osteopathy

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Definition

Osteopathy is a system and philosophy of health care that separated from traditional (allopathic) medical practice about a century ago. It places emphasis on the musculoskeletal system, hence the name—osteo refers to bone and path refers to disease. Osteopaths also believe strongly in the healing power of the body and do their best to facilitate that strength. During this century, the disciplines of osteopathy and allopathic medicine have been converging.

Description

Osteopathy was founded in the 1890s by Dr. Andrew Taylor, who believed that the musculoskeletal system was central to health. The primacy of the musculoskeletal system is also fundamental to chiropractic, a related health discipline. The original theory behind both approaches presumed that energy flowing through the nervous system is influenced by the supporting structure that encase and protect it—the skull and vertebral column. A defect in the musculoskeletal system was believed to alter the flow of this energy and cause disease. Correcting the defect cured the disease. Defects were thought to be misalignments—parts out of place by tiny distances. Treating misalignments became a matter of restoring the parts to their natural arrangement by adjusting them.

As medical science advanced, defining causes of disease and discovering cures, schools of osteopathy adopted modern science, incorporated it into their curriculum, and redefined their original theory of disease in light of these discoveries. Near the middle of the 20th century the equivalance of medical education between osteopathy and allopathic medicine was recognized, and the D.O. degree (Doctor of Osteopathy) was granted official parity with the M.D. (Doctor of Medicine) degree. Physicians could adopt either set of initials.

However, osteopaths have continued their emphasis on the musculoskeletal system and their traditional focus on "whole person" medicine. As of 1998, osteopaths constitute 5.5% of American physicians, approximately 45,000. They provide 100 million patient visits a year. From its origins in the United States, osteopathy has spread to countries all over the world.

Osteopaths, chiropractors, and physical therapists are the experts in manipulations (adjustments). The place of manipulation in medical care is far from settled, but millions of patients find relief from it. Particularly backs, but also necks, command most of the attention of the musculoskeletal community. This community includes orthopedic surgeons, osteopaths, general and family physicians, orthopedic physicians, chiropractors, physical therapists, massage therapists, specialists in orthotics and prosthetics, and even some dentists and podiatrists. Many types of headaches also originate in the musculoskeletal system. Studies comparing different methods of treating musculoskeletal back, head, and neck pain have not reached a consensus, in spite of the huge numbers of people that suffer from it.

The theory behind manipulation focuses on joints, mostly those of the vertebrae and ribs. Some believe there is a very slight offset of the joint members—a subluxation. Others believe there is a vacuum lock of the joint surfaces, similar to two suction cups stuck together. Such a condition would squeeze joint lubricant out and produce abrasion of the joint surfaces with movement. Another theory focuses on weakness of the ligaments that support the joint, allowing it freedom to get into trouble. Everyone agrees that the result produces pain, that pain produces muscle spasms and cramps, which further aggravates the pain.

Some, but not all, practitioners in this field believe that the skull bones can also be manipulated. The skull is, in fact, several bones that are all moveable in infants. Whether they can be moved in adults is controversial. Other practitioners manipulate peripheral joints to relieve arthritis and similar afflictions.

Manipulation returns the joint to its normal configuration. There are several approaches. Techniques vary among practitioners more than between disciplines. Muscle relaxation of some degree is often required for the manipulation to be successful. This can be done with heat or medication. Muscles can also be induced to relax by gentle but persistent stretching. The manipulation is most often done by a short, fast motion called a thrust, precisely in the right direction. A satisfying "pop" is evidence of success. Others prefer steady force until relaxation permits movement.

Return of the joint to its normal status may be only the first step in treating these disorders. There is a reason for the initial event. It may be a fall, a stumble, or a mild impact, in which case the manipulation is a cure. On the other hand, there may be a postural misalignment (such as a short leg), a limp, or a stretched ligament that permits the joint to slip back into dysfunction. Tension, as well as pain, for emotional reasons causes muscles to tighten. If the pain has been present for any length of time, there will also be muscle deterioration. The osteopathic approach to the whole person takes all these factors into account in returning the patient to a state of health.

Other repairs may be needed. A short leg is thought by some to be a subluxation in the pelvis that may be manipulated back into position. Other short legs may require a lift in one shoe. Long-standing pain requires additional methods of physical therapy to rehabilitate muscles, correct posture, and extinguish habits that arose to compensate for the pain. Medications that relieve muscle spasm and pain are usually part of the treatment. Psychological problems may need attention and medication.

— J. Ricker Polsdorfer, MD

A system of medicine based on the theory that disturbances in the musculoskeletal system affect other bodily parts, causing many disorders that can be corrected by various manipulative techniques in conjunction with conventional medical, surgical, pharmacological, and other therapeutic procedures.

Osteopathy first developed from the 1870s onwards in America, under the initial inspiration and guidance of Andrew Taylor Still (1828-1917), who claimed to have discovered a revolutionary new system of healing and an associated therapeutic philosophy. These were based upon two related principal elements; that the healthy body already contained all the relevant capacities for maintaining itself, and that it thus did not need the drug-based remedies of the day. These views at that time were not original, but they were combined with Still's description of ‘osteopathic lesions’. These lesions, unless treated through his system of manual manipulation, were said to disturb the necessary internal balances of the body. Their occurrence became the controversial cornerstone of a distinctive osteopathic pathology. They were thought to be morbid alterations in tissue: muscular, osseous, visceral, ligamentous, or a combination of some or all of those in individual cases. In particular, osteopathic lesions were linked to inadequate articulation of the various parts of the musculo-skeletal system, particularly regarding the condition of the spinal vertebrae. In Still's view, improper articulation produced a disposition to various types of disease, by affecting the neurological system and the circulation of blood and body fluids which were essential to good health.

