osteo for docs articles done
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import Article from "@/components/Article";
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const ArticleCranialManipulation = () => {
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return (
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<Article
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title="The Effect of Cranial Manipulation on the Traube-Hering-Mayer Oscillation as Measured by Laser-Doppler Flowmetry"
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author=""
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>
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<h2>Source</h2>
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<p>
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Alternative Therapies, Nov/Dec 2002, Vol. 8 No. 6<br />
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<a href="http://www.alternative-therapies.com/">
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http://www.alternative-therapies.com/
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</a>
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</p>
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<h2>Authors</h2>
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<p>
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Nicette Sergueff lectures throughout Europe on manual principles,
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diagnosis, and treatment, and maintains a private practice in Corbas,
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France. She is an assistant professor.
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</p>
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<p>
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<em>Kenneth E. Nelson </em>is a professor, and Thomas Glonek is a
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research professor in the Department of Osteopathic Manipulative
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Medicine, Chicago College of Osteopathic Medicine, Midwestern
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University, Downers Grove, Illinois.
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</p>
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<h2>Context</h2>
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<p>
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A correlation has been established between the Traube-Hering-Mayer
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oscillation in blood-flow velocity, measured by laser-Dopper-flowmetry,
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and the cranial rhythmic impulse.
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</p>
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<h2>Objective</h2>
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<p>
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To determine the effect of cranial manipulation on the
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Traube-Hering-Mayer oscillation.
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</p>
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<h2>Design</h2>
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<p>
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Of 23 participants, 13 received a sham treatment and 10 received cranial
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manipulation.
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</p>
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<h2>Setting</h2>
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<p>
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Osteopathic Manipulative Medicine Department, Midwestern University,
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Downers Grove, Illinois.
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</p>
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<h2>Participants</h2>
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<p>Healthy adult subjects of both sexes participated (N=23).</p>
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<h2>Intervention</h2>
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<p>
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A laser-Doppler flowmetry probe was place on the left earlobe of each
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subject to obtain a 5-min baseline blood flow velocity record. Cranial
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manipulation, consisting of equilibration of the global cranial motion
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patter and the craniocervical junction, was then applied for 10 to 20
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minutes; the sham treatment was manipulation only.
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</p>
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<h2>Main Outcome Measure</h2>
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<p>
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Immediately following the procedures, a 5-min postreatment laser-Doppler
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recording was acquired. For each cranial treatment subject, the 4 major
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components of the blood-flow velocity record, the thermal (Mayer)
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signal, the baro (Traube-Hering) signal, the respiratory signal, and the
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cardiac signal, were analyzed, and the pretreatment and posttreatment
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data were compared.
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</p>
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<h2>Results</h2>
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<p>
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The 10 participants who received cranial treatment showed a thermal
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signal power decrease from 47.79 dB to 38.490 dB (P < .001) and the
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baro signal increased from 47.40 dB to 51.30 dB (P < .021), while the
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respiratory and cardiac signals did not change significantly (P > .05
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for both).
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</p>
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<h2>Conclusion</h2>
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<p>
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Cranial manipulation affects the blood-flow velocity oscillation in its
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low-frequency Traube-Hering-Mayer components. Because these
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low-frequency oscillations are mediated through parasympathetic and
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sympathetic activity, it is concluded that cranial manipulation affects
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the autonomic nervous system.
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</p>
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<h2>Introduction</h2>
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<p>
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Cranial manipulation is a form of broadly practiced alternative, manual
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medicine. A fundamental component of cranial manipulation is the primary
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respiratory mechanism (PRM).<sup>1</sup> It is described as an
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oscillation that is palpable; the cranial rhythmic impulse (CRI)2 has an
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agreed-upon frequency of 10-14 cycles per minute (cpm).<sup>2,3</sup>{" "}
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The PRM/CRI is a subtle phenomenon that is readily palpable only by
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experienced individuals, making its very existence subject to debate.{" "}
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<sup>4,5</sup>
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</p>
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<p>
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The Traube-Hering-Mayer (THM) wave is a complex oscillation in blood
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pressure and blood-flow velocity. The Traube-Hering (TH) component of
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this oscillation has a frequency of 6 to 10 cpm. Analysis of the TH was
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first described in 1865, when Ludwig Traube reported the measurement of
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a fluctuation in pulse pressure that occurred with a particular
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frequency of respiration but persisted after respiration had been
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arrested.<sup>6</sup> Fourier-transform analysis applied to blood
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physiologic parameters shows that this fluctuation consists of 3
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principal spectral peaks: the thermal or Mayer (M) wave (1.2-5.4 cmp),
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the baro or TH wave (6.0-10.0 cpm), and the respiratory wave, which
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shifts in frequency with changes in the respiratory rate.7 Multiple
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authors have commeted on the similarity between the TH wave and the CRI.
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<sup>8-11</sup>
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</p>
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<p>
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By comparing cranial manipulation with laser-Doppler flowmetery, we have
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demonstrated that the PRM/CRI is congruous with the TH component of the
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THM oscillation in blood flow velocity.<sup>12</sup> A question,
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therefore, logically arises: can cranial manipulation affect the THM
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oscillation?
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</p>
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<h2>Method</h2>
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<p>
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Healthy adult subjects (both sexes, N=23, institutional review
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board-approved informed consent obtained) were divided randomly into
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cranial palpation (n=13) and cranial manipulation groups (n=10). A
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laser-Doppler probe (BLF 21 Perfusion Monitor, Transonic Systems, Inc.
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Ithaca, NY) was placed on the left earlobe of each subject. After the
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subject was allowed to lie quietly on the examination table for 3
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minutes of equilibration, a 5-minute baseline blood-flow velocity record
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was obtained. Cranial manipulation or manipulation, with the physician
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blinded to the flowmetry recording, was then performed for 10 to 20
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minutes. Following palpation or treatment, a 5-minute postcontact
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laser-Doppler recording was acquired. During this entire procedure, the
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subject remained on the examination table, and the laser-Doppler probe
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was not disturbed.
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</p>
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<p>
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Cranial palpation (simply counting the CRI but without intervention) and
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manipulation (therapeutic intervention) were performed while the
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subjects were supine. The individual performing the procedure was seated
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at the end of the examination table with hi or her forearms resting upon
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it. The examiner’s palms conformed to the curvature of the subject’s
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head, contacting the lateral aspect of the great wings of the sphenoid
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bone and the temporal, occipital and parietal bones bilaterally. For
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this study, similar contact pressure, firm, but light enough not to
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ablate the sensation of the CRI, was employed for both palpation and
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manipulation. Manipulation was directed at modulation of the rate,
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rhythm, and amplitude of the CRI and perceived functional asymmetry
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through equilibration of the craniocervical junction and global
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anerioposterior cranial motion. Specific interventions were dictated by
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the physical findings of the individual’s cranial pattern.
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</p>
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<h2>Results</h2>
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<p>
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For each subject, 4 component parts of the blood flow velocity record
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were analyzed: the thermal (M) signal, the baro (TH) signal and the
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respiratory signal of the THM, and the cardiac signal. The mean
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precontact and postcontact data for each group were compared using the
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paired-samples 2 tailed t statistic (see Table). After palpation only,
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the thermal signal power decreased 3 dB (42.93 to 39.58 Db, P <
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.054), while the baro (39.83 to 40.10 dB, P < .805), respiratory
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(27.54 to 27.20 dB, P < .715) and cardiac (37.92 to 37.14 dB, P <
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.511) signals did not change.
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</p>
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<p>
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After cranial manipulation, the thermal signal power decreased 9 dB
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(47.40 to 51.30 dB, P < .021), while the respiratory (29.72 to 30.02
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dB, P < .747) and cardiac (41.11 to 40.70 dB, P < .788) signals
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did not change.
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</p>
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<p>
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The 2 examples illustrated (see Figure), though visually exceptional,
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illustrate the effects that can be obtained to varying degrees with any
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subjecd, provided the treating physician possesses the requisite skill.
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</p>
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<h2>Comments</h2>
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<p>
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From the above data, we have drawn 3 conclusions. First, cranial
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manipulation has an effect on low-frequency oscillations observed in
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blood-flow velocity. It decreases the amplitude of the M wave and
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increases the amplitude of the TH wave. Second, we conclude that cranial
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manipulation affects the autonomic nervous system because it has been
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demonstrated that the M an TH waves are mediated through parasympathetic
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and sympathetic activity.7 Third, because palpation alone did not
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greatly affect blood-flow velocity oscillations, we conclude that there
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is a quantifiable difference between palpation and cranial treatment.
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This conclusion suggests that palpation alone may be used as a sham
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treatment in future research in the field of cranial manipulation.
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</p>
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<table>
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<tbody>
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<tr>
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<td colSpan={8}>
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<strong>
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Traube-Hering-Mayer signal power comparison before and after
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palpation only and cranial manipulation
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</strong>
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</td>
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</tr>
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<tr>
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<td colSpan={2}></td>
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<td colSpan={3}>
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<strong>Palpation only n=13</strong>
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</td>
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<td colSpan={3}>
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<strong>Cranial manipulation n=10</strong>
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</td>
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</tr>
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<tr>
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<td>
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<strong>Signal</strong>
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</td>
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<td>
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<strong>Doppler record segment</strong>
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</td>
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<td>
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<strong>
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Mean signal
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<br />
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power (dB)
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</strong>
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</td>
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<td>
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<strong>
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Paired difference
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<br />
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before-after +/- SD
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</strong>
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</td>
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<td>
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<em>P</em>
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</td>
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<td>
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<strong>
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Mean signal
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<br />
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power (dB)
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</strong>
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</td>
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<td>
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<strong>
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Paired difference
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<br />
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before-after +/- SD
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</strong>
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</td>
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<td>
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<em>P</em>
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</td>
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</tr>
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<tr>
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<td valign="top">
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<strong>Thermal (M)</strong>
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</td>
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<td>
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<strong>Before After</strong>
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</td>
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<td valign="top">
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42.93
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<br />
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39.58
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</td>
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<td valign="top">3.36+/-5.69</td>
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<td valign="top">.054</td>
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<td valign="top">
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47.79
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<br />
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38.49
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</td>
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<td valign="top">9.30+/-5.65</td>
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<td valign="top">.001</td>
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</tr>
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<tr>
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<td valign="top">
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<strong>Baro (TH)</strong>
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</td>
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<td>
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<strong>Before After</strong>
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</td>
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<td valign="top">
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39.83
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<br />
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40.10
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</td>
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<td valign="top">-.27 +/-3.85</td>
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<td>.805</td>
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<td valign="top">
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47.40
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<br />
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51.30
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</td>
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<td valign="top">-3.90+/-4.40</td>
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<td valign="top">.021</td>
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</tr>
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<tr>
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<td valign="top">
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<strong>Resp.</strong>
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</td>
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<td>
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<strong>Before After</strong>
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</td>
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<td valign="top">
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27.54
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<br />
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27.20
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</td>
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<td valign="top">.34+/-3.23</td>
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<td valign="top">.715</td>
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<td valign="top">
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29.72
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<br />
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30.02
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</td>
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<td valign="top">-.30+/-2.89</td>
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<td valign="top">.747</td>
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</tr>
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<tr>
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<td valign="top">
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<strong>Cardiac</strong>
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</td>
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<td>
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<strong>Before After</strong>
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</td>
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<td valign="top">
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37.92
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<br />
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37.14
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</td>
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<td valign="top">.78+/-4.15</td>
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<td valign="top">.511</td>
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<td valign="top">
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41.11
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<br />
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40.70
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</td>
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<td valign="top">.41+/-4.67</td>
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<td valign="top">.788</td>
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</tr>
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</tbody>
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</table>
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<h2>References</h2>
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<p>
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1. Sutherland WG. The Cranial Bowl. Indianapolis, Ind: American Academy
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of Osteopathy, 1986. (Original work published 1939).
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</p>
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<p>
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2. Woods JM. Woods RH. A physical finding relating to psychiatric
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disorders. J Am Osteopath Assoc. 1961;60:988-993.
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</p>
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<p>
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3. Lay E. Cranial Feild. In: Ward RC, ed. Foundations for Osteopathic
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Medicine. Baltimore, MD: Williams and Wilkins; 1997:901-913
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</p>
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<p>
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4. Ferre JC. Barbin JY. The osteopathic cranical concept: fact or
|
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fiction? Surg Radial Anat, 1991:13-65-179
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</p>
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<p>5. Norton JM. Dig on [Letter to the editor]. AAOJ. 2000;10(2):16:17</p>
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<p>
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|
6. Traube L. Uber periodische Thatigkeits-Aeusserungen des
|
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|
vasomotorishen un Hemmungs-Nervenzentrums. Centralblatt fur die
|
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medicinischen Wissenschaften 1865:56:881-885
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|
</p>
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<p>
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7. Akselrod S. Gordon D. Madwed JB, Snidman NC, Shannon DC, Cohen RJ.
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Hemodynamic regulation: investigation by spectral analysis. Am J
|
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Physiol. 1985:249-H867-H875
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</p>
|
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|
<p>
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8. Frymann VA. A study of the rhythmic motions of the living cranium. J
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|
Am Ossteopath Assoc. 1971:70-928-945
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</p>
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<p>
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9. Upledger JE. Vredevoogd JD. Craniosacral Therapy. Chicago, IL:
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|
Eastland Press; 1983.
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</p>
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|
<p>
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10. Geiger AJ. Letter to the editor. J Am Osteopath Assoc.
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1992:92-1088-1093
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
11. McPartland JM, Mein EA. Entrainment and the cranial rhythmic
|
||||||
|
impulse. Altern Ther Health Med. 1997:3(1):40-45
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
12. Nelson KE, Sergueef N, Lipinski CL, Chapman A, Glonek T. The cranial
|
||||||
|
rhythmic impulse related to the Traube-Hering-Mayer oscillation:
|
||||||
|
comparing laser-Doppler flowmetry and palpation. J Am Osteopath Assoc.
|
||||||
|
2001:101(3):163-173
|
||||||
|
</p>
|
||||||
|
</Article>
|
||||||
|
);
|
||||||
|
};
|
||||||
|
|
||||||
|
export default ArticleCranialManipulation;
|
||||||
|
|
@ -0,0 +1,269 @@
|
||||||
|
import Article from "@/components/Article";
|
||||||
|
|
||||||
|
const ArticleIntervertebralDiscHerniation = () => {
|
||||||
|
return (
|
||||||
|
<Article
|
||||||
|
title="The Basics of Intervertebral Disk Herniation"
|
||||||
|
author="Brian Leonard, D.O."
|
||||||
|
>
|
||||||
|
<h1>Introduction</h1>
|
||||||
|
<p>
|
||||||
|
There are a great number of conditions and a variety of states of
|
||||||
|
illness that result in the symptom of “back/neck pain.” Back and neck
|
||||||
|
pain can be related to conditions ranging from muscle strains, somatic
|
||||||
|
dysfunction to nerve compression and anatomic anomalies.
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
The focus of this article is to discuss herniation of intervertebral
|
||||||
|
discs as a cause of pain. We will examine the pathophysiology and
|
||||||
|
biomechanics of disc degeneration and herniation as well as aspects of
|
||||||
|
the epidemiologic data. Lastly, it is important to mention the role that
|
||||||
|
manual/manipulative medicine plays with regard to this issue. While the
|
||||||
|
general principles of herniated discs may be applied to any level of the
|
||||||
|
spine, we will discuss each spinal level from cervical, thoracic, to
|
||||||
|
lumbar.
