Positive Health Online

Leon Chaitow has done a remarkable job in bringing so much information and research references together in this extensive volume which runs to nearly 600 pages. With contributions from numerous highly experienced Osteopaths, Chiropractors, Naturopaths and academics, this book will be an invaluable resource for all Manual Therapists who wish to evaluate the effectiveness of a wide range of different physical therapies. It also provides a detailed overview of differing approaches to and theories about physical assessment.

The book starts with an excellent summary of the history and philosophy behind Naturopathic Medicine and goes on to look at the complexity of physical, environmental, social and neurological factors that might affect clients’ health.  Particularly useful for Physical Therapists of any modality is the clear and quite extensive explanation of the stress response as defined by Hans Selye and how it influences health. Linked with this is an exposition on facilitation and trigger points, how posture influences visceral and somatic function and how treatment itself can act as a stressor in some circumstances such as fibromylagia and ME.

There are several excellent sections regarding research, with comments about the pitfalls of evaluating effectiveness in CAM therapies. The research references at the end of each chapter are extensive to say the least, and provide enough ammunition to keep any ardent sceptic about these forms of CAM therapy well at bay.

Chapter 6 is a comprehensive review of assessment and palpation skills, with short descriptions of a variety of tests ranging from scanning, neuromuscular evaluations, fascial drag, trigger point and scar tissue palpation to Range-of-Motion (ROM) tests and leg length discrepancy.

What is not so clear is how the wide range of skills and knowledge base reflected particularly in chapters 6 and 7, could be used in practice without a high degree of hands-on tuition from a skilled teacher. The book does acknowledge that the kind of palpation described in the book needs “a high degree of palpatory literacy to be a meaningful process.”

To give an example, there is an exercise that describes palpation of the coronal and other sutures in the cranium.  As described, this involves intra-oral contact and motion testing of sutural mobility by the practitioner introducing gentle rocking motions into the cranium. This test done without appropriate sensitivity could quite possibly be counter-productive to the treatment process.

Likewise, palpating the motility of internal organs is described quoting the approach developed by Barral and Mercier. Although it is useful to have this method of palpation brought to one’s attention, the high degree of skills needed to obtain clear and precise clinical information takes months if not years of practice and I wonder how useful or indeed safe it would be to attempt this exercise from a book. Having said that, there are plenty of suggestions included for further reading, such as Shipley’s Manipulation Therapy for the Naturopathic Physician, and Chaitow’s own Palpation and Assessment Skills which go into more detail than is given here.

Chapter 9, written by Osteopath Matthew Wallden includes an extensive array of useful and practical information on biomechanics, ergonomics, posture and muscle physiology, placed within the context of human evolution. There are particularly good sections on sports medicine, on the muscular system as an expression of psychological state, as well as interesting comments on the relationship between chi and water, the hazards of weight-loss programmes and the role of chi in spinal mechanics. Wallden’s philosophical views which describe the hierarchy of humans in terms of dimensions, developmental planes and spiritual states may not be to everyone’s taste, but they provide a useful context for his extensive and compelling description of movement rehabilitation.

One slight criticism of this book is that it largely ignores light-touch or other ‘energy-based’ therapies. The book does mention approaches such as Ayurveda, Yoga, Alexander Technique, Zero-balancing and Meditation and looks at the research for their efficacy, but the references are brief. There is virtually no mention of the role of other modalities such as healing or Bowen. Chaitow concentrates on techniques in which he excels, such as positional release techniques, myofascial release, muscle energy techniques, Trager exercises, MLD, mobilization and manipulation – in particular high velocity low amplitude (HVLA) thrusts.

As a reference book, this volume is worth its weight in gold and if one can get through the dense writing style will be an invaluable tool for any manual therapist.

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