Osteopathy - a Definition by Way of a Brief History

Osteopathy was founded in the late 1800s by a frontier doctor named AT Still who was fed up with the inadequacy of the medical treatments available to him at the time. He wrote volumes of medical philosophy that is in many ways as valid and visionary today as it was in his time. He had a rare appreciation for the body’s uncanny ability to heal and correct itself if the right conditions were met. His tools were his hands and he used them both diagnostically and therapeutically – in ways like no other doctor before him. He palpated the bones for asymmetry, the connective tissue for strain patterns and the muscles for tone. But then he took this insight to a practical level and designed interventions to correct the dysfunctions that he found. Most of the best body work being done in the world today descents directly from Still.

Ironically, osteopathy is now better known in some other developed countries than it is in its country of origin. That’s due in large part to the fact that America is the only country where DOs are equivalent to MDs. Some would say that osteopathy sold out to conventional/allopathic medicine in the 60s when it adopted the same legal status and the protected title of “physician.” It’s a sad truth that few DOs in practice today actually practice osteopathy. Like so many other things, this has a lot to do with money; despite the years necessary to develop strong manual skills – and the remarkable therapeutic power that can be harnessed once they are developed – it simply isn’t economically viable to practice that way under the current prevailing high overhead / high volume medical business model. Because I’m passionate about osteopathy, I make it available to my patients even though the insurance reimbursement is poor. But I also know the limits of my skills so I sometimes refer patients to local non-physician body workers who do nothing else in their practice and thus have better skills than I do.

Prolotherapy - Fringe or Frontier

Prolotherapy is a powerful and elegant treatment for musculoskeletal pain. It can be effective for pain in almost any joint in the body, including the spine. Unfortunately, Medicare made a terrible decision not to cover the procedure and the nearsighted insurance industry followed suit. It’s actually relatively inexpensive and there’s some good research to back it up.

Briefly stated, ‘prolo’ involves the injection of various solutions where ligaments or tendons meet bone. Procaine is a local anesthetic (like most of us may have been given at the dentist’s office) that makes the injections less painful. The procaine only blocks signal transmission for an hour or two but the long-term effect can be long-lasting or even curative. The reasons for this long-term effect are poorly understood, but may be like rebooting a malfunctioning computer; up-regulated pathways can return to normal after a period of inactivity allows them to reestablish their baseline. The needle trauma itself also appears to be a driver of the therapeutic effect. The small punctures cause ‘micro bleeds’ that attract cells to the site of injury, including fibroblasts which deposit new collagen. Dextrose is sugar-water and the solution most commonly added to the local anesthetic. It also attracts healing cells to the area in question.

Patrons of the Sound Clinic can also choose hormonal prolotherapy injections. Abused by athletes because they facilitate and augment the healing process, testosterone and/or human growth hormone (HGH) allow for more frequent and vigorous training. These hormones, when injected directly into the site of damage, have little if any systemic effect. This breakthrough approach is also less painful than dextrose.

Knees, shoulders and hips are often the most responsive joints, even if they have begun to show signs of osteoarthritis (OA). Patients with OA are often told that their pain is due to the “wearing away of cartilage” and that the best available treatment is non-steroidal anti-inflammatory drugs (NSAIDs, like ibuprofin/Motrin/Advil) steroid injections, expensive Synvisc, and eventually, joint replacement. What this explanation fails to explain is the dynamic nature of collagen; it’s a living soft tissue that’s constantly being worn and replaced. Ligaments are supposed to keep the joint tight to minimize play and reduce the wearing that results from it. The collagen doesn’t “wear down” until the wearing process outstrips the replacement process. When the ligaments become loose, the cartilage wears faster until the body’s capacity to replace what is worn can’t keep up anymore. Loose ligaments are a common result of sprain injuries and overuse. Their capacity to return to original length and strength after injury is limited and varies from person to person. By helping to restore ligaments to their original length and strength, prolotherapy can calm pain generators triggered by laxity and allow collagen replacement to outpace erosion once again.

It doesn’t help that we have a mass media culture telling us to “take these pills” so you can keep doing whatever it is that your body’s highly-evolved pain pathways are trying to tell you not to do. In fact, some pain killers may do more to promote chronic injury than just facilitate the exacerbation of new ones. NSAIDs (which also include naproxen/Aleve) block inflammation at the site of injury. This is effective for pain relief but also blocks the body’s normal repair mechanisms. Most orthopedists are now recommending against the use of these drugs in the setting of acute fractures, but the same wound-healing biochemistry applies to soft-tissue injuries as well.

For that reason, NSAIDs are also not to be used for the short-term exacerbation of pain that usually follows prolotherapy treatments. A more comprehensive (but also more technical) discussion is available here, including references.