MECHANICAL LINKS

Talks about osteopathy with doctor Matvey Zvezdin 

All of us have some common ideas about our body and our health; about the ways we must treat our body to stay healthy.  Also we have a general idea of how the doctor works with our problems. 

Be sure, the experience you acquire visiting the osteopath breaks all these stereotypes and makes you change an attitude towards your body and to the very conception of health and disease.  

You are getting hypnotized by the movements of his hands. The osteopath seems to be practicing witchcraft over your body. You feel the slightest touches to the different parts of you body prima facie unrelated to the disturbing one. The image of a magic dance comes to your mind. Perhaps, if some choreographer decided to convey the idea of healing in the language of dance, the performance would have been looked like this. And now you start suspecting that all this beauty of the hands moving, the beauty of accurate and adjusted gestures is the necessary part of osteopathic treatment. But this thought is strange enough to evoke doubts. You got used to quite different way of being cured. Your body appears to be stubborn and obstinate. You feel that to get an effect it needs a direct and brute influence, even violence. You are disposed to think that the force of influence on the diseased organ must be proportionate to the seriousness of illness or to its painfulness, be it chemical or mechanical influence. You got accustomed to the idea that curing is unpleasant and always attended by pain. This is how the way of treating your organism is shaped. And this frame of mind is totally incompatible with osteopathic philosophy. But it’s the very model of treatment essential to traditional medicine and deeply rooted in public consciousness. It’s this model that evokes distrust and sometimes an inner resistance to the osteopath. It’s worth investigating the difference between osteopathy and mainstream medicine; and the perspective of osteopathy on a human being, his/her health and disease.  

Matvey: To my point of view, it’s the capability to listen to the organism, to hear what is going on in the organism, to grasp its intrinsic rhythms and genuine desires that differs osteopathy from allopathic medicine. If to keep it back osteopathy will disappear.  

What do you mean by listening to the organism? You are talking about a special sensitivity of the osteopath’s fingers? 

I’ve started understanding the difference between osteopathy and other manual practices at a workshop ran by a Danish specialist Johannes Fassgrin. He had put his hands on the patient. The aim was to listen to how the rib moves and not only in time with breathing. We had to hear the intrinsic movements of the rib. I had laid my hands on his hands and felt how he was feeling the inner life of the organism, its own movements. I had some experience of manual treatment before, which was of manual therapy and massage. But this workshop became a watershed for me. 

What is manual therapy? 

Manual therapy is a set of techniques applied to the three parts of vertebral column:  a cervical spine, a thoracic spine and a lumbar spine. These techniques embrace head rotation, pressing and massage as well. In other words, some manipulations are being conducted over a patient. 

Is it effective?  

Well, it’s has some effect but a scanty one. It’s like a black box. You have something at the input and you get something at the output. But osteopathy is an attempt to look inside this black box, to see what is going on there, and on the base of it to pick out an effect. The understanding of this made a revolution in my mind. 

What is the nature of osteopathic knowledge: is it rational or irrational? 

At first, you can talk about your sensations only in the sense of plus – minus, i.e. you feel nothing and suddenly start feeling something. Then the feeling is being specified. Let’s take the rib as an example. Commonly we consider it to be a structure responsible for respiratory excursion. And this is all we feel about it. But all of a sudden it turns out that some other movements are inherent to it like movements forward – backward, sideways, movements similar to a bucket handle or a pump. And when you realize that these movements exist, you clearly feel which movement isn’t carried out, that is the rib tries to move in the direction of some block but it can not, something impedes it. It’s osteopathy that helps to overcome this impediment. But performing several manipulations over this rib – pressing it, stretching it – has nothing to do with osteopathy. First you have to feel, and then you are ready to comprehend.    

Is the fine sense of touch a gift or it is gained through training and practice? 

I don’t think it’s a gift; it’s rather the result of training. 

But in the case of osteopath we are talking about a special sensitivity – about supersensitivity of hands… 

           Classics of osteopathy give an analogy to explain the nature of this alleged supersensitivity. Imagine us walking through the pine forest. Our feet feel pine-needles and twigs crunching, we feel the texture of the soil. Then we pass to the marshland and feel being sucked in, we are looking for tussocks. We move to the sandstone and feel the texture of the soil changing. If feet possess such a sense of touch, what can be said about hands! When a capability to apprehend an object is being imposed on the knowledge of this object we get a special sensitivity, alleged supersensitivity. Just we never reflect on this.  

