Osteopathy, Chiropractics and Cranio-Sacral Therapy
By Are S. Thoresen DVM
Veterinarian acupuncturist homeopath osteopath agronomist
These methods arose from older forms of "bone setting". Dr. Andrew Taylor Still (1828-1917), who was inspired by the great homeopath Dr. James T. Kent, was the main pioneer of osteopathy. He also learned a lot from his father (who treated many American Indians) and from Indian Medicine Men (shamans). Dr. Still had many students. The most famous were J.M. Littlejohn, who brought osteopathy to Europe, and Jim Atkinson, who wrote the principles of Chiropractic, and D.D. Palmer (1845-1913), who is considered to be the father of chiropractic. Osteopathy and chiropractic consist of manipulating the different joints or bones to reach a diagnosis as well a therapeutic effect.
Osteopaths, especially W.G. Sutherland (1872-1950) and John Upledger, developed craniosacral therapy. In 1983, Upledger introduced the craniosacral concept for the entire body.
Osteology is the science of the bones and joints. Osteopathy is the science of how subluxation, stiffness, or decreased range of movement in jointsaffects the body, which of course often is due to tensions of the muscles, and the therapy should thus more often be called “muscleopathy” rather that “osteopathy”, can be caused by, or cause, illness. It is also the name of a method, which uses the joints or bones or muscles as its tool and uses the relationship of the bones, which meet in the joints, to each other as basis for diagnosis and therapy. Osteopaths use this muscle/bone/joint system as their microcosm. Concerned mainly with the ability of bones/joints to move freely, they examine the ability of the vertebrae and the large and small bones of the limbs (including the small bones of the digits) to move. Then, they analyse the total movement to reach a diagnosis.
Having examined the subject and diagnosed the affected joints, osteopathic therapy consists of relaxing spasms of the muscles and restoring the functional integrity, by bringing the bones and joints into a normal position and range of movement. Without knowing the theory in detail, it is possible to make an osteopathic diagnosis and to perform an osteopathic therapy. Where one finds that joints or movements are locked or blocked, one must work to relax, release or unblock them. In most cases, manipulating the movements/joints does this. [Contraindications include severe osteoarthritis, spondylosis and spinal infections, such as tubercular spinal pathology]. In suitable cases, one first tries to relax the spasm by moving the joint carefully, both in its small movements and in its big movements. You can try this yourself with a finger joint. After some time one can feel that finger joint movement improves considerably.
Osteopathy originated in the United States with Andrew Taylor Still, who suddenly “saw” the osteopathic method on the 22nd June 1874, at 10 o`clock in the morning. It is a system of healing that places emphasis on the structural integrity of the body as being vital to the well-being of the organism. The principals of osteopathy are that the body, through a complex balance system, aims at auto-regulation and self-recovery and that the body is an entity in which structure and function are mutually and reciprocally interdependent.
Chiropractic treatment evolved from osteopathy but is directed principally at restoring joint mobility, with manipulation directed to the local site of dysfunction. The osteopathic diagnostic approach is based on identifying patterns of dysfunction, with minimal reliance on appositional factors and emphasis on the interactions of the entire body. Treatment is aimed not only at restoring local function, but also at identifying and removing factors that predispose to acute relapse. The central nervous system is continuously provided with information from the environment gathered by receptors of the α-afferent system, e.g. touch receptors or the β-afferent system, pain receptors or nociceptors.
When an injury is present the β-afferent system is encountered. A painful stimulus is conveyed to the spinal cord and passes on to the brain to register pain, and stimulates motor neurons in the ventral horn, resulting in paravertebral and peripheral muscle spasm. It also stimulates sympathetic activity in the lateral horn causing reduced blood flow to the skin. To avoid constant discomfort, a control mechanism exists at the level of the spinal cord that is mediated by the α-afferent input of touch and proprioception and by descending inhibitory activity, creating a gate for painful stimuli. The balance between α-afferent stimulation and β-afferent input determines the activity of the interneurons and the sensory, motor, and autonomic responses. The α-afferent activity from joint receptors is reduced if the movement is restricted. Thus inhibitory effects on the interneurons are reduced and β-afferent activity may even increase and register pain, without direct stimulation of pain receptors. If the β-activity is intense or prolonged, it will cause changes in the chemistry and structure of the interneurons.
