Positive Health Online

This month I am more, or less thinking aloud . . . and am unlikely to come to any final conclusions. Put simply I am wrestling with why the same phenomena observed by different people from varied disciplines should lead to such a variety of conclusions – and why so many therapeutic approaches based on these conclusions can all be successful – when their focus is so patently different.

A patient with a painful neck condition might randomly consult a massage therapist, an osteopath, a chiropractor, an acupuncturist or someone using one of the more subtle approaches such as Therapeutic Touch or Polarity Therapy.

Each would have their own assessment and diagnostic approaches, and quite distinctive therapeutic methods. And all will be reasonably likely to work towards a successful outcome.

The painful condition could be related to postural stresses, overuse, trauma, psychogenic stress factors, systemic factors, nutritional or allergic factors – or something else altogether.

Patently we tend to see what we expect to see when we evaluate a patient, conditioned as we are by our training and our belief system. We will see and feel the same patient and their dysfunctional tissues, and yet will make quite disparate interpretations, treat in varied manners and at the end of the day it is quite possible that whichever of these therapists was consulted, the patient would improve.

Why?

Firstly I suppose for the obvious reason that most health problems are self limiting – and will get better or improve whatever is done, as long as what is done does not actually make matters worse.

Secondly we all pay lip service to, but frequently lose sight of, the fact that the ability to recover, to heal, lies with the organism, the body, the immune system – and does not reside in the therapy – which at best acts as a catalyst to trigger, or focus recovery and at worst gets in the way of that recovery or makes things worse.

So what might we evaluate as we palpate our patient’s painful neck?

Trigger points, sore spots, tense muscles?

In all manual therapies a foundation of palpation skills is one way in which the budding therapist learns to appreciate the multitude of subtle sensations which are available to the listening hands as they search the skin, muscles, fascia and other available structures for information. The particular viewpoint of the individual therapist will, however, alter their interpretation of what it is they are assessing and will determine whether they focus their treatment strategies more on attempting to modify structure or function, or whether they try to utilise the purported reflex influences which the palpated tissues elements offer – or whether they mix and match, utilising elements of structural modification, functional normalisation and reflex effects.

The therapist with a western medicine orientation may consider the hypertonicity of the tissues and the neurological features which may be involved, as well as the implications of circulatory stasis and how the condition might reflexively influence both adjacent and distant structures. Having considered the physiology of the palpated (tense, indurated, edematous etc) tissues, and the reasons for the condition, decisions will be made as to ways of resolving the problem.

Therapeutic, measures could be based on western manual medicine protocols such as massage, inhibitory ischemic compression methods, muscle energy approaches, positional release methods, rehabilitation exercises etc. A TCM practitioner would evaluate the same tissues and rather than using the western model will assess for energy imbalances, blockages and deficits and would relate these findings to the larger picture ascertained by a variety of assessment methods including pulse diagnosis, observation and palpation, and would consider treatment based on the traditional methods of acupuncture, acupressure, herbal medicine etc.

Osteopathic physician Eileen DiGiovanna1 states, “Today many physicians believe there is a relationship among trigger points, acupuncture points and Chapman’s reflexes. Precisely what the relationship may be is unknown”. She quotes from a prestigious osteopathic pioneer, George Northrup, who stated as far back as 1941, “One cannot escape the feelings that all of the seemingly diverse observations (regarding reflex patterns) are but views of the same iceberg the tip of which we are beginning to see, without understanding either its magnitude or its depth of importance”2.

Felix Mann, one of the pioneers of acupuncture in the west, has entered the controversy as to the existence, or otherwise, of acupuncture meridians (and indeed acupuncture points). In New York in September 1983, Mann, in an effort to alter the emphasis which traditional acupuncture places on the specific charted positions of points, stated:3

“There are so many acupuncture points mentioned in some modern books, that there is no skin left which is not an acupuncture point.”

Clearly awareness of the reflex potential of the body surface widens the therapeutic potential of manual therapy, although deciding which of the many possible applications of reflex activity to utilise in diagnosis or treatment can be a daunting task.

Leaving aside the validity of Mann’s comment it is true to say that if all the multitude of points described in acupuncture, traditional and modern, together with those (trigger) points despised by Travell and co-workers as well, for example, as the tender points described by Chapman (Neurolymphatic points) Jones (Tender points), Bennett (Neurovascular points) were to be placed together on one map of the body surface, we would soon come to the conclusion that the entire body surface is a potential acupuncture point’.

The therapist using subtle energy approaches might scan the area away from the body as well as palpating it and associated areas before approaching the problem from the unique perspective of Polarity Therapy, Zero Balancing, Therapeutic Touch or to some such variation.

The fact that in any given case there is likely to be a positive outcome is what is interesting and we should reflect on the possibility that the therapeutic intervention may be less important than the state of the person being treated, since the healing prerogative lies with them and not in the particular therapy being employed.

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