The art and science of

osteopathy
The 3R’s
J Wernham
 It was J.M. Littlejohn who
looked 'way behind' the visible
body, and into that mysterious
unseen world of force and
function.
The difference in technique and policy is so
marked that we have, on the one hand,
'A thrust to the key lesion',
while on the other the 'key lesion' is carefully
avoided,
the purpose being that of the provision of an
improved environment in order that the 'key
lesion' may be rendered more comfortable
and the condition resolved.
This is the meaning of integration,
it is idle to pretend that forceful correction of
the most inert of all the body structures,
namely, the bones, will stay corrected
regardless of the vital and mechanical forces.
 OUR
POTENTIAL FOR HEALTH

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wellbeing
constitution

Stress and injuries

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activities

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home
environment health Family
s relationships
 The 3 R’s
• A well-known aphorism states that the
foundation of education is contained in the
three 'R's., that is to say,
• Reading,
• Riting and
• Rithmetic.
• In osteopathy, we also have three 'R's.,
namely,
• Routine,
• Rhythm and
• Rotation.
 Routine
• Every art-form is based on routine. The great
pianist dazzles the listener with a technique
and performance that is the result of endless
work on his instrument
• Every second of time thus spent called for the
closest attention to detail, and a concentration
that was never lost, together with a
persistence and patience that was always
prepared to accept the difficult.
 Rhythm.
• Among the many disorders that afflict the patient there
may be found high on the list a loss, or lack, of rhythm.
• By its very nature the body adjustment is rhythmic in
character, and the clash of rhythm versus arhythm is our
immediate concern at the commencement of treatment, is
our concern throughout the treatment and to the end of
the last treatment.
• This is why the body adjustment is slow, quiet, gentle and -
rhythmic. There is nothing spectacular about osteopathic
technique. To the observer it can appear to be casual,
indecisive and ineffective. It is quietly repetitive and herein
lies its power, provided it is accurately given. There is no
room here for boredom.
 ROTATION
All movements in the body are in circles, or
modifications of circles. The foundation and
equilibrium of movement is to be found in the
pelvis which represents a circle, or its
modification.
Therefore movements in technique are
rotational in character, which leads to that
somewhat elusive element of body
movement, the axis of rotation.
Another trio of elemental factors
have their place
mobility,
motility and
articular integrity
In the mobility we find easy and speedy
movement,
while in motility we have spontaneous
movement as a whole in terms of muscular
action.
The integration of articulation involves all the
body structures, in a smooth interplay of
movement, the attainment of which is the
high standard we have come to expect in
osteopathy.
But the list is not complete and
we are compelled to consider
the merits of
co-ordination,
correlation and
stabilisation
These three represent the major targets in
osteopathic philosophy, and are the most
difficult of attainment.
Co-ordinate - to combine, or integrate
harmoniously.
Correlate - to establish relation between either
of two things so related, that one implies the
other, or is complementary to it.
Stabilisation - the regulation of the equilibrium
of the body.
Every movement made in correction is a new
diagnosis
every adjustment is a simple extension of the
diagnosis.
The great central point of our osteopathic
technique is tactile discrimination, but it must
be backed by that philosophical interpretation
of the basic sciences which is peculiar to
osteopathy.
 Osteopathic Principles
In a word, we have our own Principles and these
must be adhered to.
It is more than unfortunate that so many
practitioners in osteopathy attempt to base
our manipulative techniques on a medical
basis,
the truth is that the two systems are
incompatible.
When routine has become established we will
have entered, almost unconsciously, the world
of rhythm.
This is an attribute of the living body that is
characteristic and is lost in the majority of
patients.
".
• Therefore, it is important to impose rhythm
where it does not exist,
• it is to this end that the long lever is applied
repeatedly, until the normal conditions are
fully established.
• This is the meaning of that well-worn phrase,
"The physiology overbears the pathology”
 MECHANICAL LAW

But we must remember that overshadowing this

great concept we must take account of the
commanding presence of mechanical law
 IT IS ALL ABOUT
MECHANICS

