During the 20th Century A.T. Still had a limited number of concepts and language forms to explain his Osteopathic Principles and Practice. 

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The 21st Century Science is providing unique concepts and language which enable us to better understand and explain OPP.

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I want to illustrate these principles with a case history.

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The patient was female in her late 50’s. She had been in the hospital for 5 days with a diagnosis of: Unilateral right lower lobe pneumonia & Pancreatitis

 

She had been consulted by the appropriate specialists, had been on the appropriate medications but X-rays showed the pneumonia to have minimally improved and she was having a lot of pain with the pancreatitis.

 

As we walked in the room at 7:00am for the OMT consult, the room was dark, she had an IV drip and was receiving a narcotic PRN for pain. She was on her side in the fetal position.

 

I explained the purpose of our visit, to see if there could be a mechanical component complicating and hindering her recovery.

 

I asked to lie on her back but she stated "it hurts when I lie on my back." This would make sense with pancreatitis and thoracic extension could be painful.

 

I explained she would be on her back for just a few moments as I screened out her system. She agreed. The Area of Greatest Restriction-Hindrance ( AGR-H ) was the right occipito-petrous suture. Since the jugular foramen is in that suture, somatic dysfunction - hindrance ( S/D-H ) could either stimulate or inhibit the CN-X / Vagus to both the respiratory and GI tract, this could be significant.

 

As I treated it, she remarked “I can take a better breath.” My backward reasoning then assumed the S/D was stimulaing the PNS and hindered her ability to get maximal branchial dilatation due to secondary bronchial constriction.

 

She then stated, “ my stomach doesn’t hurt as much.” Again my backward reasoning assumed that same S/D stimulated the PNS/CN-X and adversely impacted pancreatic physiology.

 

The next AGR-H was the upper thoracic area which is the origin of the SNS innervation to the pulmonary system. The vertebral dysfunction was treated with a Functional technique and immediately she stated “I can breath even better now.” My backward reasoning assumed the S/D was inhibiting the SNS and hindered her ability to get maximal bronchial dilation. It might have also altered the vasomotor tone of the SNS and although she had good blood levels of her medication, she may have had an ineffective tissue level of the medication in the pulmonary system.

 

The third AGR-H was in the mid-thoracic area which would be the SNS innervation to the pancreas. It was a marked flexed S/D and as soon as it was effectively treated with Functional technique, she stated, “ I can now lie comfortably on my back and my stomach pain is a lot better. Reasoning backwards, it appeared the supine pain was due to the flexed dysfunction and not all due to the pancreatitis. That midthoracic S/D may have also altered vasomotor tone to the pancreas and again impaired a good tissue level of her medications to be attained.

 

The last AGR-H was the lower six ribs on the right which were markedly exhaled and could not come into good inspiration effort. This could correlate with the right lobe pneumonia. The altered rib cage movement may have contributed to impair venous and lymphatic drainage from the right lower lobe and predisposed to the develop of pneumonia.

 

Once those S/D were effectively treated with gentle Functional techniques, the patient got out of bed and starting walking around the room saying “ I feel so much better.”

 

During that treatment many other mechanisms may have been operating. 

• Cybernetic Loop: everything I did with OMT was monitor by palpation to see if the OMT response was positive.

• Complex Science: I was removing the hindrances from multiple systems, musculo-skeletal, nervous, pulmonary and GI.

• The thoracic and rib cage S/D might alter the related fascial planes and produce non-fractal orientations in the bronchial tree which might produce either shunting or stasis. Predisposing to the development of pneumonia.

• Fractal / Chaos physiology which is nonlinear physiology. We were apparently impacting multiple systems simultaneously.

• Autopoiesis: dynamic structure and function changes probably took place once the S/D hindrances were treated. Multi-agent modeling: we may have impacted SNS and CN-X/PNS function, altered vasomotor tone to multiple organ systems. These hindered mechanisms may have lowered the patient’s resistance and increased the patient’s susceptibility.

• Emergent properties: as the S/D-Hs were effectively treated, the patient’s health potential was able to emerge.

 

Unfortunately, not all patients respond that dramatically. If S/D-H is a major etiological component, this is not an uncommon scenario. If the S/D-H present had not been playing a significant clinical role, the OMT would have been useless and ineffective.

 

The message of this patient, she was mostly a HOST component patient and excellent allopathic care did not enable her to realize her health potential. She needed both the HOST and the DISEASE model care to realize her health potential. I hope this case history enables the reader to have a more comprehensive understanding of “Osteopathic Thinking” and Osteopathic patient care.