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<h2>Anatomic Review</h2>
|
||||||
|
<p>
|
||||||
|
An intervertebral disc is formed of two elements: the nucleus pulposis
|
||||||
|
and the anulus fibrosis. The anulus fibrosis is composed of sequential
|
||||||
|
layers of fibrocartilage that envelope the nucleus pulposis. The nucleus
|
||||||
|
pulposis itself is formed of a proteoglycan and a water/gel substance
|
||||||
|
that is held loosely in place by a network of collagen and elastin
|
||||||
|
fibers. Together they form the intervertebral disc and serve to
|
||||||
|
distribute weight and force equally throughout the spine, even during
|
||||||
|
motions such as flexion and extension1. Blood vessels course along the
|
||||||
|
outer edge of the anulus fibrosis and thereby force the disc to obtain
|
||||||
|
its nutrient supply via osmosis. When the discs age, they are subject to
|
||||||
|
gradual degeneration as the water content decreases and the ability to
|
||||||
|
absorb impact diminishes. Degeneration begins on a microscopic level
|
||||||
|
around the age of skeletal maturation, or fifteen years of age. At this
|
||||||
|
time, cell densities begin to diminish, resulting in microstructural
|
||||||
|
tears and clefts (2).
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<h2>Pathophysiology</h2>
|
||||||
|
<p>
|
||||||
|
The microstructural defects accumulate over time as a person ages and
|
||||||
|
the pulposis protrudes deeper into the anulus. These defects can result
|
||||||
|
in frank tears of the anulus. There are three main tears that have been
|
||||||
|
distinguished, these include:
|
||||||
|
</p>
|
||||||
|
<ul>
|
||||||
|
<li>circumferential tears or delaminations</li>
|
||||||
|
<li>peripheral rim tears</li>
|
||||||
|
<li>radial fissures</li>
|
||||||
|
</ul>
|
||||||
|
<p>
|
||||||
|
The circumferential tears represent shearing forces acting on the
|
||||||
|
interlaminar layers of the anulus fibrosis. The characteristic disc for
|
||||||
|
this type of tear is an older disc that has an advanced amount of
|
||||||
|
dessication and degeneration, retaining a limited ability to absorb
|
||||||
|
these stressors (3). The second type of tear, the peripheral rim tears,
|
||||||
|
are most frequently seen in the anterior portion of the disc and are
|
||||||
|
associated with bony outgrowths. Histologic data suggest that the actual
|
||||||
|
tears are a result of repeated microtrauma (4). Lastly, radial fissures
|
||||||
|
represent a grouping of tears that typically occur in a posterior or
|
||||||
|
posterolateral direction and are associated with degeneration of the
|
||||||
|
nucleus pulposis. These tears have been simulated in cadavers with
|
||||||
|
repeated cycles of sidebending and compression (5).
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
These variations of degeneration, dessication, and microstructural
|
||||||
|
defects seem to be common among studies reported in the current base of
|
||||||
|
literature. These tears, however, have not been shown to have a
|
||||||
|
correlation with the actual prolapse, or herniation, of the disc. The
|
||||||
|
tears and disc degeneration have been shown to be correlated only with
|
||||||
|
repetitive mechanical loading and cigarette smoking6 (as this inhibits
|
||||||
|
the body’s regulatory healing mechanisms in a vast number of ways). The
|
||||||
|
prolapse of the disc has been shown to correlate with heavy lifting.
|
||||||
|
That is to say, the degeneration of discs, and not the herniation,
|
||||||
|
appears to be a normal process of aging (1).
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<h2>Epidemiology</h2>
|
||||||
|
<p>
|
||||||
|
For the discussion of rates of occurrence and particular mechanisms
|
||||||
|
associated with disc herniation, we will begin at the cervical level and
|
||||||
|
progress inferiorly to the thoracic and finish at the lumbar vertebrae.
|
||||||
|
</p>
|
||||||
|
<p>Cervical Disc Herniation</p>
|
||||||
|
<p>
|
||||||
|
Cervical radiculopathy, or pain in a pattern of the nerve root that is
|
||||||
|
compressed, is estimated to occur in 85 per 100,000 people in the
|
||||||
|
population. Most commonly affected regions include the seventh cervical
|
||||||
|
vertebra, C7, and the sixth cervical vertebra, C6, at rates of 60% and
|
||||||
|
25%, respectively (7). These radiculopathies in the cervical region are
|
||||||
|
commonly present in specific demographic groups. For instance, sudden
|
||||||
|
weight load on the neck while in either flexion or extension can be the
|
||||||
|
culprit. Also, in the elderly population, osteophyte formation can play
|
||||||
|
a role as previously mentioned. Sport-related injury can be more
|
||||||
|
insidious in nature, and can be attributed repetitive extension/rotation
|
||||||
|
while actively using postural muscles, as in swimming (7).
|
||||||
|
</p>
|
||||||
|
<p>Thoracic Disc Herniation</p>
|
||||||
|
<p>
|
||||||
|
Thoracic disc herniations appear to be less common than lumbar and
|
||||||
|
cervical herniations for a number of reasons. While they peak at the
|
||||||
|
third to fifth decade of life, similar to other herniations, estimates
|
||||||
|
place thoracic disc herniations only between 0.25% to 1% of all disc
|
||||||
|
herniations (10,11). One reason for decreased incidence, it is thought,
|
||||||
|
is the lesser degree of mobility in the thoracic spine due to the
|
||||||
|
presence of the rib cage. The articulation of the rib head with the
|
||||||
|
vertebral body naturally limits the amount of flexion, extension, and
|
||||||
|
sidebending. The majority of thoracic herniations occur below the level
|
||||||
|
of T7. Rib pairs 8-10 maintain a cartilaginous attachment to the
|
||||||
|
sternum, thus allowing more motion than vertebrae at higher levels. Rib
|
||||||
|
pairs 11 and 12 are known as “floating ribs” and do not maintain any
|
||||||
|
attachment to the sternum. This supports the theory that part of the
|
||||||
|
pathophysiology of herniated thoracic discs is directly related to the
|
||||||
|
ability of the segment to maintain a certain degree of flexability (12).
|
||||||
|
</p>
|
||||||
|
<p>Lumbar Disc Hernation</p>
|
||||||
|
<p>
|
||||||
|
Herniation of the nucleus pulposis of the lumbar disc is present more
|
||||||
|
commonly than the former two types. It is estimated that 95% of
|
||||||
|
herniated lumbar discs occur at the L4-L5 or L5-S1 level (13). Typical
|
||||||
|
presentation includes radicular pain that patients often describe as
|
||||||
|
shooting or stabbing pain that courses down the leg. There may also be
|
||||||
|
paresthesias present in the same distribution pattern. Often, the pain
|
||||||
|
is exacerbated by coughing, sneezing, straining, or standing for long
|
||||||
|
periods of time (14), as this increases the pressure on the disc and
|
||||||
|
therefore on the impinged nerve root. Pain is usually relieved by rest
|
||||||
|
and taking weight off of the prolapsed disc.
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>Manual/Manipulative Medicine and Cervical Disc Herniation</p>
|
||||||
|
<p>
|
||||||
|
Considering the implications of nerve root impingement (including pain,
|
||||||
|
paresthesia, and decreased motor function) secondary to a herniated
|
||||||
|
disc, there is a natural concern regarding the safety of manual
|
||||||
|
manipulation of such an anomalous disc.
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
With regard to manipulation, a 2006 study was done to evaluate the
|
||||||
|
efficacy and safety of cervical manipulation in patients with spinal
|
||||||
|
cord compression and radiculopathy. The study incorporated a variety of
|
||||||
|
chiropractic techniques, including high-velocity, low-amplitude methods.
|
||||||
|
The conclusions drawn by the authors states, “The finding of cervical
|
||||||
|
spinal cord encroachment on magnetic resonance imaging, in and of
|
||||||
|
itself, should not necessarily be considered an absolute
|
||||||
|
contraindication to manipulation.” (8) The authors are specific in
|
||||||
|
mentioning exclusion criteria such as acute myelopathy or changes
|
||||||
|
indicating myelomalacia and make clear the message that special care and
|
||||||
|
astute clinical judgement need be exercised in cases of cervical
|
||||||
|
radiculopathy and pathologic segments.
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
A separate study suggests othewise, stating, “Cervical spinal
|
||||||
|
manipulation therapy may worsen preexisting cervical disc herniation or
|
||||||
|
cause disc herniation resulting in radiculopathy, myelopathy, or
|
||||||
|
vertebral artery compression.” (9) This study describes 22 case studies
|
||||||
|
and states in its conclusion a list of absolute contraindications
|
||||||
|
including patients with rheumatoid arthritis, acute fractures and
|
||||||
|
dislocations, os odontoideum, infection of bone, osseous malignancies,
|
||||||
|
or cervical myelopathy. These case studies included reports from
|
||||||
|
patients previously treated by chiropractors as well as osteopathic
|
||||||
|
physicians. The article puts forth the modality of surgical intervention
|
||||||
|
as the best treatment for certain cases of disc herniation and
|
||||||
|
radiculopathy.
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
With regard to the necessity of surgical intervention, let us consider a
|
||||||
|
2007 article from the Massachusetts Medical Society (15). The study
|
||||||
|
examines the outcomes of two groups of patients with herniated lumbar
|
||||||
|
discs who were randomly assigned to either a surgical intervention or
|
||||||
|
observation and symptom management. The study was inconclusive
|
||||||
|
statistically due to the high rate of crossover. That is, 40% of
|
||||||
|
patients assigned to the surgical intervention declined surgery because
|
||||||
|
their symptoms improved before any intervention could take place (with
|
||||||
|
observation alone). Conversely, 45% of patients referred to the
|
||||||
|
observation therapy, opted for surgical intervention due to worsening of
|
||||||
|
symptoms (15). Even though the study is scholastically inconclusive and
|
||||||
|
statistically insignificant, it does highlight the need for
|
||||||
|
individualized care.
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<h2>Conclusion</h2>
|
||||||
|
<p>
|
||||||
|
As with any topic at the forefront of medicine, especially issues which
|
||||||
|
can be treated via different modalities and by different specialists,
|
||||||
|
there will be controversy, bias, and ever-emerging new evidence to
|
||||||
|
consider. This article demonstrates the basic science behind disc
|
||||||
|
degeneration leading to pathologic herniation. It also shows two sides
|
||||||
|
of a clinical debate to which there is no defined rule for treatment.
|
||||||
|
Patients, therefore, need to be evaluated and treated appropriately on
|
||||||
|
clinical grounds of their individual situation by a physician
|
||||||
|
well-versed in neuromusculoskeletal medicine to determine which specific
|
||||||
|
modality best suits the individual.
|
||||||
|
</p>
|
||||||
|
<h2>References:</h2>
|
||||||
|
<ol>
|
||||||
|
<li>
|
||||||
|
Michael A. Adams, PhD; Peter J. Roughley, PhD What is Intervertebral
|
||||||
|
Disc Degeneration, and What Causes It? Spine. 2006;31(18):2151-2161
|
||||||
|
</li>
|
||||||
|
<li>
|
||||||
|
Boos N, Weissbach S, Rohrbach H, et al. Classification of age-related
|
||||||
|
changes in lumbar intervertebral discs: 2002 Volvo Award in basic
|
||||||
|
science. Spine 2002;27:2631-44.
|
||||||
|
</li>
|
||||||
|
<li>
|
||||||
|
Goel VK, Monroe BT, Gilbertson LG, et al. Interlaminar shear stresses
|
||||||
|
and laminae separation in a disc. Finite element analysis of the L3-L4
|
||||||
|
motion segment subjected to axial compressive loads. Spine
|
||||||
|
1995;20:689-98.
|
||||||
|
</li>
|
||||||
|
<li>
|
||||||
|
Hilton RC, Ball J. Vertebral rim lesions in the dorsolumbar spine. Ann
|
||||||
|
Rheum Dis 1984;43:302-7
|
||||||
|
</li>
|
||||||
|
<li>
|
||||||
|
Adams MA, Bogduk N, Burton K, et al. The Biomechanics of Back Pain.
|
||||||
|
Edinburgh, UK: Churchill Livingstone; 2002
|
||||||
|
</li>
|
||||||
|
<li>
|
||||||
|
Battie MC, Videman T, Gill K, et al. 1991 Volvo Award in clinical
|
||||||
|
sciences. Smoking and lumbar intervertebral disc degeneration: An MRI
|
||||||
|
study of identical twins. Spine 1991;16:1015-21
|
||||||
|
</li>
|
||||||
|
<li>
|
||||||
|
Malanga, Gerard A MD Cervical Radiculopathy. Spine 2006 accessed via
|
||||||
|
emedicine
|
||||||
|
http://www.emedicine.com/sports/TOPIC21.HTM#section~AuthorsandEditors
|
||||||
|
</li>
|
||||||
|
<li>
|
||||||
|
Murphy, DR; Hurwitz, EL; Gregory AA. Manipulation in the presence of
|
||||||
|
cervical spinal cord compression: a case series. J Manipulative
|
||||||
|
Physiol Ther. 2006 Mar-Apr;29(3):236-44
|
||||||
|
</li>
|
||||||
|
<li>
|
||||||
|
David G. Malone, M.D., Nevan G. Baldwin, M.D., Frank J. Tomecek, M.D.,
|
||||||
|
Christopher M. Boxell, M.D., Steven E. Gaede, M.D., Christopher G.
|
||||||
|
Covington, M.D., Kenyon K. Kugler, M.D. Complications of Cervical
|
||||||
|
Spine Manipulation Therapy: 5-Year Retrospective Study in a
|
||||||
|
Single-Group Practice. Neurosurg Focus 13(6), 2002. © 2002 American
|
||||||
|
Association of Neurological Surgeons
|
||||||
|
</li>
|
||||||
|
<li>
|
||||||
|
Fisher, C., Noonan, V., Bishop, P., Boyd, M., Fairholm, D., Wing, P.,
|
||||||
|
et al. (2004). Outcome evaluation of the operative management of
|
||||||
|
lumbar disc herniation causing sciatica. Journal of Neurosurgery, 100,
|
||||||
|
317–324.
|
||||||
|
</li>
|
||||||
|
<li>
|
||||||
|
Strayer, Andrea J Lumbar Spine: Common Pathology and Intervention J
|
||||||
|
Neurosci Nurs. 2005;37(4):181-193
|
||||||
|
</li>
|
||||||
|
<li>
|
||||||
|
Thomas L. Schwenk, MD Is Surgery Necessary for Lumbar Disc Herniation?
|
||||||
|
Journal Watch. 2007;5(11) ©2007 Massachusetts Medical Society
|
||||||
|
</li>
|
||||||
|
</ol>
|
||||||
|
</Article>
|
||||||
|
);
|
||||||
|
};
|
||||||
|
|
||||||
|
export default ArticleIntervertebralDiscHerniation;
|
||||||
|
|
@ -0,0 +1,446 @@
|
||||||
|
import Article from "@/components/Article";
|
||||||
|
|
||||||
|
const ArticleNeuralBiologicalMechanisms = () => {
|
||||||
|
return (
|
||||||
|
<Article
|
||||||
|
title="Neural Biological Mechanisms"
|
||||||
|
author="Richard A. Feely, D.O., FAAO, FCA, FAAMA"
|
||||||
|
>
|
||||||
|
<p>
|
||||||
|
The goal of this article is to provide the clinician with information
|
||||||
|
and knowledge of known biological mechanisms involved in somatic
|
||||||
|
dysfunction.