The social context of the latter decades of nineteenth-century rural America provided a supportive background for Still's beliefs and his related therapeutic evangelism. He was an ‘untrained’ medical practitioner by modern standards, but, as was common in his day, learnt medicine through apprenticeship to his father. He was in practice for many years in Missouri before becoming increasingly interested in bone setting in the 1870s in Kirksville. This was an ancient craft, and the prevailing medical ridicule of it had recently been brought into question. The distinguished London surgeon, Sir James Paget, had published an article, ‘On the Cases that Bone Setters Cure’ in the British Medical Journal. This was followed by Wharton Hood's book On Bone Setting (1871), published in Britain and America. Hood, a general practitioner, was interested in the movements of flexion and extension, combined with external pressure, used by bone setters for back injuries. As Gevitz, a noted historian of osteopathy, points out, at that time Still may have picked up and refined elements of practice which existed in his environment. At this historical point many of the more drastic drug and surgical remedies of conventional doctors did not inspire public confidence, and Still with his ‘new’ methods worked within a tradition of bone setting which was at least familiar to his rural patients. His mechanical theory of health and disease, of aligned and misaligned parts, akin almost to malfunctions of farm machinery, dovetailed nicely with the cultural beliefs of Still's patients.

However, this period was only the starting point of osteopathy's subsequent growth as a rival and different system of practice to medicine in the twentieth century. Still founded a school in 1892 in Kirkville, Missouri, and from this a small group of graduates went on in 1911 to found the British Osteopathy Association. In both countries decades of medical professional opposition to osteopathy followed, but these disagreements had very different outcomes in the two countries, both for medicine and for osteopathy. In the American case, conflict has led eventually to a kind of integration: a movement by practitioners from their initial adherence to Still's beliefs to broadly accepting those of orthodox medicine. Indeed, by the turn of the century the first osteopathic colleges were already teaching some of the medical pharmacopoeia of the day, and gradually pharmacology was brought into osteopathic education and practice. By the 1960s all restrictions on osteopathy as a one-time marginal cult were disappearing, leading to eligibility for medical residencies, and appointment to hospital medical staffs and to positions in the military and public health services. In this gradual process of absorbing and sharing of notions of scientific practice with orthodox medical practitioners, American osteopathic practitioners made manipulation a part rather than the core of their practice.

In Britain and its Commonwealth, professional developments between the two groups have been somewhat different, reflecting in turn their varying social and legal contexts. In Britain osteopaths sought in the 1920s and 30s to secure from the Government the right to practise as independent but different medical practitioners. Eventually this pressure led in 1935 to a Parliamentary Select Committee enquiry into their case, conducted adversarially between two different systems of philosophy and treatment. Eight hundred leading allopathic medical and biological scientists asserted that osteopathy disputed the very basis of modern medical and surgical practice, and that in particular osteopathic lesions could not be affirmed by any objective scientific scrutiny. The osteopaths were not successful in their case for licensing or state registration. Thus they practised under marginalized conditions outside of the National Health Service for forty years after its inception in 1948. By the early 1990s, however, much had changed. Osteopaths had practised successfully for decades as private practitioners; back problems were a major cause of absence from work and were recalcitrant to conventional treatments, and furthermore medical and public attitudes had changed. British osteopaths now presented themselves as complementary practitioners specializing in biomechanics and the manipulation of the musculo-skeletal system. Although extensively trained in basic medical sciences, they did not claim the wider competence of conventionally trained doctors regarding treatment as in earlier decades. In 1993 osteopaths in Britain gained state registration and formal recognition, not so much as an adjusted part of medicine as in America, but as skilled colleagues, akin to physiotherapists, specializing in rather than diminishing the role of manipulation in the treatments they offered.

— Gerry Larkin

Bibliography

• Gevitz, N. (1982). The D. O.'s: osteopathic medicine in America. John Hopkins University Press, Baltimore.
• Wardell, W. (1994). Alternative medicine in the United States. Social Science and Medicine, 38 (8), 1061-8

Definition

Osteopathy is a "whole person" philosophy of medicine, where doctors of osteopathic medicine (DOs) endorse an approach that treats the entire person, rather than a specific complaint. Attention is given to prevention, wellness, and helping the body to heal itself. Because the body is viewed as a single organism or unit, special focus is given to understanding body mechanics and the interrelationship of the body's organs and systems. A particular emphasis is placed on the musculoskeletal system. Dos may utilize physical manipulation of muscles and bones in conjunction with, or as an alternative to, conventional treatments, drug therapies, and surgery to provide complete health care.

Origins

Dr. Andrew Still developed the osteopathic approach to medicine. Still, whose father was a Methodist minister and physician, was himself a medical doctor who served as a Union surgeon during the Civil War. After the war, personal tragedy struck the Still household when three of his children died from spinal meningitis. This event angered and disillusioned him. He became dissatisfied with the state of medical knowledge and treatments available at that time. Consequently, he began an intense study of the human body to find underlying causes and cures for ailments.

Still gave great attention to anatomy. He recognized the importance of the musculoskeletal system, the body's ability for self-healing, and focused on prevention and the concept of "wellness." In an era when drug treatment was frequently dangerous and overused, and surgery often fatal, Still was able to develop alternative treatments. For example, by manipulating the ribs and spine, Still provided treatments for pneumonia. He gave attention to the lymphatic system (which filters foreign matter and removes excess fluids, proteins, and waste products from the tissues and transports them to the blood to be circulated and eliminated) and manipulating the fascia (connective tissue that is tough, but thin and elastic; it forms an uninterrupted three-dimensional network from head to foot, sheathing every muscle, bone, nerve, gland, organ, and blood vessel), allowing him to address a range of other ailments.

Still's sons learned his philosophies and techniques, but demand overwhelmed their ability to supply care. In 1892, Still founded the first college of osteopathic medicine, the American School of Osteopathy, in Kirksville, Missouri. When he died in 1917, there were more than 5,000 practicing osteopaths in the United States. Today, osteopaths are the fastest growing segment of the total population of physicians and surgeons in the United States. In 2002, there were more than 49,000 doctors of osteopathy. Osteopathy has spread outside of the United States and is now practiced in countries throughout the world.

