What is osteopathy?

Osteopathy, or osteopathic medicine, is based on the belief that most diseases are related to problems in the musculoskeletal system and that structure and function of the body are inseparable. The musculoskeletal system is comprised of the nerves, muscles, and bones -- all of which are interconnected and form the body's structure.

What is the history of osteopathy?

Osteopathy was founded in 1874 by Andrew Taylor Still. Still was a Missouri physician who had become frustrated with what he viewed to be the ineffective and hazardous nature of remedies at that time. He believed that the doctor's role in combating disease was to restore proper musculoskeletal function to the body. Despite mainstream opposition, Still founded the American School of Osteopathy in Missouri in 1892. The school taught manual manipulation, nutrition, and lifestyle modifications rather than surgery and drug therapies.

In 1896, Vermont became the first state to license D.O.s, and the American Osteopathic Association was formed in 1901 to regulate the profession. Even with these important milestones, those in conventional medicine continued to disapprove of osteopathy until 1962, when D.O.s were recognized for full practice rights in all 50 states (provided they obtain a license in any given state). By 1973, the California Medical Association invited D.O.s to join and become voting members.

Today, doctors of osteopathy (D.O.s) receive the same basic training as medical doctors (M.D.s), but they also learn manipulation therapies (hands-on adjustments of muscles, bones, and ligaments) and use these in addition to more conventional medical treatments. Most D.O.s are primary care practitioners, specializing in family medicine, internal medicine, obstetrics/gynecology, or pediatrics.

D.O.s practice in all specialties of medicine ranging from emergency medicine and cardiovascular surgery to psychiatry and geriatrics. D.O.s trained in various specialty areas are also taught to take a whole patient approach.

According to the American Osteopathic Association, there are well over 61,000 osteopathic physicians practicing in the United States today. Although osteopathic manipulations were originally intended and used to treat all forms of disease, now they are considered useful mostly for musculoskeletal conditions.

How does osteopathy work?

Long nerves connect the spine to various organs in the body. Andrew Taylor Still believed that every disease or illness began with structural problems in the spine. According to Still, when problems arise in the spine the nerves send abnormal signals to the body's organs. Still called these spinal problems "osteopathic lesions" ("osteo" for bone and "pathic" for diseased), and devised osteopathic manipulation techniques (OMTs) to treat them. Such lesions are detected by the osteopathic doctor from abnormal texture of the skin and other soft tissues of the body as well as from restricted range of motion in the joints. OMTs range from light pressure on the soft tissues to high-velocity thrusts on the joints. These treatments, he believed, would return the nerves to their normal function and allow the blood to flow freely throughout the circulatory system. With structure restored, the body's own natural healing powers would then be able to restore the entire body to full health.

Osteopathy also pioneered the techniques that have become known as craniosacral therapy, which is now practiced in a variety of different disciplines. Craniosacral therapy is the gentle manipulation of the bones of the skull. This therapy can result in a restoration of balance to the whole system.

What happens during a visit to the osteopath?

A visit to a D.O. is much like a visit to your family doctor. The D.O. will ask you questions about your medical history, physical condition, and lifestyle. However, because D.O.s have particular expertise in musculoskeletal systems (namely, bones, joints, and soft tissues like ligaments and tendons), the physical exam of that bodily system will be more extensive than one with your family doctor. During the physical, the D.O. will assess your posture, spine, and balance; check your joints, muscles, tendons, and ligaments; and may use their hands to manipulate your back, legs, or arms. Variations in your skin temperature and sweat gland activity will also be measured. If needed, the D.O. will order x-rays and laboratory tests. When the results are in, the D.O. will make a diagnosis and establish a treatment plan for you that may even include prescriptions for medications.

For problems involving the bones, muscles, tendons, tissues, or spine, many (but not all) D.O.s use OMTs. There are two categories of OMT procedures: direct and indirect. In direct OMT, "problem," or "tight," tissues are moved (by the D.O., the person being treated, or both) toward the areas of tightness or restricted movement. In indirect OMT, the D.O. pushes the "tight" tissues away from the area of restricted movement, in the opposite direction of the muscle's resistance. The D.O. holds the tissues in this position until the tight muscle relaxes.

What illnesses and conditions respond well to osteopathy?

A majority of osteopathic doctors use many of the medical and surgical treatments used by medical doctors. OMTs are applied to a variety of health problems, both musculoskeletal and non-musculoskeletal. The best evidience showing a benefit for OMTs are most effective for back and neck pain. In fact, if you have back pain, you may be able to reduce the amount of pain medication you are taking if you receive OMTs as part of your therapy.

