« To date, for the last 18 years that I have been practicing, I have never failed on an asthmatic patient. I therefore affirm that for asthma, osteopathy is sovereign. »

A.T. Still 1897 (Founder of Osteopathy)

ASTHMA

Epidemiology :

There are 1000 deaths each year in France due to asthma. It affects nearly 3.5 million French and 10 million people under 45 in Europe, 7 to 10% of children.

Asthma is a chronic inflammatory disease of the respiratory system and more specifically of the bronchi which results in a sensitivity of these “bronchial hyperreactivity” to certain stimulations. Pollen, dust mites, animal hair, stress, food allergens, pollution, tobacco, physical exertion, climatic variations and respiratory infections can be triggers. But sometimes, the triggering factor of the crisis remains unknown … It should be noted that 80% of asthmatics suffer from allergic rhinitis.

This bronchial hyperreactivity involves:

• Bronchospasm: a contraction of the bronchioles, thus causing a narrowing of the passage of the air (1st cause of bronchial obstruction).
• Bronchial hypersecretion: the inner lining of the bronchioles will ignite and secrete mucus (2nd cause of bronchial obstruction)
• A dry cough: To clear his bronchi, the patient coughs with a dry cough.

As many reactions  result in asthma attack.

The breathing becomes wheezy, accompanied by shortness of breath and sometimes a feeling of tightness in the chest. To clear his bronchi, the patient begins to cough with a dry cough.  During the crisis, breathing, but more especially expiration of air in the lungs, are more difficult, as if the air circulated in a thin straw.

An asthma attack is often preceded by warning signs, which are different for each asthmatic. However, they rarely vary in the same person.

Symptomatic drug treatment:

The drugs can then improve breathing by limiting inflammation and obstruction of the bronchi because lack of conventional medicine to identify its cause, the treatment remains symptomatic and requires, sometimes for life, the taking of drugs if the we do not want to suffer an exhausting and oppressive respiratory discomfort.

What would be the cause of asthma?

Osteopathy brings a new way of thinking.

According to official medicine, the main factor at the origin of asthma are hereditary, allergic or infectious. An infection of the respiratory system will weaken the tissues, thus promoting their inflammation (80% of asthmatics suffer from allergic rhinitis). But a distinction should be made between “triggers of asthma” mentioned above and the real cause of asthma. Official medicine tells us that the cause of asthma is unknown. This is where osteopathy can bring new

Inflammation of the bronchi is the basis of asthma.

However, isn’t all inflammation a “normal defense of the body” in response (albeit exaggerated) to real or perceived aggression or an attempt to repair it?

And to really understand the origin of asthma, (i.e. its cause), wouldn’t it be a better approach to look into the factors that led to the inflammation rather than  on the inflammation itself in order to identify the origin of asthma ? Is this not where the supposed cause of asthma must be found? What makes certain stimuli in some people provoke this kind of reaction while that the same stimuli do nothing to others? Is there no reason to wonder why this answer is different?

This question has opened to holistic osteopaths a path of reflection that allows them to overcome asthma attacks.

« It is necessary to have a solid knowledge of the spine, because many conditions are indeed caused by a defective state of this organ. »

HIPPOCRATE De articulis § 45 (435 BC)

How many sessions in total and after how long are we entitled to expect results?

Treating children with asthma in osteopathy gives spectacular and lasting results, most of the time in one to two sessions.

For adults, it takes a little more perseverance and obstinacy but 4 to 5 sessions can largely be enough to completely eradicate asthma.

This requires that the patient be careful not to  ‘re-lock’ his spine after the sessions which would invalidate  positive effects of the treatment. So-called postural hygiene measures must be adopted by the patient (the patient must take care of himself) in order to avoid that symptoms reappear.

(Click on this link below to know them)

How can osteopathy achieve such results?

