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Robert Hale is an Osteopath, Acupuncturist and Herbalist in Santa Eulalia del Rio, Ibiza.
In Osteopathy, Research and Practice (1910), the originator of osteopathy, Dr. A.T. Still, wrote:
‘One asks, «how must we pull a bone to replace it?» I reply, pull it to its proper place and leave it there. One man advises you to pull all bones you attempt to set until they «pop.» That «popping» is no criterion to go by. Bones do not always «pop» when they go back to their proper places nor does it mean they are properly adjusted when they do «pop.» If you pull your finger you will hear a sudden noise. The sudden and forceful separation of the ends of the bones that form the joint causes a vacuum and the air entering from about the joint to fill the vacuum causes the explosive noise. That is all there is to the «popping» which is fraught with such significance to the patient who considers the attempts at adjustment have proven effectual. The osteopath should not encourage this idea in his patient as showing something accomplished.’
Just read that last line again please: The osteopath should not encourage this idea in his patient.
Yet some new patients clearly expect me to make their spines make «cracking» noises. They think something has «clicked out of place» (the «cause» of their pain) and should be «clicked in», to the relief of all. And since these are usually people who have previously been to other practitioners, and since they have obviously gained the impression that this is osteopathic reasoning and that the «crack» is what defines an osteopathic treatment, my only conclusion can be that the profession is indeed guilty of «encouraging this idea» in its patients.
But the whole idea is wrong (and it is not osteopathic reasoning). Spines do not click in and out like a broken part of some old-fashioned mechanical toy. Spines sometimes click. They sometimes strain. Sometimes they click at the same time as they strain. Sometimes they don’t. The click means nothing. Spines are complicated. Spines are intelligent. Spines learn behaviour. They are sophisticated and intricate computer-commanded biological machines, not pieces of clockwork. Would you hit your expensive laptop with a hammer when it’s not working properly? Maybe you’d like to, but that wouldn’t solve any problems!
Remember: The osteopath should not encourage this idea in his patient.
So why are some of my colleagues doing this? Are they being taught this themselves? If not, where did they learn it? I have no answer to this. All I can do is explain my own attitude to these techniques.
«Bone-cracking» techniques (technically «high velocity low amplitude thrusts» or HVLAT were not especially prominent in early osteopathy. Indeed Dr Still seemed to have preferred to use other kinds of techniques. HVLAT gained in prominence during the twentieth century, to the extent that graduates of certain schools seem to use them as standard and to be aware of little else in the osteopathic toolbox.
There are indeed a few occasions in which the rapid reduction of acute pain that HVLAT sometimes produces cannot be matched by other kinds of techniques. It is also quick, saving time for the busy practitioner, who often however, would do better by the patient by giving a more complete treatment. But mostly, I think, its popularity is because the noise produced by the joint when rapidly opened is somehow psychologically satisfying to both patient and practitioner. The feeling that something has been achieved.
The osteopath should not encourage this idea in his patient.
«Bone cracking» has important disadvantages. I treat mainly chronic cases (formally defined as symptoms of more than six months duration). In chronic conditions bone-cracking is usually useless, and can even do harm. Indeed, I have seen a fair few patients who have previously been harmed, or felt they have been harmed, by injudicious, clumsy, too frequently repeated, or indiscriminate HVLT manipulation. Sometimes, I fear, it is used as a «shotgun» technique when a practitioner does not know or cannot be bothered to identify clearly what needs to be done.
Chronic dysfunction in tissues is characterised by long-standing stiffness, and ingrained habit. It involves the whole body in compensatory muscle activity, postures and movement patterns. These too become hardened, ingrained habits. Treatment of chronic conditions should be viewed as a gradual, gentle unwinding of the whole body, not knocking isolated bits of it «back into place». The very idea would make me laugh if it didn’t make me so annoyed that some of my colleagues encourage this idea in their patients.
The osteopath should not encourage this idea in his patient.
As a technique HVLAT lends itself to application according to wrong criteria such as «manipulate the painful joint» or «manipulate the stiff bit» or simply «manipulate to make a satisfying noise», without taking into consideration
the whole body pattern which needs unwinding. «The painful joint» or «the stiff bit» rarely has a purely local cause. This vital work never gets done if the focus is on single bits in isolation, or on the production of satisfying «clicks» or illusory quick fixes.
Biological tissues should not be forced. If a joint has to be thrust forcefully in order to «adjust» it, it is not ready for «adjustment». When it is ready, it does not need to be thrust. Why use HVLAT when gentler, effective and risk-free alternatives abound? It defies sense and defies, I would say, responsible practice.
