Osteopathic Medicine and Osteopathy
Osteopathic medicine is defined as a comprehensive system of healthcare based upon a specific philosophy and distinctive art. Our philosophy and principles embrace holistic evaluation and treatment of patients to obtain the best possible outcomes in medical care. Our art is the use of sensitive palpatory diagnostic skills and osteopathic manipulative treatment (OMT) to assist in facilitating the patient’s own healing abilities. Hands-on treatment is beneficial not only for a variety of musculoskeletal problems, but also for visceral, lymphatic, autonomic, central and peripheral nervous system disorders. OMT works to balance the body, mind, and spirit of the individual and may influence bioenergetic realms. It is what distinguishes and separates us from the allopathic profession and all other healthcare professionals.
Osteopathic medicine has been in existence for over a century and a quarter. It was originally named Osteopathy by its founder, Andrew Taylor Still, MD, who envisioned a better way of treating patients without the use of drugs. Dr. Still believed that the human being contains within all drugs necessary to maintain health and fight disease. He developed hands-on manipulative therapies (osteopathic manipulation) to treat abnormalities in the patients’ anatomy (structure) and, thus, enhance his/her functioning and healing. He advocated proper exercise and nutrition and strongly believed in the triune nature of the person (body-mind-spirit). He strongly believed that the ultimate Source of healing was God.
Osteopathy developed as a form of alternative medicine against the established allopathic (MD) model of the late 19th century. It was based upon a holistic philosophy and specific principles laid down by Dr. Still. He stated, “we look at the body in health as meaning perfection and harmony, not in one part, but as a whole.” These osteopathic principles can be summarized in present-day terms as follows:
- The human being is a unit, consisting of body, mind and spirit.
- Structure (anatomy) and function (physiology) are reciprocally interrelated.
- The human being is capable of self-regulating, self-healing, and health-maintenance.
- Rational treatment is based upon an understanding of the basic principles of unity, self-regulation, and the interrelationship of structure and function.
To many patients, medicine today seems to be impersonal high-tech, low-touch. The art of osteopathy (and osteopathic medicine) is practiced through the intelligent use of the doctor’s hands to communicate with, diagnose, and treat the patient. An extraordinary amount of information about a patient’s condition can be gathered by listening to the body through the sense of touch. The patient’s neuromusculoskeletal system can relay all sorts of information about abnormal processes occurring in the body. A refined sense of diagnostic touch tells much more than what a patient thinks and says is wrong.
The use of the hands is not limited to receiving information about the health of an individual. The hands can be used to heal by restoring normal structural (anatomical) relationships in the body, thus improving body function. This is called osteopathic manipulative treatment (OMT).
For a variety of reasons, osteopathy evolved into present-day osteopathic medicine. Osteopathic medicine is the only other system in the U.S. besides allopathic (MD) medicine that provides complete healthcare. Osteopathic physicians, therefore, are fully-licensed and are trained to be family physicians, internists, orthopedists, pediatricians, sports medicine specialists, physical medicine and rehabilitation specialists, oncologists, cardiologists, gastroenterologists, neurosurgeons, dermatologists, urologists, OB/Gyn physicians, general surgeons, plastic surgeons, psychiatrists, pathologists, etc. We are able to prescribe medications and perform surgery when necessary. Many of us maintain an integrative approach to healthcare by combining our holistic philosophy and osteopathic skills with conventional medicine. For a comparison of osteopathic medicine, allopathic medicine, chiropractic, and naturopathy, please see Table 1.
|Osteopathic (DO)||Allopathic (MD)||Chiropractic (DC)||Naturopathic (ND)|
|Undergraduate college||4 years||4 years||3-4 years||4 years|
|Medical College Admission Test (MCAT)||Yes||Yes||No||No|
|Postgraduate training||7-10 years||7-10 years||4 years||4-6 years|
|Hospital internship & residency||Yes||Yes||No||No|
|Scope of practice||Unlimited including manipulation||Unlimited||Limited to manipulation, dietary supplements primarily||Limited to preventative, nutrition, manipulation, hydrotherapy|
|Licensure||All 50 states||All 50 states||All 50 states||12 states|
|Surgery||Yes||Yes||No||Only minor procedures|
|Medical Specialties||All with emphasis on primary care||All with emphasis on specialty||Some specialties||Some with emphasis on natural medicine|
|Formal training – manipulation||Yes (Osteopathic)||No||Yes (Chiropractic)||Yes (Naturopathic)|
|Founder||A.T. Still, MD||European origins||D.D. Palmer||Benedict Lust|
|Philosophy||Holistic, preventative, integrative||Reductionistic, technology oriented||Spinal manipulation primary healing modality||Holistic, natural (non-drug) approach to wellness, prevention|
What is Osteopathic Manipulative Treatment (OMT)?
