Gathering place for osteopaths
An Osteopathic Approach to Acid Reflux
Canadian Osteo Bradley Dundas has rightly pointed out that there is too little discussion of techniques and treatment on Sacral Musings, and too much whingeing about politics. (of which I stand guilty as charged.)
Much of this, I feel, is due to UK osteos abandoning their "holistic" heritage and metamorphosing into minor orthopaedic technicians, indistinguishable (in the public mind) from physiotherapists - whose treatment is free. No wonder many of us are struggling.
So in an attempt to redress the balance, can I start a discussion on one of the areas osteos used to treat on a regular basis - digestive dysfunction.
A friend of my brother's is a research pharmacologist. His area of interest is drugs for GERD. Apparently his statistics show that a significant percentage of GERD sufferers derive little of no benefit from prescribed medication, and that the pharmacologists cannot find a reason for this.
Now, if structural factors were considered, many of these sufferers would find relief from their symptoms. I myself have had good results in treating this condition using NMT of the abdomen - especially the deactivation of trigger points in the external obliques and rectus abdominis, and treating the intercostal Chapman's reflexes.
Has anyone else had experience in treating GERD and if so, would they care to share their techniques?
Tags: GERD, HCL, acid reflux, osteopathy stomach acid
Replies to This Discussion
-
Permalink Reply by Steve on -
Forgot to mention the Transversus Abdominis, whose trigger points can also cause heartburn:
http://www.webmanmed.com/disorders/disorders_files/musclgd/abdom/12...
-
Permalink Reply by Steve on
-
Here's a little article which emphasises the physiological vicious circle between LBP and GERD.
Basic osteopathic thinking, really, which too many of us have lost sight of in the rush to become evidence-based orthopaedic technicians. (There I go moaning again!) Structural dysfunction of the back leading to irritation of the splanchnic ganglion leading to acid reflux leading to viscerosomatic referred pain to the back leading to structural dysfunction of the back leading to etc. etc.
Here's a thought. How many of us ask patients specifically about GERD, IBS etc when taking a history? If we frame the question as "have you any current problems with your general health?" a lot of people might say "no" because they can't see what relevance the question has to their bad back.
Here's another thought. How many of us have charts of the abdomen, abdominal trigger points, anterior Chapman reflexes etc. on our walls? (Most clinics I've seen have spinal charts only). If we gave the patients more visual clues that we treat "fronts" as well as "backs" we might engage their interest in such matters.
-
Permalink Reply by CJ Filler on -
Are UK osteopaths trained in Visceral Manipulation? I've found that working on the iliacus fascia, renal fascia, and root of the mesentary will "loosen up" the lumbar spine. The Barral techniques are especially fascinating.
Also working on the connective tissue fascia between the lower pelvic organs (bladder, uterus, rectum) externally helps reduce cramping from menses and constipation.
-
Permalink Reply by Rich Moore on -
We're not really taught it at Brookes but a number of our clinic tutors are very experienced and can give direction if asked.
Personally, I'm really interested in it, far more so than 'cranial' which we spend a fair bit of time on in the final year - whether we want to or not ;)
I wonder if visceral osteopathy is a victim of a lack of 'evidence' hence why it isn't taught?
-
Permalink Reply by bluets on -
Visceral osteopathy was taught at one point I believe, in at least one school. My mentor trained with Wernham and Waldman, so he is teaching me visceral techniques that I'm sure he learned from them. But since we are naturopaths (in the USA, osteopathy is closed to us), we use a modification of Waldman's total body adjustment which inherently addresses the viscera. But we also use dietary changes (digestive enzymes for GERD would be helpful) and other tools (herbs like licorice root, slippery elm in GERD) to facilitate healing. But we also get to spend 60 minutes with patients so we can do the total body adjustment, then we can get more specific if necessary.
-
Permalink Reply by Steve on
-
When I qualified (back when Noah was a lad) there was no such animal as "visceral osteopathy", Dr. Barrall had yet to carve out a name for himself.
