Bingo !

 

Le 27 mars 2007, après 1847 jours d'attente, les décrets et arrêtés reconnaissant la pratique de l'Ostéopathie ont paru au journal officiel

 

Décret no 2007-435 du 25 mars 2007 relatif aux actes et aux conditions d’exercice de l’ostéopathie NOR : SANH0721330D

• Sur le site du Journal officiel

• Consulter le décret (format PDF)

 

Amélioration de l’expression orale

 

 

1.      Cas  clinique du 27.06.01  PRB AG 

 

 

 

 

 

 

Mr JE.CH, 50 ans, enseignant, consulte le 27 juin 2001, pour lombalgie apparue brutalement sur un « faux  mouvement » il y a 8 jours. Il chante dans une chorale (basse).

La consultation médicale :

-          les examens pratiqués sont dans la norme

-          le patient est orienté vers des soins fonctionnels.

 

Le traitement fonctionnel :

Une première séance a été faite le jour de la consultation :

Antécédents :

-          parfois lombalgie,

-          fait peu d'échauffement – étirement corporel.

-          parfois se plaint du genou gauche pendant les randonnées pédestres

 

Bilan :

-          Test  visuel= bréviligne de morphologie, avec un thorax souple, membre inférieur plus court à gauche et antériorité du bassin à gauche en décubitus dorsal.

La posture assise est un peu affaissée. Le passage de la position assise à debout est difficile.

-          Test de la verticale de Barré (apprécie la notion de dysfonction montante ou descendante) =  dysfonction descendante droite.

-          Testing clinique abdominal : (0) selon le concept ABDO-MG®  qui met en évidence s’il y a un défaut de transmission des pressions Références bibliographiques (a) : Résultats : obtenus suivant une cotation de +1 à -3.

-          Tests analytiques de mobilité des articulations vertébrales : Références bibliographiques complémentaires et autres références  (b)

o   NSRg totale du groupe T12-L4, sans possibilité de dissociation au niveau de L3 (Test différentiel avec la NSR lombaire totale dans la dysfonction viscéro-pariétale).

o   Le test de Downing ne révèle pas de dysfonction iliaque.

-          Test de palpation :

o   tension musculaire du psoas droit (M. psoas major), du muscle iliaque gauche (M. iliacus).

o   Spasmes des muscles para vertébraux lombaires du côté gauche (NSRg)

-          Test de mobilité globale vertébrale et périphérique :

o   Il existe au niveau lombo-pelvien une perturbation « spatiale » du mouvement de rotation, même observation pour le mouvement d’inclinaison, par contre E et F sont bien réalisés aussi bien dans « l’espace » que dans le « temps ».

-          Tests analytiques de mobilité viscérale :

o   Manœuvre Pyloro Sous Hépatique : sensible

 

Donc on peut en déduire que la dynamique du corps lors du mouvement  rotatoire de gauche à droite s’est faite par compensation  au niveau de L5 qui s’est mobilisé en même temps  que le bassin pour trouver la mobilité nécessaire. Le système proprioceptif a pris en défaut cette compensation et fixera le mouvement en dysfonction appelé Pseudo Rotation du Bassin.

Elle correspond successivement:

1.      à une compensation (physiologie articulaire respectée)

2.      à une dysfonction ostéopathique de type entorse

 

Traitement =

-          Levée des tensions musculaires des psoas iliaques à visée de déparasitage, pompage et étirement.

-          Les normalisations articulaires ont été faites en manipulant les paramètres en dysfonction de la PRB Antérieure Gauche, du groupe lombaire en NSR..

o   Réduction du slack de L4 /L5-Bassin en traction verticale puis, technique directe.

o   Réduction du slack de T12 à L4 en position N, Rd, Sg puis, technique directe

-     Les normalisations viscérales ont été faites par mobilisations viscérales basées sur des massages à type de succussions,  vibrations, pompages, appliquées à :

o   La partie inférieure sous diaphragmatique droite, les voies biliaires et en projection de la vésicule biliaire

o   La région inféro latérale droite du thorax : réveil du parenchyme hépatique

o   Massage réflexe sous diaphragmatique pour détendre ce dernier

 

-          Apprentissage  de l’aplomb assis (ressenti de l’interdépendance des différentes parties du corps entre elles) et de l’échauffement.

-          Apprentissage des étirements: psoas iliaques (M. iliopsoas) : type méthode McKenzie, (intérêt de leur mise en place suite à ce bénéfice de fonctionnalité dû à la normalisation articulaire au niveau de points pivots). 

