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Osteopathy for Parents
by Viola Frymann, D.O., F.A.A.O., F.C.A.
 A program of
monthly meetings was instituted at the
Osteopathic Center for Children & Families to provide
informative lectures on various aspects of the
work of the Center allowing for plenty of time
for questions, discussion and valuable
contributions from other parents whose
personal experiences helped the newcomers.
These were essentially extemporaneous talks,
sometimes illustrated with slides, and
occasionally with practical demonstrations of
a child being examined or treated. These were
not written lectures but from time to time a
zealous parent would make an audiocassette for
her friends. A few of these tapes were
transcribed. I trust you will read them as if
you were sitting in a group of parents eager
to learn what happens to “my
child” at the O.C.C. and how can this
approach help him?
I know that one of the questions that most
people ask is “What happens? What do you
do to my children?”. So I thought we
would have an opportunity here to talk about
some of the things we do and why we do them
and then give you an opportunity to ask the
questions which we don’t always have
time to answer in the office. If, as I’m
talking a question occurs to you, jot it down
and we will pick it up after the first part of
this presentation.
First of all, I would like to talk about
Osteopathy in general. I would like to
enlighten you about the differences between
the way in which a medically trained physician
thinks and the way an osteopathically trained
physician thinks about a problem.
When your child was born it was, first of
all, evaluated by the pediatrician. He was
looking to make sure there was no congenital
defect, either externally visible or
invisible, such as perhaps in his lungs or the
heart or the digestive tract, and also to make
sure that all the systems were functioning
efficiently.
As osteopathic physicians we are looking at
something more when your baby is born, because
we recognize that the process of being born is
probably the most traumatic experience that
most people ever have.
In the study of 1250 newborn babies it was
demonstrated that 10% have a healthy freely
movable cranial mechanism. In other words, all
of the bones of the head are in correct
relationship and moving as they should. This
is a figure that has been consistent in
several studies which have been done on
newborn babies.
The number of babies that have a gross,
visible disturbance in the cranial mechanism -
the sort of deformity that you can see across
the room - that number may be somewhere about
8% or 10%.
What about the other 80% of babies born --
that group in which the problem can be
detected by an osteopathic physician trained
to feel these minor difficulties within that
mechanism. They may not be presenting major
clinical problems at this age.
The child may be spitting up. The child may
have had a little difficulty learning to suck,
a difficulty that passed in 24 to 48 hours
perhaps. The spitting up may continue for days
or weeks sometimes, and very often the story
we hear is, "Well, it was assumed that
the milk didn't agree with the baby,"
so perhaps the mother decided to stop breast
feeding and try a formula. In many instances
that didn't solve the problem, and after
several tries, some cereal was put into the
formula to make it a little thicker, and often
that appeared to solve the problem.
The fact that the baby was spitting up in
that early period after birth, or that the
baby did have difficulty learning to suck, is
very important to us from a diagnostic
viewpoint because it tells us that there was a
degree of compression within the baby's
head that irritated two of the important
nerves that come out of the base of the skull
-one being the 12th nerve, the hypoglossal
nerve, which is responsible for the activity
of the tongue and therefore is important in
the sucking process, and the other the 10th
cranial nerve that is concerned with the
activity of the digestive tract at this age.
Those two symptoms may be very important
pointers to the problem at that time.
During the years from birth to five years,
the child is checked regularly by the
pediatrician concerning his ears, throat,
eyes, heart, lungs, digestive tract. In other
words, is this child's body functioning
efficiently?
Many children get ear infections. The ears
are examined and if the infections have
occurred a number of times there may be a
hearing test performed, and various tests that
zero in on the ears. But the ear isn't
something sitting out there in space. The ear
is part of a total mechanism in this body. For
example, the ear itself is held in what we
call the temporal bone. (If you feel just
behind your ear you will feel a somewhat
pointed bone, which is the mastoid
process.)
From the inner part of the ear, that is known
as the middle ear, the Eustachian tube extends
into the throat. Therefore, what goes on in
the throat has a bearing on what goes on in
the middle ear, and vice versa. Not
infrequently the problem may begin as a sore
throat, a cold, and it progresses to an ear
infection. Therefore, the state of the throat
and the state of the ear are very intimately
related.
Let's come back to the temporal bone for
a moment. The temporal bone articulates, or is
connected to most of the other bones of the
head, directly or with one bone in between.
