Osteopathy

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Osteopathy also is used as a general term to describe a disease of the bone.

Osteopathy is the body of medicine that originally used strictly manipulative techniques for correcting somatic abnormalities thought to cause disease and inhibit recovery. However, over the past century, osteopathy has embraced the full spectrum of medicine (to different degrees across the world), including the use of prescription drugs and surgery, in addition to manipulative techniques. Osteopathy or osteopathic medicine is thus both a philosophy and a set of manipulative techniques.

History

The osteopathic and chiropractic movements both started out in the United States Midwest in the 1890s and had similar philosophies; however, osteopathy came to adopt the use of medicine and surgery, whereas chiropractors continue to strictly use manipulative techniques. The original osteopathic movement is viewed today by scientists as pseudoscience or perhaps more correctly protoscience, since much osteopathic theory remains untested. Osteopathy was founded by Andrew Taylor Still, who was born in 1828 in Virginia. Although he is often referred to as a medical doctor, he never received a degree from a University. Still had been employed as an army doctor during the American Civil War in the U.S. Army, the horrors of battle field injury and the subsequent death of his wife and several children from infectious diseases left him totally disillusioned with the practice of medicine. Following this, it is apparent that Still perceived the medical practice of his day to be ineffective. At that time acceptable anaesthesia and aseptic techniques in surgery were not very advanced. Troubled by what he saw as problems with the medical profession, Still founded osteopathic practice. Using an alternative philosophical approach, he dogmatically opposed the use of drugs and surgery. Instead, he saw the human body as being metaphysically capable of curing itself through the use of manipulation techniques.In the intervening century some of the philosophies developed by Still have been found wanting, others have persisted and developed. The evidence base for osteopathic manipulation is poor and inherent methodological and epistemological problems make it difficult to falsify or prove the efficacy of these techniques. However, osteopaths are engaged in research in this area. An International Conference on Advances in Osteopathic Research (ICAOR) meeting is now in its 6th year ICAOR2006

Over time he and his followers developed a series of specialized physical treatments, for which he coined the name Osteopathy. Dr. Still founded the American School of Osteopathy (now the Kirksville College of Osteopathic Medicine) in Kirksville, Missouri, for the teaching of osteopathy, on May 10, 1892. Kirksville was one of few places where he wasn't figuratively "chased out of town" by other doctors. While the state of Missouri was willing to grant him a charter for the awarding of the M.D. degree, he remained unhappy with the practices of his peers and chose instead to grant his own D.O. degree.

In the late 1800s Still believed that diseases were caused when bones moved out of place, and disrupted the flow of blood, or the flow of nervous impulses; he therefore concluded that one could cure diseases by manipulating bones to restore the supposedly interrupted flow. His critics point out that he never ran any controlled experiments to test his hypothesis, his supporters would point out that many of Still's writings are philosophical rather than scientific in nature, full historical texts are available. Early American Manual Therapy. He wrote in his autobiography that he could

"shake a child and stop scarlet fever, croup, diphtheria, and cure whooping cough in three days by a wring of its neck." (Andrew Taylor Still, Autobiography, New York, 1972, Arno Press)

Still questioned the drug practices of his day and regarded surgery as a last resort. As medical science developed, osteopathy gradually incorporated all its theories and practices:

"Today, except for additional emphasis on musculoskeletal diagnosis and treatment, the scope of osteopathy is very similar to that of allopathic medicine. The percentage of practitioners who use osteopathic manipulative treatment (OMT) and the extent to which they use it have been falling steadily." (Source: Dubious Aspects of Osteopathy, Stephen Barrett)

In the 1960s in California, perceived differences between osteopathy and conventional medicine blurred enough that the California Medical Association and the California Osteopathic Association merged, and D.O.s were granted an M.D. degree in exchange for paying $65 and attending a short seminar. The College of Osteopathic Physicians and Surgeons became the University of California, Irvine College of Medicine. However, the decision proved quite controversial, and in 1974 the California State Supreme Court ruled that licensing of DOs in that state must be resumed.

