Mechanical Link: Fundamental Principles, Theory, and Practice Following an Osteopathic Approach.

Chauffour P, Prat E. Monique Bureau, trans. Berkeley, CA 94712, North Atlantic Books, 2002, hardcover, 208 pp, illus, ISBN: 1-55643-427-8, $60.

This text was translated from French by Monique Bureau, PT, DO. It was designed to provide the reader with an understanding of the osteopathic method. After a brief history of osteopathy, the authors describe the embryological development of connective tissue and its importance in the structural cohesion of the body. The embryological homogeneity of the myofascial system, the osseous system, and the cardiovascular system are depicted as the basis for the concept of the osteopathic mechanical link.

In the second chapter of the book, the authors discuss the anatomy of the fasciae of the body and their relationship to each other in detail. I found this chapter to be one of the best descriptions of the various fascial layers. The authors effectively tie the superficial and deep fasciae together and their involvement in various disorders of the trunk and extremities. This chapter concludes with an easy-to-understand description of the dura mater and the resulting craniosacral biomechanical system.

The third chapter of the book discusses osteopathic lesions. The authors define an osteopathic lesion as a restriction of the mobility of a structure resulting from scarring of connective tissue. They note that the characteristic sign of the osteopathic lesion is a tissular barrier, which includes articular tightness, muscular contracture, fascial tension, and intraosseous rigidity. The smallest identifiable osteopathic lesion is the individual lesion. The sum of all the individual lesions is manifested as the total osteopathic lesion that is found during the examination. The authors note that it is impractical to correct all of the patient's lesions; therefore, the primary lesion is identified and corrected. The primary lesion is the center of all of the other lesions, and, in their opinion, its correction will also correct the remaining lesions. The distinctions between a test of mobility and examination of posture are explained in relationship to the manifestation of the lesion and the creation of the lesion. The reader is provided with a detailed description of the nature of the tissular barriers and the development of osteopathic lesions.

The remainder of the book is devoted to examination, evaluation, and treatment of patients with osteopathic lesions. The reader is provided with a variety of tests that are designed for the various parts of the body. The authors begin by describing global tests that caret all of the functional units of the body, and then they describe specific tests for joints of the spine, the think, and the extremities. In developing the theory of their tests, the authors describe testing of fascial resistance zones, which led them to discover fixations that were not previously described. These fixations are related to a transverse and longitudinal osseous system. They have labeled these as interosseous lines of force and they argue that these forces govern minor movements. Additional chapters are devoted to barriers found in units described as the visceral unit, the vascular unit, the cephalic unit, and the dermis unit. Units are divided into functional regions that can be examined using the osteopathic techniques described by the authors.

Two units described in the book were especially interesting--the vascular unit (chapter 12) and the cephalic unit (chapter 13). In the chapter on the vascular unit, the authors discuss their discovery of the large vessel tissular lesion of retraction, which results in decreased mobility of the heart. They systematically evaluate the vascular tree using tension tests that they describe. The authors note the importance of the artery in the osteopathic concept that was first put forward by Andrew Taylor Still. They expand on the relationship of the arterial system to each of the other systems within the body, noting its importance as described by Still that "the role of the artery is absolute." The chapter on the cephalic unit begins with the work of WG Sutherland on cerebrospinal fluid fluctuation and the development of the craniosacral approach. The authors apply the mechanical link principle to the various structures of the cranium as they take the reader through the testing and treating of barriers found in this region.

The last 2 chapters of the book are devoted to treatment methods and applying those methods to different populations of patients. The authors also discuss osteopathy combined with other forms of treatment such as acupuncture and homeopathy. They conclude by stating that the mechanical link techniques are simple and allow the osteopathic practitioner to explore anatomical regions that have been neglected or misunderstood previously.

In support of the mechanical link, technique, the authors do not provide any references to literature on reliability or validity. The effectiveness of the techniques is addressed only by the anecdotal remarks of the authors. The bibliography provides only references to texts on anatomy and standard osteopathic techniques. The lack of supporting literature, however, does not detract from the book's primary purpose, which is to describe the osteopathic method and use of specific osteopathic techniques.

I found this book to be very easy to understand. The authors write in a conversational style that allows the reader to move through the material easily. The descriptions of the fasciae and how they are involved in dysfunction of the various tissues of the body are excellent. I would highly recommend this text to physical therapists who have an interest manual therapy. The techniques described, however, may be advanced for the beginning practitioner.

Byron Russell, PT, PhD

Eastern Washington University 

Spokane, Wash

Dr Russell is Chair of the Department of Physical Therapy. He teaches in the areas of anatomy and orthopedic physical therapy.