Osteopathy

Summary

Osteopathic medicine is a branch of medicine that believes the entire human being, not just the illness, should be treated. It emphasizes the relationship between the organs of the body and the musculoskeletal system. Osteopathic doctors use the body's self-healing abilities in their treatments. They are trained and licensed physicians who can prescribe medication and perform surgery. The majority of osteopaths are primary care physicians who focus on comprehensive family care and serving the medical needs of the community.

Definition and Basic Principles

Osteopathy is a focused healthcare philosophy that emphasizes the musculoskeletal system of the human body and its relationship to the body's organs. Osteopaths strive to treat not just the disease but the whole person. Osteopaths practice medicine using the body's own healing power.

Osteopaths study patient history closely, often finding that elements of the body's structure—particularly the bones and muscles—are the underlying causes of illness and dysfunction. Osteopaths must have a highly developed sense of touch, allowing them to examine and often treat patients by palpitating the flow of fluids in their bodies, the texture and movement of soft tissue and muscles, and the body's overall structure.

Osteopathic medicine is not considered alternative healthcare, as this form of medicine has a history over 125 years old. It is recognized as a complete system of medical care founded on the philosophy of treating the whole patient—the body and the mind. The predominance of the musculoskeletal system within osteopathic medicine is also fundamental to chiropractic medicine, which is considered a separate but related health discipline.

Background and History

American physician Andrew Taylor Still founded the first school of osteopathic medicine in 1892, based on a theory he had developed in 1874. He theorized that the musculoskeletal system was the primary component of good health. Still believed that the structures that supported the nervous system—the skull and vertebrae—influenced the energy that flowed through it. This energy flow could be altered by any musculoskeletal defect, thereby producing disease. To cure the disease, the physician needed to restore the supporting structures to their natural state through adjustments.

In the early 1900s, osteopathic medicine increasingly incorporated the practices of allopathic medicine while retaining the whole person approach and manipulation techniques. In 1950, a court decision in Missouri recognized the basic equivalency of an osteopathic doctor (DO) and a medical doctor (MD) and their right to practice and perform surgery in a county hospital. By 1973, all fifty states and the District of Columbia had granted full practice rights to doctors of osteopathy. Although osteopathic doctors and allopathic doctors perform the same functions, osteopaths have received education in the philosophy of osteopathy and training in manipulation techniques. The practice of osteopathy has spread from the United States to Canada and other nations.

How It Works

For osteopaths, treating a disorder involves returning a person's body to its normal alignment and functioning and also determining what caused the disorder. In the case of a joint injury, especially if a recent fall or mild blow to an area is the likely cause, osteopaths may treat the patient with manipulation.

Manipulation is a technique used by osteopaths, along with other medical professionals such as chiropractors and physical therapists. This particular hands-on approach is designed to ensure that the body's joints are moving properly, allowing the body's natural healing systems to function. Manipulation emphasizes joints, specifically those of the vertebrae and ribs. Osteopaths believe there may be two types of joint dysfunction. The joint members can be very slightly offset, which is referred to as a subluxation, or the joint surfaces may have a vacuum lock within them so that movement of the joint squeezes out lubricants and produces abrasion of the joint surfaces. Some cases of joint pain may be the result of a postural misalignment caused by, for example, the patient's legs being of different lengths. Muscles can be tight or painful because of tension or stress. If the patient has experienced pain for a long time, some muscle deterioration may have occurred. Osteopaths look at all the possible causes and at the whole person when determining how to restore the patient's health.

Some controversy exists regarding manipulation's efficacy. However, it provides relief to millions of patients. Backs and necks are most commonly manipulated. Sometimes, one manipulation or a short series is enough, but some patients require multiple treatments. Others fail to respond, and osteopaths must seek another form of treatment. Once a patient has been treated successfully by manipulation and the cause of the illness or trauma has been identified, osteopaths can create exercise programs or prescribe other rehabilitative techniques.

Although osteopaths take a whole person view of treatment, their methods of diagnosing and treating injuries and diseases are very similar to those of an allopathic doctor. Osteopaths treat patients with various forms of therapy and medicines as appropriate and perform surgery when necessary.

