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Notes from the Practice of Harold Goodman, D.O.

Post-polio syndrome and osteopathy  Thursday, April 21, 2011

It is very common for patients who have had polio to suffer decades following recovery from the initial infection with what is termed post-polio syndrome. These people often have major fatigue, paralysis and muscle weakness. In 1977 it was estimated that there were over 250,000 such people in the US.

I was trained as a physiatrist ( specialist in physical medicine and rehabilitation) during a three year post-graduate residency at the National Rehabilitation Hospital, Washington, DC. One of my mentors there was a specialist in this syndrome which he himself struggled with.

Osteopathy has much to offer such patients as I will now relate.

Today I had a visitor from Australia who is a polio survivor. She presented with very severe torso pain which had been aggravated by her long journey, packing and other factors. When I examined her I found that her entire body had been altered as a result of the polio years ago.

One leg was demonstrably longer than the other which adversely effected everything above it. In addition, her hip capsule on that side was so tight that her entire body appeared lopsided. Her diaphragm was in spasm since there are muscles (ex.psoas) which attach there and then go down to attachments in the hip. Much of this is also related to connective tissue continuity.

Her spine had been pulled over to one side which resulted in the ribs getting stuck.

All of this made her a sitting duck for neuromusculoskeletal pain which is what was brought her into the office.

She was treated with very gentle osteopathic manipulation which not only eliminated all of her complaints ( including pins and needles in her right arm) but also rearranged her body so that she no longer had such a leg length imbalance.

Osteopathy has much to offer such patients.

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Coccidynia: Tailbone pain in a pregnant woman.  Thursday, March 03, 2011

She called to say that she had been in excruciating pain for some time following a fall on her back.

At the time we heard from her she could no longer sit due to the pain. Since she was also many months pregnant she feared for the pregnancy as well as complications with labor.

When the patient finally came in she was miserable. She stood until she could be examined and then when I probed in the effected area she let me know how uncomfortable she felt.

The problem was that her tailbone, coccyx, the tiny bone at the end of the sacrum, had been traumatized during the fall. This is a very common and horribly uncomfortable problem since this area is well endowed with sensory nerves. In addition, there is a collection of nerves, called a ganglion, that is in the coccyx which has an effect on much of the autonomic nervous system. The result of such a trauma is that the patient may suffer apparently unrelated symptoms and go from doctor to doctor without much relief.

Most physicians including osteopathic physicians who are unfamiliar with osteopathic manipulation and diagnosis as the mainstay of their practice ( ie. over 95% of all American DO's) are unaware of how to diagnose and truly treat this problem.

On exam I noted that the coccyx was being pulled sideways, toward the right. Its normal position is sticking straight down the midline. Many of the soft tissues ( muscles, connective tissues) were also being pulled ( strained) in dysfunctional ways which were bound to create havoc in the system.

I gave her an extended dose of the homeopathic remedy, Hypericum ( St. John's Wort), which is a specific for coccyx injuries. This helped a bit but the real treatment lay in getting rid of all the trauma to the area and getting things back to where they belonged in relation to the rest of the body.

At some point we began intra-rectal treatment.

The gloved finger of the physician is inserted into the rectum and against the coccyx. The diagnosis of tissue pull is then not only confirmed but, with the aid of external aid from another finger, the coccyx is released along with all the other parts of the system that have been compromised.

It took several visits for this to be accomplished in full.

Since the first time this work was done the patient has reported more and more relief. Today she said that she no longer has any problems sitting and feels about 3% of the pain that she formerly did.

I was a bit surprised over how much additional release of the entire area we got today during the treatment. This leads me to believe that she will have not only a lot more relief of the coccidynia but also for all the back pain that often accompanies pregnancy.

I believe that this and attendant work we are doing will make her pregnancy much easier as well as bring about a safer and shorter labor than she otherwise would have had.

We are both very happy with her progress.

This is yet another example of osteopathy in action.

