Osteopathy sees the musculoskeletalsystem as the reflection of the conditions of the whole organism. Osteopathy is a holistic medicine that believes in the human being as a unity of body, mind and spirit and that health is a natural state of the person. By studying posture, body dynamics and manually communicating with the tissues, the osteopath reaches the root causes of ailments and remedies them. A.T. Still establishes that any form of disease, acute or chronic, generates imbalances of the musculoskeletal systemby reflex action. It then focuses on the structure and mechanics of the body and creates special manual techniques to restore body balance. The most important principles of Osteopathy maintain that the body has all the resources to heal itself. Still finds that a blocked joint or an obstructed artery can hinder self-healing forces. Thus the disease was born, which is always a phenomenon of the body adapting to a critical situation, but by means of manipulation tissues regain oxygen and mobility and the energies of health will repair the damage.
What is Chiropractic?
Chiropractic sees the patient as an overall being in relation to his environment, and not from a purely chemical and organic point of view. For the chiropractic, therefore, it is a matter of trying to find and maintain physiological activity in the best condition, correcting the structural-abnormal relationshipsin the body, so that it can use its biological resources to return to normal functions. The main interest is aimed at the integrity of the nervous system (especially the brain stem of the spinal cord and the spinal nerves themselves), because it coordinates and integrates all the main functions of the body in response to internal and external changes.
D.D. Palmer elaborating the theory of “vertebral subluxation”(that is, an incorrect anatomical-physiological relationship between two or more vertebrae) observes that this stresses, deforms vertebrae and “irritates” the spinal nerves by alternating their nervous functions. This imbalance must therefore be eliminated through manual manipulative techniques in order to restore mobility to the spine.
Osteopathy or Chiropractic?
Both use manual therapies to restore the body’s homeostasis. Osteopathy also has the advantage of W.G. Sutherland’s (1873-1954) discovery of the Cranio-Sacral Mechanism being an elective therapy for children who, due to intrauterine trauma or trauma during childbirth or falls in childhood can manifest symptoms ranging from headacheto sinusitis, from disturbed sleepto school learning difficulties, from relapsing joint sprains to scoliotic attitudes. Chiropractic has the advantage, through G.J. Goodheart’s discovery in 1964 of Applied Kinesiology, of being able to evaluate before and after a treatment, the state of health of a patient using the response (weak or strong) of a “sample” muscle. This procedure, in addition to verifying the occlusion-feet-posturerelationship, the muscle-organ association, the stress-posture emotioncorrelation, is also used as a therapy because a basic principle of Applied Kinesiology establishes that the body is self-correcting and self-sustaining.
RELATIONSHIP BETWEEN POSTURE AND MOUTH
Arguments treated in the book by Dr. De Nicolo
POSTURAL OCCLUDED RELATIONS
DENTISTRY, ORTHODONTICS AND GNATHOLOGY
Dentistry, orthodontics and gnathology are odontostomatological specializations that deal with the health of the oral cavity in different areas, but which are all strictly connected. Dentistry deals with the treatment of hard and soft tissues in the oral cavity, therefore with the treatment of caries, periodontitis, replacement of dental elements, and the prosthetic area. Orthodontics deals with the occlusal relationship of the dental arches through the movement of the dental elements and skeletal bases, while Gnathology studies the function of the oral cavity through a wide evaluation that starts from the dental elements, from their position to the muscular and articular functions and to the related metabolic and functional activities.
The oral cavity is one of the most important sub-systems in the complex postural system, due to several factors, since:
- It relates to the skull and is able to condition its development , what osteopaths call PRM (primary respiratory mechanism), or the physiological movement of the sutures of the skull.
- It relates to the cervical spine, through muscle function, in particular due to the relationships between the cervical muscles and the suprahyoid and subhyoid muscles, which are conditioned by any disharmony in the mouth and by swallowing.
- It can condition important functions such as chewing, phonation, swallowing and breathing, which if they do not work with the necessary balance, could affect adjacent metabolic activities, such as visual, neurological, otological, bio-mechanical functions, and even affect peripheral sub-systems that can decompensate, causing symptoms or disharmonies with consequences that affect the posture and often, the daily life of our patients.
