Margaret Sorrel, DO, FCA - Osteopathic Manual Medicine


Pain & Injury Back Pain Headache
Joint Problems Digestive Respiratory
Ears & Sinuses Genito-Urinary Birth Trauma
Neuro-Developmental Autism Down Syndrome
Scoliosis Bone Health in Children Orthodontia

Patients are Partners

My day-to-day work is an opportunity to remove barriers that stand in the way of optimal health. If I succeed in listening well enough, the patient often tells me what s/he needs to continue on the path towards health. When or how did the trouble begin? Was there a traumatic birth in the child who is failing to meet appropriate developmental milestones? Are all ear infections preceded by colds? Did constipation begin when solid foods were introduced into the diet? Have headaches only been a problem since the skiing injury that involved a hard blow to the tailbone? Are the seizures related to a bad blow to the head? What body motion recreates the back pain?

It is truly amazing to work with patients as partners in seeking their own best health. And to do so utilizing a system of health care that depends on science but cannot be performed without the creative force of the physician. Osteopathy is both an art and a science.

Brief introductions into the science of osteopathy in relation to various medical problems will help you to appreciate the wide range of patients who can benefit from osteopathic manual medicine. Although Dr Sorrel is not treating adults, information is provided here to offer readers an understanding of the value of osteopathic care for a variety of problems. Please consult The Osteopathic Cranial Academy to find a physician near you.

Pain and Injury

Adults often live with the effects of injuries that were not treated osteopathically when they occurred. Sports injuries, lifting injuries and auto accidents are often the original culprits. Over time their effects can make us feel older than we are.

Pursuing treatment years later can still be beneficial in reducing pain and regaining function.

Back Pain

Low back pain is probably the most common symptom of adults seeking the services of an osteopathic physician specializing in manual medicine.

The musculature of the lower back has an enormous job to do and is structurally more suited to a hands-and-knees posture than the upright posture we hold for most of our lives.

Falls onto our buttocks can change the angle of the juncture between the lowest lumbar vertebra and the sacrum, a situation that the low back finds distressing. When that fall is just off the midline the sacrum may adopt a motion pattern on the wrong axis of motion. This can result in a spasm in the nearby piriformis muscle which irritates the sciatic nerve.

A bulging disc in the lumbar spine can also cause irritation to the sciatic nerve at its origin, and the resultant pain or weakness in a leg can be quite disabling.

Stepping off a curb with a jolt or tripping into a pothole can cause a hip height asymmetry which results in spasm and pain in the muscles of the lower back.

Sometimes an individual vertebral segment is rotated or a group of segments adopts a lateral curve to compensate for an unresolved strain.

Although these issues correct more easily in the resilient bodies of children, osteopathic treatment can resolve the misalignment and improve function at any age.

Headache

Headaches may follow the neck strains common to auto accidents and head trauma, or they may be aggravated by stress or hormonal changes in menopausal women. Often the juncture of the neck and the skull is the most crucial area to address in headache. This is where the posterior muscles of the neck pass over the ridge of the skull to attach to a roughened area. The strain the muscles carry is transferred via a tendon-like sheath to the muscle of the forehead. So individuals who suffer headaches over their eyes can find relief when the posterior neck and skull strains are addressed osteopathically.

Migraine headaches which began after head trauma and even migraine headaches that appear to run in families can ease up when the relationship between two bones of the skull is corrected. This lessens the irritation to the middle meningeal artery, a culprit in migraines.

Joint Problems

Shoulders

Many patients who suffer from frozen shoulders that worsened after physical therapy find improvement with the gentle hands-on work of osteopathy. It is important to address the muscular attachments and the joint between the shoulder and the collar bone, as well as the ball and socket joint of the shoulder itself.

Knees

The knee is another joint that is better designed for getting around on all fours. It has a wonderful protector, the patella, or knee cap, that keeps the joint safe from the hazards of the ground. But when put in an upright posture, we find that two smaller bones below the knee are in relationship with the one larger bone of the upper leg with very little padding in between.

To add insult to injury, we often plant our foot on the ground and rotate our body. This can put a significant strain in the middle of the joint. If severe it might tear a meniscus or damage a ligament, situations that might require surgery. But many knees, including those that are not amenable to surgical correction, can see a new lease on life with osteopathic treatment.

Other Problem Areas

Whether the problem is in the ankle, the ribs, the back or the pelvis, the osteopathic key is to look for disturbances in the structural relationships that can affect the function of the troubled area.

Sometimes the root cause can be traced to constrictions in the minute fascial layers which surround the nerves, sometimes a congestive condition from compromised venous or lymphatic drainage, sometimes a bony relationship which affects joint motion.

