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.


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.

Tratamiento del Dolor por Osteopatía y Acupuntura

El alivio del dolor es una gran parte del trabajo de la mayoría de los profesionales de la salud. En mi profesión como profesional sanitario, el tratamiento del dolor es una de mis áreas de especial interés. Déjame contaros un poco sobre el dolor y cómo lo abordo.

Hay dos tipos generales de dolor:

  1. Dolor proveniente de alguna parte dañada del cuerpo («dolor nociceptivo»).
  2. Dolor generado por el sistema nervioso sin daño al cuerpo («dolor neuropático»).

¡Espera! ¿Cómo puede haber dolor sin daño? Bueno, aquí hay un par de maneras. Primer ejemplo: Es posible que haya habido un daño que ahora se ha curado, pero el sistema nervioso no se ha ajustado de nuevo a la normalidad. Segundo ejemplo: El sistema nervioso puede haberse sensibilizado por numerosos traumas físicos u emocionales previos, de modo que produce una respuesta de dolor a estímulos físicos menores. hay que tener en cuenta que todo el dolor se produce en el cerebro, aunque se sienta en el pie, en el estómago o en la cabeza. La diferencia es que en el primer caso está relacionado con un daño actual real y en el segundo caso no lo está.

El primer tipo de dolor (dolor nociceptivo) puede dividirse en dolor proveniente de la estructura externa del cuerpo como la piel, los músculos y las articulaciones («dolor somático») y dolor proveniente de los órganos internos del cuerpo («dolor visceral»). Este último puede ser confuso porque a menudo se experimenta primero en los músculos exteriores del cuerpo. El osteópata está excepcionalmente preparado para distinguir entre estos tipos de dolor, una distinción que es fundamental en su tratamiento.

Arriba dije que el tratamiento del dolor es una de mis áreas de especial interés. Eso no es exacto. Sería más exacto decir que el tratamiento de la persona con dolor es mi área de especialización. La diferencia es que, como terapeuta holístico, trato a las personas, no a los síntomas ni a los enfermedades. Al tratar a la persona, el síntoma desaparece o al menos mejora, lo que indica una mejora en cualquier trastorno subyacente.

Las disciplinas que practico, la osteopatía y la acupuntura, son excelentes para tratar a las personas que padecen el dolor. En mi experiencia, la osteopatía es el tratamiento de elección para la mayoría de los tipos de dolor comunes, mientras que la acupuntura a veces es preferible para ciertos tipos de dolor neuropático y algunos tipos de artritis inflamatoria. En este último caso también haría uso de mis conocimientos de fitoterapia.

Mis estudios formales me han equipado bien para reconocer condiciones que requieren tratamiento médico convencional o que serían mejor manejadas por otros profesionales de la salud. Por ejemplo, mi gran interés es ayudar a las personas con dolor crónico (dolor que ha estado presente durante meses o más), una condición en la que siempre hay factores psicológicos y de comportamiento involucrados. Cuando me di cuenta de esto, hice una curso de Master de tres años en psicología de la salud para poder ayudar mejor a estas personas. Sin embargo, no soy un psicólogo, y si hay problemas de trauma o depresión graves, conflictos emocionales profundos o adicción, entonces recomendaría a un profesional de la salud competente para este aspecto del cuidado de la persona.

Los Dolores Más Comunes

  • Dolor de columna (dolor de espalda o de cuello causado por lesiones menores o degeneración estructural)
  • Tensión muscular
  • Dolor de cabeza (por problemas de la columna cervical o tensión muscular)
  • Tendinitis (del hombro, codo, por ejemplo, codo de tenista, muñeca, rodilla, cadera y tobillo, por ejemplo, tendón de Aquiles)
  • Hombro congelado (capsulitis adhesiva)
  • Artrosis (de la cadera, la rodilla, el tobillo, el hombro, el codo, los dedos de las manos)
  • Dolor en el pie (por ejemplo, dolor plantar, dolor metatarsiano)
  • Ciática
  • Neuralgia braquial (dolor nervioso en el brazo)
  • Esguinces y torceduras
  • Dolor en la caja torácica
Copyright (c) Robert Hale 2022.
Foto de dominio público de 

Robert Hale ofrece tratamiento para el dolor mediante osteopatía y acupuntura en Santa Eulalia, Ibiza.