WHAT IS CLASSICAL OSTEOPATHY?

Irvin Korr, in his address to the British osteopathic community in 1996 at the Commonwealth Institute London, said;

 

“I remind you further of another principle.You do not treat symptoms, you do not treat pain, you do not treat diseases, you do not treat parts of the body, you do not treat the musculo-skeletal system; you treat persons, you treat human beings. It is they who get well or not depending on the competence of their built-in health care system. I would like to hear you saying this more and more, that you are treating more than a musculo-skeletal system.”

 

The overriding principle of classical osteopathy is therefore not bony adjustment, but body adjustment. This historically relevant philosophy is what makes classical osteopathy distinct. And it is this philosophy which is taught on the Institute’s courses and mentored at the London Clinic of Classical Osteopathy in North London.

 

What Makes Classical Osteopathy Distinct?

Fundamental Concepts

Classical osteopathy is a system of healing which was formulated over a hundred years ago by AT Still and then further interpreted by JM Littlejohn. It encompasses the Hippocratic concept of Vis Medicatrix Naturae, ‘the healing power of nature’, where the body is seen not as a machine, but as a vital living organism with a normal tendency towards self-healing, elimination and health. The development of disease depends on any factors which lowers the vital force or the vitalising processes of the patient and compromises the organism’s ability to recover. It follows therefore that the osteopathic lesion is not a bony lesion, but a physiological one and that any disease or disturbance must be addressed through physiological processes.

This approach of health promotion is directly in contrast to orthodox medicine, which delivers a more linear/ pathogenic approach to treatment of disease and its symptoms via the use of pharmaceuticals. In osteopathy, health is not merely viewed as an absence of disease, but as a state of complete physical, mental and social wellbeing. The osteopathic therapeutic concern is therefore to adjust the body’s capacity to deal with environmental stressors, whether these be on a mento-emotional, physical or biochemical level.

This process was termed simply as ‘Adjustment’ by JM Littlejohn and implies perfect structural adjustment, including bones, muscles, ligaments, blood vessels etc. , perfect neurological adjustment and adjustment of the individual to their environment by considering factors such as diet, hydration level, sanitation, social interactions, stress levels, sleep pattern and so on.

Applied Physiology

The notion of body as a vital living organism is fundamental to classical osteopathy. Each individual has within their body vital forces, vitalised fluids and vitalising processes which maintain the normal equilibrium of the body. A healthy body relies on ‘unity’ of the whole, or “the proper play and correct relation of all the integral parts of the organism, including the correct articulation of the entire skeleton, the proper relations of the muscles, fascia, ligaments, cartilages and tendons to one another and to their skeletal attachments, the exact anatomical structure and physiological action of the blood vessels and the nerves of the body organism, so that all these in interdependence upon one another and in correlation to the organism as a whole for the basis of the vital forces of the body”.

This concept of unity is controlled by the nervous system, whereby cerebrospinal fluid, which is highly vitalised and trophic, is produced in the choroid plexuses of the ventricles of the brain and is distributed along the spinal canal and the pathways of all the cranial nerves to the periphery and to every tissue of the body - and then back again ad infinitum. It is the neuro-endocrine system which coordinates and controls the activity of the organism as a whole in any reaction to its surroundings and itself. Hence the afferent impulse or sensory stimulation is always the starting point of the activity, normal or otherwise.

The object of osteopathy is therefore to allow the absolute or maximum activity of the vital processes. This is achieved via the vasoactive components of the nervous system by i) relaxation of contracted tissues and contraction of relaxed soft tissues, ii) adjustment of bone, cartilage tendons to each other and to the whole, iii) inhibition of overactive tissues via the nerve centres, iv) stimulation of inactive tissues through the nerve centres, and v) establishing free and uninterrupted currents of vitality.

Still recognised that there was a somatic component to disease and the intervention of the osteopath is through skilled osteopathic technique to ameliorate those aberrant reflexes. The modern term being allostatic load. See video lecture by Mervyn Waldman on Primary Concepts & Patho-Physiological Mechanisms in Osteopathic Medicine.

