Where Did The Progress Go?

American FlagMy father was an American. My father was a wrestler (he had several scholarship offers but got drafted in to the Navy during the Vietnam War), a boxer, and a running back. He often told me when I was young that if I did not enjoy the feeling of getting punched in the face that I should not fight. When I took martial arts I was taught that the first principle of conflict was that if I was unwilling to match the intensity of my opponent and accept the worst possible outcome that I should not enter the conflict. I am writing what follows in response to an exchange I had on Facebook with a member of the Institute of Classical Osteopathy on the Society for Osteopathic Wellness page.

Apparently many people that viewed the exchange have taken issue with how they perceived my words. I will make it clear that I am acutely aware of the words I chose. I will make it clear that I understand how people may see my words as rough. I will make it clear that I purposely chose my words in order to attempt to engage in dialogue regarding a theoretical model that was co-opted long after its inception to explain the basis of a treatment routine named the Body Adjustment by John Wernham. Mr. Wernham just simply placed a brand name on a general treatment and then used that as his primary tool (don’t believe me? Watch the following video).

The beginning of the video clearly states “we prefer to talk about the Body Adjustment”. There are many interesting things said in the video by Mr. Wernham however it is imperative to be clear that Mr. Wernham just put his own name on general treatment and pushed that routine. He does mention general and specific treatment combined and there are times when both are warranted for different clinical reasons (I am curious what is actually meant by specific treatment as in practice those that have studied under Wernham seem to apply an articular side roll, an articular thrust through dorsal Osteopathic gapping, and a rotary thrust to the cervical region). Mr. Wernham states that many practitioners shy away from general treatment because it is laborious. The labor involved is an issue as is the reality that many patients do not REQUIRE general treatment, they REQUIRE specific treatment. The body IS an integrated unit and that would lead one to at least CONSIDER the fact that if there are diffused effects from what is termed an Osteopathic lesion then FIXING THAT LESION should also begin removing the diffused effects it has caused. It is not rational to say that the body is an integrated unit so we should just treat the whole thing!

Back to the theoretical model that Mr. Wernham referred to as “Henry’s Lines”. There has seemed to be some muddled understanding that those lines were created by Littlejohn or Wernham – they were not, they were created by Clifford Henry, D.O. who was a graduate of the Pacific College of Osteopathy in 1898. The transmission from Henry to Littlejohn seems to have occured in Chicago in the very early 1900’s. There is also some muddled understanding that Wernham then put his own influence on the model which is wonderful because it would at least suggest that he was thinking for himself. I have heard directly from a member of the ICO that points were made about the foramen magnum and then lines were drawn in an inferior and diagonal direction and that where they crossed one another they happened to intersect some “important” anatomy. Here is the challenge – on what body do these lines exist? I could draw a hexagon on a body and it could be a new visceral model because it intersects all of the important organs of filtration and elimination. I have heard the model explained and it just does not seem to be a practical model. It is convoluted and no one has ever seemed to be able to make it clear. That being said, I take the position that a model that is HARD to understand may be a difficult one to apply. I also take the position that if someone claims effectiveness of their model, they should be willing to engage in conversation about their model and consider its strengths and weaknesses.

Still Cadaver 1Progress is made by asking the hard questions. Progress is not made by staying in a comfortable position and avoiding the hard questions. Osteopathy is NOT a theoretical science. Osteopathy IS a practical science. Dr. Still, E.E. Tucker, Arthur Hildreth, A.S. Hollis, Edith Ashmore – these people did not have convoluted theories, they STUDIED anatomy and used that to their advantage. They were doing bloodless surgery with no incisions on top of skin that they could not see through. They HAD to know anatomy so that they knew the POSSIBLE effects of their work and they governed their actions through this knowledge.

Still Quote 1Osteopathy has a long history of creating models to attempt to explain the mechanisms of action for the treatment applications that its practitioners use. Osteopathy has a long history of being wrong about some of those mechanisms. Osteopathy has a history of picking up a mechanism that seems to apply to a method that has been shown to be clinically effective long after it began being used (Lawrence Jones developed Strain Counterstrain in the early 1960’s and then assigned the work of Irving Korr on the muscle spindle reflex as his probable mechanism of action…in 1975).

