Turner Publications & Osteopathy

Treating with Awareness of Relationships

Remember HEALTH means UNITY, ease, function and a harmonious relationship of all of the components of the whole with one another.

Disease means DIS-EASE, DYS-FUNCTION, SEPARATION and an inharmonious relationship between components of the whole

This means that it is RELATIONSHIPS that we are interested in – not the parts/tissues in isolation themselves. This means that in regards to any technique, we should not use techniques in isolation on a tissue oblivious of its relationship with surrounding tissues and with the whole in which it belongs.

Treating in isolation is analogous to beating a person over the head with a stick and expecting him to function better without helping him understand what he has done wrong. Most likely he will just go back to bad habits (i.e. dysfunction) afterwards when we are not looking because he does not know any better nor understand his role within the whole. But, by helping him understand his relationship with his surroundings (health) and with the whole, he will realize he is not functioning harmoniously and want to correct himself.

Thus, with regard to a technique, articulation for example, any text book which just teaches techniques purely to relieve symptoms in a tissue has been totally distracted from the idea of helping the tissues relate with one another and as a whole. The focus is pain relief (which is really helping the relationship between tissues causing symptoms and the symptoms themselves) is a total distraction from the real underlying relationships setting up the issue and thus neglecting these predisposing relationships. Before we know it, the whole ability to treat with any real understanding of what to do to restore harmony too the whole patient by treating effectively is therefore lost.

A SYMPTOM CAN NOT EXIST WITHOUT A PREDISPOSING CAUSE, so in order to improve symptoms it would make more sense to assess and treat underlying predisposing and contributing factors setting up the issue or otherwise slowing recovery – rather than the tissue itself (or at least prior to treating the symptomatic tissue/s itself so that it stays released). Thus, an arthritic facet, a thickened inflamed tendon, a stressed ligament, and a torn muscle are all effects and treating effects, other than a short term symptomatic relief and acute injury management at best, often has little long term effect on a patient’s recovery from illness or disease. This is especially the case in chronic dis-ease states than acute injury management but even in acute management, treating involved contributing factors can make a significant improvement to optimal recovery in the shortest possible time frame.

Take a simple vertebral segment; we can try to 1) just manipulate it or push on it and hope for the best without really observing its relationships and then educating it as to why it’s stressed, or 2) explore all the relationships it has with its surrounding structures (direct and indirect) while we treat and start to learn why and how it has managed to get into trouble in the first place. For example: lets study in more detail some relationships for T8: First it has eight (8) basic joint relationships – two facet joints above, two below and two rib articulations on each side (one with the vertebral body and disc and one with the Transverse Process). Then there is the vertebral body/disc articulation above and below. Also connected and forming numerous relationships are all of the various ligaments and muscles which happen to insert into that vertebral segment. Then there is the relationship with the nervous system which innervates it and controls it and all of the various muscles which act upon it; then there is the Sympathetic nervous system relationships connecting it with all of the various organs of the body related to that segment. There are also arterial, venous and lymphatic relationships as well as potential energetic, emotional, mental and spiritual links. The list goes on. In short a multitude of possible relationships, any one or many of which could be simultaneously involved in contributing to the Imbalance or final effect (i.e. a segmental dysfunction). If a practitioner had an AWARENESS of exactly which relationships are imbalanced then when carrying out his articulation technique, as learned from a text book, he could adapt his direction of force, rhythm, rate, amplitude and depth of pressure to address whatever relationship is most in need of resolving in order for the WHOLE to function more effectively. If he were not aware of the correct relationships, he could unconsciously articulate the joint in relationship with certain surrounding tissues which, in fact, may have an already balanced relationship and thus, there would be no effect (i.e. because treating a relationship that is already ok).

Furthermore – providing the correct relationships were included into a practitioners awareness and technique (consciously or unconsciously) this will ONLY BE SUCCESSFUL IF THIS SEGMENT (OR TISSUE) HAPPENS TO BE THE PRIMARY INSTIGATOR OF THE WHOLE IMBALANCE PROBLEM PATTERN IN THE FIRST PLACE, AND NOT MERELY A COMPENSATORY, AND OFTEN SYMPTOMATIC, EFFECT.

To the outer observer it looks as if a good AWARE practitioner is simply working on a segment in a very straightforward manner (i.e. carrying out a beautifully executed text book technique) and all of a sudden a beautiful change in the tissues occurs. Thus, others may think that it looks easy if they just follow the instructions of a technique/book (and not the tissues) and that they can just articulate the segment and achieve the same effect, without realizing that there is an AWARENESS element underlying, almost intuitively guiding the listening practitioner in the correct directions, manner, rate and rhythm in which to get the best changes. They then wonder why what they thought was a simple mechanical technique is not working and nothing is happening. Obviously the technique itself is not enough. The good practitioner gets a change because he is continually FEELING the response of the body to the implementation of his technique. He is meeting an equal and opposite mutual resistance and is constantly adjusting his variables (rate, rhythm, depth, relationship, etc) and working with the tissues until he finds the correct imbalanced relationship involved. This informs the brain, mind and consciousness of the patient what is going on (the where, how and sometimes even the why of it) so it can do something about remedying the situation and bring the imbalanced patterns back into alignment with a blueprint of healthy functioning (i.e. unity). He meets all the involved elements exactly and this provides equal and opposite feedback, just as would a good counselor between two disputing parties, helping each to understand their relationship with one another and therefore HOW to mend the rift in communication. If this inner consciousness could talk (call it brain/mind/innate awareness or whatever) it would say” Ahh… Thanks for informing me of where I am in relation to where I should be. Now I have all of the coordinates I need to bring the dysfunction pattern back into balance. Before the dysfunctional tissue was lost and may not, in many cases, have even realized it was doing anything wrong in relationship with the whole in the first place. THE PRACTITIONERS ROLE IS TO HELP RE-ESTABLISH BALANCED RELATIONSHIPS between balanced and imbalanced components of the whole. He does this through AWARENESS OF THE PRIMARY RELATIONSHIPS MOST INVOLVED IN THE DYSFUNCTION PATTERN (i.e. behind and setting up the effects).

