The technique that drives the work of Paul Chauffour, DO, Eric Prat, DO, and Jacques Michaud MD, DO, is recoil. However, their systematic method, known as Mechanical Link, is more than just a technique. Mechanical Link is a comprehensive approach to patient care. It is an integrated and holistic way of looking at how Osteopathic lesions can distort local structure and function while at the same time distantly affect apparently unrelated systems. Mechanical Link uses a method of simultaneous diagnosis and treatment to isolate the most important lesions(s) that maintain the complex process of disease.
Though Recoil Technique is the distinct hands-on expression of Mechanical Link, it is not a method that is exclusive to the work of Chauffour, Prat, or Michaud. Recoil Technique is not currently listed in the American Glossary of Osteopathic Terminology and it is not commonly discussed by American DOs, but it was a part of my early education and this method has a key historic reference. Most importantly, I believe that this little known Osteopathic technique was utilized by Andrew Taylor Still.
Still was a brilliant physician and a prescient clinical philosopher. His integrated insights into the workings of the human body in health and disease are timeless. Reading his books can give the 21st Century Osteopath a pragmatic perspective that can be utilized in the everyday practice of Osteopathy. Still asked us to think Osteopathically and to treat the disconnected structures we call lesions, and to help bring these dysfunctions into the holistic context he called health. He taught the vital concepts of holism before the term was coined in 1926 by the South African philosopher and statesman J.C. Smuts1. One of Still’S terms for what we now call holism was “connected oneness2.” The beauty of this integrated expression of holism is its practical utility in an Osteopathic context. If connected oneness is the ultimate representation of health, then “disconnected manyness” is the manifestation of disease3. Mechanical Link uses an integrated, or holistic, strategy to restore connected oneness in the human body.
Though Still was a talented clinical philosopher, he was not a gifted teacher. He refused to give the Osteopathic profession a textbook of technique. Instead he asked for us to master anatomy and then apply the clinical philosophy of Osteopathy with each patient in a unique and non-choreographed way4. When A.T. Still said, “You begin with anatomy, and you end with anatomy, a knowledge of anatomy is all you ever want or need…” he was dramatically emphasizing the essential need for Osteopaths to practically know functional anatomy in order to apply the clinical philosophy of Osteopathy properly5. Chauffour, Prat, and Michaud have designed Mechanical Link to be an anatomically specific approach that is congruent with Still’s core principles of practice.
I believe that the collection of named Osteopathic techniques currently used today are in reality a tangible, and highly organized expression of what the early pioneers of our profession were taught directly by Dr. Still. Key students, who later became leaders or teaches within the early Osteopathic profession, resonated with one or more of the many diverse approaches utilized by their teacher. Following Still’s death, the first and second generation of DO’s subsequently names these techniques that were previously and generically just referred to as “Osteopathy”. They created “schools” of techniques that, ideally, applied the clinical philosophy of Still without becoming hierarchical or partisan.
As an Osteopathic historian, I have examined the works of Still and his diverse students to better understand the evolution of Osteopathic technique. What Still called “bonesetting” later became High Velocity Low Amplitude (HVLA) or the thrusting techniques. The direct “soft tissue” approaches became Myofascial Release. And, I believe that Still’s most unique contribution to manual medicine was what used to be called “exaggeration technique” and are now broadly referred to as the indirect techniques6. The many expressions of the exaggeration techniques are now referred to specifically as either Indirect Technique, Functional Method, Strain/Counterstrain, Facilitated Positional Release, Balanced Ligamentous Tension, Ligamentous Articular Strain, and is the predominate approach used in Cranial Osteopathy. Each of these methods works at the balance point, away from the barrier, rather than into the barrier, as with HVLA or direct Myofascial Release. However, each of these specific approaches to exaggeration technique achieve their endpoint in unique ways.
Hidden in the background of the more famous techniques are two lesser known approaches that were very likely utilized by Still in special situations, but they failed to dominate the early teachings. These “minor” techniques were percussion/vibration and Recoil Technique. Several of Still’s direct students utilized percussion/vibration and they recorded this approach in early textbooks of Osteopathy7. We can presuppose, and then extrapolate, from the original writings of key first generation DOs, that Still also utilized percussion and vibration.
