Biomechanical Osteopathy Introduction to Biomechanical Osteopathy

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1 Biomechanical Osteopathy Introduction to Biomechanical Osteopathy Biomechanical osteopathy can be viewed as an osteopathic school of thought an osteopathic approach that places greater emphasis on the biomechanical perspective in osteopathic assessment and treatment. Biomechanical osteopathy can simply be defined as an osteopathic approach that seeks to optimise the biomechanical set-up of an individual Biomechanical osteopathic intervention requires lengthy sessions. Typically over 1 hour treatment sessions are advised, and it is not uncommon that a treatment session lasts for up to 2 hours. Osteopaths who embrace biomechanical osteopathic approach: develop further knowledge about connective tissue and skeletal muscle with particular emphasis on applied treatment methodology to (white fibrous tissue of) ligaments, joint capsules, tendons and deep fascia, as well as applied treatment methodology to small holding muscles recognise the extensive web-like nature of deep fascia and have developed deep fascial techniques to detect and release points of focal fascial binding understand the importance of ligamentous articular balance and have developed techniques to restore an evenly balanced tension-reciprocity between ligaments of a joint are aware that the adverse effects of ghost stressors can become exaggerated through consequential myofascial tensions and torsions, which can eventually result in the development of secondary myofascial ghost stressors place great importance on the determination and remedy of ghost stressors and the key lesion Biomechanical osteopathic approach is consistently effective in the treatment of dedicated athletes who are seeking to overcome persistent & recurring injury, and who are eager to achieve peak physical performance. Biomechanical osteopathic approach is also consistently effective in the treatment of top-flight athletes and professional sportspeople who are seeking to substantially reduce their susceptibility to further injury.

2 Ghost Stressors The term Ghost Stressor has been created to help individuals better understand how the effects of historical injuries and strains can adversely affect their present-day biomechanical set-up. Some injuries do not fully recover & some strains do not fully ease, even as they become non-symptomatic. Instead, they remain in the musculoskeletal system as primary unresolved physical stressors, to which the body adapts and compensates for the consequences of this compensatory process can often result in significant adverse strain and predisposition to injury in other body structures. Ghost stressors can be defined as persistent myofascial stressors that are difficult to assess and that also exert a mysteriously harmful effect on the whole biomechanical set-up of an individual. Ghost stressor is a term applied to a primary unresolved stressor within the musculoskeletal system caused by historical injury or strain. Such stressors commonly involve misalignment of bones and joints and/or injury to deep connective tissues that hold the skeleton together. The Henshaw Manifesto by Colin Henshaw, D.O. Ghost stressors can be caused by some long-forgotten specific injury, shock or strain or some previous unduly-repetitive activity. Their origins can become obscure. Ghost stressors often become non-symptomatic within a relatively short time of the original injury or strain, and because of this a full recovery (from the original injury or strain) is often assumed. The harmful effects of ghost stressors can take many years to become apparent. The presence of ghost stressors often plays havoc in the life of a dedicated athlete & professional sportsperson decreased levels of performance; increased susceptibility to injury; recurring physical breakdown and slow recovery times are all common consequences.

3 Key Lesion(s) The term key lesion can be described as the primary or most important dysfunction in the body. If the key lesion is biomechanical in nature then it is imperative that the osteopathic practitioner determines its origins and remedies the problem. This is sometimes difficult as the key lesion is often the most awkward and most obscure ghost stressor. Despite the difficulties, success needs to be achieved as an undetected and unresolved key lesion will prevent the body from being able to achieve a state of optimal biomechanics and complete physical harmony, no matter which treatment protocol or body conditioning programme is applied. KEY LESION: The key lesion is the primary or most important dysfunction in the body and may well be the injury that prevented the patient s natural healing mechanism from effectively dealing with any ensuing injuries. This dysfunction acts like a beaver s damn across a stream. If the dam is removed, the water will flow downstream unimpeded. Likewise, if the key lesion can be removed, the rest of the body s dysfunctions may resolve themselves or be easily handled by the physician. The term key lesion is used because when it is corrected, it is like using a key to unlock the rest of the body s dysfunctions. Ligamentous Articular Strain by Conrad A. Speece, D.O. and William Thomas Crow, D.O. Key lesions can occur throughout the musculoskeletal system and it is not unusual to find that myofascial strains and torsions emanating from a long-standing twisted pelvis or a long-past sprained ankle are significantly involved. These two commonly known physical conditions are often indicated in many of the more complex cases, and sometimes one or the other is, in fact, the key lesion condition.

4 Harmony Profile The Harmony Profile is a comprehensive report about the biomechanical set-up of an individual. The profile has been designed for the dedicated athlete & professional sportsperson. Assessment modules have been devised so information can be tailored to aid the process of biomechanical integration. The essence of the profile is to highlight the extent and causes of disharmony in the musculoskeletal system, with particular emphasis on the determination of ghost stressors and the key lesion. THE HARMONY PROFILE CONSISTS OF: A summary of the initial consultation Copies of the preliminary case history sheets, ten in number. These sheets are provided to the patient/client on the initial consultation to be completed prior to the physical assessment session Copies of the physical assessment sheets, sixteen in number. These sheets are completed during the physical assessment and include assessments on: Standing position (upper body & pelvis and lower limbs) Active movements (transverse axis and antero-posterior & longitudinal axes) Active resisted movements Passive joint movements (restriction and hypermobility) Bony subluxation Condition of muscles (phasic muscles, tonic muscles and holding muscles) Deep fascia (antero-medial and postero-lateral) Also included are assessments of core stability and ankle stability, as well as a preliminary assessment of posture An indication of any obvious insufficiencies in core stability and ankle stability An estimate of the degree of physical harmony with reference to the Harmony Index of the individual An indication of the presence of ghost stressors & any identifiable key lesion A summary of the postural picture in relation to inherent posture types and the presence of any obvious poor-posture syndromes A summary of any obvious awkward (or clumsy) movement patterns Recommendations for further assessment, as well as treatment indicators

