To find health should be the object of the doctor. Anyone can find disease

--ANDREW TAYLOR STILL, MD, DO

FOUNDER OF OSEOPATHY

Joan Walton

Osteopathetic medicine commenced in the 1800’s as subsidiary of “regular” medicine

Developed by founder, Dr. Andrew Taylor Still, as a result of dissatisfaction with medical practice inadequacies of that era

Still Sought a scientific based medical and treatment system philosophy based on nature

During this time practitioners were often eclectic and homeopathic

Many individuals attended to their own medical needs

Treatments were based on traditional unresearched European Middle Age remedies

Bleeding and leeching

Purging and puking

Calomel use: Pugative mercuric compound, toxic,caused

resorbed gums, loss of teeth, mouth sores, death

and disfigurement

Surgical procedures without antisepsis

No anesthetic use until mid 1800’s

Limited understanding of illness and disease

No antibiotics, no microbial cause of illness

identified until 1872

Lack of understanding of the immune system, heart

disease and cancer

Diagnosis and outcome predictions based on empirical

identification of illness patterns

Medical intervention often was more dangerous than

the illness

By university degree Early and mid 19th century M.D. education consisted

of a 4 month course of morning lectures

A voluntary 2nd year repeated the same curriculum

By reading medicine Apprenticeships sought with established alternative

pathway frontier physicians

Completion of supervised medical and scientific textbooks studies

Clinical component was obtained through physician accompanied home and office visits

Specialty studies could be arranged with an established experts although this was not common practice

Born in Jonesboro, Virginia, family moved west to Missouri shortly after his birth

Father was passionate, anti-abolitionist, slavery opposing circuit riding physician-Methodist Minister who used spiritual and medical treatments to attend to his “flock”

Still’s study of anatomy began with hunting associated butchering

Still’s query into the relationship between the body’s anatomy and disease process began with a childhood headache relieved by a rope swing constructed pillow later thought to have been comparable to cranio-sacral therapy or myofascial release

Had innovative mind, invented a thresher and obtained patents for a churn and stove

Medical training provided by father through apprenticeship and era associated medical texts

Family moved back to Kansas after differing opinions on slavery between his father and church

Attended a Kansas medical school, did not complete his full course of studies.

Began career in partnership with his father

Practiced era specific medicine using medicine, available treatments, obstetrics and minor surgery

Served the local community and the Shawnee Indian tribe.

Experimented with manual treatment during this time

Served as an officer and a Kansas militia battalion surgeon during the Civil War.

Lost 3 children to spinal meningitis following the war which lead to his search for a more enlightened practice of medicine

June 22, 1874: Still defined principles of the osteopathic philosophy and medical care practice involving hands-on treatment to improve host disease response Methodist philosophy based viewed human beings as the highest naturally evolved life form sought to attain perfection through natural organism processes

Proposed that mal-positioned bones, joints, and abnormal muscle tone levels affect circulation and nerve function allowing for disease development opportunities

Relieved anatomical and physiological system stress through the

use of manipulation increased body’s efficiency

body returned to state in which its innate self curing abilities could

restore normal physiological processes

Promoted appropriate circulation of blood, lymph and cerebrospinal fluid, neurotrophic substance delivery, neural impulse transmission and

respiratory efficiency

Opposed opiate and alcohol use

Still donated land and supplied timber for the original Methodist University buildings in Baldwin, Kansas

Ostracized and denied teaching opportunities at the University due to a local ministers thought that his practice was of the devil and that only Jesus had the healing power to lay hands on the sick

Following a period of severe illness, moved back to Missouri, settled in Kirkville

Set up a circuit medical practice in outlying communities after finding a few followers

Following increased over time

Primary practice location established

Practice initially labeled as “magnetic healer or lightening bonesetter

Settled for the traditional medical naming approach based on central pathology and cure issues coining his practice of medicine “Osteopathy”.

