A review of the principles of William G. Sutherland s general techniques by William J. Golden, DO, Department of Osteopathic Manipulative Medicine, Michigan State University College of Osteopathic Medicine
The following paper is the result Historical background ligamentous release, or ligamentous of the author's opportunity to person- H.A. Lippincott, DO was a de- articular release. "The purpose of the al/vinteracttirith several osteopathic voted student of Sutherland s, study- technique is to establish a state of clinicians that were students of Dr. ing his philosophy and describing his ligamentous balance by placing the William Sutherland. After observing techniques.6:7 In 1949, he writes: "In joint in the position which puts just a diversity of techniques amongst these days of rapid changes in medi- enough tension on the weakened liga- them, an endeavor to discover a com- cine, older methods are constantly ments to balance the tone in the mon method of approach was pur- being replaced by new, and there is a unstrained tissues. This position is sued. This paper is not only a reflec- scoffing at the procedures that were commonly found in the direction into tion of those experiences but also of used in the days of our grandfathers."6 which the joint moves most freely. the writings of others (the majority Let us therefore neither scoff nor ig- When it is found and it is established, being students of Sutherland's) in the nore these foundations but rather it is maintained by the hold of the attempt to bring together and harmo- learn from them by examining their operator." nize the osteopathic principles taught underlying principles. In another ar- Ligamentous articular strain (or by Dr Sutherland. ticle of Lippincott s he states: "It is balanced ligamentous tension) tech- evident that Dr. Still treated his pa- niques are used to treat dysfunction Introduction tients carefully, with due consider- at lesioned segments. Historically Dr. Sutherland s approach to the ation for the delicacy and the welfare termed the osteopathic lesion, these treatment of areas other than the cra- of the tissues beneath his fingers. It dysfunctions were described as nium are referred to as "general tech- is also evident that he imparted to the "strains of the tissue of the body."9 niques." These treatment modalities students who came under his super- Strain, as defined in the Glossary of were early applications of an indirect vision this wholesome respect for the Osteopathic terminology, is a "distor- method in manipulative management tissues, the structures, and their func- tion with deformation of tissue" evi- to establish what he expressed as a tioning. One of those students of Dr. dent by the presence of " motion and/ state of "balance" in the function of Still s was William Garner Sutherland or positional asymmetry associated tissues (bony and soft). In his gen- who graduated from the American with elastic deformation of connec- eral manipulative procedures, School of Osteopathy at Kirksville, tive tissue (fascia, ligament, mem- Sutherland s hand placements, patient Missouri in 1899. brane)." 1 ° This distortion can be in- positioning, etc., have already been Dr. Sutherland referred to strains duced by physical trauma (either mi- described. Several approaches us- that involve the bony cranium and its cro or macro), reflexes (such as vis- ing variations of these procedures dural membrane as membranous ar- ceral), emotional trauma, and perhaps have also been reported! " This pa- ticular strains, and to those that in- by external forces in utero and dur- per instead will explore some of the volve joints outside the cranium sur- ing the birth process." basic osteopathic principles and rounded by ligaments as ligamentous Thomas F Schooley, DO has sum- methods that involve a variety of con- articular strains. The osteopathic tech- marized Dr. Sutherland s approach to cepts underlying these procedures. nique of William G. Sutherland, DO general techniques as follows: " The is sometimes referred to as balanced principle of indirect action tech-
32/AAO Journal Fall 1999 nique is to position the articulation in the involuntary mobility of the tures. It also contains concentrically such a manner that there is no ten- sacrum between the ilia. placed tubes which allow for the pas- sion on any of the periarticular tis- Rollin E Becker, DO states: sage of central nervous system, the ver- sues in any of the cardinal planes of "Health requires that the PRM have tebral column and related structures." motion. This position has been the capacity to be (an) involuntary, "Fascia is very extensive. If all other called... balanced ligamentous ten- rhythmic, automatic, shifting suspen- tissues and organs were removed from sion. It is this position, with all ten- sion mechanism for the intricate, in- the body, with the fascia kept intact, one sion removed, that will allow edema- tegrated, dynamic interrelationships would still have a replica of human tous fluids to escape into the sur- of its five elements. It is intimately anatomy. Fascia surrounds every rounding tissues and circulatory sys- related to the rest of body through its muscle and compartmentalizes organs tem ...when the edema has