Through my evolution as a young Operator the ART of Osteopathy is becoming more and more clear. It is not that it is an endeavor such as painting a picture or taking a beautiful photograph, it is more so that there is a physiological reality of response to stimuli and the Operator is responsible for knowing that and applying this knowledge to the way in which they INTERACT with the patient (physical touch is not the only part of the interaction, the conversation matters as does the general environment…). As Brandon Stevens often tells students at the Canadian Academy of Osteopathy you need to be easy on the senses (as an Osteopath and as a human being in general).
How does physiological response determine treatment approach? The Operator is and always will be a source of external stimuli to the patient and thus is governed by the patients inherent systems to illicit a desired and helpful response. There are many types of sensory nerves present all over the body and they are the first line of information the patient will receive from the Operator. Knowing the expected responses from the parasympathetic system through the whole body will guide an Operator to choose to stimulate (through on-off pressure) or inhibit the SYSTEM (through a gentle hold) on certain sites that provide SENSORY information to the parasympathetic system (this requires knowledge of anatomy as some sensory nerve to the parasympathetic system are quite superficial). Conversely knowing the expected responses from the sympathetic nervous system will guide inhibition or stimulation of the sympathetic SYSTEM. Due to the diffused nature of connection within the sympathetic nervous system the choice to stimulate or inhibit in a specific area for a specific response doe not hold legitimacy as that is just not how we are wired (think of the sympathetic chain ganglia as well as the possibility of going straight to the adrenal medulla). Also knowing the real anatomy of the nervous system (ie the location of spinal cord segments versus the path of the nerve through intervertebral foramina).
Similarly it is important to understand the basic levels at which nociceptors work (aka the sensory side of the ascending pain pathways). There are chemical as well as mechanical and thermal nociceptors. The signs of these signals on the surface are able to be INFERRED by looking for asymmetry (mechanical), restriction (of mechanical movement), tissue texture changes (generally chemically mediated but linkable to alterations in movement via sensory – motor/viscero-motor pathways), sensorial changes (this can relate to mechanical restriction of a nerve or chemical pathways that determine the function of a nerve), as well as temperature (hot is often chemically mediated as an acute response and cold is often chronic as mediated by vasoconstriction through the sympathetic system). When there is functional alteration that will definitely show on the surface of a body the Operator has SECONDARY diagnostic criteria as we can not legitimately see things on the cellular level or anything directly under the skin or in an organ system. When knowing these things an Operator can make an intelligent choice and monitor the previously mentioned criteria to show change. If the sensory side of the issue is altered then the motor side must change in its natural and predictable way (John Martin Littlejohn was of this mindset as was Dr. Still, Littlejohn just used a lot more words).
If we understand on a basic level that humans essentially work as entities that sense, interpret, and then create a response to the sensory stimulus we have a baseline to work from. If we look to common scientific knowledge in the field of physiology we already have all of the information to prove this. If we acknowledge that we can interact with these pathways if we know how to apply stimulus, what the paths in are, and then how that stimulus will generally direct the body then we can also recognize HOW we interact with a person in all ways (words chosen as well as how the Operator uses their body in respect of the patient) is where treatment lives. TREATMENT does not equal TECHNIQUE. What I want to make clear is that HOW AND WHY TECHNIQUE IS CHOSEN AND APPLIED does equal TREATMENT. Treatment is the sum of stimulus applied towards an expected and desired outcome. Treatment success can be evaluated based on the alterations in diagnostic criteria (whatever that may be as chosen rationally). Remember that HOW you interact with everything and everyone for all reasons has fairly predictable outcomes based on physiological realities that exist within real anatomical structures. PAY ATTENTION TO THE REALITY OF THINGS WITH AS MUCH INFORMATION AS YOU ALREADY KNOW AND KEEP LEARNING MORE.