We conceive human organism as something closed. It’s possible to look inside only cutting it or doing either an X-ray or ultrasound testing.  Osteopathy proceeds from a conception of the hand as an instrument of investigation and testing of the organism.  

You can feel even with buttocks, but hands are more suitable. The point is not in the supersensitivity of hands but in reflection over what you feel with your hands. You can feel 10 cm inside the organism but you have to know what you feel, you have to translate it into images. Being of no importance if they are verbalized or not. 

To accomplish all this you have to know anatomy well 

Yes, this is the most difficult thing. For me and for other osteopaths anatomy is the passion of all life. Andrew Still himself, the founder of the osteopathy, used to say: “There are thee principles of osteopathy: anatomy, anatomy, anatomy”. The very heart of the living anatomy is that it requires a permanent investigation. For example, an abdominal surgeon can thoroughly know everything concerned to the diseases he cures, and he has an illusion that he knows all the anatomy.  But osteopath deals with the whole of the organism. And you always have a feeling that something is left unknown. You always rest on something unknown, you always advance. I know osteopaths with 40-50 years of experience and still they keep studying anatomy every day. 

What’s the difference between the standard view on the human anatomy established in mainstream medicine and osteopathic conception of the bodily structure? 

Classical anatomy neglects lots of living structures for their functions are not clear; it’s an anatomy of the dead man, in the organism of which nothing moves. These living structures take on special significance thanks to the functions which are absent in the corpse. First of all I mean fascias. Fascias are membranes. If in the anatomy of the dead body fascias are just lifeless sacks containing organs, in the osteopathy fascias are nearly the most important thing. 

Now ultrasound testing is available. You can see almost all the inside movements there. 

Yes, they are seen but not all of them. Perhaps, kinesthetic feeling is finer than the visual one. 

How did osteopathy come to the idea internal organs move? 

This view doesn’t conflict with the traditional one. Everyone who wants to find movements of internal organs finds this.  For instance, cranial bones are considered to be fixed. But the point is that the movements of cranial bones are so slight in comparison with, lets say, the heartbeat, that most physicians think them to be inessential and simply don’t pay attention to them. I’ve already mentioned my experience of rib movements. We can recall the experience of John Aplanger, the most famous osteopath of our days. He was originally a neurosurgeon. Once he assisted at a very serious operation on the cerebrum with the trepanation of the scull.  Surgeon-in-chief entrusted him with holding the pachymeninx. Of course, he tried to hold it as best as he could but all the time it slipped away from his hands. He was very much surprised and tried to understand this phenomenon. It turned out that the slight movements, essential for the pachymeninx, were more intensive in the case of this patient because of the pathology he had.  Those movements were more energetic than the power of Aplanger’s hands and prevented him from holding the structure. So he moved from neurosurgery to osteopathy. And now he is one of the leading specialists in craniosacral therapy.  

There are three currents in osteopathy. Which one do you attend? 

I’m engaged in synthesizing all three of them. 

Why are so sharply divided? 

It’s rather difficult to develop an equally fine sense of touch for the skull, for the spine and for the internal. It’s easier to work with organs of the definite density. If to take the analogy with walking in the forest, one specialist fells better the texture of the pine forest, another one – the texture of the marshland and the third one – the texture of the sandstone.  

When you studied at Higher Osteopathic School was there a specialization? 

Yes, there was, as well as at the medical institute. In the process of studying a student little by little comes to choose a sphere of his interests. I have found a narrow specialization for myself that embraces a maximum number of organs. In other words, I have chosen to specialize in mechanical link of these structures. This is my soapbox, and by this I’ve won my spurs at Higher Osteopathic School. But certainly, it was a kind of ruse, because if I had started specializing, let’s say, in the spine I would have been moving only in this direction: I would have been teaching the spine at School, my patients for the most part would have been people with the problems of the spine, etc. But this is the very attitude –a partial one – to the human organism that osteopathy tried to avoid, and there’s no sense to return to it.  

