The Scope of Cranial Work Zachary Comeaux
Total Page：16
File Type：pdf, Size：1020Kb
Ch03.qxd 24/03/05 12:54 PM Page 67 67 Chapter 3 Integration with medicine – the scope of cranial work Zachary Comeaux INTRODUCTION CHAPTER CONTENTS Historical perspective Introduction 67 Defining osteopathy in the cranial field 69 As indicated in Chapter 1, the modern beginnings of cranial manipulation derive from the osteo- Formats for medical integration 71 pathic tradition as interpreted by William Garner Integrated osteopathic treatment – including Sutherland. And so, in part, the scope of cranial cranial 77 work is embedded in that of osteopathic medicine. Yet many in the osteopathic profession in general Case examples 78 have been slow to accept and implement this Conclusion 90 point of view. Despite osteopathy’s ambivalence, a variety of manual practitioners have been References 90 attracted to and have developed aspects of cranial manipulation. Historically, then, many practitioners have practiced cranial technique outside their culture’s definition of ‘medicine’. In a parallel development, those practitioners working in manual medicine, physical medicine and rehabilitation, sports medicine and American osteopathic medicine have to varying degrees integrated manual philosophy and techniques into orthopedic and disease model medical problem solving. This chapter deals with the some- times controversial topic of osteopathic medical integration and its relevance in cranial work both in America and Europe. It also addresses the issue of how this integration affects the definition of treatment goals and the choice of techniques. Historically, the scope of osteopathic work and thought has developed nearly independently on different continents and varied in its expression Ch03.qxd 24/03/05 12:54 PM Page 68 68 INTEGRATION WITH MEDICINE – THE SCOPE OF CRANIAL WORK even within countries. Despite common inspira- remains as a fact, influencing the health care of tions, there has been variation in philosophical millions of people. focus. In several quarters the search has concen- The progression toward legal recognition and trated on finding and treating the ‘osteopathic licensure of osteopathy has been variable through- lesion’, which has been variously defined. The out the world and continues to evolve. These emphasis has often been on the articular different national or regional expressions of osteo- components of the body, the joints. More recently, pathic philosophy have fostered different opinions at least in American circles and in that sphere of about the integration of medical concepts into influence, the goal of treatment has been to osteopathic practice. identify and treat somatic dysfunction, defined as Additionally, in the USA, the separation of John an impairment of body function caused by Upledger DO from the greater osteopathic structural distortion but possibly involving other professional community, in teaching craniosacral body systems. These may be due to congenital therapy to the general professional and lay public, conditions or may be acquired through trauma, has served as a stimulus for the osteopathic strain or adaptation. This represents an approach profession to be more proactive in teaching cranial that is broader than a biomechanical one. methods, while making treatment available to a In other settings, including among the students broader population. With these events, however, of J M Littlejohn DO, the British physician who has come a greater variation in medical competency worked with the founder of osteopathy, A T Still or commitment to osteopathic principles among and who propagated osteopathy beyond America, those treating under the name ‘cranial’. Cranio- there has been considerable focus on normalizing sacral therapists come from many backgrounds physiology and function. (Littlejohn’s point of and apply craniosacral principles to complement view will be discussed further below.) In this other aspects of their work. Since they are not setting a general protocol is often used in which necessarily medically trained, their awareness of any variation from normal is corrected until the other aspects of the patient’s medical condition whole works more harmoniously. Currently there will be highly variable. exists a muddle of methods and schools in the Chiropractic is another practice tradition that USA, Europe and Australia, competing for has included the cranial area in its treatment attention in defining what is and what is not an protocol. Although many practitioners incorporate osteopathic treatment approach. The point being the methods taught as craniosacral therapy, a made is that priorities in intent of treatment have derived system of sacro-occipital technique (SOT) shifted with time, depending on how one defines has evolved out of the work of Bertrand the patient’s problem – i.e. is it structural or DeJarnette (DeJarnette 1934, 1935) who blended functional? Sutherland’s original research with his own As implied above, the scope of osteopathic systematic thought. DeJarnette’s work then was practice has varied according to cultural and incorporated into the system of applied kinesiology, political setting. Early in its history in America, as formulated by George Goodheart and adapted the osteopathic profession fought for, and received, by others. The latter method varied from manual legal recognition as a fully privileged profession diagnosis by adding formulaic testing protocols, on a par with medical doctors. Partly this occurred simultaneously with active muscle testing, in because of the strong contribution to health care making diagnoses (Walther 1988) (see Ch. 5). given to communities in the rural mid-West where And so, it becomes apparent that cranial work the profession arose. Through these events, osteo- in particular has been introduced into practice pathic medicine has assimilated and contributed differently, at numerous locations and times. to many protocols in standard medical practice, Hence, the flavor and particulars of application of since its practitioners were free to practice the full the work vary according to the intent and bias of scope of medicine. Whether this development is the introductory contact, teaching in new cultural viewed as an advance or as a corruption of pure contexts, as well as the practical needs and osteopathy has been bitterly debated but it professional definition of the students. This leads Ch03.qxd 24/03/05 12:54 PM Page 69 Defining osteopathy in the cranial field 69 to the certainty that there is no single authoritative disadvantages, benefits and limitations of imple- voice for cranial practice. There is no ‘right’ or menting cranial concepts in a medically integrated ‘wrong’ cranial approach, whether it is bio- approach to the patient. mechanical in its focus and methodology or more ‘energy’ oriented. At present, despite heated debate, neither of these extremes has a clear DEFINING OSTEOPATHY IN THE evidence base and both seem equally effective in CRANIAL FIELD clinical practice, when appropriately applied. The dialectic: a drugless science Current focus Osteopathy’s founder, Andrew Taylor Still, This chapter aims to clarify an appreciation of the described an approach to medical care minimizing development of cranial manipulation as it evolved the use of the harmful drugs of his day and also in an osteopathic context and to provide an surgery. His intent was clear: to establish a opportunity for the reader to reflect on the complete system of health care based on dis- potential scope of application of cranial concepts covering and assisting the natural functioning of in his/her own particular health-care practice. Of body systems by optimizing structural integrity. special relevance is the interface between osteo- His scope was universal, including the study of pathic philosophy and contemporary medicine as anatomy, physiology, spirituality, philosophy and it affects cranial practices. The particular issue of theology as they applied to the patient. The integrated osteopathic thought and how it affects pursuit of knowledge, of science, was paramount perceptions, judgments and treatment strategies in diagnosing and treating (Still 1992, p. 6; 1902, in applying cranial concepts will be addressed in p. 44; 1899, p. 16). a cultural and historic review. He gave his students a philosophy but not a handbook of techniques. Briefly this included the • Does the head behave according to its own set conviction that much of patient symptoms and of dynamics or is it part of the rest of the body? illness depended on distortions of anatomic • What are the clinical consequences of one positions of bones or tension in fascia. This in turn (cranial) approach or another likely to be? led to congestion or edema, compression of nerves • Should the focus be on key symptoms and and interruption of free flow in blood vessels. His restrictions or should there be a more global main strategy in treatment was to find these approach to the patient? distortions and correct them in whatever fashion • When is it appropriate to blend information, was necessary and to then allow the body to diagnosis and treatment deriving from manual resume the natural function of healthy management. medical or orthopedic contexts? In leaving this life he gave admonitions which These questions are becoming more crucial as provide the roots of division. He told his osteo- physicians of manual medicine around the world pathic progeny to ‘keep it pure’ (Truhlar 1950), adopt osteopathic techniques. meaning not to adulterate their practice with the The issue of scope of practice and manner of use of drugs.