Asthma is an “expiratory difficulty”, (normal inspiration but wheezing exhalation). The “inspiratory difficulty”, characterized by wheezing and normal exhalation, is as common and disabling as “expiratory difficulty” but is considered “false asthma”. Doctors and patients do not always make the difference because between the two, often  treatment is the same, although it is known that taking bronchodilators (Ventolin) is much less effective on “inspiratory dyspnea”. Indeed, expiratory difficulty (true asthma) is due to a bronchial spasm (intrathoracic) while inspiratory dyspnea is caused by a pharyngeal spasm (extra-thoracic, hence the name “false asthma”). The treatment will not be the same because the blockages inducing these two types of asthma are not the same. Bronchial spasm (true asthma) is generated by blockages located mainly in the first 3 thoracic segments (or stages) whereas pharyngeal spasm (false asthma) is due to a high cervical blockage C0 / C1 / C2.

In Osteopathy, we consider the patient as a whole. The body is a unit that suffers influences of different origins: psychological, environmental and physical. These influences will cause musculoskeletal responses (joint blockage) in the body.

Therapeutics must therefore take into account all the disturbances of the body diagram, the associated emotional and visceral disorders, the sensitivity of each person, the use he makes of it, the neuro-motor reprogramming or proprioceptive education if necessary, the correction of a defective power supply, tooth rebalancing, fitting …

What happens to the asthmatic subject?

It is remarkable to note that we find almost systematically the same blockages (well-defined specific mapping) in all asthmatic patients. There is therefore a parallel between the localization of blockages at the cervical and thoracic level and a particular expression of asthma. A well-defined cartography of the blockages of the thoracic cage and the very precise cervical region is proof of this. It is these blockages that will eventually lead to the asthma attack. It should be noted that although these blockages are systematically present in any person suffering from asthma, it is not uncommon to find these same blockages in people without asthma. This suggests that there is another factor (still unknown) concomitant blockages for the pathology can be expressed. A notion of terrain could possibly be considered.

What we find as blockages (as well as variations) in asthmatics:

In true asthmatics, that is to say those suffering from expiratory difficulty and not inspiratory, we will have a predominance of blockages on the right, responsible for an overall retreat of the entire upper part of the right hemi-thorax ( costal posteriorization visible to the naked eye of the right hemi-thorax). In subjects with false asthma, that is to say having an inspiratory dyspnea, blockages will be indifferently sometimes right or sometimes left, sometimes even bilaterally and will be accompanied systematically (very specifically) cervical blockages C0 / C1 / C2 characteristics of this state. These are all blockages that will be responsible and eventually lead to the asthma attack.

The distribution and combination of all these blockages among them will define and distinguish the predominance of asthma. A blockage in the first thoracic stage will reflect the allergic aspect of the person and therefore characterize predominantly allergic asthma; in the second thoracic stage, asthma has a greater secretory component, and on the third floor, asthma has a greater broncho-constrictive component. We can see that depending on the size of the blockages, their precise location and combinations, we will face a different variety of asthma.

All this is explained by the fact that each vertebral stage is responsible for the innervation of a particular territory that corresponds to it [muscular (myotome), articular and ligamentous (sclerotome), cutaneous (dermatome), vascular (angiotome) territory, visceral (viscerotome)]. When a blockage is present, it will have a disruptive effect and will generate an excessive discharge of nerve impulses at the level of the metamère, thus lowering the threshold of sensitivity (increase of the irritability) on all the corresponding metamerican territory, which will result in hyperactivity of the region concerned, which, in the case of the visceral territory (in this case the bronchi), will cause bronchial hyperirritability at the origin of the asthma attack. It is the same for the cutaneous territory causing this time a deregulation in the skin (for example: eczema or psoriasis).

As we see, everything is played primarily at the level of the first 3 thoracic stages and the upper cervical region.

A mechanical phenomenon: the liver

Importance of the influence of the liver / diaphragm pair on the blockages of the thoracic cage or the indirect role of the diaphragm in the genesis of the torsional process of the thoracic cage.

