Gathering place for osteopaths
Tissue causing symptoms model: a load of old cobblers?
Having just graduated I have spent the last couple of years negociating the choppy waters of the tissue causing symptoms model in my rather leaky osteopathic sieve.
Looking at some of the recent physio work with neuroplasticity and neurodynamics which appears to account for the massive variability of patient response to treatment and injury, it makes much of the osteopathic sieve/tissue causing symptom stuff look alittle old fashioned and old hat.
Or is it just my jackdaw nature looking at the next shiny bauble over the horizon...
Replies to This Discussion
-
Permalink Reply by melonfarmer on -
I think I have an inbuilt contrarian gene that makes me question everything. I got into trouble a fair bit at college for not just accepting things like holy scripture handed down from on high...
where is the talk on I am interested in the subject matter...
-
Permalink Reply by melonfarmer on
-
thats one of my clinical tutors barry jacobs I think. Another of lifes contrarians and all round good egg! I learnt more from him than most of the lectures I went to...
-
Permalink Reply by melonfarmer on
-
Thats booked if you fancy meeting up for a pre talk beer in st johns let me know!h
-
Permalink Reply by Ronan O'Brien on -
The BSO is moving to a biopsychosocial model, and that is the model we are now taught. The change does not always translate into clinic however .. I guess old habits die hard. Biopsychosocial seems to make much more sense to me as a model, particularly when it comes to issues like chronic pain and central sensitization, as well as recognising the influence we have with our patients beyond the manual techniques we use.
-
Permalink Reply by Dick Wyatt on -
From my perspective, (which was chewed over at length, and grudgingly accepted as plausible in these very pages), the pathol. sieve is correct only so far as if *events proceed as expected*. When they don't, the sieve breaks down and is worthless.
The events I speak of are the involuntary assimilations of Newtonian energy. The expectation is that these will accumulate in the dense sacropelvic and sacrolumbar ligaments, amass there and eventually sleet upward along the best conductive pathway until either energy or pathway gives out. If there's spare energy, it can then re-amass and causes a T/L, C/T or O/A or other, similar problem. The sieve broadly covers these occurrences.
In less usual (but common enough) circumstances the conductive energy pathway may be frontal, or central. Then energy unpleasantly accumulates in the thyroid, lymphatic duct and face, or assaults the oesophagus, brainstem inc. trigeminal ganglia, and pituitary. Others may and do - combine all these types, and the sieve is way unable.
I think the point here is that Ost. college is only a beginning. It's well-known that Osts. are as different as...um...they differ postgrad., anyway. The sieve then serves as common ground until they've replaced it with something of their own, something informed by local experience.
Obedience to the sieve may correlate with more than 50% of my patients - but anyone could help that group. It's the more atypical sector which makes my juices flow - and these are the difficult ones, the ones who don't fit the standard pathological models. And more and more, this group presents with named diseases. I feel like it's about 1870!
Dick
-
Permalink Reply by Quatermass on -
"a load of old cobblers"
"Or is it just my jackdaw nature looking at the next shiny bauble over the horizon..."
Not a load of old cobblers, just incomplete, so it's not this model or that model, it's both and more as an integrated model. Undeniably symptoms very commonly arise with the direct involvement of specific tissues, plus of course the direct involvement of the CNS. The shift in predominance from one end to the other with increasing chronicity is a slow shift. At every stage it is still the osteopath's primary duty (in my perhaps old-fashioned opinion) to ensure that the adaptive load from the tissues, be they those specific tissues or the tissues in general, is reduced as a factor maintaining pain, or influencing central sensitisation. It may not be enough in a few very chronic cases, but although insufficient in itself, is still necessary as one of the steps towards pain relief.
-
Permalink Reply by Quatermass on
-
"From my perspective, (which was chewed over at length, and grudgingly accepted as plausible in these very pages)..."
"The events I speak of are the involuntary assimilations of Newtonian energy"
Hi Dick,
Mind reminding me where, precisely, this was accepted as plausible? I must have missed it.
Robert
-
Permalink Reply by Dick Wyatt on
-
Buggered if I can remember the name of the thread, but weren't you there?
Anyway, it became a discussion over what happens when human body meets kinetic forces, for instance in a car crash. The body absorbs such forces in blind obedience to Newton's laws of energy conservation. The forces are stored in the inherently receptive connective tissues. Encumberment ensues. Deemed as valid. End of thread.
Dick
-
Permalink Reply by Quatermass on
-
Ok, I've revisited it: It's in your discussion "Cranial workers talk technique". End of thread was a post of mine in which I accepted that forces incoming to the body can conceivably be stored (as chemical, electrical, heat, gravitational or strain energy) but questioned the significance of the dent, which you seemed to hold important: "It is just a dent", I wrote. It is inert and won't spring out without the input of a further quantity of energy necessary to do the work. However yes, I did accept the general principle. Any further discussion perhaps better in that thread.
-
Permalink Reply by Dick Wyatt on
-
Hi Rick!
Yes, you're in the ballpark. The body does indeed process and release this inconvenient energy stuff - but it does it slowly. That's why someone with whiplash, for instance takes so long (or forever!) to recover.
It's easy to see that the rebound energy of a step, for instance won't have much effect because of two factors at least: 1) the elaborate suspension of the sacrum, and 2) the immense mass of the body in contrast to the energy rebound of the step.
The problems start when the energy assimilation is great enough to interfere with the anatomy & physiol. Even then, the body will work on it (and it's part of what we call *healing*) but as I said, this is naturally slow.
The body also generates its own encumberments, which take the same form. Bad working posture, or chronic nervous debility will do it.
The fact of energy assimilation in accordance with Newtonian predictions underlies the Cranial. I got to this point by questioning the basic dogma in cranial, the observation that the cranial bones move. What actuates them? In health, yes, it's the IMS or Traube/Hering/Meyer wave, but in illness?
It's all logical, all explicable. It works splendidly. And it's flat down unbelievable how much ordinary pathology is dependent on it. I still haven't realised the full scope of how damned important the involuntary assimilation of energy is.
Dick
-
Permalink Reply by Jonathan Edis on -
Maybe see you both at barry's talk - he was an old tutor of mine at the BSO as well and is indeed an all round good egg (though eggs are egg shaped, not round, of course). I won't bring the WW1 army cap though.
I thought the whole world was moving away from TCS ideas anyway - don't the NICE and European guidelines say that we only have to decide whether LBP symptoms are mechanical or not, because after that, everyone just argues? I feel quite liberated by it all.
-
Permalink Reply by melonfarmer on
-
I was sorry to miss it. but the little baby had her first set of jabs yesterday and my wife was a bit frazzled by her grizzeling so I went home to provide paternal support...
Will try to make it to Barrys talk. do you have any handouts or anything I could have a gander at?
Top Musings Right Now
© 2012 Created by Ronan O'Brien.