These changes reduce the threshold for interneurons firing in a process called facilitation. The interneurons become supersensitive to afferent input and to internal network activity within the spinal cord. Facilitation underlies hyperesthesia, production of pro-inflammatory neuropeptides and increases central stimulation thus creating a spinal cord response out of proportion to the peripheral stimulation. This may explain horses with recurrent joint and soft tissue swellings and also some of the non-specific lameness and back pain where no pathological condition of tissue can be demonstrated by radiography, scintigraphy or nerve blocking.
Osteopathy offers techniques to manually test and normalise all joints of the body. To be able to make an osteopathic diagnosis the osteopath has to be familiar with the equine anatomy, physiology and biomechanics. The clinical investigation begins with palpation of the muscles, tendons and joints. With the information gathered the osteopath then continues with biomechanical tests of suspected joints. Ascertening what is the site of primary injury and what are secondary changes may be difficult, but in horses, the engine, the muscles of the hip joint, seems to be of outmost importance for the whole body. The major cause of injuries is the demanding work performance horses have to do, rather than the result of direct trauma, in combination with how the horse uses its body.
The biomechanical tests reveal which movements in the joint are restricted and give directions to how the joint is to be manipulated. The Sacro-iliac and hip joints are tested holding the leg up and slightly bent. Ilium carries out a slight rotation around a transverse axis through the dorsocranial pole of the joint surface of the sacrum. The movement is a combination of rotation and gliding in a transverse plane ~30 degrees to the horizontal. Ilium is tested in four different directions; dorsal, as in flexion, ventral as in extension, lateral, as in moving the leg in adduction and medial, as in moving the leg in abduction, with one hand around the fetlock, moving the leg in different directions, and the other hand on the sacral tuber, feeling the movements of the ilium.
The movements of the sacrum are very complex and are tested, with the tail as a lever, over three different axes. These are flexion and extension around a transverse axis through the center of the SI-joint, rotation and lateral flexion around oblique axes, left and right, and from the coxal tuber on one side to the great trochanter on the other side. The fingertips of one hand feel the movement of the sacral base. Mobility of the hip joint is tested by moving femur in six different directions; flexion-extension, abduction-adduction, lateral and medial rotation. The cervical-, thoracic- and lumbar vertebrae are tested by passive lateral flexions of the vertebral column, in either neutral position or flexion, while deciding if the tested vertebra is rotating in the physiological direction.
Osteopathic treatment aims to reverse changes in the areas of somatic dysfunction by restoring normal joint motion in all directions/planes, restoring normal pain sensibility by removing pain, inhibition, and restoring normal sensitivity, facilitation, and improving altered tissue function for muscle, connective and vascular tissues.
There are different kinds of techniques to treat one and the same joint. The technique of choice is decided by which direction the mobility is restricted, the state of the tissue of the area, the temperament and size of the horse. There are soft tissue techniques, articulatory techniques, and mobilization and functional techniques. These techniques result in increased α-afferent input from the muscles and joints, inhibiting the interneuron pool and blocking incoming pain signals from the β-afferent system. Usually 2 – 3 treatments 2 – 3 weeks apart are necessary. Often the outcome of the first treatment is good, but to maintain the result it is necessary to do follow ups. In my experience most of the trotters, and other high performance horses, need checkups routinely every 3rd to 4th week to avoid relapses and secondary lameness due to overload from an altered gait pattern.
Veterinary osteopathic manipulation is especially common in France, where colleagues Francois Lizon and Dominique Giniaux pioneered its use in small animals and horses, respectively. Impressed by the results of their French colleagues, vets in many other countries, including Australia, Canada, Europe, UK and USA, now use osteopathy routinely in their practices.
The Ilio-sacral joint
In horses, as well as other species including humans, sacroiliac dysfunction (SID) is an important cause of diseases and problems concerning movements, and of poor performance in horses. In the horse the most consistent clinical symptom of poor performance is a lack of impulsion from one or both hind limbs. Changes in performance also include back stiffness, resisting jumps, and subtle gait asymmetries at slow speeds during groundwork or dressage movements and in harness horses at racing speeds.
