THE CRANEO CERVICAL MALFORMATIONS AND OSTEOPATHY TREATMENT

Dr. Antonio Ruiz de Azúa Mercadal

Osteopathic doctor (Barcelona)

Publicado en 2004 en la página web Amigos de Chiari.

SOME CONSIDERATIONS ON CRANEO CERVICAL MALFORMATIONS

The congenital malformations of the spine nervous tissue may produce chronic irritation, contraction andpain in the muscles that are undertheir influence. This permanentcontraction produces a vesselalteration and exudes out substancesto the intestine tissue with theconsequent inflammation and edema.If this situation persists along the time, the tissues will become fibrous and will withdraw. This situation will produce a close circle of pain and contraction. With time this secondary stiffness and contraction become independent of the causes that produced them.

There is not always an agreement between the radiograph results and the symptoms that patients suffer from skull-cervical malformations.

We must distinguish between the symptomatology directly caused by malformations and the one result of secondary injuries in tissues around the malformation. For example, we can observe that the degrees of deviation of the scoliosis (measured by x-rays) remain stable whereas the patient undergoes a backache increase. Sometimes, also, we can observe a patient who undergoes a progressive increase of paresthesias and pain in the superior extremities, without any change in the syringomielia cavity.

OSTEOPATHY TREATMENT BASES

          Physiotherapy and osteopathy are very useful in the skull-cervical malformations. We should not speak about non-recoverable neurological injuries, but of not rehabilitated neurological injuries.

The osteopathy does not correct the deficiencies in the anatomical structures but it improves the physiology of the soft tissues that surround them.

           In order to understand the osteopathy treatment bases we must consider osteopathy founder, Dr Still. Far, who was a supporter of surgery practices when the osteopathy techniques failed, reason why the osteopathy treatments would have to be complementary of the surgical ones.

Fascias are the tissues surrounding and uniting all the organs in the human body. Nutrients and oxygen arrive at all the cells in the organism through them. In order to explain the fascia function, Dr Still compared them with a culture field. Blood in the sanguineous circulation waters this field with nutritious substances whereas the venous and lymphatic systems drain it. The nervous system directs and coordinates the irrigation of this tissue. If a nervous compression or a diminution of the sanguineous circulation takes place, this land won’t be properly irrigated, with the consequent alteration of the cellular physiology.

          Inside the tissue we found a collagen fiber net that contribute to form them.

These nets form a shell sensible to the traction produced during the manual therapy. Osteopathy acts in the collagen fiber structure increasing elasticity. With time it diminishes the retraction and the fibrosis and improves the interstitial circulation.

 All these physical improvements produce a diminution of the symptoms (pain, etc).

In some medical publications it is possible to read that the symptomatology improvement obtained by osteopathy treatment with medicinal plants, acupuncture and vertebral mobilizations are due to placebo effect. These affirmations only demonstrate the ignorance existing around osteopathy. In osteopathy, medicinal plants are not prescribed; neither uses acupuncture and in rapport to vertebral manipulations, is only one between numerous techniques that the osteopath performs. In the web pages of some international associations of Arnold - Chiari patients it is possible to read that osteopathy is not recommendable for patients with skull-cervical diseases. This is sustained by the belief that osteopathy involves only vertebral manipulations, ignoring that the professionals have very useful techniques for soft tissue treatment.

The problem is aggravated because there are people who call themselves osteopaths and use techniques that don’t have nothing to do with the osteopathy.

It is difficult that economic resources be addressed to osteopathy investigation. The osteopathy is not recognized by the public health and it d oes not interest to the pharmaceutical laboratories, which are mainly people in charge of financing the medical research. Also investigation about this subject is difficult because osteopathy treatments cannot be compared, there is a different treatment for every different pathology and patient.

An osteopathy protocol cannot be made, manual therapy cannot be standardized since there is a different treatment suitable to each particular patient. Also it is difficult to make a protocol for skull-cervical malformations treatments because under this name are reunited numerous diseases that don’t have a defined limit among them. For example, many of these diseases have in common the tension increase in the spinal marrow, and Arnold Chiari Malformation, scoliosis or syringomielia symptoms might be confused.

As we have already indicated, a part of the symptoms of the skull-cervical malformations is located in soft tissues (muscles, fascias, sinews, etc). Acting on soft tissues does not treat its origin but it allows us to improve these patients quality of life.

          Fascias and sinews insertions are very sensible structures to pain due to the great amount of sensitive completions in them. All the chronic muscular contractions caused by a nervous irritation, a mechanical overload or emotional tensions, stimulate these nervous receivers and produce pain. It is possible that this situation is one of the origins of the pain in the trigger points.

FASCIAL OSTEOPATHY TECHINIQUES

Dr. Sutherland proposed the skullosteopathy therapies for muscleskeletal disturbances treatment In this brief article its anatomical bases cannot be exposed, but we will mention that it described the presence of a mechanical force that runs inside the spine from the skull to the sacrum.

Sutherland attributed this force transmission to the spinal dura madre.. In order to reach this conclusion it was used the palpation, since in that time TAC and RMN did not exist. Thanks to the investigations of the Neuro-radiologist Dr Roth, defended nowadays by neurosurgeon Dr Royo-Salvador, we know that there is a force inside the encephalic mass that is transmitted through the spinal marrow, inside the spine, until the coccyx insertion by the "filum terminale" and the sacrum coccys ligament. This has been demonstrated by TAC and RMN images.

In this techniques slight pressures with the hands are made on the head and the pelvic waist. These techniques hardly produce mobilizations in the vertebral joints. The positioning of the professional hands in the base of the head of the patient (to the height of the occipital bone) is pleasant and relaxes the later muscles of the neck.

If, as their detractors indicate, the skull-osteopathy techniques on the occipital zone (also known as compression of the IVº ventricle) do not produce any action, would mean that they are not dangerous and, at lease, they would not be contraindicated. The support of the professional hands under the patient sacrum does not produce either any great vertebral movement, that is why, we do not find any justification to contraindicate them in the patients with skull-cervical malformations.

OSTEOPATHY TECHNIQUES

Other interesting osteopathy techniques are those that acting on fascias and they are directed to liberate the joints in which they are inserted, like for example the shoulders blade liberation techniques.

This pair of bones is located in a key place of the back; where there are some muscles that connect them with the superior extremity, with the head and the spine. If we improved the shoulder blade mobility, we produce an improvement in the muscle tension of all the back. In the simplest fascia shoulder blade liberation technique.

The patient stretches in a way that their shoulder blade rest on the therapist palms. Next the therapist, taking advantage of the patient weight and breathing, performs with its hands small movements and the patient gains mobility in that zone progressively.