TOM DUMMER - Sutherland Cranial College

Transcription

SUMMER 2014 | No. 37
MAGAZINE
REMEMBERING
TOM DUMMER
JOHN LEWIS * EDITOR
MAGAZINE
SUSAN FARWELL * CHAIR
MAGAZINE
EDITOR
John Lewis
W
PUBLISHED BY
Sutherland Cranial College of Osteopathy
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Stroud GL15 7QW
BOARD OF TRUSTEES
Susan Farwell (Chair)
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Mark Wilson
Pamela Vaill Carter
Louise Jamieson-Hull
Warwick Downes
CEO
Sally Pettipher
ADMIN
Cindy Martin
CONTACT
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reviews, experiences, questions, inspirations.
All material copyright © 2014
Sutherland Cranial College of Osteopathy.
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2
Sutherland Cranial College of Osteopathy MAGAZINE
hen William Garner Sutherland was asked if the cranial
concept was a religious one he answered, ‘If the recognition
by Dr. Andrew Taylor Still of God as creator of the human body is
religious then the science of osteopathy, in concept, is religious.
The science of osteopathy is a specialty and those who practice
that specialty are osteopaths. The cranial concept itself is not a
specialty. It is osteopathy and the credit belongs to Dr. Still.’
I’m sure that Still would have chosen the word spiritual instead
of religious. Osteopathy was founded upon the common-sense
observation that where there is life there is a tendency towards
order and health, and this to him was a spiritual truth, one that
informed all his thinking about the human body. This was his key
insight of 22 June 1874, the ‘discovery’ of osteopathy, when he
abandoned scientific materialism and adopted a spiritually-based
philosophy – that of ‘matter mind and motion’ – as more suitable
for the living being.
The 140th anniversary of his momentous discovery lies on
Sunday, 22 June 2014, and to celebrate the occasion the SCCO is
hosting a one-day conference at the Regents Conference Centre
in London entitled, ‘A. T. Still: Osteopathy into the Future.’ (See
pages 26-27.)
The revered figures in the history of the osteopathic profession
– Rollin Becker, Robert Fulford, James Jealous, and others – have
always been those to explore not only the scientific but also the
mental and spiritual aspects of Still’s philosophy of matter, mind
and motion. Another, but less well-known, person, highlighted
in this issue is ESO co-founder Tom Dummer, whose osteopathic
approach incorporated the practice of Tibetan Buddhism. Jenny
Lalau-Keraly presents eight fascinating interviews with some of his
close students.
In other articles, Sibyl Grundberg interprets the latest research
on cerebrospinal fluid in the light of Sutherland’s concept, and
Gunn Kvivik explains the powerful influence of breastfeeding
on the development of the infant cranium (nature, as Dr. Still
taught, does nothing in vain, and breastfeeding is no exception).
Continuing the stomatognathic theme, Charles McLaughlin
explains that the intricacies of vocal expression and the freeing
of our natural voice rely upon another osteopathic concept, that
of the removal of obstructions, physical, mental and emotional.
Finally, Tim Marris offers practical advice on the use of perception
and how we use our mind can have a potent effect on the
effectiveness of treatment.
A big thank you to all who have contributed.
Sutherland
Cranial College
of Osteopathy
Seeking the
whole squirrel
Summer 2014
L
ast week I was electrified to hear an orthodontist tell
me, ‘It’s amazing. There’s no need for heavy appliances.
If you get it right the patient’s body does the work for
you.’ It was encouraging to hear someone outside our
profession expressing the same view as us and made me
dream of the day when Sutherland’s profound insight that
we should work to ‘find the health’ rather than struggle
against pain and unwellness will be the usual way of
doing things. It also reminded me of the immense value
of the osteopathic approach and how important it is that
our work should be better known. We are very grateful
to SCCO Magazine editor John Lewis for putting so much
work into providing us with a forum where ideas can
be shared and results reported. May I ask you to use the
Magazine to communicate with patients and anyone else
interested? It’s easy to give copies away.
Following the college relaunch last year we continue
through the process of organisational change. The SCCO
still holds the same values as the old SCC, but we are
striving to improve our accessibility and capacity to be
effective. As ever our mission is, ‘To promote, teach and
develop the principles of osteopathy as conceived by
Andrew Taylor Still and developed by William Garner
Sutherland.’
We are now a College of Fellows, Members, Associate
Members and Friends. If you are not sure about how this
affects you, please check with us. You can book courses or
find out what’s happening either by looking at our website
or phoning Cindy Martin in the SCCO office. We cater
for both technophiles and technophobes. The website
now has a new German section, too, a step towards the
SCCO functioning as an international college, and also a
revamped online calendar.
We welcome our new CEO, Sally Pettipher, who has 25
years experience of administering charities and excellent
answers for the tough questions we throw at her. Sally has
plunged herself into the work of supporting us through our
make-over and is just the person we need.
The SCCO has a large and committed Education
Committee working hard to ensure the SCCO offers
something for everyone, whether Friend, Member or
Fellow. I would like to thank and commend its diligent
Chairman, Louise Jamieson-Hull.
Next spring we launch the new Paediatric Osteopathy
Diploma (POD), whose planning team is Hilary
Percival, Sue Turner, Lynn Haller and Mark Wilson. This
comprehensive two-year course that will include Module
9: Paediatrics, six weekend courses and twenty practice
visits. Students will undertake case studies, two reports
and a dissertation. Next summer we will present and
innovative Third Age Conference at the Columbia Hotel
in London – a three day event exploring osteopathic
treatment of those advancing in years.
As with any house move or building work there are
always glitches like ‘where’s the tin-opener got to?’ If you
become aware of any such SCCO holes or glitches, please
let me know.
Contents
Summer 2014 | No. 37
4
BREASTFEEDING
Gunn Kvivik and Line Côte
12 TOM DUMMER
An isnspirational teacher
Former students interviewed:
13 Robert Lever
15 Gez Lamb
16 Susan Turner
18 Peter Cockhill
19 Clare Ballard
21 Lynn Haller
22 Jeremy Gilbey
24 James Sumerfield
26 A T STILL CONFERENCE
28 SINGING
Charles McLaughlin
30 CEREBROSPINAL FLUID
Sibyl Grundberg
33 PERCEPTION
Tim Marris
34 SCCO NEWS
Summer 2014
3
breastfeeding
Nature’s tool to unfold
the infant cranium
Gunn Kvivik and Line Côte
T
he moulding of the foetal skull,” Harold Magoun,
Sr. wrote in Osteopathy in the Cranial Field, “should
correct itself . . . through suckling, which flexes
the sphenobasilar via the vomer and normalizes
the pull of the intracranial membranes.”
Throughout human history the natural and instinctive
way to feed babies has been via the breast. Bottle feeding
was uncommon until the beginning of the twentieth
century, and from 1950 onwards research comparing breast
and bottle feeding confirms that breastfeeding is the better
alternative physically, chemically and psychologically.
Our interest in the physiology of breastfeeding began
after we read a research paper that concluded that breastfed
children have fewer occlusion problems as well as a
better developed facial skeleton,
implying that breastfeeding has
a mechanical influence on the
cranium. This inspired the subject
of our (Gunn Kvivik and Line
Cote) osteopathic school D.O.
theses.
Breastfeeding involves more
complex muscular activity than
bottle-feeding. It activates the
muscles of the tongue, lips, and
face in synergy with velar and
pharyngeal muscles including the
muscles inserting on the styloid
process of the temporal and on
the hyoid bone. The superior
pharyngeal constrictor is the key
muscle which coordinates all
orofacial functions because of its
attachments on the cranial base
and diverse extensions.
Sucking on the breast requires
an intraoral vacuum to extract
milk as opposed to bottlefeeding where only a slight subatmospheric pressure is sufficient
to make the milk flow out of the bottle. The vacuum required
during breastfeeding stimulates depression of the hard
palate. Increased mandibular depression/protraction and
labial protrusion/occlusion is observed, causing elongation
of the facial muscles.
Our objective was to compare the influence on cranial
development of the muscular activity associated with
breastfeeding with that of bottle-feeding. To test our
hypothesis that that complex muscular activity during
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Summer 2014
breastfeeding influences the development of the cranium
and reduces restrictions in the cranial sutures, we randomly
selected sixty infants and examined them postpartum and
at three months to evaluate dysfunctions of craniofacial
sutures, sphenobasilar symphysis (SBS), and pre-osseous
elements of the occiput. We measured bizygomatic and
biorbital distances with calipers.
RESULTS (comparing postpartum to three months later):
• The breastfed group showed a 70% reduction in
membranous and osseous lesions of facial sutures.
• Where there was compression of the SBS and/or occipital
base, we observed an increase of sutural dysfunctions
in the posterior sphere. The
compression
remained
(we
only observed restoration of
membranous SBS lesions when
the occipital base was not
compressed and we observed
an increase in lesions of the
occiptiomastoid and lambdoidal
sutures. (It seemed to us like the
occiput was seeking symmetry
so, for example, if the right side
was blocked after birth, the left
side was also blocked after three
months.)
• In the breastfed infants we
observed in 15.8% a restoration of
membranous dysfunction of SBS.
These Infants had no compression
of occipital base, nor several
osseous dysfunctions of the vault.
• 18% of breastfed and 50% of
bottle-fed infants exhibited SBS
dysfunctions that transferred into
other dysfunctions (too diverse
to explain simply), preventing
statistical analysis.
• Subtracting biorbital distance from bizygomatic distance,
in breastfed infants the distance increased from 0.3 cm to
0.35 cm (16.7%). In the bottle fed infants it decreased from
0.3 cm to 0.04 cm (– 86.6%).
We concluded that our hypothesis – namely that
breastfeeding influences the development of the cranium
and reduces restrictions in the cranial sutures – was
confirmed in the anterior part of the infant cranium, where
breastfed infants showed increased growth of zygomatic
bones as well as significantly reduced dysfunctions of facial
sutures. We believe that the superior pharyngeal constrictor
muscle, which coordinates orofacial functions, plays a key
role in the angulation of the cranial base during the first
year of life.
RESEARCH ON THE BENEFITS OF BREASTFEEDING
The first orofacial motion of the foetus begins around
the tenth week with sucking on its fingers. The transition
from safe intrauterine life to the start of unprotected and
independent life is facilitated by bonding between the
mother and child through physical contact and oxytocin
produced during breastfeeding.
Breastfeeding is an essential stimulus for the three
primary senses linked to the reptilian brain: physical
contact between mother and child stimulates development
of the tactile sense, while taste and smell are present
around the twelfth intrauterine week. Recognizing the taste
and smell from intrauterine life gives the new-born a feeling
of attachment, and the mother’s varying nutrition, initially
via the amniotic fluid and then the breast milk, is of great
importance for the development of these senses.
Protein, vitamins and polyunsaturated fatty acids (DHA)
from breast milk are important for the development of the
cortex. Research shows that breastfed children have higher
IQs than their bottle fed counterparts (and the difference
is higher when breastfed for more than eight months).
They also have greater neural maturation, better cognitive
development, and earlier physical development in the first
two years of life.
Fat and caloric content of breast milk increase with
duration of lactation. Studies show that breastfed children
have increased growth, stronger immune systems with
increased antibodies and immune factors (that rise in the
second year), and improved health with reduced risk of
meningitis, asthma, otitis, respiratory infections, childhood
type 1 diabetes, allergies and childhood leukaemia. Children
breastfed for 90 days or more exhibit greater antibody
response after vaccination.
Breastfeeding influences metabolism. Mothers who
breastfeed expend an average of 480 kcal more per day,
with the long term benefits of a reduced risk of obesity,
cardiovascular disease, breast and ovarian cancer, and
diabetes.
Research on the mechanical impact of nursing shows that
breastfed children have a better developed facial skeleton
compared to bottle fed with a higher bizygomatic compared
to biorbital distance. Risk of malocclusion is 1.84 times
lower when breastfed, and is reduced with longer duration
of breastfeeding. Breastfed children have better alignment
of the teeth with a U-shaped dental arch and a lower palate
compared to bottle fed. 72% of occlusion problems occur
in the anteroposterior plane where 22.5 % had overjet
problems when bottle fed compared to 3% when breastfed.
The risk of developing posterior crossbite was 5 times
lower when breastfed from 6 to 12 months and 20 times
lower when breastfed more than 12 months. Children
breastfed less than 9 months or use a dummy/pacifier for
between 1 and 4 years have a greater risk factor for posterior
crossbite and anterior open bite.
The inferior and superior dental arches are in contact with
the tongue.
Phase 1: Depression of the mandible
Sucking requires a vacuum caused by closure of the
pharyngeal sphincters and gripping of the lips around
the areola produced by contraction of orbicularis oris,
buccinator, and the superior pharyngeal constrictor muscles.
The velopharyngeal sphincter closes the nasopharyngeal
passage to press the soft palate (velum) against the posterior
pharyngeal wall, and the pharyngolingual sphincter closes
the passage between the root of the tongue and velum.
Mandibular depression and protraction increase intraoral
volume, while intraoral pressure drops from 760mm Hg
(atmospheric pressure) to 60mm Hg as milk is transferred
from mother to baby.
Phase 2: Elevation of the mandible
Pressure reduces to slightly below atmospheric as the mandible
elevates and retracts. The central part of the tongue cups to
collect the milk before executing a peristaltic anteroposterior
movement to squeeze out the remaining milk. The infant
continues sucking until there is enough milk in the oral cavity
to trigger the swallow reflex, normally between inspiration and
expiration. The infant is forced to breathe through the nose,
because opening the mouth makes it lose both the nipple and
the vacuum.
PHYSIOLOGY OF SUCKING AND SWALLOWING
Sucking during bottle feeding
Sucking during breastfeeding
During breastfeeding the apex of the tongue is thrust
forward to press against the nipple and part of the areola.
By contrast, during bottle feeding complete closure of
the sphincters and an airtight space around the teat is
unnecessary because less vacuum is needed, and less activity
Summer 2014
5
and coordination of the velopharyngeal facial muscles is
required. Mandibular movements are reduced since, instead of
a peristaltic movement, the tongue works more like a piston
to control the flow of milk. Nose breathing is not necessary
because the child can open its mouth without losing the nipple.
The following pictures show (first) depression and (second)
elevation of the mandible during bottle feeding.
pharyngeal wall to prevent milk passing into the nasal cavity.
Along with the peristaltic movement of the pharynx, the
pharynx, larynx and hyoid rise to close the epiglottis from below
to prevent milk entering the trachea. Respiration is interrupted
during swallowing.
The follwing diagrams show the peristaltic movement of the
tongue while swallowing during breastfeeding.
VELOPHARYNGEAL FACIAL MUSCLE LOOPS
Superior pharyngeal constrictor muscle and its extensions
The superior pharyngeal constrictor muscle is the key muscle of the muscle loops and coordinates all orofacial functions. During
sucking it performs a transverse and anteroposterior contraction in synergy with buccinator and orbicualris oris, and also supports
the function of the pharyngeal sphincters and all the muscular loops. During swallowing the superior pharyngeal constrictor
elevates the larynx and pharynx.
Posteriorly the superior pharyngeal constrictor forms a median pharyngeal raphe which attaches to the pharyngeal tubercle on
the basiocciput; anteriorly it attaches to the medial pterygoid process and hamulus of the sphenoid, and the alveolar process of the
mandible.
stylopharyngeus
m.
superior
pharyngeal
constrictor m.
medial
pharyngeal
constrictor m.
inferior pharyngeal
constrictor m.
palatopharyngeus
m.
glossopharyngeal part
orbicularis oris
m.
buccinator
m.
hyoglossus
m.
The muscle loops
Swallowing during breastfeeding
Swallowing during bottle-feeding
Swallowing is initiated by a strong contraction of orbicularis
oris and buccinator muscles, while contact with the areola is
maintained. The root of the tongue lowers to open the passage
to the pharynx, and the velum presses against the posterolateral
With bottle feeding there is reduced protrusion of the lips
and protraction of the mandible. The tongue is situated more
posteriorly, with less muscular activity and reduced anterior to
posterior propulsion of the bolus of milk.
Nature intended that the newborn infant should balloon out the compressed brain case with the deep
inhalation of crying as well as the pressure of the sucking tongue against the sphenobasilar symphysis by
way of the vomer. A cotted finger may be used to advantage in directing this force either to the anterior
end of the intermaxillary suture to flex the sphenobasilar symphysis or at the cruciate suture to extend it.
In addition, breast feeding is a priceless asset. The bottle-fed baby is usually laid flat on its back to nurse,
thus locking the position of the occiput and sacrum and so the whole craniosacral mechanism. With
a generous hole in the nipple the baby does little work and hence effects little release of the cranial
sutures. The groundwork is thus laid for a contracted and nonmotile nasopharyngeal area with all the
sequellae of allergies, sinusitis and asthma.
Contrast this with breast feeding as nature intended. The babe is held in the mother’s arms, first on one
side and then the other, allowing full freedom of action to release the mechanism. In this connection
we are told that calves born in subzero weather will survive if the can be gotten to their feet to nurse at
the cow’s udder and so activate the normal craniosacral physiology. However if this is not the case and
they are bottle fed, the muzzle freezes and death ensues from pneumonia because of air which is not
warmed and moistened.
Harold Ives Magoun, Osteopathy in the Cranial Field, 3rd Ed., p. 240-241.
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Summer 2014
The extensions of the constrictor muscle form the muscle loops that are active during all orofacial functions. The short loop is a
part of velopharyngeal sphincter and consists of the superior pharyngeal constrictor and palatopharyngeus with its two extensions,
salpingopharygeus and pterygopalatine muscles. The middle loop forms the pharyngolingual sphincter and consists of two parts:
Upper part: superior pharyngeal constrictor and glossopharyngeus.
Lower part: medial pharyngeal constrictor and hyoglossus.
Synchronisation of the short and middle loops is effected by palatoglossus.
The lower part is more active during infant sucking, closing the passage between the root of the tongue and velum to create a
vacuum. Hyoglossus pulls the tongue posterolaterally, assisted by palatoglossus lowering the velum.
The upper part works primarily during swallowing, raising the tongue in synchronisation with the styloid muscles that pull the
hyoid posterosuperiorly.
With dentition the swallowing mechanism changes as the child starts swallowing with teeth occluded. The lower part is
strengthened by mylohyoid, which connects the mandible with the pharynx and the tongue, enabling hyoglossus to pull the hyoid
anteorsuperiorly.
The long loop, consisting of superior pharyngeal constrictor, buccinator and orbicularis oris, is constantly active during sucking
to maintain contact with the breast.
