MECHANICAL ENERGY

The following subsections provide some examples of manual medicine or body manipulation.

OSTEOPATHY

Andrew Taylor Still, a physician and an ordained minister, developed the diagnostic and therapeutic techniques of osteopathy after losing three of his children to

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brospinal meningitis in 1864. Feeling that conventional medical practice was inad-equate for the effective treatment of most illnesses, he introduced his concepts of osteopathy 10 years later and opened the first school of osteopathy in 1892 in Kirksville, Missouri. Still based his new methodology on the principle that the body is structurally and functionally one reciprocally interrelated system. Still felt strongly that the body has an inherent ability to repair itself and believed that the healthy body is a homeostitic unit, no a collection of functioning parts. It appears that medical science today is once again coming to terms with that fact.

Still’s diagnostic techniques included an evaluation of posture, joint function, the network of myofascial tissue, as well as the respiratory and lymphatic systems.

For many years osteopathy was primarily known for, the osteopathic manipulations he developed to restore the body’s homeostasis. The high-velocity, low-frequency technique (a thrust with an audible “pop”) is the best known manipulation and has been sanctioned by chiropractors as well as osteopaths. Other techniques involve palpating the skin or muscle to release muscle spasm or myofascial tissue and to permit lymphatic drainage. However, osteopathy also incorporates a spec-trum of therapeutic techniques, including nutrition, physical therapy, and conven-tional allopathic medical modalities such as pharmaceuticals and surgery.

A doctor of osteopathy (DO) has full medical licensing and practicing ability in the United States today. Yet, for the last 50 years or so, most DOs have divorced themselves from the classic osteopathic manipulation techniques and have largely practiced conventional medicine. It is notable that although doctor remuneration by insurance companies for the manipulation techniques are currently inadequate, there is a small group of DOs who are bringing back what is nearly a lost art of osteopathic manipulation (e.g., Magnus and Gamber, 1997). Osteopathic manipulation, coupled with the broader spectrum of osteopathic care, is currently used for numerous musculoskeletal injuries, childhood otitis media, and various respiratory conditions.

Published research largely involves reviews, case studies, description of techniques, or warnings of neurological complications. The few efficacy studies that can be found appear to be quite mixed, but they do seem to be strongest for musculoskeletal conditions (Bronfort et al., 2001b; Jarski et al., 2000; Jermyn, 2001; Pratt-Har-rington, 2000; Richards et al., 1999; Tettambel, 2001; Van Buskirk, 1996; Vicenzino et al., 1996; Williams, 1997).

CRANIOSACRAL THERAPY

The craniosacral system involves the brain, spinal cord, and cerebrospinal fluid (CSF).

In the late 19th century, William Garner Sutherland, who was a DO, discovered that the joints between skull bones have a small but palpable range of motion, as do all other joints throughout the body. He also discovered that the dural membranes that cover the CNS have a palpable range of motion. The dura is connected to the sacral and cranial bones, where a similar range of motion can be detected. Furthermore, Sutherland determined that there is a subtle rhythm, which he termed the cranial rhythmic impulse (CRI), that is part of a physiological and mechanistic structure concerned with the body’s inherent motility, called the primary respiratory mechanism (PRM). The CRI emanates throughout the body via the fascia (connective tissue) and the CSF (Magoun, 1976). The CRI cannot be detected on cadavers; it is an energetic

150 The Scientific Basis of Integrative Medicine phenomenon of life. To the skilled professional who can detect the delicate tactile impression, it is the palpable manifestation of the cyclic fluctuation (rather than cir-culating flow) of the CSF. It is a resonance that spreads throughout the body, meaning that the CRI that can be felt in the head occurs in conjunction with a fluctuation throughout the body. Cranial osteopathy involves gentle manipulation to the cranial area. A book published by the Sutherland Cranial Teaching Foundation explains that the therapeutic manipulations change the rate and amplitude of the fluctuation of the CSF and thus may have profound therapeutic effects (Magoun, 1976). Effects that extend to other parts of the body via the fascia often produce release of suppressed, emotionally laden memories. An energy transfer is said to occur between the practi-tioner and the patient, restoring balance to physical or emotional dysfunction.

While researchers found that both the subject’s and the practitioner’s CRI rhythms are not related to their respective respiratory or heart rates, the CRI rate of a patient, determined by two practitioners, is generally not the same. However, one practitioner can quite consistently palpate a CRI in the same patient at a consistent rate (Hanten et al., 1998). This study, in spite of its curious findings, states that “it is possible that the perception of CSR [craniosacral rhythm] is illusory.” Most of the few other scien-tific studies belay the authors’ skeptical attitudes, and much of the literature appears to be unable to validate Sutherland’s findings (e.g., Green et al., 1999; Rogers et al., 1998). One study supporting the use of craniosacral therapy proposes that the tional origin of CRI is the harmonizing of electrical signals from various body func-tions, particularly from signals between the sympathetic and parasympathetic systems.

This palpable harmonization is an entrainment of multiple biological oscillators. The researchers go on to speculate that skilled practitioners, who are versed with centering techniques, can also entrain their bodies with the patient’s, accessing the patient’s CRI for therapeutic benefit (McPartland and Mein, 1997).

