Osteopathy: Manipulation of the Spine

You bend down to lift something heavy, perhaps your own child, and feel something ‘go’ in the small of your back. You feel an exruciating pain and cannot even get up. One day, you feel pain and stiffness in your neck and you think that it may be due to an odd position your neck was in while sleeping.

Coming down the stairs you slip and sprain your ankle joint, or you open your mouth to yawn and cannot close it.

These pains start so suddenly and should have an equally short and effective treatment by which whatever has happened can be reversed. A lot of physiological changes occur in the pelvic region of the mother during childbirth. These may leave her with a low back pain. It was formerly thought that the cause of the pain was lack of proper care given to the mother after delivery. This is not true. Some re-adjustments which should take place of their own accord after the child is born, do not take place and the pain persists. Hence the cause of pain is purely mechanical.

Not only this, but a wrong method of sitting, standing, doing household work, or even a proloriged illness may leave you with a persistent back pain, sciatica, spondylosis, brachial neuralgia, headache, insomnia or even dysmenorrhoea.

There are innumerable problems which can be narrated one after another, and which are so common. What are the possibilities for their cure and what possible remedies can you get for them? The pain may clear in a few days and you may think it was a simple sprain or myalgic pain. Or when it is unbearable, you may land in hospital where a lot of investigations are conducted and x-rays taken. You may be told that the pain is due to a slipped disc or spondylosis.

You are probably advised to take complete bedrest for a few weeks, undergo diathermy (which will emit heat heat to your deep-seated joint) or massage, continuous or intermittent traction, wear a collar or belt, take medication, use applications, do remedial exercises or try out some other treatment.

There is a possibility of getting cured. But it is also probable that in spite of devoting a lot of time, undergoing torturous treatment and heavy expenses, the pain persists. Ultimately you are told by a specialist or a consultant, ‘you are going to have this pain throughout your life; this pain will not go and you should learn to live with it.’ You may also be advised to have disc surgery without any assurance about the result. And even if you are cured following the operation, you will have a weak back and will live the rest of your life, taking a lot of precautions and observing many dos and don’ts.

Many patients end up going to a healer who may hang them upside down and tie their ankles to the roof, for half an hour every day, day after day. Some may be given electric shocks. In other cases red hot iron rods may be pressed over the area of pain. Some patients even resort to witchcraft, faith healers, sadhus and mullas. They may be asked to wear a copper bracelet, or they may go to a bone setter and get cured by sheer luck. If they are wise, they will resort to vertebral manipulation.

After my medical graduation I joined the Central Institute of Orthopaedics, New Delhi, one of the most reputed orthopaedic institutes in the country. Patients with various types of pain came in large numbers and in spite of the best facilities of diagnosis and treatment, we did not seem to be helping them much. Week after week, month after month … the treatment seemed to be unending in quite a few cases. While we were so effective in the treatment of fractured bones and other ailments, I kept wondering why we could not help patients with chronic aches and pains. I consulted my orthopaedic books to find that manipulation was mentioned as one form of treatment. Why were we not using it? I tried to question my teachers but they could not give me a satisfactory answer. I then decided to go to England to become an osteopath.

Manipulation is an art, a science and a philosophy. Manipulation is sometimes called orthopaedic medicine or finger surgery by medical practitioners. Manipulation is one of the oldest techniques used for healing different ailments of the body. Bone-setters have been known to exist since olden days in almost all parts of the world. However they seem to have confined themselves to fracture cases, and used a few manipulative manoeuvres. Manipulation has been successful in a few cases though without carrying out any diagnosis. It was mostly done by lay persons without any knowledge of human physiology and pathology.

Hippocrates, the father of medicine, used to manipulate the spines and joints of his patients. A table used by him for this purpose is still preserved at the Welcome Historical Museum, London. Sushruta, the famous surgeon of ancient India, used to manipulate many of his patients; he described this in his Asthichikitsa (Bone Treatment). This method of treatment is not readily accepted by modern medical men. Manipulation attracts criticism, misconception and scepticism, and rightly so, as it has mostly been done by lay manipulators.

In the absence of knowledge of pathology, grievous injuries may be caused to patients. It has often been referred to in the following manner; ‘A brutal and blind treatment …’ ‘A dangerous form of psychological treatment …’ ‘An occasional good result does not compensate for the accidents it can produce…’ Often these criticisms stem from people who have not participated in a well-conducted manipulation session. This criticism is, however, now dying out, since many medically qualified people are being drawn towards it. It is now being built upon a sound scientific base and is the main therapeutic used by orthopaedic surgeons abroad and by a few in India as well.

Many appreciative comments have also been coming forward: ‘Results are astonishing …’ ‘It shortens the period of recovery and protects a patient from prolonged agony and mental apathy …’ ‘It avoids many an unnecessary operation …’ With the development of the osteopathic profession and hospitals, colleges and research centres, manipulation has become more accurate and scientific. Several orthopaedic surgeons abroad manipulate each and every case, and resort to an operation only when manipulation fails. There are signs of increased respectability being given to manipulation as a therapeutic measure. If a patient wants to recover fast, the physician is also equally anxious to cure his patient as fast as he can. This gives him great work satisfaction.

When I got admission to the London College of Osteopathy in September 1966, most of my colleagues were British general practitioners who had 10-15 years of lucrative general practice behind them. They were not happy with their results; sometimes they did not know how to help their patients. After hearing about manipulative treatment, they tried to learn one or two techniques from a friendly osteopath, used them casually on their patients and were so happy and surprised at the results that many of them decided to leave their practice, learn manipulation more thoroughly and in greater detail, and after completion of the course, and convinced of its efficacy, settled into full-time manipulative practice.

At first it seemed unbelievable to me that patients could improve so much with the use of one’s hands. How right was the saying that a certain physician had ‘fame in his hands! His mere touch was enough to cure! This may have been an exaggeration, but the importance of hands cannot be denied, especially for a manipulative physician. A physician’s hands convey compassion and understanding – more so those of an osteopath who makes use of his hands more than any other physician.

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