The term “osteopathy” has got several interpretations based on the meanings of Greek and Latin roots composing the word.  One of the interpretations relies on the translation of the Latin “pathos” as empathy or sympathy or compassion. So it turns out that osteopathy is the osteopath’s compassion to bones. Svyatoslav Novoseltsev in his book “Osteopathy: the main techniques of treatment and self-help” develops this subject and says that not everybody can be an osteopath for besides the sensitivity of hands and the knowledge of techniques you need definite personal qualities and empathy is in the first place. 

No, I don’t agree. Everyone can be an osteopath if he/she wants to gain an understanding of it. I think that when we talk abut empathy in this context we have in mind the difference between the osteopaths’ manipulations and those of the manual practitioner. Osteopath conducts manipulations in response to an impulse coming from a patient, not according to some priori pattern in his mind. Thus the knowledge of this impulse and the capability to provide a feedback distinguish osteopath from an orthodox physician.   
 

But as I got it, Novoseltsev was talking about empathy to the patient. Osteopathy, as you see it, presupposes no empathy at all just a pure manipulation, doesn’t it? Then it turns out that osteopathy professes the same naturalistic approach that characterizes mainstream medicine forgetting that patient is not merely an object but also a subject. This means that osteopathy runs a danger of losing its special double status – that of the humanitarian as well as of scientific practice.  

I think that osteopathy is such a field of medicine where humanitarian and scientific approaches meet. You can sympathize bones and tissues with all your might but without a deep knowledge of them you won’t be able to sympathize them fully. The lack of knowledge is a misfortune of the great many extrasensory practitioners and various healers. Piles of compassion, quite often a sincere love to people but the lack of knowledge leads to a deadlock. And as far as an absolute and perfect knowledge is impossible there must be an urge towards knowledge. 

Anyway, all the osteopaths graduate from medical institutes, Higher Osteopathic School, and everyone has enough medical experience, someone as a traumatologist, another one – as a pediatrist, and some one else – as an obstetrician. Mainstream physicians become osteopaths not because of wishing something extraordinary but because they realize their previous way as leading to the deadlock and try to find something all-embracing. 

Mind and Body  

Quite often we say: “It’s because of nerves”, pointing to the cause of this or that disease.  The idea that stress is the villain to be blamed for the ill-health of the contemporary mankind seems to have penetrated into our mentality. But when it comes to the cure, we forget about these truisms and start bombarding our body with drugs trying to eliminate symptoms and ignoring the very psychological causes we discuss with such enthusiasm.  

In fact we can hardly imagine how a causal relationship between our psychological problems and the states of our body is formed and is being maintained. Both sides of the connection seem for us to be hidden in the darkness. We have to rely on doctors in choosing ways of treatment. But the contemporary medicine is still in the grip of Cartesian dualism, it can not understand how two substances – the thinking one and the extensive one – can cooperate and prefers to deal with one of them – the body.   Hence all manifestations of the mind are being reduced to the laws governing the body. Depressions are being cured by antidepressants, insomnia - by somnifacients. It appears that for the physician disease as well as health always refers to the body, whatever reservations about emotions can be attached. Undoubtedly, it’s a fast and easy way to relieve a human being from sufferings but only for a while. Diseases return or suddenly catch this partial “homo corporalis”. 

Osteopathy proceeds from a fundamentally different idea of the human being as unity and integrity of body, mind and spirit. Consequently, in this case a state of being healthy presupposes the health of all the three constituents of this unity and their balanced cooperation. Hence it’s evident that it’s not easy to be healthy, it requires permanent efforts, a kind of everyday work – self-care. In other words, a serious appeal to osteopathic therapy requires the changing of your world view, forming a new culture of treating your body and mind. 

Matvey demonstrates how the idea of psychophysical unity is being embodied in his practice.   

Let’s consider such a case: you understand that your patient has some psychological problems provoking a reaction of organism. You keep healing the patient. But you can heal him all his life if the psychological source of the somatic problem has not been eliminated? Or your treatment can have a converse effect? 

Both variants are possible. You can be curing a patient all his life relieving him from a somatic problem. But I’d better consider a reverse case. If somebody comes to a psychotherapist and he has some somatic problem… 

Then the psychotherapist will tell him that it is rooted in a psychological problem. Yes, it’s a common practice in psychotherapy but not in medicine. 

