Somatic dysfunction

Somatic refers to the 'framework of the body': structures such as the skeleton, joints, muscles, and fascia, rather than the internal organs. In osteopathy, a state in which these structures cannot move properly or respond differently from one another is called somatic dysfunction. The associated blood vessels, lymphatic structures, and nerves are also included. The International Classification of Diseases (ICD) includes the entry 'M99.0 Segmental and somatic dysfunction.'

In osteopathy, manual therapy practitioners identify this condition by checking four features with their hands. This method is called TART, after their English initials.

• Tissue texture changes: The tissue feels firmer, stickier, or thicker than usual to the touch.
• Asymmetry: Bone positions or muscle tension differ between the left and right sides.
• Restriction of motion: A joint moves less in a particular direction.
• Tenderness: A particular spot is especially painful when pressed.

Dysfunction is generally considered present when two or more of these features occur together. When it is centered on a single spinal segment, it is also called 'segmental dysfunction.'

Somatic dysfunction is less a disease name than a signal from the body. In daily life, it can feel like this:

• Only one side of your neck or lower back feels stiff in the morning, with a catching sensation when you turn.
• One shoulder is always raised, and its muscles feel rock-hard to the touch.
• One side of your pelvis or one foot becomes tired sooner than the other.
• Loosening up a joint feels relieving, but the same area becomes stiff again a few days later.

Anyone can have these experiences. They commonly occur after prolonged sitting, carrying a bag on only one side, or an injury that leaves the body stiffening as if to protect the injured area.

Integrative Manual Therapy (IMT) draws on this osteopathic concept but is distinctive in not looking for the cause in just one place. The book explains that a problem inside the body can manifest as muscle and joint dysfunction through the same spinal cord segment.

For example, suppose there is a surgical scar involving the Cecum in the lower right abdomen. Signals from this tissue may enter the spinal cord at the first lumbar segment and make that segment more easily excited. This is called a facilitated segment. In this view, muscles supplied by nerves from that segment remain contracted as if protecting the area, and the tissues around the pelvis and hip joint stiffen, outwardly manifesting as dysfunction in the hip or lower back. This approach therefore examines not only the painful muscles but also abdominal tissues associated with the same segment. These connections are discussed in more detail in Viscerosomatic and somatovisceral reflexes.

In this view, stiffness of this kind also changes the reference point for movement. The central position where a joint is most comfortable is called its 'neutral position.' When muscles remain contracted protectively for a long time, that position shifts to one side. This new point is called 'pathological neutral' and becomes the midpoint of the reduced joint movement.

Practitioners examine these changes using several concepts. The point at which muscles first resist as a joint is moved is called the muscle barrier. A state in which muscles remain contracted to guard an injured area is called protective muscle spasm. Patterns are also classified into types, such as Type I somatic dysfunction, in which a group of spinal segments tilts and stiffens as a unit.

Once dysfunction has been identified, approaches may include the Muscle Energy and Beyond technique, which involves gently contracting and relaxing muscles, or techniques to release fascia. The choice of technique varies by practitioner, and many will explain in detail if you ask what they are doing and why.

• Avoid staying in the same position for too long. Get up at least once an hour and slowly rotate your neck, shoulders, and lower back.
• Try alternating sides. Changing the side on which you carry your bag or cross your legs can reduce tension that builds up on just one side.
• If the same area keeps tightening again after being loosened, consider the surrounding areas too. Surgical scars, old injuries, and abdominal discomfort may be connected, so give your practitioner a detailed medical history.
• Move gently within a comfortable range. Rather than forcing a stretch to a painful endpoint, try repeating slow movements within a comfortable range.
• If pain is severe or numbness or tingling persists, have it checked at a hospital or clinic. Somatic dysfunction is assessed through manual therapy, but another underlying cause may be present.