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Introduction to Osteopathy

Richard A. Feely, D.O., FAAO, FCA, FAAMA

Section A | What is it?

Today, only one branch of mainstream medicine follows the Hippocratic philosophy of medical care that centers on the patient, not the disease. It is Osteopathic Medicine and, currently, some 36,233 osteopathic physicians and surgeons offer this dimension in medical care.

Doctors of Osteopathic Medicine (D.O.'s) are fully licensed and recognized physicians and surgeons who stress the unity of all body systems. They emphasize holistic medicine-awareness of proper nutrition and environmental factors; a hands-on approach to medicine; and a unique aid to the diagnosis and treatment of various illnesses known as Osteopathic Manipulative Treatment.

One of the Osteopathic concepts of good medicine is that the body's musculoskeletal system is central to the patient's well-being.

The system includes the bones, muscles, tendons, tissues, nerves and spinal column–about 60 percent of the body mass. This framework works with all the body's organs. It responds–properly or improperly—every time a breath is drawn or any other body movement occurs. Besides being prone to mechanical disorders, the musculoskeletal system reflects many internal illnesses and may aggravate or accelerate the disease process throughout the body. The osteopathic physician takes advantage of this fact in management not only of problems of the musculoskeletal system itself, but also in managing disorders affecting the rest of the body as well.

Osteopathic physicians utilize all of the recognized procedures and modern technologies for prevention, diagnosis and treatment of disease, including drugs, radiation and surgery. In addition, the D.O. assesses the musculoskeletal system by the use of a finely trained sense of touch with the hands in a process called palpatory diagnosis. Disorders found there are treated by the introduction of carefully applied manual forces, directed to the bones, muscles and joints, in a type of treatment called Osteopathic Manipulative Treatment (OMT), or simply “manipulation.” Osteopathic manipulation of the musculoskeletal system is a proven technique for many diagnoses and treatments. Often, it can provide an alternative to therapies involving drugs or surgery.

Because musculoskeletal dysfunction can mimic many diseases, osteopathic manipulation is an important component in diagnosis, as well as a means of correcting structural problems.

For example, it has been well-documented that diseases of specific organs can produce pain in other parts of the body. Stomach ulcers consistently cause area of spinal pain and irritation just below the shoulders in the back. The radiation of pain to the loin 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.

Also, disturbances affecting the musculoskeletal system can cause symptoms that stimulate other illnesses. Among the most common causes of recurrent headaches, for example, is disorder of the cervical (upper) portion of the spinal column. Properly applied manipulative treatment, particularly directed to the head and neck, can often relieve headache symptoms when other remedies have failed.

Osteopathic Manipulative Treatment is often part of the medical treatment for stress headaches, sinus problems and pulmonary distress. Obstetricians often use manipulation to relieve low back pain during pregnancy or as additional medical treatment for menstrual cramps.

Studies indicate that Osteopathic Manipulative Treatment, as part of the total patient treatment, actually accelerates the rate of recovery from illness or injury, keeping hospital or home stays to a minimum.

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. The osteopathic approach is a true system of preventive medicine, treating the whole person, not just the disease.

Section B | What is the Difference?

American osteopathic physicians are fully licensed physicians and surgeons. To become fully licensed, they must graduate from one of 16 osteopathic medical schools accredited by the Bureau of Professional Education of the American Osteopathic Association. After completing osteopathic medical school, D.O.s serve a one-year internship. During that year, they gain hands-on experience in internal medicine, obstetrics/gynecology, family practice, pediatrics and surgery. Often a D.O. will opt to continue their education by entering a two to six year residency program in a specialty area such as cardiology, neurology or thoracic surgery.

There are currently 35,000 D.O.s in the United States, with 60 percent of them in primary care areas of family practice, internal medicine, obstetrics/gynecology and pediatrics. D.O.s comprise 5.5 percent of the total physician population and 18 percent of all physicians in the military. By the year 2000, there will be 45,000 osteopathic physicians in practice in the United States. Each year, 100 million patient visits are made to D.O.s.

