the bioenergetic model in osteopathic diagnosis and
TRANSCRIPT
Page 10 The American Academy of Osteopathy Journal • Vol. 24, No. 2, June 2014
O’Connell82hasdescribedfascialarchitectureofthebodyasconsistingoftwofunctionalsubdivisions.Horizontal diaphragmsaremyofascialorfibrouspartitionsthatactastension-countertensionsheets.Theyincludethetentoriumcerebelli,thoracicinlet/outlet,respiratorydiaphragm,pelvicdiaphragmandplantarfascia. Longitudinal cablesrunsuperiortoinferiorinthebodyandincludevariousmuscles(psoasmajor,abdominals,quadratuslumborum),spinalduraandlongitudinalligaments(occiputtoS2),fascia(prevertebral,alar,buccopharyneal,pericardial,investingoflowerextremity)andorgans(trachea,esophagus).
TheECMhasbeenreferredtoaspartofthe“livingmatrix”byOschman.58,60Hecallsit“living”becauseitismuchmorethanapassivenetworkoffibersandgroundsubstanceholdingthebodyanditsorganstogether.TheECMisdynamicallyactiveandconnectstothemostintimatereachesofcellsthroughthecellsurface,cytoskeleton,andnuclearmatrix.Thedynamicnatureofthelivingmatrixcanbepalpatedasrhythmicinherentmotionthatcanbeinfluencedbyvariousformsofosteopathicmanipulationandbioenergeticfields.Inherent motionisdefinedasthe“spontaneousmotionofeverycell,organ,systemandtheircomponentunitswithinthebody.”67
Leehaselegantlysynthesizedinformationfromnumeroussourcestodescribepossibleoriginsoftheoscillatoryanimationofthislifeforceinthefascia,ie,the primary respiratory mechanism(PRM).52,83FirstdescribedbySutherland,thesource,or“initiativespark,”ofthePRMwaswhathetermedthe“BreathofLife.”84Hereferredtothefluidfluctuationoftheinherentmotionpalpatedinthetissuesasthe“Tide.”85RecentscientificresearchsuggeststhatthesourceoftheinherentmotionofthecranialrhythmicimpulsemaybeduetoorrelatedtotheTraube-Heringbaroreflex.86,87
Throughthebiophysicalprinciplesoftensegrityandpiezoelectricity,fasciainfluencescellphysiologyandpathophysiology.ItprovidesforinstantaneousholographicaccessandcommunicationoutsidethenervoussystemthatextendsallthewaydowntothelevelofthecellnucleusandDNA.Itservesasalargesourceofthebioenergeticfieldsthattraversethroughandextendoutsidethebody.60
Fascia and the Extracellular Matrix
AndrewTaylorStill,MD,DO,placedmuchemphasisonthefasciaanditsrelationshiptohealth.Hewrote,“Iknowofnootherpartofthebodythatequalsthefasciaasahuntingground[sicforhealthanddisease].…Byitsactionwelive,andbyitsfailure,wedie.”75
Anatomically,fasciaisdefinedasasheetoffibroustissuethatenvelopsthebodybeneaththeskinthatenclosesthemusclesandgroupsofmusclesseparatingthemintoseverallayers.76Willardetal77,78haveclassifiedtheubiquitousfasciaintofourbasicdivisions:pannicular(superficial,subcutaneous);investing(deep,axial,appendicular);visceral(pleural,pericardial,peritoneal);andmeningeal(dural).Investingfascianotonlycoversthesurfaceofskeletalmusclesbutalsobranchesdeeplyintothemuscleinteriorinwhichcaseitistermedmyofascia.
