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Osteopathic
Sports Medicine: The Non-Cartesian Athlete by Walter Llewellyn McKone D.O. www.osteopathicphilosophy.com mckone@osteopathicphilosophy.com |
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| INTRODUCTION
Many years of involvement in athletic health care had quietened to a trickle until recently. There seems to be a renewed interest in sports medicine world wide. Not only has this happen to me here but also in Europe, particularly Milan, Italy. At the end of last year I was particularly impressed by an Italian group who were desperate to know what was the osteopathic approach and how it differed from the physical rehabilitative and the medical. This desire came from a post-graduate group who in the main were, in
a previous life, physiotherapists and masseurs. Knowing what physiotherapy
and physical medicine was they wanted to avoid it. A desire to know
why a sports manager would employ them rather than any other medical
professional was their drive. For three long days we worked through
the essence of what is osteopathic rather than what is not in the field
of athletic health care. Drawing on most of my research historically,
socially and clinically I had to answer the question, what makes
an approach to an athlete osteopathic? |
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| MIND-THE-GAP Without doubt the main weakness within the osteopathic movement is a lack of a philosophy. At best any philosophical approach used at present is unworkable and clumsy. Unfortunately all we are doing is digging a whole so deep that we find it very difficult to peek out over the top of this dominant mode of consciousness. It is from this philosophical starting point of inertia that the potential for osteopathy, as a medicine, in all fields has been diluted and disempowered. There is no field of osteopathic practice that would move the profession towards greater positioning in society than sports medicine. Someone once wrote, “all modern societies base their primary forms of medicine on its ability to control pain and treat acute injury.” Our weakness lies in the dominance a dualistic philosophical mode of consciousness. “Plato’s separation of subjective values from the world of phenomena marked the division of consciousness from nature, but this did not attain its extreme form until Galileo, Kepler, Descartes and Newton had established – as it seemed – two separate realms: the self-contained world of mathematical law determining the motions of permanent units of matter, and the second world of experienced qualities. The triumph of mathematical physics in Newton not merely robbed man of the central position which he had held in the medieval world, but left no room at all for him – or at least for his conscious experience – in the real world. Mind and matter were separated, (my emphasis) and matter was counted in the operations of nature” (Whyte, 1949). It is this splitting of mind from matter that has weakened osteopathy. Proof, as we know it, is emerging of the development of muscle strength and mass by pure intention, New Scientist, Mental Gymnastics (24 November 2001 p.17). A. T. Still spoke of the three M’s of osteopathy: mind, matter and motion all working together as a formative process. In his Psychophysiology, Littlejohn (1899) spoke of motion as not being the cogwheel process of modern science but as fluidity. Our “objective” approach to palpation is the splitting of mind and matter. It is this split between mind and matter that has led to myths of the subconscious/conscious, genetics and subatomic particles. This separation was the result of a power deal within the Church as a result of and after the Thirty Years War (Israel, 2001). Objectivity and the development of mathematics as “the science” had good reason at the time. Objectivity developed by the Church saved us from personal pain and experience. Today we follow this religious methodology of senselessness, in the name of science, but we have forgotten its original reason. Linking modern science and religion is demonstrated in the form of scientists and their metaphors of hope for the future. No other speciality presents this more than genetics. Beliefs that genes (Book of Genesis) are the “building blocks of life,” the “book of life” and the “Holy Grail” are common place (Nelkin, 2001 & Lewontin, 1992). Hubbard and Wald (1999) explain that “in 1909, Johannsen coined the word gene to denote hypothetical particles that are carried on chromosomes and mediate inheritance. Chromosomes contain both proteins and DNA (deoxyribonucleic acid). However, DNA and genes are so intertwined in the scientific and popular imagination that it is not always easy to be sure which we are talking about.” Rightly or wrongly genes are an organising idea. Without an idea we cannot progress, the osteopathic lesion was an organising idea. This power deal included nature. She was not to be trusted because if she failed we would be left high and dry. Using the senses as first hand experience was referred to as female consciousness and made us vulnerable, so mathematics and symbols, a male consciousness, were employed to allow us to manipulate based on a second hand world of experiment (Merchant, 1980). Recently this has been brought under consideration in an editorial in New Scientist, Keeping the Faith (8 December 2001) questioning the use of imagination in the hunt and validation of subatomic particles. All we have is our imagination! Our main problem is our lack of understanding of what is scientific. Since the Newtonian onset of the modern scientific movement the original remit of what is scientific has changed due to our cultural shift. We are still using the same basic religious methods developed at the end