Osteopathy or osteopathic medicine is an approach to healthcare that emphasizes the role of the musculoskeletal system in health and disease.

Osteopathy was founded by Andrew Taylor Still, an American physician. Still was disillusioned with the orthodox medicines of the time. He had been an Army surgeon in the American Civil War and subsequently lost most of his children to infectious diseases. In 1892, he founded the first school of osteopathy, the American School of Osteopathy (now known as the A. T. Still University). The first osteopathic college outside the USA, the British School of Osteopathy, was founded by a Scottish medical practitioner who had been a student of Still's, Dr. Martin Littlejohn. Osteopathy then spread to British colonies, particularly Australia and New Zealand. Today osteopathy is practised in many countries in Europe and beyond.

In most countries, osteopathy has been considered 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) aids the recuperative powers of the body.

'Osteopathy' and 'osteopathic medicine' are often used inter-changeably.^[1] The American Osteopathic Association recommends using 'osteopathic medicine' to describe 'American Osteopathy', practiced by physicians, and use osteopathy to describe the restricted-scope form of practice in other jurisdictions.^[2] Osteopathy or osteopathic medicine has an international organisation, The World Osteopathic Health Organization (WOHO),^[3] which permits membership by both 'restricted scope manual therapist' osteopaths and American osteopathic physicians. In the United States a 'medical doctor' may be a physician who is a graduate of an allopathic medical school and has the designation of M.D., or an osteopathic medical school and has the designation of D.O. Not all 'Osteopaths' are physicians. Similarly, there is also an international organisation for statutory regulators, universities/medical schools offering osteopathic education and professional osteopathic associations, the Osteopathic International Alliance (OIA).^[4] It is contestable that osteopathy/osteopathic medicine are two completely distinct professions; the regulatory framework determines the scope of practice in a particular jurisdiction and that is subject to change. In the UK, Australia and New Zealand, osteopaths have a 'physicianly' training, are regulated primary healthcare professionals and have never been subordinate to the medical opinion, diagnosing un-triaged patients and treating or referring them on as indicated. Some of these practitioners use the honorific 'Dr'. The distinction between American osteopathic physicians and manual therapy osteopaths may be lessening, with decreased communication between different countries and concurrent evolution of scope of practice.

[edit] History

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 there he developed the practice of osteopathy.^[5]

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."^[6] 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.^[7]

[edit] Osteopathic principles

These are the four major principles of osteopathy.^[8]

1. The body is a unit. An integrated unit of mind, body, and spirit (Triune of Man - A.T. Still)
2. The body possesses self-regulatory mechanisms,having the inherent capacity to defend, repair, and remodel itself.
3. Structure and function are reciprocally inter-related
4. Rational therapy is based on consideration of the first three principles

These principles are not held by osteopathic physicians to be empirical laws; they serve, rather, as the underpinnings of the osteopathic philosophy on health and disease.

[edit] Techniques of Osteopathic Treatment

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.

[edit] 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,^[9] menstrual pain, and pulmonary infection.

[edit] Cranial osteopathy

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.^[10] 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.^[11] 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."^[12]

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.^[13]

[edit] 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.

[edit] Osteopathy around the world

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 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.^[14]

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. The key difference is that in the European and Commonwealth nations an Osteopath is NOT a physician/medical doctor. The term Osteopath, as used internationally, should not be confused with a medical doctor who is a graduate of a United States osteopathic medical school.

[edit] 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. The osteopathic profession in both jurisdictions is subject to statutory regulation along with medicine, dentistry and other allied health professions. The regulatory body in Australia is the Osteopathy Board of Australian and in New Zealand the Osteopathic Council of New Zealand.

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, Victoria University, the University of Western Sydney and Southern Cross University in Lismore. In New Zealand a course is offered at UNITEC .^[15] Australasian courses consist of a bachelor's degree in clinical science (Osteopathy) followed by a master's degree.

In New Zealand in addition to the general scope of practice, osteopaths may also hold the Scope of Practice for Osteopaths using Western Medical Acupuncture and Related Needling Techniques.^[16] Osteopathic Council of New Zealand

[edit] 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,^[17] 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.^[18] Council on Manual Osteopathy Education (CMOE)? accredits certain schools in Canada to ensure they adhere to certain standards as applicable to manual osteopathy education. The following manual osteopathy schools are currently accredited by CMOE to offer manual osteopathy education in Canada: The Canadian College of Osteopathy in Toronto, National Academy 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.^[19] Osteopathy is not yet a regulated profession in Ontario; however, practitioners, designated as Osteopathic Manual Practitioners to differentiate themselves from physician osteopaths from the United States, follow best practice guidelines set by the Ontario Association of Osteopathic Manual Practitioners. The Ontario Federation of Osteopathic Professionals is the association representing Osteopathic Therapists in Ontario, Canada. The goals of OFOP are to promote Osteopathy in Ontario and Canada, to maintain a high level of professional knoweledge and conduct among Osteopaths. [http://www.ofop.ca/>

Doctors of Osteopathic Medicine (DOs) educated in the United States should not be confused with non-physician osteopaths. DOs 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 Osteopathic Medicine in Canada. The authority for licensure of American osteopathic graduates lies with the provincial Colleges of Physicians and Surgeons.^{[20][21][22][23][24][25]} The Canadian Osteopathic Association^[26] has been representing osteopathic physicians in Canada for more than 80 years and has enabled near uniform licensure across Canada for American osteopathic graduates.

[edit] 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 Osteopaths Act 1993 has issued a position paper on European regulation of osteopathy.^[27] The teaching of osteopathy in the United Kingdom, Belgium, France, Germany, Austria and Italy is well established.^{[citation needed]}

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 ^[28] - but the NHS will not usually pay for any treatment.^[29]

Spain is into a recognition process. Nevertheless it has its national registry http://www.osteopatas.org. Recognized professionals should be listed on it.^[30]

In Germany there are rules (at the country level) under which persons (non-physicians) may call themselves Osteopath.^[31]

[edit] Israel

This section does not cite any references or sources. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (June 2010)

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. USA trained D.O.'s ("Doctor of Osteopathic Medicine" degree holders) are eligible to apply for and to receive unrestricted licence to practice medicine in Israel.

[edit] 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.^[32][33] 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 or Bachelors of Osteopathy, or Osteopathic Medicine, (BOst or MOst) or else Bachelors of Science (BSc) in Osteopathy, or Osteopathic Medicine, according to the institution attended:^[34] 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,^[35] which teaches osteopathy only to those already qualified in medicine. Before using the title of "osteopath," graduates have to register with the statutory UK regulatory body: the General Osteopathic Council.

[edit] 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.^[36] The profession adopted the name "osteopathic medicine" to reflect its distinction from osteopathy.^[37] 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.^[2]

[edit] Research

[edit] Efficacy

In a 2005 meta-analysis and systematic review of six randomized controlled trials of osteopathic manipulative treatment (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.^[38]

[edit] Mechanism

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.^[39]

[edit] Safety

Safety concerns have 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 owing 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.^[40] These data primarily concern chiropractic visits, both osteopaths and chiropractors may practise cervical manipulations, although the technique by which this is performed differs, calling in to question the validity of such conclusions strictly with regard to osteopathy, absent separate regression and perhaps a larger sample.

[edit] See also

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

[edit] References

[edit] 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