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AUTUMN 2015 | No. 38
the
MAGAZINE
£3 where sold
Reviews: The Third Age
Paediatric Diploma
and more
SCCO Comes of Age
A look back at
our history
What is the
foundation for health?
The relationships between Osteopathy and Dentistry
shared learning, knowledge & practice
JOHN SILVERSTONE
Editor
the
MAGAZINE
EDITOR
John Silverstone:
With a background in
nursing and a degree
in Physiology, John
trained at the BSO,
where he later taught
CVS. After a number
of SCC courses
he trained at the
Osteopathic Centre
for Children and continued working there
for a further three years before beginning the
AT scheme with the SCC. John tells us that
he is grateful for the inclusive and supportive
learning environment maintained by the
College, one that has contributed to both
professional and personal growth.
BOARD OF TRUSTEES
Susan Farwell: Chair
David Douglas-Mort, Treasurer
Katharina Hass-Degg: German Contact
Pamela Vaill-Carter: Marketing
Warwick Downes: Chair Education Committee
Mark Wilson
Zenna Zwierzchowska
PUBLISHED BY
Sutherland Cranial College of Osteopathy
Hawkwood
Painswick Old Road
Stroud GL15 7QW
Tel: 01453 767607
Email: [email protected]
Website: www.scco.ac
Registered Charity Number: 1152353
PRINTED BY
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Office One
The Bell House
Stroud GL5 3JS
The publisher does not accept liability for
errors or omissions in this publication,
howsoever caused. The opinions and
views contained in this publication are not
necessarily those of the publisher.
2
T
he intention for this edition identified back in February
was to look forward to the Rollin Becker Memorial Lecture
and to anticipate the workshop immediately following,
“The relationship between dentistry and osteopathy”.
The SCCO 2015 calendar has included some great initiatives and the
fruit of a lot of hard work embodied in the courses offered. The Kvivik
sisters kicked off with their, at times amusing, double act presentation
of years of work, researching the relative benefits of breast feeding in
comparison with bottle feeding, offering great insights into the forces
determining facial development. Later on, the Third Age team under the
direction of Louise Jamieson Hull and the POD team headed up by Hilary
Percival and Mark Wilson inspired many of our number. The outcome is a
section of articles in review of these courses or stimulated by them.
The focus of all of these takes us back to the health that drives in
each of us the continued zest for pressing forward with the character
of energy appropriate to age, skill, self belief and perspective. Articles
have been contributed out of the generosity of heart that characterises
those motivated to “dig on”, not as individuals alone, but as a professional
body. The sense of collegiate learning is taken a step further through
reminders of the “blood, sweat and toil” that comprise the cost paid
by those that pioneered for the advancement of the profession they
loved, also their investment into the younger generation future through
modelling humility, hard work, integrity of character, open heartedness,
inclusiveness and mutual respect; values upheld in the SCCO. There are
four main groups of articles in this edition. Chair and editorial comment,
Course reviews and related articles, Historical and memoriam (amongst
which Peter Armitage has so graciously identified the validity of diverse
osteopathic approaches), Dental - osteopathic relationship. The latter
contributions carry a leaning toward the relevance of various training
modules for developing relevant understanding and practice skills.
The outcome is richer and more diverse than I could have predicted,
and if the specific focus of the original intent has become a little flabby,
we have instead gained from the genuine interests that “fire” individual
colleagues, our peers and part of the same whole collegiate learning body!
As far as the relationship between dentistry and osteopathy is
concerned, we often find ourselves picking up the pieces from oro-facial
trauma, sometimes induced by what our palpation and experience tell
us was incompletely informed dental or orthodontic intervention earlier
in life. This prompts a hope that dental appliances could one day be
designed and utilised in a manner directed by the patient’s health. The
relationship between dentistry and osteopathy is not just about which
modality determines good dental, oral and overall body posture, but
that all “platforms” (or diaphragms) are determinant to a degree and are
interactive. The articles in this issue highlight this aspect by alluding to
the “diaphragm” of the plantar fascia or pituitary fossa, mandible and
tongue, our genetics, metabolism, upbringing and emotional foundation
and even our learning environment and attitude.
Just as the most vital needs exert strong dominance, like altered head
posture to clear the oropharyngeal airway when the nose is chronically
blocked or the increased arousal in the sympathetic system accompanying
efforts to shift the soft palate at night in obstructive sleep apnoea, so the
deep need in each of us to find wholeness drives something less tangible
yet deeply insistent toward its fulfilling. If we call it “relationship to the
universe” no one is offended. If we call it relationship to the Maker of the
universe, as Still did …. Whatever, this is the Life that we look for in our
patients and in ourselves! - Ed.
Sutherland Cranial College of Osteopathy theMAGAZINE - Autumn 2015
SUSAN FARWELL
Chair of Trustees
I
n our role as trustees we
have had a fascinating
year, watching the SCCO
begin to grow into a properly
international organisation.
The process reminds me of
embryological development,
seeing the College emerge
organically into what it was
always meant to be: a forum of osteopaths, like minded in their
pursuit of understanding, contributing ideas and expertise
from different parts of the world.
Colleagues help us know and listen more deeply and broadly.
Listening to one another feeds our curiosity and fires our imagination.
We are interested in the SCCO because we want to “dig-on”, nourished by
the discoveries and insights of like-minded osteopaths.
Now that the SCCO administrative structure has been relaunched, we
are in a good position to appreciate what our new capabilities give us.
One benefit has been that it is now possible to get to know our German
and Spanish colleagues better. For example, a number of faculty members
were guests and speakers at the German VOD conference last October.
This allowed the UK faculty to see the SCCO through the eyes of our
German colleagues. This has broadened our perspective and has shown
us that the SCCO vision thrives and deepens wherever and however it is
planted. There is much to learn from one another. On a frivolous level, I
had never realised that a bottle of Tyrolean wine can be opened by hitting
its base with a shoe, at the same time learning about “fluid drive”. The
same process of “getting to know one another” is developing momentum
between Spain and Bristol. Our international AT Scheme means that
the next generation of faculty will be more naturally international. And
probably more technologically adept as well.
This edition of theMagazine is linked with the theme of the workshop
day that follows on from this year’s Rollin Becker Memorial Lecture. It
explores the relationship between dentistry and osteopathy. One of the
concepts being applied in the SCCO back-rooms is that there should be
courses of interest to everyone, however novice or experienced they might
be. For example, we are developing courses and conferences which are
attractive and accessible to those who wonder what cranial osteopathy
is all about anyway and why bother with it. We also plan to provide a
steady diet of “Fellows Level Courses” to stimulate ongoing development
amongst senior colleagues.
We rely on one another to bring awareness of new areas of study, new
knowledge and links between the tools we use already and new tools
which will enhance our work. So I invite you to share your discoveries with
us. If you discover an exciting book, theory, TED talk or light bulb idea,
please don’t keep quiet about it but bring it out into the open by writing an
article or talking about it. The SCCO is characterised by collegiate minded
professionals who like nothing more than a juicy new concept to liven
up their work. This magazine has always striven for breadth and a spirit
of enquiry that will keep our work and thinking alive and our palpation
alert. You will find this on the following pages.
Many thanks from the SCCO Trustees to John Silverstone, who makes
his debut as our guest editor and who has donated large amounts of time
and skill pulling this issue together for us.
the
CONTENTS
14
16
18
10
12
13
16
18
20
23
24
26
28
29
32
34
36
36
37
38
FULFILLING OUR
CHARITABLE OBJECTIVES
RESEARCH
COMMITTEE
NEUROCRANIUM AND SACRUM
AND DENTISTRY
OSTEOPATHY AND
OCCLUSION
RECIPROCAL TENSION AND
DENTISTRY
DEVELOPING
OCCLUSION
CASE STUDY:
BELL’S PALSY
THE PALATE AND
HEARING
THE NEUROENDOCRINEIMMUNE SYSTEM
THE ZYGOMA:
A MEMORY OF ROLLIN BECKER
SUTHERLAND CRANIAL COLLEGE
COMES OF AGE
SEVENTEEN YEARS OF THE SCCO
IN GERMANY
DON WOODS:
IN MEMORIAM
TIDE AND
STILLNESS
THE THIRD AGE:
A BIOCHEMIST’S VIEWPOINT
THE THIRD AGE AND
EPIGENETICS
CONFERENCE REVIEW:
THE THIRD AGE
COURSE REVIEW:
TUTOR TRAINING PROGRAMME
COURSE REVIEW:
PAEDIATRIC DIPLOMA
SHORT
COURSES
3
Fulfilling our
CHARITABLE OBJECTIVES
Sally Pettipher, Chief Executive Officer
T
he SCCO exists as a charity principally to
educate graduates in cranial osteopathy
and thereby improve the practice of cranial
osteopathy for their own, the profession’s and
society’s benefit. In the last twelve months we have
welcomed over 550 students to our courses and
conferences, the quality of which is judged by 99%
to be ‘excellent’ or ‘very good’.
Charitable support - bursaries
We recognise that newly graduated osteopaths need a
larger measure of support both educationally and financially
to establish confidence and access to quality cranial training.
For this reason we provide financial bursaries to new
graduates for the forty-hour Osteopathy in the Cranial Field
course, making it more affordable, and providing access to
the body of support that is the SCCO family of tutors and
fellow students.
Thanks to the generosity of a number of Faculty who
donate lecture and teaching fees to the SCCO, we have
been able in the last two years to provide ‘Anne Wales’
bursaries to new graduates for the Balanced Ligamentous
Tension course. Enormous thanks go out to these generous
benefactors whose donations have helped over twenty
young osteopaths with their early careers.
Charitable support - scholarships
There are also talented and deserving osteopaths of all
ages and backgrounds who, for specific reasons, struggle
to afford our courses. Each year a scholarship panel of our
Faculty meets to consider applications for substantial relief
for those in need. The most recent panel awarded 50%
scholarships to four people who are now able to join our
Pathway thanks to these awards.
Faculty support
Student feedback continually highlights the talent of our
Faculty, and the richness of our curriculum. To maintain
this quality of academic content and teaching experience,
the SCCO invests in the development of Faculty from new
trainee tutors to our most senior teaching Fellows. Faculty
SAYING GOODBYE
development is supported financially through bespoke
events and through opportunities to observe others teaching
on Pathway courses.
Recently, thanks to a body of generous and experienced
Faculty, a Faculty Peer Support Group has been established
to offer support and guidance to any SCCO tutor with
questions or concerns, and offering confidential advice and
support as required.
Gifts of time and service
The Trustees and other volunteers within the SCCO
donate a huge amount of time and expertise to the planning,
promotion and operation of the College. At any one time
over thirty Fellows and Members are engaged in an active
voluntary role. These span areas as diverse as course
planning and quality assurance to a bones inventory and the
lugging and shunting of training equipment on our courses.
As a very rough measure, these gifts provide the equivalent
of around five full time members of staff and must save
the College in excess of £100,000 a year. The impact of this
approaches £200 or €300 per student, making our goldstandard teaching available and affordable far beyond a
commercial operation.
Research
Research is invaluable to the promotion and
dissemination of cranial osteopathic knowledge. The SCCO
research committee was delighted to have its data collection
study published in IJOM this year (see: http://www.scco.
ac/research/ijom-published-data-study/). There is a study
in progress in partnership with the ESO into infantile colic
and we are grateful to the Sutherland Society for its funding
support for this project.
Charitable financial support
In the past year £7,700 of charitable funding was given
by the SCCO in support of new graduates, scholars and
faculty, representing a major percentage of our operating
surplus. Next year it is anticipated that we will use the
entirety of our operating surplus on charitable support with
the figure rising to £22,000 to encompass research, faculty
development and student support.
to Chloé Amos
At the end of August, the Sutherland Cranial College said goodbye to its Marketing
Assistant, Chloé Amos.
Chloé has been with the college for just over a year and in that time she has made a
considerable contribution and seen many changes at SCCO. She is leaving to embark
on a very exciting Master’s Degree in Fashion and Luxury Management and will be
studying in the beautiful town of Antibes in France. Everyone at SCCO is very grateful
for her hard work and we all wish her well; she will be very much missed.
Au revoir et bon chance, Chloé!
4
FUNDRAISING REPORT
Sally Pettipher, Chief Executive Officer
As an educational charity for healthcare professionals,
we are keen to support as many students as possible to
access the benefits that expert cranial training provides to
their patients and to their own professional and personal
development.
The SCCO is extremely grateful to a number of benefactors
and sponsors whose generosity allows young osteopaths to
access this teaching in their early years after graduation.
Anne Wales Bursary Fund
Many members of the BLT team have contributed their
time free of charge over the past few years teaching extracurricular groups in some of the osteopathic schools and
passing on their fees to this fund to enable newer graduates
to take up assisted places on the annual BLT courses run at
Hawkwood.
A former Trustee also made a personal gift to the Anne
Wales Bursary Fund on stepping down from the Board and
this gift substantially grew the fund at this point. These
tutors wish to remain anonymous but, on behalf of all the
students that they have helped, we thank them for their
generosity.
Can you help?
Could you help with our next intake of graduates. The
Fund is now spent, and there are no bursaries available for
the BLT course in June 2016. If you would consider funding a
student the cost would be a one-off gift of £250 or a monthly
gift of £21 as gift-aid adds 20% (and if you are a higher rate
tax payer 15% comes back to you).
We know that most of our BLT students go on to study
on our Pathway and thereby build their own skills and the
body of expert practitioners of cranial osteopathy within the
profession.
Research Funders:
The College is also grateful to those who fund research
without which so much of our understanding and experience
of the benefits of cranial osteopathy would simply not be able
to be described. Research is fundamental to the pioneering
of new teaching and osteopathic practice and the SCCO is an
important part of the wider profession in the commissioning
and funding of this vital work.
We particularly wish to thank The Sutherland Society
whose aims chime with ours in deepening understanding
of the groundbreaking work of Still and Sutherland, and for
developing clinical excellence for practising osteopaths. The
Sutherland Society has co-funded, with a grant of £6,000,
the investigation of cranial osteopathy as a treatment for
infantile colic.
Named Fund:
In recognition of your commitment to cranial osteopathy,
or in memory of an important individual, a Named Fund is
able to be set up to give a bursary or special award on an
annual basis.
As a direct award this would pass through the SCCO to
fund a student of your choosing or according to criteria laid
down by you.
As an endowment or legacy fund, a capital amount is
invested which returns annual dividend income, allowing
your Fund to support students in perpetuity.
A named fund may be for new graduate bursaries, but
could equally be for talented osteopaths to access the
paediatric diploma or tutor training, or it could fund a
Research Chair committed to permanent investigation of the
fundamentals and public benefit of cranial osteopathy.
SCCO Partners and Sponsors:
We wish to record and acknowledge the great contribution
of three key sponsors of the Third Age Conference this year.
Back in Action
Back in Action is well respected
for its specialist Mobiliser
spinal
joint
mobilisation
equipment which they brought
to demonstrate at the Third Age
conference. This is the first event
that we have run in partnership
with Back in Action and we hope
to work collaboratively with
this popular provider again in
the future.
https://www.backinaction.
co.uk/mobiliser
Balens
Many will know Balens for their
specialist professional insurance
services for osteopaths. The
SCCO works with Balens on
many aspects of its insurance
needs and we are delighted by
their continuing support for the
College. For more information
please contact Balens:
http://www.balens.co.uk
Handspring Publishing
Thanks
to
Handspring
Publishing we were able to offer
a hugely popular bookstore at
the Third Age Conference, and
Handspring also collaborate
with us on our online bookstore
which provides funding for our
new student bursaries.
http://www.scco.ac/aboutusabout-scco/scco/
5
RESEARCH COMMITTEE
Karen Carroll,
Committee Member
R
esearch isn’t easy - we all knew this…. As I always say “well, how
hard can it be??” This last few months we have been learning
how hard it can be!
We have learnt that the goalposts change, that recruitment isn’t easy for trials
and that you have to be prepared to be flexible, even with something you and a
team of researchers have spent months designing.
Our first project (the Data Collection exercise, which many of you helped with)
finally got published after months and many revisions - not unusual. Our second
project (the infant colic study) has required a massive redesign.
Our initial brief to the ESO research team was the comparison of osteopathic
treatment to ‘standard treatment’ i.e.: Health Visitor advice being the standard
care. The Health Visitors were up for it, we recruited the osteopaths, produced the
literature…. and waited. And waited….. We found out finally that Health Visitors
had stopped seeing babies more than a few days old, so there were no participants
recruited to the trial.
After a huge amount of debate, the ESO came up with a new proposal: the
comparison of osteopathic treatment with a no treatment group. In order to do
that, there had to be a credible no treatment group. We had various unsatisfactory
suggestions as to how this might work. They then came up with the idea of
developing a way of ‘blinding’, so that parents don’t know if their child is being
treated. The pilot part of this study is now underway.
We all know that research cannot hope to replicate what actually happens in
practice, it has to happen within controlled environments - these are necessary to
give the trial validity. What it does hope to do is to shine a light into the darkness
in the expectation that with enough trials looking from enough angles you can
start to build a picture of what is really happening.
We decided that as this project had been really difficult, we would next focus
on developing a PROM (patient recorded outcome measures) study - how hard can
it be, right?? We looked at the data from the data collection exercise, narrowed our
search down and finally decided to propose to the SCCO that we next do a PROM
on asthma. We did lots of reading. Alex Corser (our newest recruit) bravely said
she would head up the project, we chose an appropriate validated questionnaire
to measure asthma symptoms.
All good so far…… then we had the bright idea to figure out if we would do an
online or a paper version of the questionnaire. This has an impact on budget as
well as how happy patients are to participate. So we decided that each of us would
have five of our asthma patients do a paper version, whilst five do an online version. How hard can it be….right???
So we gave ourselves three weeks to get some patients. Sat back and waited…..
and waited…. No new patients turned up with asthma as a primary or a secondary complaint! So we are going to canvas more people to figure out if there is any
point in progressing an asthma PROM as we don’t see sufficient patients to make
this a feasible study…. watch this space!
We have thus started debating the possibility of a PROM study for a different
clinical presentation. We put a great deal of effort into research towards the
asthma PROM. It may or may not prove feasible - but we have learnt from this
regarding methodology for the future and hopefully the next topic will require
less work. Our idea has been to work towards streamlining a process for how we
might design future PROMs more quickly / easily. So, hopefully, we will be able
to progress more quickly with an alternative PROM proposal - how hard can it
be, right?? We feel that we are really ‘digging on’ with this science of osteopathy learning about how we might use PROM studies in the cranial field to have a tool
to show how effective this way of treating can be.
6
PATHWAY
MODULES
The SCCO Pathway is a “portfolio” or complete collection of the SCCO modules. Once all these modules and
three case study assignments have been completed by an osteopath, he or she is considered to be trained to a very
high standard in “Osteopathy in the Cranial Field” and is eligible to be a Fellow of the Sutherland Cranial College of
Osteopathy. The Modules give a thorough grounding in the theory and practice of cranial osteopathy but also present
the work from a comprehensive variety of specialized approaches. Completing the Pathway will take at least four years
and is evidence of both commitment and proficiency.
Module 1 - Foundation Course
2 days
Have you ever wondered about the anatomy above the atlanto occipital joint or what influence the structures within
the head, neck and pelvis may have on the rest of the body? Allow us to introduce you to osteopathy in the cranial
field. In some cases it is not necessary to take this course in order to complete the Pathway, please consult our
website for full details or call our office.
Module 2 - Osteopathy in the Cranial Field
5 days
This extremely popular course is an overview of the whole cranial concept, covering all the key areas, and is a
prerequisite for onward progression along the Pathway. Each topic is developed in more detail by the courses below.
Module 3 - Osteopathic Medicine
4 days
Discover the world of the internal organs. This course will give you the confidence to treat many primarily visceral
problems, and provide an understanding of the influence of the organ systems on whole-body health.
