An approach to chronic and complex health problems

I have a special interest in the treatment of chronic and more complex problems. The word «chronic» means that a problem has been present for a long time, technically more than 6 months.

Some problems, such as generalised osteoarthritis, have a naturally chronic course. In the case of osteoarthritis, this is because joint degeneration is, to an extent, part of the natural ageing process. Note however, the phrase «to an extent», the corollary of which is that to an extent it is not, and to that extent there are some very useful things we can do to help prevent it. We can also help to prevent the inflammatory response which makes the damaged joint painful.

Other problems become chronic because they never properly resolved after their first appearance. If you strain a joint, a series of reactions are set up in the body to heal any tissue damage that has occurred, but also postural and behavioural adaptations occur to favour the strained joint by removing load from it. If the healing inflammatory response is effective, the necessity for these adaptations is short-lived, and soon everything returns to normal. If however, the healing response is inadequate, pain and inflammation linger on and postural and behavioural adaptations become more and more «fixed». At this stage they are interfering with the proper function of the joint that was injured originally, thus adding to its problems in the long term.

But why should the initial inflammatory response be inadequate? One reason may be a general lack of vitality. Another frequent reason is that the strain is only the final result of years of development of postural and movement patterns that have rendered the local area vulnerable. In this context the body’s healing response has the odds stacked against it.

How may chronic problems be effectively treated? Simply working to relieve local strain may give temporary relief, but it is not a long term solution. To achieve long-term improvement, it is necessary to improve the way in which the whole body distributes the load placed upon it, as well as removing unnecessary load from the body. Furthermore, taking off the strain means removing load, or improving the organism’s handling of it, in various spheres, not just the mechanical one. For example, psychological stress, smoking and junk food can also contribute to the demands (the «load») placed upon the organism. Only by addressing all these aspects can the organism’s self regulatory mechanisms be fully adjusted towards their maximum healing potential.

This takes quite a long time. In conditions which have evolved over several years, a few manual treatments plus some brief advice is not enough. An ongoing effort is required over at least eighteen months to achieve what can be achieved. There are several points to bear in mind before embarking on such a journey:

  1. One cannot prioritise healing – the body itself does that. For example, you may consider your neck pain to be a priority and wish that to be treated first. Unfortunately, it does not work like that. All we can responsibly do is help the organism into the right conditions for healing responses to occur. The body will then decide on its priorities.
  2. A corollary to this is that we do not treat «problem X», we treat the whole person. In some circumstances, we may not even directly «treat» the symptomatic part at all, but treat the context in which it is found.
  3. Some things may get worse before they get better. It is as if the body needs an acute response to resolve the chronicity.

Palliation of symptoms does not bring long term solutions, and can even make matters worse. One reason for this is simply that by smothering a symptom, underlying causes are ignored and left unchecked. Another reason is that the treatment itself may cause long-term damage. Two examples: (1) If heavy manipulation is repeatedly used to batter a vertebra «into place», firstly that vertebrae may become unstable, and secondly the body will find another way of compensating for its underlying problems. (2) The use of non-steroidal anti-inflammatory drugs (commonly used to treat pain) in the long-term treatment of osteoarthritis, has been shown actually to increase the rate of joint degeneration.

On the other hand, the holistic treatment of chronic problems is not all plain sailing, but it is the approach which goes furthest to restoring general health.

Copyright (c) Robert Hale 2022.

Image: The original uploader was Harrygouvas at Greek Wikipedia, Creative Commons licence CC BY-SA 3.0 , via Wikimedia Commons.

Robert Hale is an osteopath in Santa Eulalia, Ibiza.

Spinal Pain: An Alternative Approach

Without doubt the most frequent kind of problem with which I am asked to deal is pain coming from the spine. This can manifest as pain in the areas near the spine (the back and the neck) or in areas connected to the spine by nerves (frequently the legs, the arms or the thorax and chest). Sometimes there are other, associated symptoms in these connected areas, like tingling, pins and needles or numbness.

My approach to these problems is based on an osteopathic view of health and illness. It follows that it differs in fundamental ways from the usual approach of orthodox medicine or physiotherapy.

The medical approach to spinal pain

As medicine is generally practised it:

  • Allows little time for the doctor to spend talking to and examining the patient.
  • Aims to identify a distinct pathological cause (i.e. a “disease”).
  • Makes frequent use of x-rays, scans and blood tests to do this.
  • Tends to regard the painful or diseased part in isolation.
  • Uses the principal strategy of suppressing symptoms.
  • Relies on drugs as first line treatment, physiotherapy as second line, surgery as third line.
  • Physiotherapy reflects these characteristics of the medical approach.

