Osteopathy, Medicine,

and Health:

a possible way of interaction

Vincenzo Cozzolino MD / DO

AIOT Pescara Italia

What is the Task of

a Doctor ?

2

Compito del Medico è

ricercare la Salute. Tutti

sanno trovare la Malattia.

Find the health should

be the object of the

doctor, anyone can find

disease

A.T. Still

Articolo 32

La Repubblica tutela la salute come fondamentale diritto dell'individuo e interesse della

collettività, e garantisce cure gratuite agli indigenti.

Nessuno può essere obbligato a un determinato trattamento sanitario se non per

disposizione di legge.

La legge non può in nessun caso violare i limiti imposti dal rispetto della persona umana.

Costituzione della Repubblica Italiana

what is

Health ?

Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19–22 June 1946; signed on 22 July 1947 by the representatives of 61 States (Official Records of the World Health

Organization, no. 2, p. 100); and entered into force on 7 April 1948.

Health

"a state of complete physical, mental,

and social well-being and not merely the

absence of disease or infirmity"

6

What is Well-being ?

In reference to medicine and healthcare as Health Related Quality of Life

, it refers to how the individual’s well-being may be impacted over time by

a disease, a disability, or a disorder

Centers for Disease Control and Prevention

www.cdc.gov

Quality of Life (QoL) is a phrase used to refer an individual's total Well-being

The

philosophers

tried

to give

a definition of

Health

Health

the ability of the organism to adapt to

challenges esposed by the environment, to

create new norms for new settings.

Normality is measured by the adaptability of

the individual;

Health a margin of tollerance for the

inconstancies of the Environment

Health is a regulatory flywheel of the possibilities

of reaction

to be in good health means being able

to fall sick and recover, it is a biological

luxury

Can We measure

Health ?

The Enigma of Health

..... it’s not possible to measure the

health, because it rappresents a

state of intrinsic adequacy ....

Is there a biological model which

could cope this statement ?

Health

the ability of the organism to adapt to

challenges esposed by the environment, to

create new norms for new settings.

Normality is measured by the adaptability of

the individual;

George Canguilhem

Allostasis

Allostasis is achieving stability through

change. This is a process that supports

homeostasis,

The concept of allostasis in biology and biomedicine

McEwen BS, Wingfield JC.

Horm Behav. 2003 Jan;43(1):2-15.

Homeostasis

is the stability of physiological systems that maintain life, used

here to apply strictly to a limited number of systems such as

- pH,

- body temperature,

- glucose levels,

- oxygen tension

that are truly essential for life and are therefore maintained

within a range optimal for the current life history stage.

The concept of allostasis in biology and biomedicine

McEwen BS, Wingfield JC.

Horm Behav. 2003 Jan;43(1):2-15.

Examples of

Allostasis

variations in blood pressure: in the morning, blood pressure rises when we get out

of bed and blood flow is maintained to the brain when we stand up in order to

keep us conscious. This type of allostasis helps to maintain oxygen tension in the

brain.

Sterling, P., Eyer, J., 1988. Allostasis: a new paradigm to explain arousal pathology, in: Fisher, S.,

Reason, J. (Eds.), Handbook of Life Stress, Cognition and Health, Wiley, New York, pp. 629–649.

Kuenzel, W.J., Beck, M.M., Teruyama, R., 1999. Neural sites and path- ways regulating food

intake in birds: a comparative analysis to mammalian systems. J. Exp. Zool. 283, 348–364.

Dramatic shifts of metabolism, muscle

morphology, and complex patterns of

behavior in migrating birds.

It is a clear adjustment to demands of state dictated by life

history stage, environmental conditions, and social context.

Allostatic processes can also go beyond immediate

homeostasis, and maintenance of body temperature and

pH, to broader aspects of individual survival, e.g., from

pathogens or physical danger.

For the immune system, acute stress induced

release of catecholamines and

glucocorticosteroids facilitate the movement of

immune cells to parts of the body where they are

needed to fight an infection or to produce other

immune responses.

Dhabhar, F., McEwen, B., 1999. Enhancing versus suppressive effects of

stress hormones on skin immune function. Proc. Natl. Acad. Sci. USA

96, 1059–1064.

Roozendaal, B., 2000. Glucocorticoids and the regulation of memory

consolidation. Psychoneuroendocrinology 25, 213–238.

In the brain, glucocorticosteroids and catecholamines act

in concert to promote the formation of memories of events

of potentially dangerous situations so that the individual

can avoid them in the future

From the standpoint of health of the individual, the

most important feature of mediators associated with

Allostasis is that they have protective effects in the

short run, but they can have damaging effects over

longer time intervals if there are many adverse life

events or if hormon secretion is dysregulated as in a

sustained allostatic state that leads to allostatic

overload.

McEwen, B.S., 1998. Protective and damaging effects of stress mediators.

N. Engl. J. Med. 33, 171–179.

Allostasis forms a continuum between events of

the normal life cycle and unpredictable

perturbations with clear transition points and

outcomes.