Module 4 - Balanced Ligamentous Tension
4-5 days
This course is an excellent way to introduce working with the involuntary mechanism into your clinical practice. You
will learn W. G. Sutherland’s gentle, precise and effective approach to treatment of joints in the whole body using the
therapeutic principle of Balanced Ligamentous Tension.
Module 5 - In Reciprocal Tension
3 days
Sutherland advised us to “treat the spaces not the structures”. What did he mean by this? Develop your palpatory
awareness of whole-body interconnectedness, discover the secrets of the body’s structural integrity and explore how
this may influence treatment of your patients.
Module 6 - Neurocranium & Sacrum
3 days
This course develops our understanding of involuntary motion in cranial bones and the sacrum, and will help you
treat complex physical trauma patterns in the whole body more effectively.
Module 7 - Spark in the Motor
3 days
This course explores the art and science of osteopathy addressing the nervous system, cerebrospinal fluid and the
subtle fluctuations and bioenergetic communication throughout the fluid fields of the body.
Module 8 - The Functional Face
3 days
Is the face the missing link in our treatment? How does the face influence the body-wide health of our patients? In small
group workshops we will re-familiarise ourselves with the intricate relationships of the facial bones, cranial nerves and
special senses and together apply our osteopathic thinking to common viscero-cranial problems that we encounter in
practice.
Module 9 - Introduction to Paediatrics
4 days
An Introduction to Paediatrics aims to give you a sound basis on which to build your paediatric knowledge and will
prepare you to practice safely and examine your young patients with confidence and with a deeper appreciation of
the extraordinary journey from embryo to childhood. This course is the starting point for the Paediatric Osteopathy
Diploma.
Module 10 - Integrating Cranial into Practice
1 day
A one-day course aimed at helping you to integrate cranial work into your existing osteopathic practice, and to give
you the confidence to communicate effectively with your patients.
M10 is an excellent “next step” for recent students of M2
To book any of the above courses please visit: www.scco.ac or call our office +44(0)1453 767607
7
Osteopathy & Dentistry
Relationships between the
NEUROCRANIUM AND SACRUM
AND DENTISTRY
Jane Easty
A
s osteopaths we have an enviable role to play
in the amelioration of certain early dental
issues. Our ability to facilitate the release of
stresses and strains at the earliest opportunity and
in the youngest of babies allows us to minimise
the influence of such distortions on growth and
development in infancy and beyond. We hope to
pre-empt the necessity for extensive orthodontic
intervention.
Each time I review my studies I become excited at how
possible it is to gather more and more supporting evidence of
the osteopathic principles we use in practice every day even
if the authors of the research do not share our interpretation
of their evidence. It is astounding to see science illuminating
the mysteries we feel under our hands. Although we cannot
as yet prove what we perceive we can certainly recognise the
resonance in much of the new science and embrace it with a
deeper understanding and honesty in the evaluation of what
we feel.
For me in particular, the study of the embryology of
the cranial bones has deepened the dimensions I consider
when listening to these tissues. One senses echoes of their
origins and the qualitative memories of the physical forces
that melded them. Sue Turner spoke of, “the forces that
orchestrate development and generation of the body in
embryonic life being those same forces which organise
healing and regeneration at all stages of life.”1
Professor Brian Freeman has done much to clarify the
work of embryologists, as has Erich Blechschmidt, exploring
in detail the biodynamics of human differentiation. Study of
biodynamic embryology greatly enhances our knowledge of
anatomy – “In order to comprehend any structure we must
first try to understand its position and the development of its
position, its form and the development of its form and finally
its structure and the development of its structure,” stated
Professor Freeman.2 Donald Ingber wrote, “mechanical
forces generated in the cytoskeleton of individual cells
and exerted on extracellular matrix scaffolds, play a
critical role in the sculpting of the embryo.”3 We now know
mechanotransduction can alter integrin switching pathways
at cellular interfaces. Further exploration of the integration
of mechanical forces and chemistry at molecular, cellular
8
I am as old as my tongue and
a little bit older than my teeth.
and tissue levels has followed. Mammoto, et al. have induced
formation of a whole tooth by mechanically squeezing
connective tissue cells and implanting them into an animal.
The physical process of compressing and changing the shape
of cells is sufficient to trigger the expression of transcription
factors that drive tooth and other organ development.4
As an osteopath of over thirty years I find these
recent, albeit indirect, affirmations of our potential to
enable fundamental changes in structure hugely exciting.
Consequently I return to old texts with renewed vigour and
respect for their clinical relevance.
Here we see a picture
of my granddaughter
Hanna being treated
at the age of one hour.
Her first breath was
somewhat compromised
although she had strong
energy. She is sleeping
peacefully although nasal
breathing is difficult. One can sense a wave of compression
across the whole sphenoid sphere with a gentle shear
posteriorly. Her facial midline was slightly compressed in
the superoinferior dimension with a mild inferior vertical
strain and the cupid bow lips of that midline tension.
I considered the maternal stress in those first eight
weeks of embryological development. Understanding the
metabolic forces that created those first pharyngeal folds
from which the face develops informs our ability to engage
with those embryogenetic forces (e.g. a timeline to when
the paired structures of the maxillary prominences met in
the midline in those first weeks). Blechschmidt describes
a growth suckling action when the embryo’s face elongates
towards the end of the second month. The margins of the lips
roll in, restricting growth with epithelial thickening, and the
dental lamina form, ultimately becoming the tooth germs.5
When scientists can manufacture a tooth and implant
pluripotent cells recognising that the different mechanical
forces imposed upon them at that site will dictate what
tissue they will develop into6 – when this is all science, it is
no longer unthinkable to consider the development of the
skills to engage with these forces.
And so it was a joy and a privilege to work to improve
“We hope to pre-empt the
necessity for extensive
orthodontic intervention.”
the function in those delicate
fluid structures acknowledging
their embryological origins
and constraints on that early
physiology. I sensed the
responsibility of enabling the
dissipation of the forces of
labour and birth to prevent tension being held in the dural
membranes or the fluid bones and cartilaginous structures.
In our practices we come across many reasons for
disturbances in the balance of growth and development
of the cranium – intrauterine crowding due to twins,
fibroids, maternal pelvis abnormalities, a hand up by the
face during delivery, abnormal presentations, etc.7 All can
lead to tension and compression forces restricting the
natural transformation of the neuro- and viscero-cranium
in response to the functional demands of feeding, sucking
and breathing in that important first year. The high position
of the newborn hard palate and nasopharynx allows a
snorkel like action where the baby can swallow and breathe
simultaneously. Any compromise to this coordinated action
may lead to feeding difficulties and subsequent problems.
We can see how this will escalate over time. Development
of the nasal cavities and hard palate will be affected. Tongue
position will alter with consequences for swallowing and
breathing patterns, affecting hyoid position and therefore
neck posture. The uniquely structured supralaryngeal space
may be compromised affecting phonation. The cascade
of events rolls on and may compromise the full growth
expression of the maxillae or mandible leading to crowding
of teeth and difficulties with dentition necessitating
orthodontic work later in life.
And so with treatment one would aim to reduce the
likelihood of such intervention and improve the quality of
the metabolic process of dentition.
It may not be possible to catch these cases quite so young.
Here we see a patient of mine and we can see the transitions
through which he passed. In the first photo his cranial base
strain patterns are expressing throughout his face and one
can sense his health beginning to struggle. By the age of three
he was complaining of dizziness. Eye tests followed with
a diagnosis of hyperopia and strong prescription glasses.
Nosebleeds and moodiness followed over the next few years
with a further diagnosis of sinus problems and a prescription
for a steroid nasal spray. The second picture shows a happy
lad despite continued nosebleeds, blocked sinuses, breathing
issues and a mouthful of increasingly wonky teeth. In his
early teens he underwent extensive orthodontic work and
wore a brace for two years from the age of fourteen.
This patient presented to me at the age of nineteen
[third image] complaining of occipitofrontal headaches,
chronic nosebleeds, sinus
congestion and continued use
of a night brace to maintain
his teeth positions. I observed
a fit young man with a
marked flexion pattern and an
established pattern of mouth
breathing. His system still retained the original shock of his
premature birth with loss of the first breath and full ignition
of his system. In addition he remained in special care for
three weeks with the resultant issues of head molding.
This lad had a joyful system despite his health problems
and responded well to the release of the shock in his
membranes and diaphragm – the potency in his system lifted
and primary respiratory motion gently swelled to irrigate
the chronically congested tissues in particular the sinuses.
Over three or four
treatments his symptoms
resolved and here we see
him at his recent graduation.
The night splint is no longer
necessary.
In one case I have hoped
to prevent undue dental
intervention. In the second,
I worked to support the
future facial development
and
final
ossification
processes following the
orthodontic work. In addition, when parents have made
the decision for orthodontic work to be carried out we have
an important role to play in easing that process, frequently
minimising the strain in the accommodating structures.
With the current trend in adult orthodontics we can see
some very interesting and difficult cases – with, in my
opinion, contrasting problems to those that babies have
when plagiocephaly helmets are used without the benefit of
cranial work to ease the transition.
The author, Jane Easty, will direct Module 6,
“Neurocranium and Sacrum: Living Bone”, in November. New
avenues of research in the understanding of the physiology
of bone and the biotensegrity of the body will be presented
whilst investigating the principles addressed above in great
detail. We will explore old concepts and refresh them in the
light of that new research. Understanding how trauma and
other injuries upset the system and how these consequent
strain patterns permeate the whole body enables better
treatment. Osteopaths know the body takes us on an
endlessly interesting journey of discovery.
References
1.
2.
3.
4.
5.
6.
7.
Turner, S. 2014. SCCO Module 5 Course Notes.
Freeman, B. 2010. DVD presentation. Human Embryology from a
Biodynamic Perspective.
Ingber, D. E. 2006. Int. J. Dev. Biol. 255-266
Mammoto, T., et al. 2011. Dev. Cell. Vol. 21(4):758-769
Blechschmidt, E. 2004. The Ontogenetic Basis of Human Anatomy. (ed) Freeman, B.
D’Angelo, F., et al. 2011. J Funct Biomater. 2(2):67-87
Moeckel, E., Mitha, N. Textbook of Paediatric Osteopathy
9
OSTEOPATHY & DENTISTRY
Osteopathy &
OCCLUSION
Caroline Penn
Osteopath & HANDLE Practitioner
upper twos were able to move into place as the dental arch
widened with the two-piece removable acrylic splint (the
best solution available at the time). He needed several of
these and fixed braces at seventeen years; perhaps some of
this could have been avoided if the mouth had stayed shut.
Now twenty-three years old, he has to wear retainers and is
still suffering the consequences of the open mouth posture.
M
any dentists, particularly orthodontists,
spend a lot of time asking their patients
to try to keep their mouths closed when
not talking or eating. It is a big dental/orthodontic
issue, alongside encouraging the tongue to work
correctly. Dentists are hard-pressed to help
patients achieve this and this is where osteopathy
can often help.
Why are dentists so bothered about the lips and the
tongue? Put simply, the way the powerful muscles of the
lips, cheeks and tongue work ultimately determines the
development and shape of the dental arches, the face and to
a large extent how we look. The teeth are simply passengers
between these forces so if muscle action provides appropriate
osseous growth stimulation then the teeth position will, to a
very large extent, look after itself. Patients who habitually
breathe through their mouth or do not close their mouths
respond poorly to orthodontics and the tendency to relapse
is high, even when they wear retainers for life.
In this article I share two cases. In the first case the child
was not able to close his mouth, the facial muscles remained
weak into adulthood and several bouts of orthodontics
improved the outcome but did not result in a stable selfmaintaining occlusal relationship. The girl in the second
case has craniofacial abnormalities and has not been
given orthodontic help, but at nearly ten years old is, with
osteopathy and exercises alone, developing a reasonable
occlusion.
9 yrs: beginning to correct
18 yrs: open mouth
posture persists
CASE 2
A girl who I shall name Kris, was born with Goldenhar
syndrome. She had craniofacial abnormalities due to failure
of the first branchial arch to unite on one side, a dorsal hemivertebra resulting in scoliosis and dermoid cysts attached to
the cornea which challenged vision. The facial asymmetry
was surgically ‘tidied up’ at one year for aesthetic reasons
and was much more challenging to her than the family
had anticipated. It was at that time that the parents sought
osteopathic help. They reported the benefit of osteopathy
to post-operative recovery and assistance dealing with
recurrent upper respiratory tract infections. Later the focus
was on establishing and maintaining a clear nasal airway, a
necessary pre-requisite for mouth closure.
I worked with Kris from four years old. Lip seal was
extremely challenging. Her tongue was over developed and
habitually held between her teeth, and her global muscle
tone was low. Through her mother’s determined efforts,
Kris learnt to suck at ten months old. From birth she was
fed breast milk through a Habenar bottle which provides a
milk reservoir to avoid drowning the infant as the parent
controls the flow of milk. This type of bottle is particularly
suitable for infants with defects of the first branchial arch.
Developmentally this is hugely better than tube feeding.
CASE 1:
This sequence
of
photographs
shows a boy; we
will call him Rob.
Anoxia at birth due
8 yrs: narrow palate and over-crowding
to a true knot in
note the cross-bite and the upper 2s are posterior to the 1s
the umbilical cord
caused developmental delay. I have worked intermittently
with Rob from seven to twenty-three years of age. He was
unable to keep his mouth shut when young so has needed a
great deal of orthodontic input to achieve a reasonable result, and now as a young man his open mouth is still a problem associated with regression of his occlusion. On a positive
note the osteopathically
guided early functional
orthopaedic orthodontic
input facilitated adequate
growth to enable him to
avoid tooth extractions.
The posteriorly placed Upper expanding removable acrylic appliance
10
5 yrs: lip closure and tongue control are
challenging, mandible deviated right
6 yrs: trying to whistle for lip and breath control
When Kris was five years old the osteopathic treatment
focussed on working on the post-operative intra-oral scar
tissue. Exercises were an important part of this process,
encouraging fuller mouth opening and helping to guide the
mandibular movements towards symmetry. The family were
trained in intra-oral massage as well as mirroring and mental
rehearsal exercises made into games. There was, and still
is, a consistent focus on practising efficient sucking, which
from the beginning of life paves the way for balanced oral
and facial muscle function. Tongue, lips and cheeks worked
well enough for Kris to become quite a chatterbox, although
at first only her family could understand her. By seven years
old she was developing intelligible speech, a skill her speech
therapist had not expected Kris to acquire.
7 yrs: mandibular deviation is more obvious
but the mouth is closed
7 yrs: closer examination reveals crossbite
locking the mandibular deviation
A very interesting scenario ensued aged seven with
Kris’s cross-bite. Her deciduous occlusion, particularly
her lower left canine, locked her into a cross bite so it
was impossible to restore normal occlusal relationships
without dental assistance. We began osteopathically guided
exercises immediately and sought functional orthodontic
consultation. Unfortunately, in Kris’s case, Great Ormond
Street Hospital did not sanction orthodontic assistance until
all permanent teeth had erupted, so we were left to grapple
without help to free her.
to the left. Her body was very right side dominant with a
leading right shoulder which exacerbated the hemi-vertebra
scoliosis. At first we underplayed mandibular movement and
concentrated on working to lead the body with the left side,
strengthening all the neuromuscular connections associated
with that missing movement. As the scoliosis straightened
and the tongue became freer the mandible began to shift to
the left. The spinal scoliosis has become straighter without
the prescribed orthopaedic spinal brace. Kris found the
brace most uncomfortable and it impeded attention to
postural body habits. The results for the jaw and occlusion
are also encouraging so far. The next challenge for Kris will
be to learn to play a wind instrument. I favour the clarinet
because it is centrally aligned so is unlikely to influence the
scoliosis adversely; it requires excellent lip seal and trains
coordination of tongue, lips, cheeks, breathing and posture.
Kris is excited at the prospect and with her determination I
anticipate she will do it!
For osteopathic purposes, I am particularly impressed by
the Myobrace, which is an Australian designed orthodontic
system of oral muscle trainers. It demonstrates how effective
the muscles alone can be in developing a good occlusion. See
the pictures below. These are not my patients.
Illustration 1
8 yrs: sucking practices for muscle & breath
control
9 yrs: balancing a beanbag for spinal
alignment also influences jaw alignment
10 yrs
Finally, at age nine and a half, the lower left canine came
out, which unlocked the cross bite and provided a window
of opportunity. We developed new exercises using water
swishing and more tongue movements and so far results are
encouraging.
10.5 yrs: exercise using water in the mouth
Kris and her family continue to be enthusiastic and
compliant to follow the advice given and there continues
to be a dynamic interchange of ideas between family and
osteopath about how the next challenge might be addressed.
Working with the whole body has been especially important.
For example, initially it was not possible for Kris to slide her
mandible to the left, neither was it possible for her to track her
eyes horizontally in either direction or to move her tongue
After 7 months of Myobrace
Illustration 1 shows how the Myobrace favourably
directed growth over a seven month period for a ten year
old girl. The August 2014 photos show an over-closed bite,
squarely flatted off anteriors (upper incisors) and narrow
premolar width with inadequate space for the erupting
canines. By March 2015 the shape and relationship of the
dental arches improved dramatically with plenty of space
for the canines and all achieved using those muscular forces.
Dr. John Mew wrote extensively about the importance of
the closed mouth posture to stimulate horizontal growth of
the face rather than the vertical growth pattern encouraged
by the open mouth posture. I have seen the effectiveness of
John Mew’s system of orthotropics.
Both of these very functional approaches (myobrace and
orthotropics) depend on the lips being together when not
talking or biting into food.
To summarise, osteopathy has much to offer to enable
and encourage this essential function of closed mouth
posture at rest. Working both locally and globally osteopaths
can attend to some of the impediments to nose breathing
and work with mechanical and neurodevelopmental issues
that may impede oral function and development.
With thanks to Rob, Kris and their families.
Thanks also to Dr. Doug Rider for the Myobrace
photographs.
11
Reciprocal Tension and
DENTISTRY
Michael Harris
O
n the pathway course In Reciprocal Tension we look at the
concept used by Sutherland to describe the function of Dura
mater. We also explore how this concept may be applied to
other body systems from microscopic to macroscopic and even to
our relationship with our environment.
In the context of this article we
will define reciprocal tension as the
dynamic relationship between parts; a
change in one part demands a change
in the whole system. This definition
finds its modern day translation in the
concept of Tensegrity that has been
successfully applied to human biology
by Donald Ingber and Steven Levine
amongst others.
Donald Ingber has researched
the effect of change on
the biomechanical shape
of cells and been able to
demonstrate that shape
change can affect the
behaviour of the cell.1 He
named this phenomenon
Mechano-transduction. For
Osteopaths this is simply
evidence of the structurefunction
relationship
utilised by A. T. Still but it
can be helpful to reinforce
the knowledge that our
influence on systemic
biomechanics has the potential to
influence the physiological choices of
every cell making up the body.
Moving up the scale from cells to
teeth, we can see each tooth suspended
in its bony socket by the periodontal
ligaments that are modified connective
tissue fibres. As with other connective
tissues, the level of hydration of these
ligaments is thought to affect their
function. In my experience these
ligaments may also be strained and
contribute to congestion and pain in
teeth which is not infective (but may
lead to an environment conducive to
infection). These strains often respond
well to a balanced tension approach
either with direct contact intra-orally
or through the skin of the cheek.
The mandible itself can be seen
as a tension strut suspended from
the cranial base and suspending the
anterior fascia of throat below. The
muscular fibres responsible for this
suspension, principally masseter and
temporalis, are rich with proprioceptors
and even slight imbalances may be
disturbing for the body. A patient
presented at my practice recently with
a picture that will probably be familiar
This nerve also supplies sensation to
the TMJ capsule, so the potential for
facilitation exists as well as muscular
compression disturbing its peripheral
vascular supply. Using a balanced
ligamentous tension approach allowed
the patients jaw to find its optimum
function given the limitations imposed
by the crown and we were able to
relieve her pain until the permanent
crown was fitted.
