Manipulation and massage

Alternative therapies based on manipulation and massage can be grouped under three headings: osteopathy, chiropractic and massage. The latter includes techniques such as Shiatsu and reflexology as well as classical massage. Osteopathy and chiropractic are related therapies with similarities but they are not the same. Differences are to be found, for example, in the actual manipulative techniques, which in chiropractic are much quicker, more vigorous and thrusting than in osteopathy.


Osteopathy is a therapy that uses manipulation of the body, particularly the spine, to treat problems that may seem to have nothing to do with the spine. The term osteopathy is made up from the Greek words osteo – bone, and pathos – disease, but it is rather misleading because osteopathy is not strictly concerned with disorders of the bones. The founder of osteopathy was Doctor Andrew Still (1828-1917), an American physician, who looked for a new approach to disease after his three sons died of meningitis. Because he had studied engineering in addition to medicine, he became interested in looking at the human body as a machine. Still had the idea that disease originates from subluxations of the vertebrae, as a result of which the circulation in the small spaces between the vertebrae is obstructed. He tried to interpret how one defective part of the body could affect the functioning of other parts, in the same way that a machine may break down because it has a broken cog. He developed a system of healing by manipulation, maintaining that the ailments we suffer from can always be explained in terms of a mechanical malfunction within the body. He believed that many diseases were related to spinal disorders which had impeded the action of the nerves, and consequently the circulation, of the blood which carried ‘Qi ‘nature’s healing force’. Based on this idea he devised the ‘rule of the artery’, which stated that if a person’s circulation is normal then that person should not suffer from disease because the blood is capable of providing immunity to protect him or her. Still also maintained that disease is related to the whole body rather than just parts of it, thus any healing therapy must be designed to restore the normal balance of the whole person. He considered manipulation to be such a therapy: an effective treatment for disorders of all kinds.

Osteopathy, then, is not just concerned with the spine, although it is generally the main focus of attention. The discs between the spine’s vertebrae come under strain simply with standing up, which makes back pain and sciatica so common. Further, our upright stance, which in evolutionary terms we have adopted only recently, results in the abnormal positioning of the abdominal organs, which can cause conditions such as hernias, constipation and varicose veins.

Osteopaths use the term ‘osteopathic lesion’ for an area of the body, usually one containing a joint, that has been damaged or involved in strain, thickening of connective tissues, shortening, pain, swelling or a combination of these disorders. Lesions in the neck vertebrae are thought to affect circulation in the brain, which in turn can cause mental and emotional problems.

Osteopaths use manipulation to try to treat these lesions, which may be either acute or chronic. This manipulation may quickly cure recent conditions; but for more long-standing ones a number of sessions may be needed.

One of the means of treatment is to move joints through their range of movement, and if an abnormality is found, to reinstate movement within restricted joints. To do this the osteopath may need to stabilize a vertebra in order to open the affected joint. As the joint opens there is an audible click which brings relief to the patient and can also be felt by the osteopath. This is because the joint’s synovial, or lubricating, fluid changes from liquid to gas and produces a vacuum ‘pop’. The separation of the joint surfaces allows the joint to move freely again and can relieve muscle spasm and inflammation. The manipulation involved in osteopathy is highly skilled and qualified practitioners have to undergo long periods of study. Of all the so-called alternative therapies, it is one of the most accepted in the West and many orthodox medical practitioners are also osteopaths. However, the theory upon which it is based remains scientifically unproven. Diagnosis is usually made from a detailed case-history taken from the patient during the first visit and using orthodox medical techniques such as X-rays, laboratory and physical examinations. Osteopathy is obviously particularly beneficial for the treatment of back-problems, neck and joint conditions, such as tennis-elbow, and strained knees. It can also be used for diseases of internal organs. For example, by manipulation of the spine, the nerve supply to the abdominal organs, which passes through the spinal cord, can be returned to normal. Osteopathy also claims success in alleviating conditions including, for example, respiratory disorders, such as asthma and bronchitis, where emphasis is put on the movement of the rib-cage and the thoracic and pelvic diaphragm.

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