Somatic Dysfunction and Osteopathic Medicine

Source: Copyright © 1996-2003 Dr. Richard M. Bachrach
317 Madison Avenue, NY 10017 - 212-685-8113
http://www.bonesdoctor.com/index.html

I’m sure many of you have looked at the diagnoses on your itemized medical bill and expressed that very sentiment, perhaps in more colorful language. The problem may be twofold:

1. In the presence of pain and/ or fear, it is extremely difficult to absorb a lot of semi-technical information often couched in unfamiliar language.

2. We may occasionally be unable to find the specific key words to open the diagnostic doors for you.

What we have, in other words, is a failure of communication. This can be very upsetting to the therapeutic relationship. The following are some frequently used diagnostic terms in a neuromusculoskeletal practice and their explanations.

I Somatic dysfunction: impaired or altered function of the related components of the body framework, resulting in pain and abnormal motion, usually decreased. The term is used most commonly in this practice in reference to joint motion. However, somatic dysfunction involves changes in all tissues in the area: skin, muscles, ligaments, fascia, tendons, nerves, blood vessels, with or without radiation to a more remote site. Some of the most frequent areas of involvement in our practice:

A. Cervico-thoracic spine (neck and upper back) or lumbo-sacral spine (low back): There is a loss of normal movement between the vertebrae. This may be produced by abnormal muscle pulls resulting from trauma, chronic poor posture, stress, too little, too much or inappropriate exercise.

B. Sacroiliac joints: These are the large joints connecting the two halves of the pelvis to the sacrum (the triangular bone at the base of the spine). Motion at these joints is slight (according to some of our less enlightened colleagues, non-existent) but essential to the normal weight-bearing and movement functions. This condition is commonly caused by trauma and/or muscle imbalances and may produce pain in the buttock, low back, hip and/or thigh.

C. Trauma, abnormal muscle pulls and stresses may produce somatic dysfunction of any other body tissue.

II Psoas Dysfunction/Insufficiency Syndrome: Characterized by tightness of the primary hip flexor muscle, the psoas major, associated with forward tilting of the pelvis, tightness of the hamstrings and weakness of the abdominal and buttock muscles. This syndrome along with the ligamentous laxity associated with aging, injury and/or poor posture, commonly contributes to dysfunction at the sacroiliac joints, with consequent pain and disability. It may also be a precursor of:

III Intervertebral Disc Disease: Intervertebral discs are the cushions between the bodies of the vertebrae. They function as shock absorbers and enhance flexibility. The fibrous cartilaginous outer ring becomes frayed and stretched. The gelatinous nucleus within may push against it, bulge or protrude through it or even break through to press on one or more of the spinal nerves exiting the spinal canal between the vertebrae. This may produce radiating pain numbness or weakness in the involved leg. Long-standing disc disease eventually results in disturbance of normal mechanics with arthritic changes in the small spinal joints, thickening of ligaments and finally narrowing of the spinal canal through which the spinal nerves travel, a condition called:

IV Spinal Stenosis: characterized by back and/or leg pain occurring while standing or walking, and relieved by sitting. As the condition deteriorates, the distance the patient is able to comfortably walk becomes progressively shorter and the patient tends to lean forward. The pain will frequently cause early awakening from sleep. It is typically severe upon attempting to get out of bed in the morning

V Myofascial pain syndromes: Muscles, and, indeed, all cells, tissues and organs are lined, covered and invested with a tough connective tissue called fascia. Fascia is three-dimensional and is continuous throughout the body. Anything affecting fascia in one area is manifested to some extent in all body regions.

Repetitive micro-trauma (injury), unresolved single injury, inflammation, poor posture or maladaptive movement habits at play or at work, stress, lack of sleep or any combination of the above will produce tightness or abnormal contraction of skeletal muscles. The investing fascia becomes taut and bound down. Circulation to and from the muscles is decreased, resulting in the accumulation of the end-products of muscle metabolism, particularly lactic acid and potassium ions. Localized areas of muscle tenderness called trigger points are formed. These trigger points are extremely sensitive and fire impulses under the slightest provocation such as pressure and stretching, to distant tissues. This produces pain and consequent loss of motion at remote locations. Toxins accumulate, muscles and fascia tighten, pain increases. The myofascial pain cycle is perpetuated.