So, if this child has had a fall on the back
of the head in which the articulation between
this bone and the occipital bone at the back
of the head has been jammed, the bones cannot
move freely, one in relationship to the
other.
Perhaps at the time of the injury the child
cried for a little while, had a bruise there
or a swelling, and it passed. A few weeks
later an ear infection develops. If you stop
to think about it, you will find the ear
infection has developed on the same side on
which the head injury occurred.
The blood supply to the ear by way of the
arteries, the venous drainage from the ear by
way of the veins, and the lymphatic drainage
is impaired if that normal, rhythmic mobility
of the temporal bone is interrupted. If there
has been an injury it has interfered to some
degree with the inherent mobility of that
bone. Furthermore, if the child fell on the
back of the head, that fall may have disturbed
the alignment of the bones of the neck. The
blood supply passes through the neck up into
the temporal bone.
So the ear problem is not confined to the
ear. It may be related to certain things that
have happened in levels below the ear. Now we
begin to see that we cannot localize ear
infection in an ear because it is tied in to
other parts of the body. Of course, the
circulation begins at the heart and ends at
the heart, so anything between the heart and
the temporal bone may be a factor in that
circulation. The lymphatic drainage is
associated with certain structures in the
neck, going all the way down to below the
collar bone. Anything in this area may have a
bearing upon that ear infection.
It is not uncommon to get the story that this
child has had ear infections over and over
again. Perhaps the first ear infection
occurred when he was six weeks of age. He was
treated with an antibiotic, he got over it;
two months later there was another ear
infection. He was treated with antibiotics, he
got over it and six weeks later there was
another ear infection, and so it has gone on,
perhaps for several years, one after
another.
At some point the parents decide there must
be some other way. Also, by this time the
child may have reduced hearing in one or both
ears.
This is the time to go back structurally and
inquire whether there is any evidence of
injury at birth which may have started the
process, and whether there had been any
injuries since then to which the child is now
responding with this susceptibility to
infection.
This brings us to the first aspect of the
osteopathic concept, the osteopathic approach
towards the patient.We are looking at a whole
patient. We are not just looking at the point
which is producing symptoms and calling your
attention to it. What is there in this whole
child which is resulting in manifestation in a
local area? The manifestation may be a
neurological disturbance. This may be the
hyperactive child who can't sit still
through a meal, who can't sit still in
school, who can't sit still period. The
more the parents or the teachers say,
"Sit still or you will go to the
principal." the worse the activity
becomes.
I wonder if any of you have a condition which
is known by the title, "restless
legs?" Have you ever sat in a theater and
thought you just couldn't keep your legs
still? If someone had said to you,
"Don't you dare move!" that
would have made you much more susceptible to
moving. So it is with this child who has an
inherent neurological dysfunction which makes
it impossible for him to be still. The more we
try to pressure him to be still, the more
restless he becomes.
There are many measures used to help these
children. One may be to give them some
medication, but the medication doesn't
make them sit more quietly, it dulls their
intellectual awareness. They may sit still and
therefore learn more to some degree, but they
are not functioning at their capacity. That is
a stop-gap measure. It hasn't done
anything about the hyperactivity itself. In
fact, the longer the child takes the drugs the
more difficult it is to break the habit
because when the drug is stopped the child
becomes more hyperactive than when the drug
was introduced in the first place.
What is the cause of the hyperactivity? Why
does the child have to keep moving as if he is
driven? Because he utilizes an external
activity to make up for severe restriction in
the inherent motion of these cranial bones and
therefore all the structures that are related
to them. They have to produce outside activity
in order to make up for lack of internal
activity.
It is not one area of the central nervous
system that is involved, but the brain is in
contact with every part of the nervous system
in the body, and therefore we are concerned
with the whole patient and not just one little
area.
What we really are talking about is whole
people, whether they be little people or big
people, and recognizing that the structure of
the body is intimately related to the way it
functions. We might compare the body to a
watch - not one of the electronic ones but the
old fashioned variety that had a lot of wheels
and gears in it. If your watch started losing
or started gaining, or perhaps even stopped,
and you took it to the watchmaker you
didn't ask him, "Which wheel is it
that is causing the trouble?" He probably
would say to you, "Well, your whole watch
needs overhauling so we can put it together so
that every part works properly."
The body is like that too. It isn't just
one piece that needs to be oiled and put back.