The vertical loop is part of the velopharyngeal sphincter and consists of levator and tensor veli palatini muscles. Tensor veli
palatini tightens the soft palate. Through its insertions
on the auditory tube, in concert with levator veli palatini
Key muscle
and salphingopharyngeus it ventilates the middle ear
during sucking and swallowing.
superior pharyngeal constrictor
m.
The velopharyngeal sphincter is formed by the
Vertical loop
muscles of the short and vertical loops. It closes the
passage between the nasal cavity and oropharynx
tensor/levator veli palatini mm.
during sucking, swallowing, respiration, mastication
Short loop
and phonation.
Levator veli palatini extends from the petrous part
of the temporal bone and the auditory tube to velum,
which it pulls superoposteriorly. Palatopharyngeus
extends from the lateral pharyngeal wall to velum,
which it pulls inferolaterally to create the vacuum
during sucking.
During swallowing palatopharyngeus pulls pharynx
superolaterally to prevent milk from intruding into
the nasal cavity.
palatopharyngeus m.
Middle loop
a. glossopharyngeal part
b. med. pharyng. constr./hyoglossus mm.
Long loop
buccinator/orbicularis oris mm.
Summer 2014
7
INFLUENCE OF BREASTFEEDING
ON CRANIOFACIAL DEVELOPMENT
Ossification
The velopharyngeal muscles attach primarily to bones
with mixed cartilaginous/membranous ossification. The
growth of cranial bones of membranous origin depend on
extraosseous stimuli. This includes nursing which, through
variation of intraoral pressure and muscle contraction/
elongation, generates a three dimensional compression
and elongation in the craniofacial sphere, essential for the
modelling of these structures.
The superior pharyngeal constrictor muscle inserts on the
cartilaginous part of the occipital bone and on the
membranous part of the pterygoid process and mandible.
The facial muscles insert around the labial commissure and
on facial bones of membranous origin.
Sucking/swallowing
Function of facial muscles during sucking (red) and
mimicry (green), arrows showing muscular action.
During sucking the cranium is stabilised in a neutral
position. The superior pharyngeal constrictor uses the
occiput as a fixed point to exert muscular action on the
insertions on the pterygoid process in a postero-inferior
direction. We believe that the pterygoids function like
lever arms to gradually stimulate the descent of the hard
palate, flexion of the sphenoid, and flexion of the primary
respiratory mechanism (PRM).
Angulation of the cranial base
Cartilaginous (grey) and membranous ossification (white).
Facial skeleton and oral cavity
Contraction of orbicularis oris and buccinator muscles
create compression on the maxilla and mandible, as
the tongue works as an antagonist exerting a peristaltic
movement against the palate and the dental arches. The
movements tongue internally and buccinator/orbicularis
oris muscles externally actively model the facial structures.
During sucking, with mandibular depression and
protraction in combination with labial protrusion and
occlusion, the rest of the facial muscles are elongated. This
elongation stimulates the growth of the facial bones and
reduces sutural dysfunctions.
The intraoral vacuum created during sucking is an
important stimulus for the descent of the hard palate. A
low and broad palate forms a u-shaped dental arch, which
is essential for good occlusion and alignment of the teeth.
By contrast a high v-shaped dental arch often leads to
malocclusion. The descent of the hard palate and straight
growth of the nasal septum relies upon mobility of the
intraoral sutures around the vomer. (The nasal septum has
a mixed ossification with ethmoid of cartilaginous and the
vomer of membranous origin.) A palate that remains high
often leads to a curved nasal septum with decreased volume
of nasal cavity and difficulties in nasal breathing; it also
creates a smaller suprapharyngeal space which may inhibit
the process of phonation.
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Summer 2014
The angle between the cranial base and the horizontal
line increases in the first six years with increased flexion of
the sphenobasilar symphysis (SBS). The osteopathic view
is that man’s erect posture causes the atlas to be pushed
superiorly, thus increasing SBS flexion. Magoun claims that
by the influence of the vomer, suckling in the first few weeks
flexes the SBS and normalizes the pull of the intracranial
membranes.
However we believe the process is more complex than
previously suggested, and that the main changes in the first
year occur through the activity of the superior pharyngeal
constrictor, which is the key muscle of all orofacial
functions. In the newborn cranium the pterygoid processes
are short, pointing anteriorly, and the palate is relatively
high compared to that of the adult. During the first year the
palate is supposed to descend and the pterygoid processes
lengthen into a more vertical position.
Orientation of the median axis of (above) a newborn
and (next page) an adult cranium (Carreiro)
The variation in sucking and swallowing is an essential
factor for maintaining the PRM. The force of sucking
sucking is dominant to the force of swallowing. The baby
does not swallow every time it sucks, but only when there
is enough milk in the oral cavity, normally after three
rounds of sucking. Breastfeeding gradually stimulates the
sphenoidal flexion and angulation of the cranial base.
During the sucking period, swallowing begins from the
apex to the root of the tongue; always in propulsion, where
orbicularis oris and the apex of the tongue are fixed points.
The swallowing mechanism evolves as the infant starts
eating solid food, until adult swallowing is fully established
at around three years. In adult swallowing the dental arches
are in contact (occlusion), the tongue is situated more
posteriorly because of the development of the larynx and
the descent of the hyoid bone around 18 months, and the
tongue presses against the palate moving in a peristaltic
manner while the mandible and the root of the tongue are
fixed points.
The palate, originally in a high position in line with the
basilar portion of occiput, is now in line with the anterior
part of atlas. According to Darraillans adult swallowing
stimulates flexion of the SBS, and we believe this occurs
because of the changed angulation of the base with a low
palate combined with a changed swallow mechanism.
It is important to verify that swallowing is developing
according to the physiology. Persistent infant swallowing
after age three blocks maxilla in extension, preventing
the flexion of maxilla and descending of the hard palate,
and inhibits the unfolding of the cranial base and optimal
development of the craniofacial growth (often resulting in
occlusion problems).
Difficulties of breastfeeding
The factors involved in breastfeeding difficulties are
complex and need a global approach. Osseous dysfunctions
of the cranial base are observed in most cases and often
lead, especially those of the occiput, to malposition of
the mandible. A deviation or excessive retroversion of the
mandible reduces the capacity to create the intraoral vacuum
required during sucking, while the sucking mechanism itself
requires strong activation and complex coordination of the
velopharyngeal muscles. Cranial osseous dysfunctions are
important in this regard too since the nerves involved in
both sucking and swallowing emerge from the base and
disturb the function of the muscles that create the vacuum.
Superior pharyngeal
Influence on infant cranial base during (first) sucking
and (second) swallowing. Red arrow with black outline
represents action of superior pharyngeal constrictor.
Structure and function
Our results corroborate the fundamental concepts of
osteopathy, confirming the interrelationship between
structure and function. Breastfeeding seems to be nature’s
tool to unfold the infant cranium and reduce negative
impacts from the intrauterine period through delivery. The
velopharyngeal facial musculature stimulates growth and
reduces craniofacial dysfunctions. Restoration of SBS lesions
was observed when breast fed and only breast fed babies did
not have occipital base compression. A compressed occiput
does not allow muscles of the neck (and lower) to stimulate
the flexion of the sphenoid and the cranial base. As Dr. A
T Still said, ‘The body has within itself all the resources to
heal as long as the pathologies do not reach an irreversible
stage.’
REFERENCES
This article includes aspects of the DO thesis, ‘Studie
über das Stillen und sein Einfluss auf den Schädels des
Summer 2014
9
Kleinkinds,’ accepted 12.02.2003 by the international jury
of DOK at ‘Fraueninsel am Chiemsee,’ Germany, which
received the Sutherland Award for the best clinical thesis.
The research was first published in Osteopatische Medizin,
Einfluss des Stilles auf den Kindlichen Schädel, 4: 9-17,
2004, and later in the book Osteopathy in Pediatrics, edited
by Torsten Liem. The references are not numbered in the
text.
Angelsen et al. ‘Breast feeding and cognitive development at age 1 and 5
years.’ Arch Dis Child. 2001 85(3): 183-8.
Ardran et al. ‘A cineographic study of bottle-feeding.’ British Journal of
Radiology, 1958a; 31:11-22.
Ardran et al. ‘A cineographic study of breastfeeding.’ British Journal of
Radiology, 1958b; 31:156-62.
Bu´lock F, Woolridge MW, Baum JD. ‘Development of co-ordination of
sucking, swallowing and breathing: ultrasound study of term and preterm
infants.’ Develop Med Child Neurol 1990; 32: 669-78.
Butte. ‘The role of breastfeeding in obesity.’ Pediatr Clin North Am. 2001,
48(1): 189-98.
Carreiro J. An Osteopathic Approach to Children. Urban Fischer, 2004, p. 65
Chancholle. ‘Les boucles musculo-aponévrotiques vélo-pharyngo-faciales.’
Ann Chir Plast 1980; 25,1:5-14.
Chancholle. ‘Le voile du palais existe’t-il? Plaidoyer anatomique pour le vélo-pharynx. Ann Chir Plast 1980; 25,2:135-146.
Chancholle, ‘Pourquoi allaiter: les raisons anatomiques.’ 1996, Dossiers de
l’allaitement.
Chancholle, Saboye. ‘Le nourrisson, le mixer et la cuillère: Une fable qui finit
mal.’ 1999. Revue de La Leche League France 39.
Darraillans, Clauzade. Concept Ostéopathique de l´Occlusion. 1989.
Obihara et al. ‘The association of prolonged breastfeeding and allergic
disease in poor urban children.’ 2005, Eur Respir J 25(6): 970-7.
Oddy et al. ‘Breast feeding and cognitive development in childhood: a prospective birth cohort study.’ 2003, Paediatr Perinat Epidemiol, 17(1):81-90.
Onyango AW. ‘Continued breastfeeding and child growth in the second year
of life: a prospective cohort study in western Kenya.’ 1999. Lancet. Dec 11;354
(9195):2041-5..
Piscane et al. ‘Breastfeeding and urinary tract infection.’ Journal of Pediatrics
1992, 120:87-9.
Pottenger. ‘Influence of breastfeeding on facial development.’ 1950, Arch Ped,
57;454-61.
Relier ‘L’aimer avant qu’il naisse.’ 1993 p.91, 97,106.
Robert E. Truhlar. Dr. A. T. Still in the Living. 1950. Privately published.
Cleveland, Ohio. p. 111.
Sadauskaite-Keuhne. ‘Longer breastfeeding is an independent protective
factor against development of type 1 diabetes mellitus in childhood.’ 2004,
Diabetes Metab Res Rev. 20(2):150-7.
Scavone. ‘Prevalence of posterior crossbite among pacifier users: a study in
the deciduous dentition.’ 2007. Braz Oral Res. Apr-Jun;21(2):153-8.
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J Epidemiol. 1997 Apr; 26(2):443-50.
Singhal A. ‘Does breastfeeding protect from growth acceleration and later
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Slykerman et al. ‘Breastfeeding and intelligence of preschool children.’ 2005,
Acta Paed, 94(7):832-7
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Fergusson et al. ‘Breast-feeding and cognitive development in the first 18
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Kobayashi et al. ‘Relationship between breastfeeding duration and prevalence of posterior crossbite in the deciduous dentition.’ 2010, Am J Orthod
Dentofacial Orthop; 137(1): 54-8.
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01453 767607
Morrow-Tlucak M. ‘Breastfeeding and cognitive development in the first two
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Upcoming coUrses
Mandel D. ‘Fat and energy contents of expressed human breast milk in
prolonged lactation.’ 2005. Pediatrics. Sep 116(3): e432-5.
Gunn Kvivik DO MNOF (right) practices osteopathy in
Kristiansand, Norway. She has lectured about breastfeeding
and craniofacial development to midwives, pediatric nurses,
physiotherapists and osteopaths in Norway, Netherlands and
England. Her identical twin Line Côte DO SFDO (left) practices
osteopathy in Le Revest (Toulon), France. She had lectured at
breastfeeding organisations and hospitals, teaching midwives
about osteopathy in obstetrics and paediatrics. She also
gives conferences for dentists and osteopaths in France and
Germany about osteopathy and craniofacial development.
On February 7-8, 2015, Gunn and Line will present a course:
‘An Osteopathic Approach to Infant Feeding Methods and
Orofacial Development’ (eligibility SCCO Fellows and
Faculty, CPD 16 hrs) at the Columbia Hotel, London.
Details on the website www.sutherlandcranialcollege.co.uk
JUne 2014
AT STill workShoP
Guest Tutor: Dr Maxwell Fraval
Fee: £100
Date: Saturday 21st June, London
Course Summary: Delivered by
Canberra based Maxwell Fraval,
leading authority on the Rule of the
Artery.
Course Director: Michael Harris
FSCCO
Fee: £895
Date: 18-20 July, Stroud
Course Summary: For established and
newly graduated osteopaths interesting
in exploring cranial practice.
Course summary: Interconnected
and dynamic; explore the anatomy
and physiology of our membranes
and fascia and how to apply them in
treatment.
MoDule 7 - SPArk in The MoTor
september 2014
AT STill ConFerenCe
MoDule 2 - oSTeoPAThy in The
CrAniAl FielD
Fee: £120 (£60 students)
Date: 22 June, London
Summary: Celebrating 140 years
with leading osteopaths, authors and
researchers.
Course Director: Ana Bennett,
FSCCO
Fee: £1225 (non-residential). New
graduate discounts apply
Date: 15-19 September, London
MoDule 1 - FounDATion
CourSe
Course summary: Introducing the key
concepts of the five phenomena as a
way of studying and understanding the
body as a whole.
Course Director: Dianna Harvey
FSCCO
Fee: £275
Date: June 28 - 29, London
Course Summary: For established
osteopaths and newly graduated
osteopaths interesting in exploring
cranial practice. Fun and accessible,
this course introduces you to the
embryology, anatomy and function
of the cranium, sacrum and related
structures by means of mini lectures,
palpation and group exercises
including model making.
JUly 2014
MoDule 5 - in reCiProCAl
TenSion
CliniCAl review DAy - The
FunCTionAl FACe
Course Director: Rowan DouglasMort, FSCCO.
Date: 24th - 26th Oct, Stroud
Fee: £895
Course summary: Understanding the
integrated role of the CNS within the
body wide fluid function.
november 2014
MoDule 10 - inTeGrATinG
CrAniAl inTo PrACTiCe
Course Director: Michael Harris,
FSCCO
Date: 8th Nov, London
Fee: £165 practice including
communicating effectively with patients.
Course summary: Michael Harris helps
integrate cranial work into existing
osteopathic
Date: 20th Sept, London
Fee: £165
Course summary: For those who have
completed Module 8 to review their
clinical practice with Dianna Harvey
FSCCO
october 2014
MoDule 1 - FounDATion
CourSe
Course Director: Penny Price, FSCCO
Fee: £275
Date: October 18th & 19th, Bath
rAChel BrookS “key eleMenTS
in My CliniCAl PrACTiCe”
Fellows & Faculty only
Course Director: Rachel Brooks
Dates: 14th - 16th Nov, or 21st - 23rd
Nov, Stroud
Fee: £445 - £545
Course summary: Covering Rollin
Becker’s teaching including the
relationship between patient and
physician, working with Stillness and
using compressive forces.
All courses and conferences are eligible for CPD
Courses also run overseas, check website for details
Summer 2014
11
Robert
Lever
Tom Dummer
An inspirational teacher
Tom influenced me more
than any other osteopath
Jenny Lalau-Keraly
interviews his close students
A
fter an SCC Module 2/3 course last
year I was sitting next to Peter Cockhill
when he began talking about Tom
Dummer and I was transfixed. It
struck me that it would be interesting
for all who didn’t have the priviledge
of knowing or being taught by Tom to learn
something about this fascinating man and the
osteopathic approach
he devised, called
Specific Adjustment
Technique. Though
mechanically based
SAT is in his words,
a ‘cli,nical practice
which offers a light,
almost “feather
touch,” painless
and distinctly nontraumatic treatment.’
I thought it would
be inspiring to hear
directly from a few of
his closest students
– nicknamed his
‘sons and daughters’
– so I conducted
phone interviews
with eight of them,
each of whom then
generously helped
edit the original
transcription. The
result is only a
snippet of their
experience.
Those interested in
learning more should
read Tom Dummer’s
books, A Textbook of Osteopathy: Volumes One and Two
(Jotom Publications), Tibetan Medecine and Other
Holistic Health-Care Systems (Paljor Publications) and
Vajrayana Student’s Notebook (Paljor Publications –
available on Amazon).
Tom was born on 23 October 1915. In the 1930s he
12
Summer 2014
began a professional career as a jazz pianist that
continued through the Second World War. In 1942,
when rheumatism in his hands began to affect his
piano playing, he sought treatment from Americantrained osteopath and naturopath Harry Clemens.
His recovery inspired his to study herbal medicine
and in 1944 he graduated as a member of the
Institute of Medical Herbalists.
In 1952 Tom
graduated from the
British College of
Naturopathy (BCN),
where he also studied
osteopathy and, the
following year, was
one of the founder
members of the
BCNO. He sat on
the BCNO’s board of
governors and was
twice president of the
British Naturopathic
and Osteopathic
Association.
In 1957 he began
teaching in France at
the French School of
Osteopathy, which
moved to England
the following year
and in 1974 became
the European School
of Osteopathy. Tom
was a co-founder of
the ESO and acted
as its principal until
1987. He also in 1971,
with graduates of
the BSO and BCNO,
co-founded the Society of Osteopaths, which later
became the European Society of Osteopaths.
In 1977 Tom travelled to Dharamsala, India, sat
with eminent Tibetan doctors for ten weeks and met
His Holiness the 14th Dalai Lama. For the rest of his
life Tom engaged in Buddhist practice.
He died on 17 May 1998.
W
hen I graduated I was working with the approach
of body adjustment that John Wernham taught,
and working in a very different way from Tom.
I remember thinking at the time that I couldn’t
make sense of Tom’s model, the one that became known as
Specific Adjustment Technique (SAT), derived from Parnel
Bradbury ’s work, which was very precise and specific. Parnel
Bradbury developed this system partly out of expediency
because he went into work one day and his colleague was
off sick so he suddenly had twice the number of patients.
He found that if he focused on the patient’s pattern and
accurately diagnosed its mechanical focal point he could
handle the increased load. More impressively he found that
his results were even better than expected. In developing
SAT, Tom created a diagnostic focus out of each patient’s
musculoskeletal pattern, very similar to Rollin Becker’s ‘eye
of the storm,’ working with the energetic pattern as a focal
point within. I don’t think Tom was particularly well up
on Becker’s work but he developed a system by which one
could be very focused, very minimal, and very precise in
adjusting, and gradually I became more impressed with it
and wanted to learn more.