Another common presentation is
of the teenager with headaches that
seem to coincide with the fitting of
orthodontic devices. These headaches
are often dull and diffuse in their nature
and don’t necessarily seem connected
to the local tooth pain associated with
adjusting the brace. Most devices fitted
to the upper jaw bridge the median
palatine suture where the maxillae
meet to form the hard palate. This
restricts the expression of involuntary
motion through the maxillae and
often has the knock on the effect of
“locking up” the neuro-cranium. The
associated headaches may be due
to a perceptual awareness of the
compression
generated
or a consequence of poor
venous
drainage;
the
mechanism is not clear and
varies between individuals.
A common finding however
is of a compressed quality
in the cranial base and low
amplitude in involuntary
motion. Patients often
respond well to a balanced
tension approach, either
through the membranes
or the fluid field that
seems to allow enough
decompression to restore comfort.
Needless to say these patients often
appreciate periodic treatment whilst
their orthodontic work continues and
reviews after the brace is adjusted are
often most effective.
So far we have talked about
reciprocal tension between structures,
but we can also consider the dynamic
balance within a structure and how
that may affect the physiology. The
mandible once again lends itself to this
type of consideration. Embryologically
the mandible arises along with the
maxilla from the first pharyngeal
arch. The mandible uses Meckel’s
cartilage as its model for ossification.
The fibrous remnant of this cartilage
is the spheno-mandibular ligament
“...this is simply evidence of the
structure-function relationship
utilised by A. T. Still but it can be
helpful to reinforce the knowledge
that our influence on systemic
biomechanics has the potential to
influence the physiological choices of
every cell making up the body.”
12
to many of you. The patient was in the
process of having a crown fitted on her
lower right first molar. This involved
a long period of drilling to remove
damaged enamel and then the fitting
of a temporary crown. Unfortunately
the crown was proud of its neighbours
and the resultant malocclusion left
the patient with intense pain of a
sharp character on the right side of
her head in front of and above her
ear. My working diagnosis was that
the temporary crown had disturbed
the TMJ balance and irritated the
auriculo-temporal nerve, a branch of
the mandibular nerve running deep
and then posterior to the TMJ and
then supplying sensation to the skin
in the area of the patients symptoms.
that helps to suspend the mandible
from the cranial base. Another way
of viewing mandibular ossification
however would be to think of the
bone being laid down around the axis
provided by the mandibular nerve. The
trigeminal nerve is highly significant
in embryological development being
a relatively large structure, with
each embryological branch anchored
securely to the anterior ectoderm and
helping to shape the developing neural
tube from which they arise. The inferior
alveolar branch of the mandibular nerve
becomes wrapped in the bone of the
mandible thus in the adult appearing
to dive into the mandibular foramen
on the medial aspect of the mandibular
ramus and emerge through the mental
foramen. The inferior alveolar artery
accompanies the nerve en route. One
functional significance of this is that
the nerve that supplies sensation to
the teeth of the lower jaw, the lower
lip and the chin (and motor supply to
the mylohyoid and diagastric muscles)
passes through a very narrow canal
within which congestion can cause
irritation. As Osteopaths of course
we have to think about improving the
surrounding drainage routes before
tackling the local problem, but if
having considered the thoracic outlet
and anterior fascia of the neck we
still find focal congestion around the
nerve then we need to address it. One
option that I’ve found really helpful for
patients with ongoing tooth pain and/
or sensitivity that defies the dentist
and involves no obvious infection is to
engage the periosteal covering of the
mandible and allow the fluid within to
find its point of balance and watch as
the potency goes to work to decompress
and decongest. I believe I have Sue
Turner to thank for introducing this
concept to me and whilst I have no
proof, I have a suspicion that more
than one extraction has been avoided
in this way.
In the final analysis whatever
concept we apply, it is just a concept.
What matters is whether that concept
helps us to relate to the story of the
patients physiology and the route that
they would like to take towards their
optimum expression of health.
Reference
1.
The Architecture of Life. Donald E Ingber. Scientific
American. January 1998.
Developing
OCCLUSION
Hilary Percival
I
have been privileged in my practising life to work with a lot of
children and their families and also to work with a dentist Dr. Bryan
Kilgallen who has studied orthodontics in its relation to the rest of
the body. To say that he is enlightened is an understatement.
When he first brought his daughter, it was for treatment of behavioural issues.
Some years later when she was developing dental overcrowding, he was not
prepared to take out her healthy teeth in order to use a brace as was common
practice at the time, so he went to the United States of America to learn how to
spread the maxilla with dental appliances. When he applied this to his daughter’s
mouth, back came the behavioural problems. This initiated our exploration of
how dentistry and osteopathy might work together to develop healthy occlusion
in the healthily growing child. This article is a summary of the experiences that
we have shared over the last twenty years.
I have found that it is important to follow the “tissue story” of a child while
they are growing. There are many knocks and bangs that could impact on the
development of a child’s anatomy; parental decisions about orthodontic treatment
also have big potential for their child’s final health. For financial or other reasons,
not all parents allow us to follow their child through the growing years with our
osteopathic fingers but when they do, we are able, in my opinion, to iron out some
discrepancies. Amongst other things, this monitoring enhances the development
of good occlusion.
Genetics and Schwartz-Korkhaus measurement 1
There is no doubt that overcrowding in a mouth can be familial at least, if not
genetic. When you are looking at the child who has overcrowding in their mouth
you will often find that the parents have had orthodontic treatment. The SchwartzKorkhaus measurement evaluates the transverse width of the maxillary arch and
correlates this with tables to indicate the genetic potential for arch width in that
individual. This is useful when explaining to the parents what you are trying to
achieve with osteopathy. By regularly measuring a child’s arch while treating
I have noticed that in conjunction with orthodontic treatment, osteopathy is
capable of producing an extra one to two millimetres expansion a month.
If a parent is missing one adult tooth from one side of the mouth, the same
genetic trait can happen in the child. This gives a lopsided bite. In my opinion
it is worth filling the gap with a false tooth to gain more symmetry. Closing the
gap simply exaggerates the asymmetry of the jaw as it grows, with far reaching
influences on the growth of the whole body.
Birth
The most difficult delivery as far as the face is concerned is a face presentation.
The facial bones with the exception of the ethmoid and inferior conchae are formed
in membrane and rather more vulnerable to compressive forces at birth. In a baby
this is very obvious to the osteopathic intelligent, searching fingers. The trauma
can be minimised by allowing the facial bones to breathe with the involuntary
mechanism but it is likely that as they grow the traumatic influence of delivery
will be strong and the embryonic blueprint for health will need supporting
Any delivery where the baby is unable to flex their neck sufficiently will exert
some drag on the facial bones. Releasing the fascia at the anterior neck and the
musculature from the mandible and hyoid is imperative for that baby to suck
correctly. A good forward and backward piston sucking motion is important as
a start to developing the right pull on the cranial bones that will lead to good
13
considering why they do this. Is it
to crank up a flabby involuntary
mechanism or is it a habit, due
to shyness, or social issues? By
identifying the reason there can
be a plan of action to help the child
avoid pressurising the maxilla.
Postural
Illustration courtesy of Colin Dove
occlusion in the future. A chomping action does not tick this
box. Watching a baby feed gives you a very important clue
as to what is happening. [For a detailed description of the
muscles and movements of suckling, see article by Gunn Kvivik
and her sister Line Cote page 4, SCC magazine 37, summer
2014. – Ed]
Plagiocephaly, with or without torticollis, will affect the
child’s dentition and bite. The increase in Plagiocephaly
since the “back to sleep” campaign has led to many more of
this type of problem being seen in our surgeries. Looking at
the grid of facial bones set out by Colin Dove (see diagram
above) shows how the bones relate to each other. It can
then be understood how the following chain of events can
happen: torticollis or positional torticollis with a low occiput
on that side can pull on the temporal bone affecting the
placement of the mandible in the temporo-mandibular joint
affecting its development and therefore its alveolar margin
and teeth placement.
Trauma
A healthy child lives and explores and in doing so can
have trauma to their growing body that may affect the way
they grow, ‘As the twig is bent is bent so doth the tree grow’
Sutherland observed (Teachings in the Science of Osteopathy
p6). If this affects the postural stability and platforms then
this will affect the way that the teeth of the lower dental arch
meet with the upper maxillary arch. I think we need to check
and put this right so the child can grow straight, before it
becomes an ingrained pattern. It is much harder to eradicate
once the child’s body has accommodated the strain and then
grown accordingly.
Dummies and fingers
Pacifiers, fingers and thumbs can wreak havoc with the
maxilla in particular. I had an eight year old patient who had
managed to keep her premaxilla sub-luxed by sucking and
pulling simultaneously on a dummy whenever she could.
Dummies can be useful to settle a colicky or reflux baby
but it should be a short term solution of weeks not months
or years. If a child sucks their fingers or thumbs it is worth
14
There is no doubt in my mind
that a child’s posture has an impact
on their occlusion. I can relate this
to a patient that Bryan Killgallen
asked me to have a look at because
they had a very noticeable cross
bite. When I examined this child
I found that he had an apparently
shorter leg. The left ankle was stiff
at the talo-crural joint and the
spine as a whole had a functional
scoliosis. This child had had an
accident involving falling off
the side of a stage. When we treated the ankle and spinal
mechanics the cross bite reduced to just a whisper. So always
look to see what the rest of the body is doing!
Milk teeth and adult teeth
When a child is approaching the time for adult teeth to
begin appearing, check to see the deciduous teeth spread
as the jaw grows and gaps appear between the teeth. If this
does not happen, you have some work to do. The bite needs
evaluating and the way that the maxilla and mandible relate
to all their neighbouring bones should be looked at carefully
and systematically. Sometimes it is enough to restore normal
involuntary motion for the mandible and alveolar arch of the
maxilla to expand and the teeth straighten up. Other times
an orthodontist needs to apply a more steady force to get the
desired spread.
Bottle or breastfed
It is my understanding that a child who breastfeeds
makes a vacuum in their mouth that helps to develop the
palatal arch and paired maxilla bones. This in my mind is one
of the ways that a child helps itself to unfold after birth. The
more difficult the labour the more important it is to establish
breastfeeding and this has far reaching implications for
developing occlusion.
Osteopathy and dentist partnership
The osteopathic dental partnership is a very important
one. In my experience, even with good osteopathic support
through growth phases, genetic (or, more likely, postural
habits including tongue and breathing habits that are
hard to break) necessitate recourse to a good cranio-facial
orthodontic approach.
The same approach is always needed, in my opinion,
when there is a class three bite where the mandible is in
front of the maxilla. In this case the patient may well have
been offered maxillary-facial surgery to reduce the mandible.
Bryan Killgallen has had a lot of success using headgear worn
at night to expand the under developed maxillary arch in a
class three bite. This of course requires a lot of compliance
from the child and support from the parent, but when
compared with the risks of surgery it can be put forward as
a reasonable option.
As the maxilla has so many connections to frontals,
ethmoid, vomer, palatines, zygomae and indirectly
through the teeth to the mandible, temporals and occiput
,all these bones need to be freely expressing themselves
and working with their neighbours, especially so during
the period that dental brace-work is being utilised.
Case histories
Patient 1 tried to come
into the world via the birth
canal but got stuck and was
delivered by C-section. One
of the noticeable things
about his appearance was his
right eye, which in the first
six months of life showed a
red mark on the eyelid. On
osteopathic assessment his
right maxilla was more in
extension than on the left, as
was the right zygomae and
the right temporal bone. To
the onlooker, his eye appeared squashed. This became the
cue for osteopathic treatment. However, when his adult
teeth came in the eye was no longer the noticeable thing but
the dentist started noticing a cross bite which was referred
to me to treat. At this stage the right maxilla appeared not
to have developed as much as its counterpart on the left and
the mandible bilaterally. This meant that the dento-alveolar
midline had shifted to the left. Treatment continued on and
off until he was fifteen to sixteen years of age when it was
pronounced by the dentist, ‘that he had as near as dammit
occlusion’. Patient 1 was treated as he grew and the problems
ironed out as they came, he did not require orthodontics just
the combined work of a dentist and an osteopath.
Patient 2 was referred to me by the dentist at eight years
of age. He had class 2 division 1 occlusion with a retro-gnathic
mandible. His two upper front incisors were so forward that
he bit his bottom lip a lot. He had been delivered normally
after an eighteen hour labour with quick second stage with
the help of ventouse suction. He was bottle fed and the only
other remarkable thing in his history “wash I not talk until
three and half years of age”. On osteopathic examination I
found that he had a very round flexed face. His temporals
were in huge flexion about as far as they could go which
resulted in the ears being much flexed. The mandible was
wide and shallow and very retro-gnathic with the tension in
the hyoid and the muscles between at maximum. This boy
had to talk with his mouth very wide open. Family likenesses
suggested a strong genetic factor in oro-facial development.
While the bottle feeding didn’t make matters worse, the
relatively posterior mandible would have made it very hard
for him to form a latch with breastfeeding unless he had
been treated at birth.
Allergies /mouth breathers
Tongue posture is a key factor. Children who are
constant mouth breathers fail to posture their tongues
in a healthy resting position, closely applied to the hard
palate. Proper swallowing action of the tongue against the
hard palate increases the breadth of the maxillary arch and
thereby lengthens the alveolar arch. The tongue performs
this swallowing action up to 2000 times a day. Increased
breadth of the roof of the mouth is accompanied by increased
breadth within the nose, around the ethmoid and sinus
spaces. In mouth breathing, the tongue postures into the
floor of the mouth, drags the mandible further backward,
whilst also failing to spread and expand the paired maxilla.
Alveolar arch development is insufficient to accommodate
all the secondary teeth in either upper or lower jaw. This
leads to dental overcrowding. In my opinion pulling teeth
out to “make space” for the remaining teeth does not
make sense. The remaining, straightened teeth often need
drawing together to close any remaining gap between them.
The final functioning of the maxilla and mandible is even
more compromised than it was before utilising this style
of orthodontic intervention. Furthermore this approach
creates a very static feel to the bone instead of a dynamic
adapting bony physiology.
Retro-gnathic jaws more common where there
are other problems e.g. developmental delay,
autism, dyspraxia
It has been my observation that children with any kind of
developmental delay are more prone to postural disorders
and a change in overall dentofacial morphology. The maxilla
often appears under developed with decrease in overall
width and flexion, while the mandible seems often to be
retro-gnathic. I am unsure as to the reasons. It could be due
in some cases to the lack of utilising the tongue properly for
swallowing, feeding and talking. There could be postural
factors.
In a Down’s Syndrome child, the palate is initially quite
flat. The crista galli feels very compressed and the vomer
development is delayed. This eventually translates into a
steeple palate with not enough room for the tongue which
then means that the maxilla is left unexpanded. Osteopathic
treatment of a Down’s child while they are growing up is
imperative, in my opinion, to help their unique anatomy
develop as well as it can. Treatment literally helps create
room in the mouth for the tongue which then helps the
development of the maxilla and vomer and has implications
too for the dealing with the sinuses and their development.
In Conclusion
In my opinion, for a child to develop good occlusion they
need to have regular checks with an osteopath. Each has a
genetic programme, added to by living life. Birth, knocks
and bangs, decisions made about life style all have an impact
on how a child grows and develops. Our job is to undo the
tensions that life places upon them and support the health
so that the child can grow in a regular and straight way. If
there are abnormal genetic forces at work, lifestyle issues
where a child cannot have regular osteopathic treatment or
where their growth is hindered by pathologies, then they
may need orthodontics to help align the teeth.
Reference
1.
PBB20 Schwartz Model Analysis: www.kemetek.com
15
Case Study
BELL’S PALSY
Louise Jamieson-Hull
C
ase Study of a forty-six year old woman
presenting with Bell’s palsy: This patient
presented with left sided Bell’s palsy of ten
days’ duration. It had been diagnosed by the GP
and treated with an impulse dose of prednisone
given within seventy-two hours of the onset and
tailing off to zero over a period of days. The patient
felt uncertain as to how much she had benefited.
Recent history
Forty-eight hours before the development of Bell’s palsy
she experienced a headache, acute left-sided ear ache and
neck pain. Twenty-four hours later an odd sensation in her
mouth developed progressing to numbness waves of nausea
and loss of her sense of taste. The left side of her face began
to droop and she was unable to close the left eye. The eye
became dry and vision blurred. Her face felt numb and yet
tender to touch. The
GP advised her to
use artificial tears
and to tape the
eyelid shut at night
to avoid drying
and ulceration of
the cornea. There
was no change in
auditory sensitivity.
Ten days prior to
this she had held her
mouth open for a
prolonged period to
allow the dentist to
repair the filling in a
lower left molar.
Longer term history:
Extraction history included upper right first premolar
(tooth 4) and first molar (tooth 6), a molar from the left
maxilla, lower right 6 and 7. All of this apparently prior to
childhood orthodontics. In adult life, all four wisdom teeth
(i.e. all the 8’s) had been removed.
Orthodontic treatment as a child had begun to regress; her
dentist pointed out two years previously that her teeth had
begun drifting and torsion, especially on the left and some
had begun to fracture. Further urgent orthodontic work had
become necessary and the alignment now appeared good.
Sinusitis, throat infections and ear problems had continued through childhood into adult life. The left side of her
head and nose sustained an impact during a road traffic accident in 1994; her fractured nose was surgically straightened and she suffered subsequent recurrent stiffness of the
16
left shoulder (upper ribs) and mid neck localised at C5. A
more recent MRI scan had apparently shown only age-related wear and tear. This lady had two male children, both born
by Caesarian section, the latter being in 2007.
Examinations and Findings:
There was no ability to contract muscles of the left face.
The texture of the skin in the most affected areas was rubbery in appearance and had altered sweating. Intra-oral palpation of the bones of the middle face revealed the vomer to
be immobile; the palatines jammed with a raised ridge at the
transverse suture between the palatal processes of palatine
and maxilla on each side of the roof of the mouth; struggle at
the spheno-squamous pivot compromised motion between
the temporal and sphenoid bones; intra-osseous strain of
the greater wing/pterygoid unit of the sphenoid. All the
bones on the left side of the face were compressed and
“woody feeling” and the right side felt turbulent and superficially locked, suggesting that it was trying to free itself. All
the ligaments of the mandible felt tight and stiff. The cranial
base felt compressed on the left, with reduced motion in the
left occipito-mastoid suture. There was also reduced movement in her mid cervical spine, especially on the left.
My impression was that the recent dental work had been
the final straw in predisposing a breakdown in her compensation patterns, leaving her vulnerable to viral infection, inflammation and compression of the facial nerve in the bony
facial canal within the petrous temporal bone.
Working Prognosis and Treatment Rationale:
I had previously had success treating a patient with acute
Bell’s palsy on a regime of alternate day attention to improve
movement and function of the cranial base, neck and face.
Significantly, I had looked beyond motion of the petrous
temporal bone (the site of impingement of the facial nerve
in the facial canal) and had also given attention to the bones
of the face and the soft tissues along the course of the nerve
terminating in the face.
My impression from this experience was that if I could
improve motion along the whole course of the nerve, I would
encourage fluid transport down the nerve from source to end
terminal and also provide biofeedback to the nerve through
motion, thus improving the recovery rate.
Treatment:
Methodically I set about taking each bone in the face and
restoring motion within its physiological limits taking into
account old trauma and more recent compression forces
from orthodontic and dental work. I improved motion of the
zygoma, vomer and both palatine bones, also of individual teeth using balanced ligamentous tension of its relation
within the periodontal ligament. Other techniques useful
in systematic release of sutural restrictions included the
Cant Hook technique to release the frontal and then free the
spheno-squamous (SS) pivot, lift and spread of the (paired)
frontal, temporal spread, occipito-mastoid (OM) release
and BLT support to the mandibular ligaments. As each area
was released there was an immediate improvement in the
visual appearance of the overlying skin. There was also an
increase in sensory and motor function at each visit. The
patient looked in the mirror at the beginning and end of each
treatment to see the changes, visible to both of us.