Throughout the history of Osteopathic Medicine acceptance by traditional M.D. physicians and their institutions has been an issue. The decision by the California Medical Association in the 1960's to essentially grant D.O. physicians an M.D. license was one of two turning points for D.O.s in their struggle for acceptance, the second being the U.S. Army's decision to allow D.O.'s to enter the military as physicans. Some felt the move by the California Medical Association may have been an attempt to eliminate the osteopathic competition by converting thousands of their physicians to M.D.s. While most Californian D.O.s did take the opportunity to become M.D.s, nationally it provided the osteopathic physicans the stamp of equivalency they so desired and continue to enjoy today.

Osteopathy is currently taught at 23 different schools in the United States.

Osteopathic Principles

These eight principles of osteopathy are taken from ‘An Osteopathic Approach to Diagnosis and Treatment’ DiGiovanna & Schiowitz, a standard osteopathic text book, and are widely accepted throughout the osteopathic community. They are taken from the curriculum of the Kirksville College of Osteopathic Medicine.

(1) The Body is a Unit

(2) Structure and function are reciprocally inter-related

(3) The body possesses self-regulatory mechanisms

(4) The body has the inherent capacity to defend and repair itself

(5) When the normal adaptability is disrupted, or when environmental changes overcome the body’s capacity for self maintenance, disease may ensue

(6) The movement of body fluids is essential to the maintenance of health

(7) The nerves play a crucial part in controlling the fluids of the body

(8) There are somatic components to disease that are not only manifestations of disease but also are factors that contribute to maintenance of the disease state

These are principles not empirical laws, nor are they commandments; they are ideas that inform the osteopathic study of the basic medical sciences, they are not an alternative to orthodox medical sciences but the basis of a philosophy that informs the osteopathic approach to health and disease.

The clinical application of anatomical and physiological knowledge is central to the practice of osteopathy. An interesting discussion of the philosophy of osteopathy is given in Chapter 1; Science in the Art of Osteopathy: Osteopathic Principles & Practice by Caroline Stone.

Cranial Osteopathy

Cranial osteopathy is a contested issue within the profession; it is not known what proportion of osteopaths are practitioners. Most medical insurance companies will not re-imburse for 'cranial' treatment as it is not based on orthodox diagnostic criteria. In the USA there is at least one documented conviction of a chiropractor for falsely describing a cranial treatment regime as spinal manipulation .

So called cranial osteopaths are osteopaths that claim they are trained to feel a very subtle, rhythmical shape change that is present in all body tissues. This is known variously as the involuntary mechanism or the cranial rhythm. The movement is said to be of very small amplitude, therefore it takes practitioners with a very finely developed sense of touch to feel it. This rhythm was first described in the early 1900's by Dr. William G. Sutherland and its existence is not accepted by mainstream scientific community. The theory underlying cranio-sacral therapy is rejected by many osteopaths and most orthodox medical doctors as the cranial bones fuse by the end of adolescence and no research has ever demonstrated that manual manipulation can move the individual bones. The brain does pulsate, but this is thought to be exclusively related to the cardiovascular system . Several studies have looked at inter-operator reproducibility of diagnostic findings when working with the 'cranial rhythm' and found there to be little agreement

How this mechanism is related to health / disease is not established, neither is the relationship between holding the head and re-establishing health. Many dismiss cranial osteopathy as pseudoscience. Moreover, cranial osteopathy is often marketed as being especially suitable for new born babies and young children. All in all, this practice appears to be popular with patients and this may be a significant factor for osteopaths embracing it. Cranio-sacral therapy is based on the same principles but the practitioners are not qualified osteopaths. Chiropractic has developed similar techniques known as sacro - occipital therapy (SOT) or craniopathy.