Unfortunately, the rise of HVLAT has been such that many people identify osteopathy with this technique. I have a very satisfied patient who once told a friend of his that he had been going to an osteopath for his back pain. «Did he crack your back?» the friend enquired. «No? You must be mistaken then. He can’t be an osteopath.» Another patient, a rally driver, asked me after his first treatment, «Aren’t you going to manipulate my back?» I explained that I had just spent half an hour doing just that. «But I know that a good osteopath always cracks the spine», he said. I suggested then that he’d better go to a «good» osteopath.
Good practice and good treatment is defined by its approach to human problem-solving, not by spectacular technique.
The osteopath should not encourage this idea in his patient.
Copyright (c) Robert Hale 2022. Robert Hale is an Osteopath in Santa Eulalia, Ibiza.
Public domain photo downloaded from https://www.keesler.af.mil/.
Eddie Izzard on bone cracking…
«Everything is energy», so some people like to say. And everybody around looks thoughtful and knowing.
Well, first define energy. That’s not so easy*. If you define it (with circular logic) by saying, «Energy is everything», well and good, but that is not going to get you very far solving practical problems in the concrete world.
«Everything is energy» (like it’s sister, «everything is connected») are such general truisms that, while sometimes they may constitute useful first principles, they are often pronounced either in ignorance of, or in lofty philosophical dismissal of the detail which actually allows us human beings to live a life in this world.
In any case, it is not true that everything is energy (taking my definition from physics). Information is not energy. At its simplest, information is a signal. A signal may require a quantity of energy for its transmission, but in itself it is not energy. It is simply something that carries meaning for, or invokes a behaviour from certain recipients, whether animate or inanimate.
Like the words you are reading now. Some energy was expended by myself to write them, some will be expended by your eye, nerve and brain cells to read them, and your device is using energy to reproduce them. But this has nothing to do with their meaning for me or for you. They may or may not provoke you to act (like writing an angry reply), whether you do or not has nothing to do with any energy quotient contained within the words.
[* The word «energy» comes from the Greek: «en» = in, and «ergon» = work. Thus, it is the work within something. But it has been extended for example in popular speech and literature to mean «vigour of expression» and in new age circles to mean «atmosphere, feeling, attitude» and such like.]
«Todo es energía», eso les gusta decir a algunas personas. Y todo el mundo a su alrededor parece pensativo y conocedor.
Bueno, primero define la energía. Eso no es tan fácil*. Si lo defines (con lógica circular) diciendo: «La energía lo es todo», muy bien, pero eso no nos llevará muy lejos a resolver problemas prácticos en el mundo concreto.
«Todo es energía» (como su hermana, «todo está conectado») son clichés tan generales que, si bien a veces pueden constituir primeros principios útiles, a menudo se pronuncian ignorando o desdeñando filosóficamente los detalles que en realidad nos permite como seres humanos vivir una vida en este mundo.
En cualquier caso, no es cierto que todo sea energía (tomando mi definición de la física). La información no es energía. En su forma más simple, la información es una señal. Una señal puede requerir una cantidad de energía para su transmisión, pero en sí misma no es energía. Es simplemente algo que tiene significado o invoca un comportamiento de ciertos destinatarios, ya sean animados o inanimados.
Como las palabras que estás leyendo ahora. Yo mismo gasté algo de energía para escribirlos, algo será gastado por tus ojos, nervios y células cerebrales para leerlos, y su dispositivo está usando energía para reproducirlos. Pero esto no tiene nada que ver con su significado para mí o para ti. Pueden o no provocarte a actuar (como escribir una respuesta enojada), ya sea que lo hagas o no, no tiene nada que ver con ningún cociente de energía contenido en las palabras.
[* La palabra «energía» proviene del griego: «en» = en, y «ergon» = trabajo. Por lo tanto, es el trabajo dentro de algo. Pero se ha extendido, por ejemplo, en el habla y la literatura popular para significar «vigor de expresión» y en los círculos de la nueva era para significar «atmósfera, sentimiento, actitud» y cosas por el estilo.]
Copyright (c) Robert Hale 2022.
Robert Hale is an osteopath and acupuncturist in Santa Eulalia del Rio, Ibiza. / Robert Hale es osteópata y acupunturista en Santa Eulalia del Rio, Ibiza.
[Image: The Mulberry Tree by Vincent Van Gogh. I have always admired Van Gogh’s painting for his wonderful capacity to produce the appearance of movement (energy!) from static paint on static canvas.
Imagen: La morera de Vincent Van Gogh. Siempre he admirado la pintura de Van Gogh por su maravillosa capacidad para producir la apariencia de movimiento (¡energía!) a partir de pintura estática sobre lienzo estático.]
