It is a perfectly well established technique, there is no mystery about it. It ought to be part of the equipment of every doctor in the country.
George Bernard Shaw (1856–1950), speaking about osteopathy in 1927
Many of you reading this book may be more familiar with CFS/ME than with osteopathy and you may by now have a clearer understanding of the mechanical processes leading to CFS/ME, but still you may be wondering how osteopathy can help.
Current treatment for CFS/ME includes dietary regimes, with evidence to suggest that essential fatty acid intake must be normalised in the management of the disease. Psychotherapy, exercise programmes and antidepressants have all been advocated. The different treatment programmes all – whether chemical, hormonal, or psychological – focus on palliative treatment rather than cure.
Osteopaths aim to treat CFS/ME by reducing the irritation of the sympathetic nervous system in the patient, thus allowing a return to a healthy homeostatic state. My hypothesis is that this can be achieved by increasing the drainage of toxins from the cerebrospinal fluid via the lymphatics. The treatment also reduces the tone of the sympathetic nervous system by improving the structure and overall quality of movement of the lower cervical, dorsal and upper lumbar regions of the spine, together with relaxation of the surrounding musculature.
The two sympathetic trunks (see page 25) are integrally related to the overall structure of this area. By reducing mechanical irritation, disturbed sympathetic afferent impulses may be minimised, further helping to stabilise blood and lymph flow. My core theory proposes that the breakdown of this system is central to the disease process of CFS/ME and that, by restoring the neurological equilibrium, one reduces the metabolic disturbance, thus addressing the cause of the symptoms.
“Osteopathy is the knowledge of the structure, relations and functions of each part and tissue of the human body applied to the adjustment and correction of whatever may be interfering with their harmonious operation,” to quote A.T. Still.1
Dr Andrew Taylor Still (1828–1917) of Kirksville, Missouri, founded osteopathy in the latter part of the nineteenth century as an alternative to the poor quality of medicine practised at the time. He called his new system of medicine ‘osteopathy’ from the Greek words for bone osteon and disease pathos. His basic tenet for viewing the body as a machine was based upon his religious beliefs and upon his despair at the futility of most medication available at the time. He formulated his original hypothesis from Biblical text. ‘Let Us make man in Our image,’ Genesis Ch 1, verse 26. Still, who was the son of a minister, took this verse literally. He postulated that if The Creator is perfect, man must have been made perfect. As he stated, “The principles of osteopathy give us an understanding of the perfect plans and specifications followed in man’s construction”. Osteopathy teaches that structure governs function. Thus illness, Still maintained, develops when the perfect structure is out of balance.
Osteopathy became popular in the American mid-west and there are now twenty established osteopathic medical schools in the USA, with an enrolment of nearly 10,000 students. The first osteopathic college in the UK was The British School of Osteopathy, established in 1921. Today, there are over 3,000 osteopaths in the UK registered with the General Osteopathic Council, formed by Act of Parliament in 1998. The profession is now accepted in Great Britain, to some extent, with other mainstream medical disciplines.
According to the General Osteopathic Council, osteopathy is an established recognised system of diagnosis and treatment, which lays its main emphasis on the structural and functional integrity of the body. It is distinguished by the fact that it recognises that much of the pain and disability we suffer stems from abnormalities in the structure of the body and their effects on function as well as damage caused by disease.
One of the major concepts of osteopathy is that the structure of the body governs the function of the organs within. Osteopaths work on the principle that a patient’s history of illnesses and physical traumas are written into the body’s structure. It is the osteopath’s developed palpatory sense that enables the practitioner manually to diagnose while treating the patient. The osteopath’s job is to restore a healthy structure to the body and thus restore its function. The osteopath gently applies manual techniques of massage and manipulation to encourage movement of body fluids, eliminate dysfunction in the motion of the tissues, relax muscular tension and release compressed bones and joints. The areas being treated require proper positioning to assist the body’s ability to regain normal tissue function.