In the 1970s, John Upledger, DO, created craniosacral therapy based on Suth-erland’s discoveries. The technique is taught to a variety of healthcare professionals, from medical doctors to those performing various types of bodywork, and requires no medical licensing. Craniosacral therapy is said to be useful for the alleviation of pain from accidents, for stress-related symptoms, for sensory disorders, and to promote overall health.

The Cranial Academy was established by Sutherland’s students to teach, research, and advance the techniques of cranial osteopathy. The Academy distin-guishes itself by certifying only osteopathic doctors, medical doctors, or doctors of dentistry and by requiring approved courses in cranial osteopathy. Cranial osteopathy is based on the same principles of osteopathic care, which emphasize treating the whole body and not any one symptom.

CHIROPRACTIC

Chiropractic treatment is a complementary modality with a long history of prejudice against its use. Daniel David Palmer, who restored hearing to a man by adjusting his thoracic vertebrae, developed the treatment in the 1880s. The profession was essentially legalized in 1987 when an injunction against the American Medical Association (AMA) ordered the AMA to cease its discriminatory practices against chiropractic

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care, a decision that the Supreme Court let stand in 1990. Chiropractic treatment involves manipulating the spine in order to correct structural imbalances, thus restoring nerve function. A misalignment in the spine is thought to cause a subluxation, which is a slight dislocation of bones within a joint. Currently, the term is used to refer to any type of vertebral blockage, but most often nerve entrapment. Chiropractors believe that such neurophysiological imbalances not only create pain in the body, but also reduce the effective functioning of the body’s immune system, leaving the individual more susceptible to disease. Thus, proper alignment of the spine results in optimal health. Currently, chiropractic treatment is prescribed for a variety of conditions, including injury, asthma, migraine and other forms of headache, and neck or back pain, with results of mixed efficacy (Balon et al., 1998; Bove and Nilsson, 1998;

Bronfort et al., 2001a; Conway, 2001; Jordan et al., 1998; Meade et al., 1990; Nelson et al., 1998; Tuchin et al., 2000). While complications may occur (Stevinson et al., 2001), studies generally show distinct improvement for some types of disorders as well as a reduction in overall side effects when compared with the side effects of pharmaceuticals (Freeman and Lawlis, 2001; Nelson et al., 1998).

M^ASSAGE

Massage, which appears to be as old as recorded history, is a manipulation of the soft tissues (i.e., skin, muscles, and fascia) of the body. The tissues are loosened and proper blood supply restored to these areas, resulting in a state of total body relaxation. Massage is also known to promote venous and lymphatic drainage (Free-man and Lawlis, 2001). In addition massage benefits the muscles, skeleton, and nervous system. It affects the ANS, which may reduce pain, support the immune system, and reduce anxiety (Chen and Chen, 1998; Cherkin et al., 2001; Zeitlin et al., 2000). Currently there are a variety of massage techniques used, but most originate from the work of Pehr Henrik Ling and his “Swedish massage” therapy.

While, historically speaking, massage is considered effective for pain relief and relaxation, it is also known to elicit feelings and memories of emotional trauma.

Several bodywork techniques have evolved in recent years that directly address the issue of the mind–body interface in bodywork, acknowledging the correlation between manipulation of the body and the releasing of deep emotions. Rolfing and the Trager method are just two examples of such approaches.

ROLFING^‚‚‚‚

Rolfing was named after Ida Rolf, who developed the technique of manipulating connective tissue, or fascia, to restore the body to a state of equilibrium in relationship to the earth’s gravitational forces. Her theory is based on the premise that if the body’s weight transmission is in a vertical central axis, it will move more efficiently and gracefully. Treatment requires ten sessions, each scheduled about a week apart. As the body is brought to this vertical position, it is thought that the sensations of pain that occur are the sites at which the body has stored emotional trauma. The practitioner applies sufficient force to stretch and move tissue, liberating old patterns of holding myofascial tissue and releasing emotions. The treatment can release lifelong patterns of tension. The result is often a more balanced manner of moving, which is mirrored by an increase in vitality and emotional well-being (Rolf Institute, 1976).

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TRAGER^‚‚‚‚ METHOD

Dr. Milton Trager developed the Trager approach to bodywork in 1927. The technique is intended to help the patient release patterns of tension held in the body. The first part of the therapy involves a treatment called psychosocial inte-gration, which entails light rhythmic rocking intended to produce a pleasurable experience and meditative state called the hookup. The mind–body interface pro-motes deep relaxation and the release of old pains and improves the patient’s flexibility and range of motion. Unlike Rolfing, the focus of treatment is on the psyche of the individual rather than the physiological changes. The Trager method sees the body as a vehicle to help the psyche achieve a sense of well-being. The second part of treatment, called mentastics^‚ or mental gymnastics, involves learn-ing exercise movements that can be performed at home. The movements are often free-flowing or dancelike. The exercise has repetitive components that are both physically and mentally relaxing and that reinforce the work of the practitioner (Trager and Hammond, 1987).

CHEMICAL ENERGY