In a previous post I talked a little about the five-element system of looking at the world. But what has it got to do with acupuncture? Well, acupuncture is a method used in traditional Chinese medicine (TCM), and as I exemplified in that post the five elements in that system have a very great deal to do with the way the body works in health and disease. One of the major classic texts of Chinese medicine, the Huang Di nei jing su wen or Inner Canon of the Yellow Emperor, describes in detail the various pathological states that are believed to arise from imbalances in the five elements.
In modern acupuncture schools five-element theory is taught as being fundamental to the practice of acupuncture. You puncture this point and you stimulate a “wood” point, that one and it’s an “earth” point and so on. There are complex methods devised to manipulate with needles the laws that govern energy transformation between the phases (“phase” is another, perhaps better word for “element” in Chinese medicine).
However, among scholars doubt exists whether these methods are actually traditional at all. One school of thought has it that for much of the history of acupuncture, points were selected on the basis of what collective experience told about what symptoms they successfully treated, rather than theoretical considerations about the five elements. According to this school of thought, the latter is a quite recent invention stemming from the “Great Leap Forward” and the “Cultural Revolution” (1950s and 60s respectively). I have also read that the relevance of the five elements to clinical practice was transplanted to acupuncture from herbal medicine, where it is more clearly applicable. That certainly makes sense to me.
My reflections on my own experience lead me to believe that five-element theory has little bearing on the success or otherwise of acupuncture treatment, and I do not base my practice of acupuncture on this theory any more.
Copyright © Robert Hale 2021. Image: The Five Elements Cycle by Manonastreet, reproduced according to Creative Commons licence CC0, via Wikimedia Commons.
Robert Hale is an osteopath, acupuncturist and naturopath in Santa Eulalia del rio, Ibiza. / Robert Hale es un osteopata, acupunturista, y naturopata en Santa Eulalia del Rio, Ibiza.
I am going to say something controversial. Holistic health systems do not «treat the cause». It is so often stated that they do, in contrast to conventional («allopathic») medicine which «just dispenses drugs and surgery». This is not true. «Finding the cause» is proper to good conventional medicine.
You are feeling weak and tired and your complexion is dull and pale. Your doctor arranges blood tests and it turns out that your blood lacks iron and your red blood cells are few and small. Your doctor prescribes an iron supplement and you begin to feel better. Your doctor has correctly diagnosed that iron deficiency anaemia is the cause of your symptoms. Your doctor goes further. Why are you lacking iron? Is your diet providing sufficient iron? If you are a woman, are your periods very heavy or are you bleeding between periods? Have you abdominal pain? Is there blood in your stools? These are all questions for good conventional medicine. The way it is practised is not always good. But the fact that a doctor may not be thorough does not damn the discipline of medicine as such. Its aim and its technical abilities are geared to finding out a cause. That is its strength and also its blind spot.
It is a blind spot because health and ill health, life itself in fact, are not that simple. To speak of «the cause» is frequently a distorted portrayal of reality. To do so habitually is a symptom of a deeply ingrained, distorted view of the world. Just say that you continued the «why game». Your anaemia, your doctor has found out, has its origin in a bleeding duodenal ulcer. That is successfully treated, but why was it there? From that point on it often becomes a complex interplay of genetic, environmental, behavioural and emotional factors. There is no one cause, it is multifactorial. At this point it should be a question of assessing influences then joining the dots rather than looking for a single cause. But here conventional medicine is inclined to stop in its tracks with a prescription of omeprazol.
Do holistic systems manage better? Perhaps the one that comes closest is true naturopathy (not the mix-and-match assortment of «techniques» that often passes for it), which focuses on diet and lifestyle. A criticism that might be levelled against the typical naturopathic mindset however, is a reluctance sufficiently to acknowledge psychological factors. I believe this to be on the one hand a reaction to the perceived tendency in conventional medicine to brand any unexplained symptoms as «psychological», and on the other the ego tendency of some naturopaths (untrained in clinical psychology or psychotherapy) to convince themselves that with their special insights they can be all things to all people.
What of other disciplines? I will speak of those I know best: osteopathy and acupuncture. The truth is, these systems do not seek out and treat «the cause», instead they find ways of:
But many osteopaths also have a naturopathic mindset and many acupuncturists also have a rounded knowledge in diet and lifestyle from a traditional Chinese perspective, so all in all, they can set up a context for healing both within and without the body.
Copyright (c) Robert Hale 2022. Public domain image from Pixabay.com.
Robert Hale is an osteopath, acupuncturist and naturopath in Santa Eulalia del rio, Ibiza. / Robert Hale es un osteopata, acupunturista, y naturopata en Santa Eulalia del Rio, Ibiza.
Robert Hale 