Unified Osteopathic Field theory - American Academy of Osteopathy

Biomechanics of the 

Unified Osteopathic Field Theory 

Clarence L. Nicodemus, D.O., Ph.D. 

(with inspiration and contribution by Ken Lossing, D.O.) 

AAO Convocation 

Louisville, KY 

March 22-23, 2012

Examine the components: 

“Osteopathic Field” 

“Unified” 

“Biomechanics” 

Biomechanics of the Unified Osteopathic Field 

March 22-23, 2012 C. L. Nicodemus, DO, PhD 

2

It all starts with Dr. Still. He was: 

An original 

Unique 

Creative 

A Visionary 

Correct 

“_____________________________________” 


3

The “Osteopathic Field” 

Commonly “Taught” 

Approaches 

HVLA 

Muscle Energy 

Myofascial Release 

Strain/Counterstrain 

Soft Tissue 

Lymphatics 

“Other” Common Approaches 

• Balanced Ligamentous 

Tension and Ligamentous 

Articular Strain 

• Facilitated Positional 

Release 

• Osteopathy in the Cranial 

Field 

• Progressive Inhibition of 

Neuromuscular Structures 

• Functional Technique 

• Visceral Manipulation 

• Still Technique 

• Chapman’s Approach 

• Fulford Percussion 

• Energy 

Chila, Anthony. Foundations of Osteopathic Medicine, 3rd Edition. Lippincott Williams & Wilkins, 2010 


4

Unified Field Theory 

Einstein's attempt to unify the General Theory of 

Relativity with electromagnetism 

Wrong Field Theory 


5

Unified Osteopathic Field Theory 

All theories of manual medicine are based on 

manipulating the same basic human tissues. 

Further, all human tissues exhibit the same fundamental 

biomechanical property, namely, viscoelasticity. 


6

Many different aspects/models 

Fascial Model- Distensability, tested with motion testing 

and fascial pull. 

Fluid model- circulation, tested with doppler ultrasound, 

perfusion studies, or palpation. 

Neurological Model- electrochemical information, tested 

with palpation and motion testing, EMG. 

Biomechanical Model- Inherent and induced-Tested with 

palpation, ROM, sensing 

Energetic Model- temperature changes, electricity, 

etc…. 


7

What is common among these 

approaches? 

Commonly “Taught” 

Approaches 

HVLA 

Muscle Energy 

Myofascial Release 

Strain/Counterstrain 

Soft Tissue 

Lymphatics 

“Other” Common Approaches 

• Balanced Ligamentous 

Tension and Ligamentous 

Articular Strain 

• Facilitated Positional 

Release 

• Osteopathy in the Cranial 

Field 

• Progressive Inhibition of 

Neuromuscular Structures 

• Functional Technique 

• Visceral Manipulation 

• Still Technique 

• Chapman’s Approach 

• Fulford Percussion 

• Energy 


8

Hands and Tissues (and more) 

It is called Manipulative Medicine because hands 

manipulate tissues 

We also engage our mind, energy, intuition, spirit 

It is very difficult to measure the latter 

So we focus on the former 


9

Biomechanics 

“the application of mechanical laws 

to living structures.” 

Saunders Comprehensive Veterinary 

Dictionary, 3 ed. © 2007 Elsevier, Inc. 


10

Fundamental Biomechanics 

Review 


11

Histology of Connective Tissue 

Ken Lossing, D.O. personal correspondence 


12

Origin and Classes of Connective 

Tissue 

http://classes.midlandstech.edu/carterp/Courses/bio210/chap04/ 

March 22-23, 2012 C. L. Nicodemus, DO, PhD 13

Molecular 

Structure of 

Collagen 

•Elongated 

•Linear 

March 22-23, 2012 


C. L. Nicodemus, DO, PhD 14

Other Components 

March 22-23, 2012 



Loose, areolar Connective Tissue 

March 22-23, 2012 



Loose, adipose Connective Tissue 

March 22-23, 2012 



Loose, recticular Connective Tissue 

March 22-23, 2012 



Dense, regular Connective Tissue 

March 22-23, 2012 



Dense, irregular Connective Tissue 

March 22-23, 2012 



Types of Connective Tissue 

Ken Lossing, D.O. personal correspondence 


21

Fascia 

The fascia is a loose, areolar connective tissue 

composed of: 

collagen-( literally glue –making) 14 types , most 

common is type 1 (90%) 

ground substance 

fibrin 

Elastin- maintains the tensile strength of connective 

tissue 

The collagen fibers are connected to other collagen 

fibers through chemical bonds. 


