Interview with Marco Fierro

edited by Adelina Detcheva

 Question: The first question concerns osteopathy seen a little more closely. What is it about?

Answer: Osteopathy is a mainly manual technique that tries to find a balance in the person. A balance both from a mechanical point of view but also from a physiological point of view. Having said this, it acts both on the most bony, joint and muscular tissues but also on tissues such as fascia, visceral organs, or even more deeply at the level of the head, skull and sacrum. So there are techniques that concern the musculoskeletal system, techniques that concern the visceral system and techniques that concern what we call the craniosacral system. All this, done with mobilizations or in some cases always very targeted manipulations that go on a segment and only after having done very specific tests on all systems that can act on the problem highlighted during the anamnesis. So these techniques, which are always manual, are used to find or create a new specific balance for each person. That is, each of us has his own balance, his own status where he is more comfor

table, where he lives better, moves better and acts better. What we osteopaths have to do is understand what is the best balance for each person, then view, study, test the person, understand in a general sense the mechanics of that person and bring it back, if it is outside his scheme, in the scheme which could be functional to the person himself, which can make it work better. We are often used to living in a condition in which we find ourselves thinking that we are well. Actually, maybe we work at 50%. Often after the first treatment we perceive a state of well-being that we never had before and this makes us aware of the limitations we had previously. I often tell my patients that once an acute phase of the problem has been overcome, so if they come with back pain or with pathologies in an acute phase, it is important that during the year we can verify the maintenance of the state of equilibrium found with two or three sessions during the year. I taught for several years and, when I talked to the students, I always said: it’s like having a Formula 1 car, the car went off the track, who knows if now the performances will be the same. And one wonders: “but how is it possible, it came out for a moment, in short, there shouldn’t be all these problems”. In reality, those are perfect cars, just a little is enough to change the set-up and make it go a little slower, however, with a different performance. For the body, perhaps it is the same thing: a little is enough to make it work at 20% less than it could. This is what we are looking for. We always say that we are Formula 1 mechanics for the body and therefore we must be very precise and attentive to all the variables. This is what we try to do in our daily practice.

Question: There is also a meeting moment, I guess. Is there a moment of anamnesis?

Answer: Yes, absolutely. We need the anamnesis to understand whether there have been physical and other kinds of traumas in the patient’s past that may have contributed to triggering a series of compensations that then lead to symptoms that are apparently distant from the initial problem. For example, we can also arrive at the moment of birth which represents an element of possible trauma. This is why it becomes interesting to have the newborn visit an osteopath who will verify the presence or absence of any compressions that over the years can negatively affect the development of a correct posture or other.

Question: Compared to the patients’ narratives, how much weight can emotional and affective factors have?

Answer: Let’s say that generally a patient who approaches osteopathy does not highlight that aspect. We are the ones who, with experience and listening, understand that perhaps there is an aspect that they have not connected to the problem and then more specific questions can be asked about a possible important emotional trauma in the past. Even if initially the patients do not take it out ourselves during the anamnesis, or during the palpation with our tests, we can understand if the triggering event of the whole problem could have been an emotional event. I must emphasize that this happens very often.

Question: Can you give me a practical example of a situation of this type?

Answer: A very classic example: let’s talk about the cervical. Many people suffer from cervical. And the cervical, in my experience, has 90% emotional base. When I say cervical, I also mean cervical hernia, which is a very important pathology. Cervical hernia is the prolapse of the internal part of the disc that comes out and causes pain in the shoulder area and also in the arm. Well, I tell you that even a cervical hernia can have an emotional origin, because there was a strong emotional compression at the base. It is as if the person had been crushed by the head. So we could use the term “the thoughts that weigh on the head”. So, the example could also be those ladies who have what we call the “buffalo hump”, behind their backs, a lump that forms. These are women who carry the weight of their lives above their heads by changing their posture, their attitude, this protuberance is created, typical of women who have dedicated themselves exclusively to the family and have never thought of themselves. In fact, the question I ask is “of course she has never thought of herself, she has thought of her children, her husband, of others”, “yes it’s true, you are right”. Always like that. So actually many things that we find at the body level have an important psychological and emotional response. Lots of them.

Question: And how did you come to this profession?

Answer: So, I was born as a physiotherapist. When I graduated in physiotherapy, I felt that I was missing some information, I felt that there was something I was missing. Then I remember that I went to do a specialization course on the spine where I met a boy who was doing the school of Osteopathy and I was very fascinated by the things he said about the skull, the movement of the bones, etc., and then I inquired and actually thought that this maybe could have been the thing for me and actually it was a nice discovery. For me it was like discovering a new world. To all my colleagues who asked me at the time “how is this Osteopathy”, I said: “I have discovered a new world”.

Question: In your practice do you encounter the most frequent pathologies and problems?

Answer: So let’s say that frequently the pathologies I work with the most are back pain, herniated disc and certainly neck pain, headaches, then in reality in our profession there are many other less known pathologies that can be treated, such as hiatal hernia, reflux, or gynecological problems, in short, various pathologies that can be approached. Those on which we go most directly are all those of the musculoskeletal system, of the vertebral column. On the others you can have an excellent approach with very positive, very good effects.

