A Distinctive Branch of Mainstream
Medical Care
Should the physician focus on the patient
or the patient's disease? This debate has raged from the beginning of
medical history when the Hippocratic philosophy centered on the patient
and the rival Cnidian philosophy focused on the disease.
Today only one branch of mainstream
medicine follows the Hippocratic approach. It is osteopathic medicine
and currently some 33,000 osteopathic physicians and surgeons offer the
public a different dimension in medical care.
What is the osteopathic medical
philosophy? In brief, D.O's or Doctors of Osteopathic Medicine, are
fully licensed and recognized physicians and surgeons who stress the
unity of all body systems. They also emphasize the musculoskeletal
system, holistic medicine, and proper nutrition and environmental
factors. They bring a hands-on approach to medicine and view palpation
and manipulation as aids to the diagnosis and treatment of various
illnesses.
Osteopathic medicine was founded on the
Missouri frontier in 1874. Dr. Andrew Taylor Still was an
individualistic and strong-willed M.D. who was dissatisfied with the
ineffectiveness of nineteenth-century medicine. He decried the
rudimentary drugs and surgery of the day and saw many people, including
his own three children, die from serious diseases. Concepts such as
anesthesia, sterile surgery, antiseptics, antibiotics, and x-rays were
not imagined in the 1870s.
In response, Dr. Still founded a
philosophy of medicine that harkened back to Hippocrates with its
central focus on the body unity. He identified the musculoskeletal
system as a key element of health. He recognized the body's capacity to
heal. He stressed preventative medicine, eating properly, and keeping
fit (which mainstream America wholeheartedly embraced in the 1970s).
He identified palpation and the human
touch as vital to gaining patient confidence and providing effective
medical care. And he stressed manipulation as a less-intrusive form of
diagnosis and treatment. Currently, many Americans seek procedures and
therapies that are less invasive and less likely to escalate cost or
engender side effects.
Today, D.O.s offer mainstream medical
care but mainstream medical care with a difference.
Osteopathic Concept:
The human body is a unified organism.
Osteopathic physicians emphasize that all body systems, including the
musculoskeletal system, operate in unison and disturbances in one
system can alter functions of other systems. By recognizing the close
relationship between body structure and organic functioning, the D.O.
has a broader base for treating the whole patient.
Practice Application:
D.O.s follow a holistic, common-sense
approach to health care that views each patient in his or her
entirety.
Osteopathic physicians not only
recognize the interdependence of all parts of that complex machine -
the human body - but also consider the patient's mental and emotional
status. In addition, the D.O. pays attention to the relationship of
the patient to his or her home environment, job, or other factors that
affect health.
For example, the surgical removal of a
diseased gallbladder is a valuable and acceptable practice of
osteopathic physicians. However, D.O.s believe that medicine must be
more than an attempt to repair, relieve, or remove the end-product of
disease processes. The gallbladder does not malfunction independently;
its nerve and blood supply and the chemical balance of body fluids
also may be implicated. Besides arresting an acute episode of illness,
the D.O.'s underlying concern is to return the patient to a state of
optimum health by dealing directly with the internal conditions that
caused the disease in the first place.
The holistic tradition of osteopathic
medicine is reflected in the fact that a great percentage of
graduating D.O.s enter primary care where they view the patient as a
total entity. In addition, the majority of today's osteopathic
physicians practice in smaller towns and rural areas - where the need
for primary health care is greatest. Even when a D.O. becomes a
specialist such as a neurosurgeon, cardiologist, anesthesiologist, or
psychiatrist, he or she still sees each patient as a whole person and
stresses that illness can have its origin in another part of the body.
Osteopathic Concept:
The body's musculoskeletal system is
central to the patient's well-being.
This system includes the bones,
muscles, tendons, tissues, nerves, and spinal column - about 60% of
the body mass. The musculoskeletal framework, D.O.s point out, is far
more than an anatomical rack on which other organs are hung. It works
in concert with all other organs. It may respond - properly or
improperly - when a breath is drawn or body movement occurs. Besides
being prone to mechanical disorders, the musculoskeletal system
reflects many internal illnesses and may aggravate or accelerate the
process of disease in the circulatory, lymphatic, nervous, and other
body systems.