|
||||||
|
</p>
|
||||||
|
<p>The reader will have the ability to describe:</p>
|
||||||
|
<ul>
|
||||||
|
<li>
|
||||||
|
The neural endocrine-immune network and its relationship to somatic
|
||||||
|
dysfunction
|
||||||
|
</li>
|
||||||
|
<li>How somatic dysfunction is endocrine-controlled and maintained</li>
|
||||||
|
<li>
|
||||||
|
Some of the known mechanisms of how somatic dysfunction is altered
|
||||||
|
biomechanically, biochemically, and bioenergetically
|
||||||
|
</li>
|
||||||
|
</ul>
|
||||||
|
<p>
|
||||||
|
The human body is a complex interdependent relationship of structure,
|
||||||
|
function, and mind. The body possesses complex homeostatic mechanisms
|
||||||
|
that maintain equilibrium for self-regulation and self-healing. These
|
||||||
|
homeostatic mechanisms represent an integrated network of messenger
|
||||||
|
molecules produced by cells in neural, endocrine, and immune systems.
|
||||||
|
Their signal coding and messenger molecules communicate through receptor
|
||||||
|
complexes located on cell membranes. The critical role of the nervous
|
||||||
|
system, especially the lymphatic, forebrain, and hypothalamus,
|
||||||
|
influences the output of the endocrine and immune systems.
|
||||||
|
</p>
|
||||||
|
<h2>Traditionally, the Immune and Nervous Systems</h2>
|
||||||
|
<p>
|
||||||
|
Traditionally, the immune and nervous systems were considered separate
|
||||||
|
and independent, each with its own cell types, cell functions, and
|
||||||
|
intercellular regulators. Altered function in each system was related to
|
||||||
|
the disease considered specific to that system. We now recognize not
|
||||||
|
only the interdependence and interlocking molecular organization but
|
||||||
|
also their extensive integration with the endocrine system. The
|
||||||
|
conceptual separations between the neural endocrine immune system
|
||||||
|
concerning structure, function, and communication have been discarded.
|
||||||
|
In their stead is a combination of multiple dimensional network
|
||||||
|
contributing to the functional unity of the body.
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
Today, we recognize this multifactorial nature is a result of the
|
||||||
|
following interactions of genetic, endocrine, nervous, immune, and
|
||||||
|
behavioral-emotional systems. This complex bi-directional interaction
|
||||||
|
occurs within the neural-endocrine-immune network. This network forms
|
||||||
|
the prime defense against disease and is responsible for the resistance
|
||||||
|
of infectious disease as well as cancer. The sensory information from
|
||||||
|
external and internal sources is tightly integrated with cognitive and
|
||||||
|
emotional processes which influence their neural endocrine immune
|
||||||
|
network through the hypothalamic-pituitary-adrenal axis.
|
||||||
|
</p>
|
||||||
|
<h2>Messengers</h2>
|
||||||
|
<p>
|
||||||
|
The basis for communication in the neural-endocrine-immune system is the
|
||||||
|
numerous messenger molecules that are released in the extracellular
|
||||||
|
fluid. These signal codes are small peptides, glycoproteins, amines, and
|
||||||
|
steroids. They express their activity through autocrine
|
||||||
|
(self-stimulating), paracrine (stimulates local tissue), synaptic, and
|
||||||
|
hormonal activity.
|
||||||
|
</p>
|
||||||
|
<h2>The Endocrine System</h2>
|
||||||
|
<p>
|
||||||
|
The endocrine system is described as using blood-borne messengers
|
||||||
|
operating over long distances by humoral transport. The neural system is
|
||||||
|
described as using chemical transmitters released into the neural
|
||||||
|
synaptic cleft, separating the pre and post-synaptic specialized nerve
|
||||||
|
cells. These common cellular mechanisms are bi-directional in
|
||||||
|
communication. Their similar molecular structure of many of the
|
||||||
|
messengers and the receptors are combined to transcend the traditional
|
||||||
|
borders that separate the neural, endocrine, and immune systems over the
|
||||||
|
years.
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
Monitoring the concentration of many of these extracellular messengers.
|
||||||
|
The central nervous system, particularly the limbic system and
|
||||||
|
hypothalamus, directly modulates the activity of the autonomic nervous
|
||||||
|
system and the endocrine systems. See The Network. Both of these systems
|
||||||
|
have extensive communication with the immune systems, thereby regulating
|
||||||
|
it under neural modulation as well. This combined action is
|
||||||
|
multi-dimensional and creates a compensatory reserve that enables the
|
||||||
|
body to mount an adaptive response to stressful conditions regardless of
|
||||||
|
their origin whether somatic, visceral, or psychogenic.
|
||||||
|
</p>
|
||||||
|
<h2>Stimuli-Somatic</h2>
|
||||||
|
<p>
|
||||||
|
Somatic, visceral, and emotional stimuli act as drivers capable of
|
||||||
|
influencing the activity via the hypothalamus, the spinal cord,
|
||||||
|
pituitary, to the autonomic nervous system, endocrine system, and immune
|
||||||
|
system, causing the general adaptive response. Noxious somatic stimuli
|
||||||
|
initiate protective reflexes providing the central nervous system with
|
||||||
|
warning signs. They influence the release of extracellular messengers
|
||||||
|
from the endocrine immune access system just described.
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
When activated by noxious stimuli such as rises from somatic
|
||||||
|
dysfunction, small capillary primary afferent fibers called alpha-gam
|
||||||
|
lambda and C-fibers, a-C-fibers or collectively referred to as (B
|
||||||
|
afferent system) from peripheral nociceptor endings, release neural
|
||||||
|
peptides such as substance P into the surrounding tissue thereby
|
||||||
|
initiating neurogenic inflammation.
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
The B afferent fibers systems represent a small subset of small
|
||||||
|
capillary primary afferent fibers with high threshold for activation
|
||||||
|
that are present in both somatic and visceral tissue. Central processes
|
||||||
|
of these fibers stimulate cells in the dorsal horn of the spinal cord.
|
||||||
|
Within the dorsal horn, the cells responding to the nociceptive input
|
||||||
|
initiate signals carried to the motor nuclei of the ventral horn to
|
||||||
|
alter the tonal muscles innervated by that particular spinal segment and
|
||||||
|
through the anterior lateral tract of the spinal cord which communicates
|
||||||
|
with the brain stem and the hypothalamus.
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
A significant result of the nociceptive input is increased activity in
|
||||||
|
the hypothalamic-pituitary-adrenal axis culminating in increased output
|
||||||
|
of norepinephrine from the sympathetic nervous system. This reflex can
|
||||||
|
be blocked by selectively eliminating the small capillary primary
|
||||||
|
afferent fibers. Capsaicin reduces the level of substance P in the
|
||||||
|
peripheral nervous system by destroying the small caliber primary
|
||||||
|
afferent fibers. This diminishes the hypothalamic response and reduces
|
||||||
|
the pituitary adrenal and autonomic responses to somatic stressors. The
|
||||||
|
neural-endocrine-immune network is affected by the output of the signals
|
||||||
|
from somatic dysfunction by initiating a compensatory shift in
|
||||||
|
extracellular messengers that then alters the function of the immune
|
||||||
|
system.
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
Collins and Strauss found that modulation of the sympathetic nervous
|
||||||
|
system plays an integral part in somatic pain and is a principal
|
||||||
|
mechanism of acupuncture’s action. The control of somatic sympathetic
|
||||||
|
vasomotor activity before and after the placement of acupuncture needles
|
||||||
|
resulted in pain relief by reducing sympathetic vasomotor activity.
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
Nakamura, et al. found that afferent pathways of diskogenic low back
|
||||||
|
pain are transmitted mainly by sympathetic afferent fibers in the L2
|
||||||
|
nerve root and after needle injection, pain dissipated.
|
||||||
|
</p>
|
||||||
|
<h2>Stimuli-Visceral</h2>
|
||||||
|
<p>
|
||||||
|
The visceral factors in the cervical, thoracic, abdominal, and pelvic
|
||||||
|
areas, as well as peripheral blood vessels, communicate with the brain
|
||||||
|
stem and spinal cord through an extensive complement of afferent fibers
|
||||||
|
also considered part of the B afferent system. The visceral afferent
|
||||||
|
fibers reach their target organs by coursing in the same nerves as the
|
||||||
|
efferent autonomic fibers. They follow the routes of the vascular
|
||||||
|
system. The visceral sensory fibers, typically small caliber and having
|
||||||
|
little or no myelin, have cell bodies located in the thoraco-lumbar
|
||||||
|
dorsal root ganglia and in ganglia of several cranial nerves. These
|
||||||
|
central processes, neurons, terminate in the superficial and deep
|
||||||
|
regions of the dorsal horn of the spinal cord.
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
Spinal trigeminal nucleus and solitary nucleus of the vagus. The
|
||||||
|
thoraco-abdominal and pelvic organs have extensive sensory innervations.
|
||||||
|
These afferent fibers travel to the central nervous system with efferent
|
||||||
|
autonomic fibers. These sensory fibers traveling in the parasympathetic
|
||||||
|
nerves such as the vagus carry non-noxious information for reflex
|
||||||
|
control of the organ. Those traveling with the sympathetic nerves such
|
||||||
|
as the greater splanchnic carry noxious information packets.
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
The neurons of the deeper portions of the dorsal horn receive extensive
|
||||||
|
convergence of information from the small caliber sensory axons arising
|
||||||
|
in both visceral and somatic sources.
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
A similar convergence of somatic and visceral input is seen in the
|
||||||
|
solitary nucleus of the vagus. Neurons responsive to both visceral and
|
||||||
|
somatic nociceptive stimuli are located in the spinal cord, brain stem,
|
||||||
|
hypothalamus, and thalamus. These dual response neurons provide an
|
||||||
|
explanation for the phenomenon of referred pain between visceral and
|
||||||
|
somatic sources.
|
||||||
|
</p>
|
||||||
|
<h2>Stimuli-Emotional</h2>
|
||||||
|
<p>
|
||||||
|
The emotional factors of the human effecting the neural endocrine immune
|
||||||
|
network arise largely from the limbic forebrain system and hypothalamus.
|
||||||
|
The major components of the limbic forebrain include large portions of
|
||||||
|
associated neocortex, which include the prefrontal area, the cingulate
|
||||||
|
cortex, the insular cortex, and the inferior medial aspect of the
|
||||||
|
temporal lobe. Hippocampal formation and the amygdala receive extensive
|
||||||
|
connections from the frontal parietal and cingulate associational areas
|
||||||
|
of the neocortex and in turn project to the hypothalamus from the fornix
|
||||||
|
and striaterminalis, influencing the hypophyseotropic and hypothalamic
|
||||||
|
nuclei.
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
This limbic forebrain areas exert considerable influence over the
|
||||||
|
pituitary gland as well as the autonomic nervous system affecting growth
|
||||||
|
hormone, ACTH, prolactin, and somatostatin. The limbic system also
|
||||||
|
increases the sympathetic output from the spinal cord. These alterations
|
||||||
|
in the neural-endocrine activity affect the metabolic processes of the
|
||||||
|
body, shifting peripheral tissue to a catabolic form of metabolism,
|
||||||
|
leading to marked changes in the function of the immune system,
|
||||||
|
including stress-induced suppression of immune function. These
|
||||||
|
conditions characterize the general adaptive response in life.
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
Highly stressful circumstances in life significantly alter the status of
|
||||||
|
the immune system. This can include the death of a loved one, caring for
|
||||||
|
a family member with chronic progressive disease, summer vacation,
|
||||||
|
change in lifestyle, divorce, new job, etc.
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
The regulation of the neural-endocrine-immune network increases
|
||||||
|
susceptibility to various disease states. Overproduction or
|
||||||
|
underproduction of extracellular messages in response to either external
|
||||||
|
or internal stimuli or as a secondary response to other
|
||||||
|
disease-dysfunctional processes result in dysfunction of many aspects of
|
||||||
|
the network. The aging process also alters the regulation of the network
|
||||||
|
and is associated with various disease-dysfunctional states.
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
Lundberg showed that psychosocial factors significantly associated with
|
||||||
|
back pain and shoulder problems were related to psychophysiological
|
||||||
|
stress levels, i.e., high psychophysiological stress levels and low work
|
||||||
|
satisfaction.
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
He also found that mental and physical stress was found to increase
|
||||||
|
physiological stress levels and muscular tension and that mental stress
|
||||||
|
is of importance for the development of musculoskeletal symptoms and
|
||||||
|
pain. In addition, mental stress is not only induced by high demands but
|
||||||
|
also by demands that are too low which happens in many repetitive and
|
||||||
|
monotonous work situations. Interestingly enough, women are more prone
|
||||||
|
than men to have somatic complaints with repetition and monotonous work.
