1
|
Bordoni B, Escher AR. Fascial Manual Medicine: A Continuous Evolution. Cureus 2024; 16:e71442. [PMID: 39403420 PMCID: PMC11472865 DOI: 10.7759/cureus.71442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2024] [Indexed: 10/30/2024] Open
Abstract
From the perspective of fascial manual medicine (FMM), the body should not be considered as a set of compartments, but as a functional continuum, where most of the tissues (considering embryology) are fascia. The cells that make up the fascia can use multiple strategies to communicate, with neighboring cells, with the tissue to which they belong, and with the entire body, thanks to biochemical (microscopy) and electromagnetic (nanoscopy) possibilities. These multiple capacities to send and receive information make the border or layer of the different tissues seem absent. All the manual techniques that profess to be the only ones that work on the patient's symptoms, dictating a standardized manual procedure that all patients should undergo, represent a clinical deviation. Likewise, thinking that the manual approach can provide biomechanical stimuli only to a single specific structure or layer is a conceptual error. This narrative review briefly reviews the history of fascial-related nomenclature and how the fascial system is currently considered, posing new reflections on how the fascial continuum could be conceived by practitioners who apply FMM in the clinic, such as osteopaths, chiropractors, and physiotherapists.
Collapse
Affiliation(s)
- Bruno Bordoni
- Physical Medicine and Rehabilitation, Don Carlo Gnocchi Foundation, Milan, ITA
| | - Allan R Escher
- Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, USA
- Anesthesiology/Pain Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA
| |
Collapse
|
2
|
Basra M, Patel H, Stern-Harbutte A, Lee D, Gregg RK, Waters HB, Potter AK. A Narrative Review on the Viability of Osteopathic Manipulative Medicine in Treating Irritable Bowel Syndrome With Constipation (IBS-C). Cureus 2024; 16:e54180. [PMID: 38496183 PMCID: PMC10941805 DOI: 10.7759/cureus.54180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/13/2024] [Indexed: 03/19/2024] Open
Abstract
Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by chronic abdominal pain and alterations in bowel habits, with global prevalence. The etiology of the disease is likely multifactorial; however, autonomic nervous system (ANS) dysfunction and immune-mediated inflammation may contribute the most to the hallmark symptoms of abdominal pain and altered motility of the gut. Current pharmacological therapies operate to modulate intestinal transit, alter the composition of the gut flora and control pain. Non-pharmacological approaches include dietary changes, increased physical activity, or fecal microbiota transplants. None of these therapies can modulate ANS dysfunction or impact the underlying inflammation that is likely perpetuating the symptoms of IBS. Osteopathic Manipulative Medicine (OMM) is a clinical approach focused on physical manipulation of the body's soft tissues to correct somatic dysfunctions. OMM can directly target the pathophysiology of IBS through many approaches such as ANS modulation and lymphatic techniques to modify the inflammatory mechanisms within the body. Particular OMM techniques of use are lymphatic manipulation, myofascial release, sympathetic ganglia treatment, sacral rocking, counterstrain, and viscerosomatic treatment. The aim of this study is to identify OMM treatments that can be used to potentially reduce the inflammation and ANS dysfunction associated with IBS symptoms, thereby providing a new non-pharmacological targeted approach for treating the disease.