Loss of sensation in the tongue
and of taste in the anterior two
thirds felt to the patient as though
the whole tongue was coated. Dryness of the tongue can also make
the tongue feel stiff, as though it is
coated. The facial nerve provides
innervation to some of the salivary
glands unilaterally, but the other
glands can provide enough secretions for the mouth not to become
too dry. Inspection of the tongue
for the typical white appearance
of thrush excluded steroid induced
oral thrush as the cause of this
sense of “coating”.
returned, there was a clear palpatory impression of inflammation
at a specific location within the
petrous portion. Improvement in
this quality was gained by using
stabilising hand holds on the mandible with temporal and sphenoid
whilst engaging the three mandibular ligaments (especially the
stylomandibular ligament) in a
stretch / BLT approach. All treatment approaches were bilateral,
starting with the affected side.
Treatment intensity:
Treatment of the Tongue:
I assessed the flexibility of the tongue by holding it between my thumb and fingers, performing a series of motion
tests in all planes up and down, from side to side and holding
the position of ease until all sense of resistance within the
tongue disappeared. I also asked the patient to do this at
home on a daily basis to encourage motion in the tongue and
to act as a lymphatic pump.
Freedom of motion in tongue helps support the position
of the teeth and of the paired maxilla. It is also important for
support of the pharyngeal fascia and in the posture of the
front of the neck and for balance.
What I felt to be of the most significant benefit in this
context however, was that moving the tongue in this way
created a draw of fluid along the nerves to the tongue,
like a milking action.
Treatment: Cervical Spine and Cranial Nerves:
I worked with the patient to restore motion in the upper
and mid cervical spine with BLT approaches, hand holds on
the posterior and anterior of her neck and improved motion in her pharyngeal fascia. I worked on inhibition to the
sphenopalatine ganglion and showed her how to do this for
herself. This really helped with the eye secretions and I feel
the incorporation of the trigeminal nerve into the treatment
helped the facial nerve to settle more quickly through their
connection via the maxillary nerve at the sphenopalatine
ganglion and the shared nerve pathways in the soft tissues.
Refining of treatment as resolution progresses:
Each treatment brought sustained improvement in the
sensory and motor symptoms. Blurring of vision was the
last symptom to resolve. This required work to restore motion to all seven bones of the orbit using BLT of the bones and
orbital contents. Accommodation to light and dark through
pupil dilation recovered moderately quickly compared to
the focusing. The upper thoracic spine expressed increased
autonomic tone - T1-3 needed support to calm down.
The cheeks overlying the zygomatic bones looked boggy and were hypersensitive to touch for a while after motor
and sensory function returned, but responded to continued
treatment. This was one of the first symptoms experienced
by this lady as the Bell’s palsy developed. There was also
tenderness in the EAM, deep within the temporal bone and
the mastoid. As all the compression reduced and motion
The first four treatments were
two to three days apart, depending on weekend spacings. I felt this
was important in order to restore CSF motion in the nerve
sheath, nutrition to the nerve and so reduce possible longer
term damage to the facial nerve. By the end of those sessions,
nine days, motor function was fully restored; she could suck
on a straw, scrunch up her eye lids and blink and smile again.
This last gave her great confidence when she had been faced
with the uncertainty concerning recovery or its extent. Aching in the unaffected side of her face, due to exaggerated and
compensatory effort, was now relieved. The patient’s GP was
sufficiently impressed with the response that she asked to
be told about the process of treatment.
Treatment continued on a weekly basis for the rest of the
month, making seven sessions in all over the first month.
Following that, she had three treatments at monthly intervals. The patient is now fully recovered, with better function
in her face, head and neck than for many years. She is returning on a three monthly basis for maintenance treatment as I
feel the longer term problems will return over time without
ongoing monitoring and detailed management. I feel there is
now low risk of her getting Bell’s palsy again. Statistics state
that there is a 14% chance of recurrence if there is a family
history of this condition.
I am immensely grateful to Sue Turner for taking the time
to record all the hand holds and approaches to the face that
she in turn learned from Ann Wales. Without these I would
not have had the accuracy of cranial assessment or the confidence in treatment potential to predict to the patient that
treatment stood a reasonable possibility of improving her
condition.
When you become familiar with the bones of the face,
working with them every day, the texture of the bone, movement patterns, flexibility and living quality become easier
to feel, together with the emotional quality that face bones
hold. You can feel the story of the bones and their shock or
traumas unfolding and dissipating in you hands. It is quite
a thrill and I can only encourage you to come time and again
to the SCCO Functional Face course to explore these things
to a greater depth and to share your experiences with other
so we can all learn more.
Further reading
More information about Bell’s palsy: http://www.nhs.
uk/conditions/Bells-palsy/Pages/Introduction.aspx
17
THE PALATE AND HEARING
Clive Hayden
W
hilst the theme of the this magazine is celebrating the link
between Dentistry and Osteopathy, I am going to ask for
your understanding for a little bit of poetic licence, by
presenting an interesting case that looks at the link between the soft
palate and hearing problems in a two and a half year old boy.
Case details.
Monty, aged two and a half, was first
brought into the practice by his mother
and grandmother looking for help with
his bilateral glue ear problem. Monty
also suffered from speech delays - but
he was born with a defect of the soft
palate - a cleft palate that meant as
a baby he regurgitated his milk back
through his nose. This was how the
palatal defect was picked up.
and whether the Tensor Veli Palatini
(TVP) and Levator Veli Palatini (LVP)
muscles might be linked in to the
hearing and palatal defect.
As can be seen from Diagram 1,
there is a clear link between the
auditory tube and the soft palate.
Monty’s birth.
He was a first child, born at fortytwo weeks, and was diagnosed during
the first stage as lying transversely
or possibly OP. The labour was seven
hours long but Monty went into foetal
distress. Forceps, described by his
mother as a ‘heavy pull’, were used to
assist his delivery. He weighed 8lb 9oz
at birth and had a head diameter of
35cms. His developmental milestones
of sitting up, crawling and walking
were relatively normal, but obviously
his speech was delayed.
Case considerations.
His speech delays could have been
associated with his hearing problems a very common association. But when
I did hear him try to speak he had the
hollow upper nasal ‘echo’ very typical
of someone speaking with a cleft palate.
YET the palatal defect had seemingly
been repaired at ten months. (His mum
said that the ENT department was
thinking that another repair operation
might be needed.)
The interesting thing was that right
from the word go, Monty had also failed
his hearing tests, and it was this fact
that made me wonder whether the glue
ear was linked to the palatal defect,
18
pressure between the middle ear and
nasopharynx.
LVP arises by a small tendon from
the inferior part of the petrous part
of the temporal bone. Additional
fibres arise from the inferior aspect
of the cartilaginous part of the
pharyngotympanic tube and the
vaginal part of the sphenoid bone. Its
fibres spread in the medial third of the
soft palate between the two strands
of palato-pharyngeus, to attach to the
upper surface of the palatine aponeurosis as far as the midline, where they
interlace with those of the contralateral
muscle. The two LVP muscles form a
sling above and just behind the palatine
aponeurosis.
LVP elevates the soft palate during
swallowing, has little effect on the
auditory tube - but might allow passive
opening.
So the anatomical description in
Gray’s Anatomy confirmed to me that
the lack of function of the auditory tube
and inability to let the ears drain must
be linked up to the palatal defect. Yet
seemingly the soft palate defect had
been repaired at ten months.
Osteopathic examination.
The TVP arises from the scaphoid
fossa of the pterygoid process and the
spine of the sphenoid bone.1 Between
these two sites it is attached to the
anterolateral membranous wall of
the phayngo-tympanic tube (auditory
tube). Inferiorly the fibres converge on
a delicate tendon that turns medially
around the pterygoid hamulus to pass
through the attachment of buccinator
to the palatine aponeurosis and the
osseous surface behind the palatine
crest on the horizontal plate of the
palatine bone.
TVP’s primary role is to open
the auditory tube, especially during
deglutition and yawning. This action
makes it possible to equalise air
I hope you will forgive me if I say
I didn’t look down Monty’s ears with
an otoscope. I could observe the loud
voices used by mum and grandmother
to speak to him and the TV was
always on loud. He was also extremely
reluctant to be approached, and the
only way I could get a hand on him was
by playing with toys with him on the
floor.
When I did manage to get a hand
on him, I was immediately struck
by the heavy feeling of tension and
compression around the sphenoid. The
logical side of my brain immediately
thought that this must have been part
of the surgery to repair the cleft palate.
However I became aware of that heavy
clamp-like compression and twist
check him again in three months but
that it is time to concentrate on the
speech therapy.
With the mucus persisting in the
ears, I would still feel that the actions
of LVP and TVP are compromised,
but Monty’s mother and I agreed that
another operation on the palate did
not seem to be necessary at the present
time, given the improvements that had
been made in Monty’s speech and
hearing.
Conclusions
Diagram 1
that I recognise as being consistent
with a forceps delivery. It was pulling
sphenoid round into a true side bending
left cranial base pattern. There was no
way that the sphenoid could move, and
this limitation of sphenoid motion in
itself would impede drainage of the
auditory tubes.
Response to treatment.
I suggested to Monty’s mother
that we try three further treatments
to see if we could make any difference
to his hearing. At the time I was still
considering that a further surgical
repair was needed to the soft palate so
didn’t hold much hope for a change in
the ‘cleft palate type of speech’.
When they returned the following
week there had been no noticeable
response to the initial treatment, but
Monty had gone down with chicken
pox immediately after the treatment.
(How often does a treatment help
these illnesses to surface??) That
meant that a treatment response was
hard to assess. It was still a challenge
being able to get my hands on him.
Apart from fluid work initially to help
the RTM and fascias become less tense,
I was able to carry on treating the
pinching effect of the forceps on the
frontals and sphenoid.
When the family returned for the
third session two weeks later, it soon
became apparent that Michael’s speech
had become more tonal and less upper
nasal ‘hollow’. He was also quieter and
was less frustrated with life, and the
mother and grandmother were talking
to him in a more normal tone of voice.
This didn’t mean it was any easier
to get my hands on him! There was a
good release of the left zygoma and
pterygoid plates of the sphenoid.
At the fourth session, it was clear
that his speech and hearing had
improved. The shape of the palatal
arch seemed to deviate to the left, but
this was a reflection of the cranial base
pattern rather than a weakness in the
soft palate.
Monty has just received his fifth
session of treatment. In the waiting
room he said ‘mummy’ quite clearly
and without any hint of hollow cleft
palate intonation. He has just had his
new hearing aids fitted, and he has
taken to wearing them quite easily. His
hearing was tested and it still seems
that there is a marked level of mucous
residue in the ears, more in one ear
than the other. He is due to start speech
therapy shortly. The compressive effect
of the forceps on sphenoid was still
apparent but much better, and this
treated comparatively easily. I felt that
there had been sufficient change and
improvement of function for me to say
to say to Monty’s mother that we will
For me Monty’s case was very
helpful in demonstrating how the
auditory tubes need a functioning
soft palate to be able to open and
close effectively. Although a cleft of
the soft palate is relatively rare, many
infants are born who have undergone
marked facial compressions during
their delivery. This case highlights the
need to evaluate the function of the
palatines and palate if we are to be
able to practice preventative medicine
and stop infants going down the route
of repeated ear infections and glue ear
with all the implications for speech and
learning that brings.
I am not saying that this is the only
cause of otitis media in children - far be
it - but it could be an area that we need
to pay more attention to.
I think the clue about the palatal
involvement with Monty’s hearing
came in the fact that he failed his
hearing tests from the beginning - and
perhaps for those children who also
show early hearing loss, then the role
of Tensor Veli Palatini and Levator Veli
Palatini in auditory tube function must
rank high in our considerations.
Lastly, it would have been very easy
to have been distracted by the soft palate
defect, but I feel that it was the limiting
effect of the forceps compression on
sphenoid that was also stopping the
palate from working. It was working
with the effects of the forceps that was
the key in helping Monty’s soft palate
to function effectively to equalize air
pressure between the middle ear and
the naso-pharynx.
References
1.
Gray’s Anatomy, pp 569-570, 40th Edition, 2008, Churchill Livingstone Press,
Elsevier
19
Early life stress and the
NEUROENDOCRINE-IMMUNE SYSTEM
an osteopathic perspective
‘Tis education forms the common mind,
just as the twig is bent the tree’s inclined.1
Pamela Vaill-Carter
A
number
of
recent
scientific studies suggest
that young
children
who experience toxic stress—
be it physical, psychological
or
environmental—are
at
high risk of a multitude of
health outcomes in adulthood
ranging from cardiovascular
and obstructive pulmonary
disease to cancers, asthma,
autoimmune
disease
and
depression.2,3,4,5,6 The fact that
early life stressors pre-set the
function of biological systems
is both a cautionary tale about
their effect as well as a note of
optimism about the promise of
osteopathic intervention.
albeit less poetic, expression of the
bent twig-inclined tree analogy that
W. G. Sutherland so often quoted to
promote the osteopathic treatment
of children.9 Another modern
scientific term, neural plasticity, is
an extrapolation of the osteopathic
tenet: experiences shape the
brain’s structure, which governs
function. Whilst the brain remains
plastic throughout life, there are
critical phases in a child’s life when
experiences—both positive and
negative—have a disproportionately
large impact on neural development
and, ultimately, their capacity to
maintain their own health.
NEI Network
Fig. 1: HPA Axis
In his final treatise on osteopathic philosophy, Irvin Korr
wrote: “The great tragedy is that while the nation’s health
care system is so extensively absorbed in the care of millions
of older adult victims of chronic disease, tens of millions of
younger people and children are embarking on life paths that
will culminate in the same diseases. The health care system
simply must move people from pathogenic to salutary (i.e.
health-promoting) paths. And the osteopathic profession
can show the way.”7
It is more important than ever for osteopaths to
understand the development of the neuroendocrine
immune (NEI) system, how early life adversity and illness
alter its function, and how these alterations then increase
vulnerability to disease. Understanding the pathways by
which early adverse experiences and
illnesses set in motion trajectories
toward poor adult health brings
osteopaths closer to helping their
young patients circumvent this
process.
Biological Embedding and
Neural Plasticity
Scientific evidence now supports
the notion of biological embedding:
that environmental stimuli shape
developmental biology which in turn
determines future health outcomes.8
Biological embedding is a modern,
20
Although the brain, endocrine
and immune systems are viewed as
separate entities, they share a common language of hormones,
signalling molecules, receptors and neurotransmitters. This
language, properly expressed, facilitates communication
across the neuroendocrine immune (NEI) network to
maintain homeostatic balance. The NEI network plays a
critical part in physical, cognitive and socio-emotional
development by sensing, interpreting and orchestrating the
body’s response to stress in the environment.
[https://embryology.med.unsw.edu.au/embryology]
Hypothalamus and General Adaptive Response
Nociceptive information ascends through the
anterolateral system (ALS) in the spinal cord, which
indirectly stimulates activity in the locus ceruleus, a
secretory centre directly cephalic to the reticular formation
within the brain stem. Under the
influence
of
neurotransmitters
secreted by the locus ceruleus, the
hypothalamus releases noradrenalin,
which
stimulates
sympathetic
activity. In this way the hypothalamus
regulates heart rate, blood pressure,
GI function, respiration and vascular
tone. Noradrenalin secreted by the
hypothalamus also increases the rate
of T cell differentiation but decreases
the rate of cell division. So, while the
immune system can react quickly to
many types of antigens, cell division is
Fig 2. Journal of
Psychosomatic Research Vol 53 Issue 4, P 865-871, Oct 2002
dampened, and the response cannot
be maintained. This immune response by the hypothalamus
is primed to respond to all stressors, be they physical or
emotional.10
HPA Axis
Key to the stress response is the endocrine regulation
of the hypo-thalamic-pituitary-adrenal (HPA) axis. It is
responsible for managing metabolic and cardiovascular
responses to acute and chronic stress.11 The HPA axis
also plays an important role in the immune response.12 In
response to pro-inflammatory cytokines, the hypothalamus
secretes corticotrophin releasing hormone/factor (CRH/
CRF above) via a capillary network to the anterior pituitary.
This influences the pituitary to release adrenocorticotropic
hormone (ACTH), which stimulates the adrenal gland to
secrete glucocorticoids (e.g. cortisol). In turn the cortisol
creates a negative feedback loop and extinguishes the HPA
axis and inflammatory response.
One of the primary consequences of early life toxic
stress is HPA dysregulation, as the developing NEI system is
chronically pressed into action.13
The effects are wide-reaching—too much cortisol
suppresses immunity and raises the chance of infection,
too little cortisol and the inflammatory response persists
after it is no longer needed. The body-wide effects of HPA
axis dysregulation on the developing child’s health can have
devastating effects. Figure 2 illustrates a partial view of the
endocrine functions that may disrupted by an imbalance in
the HPA axis as a result of chronic stress.
Early life experiences affecting stress response
Pre- and perinatal maternal stress has an enormous
impact on the development of the child’s immune
system,14 sometimes even including stressors that predate pregnancy.15 Other factors, such as sensitisation
to second-hand cigarette smoke and exposure to other
environmental allergens, increase the incidence of allergic
and atopic disease—the critical period being between
birth and age eight.16 But the overriding long term impact
on the immune and inflammatory responses results from
disruption in adequate nurturing and caregiving very early
in life. Several human studies—including those on children
raised in Romanian orphanages—showed empirical
evidence of altered neuroimmune processes and sensitised
proinflammatory pathways.17 Chronic cortisol elevation
and resulting HPA dysfunction are now linked to childhood
and adult depression,18 asthma,19 hypertension, diabetes,
obesity and cardiovascular disease.20
Ben and Gavin
In 2007 I met brothers Ben, age five, and
Gavin, age seven, when they were brought to my osteopathic
surgery for a consultation. They had recently been adopted
by their foster mother and she was trying to get to the
bottom of their health issues. Both boys complained of
chronic stomach pain, alternating constipation, diarrhoea
and, in Gavin’s case, vomiting. In addition, Gavin had recent
behavioural issues at school.
They had been taken into care four years previously when
Ben was one and Gavin three years of age. Little was known
of their birth family except that both parents were IV drug
users. They had been reunited in their current home for two
Ben, aged 5
Gavin, aged 7
years after being in a number of separate care facilities for
the previous two years.
Ben: Case Study
Case History
Ben was a five year-old boy with one year history of
constipation and abdominal pain. He was complaining of
a “hard tummy”. His last bowel evacuation was four days
prior to the consultation, which wasn’t unusual for him. Ben
had recently been diagnosed with mild asthma, for which he
used an inhaled short-acting beta2 agonist as needed.
Examination: On observation he had a pale, distracted
affect. His abdomen was very swollen, and there was some
discomfort on palpation. There appeared to be a large mass
in the subcostal left abdominal, which was firm/tender with
guarding. His peripheral extremities were very cool, and he
had obvious shortness of breath.
Osteopathic examination revealed a system in shock
with very high sympathetic tone. The primary respiration
lacked potency and was severely restricted in amplitude and
expression. The diaphragm felt high and tethered; the ribs
held in inhalation. There was significant restriction in lower
ribs and liver.
Vital signs (normal range): temperature normal; heart
rate 150 bpm (65-135); blood pressure 75/50mm (80-110 ;
55-69); respiratory rate: 60/min (50-40). Concerned about
the tachycardia, hypotension and increased respiratory rate,
I referred Ben immediately to A&E; he was admitted into
hospital that afternoon.
Investigations and medical intervention: Blood tests
and CT scan revealed that Ben had a Wilm’s (renal) tumour,
the most common intra-abdominal solid tumour in childhood. Medical intervention was chemotherapy followed by
nephrectomy of the left kidney.