Dependingonthetypeandlocationoffascia,onefindsvariousstructures(vascular,lymphatic,neurological)traversingthroughit,aswellasacellularandcellularcomponents.Fasciaiscomposedofthreebasicfibertypes—collagen,elastic,andreticular—immersedinaseaofcolloidalproteinaminoglycans.Itisthisacellularfiber-colloidpartofthefasciathatisreferredtoastheextracellular matrix,orECM.58
Cellularfascialcomponentsincludevariousleukocytes,plasmacells,mastcells,macrophages,pluripotentialcells,fibroblastsandmyofibroblasts.Interestingly,myofibroblastscontainactinandmyosinfilamentsandcanprovideacontractileforcetofascia.79Myofibroblastcontractionwithinthefasciahasbeentheorizedtobecontributorytotissuestiffness.80,81
Fasciaperformsnumerousfunctionsinthebody,includingstructuralsupport,compartmentalization,nutritionalsupport,immunity,tissuerepairandcommunication.79Asweshallseelater,theextracellularmatrixcanmodulatecellfunctionandpathophysiology.60
The Bioenergetic Model in Osteopathic Diagnosis and Treatment: An FAAO Thesis, Part 2Jan T. Hendryx, DO, FAAO
Click here to read Part 1 of “The Bioenergetic Model in Osteopathic Diagnosis and Treatment,” published in the March 2014 issue of The AAO Journal. Part 2 concludes Dr Hendryx’s thesis.
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The American Academy of Osteopathy Journal • Vol. 24, No. 2, June 2014 Page 11
CollagenfibersintheECMattachdirectlytothecellularcytoskeletonthroughspecializedproteinsinthecellmembranecalledintegrinsandcadherins.Thesemoleculestransmitmechanicalforcesfromthefasciatoassociatedfocaladhesions,junctionalcomplexes,andultimatelythecytoskeletonintheinteriorofthecellbyaprocessknownasmechanotransduction.88,89Mechanotransductioncontrolsmanycellularprocesses,includingcelldivision,differentiation,migration,proteinsynthesis,DNAandgeneexpression,immunefunction,andevenpathologicalprocesses.90-93
TensegrityisatermcoinedbyR.BuckminsterFullerfromthewordstensional andintegritytodescribestructuremaintainedbyforcestransmittedthroughasystemofinterconnectedsolidstrutsandflexiblecables.Aclassicexampleofatensegritysystemisgeodesicdomearchitecture.89Thus,biotensegrityreferstoefficientmaintenanceofthestructuralintegrityofwholelivingsystemsorevencells.Inthehumanbeing,physicalforcesaredistributedthroughthestrut(bones)andcable(muscles,tendons,ligaments,fascia)componentsoftheneuromusculoskeletalsystem.Similarly,inthecell,thecytoskeletalcomponents(microtubules,microfilaments,microfibrils)providethestructuralsupportinboththecytoplasmandnucleus.
OneofthepioneeringresearchersinthefieldsofmechanotransductionandbiotensegrityisDonaldIngber,MD,PhD.Hehaswrittenandco-writtennumerousarticlesonthesesubjects.Fromanosteopathicperspective,Ingberhasappliedtheseprinciplesinexplaininghowvariousformsofmanualtherapiesmayinfluencestructureandfunctiondowntothecellularlevel.89-91Recently,Swanson94publishedanexcellent,thoroughreviewofbiotensegrityandmechanotransductionandtheirrelevancetoosteopathicmedicine,education,andresearch.
Communicationinthebodyoccursthroughtwomainbioelectricsystems—neurologicalandnon-neurological.Neurologicalcommunicationthroughoutthecentral,peripheralandautonomicnervoussystemsandneuromuscularcomponentshappensbecauseofthephysiologicalprocessesresultinginioniccurrents.Ioniccurrentsareproducedbyionicmovementthroughmembranesandresultantpolarityreversalthatispropagatedalongthelengthofnerves.Dependingontheextentofmyelinationofnervefibers,ioniccurrentshavevaryingconductionspeeds,andthus,thistypeofcommunicationhappensovervaryingamountsoftime.58
Non-neurologicalcommunicationoccursthroughoutthefascia.Becauseoftheirpiezoelectricnature,collagenfibersandgroundsubstancefunctiontocreateinstantaneouscommunicationoutsideofthatprovidedbythenervoussystem.Thus,electricalcurrentscanalsobecarriedalltheway