The explanation of osteopaths:

The diaphragm is the most powerful muscle of the body and it is thanks to its contraction that the entry of the air into the lungs and its relaxation that we have rejection of this same air to the outside. But the main obstacle to the proper functioning of the diaphragm (alternation of contraction / relaxation) is due to the presence of the liver, the largest organ of the body, which is suspended under the two-thirds of the diaphragm. Flexible when the body is healthy, its density can increase in case of functional insufficiency and thus limit the amplitude of the diaphragm. The increased density of the liver creates traction under the right diaphragmatic cupola which causes a rotation of the thoracic cage (posteriority [recoil] of the right hemi-thorax and anterior left shoulder). Remember that the diaphragm attaches to all the inner and lower edges of the ribs.

The anatomical displacement of the shoulder increases the tension of the muscles that connect the shoulder to the cervical vertebrae and mainly the scalenes. However, the scalenes are precisely the accessory respiratory muscles that are stressed when the amplitude of the diaphragm is mechanically limited.

Stellate ganglion involvement

In addition, through these muscles pass the arteries that vascularize the stellate ganglion, precisely responsible for the regulation (through the orthosympathetic system) of the size of the bronchi, bronchial secretion (responsible for bronchial congestion) and coughing. (responsible for the reflex of irritative cough). It is also a kind of small information center that informs the brain of the state of the cardiorespiratory system, the possible presence of a danger, in order to make the body’s defense system react ( inflammation). In the case of asthma or allergy in presence of a foreign body: pollen, tobacco, mites, animal hair …), the stellate ganglion, disturbed by its poor vascularization or compression due to thoracic torsion, will be irritated (irritating thorn) and send to the brain parasitized messages (medullary facilitation) that will amplify the response provided by the brain (outbreak of an asthma attack).

This is how the osteopath manages to improve or even stop an asthma attack by releasing the first three ribs on which the scalenus are fixed. The relaxation of the muscular tension releases the arterial flow and lifts the compression exerted on the stellate ganglion.

The information it transmits to the brain is no longer parasitized and will trigger normal reactions this time, increasing the immune defenses (dilation of capillaries, regulation of nerve impulses and evacuation of excess mucus). The effect is immediate in young children whose acidosis is not yet important.

Upstream, let’s treat the liver

The liver is an omnipotent organ that is involved in all functions of the human body. It is therefore normal that it is involved in asthma attacks, which involves taking into consideration in all treatments the factors likely to lead to liver failure.

Increased acidity in the body due to liver malfunction:

The increase in the density of a liver is observed when it is loaded with fats. When the liver is fat, one speaks in medicine of steatosis. The liver stores the glucose reserves, energy source of our cells. In case of insufficiency, instead of releasing glucose into the blood, it turns it into fat.

This transformation produces an increase in acidity in the body that is naturally eliminated by the kidneys (urine), skin (sweat) and lungs (carbon dioxide). The carbonic acids are transformed into carbon dioxide and water. They represent 90% of the source of acid in the body, which highlights the permanent role of the lungs to regulate the acid-base balance of the body. Thus, poor metabolism due to liver failure, would produce an overproduction of acid that would affect the functioning of the lungs.

The results are less rapid in those who digest poorly milk and in vegetarians, because the volatile acids come mainly from the transformation of vegetable proteins and milk.

Other cause of torsion of the rib cage and durability of blockages at the thoracic level

1. Key points (blockages) in the thoracic torso wall (source of chest blockage)
2. The imbalance of the pelvis due to an asymmetry of muscular tension (pelvic inclination at the origin of scoliotic compensation of the thoracic cage).

Blocking of the 9th dorsal vertebra: key point that keeps torsion in the rib cage maintaining blockages at the level of the rib cage

Palpation pain in the ninth dorsal vertebra also confirms hepatic origin. These pains are in fact the projection of the tension of the diaphragm on the ribs which is transmitted in the back on the vertebral joint.

It is a real vicious circle, because the tension of the diaphragm compresses a large artery coming from the heart which distributes the blood in the lower part of the body. But it is precisely the liver that requires the greatest amount of blood.

In addition, sympathetic neurovegetative ganglia that, like a transformer, control the nerve impulses that drive the liver, are compressed at the level of the ninth dorsal vertebra. Poorly vascularized and poorly innervated, its functions are insufficient to ensure the proper metabolism and produce acid.