Osteopathic physicians utilize all of
the recognized procedures and modern technologies for prevention,
diagnosis, and treatment of disease including drugs, radiation, and
surgery. But the D.O. also has another pair of tools that enable him
or her to accurately diagnose areas of dysfunction and treat them
effectively. These tools are his or her hands.
Practice Application:
Osteopathic manipulation of the
musculoskeletal system is a viable and proven technique for many
hands-on diagnoses and treatments. Often, it can provide an
alternative to more intrusive therapies involving drugs and/or
surgery.
Manipulation brings an added dimension
to the osteopathic physician's diagnostic and therapeutic
armamentarium. Sometimes it is in the form of palpation (touch) as a
diagnostic procedure to detect soft tissue changes or structural
asymmetries; other times it's in the form of corrective manual forces
to relieve dysfunction or restrictions of motion in joints. Because
musculoskeletal dysfunction can mimic other disease syndromes,
osteopathic manipulation is an important component in different
diagnoses as well as a means of correcting structural problems.
It has been well-documented that
diseases of the specific organs can produce pain in distant parts of
the body. Stomach ulcers consistently cause areas of paraspinal pain
and irritation just below the shoulders in the back. The radiation of
pain to the loin from a diseased kidney is another typical example as
is the reflection of pain and disability to the left shoulder
following heart disease. In diagnosing such diseases, D.O.s recognize
that symptoms can be produced without actual disorder in organs to
which pain has been referred.
Conversely, disturbances affecting the
musculoskeletal system can cause symptoms that simulate the onset of
other illnesses. Among the most common causes of recurrent tension
headaches, for example, are disorders of the cervical (upper) portion
of the spinal column. Consequently, properly applied manipulative
treatment, particularly directed to the neck and head, often affords
relief of headache symptoms when all other remedies have failed.
Osteopathic Concept:
The body has a natural tendency toward
health as well as the capacity to resist disease and to heal
itself.
The body's own healing power, vis medicatrix naturae, is a main
principle of osteopathic medicine and a basic condition of all
diagnosis and treatment. Therefore, osteopathic practice is designed
to support, stimulate, and in some instances initiate the body's trend
toward health.
Practice Application:
In addition to treating specific health
problems, the D.O.s goal is to help every patient function at his or
her highest level of efficiency. There is a fundamental concern with
preventive medicine, proper nutrition, and keeping a patient fit.
D.O.s pioneered the concept "wellness" 100 years ago. In
today's terms, personal health risks - such as smoking, high blood
pressure, excessive cholesterol levels, stress, and other lifestyle
factors - are evaluated for each individual. In coordination with
appropriate medical treatments, the osteopathic physician acts as a
teacher and guide to help patients take more responsibility for their
own being and change unhealthy patterns.
Sports medicine also is a natural
outgrowth of osteopathic practice which focuses on the musculoskeletal
system, manipulation, diet, exercise, and fitness. Many professional
sports team physicians, olympic physicians, and personal sports
medicine physicians are D.O.s.
Osteopathic Concept:
The osteopathic profession cooperates
with all other branches of medical service. However, it maintains its
professional independence in order to sustain and develop osteopathic
medicine as a unique and comprehensive system of health care.
Practice Application:
Osteopathic medicine plays a
distinctive role in the nation's health care delivery system.
D.O.s hold the same unlimited practice
rights as M.D.s in all 50 states; they serve as commissioned officers
in the medical corps of all armed forces plus the Veterans
Administration and Public Health Service, and they are recognized by
the AMA as full-practice physicians.
D.O.s admit and treat patients in both
osteopathic and allopathic (M.D.) hospitals and clinics. Many D.O.s
and M.D.s work as colleagues in a range of medical settings, and the
patient referrals between the two professions are common. Many M.D.s
have D.O.s as personal physicians, especially for the philosophical
concepts and manipulation. Participation in federal Medicare and
Medicaid programs is also on an equal basis.