In 1974 I started working with Tom. Although he was
considerably older than me we became close friends,
socialized together and even went on holiday together once
or twice. I was flattered that he would take me into his
confidence and he was very respectful of what I was doing,
and I remember thinking how refreshing that somebody
with such seniority could actually be so supportive and even
flattering about the work I was doing, and I felt energized
by that. I worked alongside him in his practice for about
ten years, partly developing my own style, but relying very
much on Tom’s SAT model into which I was increasingly
drawn – the beauty of its specificity, its economy, its
energetic quality, and the sense that there was more going
on with it than just musculoskeletal movements. I was also
taking on the cranial model. What I enjoyed was the way
that the involuntary mechanism and SAT approaches could
be combined, and I developed a hybrid very much based
on the method I learned from Tom, incorporated with the
increasing enthusiasm I had for cranial work.
As Tom engaged the patient he would create a diagnostic
synthesis with his palpating touch that was very economical,
very light and gentle, but very penetrating. He could put
together a lot of information about the patient extremely
quickly and he developed an extremely holistic sort of
diagnostic schema. He had extraordinary touch. He had
been a pianist and musician for many years before he was
an osteopath, and in treating he developed a very sure but
gentle contact, and the patient wouldn’t have been too much
aware of what was happening. I remember him treating me
for a problem in my wrist, and the way he articulated it
seemed to be almost too gentle, but it sure was effective.
The way he used his mind in creating a diagnostic synthesis
was paralleled by the way he used his mind to project the
technique into the patient’s tissues and body. He was a
Buddhist for many years and a lot of his spiritual practice
and orientation fuelled his approach to patients both as
human beings but also his technical ability, and his ability
to work with energy in a very subtle way. All of this was
very important to me.
I think Tom influenced me more than any other osteopath,
and that’s why in the dedication of my book At the Still Point
of the Turning World: The Art and Philosophy of Osteopathy I
refer to him as my mentor. I was influenced by him not just
in osteopathic technique but also in the way in which we
embrace human qualities and become the people we are,
which I firmly believe influences our mode of operating with
patients, our compassion and empathy, and our technique,
our touch, in fact our whole clinical perspective.
When I read Rollin Becker and got into the whole ‘eye
of the hurricane’ concept he started to discuss back in the
early 60s it meant a lot to me, and I found that I could
immediately understand what he was on about and it made
me determined to adopt the cranial model and try and be
as precise and focused with it as with Tom’s SAT model.
The parallels between what Rollin Becker taught – this
focus within the mechanism – and Tom’s specific structural
focal points within his diagnostic model have rarely been
celebrated. For me this is one of the most marvellous duos.
They are both rather remarkable concepts and, for me,
while adhering to one, an appreciation of how they reflect
one another makes the other easier to do. I have taught this
to students ever since; it’s a source of great delight and
richness in developing the osteopathic art, and I’m sure I
wouldn’t have developed my cranial skills in the same way if
I hadn’t known Tom. He never actually did any cranial work
but he certainly could have done; he had the sensitivity and
the qualities that would have made it possible but he didn’t
really need to. What he could do with structure was so
complete that he engaged the connective tissue matrix just
as if he was working with the involuntary mechanism. As
we all know if we work well and holistically we affect every
level of functioning.
Summer 2014
13
immensely rich, opening up many possibilities in the way
you diagnose and treat.
So it was a very important thing for me to struggle with
Littlejohn’s mechanics as everybody else did, and I probably
took it on a little further in my own particular direction. We
all interpret these great truths in our own way.
When I read John Lewis’s book A. T. Still: From the Dry Bone
to the Living Man (www.atstill.com) I was so excited I could
hardly put it down, because looking back at how Still worked
validated the concept and the method so wonderfully. Those
of us who want to keep the art of osteopathy alive are very
happy to connect with that rather purist way of looking at
structure and function. For me there has never been any
doubt, and one of the reasons I wrote my book was because
I felt this way was under severe threat by some members of
the profession who wanted to make it much more pragmatic
and narrow, not helped of course by politics and by the
pressures from institutions in the health industry, and I feel
we have got to keep flying the flag.
I hope that in my teaching I’ve developed a way of working
that plants seeds in students’ minds so that they don’t come
out being a clone of anybody else, but develop the concept
so deeply within themselves that thye make the work their
own. There’s a strong subjective element in what we do and
that helped me justify writing a book from a very personal
perspective.
BNOA conference, c. 1961. Tom (left) with wife
Margery who after the marriage ended became Mrs.
Margery Bloomfield, another ESO principal.
Robert Lever’s book At the Still Point of the Turning World: The
Art and Philosophy of Osteopathy is available from
www.amazon.co.uk
PHOTOGRAPH COURTESY OF THE NATIONAL OSTEOPATHIC ARCHIVE
When I was an undergraduate we had a visiting lecturer
called Dr. Alan Stoddard, who was very much a structural
practitioner in osteopathy and also a doctor. He wrote two
books called The Principles of Osteopathic Technique and The
Principles of Osteopathic Practice. There weren’t many books
around at the time so his were quite widely distributed
because they contained lots of pictures on technique.
In one talk Dr. Stoddard said he didn’t feel that osteopathy
had a great deal of relevance outside the musculoskeletal
realm. Tom stood up and said, ‘if you have any doubt about
the relevance of osteopathy holistically in a wide variety
of patient’s problems come and see me in my practice any
day you like.’ Certainly that was my experience when I was
working with him. We fashioned ourselves very much as
general osteopathic practitioners, treating anything the
patients wanted to bring, espousing a kind of purist model
that osteopathy was always intended to be, going back to
Still and Littlejohn and many other pioneers.
John Wernham, who trained us in college, was influenced
a great deal by J. Martin Littlejohn. Littlejohn expanded
the anatomical-physiological concept to get across the
importance of physiology in osteopathy, developing the
idea of spinal mechanics later extrapolated by people like
Tommy Hall as well as Wernham.
So important in Littlejohn’s work, as in Still’s, was
realising the reciprocity of function and body structure,
and seeing how what happened in one area influenced
other areas, and that physiological responses were not
always expressed in a linear cause and effect way. In order
to understand how to work with the spine you need to
understand this reciprocity, otherwise nothing makes much
sense. If you marry the reciprocity between anatomy and
physiology into cranial work – with the concept of the
involuntary mechanism, the reciprocal tension membrane,
and the connective tissue matrix – the whole thing becomes
14
Summer 2014
We are all individuals, therefore
aptitudes for different techniques
and approaches are also
different. One should endeavour
to either learn or at least be
familiar with all the different
techniques and disciplines. In
the course of time one’s model
will become apparent. Often
there is no conscious choice
apparent at this point in time.
One simply follows personal
instinctive feelings. It’s a matter
of intuition and awareness.
One’s own personal evolution
as an osteopath then follows
on naturally and without
conflict between this or that.
Tom Dummer. A Textbook of
Osteopathy, Vol. 2, p.174.
Gez Lamb
As his hand performed the manoeuvre
I saw in my inner eye a flash of light
then felt the whole room fill with a
kind of mushroom cloud of energy
M
y first meeting with Tom was when I joined
the ESO back in ’78 when he was principal. He
lectured to us, and it took a while for me to realise
just how significant his Specific Adjustment
Technique (SAT) was. He had honed SAT since the ‘50s,
when he and Parnell Bradbury first hit upon the idea that
single segment adjusting, the right segment at the right
time (rather than an articulatory approach, or adjusting
several segments during a treatment) would make a big
difference to how the mechanics of the spine would behave.
One thing Tom demonstrated was how people can go into
lesion from a psycho-emotional cause and end up with a
physical fixity in the spine. His own mechanism was highly
sensitive and he could go into such a lesion at a drop of a
hat if something was said or something happened in his
life, and because of this sensitivity he tried to get across the
principle that specific adjusting wasn’t just about clicking
a single bone in a treatment, but about how you mobilised,
when you chose to do what you did, and the manner in which
you did it. It was also about where you were in yourself,
the relationship between your hands and the body and the
tissues, and your relationship to the person on the table. It
was a whole philosophy in itself, and was something that
you had to see to understand what lay behind it. He did
several demonstrations in class and his adjustments were
always impressive, in the sense that he used a combination
of speed and lightness, and he was very precise in the way
he diagnosed the spine. He would start from the occipitoatlantal joint, palpating each segment, then get a feel for
the spinal curves and where the restrictions might be, and
finally decide which segment to mobilise. We saw some
phenomenal adjusting and some amazing results, so I
started to follow him around clinic.
In those days he used to write his notes with three different
coloured pens: ordinary notes in blue or black pen; visceral
or a secondary affects in green; primary problems and
anything really important in red. In looking at his notes you
could see immediately from the colour what was important.
So I bought myself three pens – there was just enough room
in the pocket of my clinic coat – and I got to be known as
‘Tom’s boy.’ I’d walk around the school clinic watching him
performing these adjustments and giving advice to students,
so he got the (correct) impression that I was very interested
in his way of working, and when a vacancy in his practice
arose just when I graduated he offered me a position, so I
had that phenomenal leg-up into practice.
We had a room each plus an overflow room, so we could
see three patients an hour. We would greet the patient on
the hour, ask them how they were, get them to undress,
check the spine, decide which segment to adjust, do the
adjustment, and then allow them to rest. Then we’d go to
the next patient and repeat the performance; find it, fix it,
let them rest. By this time it would be about quarter past
the hour. We’d go back to the first patient, find out how
they were functioning and make arrangements to see them
again. Then we’d go back to the second patient to see how
they were. At about half past we’d greet the third patient
and we’d usually be done with them by about ten to the
hour, which gave us time to look at x-rays in the corridor,
make some phone calls or have a cup of tea.
Seeing three patients an hour was only possible because
of this technique. In those early days it just about killed me,
working a full day with twenty-four patients! I remember
the day I finally got the message about SAT. Tom invited me
in to watch him treat a patient, and I’ll never forget it. It was
a C5 adjustment. He checked the patient, decided on C5, and
performed this specific mobilisation. As his hand performed
the manoeuvre I saw in my inner eye a flash of light then
felt the whole room fill with a kind of mushroom cloud of
energy very much like a nuclear cloud, and I realised right
then that I was witnessing something very particular at the
moment he made the adjustment. After that I tried to mimic
what I had seen Tom do and, about a week later, something
happened under my hands that was qualitatively different
from anything else I had ever done before and I realised that
what I was looking for was an ‘x factor’ that you really can’t
put into words. I told the patient I couldn’t explain why
but I knew that the adjustment was going to make a huge
difference to how he felt. So there was something about
SAT that Tom could demonstrate by his whole being but
couldn’t put into words because it’s impossible to. You are
always looking for that specialness in the mobilisation. It
doesn’t happen every time, but you certainly know when
it does.
I would say my practice is split 50/50 between cranial and
specific adjustment work. Not a day goes by that I don’t
do a mobilisation. On holiday I get withdrawal symptoms
because I want to get my hands on somebody. I know
there are times when to mobilise a segment is all that is
needed, then let the body do the rest. I’m fond of saying to
students, ’why walk on water when you can take the ferry.’
It’s a matter of knowing the difference. In the early days
we always took x-rays, though later Tom could tell so much
through his hands that he stopped taking them. I take less
than I used to for the same reason that I suppose, but I still
continue to because it really helps to view the position, and
you can show the patient and get them involved, and this
makes a psychological difference to what happens.
In Tom’s book on SAT he says he would begin the
treatment with a traumatised segment, very often in the
Summer 2014
15
upper neck – from a whiplash, a blow to the head, or a
shunt from below from perhaps a fall onto the backside
that jars up to the neck. After that he would go through
the pivotal segments, usually up the spine, and over four
or five sessions get the system to balance. That is actually
called specific adjusting. Since that time Robert Lever and
I have found that SAT is not just effective for traumatised
segments, but for anybody who wants to feel in balance or
is in pain.
What I loved most about Tom was that he was truly
human and a very giving and generous man. We had some
lovely times with him. He often invited us down to his
home in the Kent countryside and we’d have a meal and a
lot of wine, and then he’d start to play the piano. He was a
great jazz pianist before he got into osteopathy. He had this
wonderful story about doing a gig for the army. It was a very
dark night and they were staying in the barracks afterwards.
He found his way to where he was staying, but stumbled
into the wrong room where there was a guy with a lady, and
they were going at it, with clothes all over the chair and
his sword draped on the end of the bed. As he went in they
stopped and the guy stood up and said, ’What are you doing
you silly little man, can’t you see I’m entertaining a lady?’
Tom roared with laughter every time he told that story.
The ESO course was second to none. We got so much
practical work and a lot less theory. We learnt all the
necessary pathology, anatomy and physiology, but it was
done in proportion to the hands-on work. I feel I got
something of an apprenticeship because we worked with
Robert Lever, Harold Klug, Mervyn Waldman, Tom and John
Wernham – all people full of the spirit of osteopathy and the
sense of treating the whole person, getting back to the roots
of what Still taught. The light that was established in the
school in those days was truly incredible. I feel very, very
fortunate, and that’s why I try to give back as much as I do.
I feel I am a direct-line descendant from Tom, and he was
steeped in the tradition of those people in the early 1900s.
So we are not far removed from the source of it all. Tom has
left a phenomenal legacy which I am still keeping alive by
teaching people who are much younger, and they continue
to teach SAT in the spirit in which I taught it, which is
faithful to Tom.
Sue Turner
The energy in that little shrine
room showed me the depth
of his spiritual practice and
the quality he brought to it
I
first met Tom Dummer when I
went for treatment to his practice
at Bingham Place in the West
End. I was very impressed with
the lightness of his extraordinary
corrections. After I’d been about
three times he said to me, ‘I don’t
understand why you keep recreating
your spinal lesions because you
haven’t got a terrible spine. Is anything
going on emotionally?’ I told him that
I would like to study osteopathy but
didn’t see how I could, because I had
already been through university and
wouldn’t be able to get a grant. He
said that they had just started a school
[the ESO] where all the lectures were
concentrated into three days a week
so that people could earn a living the
16
rest of the week. Well, that was my
introduction to Tom and it was actually
the answer to a heartfelt prayer. After
that ‘aha’ moment, however, I tried to
get away from the idea of going to the
ESO, but then time after time – this
happened eight times – kept bumping
into people who had something to do
with the college. The eighth time was
when my father wrote to me and said,
‘I’ve just been to a Buddhist Society
summer school, and came off my
motor bike and injured my shoulder.
So they rattled up a kingpin osteopath
called Tom Dummer who put my
shoulder right and then told me you
were going to come to his school to
study osteopathy. I don’t think he’s
right because you would have told
Summer 2014
me!’ So I thought OK, heavens, I will
do this.
Ten years later when he treated me
he saw that my thoracic spine was a
bit fibrotic and did a particular type
of prone articulation which he’d never
taught in the school. He crossed
his hands, pressing on either side of
the spine as if he was springing the
vertebrae, altering the tensions on
the anterior longitudinal ligament I
suppose. He did this for five minutes
and I was wiped out for the rest of
the afternoon, it was so powerful.
He explained that in the centre of
the lesion is the core, out of which
the correction comes. The way he
described it, it was as if he was reaching
in towards the place from which the
correction unfolded from within rather
than putting in force from without.
What struck me when I first went to
see him was how his corrections were
like being touched by a butterfly.
One time after he retired he invited
a group of us to go down and visit
him. That afternoon he talked about
‘beginningless time’ and the depths
to which you could reach in your
osteopathic corrections, to the essence
of who we are that has its roots in
beginningless time. I’ve never done
Tom’s Specific Adjustment Technique
(SAT) myself because I don’t have that
type of mind. I think there are a few
women who have done it but generally
men are more comfortable with it. He
used to take a long time examining
the patient to get a sense of which
vertebra to choose, the one that would
unlock the key that was holding the
body in imbalance, so that the whole
system could return to its natural
balance. Then with the lightest touch
he would bring his mind right to the
centre of it until ‘the potency ’ (though
he would never use that word) would
unfold from within. If you think of
the insemination of the sperm and the
gestation of the womb, it’s a very male
way to focus everything on one incisive
moment. It’s interesting that Tom’s
close students who took up cranial
work still used a SAT model in a way
because they tried to go for the key
– i.e. the primary – lesion to enable
everything else to unravel around it.
I work in a different way. I come
from somewhere wide and try to find
the natural energetic interface, and
from there work around until I’m in
resonance with the patient’s system.
Gradually it unfolds and reveals
itself to me. It takes longer, more
like gestation; it’s more female. But,
once again, the mind is important.
Acknowledgement of what is there
is part of what enables the tissues to
respond appropriately towards health.
They know they ’re seen. The forces
are also matched with the hands
and mind whether it be emotional,
spiritual, toxic, whatever, so I think the
importance of the mind is something I
Sue Turner with Tom Dummer, 1987.
do share with SAT.
On that same visit Tom took us
into his little shrine room, which may
have been some kind of converted
garage. One of Tom’s daughters had
died of cancer and there was a big
picture of her. There was the most
beautiful, beautiful atmosphere, with
an absolute crystalline quality to the
air. The energy in that room showed
me more about Tom than I’d ever met
in ordinary communication with him
– the depth of his spiritual practice
and the quality he brought to it.
Tom talked a lot about counselling,
the importance of talking to people.
When he was teaching us he’d always
recount how he’d talked to patients
in the past and how it had changed
people’s lives. He gave an example
when we were in our fourth year. Tom
was not prim or a prude in any way.
In He spoke of a man he had treated
who was really poorly and wasn’t
looking after himself and was lonely
and sad. Tom asked him about his
relationships and if he was married.
The man answered that he couldn’t
get married. Tom asked why not and
was told, ‘Because I have a bend in
my penis.’ Tom replied, ‘Well, if some
women knew that they ’d go mad!’
When Tom met him again two years
later the man was happily married.
Tom was very skilful actually, to take
that comment and turn it around
and give the man his confidence.
Somebody else might have said ‘Oh,
I’m sure that doesn’t matter,’ but
Tom seized the opportunity with
‘Oh Wow,’ right there in the present
moment.
Inspection of the superficial spinal structures is enhanced by relaxing
the normal vision and allowing the sixth sense to come through more
strongly. It is not only a question of seeing the usual objective peripheral
signs of somatic dysfunctions, but also to ‘see’ the more subjective
changes in the energy field in question ie the electromagnetic ‘pattern
body’ (of Burr and Northrup). Diagnosis is Fourth Dimensional!
Tom Dummer. Textbook of Osteopathy, Vol. 1, p. 166.
