Methodologies for Effectively Assessing Complementary and Alternative Medicine (CAM) by Peter W. McCarthy

Author:Peter W. McCarthy
Language: eng
Format: epub
ISBN: 9780857011978
Publisher: Jessica Kingsley Publishers
Published: 2015-04-10T00:00:00+00:00

11

Research into the Clinical Linkage between Visceral Dysfunction and Somatic Symptomatology

Peter W. McCarthy, BSc, PhD

As the book aims to provide an overview of each discipline and an acceptable methodology for studying each discipline or ethos, it is important for each chapter to construct a pathway that might be of some use in helping isolate those issues that need to be addressed. In some disciplines, obviously, this is easier than others, primarily as a result of the philosophical distance between the conceptual model being used in the discipline and that “acceptable” to the dominant medical paradigm at that time. The key element is for the reader to appreciate that, whichever paradigm or discipline is being discussed, the practitioner generally wishes to tease out what can be utilized for the ultimate benefit of the patient. As always, in order to achieve the ultimate aim, the discipline has to be dissected and invariably reconstructed before any conclusion can be drawn.

With this in mind, in considering the concept of viscerosomatic and somatovisceral interactions, there are two main elements that need to be considered—the detection and use of this phenomenon in diagnosis and the treatment via manipulation. This chapter will be concerned primarily with the potential for detection, by attempting to highlight a number of the problems associated with the use of palpation in diagnosis and to suggest a design for trialling treatment, indicating where there might be some move towards finding an answer to some of larger questions. The areas to be addressed will include:

•Overview and background—the roots of visceral and somatic relationships in manual therapy.

•Evidence for the concept—the involvement of homeostasis.

•The neurological mechanisms for visceral sensory input leading to somatic muscular change.

•Is clinical detection of visceral dysfunction possible?

•How best to test if manual therapy can be effective.

•Choosing a suitable control/placebo.

In order to address these issues, the author will fall back on experience and prior published evidence, from which some direction regarding the methods for future research will be offered.

Overview and Background

Knowledge of those conditions which may respond to manual therapy and in particular the “adjustment” of joints, especially those in the vertebral column, is of great interest to many manual therapists in general, but arguably of most significance to chiropractors and osteopaths. One of the deepest-held “philosophies” (a word used inappropriately by both professions on occasion) in both of these professions has been that of the palpable lesion, also known as spinal dysfunction (or the currently less-favored term “subluxation”), which can have wide-ranging health effects and can be used to indicate deeper internal organ dysfunction (Burns 1907; Faye 1986). However, this subject has inspired much controversy and uninformed comment throughout its stormy history—as it still does today.

Arguably, manual therapy can be divided into two distinct conceptual approaches to treatment:

•specific adjustments for correction of anatomical or biomechanical issues that impact on function via defined musculoskeletal or nerve (root impingement) compromise (structural) and

•specific adjustments for physiologic regulation (neuro-hormonal) that might involve modification of activity in internal organ function (functional).

In recent years, the primary emphasis of

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