Musculo-skeletal techniques

There are different techniques applied to the musculo-skeletal framework. These techniques can be applied to:

1. the joints (using High Velocity Technique, mobilisation, etc )

2. their surrounding soft tissues (using functional and soft tissue techniques, etc)

3. the muscles

4. the fascia

When combined, for example in the case of a sprain, these forms of treatment allow the therapist to restore the normal contact within the joint and with other structures. This eliminates muscular spasms and tensions in the ligaments, thereby restoring complete mobility to the joint.

Visceral Osteopathy

Visceral Osteopathy : Internal organs

(digestive tract, respiratory system, etc)

The visceral system relies on the interconnected synchronicity between the motions of all the organs and structures of the body. At optimal health, this harmonious relationship remains stable despite the body's endless varieties of motion.

What is Visceral Osteopathy? Visceral Osteopathy relieves imbalances and restrictions in the interconnections between the motions of all the organs and structures of the body. Jean-Piere Barral RPT, DO built on the pioneering work of Andrew Taylor Still DO and William Garner Sutherland DO, to create this method of detailed assessment and highly specific manipulation.

See drawings An example how the colon may affect the knee joint

Pelvic Organ Support Ligaments

How Pericardium Strains Can Affect The Neck

How Pleural Dome Suspension Affects The Neck

Visceral Osteopathy is Useful For : . Swallowing difficulties . Digestive problems . Headaches . Incontinence . Back and neck pain . Shoulder and hip pain . Carpal tunnel and other repetitive strain injuries . Whiplash and other physical trauma . And many other conditions

Doctors of Osteopathic Medicine in the USA today

Today in the USA, an osteopathic physician is sometimes described as a physician who, while practicing conventional medicine much like his or her M.D. colleagues, also maintains the ability to perform osteopathic manipulative medicine (OMM) (aka osteopathic manipulative techniques (OMT)). OMM is a method of touch and manipulation performed on the musculo-skeletal system to restore balance and symmetry to the individual. In a sense, the OMM practitioner is a combination of Physician, Physical Therapist, and chiropractor.

A doctor of osteopathic medicine will follow his or her name with the initials D.O., in much the same way as a Medical Doctor follows his or her name with the initials M.D. Medical students for both D.O. and M.D. programs follow essentially the same set of studies, some schools even offering both M.D. and D.O. degrees (e.g. Michigan State University), however, osteopathic students receive additional training in palpatory diagnosis and manipulative (manual) medicine. While the osteopathic community has a strong commitment to primary care, osteopathic physicians can be found in any of the subspecialties. From surgery and anesthesia to emergency and family practice, osteopathic physicians can be found practicing in all fields of medicine, and are fully-licensed physicians in all fifty of the United States.

The scientific merit of manipulative medicine continues to be a point of controversy. The American Osteopathic Association has made an effort in recent years to both support and promote scientific inquiry into the effectiveness of osteopathic manipulation as well as encourage D.O.s to offer manipulative treatments to their patients. Only a minority of D.O.s incorporate osteopathic manipulative medicine into their daily practices, a trend the AOA is working hard to reverse.

Osteopathy in the UK, Australia, Canada & NZ

Outside of the United States, osteopathy varies heavily in its acceptance of modern medicine. In some places, the original teachings of Andrew Still are practiced. In others, it is closer to modern medicine. Nowhere else is it as closely integrated as in the US. Osteopathy was intended by its founder to be a reform movement of medical practice, the orthodox medical profession was more successful in other countries at preventing the establishment and development of the osteopathic profession than in the USA. Until recently osteopathy was practiced primarily in the English speaking world.

