s whi c h m ay b e fi x ed o r f u git ive
o r d arti n g in th e di re c ti o n o f th e n e rve , p ri c ki n g an d ti n g
li n g s e n s ati o n s a s e n s e o f c reepi n g i n th e s ki n o f co l d
w ate r tri c k li n g o ver it an d n u m er ou s o th er st ate s o f pe r
verted s e ns ati o n o f wh i c h w o rd s ar e i nad eq uate to c o nvey
In th e m u scu l ar sy stem we fi n d we ak n e ss
a de s c ri pti o n
.
,
,
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‘
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,
-
,
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,
.
PR I N C I PL E S
O F O S TE O PA TH Y
65
p o wer trem o r s sp asm s o r c r amp s an d so metime s
a te n de n cy to rigi dity
“
Th e s e s ympt o m s s o m etim e s e x i s t i n so s light a degre e
t hat th e p ati e nt c o n sid er s th em u nw o rth y o f n o ti c e an d
o n ly adm it s th eir e x i ste n c e wh e n p ar t
i c u lar i n q u iry i s m ade
re s p e c ti n g th em ; th e o n ly c o mp lai n t whi ch he mak e s b e
i n g o f an u nac c o u n t ab l e s e n se o f we ak nes s and i n abi l ity
In o th er c as e s th e trem o r s h ave e x c ited alarm ;
o f e x erti o n
he n e u r alg i c p ai n s i n the S c alp o r th e fi x ed
s o me ti m e s t
p ai n i n th e m u s c l e s p arti c u lar ly wh e n it o cc u r s i n th e i n
te r c o stal m u s c l e s h ave s u gge ste d th e ide a o f s eri o u s di s e as e
i n th e br ai n o r i n th e l u n g s ; an d wh e n th e p ai n i s s e ate d
i n th e m u s c l e s o f th e ab d o m e n a fe ar th at s o m e o rg an i c
di s e as e o f th e ab d o m i n al vi sc e r a has t ake n p lac e h ar asse s
th e m i n d o f the p atie n t The m u sc u lar we ak n e s s i n so m e
c ase s te nd i n g t
o p ar aly s i s o fte n Su gge s t s th e fe ar o f ap o p l e x y
o r p ar aly si s fr o m c e rebr al di s e ase
The
D u r ati o n o f Aff e cti o ns D u e to S pi n al Ir r it at i o n
u n derg o i n g
aff e c ti o n i s o fte n o f very p r o tr ac te d d u r ati o n
alte r n ate v ari ati o n s fr o m th e sanative p o we r s o f th e c on
itu ti o n and the di ffe re n t e x i sti n g c au s e s o f di s e as e Th ere
st
ar e m an y i n d ivid u al s i n wh o m th e c o mp lai n t has e x i s te d
i n v aryi n g de gree s Of i n te n s ity fo r a s eri e s o f ye ar s with
o u t i ts re al n at u re h avi n g be e n s u sp e c ted ; th e p ati e n t s an d
th ei r m edi c al atte n d an t s h avi n g reg ard ed it th r o u gh o u t as
a rh e u m ati c o r a n erv o u s a
ff e c ti o n
“
In th i s c o mp lai n t te n de r n e s s i n th e p o rti o n o f the
verteb r al c o lu m n wh i ch c o rre s p o n d s to th e o rigi n o f th e
aff e cte d n erve s i s ge n e r ally i n a s triki n g an d u n e q u iv o c al
m an n er evi n c e d by p re s s u re In s o m e i n st an c e s th e te n
de r n e ss i s 8 0 gre at th at eve n slight p re s su re c an scar c e ly
be b o r n e an d w
i ll o fte n c au s e p ai n to strike fr o m th e S pi n e
to th e s e at o f sp as m o r n e u r al gi a
“
Thi s aff e c ti o n o f th e S p i n al m arr o w o cc asi o n ally e x i st s
t hro u gh o u t i ts wh o l e e x te n t ; m o re freq u e n t ly h o wever it
i s c o n fi n e d to s o m e p arti c u lar p o rti o n an d o c c as i o n ally i s
se ated i n d i ff e re n t an d rem o te p o rti o n s at th e sam e tim e
or
l o ss
of
,
,
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,
i
-
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'
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-
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PR I N C I PL E S
66
O F O S TE O PA TH Y
th e p arti c u l ar sym pt o m s and te n der n e ss o n p re s su re i n di
c ati n g th e aff e c te d p art
“
The sympt o m s o f co u r s e v ary co ns i derably acco rdi n g
to th e p arti c u l ar p art O f th e S p i n e whi ch i s aff e cte d an d
b e ar refere n c e to th e di strib u ti o n o f th e di ff ere nt S pi nal
n erve s
Aff e cti o ns o f the U ppe r C e r vi cal R e gi on ;
Wh e n the
u pp er c ervi c al p o rti o n o f th e sp i n al m arr o w i s di s e as ed we
fre q ue ntly fi nd n e u r algi c aff e c ti o n s o f th e scalp ; the p ai n
strike s i n v ari o u s di re c ti o n s o ve r th e p os teri o r an d l ater al
p art s o f th e h e ad ; so m etim e s th e twi g s in th e n ei ghb o r h oo d
o f th e e ar s o m eti m e s th o s e w hi ch asce n d o ve r th e o cc ip u t
to th e s u p e ri o r p art o f th e sc alp ar e m o re p arti c u l arly th e
he n erv o u s twig s di s trib u ted to the
s e at o f th e co mp lai n t ; t
i n teg u m e nt s o f th e n e ck ar e o c c asi o nally aff e cted th e p ai n
d arti n g ac r o s s th e n e ck to th e e dge o f th e lo we r jaw an d
s o m eti m e s e n c r o ac h i n g a littl e u p o n th e f ac e
Th e s e n e u
r al i c di s e as e s fre q u e n t ly as su m e an i n te rmitte n t f o rm
th
e
g
p ar o x y s m s ge n e r ally o c c u rri n g i n th e e ve n i n g A sti ff n e c k
o r i m pai r
e d acti o n Of th e m us c l e s m o vi n g the h e ad tr e
q u e n t ly atte n d th e aff e c ti o n o f th e u pp er c ervi cal p o rti o n
Of th e sp i n al m arr o w ; an d o c cas i o nal ly th e v o i c e i s co m
l
r
ff
n
l
e
t
e
o
o
s
u
a
a
o
n
l
t
er
lte
r
ti
s
s
a
d th e act o f sp e aki n g i s
y
p
atte n ded with p ai n o r di ffi c u l ty
I rrit ati o n
Ir r i tati o n o f the L o w e r C e r v i cal R e gi o n
o f th e l o we r c e rvi c al p o rti o n o f th e spi n al m arr o w give s ri s e
to a m o r b id s t ate o f th e n erve s o f th e u pp er e x trem iti e s
S h o u l de r s an d i n teg u m e n t s at th e u pp er p ar t o f th e th o r ax
P ai n s ar e felt i n v ari o us p art s o f th e ar m S h o u l der and
br e as t; s o m e ti m e s th e p ai n t ake s th e c o u r s e o f th e an ter i o r
th o r ac i c b r an ch e s o f th e br ach i al pl e x u s o ccasi o nally th e
p ai n i s fi x ed at s o m e p o i n t n e ar th e clavi cl e scap u l a o r
i n s erti o n o f th e de lt o i d o r n e ar
at th e
sho u l de r j o i n t
th e e lb o w o r S h o o t s al o n g th e c o u r s e o f so m e o f th e c u tan
e o n s n e rve s F re q u e n tly o n e o r bo th o f th e m amm ae be
e x q u i sitely s e ns ibl e an d p ai n f u l o n p re ssu re an d
co m e
so m e d egre e o f s wel l i n g o cc asi o n al ly t ake s p lac e i n th e
.
,
,
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,
‘
’
,
,
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,
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'
‘
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,
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o
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-
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,
PRI N C I P LE S
O F O S TE O PA TH Y
67
bre ast atte n ded with a k no tty an d i rreg u lar fe e l i n g wh e n
th e n e u r al gi c p ai n s h av e e x i s te d a co ns i der abl e tim e in
th at p art pri c k li n g an d n u mb n e ss ti n g li n g an d c re ep i ng
O fte n fe l t i n th e
u pp e r e x trem itie s ; an d
s e n s ati o n s ar e
al so a s e n sati o n o f c o l d w ater tri c kli n g o ver th e su r f ac e
O n r u bbi n g th e h an d s o ver th e p art aff e cte d a s o re n e s s i s
freq u e n t ly fe lt wh i ch is de scrib e d as n o t m erel y s it u ate d
i n the i n teg u m e n t s bu t also i n th e m o r e de ep s e ated p art s
In the m u s cu lar sy stem ar e Ob s e r ved m o s t freq u e ntly a
we ak n e s s of th e u pp er e x tremitie s so m etim es r eferred par
ti c u lar ly to th e wri st s trem o r s an
d u n ste adi n e s s o f th e
h an d s ; also c r amp s an d sp as m s o f v ari o u s degr e e s o f i n
te n sity O cc as i o n ally th ere i s an i n abi li ty to p erfo r m co m
l
x
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te
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th
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w s th e ar m app e ari n g re str ai n e d
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p
by th e te n d o n o f the bi c ep s ; an d tight n e ss b e i n g pr o d u c e d
i n thi s p art w he n e x te n s i o n i s attempt ed b ey o n d a c ert ai n
p o i n t A S far as I h ave o b serve d th e p ai n an d o th er mo r
bi d fe e l i n g s i n th e u pp e r e x tremiti e s an d ch e s t ar e fe lt
m o r e fre q u e n tly an d m o re s everely o n th e l eft th an o n th e
r ight s i de
F em al e s o f s ede n t ary h abit s app e ar p arti c u lar ly su b
t
ff
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e
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t
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ti
s o f th e u p per e x trem iti e s an d it i s
j
n o t u n c o mm o n f o r th em to c om p l ai n o f bei n g s c ar c e ly ab l e
to fee l th e n e ed l e wh e n it i s h e l d i n th ei r fi n ger s an d th at
th eir n eed l e s an d w o rk fre q u e ntly dr o p fr o m t heir h an d s
“
—
Wh e n the
Ir r i tati o n i n the U ppe r D o r sal R e g io n
u pp e r d o r sal p o rti o n i s aff e c te d i n additi o n to v ar i o u s m o r
bi d s e n sati o n s S i mi lar to tho s e i n th e e x t r emiti e s th e r e i s
o fte n a fi x e d p ai n i n so m e p ar t o f th e i n ter co st al m u s c l e s
to whi c h the n am e p l e u r o dy n i a has b e e n as s ign ed ; an d wh e n
th i s p ai n has e x i s ted a lo n g tim e th ere i s te n de r n e ss o n
pre ssi n g the p art
Wh e n th e
Irr i tati o n i n the L o w e r D o r sal R e gi on
lo w e r d o r sal h alf o f th e S pi n al m arr o w i s th e s e at o f irri
tati o n o r s u b ac u te i n fl a m m ati o n th e p l e u r o dy n i a wh e n it
e x i st s i s fe lt i n th e lo we r i n ter co stal mu sc l e s ; fre q u e n t ly
th ere i s als o a s e n sati o n o f a c o rd ti ed r o u n d th e w ai s t ; an d
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PR I N C I PL E S
68
O F O S TE O PA TH Y
pp re s sive se ns e o f tight n e ss ac r o ss th e epig astri u m an d
lo we r st er n al regi o n ; an d so re n e ss alo n g th e cartil age s o f
th e lo wer rib s o r i n th e c o u r se o f i ns erti o n o f th e di aphragm
V ari o u s p ai n s fi x ed an d f u gitive ar e al so fe lt i n th e par
i e te s o f th e ab d o m e n th r o u gh o u t any p ar t o f th e abd o m
i n al an d lu mb ar m u s c le s ; the p ai n i s freq u e nt ly fi x e d i n
s o me p o rti o n o f th e re c t u s m u s c l e an d n o t i n fre q u e n t ly i n
th e Ob liq u e m u scle o r tr ans ver sali s a l itt le ab o ve th e c re s t
o f th e i l i u m
p arti c u lar ly wh e n the o rigi n o f tw o o r th re e
o f th e lo we s t d o r s al n erve s i s di s e as ed
The
I r r it ati o n i n the L u m bar an d S acr al R e gi ons
aff e c ti o n o f th e l u mb ar an d Sac r al po rti o n o f th e S pi n al c o rd
o fte n p r o d u c e s a s e n s ati o n o f s o re n e s s i n th e sc r o t u m an d
n ei ghb o ri n g i n teg u m e n t s ; an d th e lo wer e x trem iti e s b e
c o m e th e s e at o f v a ri o u s m o rbi d s e n s ati o n s s p a s m s trem o r s
fo r th e m o s t p art re s e mb li n g th o s e whi c h h ave be e n
et
c
de sc rib ed as o c c u rri n g i n th e u pp er li mb s The p ati e n ts
als o co mp lai n o f a s e n s e o f i n se c u rity o r i n st abi lity i n
w alk i n g ; the i r k n e e s t o tte r an d fe e l sc ar c e ly ab l e to su p
p o rt th e weigh t o f th e b o dy
The E ff e c t o f R e cu m be ncy
In so m e ca se s very c o n
re lie f i s f o un d fr o m re c u mbe n cy th e p ai n fr e
s ide r ab le
q u e n t ly b ei n g di m i n i sh ed as so o n aS th e p atie n t reti re s to
b ed i n dep e n de n t ly o f any p ar o x y s m al rem i s si o n
I r r i tati on o f S pi nal M ar r o w No t Ne ce ssar i ly D e pe n de n t
“
o n Di s e as e o f V e r t e b r ae
Thi s i rrit ati o n o r s u b ac u te i n
fl am m ato r y st ate Of th e sp i n al m arr o w i s n o t n e c e s sari ly
c o n n e c ted with an y
defo rm ity o f th e s pi n e o r di s e as e i n
—
th e v erte br ae I t m ay c o e x i st with the s e as we ll as with
any o th er di s e as e s b u t it s o rep e ate d ly o cc u r s with o u t th em
th at th ey c an n o t b e reg arde d as d ep e n de n t u p on e ach
o th er
W h e re h o weve r i nfl amm ati o n a n d u lc e r ati o n o f
th e vertebrae o r i ntervertebr al c arti lage s e x i st it i s pr o b
ab l e th ey m ay
p redi sp o s e to an d i n s o m e i n st an c e s ac t
as an e x c iti n g cau s e o f an i n fl am m at o ry st ate o f th e n e rv o u s
s tr u c t u r es whi c h th ey c o n t ai n ; fo r we n o t fre q u e n tly fi n d
i n fl am m
at o ry aff e c t io n s o f th e vertebr ae i n c o n j u nc ti o n wit h
o
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O F O S TE O PA TH Y
PR I N C I PL E S
7O
bli ste r s to th e aff e cte d p o rti o n o f th e s pi n e ar e th e p ri n
c i pal rem ed ie s
A gre at n u mb e r Of th e cas e s wi ll fr e
q u e n tly yi el d to th e S i n g l e app li c ati o n o f any o f th e s e
m e ans S o m e cas e s wh i ch h ave eve n e x i ste d seve r al m o n th s
I h av e s e e n p e rfe ct ly re li eved by th e si n g l e app li c ati o n o f
a bli s te r to th e S pi n e alth o u gh th e l o c al p ai n s h ave b ee n
i n e ff e ct u ally tre ated by a v ari ety o f re m edi e s fo r a gre at
l e n gth o f tim e
A rep eti ti o n o f th e l o c al d ep l eti o n an d
bli ste r i n g i s h o wever o fte n n e c e s sary af te r th e lap s e o f a
few d ay s an d so m
eti m e s i s req u i re d at i n te rv als fo r a co n
In a few v ery o b sti n ate c as e s
s i de r abl e l e n gth o f ti m e
i ssu e s o r set o n s h ave be e n tho u g ht n e c e ss ary ; an d wh ere
th e di s e as e has b e e n very u nyi el di n g a m ild m e r c u ri al
c o u r s e has app e are d b e n efi c i al
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Wh e n my atte n ti o n w as fir s t di re c te d to thi s s u bj e ct
I co n s id ere d re cu mb e n cy a n e c e s sary p art o f the tr e atm e n t
it i s fo r a m o der ate l e n gth o f ti me u n d o u bted ly b e n efi c i al
an d fre q u e n tly very m u c h ac c e l er ate s r e co very
bu t s u b
se q u e n t O
b serv ati o n haS c o nvi n c ed m e th at it i s by n o
m e an s e ss e nti al . I h ave s e e n s ever al i n st an c e s o f th e m o st
‘
s eve re f o rm s o f th o s e c om pl ai n t s o c c u rri n g i n th e
rer
o
o
p
c l ass e s o f s o c iety
where co nti n u e d re c u mbe ncy was i m
p r ac ti cabl e whi ch h ave n everthe les s yi e lded with o u t di f
fi c u lty to th e o th er m e an s Of th e tre at m
e nt whil st th e i n di
v i du al s wer e p u r su i n g th ei r lab o ri o u s av o cati o n s
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pply to
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ob s
erv ati o ns ho w elv e r
t ho se cas e s i n wh i ch the re
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i n t en d e d to
ac t u al di s e as e o f th e
ar e
is
no t
.
Whe n
e x i s t s a te n de n cy to rel ap s e I h ave
th o u ght it adv an t age o u s to co n ti nu e th e u se o f so m e s tim
u lati n g l i n i m e n t to th e spi n e fo r a few we ek s afte r the
A l i ni
o th e r m e an s o f tre atm e nth ave be e n di s co n ti nu ed
m e n t co n si sti n g o f o n e p art S pirit s o f t u rp e n ti n e an d tw o
t has ge n e rally b e e n emp lo yed
o f o l iv e o i l i s wh a
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PR I N C I PL E S
O F O S TE O PA TH Y
‘
71
im i lar to th at whi ch has bee n de sc ribed i n th e pre c edi n g
c h apter as o c c u rri n g i n th e S pi n al m arr o w
A s th e di s e as e m ay b e c o n fi n ed to o n e p art o f th e
or
e x i s t S im u lt an e o u sly i n di ff ere n t po r
S pi n al m arr o w
ti o n s o r m ay eve n p erv ade i ts wh o l e e x te n t S O th e ai
f e cti o n o f gan g l i a m ay b e co n fi n ed to o n e o f th ese n erv o u s
m as se s m ay e x i s t i n s ever al whi ch ar e c o n tig u o u s o r i n
li
re mot
o m e ac h o th er ; an d as th ere i s re as o n t
a
n
a
e
fr
o
g
g
be lie ve the w ho le c h ai n m ay o cc asi o n ally b e aff e cte d
“
The di s e as e Of th e gan g l i a i s s e l d o m f o u n d e x c ept i n
co n j u n c ti o n with th at o f the c o rre s p o n di n g p o rti o n o f t
he
S p i n al m ar r o w w here as th e S p i n al m arr o w i s o fte n aff e c ted
wit ho ut th e n eighb o ri n g g an g li a b ei n g u n der th e i n fl u e n c e
o f d i se as e
Th u s we fre q u e n t ly fi n d sympt o m s o f di s e as e
i n a p o rti o n o f th e sp i n al m ar r o w with o u t any evid e n c e
o f i ts e x i s te n c e i n th e c o rre s p o n di n g g an g l i a f r e q u e n t ly th e
s ympt o m s o f b o th c o mbi n ed
an d o cc as i on ally bu t r are ly
sy mpt om s refe r abl e t
o th e g an g l i a with o u t th e S pi n al m ar
r o w b ei n g imp l i c ated
The
S y m ptom s o f Ir r i tati o n o f S y m pat he ti c G an gli a
p ri n c ip al sym pt o m s r e su lti n g fr o m i rrit ati o n o f th e g an gli a
o f the s ymp ath eti c ar e to b e f o u n d i n th o s e o rg an s whi c h
derive th e i r n erve s f r o m thi s so u r c e They c o ns i st o f p er
verte d f u n cti o n s o f th es e o rgan s an d ar e e x emp lifie d by a
v ar iety o f ph e n o m e n a The i nv o lu n t ary m u scl e s d e r ivi n g
thei r p o wer f r o m th e symp ath eti c h ave th ei r ac ti o n altere d
as m s an d i r r eg u larity i n th ei r c o n tr ac
as i s evi n c ed by sp
ti o ns The h e art i s S e i zed with palp it ati o n s th e l arge v e s
s e l s with i n o rdi n ate p u lsati o n s ; th e m u sc u l ar fib er s co n
n e c ti n g
with th e br o n chi al app ar at u s ar e thr o w n i n t o
asth m a i n dep e nde n t
of
s p asm s
n s tit u ti n g
a ge n u i n e
co
b r o n chi al i n fl amm ati on The m u scu lar fib er s o f th e st o m
n d i n te s ti n e s b e c o m e th e s e at o f s p as m s an d v ari o u s
ach a
The s e n si
o th e r de vi ati o n s fr o m th ei r n at u r al O p er ati o n
bi li ty o f th e o rg an s wh i c h d e rive th eir s e n ti e n t p o wer fr o m
th e gre at symp atheti c i s v ari o u sly p e rve rted the n erv o u s
fi lam e n t s b ei n g th e se at o f p ai n The he art an d lu ng s, fo r
S
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PR I N C I PL E S
72
O F O S TE O PA TH Y
i n st an c e ar e su bj e ct to m o rbid s e n sati o n s be ari n g gre at
an alo gy to th o s e wh i c h h ave be e n de s ig n ated
tic d o u lo u
re au x wh e n o c c u rri n g i n th e spi nal n erve s The s t o m ach
an d i n te sti n e s ar e li ab l e to s im i lar n e u r algi a to wh i c h th e
n ame s g as tr o dy n i a an
d e n te r o dy n i a h av e be e n app l ie d The
ki d n ey s th e b ladde r an d th e u ter u s ar e li ab l e to th e s am e
p erverted st ate o f th ei r s e n sibi lity The se c reti o ns also
u n derg o alte r ati o n s pr o d u c t s b e i n g f o rm ed wh i c h i n h e alth
h ave n o e x i ste n c e Th i s i s e x emp lifie d by th e e n orm o u s
s e c reti o n s o f ai r whi c h s o m eti m e s o cc u r i n th e st o m ac h
L arge q u an titi e s o f c le ar tr an sp are n t liq u id ar e als o s e creted
by thi s o rg an c o n stit u ti n g wh at is c alle d pyr o si s The
s e c reti o n s o f th e st o m ac h u n de rg o v ari ati o n i n t hei r q u an
titi e s re n d eri n g th em u n fit fo r dige s tive p r o c e ss
It is
p r o b ab le th at th e se c reti o n o f th e liv er al so e x pe ri e n c e s
s o m e alter ati o n i n t h
e s e c o m p lai n t s The u ri n e i s so m e
ti m e s i n fl u e n c e d an d I am i n c li n e d to su sp e c t th at so m e
f o rm s o f di ab ete s p art ake o f n e u r algi c c h ar ac te r
Le u
co r r ho e a i s fre q u e n t ly a co n c o m it an t Of th e s e di s e as e s an d
c e as e s o n th ei r rem o v al ; b u t I am n o t prep ared t
o s ay th at
it i s ever sympt o mati c Of th em I rreg u lariti e s i n th e cata
m e n i a ar e o fte n o b s erved th e d i s ch arge Ofte n bei n g g e n
e r al ly i n e x c e ss
M i ddle an d Lo w e r Tho r ac i c S y m pat he ti c G an g l i a
The g an g li a m o st li ab l e to th e di s e a se ar e th e m idd l e an d
lo wer th o r ac i c fr o m whi c h th e sp lan c h n i c n e rve s ar e de
rived givi n g ri s e to v ari o u s di s o rder s Of th e s t o m ac h an d
dige stive o rgan s wh i ch w i ll h e re afte r b e m ore f u lly di s
Ne x t i n freq u e n cy i s th e aff e c ti o n o f th e c ervi c al
c u s s ed
g an g li a p r o d u c i n g p ai n f u l an d sp as m o di c s t ate s of th e
h e art The s ympt o m s de n o t i n g di se as e o f o th er gan g li a al
th o u gh o c casi o n ally m et with a r e l e s s freq u e nt i n thei r
I rrit abi lity o f temp e r an d depre s s i o n o f Spirit s
o c c u rre n c e
o fte n atte n d th e s e c o mp lain t s p arti c u lar ly wh e n th e s t o m
ach i s th e p art wh i c h s u ff er s
“
The d i se as e o f th e g an g li a like th at o f th e spi n al
m arr o w i s n o t n e c e s sari ly c o n n e cte d with di s e ase o f th e
,
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O F O S TE O PA TH Y
P R I N C I PL E S
‘
73
—
c o e x i st
ve rtebr ae o r di s t o rti o n o f th e S p i n e I t m ay
with
th e s e c o mp lai n t s and wh e n it d o e s S O th e sympt o m s
p r o p er to th e g an g li o n i c di s e as e ar e o fte n err o n e o u sly sup
p os ed to b e pr o d u c e d by di st o rti o n o r by di s e ase Of th e
verteb r ae ; th ey ar e ho weve r fre q u e n t ly re l ieved by tre at
m e n t whi l st th e di s e as e o f th e b o n e s rem ai n s u i ri n fl u e n c e d
by it an d th e m o st e x trem e d i s t o rti o n o f th e S pi ne o r de
Of th e vertebr ae fr o m i n fl amm ati o n m ay e x i s t
str u c ti o n
witho u t th ere b ei n g any sympt o m s attrib u t ab l e to n e u r algi a
o f th e sym p
ath eti c n e rve s
“
In c o n j u n c ti o n with th e s ympt om
s de n o ti n g di s e as e
o f th e g an g l i a t e n der n e ss t
o a gre ate r o r l e ss d egre e m ay
ge n er ally b e f o u n d o n p re ss i n g so m e p art o f the S pi n e an d
th e te n der p o rti o n i nv ari ab ly c o rre spo n d s with th e sy m p
t o m s ; o r r ath er th e s e at o f te n der n e s s i s n e ar th e p art
o cc u pie d by th e p a rti c u l ar gan g l i a fr o m wh i c h th e n erve s
o f th e di s o rd ered o rg an ar e d erive d ; fo r e x amp l e
wh e n th e
h e art i s aff e cte d th e te n d er ne s s i s f o u n d i n s o m e o f the
c e rv i c al vertebr ae
an d wh e n th e s t o m ach i s th e s e at o f
c o mp l ai n t
it i s i n so m e o f th e mi dd le Or lo wer d o r s al ver
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H y pe r ae m i a
With re sp e c t to th e
tre atm e n t I h ave bu t l itt l e to add to wh at has be e n said
i n th e pre c edi n g c h apter re sp e c ti n g th e tre atm e n t o f irrit a
ti o n o f th e s pi nal m arr o w L ee ch e s c u p i n g b li ster s e tc
to th e n eighb o rh o o d o f th e aff e c te d g an g l i a c o n stit u te th e
”
e ss e n ti al p art
—
o
F o llo wi n g th e o b s erv ati o n o f s p i n al
i
T
n
s
n
M u scu l ar e
te n der n e s s c am e th e n o ti n g o f m u s c u lar te n si o n ac co mp any
A s n e ar as I c an d etermi n e fr o m p er u s i n g m edi cal
i n g it
l iter at u re m u s c u lar te n s i o n w as n o t re co g n ized u n ti l afte r
th e adve n t o f O s te o p athy S i n c e th e atte n ti o n o f m edi cal
writer s w as calle d to th e co n diti o n s o f th e s pi n al co lu m n
”
“
th ere ar e fre q u e n t p as sage s de sc riptiv e o f
ns
l e si o
c all ed
th es e i n m e di c al l iter at u re O n e o f th e be st o f th e s e ref
“
D i s e as e s
e re n c e s i s f o u n d i n Bo ardm e n R eed s w o rk o n
an d i s as f o l lo w s
o f th e S t o m a ch an d I n t e sti n e s
S pi n al Tr eatm e n t
.
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O F O S TE O PA TH Y
PR I N C I PL E S
74
D r J o h n P A r no l d has re c e ntly cal led atte n ti o n to
a n o vel o bj e c tive S ig n wh i c h m ay b e re c o g n ized u p o n pal
i
o
n
n
s
n
l
n
o
f
ve
r
th
e
e
itive
regi
g
id
e
th e sp i nal
a
t
o
s
o
a
o
S
s
p
ve rteb r ae an d so m etim e s i n su ch r e g i o ns w hi ch ar e n o t
o p re s su r e th o u gh i n all c as e s h e m ai nt ai n s th at
s e n sitive t
th e p art o f th e b o dy s u pp lie d by th e v aso m o t o r n e rve
fib re s im m ergi n g in th e c o rre sp on d i n g i n tervertebr al S p a
ce
will b e f o u n d to p re s e n t s o m e ab no rm al c o n diti o n The
p e cu li ari ty de sc rib ed by h i m i s i n su ch case s a so m
ewhat
d o u ghy an d i n ch r o n i c o n e s a gri st ly te n s e co rd l ike fe el
i n g o f th e b an d o f lo n git u d i n al m u sc u l ar fibre s whi c h r un
u p an d d o w n o n eith e r S id e o f t
he s pi n e
Thi s ab no rm ality
i s s u pp os e d by A r n o ld to b e du e to a co n ge s te d o r i n filtr ate d
co n d iti o n o f th e m u sc l e wh i l e th e c o rd it s e l f i s an ae mi c
p r o b ab ly i n ch r o n i c cas e s H amm o n d b el ieved the S pi nal
c o rd t
o b e an aemi c i n su ch c as e s
The fi n di ng s o bt ai n e d by
a c aref u l p alp ati o n o ver th e s pi n e sh o u l d th u s as s i st i n di
r e ct
i n g o u r atte nti o n to th e o rg an o r p art o f th e bo dy whi c h
m ay b e s u sp e c ted o f b ei n g di s e as ed
Yo u S h o ul d
D i g it al E x am i nat i o n o f the S pinal Ar e a
m ake it a r u l e to e x am i n e caref u l ly th e spi n e s o f all ch r o n i c
i nv al i d s by p re ss i n g de eply with th e fi n ger tip s ( o r with
th e th u mb s as F li n t advi se d ) c l o se to th e verteb r ae and
th e n e x ert ge n tl e tr ac ti o n i n a later al d i r ec ti o n o u tw ard
f ro m th e sp i n e o n eith er S id e The p ati e n t sh o u ld b e lyi n g
u p o n hi s right S i de wh i l e y o u p alp ate al o n g the l eft S id e o f
th e v ertebr ae an d S h o u l d th e n ch an ge to hi s l eft S i de i n
p alp ate u p o n th e right S id e o f th e
o rder th at y o u m ay
l atte r so th at th e ti s s u es m ay b e i n th e u t o st co n diti o n
In b o th cas e s y o u will fi n d it
o f re lax ati o n p r ac ti c ab l e
b e s t to st an d i n fr o n t o f th e p ati e n t an d re ach o v er hi s
pp er
u pp er S ide to m ake p alp ati o n alo n g th e regi o n O f th e u
s ide o f th e Spi n al c o l u m n
“
In n u m er o u s p ati e nt s e sp e c i ally th os e s u ff e ri ng fr o m
dige stive d e r an gem e nt s y o u will be l ikely wh i l e p alp ati n g
i n th e w ay d e sc ribe d to re co g n ize i n th e l o n git u di n al m u sc le s
r u nn i n g p ar all el and c l o se to th e S p i n e th e te ns e co rd li ke
.
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P
R I N C I PL E S
O F O S TE O PA TH Y
75
e n sati o n ab o ve m e n ti o n ed I f s im u lt an e o u sly with y o u r
re co g n iti o n Of s u ch a co n diti o n th e p ati e n t c o mp l ai n s o f
th e ac cu r acy o f y o u r
s e n sitive n e ss i n th e s am e regi o n s
”
fi n di n g wi ll b e at o n c e c o n firm ed
The U s e o f S pi n al M u s cu lar Te nsi o n i n D i ag no si s
The u se o f th e s e te n s e c o rd like m u s cl e s as di ag no s ti c evi
de n c e s o f di s e as e has be e n a c o n st an t p r ac ti c e o f O s te o
p ath s f r o m the b egi nn i n g Of D r S ti ll s w o rk J u dgi n g fr o m
th e q uo t ati o n the tr u e s ig n ifi c an c e o f the s e co n tr acti o n s has
n o t be e n app reh e n d ed by th e m edi cal p r o fe s si o n i n ge n er al
I t i s ve r y evi de n t t hat a c o n tr ac te d m u s c le i s sh o rter an d
thi c ker th an wh e n re lax ed also th at wh e n c o n tr ac ted it
e x ert s for c e to dr aw its e x tremiti e s t o geth er The e n d s o f
the m u sc l e b ei n g att ach ed to b o n e s f o rmi n g p o rti o n s o f
a m o v ab l e arti c u lati o n
a c h an ge i n th e re lati o n o f th e
b o n e s m u st f o llo w Thi s ch an ge is c all ed a su b lu x ati o n
an d i s de s c rib ed m o r e i n det ai l in an o th er c h apter
—
E
t
?
H avi n g n o te d th at s e n s itive n e ss an d
e
f
f
c
Cau s e o r
m u scu lar co ntr acti o n ar e we ll re co g n ize d c o n diti o n s f o u n d
th e q u e s ti o n a ri se s ar e th e s e
al o n g th e S pi n al co l u m n
mere ly Ob je cti v e sympt o m s o f di se as e o r ar e they to a
l ar ge e x te n t cau s ativ e f act o r s i n th e o rigi n an d m ai n te nan c e
Of di s e as ed co n d iti o n s o f th e are as o f p eriph er al di str ibu
?
?
r
ff
ti o n o f sp i n al n e r ve s Ar e th ey c au s e s o e e ct s
They h ave b e e n n o ted alm o s t e x c lu s ive ly as e ffi c i e n t
F u r th erm o re o ste o p athi c th erap e u ti c s
c au s e s o f di s e as e
h ave b ee n admi n i s tere d fr o m th at st an dp o i n t with m arke d
Th i s c h an ge i n p o s iti o n an d s ize o f ti ssu e s i s
s u cc e ss
re co g n ize d as an Ob st r u cti o n to th e m o vem e n t s o f fl u id s
an d th eref o re i s a c o n diti o n Op er ati n g i n th e sy st em to
cau s e di s e as e
s
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PR I N C I PL E S
76
O F O S TE O PA TH Y
C H A P TE R
V
.
TH E S E G M E NTATI O N O F
-
TH E
B ODY
.
The L e s i o n as a G u i de i n D i ag n o s i s — S i n c e th e S pi nal
l e si o n m ay b e eith e r c au s e o r e ff e c t i e a tr au m a o r an e x
.
.
.
,
.
,
p re ss i o n o f th e b o dy s p r o te c t i ve re acti o n we n e ed c ert ai n
f u n d am e nt al f ac t s u p o n whi c h to b as e j u dgm e n t NO m at
te r wh eth er th e le s i on i s c au s e o r e ff e c t the phy s i ci an m u st
re c o g n ize it as a g uid e fo r th e u n rave lli n g o f a s eri es o f ph e
mo m e n a wh i ch ar e q u ite s u re to b e pre s e n t i n any ca se I t i s
a we ll re c o g n ize d f ac t th at e ff e c t s b e c o me c at
i s e s an d th u s a
cy c le o f refl e x e s b e c o m e e st ab l i s h ed m aki n g i t di ffi c u lt t
o
re c og n ize Wh ere th e s e ri e s b eg an Any di agn o si s w o rthy
th e n am e m u s t b e b a s ed o n s tr uct u re an d f u n cti o n M u c h o f
th e ph e n o m e na w e ar e c alle d u p on to i n terpret is di fficu lt to
u n der s t an d u n l e s s we k n o w n o t o n ly n
o rm al s tr u c t u
re bu t
th e d eve lo pm e n t p r o c e ss e s wh ere by th i s p re se nt str u ct u r al
f o rm ati o n w as achi eve d
—
m
n
The far re ach i n g i n fl u e n c e Of a
i
e
t
The S p n al S e g
c e rvi c al l e s i o n c an re ad i ly b e u n der st o o d wh e n we st u dy th e
embry o lo gi cal d eve lo p me n t o f c ervi cal str u c t u re s To m e n
ti o n a n e rve to a di ag no s ti c i an S h o u ld i n s t ant ly bri n g to hi s
mi n d all th e s tr u c t u r al as so c i ati o n s o f th at n erve i ts o rigi n
The th o u ght o f i ts o rigi n an d d i strib u ti o n
an d di s trib u ti o n
w o u l d n at u r ally bri n g to m i n d an asso c i ati o n o f all th e tis
We w o u ld th u s have
su e s d ep e n d i n g o n it fo r i n nerv ati o n
Co n sid eri n g
a pi c t u re o f a l o c alize d c o mm u n ity o f i n tere s t s
th e sim i lar di strib u ti o n o n th e o pp o s ite s i de o f th e b o dy we
h ave pi ct u red a so rt o f tr ansver s e divi s i o n o f th e b o dy
E very p ai r Of S pi n al n erve s wi th th e ti ss u e s d ire c t ly u n der
th ei r i nfl u e n c e sh o u ld f o rm i n o u r m i n d s an e ntity a me ch
’
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PR I N C IPL E S
78
O F O S TE O PA TH Y
I t i s re adi ly se e n th at th ere i s an e lem e n t o f p r o te cti o n i n
th i s fact A S light c e n tr al l e mo n 1 e an i nj u ry to the s pi nal
i ts m embr an e s ; o r a p re ssu re le si o n du e to di s e ase o f
co rd
th e b o n e as i n P o tt s di s e as e migh t n o t pr o d u c e c o mpl ete
l o ss o f f u n cti o n i n any s i n gl e m u sc l e b e cau s e th e g o ver n i ng
w o o r m o re
n e rve to th at m u s c l e i s m ade u p o f fib er s fr o mt
c o rd s egm e n t s
I n j u r y o f a S i n gl e Ner v e E x am pl e : P o ste r i o r Tho r aci c
Co mp l ete p ar aly s i s o f a s i n gl e m u scl e i s i nd icative o f
s er i o u s i n j u ry to i t
s g o ver n i n g n e rve at s o m e p o i n t e x teri o r
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.
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.
th e c e n tr al n e rv o u s sy stem ; i n f act b ey o n d th e p o i n t o f
c o al e s c e n c e o f th e fib er s whi c h f o rm it
A S an e x amp le o f i h
j u ry o f a s i n gl e n e rve we m ay t ake a cas e o f p ar al y s i s o f th e
S e r r atu s M ag nu S
Thi s l arge m u sc l e whi c h act s to h o l d th e
p o steri o r b o rd er o f the scap u la clo s e to th e th o r ax wh e n o n e
i s p u sh i n g with the h an d o r wh e n t aki n
n
deep
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a
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g
i s i nn e rv ated by th e p o s te ri o r th o r ac i c n e rve whi c h i s m ade
up o f fib er s fr o m th e u pp er p o rti o n o f th e b r ach i al pl e x u s
to
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P R I N C I PL E S
O F O S TE O PA TH Y
79
i th an d s eve n th c e r v i cals E vi de n t ly an i nj u ry c ap a
ble o f i n v o lvi n g all th e fibe rs o f th e p o steri o r th o r ac i c n erve
an d n o o th er s m u s t b e p eriph e r al to th e p o i n t o f j u n c ti o n o f
i ts fib er s fr o m th e fifth s i x th an d s eve n th ce r v i cals
A p ati e n t c am e to me i n 19 0 1 c o mp lai n i n g Of a p e c u li ar
lo ss o f p o we r o f th e r i ght ar m
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m
r o n th e S an P edr o d o c k s w a s l o s t as a re s u l t
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e
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H e g ave a hi st o ry o f perfe ct h e alth at all
o f hi s c o n dit i o n
t im e s S ai d th at tw o d ay s p revi o u s o n S u n d ay h e had
e r e cted a te n t fo r h im s e lf an d as h e w as tighte n i n g th e g uy
r o p e s h e fe lt a sh arp p ai n u n de r hi s right sh o u l de r b lade
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PR I N C I PL E S
80
O F O S TE O PA TH Y
wh i c h w as i mm edi ate ly f o llo wed by i n abi lity to p u sh with
th e righ t ar m The p ai n w as o f S h o rt d u r ati o n H e d e
i
he
sc ribe d hi s p o s iti o n as a s o m ewh at awkw ard o n e
w as k n e e li n g o n hi s right k n e e f ac i n g o n e o f th e te n t g u y
r o p e p eg s With hi s right h an d gr aspi n g th e w o o d e n clamp
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on
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.
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lo s s
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'
.
th e g u y r o p e h e attempted to dr aw th e g uy r o pe t au t
H i s gre at s tre n gth e n ab l ed hi m to do thi s eve n th o u gh hi s
right h an d w as c o ns ide r ab ly b ehi n d him F ig s 4 an d 5
S h o w th e e ff e c t s o f th e par aly s i s o f th e S err at u s M ag n u s i n
th i s c as e
A s e c o n d c ase pre s e n ti n g e x actly th e sa m e sympt o m s
w as s e e n i n th e c li n i c o f th e P ac ifi c Co ll ege o f O s te o p athy
on
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PR I N C I PL E S
O F O S TE O PA TH Y
81
h o rt ti m e late r A te l eph o n e li n em an whi le e n gage d i n
o l e to p
o l e m ad e a vi g o r o u s aw kw ar d
stri n gi n g wire fr o m
p
p u ll with th e righ t h an d s o m e di st an c e b ack o f hi s hi p H i s
l e gs were e n twi n ed ab o u t th e c r o ss pi e c e s o f th e p o l e
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th e tim e o f gre ate st e ffo rt h e fe lt a severe p ai n u n der the
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wi n e d
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”
.
der f ollo we d by a p r o f o u n d s e ns e o f we ak n es s i n
the s h o ul der an d ar m
The sc ap u la imm e di ate ly t o o k a
wi n g p o s iti o n an d the p atien t c o u l d n o t sh o v e with th e right
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ight
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cas
PR I N C I PL E S
82
O F O S TE O PA TH Y
e rve t aki n g o rigi n fr o m th re e c e rvi c al s egm e nt s The
l e s i o n w as n o t a S p i n al on e i e s u ch as we h ave be fo re d e
sc rib ed
n eith e r w as it o n e i n v o lvi n g th e c e l l s o f o rigi n of
th i s n erve in th e S pi n al c o rd The awkw ard p o siti o n o f th e
p ati e n ts an d th ei r n at u r ally gre at stre n gth Op er ated to in
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p r ac ti c e d by th e j u j it su wre st ler The p re s su r e wh ere th e
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a s evere tr au m a o f th e n erve
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P R I N C I PL E S
O F O S TE O PA TH Y
83
e rve In o rde r to p re s e n t th e sympt o m s acc o mp an yi n g a
c ervi c al l e s i o n o f th e S pi n al l e si o n typ e we wi ll de s c ribe a
i o n fo r a l o n g tim e
A
c as e wh i c h has b e e n u n de r o bs e r v at
w om an 4 1 ye ar s o f ag e ha s b ee n u n de r my p r o fe ss i o n al
A t th e ti m e o f my fir st e x ami n ati o n
c ar e fo r th re e ye ar s
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hm s e e m e d d i sco rd an t everywh ere h e n c e o u r fir st e f
r hy t
f o rt s we re to s e e th at e n vi r o n m e n t w as f air ly n o rm al R e s t
n u triti o u s diet an d an Opti mi s ti c at mo s ph ere s erved to elim
i n ate m an y o f th e irrit ati n g sympt o m s
S he a
,
_
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,
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,
O F O S TE O PA TH Y
PR I N C I PL E S
84
The fi r st e x ami nati o n
th e sp i n al are a di sco vered a
l e si o n betwe e n th e S i x th an d seve nth c e rvi cal ve rtebrae
Th ere w as m u sc u l ar an kyl o s i s co ntr o l li n g thi s arti cu l ati o n
an d any attempted m o vem e n t o f th e wh o l e c e r vi c al are a
su ffi c i e n t to m ake d em an d o n th i s j o i n t
c au s e d p ai n o f a
sh arp n e u r algi c ch ar acter to r adi ate i n t o th e l eft s h o u ld e r
an d ar m
Th i s p ai n co u l d b e p r o d u c ed m o s t e asi ly by eithe r
v o lu n t ary o r p ass ive r o t ati o n o f th e h e ad to th e l eft A p er
si s te n t e ff o rt t
o ro t ate th e h e a d i n thi s dire c ti o n c aus ed t
he
h an d an d ar m to be c o m e n u mb The h an d w o u l d b e co m e
bl o o d le ss co ld an d m o i s t ; p o wer to p i ck u p a b oo k o r c u p
w as gre atly l e ss e n ed
Th e s e symp t o m s w o u ld we ar o ff i n
—
n
twe ty f o u r to thi rty S ix h o u r s bu t th e p ai n W
o u ld l e ave he r
i n alm o st a s t ate o f c o l l ap s e
M as sage o f the ar m and h an d
w o u l d bri ng no re ac ti o n ; h e at als o f ai l e d to sti m u l ate cir
c u l ati o n
Th e s e att ac k s had b ee n b r o u ght o n by any s o rt o f ho u s e
w o rk at fir st o n ly swe epi n g o r su ch w o rk as re q u ire d ar m
L ate r it s e em e d as th o u gh th e att ack s cam e wit h
l ever age
Th ey were acco mp an i ed by se
o u t an y m e c h an i c al re aso n
ve r e h e ad ach e ” t achy car di a m ete o ri sm col d e x tremiti e s
mp er at u re AS might b e e x p e c te d in su ch
an d s u b n o rm al t e
ix e d o n e an d i t
a c as e th e s pi nal l e s i o n pi c t u r e w as a m
ms o f au t o i n t o x i cati o n
s eem ed i n view o f S O m an y sympt o
—
th
gh
th
e
m
id
d o r sal l e s i o n s we re m o re n early p ri mary
o
as
u
th an th e o th er s The s e ns itive n e s s Of th i s S pi nal co l u mn
w as s o gre at an d so m any c o mp e n s ati o n s we r e i n evid e n c e
th at it w as de em ed b e st to attempt at fir st m ere ly to S impl ify
th e sym pt o m co mp l e x as m u ch as p o ss ib l e by giv ing th e
The p ati e nt w
as k ept i n
S pi n al c o lu m n phy si o lo gi cal re s t
b ed th u s red u ci n g th e dem an d o n the weigh t carry i n g f unc
i o n o f th e S p i n e Th i s an d th e p sy ch o l o gi cal i n fl u e n c e o f
t
tryi n g a n e w pl an u n d er Optim i s ti c ci r c u m st anc e s s e r v e d to
re d u ce th e n u mb e r an d c o mp l e x ity o f sympt o m s bu t i n n o
wi se ch an ge d th e ch ar acte r o r vi c i o us ne s s o f th e re acti o ns
ari si n g fr o m any di st u rb an c e o f th e a rti c u l ati o n b etwe e n th e
S i x th an d seve n th c e rvi cal verteb r ae
of
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PR I N C I PL E S
86
O F O S TE O PA TH Y
p o n e ach o th er i n an e ffo r t to ad apt th em se lve s to th i s
A S tim e we n t o n th e wh o l e b o dy w as e n g aged i n a
le si o n
l o si n g e ff o r t at ad apt ati o n s i mp ly be c au s e th e l e s i o n are a
w as n eve r give n phy s i o lo gi c al re st 1 e eli mi n ati n g all de
m an d o n th e w e ig ht c ar r y i n g an d b alanc i n g f u n cti o n s o f th e
j o i nt The m an ip u l ati o n o f th i s S pi n al j o i n t w as also i n th e
~
l
o
a
l
a
u
n at u re o f phy s i o
gi c re st be c se i t red u c e d th e hyp er
te ns i o n an d gr ad u ally ree st ab li sh e d n o rm al f u n ct i o n al m o v e
m e nt s
u
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P
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y
10
a r a l s i s o f th e tr a p e i u s
an d
c l a v i c u l ar
di vi s i o n
of
th e
s te r n o - c l e i d o - m a s to i d d u e to d e a th
som e
of
th e c e n tr a l c e ll s o f
of
th e s p i n a l a cc e s s o r
n e r ve
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.
'
y
In v o lv m e nt o f the C e n t r al
.
Ne r v e C e lls —The
e t s tep
i n S everity i n l e s i o n s i s th e i n v o lv m e n t o f th e c o n te n t s o f th e
S pi n al c an al eith er th r o u gh dire c t i n v a si o n o f th e ti ss u e s o f
o d e str u c ti o n o f s e c ti o n s o f th e
the c o rd o r by p re s su re du e t
The p o i n t we wi s h to i llu str ate is th at th e
S pi n al c o lu m n
di ag n o sti c i an m u st i n o rde r to do sc i e ntifi c w o rk rhak e a
di ag no si s b as ed o n th e f ac t s o f an at o my as i n terprete d by
e mb ry o l o gy I f sympt o m s were n o ted an d i n terprete d with
th e Sam e p re c i s i o n with whi ch th e tr o u b l e m an o n a tel e
”
ph o n e sy stem w o rk s o u t hi s p r o blem s we w o u ld n o t fi n d so
n x
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PRI N CIPLE S
O F O S TE O PA TH Y
87
m any f an t as ti c m edi c al th e o ri es I t i s in large m e asu re th e
ls o f an at o my phy s i o lo gy
f ai lu re to te ac h th e f u n d ame n t a
an d p ath o lo gy i n a t ho r o u gh m ann er th at i s re s p o n s ib l e fo r
h e v ag ar ie s i n m e di c al p r ac ti c e
We ar e n o t f o rgetti n g th e
t
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11
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A
t
r op h
y
of
ri
ght t
r ap e
zi u
s
.
f ac t t hat th e p u b li c i s n o t ed u c at e d to th i s view an d there
f o re th e o n e w ho attempt s to act i rre sp e c tive o f th e p u b li c s
s t ate o f ed u c ati o n has a har d r o w t
o ho e
,
’
,
'
.
C e rv i cal
th e
S err at u s
M u scl e s —In th e fir s t ca se de sc ribed w her ei n
M ag n us w as p ar alyze d we n o te d th at it te
,
-
,
i nn erv ati o n fr o m th e c ervi cal regi o n Th i s m ake s
it a c ervi cal m u s cl e In thi s s ame s e n s e th e tr ap ezi u s an d
l ati s sim u s d o r si ar e ce rvi c al m us c l e s an d wi ll n e c e s sari ly
e n ter i n t o any re acti o ns i n v o lvi n g th e s egm e n t s o f the S pi nal
co rd whi ch give o rigi n t
o thei r n erve s
In o rder to bri n g
to y o u r atte n t i o n so m e o f t he s e p e c u li ar c h an ge s whi c h h ave
c e iv e s
'
i ts
.
.
.
PR I NC I PL E S
88
O F O S TE O PA TH Y
t ake n p lac e i n th e d eve lo p m e n t o f th e b o dy we wil l r evi ew
a few o f th e m o s t n o t ab l e whi ch wil l ai d u s i n th e i n te r r e
p
tati o n o f th e e ff e c t s o f l e s i o n s
E m br y o l o gy —E mbry o l o gy i s th e
hi st o l o gy o f very
”
ay q u e s ti o n h ere wh at c o nt rib u ti o n
y o u n g bei n gs
We m
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t
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12
S h ow s
r ap ez i u s
t
a r o ph
y
of
ri
gh t
.
e m b ry o lo gy has m ad e whi ch has p r acti cal S i g
n i fi c an c e i n th e di ag n o s ti c a
n d th er ap e u ti c w o rk o f o u r p r ae
“
”
ti ti o n e r s
b o r as evi de nc ed
S i n c e we h ave a divi s i o n o f l a
by a v ari ety o f ti s su e s h avi ng s p e c i al f u nc ti o ns an d s i nc e
s e l f pre s erv ati o n fo r p u rp o s e s O
f pe r pe tu ating or g ani sm s o f
a s im i lar c h ar ac te r i s a prim e req u i s ite o f l ife gr o u p s o f ti s
s u e s ar e as so c i ate d i n t o m e c h an i s m s
Co mp ar at i ve embry
o lo gy has h e l p ed u s t
o r ec o g n ize i n p art th e s e m e ch an i s m s
The re co g n iti o n o f th e s egm e n t al arr an gem e nt o f th e b o dy
i s o ne o f th e gre at c o n trib u ti o n s o f emb ry o l o gi st s
th e st u dy
of
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PRI N C IPL E S
O F O S TE O PA TH Y
—
i
E ar ly i n th e d evel o p me n t
m
n
t
t
S e g e a on
.
89
th e em
br y o th e m e so d erm i c c e ll s On eith er s i de o f th e lo n git u di n al
gr o o ve S h o w tr anS v e r s e d ivi si o n s wh i ch f o rm a s eri e s o f s e g
m e n t s c all ed pr o t o ve r teb rae o r m e so derm i c so mite s With
of
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.
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F IG
P
y
1 3;
ar a l s i s
cl e i d o - m a s o i d
.
t
Of
ri
gh t t
r ap e
zi u
s an d
t
p o r i o n o f th e s
t
e r no
.
g o i n g i nt o a l e n gthy d e s c ripti o n o f th e arr an gem e n t
o f th e m e s o dermi c c e lls t
he spi n al co l u m n an d i ts
o fo rm t
m u sc le s we w an t thi s e arly s eri e s o f divi s i o ns kept i n m i n d
“
The app e ar an c e o f th e m e so d ermi c s o mite s i s an im
p o r t an t phe n o m e n o n i n the deve lo p m e n t o f th e e mbry o
he f u t u re str u c t u re o f th e
s i n c e it i n fl u e n c e s f u n d am en t ally t
o rg an i s m
I f e ach p ai r o f m e so dermi c so m ite s b e re g ard ed
as an e l em e n t an d term e d a m et am e r e o r s egm e n t th e
n it
may b e s ai d th at th e b o dy is c o mp o s ed o f a s erie s o f m et a
m ere s e ach m o re o r le ss re s emb li n g i ts fe ll o w s an d Su cc ee d
E ac h so mite di ff ere n
in g o n e an o th e r at reg u lar i n terv al s
tiate s as has bee n s t ated i n t o a s c le r ato m e an d a my o t o m e
an d ac co rdi n g ly
th ere wi ll p ri m ari ly b e as m any ver
te br ae an d m u sc l e s egm e nt s as th ere ar e m e so dermi c
out o ur
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PR I N C I PL E S
9O
O F O S TE O PA TH Y
mite s o r in o th e r w o rd s th e ax i al skel et o n and th e
v o l u nt ary m u s cl e s o f th e tr u n k ar e p rim arily m et am eri c
No r i s thi s all S i n c e e ach m et am ere i s a d i sti nc t u n it it
m us t p o ss e ss i ts o w n s u pp ly o i n utriti o n an d h e nce th e pr i
—
m ary arr ange m e n t o f th e bl o o d ve s se l s i s al so m et am e ri c a
b r anch p as si n g O ff o n eith e r s id e fr o m th e m ai n l o ngit u di n al
An d f u rth e r e ac h p ai r
arteri e s an d ve i n s to e ac h m et am ere
o f m u sc l e s egm e n t s re c e i ve s i t
s o w n n e rve s s o th at th e a r
r an gem e nt Of th e n erve s ag ai n i s di s ti n ctly m et am eri c
“
Thi s m et am eri s m i s m o st d i s ti nct i n th e n e c k an d tr u n k
regi o n s an d at fi r st o n ly i n th e d o r sal p o rti o n s o f th e s e r e
gi o n s th e ve n tr al po rti o n s sh o wi n g m et am eri s m o nly aft er
th e e x te n si o n i n t o th em o f th e my o t o me s Bu t th ere i s c l e ar
evi d e n c e th at th e arr an g em e n t e x te n d s also i nto the he ad
an d th at thi s l ike th e re s t o f th e b o dy i s to be reg ar d e d as
Th e re i s re aso n th eref o re fo r be
c o mp o s e d o f m et am e re s
l i evi n g th at th e f u n d am e n t al arr an gem e n t o f all p art s o f th e
b o dy i s m et am eri c bu t th o u gh th i s arr an gem e n t i s c le ar ly
d efi n e d i n e ar ly embry o s it lo se s di sti n ct n e s s i n latter
p e ri o d s o f d eve lo pm e nt Bu t eve n i n th e ad u lt th e prim ary
m et am e ri s m i s clear ly i n di c ate d i n th e arr an gem e nt o f the
n erve s an d o f p a rt s o f th e ax i al s ke l et o n an d c aref u l s t ud y
fre q u e n t ly reve als i n di cati o n s o f it in high ly m o difie d m u s
c le s an d b lo o d ve ss e ls
“
A lth o u gh th e d erm al m e s e n chym e is u n s egm e n t al i n
o it are se g
c h ar ac ter yet th e n erve s wh i ch se n d br an c h e s t
m e nt al an d it m i ght b e e x p e c te d th at i n di cati o ns o f t hi s co n
diti o n w o u l d b e ret ai n e d by th e c u t an e o us n e rve s eve n in
th e ad u l t A s t u dy o f the cu t an e o u s n erve supply in the
a d u lt re al ize s to a ve ry c o n s i der ab l e e x t e n t thi s e x p e c t ati o n
th e are as su pp l ie d by th e v ari o u s n erve s f o rmi n g m o re o r
l e s s di sti nct z o ne s an d b ei ng th eref o re segm e nt al Bu t a
c o n s i d er ab l e c o rnm i n g li n g o f adj ac e n t are as has al so o c
Th u s wh il e th e di strib u ti o n o f th e c u t an e o u s
c u rred
br an c h e s o f th e f o u rth th o r aci c n erve as dete r m i n e d e x pe r i
m e nt ally i n th e m o n key ( M acac u s ) i s di sti n ctly z o nal o r
s egm e n t al th e n ippl e lyi n g pr ac ti c ally i n th e middl e li n e o f
so
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O F O S TE O PA TH Y
PRI N C I PL E S
’
91
th e z o n e ; th e upp e r h al f o f i ts are a i s al so su ppli e d o r o ver
erve an d th e lo vVe r h alf by
lapp e d by fib er s o f th e th ird n
fiber s o f th e fifth F i g 14 so th at an y are a o f s ki n i n th e
w o se g
z o n e i s i nn erv at ed by fiber s c o mi ng fr o m at l e as t t
‘
.
,
F IG
J
g
,
g
S h ow i n
o v e r l ap p i n
o h n C o m s to c k
( a f te r S h e r r i n
.
14
.
.
m e nt al
of
"
se
gton )
gm
en
t
al
se n sor
y
D r aw n b y
n e r ve s
.
A n d f u rth erm o re th e di s
erve s ( S herri n gt o n )
tr i bu ti o n o f e ac h n e r ve c r o s s e s th e m i d ve n tr al l i n e o f the
m o re o r le ss e x te ns ive c r o s s ed o ve rlap
“
An d n o t o n ly i s there a co n f u si o n o f adj ac e n t are as
but an ar ea may s hi ft i ts p o s iti o n re lative ly to th e deep e r
he same n erve s o th at the sk i n o ver
s tr u c t u re s s u ppl i ed by t
a c ert ai n m u s c l e i s n o t n e c e s sari ly su pp l i e d by fib er s fr o m
th e ne r ve whi c h su pp l ie s the m u scl e Th u s i n th e lo wer
half o f th e ab d o m e n th e s ki n at an y p o i n t wi ll be su pp li ed
by fib e r s fr o m high e r n erve s th an th o se s u pply i n g the u n
de r ly i n g m u sc le s ( S h erri n gt o n ) an d th e ski n o f th e limb s
m ay re c eive twigs f rom n erve s wh i ch ar e n o t rep re s e n ted at
all i n th e m u sc l e s u pp ly ( se c o n d an d thi rd th o r ac i c an d third
n
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—
a
L
No s ki n
are a ( o r i n divid u al m u sc l e ) i s s upp l i ed wh o l ly by fibe r s fr o m
he S pi n al c o rd bu t i n f ac t is i n n erv ate d by
o n e s e g m e nt o f t
a n erv e m ade u p o f fib er s fr o m tw o o r m o re s egm e nt s A
Wi de spr e ad Infl u e nce
S pi n al
of
e si o n
.
‘
,
,
,
.
PR I N C I PL E S
92
O F O S TE O PA TH Y
of
tr au m ati c o rigi n gr anti ng that o n ly o ne ar
ti c u lati o n is i nv o lved wi ll i n fl u e nc e i n s o m e case s wi del y
s ep ar ated s tr u ct u re s
F o r e x amp le : A l e si o n betwee n th e
f o u rth and fifth c ervi c al ve rteb r ae might i n fl u e nc e th e dia
phr ag m lati ss im u s d or si an d t r ap ezi u s an d th r o u gh th e
S pi n al ac c e ss o ry th e m u sc l e s o f th e lary nx
S u ch app are nt
ly wi dely s ep arate d str u ct u re s m u st b e kept i nm i n d wh e n
c o n s i de ri n g a l e s i o n at th e lo c ati o n u n de r di sc u ss i o n
No r
i s thi s e n o ugh b e cau s e s ki n are as m u st b e re c k o n ed with
To le ar n th e s e ti ss u e ass o c i ati o n s thr o u gh the s tu dy
o f an at o my i s q u ite p o ss ib l e
bu t e mb r y o l o gy f ur n i she s an
i nterp ret ati o n wh i ch te n d s to ke ep them in o n e s mi nd
Wh e n we k no w th at th e di aphr agm tr ap ezi u s and l ati s sim us
d o r s i ar e e ss e n ti ally c ervi c al m u s c le s w h i ch h ave m igr ate d
bu t rem ai n u n de r th e c o n tr o l o f c ervi c al n erve s we c e as e to
th i n k o f o n e as th e d ivid i n g w all b etwee n th or ax an d abd o
m e n a gre at m u sc l e o f re spi r ati o n ; th e o th e r s as co n sti tu t
i n g th e fir st layer o f d o r s al m u sc l e s
Ass o ciat i o n o f M u s cl e s Inne r vate d by the S am e Se g
me nt—S u c h str u ct u re s as we h av e j us t m e n ti o n ed have
migr ate d far fr o m th ei r o rigi n al s egm e n t s an d hav e t ake n
o n f u n c ti o n s an d ar e c o n c er ne d i n re ac ti o n s whi ch ar e n o
l o n ge r s egm e n t al but h ave fo r th e 1 r a1m the pr e se r vati o n o f
th e wh o l e b o dy h e n c e any i n j u ry to o n e o r all o f th e m
w o u l d te n d to pr o d u c e a re fle x l o calize d i n th e segme nt f r o m
wh i ch th ey re c eived th e ir i nn erv ati o n Co mpar e w ith t he se
migr ate d str u ct u re s a s egm e nt al m u scl e o f p rimitive char ac
ter like th e i n te r transve r sali s o r i nter s p i n al i s The i n flu ence
1v e m u sc l e s i s wh o lly o n th e o n e arti c u l ati o n
o f th e s e pr 1 m 1t
bu t th ey ar e p art o f th e m e ch an i s m su ppli e d fr o m th e same
The se s m all m usc l e s
s egm e n t as th e m igr ate d m u sc l e s
wh i ch ar e th e i n tri ns i c m u s c l e s o f th e spi nal ar th r o di al
j o i nt s ar e imp o rt an t p rim e m o ve r s i n th e e ffo rt to in aintain
th e ere ct p o s iti o n i e th ey e nte r i nt o th e wei ght carryi ng
l u mn In cas e o f
an d b alan c i n g f u n c ti o n s o f th e sp i nal c o
th ei r i nj u ry a S pi n al le si o n th e lo st m o ti o n i n th e j o i n t
The
c au s e s w ide sp re ad i n fl u e n c e s as h eret o f o r e m e n ti o n ed
S
pi nal l e si o n
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P R I N C I P L ES
94
'
O F O S TE O PA TH Y
th u s d e sc rib ed by M c M u r r i ch : I t m ay b e see n th at th e
c h an ge s wh i c h o cc u r i n th e my ot o m e s m a
b
e
refe
rred
to
y
o n e o r m o re o f th e f o ll o wi n g pr o c e ss e s
“
1
A l o n git u di nal S p litti n g i nt o tw o o r m o r e p o rti o ns
a p r o c e s s wel l i llu str at
e d by th e tr ap ez i us an d ste r no m as
to i d wh i ch h ave di ff ere n t
i ated by th e l o n git u di nal spl itti ng
o f a s i n gl e sh eet an d c o n t ai n th eref o re porti o n s o f th e sam e
my o t o m e s The S ter no hy o id has al so di ff e re nti ated by the
sam e p r oc e ss an d i n d ee d it is o f fre q u e n t o cc u rre n c e
“
2
A t ange n ti al s pl it ti n g i n t o tw o o r m o r e l ay e r s
E x amp l e s o f th i s are al so ab u n d an t an d ar e aff o rde d by th e
m u s c l e s o f th e f o u rth fifth and s i xth l ay er s o f th e b ac k as
re co g n iz e d i n E n gl i sh te x tb o o k s o f an at o my ; by th e tw o
o b l i q u e an d tr an sve r s e la er s o f rt
i
h
b
o
m
n
l
l
l
s
n
a
d
a
a
a
e
d
w
y
by the i n te r co stal m u scle s and th e tr ansv er su s o f th e t ho r ax
“
A f u s i o n o f p o r ti o n s o f su c c e s s i ve my o t o m e s to
3
f o rm a S i n g l e m u scl e ag ai n a pr o ce S S o f fr eq u ent o cc u r
re n c e an d well i ll ustr ate d by th e re c t u s abdo m 1n 1s ( whi c h
i s f o rm e d by th e f u si o n o f th e ve n tr al p o rti o n s o f th e l ast six
he s u p erfi c i al po rti o n s
o r s eve n t ho r ac i c my o t o m e s) an d by t
o f th e ere c t o r sp l n ae
A migr ati o n o f p ar ts o f one o r m o re my o t om e s o ve r
An e x amp le o f th i s p r o c es s i S tO b e f o u n d in th e
o th er s
latiss i m i s d o r s i wh o se h i st o ry has alre a dy b ee n r eferre d to
an d it i s als o be au tif u l ly sh o w n by th e s err at u s an teri o r an d
th e tr ap ezi u s b o th Of wh i ch h ave e x te n d e d far b ey o nd th e
l im it s o f th e seg me n t s fr om whi c h th ey ar e de rived
“
5 A dege n e r ati o n o f p o rti o n s o r th e wh o l e o f a m y o
t o m e Thi s p r o c e s s has pl aye d a ve ry c o n si derabl e p art i n
he ev o luti o n o f th e m u sc u l ar sy ste m i n th e v e r te br ate sl
t
Wh e n a m u s c l e no rm ally dege n er at es it be co m e s c o nve rted
i n t o c o nn e c tiv e ti ss u e an d m any o f th e str o n g ap o n e u ro ti c
o thi s pr o
S h e et s wh i ch o cc u r i n th e b o dy o w e th ei r o rigi n t
Th u s fo r e x ampl e th e ap o n e ur o si s c o n n e c ti n g the
c e ss
o fr o n t al i s IS du e
o c c ipit al an d fr o nt al p o rti o n s o f th e o c c 1pi t
to th i s pr oc e s s an d i s m u s c u l ar i n s u ch f o rm s as th e l o wer
m o n key s an d a g o o d e xam pl e i s also to b e f o u n d i n th e apo
ar e
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PR I N C I P LE S
O F O S TE P O ATH Y
95
e r
i whi ch o cc u pi e s th e i n terv al b etwee n th e s u p e r i o r
an d i n feri o r s er r ati po s ti c i th e s e tw o m u sc l e s b ei n g c o n ti n
u o u s i n l o we r f o rm s
The s tr o n g l u mb ar ap o n e u r o s i s o f the
Obli q u e an d tr ans ve r se m u sc l e s o f th e abd o m e n ar e al so g o o d
e x amp l e s
“
h a m em
I n d eed in co mp ari ng o n e o f th e m amm al s wi t
hégre ate r
be r o f o n e o f th e lo wer c lass e s o f vertebr ate s t
am o u n t o f c o nn e ctive ti ss ue c o mp are d with
am o u n t o f
th e
m u sc u lar ti s sue i n th e f o rm er i s very s triki n g th e i n fere nc e
be i n g th at the s e c o nn e ctiv e ti ss u e str u c t u re s ( f asci ae apo
n e u ros i s lig am e n t s ) r ep re s e n t p o rti o n s o f th e m u sc u l ar ti s
su e o f th e lo wer f o rm ( Bar de le b e n )
M an y o f the acc e sso ry
l ig am
e n t s o cc u r r i n g l n co nn e cti o n wit h di ar thr o di al j o i n t s
app are n tly o w e th ei r o rigi n to a d ege n er ati o n o f m u s c l e ti s
su e
th e fi bu lar later al l igam e n t o f th e k n e e j o i n t fo r i n
St an c e b ei n g p ro b ably a d ege n er ate d p o rti on o f the p er
o n e o u s l o ng u s
wh il e th e s ac r o tu bu r o u s l ig ame n t app e ar s
to s t an d i n a s im i lar r e lati o n to th e l o n g h e ad o f th e bi c ep s
fem o ri s ( S u tt o n )
“
Fi n al ly th e r e m ay b e ass o c i ate d with an y o f th e fi r st
f o u r p ro c e s se s a ch an ge i n th e dire cti o n o f the m u scl e fi be r s
The o rig in al an te r o p o s teri o r di re cti o n o f th e fiber s i s r e
é
tai n e d i n co mp ar ative ly few o f th e ad u lt m u s c l e s an d e x c el
le n t e x a
m p l e s o f th e pr o c e s s h ere referre d to ar e to be f o u n d
i n th e i n ter co s t al m u s c l e s an d th e m u s c l e s o f th e ab do m 1n al
w alls In th e m u sc u lat u re as so c i ate d w
ith th e b a
n c hi al
a r c h e s th e alt er ati o n i n th e dire c ti o n o f th e fib er s o c c u r s
eve n i n the fi sh e s in wh i ch th e o rigi nal dire c ti o n o f th e
—
m u scl e fi be r s 1 8 very p erfe c tly ret ai n e d i n o th er my o t o m e s
th e br an chi al m u sc l e s h o wev er b ei n g arr an ged p ar alle l
with th e b r an ch i al c arti lage s o r eve n p as s i n g d o r s o v e n
he u ppe r an d lo wer p o rti o n s o f an ar ch an d
tr ally b etwe e n t
be r eg arde d as a c o n stri c to r o f th e
s o f o rm i n g wh at m ay
Thi s alter ati o n o f dire c ti o n d ate s b ac k s o far th at
ar c h
th e c o n stri c t o r arran gem e n t m ay we ll b e t ake n as th e pr 1
m ar y co n diti o ns i n st u dyi n g th e ch an ge s wh i ch the br an ch i al
m u s cu lat u re has u n derg o n e i n th e m amm ali a
n u os s
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PR I N C I PL E S
96
O F O S TE O PA TH Y
P l e ase n o te th at si n c e th e re lati o n betw ee n a n erve
an d th e my o t o m e b el o n gi n g to th e s am e i s e s t ab l i sh e d at a
v ery e ar ly p eri o d o f d eve lo pm e n t an d p er si st s th r o u gh o u t
l i fe n o m atte r wh at c h an ge s o f f u si o n splitti ng o r m igr a
ti o n th e my o t o m e m ay u n d erg o it i s p o ssibl e to tr ac e o u t
m o re o r le s s co mp l ete ly th e h i st o ry o f th e v ari o u s my ot o m e s
”
by dete rm i n i ng th ei r s egm e n t al i n n e rv ati o n In vi ew o f thi s
th e c li n i ci an o u ght to b e we ll ve r sed i n the k n o w ledge o f an
th e gr o s s str u ct u re s i nn erv ated fr o m th e sam e
at o my i e
M u ch o f th e phy si c al di ag no st i c w o rk
s egm e n t o f th e c o rd
o f th e o ste o p ath i s b as e d o n th e f u n d ame n t al f ac t s o f em
b ry o lo gy an d an at o my i e m et am e ri s m
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PR I N C I PL E S
O F O S T E O PA TH Y
97
C HAP TE R V I
.
TH E NE R V O U S S Y S TE M
.
The M e di um o f C om mu n i cati o n —A m as terf u l k n o w l
edge o f n erve ti s su e an d its arr an gem e n t i n th e b o dy to f o rm
th e n erv o u s sys tem i s an ab so lu te p rereq u i s ite fo r s u cc e ss
i n o ste o p athi c pr ac ti c e
E very vit al ph e n o m e n o n c alls fo r
i n terp ret ati o n by th e ski llf u l phy s i c i an I n terp r et ati o n c an
n o t b e attempte d with o u t a defi n ite k n o w l edge o f str u c t u re
an d f u n
c ti o n o f th a t ti ss u e whi ch ac t s a s a m edi u m o f c o m
m u n i cati o n b etwe e n all o th er e l eme n t s o f th e b o dy
The nam e o f o u r sy stem O s t e o p athy cal ls atte n t i o n
p rim ar i ly to o s s e o u s str u ct u re bu t it i s o n ly 1n c o nn e cti o n
with i ts e ff e ct s o n th e ti ss u e s o f c o mm u n i c ati o n an d e x
ch an ge vit al ph e n o m e n a we ar e ac t u ally i n tere s ted
The Attr i bute s o f Ne r v e Ti ssu e — A l l phy si o lo gi c al
ph e no me n a ar e ch ar ac te ri z e d by th e m an ife st ati o n o f at
trib u te s o f n erve ti s su e r r i tab ili ty c o n d u c tivity an d tr o
r e th e vit al ph e
hi
i
ti
n
e
n
a
ti
n
n
n
triti
n
a
t
M
o
o
s
o
a
u
o
s
c
d
p
y
The ref o re
n o m e n a wh o s e p er ve r si o n c o n s tit u te s d i s e as e
wh atever the p ath o lo gi c al c o n d iti o n m ay b e we ar e c alled
u p o n to n o te a ch an ge i n s o m e o n e o r all o f th e s e attrib u te s
o f n e r v e ti ss u e
Ne r v e an d M u scl e Ir r it abi l it y — S c arc e ly any th ou ght
o f m u s c l e i s eve r c o mp l ete with o u t th e n erve imp u l s e whi c h
F o r c o nve n ie n c e sake
c o n tr o l s th e m u sc l e i s al s o c o n s idered
we may s ep ar ate n erve an d m u s cl e wh e n te achi n g th ei r S pe
ci al attrib ute s, b u t f o r all pr ac ti cal p u rp o s e s th ey ar e n ever
M u scl e an d n erve ar e b o th i rri t
ab l e bu t we pay
s ep ar ated
n o atte n ti o n to th e i rrit abi l ity o f m u sc l e b e c au s e u n de r n o r
m al co n diti o ns we do n o t s e e an y evi de n c e s o f sp e c ifi c m u s
.
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PR I N C IPL E S
93
c u lar
O F O S TE O PA TH Y
i rrit abi lity We vi ew m u sc u lar i rrit abi lity a s th e r e
s u lt o f n e rve i rrit abi lity
Th eref o re n erve ti ss u e IS th e ch ief
i rrit abl e ti ss u e I r rit abi lity i s an attrib u te o f c e ll pr o t o
pl asm wh e reby ch em i cal an d phy si cal ph e n o m e na ar e e n
acte d i n re s p o n s e to i rrit an t s
I rrit ant s m ay b e m e ch an i cal
c h em i c al th erm al an d e l e c tri c al
P r ac ti c ally all th at phy s i
o lo gi st s k n o w o f th e re acti o n s o f n e rve ti s s u e t
o i rrit an t s has
be e n d erive d th r o u gh e x p e ri m e nt ati o n by m e an s o f th e e l e c
tr i c al c u rre n t
O st e o p ath i s t s ar e bri n gi n g to l ight m an y
f ac t s co n c er ni n g m e c h an i c al s ti m u lati o n H ydr o th er api st s
h ave d em o n str ated th e u ti lity o f th e rm al sti m u l i
D rug
th er apy m ake s u s e o f th e ch em i c al f o rm o f sti m u l ati o n
Nerve ti s s u e 1 5 n o t o n ly i rrit abl e bu t
Co ndu c ti v i ty
p o s se s se s th e ab i lity to tr ans mit i ts i rrit ability to o th er US
o b e i n i ti ate d th ere ;
Co n
su e s an d c au s e c ert ai n ac tiviti e s t
du c ti v i ty th e s e co n d vit al attrib u te o f n erve ti ss u e i s th e
p o wer to c arry imp u ls e s fr o m th e p o i n t o f i rrit ati o n to o th e r
p o i nt s i n th e n e rv o u s sy stem I rrit ability w o u l d b e o f sm all
m o m e n t i f c o n d u c tivity w e r e : n o t pre s e n t to tr an s m it th e
m e s sage to th e c e n ter an d ar o u s e re s p o n s e The n erve c e ll
—
an d i ts ax i s cy li nd er ar e a c o n ti nu o u s m as s o f p r o t o pl asm
wil
l
an d as l o n g as th e c o n ti n u ity i s m ai n t ai n ed co n d u ctivi t
y
be m ai n t ai n ed
—
i
Tr o phi c ty
The th i rd attrib u t e o f n erv e ti s su e tr o
n
h
i
c
l
s
o
o
o
n
o
i
i
v
ery
i
mp
e
rfe
t
y
der
t
d
We
th
i
t
u
d
t
u
s
c
s
s
e
p
y
term h ere to rep re s e n t so m u c h th e n u triti o n al i nfl ue n c e s o f
th e c e ll b o dy o ve r its ax i s cy lin d e r as th e i n fl u e n c e e x erted
by n erve ti ssu e o ver o th e r b o dy ti ssu e s c au s i ng th em to
gr o w an d p r o sp er Th i s n u triti o nal i n fl u e n c e o ver o t her
ti s su e s i s an attrib u te wh i ch we ar e c o mp el led to n o te q u ite
fre q u e nt ly i n p rac ti c e Th ere ar e i n divi d u al s i n wh o m m o ti o n
an d s e n s ati o n ar e n o rm al bu t n u triti o n f ail s h e n c e w e n o te
th at i n so m e c ase s m e ch an i cal l e s i o n s m ay c au s e o n ly a
s light c h an ge i n th e n erve ti ss u e u p o n whi c h th ey imp i n ge
an d th i s ch an ge i s m an i fe s ted by v ari ati o n i n n u triti o n o f
th e p art co ntr o ll e d by th e irrit ated n e rve I t i s p r o b ably
th i s attrib u te o f n e rve ti ssu e whi ch is p erverted o r l o st wh e n
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P RI N C I PL E S
O F O S TE O PA TH Y
99
th e ti s su e s ref u s e to t ake u p c ert ai n ch em i cal e l em e nt s wh i ch
In o st eo
ar e o rdi n ari ly n o rm al to th em ; fo r e x amp l e i r o n
p athi c pr ac ti c e w e c o n s id er n u triti on al d i so rder s as bei n g
the r e su lt o f p erve rted tr o phi c i n fl u e n c e o f n erve s O f c o u r s e
i n cas e s wh ere it i s k n o w n th at th e i n ge ste d fo o d do e s n o t
e n t o r e le m e n t s we m us t r eg u late
c o n t ai n th e req u i red e l e m
th e diet Bu t th ere ar e m any c as e s wh ere all co n di ti o n s ap
pe ar n o rm al e x c ept th at th e ti ss u e s do n o t t ake u p n o u ri sh
m e n t as the y s ho u ld In th e s e c ase s we s e ar ch fo r l e s i o n s
i n the s am e w ay we w o u ld i f m o ti o n o r s e n sati o n sh o wed
p er ve r si o n o r lo ss Thi s ph as e o f o u r su bj e c t can b e st b e
c o n s i dere d at an o th ertim e
—
U ni ty o f the Ne r v ou s S y ste m The u n ity o f th e n erv o u s
an d thi s b ri n g s d e ep an d
s y s tem i s a phy s i o l o gi c al f ac t
E very p o rti o n o f th e b o dy
s u p erfi c i al are as i n c l o se re lati o n
i s ab l e thr o u gh th e medi u m o f th e n erv o u s sy stem to w o rk
P hy s i o lo gi st s divi de the
i n h arm o n y with every o th er p art
bu t
n erv o u s sy s te m i n t o c e n tr al an d pe riph e r al p o rti o n s
fo r p racti c al p u rp o s e s th i s divi s i on i s o f l itt l e u s e to u s wh e n
attempt in g to m ake u s e o f th e irrit abi l ity an d c o n d u c tivity
he n e rv o u s sy s tem fo r th er ap e u ti c p u r po s e s
of t
S i n c e all
he n e rv o u s s y s tem ar e c o n n e c ted th ere m u s t be
p o r ti o n s o f t
so m e p lac e wh e re i mp re ss i o ns m ad e u p o n termi n al n erve
fil am e n t s m ay be as se m b led co o rdi nate d an d re s p o n d e d to
h arm o n i o u s ly Whe rever large n u mber s o f n erve c el ls ar e
as semb l e d we ex p e c t to fi n d s u ch d u tie s p erf o rm ed
O the r S y s t em s o f Inte g r at i o n —An y i n fl u e n c e whi ch we
h ave u p o n th e b o dy th r o ugh th er ap e u ti c m eth o d s m u st b e
b as ed o n th e u n ity o f th e b o dy Th at th e b o dy i s a u n it
m u st b e co n st ant ly b o r n e 1n m 1n d n o t o n ly a u n i t be c au s e
o f th e n erv o u s sy s tem bu t al so a m e ch an i c al u n it f o rm ed by
i ts fibr o u s ti ss u e s an d a c h emi c al u n it th r o u gh i ts c i r c u lati n g
m ed ia The n erv o u s sy st em i s s o p reem i n e n t ly the m aster
t issu e th at Wh e n we th i n k o f an y i ntegr ative r eacti o n we
attr i bu t
e it t
o th i s ti ss u e
whi ch n o t o n ly t ake s n o t e o f i m
pre ss i o n s se c u red by c o n t act bu t re ach e s o u t i n t o su rr o un d
i n g sp ac e an d cau s e s the b o dy to re ac t to thi ng s ata di st an c e
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PR I N C I PL E S
100
O F O S TE O PA TH Y
M e chani cal I r r it ati o n —The p arti c u lar th er ape u ti c
.
r
o
p
with wh i ch we ar e h ere de ali ng ar e aim e d to aff e ct
by c o n t ac t an d h e nc e w e ar e m o st i ntere ste d i n th o se r e
fl e x e s o rigi n ati n g th r o u gh s ti m u li app li e d to ski n vi sceral
an d s o m ati c ti s s u e s
S tr u ct u r al di s p lac em e n t s i n th e h u m an
b o dy ac t as m e ch an i cal i rrit an t s to n erve ti s su e c h an gi n g
th e ch e mi cal an d phy si cal c o n d iti o n o f th e p r o t o p las m an d
th u s alte ri n g i ts i rrit ab i lity eith e r p lu s o r m i n u s acc o rdi n g
The di s pl ac e d str u c t u re s
to th e i n te n s ity o f th e sti m u lati o n
m ay h ave o th er d etri m e n t al i n fl u e n c e s o n n erve ti ss u e f o r
i n st an c e th e p re s su re br o u ght to be ar o n th e n o u ri sh i n g
li q u id s s u rr o u n d i n g th e n erve i e th e b lo o d an d lymph
m ay cau s e s u ffi c i e n t Ch em i c al ch an ge i n th e s e li q u id s to
m ateri ally aff e ct i rrit ability o f th e p r o t o p lasm o f th e n e rve s
whi ch th ey ar e e x p e cte d to n ou ri sh
E ff e c t o n C o n du cti v it y — C o n d u c tivity i s n o t de s tr o yed
by th e se s l ight m e ch an i c al p re ssu re s I f th e p r o t o p lasm o f
th e c e ll an d ax i s cy li n d er were u n ab le to co n d u ct imp ul s e s
an d p r o j e c t th em i n s u c h m an n e r as to re ach o th er c e l l
b o di e s o f th e n er v o u s sy stem o u r w o rk w o u l d b e very lim
it
ed
Co n d u c tivity depe n d s o n th e c o n ti n u ity o f p r o t o plas m
The m e c h an i cal i rrit ati o n s we d e al with i n o ste o p ath i c pr ac
ti c e sel d o m d e str o y c o n d u ctivity If they di d so th ey w o u l d
c e a s e to b e c o m e i rrit an t s th e m o m e n t c o n d u c tivity w as l o st
O th er i rrit an t s m ay act fo r a ti m e o n the s ev ered p o rti o n s o f
p r o t o p las m bu t th e o rigi n al l e s i o n w o u ld h ave de str o yed
th e co n ti n u ity o f th e p r o t o p las m
—
i
e
r
The fiber s co mp o si n g a
r
F
b
s
ff
e
E
e
n
t
Aff e r e nt an d
n erve b u n dl e m ay b e e ff ere n t o r aff e re n t s o far as dire cti o n
E ff ere n t fiber s m ay be f u rth er d if
o f i mp u l s e i s c o n c er n ed
fe r e n tiate d by th e n ame s m o t o r v as o m o t o r s e c ret o ry ac
Aff ere n t fibe r s
c o rdi n g to th e str u c t u re s i n whi c h th ey e n d
ar e u su ally te rm ed s e n so ry to d e n o te th eir f u n c ti o n o f carry
Nerve tr u n k s
i n g i mp u ls e s to th e c e n tr al n erv o u s sy s tem
p re ss u re will
n t ai n al l o f th e s e v ari o u s fib er s th e ref o re
co
i rrit ate all o f th e fib er s an d co n du ctiv ity o f i n divid u al fiber s
wi ll tr an sm it th e imp uls e s i n th e dire c ti o n o f the n o rm al
ce du r e s
.
,
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,
,
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.
.
-
.
.
.
.
,
.
.
-
,
,
,
.
.
,
,
,
P R I N C I PL E S
10 2
O F O S TE O PA TH Y
l nt
em al cut
aneous N
Lesser i n ernal cut
aneousN
-
t
.
.
Ibo hy pogastmc N
1L
to mgu mal N
-
.
-
.
Extcut
aneo u s N
G emto ~cr ur a1 N
.
.
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Anterior
Ob tu r a lo r
su pe r i or gl u tea l
r
N
.
N
.
t
o py ifo r m i s
Nto gemel lus su erior
.
.
p
-
Hto gemellua i nfer ior
N to ouad ratus
.
.
.
F IG
15
p oin
.
.
f
ro
t
D i ag r a m
s
m
ran
gtarri
/ i
of
ri g i n f
th
p i n al
by J hn C
of
e
o
o
s
g lati n b tw n th
th
f
m g n
v
a n d th i
p i nt
p i n al n
lu m n ; a l
th i
th
mu l
d i t i b u ti n t
m t k ( a ft
m di fi d b y
D j in
t Th ma
s p i n al
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se
o
e nt
a
er
s
so
co
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gm
s oc
ti
on ,
sh o
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win
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o
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er
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sc e s
e
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e
ee
e
o
e
.
PRI N C I PL E S
O F O S T E O PA TH Y
10 3
p i nal c o rd imp u l s e s ar e d i ff u s ed b o th ab o ve an d b e lo w th e
p o i n t o f e ntr an c e The c e ll b o di e s o f the an teri o r r o o t s ar e
al s o s o m ewh at di ff u s ed bu t i n p r ac ti c e we n o te th at aff ere nt
an d e ff e re n t imp u l s e s s e e m to b e c o rre late d withi n co mp ar a
H o w th e imp u ls e s
ti v e ly na rr o w li mit s i n th e S pi n al c o rd
se t u p i n th e p r o t o p las m o f an aff ere n t fibe r ar e tran s m itte d
fr o m it to th e p r o t o p las m o f o th e r ce ll s l o cate d i n th e S p i nal
o th e pr o t
o plasm o f e ff e re n t
c o rd an d th e n c e tr an s m itted t
ow n n o r i s it n e c e ss ary fo r u s to th o r o u ghly
c e ll s i s n o t k n
u n der s t an d th e meth od i n thi s i n s t an c e so l o n g as we r e c o g
s
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F IG
16
.
.
D i ag r am
sh o w i n
g
tw o
se
g m nt
e
s
of
th e
S p i nal
co r d
.
iz e th e re s u lt s O u r sp e c ifi c k n o w le dge m u st co mp reh e n d
th e e x ac t p o i n t o f e n tr an c e to an d e x it fr o m th e s pi nal c o rd
o f e ac h n erve b u n d l e an d th e p e riph er al di strib u ti o n o f th e
H avi ng a k n o w l edge o f th e str u ct u re th e f u n cti o n
sam e
c o me s n at u r ally a
s a re su lt
S e gm e ntal Inte g r ati o n — A s egm e n t o f th e S pi n al c o rd
i e th at p o rti o n givi n g ri s e to a p air o f spi nal n erve s m
ay
b e c o n c eive d to act i n de pe n de ntly o f oth er segm e n t s O f
r at
hi s bu t fo r pu r
c o u r se it w o u l d b e di ffi c u l t to de m o n s t
e t
p o s e s o f an aly s i s we m ay b e permitted to s egreg ate th e
v ari o u s divi si o ns an d n erv o u s e le me n t s so as to bette r u n
de r s tan d th e s tr u c t u re s with whi ch we ar e de ali n g
The
n
.
.
,
.
.
,
.
.
,
,
.
.
PR I N C I PL E S
104
O F O S TE O PA TH Y
e ntr al n e rv o u s sy ste m i s co n st an t ly re c eivi n g imp u ls e s
fr o m aff e re n t fiber s an d co o rd i nati n g th em We ar e a l m o s t
e nti rely d ep e n d e nt o n refl e x acti o n fo r th e e ff e ct s we s e cu re
o n d eep ti s su e s
O u r m an ip u lati o n s aff e c t s e n so ry n e rve s i n
c
-
.
.
n er ve
Mu scle
F IG
D i ag r a m m ati c r e p r e s e nta ti o n
D r aw n b y Jo h n
s i m p l e r e fl e x ar c
17
.
.
.
of
a
si n
gl
k
C o m s to c
e
S p i n al
se
gm nt
e
a nd
a
.
ki n m u s cl e an d sy n o vi al m embr an e s Th e se i mp u l s e s ar e
c arri e d t
o th e c e n tr al n erv o u s sy stem an
d tr an s f o rm ed i n t o
e ff e re n t i mp u l se s
C e as e le ss P l ay o f R e fl e x e s —D u ri n g l i fe th ere i s n o
p eri o d wh e n th e b o dy i s no t dep e nd e n t o n e x t er nal stim u l i
Th e se o rdi nary m e ch ani cal an d th erm al stim u li keep a co n
s t an t s tre am o f i mp u l se s e n teri n g th e c e n tr al sy s tem t
o be
tr ansl ated i nt o sti m u li o f m u sc le an d gl an d Thi s c e asel e s s
s
,
.
.
,
.
.
PR I NC I PL E S
1 06
O F O S TE O PA TH Y
defi n ite c u t an e o us are a ar e i nn e rv ate d fr o m a li mit ed po r
ti o n o f th e c e ntr al sy ste m Th eref o re we may co u nt o n th e
o
stim u l i o rigi nated i n th e c u t an e o u s are a bei n g r e fl e x e d t
th e d efi n ite m u scu l ar are a
E x am pl e —An e x am pl e i n p r ac ti c e i s as f o ll o w s : P a
ti e nt s h e ad i s dr aw n S lightly to th e left si de
Co m plai ns o f
p ai n s h o o ti n g to th e l ef t S h o u ld e r and o ve r th e l eft clavi cl e
wh e n ever m o vem e n t i s attempte d H i st o ry o f e x p o su re to
dr au ght o f co l d ai r P hy s i cal e xami nati o n d i sc lo s e s co n
tr ac ti o n o f l eft tr ap ezi u s l ev at o r an g u li scap u l ae an d se a
le ni
P re ssu re u pon th e s e m u sc le s c aus e s p ai n Wh e n i h
i o n p ati e nt say s h e can no t on
str u c te d to t ake a f u ll i ns pi r at
ac c o u n t o f p ai n wh i c h i s sh arp an d d arti n g 1 n c h arac te r an d
r ad i ate s o ve r th e i n tr aclavi cu lar p o rti o n o f the l eft c h e st
Wh e n we co ns ider th e m u sc l e s i nv o l v ed an d th e are a o f
p ai n f u l s e n sati o n s o u r atte n ti o n i s i m m e di ate ly called to a
defi n ite segm e n t o f th e c o rd i n thi s c as e th e p o i nt o f o r i g i n
The c o l d air s tri ki n g
o f th e thi rd an d f o u rt h c ervi c al n erve s
th e ski n i nte n sifi e d th e n o r m al s ti m u li an d th e e ff ere nt i m
p ul s e s fr o m th at S egm e nt o f th e co rd were i nte n sifie d as th e
dire c t r e su lt o f the cu t an e o u s i rritati o n The p o i n t of irrit a
ti o n th e cu t an e o us are a g o ver ne d th e lo cati o n o f th e refl e x
S o l o n g as th e o r igi nal sti mu l u s w as o n ly m o d er ately i mte n
s i fi e d all th e refl e x e s em an ated fr o m o n e s egme n t o f th e co rd
bu t if th ey had b e e n m o r e i n te n s e o r co n ti n u e d lo n ge r w e
might have f o u n d a gre ate r are a r e fl e x ly aff e cted The stim
u li whi ch w o u l d h ave re ac h ed th e c ord w o u l d h ave b ee n
m o r e Widely di ffus e d ab o ve an d b e lo w th e p o i nt o f e n tr anc e
—
m
e
t
i
o
n
n at
S i n c e w e k n o w th at th e
C o m par ati ve S e g
highly o rgan iz ed S p i nal co rd o f m an i s n o t to b e co mpared
with the sam e str u c t u re i n lo we r f o rm s o f an i m al life an d
th at s egm e nt ati o n i n it i s i lly defi n e d th e p r acti cal q u e sti o n
ari s e s as to ho w m u ch dep e n de nc e we c an pu t u p o n refl e x e s
Will th e refl e x e s g u ide u s to
i n th e h u m an n erv o u s sy stem
d efi n ite s egm e nt s o f th e S pi nal co rd ? E x perie nc e te ach e s u s
th at a th o r o ugh k no wl edge o f th e di strib u ti o n o f aff ere n t
an d e ffe re n t n erve s i n m an wi ll i n t erp ret refle x e s with su ffi
a
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.
’
.
.
.
,
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,
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PRI N C I P LE S
o r O S TE O PA TH Y
10 7
i e n t e x ac t n e s s an d i nv ari ab ly le ad th e i nve stig at o r to a
s pi n al s egme n t whi ch i s it s elf aff e cted o r i s co o rdi n ati n g i m
p u l se s fr o m a k n o w n s e nso ry are a
c
.
E ff e r e nt Im pu ls e s
.
—Whe n we f o llo w th e e ff ere n t
im
p u ls e s to their p o i nt s o f di st r ib u ti o n o u r w o r k i s gre at ly
To r e a so n fr o m c o n tr acted v o lu n taf y m u scl e
co mp l i c ated
to c u t an e o u s s e n s o ry are a i s a co mp ar atively s imp l e pro
c e du r e
bu t to s t art with th e se n so ry i mp u ls e an d tr ac e it
thr oug h th e c e n tr al sy s t em an d th e n c e alo n g e ff ere n t p ath
w ay s to estim ate i ts fi n al e ff e ct s as m e ch an i cal w o rk d o n e
by m usc le and g lan d i n m any comb i nati o ns re q u i re s a c o n
si de r abl e k n o w l edge o f s tr u c t u re an d f u n c ti o n o f all p art s o f
the h u m an sy s t
em
h
.
,
,
,
,
.
E ff e r e nt F i be r s to the S y m pathe ti c G angli a
e ff ere n t fibe r s o f th e c e r eb r o spi nal sy stem
.
the
—M any
of
t ake th ei r
c o u r s e th r o u gh th e sy mp at heti c g an gli a an d are di st
r ib u te d
i n th at sy stem to pl ai n m u s cl e an d s e c ret o ry c e ll s o f th e
b o dy I t has b ee n asc e rt ai n ed by v ari o u s caref u l o b s erver s
th at th e se e ff e re n t fib er s after e n teri n g th e s ymp atheti c
he g an g li a n e ar e s t th eir p o i n t o f em er
sy stem eith e r e n d i n t
ge nc e fr o m th e c o rd o r p as s u p o r d o w n to gan g li a ab o v e o r
b el o w th e o n e o r igi n ally e n tered S o m e fiber s p ass th r o u gh
t he se g ang li a an d e n d i n th e m o re p eriph er ally p lac ed
pl e x u se s
-
.
