Naturopathic Physical/Manual Medicine:
- is the practice of physical medicine in the context of naturopathic medicine;
- integrates both scientific knowledge in physical medicine and the principles of naturopathic medicine into a distinct approach to physical medicine practice.
- Core components of NPM include:
- a respect for the traditional and empirical naturopathic approach to knowledge of the physical (structural and biomechanical) aspect of the human being in health and disease;
- the value of individualization of therapy and constitutional needs;
- a concentration on holistic diagnosis and the interaction of all systems;
- the general therapeutic goal of stimulation of the body's self regulating systems and mechanisms, as well as reduction of adaptive demands;
- education, self-care and prevention.”
The central concept that distinguishes naturopathic physical medicine from the other forms of manual medicine is the premise that human beings are vitalistic and holistic organisms. It is the recognition that the physical structure shifts and adapts to internal and external stressors. This adaptation can result in changes in internal functioning, psychological well-being as well as physical misalignment. There is the realization that every aspect of the body is connected and that imbalances on the structural level often affect other aspects of health.
Naturopathic medicine is a distinct system of primary health care derived from a strong philosophical belief about life, health, and disease. Its principles and philosophies are an integral component of naturopathic assessment, diagnosis, and treatment. Naturopathic medicine promotes wellness and prevention. It blends modern scientific knowledge with traditional and natural forms of medicine and it emphasizes disease as a process rather than as an entity.
Naturopathic medicine is defined by principles rather than by methods or modalities. Above all, it honors the body's innate wisdom to heal. The emphasis of naturopathic therapies is to treat the causes of disease and to stimulate the healing power of body by using natural techniques and therapies. Naturopathic doctors diagnose and treat both acute and chronic conditions and treat patients of all ages
The principles of naturopathic medicine are what distinguish it from every other type of medicine and what makes naturopathic medicine so clinicially powerful, effective and in tune with patients. If we forget, ignore or do not follow these principles, naturopathic medicine will be relegated to a historical foot note. Paul Saunders, PhD, ND, DHANP
In 1986 the American Association of Naturopathic Practitioners formed a committee that consisted of naturopathic doctors Pam Snider, Jared Zeff and others. These practitioners spent over three years reviewing the historic data and documents and interviewing over 1,000 people. In 1989 a unified definition of naturopathic medicine and the description of the six naturopathic principles were established and were accepted by the two national naturopathic associations (AANP and CAND).
Vitalism and Holism represent the philosophy of naturopathic medicine. The principles represent how these philosphies are applied in practice.
The six prinicples of naturopathic medicine are:
- First, Do No Harm (primum non nocere)
- Healing Power of Nature (vis medicatrix naturae)
- Treat the Cause (tolle causam)
- Treat The Whole Person (tolle totum)
- Doctor as Teacher (docere)
- Disease Prevention and Health Promotion
People are beginning to realize that it is cheaper and more advantageous to prevent disease rather than to cure it. Henry Lindlahr, ND (1862-1924)
Treat the Cause is one of the six principles of naturopathic medicine.
Naturopathic physicians encourage and emphasize disease prevention as one of its principles. Prevention involves promoting a healthy lifestyle, assessing risk factors, determining susceptibility to disease and making appropriate therapeutic interventions. This approach prevents minor illnesses from developing into more serious or chronic degenerative diseases.
Prevention of disease is a continual process
- it starts at conception and continues throughout all of life
- it is maintained through the homeostatic mechanisms of the body.
- it involves every aspect of a person - their lifestyle, emotional and mental health and family and community
- it takes into consideration a person's environmental and how to live in harmony with nature
The role of the physician is to faciliate increased awareness, as well as to educate each person on the changes required to address their symptoms and health concerns in order to prevent the progression of disease
Thomas Edison wrote, The doctor of the future will give no medicine, but will interest his patient in the care of the human frame, in diet and in the cause and prevention of disease.
The successful doctor of the future will have to fall in line with the procession and do more teaching than prescribing. Henry Lindlahr, ND (1862-1924)
Treat the Cause is one of the six principles of naturopathic medicine.