However, I was very much influenced by Chaitow's Neuro-Muscular Technique (1st Edition, with the hyphen) which had just been published, and was intrigued by the abdominal applications of NMT. Reading Travell & Simons' "red bible" later on consolidated these ideas.
My own approach to GERD has been based on release of trigger points in the abdominal musculature and costal attachments of diaphragm, Chapman's reflexes and general spinal treatment to sedate the sympathetics - together with diet and other advice (especially hydration).
Deeper work into the viscera and root of the mesentery etc. is unfamiliar to me. Is this covered in Barrall's books? Are there other books anyone could suggest?
-
Permalink Reply by Tracy Hannigan on -
Visceral is taught at BCOM. It is about a two and a half term long module in the third year. The book that tended to be used by most students was Caroline Stone's Visceral and Obstetric Osteopathy, and the woman who was the lead instructor lives and breathes the stuff as far as I can tell.
I was skeptical of the module at first - but I think that it was incredibly valuable experience. We got to see all of these visceral structures in dissection during Y1 and Y2, but to learn to feel a lot of the structures and relationships was really amazing.
I have not used it frequently in the practice clinic, but when I have it seems to have had some beneficial results. It seems that once patients get used to the idea and you can work more deeply, it seems to be a 'moving' experience (no pun intended - I mean it is 'gently confronting in a positive way' to have such deep work done!)
-
Permalink Reply by Steve on
-
Good to see visceral has a place on current osteo courses. I think it's very important to develop this area, as it's one antidote to us becoming bloody "lumbago technicians".
To return to treatment: Can I introduce fellow Musers to the fascinating work of Dr. Kurt Barrett D.O., whose linking of GERD to sinusitis, fatigue, ear and allergy problems is a great example of osteopathic "lateral thinking":
http://www.drkurtbarrett.com/index.html
NB Kurt Barrett is, as far as I know, no relation to Norman Barrett of Barrett's oesophagus fame - but it's interesting that here we have another Barrett specialising in reflux disease. Kurt Barrett, as a USA-qualified "medical" osteopath favours medication to fix GERD and its associated health remifications - UK osteopaths might accomplish the same using manual and nutritional therapy.
-
Permalink Reply by Small Fry on -
Can I suggest a correction? I think you mean Wernham's, not Waldman's body adjustment. Thanks
bluets said:
Visceral osteopathy was taught at one point I believe, in at least one school. My mentor trained with Wernham and Waldman, so he is teaching me visceral techniques that I'm sure he learned from them. But since we are naturopaths (in the USA, osteopathy is closed to us), we use a modification of Waldman's total body adjustment which inherently addresses the viscera. But we also use dietary changes (digestive enzymes for GERD would be helpful) and other tools (herbs like licorice root, slippery elm in GERD) to facilitate healing. But we also get to spend 60 minutes with patients so we can do the total body adjustment, then we can get more specific if necessary.
-
Permalink Reply by bluets on
-
I haven't seen Wernham's approach in practice, but having watched the few clips here of Waldman working, it is very clear to me that our approach is very similar to the latter, almost all the time.
-
Permalink Reply by Forklift on
-
Yesterday I went to visit a Naturopath (http://www.taymount.com) with my partner as she suffers with GI issues one of which is GERD. She was advised to take Betazyme (http://www.taymountraw.com/proddetail.php?prod=BETAZYME&cat=9) to help with her problem. Yet to see the results of all that was advised to take but her theory of Betazyme (bit.ly/psORks) is that it is not over production of stomach HCL but perhaps under production. The antacids prescribed by the doctor mean that undigested food was entering the small intestine and potentially causing a toxicity further troubling her UC. This coupled with low levels of glutamine inhibiting a healthy and strong turnover of colonic lining was leading to her symptoms worsening. Her treatment using these products started yesterday. I am waiting eagerly for the results (hopefully positive)....
© 2012 Created by Ronan O'Brien.
