An Osteopathic Approach to Performance

If you’re reading this article, you’re probably familiar with the Body-Swing Connection™. It’s the fundamental concept taught in TPI’s Level 1 Seminar. Very simply, many common swing faults can be traced back to the body’s inability to move correctly. The concept seems so simple and yet it’s still a relatively new, but rapidly growing, methodology for increasing golf performance; improve mobility, stability, strength & power and your client will have a much better chance of swinging more efficiently and with a reduced risk of injury.

The pyramid approach that TPI promotes where the teaching professional, medical professional and fitness professional work as a team to identify, treat and rehabilitate dysfunction in the body works extremely well. Those physical improvements can then be realized and leveraged by the swing instructor with improved swing mechanics. Brilliant. But let’s take a moment and talk about the assessment and treatment portion of this equation and see how osteopathic medicine may be the missing link in the assessment and treatment phase with your players.

Great minds like Gray Cook and Dr. Greg Rose have developed outstanding assessment tools and protocols for identifying and evaluating movement dysfunction, as well as ways to treat the dysfunction. One of the primary concepts taught in both TPI assessments and FMS assessments is the Mobility/Stability model. As Gray Cook states: “The body works in an alternating pattern of stable segments connected by mobile joints. If this pattern is altered, dysfunction and compensation will occur.” This concept, which any TPI or FMS Certified Professional is familiar with, clearly demonstrates how dysfunction in one area can lead to injury and pain in another area. The body is a marvelous series of connections, each affecting function in other areas. This concept of the body being “connected” is very similar to the holistic approach to medicine that is known as osteopathic medicine; a medical practice seen more and more in the treatment rooms across a huge variety of professional sports.

Osteopathy, the way I work, is a medical practice based on a holistic approach to medicine that focuses on the interconnectivity of all human systems (structural-functional system, visceral system and cranio-sacral system). By addressing each of these systems holistically and using manual techniques as well as proper nutrition, we can unlock the self-healing possibilities of the patient and restore mobility.

The 5 Principles of Manual Osteopathy

  1. Life is Movement
    Everything must be mobile. Every anatomical structure in the body needs freedom to move, not just the structures of the musculoskeletal system. Organs should be able to move freely as well. Fluids (for instance blood or lymph) must be able to flow without obstruction. When mobility is restricted, dysfunction and disease can result.
  2. Structure and Function
    Structure and function of the body influence one another and are reciprocally interrelated (function governs structure, structure governs function). A disturbance of function can be identified through a difference in movement of a structure. Manual osteopathy tests and diagnoses the movement of the different structures to find the disturbances in function.
  3. The Law of the Artery
    Every tissue in the human body must be well nurtured and toxins should be disposed of. A long lasting disturbance of this nurturing and disposal process can change the quality and mobility of the tissue. This counts for all body fluids (arterial and venous systems, lymphatic fluids, brain fluids, etc.)
  4. The Unity of the Human Body
    The human body functions as a unit. All mechanical structures, tissues and organ systems are connected through the connective tissue, nerves and fluids. Abnormalities of normal function and mobility in any of these individual components will have consequences in overall physical function. In osteopathic medicine, the human is always treated as a whole, not just through the lens of a specific dysfunction or illnesses.
  5. The Body Can Heal Itself
    The ability of our body to either stay healthy or to recover when ill, is a result of its self-healing powers. We see this everyday and think nothing of it. Broken bones heal, the immune system fights off an infection, blood clots, etc. The body is capable of incredible self regulation and healing when systems and structures are functioning properly.

So how does an osteopath fit into an athletic program alongside nutritionists, chiropractors, medical doctors, physical therapists and trainers?  In my opinion, the osteopath connects all of these groups like a missing link. Let me explain. Everything you eat and drink (the work of the nutritionists) must be processed and delivered to the appropriate location via the body’s logistics system. The brain, nervous system and muscular system need the right nutrition to grow and perform. Without the right proteins, lipids and carbohydrates (etc.), there is no muscle growth, hormones cannot be produced and neurotransmitters will not be of high quality. We need rocket fuel delivered to the right location at the exact moment it’s needed. That delivery is done via the body’s logistics system.

This logistic system is embedded in our mesoderm. The vascular systems (venous and arterial) as well as the lymphatic and nervous systems are all supported by mesodermal tissue. If this tissue is somehow restricted in its movement, the transport will slow down and the organs behind this immobile structure will suffer. One of the osteopath's main roles is to find and treat obstructions in the mesoderm. We do this by looking at each of three diagnostic and treatment pillars in osteopathy - the parietal, the cranio-sacral and the visceral systems. The parietal pillar of diagnostics and treatment is similar to that of physiotherapists and chiropractors (an early offshoot of osteopathy); in short, mobilization and manipulations of the musculo-skeletal system. I will leave the cranio-sacral system and its possibilities for a later discussion. Basically, it’s the treatment of the liquids and nervous structures connecting the cranium and the sacrum (and beyond). The visceral system is the missing link!