The whole body needs to be integrated. The
structure of the body is causative, it is
integrated.
Childhood is a time of falls, injuries. We
are not only concerned with falls that broke
bones or put the child in the hospital. We are
concerned with any injury that happens to
affect a critical part of this moving
mechanism, and the only sign you may notice
that it did that is that your child is less
amenable to your directives. The tendency is
to think he's naughty. As one osteopathic
physician used to say , "Don't punish
your children; treat them." You will find
that when you treat them they change, and
sometimes they change in an instant.
Some of the children come into the treatment
room acting as if everything is wrong, they
don't want any toys, don't want to
play, don't want anything done. All of a
sudden, when that mechanism begins to move,
"Can I have a toy, please?" It is
absolutely phenomenal because it happens so
fast. Once the key turns and the mechanism
begins to move freely the child becomes
himself once more. It isn't always as
simple as that because it may not have been
just the last injury. It may have been an
accumulation of injuries that have occurred,
one after another, over several years, so it
doesn't always resolve immediately. But
the principle is the same. It is that
interrelationship of structure and function
and the unity of the body functioning as a
whole. It is not a series of isolated,
independent parts.
The body has within it the process which
heals itself. If that is true why haven't
all your children been healed long ago?
I'm sure you have all had the experience
of a cut on your hand. Perhaps it was a deep
cut, perhaps it required some suturing and a
dressing put on it. Then you were told to come
back in five days for the doctor to take out
the stitches. The doctor didn't heal the
cut. Who did? You did. You healed your own
cut. But sometimes, if something is not
functioning properly in your body you will go
back at the end of five days and the cut has
not healed.
The same may be true of a broken bone. The
bone breaks, the surgeon approximates the two
ends as closely together as he can and then he
mobilizes it in a plaster cast. He usually
gives the instruction to come back in six
weeks. It will probably be healed. But
sometimes it isn't healed in six weeks.
Sometimes it isn't healed in sixteen
months because something is not working in the
body to permit that inherent healing process
to take place.
As osteopathic physicians we are very
conscious of that inherent healing process.
That healing process is not only concerned
with knitting a bone together, healing a
laceration or overcoming an infection. It is
also concerned with moving the body structure.
Probably many of you have had the experience
of doing some unaccustomed hard work, such as
working in the garden once in three months. By
the time you went to bed every bone in your
body felt as if it were out of place. But you
went to bed and relaxed in sleep and by the
morning most of that was gone. Who did that
work? You did. That inherent force in your
body which is working to bring it to its
optimum function did it. But if the strain or
the restriction in that free motion has gone
beyond a certain point, then the body needs a
little help in overcoming it. However, if we
can work with what the body is striving to do
we shall get there much faster. Therefore,
much of what we do is not visible. By that I
mean we are not forcefully manipulating the
body in this way and that way. We are
detecting how that body wants to move, how it
is striving to overcome its restrictions and
then just giving it a little help to do
so.
These are the three primary concepts upon
which our practice is actually based. They are
not just philosophical ideas in our heads
which we agree to, they are actual working
concepts - (1) the interrelationship of
structure and function, (2) the recognition of
the totality of the body, and (3) the inherent
force within the body.
Now, how do we do it? That is the $64,000
question, isn't it?
The first process is getting acquainted.
Still in the process of getting acquainted we
are running our fingers over the various
joints between the bones in the head to find
out whether there is any over-riding of any of
the bones, whether there is any hardness or
irregularity, whether one bone is pushed up
against the other, and also whether there is
any asymmetry of the head, any imbalance in
the structure of the bones of the head.
Then we move down to the spinal area. We come
down the neck and then we come down through
the thoracic area, the rib cage, and the
vertebral area and down into the lumbar
area.
After that we evaluate the lower extremities,
the hip joints, knee joints and ankle joints.
Then we evaluate the sacrum. The sacrum is
that large bone that you can feel if you put
your hand behind you (it's about the size
of the palm of your hand in an adult). In the
infant that is still five bones, not just one.
The rhythmic motion of the sacrum is brought
about with breathing. Every time you breath
you move that sacrum between the pelvic bones.
I place one hand on the sacrum and my other
hand is on the pelvic bones, evaluating how
the sacrum moves within the pelvis.
