Editorial - Of originality, breathing dysfunction and clinical education

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“Originality is the art of concealing your sources”

Benjamin Franklin

In this issue of the journal, Jordan (p. 100) provides a fascinating account of the likely origin of the concepts Sutherland proposed for the “Primary Respiratory Mechanism”. While this information may be known to some in the profession, we had certainly never heard of this before and are pleased to be able to bring this to the attention of the profession on a broader scale - if only for historical purposes.

We also think that this paper contextualizes Sutherland's concepts and provides an explanation for why he included the idea of a 'Primary Respiratory Mechanism'. Interested readers and advocates of the cranial concept may be surprised to learn that Sutherland's ideas were not entirely unique. Jordan's paper has opened the door on some of the history behind the development of these concepts and by doing so, we believe, adds a unique historical angle on the critical appraisal of the cranial concept.

In keeping with the theme of questioning the basic tenets and practices of osteopathy for the purpose of improving what we do and what we understand about what we do, Paulet et al (p. 92) have tested one of the most widely accepted truths in all forms of manual medicine; that practitioners are able to reliably, and with validity, palpate the human body and derive useful information. In discussions with colleagues, many are incredulous that such accepted practices are even questioned. Further, if these practices are not supported by the research literature, some osteopaths will choose to ignore the findings entirely.

Selectively ignoring research findings is unsatisfactory, because it fails to take advantage of the opportunity to learn and improve. In our view, this is the opposite of "digging on", as Still encouraged us to do. Paulet et al investigated the palpatory assessment of abnormal tissue texture in the thoracic paraspinal region - something that is routine for most osteopaths and from which we base clinical decisions, develop diagnoses and make various inferences about spinal somatic dysfunction, autonomic tone and ‘tissue health’. Like so many of the investigations into validity and reliability, the findings reported by Paulet et al are challenging. As a profession we need to respond to the growing evidence regarding the reliability of these procedures. We cannot continue in education and in practice to pretend that such findings aren't relevant, for the risk of doing so opens the way for public critique. We encourage readers to submit ‘Letters to the Editor’ about these important topics (osteopathicmedicine@elsevier.com) and direct prospective authors to the journal Guidelines for Authors (http://tinyurl.com/IJOMGuidelines).

The Masterclass in this issue was contributed by researcher and practicing osteopath Rosalba Courtney who provides an overview of breathing, breathing dysfunction and breathing therapy (p. 78). The influence of breathing dysfunction on health has been attracting increasing attention in the literature and this paper will be of interest not only to osteopaths, but also other practitioners. Courtney and colleagues also have two papers accepted for publication in the journal that report findings from original investigations into the assessment of breathing dysfunction. The first paper, published in this issue, compares two assessment procedures for the manual assessment of breathing. One of the clinically useful features reported in the study is a method of notation to document physical examination findings in clinical notes. Many of us routinely observe and manually assess for dysfunctional breathing in practice, but an effective form of notation has been absent. The clear description of the assessment techniques, together with the graphical notation should make this a paper of considerable interest to all practitioners. A second paper,¹ will appear in a subsequent issue.

Finally, Paul Blanchard describes the development of a student osteopathic service within a UK hospital HIV day care centre. Osteopathic manipulative therapy is most commonly applied to non-specific back and neck pain in a general population, however, this paper reports its application in those with systemic disease.

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Reference 

1. Courtney R, Greenwood KM. Preliminary investigation of a measure of dysfunctional breathing symptoms: The Self Evaluation of Breathing Questionnaire (SEBQ). Int J Osteopath Med. 2009;
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