The Osteopathic Recovery Process For Chronic Injuries
(March 2004)
by Mr. Marc Jones DO (UK), BSc(Hons)Ost, Osteopath (UK)
Chronic inflammation and chronic injuries are notoriously difficult to treat for any healthcare professional, but the osteopath does not shirk at such challenges!
It is reasonable to assume that, if it has been managed correctly, an acute injury should be pain-free and strong enough to resume normal daily and sporting activities within 6 weeks of the onset. If the injury is still causing symptoms at 6 weeks, it is then termed "chronic."
In review of last month's article (February 2004), remember that inflammation is important, as without it there is no healing process: "No inflammation" means "no healing." Histologically (that's a technical word for the study of cells), chronic inflammation is very different to acute inflammation. Put simply, acute inflammation is "watery, painful and high quality" and chronic inflammation is "gritty, granular, thicker and lower quality."
Treating chronic inflammation is not very different to treating acute inflammation. Developing directions of movement, increasing appropriate mobility and decreasing swelling are still important, but we will now probably have to deal with tissue oedema as well.
To the osteopath, there are many questions to be asked:
Why has the injured area not resolved itself within the acute inflammation phase?
Why has this led to a chronic inflammatory process?
Why is the body no longer able to compensate for the current problem?
Has the body reached a critical level of adaptability?
For inflammation to become chronic, there are three possibilities which can either be singular or in combination:
1. Predisposing factors
2. Maintaining factors
3. Aggravating factors
1. Predisposing Factors:
Osteopaths take detailed case histories about your previous medical history for many reasons. One reason is to help decide if osteopathic treatment is safe and appropriate and another is to see if any past injury or condition has the potential to affect the current complaint.
Predisposing factors cannot easily be changed within the body. Examples could be congenital defects, previous joint injuries that have not been treated successfully (or have received no treatment at all), or events that have left permanent changes in the musculo-skeletal or visceral structures. Posture is also a very important factor to consider, as this is involuntary for the majority of the time.
Changes are possible, but the chances of success are rated as "low."
2. Maintaining Factors:
These are factors that can be modified and that are sometimes difficult to avoid for the patient. Examples are sitting postures, foot and arch mechanics, mobile or restricted structures within the body.
Changes are likely and the chances of success are rated as "medium."
3. Aggravating Factors:
These factors are very easy to understand and are described as "cause and effect." If the patient avoids them, they will improve rapidly.
Changes are almost guaranteed and the chances of success are rated as "high."
The difficulty with all of these factors is in identifying each of them and then acting upon them through a combination of treatment, exercises and management of daily lifestyles. Just one malfunctioning joint has the capacity to cause a myriad of pain and dysfunction in other parts of the body.
The osteopath will first assess if there is one single structure causing the pain or if it is within a group of structures, e.g. is it a ligament or is it a whole joint area involving ligament, muscle, joint or capsule. The osteopath then decides which techniques are likely to decrease pain and alter function accordingly.
The second part of the treatment plan is to see how the dysfunctional area interacts within the body as a whole. Examples could be:
The elbow and its relationships with the neck and shoulder above and the wrist and hand below.
The lower back and its effects on the hips, intestines, ribs and neck.
The foot and the effects on the ankle, knee, hip and low back.
The upper back and the effect on breathing, the neck and migraines.
With this knowledge, the osteopath can then decide how best to modify each area within the neuro-muscular chain. If the injured area is stiff, it may be sufficient to work locally to improve movement and regain function. If a joint is hypermobile, wearing down and over-used, other areas may require modification by increasing their function so as to redistribute forces more evenly. In these cases, it is far easier to increase a small amount of motion in multiple areas, rather than a lot of motion in one area. Enough small changes will give a greater and safer benefit without the body facing undue stress.
Amongst all of this there is the recognition that there comes a critical point of limitation. The individual may want to lift 100kg, but if the skeleton can only physically lift 90kg, and every reasonable compensation has been achieved, the body WILL break down. Everyone has a limit, whether we choose to like it or not, as the human body is only as strong as its weakest link. Imagine trying to fire a cannon from a canoe - the canoe would not survive and the cannon would not be effective.
We are all becoming older, stiffer and less elastic. A general osteopathic treatment every three months can help, but taking care of ourselves on a daily basis is essential too.
Daily aches and pains are not normal. Doing something about them before they become chronic and more difficult to treat is important.
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Copyright © Marc Jones - Osteopath (UK), Osteopathy Vancouver 2003 onwards
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