MECHANICAL LINK : EVOLUTION AND PERSPECTIVES

The last twenty years have largely been devoted to the publication of different books to establish the LMO.  During that time, our daily clinical practice and our work as teachers have given rise to different reflections.

How to best define the osteopathic lesion ?

What is the difference between osteopathic lesion and somatic dysfunction ?

What is the difference between an active lesion and a passive lesion ?

How to approach atypical lesions or lesions that have not been described in classical osteopathy ?

How to reconcile a general treatment (total lesion) and a symptomatic treatment (presenting complaint) ?

With time and experience, the answers to these questions have moved the theory and practice of the LMO forward.  Although it is difficult to separate them over time,  we can distinguish several steps in the evolution of the method.

During that first period, we have simply replaced classical osteopathic tests with tension tests and articular manipulations with the recoil.  We thus revisited vertebral, thoracic and peripheral articular osteopathy  and then, using the same techniques, the visceral sphere.  In the same manner, we then entirely reconsidered the cranial approach[1]. Thus, using the same process for all structures in the human body, it became easy to compare and prioritise osteopathic lesions, no matter where they are located[2].

The recoil technique, as we developed it, quickly emerged as a natural extension of the tension test to seamlessly go from diagnosis of the osteopathic lesion to treatment.  Although other correction techniques were possible, the advantages of the recoil[3] appeared so obvious that we quickly opted to use it exclusively.  To increase the power of action of the recoil, we established different phases of execution[4]:  application of linear tension (translations), angular tension (rotations) and patient participation (respiration, mentalisation, verbalisation).

During that entire period, positive feedback from patients greatly encouraged us.  They appreciated the quality of the general examination, the relevance of the diagnosis we reached, the comfort of the treatment and, it must be said, the great results that we obtained. 

[1] Although cranial osteopathy could be considered as reserved to listening techniques, the LMO approach is extremely efficient in this case.  Within a few minutes, it is entirely possible to precisely diagnose and treat all the cranial lesions present in any subject (adult or neonate).  Thus the time saved allows us to easily integrate the cranium in the general osteopathic examination of all patients without lengthening consultation time.

[2] Conversely, if we use different techniques depending on whether we are examining the cranium, the spine or the viscera for example, it is more difficult to compare the different lesions found.  With the LMO, as the evaluation process (reference) is always the same, inhibitory balance tests between different and distant areas present no problem.

[3] Simple technique to apply irrespective of the nature of the osteopathic lesion to be treated, painless, without true contraindications and with a result immediately perceptible to both patient and practitioner.  The recoil presents practically only advantages and no disadvantage !

[4] Called phases 1, 2, 3, etc. in our previous books.

Over time, the feeling of achievement was accompanied by some less satisfactory outcomes which urged us on.  Certain failures, particularly in seemingly simple cases, still left us wondering.  Why didn't a benign ankle sprain completely recover following a thorough treatment ?  Why might a vertebra remain blocked once all the articular restrictions have been corrected ?  Why did a fixation of the pericardium remain in certain cases despite adjustments by recoil ?

Empirically[1], still using our tension tests, we have continually looked for answers to the different problems we encountered.  This was the exciting era of discovery of osteopathic lesions that were previously unknown or, at the very least, hardly known[2] : intraosseous lines of force, epiphyseal lines, articular diastases, vertebral antelisthesis, teeth, filum terminale, arteries, peripheral nervous system, encephalon, etc.  We thus were able to explore new areas, extending the scope of our practice and, generally, obtaining better therapeutic results in several cases.

[1] In the noble sense of the term : which relies more on experience and observation than on theoretical reasoning.

[2] An era that is not over since LMO practitioners always bring new ideas and still contribute to the evolution of the method.

With the LMO, even using our own techniques, we remained more or less under the influence of biomechanical models[1] and of classically taught medical rules[2]. Thus, a certain number of atypical or unlikely osteopathic lesions kept eluding our diagnosis.  And new questions occurred.  What about Fryette’s laws in an elderly patient with scoliosis, osteoarthritis and osteoporotic vertebral collapse?  What about ligamentous laxity or elongation of a peripheral nerve ?  What about visceral distension ?  What about an osteopathic lesion located at an acupuncture point ?  Etc. 

Clinical experience progressively removed us from classical osteopathic models to develop a new form of analysis applicable to all osteopathic lesions that may possibly exist.

We may describe this diagnostic approach in 3 stages.

A global test to identify in a simple and reproducible way all the lesions present in a patient.

Specific tests to precisely determine the point of blockage to be treated.

Analytical tests to optimally direct the adjustment (recoil).

This original procedure allows us to treat in a « simplex » manner any situation that is outside the usual confines of our knowledge of anatomy and physiology[3].  It is thus possible to approach in the same way all osteopathic lesions imaginable:  articular or intraosseous lesions, muscular or tendinous lesions, traumatic or post-surgical tissue lesions, visceral lesions, vascular lesions or acupuncture point located along a peripheral nerve[4].

In parallel to this evolution of our protocol of tests, different recoil modalities were also introduced.  Between the structural recoil (sustained tension to positionally correct a subluxation or dysmorphosis) and the pneumatic recoil (extremely light action, barely in contact with the structure), there is an entire spectrum of possibilities.

