Anne Wales graduated from the Kansas City College of Osteopathy and Surgery and then practiced osteopathy in Rhode Island for over 50 years.
She then lived in Massachusetts.
She was also active in teaching.
She edited W.G. Sutherland’s “Teachings in the Science of Osteopathy” and “Contributions of Thought.
The collected writings of W.G. Sutherland” and is often regarded as the direct legacy of W.G. Sutherland.
Anne Wales died on August 1, 2005 at the age of 101. The following interview, which appeared in the journal “Osteopathische Medizin” in 2/2001, is a compilation of personal conversations and correspondence between Anne Wales D.O. and Torsten Liem D.O. between 1996 and 2001.
Especially in our fast-moving times, it seems incredible and very modest that a man would spend over twenty years researching and thinking before sharing his results with the public.
Can you say something about Sutherland’s career and his contributions to osteopathy?
Dr. Sutherland was a journalist, editor of the Herald in Austin, Minnesota, when he first came into contact with osteopathy.
He attended the American School of Osteopathy in Kirksville and graduated with the class of 1900. He practiced osteopathy in Minnesota from 1900 to 1944.
He then began teaching about the human skull.
He taught in California from 1944 until shortly before his death in September 1954. For several decades, he studied the mechanical influences of the articular surfaces of the brain and facial skull on the living human head. Sutherland’s great achievement was to integrate the head into the osteopathic model, so that now not only the feet but also the head and face could be treated osteopathically.
There is no longer just one answer to the patient’s presentation, but many treatment options, adapted to the patient’s needs.
Can you tell us something about Sutherland’s courses?
We took classes from Dr. Sutherland in Des Moines, Law, Chicago, Illinois, Providence, Rhode Island and I learned a lot in his classes about the practice of osteopathy, as did many others.
His teaching was based on the mechanics of the articular surfaces of the skeletal system, especially the movement of the cranial bones.
He wanted his students to learn to see the anatomy of the articular surfaces in their own mind’s eye.
Dr. Sutherland was a good teacher and an original thinker whose foundations were based on the anatomy of the human body. G. Sutherland said that the goal of osteopathic treatment is to create a better exchange between all the fluids of the body across all contact surfaces.
I understood that the human body consists of 70% water.
Half of it is within the cells.
35% is within the blood system.
So how does air, water and food get into the cells? Sutherland saw the cranial cavity as a modified spherical space (the space in which the brain lies).
If any joint within it moves, everything else moves too.
So its shape changes.
All the cranial bones move to be able to do this.
You have described to me some Sutherland techniques that differ significantly from Lippincott’s explanations, which were published in Sutherland’s book “Teaching in the Science of Osteopathy”.
From 1945 to 1950, my husband and I attended the Lippincott Cranial Study Group meetings in Moorestown, New Jersey.
I have not read Lippincott’s written remarks.
Howard A. Lippincott studied at the American School of Osteopathy in Kirksville, Missouri with the 1918 course.
Rebecca C. Lippincot was in the class of 1923 at the Philadelphia College of Osteopathy.
They studied with Dr. Sutherland in Minnesota during their vacation in 1940.
They wanted to pass on through writing what they had learned themselves.
When you taught me the “point of balanced ligamentous tension”, I found it easier to understand than Lippincott’s descriptions.
Can you briefly summarize how you would describe a “point of balanced ligamentous tension” (PBLT) in the skeletal system and when ligamentous tension can occur?
The “point of balanced tension” in the skeletal system is where you position a joint in such a state of equilibrium that the patient’s self-corrective forces move the bone into the correct position. Ligamentary malpositions can occur in strains, sprains, subluxations, dislocations and fractures.
What other factors need to be considered in the treatment of movement restrictions?
Balanced ligamentous tension, approximation, traction, support through the patient’s breathing, support through the patient’s posture, active support, fluid drive, steering of the tide.
At which structures in the body do you set a “point of balanced membranous tension”?
In the cranium, forearm and between the fibula and tibia.
This is supported by techniques that direct the “tide” (tidal movement).
You often use the term “facial drag”.
Can you explain it in more detail for us?
In the standing position, standing on both feet with the arms hanging down at the sides, the center of gravity is in the pelvis and the line of gravity runs through the dens of the axis.
“Drag” means a sinking of tissues into the ventral region of the body.
Which structures are particularly affected?
The diaphragm and all attachments of the diaphragm.
The colonic flexures, the liver and spleen capsule and the pericardium.
The thorax is stabilized by the mediastinal fascia and the neck by the prevertebral fascia.
Upwards, the neck muscles of the back and shoulder are attached externally to the occipital bone.
The ligg.
longitudinale anterior and posterior ligaments connect the occipital bone to the cervical vertebrae.
The prevertebral fascia is attached to the basilar process of the occipital bone directly behind the pharyngeal tubercle.
The pharyngeal raphe is attached externally to the pars petrosa of the temporal bone and the free edges of the medial pterygoid process.
This forms the nasopharynx.
The lamina perpendicularis of the ethmoid and the vomer articulate with the corpus of the sphenoid…
All together, there are a lot of influences that can exert traction on the outer surface of the base of the skull and the upper neck area.
Inside the cranium, the squama is a special place.
This is where all the dura duplications meet.
As taught by Dr. Sutherland, the falx cerebri and the tentorium cerebelli, the inner layer of the dura mater, function as a reciprocal tension mechanism inside the cranium.
The dural duplications connect in the rectus sinus, harboring the venous sinus, which transports venous blood into the jugular foramina.
According to Dr. Sutherland, the inner position of the dura mater moves the cranial bones at the sutures so that everything can change shape together in a physiological rhythm.
