Osteopathic Medical Research
http://www.100md.com
《美国整骨期刊》
Phoenix, Ariz
As a busy clinician, I have neither the time nor the resources to devise and carry out the osteopathic medical studies our eminent researchers do. I am writing this letter to suggest an important addition to the current scientific method, and that is the individualization of treatment. I believe that study outcomes would improve significantly as a result.
Any two patients with a named disease, such as sciatica, will have mechanical strains unique to their history leading up to the onset of the disease. To illustrate the process of individualization, I will briefly describe a few patients that come to mind from my 28 years of practice.
One patient had sciatica on the left side due to hip strain caused by lifting. The resulting malposition of the head of the femur in the acetabulum caused tension on the pyriformis and inferior gemelli, through which the sciatic nerve passes. Relief of the femoral-coxal strain resolved the problem quickly.
A second patient had sciatica on the right side after a skiing accident. The fibular head was pulled anteriorly, tractioning the superficial peroneal nerve lying on its anterior surface and bowstringing the sciatic nerve. The mechanical stretching of the sciatic nerve caused his sciatica symptoms. Release of this fibular head strain and other compensatory strains from the fall quickly resolved his sciatica.
A third patient developed sciatica on the left side over many months. In the standing position, his left iliac crest was 4'' cephalad to the right. The underlying cause of this gravitational postural shift was a generalized weakness in the fascia from restricted fluid interchanges, possibly due to toxic chemical exposure. The elevated left hip with its resultant scoliotic curve and femoral coxal strain was the only position that his body could take, given the weakened fascial state. Such unbalanced posture created stress in the femoral-coxal joint, and with the resultant stress on the pyriformis and gemelli, led to sciatica. When the normal fluid interchanges were encouraged to flow freely via inherent lymphatic motions, the iliac crests leveled in the standing position. Other compensatory corrections resulted in complete relief within three weekly visits.
Each of the above patients had sciatica, yet each required a different osteopathic treatment. Paul Kimberly, DO, my professor at Kirksville College of Osteopathic Medicine of A.T. Still University of Health Sciences (Mo) instructed us in "the manipulative prescription." This prescription is the osteopathic analysis, individualized to each patient. The named disease condition gives very little osteopathic mechanical evidence. Only a comprehensive musculoskeletal examination can elucidate the region of dysfunction.
Once the osteopathic physician locates the source of the strain, he or she chooses a technique and then continues sequencing the strains and compensations until the results of the examination reveal enough change for that treatment (dosage). Over a course of treatment, the process is continued until the patient is well, has reached maximum improvement, or has not progressed, and another clinical course of action is needed.
Andrew Taylor Still, MD, DO, wrote on this principle of individualization.1 Considering this approach in our osteopathic research protocols will demonstrate the clinical effectiveness of individualization for a wide range of named clinical conditions.
References
1. Ward R, ed. Foundations of Osteopathic Medicine. 2nd ed. Baltimore, Md: Lippincott Williams & Wilkins; 2003: 7–8.(STEVE DAVIDSON, DO, C-SPO)
As a busy clinician, I have neither the time nor the resources to devise and carry out the osteopathic medical studies our eminent researchers do. I am writing this letter to suggest an important addition to the current scientific method, and that is the individualization of treatment. I believe that study outcomes would improve significantly as a result.
Any two patients with a named disease, such as sciatica, will have mechanical strains unique to their history leading up to the onset of the disease. To illustrate the process of individualization, I will briefly describe a few patients that come to mind from my 28 years of practice.
One patient had sciatica on the left side due to hip strain caused by lifting. The resulting malposition of the head of the femur in the acetabulum caused tension on the pyriformis and inferior gemelli, through which the sciatic nerve passes. Relief of the femoral-coxal strain resolved the problem quickly.
A second patient had sciatica on the right side after a skiing accident. The fibular head was pulled anteriorly, tractioning the superficial peroneal nerve lying on its anterior surface and bowstringing the sciatic nerve. The mechanical stretching of the sciatic nerve caused his sciatica symptoms. Release of this fibular head strain and other compensatory strains from the fall quickly resolved his sciatica.
A third patient developed sciatica on the left side over many months. In the standing position, his left iliac crest was 4'' cephalad to the right. The underlying cause of this gravitational postural shift was a generalized weakness in the fascia from restricted fluid interchanges, possibly due to toxic chemical exposure. The elevated left hip with its resultant scoliotic curve and femoral coxal strain was the only position that his body could take, given the weakened fascial state. Such unbalanced posture created stress in the femoral-coxal joint, and with the resultant stress on the pyriformis and gemelli, led to sciatica. When the normal fluid interchanges were encouraged to flow freely via inherent lymphatic motions, the iliac crests leveled in the standing position. Other compensatory corrections resulted in complete relief within three weekly visits.
Each of the above patients had sciatica, yet each required a different osteopathic treatment. Paul Kimberly, DO, my professor at Kirksville College of Osteopathic Medicine of A.T. Still University of Health Sciences (Mo) instructed us in "the manipulative prescription." This prescription is the osteopathic analysis, individualized to each patient. The named disease condition gives very little osteopathic mechanical evidence. Only a comprehensive musculoskeletal examination can elucidate the region of dysfunction.
Once the osteopathic physician locates the source of the strain, he or she chooses a technique and then continues sequencing the strains and compensations until the results of the examination reveal enough change for that treatment (dosage). Over a course of treatment, the process is continued until the patient is well, has reached maximum improvement, or has not progressed, and another clinical course of action is needed.
Andrew Taylor Still, MD, DO, wrote on this principle of individualization.1 Considering this approach in our osteopathic research protocols will demonstrate the clinical effectiveness of individualization for a wide range of named clinical conditions.
References
1. Ward R, ed. Foundations of Osteopathic Medicine. 2nd ed. Baltimore, Md: Lippincott Williams & Wilkins; 2003: 7–8.(STEVE DAVIDSON, DO, C-SPO)