The practitioner may thus, by modulating his recoil, adapt to the patient and efficiently treat any type of osteopathic lesion.  A beautiful way to go back to the initial simplicity of A.T.  Still’s techniques[5] to whom there was no distinction between structural and functional approaches.

[1] Somatic dysfunction, restriction of mobility, Fryette’s laws, the primary respiratory mechanism, the pattern of lesional chains, etc.  All these models certainly are useful in an educational setting but should not restrict us to a standardized approach of osteopathy.

[2] The point is not to dispute the usefulness of basic medical training, absolutely necessary in the osteopathic curriculum, but rather to be able to go beyond that.

[3] The concept of simplexity, or the art of being able to « simplify the complex », perfectly applies here to this new way of analysing the pattern of a structure in lesion. 

[4] This procedure will be developed in detail in each of the corresponding chapters (vertebral, peripheral, cranial, visceral, vascular, neural).

[5] Still advocated direct but gentle techniques : A soft hand and a gentle move is the hand and head that get the desired result (A. T. Still, Autobiography, 1897). He was quite reserved regarding the interest of articular manipulations : One man advise you to pull all bones you attempt to set until they pop. That popping is no criterion!  (A. T. Still, Osteopathy Research and Practice, 1910).

LMO is an open method which continuously offers new perspectives.

Over the last years, we have therefore largely exceeded the field of alleged functional problems to successfully address so-called organic pathologies: heart rhythm issues, hiatal hernias, gallstones and kidney stones, restless leg syndrome, retroversion of the uterus, endometriosis, certain infections (sinusitis, cystitis), certain hormonal issues (hypothyroid, menopause), etc.[1] Likewise, all orthopaedic or surgical interventions that were avoided as a result of LMO treatments show the possibilities of osteopathy with regard to structural lesions: plagiocephaly, congenital torticollis, carpal tunnel, trigger finger, scapulohumeral periarthritis with partial tear of the rotator cuff, disc herniation, lumbar spinal stenosis, scoliosis[2], dysmorphoses related to growth (pectus carinatum/excavatum, leg length difference, genu varum/valgum, etc.), osteoarthritis of the hip joint, osteoarthritis of the knee joint, hallux valgus, Morton syndrome, etc.  And when surgery is found to be necessary, our intervention often prevents or solves a number of postsurgical complications: reflex sympathetic dystrophy, keloid scars, painful sequalae following orthopaedic surgical interventions, herniorrhaphies, vein stripping, etc.

In another field, through an original and very specific approach of the vestibular system that we recently developed, it became possible to more efficiently treat postural imbalances and thus improve the duration of results concerning the majority of musculoskeletal complaints[3].

Technically speaking, as a complement to the prioritised treatment that is the norm, two other approaches[4] have widened our scope of action.

Regulation which consists of systematically treating all lesions, whether active or passive[5], in a given system.  Ex: regulation of the two brains (encephalon and intestines), regulation of the key points of the nervous system (major points of acupuncture), regulation of the hormonal system (arteries and endocrine glands), regulation of return circulation (diaphragm, venous and lymphatic system), etc.

Combined treatment which consists of simultaneously treating two osteopathic lesions present in a patient.  Ex: adjustment of a neural point with a vertebra (nerve root impingement), adjustment of a point of the temporal bone with C1 or C2 (craniocervical equilibration), adjustment of an epiphyseal line on one side with the line of force on the other side (regulation of the growth plate activity of a bone), adjustment of a point of the aorta with an organ (vascular and autonomic normalisation), adjustment of a zone of the encephalon with another zone in dysfunction (neural reprogramming), etc. The choice of the winning combination is based both on the reality of the lesions presented by the patient and the practitioner’s decision to associate one lesion with another. The number of combinations is nearly limitless, as are the possible therapeutic successes !

In parallel to all these perspectives in human osteopathy, in recent years we have also applied our techniques to horses and dogs with success.  Today, more and more equine or canine osteopaths show interest in this approach and, by adapting the LMO general examination and prioritised treatment to each animal, obtain very interesting results[6].

Osteopathy is not limited to the treatment of musculoskeletal issues.  With LMO, the practitioner possesses the diagnostic and therapeutic tools to practice truly osteopathic medicine.  Without being a substitution to conventional medicine and in collaboration with all professionals of the health field, the osteopathic approach we recommend, as it presents no real contraindication, may be applied to any treatment plan, whether curative, preventative, or even palliative.

[1] Of course, osteopathy does not pretend to cure everything but probably has more possibilities than what some would like it restricted to.

[2] See the article « New osteopathic approach to scoliosis ».

[3] After an osteopathic treatment, the patient still suffering from postural imbalance may very well remain or rapidly go back to his pattern of lesion.  A significant improvement of posture may be obtained by osteopathic equilibration of the central receptor – the vestibular system – without necessarily going through an adjustment of the ocular, dental or foot receptors.

[4] The protocol of these two approaches, regulation and combined treatment, will be the topic of an upcoming article.

[5] Active osteopathic lesion : tissue fixation with associated neurological disruption and, most often, increased mechanosensitivity. Upon applying tension, the active lesion always presents clear resistance (blockage).

Passive osteopathic lesion : tissue fixation with little associated neurological disruption.  Upon applying tension, the passive lesion presents moderate resistance.

[6] We can see the efficacy of the method when, sometimes after a simple recoil on the hoof, the horse immediately regains better dorsal mobility and easier locomotion.