,
,
.
.
.
—Wh ereve
erve c e lls ar e acc u m u
late d a c e rtai n amo u n t o f i n d ep e n de n t ac ti o n i s p r o b ab ly
Te rmi nal fil ame n t s o f e ff ere n t fib er s i n symp a
carr ied o n
t heti c S p i nal gan g li a ar e i n re lati o n with a large n u mb er o f
he n u mb e r o f fiber s l e avi n g th e g an g li a i s gre ate r
c e l l s an d t
t han th o s e e nteri n g Th eref o re di ff u si o n o f imp u ls e s fr o m
t he s e g an gli a m u st b e very gre at The acc u m u lati o n o f
s e n so r y imp ul s e s i n th e s e g an g l i a m ay b e e q u ally as gre at
E ac h g ang li o n m u s t h ave a d o mi n an t in fl u e n c e o ve r a c e r
t ai n vi sc e r al are a an d thi s i n fl u e n c e i s su b si di ary to th e
o an d fr o m
c o n tr o l e x er c i s e d by th e s egm e n t o f S pi n al c o r d t
wh i ch th e large r n u mbe r o f fiber s p r o c e ed
G angli o ni c C o ntr o l
.
r n
"
.
.
.
.
,
.
PR I N C I PL E S
108
O F O S TE O PA TH Y
Gland
Muscle
F IG
.
18
se
D i a g ra m
g m nt ;
.
e
an d
of
th e
.
i nhi
b
ry
an d
i to r
in
s e n so
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m o to r
flu
e nce
fi
elds
of
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r
cc - o d i n a
b
r ai n
.
t
ed
in a
s p i n al
P RI N C I P L E S
1 10
O F O S TE O PA TH Y
diti o n to th e be st adv ant age In o th e r w o rd s i ts r e ac
ti o n s rep re s e nt i ts e ff o rt to m ai nt ai n i ts e x i ste n c e
P lu r i s e gm e ntal C o ntr o l —
J u st as no ski n are a o r mu s
o th e r th an a d i sti n c tly s egm e n t al o n e
c le
d in
as m e n ti o n e
Ch apte r V n o vi sc u s i s wh o lly u n d e r th e i n fl u e n c e o f o n e
s egm e n t
Th eref o re o ne s egme nt i s me rely a co n trib u t o r o f
a p arti al i n fl u e n c e o ve r s ki n m u sc l e and i n ter n al o rg an
O ne
s egm e nt m ay f u r n i s h th e m aj o rit
o f fiber s t
o a c e rt ai n pe r
y
i phe r al n erve bu t c o mp l ete co n tr o l is div ided b etwee n tw o
Thi s S ee m
o r m o re s egm e n t s
hat phy sio lo gi
o i n di cate t
s t
c al c e n ter s i n th e spi nal co rd c o n si st o f s eri e s o f c e lls pl ac ed
ve rti c ally wh o s e fib e r s th u s em erge at v ari o u s l e ve ls Wit h
th i s f ac t in V i ew we re co g n iz e th at any r e acti o n to Sti mu li
ari s i n g i n any o n e o f th e th re e r e c e pt o r fiel ds wil l b e e x
pre ss e d in e ff e ct o r ti ssu e s b el o ngi n g to at l e ast tw o o r mo r e
m et am e re s The ref o r e a ny p r o te ctive re acti o n i n spi nal
are as wi ll i n v o lve m o re th an o n e spi nal ar ti c u l ati o n
—
i
o
e
o
n
Thi s ag r ee s wit h
l
i
i
i
e
r
L
s
s
G up
C n cal E v de nc
th e c li n i c al fi nd i n g s Take S p i nal te n d er n e ss fo r e x ample :
A p o i n t is u su ally f o u n d wh i ch s h o w s co n s ide r able te n d er
n ess an d th i s te d er n e s s sh ade s o ff th r o u gh a m et am e r e
n
ab o ve an d be lo w t
he m o st s e ns itive p oi n t
C o n t r acti o n o f a
he ere ct o r spi nae e x te n d s
S pi nal m u sc l e i e
o f a p o rti o n o f t
o ver t
O s se o u s l e s i o n s ar e u su al ly
w o o r m o re m et am ere s
o f th e gr o u p ch ar acte r
The app r o x im ati o n o r s ep ar ati o n o f
e m e nto f at l e ast
tw o s pi n o u s p r o c e ss e s re pre s e n t s th e I n v o l v
fo u r verteb r ae i e o n e ab o ve an d o ne be lo w the c e n te r o f
th e l e si o n L ikewi se th e l ater al d evi ati o n o f a spi n o u s pr o
c e ss m e ans th e i n v o lvem e n t o f th re e verteb r ae
Thu s w e s e e
th at all r e acti o ns ar e p r ac ti cally pl u ri s egm e nt al i n ste ad o f
s egm e n t al
The verti cal arr an ge m e n t o f the go ve rn i n g C CllS
i n th e S p i nal co rd i s th e f o u n d ati o n fo r thi s
J ust as we
n o ted th e m igr ati o n o f m u scl e s fo r p u rp o s e s o f bette r g uard
i n g o f th e b o dy so al so we no te th at s egme n t s have divid ed
th ei r i n fl u e n ce with adj o i n i ng o n e s
D iff e r e nti ati o n o f S pi nal L e si o ns
v i e w o f the s e
f act s it i s h ard i n f act i mp o ss ibl e to di ff e r e nti at e spi nal le
co n
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,
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,
,
P RI N C I P LE S
o r O S TE OPA TH Y
MOTOR
11 1
S ENS OI
U
S tem mastoi d
-
Diaphr agm
m
pg
i
ast
Abdominal
Gluteal
0 11 11 5
!
5 km fr om
F IG
D g
t b
g
to ar
cocc x.
y
s
m
th e a p p r o x i m ate
19
i a r am an d
a l e sh ow i n
se n sor
s p i n a l n e r v e s o f th e v a r i o u s m o o r
and r e
th e s p i n al c o d
( ow e r s )
.
.
r
.
G
t
.
y
fl
ti
r e la
ex
on
fu n t
c
to
th e
i ons of
PR I N C I PL E S
1 12
O F O S TE O PA TH Y
i
as prim ary o r s e c o n d ary
i e tr au m at i c o r refle x
b ase d o n p alp ati o n o f th e ti s su e s The c h ar ac teri sti c s ar e
q u ite sim i lar b e cau se th e p r o te ctive re acti o n s o f th e b o dy
wh eth e r i n re sp o n se to s tim u li fr o m the e x te ro i n ter o o r
p r o p ri o ce pti v e fi e lds wi ll b e m an ife ste d i n th e e ff e ct o r tis
s u e s m u sc l e an d g lan d
o f th e pl u ri s egm e n t s b e l o n gi n g to
th e re c ept o r fi el d s re c eivi ng th e s tim u li F o r e x amp l e : I rri
tati o n o f th e s ki n o f the b ac k s u ppl ie d by n erve s fr o m th e
s egm e n t s o f th e co rd wh i c h h ave r am i c o m m u n i c an te s c o n
n e c ti n g with th e re n al splan chn i c s m ay p r o d u c e re ac ti o n s i n
A
all th e ti ss u e s g o ve r n e d by th at p lu ri s egme n t al c e n t er
stre am o f c o ld ai r bl o w n o n th i s ski n w h e n it i s wet w o u l d
—
p r o d u c e a pr o no u nc e d re ac ti o n L ikewi s e a co unt er irrit an t
w o u l d p r o d u c e a re ac ti o n In th e c as e o f th e re acti o n to co l d
th e m u scle s u n der thi s ski n are a w o u l d c o ntr ac t Th e r e
w o u ld b e lo st m o ti o n in th e verteb r al arti cu l ati o n s o f th e se
m et am ere s du e to th e hyp erte n sio n o f th e m u sc le s S e n si
ti v e n e s s to p re s s u re an d a fee l i n g o f l am e n e s s w o u ld de
The p r o b abiliti e s ar e th at th e ki d n ey s w o u l d S h o w
v e lO p
m arke d ch an ge in f u n cti o n We h ave k ept ou r r eacti o n s
th u s far i n th e met am ere s wh o s e cu t an e o u s su rf ac e s ar e af
fe c te d b u t c li n i ca
lly we k n o w su ch a c o n diti o n a s thi s i s
he w ho le fighti n g p o wer o f th e b o dy i s
s e ri o u s an d h e n c e t
c al l ed u p o n t
o p r o te c t it fr o m thi s h igh te n s i o n i n a s erie s
o f i mp o rt an t m et am e re s
—
i
F
i
L e s i o ns D u e to F u nct o nal at gu e Le t u s reve r s e th e
pi ct u re an d s t art with a f u n cti o n al di st u rb an c e o f th e ki d
n ey s du e to to o gre at d em an d s o n the m i n e l i mi n ati n g n i tr o g
Th i s f u n c ti o nal f atig u e might pr o
e n o u s w as te m ate ri al
d u c e m u sc u lar c o n tr acti o n p ai n o r te n de r n e s s in th e spi nal
i e the plu r i S egm ent al
are as as so c i ate d by i nn e rv ati o n
are as an d th u s d u p l i c ate all th e ph e n o m e n a m e n ti o n e d i n
The fi e l d o f p r o p ri o ce pti v e i m
o u r p revi o u s de s c ripti o n
pre s si o n s th at i s th e s tr u c t u ral ti ssu e s i n thi s p arti cu l ar
he p o i n t at wh i ch all
p lu ri —
s egm e n t al fi el d m ay likewi s e b e t
th e s e re acti o n s ar e i niti ate d I nj u ry o r f un cti o nal fatig u e
as i s see n i n s tre et c ar m e n wh o s e b ac k s s u ff er fr o m th e c o n
s o ns
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PR I N C I PL E S
114
O F O S TE O PA TH Y
C H A P TE R
VII
.
TH E NE R V O U S S Y S TE M ( Co nti nu e d )
Al i g nm e nt, To ne , R e fl e x e s
—O st e o p ath s
.
me
e x te n t di scard e d su bj e c tive sympt o m s be l ievi n g th at they
ar e o f ve ry d o u btf u l v al u e i n th e l arge p r o p o rti o n o f p ati e n t s
H avi n g di scarde d s u bj e ctive sympt o m s th ey h ave d ev e lo p e d
a m eth o d whi c h give s e q u al o r b etter re s u l t s
I t has thre e
p hase s two o f whi ch ar e str u ct u r al an d o n e wh i c h i s p arti al
ly s u bj e c tive
F i r st in o rde r c o m e s s kel et al alig n m e n t ; s e c
mu s cu l ar t o n e ; th i rd c o n diti o n o f r efl e x e s The s e
o nd
th re e divi s i o ns all co m e u n de r th e ge n er al h e ad o f p alp ati o n
—
As an il lu str ati o n o f th e v al u e o f
Cli ni cal Illu str ati o n
o s u bj e
ct
ive sympt o m s th e fo l lo w?
o bj e c tive i n p re fe re n c e t
The ge n tl em an wh o se
i n g cas e 1 5 o f co nsi de r abl e v al u e
phy s i cal c o nditi o n is pr acti cally i llu str ate d i n F ig s 2 0 and 2 1
w as e x am i n e d i n th e cli n i c Of th e P a c ifi c C o ll ege o f O s te o
p athy H e has bee n o p er ated o n s u rg i cally fo r a p e cu li ar
e n largem e nt j u st ab o ve an
d e x te r n al to th e right k n e e The
H e s t ate d th at h e
l i n e o f th e i n c i s IO n 1s s h o w n i n F i g 2 0
ha
d s u ff ered p ai n at th i s p o i n t d u ri n g m o re th an a ye ar an d
hi s phy s i c i an had de c i d ed th at th er e w as a t u b er c u lo u s co n
diti o n o f th e b o n e The o p er ati o n di d n o t co nfirm thi s di ag
no si s
No u nh e althy ti ss u e Was fo u n d
—W e n o ted hi s p e c u li ar h an d li n g o f th e l eg
Ins pe cti o n h
wh e n w alki n g C omp ared b o th l imb s fr o m to e to hip an d
di sco vered a marked di ff e re n c e i n siz e as i s i nd i c ate d i n th e
ph o t o gr aph B y f o ll o wi n g th e co u r s e o f th e n e r ve s to th e
u sc l e s o n th e right
sp i n al co l u m n we di s c o vere d th at th e m
o th o se o f
S ide o f th e spi n e we re atr o ph ie d i n pr o p o rti o n t
th e e x tremity Fig 2 1 S h o w s th e f act th at th e atr o phi e d
.
,
have , to
so
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PRI N C I PL E S
O F O S TE O PA TH Y
t t g t
y
ty
fl
t b
y t
t
11 5
g t
t
t
m
s
c
l
e
he ri h
s
h
e
o
f
r
o
h
o
f
u
n
a
r
i
ll
s
a
i
u
C
a
s
e
p
F IG
tr o p h i c i n u e n c e o f th e n e r v e c e ll s i n th e
au l
l e g d u e to
Th e s c ar , j u s a o v e th e r i h p a e ll a, i s su
s p i n al c o r d
on e
r r o p h i c c o n d i i o n o f th e
e
h
l
a
t
o
e
r
fi
i
a
c
p
p
.
20
.
f
.
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g t
b
t
.
PR I N C I PL E S
116
F IG
.
21
G
e n e r al
vi ew
g figu
l a ly i n d i at d
nt
i gh t i d
n
.
p r e ce di n
c e
se
re
r
c
o
r
O F O S TE O PA TH Y
e
s
.
.
e
of
Th e
i l lu s
s p i nal
cas e
t
r at
ed
t
on
t
fl x
l ft
c u r va u r e
Pa te ll a r te n d o n
bu t p r e se n
in
re
th e
e
e
.
th e
is
ab
PRI N C I P LE S
1 18
O F O S TE O PA TH Y
q u ite s m all Thi s alo n e m ake s th e co nc l u s i o n
p o ss ibl e th at th e re ar e i n de e d m any se n so ry i mpre ss i o n s
wh i ch arrive at th e sp i nal co rd bu t th at w e ar e aw are o f bu t
few o f th e m at th e tim e All th e vi sc e r a o f the b o dy as the
st ai n i n g m eth o d has di sti n c t ly s h o w n
ar e tr ave r s ed by an
alt o geth e r u n e x p e c te dly l arge n u mbe r o f n e rve s an d their
arr an gem e nt an d co u rs e th e i r re lati o n s to bl o o d ve ss el s an d
g lan d s an d to m u sc le fiber s b o n e s an d e n am el m
ak es it
m o re th an pr o b ab le th at th ere i s i n thi s co n n e c ti o n a large
sy s te m w hi c h s erve s e ss e n ti ally t
o reg u late i m pr e s s i o n s a n d
refl e x a cti o n
—
i
V i sce r al S e n sat o n It i s th e refl e x e s m e n ti o n e d i n thi s
q u o t ati o n in wh i ch we ar e i nte re st e d S e n sati o n an d p er
i o n ar e di s s imil ar
S e n sati o ns fr o m th e vi s c er a ar e c o
ce pt
o rd i n ate d i n f ai rly we l l m arked are as o f th e s p i n al c o rd an d
w he n th e s e se nso ry i mpre s si o n s ar e i n te ns e th e e ff e r e n t
fib er s o f th e spi nal co rd m an ife st th e co n d iti o n e x i st
i ng in a
vi s c er al are a by cau si n g an ab no rm al c o n diti o n o f m u scu lar
Th i s c o n tr ac t u r ed
to n e i n th e i n tri n s i c m u s c l e s o f the b ack
he vi s
co n diti o n o f th e mu s c l e s 1 5 n o t th e o n ly evi de n c e o f t
P re ss u re o n th e co n tr acte d m u scl e cau s e s p ai n
c e r al refle x
The i nte n sity o f th e ae sth e si a Is u su ally i n p r o p o r ti o n t
o th e
vi sc er al irrit ati o n E ve n th o u gh th e p ati e nt d o e s no t say
i n so m an y w o rd s th at th ere IS pa1n o n s light p re ssu re th e
e x ami n e r if hi s p alp ati o n is g o o d c an dete c t the refl e x in th e
ac ti o n o f th e m u s cl e
—
i
m
o
m
D e pe nde nce o n O bje ct v e S y pt s A p atie ntco m e s
to an o ste O path d e s i ri n g tob e e x ami n ed H e d o e s n o t v o u c h
i n f o rm ati o n as to 11 15 c o n diti o n m
ere ly sayi n g
safe any
“
I wan t y o u to e x am i n e m e an d fi nd o u t wh at i s th e matt er
with me
Th i s i s a c h alle nge to th e S k i ll O f th e ex am i n e r
an d c al ls fo r so m eth i n g b e s ide s a l o n g di st anc e cate c hi s i n g
The o s te o p ath p r o c eed s wit h ab
as to s u bj e ctive fe el i ng s
o dete rmi n e th e c o n diti o n o f hi s pat
i e ri ts
s o l u te p re c i si o n t
2
S ke l et al al ig n m e n t
m
u
S
str u c t u ral f o rm ati o n
c
u
( )
lar t o n e an d ( 3 ) s egm e ntal spi n al refl e x E ach yi el d s v al u
The e x am i n er s fi nge r s may devel o p a re
abl e i n f o rm ati o n
n e c ti o ns
is
.
,
,
,
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,
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-
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w
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l
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’
,
;
,
’
.
PRI N C I PLE S
O F O S TE O PA TH Y
1 19
r
d th e si x th d o r sal S pi n e Thi s i s no ted as a refl e x
f r o m th e g as tri c are a Te s ti n g th e s egme n t s ab o ve an d be
lo w th i s wi l l sh o w ho w gre at a s e c ti on o f the co rd i s i r ri
he e x te nt o f th e i n t er nal
tate d an d wil l b e an i n di cati o n o f t
i r r i tati On i e wh eth er o th er p o rti o n s o f the dige stive tr ac t
—
The r efl e x might e x te n d as far asgthe f o u rt h
ar e a ffe c ted
d o r sal an d sti ll i n di cate th e gas tri c are a F i n di ng the refle x
at th e S i x t h d o r s al S pi n e has dire c ted the atte n ti o n o f the
ex ami n e r to the gas tr l c are a an d hasloc ated a p o i n t f ro m
whi c h fu r the r e x ami n ati o n i s to p r o c e ed P e r c ussi o n o v e r
the s t o m ac h w o u ld r e v e al o th e r f ac t s an d th e n the e x ami n a
ti o n w o u ld b e p urs u ed alo n g ge n eral li n e s o f p hy si cal di ag
no si s t
The
o d ete r m i n e the char ac te r o f th e g ast r i c di so r d e r
m o m e n t th e e x ami n e r cen te r s his e x am i nati o n o n the st om
Is n o ta thi s
ach th e co n fide nc e o f th e p ati e n t i s as s u r ed
co n fide n c e g r e atly to b e d e s i r ed i n every cas e ?
Is i t no t a
f o r c e wh i ch co m p e ls th e p ati e n t to f o llo w the di r e cti o n s o f
hi s p hy s i c i an i n m at ter s o f diet and hygie n e ? In t his e x am
l
e
r
ll
e
u
w
i
s
t
ated the at
trib u te s o f n erv e ti ssu e ( 1 )
p
i rri tabi lity ( 2 ) c o n du ctivity O th er c o n diti o n s whi ch m ake
l
m
u
l
th i s
s
c
u
a
o
n
tr
ti
i
r
c
a
c
o
n
n
r
e
( )
sp o n s e t
o n e r ve s tim u lati o n
2
( ) s egm e nt ati o n o f the S pi nal
x
c or d
3
refl
e
ac ti o n
( )
l s t an d
D e pth and E x te nt o f L e si o n s—Fr om the cl i ni ca
m
h
r di n g t
o
a
a
c
h
co
l
e
i
m
b
e
l
a
ss
ified
e
w
t
o
d
e
t
m
o
n
a
c
s
o
s
t
s
p
y
p
an d e x te n t fo r ex ampl e the l e si o n s wh i ch ar e du e to tr aum a
o f so m ati c tl ss u e s i n v o lvi n g o n e sp i n al ar ti c u lati o n w ou l d
b e d eep an d as so o n as the p atie nt i s plac ed i n a p o s i ti o n o f
re st the e x te n t o f th e m u sc ular c o n tr ac ti o n w o u l d gre at ly
de cr e as e Thi s i s n o t the c as e w he n th e l e s i o n i s du e to a
vi sc e r al i rr it ati o n The vi scu s has a plu r I s eg m e nt al c o n
ne c ti o n with th e n e r v o u s s y s tem an d h e n c e the co ntr ac ti o n
te r e x te n t
o f m u s c l e s i n th e S pi n al are a i s u s u al ly o f gre a
The po s iti o n o f r e s t i e r e c li n i n g d o e s n o t u su ally cau se
th e mu scl e s to re lax Thi s S h o w s th at th e c o n tr acti o n i s n o t
he u prig ht p o siti o n b u t a hyp er
a n o rm al e ff o rt to m ai n t ai n t
te n si o n du e to vi sc er al di st urb ance
fl ex
a o un
.
‘
.
“
,
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'
‘
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,
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PR I N C I PLE S
12 0
O F O S TE O PA TH Y
AS so o n as we h ave an
L e s i o n P i c t u r e i n Au t o tox e m i a —
au t o t o x em i a to d e al with o u r l e s i o n p i c t u re i s gre atly e m
large d Thi s i s we ll i ll u s tr ated i n th e v ari o u s m an ife s t ati o n s
o f i n dige sti o n
In s u c h cas e s n o t o n ly l e si o n s i n th e a re as
s egme n t ally asso c i ated
bu t als o ab o ve an d b e lo w wi ll be
f o u n d S o m e c ase s wi ll co mp lai n o f th e wh o l e le n gth o f th e
S pi n e wh i l e th e au t o i n t o x i c ati o n i s at i t
s h eigh t
As th e i n
te n s ity o f th e au t o i n t o x i c ati o n de c re ase s th e l e s i o n are as
b e co m e re stri c ted to th e phy si o lo gi cally a s so c i ate d s pi n al
are as
Thi s i s tr u e i n th e i n fe c ti o n s as we ll The b ac k ac he
i n t o ns i liti s la gripp e s m allp o x e tc ar e we ll k n o w n an d
evi de n t ly no t l o c ate d i n ph y s i o l o gi cally asso ci at ed are as
The ph e n o m e n a o f sp i n al hyp e rte n si o n an d hyp er ae sth e si a
ar e very p r o m i n e n t in th e s e c as e s
No thi n g s e em s to p al li ate
thi s sp i n al c o n diti o n du e to t o x emi a to th e sam e e x te nt as
m an ip u lati o n We s ay p alli ate be cau s e th e t o x e mi a whi c h
cau s e s th e te n s i o n i s n o t o ver c o m e by re l ievi n g th e s pi n al
te n s i o n
L e si o n s In de pe nde nt o f S e gm e ntal R e fl e x e s —A S so o n
as we fi n d l e s i o n s th at s e em to h ave ari s e n i n dep e n d e n t ly of
wh at we can r e adi ly re c o g n ize as s egm e n t al re fle x e s » th ey
m u st b e e x p lai n ed o n the b as i s o f so m e i n tegr ati o n o f the
bo dy o th e r th an n erv o u s Thi s i s th e case i n th e t o x emi as
The c i r c u lati n g m edi a ar e th e i n tegr ati n g fac t or s whi ch e x
pl ai n th e b ac k ach e as we ll as m an y o th er ach e s i n th o s e
c as e s wh ere th ere i s n o vi sc er al i n v o lv e m e n t w hi ch m ay
r eas o nabl y b e ass o c i at ed with th em . I nc r e as i n g elimi nati o n
wi ll u su ally co rre ct th e se sp i nal l e s i o n s du e to t o x emi a
The L e si o n as an E x pr e ssi o n o f S om e F o r m o f Inte gr a
—
An y s pi nal l e s i o n m ay b e an alyzed fr o m s ev er al
ti o n
st an dp o i n t s b e c au s e it m ay be a p arti al e x p re s si o n o f O n e o r
m o re i n tegrati n g f act o r s o f th e bo dy iI e the s tr u ct u r al
The tr au m ati c l e si o n sh o w s it s el f
c i r c u lat o ry o r n erv o u s
i e can be re sted an d l e sse n ed by a
o p o s iti o n
s u bj e c t t
p o s iti o n whi ch m e c h an i cally l e ss e n s the str ai n The l e si o n
du e to n erv o u s i n tegr ati o n is n o t so qu i ckly re li eved by th e
m e an s wh i ch re li eve the tr au m ati c l e s i o n The f ac t th at it
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PR I N C I PL E S
12 2
O F O S TE O PA TH Y
b e cau s e p ai n i s le sse n ed As so o n as th e tu be rcu
lar p r o c e s s sh o w s co nstit u ti o n al sympt o m s th e spi n al l e si o n
pi c t u re v ari e s fr o m m o r n i n g to night th at i s fl u ct u ate s
with th e v aryi n g i nte n s ity o f th e di se as e re ac ti o n s The
p o sitive an d n egativ e ph ase s o f th e b o dy s re acti o n s ar e
As th e di s e as e pr o
re fl e x ly evi d e n c e d i n th e sp1 nal are as
n
l
r e l o s t o r fi br Ou s
r
e
e
a
re
a
o
f
p
u
m
o
n
a
ry
ti
ss
u
e
a
ss
s
a
d
s
s
g
ti s su e f o rm ed with co n s e q u e n t l e sse n i ng i n an ter o po s
te r i o r d i am eter o f th e ch e st an d de c re as ed amp lit ud e o f
th e re s p ir at o ry m o vem e n t s l e s i o n s o f a str u ctu r al ch ar
ac ter app e ar i n th e spi n al a re a s uch as fl atte n i n g o f th e
d o r s al cu rve an d el ev ati o n o f th e an g le s o f th e rib s cau s e d
by th e r o t ati o n d o w nw ard o f th e an te ri o r e x trem iti e s o f
th e rib s i n th e fl atte n i n g o f th e ch e s t The ch ange i n th e
c h e st c au s e s a c h an ge i n th e te n si o n o f th e s cal e n i m
u sc l e s
i n th e n e c k an d i n cas e o n ly on e p u lm o nary ap e x i s i n
v o lve d th ere i s u n e q u al te ns i o n i n th e scale n i o f th e tw
o
s i de s o f th e n e c k
t hu s cau s i ng th e e x te n so r s o f th e ne c k
The ch an ge i n c ervi cal
to e x ert a c o mp e n sat o ry actio n
vertebr al alig n m e nt an d m u s c u l ar te ns i o n co nstit u te s i n
thi s i n s t an c e a spi n al l e s i o n whi ch i s p r o p erly co mp e n sa
t ory an d th eref o re n o t h e lp ed by co rre ctive m o ve me nt s
M any su ch l e si o ns p r o f o u n dl y co mp e nsat o ry i n ch ar ac te r
sh o ul d
re c eive no dire ct co rre c tive m an ip u lati o n S in ce
th ey ar e d ep e n d e n t u p o n t issu e i nv o lv eme n t el sewhere We
m u st m ake o u r di ag no si s fr o m cau se to e ffe ct i n o rde r to
get o u r th e r ap e u ti cs i n right s eq u e n ce
—
hi
n
e
l
a
F
v
e
r
The h e ad ach e
P ai ns Inci de nt to C l
d
n e c k ac he b ac k ac h e an d l e g ache o f chill an d fever ar e su b
ympt
h
T
se
e
o m s p r o m i ne n t i n a h os t o f c as e s
s
i
e
c
t
v
e
j
sympt o m s ar e o f v aryi n g i n te n sity bu t ev e n wh e n n o t c o m
pl ai n e d o f a te n der n e s s i n th e n e c k an d b ack i s re adi ly
e l i c ited by digit al p re s su re As th e fever su b s ide s th e s e
are as o f s e n sitive n e s s to p re s s u re gr o w l e ss an d l e ss sh ow
i n g th atth eir gre at e x te n t i n th e begi nn i n g i s a co n stitu
I t is re adily re co g n ized th at o u r spi nal
ti o nal c o nd iti o n
l e s i o n i n p u l m o n ary t u b er cu lo s i s has change d with e ach
l e sse n s
.
,
,
.
’
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-
,
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,
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,
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,
,
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‘
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,
,
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,
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,
.
O P O STE O PA TH Y
PRI N C I PL E S
i
f
a
T
r
o
a
u
l
s
a
s
h
th
e
di
e
e
hi
bl
tr
e
di
e
s
e
a
e
o
s
s
s
b
o
f
a
l
s
s
p
y
p
h e nc e th ere i s n o fi x e d le s i o n as so c i ate d with any vi sc e ral
o r s o m ati c di s e as e ;
A s lightly v aryi n g s e t o f re ac ti o n s
—
acc omp an i e s e ach
di s e as e p r o c e s s Th e s e re acti o n s ar e
u s u ally tr u e to typ e bu t n o t cap ab le o f c las s ifi c ati o n e x
The o rg an s o f th e b ody ar e i n n e r
c ept i n a ge n er al w ay
mfair ly de fi n ite a r e as o f th e co rd an d we sp eak
v ate d fr o
o f th e s e as n erve c e n ter s
bu t as bef o re s t ate d th e s e c e n
trs co nsis t o f c e ll s plac e d v er ti c ally an d e x te n di n g thr o u g h
s e ve ral
s eg m
e n t s The S p in al l e s i o n s f o u nd i n vi sc er al
—
r
e
a
n
l
e
r
i
di s as e e h e c e p u S egm e n t a
l an d if th ere i s t o x emi a
th ere i s a se t o f l e s i o n s e x pr e s siv e o f t
hi s c o n diti o n su p er
i mp o se d o u th e fir st th e n i n cas e o f de s tr u c t io n o f ti s su e
c o mp e n s at o ry ch an
ge s i n str u ct u re ar e n o ti c e ab le
The
th r e e m aj o r f o rm s o f i n teg rati o n ar e i nv o lve d in any severe
i ll n e ss an d h e nc e th e di ag n o s ti c i an m u st try to s ep ar ate
th e v ari o u s evi de n c e s o f th e b o dy s p r o t ec tive re ac ti o n s
The gre ate r v ari ati o n wi ll b e i n th o s e sy mpt o m s du e to
c ir c u lat o ry i ntegr ati o n
Thi s i s evi de n c e d by th e r api d
c h an ge s i n cas e s o f au t o i n t o x i c ati o n
The l e si o n whi c h i s
c h ar acte riz ed by i ts p e r si s te n c e wi l l b e l o c ated i n th at se
g
m e nt o r segm e nt s m o s t c lo se ly alli ed with th e c e n ter o f
vi s c er al d i st u rb an c e The le s i o n o f sti ll m o re pe rm an en ce
will be th e p rim ari ly tr aum ati c o r s e c o n d arily co mp e n sa
t o ry
The P r acti cal Us e o f Kn ow l e dge —We h ave added
n o th i n g n e w to th e w o r l d s k n o w l e dg e o f n e r ve ti ss u e bu t
we h ave app l ie d ge n er al k n ow ledge o f thi s ti s su e to S p e c ifi c
We h ave t ake n th e re su lt s o f lab o r at o ry e x p erim e nt s
u se s
an d m ade th em p r ac t i c al m eth o d s i n th e dete c ti o n an
d
It app e ar s to u s th at s u ffi c i e n t r e
al l evi ati o n o f di s e as e
s e ar c h w o rk has b ee n d o n e o n th e n e rv o u s sy s tem by m ed
i cal m e n an d S uffi c i e n t ge n er al co nc l u s i o ns dr aw n fr o m
th ei r i n ve stigati o n s to j u stify all br an ch e s o f th e p r o fe ssi o n
The Co r re la
1n m aki n g m o re e x te n s iv e u s e o f s u ch d at a
ti o n o f lab o r at o ry d at a with th e re su lt s o f cli n i cal e x pe r i
hi c di ag n o si s at the
e nc e m ake th e f o u n d ati o n o f o s te O pat
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-
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’
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,
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P RI N C I PL E S
12 4
O F O S TE O PA TH Y
p re s e n t tim e
By thi s b o l d appl i cati o n o f k no wl edge
wh i ch by th e m ed i cal p r o fe s si o n at l arge has b ee n reg ard e d
as S p e c u l ative an d at l e ast i mpr ac ti c ab l e
o st e o p athy has
g ai n e d an imp reg nabl e p o s iti o n i n th e h e al i n g art s
L ab o r at o ri es m ake sc i e nti st s n o t phy si ci an s ; h e n c e
phy s i c i ans h ave n o t alw ay s gr asp ed th e f u ll sig n ifi c an c e
o f th e sc ie n tifi c di s c o veri e s i n phy si o l o gy an d appli ed th e m
to th er ape u ti c s
Wh ateve r o ste o p athy m ay at p re s e n t p o ss e ss or g ai n
i n th e f u t u re i s du e s o l e ly to a c lo s e adh e re n c e to th e f act s
o f an at o my an d phy s i o lo gy ; an d th e appli c ati o n o f th e se
f u n d am e n t al f ac t s to s c i e n tifi c th e rap e u ti c s
.
,
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,
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PR I N C I PL E S
[ 26
F IG
22
th e
.
S
.
s
ch e
m ati c
y m p ath e ti c
r
O F O S TE OPA TH Y
t ti
b
e p r e se n a
an d c e r e
on
ro-
of
S p i n al
th e
c o nn e c
n e rv o u s
s
ti
on s
t
be we e n
yste m s
.
PR I N C I PL E S
m ai n t ai n s it s e lf
”
Br ai n p ag e 55
O F O S TE O PA TH Y
—B yr o n R bi nso n
Abd o m i n al
th e
in
o
.
1-2 7
-
,
.
O r i gi n
'
i
l
o
n
a
a
n
g
g
—The symp ath eti
pp e ar s to o rigi nate fr o m th e
th e p o steri o r r o o t s o f the Spi n al n erve s
.
c a
.
La
te r al G an gl i a — The su b st an c e o f t he sy m pthe ti c
i s co n ve n i e n t ly divi ded i n t o f ou r p o rti o n s :7 ( 1 ) The l ate ral
chains o f g an gli a p lac e d o n e o n e ach s ide o f th e v ertebr al
co lu m n
The c h ai n s ar e c o nn e c te d ab o ve by th e G an g li o n o f
18 0 0
s it u ated o n th e an teri o r c o m
mu n i cati n g arte r y and j o i n ed b e lo w by th e G an g lio n Im
h
a
r
s
i
x
T
s
t
u
a
t
e
o
n
h
n
teri
o
r
rf
e
f
th
e
c
o
cc
y
e
e
o
d
t
e
a
u
a
c
s
p
C h ai n s o f g an g li a ar e
th e c ereb r o s p i n al
c o nn e c ted with
n erve s by we ll m arked c o r ds
—
2
F
P
r
l
n
n
e
t
pr
m
i
e
t
o
u
r
e
r
e
b
r
l
P
e
x
se
s
T
h
n
x
o
v
e
t
a
u
e
( )
agg r eg ati o n s o f n erve ti ss u e ar e th e g r e at p rev ertebr al p l e x
u s e s s it u ate d ve n t r al to the b o die s o f th e vertebr ae
The
fi r st o r P h ar y n ge al i s S it uated ar o u nd th e lary nx The
se co n d
o r Ca
rdi o P u lm o n ar y P l e x u s li e s i n th e th o r ax
The third o r S o l ar P l e x us e n c i r c l e s the C o eli ac Ax i s a
nd
s u p e r i o r m e s e n te r i c arte r y
The f o u rth i s the P e lvi c P l e x u s
v
vhi c h g o ver n
the ge n
er ative o r g an s an d r e ct u m
s
—
h
f
l
i
T
h
o
a
t
ird
rt
th
e
ymp
n
a
a
s
V
i
e
r
l
a
3
sc
a
G
e
g
( )
p
th eti c ti s su e 1 8 co m p o s e d o f t hos e g an g li a p lac ed b etwee n
th e c o at s o f vi s c e r a an d c alled th e p eriph e r al app ar at u s o r
”
“
o
n
so
A u t o m ati c Vi sc e r al G an g li a
R
bi
n )
(
—
i
i
r
A
n
l
n
F
e
s
ll
o
f
th
e
s
e
g
a
g
i
a
n
mm
n
c
a
t
b
a
d
4
o
u
C
i
)
g
(
p l e xu s e s ar e i ntim ate ly co n ne c te d w ith e ach o th er by nu
Th e s e f o ur p art s c o n s tit u te wh at i s
m e ro u s n erve fiber s
The
c o mm o nly k n o w n as th e symp ath eti c n er vo u s sy stem
n erve fiber s i n the symp ath eti c sy s te m c o n si s t o f b o th th e
m ed u llated an d n o n m ed ullated v ar i eti e s i e wh i te an d
g r ay I t is c o mm o nly be li eved th at th e white ar e c ereb ro
s p i n al an d the gr ay ar e symp ath et i c fib er s th o u g h wh et her
th e y be lo n g to th e o n e o r th e o th er sy stem c ann otbe t o ld by
F u n c ti o n mu st al so b e co n s i de r e d
app e ar an c e alo n e
The
fi be r s in the symp ath eti c sy s tem ar e pri n c ip ally o f th e n o n
'
1
( )
'
.
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.
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PR I N CI P LE S O F O S TE O PA TH Y
[ 28
me d
l t ed v ari ety ; h e n c e gr ay fib er s
ul a
th eti c
,
c all
ar e
ed
y mp a
s
.
—The ch ai n s o f the l ateral
g an g li a ar e co nn e cted with th e s p i nal n erve s seri ally by tw o
di sti nc t n e rve b un d le s to e ach gan g li o n Th e s e b u n d les ar e
cal l e d r ami c o m m u n i c an te s
an d are c o mp o s e d o f : ( 1 ) A
b u n d le o f whit e o r c e r ebr o spi n al fib er s p ass i ng fr o m th e
an teri o r an d p o s te ri o r r o o t s o f th e S pi n al n erve s to th e g an
g li o n i n Wh i ch a few fiber s m ay e n d ; bu t th e m aj o rity p ass
o n to b e d i strib u te d to th e prevert eb r al p l e x u s e s
th ereby
givi n g di re c t c o mm u n i c ati o n b etwe e n vi sc er a an d th e spi n al
Th e s e white fib er s c o ns i st o f b o th m o t o r an d s e n s o ry
co rd
—
T
h
s
e
fiber
wh it e r am i c o m m u n i cant e s l e ave th e S p i nal
c o rd b etwe e n th e s e c o n d d o r sal an d se c o n d lu m bar verte
b r ae o n ly M any o f th e fib er s ar e de m e du llated i n the lat
~
e r al
i
a
n
l
a
o
n
th
er
s
ret
a
i
th
eir
h
e
th
f
r
th
e
pre
s
a
a
s
a
a
s
s
;
g
g
v erteb r al p l e x u s e s wh ere th ey als o b e c o m e de m e du llate d
The c e rvi cal regi o n has n o wh ite r ami —
c o mm un i c an te s
Di st r i bu t i on —The n erve s 1n th e s ac r al regi o n wh i ch
co rre s p o n d to White r am i c o m m u n i c an te s p ass to th e V i sc er a
with o u t e n te r i n g the symp ath eti c g an g li a We m ay — S UITE
m ariz e wh at we h ave writte n co n c e r n i n g th e e n di n g s o f the
he lat
white r am i —
c o m m u n i can te s as f o llo w s : ( 1 ) E n d i n t
er al gan g li a ( 2 ) P as s th r o u gh later al g an g li a an d e n d in
p reve rtebr al p le x u s e s ( 3 ) S p lit u p be fo re e n teri n g later al
g an g li a an d s e n d so m e fiber s to th e g ang li a o th er s to g an
l
o w afte r p ass i n g i n t o i ts o w n g an g l i a
i
b
ve
b
e
n
o
a
d
l
a
a
g
—
ti
The white r ami co m m u n i can te s h ave m any
F u nc o n
f u n cti o n s an d th e s e c an b e determi n ed by a clo s e s t u dy o f
di s trib u ti o n an d phy si o l o gi c al acti o n The f u n c ti o n s m ay
b e t ab u l ated appr o x im ate ly as fo llo w s : F i r s t i t has b ee n
—
dem o n str ated th at v aso co n stri ct o r s p as s o ut o f th e c o rd be
twe e n th e s e c o n d d o r sal an d s e c o n d l u mb ar vertebr ae ; se c
e n di n g i n th e lo wer c ervi cal g an
o n d c ardi ac au gm e n t o r s
g li a an d fir s t th o r ac i c gan gl i on ; thi rd m o t o r fiber s to th e
p lai n m u scl e s o f th e i n te sti n e s ; f o u rth m o t o r fib ers to th e
hi r d do r s al an d
s ph i n c te r o f th e i ri s l e ave th e co rd at th e t
W hit e R am i
-
co
mm u n i can t e s
.
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‘
PR I N C I PL E S
[ 30
O F O S TE O PA TH Y
m embr an e s The n e rve s p assi n g fr o m th e late r al gan g li a to
th e p revertebr al p lex u s e s th eref o re co nt ai n white and gr ay
fibe r s h avi n g th e f u ncti o n s o f th e symp ath eti c an d c erebr o
s pi nal sy stem s an d fr o m th e s e p revertebr al pl e x u s e s fib er s
p as s to th e d i st al g angli a i n th e w all s o f th e vi sc er a Th u s
we s e e th at all th e g ang li a o f th e symp ath eti c ar e clo s e ly
c o nn e c t e d with th e c e rebr o spi n al
Th e s e gan g li a de m e du l
late th e s pi n al n erve s wh i ch en ter th em an d m o re fiber s
l e ave th e g an gli a th an e n te r th em Th e s e g an g li a h ave a
tr o ph i c i n fl u e n c e o ve r th e n e rve s wh i c h p ass fr o m th em to
th e p eriph ery Th ey ar e refl e x c e n te r s
.
,
,
,
.
-
.
,
-
.
.
F u n ct i o ns
.
of
the S y
m pat he t i c
Sy ste m
ge n er al it
m ay b e s ai d th at th e symp ath eti c p re s i de s o ver I nv o lu n t ary
m o vem e n t s n u trit i o n an d se c reti o n h o ld s an I mp o rt an t i n
fl u e n c e o ver temp e r at u re an d v aso m o t o r acti o n an d i s e n
"
“
d o wed with a d u ll s e n s ibi lity ? ( R o bi n so n s A b d o m i nal
,
'
In
.
,
-
,
’
In de pe n de n t
—W h eth er th e
D
ac ti o n o f th e
symp ath eti c i s i nd ep e n de n t o r d ep e n de n t i s n o l o n ger s u b
Y
n
on
o u h ave
e
p
erim
e
t
d
i
i
x
n
a
sc
u
ss
s ee n th e
f
o
r
d
e
c
t
j
h e art be at after e x ti rp at io n fr o m th e b o dy ; also th e v e r
m ic u lar m o ti o n o f th e i n t esti n e s Th e s e ar e o ff ered as evi
de n c e s o f i n dep en d e n t acti o n bu t it m u s t b e b o r n e i n m i n d
th at u n der n o rm al Co n diti o n s th e c erebr o s pi nal n erve s c an
i n fl u e n c e th e s e ac tiviti e s eith er rep re ss i n g o r au gme n ti n g
th em
e pe n de n t
or
.
'
.
,
-
,
.
G an gli a —The
g an g li a o f th e symp ath eti c c o n t ai n ( a)
—
n
fi
e
r
a
n
r
b
ff
ere
n
t
fiber
s
c
e
ff
ere
t
b
s
d
a
e
n erve c e lls
a
(
)
( )
th e ref o re g o v er n i n g c e n ter s Th ey ar e ab le to re c eive se n
an d h e n c e
s ati o n an d tr an s f o rm thi s i n t o m o t o r 1m pu lse s
ar e i n a m e asu re i n d ep e n de n t
,
,
.
,
,
.
,
—
The
C e rv i cal G an gl i a o f Im po r tan ce to
c ervi c al p o rti o n o f th e g an g l i ated c o rd c o n t ai n s th ree g an
g li a wh i c h ar e de sig nate d as su p eri o r mi dd l e an d i nfe ri o r
Th e s e gang li a ar e i mp o rt an t to th e
ac co rdi n g to p o s iti o n
O ste o paths
,
.
.
,
P
RI NC I PL E S
O F O S TE O PA TH Y
13 1
te o p at h be c au s e th ey ar e i n a m e asu re aff e cted by dire c t
m an ip u lati o n i e p re s s u re c an b e tran s mitted to th em
th r o u gh th e so ft ti ss u e s o ver the m
-
os
,
.
.
,
.
,
.
—The s u p eri o r c ervi cal
gan g li o n li e s o n th e re ct u s c api tl s an ti c u s m ajo r mu s cl e an d
x u s ar o u nd the i n
s e n d s br an c h e s u pw ard whi c h f o rm a p le
The c aver n o u s
t er n al c ar o tid a rtery ( car o ti d p le x u s )
x
i
x
n
n
l
e
u
a
o
n
i
a
ti
o
n
f
th
i
F
r
o
m
th
e
s
pl
e
u
s
e
m
a
y
u
s
s
c
o
s
s
e
t
p
n
c o mmu n l c at
ln
a
n
n
l
b
r
h
e
ite
with
th
e
r
i
c
a
s
s
o
u
c
a
a
t
s
g
p
—
f
o
n erves o th e c erebr
s pi n al s y stem
C e r v i cal
S u pe r l o r
G an g l i o n
.
.
.
'
”
-
.
ti on s —Thi s g an g li o n i s c o nn e cte d with th e fir s t
f o u r s pi n al n er ve s an d the n i n th te nth an d twe lfth c r an i al
ItS bran ches ar e di strib u te d o n all th e b lo od ve ss e l s o f th e
h e ad and f ac e
C o n ne c
-
.
,
'
.
V as o
-
co n str i c ti on
.
—
P hy s i o lo g i c al e x p e r im e n t
dem
—
v as o c o n stri c t o r i h
th at th i s g an g li o n e x er c i s e s a
he b l o o d ve s s e ls o f th e h e ad
o ve r t
r ate d
o ns t
fl ue nc e
has
and
f ac e
.
The te rmi n al fi lam e nt s fr o m the c ar o
D i s t r i bu ti o n
ti d an d c ave rno u s p l e x u s e s ar e p r olo n ged al o n g the i n ter n al
c ar o ti d artery f ormi n g p l e x
u s e s w hi c h e n twi n e ar o u n d the
c e reb ral an d Ophth alm i c arteri e s ; al o n g th e fo rme r ve s s e l s
th ey m ay be tr ace d i n t o th e p i a m ater ; alo n g th e latter i n t o
th e o rbit wh ere th ey acco mp an y e ach o f th e s u bd ivi si o n s o f
the ve s s e l a s ep ar ate p lex u s p as s i n g with th e arteri a ce n
tr ali s reti n ae i n t o th e i n te ri o r o f the eye b al l
The fi la
m e nt s p r o lo n ged o n to th e an t
eri o r c o mm u n i cati n g artery
f orm a s m all g an g li o n th e G an g li o n o f R ibe s wh i c h Se r ve s
as m e n ti o n ed ab o ve to co n n e c t t
he s ymp ath eti c n erve o f t
he
”
right and l eft s i de
y
t
my
p
ge
a
A
n
o
G
r
a
a
s
(
R e aso n i n g fr o m th e p o s iti o n o f the g ang li o n i n th e
n e c k , i ts di s trib u ti o n to b lo o d ve s s e ls o f th e h e ad an d f ac e
an d i ts v as o Co n s tri c t o r f u n c ti o n s to t
he ve s s e l s we can
—r e adi ly u n d er st an d why m e c h an i cal le si o ns i n th e u pp e r
c ervi c al regi o n c an be th e c au s e o f gr av e p ath o lo gi c al c o n d i
ti o n s i n th e ti s su e s o f th e h e ad an d fac e An ythi n g wh i ch
.
u
-
,
'
,
,
,
-
,
.
-
,
,
,
,
’
.
,
,
‘
,
-
,
-
.
P RI N C I PL E S
[ 32
O F O S TE O PA TH Y
di s t u rb s th e no rm al c i r c u l a
ti o n i n a defi n ite are a wil l n e c e s
sar i ly aff e c t th e n u triti o n o f th e ti ss u e s i n th at are a ; t here
f o re n u triti o n al d i so rde r s o f th e eye ar e f o u n d to b e c aus ed
by s u b lux ati o n o f ve rteb r ae o r co n tr ac ti o n o f m u scle s i n r e
lati o n to th e s u p e ri o r Cervi cal g an gli o n
H e adache — S i n c e symp ath eti c br an ch e s ar e di strib u te d
,
,
.
th e bl o o d ve ss e l s o f th e pi a m ater we m ay re aso nably
e x p e c t to aff e c t th e calib er o f the s e ve ss e ls i n th e case o f
co n g e s t
i v e he adac he by rem o v i ng all o b str u cti o n s —
e
g
c o n tr acted m u s c l e s cau si n g di lat
he active f u n c
ati o n— to t
ti o n i n g o f th e s u p eri o r c ervi c al g an g l i o n
The d i s trib u ti o n
o f th e s e symp ath eti c n erve s to t
he o rbit n o s e ph ary nx
n d s i n u se s
t o n si ls p al ate a
e x pl ai n s th e p o s sibi lity y e s
—
o
p r b abil ity o f a m e ch an i cal l e si o n i n th e u pp e r c ervi cal
regi o n i n th e s e c as e s
—
i
l
i
i
l
n
o
n
The middl e c e rvi cal g an
M i ddl e C e r v ca G a g
to
,
'
'
,
.
,
.
,
,
,
,
.
,
—
,
,
.
s
,
“
gli o n i s th e sm al le st o f th e th ree
I t is p lac e d O pp o site th e
o th e s u p e r i o r
s i x th c ervi c al verteb r a u s u ally u p o n o r c l o s e t
thyr o i d artery ; he n c e th e n am e o f Thyr o id G angli o n as
I t s e n d s br an c h e s to th e fift h and
sig n e d to it by Hal ler
s i x th spi n al n erves
D i str i bu ti o n —
It s e n ds br an ch es to ac co mp any the i n
fe r i o r thyr o id artery to th e thyr o id g l an d wh ere th ey co m
m u n i c ate with th e su p eri o r an d re cu rre n t l ary nge al n e r ves
Th e s e b r an ch e s reg u late th e c al ib e r o f th e i n feri o r thyr o i d
The c h ief n erve tr un k p as si n g fr o m
arte ry an d i ts b r an c h e s
thi s g angli o n is the m i dd le cardi ac nerve The cardi ac aug
—
m e n t o r s le ave th e s pi n al c o rd as wh ite r am i co m m u n i cante s
to th e s e c o n d th i rd an d f o u rth d o r s al g an gl i a th e n p ass u p
w ard to th e mi dd le c ervi cal g an gli o n Th i s gan g li on i s
c o n n e c te d with th e s u p eri o r c e rvi c al g an l i o n
g
.
,
’
‘
.
.
.
,
.
.
.
.
,
,
.
.
—
Th f u n cti
thi s g an gl i o n ar e ( a) v aso
c o n s tri c t o r ( th r o u gh c o n n e c ti o n with th e s u p eri o r c ervi cal
g angli o n ) to th e b lo o d ve ssel s o f th e he ad and face ; ( b )
v aso co nstri ct o r to th e ve ssel s o f the thyr o id gl and ; ( c )
au g me nt o r i nfl u e nc e to th e he ar t
F u nc t i o n
.
e
o ns o f
-
.
PRI N C I PL E S
134
O F O S TE O PA TH Y
—
It has b ee n m e n ti o n ed th at th e c ervi c al
g an g li a re c eiv e n o wh ite r am i c o mm u n i can te s fr o m th e c e r
vi cal n erve s an d th at v as o c o n stri c t o r fib er s pass fr o m c ere
—
b r o s pi n al to th e sym path eti c sy s te m i n th e wh ite r ami c o m
m u n i c an te s betwe e n s e c o n d d o r sal an d s e c o n d l u mb ar ve r
te b r ae ; th e ref o re th e c o n stri c t o r i n fl u e n c e m an ife ste d by
th e c e rvi cal symp ath eti cs i s derive d f r o m th e se co n d thi rd
Th ey d erive fiber s also fr o m th e u pper
an d f o u rth d o r s al
th o r ac i c re gi o n as f o llo w s : ( a) Au gm e n t o r fiber s to th e
h e art fr o m th e s e c on d third an d fo u rth d o r sal ; ( b ) s e c re
t o ry fibe r s to th e saliv ary g lan d s s e c o n d an d th ird d o r sal ;
l
c
u
o di lat o r an
p
pi
d m o t o r fi be r s t
o th e i n v o lu n t ary m u s
( )
c l e s o f th e eye an d o rbit fr o m s e c o n d a
n d thi rd d o r s al ; ( d )
aff e re n t fib e r s wh o s e s tim u lati o n c au s e s activi t
y o f th e v aso
m o t o r c e nt er i n th e m ed u lla
“
—
l
i
i
The th o r ac i c p o rti o n o f th e g an
n
a
Tho r ac c G a g
i
l
a
e d c o rd c o n s i s t s o f a s er i e s o f g an g l i a whi ch u s u al ly
t
g
he
o th at o f th e vertebr ae bu t fr o m t
co rre s p o n d i n n u mb er t
w o th ei r n u mbe r i s u n c ert ai n
o c c as i o n al c o al e s c e n c e o f t
ing
Th e s e g an g li a are p lac e d o n e ach sid e o f th e S p i n e re st
ag ai n s t th e he ad of th e rib an d c o vered by th e p l e u r a c o s
t ali s ; th e las t tw o ar e h o weve r an teri o r to th e re s t b ei n g
e
d
th
e
i
de
o f th e b o d ie s o f th e e l eve n th an d twelft h
n
s
l
o
S
a
c
p
d o r s al vertebr ae The g an g li a ar e Sm all i n s ize and o f a
gr ay c o lo r The fir st large r th an th e re s t i s o f e lo n g ated
f o rm an d freq u e n t ly b le n ded with th e l ast c ervi cal Th ey
—
n e c te d t o geth e r by c o rd like p r o l o n g ati o n s o f th ei r
ar e c o n
In th e th o r ac i c regi o n th e g an g l i a ar e co nn e ct e d
su b s t an c e
—
n
n
o
n
with th e s pi al erve s by b th white a d gr ay r ami co m
m u n i can te s —( G r ay s An at o my p age 8 0 4 i n 19 0 1 E diti o n )
—
i
R am e ff e r e nte s The r ami e ffe r e n te s o r br an ch e s o f
di s trib uti o n ar e d ivid e d i n t o an i n te r n al an d e x te r nal s e t
The e x ter n al br an c h e s ar e smalle r b ei n g di strib u ted to th e
b o di e s o f th e ve rtebr ae an d th ei r lig am e nts The i n ter nal
b ran ch e s m ay p r o p e r ly b e divide d i n t o an u pp er an d lo wer
gr o u p wh i ch a r e di strib u te d to th e vi s c er ao f th e th o r ax an d
abd o m e n
R e capit u lati o n
.
-
-
,
-
,
.
,
.
,
,
-
,
-
.
,
.
,
,
-
,
,
,
-
,
.
,
.
,
.
,
.
”
’
,
.
-
.
-
.
.
,
.
,
.
’
PR I N C I PL E S
O F O S TE O PA TH Y
'
13 5
—
l
The
Gang i a
U ppe r F i v e T
u pp er five th o r ac i c
r e di strib u te d ar o u n d th e u p
g an g li a S e n d br anc he s wh i ch a
p er p o rti o n o f th e de s c e n di n g ao rt a F r o m th e s e co n d third
an d f o u rt h g an g li a ar e giv e n bran c h e s to th e p o s teri o r pu l
m o n ar y p l e x us whi c h co n tr o l th e ti s s u e s of th e l u n g s Yo u
w i ll rem emb er th at the p n e u m o g as tri c n erve s ar e the m o t o r
s e n so ry an d tr o phi c n e rve s to th e ai r p as s age s
The symp a
th eti c s e c o n d to s eve n th d o r s al ar e v as o m o t o r an d tr o phi c
to t
We h ave
he b lo o d vess e ls o f th e ti ss u e s o f the lu n g s
n o w l ai d a fo u n dati o n o f an at o mi c al an d phy s i o l o gi c al f ac t s
u p o n whi c h we m ay b as e o u r p ri n c i pl e s o f tre atm e n t
The
u pp e r th o r ac i c reg i o n i s an imp o rt an t o n e b e c au s e i n it we
fi n d n o t o n ly th o s e white r am i —
c o m mu n i c an te s whi c h ar e
di strib u ted to th e ao r t a an d lu n g s j o i n i n g with the p n e u m o
g ast ri c n erve to co mp lete th e p le x us e s whi ch co n t r o l lu n g
ac ti o n bu t al so th o
s e white r ami —
c o mm u n i c an t e s whi c h as
Ce n d to the c e r vi cal g an g li a and a r e di s trib u te d as f o ll o w s
—
P u pi lo di lat o r fibe r s p ass by
Ne r v e D i str i bu t i o n
r ami co m m uni c an te s fr o m th e fir s t s e c o n d an d t hi rd tho
r ac i c n e rve s asce n d i n th e symp ath eti c co rd to th e su p eri o r
n gl i o n to f0 r m arb o riz ati o n s ar o u n d the c e ll s
c ervi c al g a
The s e gr ay fib er s p ass to th e G as s eri an G an g li o n an d re ac h
th e eye b all by th e o phth alm i c divi s i o n of th e fifth an d lo n g
c i l i ary n erve s ; ( 2 ) m o t o r fib er s to th e i n v o l u n t ary m u s c l e s
o f th e o r bit an d e y e l id s fr o m th e f o u rth an d fifth th o r ac i c
n erve s f o ll o wi n g a s imi lar c o u r s e ; ( 3 ) v aso m o to r fiber s to
th e h e ad s e c ret o ry fiber s to th e s u bm ax i llar y g lan d s an d
pil o m o t o r fiber s to th e h e ad an d ne c k ar e derived fr o m the
u pp er t
h o r ac i c n erve an d re ac h thei r a re a o f di strib u ti o n
after s imi lar i n terr u pti o n i n the s u p eri o r c ervi c al g an g li o n ;
l
4
a
c
th
e
e
er at o r fib er s to th e h e art ar e derive d f r o m th e
c
( )
u ppe r th o r ac i c n erve s an d e n d S im i lar ly 1 n th e mi ddl e an d
l o wer c ervi c al ga n g l i a gr ay fiber s i n the c e rvi c al cardi ac
n erve c o mp l eti n g th e co n n e cti o n —( G e r r i sh s A nat o my
p age
In t e r scapu l ar R e gi o n —The r e fo r e w e h ave an are a e x
te n di n g fr o m the s e c o n d to th e s eve n th d o r sal i n w hi ch we
h o r aci c
.
_
,
.
.
,
‘
‘
i
,
.
.
"
-
,
,
.
i
'
.
,
,
‘
'
,
,
"
.
-
,
,
_ _
.
.
,
é
,
,
,
-
,
,
,
,
~
,
,
’
.
_
,
‘
.
,
.
,
PR I N C I PL E S
13 6
O F O S TE O PA TH Y
m u st m ake c are f u l e x am i n ati o n fo r le s i o n s aff e c ti n g vas o
m o t o r tr o phi c and se cret o ry activity in the th o r aci c vis
c e r a u pp er e x tremiti e s an d str u c t u re s o f th e h e ad f ac e an d
ne ck
Th i s e x p lai n s to y o u why a tre atm e n t i n th e i n ter
s c ap u lar regi o n ha s s u c h far re ac hi n g e ff e c t s
A C as e Illu st r ati n g the C i l i o s pi nal Ce nt e r —A s an i l
lu str ati o n o f th e n erve c o nn e cti o n b etwe e n the c i l i o Spi ii al
c e n t er fir s t
I wi s h to
s e c o n d an d th ird d o r s al an d th e eye
c al l y o u r atte n t i o n t
o a p ati e n t n o w i n th e c li n i c
Th ere
w as e x te n s ive i n fl amm ati o n o f th e c o nj u n ctiv a o f th e right
ey e
sigh t i n th at eye w a s al m o s t g o n e o n acc o u n t o f th e
o p ac ity c au s ed by th e i n fl am m
atl o n of th e co n j u n ctiv a o ver
.
,
,
,
.
-
.
-
.
-
,
,
,
.
,
rt a
1
2
F IG
.
23
.
n e r ve s
r aw n
D
D i agr a m
g v
by J
o
md d o r sa l
’
e r ni n
oh n
sh ow i n
g
g
ne r ves.
g g
an
li o n
g g
an
c i l i o -s
lio n
p i n al
a c c o m m o d a ti o n
C o m s to c
( a er
k
my
b u t) !
ft
cen
th e
S ch u l
of
t
tz )
er
ey e
an d
to
th e
li h
g t
of
cou r s e
and
“
.
t
th e
d i s an c e
.
.
th e c o r n e a Thi s co n diti o n w as p re s e n t fo r five ye ar s The
i n fl amm ati o n had tr ave l ed to th e n asal d u ct an d as a re su lt
it w as clo se d The d u c t had b ee n o p e n ed by th e s u rge o n s
k n ife lo n g bef o re we s aw th e c as e A C lo se e x ami n ati o n o f
th e c e n te r l ike ly to be i rrit ate d i n S u c h a c o n diti o n di scl o s ed
th e fac t th at th e are a be tvif e e n th e fir st an d thi rd d o r sal
vertebr ae w as e x c e e di ngly s e n sitive an d m o st i n tere sti ng
o f all p re ssu re o n th i s are a c au s e d i n te n s e p ai n i n th e i n
—
fl am ed eye an d cau s e d th e p u pi l to dil ate The m u sc l es in
.
.
,
’
.
.
,
,
,
,
.
PR I N C I PL E S
138
O F O S TE O PA TH Y
—
l
D
o
r
s
a
Tre at
to
m e nt i n th e i nte r scap u lar regi o n fir st to s eve n th v ert ebr ae
m ay re aso n ab ly b e e x p e c te d to aff e c t th e h e art be at th e n u
tr i ti o n al c i r c u lati o n i n th e l u n g s an d th e c i r c u lati o n i n th e
u pp e r e x trem iti e s h e ad n e c k an d f ac e
The rem ai n der o f th e d o r s al are a co n stit u te s wh at i s
Thre e s pl an c h n i c n erve s ar e
call ed th e S p lan ch n i c regi o n
give n o ff fr o m thi s regi o n to b e di strib u ted to th e pr e v e r te
br al pl e x u s e s i n th e abd o m i nal cavity
The G r e at S plan chni cs —
The fir s t i s call e d the G re at
S pl an c h n i c an d t ake s o rigi n fr o m th e s i x th to th e te n th do r
s al n erve s an d p r o b ab ly re c eive s m an y fi lam e n t s fr o m th e
u pp e r d o r s al n e rv es
I t i s a lar ge n erve tr u n k an d co nt ai ns
—
m any m ed u llated n e rve s fr o m th e c ereb r o S pi n al sy stem
Its c o u r s e i s d o w n w ard an d i n w ar d p erf o r ate s th e c r u s O f
th e di aphr ag m an d e n d s i n th e s emil u nar g an gli o n S o m e
fib er s e n d i n th e re nal an d s u pr are nal p l e x u s e s
L e s se r S plan chni c — The L e ss er S p lanch n i c ari se s fr o m
th e t en th and e l eve nth gang li a an d th ei r co nn e cti n g co rd
I t also t ak es a d o w nw ard an d i n w ard co u r s e pi er c i n g th e
I
t
an d e n d s i n th e Co el i ac P l e x u s
c r u s Of th e di aph r a m
g
an d so m etim e s
c o m m u n i c ate s with th e Gre at S p l an c h n i c
o th e re n al pl e x u s
s en d s fiber s t
L e ast S planchni c —The L e as t o r R e n al S pl an chn i c
he last th o r ac i c g an gli o n an d e n d s i n th e re nal
ari se s fr o m t
p l e x u s I t so m etim e s c o m m u n i c ate s with th e l e ss e r splan ch
E ff e ct s
Tr e at m e nt F i r s t
of
S e v e nth
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r
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,
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nic
.
—
F ir st v aso co nstri c ti o n ; s e c o n d vi sc er o
F u n ct i o ns
i n hibiti o n I m e nti o n m ere ly th o s e f u n cti o n s whi ch h ave
b e e n we ll dem o n s tr ate d by phy s i o l o gi cal e xp erim e n t s and
o s te o p athi c p r ac ti c e
The o r y —The o ste o path re aso n s as f o llo w s co n c er n i n g
th i s S p lanch n i c are a : S i n c e th e G re at S pl an ch n i c e n d s i n
th e s em i lu nar g an g li o n fr o m thi s g angl i o n an d p le x u se s
ar o u n d it fib er s ar e di strib u te d to th e b lo o d ve s sel s o f th e
l ive r sp l ee n and i n te s ti n e s ; th e ref o re we o p er ate
st o m ach
i n th e are a betwe e n th e fifth an d te n th d o r sal s pi n e s fo r
'
-
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‘
PR I N C I PLE S
O F O S TE O PA TH Y
”
13 9
v aso m o t o r e ff e ct s o n th e ab o ve —m e n ti o n e d vi s c er a A g ai n
th e G re at S p lan ch n i c s e n d s vi sc er o inhibit o ry fib e rs to th e
m u scu lar lay er s o f th e s t o m ach an d i n te s ti n e s ; h e n c e we
c o n tr o l e x c e s s ive m u s c u lar ac tivity i n th e s e vi s c er a by r e
m o v 1n g Ob str u c ti o n s to the n o rm al i nh ibit or y i n fl u e n c e o f
th e s e n erve s » The L e ss er S p lan ch n i c h as
fu nc
i
i
o
r
o
n
o
i
n
h
n
t
a
t
t
i
n
o
o
c
i
e
x
er
i
e
f
u
c
ti
i
efly
n
c
s
t
s
s
h
u
o
s
b
t
s
t
p
th e i n te sti n al m u s c u lar layer c o mpri se d i n the are a su pp l ied
by the s uper i o r m e sen teri c artery ; t he r ef o re th e te n th an d
—
—
e l eve nt h d o r sal are a i s a v aso m o t o r an d m o t o r i n hibit o ry
t o f th e i n te sti n e s The re n al splan ch
c e n te r fo r a s egm e n
n i c s e x e r t a v as o c o n s tri c t o r i n fl u e n c e o n th e b lo o d ve s se l s
n d the o ste o p ath s e c u r e s v as o m o t o r e ff ec t s
o f th e kid n eys a
o n th e b lo o d ve ss e l s o f the kid n ey s an d h e n c e e ff e c t s s e c r e
ti o n by r e mo v 1 n g o b str u c ti on s to th e n o rm al i n fl u e n c e o f
thi s n erve
r k s a re n al c e n ter
The s e
The t w e lft h d o r sal spi n e m a
n erve s c o n t ai n s e n so ry fib er s w
h i ch c arry se n sati on f ro m
the p r e ve r tebr al p lex u s l n th e abd o m e n to the sp i n al co r d
Theref o re a di s t u rb an c e i n the vi s c er a c an r efl e x i ts p ai n f u l
s e n s ati o n s t
o t he ar e a o f gre ate r s e n s ibi lity whi c h i s i n c l o s e
it
h the s e at o f di st
u rb an c e
C e nt r al c o n n e c t io n W
I t sh o u ld b e b o r n e i n m i n d th at th e p o we r o f m o vem e n t
re s ide s i n th e m u sc u lar w all o f the i n te s ti n e an d i s in iti ated
by the A ut o m
ati c G an g li a in i ts w al ls whi c h ar e e x c ited by
th e pre ss u re o f f o o d W e m ay st ate th at th e i n
te s ti n e s po s
ri n s i c n e r ve app arat u s whi c h i n iti ate s p eri st als i s
s e s s an i n t
bu t th e co n tr o l o f th e m o v em e n t after i t i s i n it iated i s e x e r
—
The p n e u m o g as tri c n erve
c i s e d by c ere b r o sp i n al n erve s
e x e r c i s e s a d e c i de d m o t o r i n fl u e n c e o ver th e i n te sti n e s
A S p revi o u s ly s t ated th e gre at a n d l e ss er s plan c hn i c s ar e
i n hibit o ry n erve s to th e m u s c u lat u re o f th e i n te s ti n e s
—
L um bar G an gli a F o u r sm all g ang li a co n n e c ted ab o ve
i n ter c o mm u n i cati n g fiber s c o n s titu te the
an d b e lo w by
l u mb ar p o rti o n o f th e symp ath eti c g an g li a The se gan g li a
ar e co nn e c te d with th e c erebr o S pi n al lu mb ar n erve s by
r ami c o mm u n ic an te s The fir st an d s e co n d g an g li a ar e th e
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‘
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'
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-
-
f
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P RI N C I PL E S
140
O F O S TE O PA TH Y
—
o n ly o n e s i n th i s regi o n re c eivi n g white r ami c o m m u n i
The f u n cti o n s wh i ch we f o u n d were e x er c i sed i n
can te s
th e lo wer d o r sal are a ar e c o nti n u e d i nt o th e lu mb ar g an gl i a
as far as th e s e c o n d
Th e s e g an g li a s e n d fi be rs to th e ao rti c
pl e x u s th e hyp o g astri c p le x u s an d th e n c e to th e p elvi c
pl e x u s Th ey also se n d br an ch e s as i n o th e r regi o ns to th e
bl o o d ve s se ls su pp lyi n g th e b o n e s an d ligam e n ts Of th e
S p i nal c o l u m n
S i n c e v aso co n s tri c t o r fiber s do n o t e n ter the symp a
th eti c g an g li a b el o w th e se c o n d l u mb ar we may re aso nably
e x p e ct to i n fl u e n c e th e c i r cu l ati o n o f th e lo we r e x tre miti e s
by m an ip u l ati o n s i n th i s are a
The de sc e n di n g c o lo n and re ct u mar e su pp lie d with v i s
c er o i n hib it o ry fi be rs fr o m thi s are a
V aso co n stri ct o r fib er s
ar e su pp li ed to th e b lo o d ve s s e ls i n th e l o we r p o rti o n o f th e
The i n fl u e n c e e x erte d by th e l u mb ar symp a
ab d o m e n
th eti cs m ay b e t ab u lated as f o llo w s
l st: Vi sc er o i n hibit o ry to de sc e n di n g co lo n an d re ct u m
2 n d : V aso c o n stri c t o r to lo wer ab d o m i n al bl o o d ve s sel s
—
3 r d : V aso c o n s tri ct o r to the bl o o d ve s sel s o f th e p eni s
4 th : V as o m o t o r fiber s to th e bl o o d ve s sel s o f th e bl ad
.
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-
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-
5th : V aso
u
ter u s
-
m o t o r fib er s
to
th e bl o o d ve s sel s
of
th e
.
V aso
6 th :
-
tri ct o r
th e bl o o d ve s sel s
to
co n s
of
th e p elvi c
vi sc er a
.
7 th : M o t o r to
fem
a
l
e
)
(
defere n s ( m al e )
v as
,
r o un d
lig am e n t
.
8 th : V aso
e x tremitie s
-
co n s
th e b lo o d ve s sel s
to
of
th e
l o wer
—
Th p elvi c p o rti o n Of th e symp ath eti c
i
.
S acr al
tri ct o r
G an gl a
e
h ai n u s ually co n s i st s o f f o u r g an g li a s it u ated al o ng th e
i nn er sid e o f th e s ac r al f o r am i na an d co m m u n i c ate s with
th e fo u r u ppe r Sac r al n e rv e s Th e se g an g li a ar e c onn e cted
with e ach o th er as i n o th e r regi o n s The tw o ch ai n s co n
he G an g li o n I mp ar o n th e an teri o r s u rfac e o f th e
n e e t by t
c o c cy x
c
-
,
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,
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_
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O F O S TE O PA TH Y
PR I N C I PL E S
142
The
rdi ac n e rve s fo rm th e c ervi c al symp ath eti c ch ai n ;
all e n te r th e c ardi ac p l e x u s b u t th ei r di s trib u ti o n i s v ari a
The su p e rfi c i al p le x u s re c eive s th e l eft su pe ri o r car
ble
d i ac n e rve o f th e symp ath eti c an d th e l eft i n fer i o r c e rvi c al
”
—
M
o
o
s
A
n
a
rdi
br
n
h
th
e
p
n
e
m
g
a
s
tri
c
rri
s
t
ca
ac
a c
of
u
(
ca
,
.
’
.
o
my )
The
.
d e ep c ardi ac p le x u s re c eive s al l th e o th e r cardi ac
”
n erve s
F r o m th e s u p e rfi c i al c ardi ac p l e x u s br an ch e s p as s
to th e p l e x u s ar o u n d th e right c o r o nary artery an d p ass to
th e left lu n g to j o i n th e an te ri o r p u l m o nary p l e x u s
F r o m th e d eep c ardi ac pl e x u s b r an ch e s ar e di s trib ute d
to th e an t eri o r p u lm o nary p l e x u s o f b o th s id e s th e l eft c o r o
n ary pl e x u s
right au ri c le S u p erfi c i al c ardi ac p l e x u s an d
righ t co r o nary pl e x u s
.
.
,
,
,
,
.
P u lm o nar y P l e x u s —The an te ri o r p u lm o nary p le x u s i s
f o rm e d by a b r an ch o f th e p n e u m o g as tri c and th e symp a
th eti c I t i s s it u ate d o n th e an te ri o r su rf ac e Of th e br o n ch i
an d th e b r an c h e s e n te r th e lu n g o n th e br o n c h u s
The p o steri o r p u l m o n ary p l e x u s i s f o rm ed by th e p n e u
m o g as tr i c an d fiber s fr o m th e se c o n d t hi rd an d f o u rth tho
r ac i c gan g li a o f th e symp ath eti c Its b r an che s enter th e
lu n g o n th e p o s te ri or aspe c t o f th e br o n c h us
.
.
‘
,
.
.
—
P hy si o l o gy
P hy si o lo gi c al e x p eri m e n t s h ave d em o n
r at
e d th at th e pn e u m o g as t
r 1c 1 5 m o t o r t
he m u s c le s o f
st
o t
th e br o n chi o le s s e n so ry an d tr o ph i c , wh i l e th e symp ath eti c s
—
Theref o re th e f u ncti on o f th e
ar e v aso m o t o r an d tr o ph i c
l u ng s an d h e art c an b e aff e c te d by Op er ati n g o n th e i n ter
s c ap u la r regi o n
'
.
.
,
,
.
.
—
The f u nc ti o n s o f th e th o r ac i c pl e x u s ar e
F u n cti o n s
l s t: Cardi ac au gm e n t o r s p er symp atheti c s
2 n d : C ardi ac i nhibit o r p er p n e u m o g astri c
3 r d : V as o co n stri c t o r to c o r o n ary art e rie s p e r p n e u m o
g astri c
4 th : V aso c o n st ri c t o r to br o n chi al arteri e s p er symp a
th eti c fir st to fifth d o r sal
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,
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-
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P R I N C I PL E S
OF OS
TEO PA TH Y
14 3
fib er s to the p le u r a an d lu n g s p er s y mp a
th eti c fir s t to fifth d o r sal
oth : S e n s o ry fiber s to h e art an d p eri c ardi u m per sy m
p ath eti c s e co n d to fifth d o r sal
7 th : Br o n ch o —
c o n s tri ct o r p e r p n e u m o g astri c
—
8 th : Br o n ch o di lat o r p er p n e u m o g astri c
9 th : S e n s o ry fiber s to m u c o u s l i n i n g o f air p a ss age s
per p n e u m o g as tri c
5th : S e n so ry
,
,
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,
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,
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;
,
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,
.
Tr e atm e nt— A
i n hibit o ry tre atm e n t w o u l d pr o
d u c e gre at e st e ff e c t o n th e h e art if admi n i stered o ver th e
mi dd l e an d i n feri or c erv ical g an g li a The h e art w o u ld b e
slo wed
S u ch a t re atm e n t i s r are ly give n b e cau s e ne ar ly
eve ry c as e p r e s e n t s s o m e phy si c al l e s i o n wh i ch if rem o ved
allo w s n o rm al imp u ls e s to m eet i n the c ardi ac p l e x u s an d
be r e o rgani z e d fo r pr o p e r d i strib u ti o n
A lw ay s be ar i n mi n d th at a p l e x u s i s a r e o r g an IZ In g
o reg u
c e n ter f o r n erv o u s imp u l s e s an d we c an h o p e o n ly t
late th e f u n cti o n o f an o rgan by attempti n g to e q u al iz e th e
Thi s e q u alizi n g
i m pu ls e s r e achi n g i ts c o n tr o l li n g p l e x u s
p r o c e ss i s n o t o rd i n ari ly s e c u re d by th e admi n i s tr ati o n o f
i nh ibiti o n to a defi n ite n erve tr u n k whi ch e n d s i n th e p l e x u s
—
—
u s u ally b o n y o r m u s c u l ar
but by r erif o v fng a l e s i o n
whi c h i s aff e c ti n g th e n erve fiber i n th e dire c ti o n Of i n c re ase
o r d e c re as e Of f un c ti o n
The regi o n b etwe e n th e s c ap u lae is i n cl o s e c e n tr al
g s p le u r a h e art an d p eri c ardi u m ;
con n e c ti o n with th e l u n
h e n c e p ai n f ul se n s ati o n s o rigi n at in g i n th e s e o rgan s m ay b e
refe r red to thi s are a The m u scle s i n thi s a re a wi ll co n tr act
r e fl e x ly fr o m i r rit ati o n o f th e s e o rg an s o r fr o m e x p o s u re o f
th e S ki n o ver th em to a c h an ge Of t e mp er at u re H e n c e i n
th e fir s t i n st an c e th e co n tr ac ti o n i s a s e co n d ary l e s i o n ; i n
th e latte r a prim ary o n e
P re ss u re i n thi s are a p r acti c ally cau s e s re lax ati o n o f
o ve s a l e s i o n ; bu t th e p ati e n t e x p e ri e n c e s a
m u sc le s re m
c e ss ati o no f p ai n freer re s pi r ati o n an d l e s s r ap id ac ti o n Of
’
tr u e
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‘
‘
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'
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the he ar t
'
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,
PR I N C I PL E S
144
O F O S TE O PA TH Y
R e su lt s —
After admi n i ste ri n g i n hibit o ry p re ssu re th e
o ste o p ath re alize s t hat th e m u s c l e s u n der hi s fi n ger s ar e
so fte r th an f o rm e r ly ; th e n h e k n o w s th at h e has ac t u al ly
ch an ge d th e phy s i o lo gi c al c o n diti o n o f an i mp o rt an t t i ssu e
,
.
.
—
Ar g u m e nt Co i n c i de n t with th e
fte n i n g o f th e m u s
h e has rem o ved an
c l e s th e h e art b e at
s s lo wer ; th eref o re
i rrit an t to th e au gm e n t o r fibe r s o f th e h e art ; th e re spir ati o n
i s d e ep er th eref o re a c h an ge has b ee n s e c u red i n the ac
ti v i ty o f th e w alls Of th e th o r ax an d in th e c i r c u lati o n o f
b lo o d i n th e br o n chi al an d p u lm o nary b lo o d ve s s el s ; th e
p ai n has de c re as ed th eref o re th e s e n so ry n erve s i n th e l u n g
ti ssu e ar e n o l o n ge r i rrit at e d by hy p eraem i c pre ss u re o r
t o x i c s u b st an c e s i n th e bl o o d Th i s i llu st rate s to y o u why
th e o ste o p ath s t u di e s an d tre at s the i n ter s cap u lar regi o n S O
c aref u lly
so
,
,
'
,
,
,
.
.
P l e x u s — In the ab d o m i nal cavity we fi n d th e so
lar p l e x u s whi ch o n acco u n t o f i ts gre at s iz e and w o n d erf u l
”
di s trib u ti o n Byr o n R o bi n s o n call s th e Abd o m i nal Br ai n
S o l ar
,
,
.
—
It i s pl ac ed i n fr o n t o f th e
L
ti
ao rt a at i ts e n tr an c e i n t o th e ab d o m e n an d su rr o u n d s the
C o e l i ac Ax i s
I t co n s i st s o f tw o s em i lu n ar g an g li a whi ch
ar e p lac ed o n e ac h s i de o f th e c o eli ac ax i s an d ar e c o nn ec te d
by a large n u mber o f fib er s whi ch p a
s s ab o v e and b e lo w th e
c o e li ac ax i s
F r o m th i s c i r cl e o f g an g li a an d n erve s fi ber s
ar e give n O ff whi c h ar e j o i n e d by br an c h e so f the right p n e u
m o g as tr i c an d by b o th s m al l s plan chn ic s
t
The gre a
s pl an c h n i c e n d s i n th e s em i lu n ar g an gl i o n
on
o ca
nd
F o rm ati o n
a
.
,
’
.
,
,
.
,
,
.
.
D i s t r i bu ti o n —The br an ch e s o f di strib u ti o n fr o m th e
so lar p l e x u s ar e p r o lo n ged o n th e br an ch e s o f th e abd o mi n al
ao rt a as su b s id i ary p l e x u s e s taki n g th eir nam e s fr o m t
he
arte rie s th ey ac
g astri c h ep ati c dia
as S p l e n i c
c o mp an y
h
r
m
i
a
a
t
n
i
n
p
r
re
re
l
p
eri
r
m
e
e
teri
c
s
u
a
n
a
l
n
s
u
o
s
c
n
a
d
a
p
g
fe r i o r m e s e nteri c ao rti c an d S p erm ati c
The ultim ate di s
tr i bu tio n o f th e br an
he m u s
o t
ch e s o f th e so l ar pl e x u s i s t
cu lar an d s e cr et o r y ti ssu e s o f all t
he abd o m i nal vi sc e r a and
.
,
,
,
,
,
,
,
,
,
.
,
146
PRI N C I PL E S O F
OS TE O PA TH Y
Th es e g an g li a m ay re c ei ve fib er s fr o m
per d o r sal
so
me
th e
of
up
.
“
—
The f ac t s j u st st at ed giv e u s a f o u n d ati o n
C e nte r s
fo r o s te o p ath i c tre atm e n t to i n fl u e n c e m oti o n se n sati on S €
c reti o n
an
d v aso m o ti o n in
vi sc er a The
are a i n th e verteb r al c o l u m n whi c h we m ay c o n si der a s c o n
t ai ni n g c e n ter s fo r th e s e v ari o u s f u nc ti o n s li e s b etwe e n th e
s i x th and e l ev e n th d o r s al s pi n e s The fib er s fr o m thi s regi o n
have a s egm e n t al di s trib u ti o n to th e ab d o m i n al vi sc er a ;
th erefo re th e s t o m ach live r g all bl adde r s p le e n an d in
te sti n e s e ac h h ave a l imited p o rti o n o f thi s are a whi c h i s
th ei r sp e c i al c e n te r ; at l e as t p ai n f u l s e n s ati o n s ar e r e fl e x e d
fr o m th em to a defi n ite po i n t i n th e vertebr al co lu m n be
twee n th e s i x th an d el eve nth d o r sal sp i n
e s The e n o rm o us
re g u l ativ e i n fl u e n c e wh i c h can b e e x c ite d by an o ste o p ath ic
tre atm e n t i n thi s are a i s b ei n g de m o ns tr ated d aily
we h ave al re ady m e n ti o n ed th e f act th at th e i nte sti n e s
w il l c o ntr act afte r bei n g s ep ar ated fr o m th e b o dy th ereby
pr o vi n g th at th e i n tri n s i c p o wer to cau s e m o vem e n t li e s i n
th e n e rv o u s m e c han i s m i n th e g u t w alls K eep c o n st an tly
'
in m i n d th e r e g ii lative c h ar ac ter o f th e i mp u ls e s wh i ch
”
e nte r th e abd o m i n al br ai n o ve r th e p n e u m o gastri c an d
sp l an ch n i c n erve s
The v aso m o t o r ph e no m e n a i n th i s are a h av e b e e n di s
r ch apter
Cu s s e d i n ano th e
,
,
, _
-
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,
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-
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—L
H y po gastri c
an d F o r m ati o n
—Th
ion
P lexu s
o c at
e
gre at r e o rg an izi n g c e n te r fo r th e p e lvi c vi sc era i s c all ed
th e hyp o g astri c p l e x u s wh i ch l i e s an teri o r to th e fif t
h lu m
I t i s f o rm ed by a co n ti n u ati o n o f fib er s fr o m
bar verteb r a
th e ao rti c p l e x us Wh i ch ar e j o i n e d by fiber s fr o m th e lu m
In fr o n t O f th e s ac r u m th e pl e x u s
bar symp at heti c g an gl i a
divi de s i n t o tw o p o rti o n s whi ch j o i n the p elvi c p l e x u s e s
lyi n g o n e ach S ide o f th e re c t um an d b ladder i n th e m ale
an d o f th e re c t u m v agi n a an d b lad der i n th e fem al e
-
.
-
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‘
.
,
,
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,
P e lvi c
P le x us
'
m all gangli a
s
,
,
.
—
The
and ar e
e p elvi c pl e x us e s c o n t ai n m any
j o i n e d by fib er s fr om th e u pp e r sacr al
s
RI N C I PL E S
P
O F O S TE O PA TH Y
ymp ath eti c g an g li a an d by di re c t b r an c h e s
thi rd an d f o u rth sac r al c ere e —
s pi n al n erve s
s
,
14 7
of
th e s e c o n d
,
.
—
i
i
D i str b u t o n The
br an che s Of th e s e p le x u s e s ar e dis
trib u te d o n th e co at s Of the arteri e s to th e pe lv1c V i sc er a
an d fre q u e n t ly e n ter th e su b s t an c e o f th e o rg an
S u bs i di ar y
P le x us e s —A cc o r di n g to th e artery fo l
lo we d we h ave su b s idi ary p l e x u s e s c all e d h em o rrh o id al
vi s c e ral gpr o static v agi n al an d u teri n e
F u nc t i o n s —The f u n cti o n s o f th e p e lvi c p l e x u s ar e as
f o llo w s
—
1
n
a
o
2
V
so
c
s
tri
t
o
r
v
a
o
m
o
t
o
r
e
n
o
ry
4
c
s
3
s
s
( )
( )
( )
( )
vi sc e r o i n h ibit o r p e r hyp o g as tri c p l e x u s
M
5
o t o r to re c t u m
v agi na an d b ladd er ( 6 ) se n s o ry
( )
to re c t u m v agi n a an d b ladd er
v
di
l
t
r
e
l
7
a
so
o
x
a
t
o
s
u
a
( )
O rgan s, ere c til e ti ssu e ( 8 ) v i s c e r o c o n str i cto r to n e c k o f
uter u s pe r s e co n d thir d an d f o u r th sac r al
.
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-
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—
With th e
S u mm ary
a
.
rr an gem e n t
f un cti o ns o f
tw o p ath s o ver
an d
th es e n e rve s we ll i n m i n d w e r e c o gn i z e
wh i c h we can i n fl u e n c e th e pe lv 1 c V l sc e r a
m
e fl e x e d th r o u gh th e
n
r
y
i
n
fl
u
e
n
c
e
a
b
e
r
e
s
o
s
s
l
( )
y
hyp o g astri c p le x u s an d th en c e to the s e co n d lu mb ar ; Or
th ey m ay p as s o ver s ac r al n erve s to th e s am e p o i n t s e c o n d
In co n n e c ti o n with di st u rb an c e o f th e p e lvi c v i s
lu m bar
p ai n m ay b e r e fl e x e d o n to th e b ac k o f th e s ac r u m
c er a
or t
o an ar e a ar o u n d th e s e c o n d l u mb ar
D i s t u rb an c e o f
fu n c ti o n i n th e u ter u s cau s e s refle x s e n s itive n e ss at f o u rth
an d fi fth l u mb ar
2
o
o
n
n
n
o
V
tri
t
r
i
fl
e
e
m
e
th
r
gh
hyp
a
s
c
s
c
o
u
c
c
o
u
s
o
( )
ga stri c p l e x u s fr o m sp i nal n erv e s ab o u t s e c o n d lu mb ar
3
a
o
l
n
n
l
a
s
o
u
c
c
o
i
V
di
t
r
i
fl
e
e
e
dire
t
y
th
e
p
elv
s
c
t
o
c
m
( )
p l e x u s e s fr o m s e c o n d an d th ird s ac r al n erve s ; n ervi
erige n te s
4
o
n
s
c
o
o
n
Vi
e
r
m
t
r
i
fl
e
e
hi
efly
fr
m
e
d
third
u
c
c
o
n
s
c
o
s
( )
an d f o u rth s ac r al
5
s
c
o
n
n
n
Vi
er
i
h
ibit
o
ry
i
fl
u
e
c e s c hi efly th r o u gh hyp o
( )
g as t r i c ple x u s p r o b ably fr o m upp e r l u mb ar sp i n al n erve s
,
,
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PR I N C I PLE S
148
O F O S TE O PA TH Y
We h av e th e ref o re a v aso c o ns tri c t o r c e nter fo r p elvi c
vi s c e r a at se c o n d lu mb ar ; a v aso d i lat o r an d m o t o r c e n ter
at se c o n d an d thi rd sac r al
-
-
.
Au t o m ati c
—
l
i
V i sce r al G an g a The last po r ti o n o f the
b u t li tt l e k n o w n
an d phy s i o lo gi st s h ave
,
ymp ath eti c i s
refr ai n ed fr o m sp e cu lati n g o n it u n ti l m o re d efi n ite k no wl
edge i s o bt ai n ed
Byr o n R o bi ns o n m e nti o n s a n u mb er o f au t o m ati c
”
S it u ated i n th e w all s o f th e h o llo w vi s c er a
vi sc e r al g an g li a
The f ac t th at th e h e art i n te s ti n e s u te r u s bl adde r and
fallo pi an t u b e s wi ll co n tr ac t rhyth m i cally i n r e s p o n s e to
m e ch an i cal stim u l ati o n afte r all n e rve co nn e cti o n s ar e
o p r o ve th e e x i ste n c e o f g an gli a i n th e w alls
s eve red s e em s t
o f th e s e vi s c er a wh i ch ar e c ap ab l e o f re c eivi n g s e n s ati o n
an d s e n di n g o u t m o t o r i mp u ls e s
s
.
.
,
,
,
’
,
.
—W e will th eref o re c o n clu d e th at th e
s ymp ath eti c sy s tem c an ac t i n dep e n d e n t ly o f th e c ereb r o
th at it re c eive s s e n sati o n an d i n iti ate s m o ti o n ;
spi n al ;
give s t o n e to th e arteri e s an d c o n tr o l s s e c reti o n We i n
fl u e n ce th e f u n ct
i o n s o f th e s ymp ath eti c th r o u gh its co n
n e c ti o n with th e cerebr o S pi n al sy s tem
C o n cl u s io n s
.
,
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O F O S TE O PA TH Y
PR I N C I PL E S
150
d i s c u s s so s elf evi d e n t a p r o p o siti o n as th at h e alth p ri
m ari ly d ep e n d s o n a p erfe ct c i r cu lati o n I t i s n o t eve n
n e c e ss ary to add t
o thi s th e f a
ct th at th e bl o o d sh o ul d b e
p u re b e cau se u n d er o rdi n ary c ir c u m st an c e s if th e b lo o d
c i r c u late s p r o p erly it will b e c o m e p u rified
A ll sc h o o ls o f m edi c m e h ave a th er ap e u ti c p ri n c ip le
F r o m i ts e ar li e s t i n
ar o u n d whi c h th ei r pr ac ti c e i s b ui lt
i o n th e o ste o p ath i c i de a has b e e n th at a p erfe c t c i r c u
c e pt
lati o n i s th e f o u n d ati on fo r p e rfe c t h e alth .
The p ro p o rti o n o f b lo o d to bo dy weight i s ab o u t o n e
twe lfth o f th e wh o le i e twelve p o u n d s o f b lo o d i n a
b o dy weigh i n g 1 50 p o u n d s Thi s am o u nt o f b lo o d i s di s
trib u te d app r o x i mate ly a s f o llo w s : O n e f o u rth to th e
h e art l u n g s an d gre at b lo o d ve s s el s ; o n e fo u rth to th e liver ;
—
o n e f o u rth to th e re s ti n g m u sc l e s ; o n e f o u rth to th e r e
m ai n i n g o rgan s Th e re is n o t blo o d e no u g h i n the b o dy
to m ai ntai n all o f i ts ac tiv iti e s at th e m ax im u m at th e
Th eref o re it i s di ffi c u lt to do th e b e s t phy s i cal
s am e tim e
or
m e n t al l ab o r j u s t afte r dige s ti o n has b eg u n
The
s p lan c h n i c b lo o d ve s s el s ar e c ap ab l e o f c o n t ai n i n
l
e
s
o
a
r
g
g
ap r o p o rti o n Of th e wh o l e am o u n t o f bl o o d th at de ath m ay
re su lt fr o m l ac k o f su ffi c i e n t b lo o d ret u r n i ng to th e he art
to c au s e it to be at
—
l
B
f
h
e
o
i
t
i
ti
o
n
o
t
o
d
G r an ti n g th at th e bl o o d
D s r bu
p o s s e s s e s all th e s e f u n c ti on s th e q u e sti o n sti ll Co n fr o n t s
?
n
Th i s q u e s ti on l e ad s
u s ho w c an w e aff e c t i ts d i strib u ti o
l di strib u ti o n o f
u s to a Co n s id er ati o n Of th e phy s i o l o gi c a
th e b lo o d I t i s beli eve d by th e writer th at n o th i n g b e
si de s th e u s e O i w ater has s o gre at an e ff e c t o n th e Ci r c u
lati o n o f the b lo o d as m an ip u lati o n acco rdi n g to o s te o p athi c
meth o d s Th e s e m eth o d s do n o t dep e n d o n a m e re p hys i
i st an c e o f th e v en o u s fl o w by m e an s O f c e n trip et al
c al as s
i
i
l
o
m
r
c
a
i
s
a
a
e
u
E
ff
e
emp ye d by
s
ss
ct
s tr o ki n g
su h
s on
g
c ir c u lati o n ar e Obt ai n e d i n n e ar ly all cas e s by k nowi n
w he re d efi n it e n erve s wh i c h c o ntr o l th e ac ti o n Of th e h e art
an
d bl o o d ve ss e ls ar e pl ac ed an d wh at th ei r acti o n i n re
All m an ip u l ati o ns ar e g i ve n
S po n se to i r rit ati o n m ay b e
to
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PR I N C I PL E S
with
O F O S TE O PA TH Y
151
defi n it e k n o w l edge Of th e lo c ati o n o f b loo d ve s se l s
an d th e n e rve c e n ter s wh i c h c o n tr o l thei r v ari ati o n i n
The re sp o n s e s e c u re d i s a n e w c o o rdi n ati o n o f
c al ib er
th e wh o l e c i rcu lati o n b r o u gh t ab o u t u n der th e c o n tr o l o f
th e n erve c e n te r s
I t has b ee n st ate d th at th e b lo o d i s co n t ai n e d i n a
A s h o rt re su m e Of t
he m o s t i m
c lo s e d s y s tem o f t u b e s
p o rt an t p o i n t s in th e an at o my an d ph y s i o lo gy o f th e C i r
he m o du s
c u l at io n m ay p rep are u s fo r a c l e are r i n s ight o f t
hi c m eth o d s
o p e r an di o f o s te O pat
a
.
.
.