Treatment: Ben’s osteopathic treatment commenced
when he was undergoing chemotherapy for the Wilm’s tumour and continued on a regular basis following the nephrectomy. The aims of the initial treatments were to reduce
the sympathetic tone and shock in his system by finding his
neutral, then supporting his system into an EV4. This seemed
to greatly improve the overall tone and responsiveness in his
mechanism. Once Ben’s primary respiration revealed greater expression it was possible to identify and release various
strains: a left lateral membranous strain through the SBS,
the thorax/mediastinum and sacrum; lack of first breath;
poor diaphragmatic excursion. Using a combination of fluid
and balanced tissue tension techniques Ben’s digestion and
respiration improved. His asthmatic attacks became much
less frequent, and he seemed much happier in himself. Since
then he has come for regular bi-monthly osteopathic treat-
21
ment to support his development and facilitate his immune
function.
Gavin: Case Study
Case History
Big brother Gavin was an eight year old whose symptom
history detailed ten to twelve episodes of spasmodic abdominal
pain accompanied by nausea and vomiting. These episodes
had occurred over the past two years, each lasting twelve to
seventy-two hours. Self-induced vomiting helped relieve pain,
but the cyclic vomiting episodes were associated with
confusion and aggressive behaviour. Onset of the current
episode may have coincided with bullying at school as well
as death of his (adopted) grandmother, to whom he had
formed a close attachment.
Previous investigations/treatment had included:
tests on stool, breath and blood for peptic ulcer; scan for
duodenal obstruction (NAD); nutritionist (ketogenic, then
anti-candida diet), a child psychotherapist (EMDR21), a
neurologist and a psychiatrist who had prescribed valproic
acid for six months (for suspected abdominal migraine).
All of the interventions had made a temporary change but
symptoms always returned. At the time of his first visit,
sertraline (a SSRI antidepressant) was being considered by
Gavin’s GP and psychiatrist.
Examination: Pallor, dark circles under eyes. Overweight. Very flat affect; seemed depressed.
Abdominal exam: General stasis, impacted faeces, umbilical torsion.
Osteopathic exam: Severe cranial base compression;
CNS felt hard and shut down; very high sympathetic tone
with adrenals working furiously. It felt as if he wasn’t really
present in his body. Poor ignition. The liver felt enlarged
and congested, affecting the function of the diaphragm and
drainage of the gut. The abdomen was both bloated and
dehydrated; peristalsis was static and the tissue quality of
the peritoneum and smooth muscle of the gut irritable and
spiky. There was no evident connection throughout the RTM
and generally very poor IVM expression.
Treatment: The first treatment involved releasing the
cranial base compression and finding his neutral in order
to calm the hyper-aroused sympathetic tone. There wasn’t
enough CRI present to attempt a CV4 or EV4. Ignition technique was attempted through the third ventricle, followed by
a parietal lift which improved perfusion of the lateral ventricles. This had a marked effect on the quality of the CNS and
orientation of a midline. On subsequent treatments a CV4
was employed, and a steady biphasic rhythm in the IVM established. Eventually he revealed a body-wide torsion strain
from the SBS to the pharyngeal tubercle and down through
the thoracic fascia. His diaphragm felt tethered to the pericardial fascia and seemed to flap listlessly on inhalation,
like a becalmed sail. His body felt deprived of oxygen and
he felt to me as if he was drowning in his fluids. Acknowledgement and support of the membranous torsion strain
initiated a first breath release. After that treatment his stomach symptoms began to improve, he started sleeping better
and was less angry. The following appointments were along
the same lines whilst introducing techniques to improve visceral function and focusing on blood supply and lymphatic
drainage. In addition, dietary advice was given to eliminate
triggers: gluten, caffeine, sorbitol, fizzy drinks, brassicas and
22
lactose. He began to lose weight. Because Gavin seemed to
find tremendous short-term relief from the EMDR therapy,
we scheduled his osteopathic appointments on alternate
weeks. This seemed to enhance greatly the benefits of both
treatments. Within six months, his stomach issues had nearly resolved and he seemed far less anxious and depressed.
Conclusion
Whilst treatment for the brothers varied according
to their individual needs, the overriding osteopathic aim
was to help them re-establish their connection to health.
Osteopaths who work with very ill or traumatised children
often refer to the palpatory sensation that they are not
present in their body—psychotherapists would refer to
this as disassociation. Both Ben and Gavin shared that
dissociated state as well as general lack of ignition, which
was compensated for by their hyper-aroused sympathetic
response. Osteopathic treatment offered them a respite from
the toxic stress driving their systems, and a roadmap back to
health and homeostasis.
Osteopathic treatment was one of a number of
environmental factors that contributed to the boys’ return
to health. Establishment of a loving, supportive home,
psychotherapeutic intervention (particularly EMDR) and a
nutritious diet all played an important role. Their story is one
of hope: that even in the face of extreme adversity positive
environmental and therapeutic intervention can change
many negative health outcomes seemingly preordained by
early stress experiences.
Most children don’t present with trauma as severe or
prolonged as Ben and Gavin. But even relatively common22
birth trauma, resulting in membranous birth strains, can
have a life-long impact on a child’s health. Learning disorders,
behavioural difficulties, allergies and scoliosis are often
sequelae of unresolved intracranial and musculoskeletal
birth strain patterns that every osteopath working with
children can address.
Ben, aged 11
Gavin, aged 13
References [Continued at foot of page 23]
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Anda FR, Brown DW, Dube SR, Bremner JD et al. Adverse childhood experiences and
chronic obstructive pulmonary disease in adults. Am J Pre Med. 2008;34(5):396-403.
Bjorntorp P, Rosmond R. The metabolic syndrome—a neuroendocrine disorder? Br J
Nutr. 2000;83:S49-S57.
Cohen S, Janicki-Deverts D, Chen E, Matthews KA. Childhood economic status and
adult health. Ann NY Acad Sci. 2010;1186:37-55.
Felitti VJ, Anda RF et al. Relationships of childhood abuse and household dysfunction
to many of leading causes of death in adults. The Adverse Childhood Experiences
Study. Am J Prev Med.1998;14:245-258.
Barker DJP. The developmental origins of adult disease. J Amer Coll of Nutr
2004;22:101-114
Korr I. An Explication of Osteopathic Principles. The Foundations for Osteopathic
Medicine, Philadelphia: Lippincott 2003, pp 16-17.
Nelson CA. Neural plasticity and human development. Curr Dir Psychol Sci.
1999;8(2):42-45.
Sutherland W. G. “Bent Twigs” Compression of the Condylar Parts of the Occiput.
Teaching in the Science of Osteopathy, SCTF 1990
History & Memoriam
The Zygoma - A memory of
ROLLIN BECKER
Lynn Haller
I
n 1988 Rollin Becker was the guest lecturer on the SCTF course
hosted by the postgraduate department of the BSO. This was my
second SCTF course but I had only been in practice for two years.
I first encountered Dr. Becker when,
as an undergraduate, I read his articles
on Palpation. I read and re-read these
articles gaining more each time as
my own experience grew. To attend a
course that he was teaching on was the
fulfilment of a dream, needless to say I
was hanging on his every word.
Unfortunately it was evident from
his lecturing that he was struggling
with his words. It was unclear to me if
this was his style but it reminded me
of elderly patients who suffer from
transient ischemic attacks. There was
one lecture where I was sitting in the
front row when Dr. Becker stopped
mid-sentence, pointed to the back of
the room and shouted,
“Will someone fix that zygoma in
10.
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Carreiro JE. An Osteopathic Approach to Children
(London; Churchill Livingston,2003), 109-110.
Francis DD. Conceptualizing child health disparities:
a role for developmental neurogenomics.
Paediatrics.2009;124:S196-S202
Then T, Cidlowski J. A. Anti-inflammatory action of
glucocorticoids. New Engl J Med. 2005;353(16):17111723
Gunnar MR. The neurobiology of stress and
development. Annu Rev Psychol. 2007;58:145-173
Coe CL. Mother-infant interactions and the
development of immunity from conception through
weaning. Psychoneuroimmunology. Burlington
MA:Elsevier Academic Press;2007
Sternthal MJ, Enlow MB. Maternal
interpersonal trauma and cord blood igE
levels: a life-course perspective. J Allergy CLin
Immoral,2009;124(5):954-960.
Gaffin JM, Phipatanakul W. The role of indoor
allergens in the development of asthma. Curt Opin
Allergy Clin Immoral. 2009;9(2):128-135.
Coe CL, Lubach CR. Critical periods of special health
relevance for psychoneuroimmunology. Brain Behav
Immune.2003:17(1):3-12.
Hennesy MB, Deak T. Early attachment-figure
separation and increased risk for later depression:
potential mediation by pro inflammatory processes.
Neuosci Biobehav Rev. 201034(6)782-790.
Chen E, Chim LS. The role of the social environment
in children and adolescents with asthma. Am J
Respire Crit Care Med. 2007;176(7):644-649.
Hotamisligil GS. Inflammation and metabolic
disorders. Nature. 2006;444(7121):860-867.
Eye Movement Desensitization and Reprocessing
(EMDR)
Frymann, VM. Relation of disturbances of
craniosacral mechanism to symptomology of the
newborn: study of 1250 infants. JAOA 65(1966),10591075.
the back of the room?”
Of course all of our heads turned
to whom he was pointing and I must
admit that my jaw also dropped open
at the same time. What was that all
about? He then muttered to himself
something about not being able to
hear himself think with that zygoma
screaming at him. What had just gone
on?
Later I had the realisation that he
was sensing everyone’s mechanism
in the room. On this occasion the
“screaming” zygoma disturbed his
concentration. In monitoring students
as a table tutor we learn how to tune
into the mechanisms of two pairs of
students. Why not the whole room?
How amazing!
AGM & Rollin Becker Memorial Lecture
SCCO 21st Birthday Celebration
Osteopathy & Dentistry Workshop
Regent’s Conference Centre, Regent’s Park, London
Saturday 28 November
Sunday 29 November
£70 - Non-Members
£60 - SCCO Members & Fellows
£35 - Undergraduates
£120 - Non-Members
£95 - SCCO Members & Fellows
Dr. Martin Pascoe will share his
memories of Rollin Becker in a special
two hour lecture.
He will then host a unique workshop
on the interface between Osteopathy
and Dentistry.
On Saturday at 7pm we are celebrating our 21st Birthday at the venue’s
Knapp Gallery, to include hot buffet, birthday cake, music and dancing!
£20 - Faculty | £40 Fellows, Members & Guests
Definitely not to be missed! Book your place at www.scco.ac
Dr. Martin Pascoe is a BSO graduate and one of the first Osteopaths from the UK to study
Cranial Osteopathy in America, teaching the subject at the BSO from 1976. He has a great
interest in facial mechanics, and decided the best way to study them was to qualify as a
dentist. He is now the only practitioner in the UK to combine the two professions.
23
HISTORY & MEMORIAM
Sutherland Cranial College
COMES OF AGE
Zenna Zwierzchowska
I
was first asked to write a short piece on the origins of the Sutherland
Cranial College of Osteopathy with, I think, the view that this
would consist of a few anecdotes about the “Old Days” and maybe
include a few photos in funny dress and out of date hairstyles just to
prove how young we once were.
I had been around on the periphery
of these events sufficiently to know that
maybe this task would not be as simple
as it sounded. All births are painful, a
bit messy and possibly traumatic and
the birth of the SCC was no exception.
I proceeded to write to many of those
directly involved to get their views
so I could present as detailed and
rounded an account as possible. For all,
almost without exception, these times
were difficult and at times painful. I
was even warned that it was not the
right time to look over these matters.
I decided however, a little stubbornly,
to carry on. As a history graduate in a
previous existence, I persevere in the
old fashioned view that knowing our
past can help explain the present but
also inform the future. What is certain
is that distance can give a clearer
perspective. Not to mention the fact
that what came out of the concerted
efforts of many dedicated individuals
was this thriving organization the
SCCofO, which celebrates its coming of
age this year.
This account is a melding of
memories and recollections with
thanks to all those willing to talk to me
but sadly with only one photograph of
the BSO SCTF faculty of 1989. Maybe
later everyone was too busy getting
on with the business of creating a new
teaching college to think of pulling out
a camera…no smart phones in those
days, more likely to be film needing
developing and printing. (If you have
any photographs please get in touch.)
Osteopathy in the Cranial Field
(OCF) had been taught in this country
to BCNO graduates from the mid
1960s by Jo Goodman and Bill Wright.
There was pressure on the BSO to
introduce cranial osteopathy into
the curriculum. This was led by Greg
24
Currie and Dennis Brookes. Dennis
had travelled to the USA, met up with
a number of cranial osteopaths and
attended at least one course with the
SCTF (The Sutherland Cranial Teaching
Foundation). Eventually, in 1972,
Colin Dove, as Principal of the British
School of Osteopathy (BSO), attended
a cranial course run by the SCTF in
USA on behalf of the BSO to find out
what this was all about. Colin himself
reports that he expected to be able to
dismiss ‘cranial’ osteopathy as a cult
of no scientific validity that the BSO
could disregard. However he admits to
being surprised to find that he could
not dismiss Sutherland’s concept and
principles and reported this back to
the Board of Trustees of the BSO. The
BSO ran the first Cranial postgraduate
course in September 1974 with the
backing of the Sutherland Cranial
Teaching Foundation of the USA, an
organisation established by W. G.
Sutherland and senior members of his
faculty to promote his teachings. These
courses were then run annually at the
BSO and after 1980 became part of the
BSO’s postgraduate programme. Colin
directed all the courses from 1974
until the late 1980s when, owing to
his increasing workload, he delegated
the direction of the courses to Nick
Woodhead.
Before
the
Osteopaths
Act
(1993), the osteopathic profession
was divided with several different
registers operated by different colleges
of osteopathy. The General Council
and Register of Osteopaths (GCRO)
was the registering body initially for
graduates of the BSO and the LCO only,
but eventually came to include those
from the ESO and BCNO. Graduates of
other colleges were still not eligible.
To maintain educational standards
the SCTF required at the outset that
the only osteopaths who could attend
the BSO cranial courses were those
registered under the GCRO. However in
preparation for statutory recognition,
osteopaths would have to sink their
differences and work together as
the Department of Health were
only prepared to deal with a united
profession. The area in which this could
be demonstrated easily was in the field
of postgraduate education. Colin Dove
had in the past invited graduates of
both the ESO and the BCNO prior to
their becoming ‘registered’ osteopaths
and indeed enrolled Sue Turner as
the first non-BSO tutor; all with SCTF
approval. Joyce Vetterlein a longstanding member of the cranial faculty
was at this time also on the Board of
the GCRO and privy to what was going
on in the political arena. There was a
danger of cranial teaching becoming
very fragmented with John Upledger
HISTORY & MEMORIAM
trying to franchise his cranio-sacral
therapy courses in the UK and other
individuals also offering courses that
would be open to all osteopaths (in
the case of cranio-sacral therapy,
also to non osteopaths). Therefore
at a Sutherland Society weekend
conference held at Gaunt’s House,
members of the faculty led by Joyce
voted to include all osteopaths, not just
members of the GCRO, onto the basic
cranial courses.
At this point conflict arose;
not all faculty members were in
favour of this proposal. It also
brought the English Faculty
into conflict with the American
Board of the SCTF who, as the
guardians of standards, had only
agreed to teach GCRO members
and worried about extending
this teaching to non-registered
osteopaths. There were some
accusations and hard words
were spoken, as happens when
people feel passionately and come up
against others equally passionate but
of a different persuasion. The faculty
was now fragmented with some
beginning to teach as an independent
group known as The British Sutherland
Cranial Faculty (BSCF) and others
remaining with Nick Woodhead
and Martin Pascoe within the BSO
postgraduate department. The first
course run by the BSCF was run in
1993, to which non-aligned osteopaths
(outside of the GCRO) were invited, in
order to foster closer ties within the
profession.
There were other influences at
work in the years leading up to these
major changes. Sue Turner and Jim
Jealous organised a meeting of those
involved in cranial teaching in the
UK with members of the American
Study Group around Dr. Anne Wales.
Dr. Wales was a student of W. G.
Sutherland, an early member of his
faculty and eventually editor of much
of Dr. Sutherland’s writings. This
combined Anglo-American group came
to be known as the Old England/New
England study group. The first meeting
was organized in the winter of 1989
in Bar Harbor, Maine. This first step
outside of the SCTF was described by
some as a “door into a different world”.
The brief for the meeting was very
informal, everyone could contribute
and speak on any topic of their choice.
One memorable moment was Ernest
Keeling in his inimitable fashion
placing a flowerpot in the middle of the
room and talking about the fulcrum.
New friendships were forged and
new ideas explored. Jim Jealous first
introduced the concept of biodynamic
embryology which has so informed
our understanding of how the way in
which the embryo develops and grows
influences the body’s orientation in
later life. The English group was also
introduced, for the first time, to Frank
for a more democratic set-up. Some
held the view that it was possible to
have a leaderless, non-hierarchical
collegiate association rather like the
deliberations in the longhouses of
the South Seas (except that was male
orientated and could go on for weeks!).
The breakaway group started with no
defined structure or administrative
backup. A group consisting of Nick
Handoll, Caroline Penn, Joyce Vetterlein
and Liz Hayden was set up to look into
a way forward. Nick suggested
Colin Dove be co-opted in view
of his experience in setting up
and running new organisations.
Colin agreed to join on condition
that any new organisation had
a sound structure and obtained
charitable status as a teaching
college.
The group then met several
times at a midway point at
Minster Lovell in Oxfordshire
and with the help of the National
Council for Voluntary Organisations
established a workable constitution
and a title (the longest discussion
of all!). Nick wrought miracles with
the Charity Commissioners over
remuneration of tutors, a bit of a
sticking point for a Charity. The results
were presented to the whole group at
a very stressful meeting, where each
clause of the new constitution had to
be discussed in detail but was finally
carried by the majority. Probably
swayed by the fact that he was still
convalescing from heart surgery
Colin was given immediate Honorary
Membership and asked to be the first
President. He accepted.
The original SCTF cranial courses
(equivalent to Module 2/3) were
run annually over five days. Students
attended these courses year after
year, gaining more each year as their
palpatory skills improved. In order to
share and expand knowledge, those
who had attended one of these courses
were eligible to join the Sutherland
Society, a member-led organisation
with study groups around the country
and occasional weekend conferences.
There were no other courses available
in OCF. With the formation of the new
SCC it became apparent that there was
a demand for a wider range of courses
than the five-day basic course, and
that the different educational needs
of entry level osteopaths with no
previous experience, through to those
“People were able to see and feel
the Sutherland fulcrum move, get
a first hand look at the lamina
terminalis and observe the
fasciae of the lungs. It was like
letting a bunch of deprived kids
into a sweetie shop.”
Willard, Professor of Anatomy at the
New England College of Osteopathy,
who has given osteopathy a view of
anatomy that we do not often get from
standard text books. He has shown us
aspects of anatomy that are of limited
interest to others but important to us.
A highlight of the whole event was a
trip down to his dissection lab at the
College, where there was a special
dissection of the dura. People were able
to see and feel the Sutherland fulcrum
move, get a first hand look at the lamina
terminalis and observe the fasciae of
the lungs. It was like letting a bunch
of deprived kids into a sweetie shop.
Frank says that usually he has trouble
getting students into the dissection lab
but in this case he had trouble getting
them out! The journey back to Bar
Harbor was spent on a (sugar?) high
with a lot of jokes and black humour.
There were two more international
meetings of the Old England/New
England study group: one in Cornwall
and one in Scotland. Interestingly most
of those who attended from the English
side joined the breakaway group the
BSCF and went on to play a part in the
formation of the new organization,
which came to be known as the SCC.
The BSO cranial courses were run
under the benign dictatorship (his
own words) of Colin Dove, largely
because the SCTF preferred to deal
with one trusted individual. Separating
from the BSO was in part a desire
25
HISTORY & MEMORIAM
with more experience were not being
best met by the single five-day course.
The SCC proposed an introductory
course (Module 1 equivalent), and
this led to the development of the SCC
Pathway. Around 1996 Liz Hayden and
Sue Turner, together with others, wrote
an outline for the Pathway including
core points for each aspect (module)
of the Pathway teaching programme.