Docere, or “doctor”, comes from the latin word “to teach” and a naturopathic physicians role is to educate on the factors that affect health so that individuals are more informed about the impact of their choices and so that they are more capable of maintaining their own health. It is through our choices about nutrition, exercise, spiritual well-being, posture, hygiene, rest, and sleep and our peace of mind, social,occupational and environmental situations that influence health.
Teaching takes time and hence most naturopathic visits are longer in order to allow sufficient time for the doctor to educate and teach the patient how to make and maintain the lifestyle choices and changes needed to assist them in achieving wellness. Many patients desire an understanding of why they are sick, what they can do to improve the situation, and what they have to change for the future. It is this awareness and understanding by the patient that determines long-term wellness, not the knowledge level of the doctor.
A careful physician . . . before he attempts to administer a remedy to his patient, must investigate not only the malady of the man he wishes to cure, but also his habits when in health, and his physical constitution. Cicero (106-43 B.C.)
Treat the Whole Person is one of the six principles of naturopathic medicine.
Disease affects the entire person, not just a specific organ or system. Health and disease are a result of a complex interaction of all aspects of a person, their life and environment. The mental and emotional, functional, structural and spiritual aspects of an individual are an inseparable whole that is interconnected and interdependent with family, community and environment. Any pattern of disharmony in any aspect of a person resonates throughout all levels of a being.
Treat the whole person is a holistic concept that recognizes that the whole is greater than the sum of the parts. Each individual is unique with their own specific susceptibilities and way of manifesting disharmony and disease. It is the harmonious functioning of all aspects of the individual, within themself and with their environment, that is essential to health.
When treating the whole person an assessment includes:
- addressing nutritional status
- lifestyle factors
- family history and genetic factors
- physical symptoms and conditions
- mental and emotional status
- spiritual beliefs
- environmental influences
- past injuries, accidents, medical treatments, etc.
- social, community and school or work factors
The doctor of the future will give no medicine but will interest his patient in the care of the human frame, in proper diet, and in the cause and prevention of disease. Thomas Alva Edison (1847-1931)
Treat the Cause is one of the six principles of naturopathic medicine.
Identify and Treat the Causes (tolle causam)
In order to treat the causes of symptoms, it is important to understand not only the physiology and pathology for each person, but to understand the emotional states and how a person thinks about health and disease. Health and disease are logical outcomes based on the number of factors that influence health including a person’s genetics, lifestyle, social, environment and external factors. The aim of a naturopathic assessment is to determine the specific trigger, event, environment factor or behaviour that initiated the disruption and that needs to be addressed.
The body naturally compensates whenever the internal functioning is overwhelmed. This compensation shows up as symptoms and as a disruption to health. Symptoms are viewed as expressions of the body’s natural attempt to heal. The body is complex and yet logical. It displays symptoms that correspond - provide a road map - to the root cause. For example, when a patient falls, their injuries correspond to how they fell and how they compensated.
There are times when the physical manifestation of the symptoms and their corresponding root cause indicate a direct correlation and other times the correlation is not as clear. Often when a patient is recalling their history they will use somatic metaphors to describe their symptoms or they intuitively link symptoms with events. For example, a patient recalls that their palms get sweaty and their heart races every time they have to speak to a certain person or speak in public. The primary issue that needs to be addressed is the anxiety associated with the event, not just the sweaty palms and the racing heart.
Steps Taken To Identify the Cause
Both standard and non-conventional methods of diagnosis may be used by the naturopathic physician to find the cause.
- A detailed history
- information relating to diet, emotional state, exercise and other lifestyle factors
- information related to environmental exposure and unique environmental conditions associated with where you have lived
- history of previous accidents, injuries, medical procedures, etc.
- An extensive physical examination may be performed using standard diagnostic instruments and laboratory tests as required, such as X-ray examinations and/or scans, gynaecological exams, blood tests, urine analysis, allergy testing, etc. Referral to a medical doctor may be required for some of these tests, depending on the scope of practice of the naturopathic doctor in each jurisdiction
Identifying the root cause of disease and the aggravating factors is an essential aspect of health care. Nowadays there are just more factors. An assessment needs to be more thorough. As part of the therapeutic encounter, a naturopathic doctor needs to explore a much greater number of factors as health is improved by reducing the number of factors that strain the body and interfere with its normal functioning and ability to heal. Naturopathic treatment involves teaching patients that a return to a more simple and health promoting lifestyle often is the best medicine for them.
