Two Osteopathic Adjustments Induce Stabilogram Modifications in Agreement with their frontal or sagittal Implication.

by
Alain SCHEIBEL & Maurice DEBUSSCHÈRE

Summary
     The effects of two osteopathic handlings were studied by two stabilometric criteria: the Cervical Symmetry Quotient and the Amplitude Spectrum.
     Out off 60 people, half of them were subjected to a high velocity technique, the force of which was located in a frontal (left-right) plane of the body, the other half were subjected to a fascia technique, the force of which was in the sagittal (antero-posterior) plane of the body.
     The high velocity technique induces a significant modification of the Cervical Symmetry Quotient, which tends to be normal two days later; neither 20 minutes nor 7 days later does the Fascia Technique modify this criteria.
Both techniques modify significantly the amplitude spectrum, high velocity technique in the 0,16/0,22 Hz frequency band and in the frontal (left-right) plane, the fascia technique in the 0,3 Hz frequency band and in the sagittal (antero-posterior) plane of the body. These modifications last for up to 2 and 7 days respectively.
So each of these two osteopathic techniques induces postural effects in the concerned plane of the body and not (or little) in the perpendicular plane.

Introduction
     Manual techniques used by osteopaths are controversial. They are supposed to be able to improve behaviours, perceived as painful or distressing, by modifying certain anatomical connections. But if it is so, a modification of postural behaviour of the treated subject must be observed as a result of these adaptations. This preliminary work looks for such consequences.

Material and Methods
     Sixty voluntary subjects participated in the experiment. They did not come to consult, but simply agreed to undergo one of these conventional techniques of osteopathy: The high velocity technique and the cranio-sacral fascia technique; each of them was practised by one and same experimenter.

High velocity technique
     Before the manoeuvre, limitation of cervical mobility had to be appreciated. Subject lies in supine position; a pillow can be placed under his head, according to his morphology, so that his frontal plane is parallel to that of the testing table. The practitioner, at the head of the subject, slides the pulp of his indexes under the back side of the transverses processes of the third cervical vertebra (C3) and the pulp of the middle under the back side of the transverse processes of the second cervical vertebra (C2); the other fingers spread out at the back side of the head; palms contain the head; thumbs follow the processus zygomaticus ossis temporalis. Both hands are symmetric in regard to the sagittal plane of the subject. Test consists in rotating the block «head/C2» by the same movement, until C3 itself is pulled, what feels the right index against which the C3's right transverse process props up. The same manoeuvre is repeated to the other side. The amplitude of the rotation is estimated by the position of the nose in regard to the axis of the body. Restricted side is noted.
     The manoeuvre of the high velocity technique is made on the restricted side; the description which follows, supposes it to the right.
     From the position test, the practitioner slides his hands so that the external side of his metacarpo-phalanx joint of the left index rests against the back side of C2 left articular process. The other fingers and the palm of the hand are in the position they had for the test. The right hand, in identical position on the right-hand side of the head, is synchronous to the left one. The couple of forces established by two indexes is going to mobilise C2.
First, the vertebra is brought in light flexion in the sagittal plane around a horizontal axis crossing by the centre of C3's body to introduces tension in articular and periarticular structures; the fact that they are rarely only in one of the reference planes limits mobility in the other plans. Then C2 is driven in a light right rotation in the horizontal plane around a vertical axis passing through the middle of the segment that connects two articular facets. Then, while maintaining acquired flexion and rotation, the practitioner realises, by tilting it to the left, a translation of C2 towards the right-hand side to obtain the separation of the two articular facets. A light tension on the block 'head/C1/C2' according to the subject's vertical axis ends this starting tension (Hartmann, 1985).
Then an increase of the rotation to the right, fast but of short amplitude, provokes a gaping, sometimes audible, of the joint. This particular orientation of the force during the thrust was chosen according to the technique of stabilometric examination of the cervical symmetry, which is practised only in rotation.
Then a new test controls the decrease or disappearance of rotation limitation. The protocol forecasted that a second stabilometric recording would be practised only when cervical limitation would be modified by the manoeuvre; in fact this second manoeuvre was required for only one subject.

