21st Century Scientific Support for Osteopathic Principles & Practice:
Allostasis and Allostatic Load
An additional concept is important for applying osteopathic principles. McEwen at the Rockefeller Institute has been trying to explain physiologically the shift from homeostasis to the disease state. Whenever patients experiences stress, either emotional, traumatic or environmental, the patient shifts into the state of allostasis during which the body releases epinephrine, which can elevate blood pressure, and cortisol, which in the short term acts as an anti-inflammatory agent. This is designed to be a short term “flight - fight” and protective phenomena. If the patient frequently goes into the allostasis phases, never completely comes out of that state or just remains in a full blown allostatic state, it is called allostatic load. Now the elevated epinephrine levels continue to elevate the blood pressure but also predispose the patient to cardiovascular disease. Prolonged elevated cortisol levels now can suppress the immune system and predispose to developing depression. Therefore, one should not be surprised to realize that a high allostatic loads therefore predispose the patient to developing a major health care problem within 3 years.
Once the allostatic load has developed, the patient can become “up - tight” which can further increase the potential for developing secondary somatic dysfunction. This “allostatic load” can also become ‘organized’ or “somaticized” and the patient’s body will frequently “act out” the stressful problem. For example, if the patient is carrying a heavy load mentally or emotionally, they may present with chronic low back pain. Patients with shoulder problems are often “shouldering (an emotional or mental) burden”. Patients experiencing neck pain frequently are in a situation or relationship they perceive as a “pain in the neck”. Many other examples could be given. I have called this approach “Body Language Significance (BLS)". It has often been very useful in identifying and addressing the “root causes” of the patient’s allostatic load, and secondarily, many chronic musculo-skeletal problems associated with chronic pain and disability.
Somatic dysfunction may be present in any of these B.L.S. examples but the patient responds poorly to quality OMT or the somatic dysfunction keeps returning. Often the original allostatic stressor occurred during the patient’s youth. In my experience, the stressful expression often surfaces years later, as an adult, either on an anniversary date or when one of their children reaches the age at which the patient experienced the allostatic/emotional trauma.
Many believe old emotional/allostatic memories are processed and stored in the limbic system. The limbic system has been compared to a “switchboard” between the emotions and the musculoskeletal system. This would suggest there are two possible therapeutic avenues into the limbic system; either through the emotional or the musculoskeletal side. This could also explain why patients, who have experienced severe emotional trauma years earlier, will once again re-experience those emotions as the layers of musculoskeletal trauma are peeled off and sequentially exposed with OMT. Thus we have uncovered and identified the “root cause” of the allostatic load and it now can be “composted.” Someone has been quoted as saying, “we all can be victimized in life but we decide to either become better or bitter.” I have been amazed at how profoundly some patients lives can be changed and improved once they “compost” their “allostatic garbage.”
McEwen has discovered three RESTORATIVE factors which can play a beneficial role in the successful management of the patient.
Develop and enjoying strong inter - personal relationships
Regular attendance to religious services or develop a “positive world - view”
Living a healthy life - style
Could the first two these factors in this list also represent a tensegrity correlation and explain why inter - personal, emotional and spiritual tensegrity support systems are beneficial?
I believe the combination of quality manual therapy, to address any mechanical dysfunction in the body’s musculo-skeletal / tensegrity system and secondarily the related tissues of the body, combined with the allostatic tools, can impact beneficially, from the macro to the micro levels, the complicated patient. This could represent an important combination of three approaches, osteopathy, tensegrity and allostasis-allostatic load, to offer a holistic approach of health care from the host perspective.
Interestingly, the definition of allostasis is “stability through change” but that definition and description also applies to tensegrity. This may explain why managing both the tensegrity and allostatic load components is so important for synergistically enhancing the benefits of osteopathic manipulative care...in a holistic/host orientated management approach.
I believe the host can be described as:
Interactive at all levels...macro to micro
An omni - directional structure
A constantly adapting and re - balancing system
A complexity of complexity
A tensegrity of tensegrities