Vol. 3 No. 2 March, 1999
MERIDIAN INSTITUTE NEWS
Manual Therapy in the Spotlight
Manual therapy (the use of the hands to diagnose and treat illness) is a primary modality in the Edgar Cayce approach to healing. Recognizing the importance of manual therapy, Meridian Institute has maintained ongoing research in the techniques and basic science of manual therapy (see Meridian Institute News, July, 1997; November, 1997; May, 1998).
Recently manual therapy has also been in the spotlight of attention because of a controversial study published in a prestigious medical journal. Essentially, standard chiropractic technique (high velocity/low amplitude “popping” or “cracking”) was compared to a more gentle form of manual therapy (massage and soft tissue manipulation) for the treatment of childhood asthma. The study, authored by Balon et al. and titled “A Comparison of Active and Simulated Chiropractic Manipulation as Adjunctive Treatment for Childhood Asthma,” appeared in The New England Journal of Medicine (Volume 339, 1998).
Subjects in both the experimental and control groups showed notable improvement in reduction of symptoms and improved quality of life as reported by the researchers. However, the conclusion drawn was that chiropractic is not effective in the treatment of childhood asthma.
The problem with this study is that the simulated “sham” treatment used as a control closely resembles the traditional osteopathic treatment for this condition. In other words, the favorable results obtained cannot automatically be assigned to placebo effect. Ignorance of the full spectrum of manual therapy compromised the methodological integrity of the research.
Edgar Cayce recognized the various manual therapy techniques in his readings. Although some readings recommended chiropractic treatment (which at that time usually involved the “thrust” technique which produces an audible “pop” or “crack”), more often the gentle massage andmanipulations used by osteopaths was prescribed. The gentleness of traditional osteopathy is emphasized in reading 1158-24: “Then, the SCIENCE of osteopathy is not merely the punching in a certain segment or the cracking of the bones, but it is the keeping of a BALANCE – by the touch – between the sympathetic and the cerebrospinal system! THAT is real osteopathy!”
Thus, the traditional approaches of chiropractic and osteopathy were distinctive and well-defined. However, times have changed. Whereas, modern osteopaths rely much less on manual healing, chiropractors have continued to practice manual therapy as the primary treatment. Actually, many modern chiropractors use a wide variety of techniques which include the traditional thrust method as well as a wide variety of soft tissue and energy treatments.
The asthma study cited above raises some key questions: Is manual therapy appropriate for systemic illness (such as asthma), or should it be used only for back pain? What is the role of manual therapy in the emerging health care paradigm? Should chiropractors (and other practitioners of manual therapy) be restricted to the treatment of musculo-skeletal problems? What techniques are appropriate? What is the role of soft-tissue techniques as practiced by the early osteopaths? These questions are loaded with political and economic significance.
From the Cayce perspective, manual therapy (and particularly the traditional osteopathic methods) can be very effective (and almost essential) for healing a wide variety of systemic conditions. So there is more at stake here than the scope of practice for chiropractors. The use of manual therapy in the treatment of systemic illness is fundamental to the Cayce approach.
Meridian Institute has focused on understanding and applying manual therapy in a series of research programs on various illnesses, including asthma. Furthermore, the doctors of the institute have called attention to the methodological flaws in the asthma study cited above, resulting in publication of a letter in The New England Journal of Medicine.
Meridian Institute Letter in the New England Journal of Medicine
[NOTE: The following letter was published in The New England Journal of Medicine; February 4, 1999; Volume 340, Number 5.]
