Infectious mononeucleosis or Glandular Fever, otherwise known as Pfeiffer's disease or "kissing disease" is a viral infection (Epstein-Barr) that occurs commonly in adolescents and young adults. It is usually passed person to person, saliva being the primary method of transmission. It is characterized by a sore throat due to lymphadenopathy, fever and fatigue which explains why the cause of the problem is so commonly overlooked due to it's similarity with other illnesses. These symptoms may be accompanied by splenomegaly or hepatitis.
The aim of the osteopathic treatment for this condition is, as with all conditions that osteopaths treat, to aid the body's recovery. Patients often recover slowly from mononeucliosis, and even when the primary symptoms have disappeared the patient may continue to suffer from fatigue, aching, digestive problems, depression and a reduced immune system making them prone to infection.
From my own experience in treating viral infections the osteopathic approach is usually to address the patient's systems accordingly:
1) The lymphatic system
2) The respiratory system
3) The autonomic nervous system
The osteopath begins as usual with a medical case-history gathering as much information about the patient's symptom picture as possible – each patient will be affected by the virus individually and so it is important that the osteopath gears the treatment to the systems that have been affected.
The osteopath should find out if there was any liver or splenic involvement and if so how long the symptoms lasted for. It is also prudent that the osteopath check to find out when the patient's last blood test was to be sure that there is no liver or splenic inflammation of which the patient may be unaware.
For the postural examination the osteopath should focus on specific areas:
The thoracic inlet is a crucial part of any treatment when dealing with infection. Between the clavicle and the first rib lie the sub-clavian veins into which the body's lymph drains thus the osteopath should note any postural tension in the anterior and posterior cervical fascia.
Spinal mechanics are important, paying attention to any viscero-somatic changes throughout the spine.
Respiratory mechanics – diaphragm, ribs, and secondary respiratory muscles – all involved in lymphatic drainage.
Tests:
Abdominal examination: Testing for any liver or splenic tenderness
Lymphatic: All lymph nodes – especially cervical and axilla
Observe nail beds, mucous membranes and sclera for any discolouration that may be caused by anemia or jaundice.
Treatment:
Once the examination has been done the osteopath starts on the treatment. The following is simply a guide for the osteopath as every osteopath will gear the treatment according to the individual patient. I have tried to incorporate into the osteopathic treatment some of the main osteopathic areas of importance.
I generally approach treatment using general-osteopathic-treatment beginning at the feet and working my way up to the cranium checking each and every joint for any restriction.
Lymphatic drainage:
The areas related to the lymphatic-system are widespread. The osteopath can begin with gentle work around the thoracic inlet, articulating the cervico-dorsal junction, clavicle, first rib and scapulo-thoracic articulations. Gentle soft tissue/ muscle energy/ stretching techniques can be applied to subclavius, pectoralis major, scalenes, and cervical fascia. All this is aimed at improving lymphatic drainage through the left and right subclavian veins that lie between the first rib and clavicle and through which all of the lymph drains.
Next the osteopath can move on to diaphragmatic work. It is unclear whether the lymphatic system has any inherent motility (see below) so the diaphragm is considered to be crucial to the flow of lymphatic fluid around the body. The contraction and relaxation of the diaphragm causes a constant change in pressure between thorax and abdomen. During inspiration the thorax increases in size the diaphragm descends the negative pressure in the thorax increases. Since fluid moves from an area of high pressure to low pressure fluid moves up the body from the lower limbs and abdomen into the thorax. Any restriction of the patient's diaphragm will inhibit this process making lymphatic drainage sluggish.
Technically the osteopath can use a variety of techniques to stretch the diaphragm including local inhibition under the costal margin, rib articulation of the lower 6 ribs, L1-3 articulation to affect the crura, or a technique called "doming" where the osteopath puts his hands around the both sides of the rib cage anteriorly and asks the patient to inspire. The osteopath's pressure on the ribs inhibits them from flaring and indirectly stretches the diaphragm.
Since mononucleosis causes lymphadenopathy the osteopath should do work around the face and throat (see post on pharyngitis for hyoid articulation).
To further improve lymphatic drainage the osteopath can use the thoracic lymphatic pump technique or pedal pump.
Assuming the osteopath has checked that there has been no liver or splenic damage the osteopath may wish to include liver or splenic massage into the treatment as these organs are often affected by mononucleosis.
I would like to spend some time on the treatment of the autonomic nervous system for viral infections but the scope of this article is insufficient. Dr Raymond Perrin in his book The Perrin Technique explains how the treatment of the autonomic nervous system is important in chronic fatigue syndrome/ME and he goes to great lengths to explain the importance of treatment of the autonomic nervous system treatment and recovery. In summary though, harmony must exist between the autonomic nervous system and the demands placed on the body otherwise it can lead to systemic, arterial or muscular dysfunction all of which will inevitably cause ill health. It is up to the osteopath to check for somatic dysfunction of the vertebrae with an emphasis on the thoracic spine and vagus nerve all of which can be treated by HVT or articulation as examples.
Treatment can be concluded with side-lying soft-tissue massage to the lumber erector spinae moving up the dorsal erector spinae aiding not only lymph return to the heart but also somatic restrictions around the spinal column.
Advice to the patient:
Diet: Reduce artificial substances, white-flour, sugar and caffeine. Relaxed meals and not sleeping on a full stomach. Increase fruit and veg, healthy balance of protein and carbs. Reduce fried foods.
Exercise: Start gently and build up. Preferably walking and increase as feels healthy.