Benefits

The osteopathic focus on prevention and wellness may help individuals to avoid illness by teaching healthy behaviors and encouraging health-promoting lifestyle changes. In addition to conventional treatments, drugs, and surgeries, DOs may offer manipulative therapies not available from their allopathic counterparts MDs). Many people seek care from an osteopath for back or neck pains, joint pains, or injuries. However, DOs may use manipulative therapies to treat a variety of ailments and conditions including arthritis, allergies, asthma, dizziness, carpal tunnel syndrome, menstrual pain, migraine headaches, sciatica, sinusitis, tinnitus (ringing in the ears), and problems in the jaw joints. Manipulative therapies may be incorporated into the treatment plan to speed recovery from various conditions, such as heart attack or disc surgery, and to address pediatric concerns, such as otitis media (ear infection) and birth traumas. Various manipulative therapies may also be appropriate in alleviating discomforts associated with pregnancy, for example, back pain or digestive problems. Some osteopaths even feel that regular osteopathic treatments may help minimize the effects of aging on the spine and joints. Also, as noted by the American Osteopathic Association (AOA), the field of sports medicine has found particular benefit in osteopathic practitioners because of their emphasis on "the musculoskeletal system, manipulation, diet, exercise, and fitness. Many professional sports team physicians, Olympic physicians, and personal sports medicine physicians are DOs."

Description

Osteopathic medicine considers the human body to be a complex unit of interrelated parts, a unified organism. Organs and systems do not function independently and should not be treated as such. A disturbance in one part of the body affects the entire body. Illness is also impacted by many variables, such as emotions, stress, lifestyle, and environment. Therefore, illness must be addressed by taking a whole person approach to treatment. Because the body is seen as self-regulating and self-healing, the osteopath gives special attention to illness prevention and helping the body maintain or re-establish wellness.

The nervous and circulatory systems play crucial roles in maintaining the functioning of the body's organs and systems; negative body-wide effects may occur when these two major systems are not functioning optimally. Relieving blocked blood flow or nerve impulses will help the body to heal itself by promoting blood flow through affected tissues. The blood supply will be better able to deliver vital nutrients and boost the immune system, the nerve supply to the area will be improved, and systemic balance can be restored.

The musculoskeletal system is key in this effort to achieve and maintain systemic balance and health. The musculoskeletal system is comprised of the bones, tendons, muscles, tissues, nerves, and spinal column. As the body's largest system, it encompasses over 60% of body mass and can suffer mechanical disorders or amplify illness processes anywhere in the body. Therefore, structural evaluation and attention to the musculoskeletal system is central to osteopathy.

In addition to conventional care such as drug therapies and surgery, osteopaths may use a variety of manipulative procedures to help the body systems function at peak levels. These techniques are commonly referred to as Osteopathic Manipulative Treatment (OMT). OMT is a form of noninvasive, "hands-on" care used for prevention, diagnosis, and treatment to reduce pain and restore motion, as well as help the body heal itself. OMT may be used to facilitate the movement of body fluids and normal tissue functioning, and release painful joints or dysfunctional areas. These therapies take different forms depending on patient needs.

In addition to easing the pain of physical disorders, OMT appears to be helpful in some psychiatric conditions as well. A recent study performed at the College of Osteopathic Medicine in Downers Grove, IL, found that OMT as an adjunct to psychotherapy alleviated the symptoms of depression in women, as measured by the Zung Depression Scale, a standard diagnostic instrument.

Manipulative procedures may be categorized and discussed in a variety of ways. According to the American Association of Colleges of Osteopathic Medicine, the following groupings encompass some of the most commonly used procedures. Descriptions are compiled from the American Academy of Osteopathy, Leon Chaitow, N.D., DO, and others.

• Articulatory techniques. Procedures that move joints through their range of motion (articulating the joints) may be used to restore normal functioning.
• Counterstrain. This type of therapy is used to alleviate trigger points localized areas of hyperirritability in the muscles). The procedure involves first finding a body position that relieves the patient's pain. Through a process in which the patient and practitioner repeatedly use coordinated techniques of pushing (or compression), relaxing, and changing position, the trigger point is eased.
• Cranial treatment. Cranial treatments focus on the craniosacral system which consists of the brain, spinal cord, cerebrospinal fluid, dura (the membrane covering the brain and spinal cord), cranial bones, and the sacrum (triangular bone comprised of five fused vertebrae, and forming posterior section of the pelvis). Craniosacral release is a gentle technique that focuses on normalizing imbalances in the natural rhythms of this system. A light touch is used to detect and release restrictions in the system and encourage the body's own healing processes. Craniosacral therapies arose from the work of Dr. William Sutherland, a DO who developed and explored the concept that the bones of the skull allowed movement and could be manipulated to improve the system's rhythmic movements. Some DOs choose to specialize in cranial osteopathy. Craniosacral therapy is also practiced by a wide variety of health care professionals. As listed by the Upledger Institute, these practitioners include MDs, chiropractors, doctors of Oriental medicine, naturopaths, nurses, psychiatric specialists, psychologists, dentists, physical therapists, occupational therapists, acupuncturists, massage therapists, and other professional bodyworkers.
• Myofascial release treatment. Various direct or indirect treatments are applied to release fascia tissues.
• Lymphatic techniques. These techniques focus on improving lymphatic circulation, improving the ability of the lymphatic system to do its job of waste removal.
• Soft tissue techniques. Applied to tissue other than bone, these techniques use varying pressure and may stretch, roll, or knead, resulting in the relaxation or release of tissues.
• Thrust techniques. A quick, sharp thrust (which is often described as high velocity/low amplitude) to the area requiring treatment is used to force a correction, restoring normal joint function and movement. This is similar to chiropractic adjustment.

