OSTEOPATHY AND GYNAECOLOGY AN INTEGRATED APPROACH
Course in English, translated into Polish.
The gynaecology system is a complex series of structures and events controlled by hormones and the central nervous system so that every part of the system has a predictable and sequential function without which we would not exist. To give an example of this, there is no point ovulating if the lining of the uterus is not ready to receive a fertilised ovum.
We talk about the menstrual cycle, but really, we should talk about a series of menstrual cycles. One in the hypothalamus, one in the must be in sync with all of the other cycles in order for the ultimate aim of the system, reproduction, to be possible.
Growth, Reproduction, Excretion, Nutrition, Respiration, Irritability, Movement. These are the characteristics of every cell in the body, every organ in the body and thus of the body itself. No one characteristic is any more important than any other.
From an osteopathic point of view, movement is prime. Or to put it another way, the more an organ moves, the more alive and functioning it will be. So, the study of the anatomy of not just the organs, but also of their ligaments, the fascias and supporting bones also becomes very important. The relations between the organs is given a different importance by osteopaths as opposed to gynaecologists because we look at the mobility and the motility of the organs not just in themselves but also in relation to each other, and we do this once again because it will affect function. An example of this is a uterus with a large fibroid will push against the sigmoid colon and lead to the symptom of constipation.
The nervous systems both central and autonomic are responsible for control of blood flow and connecting the organs with the brain. Thus, nociception is possible, and dysfunction can lead to pain.
Lastly the blood supply and venous and lymphatic drainage both from an anatomical and physiological point of view are given their correct importance by the osteopath when he considers treatment within this system.
Cranial osteopathy, visceral osteopathy and structural osteopathy and not to be considered separate from each other. They are techniques not philosophies. Therefore, when we consider treatment in this area we need to use as many of these techniques and others to give us the best possible results.
Before we can begin to treat, we must diagnose and before we can diagnose, we must look at anatomy, physiology, and pathology before we use our osteopathic diagnostic principles so that we know we are safe to treat. The human body is a great trickster! Organs share the same blood supply afferent and efferent, and the same nerve supply too.
Therefore, we need as much information as possible included in our diagnostics in the same way as allopathic medicine. We use a case history based on physiological function as a start to our differential diagnostic process. We assume nothing and question everything. In every way we have to know the answer to a question before we ask it so as to make sense of the answer. For example, if we ask if the patient has pain with menstruation, we need to know the type of pain. Acute spasmodic pain is more common in your women suffering from spasm of the uterus before a pregnancy, whilst a deep diffuse dull pain radiating to the back might well be associated with congestive dysmenorrhoea which itself is associated with something like a fibroid not normally found in the young. Is her back pain that she comes to see you about primary musculo skeletal pain or is it a referred pain that is worse mid cycle when the hormone oestrogen is at a peak?
Does she menstruate regularly and have there been fertility issues? A detailed knowledge of the pituitary / hypothalamus axis is needed in order to understand why she has menstrual irregularities and thus might be better treated by the gynaecologist. The use of blood tests, MRI, biochemistry and ultrasound scans are all important adjunct s needed in gynaecological diagnosis and this is all before we start to use palpation.
From an osteopathic point of view our palpatory skills are what distinguishes us from medical doctors or physiotherapists. The subtle skills of using mobility and motility to diagnose can take many years to develop and interpret. Students in classes of osteopathy and gynaecology are taught to palpate outside and inside the body as they develop these skills.
Finally, the musculo-skeletal system. Good spinal and pelvic mobility are essential to good organ movement and function. The nervous pathways to and from the organs are studied so as to understand viscero somatic and somatico visceral reflexes which are not just nociceptive but also control movement of organs such as the fallopian tubes, but the blood supply and venous drainage mentioned before.
The classes start with the anatomy and physiology and proceed through pathology to palpatory diagnostics. This logical approach will lead naturally to techniques of all types as mentioned before so that the student will feel comfortable working in this difficult area for the greater benefit of his suffering patients.
Day 1 . Introduction.
The menstrual cycles and their interlinking so that reproduction is a predictable and logical series of processes leading to a new baby. Or to put it another way, the brain and the pituitary gland, the ovaries, the uterine lining, and the cervix all have to work together otherwise what is the point. If you menstruated the day after ovulation nobody would be there!!
The menstrual cycle review.
Symptoms in gynaecology. What is normal?
The differential diagnosis of gynae symptoms, pain, bleeding, too much, too little, Inappropriate pain with bleeding spasmodic and congestive dysmenorrhoea
Gynae pathologies such as tumours benign And cancer,
Urogynaecology and pelvic floor weakness
All of the above will take up most of the first day. It is not all lecture style. I break up the classroom teaching with practical palpation sessions, and differential diagnosis with work examining he patient standing and supine.
Day 2. The Anatomy
The blood supply
The venous drainage
The central and autonomic nervous systems
Again the second day is not all lecture, but lecture and practical introducing the principles of functional unwinding techniques to the organs. This will prepare them for the external and internal specific techniques.
Day 3. The treatment techniques
Evaluation of the pelvic floor in an osteopathic way
The pubic symphysis and the Sacro Iliac joints. Direct and indirect techniques will be demonstrated and practiced according to the skill level of the group. I hope to include some simple manipulation type techniques here too.
Bimanual and single hand listening chniques for the uterus with a balanced approach.
The internal techniques. 80% of the techniques used by osteopaths are external but the internal techniques are also important. I will bring an anatomical model with me that allows the whole class to have a chance to palpate and see how the organs feel. Those students who wish to either with a partner from the class or with a girlfriend or wife will be taken off to do the techniques live. This is a guided part of the course and I shall be there every step of the way to ensure that the palpation is easy, not painful, and modest.
Each participant receives a script and a certificate in English.