totheintracellularlevel.58Thisisaccomplishedbybioelectricsemiconductorcurrents.Semiconductorcurrentsdifferfromioniccurrentsofnervesandneuromuscularjunctionsinthattheytravelinfasciaandtheperineuriumsurroundingnervefibers.58
Themovementofelectricityalongaconductororsemiconductor(nerves,fascia)producesbioelectromagneticfieldsthatcanbedetectedwithsensitiveinstrumentationorbycertainsensoryreceptorsintheskin.Thesefieldsextendintoandoutsidethebodyindefinitely.Theymaybeinfluencedbyexternalelectromagneticfields.58,60Acompletediscussionofthetheoreticalrelationshipbetweenbioenergeticsandsomaticdysfunctioncanbefoundelsewhere.54
O’Connellhasgivenathoroughreviewofthebiomechanicsandbiophysicalpropertiesofthemyofasciainrelationtodiagnosticpalpation,myofascialrelease(MFR)techniqueandbioelectricfascialactivationandrelease.BothO’Connell49,61
andOschman60havetheorizedabioenergetic-holographicmodelforthehumanmyofascialsystembasedonthesebiophysicalproperties.Inthismodel,onecanaccessanypartofthelivingsystemfromanylocationbylightlypalpatingandapplyinggentleforcesthroughtheelaboratefascialnetworkofhorizontaldiaphragmsandlongitudinalcablesandtubes.Hollandalsohasdescribedasystemofdiagnosiscalledperceptual transferenceinwhichtheexaminerholographicallysensesinhisorherbodytheareaofkeysomaticorvisceraldysfunctioninapatient’sbodywhilegentlycontactingthepatient.74
Comparison of Dynamic Strain-Vector Release and Neurofascial Release
Twoosteopathicmanipulativetreatment(OMT)techniqueswillbediscussedtoshowhowthebioenergeticmodelmaybeusedtodiagnoseandtreatpatients.Thesearedynamicstrain-vectorrelease(SVR)andneurofascialrelease(NFR).Experientially,thisauthorhasfoundthesetechniquesextremelyeffectiveintreatingpatients,whetherthesetechniquesareusedaloneorinconjunctionwithothermanipulativemodalities.Often,SVRandNFRhavebeenintegralinenhancingtherapeuticeffectswhentraditionalbiomechanicaltechniquesarelimited.
Dynamic Strain-Vector Release
Dynamicstrain-vectorreleaseisabioenergetictechniquedevelopedbythisauthorin1999-2000.54Itsprinciplesarosefrompalpatoryexperimentationwithinherenttissuemotionsandacupuncturepointsinapatientwithchronicrefractorypain.Itwasobservedthattissuesomaticdysfunctionspossessabnormalinherentmotionsthatcanbenormalizedwithoutapplyinganydirectorindirectmechanicalforces
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hand.Strain-vectorreleasepointsarelocatedbymovingthenonpalpatinghandinthedirectionofthetissuepullofthepathologicalstrain-vector.Tissueunderthepalpatinghandtightensupandreachesmaximaltensionwhenthenonpalpatinghandfindstheexactlocationofthereleasepoint.Allinherentmotionstopsbriefly(stillpoint)andrestartswhenthetissuereleases.If,afterre-evaluation,somepathologicalvectorsremain,thetechniqueisrepeateduntilnormalinherenttissuemotionisrestored.
SVRiseffectiveintreatingpatientsforacute,subacute,andchronicsomatic,visceral,neurological,andenergeticconditions,someofwhichmaynotberesponsivetootherclassicformsofOMT.Apparently,alltissuescanhavepathologicalstrain-vectorswithin.
Neurofascial Release
Neurofascial release43isabioenergetictechniquedevelopedin1987byStephenM.Davidson,DO.WithNFR,thephysicianassessesdysfunctionaltissuesforabnormaltexture,tone,rangeofmotion(fascial),andinherentmotionrestrictionsandtreatsthesebytouchingandholdinganeurofascialreleasepointlocatedonthebodyuntiltissuetextureormotionnormalizes.Neurofascialreleaseisbasedonamodelofstandingwaveformsandinterferencevibratorypatternsproduced,orheldintissues.Thesepatternsarethoughttoberesponsibleforsomaticand
tothetissues.Dynamicstrain-vectorreleaseisdirectedtowardassessingdysfunctionaltissuesforaninherentmotionabnormalityknownasadynamic strainorpathological strain-vectorandthentreatingtheabnormalitybytouchingandholdingastrain-vectorreleasepointlocatedon,inside,oroffthebodyinthebiofield.Resolutionofthepathologicalstrain-vectorresultsinresolutionofthetissuedysfunctionandre-establishmentofnormalinherenttissuemotion.
