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
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Permalink Reply by david rodway on -
As the biopsychosocial model has been mentioned could someone explain please how using that model, as opposed to another such as say TCS, would alter the process of history taking and examination and how it might alter the diagnosis, other than say just adding psychological and social elements to the mix? Is it just a question of spotting psychococial yellow flags and using them in the prognosis, or is there something more that BPS model alters on a practical level?
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Permalink Reply by Kurt on -
The BPS model is not part of the curriculum at my school but I have read around a little bit and have a few thoughts here: Because it many times seems to be difficult to actually correctly diagnose the specific tissue causing a patient's complaint it might be worth considering other factors too that contribute to and influence their experience of pain or dysfunction.
These factors can be anything from the patient's general state of health, their level of stress (due to their work or family situation etc) to their believes regarding their complaint and how it changes their behavior and so on. If one understands these factors (and how and why they might contribute to the complaint) I think that better treatment results can be achieved by aiming to identify and address them in the management of the patient. It might change the choice of technique or perhaps just the rationale behind it, but probably more important is how you apply them and what you say to your patient and how you say it. Your whole interaction could be consciously used to de-sensitise the patient’s central nervous system rather than just manually correcting a peripheral lesion.
A big part would probably also be to educate the patient in the physiology behind their complaint to help them understand how they can relate to it in a better way and be encouraged to take control (and responsability) over it and make choices in their everyday life to move towards greater ease. If something is understood it is much easier to handle.
In theory I would think that this is less important in straight forward acute injuries such as a sprained ankle or a muscle strain (where knowledge of bio-mechanics, inflammation and the natural healing process probably does more good) but when a problem becomes chronic or recurrent, the pain the patient experiences might have less to do with the periphery and so an understanding of central processes maintaining the pain state might be needed to more effectiently be able to help the patient.
Of course this increases the number of variables that has to be taken in to consideration. At times this feels a bit overwhelming, but also very exciting. It makes me want to widen my perspective and learn more about everything. I want to add knowledge about nutrition, psychology, movement therapy…and…and…to my osteopathic base. But maybe the main point is just to recognise that there might be other forces at play than bio-mechanics and tissues causing pain and that sometimes I might not be the right practitioner to handle a certaing situation. Maybe true holism might need more than one therapist.
I don't think it's only about spotting yellow flags. I think it's about understanding that there are other factors than the state of musculo-skeletal tissues that sometimes are more important to consider to successfully resolve a patients complaint.
?
Allan
(David Butler writes well about this in his book "The Sensitive Nervous System")
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Permalink Reply by Kurt on
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I am at the ESO and there is approximately one teacher who would be interested in talking about the BPS-model and few students who know about it at all. Psycho-social factors are mentioned though when it comes to "the total osteopathic lesion" concept, the neuro-endocrine-immune system and things like that but it is not practically integrated. (This is just my view at the moment and might not correlate at all with what other students here think)
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Permalink Reply by Ronan O'Brien on -
Hi David - I found Phil Latey's work helpful in developing case histories/diagnoses beyond TCS. He recently produced a DVD set called Better Body Therapy which explores his thinking and methods developed over the last few decades. Donald has reviewed it in the Book Club and Phil sells the DVDs on his website.
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Permalink Reply by Michael Duffy-Gordon on
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Hi Ronan - Mr Lateys set of DVDs are indeed a synthesis of many years of an osteopathic genius' work. Phil eloquently provides a clinical framework that puts the most complex case through to the most straight forward into perspective. And it works.
Phil offers the clinician, amongst many other things, a sort of clinical microscope that provides diagnostic detail at 10X increasing to 1000X as, and if, required. (I can confidently say, in our line of work, this 'scope' is more sensitive and more reliable than many an MRI or US). At the same time this detail may be placed within a broader spectrum encompassing the individual in their emotional and social (family,community and world) environment.
Phil's advice informs the type of inquiry that may lead to fruitful outcomes. For example, Phil's emphasis on aetiological factors (as well as others, see Donald's review) is one that may reach beyond the simplistic approach and one that could lead the osteopath to enable the patient to end their cycle of pain, dysfunction and/or disease. In my opinion, clinical experience (15 years) and knowledge of the literature (fairly extensive), to offer a patient a fraction of what can be gained from Phils clinical strategies and tactics leads to very good to excellent osteopathic practice, well and shoulders above anything else.
Phil's DVD's are an essential part of any osteopaths education.
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Permalink Reply by Theodore Jordan on -
I couldn't agree more with the initial premise of this thread: When we think we're treating muscles, we're really treating the patient's brain's representation (mapping/conceptualization) and control of that muscle. The same goes for connective tissues & joints, etc. So instead of treating peoples' bodies, I feel I am trying to change their brains' representations of their bodies. And the input into that system can be mechanical, sensory, or psychological. -
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Permalink Reply by Julia Spivack on
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A load of old cobblers indeed. We all have tissues - by this logic we should all have symptoms all of the time if tissues cause symptoms.
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Permalink Reply by Guy Edwards on -
Indeed, the nervous system really is the governing system of the body. That is why MRI studies show tissue damage is not the main determinant of pain.
It is obviously a question of how the brain is interpreting the signals it is getting and how the emotional, motor sensory and memory sections of the brain are reacting to each other. Plus how the brain inhibits the pain signal in the descending pathways, otherwise fibromyalgia and similar chemical issues wouldn't be a problem.
When we are treating the tissues, we are really having a conversation with the nervous system, whether we like it or not. Are success will depend on how the brain is actually interpreting what we are doing and whether we are actually reprogramming the causative factors that created the tissue damage or perception of pain.
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Permalink Reply by Michael Duffy-Gordon on
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I'm with you on this one Mike. Central sensitization (CS) to me is a pernicious model. Its not quite saying the pain is "all in your head", but not far off. Sure emotional, mental and social factors play a role and sometimes are key factors, but to me its obvious that these factors have direct and indirect effects on muscle, particularly by increasing tension/force which when reaches a certain threshold leads to aberrant tissue changes and related pain. Soft tissue texture change is highly underrated and grossly under diagnosed as a source of pain.
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Permalink Reply by Michael Duffy-Gordon on
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The BPS model has been great in terms of bringing greater awareness of the importance of the emotional, mental and social environment in which aberrant, pain producing, tissue exists. However, incorporating the CS concept as underpinning the mechanism of pain makes the entire model pernicious. Too many people needlessly suffer because they are convinced their pain is "phantom", while their tissue causing symptoms have been overlooked. The very tissues that continue to cause compensatory CNS changes, and of course pain.
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Permalink Reply by melonfarmer on -
http://www.medscape.com/viewarticle/726444_print
this article focuses on the p aspect of the pbs model but is none the less interesting.
this is an interesting article showing how much more interested the medical profession is becoming in the bps model. much of this looks very familiar to some of the stuff I was taught on my degree...
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