Dr. Nick Buratovich is a Professor Emeritus of Naturopathic Medicine and the former Department Chair of Physical Medicine at the Southwest College of Naturopathic Medicine and Health Sciences in Tempe Arizona where he taught physical medicine and manipulation for 25 years. Dr. Nick is an original/founding faculty member of Southwest College. He has attended a variety of post graduate workshop courses in manipulation through the Osteopathic, Chiropractic and Physical Therapy professions.
Dr. Nick graduated from the National College of Naturopathic Medicine in 1983. He maintains a private practice in Naturopathic family medicine with an emphasis in musculoskeletal disorders and pain management in Tempe and Mesa Arizona for 35 years. He has delivered a number of well received professional presentations for both the AANP and AzNMA in physical medicine/manipulation.
Statement of Purpose
Dr. Nick is committed to supporting the ongoing Naturopathic clinical practice of manipulative medicine for the variety of health conditions producing symptoms in the musculoskeletal system. He is doing this by offering his MSDW (Manipulation Skill Development Workshop) series. His intention is to provide supervised manipulative technique ‘hands-on’ workshop training sessions to licensed physicians and Naturopathic medical students. It has been his experience that following the course sequence in osseous manipulation in Naturopathic medical school there is a limited ability to get or limited options for additional ‘hands-on’ training for the practicing physician or medical student to further develop their manual skills.
It has been his observation that due to this limited opportunity for advancing manipulative technique practice that some students and physicians shy away from applying it in practice. This is probably due to an insecurity in technique application or lack of confidence or unsure competence in being effective clinically. Because of this lack of additional or ongoing training experience sometimes a physician will defer to other professions to provide manipulative care, most notably the chiropractic profession. Dr. Nick perceives this as a need within the Naturopathic profession to have additional and ongoing training experience in manipulative technique.
It is true that manipulation is not for everyone. In the same way other modalities or areas of practice provide an attraction for practitioners, manipulation has its own potency for treatment and its own attraction. Dr. Bastyr was quoted as saying if he had only one modality to use, he would “use his hands”. Practicing physicians and medical students now have an avenue for ongoing supervised training and to re-fresh their skills in manipulative medicine with the MSDW trainings provided by Dr. Nick to positively affect their sense of confidence and enhance their competence so they will utilize manipulation in the care of their patients to increase positive clinical outcomes in their practice of Naturopathic medicine.
(A poem by Dr. Nick)
To make your patient well
and to take your focused clinical differential
into a specific diagnosis, do this:
Use a history and static palpation to realize
where the lesion or fault lies.
Use motion palpation and orthopedic testing to
challenge various musculoskeltal structures
to maximize that compromize.
When you can detect it, then you can correct it.
Engage the position constriction or the motion restriction.
With a healing intention thrust through and into
the direction of correction.
With the release, the dysfunction and /or pain may cease.
Naturopathic manipulation is like joint grease.
It has its own unique way to stimulate the vis medicatrix naturae.
MUSINGS ON MANIPULATION
In HVLA (High Velocity Low Amplitude) manipulation there are basic, shared by all professions who do manipulation, mechanics of techniques which produce a method contained within a system. The method and system are not necessarily shared by all and that is what creates different professions of manipulators.
MECHANICS > TECHNIQUES > METHOD > SYSTEM
Mechanics: Applied forces in a position producing controlled motion.
Technique: A technical skill used in a specific way to affect a desired result, in this case to restore joint play or restore alignment.
Method: Is a special ability or an orderly approach in a way of doing something using systematic procedures. The word ‘method’ is derived from the Latin word ‘methodos’ which means ‘pursuit of knowledge’.
System: Is characterized by ordered principles, it often refers to a theory or practice relating to or prescribing a particular form of, in this case, medicine.
The method is ‘Dr. Nick’s’ method of manipulation practiced for over 35 years and taught by him for 25 years. His method has been influenced by all major professions of manipulators, ND, DC, DO and PT through trainings he has attended. In addition, Dr. Nick before naturopathic medical school was trained as a massage therapist.
The system is the system of Naturopathic Medicine based on its 6 principles:
- First Do No Harm
- The Healing Power of Nature
- Find and Treat the Cause
- Treat the Whole Person
- Educate the Patient.
These principles guide the practice of naturopathic medicine not only in physical medicine/manipulation but also in the other primary modalities of practice as well (nutritional, botanical, homeopathic and mind-body medicine).