Identifying and treating the root cause of dis-ease does not imply a linear causality between events in a person’s life and disease. Human beings are a complex, dynamic and integrated system and it is the accumulation of multiple factors that contribute to health and disease. A specific event might be the primary trigger that initiated or amplified a series of symptoms, but a person's overall state of health, their adherence to lifestyle factors that are suited to their constitution, the impact of environmental factors, the support of family and community etc, all play a role in their ability to handle disrupting factors. The impact of any single event, at any point in time, depends on a number of other factors. The complex workings of the body follows the concept of mutual causality and recognizes that the impact of any specific event is contextual and individual.
The Healing Power of Nature is one of the key principles of naturopathic medicine.
The term vis medicatrix naturae which means the healing power of nature was established by Hippocrates to denote the body's ability to heal itself or innate healing. This healing power is an inherent self-organizing, ordered healing process of living systems which establishes, maintains and restores health.The Vis Medicatrix Naturae is the power of nature to heal, an extension of creator consciousness or cosmic consciousness. While everything on the planet has become somewhat disharmonious, this energetic template or spiritual blueprint is held, inviolable, within our nature and is made avilable as a exemplar during the process of healing.
"The problem of the healing power of nature is a great, perhaps the greatest of all problems, which has occupied the physician for thousands of years. Indeed . . . the aims and limits of therapeutics are determined by its solution."
Although nature doctors, including naturopathic doctors, have been the greatest champions of this doctrine, the mystery surrounding the healing power of the body has been part of medicine since the beginning of time. The medical historian, Max Neuburger stated
- There are innate or natural laws surrounding life, health and disease. These laws involve man living in harmony with nature and recognizing the wisdom of the body to heal itself.
- It is the naturopathic doctor's role to support, facilitate and augment this process by identifying and removing obstacles to health and recovery, and by supporting the creation of a healthy internal and external environment.
- Symptoms are often the manifestation of the body's attempt to defend and heal itself. When the root cause of the symptoms and the obstacles to cure are identified and addressed the body will often be able to initiate the healing process on its own.
- With the use of natural therapies, such as herbs, foods, water, fasting and tissue manipulation, the vis medicatrix naturae, or the healing power of the body, is supported.
Examples of the vis medicatrix naturae
- when we cut our finger the wound automatically starts to heal
- fever is a natural response to the flu
- vomiting or diarrhea are the body's way of responding to food poisoning
- fractures heal often on their own
- after major surgeries or treatments, such as chemotherapy or radiation, the body will initiate healing
Aim Of Naturopathic Treatments
- Treat the patient; not the disease
- Remove obstacles to healing by identifying and treating the cause of disease
- Direct the vital force to stimulate the body's own defences and healing ability
- Decrease a person's susceptibility to disease
First, Do No Harm or primum non nocere has been a principle of medicine since the time of Hipprocates. From a naturopathic perspective, it refers to not only the patient but to the patient's vital force. A naturopathic practitioner applies this principle by:
choosing diagnostic techniques that are non-invasive, whenever possible
choosing treatments that support the innate healing ability of the body
choosing treatments that honour the laws of nature
teaching patients insight and awareness of how lifestyle choices and other factors affect their health
Naturopathic doctors work on the basis that there is a hierarchy to treatment choices. To do no harm, a physician chooses the therapy, and fashions the most gentle and non-invasive strategy to achieve the desired outcome for each individual patient. In situations, especially when the progression of disease is advanced or the current state is critical, it is necessary to chose aggressive treatments or treatments that pose the risk of adverse effects. An aggressive treatment may require referral for drugs or surgery, but at times it can be accomplished by changing many lifestyle, environmental or external factors at once and/or by addressing social or stressful situations more directly. By respecting the integrity and vitality of each patient the healing process is supported versus overridden or suppressed.
Do no harm involves physicians teaching their patients how to have more insight and awareness of how their lifestyle choices affect their health. Identifying and respecting the healing intention and capacity of each person is an essential part of naturopathic care.
