Two questions that I am often asked are ‘does an osteopath just treat bones?’ and ‘what is the difference between an osteopath, physiotherapist and a chiropractor?’ In truth, there is some overlap between all three professions, adopting similar techniques, and all practitioners having an individual patient management approach. Perhaps the most important distinction between osteopaths and other manual therapists is our unique philosophy. Andrew Taylor Still MD DO introduced the Osteopathic Principles in 1874. Current osteopathic management is still based upon the following concepts:
- The body is a unit and each part works intricately together as a whole, constantly adapting and compensating. Osteopaths therefore take a holistic view rather than just looking at the ‘bit that hurts’.
- The body contains its own medicine chest. Our job is to facilitate and encourage the natural healing response.
- The rule of the artery is supreme. Blood supply to, and effective drainage from an area is imperative for healing.
- Structure governs function. Injury or mechanical restrictions in an area affect the various functions of the body.
OSTEOPATHY ISN’T DISSIMILAR TO MECHANICAL ENGINEERING – IF THINGS AREN’T STRUCTURALLY SOUND, THE BODY WON’T FUNCTION!
I have decided that the most effective way of explaining a little more about what osteopaths do will be to provide a working example. Take for instance, an individual with poorly functioning lower ribs and tight diaphragm for whatever (of the many) reasons –
I WILL EXPLAIN HOW OSTEOPATHIC MANIPULATION OF THE LOWER RIBS/DIAPHRAGM MIGHT IMPROVE THE FUNCTION SOME OF THE SYSTEMS OF THE BODY:
- Lymphatic System – the lower ribs and diaphragm form part of the thoracic pump. Lymphatic drainage from the lower extremity back to the heart relies upon good function of the lower ribs to pump the fluid up from the legs.
- Ventilatory System – to optimise breathing mechanics we should breathe from our lower ribs and diaphragm, and not primarily using our upper ribs and accessory muscles of respiration in the neck. This requires optimum movement from the lower rib joints.
- Cardiovascular System –Proper diaphragmatic/lower rib breathing has been found to significantly improve heart rate variability in a number of studies. Reduced heart rate variability has been linked with heart disease and diabetic neuropathy. The thoracic pump is important for venous return to the heart, as well as lymphatic drainage.
- Genito-urinary and Gynaecology – many of the nerves innervating the organs of the pelvis exit the spine at the thoraco-lumbar junction. This is the part of the spine that the lower ribs attach to, and therefore manipulating the ribs has an effect on its attachment to the spine, as well as the function of the T/L junction as a whole and the function of the nerves in that area.
- Gastro-intestinal System – many of the functions of the body rely upon movement, for example to calf pump in the leg relies upon us walking and contracting the calf muscles to pump the blood and lymph back up towards the heart. In the same way the diaphragm massages the viscera (organs) as we breathe. The diaphragm is a huge sheet of muscle that attaches to the lower ribs on both sides of the body – and again relies upon good function of the ribs to allow full contraction and relaxation. This is thought to improve gut motility and peristalsis.
- Neurological System – if a patient is experiencing pain in the lower rib region, or any of the areas supplied by the nerves that exit the spine in the lower thoracic region (e.g. digestion pain), we might think about pain pathways, and how we can reduce the pain signals coming from the brain. In very simple terms, moving the lower ribs sends sensory information UP to the brain, to let it know that it is all right and that it should stop sending pain signals DOWN to that area. Improving the function of breathing, and working over the sympathetic ganglia that lie over the ribs will also affect the sympathetic and parasympathetic nervous system balance. Ultimately creating more of a ‘rest and digest’ response and less of a stress response. High levels of sympathetic nervous system stimulation, such as that we experience when we are under sustained stress, can impact our health in a serious way. Studies have found stress causes poor cardiovascular health and high blood pressure, mental health conditions including depression and anxiety, and even diabetes.
- Musculoskeletal System – of course working on the lower ribs affects the rib joints themselves, the muscles between and around the ribs, as well as improving force transference between the lower and upper extremities. Improving the function of the lower ribs and ultimately the thoracic spine they attach to may help to reduce low back pain or upper back/neck pain. Dysfunction of the Phrenic Nerve that innervates the diaphragm may result in referred pain in the shoulder or recurrent hiccups.
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*This is a generalised, theoretical case for educational purposes. Full medical case histories are taken from all patients to ensure osteopathic management is safe/appropriate for them.