In traditional veterinary medicine the hip joint is rarely a source of pain causing lameness in the horse. A more common problem described in the thigh area is the “gluteal syndrome”. Pain can be demonstrated with digital pressure along a line between the wing of ilium and the greater trochanter of the femur. The accessory head of M. gluteus medius was identified as the deep structure that best corresponds anatomically to the characteristic pattern of pain.
To study the mobility, or kinematics, of the back, the horse has to be filmed on a treadmill with special markers glued or pinned on the studied vertebrae. The result is calculated in a special computer program. This procedure is not possible to do in every horse with back pain in an ordinary clinic situation. Instead the veterinarian may want to take x-rays or do scintigraphy and hopefully detect changes in the skeleton, and maybe perform diagnostic analgesia.
In recent years several experienced scientists have done research of the sacroiliac joint, SIJ. The major obstacle to the successful diagnosis of dysfunction of this joint, SID, is that it is inaccessible for veterinary methods. The SIJ cannot be reached for intra-articular analgesia or radiology. Scintigraphy of the SI-joint is a diagnostic test of low sensitivity and low specificity, which means that the results are difficult to interpret. The obtained information from sacroiliac ultrasonography must be interpreted in light of thorough physical and lameness examinations, sacroiliac stress tests, periarticular SIJ analgesia, and nuclear scintigraphy. This means that in a clinic situation the veterinarian must rule out any other cause to problems of the horse, before he can diagnose pain or dysfunction of the SIJ.
Because the vertebral column and the SIJ are so inaccessible for veterinary methods, for diagnosis as well as treatment, and problems of the hip joint is mainly related to the muscles, osteopathy is a better way of diagnosing and treat injuries in these areas. The concept of somatic dysfunction is fundamental to osteopathy; somewhere in the course of entering information from the environment and body, processing the information in the central nervous system, and then generating a motor response, something has gone wrong.
This manifests itself in a horse with clinical symptoms such as stiffness, poor performance, gait asymmetry, where no pathological process can be identified. Osteopathic treatment is directed at changing the signals to the neural network to modify the way sensory information is processed and thus to correct the motor response generated in the central nervous system. Equine osteopathy offers biomechanical techniques for testing and manipulation of the ilium and sacrum as well as for the vertebrae and hip joint (femur). Restriction of mobility, in the SIJ, hip joints and/or vertebrae is an important cause to overload of the joints, ligaments and tendons of the fore- and hindlimbs.
Biomechanics of the horse
When the horse is moving, the pelvis is the centre of power, or the engine. The energy is coming from the hip joint. The muscles of the pelvic area have two main functions; with force move the body forward, and to stabilize the pelvis during stance. The movement is largest in the hip joint. The most important function of the stifle joint is to stabilize the hindlimb during stance. During stance the stifle joint is flexing and the large extensor muscles of the knee might act to resist gravity as opposed to power locomotion. The tarsal joint also has an important role during stance. Tendons and ligaments of the area behave elastically to store and return energy to be used in propulsion. The power from the proximal hindlimbs is transferred via the sacroiliac joints to the thoracolumbar vertebral column. The forelimbs act as a pivot that move the body forward until the hindlimbs can take over again.
The forelimbs are only connected to the body with strong muscles and ligaments. The shoulder joint does not have any collateral ligaments but are surrounded by strong muscles and tendons. During stance the shoulder- and elbow joints are flexing and the extensor muscles as well as the adductor muscles might act to resist gravity and abduction. The shoulder- and elbow joints behave like a stiff spring that allows forces to be transmitted through them to the proximal shoulder- and torso musculature. These muscles absorb and/or return energy, thereby functioning as a shock absorber. The main action of the muscles and tendons along the forelimb is stabilization during stance.
The carpal-, metacarpophalangeal- (fetlock) and distal interphalangeal joints behave collectively as elastic systems storing and returning energy with the ability to recover up to 40% of energy during stride. The elasticity is driven primarily by the metacarpohalangeal joints in the fore- and hindlimbs thanks to the superficial and deep flexor tendons and accessory ligaments, and the third interosseous muscle (suspensory ligament). Stabilization of the carpus during stance is done by the M. ulnaris lateralis and flexor carpi ulnaris, both relatively stiff muscle-tendon units. The head and neck help to keep the horse’s balance.