5 Osteopathy Introduction to Osteopathy WHAT IS OSTEOPATHY? Osteopathy can be described as a system of therapy based on Dr. Andrew Taylor Still s theory of healing first delineated in 1874 Osteopathic theory holds that a body in a state of wellness is correctly adjusted UK OSTEOPATHS The British School of Osteopathy was the first osteopathic teaching establishment in the UK founded by J.Martin Littlejohn in years later Osteopathy is regulated by statute under the Osteopaths Act 1993 UK Osteopaths are now subject to an externally-validated structure of training, supervision and professional development. The title Osteopath is protected by law and only those included in the UK statutory register are entitled to practice as osteopaths. For further information about UK osteopaths visit the official website of the General Osteopathic Council (GOsC). WHAT DO OSTEOPATHS DO? Osteopaths focus on the diagnosis, treatment, prevention and rehabilitation of musculoskeletal disorders. According to research by the General Osteopathic Council (circa 2009) around 30,000 people in the UK currently consult osteopaths every working day. Osteopaths are often the first point of contact for patients seeking relief from a wide range of conditions affecting the musculoskeletal system.

6 White Fibrous Tissue White fibrous tissue is a type of connective tissue composed predominantly of collagen fibres. Body structures that require anchor-like strength are composed of white fibrous tissue. Such body structures include ligaments, joint capsules, tendons and deep fascia. Strength of white fibrous tissue is determined by the regular organisation of collagen fibres, laid down in a precise geometric pattern. Many injuries to white fibrous tissue do not repair completely well the repairing collagen fibres are not able to be laid down precisely and a potential ghost stressor focus is created. When this occurs, the adjoining myofascial tissue becomes increasingly tense and is gradually drawn into the focal ghost stressor site. This causes body structures to be pulled slightly out of their optimal biomechanical setting, and a subtle harmful effect is experienced within the whole biomechanical set-up of the individual. A ghost stressor is born. A ghost stressor that exerts a more significant harmful effect will sometimes become the key lesion. It is important to recognise this, as an undetected & unresolved key lesion will prevent the individual from achieving an optimal biomechanical set-up. Remedy is of paramount importance. Applied Treatment Methodology Specialised treatment methods are often required to remedy ghost stressors and the key lesion. Deep fascial techniques & reciprocal-tension ligamentous techniques can be applied to restore structural integrity to white fibrous tissue at the focal ghost stressor site.

7 Persistent & Recurring Injury COMMONLY-KNOWN CONDITIONS INCLUDE: Plantar fasciitis Achilles tendonitis Recurring ankle sprain Recurring calf strain Shin splints Patella tendonitis Recurring knee ligament strains Recurring hamstring pulls Persistent & recurring groin strain Persistent & recurring low back conditions Persistent shoulder tightness Biceps tendonitis Golfers elbow Tennis elbow Persistent wrist strain

8 Optimal Biomechanics (1) Biomechanics can be defined as behaviour of mechanical forces in living bodies. Optimal biomechanics can be described as the most efficient behaviour of the body s mechanical forces when the body is either static or when actively engaged in simple movement or complex action. TO ACHIEVE OPTIMAL BIOMECHANICS THE INDIVIDUAL MUST REALISE A SERIES OF IMPORTANT PHYSICAL AIMS: Bones should be properly aligned (including the sacral and talar bones) Joints should move well (including the sacro-iliac joints and costovertebral joints) Ligaments of joints should have an evenly balanced tension-reciprocity between them The holding muscles should be working within appropriate strain parameters There should be a healthy balance between tonic muscles and phasic muscles The deep fascial system should be well-ordered (including deep fascia immediately adjacent to small holding muscles) A good level of core stability and ankle stability should be evident The overall health and strength of the musculoskeletal system should be to a good level CORE STABILITY, ANKLE STABILITY AND ORTHOSES CORE STABILITY - relates to the bodily region bounded by the abdominal wall, the pelvis, the lower back and the diaphragm. This bodily region is sometimes termed the core region and this can be further delineated & described as the lower pelvic core region and the upper abdominal core region. Stability of the lower pelvic core region is primarily determined by the relationship of the sacrum with its surrounding structures. Stability of the upper abdominal core region is primarily determined by the relationship of the dorso-lumbar junction with its surrounding structures. ANKLE STABILITY - is primarily determined by the relationship of the talus with its surrounding structures. ORTHOSES - are indicated when the arches of the feet require support or when the biomechanical set-up of the feet needs improving. Such devices can also help the individual gain improvement in ankle stability, as well as improvement in top-to-toe biomechanics due to the feet being the foundations on which the body stands.

9 Optimal Biomechanics (2)