Precautions

DOs use the full range of conventional diagnostic techniques, drug therapies, treatments, and surgical interventions available to MDs. If deemed appropriate by the DO, OMT may be employed in addition to these conventional diagnoses, and treatments or may serve as an alternative to drug therapies. During the course of treatment, manipulative therapies may be interrupted or stopped if complications occur—for example, a rise in blood pressure. In some situations, the osteopath may determine that no further benefit will be gained from continuing manipulative treatment. Manipulation should not be applied in several medical conditions. As listed by Chris Belshaw, these conditions are mainly "acute infections; fractures; bone disease; cancer; gross structural deformities; such severe general medical conditions as gross high blood pressure or heart attack; vascular disease, for example, thrombosis; neurological conditions with nerve damage; spinal cord damage; and severe prolapse of an intervertebral disc." Additionally, as in any area of medicine, there is the possibility of mistaken diagnosis. Patients should always discuss all medical conditions, treatments, questions, and concerns with their physicians.

Side Effects

Some patients, as noted by Belshaw, may experience mild headaches following neck treatments or discomfort after back manipulation. Some flushing and bruising may appear on those with sensitive skin. These reactions may last for several hours. Such symptoms may recur as treatment continues. Symptoms may return if treatment is stopped too soon.

Research & General Acceptance

Research has shown the benefits of osteopathic care in a range of ailments and through improved recovery times. In addition to many of the conditions discussed above, the American Osteopathic Healthcare Association reports ongoing research on patient recovery times, length of hospital stays, chronic pain, chlamydia infection in women, reduction of deep vein thrombosis, and fall prevention for the elderly. Osteopathic colleges have increased their attention to biomedical research opportunities for students and those who desire to pursue research careers. The AOA Board of Research encourages and supports development of scientific research in the osteopathic medical profession. The AOA has also conducted several campaigns to educate the public on osteopathy. In 2000, the AOA started a Women's Health Initiative, a three-year campaign to promote women's healthcare among osteopathic physicians and the public.

Training & Certification

Training and certification for DOs exceed those of chiropractors and physical therapists, two groups to which their manipulative techniques are sometimes compared. Chiropractic training focuses on spinal manipulation only. Chiropractors typically have fewer years and types of required postgraduate training, and are more limited legally in their practice. DOs also have training and licensing well beyond that of physical therapists.

Osteopathic physicians, like their allopathic physician counterparts, are complete physicians. This means they are trained and licensed to prescribe medication and perform surgery, and qualified to render complete healthcare. DOs are fully licensed in all 50 states and the District of Columbia, to serve in the military medical corps, Veterans Administration, and Public Health Service, and are recognized by the American Medical Association as physicians. They hold the same practice rights as MDs, have passed the same or similar state licensing examinations, and practice in fully accredited hospitals. DOs can practice in all branches of medicine and surgery, and can specialize in any area, but the majority are primary care physicians.

As of spring 2002, the AOA lists 20 AOA-accredited colleges of osteopathic medicine. Training for DOs and MDs parallel in many ways. Osteopathic colleges, like medical schools, offer a basic, comprehensive four-year medical education. Added to this curriculum are the osteopathic philosophies and a holistic care emphasis on prevention and community care. In addition to stressing the inter-relatedness of body organs and systems, students of osteopathy are taught to consider the whole person, including lifestyle, emotional factors, and environmental factors. Training also focuses on the musculoskeletal system and manual medicine. Manipulative therapies are taught for prevention, diagnosis, and treatment, and the osteopathic principle of helping the body toward good health.

After graduation from the four-year curriculum, DOs complete a one-year rotating internship, followed by several years in a residency program, if a specialty is desired. The areas covered during the internship period ensure that each DO is first trained as a primary care physician. Over half of all DOs are primary care physicians. Conversely, MDs are more likely to be specialists.

After the formal education process, the AOA requires members to earn continuing medical education (CME) credits every three years. To further enhance postgraduate medical education, the AOA has implemented the concept of Osteopathic Postdoctoral Training Institutions (OPTIs), which reflect the osteopathic emphasis on community care. These OPTIs are community-based consortia that include at least one hospital and college of osteopathic medicine. The intention of these is to promote institutional collaboration and enhance training opportunities that reflect the settings in which many osteopaths will practice. In early 2002, a new Osteopathic Research Center opened at the University of North Texas Health Science Center in Fort Worth. The new Research Center is the result of collaboration among the American Colleges of Osteopathic Medicine, the American Osteopathic Foundation, and the American Osteopathic Association.

Many aspects of traditional osteopathic philosophy, such as advice about diet and smoking, have entered mainstream medicine to the point that the lines between DOs and MDs are blurring. In addition, the dedication of osteopaths to holistic medicine and primary care has been a great benefit to rural areas of the United States that are often underserved by mainstream practitioners.

Resources

Periodicals

"Osteopathic Manipulative Treatment May Benefit Patients." Health & Medicine Week (October 8, 2001).

Patrick, Stephanie. "Fort Worth Chosen for Osteopathic Center." Dallas Business Journal 25 (October 26, 2001): 10.

Shepard, Scott. "Health Philosophies on Common Ground." Cincinnati Business Courier 18 (November 9, 2001): 38.

Organizations

American Association of Colleges of Osteopathic Medicine. 5550 Friendship Blvd., Suite 310, Chevy Chase, MD 20815-7231. (301) 968-4100. .

American Osteopathic Association. 142 E. Ontario Chicago, IL 6061. (800) 621-1773. info@aoa-net.org. .

The Upledger Institute, Inc. 11211 Prosperity Farms Road, D-325, Palm Beach Gardens, FL 33410-3487. Educational services: (800) 233-5880. Administration: (561) 622-4334. Fax: (561) 622&-4771. upledger@upledger.com. .

Other

HealthWorld Online. "Osteopathy." [cited October 2002]. .

The Osteopathic Homepage. .

[Article by: Rebecca J. Frey, PhD]

For more information on osteopathy, visit Britannica.com.

