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The Bioenergetic Model in Osteopathic Diagnosis and Treatment: an FAAO Thesis, Part 1

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The Bioenergetic Model in Osteopathic Diagnosis and Treatment: an FAAO Thesis, Part 1 The Bioenergetic Model in Osteopathic Diagnosis and Treatment: An FAAO Thesis, Part 1 Jan T. Hendryx, DO, FAAO Abstract functioning, and care:1,2 biomechanical-structural, respiratory-circulatory, neurological, metabolic- The classic five-model concept of patient functioning, nutritional and behavioral-biopsychosocial. These assessment and care is central to current osteopathic models are supported by principles of anatomy, principles and practice. These primary models are physiology, biochemistry and psychiatry/psychology. biomechanical-structural, respiratory-circulatory, Each model provides a lens through which the patient neurological, metabolic-nutritional and behavioral- can be viewed, diagnosed and treated. These models biopsychosocial. are not typically utilized in isolation but have various A separate sixth osteopathic bioenergetic model exists degrees of overlap with the others. that emphasizes the concepts of life force or inherent The neuromusculoskeletal system is considered the energy flow within the body, energetic communication core interface among the models that helps to integrate with the environment, and tissue biophysical and coordinate basic body functions, while playing a and bioelectrical properties. This model has been primary role in a patient’s ability to adapt to multiple minimized in the past, but actually may provide the stressors (e.g., trauma, infection, nutritional, social) basis for all others. and maintain health.1 (See Figure 1) Although other healing arts disciplines (e.g., The biomechanical-structural model views the patient acupuncture, Reiki) utilize the bioenergetic model primarily from a structural perspective. It emphasizes quite rigorously, the osteopathic profession historically the anatomy of the muscles, spine and extremities and has been resistant to discuss, research or embrace resultant functions of posture and motion. Osteopathic bioenergetics as a plausible explanation for the efficacy manipulative treatment (OMT) is directed toward of osteopathic manipulative treatment (OMT), or normalizing biomechanical somatic dysfunctions as a contributing etiology of somatic and visceral (joints, myofascia), thus restoring normal structural dysfunction and health and disease. integrity, physiological functioning, adaptive potential This thesis will review the classic five models and and homeostasis.1 Osteopathic manipulative techniques osteopathic bioenergetic model; explore bioenergetic commonly utilized to normalize biomechanics include properties of living systems in an attempt to offer high-velocity low amplitude thrusting, muscle energy, explanations behind the palpatory experiences counterstrain, ligamentous articular strain, myofascial and therapeutic results of OMT; discuss two release,2 facilitated positional release3 and Still bioenergetically-based OMT techniques; explore an technique.4 expanded osteopathic bioenergetic model and discuss The respiratory-circulatory model emphasizes why the bioenergetic model should be utilized regularly normalization of a patient’s pulmonary and in patient diagnosis and care; and offer suggestions cardiovascular functions, and the circulation of fluids for osteopathic research into possible bioenergetic (blood, lymph, cerebrospinal fluid).2 Horizontal contributions to the causes and maintenance of somatic diaphragms (tentorium cerebelli, respiratory, pelvic), and visceral dysfunctions. thoracic inlet, thoracic cage, extracellular matrix, Literature Review lymphatics1 and viscera5 (heart, lungs, kidneys) are important anatomical structures addressed. The Five Osteopathic Models Osteopathy in the cranial field, cervical, thoracic and In the early 1980s, the Educational Council on rib mobilization, lymphatic drainage, respiratory Osteopathic Principles (ECOP) developed five diaphragm myofascial release, and visceral osteopathic conceptual models related to patient assessment, manipulative techniques are helpful in restoring health Page 12 The American Academy of Osteopathy Journal • Vol. 24, No. 1, March 2014 in combination with medications, Figure 1. Classic five models of physiological function coordinated and affected by the neuromusculoskeletal (NMS) system and adapting to external and internal environmental surgery, intravenous fluids and even stressors. Osteopathic diagnosis and manipulative treatment is seen as a key modality to ventilation as appropriate.1 help restore homeostasis and facilitate health. (Adapted from Foundations of Osteopathic Medicine, 3rd edition 1) The metabolic-nutritional model encourages maximizing the efficiency of the patient’s natural self-regulatory and self-healing mechanisms.1,2 