Manual Therapy and Cranial Osteopathy

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Anshu Bahanda: This is Anshu Bahanda on Wellness Curated. Thanks for joining me on this podcast. My mission is to empower you with health and wellness, so that you can then go and empower others. We have with us today a leading light in this area, Katrine Cakuls, who is a manual therapist and a Canadian qualified physio and osteopath. She works with a network of practitioners, including medical consultants, physiotherapists, acupuncturists, homoeopaths and movement specialists, and her work’s been featured in national television in the US. She’s been quoted in books like by author Naomi Wolf. She’s worked internationally and she’s very, very well respected. We got so much invaluable information today. Katrine, tell me, what is osteopathy, cranial osteopathy and manual therapy? 

Katrine Cakuls: Okay, let’s start with osteopathy. So osteopathy is a hands-on method of medical treatment for illness and injury. And what’s important is it addresses a wide range of problems from the standard things that people here in Britain think of, like muscle, joint aches and pains but it also treats organ problems such as constipation, lung problems, nasal problems, gastric reflux. The whole basis of this method of treatment, founded by American physician in the late 1800s, Andrew Taylor Still, is the belief that the body has a huge capacity to heal itself. One example of this that we see in everyday life is that when somebody breaks a bone, the bone heals itself. All you have to do is think of a cut and the scab forms. So the body really has a huge capacity to heal itself. So what osteopathy is looking to do is to free up movement so the body can access its own internal good health and its healing mechanisms. Because if there are tightnesses in the body, then you can’t have good blood flow that brings nutrients to the area that helps it to heal. You cannot have the toxic byproducts being taken away. Nerve signals are not being sent normally if there are tightnesses, so organs cannot function well and you don’t have good muscle tone. So osteopathy really opens up the movement to allow the body to function optimally. 

AB: That’s amazing. 

KC: It looks at the person as a whole treating the cause of the underlying imbalance, not just the symptoms. It really focuses on getting the patient to be part of the treatment, so that you can establish a good lifestyle and a good self knowledge of the body, so that going forward, the body and the person can do a lot to take care of themselves, that’s osteopathy. Then if you get into what is cranial osteopathy, that is an extension of the basis of osteopathy which was developed by Dr. William Garner Sutherland, an osteopath that studied with Still. He developed this in the early 1900s and it’s the study and anatomy of the function of this cranium or the skull and its fascial relationships to the rest of the body, as well as to the fluid movements within the body. If you get into manual therapy, that is a term that’s very broad, that really just means hands-on treatment. So it’s been appropriated by all types of people. I use it because I have a background in physio. 

AB: So Katrine, then explain to me what is the difference between osteopathy and what a chiropractor does or what a physiotherapist does or does it all blend into each other? 

KC: It does to a certain degree. So I’m going to start by narrowing it down to the classics because nowadays, chiropractors have adapted osteopathic treatments or physio techniques. In its basis, chiropractic looks at the mobility of the spine and treats the spine, so that the nerve signals coming from the spine going to the rest of the body are improved and so that health can be optimised. So that’s similar to osteopathy, but they’re more spine centric and their techniques tend to be more manipulative or what might be called cracking techniques. Osteopathy actually treats the organs themselves, the fascia around the organs, to restore good fascial movement around the organs and looks also at treating the spine as well as the joints and the musculature. So our approach is slightly different in the areas of what we treat and what we’re based on in terms of our philosophies. Also what’s different are the actual treatments themselves. Chiropractic treatments tend to be much shorter in length and more frequent, and osteopathic treatments tend to be longer and done much more and on an as-needed basis. 

AB: Okay.

KC: Here in England, there is a bit of a closer link in terms of what people might experience. They might go to see an osteopath here and be cracked and go to see a chiropractor and be cracked and then they say, “what’s the difference?” So in those cases, you’re looking at a different basic philosophy, but also the type of cracking and how it might be done beforehand is different. Not only that, but again, how often they get treated is different. And then you asked about physiotherapy, it is more of rehabilitative medicine, looking at much more isolated joints. So if you come in with shoulder pain, a physiotherapist will really well assess the shoulder joint and give you exercises to help to rehabilitate that. They do some hands-on work as well and there are physios that are taking osteopathic technique courses. So again, it gets a little bit muddled. But with physiotherapists they will also use electrotherapeutic modalities, such as trans units which is transcutaneous electrical nerve stimulation. They’ll also use ultrasound machines. And these are not what are part of osteopathy. 

