Osteopathic Medicine

Osteopathic Medicine (also known as osteopathy) is a system of medicine that applies a unique philosophy to medical care. With a strong emphasis on the inter-relationship of the body's nerves, muscles, bones and organs, Doctors of Osteopathic Medicine, or D.O.s, apply the philosophy of treating the whole person (holistic approach) to the prevention, diagnosis and treatment of illness, disease and injury using traditional medical practice such as drugs and surgery, along with manual and physical therapies (OMM).

Doctors of Osteopathic Medicine (D.O.s) educated in the United States are fully licensed physicians that practice the full scope of medicine, like Doctors of Medicine (M.D.s). Currently, there are 20 accredited D.O.-granting U.S. medical schools and 125 accredited M.D.-granting U.S. medical schools. Because of the abundance of M.D. schools, many people are more familiar with them; however, osteopathic medicine is growing at an unprecedented rate. Many new schools are planned to open in the coming years and existing schools have expanded enrollment to meet the increased demand for the physician workforce, particularly as baby boomers age. The majority of entering U.S. osteopathic medical students hold bachelor's degrees and many also hold master's (M.S., M.A.) or doctorate (Ph.D., J.D.) degrees.

M.D. and D.O.-granting U.S. medical schools have similar curricula. Generally the first two years are classroom-based, with certain programs providing patient contact, while third and fourth years consist of rotations through the different major specialties of medicine. Upon graduation, M.D. and D.O. physicians pursue residency training programs. Depending on state licensing laws, osteopathic physicians may also be required to complete a 1 year rotating internship. Osteopathic physicians also have the opportunity to pursue allopathic (M.D.) residency programs; however, the converse is not allowed. Within the U.S., osteopathic physicians practice in all medical specialties including, but not limited to, internal medicine, dermatology, surgery, radiology, etc. There is no distinction in pay between allopathic (M.D.) and osteopathic (D.O.) physicans; however, physician salaries differ noticeably among the various medical specialties.

Osteopaths educated in countries outside of the U.S. do not follow the same curriculum as U.S. trained D.O.'s and are referred to as "non-physician osteopaths". Their scope of practice is limited mainly to musculoskeletal conditions and treatment of some other conditions using manual treatment [OMM], not unlike chiropractors in the U.S.

History

Osteopathic practice began approximately 120 years ago (before the chiropractic movement) in the Midwest of the United States. Early in the twentieth century, the American osteopathic profession adopted the use of medicine and surgery, whereas chiropractors continue to use strictly manipulative techniques. Outside of the US, particularly in the United Kingdom, osteopaths tended to stay closer to their traditional approach. Osteopathy was founded by Andrew Taylor Still, M.D., D.O., who was born in 1828 in Virginia. Dr. A.T. Still was trained by apprenticeship and was employed as an army doctor during the American Civil War in the U.S. Army. The horrors of battlefield injury and the subsequent death of his wife and several children from infectious diseases left him totally disillusioned with the traditional practice of medicine. Still perceived the medical practices of his day to be ineffective, even barbaric. Troubled by what he saw as problems in 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.

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 was not figuratively "chased out of town" by other doctors. While the state of Missouri was willing to grant him a charter for awarding 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 taught that "dis-ease" was 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 point out that many of Still's writings are philosophical rather than scientific in nature. He 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 muscoskeletal diagnosis and treatment, the training and scope of osteopathy in the United States is very similar to that of allopathic or bio-medicine. Internationally, all osteopathic training incorporates at least the basic biomedical sciences and differential diagnosis, while emphasizing non-surgical orthopedics.

Osteopathic Principles

These are the eight major principles of osteopathy 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 principles are not held by osteopaths to be empirical laws, nor contradictions to orthodox medical principles; they are thought to be the underpinnings of the osteopathic perspective on health and disease.

Techniques of Osteopathic Manual Medicine (OMM)

The goal of OMM is the resolution of somatic dysfunction. There are different techniques applied to the musculoskeletal system as OMM. These techniques can be applied to:

(1) The joints (using High Velocity Technique, mobilization, etc.)
(2) Their surrounding soft tissues (using functional and soft tissue techniques, etc.)
(3) The muscles
(4) The fascia.

When combined, 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.

Osteopaths have at their disposal a wide range of manual techniques including:

High Velocity (Low Amplitude) Thrust (HVT) (usually called an 'adjustment' by Chiropractors or more generally 'joint manipulation') - in which a joint is quickly and skillfully taken by the practitioner beyond its normal range of motion, but within its physiological range, with the intention of normalizing 'joint play.'

• Joint Mobilization
• Myofascial Release
• Muscle Energy Technique (MET)
• Trigger (or Myodysneuric) Point Therapy
• Soft Tissue Technique
• Cranial Osteopathy
• Visceral Manipulation
• Lymphatic Pump
• Counterstrain
• Balanced Ligamentous Tension (BLT)

These are normally employed together with dietary, postural, and occupational advice, as well as counseling to help patients recover from illness and injury, and to minimize pain and disease. Most osteopaths view manual therapies as a complement to physiotherapy, and the judicious use of invasive therapies (pharmaceuticals and surgery) where necessary.

It is probably OMM's comprehensive and eclectic style that distinguishes it most from that employed by most other manual therapists.

The immediate goal of musculoskeletal manipulation is to restore maximal, pain-free movement of the musculoskeletal system in postural balance.

Scope of Manual Therapies

There is now a well-established body of scientific literature that makes a strong case for the use of manual therapies in the treatment of many neuromusculoskeletal pain syndromes, such as low back pain and tension headache, alongside exercise and other rehabilitative techniques. In recent years, the mainstream medical profession has begun to accept the use of manual therapies to treat spinal pain of mechanical origin.

More controversial is the use of manual therapies in the treatment of seemingly organic conditions, such as asthma, middle ear infections in children, period pain, and pulmonary infection. While research is beginning to shed some light in this area, exploration of the relationship between the NMS system and organic disease and the scope of manual therapies are in their infancy. Nevertheless, the sum of research and clinical experience to date suggests that osteopathic treatment can be a safe and cost-effective means of managing (or co-managing) certain diseases.

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 reimburse for 'cranial' treatment because of the lack of awareness of research in the field.

Cranial osteopaths are trained to feel a very subtle, rhythmic shape change that is present throughout the head and body. This is known as the involuntary mechanism or the cranial rhythm. The movement is said to be very subtle, and 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. The theory underlying cranial osteopathy is rejected by many osteopaths and orthodox medical doctors because cranial bones fuse by the end of adolescence. Cranial osteopathic teaching refers to movement remaining within the thin bone of the sutures, and that flexibility within living bone occurs, in contrast to dried specimen bones. The brain does pulsate, but some research suggests this is related to the cardiovascular system . Several studies have looked at inter-operator reliability of palpating the 'cranial rhythm' and found there to be little agreement, although modern understandings in the cranial field describe a number of simultaneous rhythms with differing rates, relating to different aspects of function.

How this mechanism is related to health/disease is not established. Many without direct experience of the benefits of treatment dismiss cranial osteopathy as pseudo-science. However, cranial osteopathy is increasingly being recognised as especially suitable for newborn babies.