Osteopathy as an Effective Preventative Therapy and Rehabilitative Treatment for the Aging Process

Hadi Sunalla, DO, DN, NKT, DOMP, RMO

Introduction

As we age, there is a natural process of degeneration. The body recovers more slowly, and with every injury or surgery, we psychologically develop more fear of moving and falling. This creates a cycle that is never ending, because as we tend to move less, we create more pain, and become more fearful of movement. Aging is an essential part of life, along with all the positives and negatives that come with it. Good thing there is a treatment solution that can help us age gracefully, and can even treat chronic, lifelong pain. With Osteopathy, aging can be just another manageable part of life. Osteopathy was founded by Dr. Andrew Taylor Still in the late 1800s. The son of a surgeon, his goal was to restore the body to optimal function, treating it as a holistic entity, all while using manual techniques. This was an innovative and healthier option, especially due to the fact that surgery at the time was cruder and more invasive. It is no wonder that Osteopathy was once called “bloodless surgery” by its creator. One of the most profound benefits of Osteopathy is how it helps with the aging process. Manual osteopaths use a wide variety of techniques that assist with fall risk management, mental health, insomnia, loss of muscle mass, and disease prevention.

Fall Risk Management

Contrary to popular belief that falls are an unavoidable consequence that seniors must face due to aging, it does not necessarily need to be true in every case. Thus, it does not have to be an integral part of the aging process. However, elderly individuals are still at a higher risk than other demographics. The consequences of such falls are also more drastic, but luckily, they can be avoided with proper management with Osteopathy. Moncada’s (2011) article depicts some truths about falls that can help to provide the motivation needed in order to prevent them. Here are some facts from the American Family Physician Journal:

“A history of falls is associated with a two- to sixfold increased risk of a future fall. Noninjurious falls are a harbinger of potentially life-threatening events, and an opportunity for physicians to intervene. Falls are the leading cause of death from injury in persons older than 65 years, and mortality from falls has increased by 42 percent over the past decade. Approximately 25 percent of persons who fall have moderate to severe injuries, ranging from bruises or lacerations to hip fractures or traumatic brain injury, resulting in more than 1.9 million emergency department visits annually. Injuries, such as hip fracture, and falls are risk factors for placement in a nursing home, where the fall risk is nearly three times that of persons living in the community.”

Perhaps with Osteopathy, one fall does not have to lead to another, since dysfunctions associated with a previous fall or pulled muscle can be treated. Therefore, Osteopathy can help to regulate the body back into a rehabilitated state. In any case, we should certainly take care of our elderly and make sure they do not end up completely sedentary. Among other clinical recommendations, such as adaptation of home environment, or withdrawal and minimization of appropriate medications, exercise was found to be among the most effective and realistic methods for fall prevention (Moncada, 2011). With Osteopathy, exercise can be optimized. Osteopathy can help with balance, strength and gait training, the most clinically important aspects of exercise to prevent falls. With osteopathic Muscle Energy Technique, muscles can quickly become strong and range of motion can also be increased in a matter of minutes. The active participation of the patient is required, which allows for muscular activity in the areas that require it most. The manual osteopath can then give some at-home exercises to continue the progress on a daily basis. In such cases, improvement of muscle function and strength is felt after every session, and results are long lasting, especially if the patient maintains their short but effective exercise routine. In the case of improving balance, strengthening the gluteus medius, the posterolateral hip muscles, is a very effective treatment, since this allows for a more grounded stance and greater balance. This is due to one of the muscle’s functions, helping to keep the hips level to one another while standing. According to Lopez et al. (2011) in a scientific article about the effects of comprehensive osteopathic treatment on balance in elderly patients, postural stability, as measured in changes in sway values, was improved in healthy elderly patients compared to the control group that had no osteopathic therapy performed. Thus, Osteopathy is certainly recommended after a fall for post-rehabilitation, or even as a preventative measure altogether.