Each of Sutherland’s phenomena
was to be expanded into a separate
course to explore that phenomenon
in greater depth than was possible
in the basic course. After completing
the basic course students were able
to attend the other courses according
to individual needs at their own stage
in development and within a flexible
timescale.
An aspect that caused a lot of
discussion and some disagreement
amongst the early Trustees was that
of teacher training. In the past, SCTF
courses had taken on new tutors as
required. Those who had attended
several basic courses might be asked
to come next time as a tutor. However
when student numbers increased and
there was a shortage of tutors, people
were often thrown in at the deep end
with little experience and not much
support. Peter Cockhill remembers
being phoned up a few days before the
start of a course and asked to tutor, never
having attended before as anything but
I
a student. The new SCC, in particular
Joyce Vetterlain and Caroline Penn,
were keen to put a greater emphasis on
training the teaching Faculty. Eric Sotto,
an educationalist author of “When
Teaching Becomes Learning”, was
invited to teach the first Osteopathic
education course. This course gained
accreditation by the City and Guilds
as a “City and Guilds Level 1” and was
the forerunner of the current Ost. Ed.
The idea was to create an environment
for student-centred learning rather
than teacher-led learning, looking
from an evidence-based perspective
as to how students actually learn best.
This course changed the way the SCC
courses were presented in the future. It
was the first course in the country run
specifically for osteopathic teaching.
Together with teacher training
the assistant tutor scheme was
introduced as a means of both training
and supporting new tutors. Assistant
tutors acted as observers gradually
taking on a more active role over
at least two courses before being
accepted as full faculty members. In a
sense observation went both ways as
for the first time the more experienced
tutors were also being observed
and comparisons were being made
as to differing styles of tutoring and
monitoring. Feedback not only helped
the new tutors but also allowed other
faculty members to reflect on their
n 1997, I was back in my home country,
Germany, six years after graduating at the ESO.
Keen to make contact with German osteopaths,
I started in 1994 to teach a modest undergraduate
paediatric course. Students were mostly older,
and had previous training as physiotherapist,
heilpraktiker or medical doctor. (Heilpraktiker,
literally a “healing practitioner”; someone who has
demonstrated safe, competent medical knowledge
under German law.)
Alison Brown, who directed our first course in 1998
26
own methods.
Those early years were inevitably
a little chaotic and at times marred by
disagreements. The whole organisation
was run on a shoestring. A whole new
structure was being developed and
there were differing views as to some
of the detail. It took determination and
the vision of many to break away from
the familiar and start something new; it
then took time for things to settle down.
Eventually, under the Chairmanship
of Clive Hayden, a greater degree of
order was established and the basic
organisational structure we now know
as the SCCO began to run smoothly.
Early on it was suggested by a
good friend and advisor to the SCC,
Paddy Fitzgerald, that a good way of
putting the college on the map was
to run a prestigious event open to
all the profession. Thus the Rollin
Becker Memorial Lecture, a biennial
programme, was established. Over
the years many eminent speakers
associated with Dr. Becker or
influenced by him, including his
brother Dr. Alan Becker, were invited
to give the lecture. This year marks the
twenty first anniversary of the official
founding of the SCC of Osteopathy now
known as the SCCO. It is the privilege
of the Trustees that Martin Pascoe
has accepted their invitation to give
this year’s Rollin Becker Memorial
Lecture.
Seventeen years of the
SCCO IN GERMANY
The osteopathic courses were then
all designed as part time courses over
five years, to allow people to keep
working in their profession at the time
of training. Over the last fifteen years
however, several full time colleges, and
also one university level osteopathic
course have been established in
Germany.
During this time I had also started
to teach for the SCCO in GB. As I was
Eva Möckel
very impressed with the vigour
and enthusiasm of the first German
osteopaths, that small group that
graduated in 1995 and 1996, I asked on
their behalf whether they could come
and study with the SCCO in England
as, contrary to now, at that time there
was hardly any postgraduate training
in Germany.
Possibly because these students
had qualified at a part time college, the
HISTORY & MEMORIAM
four hundred osteopaths.
Especially since then, the demand
for courses is high.
Expansion is not always easy
The spirit of AT Still and Dr. Sutherland has been with us on many courses at the mill
trustees decided instead to offer an M1
course in Germany rather than having
students come over to GB. Alison
Brown undertook to be the course
director for the first seven years, and I
was her “sidekick”.
The first course took place in
Hamburg in 1998, with twenty one
students and Alison Brown, Nick
Handoll, Caroline Penn, Anette
Schreiber and me as faculty. Quite a
few of those students would soon also
be German faculty: Kilian Draeger,
Noori Mitha, Wiebke Butenschoen,
Axel Kutter and Guenter Steinfurt. The
students had very good anatomical
and theoretical knowledge, and
appreciated the precise feedback a 1:4
tutor to student ratio offered when
centring and palpating. The course was
deemed a success by students, faculty
and trustees alike. Word spread, and
so we started to put on a yearly M2
course in the countryside, in lovely
Proitzer Muehle, where most courses
‘Kaffee und Kuchen’ is one of the highlights of the good
food in Proitzer Muehle
have taken place so far.
More German tutors joined us over
the years: Marianne Mayer Logeman,
Katharina Hass Degg, Claudia Koop,
Jan Koop, Dennis Ehrlich, and
recently Peter Jacob Lamersdorf and
Edu Logeman. From England many
colleagues have come over, and we
are always pleased that they seem
to consider it a holiday as well, even
though the days at the courses are
often long. However, one of our early
course directors, Anette, implemented
a two-hour lunch break which nobody
wants to do without these days. Coffee
and Cake at 4 o’clock is also a German
tradition which is religiously observed.
This tried and tested venue has
recently been complemented by
another venue, Bernried, in South
Germany.
This recent expansion in Germany,
together with the general restructuring of the SCCO, had put a strain
on relationships between the growing
German faculty and the SCCO trustees
in England. Acknowledging these
difficulties, establishing dialogue with
the German faculty via a spokesperson
and the appointment of Katharina
Hass Degg as a trustee (representing
German faculty views), have all been
positive steps.
Our aim for SCCO courses in
Germany is to keep having the wellbalanced faculty, with 50% English,
and 50% German tutors, which has
worked really well in the past. Due
to the sudden increase in courses
however, we now need to train more
German faculty.
Times of expansion
Other dedicated course directors
followed, amongst them Anette
Schreiber, Sybil Grundberg, Tim Marris,
Kilian Draeger and David Douglas
Mort for the M2 courses, and others
for the different pathway courses; and
together with a wise and wonderful
faculty they have built up an excellent
reputation for our courses. By now, we
put on five courses a year.
We usually get very good feedback;
the German colleagues especially
appreciate the respectful and studentcentred teaching, and the close
supervision in the small tutor groups.
Over the last seventeen years the
SCCO has influenced osteopathy in
Germany very much in my opinion.
Many colleagues have been on our
courses that now teach
undergraduate
and/or
postgraduate.
Some
even
direct education at osteopathic
schools.
This
involvement
was
reflected by the invitation of
the VOD, one of the big German
Osteopathic associations, to a
large number of fellows of the
SCCO to come to the conference
in October 2014 “Sutherland’s
Vision”, which was attended by
We love the quiet, big class room in Proitze, which was
originally built as a dance hall
Sorting this out enables us to go
back to what we love—teaching—
and thereby helping others to get the
assistance and help we all received.
As one student said, when asked
what the SCCO means to her, “For me
a whole new world opened, outside of
technique and judgement… a whole
new huge world of sensing and letting
be… like this, exactly like this, I always
imagined Osteopathy to be like.”
June can be lovely, even in the North of Germany,
so students moved outside
27
HISTORY & MEMORIAM
DON WOODS, DO, FAAO, FCA
In Memoriam
Colin Dove writes to the
Cranial Academy of America
O
n your page 14 [Vol 68, Number 1, February 2015] in a small rectangle
there is the name Donald E. Woods DO, FAAO, FCA – In
Memoriam. Members in the USA might remember that he
was the son of Rachel Woods an early pioneer in OCF and not much
more although older members may remember him as President in
1972-3. To me however the name means far more as Don’s role in the
history of cranial osteopathy in Europe is seminal and it occurred to
me that readers in the USA might be interested in the story
In 1972 the Sutherland Cranial
teaching Foundation (SCTF) was inveigled into sending a faculty to the UK to
run a basic course in London. For the
SCTF to come to Europe was not unusual. Doctors Frymann and Schooley
had been visiting Paris on and off for
a decade and the odd UK graduate had
made the short trip across the
‘ditch’, otherwise known as the
English Channel to profit by it.
When I attended that course
in London I did so as Principal
of The British School of Osteopathy (BSO) and was expected
to return a verdict to the Board
of Directors that we need not
bother further with this ridiculous notion viz. cranial osteopathy.
The faculty was Viola Frymann, Tom
Schooley, John Harakal and Don Woods.
In 1973 I wrote to Don, not as Cranial Academy (CA) President, but in his
then capacity as a member of the AOA
council asking, as Principal, what plans
the osteopathic profession in the US
had for celebrating A. T. Still’s ‘unfurling of the banner’ in June 1874. Just by
chance I added a paragraph to the effect that I had been unable to follow up
my studies as I might have wished and
did not think ‘cranial’ had much chance
of progressing in the UK.
Don’s response was to invite me out
to the SCTF basic course in Colorado
Springs in June 1973, immediately followed by attendance at the (CA) conference and the AAO conference immediately following that. Further, Don
informed me that the SCTF were going
to give me a scholarship to pay my fees!
Don’t ask! I have spent years trying to
understand why!
To my great surprise the Board of
the BSO approved my going (purely as
an ambassador for UK osteopathy) and
an osteopathic charity paid my airfare.
On this trip I met Rollin Becker and the
rest, you might say, is history. I attended the course in Louisville, Kentucky.
Spain and Italy and well over 1,000 in
our own country. Some of our faculty
have also run workshops as far away as
South America, Russia and Canada as
indeed has your own Viola Frymann,
the remaining member of that original
quartet.
So you see when I see In Memoriam
Donald E. Woods DO FAAO FCA
November 2014 I remember a
quiet unassuming man whose
singular act in 1973 organising
my trip to Colorado Springs laid
the foundation for what is now
a significant teaching operation
involving osteopathic postgraduate study in a significant part
of Western Europe and Scandinavia. And I never did get to call in the
promise of a trip in his plane over the
beauties of Washington State. Thanks
to him I was always too busy!
“[Don] laid the foundation for
what is now a significant teaching
operation involving osteopathic
postgraduate study.”
28
in 1974 (and spoke at the CA conference afterwards) and directed a course
in London that September with Viola
and Tom again; this time supporting
our fledgling UK faculty. In 1976 I was
‘on trial’ on the SCTF faculty in Michigan and presented a paper at the CA
conference on the Occipito-Atlanto-Axial-C2 junction.1 I also taught later on
SCTF faculties in Fort Worth, Colorado
Springs and Philadelphia. For all of this
work you (the CA) awarded me Honorary Life Membership in 1987.
Our British faculty, working with
the BSO until the early 1980’s, subsequently founded the independent
Sutherland Cranial College (SCC),
now the Sutherland Cranial College
of Osteopathy (SCCO) which has just
celebrated twenty years of history. In
those forty years we have taught students from France (including some
whom you now celebrate as teachers),
Germany, Norway, Sweden, Finland,
Acknowledgement
This tribute to Don Wood’s generous
hearted and long sighted influence,
through which one man has enriched
so many in Europe and the UK –
practitioners and patients - was first
printed (May 2015) in The Cranial
Letter, the quarterly newsletter of the
Osteopathic Cranial Academy (USA).
It is reprinted here with the express
permission of the Osteopathic Cranial
Academy.
References
1.
The Occipito-Atlanto-Axial Complex
Manuelle Medizin (1982) 20:11-15
Springer Verlag.
HISTORY & MEMORIAM
I
grew up in the south west of Ireland and
so I had a very country childhood. My
brother and I roamed around 350 acres
of farm, and I think to grow up surrounded
by the natural world in a fairly natural
state is a nice thing for a child. To roam
around and climb trees and feel free lays a
good ground work to then appreciate the
natural world of the human body.
The tide was one thing that I was very aware of because
we lived on the banks of the River Shannon, on the estuary,
so there was a huge tide range and we always knew the state
of the tide. The rest of the time I’d be down in County Kerry
on an island, and again there was a big tidal range of the
Atlantic. It was essential to know the state of the tide, where
you put the boat if you wanted to take it to the mainland
and you didn’t want to be marooned. You always had to be
twitching around, changing location and moorings of boats
and all of that. That is just a little background as to why the
tide, tidal movement is natural and part of my makeup.
I never thought of a scientific vector for myself, I was
more inclined towards humanities. I studied languages at
university and was working in the periphery of the film
industry. I was making videos before there was even a
market for them...I came to that too soon!... anyway I was
bored with it. My wife, Flavia, went to an Osteopath for
treatment, and I suppose I must have been talking about
the fact that I was a bit fed up with my present
work. He said why don’t you do this, and
that was an ‘Aha’ moment. I don’t know
why, but I thought ‘I Will’. Already it
was late summer so I quickly rang
around to see what there was, and
of full time schools there were only
three: the BSO, the BCNO (as it was at
the time) and the ESO. The ESO was the
only one that would consider me at all,
what with my language qualifications and
little science (except I did have economics!). Tom
Dummer and Marjorie Bloomfield asked me to go down
for an interview, following which they said, ‘you can start in
October provided you take Chemistry and Biology A-level.’
So I did study them for a while, and then I quietly dropped it
and everyone forgot about it. I think their concern was, ‘can
you manage the science’? I found I could, so that was alright.
So I chose the ESO. They chose me and I chose them and it
was the right place at the right time.
I went to the ESO in 1976 and what sticks in my mind was
the rather disorganised nature of it, but it had the right spirit.
Although there was conflict between Tom Dummer and
John Wernham on a kind of ideological level which eventually
led to a split, the spirit of Osteopathy was very present, and
John Wernham was an embodiment of it, and Tom Dummer
was certainly an embodiment of it. There was no cranial
osteopathy being taught there at that time, nor apparently
did we even have access to it, because Osteopathy was
a disunited profession, with the three full-time colleges
registering their own graduates within their own
postgraduate organisations, each different. The BSO was the
only one which had brought the SCTF over to Britain and
access to their courses was restricted to their graduates only.
TIDE & STILLNESS
Peter Armitage
I came across Rollin Becker’s articles which were in the
AAO year books, the famous Diagnostic Touch: its Principles
and Application. It was a bit of a revelation to me, and I
recognised something essential there. I liked the sound of
it; I felt I’d like to explore that, I’d like to know how it goes.
There was also a copy of Magoun lying around and I got my
hands on that thinking, ‘somewhere in here is something
highly interesting that I want to explore.’ Around that time
my daughter injured her upper jaw and I thought that we
should find some cranial treatment. I ended up taking her
to Joyce Vetterlein, and that was interesting and somewhat
revelatory. So that is what interested me, but at the ESO
the Zeitgeist dictated that you had to articulate, to move
structures, to crack bones. John Wernham had a lot of
influence, and he denigrated cranial osteopaths by saying
that they were lazy and that they didn’t want to do the work.
So there was that to contend with. I was certain that this
was a way of working that I would enjoy. I think it was
Stuart Korth who also broke the mould a little bit
by coming and talking to our postgraduate
society, the Society of Osteopaths. After
that I went for a weekend where Stuart
was talking and demonstrating. He had
benefited from the very first cranial
courses put on at the BSO. So that gave
me an authentic taste, and I thought,
‘this is for me’.
I liked the idea of quiet hands, stillness,
let the body speak, all of that close listening
and so on. I decided that I would go and see the
man himself, (Rollin Becker) the author of these articles.
It’s fine to read about things, and maybe see them second
hand a little bit, but he inspired me through his writing, so I
thought that I’d go. Coincidentally I was going to the US for a
holiday, and had an offer of work in Arizona. I ended up living
there and going to see Rollin Becker in Dallas and I call this
baptism. It was to just observe, he wasn’t keen on letting you
get your hands on if you were a neophyte, he really wasn’t,
but you could sit in the corner! And I watched as a selection
of Texan good old boys (and girls) came in and giggled about
the visitor’s strange speech. He said to one of them, ‘at least
this guy can speak English, not like old Jacques, heh, heh, heh!’
(because Jacques Duval had visited some short time before).
They pronounced ‘Jacques’ like ‘shark’! It was like that, but
there were some very interesting cases and he did invite
me to put my hands on here and there. We sat and talked,
and he was very hospitable. I went to his house and handled
one of A. T. Still’s walking sticks, inherited from his father,
one of Still’s early associates at Kirksville. He took us on
a tour round Dallas and he showed me a particular fountain
which he loved. I grasped that it represented a moving still
point. You could see the surface of the water absolutely still
“I liked the idea of
quiet hands, stillness,
let the body speak, all of
that close listening and
so on.”
29
HISTORY & MEMORIAM
would go to the surgeon
“She had a lot to teach me about thinking
to see what could be done. We would
follow it through by talking about whether
clearly, and how the medicolegal
surgery was necessary or not. If it was, then it would
get done, and I would be seeing the patient up to that time. I
environment in America
would have talked to both the surgeon and the neurologist,
demands a certain rigour,
and yet and the patient would come back for rehabilitation. This
it poured is really how it should be. You see here, if someone comes
and I feel that has
over the edge to see us for treatment, and they don’t improve, they take
always been of
of this bowl. You the medical route and we probably will not be involved in
couldn’t quite tell that process. We may not even see them again. Over there,
benefit to me.”
where it was coming they would say, ‘let’s see if osteopathic manipulation can
in, because it was perfectly
mirror-like on the surface. It was
beautiful actually, a strange thing to find in the middle of a
Dallas commercial building, normally not beautiful to say the
least. That time spent with him acted on me primarily to say,
‘you’re on the right track, you should work like this’ and he
gave me to understand that I had understood it. So I thought,
if this is true why don’t I stay on it? And I think that is all you
need to know really: that, and occasional reality checks with
colleagues and peers, and I was able to find that in America.
I had contacts like that when I lived in Phoenix. I then
moved to Michigan and began to work within a more mixed
medical/osteopathic setting. The colleague that I worked
with was Alice Shanaver, who I met originally in London.
When I got to Michigan I got into the mainstream and was
able to meet and work with more people. Alice was a true
DO—her Father had been an Osteopath. She did 10% GP work
and 90% Osteopathy. In that environment in Michigan there
were many more Osteopaths around
and an Osteopathic Hospital nearby.
I was able to see patients there, and
was able to have contact with all
the specialists. It was a very rich
learning environment for me. Alice
would treat her patients who were
in hospital daily, and I sometimes
treated them if she wasn’t able to go.
The specialists did take me seriously.
Alice introduced me as someone who
was there doing ‘OMM’ (Osteopathic
Manipulative Medicine) but that I wasn’t qualified to practise
medicine. I was this weird misfit, but they didn’t think
anything of it, God bless them. So I could ring up and order
tests and I could talk to them about patients, and it was a
very open channel. I have often thought as to who inspired
me, and I would like to give a word to Alice, who took me on
as a physician’s assistant, and treated me entirely as friend
and colleague, as an equal, in a genuine co-operation. She
had a lot to teach me about thinking clearly, and how the
medicolegal environment in America demands a certain
rigour, and I feel that has always been of benefit to me. How
to write case notes, noting down something sensible, and not
woolly. Alice was an inspiration: a true hearted osteopath,
a good colleague, and a fantastic support. I feel those years
working with her were an absolute foundation for me. The
nice thing about the work was a seamlessness with patients
who came to us and those that needed hospital treatment.
For example, if someone had persistent pain in one hand,
they would go and see the neurologist, who would say that
there was an impingement of the Ulnar nerve, then they
improve this patients symptoms, and if it doesn’t, then let’s
see what the neurologist, the neurosurgeon, the orthopaedic
surgeon etc. might contribute’, always talking back and forth
to arrange things best for our patients. That is the kind of
thing that I was able to see and do. I had a nice colleague in
Detroit, who used to go and see the Cardiac Surgery patients
more or less immediately post surgery. She used to say,
‘well they often can’t breathe and poop and I can help them
to do both of those, and it is a huge help in their recovery
and rehabilitation’. I can tell you, for someone who has
undergone Cardiac Surgery, I could just about breathe, but I
couldn’t poop! If she could have come along and helped me
in the ICU and HDU, it would have been such a benefit.