‘
.
t or y
C i r cu l a
The
—
Appar at u s
The
r cu lat o ry app a
r at u s c o n si s t s Of th e h e art
vei
art eri e s
c a i llarie s
n s an d
p
lymph ati cs ; so m e writer s i n clu d e th e S p l ee n
M u s c u lar ti ss u e i s fo u n d i n th e h e art s m all ar t
er i e s
an d v ei n s
The he ar t i s p r ac ti c ally all m u s cl e an d i ts c o n
tr acti o ns ar e g o ver n ed by tw o s et s o f n erve fib er s fr o m th e
—
c erebr o spi n al sy s tem ; th e fir st s e t 1 s c al l ed ac c e l er at o r ;
i n h ibit o ry
s e co n d
L ikewi se th e s m all arterie s an d vei n s h ave tw o s et s
Of fib er s wh i c h i n c re as e an d de c re as e th e i nt e n sity o f th e
o f th ei r m u sc u lar fib er s
c o n tr ac ti o
n
th
h
ge
the
a
d
u
n
s
c
a
n
c al iber Of th e ve s s e ls
The capi llari e s ar e sh o rt n arr o w t u b e s h avi n g a thi n
w all co mp o s e d o f n u cl e ated c e ll s whi c h p o s s e s s th e p o wer
Of c o n trac ti o n S O far as k n o w n , th e cap i llari e s e x p an d
an d co n tr ac t i n re s p o n s e to th e d egre e o f phy s i c al p re s s u re
e x erted by th e blo o d cu r r e n t c o mi n g fr o m th e arteri o l e s
Thu s th e c h an ge i n th e c al ib er o f th e cap i ll ari e s i s pas
s ive
The lymph ati cs b egi n i n s m all irregu l ar s p ac e s i n
th e c e llu lar ti s su e o u tsi de o f th e blO Od ve ss e ls Th ey ar e
f o u n d i n dire c t re lati o n w ith th e c e lls o f p eriv as c u lar ti s
th u s br in g i fl g th e lym ph to e ach c e ll Th e s e Op e n
su e s
v e ss e ls whi c h co n vey th e
1 n g s l e ad to
s m al l lymph ati c
lymph to th e lymph ati c g lan d s wh i c h ar e s it u ated s o a s
to fi lter o u t th e imp u riti e s after whi c h i t i s emptied i n t o
th e ve n o u s c ir cu l ati o n by th e lymph ati c d u c t s The ly m
,
Ci
r
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PRI N C I P LE S
1 52
O F O S TE O PA TH Y
ph ati c ve ss e ls p o s se ss p o we r o f c o n tracti o n The lymph
eq u als ab o u t o n e thi rd o f th e b o dy we ight
The b lo o d i s a p ass ive ly m o vi n g ti ssu e
I t i s kept i n
co n st an t c i r c u lati o n with i n a c lo s e d sy stem o f t u be s by a
The pr o p u ls i o n o f th e bl o o d i s al
c o mbi nati o n o f f o r c e s
m o st e n ti rely ac co mp li sh ed by the co n tr ac ti o n o f th e h e art
Thi s i n iti al f o r c e is s u pp l em e n ted by th e as pi r ati o n Of th e
an d th e c o n tr ac ti o n o f th e sk e l e
c h e s t d u ri n g re sp ir ati o n
I t i s a d eb at ab le q u e s ti o n
tal m u sc l e s Of th e e n ti re b o dy
wh eth e r o r n o t th e m u sc ular co at o f th e arteri o l e s an d
ve n u le s as si s t i n th e dire c t p r o p u l si o n o f th e b lo o d p as si n g
th r o u gh th em
I t i s th e f u n c ti o n o f th e h e art to m ai nt ai n a c o mp ara
ti v e ly u n i f o rm te n s i o n Of th e bl o o d i n th e large arteri e s
The arteri o le s an d c ap i llari e s ar e co n c er n e d i n m ai n t ai n
i n g re si st an c e to th e p assage o f th e b lo o d
The degre e o f
re si st an c e i n th e c api llari e s i n large m e asu re determ i n e s
th e am o u n t o f n o u ri sh m e n t re c eived by th e ti ss u e s The
re lati o n betwe e n c api llary r e s i s t an c e to th e p ass age o f
th e b lo o d an d th e m et ab o li s m carried o n i n p e riv asc u lar
ti s s u e s i s a p o i n t o f gre at imp o rt an c e
The cu rre n t of
bl o o d o rdi n ari ly p as se s th r o u gh th e capi llarie s very slo w ly
at a r ate o f o n e i n c h i n tw o m i n u te s an d u n der lo w t
en
s i o n th u s givi n g amp l e o pp o rt u n ity fo r th e e s c ap e o f n o u r
i shi n g m ateri al fo r th e su rr o u n di n g ti ss u e s
Te n s i o n i n th e arteri e s is m ai n t ai n e d by th ree f act o r s
i
iti
f
r
e
o f th e h e art be at ; ( 2 ) fri c ti o n i n th e
T
h
n
a
l
o
c
1
e
( )
ve ss e l s ; ( 3 ) e lasti c ity Of th e v e s se l w all s The fir st an d
th i r d Of th e s e f ac t o r s ar e u n d er n erve c o n tr o l wh i ch ac t
ac co rdi n g to a large n u mb er o f s tim u l i
The c api llarie s bei n g p as sive i n ac ti o n th e te n si o n o f
th e b lo o d s tre am i n th e m is m ai nly dep e n de n t o n th e te n
I t may b e p r o fit ab ly n o te d th at
s i o n i n th e arteri o l e s
afte r th e i n iti al i mp u ls e i s gi ve n to th e bl oo d s tre am by
th e h e art th e d i strib u ti o n o f thi s b lo o d d ep e n d s so le ly o n
Thi s p eri ph er al
th e ar teri e s arte ri o le s an d capi ll ari e s
di strib u tiv e m e ch an i sm i s th e refo re re sp o ns ib le fo r th e
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O F O S TE O PA TH Y
P RI N C I PL E S
1 54
r ate an d s tre ngth o f th e c ardi ac co ntr acti o n s t o ge th e r
with th e re s i st an c e Off e red by th e arte ri o l e s an d capill ari e s
Co n si d eri n g th e arte ri o l e s an d c ap ill ar i e s as p o s s es si n g
fi x e d di am ete r s an i n c re ase i n th e n u mber and stre n gth
Of th e h e art be at s w o u ld i nc re as e th e s p e ed an d pre ssu re
A l e s se n e d cardi ac ac tivity w o u l d
o f th e bl o o d c u rre n t
h ave th e O ppo s i te e fte c t The s p e ed an d p re ssu re o f th e
b lo o d stre am m ay v ary with i n wid e lim it s an d still m ai n
t ai n a fai r degree o f h e alth
,
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’
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Co o r di nati n g C e n t e r s
The
e rve imp u l se s re achi n g
th e h e art ar e co o rdi nated i n tw o g o ve r n i n g c e n ter s i n th e
Th e se c e n ter s ar e lo cate d in th e
c erebr o —
s pi n al sy s te m
b u lb The i n hibit o ry c e n te r is c o n n e c ted with c el ls i n th e
w all s Of th e h e art by fibe r s whi ch f o rm a p art Of th e p n e u
m o g astr i c n e rve
S e c ti o n o f th e p n e u m o g astri c n erve r e
m o ve s th e i nhibit o ry i n fl u e n c e o ve r th e h e art s acti o n
The re lax ati o n
S tim u l ati o n o f th i s n erve s l o w s th e h e art
p eri o d i s l e n gth e n ed wh i ch re s u lt s i n gre ate r fi lli n g o f the
h e art an d th e p re ss u re i n th e vei n s is i n c re ased whi l e ar
te r i al p re ss u re de c re as e s
Th e s e re su lt s h ave be e n no te d
by many phy s i o lo gi st s
n
-
.
-
.
.
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.
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.
The P n e u m o g ast r i c Ne r v e — The p n e u m o g astri c i s
~
~
o ne
.
th e n erve tr u n k s wh i c h c an b e re ach e d by di re c t pre s
he n e c k
Its
su re m ad e th r o u gh th e s ki n an d m u sc l e s o f t
i nh ibit o ry acti o n c an b e ar o u s e d by p i nchi n g th e ster n o
m u sc le b etwee n th e th u mb an d f o refi n ge r
c l ei d o m ast o i d
t aki n g care to w o rk de ep ly u n d er th e i n ter n al m argi n o f
th e m u sc l e
I t i s no u n c o m m o n ph e n o m e n o n to h av e a p ati e nt
f ai n t as a re su lt o f th i s m an ip u l ati o n I n divid u al s d i ff e r
gre atly as to th ei r re sp o ns e to thi s stim u l ati o n The s tim
an tly v ary
u lati o n sh o u l d b e a ge n t l e pre ss u re o f a c o n st
i n g i n te n sity
A p u l s e tr ac i n g i s app e n ded F ig 24 wh i ch sh o w s th e
re s u lt s o f stim u l ati n
g th e p n e u m o g astri c i n th e m ann e r
j u st d esc ribe d The ge n t lem an u p o n wh o m th e e x pe r i
of
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.
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,
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PRI N C I PL E S
me n t
O F O S TE O PA TH Y
1 55
m ade w as i n e x c e ll e n t h e alth an d p os se s s ed a
h
n
l
n
a
T
iet
we
ll
b
a
a
c
ed
temp
er
m
e
t
e
r
a
c
i
n
g
h
w
t
u
s
o
s
q
th at the n u mb er an d f o r c e Of th e b e at s w as l e s s e n ed an d
th e arteri al p re ss u re de c re as ed Thi s tr ac i n g i s pr o b ab ly
w as
,
-
.
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t
24
S i m u l a ti o n
l n th e n e c
.
k
of
th e p n e Ii m o g as tr i c
by
p i n ch i n
g
th e n e r v e
t
run
k
.
typi c al Of th e ch an ge i n a we ll per s o n i n re sp o n se to stirn
u lati o n o f th e p n e u m o g as tri c
NO s e n s ati o n Of f ai n t n e s s
o r o th e r d sagree ab l e fe e l i n g w as n o ted
i
The i n h ibit o ry acti o n o f th e p n e u m o g as tri c s e em s
to b e m o s t ac tive i n i n divi d u als w ho s u ff er fr o m so m e di s
In s u c h p ati e n t s th e co n st an t
o rd e r o f th e dige s tive tr ac t
i rrit ati o n o f th e s e n so ry fib er s Of th e p n e u m o gastri c wh i ch
ari s e i n th e m u c o s a Of th e dige s tive vi sc er a s eem s to i n
he irrit ab i l ity O f th e wh o l e n erv e tr u nk to s u c h a
c re as e t
de li c ate p o i n t th at th e slighte st stim u lati o n m ade at any
p o i nt alon g th e c o u r s e Of th e n erve Wi ll e x c ite i ts i n h ibit o ry
M an y o ste o p ath s j u s t s t arti n g i n p r ac ti c e h ave
ac ti o n
had th eir s e lf p o ss e ss i o n s evere ly trie d by a p atie n t f ai n t
I h av e never he ard
i n g d u ri n g m an ip u lati o n o f th e n e c k
f at al re s u l t s fr o m m ani pu lati o n o f th e pn e u m o g as
o f an y
tri c Why s tim u l ati o n o f th e p n e u m o g astri c sh o u l d re sult
i n cardi ac i n h ibiti o n r ath er th an i n ph e n o me n a c o n n e c ted
wit h i ts o th er br an ch e s s eem s i n cap ab l e o f e x p lanati o n
,
,
.
.
.
,
,
,
.
,
-
.
.
.
O F O S TE O PA TH Y
PRI N C I PL E S
1 56
S o m etim e s
p asm Of th e lary n ge al m u scl e s wi ll acc o mp any
c ardi ac i n h ibiti o n
The i nte n s ity o f ac ti o n o f th e p n e u m o g astri cs i s so
we ll k no w n to e x p e ri e nc ed o ste o p ath s th at th ey ar e c aref u l
to te s t i ts irrit ab l e n e ss i n c as e s b ef o re u n d ert aki n g any
e x t e n sive m an ip u lati o n s alo ng i ts co u r s e
The i n h ibit o ry c e nter i s c o n ti n u al ly active an d ac t s
A ri s e
acco rdi n g to th e b l o o d pre s su re Withi n th e arteri e s
i n p e riph er al re si s t an c e cau se s a d e c re as e i n n u mb e r an d
he h e art be at s
stre n gth Of t
A cc e l e r at o r C e nt e r — The acc e l er at o r c e nter i s eo n
n e c te d with th e h e art by fib e rs whi c h de s c e n d i n th e c o rd
to th e u pp e r p o rti o n o f th e d o r s al regi on ; h ere c o n n e c ti o n
i s m ad e with th e c e ll s wh o s e fiber s p ass to th e symp ath eti c
spi n al g an g l i a fir st
s e co n d an d thi rd d o r s al a n d e n d th ere
ar o u n d o th er c el l s wh o s e fib er s c o n vey th ei r imp u ls e s to
th e h e art
s
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25
and
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t
yg
g
r
m o r a m s i ll u s t ati n
S ph
h i r d do r s a l
g
th e
e
ff e t
c
of
i nh i
b i ti
on,
fi t
rs
,
s e co n d
.
The
ti o n o f th e acc e le r at o r c e n ter i s n o t s o re adily
dem o n str ate d as IS th e c as e with th e i nhibit o ry c e n ter I t
o b e at f as ter an d str o n ger
th u s bri n gi n g
cau s e s th e h e art t
ab o u t a ri s e i n arteri al b lo o d p re ss u re an d a f al l in v e n o u s
p re ss u re
Thi s c e n te r ac t s i n re sp o n s e to lo we re d p er
i phe r al re si st an c e
The p r o d u ct s o f m et ab o li s m b r o u ght
ab o u t by phy s i c al e x er c i s e al so e x c ite it
D eep ste ady
p re s su re m ad e o n th e m u sc le s lyi n g o n e ach side o f the
fi r st se co n d an d th i rd d o r sal sp i n e s c au s e s a d ec re ase i n th e
r apidity o f th e h e ar ts act io n
ac
.
,
-
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PR I N C I PL E S
1 58
S ti m u lati o n
O F O S TE O PA TH Y
—A m ake
H
th e
bre ak p re ss u re
m ad e at th e edge o f
ster n u m i n th e fir s t an d se co n d
i nter c o st al s p ac e s wi ll u sually sti m u late th e h e art S o me
tim e s th e fi r s t e ff e ct is inhibitio n bu t i t q u i c k ly p as s e s to
sti m u lati o n
The m an ip u l ati o n m ad e anteri o rly i n c re ase s
th e n u mbe r an d i nte ns ity o f th e stim u li re achi n g th e s e g
me nt O f th e c o rd fr o m wh i ch th e acc e ler at o r n erv e s p as s
o ut
A ll c e n ter s act ac c o rdi n g to th e su m o f th e sti m u l i
re ach i n g th em fr o m all s o u r c e s
—
h
n
b
o
n
o
f
h
H
e
r
I i iti
t e
a t
In c as e s o f r api d h e art b e at
with high te ns i o n p u l s e th e b e st e ff e ct s ar e se c u red b y
digit al p re s su re at fir st s e co n d an d third d o r sal sp i n e s The
p n e u m o g astri c s h ave to o m any br an ch e s to imp o r tant v i s
c e r a an d act fre qu e n tly with u n e x p e c ted i n t
e n s ity The
ac c el er at o r s ac t m o re s lo w ly with l e s s i n te n s ity an d th e
ac ti o n i s s u s t ai n e d l o n ger
th at i s as a re s u lt o f m an
he
of t
e ar t
an d
.
,
.
.
.
.
,
.
.
_
,
,
i pu lati o n
.
V aso m o t o r C o ntr o l o f the C o r o nar y Ar te r i e s —A fu r
th er f act o r in rel ati o n to th e reg u lati o n o f th e h e art s ac ti o n
i s th e b lo o d s u ppl y fo r th e n o u ri sh m e n t o f th e h e art All
r e ater f o r c e wh e n th ei r b lo o d su pp ly i s
o rg an s ac t with g
he n i ts c o r on ary
The h e art be at s s tr o n ge r W
ab u n d an t
th eref o re th e
arter i e s ar e di late d th an wh e n co n s tri c ted
—
h
n
n
o
t
a
so
p o we r o f th e h e art dep e d s
m o t o r c o n tr o l Of
e v
Th e v as o m o to r n e r v e s to th e c o r o n ary
i ts o w n arterie s
arte rie s l e ave th e c erebr o sp i nal sy ste m b etwe e n th e thi rd
In case s o f an gi n a p e c t o ri s thi s
an d fifth d o r s al s pi n e s
S te ady p re s s u re h ere wi l l d il ate th e
are a wi ll b e s e n s itive
A sh arp s tr o ke w ith
c o r o n ary arte ri e s an d e as e th e p ai n
th e hyp o th e nar em i n e n c e o n th e f o u rth d o r sal spi n e wi l l
n e ar ly alw ay s s t art an att ac k with s u c h p ati e n t s .
—
r
i
P
t
i
P hy si o l ogi st s nam e th e pne umo g as
e
o
c
s
An g na
—
tri c n erve as th e v aso m o t o r n erve to th e c o r o nary arteri e s
I m e n ti o n th e are a th ird to fifth d o r sal as a v aso m o t o r
c e n ter fo r th e c o r o n ary arteri e s b e c au se c li n i cal e x p e ri e n c e
O th er o s te op ath s h ave n o te d
dem o n str ate it
o
se em s t
th e fre q u e ncy o f l e si o ns i n thi s are a i n co nn e cti o n wit h
-
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.
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O F O S TE O PA TH Y
PR I N C I PL E S
1 59
h e art di ffi c u lti e s The l e si o n s ar e co n tr acte d m u sc le s lat
e r al s u b lu x ati o n s Of th e vertebr ae o r i n s o m e i n st an c e s
With any o f
s u b lu x ati o n s o f th e f o u rth an d fifth rib s
th e s e l e s i o n s th ere i s i n te n s e s e n s itiv en e s s
D r G e o rge K e ith O f S c o tlan d m e n ti o n s digit al p re s
he an s o f i n
s u re i n th e s e co n d l eft i n ter c o s t al s p ac e as a r
hi bi ti n g an attac k o f an gi n a p e c t o ri s an d s u gge st s th e
n erve c o nn e cti o n o f th e p n e u m o g as tri c as bei n g th e n erve
p ath over w hich th e i n h ibit o ry imp u ls e tr av e ls
P e r son s s u ff eri n g w ith an gi n a p e c t o r i s wi ll p re ss th ei r
h an d s with all th e f o r c e th ey p os s e s s ag ai n st th e l eft
I h ave u s e d h e avy digit al pre s su re o n the l eft s i d e
c h e st
o f th e f o u r th an d fifth d o r s al s p i n e s wh i l e th e p ati e n t w as
i n a p ar o x y sm o f pai n
The p re s su r e n eve r f ai l ed to b e
gr atef u l to the pati e n t A f u rt he r e x p erim e n t with thi s
c e n te r w as m ade by e x te n d i n g th e p ati e n t i n a re c u mb e n t
p o siti o n W hil e e x te n si o n w as m ai n t ai n e d th e an gl e s o f
th e rib s co u l d be r ai s ed th e l eft ar m co u ld b e e x te n d ed
O ve r th e h e ad
l d b e t ake n bu t as
a f u ll i n spi r ati o n co u
o n as t
he vertebr ae were allo w e d to appr o x im ate as a
sO
r e s ult O L e e ss at
i o n o f e x te n s i o n th e s e thi ng s c o u l d n o t
b e done
H e at digital p r e ss u r e an d co u n te r i rrit ati o n ar e c ap a
—
o
f
n
c
a
u
s
o
n
bl e
i g v as co stri c t o r p ar aly si s i e v as o di lati o n
an d he n c e i n c re as e th e p o we r Of t
he h e ar t i n su c h c as e s
The g o ver n i n g c e n ter s
Acti o n o f the H e ar t C e nte r s
Of th e h e art act pri n c ip ally acco rdi n g to th e p eriph er al
The he ar t po s
r e s i st an c e m ai n t ai n ed by th e b lo o d v e s s el s
Its e n di n g s ar e
s e s s e s a n erve c all ed th e dep re s s o r n erve
i n th e w all s o f the h e art an d ar e aff e c te d by th e pre ss u re
he h e art
A ri se i n ar teri al pre s s u re
o f th e b lo o d withi n t
The
i s f o llo w e d by a ri s e i n pre s su re with i n the h e art
dep re s so r n erve n o te s thi s f ac t an d c arri e s an i n hib it o ry
i mp u l se to th e v as o di lat o r c e n te r in th e m ed u ll a th u s
b ri n gi n g ab o u t a f all i n arte r i al p re ss u re In thi s w ay th e
h e art i s p r o te c te d fr o m o ve r e x erti o n as a re s u lt o f to o
high pre s su r e
,
.
.
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.
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-
,
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-
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-
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-
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PR I N C I PL E S
160
O F O S TE O PA TH Y
e s h avi n g r ap id we ak h e art ac ti o n i nh ibit th e
acc e l er at o r s to S lo w th e h e art
al so I n hibit i n th e ar ea o f
—
v aso m o t o r co n tr o l o f th e c o r o nary arte ri e s to i n c re as e
us cle
th e am o u n t o f b lo o d f o r n o u ri sh m e nt to th e h e art m
th u s i n c re asi n g th e s tre n gth o f th e b e at
In cas e s o f r ap id
h igh te n s i o n p u l s e i nh ibit th e
S plan c hn i cs an d i n th e s u b o cc ipit al f o s s ae to l e ss e n p eri
r
h
r
l
i
l
n
l
a
o
o
s
u
l
a
re
t
e
i
hibit
th
e
e
e
r
t
r
ti
m
te
a
a
n
c
o
a
c
c
s
e
s
s
a
s
p
th e p n e u m o g astri c s
—
m
e
r
V as o o t o r N v e s In 18 4 0 H e n le d i s c o vered an d
d em o n str ated th e m u sc u lar c o at O f th e arteri e s an d as a
re s u lt o f thi s s tep f o rw ard we h ave o u r p re se n t k n o wl e dge
—
o f th e v a s o m o t o r n e rve s
As s o c i ate d with th e d em o n
st ra
—
o
n
o
f
n
n
B
r
ti
th e s e e rve s we h av e th e am e s o f
o w n S e q ua r d
B er nard W alle r an d S ch i ff
I t has b ee n p r o ve n th at tw o se ts o f fib er s i nn erv ate
the m u s c l e s o f th e arte ri e s ; a v as o c o n s tri ct o r s e t wh i c h
c au s e s a de c re as e i n th e c al ibe r ; an d a v as o di lat o r s et
whi ch cau s e s an i n c re as e i n c al ib er
The c o n s tri ct o r s
We re d em o n str ated fi r st
“
H e n le said th e m o vem e n t o f th e b lo o d depe n d s o n th e
h e art bu t i ts di strib u ti on dep e n d s 0 11 th e ve ss e ls
We
h ave f o llo w ed th e ph e n o m e n a i n c o nn e c ti o n with th e fir s t
p art o f thi s qu o t ati o n h e n c e it r em ai n s fo r u s to st u dy th e
p art p layed by th e v e s se ls In th e d i strib u ti o n o f th e b l o o d
In or de r to c arry o u r th o u ght s alo n g i n a p r op er m an
he c e n te r an d w o rk t o w ard th e
n e r we wi ll c o mm e nc e at t
p eriph ery
The ch i ef v aso m o t o r c e n ter i s i n th e m e d u l la
De
u s e s an im m edi at e f all of b lo o d
s tr u c ti o n o f thi s c e n ter c a
p re s su re all Over th e b o dy
S tim u lati o n o f thi s c e n ter
c au s e s a ge n er al ri s e o f b lo o d p re s s u re
Th e re ar e su b s idi ary c e n ter s sit u ated at v ari o u s l eve ls
i n th e s pi n al co rd
A fte r th e S pi n al co rd i s s evered t
h at p o rti on w hi ch i s
er wi ll
n o lo n ger c o n n e c te d with th e chi ef v aso m o t o r c e nt
e x e r ci se a v as o co nstri c t o r i n fl u e nc e o ver th e b lo o d ve ss els
In
c as
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PR I N C I PL E S
162
The v aso m o t o r
O F O S TE O PA TH Y
pp ar at u s c o ns i st s th e n o f thr e e
c l as s e s o f n e rve c e lls
The c ell b o di e s o f th e fi r s t c l as s li e
i n symp ath eti c g an g li a th eir n e u r ax o n s p ass i n g dire c t ly
to th e s m o o th m u scl e i n th e w al l s o f th e ve ss el s ; th e s e c o n d
ar e stim u l ated at di ff ere n t l eve l s i n th e c e rebr o s p i n al ax i s
th ei r n e u r ax o ns p as si n g h e n c e to th e s ymp ath eti c gan gli a
by w ay o f spi n al an d c r an i al n erve s ; an d th e third ar e
pl ac ed i n th e b u lb an d co n tr o l th e se c on d th r o ugh i n tr a
s p i nal an d i n tr ac r an i al p ath s
The n erve c e ll Of th e fi r s t
c l ass l i e s wh o lly with o u t th e c e rebr o s pi n al ax i s th e th ird
wh o l ly withi n it wh il e th e s e c o n d i s p art ly withi n an d p art
”
ly with o u t an d bi n d s t o get he r th e rem ai n i n g tw o
Am
Te x t b o o k o f P hy si o lo gy
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Th e —
s p a c e S i s th e p e r i o d
28
Th e s i n i c a ti o n o f a s p h
o f v e n r i cu l a r s s o l e w h e n th e a o r i c v a l v e s a r e o p e n ; th e s p a ce
th e p e r i o d o f v e ntr i c u l a r d i a s o l e ; t, th e ti d al w av e d u e to th e v e n
tr i c u la r s s o l e ; p, th e p e c u s s i o n wav e d u e to i n s r u m e n a l d e e c ;
h e a o i c v al v e s ;
a i s th e a o r i c n o c h w h i ch m a r s th e c l o s u r e o f t
d , th e di c r o i c w av e
.
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g fi
t
yg
y t
y t
t
t
r
t
gr
t
t
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D
t
k
f t
t
rt
.
V as o c on st r i ct i o n —The v aso co n stri ct o r n e rve s wh i c h
p ass fr o m th e b u lb ar an d spi nal c e n ter s O f co n tr o l l e ave th e
i cante s fr o m th e an teri o r r o o t s
c o rd as whit e r am i c o mm u n
o th e s e c o n d l u mb ar n e r ve s an d e n te r
o f th e s e c o n d d o r sal t
th e sym p ath eti c g angl i a to b e di s trib u te d as has be e n d e
It i s b eli ev ed th at all Of th e s e v aso co n
sc rib e d b ef o re
str i c to r fib er s e n d i n th e g an g li a th u s e x erti n g th ei r i n fl u
e n c e o n th e tr u e v aso m o t o r c el l s i n th e g an gl i a whi ch
All th e s e co nstr i c
alo n e s e n d fib er s to th e b lo o d ve s s el s
to r n erve s ar e gr ay
V as o di lati o n —The v aso di lat o r fiber s ar e n o t r e
bu t p as s
o n e p orti o n o f th e cord o r br ai n
o any
r i c te d t
st
o u t with b o th c r an i al an d s p i n al n erve s an d do n o t l o s e
th ei r sh e ath s u ntil th ey re ach th ei r d e sti nati o n Th ey
-
-
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-
'
~
.
-
.
,
-
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.
.
-
-
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,
,
.
~
PRI N C I PLE S
O F O S TE O PA TH Y
163
—
o f th e c ereb r o s pi n al
The
do n o t ari s e
b e st dem o n str ated in th o s e regi o n s
—
sy stem fr o m wh i c h v as o c on s tri c t o r s
v aso di lat o r s fr o m th e h e ad f ac e saliv a ry g lan d s e tc p ass
to th eir de sti nati o n with th e c r an i al nerve s s u pp lyi n g the s e
p art s Th ey do n o t e n d i n th e sym path eti c s Th ey p r o b a
bly l e ave the co rd in th e an te r i o r r o o ts Of th e Spn al n erve s
The v aso
an d p as s to th e p eriph ery with o u t i n terr u pti o n
di lat o r s l e avi n g th e c o rd i n th e s am e regi o n as th e v aso
he vi sc er al b lo o d ve s se ls
o t
o b e di s tr ibu te d t
c o ns t r i ct o r s t
p r o b ab ly p ass o u t by th e ve n tr al r o o t s an d re ach t hei r
d e s ti nati o n with o u t lo sing the i r sh e ath s i n th e symp ath eti c
g an gl i a
ar e
.
'
-
,
,
,
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F IG
yg
g
t t g T
t
t
a
m o r am s i l lu s r a i n
r a c h y c ar d i a
S ph
a c h c ar d i
an d
Up
rea
n e r v ou sn e s s a
p e r tr a gi ng ge r adi a l p u l s e o f a w o m a n e x h i i i n
s m al l
Lo w e r r a c i n
r ad i al p u l s e o f a
o i r e b u t n o e x o p h h al m o s
m a n w h o s e p o w e r o f r e c a l li n
ou n
: h i s li e wa s
p a st e v e n s o r
s u dd e n l
los
R e s u l o f m e n al s h o c
.
29
.
g
y
g t
.
t
y
t
.
NO di s ti nc t
y
g
k
B
bt g g t
t
g—
t
.
.
f
.
e n te r s fo r v aso di lato r fi be r s h av e b ee n
dem o n s t r ated Th ey p r o b ab ly ari s e fr o m segm e n ts o f the
br ai n an d s pi nal c o rd an d th eir i n fl u e n c e i s carr i e d al o n g
th e p ath s o f m o t o r n e r v e s an d is e x e r te d in a lo cal ar e a
S u mm ar y —
1
The v aso dil at o r n erve s ar e c ereb r o
s p i n al ;
a
n
r
l
h
a
a
e
n
o
e
m
l
e
i
n
s
ymp
a
th
eti
c
d
d
t
d
e
u
a
t
t
d
e
( )
g an g li a ( b ) They ar e di strib u ted p ri n c ip ally to the ar
te r i e s Of th e m u sc l e s ( c ) an d l e ave th e c erebr o sp i n al ax i s
with the m oto r n e rve s fr o m all p o rti o n s
Their i n fl u
e n c e i s lo c al
2
The v aso —
c o n stri c t o r s ar e e ss e n ti ally n e u r ax o n s o f
symp ath eti c ce ll s i n th e s p i n al g ang l i a ;
a
r
gr
y
fiber
a
e
a
s
;
( )
r
a
e di strib u ted t
b
o vi s c er a an d c u t an e o u s b lo o d ve ss e ls ;
( )
c
a
n
r
d
a
e p r o b ab l
n
n
n
ti
ti
i
t
i
th
e
c
o
o
u
c
o
n
u
s
i
m
a
n
a
n
a
o
t
( )
y
c
-
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.
.
-
.
.
—
,
.
-
,
.
.
.
'
PR I N C I PL E S
164
O F O S TE O PA TH Y
t e
th e v
r sys tem ( d ) The v aso m o t o r c ell s i n
th e symp ath eti c g ang li a can act i n dep e n de nt ly ( e ) bu t ar e
n o rm ally u n d e r th e co n tr o l o f th e c e ll s i n th e S pi n al c o rd
wh o se n e u r ax o n s e n d i n th e spi n al g an gli a ( f ) Th e se
c ell s i n th e s pi n al c o rd ar e u n der th e i n fl u e n c e o f n e u r ax o n s
o f c e ll s i n th e m ed u l l a whi c h co n stit u t e th e c h i ef v a so
m o t o r c e nte r
g
T
h e re f or e th e v aso co n stri c t o r i nfl u
( )
e n c e i s b o th l o cal an d ge n er al ( h ) The c o ntr o lli ng fi be r s
l e ave th e co rd in th e ve n tr al r o o t s o f th e s e co n d d o r s al to
th e s e co n d l u mb ar n e rve s o nly
—
S e ns o r y Ne r v e s
We h ave no w co ns idered i n det ail
o n ly o n e si d e o f th e v aso m o t o r
e ch an i s m th e m o t o r
We h ave yet to n o te th e s e n so ry S i de th at wh i c h c all s f o rth
th e m o t o r re s p o n se If th ere were no chi ef o r s pi nal vaso
m o to r c e n ter s to tr an sfer s e n so ry i mp u l s e s to th e v aso co n
he
r i c to r c ell s i n th e S pi n al g an gli a th e b l o o d ve s s el s i n t
st
V i sc e r a an d s k in co u l d not c o n tr ac t o r rel ax acco rdi n g to
th e n e c e ss i ty fo r g r e ate r o r l e s se r am o u n t s o f h e at i n the
d e ep o r s u p e rfi ci al are as
m o t o r c e n ter s i n th e br ai n an d c o rd s e n d
The v aso —
o u t i mp u ls e s i n r e sp o n s e t
o s e n s o ry s tim u l ati o n
th i s se n
i s u s u al ly o f a th e rm al o r m e ch an i c al
so ry
s tim u lati o n
ch ar ac ter
I t i s d i ffic u lt to re ali z e th e e x te n t o f th e di strib u ti o n
“
They ar e l o cate d no t o n ly i n th o se
o f s e n so ry n erve s
p lac e s u s u ally k n o w n to b e s e ns itive bu t al s o i n all o th er
ti ssu e s an d o rgan s Wh eth er o n e e x ami n e th e l ive r o r th e
kid n ey lun g o r th e w all o f a bl o o d ve s sel o n e al way s fi n d s
deli cate n erve arb o riz ati o ns i n u n s u sp e cte d n u mb er s A
l arge p o rti o n o f th em e n d p r o b ably i n the p eriph er all y
pl ac ed e n d c e ll s b e lo n gi n g to th e refl e x ar c o f th e sy mp a
th et i c ; ano th er p o r ti o n m ay very p r o b ably be trac ed to
th e s pi n al g ang li a an d eve n to th e S pi nal co rd i t self e s
i
ll
e
c
a
n
n
f
a
t
o
th
e
i
ve
tig
ti
th
e
p
t
ye ar s m aki n g
a
o
o
s
s
s
w
p
y
u se o f th e silve r and m et hyl bl u e st ai n s h ave n o t o nly dis
he we alt h O f n e r ve s in the di ff e r e n t o rgan s but
c l o se d t
have al so sh o w n t hat we have r eg arded the s e nso ry i n
on
Of
asc u la
-
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,
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-
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,
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‘
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m
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,
PRI N C I PLE S
1 66
O F O S TE O PA TH Y
f arthe r still o r wh eth e r th ey b e re co g n iz ed by th e i n
divi d u al as th ey o cc u r d o e s n o t aff e ct th ei r n at u re S e n
”
—Anat o my
s ati o n an d p e r c epti o n ar e n o t th e sam e th i n g
o f th e C e n tr al Ne rv o u s S y s tem i n M an an d i n Verteb r ate s
E di nger
i n G e n er al —
Th u s we fi n d th at th e re ar e ab u n d ant s e ns o ry n e r v e s
i n su p erfi c i al an d de ep ti s su e to re c eive the m e ch an i cal
p r o j e ct u p o n th em
s ti m u l i wh i c h th e o ste o p ath m ay
R e c e n t i nve stig ati o ns p r o ve th at m an y c o n d i ti o n s
wh i c h h ave p revi o u s ly b ee n called i n fl amm ati o n ar e i n
—
o
n
n
re al ity c ge sti o s du e to v as o c o n st ri ct o r p ar aly s i s an d
c an
b e co rre cte d by s ti m u lati o n o f th e v as o co n stri ct o r
c e n te r g o ver n i n g th e c o nge s te d are a ; th e
st i m u lati o n o f
s u c h c e n te r be i n g s e c u red by m e ch an i c al sti mu l i app l ie d to
th e s e n so ry nerve s e n d i n g i n th e c e nter
—
The v aso m o t o r m e ch an i s m re s p o n d s q u i c k ly to o ste o
p ath i c m an ip u l ati o n an d i s o u r m e an s o f co rre c ti n g any
d i st u rb an c e o f c i r cu l ati o n b o th l o cal an d ge n er al
S i n c e the bl o o d carri e s th e n o u ri sh m e n t fo r th e ti s
s ue s
an d th e v aso m o t o r s c o n tr o l th e di s trib u ti o n o f th e
bl o o d th e v aso o t o r n erve s ar e tr o phi c n e rve s In th e
s am e s e n s e th ey ar e s e c ret o ry n erve s
—
l
t
i
n
The cap ill ary c i rcu l ati o n i s de
i
r
a
o
Capi llar y C cu
p e n de n t o n th e st ate o f th e arte ri o l e s The i r w all s ar e
f o rm e d by e n d o th e li al c ell s whi ch ar e el as ti c an d h e n c e
re s p o n d to th e f o r c e o f th e bl o o d whi ch e nter s th em I f
th e v aso co n stri ct o r s ar e active in a l o cal are a the r e
an c e o ff ered to th e p assage o f the bl o o d c u rre n t by th e
si s t
an d th eref o re th e p re s s u re e x erte d
arteri o l e s i s i n c re as e d
al lo wi n g th e c ap il lari e s
o n th e c api l l ary w al l s i s l e ss e n ed
I f th e v aso c o n stri ct o r i n fl u e n c e o ve r th e
to c o n tr ac t
arteri o l e s b e l e ss e n e d th e bl o od c u rre n t i s al l o wed to e x ert
i ts pre s su re o n th e capi ll ary w all s th u s i n c re as i n g th e
cal ib er o f th e c api llary
I f i n a l arge are a o f th e b o dy v aso co n stri ct o r s ar e
ac tive th e i n fl u e n c e o f thi s r e s i stan ce i s fe lt by the h e art
wh i ch i mm e di ately b e at s harde r to o ver co m e th e re s i st an c e
,
.
.
.
.
.
,
,
,
-
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'
,
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,
-
,
-
,
m
.
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,
‘
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-
,
,
-
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,
,
.
-
,
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'
,
,
PR I N C I PL E S
O F O S TE O PA TH Y
167
to the
p a ssage o f th e b lo o d thr o u gh th e c o ns tri c t ed arteri e s
—
The h e art i s u s u ally r e l i eved by c o mp e n sat o ry di lat ati o n
o f th e arterie s i n s o m e o th er are a
The vi sc er al an d c u
tan e o u s arteri e s u su ally c o u n ter b al an c e e ach o th er i n thi s
Thi s co u n ter b alanc i n g e ff e c t i s p r o b ab ly b r o u gh t
w ay
ab ou t thr o u gh th e s e n so ry i mp re s s i on s s e n t ou t fr o m an
—
o verw o rke d h e art t
o th e v aso m o t o r c e n te r
th u s c au s i n g
a l e s s e n ed c o n s tri c t o r e ff e c t i n so m e p o rti o n s o f th e b o dy
The re lax ati o no f all th e arteri e s o f th e b o dy w o u ld
c au s e de ath b e c au s e th e b lo o d w o u l d gr avit ate to th e m o st
d ep e n de n t p art and th e re i s n o t b lo o d e n o u gh to fi ll all
th e arteri e s wh e n r el ax e d A s light rel ax ati o n o f ge n er al
b lo o d p re ss u re c au s es the h e art to b e at m o re r ap i d ly fo r
a sho rt tim e
R e lax ati o n o f th e p eri ph er al b lo o d ve ss e l s
i s no te d by the i n c re as e d Warmth an d re d n e ss o f th e are a
i n whi c h r el axati o n t ake s pl ac e
To re cap it u l ate : ( 1 ) C apill ary c i r e n
R e capi tu lati o n —
o
n
2
a
o
s
c
o
n
o
f
o
l
l ati o n i s p ass ive
V
s
c
tri
ti
th
e
a
rteri
e
s
( )
he l u m e n o f th e cap i llary
c au s e s a de c re as e i n t
( 3 ) V aso
di lati o n O i th e arte ri o l e s cau s e s i n c re as e i n the l u m e n o f
o
n
n
e
n
er
a
l
v
a
s
o
c
tri
c
ti
o
o
f
th
e
c
u
4
s
th e c apil lar y
G
( )
tan e o u s bl o o d ve ss el s S lo w s th e h e art an d cau s e s it to w o rk
ag ai n st highe r pre s su re bu t th e h e art i s rel i eved by rel ax a
ti o n o f bl o o d ve sse l s in vi s c eral are as chi efly th e splan ch
o r e ff e c t o n s u p e rfi c i al v e s
D
e
re
a
e
o
f
c o ns tri ct
ni cs
5
c
s
( )
whi c h i s q u i ck ly c o n
s e ls c au s e s a m o re r ap id he a rt be at
tr o l le d by co n stri cti on in th e s p lan ch n i c are a ( 6 ) The
v aso m o t o r c e n te r i n th e m e d u l la act s acc o rdi n g to th e
s u m o f th e s e n so ry i n fl u e n c e s re ac hi n g i t fr o m all p art s o f
—
n
o t o r c e n te r s ac t ac c o rdi n g
h
o
T
h
pi
a
l
v
a
so
m
e
s
t e b dy
7
(
to the i n fl u e n c e s se n t to th em by th e c hi ef c e n ter an d th e
s e n s o ry imp u ls e s whi c h e n ter th e ir s egm e n t o f th e c o rd
—
V aso m o to r C e nte r s The v aso m o t o r c e n ter s fo r th e
v ari o us vi sc er a o rgan s an d m ember s ar e as f o llo w s
H E A D : The s up eri o r c ervi c al g an gl i o n
E Y E : The s u p e ri o r c ervi cal g an gli o n thr o u gh th e fifth
n erve
.
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-
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.
-
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.
PR I N C I PL E S
168
O F O S TE O PA TH Y
NO S E TH R O AT TO NS I L S TO NG U E
,
,
an d
,
GU M S
°
th e sam e p ath D i lat o r fiber s fo r th e t o n g u e p er the
l i ng ual b r an c h o f th e fifth c r an i al n erve
By
.
.
B R AI N : S h erri n gt o n an d o th e r s h ave d em o nstr ated
th e p re s e n c e o f v aso m o t o r n e rve s i n th e ve s se l s o f th e
b r ai n I t i s p r o b abl e th at th e c ereb r al c ir c u l ati o n is wh o ll y
d ep e n d e n t u p o n th e ge n er al b lo o d p re ss u re a n d i nasm u ch
as th e ge n er al b lo o d p re ss u re i s very m arke dly reg u lat
ed
by th e cap ac i o u s sp lan ch n i c are a it i s o bvi o u s t hat th e
c ereb r al c i r c u lati o n m ay b e bette r c o n tr o ll ed b
m
difyi
o
n
y
g
th e b lo o d su pply o f th e splan c hni c ar e a th an by any at
tempt s at th e m o difi c ati o n o f th e c erebr al c i r c u l ati o n it sel f
S ymp ath eti c fib er s to th e an teri o r an d m id d le f o ssae
r th e car o ti d
c o m e fr o m th e s u p eri o r c ervi c al g an gl i o n p e
p le xu s S ymp ath eti c fib er s ar e d i s trib u te d to th e ve sse l s
i n th e p o steri o r f o ss a fr o m th e vertebr al p l e x u s whi ch is
f o rm e d by fib er s fr o m th e i n feri o r c ervi c al g an g li o n
THYR O I D G L A ND : M id dl e an d i n fe ri o r c ervi c al
g an gl i o n
—
The v aso co nstri c t o r s fo r th e b lo o d ve s s el s o f th e h e ad,
f ac e an d n e c k wit h th ei r c o nt ai n e d o rg ans l e ave th e Spi n al
s e c o n d to fifth
an d p as s the nc e
c o rd i n th e u pp e r d o r s al
h r o u gh th e c e rvi cal g an gl i o n
t
LU NG S : S e c o n d to th e S i x th d o r sal
I NTE S TI NE S : The v aso c o n stri c t o r s fo r th e m e se n
te r i c bl o o d v e ss e ls ar e f o u n d i n th e s p lan ch n i c n erve s C o m
rib u ti o n
m e n c i ng at th e fifth d o r s al th ere i s a s egm e nt al di s t
The lo we s t c o n
to th e v ari o u s p o rti o n s o f th e i n te s ti n e s
r ict
o r i n fl u e n c e c o m e s fr o m th e s e c o n d l u mb ar
st
Vas o
d il at o r fibe r s ar e al so f o u n d i n the splan chn i cs
LIV E R i S i x th to te n th d o r s al right s id e
KI D NE Y : Te n th to twe lfth d o r sal
S P L E E N : Ni n th te n th an d e leve nth d o r s al l eft si d e
The v ag u s i s a m o t o r n erve to the m u scu lar fib er s i n th e
tr ab e c u l ae o f th e s pl ee n
P O R TA L S Y S TE M : F ifth to n i nth d o r sal
“
-
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'
,
,
,
'
:
'
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'
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PR I N C I PL E S
1 70
O F O S TE O PA TH Y
m i a —A
i n re ality a
Hy
s t u dy o f hyp er aem i a i s
st u dy o f th e v aso —
m o t o r m e ch an i s m We h ave n o ted th e
f act o f v aso m o t o r n erve s co n tr o ll i n g th e cal ib e r o f b lo o d
ve ss els: The s e n e rve s ar e br an ch e s o f th e ce reb r o sp i nal
M o st o f th em l e ave th e S p i n al n erve s a n d p ass to
sy s tem
—
th e symp ath et ic s p i nal g an g li a as r am i c o m m u n i c ante s an d
th e n p ass u p an d d o w n to o th e r gangli a o f th e symp ath eti c
s y s tem
S o m e fib e r s ret u r n fr o m th e symp ath eti c to th e
o bl o o d ve ss el s o f s ki n
S p i n al n erv es an d ar e di strib u te d t
m u s cl e an d b o n e i n th e are a o f di s trib u ti o n o f th e sp i nal
n e rve s
A few v aso m o t o r n erve s do n o t e n ter th e symp a
h eti c sy stem bu t p ass dire ctly to their d e sti nati o n w ith
t
th e s pi nal n e r ve s Th u s tw o p ath s e x i st by wh i ch v aso
m o t o r i mp u l se s re ach th e b lo o d v e ss e ls a di re c t r o u t e with
th e spi n al n erve s an d an i n di re ct o n e thr o u gh th e symp a
th eti c s
E x pe ri m e n te r s h ave l o n g n o te d th e ret u r n o f v asc u l ar
t o n e i n an are a wh o s e v aso c on stri ct o r n erve s h ave b ee n
Th i s ret u r n o f v ascu lar t o n i c ity i s s u pp o s e d to be
cu t
du e to th e p re s en c e o f a p e riv as c u l ar m ec h an i s m wh i ch
i s cap abl e o f act ing feebly after all o th e r co n stri c t o r i n
fl u e nc e s h ave b ee n p ar alyzed
S o far as m eth od s o f tre atm e n t ar e con c e r n ed we h ave
p ai d ve ry l ittle atte n ti o n to th e p re se n c e o f v aso d il at o r
n e rve s bu t phy si o l o gi st s s e em to p r o ve th at th ere ar e fib er s
l e avi n g th e co rd wit h th e p o s teri o r r o o t s o f th e n erve tr u n k s
—
wh i c h ac t as dil at o r s wh e n irrit ated The v aso co nstr i c
to r n erve s ar e c o n si de r e d as c o n st an tly i n ac ti o n
I rrit ati o n o f th e dil at o r n erve s o r p ar aly s i s o f th e co n
s o th at
o r s wi l l re s u lt i n di l at ati o n o f th e arteri o l e s
r ic t
st
th e c api ll ari e s wi ll b e di lated to th e ir f u ll e s t e x te n t S u ch
“
”
ac tive hyp er aem i a
Whe n the
a c o n diti o n i s c all e d an
e x it o f th e bl o o d th r ou gh th e ve i ns is o b str u cted a n d co n
“
”
ge sti o n re su lt s it is de no ted p as sive hyp e r aem ia
The sam e i rrit an t s m e ch an i cal th erm al an d c hemi cal
wh i ch ar e c ap ab l e o f stim u lati ng m u scle s to un u su al o r u n
eq u al co ntr acti o n s s o as to p r o d u c e m arked evi d e n c e s o f
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PR I N C I PL E S
O F O S TE O PA TH Y
I7 1
h an ged bo ny alig n m e n t also c au s e s u ch de c i ded ch an ge s
i n th e c alib er o f b lo o d v e ss e ls as to c au s e t
i ss u e s to b e
c o m e hyp er aemi c o r i sc h aem i c
I f any hyp e r aem i a e x i st s i n th e m u c o s a o f th e sto m ac h
p alp ati o n ar o u n d th e s i x th d o r s al s pl n e wi ll di s c lo s e te n
der n e ss Th i s S pi n al te n der n e s s i s pr o b ab ly due eith er to
th e i rrit ati o n o f th e d i lat o r fib er s whi ch acco mp an y th e
p o steri o r div i si o n o f th e fi ft h d o r sal n e r ve o r to p araly s i s
he v aso c o n st ri ct o r s o f th at ar e a
of t
The r e s u lti n g di la
tati o n impi n ge s o n s e n s o ry n erve s an d cau se s te n der n e s s
The i r r i tati o n o f s e n so ry n erve s i n th e m u c o sa o f th e
s t o m ac h
cau s e s di l at ati o n o f b l o o d ve ss el s i n th at are a
an d i n th e Spi n al are a f r o m wh i c h i ts s e n
so ry n erve s ari se
The i rrit ati o n might have o rigi n ate d c e n t r ally an d th e n i n
Vo lve d th e st o m
ac h th u s rever s i n g th e c o u r s e o f th e irrit a
ti o n The s e refl e x hyp er aem i as ar e co n ti n u al ly n o te d in
p r acti c e an d i t i s th r o u gh th e r e fle x e s th at r el i ef i s o b
tai n e d
O n e o f the c las si c al e x p erim e n t s to p r o ve th e r e
fl e x ac ti o n o f v aso m o t o r n e rve s i s to im m er s e o n e h an d
i n c o l d w ater th e temp e r at u re o f th e o th er h an d wi l l b e
l o we re d als o
I t i s q u it e ge n er ally c o n c ede d th at th e sm all a rteri e s
an d arteri o l e s i n all p art s o f th e b o dy ar e s u pp l ied with
v as o m o t o r n e rve s Th ei r p re s e n c e i n the b lo o d ve ss e ls o f
th e br ai n has b e e n re c e n t ly p r o ve n by G C H u ber H i s
d em o n s tr ati o n o f v as o m o t o r n erve s i n th e c erebr al b lo o d
ve s sel s ex pl ai n s m an y o f th e c ir c u lat o ry phe n o m e n a re su lt
in g fr o m o ste op athi c m an ip u lati o n s
I rrit ati o n o f s e n so ry n erve s i n an y p art o f th e b o dy
di lat ati on i n th e i rrit ate d are a P hy s i
cau s e s v asc u lar
—
o
o l o gi cal e x p erim e n t s s ee m to p r ve th at v a so di lat o r fibe r s
ac c o mp an y th e s e n s o r y n erve s o r th at i rrit ati o n o f s e n s o ry
I r rit a
n erve s c au s e s p ar aly s i s o f v aso c o n s tri c t o r n erve s
ti o n o f th e n erv e s o f o ne sid e o f th e b o dy by p ri cki n g w i t h
a pi n c au s e s a ri s e o f temp er at u re o n t hat s id e an d a de
ate d S i de
th u s dem o n str ati n g th at
u n irri t
o n th e
c re as e
v aso di lati o n fo llo w S s e n s o ry i rrit ati o n
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P RI N C I PL E S
1 72
E x p e rim e n t s to
O F O S TE O PA TH Y
te th e e ff e ct s o f di re ct m e ch an i cal
i rrit ati o n o f th e st o m ach m u co sa de m o n str ate th at dil at a
ti o n o f g astri c b lo o d ve s se l s f o llo w s m e ch an i cal irrit ati o n
The phy si o lo gi cal hy pe r ae m a th u s pr o d u c e d i s fo r p u rp o se s
o f i n c re as e d s e c reti o n
I t i s we ll k no w n th at wh e n th i s
phy s i o lo gi cal co nge s ti o n i s co nti n u e d with o u t c e s s ati o n as
i n th e case wh e n m e al s ar e fre q u e n t an d f u ll th e c o n
ge sti o n b e co m e s p ath o l o gi c al an d th e se c ret io n o f m u c u s
i s r api d
The l ive r and i n te sti n e s b e co m e ch r o n i cal ly co n
ge sted fr o m s i mil ar c aus e s Thi s hyp e r aemi a l e ad s to e x
u date s
an d hyp erp las i a whi c h
f u rth er i rrit ate s s e nso ry
n erv e e n di n g s an d co n ti n u e s th e dil at
ati o n o f th e arte ri o l e s
Th u s a vi c i o u s c y cl e o f refl e x e s is e st ab li sh ed wh i ch te n d s
to ever i n c re a s i n g de s tr u ctive n e ss
Wh e n the se n s o ry n erve term i n als i n the st o m ach ar e
i rrit at e d an d hyp er aemi a o f th e g as tri c ve s sel s re su lt s th e
i nfl u e n c e o f th e i rrit ati o n d o e s n o t en d with g astri c c o n
ge s ti o n i e if th e hyp er aem i a b e e x c e ssiv e bu t cau s e s
di lat ati o n of arteri e s i n th e s pi nal c o rd ar o un d th e r o o t s o f
s e ns o ry n erve s di strib u ted i n o th e r p art s o f th e b o dy whi c h
The
ar e su ppli e d by bra n ch e s o f th e s am e n erve tr u n k
b r ai n d o e s n o t alw ay s no te th e re al lo cati o n o f th e irrit a
ti o n I t m ay refe r th e p ai n to any p o i nt suppl i e d by a
b r an ch o f th e n erve tr un k o n e o f wh o se br anch e s i s i rri
Th u s i n th e p re s e n c e o f c h r o n i c c o nge s ti o n o f th e
tate d
gastri c m u co s a as i n g astri c c at arrh th e irrit at io n m ay
no t b e i n te n s e e n o u gh to i mp re ss th e br ai n with a p ai n f u l
s e n s ati o n bu t a sl ight i nc re ase o f c api llary p re s s u re ar o u n d
th e tr u n k o f th e si x th d o r sal n erve su ch as w o u l d b e b r o u ght
ab o u t by digit al p re s s u re m ad e u p o n th e m u sc l e s ar o und
th e s i x th d o r s al spi n e w o u ld cau s e i n s t an t re c o g n iti on o f
hyp e r ae sth e s i a by th e p ati e n t Co n ti n u e d p re s su re m ad e
ar o u n d th e spi n e drive s th e b lo o d o u t an d l e s se ns th e se n
i v e n e ss
I f hyp er aemi a has b ee n i nte ns e e n o u gh to
si t
p re ss u re i n c re as e s th e p ai n th e lo ng e r i t i s
c au s e e x u d ate s
c o n ti n u e d
be cau s e the e x u d ate s h ave aff e cted th e ve n o u s
c i r c u l ati o n an d th er e i s n o o p e n p ath fo r e x it o f th e bl o o d
no
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PR I N C I PLE S
1 74
O F O S TE O PA TH Y
el s h e n c e i nte r nal co nge sti o n I rrit ati o n o f th e s e ns o ry
n e rve s i n th e ski n m ay c au s e m u s c l e u n der th e s ki n to co n
tr act th u s o b str u cti n g th e c i r cu lati o n i n th e s ki n Th ere
f o re o u r m an ip ul ati o n s fo r v aso m o t o r e ff e ct s n at u r ally
di v i de the m se lv e s i n t o tw o c l ass e s F ir st th o s e wh i c h i n
hi bi t cu t an e o u s refl e x e s ; s e co n d th o se whi ch rel ax m u s c l e
i n o rd er to rem o ve o b str u cti o ns
Thi s d1v 1s ro n l s p u rely
arbitr ary o n o u r p art
bu t it se rve s to e x p lai n o u r w
o rk
We p u rp o s e ly l e av e o u t o f thi s di scu ss i o n th e th o u ght th at
we m ay h ave an o s se o u s l e si o n c au s i n g o u r v aso m o t o r
di s t u rb an c e
W e divi de th e spi n e i n t o are as ac co rdi n g
to th e p red o m i n ati n g i n fl u e n c e whi c h i s s u e s fr o m it ; th u s,
—
th e s ub o cc ip it al f o ss a i s th e fi r st i mp o r tan t are a It has
l o n g b ee n k n o w n th at p r es s u re app li ed to t hi s are a i n a
c as e o f c o n ge stive h e ad ac h e give s gre at re l i ef
The g o o d
e ff e c t
s ar e n ot l o st wh e n th e p re ss u re i s re m o ve d
Thi s
p r o ve s th at th e e ff e c t o f th e p re ssu re is o n th e n erve s o f
th at are a an d that th ey ar e in cl o s e c e n tral co nn e c ti o n
with th e v as o m o t o r ce n ter i n th e m e d u lla Thi s c e nter
reg u late s th e c alib e r o f th e arterie s all o ve r th e b o dy I t
—
has be e n st ated th at p re ss u re at th e b as i o c c ip u t ret ard s
th e bl o o d fl o w to th e br ai n th e p re s su re b ei n g o n th e v e r
W e b e li eve a c aref u l e x ami nati o n o f th e
te br al a rteri e s
at las wi ll c o n vi n c e o n e th at i n th e aver age s ke l e to n th e
gr o o ve fo r the vertebral artery i s s o d eep an d we ll pr o
te c te d th at p re ss u re o n th e s u rf ac e o f th e n e c k c an no t af
I f o u r p re s su re e ff e ct is m e ch an i c al why
fe ct th e arte ry
?
n
The b lo o d s tre am i s as s wift
d
d o e s th e e ff e c t l ast s o l g
as an o c e an greyh o u n d , an d w o u l d r u sh i n t o th e p art ly
fi ll ed ve ss el with i ts p revi o u s f o r c e Ju s t the m o m e n t th e
p re ssu re i s rem o ved We c an o n ly e x p lai n the re s u l t by
s b ee n m ad e i n th e e n t ire
n o ti n g th e f ac t th at a c h an ge ha
D o w n w ard p r e ss u re o n th e c ar o ti d s i s also
c ir c u l ati o n
re co m m e n de d to ret ard th e bl o o d fl o w to th e he ad Th i s
i mpr acti cab l e S i nc e th e pre ss u re c anno t h e lp af
s eem s
fe cti n g th e ve no u s ret u r n as wel l as th e c ar o tid stre am
The b e st and m os t l as ti ng e ffe ct s ar e alw ay s v aso m o t o r
s
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P R I N C I PL E S
O F O S TE O PA TH Y
1 75
I t i s a we ll r e co g n iz ed f act i n th e o ste o p ath i c pr o fe s
s i o n th at p re s s u re i n th e s u b o cc ip it al tri an g l e s c au s e s a
Thi s f ac t i s
l e ss e n e d b lo o d p re ss u re all o ver th e b o dy
m ad e u se o f d ai ly to lo wer th e temp er at u re o f th e b o dy
i n cas e s o f fever
I f pre ss u re had a m ec h an i cal r ath er
th an a n erv o u s e ff e c t o n th e c i r cu lati o n w e c o u ld h o p e
Thi s p r o c ed u re
fo r n o ge n er al e ff e c t su ch as we do s e c u re
i s call e d i n h ib iti n g th e v as o m o t o r c e n te r
Why d o e s it
”
i n hibit ?
t o n e i s n o rm al i n th e b o dy i n o rde r
to keep th e b lo o d e q ually di s trib u t ed
Thi s v asc u lar
”
t o n e i s e as i ly di st u rb e d s i n c e it act s acc o rdi n g to th e su m
o f th e s e n so ry imp u l s e s re ac hi n g th e c e n te r i n the m e d
P re s su re i n th e Su b o cc ip it al tri an g l e s aff e c t s n o t o n ly
u lla
th e S um o f th e s tim u l i re ac hi n g th e c e n ter bu t m o s t i m
p o rt an t o f all aff e c t s th e c api llary c i r cu lati o n in thi s are a
wh i c h i s i n c l o s e n erv o u s an d c ir c u lat o ry c o nn e c ti o n with
the m ed u lla A n y e x ter n al app li c ati o n s u ch as ho t o r co l d
—
a
l
o
c
a
n
w ter
ae s th eti c s o r co u n ter irrit an t s m u s t s e c u re
al
wh ateve r i n ter n al ch an ge m ay b e m an ife sted by th e e f
fe c t th e s e th e r ap e u ti c p r o c ed u re s m ay h ave o n c u t an e o u s
n erve s
P re ss u re i n th e s u b o cc ipit al tri an g l e s wi ll r e lax th e
th u s l e s s e n i n g th e se n
str u c t u re s f o rmi n g th o s e t ri an g l e s
The
so ry imp u ls e s e n te ri n g th e c e n ter fr o m th at s o u r c e
re laxe d str u ct u re s wi ll h o l d m o re b lo o d h e nc e th ey wi ll
i n a S light degre e re l i eve c o n ge s ti o n o f th e c e n ter
Th e s e tri an gl e s ar e th e b i lat er al s u rf ac e c e n ter s i n
whi ch we Op er ate to c au s e di lat ati o n o f ve ss e ls i n th e S ki n
We i n hibit v as o co n str i cto n
o f th e tr u n k an d e x tremiti e s
o f s u rf ac e a rte r i e s
The n e x t gre at co n s tri c t o r are a i s th e spl an ch n i c si x th
Thi s an d th e p re c edi n g are a ar e th e tw o
to e l eve n th d o r s al
p o i n t s o f v an t age fo r the o s te o p ath S i n c e th e S p lan ch n i c
n e rve s c o n tr o l a s y s tem o f b lo o d ve s s e l s wh o s e co mbi n e d
cap ac ity i s e q u al to th e e n ti re am o u n t o f th e b lo o d i n th e
b o dy we can q u i c k ly re aliz e wh at it m e an s to th e g e ner al
In all c ase s o f Co n g e st iv e
c i r cu l ati o n t
o aff e ct thi s are a
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PR IN C I P LE S
1 76
O F O S TE O PA TH Y
h e ad ach e s fev e r hyp e r aemi a o f vi sc er al o rg ans e tc we
“
”
?
n
l
n
h
s
a
c
n
i
i hibit th e p
Why
cs
The refle x e s b etw ee n
th e ski n o f th e b ac k an d th e m u sc l e s o f th e b ack ar e s o
i nte ns e th at th ey cau se v asc u lar co n s tri c ti o n o f th e c u
tan e o u s arterie s an d c
o n tr acti o n o f th e d eep m u sc l e s o f
th e b ack th u s addi n g a m e ch an i c al o b str ucti o n to th e ci r
c u lati o n o f th e b lo o d i n an al re ady c o ns tri c te d are a
IS
it n o t p o s sibl e y e s p r o b abl e th at th i s s t ate o f th e s u rf ac e
ti ssu e c au ses a c o n ge sti o n o f th e v aso m o t o r c e n te rs i n
th e d o r sal are a o f th e co rd , th u s n u llifyi n g th ei r co n tr o l
o f th e S p lan ch n i c are a ?
S u c h a c o n diti o n m igh t b e br o u ght
ab o u t by c o l d
The e ati n g of i n d ig estibl e f o o d wh i c h r e
m ai n s a l o n g tim e i n th e dige stive tr act m ay al so b e a
c aus e
The f act s ar e as we h ave s t ated them we i nhibit o ver
he s pl an ch n i c are a to le s se n the i n te n sity o f th e refl e x e s
t
i n th at are a th ereby all o wi n g th e c e n ter s to reg ai n th ei r
c o n tr o l
R em emb er th at i nhibiti o n l e s se n s th e se n so ry
i mp re s si o n s re ac hi n g a c e nte r an d re lax e s m u s c l e b o th
d i r e ct ly an d i n di re c t ly
—
I
t
o
n
s
An i llu s tr ati o n o f o s te o p
ll
r
a
t
ath i c
u
s
C ase
i
m eth o ds app li e d to hy pe r ae m 1a i s aff o rd ed by th e follo w m g
case z A ge n t l em an ab o u t fi fty ye ar s o f ag e w as i n sp e c ti n g
mi n e s in th e vi c i n ity o f Y u m a A riz o na H e was o f ple
th o ri c h abit an d h e n c e th e h e at o f th at l o c ality aff e c ted
h im q u i c kly Ab o u t eight p m wh i le i n his te nt p re
p ari ng to b ath e in o r de r to get so m e re li ef fr o m th e i n
te n s e h e at h e felt a w
ave o f we ak n e s s p ass u p hi s l eft s i d e
an d al m o s t i n st an t ly p o we r o f m o ti o n o n th at s id e w as
P ar aly si s di d n o t e x te n d to th e f ac e The ge ntl e
lo s t
m an w as br o u ght to Lo s Ange l e s an d c am e u n de r th e be st
E l e c tri c ity an d m assage were tried
o f m edi c al tre atm e n t
with f ai r s u c c e s s bu t th e l eft ar m an d h an d rem ai n e d
h elp le s s an d we re c arri e d i n a s li ng The h an d w as b ad ly
l d pit un der p re ssu re th us sh o wi n g a
s w o l le n an d w o u
The hand
marke d d e g r e e o f v aso co nst r i ct o r p araly si s
and arm had be e n t ho ro u ghly m as saged fo r two mo nt hs
,
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-
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PR I N C I PL E S
1 78
O F O S TE O PA TH Y
Tre atm e n t w as dire cte d
e cu ri n g re lax ati o n o f th e
c o n tr ac ted c e rvi cal m u sc l e s an d t
o b re aki n g u p adhe s i i o n s i n
th e sh o u l de r j o i nt wh i c h had be e n all o we d to s ti ff e n No
t r e atm e n t w as give n to th e h an d o r ar m The p ati e n t w as
i n str u cte d to str ai ghte n th e b e n t fi nger s with th e wel l h an d
m any tim e s p e r day to o ve r co m e th e sp as ti c co n diti o n
Vaso m o t o r t o n e ret u r n e d to th e bl o o d ve ss el s o f th e h an d
i n p r o p o rti o n to th e am o u n t o f c e rvi cal rel ax ati o n ac
At th e e n d o f o n e m o n th th e h an d w as al
co mpl i sh e d
lo we d to h an g n at u r ally an d s car c e ly any o edem a wa s
M u s c u l ar c o n tr o l an d p o wer h ave s te adi ly
n o ti c e ab l e
i n c re as ed
to
s
.
.
.
-
.
,
.
.
ill u str ati o n i s affo rded by th e f o ll o wi n g cas e
A ge n tl em an su ff e ri n g with i n fl am m at o ry rh e u m ati sm i n
th e s e c o n d to e o f th e right f o o t so ught re li ef by me ans o f
H e had u s ed th e sali cyl ate s i n hi s
o s te o p ath i c t re atm e n t
p revi o u s att ac k s bu t hi s st o m ach had b e co m e i nt o l er ant o f
th em The to e w as re d an d an gry l o o ki ng th r o b bi n g with
p ai n an d sw o lle n to th e s iz e o f th e gre at to e
An o th e r
.
,
.
,
.
of th e
E x am i n ati o n
pi n e reve al ed te n der n e s s b etwe e n
th e fifth lu mb ar an d th i rd sac r al spi n e s als o be tw e e n the
Why S h o u l d te n d er n e ss
s e co n d an d th i rd lu m b ar spi n e s
e x i s t at th e se p o i n t s ? The an swer acc o rdi n g to anat o my
an d phy s i o l o gy i s th at th e s e sp i n al are as m ark th e p o i n t o f
em erge n c e fr o m th e s pi n al co l u m n o f the an teri o r c r u r al
e rve s whi c h ar e di strib u ted to e q u al
an d gre at sc i ati c n
p art s o f th e aff e cte d toe ; th e s e n so ry n erve s bei n g i r
r it
ate d by th e d ep o sit o f f au lty k at ab o l i c p r o d u c t s i n th e
ti s su e s o f th e to e as th e re su lt o f a slo W blo o d stre am
In th i s cas e th e p ati e n t w as c au gh t o u t i n th e r ai n an d
h
feet
wet
T
e p eriph er al i rrit ati o n o f th e s e n so ry
h
i
o
t
s
g
n erve s c au s ed dil at ati o n o f th e arteri o l e s an d c api ll ari e s
The b lo o d ve s s e l s a r o u n d th e r o o ts o f o th er s e nso ry
h e s o f th e sam e n e rve tr u n k s al s o
n e rve s whi ch were br an c
dil ate d i n re s p o n se to th i s i rrit ati o n i e hyp e r aemi a i n
th e S pi nal co rd w as br o u ght ab o ut at th e p o i nt o f o rigi n
s
'
,
.
:
'
.
“
.
.
,
.
.
,
PRI N C I PL E S
O F O S TE O PA TH Y
1 79
th e an teri o r c r u r al an d gre at sc i ati c n erve s h e n c e th e
s e n so ry n erve s to th e ski n an d m u sc l es o f th e b ac k wh i ch
ar e i n n e rv ated fr o m th e s am e ar e a o f th e c o rd as th e s e
gre at n e rve tr u n k s wi ll a l so b e te n der to i n c re ase d t e ns i o n
s u ch as th at s e c u re d by th e digit al p re ss u re
“
In a cas e su c h as thi s we do n o t de si r e to h ave the
dep o s it i n th e to e t ake n u p u n ti l th e e li m i n ati n g o rgan s
To f o r c e it i n t o th e c i r cu la
he bo dy ar e ac ti n g fre e ly
of t
ti on b e fo re s u ch tim e as it c an b e elimi n ate d m ay re s u l t i n
I t i s q u ite n e c e s sary th at th e
i n fl am i n g an o th er p ar t
th r o bbi n g p ai n be s ubdu e d so t hat S l e ep m ay b e ha d The
p ati e n t s o o n le ar n s to t ake adv an t age o f ve n o u s c i r cu l a
ti o n by e l ev ati n g th e f o o t If pre ssu r e u p o n an d a ge n t l e
he s pi n al ar e a i s
r el ax i n g m ove m e n t o f th e m u s c le s i n t
m ade th e r e wi ll q u i ckly b e n o te d a d e cr e as e i n s pi n al
s e n s itive n e ss fo l l o wed by l e s se n ed c o n s c i o u s p ai n i n th e
It i s q u it e p r o b abl e th at p ai n i n th e to e i s du e to
to e
hyp er aemi a ; s e n sitive n e s s l n th e s pi nal are a i s due to th e
th e di ff ere n c e b ei n g i n degree I t
sam e S o rt o f c o n diti o n
IS
i mp o ss ibl e
to p r o v e th e pr ese n c e o f th e s e tr an s it o ry
hyp er aemia s by any d ir e c t o b s erv ati o ns any m o r e than it
i s p o s s ibl e to p r o ve by p o s t m o rte m e x am i n ati o n th at hy
m
o r an aemi a o f th e br ai n i s p r e se n t as a fi x ed
i
e
r
a
e
a
p
p ath o l o gi c al le s i o n i n f au lty f u n cti o n i n g o f the br ai n
of
,
.
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'
.
.
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.
,
.
"
,
’
.
,
.
-
.
.
P re s su re an d rel ax ati o n i n th e spi n al ar e a dr aw s th e
b lo o d aw ay fr o m i ts p o si ti o n aro u n d th e n erve tr u n k r o o t s
ny o f t
he imp u l s e s wh i ch w o u ld o rigi n ate
an d th u s s t o p s m a
c e n tr ally a s a re s u lt o f th e i rrit ati o n o f th e s e n s o r y r o o t s o f
th e n erve tr u n k
.
.
We u su ally thi n k o f th e s e refle x se n sitive ar eas o f the
s pi n e a
s b e 1 n g evi de n c e o f th e abi l ity o f all th e br an c h e s o f
a n erve tr u n k to e x p re ss s o m e degree o f th e irrit ati o n b e
i n g b r o u gh t to b e ar o n an y o n e o f t
he b r an ch e s
I t s eem s
to m e th at in th e li ght o f wh at is k n o wn to h app e n i n th e
are a o f an i r r it a
ted n erve hype raemi a th at th e s am e
o cc u r ar o u n d th e r o o t s o f i t
ch an ge i n c i r c u l ati o n m ay
s
.
,
,
18 0
PR I NC I PL E S
o r O S TE O PA TH Y
p are n t n erve tr u n k an d b e th e so l e re aso n fo r wh at we d e
n o mi n ate a refl e x p ai n
B y givi n g th e h e avy m o vem e n t re q u ired to rep lac e a
s u bl ux ated ve rtebr a o r eve n to re lax te n s e m u sc l e s ar o u n d
an o th erwi se n o rm al arti c u lati o n it i s q u ite p r o b ab le th at
i n e x p li cab le ch an ge s ar e wr o u ght i n th e c i r c u lati o n at
th es e p o i nt s wh i ch imm e di at ely c h an ge th e c h ar act er o f
th e n e rv e i mp u l se s o rigi nati n g o r r e fl e x ing fr o m thi s po r
ti o n o f th e S pi nal c o rd
.
,
'
.
PRI N C I PL E S
18 2
'
a
b pm al
b
e r i or
po st
C
In fi
d
E xfi
r nu
Co r d
mu
mu r
l br m
.
Bit
ch
-
tu
fl
o
!,
h (
d u ru n
g
an
g
u
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p
sc u
on
W
i de
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e
c
wCa n co u a
,
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t
a
A
h
c br un c h
S amp lfl h e tt
or
m an :3 o
H
f
o
M
u
i n fi m a fé
i
r e l a tori s
me Di slttbwtwm an d Co nn e c ti on s
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a
.
F IG
.
30
.
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r an
al
R ec u r r ent br a n c h
Ve n n ( o wn In fer i o r
.
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c u tan e o u s )
,
m ul br cm o hJ M
e cf to n a
La rv
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r
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a
6
O F O S TE O PA TH Y
D r aw n b y D r J E
.
.
.
t rt
S ua
.
.
bi u m
'
PR I N C I PL E S
M e t hods
OS TE O PA TH Y
OF
Anato m y — Th e se
18 3
t tem e nt s
l e ad u S to a c los er st u dy o f e ac h j o i n t an d i ts c o n tr o lli n g
m u s c le s an d g o ver n i n g n erve o r n erve s W e m ay s t u dy
an at o my u n de r artifi c i al divi s i o n s s u c h as O ste o l o gy S y n
d e s m o lo gy M y o lo gy e tc an d sti ll afte r s e cu ri n g an
acc u r at e te c h n i c al k n o w l edge o f det ail s w e have n o th i n g
o f p r ac ti c al v al u e
I t i s i n th e co rre lati o n o f th e s e ti s su e s
with th e i r i n te rd ep e n d e n c e q u ite f u lly u n d er st o o d th at we
h ave a W Or ki ng k n o w l e dge With thi s th o u ght o f th e i n
fl u e n ce o f o n e ti ssu e o n an o the r an d the harm o n i o u s ac
ti o n se c u re d by th e co mp ar ative ly v ari e d di s trib u ti o n o f
th e n e r ve tr u n k s, we fi n d a n e w an d vit al i n te r e s t i n
an at o my
Thi s law i s b as ed u p o n the fac t s o f an at o my an d phy si
o l o gy
an d m ake s o u r c o n c ret e k n o wl edge o f th e s e s u b
i
n b o th di ag n o si s an d
r ac ti c al v al u e
t
p
n
f
c
o
n
a
o
c
t
s
s
e
t
j
“
”
Thi s law sh o w s u s the w hy o f Ce r t ai n vital
th er ape u ti cs
and t eache s u s p r ac ti c al
an d m e c h an i c al m an ife s t ati o ns
m et ho ds o f t r e atm e n t
S tu dy i n g
of
.
s a
.
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,
,
,
.
,
,
'
,
.
I
.
.
,
,
.
—
An e x amp l e o f H i lt o n s
E x am ple o f H i lto n s Law
law i s the édi str i buti o n o f th e sc i ati c n e r ve to th e an k l e
The m u sc le s m o vi n g the j o i n t the sy n o vi al m emb r an e an d
m o st o f the s ki n o v e r th e j o i n t ar e all i nn e r v ated by it
’
’
.
'
'
~
.
,
.
The
—
K n e e The k n ee
erve s E ach o n e has
The e x te n so r m u sc l e s an d
a m o t o r an d s e n s o r y c o n t r o l
the s ki n o ve r them is i nn erv ated by th e an teri o r c r u r al
The fl e x o r m u s c l e s an d th e ski n o v er t hem i s i nn erv ate d
by th e sci ati c The o bt u r at o r i n additi o n to th e se n e r ve s
f u r n i sh e s s e n so ry fi lame n t s to th e s y no vi al m embr an e All
th e j o i n t s o f th e b o dy m ay b e e x ami n e d in th e li ght o f thi s
The sam e s egm e n t o f the c e nt r al n e r v o u s sy s tem
law
wh i c h give s o ff a p ur e ly mo t o r n erve tr u n k give s o ff als o
a s e n so ry n e rve wh o s e fi lam e nt s ar e di s trib u te d o ver th e
Th u s it i s so m etim e s n e c e s s ary to g o to th e
sam e are a
n erv o u s
c e n tr al
s ys te m
to di sc o ve r thi s as so c i ati o n o f
m o t o r an d s e n so ry di st r ib u ti o n In pr acti c e we alw ay s do
.
has
th re e
n
.
.
.
.
,
,
.
'
.
,
.
"
.
PR I N C I PL E S
18 4
O F O S TE O PA TH Y
th i s be c au se it is e as i e r to w o rk fr o m th e c e nter o f th e
are as o f di strib u ti o n
The O bj e ct o f S u ch a D i s t r i bu ti o n—H ilt o n say s : The
o bj e c t o f s u ch a di strib u ti o n o f n e rve s t
o th e m u sc u l ar an d
arti c u l ar str u ct u re s o f t
he j o i n t s in acc u r ate ass o c iati o n i s
to i n su re m e ch an i c al and phy s i o lo gi c al c o ns e n t betwee n
th e e x te r n al m u sc u lar o r m o vi n g f o r c e an d th e vit al e m
d u r an c e o f th e p art s m o ve d n am e ly o f th e j o i n t s th u s
s e c u ri n g i n h e alth a tr u e b alan c e o f f o r c e an d fri c ti o n u n ti l
dete ri o r ati o n o cc u r s
“
With o u t th i s n erv o u s a s so c i ati o n i n th e m u sc u lar
an d arti c u lar str u c t u re s
th e re co u l d b e n o i n tim ati o n by
”
“
th e i nter n al p art s o f th ei r e x h au ste d c o n diti o n
A g ai n ,
th r o u gh th e m edi u m o f the m u s c u lar and c u t an e ou s n erv o u s
as so c i ati o n gre at s e c u rity i s give n to th e j o i n t it s e lf by
th o s e m u scle s b ei n g m ad e aw are o f th e p o i n to f co n t ac t
o f any
e x tr an e o us f o r c e o r vi o l e nc e Th e i r I nv o lu n t ary
co n tr ac ti o n i n sti n c t iv ely m ake s th e su rr o u n di n g s t
r u ct u re s
te n s e an d rigi d an d th u s bri n g s ab o u t an i mp r o ve d de
”
fe n c e fo r th e s u bj ac e n t str u c t u re s
Thi s ar ticu lar m u s e u
The U n if o r m ity of the Law
lar an d c u t an e o u s di strib u ti o n o f th e n erve s i s i n: my
Opi n i o n a u n if o rm arr an gem e nt i n every j o in t i n th e b o dy
We m ay fi n d n u m er o u s i llu st rati o n s o f the s am e m eth o d
whi c h h ave th e
o f di s trib u ti o n i n o th e r p art s o f th e b o dy
an d i n th i s re sp e c t
sam e d efi n ite re lati o n s to e ach o th e r
p re s e n t the sam e phy si o lo gi c al an d m e ch an i c al arr an ge
*
Thi s s am e pri n
m e n t o b se rv ab l e in j o i nt s
phy s i o lo gi c ally an d
an at o m i c ally
of
arr an gem e n t
c i pl e
p ath o lo gi cal ly c on si d ered is to b e o b s e r ved with an eq ual
d egree o f acc u r acy i n th e s e r o u s an d i n th e m u c o u s m em
br an e Th u s co ns i de re d it p re se n t s a p ri nc ip l e wh i c h if
it has any app li c ati o n i n p r ac ti c e m u st b e o n e c ert ai nly
”
o f l arge e x t e n t
—
M
l
T
h
P r e ci si o n o f Ne rv o u s D i st r ib u ti o n to
u sc e s
e
7
gre at p re c i si o n with wh i ch m u sc l e s ar e s u pp li ed by th ei r
n d i s s u c h th at if we h ave
n erve s i s w o rthy o f rem ark ; a
,
.
,
,
,
,
,
,
,
,
'
.
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.
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O F O S TE O PA TH Y
PR I N C I PL E S
18 6
th e n erve s co n tr o lli n g a j o i n t o r o th er str u ct u re
b e li evi n g th at it i s o f litt l e v alu e to anae sth etize n e rve
e n di ng s an d giv e re s t so lo n g as thi s stim u l u s is all o wed
to ar o u s e i mp u l se s i n the n e rve fiber s
lu s to
,
.
M e t ho ds —To c omp are m eth o d s
Law we wil l n o te on e o f hi s c as e s an d
C o m par i so n
of
o f uS
.
H i lt o n s
a sim
“
i lar o n e tre ate d o ste O pathi cally
In Ch apte r V I I I o f R e st
”
an d P ai n
h e d e sc rib e s a case o f i n fl amm ati o n o f th e sh o ul
d e r j o i n t an d m e nt i o ns th at th e j o i nt i s fi x e d i n a p o siti o n
o f re s t as a re s u l t o f th e ass o c i ati o n o f n erve s t
o th e sy n o
vi al m embr an e th e m u scl e s o f th e j o i n t an d th e s ki n o ve r
th e j o i n t An ae sth e si a re le as e s th e fi x e dn e ss o f th e j o i n t
be cau s e th e m uscle s do n o t co n tr act afte r th e se n so ry i m
“
p u ls e s ar e d e ade n ed by th e an ae sth eti c H e s ay s Ther a
i
m
u
a
a
n
c
e
t
s
c
a
ert
i
ly
re
c
h
th
e
i
n
te
ri
o
r
thi
j
o
i
t
n
o
f
s
n
a
d
p
y
i ts m u s c l e s thr o u gh th e m edi u m o f th e n erve s u p o n th e
su rf ac e o f th e s ki n an d so i n d u c e phy si o l o gi c al re st to all
p art s c o n c er n ed i n m o vi n g th e j o i nt I m e an to s ay th at
th e s e n erve s u p o n th e su rf ac e o f th e S ki n b ei n g i n dire ct
w e m ay
ass o c i ati o n with the i n teri o r o f th e j o i n t it s e lf
re d u c e th e m u scu lar sp asm as we ll as th e se n sibi li ty o f
th e i n teri o r p o rti o n o f th e j o i n t by applyi n g o u r an ae s
th eti c s with accu racy an d with s u ffi c ie n t i n te n si ty u p o n
th e e x teri o r o f th e de lt o i d m u sc le o ver th e di strib u ti o n o f
th e s e se n s itive fi lam e n t s The th o ught wi ll o ccu r to y o u
at o n c e th at th ere i s n o thi n g v ery rem ark ab l e i n th i s o p i n
The embr o cati o n s h o wever
i o n and th at i s q u ite tr u e
wh i ch w o u l d o rdi n ari ly b e S u gge s ted fo r th i s p u rp o se ar e
n o t o f a c h ar ac te r suffi c i e n t ly p o te n t to all evi ate th e p ai n
an d ar e
I b e li eve s e l d o m emp lo ye d with a
o f th e p atie n t
defi nite i de a i n th e mi n d o f th e pre sc riber I wo u l d sug
ge st th at we sh o u l d emp lo y o ur f o m e nt ati o n s s tr o n g ly
m edi c ate d with b e llad o nn a w ith o pi u m o r wit h h em lo ck
i n ste ad o f u si n g m ere f o m e n t ati o n o f ho t w ate r S o m e wi ll
e as g o o d but I can assu re y o u
say
O h ho t w ater i s q u i t
”
pr ac ti cal ly th at it i s n o t s o
i ng
’
,
,
.
.
,
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i
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.
.
,
,
,
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,
.
,
,
,
.
,
,
.
‘
,
,
.
'
PRI N C I PL E S
O F O S TE O PA TH Y
te th at h e make s u s e o f th e cu t an e o u s r e
fl e x e s to aff e c t th e i n ter i o r o f th e j o i n t
A re c e n t c as e c o r r e sp on di n g we b e li ev e w as tre ated
wit h m arked s u c c ess The i n fl amm ati o n
o s te o p athi c ally
i n the s h o u l de r j o i nt w as n ot tr au m ati c in o r igi n n o r did
it app e ar to b e r he u m ati c in characte r H o t fo m e n tatio n s
w o u l d give gre at r e li ef but di d n
o t give su ffi c i e n t re s t to
th e j o i n t to pe r m it o f a c u re The fe ar w as e ntert ai n ed
th at lo nger re s t of the arti c u l ati o n w o u l d r e su lt i n adh e
S i n c e th e c ir cu m
s i o n an d l o ss o f f u n c ti o n i n th e j o i n t
fl e x n e rve app e ar e d to b e the o n e i n v o lved a car ef u l e x
ami n ati o n w as m ade o f th e arti c u lati o n s b etwee n th e s i x t h
The c i r c u mfl e x n e r ve i s
an d s eve n t h c ervi c a
l vertebr ae
m ad e u p large ly o f fib er s fr o m th e S i x t h c ervi cal n erve
Te ns i o n and te n der n e s s t o get he r Wit h s light r o
tru n k
tati o n o f th e s i x t h c ervi cal we r e n o te d at t hi s p o i n t
The
o s te o path
i ns te ad o f w o rki n g o ve r th e ar e a o f di st r ib u ti o n
o f th e c ir c u mfl e x
c e ntered hi s w o rk u p o n t hi s arti c u lati o n
to b r in g ab o u t r i ght r e lati o n s be tw e e n the si x t h an d se v
Ten s i o n an d i rrit ati o n were r e
enth c ervi c al vertebrae
mo ve d Th e c ir cu mfl e x n e r ve c e as ed to m an ife s t any u m
The o ste o p at h al m ost i nv ar i ab ly w o r k s
du e i r r it ati o n
fr o m th e c e n te r to p eriph ery i ns te ad o f the r eve r se
H e r pe s Z o ste r — Ah e x amp l e o f the o s te o p ath s u se o r
r at he r re co g n iti o n o f H ilt o n s law : A cas e o f H e rp e s Z o s te r
l o c ated al o n g th e c o u r s e o f the l eft fift h i n te r co s t al n erve
w as give n a g r ave pro g n o si s by a ho m e opath i c phy s IC Ian
t h i mm edi ate ly ho p i n g th at
The p ati e n t v i sited an o s te op a
he i n t o l e r ab l e p ai n
s o m e rel i ef mi ght b e f o u n d fo r t
The
e ru pti o n e x te n de d fr o m the s pi n e to th e m e di an l i n e i n
f r o n t f o rmi ng a band a bo u t o ne i n ch wide The fift h rib
ar d th u s le s s e n i n g the fifth i n te r
w as f o u n d r o t ate d do a
c o s t al s p ac e an d pr e ss i n g o n th e n erve at s o m e p o i n t i n
Th i s rib w as r ai s ed eve n t ho u g h th e o ste o
i ts co u r s e
p ath s fi n ge r s re ste d dire c t ly u p o n the er upti o n i n o r der
The re s u lt w as m o s t gr atifyi n g
to f o r c e th e rib u pw ard
P ai n de c re as ed alm o st i m
m edi ately an d th ere w as a r api d
Yo u wi l l
no
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i i
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-
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,
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,
PRI N C I PLE S
18 8
F IG
.
31
tn e
H e ad )
S
of
enso r
b dy
o
.
.
y
O F O S TE O PA TH Y
d e r m a to m e s
on
D r aw n b y Joh n
t
Com s
or
rf a
t k ( a ft r
an e r i
oc
su
ce
e
190
P RI N C I P LE S
O F O S TE O PA TH Y
C YI
F IG
S e n so r
32
od
o f th e
H e ad )
.
b y
.
.
.
y
d e rm
t
a o
D raw n
mes
by
on
J oh n
t
rf
to k ( aft r
pos e r i o
’
~
C om s
r
c
su
ace
e
PR I N C I PLE S
O F O S TE O PA TH Y
19 1
i
by
h
s st atem e n t th at
m
n
l
e
e
t
e
d
p
has a m u s c l e att ach ed to i t, an d
every f as c i a o f the b o dy
eve ry f asc i a th r o u gh o u t
”
th e b o dy m u st be co n s i de re d as th e i n s ert i o n o f a m u scl e
Thi s carri e s th e i n fl ue nc e o f m o t o r n erve s to p o i n t s c o vered
by th eir s e nso r y co mp an i o n s
'
.
.
H e adl s
’
—
Law
An o th er
law ,
in
th i s c ase a c o mp re
he n s iv e s t atem e n t has be e n m ade by H e ad i n hi s writi n g s
“
”
i n Br ai n
Thi s i s a s t atem e n t o f phy s i o lo gi cal tran sfe r e n c e
o f p ai n fr o m i ts p o i n t o f o rigi n t
o a p o i n t o f c o n sc i o u s
Thi s phy si o l o gi cal law i s st ated as f o llo w s
s e n s ati o n
“
Whe n a p ai n f u l s tim u l u s i s app l ie d to a p art o f low s e n
i
n
n
n
c
o
s
e
a
l
co
n
l
c
e
r
e cti o n with a p ar t o f m u ch
si bili t
t
y
high er s e n s ibi li ty the p ai n p r o d u c e d is felt i n the p art o f
h igh er se n sib i lity r ath er th an i n th e p art o f lo wer s e n sibi l
”
ity to whi ch th e stim u l u s w as app li e d
.
‘
or
,
.
.
.
,
.
—Thi s phy s i o l o gi cal law can
b e app l ie d i n tw o w ay s F i r st we m ay co n s i der th e re la
tive s e nsibility o f di ff ere n t p o r ti o n s o f a n erve tr u n k I f a
o a n erve tr u n k at s o m e p o i n t i n i ts
stim u l u s i s appli e d t
e e n i ts o r 1g 1n an d di strib u ti o n th e p ai n c au s ed
c o u r s e b e tw
by th e s tim u lu s will b e felt in th e are a o f di s trib u ti o n o f
th e fib er s o f thi s n erve tr u n k r ath er th an at the p o i n t wh ere
th e stim u l u s i s app li ed The S k in m u co u s o r s er o u s m em
br an e an d m u s c l e i n wh i ch s e n so ry n erve s e n d ar e are as o f
high se n s ibil it y c o mp are d wi th th e tr u n k o f th e n erve
The b r ai n i s c o n sc i o u s o f o n ly th e are as o f di strib u ti o n o f
th e se n so ry n e r ve s h e n c e s tim u li appli ed at th e p o i nt s o f
lo w s e n s ibi lity ar e referre d to th e are as o f h igh s en s ibi l ity
Th us all l e s i o n s cau si n g pre ss u re u p o n n erve tr u n k s c au s e
p ai n co ntr acti o n o r p erv er s i o n o f se c reti o n i n the are as
The p ati e n t i s no t th o r o u gh ly co ns c i o u s
o f di s trib u ti o n
lo cati o n bu t th e are a o f di strib u ti o n whi c h i s an
o f an y
are a o f hi g h s e n s ib i l ity
The cas e s de sc rib ed u n der Hi lto n s law ar e app l i c ab l e
h e re In th e c as e o f i n fl am ed sh o u ld e r j o i n t th e p ati e nt
w as n o t co n sc i o u s o f the i rrit ati o n at th e S p i n al c o lu m n
Appl i cati o n o f the Law
.
.
,
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,
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,
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,
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,
,
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'
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’
.
PR I N C I PL E S
19 2
O F O S TE O PA TH Y
th e r o t ated ve rteb r a—th i s w as an are a o f l o w s e n sibil ity
i n th e c o u r s e o f th e n e rve tr u nk
The br ai n attrib u ted all
th e tr o u b le to th e term i n ati o n s o f th e n erve s i n th e ti s su e s
o f th e j o i n t
All o f the refle x e s ac te d acco rdi n g ly
.
.
.
The
e c o n d app li c ati o n o f th i s law is to th e rel ative i n
te n sity o f are as o f h igh s e n s ibi lity The are as i n wh i ch
s e n so ry n e rve s e n d ar e al l are as o f h igh s e n s ibi lity
bu t
We n o te in p r acti c e th at
s o m e ar e high e r th an o th er s
so m eti m e s a n e rve tr u n k whi c h s u pplie s s ever al s tr u c t u re s
wi ll m anife st p ai n i n a po rti o n o f i ts a re a o f d i strib u ti o n
wh i ch i s n o t th e p art in w
h i c h the i rrit ati o n i s l o c ated
Fo r e x am pl e th e s e n so ry p o rti o n o f th e o bt u r at o r n er ve
i s di s trib u te d to th e hIp j o i n t an d ski n o n th e i nn er s i de
The s ki n s eem s to b e an are a o f high er se n
o f th e k n e e
n
s i bi l i t
a
n
o
n
th
th
e
i
te
ri
r
th
e
h
ip
j
i
t b e cau se i n di se as e
o
o
f
y
o f th e h ip j o i n t th e p ati e n t fre q u e n tly c o mpl ai n s o f p ai n
i n th e c u t an e o u s are a r ath er th an i n th e j o i n t wh ere th e
ac t u al di se as e i s l o c ated
s
.
,
.
.
,
'
.
,
.
—
The vi sc e r a ar e n o rm al ly no n s e n sitive
The Vi
i e we ar e no t c on sc i o u s of p o ss e ss i n g vi sc er a The pre s
su re o f f o o d i n th e st o m ac h an d th e b e at o f th e h e art m ake
n o i mp re s s i o n o n o u r Co n s c i o u s n e ss ; an d s o it i s with al l
p art s o f th e b o dy go ver n ed by sym p ath eti c n erve s The
v i s c e r a ar e are as o f lo w s e n s ibility n o t lo w i rrit abi lity
fo r th ey ar e ri ch ly su ppli ed with s e n so ry n er ve s u p o n
th e sti m u lati o n o f whi c h active f u n c ti o n i n g dep e n d s The
re sp o n se to s ti m u li o f s e n so ry n erve s i n vi sc e r a i s r api d
b u t n o rm ally th i s re s p o nse t ake s p lac e e ntire ly o u t s id e o f
o u r c o n sc i o u sn e s s th e i mp re s s i o n i s n o t re c o g n iz e d as c o m
i ng fr o m th e vi s c e r a bu t fr o m a rem o te are a o f h i gh S e n
i
l
e
c e n tr al c o nn e c ti o n with th e l e s s s e n sitive
n
c
o
s
s i bi li t
y
A s an e x ampl e p ai n i s fe lt i n th e right s h o u l der as
are a
The p re ssu re u p o n
a re su lt o f hyp er aem i a o f th e liver
h e l i ve r
se n so ry n erve s i n th e l iver d o e s n o t cau s e p ai n In t
—
bu t refer s it to a m o re se n s itive are a th e ski n an d m u sc l e s
o f th e right sh o u ld er
sc e r a
.
.
-
,
.
,
;
,
,
,
.
"
,
:
,
,
,
.
,
.
‘
,
.
PR I N C I PL E S
19 4
O F O S TE O PA TH Y
C H A P TE R X I
.
O S TE O P ATIIIC C E NTE R S
-
.
C ert ai n
p o i nt s o n th e s u rfac e o f th e b o dy ar e sp o ke n
“
”
o f as
C e nte r s
Thi s w o rd has b e co m e a p art o f th e o s te o
p ath s t e ch n i cal v o c ab u lary
I t d o e s n o t c o nvey to th e
mi n d o f th e o ste o p ath th e sam e m e an i n g wh i ch att ach e s
to it wh e n u s ed i n phy s
i o lo gi cal te x t b o o k s
A phy si o l o gi c al f u n c ti o nal c e nte r i n th e c e n tr al n erv o u s
s y s tem i s th at p o i n t wh ere th e ac t
l o n o f a c ert ai n vi sc us o r
o th e r str u c t u re is g o ver n ed
A n o s te o p ath i c c e n ter i s th at p o i n t o n th e s u rf ac e o f
th e b o dy whi ch has be e n dem o n s tr ated to b e i n c lo se st
c e n tr al co nn e c ti o n with a phy s i o l o gi c al c e n te r
o r o ve r th e
c o u r s e o f a go ve r ni n g n erve b u n d l e
—
I
I
I
n
In Ch apte r
u de r th e su b h e adi n g S egme n t a
ti o n
refe re n c e i s m ad e to th e divi si o n o f th e c e n tr al n erv o u s
i n t o se c ti o ns whi c h m ay to a m o d e r at e d egre e
sy s tem
f u n c ti o n ate i n d ep e n de n t ly No p o rti o n o f th e n erv o us sy s
te m ever f u nc ti o nate s ab s o lu te ly i n dep e n de n t ly The ac
ti o n o f every p o rti o n aff e ct s all o the r p o rti o n s bu t c er tai n
are as i n th e b rai n an d S p i n al co r d s eem to b e s o m ewh at
o g o ve r n o r c o o rdi n ate th e phy s i o l o gi c al ac tivity
se t ap art t
o f c ert ai n o rg an s
P hy s i o lo gy has d em o n str ated a large
n u mb e r o f th e s e c e n t er s
P hy s i o lo gy sh o w s ho w no t o n ly th e i n divid u al g an
gl i a wh i ch l ie in th e i nte sti n e s f u n cti o n with rel ative i n
depe n de nc e bu t ho w eve n str u ct u re s l ike th e sp i nal g an
gl i a fre q u e ntly re ck o ne d in with th e c e ntr al sy stem still
”
e nj o y r el ative i nd ep e nd e n ce f ro m it f uncti o nally
Wh at we k no w o f th e an at o mi cal str u ct u re and o f
.