been elimi- fascia( connections from the base of in the face, neck, and mediastinum. nated and muscles relaxed, the body's the skull through the cervical, tho- Fascia forms sheaths around nerves and own healing forces will restore the pe- racic, abdominal, pelvic, and appen- vessels. It envelops the thoracic and riarticular tissues to their normal state dicular areas of the body physiology. abdomino-pelvic organs. Fascia con- of health. This healing mechanism is Since all the involuntary and volun- nects bone to bone, and forms tendi- known as homeostasis."12 tary systems of the body, including nous bands and pulleys." the musculoskeletal system, are found Thus, these two key principles of Osteopathic principles in fascia/ envelopes, they too, are sub- osteopathic philosophy, the unity of the The Natural Healing Power ject to the 10 to 14 cycle-per-minute body and the natural healing force, (re- rhythm of the craniosacral mechanism flected as the "inherent activity of the The principle involved in "body s in addition to their own rhythms of in- PRM,") are common to the methods own healing forces" is critical to the voluntary and voluntary activity." of Dr. Sutherland. There are two other understanding of Dr. Sutherland s important principles of osteopathic teachings and methods. Osteopathy is Body Unity philosophy that get frequent reference: an art and science based on an articu- Fascia is a Latin word that means a structure and function are reciprocally lated philosophy; the inherent ability "band." It is a sheet of continuous fi- interrelated; and rational therapy is of self-regulation, self-healing, and brous tissue that lies deep to the skin based on body unity, self-regulation, self-maintenance appears to be a cor- and invests all the structures of the and the interrelationship of structure nerstone in that foundation. Termed vis body. Another concept of Dr. and function. medicatrix naturae in Latin, or "Breath Sutherland s general technique, which of Life" by Dr. Sutherland, the " inher- also incorporates the osteopathic phi- Application of principles ent recuperative, restorative, and reha- losophy, is the unity of the person. Thomas E Schooley offers some bilitative power...(is evident when) we "Anatomically, all the body structures comments about the therapeutic pro- recover from illnesses, fevers drop, are involved in connective tissue or fas- cedures that Dr. Sutherland applied in blood clots and wounds heal, broken cia, making them continuous and me- addressing these principles: "He taught bones unite, infections are overcome, chanically interdependent... when one his students to first determine the di- skin eruptions clear up, and even can- component is stressed or altered, other rection in which the somatic dysfunc- cers are known to occasionally undergo components are affected and respond tion was produced. This is the direc- `spontaneous remission. " accordingly." As the body is united tion of greater motion. He taught us to It is this "body s own healing anatomically, that which makes the move the articulation in this direction forces" that Edna Lay, DO comments body mechanically continuous, as a to the limit of available range of mo- on as the "use (of) the power or po- unified system is the fascia. Fascia "sur- tion and then to back off or release tency of the inherent activity of the rounds each muscle, vein, nerve, and the motion very slightly to the point primary respiratory mechanism all organs of the body." where there was no tension on the sup- (PRM) within the patient to assist the "From a functional point of view, the porting ligaments in any of the three release of strains."" The PRM is de- body fascia may be regarded as a single cardinal planes of motion and then to scribed as having five anatomic- and continuous laminated sheet of con- hold the articulation at this point until physiologic components: 1) the inher- nective tissue. This laminated sheet there appeared a softening or relaxation ent motility of the brain and spinal extends without interruption from the of the periarticular tissues... the opera- cord, 2) fluctuation of the cerebrospi- top of the head to the tips of the toes. It tor actually moves the articulation in nal fluid, 3) mobility of intracranial contains pockets, which allow for the the direction in which the somatic dys- and intraspinal membranes, 4) articu- presence of the viscera, the visceral function was produced."2° The under- lar mobility of cranial bones, and 5) cavities, the muscle and skeletal struc- -, Fall 1999 AA0 JoumaY33 lying concept that many of the originally occurred, and only this po- ence of Osteopathy. Sutherland Cranial Sutherland students seemed to agree sition. When the joint is returned to this Teaching Foundation 1990, p 191 -217. 3 Miller Herbert, DO. FAAO; personal com- upon, was that maintaining this "posi- position, the muscles promptly and munication. tion of balanced tension" allows the in- gratefitIlv relax.