The imbalance of the basin

This mechanical lesion is always associated with an imbalance of the pelvis. The explanation is as follows:

The pelvis is balanced by two muscle stays that start from the hips to attach to the lumbar spine. The location of the liver and duodenum, part of the digestive tract where food is digested by enzymes, is on the right side of the abdomen. Their dysfunction creates anatomical tension in the abdomen that compresses the arterial branch that distributes blood to the muscle stay that stabilizes the right hip.

This is a perfect example of the application of both laws as stated by Still (the founder of osteopathy)

“The structure governs the function” that is to say that the structure depends on the function hence the need for a normal structure for a normal function (respiratory function).

But also “The human body contains or is capable of producing the substances and mechanisms necessary for both its self-defense and the maintenance of its health.”

Holistic osteopaths integrate all these notions. The drainage of the liver releases the amplitude of the diaphragm, the left shoulder is repositioned. The so-called “neuro-vascular” manual techniques release the tension of the scalenes in order to restore a good local circulation (remember that 80% of the arteries pass through the muscles). The osteo-articular lesions at the level of the first three ribs rise, the decompression and the best vascularization of the stellate ganglion restore all its functionality. It transmits the information to the brain that triggers the defense system to restore a normal caliber of the bronchioles. This mechanism explains the action of some reflex osteo-articular techniques, which however remain insufficient for long-term results in cases of body acidosis.

It is often found from an articular point of view but also muscular and tissue:

• A blockage of the first four thoracic, especially right (true asthma)
• A short leg to the right
• Cervical blockage of C0 C1 C2 (false asthma)
• A general postural imbalance that must be treated: feet, pelvis, thorax, ribs and ground support.

Asthma is due to blockages; the main points treated in osteopathy are:

• Chest blockages (sympathetic correspondence), especially thoracic Th1 to Th4.
• Cervical and cranial blockages (parasympathetic correspondence) (nerve X).
• The blockages at the level of the attachments of the lungs, thus work of the thoracic fascia and the diaphragm.
• Problem of mechanical attachments (asymmetry of muscular tension leading to a postural disorder).

Asthma and eczema are often linked:

In general, asthma is a recurring problem, which can occur before or after eczema (communicating slime effect: when asthma disappears, eczema appears and vice versa). This is easily explained because it is known that the costo-vertebral blockages responsible for disturbance in cutaneous and visceral metameric territories that sometimes give eczema, sometimes asthma, are the same. As a result, it is often noted that when asthma disappears, there is often a small return of eczema before everything returns to normal after treatment.

And for the skeptics, remember what Still said:

To those who claim that the manipulation of the skeleton has no impact on the organic functions, we answer that they simply did not make the painstaking, sometimes painful, learning of the art of reharmonizing the relations of the structures of the body. 

Still

And also what Hippocrates said:

“The skillful and conscientious physician must be clever at his sight as well as his hand when it comes to correct the vertebral deviations of the patient lying in front of him on the treatment table.”

HIPPOCRATE (435 BC)

As we know, asthma is regulated by medications, which although never harmless, save lives. But for conventional medicine to identify the cause, the treatment remains symptomatic and sometimes requires lifelong medication. Osteopathy, meanwhile, tries to explain the mechanism of asthma and also tries to provide a causal solution.

Everyone controls his muscles, his movements, his speed of action, his precision. But there are things that are automatically controlled by the sympathetic and parasympathetic systems (also called vegetative or neurovegetative). These systems (the parasympathetic nerve X and the costal sympathetic system) control the heart, the liver, the stomach, the spleen, the pancreas, the intestines, almost all the viscera, the corresponding skin, the joints of the same zones. Therefore, neither the organs, nor the skin, nor the irrigation, nor the possible blockages of the articulations are controlled by the will. You cannot order a joint: “slide right, a little forward, go up, turn to the right, compress yourself, unlock yourself”.

The sympathetic and parasympathetic systems are 80% sensory and 20% motor, which is to say that 80% of the neurovegetative nerve fibers provide sensory information to the brain (all cells of the body send him information permanently) and only 20 % of neurovegetative nerve fibers return motor orders.

