Osteopathy, Medicine,
and Health:
a possible way of interaction
Vincenzo Cozzolino MD / DO
AIOT Pescara Italia
What is the Task of
a Doctor ?
Find the health should
be the object of the
doctor, anyone can find
disease
A.T. Still
Compito del Medico è
ricercare la Salute. Tutti
sanno trovare la Malattia.
2
Costituzione della
Repubblica Italiana
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.
what is
Health ?
Health
"a state of complete physical, mental,
and social well-being and not merely the
absence of disease or infirmity"
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.
6
What is Well-being ?
Quality of Life (QoL) is a phrase used to refer an individual's total 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
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 ?
..... it’s not possible to measure the
health, because it rappresents a
state of intrinsic adequacy ....
The Enigma 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;
George Canguilhem
Is there a biological model which
could cope this statement ?
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.
Dramatic shifts of metabolism, muscle
morphology, and complex patterns of
behavior in migrating birds.
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.
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.
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
Roozendaal, B., 2000. Glucocorticoids and the regulation of memory
consolidation. Psychoneuroendocrinology 25, 213–238.
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.
By Francesco
Allostasometer !!!
Cardiovascular
System
Allostasis
Physical
Stress
Somatic
Visceral
Psychosocial
Stress
Emotional
Willard F. Ph.D
Seminar at the Sutherland Cranial Academy Belgium 2004
The Arousal
System
NeuroEndocrineImmune
Axis
Norepinephrine
Cortisol
Cytokines
Nervous
System
Immune
System
Renal
System
Gastrointestinal
System
• 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
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.
J.N. Howell, F. Willard
Ohio Research and Clinical Review
Vol. 15 Spring 2005
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 - [email protected]; Douglas Ivins - [email protected]; Miriam Mills - [email protected];
Frances K Wen - [email protected]; Bruce A Benjamin* - [email protected]
* Corresponding author
Published: 5 June 2008
Received: 5 October 2007
Accepted: 5 June 2008
Osteopathic Medicine and Primary
Care 2008, 2:7 doi:10.1186/17504732-2-7
Conclusion
✴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
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