|
||||||
|
</p>
|
||||||
|
<h2>The Network</h2>
|
||||||
|
<p>
|
||||||
|
<strong>SELECTED NEURAL REGULATORS</strong>
|
||||||
|
</p>
|
||||||
|
<ul>
|
||||||
|
<li>Catecholamines: Dopamine, Norepinephrine</li>
|
||||||
|
<li>Cholines: Acetylcholine</li>
|
||||||
|
<li>Indolamines: Serotonin</li>
|
||||||
|
<li>
|
||||||
|
Peptides: Substance P, Neuropeptide Y, Calcitonin gene-related,
|
||||||
|
Polypeptide, Enkaphalins, Endorphins, Neurotensin, Cholecystokinin,
|
||||||
|
Angiotensin II, Vasoactive intestinal polypeptide, Bombesin,
|
||||||
|
Adrenocorticotropin, Somatostatin, Corticotropin
|
||||||
|
</li>
|
||||||
|
<li>Amino Acids: Glutamate, Aspartate, GABA, Glycine</li>
|
||||||
|
<li>Dynorphin, Histamine</li>
|
||||||
|
<li>Purines: Adenosine</li>
|
||||||
|
</ul>
|
||||||
|
<h2>CELL TYPES OF THE IMMUNE SYSTEM</h2>
|
||||||
|
<ul>
|
||||||
|
<li>Thymocytes: Lymphoid Cells of the thymus</li>
|
||||||
|
<li>
|
||||||
|
T-Cells: Lymphoid cells that mature in the thymus & express the T-cell
|
||||||
|
receptor (TCR)
|
||||||
|
</li>
|
||||||
|
<li>
|
||||||
|
Helper T-Cells: Lymphoid cells responding to cell surface antigens by
|
||||||
|
secreting cytokines
|
||||||
|
</li>
|
||||||
|
<li>
|
||||||
|
Cytotoxic T-Cells: Lymphoid cells responding to the cell surface
|
||||||
|
antigens by lysing cell producing the antigen
|
||||||
|
</li>
|
||||||
|
<li>
|
||||||
|
B-Cells: Lymphoid cells that, when activated, are capable of producing
|
||||||
|
immunoglobulins
|
||||||
|
</li>
|
||||||
|
<li>
|
||||||
|
Natural Killer Cells: Lymphoid cells capable of killing tumor cells
|
||||||
|
and virus/infected cells
|
||||||
|
</li>
|
||||||
|
<li>
|
||||||
|
Neutrophils: Major Lymphoid cell of the acute inflammatory response
|
||||||
|
and effector cells of humoral immunity
|
||||||
|
</li>
|
||||||
|
<li>
|
||||||
|
Basophils: Effector cells of IgE-mediated immunity that secrete
|
||||||
|
histamine granules in response to IgE activation
|
||||||
|
</li>
|
||||||
|
<li>
|
||||||
|
Eosinophils: Lymphoid cells containing lysosomal granules that can
|
||||||
|
destroy parasites
|
||||||
|
</li>
|
||||||
|
</ul>
|
||||||
|
<h2>NON-LYMPHOID CELL TYPES</h2>
|
||||||
|
<ul>
|
||||||
|
<li>
|
||||||
|
Fibroblast: Connective tissue cell capable of secreting and
|
||||||
|
maintaining the collagenous fiber matrix
|
||||||
|
</li>
|
||||||
|
<li>
|
||||||
|
Endothelial Cell: Squamous cell lining of the inner aspect of the
|
||||||
|
vascular system
|
||||||
|
</li>
|
||||||
|
<li>
|
||||||
|
Mesangial Cells: Specialized mesenchymal cells found in the renal
|
||||||
|
glomerulus
|
||||||
|
</li>
|
||||||
|
<li>
|
||||||
|
Chromaffin Cell: Neural peptides secreting cell found in the adrenal
|
||||||
|
medulla
|
||||||
|
</li>
|
||||||
|
<li>
|
||||||
|
Enterochromaffin Cell: Neural peptides secreting cell found in the
|
||||||
|
lining of the gastrointestinal system
|
||||||
|
</li>
|
||||||
|
<li>
|
||||||
|
Hepatocyte Liver Cell: Liver cell capable of secreting the acute phase
|
||||||
|
proteins
|
||||||
|
</li>
|
||||||
|
<li>
|
||||||
|
Endometrial Cell: Epithelial cell lining the inner surface of the
|
||||||
|
uterus
|
||||||
|
</li>
|
||||||
|
<li>
|
||||||
|
Astrocyte: Neuroglial cell found in the central nervous system
|
||||||
|
involved in forming the blood-brain barrier
|
||||||
|
</li>
|
||||||
|
<li>
|
||||||
|
Oligodendrocyte: Neuroglial cell forming myelin sheath around axons in
|
||||||
|
the central nervous system
|
||||||
|
</li>
|
||||||
|
<li>
|
||||||
|
Osteoblast: Specialized mesenchymal cells capable of secreting the
|
||||||
|
osteomatrix for the formation of bones
|
||||||
|
</li>
|
||||||
|
<li>
|
||||||
|
Osteophyte: Connective tissue cell found in bone representing a mature
|
||||||
|
form of osteoblast
|
||||||
|
</li>
|
||||||
|
<li>
|
||||||
|
Reticular Cell: Endodermal cell creating a three-dimensional network
|
||||||
|
for lymphocytes in the thymus, spleen, and lymph nodes
|
||||||
|
</li>
|
||||||
|
</ul>
|
||||||
|
<h2>IMMUNOREGULATORS</h2>
|
||||||
|
<ul>
|
||||||
|
<li>Interleukins 1-7</li>
|
||||||
|
<li>Interferons alpha, beta, and gamma</li>
|
||||||
|
<li>Tumor necrosis factor, beta</li>
|
||||||
|
<li>Colony-stimulating factors:</li>
|
||||||
|
<ul>
|
||||||
|
<li>Granulocyte-stimulating factor</li>
|
||||||
|
<li>Macrophage-stimulating factor</li>
|
||||||
|
<li>Granulocyte macrophage-stimulating factor</li>
|
||||||
|
<li>Interleukin III</li>
|
||||||
|
<li>Leukemia inhibiting factor or neuroleukin</li>
|
||||||
|
</ul>
|
||||||
|
<li>Transforming factor, beta</li>
|
||||||
|
</ul>
|
||||||
|
<h2>
|
||||||
|
ENDOCRINE SUBSTANCES KNOWN TO INTERACT WITH THE NEURAL AND IMMUNE
|
||||||
|
SYSTEMS
|
||||||
|
</h2>
|
||||||
|
<ul>
|
||||||
|
<li>Pituitary</li>
|
||||||
|
<ul>
|
||||||
|
<li>Adrenal Corticotrophin-ACTH</li>
|
||||||
|
<li>Thyrotrophin-TSH</li>
|
||||||
|
<li>Growth hormone releasing factor-GRH</li>
|
||||||
|
<li>Somatostatin-SS-SS</li>
|
||||||
|
<li>Prolactin</li>
|
||||||
|
</ul>
|
||||||
|
<li>Adrenal Medullary Hormones</li>
|
||||||
|
<ul>
|
||||||
|
<li>Epinephrine</li>
|
||||||
|
<li>Norepinephrine</li>
|
||||||
|
</ul>
|
||||||
|
<li>Adrenal Cortical Hormones</li>
|
||||||
|
<ul>
|
||||||
|
<li>Cortisol</li>
|
||||||
|
<li>Corticosterone</li>
|
||||||
|
<li>Aldosterone</li>
|
||||||
|
</ul>
|
||||||
|
<li>Thyroid Hormones</li>
|
||||||
|
<ul>
|
||||||
|
<li>Thyroxine</li>
|
||||||
|
<li>Triiodothyronine</li>
|
||||||
|
</ul>
|
||||||
|
<li>Growth Hormones</li>
|
||||||
|
<ul>
|
||||||
|
<li>Somatotropin</li>
|
||||||
|
<li>Somatomammotropin</li>
|
||||||
|
<li>Somatomedin</li>
|
||||||
|
</ul>
|
||||||
|
<li>Thymus</li>
|
||||||
|
<ul>
|
||||||
|
<li>Thymulin</li>
|
||||||
|
<li>Thymosin</li>
|
||||||
|
<li>Thymopoietin</li>
|
||||||
|
<li>Thalmic factor X</li>
|
||||||
|
</ul>
|
||||||
|
<li>Others</li>
|
||||||
|
<ul>
|
||||||
|
<li>Estrogen</li>
|
||||||
|
<li>Testosterone</li>
|
||||||
|
<li>Insulin</li>
|
||||||
|
</ul>
|
||||||
|
</ul>
|
||||||
|
<h2>References</h2>
|
||||||
|
<ul>
|
||||||
|
<li>
|
||||||
|
Beal, Myron, D.O., FAAO, 1995-96 Yearbook, Osteopathic Vision,
|
||||||
|
American Academy of Osteopathy, 1996.
|
||||||
|
</li>
|
||||||
|
<li>
|
||||||
|
A.A. Buerger, Ph.D., Philip E. Greenman, D.O., Empirical Approaches to
|
||||||
|
the Validation of Spinal Manipulation, 1985, published by Charles C.
|
||||||
|
Thomas.
|
||||||
|
</li>
|
||||||
|
<li>
|
||||||
|
D. Thomas Collins, S. Strauss, “Somatic Sympathetic Vasomotor Changes
|
||||||
|
Documented by Medical Thermographic Imaging During Acupuncture
|
||||||
|
Analgesia“, Clinical Rheumatology, 1992, 55-59.
|
||||||
|
</li>
|
||||||
|
<li>
|
||||||
|
Richard G. Gillette, Ronald C. Kramis, William J. Roberts, ”
|
||||||
|
Sympathetic activation of cat spinal neurons responsive to noxious
|
||||||
|
stimulation of deep tissues in the low back“, Pain , 1994, 56, 31-42.
|
||||||
|
</li>
|
||||||
|
<li>
|
||||||
|
Ulf Lundberg, ” Methods and application of stress research“,
|
||||||
|
Technology and Health Care, 1995, 3-9.
|
||||||
|
</li>
|
||||||
|
<li>
|
||||||
|
Shin-Ichiro Nakamura, Kazuhisa Takahasi, Yuzuru Takahashi, Masatsune
|
||||||
|
Yamagata, Hideshige Moriya, ” The Afferent Pathways of Discogenic Low
|
||||||
|
Back Pain“, Bone and Joint Surgery, 1996, July; 78/B, 606-612.
|
||||||
|
</li>
|
||||||
|
<li>
|
||||||
|
Robert C. Ward, Foundations for Osteopathic Medicine, American
|
||||||
|
Osteopathic Association, 1997; Williams & Wilkins
|
||||||
|
</li>
|
||||||
|
</ul>
|
||||||
|
</Article>
|
||||||
|
);
|
||||||
|
};
|
||||||
|
|
||||||
|
export default ArticleNeuralBiologicalMechanisms;
|
||||||
|
|
@ -0,0 +1,854 @@
|
||||||
|
import Article from "@/components/Article";
|
||||||
|
|
||||||
|
const ArticleOsteopathicHeadPain = () => {
|
||||||
|
return (
|
||||||
|
<Article title="Head Pain" author="Herbert C. Miller, D.O., FAAO">
|
||||||
|
<p>Reprinted with permission of the American Osteopathic Association.</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
Pain has been defined in many ways, as the sensation “resulting from the
|
||||||
|
stimulation of specialized nerve endings,”‘ or, more poetically, as a
|
||||||
|
punishment or penalty, as for crime. Other definitions include acute
|
||||||
|
discomfort of body or mind, bodily or mental suffering or distress; a
|
||||||
|
distressing sensation, as in a particular part of the body, and trouble
|
||||||
|
experienced in doing something. (2) One’s concept of pain may be colored
|
||||||
|
by diverse circumstances or, in scientific language, feedback. Head pain
|
||||||
|
is usually interpreted by the clinician from the therapeutic point of
|
||||||
|
view, that is, in terms of measures that may stop in, rather than in
|
||||||
|
pathophysiologic terms.
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
When analyzing head pain, the physician often prefers to look at it as a
|
||||||
|
phenomenon or as the result of stimulation of specialized nerve endings.
|
||||||
|
In reality, pain may be an interpretation of bodily or mental distress.
|
||||||
|
Boshes and Arieff (3) stated:
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
Certain aspects of pain are predicated exclusively on a neural
|
||||||
|
substrate. Here the basis is an event or an alteration in the nervous
|
||||||
|
system per se, as contrasted to pain caused by malignant disease,
|
||||||
|
infected tissue, fractures or the like. Various divisions of the nervous
|
||||||
|
system may be implicated and a description of the disability or the
|
||||||
|
manner of posture and movement is often sufficient to enable the trained
|
||||||
|
observer to gain an impression as to whether the pain is genuine or
|
||||||
|
functional. Such involvement may be at the receptive, the conductive,
|
||||||
|
the perceptive or the apperceptive level, or combinations thereof.
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
This would appear to be a generally accepted concept, and yet head pain
|
||||||
|
often is described and interpreted on the basis of a symptom complex
|
||||||
|
rather than in terms of the anatomic and physiologic organization of the
|
||||||
|
central nervous system. It is the purpose of this paper to attempt to
|
||||||
|
describe some of the mechanisms involved in head pain and to provide
|
||||||
|
these mechanisms with an osteopathic orientation.
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<h2>Neural Pathways</h2>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
Most of the sensory nerve distribution to the head and face occurs
|
||||||
|
through the trigeminal nerve (Cr V) and fibers of cervical nerves C1,
|
||||||
|
C2, and C3 (Fig. 1.). Smith (4) stated:
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
The trigeminal fibers subserving pain have their neurons in the
|
||||||
|
trigeminal or semilunar ganglion which lies in a cave of the aura mater
|
||||||
|
in the middle cranial fossa just anterior to the apex of the petrous
|
||||||
|
temporal bone. The peripheral branches of the trigeminal nerve, . . .
|
||||||
|
the ophthalmic, maxillary, and mandibular nerves . . . supply a fairly
|
||||||
|
well defined cutaneous area and broadly speaking, the deep structures
|
||||||
|
underlying it. There is little overlap with the adjoining cutaneous
|
||||||
|
fields of the cervical nerves….
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
The glossopharyugeal nerve supplies common sensibility to the posterior
|
||||||
|
third of the tongue, the pharynx, soft palate, tonsils and fauces, the
|
||||||
|
auditory tube, the tympanic cavity and mastoid air cells, and the inner
|
||||||
|
lining of the eardrum. The vagus nerve . . . supplies the general
|
||||||
|
somatic afferent fibers to the posterior portion of the external
|
||||||
|
auditory canal, part of the eardrum, and the skin of the cranial surface
|
||||||
|
of the auricle adjoining the scalp.
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
The pain and temperature fibers of the glossopharyngeal and vagus nerves
|
||||||
|
relay to the nucleus of the descending trigeminal tract.
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
The cutaneous distribution of C I is not consistent. Larsell (5) said:
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
Occasionally it gives a cutaneous branch to the skin of the upper part
|
||||||
|
of the back of the neck and the lower part of the scalp.
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
The second cervical nerve chiefly supplies the area of the head and neck
|
||||||
|
adjoining the trigeminal territory, to which the third cervical nerve
|
||||||
|
contributes fibers. (4)
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>Kimmel (5) stated:</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
The nerve fibers supplying the cranial aura mater are derived from the
|
||||||
|
trigeminal nerve, the upper three cervical nerves, and the sympathetic
|
||||||
|
trunk. Nerve branches from the upper three cervical nerves and the
|
||||||
|
superior cervical ganglion supply the aura mater of the posterior
|
||||||
|
cranial fossa. The aural nerves derived from the three divisions of the
|
||||||
|
trigeminal nerve and from the sympathetic plexuses on the internal
|
||||||
|
carotid and middle meningeal arteries supply the remainder of the
|
||||||
|
cranial aura mater.
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
The first division of the trigeminal nerve supplies the aura mater in
|
||||||
|
the anterior cranial fossa, the diaphragm sellae, nearly all of the
|
||||||
|
cerebral falx, the tentorium cerebelli, part of the superior sagittal
|
||||||
|
sinus, the straight sinus, the superior wall of the transverse sinus,
|
||||||
|
and the terminal parts of the cerebral veins entering these sinuses.
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
The maxillary division of the trigeminal nerve supplies the aura mater,
|
||||||
|
covering the anterior part of the middle cranial fossa. Branches of the
|
||||||
|
third, or mandibular, division of the trigeminal nerve supply the aura
|
||||||
|
mater in the posterior and lateral parts of the middle cranial fossa and
|
||||||
|
the aura mater lining most of the calvaria. (6)
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
Perhaps the more important aspect of pain is that it is not a single
|
||||||
|
identifiable entity. It may be represented by vastly complicated and
|
||||||
|
intricate processes or by the mere experiencing of the touch of a sharp
|
||||||
|
object. The integration of actual pain reception and perception
|
||||||
|
represents an area of widely diverse opinion. On the basis of the
|
||||||
|
observation that successive surgical interruptions of peripheral nerves,
|
||||||
|
posterior roots, spinal cord, and thalamus, and ablations of portions of
|
||||||
|
the cerebral hemispheres, may all fail to give permanent relief from
|
||||||
|
pain, Gooddy (7) concluded that “any nervous pathways are potential
|
||||||
|
‘pain pathways.’ ”
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
Pain stimuli (or at least somatesthetic stimuli interpreted as pain)
|
||||||
|
arising from the spinal cord (C1, C2, and C3) pass principally to the
|
||||||
|
cuneate nucleus (homolateral), synapse, cross at this level, and ascend
|
||||||
|
to the ventrolateral nucleus of the thalamus.(8)
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>Finneson (9) stated:</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
The function of the thalamus is to pass impulses on to the
|
||||||
|
cerebralcortex, and it is presumed that these impulses are integrated by
|
||||||
|
the association nuclei in the thalamus before being relayed. The portion
|
||||||
|
of the thalamus that projects impulses to a specific cortical area
|
||||||
|
receives in return corticothalamic projection fibers from that area,
|
||||||
|
forming a circuit between thalamus and cortex.
