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Holistic Medicine

“It is far more important to know the person that has a disease, than it is to know the disease that has the person”. Hippocrates

“Natural forces within us are the true healers of disease”. Hippocrates

“I began to realize the power of nature to cure after a skillful correction of conditions causing abnormalities had been accomplished so as to bring forth pure and healthy blood, the greatest known germicide”. A.T. Still M.D., D.O. “The Philosophy on Mechanical Principles of Osteopathy”, Hudson-Kimberly Publishing Company, 1902

“Back pain is a 20th-century medical disaster. We can split the atom and send man to the moon and we now have cures which past generations would literally have thought were miracles. We have vaccines to prevent polio and drugs to cure tuberculosis. We have high-tech investigations that lay bare the anatomy and pathology of the spine. We can perform bigger and better operations. Yet we have no answer for simple backache.” Gordon Waddell, D.Sc., M.D., “The Back Pain Revolution”, Churchill-Livingston, 1998

Over the past 25 years, since entering medical practice, I have seen the practice of medicine become increasingly specialized, that is to say, for every medical problem there appears to be a medical specialist to consult, and as a result, fewer and fewer physicians get to see the patient is a whole, that is as a total functionally, interdependent unit.

This results in not seeing the patient is a total, integrated, interrelated, interdependent functional system. Specialists have a tendency to see a heart, a lung, a stomach, a kidney, a pancreas, and in the case of orthopedics, a neck, a back, a shoulder, an elbow, a wrist, a hip, a knee, an ankle, or foot.

By focusing on one specific organ system, and ignoring the rest of the systems can result in other problems including poor communication between specialists, as well as poor or lack of communication with the patient’s generalist.

Lack of communication can result in polypharmacy. Polypharmacy occurs when a patient is prescribed one or numerous medications by each specialist, many with serious side effects, without other physicians, including the patient’s generalist, being aware.

There is, of course, a place for medical specialists, physicians who study, and specialize in one organ system, or one disease, resulting in an increased breath of knowledge in that one system, or disease.

However, the medical profession, and the vast majority of physicians, has forgotten about the interrelationship and interdependence between cells, organs, and systems. The physician who sees his or her patient as “a neck” or “a back”, in isolation, rather than as a total integrated, interdependent organism, will ultimately be unable to obtain optimal results when treating their patients.

Most physicians have forgotten that, although, the body is composed of cells, organs, and systems, all cells, organs, and systems must work together, and are dependent on one another, if the organism is to survive.

This holistic approach was first pioneered by Dr. A.T. Still, the founder of the osteopathic profession.

A.T. Still, M.D., D.O., (1828-1917) was a medical doctor, trained by preceptorship, who served in the Civil War, and who subsequently founded the osteopathic profession, and the first osteopathic medical school in 1892.

It was Dr. Still who first recognized the importance of the musculoskeletal system, and its relationship to the maintenance of good health

After certain personal experiences, beginning when he was a boy, and later, through the diligent study of anatomy and physiology, Dr. Still formulated the fundamental principles of the osteopathic profession. These principles include the principle that the body is a functional unit, that structure and function are interrelated, and that the body has within it the necessary materials to heal itself and cure disease.

Most importantly, Dr. Still stressed the importance of an unimpeded arterial blood supply, as well as the importance of unimpeded venous and lymphatic drainage. We now add optimal nutrition, normalization of the endocrine system, and normalization of neural functioning.

Dr. Still discovered that musculoskeletal dysfunction, that is, structural derangement in the body, will result in changes in physiology, that is, a functional derangement, resulting in disease. Further, Dr. Still found that manipulative therapy, when properly applied, can remove these structural derangements (which are impediments to good health), allowing the body to function properly, resulting in cure.

The above concepts have not been embraced by the allopathic medical profession. At the turn-of-the-century, the allopathic medical community embraced the “germ theory” of disease, the notion that disease is caused by an outside invader, which must be conquered by medication or surgery. The allopathic community therefore believes that the role of the physician is to intervene, after extensive diagnostic testing, with either medication or surgery, to destroy the invading pathogen, resulting in cure.

We know today, after experiences with diseases such as AIDS, that if a patient does not have a fully functioning immune system, prognosis will be poor.

Osteopathic physicians today are trained to utilize diagnostic tests, medication, and surgery, to cure disease, however, a small number of osteopathicly trained physicians, in addition to the above training, also receive specialized training in the examination, diagnosis, and treatment of the musculoskeletal system.

The musculoskeletal system, being the largest system of the body, will have a profound effect on all other systems of the body. The relationship between structure and function has largely been ignored until very recently when some physicians have come to realize the importance of this relationship.

A number of interesting articles have appeared in the literature, several written by Dr. Stephen Levin, an orthopedic specialist, and Dr. Donald Ingber, a physician and researcher at the Harvard Medical School.

Dr. Levin and Dr. Ingber have resurrected the concept of “tensegrity” a term first coined by Buckminster Fuller, the architect, to describe the distribution of forces in a geodesic dome.

These doctors have adapted this architectural principle to explain the complex relationship between structure and function, especially the role of the musculoskeletal system, its dysfunction, and the resulting illness produced.

In 1981 Dr. Levin presented a paper at the 34th Annual Conference on Engineering in Medicine and Biology entitled “The Icosahedron As a Biologic Support System” (1).

In 1998, Dr. Ingber authored a seminal article in the Scientific American called “The Architecture of Life (2). In this article Dr. Ingber discusses the concept of tensegrity, its definition, and it’s importance in biology.

In brief, Dr. Ingber states that tensegrity adds a significant amount of mechanical stability, not because of the strength of the individual members, but because of the way the entire structure distributes and balances mechanical forces.