My approach to spinal pain

In contrast, as an osteopath, I:

  • Allow as much time as is necessary for talking to and examining the patient.
  • Am more interested in why you have become unwell than in the name of your disease. Generally the kind of treatment you receive is not greatly affected by your medical “diagnosis”. It is determined much more by how your body is working mechanically, the factors in your life which are preventing you from getting better, and your general state of health.
  • Find only secondary and relative value in x-rays, scans and blood tests. That is because in most cases of uncomplicated spinal pain, they are not relevant to your treatment or management.
  • Try to relate your problem to what is happening in your whole body, your mind, and your life.
  • Believe that suppressing symptoms can cause bigger problems (symptoms are often a necessary part of the body’s healing response), preferring instead to remove any obstacles to healing.
  • Rely on manual treatment, lifestyle changes and counselling: this is usually sufficient and complete treatment.

A complex system

The spine is not just a column of bones. It could be likened to an extremely sophisticated robotic machine controlled by extremely sophisticated computer circuitry. There is immense potential for glitches in its workings even with no sign of anything that might be labelled medically as a “disease”. Osteopaths call such glitches in spinal workings “dysfunction” or sometimes “osteopathic lesions” (an older term).

I use manual treatment to remove or reduce these «glitches», helping the spine to return to as near normal functioning as possible. Clearly, if joint or disk degeneration have significantly altered the basic shape or quality of the tissues of the spine, improvement may take longer or be incomplete. However, moderate improvements in function can turn a painful spine into a largely pain-free one even in the presence of what doctors call “disease” (for example, arthritis, disc hernias, etc.)

Craft, expertise, and modern science

In my experience the osteopathic approach, well practised, is clearly beneficial for patients who suffer from spinal pain. Osteopathy is a craft. I have been learning this craft for nearly three decades, and I am still learning. Nothing that I have learned so far has led me to doubt the basic principles underlying its usefulness as a therapeutic discipline. However, scientific knowledge of the workings of the spine and its problems is constantly expanding. As an expert in the care of patients with spinal problems, I keep myself continually abreast of the most recent research, in order to ensure that I am able to deliver the best care.

Copyright (c) Robert Hale 2022. Photo by Marco Verch, via Flickr. Creative Commons CC BY 2.0 licence.

Robert Hale practises osteopathy in Santa Eulalia, Ibiza.

What You Need to Be an Osteopath

1. Anatomy. An excellent knowledge of how the body is made is essential. For an osteopath there are three kinds of anatomy. The first is the theory, that is the names, locations, and forms of every body part. The second is what we call functional anatomy, or ‘what things do and how’. Another word for this is ‘physiology’, but I like the term ‘functional anatomy’ because it relates function with form, which is one of osteopathy’s basic principles. The third kind of anatomy is palpatory anatomy, that is, what all the parts of the body feel like to the hands.

2. An appreciation of relationships. Relationships between body parts, between form and function, between each part or function and the whole, between the body and the mind, between the body-mind and the outside world. The inseparability of all of these. This is what osteopaths deal in.

3. Problem-solving. The ability to analyse a situation, to see its essential elements, and to understand how we may most effectively induce changes, is fundamental.

4. Manual skill. We need to attain the same kind of skill level that one sees in expert musicians, for example.

5. Medical knowledge. This enables us to know what not to do in treatment in specific cases, what lifestyle advice is most appropriate, and when to refer a patient to a medical practitioner.

6. Humility. We know the lesser part of how the body works. Therefore we must use a general plan that is tolerant of our ignorance. And each of us has our personal limitations, so we must acknowledge them and work to our strengths.

Copyright Robert Hale 2021. Image by Piotr Siedlecki, from PublicDomainPictures.net.

Robert Hale practises osteopathy in Santa Eulalia, Ibiza.

The «Five Elements» in Chinese Medicine

The great ancient civilisations developed philosophical models of existence that encompassed the cosmos, living beings, physiology, health, disease and medicines. They were based on fundamental “elements” that made up the universe. The Chinese had and still have a five-element system, Ayurvedic medicine also had and still has five elements, and Ancient Greek and Islamic medicine had four elements. In medicine, all these systems had several things in common, but above all it was their focus on vitality that characterised them and differentiated them from modern medicine.

Let us look at the Chinese system. The Chinese five elements are Wood, Fire, Earth, Metal and Water. These are not to be taken literally. They are more like groups of characteristics, or you could say different “personalities”. Everything that exists in the universe is made up of different combinations of these “personalities”. However, in each thing, one of them is usually dominant.

Image by Parnassus, CC BY-SA 3.0, via Wikimedia Commons.

One can also consider the elements to be different forms of energy. Energy is transformed cyclically from one element to the next in a specific order. In traditional Chinese theory there are universal laws governing this transformation of energy. We won’t go into these here.

Instead, let us take one element and see how it manifests itself in the human body and mind.

The Wood “personality” is dominant in the energy of the liver and gall bladder, the tendons, the nails, the eye, and the emotion of anger. How are these things connected? The liver produces bile which is collected by the gall bladder for release into the duodenum in order for it to carry out its digestive functions. There is an energy channel called the liver meridian which begins in the foot, runs up the body through the liver and ends at the eye. So eye inflammations or other problems are associated with alterations in liver energy. Very often people with liver congestion or disease become irritable and this can easily spark into anger. What about the tendons and the nails? This is an example of association of ideas. Taut tendons and nails are thought to be woody in their appearance and physical characteristics and therefore believed to be associated with the Wood element, and by extension nourished by liver energy.