Normalinherenttissuemotionisasubtlerhythmicoscillationoccurringatafrequencyofapproximately8to14cyclesperminute.Aslightpause,or“neutralzone,”occursatthemidpointofeachbackandforthmotion,somewhatsimilartothecranialrhythmicimpulse.
Adynamic strainisdefinedas“apalpabledistortionofmotioninthetissueand/orhumanenergyfieldthatpulls‘pathologically’alongacertaindirectionwithacertainforce(vector),whilecontinuingtomovewithinherenttissuemotion.”54Thisabnormalmotionisastrongtissuepullinaspecificdirection,anditlackstheneutralzonefoundinnormalinherentmotion.
TheefficacyoftheSVRtechniquereliesonthephysician’sabilitytolayerpalpatetothelevelofthedysfunctionaltissue,assesssubtleinherenttissuemotionforpathologicaldynamicstrain-vectorslocatedinareasofdysfunction,andfindandtreatastrain-vectorreleasepointwiththenonpalpating
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The American Academy of Osteopathy Journal • Vol. 24, No. 2, June 2014 Page 13
visceraldysfunctions.NFRisapplicabletofascial,dural,intraosseous,andvisceralstrainpatterns;painfultissue;there-establishmentofcraniosacralrhythm;andinherenttissuemotion,aswellasmental,emotional,andtoxicthemes.43,95-97
Thebiotensegrityofthefascialsystemisthemainfocus,andthepatientisexaminedandtreatedfromanintegratedwholepersonperspective.Globalandlocalfascialrestrictionsorlaxity,aswellasinherentfascialmotion,areevaluatedinanefforttofindkeydysfunctions(“keylesions”).
Neurofascialreleasepointsarethenlocatedthat1)helptonormalizeabnormaltissuetoneandreleaserestrictionsand2)restoreinherenttissuemotion.IntheNFRmodel,thereleasepointishypothesizedtoshutdownthefascialwavegeneratorthatiscreatingabnormalfascialtensionpatternsandrelatedsomaticandvisceraldysfunctions.
Fascialrestrictionsaretreatedbyfindingarelatedneurofascialreleasepointonthebodyandholdingituntilthetissuetensionnormalizes.Thisprocesscanbefacilitatedbycreatingaslightstraininthefascialrestrictivebarrier,windingupthetensionthroughoutthefasciainthebody,andmaintainingthetensionuntilthetissuereleases(ie,“recruitingthestrain”).Fortissueexhibitingabnormaltightnessorspasm,touchinganeurofascialreleasepointwillcausethetissuetorelax.Conversely,inlaxtissues,apointcanbefoundandtouchedthatactuallyincreasestone.
Thelocationsofneurofascialreleasepointscanvaryfrompatienttopatientandtreatmentsessiontotreatmentsession.Somereleasepoints,however,havebeenfoundconsistentlyinthesamelocationsamongpatients.ManyofthesecorrespondtoacupuncturepointsandlocationsthatwereusedbyFulfordintreatingpatientswiththepercussorhammer.32
Discussion
Energy,mass,andmatterareinextricablylinkedtogetherbythefamousEinsteinequationE=mc2.98Energeticexchangesandtransformationsoccuratalllevelsintheuniverseandare,thus,anintegralpartofthestructuresandfunctionsfoundinlivingsystems.60Energyexchangesalsooccurininteractionsamonglivingsystems,suchasbetweenaphysicianandpatient.58
TwoOMTtechniques,dynamicstrain-vectorreleaseandneurofascialrelease,werepresented,bothofwhichappeartoprimarilyadheretoabioenergeticdiagnosticandtreatmentmodel.Comparisonofthesetechniquesrevealssomesimilaritiesanddifferences.
InbothSVRandNFR,thepatient’stissuesareassessedforinherentmotionabnormalities.InSVR,theexaminerisfocusedonfindingapathologicalstrain-vectorindysfunctionaltissuethathasaspecificforceanddirectionofpull.54Thedirectionoftissuepullleadstheexaminer
towardthepathologicalstrain-vector“releasepoint,”whichispalpatedandheldthroughastillpointwiththenonpalpatinghand.Tissuedysfunctionresolvesandnormalinherentmotionreturnsoncethepathologicalstrain-vectororlayeredvectorsdisappear.