This is the way in which we balance the
pelvis and sacrum and we can balance the
lumbar spine at the same time. This area is
very important because as the baby is
descending through the birth canal the head is
opening the birth canal but the pelvis, the
buttocks, gets the pressure as the uterus
contracts down on the baby. If for some reason
the baby doesn't descend smoothly and
progressively through the birth canal as the
baby's spine has to negotiate its way
around the mother's sacrum. If it gets
held up in that position this may tend to
produce a sidebending in that lumbar spine.
This does not show itself outwardly at this
age because this baby isn't standing. The
spinal curve may not show itself until the
baby begins to stand, but if we can pick it up
by feeling it, by palpating it at this age and
taking care of it (it only takes about 60
seconds) we can take out that twist which has
become locked in there through the birth
process.
Next we evaluate the head area. Sometimes, in
order to keep a little baby quiet and happy,
it either nurses or sucks on the bottle while
it is being treated. The area of the
baby's head that leads the way out of the
birth canal is the occipital area, the back of
the head. It is the area that will take the
brunt of obstruction if there is a delay in
delivery.
When there has been a long delivery, perhaps
sixteen, twenty or twenty-four hours for a
first baby, or even after twelve hours for a
later baby - and sometimes we find mothers who
havebeen in labor for several days, or perhaps
even more important, there has been a period
of false labor before the real thing began.
False labor can be particularly damaging
because the contraction is occurring and the
baby's head has nowhere to go because the
birth canal is not opening. So the baby is
being compressed from above and below. It is
the occipital area that takes that impact.
That is where the hypoglossal nerve to the
tongue and the vagus nerve to the digestive
tract pass out through the skull. These are
the areas that are the first to show the
stress of the birth.
One of the most important questions we can
ask is, "Did your baby have any trouble
vomiting, spitting up?" If the answer is
"yes" then we know that there was
some degree of a problem in this area at
birth.
Within the occiput also is that large opening
through which the whole brain stem becomes the
spinal cord. All of the nerve pathways that go
to every structure in your body below the base
of the skull must pass out through that hole
in the occiput. Therefore, if the occiput is
deformed by such pressures as we have
described, the injury to the nervous system
may vary all the way from the child who has
mild spitting up to the child who is
hyperactive, the child who is uncontrollable,
who is aggressive, who eventually goes on to
have learning problems, behavior problems and
the whole gamut. So this is a most critical
area, the area that we always look at when we
look at newborn babies.
Then we consider the skull as a whole. The
skull is made up of some twenty-six bones. At
this age some of those bones are in several
parts. Therefore, the potential for
compression in one or more areas is quite
great if there was compression in the pelvis
on the head during birth.
An osteopathic physician’s hands are
feeling hands, they are monitoring hands. They
are not pushing things around. They are
monitoring how that mechanism inside is
working and how we can go with it to permit it
to release areas of restriction.
The temporal bone, that bone which I
mentioned as carrying the ear, may also be
compressed because it is very close to the
occipital area. It is not unknown to find that
the baby has its first ear infection at a few
weeks of age. When that is so it suggests that
the problem may have arisen from the trauma of
birth. When that mechanism begins to move
freely then the child recovers from the
recurrent infections.
When the head is compressed from the front
backwards, a compressive force, which we will
find particularly if the baby who was reversed
in the birth canal. It was a posterior occiput
rather than an anterior one. This sort of
compression jams the skull at the center of
its base.
At birth the occiput is not just one bone, as
it is in the adult. In the infant the occiput
is four bones because it is not yet fully
developed. That large hole of the foremen
magnum, through which the brain stem passes,
is circled by developing parts of the
occiput.
The area of the base of the skull that
becomes compressed is the area we are
primarily concerned with in our small babies.
The problems we find there may continue and
cause difficulties later in life.
The sooner you treat the baby the easier it
is, but you never say "there is nothing
that can be done." No matter how much or
how little progress is made, progress is
worthwhile. (Slides accompanied this
presentation.)
Life is always in motion. Life is always
getting better or it is getting worse. We may
not work as frequently; we may work for an
intensive period to get over the major
problem, then watch that the progress we have
made is maintained, but let's go back
again. What we do in the process of a
treatment is just like unlocking the door so
now those who are inside can move around. We
have permitted progress to occur.
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Osteopathic Center for Children & Families
4135 54th Place • San Diego, California 92105
• 619.583.7611
information@osteopathiccenter.org
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