Though the historical documentation is less specific regarding Recoil Technique, I have strong circumstantial evidence and one recorded historical reference stating that Still utilized recoil as a mode of treatment. While a student at the College of Osteopathic Medicine and Surgery in Des Moines, Iowa in 1982, we had a part-time faculty member Rolland Miller, DO. Dr. Miller, who is now deceased, was semi-retired and helped teach two half days a week in our Osteopathic manipulation practical sessions. He had practiced Osteopathy in Iowa for over 40 years, and he contained a wealth of pragmatic clinical wisdom. He had graduated from my alma mater in 1942 (then it was called the Des Moines Still College of Osteopathy). One day during a practice session regarding the treatment of rib lesions, I was having difficulty in restoring motion to a particular rib. I had tried HVLA, muscle energy, and an indirect technique. The changes I expected were not realized. I called Dr. Miller for help and he said, “Let me show you how A. T. Still treated troublesome ribs”. He then proceeded to show me what he called “recoil technique”. It worked instantly and motion was restored. The Recoil Technique demonstrated by Dr. Miller was a simpler version of the sophisticated method utilized by Chauffour, Prat, and Michaud. Dr. Miller told me that “A. T. Still never used only one tool but had a whole toolbox filled with different techniques.” He emphasized, “To be an effective Osteopath, you need a lot of tools, but” he continued, “recoil technique is a special tool that you can use in unique situations like this.”
I knew that Rolland Miller was advanced in years, he was in his mid-70s at the time, but I knew he wasn’t old enough to have studied with Still. Playfully, I confronted him with this mathematical challenge saying, “Dr. Miller, I know you are old but you can’t be THAT old!” He laughed energetically and said, “I may look a hundred, but I’m still a young 75.”
“I learned this technique from Arthur Becker, DO who was the president of my school and a student of Dr. Still’s in the early 1900s.” Rolland Miller then revealed that as a student he was in a very similar situation as me with respect to a “troublesome rib.” He related that Becker used to teach as well as function as an administrator and one day “Dr. Becker helped me in the same way I am helping you. Becker told me that the Old Doctor taught him this technique and now I’m teaching it to you.” He then told me that the toolbox metaphor was told to him by Arthur Becker. Finally, Rolland Miller said, “I’m passing on to you an original A. T. Still technique.”
The only recorded historical reference that is known regarding Recoil Technique was related by Arthur Hildreth, DO in his book, The Lengthening Shadow of Dr. Andrew Taylor Still. Hildreth narrated this story about A. T. Still :
In the early days Dr. Still and the beginners in the osteopathic profession treated many patients while the latter sat on stools. One day he was treating a patient for some kind of chest involvement. He had put his toe on the chair between the legs of the patient and his knee on the chest. He was attempting to correct a rib on the left side, hence his knee was a little on the left side of the sternum. His hands were around the body of the patient and placed on the angles of the ribs. After he secured the position he desired, holding the knee as a fulcrum and pressing on the angles of the ribs toward the knee, as a finishing stroke of his treatment, he lifted up on the angles with hands on each side and then let loose.
I said to him “Dr. Still, what are you doing?”
He replied, “I am trying to correct the ribs and free the intercostal nerves which control the muscles between the ribs, and by pressing those ribs together at each end toward the center I am making the same tension there that a man does when shooting an arrow from a bow, pulling the string tight back to get ready for the force of throwing the arrow when loosed by pulling the ends of those ribs together, or stretching the bow. When I let loose, the reaction is to free the tissue that here is involved.” That to me was another of his real worth-while lessons in technic.”8
This vignette, or brief case history, reveals that Still utilized a technique very similar to what Chauffour, Prat, and Michaud call Recoil Technique. There are other French and British Dos who have utilized to a more limited extent, versions of recoil techniques but it has been Chauffour, Prat, and Michaud who have taken this procedure, perfected it, and made it the foundation of a systematic Osteopathic approach called Mechanical Link. Just as Sutherland, the Lippincotts, Hoover, Jones, Johnston, and Schiowitz expanded upon the exaggeration techniques; Chauffour, Prat, and Michaud have brilliantly expanded Recoil Technique making it into an elegant system of treatment9. They utilize the Recoil Technique with a high degree of anatomic specificity. They have honored Still’s demand that “An up-to-date osteopathy must have a masterful knowledge of anatomy and physiology.”10 More importantly, they know what Still meant when he said, “A knowledge of anatomy is only dead weight if we do not know how to apply that knowledge with successful skill.”11 Mechanical Link utilizes an exact knowledge of anatomy and applies that knowledge with great skill.