-24 4 Becker Rollin; Diagnostic Touch Part HI herent force, the self-healing v is Also, the positional terminology Academy of Applied Osteopathy Year- medicatrix naturae to work?' Edna Lay, and concepts such as "retracing the book, 1964, p 161166. DO writes: "keep your sensing appara- path of the lesion" are not a universal 5 Chila Anthony; Fascial-Ligamentous Re- lease. Foundations for Osteopathic Medi- tus alert so that it perceives the slow medium for describing the application cine. Williams and Wilkins, 1997, p movement of the PRM (primary respi- of indirect methods. One needs to con- 819-832. ratory mechanism). This movement sider the functional orientation for 6. Lippincott HA; The Osteopathic Tech- feels like a longitudinal ebb and flow technic in its development by Drs. nique of Wm G. Sutherland, DO, Ameri- or a subtle pumping effect up and down Hoover, Bowles, and Johnston begin- can Academy of Osteopathy Yearbook, 1964,p 138. the spine...continue to maintain this po- ning in the 1940s. "Functional" tech- 7. Lippincott HA; Basic Principles of Osteo- sitioning and to observe this rhythmic nique is also considered an indirect ma- pathic Technic: AAO Yearbook, 1961, p motion; the inherent force is working nipulative method. Instead of retrac- 45. through the tissues that are maintain- ing the path of the lesion and reiterat- 8. Wales Anne: Ligamentous Articular Strains and Membranous Articular Strains ing the somatic dysfunction. As they ing other positional concepts, their ori- American Academy of Osteopathy Year- accomplish their task for this articula- entation embodied a concept "of a book, 1951, p 74. tion at this time, the amplitude of the mobile system and mobile segments 9. Lippincott HA: American Academy of Os- inherent rhythm lessens and the pump- that acted in concert with one an- teopathy Yearbook, 1964, p 138. ing decreases, and the tissues beneath other..." It is not a positional criteria 10 .The Glossary Review Committee of the Educational Council on Osteopathic Prin- your palpating fingers seem to soften that is applied in functional; rather, it ciples. Glossary of Osteopathic Terminol- or melt.'"' is the palpable response to specific ogy, AOA, 1993. motion demands. There is a motor co- Lay Edna: An Outline of Osteopathy in Discussion ordination "necessary for each bone to the Cranial Field. Department of Osteo- be in the right place at the right time pathic Theory and Methods. 1980, p I. Presented in this paper are some ba- 12.Schooley T. Osteopathic Principles and during these demands, implying a sic, common underlying principles that Practice, 1987, p 45. were utilized by several students of Dr. theoretic basis in neurophysiology for 13.Korr I: An Explanation of Osteopathic William Sutherland. Continuing devel- indirect methods:" Principles. Foundations for Osteopathic opment of such principles as body unity, The osteopathic principles underly- Medicine. Williams and Wilkins, 1997, p ing the methods and concepts of Dr. 10. the self healing capabilities of the body, 14.Lay E. Cranial Field. Ibid. p 911. and therapy based on these concepts Sutherland's general techniques, such 15.Becker Rollin: Craniosacral trauma in the were carried on by several of Dr. as body unity and the self-regulatory, adult. Osteopathic Annual. 1976, 4:43-59. Sutherland's students (Drs. R. Becker, self-healing, and self- maintenance of 16.Seffinger M; Osteopathic Philosophy. Foundations for Osteopathic Medicine. E Lay, T. Schooley, A. Wales. and the body, continued being reflected in the writings of his students. Using in- Williams and Wilkins, 1997, p 4. Herbert Miller respectively). 17.Still AT. The Philosophy and Mechanical Key application was the use of indi- direct methods in manipulative treat- Principles, p 60. rect methods to treat somatic dysfunc- ment for somatic dysfunction also con- 18.Upledger J; Craniosacral Therapy. tions. Procedures "that initiate direc- tinued to be a frequent approach Eastland Press, 1983, p 237-238. 19.Burns N: Fascia. An Osteopathic Ap- tions of decreasing tissue resistance are amongst his students. However, the proach to Diagnosis and Treatment. concept of position or retracting the termed indirect."" Application of the Lippincott-Raven, 1997, p 19 indirect method used by several "position in which the lesion occurred" 20. Schooley T; Osteopathic Principles and Sutherland students applied terminol- may deserve reconsideration as a Practice. Privately published. 1987, p 44. ogy to express a concept of "retracing teaching tool for indirect method, in 21. Lay Edna; Cranial Field. Foundations for light of the diverse themes that have Osteopathic Medicine, p 912. the path of the lesion." 22. Ibid. p 912. emerged. The indirect method of decreasing 23. Johnston Wm, Friedman H. Functional tissue tension is not isolated to Methods. American Academy of Osteopa- Sutherland's general techniques. By Bibliography thy, Indianapolis, Indiana, 1994. 24. 1964, Lawrence Jones, DO who intro- I. Lippincott HA: The Osteopathic Tech- Jones, L. Spontaneous release by position- ing. The DO, 1964, 4: 109- 116. nique of Wm G. Sutherland, DO Acad- duced "Spontaneous Release by Posi- 25. Foundations, p 800. tioning" writes: "even the severest le- emy of Applied Osteopathy 1964 Year- book, p 138-146. 26. Johnston, Wm, DO, FAAO; Personal sion will readily tolerate being returned 2. Sutherland Wm G.: Teachings in the Sci- communication.0 to the position in which the formation
34/AAO Journal Fall 1999