Addressing these structural problems often requires only a few visits. More complex and longer standing problems are benefited by a longer treatment course. If you are an adult seeking osteopathic care please go to The Osteopathic Cranial Academy to find a physician near you.

Digestive Problems

In Infancy

Newborn babies are frequent sufferers of gastrointestinal complaints. That's no surprise when one considers that the digestive system had no job to do in utero but is asked to be responsible for the entire sustenance of the body after birth.

Digestive troubles can range from spitting up to projectile vomiting and reflux, from mild difficulty burping to hours of daily crying with a colicky baby. Waiting for the improvement which happens as the digestive system matures can be hard on both babies and parents. Relief can come much sooner through addressing the osteopathic structural problems.

The trouble often lies in the junction of the neck and head where the vagus nerve was irritated by the birth process. This nerve controls much of the digestive system, and when the bony and tissue disturbances are released osteopathically, the symptoms can improve dramatically.

Older Children (and Adults)

Abdominal pain, reflux, diarrhea or constipation are sources of much distress. Structurally there may be tension at the junction of the esophagus and the stomach or a counterclockwise impulse in the fascia (connective tissue layer) that covers the abdominal organs. This fascia should move clockwise, mimicking the normal peristaltic motion of the colon. Correction of the fascial motion can be very helpful promoting digestive health.

Constipation can sometimes be traced to a hard blow to the sacrum (at the base of the spine). This can impact nerves which prompt bowel emptying. Releasing the sacral compression can restore proper emptying of the colon. In addition it is helpful to address the muscles in this area, those making up the pelvic diaphragm. Ensuring that they move up and down with respiration will contribute to bowel health.

Food Allergies

Food sensitivities or allergies are becoming more common as we live longer in a toxic world. Although osteopathic treatment does not change the underlying sensitivity to the troubling foods, it often improves the ability of the body to cope. As the constitutional health improves, the individual suffers less.

Respiratory Health

The common cold, in infancy and childhood, should not be viewed as an enemy. It is good training ground for the developing immune system. Complications of colds, at any age, such as ear infections, sinus infections, bronchitis, asthma and pneumonia are the problem. It is in the prevention of these complications that osteopathic treatment can be so beneficial.

The common cold taxes the lymphatic system, causing enlargement of lymph glands and congestion in muscles. And this muscular congestion further compromises the lymphatic and venous drainage. Even needed white blood cells are less able to get to the infected areas when muscles are in spasm. This level of compromise in the muscles can lead to vertebral and rib displacements further compromising the respiratory health. Osteopathic treatment will address these structural disturbances allowing the body to mount a much more effective response to illness and a quicker recovery.

In situations where a cold has always led to asthma, osteopathic treatment aimed at restoring rib and diaphragm mobility and improving the lymphatic and venous drainage can allow the cold to resolve without asthma. Individuals who have used medications heavily to address asthmatic symptoms often find that osteopathic treatment addresses the underlying structural disturbances so effectively that their medication use reduces dramatically.

Ensuring rib and diaphragm motion will enhance lymphatic drainage, circulation and immune function, which in turn aids in the prevention and recovery from all respiratory illnesses.

Ears and Sinuses

Ear infections are common in the first several years of life and are a relatively rare problem for adults. This is explained mostly by the better drainage afforded by the Eustachian tubes as we grow. These tubes, which drain the fluid from the middle ear cavity to the back of the throat, are nearly horizontal in babies and toddlers, and finally begin to get some vertical drop at about age four.

If fluid cannot drain from the middle ear, it serves as a wonderful home to the organisms that cause ear infections. If present over longer periods in this early time of life, can also compromise hearing to a point which can negatively affect language development.

Osteopathic treatment cannot make a Eustachian tube more vertical. That is a benefit that comes with age. But treatment can be helpful in other ways. The temporal bones of the skull house the bony portion of the Eustachian tube and if these bones can be gently moved toward their normal motion pattern, they can promote a pump like action in the tube which assists fluid motion, even in a horizontal tube.

In addition, osteopathic treatment can loosen muscular and bony relationships in the neck. This aids the lymphatic drainage of the ears. Very few children who receive osteopathic treatment end up needing ear tubes.

Similar principles of treatment guide the management of sinusitis. Each sinus has an opening for drainage whose function is dependent on the free motion of those cranial bones which surround the opening. The same mucous membrane which lines the nose lines the sinus cavity, the Eustachian tube and extends down into the lungs. Osteopathic treatment is aimed at restoring the health of this lining, to ensure health of the entire respiratory system.