All sensory peripheral information reaches the marrow and eventually the brain and if necessary, it returns in the form of motor information, passing through the sympathetic neurovegetative ganglia that are under the ribs.

When everything goes well, the answer is appropriate. The information emitted by an organ normally arrives at the marrow which transmits it to the higher centers of integration of the brain; the information is analyzed so that an adapted response is sent back to the organ.

But, when a vertebral block comes to parasitize this information, (the metamer is said to be “facilitated” because “hyper-solicited”), the answer will be inappropriate: excessive, disproportionate, without any relation with the initial information emitted by the organ in question. The organ in turn reacts inappropriately, becoming “hyper reactive” and “irritable” By igniting, it creates a different pathology depending on the organ or tissue damaged, but the origin of the dysfunction remains the same . (According to Irwin Khor).

The excessive response will be manifested in the bronchi by asthma, in the skin by eczema or psoriasis, or on any other part of the body (specifically) as, for example, the eyes or the nose by allergy, depending on the metameric facility concerned, in this case the viscerotome (in case of asthma) or the dermatome (in case of cutaneous pathology) etc. …

If we return to the bronchi, because of the combination of vertebral and rib blockages (which implies that the marrow returns a disproportionate response in the bronchial tubes), the pathological response will result in the form of asthma. The bronchi become more reactive, more irritable, hypersensitive to increase the system of defense of the body, then follows a hyper inflammation of the bronchi, an irritative reflex cough, a constriction bronchitis, in short asthma!

Moreover, we realized that in case of asthma, the chest blockages were more easily on the right with a rocker of the pelvis also on the right showing a false short leg on the same side (right), while in the presence of psoriasis, the thoracic blockages will be located on the left, with a pelvic tilt on the left as well, and a short false leg on the same side (left). It is for this reason that when one rectifies the asthma, the eczema (if it had existed) can reappear before disappearing completely.

« The art of manual therapy is old: I hold in high esteem those who discovered it as those who generation after generation, will succeed me and whose work will contribute to the development of the natural art of healing. »

HIPPOCRATE (435 BC)

A protocol specific to the method

Since Still, the founder of osteopathy in 1878, many osteopaths have thought about the issue of asthma. We benefited from their teaching to which we added our own reflection.

The protocol we have defined benefits from all the experience and methodology of the osteopaths who preceded us and draws its substance from the substantive substance of the fundamental principles elaborated by Still.

This very specific technique is not learned in schools of osteopathy but taught postgraduate courses in specific courses, this is the reason why any osteopath is not qualified to treat this kind of pathology s he did not learn it.

The asthmatic patient always presents the same types of lesions that are responsible for his asthma.

The patient is as follows:

• At the cranial level:
• At the level of the thorax:
• At the abdominal level:
• At the basin level:

It is because we know exactly which lesions are responsible for his asthma and that we know how to treat them, that we can be effective for sure.

This protocol is to use very specific techniques on specific areas in a well-defined order

List of techniques used:

• Clavicle equilibration
• Equilibration of the pericardium
• Release of the liver and diaphragm
• Central tendon; tendinous lamina: OTTP (Occipito-thymo-thyro-pericardial lamina)
• Cervical hinges, dorsal
• Dorso-lumbar hinge
• Lumbosacral hinge
• Balanced basin
• Balancing of the column
• Equilibration of the rib cage
• Balance of the lower limbs

The goal is to preserve as long as possible the benefit of osteopathy sessions, by preventive advice.

You must be motivated and follow the recommendations to the letter.

These are LIFE HYGIENE RECOMMENDATIONS

Postural hygiene is essential to maintaining the improvements that can be seen after treatment. Otherwise, we lose everything in a few days.

NB: It is not advisable to interrupt medical treatment before the doctor decides it.

In summary

The recurrences are always possible, it is then necessary to remake the point with your therapist if the symptoms reappear.

This is often the case because of the incorrect application of the instructions:

• No postural hygiene
• No hold hold
• Traumatic shock
• Repetitive movements
• Heavy loads

An annual check is necessary to maintain its balance.