During my study of osteopathy, I learned the importance of treating the mesoderm surrounding the visceral structures. When the viscera cannot move freely, the process of absorption and secretion is impacted. Vital nutrients cannot reach the target organs and waste is not able to exit the body efficiently. Since these toxins cannot stay in our transportation system, they have to be stored in the body. We have two systems for storing toxins: lipids and mesoderm. Most people tend to store toxins in both systems to some degree but for this article, I want to focus on the group of people that primarily store toxins in their mesoderm. This is the group of athletes that often come to me seeking help. Typically, they’ve been on an endless search for wellness. These athletes are often on medications (even more toxins to get rid of) and have followed every possible diet. Stretching, massage and fascia therapy often help, but injuries tend to return and they’re left with chronic pain.  

Upon examination, many of these individuals are characterized by a very tight system of connective tissue (the mesoderm). If this system gets jammed by too much load or tension, it can manifest in a variety of ways. When the arterial supply or lymphatic drainage systems are impaired, the system will dysfunction, causing toxins to accumulate in the muscular and connective tissue systems. This leads to abnormal levels of tension in the muscular and soft tissue structures. By interventions directed at the connective tissue, the “jammed systems” can be freed up and the physiological environment to facilitate healing can be re-established. Often, these interventions will need to be focused on areas supporting the organs themselves.

From an osteopathic viewpoint, or total body approach, there are things to be learned from understanding the impact that human organs have on a player’s physical and mental development. In anatomical labs around the world, where students and researchers work with human cadavers, the connective tissue that “bridges” the human organs is readily evident. Thomas W. Myers describes the way fascia controls movement in his book Anatomy Trains. It describes how the connective tissue creates “chains of movement”. The fascia surrounds muscular tissue and even muscular fibers thus continuing to connect the soft tissues to different bony structures. This way it can explain why obstruction in one part of the body can cause a mobility or stability problem somewhere up or down the chain or body segment. Therefore, a dysfunction in the mobility of an organ can lead to a muscular tightness or even a lesion or scar that is palpable and symptom producing in athletes. The combination of both muscular and visceral fascia and its connections describes the way I specifically look at my patients, sportsmen and golfers.

Let’s take an example of this process with a very high altitude look at how a patient with chronic lower back pain may be helped via an osteopathic approach.

I see golfers who come to me with lower back pain quite often. When trying to determine the underlying cause of the pain, I use a whole body approach and many times, I find that their back problems are caused by high tension and bad mobility of the visceral organs. Storage of toxins in the connective tissue will cause a change in the viscosity of the matrix – thus impacting negatively on the mobility of the important collagen or elastic fibers in this tissue. If the mobility of the fascia is decreased, it will be to the detriment of the golfer. How many of you look at the front of the spine? Besides training the abdominal muscles (which might be the opposite of what should be done at that moment), the ventral side is typically ignored by most. But look at just some of the anatomical connections of the front of the spine:

  • The connection of the liver to the abdominal diaphragm which connects to the ribs and spine.
  • In the gastric system, the esophagus connects to the diaphragm. The stomach is a strong muscle and if tense, will give you a flexion of the spine to release.
  • The front of the spine also connects to the ventral side of the occipital bone. You can imagine the problems being caused in the cervical spine as well as the potential for typical headaches.
  • The kidneys share their fascia with the Psoas muscle. This connection is, in my opinion, the most important cause of low back pain.
  • The kidneys, over the muscle fascia, also have a large impact on the knees, especially the patella.

Either hyper or hypo tension in the visceral system is often caused by improper nutrition. Even though this is an individual problem, some common causes are:

  • Not enough water leading to dehydration of the small intestines followed by an inability to absorb many nutrients.
  • Often seen in combination with dehydration are too much refined sugars, caffeine, alcohol and nicotine. These “toxins” cause the disbiotic intestinal flora to suppress the needed symbiotic bacteria. This is usually followed by a decrease in the absorption of the needed nutrients and opening of the intestinal tissue for toxins.

Osteopathic treatment of these structures is an important part of setting the GI-tract “free” and giving the nutritionists the possibilities to do their work. In this case, teamwork is required. The osteopath will have to reestablish the normal visceral mobility and the nutritionist will have to educate the golfer on an appropriate diet. We typically have regular sessions (usually once a month) to see if there are any restrictions, hypo or hyper tensions in all the different systems. If all fluids are flowing well, the nervous system free for motion, and the connective tissue free for movement, we have a healthy athlete.

An Athletic Development Coach or PGA Professional who struggles to attain the desired mobility and thus swing mechanics for a player, may need to consult a trained osteopath who has an understanding of golf. In these cases, mobilization of the inner organs and the subsequent release of the joints can lead to marked changes in the tension of the muscular and soft tissue systems. The human body inherently looks for balance, economy and comfort. Thus tightness and restriction in the organ (or visceral) structures and connections can lead to significant mobility issues that may impact on swing mechanics. As the respected osteopath, Dr A.T Still explained: “We can only treat the entire human body by learning about its anatomy”. Through an improved understanding of the different connections between all of the systems in the human body and not just a concentration on the musculoskeletal system, we may reach our golfing goals faster without recidivism.

In part 2 of this series on osteopathy, I will go into detail on how an osteopathic approach can be beneficial in ascertaining the root cause of specific swing faults in golfers who have been diagnosed with movement dysfunction.

Jelle A. Zandveld

Jelle A. Zandveld Eur.Ost.D.O, BSc. Reg.PT Osteopath and Physical Therapist
Director - Golf Physical Performance

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