One of Still’s students, William Sutherland, noticed that when the bones of a disarticulated skull were viewed in a certain way, they resembled the gills of a fish. Accordingly, he hypothesised in 1898, that their shape was designed to allow for movement and, as explained in Chapter 8, cranial osteopathy was born.2
The main lymphatic vessels are known to be under the control of the sympathetic nervous system. The smooth muscle wall of the thoracic duct, when stimulated, produces a wave of contraction – peristalsis – aiding lymph drainage into the subclavian vein. This produces a negative pressure along the lymphatics and aids further lymph drainage.
The choroid plexus in the brain consists of many blood capillaries which allow fluid to filter out, becoming cerebrospinal fluid. Sutherland emphasised the importance of the choroid plexus in the chemical exchange between cerebrospinal fluid and the blood (see Fig 1, page 5), but stressed the part played by the lymphatics in the drainage of toxins from the central nervous system. He said, ‘When you tap the waters of the brain by compressing the fourth ventricle see what happens in the lymphatic system. Visualise the lymph node that is holding some poison that has gathered there, changing the constituency before the lymph is moved along into the venous system.”2
Andrew Taylor Still discussed the importance of examining disturbed fluid motion in the head, in the pathogenesis of many signs and symptoms such as headaches, enlarged tonsils, dizziness and loss of memory, all associated with CFS/ME. ‘We strike at the source of life and death when we go into the lymphatics.’3 Still emphasised that it was equally important to have perfect drainage as well as good blood supply.
This includes drainage of mucus from our noses. Sutherland postulated that each of the sinuses behind the face has one or more bones that help drain mucus, which is produced in special cells called ‘goblet’ cells that line the inside (epithelium) of the sinuses, by a gentle pumping action. This facilitates a wafting action that forces the mucus into the nasopharynx (back of the throat). When mechanical or other forces damage this mechanism, the sinus is less able to drain the mucus. As a result, the mucus pools, thickens and makes us prone to infection. The nasal mucosa may then become continually inflamed with large amounts of purulent mucus and associated enlargement of our adenoids and tonsils. Mechanical dysfunction such as this can be detected by palpation and can be released by gentle pressure techniques applied to the cranium and the spine.
Lymphatic vessels in the submucosa of the nasal sinuses are the initial recipients of the drainage of cerebrospinal fluid through the cribriform plate. As early as the1890s, Taylor Still noted, ‘The lymphatics are closely and universally connected with the spinal cord and all other nerves, and all drink from the waters of the brain’.4 From the earliest days of osteopathy the importance of good lymphatic drainage in the thoracic duct has been seen as paramount to sustain health. Taylor Still himself wrote: ‘At this point I will draw your attention to what I consider is the cause of a whole list of hitherto unexplained diseases, which are only effects of the blood and other fluids being prohibited from doing normal service by constrictions at the various openings of the diaphragm. Thus prohibition of the free action of the thoracic duct would produce congestion.’5
The average pulsation of the cranial mechanism is believed by many practitioners to be between 8 and 12 beats per minute in health, although in some studies authorities have calculated the average rate to be 12.47 impulses per minute with the rate for normal adults being 10-14 cycles per minute(cpm).6-9 Other investigations relying on manual palpation of the cranial rhythmic impulse (CRI) have recorded values of between 3 and 9 cpm (cycles per minute).10-13
At present there is no means of measuring the patient’s cerebrospinal fluid’s drainage into the lymphatic duct. However, clinical assessment of hundreds of CFS/ME sufferers since 1989 has revealed a weak, arrhythmic or slow CRI in patients with CFS/ME compared with any of the average healthy rates mentioned above. These findings coincided with lymphatic pump reversal leading to palpable engorged varicose lymphatics.14,15
As osteopathy’s founder stated over a century ago, ‘Harmony only dwells where obstructions do not exist’.16 The Perrin technique, which seeks to reduce the obstructions and restore harmony, thus has a very significant part to play in the effective treatment of people with CFS/ME.