Dysfunctionaltissuesunderthepalpatinghandtightenwhiletheexaminermovesthenonpalpatinghandtowardtheexactlocationofthestrain-vectorreleasepoint,whichmaybelocatedon,inside,oroffthebodyinthebiofield.
InNFR,thereleasepointsaretypicallylocatedonthesurfaceofthebodyinmostlynonpredictablelocations.Inherenttissuemotion(cranialrhythmicimpulse,primaryrespiratorymechanism,visceral)isassessedprimarilyforitspresenceorabsence,althoughqualityisalsoimportant.Ifinherentmotionisabsent,itmayberestoredbytouchingareleasepoint.Iftissueistootight,suchastypicallyfoundinasomaticorvisceraldysfunction,palpationofareleasepointallowstheabnormaltissuetoloosen.Iftissueistooloose,releasepointpalpationmayactuallyallowtheloosetissuetotighten.Nopathologicalstrain-vectorsshouldbepalpatedwiththistechnique.
NFRalsocanbeusedtoreleaselargerareafascialstrainsthroughoutthebody.Inthiscase,theexaminerpassivelymovesaregionofthebodyintotherestrictivebarrierofthestrainirrespectiveofinherentmotionqualities.TheNFRreleasepointishelduntilthebodyregionmovesthroughthebarrier.
Whatisthenatureandcauseofinherenttissuemotions?Whatisthenatureofthereleasepointineachtechnique,andhowdoespalpatingandholdingitalterinherentmotionabnormalitieswithoutapplyinganymechanicalforcestothetissues?
Theoriesontheoriginandnatureofinherenttissuemotionandstillpointshavebeenpreviouslydiscussedindetail.54Inherentmotionmayoriginatefrombiodynamic(physiological)andbiokinetic(pathophysiological)energies,41yin-yangpolaritiesandqimovementsinthetissues,coaxialenergeticcorecoherentwavepropagation,99subtleenergies,65andtheTraube-Heringbaroreflex.87
Lee100hasdiscussedthecentralroleofwaterinhomeostasisandtheinterfacebetweenspiritandthelivingmaterialbodyofthehumanbeing.HesuggeststhattheoscillationspalpatedasinherenttissuemotionmaybeduetosinusoidalwavesofchangeincalciumconcentrationswithintheECM,withaccompanyingflowofwater,changesinelectricalcharges,andtissueviscosity.
Whatisthenatureofstrain-vectorandneurofascialreleasepoints?Itmaybethattheyareholographicbiofieldswitchesthatturnonorturnoffbioelectriccircuitsandinfluence
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inherentbioelectromagneticactivity.Somecorrespondwithacupuncturepointsandmaybeconnectedtomeridiansystems.60
Interactionsofbioelectromagneticfieldswithfasciacouldexplaintheinstantaneousresponseofthebodytotouchingspecificreleasepointsorpalpatingtheenergyfieldoffthebody.60Tosomeextent,fascialtensionisduetosol-gelconversion.Electromagneticfieldscanaffectsol-gelconversion.Semiconductorcurrentsinducedinthefasciabydirectpassivecontact,stretching,acupunctureneedles,orinteractionwiththebiofieldmayexplainthepalpatoryphenomenaexperiencedbyboththephysicianandthepatient.54
Davidsonhassuggestedthatabnormalstandingwaveformsinthefasciaalongwithinterferencepatternsmayberesponsibleforfascialdysfunctionandtheresponseoftissuestotouchingneurofascialreleasepoints.96Oschmandiscussesholographicinterferencepatternsrelatingtowavefrontdisturbanceswithinthelivingmatrixanditsimplicationsforpotentialtherapies.60TheseconceptsarealsosupportedbydynamicalmedicineprinciplesaspresentedbyHolland.71Thus,therearemanyplausiblescientificexplanationsforwhatenergeticphenomenaarebehindpalpatoryfindingsofdysfunctionandnormaltissues,inherentmotions,andthetherapeuticresponseofthepatienttothephysician’stouch.Thescientificdisciplinecentraltotheexplorationofthesetopicsisbiophysics.