Osteopathic manipulative treatment (OMT) is the therapeutic use of one’s hands to restore normal structural relationships within the body. By restoring normal anatomical relationships, one can improve the functioning of the body.
“Manipulation” is a term that is often associated with various hands-on procedures performed by chiropractors to align the spine. Indeed, the spine is often a focal point of therapy and the osteopathic profession has developed many of its own unique manipulative treatments for abnormalities in spinal alignment and other body parts. Actually any joint in the body and many organs and soft tissues (muscles, ligaments, tendons) can be treated with OMT. Osteopathic techniques were developed independently of the chiropractic profession and are taught today in all osteopathic medical schools. Perhaps you have benefited in some way when your osteopathic physician performed OMT on you in the office or hospital.
How does OMT improve body functioning?
Besides aligning joints and other tissues to their proper positions, OMT also:
- Restores normal blood flow into an area by affecting the arteries (improves the supply of oxygen and nutrients into tissues).
- Restores normal blood flow out of an area by affecting the veins (improves drainage of waste products from tissues and eliminates congestion).
- Improves lymphatic drainage (reduces swelling).
- Improves nervous system function by reducing or eliminating mechanical compression of nerves and parts of the brain and spinal cord.
- Reduces abnormal reflexes from organs to the body (viscerosomatic reflexes) or the body to organs (somatovisceral reflexes) that may be contributing to the disease state.
- Decreases or eliminates pain.
- Stimulates the immune system.
- Prevents recurrences of pain, organ or body (somatic) dysfunction.
- Reduces the effects of stress.
- Restores bioenergetic balance
- Restores balance to the body-mind-spirit.
Many different OMT techniques have been developed to address the uniqueness of each individual. Some techniques primarily treat joints, while others focus on muscles, soft tissues, organs, nervous system, and the immune system. Some OMT techniques have a primary effect on emotions and even the spiritual dimensions of an individual.
Here is a partial listing of various named techniques developed within the osteopathic profession:
- Soft tissue
- Myofascial release (MFR)
- Muscle-Energy (ME)
- Strain-Counterstrain (S-CS)
- Articulatory Techniques
- Lymphatic Techniques
- Facilitated Positional Release
- Ligamentous Articular Strain (LAS)
- Balanced Ligamentous Tension (BLT)
- Osteopathic Cranial Manipulative Medicine (OCMM) (Cranial osteopathy, craniosacral)
- Visceral (organ) Manipulation
- Functional Technique (FT)
- Neurofascial Release (NFR)
- Somatoemotional Release (SER)
- Dynamic Strain-Vector Release (SVR)
- Bioenergetic Techniques and others (See Energy Medicine)
What Conditions can be Treated with OMT?
OMT can be used to effectively treat a variety of common ailments with or without the adjunctive use of medications. These include acute and chronic pain, tension headaches, migraines, TMJ (temporomandibular joint) disorders, neck and back pain, sports injuries, sprains and strains, overuse or repetitive motion injuries, carpal tunnel syndrome, thoracic outlet syndrome, motor-vehicle accident related injuries, whiplash injuries, closed head injuries, and work-related injuries. Osteopathic manipulation can also be helpful in treating chronic ear infections in children, birth trauma, plagiocephaly, sinusitis, allergies, asthma, pneumonia, gastrointestinal disturbances such as constipation, irritable bowel syndrome, hiatal hernia, gastroesophageal reflux (GERD), gastritis, peptic ulcers, post-surgical pain and complications, swelling in the arms or legs, and many other conditions. Manipulative treatment can also help to release emotions stored in the body and assist in the personal growth and transformational processes that characterize deeper levels of healing.
How Often do I Need Treatment?
The goal of osteopathic manipulative treatment is to facilitate the healing process. Every patient is unique in his or her capacity to heal, so there is some individual variation in response to OMT. Typically, an osteopathic physician attempts to help a patient get back to normal in as short a time as possible.