Gait is the biomechanical analysis of how we walk, and can give a lot of information to the trained eye of a manual osteopath, if there are any issues to be seen. Gait can, of course, be improved, essentially making walking more efficient. It is predominantly the gluteus maximus that is responsible for extending the hips and propelling the body forward during gait. Strengthening this muscle and releasing overcompensating muscles can make it easier to take walks, which is essential in keeping vitality with age. Osteopathy can further help to improve the biomechanics of walking by increasing range of motion in the ankle. It is recommended to have a minimum of 10 degrees of ankle dorsiflexion, even for an activity as simple as walking. Tight calves, usually due to weaker glutes, can limit one’s range of motion in this regard, but with Muscle Energy Technique, this can usually be increased up to a total range of 20 degrees in just one or two sessions, which is twice the recommended amount of range.

Furthermore, Osteopathy can decrease the risk of injury from falls, especially when paired along with an exercise program that can combat osteoporosis, which is the thinning of bones that occurs in the majority of seniors and post-menopausal women. Some exercises that are recommended to increase bone density involve light impact, such as gentle heel-strikes onto the ground, which stimulates bone production. In this way, Osteopathy can prepare the body for optimal exercise that can increase bone density by 10% in patients who have osteoporosis.

Mental Health

Osteopathy helps to treat the body and mind as a whole, nurturing their connection, and reducing anxiety and stress. Osteopathy is not simply defined by its application of physical techniques, but rather its philosophy as a whole (Paulus, 2013). A bottom-up approach implies treating and caring for the body first, to ultimately positively affect the mind. Inversely, a top-down approach is also possible, and aims to treat the mind before the body. Both of these methods can be applied to osteopathic treatment to achieve the goal of optimal health in both the mind and the body. In addition, Osteopathy may influence and positively improve the patient’s outlook on health and perception of beneficial knowledge (Bohlen et al., 2021). Hence it is no surprise that the founder of Osteopathy, Andrew Taylor Still, encouraged and promoted the development of a psychiatric specialty for Osteopathy (Bradley et al., 2003).

Due to its distinct approach in treating the body as a holistic entity, Osteopathy is great for all-around treatment and care for declining mental health in elderly patients. With osteopathic mobilization, beta endorphin production increases in the patient’s body. Beta endorphin can reduce stress and maintain homeostasis. In this way, it can help with anxiety and other issues related to declining mental health. Slow, deep breathing is one of the best ways to calm thoughts and ease the mind. With the help of osteopathic release of the diaphragm, deep breathing is made easier for the patient, allowing for a calmer mind. The addition of short but effective physical exercises, prescribed by the manual osteopath, and made possible from treatment, also helps with improving mental health and lung function. Osteopathic somatic release is another very calming technique that can work wonders to promote more body awareness and treat headaches and other mental strains. Lastly, osteopathic treatments can give great results for many conditions in only a few sessions. This ultimately gives hope to any recipient of the treatment, who previously thought that they would just have to live with the pain they are experiencing. In turn, it can even increase confidence, starting from the confidence that treatment is working.

Insomnia

Insomnia is a well-known and common disorder that affects the quality and ease of sleep. 10-30% of adults have insomnia, and it gets exasperated with age. In fact, by the time a person is middle-aged, they lose an average of 27 minutes of sleep at nighttime for each subsequent decade. For the elderly, it is a natural consequence of the aging process (Fry & Rehman, 2022). Changes in production of certain hormones like cortisol and melatonin is partially responsible for this, affecting the body’s ability to coordinate circadian rhythm.

An integral part of Osteopathy utilizes a technique called Grade IV mobilization, which is a gentle technique that passively places any joint towards the end of its range of motion for 2-5 seconds. By holding the position closer to 2 seconds, the patient may feel energized after the treatment. In contrast, holding this position closer to the 5 second mark can relax the patient and promote rest, inducing positive changes overnight and over the next few days. In this way, Osteopathy has many options for treating patients on a case-by-case basis. Positional release therapy is another technique that is very relaxing for the patient. Conventional methods of soft tissue therapy are painful, and aim to massage muscle spasms with force until they soften. Positional release therapy involves placing the muscle in a position of ease, and gently applying pressure for 90-180 seconds, until a release is felt. If performed by a skilled manual osteopath, the patient virtually feels no discomfort or tenderness, even if the technique is being performed on an otherwise extremely painful muscle. Using this method, the patient relaxes, and leaves the session feeling relief from pain, especially when accompanied by osteopathic mobilization.

Furthermore, cranial Osteopathy can help in preventing or treating insomnia by stimulating the vagus nerve. This nerve is largely responsible for relaxation and sleep, among many other unconscious bodily processes, including breathing, heart rate and digestion. Decompressing the vagus nerve can ease tension and increase blood flow in the muscles in the heart, stomach, intestine and throat, leading to better rest (Breit et al., 2018).

