Andrew Taylor Still (1828-1917) was a practicing country doctor in the state of Virginia when he founded and developed the theory and manipulative techniques of osteopathy.
Still had lost three of his children to spinal meningitis. It was this tragedy and the common misuse of powerful toxic drugs of the era that led to his rejection of orthodox medicine.
Influenced by his engineering background, still proposed that structural problems in the body are behind most disease processes. If the structural relationships within the body become distorted, a corresponding physiological dysfunction will occur: “structure determines function.” Any structural abnormality that causes an illness was termed an “osteopathic lesion” (Still, 1899). The term is misleading in that the Greek osteo means “bone” and pathos, “disease;” and osteopathic lesion was not intended to refer only to “bone diseases.”
Still studied the anatomy of animals and primates in terms of evolutionary directions. He pointed out that vertebrates, like man and other primates, have just recently begun to walk on two feet. This change from a quadruped to a biped has put considerable stress on the intravertebral discs by making them bear weight. Similarly, the development, according to Still, of a vertical stance displaced the organs downward causing hernias, constipation, back problems, etc. (Solit, 1962). (See figure 5.)
The key to eliminating osteopathic lesions and thus returning the body to balance and health was circulation. In 1870, Still defined the “rule of the artery”:
Whenever the circulation of the blood is normal, disease cannot develop because our blood is capable of manufacturing all the necessary substances to maintain natural immunity against disease. (Still, 1899)
FIGURE 5 – The development of the erect posture in primates: (A) gorilla, (B)Neanderthal man, (C)?average man”, (D) “balanced” man. Note the overall curvature of the spine goes from a “C” shape in the gorilla to an “S” curve in the “balanced” man. (See image below)
The rule of the artery implied more than mere blood flow through the major arteries. Still believed in a “fluid continuity” throughout the body (Frymann, 1980). This circulatory balance involved:
(1) The movement of blood from the heart to the periphery (body extremities)
(2) The lymphatic drainage from the peripheral tissues back into the venous system to the heart
(3) The adequate movement of the cerebrospinal fluid in the brain and spinal cord.
Thus, proper physiological and structural function of the body was seen as dependent on the fluid continuity among the various tissues and organs.
As traditional Chinese acupuncture theory considered the flow of chi or vital energy necessary for harmonious functioning, Still believed that proper fluid circulation was essential (see Chapter I).
Also as in oriental medicine, Still thought health had several dimensions of expression. He referred to the ?total lesion? as involving three levels of body functioning: biochemical, structural, and psychological. Remedying the total lesion involved working at all three levels simultaneously; this was called a ?total adjustment.?
Osteopathic lesions were removed by boney manipulations of the spine and soft tissues around the joints. An area on the body that exhibited the signs of a lesion wan typically characterized by swelling, thickened connective tissue, and pain (Deason, 1913).
Still and his students also recognized that balance in the nervous function, as welt as proper circulation, was crucial. As osteopathic theory developed, the controlling role of nervous system gained importance:
The osteopathic lesion.., rests for its interpretation upon a broad biological basis. It is fundamentally a blockage to the afferent (sensory) impulse. And any interference with the afferent integrity means disorder, disease, for thereby growth, development, repair of tissue and vital resistance is impaired. The body being built upon mechanical lines is subject to maladjustment whether bone, muscle, ligament or viscus, and this at once implies interference with the afferent impulse and as a result the? whole is deranged. (Deason, 1913, p. 377)
For Sill, the connective tissues, particularly the fascial sheaths, were the underlying structural component behind the dynamic unity among the body?s systems:
…fascia is… a foundation on which to stand. By its action we live and by its failure we shrink or swell and die. The soul of man with all the streams of pure, living water seems to dwell in the fascia of his body. (Still, 1899, p. 162)
He felt that the integrity of the fascia wrappings around the body?s organs, muscles, and nerves was essential in understanding and remedying disease:
…the fascia is the place to look for the cause of disease and the place to consult and begin the action of remedies of all diseases.(Truhlar, 1950, p.54)
An early student of Still’s, William G. Sutherland, developed the concept of ?cranial? ostheopathy about the turn of a century. Sutherland observed a rhythmic contractive and expansive articular motion in the cranial bones (Sutherland, 1939). He called this oscillation the “primary repiratory mechanism? that resulted from the cerebro-spinal fluid?s fluctuating pressure on the dural membranes of the spinal cord. In a sense, it can be thought of as a basic rhythm of the central nervous system:
This primary respiratory mechanism includes the brain, the intracranial membranes, the cerebro-spinal fluid and the articular mobility of the cranial bones; and also the spinal cord, the interspinal membranes, again the cerebro-spinal fluid and the articular mobility of the sacrum beyween the ilia.(Sutherland, 1962, p.2)
Normally, the primary respiratory rhythm is palpated between 8-12 cycles per minute. Sutherland and others have defined health and disease in terms of variations in the amplitude, the symmetry, and the frequency of the “cranio-sacral” pulse (Upledger and Vredevoogd, 1983). Recently some osteopathic investigators have correlated the cranio-sacral rhythm with the Traube-Herring wave, a slow wave of 6-15 cycles per minute associated with the electrical activity of the heart (Frymann, 1980).
Contemporary osteopathy appears more like orthodox, allopathic medicine than the manipulative therapy of Still and his students. Modern osteopaths use pharmacological agents extensively as well as surgery. In the United States,many states use the same licensing requirements forosteopaths (D.O,’s) and M,D.’s.
Manipulation and many of Still?s concepts, however, are taught in the osteopathic medical schools. In addition, other body therapists (e.g, Rolfing practitioners) have adopted and developed some osteopathic procedures.
Deason, J. Physiology: General and Osteopathic. kirksville, MO: The Journal Printing Co., 1913.
Frymann, V.M. The expanding osteopathic concept. Journal of Energy Medicine, 1980, 1, 86-91.
Solit, M. Study in structural dynamics. Journal of the American Osteopathic Association, 1962, 62, 30-40.
Still, A.T. Philosophy of Osteopathy. Published by A,T.Still, 1899. Sutherland, WG. The Cranial Bowl, Mankato, MN: WG Sutherland, 1939.
Truhlar, R,E. Doctor A.T. Still in the Living. Privately published, 1950.
Upledger, J.E., and Vredevoogd, J.D. Craniosacral Therapy. Chicago: Eastland Press, 1983.Osteopathy: Andrew Taylor Still