Allostatic load refers to the cumulative cost to

the body of allostasis as individuals adjust

their morphology, physiology, and behavior to

environmental changes, social state, etc. This

can fluctuate as the animal changes life history

stage and as the seasons and other cycles

progress.

If the Allostatic Load

is kept for long time

becomes an Overload

There are two types of Allostatic overload:

Type 1 and Type 2

Allostatic overload Type 1 is a state in which the costs

of the life history stage and accompanying challenges

exceed the food resources available to provide

sufficient energy

Allostatic overload Type 2 is state in which deleterious

challenges are chronic and lead to a sustained allostatic

state independent of seasonal changes in the environment.

The concept of allostasis in biology and biomedicine

McEwen BS, Wingfield JC.

Horm Behav. 2003 Jan;43(1):2-15.

Serious Pathophysiology

can occur if overload is

not relieved in some way.

Is it possible to

measure the

Allostatic Load ?

Allostatic Measures Reflecling Chronic Stress Responses

✴Cardiovascular Activity

✴Waist-hip ratio

✴Serum high-density lipoprotein and total cholesterol

✴Plasma glycosylated hemoglobin

✴Overnight urinary cortisol, Epinephrine and Norepinephrine

excretion

Epel, E. S., McEwen, B., Seeman, T., Matthews, K., Castellazzo, G., Brownell, K. D., et al. (2000).

Stress and body shape: Stress-induced cortisol secretion is consistently greater among women with central fat. Psychosomatic Medicine, 62, 623-632.

Allostasometer !!!

By Francesco

Cardiovascular

System

Nervous

System

Immune

System

Renal

System

Gastrointestinal

System

Physical

Stress Somatic

Visceral

Psychosocial

Stress Emotional

Allostasis

The Arousal

System

Neuro-

Endocrine-

Immune

Axis

Norepinephrine

Cortisol

Cytokines

Willard F. Ph.D

Seminar at the Sutherland Cranial Academy Belgium 2004

• Nervous System

• Sympathetic nervous system

• Endocrine

• HPA axis

• Immune System

• Cytokines

Willard F. Ph.D

Seminar at the Sutherland Cranial Academy Belgium

2004

Could the Somatic

Dysfunction be considered

a condition of Allostatic

Overload ?

Clinical Evidence for

osteopathic lesion

✴hyperalgesia (with or without pain),

✴abnormality in the texture or tone of soft tissues,

✴anatomic asymmetry,

✴disturbance in range and ease of joint motion

J.S. Denslow

Pathophysiologic evidence for the osteopathic lesion: the know, the

unknown and controversial

J Am Osteopath Assoc, Dec 1975; 75:415

J.N. Howell, F. Willard Ohio Research and Clinical Review

Vol. 15 Spring 2005

Abnormality in the texture or tone of soft tissues in the Somatic Dysfunction

are elicited by the activation of Primary Afferent Nociceptor which are able to

generate Neurogenic Inflammation.

Neurogenic Inflammation

There is a relation between a sustained

sympathetic activity and Somatic Dysfunction

Korr IM Sustained sympathicotonia as a factor in disease.

The neurobiologic mechanism in manipulation therapy

New York Plenum Press; 1978: 229-268

The sympathetic plays a modulatory role in

neurogenic inflammation

Wang J. Ren Y. Fang L. Willis WD. Lin Q.

Sympathetic influence on capsicine-evoked enhancement of dorsal root

reflexes in rats. J Neurophysiol. 2004; 92: 2017-2026

Osteopathic manipulative treatment and its relationship to

autonomic nervous system activity as demonstrated by heart rate

variability: a repeated measures study Charles E Henley1, Douglas Ivins1, Miriam Mills2, Frances K Wen1 and

Bruce A Benjamin*3

Address: 1University of Oklahoma Health Sciences Center, Department of Family Medicine, Tulsa, OK 74120, USA, 2Oklahoma State University

Center for Health Sciences Department of Osteopathic Manipulative Medicine, Tulsa, OK 74107, USA and 3Oklahoma State University Center for

Health Sciences Department of Pharmacology and Physiology, Tulsa, OK 74107, USA

Email: Charles E Henley - charles-henley@ouhsc.edu; Douglas Ivins - douglas-ivins@ouhsc.edu; Miriam Mills - miriam.mills@okstate.edu;

Frances K Wen - frances-wen@ouhsc.edu; Bruce A Benjamin* - bruce.benjamin@okstate.edu

* Corresponding author

Published: 5 June 2008 Received: 5 October 2007

Accepted: 5 June 2008

Osteopathic Medicine and Primary

Care 2008, 2:7 doi:10.1186/1750-

4732-2-7

✴Health could be considered an

integrative function

✴It is concerned with the ability of

organism to adapt

✴Allostasis is a biological model to

explain the ability to adapt

✴Somatic Dysfunction is assimilable to

a state of Allostatic Overload

Conclusion

Finding the way to fix the

Somatic Dysfunctions

creates the conditions

to enhance the state of

Health of the individual

Salus is the Latin name for Health

this word comes from the sanskrit

Sarva,

for an Osteopath its meaning is extremely loaded.

It means Whole !

Grazie per la Vostra Attenzione