One of the differentiating features of naturopathic medicine compared with conventional (allopathic) medicine is its strong philosophical foundations. The basic philosophical premise of naturopathic medicine is that there is an inherent healing power in nature and in every human being. It is the physican's role to bring out or enhance this innate healing power. Unlike most other systems of medicine, naturopathic medicine is defined by its principles and philosophy and not by any particular therapy or modality. Naturopathic medicine has always been eclectic with respect to its treatment options in fact, this is one of it's strengths.
Naturopathic medicine is more inclusive than exclusive. Its basic philosophical premise is based on vitalistic and holistic concepts. Yet, it acknowledges that mechanistic and reductionist concepts are useful in describing the inner workings of the body. The naturopathic premise is that there is a difference between how an individual part works and the integration of the whole. It is the integration of the whole and the interplay between individuals and their environment that is their focus with respect to health, healing and disease
Myoskeletal alignment technique (MAT) is a type of bodywork which blends the principles of osteopathy and structural integration to relieve chronic pain, and to reduce the potential for the emergence of pain which could become chronic over time. This technique is often integrated into regular massage and bodywork sessions, and it can also be used alone to treat systemic problems. Practitioners of myoskeletal alignment technique can be found in many regions of the world. The focus of this technique is on back and neck pain in particular, since this type of pain is extremely common in the industrialized world.
The basic idea behind myoskeletal alignment technique is that back and neck pain are caused by fundamental problems with the musculoskeletal system. Tight, stressed muscles contribute to pain by limiting freedom of movement, while weak muscles provide inadequate support for the body. This in turn leads to posture problems, stiffness, and other symptoms which create an endless cycle of pain. By addressing the fundamental issues in the muscles and fascia, practitioners hope to eliminate the associated symptoms.
Structural integration and osteopathy both rely heavily on the manipulation of the muscles, fascia, and skeletal system with the goal of promoting general musculoskeletal health. The idea behind structural integration is that if someone's body can be aligned properly, his or her health problems can be dramatically reduced, because the body will work as a whole. Osteopathic practitioners share this idea, arguing that many chronic health conditions are related to musculoskeletal problems.
In a session of myoskeletal alignment technique, the practitioner works to lengthen tight, strained muscles with the goal of releasing tension and allowing those muscles to function more normally. At the same time, weak muscles are encouraged to grow stronger with the use of gentle, focused stretches which work those muscles. The muscles and fascia will also be manipulated to release pain and to encourage proper musculoskeletal alignment.
A session of myoskeletal alignment technique can sometimes alleviate neck and back pain considerably. Regular sessions can be used to address the early signs of pain, bringing the body back to a neutral state before it develops a vicious cycle of pain. This type of bodywork can be especially useful for people in stressful occupations, or for people with jobs which require repetitive motion, as these careers can place a great deal of strain on the musculoskeletal system.
According to the American Medical Massage Association (AMAA) Medical Massage is:
"A system of manually applied techniques designed to reduce pain, establish normal tissue tension, create a positive tissue environment to normalize the movement of the myoskeletal system. Medical Massage is scientifically based method of manual therapy that seeks a clear understanding of the scientific principles of physiology that affect connective and soft tissue healing and treatment." What is the difference between "Medical Massage" and "Therapeutic Massage"?
Therapeutic Massage is a key method of preventative therapy as well as an important part of the Medical Massage treatment. Therapeutic Massage has numerous positive effects on the various functions of the human body. It reduces muscular tension, improves peripheral blood circulation and lymph drainage, unloads the cardiac system, normalizes pulmonary function, supports the digestive system, etc. It also stimulates or sedates the central nervous system and therefore affects the patient's mental and emotional status.
In many cases, Therapeutic Massage is part of a Medical Massage session. It can be used as preparation for special treatment, for example before ischemic compression or muscle energy techniques. Therapeutic Massage is also an important independent method of treatment of many visceral and somatic disorders.
Therapeutic Massage is a more sophisticated method of massage treatment compared to Relaxation Massage. The full arsenal of massage techniques is used during a session of Therapeutic Massage. A massage practitioner can give a full body massage or concentrate on the affected area or part of the body.