’
‘
.
-
.
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,
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,
,
,
,
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,
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.
,
.
PRI N C I PL E S
O F O S TE O PA TH Y
19 5
th e f u n cti o n s o f th e c e n tr al n erv o u s sy stem o f vertebr ate s
f o r c e s u S m o r e an d m o re to the c o n c lu s i o n s ( 1 ) th at eve n
i n div id ual p art s o f th e c e n tr al sy s tem ar e th e m s e lve s i n a
p o siti o n to f u n c ti o n to a c ert ai n e x te n t i n dep e n de n t ly an d
th
t
eve
th
e
br
i
n an d s p i n al c o rd o f v e r te b r ate s ar e
a
n
2
a
( )
Wh eth er the o n e o r th e
co mp o s ed o f a s eri e s o f c e n ter s
i s m o re h igh ly deve l o p ed wh eth er th ey
o f th e s e
o th e r
ar e i n c o nn e c ti o n with de ep er c e n ter s wh eth e r th ey h ave
th em s e lve s an d with highe r c e n ter s
c o nn e c ti ons am o n g
det
erm i n e th e m e as u re o f th e high er o r lo wer deve lo pm e n t
We wi ll fi n d later th at i n th e c o u r s e
o f th e c e n tr al sy s tem
f a c la ss i n divi d u al c e n ter s c o nn e cted
o f th e d eve l o pm e n t o
w ith th e c e ntr al n erv o u s sy ste m h ave re ac h e d a h igh d e
v e lo p m e n t wh i l e o th er s h av e arrive d at a c ert ai n s t age
r em ai n s t ati o n ar y
r
re
h
ed
ert
i
typ
e
wh
e
e
th
ey
n
o
r
a
c
a
c
a
)
(
ll s u b s e q u e n t p o sterity r em ai n everywh e re
an d thr o u gh o u t a
al ike
“
O n e can c o n c eive th at i n i ts e s s e n ti als every n erv o u s
s y ste m i s c o m o s e d o f aff ere n t tr ac ts an d e ff ere n t tr ac t s
p
an d o f tr ac t s w h i c h f o rm th e c o n n e c tl o n o f th e e l eme n t s
”
h em s e lve s
am o n g t
An at o my an d P hy s i o lo gy de m o n str ate th at fr om a
c ert ain s egm e n t
o f th e
spi n al c o rd n erve fib er s ar e di s
rib u t e d to ski n s ke l et al m u s cl e s i n v o l u n t ary m u sc le s an d
t
m u co u s m em br an e o f vi sc er a an d to th e m u sc u lar c o at s
o f th e arte ri es s u pp ly i n g al l t h e s e st r u c t u re s
P hy s i o lo gy an d P ath o lo gy dem o n s tr ate th at i mp re s
n s m ad e u p o n s e n s o ry e l em e n t s i n s ki n
sio
m u co u s m em
b ran e m u s cl e o r o th er Str u c t u re s ar e carrie d to a c e n ter
i n th e c e n tr al n erv o u s s y stem
Th e s e i mp re ss i o n s ar e c o
o rdi n ated i n th i s c e n ter
an d aff e c t th e phy s i o l o gi c al ac t io n
o f all str u c t u re s i nn erv ate d fr o mth e sam e c e n ter
Wh e n
we s p e ak o f tw o o r m o re str u c t u r e s b ei n g i n c lo s e c e n tr al
co nn e c ti o n we m e an th at th ey ar e i nn erv at
e d fr o m th e sam e
he c e n tr al n e r v o u s sy s tem
segm e n t o f t
D i agno si s — In di ag no si s th e s e segm e n ts se r ve th e pu r
p o s e o f calli n g th e o ste o path s atte nti o n to the co nditi o n
‘
.
,
'
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,
,
'
,
,
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,
,
,
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,
'
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-
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“
'
,
-
,
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,
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,
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-
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’
v
PRI N C I PLE S
19 6
F IG
.
33
.
f
S u r ac e
m ar
O F O S TE O PA TH Y
k i ng
of
th e
b
r a c h i al
pl e xu s
.
PR I N C I PL E S
19 8
O F O S TE O PA TH Y
rti c u l ati o n th e m u scl e s wh i ch g o ver n m o vem e nt s o f th e
j o i n t an d th e ski n o ve r th e j o i n t ar e all i nn erv ated by thi s
fir st c ervi cal n erve
The m u scl e s m o vi n g th e o cc ip it o atl an t al arti c u lati o n
ac t acc o rdi n g to i mp u l s e s re ach i n g th e p o i n t o f o r 1g 1n o f
a
,
,
.
-
F IG
.
F r o n t vi e w
r a c h i al p l e x u s
34
b
.
th e fir st c e rvi cal n e rve
s ki n c o veri n g th e b ac k
al s o fr o m th o s e e n di n g
j o i n t Th e s e i mp u l se s
.
of
t
p a r i al
p ar al
ysi s
of
th e
.
ve r s e n so ry fiber s e n di ng In th e
o f th e h e ad an d th i s arti c u lati o n
i n th e sy n o vi al m emb r an e o f th e
ar e co o rdi n at ed i n h igh er c e n ter s
o
,
PR I N C I PL E S
O F O S TE O PA TH Y
19 9
th e br ai n wh i ch g o ver n e q u i libr ati o n The m u sc le s o f
th i s j o i n t ac t also acc o rdi n g to o u r wi ll
The P n e u m o g as tr i c Ne r v e — F u rth erm o re th e an teri o r
divi si o n o f th i s n erve c o mm u n i cate s with th e pn e u m o g as
tri c hyp o g lo ssal an d th e s u p eri o r symp ath eti c g an g li o n
of
.
.
,
,
,
F IG
.
35
.
.
S i de v i e w
The p n e u m o ga stri c has
of
sa
h
a
me
c as e
as F i g
.
34
.
wid e di s trib u ti o n th at we
c ann o t aff o rd t
o f o l l o w all o f i ts p ath s o f i n fl u e n c e at thi s
ti me The st u de n t i s referred to any e x te n ded w o rk o n
The m u sc l e s an d m u c o u s m em
an ato m y fo r th e det ai ls
br an e s o f th e lary nx ar e i nn erv ate d by th e p n e u m o g astri c
he n Ce an y i rrit ati o n o f th e lary nx m ay r efle x i mp u ls e s to
th e c e n ter o f o rigi n o f th e fir st c ervi cal n erve an d c au s e
e d by it Thi s
u n d u e c o n tr ac ti o n o f th e m u s cl e s i n n erv at
su c
.
.
,
.
PR I N C I PL E S
2 00
O F O S TE O PA TH Y
m u s cu lar c o n tr ac ti o n c an re s u lt i n ch an gi ng th e rel ati o n
O atlan tal arti c u l ati o n u n ti l
o f th e b o n e s f o rm i n g th e o c c i pi t
a c o n d iti o n e x i st s wh i c h we c all a s u b lu x ati o n o f th e at las
H avi n g f o llo we d th e i mp u l s e s fr o m th e lary nx to th e
m u s c le s o f
c e n ter o f co o rdi n ati o n an d o u t ag ai n t
o th e
L
.
F IG
.
36
.
R e ar
vi e w o f sam e
cas e
as F i g
.
th e o cc ipit o at lan t al arti c u lati o n with c o n s e q u e n t s ublu x a
ti o n we m ay p r o fit ab ly n o te th e f ac t th at s u dde n t empe r
aff e c t th e ski n o v e r th e s e m u s c l e s
at u re c h an ge s m ay
ar o u s i n g i mp u l s e s wh i ch ar e c ar r i e d to th e c e n ter o f c o
th e n c e to th e m u scl e s c au s i n g th e m to c o n
o rdi n ati o n
t ract with re su lti ng s u b lu xati o n S o m e o f th e refl e x i m
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P RI N C I P LE S
2 02
F IG
.
38
.
P o s te ri o r
f
O F O S TE O PA TH Y
su r a ce
m ar k i n g
of
th e
lu n
g
s
.
PR I N C IPL E S
O F O S TE O PA TH Y
203
p u l s e s m ay fi n d th ei r w ay to th e lary nx an d cau s e c o n
ge s ti o n o f i ts m u c o sa The atlas m ay b e sub lu x ated by
vi o l e n c e th e n th e s e nso ry imp u l s e s o rigi n ate i n th e sy mo
vi al m em br an e o f th e j o i n t an d i n th e m u s c l e s m o vi n g th e
j oin
t Th e s e imp u l se s m ay be refl e c te d i n su ch m an n er as
to aff e c t th e lary n x ph ary nx an d o th er str u c t u r es i nn er
The refl e x i n fl u e n c e s e x i s t
v ate d by th e p n e u m o gas tri c
i n g b etwee n th e fir s t c ervi c al n erve s an d th e pn e u m o g as
tri c ar e c hi efly co n fi n e d to th e lary nx an d th e ph ary n x
be c au s e spi nal n erve s u s u ally r e ce l v e symp ath eti c refl e x es
fr o m th e s egm e n t o f th e b o dy whi c h th ey co ver I f w e
he div is i o n s o f th e p n e u m o g astri c s
S h o u l d f o ll o w al l o f t
we w ou l d fi n d a w o n de rf u l diver sity o f di strib u ti o n W e
do n o t e x p e c t th at refl e x e s fr o m the h e art lu n g s s t o m ach
et
c
ar e g o i n g to b e s u bj e c t to co o rdi n ati o n i n th e are a
j u s t b e c au s e th ere i s
o f o rigi n o f th e fir s t c ervi c al n erve
c o m mu n i c ati o n b etwee n th e p n e u m o g as tri c an d th i s n erve
The ph ary n x an d lary nx ar e i n p art s tr u c t u re s g o ver n ed
i nv o lu n t ari ly an d h e n c e th ey ar e i n large p art rem o ve d
fr o m th e i n fl u e n c e o f n erve s c arryi n g v o lu n t ary i mp u l s e s
i e s pi n al nerve s The p n e u m o g as tri c i s e ss e n ti ally s y m
p ath eti c i n c h ar acter The ti ss u e s o f th e lary n x and ph ar
n
x
r
a
ll
n
a
a
c
c
u
n
p
r
ti
y
der
th
e
i
fl
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th
e
fir
t
ervi
e
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n
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o
f
s
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y
"
cal n e rve
Y ou r atte n ti o n i s c alled to H i lt o n s law as h e
has s t ated it i n re lati o n to m u c o u s an d s er o u s s u rf ac e s
“
Thi s same pri n c ip l e o f arr an geme n t ; an at o m i c ally phy s i o !
lo gi cally an d p ath o lo gi c ally co n si dered i s to be o b s erved
with an eq u al degre e o f ac c u r acy i n th e s er o u s an d m u
co us
m emb r an e s Th u s co n s i dered it p re s e n t s a p ri n
c i pl e whi ch
if it has any app li cati o n i n p r acti c e m u st b e
o n e c ert ai n ly o f large e x te n t
S i n c e th e s pi n al acc e s s o ry f o rm s p art o f th e p n e u m o
g astri c ab ov e th e p o i n t o f c o m m u n i c ati o n b etwe e n th at
we c an p er c eive th e re as o n
n erve and th e fir st c ervi c al
fo r th e gre at i n fl u e n c e whi c h temp er at u re c h an ge s aff e c t
—
i ng th e ski n o ver th e s te r n o c l ei d o m as t o i d an d tr ap ezi u s
m u scl e s h ave o n th e acti o n o f th e m u sc le s f o rm i n g th e
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2 04
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PR I N C I P LE S
F IG
.
39
O F O S TE O PA TH Y
.
Th e l u n
g
t
ce n e r
.
2 06
P R I N C I PL E S O F O S TE O PA TH Y
F IG
.
40
.
C i li o - s p i nal an d h e ar
t
c e nte
rs
.
in e
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e
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t
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t
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2 10
PR I N C I PL E S
FIG
.
Th e
O F O S TE O PA TH Y
s to
ma c h
c e n te
r
.
PRI N C I PLE S
O F O S TE O PA TH Y
2 11
P l e x u s —The fir st f o u r c er vi c al n erve s ar e i n
E ac h di strib u t iv e br an c h
te r w o v e n to f orm a p l e x u s
fr o m thi s p le x u s p r o b ab ly c o n t ai n s so m e c o mm u n i c at in g
fiber s fr o m th e f o u r p ri m ary n erve trun k s Vi ewi n g th e
p l e x u s as a wh o l e w e fi n d th at i ts br an
c h e s ar e di strib u te d
acco rdi n g to H i lt on s law
Th ey i nn erv at e the S ki n o f
th e n e c k as lo w as the fi fth c ervi c al spi n e p o st er i o r ly th e n
o b li q u e ly f o rw ard as l o w as th e ster n o c l avi c u l ar arti c u la
—
o
n
ti n a te riorly
th e ac r o mi o clavi c u lar arti cu lati o n
an d
later ally
The s ki n o f the p o s t eri o r s u rf ac e o f the c r an i u m
an d th e e ar re c eive s s e n so ry fib er s fr o m thi s p l e x u s
Th e s e
a r e th e gr o ss p o i n t s to b e rem emb ere d c o nc er n i n g c utan
e o u s s e n s o ry di strib u ti o n fr o m th i s p l e x u s
The m usc l e s
u n d er thi s c u t an e o u s are a al l re c eive m o t o r fi be r s f r o m th e
fir s t f o u r c ervi c al n erve s
A n at o m i st s divi de th e c ervi c al n e rve s i n t o an te r i o r
'
e ly
th e n de sdr i be th e s e
an d p o steri o r d ivi s i o n s
Th i s i s an artifi c i al d ivi s i o n wh i ch d o e s n o t s e rve an y u s e
I t m u ltip l ie s de tai l with o u t givi ng
fu l p u rp o s e fo r u s
an adeq u ate c o n c epti o n o f th e re al Ch ar acter o f th e wh o l e
n erve
Whe n y o u st u dy th e u ltim ate di stri bu ti o n o f th e
an te r l o r divi si o n o f a n erve f o rm i n g th e c er vi c al p l e x u s
i
do n o t f ai l to rem emb e r th at the u ltim ate d i strib u ti o n o f
I f th e
the p o s teri o r divi s i o n i s a p art o f th e s am e n erv e
an teri o r d ivi s i o n co mm u n i c at es with a symp ath eti c g an
an d
g l i o n th e p o s teri o r divi s i o n re c e ive s i mp u l ses fro m”
I f the an te r l o r divi si o n
o th i s gan gl i o n
s e n d s i mp u ls e s t
er ve s; th e
co mm u n i c ate s with th e v ag u s an d hyp o g l o ss al n
p osteri o r divi si o n i s a party to th i s c o mm u n ic atio n an d
i n all w ay s be n efit s o r s uff er s by it acco rdi n g to th e n u m
ber an d i n t en sity o f th e sti mu l i app lie d at any p o i n t alo ng
th e c o u r s e o f eith er n erve
"
Thi s u pp er po rti o n o f th e n e c k i s th e m o st fl e x ibl e
p art o f th e wh o l e S p i n al c o lu m n I t i s su bj e c te d to m o re
c h an ge s o f temp er at u re an d m o re
str ai n s o r twi st s th an
o th er p o rti o n s o f th e s pi n e
The co n st an t e ffo rt to sav e
th e he ad f r o m i nj u ry p ut s a severe tax u p o n th e activi t
y
Ce r vi cal
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2 12
PR I N C I PL E S
F IG
.
44
.
O F O S TE O PA TH Y
Th e
s p l a n ch n i c
ar ea
.
PR I N C I P LE S
O F O S TE O PA TH Y
2 15
vertebr ae as a s o l id l eve r to s e cu re r o t ati o n an d r e
hird an d f o urth c ervi cal verteb r ae
lax at io n b etwe e n th e t
m ay give g o o d re su lt s
S i n c e hi cc o u gh i s a refl e x du e to
s o r y n erve s
e sp e c i al ly th e pn e u m o g as
s tim u l ati o n o f s e n
tri c it sh o u l d n o t b e e x p e c ted th at i n h ibiti o n o f th e m o t o r
o u ld
ph re n i c w
e n ti re ly s t o p h i c c o u ghs whi l e th e
n erve
s e n s o r y s tim u lati o n i s co n ti n u ed
C l i n i c ally we fi n d th at
i n h ibiti o n o f th e ph re n i c n e rve i s su ffi c i e n t to s t o p th e
ase o f hi cc o u ghs Th eref o re we call th e are a
or di n ar y c
o ver th e c o u
r s e o f the phre n i c n erve as i t c r o ss e s th e sca
l e mu s an ti cu s m u sc l e Opp o s ite th e fifth c ervi cal tr an s ver s e
“
”
p r o c e s s th e c e n ter fo r h i c co u gh s
S e e F i g 2 66
c al
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The Tr apez i u s
—Th
.
S pl e n i u s Capi ti s
an d
et
.
C o ll i M u s cl e s
.
erv i cal p l e x u s c o m m u n i c ate s wit h th e br ach i al
p l e x u s ; th e r ef o re we e x p e ct th at th o s e large m u sc le s s u ch
as th e tr ap ezi u s an d s p l e n i u s
whi ch ar e i nn erv ated by
—
n e r ve s fr o m s egm e n t s o f th e spi n al c o rd at v ar i o u s l eve ls
wi ll t r an sm it by th ei r acti o n th e i n fl u e n c e r e fl e x e d to th em
at the p o i n t o f th eir s eri al i nn erv ati o n
The s p i n al acc e s
s o ry i nn e rv ate s a l arge p art o f th e c ervi c al fibe rs o f th e
thi rd an d f o u rth c e rvi c al n erve s s e n d
br an ch e s to th i s m u s c l e Th eref o re an y di s t u rb an c e alo n g
th e c o u r s e o f th e se n erve s o r alo n g th e c o u r s e o f o th er
tr al co n n e c ti o n With th em whi c h m ay
n e rve s i n c l o s e c e n
c au s e ab n o rm al c o n tr ac ti o n o f th e tr ap e z i u s w i l l i n fl u e n c e
m o re o r l e s s all the p o i n t s o f att ach m e n t o f th at m u scl e
A n y le s
The tr ape z i u s i s se l d o m ab n o rm al ly c o n tr ac ted
s ac ti o n i s q u i c k ly n o te d
s e n i n g i n th e n o rm al r an ge o f i t
by th e p ati e n t The co n tr ac t u re d co n diti o n i s e asi ly r e
m o ved by a wi lle d ac ti o n We u se th e tr ap ezi u s m u sc l e
as a m e an s o f tr an s mitti n g p o wer to v ari o u s p o rti o n s o f
th e spi n al c o lu m n i e i n o u r e ff o rt s to m o ve o n e Or m o re
verteb r ae
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Ne ck —The
V as o m o ti o n
su p eri o r
c ervi c al g an g l i o n c o m m u n i c ate s with th e fir s t f o u r c ervi cal
n erve s th eref o re th e are a o ve r th e s p i n e s o f th e fir s t f o u r
-
,
,
H e ad,
F ac e
an d
.
P R I N C I PL E S
2 16
F IG
.
46
.
An
t
e r ior
su r
fa
ce
ou
O F O S TE O PA TH Y
t li n
e
of
th e l i v e
r
an d l a r
g
e
t
i n te s i n e
.
O F O S TE O PA TH Y
PRI N C I P L E S
2 18
F IG
.
47
.
c lo se
g
t
k
Th e a r r o w ma r s p o i n t o f
l a r e i n e s ti n e
c o n n e c ti o n o f c e r e r o S p i n a l n e r v e s w i h th e h p o a s r i c
p le x u s
C e n te r
.
for
b
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t
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g t
O F O S TE O PA TH Y
PRI N C I PL E S
The
2 19
h i l d w as n o t v ery s tr o n g at th e tim e o f
th e i nj u ry A s light f all wh i l e p layi n g s ub lu x ate d th e
fifth c ervi cal NO n o ti c e w as t ake n o f thi s s light f all The
wh i le b ath i n g th e ch i l d th e m o the r no te d a pe
n e x t day
T
r m c o u ld
i
th
e
p
o s iti o n o f th e sh o u l der
e
a
n
c u liar i t
h
y
The au th o r e xami n ed thi s
n o t b e r ai s e d ab o ve th e h e ad
th e day th e m o the r di sc o vered th e c h an ge i n th e
c as e
Ar fir s t g lan c e fr o m th e s i de it app e ared to be
s h o u l der
bu t p alp ati o n
a s u b Spi n o u s di s lo c ati o n o f th e h u m er u s
di sp r o ve d th i s Caref u l e x am i n at i o n sh o we d a he m i par e
si s o i th e wh o l e l eft s i de b e lo w th e f o u rth c ervi c al n erve
No n e o f th e n o rm al m o vem e n t s w ere lo st bu t i t re q u ired
the u tm o st e ff o rt o f th e p ati e n t to m ake th em
No w an d
the n th e left to e w o u l d strike th e fl o o r too s o o n an d s l ight
ly
trip h er
P alp ati o n Of th e fifth c ervi cal v erteb r a
The sl igh te s t p re ss u re at
s h o wed a lat e r al s u bl u x ati o n
thi s po i n t cau s e d th e p ati e n t to c r y o u t with p ai n
After o u r e x ami n ati o n ( th e s e ph o t o gr aph s were t ake n
at th at tim e ) th e ch i l d w as t ake n to a su rge o n w ho p re
o s tit c h th e lati s s i m u s d o r s i
s c ribed a Su rgi c al Op er ati o n t
to i ts p r o per po siti o n o n th e l o we r an g l e o f th e sc ap u l a
H e di d n o t re co g n iz e th e p areti c c o n diti o n o f th e wh o l e
A fter a sh o rt tim e th e c hi l d w as br o u ght to u s
l ef t s ide
O u r s o l e e ff o rt w as to red u c e th e s u blu x a
fo r tre at me n t
ti o n o f th e fif th c ervi c al vertebr a The te n der n e ss w as so
gre at th at thi s w as m an ife s t ly o u t o f th e r an ge o f p o s si
A fter tw o we ek s o f re lax i n g
bi li ti e s with a de l i cate ch i l d
ar o u n d th is arti c u lati o n a dire c t m o vem e n t w as m ade to
The ali g n m e n t w as p erfe c te d
re d u c e th e s u b lu x ati o n
A c o n ti n u e d
bu t n o imm e di ate g o o d re s u lt s were n o te d
i n c re as e i n n erve p o wer has gr ad u ally i n large m e asu re
he def o rm ity
o v e r co m e t
—
l
x
i
h
a
The def o rm ity i s th e e f
S u b lu at o n o f t e S capu
The lati ss im u s
fe ct o f u n eve n co n tr acti o n o f m u sc l e s
d o r s i , rh o mb o id s an d s err at u s m ag n u s ar e we ake n e d whil e
th e l ev at o r an g u li s c apu li an d c ervi cal fiber s o f th e tr ap e
z i us
ar e co n tr ac ti n g with th ei r c u s t o m ary p o wer
The
Vertebr ae
.
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PR I N C I PLE S
22 0
O F O S TE O PA TH Y
m u s c le s i n n e rv ate d by n e rve s fr o m / abo v e th e l e s i o n ar e
acti n g n o rm ally
Thi s
bu t th ei r acti o n i s n o t re s i s ted
re su lt s i n s u bl u x ati o n o f th e scap u la
'
.
,
.
W ri s b
— A divi s i o n
th e fi rst d o r sal
n erv e f o rm s th e fir s t i nter c o s t al n erve
The i nn er s ide
an d b ac k o f th e ar m re c eive c u t an e o u s br an ch e s fr o m th e
fi r s t d o r sal n e rve Th ere is c o mm u n i c ati o n betwe e n th e
o th i s are a an d th e s e c o n d i n ter c o s t al
c u t an e o u s n erve s t
n e rve by m e an s o f th e n erve o f Wri sb erg
h e n c e p ai n i s
freq u e n t ly fe lt alo n g th e i nn er s u rf ac e Of th e ar m i n c as e s
o f h e art tr o u b l e
i n te r c o st al n e u ralgi a i h th e s e c o n d s p ac e
o r p l e u ri sy
The Ne r v e
of
erg
.
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of
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The I nte r scapu l ar R e g i o n
—The divi s i o n
th e spi nal
h d o r s al vertebr ae i s
c o l u m n b etwe e n th e fir s t an d s e v e n t
c o m m o n ly c all e d th e
i n te r scap u lar regi o n I t i s an e x
c e e di n g ly
i mp o rt an t o n e I t i s so m etim e s c alle d th e pul
m o n ar y regi o n b e c au s e it i s th e are a fr o m wh i ch t
he lu n g s
de rive m an y n erv e s S e nso ry i mp u ls e s fr o m the l u n g s ar e
c o o rdi n ate d i n thi s are a
F ig u re 3 7 i l lus tr ate s th e an teri o r su rf ac e o u t l i n e o f
th e l u n g s wh i le F i g 3 8 sh o w s th e o u tl i n e o n th e p o steri o r
Th e s e m arki n g s were m ad e o n the
s u rf ac e o f th e th o r ax
Th ey
o phy s i cal m eth o d s o f di ag n o si s
s u rf ac e ac c o rdi n g t
rep re s e n t th e aver age p o s iti o n o f th e lu n g s i n a h e althy
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m an
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L u n g C e n t e r — F ig u re 3 9 i llu str ate s th e lu n g c e n te r
withi n wh i ch s e n s o ry imp u l s e s fr o m th e lu n g s ar e c o
A large p r o p o rti o n o f case s o f br o n c hiti s
o rd i n ate d
p u l m o n iti s o r p l e u riti s o f e it her th e s i mp l e o r b acte ri al
typ e s ar e acc o mp an i e d by gr e at s e n sitive n e ss i n thi s are a
Th i s s e n s itive n e s s i s i n the co n tr ac te d m u sc l e s o r
wh e n th e sh ap e o f th e th o r ax i s gre at ly c h an ge d at th e
S u b lu x ati o n s o f rib s o r vertebr ae i n
an g l e s o f th e rib s
thi s are a ar e so m etim e s f o u n d i n co nn e cti o n with the i n
Wh eth e r th ey are th e c aus e
fl am m ati o n s ab o ve n am ed
o r th e e ff e c t o f th e i n fl amm ati o n c an o n ly b e t o l d by th e
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,
PR I N C I PL E S
222
The
O F O S TE O PA TH Y
diti o n m ight b e j u st th e o pp o site We do n o t de
bu t it sh o u l d b e
o c o n f u s e o u r re ad e r s i n th e l e as t
si re t
re m emb ere d th at b ef o re m aki n g a d o gm ati c st atem e nt
“
di se as e i s th e re s u lt o f anat o mi c al ab no rm al iti e s
s u c h as
”
f o llo wed by phy si o lo gi cal d i sc o rd we S h o u ld b e c e rt ai n
co n
.
,
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PR I N C I PL E S
O F O S TE O PA TH Y
22 3
th at o u r s t atem e n t i s n o t b ase d o n a s eri e s o f s e l e cte d co
“
i n c i de n c e s The o ld saw : Its a p oo r r u l e th at d o e s n o t
w o rk b o th w ays i s d e c i ded ly app li cab l e to n erv e refl e x e s
C i l i o S pi n al C e n t e r
Te n der n e ss i n thi s are a i s n o t
n e c e ssari ly i n di c ativ e o f phy s i o lo g i c al di s t u rb an c e in an y
th o r ac i c vi s c u s
F i g 40 i n d i c at e s tw
o c e nte r s: Th e o n e
betwee n th e seco n d an d thi rd d or s al i s call ed th e c i l i o
S pi n al c e n t er
D et ai l c o n c e r n i n g th i s c e n ter wi ll b e f o u n d
i n the Cha
he S ymp ath eti c Nerv o u s S y s tem
pt er o n t
—
The f ac t th at th e v aso c o n s tri c t o r fib er s to th e c e rvi cal
symp ath eti c g an g l i a l e ave th e s pi n al c o rd b el o w th e s e c o n d
d o r sal vertebr a sh o w s th at s o m e refl e x e s fr o m th e h e ad
f ac e an d n e ck m ay b e c o o rd i nated i n th e i n te r s cap u lar
regi o n
—
H e art Ce nt e r The p o i n t b etwe e n th e f o u rth an d fifth
d o r s al spi n e s i s n o te d as a h e art c e n ter W e h ave n o t f o u n d
te x t b o o k au th o rity fo r th i s s t ate m e n t
an y
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p o i n t Wh at th e ab s o lu t e i n fl u e n c e o f thi s c e n ter i s we do
no t k n o w
F r o m o b s erv ati o n o f c as e s o f an gi n a p e c t o ri s
he
it app e ar s to b e a se n s o ry an d v as o m o t o r c e n te r fo r t
h e art S tim u lati o n o f th i s c e n ter by a q u i c k p er c u s si o n
str o ke o f th e fi n gers wi ll bri n g o n an im m edi ate att ac k o f
p ai n i n th e h e art b lu e n e s s o f lip s an d fi n ger tip s H e avy
digit al pre s su re at thi s p o i n t re li eve s the p ai n S te ady e x
te ns i o n o f th e wh o l e s p i n al co lu m n d o e s n o t s ti m u lat e s u ch
c as e s b u t a s th e p u ll i s red u c ed an d th e vertebr ae ar e d r aw n
c lo s er t o geth e r
thi s p oi n t i s fre q u e n t ly stim u late d In o r
der to av o id an att ac k afte r e x te n si o n it i s ne c e s s ary to
l e iss e n th e f o r c e o f th e p u ll very gra d u ally an d ev enl y
F i g 4 1 i llu str ate s th e s u rf ac e m arki n g s O f th e h e art
Thi s o rgan has th ree c e n ter s ( 1 ) The p n e u m o g astri c n e rve
e x ert s an i n hibit o ry i n fl u e n c e Th i s n erve can b e stim u
l ate d i n th e n e c k
2
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ter i n clu de s s e c o n d th ird an d f o u rth d o r sal S e e Ch apter
V I O n th e S ymp ath et i c Nerv o u s S ys tem
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O F O S TE O PA TH Y
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R e e x e s r o m th e O v a r i e s m ay
f o l l o w th e o v a r i an p l e x u s to th e a o r ti c a n d r e a c h th e c e r e r o
s p i n al s s e m a t
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2 26
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whe n m aki n g a phy s i cal e x am i n ati o n The
i n e i s i n di cated by F i g 4 7
o f th e l arge i n tes t
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ti n e d u o de n u m i s i nn erv ate d fr o m ab o u t th e s am e are a
Fi g 4 5
as th e liver
I t m u st b e b o r n e in m i n d th at the
are a i s a large o n e
an d c o mp re hen d s th e s e
S p lan c h n i c
M any o f th e s e p o i nt s i ndi cate d as ce n
s m all er c e n ter s
t e rs ar e the are as wh i c h c li n i c al e x p eri e n c e has n o te d i n
io n w 1 th vi s c er al di st u rb an c e
The rep e ate d e x
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4 8 th er e i s a c e n ter u s u al ly de s c rib ed as th e eighth do r
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s al whi ch has re c eive d th e n am e o f
th e c e n ter fo r c hi lls
O u r fi r st o b s erv ati o n o f th e ac ti o n Of th i s c e n ter w as i n
c o nn e c ti o n with a c as e o f m alari al fever
H e av y i n hi bi
ti o n o f th i s are a l e ss e n e d the s everity o f the chill W e
h ave o b s erve d th e e ff e ct s o f i n hibiti o n o f th i s ce n ter i n
m any cas e s o f ch i ll du e to n erv o u s n e s s o n s et o f La
G ripp e o r o th er i n fe c ti o u s di s e as e s an d to ab sc e ss f o rm a
ti o n
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th e s e ch ar ac teri s ti c s as i n d i cati o n s f o r th e admi n i s tr a
ti o n o f sp e c i al dr u g s as th o u gh a n erve fib er e x p re ss e d a
l an g u age o f p ai n
To th e o ste O pathi c phy S 1 c 1an i t i s su f
fi c i e nt th at a n er ve e x p re s s a di s t u rb an c e at s o m e p o i n t
o f i ts c o u r s e
Th is c ry o f th e ne rve s c al l s fo r j u st o n e
thi n g rem o ve th e c au s e S e ar ch i s m a de for thi s c au se
alo n g i ts e n tl r e c o u r s e
an d th e c o u r s e o f i ts co n n e c ti o n s
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i n wh i ch th e o s te o p ath i c p ath o lo gy
s ch o o l s o f m edi c i n e i s i n th e w ay we
ti on s o f a vi scus To th e m edi cal
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di ff er s fr o m o th e r
vi ew v ar yi n g co n di
p r actiti o n e r S i mpl e
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PR I N C I PL E S
22 8
F IG
r
E n d o f th e s p i nal c o d
52
d e f e ca i on and m i c u i i on
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A r e a s o f th e l u m b a
and s a c r al
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PRI N C I PL E S
O F O S TE O PA TH Y
231
time s s e n d refle x e s h ere The u ter u s m o re th an any
di s t u rbe d co n dit 1o n by
o th er p e lvi c o rg an m anife s t s i t
s
te n der n e s s at th i s p o i n t
The u ter u s is s u ch a c h an ge ab l e o rg an th at it i s th e
c h i ef di st u rbe r o f s ymp ath eti c rhythm i n a w o m an s b o dy
A c h an ge i n i ts p o s iti o n cau s e s a c h an ge i n i ts b lo o d su p
l
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ge s ted co n d iti o n s et s u p a s erie s o f i mp u ls e s i n th e symp a
the ti c Sy ste m whi c h m ay n eve r re ac h th e c erebr o s p i n al
They s p e n d th e ir f o r c e o n th e v ari o u s o rgan s
sy s tem
g o ver n ed by the sy m pathe ti c n erv o u s sy s tem th e h e art
F i g 5 5 i llu str ate s th e d i ff ere n c e
s t o m ac h
b o we ls e tc
i n th e he ar ts rhythm i n th e sam e p atie nt
The fir st
s phygm o gr am w as t a ke n wh i l e th e p atie n t had c o n s i der a
bl e di ffi c u lty i n m o vi n g ab o u t o n acc o u n t o f th e h e art s
very i rreg u lar acti o n The u te r u s i s p r o lap s ed P ati e n t
ha s w o r n a stem p e s sary fo r ye ar s
W h e n th e p ati e nt
t ake s th e ge n u p e c t o r al p os iti o n an d i n h ale s str o n gly
whi l e p u lli n g u pw ard o n the abd o mi n al m u s c le s th ere i s
gre at re l i e f bu t wh e n th e h e art b e c o m e s as i rreg u lar as
th i s sphygm o gr am i n di c ate s she i s afr aid to t ake th i s po
—
A fter t we n ty f o u r to s eve n ty tw o h o u r s o f ir
s i ti o u
reg u lar ac ti o n th e h e art reg ai n s i ts r hythm The p o s iti o n
o f th e u ter u s be c o m e s ch an ge d by th e m o vi n g o f th e pa
ti e n t in b ed The p eri n e u m i s b ad ly t o r n an d th e u teri n e
lig am e nts ar e gre atly l e n gth e n ed h e n c e th e o rg an can n o t
b e kept i n o ne p o s iti o n S he has ref u s ed o p er ati o n
M any di ff ere n t p o i n t s ar e n ame d as c e n ter s fo r th e
u te ru s
bu t th ey al l r e s t o n th e f ac t th at after th e o rg an
has i n iti ate d a large n
u mbe r o f i mp u l s e s i n th e symp a
th eti c sy s t em th e y m ay b e p as se d to th e c erebr o spi n al
s y stem at any p o i n t o f u n i o n o f th e t
w o sy stem s
—
r
T
e
e
The s e o rg an s re c eive th eir sy m
st s
O v a y an d
p atheti c i nn erv ati o n fr o m th e p l e x u s wh i ch li es On th ei r
The o v ari an p l e x u s i s give n o ff fr o m th e ao r ti c
art e rie s
p l e x u s wh i ch re c eive s fi be r s fr o m as h igh as th e el eve n th
an d twelfth
d o r s al g an gli a Th erefo re a l e si o n i n th e
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P RI N C I PL E S
F IG
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54
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O F O S TE O PA TH Y
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PR I N C I PL E S
2 34
ti vi ty
of
O F O S TE O PA TH Y
th e re ct u m b lad der o r u ter u s D i st u rb anc e s in
th e s e vi sc er a ar e n o t n e c e ss ari ly m an ife ste d to th e o ste o
p ath by te n d er n e ss ar o u n d th e s e c o n d l u mb ar vert ebr a
Any p o i n t alo n g the s pi n al c o lu m n b e lo w th e s e co n d
lu mb ar m ay b e se n s itive as a re su lt o f di s t u rb an c e in th e
p e lvi c vi s c e r a F ig 52
D u ri n g p art u riti o n th ere i s co n sc i o u s ach i n g alo n g
th e wh o l e lu mb ar are a th u s de m o n str ati n g th at th e s e n
so ry n e rve s o f th e u ter u s c an refl e x th ei r irrit ati o n t
o al l
th e l u mb ar n e rve s I nj u ry o f th e s pi nal c o l u m n at th e
j u ncti o n o f th e d o rs al an d lu mb ar po rti o n s may aff e c t m o
ti o n s e n sati o n an d n u triti o n o f all th e str u ct u re s i n n er
A n i n j u ry b e lo w th e s e c o n d
v ate d by th e c au d a e q u i n a
—
u
a
a
l
n
l mb r v erteb r wi l o t h ave as f ar re ach i n g e ff e ct as
an i n j u ry o f th e s am e c h ar ac ter ab o v e th at p o i n t
P ar apl e g i a Whe n th e b ac k i s b r o ke n at th e d o r s o
l u mb ar arti cu lati o n p ar ap l egi a re su lt s I t i s n o t n e c e s sary
he b ac k i n o r der to c au s e p ar ap l egi a
to ac t u al ly bre ak t
A s evere s tr ai n c au s ed bly a f all m ay i n d u c e s u ch an
ex u d at e ar o u n d thi s arti c u lati o n th at p re ss u re i s e x erted
M an y o f the so
o n th e l u mb a r e hlar g e m e n t o f th e c o rd
wh i ch ar e s p o ke n o f as c au sative o f
c al l ed b r o ke n b ac k s
p ar apl egi a ar e n o t br o ke n at all bu t th e lig am e nt s ar e
The sam e co n diti o n e x i st s h ere as i n
b adly spr ai n ed
Th ere m ay b e m arke d kyph o s i s
s p r ai n e d j o i n t s
o th e r
The
b u t th i s d o e s n o t n e c e ssari ly i n di c ate di s lo c ati o n
p ar aplegi c co n diti o n m ay b e p erp et u ate d by th e p re ssu re
of c o nn e ctive ti s su e f orm ed i n th e rep ai r o f th e i nj u ry
Thi s is e sp e c i ally l i ab l e to f o llo w i f so m e f o rm o f m an i pu
o t p er s i s ted i n fo r fr o m o n e to thr e e
lative tre atm e n t i s n
ye ar s The au th o r has f o rt un ate ly be e n able to o b s erve
th e s l o w rege n er ati o n o f n erve ti s su e f o llo wi n g c o mp lete
p ar apl egi a as a re su lt o f i nj u ry o f th e d o r so lu mb ar ar
Thi s c as e has b ee n o b s erved by u s d u ri n g
ti c u lati o n
D u ri n g all o f th i s tim e she has r e
n e ar ly f o u r ye ar s
Thi s m eth o d o f tre atm e nt
c e i v e d o s te o p ath i c tre atm e n t
w as n o t b eg un u n ti l te n m o n th s after th e acc id e n t th ere
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PR I N C I P LE S
O F O S TE O PA TH Y
2 35
f o re sy n o vi al a dhe s i o ns had fo r me d to s u c h an e x ten t i n
th e j o i n ts o f the l im bs th at m u ch p ai n f u l m an ip u lati o n
o f th e s e j o i n t s has b e e n n e c e ssary
F o llo wi n g th e ac c i d e nt th ere w as m o t o r an d s e n so r y
p ar aly s i s o f the e x t r em iti e s b ladd e r an d r e ctprn Co ntr o l
o f th e b ladder an d r e c t
u m ret u r n e d aft er t
o n th s o f
wo m
o s te o p athi c
tre atm e n t
S e n s ati on an d m o ti o n h ave re
t u rn ed to the e x t r em iti e s Th e r e i s def o rmity as a r e s u lt
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he a£ t
g
S p h y g m o g r am s i l l u s tr ati n
e ff e c t o f
th e
u te r i n e
re
fl
on
exe s
th e
.
of th e adh esi o n s fo r m ed d u ri n g the te n m o n th s p r evi o u s
to th e fir st o s te o p athi c man i p u lati o n
The patl e n t had
be e n m as sage d du ri n g the te n m o n th s m e n ti o ne d
—
u
a
r
n
r
Pl
x
L mb a d S ac al e u se s F r o m th e n erve s of the
c au d a e q u i n a a r e f o rm ed t
w o lar ge p l e x u s e s th e l u mb ar
an d s ac r al
i n di c ated i n F ig 53 The b r an c he s of the se
p l e x u s e s i nn e rv ate th e m u sc le s o f th e lo we r e x tremitie s
The spi nal are a fr o m whi c h t he s e p l e x u se s r ec e i ve t
hei r
fib er s sh o u ld b e c aref u lly e x ami n ed w he n e v er any di ffi
c u lty o f m o vem e n t o r se n sati o n i n th e l o wer e x tremitie s
i s p re s e n ted
The s t u de n t sho u l d l e ar n th e s e n so ry an d m o t o r di s
tr i bu tio n o f e ac h br an c h o f th e s e p le x u s e s so that; pe r
i phe r al di st
imm e di ate ly as so c i ate d Q w i th
u rb an c e c an b e
th e p o i n t o f em erge nc e fr o m th e S pi n al co lu m n o f the
affect
e d n erve o r n e r ve s
—
The Bladde r
F i g 54 i n di cate s th e s u p e r fi c i al are a
i n whi ch refle x e s f ro m th e b ladde r ar e m o s t fre q u e n tly
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2 36
T
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PR I N C I PL E
P RI N C I PL E S
2 38
O F O S TE O PA TH Y
S i ti v e
wh e n th e p r o st at e i s e n l arged ; i n f act al m o st any
di so r de r o f th e m al e se x u al o rg an i sm i s acco mp an ie d by
thi s se n sitive co n diti o n;
I n h ib it o ry m o vem e n t s o ve r th e b ac k o f th e s ac r u m
an d i s ch i ati c s pi n e will re s u lt i n re lax ati o n o f th e p eri n e al
m u scl e s I t aff e ct s s p asm o di c stri ct u re o f th e u rethr a i n
The lo cal an ae s th eti c e ff e c t o f i n
a w o n derf u l m an n e r
hi b iti o n i s n o t s o e asi ly dem o n str ate d i n any o th er po r
ti o n o f th e b o dy as i n th i s sac r al are a
Wh e n th e u ter u s i s t u r n e d eith e r b ac kw ard o r fo r
w ard o r p r o lap s ed th ere ar e 1m pu ls e s ar o u se d i n s e ns o ry
n e rv e fib er s i n th e re c t u m o r bl add er
Th e s e i mp u l s e s
ar e r e fl e x e d to th e sac r al are a W
h il e th o s e ar o u se d in th e
u te r u s p as s to h igh er p o i n t s i n th e s p i n al co l u m n
In
hi bi ti o n o f th i s s acr al are a wi ll h ave a temp o r ary e ff e c t
The o n ly tre atm e n t w o rth whi l e 1 8 th e co rre cti ng o f th e
u
s
iti
n
o
f
th
e
u
ter
o
o
s
p
,
.
.
.
.
,
‘
—
.
,
.
.
.
.
—
Th ere ar e m any m o r e so c alle d ce n
C o n cl u si o n s
ter s m e n ti o n e d by o s te o p ath i c writ er s : We h ave n o t
attempte d to eve n re c apit u l ate th o s e o th er c e nter s whi ch
The
o b e qu ite to o f an c if u l fo r pr acti c al u se
o us t
s eem t
i n thi s ch apter ar e th o s e whi c h c an
c e n te r s m e n ti o n ed
be dem o n s tr ate d i n d ai ly p r ac ti c e an d h e n c e ar e us ed
b o th as g u ide s fo r d i ag n o si s an d as i n di ca
c o n ti n ual ly
ti o ns fo r th e app li cati o n o f m an ip u lative th er ap e u ti cs No
“
”
“
s e n sati o n
m o ti o n o r
symp ath eti c s p i n al c e n ter s fo r
“
”
Th e s e ar e c har acte r i s
n u triti o n
c an b e dem o n s tr ated
t i c s o f n erve fibe r s i n ge n er al an d it i s e nti re ly mi s le ad
i n g to l im it th e s e ch ar ac teri s ti c s to any o n e po r ti o n o f
E very o s te o p athi c c e n ter s h o u l d b e
he sp i n al c o l u m n
t
d em o ns tr ati o n an at o mi cally phy si o l o gi cal ly
of
c ap abl e
an d c li n i c ally
O n ly th o se whi c h c an p ass th i s te st sati s
facto r ily ar e w o fthy o f o u r co ns i de rati o n
-
‘
‘
.
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,
,
,
,
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,
n
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,
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.
PR I N C I PL E S
O F O S TE O PA TH Y
C H A P TE R X I I
TH E BA C K
‘
.
.
The S pi nal C o lum n. The b ac k i s
h ar acterized by tht
s pi n al c o lu m n wh i ch c o n stit u te s th e lo ng ax i s o f th e b o dy
Thi s c o lu m n c o n si st s o f twe n ty f o u r m o v abl e verteb r ae
th e s ac r u m an d c o ccyx The m o v ab l e b o n y s eg me n t s ar e
—
s ep ar ated
fr o m e ach o th er by fi br o c ar tilag in o u s di s cs
E ac h ve r tebr a i s ch ar ac teriz e d by a b o d y an d an ar ch whi ch
e x te n d s fr o m th e p o s te ri o r later al p o r ti o n s o f th e b o dy
The bo dy s erve s to give stre n gth , st abi lity an d weight
ca rryi n g c ap ac ity
The ar c h e s s erve tC
to th e co lu m n
f o rm an i n c o mp l ete b o ny c anal fo r th e p r o te cti o n o f th<
s pi n al co r d an d i t
A lth o u gh th e s e ar c h e
s m embr an e s
f o rm a fai r ly co mp l ete p r o te c ti o n to th e co n te n t s o f th e
n al i n th e u pp e r d o r s al regi o n th e appr o x im ati o n o f th e
ca
l ami n ae i s n o t n e ar ly so p erfe c t i n th e lu mb ar regi o n
I t is
t hr o u gh th e g ap s b etwe e n the l am i n ae i n th e l u mb ar regi o n
th at p u n ct u re c an m o st e a si ly b e m ade
-
c
.
,
-
,
.
‘
-
.
.
“
.
,
s
.
,
.
.
—
—
The di s c s o f fi br o carti lage ar e
S pi nal L i g am e n t s
very str o n g ly att ach e d to the b o di e s o f th e ve rtebr ae an d
th e fi b r o u s ti ss u e o f th e se di sc s i n terwe ave s with th e fib er s
o f th e co mm o n l ig am e n t s whi ch e x te n d fr o m e n d to e n d o f
th e spi n al co lu m n o n th e an teri o r an d p o steri o r s u rfac e s
A fter c u tti n g th e n e u r al ar ch e s at th eir
o f th e b o d ie s
j u n cti o n with th e b o die s we h ave l eft a str o n g co l u m n o f
b o ny s egme n t s s e par ate d by fi bro c arti lagi n o u s di sc s wh i ch
B o th b o n e s an d cartil age s ar e ve ry
ar e st r o n gly adh ere nt
h
o r and po ste r i or co m
r o n gly b o un d t o et he r by t
a
n
r
e
te
i
st
g
mo n li gaments
.
'
’
,
.
,
-
,
.
.
2 40
P R I N C I PL E S
O F O S TE O PA TH Y
atton
of r ot
lo cated in
t
he
cu r ves
in
Cer vi cal
r
D awn by
t
J ohn C oms ock
.
PR I N C I PL E S
2 42
O F O S TE O PA TH Y
—Thi s co l u m n i s ch ar acterize d by m o der
ate fl e x ibil ity an d c ert ai n c u rve s
The el as ti c ity i s du e to
th e st r u ct u re o f th e fi br o carti lagi n o u s d i scs The c e nte r
o f th e d i sc s i s a very s o ft m as s o f fi b r o c arti lage
th i c ke r
th an th e m argi ns an d c o nt ai n i n g th e rem ai n s o f th e ch o rd a
d o r sali s o f th e emb ry o
F l e x ibi l ity
.
.
-
.
-
,
.
F IG
t b
t
C u r v e s o f th e v e r e r a l
c o lu m n
A
w i h i n te r
(F ic )
v e r te r a l d i s c s ; B
w i hou t i n e r
v e r e r a l d i s cs
.
k
b
t b
.
.
,
,
t
t
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No r m al S pi n al Cu r v e s —The
rve s ar e du e to th e
e q u al th i c k n e s s o f th e an teri o r an d p o st eri o r p o rti o n s o f
th e di s c s The di s c s ar e thi c ker an ter i o r ly i n th e c ervi cal
an d l u mb ar regi o n s th i c ke r p o s teri o rly i n th e d o r sal regi o n
th u s p r o d u ci n g anter i o r cu rve s i n th e c ervi cal an d lu mb ar
The b o die s o f th e v e r
an d a p o steri o r c u rve i n th e d o r s al
te br ae also v ary s lightly i n th i c k n e s s an teri o rly an d po s
i e th e an te ri o r d epth o f th e b o di e s i s l e s s th an
te r i o r ly
th e p o ste ri o r so th at with o u t th e di sc s the wh o l e co l u m n
p re s e n t s a p o steri o r c u rve with a l o s s o f th e anteri o r c u rve s
Th e s e c u rve s and th e
i n th e c ervi c al an d l u mb ar regi o n s
di scs
ch ar acteri s ti c s o f th e c e n te r s o f th e i nter vertebr al
.
cu
.
,
,
,
.
,
.
.
,
'
.
.
-
PR I N C I PL E S
O F O S TE O PA TH Y
2 43
give th e co l u m n its re s i l ie n c e In b en di n g thi s co lu m n to
th e si de r o t ati o n o f th e v erteb r al b o die s i s i n evit ab l e
—
i
L im itati o n o f F l e x bi l it y
The an teri o r an d p o s teri o r
c o mm o n l ig am e n t s o f th i s c o lu m n o f vertebr al b o di e s an d
i n ter vertebr al di s cs te n d by th eir i n e las ti c fibr ou s ti s su e
B y addi n g th e n eur al ar ch es with th ei r
to limit fl e x ibi lity
l ig am e n t s th e fl e x ibi l ity o f th e c o lu m n i s sti ll f u rth e r l i m
Be si de s the co m m o n l ig ame n t s bi n di n g th e b o die s
i te d
the r e i s o n e o th e r l ig am e n t whi ch e x te n d s th e wh o l e l e n gth
i e th e su p r aspi n al ligam e n t co ns i sti n g o f
o f th e c o l u m n
i n e lasti c fib r o u s ti ssu e e x te n di n g o ve r th e sp i n o u s p r o
he s ac r u m to th e s eve n th c ervi c al wh ere i ts
c e s s e s fr o m t
s t r u c t u re c h an ge s to ye l l o w e lasti c fib er an d i s k n o wn as
th e l igam
e n t u m n u ch ae th r o u gh i ts co n ti n u ati o n to th e
c ervi c al s pi n o u s p r o c e s s e s an d th e
o cc i p i t al
b on e
Th i s
li g ame n t l imit s fl e x ib i l ity i n th e d o r s al an d l u mb ar regi o n s
The rem ai n de r o f th e S p i n al l igam e n t s ar e i n tervertebr al
i e e x te n d betwee n tw o verteb r ae Th ey ar e i n el as ti c
with On e e x c epti o n th e l ig ame n t a s u bfl av a co n n e c ti n g th e
lami n ae o f t he n e u r al ar c h e s
Th ere ar e m an y o t her th i n g s
—
wh i c h ar e facto r s i n l imiti n g th e i n h ere n t fl e x ibi l ity o f th e
Sp i n al co lu m n viz th e arti cu lati o n with the r ib s to f o rm
th e th o r ax th e arti c u lati o n with p e lvi c b o n e s th e co n te n t s
o f abd o m e n an d th o r ax an d th e b u lk o f th e so ft ti ss u e s
wh i ch r o u n d o u t th e b o dy
.
.
,
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-
,
,
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,
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,
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,
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,
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,
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'
.
‘
‘
‘
,
‘
.
,
,
,
.
.
P r o c e ss e s — Alth o u gh th e S pi n al lig ame n t s
th e fl e x ibi lity o f th e s pi n al
and o th e r s tr u c t u re s l imit
th e ch aracter o f i ts evi de nt fl e x ibi lity i s l argely
c o lu m n
go ver n ed i n th e v ari o u s regi o ns by th e sh ap e an d p o siti o n
o f arti c u l ar pr o c e s s e s wh i c h f o rm a s erie s o f glid i n g j o i n t s
b etwee n th e n e u r al ar ch e s The arti c u lar pr o c e ss e s ar e
l o cated at the j u n cti o n s o f th e p edi c l e s an d lami nae Th ey
co n si s t o f tw o s 11 p e r i o r an d t
w o i n feri o r fo r e ach vertebr a
—
In th e c ervi cal regi o n th e arti c u lar
Ce r vi cal R e g i o n
pr o c e ss es ar e pl ac ed very o b l iq u e ly The su rfac e s o f th e
su p e r i o r l o o k u pw ar d an d b ac kw ard an d ar e so m ewh at
Ar ti cu lar
.
,
,
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PR I N C I PLE S
2 44
F IG
.
61
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R ad i og rap h
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e
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of
th e
ce
O F O S TE O PA TH Y
rvi cal r g i
e
on
t
i n p os i i o n f o r b al an c i n
g
th e
O F O S TE O PA TH Y
PR I N C I PL E S
2 46
r h ed to fit th e s light co ncavity o f th e i n feri o r wh i ch l o o k
d o w nw ard an d f o rw ard Thi s arr an gem e n t p ermit s fl e x 10 n
e x te ns i o n an d sid e b e n di n g ac co mp an i ed by sl ight r o t ati o n
Th e s e ar e re co g n ize d as th e phy si o l o gi cal m o vem e nt s fo r
thi s regi o n o f th e c o lum n The h ighly sp e c i alize d arti cu
lati o ns b etwe e n th e o c c ipit al b o n e an d at las th e ax i s an d
a c
.
,
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F IG
.
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R ad i o gra p h
i ll u s
trati n g
n o r m al
fl e x i on i n
th e
c e rv i c al
re
gi
on
.
P RI N C I PL E S
F IG
.
64
.
R ad i o g r ap h
of
O F O S TE O PA TH Y
th e
c e r v i c al
re
gi on
in
2 47
t ti
ro a
on
.
.
PR I N C I P LE S
2 48
O F O S TE O PA TH Y
tl as ar e w o rthy o f m o re d et ai led c o n sid e r ati o n
e
e
S
(
Ch ap X I V )
D o r sal R e g i o n —The s u rfac e s o f th e d o r sal arti c u l ar
p r o c e ss e s ar e verti cal th e su p e ri o r f ac i n g b ac kw ard th e
i n fe ri o r f o rw ard The s u rf ace s ar e slight ly c u rved fr o m
he su rf ac e o f a th e o
s id e to si d e th u s f o rmi n g p art s o f t
ret
i c al c y li n d er h avi n g i ts ax i s l o cated i n fr o n t o f th e b o dy
The m o vem e nt s p e rm itte d by thi s str u c t u r al arr an ge me nt
ar e th e phy s i o lo gi cal o n e s k n o w n as fl e x i o n e x te n s i o n an d
R o t ati o n i s th e m o st c h ar ac teri s ti c
s i de b e n di n g r o t ati o n
o f the m o vem e n t s i n thi s regi o n
I t i s gre ate st i n th e u pp er
d o r sal arti c u lati o n s an d d e c re as e s as th e arti c u lar p r o c e s se s
b egi n to t ake o n lu mb ar ch ar ac teri sti cs The el eve n th
d o r s al v e r te r br a m ark s th e limit o f
so m eti m e s th e te n th
th i s ch ar ac teri sti c d o r sal m o vem e n t All m o vem e nt s ar e
lim ite d i n th e d o r sal regi o n n o t o n ly by th e i nhere n t f o rm
o f th e vertebr al arti c u lati o n s b u t als o by th e att achm e n t
o f th e rib s
The typi cal c o st o vertebr al ar ti cu lati o n i s ch ar
ac te r i z e d by th e h e ad o f th e ri b arti c u l ati n g with th e b o di e s
of
tw o vertebr ae wh il e th e t u b er c l e o f th e rib u n i te s
with th e arti c u lar -f ac et o n th e tr an sver s e p r o c e s s o f th e
lo we r o f th e s e tw o vertebr ae
The fir s t e l eve n th an d
a
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le ftl ate ral
F IG
.
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.
,
mem
.
D ra w n b y J o h n
C om s
t k
oc
.
PR I N C I PL E S
2 50
F l exi on
E x t e ns i o n
O F . O S TE O P ATH Y
S i nc e
rr an ge me nt o f th e
arti c u l ar p r o c e s se s i s an i n d ex to
c h ar acte r o f m o v e:
m e n t no rm ally p e rmitted b etwee n the vertebr ae i n the
v ari o u s regi ons o f the s pi nal c ol u m n it i s advi sabl e th at
we cal l atte nti o n to a few p o i n t s c o n c e r n i n g th em I t is
re adily se e n th at fl e x i o n i s a f ai rly free m o vem e n t i n all
p o rti o n s o f th e co l u m n with th e e x c epti o n o f th at p o rti o n
o f th e d o r s al wh i ch arti c u l ate s with th e s eve n tr u e rib s
E x te n s i o n is li kewi s e fre e i n th e s e s ame s e c t i o n s i e
wh e re fl e x io n i s fre e it i s m et by f ai r ly fre e e x te n s i o n
—
B
n
n
o
t
S i de
e di g R t
a i on
S id e b e ndi n g o f a c o lu m n
—
n
n
a
a
o
h vi g
te r p o s teri o r c u rve s i s ch ar ac teriz ed by r o t a
an d
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th e
th e
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I
r o ta twn
F IG
.
D rawn
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J
oh n
C om s
t k
oc
.
.
.
P R I N C I PL E S
O F O S TE O PA TH Y
2 51
ti o n Th i s i n h ere n t r o t ati o n o f the segm e n t s o f th e spi n al
c o l u m n wi ll n at u r ally t ak e p l ac e with a c e n te r o f r o t ati o n
the o reti cally lo cate d o n a l i n e e x te n di n g dire ct ly f r o m e n d
Thi s l i n e w o u l d p ass o n th e co nc av e sid e o f th e
to e n d
b e p o steri o r to th e b o die s in th e c ervi cal r egi o n
c u r ve s 1 e
an teri o r to th e b o di e s i n th e d o r sal an d p o ster i o r to th e
b odi e s i n th e lu mb ar A s t u dy o f th e arti cu lar p r o c e ss e s
wi ll S h o w ho w thi s acti o n i s f av o re d by the f ac in g o f th eir
ces
L i n e s dr aw n p erp e n di c u lar to th e sur
art ic u lar s u rf a
f ac e s o f th e s u p eri o r art i c u lar p r o c e s s e s o f a typi cal c erv
i c al i e th e f o u rth o r fifth c e rvi cal wi ll m eet at a p o i n t
beh i n d th e S p i n o u s p ro c e sse s an d ab o u t th re e i n ch e s ab o ve
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er io r
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D r aw n b y J o h n
C om s
su r fa ce
t k
oc
.
.
PR I N C I PL E S
2 52
F IG
S
TO CK
.
D r aw n
J
O F O S TE O PA TH Y
oh n
C oms
.
F IG
.
70
.
t k
oc
(a
ft T
er
old
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.
O F O S TE O PA TH Y
PR I N C I P LE S
2 54
di m i n ish e s as th e n e c k i s e x te n de df In e i th er fl e x i On
e nt s b e co m e s te n s e an d h e n ce
o r e x te n s i o n a s erie s o f l ig am
l imit s th e e x te n t o f ano th er m o vem e n t whi ch r eq u ire s free
The er e ct po s iti o n o f th e n e ck
do m o f thi s t en s e l ig am e n t
als
o
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,
‘
,
-
.
L e ft
b
d o r s a l- fi r l g h t l u m a r
ln
c u v a tu r e ,
p r o g r e s s 1v e
pe
o di e s o f
an d th e r e o r e p a i n u l
th e d o r s a l v e r te r a e r o a e d to
o di e s
of
th e l u m a
th e l e
v e r te r a e r o a e d to th e r i h
F IG
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ft
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ty
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B
b
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h e l u m ar v e r
F IG 7 a
te b r a e
rot
ar e
a ed
i n o p r o pe r
a li n m e n t
e l e v a ti n
r i gh
bu t
to c
.
.
g
k
by
t
g
t
”
t
.
.
ig n ifi e s ligam e nt o u s re lax ati o n an d i s th eref o re th e p o si
i o ns i n th e c e rvi cal
ti o n o f e l e cti o n fo r r e du cm g subl ux at
regi o n The sev e nth c ervi cal m ark s the chan g e i n dire cti o n
Its su p e r i o r s ur
o f th e f ac i n g o f th e arti cu l ar p r o c e ss e s
s
,
.
.
PRI N C I PL E S
O F O S TE O PA TH Y
2 55
f ac e s adhere to c ervi cal ch ar acteri sti c s whi l e i ts i n fe r i o r
be co m e m o re v erti cal an d li n e s p erp e n di cu lar to th em m eet
There i s fre q u e n t ly a
at a p o i n t i n fr o n t o f th e c o lu m n
g r ad u al ch an ge in th e f ac i n g o f th e c ervi c al arti cu lar pr o
.
74
S h ows
e r al
fl e x 10 n i h
d o r s al c u r v e
F IG
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ri
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c o n c av i t
.
gh t
la t
of
th e
75
S h o ws
e r al
fl e x i on i n
F IG
.
lu m
.
ba
r
cu r v e
gr at t l eft
n av i ty Of
e
co
l at
th e
es
c
.
e e whi ch begi n s at th e s i x th c ervi cal; The i nf e r i o r
ay fac e so as to b r i n g th ei r p er
p r o c e ss e s o f th e s i x th m
pe n di cu lar l i n e s t o geth er i n fr o n t o f an d b e lo w the b o dy
c ss s
.
D o r sal R e gi o n — The arti c u lar pro
c e ss e s i n th e d o r s al ar e c h ar acte ri sti c ally verti cal an d th e o
ret
i c ally m o ve i n l i n e with th e s u rf ac e o f a cy l i n d er hav i n g
its ax i s an teri o r to th e b o die s o f th e ve r teb r ae
Th u s to
tatio n in th e d o r s al app e ar s to m o v e o n a fi x ed p o i n t j u s t
anteri o r to the b o die s o f th e ve rteb r ae an d he n c e th e sp in o us
R o tat i o n i n the
.
,
.
PR I N C I PL E S
2 56
O F O S TE O PA TH Y
p r o c es ses m ake an ac t u ally as we ll as app are nt ly gre ate r
e x c u r s i o n to right o r left The sam e r ul e with rel ati o n to
freed o m o f m o vem e n t b ei n g gre ate s t i n th e n o rm al p o i sed
R o t ati o n i s gre ate r i n th e u pp er
p o siti o n app lie s h ere
.
.
,
F IG
.
76
a ti o n
.
t
lu m b a
l ft d
v at
ro
r
e
cu r
I ll u str ate s
of
th e
t b a
al
i ght
ver
ors
’
.
ure
e
-
r
e
r
g
th e d e r e e o f
th e
o di e s
of
in
h i s case o f
lu m ar la e r al
b
t
b
t
I
g
l l u s r a te s th e d e r e e o f
77
r ot
a ti o n o f th e
o d i e s o f th e d o r
s a l v e r te r a e i n th i s c a s e o f l e t
d o r s al - r i h t l u m ar l a e r a l c u r v
a tu r e
F IG
.
.
b
b
b
g
t
.
f
t
.
d or sa
l an d de c re ase s d o w n w ard di sapp e ari n g at the v ari
abl e p o i n t wh e re l u mb ar c h ar ac teri s ti c s b egi n to i n fl ue n c e
th e fo rm o f th e arti c u lar p r o c e ss e s Th i s v ar iab le p o i n t i s
f o u n d fr o m th e n i n th to el eve n th d o r sal R o t ati o n with
th e ax i s o f m o veme n t an teri o r to th e verteb r al b o dy u s u
ally ce ase s at th e arti c u lati o n b etwe e n t
h e eighth an d n i n th
d o r sal ; The late r al fl e x i o n b etwe e n th e n i n th an d te nth ,
te nth an d el e ve n th an d el eve nth and twelft h i s ch ar act er
iz e d by ve ry littl e ro t ati o n o f eit he r the d o rsal o r l umb ar
,
.
'
.
_
.
.
‘
,
PR I N C I PL E S O F O S TE O PA TH Y
2 58
th e ir i n te r o v e r te br al d i sc it i s app are nt th at th i s w o ul d
te n d to b lo c k th e m o vem e n t o f o n e verte br a o n th e o the r
an d h e n c e gre atly lim it r o t ati o n
A lth o u gh a st u dy o f th e
m e ch ani c s o f th i s p o rti o n o f th e co l u m n s eem s to sh o w a
an d
,
.
f
F IG 7 9
F l e x i o n to th e l e t, i n c a s e
i l l u s r a ti o n
i n p r e c e di n
s how n
r e a e s t fi e x i on
is
Th e p o i n t o f
of
th e
l o c a e d i n th e c o n c av i t
lu m a r cu r ve
i h
.
t
rg t
.
g
b
g
t
t
y
.
.
gh t i n
ca
h wn i n
ding il
p
l
t a ti n Th p i n t f g at
t fl
i n t th
i ght i
ab u t
th
n i n th d
i
al
a b u t th
nt
f th
n av i ty
f th
l f t lat al p a t
f th
v a tu
F IG
80
.
F le x i on
.
s
se
to
th e
o
th e
ri
,
rece
'
us r
o
ex o
es
e
ce
e
e
.
o
o
ors
o
er
e
er
,
co
r
o
s
r
e
e
.
re
o
.
,
o
o
c
e
e
o
e
cu r
re
.
very so li d an d u n yieldi n g c o n str u c ti o n the fac t e x i s t s th at
we h ave a c o ns i de r abl e am o u nt o f m o vem e n t i n th e u ppe r
d o r sal arti c u l ati o n s R o t ati on is pr o b ably th e m o s t pr o
n o u n c e d o f th e u pp e r d o r s al m o v m e n t s an d it i s i n thi s
e
regi o n o f th e co l u m n l ate ral subl ux ati o ns ar e f o un d
Fl e x i o n an d e x te n si o n ar e re adily dem o nstr ate d fr o m fi r st
th e se
to f o u rth an d fr o m eighth to twelfth d o r sal i
regi o n s th ey ar e m o re p r o no u nc e d th an i n th e mi d d o r sal
,
.
,
“
.
,
.
-
.
PRI N C I PLE S
Char acte r i s ti c
lu mb ar
O F O S TE O PA TH Y
2 59
M o v e m e nt i n the L u m b ar R e g i o n —The
rti c u lar p ro c e ss e s ar e verti c al an d f ac e s o th at
t hey m o v e in l i n e with th e su rfac e o f a th e o reti c al cy l i n der
h avi n g i ts ax i s r u nn i n g i n th e tip s o f th e sp i n o u s p r o c e ss e s
a
'
.
g t t
r t
ty
by t t
ft
b
g t
r
l a e r a l c u v a tu r e
81
F IG
S li h
o f th e s t u c u r a l
p e a s i s e vi
d e nce d
r o a i o n o f th e
o di e s
o f th e
l o w e r d o r s a l v e r e r a e to
th e l e
th e
o d i e s o f th e l u m a
to th e r i h
.
.
,
t b
b
,
b r
.
Th ere i s m u ch v ari ati o n i n th e f o rm
th e lu mb ar ar ti cu
lar su rfac e s
S i n c e th ey h ave m u ch gre ater weight fo r th eir
b e ari ng s u rf ace s to su pp o rt th ey ar e h e avi ly deve lo ped
E x ag ger ati o n o f th e n o rm al lu mb ar c u rve d u ri n g the de
of
.
.
PRI N C I PL E S
O F O S TE O PA TH Y
'
O pi n g
ve I
p e ri o d cau se s th em to t ake o n a gre ater weight
c arryi n g f u n c ti o n th an n o rm al an d h e n c e c h an ge s th e b e ar
i ng m o v abl e s u rf ac e so as to d e c re as e th e r an ge o f m o ve
m e nt The m o r e n e arly the b o di e s o f th e verteb r ae te n d
.
F IG
ri
.
g
h
th e
.
t
82
L a e r al fl e x i o n to
t, Is
r e a te s t i n c o n c a v i
d o r s a l cu r v a u r e
g
t
th e
of
ty
.
t
ft
L a e r al fl e x i o n to th e l e
83
i n con
h i s case , i s
rea es
o f th e l u m a r c u rv e
cav i
F IG
in
.
t
g
b
ty
t t
,
.
pp o rt th e su p e ri n cu mb e n t weigh t th e gre ater free d o m
hro di als betwee n
o f m o vem e n t wi l l n at u r ally e x i st i n th e ar t
th e a rti c u lar p ro c e ss e s The ch ar acteri sti c f o rm o f the
l u mb ar arti c u lar s u rfac e s i s n o t c o n d u c ive to r o t ati o n as
a we l l d efi n e d m o vem e n t
su ch as we fi n d i n th e u pp er
d o r sal an d c e rvi cal bu t n everth el e s s si d e b e n di n g in thi s
regi o n i s ch ar acterize d by r o t ati o n h avi n g i ts c e nter i n a
l i n e dr aw n v erti cally th r o ugh th e spino us pr o ce sse s Th us
w e no te t hat r o t ati o n in the t hr e e r egi o ns o f the co l umn
to
su
‘
.
,
,
,
,
'
,
.
PR I N C I PL E S
2 62
O F O S TE O PA TH Y
th an th e rever s e M o vem e n t i n th e o pp o s ite di re cti o n co m
pre s se s th e i n te rve rteb r al di sk s an d h e n c e l e s s e ns th e 1 r re si
.
l ie n ce
.
P o s iti o n to Bo dy W e i ght Fle x i o n an d
th e lu mb ar ar e n o rm ally q u ite fre e h e n c e th ere
Ad apt abi l it y
e x t e n si o n
in
of
-
.
,
g
I
r
ll u s tr a ti n
th e p e s e n c e
85
rot
a ti o n i n th e d o r s a l r e i o n
w i h l a te r a l c u r v a u r e
co e x i s e n
F IG
of
.
.
t t
t
g
t
,
.
gre at ad apt abi lity to th e p o s iti o n o f th e b o dy we igh t
A de c i de d d evi ati o n o f a s i n g l e s pi no u s pr o c e ss i s s e l d o m
f o u n d i n th i s regi o n The di re c ti o n o f th e ar ti cu lar s u r
fac e s te n d s to p reve n t s u ch d evi ati o n
is
.
.
'
.
PR I N C I PL E S
O F O S TE O PA TH Y
2 63
C H A P TE R X I I I
.
TH E P E L V I S
.
The F ift h L u m bar . The fifth lu mb ar verteb r a p re
-
e t s o m e p o i n t s o f i mp o rt an c e
Its m as s ive n e ss i s an
—
evi de n c e o f i ts weight c arryi n g c ap ac ity The d epth o f i ts
an teri o r m arg i n i s m arked ly gre a te r th an th at o f the po s
te r i o r p o rti o n o f i ts b o dy T he i n t ervertebr al di s c b etwe e n
th e fifth an d th e s ac r u m s ti ll f u rth er ac c e n t u ate s by th e
re lative ly gre at thi c k n e ss o f i ts an te ri o r m argi n th e an g l e
f o rme d by th e arti c u lati o n o f th e fi fth with th e sacr u m The
in feri o r arti c u lar p r o c e s s e s ar e wi der ap art th an th o s e o f
S n s
‘
.
.
.
,
,
.
F IG
D ra w i n g
D r aw n b y J o h n
.
86
.
of
p e lv i s ,
C om s
t k
oc
sh o
(a
win
ft
er
g
H
sacr o - v e r
olde n)
.
t b ra l
e
an
gl
e
.
O F O S TE O PA TH Y
PR I N C I PL E S
2 64
th er lu mb ar s
The tr an sv er s e p r o c e s se s ar e u s u ally
h e avily d evel o p ed bu t th e spi n o u s pr o c e s s is apt to b e
Thi s vertebr a
s m all er th an th o s e o f th e o th er l u mb ar s
j o i n s th e sacr u m at a r at he r abr u pt angl e f o rm i n g a de
th e Sac r o —
ve rtebr al an gl e A li n e draw n
c i de d pr o j e cti o n
th r o ugh th e i nte rvertebr al d i sc be tw e e n the fifth l u m bar
an d th e sac r u m w o u l d f o rm an an gl e with th e h o riz o n t al
he i n feri o r ar ti cu
o f ab o u t 30 degree s
I t is evid e n t th at t
lar p r o c e s se s o f thi s vertebr a h ave a co n si d er abl e f u n c ti o n
o f weight carryi n g
I f it were n o t fo r th e br ac i n g acti o n
o f th e s e p r o c e s s e s th e s u p eri n c u mb e n t w eight w o u l d t e n d
rd o n th e b as e o f th e
to sli de th e b o dy o f th e fifth f o rw a
sac r u m
o
.
,
.
,
.
'
.
.
,
.
—
A
s
L o ss v s
o f No r m al C u r v e
s a g en
er al pr o p o s iti o n it m ay b e st ated th at th e l o s s o f a n o rm al
c u rve i n th e S p i n al co l u m n i s apt t
o c au s e m o re di sco mf o rt
th an w o u ld th e e x aggerati o n o f a n o rm al c u rve Th ere i s
pr o b ab ly n o b ett er e x ampl e o f th i s th an th e e ff e ct s n o t ed
i n ch an ge s o f th e l u m b o s acr al arti c u l ati o n
I t is m an i
fe s t th at e x te n si o n in th e ar thr o di al arti c u l ati o n s b etw ee n
th e arti c u l ar p r o ces s e s o f th e s e tw o b o n e s s erve s to ho ld
th em m o re fi rm ly t o geth er an d m ake the sac r o vertebr al
an g le m o r e pr o mi n e n t
Th i s s erve s to m ak e the l o wer ab
d o m e n m o re p r o m i n e n t and m ake s th e li n e o f divi s i o n b e
twee n abd o m e n an d p elvi s m o r e m arked
.
E x agg e rat i o n
,
”
,
,
.
,
,
-
.
,
"
,
-
’
.
.
—
F l e xi o n of th e
M o t i o n i n L u m b o S acr al Arti cu latio n
fifth o n th e s ac r u m co mpre ss e s th e th i ck ant eri o r m argi n
n d s l i de s i ts arti c u lar p r o c e s s e s
o f th e i n te rverteb r al d i s c a
u pw ard o n th o s e o f th e sac r u m th u s te n di n g to gre at ly de
c re as e th e sac r o ve rtebr al an gl e an d m ake th e s p i n o u s pr o
I t i s co n c e iv
c e s s o f th e fifth b e c o m e m o re p r o mi n e n t
abl e th at f o r c ed fl e x i o n i n th i s arti c u l ati o n c o u l d cau s e a
Fl ex i on
d i s lo c ati o n o f th e arti cu lar su rfac e s
co mpl ete
an d e x te n s i o n ar e s o fre e i n thi s arti c u lati o n th at m u ch o f
th e m o vem e n t asc ribe d to th e l u mb ar regi o n as a wh o l e
L o ss o f m o ti o n h ere as i n l u mb ag o
i s co n trib u te d by it
-
,
,
,
-
.
.
,
,
.
,
,
.
PR I N C I PLE S
2 66
O F O S TE O PA TH Y
h ar acte riz e d by a rigi dity wh i ch cau se s th e st rid e i n
w alki n g to b e gre atly sh o rte n ed
Adapt ati o n i n L u m b o S acr al Ar ti cu lat i o n — In cas e s o f
—
u n eq u al l e n th o f l eg s as a re su lt o f i n j u ry fl at f o o t s l i g
h
t
g
be n d o f an i nflam ed k n e e o r h ip th ere i s a tilti ng o f th e
2
i
fifth o n th e b as e o th e s ac r u m in o rd er to b al an c e the
weight o f th e b o dy Th e re i s u n eq ual m o ve m e nt i n th e
is
c
.
-
,
.
,
,
,
,
.
F IG 8 8
.
D r aw n
H
o l de n
N o r m al p o i s e o f th e b o d y
b y J o h n C o m s to ck ( a fte r
.
)
f o rm e d by th e arti cu lar p r o c e ss e s i e th e j oi n t
whi l e th e o p posite
o n th e s id e o f th e s h o rt er l eg e x te n d s
Thi s r o c k
o r o t ate
o n e fl e x e s th u s pr o d u c i n g a te n de n c y t
i ng ac ti o n p e rm it s a gre at r an ge o f ad apt ati o n i n th i s j o i nt
an ac ti o n wh i c h i s a b so l u tely e ss e n ti al to th e m ai n te nan c e
o f b al an c e i n th e u p right p o siti o n
—
i
h
f
e
m
A
i
l
o
u
b
o
a
c
r
a
l
r
bi
t
L
t
l
a
t
S
c
u
a
t
i
o
n
T
St
he an
y
te r i o r co mm o n lig am e n t i s s o pl ac ed as to l e n d s u pp o rt to
ar thro dials
-
,
.
.
,
,
.
,
,
.
-
.
P R I N C I PL E S
F IG
P l an ta r
i m p r e s s i on
O F O S TE O PA TH Y
th a t
gh t
rt
mb
f
f o r a s ac r o
c o r r e c e d th e s u p p o s e d
Th e u s e o f a n a r c h s u p p o
i l i a c s u lu x a i o n
i
l
t
i
n
h
o
sa cr al
t
d
a
a
o
n
e
u
a
a r i c u la i o n
le s i o n
Th e e o r t a t
p
a i u e p ai n
c au s e d a
89
.
b
.
H
.
t
ff
f tg
of
a
t
.
.
cas e
sou
r e li e
t
t
t
O F O S TE O PA TH Y
P RI N C I PL E S
2 68
rti c u lati o n i n th e e x te n de d p o siti o n L ig am e n t s o r
di n ar i ly l im i t m o ti o n bu t ar e e x te n s ibl e ti s su e s wh e n u n der
c o nti n u ou s s tr ai n
h e n c e th e weight o f th e b o dy te n d s
To change
alw ay s to b e tr an s mitte d fr o m b o n e to b o n e
thi s arr angem e n t an d th us pu t th e str ai n co nti n u o us ly o n
l ig am e n t o u s ti s s u e l e ad s to rel ax ati o n in th e j o i n t
Th e r e
ar e m an y j o i n t s i n th e b o dy whi c h
so far as th e ad apt a
ti o n o f th e arti cu l ati n g su rf ac e s o f th e b on e s whi ch f o rm
th e m ar e co nc e r n ed f u r n i sh n o s t ability The k n e e j o i n t
i s a g o o d e x ampl e o f thi s
I t has si x tee n ligam e n t s wh i ch
s erve to f u r n i sh i t a s t abi l ity n o t w arr an ted by
th e f o rm
o f th e arti c u lati n g su rfa c e s o f tibi a a
n d fem u r
The l u mb o
s ac r al arti c u lati o n has a st abi l ity i n i t
s n o rm al an gl e du e t
o
th e l o cki ng o f its arti cu l ar p r o c e ss e s The mo re th e se pr o
c e ss e s ar e lo c ke d as i n hy pe r e x te n s i o n th e gre ater th e te n
de ne y to tr an s mit weight th r o u gh th em Thi s i s u nnat
u r al an d h e n c e pr o d u c e s f atig u e b o th by co n ti n u o u s p re s
s u re o u th e arti c u l ar su rf ac e s an d b y
he an
str et chi n g o f t
Thi s i s th e co n diti o n cau s ed by
te r i o r c o mm o n l ig am e n t
a p e n d u lo u s ab do m e n
i o n o f the L u m b o S acr al Ar ti cul ati o n
D e c o m pe nsat
F l ex i o n o f th e lu mb o sac r al arti c u l ati o n c au s e s a s tr aigh t
c u i n g o f th e l u mb ar th u s bri n gi n g th e W
e ight o f th e b o dy
m o re co mpl ete ly o n th e co l u m n o f b o di e s an d ch angi n g
th e lu mb o s ac r al angle s o th at th e ax i s o f the p elvi c c avity
i s b r o u ght m o re n e arly i n l i n e with th at o f the ab d o m e n
The o bl iter ati o n o f th e n o rm al lu mb ar cu rve p r o d u c e s a
ge n er al c u rve i e co i nc id e s with th e d o r s al an d th u s be
Thi s p u t s a gre at
c o m e s p art o f a ge n er al p o steri o r c u rve
Th i s i s a s t at e o f
s tr ai n o n th e p os teri o r sp i n al lig am e n t s
de co mp e n sati o n o f th e no rm al spi n al cu rve s wh i c h n ece SS i
t ate s a de c i de d e ffo rt to b al anc e th e b o dy
P art o f the P e lv i s O b s tetri ci an s c o u n t th e fifth lu m
bar as a p art o f th e p elvi s s i n c e it i s b ou n d to th e i n no m i
—
n ate s by ili o l u mb ar lig am e nt s whi c h e x te n d fr o m the tip s
o th e c re st s o f th e i l i a
Th e s e
o f i ts tr an sver s e p r o c e ss e s t
ili o lu mb ar lig am e n t s te n d to co mp el th e fifth l u mb ar ve rte
th i s
a
.
.
,
.
i
.
,
,
.
,
.
.
.
-
,
,
.
,
.
‘
-
.
-
.
'
-
-
,
.
,
.
,
.
.
,
.
-
.
,
,
.
-
P R I N C I PL E S
2 70
O F O S TE O PA TH Y
reg ai n co mp ar ativ e im m o b i lity f o llo wi n g par tu r i
ti o n a co nd iti o n o f i n st ab i lity wi ll e x i st wh i c h wi ll e x pre ss
it s el f i n a dis tu r ban ce o f th e st at ic s o f th e b o dy Bal an c i ng
an d weight c arryi n g fu n c ti o n s wi ll b e i nj u re d
do
no t
,
,
,
‘
.
-
.
P hy si o l o g i cal R e lax ati o n —The m e ns tr u al p eri o d s in
m an y w o m e n ar e ch ar acterize d by r e lax ati o n o f th e p e lvi c
l ig am e n t s with c o n s e q u e n t d i st u rb an c e o f the weight carry
i n g p o we r o f th e s ac r o i li ac arti c u lati o n s
.
-
,
‘
-
.
The M al e P e lv i s —The m al e p e lvi s
eve r e x hibit s any
f o rm o f n o rm al re lax ati o n o f lig am e n t s th eref o re th e e x
i ste n c e o f any i n st abi lity i n th e s ac r o i l i ac arti c u lati o n s i s
p ath o l ogi cal i e du e to debi lity o r tr au m a The traum a
m ay b e di re ct an d f o r c ef u l e no u gh to str ai n the lig am e n t s
o r it m ay
whi ch
s u dd e n ly
c o n s i s t i n a f o rm o f f atig u e
eve nt u ally allo w s th e l ig am e nt s e n g aged in th e w eight
c arryi n g f u n c ti o n s Of th e s e j o i n t s
to b e c o m e s tr ai n ed
n
,
-
,
.
.
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,
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F IG
.
91
.
s e c on
C om s
D ra wi n g
gk
s ac r a l
oc
.
to
t
r
t
.
g r
t
by J
of
of
as p e c
el a i on
p e lv i s , sh o w i n
pos e r io
th e p o s e r i o r s u p e r i o r i li a c S p i n e s
r aw n
oh n
of
t
.
.
D
PRI N C I PL E S O F O S TE O PA TH Y
L o ss
—It
S t ab i li ty
2 71
i m ati c th at lo ss o f s ta
b il ity in th e pe lv i c g i r dle wi ll w e ak e n i ts w eight c arryi n g
c ap ac ity an d h e n c e di s t u r b th e n o rm al s t ati c c o n diti o n o f
th e w ho l e bo dy
In v i e w o f th i s f act we m u s t m ak e a
r ath e r c ar ef u l st u dy o f th e st r u c t u re o f the s e j o i n t s an d
at
n o te an y evid e n c e s o f i n h ere n t we ak n e ss i
wh at p o i n t s u n u sual f o r c e m ight m o st e as i ly p r o d u c e a
le si o n
of
is
ax o
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F IG
Analy si s
.
92
of
.
N o r m al
r e la
ti
on s
of
s a c ru
m
an d i l i u m
S acr o Il i ac Ar ti cu l ati o ns
-
.
— D i ss e cti o n
of
the s e j o i n t s di sc l o s e s the e x i s te n c e o f the sam e s tr u c t u re s
f o u n d in o t her j o i n t s i e b o n e car ti lage sy n o vi al m em
b r an e an d ligam e n t s The fact th at th e s e s tr u ct u re s do
e x i s t in th e s ac r o —
i l i ac ar ti cu lati o n s nat u r ally class ifie s
th e se j o i n t s as h avi n g p o ss ib l e m o bility
The se j oi n t s
serv e t o ab so r b sho c k s tr an s mitted t hr o u g h t
he l eg s to the
pelvi c gird l e The sli ght m o vem e nt no rm ally p o ss ib l e in
th em su bj e ct s th em to m u c h th e s am e co n d it i o ns wh i ch
s erve to i n j u re o t
he r jo i n ts
e
,
.
.
,
,
,
.
,
.
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.
,
,
'
.
2 72
PR I N C I P LE S
F IG
93
.
F IG
.
I li u m f o r c e d
.
94
O F O sTE O P ATH y
.
I l i u m f o rc e d
u p w ar d
a nd
fo r w ar d
rd
an d
b ac war d
u p wa
k
.
.
PR I N C I PLE S
2 74
F IG
.
96
i li a
.
.
N o r m al
su r
fa
ce
O F O S TE O P ATH Y
mar k i n gs
of
th e
'
ti
r e la
on s
of
th e
sa
cr u m
a nd
PR I N C I PL E S
O F O S TE O PA TH Y
2 75
pp o s i ng au ri cu lar s u rf ac e s ar e re c ipr o c ally
u n eve n but n o t e n o u gh so to s u s t ai n an y we ight
s l ight ly
F ig
The i l lu s trati o n
with o u t lig am e n t s
90
sh o w s
c l e ar ly th e re lat i o n o f th e f o rm o f th e sac r u m to th e di r e c
ti o n o f the wei ght it su st ai n s The s tr u c t u re o f th e s ac r o
i li ac syn ch o n dr o s e s i n di c ate s that m o v e m e nt i s p o s sib l e
p r o b ab l e The p rim ary o bj e ct o f th e m o ve
an d i n f ac t
m e n t i s to p r o d u c e e last i c ity i n th e p e lvi c gi rd l e an d i n t er
hi ch w o u ld b e tr an smitte d fr o m th e l eg s to
r u pt Sho c k S w
th e tr u n k A f u rth er o bj e c t w o u l d b e i n th e fem al e ad apt a
ti o n o f th e bi rt h c anal to i ts c o n te n t s
s ac s
The
.
a
,
,
.
,
.
,
.
.
'
‘
.
,
.
,
T
’
.
,
,
.
S u blu x ati o n sé—
C l i n i c ally
we re co gn ize th e
e xi ste n c e o f dis tu r banc e s i n th e s e j o i n t s as du e to re lax a
ti o n o f lig am e n t s du e to p reg n an cy m e n s tr u ati on ge n er al
d ebi l ity o r tr au m a F u n c ti o n al ad apt abi lity i n the fem ale
p e lvi s m ake s w o m e n e asi ly su bj e c t to ch an ge s i n the se
j o i n t s an d l ikewi s e p erm it s e as i er c o rre cti o n The m al e
pe lvi s i s p ra c ti c ally n ever di s t u rb e d e x c ept as re s u lt o f
d ebi lit y o r tr au m a an d i s th eref o re m o re d i ffi cu lt to c o rre ct
Cau s e s
of
'
,
,
,
.
-
,
.
,
.
R o tati o m— The
m oti o n i n th e se j o i n t s i s d e s c ribe d by
v ar i o u s au th o r s J u dgi n g fr o m c li n i c al e x p e rie n c e th e m o
ti o n s eem s to b e i n th e n at u re o f r o t ati o n Thi s r o t ati o n
t ake s p lac e o n an ax is whi c h p as se s th r o u gh th e ar ti c u lat
i n g s u rf ac e s o f th e s ac r u m an d i li a o n a l eve l wit h th e po s
te r i o r s u p eri o r S pi n e s o f th e i li a an d th e s e co n d s ac r al
Thi s m ake s th e s e c o n d s ac r al spi n e an d th e po s
s pi n e
te r i o r s u pe ri o r S p i n e s o f th e i li a th e b o n y lan dm a rk s i n di
R o t ati o n o f th e
c ati n g th e p o si ti o n o f th e j o i n t su rf ac e s
i li u m f o rw ard w o u l d m ake th e p o ste ri o r su p eri o r s p i n e l e s s
pr o m i n e n t an d s light ly high er s o th at a li n e dr aw n ac r o s s
th e sac r u m thr o u gh i ts s e co n d s pi n o u s p r o c e s s w o u l d p ass
thr o u gh th e lo wer b o rder o f th e p o st eri o r s u p eri o r s pi n e
i n ste ad o f i ts ap e x R o t ati o n o f th e c re st o f th e i li u m b ac k
w ard m ake s th e p o steri o r su p eri o r s pi n e m o re pr o mi n e n t
an d slight ly lo wer th an n o rm al
A ll th e p o s iti o n s de sc rib ed
by v ari o u s au th o r s can b e red u c e d by an aly s i s to th e tw o
.
.
.
.
,
,
.
.
2 76
PR I N C I PLE S
F IG
.
97
.
O F O S TE OP A TH Y
R o tat i o n
of
th e
i li
um f o r w ard
,
.
PR I N C I PL E S
2 78
O F O S TE O PA TH Y
r o t ati o n s j u st d e sc rib ed S i nc e th e se r o t ati o n s ar e u nilat
e r al th e p elvi c di st o rti o n re su lt s i n a sl ight app are nt dif
fere nc e i n th e l e ngth o f th e leg s s o th at wh e n th e p ati e nt
l ie s o n th e b ack o n a h ard s u rf ac e w ith th e l eg s s tret ch ed
o u t as eve n ly as p o s sibl e th e h ee ls wi ll b e f o u n d n o t to be
e q u al In o rd er to c o mp e nsate fo r th i s app are n t i n e q u ality
i n l e n gth th e p e lvi s wil l b e f o u n d to b e t i lt ed with re l ati o n
Thi s c o mp e n sat o ry ti lt i s th e sam e
to th e spi n al c o lu m n
ph e n o m e n o n th at i s p re se n t i n every c as e h avi n g u n eq ual
.
,
,
,
,
.
.
,
'
.
r g t
r
z by
g t
t b
ri h
A c a s e o f p o s te r i o
F IG
99
i l i a c w h i c h w a s c h a a c te r i e d
p e r s i s e n t p a i n i n th e r i h s a c r o
i li a c a n d th e s a c r o - v e r e r a l a r
ti c u l a ti o n s
.
.
t
.
,
PR I N C I PLE S
l e n gth
O F O S TE O PA TH Y
2 79
pp o rt In o rd er to m ake s u re whi ch j o i n t
i s th e o n e at f au l t on e m u s t u s e th o s e b o n y l an dm ark s
whi c h ar e a p art o f th e p e lvi s i e p o s t eri o r su p eri o r i l i ac
A n app are n t d i ff er en c e
sp i n e s an d th e s e c o n d s ac r al s p i n e
in th e l e n gth o f th e l eg s m ight b e du e to a lu mb ar c o n di
ti o n i rre s p e c tive o f any c h an ge in th e r e l ati o n of the b o n e s
o f th e p e lvi s
C o m pe ns at o r y P e lv i c Ti l t—It sh o u l d b e rem embere d
—
th at n o ch an ge i n a s ac r o i li ac s y n ch o n dr o s i s i s ever u n ac
co mp an i ed by a c o mp e n s
at o ry e ff o rt o f th e b o dy to tr an s
m it th e b o dy weight th r o u gh th e n o rm al h al f o f th e p e lvi s
Thi s p r o d u c e s a s l ight s pi n al c u rv at u re wh i c h i s p art o f
the c o mp e n sat o ry ti l t o f th e p e lvi s to av o id tr an s mitti n g
b o dy weight thr o u gh th e we ake n e d j o i n t o f th e p e lvi c gird l e
—
Tw o c lass e s o f cas e s c o mp l ai n o f
l
f
C as se s o C as e s
p ai n wh i ch m ay b e tr ac e d to d i s t u rb an c e i n th e se j o i n t s
The fi rs t gr o u p c o mp ri s e s th o s e o f b o th s e x e s w ho ar e
d eb i l it ate d an d h e n c e do n o t h av e n o rm al t o n e i n m u s cl e s
an d l ig am e n t s
Th e s e cas e s e ith er ar e b ed f ast o r i n c li n e d
to as su m e th e re c u mb e n t p o siti o n
Ca s e s co mp e ll e d to l i e
—
o n th e b ac k f o r a lon g p eri o d f o ll o wi n g su rgi c al o p er ati o n s
The s e co n d gr o u p
ar e apt to s u ff er di s tre ss i n th e se j o i n t s
c o mpri s e s t ho s e w ho ar e o v e r we ighte d i n th e ab d o m e n
Bo th o f
an d he n c e te n d to l o rd o s i s i n th e l u mb ar regi o n
the se clas se s ar e gre at ly h e lp e d by co rre ctive m an ip u la
ti o n an d b an d age s
The debi lit ated i n divi d u al i s t o n ed by c o rre c tive m an
ipu lati o n an d th e we ake n ed l ig am e n t s rei n f o r c ed by So m e
si mp l e f o rm o f gird l e whi c h h e lp s to h o l d th e p e l vi s firm
The i n divid u al with th e o ve r weighte d abd o m e n i s phy si o
l o gi c ally re s ted by co rre c tive m an ip u lati o n an d the u se o f
a s u pp o rt wh i ch wi ll ass i s t the b ac k i n ca rryi n g th e e x
ce s si v e weight whi c h l i e s an teri o r t
o it
s n o rm al weight
c arryi n g str u c t u r e
The re ally d i ffi cu lt s ac r o i l i ac l e s i o n to co rre ct i s th e
t
r au m ati c S u ch a l e si o n has all th e el em e n t s whi c h m ake
p erfe ct re c uper ati o n pr o b l em ati cal in any j o i n t
of
le g
su
.
,
.
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.
,
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-
.
,
-
,
.
'
.
.
,
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-
.
.
.
-
,
.
.
I
.
,
.
-
.
-
.
.
.
280
PR I N C I PL E S
F IG
100
O F O S TE O PA TH Y
E l e v a ti on
of
th e
f
in
a
cas e
of
p o s e r i o r r o ta ti o n o f
th e r i h t i l i u m
h i s i s n o t su f
fi c i e n t, i n s u c h c a s e s , to c o r r e c t
th e c o m p e n s a to r
c h a n e s i n th e
lu
a r a r i cu l a i o n s
.
.
t
g
mb
.
t
T
y
t
g
.
oo t
PRI N C I PL E S
282
O F O S TE O PA TH Y
bl u x at i o n s th e c au s e IS th e co ntr o ll i n g f act o r as to th e
m e an s to b e emp lo ye d i e d ebi lity m us t b e co ntr o l led
by ge ner al m e an s so th at l o c al re i n f o r c em e n t o f w e ake n e d
lig am e nt s wil l n o t b e co n ti n u o u sly n e c e ss ary
I t i s usu
ally e asy to m ake a s p e c ifi c co rre c ti o n o f th e l e s i o n i n a
d eb i l it ate d c as e bu t no t e asy to m ai nt ai n th e co rre cti o n
I t i s di ffi cu lt to c o rr e c t a tr au m ati c l e s i o n , bu t wh e n o nc e
o m ake th e co r
co rre c ted th e vit ality o f th e ti ss u e s te n d s t
In all d ebi lit ate d cas e s v o lu nt ary e x e r
re cti o n p e r m
an e n t
c i s e m u s t f o rm an imp o rt an t p ar t o f th e tre atm e n t
C limb
i n g o n r o u gh gr o u n d is th e b e st ai d i n s u ch c as e s b e c au s e
n o tw o s t ep s ar e al ike
an d h e n c e th e ti ss u e s ar e n o t
f atig u ed by repetiti o n s o f sim i lar m o v em e n t s
su
,
.