Summer 2014
17
Peter
Cockhill
I think he was probably a master of
the art judging by the results he got
W
hen I first went to work with Tom he was
sixty-six and I remember him telling me more
or less the first day how painful it was being on
his feet, because he had suffered from rickets
when he was little. Being on his feet all that time was a
challenge, because his arches weren’t that good, and he
used to find his scoliosis uncomfortable to support all day
long too. He would have three patients an hour, eight hours
a day, probably four days a week. So I am thinking for me
now, as a 64 year old, what amazing stamina he had, and also
what patience he had with his patients. At the end of the day
he would stop and invite me into the back room where there
was always a bottle of Spanish Rioja, and I can remember
the name, because it was his favourite and he always had
the same, Marques de Caseras. He and Jo (his wife) and me,
and maybe one or two others, would get through maybe
two bottles after a day ’s work and I remember being rather
shocked, but he just laughed and said its always a question
of how you use your energy. This was very interesting for
me, that he could do that and constitutionally manage it. I
never remember him not turning up for a day ’s work so he
was obviously in very good health.
In his back room he would go and do his Buddhist practice.
He would say [Peter imitates Tom’s accent], ‘now Peter I’ll
just be doing my pujas for a little while, and there’ll maybe
a strange smell coming from the room, but not to worry!’ So
that was obviously an important part of his practice as well.
He kept an esoteric side to his work, although he didn’t
advertise this. Occasionally he would say, ’with this patient
I need to get out my box’ and he’d dowse over a wooden
box with all kinds of stuff in it, and prescribe various herbs
– or was it homeopathy? He had such a large scope and
parameter of awareness, with different tools that he would
draw on specifically for certain people.
I remember also how meticulous he was, and it could have
been for my benefit. He took x-rays for specific adjustments
and would measure degrees of rotation or hyperflexion
with a compass, explaining to me how he saw the difference
between C2/3 lesions and C5/6 and L5/S1 for the positional
adjustments he used to do, and it was extraordinary being
in the room with him when he did them, they were just
so artful. When we’d look through these x-rays he’d say,
’now you can see that there are ten degrees of rotation and
we have to take into account this little hyperflexion of C2/
C3’ and, as he was lining the patient up, would say, ‘now
we put all that out of our minds.’ So visually he would
measure all that out, but his hands would then take over
and he was guided by the feedback from the tissues as to
18
Summer 2014
what directions and angles the adjustment demanded. It
reminded me of A. T. Still saying, ‘when you come into the
clinic you forget your books and it’s Nature’s book that you
follow.’ And I think everybody gets to that point when you
know your stuff, that ultimately it’s something else that
takes over. You have to learn to trust, and I think he was
probably a master of the art judging by the results he got
with people. I still have four or five of his patients in Bath,
all now mid-80s, and it’s amazing the part that osteopathy
has played in their lives because of Tom. He was such an
influential person.
I think what I have taken from Tom is that width of
application. There was something about the way he brought
that spiritual practice into his work. He kept the boundaries
with people too. It was a great lesson to watch him practicing
as an osteopath but bringing all this awareness that he had
and depth of practice. He was very good at meeting people on
their level and giving them the information they could take
in and needed to know. He never tried to bamboozle people
or talk to them in a way that they wouldn’t understand. I
don’t think many people knew about his Buddhist practice,
except those that were interested.
I also got from him that I can’t see three patients in an
hour. I did it for a bit but it wore me out! I had only just
left college and the thought that I had to be so accurate
with my treatment was daunting. Also the fee structure – it
seemed to me that people were paying an enormous sum for
my treatments, but Tom was insistent that the fee was the
same for the experienced practitioners and the junior ones.
He said what people are paying for is a good osteopathic
treatment and that’s what you give them, and it was a very
supportive thing to do. For me that was an interesting way
to run a practice, so I’ve always gone by that. I also learnt
from him and Jo how to manage people who complained. He
was very clear about that, he said it was an energetic thing –
you send them back their money so that you send them back
their energy. He was a master at feeling energy. Jo used to
say that we never heard from those who complained again
if we sent back the money and worded the letter properly.
Seeing how someone handles things like that early on in
practice is really very useful.
I remember a couple of times when I was there he put on
his top hat and went to Ascot. He turned up in his jacket
and top hat and Jo got dressed up, and they hired a Rolls
Royce and went off for the day. I think they were invited by
patients.
When he was head of the college he never foulmouthed
anyone; he never talked about John Wernham in the way
that John Werham talked about him. I think as a political
manoeuverer he was quite astute, as well as knowing how
to push things through and get the college functioning. He
was clever.
He took me in to see his patients when I was first in
practice and I witnessed methods I had never seen in
college. He did a lot of neuromuscular stuff, but only in
short bursts because he said it screwed up his thumbs. He
used it a lot on shoulders. He’d think of every insertion and
every angle of everything coming in and used very precise
amounts of force to get the inflammatory response he was
looking for. I saw him do a lot of very specific neuromuscular
work around joints, and that would be the treatment for
that day. I still see a patient of his, a concert pianist who
had a motorbike accident. He went to A&E where an expert
neurosurgeon managed to sew together all the severed
nerves across the back of his wrist. He did an amazing job,
but the guy had never been able to get full use of his fingers
because of all the fibrotic changes. Tom worked for about
six months doing neuromuscular work on the back of the
hand until he got complete movement back. It was a long
job. This made me realize how you have to have faith. This
guy is still playing now. He would never have been the same
if Tom hadn’t been able to break down the connective tissue
that had healed and contracted.
It was a gift to me to be able to spend that time there. Tom
was always looking for the right person to take on his role.
He really wanted someone to fit right alongside him and
for various reasons I didn’t do that. I was more interested
in doing cranial work, and I think he knew that really and
felt let down.
I remember when Tom wasn’t there and I had to treat his
patients there would be a Buddhist monk in robes sweeping
in, followed by an MP, followed by an author, then a fast
bowler from the MCC, followed by musicians, and it was
just an amazing practice which reflected the spectrum of
his geniality, the variety of different people – lords and
ladies right down to jobbing professionals. A very nice
introduction to practice for me.
Nice, nice.
Clare
Ballard
One felt he was lining himself up,
lining the patient up, lining the room
up and coming to the fulcrum
T
om had a big mind, a deep and
wide open view in approaching
patients. When he was working
with somebody he was very
precise in diagnosis and would ask a lot
of questions and take careful but well
abbreviated notes. He worked a lot with
Sheldon’s somatotypes – mesomorph,
ectomorph, endomorph – and adjusted
his treatments accordingly. As well
as mechanics he would factor in the
whole psychological sphere, the
autonomic balance, and he also had
a strong awareness of the energetic
and spiritual aspects. He would think
about all these different spheres as he
was asking questions. He took a long
time in diagnosis and a short time in
treatment, and often the first session
was by and large diagnostic. He would
frequently obtain positional x-rays,
particularly of the upper cervicals,
and then spend time looking at them,
circling round, measuring with ruler
and calipers, getting the feel of the
area. At the second session he would
usually sum all that up and often
correct the primary lesion at that
point, but if he felt it was inappropriate
to make a specific adjustment he
might articulate very specifically. His
adjustment of the primary lesion was
so skilful and particular. His Specific
Adjustment Technique was so right for
his personality, very clear and precise
and analytical and quite male, not
soft. In his later life I sensed a kind
of sadness in him that more people
didn’t follow in his footsteps, but he
was quite a hard act to follow.
He had these very delicate hands,
and such a funny kyphotic posture
because of his spinal problem after
having rickets as a child. He was very
stooped over. After deciding what to
do he would footle around getting
the patient in position, and then line
everything up very carefully. One felt
he was lining himself up, lining the
patient up, lining the room up and
coming to the fulcrum – I think he
had a very strong sense of a fulcrum
for that patient in that moment. I am
thinking of these big atlas/axis, C3
adjustments he would do. He would
bring the moment to bear, then do a
lightening quick adjustment – light
or deep and strong – summing up the
tissue quality and tone so precisely,
which is why he got such fantastic
results. It was very Zen. He always did
a lot of precise motion testing, and
took the tissue tone and autonomic
tone into account when making the
adjustment. He worked in a precise
but visceral way with the nervous
system. He usually adjusted the
atypical vertebrae first – the upper
cervicals or the pelvis – and often did
Summer 2014
19
a prone sacral toggle, at lightening
speed. As well as his usual treatment
table he had a special low table with a
sprung piece in the middle. I think it
was a chiropractic one that had come
from his teacher Parnell Bradbury.
His neck adjustments were almost
always prone and short lever – I don’t
remember him doing a supine cervical
adjustment.
I personally was drawn to the
cranial model because I found his
method quite austere, and wanted
something more fluid and tactile; I
wanted to make more physical contact
with the patient. With Tom’s method
one didn’t spend much time with the
tissues. He did have very good results,
though, and when I used his method I
did too. What I have taken from Tom’s
teaching is that when I feel a change
I try and accept it, and even if I am
tempted to continue I try and stop
there. It’s ‘find it fix it and leave it
alone.’ I suppose it feels like ‘this is
what the body wants now,’ and if one
gets a change in a deep way this time,
next time there will be a different
picture and one can engage in a new
way. In the cranial context we would
call that a fulcrum: the body takes up
a shape that has a point of balance
which is energetic, emotional, visceral,
autonomic, neurological and fluid; all
those layers are tied in together, not
superimposed but knitted together,
and the more one can incorporate all
that, the deeper the changes.
Though Tom was very articulate, he
had an unfortunate way of delivering
his lectures, his voice would drone
on, and it was terribly difficult to
stay alert and awake. I have pages of
lectures where the writing just trails
off in the middle of a sentence. Such
words of wisdom, so fascinating, but I
was left without a clue because it was
20
impossible to resist sleep. Poor Tom,
he must have seen all his students in
front of him comatosed. There was
a sadness there; we were all such
failures!
Tom’s approach never felt formulaic,
however he did have a method and
principles – he tended to adjust the
primary lesion in the upper cervicals
or sometimes the sacrum, then work
through the pivots, C5 or C6 then
often D4, sometimes D9 – this was
Tom’s way of working with Littlejohn’s
mechanics. It never seemed like a
formula with Tom because he brought
so many other elements to bear that it
was never the same, but with someone
less experienced it could have become
so. He told me and others that in
another time period he would have
got involved with cranial work, but
didn’t because he was too old when it
all came over to this country. He was
interested, though, and wasn’t closed
minded towards it.
I often worked as a locum for Tom at
his Bingham Place practice in London.
I was one of the Bingham Place lot, I
suppose there were a few of us in that
group.
One anecdote stays with me. I was
visiting Sue Turner and it was very
random because I wasn’t often there.
It so happened that Tom phoned to
chat to Sue, and then we had quite a
long talk that particularly touched my
heart. It was memorable. He was very
warm, reminiscing about old times,
how we had all been pioneers at the
ESO and how we had all made it work
, how it had all been so basic and how
we had put up with quite a lot in those
early days through force of enthusiasm
and belief in the work. When I put the
phone down my heart was singing
from the connection with him and how
blessed I felt to have known him. He
died two days later and had apparently
been on the phone constantly for the
last few days. He knew that he was on
his way and wanted to say goodbye. It
showed me the depth of his Buddhist
practice. It brings tears to my eyes
now, because it was such a precious
moment to know that he valued us all
so much and that time we had shared
together. I suppose we did stick our
necks out; there must have been about
twenty of us, fed up to the back teeth
with the college in London (BCNO,
now BCOM) which was pretty awful at
that time, and we were instrumental
in its cleavage down the middle. After
my first year at the BCNO in 1974
we all decamped to John Wernham’s
school premises in Maidstone, where
Tom had already been teaching French
physiotherapists, as the EEO.
Tom wanted to set up an English
Summer 2014
school and so the ESO was born. A
group of faculty came with us: Stephen
Pirie, Robin Kirk, Paul Greenhalgh –
that was in 1975. Various other people
who had not wanted to be involved
with the BCNO, like Robert Lever and
Peter Blagrave, also started to teach
at the ESO. John Wernham and Tom
Dummer were like chalk and cheese
and it is creditable that they worked
together to make the college happen.
In the end the ESO needed more space
and purchased the building further up
Tonbridge Road.
I was always inspired by Tom and
Robert. Their approach fired me up.
I loved it, it was so thoughtful, and
deep and imaginative, interesting, and
it was fun. The college in London had
been so puritanical, I couldn’t bear it.
It was big and dusty and moralistic
and outdated: ‘thou wilst cleanse thy
bowels’ kind of stuff! Copying material
down from the blackboard. Tom was
more a bottle of good red wine, good
conversation and jazz. There were
plenty of parties and celebrations.
We all worked very hard under rather
difficult circumstances but it was a
wonderful time.
By mind awareness,
one ‘empties’ the mind,
ratiocination is suspended
and the manual procedure
is spontaneously applied
with specific therapeutic
intent, whether it be a brief
or prolonged application.
Something happens, an
event which is as subtle and
on the same level as the
mysterious ‘highest known
element’ of Dr Still- the level
of the void. There is a kind of
transmutation analogous to
that which happens in another
context, i.e. Zen martial
arts and indeed in the Tao.
Health is the proper
relationship between the
microcosm, which is man,
and the macrocosm, which
is the Universe. Disease is a
disruption of this relationship.
Unimpeded reaction of
the macrocosm to such
a disruption results in a
cure, unless the distuption
is irreversible when drath
becomes the cure.
Tom Dummer. Tibetan
Medicine and Other Health
Care Systems, p. 198.
Lynn Haller
He had this incredible touch, a way
of moving into and through the body
with his hands, and it was remarkable
to experience that kind of treatment
T
om Dummer did a great deal of classroom and
clinic teaching during our four years at the ESO.
Charlie Shaw, Jeremy Gilbey, James Summerfield
and I would sit together in the front row showing
our interest, and he seemed very generous to us. I am not
sure if our class (ESO ‘87) had more time with him than
other classes but he certainly responded to our enthusiasm.
I also had a Buddhist connection with him, as did James
Summerfield, so Tom would invite us to his house when
he organised some remarkable teacher to come and give
teachings and initiations. I remember one particular Ngagpa
called Yeshe Dorje, the official weather man for the Dalai
Lama, a real shaman who could literally control the weather.
This was the side of the Tibetans that Tom was particularly
attracted to – the wild side!
I got a huge amount from Tom. The approach he primarily
put forward was referred to as Specific Adjustment Technique
(SAT), a particularly interesting and practical application of
‘Littlejohn’s Mechanics.’ He would look at all the different
interactions throughout the body, and how these were
reflected in and organized by the spine, particularly when
there had been an impact injury. He saw the spine as central
to how the body tried to resolve conflicting forces throughout
the system, whether visceral or musculoskeletal. He would
walk around the patient stalking the lesion, wiggling this
and testing that, and doing it in such a way that one could
see the body organizing itself around the attention he paid
to it. He would find the primary focus – the centre – of the
entire pattern and adjust that ‘primary lesion,’ as he called
it, and afterwards you would see an unravelling through the
rest of the body.
We got to understand that some areas were secondary to
others; some areas might look primary but usually are not,
like T4 is rarely primary, but it might stand out because
it’s trying to deal with everything above and below. In,
for example, a whiplash injury, this model would help
you know which areas to look at, particularly if C2 was
involved. The lesion could often be positional, in other
words, the injury had exceeded normal physiological limits
and pushed anatomical limits though not necessarily to the
point of fracture or complete dislocation. Transitional areas
are more susceptible to this type of injury. I found this SAT
map very helpful, particularly early on in practise, because
it gave a sense of how the body integrated itself and so was
a way of approaching the treatment of the whole.
Another type of treatment that Tom practiced, but taught
less, was what he called General Articulatory Treatment
(GAT). He seemed to reserve this for people who were more
ill. An ill person wouldn’t have the capacity or the energy
to organize their body into a nice neat primary lesion on
which you could perform an HVT to unravel the whole
pattern. That’s when he would perform his GAT, often with
the patient prone rather than supine.
Once when he treated me he put one hand on the body as
a fulcrum and took an arm or shoulder or leg with the other
hand and moved it around. I swear I couldn’t feel where his
hand was, not because his touch was light but because its
penetration was such that you felt not his hand but the area
that needed to move.
Whether he was calming the sympathetics, working
on specific tissues, or activating the fluid dynamics in
a particular area he had this incredible touch, a way of
moving into and through the body with his hands, and it
was remarkable to experience that kind of treatment. Then
he would hold the feet or the head and do some traction –
something we have incorporated into the SCCO BLT course
– to help integrate the body. When he did this you could
feel the connection right through from head to foot – if he
tractioned from the neck you’d see your toes move. It was
very deep and thorough and balancing.
I remember a faculty meeting where Tom pissed everybody
off by saying he felt cranial work was too superficial and
what he did was deeper. Sue Turner, Harold Klug, Gez Lamb
and Robert Lever were there and you could see everyone’s
hackles go up. But he had a point because I think that at that
period in our evolution many people were ‘swimming on or
in the fluids’ and not getting to that deeper place. The fluids
are important but they’re not necessarily what you need to
be lost in.
When Tom lectured his side comments and stories were
often far more valuable than the topic he was trying to teach.
He published three osteopathic books, two volumes on
osteopathic medicine, and one on his Specific Adjustment
Technique. He would drone on, a bit like how he played
his jazz piano; he would lull you to sleep, but if you kept
awake you would catch some titbit, some little comment
or story that was like gold dust. Of course, without the
framework the ‘extras’ wouldn’t make sense, but they were
often amazing. He would throw out things like, ‘Of course
everybody knows that T2/3 controls the eyesight.’ What?
Where did he get that? But when you looked into it you
could see neurologically and anatomically why it was so.
Summer 2014
21
Our class spent a lot of time watching Tom treat patients.
We often observed while he hunted down a lesion and tried
to guess where the primary one might be. Sometimes we
got it right, but getting it wrong was often more interesting
because it enabled us to ask how and why. Watching him
was an interactive way of looking closely at how the body
organizes itself into these familiar patterns.
One time I went straight from Tom’s clinic to watch
Stephen Pirie treat somebody. Both he and Tom worked
with the same SAT model, but Stephen adjusted all the
compensatory areas first and left the primary to the last. For
me that was quite an insight. Although both agreed with
the fundamentals they approached the same problem from
almost polar opposite directions. Other senior osteopaths
used different approaches too, but one would see a common
underlying thinking and understanding.
I have incorporated those fundamentals into my own
approach. I definitely use Tom’s interpretation of Littlejohn’s
Mechanics in trying to understand how the patient’s body is
trying to organize itself around the lesion, as well as to ask if
the body is healthy enough to organize itself into a primary
area or not. If it is healthy enough, how do I approach the
problem? Do I set it all up and make that adjustment – and
I don’t necessarily mean by HVT/HVLA, because you can
address the segment equally well with balanced ligamentous
tension (BLT).