AB: And one time when I came to you, I remember you were working on me, and you said, “I’m taking out the stress from this area”, one area which was not the basis of the pain. How does it help the nervous system? People just see it as a body thing. I mean, as a physical body thing. They don’t see it normally as something that goes into the nervous system. 

KC: So if you look at the three pillars of health, you’ve got the biomechanical which is how the body moves, the biochemical, which is what the body’s own internal pharmacy is doing with what you ingest, with what you eat or what you drink and how it converts it into the minerals that you use and what is created by one gland being sent to another area and the psychospiritual. Those three form an isosceles triangle in terms of importance. And all those three factors are always interacting. So if I treat somebody’s sprained ankle and they’ve sprained their ankle while they’ve been running to the audition of their life, and they miss the audition, when you have a mechanical injury, there can be a psychospiritual component.

AB: That’s really interesting. 

KC: What happens with this is that while I’m treating the ankle for nuts and bolts, getting the bones to move better because the nerves are going to be signalling differently, then that’s going to send different messages up to the brain. The brain then might come across the psychospiritual impact of missing the audition and then somebody might suddenly start to cry. But from a basic viewpoint, anytime you improve or change movement in the body, you’re affecting the way that nerves signal and the way that the nervous system functions. And so one of the things that I see on a regular basis is the impact of stress that’s creating almost like a varnish on top of the mechanical restriction that’s underneath. And of course, there are various types of stress. 

AB: I mean, this is one thing that you explained to me. I didn’t even know that’s the difference. And I would love for you to tell us about the difference between Cranial osteopathy and Craniosacral therapy, because most of us think it’s the same thing. 

KC: Yeah, a lot of people do. I’d say 99.5% of people think it’s the same. Cranial osteopathy was developed by an American osteopath to be an extension of the osteopathic concept, so Cranial work within an osteopathic treatment, within osteopathy is one tool that we use. It’s like antibiotics that are used by physicians. What happened in the 1970s is another American osteopath named John Upledger furthered Cranial research in the osteopathic field, from which he created Craniosacral therapy. This is something that anybody could study. Your granny or neighbour could study it with no medical background. So you do not have to be an osteopath to study craniosacral therapy. The techniques are different, the basic ideas are the same, but it feels different to the person. And how it’s employed is very different from cranial work within an osteopathic treatment. Why I’m saying that is because in certain places, cranial osteopathy is thought of as something just to treat infants, babies, because they say it’s very gentle and very soft and soothing. Either that or to treat pregnant women, whereas in a traditional osteopathic practice, it’s one of the tools we’ll use for anything. I might use a cranial technique if I’m treating a football player who’s injured his back. 

AB: Just to clarify, you don’t have to be a qualified osteopath to learn craniosacral therapy. You can just go and do a few courses of that. Katrine, on that note, I believe you have to study for years and years to become an osteopath. Tell us a bit about that. 

KC: Well, it varies from country to country. In America, where osteopathy was founded, you have to go to medical school. So you do your premed courses in university and then you’re accepted into an osteopathic medical school and you graduate as a physician, an osteopathic physician with all the same rights that any other physician would have. In the UK, it’s different. You are not a physician. Same as in Canada. So I’m not a physician. So in Canada, with my course, when I went through it, you had to be a graduate of a professional medical school. In my case, I was a physiotherapist, so you could have been a physiotherapist or a physician. Plus you needed to have five years experience working in a hospital and then you would be accepted onto the program. And the program, when I went through school was five years part time, and then it was two years to do a research thesis. 

AB: So, in terms of that, what treatments do you typically find that people come to you for that you treat? I know you’ve seen multiple people over the years.

