It’s about the reading and writing bits that I want to offer some thoughts in this posting – as it seems to me that there has been a definite shift in terms of new therapeutic directions, since the first Fascia Research Congress back in October 2007. Now when I say ‘new’ I realize that for many practitioners and therapists fascial considerations have long been a major focus – but for the vast majority my sense is that fascia has remained in the  background – not right at the center of what those of us who work on the human body could and should be considering.

I was modestly involved in the 1st Congress (Boston, 2007), and am a small cog in the wheels that are turning to organize the 2nd – Amsterdam, October this year. The Journal of Bodywork & Movement Therapies that I edit published many abstracts, articles and research reports from the Boston event, and will do so again this time….and it’s about some of the topics that will be discussed and taught (post Congress workshops) that I want to write today. I’ve been looking through the hundreds of abstracts sent for review by the Scientific Committee and although I cannot preempt the actual event by revealing details, I can share topics – which may offer a flavor of the range and variety of fascial topics that will be available (at the congress and in JBMT).

These are some of the abstract titles:

• Undiagnosed Posterior Thigh Pain, A Fascial Rather Than Neural Cause? (Australian study)
• Fascial Distortion Model (FDM) – An Effective Method For The Treatment Of Shoulder Pain (German research)
• Anatomical Discovery of Meridians and Collaterals (Chinese research)
• Evaluating the effectiveness of Myofascial Release to reduce pain in people with Chronic Fatigue Syndrome (CFS): A Pilot Study (U.K. study)
• Myofascial Release (MFR) efficacy in alleviating specific symptoms in Systemic Lupus Erythematosus: Two Case Studies (U.K. study)
• Visceral Adhesions as Fascial Pathology (dissection evidence, USA)
• Effect of Osteopathic Manipulative Treatment in Essential Hypertension and Initial Vascular Wall Alteration (Italian research)
• Prospective Investigation on Hip Adductor Strains Using Myofascial Release (Canadian study)
• Healing Anterior Cruciate Ligament Without Surgery (Spanish research)
• Distant Surgery Scars and Other Fascial Restrictions Perpetuate Pectoralis Minor: Trigger Points in Two Cases of Severe Chronic Hand Pain (USA)
• Asessment and treatment of fascial strain in thepelvic girdle (Canada)
• Fascia slings and lumbopelvic stability from a new perspective (Holland)

• Inflammation Release Technique:Light Pressure Deep Tissue Protocol for Fascial Restriction (USA hospital study)
• Inner Psoas Tri-axial Deformation Under Tensile Load Corresponds to Superficial Dense Connective Tissue Morphology (Canadian study)
• The Strain Patterns of the Deep Fascia of the Lower Limb (Australian report)

……and these are just a random sample!

Cover of Fascia book

If you want to get a recent overview on the entire topic see Mark Lindsay’s new book “Fascia: Clinical Applications for Health and Human Performance” (Delmar.Cengage 2008)

I will write more on the topic of fascia in genera,l and the conference in particular over the coming months …for now though, my suggestion is that all therapists should investigate the ideas and methods that are evolving in this field.

This post builds on information that you will find on my other post “Chaitow’s Chat”, that – in Part 1 of this post – gives background information on osteopathic treatment of infected patients, during the great Flu Pandemic of 1918.

In this post I will outline some of the evidence that manual approaches (described in the various studies as “OMT”, which equates to osteopathic manipulative treatment) is potentially helpful in immune enhancement; and I will also provide information about protection from flu, or any other infection, via simple naturopathic and nutritional methods.

The health enhancing result of osteopathic (and other manual) health care approaches

In order to have an appreciation that manipulation and mobilisation might encourage greater resistance to infection, and/or might assist in recovey from it (and other serious conditions), a few research studies are listed below.

Elderly hospitalized pneumonia patients: Noll et al (1999, 2000) showed that when osteopathic manual methods were used on elderly hospitalized patients with pneumonia (for example the spleen pump method as illustrated above), the result included reduced time in  hospital, from a mean of 8.6 days, without osteopathic care(OMT), to 6.6 day with osteopathic care . The patients receiving receiving OMT, also required significantly less in the way of intravenous antibiotics.

Manual methods and pancreatitis: In 1998 Radjieski et alwere able to demonstrate that when OMT (10 to 20 minutes daily of a standardized protocol involving myofascial release, soft tissue and strain-counterstrain techniques) was combined with their regular hospital treatment, patients with pancreatitis had their length of hospital stay  cut by aproximately half – a mean reduction, 3.5 days compared with control subjects who did not receive OMT.

