Osteopathy is a holistic therapy. Holism is important for addressing the root causes for a problem, and managing them; not only to improve symptoms, but also to reduce the chance of recurrence. A dictionary definition of holism is:
The treating of the whole person, taking into account mental and social factors, rather than just the symptoms of a disease
Addressing the mental factors of lower back pain can be as simple as giving the patient a green light to get back to gardening. Unnecessary worry about pain or injuries can cause physical changes (avoiding exercise, holding muscles tense) that exacerbate the problem. This reassurance works in conjunction with treatment. It’s not unusual for the psychological factors of pain to be more complicated than this.
Of course, we look at the whole body in a holistic way too. This applies in diagnosis and dictates how we work moving forward. I recently saw a patient who had been suffering from lower back pain for five years. It was getting worse, and now he couldn’t walk more than a few metres before he needed a wheelchair. He came to me frustrated with how the hospital was managing him, and opened his story with “this is quite complicated”. He was under two departments at the hospital: one who thought that the problem was in his spine, and the other that thought it all came from hip arthritis. He had eventually got the two departments to discuss his case, but this didn’t bring him any closer to a solution.
This way of working is the opposite of holistic: it is reductionist. Reductionism absolutely has its place, but when it isn’t working, we need to take a broader look at the problem again.
When the patient told me his whole story and showed me exactly where it hurt, I could give him a diagnosis. Unsurprisingly, it encompassed the hip, the back, and something that neither department had considered. His hip was quite arthritic on the painful side, causing the sacroiliac joint to overwork, with the muscles of the lower back protecting the whole area. So with this holistic diagnosis, I could make a treatment plan to encompass all that plays a role, treating the hip, pelvis, and lower back.
The best part is that when the hip improves and he becomes more mobile, everything else will benefit too. This is not something he will always have to see me for, or suffer with. Explaining all of this is holistic in itself. By debunking painful ideas of crumbling joints and unstable discs, I can give the patient back control. It wasn’t too surprising when he stood up at the end and described the feeling as “remarkable”.
Often, the psychological and emotional factors in a person’s pain are more prominent than this. When pain causes a person to be unable to work, or to require help from a friend or relative, the pain gets more complex. Likewise, when we start avoiding things (particularly exercise we enjoy) for fear of exacerbating pain, it gets more difficult to overcome. We work with the patient to help them get past these emotional and mental factors for pain. Education about what’s really going on, and what patients can do for themselves, as well as what we can do for them in the clinic can give improvement before any formal treatment even happens.
When the psychological picture extends into anxiety, changes in breathing can exacerbate existing problems and cause new ones. An anxious patient with diaphragm pain that extends into the chest is not going to feel any calmer! Again, explanation and exercise can help get back on track here. It also helps these patients to know that I see a lot more patients than they might expect who also suffer from anxiety. I think that anxiety will be much less of a problem when we all start to open up about it.
