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· Introductory points
· Style of treatment: What to expect
· What is Osteopathic Massage? A short explanation.
Osteopathic massage is intended to address the whole body, to increase its vitality. This is achieved by freeing restrictions within joints and muscles, thereby affecting posture and mobility. This helps to remove any blockage or restriction to the flow of blood, lymph or nerve. It is this increase in flow, this increase in the body’s tissues receiving nutrition and oxygen, and the increase in drainage and removal of waste, which increases the vitality, the health, of the body. This in turn gives the person reserves of energy and building blocks for repair, when needed, and further, improves immune function and response for the prevention of disease in general.
Style of Treatment: What to expect.
- At the beginning of each treatment session a brief assessment is done for posture, alignment of the spine, for muscle balance issues, and joint function of the spine and pelvis. This assessment is continued, and expanded on, throughout the treatment. This is achieved during treatment by the gentle motions, rocking and oscillations used on parts and on the whole body. Restrictions are found, and with these same motions, and with the addition of other techniques, they are immediately treated.
- The whole body is usually addressed, except when that may be contraindicated due to specific illnesses or conditions.
- However, the therapist will performed focussed treatment to the areas that they judge to be the source of a client's impairment or pain, with the client's consent. Note: It is very common for the problem not to be where the client feels the pain.
- Treatment can be done with the client clothed, if that is preferred, but with loose clothing (shorts/tights and for women a sports-bra or similar). Or, the client can be draped under sheets, as they are when receiving massage.
- Lotion can be used, but often after some of the manipulations mentioned above have been completed and then a combination of Swedish massage, myofascial/deep tissue or other similar techniques may be used.
- Generally, the body is moved with a gentle rhythmic motion; and the limbs are gently moved, often in a rotational manner. One of the therapist's hands provides movement, while the other palpates and 'listens' to the tissues. Further, this listening hand can be used to bring the focus of motion, of treatment, to a very specific sight.
What does Osteopathic Massage Mean?
If I could sum up osteopathic massage in one word, it would be: Flow. However, what I mean by this term is not necessarily self-evident. If you have the patience to read along, you will hopefully see why I chose this word.
First, let us try and quickly describe massage therapy. As a place to start from, I like the College of Massage Therapist of Ontario’s definition of our scope of practice:
The practice of massage therapy is the assessment of the soft tissue and joints of the body and the treatment and prevention of physical dysfunction and pain of the soft tissue and joints by manipulation to develop, maintain, rehabilitate or augment physical function, or relieve pain. (Massage Therapy Act, 1991) http://www.cmto.com/index.html
Now, that may sound a bit clinical, but nonetheless, it does a good job in describing massage therapy, especially if you see massage as therapeutic. This view looks at massage therapy as a way to assist the client to achieve wellness, or in other words, achieve a state of health and well-being that is optimal for them. Through their wellness a person is able to:
1. Live and move with the maximal vitality achievable for them;
2. to recover from injury or dysfunction, (as fully, and as quickly, as is possible for them);
3. to maximize their resistance to further injury and disease;
4. and with this physical wellness, they can have a firm foundation for emotional, social and spiritual wellness.
Therefore, it is possible for massage therapy to not just treat injured parts, bring relaxation to areas of the body, or reduce pain in a limb, for example; it can also treat the whole person. Especially, when treating each and every client as unique. No two injuries are the same, just as no two individuals are the same. Each individual needs individual treatment, and each treatment should be done within the context of that client's whole body. This view is not one necessarily shared by all massage therapists, but it is thread that has run through the history of massage. Sometimes ignored, sometimes embraced. It is, in fact, this view that brought me into massage therapy. I do not, and will not, apply recipe-style treatments: those prescribed treatments that are designed to treat a specific condition, yet are applied the same to all clients who have that condition.
Let us leave the topic of massage for a while, and now talk about osteopathy. Then, we can discuss how much they share, and how they can successfully be melded together.
Osteopathy has its origin in the 1870’s, in the mid-western U.S. and was the creation of Dr. Andrew Taylor Still. See: http://www.meridianinstitute.com/eamt/files/still3/st3cont.html He developed this form of manual therapy as an alternative to the medical practices of his day, practices which still included ‘bleeding’ a patient, and the use of medicines that contained ingredients such as mercury. He did not like the idea of fighting disease by weakening a person: by trying to kill (poison) a disease, and hope that the patient somehow lives through this approach.
Still asked himself, why is it that some people get ill, while others seem to have the vitality, the ability to avoid or overcome disease and injury? After several years of contemplating questions like this, while he continued his medical practice, he came up with a principle of health: “The rule of the artery is supreme.”
This principle arose from his observations that when a person has restricted blood supply (poor circulation, etc) to an area of the body, that area, part, or organ, will eventually become impaired and would end up diseased. In turn, if a person had good blood flow, in all areas of their body, such a person seemed to heal well after a trauma, and resist, or recover quickly, from illness. This principle about the flow of blood was extended by Still to include lymphatic flow, nerve flow, and respiratory health (air flow).