OMT should be performed at a minimum effective frequency for a minimum effective duration. A patient usually needs treatment at a maximum of once or twice a week. The minimum effective duration varies depending upon the condition being treated as well as other factors. Many types of acute sprains and strains of the neck or low back may only require one to three treatments to resolve. More chronic conditions or multiple areas of injury (such as in a motor-vehicle accident) require more prolonged treatment. In addition to OMT, adjunctive therapies such as exercise, nutritional modifications, physical therapy, psychotherapy, biofeedback, neurofeedback, massage, Rolfing, trigger point myotherapy, meditation and acupuncture can be beneficial and are often vital in facilitating rehabilitation.
The efficacy and cost-effectiveness of osteopathic care have been shown time and time again. Comparison studies performed by Colorado, Hawaii, and Florida workers-compensation commissions demonstrated that for work-related low back problems, treatment by osteopathic physicians was significantly more cost-effective than treatment by surgical and non-surgical MDs, physical therapists, and chiropractors.
An Overview of Osteopathic Manipulative Techniques (OMT)
The value of touching a patient for diagnostic or therapeutic purposes is universally acknowledged by healthcare professionals. This essential component of the doctor-patient relationship has a great deal to do with the patient’s well-being, whether he/she suffers from the common cold or a terminal disease.
The overview below describes common techniques that are taught to osteopathic medical students and/or employed by those physicians who practice hands-on osteopathic manipulative care. There are many advanced-level techniques, such as Dynamic Strain-Vector Release and Somatoemotional Release that provide a deeper body-mind-spirit approach.
This procedure is commonly applied to the musculature surrounding the spine and elsewhere consisting of a rhythmic linear stretching, and deep pressure and traction.
Its purpose is to relax tight muscles and fibrous tissue layers and to move tissue fluids.
Here the patient is directed to use his/her muscles from a precise position and in a specific direction against a counterforce applied by the physician in order to increase the mobility of a particular joint or body area. Muscle-energy helps restore muscle balance.
A technique developed by Larry Jones, DO, in which the physician finds an exquisitely sensitive tender point in the muscles that is associated with a particular dysfunction. The patient is positioned in a manner as to relieve tension and tenderness at the point. The position is held for 90 seconds, during which time the tissue releases and tenderness and dysfunction resolve.
Articulatory or Thrusting
Here a physician applies a quick force to restore normal joint motion. This technique uses biomechanical long- and short-lever systems in the body and can be done very gently. In some respects, these are similar to some chiropractic techniques where one often hears the joint pop.
These methods promote the circulation and drainage of lymphatic fluids and can be used to relieve respiratory tract infections, swelling in the tissues, and other conditions.
Osteopathic Cranial Manipulative Medicine (OCMM)
A gentle technique developed by William Garner Sutherland, DO, in the early 1900s. It uses the inherent subtle rhythmic motion of the body to restore normal cranial and sacral structural/functional relationships. Can be used to treat traumatic head injuries, birth trauma, headaches, TMJ disorders, ringing in the ears, dizziness, and even some visual disturbances. It is also extremely useful for treating middle ear infections (otitis media) in children and can prevent the need for antibiotics. OCMM can be utilized to balance and normalize the structure of the head and face in newborns and infants who have plagiocephaly (crooked heads) and potentially replace or limit the need for helmets.
Developed and practiced in the early days of the osteopathic profession. Re-popularized by French osteopath Jean-Pierre Barral, DO, and his American protege, Kenneth Lossing, DO. Involves gentle manipulation and stretching of the viscera (internal organs) to restore normal motility and function.
Dynamic Strain-Vector Release
Developed in the early 2000s by myself and Richard O’Brien, DO. This OMT technique utilizes energetic strain-vectors within tissue distortions to normalize physical structure and function. Efficacy is based upon Einstein’s famous equation E=mc2 which describes energy and matter as interconvertible, and upon Chinese medicine concepts. Energy, rather than matter (the physical body), is actually manipulated. Correction of energy dysfunction thus changes physical dysfunction in the body.
A technique combining OCMM with guided-imagery to create powerful body-mind healing. Co-developed by Martin Rossman, MD, and John Upledger, DO, in the 1980s.
Energy Medicine is a system of healthcare that uses energetics (i.e. biophysics) for diagnosis, treatment, and prevention of disease. Although commonly applied to certain aspects of integrative or complementary and alternative medicine (CAM), energy medicine principles have been used extensively in conventional Western medicine for years.
