Integrative Manual Therapy, Bone Bruises and Bone Health
There are many ways to normalize bone health: exercises, good nutrition, Integrative Manual Therapy (IMT), acupuncture, massage therapy and more. The Integrative Manual Therapist looks at bone health from a variety of perspectives and uses several hands-on techniques to improve bone health. At the center of these techniques is the "Bone Bruise Technique" developed by Drs. Sharon W. Giammatteo and Thomas Giammatteo.
Definition: A bone bruise is defined as a micro-trabecular fracture.
The developers of the Bone Bruise Technique have expanded the definition of a Bone Bruise. Thousands of persons diagnosed with various bone dysfunctions (beyond micro-trabecular fractures) have responded to the ‘Bone Bruise Technique’. Persons diagnosed with fractures, osteopenia, osteomalasia, osteoporosis and other bone-related problems respond to the Bone Bruise Technique. This technique promotes bone healing for people of all ages, from infancy through adulthood, including the geriatric population. Whether or not the original etiology of the bone bruise is trauma, inflammation or infection, the Bone Bruise Technique will promote healing of bone.
The concept behind this technique indicates that therapists using the "Bone Bruise Technique" are addressing the physiology associated with bone bruises as well as the connective tissue dysfunction that presents with bone bruises.
At the Center for Integrative Manual Therapy and Diagnostics, bone health is also addressed with other bone related techniques including: Bone Synchronizers and other reflex points (points thought to influence bone health through a nervous system reflex similar to acupuncture), Blueprints (protocols of how to use manual therapy to connect up the various aspects of the bone making, breaking down and healing system), Templates (addressing the autonomic nervous system aspect of bone health) and Manual Pattern Recognition (addressing some of the energetic components of bone healing), and more.
IMT practitioners often make nutritional and self-care recommendations on ways each client can improve their own bone health.
These techniques are appropriate if a person has fractured a large bone in the leg or arm as well as bone related issues such as osteoporosis, osteopenia, bone bruises, tiny microtrabecular fractures and swollen joints due to bone injuries.1
(Weiselfish-Giammatteo,2000). 2 (Crowell,2005), 3(Wheeler, 2004).
History: Development of the Bone Bruise Technique
The Bone Bruise Technique was developed in 1994 by Drs. Giammatteo and Giammatteo. A young man came to Regional Physical Therapy, now CenterIMT Headquarters in Bloomfield, CT, following a basketball injury. He complained of severe right mid-tibia pain. He walked non-weight bearing using two Lofstrand crutches. The patient was referred to the clinic by a Physical Therapist, following x-ray results that were negative—they showed no clinical evidence of a fracture.
When the authors assessed the mid-tibia site of pain, there was excessive mobility upon mobility tests. In other words, the bottom and top halves of the tibia showed movement—the top half of the tibia could be moved to the right side, while the bottom half of the tibia could be moved to the left side.
Myofascial Mapping, an Integrative Diagnostic technique developed in 1982, was positive on the transverse plane at the mid-tibia site of pain,an indication of local dysfunction. Myofascial Mapping on a sagittal plane was positive as well, often an indication of bone dysfunction. Mobility tests were clearly indicating a fracture: the bottom and top halves of the tibia were moving; the top half of the tibia could be moved to the right side, while the bottom half of the tibia could be moved to the left side. Another diagnostic was also palpable at the site of pain—the Bone Bruise Motility.
Drs. Giammatteo developed the Bone Bruise Technique to correct the patient’s apparent bone bruise. The rationale is as follows:
Step 1: Utilize the Bone Bruise Motility which the patient manifested in order to engage the bone.
Step 2: Incorporate the connective tissue system. Bone is considered connective tissue. Thus, two fascial glides were included in the Technique. The patient responded best to indirect fascial glides, rather than to direct fascial glides.
Step 3: Drs. Giammatteo understood that Fryette’s laws of movement for Type II movement dysfunction affects spaces. They considered that medullary cavities of bone are spaces. Muscle Energy Technique for Type II dysfunction is a direct technique, for three planes of motion: sagittal plane flexion or extension; coronal plane right of left side bending; transverse plane right or left rotation. All of these planes must be involved and included in the Technique. Also, side bending and rotation movements occur naturally to opposite sides. Thus, the bone above and below the site of mid-tibia pain was grasped; a Muscle Energy Technique was performed to this part of the bone as Step 3 of the Technique.
Therefore, the Bone Bruise Technique was developed, incorporating all of the steps listed above.
Bone Health and Complementary Medicine
In an Archives of Internal Medicine article, Perlman and Sabina, et al. (2006) concluded, "Massage therapy seems to be efficacious in the treatment of Osteoarthritis of the knee."
Tanya Crowell, PT links the importance of addressing immune system issues, lymphatic flow and proper nutrition in any pain and structural dysfunction. In the Jan 2005 issues of Townsend Letter for Doctors and Patients, she goes on to explain the benefit of the Integrative Manual Therapy’s "Bone Bruise Technique" in decreasing lymphedema, pain and dysfunction in the leg.2 (Crowell,2005)
In 2006, Biomech Model Mechanobiol, Upton and Guilak et al note an important mechanical role of extracellular matrix in knee meniscus cells. There are many Integrative Medicine techniques which have been shown to alter mechanical tensions.4 (Burnham, 2007)
When Drs. Giammatteo discovered bone bruises, they first called their technique the ‘Bone Fracture Technique’. There was resistance to this first name. Consequently, the name, ‘Bone Bruise Technique’ was chosen. At that time, there was no mention made of bone bruises or bone bruising in the literature or on the internet.
During the following years, clinical research continued. A phenomenon was noted anddocumented, which Drs. Giammatteo referred to as bone exudate. From a bone bruise site, exudate (exuded matter) which appeared to be bone exudate, migrated from the site.
At the time, there was no reference to bone exudate in the literature. Today, bone marrow edema is mentioned hundreds of times on the internet, and well documented in journals of Radiology.
As clinical research progressed, another phenomenon became apparent, which Drs. Giammatteo titled osseous bridges. Once again, at the time there were no references in the literature to this phenomenon. Yet, today, the terminology used in various radiologic journals is the same; radiologists refer to this phenomenon as ‘osseous bridges’.
Osseous bridges cause a lot of pain, dysfunction and disability. For example, when there is a bone bruise on the femoral head, if bone marrow edema (bone exudate) migrates from the femoral head, this exudate can cross from the femoral head across the hip joint space, affect the joint, the sacroiliac joint, and the pelvic bowl.
Often, arthroscopy, which incorporates scraping of the joint space, will attest to bone particles which are calcium deposits, in the joint space.
The osseous bridges can lead to bone bars. Drs. Giammatteo discerned this phenomenon with hands-on diagnostics. These bone bars cause exceptional limitations of joint mobility and thus limitations of ranges of motion.