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
Smith (4) said that pain fibers of the great auricular nerve synapse in
|
||||||
|
the substantia gelatinosa Rolandi, from which second order neurons
|
||||||
|
ascend in the lateral spinothalamic tract to the posteroventral nucleus
|
||||||
|
of the thalamus. He added:
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
Pain fibers from the trigeminal nerve have their cell bodies in the
|
||||||
|
semilunar ganglion…. Their central processes descend, as the spinal
|
||||||
|
tract of the trigeminal nerve, in the lateral brain stem from the upper
|
||||||
|
pons to the C-2 level of the cord or even somewhat lower, to terminate
|
||||||
|
in the associated spinal trigeminal nucleus which lies adjacent and deep
|
||||||
|
to the tract. The spinal tract and the spinal nucleus correspond to and
|
||||||
|
are continuous with the dorsolateral fasciculus of the cord and the
|
||||||
|
substantia gelatinosa respectively.
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
Pain afferents from the face, arriving via the trigeminal,
|
||||||
|
glossopharyngeal, and vagal routes, relay to the portion of the spinal
|
||||||
|
nucleus lying below the inferior limit of the fourth ventricle….
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
Second order neurons from the spinal trigeminal nucleus cross the
|
||||||
|
midline . . . at the ventral secondary tract to ascend on the medial
|
||||||
|
aspect of the lateral spinothalamic tract to gain the thalamus. There is
|
||||||
|
doubt as to the thalamic termination of these fibers. The classic view
|
||||||
|
is that the trigeminal lemniscus (combining the ventral and dorsal
|
||||||
|
secondary trigeminal tracts) projects to the medial portion (arcuate
|
||||||
|
nucleus) of the posteroventral nucleus of the thalamus…. From the
|
||||||
|
posteroventral nucleus of the thalamus, third order neurons pass in the
|
||||||
|
sensory radiation via the posterior limb of the internal capsule to the
|
||||||
|
somatic sensory area of the cortex in the lowest portion of the
|
||||||
|
postcentral areas (Brodmann’s areas 3. 1. 2) just above the fissure of
|
||||||
|
Sylvius. There is evidence of the face being represented bilaterally in
|
||||||
|
the thalamus and cortex…. It is likely that the thalamus is responsible
|
||||||
|
for the recognition of pain but that the perception of pain as a mental
|
||||||
|
event requires cortical participation-probably diffuse and generalized
|
||||||
|
cortical participation….
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
There is also evidence that pain pathways from both cord and medulla
|
||||||
|
relay bilaterally in the reticular formation of the brain stem and
|
||||||
|
ascend by slow, multisynaptic routes to the medial thalamic nuclei and
|
||||||
|
become part of the diffuse thalamic system. The latter system, which is
|
||||||
|
thought to control the general level and direction of attention. May
|
||||||
|
also be responsible for the affective coloring of pain.
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<h2>Vascular Elements</h2>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
The sensitiveness of the vascular elements has been discussed by Wolff
|
||||||
|
(11). His investigation showed consistent sensitiveness to compression,
|
||||||
|
stretching, and faradic stimulation in the arterial system. The great
|
||||||
|
venous sinuses were less sensitive than the arteries to these stimuli,
|
||||||
|
and the lesser sinuses and veins lost sensitiveness in proportion to
|
||||||
|
their distance from the greater sinuses.
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>Crosby and associates (11) stated:</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
The blood vessels of the head receive their preganglionic sympathetic
|
||||||
|
innervation from T-1 to T-2, but C-8 and T-3 and even T-4 may also
|
||||||
|
contribute. The axons pass out into the sympathetic chain and ascend to
|
||||||
|
synapse in the stellate and the superior cervical sympathetic ganglia.
|
||||||
|
The postganglionic fibers distribute from the superior cervical
|
||||||
|
sympathetic ganglion with the external and internal carotid arteries to
|
||||||
|
the head. The intracranial postganglionics follow along the internal
|
||||||
|
carotid artery to the circle of Willis and along branches of the
|
||||||
|
external carotid and distribute to the adventitia and the smooth muscle
|
||||||
|
of intracranial vessels, including arterioles of the pie mater, but not
|
||||||
|
to the blood vessels in the brain substance. Postganglionic fibers also
|
||||||
|
distribute to the middle meningeal artery. The plexuses along the common
|
||||||
|
carotid and the internal carotid are not continuous with those on the
|
||||||
|
external carotid, so that stripping the plexuses from the common and
|
||||||
|
internal carotids will not destroy the sympathetic supply to the blood
|
||||||
|
vessels of the face and the head. Postganglionic fibers from the
|
||||||
|
stellate ganglion ascend along the vertebral arteries and the basilar
|
||||||
|
artery….
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
A parasympathetic innervation to some of the blood vessels of the head
|
||||||
|
likewise has been demonstrated. Preganglionic parasympathetic fibers of
|
||||||
|
the facial nerve turn off in the region of the geniculate ganglion to
|
||||||
|
run in the great superficial petrosal nerve to the plexus on the
|
||||||
|
internal carotid artery. Postganglionic fibers from small clusters of
|
||||||
|
ganglion cells on the blood vessels distribute as vasodilators of the
|
||||||
|
vessels.
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
The vascular tone (sympathetic-parasympathetic influence) appears to be
|
||||||
|
mediated through the forebrain with connections in the hypothalamic
|
||||||
|
nuclei. Crosby and associates (11) wrote:
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
The pathways by which these impulses are discharged to hypothalamic and
|
||||||
|
midbrain segmental areas . . . constitute the various
|
||||||
|
cortico-hypo-thalamic . . . systems and the cortico-thalamo-hypothalamic
|
||||||
|
tracts by way of the dorsomedial thalarnic nucleus.
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
It seems probable, as others have suggested, that the cortical paths are
|
||||||
|
regulatory over the hypothalamic systems…. The pathways in general
|
||||||
|
provide for emotional accompaniments to cortically initiated motor
|
||||||
|
responses carried over pyramidal and extrapyramidal systems. . . .
|
||||||
|
Evidence has been forthcoming that pyramidal as well as extrapyramidal
|
||||||
|
systems carry corticofugal fibers for autonomic centers of the spinal
|
||||||
|
cord.
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
Before proceeding to a discussion of the types of stimuli that may be
|
||||||
|
interpreted as pain, the character of nerve endings present in the
|
||||||
|
meninges and associated structures of the head and neck should be
|
||||||
|
considered in order to clarify the types of stimuli that may give rise
|
||||||
|
to pain. Crosby and associates (11) wrote:
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
The sensory terminations in the aura have been studied by various
|
||||||
|
observers…. The nerve endings at the base of the skull are less numerous
|
||||||
|
than on the convexity. They are in the form of end-branches knob- or
|
||||||
|
club-shaped terminations, or are like balls of twine.
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
They reported that Meissner corpuscles are associated with the finest
|
||||||
|
tactile sensation. The Golgi-Mazzoni receptor is said to be a pressure
|
||||||
|
receptor, of similar function to the Pacini corpuscle. The Krause
|
||||||
|
corpuscle has been associated with discrimination of low temperatures.
|
||||||
|
It has been suggested (11) that it may function to distinguish cool
|
||||||
|
rather than cold. Ruffini end organs appear to serve in more than one
|
||||||
|
type of receptor. The larger Ruffini endings serve as pressure endings,
|
||||||
|
while smaller endings of this type are present in the subcutaneous
|
||||||
|
connective tissue and are regarded as receptors of warmth. (11) Golgi,
|
||||||
|
Meissner, and Pacini corpuscles have been described as receptors of
|
||||||
|
discrimination in joint motion. They are credited with reporting motion
|
||||||
|
characteristics in regard to rate of position change, direction of
|
||||||
|
motion, and force required to produce position change. (12)
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<h2>Characteristics</h2>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
Now that the involved circuitry has been described, pain itself may be
|
||||||
|
considered. Pain may result directly from factors originating outside
|
||||||
|
the body (a sharp object or excessive heat), from pathophysiologic
|
||||||
|
changes within the body (sustained muscle tension or a tumor) or from
|
||||||
|
abnormally mediated psychologic factor~ through autonomic response. Pain
|
||||||
|
may result from mechanical or psychologic stimulation or a combination
|
||||||
|
of these. It may be described, then, as a response to stimuli that
|
||||||
|
threaten tissue integrity or organizational integrity of the body unit.
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
Various authors have classified pain according to the particular portion
|
||||||
|
of the nervous system immediate!! Responsible for the transmission of
|
||||||
|
the stimulus to the central nervous system. As Boshes and Arieff (3)
|
||||||
|
said pain may be classified as being at the receptive, the conductive,
|
||||||
|
the perceptive, or the apperceptive level, at a combination of these.
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
Pain must be discerned as a local, projected, or referred phenomenon.
|
||||||
|
Localized pain is restricted to the immediate area of reception, as in
|
||||||
|
pain in a toot from an apical abscess. Projected pain in the head may be
|
||||||
|
exemplified by trigeminal neuralgia, which Magoun (13) stated is . . .
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
apparently due to restriction in the aural investiture of the root as
|
||||||
|
passes over the petrous ridge, in Meckel’s cave housing the ganglia or
|
||||||
|
in the sleeves around the three branches as they exist from the skull.
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
ain is projected at times over the entire hemiface served by the nerve.
|
||||||
|
Referred pain may be exemplified by reference to the face of thrombosis
|
||||||
|
of the posterior inferior cerebellar artery. (4)
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
Although these classifications of pain overlap to some degree, the use
|
||||||
|
of a combination of classification helps to explain various phenomena of
|
||||||
|
pain production. The Patient waiting for the attention of the dentist or
|
||||||
|
surgeon may suppress pain mentally and say, “It doesn’t hurt as it did
|
||||||
|
yesterday,” until the approach of the time for local anesthetic
|
||||||
|
preparation. Then a touch by any object may produce a unique response in
|
||||||
|
the area of attention. The apperceptive mechanisms, mediated through the
|
||||||
|
nuclei of the thalamus and modified through the cortifugal control
|
||||||
|
systems of the cerebellum, (14-17) plus the pituitary-adrenal
|
||||||
|
hyperfunction due to fear, cause pain uniquely individualized by the
|
||||||
|
patient’s level of apprehension. The cortifugal controls exerted through
|
||||||
|
the cerebellum modify the intensity of activity occurring both on a
|
||||||
|
motor level and through the thalamic nuclei. It appears that damage to
|
||||||
|
or suppression of the control system may be responsible for the
|
||||||
|
rigidity, hyperactivity, dysmetria, ataxia, and epileptiform activity
|
||||||
|
exhibited by patients with brain damage or trauma.(15)
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
Sutherland (18) described his observations and conclusions in reference
|
||||||
|
to stress mechanisms involving the aura mater and cranial sutures. The
|
||||||
|
observations of the various types of nerve endings in the leptomeninges
|
||||||
|
make the information supplied by stress on the aura mater and pie mater
|
||||||
|
available to the centers of perception, apperception, and motor
|
||||||
|
activity. It has been demonstrated (19) that the recurrent meningeal
|
||||||
|
nerves in the spinal area (especially the branches that enter through
|
||||||
|
the foremen magnum along with the internal carotid artery) are derived
|
||||||
|
from the sympathetic trunk and supply the aura mater lining the
|
||||||
|
posterior cranial fossa. This distribution makes available to this area
|
||||||
|
information from the outer layers of the cranial aura mater, which forms
|
||||||
|
the periosteum of the cranium, and the inner layer, which forms the
|
||||||
|
investing aura of the brain (the tentorium cerebelli, falx cerebri, and
|
||||||
|
falx cerebelli), and from the spinal cord meninges and supporting
|
||||||
|
ligaments.
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
Ray and Wolff (20) in 1940 studied the probable causes of headache or
|
||||||
|
head pain in relation to the aura mater from observations made on 30
|
||||||
|
patients during surgical procedures on the head; they concluded that the
|
||||||
|
pains result primarily from inflammation, traction, displacement, and
|
||||||
|
distention of pain-sensitive structures, of which cranial vascular
|
||||||
|
structures are most frequent and widely distributed. Unfortunately, they
|
||||||
|
failed to mention until Wolff’s later work (10) that the actual pain
|
||||||
|
sensitive nerve endings are located in the aura mater, the arachnoid,
|
||||||
|
and the pie mater supporting the vascular structures. These factors cast
|
||||||
|
new light on the observations of Sutherland, especially since the aura
|
||||||
|
mater on the internal surface of the cranium is continuous with the
|
||||||
|
periosteum of the head.
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
No studies have been published to support the possibility of a strain
|
||||||
|
gauge type of reporting across the sutures, but the observation of the
|
||||||
|
sensory distribution to the internal and external surfaces of the
|
||||||
|
cranial vault would appear to make such an arrangement feasible. (4, 6)
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
The information available indicates that essentially the same types of
|
||||||
|
stimuli elicit painful reactions whether they arise inside or outside
|
||||||
|
the cranium. Psychologic modification, through mechanisms mentioned, is
|
||||||
|
most likely to affect those areas of reception most easily observed
|
||||||
|
through the special senses, such as sight and hearing.
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
Since involvement of the special senses introduces the possibility of
|
||||||
|
modification of afferent stimuli by the limbic system, Aird (21) stated:
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
Neurophysiologic evidence has suggested that this portion of the nervous
|
||||||
|
system is concerned with smell, taste, and other special senses, the
|
||||||
|
gastrointestinal system and other autonomic functions, and behavioral
|
||||||
|
reactions.
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
This brings pain into the area of psychoneurophysiologic processes of
|
||||||
|
reception, conduction, and perception to the stage of apperception or
|
||||||
|
total integration of the process of interpreting pain, and a possible
|
||||||
|
introduction of the subject of pain threshold (which is beyond the scope
|
||||||
|
of this paper).
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
It should be mentioned that there are definite interrelations between
|
||||||
|
the cortifugal system, mentioned earlier, and the limbic system, which
|
||||||
|
as yet are not clearly defined.
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<h2>Osteopathic Approach</h2>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
The foregoing discussion has described the circuitry necessary for the
|
||||||
|
identification and response to head pain. Feedback mechanisms necessary
|
||||||
|
to establish a cybernetic model have been outlined. On the basis of this
|
||||||
|
description it should not be difficult for the knowledgeable physician
|
||||||
|
to apply therapeutic measures. The knowledgeable osteopathic physician
|
||||||
|
possesses the palpatory skills to intervene directly in the
|
||||||
|
pathophysiologic process. Pain in the head, through the mechanism
|
||||||
|
described, produces palpable reflex area or tissue response, in the
|
||||||
|
superficial tissues such as the skin, the muscle, and deep connective
|
||||||
|
tissues. By discriminatory palpation he can determine the relative
|
||||||
|
duration or stage of chronicity of the condition and apply therapy.
