The Doctor's Corner

INJURY AND CRANIAL OSTEOPATHY:
A GENTLE APPROACH TO WHIPLASH AND OTHER TRAUMAS

by Paul J. Dunn, MD, charter member of the American Holistic Medical Association, member of the American College for Advancement in Medicine, the American Academy of Environmental Medicine, the Academy of Orthomolecular Medicine, and member and past president of the International Academy of Nutrition and Preventive Medicine, retired from a private practice in holistic medicine in Oak Park, Illinois. He is a member of the Cranial Academy and has been awarded a certificate in Cranial Osteopathy by that organization. He is also a member of the American Academy of Osteopathy.

Why would a board certified practicing pediatrician spend a significant amount of time during the last thirty years of his practice doing osteopathic manipulative treatment, including cranial osteopathy with children but primarily with adults? Some may say "First of all, what is osteopathy and especially, what is cranial osteopathy?"

Osteopathy is a form of medical practice promulgated over a hundred years ago by Andrew Taylor Still, MD. It is based on several holistic principles, one of which is that the body functions as a unit, and in order to function efficiently, there must be structural, i.e., musculoskeletal balance. If there is a structural imbalance this can result in symptoms, not only in the musculoskeletal system, but also in many other internal organ systems. Osteopathic physicians also have had the same medical training as their allopathic medical colleagues.
My introduction to osteopathy came through my work with children with brain injury and reading and learning problems (now referred to as ADD and ADHD). In 1974, after twenty years in practice, I met Robert Fulford, DO. He was a student of William Garner Sutherland, DO, who conceived of the cranial concept in the early 1900's. Dr. Fulford came to my office from Cincinnati once a month for the next two years seeing my patients with disabilities. Working with him along with my further osteopathic training led to my including this as an integral aspect of my integrated, complementary medical practice over the next thirty years. In time, the practice evolved to working mainly with adults whose chronic problems were not responding to their usual medical treatment.

Osteopathy is . . . based on several holistic principles, one of which is that the body functions as a unit, and in order to function efficiently, there must be structural, i.e., musculoskeletal balance. If there is a structural imbalance this can result in symptoms, not only in the musculoskeletal system, but also in many other internal organ systems.

In my regular pediatric practice, relative to osteopathy, there is an example of the importance of this concept in the newborn. This infant was thirty-three hours old at the time I was called to see him. From the time the baby came into the nursery until that moment, he had not stopped crying! It was not a normal newborn cry, but rather almost a scream with eyes wide open. He would not eat nor sleep. The usual pediatric exam of a newborn was unremarkable. However, his head felt like a little rock and all the skull bones were markedly pushed together. Passive head movements were restricted in all directions. His thighs were constantly flexed up onto his abdomen. This was obviously a cranial problem requiring osteopathic treatment. After five minutes of very gentle, non- forceful cranial manipulation, the baby stopped crying and went to sleep. He slept through ten more minutes of very gentle treatment. The abnormal findings were corrected. He subsequently ate and slept normally and continued as a normal newborn. Without this treatment he probably would have had significant future problems.

Viola Frymann, DO, another pioneer in cranial osteopathy, studied 1,250 newborns relative to the cranial concept1. Ten percent of the infants showed that severe visible trauma had been inflicted to the head, either before or during labor. Careful examination revealed less obvious osteopathic problems in an additional seventy-eight percent. Thus nearly nine out of ten infants in this study were affected in some degree. Problems with sucking, swallowing, spitting up, and colic in the newborn are probably the result of a cranial problem. Also, this is probably a factor in repeated middle ear infections in a young infant.

The cranial concept of the primary respiratory mechanism as developed by William Garner Sutherland, DO, involves the movement of the cranial bones,2,3 the movement of the sacrum between the hip bones, the rhythmic fluctuation of the spinal fluid, and the movement of the brain and spinal cord. Along with these movements there is a slight but detectable movement felt through the body. So the whole body is moving with this craniosacral, or, more accurately, the primary respiratory mechanism. The cranial rhythmic impulse occurs at a rate of about eleven to fourteen times a minute. It has its own frequency-separate from the cardiac or pulmonary respiratory rate.