Osteopathy is a system of medicine in which the structure and functions of the body are given equal importance and advocates the body's natural ability to heal itself under the right conditions. Focusing on the "rule of artery," osteopaths manipulate body joints in an effort to improve circulation. The frontier physician Andrew Taylor Still (1828–1917) developed the system in 1874 while living in Kansas. As Still's system of treatment evolved, he attempted to present his methods to the faculty of Baker University in Kansas but was turned away. Without the support of the medical community or any patients, Still made his living as an itinerant doctor until his popularity grew enough for him to establish an infirmary. He settled in Kirksville, Missouri, in 1889. Just three years later, Still opened the American School of Osteopathy (later renamed Kirksville College of Osteopathic Medicine); the school was chartered a year later. The first graduating class of seventeen men and five women studied under Still, his sons, and other doctors. Dr. James Littlejohn and Dr. William Smith—Smith, the first to be awarded the Doctor of Osteopathy (D.O.) degree, from Scotland—played important roles in the growth of the school and popularity of osteopathy. In 1897, the American Association for the Advancement of Osteopathy, later called the American Osteopathy Association, and the Associated Colleges of Osteopathy were formed. Once organized into professional associations, osteopaths began to formalize educational and professional standards. In 1905, a three-year course of study was developed; in 1915, the course was increased to four years. As the profession grew, it received recognition from governmental departments as well as the Department of Defense, which granted officer rank to osteopathic doctor volunteers. By the close of the 1970s, Doctors of Osteopathy held full practice rights in all fifty states. In 1982, more than twenty thousand doctors of osteopathy were practicing in the United States.

Bibliography

Wardwell, Walter I. Chiropractic: History and Evolution of a New Profession. St. Louis, Mo.: Mosby-Year Book, 1992.

A system of medicine that stresses healing through the manipulation of body parts while also using many standard medical practices, such as surgery or drugs.

1. any disease of a bone.
2. a system of therapy utilizing generally accepted physical, medicinal and surgical methods of diagnosis and therapy, and emphasizing the importance of normal body mechanics and manipulative methods of detecting and correcting faulty structures.

• hypertrophic o. (HOA) — symmetrical periosteal proliferation of new bone on the four limbs, chiefly localized to the phalanges and terminal epiphyses of the long bones, almost always associated with a chronic intrathoracic, occasionally an intra-abdominal, disease particularly a neoplasm. Called also Marie–Bamberger's disease (osteopathy), hypertrophic pulmonary osteopathy, secondary hypertrophic osteopathy.
• metaphyseal o. — see hypertrophic osteodystrophy.
• nutritional o. — includes rickets, osteomalacia, osteodystrophia fibrosa.

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Alternative medical systems

Acupuncture • Anthroposophic medicine • Ayurveda • Chiropractic • Herbalism • Homeopathy • Naturopathy • Osteopathy • Traditional medicine (Chinese • Tibetan)
NCCAM classifications
Whole medical systems • Mind-body interventions • Biologically based therapies • Manipulative therapy • Energy therapies
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Osteopathy is an approach to healthcare that emphasizes the role of the musculoskeletal system in health and disease. It is practised in the United Kingdom, the rest of the European Union, Israel, Canada, and Australia. Osteopathy is not to be confused with the historically related but now distinct field, osteopathic medicine in the United States.^[1]

In most countries, osteopathy is a form of complementary medicine, emphasizing a holistic approach and the skilled use of a range of manual and physical treatment interventions in the prevention and treatment of disease. In practice, this most commonly relates to musculoskeletal problems such as back and neck pain. Osteopathic principles teach that treatment of the musculoskeletal system (bones, muscles and joints) facilitates the recuperative powers of the body.

Contents 1 History 2 Osteopathic principles 3 Techniques of Osteopathic Treatment 3.1 Scope of manual therapies 3.2 Cranial osteopathy 3.3 Visceral osteopathy 4 Osteopathy around the world 4.1 United States 4.2 United Kingdom 4.3 Australia & New Zealand 4.4 Canada 4.5 Israel 4.6 European Union 5 Criticism 6 See also 7 References 8 Further reading

History

See also: Andrew Taylor Still#Osteopathy

The practice of osteopathy began in the United States in 1874. The term "osteopathy" was coined by Andrew Taylor Still. Still was a free state leader who lived near Baldwin City, Kansas at the time of the American Civil War, and it was here he developed the practice of osteopathy.^[2]

Still named his new school of medicine "osteopathy," reasoning that "the bone, osteon, was the starting point from which [he] was to ascertain the cause of pathological conditions."^[3] Still founded the American School of Osteopathy (now A.T. Still University) in Kirksville, Missouri, for the teaching of osteopathy on May 10, 1892. While the state of Missouri, recognizing the equivalency of the curriculum, was willing to grant him a charter for awarding the MD degree, he remained dissatisfied with the limitations of conventional medicine and instead chose to retain the distinction of the DO degree.^[4]

Osteopathic principles

These are the eight major principles of osteopathy and are widely taught throughout the international osteopathic community. ^[5]

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 principles are not held by osteopathic physicians to be empirical laws; they are thought to be the underpinnings of the osteopathic philosophy on health and disease.

Techniques of Osteopathic Treatment

Main article: Osteopathic manipulative medicine

The goal of OMM is the resolution of what many osteopaths call somatic dysfunction in an attempt to aid the body's own recuperative faculties. Osteopathic manual treatment of the musculoskeletal system employs a diverse array of techniques. These are normally employed together with dietary, postural, and occupational advice, as well as counseling in an attempt to help patients recover from illness and injury, in an attempt to minimise or manage pain and disease.

Scope of manual therapies

Osteopathy employs manual therapies for the treatment of many neuromusculoskeletal pain syndromes, such as lower back pain and tension headache, alongside exercise and other rehabilitative techniques. Many osteopaths also attempt to manage (or, more often, co-manage) organic or Type-O disorders conditions, such as asthma and middle ear infections in children,^[6] menstrual pain, and pulmonary infection.

Cranial osteopathy

It has been suggested that this section be split into a new article entitled Cranial osteopathy. (Discuss)

Cranial osteopathy is a set of theory and techniques that have been developed from the observations of Dr William Sutherland that the plates of the cranium permit microscopic movement or force dissipation and that there is a 'force' or rhythm that is operating in moving the plates of the skull.^[7] Cranial osteopathy is said to be based on a primary respiratory mechanism, a rhythm that can be felt with a very finely developed sense of touch. Some osteopaths believe that improving dysfunctional cranial rhythmic impulses enhances cerebral spinal fluid flow to peripheral nerves, thereby enhancing metabolic outflow and nutrition inflow. It has gained particular popularity in the treatment of babies and children.