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
Hoover (22-25) has written extensively and descriptively in regard to
|
||||||
|
application of technique to the various ages or stages of the process
|
||||||
|
involved in stress. He described a functional technique as opposed to
|
||||||
|
structural technique. By this technique the physician may affect the
|
||||||
|
established cybernetic system by entering the system as an aid in
|
||||||
|
diminishing the stress system established. In this mode of treatment
|
||||||
|
enough force is exerted, through the various planes of motion of
|
||||||
|
accommodation of the tissue or articulation, to bring the structures
|
||||||
|
involved to a point of what Hoover called “dynamic reciprocal balance.”
|
||||||
|
(25) In this way the physician establishes a servocybernetic system
|
||||||
|
which allows the tissue or articulation to establish a new state of
|
||||||
|
equilibrium within the limits of its ability to accommodate
|
||||||
|
physiologically. Hoover (24) stated:
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
Treatment by functional technic depends upon and is directed by the
|
||||||
|
reaction of a part of the patient to demands for activity made upon that
|
||||||
|
part.
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
By the recruitment of the demonstrable changes in tissue and its
|
||||||
|
activity, it is possible for the palpating hand to discern the
|
||||||
|
cybernetic mechanisms involved in the origin of head pain.
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>Harvey (25) stated:</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
A basic cybernetic mechanism is “feedback.” This is the process of
|
||||||
|
transferring energy or information from the output of a circuit to its
|
||||||
|
input and is a generally accepted control mechanism in all types of
|
||||||
|
self-regulating systems that use closed-loop, negative feedback
|
||||||
|
networks.
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
I have not found active and passive joint motion palpation to be
|
||||||
|
sufficiently discriminating in the analysis of such cybernetic
|
||||||
|
mechanisms to allow me to enter into a servocybernetic relation with the
|
||||||
|
patient on a therapeutic level. After observation of several highly
|
||||||
|
skilled osteopathic physicians in their approaches to palpation and
|
||||||
|
treatment of a wide variety of pathophysiologic processes and syndromes,
|
||||||
|
a method of diagnostic palpation became apparent. As the newly found
|
||||||
|
method was used, its applications and uses began to reveal themselves,
|
||||||
|
and this continues. Articles (27, 28) have been published by two of the
|
||||||
|
highly skilled physicians whose work has been observed. The use of the
|
||||||
|
principles presented by these physicians allows one to determine the
|
||||||
|
area or areas of stress and the character of the assault involved and to
|
||||||
|
counteract their deleterious effects.
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
The previous discussion of mechanisms in the central nervous system
|
||||||
|
covered what is presently known of the circuitry involved in feedback
|
||||||
|
mechanisms of the human body in relation to head pain. After the
|
||||||
|
physician has determined the areas of stress and the character of the
|
||||||
|
assault, he bases his treatment on the counterbalancing of the stress
|
||||||
|
forces, that is, changing the characteristics of the input and feedback,
|
||||||
|
so as to create a servocybernetic system. Establishing controlled input
|
||||||
|
alters the level of control influence exerted by the negative feedback
|
||||||
|
network.
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
The completion of treatment for any particular time is signaled by
|
||||||
|
improved physiologic reaction of the tissues involved, that is, an
|
||||||
|
increase in activity in hyperactive tissue, and a synchronous motion
|
||||||
|
(internal or external rotation; flexion or extension) with the basal
|
||||||
|
respiratory cycle or primary respiratory mechanism, as defined by
|
||||||
|
Magoun. (13) This allows the patient to establish a new level of
|
||||||
|
homeostasis compatible with his or her ability at any particular time to
|
||||||
|
recover from the original assault.
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
Stress patterns of considerable duration complicated by numerous
|
||||||
|
overlying injuries have responded in a surprising manner to treatment
|
||||||
|
applied in this manner.
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<h2>Case Report</h2>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
A 44-year-old white woman was admitted to the hospital with a chief
|
||||||
|
complaint of severe headaches, which occurred in the left occipital area
|
||||||
|
and radiated to the left temporal bone and vertex of the skull. The
|
||||||
|
headaches were associated with nausea and vomiting. Their onset was
|
||||||
|
associated with an automobile accident that had occurred six years
|
||||||
|
before this admission. Following the accident hemianesthesia involving
|
||||||
|
the left arm, leg, and side of the face developed. At that time the
|
||||||
|
patient had been hospitalized for 22 days. Her condition improved with
|
||||||
|
bed rest, but she had not been freed of pain, and paresthesia of the
|
||||||
|
left arm, leg, and side of the face remained. She was unable to turn
|
||||||
|
from a supine position to a left lateral recumbent position. It was not
|
||||||
|
clear whether this was due to weakness, loss of proprioception, or loss
|
||||||
|
of motor control. The patient had spent a total of 66 days in the
|
||||||
|
hospital over the next two years for paresthesia of the left side of the
|
||||||
|
body and headache (hemicephalgia on the left). The patient said that she
|
||||||
|
had not been unconscious at the time of or after the accident. There was
|
||||||
|
no familial history of neurologic disease or headache.
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
During the six years after the accident the patient had received nearly
|
||||||
|
every know type of therapy for cephalgia and migraine, including
|
||||||
|
administration of narcotics and adrenocorticoids and trigger-point
|
||||||
|
injections.
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
The patient’s surgical history included appendectomy, cesarean section,
|
||||||
|
and total hysterectomy. Neurological examination did not demonstrate any
|
||||||
|
abnormality, and the cellular structure of the cerebrospinal fluid and
|
||||||
|
the chemical contents were not remarkable. The pressure of cerebrospinal
|
||||||
|
fluid was in the middle of the normal range, and the Queckenstedt test
|
||||||
|
did not show abnormality. Laboratory tests, including complete blood
|
||||||
|
count, measurement of fasting blood sugar an creatinine, urinalysis, and
|
||||||
|
the VDRL test for syphilis at the time of admission and discharge showed
|
||||||
|
no abnormality. X-ray examination at the time of admission showed what
|
||||||
|
appeared to be an articulation between the posterior tubercle of the
|
||||||
|
posterior arch of the atlas an the occiput, and a decrease of the normal
|
||||||
|
lordotic curvature of the cervical spine, that is, a reversal the normal
|
||||||
|
cervical curve.
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
After a week’s hospitalization, I was called in consultation, and my
|
||||||
|
examination elicited the following additional findings: decrease in
|
||||||
|
backward bending the cervical spine, decrease in mobility in all
|
||||||
|
direction through the occipito-atlanto-axial articulation flattening of
|
||||||
|
the cervical lordotic curvature, bilateral compression through the
|
||||||
|
sacroiliac articulation sphenobasilar compression of the cranial
|
||||||
|
mechanic, with vertical strain (spheroid high), side bending rotation,
|
||||||
|
with convexity to the left, and slight torsion on the right. The entire
|
||||||
|
paravertebral mass from occiput to sacrum was under extreme tension.
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
The findings were compatible with the following diagnosis: Spinal
|
||||||
|
ligamentous strain and sprat (spheroid high), left side bending
|
||||||
|
rotation, and right torsion of the cranial mechanism. Treatment was
|
||||||
|
directed at relieving the stress on the meninges an vascular channel
|
||||||
|
throughout the cranial sacral mechanism to reduce edema, muscle tensions
|
||||||
|
and spasm and to reduce the level of afferent CNS input to establish a
|
||||||
|
more physiologic level of function.
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
Both cranial treatment and fascial release technique were directed to
|
||||||
|
the sphenobasilar vertical strain suboccipital area, and sacrum because
|
||||||
|
of the hyperirritability of these tissues and their inability to react.
|
||||||
|
The patient was not treated again for 48 hours because of other demands
|
||||||
|
on the physician’s time. At the second treatment the tissue reaction was
|
||||||
|
much improved, an the patient could withstand deeper treatment to the
|
||||||
|
involved area without excessive pain or tissue reaction After this
|
||||||
|
treatment the patient’s cervical spine was reexamined
|
||||||
|
roentgenologically, and the films showed that the posterior arch of the
|
||||||
|
atlas was no longer in contact with the occiput and that there was
|
||||||
|
improvement in the cervical anteroposterior curvature. The patient’s
|
||||||
|
pain decreased over the next 24 hours, and she was released from the
|
||||||
|
hospital to be seen at my office within 48 hours. The patient was seen
|
||||||
|
twice a week for the next three weeks. At the end of this time the
|
||||||
|
patient had been free of pain for approximately 10 days, end that length
|
||||||
|
of time between treatments was extended to, a week.
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
As the patient’s tissue response improved, the interval between
|
||||||
|
treatments was lenghtened correspondingly, without recurrence of severe
|
||||||
|
headaches until her daughter, who had a congenital cardiac valvular
|
||||||
|
lesion, told her parents she was pregnant. Headaches recurred, but
|
||||||
|
responded well to treatment. They recurred frequently but were
|
||||||
|
terminated on the arrival for a normal healthy granddaughter. At the
|
||||||
|
time of this report the patient still was seen on occasion for
|
||||||
|
maintenance and preventive treatment
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<h2>Treatment Discussion</h2>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
The treatment of this patient was carried out according to the
|
||||||
|
principles already described.
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
After routine physical examination a thorough palpatory examination was
|
||||||
|
carried out. Palpation began at the sacral area. With the patient in the
|
||||||
|
supine position, her sacrum was cupped in the examiner’s left hand, with
|
||||||
|
the first finger extending over the right sacroiliac articulation to
|
||||||
|
make contact with the right iliolumbar ligament (lower portion). The
|
||||||
|
little finger was placed at the left sacroiliac articulation and the
|
||||||
|
second and third fingertips placed just lateral to the tip of the
|
||||||
|
spinous process of the fifth lumbar segment of the spine. Light
|
||||||
|
palpation demonstrated relatively little activity of the tissues. When
|
||||||
|
palpation was deepened it demonstrated a rigidity of the ligamentous
|
||||||
|
structures supporting the sacroiliac articulations both anteriorly and
|
||||||
|
posteriorly and extreme tension through the iliolumbar ligaments
|
||||||
|
bilaterally.
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
The examining procedure is as follows: Light palpation is carried out
|
||||||
|
with light contact with skin. The depth of palpation is increased by
|
||||||
|
establishing a fulcrum and gently increasing the tension or pressure
|
||||||
|
distal to the fulcrum so that the palpating hand may remain relaxed and
|
||||||
|
be used as a palpating instrument rather than attempting to constantly
|
||||||
|
monitor its own proprioceptive phenomena. The pressure is gently
|
||||||
|
increased until reaction is stimulated in the layer of tissue the
|
||||||
|
examiner wishes to palpate. The resulting tissue reaction will
|
||||||
|
demonstrate to the examiner the resultant force (the summation of the
|
||||||
|
various forces exerted at the time of injury) that elicited the
|
||||||
|
protective reaction of the tissues under examination.
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
The transition from examination to treatment is a matter of following
|
||||||
|
the resultant force to the point of dynamic reciprocal balance and
|
||||||
|
maintaining this balance until the tissues complete their accommodation.
|
||||||
|
This accommodation is accompanied with increased tissue relaxation, a
|
||||||
|
feeling of increased tissue vitality, and a longitudinal to-and-fro
|
||||||
|
motion corresponding to the primary respiratory cycle.
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
If continued force is applied to the injured tissues after the immediate
|
||||||
|
response, the ensuing fatigue may result in an adverse or excessive
|
||||||
|
reaction of the treated tissues, which appears to create a type of
|
||||||
|
kinesthetic shock (a dissociation of the proprioceptive motor feedback
|
||||||
|
mechanism resulting in a loss of coordinated, previously programmed or
|
||||||
|
learned motion patterns with an increase in sensitiveness and possibly
|
||||||
|
pain in the particular ligaments and connective tissues. This causes
|
||||||
|
gait or motion aberration that is not typical of the individual. This
|
||||||
|
usually occurs in a single member or limb or segment of such member or
|
||||||
|
limb.
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
Each area found to be involved in the total stress mechanism is treated
|
||||||
|
in a similar manner, the only differences being in the method of
|
||||||
|
application of the testing or treating forces to accommodate the
|
||||||
|
peculiarities of anatomic structure, of the region under study and
|
||||||
|
treatment. In the cervical area palpation is performed along the lateral
|
||||||
|
margin of the paravertebral mass that is located over the articular
|
||||||
|
pillar. This permits palpation of the paravertebral mass, the
|
||||||
|
periarticular ligaments, and the reaction of the musculature attached to
|
||||||
|
the anterior aspects of these vertebral segments. In palpation of the
|
||||||
|
cranium, the index finger approximates the lateral aspect of the great
|
||||||
|
wing of the spheroid; the second finger is placed posterior to the
|
||||||
|
sphenosquamal articulation; the third finger is placed at the
|
||||||
|
parietotemporo-occipital articulation (asterion), and the little finger
|
||||||
|
is placed on the occiput.
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
This contact is often altered to suit unusual injury patterns, but in
|
||||||
|
any case the application of treatment follows the same basic principles.
|
||||||
|
The fulcrum is usually established by crossing the thumbs. The flexor
|
||||||
|
pollicis longus muscle of each thumb is utilized to maintain good
|
||||||
|
contact and allow the hands to remain as relaxed as possible. Thus the
|
||||||
|
hands may be free to move within the demonstrated force mechanisms and
|
||||||
|
establish the dynamic reciprocal tension necessary to allow the tissues
|
||||||
|
to overcome injury force mechanisms. The mastering of this type of
|
||||||
|
therapeutic and diagnostic approach is not difficult but requires
|
||||||
|
studious concentration to avoid hindering the activity of the tissues,
|
||||||
|
so that they may reveal the stress patterns to which they have been
|
||||||
|
subjected. The physician must remain relaxed and observant so he may
|
||||||
|
participate in assisting the tissues to reach and maintain the point of
|
||||||
|
dynamic reciprocal tension.
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<h2>Comments</h2>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
The studies reviewed here demonstrated the possibility that pain may
|
||||||
|
arise from the neck and possibly lower levels. In many cases the
|
||||||
|
involvement of arthrodial articulations may require more stringent or
|
||||||
|
forceful modes of treatment than those described here. Hoover (22)
|
||||||
|
described the use of high velocity manipulation to accomplish a
|
||||||
|
“popping” of the joint so that the involved levels of discrimination
|
||||||
|
must rearrange their synaptic organization in response to shock produced
|
||||||
|
by the forceful articulatory motion. By this method a new level or at
|
||||||
|
least a different degree of function is established.
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
The little understood mechanisms of the central nervous system are
|
||||||
|
slowly revealing their intricacies through the devoted efforts of many
|
||||||
|
dedicated and curious researchers. These workers can divulge their
|
||||||
|
observations, but it becomes the responsibility of the physician to be
|
||||||
|
aware of their discoveries, analyze the information, and apply it
|
||||||
|
discreetly in clinical situations. The information presented here may
|
||||||
|
give the osteopathic physician a slightly different view and increase
|
||||||
|
the effectiveness of his application of osteopathic manipulative therapy
|
||||||
|
to his patient.
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
The neuroanatomy and physiology involved in head pain have been
|
||||||
|
discussed. Various types of input that may be characterized as pain have
|
||||||
|
been mentioned, and mechanisms involved in the apperception as pain have
|
||||||
|
been demonstrated. An attempt has been made to correlate the wide
|
||||||
|
varieties of osteopathic manipulative approach to the particular
|
||||||
|
situation in which pain is expressed in the head. A case history
|
||||||
|
exemplifying my approach to such problems has been presented and the
|
||||||
|
principles of treatment described.