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Rapid ligament injury relief.  Saturday, August 28, 2010

For twenty years I have been treating patients with torn and injured ligaments. I have never done surgery on them though I am a licensed physician and surgeon and could easily do so.

The reason these patients do so well and get back into life so quickly is that the real problem is addressed. This is not the case with surgery in many cases.

Recently the baseball player, Stephen Strasburg, a 22 year old rookie pitcher for the Washington Nationals, has been receiving a lot of media attention after he injured ligaments in his elbow while pitching.

According to the Washington Post, he will receive surgery in Los Angeles and then spend one to one and a half years in rehabilitation before he is capable of returning to pitching and baseball.

This is very sad since he could easily be back playing baseball in about thirty days or so if he was treated by people trained in my work.

In addition to being a trained osteopathic physician, I went through a complete post-graduate residency at the National Rehabilitation Hospital in Washington, DC and am also a specialist in rehabilitation medicine. I know how such physicians do rehab and understand quite well the care that Stephen Strasburg will be receiving. It will be done by physical therapists and occupational therapists based on orders from a physician. It will essentially prolong his recovery from the trauma of surgery.

What do I do with such patients?

I examine them in a way that allows me to understand exactly what is the nature of their injury, how it has effected the entire body, and the best way to reverse the process.

In twenty years of practice I have never sent such patients for surgery. They not only didn't need it but would have been harmed by it since no treatment is without side effects. I have care for many patients who after surgery felt better, though not always, but later on developed other problems due to the response of the entire body to the surgery and the scar tissue which it produced.

The problem is essentially one of connective tissue disfunction. That is, parts of the connective tissue system, which is a part of the largest system in the body, the musculoskeletal system ( over 60& of the body), are injured. They respond to this injury by compensation. The entire body compensates to avoid further stress on the injured area. Surgery never addresses this issue. It will later come back to haunt the patient. However, since they have no idea that such a thing exists, surgeons never consider this and, ironically, may do more surgery to treat the resultant problems.

I use very gentle osteopathic manipulation using my hands to correct the strain and sprain in the connective tissues ( ligament, tendon, fascia, dural membranes, etc.) throughout the entire body.

We must treat the entire body since the entire body responded to the injury.

One of the first things that was changed was the patient's breathing. At the time of any injury the patient is stunned. They inhale. No one ever exhales at the time of an injury! So the spasm of the diaphragm, the major muscle of resperation, must be released. Without this the recovery is limited. No one in the medical field, the rehabilitation area or other related fields is competent to diagnose and treat this.
They lack the training and, in most cases, even the awareness that it exists.

After an injury how many times did your doctor examine your breathing?

The gentle osteopathic treatment may be followed up, in cases of extreme injury where the tendon or ligament has truly been badly torn ( most are micro-tears), with injections of a sclerosing agent. This is called sclerotherapy or prolotherapy. It lays down a tiny area of scar tissue between the tendon and the bone to which it attaches. It help the tendon to be more stable and completely avoids surgery. The healing from this is very short.

I also do other things which make it so that the patient is quickly pain-free and returned to what they really want to do; living and enjoying their lives instead of endless visits to doctors and therapists.

Stephen Strasburg is unfortunately, at age 22, becoming a pawn in medical politics. Like most politics, it pits the rich and the famous against those without power or a real education as to how to best deal with their situations.

Millions more like him must suffer, miss work, and, in the end, deal with many more problems due to their treatment.

In medical school we were taught that over 20% of all problems that patients would present with are iatrogenic (Greek: iatros= medical, genesis= beginning). Actually, the percentage is a lot higher when we consider all the wrong diagnoses out there, the bogus and unnecessary treatments, the treatments that went wrong, the side-effects of treatments ( medications, surgery, chiropractic, etc.) and on an on. Twenty percent is very, very low from what I have seen.

My patients do not have to wait 12 to 18 months to feel fantastic after a ligament injury.

And neither should Stephen Strasburg.

If he ever discovers how he was duped his minders may have a major lawsuit on their hands.