The first volume of this work by Chauffour and Prat, Mechanical Link: Fundamental Principles, Theory, and Practice, was a general overview of the basic principles of Mechanical Link as a diagnostic and treatment system. This second book expands their approach to the arterial circulation and the autonomic nervous system. The unique anatomy of these extensive systems requires a separate and distinct work. Most importantly, these Osteopaths have maintained an alignment with Still’s principles regarding the arterial system and its vital interaction with the nervous system.`
When Still recorded this essential Osteopathic principle in 1908, he recognized the interdependence of the arterial system and the nervous system.
The rule of the artery is absolute, universal, and it must be unobstructed, or disease will result. I proclaimed then and there that all nerves depended wholly on the arterial system for their qualities, such as sensation, nutrition, and motion, even though by the law of reciprocity they furnished force, nutrition, and sensation to the artery itself, and further proclaimed that the body of man was God’s drug-store and had in it all liquids, drugs, lubricating oils, opiates, acids, and anti-acids, and every sort of drug that the wisdom of God thought necessary for human happiness and health12.
Mechanical Link: Osteopathic Lesions of the Arteries and the Autonomic Nervous System takes the accepted significance of the arterial system, links it with the nervous system, and like Still ties it all together in the greater context of holism. This book begins, what I hope will become, a series of publications applying the principles of Mechanical Link to other unique anatomic regions.
There is no single “Still technique” that defines the work of an Osteopath. Our work is a clinical expression of a philosophy. As Miller and Becker revealed, Still had a diverse and expansive toolbox of techniques. Thankfully, Chauffour, Prat, and Michaud have revived and greatly expanded upon an unfamiliar technique. More importantly, they have created an integrated and systematic approach, with Mechanical Link, that would make Andrew Taylor Still very proud.
Dr Steve Paulus Osteopath DO (US)
1 Smuts, J. C., Holism and Evolution, Mcmillan Press, New York, 1926, p. 86
2 Still, A. T., Philosophy and Mechanical Principles of Osteopathy, (1902 reprint, Osteopathic Enterprises, Kirksville, Missouri, 1986), p. 73
3 In English, the opposite of “one” is “many”. I utilize the term “manyness” to convey the contrary form of oneness in this Osteopathic context. “Manyness” is not a formal word in the English language.
4 Still, A. T., Autobiography of A. T. Still Revised Edition, (1908; reprint, American Academy of Osteopathy, Indianapolis, Indiana, 1981), p. 202
5 Still, A. T. Philosophy of Osteopathy (1899, reprint, American Academy of Osteopathy, Indianapolis, Indiana, 1977), p. 16
6 Sutherland, W. G., « Dr. Sutherland Invents “Osteopathic Hammock” », The Osteopathic Physician, volume XV, March 1909, p. 5
7 Percussion and vibration were reported by several of A. T. Still’s students in classic Ostoepathic textbooks of the 1890s and early 1900s. These early Osteopathic pioneers who discussed percussion and vibration in detail included J. Martin Littlejohn, DO, MD; Eduard Goetz, DO; and Elmer Barber, DO.
8 Hildreth, A. G. The Lengthening Shadow of Dr. Andrew Taylor Still, Simpson Printing Co., Kirksville, Missouri, 1938, pp. 198-199
9 William Sutherland, DO, developed the Cranial Concept in the 1920s & 30s and began teaching this approach in the 1940s. He utilized exaggeration as one of the main approaches Cranial treatment. He also coined the term Balanced Ligamentous Tension to describe the treatment of non-cranial structures using an indirect approach. Rebecca Lippincott, DO and Howard Lippincott, DO described the various procedures associated with Ligamentous Articular Strain. In the 1950s, Harold Hoover, DO began teaching American and British DOs what he termed Functional Method. William Johston, DO expanded upon Hoovers work. In 1981 Lawrence Jones, DO published the book Strain-Counterstrain which utilizes indirect methods combined with monitoring tender points. Stanley Schiowitz, DO, develped Facilitated Positional Release (FPR) in the 1980s and continues to teach this approach currently across the United States.
10 Still, A. T., Philosophy and Mechanical Principles of Osteopathy, (1902 reprint, Osteopathic Enterprises, Kirksville, Missouri, 1986), p. 18
11 Still, A. T., Philosophy and Mechanical Principles of Osteopathy, (1902 reprint, Osteopathic Enterprises, Kirksville, Missouri, 1986), p. 20
12 Still, A. T., Autobiography of A. T. Still Revised Edition, (1908; reprint, American Academy of Osteopathy, Indianapolis, Indiana, 1981), p. 182