The primary respiratory mechanism is not acknowledged as existing in standard medical texts, and at least one study has failed to show inter-rater reliability between craniosacral therapists attempting to detect this rhythm.^[8] While other studies have reported evidence of the existence of such a rhythm, the link between any such mechanism and states of health or disease has also been contested. One meta-analysis from the British Columbia Office of Health Technology Assessment (BCOHTA) concluded that "there is evidence for a craniosacral rhythm, impulse or 'primary respiration' independent of other measurable body rhythms", however it was noted that "these and other studies do not provide any valid evidence that such a craniosacral 'rhythm' or 'pulse' can be reliably perceived by an examiner" and that "The influence of this craniosacral rhythm on health or disease states is completely unknown."^[9]

Craniosacral therapy is based on the same principles as cranial osteopathy, but the practitioners are not qualified osteopaths. The theory and techniques of cranial osteopathy have also had a major influence in alternative medicine in general.^[10]

Visceral osteopathy

Proponents of visceral osteopathy state that the visceral systems (the internal organs: digestive tract, respiratory system, etc.) rely on the interconnection synchronicity between the motion of all the organs and structures of the body, and that at optimal health this harmonious relationship remains stable despite the body's endless varieties of motion. The idea is that both somato-visceral and viscero-somatic connections exist, and manipulation of the somatic system can affect the visceral system (and vice-versa).

Practitioners contend that visceral osteopathy relieves imbalances and restrictions in the interconnections between the motion of all the organs and structures of the body—namely, nerves, blood vessels, and fascial compartments. During the 1940s, osteopaths like H V Hoover and M D Young built on the work of Andrew Taylor Still to create this method of assessment and manipulation. The efficacy and basis of this treatment remains controversial even within the osteopathic profession.

Osteopathy around the world

Osteopathy & Osteopathic medicine

Osteopathy in Australia & New Zealand

Osteopathy in Canada · Osteopathic medicine in Canada

Osteopathy in Europe · Osteopathic medicine in the UK

Osteopathy in Israel

Osteopathic medicine in the United States

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The osteopathic profession has evolved into two branches, practitioners in the United States and Canada, and practitioners in European and Commonwealth countries. These groups have have grown so distinct that in practice they function as separate professions, though there have been attempts in the recent years to enhance exchange and dialogue between them.^[11]

In Europe, commonwealth countries and elsewhere, osteopaths rely on non-surgical, non-pharmaceutical approaches, and see themselves as a complete school of manual medicine or NMS specialists, complementary to most mainstream medical practices. Commonwealth osteopathic students may spend up to ten times as many hours training in osteopathic diagnosis and technique as their American counterparts. Because of this specialization, they have traditionally remained as an alternative to mainstream healthcare alongside naturopaths and chiropractors. In commonwealth countries, osteopaths have also had to compete with physiotherapists, many of whom have integrated manipulative therapy into their practice. Nevertheless, osteopathy is growing in size in many countries of the Commonwealth and Europe.

United States

Main article: Osteopathic medicine in the United States

In the 20th century, osteopathy in the United States moved closer to mainstream medicine in its philosophy and scope of practice. Although manipulation and other principles of traditional osteopathy are still taught in some form in U.S. osteopathic medical schools, they are used by a small minority of graduates in actual practice.^[12] The profession adopted the name "osteopathic medicine" to reflect its distinction from osteopathy.^[13] Since all former schools of "osteopathy" now refer to themselves as colleges of "osteopathic medicine", there are currently no schools of osteopathy in the United States.^[1]

United Kingdom

The first osteopathic college was established in the UK in 1917 by John Martin Littlejohn, a Scot who had studied under Andrew Taylor Still. Littlejohn altered the osteopathic curriculum to include the study of physiology. The UK school he founded, the British School of Osteopathy, was the first osteopathic education institution outside the USA, and it still exists today, now located in Borough High Street, Southwark. British osteopaths use manipulative techniques based on the philosophy of Andrew Taylor Still, but do not receive medical or surgical training and are not physicians. Some medical doctors do undertake osteopathic training as a postgraduate interest. The profession is subject to statutory regulation following the passing of the Osteopaths Act in 1993. The General Osteopathic Council (GOsC) was established by the act to regulate the profession. 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 that demonstrates positive clinical and cost effectiveness of manipulation in the management of lower back pain, the latest being the UK Back pain Exercise And Manipulation (UK BEAM) trial.^[14][15] The physical manipulation condition of the UK BEAM trial involved "... a package of techniques representative of those used by the UK chiropractic, osteopathic, and physiotherapy professions."

Some 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 2005 the General Medical Council of Great Britain announced that U.S.-trained DOs would be accepted for full medical practice rights in the United Kingdom. This decision was an important departure from the United Kingdom's long-standing tradition of exclusively manual, or "traditional" osteopathy.

In the United Kingdom, courses in Osteopathy have recently become integrated into the university system. Instead of receiving a Diploma in Osteopathy (DO), with or without a Diploma in Naturopathy (ND), graduates now become Masters of Osteopathy, or Bachelors of Osteopathy, or Bachelors of Science in Osteopathy, according to the institution attended:^[16] but these degrees do not lead to prescribing rights and in this case Osteopathy and Osteopathic Medicine are synonymous. There is one "cross-over" institution, the London College of Osteopathic Medicine^[17], which teaches osteopathy only to those already qualified in medicine. Before using the title of "osteopath," graduates have to register with the UK regulatory body by statute; the General Osteopathic Council.