Age: 40 years
Occupation: Computer science teacher
Marital status: Married, with one 10-year-old daughter.
When I first examined him Mr I complained of severe pain in his neck, shoulders and low back, which had been troubling him for many years. In the past, he had suffered a few minor injuries to his spine, and presented with a stiffened, arthritic thoracic spine. This postural problem was exacerbated by his profession, spending much of his working day bent over a computer console. He also complained of aches in both legs and weakness in his arms, as well as a general feeling of fatigue and dizziness. As with some of the other patients, his CFS/ME was associated with a permanent restriction of the dorsal spine due to wear and tear.
With treatment to improve the mechanics of the upper back, Mr I’s symptoms of CFS/ME have improved. However, his spine will never be completely mobile, and because of the damaging nature of his work, Mr I will continue to need periodic treatment.
As soon as Mr I experiences more back pain than usual from the physical strain of his work, he immediately begins to suffer from fatigue symptoms. These are quickly relieved by manipulative treatment. The speed of his improvement following therapy neatly demonstrates the relationship between the mechanical health of the spine and CFS/ME.
1. Webster GV. Sage Sayings of Still. Wetzel Publishing Co, London; 1928: 11.
2. 2. Sutherland WG. In: Wales AL (ed) Teachings in the Science of Osteopathy, Sutherland Cranial Teaching Foundation, Ft Worth, Texas; 1990: 64
3. Still AT. The Philosophy and Mechanical Principles of Osteopathy, Hudson-Kimberly, Kansas City, Mo; 1902: 68.
4. Still AT. The Philosophy and Mechanical Principles of Osteopathy, Hudson-Kimberly, Kansas City, Mo; 1902: 66.
5. Still AT. The Philosophy and Mechanical Principles of Osteopathy, Hudson-Kimberly, Kansas City, Mo; 1902: 150.
6. Woods JM, Woods RH. A physical finding relating to psychiatric disorders. Journal of the American Osteopathic Association 1961; 60: 988-993.
7. King HH, Lay EM. Osteopathy in the cranial field. In: Ward RC, ed. Foundations for Osteopathic Medicine. 2nd ed. Baltimore, Md: Lippincott Williams & Wilkins; 2003: 985 -1001.
8. Magoun HI. Osteopathy in the Cranial Field. 2nd ed. Kirksville, Mo: The Journal Printing Company; 1966.
9. Upledger JE, Vredevoogd JD. Craniosacral Therapy. Chicago, Ill: Eastland Press; 1983.
10. Nelson KE, Sergueef N, Glonek T. Recording the rate of the cranial rhythmic impulse. Journal of the American Osteopathic Association. 2006; 106 (6): 337-341.
11. Norton JM, Sibley G, Broder-Oldach R. Characterization of the cranial rhythmic impulse in healthy human adults. American Academy of Osteopathy Journal. 1992; 2 (9):12, 26.
12. McAdoo J, Kuchera ML. Reliability of cranial rhythmic impulse palpation. Journal of the American Osteopathic Association. 1995; 95: 491.
13. Hanten WP, Dawson DD, Iwata M, Seiden M, Whitten FG, Zink T. Craniosacral rhythm: reliability and relationships with cardiac and respiratory rates. J Orthop Sports Phys Ther.1998; 27: 213 -218.
14. Perrin RN. The Involvement of Cerebrospinal Fluid and Lymphatic Drainage in Chronic Fatigue Syndrome/ME (PhD Thesis). University of Salford, UK, 2005.
15. Perrin RN. Lymphatic drainage of the neuraxis and the CRI: a hypothetical model. Journal of the American Osteopathic Association. Accepted Feb 2007: In Press.
16. Still AT. Philosophy of Osteopathy, Published by the Author, Kirksville, Mo; 1899: 197.