Osteopathy

Definition

Osteopathy is a system and philosophy of health care that separated from traditional (allopathic) medical practice about a century ago. It places emphasis on the musculoskeletal system, hence the name—osteo refers to bone and path refers to disease. Osteopaths also believe strongly in the healing power of the body and do their best to facilitate that strength. During this century, the disciplines of osteopathy and allopathic medicine have been converging.

Purpose

Osteopathy shares many of the same goals as traditional medicine, but places greater emphasis on the relationship between the organs and the musculoskeletal system as well as on treating the whole individual rather than just the disease.

Precautions

Pain is the chief reason patients seek musculoskeletal treatment. Pain is a symptom, not a disease by itself. Of critical importance is first to determine the cause of the pain. Cancers, brain or spinal cord disease, and many other causes may be lying beneath this symptom. Once it is clear that the pain is originating in the musculoskeletal system, treatment that includes manipulation is appropriate.

Description

History

Osteopathy was founded in the 1890s by Dr. Andrew Taylor, who believed that the musculoskeletal system was central to health. The primacy of the musculoskeletal system is also fundamental to chiropractic, a related health discipline. The original theory behind both approaches presumed that energy flowing through the nervous system is influenced by the supporting structure that encase and protect it—the skull and vertebral column. A defect in the musculoskeletal system was believed to alter the flow of this energy and cause disease. Correcting the defect cured the disease. Defects were thought to be misalignments—parts out of place by tiny distances. Treating misalignments became a matter of restoring the parts to their natural arrangement by adjusting them.

As medical science advanced, defining causes of disease and discovering cures, schools of osteopathy adopted modern science, incorporated it into their curriculum, and redefined their original theory of disease in light of these discoveries. Near the middle of the 20th century the equivalance of medical education between osteopathy and allopathic medicine was recognized, and the D.O. degree (Doctor of Osteopathy) was granted official parity with the M.D. (Doctor of Medicine) degree. Physicians could adopt either set of initials.

However, osteopaths have continued their emphasis on the musculoskeletal system and their traditional focus on "whole person" medicine. As of 1998, osteopaths constitute 5.5% of American physicians, approximately 45,000. They provide 100 million patient visits a year. From its origins in the United States, osteopathy has spread to countries all over the world.

Practice

Osteopaths, chiropractors, and physical therapists are the experts in manipulations (adjustments). The place of manipulation in medical care is far from settled, but millions of patients find relief from it. Particularly backs, but also necks, command most of the attention of the musculoskeletal community. This community includes orthopedic surgeons, osteopaths, general and family physicians, orthopedic physicians, chiropractors, physical therapists, massage therapists, specialists in orthotics and prosthetics, and even some dentists and podiatrists. Many types of headaches also originate in the musculoskeletal system. Studies comparing different methods of treating musculoskeletal back, head, and neck pain have not reached a consensus, in spite of the huge numbers of people that suffer from it.

The theory behind manipulation focuses on joints, mostly those of the vertebrae and ribs. Some believe there is a very slight offset of the joint members—a subluxation. Others believe there is a vacuum lock of the joint surfaces, similar to two suction cups stuck together. Such a condition would squeeze joint lubricant out and produce abrasion of the joint surfaces with movement. Another theory focuses on weakness of the ligaments that support the joint, allowing it freedom to get into trouble. Everyone agrees that the result produces pain, that pain produces muscle spasms and cramps, which further aggravates the pain.

Some, but not all, practitioners in this field believe that the skull bones can also be manipulated. The skull is, in fact, several bones that are all moveable in infants. Whether they can be moved in adults is controversial. Other practitioners manipulate peripheral joints to relieve arthritis and similar afflictions.

Manipulation returns the joint to its normal configuration. There are several approaches. Techniques vary among practitioners more than between disciplines. Muscle relaxation of some degree is often required for the manipulation to be successful. This can be done with heat or medication. Muscles can also be induced to relax by gentle but persistent stretching. The manipulation is most often done by a short, fast motion called a thrust, precisely in the right direction. A satisfying "pop" is evidence of success. Others prefer steady force until relaxation permits movement.

Return of the joint to its normal status may be only the first step in treating these disorders. There is a reason for the initial event. It may be a fall, a stumble, or a mild impact, in which case the manipulation is a cure. On the other hand, there may be a postural misalignment (such as a short leg), a limp, or a stretched ligament that permits the joint to slip back into dysfunction. Tension, as well as pain, for emotional reasons causes muscles to tighten. If the pain has been present for any length of time, there will also be muscle deterioration. The osteopathic approach to the whole person takes all these factors into account in returning the patient to a state of health.

Other repairs may be needed. A short leg is thought by some to be a subluxation in the pelvis that may be manipulated back into position. Other short legs may require a lift in one shoe. Long-standing pain requires additional methods of physical therapy to rehabilitate muscles, correct posture, and extinguish habits that arose to compensate for the pain. Medications that relieve muscle spasm and pain are usually part of the treatment. Psychological problems may need attention and medication.

Risks

Manipulation has rarely caused problems. Once in a while too forceful a thrust has damaged structures in the neck and caused serious problems. The most common adverse event, though, is misdiagnosis. Cancers have been missed; surgical back disease has been ignored until spinal nerves have been permanently damaged.