Loss of Muscle Mass

Sarcopenia is the clinical term for age-related muscle loss and function, and is a fundamental cause of disability with age. It begins to occur after the age of 30, where muscle mass declines by 3-8% per decade, with an increased rate of decline after age 60 (Bradley, Osborn, Jerome, & Williams, 2003). Inactivity is a leading cause of loss of muscle mass. This inactivity is usually due to pain from a chronic condition. If someone is already in pain at the end of the day from menial tasks, such as chores around the house or running errands, they are unlikely to seek further exercise. Luckily, Osteopathy is great for treating chronic pain. Osteopathy aims to find and treat the cause of pain, and not just symptoms, as they are side effects and are likely to return if the cause is left untreated. This is an important reason for why osteopathic manual therapy is so effective, as the unique and tailored solutions ensure that dysfunctional biomechanics are addressed. Proper care is taken to achieve maximum medical benefit, which can happen as early as several sessions. One very special benefit of osteopathic mobilization is the decrease in pain through the body’s increased production of beta endorphin, a natural painkiller that is more potent than morphine. This, along with correcting chronic dysfunction, means exercise becomes more accessible to the patient. By helping the patient in reducing pain or being pain-free altogether, more movement can follow. Since an important contributor to sarcopenia is inactivity, osteopathic Muscle Energy Technique can help to combat this. Muscle Energy Technique involves the active participation of the patient to increase strength and range of motion, and can be performed on nearly every muscle. Muscles are maintained with use, so this is a powerful method of treatment for declining muscle mass as we age, especially when paired with resistance and aerobic exercises. Osteopathy can improve one’s effectiveness during exercise and boost safety, by ensuring muscles are efficiently flexing, and lowering the risk of injury from exercise.

Some common conditions seniors are more prone to develop that can contribute to inactivity and further loss of muscle include meniscus injuries, back pain and frozen shoulder. Seniors are more likely to have meniscus injuries because blood flow decreases with age in the meniscus of the knee. Osteopathic techniques increase blood flow in the body, and can work to strengthen the vastus medialis muscle in the quad, which can greatly reduce pain symptoms in the knee. A manual osteopath can also provide advice for activity modification, and prescribe therapeutic exercises. Back pain is another prevalent issue as we age, with a massive 80% of adults experiencing it at some point in their lives. Osteopathy is among the best methods to release back pain and identify the root causes, which are usually weak core muscles. In the case of frozen shoulder, people aged 40-60 are at the highest risk. Daily gentle stretches are important for treatment of frozen shoulder, along with osteopathic mobilization. Osteopathy is also great at treating total hip replacement and total knee replacement, considering the contraindications, such as movements to avoid, are respected. Positional release therapy can lead to very positive outcomes on surgically re-attached muscles, and scar tissue can drastically be improved. In some cases, with mild to moderate osteoarthritis, Osteopathy can even prevent the necessity to undergo a hip or knee replacement surgery altogether, if the issues are addressed early enough.

By the time one becomes a senior, or even middle aged, the body generally has a significant amount of trauma in the form of scar tissue. Scar tissue is known to be a stubborn, thick type of tissue that disrupts the harmony in the body and causes pain. That is why it is usually preferred to receive soft tissue therapy in the early stages of a muscular injury or post operation, to prevent hardening of tissue, or scarring, that becomes difficult to unwind back to its original state. Since Osteopathy is great for chronic pain, there does not need to be a grave consequence for not receiving immediate treatment. A pilot study on osteopathic treatment found that scar tissue, whether from a wound or an operation, responded very well to osteopathic mobilization and soft tissue therapy. Infrared imaging was used to measure the temperature of the scar tissue before and after treatment, and an increased temperature was found, suggesting an improvement in the function and neurological response of the tissue (Riquet et al., 2019).

Disease Prevention

A culmination of effects from the aging process, including loss of muscle mass and changes in the body’s composition, can lead to progressive accumulation of adipose tissue and an increased incidence of insulin resistance for the elderly population. These changes, accompanied by joint stiffness, decreased bone density, lower energy levels, and a tendency to develop structural kyphosis, contribute to an increase in the rigidity of the body, perpetuating a downward cascade of events, leading to declining health, and causing disease. Some diseases seniors are more prone to develop include type 2 diabetes, obesity, heart disease, and osteoporosis (Bradley, Osborn, Jerome, & Williams, 2003).

