Lesionology

Dr. John Martin Littlejohn’s lectures on Lesionology include: The Cervical Region; The Dorsal Region; Vertebral Lesion in the Neoplasms; The Tenth Dorsal Region; The Ninth Dorsal Region; Bone Lesions and Infectious Diseases.

J.M. Littlejohn states in the book entitled Lesionology that “The osteopathic lesion is not to be regarded as a malformation, or even a maladjustment of structures, but should be defined in terms of mobility.  That is to say, the lesion is a physiological and not an anatomical condition.  It is a modification of the movements of extension, flexion, rotation and sidebending as an isolated change, or an abnormal and artificial group movement.

In the lesion field, the involuntary movements are chiefly at fault, and the technique of diagnosis and treatment is to be discussed from the point of view of mobility, locally and generally.  The physiological movements for the purposes of adjustment are represented by the normal movements of the body trunk, the extremities, and parts of these in so far as they are unified in the body activity. Therefore the central factor to be considered is the gravity centre and the gravity lines of the body, all movements being around some axis in relation to these central lines, or points.

The movements are in circles, or modifications of circles.  The foundation of the body and its equilibrium of movement is found in the pelvis, which represents a circle, or its modification.  These movements are all in relation to the sacro-iliac articulations, the fifth lumbar and the sacral articulation on either side of the pelvis.  Also the sacro-coccygeal articulation as a unit of the gravity line movement and the triangles of the body trunk.  Lastly the femoral articulations in relation to the innominates, forming the angles of the basal triangles of support, and foundation for the trunk and the extremities.”

J.M. Littlejohn states further:  “In the acute lesion the synovial membrane shows a slight redness and the amount of synovial fluid is increased, while on the lymphatic side there is some oedema of the membrane.  In the chronic state the membrane is irregular and thickened on one side.  Post mortem there is often found a small pad of fatty material left by the disturbance of the articular relations, and derived from the synovial membrane with which the surfaces are continuous.  The pad of fat is larger where the articulation has been disturbed by strain – as in the sprained ankle.

In the early stages of the lesion condition, the most noticeable effect is that of oedema.  In the second stage there is fibrosis of the ligaments, especially the capsular ligament, followed by changes in the tendons of the muscles that move the joints with a resultant stiffening, or rigidity.  At this stage there is swelling of the periosteum over the articular processes and around the insertions of the tendons.  The joints are painful on movement and mark the beginning of the immobility which leads to the arthritic articulation.  The swelling is hard, especially on the side of the strain, indicating capsular ligament involvement, and corresponding to that side to which the spinous process is rotated.”

J.M. Littlejohn also comments that: “Frequently, an apparent lesion is a compensatory change and, in the case of vertebral immobility we find hypermobility in the neighbouring joints, which is a natural attempt to compensate for the effects of the rigidity.  The hypermobile condition is due to: (1) Weakness in tension of the supporting cartilage, ligament or muscle.  The lost tone should be re‑established and the rigid vertebrae corrected by simple articulation from the hypermobile to the rigid area, (2) An oedematous condition of the discs, caused by acidosis which should be dealt with dietetically, together with persistent traction-extension.  Simple articulation of the vertebrae towards the area of rigidity will correct.  (3) In some cases the group in which the lesion is present may be normal, but outside the group compensation may exist in the form of rigidity, swelling etc.  Although the vertebral lesion is individual, the treatment is for the group and in the arch relation.  Note that 7C and 9D are the key vertebrae in problems of group lesioning, the articulation moving from the key to the lesion field.  (4) The passive movement of an articulation.  If the lesion is recent, the mobility is increased, the elasticity of the joint muscles and the tonicity of adjacent muscles being diminished, resulting in an imbalance between the hard and soft tissues and laying the foundation for oedema.  In the treatment first attention must be given to the tonicity and elasticity before correction is attempted.  Begin by stretching the soft tissues in relation to rotation of the arm down to 8D and flexion and rotation of the leg from 5L to 9D.  Follow with spinal articulation towards the lesion.”

To read more of “Lesionology” you can purchase a copy from the JWCCO Bookshop for £10.00 here:http://www.johnwernhamclassicalosteopathy.com/dr-j-m-littlejohns-lectures-on-lesionology/