The skeletal asymmetries of the face always represent three-dimensional and deep disharmonies of the skull. Considering the bones of the skull as many articulated cogwheels, it is easy to understand that asymmetries are the result of a problem with some of the wheels of the mechanism. (Fig.1)
Fig. 1 – Dento-facial asymmetries
Fig.2 – Postural view of a lateral occlusal dysfunction
Symmetric cranial ratios lead to a symmetrical occlusion
In fact, it is almost impossible for an asymmetrically distorted functional matrix to shape a subsequent normal bone growth. There must be an evolutionary advantage, although not always evident, in having anatomical structures around axes of symmetry. It is difficult to grasp the biological advantage of symmetry, even more difficult to ask how far the geometric perfection of this case needs to be pushed for the advantage to materialize. We do not even know if the left and right structures are represented from a geometric point of view in a situation of absolute potential symmetry, or only relative. The fact is that: the condition of perfect geometric symmetry does not seem to be important in biological terms and therefore does not constitute the norm. This general assumption obviously also applies to the anthropometric and orthodontic field of interest. Each face, however attractive, does not present a level of symmetry perfectly mirrored on the two emilates, but has slight asymmetries. Each dental arch, although harmonious, does not have a level of asymmetry perfectly mirrored on the two emilates, but has slight asymmetries.
Fig. 3 – The asymmetries of the face, the true image is in the centre
The photo of the “true” female face is the one reproduced in the centre. On the left and right the two composites of the right and left parts of the face duplicated and reflected. If the facial symmetry were perfect, the three images would be the same, which is not the case at all. Although the “true” face is pleasant, it has asymmetries that are hardly perceptible, certainly not pathological, but only geometrically relevant.
EFFECTS OF OCCLUSION IN THE POSTURAL SYSTEM AND EFFECTS OF THE POSTURE IN OCCLUSION
Changes that occurred during evolution allow an upright posture that does not cost us enormous muscle energy (although this probably makes us the animal with less physical performance), the weight load is absorbed by the bones with the mediation of articular discs and menisci. The way our body reacts to the force of gravity, or posture, is physiological when the organs responsible for weight load are able to distribute the weight with minimal muscle work and reduced stress on the ligaments. This postural control is neurological and there are several organs intended for this purpose: vestibules, eyeballs, soles of the feet, periodontal receptors, neuromuscular spindles, cut etc.
From a mechanical point of view, our body responds to two needs:
- solidity to combat gravity and protect the cerebrospinal axis
- mobility for a life with interrelation and absolute life.
Solidity is the prerogative of three rigid compartments (skull, thorax, pelvis) which have an impressive bone structure and which represent ideal containers to protect our internal organs (brain, lungs, heart, liver, kidneys and genital organs), and have three hanging limbs (jaw, arms, legs). They form the kyphotic curves of the vertebral column (cranial, dorsal, pelvic) and are connected to each other by two cervical and lumbar lordosis.
Mobility is the prerogative of these two lordotic curves which connect the three rigid spheres together. Lumbar lordosis is the one that differentiates us from all the other animals: it was crucial for the transition to erect posture. Other primates (chimpanzees, gorillas etc.) lack them.
Kyphosis and lordosis are connected by two systems (muscle and fascial) responsible for static and dynamic:
- a direct anterior, median system that connects the skull to the sternum and then to the pubis: its activation brings the skull closer to the pubis, that is, it is responsible for the flexion movement
- a direct posterior system that connects the skull to the coccyx: its activation moves the skull away from the pubis, is responsible for the extension movement (Fig 3).
Fig.4 – Representative scheme of the system
The dynamics of the human body also requires two oblique muscular systems that are used to connect in the transversal sense anteriorly and posteriorly, the two direct systems and are named :
- Anterior cruciate system
- Posterior cruciate system
The task of the cruciate systems is to ensure coordination in the movements.
Fig.5 –Representative scheme of the systems
Direct anterior and direct posterior cruciate, anterior and posterior cruciate.