Although osteopathic medicine
represents only five percent of the U.S. physician population, it is a
fast-growing segment of the health care field. The number of
osteopathic medical colleges has more than tripled since 1975.
By combining unique osteopathic
principles with traditional diagnostic and therapeutic procedures, D.O.s
offer a balanced system of health care to both prevent and cure disease.
In fact, the osteopathic approach is philosophically the only true
system of preventive medicine.
And by treating the whole person, not
just the disease, the D.O. actively seeks to improve the quality of life
of each patient.
The American Academy of Osteopathy is
ready to answer your questions about the profession and its special
contributions to U.S. health care.
AN OVERVIEW OF OSTEOPATHIC MANIPULATION
TECHNIQUES
The spectrum of osteopathic manipulation
techniques focus on the principle that body structure and function are
dependent on one another. When structure is altered via the
musculoskeletal system, abnormalities occur in other body systems. This,
in turn, can produce restriction of motion, tenderness, tissue changes,
and asymmetry (somatic dysfunction).
Following are some of the manipulation
procedures most commonly used by osteopathic physicians to diagnose and
treat somatic dysfunctions.
HANDS-ON CONTACT
The value of placing of hands on a
patient is universally acknowledged by health professionals. This
essential component of the doctor-patient relationship has a great deal
to do with the patient's well-being, whether he or she suffers from a
cold or a terminal disease. When the D.O. examines a patient by
auscultation of the chest or palpation of the abdomen or spine, the
treatment already has begun.
SOFT-TISSUE TECHNIQUE
This procedure is commonly applied to the
musculature surrounding the spine and consists of a rhythmic stretching,
deep pressure and traction. Its purpose is to move excess tissue fluids
(edema) and to relax hypertonic muscles and myofascial (fibrous tissue)
layers associated with somatic dysfunction.
MYOFASCIAL RELEASE
This procedure is designed to treat
primarily the myofascial structures. In the use of direct myofascial
release treatment (MRT), a restrictive barrier is engaged for the
myofascial tissues; the tissue is loaded with a constant force until
release occurs. In treating with indirect Mrt the dysfunctional tissue
are guided along a path of least resistance until free movement is
achieved.
CRANIAL OSTEOPATHY
Cranial osteopathy is a specific approach
within the osteopathic concept. It influences the structure and fluid
surrounding the central nervous system creating an impact on the total
body and initiating the body's inherent capacity to heal itself. Fascial
connections throughout the body are contiguous with the linings around
the central nervous system including the dura and other structures.
Practitioners of cranial osteopathy utilize a manual approach to
accomplish these goals within the practice of osteopathic medicine.
LYMPHATIC TECHNIQUE
This manual procedure is designed to
promote circulation of the lymphatic fluids and can be used to treat
various difficulties. One technique is pressure applied with the
physician's hands to the supine patient's upper anterior chest wall.
When the force that is applied to the chest reaches its maximum on
expiration, the physician's hands are removed suddenly. This increases
negative pressure of the chest to assist the body's respiratory
mechanism to move lymphatic fluids.
THRUST TECHNIQUE
In this form of manipulation, the
physician applies a high-velocity/low-amplitude thrust to restore
specific joint motion. With such a technique, the joint regains its
normal range of motion and rests neural reflexes. The procedure reduces
and/or completely nullifies the physical signs of somatic dysfunction:
Tissue changes, asymmetry, restriction of motion, and tenderness.
MUSCLE ENERGY TECHNIQUE
In this manual technique, the patient is
directed to use his or her muscles from a precise position and in a
specific direction against a counterforce applied by the physician. The
purpose is to restore motion, decrease muscle/tissue changes and modify
asymmetry of somatic dysfunction.
COUNTERSTRAIN
The Counterstrain technique is a manual
procedure in which the patient is moved passively away from the
restricted motion barrier toward the position of greatest comfort. At
this point, passive asymptomatic strain is induced.
For more information on osteopathy,
please contact:
American Academy of Osteopathy
3500 Depauw Boulevard, Suite 1080
Indianapolis, Indiana 46268-1136
Phone: 317/879-1881
FAX: 317/879-0563
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