FIRST DO NO HARM:
This principle is shared by all medical practices. Because HVLA manipulation involves a thrust or impulse (controlled motion) it must be applied correctly so as to do no harm. It is possible to be sore after a proper treatment however. I like to think of it as ‘The Goldilocks Principle’: ‘Just Right’. Meaning, not too hard, not to soft, not to fast, not to slow for example. It is like finding ‘the sweet spot’. Developing this skill takes time, experience and practice. It is also helpful to have an undistracted focus on the patient, their condition and the technique utilized. It is best to not be overly aggressive and I recommend to not substitute more force for bad technique. In most cases just touching the patient transmits your healing energy and intention which can result in a feeling of well-being. This is also known as magnetic treatment.
THE HEALING POWER OF NATURE:
This is the Vis Medicatrix Naturae. The use of movement and manipulation (controlled motion) helps to stimulate the vis by stimulating the flow of the bodies vascular (artery, venous, lymphatic), and neurological (axoplasmatic flow) fluids and energies to foster the reparative, recuperative, and regenerative properties of the body along with enhancing the self-regulatory mechanisms of the body which are naturally and innately present but may become stagnant and contribute to ill-health.
FIND AND TREAT THE CAUSE:
With physical medicine/manipulation the primary area of focus is usually the structural (mechanical) musculoskeletal system where structure governs function but can also include organ reflexes and stress (somatization) circumstances. The use of a thorough history and physical exam supported with diagnostic imaging, lab tests and other specialty assessments, the physician can usually come up with a focused differential leading to a specific diagnosis of any organ system condition or dysfunction causing musculoskeletal symptoms. Depending on the cause, if it is more structural in nature you can use instrumental manipulation which is a more bio-mechanical approach. If the symptoms are a result of somatization (mind-body stresses) then you can use a more expressive manipulative approach, which is usually less forceful and more intuitive or a combination of the two. In either case, you would follow the basics in the application of the mechanics of the techniques coupled with your healing intention (magnetic treatment).
TREAT THE WHOLE PERSON:
This is where somewhat independent of the cause of the condition or dysfunction the whole person is taken into consideration with the treatment or treatments that are utilized. The whole person should be considered to be an integration of bio-mechanical, metabolic or nutritional, mental-emotional, spiritual factors and existential integrity. For example, diet is looked at as an inflammatory or allergenic diet may contribute to the symptoms of a structural complaint. Stresses in a person’s life may also contribute to or intensify presenting symptoms of a patient’s complaint. You want to support the whole person by removing any obstacles to cure, usually bad habits and install good habits (the determinants of health) which are health promoting. These of course are individualized to the patient and their condition or dysfunction.
This is looking at bio-mechanical (posture, overuse, injury) or emotional stress patterns (anxiety, depression) along with nutritional influences (diet, supplements), sleep, rest, and time spent in nature to help reduce or eliminate the negative influences on the patient. Hippocrates has said “an ounce of prevention is worth a pound of cure”. This is typically achieved through better lifestyle choices to instill the determinants of health. A common denominator of ill health is poor choices made through ignorance, indifference, self-indulgence and lack of self-control. These choices can be considered to be in violation of nature’s laws and therefore an obstacle to cure. The only consistent strategy to reverse these choices is commitment and discipline to better lifestyle choices. Once you accomplish this, the better choices are what you do, and therefore easy, and not what you try to do and then become a challenge through resistance and resentment. True health is an active process not a passive one.
This principle goes hand in hand with prevention. The patient is educated about their condition and the circumstances of patterns, triggers and choices that may have contributed to it or them. They are also educated about the strategies recommended to address and reverse their presenting condition(s) or complaint(s). This is because it has been said “if you don’t get it, you won’t do it”. The patient, if necessary, is also educated about the practice of Naturopathic medicine and these principles. While these principles are philosophical in nature, they are also practical in their application to foster a healthier lifestyle and therefore better health. Education is about knowledge and information. While they are similar and share an overlap, they are not the same. Knowledge is foundational and fundamental. Sometimes intuitive but mostly learned through experience and observation. Knowledge is anchored in the beliefs and commitment of its holder. Knowledge may evolve over time. The principles are like knowledge, they are consistent and constant. Information, while it may inform knowledge, is not constant or consistent. It is usually subject to change. It is simply data, which is accumulated, filed, sorted, indexed and revised. It has no soul really. It is, however, data with context. So, when we educate our patients, we must provide them with knowledge, which is supported and informed with information.