The activation of these two systems allows our body to have a fine regulation of both static and movement, thus allowing us to maintain a correct postural position, that is, with the best possible balance, economy and comfort ratio. The result of the activation of these muscular and fascial systems are a movement with a helical physiognomy: that is, in walking, we load the support on one limb and unload it at the same time from the other, modifying the centre of gravity of the body and therefore allowing a re-adaptation of the various sectors of the body, easily seen at pelvis, shoulder and jaw level as a misalignment (Fig. 6).
Fig. 6 – Posture while walking
Study of physiological posture
For a profile reading, the patient must be positioned with the external malleolus 1 cm behind the plumb line; in this position the physiology of the profile is seen aligned on the plumb line: knee, femur axis, coxo-femoral joint, elbow, shoulder and external acoustic meatus. L3 and C3 should ideally be aligned on the plumb line. The tangent line to the head results physiologically parallel to the Frankfurt plane and the ground plane (Fig. 7).
Fig. 7 – Anthropometric references with respect to the Frankfurt plane
Observation in latero-lateral posture:
- with external acoustic meatus on the plumb line
- head moved forward by flexion of the higher cervical
- head moved forward due to flexion of the lower cervical
2) pelvis: L3 on the plumb line anterior or backward
3) knees: on the plumb line hyper-extended or flexed
4) feet: normal, flat or arched
Fig. 8 – Reading the antero-posterior posture
In physiological conditions, compared to the plumb line, the right and left half of the head and body are roughly equal; ears, shoulders and iliac crests are at the same height on both sides. It must be remembered that a right-handed person falls a little to the right with respect to the plumb line while the left-handed falls a little to the left.
The most important things to observe for the dentist:
1) head: centred, moved to right or left, inclination, twist
2) pelvis: centred, moved to right or left, inclination, torsion
3) knees: straight, varus or valgus
4) feet: straight heel, right or left valgus heel, right or left varus heel
Fig. 9 – Podalic support for flat feet and for arched feet
Plantar support study
Figure 8 shows an example of a flat foot characterized by a flattened plantar vault, outstretched forefoot and valgus heel, seen with a podoscope.
Also in figure 8 an arched foot is represented, characterized by an accentuated plantar vault, a contracted forefoot and a varus heel, seen with a podoscope.
Fig. 10 – Mechanical sequences of flat-valgus feet
Typical attitude of an arched foot: the varus heel favours the presence of valgus and flexed knee, the external rotation of the head of the femur leads to the retroversion of the pelvis (Fig. 10). There is a prevalence of the posterior muscle chain tone, strong psoas, the contracted spinal and multifidus stabilize the vertebrae giving a typically tense profile image. Shoulder blades and sacrum are on the same posterior plane and also in this case the head is forward (Fig.11).
Fig. 11 – Mechanical sequences of arched–varus feet
Fig. 12– Scheme of typical postural alterations in flat and arched feet
GENERAL POSTUROLOGY AREA
Arguments taken from the book by Dr. G. de Nicolo “Dall’otoneurologia alla posturologia statica e dinamica” coautore con dr. P. Ranaudo, dr. F. Grazioli, dr. C. Condorelli
L’equilibrio è la risultanza di un coordinamento fra i vari movimenti (volontari ed involontari) della muscolatura che concorre a contrastare o ad esplorare l’ambiente e l’orientamento percepito dei vari segmenti corporei fra di loro e dell’ambiente circostante
POSTURAL BALANCE SYSTEMS
A) Skull and spine
The skull and the spine are among the most important systems of postural balance. Through a harmonious development of the skull, which depends on numerous factors, from genetics, to gestation, to childbirth, to postnatal trauma, etc., we can draw interesting assumptions for a wider balance on each subject. The osteopathic theory explains in a complete and exhaustive way how lesions present at the level of the skull base can affect the postural system, as well as the viscera of our body.
The stomatognathic system is composed of three sub-systems: skeleton and temporomandibular joint, neuro-muscular system and dento-periodontal complex, each of which has an important function in maintaining the erect position and posture thanks to their connection with the central structures of equilibrium. (TREATED MORE DEEPLY IN A SPECIFIC AREA OF THE SITE create links)
The eye is one of the main posture receptors.