Normal results

Many patients find that one or a series of manipulations cures long-standing pain. Other patients need repeated treatments. Some do not respond at all. It is always a good idea to reassess any treatment that is not producing the expected results.

Resources

ORGANIZATIONS

American Association of Colleges of Osteopathic Medicine. 5550 Friendship Blvd., Suite 310, Chevy Chase, MD 20815-7231. (301) 968-4100. 〈http://www.aacom.org〉.

American Osteopathic Association. 〈osteomed@wwa.com〉 〈http://www.am-osteo-assn.org〉.

KEY TERMS

Orthotics— Mechanical devices that assist function.

Prosthetics— Mechanical devices that replace missing body parts.

OSTEOPATHY

OSTEOPATHY is a system of medicine in which the structure and functions of the body are given equal importance and advocates the body's natural ability to heal itself under the right conditions. Focusing on the "rule of artery," osteopaths manipulate body joints in an effort to improve circulation. The frontier physician Andrew Taylor Still (1828–1917) developed the system in 1874 while living in Kansas. As Still's system of treatment evolved, he attempted to present his methods to the faculty of Baker University in Kansas but was turned away. Without the support of the medical community or any patients, Still made his living as an itinerant doctor until his popularity grew enough for him to establish an infirmary. He settled in Kirksville, Missouri, in 1889. Just three years later, Still opened the American School of Osteopathy (later renamed Kirksville College of Osteopathic Medicine); the school was chartered a year later. The first graduating class of seventeen men and five women studied under Still, his sons, and other doctors. Dr. James Littlejohn and Dr. William Smith—Smith, the first to be awarded the Doctor of Osteopathy (D.O.) degree, from Scotland—played important roles in the growth of the school and popularity of osteopathy. In 1897, the American Association for the Advancement of Osteopathy, later called the American Osteopathy Association, and the Associated Colleges of Osteopathy were formed. Once organized into professional associations, osteopaths began to formalize educational and professional standards. In 1905, a three-year course of study was developed; in 1915, the course was increased to four years. As the profession grew, it received recognition from governmental departments as well as the Department of Defense, which granted officer rank to osteopathic doctor volunteers. By the close of the 1970s, Doctors of Osteopathy held full practice rights in all fifty states. In 1982, more than twenty thousand doctors of osteopathy were practicing in the United States.

BIBLIOGRAPHY

Wardwell, Walter I. Chiropractic: History and Evolution of a New Profession. St. Louis, Mo.: Mosby-Year Book, 1992.

Lisa A.Ennis

osteopathy , practice of therapy based on manipulation of bones and muscles. This school of medicine, founded by A. T. Still in 1874, maintains that the normal body produces forces necessary to fight disease and that most ailments are due to "structural derangement" of the body. Frequent slight strains are held to be capable of causing misalignment of bones and various other conditions of the muscle tissue and cartilage, and treatment is directed toward correction of these conditions.

The first school of osteopathy was founded at Kirksville, Mo., in 1892. A growing number of other colleges in the United States are accredited by the American Osteopathic Association to give the required four-year course of training and to grant the degree of D.O. (Doctor of Osteopathy). These colleges give a complete course of instruction in conventional medicine as well as in osteopathic theory and practice. Osteopaths are licensed to practice medicine, including surgery and the prescription of drugs, throughout the United States. Many specialize in treating bone and muscle conditions, but about half are primary-care physicians in general medical practice.

Bibliography: See E. R. Booth, History of Osteopathy and Twentieth-Century Medical Practice (1924); E. H. Bean, The Spirit of Osteopathy (1956); J. M. Hoag, Osteopathic Medicine (1969).

os·te·op·a·thy / ˌästēˈäpə[unvoicedth]ē/ • n. a branch of medical practice that emphasizes the treatment of medical disorders through the manipulation and massage of the bones, joints, and muscles. DERIVATIVES: os·te·o·path / ˈästēəˌpa[unvoicedth]/ n. os·te·o·path·ic / ˌästēəˈpa[unvoicedth]ik/ adj. os·te·o·path·i·cal·ly / ˌästēəˈpa[unvoicedth]ik(ə)lē/ adv.

osteopathy (osti-op-ă-thi) n. a system of diagnosis and treatment based on the theory that many diseases are associated with disorders of the musculoskeletal system. Diagnosis and treatment of these disorders involves palpation, manipulation, and massage. Osteopathy provides relief for many disorders of bones and joints.
—osteopath (ost-i-ŏ-path) n. —osteopathic (osti-ŏ-path-ik) adj.

osteopathy System of alternative medical treatment based on the use of physical manipulation of joints to rectify damage caused by mechanical stresses. US physician Andrew Still founded osteopathy in 1874.

osteopathy •Cathy •Iolanthe, Xanthe •McCarthy • breathy •healthy, stealthy, wealthy •lengthy •heathy, Lethe •pithy • filthy •bothy, frothy, mothy, wrathy •toothy •polymathy, timothy •apathy • telepathy • empathy •antipathy • sympathy •encephalopathy, homeopathy, osteopathy •Dorothy • earthy