KC: Yeah, I’ve seen everything from a one day old child to a 100 year old person, from desk workers, to homemakers to Olympic athletes, dancers. So really, across the spectrum, I have people coming for joint aches and pains, for backs that they’ve thrown out, headaches, neck pain, jaw pain. I also deal with women’s health. I deal with fertility issues, incontinence, pelvic pain. I work with children who have flat hedge syndrome, who have a tight neck called torticollis. I deal a lot with jaw pain, ringing in the ear, sort of more organ related problems, reflux, stomach pains. So it’s a variety.

AB: Do they normally get temporary symptomatic relief or is it a longer lasting relief that people get by coming to you? 

KC: So the goal of my treatment is to allow the patient’s body to take care of itself. So what I’m looking for is to meet the patient where they’re ready to go, because this is a combined treatment where the patient is involved. And some people come in and they say, “look, just snap my ankle, and I want to walk out of here and feel great”, whereas some people are really digging deeper, and they want to feel good going forward. So there are two factors: number one, the intent of the person coming in for the treatment and number two, how much they are willing to put into the treatment. And sometimes, they don’t have to put a lot into the treatment. They’ve jammed their thumb playing basketball, I loosen it up, and that’s that. But the goal really is for the longer standing relief again, so the body can take care of itself. And this is also dependent on the health of the patient. I’m here to deal with the biomechanics, but if somebody goes home and they live a very biochemically unhealthy lifestyle, they’re eating Cheetos and drinking Coca Cola and skipping meals and smoking, that’s going to affect the impact of the treatment, how well it integrates, how long it lasts. And if they’re in an abusive relationship, that’s also going to affect how much their pain is going to stay away and to what degree. So I really take that into account, looking at those factors. I don’t address them because that’s left to the specialists in the biochemical field, in the psychospiritual field, but I will make note of that to the patients.

AB: Have you ever been surprised, Katrine, by the results you’ve got? Like, have you ever found that you were trying to treat one thing and something else got sorted? 

KC: When a patient first comes in, I take a very detailed medical history, and so I make note of all the complaints that they have. They might come in for a sprained ankle. They say their shoulder also hurts, complain about a little tummy rumbling, and I make note of that. And so there’s always usually a main complaint. So I’ll say “how is the ankle?” And they’ll say, “oh, yeah, it’s fine” and I say, “and how’s your back pain?” and they say, “did I have back pain?” And I say, “yeah, you did.” and they’re like, “oh, well, I haven’t had any back pain.” That happens very, very often. I think some of the things that have surprised me is the speed at how some things can resolve. So for instance, I was working with an infant who had a flat head syndrome, and from one treatment to the next, the paediatrician called me and said, “what have you done? The head’s in a good shape now.”

AB: Wow. 

KC: It’s the speed sometimes at which things happen. But I also think what also surprises me is how people really blossom on several levels, that they really are able to connect more with the joy of life when they realise that they’ve been moving in pain for a long time.

AB: When they come to you, you ask them what the issues are. So talk to us about what happens when someone walks into your room, the whole process, because sometimes people get scared? People get scared of osteopathy. 

KC: So the first thing when somebody comes in, I take a detailed medical history and what that means. I ask them what I can help them with. And we go through all the details of that. And then I ask about medical history, about heart problems, lung problems like a standard medical history. And then what I do is I ask them to undress so that I can see how the body’s moving as a whole. It’s really important to see how the whole body’s moving because even though somebody’s coming in for a knee problem they might have a really twisted spine that’s shifting their weight onto the knee. It’s really important for me to see the body as a whole. So then I do a physical examination and then I ask them to either lay down or sit down and then I start the hands-on treatment. So the first visit always and all visits always include hands-on treatment. Personally, I found over the years that I don’t need to do cracking. If some people really like joint cracking, I can do it and that’s not a problem, but I found that there are other ways to achieve the same thing osteopathically. I do a variety of osteopathic techniques, some of them are slow in health. Some of them are quicker with some resistance from the patient but you won’t find them to be painful. There are certain techniques, and I can tell you one for sure – when somebody’s got a frozen shoulder and you have to try to move the joint or a frozen elbow or frozen wrist, sometimes you have to push through some of that stiffness and that’s when it might be a little uncomfortable. But in general, techniques are not uncomfortable. 