Irritation leads to inflammation, which leads to infection. This cycle is well known in Osteopathy. That is why manual osteopaths work diligently to stop this cycle at its source, by reducing irritation or even inflammation caused by dysfunction, and restoring proper order in the body. Osteopathy can help to reduce blockages, and increase blood flow in the body. Since healing is proportionate to blood flow, this is essential for good health. Since the elderly population cannot heal as efficiently, Osteopathy serves as a treatment that can enhance the body’s natural abilities in doing so. Osteopathy also helps to stimulate the lymphatic system, boosting immune function. Digestion can also be improved with visceral Osteopathy, utilizing gentle intra-abdominal techniques. In this way, many blockages can be addressed.

One of the best techniques for reducing irritation and inflammation is positional release therapy, a very gentle soft tissue technique that treats muscle spasms and many forms of inflammation, including tendinitis and bursitis. Osteopathy also offers several solutions for many chronic problems with cranial Osteopathy. Such techniques can work to decompress the cranial nerves, having drastic effects and solving many issues. Among the cranial nerves, the vagus nerve is considered to be the most important, as it is largely responsible for proper function of the heart, lungs and intestines. By treating the vagus nerve, heart issues such as tachycardia and bradycardia, as well as lung innervation, stomach innervation, acid reflux, vomiting, nausea, and difficulty with swallowing, can be treated, among other essential health benefits such as improved rest.

Conclusion

In conclusion, Osteopathy can help with the aging process in many ways. By tackling core issues that come with aging, it is a great choice for management or prevention of fall risk, mental health issues, insomnia, muscle loss, and disease. It is an effective therapy for acute conditions, and chronic conditions alike. Its techniques are gentle enough for all ages, so it is never too late to start treatment and see some benefits. Here are some closing thoughts from the Journal of Osteopathy, in which Dr. Andrew Taylor Still (1903) was a major contributor:

“The osteopathic school of medical and surgical practice, which has been growing so marvellously in this country in the last decade, appears, and with seemingly good grounds, to have a claim prior to Dr. Lorenz as the pioneers of bloodless surgery. The osteopaths claim to be doing and have done all that the Austrian surgeon has done and to do it better than he does. For they usually do not find it necessary to tear asunder the muscles or skin in their operations.”

References

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Bradley, R. H., Osborn, G. G., Jerome, J. A., & Williams, M. C. (2003). Osteopathic psychiatry. Foundations for osteopathic medicine.

Breit, S., Kupferberg, A., Rogler, G., & Hasler, G. (2018). Vagus nerve as modulator of the brain–gut axis in psychiatric and inflammatory disorders. Frontiers in Psychiatry, 9. https://doi.org/10.3389/fpsyt.2018.00044

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Lopez, D., King, H. H., Knebl, J. A., Kosmopoulos, V., Collins, D. R., & Patterson, R. M. (2011). Effects of comprehensive osteopathic manipulative treatment on balance in elderly patients: A pilot study. Journal of Osteopathic Medicine, 111(6), 382–388. https://doi.org/10.7556/jaoa.2011.111.6.382

Moncada, L. V. V. (2011, December 1). Management of falls in older persons: A prescription for prevention. American Family Physician. Retrieved May 30, 2022, from https://www.aafp.org/afp/2011/1201/p1267.html

Paulus, S. (2013). The core principles of Osteopathic Philosophy. International Journal of Osteopathic Medicine, 16(1), 11–16. https://doi.org/10.1016/j.ijosm.2012.08.003

Riquet, D., Houel, N., & Bodnar, J.-L. (2019). Effect of osteopathic treatment on a scar assessed by Thermal Infrared Camera, pilot study. Complementary Therapies in Medicine, 45, 130–135. https://doi.org/10.1016/j.ctim.2019.06.005

Still, A. T. (1903, April). The Journal of Osteopathy. Retrieved May 30, 2022, from https://www.atsu.edu/museum-of-osteopathic-medicine/wp-content/uploads/2019/04/TheJournalofOsteopathy1903April.pdf

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