Monday, November 28, 2011

Cayce, Osteopathy, General and Specific Treatments

General and Specific Treatment Formats
    In attempting to explain the meaning of Cayce's statement about osteopathic and neuropathic "coordination WITH drainage," we have considered the theoretical aspects of these forms of regulation as well as specific clinical techniques.  However, to help make this information more practical in its application it is necessary to utilize a format which recognizes general and specific treatments.
    In certain respects, the distinction between general and specific treatments is merely an extension of the concepts of anatomical correction and physiological regulation into a clinical setting.  The practitioner provides specific treatments for specific structural defects.  For regulatory purposes, a general treatment may be useful to put the body through it paces and thereby increase coordination and improve eliminations.
    In making therapeutic recommendations, Edgar Cayce often made the distinction between general and specific treatments. In the following excerpt, he recommended a general osteopathic treatment for relaxation:
    Once a week, or once in ten days would be preferable, have an osteopathic relaxation.  This does not mean that there are to be corrections attempted.... This should be a treatment not so much for adjustment as for a thorough, thorough relaxing, each and every segment, each and every muscular force of the body receiving special attention.  Use the limbs or the structural portions as leverage to make muscular reaction.  (3095-1)
    Often, Edgar Cayce would recommend both specific and general treatments for the same person.  Sometimes these two types of treatment would be alternated:
    With the corrective forces as will be made through those of adjustments OSTEOPATHICALLY given, and the massage following same - two of the general treatments to one of the [specific] adjustment treatments should be given.  These should be given at least every week, two general, one corrective ...  (53-1)
    We would take, now, about twice each week, the osteopathic manipulations, - a general manipulation at one treatment and a specific adjustment at the next, as has been indicated. (1844-2)
    In other instances, Cayce would recommend that general and specific treatments be combined in the same session:
    After the condition is lessened, begin with deep manipulation, osteopathically given - a general treatment every other day, and the specific treatment in the region of the lower cervical, the upper dorsal and the sacral and lumbar.  These would be given together (the general and the specific treatment), that the whole system may be aroused to better elimination and better relaxation.  (4999-1)
    We would have at least two treatments osteopathically each week, one of these being an adjustment treatment followed with a general manipulation - the other rather the massage over the whole system, keeping the coordination of nerve impulses from the ganglia in this area of the cerebrospinal with the cerebrospinal ganglia in the locomotory areas and the sympathetic areas.  (3722-1)
    The osteopaths of Cayce's era were also well aware of the distinction between general and specific treatments.  Some practitioners focused mainly on specific treatment following A. T. Still's admonition of "Find it, fix it and leave it alone" (in Brantingham, 1986).  Other early osteopaths were inclined to use general treatments as a regular part of their practice (e.g., Goetz, 1909; Riggs, 1901; Barber, 1898; Murray, 1925).
    "A General Treatment is given by a great many Osteopaths in connection with the specific treatment needed for the ailment for which the patient is being treatment.  General treatment is an advantage in a number of cases.  It is given for nerve troubles and for the general circulation."  (Murray, 1925, p. 61)
    "In giving a general treatment, try to do the work in twenty minutes.  When you begin to practice Osteopathy it will take thirty minutes or longer to give the general treatment, but after you have practiced for a while you will feel that you are wasting time if you do not give it in twenty minutes or less.  In using the shorter time you will do the work very effectively....
    In nervous troubles and in many constitutional diseases Osteopaths have discovered that they get better results when they give the general treatment.  This helps the circulation and makes a tired patient feel like new; and the treatment, after all, when there are no specific lesions to remove, is but little more than deep massage, in which nearly all the muscles of the body are manipulated.
     One may give this treatment, in such a manner that many patients come to look upon it as a luxury.  And many will take it when they are only slightly indisposed.  Some business men take the treatment as a means of relaxation. Many others take it when they are simply tired."  (Murray, 1925, pp. 18-20)
    Here is an example of a general osteopathic treatment as described in the Text-Book of Osteopathy (American College of Mechano-Therapy, 1910).