Sometimes HVT might be more emphatic for positional
lesions. Tom’s way of doing an HVT was to set the whole
thing up, first exaggerating and holding in his mind all the
lesion’s interconnections, then empty his mind before doing
the adjustment. Clearing the mind is a way of connecting
with the ‘health’ that one hopes will make the correction.
So I learnt about what a correction is from him, about being
present and how deep a treatment can be.
I also learnt that everything in the body is connected to
everything else. So Tom was a huge influence.
Jeremy
Gilbey
The more I teach the more I
come to realise that the patientpractitioner dynamic is the primary
context for treatment
W
hat was special when
observing
Tom
treat
was the way he made
contact with the patient,
which started from the moment the
person contacted the practice, and the
treatment began from the moment
he placed his hands on the patient
to start the diagnosis. He had the
hands of an artist, the long fingers
of the jazz pianist that he was. The
relationship between patient and
practitioner looked so complete, with
his two hands working, introducing
subtle movements and palpating
the expression of those movements
through the body.
Intellectually he would divide the
body into three unities: the head, neck
and upper extremities; L3 to the pelvis,
sacrum and lower extremities; and T4
to L3 in between. He would perhaps
find a primary focus in each of those
three unities and make a decision as to
22
the key component in this individual
at this moment in time and space,
and then would address that using his
version of a high velocity thrust, which
was his primary way to influence the
health of the patient – although its
gentleness and fluidity didn’t resemble
what is usually described as an HVT.
This was quite remarkable. It wasn’t
like the way others teach it, where
you take in the different components
bringing them to engagement to take
through a range of motion. Tom did it
in a floating field; everything would be
in a floating dynamic continuity and
he just set it in motion to produce an
incredible adjustment, a mobilisation
of the segment with ramifications
throughout the whole spine and the
rest of the body, with very little effort
whatsoever. It was quite extraordinary
to watch. Often you would feel the
effect of that in the room, and the
patient would lie down and rest for a
Summer 2014
few minutes for the treatment to take
effect. Then he would reassess to see
if it had been therapeutically useful. If
the primary focus had been addressed
the compensatory patterns would have
disappeared.
Tom’s
approach
has
greatly
influenced me and the way I work. I
look at people standing, sitting, lying
down, in different relationships with
gravity. If you change this relationship
the compensations disappear and you
are left with something fundamentally
significant. I look to see if there is a
primary focus or way in within the
patient/practitioner dynamic that
allows me to do as little as possible
to initiate change, and make room for
the patient to do the work. I believe
this allows treatment to go beyond
the model in which I am working. I
attribute this perception to Tom.
As an ultimate expression of a
minimalist treatment I once saw Tom
assess a patient in front of a group
of us, go through the diagnosis with
the patient, and after reviewing the
findings say, ‘ I think that we won’t do
anything else today, I think we’ll get
you to come back in a couple of weeks’
time.’ So his choice for treatment was
not to do a treatment because the
body was in a process of therapeutic
change already, and a treatment would
only get in the way of that process.
For me that’s the ultimate osteopathic
treatment, choosing not to do a
treatment.
Tom influenced me in terms of that
minimalist approach, but I’ve learned
much from lots of different people in
terms of the work that I’ve developed
with the IVM (although, as always,
the patients are our greatest teachers).
Straight after qualifying I went to
work with Stuart Korth, because that
was the only place you could work
with babies and children at the time.
I’ve been taught by Sue Turner, and
I shall never forget when we were in
a class working on the viscera. She
said, ‘feel the essential liverness of
the liver,’ and this is quite unusual in
your second year osteopathic training
to palpate the quality of the liver! Jim
Jealous has been very important to me
in terms of providing a vocabulary for
experiences and a map to understand
what I was feeling. Most importantly
he fuelled my quest to seek what lay
beyond my limitations, to always be
humble, and to ‘turn another page’
and see what else is over the horizon.
I’ve always thought it’s important to
plough your own furrow, to find your
own way. I’m a great believer in finding
the models that work for you and then
moving on beyond them – they are just
models after all and so not necessarily
true. Sutherland’s model is of course
just a model. I was very influenced by
the SCTF, with whom I did my first
two cranial courses at the BSO. I met
Rollin Becker on my second SCTF
course, and during my student days
was greatly inspired by his writings and
his perception of the patient in their
biosphere. I was part of the founding
group of the SCC which has been very
important to me and my development.
It is a great learning experience having
to go back to fundamentals and first
principles in order to share the love
of our work with others. The more I
teach the more I come to realise that
the patient/practitioner dynamic is
the primary context for treatment and
each one is individual and unique with
respect to the personalities involved.
My role when I am teaching is to foster
the student’s individual relationship
with their patient and not impose
myself upon them.
I was very fortunate in terms of the
year I entered the ESO. As well as
having lectures from Tom Dummer
we would also see him treat patients
in front of small clinic groups, and
this was a great opportunity to ask
questions. After I qualified he asked
me to come and teach with him on his
undergraduate course and I assisted
him for about three years. When
he stopped teaching I took over the
course, but it wasn’t my material and
I found it difficult to teach from the
heart – it wasn’t entirely mine – so
after a couple of years I stopped.
The Specific Adjustment Technique
(SAT) was his particular way of looking
at traumatically induced patterns. If
someone had been in a RTA he would
Patients will automatically and unconsciously
choose their osteopath – the one that they
need to help them at that point in universal
and cosmic time, i.e. in terms of whether he or
she ‘thinks osteopathy’ or rather only ‘thinks
osteopathically.’ Thinking osteopathy means
that the osteopath is totally identified and in
complete empathy with the patient; they are
as one. Thinking osteopathically on the other
hand means merely conceptualizing in terms
of this or that, in which case practitioner
and patient are not in true empathy.
Tom Dummer. Tibetan Medicine and Other
Holistic Health Care Systems, p. 198.
Tom’Dummer’s hands.
assess what was going on, very often
finding a focus in the upper cervicals
that he would then have x-rayed to
assess the force vectors that had been
applied, and that enabled him to more
precisely address that traumatic focus.
So that is where that term Specific
Adjustment comes from. The x-ray
gives additional information over
and above what you have established
through your hands, and when it
comes to doing the adjustment you let
all the intellectual stuff go and let your
innate ability do it. So it comes from
your whole body ’s expression of the
dynamic of osteopathy in relationship
to that patient – what is in your hands
and body and not in your mind. I don’t
use SAT, it’s not part of my model that
those segments with traumatically
induced focuses need to be mobilized.
I tend to work with the cranial
approach where I engage with the
whole body dynamic, looking at the
relationship between the patient and
the field around them and creating the
context for those traumatic focuses to
release.
What I learned from Tom with his
diagnostic routine takes years to learn
on your own. That way of finding out
what is and what isn’t significant.
When you ask students after they
qualify ‘what’s important here,’ they
might reply, ‘well, C3 on the right and
C4 on the left is doing this, and C5 and
C6 that.’ Everything is doing
everything, but what is functionally
important in this patient in this
moment? If you’ve got a way of
breaking it down to gain an
understanding, a short cut, it saves
you an awful lot of struggle and effort,
and that’s what we got from Tom.
Summer 2014
23
James
Sumerfield
Tom was deeply involved with Tibetan
Buddhism, as I was, and that was the
fundamental place we related from
I
n 1983 I had been greatly helped through osteopathic
treatment given by Sue Turner, and that summer I had a
dream involving the Dzogchen Master Namkhai Norbu
Rinpoche that suggested I should do healing work with
my hands.
I was quite rapidly directed to apply to the European
School of Osteopathy, so one Friday I travelled from
Devon, where I was living, to be interviewed by Marjorie
Bloomfield. She was keen to take me, but said that I would
have to wait another year as the term started in ten days and
the course was full. I remember thinking that a year would
be too long to wait.
That Saturday a revered Tibetan doctor, Dr. Trogawa
Rinpoche (1932-1985) – who, at the request of His Holiness
the Dalai Lama, continued the Chagpori medical lineage
originally established in Lhasa in 1696 – was speaking in
London at the Rigpa Centre. He gave a Medicine Buddha
initiation and afterwards I was talking to someone about my
interview the previous day at the ESO and they pointed out
Tom Dummer sitting at the back. I went over to introduce
myself and told him what had happened. The following
Monday morning I got a call from Marjorie saying they had
a place. So I gathered up my things and a week later I was
in Maidstone.
For me osteopathy is very much connected first to meeting
Sue and then to meeting Tom. Tom and I became good
friends and he was a great mentor for me, particularly in
those early years. He had always taken a deep interest in
esoteric matters, osteopathy, tridosha, homeopathy, nature
cure, radionics, orgone energy, and aromatherapy, and was
involved in the development of what we would now call
holistic medicine. He then met the 16th Karmapa, which
was a transformative experience for him, and after that he
travelled to India and started listening to teachings, and met
the Dalai Lama and other Lamas. When I knew him Tom
was deeply involved in Tibetan Buddhism, as I was, and
although I had a different teacher that was the fundamental
place we related from.
When Tom worked he had a real ability to look at all the
subtle levels in the body and I think what inspired him was
the Buddhist teachers, their teachings, and the whole link
with Tibetan Medicine, which has a truly holistic vision of
health care. One could argue that it’s a health care model
fast forwarded virtually from the middle ages to the 20th
/21st century because of the history of Tibet. It takes into
account all the interdependent aspects of people and their
environment, and the factors necessary for health.
24
Summer 2014
Over time his spiritual practice and his osteopathic
practice became more and more integrated and aligned
– integrated in the same way as Buddhist practices and
beyond a dualistic way of looking at reality. He wasn’t
looking at left and right, black and white, but trying to
grasp what was happening in the moment. When he taught
his Specific Adjustment Technique (SAT) and talked about
releasing complex forces in what he called a ‘positional
osteopathic lesion,’ his approach was about engaging those
held forces in the body at that moment while letting go of
the judgemental mind. He described this as a ‘Zen’ moment
of emptiness, and his gift was to make a fundamental shift in
the health pattern of the person. He was also developing his
own idea of being compassionate towards his patients, and
if they were interested would teach them simple meditation
techniques as a form of medicine.
It was at this stage of his development that I first met Tom.
He had been an osteopath for a long time and had trained
the 1950s when things were quite mechanistic – Parnell
Bradbury and the early days of the BSO and the BCNO – a
very different osteopathy to the one I’d known. He always
carried something slightly different, and a lot of people
who gravitated towards the IVM and ‘cranial’ approach
were interested in his SAT approach because it was a way of
working in a structural way that was incredibly gentle and
energetically sensitive. I think that Tom will be enduringly
Health is the proper relationship between
the microcosm, which is man, and the
macrocosm, which is the Universe.
Disease is a disruption of this relationship.
In macro/microcosmic terms the spinal
column (including the pelvis) represents
Mount Meru, the axial centre of the
Universe. Osteopathic somatic-dysfunction
or ‘lesions’ occur principally at this
level when the dynamic homeostatic
equilibrium is interrupted, the somaticdysfunction being the focal point of the
break in the time-space continuum.
Tom Dummer. Tibetan Medicine and Other
Holistic Health-Care Systems, p.199
remembered for the way he practiced, which was deeply
went to making up his book, ‘Tibetan Medicine and Other
informed by his spiritual practices and aspirations, and
Health Care Systems,’ and finding references in his own
his relationships with inspiring spiritual figures including
library and beyond. He commissioned a painting of the
the 16th Karmapa, HH the Dalai Lama, Dilgo Khyentse
Medicine Buddha for the cover and that painting eventually
Rinpoche, and others.
ended up on the wall of my practice room, so all my patients
I remember when Yeshe Dorje, the Tibetan Ngagpa
and I have worked together for many years together under
‘rainmaker’ from Dharamsala, came to England for the
the auspices of that Medicine Buddha. It’s very linked in my
first time he stayed in Tom’s house in Yalding. Yeshe Dorje
mind to Tom and to Robert Beer, another spiritual friend,
was so fascinated and delighted to experience a bath with
who painted it. So I feel Tom’s gift is always with me.
running hot water that he entirely flooded the bathroom.
Tom’s ambition was to have one of his ‘sons’ be the
He saw the water coming to the top and didn’t know how to
vehicle to carry forward his teaching, and it always amuses
turn off the taps, and fused all the lights in the house. Tom
me that he often chose people who were quite like himself
took this gaily in his stride.
in that they were independently minded, stubborn, and
I still sometimes treat some of the monks and Rinpoches
wishing to tread their own path – so inevitably they were
when they come over,
never going to quite fit
and I always feel that the
in with the other part of
thread I shared with Tom
him that wanted them to
continues to be a strong
remain the dutiful son. I
part of my own life. In
arrived at a time (maybe
my first years in practice,
I was the ‘last son’) when
whenever I was finding
he was stepping down
a patient challenging,
as principal of the ESO
I would visualize his
and leaving his practice
hands over mine and
in London. There were
think, ‘Tom would have
huge amounts of endings
done this.’ I took in a
for Tom at that time, and
lot from Tom, and have
that inevitable fracture
an enduring love and
with me came. We spent
affection for him and
several hours on the
the memory of what he
phone just a few weeks
gave to everyone. He
before he died, and we
and Marjorie launched
talked about it all and
this fantastic institution,
resolved it, which was
the European School of
very good for both of us.
Osteopathy, which was a
My respect and love for
real beacon of informed
Tom never waned even
independent Osteopathy,
during those difficult
and I hope it still is.
times.
I
started
studying
For several years up
Tom’s
SAT
method
until his death Tom was
IMAGE OF TOM DUMMER (RIGHT) COURTESY OF
thirty-one years ago. I
practicing a particular
NATIONAL OSTEOPATHIC ARCHIVE.
don’t think anything is
practice he had been
still ‘on board’ for me
given, called Phowa, in
in the way it was then. After working with all the various
preparation for that moment, and had a very good death I
models there comes a point when we have to take matters
believe. His wife Jo told me that on the Saturday they had a
‘into our own hands’ and become what we have to offer our
nice evening with friends and on the Sunday morning she
patients. Tom taught me to look, to see the patient standing
said, ‘are you feeling OK?’ and he just sat down and died.
before me, and view how everything is functioning together.
Through all that practice, he reached that moment and
That is something that I have continued with. I suppose what
was gone.
I am doing is looking for the place in the three-dimensional
space of the patient where there is a door, and I am trying
to open that door to enable the person to take steps towards
better health. My ideas about the location of those doors
are still influenced by what Tom taught me. Not so much
intellectually – Tom was never an intellectual – and I’m sure
if he was sitting here now I would hear him chuckling as he
always said the same thing himself. He was very intuitive.
after I graduated one of the things that occupied me was
trying to understand the rationale behind some of the great
things he did but which didn’t quite make sense! I remember
at the beginning standing with him looking at patients and
he would say, ‘yes, there, you can see the problem, it’s
there!’ And I’d say, ‘no I can’t see, show me!’ Eventually,
after a few years, I saw what he was talking about.
I had a previous degree, so needed to pay my way through
the four year osteopathy course, and Tom kindly gave me
These interviews with Tom
quite a lot of editing work, which was useful. It was useful
Dummer’s former students
for him too because I’ve got a reasonable grasp of English
were conducted, compiled and
and I spent many hours with him discussing the parts that
edited by Jenny Lalau-Keraly.
Summer 2014
25
A. T. Still Conference:
‘Osteopathy into the future . . .’
A.T. Still Conference:
Sunday 22 June 2014
Celebrating osteopathy’s 140th anniversary
‘Osteopathy into the future…’
‘On June 22nd 1874 I flung to the breeze the
banner of Osteopathy’ so said Andrew Taylor Still
(Autobiography of A.T. Still p 94)
On the 22 June 2014 we are gathering together
in London to celebrate the 140th Anniversary of this
event and the continuing inspiration of Osteopathy.
nd
Our conference speakers will be:
JOHN LEWIS - writer of the acclaimed authoritative
biography of Dr Still ‘A.T. Still from the dry bone
to the living Man’. John will consider this legacy
exploring the unique contribution of Dr Still to the
world and will share his Osteopathic vision and
inspiration.
SUSAN TURNER – Susan has made significant
contributions to the development of Paediatric
Osteopathy in Europe. She lectures in the USA,
Australia and Russia as well as throughout Europe.
Susan will consider WG Sutherland, a man of his
time in the tradition of the philosopher scientist.
F
ROBERT LEVER - author of ‘At the Still Point of
the Turning World – the Art and Philosophy of
Osteopathy’. Robert will reflect on the current
dilemmas within and around the practice of
osteopathy and will consider how we might heal this
fragmentation and develop our Osteopathic future by
reinterpreting our heritage.
MAXWELL FRAVAL – Maxwell has been working for
many years exploring Osteopathic principles and has
developed a particular understanding of the ‘Rule
of the Artery’. A renowned international lecturer,
he joins us from Australia to turn a microscope on
how science is beginning to validate many of the
observations of Dr A.T. Still.
There will be time for discussion and questions.
This conference is a must for anyone who cares
about and desires to participate in the future of
Osteopathy.
On Saturday 21st June 2014, Maxwell Fraval will also present a workshop on his innovative thinking in the field of
Osteopathy and his many years of exploration to understand what Dr A.T. Still meant by the phrase ‘The Rule of the Artery’.
COST:
BOOKINGS:
£120 for the conference day
with £60 for students
Please visit our website conference page at -
£100 for workshop on
Saturday 21st June 2014
SCC_Full Page.indd 1
www.sutherlandcranialcollege.co.uk/
why-us/events/still-conference/
Or, call the office to reserve your place.
or too long the collective noun for a group of
DOs has been a ‘difference of osteopaths.’ This
conference is an opportunity for the profession to
gather on the 140th anniversary of osteopathy’s discovery
to celebrate our differences and unite in the pursuit of
excellence. We have invited four inspirational speakers:
JOHN LEWIS will explain why Andrew Taylor Still’s
vision of osteopathy remains so relevant today. The founder’s
lengthening shadow has engaged us, inspired us, and
continues to encourage us to develop osteopathy. John says,
‘When we work with the living human body we are working
with an intelligence far superior to our rational thinking
minds. We must humble ourselves and try to remove
obstructions to the expression of the infinite wisdom
inherent in every living cell. That is Dr Still’s message, as
stated in his dictum, ‘Find it, fix it, and leave it alone.
Nature will do the rest.’
Osteopathy, in the true sense of the word, is only
secondarily a practice of manual medicine. It is first and
foremost a philosophy based upon nature’s innate tendency
to express health, a tendency unexplained by all known
scientific laws. Since the basis of all healing is threfore
‘unscientific’ Still argues that we need a different philosophy
when dealing with living nature. A philosophy with a place
for all scientific knowledge, but one that subordinates
science to principles of how nature is observed to work.
