Osteopathy

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Osteopathy is an approach to healthcare that emphasizes the role of the musculoskeletal system in health and disease. It is practiced in the United Kingdom, the rest of the European Union, Israel, Canada, and Australia. Osteopathy is not to be confused with the historically related but now distinct field, osteopathic medicine in the United States.[1]

In most countries, osteopathy is 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) facilitates the recuperative powers of the body.

Contents

[edit] History

See also: Andrew Taylor Still#Osteopathy

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 here he developed the practice of osteopathy.[2]

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."[3] 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.[4]

[edit] Osteopathic principles

These are the eight major principles of osteopathy and are widely taught throughout the international osteopathic community. [5]

  1. The body is a unit.
  2. Structure and function are reciprocally inter-related.
  3. The body possesses self-regulatory mechanisms.
  4. The body has the inherent capacity to defend and repair itself.
  5. When the normal adaptability is disrupted, or when environmental changes overcome the body’s capacity for self maintenance, disease may ensue.
  6. The movement of body fluids is essential to the maintenance of health.
  7. The nerves play a crucial part in controlling the fluids of the body.
  8. 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.

[edit] Techniques of Osteopathic Treatment

Main article: Osteopathic manipulative medicine

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,[6] menstrual pain, and pulmonary infection.

[edit] Cranial osteopathy

 It has been suggested that this section be split into a new article entitled Cranial osteopathy. (Discuss)

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, although fused, do permit microscopic movement or force dissipation and that there is a 'force' or rhythm that is operating in moving the plates of the skull.[7] 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.[8] 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."[9]

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.[10]

[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

Osteopathy & Osteopathic medicine
Osteopathy in Australia & New Zealand
Osteopathy in Canada · Osteopathic medicine in Canada
Osteopathy in Europe · Osteopathic medicine in the UK
Osteopathy in Israel
Osteopathic medicine in the United States
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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 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.[11]

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.

[edit] United States

Main article: Osteopathic medicine in the 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.[12] The profession adopted the name "osteopathic medicine" to reflect its distinction from osteopathy.[13] 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.[1]

[edit] United Kingdom

The first osteopathic college was established in the UK in 1917 by Littlejohn, a Scot who had studied under Dr 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 Dr 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 Osteopathy 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.[14] [15] 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."

Many 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 Bachelors of Osteopathy or Bachelors of Osteopathic Medicine, or Bachelors of Science in either Osteopathy or Osteopathic Medicine, according to the institution attended:[16] 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[17], which teaches osteopathy only to those already qualified in medicine. Before using the title of "osteopath," graduates have to register with the UK regulatory body by statute; the General Osteopathic Council.

[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. 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, VU, SCU and UWS - and one course is offered at UNITEC in New Zealand.[18] Australasian courses consist of a bachelor's degree in clinical science (Osteopathy) followed by a master's degree.

[edit] Canada

"Osteopathy in Canada" redirects here. For a branch of the medical profession in Canada, see Osteopathic medicine in 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,[19] 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.[20] Colleges of Osteopathy in Canada are the Canadian College of Osteopathy in Toronto, the Canadian College of Osteopathic and Holistic Health Sciences in Hamilton, Ontario, and the Collège d'Études Ostéopathiques in Montreal, Quebec.[21] Graduates of these schools do not currently qualify for registration to practice in Canada.[22]

Osteopathic physicians educated in the United States should not be confused with non-physician osteopaths. Osteopathic physicians 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 osteopathy and Osteopathic Medicine in Canada. The authority for licensure of American osteopathic graduates lies with the provincial Colleges of Physicians and Surgeons.[23][24][25][26][27][28] The Canadian Osteopathic Association[29] has been representing osteopathic physicians in Canada for more than 80 years and has enabled near uniform licensure across Canada for American osteopathic graduates.

For more details on osteopathic physicians trained in the United States, see Osteopathic medicine in the United States.

[edit] Israel

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.

[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 1993 Osteopaths Act has issued a position paper on European regulation of osteopathy.[30] The teaching of osteopathy in the United Kingdom, Belgium, France, Finland, Iceland, Denmark, Malta, Switzerland is well established - but not all European nations have yet embraced this form of medicine.

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 [31] - but the NHS will not usually pay for any treatment.[32]

Spain is into a recognition process. Nevertheless it has its national registry http://www.osteopatas.org. Recognized professionals should be listed on it.[33]

[edit] Criticism

Osteopathy has been criticized for having limited research into the efficacy of treatment.[citation needed] One placebo-controlled trial concluded that osteopathy is no better than sham treatment for chronic nonspecific lower back pain, although the authors acknowledged the difficulty of providing a non-therapeutic sham treatment or for pain after knee/hip surgery.[34][35] However, in a meta-analysis and systematic review of six randomized controlled trials of 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.[36]

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.[37]

Safety concerns have also 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 due 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[38]. Although this data primarily concerns chiropractic visits, both osteopaths and chiropractors may practice cervical manipulations.