Question: Do you have a specific interest in any of these diseases in particular?

Answer: The ones I deal with most frequently are all the pathologies of the spine, those without a doubt. So neck pain, back pain, sciatica, herniated disc, all of these, many headaches. These are the ones we find most frequently.

Question: I was thinking about the role of stress and physical tension. Are there any benefits that can be obtained through Osteopathy?

Answer: Let’s say that from this point of view, mechanics comes to us a little more, in the sense that when we talk about stress, emotions, we must always think that the body reacts to everything around us and everything inside. And it reacts through very specific lines which are hormones. Hormones cause there to be mechanical and physiological changes within our body. Let me give you a very simple example: in an important situation that we have before us, therefore a situation in which we have to react, we generally have two possibilities: what we call the attack reaction or the flight reaction. And this is precisely given by the stimulation we have from an emotional point of view. So, let’s take the example of the person who lives a tiring situation in the office, difficult at home: this will be subjected to stress every day. What is the reaction? That mechanically the diaphragm is positioned in a way to stimulate the adrenal glands that are above the kidneys, because the stimulated adrenal glands produce adrenaline, noradrenaline and cortisol, which are the ones that then arrive at the central level, at the pituitary gland, and give the body the urge to react. The position of the diaphragm involves the muscles that attach themselves to the cervicals by pulling them down and thus creating a cervical compression which is at the basis of the development of a whole series of pathologies related to this area. This is what happens when we fail to return the system to a state of comfort. And since this always happens in everyday life, especially in the society in which we live, all people have this blocked diaphragm and consequently brings the whole system into an impasse and in any case in difficulty and creates a vicious circle. And if I feel bad, I can no longer react to certain situations and this is a continuous one, it is a vicious circle that continues. The origin was stress, it is the negative emotions that created all of this. Clearly, in front of a patient who has this situation I have to find the right words to make him understand that some emotional situations have a strong impact on his problem. Clearly then I stop because it is no longer my field and I try to direct him to the specialist in this sector. However, it is always a somewhat delicate subject. You try to make the person understand that maybe he has to deal with those situations too with the right people. I do mechanical work, but if the person does not understand at the base that that behavioral and relational situation must also improve, it takes a bit of effort. Sometimes it is not really easy to make people understand the origin of the problem. However, the emotional relationship in our work is very frequent, so much so that there is a branch of Osteopathy called somato-emotional Osteopathy. There are these somato-emotional techniques.

Question: In this regard, it seems to me that the damage can be created by the restrained tensions, the stress that is not abreacted or in any case not processed, which somehow is blocked in the body.

Answer: Absolutely yes. In fact, in these somato-emotional techniques we also speak of energy cysts, we are looking for energy cysts. So, an accumulation of this tension, this stress, which has blocked a system. Taking into account that an important element of Osteopathy is also the vascularization of the systems. Andrew Taylor Still, the founder of Osteopathy, based everything on the artery rule, that is: if an organ, if a fascia, if a tissue is well perfused, it works well. If this spraying is not there, it works badly. Therefore, sometimes these energetic cysts block the system from the vascular point of view and therefore the pathology comes out from there.

Question: Sure. And what about the role of pain?

Answer: So, let’s say that pain from our point of view has a relative importance, in the sense that luckily we have to rely on manual tests to actually understand how much that pain is referable to the block we find. And therefore pain, in short, you know it well, is very subjective. So, we have to rely on it but relatively. I can also see a person asking nothing about the anamnesis, about pain, doing I can find painful areas of the tests. Luckily, pain is more important for the patient than for the osteopath. Then it is clear that the final result must be that the person feels well and must say that has no more pain.

Question: Of course. On the other hand, with regards to this historical moment of COVID-19, how much has it changed from working manually with physical contact on the body? How does it affect your profession?

Answer: We now use gloves, generally we don’t use gloves. Among other things, I struggle a lot because I can’t see people’s faces, because they have masks! People don’t see me in the face! In medicine in general, it is important to give reassurance or to have a serene and soothing face towards the patient; in the same way, the fact of not being able to see even the facial expressions of the patient creates a bit of difficulty, especially when they tell their story. And then we try to make people undress as little as possible so as not to get cold, in short, and I must say that this creates a technical difficulty from my point of view and also a detachment emotionally. I am very empathetic with my patients, it often happens that there is a very friendly relationship right away. I also like to hug, touch, because it is part of my way of approaching people, so since there isn’t all of this, an important element is actually missing. For me it is a very very important element. And then clearly there is the fear of people and many are not being treated and this is a big problem. But let’s hope it ends soon!

Question: Hopefully! So both communication and technique change.

Answer: Communication changes and also the approach, let’s say not so much the technique, but the sensitivity on the hand! Since we use gloves, there is a sensitivity that could be slightly altered. Some techniques try not to do them, because maybe they are too close to the mouth, on the chewing muscles. In short, there is actually a bit of difficulty for us too. Then I must say that the experience comes to me personally, so I know that I can do other things with the same result. So in the end, the experience helps a lot in this moment.

Translated from Italian by Adelina Detcheva