When we grasp Dr. Still’s message there can be no factions
or divisions within osteopathy, for his philosophy of ‘matter,
motion and mind, blended by the wisdom of Deity’ allows
for a variety of treatment approaches.
SUSAN TURNER will speak on ‘Still and Sutherland
in the Tradition of the Philosopher Scientist’ and discuss the
contribution of William Garner Sutherland to osteopathic
thinking and development. In Contributions of Thought
Sutherland wrote, ‘Dr Still has taken my hands in his and
allowed me to feel the lesion as it was being exaggerated
and then as the natural agencies pulled the bones back
into place.’ Sutherland absorbed and developed Still’s
teachings, and credited the cranial concept to the founder.
‘It is not mine,’ Sutherland stated,’ it never has been. Like
many of you I was sceptical and my first endeavour was
to prove that there could be no mobility of the skull.’
Osteopathy as defined by A T Still and W G Sutherland
is a philosophy and a science, but is it a science solely
in the Newtonian sense? The aim of this lecture is to reevaluate what our profession may mean by ‘science’ in
the light of the historical and philosophical influences on
our osteopathic forebears, through Emmanuel Swedenborg
to Wolfgang Von Goethe and Walter Russell. The word
‘science’ originates from the Latin word for knowledge,
but in its modern definition this involves only the rational
faculty of the mind. There are broader definitions of
knowledge and of science that sat more naturally with
A T Still, W G Sutherland and J M Littlejohn, which are
just as relevant to us who seek to ‘dig on’ today.
ROBERT LEVER explains that the osteopathic
profession has faced many challenges over its 140-year
history. Some have been political, some academic, but
all have contributed to issues relating to identity, scope
and method. These struggles persist to this day and the
irony is that, to some extent, they are perpetuated by
members of the profession itself, creating at best much
healthy discourse and at worst destructive argument.
The practice of osteopathy become stereotyped in the
public mind to resemble various methods of manual
treatment with which it shares few conceptual ingredients.
It is also frequently represented by its own practitioners in
such varying hues that it begins to look like a panoply of
entirely different disciplines with very little consensus or
coherence. And all too often its exponents have struggled
to discover common ground or celebrate their differences.
Perhaps it has taken the emergence of quantum theory
to demonstrate that science can accommodate qualities
we’ve come to associate with ‘spirit’ and vice versa, and
bring about a convergence of objective and subjective,
matter and consciousness, to give a more holistic
conception of the world, with the a sense of reality based
on experience as well as logic and analytical thought.
The art of medicine stands to benefit from such a
convergence in that its skills, however technically
based, are immeasurably enhanced by human qualities
engendered by a truly ‘listening’ attitude. Osteopathy is
not the only discipline that gives expression to such an
attitude but, at its best, it can exemplify it to perfection.
MAXWELL FRAVAL writes, ‘Dr Still’s states in Research
and Practice that, “The heart, the fountain of life, is the
organ in the human body which imparts the attributes of life
and knowledge to the blood so that it can proceed correctly
with all its work.” Many pieces of research have confirmed
Dr Still’s insightfulness. Dr J A Armour describes the “little
brain within the heart” which influences the brain as much
as the brain influences the heart, and we have discovered
the wonderful work of Dr Torrent Guasp who, after hundreds
of years of failed attempts by other anatomists, has solved
the puzzled of the spirals of the ventricular heart muscle.
We have found the fascinating way in which the vortical
flow of blood has been described by Schauberger and
then much more recently the brilliant work of Gerald
Pollack whose work has resulted in a completely new
understand of the manner in which bio-water is structured.
Dr Still’s emphasis of the importance of the fascia and
its close relation to bio-water is confirmed and verified
by the work of Szent-Gyorgi, Adey, Oschman and many
others, while the way in which light is present in all living
things and forms a fundamental part of our physiology is
demonstrated by the research of Popp and Mae Wan Ho.’
PETER ARMITAGE, past chairman of the SCCO and
presenter of the 2011 Rollin Becker Memorial Lecture,
will chair the conference and discussion sessions to
facilitate our shared vision of osteopathy into the future.
On Saturday 21 June 2014 , the day before the
conference, MAXWELL FRAVAL will present a workshop
to explore the interface between bioluminescence (light)
and the auto repair processes in the body, and introduce
concepts leading to an osteopathic perceptual experience
of vascular function. Participans must have some
experience of working with the involuntary mechanism.
Come and help us celebrate a difference of osteopaths
working together within a united community.
Jeremy Gilbey, Conference Organiser.
28/01/2014 10:01
Summer 2014
27
Singing
Science, art and mystery
Charles McLoughlin
C
asanova once said, “The trouble with sex is that
anyone can do it.” The same could be said of
singing. Just as we all have a sex drive, we all have
a voice, and both have their journeymen and their
geniuses. This is my attempt to bring some clarity to the
art, science and mystery of singing.
There are many theories about singing. I would prefer
to talk about voice, since singing is use of the voice. I see
the relationship between the singer and their body in the
same way as an instrumentalist sees his instrument. Our
instrument is our own body and we must learn to play it,
thus to express musical art as a singer we need to acquire
completely reliable and effective vocal function. First we
must recognise that our body is a living instrument unlike
a piano, which is brought to life only when it is played. A
piano has no intrinsic emotion; it merely gives voice to the
emotion of the player.
Our body instrument intrinsically possesses emotion,
and its emotion is not necessarily connected with music.
It already has its own agenda, influenced by its past, its
dreams and its fears. These things are already in place before
we start to learn to play our instrument. Indeed, if we just
consider the physical human body without the complexity
of emotion it is still unfathomably complex. We must learn
to play an instrument that has a life and agenda of its own,
and until we acquire a degree of mastery we frequently find
ourselves in conflict.
Having made the case for singing as instrumental playing
we must still remember that a singer’s relationship with
their ‘instrument’ is not the same as that of an instrumental
player. It is a more difficult marriage. In the matter of
playing our body instrument we are seeking to impose our
musical vision on an instrument with its own autonomous
life which may be unformed and not fully understood, for in
many cases it is physically or, more commonly, emotionally
damaged.
For long periods in the history of singing these factors
have presented seemingly insurmountable problems,
leading to the notion that singing is impossibly difficult and
perhaps even unnatural, and techniques based upon these
false premises have, in some measure, become accepted
practice. But take heart – everything we do with our bodies
is complex if we take this reductionist view: brushing our
hair, taking a shower, putting on our shoes. But these
are things that we just do, they are easy. We learn these
28
Summer 2014
activities as we grow up, and they are not weighted with
anxieties and conflict.
It is possible to arrive at this happy juncture with singing.
Singing is a process that evolves from speech. This is
the starting point and it returns over and over again as
an integrating concept as the voice grows with ease and
freedom.
Before discussing the practical means of learning how to
sing in this way, let me first try to envisage the ideal, albeit
unattainable, state of the body/voice in the act of singing.
Sporting metaphors are pertinent here. For example, one
tennis player may be a hard hitter of the ball and his
opponent may find this to his advantage. A ball hit hard has
high energy which a dextrous opponent can harness and
use. Similarly in cricket the able batsman can use the energy
from a fast bowler to his advantage.
So too with the voice we can learn to become aware of and
use natural energy rather than oppose it. I like the metaphor
of pushing a child on a swing. We push lightly as the swing
reaches its high point and begins its descent – push too
early and we have to push harder, too late and the swing has
gone and we are pushing on nothing. Timing is all, and this
is true too in voice.
The Teaching Process
Beniamino Gigli said that singing is a combination of
‘imagination and will.’ Enrico Caruso advised, ‘In order to
sing look for ease. When you have found ease look for more
ease.’ In these two cryptic observations the whole matter
of singing is expressed. Feel easy, imagining the sound you
want to sing, apply your will, and let it happen.
As I have said, voice is an extension of speech. A highly
evolved extension maybe, but the place of speech at the
root of singing is always paramount. In my experience the
learning process has two phases.
In the first phase we clean up the voice by releasing
residual restrictions to pure sound formation. These
restrictions are mostly psychological in origin and arise
from who we are – the nature of our life experiences and our
cultural upbringing. These things become institutionalised
in our mind and body and we probably don’t know they
are there until we try to sing. The fine tuning required for
releasing them cannot be addressed as simply a mechanical
process. All attempts to achieve free singing without taking
account of this tend to consolidate the restriction rather
than release it. Therefore some other approach is called for.
This other approach lies in the realm of consciousness.
Consciousness is a subtle and profound quality. We are not
conscious of consciousness itself, only of what it reveals to
us, and with most of us these revelations become classified
and are retained or suppressed according to custom and
experience. Although we cannot understand the nature of
consciousness we can choose to direct it to aspects of our
being from which we have hitherto excluded it. This truly is
doable, though sometimes it takes a lot of courage.
The act of intentionally shifting our consciousness may
make us dimly aware of previously denied feelings. When this
occurs I ask the pupil to sing an exercise which I prescribe
without moving away from that new consciousness, and the
act of vocalisation further enhances the release of feeling.
It is vitally important to sing the exercise both dynamically
and emotionally with a softness of feeling. To sing loudly
and aggressively would totally abort the exercise much in
the same way that anger in classic ‘psychology speak’ is
used as a defence against hurt feelings.
I achieve the act of moving consciousness from a safe
(familiar) place to an unsafe (unfamiliar) place by the use
of metaphors or parables which I find initially within myself
as my singing body is naturally attuned to the pupil’s. The
metaphors come spontaneously into my consciousness and
may be banal, profound, grotesque or even comical. I never
question them but deploy them immediately. They may be
significant for a whole lesson or just a few minutes. As
they work in the pupil they are a revelation of some kind
of truth and, as time goes on, the pupil begins to create his
own exercises or improve mine. Thus, by consciousness, we
learn to classify pure experience in a truly nonverbal way
and to respond directly to what it is telling us.
Vocal exercises are, at best, a repeating pattern. To sing a
song is a major leap forward insofar as it is now a random
pattern of constantly changing vowels, consonants, pitch,
rising and falling intervals. At some point, and we know
when this point arrives, music and phrasing takes over as
the creative energy in the process. This is the second phase
of the learning process.
It is worth reiterating here that everything we do with
our bodies becomes boundlessly complex if we follow a
reductionist approach and singing is no exception. Every
pure vowel that we sing corresponds to a precise formation
of our body, and has no connection with the vowel which
precedes it or that which follows. Many – even the best –
singers develop a stream of tone on which they try to impose
vowels. This is impossible. Such singers, however beautiful
their sound, have bad diction. You cannot hear their words
and sometimes you cannot be sure which language they are
singing in. This has, in some measure, become acceptable.
Then we come to consonants . . . . But let’s not, I have said
enough.
If it all sounds a little daunting, here is a quote from
another great performer, the dancer Anna Pavlova, that is
equally applicable to singing: ‘No one can arrive from being
talented alone. God gives talent, work transforms talent
into genius.’
Possible health benefits
I offer the following thoughts with some reservations. The
act of learning to use your voice in order to sing freely cannot
simultaneously be offered as some kind of therapeutic or
healing process.
However the nature of this work, as I have presented
it, is firstly to seek a deliberately induced psychological
Charles McLoughlin teaching natural voice.
change merely by focusing your consciousness on some
aspect of your experience, which is something that perhaps
you have been unwilling to do. Next, through singing, you
are asked to give vocal expression to that feeling. These
actions produce emotional and physical change, and in
both instances this change is away from restriction and
into freedom. This produces a slow incremental change,
but pursued on a regular basis results in significant change
in how we experience life and cope with its vicissitudes.
My experience has been that this change – always towards
natural function – continues between lessons. A pupil once
said that my lessons ‘kick-in’ about three or four days
afterwards.
For these reasons I speculate that singing, correctly
pursued, is significantly beneficial to psychological and
physical health. All healing change moves in our being in
such a way as to stimulate further healing change. I stress
again that therapeutic changes are not the prime purpose
of the work which is to learn to sing with freedom and
pleasure.
BIOGRAPHY
Charles McLoughlin took up singing at the age of twentyeight, initially to improve his health following serious
bronchial illness. Subsequently he became fascinated with
the natural voice: the importance of physical fitness, a
secure balanced posture, and an awareness of the need for
a high degree of subtle coordination in the use of the body.
His approach has its roots in the Italian Bel Canto tradition,
an approach he applies not only to established singers but
also to people without obvious singing voices or those with
good voices who have experienced difficulties. He continues
to work daily on the developing his own singing voice.
Visit Charles’s website:
www.natural-voice.co.uk
Summer 2014
29
Cerebrospinal Fluid
The science behind our palpation
Sibyl Grundberg
D
r. A. T. Still described
the cerebrospinal fluid
(CSF) as a substance
containing the ‘highest
known element.’ W. G.
Sutherland stated that CSF was the
most important thing to guide us in
treatment. This raises a number of
questions: What does CSF mean for
us in daily practice? Do we sense
CSF as ventricles or as waterbeds or
as a fluid quality in the tissues of the
cranium and elsewhere? How do we
use ‘fluid management’ techniques? I
imagine that in practice each of us has
a slightly different relationship to CSF
(and its related fluids) and I suspect
that others, like me, have to remind
ourselves continually of its presence
and power.
A recent article published by the
Nedergaard Medical Research Centre
at the University of Rochester1
(brought to the September 2012
SCCO Module 2 course by Michael
Harris) opened a window on a large
and growing body of cerebrospinal
fluid research. There has been much
excitement in the college about ‘the
glymphatic system’ – the paravascular
channels created by the ‘endfeet’ of
astrocytes, formed around surface
capillaries of the brain. CSF has been
traced within these channels and seen
to be taken up by brain tissue.
Does this have any significance
in terms of osteopathic palpation?
Few would claim to sense these
paravascular channels discretely, but
for me this new knowledge reawakened
an old drive to find parallels between
Sutherland’s teachings and science.
Fifteen
years
ago,
before
the
internet made scientific papers so
much easier to find, I was intrigued
by a report written by a Swedish
researcher, D. Greitz, who used MRI
to make observations of CSF flow.2
His conclusions, picturing a ‘pulsating
flow’ and ‘brain expansion’ related to
30
The peri-vascular
space, showing
contribution of the
astrocytes, and
the Virchow-Robin
space (but not
the vascular pia
forming a ‘funnel’
with the pia of the
brain). The cross
section shows
the capillary
in a process
of dynamic
interchange with
water and other
solutes, and the
contribution of
AQP4 to this
process. Source:
http://quizlet.
com/11161076/
neurocytology-
have been limited by the prevailing
methodology. The investigation of
cadavers can shed little light on
the brain’s complex physiology, so
attempts have been made to reproduce
it by models and observations of
laboratory animals. But models are
not living tissue, and the animals,
however similar to humans, have not
been observed under ‘physiological’
conditions, for experiments to occlude
the foramina of Monro or to insert a
cannula into the SAS or Aqueduct of
Sylvius inevitably alter the physiology.4
CSF AND LYMPHATICS
‘intracranial arterial expansion during
systole,’ contradicted the traditional
view of ‘circulation’ through the
subarachnoid space (SAS) and drainage
into the arachnoid granulations. It also
seemed closer than the long-accepted
textbook concept of circulation to
Sutherland’s concept of ‘fluctuation.’
Since
Still’s
time
alternative
theories of CSF production, perfusion
and drainage have been posited, 3 yet
textbooks continue to emphasise
the roles of the choroid plexi and
arachnoid granulations as the primary
source and reuptake mechanism of
CSF. The proposed function of CSF
has remained somewhat mysterious,
too, beyond its protective function as
a cushion or ‘waterbed.’ Some have
identified CSF as an ‘interstitial’
fluid by contrasting its electrolyte
composition with that of blood
and intracellular fluid, and because
the brain lacks obvious lymphatic
channels, proposed a lymphatic role.
More recently its role as a carrier for
neuropeptides has been explored, with
interest focused on the blood-brain
barrier and the circumventricular
organs that lack this barrier.
In following my line of enquiry
I found several recent papers that
tracked the history of CSF research1,2,3,8
and was struck by how often the same
good ideas cropped up and were
tested, often without satisfactory
results, and then left alone (or not)
until someone else picked them up.
My quest for a linear path to the Truth
was frustrated, but I discovered a rich
overlapping texture, a treasure trove
of research on the origins of CSF and
its destinations. I am not equal to
the task of absorbing it all, but will
describe some of the clearest trends.
Sutherland, a man of science as well as
of inspiration, must surely have placed
his hypothesis of the ‘potency ’ of CSF
against a background of these varying
ideas of CSF flow, and drawn his
own conclusions based on palpatory
experience.
Attempts by researchers to match
suspicions
with
hard
evidence
Blood-brain barrier. Astrocytes (mauve) surrounding capillaries in the brain.
Source: http://en.wikipedia.org/w/index.php?title=File:Blood_
Brain_Barriere.jpg License: Creative Commons Attribution
3.0 Contributors: Ben Brahim Mohammed
Summer 2014
In the last 15 or 20 years, Johnston,
Koh and others have proven that up
to 50% of tracer injected into the
subarachnoid cisterns of various
animals drained via the perineural
spaces of the olfactory nerves into the
nasal and cervical lymphatics.5 Here
is another indication for checking for
the free movement of that neglected
ethmoid bone. Remember what
Sutherland said: ‘When you hear
someone sneeze, do not tell him that
he is catching cold. He is, instead,
protecting his nasal mucosa with
cerebrospinal fluid.’6 (TSO page 82)
ASTROCYTES,
AMYLOID-ß
AQUAPORINS
AND
Iliff et al.7 injected tracer substances
into the SAS and found that they entered
the brain interstitium via para-arterial
spaces, and drained via interstitial
fluid drainage along pericapillary and
paravenous spaces into, ultimately,
the
cervical
lymphatics.
These
experiments broke new ground, partly
because they used smaller molecular
weight tracers that penetrated further
into the brain substance. Their results
challenge the assertions of previous
investigators (using larger molecularweight tracers) who claimed that the
microcirculation makes only a very
small contribution to the circulation
of CSF.
The Iliff team (drawing, as ever,
on earlier research along similar
lines) went on to propose a specific
pathway for fluid transport from
the SAS into and out of the brain
substance. (figure 2) Astrocytes, the
most numerous glial cells that support
neural tissue, completely enclose the
cerebral vasculature via ‘endfeet’
which express on their surface potent
water channels called aquaporins
(AQP4). This arrangement appears
to be a low-resistance facilitator of
CSF flow into the brain parenchyma,
allowing some solutes to pass through
while entrapping larger ones. There
is hope that this will point the way
to understanding neuropathologies
such as Alzheimer’s disease, which
is associated with the large plaqueinducing protein amyloid-ß.