Fascia Technique
     The cranio-sacral fascia technique, as used in this protocol, tried only to increase the expansion phase of the primary respiratory mechanism by two flexion manoeuvres, the first on the «cranial sphere», the second of the «pelvis sphere» (Magoun, 1970); all other sense or direction of the technique were excluded.
     First manoeuvre on the head/vomer. The patient lies in decubitus. The cephalic hand of the practitioner holds the occiput of the patient in the cavity of its palm, the index and the middle finger, shaped like a letter V, support the lateral masses. The pulp of the other hand index presses on the intermaxillary suture of the palate, vertically from bottom to top, just behind the superior incisors. The direction of the movement is forwards and upwards for the lateral masses of the occiput, backwards and downwards for the lambda. The manoeuvre was practised on every patient during two minutes with a force of five kilograms on the intermaxillary suture.
Second manoeuvre on the sacrum. The patient lies in decubitus. The practitioner slides one of his hands under the sacrum so as to provoke a forward movement of its point and a backward movement of its base, under the weight of the subject. As the previous one, this manoeuvre lasts two minutes, separated from the first by a one-minute rest.
     This fascia technique was retained for several reasons. It is working in the antero-posterior plane, perpendicular to the left-right plane of the high velocity technique, as it was used for this protocol. It looks for a global action, on the deep fascias of the dura extending from the skull to the coccyx, at the opposite of the high velocity technique, which looks for a local action at only one vertebral level. Finally, practised without preliminary test, the systematic flexion of the primary respiratory movement opposes to the aim to normalise C2/C3 articular amplitude that is tested and found limited either to the right or to the left.

Stabilometry.
     Modifications of the postural behaviour were appreciated by three series of stabilometric recordings executed in the standard conditions of the Association Française de Posturologie (Normes85, 1985). The first recording was made before the manoeuvre, the second after 20 minutes, the third either after two days for the high velocity technique, or after seven days for the fascia technique. The subjects rested ten minutes lying then ten minutes sitting between the manoeuvres and the second recording.
     Every series of stabilometric recordings included this sequence of situations: eyes open, eyes closed, head rotated to the right, head rotated to the left.
     The cervical symmetry quotient was calculated as:

Ahr / Ahl

Where Ahr and Ahl is the value of the statokinesigram area in the head to the right or head to the left situation.

     The amplitude spectrum was calculated in the frequency band 0,04 to 0,6 Hz where centre of pressure oscillations are not far from being the same as centre of gravity oscillations in these recording conditions (Gurfinkel, 1973, Gagey, Bizzo and al., 1985).
     Mean comparisons of paired samples were made by Student's t-test.

Results

TAB I - Cervical symmetry quotients observed at the different periods of the experimental protocol.
There is a statistically significant difference of the cervical symmetry quotient after the high velocity manoeuvre but no statistically significant difference after the fascia manoeuvres.
N=30 for each technique.

TAB. II - Mean differences of the amplitude spectra in some frequency bands, for right-left (R/L) or forward-backward (F/B) postural sway, according to different visual conditions and techniques.
     The high velocity technique brings about a statistically significant difference (p<0.03) of the amplitude spectra in the frequency band 0.16/0.22 Hz (fig. 1) but only for right-left postural sway not for forward-backward postural sway (Tableau II).
     For normal subjects the mean difference of amplitude spectra between two successive recordings made in exactly the same conditions is null in the frequency band 0/0.6 Hz (Gagey et al., 1985).

     The fascia technique brings about a statistically significant difference (p<0.02) of the amplitude spectra in the frequency band 0.3 Hz, but only for forward-backward postural sway not for right-left postural sway, in the eyes open situation (Tableau II).

Conclusion
     According to these stabilometric criteria, cervical symmetry quotient and amplitude spectra differences, two different osteopathic techniques bring about statistically significant variations of postural control, in the plane where each of these techniques is supposed to act, right-left for the high velocity technique, forward-backward for the fascia technique (Kapteyn, 1973). Moreover each of these techniques has no effect (or a lesser effect) on the same criteria but in the perpendicular plane to that where it is supposed to act.
     It is rather amazing to notice that the immediate effect on the amplitude spectrum persists during two days for the high velocity technique, seven days for the fascia technique. This preliminary work cannot give any explanation of these persistences, but it is to underline that these delays of two and seven days were retained according to clinical results of these two techniques.

References
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