Asfarbackasthelate1930s,CarlPhilipMcConnell,DO,discussedhowimportantitwasforosteopathicphysicianstorecognizethekeyroleofbiophysicsinunderstandinganatomy,physiology,health,anddisease.55Inanarticletitled“TheOsteopathicApproach,”101hechallengedtheosteopathicmedicalprofessiontostretchbeyondprecedenceanddogmatolearnaboutandapplybiophysicalprinciplessothatourtreatmentswouldtrulybecomeindividualized,comprehensive,andmaximallyeffective.Ourprofessionisslowlybeginningtomakethatstretchasevidencedbythepresentationofbiophysics-relatedtopicsatrecentcontinuingmedicaleducationevents102andinosteopathicscientificliterature.30,47,51,54,61DiGiovanna,103O’Connell,61DeStefano,104andGreenman105havereintroducedthe“bioenergetic,”or“bioenergy,”modelintomainstreamosteopathicmedicaltextbooks.
Itisthisauthor’sopinionthatthestretchneedstobetransformedintoaquantumleap.Biophysicalprinciplesandapplicationstoosteopathicdiagnosisandtreatmentshouldbeintegratedintotheeducationalprocessformedicalstudentsandphysiciansalike.Why?Itispartoftherealitywithwhichwedealeverydayinthediagnosisandtreatmentofourpatients.Biophysicalprinciplesandmathematicsarebehindthefunctioningofalllivingsystems.Thephysicsofbiologicalsystemshasbeenstudiedanddocumentedformorethanacentury.Interestingly,McConnellcitesa1921referencebooktitledAn Introduction to BiophysicsbyDavidBurns.106Thiswasapparentlythefirsttimethetermbiophysicswasused
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CLASSIFIED ADVERTISEMENTS
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The American Academy of Osteopathy Journal • Vol. 24, No. 2, June 2014 Page 15
inabooktitle.107Why,then,havewenotmadethissubjectafocusinosteopathicprinciplesandpractice?
Partoftheprobleminmakingthisleapisthatbiophysicsandrelatedtopicsaretaughtsomewhatsparinglyinconventionalbiologyandinmedicalschool.Thebiochemicalnatureoflifeisemphasized,presumablybecausemedicineisfocusedonthechemicalhumanbeing.Energeticphenomenaareacknowledged,especiallyinbiochemistry,physiology,andpharmacology,buttheyarenotstressedaswaystoinfluencebiologicalsystemsfromthestandpointofhealing.
Duringthepastseveraldecades,wehaveexponentiallyincreasedourknowledgeaboutenergeticinteractionsinlivingsystemsandhowtheymayberelatedtohealingandhealth.58,60Nowemergesthesubjectof“quantumbiology”108withdescriptionsofquantumpropertiesandphenomenaoccurringinseveraldifferent“quantumbiologicalsystems.”
Anintegrativemodelofbiophysicslinksallmedicaldisciplinestogetherinaunifiedmannertoexplainanatomical-physiologicalrelationships,diagnosis,andtreatmentofpatients.Althoughitmayseemthatwearedealingwithaphysicalbody,underlyingthatphysicalityarevibratingenergiesofvarioustypesthatareconstantlybeinginterconvertedtoothertypesofenergiesinthedancewecalllife.
Six Osteopathic Models
Energeticprinciplesdescribedbymathematicsandphysicsultimatelygovernthefunctioningoflivingsystemsfromtheatomicormolecularleveltothesynthesizedwholeorganism.Energyofvarioustypesisconstantlyexchanged,transformed,andcommunicatedwithintheindividualinallaspectsofbody,mind,andspirittomaintainhomeostasisandhealth.Thus,thisauthorproposesexpandingtheclassicosteopathicfivemodelconceptintosixmodels,withbioenergyasthefoundationofall.(See Figure 2.)
Aproposeddefinitionofthebioenergeticmodelforosteopathicmedicineis:
Thebioenergetic modelseekstoaddressthebioenergeticnatureofthehumanbeinginhealthanddisease,strivingtomaintainandsupportthereturntohomeostasisthroughtheapplicationofbiophysicalprinciplesinthebiofield.Thiscanbeaccomplishedbyusingawiderangeofosteopathicmanipulativetechniquessuchasdynamicstrain-vectorrelease,neurofascialrelease,bioelectricfascialactivation
andrelease,facilitatedoscillatoryrelease,myofascialrelease,traumavectorrelease,percussortreatment,andosteopathiccranialmanipulations.Bioenergeticsservesasthefoundationandintegrationpointforallotherosteopathicmodelsofcare,andthebioenergeticmodelcanbeusedtodiagnoseandtreatalllevelsofdysfunction.