But they can sleep OK.

He will never find out.

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Newborn treatment  Wednesday, July 28, 2010

Recently I have been treating a lot of newborn babies.

For the most part, the children were having problems with colic, excessive spitting up, problems nursing, sleep issues, misshapen heads, torticollis ( head deviated to one side) and other common neonatal problems.

Every one of these children presented with severe strains when I put my hands on them.

What is a strain?

It's a pull in the internal tissues of the body.

When the connective tissue, which is everywhere in the body, is twisted or pulled, the nerves, blood vessels, and lymphatic vessels ( ie. the vessels which suck up all the crud in the body and get rid of it) are unable to function normally.

The child will then get sick, be irritable, have many health problems.

So I take out the strains with very gently osteopathic treatment and the children get well.

I don't try to get the child to calm down or just get rid of the symptom.

I get rid of the reason for the symptom, the problem.

Then the child is well.

It doesn't take very long for this to happen.

If it does, I know that I am missing something important.

I also use homeopathic medicines to help the children if I believe they will be helpful.

The nice thing is that these children often do very well for many years.

Because these underlying problems in their bodies were treated early on, they tend to be a lot healthier than other kids.

There is no greater investment than getting all the problems worked out for the child when they are very young.

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Osteopathy and Autism  Sunday, August 23, 2009

There is so much that osteopathy has to offer the autistic spectrum patient.

I am currently treating a 21 year old man who has been labeled autistic for much of his life.

He did not use words when I first met him.

Most of his actions are disjointed and spirited with a lot of jumping, chewing, self-mutilation, rapid and loud outbursts as well as seemingly constant tension.

Off and on over the last eighteen years I have had patients who had been given the label autism.

They had little in common once I began to dig beneath the surface.

However, they all seem to have major issues in communication.

My impression is that they communicate quite well.

Unfortunately, many of the people in their lives don't realize this.

Their caregivers seem to believe that if the person labeled autistic doesn't communicate like they do then they don't communicate.

This is absolutely wrong.

If a Chinese speaker can't communicate in English must we conclude that they can't communicate?

If a deaf person can't speak as others do, is it appropriate to assume that they not only can't communicate but, as many formerly concluded, that they are actually dimwitted?

For example, the languages created by deaf people to communicate amongst themselves, the various sign languages, have proven to be highly complex ways of interchange which, in many cases, go way beyond the possibilities inherent in spoken languages.

It is the same with the so-called autistic people.

How do I know this?

I just asked my patient.

His family is very concerned for his well being. They truly love him and he loves them, too. It is quite obvious to anyone who spends even minimal time with them.

After a hiatus of seven years he returned as a patient.

During those seven years a lot of major changes had occurred in my life.

As a result, my entire approach to working and communicating with my patients is different.

I love to see some of the patients who haven't come in for many years. It is like seeing an entirely new patient, someone whom I have never met before.

Indeed, I never had met the person who is now standing before me asking for help.

How do you communicate with a neonate who can't speak?

What would you do to really understand their needs?

It has been repeatedly stated that over 94% of our communication is non-verbal.

Much of this is completely non-physical.

Have you ever been in a room and become aware while you were engaged in speaking with someone that someone else had entered the room?

You hadn't seen or heard the newcomer; you just knew that something had changed, that someone was in the room who hadn't been there before.

There is a part of our awareness that is beyond our everyday consciousness. It is from this awareness that we can track or tune into these phenomena.

Hunters use it. Aborigines do so. And we can,too.

I have a way of using this so that I am able to ask and receive information from patients without verbal speaking.

I asked my patient what he most wanted.

He replied, " To be acknowledged as a human being, as I am."

I asked him if there was some way we, his care givers, could support him in this.

" Just treat me as one of you. Whatever you do, don't treat me like damaged goods, like someone with a problem. I don't have a problem; I am just very different in some ways than you. My frustration is that I am trying, in the only way I know, to be with you. This is not acknowledged or welcomed. I feel very, very isolated and alone. You can't imagine my frustration. I feel lost."