Applications and Products

Osteopathic Manipulation. Osteopathic doctors look for restrictions in normal joint movement and try to correct the problem by moving the joint through the restricted area of motion yet not beyond the joint's normal range of motion. This contrasts chiropractic medicine, as this discipline may manipulate an affected joint beyond its normal range of motion. There are several approaches to osteopathic manipulation, and the techniques vary among osteopathic practitioners. For manipulation to be successful, the muscles must first be somewhat relaxed. To help relax muscles, osteopaths use forms of heat such as hot packs or ultrasounds, medication, or gentle stretching. Articulation and thrust are commonly used in manipulation. Articulation (applying a gentle force against the restricted area) is used to improve motion, and thrust (applying a sharp force against the restricted area) is used to regain the range of motion.

Cranial Osteopathy. Some, but not all, practitioners believe that the skull bones can also be manipulated. Cranial osteopathy is a theory based on the premise that the bones of the skull permit small increments of movement. This application, which became popular for treating babies and children, is said to be based on a rhythm that can be felt by practitioners whose sense of touch is highly developed. Some osteopaths believe that improving the cranial rhythmic movement helps increase the flow of the cerebral spinal fluid that surrounds the brain and spinal cord. This increase in flow can then raise metabolic outflow and nutrition inflow.

Craniosacral Therapy. Craniosacral therapy (CST) is a hands-on approach to monitoring and mobilizing what osteopaths refer to as the craniosacral rhythm. In this therapy, the spine and the cranial junctions of the skull as well as soft tissue are gently manipulated to improve the flow of cerebrospinal fluid in the spinal cord and to open restricted nerve passages. Craniosacral techniques are used in the treatment of neck and back pain, mental stress, chronic pain, and migraines.

Craniosacral therapy and cranial osteopathy are two separate practices with different training backgrounds. Although the two are based on similar principles, craniosacral therapists are not doctors but rather an unlicensed group of individuals who perform such therapies. Cranial osteopaths, however, are fully licensed doctors of osteopathic medicine. They have graduated from medical school and passed medical boards, so they are significantly more qualified than a craniosacral therapist.

Visceral Osteopathy. Osteopaths who propose the application of visceral osteopathy state that the internal organs and bodily structures (such as the digestive tract and respiratory system) and the body's motion are interconnected. For optimal health, connections among the organs and structures need to remain balanced and stable despite the body's endless motion. Visceral osteopaths believe that manipulating the musculoskeletal system benefits the internal organs and vice versa. The effectiveness of visceral osteopathy remains controversial even within the osteopathic profession.

Muscle Energy Technique. Osteopaths also use muscle energy techniques to treat dysfunctional joints and the spine. Patients perform a combination of movements, such as pushing against manual resistance, then relax and stretch the muscle at several points in the limb's motion. Such techniques can be used with various joints of the body, such as the hip, knee, and shoulder. The technique can help decrease joint restriction and restore the full range of motion.

Primary and Specialized Medical Care. Osteopathic doctors practice in many primary care areas, including family practice, internal medicine, obstetrics, gynecology, and pediatric medicine. They are licensed to prescribe pharmaceuticals and can specialize in areas such as surgery. The medical and surgical treatments that osteopathic doctors use on their patients are, for the most part, the same as those that allopathic doctors use.

Pain Management. Osteopathy is often used in pain management. In the treatment of pain, osteopaths and traditional doctors share the same goals and some of the same treatments, but osteopaths are regarded as having a more in-depth understanding of the interrelationship between the body's own healing capabilities and the musculoskeletal system. Most doctors commonly prescribe drug therapies and surgical treatments to treat chronic pain, but osteopaths often take other approaches. In the treatment of acute or chronic pain, osteopaths place greater emphasis on how the organs and the musculoskeletal system are related and how to treat the whole individual, not just the pain. For example, emotional problems can cause muscles to tighten, resulting in pain that produces more spasms and additional pain. The treatment is often drugs that relax muscle spasms and reduce pain. If the patient has been experiencing pain for a long time, their muscles may have deteriorated and lost strength, so osteopaths may recommend specific exercises or refer the patient to physical therapy. Osteopaths may investigate whether the patient has psychological problems that may need attention and medication. The osteopathic approach looks at the whole person, looking at multiple ways to decrease or eliminate the patient's pain.