Thebioenergeticmodelbringstothetablereal-timeassessmentandtreatmentbasedonwhatishappeningwiththepatientatthevisit.Itexaminesanotherdimensionthatistypicallyignoredinmostofmedicine.Patientsmayhaveclassicpatternsofsomaticorvisceraldysfunctionsthatfromabiomechanicalstandpoint,areeasilydocumentedand,theoretically,shouldrespondtoclassicformsofOMT,butforwhateverreason,theydon’trespondcompletelyoratall.Evaluationofabnormalbioenergeticphenomenaandbiophysicalfascialabnormalitiesunderlyingthesedysfunctionsaddssignificantlytotheinformationavailabletothephysicianonhowtotreatmoreappropriately,effectively,andefficiently.
Combinationsofbioenergetictechniques,includingacupuncture,areoftenusedeffectivelyandgentlytodecreasechronicpainanddysfunctionandtoincreasehealthandhomeostasis.Giventhepotentialadverseeffectsofothercommontreatments(opiates,antidepressants,nonsteroidal
Figure 2. The classic osteopathic model is expanded to six concepts, with bioenergy serving as the foundation. Additional environmental stressors have been added (poor lifestyle, pollution, electromagnetic exposures, etc.). Energy is the primary adaptive response to stressors. The holistic view of the patient includes body, mind, and spirit.
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anti-inflammatorydrugs,musclerelaxants,anxiolytics,corticosteroidinjections,epidurals,surgeries,ganglionblocks,neuro-stimulatorimplants,etc.),onemustaskwhybioenergeticevaluationandtreatmentarenotattemptedinitiallyinpatients.Therearevirtuallynoadversesideeffects.
Inpart,theanswermaylieinthefactthatthebioenergeticmodeltypicallyisnotpresentedtostudentsandphysiciansasaviablealternativetoothermodels,eventhoughbiophysicshasalonghistory,isawidelyrecognizedscientificdiscipline,andhasamassiveresearchdatabase.Biophysicsisprobablyalotmoresolidfromatheoreticalandpracticalstandpointthanarebiologyandpharmacology.
Conclusions
Dynamicstrain-vectorreleaseandneurofascialreleaseareeffectivebioenergeticallybasedmodalitiesfortreatingpatientsfortissuedysfunctionsofallkinds.Inthisauthor’sexperience,SVRandNFRcanbeusedquiteeffectivelytomovepatientstoamuchhigherleveloffunctioningwhentraditionalmanipulativeandnonmanipulativemodalitiesfail.Thisisespeciallytrueforpatientswithchronicpainwhohaveexhaustedallavenuesofconventionaltreatment,includingmedicationsandsurgery.
BothSVRandNFRcantreatmosttissuesexhibitingsomaticandvisceraldysfunctions,andemotionalandtoxicstatescanbereached.Thesetwotechniquescanbemixedandmatched,notonlywitheachotherbutalsowithanyotherOMTtechniqueandwithacupuncture.
Althoughthesebioenergetictechniquescurrentlycanbetaughttoandusedbyosteopathicmedicalstudentsandosteopathicphysicians,relativelyfewclinicianstakeadvantageofthesetreatmentmodalities.Biophysicalprinciplesshouldbeincorporatedintobothundergraduateandmedicalcurriculatobalancetheconventionalemphasisonbiology,anatomy,physiology,andbiochemistry.Thiswouldrequireosteopathicmedicalschoolstoassimilatetheseconceptsandtermsintocommonmedicalvocabulary.Theprofessionshouldconsiderintegratingbiophysicalprinciplesintothecoreosteopathiccompetencies.Thiswouldallowfortheknowledgeanditsapplicationstobespreadthroughoutthecurriculumandintograduatemedicaleducation.