It acts as a passive coordination of movement at the joint-like connections of the cranial bones.
Dr. Sutherland also mentions a “point of balanced membranous tension” when treating the facial bones, although there is no direct contact with the dura.
As the facial skull is connected to the base of the skull, it is strongly influenced by the base of the skull, even the bones that have no direct connection to the base of the skull, such as the maxilla.
Here the influence of the base of the skull is transmitted via the articular surfaces of the sphenoid bone to the palatine bone and from there to the maxilla.
What are the influences on the movement of the cranial bones and the sacrum?
The brain lies in a waterbed.
Surrounded on the outside by cerebrospinal fluid in the subarachnoid space and embedded in the cisterns and cerebrospinal fluid on the inside in the ventricles of the brain, like a house in the ocean, a house with open doors.
Due to the fluctuation of the cerebrospinal fluid and the inherent motility and brain tissue, the container (meaning the bony skull) continuously changes its shape, e.g. in the synchondrosis sphenobasilaris.
If the midline flexes from the nasal septum to the coccyx, all paired structures go into external rotation and vice versa.
The inner layer of the dura mater is firmly attached to the foramen magnum.
Also to the lig.
longitudinale posterius and to the upper cervical vertebrae.
The dura then hangs relatively loosely in the spinal canal up to the second sacral vertebra.
Thus the sacrum is part of the inherent mechanism.
Still already said that the nerves would drink the cerebrospinal fluid.
The meninges follow the nerves.
After leaving the brain, the cerebrospinal fluid becomes tissue fluid.
The name changes, but there is a certain connection and continuity.
Please explain the difference between the longitudinal “tide” (fluctuation) and the transverse “tide” (fluctuation)?
In my opinion, the longitudinal fluctuation of the cerebrospinal fluid (LCS) is a physiological phenomenon.
The movement of the structures of the PRM in flexion and extension is related to longitudinal fluctuation.
When the fluctuation appears, I perceive during palpation as if the cisterns and cerebellum are expanding and the fluctuation continues along the falx.
Lateral fluctuation is usually induced by a technique.
At any time I could place the pads of my thumbs on the mastoid processes, or place my hands on the large sphenoid wings, the parietal bones or the sacrum and induce a lateral fluctuation.
This is a process to direct the “tide”.
The 4th ventricle can be compressed (CV-4) by changing the shape of the posterior fossa, below the tentorium cerebelli.
To do this, the hands must be in contact with the supraocciput.
This achieves a certain clinical effect, the same as if I induce an alternating lateral fluctuation.
Once I was asked to treat Dr. Sutherland.
So I visited him at home.
His wife opened the door for me and escorted me to Dr. Sutherland.
He was already lying down and after greeting him, I sat down at the head of the bed.
I asked Dr. Sutherland what I should do.
He told me to put my hands on my head.
He took my hands and placed them on the mastoid processes and crossed his fingers under his neck.
I said nothing.
He said nothing.
That’s how I began.
I followed what I felt.
His head moved from side to side.
After a while, he asked me if I could feel anything.
I said the head was moving from side to side.
Look good, he said, now bring the movement to a standstill.
You do that by following the extension until it stops.
And then you stay there, he said.
You can do this in the same way with internal and external rotation of the parietal bones.
For example, if the patient is having an epileptic seizure and you want to stop it, gently bring the parietal bones or the sacrum into internal rotation/extension.
Another time I had a patient with a livid blue, very swollen hand.
It was so painful that I could not touch it.
I thought about what I could do.
I formed a fist and asked the patient to grasp my fist with his hand.
I induced a lateral fluctuation in the hand and a stop.
And his skin color changed.
And then I noticed how we were breathing synchronously.
The swelling in the hand literally disappeared.
What do you think about the described axes of movement of the skull bones? In my palpatory experience, I often have the impression that the theory of axes of motion only very inaccurately reflects what is directly perceptible when my hands palpate the skull.
And in the beginning, the biomechanical model of the description of cranial bone movement sometimes made it very difficult for me to come into direct contact with the tissue without projecting this model into my palpation experience. The bony skull represents a three-dimensional container for the brain.
There are sutures between the individual bones of the skull.
All these joint-like connections move in space.
If a single bone moves, all the others must also move at the same time.
I’m not necessarily thinking of the so-called axes of movement of the individual cranial bones, I’m thinking more of the different articular surfaces of the cranial bones.
Everything has to move at the same time.
These days, there are many discussions about rhythms: Magoun (10-14 min.), Upledger (6-12/min.), Becker 6-10/10 min.), Jealous (2.5/min.). Did Sutherland himself name a frequency for the primary respiratory mechanism? And what do you think about the different rhythms?
I know nothing about any particular frequency of the Primary Respiratory Mechanism and I do not recall Dr. Sutherland counting the rhythm of the fluctuations.
Dr. Woods introduced the term “Cranio Rhythmic Impulse” and counted the rhythm.
In your opinion, what is special about an osteopath?
As an osteopath, you examine the patient’s body with your hands.
You study the anatomy so that you can understand how the body works and what the problem is that brings the patient to you.
You want to understand the problem before you prescribe any kind of treatment.
You want to understand what his complaints are, the history of his complaints and then you want to find out what the problem is behind his complaints.
Anne, how is it that you are still so young in your old age.
Is that an osteopathic secret?
I have received a lot of treatments since I went to college in 1922.
I began practicing osteopathy in 1927 and ended my practice in 1977.
I try to respect my physical limitations and work within them. I still treat my family, friends and close colleagues, which means I have one to three treatments a day.
