The long (and very worthwhile) journey through my Osteopathic education continues on and my personal thought process keeps running with it. At the moment I am very much concerned with what I see as giant blind-spots in the way human health is approached on an intellectual level as well as on a treatment based level. At the moment I am thinking through Wolff’s Law (tissue forms and re-forms along lines of strain). This particular line of thought leads me to be able to talk specifically about musculo-skeletal concerns while also having the opportunity to extend those thoughts to physiological pathologies (realistically in this thought process I am at best following in the footsteps of giants).
Enough preamble! It is very common knowledge that biological tissue is responsive to stimuli (both external and internal). This can be seen in some cultural practices such as with the Kayan people in Burma, ear stretching (which is currently broadening its presence through many cultures), as well as the most common which is physique sculpting (aka body building). We can change the shape of tissue through specific, continuous loading. The tissue will remodel in response to the environment it is presented with as well as the loads placed through it.
While the ability to remodel tissue in a specific direction is clearly evident on a day to day basis the basic reality of this information is often overlooked in a healthcare sense or blatantly ignored and called nonsensical. The most commonly known occurrence of tissue remodeling is bunions which currently have a foolish argument over the causative mechanism. The argument is not over whether it is footwear (which it sort of is and it sort of isn’t), it is whether it is just footwear or if it is a genetic predisposition that footwear happens to exacerbate. Their is no argument over whether or not an external mechanical factor (in this case assumed to be footwear) is at play so why would the basic knowledge of tissue loading and remodeling not be used to deal with the issue? Why would the relationship between the foot, the leg, the thigh, the pelvis, the lumbar spine/abdomen, the thoracic spine/thorax, the neck and position of the head not be considered when it is clear there is an excessive load placed on the great toe?
There is a well understood mechanism that seems ignored outside of traumatic issues that are followed by fixation (ie casting a broken bone). It is necessary to know that tendons do not attach to bones…funny, that is the common thought right? TENDONS BLEND WITH PERIOSTEUM. Why does that matter? The osteogenic layer is essentially the most superficial layer which means that as the tendon receives force from the muscle and transfers it through the periosteum to the osseus bone creating movement there is movement away from the osseus bone core by the periosteum. This movement creates a strain that needs to be responded to which will be done by that osteogenic layer creating more osseus tissue to ensure that their is resistance to injury as well as efficiency of habitual movement. Extending from that there is the reality that there is also thickening of all other tissues in response to stress and strain which is a NORMAL response to loading. If a person has a shoulder issue that was not caused by direct trauma then we are looking at a NATURAL and NORMAL response to biased loading.
Alright, who cares? Everyone should care! Our current proclivity for biased movement or, more accurately, non-movement leads to very predictable outcomes. Sitting on a couch more than moving through the world, sitting at a desk typing a blog post (as I am doing now), driving long distances to get to a desk job to afford the couch you will drive home to after maybe spending an hour in the gym…the picture should be coming in to focus. While I have specifically provided a very brief overview of bone growth with relation to loading through muscle and tendon the same basic process applies to ALL TISSUE. We have recognition of the basic fact that using tissue helps at least maintain function in common language through the saying “if you don’t use it you lose it”.
How does this apply to Osteopathy? In every possible way! The human body, or any other thing that is naturally formed or even synthetically made is 100% subject to the laws of nature and the mechanisms it has to respond to the environment as it is ever changing. The human body is built to move and its functions REQUIRE this movement or else they work at a lower efficiency either globally, locally, or focally. Movement through the environment DRIVES remodeling in humans. Myositis ossificans is bone remodeling in a spot that is not ideal for function while osteoporosis is bone remodeling that is not up to snuff. In the case of osteoporosis there are a myriad of possibilities for causative mechanisms, many of which happen to locate their hormonal governance in the kidneys/liver/thyroid/individual bones and as such it would make sense to make sure that the environment in which these functions operate are working freely such that they are able to call for substances they need and send out their products to the body. As a united structure that requires all of its tissues to promote function which means they all need to be subjected to loads and movement to call for blood and move it on through the system which will also send signals along the information superhighway which is the nervous system. These loads SHOULD be delivered through daily life, and when they are not, a smart Osteopathic Operator has the tools to understand the structures and functions that work in unity that may be hindering global, local, or focal dysfunction and then apply an intelligent solution. The intelligent solution may be found in interfacing with a muscle, it may be found in interfacing with a tendon, it may be found in interfacing with a ligament, it may be found in interfacing with a spinal joint, it may be found on any level. It is an intelligent Operator that is aware of the HOW of the way they interface with the tissue that will create a desired effect. The rate, the rhythm, and the repetition of treatment will send specific stimuli through the body that will guide the response. It is not the application of treatment that is important, it is the response to treatment that is important.
As a young Operator I may understand the preceding intellectually but I definitely need to hone my skills so that I am able to take aim at the appropriate application for the appropriate response. All of that being said I will close by saying that it takes a lot of hubris to have information readily available in common science that would lead to non-invasive application of treatment and completely ignore it until there is an allopathic pathology in place.