I worked during that visit to support him according to the feedback he was providing me with.

He noticeably calmed down. His parents remarked on this.

When I next saw him his father mentioned repeatedly that he had never seen his son so calm, responding to cues and commands so well. In addition, he had said his first word.

He said, " Hi."

It was a long and drawn out, " Hi". He looked directly into my eyes when he said it. He was smiling.

I use my osteopathic skills to reduce the tremendous stress in the dural membranes of the cranium which I often find in these patients.

I have also started the father and another caregiver in the use of baby sign language to speak with him. We are just using a few signs for now. When these are assimilated we shall build on them. Many of my pediatric patients have greatly benefited from this approach,too.

However, the mainstay of my work is building meaningful communication with him.

I am very excited about this breakthrough.

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Update.  Saturday, September 20, 2008

Update.

I am now accepting new patients.

The initial appointment is 9:15 am and the last one in the early afternoon.

Patients of all ages are welcome; neonatal, pediatric, adolescent, adults, older patients and those who are ageless, as well.

Just contact me if you have any questions about my practice. See the e mail contact below.

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It all started with a sprained ankle  Saturday, April 21, 2007

Sprained ankles are very common. You step the wrong way and twist the ankle. Then it swells up, may get warm ( both signs of inflammation), and is painful to stand or walk on. So far, nothing unusual. What all of us know or have heard is that once you have sprained an ankle it is likely that you will sprain it again.

The typical medical advice is to keep the ankle raised, iced, wrapped or compressed and to rest it, keep off of it. Hence, the large number of people hobbling around on crutches.

Why is it that the same ankle is prone to further sprain?

To be very blunt, the reason is that the original trauma, the sprain or strained connective tissues, ligaments, tendons, fascia ( a type of connective tissue) has never been treated. The above mentioned measures do not treat the trauma. They treat the symptoms of the trauma, the inflammation.

In order to treat the trauma the actual strain pattern in the tissues must be diagnosed and removed. Only osteopathy does this.

I have had people limp into my office on crutches from a recent strain (often young men) and walk out pain free without crutches and not prone to future restraining of the tissues. I have learned how to identify and remove the strain in the tissues.

If I were present at a football game and one of the players sprained their ankle I could have them back in the game, playing within 20 minutes. This is rarely the case with team physicians or sports medicine doctors. Also, the player would be less likely to resprain the same ankle.

I mention this because someone recently told me that a car ran over their foot. They have been receiving acupuncture for some time ( I am a licensed medical acupuncturist, so I believe I am qualified to speak about acupuncture) but were still in quite a bit of pain.

I told them that I often treat such problems with a lot of success. I treat the strain and the symptoms ( read: pain) go away. It is really quite simple and logical. Strains will not show up on imaging studies ( X rays, MRI, CT, etc.). The patient is given the same instructions mentioned above, anti inflammatory medications, and, if they are still complaining, sent to a physical therapist. The problem, the strain, is never treated.

I treat strains. I find them in almost every patient including babies. They result from traumas to the system. How can a new born have a trauma? Being born is quite traumatic. The neonate must travel through a passage which is not large enough to accomodate the body.They have to twist around to get through, their head gets squished which is why it is still soft in parts when the child is born. This is natures way of dealing with the trauma of birth. If the child is large the birth can be even more traumatic. Many obstetricians routinely do an episiotomy where they will cut the muscles so that there will be more give in the mother's tissues to accomodate the child. If this were not done then the muscles might be torn as the large mass ( the neonate) emerges from the relatively small canal. Labor is not called labor for nothing.

People come in with back pain, neck pain, numbness, tingling in their arms or legs, headaches, eye problems, jaw pain, infections, asthma, and so many other problems. In every case I find strains. The strains are removed and the symptoms disappear. It's a no brainer but, unfortunately, something which is not taught and virtually unappreciated outside the community of osteopathic physicians who practice osteopathy in the cranial field.