Click here to read: Asthma according to A. T. Still in French for the moment
By A. T. Still From “Osteopathy: Research and Practice” 1910

Thoracic region
By A. T. Still From “Osteopathy: Research and Practice” 1910

“Osteopathy: Research and Practice” published in 1910:

Ultimate book by Still, considered as a summary of his osteopathic journey and as a legacy left to his successors. He develops the conception that he has of the different parts of the body and their functioning as well as the treatment that he proposes for all the regions of the body and their diseases.

“Osteopathy is based on the perfection of nature’s work, when all parts of the human body are in line, we have health, and when that is not the case, the resulting effect is disease. When the parts are readjusted, the disease gives way to health.The job of the osteopath is to adjust the body from abnormal to normal, so the abnormal condition gives way to normal, the health resulting from the condition normal “

(AT Still).

Based on her anatomical and physiological knowledge, Still explains how she thinks to treat each region and each disease. Our knowledge in the fields of biology and physiology has seriously evolved since the time of Still, some statements now seem obsolete, see erroneous. However, the reasoning is still consistent, especially with respect to the organization of life and anatomy, which have not changed since Still’s time. He gives us every page a wonderful lesson in osteopathy.

Click here to read: Asthma according to A. T. Still in French for the moment

L’asthme selon A. T. Still    ⇒ Lire

Click here to read: Thoracic region

Région thoracique    ⇒ Lire

1. Clavicle adjustment
2. Course on the lungs.
3. The action of the lungs (course given to the dissection class)
4. Course on the lungs (in front of the dissection class)
5. Prevention and eradication of lung diseases
6. Lung diseases (general)
7. Pneumonia
8. Pulmonary tuberculosis
9. Asthma ⇒ Read
10. Course on the heart
11. Heart disease
12. Hoquet 119

Manipulative treatment of asthma
By Dr. Perrin, T. Wilson
JAOA Year book 1938

• Condensed noted from a symposium A.O.A. Convention
• Arranged by Dr. Perrin, T. Wilson, assisted by Dr. T. L. Ray and Dr. Harry W. Gamble. Compiled by Dr. T. L. Northup.
• Cincinnati

⇒Lire

Manipulative treatment of asthma
By EARL J. DRINKALL, D. O.
JAOA  Year book 1941

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The osteopathic treatment of asthma
By Perrin T. Wilson D.O.
JAOA Year book 1949

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The osteopathic treatment of asthma
By Perrin T. Wilson D.O.
JAOA Year book 1965

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Quantifiable effects of osteopathic manipulative techniques on patients with chronic asthma Pilot study.
SUSAN E. BOCKENHAUER, DO
JAOA (J Am Osteopath Assoc.) 2002

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Parameters of asthma and MANIPULATION study question / Response
JAOA letter (J Am Osteopath Assoc.) 2002

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Use of osteopathic manipulative treatment by Ohio osteopathic physicians in various specialties
Donald G. Spaeth, DO, PhD
Alfred M. Pheley, PhD
JAOA ORIGINAL CONTRIBUTION Jan 2003

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Effects of Osteopathic Manipulative Treatment on Pediatric Patients With Asthma: A Randomized Controlled Trial
Peter A. Guiney, DO; Rick Chou, DO; Andrea Vianna, MD; Jay Lovenheim, DO
JAOA ORIGINAL CONTRIBUTION 105 January 2005

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Immediate Effects of Osteopathic Manipulative Treatment in Elderly Patients With Chronic Obstructive Pulmonary Disease
Donald R. Noll, DO; Brian F. Degenhardt, DO; Jane C. Johnson, MA; and Selina A. Burt, DO
JAOA ORIGINAL CONTRIBUTION 108 May 2008

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Mechanical Strain and Asthma
JAOA THE SOMATIC CONNECTION 109 may 2009

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Effects of Rib Rising on the Autonomic Nervous System. A Pilot Study Using Noninvasive Biomarkers
Aaron T. Henderson, OMS III; Jason F. Fisher, OMS III; Janelle Blair, OMS I; Caitlin Shea, OMS III;
JAOA letter (J Am Osteopath Assoc.) 110 Oct 2010

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An osteopathic approach to asthma