of the Thirty Years War and we are mistaking a technological mindset for true science. Science from Scientia means, “to come into knowing” not “to know.” A coming into knowing is a formative process of transformation not a series of “controlled” evidence-based experiments. True science is the search for a universal law after the experience with a natural phenomenon. In the words of Mary Midgley (2001), “centrally, the term scientific still had very general meaning of thinking things out for oneself in an appropriate manner rather than just relying on tradition or authority. As time went on, the rising success of the physical sciences gradually biased its meaning towards presenting them as the only model.” Osteopathy is not a physical medical science it is an organic medical science based on an organic ecological philosophy of Johann Wolfgang von Goethe. It is the dominance of cause and effect (pro toto) in our diagnosis that weakens osteopathy. To make a diagnosis, from the Greek dia meaning through and gnosis from Gnostic meaning to know, we should actually be looking beyond the injury, not at it. Some osteopaths have even referred to this improper use of diagnosis as “the end.” All cause and effect approaches must have a gap otherwise there is no process. This gap is the space for belief and religion and the more complex and reductionist you make the pieces the result is more gaps. This was emphasised in the work of Spinoza and the development of modernity (Israel, 2001 and Toulmin, 1990). Our present style and dominant philosophy is not the Stoicism of old. It is a dichotomy and dualism that has penetrated the very depths of osteopathy. “Turn to the OED, and “philosophical” is defined as: “Befitting or characteristic of a philosopher, wise; calm; temperate.” Of course, most philosophers today are far from those things: they’re timid, anxious men (rarely women) who haunt universities with egg on their beards and transatlantic lags in their conversations (de Botton, 2001).” This analytical introvert approach is expressed in the “specialities” of cranial, structural and visceral. An example is the addition of axis to the motion to viscera and cranium. Descartes would have loved this. Additionally a geometric approach is expressed (cogwheel) as forms of rhythm and motion, this in itself is a Cartesian development. At best we have developed a unifying consciousness rather than a consciousness of unity. A unifying approach places pieces into an already formed experimental image (a priori) rather than entering into the experience of organic matter with an idea (a posteriori) of wholeness that includes your presence. |
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| THE LEGO MENTALITY
A Lego mentality of measurement, building and objectivity, and therefore supposed reality, dominates sports medicine. Anthropomorphism of the human form into a modern machine derives from Cartesian geometry (itself from Gallileo) and quantifies the musculoskeletal system with symbols making our experience second hand in the form of an experiment. Symbols desensitise the practitioner, “never trust the senses, the senses deceive,” Gallileo would say. To which Goethe replied, “it is not the senses that deceive, but the judgement.” To placate the quantitative approach of research we have developed the holistically counterfeit approach of qualitative research. Whatever happens in modern science we are always the onlooker and place the criteria into the experience as an order and discipline. We take parts and create a synthetic manageable whole. The organic grows from inside out and is always a whole from cell to entire body. Recently I have had to bring to light the importance of the autonomic nervous system and the importance of one of its three (yes, three) academic divisions, the sympathetic nervous system. The physician Galen, supposedly the first sports medicine physician, coined the word sympathetic (vasomotor), in this context. Galen (meaning calm, because his mother was always shouting at his father) was the first documented physician to the gladiators and recognised the sympathetic system as the mediator in emotion, circulation and healing. As Grays Anatomy reminds us the “nervous system functions as a whole at all times and any separation is purely academic and misleading.” It is also the organiser of disease and injury processes. Why do we have so much difficulty in understanding this concept? It is the manipulation of this sympathetic system that is essentially osteopathic, especially in relation to physical and emotional trauma. In osteopathic physical and psychological interventions it is the action of the sympathetic that we must try and interpret. Once we understand this system in the context of the whole athlete then we can attempt to use it as a primal underpinning in all our treatments. The sympathetic brings the formative processes of change or morphology to the human form. Any regional advance or delay in this process leads to pain and dysfunction. Our hands, mind and presence is one and is there to direct this process to wherever we desire. In addition the nerve impulse theory is a minor and superficial function of a nerve. The main activity of the entire nervous system is that of a trophic function. This nutritional function is a major factor in the formation and expression of disease and injury. The presence of a micro-organism and virus is not a disease, it has to be organised. |
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| THE TECHNIQUE