Unlike in England, in the USA an osteopathic doctor is a fully licensed and trained physician and surgeon like an MD but with the addition of osteopathic manipulation. Each DO is licensed by each individual state to practice Osteopathic Medicine and Surgery. An English DO to practice in the US would have to take 4 years of Osteopathic Medicine at a US college plus 3 years of residency/internship, then pass a national or state board exam. He would then be able to apply and receive a state license.

DOs and MDs are Similar

  1. All must have four years of undergraduate training with an emphasis on science courses.
  2. All must complete four years of basic medical education.
  3. All may choose a medical specialty after completing medical school.
  4. All must pass an unlimited physician and surgeon state licensing examination.
  5. All may practice in fully accredited, licensed hospitals and medical centers.

DOs and MDs are Different

  1. D.O.s focus on preventive health care.
  2. D.O.s receive additional training in the musculoskeletal system, gaining a therapeutic and diagnostic advantage.
  3. D.O.s do not treat specific illnesses or symptoms, but instead practice a whole person approach to medicine.
  4. D.O.s incorporate osteopathic manipulative treatment (OMT) into their practice which allows them to use their hands to diagnose and treat soft tissue injury or illness, thereby encouraging the body's natural tendency toward health.

DOs, MDs and DCs

While health care practitioners are very familiar with the similarities and differences between their particular treatment approaches, many times the public is not. The following table is provided to help give a general overview of the training and root philosophies of these three professional disciplines.

Osteopathic Physicians (DO)Allopathic Physicians (MD's)Chiropractors (DC's)
Undergraduate Training Required4 years4 years4 years
Postgraduate Training Required5-8 years5-8 years3-4 years
Hospital Residency RequiredYesYesNo
Able to Prescribe DrugsYesYesNo
Able to Perform SurgeryYesYesNo
Training in Bodily ManipulationReceives 300-500 hours extensive training in bodily manipulation including cranial, extremity, spinal joints, and connective tissueReceives no formal training in manipulation, spinal or otherwiseReceive up to 600 hours in the use of spinal manipulation
FoundersA.T. Still, physician whose philosophy is a “whole person” approach and whose emphasis was on disease prevention as well as cure. A.T. Still was an American original.German trained physicians who viewed the body as being comprised primarily of parts and who emphasized treating symptoms through drugs and surgery.D. D. Palmer who felt that spinal manipulation could effectively address 95% of all illness. Briefly studied with A. T. Still, then developed his own techniques.

Section C | Principles

Osteopathy is the knowledge of the structure, relations and functions of each part and tissue of the human body applied to the adjustment in the correction in whatever may be interfering with the harmonious operation. Doctors of osteopathy conceive of man as a biomechanism, an organic machine which, as long as the cells, tissues, organs, muscles, ligaments and bones are normal in themselves in their reciprocal relationships, they will function normally. They maintain that structural integrity and physiological adjustment of the tissues and fluid tensions of the organism which form the most important factors in maintaining health. Life essentials-food, water, light, air, heat, exercise, protection and rest-are necessary also environmental and psychological harmony. In an organism structurally perfect, these constitute the requirements of man for maintaining health. The principles of osteopathy follow the logic of an applied knowledge of anatomy, physiology and pathology.

The principles of Osteopathy are as follow:

  1. that the body is a unit
  2. structure and function are reciprocally interrelated
  3. the body possesses self regulating mechanisms
  4. the body rationale therapy is based upon knowledge and use of the above three principles.

The osteopathic concept includes surgery which osteopathic physicians practice and recommend as indicated. Osteopathy is not drug-less profession in the strict sense of the word. It uses drugs which have specific scientific value and proven effectiveness. The osteopathic physician is a skilled engineer of the vital human mechanism influencing by manipulation and other osteopathic measures the activity of the nerve cells, glands and organs and the distribution and the distribution of fluids and the discharge of nerve impulses therefore, normalizing tissue fluid and function.

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