The human body is

subject to the same
mechanical laws as is a
bicycle or a building.
A bicycle , if it has a mechanical fault will work
inefficiently and will eventually break down.
• Similarly if a building’s
foundations are not level
cracks will appear in the
walls; perhaps the building
will fall down.
• By contrast the human body
will compensate for any
strain or maladjustment and
may continue to work
without giving any obvious
symptoms.
• However, Osteopathic research has shown
that strains of the spine and “musculoskeletal”
system tend to impede or interfere with the
efficient flow of blood and nerve impulse
throughout the body and leave the body more
prone to disease and ill health.
 YOUR SPINE
• The spinal cord is surrounded by rings of bone called
vertebra. These bones constitute the spinal column (back
bones).
• The vertebra are named according to their location. The
eight vertebra in the neck are called the Cervical Vertebra.
The top vertebra is called C-1, the next is C-2, etc
• The twelve vertebra in the chest are called the Thoracic
Vertebra. The first thoracic vertebra, T-1, is the vertebra
where the top rib attaches.
• The vertebra in the lower back are the Lumbar Vertebra.
The sacral vertebra run from the Pelvis to the end of the
spinal column.
 YOUR SPINE
The spinal cord is about 18 inches
in length and extends from the
base of the brain, surrounded by
the vertebral bodies, down the
middle of the back, to about the
waist.
The spinal nerves exit and enter
at each vertebral level and
communicate with specific areas
of the body.
The spinal cord is the major
bundle of nerves that carry nerve
impulses to and from the brain to
the rest of the body
 A HEALTHY SPINE
• IS perfectly aligned
• Has freedom of movement a every joint and
no restrictions at the exit of the spinal nerves
• Normal movement massages the blood flow
to and from the nerves in the spine
• Communicates with all parts of the body,
including the vital organs and brain
 Gravity and Mechanics
• , that silent inexorable factor
• which cannot, and will not be disobeyed
• It is the arbiter of all our adjustive work
• and the common refusal to accept the
existence of gravital stress and its importance
in osteopathic practice has resulted in a
severe loss in our clinical standard
 how are we to deal with these Ten
Commandants
• The high velocity, short amplitude technique
has no place in osteopathy;
• in fact it represents an intrusion into the body
function that is unwarranted and of doubtful
value.
 The Osteopathic Lesion

It is not a bone out of place

• At the other end of the scale the soft tissue
techniques, whether they be functional, muscle
energy, neuromuscular or physiotherapy,
• These cannot of themselves resolve the lesion
state and will result in irritation to the patient,
if continued over a long period.
The long lever technique, on the other hand is
capable of;-
• prolonged treatment
• the care of the long-term, chronic patient,
with continued good results.
• In fact, it could be said that osteopathy, as it
was laid down by the Founders, is the only
therapy capable of carrying out such a
programme.
The levers are long and flexible while the fulcra
are soft, offering only the minimal resistance
to the leverage offered.
The problem here is one of coordination
between the lever and fulcrum,
The flexibility in both aspects of this mechanical
device is a basic necessity, and the clinical skill
rests in the applied technique that is accurate
and yet freely flowing, employing rotation and
rhythm in routine.
thrusting techniques have no place in
this programme

if strenuous efforts insist that the solitary

structure remains in its new position, then a
new lesion has been created
while closely allied we have those three great
cardinal objectives, coordination, correlation
and stabilisation. Perhaps the most difficult of
these is the correlation

To face functional disorder presented by the patient,

and to bring about a new relationship in the
physiology demands the very highest standard of
concentration and careful handling In clinical practice.
• To face functional disorder presented by the
patient, and to bring about a new relationship
in the physiology demands the very highest
standard of concentration and careful
handling In clinical practice
• These ideas suggest that although osteopathy
is mechanistic in outlook and deals with the
visible body in the most practical terms,
• we must remember that mechanical forces
and biological reaction lie beyond those things
we can touch and see,
• if we are merely content to restrict our
manipulative skills to the visible world, then
the osteopathy is lost and we are reduced to
the ranks of the bonesetters.
Inspection and palpation of the spine
will indicate
• left lateral movement of the cervical vertebrae
• a corresponding right lateral movement of the upper
dorsal spine with a cross-over' point at the level of the
2nd dorsal vertebra.
• In the lower dorsal, the movements are irregular and
broken into groups,
• in the lumbar spine, the deviation is to the right
• corresponding pelvic torsion
• in which the right ilium has moved upward and forward
• the left ilium downward and backward
• accompanied by a sacral rotation on the horizontal and
vertical axes.
•
• Involvement of the lower limbs is commonly a
rotation outward of the right leg and/or genu
valgum on the left.
• Another factor is the deviation of the axis of
symmetry to the right due to the weight of the
liver on that side
• This may be aggravated by the swayback
posture in which we find the shoulder girdle
posterior to the pelvic girdle, and causing the
latter to twist under the chronic stress.
The direct result of this mechanical malfunction is
the pivoting of the left sacro-iliac articulation with
shortening and hardening of the supporting
attachments, especially the interosseous ligament,
while the right ilium tends to swing forward with
the sacrum.
In practice we find that the right side of the
patient is relatively free,
is often the seat of pain, i.e. brachial neuritis, or
sciatica.
On the left side of the patient there is stiffness
and rigidity.
We are confronted with this problem in
practically every patient and if treatment is to
be successful we must try to establish an
improved measure of equilibrium
 Centres of oscillation
The explanation for this remarkable state of affairs is to
be found in the oscillatory movements of the spinal
column.
In the neck the centres of oscillation are posterior to the
vertebrae and correspond with the cervical portion of
the P.A. line.
At the level of 2D the centres change course and follow
the structural A.P. line down to 4D, becoming anterior
to the spine, then axial in the lower dorsal spine,
and finally emerging posterior to the lumbar curve
These are the individual centres,
 group centres are to be found at 7C: 9D; 5L:
around which the compensatory forces tend
to rotate.
It is for this reason that so many problems have
their concentration at the2D and the constant
wrangling that goes on between 7C and 2D
can only be explained by the powerful
influence exerted here by these centres of
oscillation.