In the United Kingdom osteopathy developed as a distinct profession. The first osteopathic college was established in the UK in 1917 by a Scottish man, Littlejohn, who had studied under Dr Andrew Taylor Still. Littlejohn altered the osteopathic curriculum to include the study of physiology, the school he founded in the UK, the British School of Osteopathy was the first osteopathic education institution outside the USA and it still exists today . British osteopaths use manipulative techniques based on the philosophy of Dr Andrew Taylor-Still, but are not medical doctors, although some medical doctors undertake osteopathic training as a postgraduate interest. The profession is subject to statutory regulation following the passing of the Osteopathy Act in 1993. The General Osteopathic Council (GOsC) was established by the Act to regulate the profession, to protect the public by maintaining a register of practitioners, investigating allegations of professional misconduct and ensuring the quality of training is adequate. Since 2001, there has been graduate only entry to the register. There are 7 approved training institutions in the UK. There are approximatley 5000 registered osteopaths in the UK, a small but growing profession, for the sake of comparison there are approx 36,000 physiotherapists. Most medical services in the UK are delivered through the state funded National Health Service, osteopathy is largely excluded from this with most osteopaths working in private practice. Several large studies in the UK have produced evidence of the cost-effectiveness and clinical effectiveness of manipulation in the management of low back pain, the latest being the UK Back pain Exercise And Manipulation (UK BEAM) trial, , . There is an increasing interest in osteopathy amongst patients, barriers remain though to osteopathic provision within the state system; not the least being hostility from the orthodox medical profession and physiotherapists. Many UK osteopaths are also naturopaths, with one osteopathic college offering a dual training in osteopathy & naturopathy (the British College of Osteopathic Medicine) and another offering a post-graduate programme (the College of Osteopaths).

In Australia and New Zealand the profession has developed along the same lines, until recently neither country trained its own practitioners and relied on migrants from the UK. Likewise, each country maintains a state approved list of practitioners and health insurance reimbursement is available for osteopathic treatment. In Canada osteopaths are trained along similar lines to those in Britain and other Commonwealth Realm countries, although US trained osteopathic physicians may also practice there. .

In all four countries osteopathy is on the boundary between orthodox and complementary / alternative medicine, with a great variety of approaches and philosophies being brought to the practice. The model of osteopathy employed is essentially a drug free system of manual therapy. Osteopaths are trained in standard medical differential diagnosis and have diagnostic competencies similar to primary care physicians, but with a scope of practice limited mainly to musculoskeletal conditions. Osteopaths in all four countries do not have prescribing rights, although the UK Government has included osteopathy in the list of professions allied to medicine that may be granted prescribing rights in the future. Unless separately qualified as a medical doctor or holders of a doctorate degree, osteopaths in Australia, New Zealand or the UK do not use the honorific title of Dr. This is contested by some osteopaths and there is a campaign to use the title Dr. There is a debate on what differentiates an osteopath from a chiropractor from a physiotherapist in these countries, rather than the DO / MD debate in the USA.

Osteopathy in the European Union

Within the European Union there is no standardised training or regulatory framework for the profession, although attempts are being made to co-ordinate the profession within the EU. At present there is a conflict between the principle of free movement of labour and right to practice osteopathy in different member states as there is little equivalency in training and regulation of the profession. Previously the practice of spinal manipulation by non-medically qualified practitioners was outlawed in many European countries. This lead to the arrest and imprisonment of the osteopathic faculty in France in the 1960s, who on their release then sought refuge in the UK and established the European School of Osteopathy. The General Osteopathic Council, the UK osteopathic regulatory body, has issued a position paper on pan-European regulation of the profession. However, Formation in osteopathy is built up in very few states : England, France and Switzerland are the only one to already have a solid, well-shaped conception of the osteopathy they wish to defend. In the other states, osteopathy is studied in rare schools.

Misplaced Pages

History

Osteopathic Principles

Cranial Osteopathy

Musculo-skeletal techniques

Visceral Osteopathy

Doctors of Osteopathic Medicine in the USA today

Osteopathy in the UK, Australia, Canada & NZ

Osteopathy in the European Union

See also

Further reading

External links

Canadian College of Osteopathy

USA Osteopathic schools

Applying to Osteopathic Schools in the USA

UK Osteopathic schools

NZ Osteopathic school

Osteopathic Associations & Regulatory Bodies

Other links