Osteopathy

Osteopathy was devised in 1874 by Andrew Taylor Still (1828-1917). His philosophy was that structure governs function, a belief that remains one of the basic principles of modem osteopathy. He claimed that tension in muscles and misaligned bones places unnecessary strain on the body as a whole. The initial strain can be caused by any number of factors, such as physical injury, or habitual poor posture, or by destructive emotions such as anxiety and fear. Adjusting the framework of the body would relieve that strain and enable all the systems to run smoothly so that the body would heal itself. Osteopathy is a manipulative therapy that works the body s structures (the skeleton, muscles, ligaments, and connective tissue) to relieve pain, improve mobility, and restore all-round health (Thomas, 1997 and General References). 

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Di Stefano M, Veneto G, Malservisi S, Corazza GR Small bowel bacterial overgrowth and metabolic osteopathy. Dig Dis Sci 2001 46 1077-1082. 

It is illegal to write a prescription or an order for meperidine without a valid medical license. Professionals who may legally write prescriptions or orders for meperidine include medical doctors, doctors of osteopathy, podiatrists, dentists, and veterinarians. Physicians or dentists who knowingly write multiple prescriptions for patients without a valid medical reason may end up in prison. Writing and filling bogus prescriptions for profit is an even more serious offense. 

Alternative medicine includes (but is not limited to) the following herbal medicine, homeopathy, aromatherapy, chiropractic, osteopathy, acupuncture, acupressure, yoga, tai chi, meditation, music or art therapy, shamanism, and faith healing. In this chapter our focus is on herbal medicine. The increased use of herbal medicine outside of the traditional physician-patient paradigm represents a search for other sources of health as well as an expression of assuming greater responsibility for our own health maintenance. In one sense, it is a return to an earlier period. The shift from traditional medicine to modern medicine can be traced to the Flexner Report of 1910. 

Cholestasis-linked osteopathy (M. Loeper et al., 1939), which occurs much more frequently in the form of osteoporosis than osteomalacia, can be expected in up to 50% of cases. The pathogenesis is complex. Vitamin D status can be examined by determining 25-OH-cholecal-ciferol in the serum. Intestinal calcium loss and reduced calcium absorption due to vitamin D deficiency are key pathogenetic factors. It is still a matter of debate whether vitamin K deficiency (which can lead to reduced osteocalcin synthesis) and deficiencies in IGF I and II (which can cause dysfunction of the osteoblasts) are possible causes of this condition. Muscle and bone pain are frequent clinical symptoms, occurring mainly in the wrists and ankles. 

Osteopathy Prevention or improvement in osteopathy typical in PBC can be achieved by means of UDCA. In addition, sodium fluoride (50 mg/day), calcium (1,500 mg/day), alendronate (10 mg/day orally), and vitamin D, e.g. 1.25 (0H)2 Ds (500-5000 units/day orally) should be administered. Calcitonin (50 units 3x/week i.m.) has also been used. (113) Substitution of oestrogens is advisable for postmenopausal women. (228) Daily muscular activity is considered to be the most important measure (e. g. regular physical exercise, stretching exercises, purposeful swimming). Every patient should engage in physical exercise as a daily must , because this is very effective for the activation of the muscular system (s. pp 536, 732) ... 

Twice a day, 10 to 15 slow knee-bends (= thigh muscles), plus 10 to 15 times standing on tiptoe (= calf muscles), plus 10 to 15 times upper arm flexing (= biceps), plus 10 to 15 times bending from the waist (= back muscles). This activates >60% of the total musculature on a daily basis without any special effort or expense, i.e. in the home environment, in all weathers . Such regular exercise is essential for both prevention and treatment of osteopathy. 

At first, symptomatic measures (s. p. 648) are required in order to eliminate pruritus, prevent malnutrition, counteract osteopathy by means of regular physical exercise and eliminate the occurrence of complicative developments. This also includes careful observation with regard to any possible side effects of medicaments or metabolic disorders. The intensity of these measures as well as the intervals between any necessary monitoring measures depend on the initial findings and the individual course of disease. 