. . . there are the falls and bumps that infants, children, and adults take, many of which we don't pay much attention to. But the force is still significant enough to cause a problem in the cranial mechanism. Even injuries like whiplash or falls on the tailbone, while they do not hit the head directly, they transmit force up the spinal column to the cranium and throughout the body. This type of injury can cause widespread symptoms even years later.

There are many things that can happen in life to cause a problem with this mechanism. Basically, the problem is a jamming together between some of the cranial and/or facial bones. It is not a fracture. It would not show up on an X-ray, EEG, CAT scan, or MRI. As indicated above, even a normal labor and delivery can contribute conceivably to a problem later in life. Then there are the falls and bumps that infants, children, and adults take, many of which we don't pay much attention to. But the force is still significant enough to cause a problem in the cranial mechanism. Even injuries like whiplash or falls on the tailbone, while they do not hit the head directly, they transmit force up the spinal column to the cranium and throughout the body. This type of injury can cause widespread symptoms even years later. It isn't only the neck that is involved in a whiplash4. Physical trauma is the usual cause of a cranial problem but previous emotional trauma can also be the culprit.

The resultant symptoms may first of all be musculoskeletal with various muscle aches, pains, stiffness, and asymmetries. They may be related to one or more of the twelve pairs of nerves that come off the brain. These nerves are related to vision, eye movements, hearing, smell, balance, sucking, chewing, swallowing, speech, heart, lungs, stomach, all the small intestine, and most of the large intestine. Also involved is the flow of lymph fluid so that a problem in the cranial mechanism can result in a backing up of lymph fluid which in turn can result in some degree of chronic or recurrent respiratory congestion. This could affect the sinuses, nose, middle ears, lungs, or some combination. So the symptoms could be only a few and very mild, or more numerous and severe depending on the individual situation.

Here is an example of a severe whiplash injury. This lady came to the office with a history of severe headache for the previous two years. It started after being hit from behind in her stopped car by another fast moving car. She also had neck pain and stiffness. Her general health was significantly affected. She had been seeing her chiropractor regularly since the onset with very little improvement. An osteopathic exam revealed structural imbalances from head to foot. After the first osteopathic treatment the headaches were significantly improved. I had also recommended a comfortable postural exercise which she did at home. After a few more treatments there were no more headaches or neck pain and her overall health greatly improved.

. . . the infant bumped the back of his head in a seemingly insignificant way. Subsequently he became very irritable and was crying much of the time day and night. . . . . Repeated physical exams and some basic tests revealed nothing. . . . . Benadryl was also prescribed because the baby was not sleeping (and neither were his parents). An osteopathic exam revealed a definite problem with the cranial mechanism. The day after his first treatment, his mother called to say that he had slept most of the night for the first time in weeks!

Another incident involved a seven month old baby who, until that time, was a very happy baby with no symptoms whatever. But one day the infant bumped the back of his head in a seemingly insignificant way. Subsequently he became very irritable and was crying much of the time day and night. He began to spit up his food consistently for several weeks. Repeated physical exams and some basic tests revealed nothing. A diagnosis of gastroesophageal reflux was made and an antacid was prescribed. Benadryl was also prescribed because the baby was not sleeping (and neither were his parents). An osteopathic exam revealed a definite problem with the cranial mechanism. The day after his first treatment, his mother called to say that he had slept most of the night for the first time in weeks! I saw the baby again in one week. He had continued to sleep through the night and was no longer regurgitating his food. The medications had been stopped. Osteopathic exams were now normal.

At the other end of the chronological scale was a man in his sixties who for two years had a constant loud ringing in his right ear with a feeling of pressure against the inside of the same ear. His head felt like a rock with no cranial movement detectable. Passive head movements were all restricted. Other osteopathic abnormalities were evident in his extremities, back, chest, and pelvis. He also had other symptoms and metabolic imbalances, but his head symptoms were his main problem. His first treatment lasted forty minutes. I gave him a postural exercise to do at home and had him return in two weeks. At that time he said, "Doctor, the night of your first treatment the ringing in my ear and the feeling of pressure went away and hasn't been back, and it had been there for the last two years. Can I expect that to continue?" I told him that it probably would continue. I told him to continue the exercise every day for the rest of his life because it has many benefits. Based on his total picture, a multifaceted treatment plan was outlined for him. He went to Florida for the winter. In March I received a letter from him saying that as I predicted the problem had not returned. He also said "Doctor, I haven't told you this before but that ear problem over those two years involved two hospitalizations and at least twenty-two different doctors. Nothing they did helped, and you fixed it in one osteopathic treatment. That's a miracle." I told him it wasn't a miracle. It was a matter of knowing about the basic cause, being able to detect it, and knowing what to do about it.