Medical Massage is not a method of preventative therapy. It is a highly effective method of treatment and an important part of modern medicine. Methods of medical massage are special procedures which were designed by scientists in different countries for the treatment of various pathologies of the human body. Medical Massage is results oriented and the treatment is specifically directed to resolve conditions that have been diagnosed by a physician. The therapist may use a variety of modalities or procedures during the treatment, but will focus that treatment only on the areas of the body related to the diagnosis. Medical Massage is generally billed in 15-minute segments using current procedural terminology and adhering to the usual and customary reimbursement fee schedule.
1.The major characteristic of medical massage compared to any other type of body work is the selectivity of its application. There are four types of soft tissues that the massage practitioner deals with: skin with subcutaneous tissues, connective tissue structures, skeletal muscles and periosteum. Each type of soft tissue has its own unique structure and unique combination of peripheral receptors.
Thus, methods of medical massage were designed selectively for each type of tissue separately and for each separate condition. Therefore, medical massage very precisely targets soft tissues on each level. The technical application of Medial Massage demands a layer-by-layer approach using special methods or techniques that have been developed for each type of soft tissue. To address the skin, the practitioner may use superficial effleurage, superficial friction, kneading of the fold of skin, and connective tissue massage. The best techniques to address superficial fascia are connective tissue massage and myofascial release. The superficial and deep muscular groups should be treated with trigger point therapy, postisometric muscular relaxation and myofascial release. To address the deep fascia, the practitioner may use connective tissue massage as well as kneading of the superficial muscular group applied in the inhibitory regime. The best way to address the periosteum is through the application of periostal massage and Cyriax's friction
2. Each method of medical massage has its own goals, techniques and level of application. However, the practitioner needs something which will hold together the application of the different methods of medical massage and unite them into one perfectly organized medical massage session. Therapeutic massage fulfills this goal. Therapeutic massage is used every time when the practitioner changes or applies a new method or technique of medical massage during the same session.
3. Medical massage is restricted to the parts of the body related to the pathological process. A full-body should never be used (except in case of Fibromyalgia) because the practitioner wants to concentrate on the soft tissues which show local or/and reflex abnormalities. The goal of such a selective approach is to work with correct combination of medical massage techniques and methods to activate peripheral receptors and elicit the correct response from the segment of the spinal cord which are responsible for the innervation of the affected area. Thus, the more precise the application of medical massage techniques, the better the results are.
4. Medical massage requires between 30 minutes and an hour session. However, the duration may fluctuate between 30 minutes and an one hour and a half.
5. After the first session, the patient has to have a break of 2-3 days to determine the initial reaction of the body to the therapy.
6. Medical massage therapy should be used as a course of treatment. Usually between 5 and 15 sessions should be required.The specific number of sessions depends upon the type of pathology and the age of the patient. When necessary, the course of treatment may be repeated after a break of 15-30 days, again depending upon the disorder and the age of the patient.
7. Each course of medical massage has to start with a diagnostic evaluation of the soft tissues. This allows the practitioner to select the optimal method of medical massage or the combination of massage procedures.
8. All pathological changes are recorded on prepared diagrams.
9. Each new session has to start with detailed questioning of the patient to clarify any changes which have occurred since the previous session or since the beginning of treatment. It allows the practitioner to evaluate the impact of medical massage on the patient.
10. Each session starts with massage of the paravertebral areas and the vertebral column in the level of segments of the spinal cord which innervate the affected inner organ or somatic structure.
11. In cases of disorders of the nervous and musculoskeletal systems, the greatest impact from medical massage is achieved by its application at the earliest sign of abnormality. Patients with a newly diagnosed inner organ disorder (e.g., Acute Gastritis) are less responsive to treatment compared to patients with the same, but chronic disorder(e.g., Chronic Gastritis). In cases of a newly diagnosed visceral disorder, the practitioner should work on the soft tissues in the areas where reflex zones may develop. In such cases, the practitioner uses the preventive role of massage therapy to extend periods of remission and to prevent further progress of abnormality. For these patients, regular application of therapeutic massage sessions is the first choice of treatment.
12. It is mandatory that a rest period of 5 to 10 minutes occurs after each medical massage session. The patient must either lie down or recline to decrease the possibility of autonomic reactions.