There is a common understanding of a dose-response curve in pharmacology. This is also an issue in general life as well as Osteopathic treatment. The basic idea is that a specific stimulus will provide a given response based on intensity and the same level of response will eventually require an increased level of stimulus through decreasing sensitivity (there are other dynamics where this is not the case and those are noted through observation). This is the way our body learns to ignore constant stimuli such as clothes, breathing, organ movement, constant road noise, and any other consistent stimulus (this is most often done by the reticular formation).
So what? Why should anyone care outside of pharmacists? Why should an Osteopathic Operator care? Every treatment is a specific stimulus that will create a response and the nature of this relationship is important in determining the course and frequency of further treatment. A chronic condition will necessitate a different approach than an acute one. A patient with a major deformation of bony tissue will require a different approach then someone who has a detrimental habitual posture. Further, each individual will respond uniquely to the same stimulus. It is the observation of the response that will allow the Operator to make an intelligent decision towards subsequent interactions.
An acute patient needs to have the present symptom removed before any correction can be made. This may require many short treatments/interactions in one day or over multiple days, it depends on the patient. The treatment may begin with the Operator not touching the patient while instead directing them to a comfortable position to drop the symptomatic dysfunction to a comfortable level. After that the Operator may continue with this method so the patient controls their own symptom until they can handle external mobilization from the Operator.
A chronic patient may need to be treated multiple times a week initially or they may only be able to handle treatment once a week or every other week dependent on their response to treatment. If someone has a painful reaction to treatment that may be a very positive sign showing that the poorly functioning tissues and regions have been called to action and they are complaining – this then turns the treatment to an acute situation for a brief time before the chronic condition is addressed directly again.
In the case of an injured athlete that has a short window before they need to perform more frequent, specific, and brief treatment may be appropriate and the nature of those treatments will be dictated by the response. Similarly an individual that will only be able to attend treatment for a short window may be approached similarly. On the opposite end of the spectrum some individuals may have many obstacles blocking them from attending treatment so they may be treated more deeply and less frequently unless they show a poor response at which point the infrequent treatment may be required to be gentle and given over an extended period.
These are considerations that require experience and observation to streamline. The young Operator is capable of these things while in a situation where they are still gathering information to streamline their decisions to make appropriate choices on how vigorous or gentle treatments need to be and then observe the results to see if they made the appropriate choice. The amassing of this information sharpens the Operator’s skill set and is always an evolving process.
This is a process that takes place in life in general if we are willing to be present and observe as openly as possible the reality in which we exist. Through that openness, willingness, and observation we can streamline our decision making process in all things. This is my interpretation of Dr. Still’s insistence that Operator’s avoid the trap of “treating by rule and not reason”. Living life by reason is not a situation where one thing is right and one thing is wrong, it is more a situation of making the most effective decision based on the greatest amount of information as one is capable of (sort of like the old idea of stealing to feed a starving family with no money as less offensive than stealing for simpler personal gain). It is very useful to take a thoughtful approach towards dosing out Osteopathic treatment! As always, just my thoughts right now that are continuing to evolve.