 

Osteopathic Mechanics

Although the body is vital living organism, it is, as are all structures, subject to the laws of gravity. Although this gravitational stress is normal, it is the inability to sustain this stress and the subsequent malposition of the body in relation to gravity that leads to altered physiology and hence disease. As Fryette reminded us “gravity is the great killer of the body”. Ignoring the effect of gravity will therefore provide temporary relief of the lesion state only. We have to think in terms of parallel and non-parallel forces and of curved forces as they act over the spinal arches and more importantly of the problem of weight-bearing as it operates on the normal or abnormal structure. The living organism must be mechanically sound but must also be segmentally and collectively free to be able to function normally. “Fixation at one point of the spine will find expression throughout the column.”

Polygon of Forces’ diagram (click to enlarge):

ICO_chart_polygon

The effects of gravity on the body can be represented by non-parallel lines traversing the spinal column - the structural line passing from the atlas to the coccyx balanced by the functional line from the atlas to the centre of gravity at the 3rd lumbar vertebrae. Vector lines can then be drawn from the atlas to the coccyx and the acetabula, thereby forming a large pyramid, based on the pelvis and a smaller pyramid balanced and inverted on the point at the apex of the large pyramid opposite the 4th dorsal vertebra. This polygon of forces provides us with a diagnostic model to illustrate three dimensional forces on the body. It is essential that the bases of these triangles be freely operative - which is possible only if the spine is properly integrated. Treatment must therefore “appeal to the lines”.
ICO_chart_lines

Curved lines or spinal arches provide a dynamic representation of the spinal column whereby the four arches provide a balance between the primary dorsal and sacral arch and the secondary cervical and lumbar arches. The most important factor in spinal balance is the double arch from D5 to 2L – commonly known as the ‘power house’ of the spine – acting as a link between the upper and lower parts of the body.

It is essential to our work as classical osteopath to remember that the above discussed straight and curved lines are essential for the wellbeing of the living moving body and that any functional derangement surrounding a spinal segment will result altered afferent nervous input, reduced circulation and nutrition, toxic conditions and atrophy. This is why “no amount of correction will avail much in the treatment and recovery of the patient, unless the static and dynamic structures are brought into play, alongside the joint release and relief of soft tissue rigidity”.

Body Adjustment

It is not possible to “adjust the abnormal to the normal”, i.e. it is impossible to deal with only the injured/painful area of the body in isolation, whether this be a particular joint, organ or nerve supply – we must address the whole body.

For this reason, classical osteopaths practice a ‘whole body’ routine, which uses palpation to provide a method of assessment and reassessment of tissue response. This approach ensures that nothing is missed in diagnosis and it deals with tissues conjointly in order to “correlate and co-ordinate the structural and functional activities of the body”. Long lever techniques through the extremities are used to allow every soft tissue insertion into the spine and pelvis to be addressed and restore blood flow where lacking. It is aimed at achieving a stable, integrated structure, thus restoring the internal environment and providing essential long term stable and stress resistant recovery of the lesion state.

The elements of rhythm and balance are also considered when applying the body adjustment. “Balance is the key and it is applied in the spinal curvatures, in the distribution of the body fluids, the combined influence of inhibition and stimulation, of constriction and dilation”. Rhythm is inherent to all body functions and is lost in the majority of patients becoming uncoordinated and confused. It is our task as osteopaths to restore both these qualities without irritating the body in accordance with physiological and mechanical laws.

Acute conditions, it is essential for osteopaths to be able to recognise what stage the patient is ‘at’ with respect to their body state, i.e. whether the disease process is in acute, sub-acute or chronic phase.   In an acute phase, it is generally necessary to adopt a more specific and distinct approach than the Body Adjustment. A key feature of treating acute disease is timing and frequency of treatment, where too long a treatment will tire the patient and nullify the purpose. All treatment is performed sensitively, respectfully and delicately and with the minimum intervention possible to assist the body in its own recovery.

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The Institute of Classical osteopathy currently runs the Foundation course, Applied Clinic and Applied Course. 

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The London Clinic of Classical Osteopathy is our post-graduate teaching clinic based in North London.