Therefore, Still began to use manual therapy to create mechanical changes to joints, etc. in order to open up areas of restriction that could impede the flow of fluids and nerve impulses. In part, Still saw that this was also a flow of information to and from one part of the body, to and from the brain and spinal cord, and in turn, to all the other parts of the body. All the parts of a body need to work together, in a co-ordinated, interdependent manner, as a whole unit. In this harmony of structures and their functions, health is to be found.
Still decided that the body was capable of being its own drug manufacturer and distributor. We now know how true this is: that the immune system (within the lymphatic system, tissues and organs) does just this. It organizes, manufactures, and distributes specific responses to specific infections or diseased areas of the body. Another example is the production of endorphins by the body to fight pain.
From Still’s observation of what constitutes health, and what jeopardizes it, the following principles of osteopathy have been formulated:
1. The body is a unified whole, one entity; (not a collection of parts).
2. The body is self-regulating and self-healing.
3. Structure and function are intimately related. (Structural differences – shape, composition - in bone or muscle, for example, must impact on, and affect how, a joint will function. So too, for all tissues of the body. )
4. Reasoning from these three principles provides a rational, sensible, therapy for each individual.
Still’s approach to treatment was based on this unified view of the body. He had observed that people who exhibited postural and mechanical (movement) imbalances, especially when they have been chronic, were unable to heal well from injury, or from illness. These people would often succumb to their injury or illness. He found that if he corrected these imbalances, these asymmetries in structure and function, with the intent of improving flow, then a person’s ability to recover was greatly enhanced. For this reason he experimented and developed a manual approach to physical dysfunction and towards disease that relied on using various limbs, bones and tissues as levers and pulleys to open up restrictions to joints and tissues, with an eye to removing restrictions to the flow of blood, lymph, and nerve impulses. With this, he had great success, and due to this success, he opened a school of osteopathy in Kansas.
Since his time many specialized techniques have been researched and developed within the field of osteopathy. Some of the most well know are Cranial osteopathy (Cranial-Sacral therapy), numerous myofascial techniques, Visceral Manipulation, positional release (or, Strain-Counterstrain), Muscle Energy (mobilizing joints and changing the tension and tone in muscle simultaneously), and lymphatic techniques.
Note: All of these modalities are within a massage therapist’s scope of practice, and most therapists have received some (post-graduate) training in one or more of them.
Massage & Osteopathy - a Summery
In concluding the discussion on osteopathy, I would just like to summarize what I believe osteopathy addresses through manual therapy, and how massage, (whether Swedish or other types) seeks to do the same.
- Improving blood flow; both arterial and venous.
- Improved lymphatic flow; both for drainage and enhanced immune response.
- Improved nerve flow; both for nerve impulse transmission and for transport of materials within the nerve itself.
These are achieved through manipulations that act on the musculoskeletal system – through the manipulation and mobilization of skin, joints, muscles, and related tissues. The general flow and movement of blood and lymph throughout the whole body is improved during a full body treatment. However, if a specific region, limb, or tissue is swollen then specific techniques can additonaly be employd to directly increase the flow in that area. Further, through an understanding of osteopathic principles, the flow of fluids, including flow within the long axon of a nerve, can also be affected by reflex reactions caused by musculoskeletal manipulations. Using physiological reflexes can more efficiently not only move fluid in general, but are especially effective when wishing to move fluids within deeper structures, tissues and organs of the body.
Our Early Warning System
With respect to diseases taking hold, the importance of this general increase in efficiency of flow to tissues is crucial. We all know that early detection of a disease process is crucial in defeating it, whether that be the flu, pneumonia, arthritis, or cancers. Therefore, ensuring that there is proper fluid motion into and out of the tissues is required so that, especially in the case of lymph, any invasion by a bacteria, virus, or with any alteration to the normal physiological process (autoimmune responses, or cancers, etc.) is recognized sooner by the body’s defences, the immune system. Moreover, once a disease process is recognized, and the body’s defences mobilized, the sooner the fight begins, and the more likely a positive outcome will occur. On the other hand, If delayed, then more damage is done to the body, and possibly the body will be overwhelmed before it even knows what is happening, or has a chance to adequately respond.
The early warning system we all have is both in the local tissues and in our lymphatic system. Local responses, however, can easily be overwhelmed. But even then, these defences will have secured pieces or traces or the disease and prepare them to be shipped out so that the body’s whole defence system can become involved quickly. It is then up to the circulatory system (blood and lymph flow) to get the alarm signals sent to the appropriate centres of defence and response. The body can manufacture specific and general responses, producing its own pharmacological and biological agents to attack. Further, the regulatory systems (governed by hormones, and neural reflexives) can change the body’s environment in ways that make it less friendly for the disease process: Fevers, chills, accelerating some bodily functions while slowing others, conserving resources as well as unleashing others, increasing the elimination of wastes from the body, etc.
You can see how an osteopathic approach in massage therapy can help a person not only better resist disease processes, but can also be helpful in fighting them. However, in the case of serious illness, ensure you are receiving care from all your health providers: physicians, nurses, pharmacists, and manual therapists. Be sure that each knows all of those providers that are involved in your care.