,
.
,
,
.
.
,
,
.
.
,
,
.
O F O S TE O PA TH Y
PR I N C I PL E S
C H A P TE R
XIV
283
.
S U BLU X ATI O NS
.
D e fi n i ti o n — The
w o rd s u b lux ati o n w as s o n e w to th e
ge n e r al m edi c al p r ofe s si o n th at m u ch ri di c u l e w as h e ap e d
u p o n th e o s te o p ath s b e c au s e th ey adv o c ate d s u c h a r i di c u
“
lo u s th e o ry a s th at all di s e as e s ar e c au s ed by di s lo cati o n o f
bone
We ar e n o t so su re bu t th at thi s ridi cu le w as to a
large e x te n t we ll m erit ed by th e o ste o p ath s The l o o s e w ay
i n whi c h th e w o rd s lu x ati o n di slo c ati o n an d s u b l u x ati o n ar e
u s ed in s o m e o f o u r l ite r at u re sh o w s th at th ey do n o t alw ay s
c o ver a defi n ite i d e a i n th e m i n d o f th e writer
Th ey can
n o t b e u s ed i n ter c h an ge ab ly
The w o rd su b lu x ati o n s h o u l d
b e u s e d to d en o te a d efi n ite co n diti o n S u b lux ati o n i s de
fi n ed as a p ar ti al di slo c ati o n i n whi c h th e n o rm al re lati o n s
he arti c u lati n g s u rf ac e s ar e b u t s l ight ly ch an ged
of t
D a C o s t a d e sc rib e s s u b lu x ati o n o f th e sh ou l der al so o f
th e h e ad o f th e r adi u s F o r th e latte r co n diti o n h e has c o l
We h ave n o t b ee n ab l e
le c te d eight di ff ere n t e x p l an ati o n s
to fi n d th e term u s ed i n refere n ce to any o th er arti c u l a
ti o ns
The o s te o p ath u s e s th e term to defi n e c ert ai n i n eq u alitie s i n
the arr an gem e n t o f verteb r ae an d rib s s ac r o i l i ac an d o th e r
arti c u l ati o n s
P erh ap s we h e ar th e ter mu s ed in c o n n e c ti o n
with th e at las m o re th an with any o th er b o n e
—
h
l
x
r
a
e
r
s
f
C a ct i ti cs o
S u b u ati o ns
S u bl u x ati o ns all o w
co n s i der ab l e m o vem e nt i n th e arti c u lati o n bu t to th e tr ai n ed
h an d th ere ar e evi d e n c e s o f m alp o s iti o n P ai n is deve lo p ed
wh e n th e c omp l ete n o rm al m o vem e n t i s attempted by th e
o p e r at o r
D igit al p re ss u re ar o u n d th e j o i n t cau se s d eep
p ai n Th ere is u su ally a hi st o ry o f acc ide n t e x p o s u re o r
vi s c er al di so rder
,
,
,
.
.
,
,
.
.
.
"
.
.
,
.
.
.
-
,
.
.
.
,
.
.
.
,
.
PR I N C I PL E S
284
F IG
’
102
A la s
.
t
N o r m al
.
.
su r
fa
ce
O F O S TE O PA TH Y
m ar
k i ng
of
th e
tr an s v e r s e
p r o ce s s
of
th e
PR I N C I PL E S
28 6
O F O S TE O PA TH Y
p o rt an t n e rve s an d bl o o d ve ss el s wh o se s lighte st m al adj u st
m e n t cau s e s i ns t an t di s t u rb an c e at th e very f o u nt ai n s o f
life
No phy s i cal e x ami n ati o n is co n sid ere d c o mp l ete with
o u t n o ti n g ac c u r ate ly th e p o siti o n o f th e at las
Th ere b ei n g
n o s pi n o u s pr o c e s s all re c k o n i n g m u s t b e m ade fr o m the
tr an sver s e p r o c e ss e s
—
l
Acc o rdi n g to G r ay s
O cc i pit o At l an t al Ar ti cu ati o n
“
A n at o my :
The m o v em e n t s p e rmitte d i n th i s j o i nt ar e
fl e x i o n an
d e x te n s i o n whi c h give ri s e to th e o rdi n ary for
.
.
.
’
-
.
.
,
F IG
1 03
Abno
th e A la s
.
.
t
.
rm a l
f
s ur ace
m ark i ng s
of
th e
tran
sv e
r
se
p
r
o c e ss
of
O F O S TE O PATH Y
PR I N C I PLE S
28 7
w ard an d b ac kw ard n o ddi n g o f th e h e ad b e s ide s slight lat
The
er al m o ti o n to o n e o r th e o th er s i de
R e cti L ateral es ar e m ai n ly c o n c er n e d i n th e s light later al
m o vem e n t A c co rd i n g to C r u v ei lh ie r th e re i s a sl ight m o
A c c o rdi n g to G erri sh
ti o n o f r o t ati o n in th e j o i n t
,
.
.
.
F IG
.
N o r m al
1 04
o c ci p i al
t
b
on e
ti
r e la
ons
b
e tw e e n
th e
a tl a s
an d
.
gi ldi n g i s also allo wed by w hi ch th e
o ute r edge o f th e c o n dy l e o n th e o n e s i de i s depre s s ed an d
o n th e o th er i s e l ev ated i n re lati o n t
o i ts so c ket
O r the
m o vem e n t m ay b e o b li q u e ly later al o n e c o n dy l e adv an c i n g
s l ight ly at th e s am e tim e th at it i s d epre s s e d t o w ard th e
m e di an li n e wh i l e th e o pp o s it e c o n dy l e t ake s th e reve r s e po
s i ti o n
Thi s i s th e p o siti o n o f gre ate st st abi l ity an d i s as
s u med i n th e m o s t e asy an d n at u r
al atti t
u de s L ater al m o ve
m e n t s ar e re strai n e d by th e ch e c k lig am e n t s an d th e later al
p art s o f th e cap sul e s No tr u e r o t ati o n i s allo wed
“
S o m e later al
'
,
'
.
,
-
,
.
‘
,
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.
288
P R I N CI P L ES
F IG
tw
b n
105
.
e en
o
F IG
e
.
ce ss
O F O S TE O PA TH Y
N or m a l
.
th e
a tl a s
r e la
ti
an d
on s
be
o c ci p i
tal
.
g t t
r
r a n sv e s e
Ri h
106
pr o
e io
o f th e a tl a s to o f a r p o s t
.
r r
.
P R I N CI P L ES
2 90
The
O F O S TE O PA TH Y
p s u l ar lig am e n t s ar e very lo o s e he n c e th e
stre n gth o f th e j o i n t li e s i n th e an teri o r p o steri o r an d l at
e r al lig am e n t s Th ere i s n o c arti lagi n o u s di s k b etwee n th e
atlas an d o c c ip u t h e n c e m o t i o n 1 8 li mite d o n ly by th e l ig a
m e nt s nam e d
ca
,
,
.
‘
,
.
F IG
109
.
.
T wi t
s
ed a
tla
t ti
s-ro a
on
.
I f o n e sh o u ld j u dge o f th e p rev al e n c e o f di s l o c ati o n s o f
th e at las by th e n u mb er o f tim e s s u c h a co n diti o n is m e n
ti o n e d i n o ste o p athi c l it er at u re we w o u ld dr aw th e c o n c lu
The term di slo ca
s i o n th at every o n e s at las i s di s l o c ated
ti o n i s a s tr on g o n e an d o u ght n o t to b e u s ed 1n co nn e c ti o n
with th e at las Its di sl o cati o n w o u ld c au s e d e ath i ns t ant ly
S u bl u x ati o ns can b e
S u b lu x ati o n i s th e p r o per term to u s e
re adi ly di ag n o s e d ; th e f ac t th at th ey e x i st can n o t b e
d o u bted ; all p o siti on s betwee n th e no rm al re lati o n s an d
The c o mpl ete di sl o c ati o n
c o mp l ete di sl o c ati o n ar e p o ss ib l e
o f th i s b o n e fr o m th e o cc ip u t m e an s de ath ; i n term edi ate po
m e an i rrit ati o n o f n erve s dire ct
s u bl u x ati o n s
s i tio n s
i
,
’
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,
,
PR I N CI PL E S
O F O S TE O PA TH Y
29 1
b o th dire c t an d i n dire c t di st u rb an c e s o f c ir c u lati o n di
re c t di st u r b an c e by p re s su re ex erte d o n arteri e s an d ve in s
i n di re ct di s t urb an c e by e x c it ati o n o f v as o m o t o r n e r V e
—
It i s di ffi c u lt to acc o unt
The Cau s e s p f S u blu xat i o ns
fo r th e se s u b lux ati o n s o f th e at las with o u t b rin gi n g in th e
Thi s s eem s to u s to be the m o st
c o n tr a
cti o n o f m u s c l e s
p rev ale n t cau se o f mi s p lac em e n t o f th e at las E ve n th ou gh
we r e c o g n i z e the n u mber l e ss j ar s twi s t s an d s tr ai n s o f thi s
ti o n st i ll th e; re su lt an t bad e ff e c t s ar e m ai n t ai n e d by
arti c ula
th e u n eq u al co n tr ac ti o n o f Opp o si n g gr o u p s o f m u scl e s
whi ch i s br o u gh t on by th e s e ac c ide nt s Take fo r i n s t an c e
th e v ari o u s twi s t s o f th e at las f o u n d by o ste o p athi c m eth o d s
o f phy s i c al di ag n 0 5 1 s
G r ay s ay s : The R e c ti L ater al e s ar e
”
Thi s i s
m ai n ly c o n c e r n ed i n th e s light later al m o vem e n t s
th e m o vem e n t co n c er n ed i n a later al s u b lux ati o n The po
S i ti o n i n whi ch we u s u ally fi n d th e at las i s an o b l iq u e o n e
h avi ng th e right tr an sver s e p r o c e s s h u ggi n g th e an g l e o f
th e jaw w hi l e th e l eft i s to o c lo s e to th e m as t o i d pr o c e s s
”
ter al a
G e rri sh de sc rib e s thi s p o siti o n as th e o b li q u e ly la
n o r m al m ov e m e n t
We als o co ns i der it no rm al i f it po s
—
he a bi li ty to slip b ac k i n t o a p o siti o n h avi n g s i mi lar
s e ss e s t
re lati o n s o n b oth si de s
I t is a s u bl u x ati o n wh e n it can n o t
get o u t o f th at p o siti o n with o u t assi st an c e I f th ere i s fre e
m o vem e n t in th e o cc ipit o —
a tl an t al art i c u lati o n eve ry chan ge
o f th e p o s it i o n o f th e h e ad wi l l c h an g e th e re lati o n s i n thi s
j o i n t O u r b o di e s ar e c o n st r u cted so th at wh e n th e b o n e s
f o rm i n g a j o i n t ar e mo v e d to th ei r f u lle s t e x te n t p re ssu re
i s u su ally e x e rte d o n th e s o ft ti s s u e s ar o u n d th e j o i n t
Th i s
i s n o rm al bu t wh e n t he se n o rm al re lati o n s ar e ret ai n ed to o
lo n g an d th e b o n e s do n o t r e su m e th eir e asy re s ti n g p o s i ti o n
th e c o n diti o n b e c o me s ab n o rm al ; it i s th e n a s u b lux ated
j o i nt
Th ere i s no arti c u lati o n i n the b o dy wh o s e b o ny p art s
ar e ab n o rm ally rel ated wh e n th e e x tr em e m o vem e n t i n th e
j o i nt i s m ade ( We wi ll e x c ept th e s ac r o i li ac arti cu l at i o n
be cau se it i s no t o rdi n ari ly co n s id ered a m o v ab l e jo i n t )
The su bl u x ati o n co ns i st s i n th e re lati o n o f th e b o ny su r
an d
,
s
.
-
"
i
‘
'
.
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,
‘
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'
,
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-
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,
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-
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,
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PR I N C I PL E S
2 92
O F O S TE OP A TH Y
fac e s i n a p o s iti o n o th er th anth at wh i ch th ey sh o u l d h o l d
d u ri n g rel ax ati o n o r e q ual te n si o n o f all th e m u scl e s The
n o rm al p o s iti o n o f th e tr ans ve r s e p r o c e ss e s o f th e atl as i s
p i c t u red i n F i g 10 2 The s ubl ux ati o n s ar e pi ct u red i n Fig
.
.
.
10 3
.
.
No r mal R e l ati o ns
he Atl as
of t
—Th
rm al rel ati o n s
o f th e atl as ar e i ll u s tr ated by ph o t o gr aph s o f th e s k u l l an d
fi r s t vertebra i n F i g 10 4 F ig 10 5 sh o w s an o b li q u e s ide
view In F i g 10 6 th e atl as i s slight ly twi sted so th at th e
right tr an sver se p r o c e s s i s p o steri o r Thi s re ar vi ew sh o w s
th e di st an c e b etwe e n th e l e ft m as t o i d an d left tr ansver se
p r o c e ss i nc re as ed The righ ttr an sver s e p r o c e ss i s p r o mi
n e nt
The sam e rel ati o n s viewed fr o m b el o w ar e sh o w n 1n
F i g 10 7
The right tr ans ver s e p r o c e ss i s s light ly p o steri o r
to th e m ast o i d
Abno rm al P os i ti on s o f the Atl as —F ig 10 8 an d F i g 10 9
sh o w s i d e an d l ater al vi ew s o f a twi s te d atl as
In p rep ar i ng
th e s e b o n e s fo r ph o t o g r aphi n g i t has b ee n b o r n e ih m i nd
th at th e ar ti c u l ati n g su rfac e s m u st be k e pt in cl o se app o si
ti o n The rel ati ons i l lu s tr ated ar e n o rm al to th e arti c u l a
ti o n bu t abno r m al w he n ret ai n ed i n th e s e p o s iti o n safter re
l ax ati o n o f o pp o si n g m u sc l e s
—
r
a
s
l
o
n
t
i
o
n
If as C r u vei lhi er
t
f
M
u
c
c
The E ff e ct o
e C
—
an d Oste o p athi c
s ay s th ere i s a sl ight r o t ati o n i n th i s j o i n t
p r ac ti c e p r o ve s Cr u v e 1lhi e r s st atem e n t tr u e
th e n wh at
m u scl e c o u l d by i ts p er s i s te n t co n tr acti o n cau s e th i s r o t a
ti o n to b e m ai n t ai n e d ? The R e c t u s C ap iti s An ti c u s M i n o r i s
o cau s e th i s m o ve me n t I t ari se s fr o m th e ah
so p lac e d as t
te r i o r s u rf ac e o f th e late r al m as s an d r o o t o f tr ansver s e pr o
u pw ar d an d i n w ard
c e s s o f th e atl as an d p ass e s o b l iq u e l
y
I t i s i n s e rted i n t o th e bas i lar p r oc e ss o f th e o ccipit al bOn e
Thi s m u scl e has as i ts e x ter n al rel ati o n th e su p e r i o r c e rvi
an d a s a co n tr ac te d m u s
cal g an g li o n o f th e symp ath et ic
pre s su re m ay be
c l e i s th i c ke r th an an u n co n tr ac te d o n e
e x erte d o n thi s gan g li o n whi ch m ay al so be i rrit ate d by the
t ransve r se p ro c e ss o f the atl as b ei ng pull e d t o w ar d it t he r e
han o ne d irecti on
ce i n mo r e t
by l e sse ni ng its no r mal spa
.
.
.
no
e
.
.
,
.
.
.
.
.
.
.
.
.
.
,
‘
.
‘
'
,
.
,
,
’
.
.
‘
'
.
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,
,
,
.
PR I N C I PL E S
2 94
O F O S TE O PA TH Y
axi al A rti cu lati o n —The arti c u l ati o n betwee n th e
ol
at las an d ax i s i s th e m o s t i n tri c ate i n th e wh o l e s p i n al c
i n g o f f o u r di s ti n c t j o i n t s
u m n co n s i s t
R o t ati o n t ake s pl ac e
be tw e e n the s e b o n e s b u t th i s m o ti o n i s l im ite d by th e ch e ck
ligam e n t s
D i slo cati o no f th e o d o n t o i d p r o c e s s c au se s ih
st an t de ath by p re s s u re o n th e l o wer p ar t o f th e m ed u ll a
The ar ti c u lati o n s betwee n th e arti cu lar pr o
o b lo n g at a
The arti culati o n b e
c e ss e s o f th e s e b o n e s ar e arth r o di al
twe e n th e o d o nt o i d p r o c e ss o f th e ax i s an d ante r io r ar ch o f
th e at las h o ld s th e b o n e s fi r mly t o gethe r M o s t o f th e r o t a
ti o n i n th e c ervi c al regi o n is i n th i s j o i nt Alth o u gh th er e
i s so m u c h m o vem e n t allo wed by th e se ar ti c u l ati o n s w e se l
do m fi n d th e ax i s su b l ux ated
U n e q u al D e v e l o pm e nt— D evi ati o n o f th e s pi n e o f th e
ax i s fr o m th e m edi an l i n e i s a fre q u e n t c o n d iti o n b u t in th e
m aj o rity o f case s i s i ts n o rm al re lati o n o n ac c o u n t o f u n
eve n deve lo pm e n t
—
H i lt o n d e sc rib e s cas e s o f di s eas e o f th e arti cul a
Car i e s
ti o n b etwe e n th e atl as an d ax i s sh o wi n g ho w de str ucti o n o f
th e tr an sve r se l i gam e n t s all o w s th e h e ad to tip f o rw ard
th ereby cau s i n g the _o do nto i d p r o c e ss to i mp al e th e m e d ull a
D i sl o cati o n ¥ —
We m ay s afe ly say th at di slo cati o n o f th e
at lo ax i al arti c u lati o n s i s p ro b ably th e r are st c o n d iti o n w e
wi ll eve r m eet V ari o u s degre e s o f r o t ati o n m ay b e m et
with wh i ch ar e i n th e n at u re o f s u b lu x ati o n s du e to m u scu lar
c o n tr ac ti o n s
—
S i n c e th e ab o ve p ar agr aph
S po n t an e o u s R e du c ti o n
w as writte n an arti c l e in th e M e di c al R e co rd M ar ch
The arti cl e i s e n
19 00 has c o m e u n der my o b s erv ati o n
”
“
—
The au th o r D r R o b
tit l e d S pi n al F r act u re P ar ap legi a
er t A bb e e x h ibit s a r adi o gr aph i llu s tr ati n g a c as e o f di s lo
The di sl o c at ion i s be tw e e n the arti c ular
i o n o f th e n e c k
c at
pr o c e s s e s o f the at las an d ax i s The m o st i ntere s ti n g fe at u re
o f th e c as e i s th e s p o n t an e o u s red u c ti o n o f th e di s l o c ati o n
wh i le th e p ati e n t w as asl e ep The au th o r th i n k s th at the
rel ax ati o n o f sleep an d th e re s t le ssn e ss o f the p ati e n t co m
bi n e d to red u c e it
At l o
,
-
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-
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-
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‘
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PR I N C I PLE S
O F O S TE O PA TH Y
295
—
The r em ai n i n g c ervi c al vert eb r ae
C e r v i c al V e r t e br ae
ar e o c c as i o n all y f o r c ed fr o m th ei r p r o p er re lati o n s by v i o
Q u ite a n u mbe r o f c as e s ar e o n r e co rd whi ch sh o w
le n ce
ho w gre at th e di st u rb an c e i s i n s u ch c o n d iti o n s
Th o se
c as e s re c o rd ed i n m e di c al l iter at u re ar e c o mp l ete di sl o ca
.
.
.
F IG
t
.
.
t b
ve r e
ti o n s
r ae
ver
N o rm a l
F IG
110
ions
or
th e
111
.
t b ra
i gh t
su
e
th e _ r
r e la
Thi r d
.
.
c e r v i c al
b l u x at
Th e
ed
to
s u p e r i or
p r o c e s s o f th e
i s vi s
c e r v i c al
a r tl c u l a r
c e r v i c al
fO
ih
.
rt
h
p
e
.
h e n c e c an n o t b e c la s s e d with su b lux at i o n s s u ch
In o rd er fo r co m
as ar e m et with i n o s te o p athi c p r ac ti c e
l
l
r
l
di
l
o
c
ti
o
n
t
o
t
ke
p
a
e
i
e
th
a
t
th
e
a
rti
c
u
a
r
o
a
e
t
s
a
c
so
e
p
p
c e ss e s ar e b o th lo c ke d th e i n te rvertebr al di s k s w o u l d h av e
to b e t o r n an d w o u l d p r o b ab l y bri n g gre at p re ss u r e o n th e
Co rd
A ll gr ade s o f su b lu x ati o n ar e f o u n d b e tw e e n c e r v i cal
vertebr ae W here th e vi o l e n c e has n o t b ee n su ffi c i e n t to
c au s e lo c ki n g o f th e arti c u lar p r o c e s s e s it has e x agger ated
th e n o rm al m o vem e n t su ffi c i e n t ly to i n j u re th e l ig am e n t s
o r m u s c l e s whi c h th eref o re m ai n t ai n th e s u b lu x ated p o s i
ti o n
,
an d
.
,
.
.
,
,
.
_
‘
.
,
,
.
D i spr o por ti o n Be tw e e n C au s e
e stim ate th e e x te n t
of
—
E
an d
ff e ct W e
th e sy stemi c e ff e ct s
of a
t
th e
c an n o
le si o n i n
'
PR I N C I P LE S
296
O F O S TE O PA TH Y
pi n e Wh at migh t app e ar to u s to b e a very slight l e s i o n
m ight b e th e cau s e o f a very p r o f o u n d n erv o u s di so rd er
The p o s iti o n o f th e l e s i o n i s th e ch ief m e an s o f e s tim ati n g
re s ul t s
s
.
.
.
E x am pl e
—T
i llu s tr at e th i s po m t we m ay m e n ti o n th e
cas e o f M r No rt o n R u ss e ll
A l e s i o n o f th e s i x th c e rvi cal
v erteb r a w as f o u n d The verteb r a w as s lightly twi ste d
M r R u s se ll had n o t sl ept d u ri n g o n e h u n dre d n ight s an d
d ay s with o ut th e u se o f s u lpho n o l o r m o rph i n e The fi r s t
o s te o p ath i c tre atm e n t app l i e d to th e s i x th c e rvi c al v ertebr a
m ad e it di ffi c u lt fo r hi m to ke ep aw ake u n ti l h e re ach e d his
h o m e and th e n h e fe ll i nt o a p r o f o u n d s l e ep Th er e w as a
h i st o ry o f s evere acc i de n t M u s cu lar c o n tr acti o n w as very
evi de nt
o
,
.
.
.
.
.
.
.
.
.
U n e q u al D e v e l o pm e n t o f S pi n o u s P r oc e s se s i n Ce r v i cal
V e rte br ae —F ig 1 10 i ll u s tr ate s th e app e ar an c e o f th e p o ster
i o r su rfac e s o f th e c ervi c al vertebr ae s e co n d to thes eve n th
wh e n all th e verteb r ae ar e i n n o rm al po s iti o n i e arti c u lar
o e ac h o th e r
The ch an gi n g ch ar
s u rf ac e s eve n ly O pp o s e d t
o c e s s e s i s re adily n o te d
arly all
p
r
e
ac t er o f th e s p i n o u
N
s
h at pal
o f th e s e p r o c e s s e s ar e u n eve n ly d eve lo p e d sh o w i n g t
f
n
n
o
n
n
n
n
n
i
th
e
e
p
r
m
i
e
t
p
i
t
o
h
elp
b
ei
g
t
i
o
n
o
o
s
c
a
t
u
s
a
t
s
a
s
p
f act o ry The t u b er c l e s o h th e b ac k an d o u te r su r f ac e s o f th e
i n feri o r arti c u l ar p r o c e ss e s p re s e n t a m u ch m o re u n if o rm
d eve lo p m e n t an d th ey c an b e e as i ly p alp ate d after o n e has
be co m e accu s t o m e d to th e fee l o f th e c e rvi c al m u sc le s Fig
11 1 sh o w s th e th ird c e rvi cal su b lu x ate d to th e right The tu
be r cle o n th e l eft i n feri o r arti c u l ar p r o c e s s i s m ade m o re
pr o mi n e n t The m u scl e s o ver th i s p o i n t will be f o u n d co n
tr acte d
P alpati o n o f D o r sal S pi no u s P r o ce ss e s — Whe n th e
th e tr ai n ed
S pi n e s o f th e d o r s al ve rteb r ae ar e p alp ated
fi n ger s m ay fi nd i n divi d u al s pi n e s whi ch ar e n o t i n li n e with
th o s e ab o v e an d b el o w o r th at the s pac m g s b etwe e n th e
The devi ati o n s fr o m the n o rm al ar e
spi ne s ar e n o t e q u al
i n di cative o f ch ange d rel ati o n s b etwe e n th e vertebrae
.
.
,
,
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O F O S TE O PA TH Y
P RI N C I PL E S
2 98
pi n o u s p r o c e s s S u ch a defl e cti o n fr o m th e m edi an l i n e
w o u ld b e n o te d by the u ns ki lle d t o u ch o f a laym an Thi s
defl e cti o n has n o di ag no sti c s ig n ifi can c e u n le s s th ere is pr o
n o u n c e d s e n s itive n e s s ar o u n d it an d th e n it i s th e hy pe r ae s
the s i a an d n o t th e o s se o u s f o rm ati o n th at m u st b e n o te d ;
S
.
.
,
,
.
t
F IG
116
E x e n s i o n i n th e
d o r sa l r e i o n s h o w i n
ap
p r o x i m a i o n o f th e s p i n o u s
.
.
t
p r o ce sses
g
g
.
.
very ski llf u l o s te opathi c di ag n o s ti c i an might b e m l sle d by
thi s l e s i o n Th e re d o e s n o t appe ar to b e any w ay to pr o
te e t ag ai n st a wr o n g i nterp ret ati o n i n a cas e l i ke thi s e x cept
th e e x p eri e n c e o f th e phy s i c i an i n weigh i n g all th e evid enc e
'
l
.
.
1
L at e r al S u blu x ati o n —Fig 1 13 i llu s tr ate s a ge nu i n e lat
er al s u bl u x ati o n o f a d o r sal ve rtebr a The arr an gem e n t o f
th e R o t at o re s S pi n ae acc ou n t fo r su ch a le si o n as thi s Th ey
ari s e fr o m th e u pp er s u rf ace s o f th e tr an sver s e p r o c e s s e s an d
i ns ert i n t o th e l ami n ae ab o ve The s ubl ux ated vertebr a in
thi s gr o u p i s th e fifth The digit ati o n o f the R o t at o re s
S pi n ae b etwe e n th e right tr an s ver s e pr o c e s s o f th e s i x th an d
l ami n a o f th e fifth m u st c o n tr ac t i n o rder to p r o d u c e th i s
Th i s digit at i on may re sp o n d to a s evere vi s c er al
c o n diti o n
refl e x an d c au s e a su bl u x ati o n o f thi s ch ar ac ter Di re ct
vi o le n c e m ay cau s e it also a c u t an e o us r e fl e x i n iti ated by
temper at u re ch an ge i n th e atm o s ph ere
.
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:
,
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O F O S TE O PA THY
PR I N C I PLE S
299
.
—M u s cle s c o n tr ac t a s a re s u lt o f
e x c e s sive str ai n i n g o r wr enc hi n g o r e x p o su re to co ld an d
o f refl e x i rr i t a t i o n
I f O pp o s i n g m u s c l e s u n de r all c o n di
ti o ns o f tem per at u re m e ch an i cal an d refl e x irrit ati o n w o u l d
c o n ti n u e t
o e x er t eq u al i n fl u e n c e o n a j o i n t
the n n o th i n g
bu t a c o mp l ete di sl o c ati o n w o u l d b e p o s s ib l e
A m o v ab l e
n
i
n
i
i
l
o
i
t
e
l
o
e
d
n
n
vi
l
m
embr
n
e
wh
h
f
a
c
i
it
a
te
s
s
c
s
a
s
o
a
a
c
j
y
th e r api d retu rn to a n o rm al p o s iti o n A ll th e me ch an i cal
c o n dit i o n s i n an d a r o u n d a j o i n t ar e c o n d u c ive to th e q u i c k
ret u r n to n o rm al I t i s th e vit al an d n o t th e m e ch an i cal
p ri n c ip le wh i ch ke ep s u p a conditi o n o f m aladj u stm e n t No
i n te rm edi ate p o s iti o n i s p o s s ib l e th ere b e i n g n o un eve n n e ss
o f s u rf ac e to b e co m e lo c ked
u n l e ss we t ake i n t o c o n s ide r a
ti O n the vit al ac tivity as m an ife s ted i n a c o n tr ac te d m u sc l e
—
E
ff
e
f
l
o
i
E
f
c
t
s
O
M
u
c
r
n
t
r
o
n
r
i
n
o
s
u
a
C
a
c
t
m
a
s
o
Co p
J
S t u art D O has m ad e an apt c o mp ari so n b etwe e n th e p u ll
u s c l e s o f th e b ac k o n th e i n divi d u al ve rtebr ae an d
o f th e m
th e we ll re c o g n i zed in su ffi c i e n ci e s o f th e o cu lar m u s cl e s All
phy si c i ans re co gn iz e th e s e r i o u s e ff e c t s Of lo n g co n ti n u e d
i n s u ffi c i e n cy o f an o cu lar m u sc l e bu t few i n de e d hav e give n
any tho u g ht to the p oss ibi l ity o f a s imi lar c o n diti o n aff e c t
i n g s tr u c t u re s l e s s m o v ab l e o r l e s s s e n s itive th an the eye
b all The re lati o n o f a ve rtebr a wit h i ts fe llo w s i s o f gre at
imp o rt an c e to the de li c ate n erv o u s ti ss u e wh i ch it su r
r o u n d s It i s n o t n e c e ss ary fo r a vertebr a to p r e s s u p o n th e
o r n e rve fib er s c o m i n g f r o m o r g o i n g to it
in
spi n al c o rd
Th ere i s a n erve s tr ai n i n c o n
o p r o d u c e irrit ati o n
o rder t
n e cti o n with th e s e l e s i o n s whi c h i s n o t th e r e s u lt o f di r e c t
p re ss u re bu t o f th e e ffo r t s o f th e c e n tr al n erv o u s sy s tem to
b alan c e an d co o rdi n at
e th e co n tr acti o n o f th e m u scl e s p u ll
i n g o n th e verteb r a
I t i s n o t n e c e s sary fo r d iverge n t o r
c o n verge n t s q u i n t to b e s o m arked th at th e e x pre s si o n o f
th e eye s i s i n st an t ly n o ted by all o b s erver s befo re any sy m p
t o m s o f eye s tr ai n ar e fe lt by th e p atie n t Neith er i s it n e c e s
s ary fo r a vertebr a t
o b e di s lo c ated i n o rde r t
o c re ate a di s
tu r ban c e
I t i s co n c eiv ab l e th at a co mp l ete ly di sl o cate d
verte b r a m ight after a t
im e c au s e as l itt l e i r r it ati o n as an
M u scu lar C o n t r acti o n
.
,
'
.
,
,
"
.
.
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.
,
,
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,
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’
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,
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'
.
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,
,
.
PR I N C I P L E S
3 00
eyeb all wh i c h i s
bi no c u l ar vi s i o n
ch an ge
O F O S TE O PA TH Y
diverge n t th at n o e ff o rt i s m ad e
The b o dy b e c o m e s acc o m m o d ate d
to u se
so
.
th e
to
.
—
ti o n o f S pi
P
F i g s 1 14 an d 11 5 give
tw o vi ew s o f th e fifth s i x th an d s eve nth ve rteb r ae i llu str at
i n g th e s ep ar ati o n o f th e s pi n e s as i n e x trem e fl e x i o n No te
th at th e s u p eri o r arti c u l ar f ac et s ar e un c o ve re d by the m o ve
m e nt The v ert eb r ae assu m e thi s p o s iti o n i n kyph o si s We
freq u e nt ly fi n d th at th ere i s a g ap b etwee n tw o spi n e s whil e
th e sp ac i n g ab o v e an d b e lo w is q u ite eve n E ith e r th e sp ac e
d ire c tly ab o ve o r th at b el o w thi s g ap i s l e s se n ed F ig 1 16
sh o w s th e s p i n e o f th e fifth s i x th an d s eve n th d o r s al ve rte
b r ae i n th e p o siti o n o f e x trem e e x te n si o n The sp i n e s c r o wd
h ard u p o n e ach o th er Th e s e i llu str at
i o ns all S h o w n o rm al
p o siti o n s bu t th ey ar e th e o n e s wh i ch o u r fi n ger s d i sc o ve r
as l e s i o n s o f th e ve rtebr ae
—
o
r
o
e
w o spi n e s
Appr o x i m ati o n o f S pi n u s P ces s s Wh e n t
1 16 th e r e i s n e ce s
as i n Fi g
ar e c l o s e ly appr o x im ated
Sar ily a wi de n i n g o f th e n e x t s p ac e ab o ve o r b e lo w dep e nd
The c o ntrac ted sp ac e
i n g u p o n wh i ch verteb r a i s aff e c ted
wil l u s u ally b e s e n s itive to digit al p re s su re Th ere i s a c o n
tractu r e d c o n diti o n o f th e m u sc l e s c au s i n g thi s e x trem e
Thi s co n tr ac t u re di st u rb s th e
m o vem e n t o f e x te n si o n
rhyth m o f n erve mp u l se s fr o m th at s e cti o n o f th e s p i n al
Th ere
te br a
co rd i n c lo s e s t re lati o n with th e di st u rb ed v e t
i s lac k o f co o rdi n ati o n o f m o ve m e n t i n th e aff e c te d j o i n t s
Wh e n sever al v ertebr ae ar e tight ly b o u n d t og eth e r a
—
l c o lu m n i s th e re s u lt
tr
ight
The m u s
n o n fl e x i bl e s p i n a
a
s
o digi
c l e s ar e tight ly c o n tr ac te d an d m o re o r l e ss se n s itive t
tal p re s su re
P r i m ar y S u b lu x ati o ns —Th e s e c o n diti o n s as h ere il lu s
tr ate d ar e wh at o ste o p ath s u su ally de sig n ate as s pi n al su b
l ux ati o ns whi c h ar e c au sative f act o r s i n di se as e Th ey ar e
so u r c e s o f i rrit ati o n to th e spi n al n erve s i n dire c t c e n tr al
rel ati o n with th em an d th e s e n erve s co n vey di s t u rb ed o r
aryth mi c al i mp u l s e s to th e vi sc er a an d bl o o d ve s s el s th u s
S e par a
nou s
r o c e s ses
.
,
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-
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i
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,
O F O S TE O PA TH Y
PRI N C I PLE S
3 02
v e rteb r ae t ake o n th e ch ar act e r o f th e lu mb ar h e n c e r o t a
ti o n i s p r ac ti cally i mp o ss ib l e Th e re is a digit ati o n Of th e
R o t at o re s S p i n ae betwee n th e e l eve n th an d twe lfth d o r sal
v ert ebr ae
,
.
.
L ow e r D o r sal V e rte b r ae — F ig s 1 17 an d 1 18 give a po s
te r i o r and l ate r al vi ew o f th e five lo wer d o r sal Vertebr ae
The c h an gi n g c h ar ac teri sti cs o f th e s pi n o u s pr o c e ss e s o f
th e se ve rtebr ae sh o u l d be caref u lly n o ted so th at th e stu
de n t m ay n o t b e m i sle d as to th e s ig nifi c anc e o f th at whi ch
his p alp ati o n m ay di s c o ver The e l eve n th d o r sal s pi n e t ake s
a h o riz o n t al di re c ti o n an d i n so m e case s thi s m ake s eith e r
a ve ry n arr o w s p ac e b etwe e n it an d th e t e n th o r a very wid e
s p ac e betwe e n it an d th e tw e lfth
.
.
.
,
’
.
'
»
,
.
u m bar
Ar ti cu l at i o n —The
L
j u n ct i o n o f th e do r
A large p o rti o n o f
sal an d l u mb ar r egi o n s i s very fl e x ib l e
fl e x i o n an d e x te n si o n o f th e S pi n al c o lu m n is m ade i n thi s
The m o st c o mm o n c o n diti o n no ti c e abl e i n th e
arti c u l ati o n
l o wer d o r s al regi o n i s i n c r e ased p r o m i n e nc e o f the spi n e s
Th i s c o n d iti on fre q u e n tly aff e c t s
an d i n c ip i e n t ky ph o s i s
th e j u n c t io n o f the d o r sal an d l u mb ar regi o n s
D
o rs o -
.
.
'
,
.
.
Ky phos i s—L ow e r Do r sal —A slight kyph o s i s i n th e
l o we r d o r sal regi o n i s i n di c ative Of lo ss o f t o n e i n th e ex te n
so r m u sc l e s g o ve r n i n g th e arti c u lar s u rf ac e s
The sp i n e s
i c u lat
ar e s ep a r ated f arthe r th an n o rm al an d th e i n feri o r ar t
i n g s u rf ac e s ar e p art ly u n co vered by th e su p e r i o r o n e s
Thi s we ak en ed co n d iti o n o f th e b ac k m ay b e br ou ght o n
by i n j u ry , o r refl e x e s fr o m th e b o we ls o r kid n ey s C o nti n
u al vib r ati o n o f th e S pi n al c o l u m n a s i n c as e s o f s tre et c ar
m e n we ake n th e b ac k an d the n f u n c ti o n al di st u rb anc e s o f
th e kid n ey s ar e n o ted
'
.
.
.
.
,
,
.
—
e
o
n
F ig s 119 an d 12 0 i llu str ate th e l ater al
L
b R gi
an d p o ste ri o r app ear an c e o f th e n o rm al lu mb ar vertebr ae
The s pi no u s p r o c e s se s ar e e as i ly p alp ated i n thi s r egi o n
The i r de v e lo pm e n t Vari e s e no rm o u s ly i n di ff e re n t i n divi d
nal s
The f o rm ati o n o f the arti c u l ar pr o c e ss e s preve nt s
um
ar
.
.
.
.
.
PRI N C I PLE S
O F O S TE O PA TH Y
30 3
r o t ati o n h e n c e we do n o t fi n d any later al su b lux at io n s
The po s i ti On o f i n divi d u al v ertebr ae i s r are
i n th i s regi o n
”
Bre ak s
th at i s s ep ar ati o n s o f th e spi n e s
ly aff e c ted
Vi o l e n c e i s th e ch i ef
ar e so m etim e s n ote d bu t n o t o fte n
The m u scl e s i n thi s r e g i o n ar e
c au s e o f th e s e s ep ar ati o n s
an y
,
.
,
,
.
,
.
,
'
e
.
F IG
—
FIG
.
119
.
—L
n or mal
.
r e ar
u mb ar
r e g i on
.
S i de
12 0
vi ew
.
Lu m b ar
—n o r m al
re
gi
on,
.
Vi e w
.
th i c k an d p o we rf u l h e n c e th eir i n fl u e n c e i s no t e x erte d so
m u ch o n i n divid u al verteb r ae as u p o n th e wh o l e s er i e s o f
vertebr ae The r ef o re we fi n d c u rve s i n ste ad o f s u bl u x ati o ns
i n thi s regi o n
E x agger ati o n o f th e n o rm al m o vem e n t s i s
E x trem e
re s p o n s ib le fo r kyph o si s lo rd o s i s o r sc o l i o si s
we a ri n e s s as a re s u lt o f m ai n t ai n i n g a s itti n g o r st an di n g
p o s iti o n le ad s the i n divid u al to shift th e weight o f th e b o dy
so as t
o t ake som e adv an t age o f th e l ig ame n t s wh i c h l im it a
m o vem e n t
The stre n gth an d fl e x ibi l ity o f th e lu mb ar
region i s fre q u e n t ly a very g o o d c rite ri o n o f th e p ati e n t s
b o di ly vig o r I t i s e asi er to aff e c t th i s p o rti o n o f the spi nal
c o l u m n by
l ever age m o vem e n t s th an any o th e r regi o n
,
.
.
.
,
,
,
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’
.
,
,
.
P R I N C I PL E S
3 04
O F O S TE O PA TH Y
R ib s —The p o s iti o n o f th e rib s i s al
w ay s n o te d by th e o ste o p ath i c phy s i c i an I t i s n o te d i n
m e di c al t e x t b o o k s o n di ag no si s th at th e ge n er al co n f o rm a
ti o n o f th e th o r ax i s in di c ative to a v ari abl e de g re e o f eith er
th e p ast m ed i cal h i st o ry o f th e i n divi d u al o r i s evi d e nc e o f
th e p re s e nt e x i ste n c e o f p re di sp o s iti o n to c ert ai n di s e ase s
A f u ll r o u n d n o n fl e x i ble c h e st d e n o te s as thm a o r e m phy
o te s te n de n c y to t u b er c u l o si s e t
c
The se
s e m a ; fl at c h e st d e n
s t atem e n t s ar e ge n er al iz ati o n s b a s ed o n l o n g o b s erv ati o n
The r e spir at o ry m o ve
an d ar e u s u al ly v ery n e ar th e tr u th
m e n ts sh o u ld b e no ted w he the r fu ll an d fre e co mp are d
with th e cap ac ity o f th e th o r ax The o ste o p ath i c phy s i c i an
go e s f arth e r th an th e se e x c e lle n t ge n er al iz ati o n s i n his di ag
n o si s
The re lati o n an d p o siti o n o f e ach i ndiv i du al r i b ar e
e x trem ely imp o rt an t The c o n diti o n o f the wh o l e th o r ax
an d i ts c o n te n t s i s dep e n den t o n th e re lati o n s o f th e b o n e s
whi ch f o r m it With th is i de a i n mi n d a caref u l e x am i na
ti o n o f e ach rib i s m ade
Th eir spi nal
The rib s ar e n o rm ally qu i te m o v abl e
arti c u l ati o n s ar e so arr an ged th at an e asy ri s e an d f all o f th e
The r i s e an d f al l is th e r es u lt
s h aft o f th e rib is p erm itted
o f r o t ati o n o f th e rib o n a n ax i s p as s i n g th ro u gh th e c o st o
s
c e n tr al an d c o st o tr ansver s e arti c u lati o n
—
l
a
n
The co s t o c e n tr al ar ti c u
C o st o ce n t r al Ar ti cu ti o s
lati o n s o f th e fir s t te n th e l ev e n th an d twe lfth rib s h av e n o
i n ter arti c u lar l igam e n t The m o vem e n t o f th e h e ad s o f th e s e
rib s i s limited by th e c ap su lar l ig ame nt s The h e ad s o f all
th e o th e r rib s ar e h e ld i n p lac e by i n ter arti c u lar ligam e n t s
att ac h ed to ridge s o n th e h e ad s o f th e rib s an d to th e i n te r
verteb r al di sk s
—
The t u b er c le s o f th e
C o s t o t r an s v e r se Ar ti cu l ati o n s
rib s arti cu late with th e tr an s ver s e p r o c e ss e s o f th e verte
br ae f o rm i n g arth r o di al j o i n t s The s u p eri o r c o s t o tr ans
v er se lig am e nt s p re ve n t : th e dr o pp i n g d o w n o f th e co st o
tr an sver s e arti c u lati o n The re i s very li m ited g lidi n g m o ve
m e nt in t hi s arti cul ati o n As be fo r e state d th e m o v em e nt
i n the co st o c e nt ral and co sto t r ansv e r s e ar ti cul ati o ns i s to
E x am i nati o n
of
the
.
,
-
,
,
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.
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I
.
,
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‘
-
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-
-
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-
'
-
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.
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-
-
.
PR I N C I PL E S
306
C o o r di n ati o n
—F ig
O F O S TE O PA TH Y
12 1 i ll u str at e s
th e no rm al o bl i q u ity
o f th e fifth an d si x th rib s
Wh en th e c o ntr acti o n o f all th e
m u s cle s o f re s pi r ati o n i s p r o p e rly co o rdi nated th e i nte r
c o s t al s p ac e s ar e all e q u al i n width
The re s p ir at o ry rhyth m
sh o u l d b e e q u al i n all p art s o f th e th o r ax
.
.
,
.
.
123
F IG
s i x th r i
.
.
b
S e p a r a ti o n
s
of
th e
fifth
an d
.
—Wh e n th r o u gh so m e n erv o u s refle x
i n spi r ati o n i s m ade di ffi c u lt th e i n sp i rat o ry m u scle s e x p an d
the tho r ax to i ts fu l le st e x te n t an d ret ai n th e e x pan s i o n
Th e n th e di am eter s o f th e th o r ax ar e i n c re a sed Thi s p o si
ti o n o f e x trem e i n spir ati o n i s typ i c al o f th e asth m ati c ch e st
Th ere m ay b e lac k o f coo rdi n ati o n o f th e m u sc l e s i n any
i n te r c o st al sp ac e Thi s i n c o o rdi nati o n m ay b e m an ife sted
by to o m u ch c o n tr ac ti o n o r re lax a
ti o n The re s u lt i s a
c h an ge i n th e n o rm al width o f an i n ter c o s t al s p ac e
—
i
i
r
l
f
e
r
n
Ne r vo u s C o nt o o R sp at o
R e s pi r ati o n i s car
ri e d o n by a c o mpli c ated m e ch an i sm Its c hi ef c e nter o f n o r
m al co n tr o l i s i n th e m ed u lla b u t s u b s idi ary c e nter s i n lin
E ac h spi nal n e rve whi ch
e ar s eri e s e x i s t i h th e s pi n al c o rd
i nn erv ate s i n ter co st al m u sc l e s o r o the r m u scle s o f i n spi r a
ti o n ari s e s fr o m a s ub sidi ary r e spir at o ry c e nter On e o f
th e s e sub sidi ary c e nte r s may be co m e to o active o r p assiv e
as a re su lt o f l oc al i rrit ati o n du e to ci r c u l at o ry ch ang s
e
In c o o r di n ati e n
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,
'
'
,
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-
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,
,
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,
4
,
.
,
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,
.
PRI N C I PLE S
O F O S TE O PA TH Y
The m u scl e s go v e r n e d by th i s di stu rb ed
307
e n ter wi ll
m o vemen t o f
c
n o t ac t
h arm o n i o u sly h e n c e th e rhyth mi c al
all th e
rib s i s i n terfere d with
W e have no te d th at s p i n al m u scle s c o n tr act u n eve nly
as a re s u lt o f dire c t s p i n al i n j u ry e x p o su re o f th e s ki n o ver
th em to c o ld o r fr o m vi s c er al refl e x es The res p ir at o ry
m u s cl e s ar e s u bj e cted to th e s am e c o n diti o n s A lat er al su b
lu x ati o n i n the do r sal re g i o n c arri e s i ts arti cu lated rib with
it P alpati o n wi ll di s c o ver th eir c h an ged re lati o n s A k y
ph o si s i n th e do r sal r egi o n cau se s th e rib s to r o t ate u pw ard s
th u s i n c re as i n g th e di am eter s o f th e th o r ax L o rd o si s i n
thi s regi o n has the Opp o site e ff e ct
,
.
‘
'
,
,
.
~
.
-
L
f
’
:
.
.
-
,
.
.
C os tal S u b l u x ati o n s—F ig s
i llu str ate the
he r i b s du e to i n c o o rdi n ati o n o f m u s
c h an ge s i n s p ac i n g o f t
The se po si ti o n s o f th e rib s ar e sp o ke n o f
c u lar c o n tr ac ti o n
In Fi g 12 2 th e u pp er rib i s r o t ate d
as c o s t al s u b lu x ati o n
d o w n w ard as a re su lt o f a c o n tr ac ti o n o f th e i nter c o st al
m u s c le s i n th e sp ac e b e lo w i t o r th e re lax ati o n o f th o se
P alp ati o n e li c it s s e n sitive n e ss at th e lo we r b o rder
ab o ve it
o f thi s fi ft
h r ib
The s e n s itive n e ss i s u s u ally f o u n d wh ere
th ere i s c om p re ss i o n du e to th e dr o ppi n g o f th e rib an d th e
Th i s rib might h ave b e co m e
c o n tr ac ti o n o f th e m u sc l e s
d i sp lac ed as a re s u lt o f vi o l e n c e o r th e p ati e n t m i ght h ave
b ee n e x p o s ed to c o l d ai r whi l e s we aty o r so m e di s e as e o f
an o th er p art o f th e b o dy m ight h ave c au s e d s u ffi c i e n t we ak
n e s s to allo w thi s rib to dr o p as a re su lt o f p re ss u re o c c a
s i o n e d by th e p o s iti o n i n be d o r o th erwi s e
Wh atever the c au se o f th e s e su b lu xati on s th ey c ert ai n
ly be c o m e so u r c e s o f gre at irrit ati o n to th e n erv o u s sy s tem
S o m etime s th e b o dy be c o m e s acco mm o d ate d to th e s e s ub
lu x ati o n s bu t th e f ac t th at cas e s o f asthm a h ave b ee n c u red
after ye ar s o f s u ff eri n g by red u c i n g th e s e m alp os iti o n s i s
a fac i e e vid e n c e th at acc o mm o d ati o n i s so m eth i n
p ri m
th
t
a
g
c an n o t alw ay s b e dep e n de d o n
12 2
!
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.
12 3
an d
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'
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‘
,
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The h e ad s
c at
ed
with o ut
of
ru
the
pt ur e
e
d to n i nt h rib s canno t be di slo
th e i nte rarti cu l ar l ig am e nt s Co n
s co n
of
.
PR I N C I PL E S
30 8
O F O S TE O PA TH Y
s i de r abl e c
i
rib
s o ns
h an ge in th e p o s iti on o f th e s h aft o f th e rib o cca
ve ry littl e ch an ge i n th e p o s iti o n o f th e h e ad o f th e
.
—
R ib The fir t rib d o e s
t m o ve i n the same
m ann e r as th o s e bel o w The att ach m e n t o f th e scale n u s an
ti c u s ke ep s th e s h aft alw ay s r ai s ed
No m atte r ho w fl at th e
rem ai n der o f th e th o r ax m ay b e th e fir s t rib s t an d s o u t
p r o mi n e nt ly The ch i ef ch an ge in i ts p o s iti o n i s du e to th e
c o n trac ti o n o f th e s c al e n u s an ti c u s th eref o re it n eed s t
o be
d ep re s s ed r ath er th an el ev ated
F i r st
no
s
.
q
.
.
,
.
,
.
—The he ad o f the te nth rib i s arti cu l ated
with th e b o dy o f th e te n th vertebr a ; th e re i s no i nte r ar ti cu
lar l ig am e n t
Thi s allo w s fre er m ov em e nt
Its an teri o r
e x tremity is i n s e c u re ly arti c u lated to th e c arti lage o f th e
n i n th rib
Th i s co nn e c ti o n i s freq u e ntly b r o ke n th u s m ak
i n g an a dd e d fl o ati n g rib
Te n t h R ib
a
.
'
.
.
-
,
.
.
R ib s —The e le v
e n th an d twe lfth
rib s ar e very lo o s e ly arti c u late d to th e v e r t
ebr ae They
have n o c o s t o tr n s ver s e lig am e n t s h e n c e d e p
e
n d o n the ac
a
ti o n o f m u sc le s to h o ld th em i n p lac e Th ey ar e fre qu e ntly
fo u n d r o t ate d u p ward o r d o w n w ard
We h ave e nd e av o re d to S h o wth at th e n o rm al m o ve
m e n t s o f th e rib s as a wh o l e m ay be c o m e very ab n o rm al
wh e n m ade i n d ivi d u ally or o u t o f rhyth m with e ac h o th e r
The d epre s si o ns o r e l ev ati o n s o f i n divi d u al rib s h ave n o t di s
l o c ated th ei r arti c u lati on s ; th e y h ave m ere ly carri e d an d r e
tai n e d th em i n p o s iti o n s o u t o f har m n o y with th e rem ai n der
Th ey h ave be c o m e di sc o rd an t m ember s o f a
o f th e rib s
h arm o n i o u s b o dy an d u n le s s m ad e to c o op e r ate fo r the g e n
er al we lfare th ey wi ll r api d ly m ake o ther m emb er s i nhar
E l e v e nth
an d
Tw el f t h
.
-
,
.
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,
,
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.
.
,
.
.
,
,
mo n io u s
.
E ff e ct o f
P o si ti o n of V e r t ebr ae o n P os i ti o n o f R ibs
L ack o f symm etry in th e d o r sal vertebr ae cause s ach ange i n
B o th co nditi o n s can be co r re cted
the p os iti o n o f the rib s
by red u cti o n o f th e vertebr al subl ux ati o ns
.
’
'
.
.
O F O S TE O PA TH Y
PR I N C I PLE S
3 10
whi ch we call a le si o n m ay b e o n ly evid e nc e o f a l e s i o n
whi ch li e s i n th e e x c e ss ive ly ac tive m u s c l e o r at so m e o ther
p o i n t in c lo s e n e rv o u s c o nn e cti o n
A su bl ux ati o n m ay be call ed a p rim ary l e s i o n wh e n it
re su lt s fr o m acc i de n t It i s s e c o n d ary wh e n du e to refl e x
acti o n
I t i s n o t alw ays p o ss ibl e to d eterm i n e wh ethe r a
l e s i o n i s p rim ary o r s e co n d ary , bu t i n ge n e r al i t i s b e st to
re d u c e th e m wh ereve r f o u n d i f any d i s t u rb an c e c an be
tr ac e d to th em
In r are i n st an c e s on e tre atm e n t has be e n f o u n d s u ffi
The fac t th at the m aj o rity o f
c i e n t to red u c e a s u b l u x ati o n
c as e s m u st be tre ated t
w o o r th re e m o n th s p r ove s th at th ey
ar e n o t e as i ly kept red u c ed
,
.
.
.
]
,
.
,
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.
.
PRI N C I PL E S
O F O S T E O PA TH Y
C H A P TE R X V
311
.
TH E D IA GNO S TI C V A LUE O F BA C K A C H E
.
—It i s fre qu e n t ly sai d th at a m an is as o ld
Itm ay with e q u al sig n ifi can c e b e s ai d th at
as hi s arte ri e s
In eith er c as e a l o s s o f
a m an i s as o l d as hi s s pi n al c o lu m n
e lasti c ity l e ss e n s o n e s y o u thfu ln e ss o u t o f all p r o p o rti o n to
o n e s act u al ye ar s
A F i e l d fo r S t u dy —The u se Of th e b ac k an d th e s pi n al
o di ag n o s e th e
c o l u m n as a fi e l d fo r i n iti ati n g an e ff o rt t
phy s i cal c o n diti o n o f h u m an b ei n g s has m an y adv an t age s
b o th fo r e li c iti n g o bj e ctive an d s u bj e ctive i n f o rm ati o n
P r o b ab ly few phy s i c i an s re aliz e ho w m u c h o f phy si cal di s
tre ss i s m i r r dr e d i n s ympt o m s co n s c i o u sly o r u nco n sc i o u sly
referre d to th e b ac k
O bj e ctiv e an d S u bje ctiv e S y m pt o m s — In o rde r th at we
m ay h ave s o m eth i n g fo r refere n c e we wi ll p ass a few fac t s
i n r evi ew
As diag n o sti c i an s we ar e alw ay s de s i r o u s o f
k no wi n g wh eth er th e s tr u ct u re o f th e b ac k i s n o rm al an d
wh ethe r th e r e i s any di stre ss i e p ai n o f any ch ar acter i n
the ti ssu e s o f th e b ac k H e re we h ave th e o ld d ivi s i o n o f
o bj e ctive an d su bj e c tive sympt o m s
P ai n —P ai n i s th e sympt o m whi ch u s u ally l e ad s a pa
tie n t to s eek re li ef o r advi c e h e n c e we ar e i n tere s te d i n seek
i n g th e c au s e o f th e p ai n
The s imp l e s t p o s s ibl e c au s e o f
th e p ai n Sh o u ld n at u r ally b e th e fir s t th i n g c o n s idered S i n c e
m any lo cal ized p eriph e ral an d vi sc er al p ai n s eith e r ar e
cau se d by c o n diti o ns i n th e str u ct u re s o f th e b ac k o r at l e as t
reflexl
o
u
c
e
a
a
o
f
s
s
o
c
a
p
r
d
re
i
te d hyp e r ae sthe si a th ere we
s
a
y
s eek t
o di s c o ver wh at s tr u c t u r al f au l t o r referred s e n s itive
n e ss m ay e x i s t
E l asti c i ty
.
.
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’
’
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,
,
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,
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,
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,
,
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PRI N C I PLE S
3 12
O F O S TE O PA TH Y
—
The fir s t o b s erv ati o n sh o u ld be addre s se d to d e
P i
te r m in i n g th e p o i s e o f th e b o dy i e
I t i s very i m
st ati c s
p o rt ant to n o t e th e p o i se o f th e b o dy Th ere ar e m any d ev
i ati o n s fr o m n o rm al wh i c h ar e o n ly s light ly app are n t bu t
n everth el e s s give ri s e to b o di ly di s tre ss
P o s t u r al f au lt s in
ad u lt s l e ad to di stre s s du e to f atig u e o f th e ti s su e s an d as
th e b o n e s ar e n o t p lasti c p ai n i s fe lt The ch i ld s b o n e s ar e
p las ti c h e n c e th e s am e f o r c e th at p r od u c e s di stre s s i n m a
t u re p er s o n s c au s e s str u ct u r al d i s t o rti o n i n c hi ldre n i e
th e st ati c co n diti o n s whi ch i n c hi ldre n p r o d u c e spi n al d e
fo rmity p r o d u c e i n m at u re p e r so n s spi nal d i stre s s
—
S t r u ct u r al D e fe ct s
P ai n in th e b ac k i s o f su ch fr e
q u e n t o c c u rre n c e th at it i s advi sab le fo r u s to co n s ider so m e
o f th e ge n e r al an d s p e c i al co n diti o n s wh i c h m a
be
m
re
o
or
y
l e s s c h ar ac teriz ed by b ac k ach e
S i n c e we ar e e x p o n e n t s o f
a sy stem o f c o rre c tive m an ip u lati o n we n at u r ally lo o k fir st
fo r p o s s ib l e str u c t u r al defe c t s
The simp l e st str u ct u r al d e
fe e t w o u ld b e a bad p o st u re with its c o n s eq u e n t i m
b alan c e
i n the m u s c le gr o u ps wh i c h m ai n t ai n th e b ody ere c t
ati c s
U n de r thi s h e ad we mu s t c o n s i de r
S t ati cs — 1 S t
b ac k ach e as a p o ssi b l e re su lt o f any ch an ge in str u c tu r al s up
p o r t The m u sc l e s o f th e b ac k m u s t c o m pe n sate y altere d
te n s i o n fo r an y ch an ge i n th e le n gth o f a le g s u ch as th at
p re s e n t i n fl at f o o t sl ight ly fle x e d k n ee k n o c k k n e e o r a s a
—
The p ai n du e to fl at f o o t i s o n e o f th e m ost
cr o i li ac l e s i o n
“
M any cas e s o f s o called i nn o mi n ate
co m m o n c o mp lai n t s
”
l e s i o n s ar e n o th i n g m o re th an b ac k ach e c au s ed by th e e f
f o rt to co mp e n sate fo r a we ak ar ch M an ip u lati o n o f the
m u sc l e s o f th e b ack give s re li ef bu t d o e s n o t rem o ve th e
The lo n ger s u c h a c o n diti o n e x i st s i e fl at f o o t the
c au s e
m o re wi de s p re ad wi ll b e th e b ac k p ai n s S egm e n t s above
th e lu mb ar ar e gr ad u ally i n v o lved u n ti l it i s h ard to re c o g
n
Bac k ach e du e to di s
n ize wh ere th e v i c i o u s c y c l e beg a
tu r be d s t ati c s i s a f atig u e p ai n i e i s evid e nc e Of ti re d m u s
A ll s u c h b ac k ac h e s ar e rel i eved
c l e s o r s tr ai n ed lig am e n t s
by m an ip u lati o n Th ey di sapp e ar u n d e r th e i n fl u e n c e o f
t o n i c e x er c i se su ch as m o u nt ai n climbi n g be cau se th e u n
o se
,
.
.
,
.
.
‘
.
,
’
,
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,
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,
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,
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‘
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,
,
-
-
,
,
,
-
-
.
-
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-
,
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,
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,
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,
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,
,
PR I N C I PL E S
3 14
O F O S TE O PA TH Y
eve n n e ss o f th e gr o u n d n e c e s sit ate s c o nst an t v ari ati o n i n
m u sc u lar t e n si o n W alki ng o n p avem e n t r api d ly pr o d uc e s
f atig u e b e cau s e e ach m o v em e n t is a rep l i c a o f th e p re c edi ng
.
,
o ne
.
—
G e n e r al D e bi l it y
G e n er al d ebi lity m ay l e ad
t ti c
err o r s with c o n se q u e n t di stre ss M any st ati c err o r s m ake
th ei r app e ar an c e d u ri n g a slo w c o n v ale sc en c e an d th e n p e r
.
.
P
by
t
o si t
F IG 1 2 6
i o n w h i ch sh o w s ,
th e o u l i n e s o f th e v e r e r a l b Or
ro a
d e s o f th e s c a p u l a e , th a
ti o n o f th e v e r te r a l
odi e s e x
i s ts a s h i h a s th e s i x h d o r s al
.
r
t
.
g
b
t b
t
b
t
.
to
s a
P R I N C I PL E S
O F O S TE O PA TH Y
t
127
C o r re c i on o f
F IG
b ar
cu r v e
r ai si n
u to c
.
b t
by
.
k
.
g
'
th e l u m
th e
le
ft
3 15
PR I N C I PL E S
3 16
in
O F O S TE O PA TH Y
pit e o f i mp r o ve d m u s cl e t o n e ;
o g n i z e d u n ti l s u c h tim e as th ey f o r c e
cau s e o f th e di stre s s they c au s e
i t
s s
s
f ac t ar e n ever r e c
s p e c i al atte n ti o n be
in
.
S acr o
-
i l i ac S u b lu x ati o n
m o st p r o m i n e n t
f t
sympt om s
r t t
t b
t
g
F IG 1 2 8
Th e e f e c o f o a i o n o f
th e
o di e s
of
th e v e r e r a e
in
s p i na l c u r v a u r e
o n th e l o c a i o n
an d e x e n
o f si d e
e nd i n
b
.
.
t t
t
,
,
b
.
—S i n c e b ack ach e i s o n e o f th e
i n cas e s o f sac r o i li ac s u b lu x a
-
12 9
F IG
th e l e
S am e
.
ft
.
c as e
b
e n di n
g
to
.
.
ti o n n o e x am i n ati o n w o u ld b e c o mpl ete with o u t t aki n g th e
p o s sibi lity o f su c h a l e s i o n u nd e r c o n s i der ati o n
,
.
—
R o t ati
P r ac ti cally all s t ati c co n diti o n s o f
l o n g s t an di n g ar e ch ar ac terize d by slight s pi n al r o t ati o n
Th i s i s th e n at u r al re su lt o f th e b o dy s e ffo rt to tr an smit i ts
weigh t th r o u gh its str o n ge st s ide Thi s c o mp e n sat o ry r ot a
ti o n c an n o t b e co rre cte d with o u t t aki n g i n t o c o ns id er ati o n
th at co n diti o n fo r wh i ch th e r o t ati o n i s it se lf a co rre cti o n
S pi n al
on
.
’
.
.
PR I N C I PL E S
3 18
S pi n al C u rv at u r e
O F O S TE O PA TH Y
— C u rvat u re
th e s pi n al c o lu m n is
n o t alw ay s c h ar acte riz ed by l o c al o r ge n e r al b ac k ach e
As
a ge n e r al r u l e str u c t u r al sc o l i o s e s ar e n o t p ain f u l
Th i s i s
p r o b ab ly b e cau se th e sh ap e o f th e b o n e s has b e com e a d apte d
to th e weight o f th e b o dy i n th e n e w p os iti o n
P ai n i s apt
of
.
‘
-
.
.
g
G
y f
f ty
ff t
t y
1 32
r e at i r r e u l a r i t
O th e
s p i na l
c o lu m n ,
i n a c a s e o f te
al o u s c o n v al e s c e n c e , a te r
ph oid
eve
S h o w s th e e e c
re
of
m ai ni n
a lm o s t
c o n s a n tl
on
th e r i h t s i d e
F IG
.
.
f
r
g
g
F IG
t
fi
133
e n si o n
.
.
u e nc e
ff t f
f
t
a
g u la i t y f
th
i
l m n du
t w ak n
C o r r e c ti v e
o f l e t ar m
e
e
so
rr e
s p i n al co u
ec
o
o
s
r
e
,
o
o
e
ex
ih
th e
e ss
.
.
b e ass o c i ate d with a f u n c ti on al cu rve be c au s e su ch a
c u rve p u t s m u sc l e s an d l ig am e n t s o n a s tr t ch A s th e b on e s
e
and i n terve rt ebr al di sc s gr ad u ally yiel d to th e un e q u al p re s
o
su re o i a f u n c ti o n al c u rve r o t ati o n t ake s pl ac e acco rdi n g t
to
:
,
.
.
'
,
,
PR I N C I PL E S
O F O S TE O PA TH Y
3 19
the law s whi c h g o ver n r o t ati o n i n the fdo r s al an d lu mb ar
regi o n s an d a c o mp e n s at o ry c o n diti o n re s u lt s whi c h we r e c
o g n i z e as a right d o r sal l eft lu mb ar s co l i o s i s o r th e rever s e
,
,
.
,
Car
c au s
e
—
i es 2
of
.
di s e ase o f vertebr ae m ay b e th e
S u ch a co n diti o n i s u s u ally a l o calized
A c t u al
b ac k ach e
-
.
F IG
t
“
.
134
t t
kyp h
t al u v a
i
g a t i g i d i ty
mf t
r u c u r al
S
an d
p ai n or
ure
no
.
os s,
di s c o
la
c
er
re
or
r
r
,
.
ri e s du e to t u b er c u lo si s C arie s i s ch ar ac terize d by an g u
lar def o rm ity gre at s e n s itive n e ss to digit al p re ss u re an d
e sp e c i ally to verti cal p re ss u re ; 1 e any additi o n to th e
W e i ght o f the b o dy ab o ve the i nv o lved vertebr ae
L o calize d
b ack ache as so c i ated with a pr o mi n e nt sp i n o u s p r o c e s s and
ca
.
,
.
.
,
.
P RI N C I PL E S
32 0
O F O S TE O PA TH Y
e n sitive n e ss to ve rti cal p re ssu re S h o u ld b e
c au s e any phy s i c i an t
o s u sp i c i o n th e e x i s te n c e
s
fi c ie n t
c ari e s
su f
of
to
.
R i g i dit y —E ve n th e s e c o n diti o n s with o u t app are nt de
f o rmity sh o u ld m ake o ne h e sit ate b efo re u s i n g any l ever age
th r o u gh th at are a O n e o f th e ch ar acteri sti cs o f l o calized
b ack ach e i n di se ase o f th e str u ct u re o f the sp in al c o l u m n
i s rigi dity i e th e b o dy p r o te c t s it s e lf by m u s c u l ar te n
lim it o r p reve n t m o ve m e n t i n th e i n
s i o n su ffi c ie n t to
fl am ed are a Wh e n ever thi s p r o t e ctive ph e no m e n o n i s
o b s e rved i t s h o u l d b e a w ar n i n g ag ai n st i n te rfe re n c e
u n ti l
o n e i s c o nvi n c e d th at m o re i s t o b e g ai n ed t
h an l o st by
i nterferi n g with n at u re s p r o te c tive m e chan i s m
.
_
.
‘
,
.
.
,
.
,
’
.
Ar t hr o pat hi e s —C as e s
of
p are si s an d t ab e s d o r sal i s ar e
o arth r o p ath i e s an d h e n c e h e avy m an ip u lati o n o f a
su bj e c t t
l ever age o r th r u sti n g typ e sh o u l d b e av o i ded Th ere i s dan
ge r th at an arth r o p athy m ay e x i st an d as s u ch c o nditi o n s
ar e n o t ch ar ac te rized by pai n th e n o rm al p r o te c ti ve m e c h an
F ig 13 5 s h o w s an an g u lar de
i sm d o e s n o t as se rt it s e lf
f o rmity i n a c ase o f p are s i s The d ef o rmity w as cau sed by
s eve re m an ip u lat o n by o n e w ho had n o k n o wl edge o f p ath
i
i n f act any o f th e b as i c m e di c al s c i e n c e s
o lo gy o r
Thi s
w o m an had a c o mp ar ative ly s traight S pi n al c o lu m n whi ch
e xhi bi ted so m e sti ff n e ss an d s e n sitive n e ss eighth to twel fth
d o r s al The w o m an w as pl ac ed o n he r b ack k n ee s d o u bled
u n d e r h er c h i n th e n r o ll e d o n to h e r s h o u ld er s an d a h e av y
d o w nw ard thr u st give n s o a s to str o ng ly fl e x th e lo we r do r
The sh arp kyph o si s w as i n st ant ly p r o d u c ed with r e
s al
s u lti n g p re ss u re o n th e s pi n al c o rd
.
,
,
.
,
~
,
.
.
.
,
I
'
.
,
,
,
,
,
.
_
,
,
.
.
D e fo r m an s —
A ge n er al p o steri o r c u rve with
an ky lo s i s o r di mi n i s h ed fl e x ib i lity thi c ke n e d s pi n o u s p ro
te n de r n e ss to digit al p re s s u re l o c alize d p ai n s no t
c e ss e s
m arkedly s e n sitive to verti c al pre s su re i s re co g n ized as
sp o n dyl iti s d ef o rm an s
O th er j o i nt s o f th e b o dy ar e u su ally
s i mi l arly aff e cted
S po n dy li ti s
.
,
,
,
,
,
,
.
—Th
.
ge s due to m al nut r iti o n r achi ti s
f r e q u e ntly re co g niz ed The f act th at ch ange s el s ew he re
R achiti s
ar e
.
e
chan
,
.
,
P R I N C I PL E S
3 22
O F O S TE O PA TH Y
m o re p o sitively i n di cate th e p revi o u s e x i s te n c e
r ach iti s m ake s di ag n o s i s co mp ar ative ly e asy
ar e apt to
of
.
M al i g nan t G r o w ths
—
Wh e n l o cali ze d b ack ach e
.
is
co
m
a
n
o
f
n
n
a
d
o def o rm ity i s evi de n t th o r o u gh te st s s h o u ld
l
i
e
d
p
b e m ade to determ i n e th e e ff e ct s o f p o s iti o n s an d m o ve
m e n t s The p r o te ctive co n tr acti o n o f the m u sc le s sh ou ld
b e caref u lly analyz ed so as to j u dge wh eth er th e p ai n i s du e
to any i n fl am m at o ry p r o c e s s i n v o lvi n g th e vertebr ae ,o r any
o f th ei r j o i n t s
Ne ar ly all p ai n s i n th e l u mb ar regi o n ar e
“
l u mb ag o
c all ed
bu t o n e m u st alw ay s b e o n g u ard l e s t a
—
n
s
u
o
p er i ste t l mb ag l ike p ai n b e no t give n i ts tr u e v al u e
P ai n s o f a sh arp lanc i n ati n g c h ar acte r wh i ch p er s i ste n tly
app e ar i n a d efi n ite s p i n a
l are a o r alo n g n e rve tr u n k s o r i g
i n ati n g fr o m th at are a u s u ally h ave a s i n i ster s ig n ifi can c e
A d efi n ite di ag no si s i s p r ac ti cal ly imp o s sib l e but th e p er
s i s te n c e o f th e p ai n s
i n s pite o f all e ff o rt s t
o reliev e with
h eat p o siti o n s o f re s t o r m an ip u lati o n s i s p retty g o o d evi
de n c e th at so m e m al ig nan t p r o c e ss i s atw o rk whi c h i nv o lve s
th e se S pi n al ti ss u e s I f no feve r e x i sts o r o th e r co n s ti tu
e nt o f
ti o n al sig n it m ay b e th at th e p ai n i s du e to i n v olve m
th e s pi nal co lu m n by a gr o wth with i n th e b o dy A s e x am
pl e a m an 44 ye ar s o ld c o mp lai n e d bitter ly o f sh arp lan
c i n at
i n g p ai n s i n th e lu mb ar regi o n an d e x te n di n g d o w n
br an ch e s o f th e lu mb ar an d sac r al p l e x u s e s Al l e ff o rt s at
rel i ef we re u nav ai li n g Th ere w as n o def o rm ity o f th e
M any
bu t th e p ati e n t h e ld him se lf rigi d
S pi n al c o lu m n
attempt s we re m ade by m an y phy s i c i an s to m ake a di ag
no si s
O n e o f th em u s e d h e avy m an ip u lati o n o f a l ever age
In o rd er to te st th e e ff e ct Of ve r ti c al pre s su re h e
ch ar ac ter
i n g b lo w o n th e to p o f th e h e ad an d th e n o n
u s e d a co ncus s
th e h e e ls Th i s latte r p r o d u c ed ag o n izi ng p ai n whi c h w as
f o llo we d rap i d ly by p ar apl egi a The case r an a tedi o u s
Au t o p sy S h o we d c anc e r i n v o lvi ng
c o u r s e o f m an y m o n th s
The p r o gre ss o f
l eft kid n ey an d th e s pi n al are a u n d er it
th e di se as e w a s e x c ee di n g ly s lo w an d h e nc e hi s b o dy w as
abl e to bri n g m an y co mp e n s at o ry m e c h an i s m s i n t o ac ti o n
,
.
,
.
,
.
,
,
.
,
-
,
,
,
,
,
.
,
t
.
,
,
,
.
.
.
.
,
.
.
.
.
.
.
,
,
PR I N C I PLE S
wh i ch m ade it di ffi c u lt
n ize th e tr u e c o n diti o n
fo r
O F O S TE O PA TH Y
32 3
eve n th e m o st s ki llf u l
re co g
to
.
—
The s o c all ed typh o i d spi n e i s an
Ty pho i d S pi ne
y whi ch m ay
o th er f o r m o f spi nal tr o u b l e with o u t def o rm i t
b e a sp o n dy liti s bu t p r o b ab ly i s a pu r e n e u ro s is
-
,
,
'
L u m b ago 3 U n der th i s h e ad we m ay c o ll e c t a v a
o
n
n
diti
rie t
f
c
o
o
s whi c h ar e c h ar ac terized by p ai n whi c h
y
i s par tfcu
lar ly aggr av ate d by v o lu n t ary m o vem e n t
It is
Ofttim e s di ffi c u lt to determ i n e wh at th e str u ct u r al ch an ge
i s wh i c h give s r i s e to t hi s p ai n
E ach c as e will S h o w p e cu l i
ar i ti e s as to th e e x ac t lo c ati o n o f th e p ai n an d th e am o u n t
o f p o s s ib l e v o l u n t ary m o ve m
e n t Th ere may b e i nv o lv
m e n t o f m u sc l e lig am e n t f as c i a o r p eri o ste u m The caus e
o f the tr o u b l e m ay
b e f atigu e as re s u lt o f p o st u re st r ai n
fr o m l ifti n g o r m ay b e du e to a to x em i a
.
.
'
.
'
.
.
.
,
,
.
,
,
.
,
P o s t u r e — Bac k ache
mm o nly pr o
du c e d i n an y o n e w ho attempt s to do w o rk wh i ch c o m
p e ls b e n di n g o f th e b ac k f o rw ard
U n ti l s u c h ti m e as
th e i n divi d u al d eve lo p s ad apt ati o n to thi s p o s iti o n th ere
wi ll be s e n s itive n e s s at th os e p o i n t s i n th e s pi n al co lu m n
wh i ch e n d u re th e gre ate st str ai n The s tr ai n th u s pr o
du c e d m ay aff e c t th e e x te n s o r m u sc l e s o f th e b ac k o r i n
th ere
c as e th e p o s t u re i s s u c h as p u t s s tr ai n o n l ig ame n t s
wi ll b e hyp ere s th eti c p o i n t s dire ct ly o n th e ve rtebr al sp i n o u s
p r o c e s se s wh ere th e su pr aspi n o u s ligame n ts att ac h Back
The r e
ach e du e to s tr ai n i s n o t c h ar ac terize d by fever
c umb e n t p o s iti o n give s reli ef
du e to
,
p o st u re
,
is
co
‘
.
.
.
,
,
.
[
.
.
.
—
Bac k ach e du e to t o x e mi a i s n e ar ly alw ay s
o f s u dde n app e ar an c e
The f ac t th at th e p ati e n t fir s t be
c o m e s co n s c i o u s o f i ts e x i s te n c e wh e n so m e m o vem e n t is
m ade su ch as q u i c k ly s itti n g u p i n b ed o r be n di n g fo r
w ard to pi c k u p s om eth i n g o r p u tti n g o n c lo thi n g alw ay s
l e ad s to th e be li ef th at th e p ai n i s du e to str ai n
Ne ar ly
all s u c h cas e s s h o w a c o ated t o n g u e bad bre ath
c o n s tip a
ti o n h e ad ach e an d g e n er al phy s i c al dep re ss i o n The pain
To x e m i a
.
.
,
,
,
.
,
,
‘
,
,
.
PR I N C I PLE S
32 4
F IG
O F O S TE O PA TH Y
g
t k
h o f th e
A s w e ll i n
1 36
u n d e r th e s h e a t
l e t e r e c to r S p i n a e m u s c l e , w h i c h w a s c o i n
”
“
lu m a o ,
o llow
e ide n
w i th a n a t a c
of
i n g a h e av
s r ai n
.
f
.
t
y t
.
b g
f
PRI N C I PL E S
32 6
O F O S TE O PA TH Y
ert ai n c o n diti o n s o f th e atm o s ph e re e sp e c i ally c o ld dry
el e ctri cal wi n d s Alth o u gh th e se c as e s S h o w so m e sig ns
o f i n dige sti o n th ey do n o t s ee m to be o f th e sa
m e ch ar
ac ter as th o s e we h ave p revi o u sly m e n ti o n ed
c
,
,
,
.
.
I nv o lve m e n t o f the S pi nal C o r d 4 P ai n i n th e b ac k
m ay b e du e to so m e i nv o lvem e n t o f th e S pi n al c o rd o r i ts
m emb r an e s As a ge n er al r u l e th ere ar e e no u gh o th er
s ympt o m s s u ch as m o t o r o r s e n s o ry ph e n o m e na t
o d i re c t
o n e s atte nti o n to th e re al s e at o f di s e as e
The p ai n i n
th e se cas e s i s like ly to b e sym m etri c al o r at l e ast defi n ite ly
lo c ated with re s p e c t to c ert ai n sp i n al n erve tr u n k s
F ur
the r m o r e p ai n du e to i n v o lve m e n t o f th e c o rd o r i ts m e n
i n ge s d o e s n o t c al l f o rth th e p r o te c tive r e fl e x e s w hi ch ar e
so evi de n t wh e n any str u c t u r al ti s su e o f th e s p i nal c ol u m n
i s i n v o lved
Th ere i s n o n e c e s sity fo r rigidity to p r o te c t
su pp o rti n g ti ss u e s
We
r
i
n
l
di
n
g
p
i
n
l
m
e
n
i
n
n
a
e
o
t
c
u
s
a
(
giti s i n thi s gr o u p ) Wh e n th e n erve r o o ts ar e i n v o lved
th e p ai n i s i n te n s e an d d efi n ite ly l ocated . Wh en th e r o o t
gan gli a ar e i n v o lve d w e h ave th e we ll k no w n c on diti o n
c all ed h erp e s z o s e r
t
.
.
.
.
’
.
.
,
,
,
.
.
-
.
~
.
er s
Inf e cti o u s F e v
M any o f th e acu te in fe cti o u s
feve r s ar e c har ac terized i n p art by s evere b ack ach e Ih
fl u e n z a t o n s i l iti s s m allp o x typh o id diphth eri a an d de n g u e
It
all h av e s eve re b ack ac h e s as an i n c i de n t i n th ei r c o u r s e
i s n o t k n o w n wh at pr o d u c e s th e p ai n i n th e s e feve r s
‘
5
.
.
,
,
.
,
,
,
,
.
.
R e f er r e d Vi sc e r al P ai ns 6 P r o b ably th e gre at pr o
p o rt i o n o f back ac h e s ar e referred p ai ns du e to i nv olve me n t
A tte n ti o n has
o f th o r ac i c abd o m i n al o r p elvi c vi s c er a
b ee n c all e d to H e ad s law o f referre d p ai n
al re ady
s o ry
an d to th e e x i s te n c e o f th e re c ept o r field s f o r s e n
i mp re s si o ns fo r c ert ai n segm e n t s o f th e s pi nal co rd The
i n ter o ce pti ve fiel d i s an ar e a o f lo w s e n sibil ity so far as
No t
o ur c o n sc i o u s re co g n iti o n o f th i s fiel d i s co n c er n e d
all s egm e n t s o f th e s pi n al c o rd re c eive s e ns o ry fib er s fr o m
th i s fie ld h e nc e vi s c e r al refl e x e s ar e f o un d o nly i n th o se
p o rti o ns o f th e b ac k asso ci ate d wi th th o s e segm e nt s h avi n g
.
.
.
,
’
’
,
.
'
-
,
'
.
,
PRI N C I PL E S
F IG
O F O S TE O PA TH Y
t
32 7
t fl tt
g
P t t
1 37
enin
A n o c cu p a i o n c u r v e w i h
a
in
th e u p p e r d o r s a l
e l e r aph e r
a ien
com
of
an d
te n d e r n e s s ,
se con d
to
p la i n e d
p ai n
o u r h d o r s al o n t
h e l e t si d e
i e d s i x t da s
a
e r th e p h o o w a s m a d e , a n i n a p e c o r i s
.
.
.
f
ft
t
t
g
T
f
.
.
g
D
t
y
y
.
O F O S TE O PA TH Y
PR I N C I PL E S
32 8
i nter o ce ptiv e s e n so ry c o mm u n i cati o n
D i st u rb an c e s i n
h o llo w vi s c er a su ch as th e s t o m ach and i n te sti n e s ar e du e
F atig u e an d co n
to o verl o adi n g th e dige s tive app ar at u s
o di s te n ti o n with g as
s e q u e n t f ai l u re o f dige s ti o n l e ad s t
ab s o rpti o n o f to x 1 n s fau lty el i mi n ati o n
D i ste nti o n cau s e s
p re ssu re o n n erv e e n di n g s i n th e w all s o f th e vi s c era an d
E x agger ati o n o f phy si o
th u s i n iti ate s refl e x b ac k ach e
lo gi c al ac tivity o f th e l ive r o r sp l e e n cau s e s te n si o n o n th e
c ap su l e s o f th o s e o rg an s an d h e n c e i rrit ati o n o f th eir s e n so ry
n erve s with refl e x b ac k p a i n s
The sam e i s tr u e o f th e ki d
ney
D i st u rb an c e s i n th e b lo o d su pp ly to any o rg an s uc h
as o cc u r s i n arteri o sc l er o s i s, o r as re su lt o f an e u ri s m u su
The referre d p ai ns th at ar e du e
al ly c au s e referre d p ai n s
to f u n c ti o n al f atig u e ar e u s u ally o f a so m ewh at d iff ere nt
o i n fl amm ati o n i n vi sc er al o r
c h ar ac ter fr o m th o s e du e t
g ans A cu te i n fl amm at o ry s t ate s in th e vi sc er a give ri s e
i n m any i n st an c e s to c u t an e o u s hyp er s e n s itive n e ss i n th eir
Th e s e cu tan e o u s ar eas ar e
s egm e n t ally ass o c i ate d are as
hyp er s e n s itive to a s light t o uc h bu t n o t e sp e c i al ly so to
p re ss u re S t ate s o f f u n cti o nal strai n an d f atig u e wh eth e r
ac u te o r
m o re apt to p r o d u c e a refl e x i n th e
sp i n al are a wh i c h i s ch ar ac teriz ed by te n d er n e s s t
o p re s
ve r th e e x te ns o r m u s cl e s at so m e p o i n t bet we e n th e
su re o
S p i n o us p r o c e s s e s o f th e vertebr ae an d th e an gl e s of th e
rib s Cu t an e o u s an d de ep ti s su e hyp er s e ns ibi lity m ay b e
The de ep hyp er s e n sibility
as s o c i ate d i n th e sam e c as e
i s th e m o re c o n st ant f o rm di sco vered by p alp ati o n
—
m
r
e
Wh e rever th e
In fl amm at i o n o f S e r o u s M e b an s
n e c e ss ity fo r fri c ti o n o f o n e o rg an o r s tr u c t u re o n an o th er
is n e c e s sary we fi n d s er o u s ti ss u e i n th e f o rm o f a b u rsa
te n d o n sh e ath sy n o vi al m embr an e t u n i ca v agi n ali s testi s
m
fl
n
u
n
a
a
o
n
o
f
p
eri
rdi
m
p
erit
o
e
m
I
m
ti
a
o
r
u
c
a
e
u
r
l
a
b
p
s e ro u s m e mbr an e i s acc o mp an i e d by m u s c u lar fi x ati o n o f
th e s tr u ct u re s wh i ch d ep e n d o n th at m embr ane fo r fre e
m o vem e n t Th i s is a p r o te c tive acti o n re q u ire d to p reve nt
fri c ti o n o f th e i n fl am e d s u rfac e s I nfl am m ati o n o f a pl e u r al
s u rf ac e calls f o rth a p r o te c tive c o n tr ac ti o n o f al l th e m u scl e s
-
.
.
,
.
,
'
.
,
,
.
,
.
-
,
.
.
,
‘
.
.
,
,
,
.
.
.
,
,
,
,
,
,
,
,
i
.
.
.
o F O S TE O PA TH Y
PRI N C I PL E S
330
th e fifth laye r o f th e b ac k i s co mp l etely i nn erv ated fr o m
we fi nd also th at n o vi scu s
si n gl e s egm e n t o f th e co rd
wh o l ly co ntr o lled by fib e r s fr o m o n e s egm e n t
of
,
a
,
is
.
—
The c o nti nu o u s ac ti o n o f a r e
R fl
fl e x s u ch as th at du e to i n fl am m ati o n o f a s er o u s s u rf ac e
o c o n ti n u e d c i r
o r to l o n g c o n ti n u e d f u n cti o n al s tr ai n o r t
di s t u rb an c e u s u ally re su lt s i n a ch an ge i n th e
c u lat
o ry
er o f th e b ac k i e a c ert ai n d egre e o f s t ati c alter a
ch ar ac t
ti o n t ake s pl ac e as a c o mp e nsat o ry ad apt ati o n t
o v aryi n g
deg r e e s o f m u scu l ar an ky lo s i s Th i s m u scu l ar an kyl o si s
i s th e e x p re s s i o n o f th e vi sc e ral refl ex
I t p r o d u c e s ch an ge s
i n b o ny alig n m e n t wh i ch we re co g n iz e as s u bl u x ati o n s
wh e n o nly thre e o r f o u r v ertebr ae ar e aff e cte d ; o r as c u rv a
t u re s wh e n gre ater n u mb er s ar e i n v o lved
e
ex
S u b lu x ati on s
.
'
,
,
,
,
,
.
.
,
.
.
‘
.
,
Int e nsi ty
—Th e x te n t
R
e
an d c o mp l e x ity o r
i n te ns ity o f a refl e x o r co Ordi nated se ri e s o f refl e x e s i s
eri o n by wh i ch to e stim at e th e e x te n t o f p at ho
n o t a c ri t
Very s eri o us p ath o
lo gi cal ch an ge i h a vi scu s o r vi sc er a
l ogi cal ch an ge s m ay b e p re s e n t i n a vi scu s with o u t pr o
du c i n g i n te n s e o r eve n dete rm i nab l e sp i n al refl e x e s Th e s e
d su c h
ch an ge s m ay h av e p r o gre ss ed so sl o wly an d i nv o lv e
s m all are as th at n o i n te n s e p r o te c tive re ac ti o n w as c all e d
f o rth
io n
e act
of
.
,
-
,
,
,
.
"
.
,
.
—
R e fl ex e s
B as ed u p o n cli n i c al
L o cat i o n o f
an d e x pe r i
m e n t al o b s e rv ati o n s a c on s id er ab l e am o u n t o f d at a has b ee n
s e c u re d b e ari n g u p o n th e l o c ati o n o f refl e x e s i n co n n e c ti on
a with re sp e c t to
with v ari o u s vi sc er al di s e a se s The d at
th e lo cati o n o f c u t an e o u s hyp er ae sth e si a has b ee n we ll
m app ed o u t but u n ti l o ste o p ath s b eg an to p l an th ei r m
an ip
u lati v e tre atm e n t acc o rdi n g to th e str u c t u r al ch ange s i n
h ere w as
l ig n m e n t du e to m us c u l ar hyp erte n si o n t
s p i n al a
practi cal ly n o atte n ti o n p ai d to th e ph e no m e no n o f r efl e x
hyp erte n si o n The refe rre d vi sc er al p ai n s an d th e hyp e r
te nsi o n o f th e spi nal m u scl e s ar e e x p r e ss i o n s o f a di st u r bed
s egm e n t o r s egm e n t s o f th e s pi n al c o rd
.
,
.
"
'
,
,
,
.
.
PRI N C I PLE S
O F O S TE O PA TH Y
33 1
—
P att e rns Bas ed
R e fl ex
o n c l i n i c al an d e x p eri m e n t al
d at a it i s p o ss ibl e to o u t li n e a s erie s o f refl e x p atter n s whi ch
of
c ert ai n
vi sc er al i nv o lv m e n ts The
c h a r ac teri s ti c
ar e
h e p atter n s dep e n d s large ly o n ho w gre at
c o mp l e x ity o f t
an e ff o rt i s req u ire d by th e b o dy to o v e r c o m e th e di s e ase
S o m e di s e as e s h ave a s p i n al refle x p atter n ap p are n t ly o u t
p o rti o n to th e gr avity o f th e i lln e s s Thi s is e s p e
o f all pr o
c i ally
mar k e d w he n au t o t o x emi a i s a ch ar ac teri sti c o f th e
i lln es s Un der s u ch ci r c u m s t an c e s mu s c u lar te n s i o n an d
te n der n e s s e x te n d far o u t s i d e th e limit s o f th e n o rm al s e g
m e n t al i n n erv ati o n
,
.
.
.
‘
’
”
.
(
PR I N C I PL E S
3 32
O F O S TE O PA TH Y
C H A P TE R X V I
.
A D A P TATI O N A ND C O M P E NS ATI O N
.
E x ami n ati o n
p ati e nt s fre q u e n t ly reve al s th e re s ult s
o f acc i de n t s o r di s e as e wh i c h do n o t app e ar to h ave an
y
p re s e nt de l ete ri o u s i n fl u e n ce o n th ei r h e alth I t i s alw ay s
n e c e s sary fo r th e phy s i c i an to e s ti m at e th e rel ati o n s whi ch
th e s e ch ange s h ave i h th e p as t b o r n e to th e ge n er al
h e alth o r m ay at p re s e nt b e l i abl e to e x ert un de r k n ow n
co n diti o n s o f c li m ate
di et an d e nvir o n m e nt
of
I
.
‘
'
,
,
‘
,
,
,
,
D e fi niti o n
.
—In sp e aki n g
tr u ct u r al an d f un c ti o n al
w e u s e th e w o rd s ad apt ati on o r c o mp e ns a
ti o n
c h an ge s
A d apt ati o n m e an s i n bi o l o gy f av o r abl e o rgan i c m o di fi ca
ti o n s su iti ng a pl an t o r an im al to i ts e nvi r o n m e nt Co m
” “
“
”
n
o m ake u p fo r
t
o c o u n te rb alan c e
m
e
i
t
n
o
n
a
s
e
s
a
t
!
p
t hat wh i ch m ake s g o o d the lack o r v ari ati o n o f som e
”
th i n g el s e
The e x ampl e s o f ad apt ati o n an d c o mp e n sa
ti o n ar e very n u m er o u s an d it i s n e c e ssary fo r th e phy s i
o re c o g n ize th e c as e s i n wh i c h th e b o dy
c i an t
o b e abl e t
o
n
x
with
p
r
p
er
a
ss
i
s
t
a
c
e
e
e rci se
has e x er c i sed o r m a
y
th i s p o we r to a g re at degre e I t i s so m eti m e s sai d th at
di s e as e i s an e ff o rt o f th e b o dy to acc o m m odate it s el f to
th at i s ch an ge s in th e q u antity and
ne w
c o n diti o n s
q uality o f s tim u l i o ccas i o n ed by v ari ati o n s i n c l im ate , d ie t
e nvir o n m e n t o r acc id e nt
O ste o p athy app are n tly o rigi n ate d fr o m th e f ac t th at
With thi s as a b asi s all e x am
s tr uc t u re aff e c t s f u nc ti o n
in atio n s ar e m ade fr o m th e s tr u c t u r al st an dp o i n t an d
th eref o re if we f o l l o w th i s meth o d to o liter ally we ar e
apt to o verl o o k th e f ac t th at th e c e l l s o f o u r b o die s have
th e p o wer o f ad apti ng th em s e lve s to ve ry p r o no unc ed
.
of
s
.
,
,
,
‘
.
,
,
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.
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,
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,
-
.
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,
,
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,
.
.
,
,
,
'
‘
P RI N C I PL E S
3 34
F IG
t t
O F O S TE O PA TH Y
y
A d a p a i o n o f th e b o d
to th e s ta te o f i ts
c o n te n ts
E n l ar e m e n o f th e s p l e e n w h i c h c a u s e s
a
ul in
o f th e r i s a n d a c o i n c i d e n t s p i na l l e s i o n
.
1 38
.
b g g
.
g
b
t
.
.
PR I N C I PL E S
O F O S TE O PA TH Y
33 5
tr aighte n i n g o f th e sp i n e o r e n d u r e de fo r m i ty w i th f ai r
he alth D ef o rmity i s alw ay s a w o u n d i n th e s e l f e steem
o f th e i n divi d u al
M an y w o u ld ri s k life tim e an d ag ai n
to be rid o f it
I t i s th i s wh i ch give s th e e x p e ri me n ti n g
phy si c i an o r s u rge o n amp l e o pp o rt u n ity to try hi s s ki ll
o r hi s ig n o r an c e
I t i s all o n e to th e p ati e n t; a ch an c e
to b e ri d o f def o rm ity
—
A later al c u rv at u re o f th e
C o m pe nsat o r y Cu r v at u r e
spi n e usu
ally ha
s t
w o p art s th e p rim ary an d the c o mp e n
The c o mp e n sat o ry c u rve i s th e e ffo rt to
s at o ry c u rve
m ai n t ai n th e ere c t p o siti o n th at i s ke ep th e weigh t o f
th e b o dy p r o p er ly b alan c ed The phy s i c i an m u s t determi n e
wh i ch c u rve IS pr l m ar y an d whi ch i s c o mpen sat o ry
Wh e n th e hip i s d i s lo c ated o r any c on d iti o n e x i st s
whi ch sh o rte n s o n e l eg th e sp i n al co lu m n i s Cu rved to
I t w o u l d b e u s e l e ss
c o mp e n s ate fo r thi s red u c e d le n gth ;
to tre at a c o mp e n sat o ry s p i n al c u rv at u re with o u t l e n gth
d i slo cati o n o r p u tti n g
e n i n g th e l eg by re d u c i n g a h ip
Wh e n th e fem u r is di sl o cated
an e x ten s i o n o n th e s h o e
all th e th i gh an d hip m u sc l e s ac co mm o d ate th em s elve s
to a n e W po s i ti o n the n th e s pi n al c o lu m n c u rve s b e c au s e
th e p e lvi s tilt s e n o u gh to co mp e n sate fo r th e lac k o f
The lo n ge r th e di slo cati o n has
l e n gth i n th e e x tremity
he m o r e p erfe c t i s th e ad apt ati o n an d c o mp e n s a
e x ist
ed t
ti o n To red u c e th e di slo cati o n we m u s t u n d o th e w o rk
o f ad apt ati o n
th at i s le n g the n th e m u sc l e s an d f o r c e th e
h e ad o f th e fem u r i n t o th e ac et ab u lu m
All i n divid u al sp i n al l e si o n s m u s t be j u dged caref u l
ly as to th ei r r e lati o n s to f u n c ti o n al di s t u rb an c e
The
f act th at s p i n e s d evel o p u n eve nly i n m an y c ase s m ake s it
h ard to defi n e th eir e x act co n diti o n A late r al s ublux a
ti o n m ay e x i s t to whi ch th e b o dy has b e co m e acco m m o
d ated To red u c e th i s s u b lux ati o n might ag ai n su bj e ct
th e i n divid u al to di s t u rb ed f u n cti o n
The Tho rax — D r o o p i n g o f th e rib s l e s s e n s th e an
ter o p o st eri o r di am e te r bu t i n c re ase s th e verti c al di am
ete r The fu ll r o u n d ch e s t o f large cap ac ity i s u su ally
s
‘
~
.