After mixing with interstitial fluid,
CSF passes out of brain tissue via
pericapillary and perivenous spaces. As
the arteriole approaches the capillary
bed the pial membrane becomes
increasingly porous, suggesting that
much fluid exchange occurs there.
The tiny space – 20 nm – between
the endfeet of astrocytes might also be
a route for fluid to seep into the brain
interstitial fluid. But the Rochester
team showed reduced fluid transport
in mice whose aquaporins were
experimentally ‘deleted,’ providing
strong evidence for the importance of
the AQP4 water ‘channels.’
In a May 2014 paper, Brinker8
describes the characteristics of six
different types of aquaporin, each
specialised to transport different
sizes of solutes and water across
cell
membranes.
Interestingly
these aquaporins exhibit ‘dynamic
regulation,’ some becoming more
and others less permeable in, for
instance, brain injury. The aquaporin
known as AQP4 is found in high
concentrations at all borders between
brain parenchyma and major fluid
compartments, such as the SAS and
the spaces around brain arterioles.
CSF PRODUCTION
Croatian
researchers,
inserting
cannulas into the cisterna magna
or aqueduct of Sylvius of cats,
demonstrated problems with the
principle of a linear ‘bulk flow’
through successive ventricles into
the cisterns and SAS. In a 2010 paper
investigating the origins of CSF flow
Orešković9 reasoned that for the body
to preserve homoeostatic values of
CSF and other fluids, the production
of CSF must be the generator of its
flow and that ‘pulsations’ – ‘which
are mostly a consequence of organ
functions (heart, lungs) . . . outside
the CNS’ – are unimportant. However
after evaluating the literature on a long
history of experimentation – including
treatment
of
hydrocephalus
by
removing the choroids, as well as their
own experiments measuring CSF flow
into an external receptacle(!) – they
concluded that neither the choroid
plexi nor the ventricles are primarily
responsible for CSF formation, and
that ‘CSF appeared and disappeared
everywhere in the CSF system.’
Brinker has rightly questioned their
methods, in part because they are
‘surgically invasive’ and their claim
to observing under ‘physiological
conditions’ is doubtful. He also
questions their insistence on passive
forms of fluid transport within the
brain, given the recent developments
discussed above. Citing Greitz’s 1993
MRI work, Brinker concludes that, ‘CSF
circulation is much more complex, a
combination of directed bulk flow,
pulsatile to and fro movement,
and continuous bi-directional fluid
exchange at the blood-brain barrier
and the cell membranes at the borders
between CSF and ISF spaces.’
However, it is clear from the research
Summer 2014
31
references above, and the long and
intriguing lists of references contained
in just the few research papers cited in
this article, that the subject of CSF’s
origins and destinations remains wide
open. I think Sutherland would have
been pleased. He seemed sceptical of
the assumptions being made in his
day about choroid plexus function,
stating, ‘Some say the cerebrospinal
fluid is produced there.’10 He explicitly
regarded the choroids as sites of
exchange:
In the choroid plexuses the
interchange is between the blood
and the cerebrospinal fluid, not
a manufacturing of the fluid. You
would have a hard time replenishing
the waters of the brain through such
a process. It is a mechanism for the
interchange between all the fluids
of the body. Put something into the
cerebral spinal fluid and you will
find it in the blood later.11
Harold I. Magoun, acting as
Sutherland’s scribe in the first edition
of Osteopathy in the Cranial Field (1951),
described CSF fluctuation as, in the
inhalation phase, an increase in size of
the ventricles relative to brain volume,
followed in the exhalation phase by an
apparent release of CSF into the brain
substance:
This
is
not
circulation
but
fluctuation. . . . There is an alteration
in the size of its ‘water beds’ and the
fluid may shift.
The volume variation which results
from the increase in the size of the
ventricles and subarachnoid space as
the tissues of the central nervous system
exhibit their inherent motility and
express the fluid.
Dispersal of the fluid as the excess
fluctuates out along the perineural
channels during the exhalation phase
of action.12 (my italics)
The concept of ‘fluctuation’ is
fundamental to our work and informs
our palpation. The assertion that
the fluid spaces increase in size is
unproven but, given the dense presence
of microvasculature in the brain,
doesn’t it make sense to feel the ‘soft
custard’ of the CNS as a great sponge
in a continual state of replenishment?
Sutherland wrote, ‘Thus this system
in the blood stream is surrounded by
cerebrospinal fluid within the neural
tube and without it.’13
Anne Wales reminds us, ‘The aim of
an osteopathic treatment is to improve
Rhythmic Balanced Interchange across
all the interfaces.’14 This is echoed by
Sutherland’s description of a CV4:
Bring the fluctuation of the
cerebrospinal fluid down to its
rhythmic balance where all the fluids
have that immediate interchange between
the cerebrospinal fluid and the blood. Do
you get the picture? An interchange
from the chemicals in the blood with
those in the CSF.15(my italics)
A. T. Still referred to the
cerebrospinal fluid as ‘the
highest known element in
the human body.’ W. G.
Sutherland concurs and
calls the innate principle
that centers the physiology
of the cerebrospinal fluid
the ‘liquid light,’ the ‘breath
of life,’ the ‘fluid within
a fluid,’ and other terms
to indicate its inherent
Intelligence. Certainly some
greater explanation than just
hydrodynamic and chemical
qualities as exhibited in the
laboratories is needed to
explain the uncanny accuracy
that is portrayed when the
craniosacral mechanism
is started into a functional
pattern of correction. There
is an unerring potency within
the cerebrospinal fluid.
Whatever we do, be it a parietal lift,
BLT, or just watching the body ’s fluid
spaces – this can, and should be our
aim. Science has been supporting us
all along.
Rollin Becker. Journal of
the Osteopathic Cranial
Association 1953, p. 17.
Quaghebeur, J. ‘Reassessing cerebrospinal
REFERENCES
review presenting a novel hypothesis for CSF
physiology.’ Journal of Bodywork & Movement
G. A. Gundersen, H. Benveniste, G. E. Vates,
Therapies (2013), http://dx.doi.org/10.1016/
R. Deane, S. A. Goldman, E. A. Nagelhus, M.
j.jbmt.2013.02.002
Nedergaard. ‘A paravascular pathway facilitates
4. Orešković D., Klarica M. (2010) ‘The
CSF flow through the brain parenchyma and
formation of cerebrospinal fluid: nearly
the clearance of interstitial solutes, including
a hundred years of interpretations and
amyloid b.’ Sci. Transl. Med. 4, 147ra111 (2012).
misinterpretations.’ Brain Research Reviews, 64
2. Greitz D. ‘Cerebrospinal fluid circulation and
(2). pp. 241-62. ISSN 0165-0173
associated intracranial dynamics. A
5. e.g. Johnston. M., Zakharov, A., Koh, L.,
radiologic investigation using MR imaging and
Armstrong, D., 2005. ‘Subarachnoid injection
radionuclide cisternography.’
of Microfil reveals connections between
Acta Radiol Suppl. 1993;386:1-23.
cerebrospinal fluid and nasal lymphatic in the
3. Schwalbe, Quincke, cited in Chikly, B.,
non-human primate.’ Neuropathol Appl Neurobiol.
31, 632-640.
6. W. G. Sutherland. Teachings in the Science of
Osteopathy, p. 82.
7. See note 1.
8. Brinker, T. et al. ‘A new look at cerebrospinal
fluid circulation, Fluids and Barriers of the
CNS.’ 2014, 11:10 http://www.fluidsbarrierscns.
com/content/11/1/10
9. See note 4.
32
10. W. G. Sutherland. Teachings in the Science of
Osteopathy, p. 58.
11. Ibid. p. 60.
12. H. I. Magoun. Osteopathy in the Cranial Field,
1st Edition, p. 16-17.
13. W. G. Sutherland. Contributions of Thought
(spiral bound version), p. 239.
14. Anne L. Wales. Reference lost in the mists
of time.
15. W. G. Sutherland. See note 13.
Summer 2014
The Conscious Practitioner
Timothy Marris
P
erception is a key element of our osteopathic
work. At all times we unconsciously select how we
interpret our understanding of clinical events.
According to Bandler and Grinder – the founders
of Neurolinguistic Programming (NLP)
– when an
external event happens (for example the patient enters our
consultation room):
change what we see, hear and feel about our patients. We
can significantly reduce these changes and distortions by
using an ‘osteopathic toolbox’ to perceive a greater truth
about our patients and their tissues, and thereby obtain a
truer diagnosis and better effectiveness.
1. Knowledge enters our psycho-physiology via the
senses: case history (hearing and sight) and examination
(sight and touch).
This is something we should bring into every consultation.
The ostopathic toolbox contains 10 tools:
2. This data gets filtered by our mind (to prevent
overload) and is unconsciously changed by our past
experiences (meta-programmes), before becoming our
conscious understanding – our ‘internal representation’
(our conscious clinical information).
fluid (CSF) hydrodynamics: A literature
1. J. Iliff, M. Wang, Y. Liao, B. A. Plogg, W. Peng,
The brain’s rich
vasculature.
Source:http://1.
bp.blogspot.com/_
mHyXwV_T3g0/
SSJrguKecOI/
AAAAAAAAACw/
oXaRRCaKNMc/
s200/
Perception
3. This creates our state of mind – how we feel about the
situation (our diagnosis and treatment approach).
4. How we feel about the situation gets transmitted to
our physiology and this determines our behavioural/
action response (clinical response).
In our osteopathic work we always apply these NLP
principles. Our perception is our internal representation.
Depending on our state of awareness we unknowingly
THE OSTEOPATHIC TOOLBOX
1. The conscious practitioner
2. Posture/personal comfort/table height
3. Centring and re-centring
4. Hand holds, fulcrum and forearm muscle tone
5. Listening
6. Give space
7. Give time
8. Peripheral vision & matching
9. Anatomy and physiology
10. Knowing when to finish
1. The Conscious Practitioner
We are partly unconscious of what we are doing nearly
all the time. When you learn to drive a car you are told
to look in the rear view mirror and at the road for other
cars and pedestrians. While listening to the instructor you
have to think of your directions and
move each foot independently on
the pedals while at the same time
coordinating the gear lever. This is
conscious driving.
After you have been driving for a
while you are able listen to the radio
and talk to other passengers, and
the next thing you know you have
arrived home. This is unconscious
driving. You would suddenly switch
into conscious mode if a difficult
traffic situation or some other
emergency occurred, but otherwise
much of your driving is highly
unconscious.
This
unconscious
skill happens when any activity is
repeated many times. A toddler
learning to walk is conscious of each
and every step, but the skill moves
on to unconscious walking a month
or so later.
When we see patients are we
Summer 2014
33
the proprioceptors, you are mechanically listening to the
function that’s going on in that particular area.
acting consciously? Are we conscious of how we use our
osteopathic toolbox? Most times not. When we become
conscious practitioners – conscious of using our toolbox
– then our treatments become more effective. This does
not mean that we have to be conscious of all aspects of the
toolbox all the time, but we do need to consciously check
each aspect when we start osteopathic work.
2. Posture, personal comfort and table height
When we have good and comfortable posture we have
greater clarity of mind; when we are less comfortable our
postural muscles tighten and our thinking becomes duller.
Having good posture whilst working is essential. Employing
the principle of tensegrity,
I have developed a simple
method of enhancing our postural efficiency.
a. Sit on a chair with your eyes closed.
b. Do not let your spine touch the back of the chair.
c. Take four or more minutes to allow any tension you
experience in your body to dissipate to adjacent tissues.
d. Imagine all tensions being spread across your
cell membranes, across the extra-cellular matrix
to neighbouring cells and further afield.
e. As you do this allow your posture to be led into a
better position – without your intellect interfering.
f. Keep doing this until you feel a sense of lightness
and spaciousness throughout your whole body.
g. Note how this has made your mind feel
lighter and calmer yet more alert.
h. Adjust your treatment table/chair to a height that
allos you to work from this ‘tensegrity ’ position.
i. Your posture is king and everything else that is
adjustable should be adjusted to this position.
j. You can do the same exercise for your
car seat and seats at home.
3. Centring
Centring is another key element of our toolbox. If we
are not properly centred our ego can distort our internal
representation by our ‘filters’ and ‘meta-programmes.’ Our
ego loves to think we know best.
Our role when diagnosing is to ignore past preconceptions,
past influences and ideas, so we can read the body tissues as
they are and not as we would like to see them. Our perception
(our mind state) comes afterwards. Our awareness needs
to be like a blank screen, allowing anything (the patient’s
tissue state) to be projected onto it.
The ego can cause us to project onto our screen a
pre-existing image which is only partially modified by
information from the patient. In this scenario we partially
or fully diagnose what we were expecting to diagnose, rather
than the reality. This happens at an unconscious level. We
are not aware of the ego getting in the way, which is why
we need to consciously centre ourselves to clean our screen.
Centring allows the mind to be more relaxed, yet alert,
more creative and dynamic, without ego. Many world
philosophies teach techniques to achieve this state. On
a physiological level, when we are centred the central
nervous system and other body systems are in a state of
neutrality at an involuntary level, which may also include
periods of ‘still points.’ As osteopaths we can therefore use
our physiological knowledge to centre ourselves. To become
centred:
a. Sit comfortably from a tensegrity posture – see tool 2.
b. Be aware of your ischial tuberosities on
the chair and your feet on the floor.
34
Summer 2014
Sur cette photo, avec notre vision déformée, nous percevons Tim
sur la Côte d’Azur Cumbria.
c. Take your awareness to your coccyx.
d. Be aware of your sphenoid body behind your eyes.
e. Make a mental connection between your coccyx
and sphenoid body via the vertebral bodies
and cranial base – the notochordal axis.
f. Be aware of how your awareness
becomes more calm and expanded.
If during a treatment you find you cannot feel anything
happening under your hands, re-centre yourself. This will:
i. Relax your posture and improve other
aspects of your toolbox to allow you to better
receive information from the tissues.
ii. Increase your clarity to discern whether
the feeling that nothing happening is due to
compression, shock, or something similar causing
the involuntary mechanism to shut down in those
tissues so that there is very little to feel.
Remember to centre before each treatment and
to consciously re-centre during the treatment.
iv. A fulcrum is the point of a lever that does not move
and gives power to the leverage. Your osteopathic fulcrum
is generally your elbow contact on the treatment table and
needs to be stable. Any instability of your fulcrum will
increase the tension in your shoulder girdle and reduce the
afferent signals from your hand contact.
When using standing techniques without elbow contact
on the table, for example when working intraorally, a good
stable posture is required with a mental sense of being
grounded through your feet. Your feet on the floor and
perhaps your thighs leaning against the edge of the table
become your fulcrum.
Altering your fulcrum pressure changes the perception of
what you feel. Be conscious of your fulcrum and modify
how much you lean on your elbows. A subtle change can
make a big difference to your palpation.
5. Listening
Rollin Becker wrote that he had to ‘give up the practice of
“osteopathy ” and study the practice of Dr Still.’ He went
on to say:
I began this by simply putting my hands on various
segments that related to their [the patients’] complaints,
and I learned to listen, listen, listen to the tissues within.
I did this because the Old Dr. Still had said that every
body physiology has a physician within that allows
physiologic function to work towards self-correction;
all the powers, motive forces, and everything necessary
for the treatment of that case are already built into that
machine; all that is necessary is to recognise and work
with these mechanisms.
physics. Tissues need time to get used to our presence,
time to give us their story, time to experience a therapeutic
process, and time to settle back to a new state of function.
As with space, if we do not give the tissues time, they get
irritable and react negatively to our work.
8. Peripheral vision and tissue matching
Using peripheral rather than focal vision helps give the
tissues a sense of space. When we look at a person we
do not stare because staring is impolite and makes them
feel uncomfortable. In the same way excessive focal vision
makes the tissues feel they are being stared at.
Tissue matching if often the key to releasing tight,
compressed tissues. Matching makes the tissues feel
comfortable so that they want to tell us everything about
themselves. We need to match the tissue tone/degree of
internal compression and the rate of involuntary motion.
When a tissue is compressed it is expressing a degree of
fear within. This fear is from trauma/pressure, chemical or
psychological excess. If we match the degree of tone the
tissue automatically starts to reduce its internal fear and
tension, and thus becomes more comfortable.
When a child is frightened by a thunderstorm it may sit
in a small space to feel more secure. Instead of just pulling
the child out, a wise parent sits next to him with empathy
(matching). This empathic state makes the child feel
understood, releases tension and fear, and helps him leave
the safe hiding place. Osteopaths need to be wise parents to
tight and tense tissues.
9. Anatomy and physiology
Becker also talked about using the proprioceptors of the
whole upper limb to feel. I would expand that to suggest
feeling the tissues with your whole body.
We need a good understanding of anatomy and physiology.
This clarifies our perception of healthy tissue and enables
us to compare the theoretical map with the actual territory
– the physical state of the tissues.
Explore how refined you can make your perception. Some
structures are minute yet can still be palpated. Stretch your
perception of what you can feel and treat.
4. Handholds, fulcrum and forearm muscle tone
6. Space
10. When to end a treatment
i. Remember to use both hands. I have observed students
with one hand under the sacrum and the other on their
own thigh. While their own thigh might be interesting, the
patient’s tissues are more so.
Tissues need space. When they are cramped or crowded –
either by our physical contact or by our mental awareness,
they respond by ‘shutting down’ and refusing to show their
information.
When you meet someone for the first time, it is important
to acknowledge their personal space and not stand too
close. The other person will back away until you are at the
distance that feels appropriate (and having already abused
their personal space, will want to back away even more).
This is a natural response that we unconsciously learn at
an early age.
The tissues respond in exactly the same way. If we get too
close to the tissues mentally they instantly shut down and
go into protective shock. This happens before we are even
conscious of it, so we then try harder to feel the tissues.
This causes more locking of the tissues and we get into
a negative spiral with the patient becoming less and less
comfortable, initially unconsciously and then consciously.
When we palpate we must become ‘polite practitioners,’
politely acknowledging the space the tissues require to feel
comfortable with our presence.
If we continue to treat after the tissues are saying, ‘I have
had enough’ we will cause irritation and discomfort. The
ego might say, ‘I can treat this even more, to make it even
better,’ but we must ignore the ego at all costs. Who is the
judge of when it is best to stop – us or the tissues? The
tissues are. We must be without ego when we palpate and
treat, so that we have clean filters and pure perception.
The tissues tell us when they have had enough treatment
by returning to a smooth flexion and extension pattern,
with fuller expression of motion and greater fluidity than
before. We may then decide to move on to a different tissue.