It is at the same time an endoreceptor and an exoreceptor of the postural tonic system. Esteroception is linked to the presence of rods in the peripheral vision, proprioception is generated by the muscle activity of the oculomotor muscles and through the oculo-cephalogyrus that serve the neck and eye muscles. Refraction disorders concern the exoreceptor and can cause, for example, diseases such as nearsightedness, astigmatism and hyperopia. The endoreceptors, through their dysfunction, cause ocular convergence and heterophoria disorders.
Occlusal, dental and lingual disorders should be especially considered. The experience of BARON and MEYER has demonstrated the relationship between a dental stimulation, an oculomotor dysfunction on the ipsilateral eye to this stimulation, and postural imbalance. Cross-bites, mandibular latero-deviations, neurological teeth,amalgams,cysts, granuloma, bimetallisms, low lingual position can decompensate the eye, provoke a postural imbalance through an abnormal tonic asymmetry and compromise the quality of re-education of the eyes and its effects over time.
Posture is a motor act and can be defined as a multimodal system. The foot is one of the main elements that regulates the postural system, often appearing more as a balance organ than as a simple support organ. It is characterized by the presence of a six degree freedom joint. The foot exerts dynamic forces on the ground and bears its effects on the basis of the ground reaction principle; the ground on which you walk, in relation to Newton’s third principle (Law of Action and Reaction), produces forces equal to and contrary to those exerted by the subject on the ground when treading on it. The sole of the foot is therefore an indispensable link between man and the ground. It constitutes an essential source of exteroceptive and proprioceptive information for the balance and posture regulation system. Neuromuscular spindles are abundant in the foot muscles, while the joint receptors are numerous, especially in the ankle. All these elements make the foot a fundamental element of the postural system: it is simultaneously an “exo-receptor” and an “endo-receptor”. We can schematize the system of sensory afferents of the foot in: Cutaneous receptors, Joint receptors, Muscle receptors, Integration of the nervous system at peripheral and central level.
The sole of the foot is extremely rich in sensory articular and muscular cutaneous receptors implicated in somatic sensibility. Almost all of these receptors depend on the posterior tibial nerve through the intermediation of its three last dividing branches (Fig. 2.10):
- The internal calcaneal nerve for the heel region;
- The internal plantar nerve for the internal two thirds of the forefoot;
- The external plantar nerve for its external third
The skin, joint and muscle afferents converge on the spinal cord which forms the first level of integration, with a rapid response (Fig. 2.9). The second level of integration is the brain, more latent but with greater gain. The posture adjustment system integrates the general information derived from the eye, from the vestibule, from the whole of the loco-motor system, from the jaw. So the foot is a sensory organ capable of providing external ( relationships with the ground) or internal (sense of position) information essential for postural control.
E) The skin
The skin, joint and muscle afferents converge on the spinal cord which forms the first level of integration, with a rapid response (Fig. 2.9). The second level of integration is the brain, more latent but with greater gain. The posture adjustment system integrates the general information derived from the eye, from the vestibule, from the whole of the locomotor system, from the jaw. So the foot is a sensory organ capable of providing external ( relationships with the ground) or internal (sense of position) information essential for postural control
The somatosensitive system transmits information on four main sensory modalities: touch, proprioception, pain, thermal sensitivity.
Although these four modalities have the same type of sensory neuron in common, consisting of the neurons of the dorsal root ganglia, the receptors that mediate one of these modalities have different morphological and molecular specializations, which allow them to detect different types of stimuli. The discriminative touch and proprioception depend on capsulated mechanoreceptors, sensitive to the physical deformation produced by the skin sinking or the movement of stimuli on the skin, the stretching or contraction of muscles or the joints taking particular angles of articulation. The cutaneous mechanoreceptors can be further divided according to their ability to convert specific forms of energy such as the pressure or movement of the stimuli, and the basis of these, they are able to provide information relating to the shape and characteristics of the surface of objects. The spatial resolution capacity of these receptors depends on the size of their receptive fields, which is at its greatest on the fingertips and lips, where they have maximum density (Fig 2.11).