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<h2>References</h2>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
Dorland’s illustrated medical dictionary. Ed. 24. W.B. Saunders Co.,
|
||||||
|
Philadelphia, 1965
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
1. Emery, H.G., and Brewster, K.G., editors: New century dictionary of
|
||||||
|
the English language. Appleton-Century-Crofts, Inc., New York, 1959
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
2. Boshes, B., and Arieff, A.J.: Clinical experience in the neurologic
|
||||||
|
substance of pain. Med Clin North Am 52:111-21, Jan 68
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>3. Smith, B.H.: Anatomy of facial pain. Headache 9:7-13, Apr 69</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
4. Larsell, O.: The nervous system. In Human anatomy. By H. Morris. Ed.
|
||||||
|
11, edited by J.P. Schaeffer. Blakiston Co., New York, 1953
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
5. Kimmel, D.L.: The nerves of the cranial aura mater and their
|
||||||
|
significance in aural headache and referred pain. Chicago Med Sch Quart
|
||||||
|
22:16-26, Fall 61
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>6. Gooddy, W.: On the nature of pain. Brain 80:11831, 1957</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
7. Netter, F.H.: Nervous system. Vol. 1. Ciba collection of medical
|
||||||
|
illustrations. Ciba Pharmaceutical Co., Summit, N.J., 1953
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
8. Finneson, B.E.: Diagnosis and management of pain syndromes. Ed. 2.
|
||||||
|
W.B. Saunders Co., Philadelphia, 1969
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
9. Wolff, H.G.: Headache and other headpain. Ed.2. Oxford University
|
||||||
|
Press, New York, 1963
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
10. Crosby, E.C., Humphrey, T., and Lauer, E.W.: Correlative anatomy of
|
||||||
|
the nervous system. Macmillan Co., New York, 1962
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
11. Korr, I.M., and Buzzell, K.A.: Personal communication to the author
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
12. Magoun, H.I.: Osteopathy in the cranial field. Ed.2. Journal
|
||||||
|
Printing Co., Kirksville, Mo., 1966
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
13. Steriade, M.: The cerebello-thalamo-cortical pathway. Ascending
|
||||||
|
(specific and unspecific) and corticofugal controls. Int J Neurol
|
||||||
|
7:177-200,1970
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
14. Gerstenbrand, F., et al.: Cerebellar symptoms as sequelae of
|
||||||
|
traumatic lesions of upper brain stem and cerebellum. Int J Neurol
|
||||||
|
7:271-82, 1970
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
15. Snider, R.S., Mitra, J., and Sudilovsky, A.: Cerebellar effects on
|
||||||
|
the cerebrum. A microelectrical analysis of somatosensory cortex. Int J
|
||||||
|
Neurol 7:141-51, 1970
|
||||||
|
</p>
|
||||||
|
|
||||||
|
<p>
|
||||||
|
16. Ito, M.: Neurophysiological aspects of the cerebellar motor control
|
||||||
|
system. Int J Neurol 7:162-76, 1970
|
||||||
|
</p>
|
||||||
|
</Article>
|
||||||
|
);
|
||||||
|
};
|
||||||
|
|
||||||
|
export default ArticleOsteopathicHeadPain;
|
||||||
|
|
@ -0,0 +1,465 @@
|
||||||
|
import Article from "@/components/Article";
|
||||||
|
|
||||||
|
const ArticleTheTraumaOfBirth = () => {
|
||||||
|
return (
|
||||||
|
<Article title="The Trauma of Birth" author="Viola M Fryman, D.O.">
|
||||||
|
<p>
|
||||||
|
The newborn skull is designed to provide maximum accommodation to the
|
||||||
|
forces of labor and minimum trauma to the developing brain. However,
|
||||||
|
injury to the head during birth is more common than many people realize.
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
In a study of 1,250 newborns I conducted a few years ago, it could be
|
||||||
|
demonstrated that severe visible trauma was inflicted on the head–either
|
||||||
|
before or during labor–in 10 percent of the infants. Membranous
|
||||||
|
articular strains, which could be detected by the physician proficient
|
||||||
|
in the diagnostic techniques of osteopathy in the cranial field, were
|
||||||
|
present in another 78 percent. Thus, nearly nine of every 10 infants in
|
||||||
|
the study had been affected. (1)
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
How important are these membranous articular strains to the physician? I
|
||||||
|
have found that common problems of the neonatal period–such as
|
||||||
|
difficulty in sucking, vomiting, nervous tension, and irregular
|
||||||
|
respiration–are frequently overcome just as soon as these strains are
|
||||||
|
corrected. Similar strains are encountered in school children who have
|
||||||
|
learning and behavior problems.
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
In a study of 100 children between the ages of five and 14 who were
|
||||||
|
having learning or behavioral difficulties, it was found that 79 had
|
||||||
|
been born after a long or difficult labor and had one or more of the
|
||||||
|
common symptoms of the neonatal period. Also, it is my impression that
|
||||||
|
many cases of childhood allergy can be traced to musculoskeletal strains
|
||||||
|
originating at the time of birth. (2) And vertebral scoliosis occurring
|
||||||
|
in childhood and adolescence is, in many instances, the consequence of
|
||||||
|
cranial scoliosis originating during birth. (3 ) Thus, recognition and
|
||||||
|
treatment of dysfunction of the craniosacral mechanism in the immediate
|
||||||
|
postnatal period represent one of the most, if not the most, important
|
||||||
|
phases of preventive medicine in the practice of osteopathic medicine.
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
To gain a clearer understanding of the origin and nature of these
|
||||||
|
membranous articular strains, it will be helpful to review the anatomic
|
||||||
|
features of the newborn skull and to note how they are affected by the
|
||||||
|
forces of labor.
|
||||||
|
</p>
|
||||||
|
<h2>Labor</h2>
|
||||||
|
<p>
|
||||||
|
As was mentioned above, the newborn skull is designed to provide maximum
|
||||||
|
accommodation to the forces of labor, minimum trauma to the infant’s
|
||||||
|
brain, and complete restoration to free mobility of all its parts once
|
||||||
|
the stress of labor is over.
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
Just before birth, the infant in utero is positioned for delivery by
|
||||||
|
presenting the smallest diameter of his head to the largest diameter of
|
||||||
|
the mother’s pelvis; this is the position of full fetal flexion. As
|
||||||
|
contractions continue, the infant is conducted by the inclination of the
|
||||||
|
maternal pelvic floor into the midline for delivery around the pubic
|
||||||
|
symphysis by a process of extension of the head.
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
This descent in full flexion, progressing to birth by extension of the
|
||||||
|
head, is of profound significance to the initiation of pulmonary
|
||||||
|
respiration. The respiratory activity associated with the vigorous vocal
|
||||||
|
activity of the newborn serves to expand the cranial mechanism and
|
||||||
|
restore the bones and membranes to their anatomic relationships
|
||||||
|
(permitting their free physiologic motion). Healthy sequential
|
||||||
|
development of the central nervous system within can then continue.
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
These ideal circumstances, however, seldom occur in our modern,
|
||||||
|
civilized world. Owing to such factors as poor nutrition of the mother,
|
||||||
|
structural inadequacies before and during pregnancy, drug abuse,
|
||||||
|
inadequate preparations for labor, and, sometimes, the mechanical or
|
||||||
|
artificial acceleration of labor by an impatient obstetrician, only a
|
||||||
|
relatively few infants are born without undue skein or cranial trauma.
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
Instead, structural inadequacies of the maternal pelvis may cause the
|
||||||
|
fetus to assume a degree of extension (and lateral cervical flexion)
|
||||||
|
greater than the ideal; the result will be a presentation of a portion
|
||||||
|
of the head greater than the minimum occipitobregmatic diameter. This
|
||||||
|
can range from a moderate extension to posterior occiput, to transverse
|
||||||
|
arrest, to brow presentation, or even to a complete extension in which
|
||||||
|
the face itself presents-a position in which vaginal delivery is
|
||||||
|
impossible. In such a circumstance, cesarean section will be necessary
|
||||||
|
if the baby is to survive.
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
But the compressive forces will have already traumatized the head as the
|
||||||
|
uterine contractions force it progressively towards the birth canal.
|
||||||
|
Prominence of the base of an anterior maternal sacrum may obstruct
|
||||||
|
descent of the head on one side, and such asynclitism can distort the
|
||||||
|
cranial mechanism. The presence of large twins, both striving to present
|
||||||
|
the head at the same time, may cause cranial stress to one or both even
|
||||||
|
before active labor begins. These are only a few of the mechanical
|
||||||
|
insults that may occur before birth.
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
So much for the passage of the infant into the birth canal. Now let us
|
||||||
|
consider the structure of the infant skull itself at the time of birth.
|
||||||
|
</p>
|
||||||
|
<h2>Anatomy</h2>
|
||||||
|
<p>
|
||||||
|
The vault of the newborn skull is a membranous structure. Plates of bone
|
||||||
|
are enveloped in two layers of membrane, which are in apposition at the
|
||||||
|
anterior and posterior fontanelles and sometimes at the pterion and
|
||||||
|
asterion. These plates of membranous bone are designed to telescope into
|
||||||
|
each other as the skull passes through the birth canal-the parietals
|
||||||
|
overriding the frontal at the coronal suture, and the occiput at the
|
||||||
|
lambdoid suture. The degree of this overriding is controlled and limited
|
||||||
|
by the investing aural membranes.
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
The bones of the base develop from the cartilaginous chondrocranium. At
|
||||||
|
birth, development is still incomplete.(4) The occipital bone is in four
|
||||||
|
parts, united by intraosseous articular cartilage. The spheroid is in
|
||||||
|
three parts, the temporal in two, the maxilla in two, the frontal
|
||||||
|
frequently in two.
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
The cranial suture is designed for a very small but vital degree of
|
||||||
|
motion.(5) How much greater is the potential motion of the bones of the
|
||||||
|
developing newborn skull! At this time each part of each of these bones
|
||||||
|
functions virtually as a separate bone, moving in relation to its other
|
||||||
|
parts.
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
Let us consider the occiput. It is most commonly the presenting part,
|
||||||
|
and therefore the part that may take the brunt of the trauma of labor.
|
||||||
|
The four developmental parts surround the foremen magnum. The base
|
||||||
|
articulates anteriorly with the base of the spheroid. Posterolaterally,
|
||||||
|
it articulates with the lateral masses. The hypoglossal nerve, which
|
||||||
|
innervates the muscles of the tongue, passes out of the skull between
|
||||||
|
the base and the lateral mass, through the intraosseous cartilage in the
|
||||||
|
space that will become the condylar canal. The occipital condyle, which
|
||||||
|
articulates with the atlas, spans the intraosseous cartilage; its
|
||||||
|
anteromedial third is found on the base, the posterolateral two-thirds
|
||||||
|
on the lateral mass.
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
Immediately anterolateral to this condylar area is the jugular foremen,
|
||||||
|
a space between the condylar part of the occiput and the petrous portion
|
||||||
|
of the temporal. This foremen gives passage not only to the jugular vein
|
||||||
|
but also to cranial nerves IX, X, and XI (glossopharyngeus, vague, and
|
||||||
|
accessorius, respectively). The vagus nerve provides innervation to the
|
||||||
|
gastrointestinal and cardiorespiratory systems.
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
The supraocciput formed in cartilage fuses with the membranous
|
||||||
|
interparietal bone to form the occipital squama. Compression transmitted
|
||||||
|
through the squama to the condylar part on one side may disturb the
|
||||||
|
function of the vagus and/or hypoglossal nerve, causing vomiting,
|
||||||
|
irregular respiration, and difficulty in sucking. If this compression is
|
||||||
|
transmitted further to the base, the relationship of the base of the
|
||||||
|
occiput to the base of the spheroid may be distorted, causing a lateral
|
||||||
|
strain of the sphenobasilar articulation and a parallelogram deformity
|
||||||
|
of the cranium(5) (Figure 1).
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
Figure 1. Lateral strain of the sphenobasilar articulation. Viewed from
|
||||||
|
above, the sphenobasilar symphysis has been strained (displaced), with
|
||||||
|
the basisphenoid moving to one side and the basiocciput to the other.
|
||||||
|
Both bones side-bend about parallel vertical axes in the same direction.
|
||||||
|
The lesion is named from the position of the basisphenoid: lateral
|
||||||
|
strain with the spheroid to the right, etc. (From Magoun, H.{" "}
|
||||||
|
<em>Osteopathy in the Cranial Field.)</em>
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
Bilateral condylar compression may cause a buckling type of strain of
|
||||||
|
the cranial base, producing a vertical strain between the occiput and
|
||||||
|
the spheroid at the sphenobasilar articulation. This may be associated
|
||||||
|
not only with vagal dysfunction but also with symptoms of tension,
|
||||||
|
spasticity, opisthotonic spasms, sleeplessness, and excessive crying due
|
||||||
|
to the irritation of the pyramidal tracts on the anterior and lateral
|
||||||
|
aspects of the brain stem in the foremen magnum. This should be
|
||||||
|
considered as a precursor of the spastic type of cerebral palsy.
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
The spheroid bone is in three parts at birth; the central body bears the
|
||||||
|
lesser wings, with the greater wings (from which the pterygoid process
|
||||||
|
subtends) on either side. The greater wing-pterygoid unit articulates
|
||||||
|
with the body by an intraosseous cartilage. This is situated immediately
|
||||||
|
beneath the cavernous sinus, through which pass cranial nerves III, IV,
|
||||||
|
and VI, innervating the extraocular muscles, and the ophthalmic division
|
||||||
|
of V, which is sensory to the orbit, upper face and scalp. The body of
|
||||||
|
the spheroid articulates with the base of the occiput posteriorly and is
|
||||||
|
therefore distorted by the lateral or vertical strains resulting from
|
||||||
|
condylar compression. Anteriorly the body carries the lesser wings,
|
||||||
|
which enter into the formation of the orbit. The orbit is approximately
|
||||||
|
pyramidal in shape; the apex is at the optic foremen-that is, the root
|
||||||
|
of the lesser wing at the body. Its anatomic integrity is dependent on
|
||||||
|
the relationship of the greater wing to the lesser wing, which is in
|
||||||
|
fact the relationship of the greater wingpterygoid unit to the body.
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
In the event of a lateral strain at the base due to unilateral condylar
|
||||||
|
compression of the occiput, the orbit will be distorted by rotation of
|
||||||
|
the base of the spheroid carrying the lesser wing anterior on one side
|
||||||
|
and posterior on the other. In the parallelogram head due to lateral
|
||||||
|
compression, the greater wing is compressed medially and carried forward
|
||||||
|
on one side and posterior on the other. In either event, lateral muscle
|
||||||
|
imbalance of the eyes is commonly found in varying degrees ranging from
|
||||||
|
mild esophoria or exophoria to severe strabismus.
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
The temporal bone is in two parts at the time of birth -the petromastoid
|
||||||
|
portion, developed in cartilage that projects obliquely between the
|
||||||
|
occiput and the greater wing of the spheroid to articulate at its apex
|
||||||
|
with the body of the spheroid, and the squamous portion, developed in
|
||||||
|
membrane the forms the greater part of the lower lateral wall of the
|
||||||
|
skull. The tympanic portion is not yet a bony canal but resembles a
|
||||||
|
horseshoe adherent to the inferior posterior aspect of the squama. These
|
||||||
|
two parts, the squamous and tympanic, unite just before birth. The
|
||||||
|
petromastoid portion contains the auditory and the vestibular apparatus.