Australia & New Zealand

In Australia the profession has developed along the same lines as in Britain, and Osteopathy celebrated 100 years in Australia in 2007. The professional body representing Osteopaths in Australia is the Australian Osteopathic Association (AOA), and in New Zealand the Osteopathic Society of New Zealand (OSNZ). Since the 1970s Australia has formally trained practitioners although many were trained less formally prior to that time. Both Australia and New Zealand require registration, and thus disallow osteopathic practice except by government registered practitioners. Osteopathic treatment is recognized and reimbursed by Workers' compensation, the various motor accident authorities, Medicare, private health insurers, and the Accident Compensation Corporation (ACC). Four publicly-funded Universities now offer osteopathic medical courses in Australia - RMIT, VU, SCU and UWS - and one course is offered at UNITEC in New Zealand.^[18] Australasian courses consist of a bachelor's degree in clinical science (Osteopathy) followed by a master's degree.

Canada

"Osteopathy in Canada" redirects here. For a branch of the medical profession in Canada, see Osteopathic medicine in Canada.

The first self-identified college of Osteopathy in Canada opened in 1981. Non-physician osteopaths in Canada are currently represented by the Canadian Federation of Osteopaths,^[19] a group that advocates for the standardization of training requirements and more legal recognition for the non-medical osteopathic profession. This organization and the schools from which its membership have graduated are not recognized or accredited by any Canadian federal or provincial regulatory authority.^[20] Colleges of Osteopathy in Canada are the Canadian College of Osteopathy in Toronto, the Canadian Academy of Osteopathy and Holistic Health Sciences in Hamilton, Ontario, and the Collège d'Études Ostéopathiques in Montreal, Quebec.^[21] Graduates of these schools do not currently qualify for registration to practice in Canada.^[22]

Osteopathic physicians educated in the United States should not be confused with non-physician osteopaths. Osteopathic physicians are educated and trained in the United States and may practice in Canada as fully licensed physicians. There are no colleges of Osteopathic medicine in Canada. Only those graduates of American Colleges of Osteopathic Medicine are eligible for licensure to practice osteopathy and Osteopathic Medicine in Canada. The authority for licensure of American osteopathic graduates lies with the provincial Colleges of Physicians and Surgeons.^{[23][24][25][26][27][28]} The Canadian Osteopathic Association^[29] has been representing osteopathic physicians in Canada for more than 80 years and has enabled near uniform licensure across Canada for American osteopathic graduates.

For more details on osteopathic physicians trained in the United States, see Osteopathic medicine in the United States.

Israel

In Israel a joint Osteopathy and Chiropractic Bill is in the process of going through the Knesset (Israeli Parliament). The bill will in effect define osteopathy as an academically based profession. Only those holding at least an undergraduate degree in osteopathy will be able to call themselves osteopaths in Israel. The members of the Israel Osteopathic Association have been working in conjunction with the Ministry of Health on drawing up the bill.

European Union

Within the EU there is no standardized training or regulatory framework for osteopaths but attempts are being made to coordinate the profession within the union. There is a conflict between the principle of free movement of labour - a cornerstone of the EU - and the right to practice osteopathy in different member states as there is cross-border equivalence in training and regulation of the profession. The UK's General Osteopathic Council, a regulatory body set up under the country's 1993 Osteopaths Act has issued a position paper on European regulation of osteopathy.^[30] The teaching of osteopathy in the United Kingdom, Belgium, France, Finland, Iceland, Denmark, Malta, Switzerland is well established - but not all European nations have yet embraced this form of medicine.

In the UK, since the Osteopaths Act, osteopathy has been a recognised profession. Some doctors within the country's National Health Service recognise osteopathy as a therapy and refer patients to its practitioners when other forms of treatment are not successful or are considered inappropriate ^[31] - but the NHS will not usually pay for any treatment.^[32]

Spain is into a recognition process. Nevertheless it has its national registry http://www.osteopatas.org. Recognized professionals should be listed on it.^[33]

Criticism

Osteopathy has been criticized for having limited research into the efficacy of treatment.^{[citation needed]} One placebo-controlled trial concluded that osteopathy is no better than sham treatment for chronic nonspecific lower back pain, although the authors acknowledged the difficulty of providing a non-therapeutic sham treatment for pain after knee/hip surgery.^[34][35] However, in a meta-analysis and systematic review of six randomized controlled trials of OMT that involved blinded assessments of lower back pain in ambulatory settings, it was concluded that OMT significantly reduces lower back pain, and that the level of pain reduction is greater than expected from placebo effects alone and persists for at least three months.^[36]

Another study, which aimed to identify cellular mechanisms at work during osteopathic treatment, was published in the Journal of American Osteopathic Association in December 2007. Data from this study suggest that fibroblast proliferation and expression/secretion of proinflammatory and anti-inflammatory interleukins may contribute to the clinical efficacy of indirect osteopathic manipulative techniques.^[37]

Safety concerns have also been raised in relation to manipulative techniques used by some osteopaths. 'Neck cracking', i.e. cervical high-velocity low-amplitude thrusting, has received particular attention in the popular media due to a possible risk of arterial occlusion and consequently of stroke. Although the existing data cannot provide a conclusive estimate of the cervical artery dissection risk researchers have stated that a stroke risk of about 1.3 per 100 000 chiropractic visits for individuals aged under 45 years, with a 95% confidence interval of 0.5–16.7 per 100 000 is a theoretically unbiased estimate^[38]. Although these data primarily concern chiropractic visits, both osteopaths and chiropractors may practise cervical manipulations.