[edit] See also

[edit] References

  1. ^ a b "Osteopathy should only be used when referring to the occupation of non-physician osteopaths or those trained outside of the United States." Osteopathic Style Guide. American Osteopathic Association.
  2. ^ Baldwin City, Kansas "Among Free State leaders was Andrew T. Still, founder of osteopathy, whose theory of healing developed here."
  3. ^ "Early American Manual Therapy". http://www.meridianinstitute.com/eamt/files/webster1/webcont.html#HOW%20I%20CAME%20TO%20ORIGINATE%20OSTEOPATHY. 
  4. ^ "Education firmly established". American Osteopathic Association. http://history.osteopathic.org/educate.shtml. 
  5. ^ Extracted from the curriculum of the Andrew Taylor Still University Kirksville College of Osteopathic Medicine
  6. ^ Mills M, Henley C, Barnes L, Carreiro J, Degenhardt B (2003). "The use of osteopathic manipulative treatment as adjuvant therapy in children with recurrent acute otitis media". Arch Pediatr Adolesc Med 157 (9): 861–6. doi:10.1001/archpedi.157.9.861. PMID 12963590. 
  7. ^ What Is Osteopathy In The Cranial Field (OCF)? Osteohome website (Accessed 2nd Aug 2006
  8. ^ Wirth-Pattullo V, Hayes KW. Interrater reliability of craniosacral rate measurements and their relationship with subjects' and examiners' heart and respiratory rate measurements. Phys Ther. 1994 Oct;74(10):908-16; discussion 917-20. PMID 8090842
  9. ^ "A SYSTEMATIC REVIEW :AND CRITICAL APPRAISAL OF THE SCIENTIFIC EVIDENCE ON CRANIOSACRAL THERAPY"
  10. ^ Huba, S. (April 2, 1997). Holistic healing's new role. The Cincinnati Post.
  11. ^ Wickless, Larry (PDF). The Osteopathic International Alliance: Unification of the Osteopathic Profession. Osteopathic International Alliance Steering Committee. http://www.oialliance.org/pdf/oia_article_triad0905.pdf. Retrieved on 2006-09-19. 
  12. ^ Johnson SM, Kurtz ME. Diminished use of osteopathic manipulative treatment and its impact on the uniqueness of the osteopathic profession. Acad Med. 2001;76:821 –828. PMID 11500286]
  13. ^ Wilson, Jennifer Fisher. Osteopathic medicine's growing pains. American College of Physicians Observer. November 1997.
  14. ^ UK Back pain Exercise And Manipulation (UK BEAM) Trial Team. United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care." BMJ. 2004 Dec 11;329(7479):1377.
  15. ^ UK Back pain Exercise And Manipulation (UK BEAM) Trial Team. United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: cost effectiveness of physical treatments for back pain in primary care." BMJ. 2004 Dec 11;329(7479):1381.
  16. ^ General Osteopathic Council [1]
  17. ^ London College of Osteopathic Medicine [2]
  18. ^ "Master of Osteopathy courses, postgraduate study for a masters degree" (in English) (HTML). Unitec website. Unitec. http://www.unitec.ac.nz/?C7B4901F-385F-44F0-B37B-609CE4CC0E1E. Retrieved on 2009-01-26. "The Master of Osteopathy is the only New Zealand-based programme that enables you to register with the Osteopathic Council of New Zealand, and to enter practice as an osteopath in New Zealand." 
  19. ^ http://www.osteopathy.ca/index.html
  20. ^ Osteopathic International Alliance Statement Regarding Non-physician Osteopaths in Canada
  21. ^ The spread of Osteopathy worldwide World Osteopathic Health Organization. 26 April 2006. Accessed 13 Feb 2009.
  22. ^ Osteopathic International Alliance Statement Regarding Non-physician Osteopaths in Canada[3]
  23. ^ Canadian Osteopathic Practice (.doc)
  24. ^ Ontario Medicine Act – Restricted Titles, Section 9 [4]
  25. ^ Ontario College of Physicians Doctor of Osteopathy Registration Policy Statement [5]
  26. ^ British Columbia Medical Practitioners Act Section 40 Registration of Osteopaths [6]
  27. ^ Alberta Medical Profession Act Sections 3 and 18 [7]
  28. ^ Albert Health Professions Act Schedule 21 Use of Titles [8]
  29. ^ [http://www.osteopathic.ca/index.htm Canadian Osteopathic Association
  30. ^ European Public Health Alliance UK GOsC Position paper on pan-European regulation. Accessed 2nd August 2006
  31. ^ [9]
  32. ^ The British School of Osteopathy, Nicola Sturzaker, Education Guardian, 2 November 2004.Retrieved on 2007-07-22.
  33. ^ Osteopathy in Spain, Ma. Virginia Suarez Pereda, Osteopata Madrid, 14 January 2009.Retrieved on 2009-02-14.
  34. ^ >Licciardone JC, Stoll ST, Fulda KG, Russo DP, Siu J, Winn W, Swift J (2003). "Osteopathic manipulative treatment for chronic lower back pain: a randomized controlled trial". Spine 28 (13): 1355–62. doi:10.1097/00007632-200307010-00002. PMID 12838090. 
  35. ^ Licciardone JC, Stoll ST, Cardarelli KM, Gamber RG, Swift JN, Winn WB (2004). "A randomized controlled trial of osteopathic manipulative treatment following knee or hip arthroplasty". J Am Osteopath Assoc 104 (10): 193–202. PMID 15176518. 
  36. ^ Licciardone JC, Brimhall AK, King LN (2005). "Osteopathic manipulative treatment for low back pain: a systematic review and meta-analysis of randomized controlled trials". BMC Musculoskelet Disord 6: 43. doi:10.1186/1471-2474-6-43. PMID 16080794. 
  37. ^ "Modeled Repetitive Motion Strain and Indirect Osteopathic Manipulative Techniques in Regulation of Human Fibroblast Proliferation and Interleukin Secretion."
  38. ^ Moira K. Kapral and Susan J. Bondy (October 2001). "Cervical manipulation and risk of stroke". Canadian Medical Association Journal 165: 907–908. PMID 11599330. http://www.cmaj.ca/cgi/content/full/165/7/907. 

[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
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