Dr. Ingber states that tensegrity structures continuously transmit tension across all structural members. As an example, the force applied to the ankle, resulting in an ankle sprain, will distribute itself throughout the body and have an effect on the knee, the hip, the pelvis, sacrum, low back, the upper back, the rib cage, the upper extremities, the neck, and the head. In fact, by pre-stressing any element of musculoskeletal system, all other elements will be stressed, down to the single cell. Pre-stress will then have significant effects on the function of the cell, the organ, the system, and the organism. Further, a local stress or injury may have a significant deleterious effect at another location distant from the initial stress or injury.

Further, it is well known that arteries, veins, nerves, and lymphatic channels must travel through the musculo-skeletal system to nourish all individual cells, and to remove waste products from those cells. If the musculoskeletal system is dysfunctional or “stressed”, all structures passing through the musculoskeletal system will also be “stressed” or “compressed”, and that will affect the nourishment of the cells, as well as the elimination of waste products.

In addition, Dr. Still stressed the importance of the autonomic nervous system, especially the sympathetic nervous system, which, if dysfunctional, will lead to constriction of arteries and decreased arterial blood flow.

Dr. Ingber takes this hypothesis further in his 2003 article “Mechanobiology and diseases of mechanotransduction” (3). In that article, Dr. Ingber states that modern medicine focuses exclusively on molecular genetics, biochemistry, and disease causing agents, ignoring the mechanical basis of disease from the cellular level, to the organ level, to the system level, and ultimately to the level of the entire organism. In this article, Dr. Ingber reviews the mechanical basis of a number of diseases, which, heretofore, had not been thought of as having a mechanical component.

Unfortunately, most physicians are not trained to diagnose this mechanical dysfunction. With rare exception, even physicians now being trained at most osteopathic medical schools do not receive enough instruction and training to diagnose and treat musculoskeletal dysfunction.

As stated above, the situation is further complicated by the fact that the derangement which causes an Illness or Disease may be at a distant site from the patient’s original injury, and even distant from where the patient’s symptoms are localized.

Therefore, proper diagnosis and treatment of an Illness or Disease requires a competent structural examination in order to determine which areas of the body are dysfunctional, as well as a detailed knowledge of anatomy and biomechanics in order to render the dysfunctional area functional again.

It is my hope that, in the future, all physicians will receive enough training in medical school and/or residency to at least recognize the biomechanical component of disease, and, if not able to treat that component themselves, to at least refer their patients to a specialist in biomechanics who would be able to treat this component of their disease.

This concept of holism and tensegrity have led to a new paradigm in medicine, represented by the formula “Host + Disease = Illness”.

The Illness part of the equation describes a constellation of symptoms. The Disease part of the equation describes the pathophysiological changes in the body, which can include a genetic mutation, an infectious agent, or a traumatic injury. The Host part of the equation describes the integrity of the body, and all natural defenses available to the body, which will enable the body to combat the disease, thus eliminating the Illness.

The Host component of the equation specifically includes the ability of the body to provide all cells, organs, and systems, with an adequate arterial blood supply, and also includes the ability of the body to remove waste products, including lactic acid, urea, and carbon dioxide from the cells, organs, and systems.

The Host component must include such factors as proper nutrition, a normally functioning immune system, and a normally functioning endocrine system.

It follows that, if the body is structurally unsound, then the functions controlled by the body, necessary to fight disease and restore health, will be adversely affected.

Modern medicine relies primarily on medications and surgery to combat the Disease and Illness components.

Very few practicing physicians attempt to intervene in the Host component.

If the Illness is primarily the result of trauma or infection, then, modern medicine will be quite successful in treating the Illness. However, if an Illness has a large Host component, and that component is not addressed, then modern medicine alone will fail to treat the Illness, and fully and restore health.

This is where a competent structural examination becomes essential for proper diagnosis, and, along with an understanding of the anatomy and the treatment modalities required to restore musculoskeletal function.

In addition, to effectively intervene in the Host component, a physician must evaluate the patient’s nutritional status, the patient’s immune system, and the patient’s endocrine system.

Our practice treats Illness by approaching the Disease and Host components simultaneously.

Our practice will utilize a combination of osteopathic manipulative therapy, physical therapy, prolotherapy, and neural prolotherapy to intervene in the Host component. This treatment will address the musculoskeletal, or structural component of the Disease and Illness process, which, if not treated, will prevent the body from realizing its potential for health by preventing the body access and utilize the bodies innate healing mechanisms,

My personal journey began when, during medical school, I injured my own back. Not only did I have back pain but also had a “foot drop” on the left. After consulting a neurosurgeon, it was recommended that I undergo back surgery, but, after and being treated osteopathicly, I made full recovery without surgery.

Over the past 25 years I have studied osteopathic technique under such luminaries in the profession as Philip Greenman, D.O., Edward G. Stiles, D.O., Stephen Myles Davidson, D.O., and Joseph Field, D.O..

Nine years ago, in 2002, I began to study prolotherapy, an injection technique which restores damaged ligaments and tendons, under Dr. Thomas Ravin, Dr. Mark Cantieri, and Dr. George Pasquerello.

More recently, I have studied polotherapy under Dr. Jeffrey Patterson and Dr. Jon Trister.

I believe that every patient, no matter their age or condition, has the potential for better health. It is my goal, and the goal of my practice, to work with each patient in an effort to unlock that potential, to release the full force of the bodies innate healing mechanisms, and to allow each patient to reach their full potential for Health.

(1) Levin, Stephen: Proceedings, 34 Annual Conference on Engineering in Medicine and Biology, Volume 23, September 21-23, 1981, Houston, Texas.
(2) Ingber, Donald: The Architecture of Life: Scientific American, January, 1998, 1-13
(3) Ingber, Donald: Mechanobiology and diseases of mechanotransduction, Annals of
Medicine, 2003; 35: 1-14

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