Physical Medicine and Rehabilitation: State of the Art Reviews 2000; 14 (1)
Eric A. Mein, MD, Douglas G. Richards, PhD, David L. McMillin, MA,
John M. McPartland, DO, MS, Carl D. Nelson, DC
From the Meridian Institute Virginia Beach,
Virginia (EAM, DGR,DLM,CDN) and
Department of Osteopathic Manipulative Medicine
Michigan State University College of Osteopathic Medicine
East Lansing, Michigan (JMM)
CORRECTION AND REGULATION
Manual therapy can be divided into two distinct conceptual approaches to treatment: specific adjustments for correction of anatomic issues (structure) and adjustments for physiologic regulation (function). In recent years, the primary emphasis of most practitioners has been on finding structural problems associated with musculoskeletal issues and
correcting anatomic findings ("lesions" and "subluxations"). Less emphasized has been the capability for manual therapy to regulate physiology, reestablishing equilibrium and balance among the various systems and processes of the body. Historically, however, the origins of both osteopathy and chiropractic can be traced to positive outcomes in the treatment of systemic dysfunction. A. T. Still, founder of osteopathy, used an "inhibition" technique (lying with his head in a sling) to relieve his own headaches; D. D. Palmer, founder of chiropractic, first treated a patient with a hearing impairment.
Recognition of the structure versus function choices within manual therapy dates to the early days of osteopathy. For example, Hazzard (1899), a prominent early osteopathic physician, acknowledges both of these approaches in his textbook Principles of Osteopathy:
In our treatment of a spine there are two points which we may take into consideration; two objects which we may have in view. In the first place, we may wish to TREAT THE SPINE ITSELF [anatomical correction. In the second place, we may wish to REACH, BY TREATING THE CENTERS ALONG THE SPINE, THE VISCERA TO WHICH THESE NERVES RUN [physiologic regulation]. It is not always possible to disassociate these in your practice. 
The textbooks of the early 1900s emphasized regulation, [2, 5, 11, 19, 23, 30a, 51, 60] yet by 1991, Kuchera and Kuchera state: "The majority of DOs do not use manipulation. Many of those physicians who do so use it primarily for treating musculoskeletal complaints. They do not use manipulation for its homeostatic benefits [regulation] to the body's physiology." 
Johnston points out that there are aspects of osteopathic manipulation in which spinal segment dysfunction is not necessarily the focus for diagnosis and treatment.  These include direct manipulation of the visceral organs themselves, influencing cerebrospinal fluid flow, and adjustment of postural influences on visceral support systems.
All of these are interventions that regulate physiology.
The general lack of awareness of regulatory techniques and effects can complicate the interpretation of research. For example, Balon et al. compared active and simulated chiropractic manipulations as an adjunctive treatment for childhood asthma.  They concluded that, because there were no significant differences in response to the active and simulated treatments, chiropractic spinal manipulation provides no benefit. However, the so-called simulated or sham treatment involved "soft tissue manipulation and gentle palpation to the spine, paraspinal muscles, and shoulders." Additional manipulations were applied to the head, ankles and feet, gluteal region, and occipital protuberance. "Low-amplitude, low-velocity impulses were applied in all these nontherapeutic contacts,"
in contrast to the standard high-velocity chiropractic manipulation.
Unfortunately, this simulated treatment resembles a traditional general osteopathic regulatory treatment. [17, 23] The Early American Manual Therapy website provides easy access to several such examples from the traditional manual therapy literatures.  Figure 1, which dates back to 1909, demonstrates such a technique. In the Balon study, both treatments produced positive effects. The authors note, "We are unaware of published evidence that suggests that positioning, palpation, gentle soft-tissue therapy, or impulses to the
musculature adjacent to the spine influence the course of asthma."  Richards et al. and Nelson et al. have, however, shown that there is substantial published evidence that such techniques are effective in regulating a large number of physiologic parameters. [41, 50]
FIGURE 1. Manipulation of the muscles in the
back, in general treatment of the spine from A Manual of Osteopathy
by Eduard W. Goetz, D.O., published in 1909. Soft tissue manipulation
was often used by the early osteopaths for a wide range of systemic disorders.
Typically, paraspinal massage and manipulation were included in the osteopathic
general treatment format to improve nervous system coordination and drainages
throughtout the system. This type of soft tissue technique is similar
to the "simulated" (control) treatments given in a study for childhood
asthma.  (From Goetz EW: A Manual of Osteopathy with the
Application of Physical Culture, Baths and Diet. Cincinnati,
Nature's Cure Company, 1909.)
Read the full article now
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