Manus Sinistra
‘Heads Down Bottoms Up’ A functional approach to the cervical spine. By Matt Harris and Chris Wilkes
Matthew qualified from Victoria University Melbourne in 2003 with a B.App.Sc in Clinical Science and an M.H.Sc in Osteopathy. Matt has a particular interest in functional biomechanics (having completed the Gray Institutes’ prestigious GIFT mentorship), nutrition, shoulders and lower limb injuries. He combines his Osteopathic practice with teaching and lectures on shoulder and lower extremity rehabilitation. Alongside his Osteopathy, Matt is also experienced in dry needling and functional rehabilitation techniques.
Chris graduated with Distinction from the British School of Osteopathy in London. Since qualifying he has completed post graduate studies in the USA, working with some of the world’s leading rehabilitation experts. He is one of only a handful of clinicians in the UK qualified in ‘Applied Functional Science’.
This manus talk was a functional approach to the cervical spine,with there being four functional units; the atlas, axis, c2-3 and the rest of the column. The Occipital Atlas (OA) joint has a concave surface (occiput) on a convex surface (atlas) that allows flexion and extension. In flexion, there is a posterior glide of the occiput on the atlas to stop sliding. The axis has two types of joints, lateral and medial. The medial joint has an anterior arch, which swings on process, the lateral has a convex surface on a convex surface of the rest of the cervical spine to allow large rotation. The C2-3 has atypical facets because the facets are type one motion, which is side bending and contralateral rotation and the rest of the spine is type two motion, which is side bending and ipsilateral rotation.
The interactive part of this lecture focused on how we actively assess the cervical spine, which is usually through asking the patient to drive their head to look down to the floor for flexion, look up to the ceiling for extension, look round to the right and left for rotation and put left and right ear to associated shoulder for side bending. The functional approach would be to use 5 different strategies to drive the cervical spine from the bottom joint upwards rather than the top joint downwards. These strategies include extension of the joint from below, rotation of the joint below and side bending of the joint below.
This talk made me reflectively look at how I would carry out a cervical spine active exam and realise that you do not get a complete picture from just looking at the top joints moving against the joints below. In order to truly segmental assess range and quality of movement, it would be useful to include the other strategies to determine if the bottom segments are also moving against the top joints. My original opinions have been questioned and I will certainly be using these modifications in clinic to look at the function of the cervical structures!
Chris graduated with Distinction from the British School of Osteopathy in London. Since qualifying he has completed post graduate studies in the USA, working with some of the world’s leading rehabilitation experts. He is one of only a handful of clinicians in the UK qualified in ‘Applied Functional Science’.
This manus talk was a functional approach to the cervical spine,with there being four functional units; the atlas, axis, c2-3 and the rest of the column. The Occipital Atlas (OA) joint has a concave surface (occiput) on a convex surface (atlas) that allows flexion and extension. In flexion, there is a posterior glide of the occiput on the atlas to stop sliding. The axis has two types of joints, lateral and medial. The medial joint has an anterior arch, which swings on process, the lateral has a convex surface on a convex surface of the rest of the cervical spine to allow large rotation. The C2-3 has atypical facets because the facets are type one motion, which is side bending and contralateral rotation and the rest of the spine is type two motion, which is side bending and ipsilateral rotation.
The interactive part of this lecture focused on how we actively assess the cervical spine, which is usually through asking the patient to drive their head to look down to the floor for flexion, look up to the ceiling for extension, look round to the right and left for rotation and put left and right ear to associated shoulder for side bending. The functional approach would be to use 5 different strategies to drive the cervical spine from the bottom joint upwards rather than the top joint downwards. These strategies include extension of the joint from below, rotation of the joint below and side bending of the joint below.
This talk made me reflectively look at how I would carry out a cervical spine active exam and realise that you do not get a complete picture from just looking at the top joints moving against the joints below. In order to truly segmental assess range and quality of movement, it would be useful to include the other strategies to determine if the bottom segments are also moving against the top joints. My original opinions have been questioned and I will certainly be using these modifications in clinic to look at the function of the cervical structures!
The clinical relevance of current fascia research. By Leon Chaitow
Leon Chaitow is a graduate of BCOM who has been in practice since 1960. He was until 2004 Senior Lecturer at the University of Westminster. He lectures widely in Europe, USA and Australia on osteopathic and naturopathic topics, to chiropractors, osteopaths, physiotherapists and massage therapists; is author of over 60 books (including Chronic Pelvic Pain, Churchill Livingstone 2012 and Fascia: The Tensional Network of the Human Body (with Schleip, Huijing and Findley) Elsevier 2012). He has been a member of the planning and scientific committees for the past three International Fascia Research Conferences, as he is for the 2015 conference which it is hoped will be run in conjunction with the American Osteopathic Association. He is Editor-in-Chief of the peer reviewed Journal of Bodywork & Movement Therapies, and practises in the UK and Greece. His presentation consisted of research conducted by many professionals to explore the concept and function of fascia. Somatic dysfunction can be conceived as representing failed adaption and as manual practitioners, we can use application of adaptive load which translates over time via homeostatic responses into benefit.