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
The auditory apparatus consists of the bony eustachian tube emerging
|
||||||
|
between the petrous and squamous portions, from which the cartilaginous
|
||||||
|
tube extends to the fossa of Rosenmuller. The eustachian tube is
|
||||||
|
susceptible to distortion, which may impair hearing if lateral stress
|
||||||
|
compresses the squamous portion. Laterally the eustachian tube opens
|
||||||
|
into the middle ear, which, by the ossicular mechanism, transmits the
|
||||||
|
auditory vibrations received from the tympanic membrane to the internal
|
||||||
|
ear. The vestibular apparatus includes the semicircular canals,
|
||||||
|
precisely related to each other and geometrically balanced with those of
|
||||||
|
the opposite side. Distortion of the axis of the petrous portion may
|
||||||
|
disturb this delicate mechanism of equilibrium.
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
The maxilla develops in two parts-the premaxilla, which will give origin
|
||||||
|
to the incisor teeth, and the body, which carries the canine and all the
|
||||||
|
other upper teeth. Angulation between these two developmental parts of
|
||||||
|
the maxilla gives rise to malalignment and malocclusion in later years.
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
Thus far our consideration has been directed to certain structural
|
||||||
|
changes that may sometimes be visible and are always palpable following
|
||||||
|
various difficulties of labor. Radiologic techniques have been developed
|
||||||
|
to substantiate many of these palpatory observations and confirm their
|
||||||
|
persistence in childhood problems.(7)
|
||||||
|
</p>
|
||||||
|
<h2>Examination</h2>
|
||||||
|
<p>
|
||||||
|
The craniosacral mechanism of the newborn infant should be examined
|
||||||
|
within the first few days of life. There is probably no field of
|
||||||
|
osteopathic diagnosis where the injuction “if at first you don’t
|
||||||
|
succeed, try, try again” applies more than in the examination of the
|
||||||
|
newborn cranium. The mobility of the cranial mechanism is much greater
|
||||||
|
at this age than it is in the adult skull, although the range of motion
|
||||||
|
is of course much smaller. Dr. R. McFarlane Tilley used to speak of the
|
||||||
|
amplification mechanism within the human hand and brain, which permits
|
||||||
|
the perception of motion in the range of 0.0001 inch. It is this
|
||||||
|
perceptive mechanism that must be developed in order to make a
|
||||||
|
meaningful examination and to complete an adequate treatment program for
|
||||||
|
these infants.
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
Furthermore, one must learn to palpate motion within motion, for these
|
||||||
|
infants rarely lie absolutely still for an examination. One should first
|
||||||
|
consider the contours and articulations by passing the hands gently over
|
||||||
|
the surface. Look for asymmetry, bossing of the frontals or parietals,
|
||||||
|
grooves above the eyebrows, overlapping of one bone on the other at the
|
||||||
|
coronal or lambdoid suture, prominence and compression of the sagittal
|
||||||
|
or metopic suture, and depression of the pterion. Let the occiput rest
|
||||||
|
in the palm of the hand, and note unusual prominence of the
|
||||||
|
interparietal occiput or hard flattening of the supraocciput. Study the
|
||||||
|
relative size and position of the eyes and nostrils and the inclination
|
||||||
|
of the mouth. Examination for inherent motility will be facilitated if
|
||||||
|
the baby is nursing or sleeping. Here is a check list that may be
|
||||||
|
helpful:
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
1. Place the hands gently on the vault, with the index fingers on the
|
||||||
|
greater wing of the spheroid and the little fingers on the lateral
|
||||||
|
angles of the occiput. The other fingers lie comfortably between them.
|
||||||
|
Is your first palpatory impression that your two hands are symmetrical?
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
2. Are the index finger and the little finger of one hand cephalad or
|
||||||
|
superior to those of the other, as in a torsion strain. If so, the
|
||||||
|
spheroid and occiput will have rotated around an anteroposterior axis in
|
||||||
|
opposite directions, elevating the greater wing of the spheroid on one
|
||||||
|
side and the lateral angle of the occiput on the other (Figure 2).
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
Figure 2. Torsion strain. Torsion of the sphenobasilar symphysis occurs
|
||||||
|
about an axis running from the nasion (anterosuperior) to opisthion
|
||||||
|
(posteroinferior) at approximately right angles to the plane of the
|
||||||
|
sphenobasilar symphysis. In bottom view, a left torsion lesion is
|
||||||
|
diagrammed, with the greater wing and basisphenoid high on the left side
|
||||||
|
and the basiocciput and squama lower on that same side. (From Magoun, H.{" "}
|
||||||
|
<em>Osteopathy in the Cranial Field, </em>Second Edition. Kirksville,
|
||||||
|
Mo.: Journal Printing Company, 1966).
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
3. Are the index finger and little finger of one hand caudad or inferior
|
||||||
|
to those of the other hand, with a sense of fullness in the palm of the
|
||||||
|
inferior hand, as in a side-bending rotation strain. In this instance,
|
||||||
|
the spheroid and occiput have side-bent in opposite directions around
|
||||||
|
parallel vertical axes and rotated inferiorly into the convexity thus
|
||||||
|
created.
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
4. Is there a sensation that the index fingers on the greater wings are
|
||||||
|
directed towards one side, while the little fingers on the occiput are
|
||||||
|
carried to the other side? This is lateral strain (Figure 1). Owing to a
|
||||||
|
lateral force, the spheroid and the occiput have rotated in the same
|
||||||
|
direction around parallel vertical axes, causing a shearing strain at
|
||||||
|
the symphysis between them.
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
5. Are the two index fingers on the greater wings forward and downward
|
||||||
|
(caudad) as compared with the little fingers on the lateral angles?
|
||||||
|
Conversely, the index fingers may be superior (cephalad). These are
|
||||||
|
vertical strains (Figure 3 ). Both superior and inferior strains are
|
||||||
|
shown in the diagrams (superior on the left). The spheroid and the
|
||||||
|
occiput have rotated in the same direction around parallel transverse
|
||||||
|
axes, producing a vertical shearing strain at the sphenobasilar
|
||||||
|
articulation.
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
Figure 3. Vertical strains of the sphenobasilar symphysis. Viewed from
|
||||||
|
the side, the sphenobasilar symphysis has been strained or displaced
|
||||||
|
before ossification, with the basisphenoid moving cephalad (flexion) and
|
||||||
|
the basiocciput moving caudad (extension), or vice versa. Both bones
|
||||||
|
rotate about parallel transverse axes in the same direction. (From
|
||||||
|
Magoun, H. <em>Osteopathy in the Cranial Field </em>Second Edition.
|
||||||
|
Kirksville, Mo.: Journal Printing Company, 1966.
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
6. Is there a sense of hardness and tension under your hands, resembling
|
||||||
|
wood? This suggests a compression strain.
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
These palpatory observations of asymmetry are clues to the dysfunction
|
||||||
|
of this mechanism: But it is the nature of the inherent cranial rhythmic
|
||||||
|
impulse-its symmetry, rate, amplitude, and constancy of pattern- that is
|
||||||
|
important. If the inherent motion is distorted, impeded, limited, or
|
||||||
|
retarded, there are certainly membranous strains that need attention.
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
It is not possible to develop the necessary tactile skills in a few days
|
||||||
|
or during a brief course of instruction. But with assiduous application,
|
||||||
|
the sensitivity will be developed, and you will be able to make these
|
||||||
|
vital diagnoses at the age when they are most susceptible to correction.
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
7. With your index finger on the greater wing of the spheroid and your
|
||||||
|
little finger on the lateral angle of the occiput, be still and permit
|
||||||
|
the mechanism to convey its movement through your fingers and hands. Is
|
||||||
|
there rhythmic, symmetric expansion and contraction of{" "}
|
||||||
|
<strong>external and internal rotation </strong>of the bilateral vault
|
||||||
|
bones that accommodates the <strong>flexion and extension </strong>of
|
||||||
|
the spheroid and occiput? (This is transmitted to the index fingers as a
|
||||||
|
rhythmic downward and forward and then upward and backward cyclic
|
||||||
|
motion, while the little fingers also move downward and backward, then
|
||||||
|
upward and forward. ) Is the direction of motion that of the torsion,
|
||||||
|
side-bending rotation, vertical or lateral strains?
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
8. Cradle the occiput in the hands, and place the tip of the index
|
||||||
|
fingers on the mastoid process of the temporal bone bilaterally. (While
|
||||||
|
there is no bony mastoid process at birth, the attachment of the
|
||||||
|
sternomastoid muscle provides the palpatory landmark.) Is the sensation
|
||||||
|
that of symmetry, or does one fingertip seem posteromedial to the other?
|
||||||
|
If the tip of the mastoid is posteromedial (i.e., less prominent) the
|
||||||
|
temporal bone is externally rotated. If it is anterolateral (more
|
||||||
|
prominent), the temporal bone is internally rotated. This asymmetry of
|
||||||
|
the mastoid process is indicative of the position of the occiput, with
|
||||||
|
the internally rotated temporal bone or the prominent mastoid process
|
||||||
|
being associated with the elevated lateral angle of the occiput. Is one
|
||||||
|
temporal bone more anterior than the other without the medial or lateral
|
||||||
|
motion? This suggests a lateral strain of the sphenobasilar articulation
|
||||||
|
that has carried the head into a parallelogram distortion. Again, be
|
||||||
|
still, and observe the relative mobility of the two temporal bones.
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
9. Steadying the head with the two fingers gently on the frontal bone,
|
||||||
|
slip the other hand down and around the curve of the prominence of the
|
||||||
|
occiput. Two fingers are usually adequate. Note the tension of the
|
||||||
|
suboccipital muscles, and compare the two sides of the midline. Does one
|
||||||
|
of the two palpating fingers come in contact with the arch of the atlas
|
||||||
|
before the other? If it does, this is probably the side of condylar
|
||||||
|
compression, for the occiput will have rotated anteriorly on this side.
|
||||||
|
Be still, and observe the motility. Impaired motion on one side or both
|
||||||
|
will suggest, respectively, unilateral or bilateral condylar
|
||||||
|
compression.
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
10. By now the baby may have finished nursing and may even be asleep.
|
||||||
|
Now change your position, and sit at the infant’s right side, at the
|
||||||
|
level of his lower limbs. Steady the pelvis with the left hand while
|
||||||
|
placing two fingers of the right hand under the sacrum. Are the two
|
||||||
|
sides of the body symmetrical? Does the sacrum project into the hand at
|
||||||
|
the coccyx? Be still; observe the motion of the sacrum in relation to
|
||||||
|
the ilia. Is the motion symmetrical, around a transverse axis? Or do you
|
||||||
|
find a rotating motion superiorly on one side, around an anteroposterior
|
||||||
|
axis?
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
11. Place the hands under the lumbar spine, and note the presence of
|
||||||
|
lateral flexion producing a concavity to one side. Relate this to
|
||||||
|
lateral motion of the pelvis.
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
The treatment of the craniosacral mechanism cannot be learned solely
|
||||||
|
from the written word. The palpatory skills must be developed and
|
||||||
|
evaluated with supervised experience. But the treatment, in summary,
|
||||||
|
consists of finding the point of balanced membranous tension of the
|
||||||
|
mechanism, holding it, and permitting the inherent therapeutic force
|
||||||
|
within to normalize the body.
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
“The osteopath reasons that order and health are inseparable,” said Dr.
|
||||||
|
Andrew Taylor Still, “and that when order in all parts is found, disease
|
||||||
|
cannot prevail.” And as Dr. W. G. Sutherland reminded his students, as
|
||||||
|
the twig is bent, so the tree is inclined.
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
Give attention to those little bent twigs, so that they may grow into
|
||||||
|
handsome, healthy, happy generations for the future.
|
||||||
|
</p>
|
||||||
|
<h2>References</h2>
|
||||||
|
<p>
|
||||||
|
1. Frymann, V. M. Relation of disturbances of craniosacral mechanism to
|
||||||
|
symptomatology of the newborn: Study of 1,250 infants.{" "}
|
||||||
|
<em>J.A.O.A. 65 </em>(1966), 1059-1075.
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
2. Frymann, V. M. The osteopathic approach to the allergic patient.{" "}
|
||||||
|
<em>D.O. 10:7 </em>(1970), 159-164.
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
3. Cathie, A. Growth and nutrition of the body with special reference to
|
||||||
|
the head. <em>Yearbook of the Academy of Applied Osteopathy, </em>
|
||||||
|
1962,pp.149-153.
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
4. Crelin, E. S. <em>Anatomy of the Newborn: An Atlas. </em>
|
||||||
|
Philadelphia: Lea & Febiger, 1969.
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
5. Pritchard, J. J., Scott, J. H., and Girgis, F. G. The structure and
|
||||||
|
development of cranial and facial sutures. <em>J. Anat. 90 </em>
|
||||||
|
(1956), 73-86.
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
6. Magoun, H. I. <em>Osteopathy in the Cranial Field, </em>Second
|
||||||
|
Edition. Kirksville, Mo.: Journal Printing Company, 1966, p. 133.
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
7. Greenman, P. E. Roentgen findings in the craniosacral mechanism.{" "}
|
||||||
|
<em>J.A. O.A. 70 </em>(1970), 60-71.
|
||||||
|
</p>
|
||||||
|
<p>
|
||||||
|
8. Still., A. T. <em>Philosophy of Osteopathy. </em>Ann Arbor, Mich.:
|
||||||
|
Edwards Brothers 1899
|
||||||
|
</p>
|
||||||
|
</Article>
|
||||||
|
);
|
||||||
|
};
|
||||||
|
|
||||||
|
export default ArticleTheTraumaOfBirth;
|
||||||
|
|
@ -1,7 +1,26 @@
|
||||||
|
import Link from "next/link";
|
||||||
|
|
||||||
const ArtsForDocs = () => {
|
const ArtsForDocs = () => {
|
||||||
return (
|
return (
|
||||||
<section className="min-h-screen" id="artsfordocs">
|
<section className="min-h-screen" id="artsfordocs">
|
||||||
ArtsForDocs
|
<div>
|
||||||
|
<h1>Osteopathy</h1>
|
||||||
|
<Link href="/articles/osteopathic-head-pain" className="block">
|
||||||
|
Head Pain
|
||||||
|
</Link>
|
||||||
|
<Link href="/articles/neural-biological-mechanisms" className="block">
|
||||||
|
Neural Biological Mechanisms
|
||||||
|
</Link>
|
||||||
|
<Link href="/articles/intervertebral-disc-herniation" className="block">
|
||||||
|
The Basics of Intervertebral Disc Herniation
|
||||||
|
</Link>
|
||||||
|
<Link href="/articles/cranial-manipulation" className="block">
|
||||||
|
Cranial Manipulation
|
||||||
|
</Link>
|
||||||
|
<Link href="/articles/the-trauma-of-birth" className="block">
|
||||||
|
The Trauma of Birth
|
||||||
|
</Link>
|
||||||
|
</div>
|
||||||
</section>
|
</section>
|
||||||
);
|
);
|
||||||
};
|
};
|
||||||
|
|
|
||||||
Loading…
Reference in a new issue