Collapse
Affiliation(s)
- Mahi Basra
- Foundational Sciences, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA
| | - Hemangi Patel
- Foundational Sciences, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA
| | - Alison Stern-Harbutte
- Foundational Sciences, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA
| | - David Lee
- Foundational Sciences, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA
| | - Randal K Gregg
- Research, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA
| | - Holly B Waters
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA
| | - Anna K Potter
- Foundational Sciences, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA
| |
Collapse
|
3
|
Bordoni B, Escher AR, Castellini F, Vale J. The Sentient Cell: Implications for Osteopathic Medicine. Cureus 2024; 16:e54513. [PMID: 38384870 PMCID: PMC10879650 DOI: 10.7759/cureus.54513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2024] [Indexed: 02/23/2024] Open
Abstract
The Foundation of Osteopathic Research and Clinical Endorsement (FORCE) is an organization that includes various figures involved in clinical and non-profit research and does not depend on any private or government body. To better understand how the human body behaves, we need to observe cellular behavior. Considering the human body as layers, districts, and regions, or just as a machine, is severely limiting to understanding the systemic mechanisms that are implemented to maintain bodily health. For some years, FORCE has contributed several articles to the literature to support the view of a human body as a unit, a fascial continuum (solid and fluid fascia) capable of interacting consciously, and not as a passive mirror, with respect to external stresses. The article reviews the tensegrity theory applied to the cell, trying to bring to light that the mechanistic vision on which this theory is based does not meet biological reality. We review some concepts related to biology, the science that studies life, and quantum physics, the science that studies the invisible physical phenomena that underlie life. Understanding that the cells and tissues are aware of the therapeutic approaches they receive could better guide the decisions of the osteopathic clinician.
Collapse
Affiliation(s)
- Bruno Bordoni
- Physical Medicine and Rehabilitation, Foundation Don Carlo Gnocchi, Milan, ITA
| | - Allan R Escher
- Anesthesiology/Pain Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA
| | | | - Joanna Vale
- Osteopathy, Body Lab Clinica di Osteopatia, Milan, ITA
| |
Collapse
|
4
|
Bordoni B, Escher AR. The Future of Osteopathy. Cureus 2024; 16:e51636. [PMID: 38187022 PMCID: PMC10767465 DOI: 10.7759/cureus.51636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2024] [Indexed: 01/09/2024] Open
Abstract
Every clinician has the duty to keep clinical and scientific knowledge updated, with the aim of improving clinical practice. Many homeostatic reactions of the organism are not yet well understood and framed by medicine or classical physics. Quantum physics offers new and multiple information to understand how the human body works, starting from the assumption that the macroscopic is managed by nanoscopic quantum coherence. The future of osteopathy should be to integrate the educational path with quantum physics.
Collapse
Affiliation(s)
- Bruno Bordoni
- Physical Medicine and Rehabilitation, Foundation Don Carlo Gnocchi, Milan, ITA
| | - Allan R Escher
- Anesthesiology/Pain Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA
| |
Collapse
|
5
|
Bordoni B, Girgenti GT, Escher AR. Practice of Peritoneal Adhesions in Osteopathic Medicine: Part 2. Cureus 2023; 15:e43092. [PMID: 37554375 PMCID: PMC10406449 DOI: 10.7759/cureus.43092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2023] [Indexed: 08/10/2023] Open
Abstract
Peritoneal adhesions are an unwanted and frequent event following abdominal surgery, with a response rate that can reach 100%. The adhesions can be symptomatic, becoming a source of pain and discomfort for the patient, or asymptomatic, with possible chronic or acute visceral dysfunction. The article reviews what the diagnostic strategies are and discusses what could be the causes that lead to chronic pain in the presence of adhesions. The text reports the knowledge of the literature on the manual treatment of adhesions and illustrates possible symptoms that are not easily recognized by the clinician. To conclude, the article proposes osteopathic manual approaches derived from clinical experience and from what has been explained about the formation of peritoneal adhesions. Research must make further efforts to identify not only the causes triggering the formation of peritoneal neogenesis but also seek the most appropriate non-invasive treatments to help the patient.
Collapse
Affiliation(s)
- Bruno Bordoni
- Physical Medicine and Rehabilitation, Foundation Don Carlo Gnocchi, Milan, ITA
| | - Gregory T Girgenti
- Anesthesiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA
| | - Allan R Escher
- Anesthesiology/Pain Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA
| |
Collapse
|
6
|
Impact of timing of preoperative gabapentin administration on postoperative somnolence. J Osteopath Med 2022; 122:303-311. [DOI: 10.1515/jom-2021-0256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/25/2022] [Indexed: 11/15/2022]
Abstract
Abstract
Context
Enhanced Recovery After Surgery (ERAS) is a multimodal protocol aimed to improve quality of postoperative recovery, minimize complications, and optimize overall self-regulation. Preoperative gabapentin decreases postoperative pain but can be associated with prolonged postoperative somnolence and respiratory depression risk. Although it is known that gabapentin affects the postoperative course, it is unclear if the timing of preoperative administration affects this finding.
