Having finished my first round of second year exams a little over a month ago I have been in a bit of a recovery period…it won’t last too long as there are more exams coming up. My intention at the moment is to begin writing about the REASON that there is an order to treatment that is guided by principle (from the base up and down then the center out). Right now I will start with the reason that the neck is GENERALLY worked with in the latter stages of a treatment.
In Osteopathy (in anatomy really) the base of the body is the pelvis. The pelvic complex is where gravity and ground reaction forces meet (ie compression from gravity above and compression from the ground below). Nature has made this very clear in the design of the pelvic complex by creating loops that are oblique to the 3 cardinal planes so that force may be redirected as opposed to shearing a flat/level pelvis. Since the pelvis is the base that the entire body stems from it would follow that the base must be treated (or at least checked) first so that any portion of the treatment that follows is performed with respect to a FUNCTIONALLY level (it is unlikely that it will ever be truly level) base.
Now that the pelvis has been taken care of and, like an intelligent Operator, the lower limbs have been checked and cleared of lesions that may drive a pelvic or vertebral lesion, the vertebral column is examined and treated. The idea here is to create a FUNCTIONALLY straight column (more accurately – a vertebral column that displays multi-directional freedom of movement within the confines of present anatomy). The other reason that the legs are checked for lesions and used as levers is ESSENTIALLY 1 muscle – the psoas. If there is some form of lesion anywhere between the foot and the 12th thoracic/dorsal vertebrae the psoas can be used to correct it. Why? The psoas attaches to the transverse processes, the vertebral bodies, and the intervertebral disks from D12 to L5. Even more than that, the psoas blends with the crus of the diaphragm bilaterally and it also forms part of the posterior abdominal wall (meaning that ALL of the viscera are directly tied to the psoas and the quadratus lumborum through the mesenteries). I am clearly getting a little derailed here!
After correcting the lumbar spine, moving through the thoraco-lumbar (or dorsal-lumbar) junction, it is now time to correct the thoracic/dorsal spine. The side bending/rotation coupling in the upper dorsals (D1-D4) will LIKELY relate to the rotation (and thus side bending of the neck). Here is where we start talking details! The lower cervical complex follows a Fryette Type 2 mechanic – side bending and rotation to the same side, while the thoracic/dorsal spine follows a Fryette Type 1 mechanic – side bending and rotation to the opposite side. In a simplistic sense, if the thoracic spine is side bent right and rotated left the cervical spine seems to pick up the rotation and thus side bend and rotate left. To add to the anatomical picture it is very important to look at the soft tissue and the ribs. Dorsal side bending will have related alterations in the soft tissues of the thorax (ie – rhomboids, pectoralis major and minor) which will alter not only the vertebral mechanics, it will also alter rib mechanics. Why do rib mechanics matter to the neck? Look at the scalenes (anterior and middle scalenes attaching to rib 1, posterior scalenes attaching to rib 2). Look at SCM (attaching to the clavicle…the pectoralis major that will affect the position of the thorax attaches to the inferior aspect of the clavicle – your pecs can mess up your neck). How do the upper dorsals affect your neck? Look at longus colli (it attaches on the anterior aspect of cervical vertebrae as well as the first 4 thoracic/dorsal vertebrae). Look at splenius capitis and splenius cervicis. All of this soft tissue represents direct links between the thorax, the thoracic/dorsal vertebrae, and the cervical vertebrae.
Now that we have a baseline of anatomy running from the pelvis, through the regions of the vertebral column, to the cervical spine, it should now begin to make more sense as to why the cervical spine is generally corrected later on in the treatment process. No part of the body can be adjusted in a meaningful way if it is not coordinated with the rest of the body. The cervical spine will be adjusted to the thoracic/dorsal spine, the thoracic/dorsal spine will be adjusted to the lumbar spine, the lumbar spine will be adjusted to the pelvis. Based on functional anatomy MOST treatments begin at the pelvis. I will keep on chugging along and look at more treatment rationale going forward…BECAUSE FUNCTIONAL ANATOMY SAYS SO!