Now let us look at different kinds of liver problems in Chinese medicine:

If liver energy fails to flow and stagnates, you can experience rib pain, mood swings, nausea, acid reflux, belching, and if you are a woman, premenstrual syndrome. The stagnation may cause the energy to rise (imagine a small river that has become blocked by vegetation and fallen branches – the water rises!). This in turn causes irritability, tension around the temples, dizziness, tinnitus, dry mouth and eyes and insomnia. Liver “Fire” is even worse. The stagnated energy becomes very hot, and rising, it causes anger, headaches around the temples, a red face and eyes, thirst, a bitter taste in the mouth, vertigo, tinnitus, nosebleed, constipation with dry stools, and dark urine. If very serious excessive liver energy can cause convulsions or strokes.

Stagnated energy, as we have said, can overheat. It can also cause congestion. When this happens with the liver, it is called “Damp-Heat in the liver” and may result in jaundice, bloating, nausea and vomiting, scanty dark urine, and inflammation or infection of the genitals.

A deficiency of Yin energy in the liver can allow the liver’s Yang energy to rise, too. (If you don’t know what Yin and Yang are, see my posts here and here). This time too you can experience dizziness, tinnitus and insomnia, but also weak vision, night sweats, and thirst during the night.

Liver symptoms plus respiratory symptoms such as a chronic cough, asthma, shortness of breath, or yellow or bloody phlegm are believed to result from excessive liver energy affecting the lungs.

There is another syndrome called “Liver Blood Deficiency” which is basically anaemia together with liver symptoms like dizziness, insomnia, brittle nails, and weak or blurred vision.

Now I have said not to regard the five elements too literally. These descriptions of liver problems are a coherent way of explaining things that are nevertheless completely different to what we know from anatomy and physiology. I view them as symbolic rather than literal. One example of the difference in thinking is strokes: in Chinese medicine, symptoms of stroke like hemiplegia (one-sided paralysis) are explained by hot, rising liver energy blowing up an “internal wind”. Today we know that strokes are caused by the blockage of an artery in the brain or, less commonly, bleeding in the brain.

Copyright © Robert Hale 2021.

Robert Hale provides acupuncture treatment in Santa Eulalia, Ibiza.

Osteomyths

1. Osteopathy is a therapeutic technique.

False. Osteopathy is not a «technique», it is a discipline based on a particular way of thinking about health and ill-health.

2. Osteopathy is a kind of physiotherapy.

False. Physiotherapy is physiotherapy. Osteopathy is osteopathy. Physiotherapy comes from conventional medicine. It thinks in terms of treating this disease or that lesion in this place or that place. Osteopathy comes from a refutation of conventional medical thinking. It thinks in terms of finding global health.

3. Osteopaths are spine specialists.

False. Osteopaths know a lot about bones, muscles, and joints. Some specialise in the treatment of musculoskeletal complaints, others do not.

4. Osteopathy is just for back, joint and muscle problems.

False. Osteopathy has applications in a wide range of health problems, including but not exclusively back, joint and muscle problems. Osteopathy promotes general health. Good general health is an antidote to every health problem.

5. Osteopaths crack your bones.

False. Many use techniques that produce joint noises. Others never do. The osteopathic toolbox is vast. «Cracking» techniques are sometimes useful, but more often than not they are quite unnecessary.

6. Osteopaths try to cure your ailments by manipulation.

False. No doctor or therapist «cures» anything. Your own body heals itself within limits imposed by the nature of the problem and any impediments to self-regulation. Osteopaths understand that, and help you to remove impediments to self-healing, whether that involves manual treatment or not.

7. Osteopathy is a discipline complementary to medicine.

False, in my opinion. There are many medical practices in direct opposition to osteopathic principles.

8. Osteopaths put your bones back in place.

False. Osteopaths do not do that, except in a few relatively rare circumstances. Osteopaths improve the workings of your body. That is a very different thing.

9. A pain in the neck is caused by a problem in the neck.

False. A pain in the neck is either caused by a short-term physiological reaction to direct trauma (in which case it is not a problem, it is part of the solution), or it is a global problem.

10. I strained my knee playing football. I need osteopathic treatment before the match on Saturday so I can play.

False. You cannot pretend it is osteopathic treatment to bend the laws of physics or disregard natural biological processes. First do no harm. You do not need to play again on Saturday. You need to rest. Otherwise, go to a physiotherapist or a magician!

11. Osteopathy is expensive.

False. My belief is that osteopathy has an excellent cost/benefit relationship. For example, in my experience many spinal surgeries have been avoided by osteopathic treatment. Compare a few hundred euros for a course of osteopathic treatment, with a few thousand for surgery. Osteopathy is for those who value their health and who value quality natural health care.

Copyright © Robert Hale 2022.
Image © Nevit Dilmen via Wikimedia Commons, Creative Commons CC BY-SA 3.0 licence.

Robert Hale practises osteopathy in Santa Eulalia, Ibiza.