Exactly! But there must be a bidirectional movement. The psychotherapist should refer a patient to the osteopath when psychotherapy rests on some somatic problem, otherwise this somatic problem will again provoke a chain of associative reactions leading to a low psychological status. And vice versa – if psychological status constantly renews a somatic problem, it’s worth referring a patient to a psychotherapist. But the best way is to combine both forms of cure. Probably, it’s the only way to keep your organism healthy. 

Do you talk to your patients about the mental aspect of disease? Do you give advices? 

I have a limited psychotherapeutic resource at my disposal. When I consider the case not so complicated I can help by advice or to use some psychotherapeutic techniques I know. But if I see that the case is knotty I tell a patient that it’s beyond my scope. And then it’s the patient’s business to make his mind – to go or not to go to a psychotherapist. He could be satisfied with his psychological problem, be aware of it and agree to live with it further.  

When you see the source of the problem do you tell your patient about it? 

Yes, I do. I often notice the effects of mind over body, and it helps me to diagnose as well as to choose the direction of treatment. Let’s suppose that I see the spine tend to deviate heavily backwards. And this tendency betrays definite problems. I understand that a patient rests on a kind of psychological ceiling; some circumstances prevent him from advancing. As a result e begins to bend backwards in order to remain inside these circumstances. Accordingly, I work with the spine and let a patient know about my version. And then it’s up to him to accept it or not to accept. 

Is this your own idea, your own image? 

Yes, it’s mine 

But it’s only a hypothesis and the point can be in something else? 

Yes, but hypotheses mostly help somehow in treatment. 

Could you give some examples? 

Yes. A man was capable to change his social environment, his work and family for the sake of his spine. The spine became more straight and the man - happier. 

What kinds of cases prevail in your practice: those ones when the body induces a psychological problem or those ones when the source of a somatic pathology lies in a psychological misbalance? 

Mostly there’s a clew of problems being winded up around some basic, initial problem. For instance, a somatic problem leads to a psychological clew. A person tries to grasp it from the side of psychology but it’s totally of no use. But after two visits to me psychological problems of this person start rapidly being solved though I could haven’t touched them at all but have worked only with body.  But also there’re cases where psychological problems are fundamental. And then I “spin up” the body bringing a patient to an understanding that the problem is purely psychological, it’s just being channeled to the body. And after that a person makes a choice either to go to a psychotherapist, to a priest or not to go anywhere and to live with this problem. A human being is always a clew of psychological and somatic ailments. And the question is from what side to unravel it. Certainly, it’s better to unravel from that side that is nearer. But there’re also pure somatic problems, e.g. maternal dystocia. A collar-bone of a patient was gripped in maternal passages, and it caused a change in bodily balance. And until I straighten this collar-bone it’s useless to talk about psychological problems. 

Is it an accepted view in osteopathy?  

Certainly it is. Anyway, every osteopath tends to some camp. Somebody begins to study body-oriented psychotherapy and uses it in his practice, somebody just go to the church and brings there his patients. It doesn’t matter, which confession is chosen – catholic or orthodox or some other else.  

This correlation of mind and body is of a great interest. Did anybody investigate it? 

Of course! It’s constantly being investigated. Applanger applies techniques of somato-emotional release.  Philip Druel uses techniques of solving family problems. Some psychological problem can affect the body and not of one man but can be handed down. A practitioner can find identical somatic problems in a series of generations and he works with these problems. Jean-Pierre Baral has very interesting techniques of diagnosing the origin of psycho-emotional problems, which include exact determination of time, place and an event itself basing only on the somatic indicators. 

It sounds incredible! 

But all this has a rational foundation and is based on a perfect knowledge of anatomy. We test tissues and, in particular, a tissue of the brain. It’s the same tissue as that of the kidney or the knee-joint. And the condition of this brain tissue, in particular, the level of tension in the definite zones of the brain makes it possible to understand how it functions; here the “memory” of emotional traumas is included. 