Genito-Urinary Problems

Problems such as bladder infections, menstrual cramps, enlarged prostate and other congestive problems of the pelvis are often associated with poor venous and lymphatic drainage of the pelvis. A sling of muscles, called the pelvic diaphragm, moves upward as the breath is released and downward as the breath is inhaled, and this motion prompts venous and lymphatic drainage of the pelvis.

Injury or surgery to this area can compromise the motion of the pelvic diaphragm and can be an important reason for the congestive problems of the pelvis. Osteopathic treatment aimed at restoring the appropriate respiratory motion of this diaphragm is essential to good genitourinary health.

Birth Trauma

We have been taught to believe that birth is a normal process that leaves no negative effect on the baby or, if complications are present, we believe their effects must by accepted and endured by child and family.

The immediate effects of a prolonged or difficult delivery often manifest in improper sucking, spitting-up, sleep disorders, poor digestion or a just plain fussy baby. These may simply be the result of the normal compression of the skull, (necessary as the baby descends in the birth canal) failing to expand fully after birth. A good strong birth cry helps the skull to re-expand but sometimes osteopathic treatment is needed to fully restore the misshapen head to the shape and size it was in utero.

Two nerves are often affected, one influencing the suck and one affecting digestion. Babies in distress can sometimes show remarkable improvement after a single osteopathic treatment though, in more difficult birth experiences, a course of treatment may be necessary.

It would be ideal if every infant were afforded the opportunity to release the trauma of birth through osteopathic treatment shortly after birth. Treatment initiated later is still helpful and may help ensure good neurologic development throughout childhood.

Neuro-Developmental Problems in Children

Eighty percent of all neuro-developmental problems in children are not associated with a specific diagnosis. Many of these have their origin in a traumatic birth experience which left an ongoing compromise to the central nervous system, either due to direct structural injury or compromised oxygen levels at this critical time.

A prolonged labor, or one that needed the help of forceps or vacuum extraction, may take its toll in the relationship of one bone to another, or in irritation and tension on the membranes that surround the brain and spinal cord. This affects the function of the central nervous system as it grows and may lead to developmental delays or learning disabilities. If oxygen was at a lower than ideal level surrounding the time of birth similar complications may ensue.

Osteopathic treatment helps the body to use its inherent abilities to heal by correcting structural disturbances. A few examples demonstrate the principles involved in treatment.

When the compression on the baby's head distorts the shape of the opening where the brainstem leaves the skull to become the spinal cord, the resultant pressure causes spasticity of the limbs. Gentle osteopathic treatment to help this opening return to the shape it had before the difficult birth can normalize the tone of the baby's muscles.

When the membranes which lie between the skull and brain are irritated from the compression of the skull in the birth process, one may see tremors and twitches and generalized irritability. Gentle osteopathic treatment to release this membrane restriction can result in a calm nervous system able to function more normally.

When oxygen compromise was a factor, osteopathic treatment aims to ensure good function of the respiratory center in the brain as well as free motion in the ribs and diaphragm.

Autistic Spectrum Disorders

The incidence of autism has risen dramatically in recent years causing parents and professionals to desperately seek causes and effective treatments. Research is exploring causes ranging from genetic predisposition and heavy metal toxicity to birth practices. Many autistic children have associated health problems such as allergies, poor immune systems and digestive problems.

There is no one-size-fits-all for children on the autism spectrum, either in the arena of cause or helpful interventions. For some of these children cranial osteopathic treatment has been a significant key to improving the child's functional capabilities.

The majority of children on the autism spectrum demonstrate a fairly consistent set of cranial osteopathic structural findings, including left sided suture and membrane restrictions. These can be improved or resolved through a course of osteopathic manual treatment resulting in a notable improvement of brain function.

For some of these children, this manifests as better eye contact or more willingness to be held and touched by his or her parents. For others, the self stimulatory behaviors lessen or steps are made toward better communication skills and social interaction.

Children on the autism spectrum make most progress when a variety of interventions tailor-made to the individual are employed.

It is incumbent on those of us blessed by neurological systems that are closer to what the culture expects to foster acceptance and compassion for those with autism. With the growing number of people affected, we must learn ways to successfully incorporate individuals with autism into our schools, workplaces and into society in general.

Down Syndrome

What can the osteopathic approach offer to a genetic syndrome? When one thinks about the dynamic relationship between body structure and body function, one can see the value of osteopathy in Down Syndrome.

The typical face of a child with Down Syndrome is flat in the area of the cheeks and the bridge of the nose, and the whole head is short from front to back, wide from side to side. The ears are often low set and the tongue often protrudes from the mouth. Even though there is a genetic component to these typical features, they are all capable of change with treatment. As the structure becomes more anatomically typical, the function of related systems improves. One example might help to illustrate.