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Components:

• Cybernetic: my first exposure with Charles Bowles. OMT mastery with “feed-back” loop development

• General Systems Theory

  • When one of the clinical systems of the body is 
    comprehensively discussed, it is considered within the context of General Systems theory

• Complexity Science

  • When several of the clinical systems of the body are comprehensively discussed, it is done within the context of complex science. For example, the cardiovascular system is being discussed; one must also consider the pulmonary and nervous systems. Thus several multi-functional systems are simultaneously considered and discussed to appropriately understand the cardiovascular system. It is hypothesized that somatic dysfunction might alter the functional component of any one or all involved systems and how they interact. 

• Fractal Geometry

  • These systems are designed by a multiple division pattern of self similar patterning. This is the design of the nervous, arterial, venous, lymphatic and bronchial systems. This design enables a rapid distribution of impulses, blood and lymphatic fluids and air during ventilation. It is suggested somatic dysfunction might change the fascial tissues tension and turn parts or the whole fractal geometric system into a non-fractal section and result in either stasis or shunting in the involved region.

• Fractal Chaos Physiology 

  • Fractal physiological systems are complex non-linear systems. The metaphor to illustrate the complexity of these system is by the question what keeps the high wire acrobatic perform without falling. It requires all the complex data must be appropriately collected and displayed via attractor display strategies. Bell Curves and 2 standard deviation strategies can not account for the complexity. Fractal physiological analysis enables one to better understand and explain the 
    complexity and uniqueness of each patient. I’m suggesting somatic dysfunction may introduce confusion into these complex systems. The goal of OMT is to identify the hindrances to these complex systems from realizing their health potential. 

• Autopoiesis/Adaptation

  • Autopoiesis represents a form of dynamic structural and functional interactions. The most common example would be the barrel chest development of the COPD patient. Somatic dysfunction (S/D) of the thoracic and rib cage regions could contribute to these changes. 

• Multi-Agent Modeling 

  • ​This is a concept that really enables one to appreciate Osteopathic Thinking. Depending the location of the S/D, it might either stimulate the innervation of the SNS/vasomotor system and adversely impact circulation to a related tissue. Thoracic S/D might either stimulate or inhibit the SNS/motor innervation. S/D in the cranial base or cervical region might either stimulate or inhibit the PNS/vagal innervation. Altered rib cage mechanics might hinder ventilation, venous or lymphatic circulation. Thus challenging fluid and electrolyte function. S/D can hinder anyone, all or any combination of arms of the cell Schematic plus the Complex Adaptive Systems mechanisms and conceivably lower the patient's resistance and increase the patient's susceptibility,of the related tissues, enabling those tissues to become vulnerable to various etiology agents like viruses, bacteria, parasites, toxic agents, etc. and out of that chaotic condition a cancer or disease process could emerge. Thus this could be an example of multi-agent modeling. OMT to remove these hindrances may enable the patient to realize their health potential. Note, the OMT is not utilized to treat the disease but to remove the hindrances to normal physiological function.

• New science of Networks within networks

  • All the systems of the body are inter-connected and inter-woven as a complex system.

• Emergence Properties 

  • What emerges out of all these multiple complex systems interactions represents the patient’s illness. We must realize that you could have 100 patients who all have the same clinical diagnosis but each of the patients got to that end point by different routes. Thus S/D might produce hindrances to any of these mechanics, all of them or in any possible combination. Patient specific/sequenced OMT might enable the patient’s physiology to realize it health potential once the hindrances are removed.

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The above discussion can be best illustrated by a Kirkldy - Willis quote:​

Effective care must address not only the patient's diagnosis (the disease) but also the human needs (the host) in context of family, home, work, life interests and spiritual beliefs. 

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Professionals from all disciplines should come together to exchange ideas and learn from one another in an atmosphere of intellectual honesty, openness and congeniality.
 

He likens the relationship between Orthodox and complimentary Medicine to the bond between Newtonian and Quantum physics.

 

The Nature of our work is to combine the two.

Most clinical problems are part Newtonian and part Quantum.

When we combine the concept and principles of Tensegrity with the Complex Adaptive Systems concepts and language, we have a more comprehensive language and concepts potential to better understand and explain Osteopathic Principles.

These are all important tools utilized in Stiles’ teaching and practice.

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