Attitude to medicaments 

I consider contemporary pharmaceutical therapy to be necromancy. What is mostly taken in a medicament is a level of influence a given chemical substance has on a separate process in the human biochemistry. And this process is either being stopped or weakened depending on what we need to achieve. But since the organism is not an ideal test-tube with one substance, which can be affected this or that way but a complex of interdependent substances, it’s impossible to trace how an influence on one process will affect other processes in the organism. In other words, I’m talking of necromancy because when we affect a process in some way we can reveal only evident and immediate drug side effects but remote ones nobody can and, as a rule, doesn’t want to reveal. Besides, medicaments are invented in laboratories by one category of practitioners and are used by another one. And often both sides have a mutual deficiency of knowledge. Those who synthesize drugs do it basing on some theoretical assumptions. They don’t know all the reactions of the organism since studying the organism is a dynamic process and it’s impossible in isolation from a patient. 

Limits and possibilities of osteopathy 

The whole osteopathy is based on the idea of the self-regulatory capacities of the body. Our organism possesses inner resources for self-maintenance and self-repair. The osteopath just helps to recover these capacities and stir them to activity. But there must be limits of the osteopath’s competence, some bounds beyond which it’s impossible to strive against disease without pharmaceutical or surgical invasion. 

I have plenty of experience in mainstream medicine. I worked in the ambulance and in cardio-reanimation at the Institute after Sklifosofskiy. So I can avoid talking baselessly on this subject. The overwhelming majority of cases demanding such sharp methods of therapy as operation or antibacterial therapy is determined.  

And let’s take high blood pressure or cardiac diseases. When you have high blood pressure you are dependent on drugs. 

One of the causes of increased blood pressure is a psychological disadaptation. Besides, quite often it can be damage of cervical vertebra or, for instance, brain tunic. These pathologies can be cured with osteopathic techniques. And without solving these problems vascular centers remain in the state of compression, that is, abnormal functioning.  

Is this also true for the heart? 

The heart is also a complex psychological and osteopathic problem. Once I managed to put off myocardial infarction for long but, unfortunately, I didn’t manage to eliminate its possibility. Tension of intercostal muscles and intraosteal tension of sternum permanently squeezed the heart of the patient. I managed to remove these extra tensions and this way to prevent heart attack.   This was confirmed by EKG: the patient had heart attacks before and he stopped having them after osteopathic treatment. But this patient lived in another city and besides, there was a strong psychological background, so myocardial infarction did take place 10 years after treatment.  

Can you help those patients with very advanced cases?  

Sometimes I can and sometimes it’s too late. If some changes occurred in the heart, then the organism will not be able to function as before. But if to choose the ways of rehabilitation I would discuss which one is better: pharmaceutical or non-pharmaceutical. It’s quite possible when you have heart disease or high blood pressure to keep your organism at a level of stable functioning by non-pharmaceutical methods, combining osteopathy, psychotherapy, homoeopathy, curative gymnastics, meditation and stress-therapy. It’s possible to do without drugs even in serious chronic cases. 

Is it possible and necessary? 

In my opinion, it’s a patient’s own choice.  Here a lot depends on the up-bringing. 

Pills are not good because the organism stops using its inner resources when becomes dependent on them? 

Certainly! Plus lots of side effects appear, and a man/woman recognizes them as independent diseases. A typical case: somebody takes pills for the heart but, simultaneously, his kidneys, hearing, vision, gastrointestinal tract, etc. start pinking. And he begins to take pills for these diseases.  Until one day he, by fortune, spits upon all this and starts living without any cure, still being ill. 

Cancer. You can not do anything about it! 

And what traditional medicine can do about it? 

Cancerous growth is being cut out, and a patient is being exposed to chemotherapy. 

And a person becomes physically deficient? 

What do you mean by this?  

After chemotherapy immune system and musculoskeletal system go headlong. 

And what should we do? Is there an alternative? 

Yes, there is an alternative. As well as you are able not to allow cancer to ensue by preventive treatment, you can maintain the life of the patient with non-pharmaceutical, noninvasive methods during the same period of time as with the help of chemotherapy.  

Can you diagnose cancer on an early stage? 

Yes, there were cases when we diagnosed cancer. 

It’s due to the sensitivity of hands? You can feel it? 

Yes, you can feel a cancer. A target affected organ stops moving, stops doing micro-movements. Or, perhaps, first an organ stops moving and then cancer emerges. And this limitation of mobility you can reveal earlier than substratum appears. But, unfortunately, our experience was unsuccessful. We had diagnosed cancer early than doctors did. They diagnosed it only post-mortem. But we failed to help that man because he hadn’t trusted us and went to different doctors to be examined. But they couldn’t diagnose anything. The result was failure. 