 

 

Mr JE.CH a pu constater après le traitement les effets suivants qui ont été
notés sur sa fiche de soin le 4 juillet 2001:
-  Amélioration particulièrement efficace sur son motif de consultation.

-  Des effets concomitants sur sa pratique musicale : il peut chanter debout plus longtemps, retrouve une aisance dans son bassin et ne force plus sur les cordes vocales.

Concernant « l’amélioration de l’expression orale », il précise : plus d’aisance, de soutien, de puissance, surtout dans les aigues, les attaques.

 

 

VÉRIFICATION : faite conjointement avec un Kinésithérapeute, FR. LE., spécialisé dans le travail postural :

 

 

 

 

 

 

Ont été appliqués comme moyens d'évaluation :

-          Test de la verticale de Barré : Résultat AVANT / résultat APRES TTT = recentrée.

-          Testing clinique abdominal : (0) selon le concept ABDO-MG® 

-          Test des pouces montants de Bassani = pas de restriction.

-          Le mouvement lombaire en S et en R n’est plus limité dans le temps de son déroulement

-          J’effectue comme d’habitude dans ce cas un test personnel : «Test simulé de mise en situation  gestuelle instrumentale optimisée » qui consiste à évaluer l’aisance du geste instrumental et la tonicité posturale contre résistance appliquées par le praticien : ici adapté aux chanteurs.

o   La grille d’évaluation de 0 à 5 permettait d’attribuer la note : 5 (?)

L’entretien avec la personne est effectué en recherchant à cibler l’efficacité du traitement : Résultats : obtenus suivant une cotation 0 ou 1 sur 5 points.

 

Amélioration des signes cliniques du début des soins

1

Compréhension des facteurs occasionnant ses perturbations

1

Assimilations des exercices d’entretien

1

Amélioration de sa gestuelle spécifique

1

Bénéfices secondaires dus au traitement

1

Résultats   5/5

 

 

 Bénéfices secondaires dus au traitement = amélioration de la dynamique dans l’expression orale : plus de soutien, de puissance, surtout dans les aigues, les attaques. 

 

 

 

 

  

Improvement of oral expression  

 

by osteopathic treatment  

 

of the postural lumbo-pelvian diagram  

 

 

Introduction  

 

The « functional re-equilibration » is the method that we’re used to employing in of disfunctioning functional viscero-parietal entity. A such  treatment is indicated when the bad distribution of constraints in the lumbo-pelvian complex change the postural diagram and cause functional troubles without any organic causes can justify the origin of exteriorized problems.  

 

This method of application of Osteopathy allows to bring to Posturotherapy a complementary technique as a  very interesting scientific argumentation for the continuity of researches in  Posturology.  

 

It is known that postural problems with an neurologic origin breed physical disfunctioning (functional and/or pathological) and it already has been published  works which show the interest of the technic contribution of the osteopathy to the posturology.  

 

The most of these works show the mechanical  temporo-maxillar incidence and precise therapeutic acts according to specific methods characterize  in the specific litterature the application of this contribution.  

 

Without being neglectful of this established scientific fact, it appears interesting to argue again more about postural problems with an mechanical origin. By now, the medical litterature concerning Postology doesn’t speak yet about the interest of a osteopathic treatment upon functional viscero-parietal entity. This new approach has been introduced for the first time at the World Congress of Posturology in Burarest in October 2005.  

 

 

 

 

1   Lumbar-pelvien starting point  

 

To point an Osteopathic treatment ‘s got sedative effects upon mechanisms paintful syndromes won’t surprise anyone!  

 

To stress on a such treatment comes with nearly always an improvement of gesture expression would be a bit usual... The purpose of our conference is to introduce in ours capacity as Osteopaths our reflexion about a phenomenon more singular, it concerns the improvement of oral expression by Osteopathic treatment of lumbo-pelvian complex.  

 

The therapeutic effectis in the lumbo-pelvian complex are not limited to the diminution of paintful syndromes... The theoretical model we puts into practice allows to establish coherent observations. We have noticed the reproductibility of effects of an osteopathic treatment upon the dynamic of oral expression when the postural correction integrated in the treatment the diagram of a disfunction of type N.S.R Lumbar.  

 

2    A disfunction of type osteopathic  

 

The NSR lumbar is a disfunction of type osteopathic, is to say a disfunction whom the mechanical origin isn’t the cause of the modification of the structure. The osteopathic disfunction results from a disfunctioning of the psysiology of the movement.  

 

N means Neutral: position where an articular mobility with a slight amplitude is possible without any intervention of agonistic or antagonistic muscles.  

 

This “easy position” allows to adjust fine movements without spending any energy.  

 

S means Side ( lateral tilting), R means Rotation.  

