Form and function

One of the specifics of manual medicine is the fact that it deals with (dys-)function. First the functional disorders of the patient are analyzed, then the individual’s functional equilibrium is re-established as well as possible. Lewit remarked rather dryly ‘the central nervous system only knows about function, not about structure’ 1 and added ‘The clinical picture correlates better with the changes in function than with the structural pathology. Very frequently indeed, pathological changes do not manifest themselves so long as function is not impaired.’ The stage is thus set for a closer look at the interaction between these two phenomena. The term ‘form follows function’ was popularized by Buckminster Fuller and is traceable via Louis Sullivan back to the Roman architect, Vitruvius. All three meant it as a motto to build and design with function as the paramount consideration, a call to delete unnecessary embellishments. This paradigm was ‘exported’ to other venues, not the least of which was biology. On the phylogenetic level ‘form follows function’ certainly holds true for the human body, too. Our morphology is the result of evolutionary pressures exerted by the environment we are obliged to function within. The most efficient design generally trumps all else in this developmental picture. But: Is this rule true for ontogenetic development as well? Humans are born completely helpless and ‘physiologically immature,’ comprising immunology, metabolism and – last, but not least – the musculoskeletal system. This ‘unripe’ organism reacts and adapts more intensely to external stimuli, rendering the first months of life more important for the eventual shape of the individual than all the years that follow. The forming influence of the months around birth and the consequences of disturbances seen decades later are well documented. 2