What kind of cancer it was? 

It was an intricate cancer of stomach. But the cancer was under the slime layer or even inside the muscular layer of stomach, which is a rare thing. We defined neatly a character and localization of that cancerous growth.  

In your practice were there such cases when you diagnosed something and the results of X-ray or

ultrasound examination contradicted your diagnosis? 

To tell the truth, there were no such cases because the patients coming to me have already visited all the traditional doctors and have in there hands the results of different kinds of testings. But since an ordinary treatment doesn’t help them so much they appeal to me. And on the whole, osteopaths are honest guys. The say that if after the third visit there’re no results, it’s necessary to go to some other specialists. 

What kind of specialists? 

From my point of view, first of all, to psychotherapists. 

The medicine of the future? 

All the logic of our talk brings us to the point that the people who really care about their health should stop visiting policlinics and apply to osteopaths. But it’s well-known that the number of osteopaths is far less than the number of traditional doctors. 

In theory, it would have been absolutely right. After all, if the medicine becomes preventive, and osteopathy aims at this, it will be enough to visit osteopath once half a year for the sake of prophylaxis. 

Yes, but at the same time you also need a psychotherapist as well as homoeopath. It turns out that our picture of self-care is for the rich. It’s impossible to accommodate osteopaths, psychotherapists and homoeopaths in policlinics, isn’t it? Perhaps, it’s possible but what kind of specialists will they be? So people in any case are doomed to ill health. 

I’d better change the perspective of argumentation: there are few good doctors as well as there are few good osteopaths, psychotherapists and homoeopaths. I often deal with high-class professionals: surgeons, ENT, oncologists whose frame of mind is closer to that of osteopaths than to that of mainstream doctors. As well as I see a good deal of osteopaths that act like the most old-fashioned surgeons: rummage a diseased knee even if the cause of the disease is somewhere else. There are surgeons who treat every tissue with care. They perform a filigreed operation ablating only what is necessary to ablate and not touching what it’s possible to reserve.  In fact, they are acting like osteopaths. 

I can not imagine how surgeons can abandon using medicaments! 

Yes, but we must aim at using as few drugs as possible. We must pass along the edge: to achieve a medical effect leaving out side effects as much as possible. But this is the very principle of osteopathy though expressed in another language. I gave an example of John Aplanger who was a surgeon and had become an osteopath. But many osteopaths become surgeons, especially at war. It would be rather an osteopath with a thorough knowledge of anatomy to extract the bullet than a professional surgeon but with the lack of anatomical knowledge. 

Masculine and feminine 

What’s the main difference in treatment of women and men? 

The difference lies in psychology as well as in physiology. Feminine hormone cycle, capability of child-bearing introduce some amendments into the way of treating women. Besides, masculine and feminine organisms have a different structure and mechanics, for example, the pelvis is different, the body center of gravity is different. But the basic method I employ tends to universality. I.e. I estimate the condition of structure regardless of its functional peculiarities. So we can say that this method is applicable to the treatment of men as well as of women, of children as well as of old people. Broadly speaking, it’s possible to remove basic tensions irrespective of their cause. For example, when I make testing of the sacrum by the method of mechanical connections, I take into account that men have a flat sacrum and women – a concave one. Besides, in women’s case the uterus is being tested and in men’s case – the prostate. 

All gynecology is based on the medicinal ways of treatment. 

Yes, it is, but it must be based totally on osteopathy. In gynecology as well as in urology osteopathic methods give much more exact results because we can come directly to the tissue: not indirectly through the skin but outright through the vagina in women’s case and through the rectum in men’s case.  

But inflammations of vaginal mucous tunic are cured mostly by suppositories.  

The osteopath can correct the functioning of the immune system in the zones responsible for immunity, i.e. in the hypophysis and thyroid gland as well as he can remove blocks and congestions in the pelvis. 

And what about venereal diseases? 

It’s quite an interesting story about venereal diseases. Not everyone who contacted with carrier of syphilis becomes infected. It’s a question of resistance of the organism.