“The conclusion reached by Balon et al. is based on the finding that there was no significant difference between low-velocity, high-amplitude chiropractic manipulation and a “simulated” chiropractic treatment involving low-velocity, low-amplitude manipulation. Regarding the rationale for this simulated treatment, the authors state, “We are unaware of published evidence that suggests that positioning, palpation, gentle soft-tissue therapy, or impulses to the musculature adjacent to the spine influence the course of asthma.” Although this may be true of the chiropractic literature, the manipulations used for the simulated treatment are those typical of osteopathic manipulative therapy, and there is substantial research on the effect of these types of manipulations on physiologic functioning, including respiration. Examples include the report by Howell et al. (1) on osteopathic systemic therapy for chronic obstructive lung disease and the report by Purdy et al. (2) on the systemic effects of manipulation of the neck. Kuchera and Kuchera (3) and Stanton and Mein (4) provide detailed discussions of techniques and mechanisms.
“Balon et al. found that both forms of treatment resulted in improvement in symptoms, decreased use of medication, and improvement in the quality of life. Although the relevant statistical data are not provided, an examination of the reported data suggests that these improvements were likely to have been significantly different from the base-line findings in both groups.
“Thus, the most that can be concluded from the study is that chiropractic spinal treatment is not significantly better than a rather crude form of osteopathic soft-tissue treatment. Concluding, as the authors do, that the improvement in both groups was simply due to a placebo effect is not justified, since the physiologic effects of manipulations similar to the simulated treatment are well documented.”
Douglas G. Richards, Ph.D.
Eric A. Mein, M.D.
Carl D. Nelson, D.C.
Meridian Institute
Virginia Beach, VA 23454
References
1. Howell RK, Allen TW, Kappler RE. The influence of osteopathic manipulative therapy in the management of patients with chronic obstructive lung disease. J Am Osteopath Assoc 1975;74:757-60.
2. Purdy WR, Frank JJ, Oliver B. Suboccipital dermatomyotomic stimulation and digital blood flow. J Am Osteopath Assoc 1996;96:285-9.
3. Kuchera M, Kuchera WA. Osteopathic considerations in systemic dysfunction. Kirksville, Mo.: KCOM Press, 1991.
4. Stanton DF, Mein EA, eds. Manual medicine. Phys Med Rehabil Clin North Am 1996;7.
Early American Manual Therapy Website
A website has been created to make the traditional manual therapy literature more accessible. The Early American Manual Therapy (EAMT) website contains the text from several books and articles from the late 19th and early 20th centuries. The principles and techniques discussed in these sources are virtually identical to the recommendations made by Edgar Cayce. In part, the EAMT collection includes:
Osteopathy Complete (1898 – 566 pages)
by Elmer D. Barber, D. O.
The Practice and Applied Therapeutics of Osteopathy (1905 – 442 pages)
by Charles Hazzard, D. O.
The Abdominal and Pelvic Brain (1907 – 671 pages)
by Byron Robinson, M. D.
Neuropathy (1909 – 136 pages)
by A. P. Davis, M.D., N.D., D.O.
A Manual of Osteopathy (1909 – 174 pages)
by Eduard W. Goetz, D.O.
Text-Book of Osteopathy (1910 – 97 pages)
by American College of Mechano-Therapy
The EAMT website is located at:
http://members.visi.net/~mcmillin
If you have access to old manual therapy resources that would be appropriate for the EAMT collection, please contact Meridian Institute.
Dr. Mein Speaks on Manual Therapy
Dr. Eric Mein will speak at a meeting of the American Academy of Osteopathy in St. Louis this month. The title of his talk is “Models and Techniques of Manual Regulation.” Dr. Mein will compare the philosophy of Andrew Taylor Still (the founder of osteopathy) with Edgar Cayce’s approach. Both recognized the crucial ability of the body to become well if obstacles to healing were addressed and treated. Cayce emphasized four key manual therapy concepts to achieve physiological regulation: coordination, centers, reflexes, and drainage. The talk will focus on the first two of these as they are not commonly discussed or taught at the present time. This will include presenting the concept of stimulation vs. inhibition with treatment and the importance of coordinating certain centers along the spine vs. localized treatment alone. The presentation will draw both on the historical osteopathic literature and the Cayce readings for techniques and examples, and review research exploring the mechanisms of these techniques.