THE GOAL OF TREATMENT

The goal of osteopathic treatment is to restore equilibrium within the body and between the body and the environment. In other words, osteopathy does not treat any disease and does not "put vertebrae back into place", but attempts to optimise functioning of the locomotor system so that a patient can continue with the chosen lifestyle and continue doing desirable activities. Only in exceptional cases is there a need to radically change one's lifestyle and activities. In most cases it is enough to make changes and adjustments to the area causing the problem, such as posture, physical activity, work and the workplace, or the type of bed.

Complete recovery is expected in uncomplicated cases (acute and subacute mechanical back pain, and sprains) within 4 to 6 treatment sessions. Where biomechanical derangements are secondary to other diseases such as severe osteoarthritis, spasticity, or paralysis, supportive therapy is effective in improving the patient's activity and lessening his/her suffering.

From the osteopathic point of view, optimising the locomotor system includes establishing a biomechanical balance and removing barriers to the efficient spreading of the load (mechanical forces). Treatment techniques are aimed at improving quality and range of impaired movements, softening fibrotic areas, relieving muscle spasm, and mobilisation of joints.

In chronic cases the next stage is very important, which is elimination of, or recommendations for minimising the cause of the problem. This can be postural correction, exercises to do, or a temporary break in certain activities.

METHODS OF TREATMENT

Traditionally, osteopathic treatment starts with working on soft tissues, then mobilisation or articulation techniques. Specific manipulation of the involved segment, if necessary, ends the session.

Soft tissue techniques are an independent treatment method and not just a "warming up" before "proper work". They include specific osteopathic soft tissue and some massage techniques.

Mobilisation (or articulation) is a no less important (and sometimes even more important) method of treatment than manipulation. Osteopathic techniques of mobilisation have won recognition amongst other schools of manual treatment. Mobilisation techniques include repetitive rhythmic, cyclic movements in a certain plane with the forces focused on the lesioned segment.

MANIPULATION

Manipulation as a method of treatment is well known in many professions. Osteopathic manipulation works very specifically with regards to the segment and the joint on target. Osteopathic manipulation is not accompanied by a half a dozen "cracks" and is not done as a "running jump". Experts employ an amplitude for a manipulative thrust of 3 mm in a precise direction, based on the diagnostic findings or the type of manipulation required for that particular segment.

There is a disagreement as to how many joints should be manipulated in one treatment session. Some practitioners believe that an Osteopath should find a key lesion and manipulate only that segment and this should make compensatory lesions resolve spontaneously. Others manipulate all lesioned segments thinking that compensatory lesions became independent lesions within a very short time and need separate manipulation.

PRESCRIBING EXERCISES

Most Osteopaths prescribe or recommend physical exercises to help the recovery process and to stabilise clinical improvement. This can be advice to go swimming or jogging regularly, or an Osteopath can recommend some specific exercises to work on a lesioned area or a segment.

In cases of instability and hypermobility, stabilising exercises show good results. Often it is recommended that a patient continue doing exercises after the treatment has finished in order to keep the stiff area mobile, increase stability, and to give a feeling of control of the situation.

ELIMINATING THE CAUSE

The most effective treatment modality is finding and eliminating the cause of the problem. Without this all other treatment methods may give only temporary relief. Many different factors may be causal and a good history with a detailed analysis of the mechanical loads initially present usually proves to be invaluable. Just a few examples:-

• Posture. Hyperlordosis, hyperkyphosis, protraction of the head and other postural deviations may predispose to lesions. Patients need to do exercises to correct posture and also need to keep conscious control over their posture.

• Workplace. Wrongly selected furniture (a desk, a chair, a bench), incorrect positioning of a computer screen or a keyboard, badly organised labour (carrying too heavy a weight in one trip instead of small ones more often, not enough breaks) - all this inevitably affects the body and require correction. Ergonomics is the speciality that deals with workplace issues.

• Anatomical and structural defects. Leg length inequality, feet anomalies, and paralysed limbs all cause imbalance and increase load on other parts of the body. Correction may be needed by way of a heel raiser, orthotics or a sling for a paralysed arm.

• Bed. A bad quality mattress or pillow or a bed that is not long enough may have decisive roles in decompensation of spinal alignment. Pathological changes. Rheumatic diseases of the musculo-skeletal system (gout, spondyloarthopathies), diseases of internal organs (bronchitis, pelvic organs) are often accompanied by secondary biomechanical changes or referred symptoms and require nosologic treatment.

• Psycho-emotional factors. At the moment, so called Yellow Flags (signs of psycho-emotional and psycho-social disturbances expressed by a patient) have shown good correlation with the development of chronicity. In my opinion, we do not know yet whether psycho-emotional factors are the cause or the effect of a chronic problem. However, emotional changes can objectively change the function of the musculo-skeletal system and lead to dysfunction. Some patients reveal signs of borderline psychiatric disease (neurosis or depression) that need separate attention.