Manual Therapy as the Communication of Information
From what we have just discussed, therefore, we can say that within the context of the person, what is also flowing or coursing through these pathways (vascular, lymph, and nerve), is information. In fact, this information is what guides the body to direct supplies to specific areas, whether to increase or decrease the blood flow, lymph flow, and neural responses.
Within the context of the treatment of a client, there is also a flow of information, a discussion, between the therapist's hands and the client's tissues. The client senses the touch of the therapist and the tissues respond; the therapist hears this response and, in turn, replies by adapting to the needs of the tissue as they are, and as they change. This conversation continues all through the treatment session, going back and forth between the client and the therapist. I have, since school, thought of this as "talking with tissues."
Improvements (or ‘normalization’) to the flow of blood, lymph/drainage and nerve conduction are also the classic aims of treatment by massage. As is this innate skill of tissue-talk. Therefore, it is in these aims of treatment that osteopathy and massage therapy have common ground.
Now, osteopaths will often have as their goal the overcoming of a pathological disease process. Massage therapy does not directly share this intent. However, as osteopathy focuses on affecting health through the musculoskeletal system, (normalizing posture, function, etc.), the two can be very similar in how they treat. The assistance and support to the organs and glands of the body that massage can give, especially when it is an osteopathically conceived massage treatment, can also be of assistance as a complementary modality to accompany other forms that specifically treating pathological diseases.
My Approach to Treatment as an Osteopathic-Massage Therapist
As I have mentioned, many massage therapists learn various techniques developed by osteopaths. However, simply because you have learned and use a technique does not make the treatment osteopathic, nor, make it what I understand as osteopathic-massage. When I treat, I am not picking and choosing which technique to use, or in what order. I work from the perspective of using the principles and aims that both massage and osteopathy share. Precisely because I have spent so much time learning technique and theory, learning the purpose and principles of massage and osteopathy, I can now leave behind any recipe approach. I no longer treat a condition with a text-book approach, nor do I follow the prescribed steps of any single technique. With each and every client, and within each treatment session, over a series of treatments, I ‘create’ manipulations and approaches as I proceed. I listen and respond to the needs of the tissue, to the client as they are right now.
This, I believe, is treating osteopathically. This is what I call osteopathic massage therapy. I have spent many years trying to understand what lies behind specific techniques. I have gone back to A. T. Still’s approach: Study, and study some more, and never stop studying, the anatomy and physiology of the human body. The more you understand the structure and function of the body, the more ways you will develop to treat the client’s musculoskeletal pain and impairments. You can create new treatments, new combinations of techniques, and even new techniques. If there are other health benefits with respect to illnesses etc., then that is great. However, as a massage therapist my focus remains with joints and soft-tissues. None the less, the treatment of the musculoskeletal system will inform the client's whole body as this physical wellness permeates the whole person. The restoration of vitality in the physical realm will impact on the person's general health and well being.
If you are still reading this and cannot tear yourself away: More on flow-
Blood flow. By removing restrictions/compressions to arterial flow in and venous flow out of tissues. This improves nutrition of tissues and proper removal of waste (carbon dioxide, and other by-products of cellular function). Think of cells, wherever they are in the body, as a household: food and building (repair) materials come in, and garbage goes out and needs to be collected and removed.
Improved lymphatic flow. Only 80% of the fluid that leaves the blood vessels and enters into the tissues, carrying these nutrients and building materials, will leave via the veins. A lot of waste material, like old cells, and bacteria or virus that may have entered into the tissue, are broken down into parts and removed through the lymphatic system. These parts that belong to us are further broken down and sent back to the blood system to be recycled (as building materials, etc.), while bacteria and virus are identified, and if they have not been destroyed by local defences at the site of the tissue, then they are neutralized in the lymphatic nodes, and/or anti-bodies are made and shipped out via the flow of blood back to the site to fight the invasion, and to patrol all other areas of the body.
Improved nerve flow. This happens primarily in two ways. The first is more obvious, when we talk about removing restrictions to nerve impulses or signals. Nerve impulses travel along the outside of the nerve – along the axon that extends from the cell body in the spine, for example, and runs, continuous, to the tissue (to the big toe, for example). Nerves compressed in joints and tissues, anywhere along their route, often have their conduction of information disrupted. This change to the information at a specific site along the nerve must, undoubtedly, change the information sent along the rest of the nerve. Nerves that collect both information from tissues (sensory nerves) and nerves that bring information to tissues (on how to act or respond - motor nerves) will be affected. Necessarily, things are going to go wrong eventually. The second way nerves are affected by restrictions is what happens inside the nerve – especially its axon. Inside the axon is cellular fluid that needs to carry nutrients along it for the health of this pathway, and to feed the nerve ending and also supply it with the materials to make, complete, or process and recycle neural transmitters (chemical signallers). Obviously, the flow of these supplies along the nerve, and the return of waste and information back to the cell body, can be impeded. This restriction to flow inside the nerve is not only going to affect its own tissue health, it will necessarily disrupt and alter the nerve conduction of information on the outside of the axon, directly effecting the those tissues that a specific nerve innervates and informs.