22

Effects of loading 



23

Collagen Structure 



24

Muscle Fiber Structure 



25

Terminology 

terminology [tur-muh-nol-uh-jee] 


26

Strain and Stress 

Strain: is a measure of the degree or intensity of 

deformation. Elongation per unit gage length. Units of 

strain – mm/mm, in/in STRAIN = ΔL/L 

Stress: force per unit area, may be shear stress, tensile 

stress, or compressive stress. Units of stress- N/m 2 

(pascal), dyn/cm 2 , lbs/in 2 . STRESS=F/A 

Shear stress is a “cross fiber” action. Units of stress- 

N/m 2 (pascal), dyn/cm 2 , lbs/in 2. SHEAR STRESS = F ’ /A 


27

Elastic Deformation 

Stress 

loading 

1 

Strain 

E 

Strain 

unloading 

Ken Lossing, DO 

IDEAL or PURELY elastic 

Stress > PE > KE 


Think rubber band 

E= elastic modulus = Δ 

stress/Δ strain 

28

Real Deformation 

Stress 

loading 

H 

Strain 

unloading 



Stress > PE > KE + H 

H = Heat loss, fluid motion, 

molecule structure 

The area in the hysteresis loop 

(H) represents the energy 

dissipated as heat during 

loading and recovery and the 

work done in mechanically 

altering fibrin and collagen 

structures. 

29

Actual Data for a Tendon (rat) 

http://www.engin.umich.edu/class/bme456/ 

Repetitive cycles 

change the response 

10 cycles = stable 


30

Creep and Hysteresis 

? Hysteresis?? 


31

Creep I 



32

Creep II 



33

Viscoelasticity 

having viscous as well as elastic 

properties 

a combination of viscous and elastic 

properties in a material, with the 

relative contribution of each being 

, , 

, and . [and 

] 


34

Actual Data for a Tendon (rat) 


Repetitive cycles 

change the response 

10 cycles = stable 


35

Fluid - Viscosity 

Stress 

Strain 

N=coefficient 

of viscosity 

1 N 



Stress > HEAT only 

Each fluid has a 

“coefficient of 

viscosity”. 

The higher the 

coefficient of viscosity, 

the thicker the fluid. 

36

Viscosity 

Peanut 

Butter 

Catsup 


OR 

37

Viscoelastic change 

Stress 

Temperature 

Strain 

Increasing 

stiffness 

Strain Rate 



Resulting stress is not 

only a function of strain, 

and temperature, but 

also the strain rate, in 

other words the speed at 

which a load ( strain) is 

applied will affect the 

amount of stress in the 

tissue. This is called 

“time dependant 

material behavior”. 

Rhythm of the tissue! 

38


39

Creep and Hysteresis 

When a load (stress) is applied to a viscoelastic 

material, molecular bonding is re-arranged and thus the 

material elongates or “creeps”. 

As the re-arrangement occurs, a back-stress develops. 

When the back stress matches the applied stress, creep 

stops. 

When the load is released, the back stress returns, the 

original length returns (with losses of energy due to the 

heat of mechanical re-arrangement). This is hysteresis. 

Visco = creep; Back stress return = elastic 


40

Viscoelasticity 

having viscous as well as elastic properties 

The property of a substance of exhibiting both elastic 

and viscous behavior, the application of stress causing 

temporary deformation if the stress is quickly removed 

but permanent deformation if it is maintained 

a combination of viscous and elastic properties in a 

material, with the relative contribution of each being 

dependent on time, temperature, stress, and strain 

rate. [and electrical field] 


41

Stress 

Full Tendon Stress/Strain Curve 

Strain 

A = Relaxed (Elastic) 

B = Operating (Hysteresis) 

C = Overload (Plastic) 

D = Failure 

E = Rupture 



42

Stress 

Elastic Deformation 

P 

E Y 

Strain 

PD 

unloading 

Strain 

U 

R 


A strain applied to a tissue will 

result in a stress in the tissue 

P=Proportionality limit-linear 

until then, and loading is 

matched with unloading 

E=elastic limit 

Y= yield strength, considerable 

elongation occurs without 

corresponding increase of stress 

PD= Plastic deformation area 

U=ultimate strength 

R=rupture 


43

Stress 

Plastic Deformation 

P 

E Y 

Strain 

PD 

Strain 

U 

R 



A stress load that is 

larger than the yield 

strength of a tissue will 

cause a plastic (or 

permanent) 

deformation. 

The whole curve 

changes. 

The plastic deformation 

will remain unless 

something changes it. 

Sounds like a visceral 

dysfunction! 

44

Summary 

Force Effects in Connective Tissues 

•Elastic Deformation 

•Plastic Deformation 

•Viscosity 

•Stress 

•Strain 

•Creep 

•Hysteresis 

•Temperature 

•Density 

Pizoelectricity 



45

Pizoelectric properties of 

Collagen 

Transducer (Stress > Current > vibration) 

Biphasic signal (- load, + release) 

Stress related signal (Current α Stress) 

Stimulates osteocytes (- charge) 

Stimulates and directs the migration of electrically 

sensitive cells (chemotaxis) 

Activates cells (electro-sensitive cells) 



46

Acupuncture is a pizoelectric 

fascial phenomenon. 


47

Now look at applications 

Visceral 

Mechanical 


48

Visceral (Broad) Ligament 

VS 

Sacral Ligament 


49

Comparison of Young’s Modulus 

1600 

1400 

1200 

1000 

800 

600 

400 

200 

0 

E = 1500 MPa 

E = 150 MPa 

0 5 10 15 

Fascia 

Tendon 

March 22-23, 2012 C. L. Nicodemus, DO, PhD 50

As Applied to Visceral Dysfunction 

Constantly applied loads on visceral ligaments and fascia will 

have caused them to maximally elongate and to stiffen as a 

result of the molecular re-arrangement. 