Medical tests that use a person’s electrical and magnetic energy to diagnose and image abnormal conditions in the body include the:
- ECG (heart)
- EEG (brainwaves)
- EMG (muscles and nerves)
- Pulse oximetry (blood oxygen levels)
- Holter monitor (heart)
- Thermography (heat, cold, blood flow)
- MRI (structural abnormalities)
- X-rays and CT scans all utilize radiation energy to image bones and soft tissues.
- Ultrasound (US) uses sound waves to image organs.
- Newer computerized techniques such as PET scans and functional MRIs can give us a 3-dimensional view of a person’s anatomy.
- SQUID (Superconducting Quantum Interference Device) Magnetometry (magnetic fields produced by the body)
Energy-based conventional therapies include:
- Ultrasound (US)
- Thermal (heat and cold)
- Bone stimulators (electric/magnetic)
- TENS units
- Electrical stimulators
- X-ray and gamma radiation (for cancer treatment)
- Heart defibrillators
- Light therapy (newborn jaundice, skin conditions, laser surgery)
- Radio frequency devices
Einstein’s famous equation E=mc2 means that energy and matter are interconvertible, and that matter is simply condensed energy. Our bodies (matter) produce energy and are energy. They are animated by an energetic life force. This energetic flowing life force goes by various names such as L-field, chi, qi, ki, prana, vital force, subtle energy, spirit, breath of life, tide, potency etc. A bioelectromagnetic field can be detected around the body with sensitive scientific instruments.
The biophysics of living systems is not emphasized in conventional biology and medicine. However, energy is the driving force behind chemical reactions and communication within the body. Energy is behind the healing phenomenon in large part.
In integrative medicine, energy models of healing abound. They underlie such modalities as acupuncture, hands-on healing, Reiki, Qi Gong, Pranic Healing, Therapeutic Touch, Healing Touch, Polarity Therapy, Jin Shin Jyutsu, acupressure, reflexology, shiatsu, chakra balancing, Zero balancing, homeopathy, music therapy, color therapy, laser acupuncture, auricular or ear acupuncture therapy, flower essence therapy, homeopathy, and many others.
Energy models to explain how osteopathic manipulation works have also been theorized. One of the techniques that employs this concept is Dynamic Strain-Vector Release.
Do a Healers Hands Actually Emit Energy for Healing?
Patients often report feeling a sensation of heat in an area of their body that is being treated with one’s hands or with acupuncture needles. When treating the head region with manipulation (i.e., OCMM, cranial osteopathy, craniosacral treatment), patients often report seeing colors, even though their eyes are closed.
The photos below were taken without a flash using what light was available in the room.
This first photograph was taken by me for a physician CME presentation on acupuncture. It illustrates an acupuncturist taking a patient’s pulses to aid in oriental medicine diagnosis. You will notice an apparent image of whitish-yellow light emanating from the area.
Both photographs were taken with a SLR camera and standard film with no special lighting or flash. The images of light or energy surprisingly showed up when the film was developed and were not visible during the photo shoot.
Energy emanating from the hands of healers has been measured scientifically in several ways. John Zimmerman, PhD, at the University of Colorado measured magnetic fields projected by the hands using an exquisitely sensitive instrument known as the SQUID magnetometer. These fields generally resonated at a frequency of 8 Hz (8 cycles/second). This 8 Hz frequency is actually the same as our brainwaves during meditation.
Healing energy emitted from the hands was measured using a digital real-time neurofeedback machine developed by Margaret Ayers. One simply placed the hand near (but not touching) the amplifier for this device, and recorded what appears to be an amplified EEG reading. By consciously thinking about sending energy from the hand, one could increase the voltage significantly over the background activity. In this preliminary study, the electrical activity measured follows a similar pattern to that recorded by Dr. Zimmerman. Thus, it appears that the nature of this energy may be, at least in part, electromagnetic.
Margaret Ayers’ digital real-time EEG biofeedback machine recorded 250,000 samples of data per second. This data was stored on a computer in several ways, including average voltages (microvolts) per minute. Below is a table showing the average voltages before, during, and after sending energy. Actual data shows average voltages (microvolts) of Beta and Theta filtered frequencies measured during the above preliminary experiment.
More research into the true nature of energy healing needs to be conducted. For an in-depth discussion on this subject, please refer to informative books by James L. Oschman, PhD, entitled, Energy Medicine: The Scientific Basis, 7, 8 and Energy Medicine in Therapeutics and Human Performance.9