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Osteopathic medicine in the United States - Health Web

Osteopathic medicine was developed in 1874 by a frontier doctor named Andrew Taylor Still.

Osteopathic medicine is a branch of medicine based on the premise that the primary role of the physician is to facilitate the body's inherent ability to heal itself. Though practiced mainly in the United States, osteopathic medicine shares a common historical origin with a type of complementary medicine practiced worldwide, known as osteopathy. Physicians who graduate from osteopathic medical schools are sometimes known as osteopathic physicians and hold a doctorate in osteopathic medicine (D.O.), while holders of a similar, but far more common M.D. degree are known as allopathic physicians. The existence of this distinction and of D.O.s as licensed physicians is not widely known.

Founded as osteopathy by frontier physician Andrew Taylor Still as a radical rejection of the prevailing system of medical thought of the 19th century, the profession gradually moved closer to mainstream medicine in its practices, and came to be called "osteopathic medicine" within the United States. Today, osteopathic medicine is "no longer considered alternative medicine" and the training of osteopathic physicians is "virtually identical" to that of M.D. physicians. Osteopathic physicians use all conventional methods of diagnosis and treatment but are trained to place additional emphasis on the achievement of normal body mechanics as central to maintaining good health. D.O. physicians receive training in Osteopathic Manipulative Medicine (OMM), a form of manual therapy shown to be of some benefit for patients with certain musculo-skeletal disorders. However, this form of therapy is used by a minority of osteopathic physicians in actual practice. In the United States, osteopathic medicine is considered by some both a profession and a social movement.

Although U. S. osteopathic medical physicians currently may obtain licensure in 47 countries, osteopathic curricula in countries other than the United States differs. D.O.s outside the U. S. are known as "osteopaths" and their scope of practice excludes allopathic medical therapies and relies more exclusively on osteopathic manipulative medicine and other alternative medical modalities.

Discussions about the future of osteopathic medicine frequently debate the feasibility of maintaining distinctiveness within the broader U.S. physician community. More recently, the topic of for-profit medical education has become an issue.

History

The practice of osteopathic medicine began in the United States in 1874. The term "osteopathy" was coined by Andrew Taylor Still, M.D., who was born in 1828 in Virginia. 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. Still was trained by apprenticeship, as were most physicians of the day, 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 opposed the use of drugs and surgery as remedial agents, reserving their use for cases in which he considered them to be the cure for the condition, such as an antidote for a poison or amputation for gangrene. He saw the human body as being capable of curing itself, and the duty of the physician to remove any impediments to the healthy function of each person. He promoted healthy lifestyle, nutrition, abstinence from alcohol and drugs, and used manipulative techniques which he believed, improved physiological function.

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." The object of osteopathy was to "improve upon the present systems of surgery, midwifery, and the treatment of general diseases." Its scientific foundation was the discipline of anatomy. Its philosophy was based on the understanding of the integration between body, mind and spirit, the interrelatedness of structure and function, and the posited ability of the body to heal itself when mechanically sound. Osteopathic treatment emphasises comprehensive patient care with a focus on the neuromusculoskeletal system as an integral part of health and disease processes. Over time Still and his students and faculty developed a complete medical school curriculum which included a series of specialized physical treatments, now called Osteopathic Manipulative Treatment (OMT). Still founded the American School of Osteopathy (now the Andrew Taylor Still University, Kirksville College of Osteopathic Medicine) in Kirksville, Missouri, for the teaching of osteopathic medicine 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 M.D. degree, he remained dissatisfied with the limitations of conventional medicine and instead chose to retain the distinction of the D.O. degree.

In the late 1800s Still taught that "dis-ease" was caused when bones were 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 interrupted flow. Still stimulated his students to investigate these postulates. Research began in the 1890s at Kirksville and has continued there and at other osteopathic institutions ever since. The A.T. Still Research Institute was founded in 1913 and Louisa Burns, D.O. and others developed a rigorous series of scientific investigations of the relationships between musculoskeletal dysfunctions and health and disease. Still's critics point out that he never personally 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.

By the 1960s, osteopathic medicine had become integrated into the American mainstream, and the reliance on manipulative therapies had fallen into less common usage. The osteopathic profession has evolved independently outside the US, where it has remained essentially a drug-free system based on manipulative techniques - a scope of practice similar to chiropractors. Chiropractic is a distinct manipulative profession that originated around 1895 in the US.

Osteopathic principles

These are the eight major principles of osteopathy and are widely believed throughout the International osteopathic community.

The body is a unit.
Structure and function are reciprocally inter-related.
The body possesses self-regulatory mechanisms.
The body has the inherent capacity to defend and repair itself.
When the normal adaptability is disrupted, or when environmental changes overcome the body’s capacity for self maintenance, disease may ensue.
The movement of body fluids is essential to the maintenance of health.
The nerves play a crucial part in controlling the fluids of the body.
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

The goal of OMM is the resolution of what many osteopaths's 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 low 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, menstrual pain, and pulmonary infection.

Cranial osteopathy

Cranial osteopathy is a well-established branch of medicine based on working with what is known as the cranial rhythm. Cranial osteopaths/osteopathic physicians are trained to feel a very subtle, rhythmic pattern of movement or shape changes while holding a patient's head. Outside the profession this is a contested phenomenon; also it is not known what proportion of osteopaths or osteopathic physicians are practitioners nor is it known what portion of practitioners have formal osteopathic training. Cranial osteopathy is based on the subtle involuntary mechanisms or rhythms which can be felt with a very finely developed sense of touch and, generally, through the use of an elaborate adjustable "lift" massage table which allows the practitioner to position the hands, arms and shoulders of the practitioner with a sufficiently relaxed angle (attitude) that the rhythms can be felt. From the experienced cranial osteopath, pulses in hydrostatic pressure can be initiated by pulsing the pressure of the practitioner's palms and fingers on the head and neck of the patient. The practitioner's own neurotransmitters are said by many practitioners to be somehow "activated" as the practitioner's fingers and palms find and settle in on locations on the patient's head which have an electrostatic presence. Treatments are generally weekly and continue until cranial osteopathy has re-established the rhythmic movement of the plates which together form the skull. Generally the patient begins with the plates locked into a single unit by calcification. This rhythm was first described in the early 1900s by Dr. William G. Sutherland.

The theory underlying cranial osteopathy is rejected by many physicians. It is believed by most modern osteopathic physicians working within the cranial field, that the spheno-basilar symphysis (a large joint in the skull base) ossifies (turn to bone). 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. Research suggests that examiners are unable to measure craniosacral motion reliably, as indicated by a lack of interrater agreement among examiners. The authors of this research suggest that this "measurement error may be sufficiently large to render many clinical decisions potentially erroneous".

No scientific links have been found between this mechanism and health/disease. Some osteopathic physicians believe that healing dysfunctional cranial rhythmic impulses enhances cerebral spinal fluid flow to peripheral nerves, thereby enhancing metabolic outflow and nutrition inflow.

Craniosacral therapy is based on the same principles but the practitioners have not attended medical school and are therefore not osteopathic medical physicians. Chiropractor and osteopathic physician, M.B. Dejarnette further developed craniopathic techniques inside of a complete Chiropractic system known as Sacro-Occipital Technique or simply "S.O.T."

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.