In conclusion, the osteopath needs to guide the patient back to good health. There are neither quick-fixes nor one single approach. Treatment is about the osteopath aiding the systems most affected by the particular virus (in this case Barr-Epstein). Treatment needs to be gentle and accurate with the osteopath focusing on the areas that physiology and anatomy indicate are vital to restoring homeostasis.
The aim of the osteopathic treatment for this condition is, as with all conditions that osteopaths treat, to aid the body's recovery. Patients often recover slowly from mononeucliosis, and even when the primary symptoms have disappeared the patient may continue to suffer from fatigue, aching, digestive problems, depression and a reduced immune system making them prone to infection.
From my own experience in treating viral infections the osteopathic approach is usually to address the patient's systems accordingly:
1) The lymphatic system
2) The respiratory system
3) The autonomic nervous system
The osteopath begins as usual with a medical case-history gathering as much information about the patient's symptom picture as possible – each patient will be affected by the virus individually and so it is important that the osteopath gears the treatment to the systems that have been affected.
The osteopath should find out if there was any liver or splenic involvement and if so how long the symptoms lasted for. It is also prudent that the osteopath check to find out when the patient's last blood test was to be sure that there is no liver or splenic inflammation of which the patient may be unaware.
For the postural examination the osteopath should focus on specific areas:
The thoracic inlet is a crucial part of any treatment when dealing with infection. Between the clavicle and the first rib lie the sub-clavian veins into which the body's lymph drains thus the osteopath should note any postural tension in the anterior and posterior cervical fascia.
Spinal mechanics are important, paying attention to any viscero-somatic changes throughout the spine.
Respiratory mechanics – diaphragm, ribs, and secondary respiratory muscles – all involved in lymphatic drainage.
Tests:
Abdominal examination: Testing for any liver or splenic tenderness
Lymphatic: All lymph nodes – especially cervical and axilla
Observe nail beds, mucous membranes and sclera for any discolouration that may be caused by anemia or jaundice.
Treatment:
Once the examination has been done the osteopath starts on the treatment. The following is simply a guide for the osteopath as every osteopath will gear the treatment according to the individual patient. I have tried to incorporate into the osteopathic treatment some of the main osteopathic areas of importance.
I generally approach treatment using general-osteopathic-treatment beginning at the feet and working my way up to the cranium checking each and every joint for any restriction.
Lymphatic drainage:
The areas related to the lymphatic-system are widespread. The osteopath can begin with gentle work around the thoracic inlet, articulating the cervico-dorsal junction, clavicle, first rib and scapulo-thoracic articulations. Gentle soft tissue/ muscle energy/ stretching techniques can be applied to subclavius, pectoralis major, scalenes, and cervical fascia. All this is aimed at improving lymphatic drainage through the left and right subclavian veins that lie between the first rib and clavicle and through which all of the lymph drains.
Next the osteopath can move on to diaphragmatic work. It is unclear whether the lymphatic system has any inherent motility (see below) so the diaphragm is considered to be crucial to the flow of lymphatic fluid around the body. The contraction and relaxation of the diaphragm causes a constant change in pressure between thorax and abdomen. During inspiration the thorax increases in size the diaphragm descends the negative pressure in the thorax increases. Since fluid moves from an area of high pressure to low pressure fluid moves up the body from the lower limbs and abdomen into the thorax. Any restriction of the patient's diaphragm will inhibit this process making lymphatic drainage sluggish.
Technically the osteopath can use a variety of techniques to stretch the diaphragm including local inhibition under the costal margin, rib articulation of the lower 6 ribs, L1-3 articulation to affect the crura, or a technique called "doming" where the osteopath puts his hands around the both sides of the rib cage anteriorly and asks the patient to inspire. The osteopath's pressure on the ribs inhibits them from flaring and indirectly stretches the diaphragm.
Since mononucleosis causes lymphadenopathy the osteopath should do work around the face and throat (see post on pharyngitis for hyoid articulation).
To further improve lymphatic drainage the osteopath can use the thoracic lymphatic pump technique or pedal pump.
Assuming the osteopath has checked that there has been no liver or splenic damage the osteopath may wish to include liver or splenic massage into the treatment as these organs are often affected by mononucleosis.
I would like to spend some time on the treatment of the autonomic nervous system for viral infections but the scope of this article is insufficient. Dr Raymond Perrin in his book The Perrin Technique explains how the treatment of the autonomic nervous system is important in chronic fatigue syndrome/ME and he goes to great lengths to explain the importance of treatment of the autonomic nervous system treatment and recovery. In summary though, harmony must exist between the autonomic nervous system and the demands placed on the body otherwise it can lead to systemic, arterial or muscular dysfunction all of which will inevitably cause ill health. It is up to the osteopath to check for somatic dysfunction of the vertebrae with an emphasis on the thoracic spine and vagus nerve all of which can be treated by HVT or articulation as examples.
Treatment can be concluded with side-lying soft-tissue massage to the lumber erector spinae moving up the dorsal erector spinae aiding not only lymph return to the heart but also somatic restrictions around the spinal column.
Advice to the patient:
Diet: Reduce artificial substances, white-flour, sugar and caffeine. Relaxed meals and not sleeping on a full stomach. Increase fruit and veg, healthy balance of protein and carbs. Reduce fried foods.
Exercise: Start gently and build up. Preferably walking and increase as feels healthy.
In conclusion, the osteopath needs to guide the patient back to good health. There are neither quick-fixes nor one single approach. Treatment is about the osteopath aiding the systems most affected by the particular virus (in this case Barr-Epstein). Treatment needs to be gentle and accurate with the osteopath focusing on the areas that physiology and anatomy indicate are vital to restoring homeostasis.