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.

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.

Treatment of Pain by Osteopathy and Acupuncture

Pain relief is a large part of most health professionals’ work. In my profession as a healthcare provider, the treatment of pain is one of my areas of special interest. Let me tell you a little bit about pain and how I approach it.

There are two general kinds of pain:

  1. Pain coming from some damaged part of the body («nociceptive pain»).
  2. Pain generated by the nervous system without any damage to the body («neuropathic pain»).

Whoa! Wait! How can there be pain without damage? Well, here are a couple of ways. First example: There may have been damage which has now healed, but the nervous system has not adjusted back to normal. Second example: The nervous system may have become sensitised by numerous previous physical or emotional traumas, so that it produces pain response to minor physical stimuli. Note here that all pain is produced in the brain, even though it is felt in the foot, or stomach or head. The difference is that in the first case it is related to actual current damage and in the second case it is not.

The first kind of pain (nociceptive pain) can be further broken down into pain coming from the outer body like skin, muscles and joints («somatic pain») and pain coming from the inner body organs («visceral pain»). The latter can be confusing because it is often first experienced in the muscles of the outer body. The osteopath is uniquely prepared to distinguish between these kinds of pain, a distinction which is critical in their treatment.

Above I said that the treatment of pain was one of my areas of special interest. That is not exact. It would be more accurate to say that the treatment of the person in pain is my area of expertise. The difference is that as a holistic practitioner I treat people, not symptoms or disorders. By treating the person, the symptom goes away or at least gets better, indicating an improvement in any underlying disorder.

The disciplines that I practise, osteopathy and acupuncture, are excellent at treating people suffering with pain. In my experience osteopathy is the treatment of choice for most kinds of common pain complaints, while acupuncture is sometimes preferable for certain kinds of neuropathic pain and some kinds of inflammatory arthritis. In the latter case I would also make use of my knowledge of herbal medicine.

My formal studies have well equipped me to recognise conditions which require conventional medical treatment or which would best be managed by other health professionals. For example, my great interest is helping people with chronic pain (pain that has been present for months or more), a condition in which there are always psychological and behavioural factors involved. When I recognised this, I took a three-year masters degree in health psychology in order that I may help these people better. Nevertheless I am not a qualified psychologist, and if there are issues of serious trauma or depression, deep emotional conflicts, or addiction then I would refer to a competent health professional for this aspect of the person’s care.

Most Common Pain Complaints

  • Spinal pain (back pain or neck pain caused by strains, minor injury or degeneration)
  • Muscle tension
  • Headaches (from spinal problems or muscle tension)
  • Tendinitis (of the shoulder, elbow e.g. tennis elbow, wrist, knee, hip and ankle e.g. Achilles tendon)
  • Frozen shoulder
  • Osteoarthritis (affecting the hip, knee, ankle, shoulder, elbow, fingers)
  • Foot pain (e.g. plantar pain, metatarsal pain)
  • Sciatica
  • Brachial neuralgia (nerve pain in the arm)
  • Strains and sprains
  • Pain around the rib cage


Copyright (c) Robert hale 2021.
Photo by Nick Youngson via Picpedia, reprosuced according to Creative Commons CC BY-SA 3.0 licence.

Robert Hale provides treatment for pain by osteopathy and acupuncture in Santa Eulalia, Ibiza.