Thisintegrationiscrucialtothetotalholisticapproachtopatients,whichiscentraltoosteopathicphilosophy.Additionally,wenowenteranuncertainfutureinmedicineinwhichwearemandatedtobecomemoreproficient,efficient,effective,andprevention-orientedphysicians.Patientsareawakeningtothefactthatcurrentconventionalmedicalinterventionsareoftendangerous,costly,andineffective.Thereissomethingwrongwithamedicalsystem
thatisthethird-largestcauseofdeath,laggingonlybehindcardiovasculardiseaseandcancer.109
Itis,therefore,imperativethatweprovidethemostadvancedandhighestqualityhealthcarepossible.Weshouldconsiderresearchinghowbiophysicsandthebioenergeticmodelcanbeincorporatedintoaqualityandtotallyintegratedhealthcaresystem.Thiswouldputosteopathicmedicineatthecutting-edgeofhealthcareinthe21stcentury,asitisthenaturalprogressionofourphilosophyandprinciples.
Moreresearchneedstobedoneintohowendogenousandexogenousbioelectromagneticfieldtherapies,includingOMT,affectthebodyfrompostural,gait,andbiomechanical(somaticandvisceral)dysfunctionstandpoints.Onesuggestionwouldbetousegaitandposturalanalysisvideoandcomputertechnologytodocumentspecificchangesbeforeandafterabioenergetictreatment.Thiscouldbeaccomplishedacutelyorlong-term.
Additionally,onemightuseasuperconductingquantuminterferencedevice(SQUID)magnetometertomeasurebiomagneticchangesofaspecificsomaticdysfunctionbeforeandaftertreatment.
Apreliminaryresearchprojectisunderwaybythisauthortofurtherassessrelationshipsbetweenacupuncturepointsandsomaticandvisceraldysfunctions.
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The following submission tied for first place in the residents’ case history category in the Louisa Burns Osteopathic Research Committee’s poster presentation at the AAO Convocation in Colorado Springs, Colorado, on March 21, 2014.
OMTprotocolincludedintrarectaltreatmentoflevatoraniandcoccygealmuscles.Twomonthsintohertreatment,thepatientreceivedpelvicfloorphysicaltherapy(PT)inadjuncttoOMT.Thisfacilitatedimprovementofsymptoms.Magneticresonanceimages(MRIs)ofthepelviswereobtainedpre-andpost-treatment,fivemonthsapart.
Results
Subjectively,thepatientreporteda60%reductioninsymptomssincestartingOMTafterfivemonthsoftreatment.Objectively,apost-treatmentMRIofthepelvis,takenfivemonthsafterpre-treatmentMRI,showedsignificantchangestothepubococcygeusandotherlevatoranimuscles.Improvedpalpablechangeswerefoundonexam.
Conclusions
BothobjectiveimprovementandsubjectiveimprovementwerefoundusingOMTtotreatpatientsforlevatoranisyndrome.Inthiscase,OMTincombinationwithpelvicfloorPThasbeenshowntobebeneficialintreatinglevatoranisyndrome.Thus,OMTshouldbeconsideredasthestandardofcareforpatientswiththisdisorder.
Management of Levator Ani Syndrome With Osteopathic Manipulative Treatment: A Case StudyMiho Yoshida, DO, NMM+1; Dominic Derenge, OMS IV; and Katherine Worden, DO, MS
Background
Levatoranisyndromedescribesadisorderinwhichpelvicpainisattributedtoshort,tight,andtenderpelvicfloormuscles,commonlyoccurringinconjunctionwithhypersensitivetenderpoints.Itcancausechronicpelvicpain,whichcanbesufficientlydebilitatingtoapatientbyinterferingwithdailyactivitiesandthepatient’ssenseofwell-being.Osteopathicmanipulativetreatment(OMT)canbebeneficialintreatingthisdisorder.ThiscasedescribeshowtreatingpatientswhohavelevatoranisyndromewithOMTproducespositiveresultsshownobjectivelyviaimprovementonimagingandsubjectivelythroughreassessmentbythepatient.
Material and Methods
Thepatientinthisstudycomplainedofpainwithsitting,identifiedtobecausedbyspasmofherlevatoranimuscles.ShewastreatedwithOMTforfivemonths.Theunrestricted
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Accepted for publication November 2013.
Address correspondence to:
JanT.Hendryx,DO,FAAO5401 Peach St., Suite 3400Erie, PA 16509