 

The disfunction NSR  is characterized by a test of mobility. This test, puts into practice to the lumbar segment, reveals the existence of a mobility in the N joins in restriction of mobility in S and R.  

 

This adptation with regard to articular physiology of lumbar functioning gets settled in N.SrRl or N.SlRr                              l= left          r=right  

 

N.SrRl= easy position with Sl and Rr in restriction of mobility  

 

N.SlRr= easy position with Sr and Rl in restriction of mobility  

 

This articular disfunction of type osteopathic gets settled on a vertebral lumbar group,  

 

T12-L1-L2, sometimes from T12 to L5.On the mechanical plan, this organisation (S and R opposed direction) in a segment (the lumbars) is a phenomenon of shock-absorber of constraints.  

 

The N.S.R. Lumbar is an adaptation in the lumbar segment which results from the compensation of a visceral functional suffering..  

 

The N.S.R disfunction is directly linked to functional  suffering of visceral system. This souffrance in the visceral structure breeds incidences on the diaphragm.  

 

This compensation of N.S.R. in the vertebral structure breeds incidences on postural balance. 

 

These two generative of incidences will produce particular effects at postural level. 

 

 

 

 

3   Spatial-temporal dysfonctioning  

 

N.S.R. vetebral group is more a temporal problem than a spatial one. The restriction S and R of a N.S.R. lumbar is not a restriction of amplitude in space, it’s a restriction in the physiologic time of the movement made in space. The temporal restriction in the mechanism of a physiologic function is a slackening in the speed of execution. Therefore, the temporal restriction of a N.S.R. Lumbar disturbs the rythm of the diaphragm disturbs the time of adaptation to balance. The temporal restriction in the functioning of the lumbar segment is objectivable by dynamique anthropometry machines. ( research works Ph.D SOLERE R., JOLLY A. VACCARO R. , CASALI D. Research center in alternative therapies, CRTA Program, 2004-2006).   

 

Biometric statements are realised by 3 machines equiped with electronic sensors and with officially confirmed measure instruments, linked to an officially confirmed network.  

 

This antropométric group allows “dynamique anthropometry” upon movements into three levels of space,precisely on the lumbar segment. Moreover, this machine has been created with a platform where we can go up on it, ajustable in the three plans to provoke at the iliac level different constraints of compression.  

 

This dynamique anthropometer allows an analysis of elements of the spatial organisation and of the temporal organisation of the lumbar articular physiology, and establishes the value of the incidence of the sacro-iliac disfunctions on this segment.  

 

At the begining of the publication of these works, we can say that the N.S.R. lumbar is a disfunction of type osteopathic, with a “temporel”kind.  

 

It’s easy to notice that the individual hasn’t got any articular limitation in the functional space.He’s just got more difficulties to move and for instance, it takes more time (for him) to execute on the right, the same movement than he does on the left without any constraint.  

 

The compared research of biometric forms allows to notice new scientific elements upon  the temporal function of a movement which will be interesting to integrate into osteopathy and into clinical posturology.  

 

4-   incidence of spatial-temporal disfunctioning  

 

The lumbar segment, whose the articular physiology allows a mobility in the “N”, is a “shock-absorber” of constraints from visceral system. If there is suffering in the visceral functional system, the adaptation of lumbar will impose several informations to the others systems ( neurologic, articular, muscular,ligamentar system). The viscero-parietal entity fits... and forces the structure to be the same. If there are difficulties to ensure this adaptation, some functional multifactorial suffering breed FMS (Fibromyalgia Syndrome) or (diffused idiopathic polyalgic syndrome). The lumbar segment, in the position “N” acts  like “shock-absorber” of constraints. It executes a slight twisting organising an opposition S and R.( example NSlRr). The sacro-iliac joints can also play the part of a “shock-absorber” of constraints ( research works Ph.D SOLERE R., JOLLY A.) “The axial ligament ensure the absorption of constraints in the absence of interweaving of sacro-iliac”.  

 

When  the “lombo-pelvien shock-absorber” (NSR+ sacro-iliaques) are “set”,the lumbar zone is in articular suffering and the disturbance is more temporal than spatial (research works CRTA).The diaphragm pillars (crus diaphragmatis) fitting from L2 to L4 will have an insertion zone in temporal suffering. This won’t be favourable to the rythm of the diaphragm, all the more so since the visceral suffering cause changes of shape and volume not favourable to good fulcrums for his phrenic center.  

 

The necessity of adaptation imposes variables in the ”spatio-temporal”organization of the physiologic movements.  In the temporal plan, these variables become important if there is a NSR and sacro-iliac disfunction. In the spatial plan, these adaptations can trigger disturbances off in the functional space and generate or increase a postural problem.  