. . . he said, "Doctor, the night of your first treatment the ringing in my ear and the feeling of pressure went away and hasn't been back . . .". He went to Florida for the winter. In March I received a letter from him saying . . . the problem had not returned. . . [and] "Doctor, I haven't told you this before but that ear problem over those two years involved two hospitalizations and at least twenty-two different doctors. Nothing they did helped, and you fixed it in one osteopathic treatment. That's a miracle." I told him it wasn't a miracle. It was a matter of knowing about the basic cause, being able to detect it, and knowing what to do about it.

Obviously the results with every patient are not dramatic like those discussed above. Cranial osteopathic problems are certainly not the cause of everything and treatment is not a cure-all. One thing is certain. Cranial osteopathy is a very frequent and significant factor in chronic problems for patients of all ages. In my work with several thousand children with brain injury, learning problems, ADD, and ADHD, I have found evidence of significant osteopathic problems in the VAST MAJORITY. It is almost one hundred percent. In my integrated, complementary approach with adults having chronic problems and not responding to the usual, customary treatment, the same thing is true. This treatment enhances the benefits of other treatment modalities that are part of the multifaceted treatment plan.

How does a doctor diagnose this condition? It is not diagnosed through X-ray, scans, MRI, or any other test. First of all, a good medical and osteopathic history is essential. This is followed by a good osteopathic, i.e., musculoskeletal exam, including the cranial field. So the diagnosis is made with the eyes, ears, and hands of the examiner. First of all, of course, there has to be an awareness of the cranial concept. Most osteopaths have at least heard of this aspect of osteopathy, but the majority are not including the cranial concept in their treatment armentarium. Among the couple of hundred thousand MD allopathic physicians in the United States, only a small minority have even heard of it much less had the training to use it.

The treatment, when performed by someone with adequate training, is safe, comfortable, and very relaxing. It does not involve forceful manipulation. It consists of a combination of usually indirect osteopathic procedures involving the whole body. It involves more than just the cranium and the sacrum. Many also use percussion vibration as part of the treatment. This is also very comfortable and it enhances the effect of other aspects of the treatment. Dr. Fulford, whom I mentioned above, was the first one to use percussion vibration many years ago. He was also the first one to recommend doing particular exercises at home to enhance the office treatment-in effect continuing the treatment at home. This reduces the frequency of office visits that might otherwise be needed. The number of treatments needed varies with the individual from one or two up to several.

[osteopathy] . . . when performed by someone with adequate training, is safe, comfortable, and very relaxing. It does not involve forceful manipulation. It consists of a combination of usually indirect osteopathic procedures involving the whole body.

To obtain the name of a physician in one's area who does this type of osteopathy, you can call the Cranial Academy at (317) 594-0411 in Indianapolis, Indiana.

This is a subtle, safe, comfortable, relaxing, and effective treatment of a frequent and significant aspect of chronic medical problems.

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1Frymann, Viola, "Relation of Disturbances of Craniosacral Mechanism to Symptomatology of the Newborn: Study of 1250 Infants," Journal of the American Osteopathic Association, 65: 1059-75, June, 1966.
2Frymann, Viola, "A Study of the Rhythmic Motion of the Living Cranium,"Journal of the American Osteopathic Association, 70: 928-45, May 1971.
3St. Pierre, N., Roppel, R., and Retzlaff, E., "The Detection of Relative Movements of Cranial Bone,"Journal of the American Osteopathic Association, 76: 289, December 1976.
4Magoun, Harold I., Sr., "Whiplash Injury: A Greater Lesion Complex,"Journal of the American Osteopathic Association, 63: 524-35, February 1964.

Article from NOHA NEWS, Vol. XXIX, No. 3, Summer 2004, pages 3-4.