What is the Total Lesion?
An Osteopathic lesion is an altered state of movement within a joint. It has 3 components,
Exciter focus, structure that is activated to become the origin of abnormal function,
Communication mechanism, the system via which abnormal function will be transmitted.
The target structure, the tissues that responds.
Diagnostic criteria
- Inflammation
- Change in mobility
- Reduction in elasticity
- Vascular changes
- Chronic tissue
- Spasm/reactivity
In Osteopathy the overall state of disease, the summation of all the homeostatic mechanisms, which have been upset in one way or another, is known as the total lesion. (J Mickerson 1980, ESO project)
In a normal healthy person the homeostatic responses to its environment are responding accordingly, if this changes and disease or the precursor to it, lesioning takes place the bodies homeostatic mechanisms are trying to overcome this hindrance, but unsuccessfully or compensating as best it can. This compensation will continue until the disease or lesion process has been alleviated. If this doesn’t occur a gradual fatigue or decompensation recompensation will take place with more effort on the body to deal with the problem. The sum total of this process and its effect on the body is the total lesion. (Russell Sutton, 1980)
Osteopathy deals with the relationship between the structure of the body and its function. Osteopathy considers the musculoskeletal system as the primary machinery of life, with the visceral systems being supportive. (H Klug 1990)
Diagnosis
Treatment is never given to alleviate symptoms without a diagnosis.
The first diagnosis an osteopath makes is whether there is pathology.
The next diagnosis is the nature of that pathology.
The next is osteopathic lesioning present. (H Klug 1990)
Motion is the only reliable criteria for diagnosis. (Magoun on Dr D L Clark, JAO 1938)
Primary Lesion
Original lesion originating from;
- Trauma
- Infection
- Disease
- Segmental irritation from organ dysfunction
- Shock
- Chronic/Acute emotional strain
This gives rise to the signs and symptoms we find on examination.
This can result in facilitation of the affected area. (Dummer 1990)
Secondary Lesion
These are mechanical compensations to primary lesions. Hyper-mobility, to counteract the hypo-mobility of the primary. (Dummer 1990)
Secondary Osteopathic lesion occurs as a result of the primary lesion,
Passively follows the movement of the primary above or below it. Present in order to compensate to balance out the primary i.e. secondary curve balancing the primary spinal curve. Present to correct the primary attempts to move in the opposite direction of the primary to draw it back to normal. (Klug, 1991)
Pain in tissues
Capsular, painful arc, pain throughout the range of movement in that joint.
Ligamentous, pain at the end of the range, lax on damaged side relatively tighter on healthy side. Localised swelling and tenderness on palpation of effected ligament.
Muscular, weak, ache and fatigue with ache on use of effected muscle, tender points in muscle, contracture expends energy produces heat. Fibrous texture chronic muscle contracture.
Treatment
Osteopathic treatment is by manual means.
Purpose of treatment is to encourage the body to restore its capacity to heal itself.
In presence of pathology the osteopath’s role is supportive.
Where appropriate an osteopath would refer i.e. GP.
We seek to reach the patient via their structure /function relationship in the context of the pathology or lesion pattern. (H Klug, 1990).
Prepare the tissues first as it is these that hold the lesions as they are.
(Magoun on Dr D L Clark, JAO 1938)
Never make a correction more than once; if the tissues are suitably prepared it won’t need readjusting. (Magoun on Dr D L Clark, JAO 1938).