As long as the shock-absorbing musculature of the scapula and torso function normally, there should not be any overload of the distal joints and tendons. What interferes with this function? Is the main problem the condition of the track or training surface, bad shoeing, poor conformation, inherited or congenital bad composition and stamina etc.? These all play a part in the problem, but primarily, in most cases, I believe it is a combination of workload and motor laterality.
Chiropractic is more understandable and clearly arranged than osteopathy. Like osteopathy, it has both diagnostic and therapeutic aspects. While osteopathy uses all the joints of the body in its system, chiropractic mainly uses the vertebrae. It is relatively well known in Norway and is accepted fairly well by the public health sector.
The diagnostic method
Diagnosis of spinal disorders begins with examination of the vertebrae, from the atlas to the sacrum and hip. One must identify which vertebrae are misaligned, incorrectly positioned, or in any way restricted or blocked in their movement.
We recognise three degrees of spinal injury or restriction:
- Stage 1 is blockage, or reduced ability to move.
- Stage 2 is subluxation (almost dislocated joint), or misalignment (vertical, horizontal or in the long axis of the body); in Stage 2, the vertebra is slightly luxated or misaligned.
- Stage 3 is total luxation, i.e. complete dislocation of the vertebra.
All 3 Stages involve a "blockage" at one or more of the vertebrae. This means that the affected vertebrae have reduced mobility or range of movement that causes pain, "guarding", stiffness and other signs of abnormal function and behaviour. There may be accompanying reflex disorders in the skin, muscles and internal organs that share a common spinal innervation with the affected vertebrae. When physical examination identifies the affected vertebrae, one proceeds to "release the blockage". This involves manipulation of the spine and its muscles so that the affected vertebrae return to their correct alignment and normal range of movement.
Oseopathic and chiropractic methods are as effective in animals as they are in humans. However, it is important to differentiate between horses and other animals. Dogs can have any of the three stages: reduced vertebral mobility, subluxation and luxation; the vertebrae must be checked for all three possibilities. If necessary, the affected vertebra must be manipulated back to normal position. In horses, however, Stage 1 (blockage, or reduced vertebral mobility) is the most common finding; Stage 3 (full luxation) in the development of the spinal disorder is almost impossible in horses. The examination of horses consists of checking each vertebra, feeling whether it has normal mobility, or if its mobility is restricted even slightly.
Cervical vertebral trauma and pain
Disorders of the cervical vertebrae, nerves and spinal cord are common in humans and animals. Cervical trauma in humans often occurs in car accidents (whiplash injury). Cervical trauma in dogs and horses usually has a different cause.
- In dogs it usually is due to improper use of the leash, especially if the owner applies too much traction on the leash to control the dog. It may also occur if susceptible dogs jump down from a height.
- In horses it usually is due to serious falls, or improper use of the halter or lunge rope. It may also arise in show- or dressage- horses whose freedom to move the neck naturally is prevented by the use of tight straps from the chin ring to the girth strap.
Neck injuries can manifest many different symptoms. These include neck and thoracic limb pain, paraesthesia, paresis or circulation disorders; ataxia or hindlimb paresis or paralysis (Wobbler Syndrome); digestive disorders (LI, SI, ST, GB Channels); reproductive disorders (TH Channel) and headache, tinnitus, facial disorders and fatigue.
In horses and dogs the most common symptom is neck pain, tenderness, or guarding / spasticity. As a result, the animal does not walk in a straight line, or walks awkwardly at an angle, like a crab. Dogs may have difficulty turning around, jumping off a chair, or walking downstairs. Horses tend to both pull away from the painful side and turn in a circle more easily towards the pain side. This is because they want to get away from the pain, and avoid extension of the affected side, which often increases the pain.
In all cases of suspected cervical disorders the atlas (vertebra C1) deserves special attention; because of its anatomy, C1 is especially vulnerable to trauma. Treatment of an injury to C1 is difficult; it requires the care of a trained vet or chiropractor.