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Liem T. J Am Osteopath Assoc ; 10 — Andrew Taylor Still, MD, DO, coined the original idea of lesion based on the obstruction of flow of body fluids, but primarily referring to bony structures and more precisely to the spine. Throughout the 20th century, this idea was shaped and developed into the concept of somatic dysfunction, a term that is familiar to both US-trained osteopathic physicians and foreign-trained osteopaths and has been an essential cornerstone of osteopathic practice and teaching.

Keywords: Andrew Taylor Still, A. Still, osteopathic lesion, osteopathy, somatic dysfunction. Impaired or altered function of related components of the somatic body framework system: skeletal, arthrodial and myofascial structures, and their related vascular, lymphatic, and neural elements. Somatic dysfunction is treatable using osteopathic manipulative treatment.

Sign In. Forgot password? October Author Notes. E-mail: tliem osteopathie-schule. Article Information. Get Citation Citation. Alerts User Alerts. You will receive an email whenever this article is corrected, updated, or cited in the literature.

You can manage this and all other alerts in My Account. In , Andrew Taylor Still, MD, DO, the founder of osteopathy and its clinical, diagnostic, and therapeutic implementations, developed a theory that the disease process arises when the flow of life is interrupted. To understand and classify osteopathic approaches, knowledge of the lesion concept ie, somatic dysfunction and its history are important.

Models of the concept based on research findings published as recently as may aid in clinical reasoning of the most appropriate treatment strategies, as well as specific osteopathic manipulative treatment, osteopathic manipulative therapy manipulative care provided by foreign-trained osteopaths , and nonmanual therapeutic approaches. Likewise, Still described the human body as a delicate and perfect machine and the osteopath as the mechanic who examines the machine man for stress, strain, and variations from the norm and then corrects or adjusts to reestablish the fine balance so that healing can commence.

Still developed a predominantly mechanistic theory on how disorders of the vital body fluids ie, blood, lymph, cerebrospinal fluid and their flow occur. He posited that bones, muscles, membranes, organs, nerves, blood, and lymph are interlinked harmoniously. If these mechanical disturbances were eliminated, the unhindered flow could be restored.

He believed that health is based on structural integrity and develops when the flow of body fluids is unhindered. Still generally referred to bony lesions, mostly of spinal structures, but also to other joints, such as hip, rib, and pelvic joints. Still and other osteopaths of his time essentially agreed that primary lesions were caused by more or less strong external forces, particularly in the region of the spinal column, and that the main cause in secondary lesions was not within the respective joint but in a location distant from the spine.

The lesion model was important for the early teaching of osteopathy in the United States. At the sixth annual meeting of the Committee of Education of the American Association for the Advancement of Osteopathy in Milwaukee, Wisconsin, in , the prevalence of lesions in all states of disease was an important point on the agenda.

Although Still used lesion relatively imprecisely and without further definition, other osteopaths developed and shaped it over time. To define an impairment as an osteopathic lesion, it was initially necessary to have a structural disorder of interrelated parts or a change in the size of the individual parts, such as overgrowth, growth arrest, and atrophy, which then led to a functional disorder.

Hulett 16 differentiated 3 types of osteopathic lesions, characterized by a change of the positional relationships of bones, joints, and organs Table 1. Dislocation and subluxation mainly referred to bony tissue, making a distinction between complete dislocation and incomplete subluxation separation of the joint surfaces.

Displacement referred in particular to flexible structures, such as organs eg, a prolapsed uterus. Hulett used the term spinal lesion , not to define diseases or malformations of the vertebrae, but instead to describe mostly unobtrusive subluxations that were involved in the maintenance of that lesion, usually in conjunction with bones, ligaments, and muscles.

Hulett for example, mentioned the involvement of spinal lesions in cardiac disorders and constipation. McCole differentiated 4 types of lesions: traumatic, reflectory, acute, and chronic, as well as a combination of these lesions Table 2. These lesions change over time and should be understood to some degree as a mixture of lesions rather than in isolation.

At the time, osteopathic lesion generally referred to disturbances of the spinal structures. A spinal lesion was said to be characterized by the nonphysiologic articulation of affected joint surfaces in the resting phase or by a disturbed intra-articular tension caused by paravertebral contractures or contractions of tissue eg, muscle, ligaments, capillaries, nerves, nerve centers.

Yale Castlio, DO, differentiated an osteopathic lesion as a faulty position and movement restriction of bony joint structures from a spinal lesion as a lesion of one of several joint facets between 2 vertebrae. According to Castlio, an osteopathic lesion affected nerves that innervate an organ and may impair the organ as well as the overall health of the organism and thus predispose it to disease.

An osteopathic lesion also potentially affected an organ in immediate physiologic interaction with a different tissue and therefore also affected this tissue. Further Evolution of the Osteopathic Lesion Concept. In , the osteopathic lesion concept was extended by Carter Harrison Downing, MD, DO, 19 who used the term greater osteopathic lesion complex to describe adaptive consequences in the nervous system, circulatory system, secretory system, and excretory system.

John Martin Littlejohn, PhD, DO, MD, explored a lesion concept that differed from previous definitions and stated that the body is not a mechanism but an organism. He went on to say that purely mechanical lesions therefore may not occur, as they are, for example, coupled with mental and psychological states, health, function, and structure.

