Vol. 3 No. 2 March,
1999
MERIDIAN INSTITUTE NEWS
Included in this issue:
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.]
Chiropractic Manipulation for Childhood
Asthma
To the Editor:
"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.
|
