Letters to the Editor  |   July 2007
Reported Prevalence Rates of Somatic Dysfunction Raise an... Heel?
Author Affiliations
  • Donald E. Kotoske, DO
    South Bend, Ind
Article Information
Neuromusculoskeletal Disorders
Letters to the Editor   |   July 2007
Reported Prevalence Rates of Somatic Dysfunction Raise an... Heel?
The Journal of the American Osteopathic Association, July 2007, Vol. 107, 281. doi:
The Journal of the American Osteopathic Association, July 2007, Vol. 107, 281. doi:
To the Editor: In their December 2005 study, John C. Licciardone, DO, MBA, and colleagues, indicated that they found evidence of somatic dysfunction in 31% of subjects (J Am Osteopath Assoc. 2005;105:537-544). I have been practicing osteopathic medicine for 35 years. I am board certified in osteopathic family medicine and surgery, osteopathic manipulative medicine, and psychological evaluation and treatment. And yet, my experience (albeit anecdotal) disagrees with the findings of these researchers. 
Andrew Taylor Still, MD, DO,1 said that there is an element of somatic dysfunction in every illness: “disease is the result of anatomical abnormalities followed by physiological discord.” I agree and have based my successful practice of osteopathic medicine on this tenet. 
The tenets of osteopathic medicine further state that structure governs function.2 This principle explains why it is so important for osteopathic physicians to recognize the importance of, for example, leg length disparity. I have found this particular kind of somatic dysfunction present in approximately 95% of the patients I see with all manifestations of illness. 
I find that a simple hard rubber lift inserted into the heel of the patient's shoe on the short leg side can balance the pelvis and level the sacral base on which the spine rests. If osteopathic physicians do not make this determination on the first visit, I believe that they are not truly practicing bona fide osteopathic medicine. (Incidentally, in 95% of my patients with this condition, the left leg is affected.) The human spine must be balanced to maintain health. Heel-lift therapy to level the sacral base, straighten the spine, and achieve proper blood supply to the organs is often the best way to give patients the best chance at maintaining health. 
Dr Still3 goes on to indicate that the rule of the artery is supreme, meaning that there must be appropriate blood supply to all the organs. This optimal state is not possible concurrent with a misaligned spine. 
My patients come to me for their medical-surgical problems. I operate a comprehensive diagnostic treatment center. We are capable of performing over 65 different diagnostic tests on site, many of which are available to most patients only in a hospital on an outpatient basis. On their first visit, patients receive a thorough osteopathic spinal balance examination. If I diagnose a patient with short leg syndrome, I provide him or her with lift therapy, OMT during each visit, and treatment for the chief complaint. 
For the patients described, I prescribe a monthly treatment plan. First, these patients undergo routine testing for any chronic conditions (eg, complete blood count, ultrasonography). Second, to relax and prepare patients' muscles, tendons, and ligaments for osteopathic manipulative treatment, I provide a short preparatory treatment for them using an anatomotor massage and traction table. After patients have received 15 minutes of treatment with the anatomotor, I enter the examination room to reevaluate and quickly manipulate approximately 10 body regions. Finally, I devote adequate time to speaking with patients to make certain I have appropriately addressed all of their medical-surgical complaints. 
If you will notice, I said that I treat approximately 10 body regions in all patients. Why? It is simple: treating only one or two areas of the body is foolish because the human body is an interrelated unit.2 Somatic dysfunction in one body region affects the entire organism, causing somatic dysfunction in all regions of the body. 
I have practiced in South Bend, Ind, in this manner for 35 years. I believe that it is a clear testimony to my adherence to osteopathic principles that it generally takes new patients 4 months to move from the waiting list to receiving full medical care in my practice. One third of our patients travel from nearby states to be seen by me. Practicing medicine according to the tenets of Dr Still, I have helped thousands of patients over the years. 
I believe that my success is rooted primarily in three essential tenets of osteopathic medicine: 
  • In every illness, there is an element of somatic dysfunction
  • Somatic dysfunction is best treated via osteopathic manipulative medicine
  • The rule of the artery is supreme
It is just that simple. 
Still AT. Osteopathy: Research and Practice. 1910. Paulus S, ed. The Still Project. Soquel, Calif: Inter Linea; 2005. Available at: Accessed July 18, 2007.
Special Committee on Osteopathic Principles and Osteopathic Technic, Kirksville College of Osteopathy and Surgery. Interpretation of the osteopathic concept prepared by committee at Kirksville. J Osteopath. October(1953). ;60:7-10.
Still AT. Autobiography of A.T. Still. 1908. Paulus S, ed. The Still Project. Soquel, Calif: Inter Linea; 2006. Available at: Accessed July 18, 2007.