    "Uses - A general treatment is indicated for the correction of nerve troubles and general circulation.
    Patient reclines on table, lying on the side.  Relax the tissues of the back by the following methods:
  1. Stand in front of patient and grasp uppermost arm.  Relax the tissues about the shoulders and down to the spine and back with the other hand.  Hold the arm at the elbow, and using the joint as a lever, work the arm back and forth.  By this means the spine is manipulated and any deviation corrected.
  2. With patient in same position, place one hand beneath the neck and grasp the occiput.  Rest the other side of the patient's head against your breast, and apply traction to the tack and upper dorsal region.
  3. Place one elbow on the hip and the other on the shoulder. Stretch the spine by extending the arms and stretching the hips away from the shoulder.
  4. Manipulate the shoulder.  Pull up the scapula with one hand, while with the other press the shoulder.
  5. Place one hand under patient's scapula and grasp the shoulder with the other hand.  Then rotate the shoulder.
  6. Manipulate the limbs by seizing the limb in both hands, relaxing all tissues with a rotary movement of the hand.
  7. Manipulate the spine by pulling it toward you, while patient is lying on his side with knees flexed and braced against you.
  8. Turn patient on other side and repeat above treatment.
  9. Place patient face downward, with toes extended and arms hanging down over the sides of the table.  Describe a circular movement with the palms of the hands, at the same time apply pressure, to relax all contracted tissues of the back.  Pull the muscles away from the spine with the fingers.
  10. With the patient lying in a prone position, stand at one side of the table and grasp the hip of patient on further side in front.  Apply pressure up and down the spine with the heel of the other hand, while pulling the hip upward.  Treat both sides.
  11. Patient in same position.  Operator stands at head of the table.  Apply considerable pressure on each side of the spine with the thumbs.
  12. Raise the limbs in one arm and rotate them, while applying considerable pressure at the lower part of the abdomen with the other hand.
  13. Apply pressure to lower part of spine while one limb is raised.  Raise the other limb and repeat the pressure." (American College of Mechano-Therapy, 1910, pp. 12-15)
    The significance of the general treatment is that it provides a simple format for regulatory techniques such as coordination and drainages.  By its very nature, a general treatment will improve circulation which is a prerequisite for drainages.  Because the general treatment tends to stimulate all the nerve centers, it also has a coordinating effect that is lacking if only a specific adjustment is made.
    Yet, the osteopathic literature contains certain reservations against general treatment.  The primary concern is that general treatment may lapse "into routinism, to be followed by carelessness or slipshod methods"  (McConnell, 1932, in Jordan, 1994, p. 58).  However, like the Cayce readings, McConnell does see a valid role for general adjustment when it is precisely and intelligently performed in conjunction with specific corrective adjustment.
    "Unquestionably, as stated, there is merit in various soft tissue general manipulations.  They do affect circulation and nerve impulses.  They help to release abnormal tensions and to tone flabby musculature.  No doubt many beginning lesions are normalized and others are more or less modified as to severity.  But (and this is an extremely important "but") general manipulations will not, can not, adjust the serious deep-seated lesions.  Only skilled operative work can do this.  The very nature of the pathologic condition demands specificity in order to normalize it....
    Integration: What may be termed therapeutic integration of structure is essential, because each part of the structure is requisite to the unified action of the organism [coordination].  This means that not only should the local solution of structure be rectified [specific adjustment], but also that all abnormal correlative mechanisms should be carefully adjusted.   Integration [coordination] implies the necessity of general treatment, but not in the sense of general or routine manipulation....
    Diagnosis of the primary physical abnormal condition is of first consideration.  But unless one subsequently elicits the full value of the integrative [coordinating] trend of the organism, many pathological factors will be overlooked....
    Too much time, relatively, may be given to the local physiochemical derangement.  Ignoring the coordinative function and integrative trend of nerve impulse and chemical activity may defeat the very purpose of a localized therapy. Hence therapeutic specificity ofttimes depends upon adjustments of more than one region.  Function is no more confined to a local influence than is structure to a local requirement.  Both are adapted to body wholeness." (McConnell, 1932, in Jordan, 1994, pp. 58-59)
    Thus it is the careful integration of specific adjustment and general coordinating/integrating treatment that is the highest achievement of the osteopathic profession.

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