Releasing the cause of the chronic loading by re-balancing 

muscles, reducing joint restrictions, and balancing fascial strain 

patterns, internal stress of the tissues is reduced. 

Reduction of the internal stress and stiffness causes release of 

constrained fluids held with in, such a lymph, venus and arteriol 

vessels. 

Circulation returns, pain is reduced, and function returns. 

Temperature changes occur; heat of inflammation is reduced, 

heat of circulation is increased, and heat of tissue molecular rearrangement 

is increased. 


51

Visceral Dysfunction 

“Impaired or altered mobility or motility of the visceral 

system and related fascial, neurological, vascular, 

skeletal, and lymphatic elements”. 

American Osteopathic Association Glossary, 2011 

This is reflected in abnormal motion tests, 

showing a change in the distensability of 

the attachments, or a change in their 

normal viscoelasticity. 


52

SO,(to quote Dr. Lossing): 

If there is a visceral dysfunction, the ligament has a 

certain amount of strain stored (potential) energy- 

“potency”, in a certain direction, and that tissue has a 

certain strain rate (speed) that it will respond to. This 

results in an altered viscoelasticity curve for that 

ligament. ( The viscosity is more, the elasticity is less). 

When the internal strain is exactly matched, by 

application of force, direction, and speed, the tissue 

will change. Increasing the fluid exchange should 

accelerate the change. In the process there is a 

dissipation of heat, movement of fluid, and a 

restructuring of the elasticity curve. 


53

Multiple strains 

50 

30 

10 

20 



The body generally 

accumulates many strains 

over a life time. The strain 

takes a certain amount of 

force to hold it there, 

exerting tension into the 

fascia. The one with the 

most force will have the 

biggest effect on the fascia. 

Therefore, removing the 

biggest strain will have the 

largest effect on the body 

54



Lines of tension 

Liver-superiorly-coronary, 

triangular and falciform 

ligaments to resp 

diaphragm- inferiorly- 

right kidney 

Right kidney, colon 

iliacus and psoas 

Pancreas can affect whole 

peritoneum, duodenum, 

both kidneys, stomach, 

etc.. 

55

Visceral Dysfunction, a Plastic 

Deformation 

Stress 

E Y 

P 

Potency 

Strain 

March 22-23, 2012 

Strain 

U 

R 


A stress load that is 

larger than the yield 

strength of a tissue will 

cause a plastic or 

permanent deformation. 

The area under the 

graph represents 

therapeutic gold, the 

potency of the stored 

charge. 

The distensability of the 

tissue is changed 

C. L. Nicodemus, DO, PhD 

56

Ligaments and Fluid Shift 

With minimal additional 

mechanical tension in ligaments, 

the first fluid vessels to be 

Neurovascular Bundle 

compressed (compromised) will 

be those of lowest pressure, the 

Artery Vein 

lymphatic vessels- relative 

edema, retention of metabolic 

byproducts. 

Nerve 

Lymph vessel 


With increased tension, comes 

venous congestion, increased 

retention of metabolic 

byproducts 

and with more tension comes 

arterial compression- decreased 

nutrition, oxygen, and eventual 

death. 

“obstructive lymphedema” - 

Robbins Pathologic Basis of 

Disease March 22-23, 2012 C. L. Nicodemus, DO, PhD 

57

Barriers 

Physiologic Barrier: the limit of active motion. 

Anatomic Barrier: The limit of motion imposed by anatomic 

structure: the limit of passive motion. 

Neutral: The point of balance of an articular surface from which 

all the motions physiologic to that articulation may take place 



58

Mechanical 

End feel 

Tightness 

Bogginess 

Hypertonic 

Stiff 


59

Motion testing 

Elastic Barrier: 

The range 

between the 

physiologic 

barrier and 

anatomic 

barrier of 

motion in which 

passive 

ligamentous 

stretching 

occurs before 

tissue 

disruption. 

If we move a ligament to its 

physiological barrier, it removes any 

slack in the ligament and starts to 

engage the elasticity of the ligament 

At this point, we are still below the 

elasticity limit of that tissue. 

When we remove the straining force, 

the ligament returns to it’s original 

configuration- an elastic deformation. 


60

This Applies to the whole body 

Embryology, Histology , Gross anatomy, 

micro anatomy. 

Ear, nose and throat 

Visceral System 

Lymphatic system 

Nervous System 

Endocrine system, immune system 

Musculoskeletal System 


61

Summary 

Therefore, we need to expand our vision of 

osteopathy, to have the same vision as Dr Still. 

All problems/symptoms that a patient experiences 

may have a functional component that is treatable. 

Most of how we diagnose and treat is a function of 

its viscoelasticity…. 

No matter which dysfunction or treatment model 

we use. 

A very unifying idea! 


62

Thank you! 

Any questions? 

Niles, Superdog 


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Unified Osteopathic Field theory - American Academy of Osteopathy

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