How does he recognize these imbalances?

The obvious ANSWER is: FROM A WHOLISTIC ASSESSMENT or SCREENING PROCESS (which incorporated contributing primary regions and symptomatic regions) identifying a WHOLISTIC WORKING DIAGNOSIS, explaining the link from cause to effect, and NOT from a mere intellectual knowledge of symptoms or even advanced treatment techniques. Symptoms merely tell him the effect. Treatment based upon this is symptomatic management at best, not true healing (as true healing would build in more health). ASSESSMENT will UNCOVER THE CAUSES, PREDISPOSING AND MAINTAINING FACTORS, underlying the symptom picture and thus give him an understanding of the primary relationships he need to hold in his awareness and relate through his contact while he performs his treatment techniques.

This is true of any technique.

Thus, when learning any new technique and treatment approach, consider the following;
– Specific techniques for specific parts/segments learnt in class as part of formal training or from a text book are usually focused upon specific tissues – often the immediate tissues causing symptoms and not necessarily the primary tissues in primary areas of dysfunction setting up the whole problem pattern in the first place. Focusing on these specific tissues or symptomatically therefore means nothing if these tissues are not placed in context with the surroundings in which they dwell and with the whole (as well as being consciously linked to any potential condition a patient may be suffering). This context is uncovered via a good wholistic general and regional screening process.
– Treating any specific tissue and its relationships will only effective and useful long term, if the treatment technique addresses a primary tissues and relationship imbalances and not merely secondary or compensatory effects. Treating secondary dysfunctions (adaptive or compensatory components) – whether causing symptoms or not, will at best, deal with effects and not necessarily improve health and well being in the long term (in fact, it can delay it by delaying the day when the real underlying issue is dealt with in its entirety – cause to effect).
– Techniques to any parts of the whole should always be done to restore function (i.e. balanced relationships) between healthy tissues and unhealthy tissues (and not just between one structure and another relating to it, due to the fact that they both could be unhealthy when not compared with the whole and its healthy areas). Therefore techniques should always be performed with an AWARENESS of RELATIONSHIPS between areas and not in isolation on any specific structure. How else are we going to recognize when a component releases and functions once more in harmony with the rest of the WHOLE or not (i.e. as ONE).
– Pain and its relationship to the tissues which cause it are a distraction, quite often, from the underlying predisposing relationships which really need to be addressed in order for the patient to feel whole and balanced. The patient should emerge from a treatment feeling more balanced as a whole rather than one region just free of pain.
– One technique can be used more effectively if done with AWARENESS of involved relationships rather than a thousand techniques done without awareness, no matter how good is the technical performance of the technique. This awareness is what makes the technique work. Technique is useless unless it addresses the right imbalanced relationships. Thus, students should be taught to ASSESS with AWARENESS, (prior to and as well as the techniques themselves) so that they can treat and perform their treatment techniques effectively with awareness. Anyone can articulate a joint but only a physician who articulates with awareness will create an effective long term change.

Hopefully this discussion has given you food for thought when applying any technique. Next time when you work the tissues, whether it be with articulation, massage or any other technique, try exploring the anatomical relationships that structure has, one by one, with the surrounding structures, whilst performing you technique and OBSERVE the response of the tissues as you do so. Energy follows thought and so what you think about (provided you know your anatomy, know where each structure is and truly connect with the structure thought about) you will feel. Don’t be surprised if the textures of the tissues change as you bring into your awareness consciously to the different relationships, especially if they are involved. If relationships are ok, they will feel blended – as one. If not ok, you will feel a difference between the relationship previously explored (and held in the awareness) and the new relationship explored. You will then be able to feel and acknowledge healthy and unhealthy relationships. Then, holding the imbalanced relationships in your awareness while you treat, in relation to the healthy relationships also noticed, you can find the point of balanced relationship between these two patterns as you perform your technique and see what happens. It should make a difference in the engagement of the correct tissues and therefore the results of your treatment – provided you allow the changes by giving equal and opposite feedback and not force them (which is not equal and opposite force). Note: you can note this balance by sensing if you are pushing too hard, too light or just right. When equal and opposite – you will feel the tissues engage telling you that you are communicating both ways with the tissues, as you would with an interactive conversation over the phone with a friend. You will find that results come not by pushing or trying to push hard at all, but by being aware of responses and simply sinking your awareness into the tissues (and their relationships) and meeting the tissues responses. This takes practice to perfect but hopefully I have given you some important concepts to think about in your practice.

By Paul Turner: Resource: “Wholistic Integrated Assessment, A Teacher-Student Guide, 12 DVD set and Manual, by Paul Turner 2010, (www.turnerpublications.com)

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