Manual medicine can be maddening…

I often say that the human body is complex and the answers are never straightforward or easy. Right when you think you have a handle on treating, something new comes along to make you question everything.

The writings of my friend and colleague Craig Harness, DO(Q), PhD(c), remind me that my thoughts on this subject may not be quite accurate. Craig states in a blog post he wrote for somafinder.com that our shared mentor, Guy Voyer says that “osteopathy (manual medicine) is easy once you know the anatomy.”

I was reminded of this lesson in a challenging way recently.

While treating a woman for persistent pain at the ischial tuberosity with limited and transient results, I was at a crossroad. I thought I had tried everything in my arsenal. I worked distal from the lesion. I worked all of the chains. I tried strengthening all of the areas that might be contributing to the problem. We tried myofascial stretching and ELDOA.  I treated all of the relevant tissue in the area. Or at least I thought so…

While going through an anatomy book from the turn of the last century by Carl Toldt researching other issues, I came across this picture:

I realized that I forgot to take into account ALL of the structures that were in the area. Toldt beautifully depicts the many bursae in the buttock area. Specifically, the bursa of the biceps femoris muscle (yellow arrow above) was depicted. Volia! I suddenly had another avenue to explore.

I had not been instructed in a technique exactly for this bursa. I had, however been instructed in treatment techniques for many other bursae in the body. So, as Voyer told Craig, if I knew the anatomy and I understood the principles, this problem should be easy to solve. With both of these data points, I set out to treat this bursa as best I could.

The author treating the bursa of the biceps femoris

The author treating the bursa of the biceps femoris

After treating the bursa with the “new” technique for a few minutes, I asked the patient to test the movements that always elicited the pain. She complied, and for the first time in our efforts to help her. she had no pain.

Zero, nada, zilch!

I share this story not to bring attention to myself or the techniques. I wanted to share this story to remind us all about the power of life long anatomical study. The best manual therapists I know spend time with anatomy every day. They also have multiple sources of anatomical references.

Carl Toldt’s books are free in the public domain and are better than most books written today.

One of my favorite references is the five volume series of French anatomy books from Alain Bouchet and Jacques Cuilleret. There is no need to speak French. The drawings are clean and there are many views of the same structure to get a clear understanding of its relation to other structures.

And, there is always the Complimentary and Alternative Medicine Human Dissection Experience presented by the aforementioned Craig Harness. The CAM-HDE is an open curriculum dissection of soft-embalmed cadavers at Queens University in Kingston, Ontario. I did this course and it changed the way that I treat and see the human body forever.

Remember, like Voyer says, treating is easy if you know the anatomy. Now just go get it.


When something is right…


Brian Murer, DC/SMTh, is the co-founder of the Evolutions Institute of SOMA Instruction.  EISI is a school based on the work of Guy Voyer, MD/DO and is committed to training the next generation of manual therapist and exercise professionals. To learn more about EISI and their course offerings, go to www.evolutionsinstitute.com


Craig Harness, MSc, PhD(c), RMT, DO(Q),  is a Lecturer of Anatomy and Pedagogical Director of the CAM - HD Experience at Queen’s University with an extensive background in the fields of both Anatomy and Osteopathy.  He completed his Bachelor of Science, Human Sciences degree (Athabasca University) and his Masters of Anatomy & Cell Biology (Queen’s University) with a focus of professional anatomy education for members of the Complementary and Alternative Medicine streams.  He completed his Diplôme d’Ostéopathie from Académie Sutherland d’Ostéopathie du Québec where he has also held the position of professor.  For more information about the CAM-HDE go to: dbms.queensu.ca/home/camhde

A New Reality

Today I finished Graham Scarr’s fantastic book on biotensegrity, Biotensegrity - The Structural Basis of Life (Scarr, 2014). In his book, Scarr deftly outlines the history, theories and functional implications (therapeutic and performance) of biotensegrity. It’s a must read for the therapist and exercise professional alike. 

Near the end of the book, Scarr’s chapter entitled,  “Biotensegrity: a rational approach to biomechanics,” includes “A new reality.” In this section, he proposes that the old terminology, traditionally used in the study of human anatomy and biomechanics has, through its lexicon, “reduced human anatomy down into a collection of distinct ‘parts’ which are then regrouped into functional units. (Scarr, p. 102). He argues that these regrouped units are well-meaning but misguided efforts, leaving out many important structures (e.g. connective tissue, blood vessels, etc.) that have important roles in human locomotion and stability.

Scarr then proposes a term credited to Stephen M. Levin, MD and himself, mesokinetics. (Levin & Scarr, 2012). Mesokinetics, he says, is a term that is much more inclusive of structures involved in human locomotion, and it also describes their origins and functions. 

The term Meso refers to the embryonic mesoderm from which connective tissues (fascia and bone) and muscles evolve. Kinetics is the branch of mechanics concerned with the study of bodies in motion. 

