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Osteopaths are famed for treating back-ache, but we are trained to treat the whole body from top to toe. Nowadays back pain is so common that it usually accounts for the majority of the cases seen by osteopaths. However in an average day in my practice we treat anything from a ‘tennis elbow’ to arthritis in the big toe, although at present I tend to spend most of my day treating CFS/ME
Osteopathy is one of a few different therapies available that employs manual techniques in treating the body. Physiotherapy and chiropractic treatment are also widely used, and I have every respect for these other professions. As a trained osteopath I am obviously much more knowledgeable in the principles of osteopathic techniques and these form the basis of my treatment for CFS/ME
In most mechanical problems affecting the spine one mostly finds that there is either too much or too little movement in one or more segments of the spinal column. Both stiffness or hypermobility could lead to a neurological impairment at that section.
If the intervertebral joint is too mobile, the increased stretch to the disc could lead to a prolapsed or ‘slipped’ disc. This bulging, jelly-like mess may protrude on to the nerve root as it exits the spinal cord. If this is the cause of the irritation, then it is difficult to resolve. Completely prolapsed discs are rare. What usually occurs in a chronically hypermobile joint, is that the ligaments holding the spinal vertebrae together become over-stretched. If the discs are affected, then the problem is usually a strain of the fibrous outer layer (the annulus), with maybe only a bulge of the inner nucleus.
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It is difficult to tighten weakened ligaments or discs without surgical intervention. However the manual therapist can improve the mobility of the adjoining areas of the spine. This will take the strain off the hypermobile segments. If exercises are prescribed to strengthen the surrounding musculature, then the overall effect will be a stronger and more stable spine. The appropriate exercise routine will be given by your osteopath.
Hypermobile dorsal spines are uncommon, as the rib cage and the large number of muscles acting on the thoracic region of the spine produce a strong resistance to excess movement.
What is far more common, especially in patients with CFS/ME is a restricted dorsal spine. Frequently the entire thoracic region is stiff, but occasionally only a few segments are affected.
The treatment to increase mobility of the spine can take many forms and in these cases I usually combine joint manipulation with soft tissue stretching. The treatment schedule may alter slightly depending on the patient and is listed in a step by step guide for osteopaths which is available free on request by any registered osteopath from the Osteopathic Information Service.
The question most patients ask is ‘How long is it till I will be well again?’ This is the most difficult question for any practitioner to answer. Especially since CFS/ME presents, or shows itself in so many different ways, with no patient being exactly the same as another, a little like snowflakes.
The one encouraging point regarding my treatment plan is that after around three months, most of my patients notice an improvement in their symptoms. There are some that feel improved almost immediately and there are some who take much longer than three months. The improvement as a whole is sinusoidal, in other words it goes up and down, with the symptom picture often worsening before getting better. This is the way the body reacts to most treatment when it has been out of sorts for so long. The sympathetic nervous system in CFS/ME has become used to working incorrectly and responds wrongly to stimuli that encourage relaxation and normal operation of the nerves. Another example of this occurring within the nervous system is a well known experiment often tried in medical colleges.
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If a person were to wear glasses with prisms instead of lenses, they would see everything upside down. The brain eventually adapts to this situation and deduces that people cannot be walking on the ceiling and so after a period of time turns everything back to normal. When the prism glasses are removed the person sees everything upside down again, and as before the brain eventually corrects the vision of the subject.
This demonstrates that when the central nervous system works wrongly it may at first adapt poorly, (i.e. seeing everything upside down when the prism glasses are removed) when corrected by an external factor. In the case of CFS/ME this outside factor is the osteopathic treatment.
As I have said before, in some cases the patient’s spine is permanently restricted and their musculature may be damaged beyond repair. In these unfortunate individuals the CFS/ME may never be fully cured. However it is possible even in severe arthritis to improve the mobility and function of the thorax with beneficial results.
One of the most intriguing methods of osteopathic treatment forms a system known as cranial osteopathy. Over the years cranial techniques have been criticized by many practitioners who challenge the validity of this form of treatment. However there is no question about the results of these techniques. In thousands of cases of all types of illnesses, where patients have improved dramatically following osteopathic treatment, the recoveries are regularly attributed to cranial methods.
The fundamental principle of cranial osteopathy is that the brain, spinal cord and the cerebrospinal fluid, which surround the brain and the cord, contain an inherent rhythm of movement. This rhythm is distinct from the respiratory movement of the lungs and the pulse from the heartbeat. The flow of cerebrospinal fluid can be monitored by careful palpation.
Cranial treatment is also based on the fact that even though the bones of the skull (the cranium) seem to be fused in adulthood, there still appears to be slight mobility with minute articulation existing between these bones.
The cranial rhythm can be felt through the entire body by trained individuals, but is easier to palpate at the base of the skull, and below the bottom of the spine, around the sacrum and the pelvis.
When there is a disturbance in the normal health of a person, their cranial rhythm is affected. In fact this flow of the cerebrospinal fluid is sometimes referred to as the ‘primary respiration’ of the body, with the blood flow and respiration of the lungs being the secondary. The body is unable to function correctly without an efficient cranial flow.
Cranial manipulation is extremely gentle, with the patient often feeling very little happening during the actual treatment. However the effect of a too strenuous treatment to an CFS/ME sufferer can be quite drastic and thus the patient should be careful that the practitioner is fully trained in gentle cranial methods.
The healthy cranial flow feels like an inflated balloon (exaggerating the movement of course). Likewise when palpating the head of an CFS/ME patient, it is like feeling a deflated football. In all CFS/ME cases the cranial flow is much slower than average, and in time the treatment eventually restores the flow to a healthy rhythm.
Although there are some osteopaths who are strictly ‘cranial only!’ osteopaths, and others who employ only more conventional methods, experience has taught me that the best results in the treatment of CFS/ME are achieved when combining both forms of treatment.