OF OSTEOPATHY “It should be remembered that at about the time that Dr. Still developed and announced his theory of Natural Immunity Lister was developing the first methods of antisepsis and Koch was identifying the first known specific disease producing organisms such as those of tuberculosis, typhoid, tetanus and diphtheria. Dr. Still was a pioneer in his own right and gave to the world a theory of immunity a half a century in advance of his time.” Philosophy of Osteopathy (by Andrew T. Still, 1899), Forward by Committee of Publication of the Academy of Applied Osteopathy, January 15, 1946. Osteopathy was originally a system of immunity that used the myofascioskeletal system and its relationship with the sympatheticolymphatic (circulatory, vasolymphatic) system as the application medium for a manipulative approach. Essential to its success was the understanding the three M’s. An osteopathic intention allows us to palpate all as a unified rather than parts as a unifying process. Our dominance of an orthopaedic and physical therapeutic approach coupled with objective (mindlessness) palpation with procedural and imitative manipulative techniques are taking us nowhere fast. Dr Still was cautious about the formulation of exercises (Booth, 1905) and against the formal procedural teaching of manipulative techniques. Green (1921) wrote the following: “During the close of my last year at the American School of Osteopathy, where at a time it was the prevailing custom of the student members of the various fraternities, clubs and cliques to obtain special lessons in manipulations outside of the clinics and classrooms, I had an argument with one of the members of the operating staff, protesting against such practice. Let us begin with osteopathy – the absolute science, which means “a definite knowledge of things as they actually exist.” Technique is “the manner of artistic performance; the details, collectively considered, of mechanical performance in art.” The “desired end” in osteopathic practice is the correlation of the physiological action of the human body through normalisation of structure. The manner and means adopted to produce this normalisation of structure is “technique,” but we cannot become technicians until we have made a skilful arrangement in our minds (my italics) of each and every condition, direct or contributory to the maintenance of the abnormality, before attempting a correction. This is one of the great objections to any plan to attempt a standardisation of technique. Another is the tendency of many merely to imitate the manipulations employed by a demonstrator without giving due thought and consideration to his particular reasons for their employment.” Over standardisation of technique dominates osteopathy under the guise of more efficient and precise procedures with the promise of greater safety. The tail is wagging the dog. Care and effective treatment of the athlete will continue to elude us as we are techniquing the athletes instead of treating them. And always we trust the method, machines and technology developed by the hand and mind, but we do not trust the hand and mind that developed the method, machines and technology. We have lost our subjectivity (mindfulness) and with it our ability to reason scientifically. Our palpation is objective and contracted leaving us feeling what we are thinking not what is actually under our hands. With this lack of sense we are missing the majority of the athlete as a patient and as a consequence we are unable to scientifically validate the majority of what we can do and the potential to do more. The osteopathic movement in sports medicine is dominantly mindless (objective) and although this is a powerful method it weakens the osteopathic potential. The technique of osteopathy is to return the relationship of the body as a whole to itself. Reflecting upon itself a polarity, not a balance, allowing formative movement at all levels, with a degree of independence from the environment. Many osteopaths do not want the experience, from experiens “to fear,” of responsibility for their own mode of consciousness they would rather ride along on the wave of objectivity. Osteopathy is a scientific orphan; this organic, ecological, eubrotic medicine has been dominated and hijacked by a materialistic, technological, antibiotic medicine. What makes an approach to an athlete osteopathic? Reasoning, sense and mindfulness with an organic philosophy of mind, matter and motion as One not one. |
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| REFERENCES de Botton, A. (2001): Terror. Recession. War…, The Wise have had and Answer. It’s Called Philosophy. The Independent. Wednesday Review. 21 November p.1 & 7. Booth, E. R. (1905 ): The History of Osteopathy and Twentieth Century Medical Practice. The Caxton Press, Ohio. Green, C. S. (1921): Technique. The Journal of the American Osteopathic Association. January, p.250-54. Hubbard, R. & Wald, E. (1999): Exploding the Gene Myth. Beacon Press, Boston. Israel, J. I. (2001): Radical Enlightenment: Philosophy and the Making of Modernity 1650-1750. Oxford University Press, Oxford. Lewontin, R. C. (1992): The Doctrine of DNA: Biological Ideology. Penguin, London. Littlejohn, J. M. (1899): Psychophysiology. Kirksville, Missouri. Merchant, C. (1980): The Death of Nature: Women, Ecology and the Scientific Revolution. Harper and Row, San Francisco. Midgley, M (2001): Why Memes? In Alas Poor Darwin: Arguments against Evolutionary Psychology, ed. Hilary Rose and Steven Rose. Vintage, London. Nelkin, D (2001): Less Selfish than Sacred? Genes and the Religious Impulse in Evolutionary Psychology. In Alas Poor Darwin: Arguments against Evolutionary Psychology, ed. Hilary Rose and Steven Rose. Vintage, London. Toulmin, S. (1990): Cosmopolis: The Hidden Agenda of Modernity. The University of Chicago Press, Chicago. Whytte, L. L. (1949): Goethe’s Single Vision of Nature and Man. In German Life and Letters, ed. S. Walker, chapter V, p. 287 – 97. |
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