Often the whole body tells us that the end of the session
has been reached, by the patient taking a full inspiration,
with a sense that the whole body of fluid within the patient
is more settled.
ii. Use a full hand contact where possible – the greater the
degree of contact, the less pressure per mm2. Using your
whole hand is more comfortable for the patient, too, since
it feels like you are using less pressure and not prodding
with your fingers.
iii. Use the flexor digitorum profundus (FDP) muscles
of the forearm to adjust your contact pressure, and use
proprioception to feel the motion under your fingers. Do
not grip. Changing the tone of FDP will alter what you
feel. In the words of Rollin Becker:
Just let your hands make contact somewhere on the body.
Then, don’t do anything except barely contract your (FDP)
muscles. Do you feel something which you didn’t before?
Now, go back to not feeling with the proprioceptors. There
is a difference in the quality of the feel because with the
proprioceptive contact, you are reaching through to a body
of fluid and a set of ligaments and muscles, and they are
all in motion. With superficial contact you are not feeling
motion; all you have is a hold of the body. When you use
7. Time
Einstein elucidated that space and time are intimately
intertwined – and this is as true in osteopathy as it is in
Conclusion
All information – including diagnostic – gets distorted,
generalised, deleted or altered by our memories, values,
beliefs and decisions. We unconsciously perceive what we
experience and not necessarily what is real, and this affects
our state of awareness and thus our diagnosis and treatment.
By being conscious practitioners and using all elements of
our osteopathic toolbox we limit these unconscious changes
and maximise our empathy and effectiveness.
Summer 2014
35
Sally Pettipher
(left) is the
SCCO’s new
CEO.
NEWS
PAEDIATRIC OSTEOPATHY DIPLOMA
With so much presently going on at the SCCO it is wonderful
to watch its dynamic evolution. For years the idea of an
SCCO Paediatric Osteopathy Diploma (POD) has been
mooted, but continually met various obstacles. Now it’s
finally going to happen.
The POD is set to run over a two-year cycle starting with
the newly-styled Module 9: An Introduction to Paediatrics (in
March 2015), which remains a part of the SCCO’s Pathway
to Fellowship. This will now be a single four-day course
comprising of the existing three day Module 9b with the
fourth day covering essential ‘red flags.’
Students will attend six weekend seminars based on
‘systems,’ run in the same format as other SCCO modules,
but including red flags specific to that subject. They will
complete six case study assignments, one relevant to each
weekend’s topic, and give one case presentation. Other
written assignments will include two reports with reference
to a patient and one longer dissertation essay.
One of the stumbling blocks to getting the POD off the
ground was the issue of clinical experience. It has therefore
been proposed that each POD candidate will be required to
attend twenty practice visits – and this is where the faculty
come in.
The new mentoring scheme is already a way to benefit
clinically from faculty members’ years of experience, and we
are hoping that they will be prepared to have POD students
come and visit – and perhaps bringing their own patients
for second opinions. We shall be facilitating local study
groups, too, giving students the chance to peer review case
studies. In this way we hope to generate a vibrant learning
environment.
To complete the POD candidates will also have to
complete SCCO Module 4: Balanced Ligamentous Tension
and Module 8: The Functional Face. Those who have not
taken these courses will be allowed one more year to do so.
The SCCO wishes to thank the POD Sub-committee for their
hard work: Hilary Percival, Mark Wilson, Sue Turner and
Lynn Haller.
THE SCCO PATHWAY
The SCCO Pathway is a ‘portfolio’ or complete collection
of the SCCO Modules. Once these and three case study
assignments have been completed you are considered to be
trained to a very high standard in Osteopathy in the Cranial
Field and are eligible to be a Fellow of the Sutherland
Cranial College.
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, for
example, neurological and bioenergetic, facial and dental,
paediatric and visceral. Completing the Pathway will take
36
Summer 2014
at least four years and is evidence of both commitment and
proficiency.
How do I get on the Pathway? Any osteopath who has
joined the SCCO as a Member or Associate Member and
taken an SCCO courses is automatically on the Pathway.
There is no requirement to ‘join’ or pay an extra fee. The
SCCO office keeps a record of Modules completed by
individual osteopaths.
Is help and support is available? Experienced faculty
member Jenny Lalau-Keraly is available to answer questions
and provide advice to osteopaths interested in completing
the Pathway and achieving SCCO Fellowship. If Jenny
does not have the answers, she can put you in contact with
someone who does.
Mentoring Our mentoring scheme is still in development.
We are working with the GOsC to ensure that our mentoring
system dovetails with future and developing GOsC
requirements. Meanwhile experienced mentors are available
through the SCCO network and students are allocated a
mentoring faculty member when they attend courses. Penny
Price and Jenny Lalau-Keraly are coordinating student
support.
For futher details, see the Pathway pages on our website:
COURSE CALENDAR
The new course calendar on the SCCO website’s home page
shows courses and conferences up to two years ahead. It is
accessible directly on:
http://teamup.com/ks02ef641b45c325fe/
The course calendar has entries colour coded to allow easier
navigation to courses of particular interest to you.
Green - Pathway Courses and relevant Clinical Review Days
Blue - Fellows and Faculty Only
Pink - Paediatric Diploma
Red - Open Access conferences, workshops and lectures
Yellow - Courses in development, not yet confirmed
COURSE ROTATION
The College has always had a two-year rotation of its
Pathway Courses continue to run on a two year rotation.
Some courses are more frequent. Module 1: Foundation and
Module 2: Osteopathy in the Cranial Field run twice a year,
while Module 4: BLT and Module 8: The Functional Face run
every year.
Cindy Martin
(right) is
the college’s
new office
administrator
putting in place a Fellows and Faculty only programme,
starting with two weekends in November led by Rachel
Brooks, followed by a Breastfeeding and Orofacial
development weekend in February 2015.
CONFERENCES AND LECTURES
To allow access to all our students and people outside the
SCCO, we now offer a range of ‘open access’ events, such
as the upcoming A T Still Conference, and the 3rd Age
Conference to be run next year.
CLINICAL REVIEW DAYS
We have renamed our ‘refresher days’ to more adequately
reflect their format. This also acknowledges the likely
requirement for peer review from GOsC when they launch
their new CPD guidelines.
SCCO MEMBERSHIP CATEGORIES
To gain maximum benefit from wha the college has
to offfer we recommend joining as a member.
FELLOWS are the most experienced members of the SCCO,
having completed all Pathway courses (or their equivalents)
and have shown a longstanding commitment to the work of
the College. Faculty and trustees are drawn from Fellows.
They can use the post-nominal letters FSCCO.
MEMBERS will have done at least three SCCO courses of at
least three days. They are in the process of completing the
Pathway and can use the post-nominal letters MSCCO.
ASSOCIATE MEMBERS are osteopaths who have attended at
least one SCCO course and we hope they will be inspired to
pursue further postgraduate studies with the College.
FELLOWS AND FACULTY ONLY EVENTS
FRIENDS include any interested person, including
osteopathic undergraduates, patients, or people in
associated professions, for example dentistry, midwifery or
physiotherapy.
We recognise that our Fellows are highly qualified and
would enjoy a number of specialised courses and events,
in addition to observing on Pathway courses. Therefore are
HONORARY MEMBERS are individuals who have made a
substantial contribution to the SCCO, for example retired
faculty members who are no longer practising.
SCCO STAFF
The SCCO would like to offer sincere thanks to Hester
Joubert who has left the college after ten years of
dedicated service. Stepping into her shoes is Cindy
Martin, who lives near the new office in Hawkwood,
previously the administrator for a management training
company. Cindy works four days a week, Monday to
Thursday, and is always welcoming to students, Members,
Fellows and Faculty on the phone or in person.
Congratualtions to CEO Sally Pettipher for winning
a gold medal at the British Rowing Masters National
Championships on May 18 - which, as she says, shows ‘a
certain ortitude that has come in very handy at the SCCO
in this year of change and transition, and demonstrating my
belief that the only way to win is to work together as a team.’
The SCCO is currently recruiting a financial officer
and a marketing assistant as two part-time roles.
These posts should be filled by the end of July
to bring the office back up to full speed.
OSTEOPATHY AND THE 3rd AGE
The SCCO invites you to attend ‘Osteopathy and the 3rd
Age,’ a two day conference in June 2015 in London.
We will explore different aspects of the ageing process, the
challenges for osteopaths with growing ageing population,
and how to work alongside other health practitioners in
supporting the body through the effects of advancing years.
Speakers will share their work and experience in a series
of lectures and workshops on a variety of disciplines:
osteopathy, psychology, neuroanatomy, occupational health
and movement therapy.
Further details, speaker profiles and booking information
will be posted on www.sutherlandccevents.org.uk and the
SCCO website.
SUTHERLAND CRANIAL COLLEGE OF OSTEOPATHY
IS COMMITTED TO PROMOTING, TEACHING AND
DEVELOPING THE PRINCIPLES OF OSTEOPATHY
AS CONCEIVED BY ANDREW TAYLOR STILL AND
DEVELOPED BY WILLIAM GARNER SUTHERLAND
Summer 2014
37
RESEARCH
We are delighted to report action on many fronts:
o We have recently received confirmation from IJOM
that our first research project – the data collection
exercise comparing aspects of practice of Osteopathy in
the Cranial Field with the general Osteopathic profession
– is to be published. There has been an extremely long
wait for confirmation of publication, due to lengthy
communications with the peer reviewers, and I cannot
give you a date for publication, but all the same it is
happening!
o We have recently received confirmation that Ethics
Board approval has been granted for our second research
project, the feasibility study on Infantile Colic. This will
compare NHS care with Osteopathic care of colicky
infants. This means that the ESO post-graduate research
team led by Dr. Anne Jaekel can now recruit for the
clinical study – both osteopaths and patients. It’s definitely
an exciting and busy time.
o Following the success of the SCCO Research
Conference, Hidden Treasure, last October all the lectures
will shortly be available for viewing on YouTube. Links will
be entered onto a Research page on the SCCO website
and these links can be disseminated freely. Many thanks
to Caspar Hull for arranging the conversion of the format
with Danielle Harvey-Kummer (Dianna’s daughter) and
for the continuing support of the SCCO Board of Trustees
in allowing osteopathic research to become more widely
available. I think the whole project should reflect well on
the SCCO.
o We are starting to discuss the nature of our next
research project. Whether this will be another clinical
study remains to be seen. There is a huge amount of useful
information that can come out of outcome/data collection
studies (and at a more affordable cost) and this makes
these studies quite attractive.
Summer 2014
A weekend with Rachel Brooks, MD
STUDENT FEEDBACK
I just finished Module 2/3 for the second time, having first
taken it in September 2012, and I am so glad I decided to
come back. I enjoyed the course last year, but felt quite
overwhelmed by the information, practical and theoretical.
Throughout the year I’ve tried to use the skills I learned,
but at times found that memory failed me or I doubted my
palpation. I had promised myself to review the anatomy
and concepts, but in a busy life that never happened to the
extent that wished it.
Repeating the course forced me to do just this. Also I
found the experience this year much more relaxed and
enjoyable. I could allow myself to let everything wash over
me and take in the information more holistically. It’s as if it
permeates me now and some of the knowledge is actually
internalised within me.
I realise I still have massive amounts of anatomy to learn
and palpation to improve, but I’m better equipped for my
future as an osteopath by having taken this course a second
time. I would do it a third time, and maybe I will. After all,
repetition is the master of all skill.
have come to work with them in my practice.
We will also explore Dr. Becker’s ideas on the nature of
potency and health; the role of the physician; the effects of
trauma, and treating the ‘locked sacrum.’
Approximately half the course will be practical work.
Rachel’s informal, informed and personal approach, and the
depth of her experience, create a learning atmosphere that is
very special.
The course is particularly aimed at those who are engaged
in teaching, mentoring or otherwise furthering Sutherland’s
and Becker’s work. Rachel has incorporated into the course
how she teaches these skills, with the hope that others can
use them in their own teaching. Experience of the previous
course is welcome, but not necessary.
Both weekends are limited to a maximum of 26 delegates.
See the website for availability.
FELLOWS and FACULTY £545 single room, £505 shared
room, or £445 non-residential.
EXTERNAL CRANIAL TEACHERS (e.g. teaching cranial to
undergrads at university) may reserve a place on a first come
first served basis after Faculty and Fellows from 1 June 2014.
NON-MEMBERS (of SCCO) £595 single room, £555 shared
room, £495 non-residential.
For further information contact the SCCO office:
01453 767607l
[email protected]
www.sutherland cranialcollege.co.uk
Rollin Becker’s Life in Motion and The Stillness of Life,
edited by Rachel Brooks, are available in the UK from
www.atstill.com
Gudrun Goransson (Sweden)
Rollin Becker. Life in Motion, p. 261-2.
38
OSTEOPATHIC PRACTICE
Clive Hayden, Research Committee Chairman.
Say you decide for that day that your treatment
is to be directed at a torsion right lesion; you
initiate it into that torsion pattern, you allow it
to go the full excursion, and then you gently
hold it in that area and do not allow it to come
back to neutral again. As you hold it there, it
goes through its cycle of argument, goes through
a stillpoint, and then you allow it to drift back
to whatever new neutral it has discovered.
In doing this, you have not only worked on a
torsion membranous articular strain pattern, you
have induced a change through the fascial structure
of the thirty-four muscles attached to the base of
the skull and through all the fascias of the system.
Therefore, if you run into one that has a lot of
arguments and takes forever, be glad; it is not that
the local cranial problem is holding you up, it’s that
there are torsion factors in the fascia, clear down
through the pelvis to the feet, that also have to get
quieted down and shift gears so these forces can
come and go through a stillpoint. Also, you will
find that somebody with a sick body is going to
respond slower than somebody with healthy fascia.
PHOTOGRAPH: JOHN LEWIS.
KEY ELEMENTS IN EFFECTIVE
14-16 November 2014
Repeated 21-23 November 2014
Both weekends begin 1pm Friday and end 4pm Sunday
Hawkwood College, Stroud.
The SCCO is privileged once again to host Rachel Brooks,
MD, editor of Rollin Becker’s collected papers Life in Motion
and The Stillness of Life.
Six years ago her two-day course was oversubscribed
and many were disappointed, so we are especially pleased
that she has agreed to deliver this course on two separate
weekends. Here is what she has written about her motivation
to share what she learned from Becker in a unique one-onone tutorial setting. Rachel writes:
Beginning in 1975 I had the privilege of spending time
with Rollin Becker, DO over a span of years and later
further immersed myself in his teachings as I edited his
work for publication. Then, about ten years ago, I began
teaching courses on the legacy of his work. In the process
of developing and teaching these courses it became clear
to me that there are three key areas of understanding and
skills I learned from Dr. Becker. These are: the relationship
between the patient and physician; working with Stillness;
and using compressive forces. In this course I will cover
both Dr. Becker’s teaching on these subjects and how I
While we may lack ‘scientific, laboratory
proof’ that the primary respiratory
mechanism is responsible for this total
involuntary system throughout the whole
body, we can say categorically - we can
very definitely make this statement - that
this is the only way the primary respiratory
system works. There are no muscular
agencies or other voluntary mechanisms
within the primary respiratory mechanism
to cause it to do this flexion/external
rotation, extension/internal rotation - but
this is the only way it does work.
It is a mechanism and that means we have
to study it as a mechanism. We have to
study the bones, the membranes, the central
nervous system, and the cerebrospinal fluid
as the working units of a something that is
already doing what it does because that is
the way it was designed and it’s the only
way it can function.
Rollin Becker. Life in Motion, p. 98.
Summer 2014
39
Courses 2014 - 2015
A. T. STILL WORKSHOP
Saturday 21 June 2014 | BCOM, London
CPD 8 hrs | £100
Leader | Maxwell Fraval (Australia)
A. T. STILL 140th ANNIVERSARY CONFERENCE
Sunday 22 June 2014 | Regent’s Conference Centre, London
CPD 8 hrs | £120
Leader | Jeremy Gilbey
OSTEOPATHY IN THE CRANIAL FIELD | Module 2
23-27 June 2014 (Monday-Friday) | Germany
CPD 40 hrs | £1470 (residential)
Leader | Eva Moeckel
PAEDIATRICS | Module 9
27-29 June 2014 (Friday-Sunday) | Spain
CPD 32 hrs
Leader | Jose Apeztegia
FOUNDATION COURSE | Module 1
28-29 June 2014 (Saturday-Sunday) | BCOM, London
CPD 16 hrs | £270 (non-residential)
Leader | Dianna Harvey-Kummer
IN RECIPROCAL TENSION | Module 5
18-20 July 2014 (Friday-Sunday) | Stroud
Leader | Michael Harris
W G SUTHERLAND’S APPROACH
TO THE BODY AS A WHOLE | Module 4
23-27 May 2013 | Stroud
Leader | Susan Turner
SPARK IN THE MOTOR | Module 7
24-26 October 2014 (Friday-Sunday) | Stroud
Leader | Rowan Douglas-Mort
INTEGRATING CRANIAL INTO PRACTICE | Mod 10
Saturday 8 November 2014 | BCOM, London
CPD 8 hrs | £165
Leader | Michael Harris
RACHEL BROOKS FELLOWS DEVELOPMENT PART 1
14-16 November 2014 (Friday-Sunday) | Stroud
CPD 20 hrs | £445-595 depending on status
Leader | Rachel Brooks
RACHEL BROOKS FELLOWS DEVELOPMENT PART 2
21-23 November 2014 (Friday-Sunday) | Stroud
CPD 20 hrs | £445-595 depending on status
Leader | Rachel Brooks
SCCO AGM
Saturday 6 December 2014 | BCOM, London (provisional)
£ FREE (Fellows and full members may vote, others are welcome to observe)
15-19 September 2014 (Mon-Fri) | Columbia Hotel, London
Leader | David Douglas-Mort
VISITING LECTURER AND WORKSHOP
MODULE 8 CLINICAL REVIEW DAY
FOUNDATION COURSE | Module 1
AN OSTEOPATHIC APPROACH TO INFANT FEEDING
METHODS AND OROFACIAL DEVELOPMENT
28 June 2014 | London
CPD 8hrs | £165
18-19 October 2014 (Saturday-Sunday) | Bath
DENTAL WORKSHOP
9 March 2014 | Stroud
CPD 2.5 hrs | £55
Leader | Dr Helen Jones
Sunday December 2014
CPD 8 hrs | Details to be confirmed
12-16 January 2015 (Mon-Fri) | Germany
Leader | David Douglas-Mort
7-8 February 2015 | Columbia Hotel, London
CPD 16 hrs | £ to be confirmed
Leader | Gunn Kvivik and Line Cote
Phone: 01453 767607
Email: [email protected]

TOM DUMMER - Sutherland Cranial College

Transcription

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