Post-operative pain: Nicholas & Oleski (2002) reported that, following major surgery: “Patients who receive morphine preoperatively and OMT postoperatively, tend to have less postoperative pain and require less intravenously administered morphine. In addition, OMT and relief of pain lead to decreased postoperative morbidity and mortality and increased patient satisfaction. Also, soft tissue manipulative techniques and thoracic pump techniques help to promote early ambulation and body movement.” The manual methods they used included a combination of approached that improve lymphatic flow, and general circulatory efficiency – including  rib mobilisation, thoracic inlet release, relaxation of the respiratory and pelvic diaphragms.

Post-coronary bypass surgery : In 2005 O-Yurvati et al (2005) discussed the beneefits of (OMT) following a coronary artery bypass graft (CABG). OMT was performed while subjects were completely anesthetized.
Results suggested improved peripheral circulation and increased mixed venous oxygen saturation after OMT. These increases were accompanied by an improvement in cardiac index

Which proves what?

If these results are coupled with the reported benefits when osteopathic care was offered during the 1918 flu pandemic (see my May 3rd blog, on Chaitow’s Chat), it suggests that – in addition to standard medical care – such approaches offer general health benefits, including enhanced immune function – and this should be considered by health care providers and patients alike.

What about massage?

We should not neglect to mention in this context, the proven value of massage.

For example Massage and recurrent respiratory tract infection:

• Massage was employed to treat and prevent recurrent respiratory tract infection in children.
• Susceptible and healthy children of the same age were used as controls.
• The therapeutic effect of the treatment group was shown to be significantly better (p < 0.01) than that of the controls
• All of the immunological indices being approximately normal when the patients were re-examined 3 and 6 months after the massage intervention.
• Massage was shown to be helpful in enhancing immune function, both preventing and treating the condition (Zhu et al 1998).

There’s much more about massage and other physical medicine methods (including hydrotherapy) in the book I edited and co-authored on Naturopathic Physical Medicine (2007)

Other protective methods

Vitamin D

Much of the information summarized in this section is taken from a paper by Cannell et al (2007) titled “On the epidemiology of Influenza“.

• Hope-Simpson & Golubev (1987) have suggested that a ‘seasonal stimulus’ that is, “inextricably bound to solar radiation, substantially controlled the seasonality of influenza”, and that this involves (among other biological effects) impairment in levels of 25-hydroxy-vitamin D [25(OH)D] [Hypponen & Power 2007].
• The evidence that vitamin D has profound effects on innate immunity is rapidly growing [Adams 2008]
• Hypponen & Power (2007) have shown that Hypovitaminosis D in British adults at age 45  following a nationwide cohort study of dietary and lifestyle predictors.
• Aloia & Li-Ng (2007) presented evidence of a dramatic vitamin D preventative effect from a randomized controlled trial in which 104 post-menopausal African American women who were given vitamin D were three times less likely to report cold and flu symptoms than 104 placebo controls. A low dose of800 IU/day reduced reported incidence, and  abolished the seasonality of reported colds and flu. A higher dose (2000 IU/day) virtually eradicated all reports of colds or flu.
• Recent discoveries about vitamin D’s mechanism of action in combating infections led Science News to suggest that vitamin D is the “antibiotic vitamin” due primarily to its robust effects on innate immunity.(Raloff 2006)

Naturopathic hydrotherapy and immunity from colds

This extract is taken from my other blog’s December 18 2008, posting:

“Ernst (1990a) showed that the regular (daily) use of a cold shower had a progressively beneficial effect on immune system efficiency (although in personal communication he denies that this was what the evidence suggests).
Medical students were divided into two groups [I imagine the scene as ..."we need volunteers for this study...you, you and you!")

• For 6 months one group took a graduated cold shower (i.e. ending a hot shower with a brief cold shower application, increasing the length of the cold application to tolerance for up to 2 minutes).
• The other group took a warm or hot shower.
• After 6 months those taking the cold shower were found to be having half the number of colds compared with those having warm showers.
• The cold shower group’s colds lasted for approximately half as long as those having warm showers, and were accompanied by far less mucus production (measured by weighing the used paper handkerchiefs of cold sufferers - now there's teutonic efficiency for you!).
• Cold showers were avoided during, and for 1 week after, experiencing a cold.

The various protective benefits did not become apparent until almost 3 months of regular cold showering
Just for balance Ernst et al (1990b) also recommend saunas for cold prevention (remember to finish with a cold plunge though!)"

