To some the saying “global, local, focal” with regards to Osteopathic treatment may not be one they have heard. Considering that it may not be a common saying for some I obviously first need to clarify the statement. It is clinically efficient to look at the global pattern that a patient presents followed by the local pattern and finishing with the focal pattern. Said another way it is necessary to clear the smoke to even find the fire.
Everyone has a primary behavior pattern that will put uneven stress and strain through the body and this will likely set the global pattern. If this global pattern is not dealt with then no other issue can be dealt with. If the primary reason for the global pattern is a habitual overuse issue it is important to consider what, if anything, may be done to moderate the behavior. Following moderation of the behavior it is important to then provide intelligent adjustment so that the affected tissues, nerves, vasculature, and systems may then begin to regulate themselves towards neutral function. When the global pattern is neutralized the local and focal patterns will often begin to unravel themselves as the uneven stresses and strains they react to are no longer present.
It is the large muscles that bring the strain to the small muscles as well as joints and all related tissue (this information is presented nicely in the book “An Analysis of the Osteopathic Lesion: A Study in Pathology, Physiology, and Anatomy” by George Malcolm McCole). The smaller and more reflexively driven tissues (vertebral musculature, vertebral ligaments, visceral tissue under local neurological control) will drive the local and focal patterns through bony malposition and related tissue changes (as described by Wolff’s Law – tissue forms and reforms along lines of strain). The local and focal lesions seem more important in the chronic condition as they are driven through reflex which must be broken. For the reflex to be broken the initial force needs to be reversed and the initial forces come in through the large muscles especially via the appendicular muscles and the superficial axial muscles. It is through this understanding and lens that the global lesion becomes the first one to interact with especially while employing a long lever as the limbs will place the most uneven strains on the body and all parts will have to REACT to the force brought to the body by the limbs. Since the limbs bring most of the force to the body and the body then reflexively reacts to that it is almost always necessary to use the limb to remove the line of strain to then clear the path to the local and focal lesions so that the chronic tissue changes surrounding them may be corrected and be less likely to return as the initial strain has been removed (or at least as much of it is possible within a single or successive treatments).
To further this reasoning it is necessary to recognize the basic reality of mass. A larger mass will overcome a smaller mass, period. The smaller mass will need to exhaust all of its resources to even attempt to keep the larger mass from overcoming it while the larger mass can overcome the smaller mass with relatively small expenditure of resources. Considering this it follows that an arm will do more to the cranium then the spheno-basilar joint. The spheno-basilar joint, as an example (one that I am highly annoyed with), is heavily invested in the shoulder girdle via the HUGE trapezius and the SCM as well as the extraordinarily forceful temporal-mandibular joint (TMJ). It is unlikely that the spheno-basilar joint will overcome the forces produced by the arms/shoulder girdle or the TMJ. The same will be said of individual inter-vertebral joints: the arms, legs, and large muscles attached to the vertebral column (such as the trapezius, psoas, quadratus lumborum, latissimus dorsi) will overcome an individual joint or inter-vertebral muscle and MUST be dealt with prior to the small lesion. This is not to say it is not relevant to interact with the small joint lightly to open the door to dealing with the large forces and go back to the small joint, there are many roads to travel, it is however to say that the small local or focal lesion will not leave or stabilize without the removal of the global pattern. The same will be said of the sacrum: the legs and the vertebral column will overcome the sacrum and as such it MIGHT not be as clinically relevant to balance the sacrum without first dealing with the vertebral column or the legs as they are more forceful than the sacrum itself.
There is a need for legitimate differential diagnosis in Osteopathic treatment and this requires a logical approach to prove or disprove where the issue actually lives. Based on the basic physical principle that a large mass (especially a highly mobile one) will overcome a smaller mass (especially a minimally mobile one) it follows that the large force needs to be removed to see if the global, local, or focal pattern are being driven by the larger or smaller patterns. When the large force is removed and the global pattern is neutralized the medium/local pattern may be dealt with if it is still present (it is here that one will KNOW if the global pattern was the driver due to the local pattern remaining or leaving). After the medium/local pattern is neutralized then the small/focal pattern may be dealt with (again if it is still present). After these steps are taken it is then reasonable to check for visceral dysfunctions or LEGITIMATE cranial dysfunctions as before this point those patterns are required to be considered reflexive or reactive due to the fact that the forces at play are small compared to the force exerted by natural, normal, and habitual movement. Once the global, then local, then focal patterns are dealt with it is then REASONABLE to say a visceral or cranial dysfunction actually exists as a driving force.
All of the information that travels through the human body runs through mobile tubes that require a relatively tight range of pressure gradients to function effectively, this includes nerves and blood vessels (nutrition, gas, metabolic waste, hormones and many other substances are INFORMATION traveling through blood as a fluid medium and they all help the body as a unit make the proper functional decisions in response to their presence in general as well as their location). These tubes run through mobile tissues that have the possibility of altering the pressure gradients through the whole system which will cause dysfunction due to the GLOBAL pattern first.
Saying all of this it is of primary importance to know that the most important element of health is ADAPTABILITY – there is no movement or position that is inherently bad as long as there is no fixation or habituation towards it. Right now, intellectually it is my goal to return adaptability to a patient while minimizing habituation as best as possible considering their greater life circumstances.