AB: Amazing. 

KC: Then I’ll give people some homework. So it’s either doing certain stretches, certain things to avoid. Talking about posture, maybe making suggestions about things that they could look into either on their own or with other practitioners to resolve some dietary issues or to maybe investigate some psycho spiritual issues. And then when they come back, we’ll review all that. Again, I’ll take a little history, examine how they’re moving and then get into the treatment again. 

AB: And typically with your average clients how many treatments do you ask them to come back for before you can feel something has moved? 

KC: It’s a million dollar question. So I would expect that from one treatment to another that there would be a change in mobility already within a given problem. If somebody comes to me with a frozen shoulder, that’s going to take longer and it depends, again, on the person’s health. It depends on what kind of issues they’re bringing to me. It depends on their age. If you want to give a rough ballpark, I’d say within three treatments, you need to see a difference. 

AB: Okay. 

KC: There’s lots and lots of research that’s being done on osteopathic techniques, osteopathic approaches. I think the biggest difficulty is that osteopathy is an individualised treatment. So if somebody comes to me for low back pain, it’s not a type of treatment where I do ABCD on every single person. You treat what’s in front of you. And so to create a study, looking at a treatment for low back pain, you have to create a different type of a study. But there is lots and lots that’s been done in terms of osteopathic research. You can go to the American Osteopathic Association, look at their journals. You can go to the Canadian College of Osteopathy. They have hundreds of thesis, research studies that have been done. So there are lots and lots of sources. 

AB: We always like to give people some tools that they can take away from this, which will always help them. So is there something we can tell people? So say, I have no issues with my body. Can you say that if you did these four exercises at home every day, you would more or less stay? Okay, of course, you can’t guarantee everything, but is there something like that that you can give us? 

KC: The first thing that I would say is breathing. Breathing is very basic to creating some good health in the body, even if you’re not feeling anything. Because if you do a cycle of breathing 5 seconds in through the nose, 5 seconds out through the mouth, you’re going to decrease the stress response in the body. You’re going to improve global body function. And if you did that for ten minutes a day, focusing on visualising and trying to feel a positive emotion, you’ll be in a much better healthier place. So that would be the main thing I would say, is whatever kind of breath work I’ve given you an example, but there are million types of breathwork approaches out there. That and spending some time in reflection and meditation. And then the third thing would be stretching. We all get into these tight, tight, tight positions for long periods of time, looking at our phones, looking at our computers, sometimes walking, carrying these heavy bags and it’s really nice to stretch out the body to create some space between the fascial layers so you get better circulation, better weight bearing on the joints. 

AB: And any last bits of advice? 

KC: Absolutely. What I’d like people to remember is that all of us have an incredible amount of great health within us and the body is always trying to express that good health, and it gets stuck sometimes, and then the health can’t come out. So unstick yourself through stretching, unstick yourself through, clearing your mind of limiting thoughts, unstick yourself by having a treatment. Sometimes it’s hard for us to stretch ourselves out. Go and have somebody stretch you out, an osteopath, a physio, chiropractor, anything to improve your movement. And also remember that there are three pillars to health: biochemical, psychospiritual and biomechanical. If you’re stuck with a problem, look at it. Is it a problem because I’m moving incorrectly? Is it a problem because of something wrong in my life, psycho-spiritually, or maybe I’m not eating well or I’m drinking too much? So really look at those three aspects. When you’re questioning any issue that you have, even if you go to see a practitioner, make sure that they’ve addressed those three by sending you to specialists, to those areas or just making you aware that you might pull up your socks in one of those areas.

AB: Thank you so much for that, Katrine. That was an incredible chat. Thanks for joining us. Hope you enjoyed the Wellness Curated podcast. And here’s to you, leading your best life.