Dear Reader, just a quick pre-amble to the blog about Bronchitis. This is not always an easy condition to treat, often takes a bit of persistence and patience as do many breathing conditions. I just wanted to have a word about a traditional approach to such conditions, which like many acute disorders responds well to treatment. Enjoy.

Bronchitis

During the winter months in this part of Europe, head colds, influenzas and bronchitis are very common. It is a condition we are likely to see and certainly are able to treat with classical osteopathy. In order to treat it effectively, as with any condition it is important to understand the applied anatomy and physiology related to the condition.

Bronchitis is characterised by catarrhal cough, râles (sibilant at first, then as the cough loosens there is more of a bubbling), usually mild fever, with congestion of the bronchi and hence dyspnoea. The onset of bronchitis is usually preceded by a head cold, influenza, sore throat malaise and chilliness.

Pathology

'Microscopically the fibrous membrane is purely lymphatic, the network of fibrin enclosing leucocytes and debris. In the diptheric type there is the appearance of a network, but underneath the surface there is a distinctly new tissue formation, which represents the simplest form of neoplasm.

'There is an acute form of bronchitis, unclassified, representing the catarrhal inflammation of the bronchial tubes. Here the pathology is:

(1) Engorged blood vessels.

(2) Swollen lymph follicles together with increased cell formation.

(3) The increase of mucous secretion mixed with leucocytes, epithelial cells and lymph.

(4) In the chronic form the cells of the connective tissues are elongated and therefore the membrane is enlarged, forming a super-epthelial structure. This super coating takes on a new function of secretion, which is the characteristic of bronchitis, that is, the mucoid and pasty material are eliminated by coughing.’1

The Treatment of Bronchitis

As with any condition, the treatment is relative to the condition and status of the patient. If the patient is febrile, the treatment must be initially light, brief and focussed.

Littlejohn outlines the general approach to acute disease, as follows ²:

‘In acute diseases, there is generally a primary lesion, which adversely influences organic resistance to toxic conditions, or to germ invasion. This practically always arises from the minute terminals of the sensory nerves in the spinal articulation, which then operates on the organ or tissue from the vasomotor side. The secondary lesions are chiefly muscular contracture, caused by irritation to the end organs in the organic disturbance leading to loss of nerve tone and exhaustion. In bedside treatment, slow and gentle stimulation of the spinal muscles is employed to relieve the deadened condition of the organ involved, and inhibition is only used when the spinal muscles are intensely contracted. Exhaustion in the acute case irritates the affected nerves to their point of origin, disturbing the sympathetic ganglia and the spinal nerves, which now become irritated in the attempt to resist the loss of sympathetic tone, resulting in muscular contraction followed by relaxation, as soon as the nerve temper passes off and, finally, exhaustion. Therefore muscular stimulation will have an important reaction on the organs involved, via the spine’.

The Acute febrile State

Look to relieve tension around upper ribs and clavicle with the use of the arm as a lever - this also releases the superficial tissues of the thorax and can flow into a light unilateral thoracic lymph pump movement. Very gentle release of the cervical area follows with close attention of the first and second cervicals, which very gently released should help to stabilise the temperature control. The pressure involved, the timing and the sensitivity employed during the treatment of a febrile condition is quite different to that usually used in general practice. The handling is much lighter and much more sensitive to palpate the subtlest of changes in the tissues it is similar to the pressure used to make an indent in fresh butter!

A gentle lymph pump serves several purposes at this stage of the treatment - it encourages lymphatic drainage of the thorax, aids movement of the upper ribs and rib cage generally and frees up the centres for the superficial circulation (D2-4). This can be followed by a light 'osteopathic mustard compress' as it referred to, where the surface tissues of the thorax are lightly irritated with the fingers to encourage and further the effect on the superficial circulation and assist the circulatory imbalance in the thorax. This entire process should not take more than five to seven minutes, unrushed. Throughout the treatment one should be highly sensitive to the state of the tissues one is working with to establish whether there is a more serious pathology under ones hands, an example of which Mc Connell describes³:

'It should not be overlooked, however, that spasticity of muscle and immobilization of ribs here may be a reflex phenomenon due to serious disease of the lung apex'.