 

These variables become important if there is a NSR and sacro-iliac disfunction. Therefore, some mechanical disfunction (in the articular plan) associated with(non organic) visceral disfunctions can be at the origin of a direct incidence upon some postural unequilibrum. We brought to the fore that the components of this viscero-pariétal adapter system disturb the “ rythm” of the diaphragm muscle, which will have as a result, a direct trouble of the dynamique of the oral expression.  

 

The notion of “temporal block” is important. Everything which must be executed in space needs to be in the good time of the putting into movement. The “tempo” of physiology! The music of well-being: health!  

 

5  Reversibility of this kind of problem  

 

Such functional problem are at the origin of this diagram, revealing surprising syndromes! Luckily for people who suffers, the “temporal” disfunctions are reversible. The treatment must associate visceral Normalizations and articular Normalizations.  

 

Loads of  “ asthenia” without organic etiology come with these problems and are very often indicated by a lack of  energy in the oral expression and by a breathlessness as soon as the individual make an effort!  

 

This sort of problem is commun to different syndromes: 
FMS (Fibromyalgia Syndrome) or (diffused idiopathic polyalgic syndrome).  

 

RSI (repetitive strain injury) 

 

CAP (chronic abdominal pains) 
IBS (irritable bowel syndrome)

PMS (premenstrual syndrome). 

 

6   Therapeutic model  

 

If we consider (theoretical model),that visceral problems from non- organic would breed a temporel defect in the physiology of fonctions, and that a such problem is objectivable, a functional re-equilibration sub- diaphragmatic should breed the disparition of indicated troubles and will show a very distinct improvement in the dynamic of oral expression, with only an articular and visceral normalizations as means.  

 

It’s been possible to view a non-medicinal therapeutic model because it’s clinicly possible to objectivize the mechanical dicfunctionings of type osteopathic.Allow the diaphragm muscle to recover its functionality is realisable in osteopathy. This treatment acts upon abdominal circulation and upon mechanical components of visceral spasms which allow a diminution of tension in diaphragm pillars, a better fulcrum for the phrenic center. This therapeutic model fits well when: 

 

-         the medical diagnosis establishes that the clinic manifestations are those of a painful syndrome coming with a vertebral functional discomfort without restriction of amplitude

 -         the stock of osteopatic allows to identify the mechanical components of this syndrome, that is to say, a NSR Lumbar disfunction of type temporal and a sacro-iliac disfunction of type “ interweaving ”.

 A such osteopatic treatment is composed of manipulations at lumbar level (N.SlRd or N.SrRl) and at sacro-iliac level (Ant or Post on the right or on the left) as so operations of massages on sub-diaphragmatic organs and on visceras of the abdomen.  

 

 

 

7       Improvement of oral expression  

 

The relation between the correlation of the lumbo-pelvian postural diagram and the improvement of oral expression seemed obvious behind a treatment by functional re-equilibration. But the comments concerning the estimation of the patient upon the  feeling of an improvement of oral expression could subjective. In order to make more objective this deduction, we have analysed the results when this therapeutic model had been made on musicians.We have thought that those professionals of oral and vocal expressions, had perfectly the logic elements of an sound interpretation, precise and objective, of all the variables upon this mode of expression. We have concluded that “the musician’s ear” had the required performance for this kind of  analysis and at least the same value than the one we could have attached importance at data processing devices.

 

 

 

Therefore of the objectivity revealed to musicians for this kind of analysis, we managed to explain  at the time of  a congress at the World Congress of Posturology, some tables relative to the clinic cases treated showing  the efficiency of this osteopathic treatment.  

 

The results of this research show the relation between the correlation of the lumbo-pelvian postural diagram and the improvement of oral expression which tend to prove the mechanical origin of a such problem. Until now, for this kind of problem, only the psychologic incidence was lightened. This omission  should be corrected then, because it has the disadvantage to deprive of a non “iatrogene” treatment loads of patients  for who the only need of functional re-equilibration give the appropriate answer, curative and non-medicinal.  

 

Conclusion 

 

This showed out the incidence of the lumbo-pelvian postural diagram upon the mode of oral expression would explain an etiology for the different aphonies which accompagny the painful syndromes, especially the dropping of dynamics in the vocal expression of the fibromyalgics. We hope these observations will arouse lots of practitioners’ clinic curiosity, so that research works can produce scientific knowledges which are still lacking,when it’s a question of understand well syndromes called “idiopathic” in order to  treat well the vast number of  people who suffer without being able to determine the least pathology.