Objectives
This study aims to assess the optimal preoperative timing for gabapentin administration in patients undergoing gynecologic surgery to minimize postoperative somnolence risk.
Methods
A retrospective cohort study evaluated patients who underwent major gynecologic surgery and received preoperative gabapentin. Patients were grouped based on timing from gabapentin administration to surgical incision (<4 h group vs. ≥4 h group). Preoperative, intraoperative, and postoperative data were abstracted and compared. Univariate associations between the timing of gabapentin administration and the patient and surgical characteristics and outcomes were tested utilizing two-sample equal-variance t-tests, linear model ANOVA, or Fisher’s exact tests. Associations between the timing of gabapentin administration and the time until the Richmond Agitation Sedation Scale (RASS) score of 0 were modeled utilizing linear regression, adjusted for age, initial postoperative anesthesia care unit (PACU), RASS score, and postoperative narcotics.
Results
Each group contained 127 patients. Demographics were similar except for age (<4 h group mean=44.2 years; ≥4 h group mean=40.5 years; p=0.021), chronic pain (<4 h group=17.6%; ≥4 h group=43.3%; p<0.001), and surgical indication (<4 h group=pelvic pain [29.1%]; ≥4 h group=pelvic pain [51.2%]; p=0.007). The <4 h group had a similar postoperative narcotic administration (<4 h group mean morphine milligram equivalents [MME]=3.667; ≥4 h group mean MME=4.833; p=0.185). The minutes from surgical closure until the patient received a RASS score of 0 and initial PACU pain score (Visual Analogue Scale [VAS]) were similar. The initial PACU oxygen administration volume, hours from surgical closure until the patient transitioned to room air, and initial PACU respiratory rate were similar. The PACU duration, admission secondary to somnolence, and initial PACU Glasgow Coma Scale (GCS) score showed no difference. Postoperative nausea/vomiting was decreased in the ≥4 h group (<4 h group=24.4%; ≥4 h group=13.4%; p-value=0.036), and urinary retention (<4 h group=14.2%; ≥4 h group=5.5%; p-value=0.033) was decreased in the ≥4 h group.
Conclusions
The timing of gabapentin administration less than or more than 4 h preoperatively in patients ≥18 years does not significantly affect postoperative somnolence or respiratory depression. Further, it does not have a significant effect on GCS scores or VAS scores.
Collapse
|
7
|
Bordoni B, Escher AR. A Missing Voice: The Lingual Complex and Osteopathic Manual Medicine in the Context of Five Osteopathic Models. Cureus 2021; 13:e18658. [PMID: 34659928 PMCID: PMC8503936 DOI: 10.7759/cureus.18658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2021] [Indexed: 12/19/2022] Open
Abstract
The five osteopathic models recognized by the American Association of Colleges of Osteopathic Medicine guide clinicians in the evaluation and therapeutic choice which must be the most appropriate concerning the patient's needs. Skeletal muscles represent an important interpretation, such as screening and treatment, on which these models are based. A muscle district that is not considered by the usual osteopathic practice is the tongue. The lingual complex has numerous functions, both local and systemic; it can adapt negatively in the presence of pathology, just as it can influence the body system in a non-physiological manner if it is a source of dysfunctions. This paper, the first of its kind in the panorama of scientific literature, briefly reviews the anatomy and neurophysiology of the tongue, trying to highlight the logic and the need to insert this muscle in the context of the five osteopathic models. The clinician's goal is to restore the patient's homeostasis, and we believe that this task is more concrete if the patient is approached after understanding all the contractile districts, including the tongue.
Collapse
Affiliation(s)
- Bruno Bordoni
- Physical Medicine and Rehabilitation, Don Carlo Gnocchi Foundation, Milan, ITA
| | - Allan R Escher
- Anesthesiology/Pain Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA
| |
Collapse
|