Supposeap ea person wereh rehit onth on the top otth ot the head. Wou Wouldthat blowja lowj amdown on the fluidt fluid there in fron front of the pituitary body and around it? I t seems that there are many spaces around the outside of the the brain where the flu fluid should not be distu isturbed. What if the head became warped into a side-bending/rotation shape so that one chamber of flu fluid became smalle ll er and its like li ke on the other side became larg larger? Would there be more ore flu fluid where there was moreroo ore room and less flu fl uid where there was less room? Could that situationbestra tion bestraightened out? This tour islon islong enough. He has been insideth ethe craniumall the time while il e touring ring on the insidea ide and on the outsideo ide of the livin li ving ghuman brain. The litt li ttle minnowh ow has seen enough to prorovidethought for alongtim longtime.
The Ost Osteopathic Tec Techniqu ique of Wm. Wm. G. Suth Suthe er land, land, D.O.! H. A. L ippinc ippinco ott, tt, D.O. D.O.
ATTHE THETI METHA THAT Dr. Sutherland received his osteopathic training at K irksville vill e, Dr. An A ndrew Taylor Taylor Stil Stilll was carefully supervising rvising all the instruction givena given at the colle ll ege. The principles principles that were taught had to conform exactlyto ctly to his concept. Dr. Sutherland made good use of every opportunity to learn and understand them and has adhered closelyin ly in his thinking and practice to Dr. Stil Still's l'sp principles throughout his professional career. In I n consequence, the technique which he has presented to us is a refle flection of the the clear vision vision of our founder. In In theseda se daysof ysof rapid changes in medicine, older methods are constantly being replaced by new, and there is i s scoffing offing at the procedures that were used in the day of our grandfath fathers. On the other hand, the changesin the human structure, due to environment, aresu re suchthat it is now even more susceptible to the strains that were considered by Dr. Still to be the most important cause of disease. Physical responseto se to varioustyp rioustypes of osteopathic treatment is is essentiallythe ll ythesa same now as in the nineteenth century. The technique presented here is of more than historical interest; it is of real practical valuein luein our everydaywork.
Ligamentous Articular Strains Osteopathic lesions are strains of the tissues of the body. When they involvejoin olvej oints, it is the lig li gaments that are primarily affected, so 1 This article rticle was originally publishe lished in the 1949 A de of A lied li ed Oste thy.
Year Book
of the
the term "liga "ligamentous articular strain" is the one preferred by Dr. Sutherland. The liga li gaments of a joint are normally ll y on a balanced, reciprocal tension, and seldom if ever are they completely relaxed throughout the normal range of movement. "\Vhe "\V henthe motion is carrie ried beyondth ndthat range, the tensionis on is unbalanced, andth ndthe elements of the liga li gamentous structure which lim li mit motion in that direction are straineda inedandweakened.The d.The lesioni sionismaintained bythe overbalanceof the reciprocal tension byth by the elements which haveno venot been strained. This loc locks the articu icular mechanism or prevents its its fre free and normal movement. The unbalanced tension causes the bones to assume a position ition that is nearer that in which the strain was produced than would beth bethe caseif the tension wereno re normal, andth nd the weakened part of the liga li gamentspermits motion in the direction of the lesionin ion in excess of normal. The range ofm of movementin nt in the opposited ite directionis tion is lim li mited by the more firm fi rma and unopposed tension of the elements which had not been strained.
Principles of Corrective Technique Sinceit is the lig li gamentsth ts that arep re primarily rily invo involvedin di n the maintenance of the lesion, it is they, not muscular leverage, that areus re used as the main agencyfor yf or reduction. The articulation is carriedin rriedi n the direction of the lesion, exaggeratingthel tingthe lesionpo sionposition asfara far asisnecessary to cause the tension of the weakened elements of the ligamentous stru tructure to be equal to, or slig li ghtlyin tly in excessof, the tension of those that wereno re not strained. This is the point of balanced tension. Forcing the join joint to move beyondth nd that point adds to the strain which is alreadypresent. Forcing Forcing the articulation lation backa ck anda nd awayfromthe direction of lesion strains the liga li gaments that are normal and unopposed, and if it i t is i s done with thrusts or jerks jerks there is a definitepo finiteposs ssibility ibil ityof of separatingfi ting fibe bersof rsof the ligaments fromth fromtheir bony attachments. "\Vhe "\V henthe tensioni on is properly rly balanced, the respiratory or muscular cooperation of the patient is employedto ployedto overcometheres the resistanceof thede the defensemechanismof nismof the body to the releaseof the lesion. I f the the patient holds the breath in or t long ible,th ible, th is riod durin hisinvo his involunta ffort ffort
lesionsth ions the patient holds the articulation lation in the position ition of exaggeration, andth ndthe releaseoccursth ursthrough the agencyof the ligaments when, or just before, the musclesarerelaxed. There ar areex eexceptionsto thege egeneral principleof leof correction byex yexaggerating the lesionpo sion position. The disengagementm nt method, with the rib rib technique as an example,us ple,uses a fulcru fulcrumupon whicha ch a leveragetends to separateth te the bony surfaces andte nd tense the ligamentous connections. This me method is combined with ith exaggeration ion of the lesion positio ition n in treatment of the long bones of the extremitie iti es. Under some circumstances it is unwiseto addte ddtension to the involvedliga li gaments, as in the caseof seof aseverestra restrain of recent production. In that eventth nt the pain will bei beincreased under exaggeration,a tion, andth nd the correction is madeby de byho holding the more dista istal bone in the direction of the normal position while il e the patient participa rticipates by gently and slowly moving the proximal bone toward its proper relationship. This is known as the "direct action" technique nique. It is used in the postural sacroiliac il iac or ili i lios osacral lesion in which the irregularity of the auricular surfaces prevents a wide range of motion, especially ll y on the axis through the second sacral segment. The particip icipation ion of the patient in the, technique is a matter of importance. If the operator holds the bone'which is in lesion andth nd the patient moves the one uponwh on which it is lesioned, there is less like li kely to beunduest ue strain placed upon the liga li gaments than if the operator exerts the force force necessary to accomplish a reduction. Conside sidering the lesioned bone as the "bolt" "bolt" an and the one proximal toit to it as the "nu "nut," t," it is a better mechanical principle for the operator to hold the bolt and allowt ll owth he patient to turn the nut than forth for the operator totu to turn the bolt. The physica ical equipment needed for this technique is simple. An osteopathic table, a stool, and a chair areth re the main items. Mention is made of use of the Ritter stoo stool in some of the procedures. I t is astool that tilts from the base; the seat turns and is adjustable for height. The stool ismade with ith aminimum height of twenty-one inches for use in this work. Of greatest importance, however, is the mental equipment of the operator, his ability bili ty to visualizethe li zethe structures concerned in the lesion andth nd the keen tactile ctile sensecommonto on to osteopathic