Homeostatic adaptive responses are orchestrated through positive and negative feedback systems to regulate various forms of energy exchange and conservation that occur through metabolic processes and organ functioning. The neuroendocrine-immune system and all internal organs are the focus. Lifestyle changes such as appropriate exercise, nutritional counseling and stress reduction are primary therapeutic modalities, as are appropriate use of medications. Osteopathic manipulative treatment includes lymphatic pump and visceral techniques.1,2 The neurological model addresses aberrations in the peripheral, autonomic and central nervous manipulative treatment also may be helpful in the form systems that may cause pain and dysfunction. These of somatoemotional release with guided imagery13 and elements control, coordinate and integrate body emotional release.14 1 functions. Proprioceptive reflex and muscle strength The Bioenergetic Model in Osteopathic Medicine imbalances,6 spinal segmental facilitation,7,8 nerve compression and entrapment disorders, autonomic Healers in various cultures have utilized bioenergetic reflexes and visceral dysfunctions,8 nociceptive models of healing throughout the millennia. Oriental influences9 and brain dysfunctions10 are common medicine, for example, which originated in China problems. Manipulative treatment may include at least 5,000 years ago, describes the concept of qi osteopathy in the cranial field,11 Chapman reflexes, (ch’i)—energy or life force. Qi is thought to maintain rib raising, counterstrain, muscle energy, neural homeostasis and/or cause aberrations in health. In release12 and inhibition.9 Exercise therapy, including other words, abnormalities in qi (excesses, deficiencies proprioceptive balance training, stretching and or stagnation) are thought to be the root cause of strengthening,6 as well as appropriate neurological illness.15 evaluation, referral, surgery and medications may be Throughout the history of the osteopathic profession, appropriate in patient management. numerous manipulative techniques have been The behavioral-psychosocial model addresses a patient’s developed to treat a variety of patient ailments mental, emotional, social and, to some degree, and assist in maintaining homeostasis. These spiritual dimensions in relationship to health and techniques are primarily based upon biomechanical, disease.1,2 Mind-body interactions can have a huge neurophysiological or lymphatic/fluid models.1 Not influence on a patient’s wellbeing and functioning in included in the five classic models above, and rarely society. Depression, anxiety, stress, habits, addictions discussed both in the medical literature and clinically, and numerous other conditions must be addressed is the bioenergetic model. Bioenergetics is, perhaps, the appropriately, often in conjunction with medications, all-encompassing model that underlies the classic five psychiatry or psychotherapies, stress reduction, models, as well as life itself. meditation, and support groups. Osteopathic Vol. 24, No. 1, March 2014 • The American Academy of Osteopathy Journal Page 13 Bioenergetics is a unique field of research that acting in positive and negative phases. He suggested falls under the category of biophysics, and is not that electrical energy might be generated by the coiling emphasized, per se, as an important part of traditional and uncoiling of the neural tube. Additionally, he biology or clinical medicine. It is the study of how wrote, “In the cranial concept, human electrobiology is endogenous and exogenous energy sources/forms tremendously affected by its environment as it carries influence and control living systems and their out a similar transmutation throughout the body.” environment. Scientific study of bioenergetics of both One of the greatest champions for the bioenergetic plants and animals, including humans, has been prolific model was Robert Fulford, DO. Throughout much of and ongoing for at least a century.16,17,18,19 his career, he relied on his understanding of bioenergy Bioenergetic concepts actually have been a part of the to explain his hands-on techniques and use of the language and practice of osteopathic medicine from percussion hammer.30,31,32 He continually questioned the early beginnings. Andrew Taylor Still advertised and sought answers to the true nature and greater scope and practiced as a magnetic healer prior to founding of healing and osteopathic principles. He had a wide- our profession.20,21 In his book The Philosophy and ranging interest in research and therapies related to the Mechanical Principles of Osteopathy, he discussed the energetic life force, including polarity therapy.33 concept of “biogen”22 as vital (energetic) force operating Polarity therapy is an energetically-based system of through protoplasm to produce living matter.23 He health, diagnosis and treatment founded upon
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