.
.
.
.
.
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,
.
,
,
.
.
,
,
,
.
.
;
,
,
.
.
.
,
,
.
.
,
,
.
.
.
.
-
,
I
.
.
PR I N C I P LE S
33 8
O F O S TE O PA TH Y
i nc re as e i n th e si ze o f o n e o r m o re o f i ts ch amber s
Thi s i n c re as e i s at th e e x p e n se o f th e th i c k n e ss o f i ts
w al l s th u s re su lti n g in di spr o p o rti o n b etwe e n th e size o f
th e cavity o f th e v e n tri c l e o r au ri cl e an d th e am o u nt o f
m u sc u lar ti s su e req u i red to empty th em o f th ei r c o nte n t s
Wh e n th e p r o p o rti o n b etwe e n th e cavity an d i ts w alls
is so far re st o re d th at th e h e art i s abl e to o ver co m e th e
s t as i s o f th e b lo o d i n th at p o rti o n o f th e c ir c u l at o ry a
p
ar at u s b eh i n d th e l e s i o n
we
th
t
s ay
a
o mp e n sati o n e x
c
p
i sts
The abi l ity to re c o gn ize th e s t at u
s of a h e art l e s i o n
i s o f gre at v alu e to a phy si c i an
is
an
.
,
,
.
,
.
.
S ki n
—
i
n
e
K d ys A
an d
p i nal l e s i o n might c au s e a di s
tu r ban ce i n th e f u n cti o n i n g o f th e kid n ey s de c re as e o f
ac tivity
w hi c h i n t u r n i s c o mp e n sate d fo r by i n c re as ed
ac tivity o f th e ski n wh i ch in tim e i s c o mp e nsate d fo r by
i nc re as e d activity o f th e b o we ls The diarrh o e a i n thi s
an d y et it i s v ery di ffi c u lt
c ase w o u l d b e c o mp e n s at o ry
I f th er ap e u ti c m e ans
fo r th e phy s i ci an to n o te th i s f act
we re u se d to sto p th e d i arrh o e a an d th e ki d n ey s o r s ki n
di d n o t i mm edi ately t ake u p th e w o rk o f elimi n ati o n , th e
b o dy w o u l d cal l u p o n th e s er o u s m emb ran e s an d are o lar
ti s su e , to t ake care o f th e su rp lu s li q u id i n th e c 1r c u lati o n
As a re s u lt th ere w o u l d b e e dem a o f th e e xtrem iti e s as
c ite s p l e u riti c e ff u s i o n
s
,
.
’
,
-
,
.
,
‘
.
‘
,
.
.
,
.
,
mp e n s ati n g acti o n wh i c h m ay t ak e pl ac e be
twe e n th e kid n ey s s ki n m u co u s an d s er o u s m emb r an e s i s
15
m o re freq u e n t ly re c o g n ize d an d m ade u se
o n e wh i c h
o f by phy s i c i an s th an an y o th e r e x amp l e o f th e s am e po w
e r m an ife sted i n th e b o dy The fac t th at th e s ki n an d kid
n ey s re s p o n d to e ac h o th er s n ee d s
f o rm s th e b asi s fo r
M u co u s memb r an e s be
m any th e r ap e u ti c p r o ced u re s
P e r s p ir ati o n red u c e s
co m e
ac tive wh e n th e s ki n f ai l s
S e r o us m embr an e s
ac tivity o f th e m u c o u s m embr an e s
e x c e ssive activity wh e n m u c o u s m e m
b r an e s
c e as e th eir
elimi nate freely The o edem a o f are o lar ti s s u e give s w ay
The phy s i c i an m u s t
to ac tivity o f m uc o u s m emb r an e s
The
co
,
,
,
.
’
,
.
.
.
.
.
PR I N C I PL E S
O F O S TE O PA TH Y
3 39
re c o g n ize wh i ch i s th e di s e as e d ti s s u e an d wh i ch i s th e
The f ai lu re o f th e ki d n ey to e x c rete
c o mp e n s ati n g o n e
might n o t b e the f au lt o f i ts o w n str u c t u re bu t re su lt
fr o m the v is a terg o give n th e c ir cu lati o n by a di s e as e d
h e art
—
E
n
s
n
In th1 s we ster n co u n try C ali
P ow e r o f
cy ti g
fo r n i a we h av e amp l e Opp o rt u n ity to wit n e ss th e abi l ity
,
.
,
'
.
.
,
,
F IG
k
g
1 41
S i d e V i e w o f ca s e o f l e u e m i a , sh ow i n
su l
o f a d a p a i o n o f th e s p i n a l c o l u m n an d
to th e c o n e n s o f th e
od
.
t
.
t t
t t
b y
.
re
ri
b
s
.
PR I N C I P L E S
3 40
F IG
P
O F O S TE O PA TH Y
l a n ta r i m p r e s s i o n o f a l m o s t c o m
1 42
d o w n o f th e l o n i tu d i na l a r c h
p l e te l e ti n
.
.
t
g
g
.
P RI N C I PL E S
34 2
F IG
1 43
f t
.
oo
P la n ta r
.
Th e
.
down
.
O F O S TE O PA TH Y
i m pr e s si on
l o n i u d i n al a
gt
r
of
ch
ca se
is
co
of
b lu t fl a t
t ly b r k n
a
m p le
so
e
e
o
e
PR IN C I PL E S
F IG
O F O S TE O PA TH Y
P l an ta r
t
r an s
i m p r e s si o n o f lo ss of
v e r s e a r ch an d c o n s e q u e n t i n c r e a s e o f p r e s
s u r e o n th e h e a d o f t
h e s e c on d ,
h i r d an d
ou r h
m e a a s al
on e s,
a s e vi d e n c e d b y
th e c al l o u s
.
1 44
.
,
f
t
t t r
.
b
t
343
PR I N C I PLE S
3 44
O F O S TE O PA TH Y
i nj u ri e s to o r lo s se s o f th ei r o wn s tr u ct u re A d apt ati o n
to e x te r n al co n diti o n s c alls fo r th e Op er ati o n o f c o m pe n
o r an l s m
th
ere
s ati n g o r b alan c i n g devi c e s with i n th e
g
f o re th e lo gi c al s t u dy o f th i s s u bj e ct w o u ld nat u r ally gr o u p
th e ph e n o m e n a u n d er th re e h e ad s
F ir s t th e st u dy o f
with a vi ew to dete rmi n i n g th e e x i ste n c e o f
s tr u c t u re
b alan c i n g d evi c e s i n th e arr angem e n t o f b o n e s l ig am e nt s
m u sc l e s b lo o d v e ss e ls vi s c er a an d n erve s The s e c o m
m
h
a
n
i
m
i
n
o
r
e
c
s
s
m
u
t
b
e
c
o
n
ide
red
n
every
e
ff
o
rt
e
a
t
s
s
s
y
p
Th i s fi rs t divi s i o n de als with i n te r n al
at ad apt ati o n
i e an at o my
an d th eir f u n c ti o n s
s tr u c t u r al co n diti o n s
S e c o n d the S t u dy o f c o n diti o ns u n der
an d phy s i o l o gy
whi ch livi n g str u c t u re s ar e e x i sti n g Thi s divi si o n d eal s
W ith all th o s e th i n g s whi ch c o ns tit u te e n vi ro n me n t s u ch
te mp er at u re atm o sphe r i c pr e s s u r e ; re lati o n to
as f o od
l ivi n g th i n g s s u c h as i n s e c t s p r o t o z o a a n d bac
o th er
teri a ; an i m al an d veget ab l e p o i so n s Thi 1 d a lo gi c al o u t
gr o wth o f th e fi r st an d s ec on d divi s i o ns i e a s t u dy o f
th e artifi c i al c o n diti o n s u s ed by phy s i c i ans to i n fl u e n c e
th e n at u r al c o n diti on s o f th e fir s t an d s e co n d d ivi s i o n s
S i n c e m an s po s i ti o n i s u p right it app e ar s th at all
p art s o f his b o dy ar e c o n str u cte d with th e e n d i n vi e w
A b ew i ld er
o m ai n t
ai n
o f m aki n g th at p o s iti o n e asy t
i n g s erie s o f c o mp e n sati n g devi c e s serv e to b alan c e th e
b o dy in th e u pright p o siti o n An y de vi ati o n o f any p art
1 5 i mmed i ate ly m e t
as the re s u lt o f ac c i d e n t o r n e c e s s ity
by an o pp o si ng co u n terb alanc i n g e ffo rt o f i ts n at u r al
I f thi s c o mp e n sat o ry
str u c t u re
o pp o s i n g
c o mp e n s at o ry
e ffo rt i s n o t pre s e nt th ere i s lo s s of b alance betwee n r e
i n g p art s re s u l ti n g i n s tr ai n an d di sc o m fo 1 t As
c i pr o c at
a ge n e r al p r o p o s iti o n th e fO 1 e g o in g i s re c o g n ized by all
bu t to ac tu ally re c o g n ize th e f ai lu re o f c o mp e n sati o n
th e p re s e n c e o f s tr ai n i mb al an c e re q u i re s k n o w ledge o f
th e s tr u ct u re o f re c ip r o cati n g p art s
The fe et p re sent so m e i n tere sti n g m e c hani s m s fo r
re sp o n di n g to th e n e ed s o f th e b o dy i n balanc i ng i n th e
E very c h an ge i n s h o e las t c all s fo r a
u p ri ght p o s iti o n
,
.
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,
‘
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'
,
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,
'
.
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PR I N C I PL E S
F IG
1 45
o f th e
.
An
.
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t
Vi ew
e r i or
of
old
f
t
O F O S TE O PA TH Y
r ac u r e
s cap h o i d
.
F IG
S i de Vi ew
s c ap h o i d
1 46
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.
the
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ol
of
d
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f
t
r ac u r e
.
th i s gr o o v e w as de c i d edly app are n t F i g 146 P alp ati o n
whi le th e we igh t w as o n th e ar ch se em e d to i n di c ate th at
th e tibi a an d fib u l a h e ld a re lati o n to th e astr ag alas sim
n
x
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f ac e o f th e as tr ag al u s w as b e ari n g th e weight The sh o rt
l
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tu di n al a c
a
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with
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igh
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o nt
an l
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dil ate d ve i n s an d d u l l p ai n i n th e arc h an d l e g but no
n
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ll
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x
s
f
ti
m
bi
l
ity
e
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te
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lo s s o f u n c o n (
m et at ar s al arti c u l ati o n s ) we re i n di cative o f so m e de c i ded
o
u
a
n
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PR I N C I P LE S
F IG
g
t
1 47
Rad i o
d i s p la c e m e n
.
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r aph
of
of
an
th e a s
Ol d
t a g al
r
O F O S T E O PA TH Y
f
t
r ac u r e
us
of
th e
s c ap h o i d
34 7
an d c o n s e q u e n
t
.
m o vem e n t s w as th at i n v er s i o n an d ever si o n o f th e f o o t
t o o k p lac e with th e f o o t i n th e n o rm al re lati o n to th e le g
as th o u gh it w as e x te n d ed
th u s dem o n str ati n g th at th e
astr ag alu s w as i n f ac t i n a p os iti o n o f e x te n si o n
ev en
th o u gh th e f o o t app e are d n o t to b e s o
The c o n diti o n o f thi s f o o t i s e x c eedi n g ly i n tere sti n g
wh e n th e hi st o ry i s c o n s idered M r C s ay s hi s f oo t was
i nj u re d by a large r o c k whi c h a fe llo w w o rkm an acc i
de n t ally dr o ppe d
Th i s acc i d e n t t o o k p la c e f o ur ye ar s
ag o wh i l e h e w as w o rki n g i n a m i n e
The f o o t s we ll ed
s light ly
i e to ab o u t i ts p re s e n t s iz e an d w as p ai n f u l
bu t di d n o t i n c ap ac it ate h i m fo r w o rk
C l aim s h e n ever
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P RI N C I P LE S
348
l o st
a
day
on
i ts
acc o u n
t
O F O S T E O PA TH Y
an d
,
it
w as
n o t e x am i n e d
'
by
a
phy si c i an The s we lli n g gr ad ually s u b si de d an d th e f o o t
g ave h im n o i n c o n ve n ie n c e fo r th re e ye ar s e x c ept i n th e
m atte r o f fitti n g a sh o e R e c e n t ly s we lli n g an d p ai n h ave
d eve lo p ed
.
,
.
.
F IG
gr
fr t
of
th e
R a d i o a p h o f an o l d
ac u r e
1 48
of
r ot
a i on
s cap h o i d
s ho w i n
c o m p e n sa or
th e
oo
o n to i ts o u te r m a r i n , to a v o i d tr a n s
th e
od
m i t in
w e i h t th r o u h th e l o n i
tu d i nal a r c h
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f t
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PR I N C I PL E S
350
O F O S TE O PA TH Y
—
n
a
i
n
ter
n
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l
c
u
eif
rm
fir
s
t
m
et
t
a
r
s
a
l
i
b
d
y
h
o
i
l
d
s
a
p
di st o rted The re lati o n s o f th e m et at ar s al s as sh o w n i n
th i s il lu s tr ati o n i n di c ate th e t e n de n cy to thr o w th e
weight o n th e o u t e r edge o f th e f o o t The s ide vi e w
149 dem o n str ate s ag ai n the d i s lo cati o n o f
sh o w n i n F i g
th e h e ad o f th e astr ag alus d o w n w ard to a p o s iti o n u n d er
th e s caph o id The scaph o id sh o w s an i rreg u lar o u t li ne
o
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an d
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,
P l a n ta r
i m p r e ss i o n s h o w
of
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ure
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d o w n w ar d
s ca p h o i d a n d
conse qu e n
m o v e m e n t o f th e h e ad o f th e a s
tr a g al u s
F IG
i ng
.
150
ff
.
.
f
t
O F O S TE O PA TH Y
PR I N C I PLE S
3 51
‘
th o u gh h avi n g b e e n fr ac t u re d an d rep ai red le avi n g i r
reg u lar m as s e s o f callo u s
A n imp re ss i on o f th e p lan t ar su rf ac e o f th e f o o t w as
ake n
Fi g 150
Th i s sho w s the gre at i nc re as e i n c o n
t
t ac t su rfac e e s p e c i ally u n der th e he ad o f the astr ag alu s
An o th er i n tere s ti n g th i n g d em o n str ate d by thi s i mp re s
si o n i s th e c h an ge th at has t ake n p l ac e i n th e s e co n d m et a
t ar sal and s e co n d to e Bo th h ave b ee n e l ev ated so th at
they n o l o n ger be ar m u ch di re c t weight The thi rd an d
at ar s al s ar e b e ari n g th e di re c t app l i c ati o n o f
f o u rth m e t
th e weight o f the b o dy
In o rde r to m o re c l ear ly an alyz e thi s c as e we wil l
c o n s i de r
s o m e g e n e r al fu n dam e n tal i de as co n c er n i n g t
he
The f o o t act s p ri
fo ot
s t r u c t u re an d f u n cti o n o f th e
m ari ly as a p as sive su pp o rt o f the b o dy weight ; s e c o n
dar i ly as an ac tive l eve r to m o ve th i s weight as i n r u n
n ing
In o rder to p erf o rm the s e fu n cti o n s i t m u st h ave
e lasti c ity an d ad apt abi li ty th u s p e r m itti n g it
stre n g th
o p r o te c t it fr o m
o as su m e v ari o u s attit u de s n e c e ss ary t
t
i nj u ry S i n c e th e p rim ary f u n c ti o n o f th e f o o t i s to act
he i n tegrity o f the l ig am e n t s i s e s s e n ti al
as a s u p port
t
Wh e n th e f oo t i s p ass ive u n der weight th e ar ch e s s ett l e
The ar ch as a wh o le i s e lasti c bu t th e l igam e n t s
s l i ght ly
The el asti c ity o f th e ar c h i s th e re s u lt o f th e
ar e n o t
m o vem e n t o f th e b o n e s i n t o a p o s iti o n wh ere th e lig a
M u scle s l ig am e n t s an d th e
m e n t s re c eive th e weight
p lan t ar fasci a all s erve to s u pp o rt th e f o o t bu t wh e n
p ass ively be ari n g th e weight o f th e b o dy th e lig am e n t s
b e ar th e s tr ai n L o ss o f e lasti c ity 1n th e f o o t cau se s i n
c re a
s e d p re ss u re o h
p o i n t s o f c o n t ac t o n th e so l e o f th e
f o o t al so o n th e t o e s The s k in th i c ke ns o v er th e se b o ny
co n t ac t p o i n t s i n an e ffo rt to co mp e n s ate fo r lo ss o f e las
ti c ity
th u s co r n s an d call o u s e s ar e evide n c e s i n m an y
c ase s
o f c o mp e n sati o n an d s h o u l d i n di c ate th e n ec e s s ity
fo r a c aref u l e x am i n ati o n o f th e s tr u c t u re o f th e f o o t
In th e attit u de o f re s t th e astr ag alu s r o t ate s s l igh t ly
i n w ard an d d o w n w ard o n th e o s calc i s th u s m aki ng th e
as
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PRI N C I PLE S
3 52
O F O S TE O PA TH Y
h e ad o f th e astr ag alu s s o m ewh at p r omi n e n t o n th e i nn e r
s id e
o f th e
fo o t
Thi s m o v e m e n t i s c h e c ke d by lig a
m e nt s an d thi s p o siti o n o f fi x ati o n rem o ve s all s tr ai n fr o m
th e m u s c le s In th e c as e we ar e st u dyi n g the c alc an e o
s c aph o i d
lig am e n t w as t o r n h e n ce th e r o t at io n o f th e
astr ag al u s i s li mite d o n ly by c o mp re ss i n g th e s o ft ti ss u e s
o f th e so l e ag ai n s t th e fl o o r
as i s evide n c ed by th e i m
pr ess i o n alo n g th e i n n er b o rder o f th e f o o t i n F ig 150
The p o siti o n o f th e h e ad o f th e as tr agal u s u n d er th e
s c aph o id r ai s e s th e i n n er b o rde r o f th e f o o t an d th r o w s
th e weigh t o n th e o u ter b o rd e r a n at u r al c o mp e n sat ory
p o s iti o n F r o m th e f o reg o i n g w e j u dge th at thi s f o o t i s
a p oor
p as sive s u pp o rt Alth o u gh it ha s d o n e g o o d
s ervi c e fo r n e ar ly f o u r ye ar s i t ha s n ever b ee n ca ll e d ii po n
u n ti l withi n th e p re s e n t ye ar
to ac t fo r lo n g p e r i o ds o f
tim e as a p a ss ive s u pp o r t H e ret o f o re thi s f o o t has
ad apte d
it se l f to u n eve n su rf ac e s p r o d u c i n g! co nst ant
v ari ati o n o f p re ss u re
No w th at c o n t ac t wit h s m oo th
h ard p avem e n t give s n o o pp o rt u n ity fo r sh ifti n g o f weight
and alte rn ati n g co n tr ac ti o n o f m u s c l e s
i t f ai l s a s a S u
p
p o rti ng m e ch an i s m S te ady pre ssu re o f th e h e ad of th e
as tr ag al u s o n th e s o ft ti ss u e s o f th e pl an t ar su rf ac e 1n t e r
fe r e s w i th c ir c u lati o n c au s e s edem a an d p ai n
The s e c o n d ary f u n c ti o n o f th e f o o t i s as a l eve r i n
We d ivid e the s e
ac tive ly r ai s i n g an d p r o p e lli n g th e b o dy
f u nc ti o ns i n t o prim ary an d s e co n d ary be c au s e a f o o t th at
m ight se rve as a g o o d p as sive S u pp o rt might p o s s e ss n on e
e lem e n t s req u i re d i n r u n n i n g A WO o de n
o f th e ac tiv e
f o o t w o u ld s e rve as a s u pp o rt bu t n o t a s an active l e ver
The h e ad s o f th e m et at ar s al b o n e s act as a f u lc r u m , th e
th e weight re s t s o n th e
c al f m u sc l e s f u r n i sh th e p o we r
Wh e n th e f o ot is u sed n o rm ally th e li n e o f
as tr ag alu s
weight p as s e s d o w n w ard th r o u gh th e c e n ter o f the k n e e
h e n c e f o rw ard alo n g th e li n e o f th e
an d an k l e j o i n t s
The f ac t th at th e i n n er sid e Of th e f o o t i s
oe
s e co n d t
l o nge r th an th e o u ter cau s e s th e s tr ai n re s u lti n g fr o m
l ifti ng th e weight Of th e b o dy o ver th e f ul cr u m to b e car
-
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P R I N C I PL E S
3 54
O F O S TE O PA TH Y
C H A P TE R X V I I
.
I NH I BI TI O N
.
—I
—
i biti
We h av e n o te d in a fo rm er
c h apt er th at th e attrib u te s o f n erv o u s ti ssu e ar e i rrit abil it y
We m ay add to th e s e ac
co n d u c tivity an d tr o phi c ity
We do n o t u s e th e term s sti m u
c e le r ati o n an d i n h ibiti o n
l ati o n an d i nhibiti o n as de n o ti n g Opp o site Co n diti o n s be
o th e i n iti ati o n o f an i mp ul s e
c au s e s t i m u l ati o n app l i e s t
Th i s i mp u ls e m ay b e acc el er at ory o r i nhibit o ry i n ch ar ac
te r We m ay sti m u late a n erve wh o s e c h ief f u n c ti o n i s
i n h ibiti o n A n imp u ls e wh eth er accl e rato r y o r i n h ibi to ry
i n c h ar acte r i s th e re su lt o f st
im u l ati o n
A ll b o d i ly fu n cti o n s re q u ire stim u l ati o n i n th e s e n se
we h ave u s e d the term i e s o m ethi n g m u st i n iti ate an
i mp u l s e wh i c h i s d e s ig n e d to e x c ite ac tivity After thi s
activi ty i s st arte d
it m u s t b e go ver n e d I t i s th e m e an s
h e s e ac tiviti e s we ar e i n tere ste d i n s t u dyi n g
o f g o ve r n i n g t
Acce l e r ati o n
nh
on
.
.
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,
.
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,
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.
,
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,
.
,
M u s cu lar
.
—
i
M u scl e m ay
C o ntr act o n
b e s i m u l ate d to
Thi s c o n tr ac ti o n m ay b e i n c re ased o r de
c o n tr ac ti o n
th u s s ho w i n g that afte r i n i tiato ry i m pu ls e st art s
c re as ed
to th e p o i nt o f co nver s i o n i n t o w o rk d o n e by
o n i ts w ay
th e m u scl e it i s acc el e r ated i n c re as e d o r i n h ibited r e
by c ert ai n i n fl u e n c e s whi ch we c an n o t e as ily
s tr ai n e d
The co n tr ac ti o n and rel ax ati o n ph e no me n a o f
an alyz e
m u sc l e ar e eq u al ly i mp o rt an t V aso c o n stri cti o n an d v aso
di lati o n ar e e x ampl e s o f th e s e ph e no m e na
.
~
,
,
,
,
,
.
-
.
.
—
The ac tivity o f s e c ret o ry ti ss u e s i s reg u
S e cr e ti o n
lated by so m e arr an gem e n t si mil a r to th at c o n tr o l li n g m u s
Afte r a c ell be c o m e s ac tive i t i s s ti ll u n der
c u lar ac ti o n
.
,
PR I N C I PLE S
O F O S TE O PA TH Y
3 55
th e c o n tr o l o f a g o ver n i n g c e n ter wh i ch acc e l er ate s o r
i n h ibit s acc o rdi n g to th e ne c e s siti e s o f th e c ase
Acce l e r at i o n an d Inhi b iti o n as Att r i b u t e s o f Ne r v e
Ti ssu e —C e lls ar e f u ll o f p o te n ti al e n ergy whi ch n e ed s a
i c e nergy
o k in e t
We
stim u l u s to s t art i ts c o n ve r s i o n i n t
m ay as k o u r s elve s th e q u e s ti o n ; Why i sn t all of th e po
o r in
te n ti al e n ergy co n verte d i n t o ki n eti c at o n e tim e
re sp o n se to a s m g le stim u lu s ? I f th e e x pl o sive m ateri al
—
i n a m agazi n e i s i gn ited it all e x p lo de s th ere i s c o mp l ete
The re i s n o
c o n ver s i o n o f p o te n ti al i n t o ki n eti c e n ergy
The el em e n t
r e str ai n i n g
or
acc e ler ati n g i n thi s c as e
nit r o ge n wh o s e l ib er ati o n in th i s ca se c au s e s su ch dire
re s u lt s i s th e sam e e l em e nt i n th e c e ll s w
h o s e lib er ati o n
“
”
i s n o te d as w o rk
d o n e by m u s c l e o r glan d Why i sn t
all the n it r o ge n i n th e c ell s l ib er ated by a s i n gl e s tim u l u s
?
i
h
We c an th i n k o f n o e x pl an ati o n e x
as n t e m ag az i n e
i mp u l se s p ass i n g o ver n erve s ar e q u al ifie d by
c ept th at
o the r imp u ls e s p as si n g o ver o th er n erve s
th e tw o sti m u l i
o f Opp o s ite
th u s m o difyi n g e ac h o th er o r i n
c h ar ac ter
n
a
d
di
g
th
ei
so m e c as e
r f o r c e s wh e n o f like ch ar ac ter
s
io n as an attrib u te o f th e n erv o u s sy stem d o e s
I nhi bi t
n o t s eem to b e e x er ci s ed i n s h o rt refl e x ar c s n eith er d o e s
it app e ar to b e e x er c i s ed by c e nter s in th e S pi n al c o rd
It m ay b e th a
t a c ert ai n a m o u n t o f i n hibit o ry i n fl u e n c e
i s e x erted i n th e s e s u b s i di ary c e n ter s bu t th u s far i h
i o n s d em o n str ate thi s attrib u t e to b e p o ss e s se d by
v e s ti g at
th e br ai n c ell s
Inhi bit i o n a No r m al Att r i bu te o f the C e n t r al Ne r v o u s
S y ste m —I n h ibiti o n i s a n o rm al re str ai n i n g i n fl u e n c e po s
s e s s ed by th e c e n tr al n e rv o u s s y s tem
Wh e n th e o s te o
p ath i c phy s i c i an sp e ak s o f i nh ibiti o n h e m e an s a th er a
i
e
u
c
t
o
c ed u re
pr
wh i ch e x er ci se s a re str ai n i n g i n fl u e n c e
p
o ver so m e f u n c ti o n
th i s re str ai n i n g i n fl u e n c e b ei n g i n d e
p e n den t o f th at i n hibiti o n wh i c h i s an attrib u te o f th e
c e n tr al n erv o u s sy s tem
A n ythi n g wh i ch de c re as e s th e n u mb e r o r s tre n gth o f
s e ns o ry imp u l s e s r e achi n g a refl e x ce nt
e r i s i nh ibit o ry i n
,
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P RI N C I PL E S
3 56
O F O S TE O PA TH Y
h ar acter The m e di cal p r o fe s si o n has m ade u se o f a large
n u mbe r o f ag en t s fo r th i s p u rp o s e o p i u m fo r e x ampl e
H i s t o r y — I n h ibiti o n i s a w o rd f o u n d i n l ite r at u re
b e ari n g o n th e ph e n o m e n a o f th e n erv o u s sy s tem It i s
we ll fo r u s to i nve stig ate th e h i s t o ry o f th i s w o rd an d
th e ph e n o m e n o n wh i ch it i n di c ate s
The ph e n o m e no n
whi ch o c cas i o n e d the u se o f th i s w o rd w as fir st o b served
by th e br o th e r s W eb e r ( 18 4 5 ) an d m any i nve s tig at o r s
h ave s i n c e c o nfirm e d it Th ey n o te d th at e x c it ati o n o f
fib er s o f th e p n e u m o g astri c n e rve o cc asi o n e d sl o wi n g o r
Thi s n e w ph e
s t o pp age o f th e co n tr ac ti o n s o f the he ar t
n o m e n o n m u s t h av e a d e s ig n ative te r m h e n c e th e w o rd
“
”
s t o pp age
w as u s e d m e an i n g th e arre st o f ac ti vity o f
The
an o rg an by ar o u s i n g ac tivit y i n a n erve su pp lyi n g it
“
”
—
w o rd i nh ibiti o n w as p r o po se d later by Br o w n S e q uard
an d has rem ai n e d i n u se
to th e e x c l u s i o n o f th e e arl i er
t erm s
A fte r o b s ervi n g th e ph e n o m e n o n o f n erve arre st i n
th e h e art o th e r ph e no m e n a o f a so m ewh at s i mi lar ch ar ac
ter were gr o u p e d u n de r the sam e h e ad Th u s we fi n d th e
term i nhibiti o n c o n fu se d with s u ch ph e no m e n a as th e
p ar aly s i s o f m o t o r n erve s by c u r are l o ss o f s e ns ati o n f o l
lo wi n g th e i n h alat i o n o f c h lo r o f o rm sh oc k an d f atig u e
We c an th u s re aliz e th e gre at co nf u s i o n o f m e an i n g s
Late r i nve s tig at o r s re alized th e
att ac h e d to thi s t erm
e sse nti al di ff e re n c e s i n th e s e ph e n o m e na an d drew atte n
ti o n to th e f ac t th at p ar aly si s s h o c k an d f atig u e were n o t
c o mp ar ab l e t
o th e ph e n o m e n o n o f arre st o f c ardi ac co n
tr act i o n f o llo wi n g stim u lati o n o f th e p n e u m o g astri c
“
M o ro t s ay s In o rd er to p reve n t th i s co n f u si o n it i s n e c e s
o ret u r n to th e e x p e rim e n t al d at u m wh i c h l i e s at th e
s ary t
f o u n d ati o n o f th e c o n c epti o n o f i n h ibiti o n Thi s app e lla
ti o n wi ll b e give n to every ph e n o m e n o n rep r o d u ci n g th e
ch ar ac ter s an d th e e ss e n ti al c o n diti o n s Of st o pp age o f th e
”
h e art by th e stim u lati o n o f th e v ag u s n e r v e s
—
P ar aly si s sh o c k f atig u e an d i n
Ar r e s t o f Acti v i t y
hi bi ti o n all s ig n ify arre st o f activity bu t ar e n o t sy n o ny
c
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O F O S TE O PA TH Y
P RI N C I PL E S
3 58
th at wh i ch c all s f o rth co ntr ac ti o n M u sc u la
r rep o se
re s u lt o f n erve activ ity Th i s is th e i mp o rt an t p o i nt
pr acti cal c o n si de r ati o n o f i nh ibiti o n
.
th e
th e
is
.
in
,
.
Thr e e Char ac ter i sti cs
of
the
Ne r v o u s S y s t e m
.
—
The
e rv o u s sy stem d u ri n g i ts d eve lo pi n g p eri o d S h o w s th re e
s p e c i al ch ar ac teri s ti c s
i e it eith er app r o p ri at e s o r pr o
—
n
d u c e s e ergy i t i s u n d eterm i n e d ho w th e e n e rgy i s se
cu r e d
tr an s m i ts e n ergy an d las t ly ret ai n s th e di sc harge
The las t c h ar acteri s ti c i s i nh ib iti o n
o f e n ergy
n
,
,
.
.
,
u
,
.
.
D e v e lo pm e n t o f I n hi biti o n — Wh e n w at chi n g th e m o ve
m e n t s o f a y o u n g b ab e we ar e am u sed by th e i n c o o rdi nat e
A t th i s s t age i n i ts devel o p
ac tivit y o f i ts e x trem iti e s
m e nt i n hibiti o n is n o t an acc o m plishe d fu n cti o n o f i ts
n erv o u s sy ste m
The b l adder an d b o we ls act r e fl e x ly
If
i nh ibiti o n d eve lo p s n o rm ally the c h il d so o n c o n tr o l s de
fe c ati o n a n d m i c t u riti o n ; if n o t a c as e o f e n u re s i s e x i st s
u n til su c h ti m e as th e i n h ibit o ry f u n c ti o n i s devel o p e d i n
th e c e n tr al n erv o u s sy stem
,
.
i
'
,
‘
.
.
,
,
,
.
Ne u r o ti c D i at he s i s Cho r e a —The we ll re c o g n ize d f act
.
,
th at m any c hil dre n ar e e as ily pre c i pit ated i n t o th e co n
el o p e d co n di
v u l si v e s t ate i s an evi d en c e o f th e p o o rly de v
ti o n o f thi s thi rd attrib u te o f n erv o u s ti s su e s The so
o m e an l ittl e m o re th an
cal l e d n e u r o ti c di ath e s i s s e em s t
f au lty d ev el o p m e n t o f i n h ibiti o n I n hib i ti o n m ay deve lop
i n a fairly n o rm al m an n er b u t o n ac c o u n t o f n u triti o n al
b e i n p art i mp aired
e n v i r o n m e n to r acc i d e n t
co n diti o n s
An e x ampl e o f th i s i s e x h ibite d by th e we ll k n o w n u n
I mp ai rm e n t o f the i n
c o n tr o ll e d m o vem e n t s i n c h o re a
hi bi to r y fu n c ti o n o f th e c e n tr al n erv o u s s ys tem w o ul d
s e em to b e s u ffi c ie n t c au s e fo r c h o re a
,
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‘
~
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—
P ar alys i s A git ans To c arry o u r th e o ry i n t o l ater life
we m ay t ake p aralys i s agit an s as an e x amp le o f th e i m
p ai rm e n t o f th e i nhibit o ry f u n c ti o n o f th e c e n tr al n e r vo u s
Thi s f u n c ti o nal n e u r o n i c di s e ase p re s e n t s n o l e s i o n
sy s tem
wh i ch has be e n det ected u p to th e
o f th e n erv o u s ti s su e
.
.
,
PR I N C I PL E S
3 59
I t m ay b e th at f u t u re s t u dy o f n erv e ti ss u e
w ho s e p u rp o se i s i n
a d e l i cate m e c h an i s m
p re s e n t tim e
wi ll di s co ve r
.
hi biti o n
O F O S TE O PA TH Y
,
,
.
D e v e lo pi n g In hib i ti o n by Tr ai ni n g —The f u n cti o n al
ac tivity o f n erve ti ss u e i s au gm e n te d by u se j u st as m u sc u
K n o wi n g thi s
lar p o we r i s e n h an c ed by p r o p e r tr ai n i n g
fac t i s evi de n c e d eve r ywhere i n th e fie l d o f e d u cati o n al
e n d eav o r ; we feel th at i n hibiti o n as an i mp o rt an t f u n c ti o n
of t
he n erv o u s s y stem ( i n f ac t we m ay call it a pr o te c
tive f u n c ti o n ) sh o ul d b e r e c o g n ize d an d c u ltiv ated e ar ly
i n l ife
The we ll tr ai n e d c hi l d i s th e o n e p o s s e ss i n g a
we ll b alan c e d ne rv o u s s ys tem S u ch a chi ld do e s n o t h ave
s p as m s b e c au s e ap petite an d d e s ire h ave b ee n tr ai n ed
an d
t he s e vi rt u e s o f se lf co n t r o l m an ife s t th em s e lve s i n n erve
p o we r an d Co n tr o l Th u s do we fi n d th e co n s i de r ati o n o f
a p u re ly s c ie n tifi c asp e c t o f th e d eve l o p m e n t o f th e n e r v o u s
s y stem l e a d s u s i n t o th o u ght s co n c e r n i n g m o r al d evel o p
m e n t o f th e u n it s o f h u m an so c iety Thr o u gh su ch s t u die s
a s th i s th e phy s i c i an b e co m e s an imp o r t an t fac t o r i n th e
de v e lOpm e n t of a p r op e r an d he alth f u l s o c i al life
i
,
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,
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,
-
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'
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-
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—
P
No w to ret u r n to an
we call y o u r atte n ti o n to a few
o th er vi ew o f o u r su bj e c t
o f th e re c o g n iz e d ph e n o m e n a co n s t an t ly p r e s e n ted to u s
by o u r e ffo rt s to all evi ate di s e as e co n diti o n s W e k n o w
by m an y e x p eri e n c e s th at by p re s su re o n th e su rf ac e o f
th e b o dy o ver th e c o u r s e o f a n erve b u n d l e a re str ai n i n g
i n fl u e n c e i s o fte n e x er c i s ed Over th e f u n c ti o n o f th e ti s su e
E ve n m o re
r e ce 1v 1n g th e termi n al s o f th at n erve b u n d l e
i n tere s ti n g i s th e o b s erved f ac t th at a re s tr ai n i n g i n fl u e n c e
e d o n ti ss u e s rem o te fr o m th e p o i n t o f p re s
i s o fte n e x er t
wh i ch do n o t re c eive any o f th e term i n als o f th e
s u re
bu t re c eive term i n als o f
n e r v e whi c h i s pre s s ed u p o n
o the r ne rve s fr o m th e sam e s egm e n t o f th e c e n tr al n erv o u s
W e m ay eve n g o f arth er an d say th at i t i s n o t
s y s tem
an u n o b s erve d ph e n o m e n o n to h ave f u n c ti o nal ac tivity
o te
re s tr ai n e d in very re m
ti s su e s wh i ch do n o t seem
Inhi bi to r y
E ff e ct
of
r e s su r e
.
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-
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,
O F O S TE O PA TH Y
PR I N C I P LE S
360
rdi nari ly to b e i m me di ate ly c o n n e cte d with th e s egm e n t
o f n erve
ti ssu e dire ctly aff e cted
Thi s di ffu si o n o f r e
i n fl u e n c e s f o ll o wi n g e x ter n al p re ss u re w o ul d
str ai n i n g
o p o i nt t
o th e p r o b abi lity th at th e pr es su re ac t s as
s e em t
m e chan 1 s m 1n th e c e n tr al
i n hibit o ry
a s tim u l u s to
an
n e rv o u s sy stem
I f thi s we re no t s o w e co u ld n o t e x p e ct
refl e x re str ai n i n g e ff e ct s su c h as we ar e c o nst an t ly
an y
A s e x amp l e s o f p re ss u re e ff e ct s l et u s cal l at
s e eki n g
te nti o n to p re s su re o f th e s u b o cc ip it al n e rve s i n cas e s o f
h e ad ac h e Th e se n erv e s ar e i n p o s iti o n to b e c o mpre s s e d
The e ff e c t o f co mp re s s i o n s e em s to b e
ag ai n s t b o n e
man ife ste d p e riph er ally by a de cr eas e i n p ai n P ai n i n
th e abd o m i nal vi sc er a can freq u e n t ly b e l e ss e n e d to a
very app re ci ab l e e x te nt by e x ter n al pre ssure m ade o ve r
th e p r o p er ass o ci ate d S p i n al are a In thi s we h ave a g o o d
e x amp l e o f th e refl e x e ff e c t o f p re ssu re w hi ch s ee m s to
i on of a
u ph o l d th e i d e a th at p re ssu r e i s re ally s tim u lat
f u n c ti o n re si di n g i n th e c e ntral n erv o u s ti ss u e s
P re s
s u re Over th e sacral n erve s i n a wo m an p a ss i n g th r o u gh
th e m e n o p au s e an d tr o u bl e d by irreg u l ar h e art actio n has
b e e n k no wn to b e al m o s t im m ed i ate ly fo ll o we d by reg
u l ar h e art rhyth m
S i n c e the c ardi ac i rreg ul arity w as a
refl e x, o c c as i o n ed by di st u rb an c e o f th e sac r al pl e x u s th ere
m u s t h ave b ee n a r e adj u s tm e n t o f n erv o u s ac tivity du e to
I t s eem s very p r o b abl e th at a
so m e f o rm o f s ti m u lati o n
m o ve m e n t whi ch we n am e i n hib iti o n m ay i n re ality b e
a f o rm o f stim u lati o n wh i c h c alls f o rth a f u n c ti o n o f th e
!
c e n tr al n erv o u s sy s t em , th e
re s u lt an t ac ti o n o f th e c e n
tr al n erv o us sy stem b ei n g m erely evi de n c e o f th e f act th at
r e adj u s tm e n t t ake s p lac e as a se lf p re serv ative activ ity ,
i e a m an i fe st ati o n t o w ard th e n o rm al
D os ag e —W e ar e l ike ly to b e mi sled i n t o th e f at u o u s:
b e li ef th at i f we give j u st e no u gh stl m u lati o n o r i nhibi
ti o n i n a give n c ase i e if o u r d o sage is j u st right We
wi ll get p erfe ct re s u lt s Th i s i s th e o l d s t u mb li n g b l o c k
D ev o te e s o f the s e sy stem s
o f h o m e o p athy an d al l o p athy
beg u i le th e mse lve s with th e i de a th at sp e c ifi c ity o f d o sage
o
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PR I N C I P L E S
3 62
O F O S TE O PA TH Y
i nc re ase d w o rk i n m u s cle an d gl an d s o m etime s to th e p o i nt
o f e x h au stio n
To d e c re ase th e am o u n t o f w o rk we m u st
de c re as e th e n u mb er o f st i m u li The stim u l i o rigi nate at th e
p eriph e ry o f s e n so ry n erve s
S e nso ry n erve s ar e m o st
n u m e r o u s 1 n th e ski n m u c o u s m embr an e an d m u s cl e
Inhi b
i to r y i n fl u e n c e s m u st b e appl ie d to o n e o r m o re o f th e s e
str u c t u re s
S ki n i s th e su rf ac e ti s su e ri chly s u ppli ed by
an d u n de r it ar e m u sc l e s
s e n s o ry n e rve s
al so wel l su p
pl i ed by s e ns o ry n erve s
—
l
L
H i to n s aw H ilt o n by sh o wi n g th at th e s ki n m u s
c l e s an d sy n o v i al m embr an e o f a j o i n t
mu s
o r th e ski n
cl e s o f th e abdo m e n an d c o n te n t s c o vered by p erit o n e u m
ar e i n n erv ated fr o m th e s am e s egm e n t o f th e c ord laid a
f o un d ati o n fo r th e r ati o n al u se o f i nhibiti o n i n o s te o p ath i c
p r acti c e
The r ape u ti c —
I nhi b iti o n—
I n h ibiti o n as a te rape uti c
p r o c e d u re c o ns i st s i n a ste ady d igit al p re s su re m ad e o ver
o r o ver an are a whi c h i s c l o s ely c o n
s o m e n erv e tr u n k
n e c te d with a spi nal s egm e n t fr o m w hi ch n e rve s p ass to
an i n ter nal v 1sCu s whi c h we de s ire to aff e c t
In o rde r to e x pl ai n th e n e c e ss ity fo r th i s m o vem e nt
an d i ts b e n efi c i al e ff e c t s we m u s t n o te th e ph e n o me n a o f
v aso m o ti o n
—
—
e
e
r
A
ct
V aso m o t o r c e nte r s
H OW V aso m o to r C nt s
act acc o rdi n g to th e s u m o f th e stim u l i r e achi ng the m
fr o m s ki n m u scl e g lan d s e tc I f th e se nso ry n erve s o f
o n e l ater al h al f o f th e b o dy a r e stim u l ated as by p ri c ki n g
with n eed l e s th e te mp e r at u re o f th at h alf Of th e b o dy
wi ll b e high er th an th e o th e r thu s d em on str ati ng t hat
e x c e ss ive s tim u l ati o n o f se n s o ry n erve s e n d s i n vaso
dil ati o n i e 10 5 5 o f t o n e o f th e m u scu l ar c oat o f the bl o o d
ve ss el s S i n c e e x c e ssive i e o ve r s tim ul ati o n o f s e n so ry
n erve s i n thi s e x p erim e n t c au se s i n hibiti o n o f v asc u l ar
t o n e an d hyp er aemi a re s u lt s we arg u e th at any p r o c ed u re
wh i ch l e ss e ns th e e x c e ssive am o u n t o f stim u l ati o n p ass
i n g to a v aso m o t o r c e n te r wi ll f av o r th e r et u r n o f th e
v ascu l ar t o n e Theref o re S i n c e it i s e asily dem o nstr ate d
,
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’
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,
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'
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-
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PRI N C I PL E S
O F O S TE O PA TH Y
3 63
th at di g it al p re ss u re l e s s e n s p ai n an d s e n s itive n ess i n th e
are a pre ss e d u p o n we k n o w th at th e regi s te ri n g p o wer o f
th e s e p eriph er al nerve s i s de c re a se d an d th e re re su lt s a
better v asc u lar t o n e i n th at are a
—
—
If o ver s ti m u la
O v e r sti m u l ati o n E qu als I nhibiti o n
ti o n re su lt s i n i n hibiti o n o f v as c u lar t one a s the ab o ve e x
i
m
n
n
n
e
r
e
s
eem
t
o
dem
o
tr
a
te
the
n
it
a
pp
e
a
r
r
a
ti
o
a
l
t
o
t
s
s
s
p
de c re ase th e— sti m u lati o n to a p o i n t wh ere v asc u lar t o n e
i s ri o t di s t u rb ed
Digit al p re s su re d o e s de cre as e th e ir
r it
l
abi li t
o
m
a
x
s
l
o
l
th
eref
re
w
e
e
pre
r
e
ve
f
w
s
o
u
s
a
o
s
s
s
;
y
y
I n hibiti o n o f s e n so ry n erve s i n s ki n an d m u s cle whi ch
ar e o ver s tim u lated
wi ll f av o r th e ret u r n o f v as cu lar t o n e
i n all are as whi ch ar e S u pp l ie d with n e r v e s fr o m th e s am e
s e m e n t o f th e co rd
g
O ver stim u lati o n o f s e n s o ry n erve s c au s e s v ascu lar
di lat ati o n
I n h ibiti o n l e ss e n s th e irrit abi lity o f s e n so ry
n e r v e s an d h e n c e d e c re as e s th e n u mb er o f s ti m u l i re ach
o r c e n ter s
th u s allo wi n g a ret u r n o f v as
i n g th e v aso m o t
e
c u lar t o n
—
h
o
I
K n o wi n g th e
The G uide f o r t e U s e f nhi biti o n
n erve tr u n k
we m ay j u dge
co mp l et e di strib u ti o n o f any
th e c o n diti o n o f th e i n ter n al str u ct ure s su pp l i e d by o n e
by the phy s i o lo gi c al ac tivity o f su rfac e
o f i ts br an ch e s
ti ssu e s su ppl i ed by o th er s o f i ts b r an ch e s In thi s w ay
we ar e g u i ded as to o u r u se o f i n h ibiti o n
P atho l o gi c al Chan g e s W hi ch Acc om pany O v e r sti m u
l ati o n — If an i n divi d u al e at s a h e arty m e al an d b ef o re it i s
dige sted e at s an o th e r an d co n ti n u e s th e p r o c e s s th e sti m u
lati o n o f th e s e n so ry n erve s i n th e m u co s a o f hi s dige s tiv e
vi sc er a r e su lt s i n a phys i o lo gi c al hyp er aemi a w hi ch u n de r
th e c e as e l e ss stim u lati o n o f th e p re s e n c e o f f o o d fi n al ly
b e co m e s c hr o n i c The l iver be c o m e s hyp er aem i c an d i ts
s e n so ry n erve s a r e s tim u late d by th e i nc re as e d am o u n t o f
Th e s e s e n s o ry n erve s
bl o o d pre s e n t i n th e cap i llarie s
do n o t re gi ste r th ei r i mp re s si o n s o n th e s e nso ri u m o f th e
b r ai n bu t do e x c ite th at are a o f th e S pi n al co rd w ith whi ch
th ey ar e c o n n e c te d by m e an s o f th e r am i co mm u n i can te s
,
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PRI N C IPL E S
364
Thi s
O F O S TE O PA TH Y
re a o f th e spi n al co rd lie s betwee n the s i x th an d
te nth d o r sal s pi n e s F r o m th i s are a n erve s p ass to th e
d ee p m u sc le s o f th e b ac k The s e m u scl e s ar e e x c ited to
u n d u e c o n tr ac ti o n
an d th ei r s e n so ry n e rve s ar e th ereby
m ade s e n sitive The capi llary c ir c u lati o n i n th e s e m u scl e s
is poo r
th ereby i n c re asi n g th e m u scu lar se ns itive n e s s
Thi s m u s c u lar se n s itive n e ss o r r ath er i n c re as e d stim u la
ti o n o f th e s e nso ry e n di n g s i n th e m u sc l e s s e n d s a n e w
se t o f i m
p u ls e s to th e sam e are a o f th e spi nal c o rd s i x th
to th e te n th d o r sal an d th e c o rd refl e x e s th e m b ac k to th e
Th u s a fig u re 8 i s f o rm ed with th e
symp ath eti c s y s te m
u n i o n o f th e c i r c l e s repre s e n ti n g the spi n al co rd
W ith
imp u ls e s e n t eri n g th e co rd fr o m b o th lo o p s symp ath eti c
an d c e reb r o s p i n al
th e c o rd it s e lf b e co me s hyp er aem i c
The c o n st an t i n ter c h an ge o f refl e x e s wh i c h were o r 1g 1n ate d
by e x c e s s ive dem an d s o n th e phy si o lo gi cal activity o f th e
ti s su e s i nv o lve d either e n d s i n a s p asm o di c eff o rt o f n a
t u re to ri d it s e lf o f th e i n t o l er abl e c o n diti o n by m e an s o f
“
a
bi l i o u s s p e ll o r th e hyp er ae mi a c au se s e x c e s sive s e c re
ti o n o f m u c o us hyp ertr o phy o f c o n n e c tive ti ss u e an d
atr o phy o f p are n chym at o u s ti ss u e
The bi li o u s s p e ll i s
n at u re s safety v alve
Afte r su c h a co n d iti o n a s we
R ati onal Tr e atm e n t —
h ave de sc rib ed i s wel l e st ab li sh ed di eti n g m ere ly l e ss e n s
th e refle x e s in th e symp ath eti c p o rti o n o f o u r fig u re 8
The refl e x e s i n th e c erebr o spi n al p o rti o n ar e s ti ll ac tive
be c au s e th e d eep m u scle s o f th e b ack h ave b e c o m e c h r o n
i c ally c o n tr ac te d an d c o n ti n u e to o ve r s ti m u late th e se n
Th e s e c erebr o spi nal refl e x e s sti ll he lp to
s o ry n erve s
m ai n t ai n th e hyp e r aemi a o f th e s pi nal c o rd wh i c h co n
ti n ne s to d i st u rb th e rhyth m o f th e symp ath eti c M an i
th e tre atm e n t m u st co n sid e r b o th p o rti o ns o f th e
fe stly
fig u re 8 Di eteti cs wi ll l e s se n to s o m e e x te n t the hype r
D igit al p re s s u re i nhibi
activity o f th e symp ath eti c lo o p
ti o n wi ll re lax th e spi n al m u scle s an d le ss e n th e hyp e r
The tw o li n e s o f tre at
ac tivity o f th e c ereb r o s pi nal lo o p
m e nt wi ll d e c re as e th e n u mber o f s ti m u li e n teri n g th e
a
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-
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PR I N C I P LE S
3 66
O F O S TE O PA TH Y
e cti o n with it Th eref o re if we aff e ct th e t o n us o f
b o th s ke let al an d i nv o l u nt ary m u s c le s s e n sati o n i n th e
"
c e reb r o s pi n al an d symp ath eti c s y s tem s
we c e rt ai n ly af
fe c t th e c alibe r o f blo o d ve s se l s an d th e activity o f s e c re
t o ry an d e x c ret o ry g lan d s
I t is n o t to o m u ch to say th at i nh ibiti o n d o e s n o t de
c e i v e c o n sc i o u s n e ss by l e s s e n i n g t
he p o wer o f regi s teri n g
n e rve s b u t d o e s st o p a s t o rm o f refl e x e s wh i ch h ave n o
rep arative te n de n cy an d th at it d o e s aff e ct th e are a o f lo w
s e n s ibil ity
as i s evi d e n c e d by a c h an ge i n th e c o n diti o n
o f i ts m u s c u lat u re
bl o o d s u pp ly a n d se cret o ry activity
Th e re ar e m an y o s te o p ath s w ho c o n te n d th at th e key
n o te o f all m an ip u lative w o rk
th i c
ac co rd i n g to o ste o p a
“
”
p ri n cip l e s i s the di sco v ery an d rem o v al o f a l e s i o n
o ss e o u s i n c h ar ac te r
With thi s i de a c arri e d to e x trem e
th e au th o r has n o symp athy
In co nn e cti o n with th i s
i de a th e s t u de n t i s referre d to th e ch apte r o n S u bl ux ati o n
p age 2 8 3
—
The P hr ase R e m o v e Le s i o ns
The ph r as e R em o ve
”
L e s i o ns i s a g o o d o n e an d yet it i s i n e x act i n m any
I t i s ah e las ti c ph r as e an d c ap ab l e o f many an d
c as e s
v ari e d i n te rp ret ati o n s E ach ye ar o f active p r acti c e add s
O u r l iter a
to th e o s te o p athi c id e a o f wh at l e si o n s ar e
t u re c o n t ai n s m any refe re n c e s to l e si o n s wh i c h ar e n o t
m e nti o n e d i n D r S ti ll s writi n g s an d yet D r S til l s b as i c
Oss e o us
w o rk has m ad e th e l ate r co nc epti o n p o ss ibl e
l e s i o n s h ave alw ay s b ee n p ar am o u n t i n o u r w o rk an d
tho u ght bu t m u s c u l ar l e s i o n s no w h o ld an eq u al p lac e
wh e n we se e m o re cle arl y i n t o th e
an d bi d f ai r to l e ad
s u bj e ct
—
M
B
I
l
e
h
m
The H um an
o dy
c an i s
s a Vit a
W e say
th at wh e n th e anat o mi c al i s ab so lu te ly co rre c t th e phy s i
”
Thi s c o n c epti o n is b as ed o n th e
o l o gi c al p o t e n ti ate s
The h u m an
st atem e n t th at th e h u m an b o dy i s a m ac hi n e
b o dy i s v ast ly m o re th an a m ach i n e I t i s a vit al m e ch
an i sm an d th e f ac t th at it i s v it al re n d er s it su s c eptibl e
to o th er i n fl u e n c e s be s i de s m e ch an i c al s u ch as f all s twi st s
co n n
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PR I N C I PL E S
O F O S TE O PA TH Y
36 7
t i
We m ay tr u th f u lly s ay th at wh e n th e
et
c
phys i o lo gi c al i s o ver ac tive th e an at o mi c al alig n m e n t is
di sarr an ged The p ri n c ip le s o f o s te o p athy as th ey were
fir s t p r o m u lg ated d e c lared th at a str u ct u r al defe c t i s at
th e b o tt o m o f every phy si o l o g i c al d efe ct
S tr u c t u r e al
w ay s aff e ct s f u n cti o n A s u ffi c i e n t n u mb er o f c as e s were
fo u n d to give a f o u n d ati o n o f f ac t to th i s s t atem e n t
H asty re aso ni n g tri ed to m ake thi s an all emb r ac i n g pri n
c ipl e, a
l
i
e
r
l
c
a
bl
e
o
ev
e
ry
c
a
s
e
o
f
di
s
e
a
O
th
e
s
c
h
o
o
s
t
s
p
p
The al lo p at hi c
o f m e di c i n e hav e m ade s imi lar mi st ake s
“
s c h o o l p r o m u lg ate d th e
law o f co n tr ari e s
The h o m e o
“
”
p athi c s ch o o l h o ld s alo ft th e law o f si m i lar s
Neit her
o f th e s e ar e l aw s
A law i s ab so l u te n o e x c epti o n s ar e
—
t o ler ated I f th ere ar e any e x c epti o n s to a so c all ed law
it c e ase s to be a law
s ra n s ,
.
-
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,
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,
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-
"
.
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'
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‘
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,
‘
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,
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.
—
By th e term in
hibi ti o n we do n o t attempt to c o n vey any o the r m e an i n g
th an th at o f pre s su re app l i ed at s o me p ar ti c u lar p o i n t o n
the su rf ac e o f th e b o dy fo r th e p u rp o s e o f l e ss e n i n g th e
hy pe r ac tiv ity o r hyp er ae s th e s i a o f th e imm e di ate o r s o m e
The i n h ibiti o n it se lf d o e s i n so m e
di st an t p art o f the b o dy
o c al l a l e mo n l n o th er
c as e s rem o ve wh at we m ay ch o o s e t
s e s it m ay
ca
make th e re m o v al o f a l e s i o n p o ss ib l e bu t
i n th e m aj o rity o f c as e s, i ts e ff e ct i s p u re ly o n th e n erve s
th e r eby acti ng On b o th th e m o t o r an d s e ns o ry p o rti o ns
l e s s e n i n g mus c u lar c o n tr ac ti o n an d p ai n
o f th e refle x ar c
eo pathi c M e ani n g
O st
o f Inhi b it i o n
.
,
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,
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‘
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r
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,
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,
T he S ci e nti fi c Us e Of I nhi bi ti o n
.
.
—It has b e e n p r o ve n
m any time s th at th e o s t e o p ath i s cap abl e o f ch e c ki n g e x
c e ss w e f u n c ti o n al ac tivity i n vi s c er a by th e s imp l e m e an s
o f i n h ib iti o n
S o m e w o u l d q u ibb l e as to th e c au s e o f th i s
The o rigi n al s tim u lu s m ay h ave di sapp e ar e d
ac tivi ty
bu t the refl e x e s whi c h it i n iti ate d m ay b e p erp et uati n g
th e c o n di ti o n M any c as e s h ave b ee n tre ate d in wh i ch n o
d efin ite c au s e o r o s se o us le s i o n c o u l d b e di s co ve r ed S o m e
o f th e s e c as e s c am e u n der th e h e adi n g I n di sc reti o n s
o th e rs
u n de r p u re ly m e n t al c o n diti on s
Th e s e ca
s e s were tre ated
.
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’
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PR I N C I PL E S
368
O F O S TE O PA TH Y
by i nh ibiti o n b as ed o n a k no wl edge o f th e an at o my an d
The tre atm e n t w as
phy si o lo gy o f th e p art s i nv olve d
We ar e su re th at su ch su cc e ss e s ar e j u s t as
s u cc e s s f u l
gr atifyi n g j u s t as sc ie n tifi c as ar e th o s e in wh i ch th e fi n d
i n g an d red u c i n g o f a s u bl u x ati o n bri n g s th e g lo w o f tri
u mph to th e eye o f p ati e n t an d phy s i c i an alike
,
.
.
,
,
.
I nhibiti o n as a L o cal An ae s t he ti c —I nh ibiti o n i s a lo c al
i s b ei n g u s ed u n iver sally i n the
anae sth eti c
an d as s u c h
hi c p r o fe ss i o n t o d ay
o ste O pat
Tr u e it i s n o t a tre atm ent
wh i c h wi ll s e c u re re s u lt s i n a mi n u te We c an h o t i n
hi bi t fo r five m i n u t e s at th e eighth do r s al s pi n e i n a cas e
o f m alari al feve r
an d e x p e c t to ch e c k th e c hi ll
The chill
he i n h ibiti o n i s
c an s o m eti m e s b e co n tr o l l ed as l o n g as t
m ai nt ai n ed The i n fl u e n c e th u s g ai n e d o ver th e m u sc u lar
c o n tr ac ti o n s
to i n c re a
se
th e p ati e n t s re si st an c e
s e em s
The o n s et o f th e n e x t ch i ll u s u ally sh o w s a de c re as e i n
th e i n te n s ity o f m u s c u lar c o n tr ac ti o n an d th e d u r ati o n
i s sh o rte n e d
NO o n e w o u l d say th at we rem o ve a phy s i cal
l e s i o n by th i s tre atm e n t o r th e cau se o f th e chill M u s
co n tr ac t i on
o f th e
d eep d o r sal m u sc le s co m e s o n
c u l ar
with the ch i ll bu t d o es n o t cau s e it S u rely i n h ibit io n i n
th i s c as e w o rk s a n erv o u s ch an ge o f a p r o n o u n c ed c h ar
ac te r
A n e x amp l e o f the g o o d re s u lt s o f i n h ibiti o n is af
f o rde d by o n e o f th e au th o r s c as e s W o m an fifty ye ar s
w o ye ar s d u r ati o n
F ive
s u ff ered fr o m di arrh o e a t
o f ag e
No f o rm ed fe c e s
b o we l m o vem e nt s d ai ly
to
s eve n
U su ally th e st o o l s we re typh o i d i n ch ar ac te r
U teri n e
fibr o id rem o ve d p ri o r to deve lo pm e n t Of di arrh o e a H i s
t o ry o f co n ti n u o u s d r u g tre atm e n t O ste O pathi c e x am i na
ti o n di d n o t reve al any o ss e o u s le si o n Th ere s e emed to
b e n o th i n g to lay th e b lam e u p o n e x c ept th e o n c e e x i ste nt
fib r o id o r th e re su lt o f th e o p er ati o n S i n c e n o d efi n ite
l e s i o n e x i sted th e tre atm e n t w as pl ann ed as a te st o f i n
At th e e n d o f th ree
hibi ti o n with o u t any o th e r m eth o d
m o nth s th e p ati e nt had bu t o ne m o vem e n t d aily an d th e
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PRI N C I PL E S O F O S TE O PA TH Y
3 70
e x c r u ci ati n g p ai n in th e sid e I t w as a case o f dry pl e u
r i sy
S te ady i nh ibiti o n w as give n fo r fifte e n m i n ute s be
twe e n th e tran sve r s e p r o c e s se s o h th e right s i de i n th e
are a b etwee n th e th i rd an d th e s eve n th d o r s al vertebr a
e
A fte r thi s l e ngth o f ti m e th e p atie nt co u l d r ai s e the righ t
ar m ab o ve th e h e ad an d t ake m u ch b ette r i n spir ati o n
As
a re su lt o f thi s tre atm e n t give n twi c e p er da
th
e
p
ti
e
a
nt
y
m ad e a g o o d re co v ery th o u gh all th e m et ab o li c p r o c e sse s
we re carri ed o n in a ve ry u n sati s f act o ry w ay
.
.
,
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,
,
.
P r e par ato r y Tr e at m e nt—There i s s ti ll
an o th er tim e wh e n i n h ibiti o n i s O f i n c al c u l ab l e v al u e : In
m aki n g e x ami n ati o n o f th e v agi n a o r re ct u m e s p e ci ally
th e f o rme r S ev eral ti me s in th e au th o r s pr acti c e e x am
i n ati o n o f th e v agi n a s e em ed i mp o s s ib l e with o u t g re at dis
tre ss to th e p ati en t The irrit ability o f th e m uco u s m em
br an e o f th e v agi na cau s e d i n te n s e sp asm o d i c c o ntr acti o n
bu t ste ady i nhi bi ti o n i o v e r th e third an d
o f th e sph i n c te r
f o u rth s ac r al f o r ami n a fo r ab o ut five m i n u te s c au s e d co m
x am i n ati o n c o u l d th e n be m ade
n
n
re
ti
th
e
e
l
a
x
a
o
a
d
l
e
t
e
p
with o u t any t ro u bl e
C as e s h ave b ee n rep o rted to th e
au th o r by m an y o s teo p ath s d e sc rib i n g th e g o o d re s u lt s o f
i n h ibiti o n i n gy n e c o l o gi c al c as e s Th e s e c ase s h ave r an ged
fr o m s i mp l e n erv o u s v agi n i s m u s to c u rettem e n t
S i nc e
th e sac r al n erve s ar e so n e ar th e s urf ac e an d ar e no t i n
te r r u pte d i n th e ir c o u r s e to th e p elvi c vi sc er a th ey aff o rd
e xc el le n t Opp o rt u n ity fo r th e g o od e ff e ct s o f i nhibiti o n to
b e dem o n str ated
In hi biti o n
as a
’
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’
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PR I N C I PL E S
O F O S TE O PA TH Y
C H A P TE R
S OU
NDS
PR O D U C E D
IN
XVI I I
37 1
.
.
J O I NTS BY M ANI P UL A
TI O N
.
—
It i
No r mal S o u nds
m m o n to he ar p ecu li ar
so u n d s ac c o mpan yi n g th e no rm a
l m o vem e nt o f j o i nt s The s e
”
“
so u n d s ar e i n di c at
c r ac ki n g
e d by p o p u l ar terms s u ch as
“
s n app i n g
a
n
r
d
ey
m
m
o
n
th
a
t
eve
y
T
r
a
e
o
co
s
h
”
o ne has h e ar d th em
eith er i n th eir o w n bo di e s o r th o se o f
fr ie nd s P u l li n g the fi n ger s is th e b e s t k n o w n m eth o d I t Is
co m m o n ly s u pp o s e d th at s u ch a m eth o d i f p e r s i s te d
e n l ar g e the j o i n t s I t i s d o u btf u l wh eth er th e r e i s any pr o o f
o f thi s
D o ubt l e ss th e fe ar o f it o rigi nate d as an e ffo r t to
f r ight e n s o me o n e i n wh o m the p he no m e n o n w as e asily pr o
du c e d
L o o s e j o i nte d p eo pl e ar e abl e to p r o d u c e so u n d s in
m any j o i nt s by ec arryi n g n o rm al m o v em e n t s to th e li mit
S c ar c e ly any m o v abl e j o i n t i n whi ch the lig am e n t s an d
m u scl e s ar e n o r m ally r e lax ed i s fre e f r o m th e p o ss ibilit y o f
p r o d u c i n g s o u n d w he n th e o pp o si n g m u sc le s ar e c o n trac ted
eith er th e fl e x o r s o r e x te n so r s p red o m i n ati n g
u n eve n ly 1 e
The j o i n t s u rf ac e s wi ll sl i p u p o n e ach o t he r su d de n ly t hu s
pr o d u ci n g the s o u n d After ithas b ee n o n c e m ade i t is
r arely rep e ated wit ho u t th ere has b ee n an i n terv al o f re st
d u ri ng whi ch the m u s cl e s ch an ge th ei r te ns i o n The c rack
i ng i n th e temp e r o m ax i llary arti c u l ati o n can be r e pe ate d
u n ti l the s t r u c t u re s ac h e b e c au s e it i s oc ca
s i o n e d by th e sli d
mg o f th e i nte r arti c u l ar carti lage o n to the emi n e n ti a ar ti cu
lar i s f The wri st an d sh o u l de r ar e ca
p abl e o f pr o du cm g fr e
q u e nt so u n d s o n acco u n t o f the i i free m o vem e n t an d th e
many di r e cti o n s in w hi ch th e f o r c e i s appli ed
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s n o t u n co
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PR I N C I PLE S
3 72
O F O S TE O PA TH Y
— A large n u mbe r o f so u n d s wh i ch
o rigi n ate i n j o i n t s ar e ab n o rm al ; i
th e j o i n t s ar e n o t
e
n o rm al o r e ls e th e s e p arti c u lar s o u n d s w o u ld n o t b e pro
du c e d S o m e o f th e se s o u n d s ar e f ami li ar to all phy si c i an s
Th ey re s u lt fr o m f o r c e d m o ti o n ac tive ly o r p as sive ly m ade
i n a j o i n t h avi n g li mite d m o vem e nt as a re su lt o f i n j u ry ; o r
i ntr acap su l ar dep o sit s du e to d i s e ase
An o th e r c lass o f
so u n d s i s p r o d u ced by f o r c e d m o vem e n t
p ass ive i n j o i n t s
h avi n g lo St s o m e o f th e n o rm al re lati o ns o f th ei r s u rf ac e s
—
l
h
o
f
A
P at o o gy
J o i nt s P r o d u c i n g b n o r m al S o u n d s It
m ay b e we ll to re c ou n t sy s te m ati cal ly th e c o n diti o n s i n
whi chp ass i ve m o vem e n t o f j o i nt s p ro d uc e s so u n d s In th i s
w ay we c an n o te th e di ff ere n c e b etwe e n th e c h ar acter s o f
s o u n d s u s u ally re c o g n ize d by phy s i c i an s and th o s e e s p ec i al
i o ns
ly p e c u li ar to m an ip u lative tre at
me n to f s u b lu x at
—
S y n o vi al Adhe s i o ns
The br e ak in g o f adh e s i o ns be
twee n arti c u lar su rfac e s p r o d u c e s a so u n d c o mpar able t
o
th at o c c as i o n ed by th e b re aki n g o f a gre e n s ti ck i n whi ch
th e fiber s b re ak i n divi d u ally as th e f o r c e b ecom e s gre ater
an d gre ate r
Sy n o vi al adhe s i o n s ar e du e to m any cau se s
1
th e s imp le st o f hzvhi ch ar e S light i nj u r y an d n o n u se o f a
m
A
n
o
n
u
f
n
t
i
j
ry
fi
i
e
t
e
igh
rt
ep
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s
u
c
t
o
C
a
u
s
S
l
ff
o
r
t
e
s
a
a
t
j
wh e n acc o mp an i ed by re s t wi ll re su lt i n a few adhe si On s
V o lu nt ary m o v em e n t o f th e j o m t i s arre ste d by th e se adh e
S u c h co n diti o n s fre q u e n t ly f o llo w a S pr ai n o r th e
si o n s
sp l i n ti n g o f a j o i n t j u s t ab o v e o r b e lo w a fr ac t u re
The j o i n t
m ay b e q u ite we ll but by ke epi n g it p erfe c t ly fi x ed d u ri n g
th e rep ai r o f th e fr actu re th e p eri arti c u lar s tr u ct u r es lOS e
th ei r el asti c ity an d a few adhe si o n s may f o rm with i n
—
l
h
l
a
n
e
o
n
No n u s e Of a S ig t y S pr i d J i t S o m etimes a
tim i d p er so n m ay be so fe arf u l o f m o vi n g a slight ly s prai n e d
j o i n t th at adh e si o n s f o rm an d c o n tr o l o f th e j o i n t i s l o st I
w as re c e n t ly c alle d to e x ami n e a f o o t whi c h w as v ery p ai n
fu l an d u s e le ss
S eve n m o n th s p revi o u s ly th e an k le w as
The f o o t had n o t b e e n u s ed s i n c e th at i n j ur y I
s p r ai n ed
fou n d th e f o o t sti ff co l d an d re sti n g o n api ll o w E x ami n a
ti o n r e v e ale d slight m o ti o n wh i ch se em ed to be limit ed by
A b no r m al S o u n d s
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PR I N C I PLE S
3 74
O F O S TE O PA TH Y
i
th e j o i nt By t aki n g th e le g betwe e n my k n ee s an d
m aki ng th u mb pre s su re o n th e p ai n f u l pr o mi n e nt sp o t the n
ge n tly fl e x i n g an d s light ly r o t ati ng th e tibi a o n th e co n dyl e s
o f th e fem u r f o llo we d by q u i c k e x te n s i o n a di s ti n c t so u n d
The
w as e l i c ited an d th e acti o n o f th e j o i n t w as r es t o re d
so u n d i n di c ate d rep lac em e n t o f th e c arti lage
“
”
Bo n e S etti n g —It has b e e n s u pp o s e d th at m u c h o f
th e w o rk o f o st eo p ath s co n s i ste d i n br e ak i ng a dhe sio n s
wh i c h we re si mp l e e n o u gh bu t h app e n e d n o t to h ave b ee n
Th e re i s m u ch ch an c e
s tri c t ly atte n d e d to by th e su rge o ns
to m i s i n te rp ret th e w o rk o f th e o ste o p ath s i n red u c i n g s ub
l u x ati o n s M e di cal m e n o f e stabli she d s cho o ls o f m edi c i n e
h ave fai le d to c l o s ely an alyze th e str u ct u r al c o n diti o n o f
j o i nt s b ef o re an d after m an ip ul ati o n he n c e th ey h ave j u mp ed
to th e c o n c lu s i o n th at all o f o u r w o rk w as o f th at ki n d c all e d
”
“
b o n e setti n g fo r Wan t o f a b e t
ter de scriptive te rm Thi s
b o n e setti n g i s a p o p u l ar o n e fir s t u se d i n
app el lati o n
he w o rk o f i n divid u al s u su all y u n
E n gl an d to de sc rib e t
ed u cated w ho tre ate d p ati e n t s by m an ip u l ati o n o f j o i nt s
wh i c h th ey sai d we re o u t Q u i c k f o r c ef u l m o ve me nt s in th e
di re cti o n o f n o rmal j o i n t acti o ns u su al ly re su lte d i n a po p
”
“
”
pi n g s o u n d Wh e n th i s o ccu rre d th e b o n e sette r c o ns i d
e re d hi s w o rk ac co mp li sh e d
H i st o r i cal R e fe r e nce —As id e fr o m adhe s i o n s th e c o n di
ti o ns W hi ch we fi n d lim iti n g th e m o ve m e n t s of j o i n t s ar e
Wh art o n P H o o d M D
f u r n i sh e d
su bl u x ati o n s
th e L anc et a de s cripti o n o f wh at w as co m m o n ly call ed
“
b o n e setti ng
H i s arti c l e s were p u b li sh e d i n th at j o u r n al
M ar ch an d April 18 7 1 The arti cl e s were p u bli sh e d i n b o o k
“
f o rm th e sam e ye ar e n titl e d O n B o n e S et ti n g ( S o Ca
l l ed )
an d Its R el ati o n to th e Tre atm e n t o f J o i n t s C ripp l e d by In
”
j u ry R h e u m at i sm I n fl amm at io n E tc
D r H o o d m ade
“
b o n e s etter —
M r H ut
c lo s e o b s erv ati o n s o f th e w o rk o f a
to n Thi s ge n t l em an s o u ght to te ac h D r ; H o o d hi s art as a
m atte r o f gratit u de fo r p r o fe s si o nal atte nti o n give n hi m by
D r P ete r H o o d In th e p age s o f thi s b o o k I fi n d a c l e ar
c o n c i s e e x p o s iti o n o f th e b o n e setter s ar t t o geth er wit h a
s on of
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,
“
PR I N C I PLE S
O F O S TE O PA TH Y
3 75
re co r d o f th e o b serv ati o n s o f th e au th o r w ho has th e adv an
t age o f e x c e lle n t tr ai n i n g in th e m edi cal art s Th ere i s n o
d o u bt i n my mi nd as to th e s im il arity e x i sti n g b etwe e n th e
”
b o n e s etter s
co n diti o n s whi c h were re c o g n ized by s o call e d
an d th o s e w ho h ave f o rm e d th e b as i s f o r th e su c c e ss f u l ad
van c em e n t o f o ste o p athy The di ff ere n c e l ie s p ri n c ip ally i n
th e ed u cati o n al q u alifi cati o n s D r H o o d n o te s th at th e m an
i pu lati o ns w e r e m ad e with o u t any k n o w l edge o f anat o my an d
phy si olo gy bu t were n everth e l e s s ast o n i sh i n g ly su cc e ss f u l
o th e f ac t th at m u c h gre ate r su cc e s s
and h e c al ls atte n ti o n t
with l e s s p r o b abi l it y o f 1 nj u r y o u ght to re su lt fr o m th e s e
m an ip u lati o n s wh e n the tr u e p ath o lo gy o f th e j o i n t i s u n der
e
wh e n th e o p erat o r is i n f ac t a tr ai n e d s u rge o n
st o o d ; i
th o r o ugh ly ver s ed i n th e det ai l s o f anat o my D r H o o d e vi
de ntly di d n o t u n d er st an d th e co n diti o n s whi ch we re c o g
n ize as su bl u x ati o n s o f th e rib s an d ver tebr ae alth o u gh he
o it as y o u wil l o b s e r ve here afte r
came very n e ar t
H i s at
te nti o n w as pr 1n c1pally fi x e d o n th e c o n diti o n s f o ll o wi ng
gre ate r o r l e s s er d egre e s o f j o i n t i n fl amm ati o n re s u lti n g i n
i n tr a¥ar ti cu lar adhe s i o n s o r e x tr a—
arti c u l ar co n tr ac ti o ns
In
th e cas e o f adhe si o ns bre aki n g th em caus e s a so u n d w hi ch
can n o t be re pe ated bu t su bl ux ati o n s may o cc u r r ep e ated ly
i n the sam e j o i n t e ach r e du cti o n cau s m g a so u n d
Tar sal and Car pal S u blux ati o ns —In D r H o o d s ch ap
ter o n p ath o lo gy I fi n d th e fo llo w m g : S u b lux ati o ns o f tar
sal an d c arp al b o n es m u s t o cc u r
I thi n k i n a c o n s ider abl e
n u mb er o f i n s t an c e s
I m e an by s u b lux ati o n s so m e dis
tu r ban ce o f th e p r o pe r rel ati o n s of a b o n e with o u t ab so l u te
di spl ac eme n t an d I b e l i eve th at s u ch di st u rb an ce m ay b e
p r o d u c e d eithe r by th e tr acti o n o f a b an d o f adh e si o n ab o u t
th e j o i n t s or by a twi st o r o th er dire c t vi o l e nc e
G r an t the
p o ss ibi lity o f su b lu x ati o n i n th e arthr o d i al j o i n t s o f th e c ar
pu s an d t ar s u s it i s n o t imp r o b ab l e to c o n c eive o f th em i n
“
”
any o th er j o i n t
As a p u re e x amp l e o f b o n e s etti n g
o ne
o f my re c e n t c as e s i s ap r o p o s
A lady stepp e d o n s o m e small
h ard o bj e ct th e p o i n t o f co nt act bei n g j u st u n d er t
he i n step
S h arp p ai n lo c alized o n to p o f th e i n step beg an at o n c e an d
,
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PR I N C I PL E S
3 76
w as
O F O S TE O PA TH Y
rel ieve d by h e at o r o th e r antiphl o gi s ti c m e as u re s
F o rty eigh t h o u r s afte r th e o n set o f p ai n I w as c al led to
e x ami n e th e f o ot
F o u n d s o m e swel li n g o ve r th e i n step
bu t p alp ati o n l o cali z e d th e pa1n 1n th e arti cu l ati o n b etw ee n
th e scaph o i d an d i n ter n al c u n eif o rm Any attempt at l o c al
m o vem e nt o f th i s j o i nt cau sed sh arp p ai n The p ati e nt co u l d
n o t s t an d o n th e f o o t o n a cc o u n t o f th e p ai n wh i c h w as i n
E x te n si o n o f th e f o o t with firm pre s su re
c re as e d th ereby
o n th e u pp e r si de o f th e arti c u l ati o n
c au s e d a very l o u d
so u n d th e p r o mi n e n c e o f th e s c aph o i d w as n o t so app are n t
an d th e p ati e n t co u l d pu t h er weigh t o n th e f o o t im m edi ate
Thi s w as a c as e o f t ar sal su bl ux ati o n I f th e sam e d e
ly
gre e o f di spl acem e nt had e x i ste d in a ve rtebr al arti c u l ati o n
th e e ff e c t o n c ir cu l ati o n i n th e n erve c e n ter s o f the co rd
m ight h ave c au s e d very wid e sp re ad sympt o m s
“
”
The s u bl u x ati o n s tre ate d by b o n e s ette r s h ave u su al
ly b e e n t ho s e whi ch o ccas i o n ed p ai n i n th e j o i n t
The o s te o
p ath d o e s no t dep e n d u p o n p ai n as a sympt o m o f su bl ux a
ti o n but m ake s p alp ati o n th e tr u e g u i de
—
Wh e n th e h e ad
E nar t hr o di al an d A r thr o di al J o i n t s
of th e fem u r i s f or c e d o u t o f the a s c e tabulu m th ere i s m o re
o r l e s s te ari n g o f lig am e n t s with c o n s e qu e n t i n fl am m ati o n
R ep lac em e n t o f th e h e ad i s n o t acco mpl i she d with o u t a di s
ti n ct so u n d The so u n d i s c o n si dered as au dibl e evi de nc e o f
The sam e i s tr u e o f the sh o ul d er j o i nt
s u c c e ss f u l op e r ati o n
The gre at r ange o f m o vem e nt i n th e se j oi n t s n e c es sarily r e
q ui re s lax lig am e n t s th eref o re gre at sep ar ati o n o f th e j o i n t
The arth r o di al j o i n t s i nall p art s o f
s u rf a c e s i s po ssib l e
the b o dy ar e co n s tr u c ted o n a diffe r e n t p ri n c ip l e The r an ge
e n t i s n o t gre at i n th em an d th eir lig am e nt s ar e
o f m o ve m
The f o rm o f th e b o dy s u rf ac e s o f th e
co mp ar atively sh o r t
arth r o di al j o i n t s d o e s n o t l imi t m o ti o n , as i n th e c as e o f e n
arthr o di al j o i n t s
R ep lac em e nt o f th e h e ad o f th e fem u r o r hu m er u s re
n e o r c artil age an d w
n
o
ire
it
m
ve
ve
r
a
ri
dge
o
f
b
h
e
o
o
u
o
s
t
q
it s i nk s su d d e n ly i n t o i ts p r o p e r pl ac e a so u n d i s h e ard .
P r o b ably th e s o u n d whi ch ac co mp an ie s th e red u c ti o n o f a
no t
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P R I N C I PLE S
3 78
‘
O F O S TE O PA TH Y
’
ve n t o f o ste o p athy we q u o te a p o rti o n o f D r H o od s ch ap
te r o n Affe cti o ns o f th e S pi n e
”
“
D r H o od
Aff e c ti o ns o f the S pi ne
I fe ar it m u st
b e adm itted that th e gre at i mp o rt an c e o f th e spi nal co rd
an d th e gr avity o f i ts di se as e s h ave r ath er te n de d to m ake
p r o fe ssi o nal m e n o verl o o k th e o sse o u s an d l ig am e n t o u s cas e
by whi ch it i s e nc l o s e d an d wh i ch is li abl e to all th e m ala
The q u ac k
di e s that bef al l b o n e s an d l i g am e n t s el s ewh ere
o n th e o th er h an d w ho pr o b ably n ever h e ard o f th e s pi nal
c o rd re c o g n ize s th e p re s e n c e o f str u c t u re s with whi c h h e i s
fami li ar an d de al s with th e m as h e d o e s i n o th er s it u ati o n s
The re su lt i s m u ch the s am e as in th e hi p j o i n t The q uac k
every n o w an d th e n c u re s co n diti o n s wh i ch th e au th o riz ed
p r actiti o n er had reg arded with a so rt o f rev ere nc e be c aus e
”
“
th ey were s pi nal ; and h e every n o w an d th e n kill s a pa
ti e n t be cau se thi s reve re n c e di d no t e x i s t fo r hi s pr o te cti o n
I f th e p r o fe s si o n ge n e r al ly wo u l d s o s t u dy th e di s e ase s o f th e
ep
s pi n al co rd a s to re sc u e th em fr o m s p e c i al i st s th e fi r st s t
w o u l d b e t ake n to w ard s re scu i n g th e di se as e o f th e verteb r al
c ol u m n fr o m q u ac k s
“
“
”
H o wever th e m atte r m ay b e e x
Cr i ck i n the Back
pl ai n ed it i s q u ite c ert ai n th at m any p e o p l e n o w re sort to
“
”
b o n e setter s co mpl ai n i n g o f a c r i ck o r p ai n o r we ak n e ss
i n th e b ac k u s ual ly co nse q u e n t u p o n so m e i nj u r y o r u n d u e
e x erti o n an d th at th e s e app li can t s ar e cur ed by m o vem e nt s
o f fl e x i o n an d e x te n s i o n
c ou pl e d with p re ssu re u p o n any
p ai nf u l sp o t
M an i pu l ati o n o f the Ne ck
In a few cas e s M r H u
t
to n w as c o n su lted o n acc o u n t o f s ti ff n e ss ab o u t th e n e c k o r
c ervi c al vert eb r ae an d h e th e n w as ac cu st o med t
o s tr ai ghte n
H is l eft f o re arm w o u l d b e pl ac ed u m
th em
de r th e l o were d chi n o f th e p ati e n t with th e h an d co m i n g
r o u n d to th e b as e o f th e o cc ip it al b o n e The right th u mb
wo u ld th e n b e pl ac ed o n any p ai n f u l spo t o n th e c ervi cal
an d th e chi n s u dd e n ly el ev ated a
s i ne
m
u c h as s eem e d
s
p
A s far as my o b serv ati o n e x t
e nd s the i h
to b e re q u i red
s t an c e s o i thi s ki n d were n o t b o n a fi de e x ampl e s o f adh e
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PRI N C I PLE S
F IG
.
1 51
.
O F O S TE O PA TH Y
I ll u str ati o n f r o m O n B o n e
to n P H o o d 1 8 7 1
.
,
Se
3 79
tti ng b y W h a
r
.
i
bu t g e n e r ally su ch as m ight b e attrib u te d to s light
m u scu lar r igi dity o r e v e n to so m e f o rm of i m agi nary m al
ady
The b en efit g ai n ed w as pr o b ab ly r ath er du e to the
the
Op
er
ti
o
n
th
e
e
ff
e
c t p r o d u c ed by it u po n th e
1
n
o
f
a
n
a
d
a
p
m i n d Of th e p ati ent th an to any act u al ch an ge i n th e phy si
c al c o n diti o n c on c er n ed
F o r th e lo wer regi o n s Of
M an i pu lati o n o f the Back
th e sp i n e h e had tw o m eth o d s o f tre atm e n t di ff eri n g i n de
t ail but n o t in pr 1nc1ple In th e fir s t wh e n th e p ai n f ul sp o t
w as f o u n d th e p ati e n t w as m ad e to get o u t o f b e d an d to
with th e fr o n t o f th e l eg s o r p erh ap s
s t an d f ac i n g i ts s i de
th e k n ee s—ac co rdi n g to th e h eight o f th e p atie nt an d th e
—
b ed ste ad p re s se d ag ai n st it S he w as th e n t o ld to b e n d
f o rw ard u n ti l th e b e d w as t o u c h e d by th e e lb o w s H i s left
ar m w
as th e n pl aced ac r o s s th e ch e s t
an d th e th u mb o f
th e right han d u p o n th e p ai n f u l sp o t F irm p re s sure w as
the n m ade with th e th um b an d as s o o n as he fe lt th at h e
had s ettl e d h im s elf i nt o s u c h a p o s iti o n th at h e cou l d o bt ai n
'
s o n s,
;
,
s
.
‘
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,
PR I N C I PL E S
3 80
O F O S TE O PA TH Y
th e f u ll p o wer o f th e left ar m th e p ati e nt w as t o l d to assu m e
th e ere c t p o st u re with as m u ch r ap idity an d vig o r as she
co u l d c o m m an d
Th i s m o ve m e nt w as f ac i lit ate d an d e x
o
n
e
i
e
o
n
hi
l
r
m
n
s
by
th
e
th
r
wi
g
eft
th
e
Opp
i
g
d
d
u
o
f
a
a
t
s
d
p
p
f o r c e o f th e right th u mb A s a r u le th ere se em e d to b e tw o
p ai n f u l s p o t s an swe ri n g to th e u pp er an d l o wer b o rd er o f
th e aff e c ted ve rtebr ae so th at th e m ano e u vre w o u l d re q u i re
to b e repe ated
“
In th e s e c o n d m eth o d th e p ati e n t w as s e ate d i n a ch ai r
pl ac ed a sh o rt di st an c e fr o m th e w all s o th at th e fe et co u ld
b e firmly p re s sed ag ai ns t it S he w as t o l d to be n d f o rw ard
an d pl ac e h e r arm s b etwe e n h er l eg s with th e e lb o w s re st
i n g ag ai n st th e i nn er s i d e o f th e k n e e ; to si t firm ly o n th e
c h ai r an d at a giv e n sig n al to th r o w h er s e l f u p right
The
Op er at o r p ass ed his l eft ar m u n de r th e ch e s t p lac ed hi s right
th u mb o n th e p ai n f u l s p o t an d i n o rde r to Obt ai n firm an d
re s i sti n g pre ss u re re s ted hi s e lb ow ag ai n st th e back o f the
The sig nal be in g give n th e o p e r at o r keep i ng hi s fi st
c h ai r
c l e n c h ed so as to s u pp o rt hi s th u mb s an d th e elb o w bei n g
h e l d firm i n i ts p os iti o n wh e n th e p ati e n t thr o w s h e r self
he app r o ac h o f h er b ac k to th e chair an d
u p right re s i st s t
be n d s h er h e ad an d sh o u l d er s as far b ac kw ard s as p o s sib l e
th e p o siti o n o f th e feet p reve nti n g any f o rw ard m o ve m e nt
“
—
l
Th e s e tw o m eth o d s ar e
Tr e atm e nt o f U ppe r D o r sa
u s ed fo r c as e s i n wh i c h p ai n i s p re s e n t i n th e d o r s al verte
br ae b e lo w th e eighth o r i n any o f th e lu mb ar The tre at
m e n t u se d fo r th e u pp er d o r sal an d lo we r c ervi cal verteb r ae
w as to plac e th e o p e r at o r s k n e e ag ai n st the p ai n f u l s p ot
an d with th e h an d s plac e d u po n th e s h o u l der s to draw th e
u pp er p art o f th e b o dy as far b ac k as p o s sib l e
“
In cas e s wh e n p ai n w as c o mpl ai n ed o f i n th e d o r sal
an d l u mb ar regi o n an d th e b ac kw ard m o vem e n t s did n o t
o be n d sid e
affo rd th e req u ire d re l ief th e p atie n t w as m ade t
w ay s an d a s imi lar p r o ce s s w as g o ne th r o ugh as i n the
o th e r m an ip u l ati o n s
“
—
t
e
n
A s a co m me n t ary o n all thi s th ere i s
Comm
m an ife st ly litt le to say e x c ept th at th e size o f th e vertebr al
,
'
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,
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,
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,
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,
,
‘
‘
,
,
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,
,
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’
'
,
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,
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,
,
PR I N C I PL E S
38 2
O F O S TE O PA TH Y
h o u r ; th e n h e felt a s ti ff n e ss an d n u mb n e ss at th e si de s an d
b ac k o f hi s h e ad and the b ack o f hi s n e ck with a f u ll n e ss in
th e th r o at an d di ffi c u lty o f sw al lo wi n g At fir s t h e had no
l o ss o f p o we r o ver his l imb s o nly s ligh t p ai n d o w n h1s r i ght
ar m ; so m e d ay s after admi s si o n h o wever
h e had p arti al
l o ss o f p o we r i n th e right ar m whi ch sh o rtly re co vered
it s el f O n admi ss i on h e car r i e s hi s h e ad fi xed an d has p ai n
fl e x o r e x te n d th e h e ad ; hi s
o n sl ighte s t att empt t
o r o t ate
i
xed
n d h e can n o t o p e n hi s m o u th wid e
p
rti
a
l
ly
fi
a
a
s
a
w
j
e n o u gh to ad mit o f a fi n ge r bei n g p asse d to th e b ack o f th e
i
i
x
h
i
o
1
1
t
u
r
1
l
u
n
n
o
t
h
ry
n
v
e
thi
k
a
c
8
n
u
a
t
t
o
a
s
c
d
t
d
e
a
t
;
p
g
g
te nd ed by any gre at u n e as i n e ss Co mpl ai n s o f all sympt o m s
E x te r n ally o ver the spi n e o f th e se co nd
bef o re e n u m er ate d
c e rvi c al ve r
tebr a th ere i s a t u m o r h ard and re si sti n g bu t
te n de r o n p re s su re ; thi s i s evi d e n t ly f o r m ed by th e u n d u e
p r o m i n e n c e o f th e spi n e o f the ax i s it s elf ; the te n d er n e ss
i s n o t ge n e r al bu t c i r cu m s c rib e d ; th e p art s all ar o u nd ar e
n u mb
H e w as pu t o n hi s b ac k o n a h ard b e d hi s h e ad
w as s l ightly e l ev ated an d a s m al l san d bag w as p l ac ed
b e n e ath th e pr o j e c ti n g S pi n e and th e wh o l e h e ad m a1n
H e w as
tai n e d i n a fi x é
d p o s iti o n by large r san d b ag s
b i s d ie
D o v gr V ; hydr c c ret a ;
o r dered p u lv
ys Wh e n hi s gu m s
Th is w as c o n ti n u ed fo r ab o u t te n d a
b e cam e aff e cted s light ly an d it w as th e n o mitted M arke d
1 m pr o v e m e n t ha s t
ak e n p lac e i n hi s ge n er al app e ar an c e
H e co n
an d m o re p arti c u l ar ly i n hi s sp e c i al s ympt om s
He
ti n u e d u n ti l J u ly 3 g r adu ally an d ste ad i ly imp r o vi n g
th e n had ac u te rh e u ati c i n fl am m ati o n o f the right k ne e
f o ll o we d i n a day o r tw o by a simil ar
an d e lb o w j o i n t
Th ere w
as n o evi de n c e o f a
s t ate i n th e l eft k n e e j o i n t
py aem i c s t ate The j o i n t s were b li stere d ; h e has bee n
tre ate d with po t n itr an d le m o n j u i c e an d i s n o w f as t r e
eri n g The te n d er n e s s an d all th e sympt o m s h ave di sap
co v
r e d th e p r o j e c ti o n s til l r e m a1n 1 n g an d h e e x pre s se s h im
e
a
p
he c o n ti nu ed re st i n b ed
u c h re l ieved by t
s el f m
H ilt o n i n rem ark
S iz e o f the V e r t e b r al C anal
i n g o n th i s c ase o b serve d th at it had b ee n dem o ns t rated t hat
,
'
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'
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,
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,
,
-
'
.
-
.
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,
“
.
,
'
.
.
‘
,
m
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,
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‘
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'
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,
’
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,
.
PRI N C I PL E S
O F O S TE O PA TH Y
38 3
th e are a o f th e vertebr al canal might be dimi n i sh e d by o n e
p r o vi d e d th at th e dim i n u ti o n w as S l o w ly e ff e cte d
th ird
w ith o u t givi n g r is e to an y alarmi n g o r i n de e d m arked sy mp
to m s o f co mp re ss i o n o f th e c o rd
,
,
.
m e nt
R adi cal Tr e at
No w th ere can
be n o d o u bt th at m o s t s u rge o n s w o u l d agree th at Mr H i lt o n
e x er c i s e d a so u n d di sc reti o n i n S imp ly p lac i n g th i s m an i n
i on s fav o r abl e to re c o ve ry o r i n ke ep i n g hi m at re st
c o n di t
u n t il th e ax i s w as fi x e d i n i ts n e w p o s iti o n an d th e S pi n al
Th ere can
c o rd acc u s t o m e d t
o th e ch an ge i n i ts re lati o n s
be l itt l e d o u bt th at M r H u tt o n w o u l d h ave m ade th u mb
n
h
l
re
re
th
e
p
r
o
m
i
n
e
n
t
s
pi
e
wh
il
e
e
s
h
a
rp
y
r
a
i
s
e
d
s
u
o
n
s
p
the h e ad
The p r o b abi lity i s th at h e w o u l d by thi s m ano e u
w e h ave c u red hi s p atie n t ; th e p o ss ibil ity i s th at h e m ight
h ave ki lle d h im Thi s so r t o f m ake a sp o o n o r s p o i l a h o r n
p r acti c e we m ay co n te n te dly l e ave to q u ack s an d with o u t
ri ski n g rep u t ati o n i n d o u btf u l c as e s I t
hi n k we m ay fi n d
a c o n s i d er ab l e n u mb er wh i c h ar e n o t d o u btf u l
i n whi ch
e x c lu de all el em e n t s o f d an ger
S ki ll e d o b s erv ati o n m ay
an d i n wh i c h th e r e c tifi cati o n o f di s pl ac em e n t o r th e r u p
t u re o f adh esi o n s wi ll b e c ert ai n ly f o llo we d by th e m o st
f av o r ab l e re s u lt s F o r th e di sc o very o f th e s e c as e s n o s e t
tle d r u l e s c an b e l ai d d o w n S i n c e th ey c an o n ly b e k n o w n
—
by n eg ati o n s by th e ab s e n c e o f th e sympt o m s th at w o u ld
give w ar n i n g o f d an ger The di ag n o si s m u st b e m ad e in
e ach i n st an c e fo r it s e lf an d i n e ach m u st d ep e n d u p o n th e
”
sag ac ity an d ski ll o f th e p r ac titi o n er
C on se r vat iv e
vs
.