Counterstrain Technique. Counterstrain techniques are used by osteopaths to treat joint dysfunction and relieve pain. These techniques place the affected joint in the position of the least discomfort, which is usually with the muscle at its shortest length. While monitoring the degree of discomfort at a nearby tender point, the position is held for ninety seconds and then the joint is slowly returned by the osteopath to a more neutral position.

Myofascial Release Techniques. Myofascial release techniques are similar to massage. However, osteopaths use their hands to apply a traction force to the alignment of muscles to stretch them and to the surrounding soft tissues to reduce tension. Related methods called soft tissue techniques involve massaging the muscles and the surrounding soft tissues. Osteopaths use their hands to stretch or relax dysfunctional soft tissue structures. Such techniques are applied almost anywhere throughout the body but are especially useful for the paraspinal muscles, which surround each vertebra. The ultimate goal of all soft tissue techniques is to relax tight muscles and stretch tight surrounding soft tissue structures called fascia.

Careers and Course Work

Individuals interested in osteopathy must understand that those practicing osteopathic medicine must genuinely be concerned for people. Therefore, prospective applicants should observe an osteopath at work and, if possible, perform volunteer work in a hospital or clinic to determine if they have or can develop the skills needed to interact with people.

To be admitted to an osteopathic school, applicants must have a Bachelor's degree. Although they can choose almost any major, they must meet the minimum course requirements for osteopathic school. Some recommended courses include biology, genetics, general and organic chemistry, physics, mathematics, psychology, and English. Another requirement is a good score on the Medical College Admissions Test. Osteopathic medical colleges generally interview candidates, partly to determine the depth of their interest in osteopathy.

During the first two years of osteopathic medical school, students learn basic sciences, and in the next two years, they gain experience in clinical work as well as study general medicine. Clinical rotations take students to urban, suburban, and rural settings, enabling them to gain exposure to all areas of medicine. Following graduation, osteopathic doctors complete an approved twelve-month internship, which provides exposure to hospital departments. At this point in their education, some students complete a two- to six-year residency program in a medical specialty. Osteopathic physicians can become certified in a specialty by completing a residency program and passing the pertinent exams.

Like all physicians, osteopaths must pass a national licensing exam. Osteopathic doctors are licensed to practice medicine and perform surgery in all fifty states and the District of Columbia, although state licensing procedures vary. Earning continuing medical education credits is a requirement for maintaining licensure.

Social Context and Future Prospects

Like traditional medical physicians, the demand for osteopathic doctors is projected to grow faster than the average for all occupations. The growing and aging population contributes to this need, and technological advances in tests and procedures enable physicians to better treat patients. As more patients embrace holistic care, osteopathy will become even further integrated with traditional medicine. The growth in educational programs centered on osteopathy signals this growing acceptance. General and primary care practitioners will likely have the best prospects, and those pursuing specialties, such as surgery, will find the competition more intense. Compensation for osteopathic doctors depends on their specialty, the location and type of facility where they practice, and how long they have practiced.

Bibliography

Gintis, Bonnie. Engaging the Movement of Life: Exploring Health and Embodiment Through Osteopathy and Continuum. Berkeley, Calif.: North Atlantic Books, 2007.

Hebgen, Eric. Visceral Manipulation in Osteopathy. Stuttgart, Germany: Thieme, 2011.

Liem, Torsten. Cranial Osteopathy: A Practical Textbook. Seattle: Eastland Press, 2009.

Mazzolini, Chris. “The Changing Face of Physicians: The Growth of Osteopathic Medicine.” Medical Economics, 28 Sept. 2023, www.medicaleconomics.com/view/the-changing-face-of-physicians-the-growth-of-osteopathic-medicine. Accessed 29 May 2024.

Möckel, Eva. Textbook of Pediatric Osteopathy. New York: Churchill Livingston Elsevier, 2008.

O'Brien, Emily. “The Continued Growth of Osteopathic Medicine.” Health eCareers, 2 Nov. 2022, www.healthecareers.com/career-resources/industry-news/the-continued-growth-of-osteopathic-medicine. Accessed 29 May 2024.

Parsons, Jon, and Nicholas Marcer. Osteopathy: Models for Diagnosis, Treatment, and Practice. New York: Churchill Livingstone, 2006.

Richter, Philipp, and Eric Hebgen. Trigger Points and Muscle Chains in Osteopathy. New York: Thieme, 2009.