Examples of conditions for which OMTs have NOT been shown to be helpful include:

• Stress-related problems (such as tension headaches, muscle spasm)
• Strains and sprains (especially of the neck and back)
• Shoulder pain
• Osteoarthritis
• Headaches
• Painful menstruation
• Injuries (such as whiplash or ankle problems)
• Scoliosis (side to side curvature of the spine)
• Infantile colic
• Insomnia
• Parkinson disease
• Asthma and bronchitis
• Postoperative pain or function

Are there conditions that should not be treated with osteopathy?

You should avoid osteopathic manipulation if you have a broken bone or dislocation, bone cancer, a bone or joint infection, damaged ligaments, rheumatoid arthritis of the neck, or osteoporosis. Osteopathic manipulation is also not recommended for people who recently underwent joint surgery or for people taking an anticoagulant (blood-thinning) medication, such as aspirin or warfarin (Coumadin).

Are there risks associated with osteopathy?

Shortly after an OMT treatment you might feel an increase in pain, slight headache, or fatigue. These symptoms are temporary, and generally disappear within a day. More serious adverse events of stroke and spinal injury have been reported following manipulation of the neck. This complication is extremely rare.

How can I find a qualified practitioner?

Locate a licensed D.O. in your area who has been trained in one of the medical schools or teaching hospitals approved by the American Osteopathic Association (AOA), at www.osteopathic.org.

For additional information or referrals, see:

• American Academy of Osteopathy: www.academyofosteopathy.org
• American College of Osteopathic Family Physicians: www.acofp.org

Eisenhart AW, Gaeta TJ, Yens DP. Osteopathic manipulative treatment in the emergency department for patients with acute ankle injuries. J Am Osteopath Assoc. 2003;103(9):417-421.

Gamber RG, Shores JH, Russo DP, et al. Osteopathic manipulative treatment in conjunction with medication relieves pain associated with fibromyalgia syndrome: results of a randomized clinical pilot project. J Am Osteopath Assoc. 2002;102(6):321-325.

Guiney PA, Chou R, Vianna A, et al. Effects of osteopathic manipulative treatment on pediatric patients with asthma: a randomized controlled trial. J Am Osteopath Assoc 2005;105(1):7-12.

Hing WA, Reid DA, Monaghan M. Manipulation of the cervical spine. Man Ther. 2003;Feb, 8(1):2-9.

Hondras MA, Linde K, Jones AP. Manual therapy for asthma. Cochrane Database Syst Rev. 2005 Apr 18;(2):CD001002. Review.

Huntzingkr A. AAP Publishes recommendations for the diagnosis and management of bronchiolitis. Am Fam Physician. 2007 Jan 15;75(2); 265-244.

Jarski RW, Loniewski EG, Williams J, et al. The effectiveness of osteopathic manipulative treatment as complementary therapy following surgery: a prospective, match-controlled outcome study. AlternTher Health Med. 2000;6(5):77-81.

Licciardone J, Gamber R, Cardarelli K. Patient satisfaction and clinical outcomes associated with osteopathic manipulative treatment. J Am Osteopath Assoc. 2002;102(1):13-20.

Licciardone JC, Stoll St, Cardarelli KM, et al. A randomized controlled trial of osteopathic manipulative treatment following knee or hip arthroplasty. J Am Osteopath Assoc. 2004;104(5):193-202.

Licciardone JC, Brimhall AK, King LN. Osteopathic manipulative treatment for low back pain: a systematic review and meta-analysis of randomized controlled trials. BMC Musculoskelet Disord. 2005 Aug 4;6:43.

McReynolds TM, Sheridan BJ. Intramuscular ketorolac versus osteopathic manipulative treatment in the management of acute neck pain in the emergency department: a randomized clinical trial. J Am Osteopath Assoc. 2005 Feb;105(2):57-68.

Spiegel AJ, Capobianco JD, Kruger A, Spinner WD. Osteopathic manipulative medicine in the treatment of hypertension: an alternative, conventional approach.Heart Dis. 2003;5(4):272-278.

Suchowersky O. Practice parameter: neuroprotective strategies and alternative therapies for parkinson disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2006 Apr 11;66(7): 976-82.

Williams NH, Wilkinson C, Russell I, et al. Randomized osteopathic manipulation study (ROMANS): pragmatic trial for spinal pain in primary care. Fam Pract. 2003;20(6):662-669.