Osteopathy is, and always will be, an American science. That is not to say only an American can do it. That is not to say only an American can understand it. That is to say that Osteopathy comes from a time in American history that was highlighted by people looking for innovation out of practical necessity. That is to say that Osteopathy comes from a time in America where anything that wasn’t practical was a plain old waste of time. That is to say that Osteopathy came from a time in America where snake oil was being peddled, when people were copying the Bohemian Thrust as well as hanging out in Kirksville with Dr. Still and then going back to Iowa to cure a deaf man that wasn’t actually deaf, and when there was just generally people trying to lie to get ahead everywhere. That is to say that the discoverer of the profession, Dr. Still, was a man who came from little means so he CARED about practical things because they kept people alive. Theoretical discussions are a sign of affluence. Practical discussions are a sign of necessity. The patient on the table does not care about our theories, they care about our practical results. The patient on the table does not deserve repeated attempts to prove one person’s routine as superior to all others.

Still Quote 3Osteopathy is a fractured profession. Osteopathy is filled with people that for some reason prefer to stand in the shadow of someone who created a method they are comfortable with. Osteopathy is not populated by many people who are willing to stand on their own feet and accept that they might be wrong. Osteopathy is not populated by people who will work on improving after they fail. Most people prefer comfort, I get it, but comfort means you just stay where you like to be and there is no progress there!

Still Quote 2I see almost no one asking the hard questions. I see almost no one attempting to push the profession forwards. I am willing to be wrong. I am willing to fail (I have failed oral practical exams on more than one occasion and I am a better practitioner for it…as a matter of fact there are times when I fail to deliver a successful treatment and my skills develop from that experience). I am willing to admit I don’t have all the answers and that I am a work in progress. I am willing to use the parts of me that are informed by a father that told me I had to tell him the truth or he wouldn’t be able to help me effectively. I am willing to use the parts of me that are informed by a father who told me not to accept things blindly. I am willing to use the parts of me that are informed by many people that told me not to get in to a situation that you are not willing to accept the consequences of. Osteopathy has given me a chance at a future. Osteopathy has given me an opportunity to use the mind I have in my head to do something useful. I will challenge anyone that is pushing dogma. I will challenge anyone that has undeserved confidence. I will challenge anyone that is not willing to examine their position and change it if there is a better position to be had. I have a deep seated drive to push the profession forward so I EXPECT to be challenged on my positions and others should welcome that from fellow colleagues. Dr. Still laid out the principles and wanted each person to figure it out for themselves as he recognized that each person has unique characteristics and they will not be able to do things exactly as others do. If one is working from the principles and creating their own methods then they are an Osteopath. If one is following the methods of someone that came before them and attempting to perfect those methods then their work is commendable and likely successful however they are not an Osteopath, they are a disciple of someone that was an Osteopath. The amount of time a person has put in to perfecting the methods of someone that came before them holds merit in so far as their is effort involved however that does nothing to improve the profession. The amount of time someone puts in to attempting to push their skill set as well as their understanding of the Osteopathic lesion and Osteopathic principles forward with varied success and failure does help to push the profession forward. Willingness to be critical coupled with willingness to shift a view point is where the growth of the profession will come from.

I will end this lengthy post with a quote from Dr. Still:

“This is the day when man’s useful education is the practical. The time has come for the practical man to lay down all undemonstrable theories and prove what he says by what he does. He cannot afford to be a laughing stock for those who know and are governed by the absolute laws of Nature, the laws that have been demonstrated in steam, electricity and all professions by such men as will not walk in the footsteps of past days in the pursuit of any subject sacred or profane. The original thinker on any subject cares nothing for so-called authority either of the past or present. He does not care for the priest, pope, president, czar, emperor, sultan or any authority but one and that is the God of Nature who proves His perfection by His architecture, His plan, His specification, His building and engineering of all the mechanism of the solar and planetary systems and all of their works. That Philosopher, that Mechanic and Engineer is the only Author to whom I pay homage. Keep your mud valves open and your engine in such condition that you can move out of the hearing of theories, and halt for all coming days by the side of the river of the pure waters of reason and be able to demonstrate that which you assert. The more we know of the architecture of the God of Nature, and the closer we follow it the better we will be pleased with the results of our work.”

I AM ACCOUNTABLE FOR MY WORDS. I am looking to the discoverer of the profession. I know that some people will find my choice of words or my tone abrasive. Will others in the profession be accountable for their words? Will others in the profession be accountable for their positions?

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