DR STEPHEN SANDLER PhD DO
Academic Qualifications and Professional Associations:
Member of the Register of the General Osteopathic Council of the United Kingdom
Member and former Council Member of the British Osteopathic Association. I joined the old OAGB in 1975 which became the BOA and then the IO. I served on council in various roles from 2006-14.
DO 1975 The British School of Osteopathy
FETC West London Institute 1978
PhD March 2006 for research into the changes in collagen during the menstrual cycle and the link with injury incidence. This was awarded by the Open University of the United Kingdom and it was completed in association with the Academic Department of Obstetrics and Gynaecology of the Chelsea and Westminster Hospital in London where I was a research fellow between 1984 and 1993.
Visiting Professor The Japanese Osteopathic Association 1996.
2004 Elected Chairman of the Waltham Forest Osteopathy Group.
Together with Dary Herbert DO I co-founded The Waltham Forest Osteopathy Group.
Initially this was a group of osteopaths working in the Waltham Forest area to negotiate with the NHS for provision of an NHS contract to provide osteopathic services. Unfortunately because of funding issues and problems relating to commissioning the project failed however instead we turned it into a postgraduate association that provides CPD for its members. We have met every month for 10 months each year at a local private hospital for two hours. The programme can vary from specialists provided by the hospital to members of the group presenting topics they have prepared for the group. We have had technique sessions and meetings with the GOsC and IO discussing various matters ranging from CPD to consent issues. We have also had some very successful study days where for a small additional fee we have met at a local medical school for an anatomy day in the dissection rooms or had a first aid validation day where we all received a certificate bringing our first aid skills up to date. It remains a group of 60 people who meet regularly and learn together making CPD relevant to osteopathic practice. Despite yearly elections I am still the Chairman and Daryl is still the Secretary.
Teaching and Examining experience:
I was involved in teaching at The British School of Osteopathy since graduating in 1975. I started as a junior clinical tutor. This developed into my becoming a Senior Clinical Tutor and Senior Lecturer and Examiner and eventually the head of department of Applied Anatomy and Physiology.
Apart from general clinic tutoring I started a demonstration clinic at the school where students were encouraged to bring difficult cases for evaluation and treatment.
I was a Senior Lecturer at The BSO where I taught Osteopathy and Obstetrics to the fourth- year students as part of their elective studies.
I founded the first specialist clinic for the treatment of Expectant Mothers at the BSO in 1982 where more than 5000 patients have been treated. The clinic continues to this day.
I taught many times at the BSO at a postgraduate level since the late 1970s. Subjects included Osteopathy and Obstetrics, Visceral Osteopathy, The TMJ, and related subjects.
I taught at postgraduate levels many times for the annual conference of the British Osteopathic Association now the Institute of Osteopathy, and at postgraduate weekends around the UK usually organised by the regional societies.
I also taught at the manipulation modules organised by the Chartered Society of Physiotherapy as part of their Masters Course foe extended scope practitioners.
Apart from my role as teaching role at the BSO I have extensive experience teaching and examining at osteopathic schools internationally in Belgium, France, Italy, Spain, Portugal, Germany, Austria, Sweden, Norway, Denmark, Israel, Russia, Poland, Argentina, Brazil, Venezuela, North America, Canada, Russia and Japan.
I was module examiner for the undergraduate programme at The BSO from 1982 until 2014.
As head of department I was responsible for the final written examination papers at BSc and MSc level.
I was chairman of the International Jury and External Examiner for The Flanders
International College of Osteopathy in Antwerp Belgium 1987- 2016
2013-18 I was the External Examiner appointed by the Anglia Ruskin University of East Anglia to The London School of Osteopathy.
Publications and Journal Articles:
A clearer understanding of migraine, BOJ (Old Series), Vol. 13, No. 1, Winter 1981-2, pp. 23-32.
Innominate rotation – fact or fiction, BOJ (Old Series), Vol. 14, No. 2, December 1982, pp. 101-7.
Osgood-Schlatters disease: a realistic osteopathic approach, BOJ (Old Series), Vol. 16, No. 2, December 1984, pp. 79-81.
The physiology of soft tissue massage, BOJ (Old Series), Vol. 15, No. 1, June 1983, pp. 1-6.
Approaches to treatment an historical perspective, BOJ (New Series), Vol. VII, 1991; pp. 19-20.
Report on a survey to look into the incidence of acute musculo skeletal pain and the phasesnof the menstrual cycle, BOJ (New Series), Vol. XXI, 1998, pp. 7-8.
The management of low back pain in pregnancy. Man Ther. 1996 Sep;1(4):178-185. Sandler SE.
Books and DVD:
Osteopathy A Patients Guide Optima Press 1987
Osteopathy Macdonald Publishing 1989
Osteopathy and Obstetrics Anshan Publishing 2012
2 nd Edition is now in preparation. This book has been translated into French , German and Russian languages.
DVD Osteopathic Functional Technique.
I have run a private practice at Chingford in East London since 1975. The practice has a team of 4 osteopaths and an acupuncturist serving the local community. We see a wide variety patients in general osteopathic practice from babies to great grandparents who are self-referred, referred by family and friends and from local GPs. I worked as a clinical assistant for Colin Dove DO former principal of the BSO at his private practice in Romford from 1975-1983.
I was appointed Consultant Osteopath to The Portland Hospital for Women and Children in 1998 where I continue to work on a part time basis treating referrals of pregnant patients and others from Consultant Gynaecologists and Obstetricians.
I have extensive experience in teaching and treating cases of coccyx pain and my Power Point presentation for the manual treatment of Coccyx pain has been extensively used and referenced via the internet. In April 2017 I was invited to attend the International Symposium on Coccygeal Pain at the Hospital Dieu in Paris organised by Prof. Yves Maigne.