The recessed mid face makes for small sinus cavities which drain poorly. As osteopathic treatment allows the mid face to come forward and the bridge of the nose to become more prominent, the sinus cavities can drain more normally and these children are no longer sicker than their peers.

The distorted shape of the whole skull in children with Down Syndrome is partly due to the way the bones of the skull come together. But this is dramatically influenced by the membrane system that lies beneath the bones. These membranes are typically very restricted in these children and when released osteopathically, the skull attains a more typical shape.

Since healthy neurologic development is partly dependant on the precise geometry of the skull, allowing the nerve pathways to lay themselves down correctly, this improvement of cranial shape can have a beneficial effect on development and learning.

Scoliosis

Scoliotic curves are most often seen in girls between the ages of 10 and 14. More severe curves require orthopedic treatment, bracing or rarely surgery. In scoliosis, the vertebrae are both sidebent and rotated, ribs are displaced and muscle groups are stretched or shortened. Discomfort is rare during adolescence but pain and disability are likely to be experienced later in life if left untreated.

Osteopathic treatment can be of help both in the more mild curves and in those requiring orthopedic intervention. Treatment improves both spinal mobility and degree of curve.

Many adolescents, during their periods of most active growth, show some spinal curve, often accompanied by a pelvis which is not level. These growth related curves can often be completely resolved through treatment which includes the correction of the unlevel pelvis.

It is not reasonable to expect a change in the degree of curvature of a scoliosis in an adult but one can certainly expect a more pain free and functional spine through osteopathic treatment at any age.

Bone Health in Children

Most of the orthopedic problems in childhood are seen in the lower extremities: the feet, legs, knees and hips. Considering the changes that this small body makes as it grows from a cramped in utero position, through crawling to walking, this shouldn't be a surprise.

Congenital hip, where the head of the femur (upper leg bone) does not seat itself properly in the ilium (hip bone), must be treated with bracing, but osteopathic treatment can help normalize the joint function.

Tibial torsion, the outward bowing of the lower legs, caused by the cramped in utero position, often resolves on its own. But if there is a strain between the knee cap and the tibial bone or between the tibia and the nearby fibula, the problem will persist unless addressed osteopathically, hopefully before the baby begins to walk.

All early walkers adopt a wide stance, for stability. But the continuation of the wide stance longer than a few months indicates the need for osteopathic evaluation. The frequent falls taken by early walkers can compress the juncture of the sacrum (at the base of the spine) and the vertebrae of the lower back. This common insult, left untreated, is one of the underlying causes of low back pain suffered by adults.

Flat feet should not be a concern in toddlers, as the instep is slow to develop. Nor are "knock knees" a problem in a three year old. If knee alignment has not improved by age five, treatment can address the underlying structural problems.

Children of all ages live in their bodies. They stretch the limits of their skills and suffer sprains and strains just as adults do. It can be tempting to ignore these injuries since they often just get up and keep going without complaint.

Left untreated, the cumulative effects of sports injuries and falls to the head, the extremities, the back, and the torso, leave a legacy in the body which becomes troubling as the body ages, and is more difficult to resolve in adulthood.

Orthodontia

Osteopathic treatment is an integral part of assisting the body in making an orthodontic correction. The proper alignment of the teeth is dependent on a correct relationship of the upper jaw (maxilla) to the lower jaw (mandible).

To make changes in tooth alignment requires changes not only in relationship of the maxilla to the mandible but in complex relationships of these bones to several other bones of the face and skull. All places where bones come together in the skull, have the capability of motion, more in childhood than in adulthood. This small amount of motion is essential to a successful orthodontic correction.

Osteopathic cranial treatment assists orthodontic correction by helping all the bones of the skull adjust to the orthodontic changes.

It is expected that the normal cranial mobility will be somewhat compromised during orthodontic correction. The degree to which this happens depends in part on the types of appliances used.

Fixed appliances such as braces, which hold firm the relationship of some teeth to other teeth, result in rigidity in the motion of the maxilla and mandible and greater compromise in the motion of the rest of the cranium.

Functional appliances, such as adjustable palate expanders, permit the cranial bones to maintain more of their motion pattern during correction. They are therefore preferable whenever they are capable of making the needed correction.

Not only can osteopathic treatment before and during the orthodontic correction be helpful in maintaining the general health and vitality of the patient, the desired orthodontic results are often obtained in half to two thirds of the time estimated by the orthodontist, and the correction is more likely to hold well over time.


"It has been five days since my granddaughter's first treatment. The change is remarkable. She is no longer fussy or quick to cry. She is a whole different baby. She falls asleep without a bottle and no longer cries when she empties her bowels. You have given her and us such a gift. We are so grateful."
— Terry B.

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Margaret Sorrel, DO, FCA - All Rights Reserved © 2011