We organised a study group around Detroit, and we
would invite some of the veteran DOs to come there and
give short courses. Bob Fulford came twice, Tom Schooley
once. We also visited older retired DOs, not famous names,
who nevertheless had had long careers as true ‘tenfingered’ osteopaths and had that
unmistakable flavour of rock-solid
competence and capability —very
like Anne Wales. Michigan State
University was nearby, where Fred
Mitchell Jr. was teaching and Viola
Frymann would come to teach the
undergraduates. I did table tutoring
there. Altogether, I lived in America
for eleven years, from 1981 to 1992.
Returning to England, I started to
work at the OCC, which was just up
and running in Cavendish Square. So it was out of one really
interesting working environment, into a completely different
one, which was solo practice plus a day a week at the OCC,
which I did for sixteen years. I was called a consultant, but
I think of it as a teaching clinician. There was a lot of on
the job learning, because in those early days every kind of
strange case could and would come through the door, and
their case notes got plonked on a pile, from which the first
free osteopath took the top file. It was a little chaotic, but
there was something very good and creative about it. It
was very challenging and you had to be quick about it: the
pressure of numbers was very great. I remember one time
we couldn’t get in because someone had forgotten the key.
We were standing around in the hall of Harcourt House, and
we decided that we had better start treating the children,
because the key wasn’t arriving. There was a queue forming
out into the street, push chairs and so on. I can’t imagine
what the other inhabitants of the building thought. There
was a lovely porter there called David and he loved helping
the children with severe difficulties in any way he could,
“... ‘well they often can’t
breathe and poop and I
can help them to do both
of those, and it is a huge
help in their recovery and
rehabilitation’”
30
HISTORY & MEMORIAM
and that morning he didn’t bat an eyelid. I think there is a
tremendous learning opportunity in being forced to step up
and meet a challenge, and it was very challenging to discover
oneself in charge of a room full of twelve treatment tables.
But in that situation you have to step up and get there, and I
do feel that benefited enormously. Part of the key to dealing
with it was stillness, and if I hadn’t known that there was
such a thing as stillness available ever present and full of
power I couldn’t have survived I don’t think. There were
others who worked there five days a week (Gaby Colangelo
and Suzy Booth) so I don’t particularly consider myself
heroic at all at one day a week. I went home and the rest of
the week was comparatively sane.
If I look back and think, ‘what was it that came out
of that?’, it was that stillness. I knew it already, I had
understood its role, but it certainly reinforced it and made
it into something that I find utterly reliable. It is a beautiful
part of our work, and I think it
is very inspiring when you are
able to show someone else that
it exists. You bring them to the
point where they can experience
it, and if they are able they will.
The sort of ‘Aha’ that occurs
when people grasp that... they
are transformative moments I
think. You don’t pass from being in one state, a novice, to
getting it all sorted because you’ve discovered this, no, but
you progress, and when you look back, you see that we go on
and on developing.
Perhaps I’m a one trick pony, I haven’t changed very
much. I think I found a way of working quite early that was
suited to me and I stuck with it. It is certainly Rollin Becker
that influenced me the most, there was something about
him and his work with patients, both written and in person,
as well as his teaching, which just chimed with me and I
found myself to be in tune with it. When I met Bob Fulford,
I thought that he was a wonderful man, and a very inspiring
teacher, but I didn’t go down his route. It is the same with
Jim Jealous: he is a great inspiration and a pioneer, digging
on, particularly discovering the significance of embryology.
Yet Biodynamics, I find I don’t use it as formulated, or get on
with it necessarily.
It has always been of interest to me that Rollin Becker
practiced originally in Michigan, in Pontiac, in the early
1940s. I ended up living nearby at one point. He was getting
good enough results using what we would call a more
structural approach, but he became dissatisfied. So he
went back to reading A. T. Still, and that was how he came
to practise what we think of as his approach. Later he met
Sutherland and began to work with him, but it was through
reading Still with close attention that he found his way of
working. One should bear in mind that Rollin’s father was
a close friend and associate of Still, so he grew up in that
milieu.
If you want to play an instrument you have to practice!
That’s all one can say! And it’s only through seeing patients
and having patience with yourself. The great thing about our
work is a lot of the healing effect is coming out of stillness,
and we don’t have to do a lot, very little is asked of us
actually. Less, is more. You get yourself out of the
way so that things can happen. It’s no
coincidence that Becker and Sutherland coined the phrase,
‘something happens’, because you can’t say anything about
it really: it is a mystery. At the centre of healing is a mystery.
I read a wonderful line in a novel recently: in the mouth of a
character was placed the thought that people talk nonsense
when they talk about mysteries, and then because they are
talking nonsense, other people assume that the mystery
itself is a nonsense! This is a great shame, and probably
the less we say the better! This is why I honour the phrase
‘something happens’ because its pretty good isn’t it? I have
never known a patient dissatisfied with that explanation
either. If they ask what goes on, ‘something happens’ is a
perfectly adequate way of putting it. And provided they
experience the ‘something happens’ as something good
and positive, and mostly thank heavens they do, they won’t
argue. Novice practitioners often burble out complicated
stuff to patients, and you think, ‘Oh, please!’ It is really
because they’ve internalised
some pressure that they have
to be either very fully explicit
or very scientific, but there is no
such pressure. You must divorce
yourself from that feeling. Stay
still and say little. Becker used
to sit there, and say not a lot for
a long time, and then he and his
patient would have a little conversation about nothing in
particular, and he virtually said nothing about the treatment
at all. We shouldn’t be ashamed of ‘something happens’. I
think we as a profession often internalise this pressure to
look respectable to the outside world, to please the medical
profession and our regulatory authorities, to not impede our
political progress, whatever that might be. God, does it make
us curb our speech!
Years ago I grasped what I was doing (in the way of
curbing my own speech). It was because of someone that I
met at a dinner party, a very intelligent man, who had played
a large part in getting Classic FM started. I had treated the
wife of the host giving the dinner party and she was saying
how well she was feeling, but I had appeared to do nothing.
Therefore, how did it work? What was going on? So I tried
to explain myself, and this man pricked up his ears, he was
interested and had an analytical mind. So when I had done all
my blah, blah, blah, he said to me, ‘there’s a hole in the middle
of that explanation’. When I went home I thought about it,
and I realised, ‘you’re right’. We won’t mention God will
we? We won’t. Well I’m going to because
I’m fed up with not mentioning it.
And I do think that the Health is
simply another name for this
thing that was missing in
the centre. If we see it
truly, that’s how we
should see it: as
transcendent ,
not ‘here’, not
of
this
world.
“but it was through reading
Still with close attention that
[Rollin Becker] found his way
of working ”
“...that
people
talk nonsense
when they talk
about mysteries, and
then because they are
talking nonsense, other
people assume that the
mystery itself is a nonsense!”
31
Courses & Conferences
THE THIRD AGE
A Biochemist’s Viewpoint
Ashley Robinson
T
he philosophy to which I subscribe goes something like this:
our bodies have the ability to regulate, maintain and repair
themselves. This capacity is not omnipotent nor is it unique to
humans, but is found in all living organisms. The concept also extends
into mental & emotional aspects. Dysfunction occurs when this selfcorrecting mechanism is impaired or obstructed. Restoration of health
occurs when these obstructions are removed or in some way lessened.
Osteopathy is a fine tool to achieve
this and not only finds and fixes
problems, but also provides positive
improvements in health and wellbeing. Despite this, at the recent Third
Age conference, there was plenty of
evidence that by itself, osteopathy is
not enough! How many times have you
beautifully balanced a patient and had
them return with the same problem?
Between these treatments something
has degraded or obstructed the body’s
ability to maintain itself. Much more
commonly than trauma, it has been
lifestyle factors that have caused
the degradation.
These
lifestyle
factors
include:
1. exercise and posture;
2. mental and emotional
environment; 3. food and
drink and the chemical
environment.
All of these factors need
to be addressed—the price of
health is constant vigilance!
Of the three categories,
the last one is the most
important because it is the
most ubiquitous. In the UK,
we eat on average three times
in a day, and drink more
frequently than that. The
quality of what we put into
our bodies is crucial.
32
What does quality mean in this
context?
The purpose of food is to provide
our bodies with needed fuel and other
factors. The three macronutrients
(carbohydrates, proteins and fats)
that provide the fuel should be in
the proportion appropriate to the
individual. Ideal proportions of
these three macronutrients may be
quite different from one person to
the next. Proportional variations
from 60-25-15% to 30-40-30% are
commonly found.1 The other factors
are the micronutrients, vitamins
and minerals. These are commonly
deficient in the modern diet due to
methods of producing and processing
food. Yet the body’s demand for these
micronutrients is higher because of
the chemical pollution load from the
environment.
Each second there are about ten
million chemical reactions taking
place in the body, all controlled by a
huge variety of enzymes. Enzymes are
proteins that take a particular shape
due to their chemical structure and it
is this shape that allows enzymes to do
their job (structure governs function).
The substrate follows the shape of
the enzyme, which promotes the
desired reaction, e.g. breaking apart
the substrate or joining two entities
together to create a new third entity.
Vitamins and minerals are cofactors
in these reactions, binding to the active
site on the enzyme and activating it.
Without the cofactors (and there
may be several for each enzyme) the
enzyme cannot function. Furthermore,
several vitamins in their active forms
function as carriers. For example, NAD
and NADP (derived from vitamin B3)
carry electrons.
From a clinical perspective, the
most important enzyme-controlled
reactions are those involved in energy
production; digestion and absorption;
detoxification
and
elimination;
hormone synthesis; inflammation
and immunity. I’d like to use energy
production as an example, not least
because everything else depends on it.
Dietary carbohydrate is broken
down, giving glucose. If that glucose
were burnt directly, it would release
its energy mainly in the form of heat
which would not permit life. So the
energy is released in small steps, each
step requiring enzymes and cofactors.
The first stage is called glycolysis (or
anaerobic respiration or fermentation).
This first stage itself comprised of 10
steps that can be summarised as the
breaking down of the 6-carbon glucose
molecule to produce two 3-carbon
fragments of pyruvate/pyruvic acid.
(It is pyruvate/pyruvic acid that give
onions their acrid character). The
energy released in this process is stored
in high-energy bonds in the form of
ATP (adenosine triphosphate). There
is also an important coenzyme, derived
from vitamin B3 (niacin).
This cofactor is NAD, which
picks up a hydrogen ion to
become NADH, which also
involves the creation of a
high energy bond.
In splitting one glucose
molecule into two pyruvate
molecules, 6 molecules
of ATP and 2 of NADH
are formed. Pyruvate is
then fed into the Krebs
cycle, also known as the
citric acid cycle, which
comprises 11 steps and
uses oxygen, producing
24 molecules of ATP and
8 of NADH. Therefore,
approximately 80% of
the energy released in the
degradation of glucose to
carbon dioxide and water
comes from the aerobic
phase. It is also important
to note that pyruvate
can be formed from fat
or protein. This goes a long way to
explaining why fat and protein have
an energy value approximately double
that of carbohydrate. From the crucial
viewpoint of energy production, a
balanced diet is one that provides these
three macronutrients in the proportions
needed by that individual. As noted
above, those proportions can be highly
variable from person to person. Most
patients claim to have a balanced diet,
although very few actually do. This is
through no fault of their own but as a
result of contemporary government
propaganda and exploitation by media
and advertising.
Many cofactors are used in energy
production, all of them either B
vitamins or minerals.
Magnesium
features heavily in both phases, but
especially in the anaerobic phase.
Nutrition courses often teach that
magnesium supplementation can
be extremely useful for ligament or
disc problems. Formulations aimed
at supporting these tissues always
contain magnesium. Since both these
tissues have relatively poor blood
supply, it is probable that they derive
proportionately more of their energy
from anaerobic respiration, which is
highly reliant on magnesium. Moreover,
in biped stance the psoas muscle is
used to stabilise the sacroiliac joint, a
function to which it is not ideally suited,
since it contains a high proportion of
fast-twitch fibres. (Incidentally, it’s
worth recalling that the origins of
psoas interdigitate with the crura of
the diaphragm, hence the importance
of the latter in low backache.)
Fast-twitch fibres derive their
energy from anaerobic respiration,
dependent upon magnesium. Psoas is
often found to be weak in humans, as
revealed by the pelvis sagging forward
ipsilaterally on a simple side-bending
test. A cheetah with weak psoas
muscles will not catch its prey! The diet
of yesteryear’s manual worker would
have featured bread and dripping and
fried bread (fried in lard). Surprisingly,
this was a more balanced diet in terms
of energy production than today’s
high carbohydrate/low-fat dietary fad,
because the fat would have produced
pyruvate, reducing the dependence on
carbohydrate and slowing down rapid
glycolysis.2
Magnesium is one of the cofactors
assisting the action of insulin on the
cell wall membrane, opening glut-4
channels to allow glucose to enter the
cell.
Magnesium levels in the soil are low
all over the UK. Ask any sheep or cattle
farmer. He will be giving his animals
salt licks rich in magnesium, quite
likely produced just across the field
from where I live and work. Without
this, the animals are prone to “the
staggers”3 (hypo-magnesium tetany in
ruminants leading to death and due
to seasonal variation in magnesium
content of their forage -Ed).
It can be seen that one nutrient
features in many different roles with a
common theme, an illustration of what
Dawkins calls the toolbox concept,
which is found repeatedly in body
chemistry.
The nervous system is a massive
consumer of energy. Something like
88% of resting basal metabolic rate
is consumed by the sodium pump
alone. NADH is used in both anaerobic
& aerobic phases of respiration,
but especially the latter. This would
explain why NADH supplementation
can be helpful for Parkinson’s disease
patients.
References
1.
2.
http://www.MetabolicTyping.info
The Law of Mass Action says that a buildup of the
end product of a reaction will tend to slow down that
reaction, producing an equilibrium
3.
https://en.wikipedia.org/wiki/Grass_tetany
33
COURSES & CONFERENCES
The Third Age and
EPIGENETICS
Ashley Robinson
T
he rate of growth in the understanding of
genetics has been phenomenal. Watson and
Crick discovered DNA in 1953 and just fifty
years later the human genome was revealed. Now
anyone can discover their own genomic make
up from a saliva sample.1 True, the raw data then
needs to be interpreted using a separate service,
but never has biological self-knowledge been so
readily available.
What is the point? So often we hear of people being told
that a problem is or might be genetic. The inference is that
this was the hand of cards you were dealt at conception
and you just have to make do and accept it, while you wait
for the creation of a wonder drug. But this is not the case.
With the appropriate knowledge, there is huge potential
for improvement in health and well-being. This is where
epigenetics has a part to play.
34
Epigenetics includes the effect of making positive
lifestyle changes to minimise the potential negative effects
of our genetic inheritance. It is often difficult to do this by
willpower alone when old unconscious patterns are running
the show. (Hence the value of Neuro-linguistic programming
—see appendix—or other means of revising ingrained
harmful thought patterns. - Ed)
Firstly, let us remind ourselves of the structure and
function of genes in multicellular organisms (RNA viruses
are similar but a little different). A gene is a sequence of DNA
encoding a bit of information. The information contained
in all the genes in a nucleus is what directs the creation of
an organism and its continued day-to-day existence. The
genes in the nucleus respond to chemical messages coming
from the cell membrane, the interface of the cell with its
environment.
A common misconception is that our genetic make-up is
a blueprint from which we are built. There is some truth in
it, for example, eye colour is represented in a gene. But it
would be more accurate to describe this genetic information
as a recipe, a series of instructions for processes, rather than
a blueprint. Also, several genes work together in even the
simplest process.
DNA is a pair of chains arranged as a double helix. The
basic structural unit of DNA is a nucleotide, which consists of
a molecule of sugar (deoxyribose) attached to a phosphate
group, which in turn is attached to the sugar part of the
nucleotide above or below. One of four nucleic acid bases
(adenine, thymine, guanine, cytosine) is attached to the
sugar. These bases are strongly attracted to the bases in the
other chain in totally predictable pairs, creating the coiled
spiral ladder effect. A sequence of three of these nucleotide
pairs makes a functional unit called a codon. There are sixty
four possible codon variants (4x4x4). A gene consists of a
lengthy chain of codons and a chromosome is a lengthy
chain of genes. There are approximately 30,000 gene pairs
distributed on our twenty three pairs of chromosomes.
Genes function by creating proteins. Usually in response
to chemical signals from the cell membrane, a small part of
a chromosome unwinds so that the nucleic acid bases are
separated & therefore become active. This sequence attracts
the appropriate opposite nucleic acid bases to create RNA,
which is then used as a template for manufacturing proteins.
Each triplet of nucleotide pairs that comprise a codon
(see above) is the template for a specific amino acid. So a
sequence of codons will contain the information for building
a sequence of amino acids, i.e. a protein. These proteins are
of variable lengths; e.g. Histone P4 (found in both animals &
plants) is a chain of 306 amino acids. Since there are twenty
two amino acids and sixty four codon variants, there’s a
good deal of repetition as one amino acid may be produced
by a number of different codons. This apparent redundancy
is extremely useful, as will be shown below. There are also
specific codons for beginning and ending protein chains.
Once produced, the electromagnetic forces in the protein
chains cause them to adopt a variety of shapes, some of
which are extremely complicated, as in enzymes.
The information stored in DNA is copied extremely
faithfully, but not perfectly. There are a number of correction
and DNA repair devices that have been evolved over time (it is
thought that the more sophisticated repair procedures were
a necessary prerequisite for the development of multicellular
organisms, explaining why single-cell
organisms, such as bacteria, were the
only life on the planet for something
like 75% of its history).2 Even so,
mutations occur in 1 in 100,000 cells.
Frequently the mutation does not
matter, if it is in a non-functional area
of DNA, but otherwise it does. Several
factors tend to create mutations,
including x-rays, ultraviolet light,
reactive oxygen species (free radicals)
and chemical mutagens. There are
different kinds of mutations, but the
simplest is when one nucleic acid
base is substituted for another. This
means the protein encoded may have
a different amino acid at that point in
the sequence. Sometimes the protein
may be truncated.
If the protein in question is an
enzyme, its function may be impaired.
A current hot topic is methylation;3
this is an enzyme-controlled process
whereby a methyl group (-CH3)
is added to a chemical compound,
changing its properties. Methylation is
used in several different biochemical
pathways, including neurotransmitter
synthesis and recycling, detoxification,
DNA repair and amino acid
transformation. As such it is an excellent example of what
Dawkins calls the “toolbox” concept.4 (The toolbox concept
simply means that, just as methylation has multiple and
apparently disparate applications [above] the tool, e.g.
determination/training, could be used to achieve apparently
disparate purposes: to become an athlete, a concert pianist,
a mountaineer or a chess champion. Ed)
There are a few genes that encode methylation enzymes,
but one of them (at location C677C->T)5 is affected by
mutation in about 50% of the world’s population. If a
person receives one such variant (called a single nucleotide
polymorphism6 or SNP) from one parent, his/her
methylation efficiency is reduced by 40%. If he receives an
SNP from both parents, the reduction is 70%. One glance at
the (incomplete) lists of functions above, hints at the clinical
havoc that could result.