Whether the flu pandemic emerges or not, it should be clear that we can defend ourselves, as well as adopting positive approaches to recovery.......

REFERENCES

• Adams J  Hewison M 2008 Unexpected actions of vitamin D: new perspectives on the regulation of innate and adaptive immunity. Nat Clin Pract Endocrinol Metab 4:80-90
• Aloia J Li-Ng M 2007 Re: epidemic influenza and vitamin D. Epidemiol Infect  135(7):1095-1096.
• Ernst E 1990a Hydrotherapy. Physiotherapy76(4):207–210
• Ernst E 1990b [Hardening against the common cold--is it possible?] (in German). Fortschr. Med. 108 (31): 586–8. PMID 2258128.
• Cannell J  et al 2008 On the epidemiology of influenza Virology Journal 5:29
• Hope-Simpson R  Golubev D  1987 A new concept of the epidemic process of influenza A virus. Epidemiol Infect   99:5-54
• Hypponen E, Power C 2007 Hypovitaminosis D in British adults at age 45 y: nationwide cohort study of dietary and lifestyle predictors. Am J Clin Nutr 85:860-868
• Raloff J 2006The Antibiotic Vitamin  Science News 2006, 170:312-317
• Zhu S, Wang N, Wang D et al 1998 A clinical investigation on massage for prevention and
  treatment of recurrent respiratory tract infection in children. Journal of Traditional Chinese Medicine 18(4):285–291

Before attempting to offer a summary of Zink’s ‘common compensatory pattern’ (CCP) (Zink & Lawson 1979), lets consider a not uncommon clinical experience – in all areas of health care – when the patient/client with a background of (perhaps) chronic muscular pain, reports back that whatever was done at the previous visit to you, has made matters worse.

A rapid look at your case notes tells you that nothing you did in the way of entirely appropriate treatment (- or advice offered -) at the last session, should have had negative effects. Nevertheless, here is the individual, and her/his report of increased discomfort needs to be understood.

• Is there anything you could have done to warn you of possible over-reactions in this case?
• And what should you do next?

If a general bodywork session involving – say, trigger point deactivation, some simple myofascial release, and general soft tissue work – produced this reaction, what can be safely offered next time you offer treatment to this person?

The Zink test can guide you – not as what to do – but what not to do. The Zink test is not a diagnostic procedure. It is an attempt to gain an insight into how adaptively exhausted this individual is….and to therefore pre-warn regarding possible negative reactions to what – in other circumstances – would be well tolerated methods of treatment.

Let me explain.

In the mid-1970′s Zink and his colleague Lawson – both osteopathic physicians, examined several aspects of well over 1000 hospitalized patients,  in an attempt to establish with some certainty that a concept they had been working on, based on their clinical experience – was valid.

Defeo & Hicks (1993) explain:
“Osteopathic physicians Zink and Lawson observed clinically that a significant percentage of the population assumes a consistently predictable postural adaptation, arising from nonspecific mechanical forces such as gravity, gross and micro-trauma, and other physiological stressors. These forces appear to have their greatest impact on the articular facets in the transitional areas of the vertebral column.”

Zink & Lawson (1979) described methods for testing tissue preference in these transitional areas where
fascial and other tensions and restrictions can most easily be noted, i.e. the occipitoatlantal (OA),
cervicothoracic (CT), thoracolumbar (TL) and lumbosacral (LS) levels of the spine. These sites are tested for rotation and side-fl exion preference. Zink & Lawson’s research showed that most people display (assessing the occipitoatlantal pattern first) alternating patterns of rotatory preference, with about
80% of people showing a common pattern of left-right-left- right (L-R-L-R) compensation, termed the ‘common compensatory pattern’ (CCP).

A= appropriate/minimal adaptive compensation - capable of absorbing additional stresses & change B= poorly compensated pattern, reduced adaptive capacity, unlikely to easily accept additional load & change

In their hospital-based study involving over 1000 patients Zink and Lawson also observed that the approximately 20% of people whose compensatory pattern did not alternate in the CCP manner had poor health histories, low levels of ‘wellness’ and had poor stress-coping abilities. More recent clinical evidence has emerged for the value of this attempt at reading the levels of adaptation exhaustion present in the physical structures of the body.