Fig. 2.11 – Skin receptors
According to American statistics, 93% of individuals have suffered, suffer or will suffer with their the back; It is interesting to note that 93% of individuals have a tonic-postural imbalance. In light of these figures, it is clear that the problem of vertebral and rheumatic pain is far from being solved. However, these are one of the most frequent reasons that lead an individual to consult their doctor. Now, if analgesic drugs, anti inflammatory drugs can work on pain and inflammation, they have no action on the mechanical component of pain. In light of recent studies, static disturbances seem to be one of the main causes of vertebral and related pain. The proof is that 85% of patients treated with etiological methods see their pains disappear. Responsible for this is the “Postural Tonic System” which, if irregular, gives inaccurate information from its peripheral receptors, especially the ear, eye, teeth and foot. The Postural Tonic System or Fine Postural System (vestibular nuclei, reticular formation and cerebellum) is an automatic balance regulation system. The regulation of balance occurs through the regulation of postural reflexes that determine postural oscillations of small amplitude (between 0 and 4 degrees) thus allowing the physiological maintenance of the centre of gravity to be projected to the ground.
In order to correctly integrate postural reflexes (Fig. 11.1), the Fine Postural System (SPF) must be able to correctly receive information coming from the sensitive and sensorial periphery, i.e. visual, labyrinthine, stomatognathic, podalic esterocceptive, proprioceptive afferents and introceptive (extraocular, sub-occipital, lumbosacral, dural mechanoception and visceroception).
Fig. 11.1 –Integrate postural reflexes
When one or more of these receptors send disturbed signals (these sensory deficits are called proprioceptive dysfunctions or informational parasites) the SPF no longer receives information that is sufficiently clean to correctly integrate postural reflexes, balance and posture. Taking an interest in the Postural Tonic System means researching the mechanical cause of pain and this will go beyond the picture of vertebral pain to incorporate all the pathologies that cause a tonic-postural imbalance to intervene.
The Postural Tonic System (PTS) is therefore involved in: pains in the vertebral component, pains in the static component (feet, knees, also …), rheumatic pains in which the static component seems predominant, deformations of the spine (scoliotic attitude , scoliosis, kypho-scoliosis, etc.), sport pathologies where repetitive accidents, and reduced performance or non-progression despite training, are related to an imbalance of PTS, tendonitis, herniated discs (consequence of oblique tensions on a disc exercised over the years)., Whatever technique is used to cure the hernia, it must always be accompanied by a correction of the Postural Tonic System. On the contrary, the oblique tension will transfer to the upper or lower level thus causing relapses, or on the posterior joints explaining the pains that occur long after an operation.
The well-known postural deficiency syndromes in the ophthalmological, otoneurological, posturological, osteopathic and chiropractic fields due to their frequent dural mechanoreceptive etiology (dural strains following whiplash injuries, head injuries, emotional trauma or other), concern:
- the orthopedist, the physiatrist, the osteopath and the chiropractor, for their ethiopathogenetic importance in determining pathologies of muscular origin such as backache, analgesic scoliosis and degenerative processes of the column and limbs;
- the otolaryngologist, neurologist and psychologist, for the role they play in causing pseudo-vertigo, hearing loss, tinnitus, spatial localization defects, concentration defects, memory loss, asthenia, anxiety, depression;
- the ophthalmologist, for the role played in the genesis of many functional ophthalmological disorders such as amblyopia, asthenopia or directional scotoma;
- the orthodontist and the gnathologist, for the role they play in provoking alterations in the tone of the orofacial muscles (spasms of the TMJ muscles and alterations in the lingual, dental and labial posture).
Such oro-facial neuromuscular dysfunctions are an important factor in the appearance of:
- malocclusion (any dento-facial dysmorphosis is maintained and aggravated, and often caused by the oro-facial dysfunctions that accompany it);
- parafunction and bruxism, responsible for the hyper-tonicity of the jaw elevating muscles with reduction in free space and TMJ dysfunction.