The success rate of OLT is convincing in cases of PBC. However, consistent and regular osteopathy treatment... 

Osteopathy, which is expected in chronic cholestasis and often verifiable in PBC as well, is less frequently detected in PSC. (302,350) Xanthelasmas, which are prevalent in PBC, are likewise less common in PSC (19% vs. 3%). The frequency of cholangitic episodes, however, is about 7 times higher in PSC than in PBC there is a risk of liver abscess formation. In PSC, hyperpigmentation can be identified in only 25% of cases (compared to >50% in PBC). Cirrhosis-related complications are more frequent in PSC (13%) than in PBC (8%). 

The term hepatic osteopathy (J.E. Compston, 1986) describes skeletal changes in chronic liver diseases, including osteoporosis, which is by far the most prevalent form, and osteomalacia, which is detected very rarely, as well as their respective mixed forms. 

In cirrhosis, reduced bone density of the vertebral bodies could be observed in 16% and of the antebrachial bones in 23% of patients (compared to 7% and 5% respectively, in the control group). Fractures of the vertebral bodies were detected in 16% and of the antebrachial bones in 21% of cases (compared to 8% and 8% respectively, in the control group). Hepatic osteopathy usually occurs independently of the cause and type of the chronic liver disease. However, alcoholism, haemochromatosis and Wilson s disease result in osteoblastic hypofunction, so that osteopathy is more likely to occur in these patients, even prior to the development of cirrhosis. The occurrence of osteopathy is closely correlated with the severity of the liver disease and with hypogonadism. In liver cirrhosis, the prevalence of osteopenia is about 30%. (49,73)... 

The pathogenesis of hepatic osteopathy is primarily characterized by disturbed bone formation due to (7.) reduced osteoblast surface (with the number of osteoblasts being in the normal range) and (2.) reduction in osteocalcin. The latter substance is a bone-matrix protein formed by the osteoblasts. Therefore, the serum value is considered to be a marker of osteogenesis. There is no increase in osteoclasis. The causes and risk factors of disturbed bone metabolism are manifold and not totally understood as yet. (73)... 

Osteomalacia, a very rare manifest form of hepatic osteopathy, causes pain mainly in the muscles, but less so in the bones. Biochemically, AP is markedly increased there is a deficiency of calcium, phosphate and 25-hydroxycholecalciferol. Radiologic diagnosis shows signs of Looser-Milkman s syndrome coarsening of cancellous bone structure, narrowing of the compacta in the tubular bones, reduced density of the skeletal system, and band-shaped zones of decalcification. 

The most important prophylactic measures for preventing the development of hepatic osteopathy are (i.) avoidance of harmful noxae (alcohol, nicotine), (2.) avoidance of risk factors (e. g. overweight calcium, phosphate or vitamin D deficiency use of glucocorticoids, cholestyramine and antacids containing aluminium), (2.) administration of vitamin K2 (menatetrenone) in women with risk factors, and (4.) routine physical exercise. (s. p. 650) We have instructed our chronic liver patients to carry out the following exercises on a regular basis ... 

Rottembourg J, Jaudon MC, Legrain M, Galh A. Les gels d alumine chez les insuffisants renaux chroniqnes. [Aluminum gels in chronic kidney failure patients. A potential risk of encephalopathy and osteopathy.] Ann Med Interne (Paris) 1980 131(2) 71-4. 

The fact that much bismuth is ordinarily stored in the skeleton may be relevant in the etiology of bismuth osteoarthropathy. In two reported cases a differing type of osteopathy occurred, associated with different localization of the pathological lesions and with unusually high bismuth concentrations in the bone both patients had received bismuth injections for syphilis many months or even years before (SEDA-4,169). 

Manipulative therapies (chiropractic and osteopathy) are amongst the most prevalent of complementary treatments. Spinal manipulation is carried out by chiropractors, osteopaths, physiotherapists, and other healthcare professionals to treat back and neck pain as well as other (predominantly musculoskeletal) disorders. 

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