A prominent German osteopath/author Torsten Liem (2004) has suggested that if the rotational preferences alternate (L-R-L-R) when supine, and display a greater tendency to not alternate (i.e. they rotate in the same directions – for example, L-L-L-R or L-L-R-L or R-R-R-R, or some other variation on a non-alternating pattern) when standing, a dysfunctional adaptation pattern that is ‘ascending’ is more likely, i.e. the major dysfunctional influences lie in the lower body, pelvis or lower extremities.
However if the rotational pattern remains the same when supine and standing, this suggests that the adaptation pattern is primarily ‘descending’, i.e. the major dysfunctional influences lie in the upper body, cranium or jaw

The Assessment

Occipitoatlantal (OA) area
• With the patient supine the therapist is seated or standing at the head of the table. Both hands are used to take the neck into maximal unstressedflexion (to lock the segments below C2) and the rotational preference to an easy end of range – not a forced one, is assessed. Is rotation more free left or right?
Cervicothoracic (CT) area
• The patient is supine and the therapist’s hands are placed so that they lie, palms upward, beneath the scapulae. The therapist’s forearms and elbows should be in touch with the table surface. Leverage can be introduced by one arm at a time as the therapist’s weight is introduced toward the floor, through one elbow, and then the other, easing the patient’s scapulae anteriorly. This allows a safe and relatively stress-free assessment to be made of the freedom with which one side, and then the other, moves, producing a rotation at the cervicothoracic junction. Rotational preference can easily be ascertained. Is rotation more free left or right?
Thoracolumbar (TL) area
• The patient is supine or prone. The therapist stands at waist level facing cephalad and places the hands over the lower thoracic structures, fingers along lower rib (7–10) shafts laterally. Treating the structure being palpated as a cylinder, the hands test the preference for the lower thorax to rotate around its central axis, testing one way and then the other. Is rotation more free left or right? The preferred TL rotation direction should be compared with those of OA and CT test results. Alternation in these should be observed if a healthy adaptive process is occurring.
Lumbosacral (LS) area
• The patient is supine. The therapist stands below waist level facing cephalad and places the hands on the anterior pelvic structures, using the contact as a ‘steering wheel’ to evaluate tissue preference as the pelvis is rotated around its central axis, seeking information as to its ‘tightness/looseness’ preferences. Is rotation more free left or right?
Alternation with previously assessed preferences should be observed if a healthy adaptive process is occurring.
As a naturopath/osteopath I have used this assessment method for many years, and am convinced it has saved many patients from unnecessary reactions to what would be considered in someone else to be perfectly safe and useful treatment.

So…if specific interventions are not indicated because of the poor compensation pattern – what should be done?

I will finish this post with the words I used on the osteopathic forum earlier today:

I use the Zink test to guide me towards, or away from, specific interventions.
I will give as an example someone with widespread pain – perhaps with a diagnosis of fibromyalgia (FMS) or myofascial pain syndrome (MPS) (or a combination of both).
Inevitably I would attempt to deal with constitutional/whole-person focus on lifestyle modification, exercise issues, nutrition, breathing patterns, postural advice etc.
And – if the Zink test proved negative (i.e. normal alternating rotational preferences at the spinal transition regions) -  I would also consider specific interventions such as trigger point deactivation, or key spinal or pelvic manipulation – if indicated.
If, however, the Zink test proved positive, with a strong indication of a likelihood that specific interventions would be poorly coped with, I would avoid specific interventions, and would utilise constitutional approaches alone – selectively, and in slower motion (so to speak) than if Zink were negative – and would stick to offering or recommending whole-person approaches (consitutional hydrotherapy, whole body massage, relaxation methods etc).
Simplistically – all treatment involves adding additional stressor input to an already compromised system (taking pain and disease as representing failed adaptation)  – which means that treatment needs to be carefully tailored to the individual’s ability to respond to it…..and Zink allows me to judge this objectively (relatively)

There is more discussion of the Zink test in several of my books, including :

Palpation & Assessment Skills

Clinical Applications of Neuromuscular Techniques

Naturopathic Physical Medicine

Details of these books can be found on my website: http://www.leonchaitow.com/

I hope this proves of use to you in your patient/client management ….please let me know.

References

• Defeo G, Hicks L 1993 A description of the common compensatory pattern in relationship to the osteopathic postural examination. Dynamic Chiropractic 24:11
• Liem T 2004 Cranial osteopathy: principles and practice. Churchill Livingstone, Edinburgh, p340–342
• Zink JG, Lawson WB 1979 An osteopathic structural examination and functional interpretation of the soma. Osteopathic Annals.7:12 -19