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,
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'
,
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‘
’
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PR I N C I PLE S
38 4
O F O S TE O PA TH Y
C H A PTE R X IX
P O S I TI O NS FO R
.
E X AM I NATI O N
—
O b s e r v ati o n
The m eth o d o f e x ami n ati o n sho uld be
s o m ewh at aff e c te d by o n e s getti n g a s e n s e Of th e i n divid u
e
Th e re ar e
an y th i n g s wh i c h o n
al ity o f th e p ati e n t
s h o u l d be tr ai n e d to O b s e rve q u i c kly s u c h as th e p o s e an
d
m o vem e n t o f th e p ati e n t n u triti o n ch ar acte r o f the Ski n
he
Al l o f th e s e th i n g s give a s e n s e o f d ire c ti on to t
et
c
e x ami nati o n i e O dd po se s c omp e ns at o r y m o v e m e n ts o r
c ach e x i as l e ad o n e to try t
o dete rmi n e th e c au s e s o f t he se
‘.
very app are n t ab n o rm aliti e s M i n o r ph as e s o f th e se th i n g s
m ay e s c ap e o u r c u r s o ry g lan c e bu t i t i s u n wi s e to c o m
m e n c e any e xam i n ati o n with o u t fi r st d etermi n i ng th e
‘
p r o b abl e r e g io n o r regi o n s e sp e c i ally re qu iri n g e xami n a
ti o n Thi s do e s n o t m e an b ei n g p arti cu l arly g u id e d by
th e p ati e n t s o w n st atem e n t bu t r ath e r s e eki n
g to e xe n
c i s e o n e s p o wer s o f o b s e rv ati o n an d ded u c ti o n
We wi sh it d i sti n c t ly u n d er st o o d that w e ar e s tr iv
am i n ati o n w h i ch
h
ere
o e x p lai n a S p e c i al f o r m o f e x
1n
t
g
A n ex ami n a
i s o nl y a p art o f ge n er al d i ag n o sti c w o r k
ti o n whi ch c o mp reh e n ds m ere ly th e u s e Of p alp ati o n w o ul d
give a lim ited u n d er s tan di n g o f a p ati e n t s ai lm e n t , bu t
i s co n c e r n e d with e lu c id ati n g g r o u ps o f
si n ce thi s b o ok
ph e n o m e n a wh i ch c an q u ite c l e ar ly b e re c o g n ize d by pal
o
s c ribe o th er
we
wi
de
ll
n
o t u s e ti m e o r sp ac e t
n
i
a
t
o
p
c o o rdi n ate m eth o d s whi c h ar e ab ly t au gh t i n o th e r t e x t s
i n th e e x am m ati o n o f
ati c
be sy s te m
In o rder t
o
p ati e n t s it i s we ll to ad o pt th e u s e o f a c ert ai n r o u ti n e o f
p o s iti o n s whi ch will be st sho w th e det ail s o f o ss e o u s str uc
t ur e
l
'
'
’
m
.
,
’
,
,
,
'
.
'
,
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g
,
,
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,
'
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’
’
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-
-
‘
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’
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PR I N C I PL E S
38 6
O F O S TE O PA TH Y
l ate r al devi ati o n I f th e am o u n t O f fl e sh o ver the sp i n e s
p re c lu de s th e u s e o f th e s e n se o f s ight
as i n fat p e o p l e
n
l
n
o
n
o
a
a
s
e
rt
a
i
n
th
e
re
a
ti
by
th
e
s
e
e
o
f
t
o
u
c
h
u
c
c
s
y
.
.
,
,
,
.
To u ch — W e wi sh
emph asize th e n e c e s sity
o f th e st u d e n t s acq u i ri n g th e h abit o f d ep e n d i n g o n th e
r ath e r th an o f S ight In all o ste o p ath i c
s e n s e Of t o u c h
e x am i n ati o n s th e s e n s e o f t o u ch sh o u l d b e u s e d to o bt ai n
th o s e d at a c on c er n i ng str u c t u re wh i c h f o rm th e b asi s o f all
di ag n o s i s R em emb e r th at y o u c an n o t se e b o n e m u s cl e s
an d g lan d s bu t y o u c an fe e l th em
S e n se
of
'
.
to
’
.
,
,
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,
.
,
I n sp e cti o n —Wh i l e th e p ati e n t i s sitti n g ere c t asce r
t ai n th e fl e x ibi lity o f th e S pi n al c o lu m n No te th e p o siti o n
o f th e s c ap u lae
wh eth er n e ar Or far fr o m the s p i n al c o l
wh eth e r u n eve n ly p lac ed
umn
No te th e dev e lo pm e n t
Of th e tr ap ezi u s lati ss im u s d o r si an d e re ct o r spi n ae i e
Ob s erve th ei r s u rf ac e m arki n g s I f the p ati e n t d o e s n o t
v o lu n t ari ly re lax whi l e i n th e er ec t p o siti o n as k hi m to
as s u m e hi s n o rm al p o st u re
Th i s w 111 i llu str ate th e p o i n t s
o f gre ate s t S p1n al s tre s s an d S h o w ho w th e s p i n al c o lu
mn
act s i n i ts n o rm a
l wei ght c arryi n g cap ac ity
'
,
.
,
.
,
,
,
.
,
.
,
.
,
.
'
.
ti o n o f the R ib s — Fi g 1 53 i llu str ate s a m eth o d
ly i n t o vi ew o r i n c as e o f
o f b r i n g i n g th e r i b s pr o mi n e n t
fl e shy p e r s o n s m aki n g it e asy to p alp ate th em By p ull
i n g th e ar m u p an d ac r o s s th e c h e s t th e lati s s i m u s d o r si
i s s tret ch ed wh i c h b ri n g s th e f o u r lo we r rib s i n t o a g o o d
p o siti o n fo r e x ami nati o n The m o vem e n t Of th e s c ap u l a
aw ay fr o m th e ve rteb r ae m ake s it e a si er fo r th e e x ami n er
I t i s n o t we ll
to fe e l th e an g l e s Of the f o u rth an d fifth rib s
to d epe n d o n thi s p o s iti o n f o r evi d e n c e o f rib s u b l u x ati o n s
b e c au se th e te n si o n Of th e lati s si m u s d o r si bri n g s at le ast
th e f o u r lo wer rib s i n t o p r o pe r alig n m e n t The S p aci n g
o f th e se rib s wi ll th e n b e eq u al
The ch i ef v alue o f th i s p o smo n i s to give th e e x am
i n er b ette r o pp o rt u n ity to p alp ate th e an g le s o f th e rib s
ab o ve th e n i n th an d to n o te th e c h an ge d re lati o n s whi ch
P al pa
.
’
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‘
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,
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.
.,
PR I N C I PL E S
F IG
.
153
'
.
P o s i ti o n
m ay t ake p lac e
to
t
a c c e n u a te
at the
387
O F O S TE O PA TH Y
an
p r om i n e n ce
th e
teri o r
e nd
of
Of th e
th e
.
ri
b
s
n In th
.
.
t e n th
e leve n th an d twe lfth rib s
—
P alpati o n o f the S pi n e A fter g athe ri n g as m u ch i n
fo rm ati o n as p o ss ib l e by Ob s ervi n g the f o rm Of th e b ac k
p o s iti o n Of th e s c ap u l ae an d c o n to u r Of th e m u sc le s e x
am in e the sp i n e by m e an s Of y o u r s e n s e Of t o u c h
TO do
thi s have th e p ati e n t si t ere c t b ei n g c aref u l no t to e x ag
e
a
n
o
l
o
e
n
h
1
n
r
te
th
e
rm
p
t
u
re
i
e
d
a
s
t
s
f
a
r
f
r
o
e
e
b
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eith er p o siti o n i s i n di c ative o f we ak m u sc l e s
U se th e i n d e x an d m i dd l e fi n ger o f eith er h an d to c are
f u l ly n o t e th e re lati o n s o i th e i n divi d u al vertebr ae as i n
Begi n at th e fi rst d o r s al an d w o rk d o w n w ard
F i g 1 54
L ater al s u b lux ati o n s ar e e as i ly n o ted with
to th e sac r u m
th e p ati e n t i n th i s p o s iti o n G e n t le digit al pr es su re m ay
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392
O F O S TE O PA TH Y
wi ll b e ab le to di sti ng u i sh e asi ly betwee n th e s e ns e o f
m ere p re ssu re an d a p ai n f u l o r hyp er s e n sitive fe e li ng
B egi n o nc e m o re at th e fir st d o r s al an d e x am i n e alo n g
th e si de s Of th e spi n e s and ab o u t th re e i nche s fr o m th em
Th i s s p ac e b ri n g s th e i n te r nal an d mi dd le gr o u p s o f i n
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we de s ire y o u to b e ar i n m i n d th e di ff ere n t gr o u p s as th ey
ar e n o te d i n G r ay s A n at o my
G r ay divi d e s th em i n t o
fi v e l aye r s
The fi rs t th re e layer s ar e e x tri n si c i e ari s e
fr o m ve rtebr ae an d i ns ert i n t o th e h u m er us scap u l ae o r
Th ey d ep e n d u p o n th e i ntri n s i c m u sc l e s o f th e
rib s
f o u rth an d fifth layer s to fi x th e S pi n e s o that Op er ati n g
fr o m th e sp i n al co lu m n as a fi x ed p o i nt th ey c an m o ve
th e u pp er e x trem iti e s an d rib s
Wh il e p alp ati n g a b ac k wh i c h is mo d er ately wel l m u s
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layer s an d di sti n g u i sh th e co n diti o n o f th e m u s c l e s o f th e
f o urth l aye r I t i s i mp o rt an t th at th e s t u de nt S h o u ld l e ar n
to fe el th r o u gh th e so ft ti s su e s to h arde r o n e s bel o w
S ki l l
i n dete c ti n g v aryi n g degree s o f de n sity an d h ard n e s s i s an
ab s o l u tely e ss e n ti al q u al ifi c ati o n o f th e di ag n o s ti c i an
A c aref u l di ss e c ti o n o f th e f o u rth layer wi ll di sc l o s e
th e f ac t th at th ere ar e th ree p ar allel gr o u p s o f m u s c l e s
The fir st i s th e s p i nali s d o r s i wh i ch l i e s o n th e s i de o f th e
The s e c o n d gr o u p li e s m o re o n th e tr ans ver se
spi n e s
p r o c e ss e s
The l o n gi ss i m u s d o r s i an d i ts c on ti n uati o n s
m ake u p thi s gr o u p The s ac r o lu mb ali s an d c o n ti nu ati o n s
m ake u p the th ird gr o u p whi ch l i e s o n th e an g le s o f th e
rib s C aref u l p alp ati o n wi ll d i s ti n g u i sh th e se divi s i o n s
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p o i n t s alo n g th e li n e o f th e fir s t gr o up , whi ch ar e hyp er
m ay b e evi de n c e Of dire c t s t rai n o f a S i ng l e v e r
s e n s itive
te br al arti c u lati o n o r th e re s u lt o f a vi sc er al refl e x o r eve n
i n symp athy with a rib s u b lu x ati o n whi ch aff e ct s se n so ry
The D i ag no sti c V alu e
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PR I N C I PLE S
39 4
re lated The o rigi n al i rrit ati o n might h ave b ee n an e x c e s
sive d em an d o n th e abi lity o f th e vi s c u s as i n th e c as e o f
th e s t o m ach b ei n g o ver lo ade d
In an y c ase th e di sc o ve ry o f wh at app e ar s to b e an
l e ad s u s to te st th e co n d iti o n o f i ts re lated
o ss e o u s l e s i o n
I f th ey do n o t sh o w u n d u e e x c it abi lity th e l e s i o n
n e rve s
A c aref u l e x ami n ati o n o f
i s d o u btf u l as a cau sative f ac t o r
v erteb r al sp i n o u s p r o c e s se s m ay S h o w m any d evi ati o n s fr o m
deve lo p m e n t an d th e di ag n o sti c i an sh o u l d
s ym m etri c al
g u ard ag ai n st th e f als e evi d e n c e o f th e s e di st o rted s pi n e s
I f a s pi n e has b ee n di s t o rte d by u n e q ual deve lo pm e n t th ere
he re su lt
S h o u l d b e n o s e n s it i ve n e ss ar o u n d it e x c e pt as t
In c as e o f s u ch vi sc er al refl e x th e e x
o f a vi s c er al refl e x
am i ne r c an n o t h e lp b ei n g mi s l ed a s to th e v alu e O i th e ap
p are n t o s s e o u s m alfo rm ati o n H i s fi nger s c an no t i n f o rm
hi m th at wh at h e c o n s i der s an os s e o u s le s i o n i s i n re ality
The o n ly w
ay he c an e s c ap e fr o m m ak
bad d eve lo pm e n t
i n g a m i st ak e i s by c o n ti n u i n g hi s e xam i n ati o n with o u t h o ld
The hi s t o ry
i n g a p o sitiv e i de a th at h e has f o u n d th e cau s e
ve lo pm e nt Of th e c ase m ay ar o u s e s tr o n g d o u bt s as
an d d e
to th e v alu e o f hi s di s co vered S pi n al l e s i o n
Y o u r atte n t i o n i s c alle d to thi s p o ss ib l e m i st ake i n v al
i o n o f a l e s i o n s o th at y o u m ay n o t b e c o m e we dded to
uat
th e i de a th at wh e n y o u h ave f o u n d wh at ap pe ar s to b e a
mi sp lac em e n t y o u ar e free to e nd y o u r e x ami nati o n an d
p r o n o u n c e a co mp ete n t j u dgm e n t
—
Whi le th e p ati e n t i s o n hi s
Te s t M u scu l ar Te n s i o n
s id e e x ami ne c aref u l ly th e am o u n t o f te n s i o n i n th e s e t hre e
gr o u p s c o n stit u ti n g th e f o u rth layer A fter c o n s id er ab l e
ed u cati o n o f th e s e n s e o f t o u ch it wi ll be p o ss ib l e fo r y o u
to determi n e th at th e p o i n t s u n d er y o u r fi n ger s ar e p r o b ab ly
Wh e n th e s e m u s cle s fe e l h ar d an d u ny i e l d
to o se n sitive
The c on tr ac t u re d
i n g th ey ar e u s ually so re to p re ss u re
co n diti o n o f th e mu sc l e has aff e c te d th e s e n so ry n erve fi la
m e n t s i n tw o w ay s : F i r st by di re c t pre s su re betwe e n the
by rete nti o n o f m et a
c o n tr ac ted m u s c l e b u n dl e s ; s e c o n d
ho li c w a ste p r o d u c t s whi ch re s u lt i n c h em i c al p o i so n i n g
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F IG
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y
p l i a i li t
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39 5
i n te r s c ap u l a r
t
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of
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Tho rac i c F l e x ibi l it y — F ig
1 58
i llu s tr ate s a m eth o d o f
as
c ert ai n i n g th e e lasti c ity Of th e d o r s al s p i n e an d th o r ax
Thi s p r o c ed u re as s i s t s i n e s tim ati n g th e ge n er a
l Co n diti o n
Of th e b o dy I f th e th o r ax i s fi x ed i n e las ti c re s p ir ati o n
c an n o t b e c arrie d o n p r o p er ly
O x y g e n ati o n o f th e b l o o d
will b e imp erfe ct I f de s i re d we m ay p alp ate th e spi n o u s
p r o c e s s e s an d th e m u sc u lat u r e whi l e th e pati e n t i s i n thi s
p r o n e p o s iti o n
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1 59
h o w s th e
p r o p e r p o s iti o n o f th e p ati e n t fo r e x am m atl o n Of th e abd o
men
The k n e e s b ei n g dr aw n u p allo w s re lax ati o n o f ab
do m i n al m u s c l e s
W h ere th e abdo m e n i s very s e n sitive to
th e t o u ch eith e r b e c au s e o f p ai n o r ti c k li sh n e s s us e the
wh o le h an d u n ti l th e p ati e n t b e c o m e s so m ewh at acc u st o m ed
to th e t o u c h
S o m eti m e s it i s n e c e s s ary fo r th e phy si c i an
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PR I N C I P LE S
396
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P a l p at i o n
of
th e
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men
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lift th e feet fr o m the tabl e an d fl e x th e k n e e s q u ite c lo s e
he abd o m e n
A ste ady eve n pre ss u re o f th e h an d o n
to t
th e ab d o m e n wil l so o n b e co m e n o n i rrit ati n g to th e p atie nt
an d deep e r p alp ati o n c an be m ade
I f th e e x ami n ati o n i s a ge n er al o n e c o m m e n c e y o u r
w o rk w
ith th e p ati e n t i n th i s p o s iti o n by p alp ati n g th e
th o rax No te f o rm an d fl e x ibi lity e s p e c i ally th e fl e x i bility
The fre e m o vem e n t o f th e s e rib s i s
o f th e five l o wer rib s
e sse n ti al to m any f u n cti o n s ch i efly re sp irati o n bu t i tal so
h
1 c al
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s
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S u c h o b s erv ati o n s o f f o rm an d fl e x ibi lity ar e very g e n
e r al bu t th ey le ad i nv ar i ably to so m e clu e o f e sp e c i al v alu e
i n th e s e ar c h fo r e ff e c t s an d th ei r cau s e s
—
E l e vati o n o r D e pr e s s 1o n o f R ib s
No te th e sp ac i n g o f
th e rib s to d etermi n e wh eth er any rib i s el ev ated o r d e
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PR I N C I PL E S
398
O F O S TE O PA TH Y
b o o k s o n di ag n o s i s By th e u se o f all th e s e phy s i cal meth
o ds it i s p o s s ib l e t
o arriv e at a ve ry defi n ite c o n c lu s IOn o f
th e s t at e o f th e th o r aci c vi s c e r a
The ab d o m e n sh o u l d b e p alp ated th e n p er c u ss e d
Th e s e tw o m eth o d s sh o u l d m ake evi de n t a ny o rg an i c ch an ge
i n th e abd o m i n al vi s c er a
E x am i n ati o n o f the R e ctu m an d P r o s t ate G l an d: — F ig :
160 i llu str ate s a p o s iti o n fo r e x am i n i ng th e re c t u m an d po s
F ig 16 1 i s «
t ate g land
k n o w n S i m m s p o s iti o n
the we ll—
whi ch m ay b e u s e d fo r th e s am e p u rp o s e as the pr e ce di ng
O th e r p o s iti o n s u s ed by th e o s te o p ath fo r e x ami n ati o n
an d tre atm e n t ar e th e we ll k n o w n gy n e co lo gi c al p o siti o n s
—
ge n u p e c t o r al an d Tre n d el e n b u rg
E x am i n ati o n o f the Ne c k —
F o r e asy ex am i n ati o n o f
th e n e c k th e pati e n t sh o u l d be re c u mb e nt
1 59
, as i n F i g
The m u sc l e s o f th e n e c k m u st h ave all te n si o n rem o ve d
S O th at th e e x a mi n er s fi n ger s c an fe e l th e p r o c e s s e s o f th e
c ervi c al ve rteb r ae
he m
A fl at t ab l e i n s te ad o f t
o d e l sh o w n i n the illu s
A h ard s m all pi l lo w m ay b e u s ed to Su p
tr ati o n i s b ette r
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PRI N C I PLE S
S i nce
th e
O F O S TE O PA TH Y
39 9
pi n o u s p r o c e ss e s i n th e c ervi cal regi o n ar e
sh o rt
an d bi fi d
an d o fte n ti m e s deve l o p ed u n eve n ly an d
are c o vere d with s ever al layer s o f m u s c l e s an d l ig am e n t s
it i s n o t sati sf ac t o ry to u se th em as l an dm ark s fo r re lati o n s
o f c ervi c al ve rtebr ae
The t u be r c l e s o n th e tr an s ver se pr o c e ss e s ar e e as i ly
p alp ated h e n c e th e s e s erve as g u i d e s in th e d ete c ti o n o f
n t s o f c ervi cal v ertebr ae
S l ight m i sp la c m
e
e
The t
r an sv
e r s e p r o c e s s e s o f th e at las ar e u s u ally l arge
an d s u ffi c i e n t ly p r o mi n e n t to e n ab l e th e e x ami n er to asc e r
t ai n acc u r ate ly i ts po s iti o n Wh e n th e at las i s i n i ts tr u e
p o siti o n i ts tr an sver s e ! p r o c e sse s wi ll b e f o u n d ab o u t mi d
w ay betwee n th e m as t o i d p r o c e s s e s O i the temp o r al b o n e s
Thi s re lati o n sh ip m ay app e ar
an d th e an g l e s Of th e jaw
u n tr u e wh e n th e m as t o i d p r o c e s s e s ar e q u ite l arge o r s m al l
o r th e an g l e
I t is
s o f th e jaw ar e m o re o r l e s s o bt u s e
n e c e s sary to s t u dy th e re lative deve lo p m e n t an d p o s iti o n s
i n every c as e o n b o th s ide s i n o rde r to di s c o ver wh eth e r
a su b lu x ati o n ex i s t s
The f ac t th at n e ar ly all su b lu x ati o ns
he at las ar e t wi s t s i n s te ad o f di re c t f o rw ard o r b ac k w ar d
of t
s it c o mp ar ative ly e asy to d ete c t th e
i n e q u al iti e s an d u n der st an d th e f au lty p o s iti o n S e n sitive
n e ss wi ll b e f o u n d i n th e ti s s u e s o n th e si d e wh o s e tr an s
ver s e p r o c e ss i s po ste r i o r In c as e th ere i s m arked S e ns i
ti v e n e s s o n b oth s ide s th at i s o n th e p o s teri o r su rf ac e s o f
b o th tr an sver s e p r o c e ss e s th e at las i s pr o b ab ly d r awn
S lightly p o s te ri o r o n b o th S id e s by th e s ev ere c o n
tr ac ti o n
o f i ts a t
t
a
c he d m u s c l e s
,
The th i rd c ervi c al v ertebr a s e em s to b e e asi ly su b l u x
ated
I t i s u su ally twi sted n o t su ffi c i e n t ly to lo c k i ts ar
ti c u lar pr o c e s s e s bu t j u s t e n o u gh to m
ake th e d o r s al s u r
f ac e O f i ts i n feri o r arti cu lar p r o c e s s e as i ly p alp ab le thr o u gh
th e m u sc l e s wh i ch li e Over it Thi s p r o mi n e n t p o i n t wi ll
be se n sitive be cau s e th e m u sc l e s o ver it ar e alw ay s te n s e
S o meti m e sth e s i x th c ervi c al verteb r a i s twi sted Wh e n
thi s c o n diti o n e x i s t s th ere i s m arked di st u rb an c e o f c i r c u
lati o n i n th e h e ad
The p ati e n t i s u s u ally w akef u l and
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PRI N C I PL E S
4 00
O F O S TE O PA TH Y
O
e x cit abl e o n acco u n t o f th e c o n ge ste d co nd iti o n o f th e c ere
b r al b lo o d ve ssel s c au sed by th e p re ssu re o n th e verteb ral
vei n s
No te th e t o n e o f all th e c e rvi cal m u s c l e s th e fl e x ibi lity
o f th e n e c k
th e temp er at u re o f th e S ki n o n di ff er en t p art s
o f th e n e c k
Pa
lp ate th e ch ai n s O i lym phati c gl an
d s th e
thyr o id an d th e su bm ax il lary s al iv ary gl an d s
A fter a th o r o u gh p alp ati o n o f th e n e c k lo o k caref u lly
fo r any evi d e n c e s o f di s t u rbe d c ir c u l ati on i n th e h e ad as
m ay b e evi de n c e d by th e app e ar an c e o f the S ki n m uco us
m e mb r an e o f th e m o u th th e t o n s i ls c o n j u n c tiv a O r the
we ari n g o f g lasse s Y o u r k n o w l edge o f o pti cs sh o ul d e n
ab l e y o u to j u dge th e ge n e r al c o n diti o n o f th e eye s by In
i o n o f th e g las se s w o r n
spe c t
S u c h an e x am i n ati o n o f th e h e ad an d n e c k as h erei n
o u t li n e d S h o u l d give th e exami n e r a g o o d u n der s t an di n g
o f th e s tr u c t u r al an d f u n cti o n al co n diti o n e x i sti n g at th e
tim e o f e x am i n ati o n an d ev e n g u i de hi m to wh at o th er
p art s o f th e b o dy m ay n e e d S p e c i al atte n ti o n
The H i st
or y o f L e s i o n s — A ll f act s as t
o str u c t u re a
nd
f u n c ti o n de tei m i n e d by y o u r e x ami n ati o n ar e hi st o ri cal
t hat i s th ey h ave d ate s an d c i r c u m st an c e s whi c h g 1v e th em
mu c h o r littl e v alu e The e x p e ri e nc ed di ag no sti c i an de
light s i n fi lli n g i n th e l ife h i s t o ry o f th e p ati e n t to fit th e
H erei n li e s th e o ppo r
s tr u c t u r al an d f u n c ti o n al c h an ge s :
tu n i ty fo r th e phy s i c i an to b ri n g to hi s aid all hi s re s o u r c e
l o n l n j u dgi n g ho w the s e l e si o n s
o f e x p eri e n c e an d e du c at
h ave b ee n b r o u ght abo u t and ho w th ey ar e n o w i n fl u e nc ing
o th e r t
i ss u e s
—
m
e
The E x t r e iti s
Whil e the p ati e nt i s in th e re c u m
b e n t d o r s al p o siti o n Fig 1 59 th e lo wer e x trem iti es can b e
e x ami n ed No te the c o mp ar ative le ngth o f the l egs but
b e c aref u l to e li m i nate all p o ss ibi lity o f i s t ake by O bse r v
i n g wh eth er th e p ati e n t i s lyi n g eve n ly o n the b ac k i l i a
an d m u sc l e s o f b o th l eg s e q u ally re lax ed
s am e h ei ght
A
me asu rem e n t fr o m th e anteri o r su p e ri o r ili ac S pi n e to th e
i nter nal m all e o l us determ i n e s th e l e n gth o f th e l eg
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PR I N C I PL E S
40 2
O F O S TE O PA TH Y
C H A P TE R
XX
.
M A NI PUL ATI O N
.
Th ere has b ee n
ve ry rap id ev o lu ti o nary d eve lo p
m e n t Of m an ip u lati o n as a th e r ap e u ti c m eth o d
I t has
b ee n f o u n d to be a w o n de rf u lly ad apt ab l e m e an s o f al
l e v i ati n g h u m an su ff eri n g
U n d o u b te d ly th e p ri n c ip l e s
u n de r lyi n g a n y
m eth o d o f m an ip u lati o n c on trib u te s o m e
th i n g to all o th er so —
c all ed
sy s tem s o f m o vem e n t cu re s
M an ip u lati o n i s h and p r ac ti c e i n th e s u rgi cal s e n se
It
i s app l i c ab l e i n a treme n d o u s ly wi de r ang e o f di so rd e r s
fo r e x amp l e th e tre atm e n t Of fr ac t u re s s pr ai n s b re aki n g
adh e s i o n s
re d u c i n g di slo cat i o n s as si sti n g v e n o u s cir cu l a
ti o n stim u l ating p eri st al s i s re d u c i n g c o n ge sti o n s q u i et
i n g refl e x e s s ti m u lati n g n erve c e n ter s an d m any o th er
th i n gs o f a h elp f u l char acte r
The f o rm Of m an ip u lati o n m o st ge n er ally u n der s t o o d
i s m as sage
Th i s term i s u s ed by so m e to m e an any
m eth o d o f m an ual m an ip u lati o n M as sage i s a m eth o d o f
m an ip u lati o n wh i c h has b e e n e x te n s ive ly p r acti c ed an d
writte n ab o u t h e n c e th ere is n o e x c u se fo r th e prev ai li ng
u se
s lo ve n ly
Of the te r m to co ve r all f o rm s o f h an d
m an ip u lati o n The c h ar ac teri s ti c m o vem e nt s o f m as sage
They h ave p r o ve n w o n de rf u lly
ar e fri c ti o n an d k n e adi n g
s ati s f ac t o ry a s adj u v an t s i n o ve r c o m i n g ve n o u s s t as i s an d
t o n i n g th e n e u r o m u sc u lar m e ch an i s m o f th e b o dy NO
o n e w ho IS at all c o n ver san t with th e ph e n o me n a o f n at
u r al re c o ve ry f ai ls to re co g n iz e th e gre at ass i st an c e whi ch
—
eve n th e c r u de st u se O f m ass age f u r n i s h e s
The n e x t step o f a sc i e n tifi c c h ar ac te r i n th e d eve l
m an ip u lative m eth o d s w as S we di sh m o v e
o pm e n t o f
a
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-
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PR I N C I PLE S
m e nts
O F O S TE O PA TH Y
The s e i n tr o d u c e d l ever age
40 3
v o lu n t ary re s i st an c e
—
as n e w f ac t o r s i n i n c re as i n g th e t o n e o f th e n e u r O m u s
A very l imite d fie l d w as acco rde d to
app ar at u s
cu lar
m ass age an d S wed i s h m o vem e n t s Bo t h th e s e m eth o d s
w e r e pr acti c ally n eve r u s ed e x c ept as p re sc rib e d by a
phy si c i an
P racti c ally n o di ag n o sti c ab i l ity o r 1n 1t1at1v e
i s c redite d to th o s e w ho app ly th e m eth o d s
S u rgery w as
“
F o rm er ly t hat br an c h Of m edi c i n e c o n c er n e d wit h m an
”
u al o per ati o n s u n der th e dire c ti o n Of th e phy s i c i an
If
th e ev o lu ti o n Of su rgery c an b e u s ed as a c riteri o n fo r
j u dgi n g th e f u t u re o f m an u al m an ip u lati o n th ere can be
n o d o u bt as to th e c o m m an d in g p o s iti o n th at wi l l b e at
.
an d
‘
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(
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tai n e d
.
i n tr o d u c e d a n e w f ac t o r i n m an ipu
th e adj u s tm e n t o f j o i n t lu x ati o n s
lative th er ap e u ti cs i e
It i s i n tere sti n g to n o te th at th e ar t
an d s u b l ux ati o n s
Of m an ip u lati o n app li c ab l e to th i s c o rre ctive w o rk w as
deve lo p ed i n d ep e n de n t ly Of m ass age an d S wedi sh m o ve
m e nts
O s te o p ath i c m o vem e n t s c o u l d n o t h ave ev o lve d
b e c au se
n at u r ally fr om m as s age an d S we di sh m o vem e n t s
di re c t re s u l t o f th e th e o ry
o ste o p athi c te chn i q ue i s th e
rdi ly ass erte d an d d efe n d ed by D r A T S ti ll th at
st u
“
H i s re c o g n iti o n an d tre at
s tr u c t u r e g o ver n s f u n c ti o n
”
“
m e n t o f j o i n t l e si o n s s u b lu x ati o n s l e d to th e d eve l o p
m e n t o f a sys tem o f m o vem e n t s p rim ari ly s u r g i cal i n
c h ar ac ter
NO m atter ho w m u c h any o ste o p ath i c phy si
t ake i ss u e with h i m i n m atter s o f th e o ry th e
c i an may
f ac t e x i st s th at n o t o n e o f th e m b e li eve s th at h e has ever
b ee n app r o ache d in s ki ll i n th e ar t o f co rre c tiv e m an ipu
lati o n
P re s en t day o s te o pathi c phy s i c i an s ar e b e n
efi c i ari e s
o f al l th e su c c e s s e s c redited to m as sage
S we di sh m o ve
m e n t s D r A T S ti ll s o rigi n al w o rk sp e c i al o p er ati o n s
d evi sed by o r th o p aedi st s all o ve r th e w o r l d an d th e
bri lli an t w o rk o f P r o fe sso r L u cas Cham po n i e r e i n th e
”
—
tre atm e n t o f fr ac t u re s by g lu c o ki n e si s an d m o b i l i s a
ti o n W e ar e b e n efi ciari e s o f all th e s e b e cau s e D r S ti ll
O ste o p athy has
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PR I N C I PL E S
4 04
b e li eve d
O F O S TE O PA TH Y
f u n d am e nt al m e di cal e d u c ati o n an d th e e s
tabls hm e n t Of a s ch o o l o f m edi c i n e an d su rge ry p rim ari ly
d ev o te d to th e sc i e ntifi c d eve lo pm e n t o f m an ip u lative
th e r ap e u ti c s S i n c e at th e tim e o f hi s m o st active w o rk
i n p r ac ti c e an d te ac hi n g th e ab u s e o f d r u g s an d s u rgery
w as at i ts h eight it i s n o w o n der th at h e de s i re d to e st ab
li sh a sy s tem o f p r acti c e wh i c h w o u l d n o t b e b u rd e n ed
by i n h erit anc e Of th e f o ib le s an d f ai lu re s o f dr u g th er apy
A S a re s u l t o f th e s u cc e ss o f o st e o p athi c th e o ry an d
p r ac ti c e th ere has b ee n th e i n evit ab le p lagi arizi n g o f i ts
lite r at u re an d m eth o d s by tho s e w ho fi n d it pr o fit ab l e to
im p o s e o n an ig n o r an t p u b li c Thi s plag i ar l z i n g has b e e n
d o n e u n der s ever al n am e s bu t e sp e c i ally u n d er th at o f
The h i st o ry Of th i s attemp t to app r o p ri ate
c hi r o p r ac ti c
th e p ri n c ip l e s an d m eth o d s Of O ste o pathy t with ou t r e
q u i ri n g any c re dit ab l e e d u cati o nal w o rk to m ake th em
i s a sad tr av
s afe m e an s o f tre ati n g ai l i n g h u m an b ei ng s
i
n
e st
o
n
t
n
f
a
l
a
n
n
o
th
e
d
rd
m
edi
ed
ti
o
th
i
s
a
a
s
o
c
u
c
s
c
u
y
try
U n de r o u r pre s e nt law s n e w sch oo ls o f m e di c i n e
m ay be st arted as sh o rt c u t s to av o i d th e m o der at ely
re q u i re me n t s o f e st abl i sh ed sch o o ls S o lo n g as
s evere
”
thi s i s p o s sib l e th ere wi ll c o n ti n u e to app e ar n e w s ch o o l s
e x p lo iti n g so m e ph as e Of e s tab li shed m eth o d s u n d e r n e w
n am e s
—
O ste o p athi c phys i c i an s f r e
M e t ho ds o f P r oc e du r e
q u e n t ly di ff er as to m eth o d s o f p r o c e d u re but th ey all
F o r i n s t an c e a
w o rk ac co rdi n g to th e sam e p ri n c ip le
o f a ve t
te br a might b e di s co ve re d by tw o
s u b lu x ati o n
The fir st o n e m ight u nd ert ake to re du c e th e
o ste o p ath s
p re lim i n ary w o rk o n th e m u s
any
s u b lu x ati o n with o u t
b e li evi n g th at it i s be st to g o ri ght to th e S e at o f
c le s
tr o u b l e an d rem o ve i t H i s tre atm e nt w o u l d b e s e v ere
b e c au s e m u ch stre n gth w o u ld b e re q u i re d to o ve r co m e
th e re s i st an c e o f th e m u sc l e s g o ver n i n g th e arti c u lati o n
The se co n d o n e m i ght s p e n d c o n s ider ab l e ti m e o n th e
p re lim i n ary w o rk o f re lax i n g th e m u scle s Of th e arti cu la
ti o n i nc re asi n g fl e xibi lity red u ci n g se n s itive n e ss e tc
in
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PR I N C I PLE S
406
O F O S TE O PA TH Y
The m o vem e n t s h ere afte r p i ct u re d
d e sc rib e d
an d
ar e
m ad e with refere n c e to s tr u ct u re r ath e r th an f u nc ti o n
F e w refere n c e s ar e m ad e c o n c e r n i n g th eir app li c abi l ity to
s pe c i al di s e as e s
We do n o t c are wh at th e nam e o f th e
di s e as e i s The gr o u p s o f sympt o m s whi ch m ake u p th e
pi ct u re s d e sc ribe d i n sym pt o m at o lo gy h ave very litt le
s ig n ifi c an c e
to th e o s te o p ath
H i s m o vem e n t s ar e n o t
m ad e with ref ere nc e to a n am ed di s eas e b u t to a fau lty
co n diti o n
The s tr u c t u r al c o n diti o n m ay b e
str u c t u r al
th e b as i s fo r th e phy s i o lo gi c al Fu n c ti o n d o e s aff e c t str u ct
ure
W e ar e n o t to lo s e s i gh t o f th i s f act
F u n c ti o n
m ay b e p erverte d by bad h abit s h e n c e o u r th er ap e u ti c s
m u s t c o mp reh e n d th e hygie n i c an d diet eti c s i de Of life as
w e ll as s tr u ct u r al
E very m o vem e n t h ere i n o u t li n ed s e c u re s a d efi n ite
e ff e c t o n a m u sc l e o r i s us e d to aff e ct th e re lati o n o f b o ny
p art s
The m o vem e n t s m ad e to aff e c t th e m u s c le s o f the
b ac k an d S pi nal c o lu m n ar e b ased u p o n th e att ach m e n t o f
th e m u scl e s an d th e l ever age th ey e x ert o n th e s p i nal
c o lu m n
—
D
o
r
si
The arr an ge
R e l ax ati o n o f the Lati ss i mu s
m en t o f th e b ac k m u s c l e s has b ee n n o t
e d i n th e ch apter
In o rd er to rel ax th e se
E x am i n ati o n
o n P o s iti o n s fo r
m usc l e s in th eir nat u r al rel ati o n s i e fr o m s u p erfi c i al
to d eep gr o u p s we b egi n with su c h a m o veme n t as wi ll
s ep ar ate th e e x trem iti e s o f th e m os t s u p erfi c i al m u scl e s
F i g 162 i ll u str ate s th e m eth o d O i
to th ei r f u lle st e x te n t
re lax i n g th e lati s sim u s d o r s i O n e h an d e x te n d s th e ar m
It
to i ts f u l l e s t e x t e n t th e o th er h an d an ch o r s th e i li u m
wi ll b e n o ted th at th e lo we r d o r s al an d l u mb ar p o rti o n s
o f th e sp i n al c o lu m n ar e l ifte d by th e p u ll o f thi s m u sc l e,
The i n tri n si c e ff e ct
A l s o th e f o u r lo we r rib s ar e r ai s e d
o t ake m o s t o f th e te n
o f thi s s tret chi n g m o vem e n t i s t
s i o n o u t o f th e m u sc l e it s e l f an d i n c re as e th e am o u n t o f
m et ab o li c ch an ge t aki n g p lac e withi n it Bu t th at is n o t
wh at i s p rim ari ly i n te n ded The i ntri n si c e ffe ct s ar e m ere
all
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PRI N C I PL E S
F IG
.
163
.
O F O S TE O PA TH Y
R e l ax ati o n
of
th e
t
r ap e
ziu
s
40 7
.
phy s i o lo g ic al life Of th e m u sc l e an d a s
n
s
o
l
a
sc
u
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s
l
l
h
f
d
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ki
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Of
m
r
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vem
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o un
are
su c
ff
c
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o
m
s
n
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n
c
o
e
tri
i
e
t
wh
t
er
t
th
e
e
t
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;
The x n s c eff c s
f
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verteb
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th
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s
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here
thre
e
thi
m
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e
t
ir
t
f
o
e
u
s
s
ar e
T
p rep ar at o ry to w o rk u p o n m u sc l e s lyi n g be n e ath it i e
p u re ly r e lax i n g S e co n d i n cas e o f o ver lappi n g by any
o
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th
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der
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r
b
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h
fi nd t e
e leve n th The p u ll o f th e lati s s im u s d o r s i i s e x e r te d o n
n
h
o
t
r
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r
b
a
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g
p r o p er re lati o n s
R e lax ati o n u s u ally allo w s a re tu r n o f
th e f au lty p o s iti o n bu t if th e rib s ar e h e l d at th ei r e x
tr e m i ti e s by th e Op erat o r fo r a few s e c o n d s after re l ax a
ti o n the i n ter c o st al m u scl e s an d q u adr at u s lu mb o r u m wi ll
I n c i de n t s i n
the
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PR I N C I P L E S
40 8
'
F IG
.
1 64
.
R e l ax at i o n
O F O S TE O PA TH Y
th e
of
rho
m
b
m aj o r
oi de u s
an d
mi nor
.
The
b e fi ll e d with arte ri al b lo o d wh i ch t o n e s th em
p ati e n t sh o u ld b e di re cted to h an g by th e h an d s sever al
ti m e s p e r day s o as to get a go o d e ff e c t o n th e p o s iti o n o f
th e lo wer rib s Th ir d to aff e c t later al cu rv at u re o f th e
S pi n e i n th e l u mb ar o r lo wer d o r s al p o r t
i on
—
h
r
R e lax ati o n o f t e T ape zi u s The tr ap ezi u s i s ah
o th e r O i th e s u p e rfi c i al gr o up o f b ac k m u s c l e s
Its fib er s
ar e s o v ari o u s ly att ac h ed th at s ever al m o v e m e n t s ar e re
q u i red to re lax all i ts divi si o n s F ig 163 i llu str ate s th e
m eth o d Of gr aspi n g an d ho ldi n g th e s cap u l a wh i l e re lax
i n g th e tr ap ezi u s
The sc ap u la i s r o t ated o n the th o rax
as far as p o ss ib l e t o w ard th e h e ad s o as to stret c h th o se
fib er s e x te n di n g fr o m th e spi n e Of th e s c ap u l a to the S i x th
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P R H M HP LE S CHI O S TE O P ATH Y
M0
G
FI
.
1 65
R e l a x at i o n
.
of
th e p e c to r al i s
m aj o r
t
an d s e r r a u s
ma
gnu
s
.
e x erte d o n a later al c u rve In th e 1 n te r s capu lar regi o n I t
i s ge n er ally u s e d as p rep ar at o ry to w o rk o n deep e r str u e
t u re s
—
The P e ct o r al i s M ajo r an d S e r r at u s M ag nu s
F o llo w
i n g th e s e m o vem e n t s wh ere ge n eral th o r ac i c an d spi n al
re lax ati o n ar e d e si re d th e m o vem e nt illu str ated 111 Fig
16 5 m ay b e u s ed
I t aff e ct s th e P e c t o r ali s M aj o r an d
S err at u s M ag n u s f By p u shi n g th e p atie n t s e lb o w as far
b ack as p o s s ib le th e scap u la is appr o x im ated to th e s p i n al
h e n c e th e serr at u s m ag n u s i s pu t u p o n a te n
co l u m n
wh i c h l ift s th e eight u pp er ribs The pect o r al i s
si o n
m aj o r al so aff e c t s th e u pp e r rib s The phy s i c i an s h an d
o n th e an g l e o f th e rib s ac c e n t u ate s th e e x p an s i o n o f th e
.
.
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.
O F O S TE O PA TH Y
PR I N C I PL E S
F IG
166
.
R e l ax at i o n
f
.
of
ou r
t
th e
h la
.
s e r r a tu s
ye r
of
.
ma
gn
d o r s al
me
so
an d
us
m u s cle s
41 1
fi
bres
of
th e
.
h e st Thi s is a ge n er al m o vem e n t bu t o n e wh i c h has far
reach i n g e ffe ct s u p o n r e sp1r ati o n an d c ir c u lati o n
It is
ad apt ab l e to m an y sp e c ifi c s tr u c t u r al defe c t s o f the rib s
In F i g 166 th e phy s i c i an ag ai n u s e s the h u m er u s an d
s c ap u l a a s m e an s by wh i c h to aff e c t th e s pi n al c o lu m n
The l eft h an d e x ert s tr ac ti o n o n th e m u s c l e s ab o ve the
s pi n e
wh i le th e right h an d an d ar m f o r c e s th e p ati e n t s
sca
p u la t o w ard th e h e ad an d s pi n e The m o vem e n t i s
m ade to e n ab le th e phy s 1c 1an to re lax th e s err at u s m ag
n u s an d s o m e Of th e fib er s o f th e f o u rth l ayer o f th e b ac k
S light t o r s i o n o f th e d o r s al S pi n al c o lu m n i s al so s e c u re d
c
.
,
.
‘
.
.
.
’
,
.
.
.
'
‘
.
.
.
—
m
The
Lu m b o r u
Q u adr at u s
re lax ati o n o f th e q u ad
r at u s lu mb o r u m i s se c u red acc o rdi n g to F i g 167 In all
di sp lac em e n t s o f th e twe lfth rib it i s n e c e s sary to s e c u re
The
a free c ir c u l ati o n i n th e m u s c l e s att ac he d to th at rib
f ac t th at it i s a fl o ati n g rib m ake s i ts p o siti o n dep e n de nt
.
-
.
.
,
.
PR I N C I PL E S
4 12
F IG
.
1 67
.
R e l ax at i o n
O F O S TE O PA TH Y
of
t
th e q u a d r a
us
lu m
b
o ru
m
.
th e t o n e o f th e m u sc le s att ac h ed to it I t i s fre q u e n t
Thi s m o ve m e n t s ep ar ate s
ly sl ipp e d u n de r th e el eve n th
th em
e re sp e ct s si mi lar to th e m o vem e n t
F i g 16 8 i s i n s o m
he s c ap u la i s f o r c ed
il l u str ate d i n F i g 166 e x c ept th at t
d o w nw ard an d th e left h an d is ab le to w o rk t hr o u gh th e
re lax ed su p erfi c i al m u s cl e s After th e u s e o f th e m o ve
m e nt s alre ady i llu str ated it 1 s ast o n i shi n g ho w e asily o n e
c an w o rk u p o n th e f o u rth laye r o r e x ami n e th e c o n diti o n
o f d e ep s tr u c t u re s
on
.
.
.
.
.
,
,
.
,
.
—
The w o rk u p o n th e f o u rth layer
E r e ct o r S pi
d o n e ac co rdi ng to F ig 1 5 5 The fi nger s ar e
sh o u ld b e
p lac ed b etwe e n th e m u sc le s an d th e sp i n e s o f th e verte
n ae
.
.
PR I N C I PLE S
4 14
F IG
FIG
.
.
1 69
170
.
S p r i ng i ng
-
.
A
me tho d
O F O S TE O PA TH Y
a
d or so - lu m
of s p r i ng i n g
a
ba kyph
r
o si s
b kyph
l u m ar
os i s
.
.
PR I N C I PLE S
F IG
.
171
.
S pr in
O F O S TE O PA TH Y
gi n g
an
4 15
d o r sal l o r d o si s
upper
th e j u n cti o n o f th e d o r s al an d lu mb ar The
f o r e arm s ar e p lac e d ag ai n st th e p atie n t s
s
wh i l e th e fi n ge r s re s t o ver th e ky
S h o u l de r an d i l i u m
T
h
n
r
h
o
n
l
o
l
n
e
a
a
f
o
p
rti
th
e
pi
u
m
h
d
dr
w
se
o
o
n
o
f
a
c
s
d
s
p
w ard wh i l e th e f o re arm s p u sh aw ay C o n sider ab le f o r c e
o n S l en der p ati e n t s
c an be e x erted i n thi s w ay
G r eat f o r c e c an b e e x erte d o n a p o steri o r c u rve Of th e
l o wer d o r s al an d lu mb ar p o rt 1o n s by th e m o vem e n t S h o w n
i n F i g 17 0
Th i s m o vem e n t i s als o u s ed fo r p u rp o s e s o th er
th an c o r re ctive o f s tr u ct u r al defe c t s S i n c e th e l ever age
i s S O gre at it i s q u ite e as y fo r th e phy si c i an to carry it
The re s u lt i s an active c o n ge s ti o n Of th e lo wer
to o far
o
n
l
x
rti
o
o
th
e
p
i
n
a
l
co
rd
f
o
l
o
wed
by
e
e
iv
e
tivity
f
S
c
ss
a
c
p
Of th e n erve c e n ter s l o c ated th ere In givi n g thi s m o ve
m e n t to w o m e n as c ert ai n wh ethe r preg n an cy e x i s t s I f
ky pho s e d
h
1 c 1an
S
p y
at
.
’
’
.
.
.
.
.
.
,
"
.
,
.
,
.
PR I N C I P L E S
4 16
O F O S TE O PA TH Y
der any co n si der ati o n u s e it The c e nter fo r
p art u riti o n m ight b e e x cite d by it eve n th o ugh th e m o ve
m e n t m ad e is slight
Th ere i s p r acti c al ly n o d an ge r i n thi s m o ve me n t wh e n
i n te llige n t ly u s ed e x c ept in th e case o f p reg nan cy A
li ft m ad e whi le th e phy s i c i an i s w at ch i n g
S lo w
s te ady
am o u nt o f re s i s t an c e o ff ere d by th e b ac k
c aref u lly th e
wi ll u su ally i n h ibit th e e x c item en t o f th e c e n ter s lo c ated
i n th e l u mb ar e n l argem e n t o f th e spi n al c o rd
The s lo w
n e s s an d ste adi n e s s o f the m o vem e n t re lax e s th e m u sc l e s
te r dr am ag e fo r b l o o d i n
o f th e fifth l ayer an d s e c u re s b e t
th e sp i n al can al
No active c o n g estl o n 1 8 br o u ght o n
h e nc e a s e d ativ e e ff e c t 18 g am e d Q u i c k i n te n s e e xe cu
ti o n o f thi s m o vem e n t has fr e q u e ntly a r eve rs e e ff e ct be
c au s e th e s h arp
str ai n pu t u p o n th e m u s c l e s re su lt s i n
ac tive c o n ge s ti o n an d Ob s tr u c ti o n to
ad ded c o n tr ac ti o n
g o o d d r ai n age o f th e sp i n al can al Th e s e c o n dit i o n s r e
s u lt i n f u n c ti o n al ac tivity o f th o se o rg an s g o ver ne d
by
th e n e rve c e lls i n th e lu mb ar e n l argem e nt Ac tiv e co n
ge s ti o n o f a g e n te r r es u lt s i n i n c re as ed f u n cti o n o f t
he
"
o rg an
o ve r n
e d by
n
th
t
e
ter
a
c
g
S O,
do
no t u n
.
,
.
'
,
.
,
.
.
,
.
.
,
,
,
-
.
.
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.
.
ge n e r al r u le , th i s m o v em e n t i s co n tr a I n di c ated
fo r any p u rp o s e b u t th at o f c o rre c ti n g a str u c t u r al d efe c t
The re ac ti o n Of m any pati e n ts i s an u n c ert ai n q u an tity
h e n c e it is n o t wi s e to u s e th i s tre atm en t f o r p u re ly f u n c
ti o n al e ff e c t s
As a re s u lt o f th e ig n o r an t u s e o f thi s m o veme n t by
th o s e w ho ar e p alm i n g th em s e lve s o ff as o ste o p ath s th e
n ger o u s c o n dit i o n s
au th o r k n o w s o f s ever al c as e s wh ere d a
we re br o u ght o n
AS
a
-
.
,
”
.
,
.
—U pp
—
or
L or d o si s
D o r sal
An an teri o r c u r ve
er
he s p i n e i n th e i n ter s cap u l ar
of t
c o n diti o n
str aighte n ed
regi o n is r ath er di ffi cu lt to tre at o n acc o u n t o f i n abi lity
o f th e phy si c i an to u se th e e x trem iti e s a s l ever s
i llu str ate s a m eth o d o f applyi n g lever age by m e an s o f th e
The p o s iti o n o f the k n e e o n th e sp inal
c e rvi c al ve rteb r ae
.
,
'
,
.
‘
.
PR I N C I PL E S
4 18
O F O S TE O PA TH Y
l m n reg u late s th e e x te n to f th e f o r c e o f th e m o vem e nt
The k n e e i s th e weight to b e l ifte d th e spi n al co l u m n i s
a fl e x ib l e l eve r
The phy s i c i an s f o re ar ms ar e th e f u lc r u m
wh il e his h an d s app ly th e f o r c e to l ift the weight ( th e
he p o i n t g o ve r n ed by
k n ee ) wh i ch b e n d s th e l eve r at t
the p o s iti o n o f th e we ight an d f u l c r u m
The p o s iti o n o f
th e phy si c i an s h an d s i s i mp o rt an t b ecau s e th e c ervi cal
"
i s n o t th e p o rti o n o f th e S p i n al co l u m n we de s 1 r e to b e n d
I f th e h an d s ar e all o we d to re s t c l o se to the he ad th e
f o r c e e x e rte d i s n e arly all sp en t o n th e n e c k ; the m o st
fl e x ib l e p art o f th e s pi n al c o lu m n i s aff e c t ed— a re su lt n o t
de s ire d P l ac e th e h an d s as n e ar ly Over th e c e rvi cal a
nd
fi rs t d o r sal s p i n e s as p o s sible S i n c e tht u n cti o n o f th e
d o r sal an d l u mb ar s egm e n t s is a very fl e x ib l e p oi n t th e
k n e e sh o u l d b e l o c ate d h igh er
co u
.
,
’
.
,
-
.
’
,
.
,
‘
.
.
,
.
172
i ll u str ate s ano th e r m eth o d o f p r o d u c i n g
The l eve r age l n th i s
fl e x i o n i n th e u pp er do r s al r e g i o n
p o s iti o n i s s o gre at th at th e Op er at o r m u st e x er c i se c au
ti o n i n i ts u se The O perat o r S h o uld n eve r aim to o ver
i e rits re sis tan c e by e x erti n g a g r e até
r f o r ce
c o m e th e pat
The p ati e n t wi ll u s u ally rel ax un der th e i n fl u e n c e o f a
ge nt l e app li c at io n o f th e
sh o rt
tete r i n g m o vem e n t i e
F ig
.
“
.
.
.
\
’
’
.
‘
,
le v e i ag e
.
.
,
,
.
‘
.
m
h
l
l
r i et
o
f
o
v
e
e
n
W
c
h
W
e
t
i
i
The Po s sib l e va
M
s
S
y
—
A ll o f th e e ff e c t s de s cribe d m ay
h
m
R
t
e
es u l s
cu r e t e S a
.
e c ur e d by m ov em e n t s di ff eri n g fr o m th o se o ut li n ed
l
The au th o r de si re s to i llu s tr ate th e a
p
i
c ati o n o f o ste o
p
p ath i c p ri n c i pl e s I t i s b el i eve d by him th at th e S erie s o f
m o vem e n t s i ll u str ate d h ave th e V 1 r tu e o f dir ectly an d
f o r c ib ly aff e cti n g th e p art d e si red with o u t u s i n g u p to o
m u c h Of th e phy si c i an s stre n g t
h i n th ei r app li cati o n
‘ Nhe r e m u c h w o rk i s d o n e by a ph s i c i an
it
b
e
c
o
m
e
s
a
y
vit al p r o b lem with h im ho w to c o n se rve hi s o w n stre n gth ;
B y th e s e le cti o n o f th o s e m o vem e n t s wh i ch giv e the gre at
e st l ever age h e s ave s h im s el f
be
s
.
"
'
“
.
.
’
.
,
-
,
.
.
PR I N C I PL E S
O F O S TE O PA TH Y
4 19
L e ve r — Ii th e an teri o r o r
s tr aighte n ed co n diti o n o f th e sp i n e i s very m arke d i n th e
upp e r d or sa
l it i s p o ss ib l e fo r th e phy s i c i an to u s e th e
h e ad an d n e c k i n s e c u ri n g hi s l ever age Wh e n th e p osi
ti o n o f th e sp i n e i s as de s c ribed th e S p i n al m uscl e s i n th at
are a wi ll b e very c o n tr ac te d
Th e verteb r ae wi ll b e h e l d
tight ly t o geth e r th u s l e s se n i n g th e fl e x ibi lit y
Lo s s o f
fl e x ibi li ty o f the s pi n al c o lu m n re su lt s i n p o o r c ir c u l ati o n
i n th e s pi n al c o rd wit h co n s e q u e n t p erver si o n o f th e ac
ti v i ty
of
th e ph y si o lo gi c al n erve c e n ter s l o cated th ere
C o n ge sti o n p as s iv e typ e u s u ally e x i s t s ar o u n d th e s e ce n
ter s wh e n dr ai n age is i n terfer ed with by th e s e c o n tr acte d
m u scl e s
L o r do si s o r Ky phos i s M ay Aff e ct a F u ncti o n S i m i lar ly
—A ch an ge in th e co n t o u r o f th e sp i n e eith er an te ri o r o r
p os terio r m ay re su lt i n th e s am e di st u rb an c e s In th e
p eriph er al di st r ib u ti o n o f th e n erve s fr o m th e dis
The an teri o r c u rve i n th e i nte r s c ap u l ar
to r te d s e c ti o n
regi o n u s u ally cau se s th e rib s to dr o o p whi ch o c c asi o ns
th o r aci c c avity i s l e s s e n e d h e n c e re sp ir a
t
a fla
The H e ad
an d
Ne c k
as
a
.
,
.
,
)
.
.
,
f
.
,
,
'
.
.
,
,
’
.
,
,
FIG 1 73
.
.
Vol un tar y tr e atme nt of
an u pp e r
do r sal l o r do si s
.
PR I N C I PLE S
42 0
O F O S TE O PA TH Y
fe ebl e P e o p l e with fl at ch e st s m ay d evel o p w o n
de r fu l b re ath i n g c ap ac ity by p er si s t e n t e x er c i s e
The
re sp i r at o ry m u sc le s l ift th e rib s E x er c i se o f the s e m u s
c le s
wil l i n c re as e th e ante r o p o ste ri o r di am ete r o f th e
c h e st
t ion
is
.
,
.
.
-
-
.
Wh e n di re c ti n g a p ati e n t ab o u t th e d et ail s Of e x er c i s e
to i n c re as e th e bre ath i n g c ap ac ity do n o t f ail to i mpre s s
th e f act th at a f u ll r o u n d ch e st with o u t fl e x ib il ity i s j u st
F l e x ibility
a s bad a c o n diti o n as an ab n o rm al ly fl at c h e st
Th ose e x ei c i se s wh i ch m ere ly
i s th e key n o te o f h e alth
i n c re as e th e c o ntr acti n g p o wer o f m u s c l es With o u t at th e
s am e tim e i n c r e as m g th eir rel ax i n g p o wer ar e n o t h e alth
“
,
“
.
.
,
fu l
.
h o w s th at w heth er we h ave an te ri o r o r
p o steri o r con diti o ns i n th e i n ter sc ap u l ar regi o n , th e s pi nal
m u scl e s ar e c o n tr acted The p ati e n t s p o we r to rel ax th em
The p ati e n t m ay fe e l tire d an
i s lo st
d we ak but th e s e
m u sc l e s wi ll n o t c e ase th ei r c o n tr acti o n The rigi dity has
p as se d b ey o n d th e p ati e nt s c o n tr o l
E x am i n ati o n
s
’
.
,
.
.
.
’
.
The p ati e n
t
m ethi n g t
o w ard re st
o ri n g fl e x i
bi li ty to an an te r l o r ly c u rved o r s tr aight s pi n al c o l u m n
Fi g 17 3 i ll u s tr ate s th e eff e c t
i n th e u pp e r d o r sa l regi o n
o f fl ex i ng
th e n e c k f o r c ibly by pu ll1ng d o w n with th e
h an d s Th e s e S p i n e s ar e gre at ly s ep ar ated an d h e n c e th e
m u sc l e s Of the f o u rth an d fifth laye r s ar e re lax ed
c an
do
so
.
.
,
.
.
F ig
174
i llu s tr at es ho w th e phy s i c i an c an u s e th e do r
an d by S hift
s al an d c e rvi c al vertebr ae as a fl e x ib l e l ever
i n g th e p o s iti o n o f th e h an d u p o n th e s p i n e app ly th e
m o vem e n t s p e c ifi cally to an y p arti c u lar v ertebr a NO
m o vem e n t whi c h u s e s th e arm s as leve r s wi ll aff e ct th e
p o siti o n o f th e s e ve rtebr ae b e c au se th e fir s t an d se co n d
layer s o f m u scle s w hi ch ar e aff e cted by ar m m o vem e n t s
o bi l ity Of thi s p o rti o n o f th e
do n o t c o n tr o l th e i n tr i n s Ic m
The f o u rth an d fifth layer s o f b ac k m u s
S p i n al c o l u m n
c l e s ar e th e gr o u p s wh i c h cau s e th e m al p o siti o n o f ve rte
b r ae i n th i s regi o n
.
,
.
,
'
.
-
.
PR I N C I PL E S
42 2
F IG
1 75
.
.
A
m e th o d
of
a
ff
O F O S TE O PA TH Y
e ct
in
re
Th ey
ar e
no t
'
w el l
a
d apte d
g
g kyph
i on
to
o si s
in
th e
.
.
u ppe
r
d o r s al
.
tre atm e n t
of
an
i n d ivi dual
ve rteb r a
.
K y pho s i s—U ppe r D o r sal — A p o steri o r cu rve i n th e
u pp e r do r s al regi o n c an b e tre ate d by th e m eth o d i ll u s
The p hy s i c i an s right ar m i s p l ac ed
17 5
tr ate d i n F i g
ab o ve th e p ati e n t s right S h o u ld er an d u n de r th e che s t s o
th at th e h an d can b e p lac e d in th e p atie n t s l eft ax i lla
The p atie nt s h e ad s h o u l d b e t u r n e d aw ay f ro m th e phy s 1
c i an s o th at th e u pw ard p re s su re o f hi s ar m wi ll n o t i nter
fere with th e trach e a The phy si c i an s l eft h an d m ay be
m o ved fr o m p lac e to pl ac e alo n g th e sp i n al c olu m n The
f arthe r th e h an d s ar e sep ar ate d th e m o re l ever ag e i s
g ai n ed Co n sid e r abl e f o r c e c an b e e x e r te d i n th i s m o ve
m e n t with o u t any d an ger to th e p ati e nt i n f act to b e o f
The p ri m ary use
any v al u e it m u s t be m ad e f o r c ef u lly
o f thi s p r o c ed u re i s t
o red u c e th e e x c e s s o f p o s teri o r c u rve
.
’
’
.
.
’
,
’
‘
.
’
,
’
.
.
,
'
.
,
,
.
.
PR I N C IPL E S
O F O S TE O PA TH Y
42 3
Th at whi ch has b ee n writte n Co n c er ni n g th e
erve
wh e n s tr aighte n i n g o r
c e n t er s i n th e i n ter sc ap u la r r e gi o n
to
app l i e s e q u ally
an teri o r c u rv at u re Of th e s p i n e e x i s t s
th e p o s te r i o r c u rv at u re
n
"
,
,
.
F IG
.
176
.
A
me
th
od
of
-
t g k yp h
aff e c i n
r e g l on
.
o si s
in
th e
d o r s o - lu m
ba
r
PRI N C I PL E S
42 4
O F O S TE O PA TH Y
P o ste ri o r cu rv at u r e i s acc o mp an i e d by i n c re ase d ah
t e r o p o ste ri o r di am ete r o f th e ch e s t an d lo ss o f fl e x ibi l
ity Thi s m o vem e n t i nc re as es fl e x ib i lity I t c an e asi ly b e
ad apted to th e t re atm e n t Of th e fifth o r s i x th r ib s
-
,
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.
F IG
177
r g on
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e
i
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.
m e th o d
of
a
ff ti ng k y p h
ec
o si s
in
th e
l o we
r
d o r s al
PR I N C I PL E S
42 6
O F O S TE O PA TH Y
gr avi d u te r u s co n tr a i n di c ate th e u s e o f any m o vem e nt
wh i c h co mp re ss e s th e abd o m i nal co nte n t s an d al so i n th e
Case o f a gr avid u ter u s any m o vem e n t w hi ch i s li abl e to
c au s e ac tive c o n ge sti o n o f th e l u mb ar e n largem e n t o f th e
S pi n al c o rd
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.
M o v e m e nt s —Fi g 17 7 il lu str ate s
O the r
an o
.
th er m eth
Of e x e rti n g p re ssu re o n th e p r o m i n e n t p art o f a ky pho
The l ever age i s n o t s o gre at as i n th e pre c ed i n g
s is
m eth o d bu t wh ere th e kyph o si s i s s light it i s th e b etter
m o ve m e n t
S til l an o th e r s i mpl e m eth o d o f sp ri n gi n g th e lu mb ar
p o rti o n o f th e sp i n al c o lu m n i s sh o w n i n F i g 178 The
p ati e n t s k n e e s ar e h e l d ag ai n st th e phy si c i an s abd o m e n
whi le the phy s i c i an s h an d s m ake co u n te r p re ss u re o ver
th e ap e x O f th e kyph o s i s The bu tt o c k s ar e f o r c ed b ac k
w ard by th e p re s su re o n th e patl e n ts k n e e s S o m e o ste o
p ath s o bj e c t to th i s m o vem e n t o r any o th e r whic h n e ce s
od
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F IG
.
179
.
A
m e th o d
of
a
ff ti n g
l u m b ar
ec
ei
re
th
gi
k y ph
er
on
.
1
o si s
or
l o r d o s i s i n th e
PR I N C I PL E S
O F O S TE O PA TH Y
42 7
a
te s pre ssu re O i the p ati e n t s k n e e s o r e lb o w s ag ai n s t
th e abd o m e n
Th ere i s an e l em e n t o f d an ge r to th e
o s te o p ath
Thi s p o s iti o n F i g 178 i s u s e d freq u e n t ly wh ere
s tr o n g i n h ibit o ry p re ssu re i n th e l u mb ar r e g i o n i s re q u ire d
An y hyp er
F o r e x amp le i n cas e s o f di arr ho e a o r c r amp s
ac tivity O f s tr u c t u re s g o ver n ed by c e ll s i n th e l u mb ar e u
largem e nt m ay be i n hibite d i n t hi s reg i o n
Wh e n l o rd o si s o f th e lu mb ar r egi o n ex i st s i t is n e ce s
s ary to fl e x th at reg i o n i n o r de r t
F i g 179
o c o u n ter act it
i llu str ate s an e asy m eth o d o f acco mp li shi ng t hi s r e sult
n s r i ght h an d
Th i s s am e m o v e m e nt with th e phy s i ci a
u n der th e sp i n e can b e m ade t
o do d u ty i n co rre ct
ing a
p o s teri o r cu rve Wh e n th e h an d i s p lac e d dire ct ly u n der
th e kyph o s i s th e b ac k i s l if ted ; th e n i f th e b u tt o c k s b e
f o r c e d to th e t abl e the S p i n e wi ll b e spr u n g i n th e di r e c
ti o n de si r e d
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Ky p o s s A l arge p r o p o r ti o n o f p ati e n t s
in
S p i n al c o lu m n s e x hib it a te n de n c y to kyph o s i s
F u n cti o n al
.
wh o se
th e sp lan ch ni c are a S u ff e r fr o m eith er vi s c er al refle x e s o r
Th e r e
a hyp o t o n i c co n diti o n o f the e r e cto r spi n ae m u s cl e s
i s s car c e ly a cas e Of vi sc er al pt o s i s t hat d o e s n o t pre s e nt
The
i o n o f th e se e x te n s o r m u s c l e s
a hyp o t o n i c c o nd i t
f u n c ti o n al kyph o si s so fre q u e nt ly app are n t i n thi s regi o n
i s trem e n d o u s ly
b e n efited by r ath e r f o r c ef u l l ever age
m o vem e n t s whi ch ar e acc o mp an ie d by co u n ter p re ss u re at
the ape x o f th e kyph o si s
I f thi s c o u n ter p re s su re i s ap
p li e d s u dde nly bu t n o t s everely it u su ally p r o d u c e s a
s o u n d i n the arth r o di al ar ti c u l ati o n s o f th e s p i n al co l u m n
Thi s p o ppi n g s o u n d
un de r th e p o i n t o f c o u n ter p re s su re
ho ds m an y o f w hi ch
c an b e p r o d u c ed by a v ari ety o f m e t
The p ati e n t p r acti cally
ar e i ll u s tr at ed i n thi s ch apte r
alw ay s f e e l s a n i n c re as e o f m u sc l e t o n e after th e p o pp i n g
Th i s i s evi de n c e d by a fee l i n g o f gre ate r
s o u n d i s e l i c ited
Th ere i s a g en u i n e fee l i n g
abi l ity to h o l d th e b o dy ere c t
o f i n c re as e d p o wer
p sy ch o l o gi cal e ff e ct
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O F O S TE O PA TH Y
PR I N C I PL E S
42 8
F IG
.
180
A
.
m
e th o d
mp an y
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s e cu r i n g
of
‘
g e n e r al
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ro
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ph e n o m e n o n As a s imp l e
i
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fl e x e d fo r a c o n s i derab l e ti m e Th ere is a fe eli n g o f li m
a
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to a
f o r c e s o f e x te ns i o n an d fl e x i o n is p r o b ably wh at tak es
p lac e wh e n w e h e ar th e s o u n d i n c id e nt al to m o vem e n t s
whi ch pr o d u c e su dd e n p ass iv e e x te n s i o n i n a j o i ntwh i ch
r
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P R I N C I PL E S
43 0
The eff o rt
O F O S TE O PA TH Y
p r o d u c e such a so u n d i n all so call ed sub
l ux ati o ns wi ll su re ly re s u lt i n s tr ai n o f th e p e ri arti cul ar
ti ssu e s The Op e r at o r m u st h ave a tr ai n e d s e n se o f ti s su e
re s i st an c e an d b e g o ver n e d acco rdi n gly
L ever age an d
co u nte r p re s s u re s h o u l d n eve r b e u se d i n t
he tre atm e n t
o f an y
j o i n t wh i ch e x h ib it s sympt o m s o f i n fl amm ati o n
In cas e o f i nfl amm ati o n i n a j o i n t i ts p o s iti o n i s p r o b ably
s el f p r o te c tive an d h e nc e sh o u l d n o t be
r o u ghly tre ated
The l ac k o f abil ity to di ag n o s e th e tr u e c o n diti o n o f a
j o i nt l e ad s to fre q u e n t mi s u se o f m an ip u lative m eth o d s
to
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Ne w S cho o ls — It i s
t i hi n g ho w v ari e d a cl as s
o f p ati e n t s i s b e n efited by r ath er h e avy c o u n t er pre ss u re
m o vem e n t s Th i s f act has l e d to th e r ap id ex p l o it i n g o i so
“
”
ne w S ch o o l s whi ch c lai m th eir m et ho d s ar e di ffer
ca ll e d
o o ste o ath i c m et ho d s
i
I
t
e n t fr o m an d f ar su p eri o r t
n
s
a
p
i nt e re sti n g f act te s tifie d to by m any pati e n t s w ho h av e b ee n
tre at ed by ma n y o ste o p ath i c phys i c i an s th at n o tw o o f
th ei r phy si c i an s o p e r ate d al ike Thi s i s ch ar acteri sti c i n
th at th e o st eo p ath i c c o lle ge s h ave n o t co n c e ntr ate d s o
rti c u lar m eth o d as o n te ach i n g p ri n c ipl e s
m u ch o n a p a
whi ch ar e c ap abl e o f m any m eth o d s o f app li cati o n
as o n s
.
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F IG
.
182
.
S i m pl e s
t f m
kyp h i
or
of
os s
m ov e m e n t
i n th e
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s al
to
re
ove r co
gi
on
.
me
a
fu n ti o nal
c
PR I N C I PLE S
O F O S TE O PA TH Y
V ar i o u s Appl i cati o ns o f a P r i n c i pl e
f u n cti o n al kyph o s i s, i n th e s p lan ch n i c
—
Ii
43 1
p atie n t with
a re a l ie s pr o n e o n
a
th e fl oo r o r any o th er u n yie l di n g s u rf ac e as i n F ig s 18 2
i t o fte n su ffi c e s to m e re ly m ake su d de n d o w n
an d 18 3
w ard p re s su re o n th e ap e x o f th e k y pho se d af e a with th e
p alm o f th e h an d O n e o r s ever al p o pp i n g so u n d s wi ll b e
h e ard if th e p ati e n t re lax e s an d th e f o r c e o f th e su dde n
n
n
a
a
ce
re
r
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p
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er
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re
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t
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o
s
s
p
p
I t m ay b e n e c e ssary to c o n c e n tr at e
o f th e S p i n al ti ss u e s
th e p o i n t o f p re s sure i e u se a th u mb o r h eel o f th e h an d
rei n f o r c ed with th e o pp o s ite h an d The r e aso n so m e o p
e r ato r s u se
lo w t ab l e s IS m e re ly to al l ow th em to u s e
th ei r o w n weight to th e b es t adv an t age i n u si n g d o w n
“
w ard p re ss u re . A c c o rdi n g to th e e x te n t o f th e l e si o n e d
”
are a
i e th e kyph o si s an d acc o rdi n g to th e v o lu n t ary
p o wer o f re lax ati o n ch ar act eri sti c o f th e p ati e n t th e 0 p
e r at
o r c an u s e a large o r s m all c o n t ac t are a i
th e he el
e
o f th e han d
hyp o th e n ar em i n e n c e o r th e th u mb
The
am o u n t o f p re ss u re m u s t b e p r o p o rti o n e d to th e p ass ive
re si st an c e o f th e ti s su e s No e ff o rt sh o u l d b e m ad e to
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F IG
k y p h i i n th up p d al
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m ay
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m w h i l m ak i n g u dd n
t an v
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f th
v
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b a w i th th th m b T h i m v m nt
al l y
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n ap
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m t a ff t d b y th
th u m b
pi ng
.
183
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.
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pr e ssu r e
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e
P RI N C I PL E S
4 32
O F O S TE O PA TH Y
ve r c o m e any activ e re s i st an c e o n th e p art o f th e p ati e n t
The Op er at o r m u s t co n trive to u s e th e p re s su re b ef o re th e
p ati e n t c an b ri n g hi s m u sc l e s i nt o active co ntr ac ti o n
H e re i n li e s th e n e ce s sity fo r th e e x e r c i se o f c o n sid er abl e
d i sc reti o n as to wh e n th e adv ant age o f th e p ati e n t s O ff
g u ard m o m e nt sh o u ld b e t ake n
—
l
m
c
r
Adv an t age o ve r a p ati e n t s
h
f
a
F
u
u
T e Us e o
n at u r al spi n al re s i s t an c e i s g ai n ed by u s i n g a f u lc r u m at
A
so m e c h o s e n p o i n t o n th e an teri o r su rf ac e o f th e b o dy
very si mpl e u se o f th i s p ri n c ipl e i s i ll u str ate d by F i g 18 4
wh e rei n th e o p e r at o r s f o r earm s e rve s th e p u rp o se o f a fu l
cru m
Fi gs 18 5 an d 18 6 il lu str at e th e appl i c ati o n o f th e
Th i s i s p r o b ab ly
s am e p ri n c ipl e with th e p ati e n t s itti n g
th e e as i e st p o siti o n fo r th e o p er at o r to u s e co u n ter p re ss u re
H i s h an d s gr asp i n g th e pa
H i s k n ee s s erve as a f u l c r u m
ti e n
ts elb o w s h ave a s e c u re h o l d s o th at a Su dde n p u ll
b ackw ard s erv e s to f o r c e th e weight o f th e u pp er p o rti o n
o f th e p ati e n t s b o dy o ve r th e f u lc r u m an d th u s f u lfi ll th e
co n d iti o n s o f exte n si o n an d c o u n te r p re ss u re re q u i re d fo r
By v aryi n g th e p o s iti o n o f th e
c o rre c ti o n o f th e kyph o si s
o
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.
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F IG
.
184
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t
To
co r r e c
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t
a
fu n ti
i ght f
c
o n al
kyph
o r e ar m
O p e r a o r u si n
his r
w a d p r e s s u r e i s m ad e w i th th e
’
th e p r e s s u e o f th e o p e r ato r s c h e s t
r
r
g
d o r sal r e i o n
as a
u l c r um
S u dd e n d o w n
O p p o s i te h an d , e i n o r c e d
.
osis
f
in
th e
.
r
f
.
by
PR I N C I PLE S
4 34
Op e r at o r
’
O F O S TE O PA TH Y
k n e e s an d i nter lo cki n g his fi n ger s o ver th e pa
ti e n ts c h e s t as i n F i g 18 5 th e m o vem e n t c an b e m ade
ve ry sp e c ifi c as to a s i n g le sp i n al segm e nt
A m o vem e n t o f gre at ad apt abi l ity i s i ll u str ate d by
Fi g 18 7
The p ati e n t p lac e s hi s h an d s o n Opp o s ite sh o u l
d er s an d th e n allo w s his weight to re s t On th e o p er at o r s
f o re arm
In th i s m an n er th e o p e r at o r m ay u s e hi s l eft
o r righ t h an d
a cco rdi n g to c o n ve n i e n c e
as a f u l c r u m to
b e app li ed at any se le cte d p o i n t i n th e d o r s al o r lu mb ar
are a
By lifti n g th e p ati e n t s b o dy ag ai n s t th e f u lc r um
e ith e r s u dd e n ly o r gr ad u ally the o p er at o r is ab l e to c o n
c e n tr ate
c o rre c tive l ev er age
de s i red
an d p re ss u re at an y
p o i n t R o t ati o n o f th e sp i n al c o lu m n c an b e s e cu red by
th i s m o vem e n t an d h e n c e it s e rve s as o ne o f th e m o st
ad apt ab l e m o vem e n t s fo r a ll s o rt s o f c o r re ctive w o rk
The
o p er at o r
d o e s n o t ac t u ally c arry m u c h o f th e p ati e n t s
weight o n hi s ar m
The fir s t f o u r d o r s al vertebr ae ar e r ather d i ffi c u lt to
m an ip u late The p o s iti o n i llu s tr ated by F i g 2 3 0 sh o w s
h e na r em i n e n c e o f th e Op er at o r s l eft h an d
h o w th e hyp o t
whi l e th e r e st o f th e h an d rei n f o r c e s
s erve s as a f u lcru m
th e n e c k s o th at th e h e ad an d n e c k th u s r ei n f o r c e d c an
b e u s ed as a l ever wh i c h i s f o r c ed b ac kw ard by th e right
h an d on th e p ati e n t s c h i n F ig 18 9 sh o w s ho w m o re po w
e r fu l l eve r age m ay b e ap p l i ed by o n e w ho ha s a ke e n s e n s e
A n y m o vem e n t emb o dy i n g gre at
ti s s u e re si s t an c e
of
l ever age m u st b e u s e d with e x trem e c au ti o n
—
m
e
n
The su cc e s s
M
v
di
ti
r
tiv
o
t
f
o
r
e
e
s
ec
C o o r na o n o C
o vem e n t s dep e n d s e n tire ly o n th e o p er
o f any
o f th e s e m
ato r s abi l ity to c o o rdi n ate hi s m o vem e n t s so as to aff e c t
th e sp e c i al p o i n t i n th e s p i nal ti s s u e s r e q u l r m g adj u s t
m e n t J u s t as o n e s eye s c o o rdi n ate to pr o d u c e bi n o cu lar
vi si on o n e s h an d s m u s t w o rk harm o n i o u sly to s e c u re g o o d
re su lt s The ski ll f u l o p e r at o r cau s e s p r ac ti c ally n o p ai n
by hi s m o vem e n t s Th ey ar e ti med an d gr ad u ate d to s u it
he n ee d s o f hi s c as e
t
F ig
19 1 i llu str ate s a m eth o d o f e x e rti n g l ever age
an d p re ss u re to c o rre c t a later al su bl u x ati o n i n th e u pp er
s
’
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O F O S TE O PA TH Y
PR I N C I P L E S
F IG
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43 5
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186
To c o r r e c
a
u n c ti o n a l k p h o s i s i n th e
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th e s am e m o v e m e n t a s i n p r e c e d i n
r an s m i t
th e p u ll
i ll u s tr a i o n
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’
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ti e n t s a r m s , th e p a i e n t s p e c o r a l a n d s e r r a tu s m a n u s
th e a n e r i o r e x r e m i ti e s o f th e r i s
hi s
m u s cl e s l i
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PR I N C I PL E S
436
F IG
187
an d
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e x c e ll e n
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O F O S TE O PA TH Y
m ov e m e n t
by
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p r e ss u r e i n th e d o r s al a n d l u
t l v ag
m b ar r g i n
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PR I N C I PLE S
438
F IG
O F O S TE O PA TH Y
g
k
g
r
g
w h i l e th e
18 9
th e h e a d a n d n e c
as a le ve
U si n
h p o th e na r e m i n e n c e o f th e r i h t h a n d i s u s e d a s a
th e th u m
u si n
u l c r u m i n th e u p p e r d o r s a l r e i o n o r
n e
f o r c e o f th e m o v e
an d
o e
a s th e
u l c r u m th e
m e n m ay b e e x e r e d to c o r r e c t a c e r v i c al l e s i o n
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f
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f r fi g r
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PRI N C I PLE S
F IG
190
c e di n
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ti
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O F O S TE O PA TH Y
th e
m ov e m e n t
t
p i c u r e d i n th e p r e
439
PRI N C I P L E S
O F O S TE O PA TH Y
d o r sal The Op e r at o r s right h an d s e rve s to f o r c e th e h e ad
an d n e c k i n a di re cti o n to b e n d th e c o l u m n o ver th e th u mb
o f th e l eft h an d as a f u lc r u m
The p ati e n t s fac e i s i n cl i n ed
t o w ard the l e sio n s id e s o as to acc e nt u ate r o tati o n wh i ch
i s th e ac t u al co rre c tive p art o f th e m o vem e n t
—
o
r
l
D s a R o t ati o n F i g 18 1 i s a s imp l e m eth o d o f s e
c u ri n g fl e x i bi li t
i
n th e l o we r d o r s al p o rti o n o f th e b ac k
y
R o t ati o n i s p o s si b le i n th e d o r s al bu t n o t i n the l u mb ar
regi o n h e n c e by h o l di n g th e sh o u ld er s d o w n an d li fti n g
o n e h ip
r o t ati o n i s s e c u red i n th e d o r s al regi o n Thi s
m o vem e n t f o r c e s th e n o rm al ac ti o n betw e e n i n divid u al v e r
te b r ae o f th e lo we r d or s al reg i o n
I f any p arti c u lar ar tic u
lati o n is at f au lt it wi ll n o t yie l d to s u c h a g e n er al m o ve
m e nt as th i s The o n ly g ai n m ade by it i n th at c ase i s to
p rep are th e s u rr o u n di n g ti ss u e s fo r m o re sp e c ifi c w o rk
—
L at e r al C u r v at u r e Th i s ki n d o f d ef o rm ity i s fr e
q u e n t ly f o u n d an d a large p r o p o rti o n o f su c h c as e s ar e be n
A we ake n ed c o n
by o ste o p athi c m an ip u lati o n
e fi te d
d iti o n o f th e wh o l e b o dy predi s p o s e s to th e f o rm ati o n o f
19 2 i l lu str ate s an u n c o mp e n sated
F ig
a l at er al c u rv e \
t is th e c u rv at u re is all i n o n e di f ecti o n
late r al c u rv e th a
In s u c h a c a se th e m u sc l e s o n th e c o n ve x si de ar e n o t d o i n g
th ei r f u ll d u ty The p ati e n t i s allo wi n g th e weight o f the
u pp er p o rti o n o f th e tr u n k to b e h e l d by th e lig am e n t s i n
Th i s si mp l e c u rv at u re c an b e re adi ly
st ead o f th e m u sc l e s
o ve r c o m e by e x er c i s e s wh i c h wi ll d eve lo p th e we ak s p i n al
m u scle s
F i g 13 4 i ll u str ate s a c o mp e n sated c u rve th at i s a
The p ri m ary c u rv e i s i n the i n te r sc apu lar
l ette r S c u rve
regi o n an d i s co mp en s ate d fo r by a c u rve i n th e o pp o s ite
di re c ti o n i n th e l u mb ar regi o n
—
The o s te o p ath
K n ow H o w to A pply P r i n c i ple s
o app ly his p ri n c ipl e s so th o r o u
gh ly th at
s h o u ld k n o w ho w t
th e p o siti o n o f hi s p ati e n t wh eth e r ly in g s itti n g o r st an d
o m e o ste o p ath s de si re t
o give
in
ill
c o n f u s e h im
S
n
o
t
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g
th ei r m an ip u l ati o n s to th e p ati e n t s itti n g o th er s l ike th e
re cli n i n g p o siti o n b ette r O n th e wh o l e it s e em s b e st to
s el e c t th e p o siti o n su ited to th e s p e c i al w o rk req u ire d
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PR I N C I PL E S
442
O F O S TE O PA TH Y
D O No t C o py M o v e m e n t s
—DO
’
py anyb o dy s
m o vem e nt s L e ar n th e p ri n c ip le s th e n apply th e m i n th e
m an n e r m o st sati s f act o ry to y o u r se lf an d h el pf u l to the
To u n d er s t an d th e p ri n c ip l e s an d apply th em
p atie nt
i n te llige n tly o n e c an n o t k n o w to o m u ch c o n c er n i n g all
th e s u bj e ct s wh i c h ar e th e b as i s o f a b r o ad m edi c al e du
c ati o n
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19 2
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mp e n sate d l ate r al
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i
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PR I N C I PL E S
O F O S TE O PA TH Y
C H A P TE R X XI
443
.
O F S U BLUX ATI O NS
R E D U CTI O N
‘
.
H avi n g n o ted a fe wm Ov e m e ri tS whi c h h ave a ge n er al
—
be n efi c i al e ff e c t o n g r o u p s o i s tr u c t u re s w e wi ll n o w e x
am i n e a few o f th e mo vem e n t s wh i c h ar e app l i c ab l e to
s p e c ifi c s u b l u x ati o n s
In th e c h apte r o n S u b lu xati o n i n th e th e o reti c al s e c
“
ti o n o f th i s v o lu m e we call e d atte n ti o n to th e f act th at A
s u b l u x ati o n i s a sl ight
ab n o rm al re lati o n b etwe e n b o n y
s u rf ac e s
m ai n t ai n e d by u n eve n co n tr ac ti o n in Opp o s i n g
gr o u p s o f m u s cl e s wh i c h co n tr o l th e a rti c u lati o n
The
he co n tr acti o n ar e vi o l e n c e temp er at u re c h ang e s
c au s e s of t
an d refle x irrit ati o n
A red u c ti o n i s s e c u re d by e q u al izi n g
vit al ac tivit y : With th i s st atem e n t i n mi n d we wi ll s t u dy
fir st th e lat
e ral s u b lu xati on s i n th e d o r sal regi o n
—
L at e r al S u bl u x ati o n A later al s u b lu x ati o n i s p o s sib l e
in th o s e p o rti o n s Of th e s pi n al c o l u m n wh e re the
o n ly
f o rm ati o n o f th e arti c u lar f ac et s allo w r o t ati o n The c e r
vi c al an d d o r sal ar e the regi o n s i n wh i ch th i s o cc u r s Lat
er al s u b lu x ati o n i s m o s t c o m m o n i n th e arti c u lati o n s o f
th e at las thi rd c ervi c al an d an ywh ere in th e d o r s al w itli
th e e xc epti o n o f th e twe lfth The i n feri o r arti c u lar fac et s
h e n c e allo w o n ly
o f th e twe lfth ar e l u mb ar i n c h ar ac ter
fl e x i o n e x te n s i o n an d c i r c u m d u c ti o n
I t m ake s n o di ff ere n c e wh at th e cau s e o f th e l ate r al
b e th e u n eve n c o n tr acti o n o f m u scl e s
s u b lu x ati o n m ay
i s the fi ri al re s u lt h e n c e all ar e tre ate d i n th e s am e m an n er
Wh e n th e vertebr al S pi n e i s di sco vere d o u t o f li n e with
th o s e ab o ve an d b e lo w an d te n d er n e s s n o te d o n i ts p r o m
i n e nt S i de we ar e di sp o s ed to c o n s id er it a tr u e l e s i o n an
irrit an t to th e n erv o u s sy ste m Wh ethe r it i s th e re su l t o f
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P R I N C I PL E S
44 4
F IG 1 9 3
.
f
S u r ac e
.
O F O S TE O PA TH Y
i n d i c a ti o n
of
a
la
t
e r al
su
b lu x at i
on
i de nt c o ld o r refl e x e s d o e s n o t n ee d to b e s eri o u s ly
Wh il e it e xi s t s it i s a c o n ti n ual so u r c e o f i r
c o n s i de red
he n c e sh o u ld be rem o ve d
r it
ati o n to th e n er v o u s sy s te m
with o u t d el ay I f it i s th e re su lt o f refl e x e s i ts red ucti o n
wi ll at l e as t re m o ve o n e di st u rb i n g f ac t o r fr o m th e cas e
The p r o mi n e n t si d e o f th e sp i ne i s th e o n e o n whi ch
th e m u sc le s ar e co ntr acte d The c o n tr ac ted m u sc le s m u st
b e th o s e wh i ch ar e hOldi n g the b o n e i n i ts m al p o siti o n
In o rd e r to e x ert th i s i n fl u e n c e th ey m u s t b e att ach ed i n
as to m o ve th e b o n e i n thi s dire c ti o n wh en
s u c h a w ay
th ey act n o rm al ly Th eir p re s e n t c o n diti o n i s o n e Of hyp er
With th i s l i n e o f re as o n i n g any arti c u l ati o n can
ac tivity
b e e x ami n e d th e p u ll o f its m u sc l e s d etermi n ed an d m o ve
ac c
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PR I N C I PL E S
446
O F O S TE O PA TH Y
'
F IG
.
1 95
.
F lex i on
of
l a te r a l
a
su
blu
x a ti o n
..
Th i s p r o c ed u re
p r om i n e n t S id e o f th e le s i o n as i n F i g
s tret c h e s
th e co n tracte d r o t at o re s S pi n ae an d al so s e p
ar ate s th e th re e verteb r ae
i e th e s u bl u x ate d o n e an d
th e s u p e ri o r an d i n feri o r o n e s th u s m aki n g it e as ier to
p u sh th e s u b lux ated v ertebr a i nt o i ts tr u e p o s i ti o n
The s e c o n d m o vem e n t i s an an teri o r fl e x i o n to permit
o f gre ater free d o m o f m o vem e n t b etwe e n th e arti c u lar pr o
By f o r c i n g th e b o dy fir st i n t o th e p o siti o n o f later al
c e ss e s
fl e x i o n th e n an te r 1o r fl e x i o n al l th e m u s cl e s o f th e fifth
gr o u p wh i ch affe ct th e s u b lux ate d vertebr a ar e re lax ed
“
”
D u ri n g th i s an te ri o r fl e x i o n a c li ck i s s o m etim e s h e ard
wh i ch is evi d e nc e o f re lax ati o n s u ffi c i e n t to allo w appr o x i
m ati o n o f th e su bl ux ated su rfac e s D u ri n g all th e tim e o f
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PR I N C I PL E S
F IG
.
196
du ce
.
a
Ex te n s i o n
l a te r a l
su
O F O S TE O PA TH Y
c o u n te r
an d
bl
uxa
ti
on
p r e s su r e
44 7
O
t
re
.
m aki n g t he s e fl e x io n s th e phy si c i an s righ t th u mb S h o u ld
m ake s te ady pre s s u re ag ai n st the p r o m i n e n t S i de o f th e
th u s t aki n g adv an t ag e o f th e re lax ati o n g ai n e d by
spi n e
e ach fl e x i o n The an teri o r fl e x i o n i s i llu s tr ate d i n Fi g 19 5
The fi n al m o vem e n t i s later al fl e x i o n t o w ard th e l e s i o n
whi l e l ifti n g th e p ati e n t fr o m th e s t o o l i n s u c h a w ay th at
th e weight o f th e b o dy be lo w th e l e si o n e x ert s its i n fl u e n c e
F i g 19 6
to s ep ar ate th e verteb r ae
C o u n te r p re s su re with
th e th u mb i s m ade vig o r o u sly d u ri n g thi s fi n al m o vem e nt
The S u c c e s s f u l red u c ti o n o f thi s su b lu x ati o n m ay b e
“
”
ac c o mp l i sh e d with o u t an y
or
evi de n c e Of
c li c k
o th er
move m e n t o f th e s u rf ac e s The vertebr a u s u ally m ove s
i nt o its tr u e p o siti o n with o u t any au dib le sig n The phy s i
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PR I N C I PL E S
44 8
O F O S TE O PA TH Y
fi n ge r s c an d ete rm i n e th e su cce ss o r f ail u re o f th e
m o vem e n t I f th e su b lu x ati o n w as c au se d by ac c ide n t o r
i ts re d u c ti o n i s all th at i s n ee de d bu t if it i s th e r e
c o ld
th e phy si
o r i gi nati n g i n a vi s cu s
s u lt o f refl e x i rr i t ati o n
be
c i an m u st di re c t su ch a m o d e o f l ivi n g th at re st m ay
H abit s o f life m u s t b e
s e c u red fo r th e stim u lated vi s c u s
lo o ked i n t o
F i g 19 7 i ll us tr ate s an o th er m eth o d of red u c i n g a sligh t
The phy s i c i an s left ar m p a ss e s u n de r
late r al s u b lu x ati o n
la th e n th e h an d i s plac e d firm ly o n
the p ati e n t s l eft a
l
th e b as e o f th e n e c k p o steri o r ly Thi s give s th e phy si c i an
gre at l ever age
The phy s i c i an s k n e e right o r l eft i s
p lac ed ag ai n st th e S pi n al co lu m n at a p o i n t fo u r o r five
c i an s
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g
L e ve r a
1 97
d o r s al r e i o n
.
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t ral
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su
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PR I N C I PLE S
4 50
O F O S TE O PA TH Y
wh e n c o u n ter e x te n s i o n i s give n by tw o m e n
p u lli n g at th e h e ad an d fe et o f th e p at ie nt whi l e a thi rd
o ne
d e vo te s his atte nt io n to f o r c i n g th e ve rtebr al spi n e
i nt o p lac e Wh e n th e p ati e n t i s S h o rt an d h e avily m u s cl ed
it i s imp o s sib le to e x e cute this m o v e m e n t sati sf act o ri ly
—
l
l
x
a
e
r
a
o
n
e
r
l
L t
S u b u ati
L ow r D o sa A late r al le S IO n
o f th e n i n th
te n th o r e leve n th d o r sal i s m o re e asi ly han
dle d th an th o s e high er u p b e c au s e the phy si c i an can
gras p th e p ati e n t in a m u ch m o r e s ati s f act o ry m an n e r
F i g 19 8 i llu str ate s th e m eth o d
The se ri e s o f m o vem e nt s i s alw ay s th e s am e as al
re ady d e sc ribed th at i s lat e r al fl e x io n o r e x agger ati o n
an te ri o r fl e x i o n
th e n lat er al fl e x i o n t o w ard th e le s i o n a s
i llu str ate d by th e c u t
With th i s s am e p o s iti o n o th er f o rm s o f s u b lu x ati o n i n
th e lo we r d o r s al an d l u mb ar regi o n s c an b e co rre c ted ;
A D e pr e s s e d S pi n e — S ligh t depre s si on Of a d o r sal
th at i s betwe e n its ap e x
s pi n e with s e n s itive n e s s o ve r it
i n di cate s th at th e m u s c l e s in th at
an d th e spi n e b e l o w
o dr aw the S pi n e o f
S it u ati o n ar e s ffi c i e n tly co n tr ac te d t
u
th e u pp e r verte br a d o w n w ard The de pre S Se d s pi ne i ri di
c ate s th at th e b o dy o f th e verte b r a i s S l ight ly tipp ed b ac k
w ard an d d o w nw ard S e e c h apter o n S u b lux ati o n s!
To red u c e th i s l e s i o n a fl e xi o n o f th e spi n al Co lu m n
a s far as th e verteb r a b e lo w th e l e s i o n i s m ade an te ri o rly
I f th e d epre s se d S p i n e i s any o n e o f th e u p pe r s ix d o r sal
i e fle x th e
u se th e p u ll o f th e S p l e n i u s c apiti s e t c o ll i
The phy si c i an s right han d
h e ad an d n eck as i n F i g
i s p lac e d o n the S p i n e Of th e vertebr a be lo w th e S ublux a
ti o n th u s allo w m g all th e f o r c e o f th e m o v e m e n tito ter
mi n ate i n a p u ll o n th e m u s c le s b etwee n th i s ve rtebr a an d
th e d ep re ss ed s pi ne Thi s s am e pri n c ip le can b e app li ed
to al l p o rti o n s o f th e S pi n al co lu m n
Wh e n i n divid u al sp i n e s ar e p r o mi n e n t an d se n sitive
ne ss i s f o u n d ab o ve th e p r o c e ss i n ste ad o f be lo w w e h ave
Its tre at
a c o n diti o n th e rever s e o f th at j u s t d e s c rib ed
m e nt i s s i mi l ar to th at o f the pre c ed i n g e x c ept th at by
tai n e d as
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PRI N C I PLE S
O F O S TE O PA TH Y
4 51
h an gi n g th e p o siti o n o f th e right h an d to re s t u p o n th e
p r o mi n e n t S p i n e o u r l e ver age aff e ct s th e c o ntr acte d m u s
c le s ab o ve th e S p i n e
K y pho s i s—P o tt s D i s e ase W h e n ever a k n u c k l e i s
f o u n d i n th e S pi n e i n q u i re c aref u lly as to th e p os sibi lity
i
i
i
t
o
n
u
c
u
o
t
c
r
e
d
o
s
t
o
t
b
er
l
s
i
s
e
P
o
tt
s
s
o f di re ct i n j u ry
p
p
c
,
—
.