In this regard he used the term environmental lesion. Becker, DO, who considered the total structural lesion as the primary mechanical lesion in addition to all consequential mechanical compensations. Table 1. Hargrave-Wilson, DO, classified lesions according to causal aspects as primary and secondary lesions. This reflex or irritation could lead to ligamentous and muscular tension in the corresponding spinal area, which could become an active lesion that could in turn affect the organ even more ie, somatovisceral reflex.

Table 2. The effects of these lesions would manifest as local pressure phenomena, peripherally by vascular, sympathetic, or somatic nervous somatovisceral reflexes and generally directly or reflexly on the nervous, vascular, or endocrine system. The classifications MacDonald and Hargrave-Wilson 22 described are integral because they took into account, for example, pathophysiologic organ influences that would be supported by later research findings. The Educational Council on Osteopathic Principles defines somatic dysfunction as follows:.

Typical diagnostic indicators for somatic dysfunction are tissue texture abnormality, asymmetry, restriction of motion, and tenderness of affected tissues. Both causes can be accompanied by neurologic and functional changes, which may relate to the acute or chronic nature of somatic dysfunction.

Early evidence for a neurologic explanation of somatic dysfunction was provided in the late s when J. Stedman Denslow, DO, and Irvin Korr, PhD, first introduced the spinal facilitation theory to explain the common findings of soft tissue changes, pain and tenderness, and muscular hypertonicity.

Wilbur Cole, DO, added to this theory in by evaluating the effects of induced somatic dysfunction in animals and identifying histologic changes. In , Michael M. Patterson, PhD, suggested a possible mechanism for genesis and maintenance of spinal facilitation, assigning an active, vital role to the spinal neural pathways in the generation of somatic dysfunction.

Thus, the control of higher centers in the sensitized areas would decrease and lead to impaired segments. Richard L. Van Buskirk, DO, PhD, introduced his own model of somatic dysfunction in based on the central role of nociceptors in the development of segmental somatic dysfunction. Van Buskirk proposed that pain-related sensory neurons and their reflexes cause motility restrictions and visceral, immunologic, and autonomic changes.

Gary Fryer, PhD, BSc, has reviewed and updated this somatic dysfunction based on nociceptors concept theory over time, taking into account the newest literature on the topic. Pain causes impairment of proprioception and motor control, leaving the segment more vulnerable to further injury. Regarding signs of somatic dysfunction, tissue texture changes may be produced by soft tissue inflammation and guarding activities.

Tenderness will most likely occur because of nociceptor activation and central sensitization processes, and change in range of motion would be the result of degenerative changes caused by sprain and inflammation. By providing an extensive evidence-based review of the literature, Paolo Tozzi, MsC Ost, DO, PT, 41 suggested a model that combined dysfunctional processes and manual therapeutic effects. Tozzi 41 proposed a change from the nociceptive model to a neuro-fasciogenic model by integrating neurologic processes into a multidimensional interpretation of the process of somatic dysfunction that may be mediated by fascia in some way.

With an ever-expanding evidence base in modern neurobiology, an increasing number of publications have begun to challenge the spinal facilitated theory, both from within and outside the osteopathic medical profession. A review by Fryer 30 explored the plausibility of the concept and questions its relevance to the modern profession both within and outside the United States, taking into account its unclear pathophysiologic processes and poor reliability in detection of tissue manifestations.

Fryer points out that the International Classification of Diseases may serve the interests of US-trained osteopathic physicians but has little relevance to foreign-trained osteopaths or to members outside the profession. The founder and early developers of osteopathy used metaphors from mechanistic materialism to define the osteopathic lesion as a monocausal event—that is, with 1 source of dysfunction.

With the introduction of evidence-based models, this concept has been updated, shaped, and challenged, with a current viewpoint on the nociceptor-based model. The most up-to-date evidence derived from bioscience and medicine has led to a multidimensional interpretation of somatic dysfunction, including the suggestion of a neurofasciogenic model, in which the role of the fascia in the development of its palpable features is taken into account.

Still AT. Autobiography of Andrew T. Rev ed. Kirksville, MO: published by the author; Booth ER. Cincinnati, OH: Caxton Press; Schiller F. Spinal irritation and osteopathy. Bull Hist Med. Swedenborg E. Vol 1. Wilkinson; Stark J.

Stills Faszienkonzepte. Gevitz N. Trowbridge C. Andrew Taylor Still, Fuller D. Hartman C, ed.

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The Collected Papers of Irvin M. Korr Vol. I

Liem T. J Am Osteopath Assoc ; 10 — Andrew Taylor Still, MD, DO, coined the original idea of lesion based on the obstruction of flow of body fluids, but primarily referring to bony structures and more precisely to the spine. Throughout the 20th century, this idea was shaped and developed into the concept of somatic dysfunction, a term that is familiar to both US-trained osteopathic physicians and foreign-trained osteopaths and has been an essential cornerstone of osteopathic practice and teaching.

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This theory is attractive and partly explains the results obtained by osteopaths. It is the result of long years of scientific studies by Professor Irvin Korr and his team. It sheds light on the action of manual therapy. Any functional anomaly corresponds to a structural dysfunction. We are therefore looking for what structures are disturbed. Still the founder of osteopathy.

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