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Suppose a person were hit on the top ot the head.

Would that blow jam down on the fluid there in front of the pituitary body and around it? It seems that there are many spaces around the outside of the brain where the fluid should not be disturbed. What if the head became warped into a side-bending/rotation shape so that one chamber of fluid became smaller and its like on the other side became larger? Would there be more fluid where there was more room and less fluid where there was less room? Could that situation be straightened out? This tour is long enough. He has been inside the cranium all the time while touring on the inside and on the outside of the living human brain. The little minnow has seen enough to provide thought for a long time.

The Osteopathic Technique of Wm. G. Sutherland, D.O.!

H. A. Lippincott, D.O.

ATTHE TIME THAT Dr. Sutherland received his osteopathic training at Kirksville, Dr. Andrew Taylor Still was carefully supervising all the instruction given at the college. The principles that were taught had to conform exactly to his concept. Dr. Sutherland made good use of every opportunity to learn and understand them and has adhered closely in his thinking and practice to Dr. Still's principles throughout his professional career. In consequence, the technique which he has presented to us is a reflection of the clear vision of our founder. In these days of rapid changes in medicine, older methods are constantly being replaced by new, and there is scoffing at the procedures that were used in the day of our grandfathers. On the other hand, the changes in the human structure, due to environment, are such that it is now even more susceptible to the strains that were considered by Dr. Still to be the most important cause of disease. Physical response to various types of osteopathic treatment is essentially the same now as in the nineteenth century. The technique presented here is of more than historical interest; it is of real practical value in our everydaywork.

Ligamentous Articular Strains Osteopathic lesions are strains of the tissues of the body. When they involve joints, it is the ligaments that are primarily affected, so
1 This article was originally published in the 1949 Year Book of the Academy of Applied Osteopathy.

the term "ligamentous articular strain" is the one preferred by Dr. Sutherland. The ligaments of a joint are normally on a balanced, reciprocal tension, and seldom if ever are they completely relaxed throughout the normal range of movement. "\Vhenthe motion is carried beyond that range, the tension is unbalanced, and the elements of the ligamentous structure which limit motion in that direction are strained and weakened. The lesion is maintained by the overbalance of the reciprocal tension by the elements which have not been strained. This locks the articular mechanism or prevents its free and normal movement. The unbalanced tension causes the bones to assume a position that is nearer that in which the strain was produced than would be the case if the tension were normal, and the weakened part of the ligaments permits motion in the direction of the lesion in excess of normal. The range of movement in the opposite direction is limited by the more firm and unopposed tension of the elements which had not been strained. Principles of Corrective Technique Since it is the ligaments that are primarily involved in the maintenance of the lesion, it is they, not muscular leverage, that are used as the main agency for reduction. The articulation is carried in the direction of the lesion, exaggerating the lesion position as far as is necessary to cause the tension of the weakened elements of the ligamentous structure to be equal to, or slightly in excess of, the tension of those that were not strained. This is the point of balanced tension. Forcing the joint to move beyond that point adds to the strain which is already present. Forcing the articulation back and away from the direction of lesion strains the ligaments that are normal and unopposed, and if it is done with thrusts or jerks there is a definite possibility of separating fibers of the ligaments from their bony attachments. "\Vhenthe tension is properly balanced, the respiratory or muscular cooperation of the patient is employed to overcome the resistance of the defense mechanism of the body to the release of the lesion. If the patient holds the breath in or out as long as possible, there is a period during his involuntary efforts to resume breathing when the release takes place. In appendicular

lesions the patient holds the articulation in the position of exaggeration, and the release occurs through the agency of the ligaments when, or just before, the muscles are relaxed. There are exceptions to the general principle of correction by exaggerating the lesion position. The disengagement method, with the rib technique as an example, uses a fulcrum upon which a leverage tends to separate the bony surfaces and tense the ligamentous connections. This method is combined with exaggeration of the lesion position in treatment of the long bones of the extremities. Under some circumstances it is unwise to add tension to the involved ligaments, as in the case of a severe strain of recent production. In that event the pain will be increased under exaggeration, and the correction is made by holding the more distal bone in the direction of the normal position while the patient participates by gently and slowly moving the proximal bone toward its proper relationship. This is known as the "direct action" technique. It is used in the postural sacroiliac or iliosacral lesion in which the irregularity of the auricular surfaces prevents a wide range of motion, especially on the axis through the second sacral segment. The participation of the patient in the, technique is a matter of importance. If the operator holds the bone'which is in lesion and the patient moves the one upon which it is lesioned, there is less likely to be undue strain placed upon the ligaments than if the operator exerts the force necessary to accomplish a reduction. Considering the lesioned bone as the "bolt" and the one proximal to it as the "nut," it is a better mechanical principle for the operator to hold the bolt and allow the patient to turn the nut than for the operator to turn the bolt. The physical equipment needed for this technique is simple. An osteopathic table, a stool, and a chair are the main items. Mention is made of use of the Ritter stool in some of the procedures. It is a stool that tilts from the base; the seat turns and is adjustable for height. The stool is made with a minimum height of twenty-one inches for use in this work. Of greatest importance, however, is the mental equipment of the operator, his ability to visualize the structures concerned in the lesion, and the keen tactile sense common to osteopathic physicians.