Incidentally, this is not taught to cranio-sacral therapists, chiropractors and message therapists all of whom receive good training and help many people in need. How do I know they don't receive this training? Because I treat them and they are fascinated to learn what I am doing.

If you have a question on this or anything related to my work, don't hesitate to contact me. I am always happy to answer questions.

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Chronic ear infections in children  Saturday, March 24, 2007

About 30% of my patients are children. Since I treat a lot of pregnant women to get them through pregnancy with a minimum or absence of problems ( back pain, morning sickness, premature labor, etc.) I have long offered a free first visit for the newborn to get the child started off on the right foot. Often this first visit reveals many structural and functional problems ( feeding issues, irritability, reflux and spitting up, asymmetrically shaped heads, asthma and other respiratory problems, etc. etc.) which can be easily treated and quickly reversed.

As the children age they may display delayed development, frequent infections and other common pediatric problems which osteopathic and homeopathic treatment can solve. There are two local pediatricians who have been referring such children to me for many years. Also, word of mouth among moms has been one of my best means of letting people know what osteopathy has to offer these young ones.

By far, the most common pediatric issue I see is the child who suffers from serous otitis media or ear infections. These children receive many rounds of antibiotics and may or may not improve but inevitably come down with yet another infection. At some point the parents are told that the child must receive tubes. This is often when I see the child.

Usually I find that the base of the cranium and especially one or more of the temporal bone are malfunctioning. This impairs normal drainage of the inner ear via the eustachian tube which, in turn, renders the child vulnerable to infections. Hence the ineffectiveness of antibiotics. This is a structural problem which must be treated structurally and will not be cured with a biochemical ( antibiotic) approach.

Often it takes just a few treatments for the pediatrician to notice that the ears look clear. The parents, especially if the child has been in pain, pulling or boring its ear or complaining, will notice earlier. I am able to then discharge these patients. They usually don't require much further treatment unless there is an additional problem.

In 2003 The Archives of Pediatric and Adolescent Medicine, an MD journal published by the AMA, did a study on osteopathic treatment of ear infections.
This is the link which you can paste into your browser to examine:
http://archpedi.ama-assn.org/cgi/content/extract/157/9/852
The authors concluded that there was a significant positive correlation between children who received osteopathic treatment for ear infections and the subsequent improvement in their health. This was welcome news indeed since I realize many people rely on such sources for their knowledge of medicine.

It was also reassuring that such a study appeared in a prominent MD specialty journal. This lends additional credibility to what many osteopathic physicians witness on a daily basis; osteopathy ( and, I would add, homeopathy) are a veritable God-send to a sick child.

What I regularly have witnessed over the years is that children treated in this way are healthier overall, develop better than their peers, and need far fewer doctor visits. It is the most valuable foundation that can be given them for future health.

We have a saying in osteopathy. As the twig is bent so grows the tree. Imagine a small sapling that is bent over. When the twig is small there is not much to notice. When it grows into a tall tree its "bentness" becomes more obvious. However, then it is harder to reverse what formerly could be treated in just a few visits. The earlier we can get to these bent twigs the easier will their lives be. There are few investments with such enormous and long term benefits.


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How a head injury can lead to abdominal problems  Thursday, March 22, 2007

Did you ever see a spider web? They are actually quite intricate in design. Starting from one point the spider creates an enormous mosaic of crafted spittle. Sit and contemplate the web. It is really a work of art. These insects build them to catch other insects.

The web must be of a certain size. Some are quite large. It must have a great degree of bounce. If a fly crashes into it the web must not break. It must absorb the kinetic energy generated by the impact and deftly imprison the hapless fly. The fly must be trapped, unable to escape. The web is designed with all of this in mind. For what it does it functions perfectly.

Consider the human body as a vast spider web. If you pull on a part of the web the entire web responds. It will conform to the impact and absorb it. The web, if pulled at one point, will change shape to accommodate itself to the deformation. Say you grab one piece and gently shift it around in space. The entire web rearranges itself. Every single piece of the web shifts. It works as a single unit.