’
'
,
’
o
,
F ig
.
199
.
S p r e ad i n
g
th e l o w e r
ri
b
,
s
an d
s tr e tc h i n
g
.
g
th e d i a p h r a m
.
PR I N C I PL E S
4 52
di se as e o f th e spi nal
s i n g l e verteb r al S pi n e
kyph o si s is d eve lo p ed
O F O S TE O PA TH Y
m n m ay c au se pr o m i n e nc e Of
A s o th er ve rtebr ae ar e aff e cted
c o lu
a
a
,
.
.
—
R ib
R ib S u b lu x ati o n s
pre se n t m any
su b l u x ati o n s
di ffi c u lti e s to th e o s te o p ath The m eth o d s u se d i n th eir
re d u cti o n ar e as v ari e d as can we ll b e i m agi n e d A fe w
o f th e m o st u s e f u l an d dire c t ar e give n here
In F i g 199 th e phy s i c i an i s app lyi n g a m e th o d o f
W he n th e te nth rib S i n k s u n der
s p re ad i n g th e lo wer rib s
th e n i nth and th e re i s a g en e r al j amm i n g o f th e f o u r lo wer
rib s t o geth er th e phy s i c i an st an d s b eh i nd th e p ati e n t w ho
r ai s e s hi s h an d s ab o ve hi s h e ad to s pre ad th e lo w e r rib s
by m e an s o f th e lati ssi m u s d o r s i Wh il e th e h an d s ar e
e lev ated th e phy si c i an gr asp s the anteri o r e x tremiti e s o f
th e rib s an d h o ld s th em u p wh i le the p ati e nt l o w er s hi s
h and s to hi s thigh s S u ch a m o v eme n t as thi s w ill rep lac e
th e rib s i n th ei r right re lati o n s b u t a fl e x i o n o f the p atie nts
b o dy Wi ll u n d o th e w ork Co n ti n ual w e ll dire cte d tre at
m e n t an d v o lu n tary e x er c i s e ar e n e ede d to br i n g the m to
'
p lac e an d h o ld th e m th e re
The f o u r l o we r rib s c an b e s ep ar ate d an d th e ante ro
p o ste ri o r di amete r o f the th o r ax i n c re as e d by th e m eth o d
i llu s tr at ed i n F ig
The l eft h an d lift s o n th e an g le s o f th e depre s sed rib s
wh i le th e p ati e n t s ar m i s e xte n d ed b e y o n d hi s h e ad , th u s
m aki ng u se o f th e l ever age g ai ne d th r o u gh th e att achm e n t
Thi s m o vem e n
t i n c re a s e s th e right
o f th e lati ss im u s do r s i
an d l eft hyp o c h o n d ri ac al s p ac e s
th e
The p o s iti o n o i an i n divid u al rib i s aff e c te d
i o n o f th e i n ter c o st al m u s c le s ab o ve and b e lo w i t
r ac t
co n t
The sp ac i n g determi n e s wh eth e r th e rib is e lev ate d o r de
p re ss e d The width o i an i n ter c o st al sp ac e wi ll n o t b e th e
This
he an g le s an d an ter io r e x tremiti e s
sam e b etwee n t
i s c au s e d by th e f act th at th e h e ad o f th e rib i s fi x e d s o
th at it c an no t m o v e u p o r d o w n The mo vem e nt wh i ch
t ake s pl ac e be twe e n the he ad o f the r ib and the ve rteb ra
.
.
'
.
.
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.
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.
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.
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'
'
.
-
.
.
’
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.
.
-
-
'
.
-
.
.
.
'
'
PR I NC I PL E S
4 54
The te n d e n cy i n
O F O S TE O PA TH Y
th m ati c an d br o nchiti c pati e nt s is
to c au s e el ev ati o n o f th e rib s th u s d eve lo pi n g a b arrel
S h ap ed ch e s t
Wh e n all th e i nter co st al m u s cle s act e q ual
ly th e rib s ar e e q u ally sp ac ed bu t i n a case o f b r o nc hiti s
s o m e l o cal p o rti o n o f th e b r o n c h i al t u bi n g i s e sp e c i a
lly
as
,
.
'
,
,
F IG
2 01
.
F irs
t
p o s i ti o n to
r e du c e
,
a
su
b l u x at
ed
fi f th
'
rib
.
PR I N C I PL E S
O F O S TE O PA TH Y
4 55
ated
F r o m thi s are a irrit an t i mp u ls e s re ach th e s p i n al
i rri t
c e n te r with whi c h it i s m o s t c lo s e ly as s o c i ated . The i n ter
co st al m u s c
l e s i n dire c t re lati o n wi th thi s c e n ter re c e iv e
a gre ater n u mber o f i mp u ls e s h e n c e
c o n tr a
c t m o re vig o r
o u sl . A str ai n o r b l o w m ight c au s e th e S a
m e re s u lt
y
.
,
,
,
.
F IG
.
2 02
.
S
e co n d
t
p o si i on
to
r e du c e
a
su
bl
t
uxa ed
fifth
rib
.
PR I N C I PL E S
4 56
O F O S TE O PA TH Y
To bri n g th i s fifth rib d o w n to i ts p r o p er p o s iti o n th e
phy s i c i an may st an d b eh i n d hi s p atie nt as i s il lu str ated
,
,
Fi g 2 0 1
by
"
H is
l eft h an d gr asp s the p atie n t s right e lb o w
an d p u s h e s i t ab o ve t
he S h o u ld er th u s c au si n g th e m u s
c l e s to l ift th e r ib s
Thi s m o vem e n t wi ll p u ll o n all th e
rib s o f th e right s id e an d te n d to e qu aliz e th e s p ac i n g
The phy si c i an pl ac e s hi s left k n e e dire c t ly o ve r th e an g le
o f th e fifth r i b hi s right h an d o n th e ante ri o r e x tremitie s
of t
he fifth s i x th an d s eve n th rib s th e mi d dle fi n g e r o f
thi s h an d b e i n g app li ed aga
i n st th e lo we r m argi n o f th e
fifth rib The rib b ei n g n o w i n r ig ht r e lat
i o n w ith i ts fel
lo w s th e c riti cal p eri o d o i th e m o ve m e n t i s wh e n rel ax a
ti o n i s allow ed by lo we ri n g th e ar m The k n ee ab 6v e an d
o v er
th e ang le p re ss i n g f o r ward an d d ow nw ard
hi le
th e m i dd le fi n ger o f th e right h an d p reve n t s d ep re ss i o n
o f th e
an te ri o r e x trem it y
Thi s l ever ag e f o r c e s th e rib
to ret ai n right re lati o ns with its fel lo w i n re lax a
ti o n o f
th e ch e st The te rm i n at i o n o f th e m
o vem e n t i s i l l u s tr ated
by F ig 2 0 2
.
.
;
.
,
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,
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.
'
-v
,
'
w
.
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.
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.
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.
ge n er al “ dep re ss i on Of all th e an g le s o f th e rib s
A fl at c h e s t
o b e p r o mi n e n t :
c au s e s th eir s u p eri o r m ar gi n s t
Th i s co nditi o n fr equ e n tly f o llo w s p n e u m o
i s th e re su lt
n ia o r s o m e di s e a s e wh i c h c au s e s the p atie n t to l i e o n the
b ac k d u ri n g a lo n g p eri o d of we ak n e s s
A
.
’
.
.
'
.
Wh e n a S i ng l e d ep re ss e d rib is f o u n d it u su ally has
b e e n cau s e d by a s tr ai n wh i c h has we ake n ed th e i n ter
T
at i t whi l e s t an d
re
c o s t al m u sc l e s i n th e s ac e ab o ve it
p
i n g i n fr o n t o f th e p ati e n t
P lac e th e mid dl e fi nger o f th e
The p ati e n t s right elb o w
l eft h an d u n de r th e an g l e
m ay re st a g ai n s t th e phy si c i an s abd o m e n
P re s s u re m ade
o n th e elb o w f o r c e s th e s cap u la b ac k an d bri n g s i n t o ac
ti o n th e se rr at u s m ag n u s whi c h lift s th e rib s A sk th e
p ati e n t to i n sp i re an d th i s wi ll r ai s e all th e ribs W h e n
rel ax ati o n c o m e s with e x pi r ati o n lift th e an gl e o f the rib
f o r c ef u l ly an d i t wil l reg ai n i ts pr o p er p o s iti o n F i g 2 0 3
i l lu str ate s th i s m o vem e n t
S o m e o ste o p ath s gr as p th e
'
,
.
.
.
.
.
’
!
.
’
.
-
.
.
.
,
.
,
.
.
O F O S TE O PA TH Y
P R IN C I PL E S
4 58
F IG
.
204
.
t
F i r s t p o s i i o n i n li
ft i n g
a se r i e s o f
d e p r e s s e d l ow e r
ri
b
s
.
i llu str ate th e meth o d o f r ai s m g
an d S p re adi n g th e lo wer rib s
With th e p ati e n t i n thi s
p o s iti o n th e phy si c i an c an m ake e x te n sive p as sive m o ve
m e n t s with o u t m u c h re si st an c e
Th e se m o vem e n t s ar e
S imi lar to th at i llu s tr ate d by F i
1
99
g
”
“
Wh e n th e rib s dr o o p to a m arked degree th e re i s a
de c id e d ch an ge i n th e sh ap e o f the di aph r ag m The e x te n t
an d it m ay
b e th at th e
o f th e th o r ac i c fl o o r i s l e s s e n e d
s tr u c t u re s p as si n g th r o u gh th e di aph r agm are d etrime n t al
The m o vem e nt pi ct u re d in Fig 19 9 i s
ly aff e cte d by it
we ll c al c u lated to s pre ad th e lo we r rib s an d th e reby i n
c re as e re s pi r at o ry c ap ac ity
F ig s 2 04 , 2 0 5
.
an d
2 06
.
.
,
.
.
.
,
.
,
"
.
.
.
S
O F O TE O PA TH Y
PR I N C I P L E S
The fi r st r i b i s
459
‘
tr o n g ly h e l d by the s cal e n u s anti
c u s th at it p r a c ti c ally n
ever i s dep re ss ed I t i s h o wever
r qu n l
f e e t y e l ev ated to s u c h an e x te n t th at it i n fri n ge s o n
s tr u c t u re s ar o u n d th e fir s t th r
o ac i c s y mp ath eti c
gan g li o n
t hu s aff e cti n g h e art acti on
To dep r e ss the fir s t rib to i ts p r o p e r p o s iti
it i s
on
n e c e ssary to t ake th e e x tr a co n tr
ac ti o n o u t o f th e s c al e n u
s
so
s
:
.
,
,
,
"
.
,
F IG
.
2 05
.
S
e co nd
t
p o s i i on
in
f ti n g
b
li
ri
s
.
a
se r i e s
of
d e p r e ss e d
low e r
P R I N C I PLE S
460
HY
O F O S TE O PA T
ti c u s Thi s i s d o n e by m aki n g th e fir s t rib a fi x ed i n
F i g 2 18 i llu s tr ate s th e
s te ad o i a m o v abl e att ach m e n t
m eth o d o f re lax i n g th e s c ale n u s an ti c u s The phy s i ci an s
th u mb h o l d s th e fi r s t rib d o w n wh i le th e m u sc le i s stret ch e d
by f o r c i n g th e p ati e n t s h e ad dire ctly to th e o pp o site S i d e
The sc al e n i m u scl e s c an b e e asi ly d ete c te d by p lac i ng
Th ey
o n e s fi n ger s 0 11 th e S id e o f th e n e c k n e a r th e b as e
wi ll b e fe lt h ard en i n g d u ri n g i n s pi r ati o n
“
an
.
.
.
’
.
’
.
’
.
.
F IG
.
206
.
Th e th i r d p o s i
ti
on
f
i n l i ti n
g
a
serie s
of
d e p r e s s e d l ow e r
r ib s
.
O F O S TE O PA TH Y
PR I N C I PL E S
46 2
FIG
.
2 07
P o si ti o n
.
r
f o r tr e a tm e n t o f a n u p w a d
l o c a ti o n o f th e i l i u m
'
an d
f
o r w ar d
di s
.
The
h o ck wh i c h i s tr an s mitte d to thi s arti c u lati o n i n
an ac c i de n t u s ually s trike s th e t u b er i s ch i i fr o m b e l o w o r
p o s teri o r ly o r s trike s th e k n e e an d th e f o r c e i s ex erted
Wh e n th e f o r c e i s ag ai nst the
ag ai n st th e a sc e tabu lu m
t u be r i s ch ii fr o m b e lo w o r p o steri o r ly w e h ave an u v ar d
di sp lac em e n t o r a twi s t c au s i n g th e p o s teri o r su p eri o r
Whe n th e f o r c e
ili ac spi n e to b e c om e m o re p r o m i n e n t
th e twi st
ab u lu m by m e an s o f th e fem u r
s trike s th e asce t
i s i n th e o pp o site di re c ti o n an d the s pi n e i s l e s s p r o mi n e n t
H ave th e p ati e n t g ive det ai ls if p o ssib l e c o n c er n i n g
hi s p o s iti o n with refere n c e to th e dire c ti o n o f th e f or c e at
-t
o
a
n
n
o
o
s
c
n
tim
e
th
e
id
e
t
o
if
th
e
diti
p
e
r
b
e
c
a
c
f
o
r
a
h
e
t
;
p
du e to Oth e r c au se s striv e to fi n d o u t wh at th ey ar e
H avi n g d eterm i n ed the di r e c ti o n o f th e twi st th e f o r c e
p li ed
o t hat ap
o f o u r m an ip u lati o n m u s t b e m ad e c o u n ter t
S i n c e th e
he acc id e n t
ve ry
at th e tim e o f t
m o v ab l e we c an n o t u se th e thigh as a sti ff lever th ere
f o re o u r f o r c e m u s t b e app lie d to eith er th e an te r io r o r pos
n d to the an teri o r o r
te r i o r su rf ac e o f th e t u b er i s ch ii a
s
,
,
.
,
,
,
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.
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,
.
,
,
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.
,
,
.
,
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.
,
.
PR I N C I PLE S
O F O S TE O PA TH Y
p o ste ri o r s u p e r i o r S p i n e o f th e i l i u m i e p u s h an d p u ll
Thi s m o vem e n t i s
s ax l e
s u c h as t u r n i n g a wh ee l o n i t
i llu strated in F ig 2 0 7 The o rigi n a
l f o r c e whi c h thi s m o ve
m e n t i s tryi n g to o ver c o m e w as tr an smitt ed fr o m th e k n e e
by th e fem u r to th e ac et ab u lu m an d re su lte d in a twi st
Of th e i li u m wh i ch m ad e th e p o steri o r su p eri o r S p i n e l e ss
p r o m i n e n t th an its fe llo w o f th e Opp o s ite S i de In o rd er
to make th i s n
i oV e m e n t e ff e c t u al an ass i st an t m u st m ake
eve n pre ss u re o v er th e arti cu lati o n o f the sa c r u m
s te ady
an d fifth lu mb ar verteb r a i
e
o ve r c o m e th e te n de n cy o f
th e twi sti n g m o ve me n t to m ere ly aff e c t the m o v ab l e sac r o
vertebr al i n ste ad o f th e i mm o v ab l e s ac r o i li ac ar ti c u lati o n
By fl e x i n g th e p ati e n t s thi gh o n to his ab do m e n s u f
fi ci e n t Opp o rt u n it y i s give n th e phy s i c i an to m ake p re s
s u re o u th e an teri o r s u rf ac e o f th e t u b er i sch ii
an d p u ll
fo rw ard o n th e p o steri o r S u p eri o r i li ac S p i n e th u s reve r s
i ng th e m o vem e n t i llu str ate d by F i g 2 0 7 i
F i g 2 0 8 i llu str ate s an e ffo rt to u s e th e thigh as a l eve r
to aff e c t th e sac r o i l i ac arti c u lati o n wh e n th e p o s te ri o r
s u p eri o r s p ine is pr o mi n e n t
Thi s i s a d an ger o u s m o ve
m e n t an d sh o u l d n o t b e u s ed The f o r c e tr an smitted by
th e th igh aS a l e v e r wi ll n o t re ach th e j o i n t de s ired an d
wi ll o n ly re su lt i n str ai n i n g th e i li o fem o r al l ig am e n t
—
A s ac r o i l i ac s u bl u x ati o ni s di ffi c u lt to c o rre c t b e c au s e
th e j o i n t i s p r ac ti cally with o u t n o rm al m o vem e n t The
p elvi s te n d s alw ay s to re si st any app re c i ab l e m o vem e n t i n
i ts j o i n t s th eref o re th e phy s i c i an m u st d evi s e w ay s o f
g lever age to d ire ct ly aff e c t th e s e j o i n t s with o u t
s e c u ri n
tr an smitti n g hi s c o rre ctive l ever age th r o u gh th e very
—
m o v ab l e sac r o vertebr al j o i n t ab o ve o r th e hip j o i n t b e lo w
Thi s i s a di ffi c u lt c o n diti o n to f u lfi ll
—
l
f
h
m
An t e r io r R o t ati o n o t e I i u
W h e n th e i li u m i s
r o t ated f o r ward th e p o s teri o r su p e ri o r S pi n o u s p r o c e ss i s
l e ss p r o mi n e n
t th an i ts fe llo w o f th e o pp o s ite s i d e Th i s
c o n d iti o n c an b e m et by h avi n g th e p ati e n t p r o n e o n an
u n y ie l di n g s u rf ac e ;
s light ly
p adde d S O as n o t to br u i s e
th e an teri o r s u p eri o r sp i n e o f th e i li u m Si n c e the twi s t
.
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P R I N C I PL E S
464
FIG
2 08
.
F IG
.
209
g
A
.
.
dan
To
ge
ro u s
O F O S TE O PA TH Y
m e th o d
i li a c
ar
t
r
to
S ac r o
th e
.
o
e
din
u n d e r th e a n e i o r s
e
a r d p e ss
h e av , d o a
s p i nou s p oce ss an d th e i li ac
y
y i ng f o r c e
r ta ti n f th i l i u m H a d p a d
d
n
d
i
l
i
m
S
u
u
f
t
h
i
n
u p ri o
p
sacru m
b tw n i ts fi r t
o n th
ur
c o r r e c t a n te r i o r
t r
r
a ppl
i c u l a ti o n
of
’
o
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r
s
e
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on
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spi ne ,
o
r
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th e l e s i o n
s
ee
si d e
,
.
PR I N C I PL E S
O F O S TE O PA TH Y
.
th e p ati e n t s l eg o n th e s i d e o f th e l e si o n to h an g o ff th e
t ab le so as to b e at a right angl e to th e s pi n al c o l u mn
Th i s te n d s to ti lt th e p e lvi s b ac kw ard an d th u s p ermit a
gre ate r d o w nw ar d m o vem e n t i n re sp o n se to th e s u d d e n
p re ssu re
S o m etim e s it i s advi sabl e to u s e s everal par
ti al appli cati o n s o f th e p re s s u re b ef o re th e fi n al co rre ctive
Thi s te n d s
eff o rt with o u t rem o vi n g th e c o n t ac t h an d
to p e rm it th e p at i e n t to rel ax by t aki n g aw ay th e fe e li n g
The o p e rat o r
th at p r o te c tive re s i s t an c e m u s t b e m ade
m u st c re ate and r e co g n ize th e p sy c h o lo gi c al m o me n t fo r
th e appli c ati o n o f th e co rre c tive m o vem e n t
The pr 1n ci ple un de r lyi n g th e Op er at i o n j u s t de sc ribed
The l eg
c an b e app li ed if th e p atie n t l ie s o n hi s b ac k
he thigh and th e
o n th e l e s i o n s id e sh ou l d b e fl e x ed o n t
th igh o n th e abd o m e n th u s t ilti n g th e p e lv i s bac kw ar d
B y p lac i n g th e p elvi s s o th at th e i li u m o n th e le s i o n s id e
i s j us t o ff th e p ad de d e dge o f th e t ab l e th e o p e r at o r can
p lac e his c h e st ag ai n st th e fl e x e d le g an d th igh whi l e hi s
h and s re st o n th e o pp o s ite an te ri o r su p eri o r S pi n e s o f th e
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betwe e n i ts fir st spi no us p ro c e s s and the
o f th e s acr u m
i li ac c re st Th e s e m o vem e n t s h av e th e advantag e o f ap
p lyi n g co rre c tive f o r c e with o u t h avi n g any o f th at fo r c e
d i s sip ate d by p as s i n g it th r o u gh a m o vable l jo i nt b ef o re
re ac h i n g th e i n te n ded po i nt o f app li c ati o n Thi s i s a very
i mp o rt an t f act o r if th e p ati e n t i s an ae s thetiz ed
—
P o ste r i o r R o t ati o n o f the Il iu m Wh e n th e po steri o r
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su p eri o r s p i n e o f o n e o f th e i l i a i s ap p
i n e n t c are S h o u l d b e t ake n to n o te wh eth e r the appar e nt
p r o m i n e n c e i s n o t du e to a r o t ati o n an d ti ltin g of the p el
n
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i n th e S itti n g
o f th e tr u n k o n th e p elvi s i s c h ar ac t eri sti c
p o s t u re an d all p e o p l e te n d to re st th em s elve s whi l e st an d
i n g by tr an s mitti n g th e weight o f th e b o dy th r o u gh o n e
l eg co n ti n u ed m ai nte n anc e o f th e s e p o siti o ns ch ange s th e
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PR I N C I PL E S
O F O S TE O PA TH Y
467
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re lati o n o f th e p e lvi s to th e s p i n al c o lu m n i e c au se s a
—
u n i later al
l u mb o s ac r al S u b lu x ati o n
S t ati c err o r s ar e
c h ar ac te riz ed by a c o mp e n sat o ry ti l t o f th e p e l vi s
h e n ce
all the fac to r s th at might p r o d u c e s u c h a c o n diti o n m u s t
b e t ake n i n t o co n s i d er ati o n A S p revi o u s ly n oted th e o n e
te st o f wh eth e r a s u b lu x ati o n e x i s t s i s a co mp ari so n o f th e
re lative p o s iti o n s o f th e p o s teri o r s u p eri o r sp i n e s with
re lati o n to the se c o n d S ac r al S p i n e
To c o rre c t a p o ste ri o r r o t ati o n we u se p r acti c ally th e
s am e p o s iti o n an d l ever ag e re q u ire d to c o rre c t a ti l t o f
th e p e lvi s o n th e S p i n al c o lu m n The p ati e n t s h o u l d r e
th u s p re se n ti n g th e s u b lu x ati o n
c l i n e o n th e n o rm al s ide
F o r c e m u s t be a pp l ie d o n th e c re st
ar e a to th e Op er at o r
an d S id e o f th e i l i u m c lo s e to th e p o s teri o r su p eri o r s pi n e
The b o dy m u st b e to
so as to r o t ate th e i l i u m f o rw ard
tate d b ac kw ard th u s te n di n g to h o l d th e sac r u m fr o m r o
t ati n g i d ly with th e i l i u m The s e c o n d iti o n s c an b e fu l
fi ll e d i f the Op er at o r t ake s th e p o s iti o n i llu str ated i n F i g
211 i e gr asp s th e p ati e n t s e lb o w with hi s h an d an d
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O F O S TE O PA TH Y
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e cu ri ng an adv an t age o u s h o l d fo r f o r c i n g th e p ati e n t s
b o dy to r o t ate b ac kw ard The Op e r at o r pl ac e s hi S o the r
f o re arm s o li d ly ag ai n st th e c re s t Of th e il i u m an d gl u te al
ti s su e s j u s t ab o ve an d e x ter n al to th e p o steri or ili ac spi n e
By r o c ki n g th e p e lvi s f o rw ard and th e b o dy b ac kw ard a
few ti m e s th e p ati e n t wi ll yi e ld to th e m o vem e n t an d th e
o p e r at o r S h o u l d s e l e c t th e m o m e n t o f th e p atie n t s gre ate s t
rel ax ati o n to S udd e n ly ac c e n t u ate th e s e Opp o si n g r o t a
ti o n s No atte mpt S h o u ld b e m ad e to m ake m o re th an a
m o d e r ate r o t ati o n u n ti l i t i s felt th at th e p atie n t i s p e r
m itti n g th e m o vem e n t to be m ad e with o u t i n te rp o s i ng any
str o n g p r o te c tive m u s c l e te n s i o n
I t IS q u ite i mp o ss ibl e
to c o rre c t a s u b lu x ated i li u m i f th e p ati e n t e x ert s an y pr o
te c ti v e c o n tr ac ti o n o f hi s m u sc l e s
The f o r c e o f th e r o t a
ti o n m o ve m e n t mu s t g o th r o u gh th e m u s c le s with o u t r e
an c e so as to re ac h th e lig am e n t s an d o th er de ep s tr u c
s is t
t u re s ar o u n d th e j o i n t The ar t o f getti n g su cc e s s f u lly
by th e m u sc u lar te n s i o n o f the p atie n t with o u t e x erti n g
a f o r c e ca p ab le o f p r o d u c i n g tr au m a re q u i re s n o s m all
degre e o f skil l NO gre at am o u n t o f f o r c e s ee ms eve r to
be req u ire d i f one has a fi n e s e n s e o f ti s s u e re s i s t an c e
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PR I N C I PL E S
470
O F O S TE O PA TH Y
th e ti s s u e s is advi sab le
I t m ay b e n e c e ssary to re pe at
th e c o rre ctive m o vem e nt s m any ti m e s if the cas e is o n e o f
lo w vit ality o r has a st ati c ar e a w hi c h d o e s n o t p erm it th e
p e lvi s to h o ld i ts n o rm al re lati o n to th e sp i n al c o lu m n
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C H A P TE R X XI I
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R E GI O N
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The tre atm e n t o f th e c lavi c l e m u s t b e co ns i dere d h ere
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to o c l o s e ly to the fir s t rib by sh o rt e n i n g o f th e s u b c lavi u s
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Th e n as far o u tw ar d as th e p hy s i c i an s
Thi s m o v e m e n t c au s e s th e c lavi c l e to p re ss d o w n
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e n t ire ly o n th ei r ligam e n t s to keep th em t o geth e r an d to
l imi tth ei r m o ti o n c an n o t be ret ai n e d i n p lac e if th eir l ig a
me nt s h ave b e e n i n j u red I f th e li gam e n t s o f th e ster n o
j o i n t b e co m e re lax ed th e p u ll o f th e s ter n o
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P r e par ato r y Tr e atm e nt o f the Ne ck—Tr ape z iu s —
The
prep ar at o ry tre atm e n t o f th e n e c k co n si st s in m o vem e n t s
F i g 2 16 i l lu s tr ate s
he v ari o u s gr o u p s o f m u s c l e s
to re lax t
h o d o f re lax i n g th e c ervi c al p o rti o n o f th e tr ap e
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th e o th er h an d f orc e s th e h e ad as far as p o s sib le i n th e
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Fig 2 17 al so by d ire c t m anip u lati o n
O b s erve
wh eth e r b o th m u sc le s wi ll re lax eq u ally Th e s e large m u s
S i n c e th e
c l e s ar e freq u e n t ly f o u n d u neve n ly c o n tr ac ted
any
acc e s so ry n erve s c o n tr o l th e s e m u s c l e s
co n
S pi n al
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A refl e x fr o m th e lary nge al
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PR I N C I PL E S
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O F O S TE O PA TH Y
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th e n e c k m ake s an
e q u al p u l l o n all th e v erteb r ae Wh e n th e p ati e n t s feet
the i fo r c e o f th e p u ll i s fe lt i n th e we ake st
ar e an c h o re d
p o rti o n s o f th e S pi n al c o lu m n The aver age p ati e n t r e qu i r
i n g th i s tre atm e n t e nj o y s a d e li c i o u s s tim u l ati o n after r e
l ax ati o n o f th e e x te n s i o n A few w ho ar e e x trem e ly n e r
v o u s m ay giv e a b ad re acti o n The i n fl ux o f b lo o d i n th e
o th o s e w ho h av e s u ffi
S pi n al c o rd i s h igh ly b e n efi c i al t
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th i s t o n e wi ll fe e l f ai n t o r eve n ab so lute ly lo s e co n sci o u s
n e ss
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v asc u lar sy stem re ac t s wi ll e nab le th em to re ap th e f u ll
be n efit o f th e tre atm e n t The e x te n si o n s h o u ld b e m ade
with ab so lu te ste a di n e s s The re lax ati o n p eri o d i s u su ally
th e o n e i n whi c h any v aso m o t o r ph e no m e n a ar e n o te d
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O F O S TE OP A TH Y
R e l a x a ti o n O f
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m as t o i d
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l o n g p r acti c e i s re q u i re d i n o rder to get an yth i n g l ike a
I t co n s i s t s i n gr asp i n g th e
s u cc e ss f u l re su l t f ro m i ts u s e
p ati e n t s n e c k with th e l eft h an d as i n F i g 2 2 1 The pa
ti e n t s he ad re s t s ag ai n s t an d sl ight ly to th e right o f th e
phy s i c i an s f o re arm The right h an d gr as p s th e c hi n wh i l e
th e fo re arm re s t s firm ly ag ai n s t th e p atie n t s h e ad The
o bj e c t i s t
o h o l d th e n e c k an d h e a d rigi d ab o ve th e p o i n t
gr as p ed by th e th u mb an d fi n ger s o f th e l eft h an d W h i l e
h o l di n g th e h e ad an d n e c k rigi d th ey ar e m o ve d s o as to
fo r c e c ir c u m d u cti o n i n th e j o i n t b e lo w th e gr as p o f th e
l eft h an d A fte r e ac h c i r cu m d u c ti o n th e l eft h an d i s sh ifted
th e depth o f On e v ertebr a n e arer th e h e ad Th u s all th e i n
te r v e r te br al arti c u lati o n s i n th e c ervi c al regi o n ar e re l ax e d
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476
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O F O S TE O PA TH Y
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p e c ifi c w o rk o n a d efi n ite a rti c u l ati o n c an b e d o n e
m o re e as i ly
The H y o i d Bo n e — W o rk o n th e an teri o r p o rti o n o f
th e n e c k c o ns i st s in aff e cti n g th e c o n diti o n o f gr o u p s o f
m u s c l e s f o rmi n g th e fl o o r o f th e m o u th an d e x tri n s i c m u s
c l e s o f th e l ary n x
The H y o id b o n e i s th e m o v able par t w hi ch c an b e
gr asp e d by th e phy s i c i an s fi nger s D r awi n g it d o w n w ard
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hy o g lo ssu s f o rmi n g th e fl o o r o f th e m o u th m ay b e tre at ed
Wh e n th e m ax i llary g lan d s ar e c o nge sted
as i n F i g 2 2 3
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PR I N C I PL E S
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O F O S TEO PA TH Y
Exte nsi on
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I nt r i n s i c M u scl e s o f the L ar y nx —The i n tri nsi c m u s
c le s o f th e l ary n x S o m etim e s n e ed atte n ti o n
The c ri c o
thyr o i d i s th e t u n i n g m u sc l e o f th e l ary nx Thi s m ay b e
dem o n s tr ated by gr a sp i n g th e thyr o i d c arti lage with th e
t hu mb an d f o refi n ge r o f o n e h an d wh i le th e th u mb an d
f o refi n ger o f th e o th er h an d grasp s ligh tly th e c ri c o i d
c arti lage
as i n F i g 2 2 4
I f th e carti lage s ar e sl ight ly se p
ar ate d wh i l e th e p ati e n t m ake s a v o we l s o u n d
th e p it ch
o f th e v o i c e wil l b e p er c eptib ly l o were d
Th i s i s o cc a
s i o n e d by re lax ati o n o f th e v o c al c o rd s by s ep ar ati n g th e
c arti lage s
w hi c h stret ch e s th e c ri c o thyr o i d Thi s m u s
c le i s i n n e rv ated by t
he e x ter n al b r an c h o f th e s u p eri o r
lary n ge al b r an c h o f th e p n e u m ogastri c
The m o t o r fib er s
o f th e s u p e r i o r l ary n ge al c o m e fr o m th e s pi n al a
cc e sso ry
h e n c e we fi n d l e si o ns i n th e c e rv i cal arti c ul ati o ns wh i ch
ar e p ri m ary c au se s o f l ary n ge al di so rd er s
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PR I N C I PLE S
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m u s cl e s
of
th e
.
p o s iti o n fre e
do mo f mo vem e nt n u m er o u s m u sc u lar att achm e n t s e tc
F i g 10 2 sh o w s th e
i s s u bj e c t to f r eq u e n t s u b l ux ati o n
tr ans ver se pr o
n o rm al re lati o n s o f th e m as t o id p r oce s s
F i g 10 3 S h o w s
c e ss o f th e at las an d th e an g l e o f th e jaw
th e abn o r m al re lati o n s o f th e s e v ari o u s p r o mi n e n t p o i nt s
Wh e n
as th ey ar e fre q u e n t ly f o u n d by th e o s te o p ath
the right tr an s ver s e pr o c e ss i s n e a r th e m ast o i d th e l eft
i s to o c lo s e to th e an g l e o f th e jaw an d vi c e ver sa
In r ed u c i n g thi s twi st Of th e at las
th e phy si c i an
S h o u ld w o rk o n th e S i d e wh i c h s h o w s th e tr an s ver s e p r o
The sam e pri n c ip le i s app l i e d i n r e
c es s t
o b e p o steri o r
du c i n g thi s s u b lu x ati o n as w as d e sc rib e d i n c o nn e c ti o n
with th e d o r s al later al s u b lu x ati o n s F i g 2 2 5 i ll us tr ate s
”
“
F i g 2 2 6 s h o w s later al fl e x i o n to th e l eft
e x aggerati o n
wh i le th e phy s i c i an s fi nger s m ake firm pre ssu re b ack o f
th e p r om i n e n t tr an sver s e p r o c e s s th u s ste adily t aki ng
r
e
i
l
,
o n ac c o u n
t
of
i ts
,
,
,
.
.
,
.
n
,
.
.
,
.
,
-
.
,
,
.
.
.
.
.
,
’
,
PR I N C I PL E S
48 0
F IG
2 22
.
.
R e lax a ti o n
of
OF
ty
g t
lo - h
th e s
di a s r i c
OS TE OPATH Y
yo i d
a nd
pos
t
e r i or
b lly
e
of
the
.
dv an t age o f all th e re lax ati o n g ai n ed i n e ach p o rti o n o f
th e m o ve m e nt The termi n ati o n o f th e m o vem e n t i s i 1
lu str ate d i n Fi g 2 2 7 S o m etim e s th e at las sl ip s i n t o p lac e
“
with an au dib le c li c k bu t m o re o fte n th e phy si c i an fe e l s
“
a
gritti n g s e n sati on as th e ar ti c u lar su rfac e s r ub o ve r
e ach o th e r Wh e n th e s u b lu x ati o n o f th e at las l s red u c ed
by th i s m o vem e nt it wi ll h o ld i ts tr u e p o s iti o n m o re firmly
th an wi ll any o th er ve rtebr al arti c u lati o n whi ch has b ee n
aff e cted i n a l ike m an n e r
Thi s i S be cau se the c o n dyl e s
o f th e o c c ip u t fit m o re d e eply i n t o th e su p eri o r art
i c u lat
i ng su rf ac e s o f th e atl as th an i s th e case b etwee n ar ti c u lat
i ng su rf ace s o f p ai r s o f verteb r ae
F i g 2 2 9 il lu str ate s a
a
.
.
.
,
.
'
.
,
'
.
.
.
P R I N CI P L E S
48 2
224
F IG
O F O S TE O PA TH Y
R e l ax a ti o n
.
of
th e
c r i co -
th y
r oid
.
e x e rt m u c h p r e s su r e u p o n b o ny str u c t u re s fr o m the an
The re a r e s o m an y glan d s
te r io r s u rf ac e o f th e n e c k
s
r
o
c
s
s
e
n
s
h
a
s
e
t
e
rve
rte
ri
e
yi
n
g
o
ve
r
tr
ver
e
p
e
l
c
t
s
a
s
n
e
th at d ire c t p re s sure i s li ab l e to i nj u r e them
Fi g 2 2 8 il lu s tr ate s a m eth o d o f red u c i n g a s u b lu x ati on
i
n
n
s
s
n
c
h
a
T
s
th
e
i
th
ervi
v
er
ebr
a
p
ti
e
t
h
i
re
t
e
t
l
c
a
c
x
of
s
th e phy s i ci an s h an d s wh i ch ar e p lac e d o n e ac h S i d e o f the
th e
n e c k an d n e ar e n o u gh to th e c h i n to su pp o rt i t by
The th u mb s ar e u s e d to aff e c t th e spi n e
litt l e fi n ger
d ire c t ly The c o m p re s s i o n o f th e h e ad and n e c k ab o ve
th e l e s i o n by b o th h an d s ke ep s th em rigi d a n d all ar e
m o v e d t o geth er fir s t to e x ag g e r ate th e le s i o n o f th e S i x th
th e n anteri o r fl e x i o n i s fo rc e d i n th e arti c u lat i o n aff e cted
t he n l ate r al fl e x io n wit h counter p ressur e by the t humb
he p r o m i n e n t sid e o f the spi ne
on t
:
,
.
.
,
,
.
,
,
‘
.
.
’
.
’
,
u
.
.
.
,
,
,
,
'
~
,
.
PR I N C I PLE S
°
F IG
.
225
ver se
.
R e d u c ti o n
pr o ce ss
to o
of
f ar
O F O S TE O PA TH Y
bl
t
p
su
u xa
ti
on
os e r i or
of
a tl a s ,
th e
—e x a gg e r ati o n
48 3
ri
gh t t
r an s
m ov e m e n t
.
f
n
o
o
l
x
a
s
u
u
t
o
s
hi
m
vem
e
t
b
e
pp
ie
d
b
ti
th e
l
n
a
c
a
n
o
T s
fir st an d s e c o n d d o r s al
n
s
m
e
o
e
v
M
e
v
e
r
r
c
o
l
n
C
P
i
i
e
U
d
r
yi
ti
t
n
e
l
s
l
r
n
c
G e ne r a
g
p
f
o
n
o
c
o
c
n
n
m
e
ge
er
e
g
o
ver
i
g
th
e
rre
ti
i
i
l
r
n
C
al p
n
The s a
p
n
i
s
o
l
u
c
n
a
s
b
ti
th
er
p
rti
o
f
th
e
pi
l
m
n
o
s
o
o
s u lu x a o n s i n
r
o
n
o
e
n
pp
i
bl
e
th
e
ervi
regi
i
th
e
m
vem
e
t
o
l
a
c
i
c
n
l ca
a
o
m
r
c
o
o
e
o
a
t
s
a
s
e
e
m
vem
e
t
t
b
e
m
d
e
v
e th e
m
s
u
n
s
o
s ri s o f
i nfl u e nce o f a d o mi nant muscl e gr o up As w e have pr e
.
.
,
'
,
,
.
.
,
,
.
,
PR I N C I P L E S
48 4
F IG
.
226
.
R e d u c ti o n
of
su
O F O S TE OPA TH Y
b lu ati
x
on
of
th e
t
a las,
t ral
la
e
fl e xi on
.
te d th e p o siti o n o f an arth r od i al j o i n t i s e x p re s
s iv e o f th e re lative te n s i o n o f th e m u sc l e s whi c h ac tiv ate it
—
r
r
The simpl e st f o rm
The S i m pl e st F o r m o f C o e cti o n
1
e
a di re c t p u l l i n
o f c o rre c tiv e m o vem e n t i s e x te n s i o n
th e lo n g ax i s o f th e S p i n al co lu m n Th i s te n d s to put
v i o u s ly
no
,
.
'
,
.
.
.
,
F IG
O F O S TE OPA TH Y
PR I N C I PL E S
48 6
.
22 8
.
M an n e r
.
g
k in
t ba
h o ld i n
th e h e a d a n d n e c
s u l u x a te d s i x h c e v i c a l v e r
of
b
t
r
e
r
o r de
r
to
r e du c e
a
.
t
P r e s su r e — S i n c e th e c e rvi c al
regi o n i s n o r mf lly ve ry fl e x ibl e c o n s i de r abl e ski ll i s r e
q u ire d if an o p er at o r m ake s us e o f r o t ati o n an d co u nter
p re ss u re fo r c o rre c ti o n o f j o i n t l e s i o n s The re su lt s s e
bu t th e re i s a
c u re d by th e s e m e an s ar e v ery gr atifyi n g
l arge r e l em e n t o f d an ge r th an i n th e u se o f e x te n s i o n The
s ki l lf u l o p er at o r m u s t h ave a g o o d k n o w l edge o f th e an at
A to r
o my o f th e regi o n an d a s e n s e o f ti ss u e re s i s t an c e
se d
si o n m o vem e n t i s a p o werf u l l ever an d s h o u ld b e u
ve ry c aref u lly Alth o u gh it is p o ssib l e to de sc rib e th e
r e lative p o s iti o n s o f th e o p e r at o r s h and s an d th e g e n er al
di re c ti o n o f th e m o veme n t s i t i s n o t p o s s ib l e to c o nvey to
th e re ad e r an i de a o f th e am o u n t o f f o r c e u s ed o r th e re la
tive am o u n t o f re s i st an c e to b e o ver c o m e I t i s thi s var
i able e l em e n t whi ch m ake s th e d i ff ere n c e b etwe e n su cc e s s
No rm al m u sc l e t
one
is
an d f ail u re i n O p er ative w o rk
e q u al to ab o u t six p o un d s p u ll h e n c e i f a pati e nt vo lu n
tar ily rel ax e s o r i s p l ac e d i n a p o s iti o n wh i ch d oes n o t
To r s i o n
an d
Coun e r
.
t
,
“
!
,
.
,
.
.
.
’
-
,
,
.
.
’
,
,
PR I N C I P LE S
F IG
.
229
.
P o s i ti o n
O F O S TE O PA TH Y
g
48 7
t
s tr u c t
u r e s a r o u n d th e a l a s
f o r l o o se n i n
i t o r w ar d
o r ci n
an d
f
g
f
.
PR I N C I P LE S
48 8
F IG
O F O S TE O PA TH Y
t
M o v e m e n t to se c u r e c o r r e c i o n o f a c e r v i c o
d o r sal
y p h o s i s M a n y va r i a ti o n s o f th i s l e v e r a e m ay
b e u se d
Th e e f e c ti v e n e s s o f th e m o v e m e n t d e p e n d s o n
th e
u lc r u m
e in
p o p e r ly ap p l i e d
.
2 30
f
.
k
.
f
b g r
.
.
g
PRI N C I PL E S
4 90
O F O S TE OPA TH Y
h
T
e
n
o
n
a
c
th
e
rre
tive
m
vem
e
t
i
n
a
ert
i
j
i
t
n
o
c
of
co
ti ve r o t ati o n m o vem e n t i s alw ay s as so c i ate d with
fl e x i o n o r e x te n s i o n ac c o rdi n g to th e ch ar acter
.
,
F IG
.
2 31
.
Th e u s e
of
ti
r ot
a
on
to
s e cu r e
cor r e c
ti
on
of
c e r v i c al
c or r e c
l itt le
of
th e
a
l e s i on s
.
PR I N C I PL E S
le si o n
.
O F O S TE O PA TH Y
49 1
The h ead i s r o c ked ge n t ly i n th e dire c ti o n re q u i red
th e co rre cti o n an d w he n th e r o t ati o n re ach e s a p o i nt
wh er e th e r e si st anc e in th e 1e 8 1o n i s fe lt F i g 2 3 1 th e o p
fo r
.
,
FIG 2 32
.
.
,
.
Le v e r ag e
an d co u nt
e r p r e ssu r e ap pl i e d t
ie nt
o a r e cl i n i ng p at
i s se cu r e d i n t
h e u p p e r d o r sal o r any p o m t i n th e ce r vi cal
he l ocati o n o f th e u l cr u m
acco r di n g t
o t
.
.
.
f
.
t
R o ati o n
PR I N C I PL E S
49 2
O F O S T E O PA TH Y
trive s to c re at e a c o n d iti o n o f r e laXati o n by ad
m o n i sh i ng hi s p ati e n t n o t to re si s t S O th at by a s u d de n
bu t very S light i n c re ase i n r o t ati on th e le si o n w i ll re c eive
th e f u ll e ffe c t o f th e m ovem en t an d yie ld to it The yie ld
in
i s u su al ly
o
l
n
i
n
mp
i
ed
by
i
ki
g
o
n
d
th
e
a
cc
a
n
a
c
c
u
s
g
j o i n t an d a fe e li n g o f c o mf o rt The r an ge o f v o l u n t ar y
m o vem e n t i n th e arti c u lati on i s i n c re as ed an d th e p atie n t
u s u ally e x p e ri e n c e s a fe e l i n g o f adde d p o wer
The p o s iti o n o f th e f u lc r u m i n d ivi d u alize s th e ch ar ac
te r o f a m o v em e n t th e ref o re th e S h ift o f th e depth o f o n e
ve rteb r a eithe r m ake s o r m ar s th e su cce ss o f o n e s e ff o rt
In o rd e r to u s e th e f u l c ru m h an d with m o re
at c o r r e c tl o n
or
spe c ifi c ity
f o r c e th e o p er at o r m ay re st th e p ati e nt s
c hi n i n th e
be n d o f hi s e lb o w an d th en by anch o ri n g
th e h e ad with hi s b o dy f o re arm an d h an d F ig 18 9 e x
te n d th e p ati e n t s n e c k by a ge nt le lift Th i s e x te n si o n
fre q u e n t ly o ver c o m e s e n o u gh o f th e m u s c u lar te n s i on to
p ermit a S light ad diti o n al r o t ati o n m o vem e n t , with c o u n
ter p re s su re t
o c o rre c t th e le s i o n
S ever al i llu s tr ati on s ar e p re s e nted h e rewith to S h o w
th e m an n e r o f app lyi n g th e o s te o p ath i c pri n c ip l e o f c o r
"
by e x te n si on an d t o r s i o n
s u b l u x ati o n s
c ervi c al
r e c ti n g
g o r S itti ng is p u re
The p o siti o n o f th e p atie n t eith e r lyi n
rbitr ary with th e o p e r at o r The p ri n c ip le s i n v o lve d i n
ly a
th e Op er ati o n ar e th e s am e i n eith e r p o s iti o n F i g 2 3 2
h en
sh o w s ho w t o r s i o n an d c o u n t er pre ss u re m ay b e us e d W
th e p atie n t i s re c u mb e nt The p o s iti o n o f th e right h an d
i llu str ate s ho w th e in flu e n c e o f th e l ever age m ay be c ar
ri e d i nt o th e u ppe r d o r s al regi o n F i g 19 1 i ll u str ate s th e
app li c ati o n o f th e s am e p ri n c ip l e wh e n th e p at i e n t 1 8 si t
ti n g A s we h ave prev i o u sly s t ated th e p o s iti o n o f th e
f u l c r u m i s th e p art o f any c o rre c tive m o vem e n t o f thi s
wh i ch lo cali ze s th e e ff e c t S i n ce w e ar e aimi ng
c h ar ac te r
to ch an ge th e re lati o n s o f th e b o ny e le m e n ts i n a fl e x ib l e
l ever th e S pi n al c o lu m n at a c ert ai n p o i n t the f u lc r u m
m u st b e u se d with refere n c e to the ki n d o f m o vem e nt
ch ar ac te ri s ti c at th at p o i n t
e r at
or
s
'
,
.
.
.
,
’
-
.
’
,
,
,
,
,
.
,
’
.
.
,
.
,
.
,
,
.
.
.
.
.
.
'
,
.
,
.
,
,
,
,
.
PR I N C I PLE S
49 4
O F O S TE O PA TH Y
Th i s c o n diti o n m ay b e term e d b o ny
b e an kyl o s e d
—
o m p l ete
l
o
r
fib
r
o
u
i
n
co
mp
l
ete
tr
e
i
n
tr
a
a
rti
c
u
a
r
u
c
s
(
(
)
(
)
)
”
—
o r f al s e ( e x tr a arti c u lar ) an ky lo s i s
“
Th e s e ar e th e te rm s u s ed by D a C o st a to defi n e
yet s o m e c lai m th at j o i n t sti ffn e s s c au se d by
an ky lo s i s
—
e x tr a arti c u lar co n tr acti o n o r o b st r u c ti o n i s no t ankyl o s i s
i n th e co rre ct s e n s e ; bu t o n l o o ki n g at th e d eriv ati o n o f th e
w o rd ( an ( g ) k u lo s —c r o o ke d o r b e n t ) it s e em s th at th e
te rm an ky lo s i s w o u ld b e co rre ct wh e n app li ed to any f o rm
”
o f re s tri cte d j o i n t m o vem e n t
“
The c au s e s o f an ky lo s i s are m an y
F i r s t l et u s co n
s id e r th o s e wh i c h re s u l t i n co mp l ete a n d i n c o mpl ete a n
ky lo s i s
In fl amm ati o n s i n o r a r o u n d th e jo i n t fr o m wh at
eve r c au se i f co n t i n u ed l o n g e n o u gh fo r n e w ti ss u e f o rm a
ti o n wi ll c au se an ky lo si s A fte r as epti c i n fl amm atio n s we
to
.
,
.
-
,
,
,
'
,
.
.
,
.
,
(
,
.
,
F IG
.
233
.
M ann e r o f
f o rm i n g
th e
y i ng
r g
l e v e a e to
s c ap u l o - h u m e a l a
ap p l
r
re t
st
ch
rti
'
th e
ti o n
c ul a
.
t
t
s r u c ur e s
PR I N C I PL E S
O F O S TE O P ATH Y
49 5
wi ll m o s t l ik ely fi n d fibr o u s bu t wh e n th ere i s i n fe c ti o n
”
b o ny an ky lo si s i s m o re p ro b ab le
Thi s fib r o u s f o rm ati o n i s th e re s u lt o f i n fl am m ati o n
fo r wh erever th e re i s i n fl am m ati o n th ere i s an i n c re as e o f
ti s su e
S upp o s e a c as e o f di slo cati on with co n si der ab l e
,
,
.
,
.
,
.
,
F IG
.
234
.
A
t
p o si i on
“
f or
'
eas
m e r al
y
m an i p u lat i on
rti
a
ti o n
cu l a
.
of
th e
s cap u l o - hu
O F O S TE O PA TH Y
P R I N C I PL E S
496
t
i
th e ti ss u e s ar o u n d th e j o i nt i n fl amm ati o n r e
e
s u lts an d embry o n i c ti s s u e b egi n s to f o rm as a rep ar ati v
p r o c e s s ; th e embry on i c ti ssu e se n d s o u t s m all p r o c e s se s
wh i c h s t art fr o m n e w c e nter s an d S pre ad th r o ugh th e
ge lati n o u s m ass i n an d ar o u nd th e j oi n t u n ti l a v ery i r
reg u lar n etw o rk i s spre ad all ar o u n d th e j o i n t su rfac e
wh e n th e co n tr ac ti o n p r o c e s s b egi n s th e n e w t i ss u e i s
f o rm ed i n t o fib r o u s ti ss u e wh i c h u n ite s th e b o n e s clo se ly
t o geth e r ; by c i c atri c i al c o ntr acti o n th e b o n e s m ay b e dr aw n
”
s o c lo s e ly t o geth e r th at m o vem e n t i s al m o s t i mp o ss ib l e
“
Bo n y u n i o n o f th e j o i n t s ur f ac e f o llo w s fibr o u s an ky
lo s i s ; it o c c u r s w he n th e b o n e it s e lf i s i n j u re d o r di s e as ed
an d th e su rf ac e Of th e b o n e er o d e d o r b r o ke n
O ss i fi c ati o n
begi n s c hi efly i n th o s e layer s o f fibr o u s ti ss u e lyi n g n e x t
to th e b o n e
“
F als e o r e x tr a arti c u lar an ky lo s i s i s c au s ed by th e
c o n tr ac ti o n o f ti s su e s ar o u n d
Th e s e c o n tr ac
the j o i n t
ti o n s e x ter n al to th e j oi n t m ay b e th e re s u lt o f m any
rem o te an d o b scu re cau se s
co n u s o n
of
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,
,
,
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,
,
.
,
-
.
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-
-
.
,
,
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.
F IG
.
2 35
.
R e l ax a t i o n
of
th e
q u adr i c e p s
ex
t
e nsor
.
P R INC Il LE S o r O S TE O PA TH Y
’
49 8
by e x u d ed s e r u m an d w aste m ateri al n o t carri e d aw ay by
th e c i r c u lati o n s lu ggi sh th r o u gh i n activity o i th e m u scl e s
“
The t e n d o n s an d lig ament s ar o u n d th e j o i n t ar e
th i c ke n e d an d h ar d e n ed to th e le n gth th e l imb w as h el d
by th e ac tive co n tr acti o n bu t after th e m an n er o f all n e w
ly f o rm ed ti s s u e it co n ti n u e s to retr ac t an d dr aw th e limb
”
m o re o u t o f i ts n o rm al p o s iti o n
“
Th i rd
C o n tr ac ti o n s m ay b e th e re s u lt o f c ert ai n
di s e as e s ( as rh e u m ati sm g o u t t u b er cu lo s i s syph i li s o r
—
d i s e ase c au si n g n o n u se o f th e j oi n t o r m al n u triti o n
any
”
o f th e c o n tr o ll i n g m u s c l e s
“
In e x am i n i n g an an kyl o s e dj o i n t we m u s t di sti n g u i s h
betwe e n b o ny an d fib r o u s an ky lo si s an d e x tr a arti c u lar co n
tr ac ti o n A j o i n t m ay b e i mm o v abl e and yet no t so be
c au s e o i b o n y an ky lo s i s
“
D a C o st a s ay s th at a jo i n t i mm o v able fr o m fi br o u s
di s ti n g u i sh e d fr o m a j o i n t i mm o v ab l e fr o m
an ky lo si s IS
b on y an ky lo s i s by th e f ac t th at i n th e f o rm e r attempt s
at m o ti o n ar e p r o d u ctiv e o f p ai n an d su b s e q u e n t ly o f i n
fl am m ati o n ; th eref o re p ai n o n attempted m o ti o n e x clu de s
.
,
,
,
.
.
,
,
,
,
.
,
,
.
.
'
‘
-
‘
,
,
,
I
F IG
.
2 37
.
R e laxat i on
of
t or
th e ad du c
m u s cl e s
of
th e
t hi g h
.
O F O S TE O PA TH Y
PR I N C I PLE S
499
ky lo si s fr o m ou r di ag n o si s An appr o x i m ate ide a
o f the e x t
e n t o i th e sti ff ne ss may b e o bt ai n e d fr o m a hi s
t ory o f the cas e as to wh et her th e di s e as e has bee n s eve re
in c h ar acter an d lo n g i n d u r ati o n
The n erve s o f th e j o i n t
s h o u l d b e e x am i n ed at th e ir p o i n t o f e x it fr o m th e spi n e
”
an d thr o u gh o u t th ei r c o u r s e to th e j o m t
The s am e c o n diti o n s i n ge n er al whi c h c au s e p ai n i n
a j o i n t may c au s e an ky lo si s , wheth er th at p ai n b e du e t
o
lo cal i n j u r y o r referred fr o m so me o the r p art A c o n tr acte d
p so as m u scl e by i r ri tati o n to the b r an ch e s o f th e o bt u r a
to r
n erve c an c au s e p ai n c o n tr ac ti o n an d c o n s eq u e n t s ti ff n e ss
o f th e k n ee j o i n t
“
What c an o ste o p at hy do fo r thi s c o nditi o n ? Fo r
bon y an ky lo si s n o th i n g s h o u ld be attempted fo r the tre at
me n t w ou ld o n ly re s u lt i n di sco u r agem e nt an d di sapp o i n t
m e n t to b o th phy s ic i an an d p atie n t ; bu t if th e j o i n t is i n an
al m o st u s e le ss p o s iti o n e x c i s i o n o r o s te o t o my m ay b e tri e d
with g o o d re s u lt s
I f th e j o i n t has be c o m e an ky lo sed
h r o u gh s epti c i n fl aim m ati o n it sh o u ld n o t b e f o r c ib ly
t
—
n
a
o
f
r
e
br o ke n u p b e c au se o f th e d ger
i n fe c ti o n o f th e
bo ny
an
.
-
.
.
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'
.
.
,
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'
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-
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,
,
F IG
.
2 38
.
M e th o d
of
t t
s re
c hi n
g
th e
ti
s ci a
c
r
n e ve
.
.
PR I N C I PL E S
50 0
O F O S TE O PA TH Y
wh o le j o i n t o r o th e r p art s o f th e b o dy th r o u gh th e c i r
”
c u lati o n
“
1 11 c as e s o f fibr o u s an d e x tr a arti c u lar an ky lo si s o ste o
p athy c an refer to th e m os t e n c o u ragi n g re c ord s an d i s u n
d o u bted ly ah e ad o f any o th e r m eth o d o f tre atm e n t The
m ai n p o i n t i n th e tre atm e n t co n s i st s p ri n c ip ally i n m aki n g
ac tive th e ret arde d c ir c u lati o n
gr a d u ally bre aki n g u p th e
adh e s i o n s
th o ro u gh ly re lax i n g all th e m u s cl e s an d a
s ti m u lati n g tre atm e n t t
o th e n erve s
“
—
F o r e x tr a arti c u lar an ky lo si s th e tre atm e n t i s v arie d
O s te o pathy has a gre at m i s s i o n
ac c o rd i n g to th e c au s e
to fi ll i n fi n di ng an d rem o vi n g the p rim ary cau s e o f m any
H i lt o n spe ak s o f a c as e o f di s e ase d
c as e s o f an ky l o si s
o
s
n
l
!
T
t
ber
l
r
k
n
e
e
j
o
i
n
t
c
u
re
d
by
a
ky
s
i
r
u
e
th
e
c
u
a
u
)
(
re st an d an ky lo si s w as n at u re s w ay o f re d u c i ng the i n
fl am m ati o n an d di s e ase wh e n it had p r o gre s s e d s o far
Bu t th e w o rk o f th e o s te o path is to lo o k fo r th e c au s e s
”
wh i c h m ade th e k n e e j o i n t a p o i n t o f l e ast re si s t an c e fo r
E x ami n e the s p i n e
th e t u b e r c l e bac 1111 to m u ltip ly i n
th o r o u gh ly th e s ac r o i li ac arti c u lati o n an d th e h ip fo r di s
l o c ati o n s wh i ch c au s e p ai n i n th e k n e e j o i n t t hr o ugh irri
Bu t d o e s p ai n alo n e i n th e
tati o n o f th e obt ur at o r n erve
j o i n t s le ad to the c on diti o n k n o w n as a po i n t o f l e as t r e
?
1
P ai n p reve nt s m u c h m o vem e n t i n the j o i n t
s st
an c e
an d r e m embe ri n g th at co nti n u ed 1i on u se o f m u scl e s Cau s e s
m al n u triti o n s lu ggi sh c i r c u l ati o n an d d ege n er ati o n o f th e
mu scle we m ay s e e ho w the j o 1 n t m ay be co m e a p lac e fo r
”
germ s to m u ltip ly
“
Is it to o lo n g a c o u r s e fr o m simp l e p ai n to d i s e as e ?
R em emb er th at p ai n i s u sually ac c o mpani e d by c o ntr acti o n
o f m u sc le
O u r tre atm e n t m u s t b e b o th p reve ntiv e an d
”
c u r ative
“
F ol lo wi ng i s a cas e o f fibr o u s anky lo s i s and p a
r aly si s
i llu str ating th e e ffi c i e n cy o f o ste o p athy to tre at thi s class
five ye ar s o f ag e had an an ky
o f su ff erer s Vi n c e nt P ete
l o sed e lb o w as a re s u lt o f a di s lo cati o n an d b re ak The
j o i nt w as atte n de d to i mm edi ately after th e acc ide nt by a
,
,
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-
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,
.
,
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,
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.
.
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.
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.
‘
’
,
’
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-
,
.
.
,
"
‘
.
,
,
.
PR I N C I PL E S
50 2
O F O S TE O PA TH Y
h an d were p erfe ct ly n o rm al C o ntr as t th i s c ase with o n e
tre ated by m e ch an i c al re st re s u lti n g i n a fi x ed elb o w jo i n
t
or
p e rh ap s a m od e r ate ly u s ef u l j o i n t f o llowi n g f o r cib le
b re aki n g o f adh e s i on u n d e r anae sth e si a wh i c h i s a dan
e
ro
u s tre atm e n t with v ery d o u btf u l re su lt s as th e o p er a
g
ti o n m ay h ave to be d o n e o ve r an d o ve r ag ai n b ef o re a u se
”
fu l j o i nt i s g ai n ed
.
,
,
,
,
,
.
The
S capu l o hu m e r al
-
Ar
ti cu lati o n
— F ig
.
2 33
il lu s
r te s a m eth od o f p ryi n g th e h e ad o f th e h u m er u s o u t o f
th e g l e n o i d f o ss a i e sep ar ati n g th e arti c u lar s u rf ac e s
Thi s m o vem e n t c an b e u se d i n c as e s o f m u s c u lar rh e u ma
It
ti s m wh e n c o mp l et e abdu c t1o n o f th e ar m i s imp os sib l e
al s o allo w s an i n fl u x o f fre sh arteri al b lo od
Wh e n abd u c ti n g th e ar m th e sc ap u la m u s t b e h e l d by
P lac e th e fi n ger s o n the ve rtebr al
the phy s i c i an s h an d s
b o rd er o f th e s c ap u la whi l e th e ax i llary b o rd er i s c o m
p re s se d by th e th u mb By h oldi n g th e s cap u la s e cu re ly
th e phy s i c i an i s s u re th at all th e m o vem e n t h e f o r c e s is in
th e sh o u lder arti c u lati o n an d n o t th e gl idi ng o f th e s cap u l a
Ihe m u sc le s o f th e ar m m ay b e re lax
e d by
o n th e th o r ax . C
di re c t m an ip u lati o n The i n s ert i o n o f th e de lt
o id i s i re
q u e n t ly te n der An y w astl n g o f th e m u s c l e s o f the e x
ll
n
o ted
o th att
h
i
h
o
u
l
d
b
e
c
a
ref
u
y
s
e
c
o
u
r
e
f
o
s
t
tr e m i t
s
s
y
ta
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2 40
.
S
t t
re
ch i n
g
th e
de e p
ba k
c
of
an d
th e
su p e r
le g
.
fi
c i al
m u s cl e s
on
th e
O F O S TE OPA TH Y
P R I N C I PL E S
be
nerve m ay
go ver n i n g
pre ss i o n
s
e ar ch ed
fo r
.
a
50 3
p oint
of
co
m
.
P l e x u s — The p ri n c ip al
m o t o r divi s i o n s o f th e b r achi al p l e x u s m ay b e te s te d by
p l e m o vem e n t s m ad e by th e p ati e n t
The p ati e n t s
si m
gripp i n g p o wer i s an i n d e x to th e co n diti o n o f th e m edi an
E x te n si o n o f th e
n erv e
an d th e m u s c l e s it i n n erv ate s
an d fi n ge r s m ad e ag ai n
s t re s i st an c e i s an
i n de x o f p o wer i n th e m u sc u lo S pi r al n erve tr act Ab du c
ti o n an d add u c ti o n o f th e fi n ger s ar e c o n tr o l le d by th e u ln ar
n erv e
F l e x i o n o f th e f o re a rm by th e m u sc u l o c u t an e o u s
O b s erve th e co n diti o n o f th e fi r st po s teri o r i n te r o s
s e o u s m u s c l e whi c h f o rm s th e l itt l e m u sc u lar s we ll i n g wh e n
th e th u mb is add u c te d to th e s e c o n d m et ac arp al b o n e I f
h i s w asted th ere i s evid e n c e o f n erve c e ll d ege n er ati o n
Thi s m u s c l e sh o u l d b e we ll d eve lo p ed i n thi n h an d s as
We ll as i n fat o ne s I f th e w as ti n g i s u n i later al lo o k fo r
i mp i n gem e n t o n th e u lnar n erve at so m e p o i n t i n i ts c o u r s e
I f it i s bi later al th e c e ll s in th e s pi n al c o rd ar e p r o b ab l y
at f au lt
The de lt o i d i s fre q u e n tly p ai n f u l as a re su lt o f p re s su re
o n the cu c u mfl e x n erve
The p re ss u re is u su ally at th e
p o i n t o f e x it fr o m th e v erteb r al c an al R e lax ati o n o f th e
s tr u c t u re s ar o u n d i ts p o i n t o f e x it u s u al ly give s re l i ef
—
l
i
T
r
f
o
a
t
o
n
a
o
n
The ge n eral
R e du c t io n o D i s c
s by
c ti
m eth o d ap pl i ed to di slo c ati o n s o f all j o i n t s o f th e e x tr e m i
ti e s i s di re c t tr acti o n Thi s i s so m etim e s aide d by p re s
su r e f o n th e p r o mi n e n t po m t o f th e di s l o c ated b o n e to ai d
it i n s l ipp i n g to i ts p lace A ll o f th e d islo c ati o n s o f th e
h u m e r u s s u b co r aco i d s u b c lavi c u lar s u bgl e n o i d an d su b
c an b e red u c ed by u s i n g tr a c ti o n to s tret c h th e
S pi n o u s
m u s cl e s an d lig am e n t s o f th e j o i n t to th e e x te n t th at th e
h e ad o f the h u m er u s w s lip o ver th e rim o f th e g l e n o i d
f o s sa ThIS tr ac t i o n m a be m ade with th e p ati en t s itt in g
i
i
i
2
4
f he k n e e i n the ax illa sp ri ng s th e he ad
as
n F g
3
The s am e tre atm e n t m ay b e ap
o f th e hu m e r u s o u t
w ar d
p l ied with th e p ati e n t re c li n i n g The phy s i c i an sho u ld
E x am i n ati o n
of
Br achial
the
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,
,
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,
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,
'
a
.
.
'
.
.
PR I N C I PL E S
504
O F O S TE O PA TH Y
p lac e a b all o f w o o le n y ar n i n th e ax i lla th e n p lac e his
s t o c ki n ged f o o t u p o n it
an d m ake tr ac ti o n o n th e ar m
I t i s p o s sib le to app ly th e trac ti o n m eth o d in a s impl er
A n o rdi n ary c an v as c o t with a h o l e c u t i n it so th at
w ay
th e ar m c an b e pu t th r o u gh whi le th e p ati e nt re st s e as i ly o n
hi s s id e sh o u ld b e e l ev ate d far e n o u gh fr o m th e fl o o r to al
Th i s
lo w a si x p o u n d wei ght to b e att ach ed to th e wri st
eight q u i c k ly re lax e s th e m u sc le s an d red u c e s th e
s te ady W
s u b lu x at i o n
Tr ac ti o n alw ay s str ai n s th e m u sc l e s an d c au s e s so m e
h e at an d swe lli n g th eref ore c ar e s h o u ld b e t ake n to p re
ve n t e x u d ate s an d adh e s i o ns
—
e
r
R e du c ti o n o f Di sl o c ati o n s by L v e ag e Th o s e w ho
ar e e x p ert i n re d u c i n g sh o u l der di slo cati o n s u su ally m ake
t s whi ch e x agge r at e th e l e s i o n
u s e o f a s eri e s o f m o vem e n
i e m ake th e h e ad o f th e di slo cat
ed b o n e m o re pro m 1n e nt
In s u bc o r ac o i d di slo c ati o n s o f th e h u m er u s abd u c ti o n of
The phy s i c i an s t an d s at
th e ar m c au s e s e x agger ati on
th e si de o f the p ati e n t w ho i s re c li n i n g o n a h ard su rf ac e
As abd u c ti o n i s m ad e th e phy s i c i an s fre e h an d re st s u p o n
,
,
.
.
,
,
,
-
.
.
,
,
.
.
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,
-
,
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’
.
F IG
.
2 41
.
P o s i ti o nf o r
,
e as
y
m a n i p u lati o n
of
th e
s aph e n ou s
open in
g
.
PR I N C I P LE S
506
O F O S TE O PA TH Y
th e u l na i nt o p lac e Thi s di sl o c ati on is u su ally co m
pl i
c are d w ith fr ac t u re o f th e c o r o n o i d pr o c e s s
The R adi u s —The r adi u s m ay b e di sl o cate d p o steri o r ly
o r an teri o r ly
L ater al di s lo c ati o n s o f eith er r adi u s o r u ln a
ca rry b o th b o n e s t o gethe r
A p o s te r i o r di s l o cati o n o f th e
r adi u s can b e red u c e d by fl e x io n o f th e f o re arm th e n e x
te n s i on with c ou n ter p re ss u re o n th e p r o mi n e n t p o i n t o f
th e h e ad o f th e r ad i u s p o steri o rly A f or w ard di sl o cati o n
req u i re s s u pi nati o n o f th e ar m an d add u cti o n o f th e h an d
t o gethe r with p re s su re o n th e anteri o r su rf ac e o f th e h ead
o f th e r adi u s
Di slo cati o n s o f th e b o n e s o f th e wri st o r h an d are r e
du c e d by tr acti o n o r p re s su re
—
l
o
n
All di s lo c ati o n s tw e n t y f o u r h o u r s
s
O ld Di s o c ati
The o l de r
re q u ire co n si der ab l e r el ax i n g tre atm e n t
o ld
Nat u re beg i n s
th ey ar e th e h ard er th ey ar e to red u c e
lf to n e w c o n d iti o n s alm o st im m edi ate ly
to ad apt h e r s e
A ll th e s lac k o f m u sc le s an d l ig am e n t s i s s wift ly t ake n u p
Th o s e ti ssu e s m o st c o mpre s s e d by th e n e w p o s iti o n o f the
b o n e ar e imp o ve ri sh e d by th e lac k o f n o u ri shm e n t Thi c k
s o th at o l d di sl o cat
i
o ns
e n i n s an d adh e s i o n s qu i c kly f o rm
g
i o n s ar e tre at ed i n
O l d di s lo c at
ar e n o t e as i ly h an d l ed
th e sam e m ann er as fre s h o n e s e x c ept th at m u ch rel ax i n g
an d re s t o ri n g o f vit al ity i s n e c e ssary
M u s cl e s o f the L o w e r E x t r e m i ty —The m u scle s o f th e
lo wer e x trem ity m ay b e re lax ed eith er by di re c t m an ipu
lati o n o r by t aki ng adv an t age o f th e m o vem e n t o f v ari o u s
j o i nt s to pu t th e m o n a s tret ch D i re ct m an ip u lati o n is
lab o ri o us an d re q u i re s c o n sid er abl e ti m e :
The m u s c le s o f th e hi p j o i n t fre q u e n tly co n tr act s uf
Th ey c o n tr ac t a
fi c i e n tly to make w alki n g d i ffi c u lt
s a re
b r u i se di se as e o f th e j o i nt s u blu x ati o n o f
s u lt o f s tr ai n
The sub
l u b ar verteb r ae o r lu x ati o n o f th e i li ac b o n e s
lu x ati o n s i rrit ate th e n erve s wh i ch i nn erv ate th e m u sc le s
tr o l li n g th e j o i n t
co n
The m o vem e n t s h e re after o u t li n ed m ay be u sed fo r
m any d i ff e re n t p u rp o se s bu t th ey ar e appli ed h e re to s pe
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PR I N C I P L E S
O F O S TE O PATH Y
50 7
gr o u p s o f m us c le s A ll th e m o veme n t s we h ave th u s
far o u t li n ed h ave b ee n de sc ribe d acc o rdi n g to th e w ay th ey
aff e c t s tr u c t u re n o t f u n cti o n
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In th e a r th r o d i a l a r ti c u la ti o n
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PR I N C I PL E S
5 10
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PR IN C I PL E S
The m o ve
O F O S TE O PA TH Y
5 11
me
t m ade to re d u c e th e s e su b lu x ati o n s
t ake i nt o con si d er ati o n th e fac t th at th e h e ad o f th e fem u r
must: be m ade to retr ac e its r o u te i n o rd er to regai n its
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to the sp i n e o f the i s ch i u m c au s e s the to e to t
The phy s i c i an
an d the re i s s li ght s h o rte n i n g o f th e l e g
ta
ke s a p o s iti o n as i n F i g 2 3 9 an d c arri e s th e k n e e u pw ard
an d i n w ard
H e f o rc e s th e k n ee as far as p o ss ib l e ac r o s s
the m edi an l i n e th e n fl e x e s th e thigh h ard o n th e abd o
men
Thi s t u rn s th e h e ad o f t
he fe m u r d o w n w ard an d
i n w ard R em em ber th at th e h e ad p o i nt s alw ay s in th e
sam e di re cti o n a s th e i n ter n al c o nd y le
Now f o rc ib ly ab
d u c t i an d e x te n d th e th igh with a q u i c k e x te r n al r o tati o n
Th e s e m o vem e n t s c ann o t b e m ade su cc e ss f u lly with o u t a
lo n g co u r s e o f p r e l imi n ar y re laxi n g tre atm e nt s th at i s if
the di s lo c a
ti o n i s an ol d o n e
D i r e c t tr acti o n m ay b e u s e d fo r all di slo cati o n s o f th e
fem u r j u st as fo r th e sho u ld er bu t th e m usc l e s ar e so
h e nc e
s tr on g t hat it i s n o s m all m atter to o ver c o m e th em
m o vem e n t s whi ch t
ake adv an t age o f l e v e r ag e a r e m u c h
m o re sati s f act o ry
ti o n o f the hip m ay b e
The f o rm u la fo r any di s lo c a
he h e ad of th e fem u r
w o rke d o utby n o ti n g the p o s iti o n of t
o as t
o m ake th e
and th e n c arryi n g th e i n ter n al c o n dy le s
h e ad retrac e i ts c o u r s e W he n sh o rte n i n g o r len gth e n i n g
he le g i s n o te d m ake s u re th at th e i li ac b o n e s ar e eve n
of t
A h alf i n c h di ff ere n c e i n th e l e n gth o f th e l eg s m ay e as i ly
b e ac co u n te d fo r by th e ac ti o n o f the hip m u scle s
The pyrif o rmi s m u sc l e m ay co n tr act an d co mp re ss th e
sc i ati c n e r v e i n i t
s c o u r s e th r o u gh th e gre at s c i ati c f o r am e n
Fi g 2 39 i llu s t r ate s th e m o veme n t to stret c h the p y r i fo r
m i s The phy s i c i an h o ld s th e p e lvi s to th e t ab l e by p re s s
i n g o n th e an teri o r su pe ri o r spi n e o f th e i li u m
The thigh
i s th e n s t ro n gly add u c ted
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s u cc e ss f u lly t r e ated by r el ax i ng th e pyrif o r m i s
but th e
majo r ity o f case s re q u i r e a st r et chi ng o f the sci ati c ne rv e
n s
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P R I N C I P LE S
5 12
F IG
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P o s i ti o n
for
O F O S TE O PA TH Y
r e du c i n
g
tar s a l
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PR I N C I PL E S
5 14
F IG
O F O S TE O PA TH Y
2 47
D i s te n s i o n o f v e i n s d u e to tr i c u s p i d i n s u f
o h sh i n s a n d u n d e r
ar i c o s e u lc e r s o n
fi ci e n cy
s tr a p p i n
o th a n l e s w e r e h e a l e d
m a ll e o l i o f
ov e
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PR I N C I PLE S
O F O S TE O PA TH Y
51 5
Op e ni n g The de ep an d s u p e rfi c i al vei n s o f th e l e g h ave
l itt l e o r n o c o mm u n i cat i o n ab o ve a p o i n t ab o ut th e j u n c ti o n
Thi s ap pl i e s
o f th e lo we r an d m i dd l e th ird of th e l e g
es p e c i ally to the l o n g saph e n o u s ve i n
V ari co se ve i n s o n
th e fe et o r an k le s m ay b e dr ai n ed by b o th S uperfi c i al an d
deep vei n s th eref o re thei r e x i s te n c e in th e s e lo c ati o n s
m ay b e du e to V i sc er al cau s e s eve n wh e n th ere i s n o o b
o
s t u c ti o n t
the
a
ph
e
o u s O p e n i ng
s
n
r
P o pl it e al S pac e — The po pli te al s p ac e so m etim e s n eed s
re lax ati o n Th i s i s p erf o rm ed by dire c t m an i p u l ati o n a s
The p o s iti o n o f th e ph y s i c i an s
i llu str ated i n F ig
h an d s i n th i s i llu str ati o n aff e ct th e u pper po r ti o n o f th e
By f ac i n g th e p ati e n t th e lo wer p o rti o n
l sp ac e
p o p l ite a
c an b e e as i ly aff e c ted
—
n
e
e
The s e c arti
The sem i l u n ar Car ti lag e s o f the K
—
lage s whi c h s e rve to f o rm c u p l ike d ep re ss i o n s fo r th e
o n th e s u p eri o r arti c u lar
c o n dy l e s o f th e f em u r to re s t i n
m ay b e c o m e s light ly di s p lac ed an d
s u rf ac e o f th e tibi a
h e n c e ac t as wedge s to lim it m o ti o n i n th e j o i n t S i n c e
h th e c o n dy l e s it i s p r ob ab le th at
th ey n o rm a
y
m
o ve wi t
l
l
ri ly th e c au se o f th e
s o m e s l ight l ig am e n t o u s s tr ai n i s p ri m a
The e x ter n al
c h an ge i n p o s iti o n o f a s em i l u n ar c arti lage
i lu n e i s th e o n e m o st fre q u e n t ly aff e c te d The re aso n
s em
fo r thi s p r o b ab ly i s du e to th e f ac t th at th e i n ter n al c o n
dy l e o f th e fem u r is lo ng e r th an th e e x ter nal h e n c e i n a
m o veme n t s u c h as p e d al i n g a b icy c le the e x te n s i o n o f
th e j o i n t i s m ad e with th e k n e e s r ath er wid e ap art Thi s
te n d s to s tr ai n th e e x te r n al later al l ig am e nt The c arti lage
s l ip s S light ly f o rw ard an d p reve n t s eith er fl e x i o n o r e x te n
—
The j o i n t rem ai n s i n a s em i fl e x e d p o s iti o n an d i s
si o n
e x q u i s ite ly p ai n f u l S o m e o f th e s e c as e s c an b e q u i c k ly
re li eved by h avi n g th e p ati e n t S it so th at th e o p er at o r can
gr asp th e k n e e with b o th h an d s as in F i g 2 4 3 The o p
e r ato r s th u mb m ake s c aref u l pre s s u re o n th e p ai n f u l S p o t
wh e re th e e x ter n al s e mi lu n e c au s e s a l itt le tr an sve r s e
ri dge By g ent ly r o t a
ti ng th e tibi a an d u s i n g a sli ght e f
fo r t to sl id e th e tibi a o n th e co n dyl e s with o u t p ro d uci n g
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PR I N C I PL E S
5 16
F IG
O F O S TE O PA TH Y
S am e case as the p r e ce di ng ill u str atio n
me du sae p r e s e nt thu s sh owi ng that p o rtal
cap u
ed
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r u ct
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PR I N C I PL E S
5 18
F IG
.
250
.
M e th o d
su p p o r
t
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f
r
t
O F O S TE O PA TH Y
s r appi n
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on
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PR I N C I PL E S
O F O S TE O PA TH Y
-
th at a S light edem a e x i st s i n th e s h e ath o f th e n erve at the
In th o s e
p o i n t wh i ch su ff ered th e tr au m ati c p re ssu re
re c o very i s alw ay s
c as e s
du e to e x te n s i o n o f th e l e g
p r o b l em ati c al b e c au s e th e tr au m ati c p re s su re m ay h av e
be e n p r o d u c ed by a f o l d o f f as c i a Thi s i s e s pEc i ally th e
n teri o r t ibi al n erve i s th e o n ly br an c h o f
c as e wh e n th e a
th e P er o n e al p ar alyzed Th e s e c ase s n ee d to b e tre ated
by sem i fl ex in g th e k n e e s o th at d eep digit al m an ip u lati o n
Of all the s o ft ti ss u e s o f th e k n ee wi ll h aste n ab so rpti o n
o f th e edem a
J u dgi n g by so m e o f th e c ase s we h av e see n
th e p ati e n t s w o u l d h ave b e e n i n m o re c ap ab l e co n diti o n
with b o n y d ef o rm iti e s du e to fr ac t u re s th an with th e
p ar aly s e s re su lti n g fr o m the e ffo rt s to m ai n t ai n red ucti o n
o f th e fr ac t u re s
Th e s e p ar aly s e s a r e h o wev e r u n av o i da
le i n so m e c as e s b u t re co very w o u l d b e m o re r a
i
d an d
p
b
c e rt ai n i f i n te ll ige n t m an ip u l ati o n w as u s ed al m o s t fr o m
th e b egi n n i n g o f th e c as e s
“
—
M
l
M an y e ff o rt s h ave
i
o
s
o
n
bi i ati
G lu co k i n e s s an d
b ee n m ad e to deve lo p a m eth o d o f tre ati n g fr ac t u re s th at
wi ll n o t o nly —i n s u re a re aso n ab ly p erfe c t u n i o n b u t wi ll
av o i d th e s eri o u s s e q u e lae i n c i de n t to th e u se o f cast s
No S i n g l e m eth o d o f
an d e x te n s i o n app ar at u s
S p li n t s
tre atm e n t i s app li cab l e to al l f o rm s o f fr ac t u re s bu t th ere
ar e c ert ai n p ri n c ip l e s u n d er lyi n g th e ar t o f m an ip u l ati o n
whi c h ar e app li cab l e i n the tre atm e n t o f c ert ai n fo rm s o f
fr act u re s The u se o f a f o rm o f m ass age by D r J u s t
L u c as Ch ampi o nn i e re i n th e tre atm e n t o f fr act u re s i s a
n e w d eve l o p m e n t i n th e ar t o f m an ip u lati o n
H e cal ls
“
hi s meth o d g lu c o k i n e s i s
p ai n l e s s m as s age I t i s s o dif
fe r e n t fr o m m ass age as ge n er ally u n de r s t o o d by m ass e u r s
th at n o n e bu t phy si c i an s w ho u n der st an d th e ph e n o m e na
i n ti ssu e s i n v o l ved i n fr ac t u re can u se it i n te l lige n tly
It
c o n s i s ts i n str o ki n g th e i n j u re d p art very ge n t ly
in th e
di re c ti o n o f v e n o u s c ir c u lati o n an d th e m u s c l e fib er s Thi s
s tr o ki n g i s rhyth mi c al an d c o n ti n u o u s f o r ab o u t fiftee n o r
twe n ty mi n u te s The s tr o ki n g i s so ge n t l e as to s e em
“
q u ite i n e ff e ctive The fir st p ri n c ip l e i s : Never b e afrai d
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PR I N C I PL E S
52 0
of
O F O S TE O PA TH Y
r u bbi n g to o ge n t ly o r o f givi n g to o sm al l a d o s e o f
m o bi li sati o n ; alw ay s fe ar th at th e m ass age i s to o h e avy
”
an d th e m o vem e n t to o gre at
The re su lt o f thi s str o ki n g
i s th e rel i ef o f p ai n i n th e i nj u re d p art an d a co i n c id e n t
rel ax ati o n o f th e m u scl e s i n v o lve d i n th e fr act u re Thi s
rel ax ati o n o f m u scl e s al l o w s rep lac em e n t o f th e fr agm e n t s
“
”
M o b ili s ati o n co n s i st s o f m i n u te d o s e s o f p as s ive m o ve
m e n t i n all o f th e j o i n t s ab o v e an d b el o w a fr act u r e The
”
“
d o s e S h o u l d c au s e n o p ai n i n th e l imb The app li ca
ti o n o f P r o f L u c as C ham pi o nn i e r e s m eth o d s has be e n
e x c e ll e n t ly de sc rib e d by D r J am e s B M e nn ell i n hi s w o rk
o n The Tre atm e n t o f F r ac t u re s by M o bili sati o n an d M as
sage M ac M i llan an d Co
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P ai n i n the
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c as e s co mpl ai n o f
p ai n o f v ari ab l e ch ar acte r i n th e l eg s an d fe et I t i s g o o d
p r acti c e to te st th e pl ant ar ar ch e s i n all s u ch case s We ak
n e s s o f th e l o n git u di n al ar c h m ay
n o t b e evide n t e x c ept
wh e n th e l eg m u s c l e s ar e fat i g u ed th eref o re a p l an t ar
imp re ss i o n m ay n o t s h o w any saggi n g I f n o str u c t u r al
d efe c t i s appafe n t i t i s s afe to as su m e th at we ak n e s s
e x i st s The app li c ati o n o f s trip s o f a dh e s ive to p ar all el
the su s p e c te d te n d o n s wil l give e n o u gh s u pp o r t to d em o n
str ate wh eth e r th e di ag n o s i s i s re aso n ab ly c o rre ct
e g s an d
F e et
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Tar sal l ig am e n t s m ay b e str ai n ed o r a t ar sal b o n e
b e co m e s ub lu x at ed The pai n i n c id e n t to th e s e co n diti o n s
,
,
,
.
very ac u te S u b lu x ati o n s ar e u s u ally red u c ed by pas
whi ch m ere ly t e n d to pr o d u c e m o b i l ity
s iv e m o vem e n t s
I f th i s d o e s n o t p r o d u c e r e du c
i n th e t ar s u s as a wh o l e
ti o n it wi ll b e n e c e s sary to u s e th u mb p re s su re o ver th e
p r o m i n e n t p ai n f u l s p o t an d th e n fl e x an d e x te n d th e tar
s o a s to al lo w th e p re ss u re to b e
s u s with th e o th er h an d
In any c as e o f we ak a r c h o r s ub l ux ated
c o m e e ff e c tive
t ar sal b o n e it i s advis abl e to u s e so m e m e an s o f p as sive
S o m e cas e s wil l
s u pp o rt u n til th e ac u te ph a s e s ar e p as t
re c o ve r c o mp l ete ly u n de r th e i n fl u e n c e o f v o l u nt ary e x e r
c i s e s wh i l e o th er s c an no t get al o n g with o u t su pp o rt
is
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,
.
PR I N C I PL E S
522
O F O S TE O PA TH Y
C H A P TE R X X I V
M A NI PU LATI O N
V A S O M O TO R
FOR
-
E F F E CTS
Th ere
.
NE R V E
.
ti m e s wh e n th e phy si c i an de s i re s to aff e ct
th e am o u n t o f b lo o d i n th e ti ss u e s o f th e h e ad Th e re m ay
b e co n ge sti o n o f th e n as al ph ary n ge al an d l ary n ge al m u
“
”
c o s a as d u ri n g a h ard
A fter m an ip u lati n g to r e
c o ld
lax th e mu s c l e s o f th e n e c k an d o ve r co m e any e ff e ct s th e s e
m ay h ave had o n th e p o s iti o n o f th e c ervi c al vertebr ae it
r i ct
i s we ll to try to c au s e v as o —
co n st
o r a ct
i o n by s ti m u lat
2
n g n e r ve e ndi n g s
F
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i
lati n g d e ep ly u n d er th e zyg o m a i n th e sigm o i d n o tch o f
th e i n feri o r m ax i llary b o n e Wh e n the pati e n t o p e ns hi s
m o u th th e phy s i c i an p lace s hi s fi n ger o ver th e depre ssi o n
b e lo w the z y g o m a an d p re sse s i n ward at th e sam e tim e
m aki n g a vibr at o ry m o vem e n t o f th e fi n ge r Thi s aff e ct s
th e b r an c h e s o f M e c kel s G an g li o n an d thr o ugh it the
n asal m u c o s a
I t i s a p ai n f u l tre atm e n t but th e b l o od
wi ll o ft e n s u rge fr o m th e m u co u s ti ss u e s to th e s ki nas a
re s u lt o f it
t th e s am e e ff e c t i s se c u re d by u s i n g th e m o ve
Ab o u
m e n t i llu str ate d i n Fi g 2 52 Whi l e th e p ati e n t s m o u th
i s o p e n th e phy s i c i an pl ac e s his th u mb s o n th e bridg e
The
an d hi s fi n ger s a
o f th e n o s e
t th e an g le so f th e jaw
tip s o f th e l itt l e an d ri n g fi n ger s ar e p re s sed i n t o th e d e
p re s s i o n cau s e d by th e f o rw ard m o ve me n t o f th e c o n dy l e
em i n e n ti a arti c u la
ri s The p hy si c i an
o n th e
o f th e jaw
f o r c e s th e m o u th s h u t wh i l e the p ati e n t o pp o se s The
p o siti o n o f th e tip s o f th e litt l e an d ri n g fi n ger s p reve nt s
the e asy s l i ppi n g o f th e c o n dyl e s i n t o th e g le n o i d f o s sa
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O F O S TE O PA TH Y
P RI N CI PL E S
The
52 3
e n s o ry fiber s ar o u n d the c on dy le ar e i n te n s e ly stim
u l ate d an d fre q u e n t ly m an ife s t it by sp re adi n g a fl o o d o f
Thi s i s al so a p ai n
c o lo r o ver the f ac e i n fr o n t o f th e e ar
I t i s h igh ly p r o b ab le th at all mo ve m e n t s
fu l s tim u lati o n
hi ch ar e p ai n f u l s e cu re re su lt s b y cau s
o f thi s c h ar ac te r W
i n g ac tivity o f th e di lat o r n erve s to b lo o d ve s s e ls i n s u pe r
fi c i al ti ss u e s t hu s d ep l eti n g th e b lo o d i n th e c o n ge s te d
A Sh arp pai n m ay cau s e a su dde n b lan c h i n g bu t i t
are a
i s f o llo we d by v aso dil ati o n
I f it i s di ffi c u lt fo r th e p ati e n t to bre ath e th r o u gh th e
re ss o n th e n as al b o n e s fir s t o n th e right sid e
n o s tri l s p
th e n l eft th e n m ake a h e avy p re s su re o ver th e j u n c ti o n o f
th e nas al an d fr o n t al b o n e w ith O n e th u mb ab o ve th e o th er
Thi s m o vem e nt i s very p l e as an t to th e p ati e nt o rdi nari ly
To c ar ry o ff th e ve n o u s b lo o d m ake a str o ke fr o m
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t
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S i mu l a i o n
b
e tw e e n
of
th e
zyg
th e
in e r i or
f
o
ma
an d
m ax i lla
.
th e
si
gm
oi
d no
t
ch
PR I N C I PL E S
52 4
O F O S TE O PA TH Y
th e i n n e r c an th u s o f th e eye d o w n w ard o ve r th e j u ncti o n
th e n c e to th e
o f th e m ass eter m u s c l e with th e lo wer jaw
s u p r acl avi c u lar f o ss ae
—
r
The F ift h Cr an i al Ne v e
The fifth c r an i al n erve can
b e t re ate d at i ts p o i n t s o f e x it th r o u gh th e b o n e s o f th e
f ac e F ig 2 53 i ll u str ate s th e po si tio n o f th e se p o i nt s A
vib r at o ry p re ssu re o ver th e s e p o i nt s cau s e s a d ull bu t i n
I f th e m o vem e nt i s m ad e q u i ckly an d v ig
c r e as i n g pai n
th ere wi ll b e evi de nc e o f a re acti o n i n a fl us h ed
o r o u sly
app e ar an c e
—
L
l
I nhi biti o n o f S u bo c ci pit a
Whe n th ere i s a high
bl o o d p re ss u re i n th e he ad an d th e p ati e n t i s su ff eri n g
with h e ad ach e it is po s s ibl e to give gre at r eli ef by ste adi ly
i n h ibiti n g i n the Su b o c c ipit al f o s sae and te mpl e s as i ll u s
,
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S i m u l a ti o n
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ce
.
of
th e
m ou th
a
g ai n t
s
’
PR I N C I PL E S
52 6
The ph re n
ic
O F O S TE O PA TH Y
p u di c an d p n e u m o g astri c ar e th e o nly
n e rve tr u n k s di str ib u te d i n th e b o dy wh i c h c an b e e asi ly
c o m re ss e d th r o u gh s o ft ti s su e
i
i
tr
te
ti
m
F
2
l
5
6
l
u
s
a
s
s
p
g
u lati o n o f th e p n e u
m o gas tri c The phy si c i an s fi n ger s r o l l
o ve r th e n e rve tr u n k wh ere it l i e s alo n g th e i nn er e dge
o f th e ste r n o c l ei d o —
m as t o id
The ge n e r al t e n d e n cy o f an o s te o p athi c tre atm e n t
whi ch aim s to re lax th e e x te n s o r m u sc l e s o f th e n e c k an d
tr u n k i s to red u c e b lo o d pre s su re C as e s whi ch ar e ch ar
ac te r i z e d by h igh b lo o d p re s su re ar e gre at ly be n efited by
r el ax ati o n o f m u scl e te n si o n by m e an s o f ge n t l e lever ag e
The u s e o f h e avy p re ss u re m o vem e nt s i s c o n tr ai n di c ated
b e cau s e th ey m ight o cc as i o n i nv o lu nt ary r esi s t an c e by th e
p atie n t an d th u s s u dd e n ly r ai s e bl o o d p re ssu re to a dan
e
r o u s d egre e
g
I t i s very p r o b ab l e th at the e x te n s i o n and c o u nte r
p re s su re m o vem e nt s we use to re d u c e s ubl ux ati o n s act al so
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254
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I n h i b i ti o n
in
th e
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b
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tal f
o s sa
.
P RI N C I PLE S
as
f ac t o r s
in
c
52 7
O F O S TE O PA TH Y
i n lo c al ized
h an gi n g b lo o d pre ss u re
vi sc er al
re as
Vaso m o t o r e ff e c t s c an b e s e c u re d by v ari o u s f o rm s
n
a
o
n
o
u
a
s
C
n
a
l
a
ti
m
ti
pp
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ter
irrit
ti
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of s
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2 55
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,
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I n h i b i ti o n
of
th e
ph r e ni c n e r ve s
.
C e n te
r
f or
h i c co u
gh
.
PR I N C I PL E S
52 8
O F O S T E O PA TH Y
th e p o i n t o f p r o d u c i n g a cli ck i n an arth r o di al j o i nt all
—
o
u
c
a
o
s
pr d e v
m o t o r e ff e ct s o f v ari o u s degre e s They all
s erve a u s ef u l p u r o s e an d te n d t
n
ei
f
r
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.
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2 56
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t
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S i m u la i on
of
th e
g t
pne u mo as
ric
n e r ve s
.
PR I N C I P LE S
53 0
P hy s i o lo gy
O F O S TE O PA TH Y
th e Ne rv o u s S y stem
of
Te x t Bo o k
of
P hy s i o lo gy
Tre atm e n t
of
F r ac t u re s
M o ro t
by M o b i l i s ati o n
an d
M ass age
M e nn el l
S p o n dy lo th er apy
At las
H an d
Ey
S tr ai n i n
e
Abd o mi nal
A n at o m y
H u m an
of
H e alth
an d
D i se ase
R ann ey
M ay lar d
P ai n
The A bd o m i n al
an d
P e lv i c
th e Nerv o u s
an d I n j u ry
D i s e as e s
d e nt
.
of
Br ai n
S y stem
-
R e su lti n g fr o m Acc i
”
Bai l ey
-
M o d er n ized C hir o pr acti c
S m ith
L an gw o rthy P ax so n
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S u rgi c al An at o my
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C l i n i c al An at o my
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S t e wart
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D an te c
P RI N C I PLE S
—
O F O S TE O PA TH Y
D efo rm itie s i n cl u di n g D i s e as e s
Jo i nts
The Tr e atm e n t o f F r actu r e S
the
of
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43
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phr e n i c n e rv e
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409
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54
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4 78
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40 7 4 1 1
Q u adr at u s lu m b o r u m
509
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s u bl u x at i o n s
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V i s c e r a P lu r i s e g m e n tal c o ntr o l
as o - m o
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l 73
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