By Kelly Clancy, OTR/L, CHT
“Biomechanics is the study of the structure and function of biological systems by means of the methods of mechanics.” (Herbert Hatze,1974
In biomechanics, the physical body is understood as ‘a machine made up of parts.’
The biomechanical model has been driving physical medicine since Aristotle, who saw in animals’ bodies mechanical systems. Giovanni Borelli, the father of biomechanics, regarded the human body as a machine whose functions could be explained by the laws of physics. He examined parts of the body and explained them as a series of levers and pulleys. This theory of examining and treating the body as a machine has persisted in medicine, the field of biomechanics expanding and accelerating in the19th century through the present day. The application of biomechanics, focused on parts of the human body and their functions in isolation, has moved from explanatory to driving therapeutic interventions.
Biomechanical Mechanistic reasoning in education:
Anatomy dissection and labeling of parts has been used as a way to describe the human body for over two millenia. The notion of the body as a machine was codified and reinforced by Cartesian philosophy, advancing mind/body dualism and reductionism, examining the whole by breaking it into parts.
We have studied the human form within this biomechanical framework, dependent upon the scalpel and the anatomists’ skillful hands to determine where one structure stopped and another began. Whom amongst medical professionals didn’t spend countless hours in the anatomy lab, separating and isolating structures to label them as parts? We learned how to understand them in isolation, studying their action, origin, innervation and insertion. After mastering basic anatomy, we were often encouraged to chose an area of subspecialty within a field. In Physical Therapy, one’s speciality may involve specific orthopaedic or neurologic disciplines, or the focus may be on a particular body part. In Occupational Therapy, one may choose mental health or physical disabilities, again perpetuating the Cartesian split of mind separated from body. If you become a physical disabilities Occupational Therapist, the focus is on the physical with a goal of functional independence. Again, one can choose to specialize in a particular region of the body, becoming a certified hand therapist, for instance. Even our disciplines are defined by division of body parts. How often therapists have heard that OT’s treat above the waist and PT’s below the waist?
Though the philosophy of Occupational Therapy has, from its origins, emphasized whole person integration, our training programs and reimbursement models have encouraged breaking the person up into parts or systems. This approach appears to wrong.
With newer clinical research evolving around connective tissue/fascia, neuroscience, and psychoneuroimmunology, clinicians and scientists are beginning to question the focus on the biomechanical model and ‘parts-focused’ treatment interventions. Based on these new insights, the biotensegrity model has grown to challenge the biomechanical model. Derived from the concept of tensegrity originally developed by Buckminster Fuller and Kenneth Snelson, the model was expanded to include biologic forms by Stephen Levin, MD. This model provides a new biologic rationale for understanding, evaluating and treating the whole body and the whole person.
Levin defines the human form as a biotensegrity structure held together by continuous connective tissue/fascia organized through the balance of tension and compression forces. These mechanical forces determine the positioning of the bones, nerves, vessels and muscles, the three dimensional tension- compression balance necessary for overall health and functioning. When this tensional integrity becomes compromised, the global structure becomes dysfunctional and system(s) can become disorganized and potentially diseased.
Adopting this biotensegrity model, along with the newest information and research related to fascia and the nervous system, Tensegrity Medicine is a methodology which utilizes myofascial, orthopaedic, and functional movement testing along with specific mechanistic reasoning of tensional balancing of the fascial planes. This approach allows us to determine how, where, and what treatment interventions need to be applied.
The therapist utilizes a holistic intake which examines the physical balance of the body, the cognitive belief patterns, and the emotional state of the patient to establish a progressive course of care. By practicing a ‘less is more’ manual therapy approach, the connective tissue tension patterns are addressed through light touch techniques and dialoguing with the client about their sensations and holding patterns. Movement integration follows, with an emphasis on interoceptive and proprioceptive awareness of movement and holding patterns. The practitioner’s goal is to restore the tensional integrity of the global system, thus returning the balance of the soft tissue structures and restoring ‘homeostasis’ and normalized global functioning. This treatment approach facilitates independence by restoring ease in functional movement, Activities of Daily Living and avocational functioning. It also informs and empowers the patient in understanding how their lifestyle habits and patterns shape their physiology.
Abandoning the biomechanical model and rejecting mind/body dualism is to practice consistent with the underlying philosophy of Occupational Therapy by which it examines and treats the whole individual to maximize independence, health and well being.
Kelly Clancy, OTR/L, CHT is the developer of the Tensegrity Medicine methodology. You can find out more about this therapeutic approach at www.kellyclancy.com.