Please welcome Victory’s newest team member: osteopath Jonathan Grice. This week, Jonathan explains why he decided become an osteopath.
I can’t remember whether it’s Tolstoy or Chekhov who said happy families are boring; they’re all the same. Unhappy families, on the other hand are interesting because they’re unhappy for their own particular reasons. That’s how I feel about the difference between osteopaths, chiropractors and physiotherapists. Good practitioners tend to resemble each other in their methods and approach and keep an eye out across the whole field of good practice. Bad practitioners often become closed, fixated on their own obsession and arrogantly dismissive of alternatives.
I am an osteopath. I chose to study osteopathy over chiropractic and physiotherapy. I had lots of reasons; but when I decided, I knew a great deal less about the subject. I’m going to discuss osteopathy and its history and end with a critique. When I’m finished I hope you’ll better understand what I’m thinking, or how I was trained to think as an osteopath.
Osteopathy was invented by Dr A.T. Still in 1874 in the USA. Dr Still was a frontier doctor earned his medical licence by apprenticeship, which wasn’t unusual in the US in the nineteenth century. He witnessed his entire family perish from meningitis as a doctor and the experience lead him to lose faith in medication. This shouldn’t be a surprise, since the core of the nineteenth century doctor’s kit was four drugs: mercury salts, laudanum (opiates), purgatives and emetics. If the doctor was old-fashioned they might bleed a patient also.
After flirting with magnets and mesmerism, Dr Still experimented with manual therapy. He became a “lightning bone setter”. He also developed gentle harmonic mobilisation techniques and proved to be successful enough to develop a reputation in the Mid-West. By the 1890s he had opened a number of medical schools and universities. He attracted enough attention that Europeans crossed the Atlantic to be treated by him.
One was a Scottish lawyer called J.M. Littlejohn, who was so impressed he trained to become a Doctor of Osteopathy in Still’s medical school in Knoxville, Missouri; and on graduation was asked to become principal of the Chicago School of Osteopathic Medicine. Dr Littlejohn returned to the United Kingdom early in the twentieth century to share osteopathy with the British medical establishment. Littlejohn presented at the Royal Society and the Royal Society of Medicine. He received an underwhelmed response and so, determined to found a new profession he felt would quickly replace medicine in its current form in Edwardian England, he set up the British School of Osteopathy (now the University College of Osteopathy) in 1917.
The timing was fateful. The First World War was the making of the fledgling physiotherapy profession, with so many wounded and maimed returning servicemen requiring rehabilitation and orthotic prostheses. Records show that Littlejohn taught manual therapy within more than one of the new physiotherapy schools which were set up to train those set the task of treating the victims of Flanders.
There are two aphorisms coined by Still that I repeat all the time. First, Find it, Fix it, and then Leave it alone. This basically means don’t mess around. There’s an implication that the body heals itself once you eliminate the impediment to normalisation, so long ongoing treatment is probably futile at best and may be detrimental to health at worst.
Second, the structure of the body governs function, and the function of the body determines the structure. There’s both more to this and less to this than meets the eye.
There is no blueprint in the growth and development of a human body. While there are general patterns and the main trunks are the same, the minor nerves, veins and arteries are highly variable from person to person. Similarly, within limits the body is constantly reshaping itself to meet the needs of the environment: a compensation mechanism. Place stress on the body severely enough for long enough and this compensation mechanism turns pathological. Pain in musculoskeletal structures inhibit the body’s ability to normalise.
The impairment that results used to be called an osteopathic lesion by the osteopathic profession. When osteopaths realised that they weren’t the only professionals to be addressing it and that they needed to use a more universal term, they changed the name to somatic dysfunction. However, somatic dysfunction is now considered old-fashioned by osteopathy colleges, and they try to use other terms where they can. What it refers to is a self-sustaining neuromuscular (mostly joint) lesion that may or may not be associated with a traumatic injury.
The lesion sustains itself in a vicious cycle. Firstly a pain inducing localised hyper tonic muscles (spasm) prevents movement in a joint. Secondly, the spasm induces pain through compression of nerves in joint spaces, spinal nerve roots, insufficient blood supply through constricted blood vessels, through inflammation and swelling, and through the production of noxious substrates in the muscle.
It is an elegant model. It has some evidence behind it. But on the finer points it is incomplete and a hypothesis rather than a proven fact.
Osteopaths tend to look at the whole body when trying to understand the patient. Osteopaths try to not focus solely on the points of pain, but understand disease and dysfunction in the whole.
If you held a gun to my head and asked me about the weaknesses of my profession, I would say its strength is its weakness. Osteopathy was founded on a philosophical approach to health. Its founders were philosopher physicians. Contemporary osteopaths tend to get hung up on philosophy, and tend to look backward into their history for answers, as if the old doctors had the real thing, and nowadays we have a watered-down approach. Osteopaths can be dismissive of ideas from outside the profession and have deep philosophical suspicions of medicine and medical science.
For me, ideas have no professional stamp or water-mark. Good healthcare practice remains good no matter the profession of the practitioner. Every day I read papers and articles, and the utter miracles of science that are commonplace things still astound me. If I can use a couple of these to take a few people out of pain, why wouldn’t I do that?
To experience Jonathan’s approach first-hand, you can now book assessment appointments with him at our Sun Street clinic. To book, either fill in the form below or give us a call on 0207 175 0150. And if you book an assessment with Jonathan before the end of May 2019, then we’ll give you 50% off the price of the first session.