Examination preceding treatment can include auscultation of the lung field to assess this, but sensitive fingers and an awareness of other potential pathologies should enable such a diagnosis.  Studying the Fundamentals of Osteopathic Technique by J M Littlejohn, Symptoms of Visceral Disease by Pottenger are good starting points for the preparation for treating and diagnosing osteopathically. Once the patient has gone beyond the febrile state, work on a more constitutional basis can proceed, through the body adjustment or its principles (where movement of the patient is restricted - such at the bedside) this treatment is highly adaptable and will have the same effect as long as its principles are being followed.

Aspects of the treatment can be applied sidelying, where the treatment is usually done prone. Freeing up of the thorax is important with particular attention to the freedom of respiratory movement as regards the intercostal tensions, the rib articulations and the spinal centres involved. Do not neglect the effects of the coughing itself, which causes substantial irritation in the upper cervical and anterior cervical tissues, especially around the hyoid bone- freeing up of tensions in these structures is important in resolving the chronic irritation of the cough. Also in this respect look to the condition of the cough reflex centre at D3, which will likely be sensitive and part of the imbalance of deep and superficial circulatory field around it (D2-6). Rib articulation with the use of the arms as levers is very effective as Mc Connel implies:

‘…hyperextension of the dorsal spine...increases pulmonary capacity, enlarges the diameter of the spinal foramina, raises the ribs and encourages doming of the diaphragm.. The same hyperextension with the assistance of the arms as levers will usually will usually release the articulation between the first and second sections of the sternum. Careful freeing of the tissues here and attention to the upper three or four will frequently restore normal range of the upper ribs.’

This kind of treatment is inappropriate, if not impossible in the treatment of pleurisy, due to the extent which it stretches through to the pleura. Releasing the ribs can be done more specifically without this arm leverage – note how the hand reaches right around to grasp the rib angles. Spleen pumping technique can be integrated to good effect here, to aid in overcoming the infection side of the condition. 

Mechanical Stimulation of The Spleen

In the 1955 Year Book of The Academy of Applied Osteopathy were given details of the investigations, first by Whiting in 1911-12, and by Castlio and Ferris –Swift, published in 1932, of some effects of the mechanical stimulation of the spleen. The stimulation was applied by bimanual pressure on the spleen, about twenty times per minute, for from three to five minutes … the actual leucocyte count was increased, and the erythrocyte count decreased in approximately eighty percent of cases...

Recovery

In the context of the long-term resolution of the aetiology of the condition we must consider the wider implications as Mc Connel states:

‘The greatest difficulty rests, however, in securing alignment when the predisposing factor is a series of deep seated firmly anchored lesions of a rotation and lateral flexion character. Contractions of muscles like serratus superior or of the complexus, for examples, that exert considerable tension on the ribs, or sidebend and rotate sections of the spine are, of course, to be considered, but of greater significance are contractures of the rotatores and thickenings of the capsular ligaments.’

In order to get behind the condition, we look to our principles and the mechanics. The charts TE Hall and John Wernham illustrated allude to the need to balance the gravity lines and forces in order to get behind the lesion pattern and balance the inter-cavity pressure gradient. 

It is useful during the recovery period to avoid foods that encourage mucous production, such as dairy products, refined carbohydrates and sugars. At times of most illness, it is always helpful to simplify ones diet in terms of consuming simple, less refined or processed sources of nutrition. Certain food, vitamins and minerals can aid recovery, such as foods high in vitamin C (good examples being lemons, melons and sprouting grains, seeds or beans), leafy green vegetables (the most important elements in any healthy diet), garlic (well proven anti-bacterial, anti-fungal and anti-cholesterol properties). Echinacea is a herb frequently renowned for clearing infections, but the advice of a herbalist would be advised with dosages and compatibility with existing medication.

References:

1   Lectures on Pathology- J M Littlejohn

2  The Fundamentals of Osteopathic Technique. J M Littlejohn

3  Selected Writings of Carl Philip McConnell, D.O.

4  The Institute of Applied Technique1958-Year Bk

Other  Reading:

1   Symptoms of Visceral Disease. F M Pottenger

2  Osteopathic Principles in Disease C H Downing

3  Differential Diagnosis in Physical Therapy. Goodman, Snyder