This is exactly how the human body functions. The body is actually a vast web. The various pieces of the web have many shapes and different tissues. However, they are all part of the same web. If one piece is shifted, every part is shifted no matter how far away from the point of impact or seemingly unrelated.

A blow to the head effects the membranes which make up the skull. Originally, the skull is membranous. The outer layer of membrane becomes bone. The inner layers remain membrane. They have the consistency of shoe leather. They can be bent, twisted, and moved about. They cannot be stretched without tearing which really takes an enormous amount of force. So, in the normal course of life, the membranes get twisted and strained a lot. We call this cranial membranous strain or sprain. It is like a sprained ankle ( which remains vulnerable to reinjury even after the swelling, pain, and other acute symptoms are gone) . You can have these membranous or tissue strains anywhere in the body. They always are accompanied by body dysfunction.

So, again, imagine the spider web. If one piece is twisted upon itself or pulled asymmetrically the entire web mirrors and compensates for this. It's health in action, always finding a perfectly balanced response to the stressor.

The cranium is struck. The membranes in the gut follow suit. The person, sooner or later, experiences gastrointestinal and pelvic problems. No one but a trained-osteopath realizes the connection. No one but a classical osteopath is trained to think, diagnose and treat in this way.

I have seen hundreds of such cases over the last seventeen years. It just reaffirms the intrinsic somatic - visceral connection for me. The body works like a big spider web. Tweak one part, everything else responds.

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Learning and Relearning Osteopathy  Saturday, March 03, 2007

I recently returned from Orlando,Florida where I helped teach a five day course in Cranial Osteopathy for 21 physicians, residents and medical students. I have helped teach this course before and will be helping to teach a similar course in Tucson, Arizona in June, 2007.

Maybe you have had the experience of reading the same book more than once. I have done this several times. Each time, it seems, it is like reading a totally new book. Of course, it is me that has changed, not the book. It is not the same person reading the book.

It is the same thing with teaching and medical practice in general. Every time I help teach a course I experience it differently. This last time I was taking a lot of notes. Most of the students I had around me were sitting and quietly listening. Few were taking notes. When they were it was somewhat sparingly.

One of them leaned over and asked why I was taking so many notes. " I am so excited by what I am learning. I want to write down enough to jog my memory so that I can carry this back to my practice," I told him. He was surprised, he said, that someone who has been in practice for 17 years doing this work full-time would have so much to learn from what was billed as an introductory 40 - hour course. I explained to him that it is precisely because I do this on a daily basis that I find these lectures and presentations by my colleagues to be so valuable. They are sharing what they do. We are all supposedly doing the same thing but we are all doing it in our own unique ways. I find this amazingly creative and inspiring.

When I returned to the office I thought, My patients are in for a real treat! And, indeed, patient after patient related to me how satisfying these treatments were. I told them that I had learned things which enabled me to go deeper with what I was doing.

The human skull (cranium) is formed in cartilage and membrane. The base ( bottom) is formed by compressive forces in utero in cartilage. The rest (the vault) is formed in membrane. All of the 12 cranial nerves that come from the brain and which essentially control the rest of the body function exit the bottom of the skull via the membrane. The same goes for the blood supply to and from the brain.

Because the base of the skull is formed by compressive forces it can become very hard. Osteopaths can feel the relative hardness of the bones of the skull. The harder they are, especially in the base, the more problems that patient will have in many areas of life and body function. Using very gentle cranial manipulation I am able to get these areas of the skull to soften enough so that the patient can finally begin to really feel like a human being instead of someone who is trapped in an unyielding box.

Besides compressive in utero ( before birth) forces such hardness and jamming of cranial bones can also come about from traumas both physical and emotional. The release of this tension brings tremendous relief.

When I returned to my office I found several new patients both adult and children who had extremely hard heads. The work that I was able to do was immediately noticed by the patients. I know that these people will go on to do well.

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