One example of the above involves cardiovascular
disease. The amino acid cysteine is cyclically transformed
to methionine and back via methylation. Deficiencies in
this process can lead to a build-up of an intermediary called
homocysteine. This has damaging effects on arterial walls
leading to atherosclerosis, as discovered by Kilmer McCully
in 1970. He found that the vitamins B6, B12 & folic acid (all
methylation cofactors) corrected the problem.7 Forty-odd
years later, a group of researchers at Oxford8 found that the
same three B vitamins can halt Mild Cognitive Impairment
(MCI), a precursor to Alzheimer’s disease. Predictably, the
response from those controlling public health procedures
has been deafening silence.9
People with genetically deficient methylation pathways
may function efficiently enough when external factors are
relatively benign. But when times are tough, the weakness
is laid bare. An example may be
found in the onset of allergies, such
as hay fever. The case history often
reveals that the onset coincided with
emotionally stressful events. The
solution in these cases may involve
nutritional supplementation, such
as the appropriate B vitamins, to
support methylation or bioflavonoids
to quieten down the histamine
reaction, as well as appropriate cranial
treatment in relation to various
aspects of the patient’s needs. In the
long-term it may also involve going
back into the patient’s past to resolve
the old traumas using techniques like
NLP timeline therapy or Matrix Reimprinting. According to Dr. Bruce
Lipton this could also be called
epigenetics.10
References
1.
2.
3.
4.
5.
www.23andme.com
Mark Ridley - Mendel’s Daemon: Gene Justice & the
Complexity of Life
Michael McEvoy - http://metabolichealing.com/
Richard Dawkins - The Blind Watchmaker (2006)
http://holisticprimarycare.net/topics/topics-a-g/
functional-medicine/1353-mthfr-mutation-a-missingpiece-in-the-chronic-disease-puzzle
6.
http://ghr.nlm.nih.gov/handbook/genomicresearch/snp
7.
Vulnerable Plaque Formation from Obstruction of Vasa Vasorum by
Homocysteinylated and Oxidized Lipoprotein Aggregates Complexed with Microbial
Remnants and LDL Autoantibodies www.annclinlabsci.org
8.
Homocysteine-Lowering by B Vitamins Slows the Rate of Accelerated
Brain Atrophy in Mild Cognitive Impairment: A Randomized Controlled
Trial - http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.
pone.0012244;jsessionid=ED47C0DAF4BEA0C514AB66E7741DF221.ambra02
9.
http://www.express.co.uk/life-style/health/463873/Experts-recommending-statins-arepaid-by-drugs-firms / http://www.thincs.org/unpublished.php / http://www.nytimes.
com/1997/08/10/magazine/the-fall-and-rise-of-kilmer-mccully.html
10.
Dr Bruce Lipton, cell membrane researcher and Peace Award recipient, who
is also exploring the interface between biochemistry & belief, an example of
psychoneuroimmunology.
Appendix
NLP (Neurolinguistic programming) has many highly
effective techniques for optimising belief systems. One of
those, developed by Tad James, involves creating a physical
representation of your timeline and walking along it to encounter and resolve beliefs about one’s past or future. It can
create spectacular results, as in the case of sixty-a-day smoker who quit after experiencing insights into the near future.
Matrix Reimprinting http://www.matrixreimprinting.
com was developed by Karl Dawson in 2008 as an extension of EFT (Emotional Freedom Technique) http://www.
emofree.com/ It involves tapping on specific acupuncture
points while experiencing feelings in the body in order to
allow the feelings or emotions to be dissipated rather than
being suppressed. EFT tends to be used more with current
issues, while Matrix Reimprinting is a blend of EFT and NLP
Timeline which offers the potential to access events that
have shaped inner beliefs, usually acquired in early life, to
run their natural course or to be discharged, thus enabling
people to work on unconscious patterns that are dominating
their lives and health.
35
Conference Review
cellular to gross level enabled me to finally grasp the
true fluid and continuous nature of this structure,
and how, as we age, this situation changes. Back in
practice I have found I can more easily differentiate
this system and use my enhanced awareness to aid
my effectiveness, and not just in the elderly!
Anne Davies, a geriatrician from the Royal Free,
London, talked about the importance of the prevention
of falls, and gave a simple workshop to demonstrate
and teach Hallpike’s test and Epley’s manoeuvre.
Taught under Anne’s experienced guidance, this was
a simple procedure to learn, and we were encouraged
to take this back into practice. Again this was very
relevant to me as I had that week seen a gentleman, who has
been a patient of the practice for many years, suffering from
an acute episode of benign positional vertigo. My attempts
at supporting this situation had not met with success, and
he was left waiting three weeks for a specialist appointment
to have the Epley’s manoeuvre performed. Had I received
Anne’s expert guidance and encouragement prior to this, I
just might have been brave enough to have a go!
When I set up my practice twenty years ago, it never
occurred to me that the young patients who came to my
clinic would still be coming twenty years later, and also they
(and I) would be twenty years older and facing very different
health issues.
This conference provided a forum for discussion and
exploration with experienced and informed professionals on
a wide range of issues relating to the third age. It has given
me many new tools to take back into practice to help support
my older patients, and enable them to have as healthy a third
age as possible. This feels the least I can do after the support
they have shown me over the last twenty years!
Well done to Louise Hull and her team for putting
together such an interesting conference
THE THIRD AGE
Lesley Griggs
T
o my knowledge this was the first osteopathic
UK conference on this subject. One might be
forgiven for thinking that this was going to be
a “somewhat tame” event, in comparison to some
of the more “sexy/upbeat” paediatric and sporting
events on offer on the CPD circuits this year—how
wrong you would have been!
This conference had a fabulous line up of international
speakers, delivering fresh and osteopathically relevant
information regarding this (to my surprise) extraordinarily
interesting arena. Afternoon workshops provided an
opportunity to deepen understanding on specific topics.
To give you a taste of the weekend, I will outline two
events that inspired me and proved useful back in practice;
Frank Willard’s lecture and Anne Davies’ workshop.
I have heard Frank Willard—Professor of Anatomy at
the New England College of Osteopathic Medicine—talk on
several occasions, but never fail to be inspired by his depth of
knowledge, and the clarity with which he portrays this. Frank
walked us through a detailed anatomical presentation of the
body’s fascial structure. His depth of understanding from a
T
he SCCO tutor training
programme involves being
an Assistant Tutor on
three Module 2 courses AND
participating in three weekend
courses, each with various
themes, preparatory work and
reflective assignments.
The second weekend took place
in Bristol in July, facilitated by Alison
Brown and Dianna Harvey. This was
the first opportunity for all Assistant
Tutors to meet and learn together.
They represented all stages of the Tutor training programme: some are
waiting to assist on their first Module
2 while others will soon begin tutoring for the SCCO. “Learning from our
teaching” was the main theme. Friday
afternoon opened with a review of current priorities and challenges, followed
by a worksheet on avoiding and managing reactions.
36
Course Review
TUTOR TRAINING
PROGRAMME
Alison Brown
Everyone had prepared a ten minute mini lesson on any theme—except
osteopathy. Saturday began by discussing different types of comments
and what we want to know about our
teaching. Each person gave their lesson
to a group of six colleagues and a facilitator, and then received comments. It
is always nerve racking to teach your
peers, and ten minutes is not long, so
careful planning and adaptability are
needed. As ever, the group rose to the
challenge.
The themes and styles of mini lessons were varied and wide-ranging:
including perception after spying a
rainbow, dyslexia, keys to a successful
life and the bowline (or saving yourself
from drowning). Several participants
chose topics illustrating aspects of
Course Review
PAEDIATRIC OSTEOPATHIC DIPLOMA
Lucie Smith
A
t a time when it appears to be ‘open
season’ to criticise alternative therapies,
and influential groups become driven to
challenge accepted interventions delivered by
trained therapists, I find myself bursting with the
need to be extremely evangelical about the course
I recently started!
I initially trained as an osteopath (qualifying some eight
years ago from BCOM) and since then have been developing my skill set. Early this year, after four years following the
SCCO pathway, I became a Fellow of the Sutherland College
of Cranial Osteopathy. For me the natural extension of that
programme was to join the newly formulated course entitled ‘Paediatric Osteopathic Diploma’, POD for short.
I arrived at ‘The Abbey’ (Sutton Courtenay in Oxfordshire) to attend the first module (4th to 6th July), “Obstetrics and Safeguarding Children”. I was a little anxious but
full of anticipation to start the new learning experience. The
place was very quirky but lovely and welcoming. I was really
pleased to see many familiar faces, both students and tutors.
After a brief and succinct introduction by Hilary Percival
(one of the directing staff), we went straight into the first
subject of the morning session. And I was not disappointed…
The experience and knowledge shared by Claudia Knox and
Lynn Haller was exceptional. Their passion about the subject
radiated from them. The techniques demonstrated and then
carefully practiced in small groups with support tutors were
teaching which prompted discussion
on the development of perception and
learning, the presence and leadership
of a teacher, and the close parallels between our roles as osteopathic practitioners and teachers.
Comments were both thoughtful and empathetic; giving speakers
data to help them interpret accurately
what they were noticing. At the end,
the whole group discussed recurring
themes: questions, signposts, time
management, the interface between
teacher and students, the role of enthusiasm, and humour. We also talked
about managing nerves – an article by
Anne Wales on “Public Speaking for
Cranial Osteopathy” dating from the
1940s proving remarkably pertinent.
On Sunday, Dianna led a workshop
on the face with intraoral practical. A
review workshop on teaching patterns
followed, which led into a discussion
of the essentials of patterns, teaching
both effective and productive. There are not many courses
where you have one tutor for every four students. It was not
just the experience of the teachers which made it so great
but also the interactions between us eager ‘PODees’ as we
are endearingly called. Over the whole weekend the level of
knowledge passed on to us, the pace, the professionalism
and the care given to us was superb and invaluable. You cannot read the stuff I learnt on this module in any textbook. It
made me want to know more and I cannot wait ‘till September for my next fix!
Had I made the right decision twelve months ago when
I signed up for POD? Judging by the quality of the first module, YES most definitely!! There are five more modules to
attend, a lot of course work and reflective learning to do,
clinic hours to complete and a mini dissertation to write. Hilary Percival and Mark Wilson have worked very hard over
the last two years to ensure that this course is going to be
worth more than just yet another ‘box ticked’ for CPD. There
is more learning to do for them and their team too as this is
the first POD run by SCCO. But I feel confident and proud
to be part of this process, sort of PODee pioneer. Now, I’d
better go and write up my first case study…
strategies and a whole group discussion of questions arising from Module
2s. We concluded with an overview of
the assignment and a stillpoint.
The third and final weekend takes
place in January 2016 in Barcelona.
Photograph: Bernd Jagomast
37
Sutherland Cranial College
SHORT COURSES
Clare Ballard
O
ver the last few years the SCC has been gradually building up
its programme of short courses to complement the Pathway
and give an opportunity for Fellows-level graduates to
continue in developing their skills, to fulfil their CPD requirements
and to get together with colleagues and maintain the network of
ongoing support that we all need in our practice life.
We are aiming to put on at least
three Fellows-level courses a year. We
were delighted at the recent success
of the Third Age conference, and so
pleased to welcome Frank Willard
back after a few years as well as many
other eminent speakers. Many people
felt that it was an engaging and wellpitched conference with a good range
of speakers: osteopathic, medical and
complementary. We are beginning
to plan another conference for two
years’ time. The theme and date will be
announced in the next few months.
This September we welcomed back
Maxwell Fraval from Australia to lead
the Rule of the Artery course. The
course was fully booked and has been
so successful that we will be putting
it on regularly and are awaiting a
Part 2.
Next February we will be putting
on a weekend looking at the endocrine
and immune systems. Even though
these days can be taken separately we
are excited at the links between the
two days and hope that people will find
time to do them both. We feel that in
the light of concerns about antibiotic
resistance this is a particularly
timely course, and it is interesting
that the inspiration for Osteopathy
came initially from the treatment of
infectious diseases. This is a skill that
38
we have moved away from in the era of
effective antibiotics, but we have to be
open to changing times. We will also be
presenting a Part 2 of this course in the
Autumn looking at the more long term
chronic immune system issues that are
also a theme of our time.
Next summer we are welcoming
Renzo Molinari for the first time to
present a weekend on Osteopathy
in Pregnancy, Birth and Postpartum.
With his depth of experience and his
engaging style we feel that this will be a
wonderful addition to the programme
and will fit in well with the new
Paediatric Osteopathic Diploma (POD).
In November this year we will be
welcoming Martin Pascoe, Osteopath
and Dentist, to give the Rollin Becker
Memorial Lecture followed by a day
presenting material on the links
between Cranial Osteopathy and
Dentistry, a topic which many people
have been interested in over a long
period of time.
There are various other things in
the pipeline, including two weekends
on Embryology in Göttingen, Germany
with Guus van der Bie MD.
We are always looking for
interesting topics and speakers, so if
you have any particular requests please
let us know. We look forward to seeing
you on courses through the year.
Prof Renzo Molinari
Osteopathy in Pregnancy, Birth
& Post-Partum
SPECIALIST
COURSES
Full details of all the courses and special events listed below can be found on our website.
Please be aware that certain courses require a minimum qualification level to take part. Correct at time of going to press.
28 November 2015 - 5pm
Rollin Becker Memorial Lecture
Regent’s Conference Centre, London
Leader: Dr. Martin Pascoe
£70 (£60: Members/Fellows, £35: Undergraduates)
Dr. Martin Pascoe is a BSO graduate and one of the first Osteopaths from the UK to study Cranial Osteopathy in America.
He then taught the subject at the BSO from 1976. He has a great interest in facial mechanics, so decided the best way to study
them was to qualify as a dentist. He now is the only practitioner in the UK to combine the two professions.
28 November 2015 - 7pm
SPECIAL EVENT: SCCO 21st Birthday Party
Knapp Gallery, Regent’s Conference Centre, London
£40 (£20: Faculty)
This very special evening will include a hot buffet, birthday cake, music and dancing, to celebrate our
21st Birthday at the venue’s beautiful Knapp Gallery.
29 November 2015 - 1 Day
Osteopathy & Dentistry Workshop
British College of Osteopathic Medicine, London
£120 (£95: Members/Fellows)
This will be a fantastic opportunity to take part in a workshop led by the uniquely qualified Dr. Martin Pascoe.
Leader: Martin Pascoe
G
FILLISNT
FA
Special ‘Mini’ Module 2 (in partnership with ESO)
12 February 2016 - 3 Days
ESO Campus, Maidstone
£490
This non-residential course is designed for ESO graduates as an overview of the whole cranial concept, covering all the key areas.
Each topic is then developed in more detail in the other courses on the pathway.
Leaders: Sue Turner & Dianna Harvey
Hormones, Health & Homeostasis (Advanced level)
27 February 2016 - 2 Days
W12 Conference Centre, Hammersmith Hospital
£330 (£290: Fellows/Members)
Leaders: Pamela Vaill-Carter & Jane Easty [Day 1]
Leaders: Kok Weng & Taj Deeora [Day 2]
Fellows level Course Director: Clare Ballard
Focussing on hormones, health and homeostasis on the first day and immunity on the second, this special, advanced-level
weekend will be an exciting look at balance in the endocrine system throughout all the stages of life, including women’s
health. The course will also examine the development and function of the immune system with practical applications,
including revisiting the lymphatic siphons.
This weekend course can be booked as separate days for £165 (£145: Fell/Mem) per day.
Osteopathy in Pregnancy, Birth & Post-Partum
G
FILLISNT
FA
9 July 2016 - 2 Days
Wokefield Park, Nr. Reading
£390 (£340: Fellows/Members)
This course is being given by the eminent Professor Renzo Molinari who will be presenting a two-day gynaecology course on
the full process of child birth, from pregnancy through to birth and post-partum.
Leader: Professor Renzo Molinari
8 September 2016 - 4 Days
Faculty Development Weekend
Ses, Salines, Majorca
£299 / €398
Our once-a-year opportunity to mingle with other Faculty and Fellows, and get to know the SCCO better, this time will be at
the Hotel C’an Bonico in Ses Salines, a quiet seaside town in an unspoilt area of the island. (Flights and transport not included)
Paediatric Emergency First Aid & Trauma Care
15 October 2016 - 2 Days
Wokefield Park, Reading
£440 (£390: Paediatric Students/Fellows/Members)
This special weekend will focus on paediatric emergency first aid and paediatric trauma care, with specialist emergency
medical tutors and with SCCO Fellow Michael Harris.
Leaders: Hilary Percival & Mark Wilson
To book any of the above courses please visit: www.scco.ac or call our office +44(0)1453 767607
39
COURSE CALENDAR
2015-16
NOVEMBER 2015
FEBRUARY 2016
JUNE 2016
SCCO Pathway Module 10
Integrating Cranial into Practice
The Functional Face
Balanced Ligamentous Tension
An ideal “next step”after Module 2
7 November 2015
1 day
Location: London
CPD: 8 hrs
£165
Leader: Michael Harris
5 February 2016
Hawkwood, Stroud
£945
Leader: Louise Hull
in partnership with the ESO
Neurocranium & Sacrum: Living Bone
12 February 2016
3 days
ESO, Maidstone
CPD: 20 hrs
£490
Leaders: Dianna Harvey & Sue Turner
13 June 2016
Proitzer Mühler, Schnega
£1470/€1850
Leader: David Douglas-Mort
Hormones, Health &
Homeostasis
Advanced Level Weekend
25 June 2016
(venue/location tbc)
£275
Leader: Penny Price
20 November 2015
Hawkwood, Stroud
£945
Leader: Jane Easty
3 days
CPD: 24 hrs
Foundation Course
21 November 2015
Clitheroe
£275
Leader: Penny Price
2 days
CPD: 16 hrs
Rollin Becker
Memorial Lecture
28 November 2015
5pm
Regent’s Park, London
CPD: 2hrs
£70 (see page 39 for discounts)
SCCO 21st BIRTHDAY PARTY
28 November 2015
7pm
Regent’s Park, London
£20 Faculty | £40 Fellows/Members/Guests
Osteopathic & Dentistry
Workshop
29 November 2015
1 day
BCOM, London
CPD: 8 hrs
£120 | £95 SCCO Members & Fellows
JANUARY 2016
Module 2/2+ (Germany)
18 January 2016
5 days
Bildungshaus, Bernried
£1470/€1850
Leader: Marianne Mayer-Logeman
Foundation Course
30 January 2016
Crista Galli, London
£275
Leader: Penny Price
2 days
CPD: 16 hrs
3 days
CPD: 24 hrs
Module 2 (mini)
5 days
Foundation Course
This weekend course can be booked as separate
days for £165 (£145 Fellows/Members) per day.
Organs & Systems
30 June 2016
Hawkwood, Stroud
£1250
Leader: Lynn Haller
4 days
CPD: 32 hrs
Osteopathy in Pregnancy
Birth & Post-Partum
5 days
CPD: 40 hrs
APRIL 2016
9 July 2016
2 days
Wokefield Park, Reading CPD: 16hrs
£390 | £340 Fellows/Members
Leader: Renzo Molinari
HOW TO BOOK
Foundation Course
2 days
CPD: 16 hrs
Full details of all courses can be
found and booked on our website:
www.scco.ac
For telephone bookings and email
bookings, please contact:
Module 7 (Germany)
Spark in the Motor
11 April 2016
Proitzer Mühler, Schnega
£1050/€1350
Leader: Rowan Douglas-Mort
2 days
CPD: 16 hrs
JULY 2016
MARCH 2016
9 April 2016
Venue (tbc), London
£275
Leader: Penny Price
4½ days
CPD: 34 hrs
Module 2/2+ (Germany)
27 February 2016
2 days
W12 Centre, London
CPD: 16 hrs
£330 | £290 Fellows/Members
Leaders - Day 1 : Pamela Vaill-Carter &
Jane Easty
Leaders - Day 2 : Kok Weng &
Taj Deeora
Fellows-level Course Director :
Clare Ballard
7 March 2016
Columbia Hotel, London
£950
Leader: Carl Surridge
9 June 2016
Hawkwood, Stroud
£1230
Leader: Sue Turner
3 days
Britain:
[email protected]
01453 767607
Germany: [email protected]
Please be aware that certain courses
require a minimum qualification level.
Information correct at time of going to press.
Sutherland Cranial College of Osteopathy · Hawkwood · Painswick Old Road · Stroud · Gloucestershire · GL6 7QW

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