See also

• Doctor of Osteopathic Medicine
• List of osteopathic colleges
• List of medical schools in the United States
• Naturopathic medicine

References

1. ^ ^{a b} "Osteopathy should only be used when referring to the occupation of non-physician osteopaths or those trained outside of the United States." Osteopathic Style Guide. American Osteopathic Association.
2. ^ Baldwin City, Kansas "Among Free State leaders was Andrew T. Still, founder of osteopathy, whose theory of healing developed here."
3. ^ "Early American Manual Therapy". http://www.meridianinstitute.com/eamt/files/webster1/webcont.html#HOW%20I%20CAME%20TO%20ORIGINATE%20OSTEOPATHY. 
4. ^ "Education firmly established". American Osteopathic Association. http://history.osteopathic.org/educate.shtml. 
5. ^ Extracted from the curriculum of the Andrew Taylor Still University Kirksville College of Osteopathic Medicine
6. ^ Mills M, Henley C, Barnes L, Carreiro J, Degenhardt B (2003). "The use of osteopathic manipulative treatment as adjuvant therapy in children with recurrent acute otitis media". Arch Pediatr Adolesc Med 157 (9): 861–6. doi:10.1001/archpedi.157.9.861. PMID 12963590. 
7. ^ What Is Osteopathy In The Cranial Field (OCF)? Osteohome website (Accessed 2nd Aug 2006
8. ^ Wirth-Pattullo V, Hayes KW. Interrater reliability of craniosacral rate measurements and their relationship with subjects' and examiners' heart and respiratory rate measurements. Phys Ther. 1994 Oct;74(10):908-16; discussion 917-20. PMID 8090842
9. ^ "A SYSTEMATIC REVIEW :AND CRITICAL APPRAISAL OF THE SCIENTIFIC EVIDENCE ON CRANIOSACRAL THERAPY"
10. ^ Huba, S. (April 2, 1997). Holistic healing's new role. The Cincinnati Post.
11. ^ Wickless, Larry (PDF). The Osteopathic International Alliance: Unification of the Osteopathic Profession. Osteopathic International Alliance Steering Committee. http://www.oialliance.org/pdf/oia_article_triad0905.pdf. Retrieved on 2006-09-19. 
12. ^ Johnson SM, Kurtz ME. Diminished use of osteopathic manipulative treatment and its impact on the uniqueness of the osteopathic profession. Acad Med. 2001;76:821 –828. PMID 11500286]
13. ^ Wilson, Jennifer Fisher. Osteopathic medicine's growing pains. American College of Physicians Observer. November 1997.
14. ^ UK Back pain Exercise And Manipulation (UK BEAM) Trial Team. United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care." BMJ. 2004 Dec 11;329(7479):1377.
15. ^ UK Back pain Exercise And Manipulation (UK BEAM) Trial Team. United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: cost effectiveness of physical treatments for back pain in primary care." BMJ. 2004 Dec 11;329(7479):1381.
16. ^ General Osteopathic Council [1]
17. ^ London College of Osteopathic Medicine [2]
18. ^ "Master of Osteopathy courses, postgraduate study for a masters degree" (in English) (HTML). Unitec website. Unitec. http://www.unitec.ac.nz/?C7B4901F-385F-44F0-B37B-609CE4CC0E1E. Retrieved on 2009-01-26. "The Master of Osteopathy is the only New Zealand-based programme that enables you to register with the Osteopathic Council of New Zealand, and to enter practice as an osteopath in New Zealand." 
19. ^ http://www.osteopathy.ca/index.html
20. ^ Osteopathic International Alliance Statement Regarding Non-physician Osteopaths in Canada
21. ^ The spread of Osteopathy worldwide World Osteopathic Health Organization. 26 April 2006. Accessed 13 Feb 2009.
22. ^ Osteopathic International Alliance Statement Regarding Non-physician Osteopaths in Canada[3]
23. ^ Canadian Osteopathic Practice (.doc)
24. ^ Ontario Medicine Act – Restricted Titles, Section 9 [4]
25. ^ Ontario College of Physicians Doctor of Osteopathy Registration Policy Statement [5]
26. ^ British Columbia Medical Practitioners Act Section 40 Registration of Osteopaths [6]
27. ^ Alberta Medical Profession Act Sections 3 and 18 [7]
28. ^ Albert Health Professions Act Schedule 21 Use of Titles [8]
29. ^ Canadian Osteopathic Association
30. ^ European Public Health Alliance UK GOsC Position paper on pan-European regulation. Accessed 2nd August 2006
31. ^ [9]
32. ^ The British School of Osteopathy, Nicola Sturzaker, Education Guardian, 2 November 2004.Retrieved on 2007-07-22.
33. ^ Osteopathy in Spain, Ma. Virginia Suarez Pereda, Osteopata Madrid, 14 January 2009.Retrieved on 2009-02-14.
34. ^ >Licciardone JC, Stoll ST, Fulda KG, Russo DP, Siu J, Winn W, Swift J (2003). "Osteopathic manipulative treatment for chronic lower back pain: a randomized controlled trial". Spine 28 (13): 1355–62. doi:10.1097/00007632-200307010-00002. PMID 12838090. 
35. ^ Licciardone JC, Stoll ST, Cardarelli KM, Gamber RG, Swift JN, Winn WB (2004). "A randomized controlled trial of osteopathic manipulative treatment following knee or hip arthroplasty". J Am Osteopath Assoc 104 (10): 193–202. PMID 15176518. 
36. ^ Licciardone JC, Brimhall AK, King LN (2005). "Osteopathic manipulative treatment for low back pain: a systematic review and meta-analysis of randomized controlled trials". BMC Musculoskelet Disord 6: 43. doi:10.1186/1471-2474-6-43. PMID 16080794. 
37. ^ "Modeled Repetitive Motion Strain and Indirect Osteopathic Manipulative Techniques in Regulation of Human Fibroblast Proliferation and Interleukin Secretion."
38. ^ Moira K. Kapral and Susan J. Bondy (October 2001). "Cervical manipulation and risk of stroke". Canadian Medical Association Journal 165: 907–908. PMID 11599330. http://www.cmaj.ca/cgi/content/full/165/7/907. 

Further reading

• Science in the Art of Osteopathy: Osteopathic Principles and Models, Caroline Stone, Nelson Thornes, 1999, paperback, 384 pages, ISBN 0-7487-3328-0
• An Osteopathic Approach to Diagnosis and Treatment , Eileen DiGiovanna, Lippincott Williams and Wilkins, 2004, hardback, 600 pages, ISBN 0-7817-4293-5
• Osteopathy in Britain. The First Hundred Years, by Martin Collins, Booksurge, 2005, paperback, 359 pages, ISBN 1-4196-0784-7

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