From my anatomy knowledge I am aware that fascia provides structural and functional continuity between the body's hard and soft tissue, allowing sliding and gliding motions to play an important role in transmitting mechanical forces between structures. Chaitow spoke about endocannabinoid affects throughout treatment, which I have since read about and refers to a group of neuromodulatory lipids and their receptors that are involved in a variety of physiological processes including appetite, pain sensation, mood, and memory. The endocannabinoids create a euphoric and analgesic affect throughout treatment, which I find fascinating that the body can do this naturally! He also explored the use of mechanical forces initiating a neurophysiological response, both peripherally and centrally, meaning that muscular hypertonicity is reduced through applying manual treatment.
I was really pleased that I had attended this talk as it was informative to know what researchers are currently discovering about a structure that resembles cling film! We were given a journal of bodywork and movement therapies, which I look forward to reading!
From my anatomy knowledge I am aware that fascia provides structural and functional continuity between the body's hard and soft tissue, allowing sliding and gliding motions to play an important role in transmitting mechanical forces between structures. Chaitow spoke about endocannabinoid affects throughout treatment, which I have since read about and refers to a group of neuromodulatory lipids and their receptors that are involved in a variety of physiological processes including appetite, pain sensation, mood, and memory. The endocannabinoids create a euphoric and analgesic affect throughout treatment, which I find fascinating that the body can do this naturally! He also explored the use of mechanical forces initiating a neurophysiological response, both peripherally and centrally, meaning that muscular hypertonicity is reduced through applying manual treatment.
I was really pleased that I had attended this talk as it was informative to know what researchers are currently discovering about a structure that resembles cling film! We were given a journal of bodywork and movement therapies, which I look forward to reading!
Osteopathic treatment – How can we help? What can we help? A personal view by Paddy Searle-Barnes
Paddy Searle-Barnes qualified from the BSO in 1983, and returned to teach in 1988, initially in the clinic, but moved to academic teaching in 1991 teaching osteopathic diagnosis and evaluation. He currently has a special interest in the management of patients with chronic pain, particularly those who have psychological, emotional and social factors contributing to their disability.
Paddy discussed the current biopsycho-social model of pain, in order to explore how we as osteopaths impact on patients.He explained that manual therapy can be much more effective if we engage with the person fro the very beginning of the case history, with their mind and emotions as we handle their physical body. He believes that the way in which we talk to patients using layman terms is vital in helping the patient relax and be at ease in your care rather than not knowing what is going on with their body and remain anxious and tense throughout treatment.
His presentation focused on the practical implications of these ideas in clinical practice. For example, finding the right questions to ask of the patient, particularly in relation to social context, may provide the key to why the patient's defence system makes them sub-conciously hold themself the way that they do through the motor output triggering muscle tone and balance system. The limbic system of emotion also has a large input on the defence system, therefore if a person is feeling down or suffer from depression, it has a physical way of expressing itself within the musculoskeletal system.
These issues are applied equally to non mechanical symptoms in other body systems, and may help us decide how and where we may help patients with such symptoms. This is particularly relevant to patients with disorders such as asthma, IBS, and headaches. We can help patients to become autonomous with their health by giving them lifestyle advice according to their presentation.
I am glad I went to the talk this evening as I feel it has reminded me of how we, as osteopaths, can benefit a person not only physically, but emotionally, socially and pyschologically too. One domain of health directly affects the other so it is important that practitioners are able to explore all avenues to ensure we are seeing each patient hollistically. Thank you Paddy Searle-Barnes!
Paddy discussed the current biopsycho-social model of pain, in order to explore how we as osteopaths impact on patients.He explained that manual therapy can be much more effective if we engage with the person fro the very beginning of the case history, with their mind and emotions as we handle their physical body. He believes that the way in which we talk to patients using layman terms is vital in helping the patient relax and be at ease in your care rather than not knowing what is going on with their body and remain anxious and tense throughout treatment.
His presentation focused on the practical implications of these ideas in clinical practice. For example, finding the right questions to ask of the patient, particularly in relation to social context, may provide the key to why the patient's defence system makes them sub-conciously hold themself the way that they do through the motor output triggering muscle tone and balance system. The limbic system of emotion also has a large input on the defence system, therefore if a person is feeling down or suffer from depression, it has a physical way of expressing itself within the musculoskeletal system.
These issues are applied equally to non mechanical symptoms in other body systems, and may help us decide how and where we may help patients with such symptoms. This is particularly relevant to patients with disorders such as asthma, IBS, and headaches. We can help patients to become autonomous with their health by giving them lifestyle advice according to their presentation.
I am glad I went to the talk this evening as I feel it has reminded me of how we, as osteopaths, can benefit a person not only physically, but emotionally, socially and pyschologically too. One domain of health directly affects the other so it is important that practitioners are able to explore all avenues to ensure we are seeing each patient hollistically. Thank you Paddy Searle-Barnes!
Visceral Manipulation - An introduction to the work of Jean-Pierre-Barral by Alison Harvey
Unfortunately I was unable to attend this talk due to confirming attendance at another lecture however am awaiting for the Manus talk to be released on DVD to further understand the work of Jean-Pierre Barral and visceral osteopathic principles.