In modern orthodontics and posturological gnathology, therefore, the ethiopathogenetic treatment of malocclusions, TMJ dysfunctions of muscle origin and oro-facial dysfunctions and parafunctions (classically treated with myotherapeutic and physiotherapeutic techniques) often pass by means of treatment of these deficiency postural syndromes . These syndromes, if not treated before starting orthodontic correction (especially with fixed appliances), can be responsible for lengthening treatment times, unexplained recurrences and iatrogenic pathologies induced by multiband treatment, such as, for example, joint clicks, migraines, tension headaches, dizziness, neck pain, low back pain, analgesic scoliosis. Let’s repeat once more that for many pathologies the Postural Tonic System is responsible, disturbed by wrong information from its peripheral receptors which are mainly: the eye, the foot, the stomatognathic system, the skin, the muscles and the joints . So the static disturbance is the basis of the mechanical tensions that are in compression, in distraction, in rotation, in torsion, scissor, etc …; these tensions can be localized at the joint, capsular, osteo-ligamentous, muscular, aponevrotic level etc…
The consequences will therefore entail:
- appearance of pain in a more or less short time;
- rigidity and contracture.
Limitation of joint movements favouring arthrosis (“life is movement” A.T. Still).
Limitation and reflex contractures cause a decrease in muscle performance, a depletion of glycogen stores, an acidosis. In sport, this is the ground for cramp and tendonitis. In the same way, oblique tension causes functional vertebral blocks in the long run. It is therefore understood now that the usual treatments such as kinesitherapy, analgesics, anti-inflammatory drugs are not completely satisfactory. As for manipulative techniques, mechanical actions that act on vertebral displacements are not etiological, except in the case of traumatic blockage. In most cases vertebral displacement is due to static, therefore functional, muscle imbalances. This explains relapses and the need to repeat the sessions; therefore it is now understandable why therapies such as homeopathy, mesotherapy, acupuncture can help, but only the treatment of the mechanical causes will re-establish the patient. The consequences in the various zones are present also at the neuromuscular and micro-circulatory level, explaining in particular the unsystematic and accentuated pain in certain parts, as well as post-trauma and post-surgical complications:
- algo-neuro-dystrophic syndromes,
- delays in consolidation,
- pseudarthrosis and healing delays.
To function normally, the posterior vertebral joints need a sacral angle of 32 °, a strictly horizontal L3-L4 disc, balanced muscle tension, harmonious curvatures; when there is a tonic-postural imbalance these conditions are no longer respected and tension appears.
All static disturbances come, at different levels, within the genesis of painful and non painful pathologies; a single etiological treatment consists in reprogramming the Postural Tonic System and arthrosis (apart from alimentation etc., mechanical tension, associated with the decrease in the amplitude of movements and local microcirculatory disturbances) comes within the genesis of arthritic phenomenon. It is wrong to think that it is arthrosis that causes suffering. The cause of the pain is rather the static imbalance responsible for the arthritic genesis. All these tensions are linked to a static imbalance. What is responsible is the postural tonic system unregulated by the pathological information which starts from its peripheral receptors.
The Postural Tonic System is specifically related to the following systems:
- the eye: two types of pathologies can be the basis of postural imbalance: those that trigger a sensory proprioception (refractive disorders) and those that trigger extra-ocular muscular proprioception (convergence defects). In these cases, new notions based on modern neurophysiology are usedmethods of analysis and correction.
- teeth: at this level two types of proprioception can disturb the postural tonic system: the reactive dental foci and the imbalances of the masticatory apparatus (which alter the physiology of the Craniosacral Mechanism – concept on which cranial osteopathy is based).
- the foot: it is involved in postural imbalances. In fact, if it is not causative, in all other cases it is adaptive whatever the origin of the imbalance. It represents the connection between postural disturbance and the ground, a true terminal buffer system, compensating for all postural disorders. The adaptive foot will be reversible at first, while at a later stage it can be identified as a true injury mechanism, if the cause is not removed. This makes its correction mandatory. There are common types of feet: the mixed foot which associates both an adaptive factor and a causative factor. All types of feet must be analyzed, considered and treated accordingly.