He then goes on to state, “The mesokinetics system as the ‘organ of movement’ then becomes the inclusive structural and functional entity upon which the biomechanics of tensegrity can now proceed...” (Scarr, p. 102)

As a student of Voyer, this term - mesokinetics - instantly appealed to me. Voyer, at his roots, is a traditional Osteopath (as is Scarr). His therapeutic and exercise interventions are based on the idea that all structures - muscles, fasciae, tendons, ligaments, organs, etc. have equal importance as they are part of a connected whole. Pathological structure precedes pathological function and vice versa. 

Voyer’s methodologies also respect and follow the ideas of biotensegrity. Voyer, like Scarr, speaks of how biotensegrity and complex systems go hand in hand. The result of this pairing is that there are no therapeutic or exercise algorithms. The body is a complex system and as Voyer states - all is possible

Treating and prescribing exercise in a biotensegritous, complex paradigm demands that the practitioner has a command of detailed relational anatomy and a commitment to real-time problem solving, as treatment and diagnosis happen almost simultaneously. This model is not easy, but it lends itself to undeniable, long lasting results rooted in Scarr’s ideas and outlined in his new reality term - mesokinetics

When something is right, you just feel it. 

 

Brian Murer, DC/SMTh, is the co-founder of the Evolutions Institute of SOMA Instruction.  EISI is a school based on the work of Guy Voyer, MD/DO and is committed to training the next generation of manual therapist and exercise professionals. To learn more about EISI and their course offerings, go to www.evolutionsinstitute.com

When something is right…

…you just feel it. This was my response after I took my first ELDOA group exercise class from the incomparable Scott Herrera at Legacy Sport and Wellness in 2012. I was five months into my studies with Guy Voyer, MD/DO. I had been impressed with Guy’s powerful intellect, his command of biomechanics and anatomy, and the unique and specific nature of his manual medicine interventions. But, it was only after I had experienced that first ELDOA class, did I realize the comprehensive nature of what VOYER was trying to do. It was at that moment that I realized that he was going to leave no stone unturned when trying to restore health and wellness to his patients. I also realized the magnitude of VOYER’S guiding tenant – “You are your own best therapist.”

After eight years as an elite athlete, three years of chiropractic school and almost seven years of private practice, I had been treated by a lot of people. VOYER was the best manual therapist I had ever met. So, in a world where intervention (what the therapist could do to the patient) dominated, it was shocking and disorienting that the best I had ever seen, placed most of the emphasis of treatment and recovery on the patient’s exercise program. It’s VOYER’s attention and demand for QUALITY exercise that is paramount. Precision and specificity dominates everything VOYER does and his exercise methodologies are no exception. 

So, soon after that first ELDOA class in Dallas, I found myself learning VOYER’S exercise methods as well. There I was, a doctor in a room full of trainers watching VOYER being tougher on the trainers than he was on the therapists in treatment classes. For some reason, I felt I was in the right place.

Along the way, I introduced a patient, friend and local trainer, Jona Kerr to Guy’s world. During Jona’s first ELDOA class, I peeked over, looked at her, and saw that she got it too. Jona was hooked. She says the ELDOA felt different, powerful and unlike any other training methodology she encountered. Four years later, she is almost finished with the Soma-trainer program with Guy, and is a valuable part of the team who treats patients almost exclusively with VOYER’S therapy and exercise methods in my Bloomington, Indiana office.

Now four years into this journey, Jona and I have created the Evolutions Institute of Soma-Instruction. Evolutions was a long time coming. She and I spoke many times at length about a center where we could more fully integrate Guy’s methodologies. We first thought it would be a bricks and mortar facility, but when VOYER and Scott Herrera reorganized the ELDOA training into six parts, Evolutions became the educational arm of what we were trying to do. In late 2015, as demand for VOYER’s Soma-therapy courses had started to outgrow his availability, Guy approached me to see if I would like to begin teaching his Soma-Therapy program. This was very appealing, because I have never lost the desire to teach after leaving collegiate track and field coaching. Teaching feels like home for me. 

Dr. Voyer speaks a lot about how the human body is complex. He lectures about how complex systems work, and the difference between linear and complex thought processes. Invariably, Guy gets to a point in these lectures where, in a complex way of thinking, decisions in life come down to a feeling.

Creating EISI just feels right. It is a place where Jona and I can teach and share our passion for the ELDOA, and where I can help Guy pass along his extraordinary manual therapy methods. 

2016 is shaping up to be a great year. 

So, remember, WHEN SOMETHING IS RIGHT…

 

Brian Murer, DC/SMTh, is the co-founder of the Evolutions Institute of SOMA Instruction.  EISI is a school based on the work of Guy Voyer, MD/DO and is committed to training the next generation of manual therapist and exercise professionals. To learn more about EISI and their course offerings, go to www.evolutionsinstitute.com