Founded in 1892 by Still

William Smith, Scotland educated reform minded MD traded anatomy instruction for Still’s teaching methods

10 student 1st year enrollment

Lead to: Curricular expansion

Enrollment expansion

First students became professors, joined by other physicians and college graduates

Osteopaths bore the title of Doctor of Osteopathy, (DO) upon graduation which changed to Doctor of Osteopathic Medicine(DO) at the end of the 20th century

The autobiography of Andrew T. Still, 1897

The philosophy of Osteopathy, 1899

The philosophy and Mechanical Principles of

Osteopathy, 1902

Osteopathy, Research, and Practice, 1910

Books revealed the continued occasional but rare

use of medication in osteopathic practice

Published in Osteopathy, Research, and Practice

Adopted by the ASO as its educational program foundation.

Believe in sanitation and hygiene

Opposed vaccination and serum

Surgery used as a last resort

Treatment not dependent of electricity, x-radiance, hydrotherapy, or other adjuncts for treatment

Osteopathic measures enlisted

Friendly to other non-drug measures but believed in body readjustment healing approach

Applicable in all disease conditions including surgery

Treatment measures were not in conjunction with other methods, when other methods were used osteopathy moved out

Allopathic profession Established monopoly on medical training and licensure

Still’s comparative illness treatment success spoke for itself Wide variety of illness treatments

Affected cures in some “hopeless patients”

1919 Spanish Flu pandemic revealed that patients receiving osteopathic autonomic targeted treatments had lower morbidity and mortality rates

The Osteopathic advantage Special expertise in neuro-musculoskeletal conditions, including joint

pain and soft tissue injuries

Lack of publicly available physical medicine, rehabilitation and physical therapy

Lead to rapid expansion of the ASO, the profession, and graduate founded schools

1910 Flexner report Carnegie Foundation sponsored comparison of all American medical

schools against the John Hopkins University School Medicine standard

¾ of all U.S. medical schools , including osteopathic, were closed following criticism surrounding the report results

6 schools remained open following this and further institutional development of Osteopathic schools had to rely on self generated funding

Increased practice of antiseptic procedure for surgery

Development of sulfa and penicillin

The use of medicine in Osteopathic practice in conjunction with Still’s principles

By 1928, all Osteopathic schools taught materia medica (the part of medicine concerned with formulation and use of remedies or natural pharmacological preparations) including the newly researched and efficacious antibiotics

Most were general practitioner

No armed forces service as a physician during WWII

Lead to many staying home and serving the patients of the physicians who were overseas which increased growth

Record Post war Osteopathic college enrollment

American post-graduate training programs were not generally available to DO’s.

1953-AMA president received a report on the status of osteopathic medicine indicating DO training was equivalent to M.D. training and that as long as they were prescribing proven effective medications their was no concern with osteopathic manipulative treatments.

Greater osteopathic professional acceptance in the mid to late 20th

century due to:

California government regulatory merger of the osteopathic profession with the allopathic medical profession

The establishment of 10 additional osteopathic medical colleges between 1969 and 1981 followed by more in the 1990’s

Some state legislatures increase

osteopathic college funding after

realizing that many DO’s practiced

general medicine, especially in

underserved areas

Lead to a rapid profession expansion Numerous new Osteopathic medical colleges

Increase in Osteopathic grads entering allopathic

residencies

The movement of young osteopathic physicians

into allopathic hospitals which was previously

forbidden

Daniel David Palmer-investigated osteopathy prior to originating chiropratic practice

Edith Ashmore, DO, recommended in her published 1915 manual that student should not be taught the original Still methods of osteopathy due to difficulty level especially in relation to high velocity manipulative techniques.

Ida Rolf, Rolfing founder, wrote that her techniques were learned from a blind Osteopath which were combined with yoga to create a systematic protocol for whole body integration.

John Barnes-a physical therapist who studied myofacial release at Michigan State University taught it to physical therapists

John Epledger, DO, mixed cranial and other manipulative techniques, taught by a Still student, William Garner Sutherland, DO, mixing light trance work and other techniques to develop craniosacral therapy which is generally practiced by non-physicians.

Postgraduate programs and courses offered by Osteopathic physicians allowed U.S. physical therapists to begin using osteopathic techniques such as muscle energy, myofascial release, counterstrain, and high velocity low amplitude thrust

United philosophy of medicine-Developed by Andrew Taylor Still in the last half of the 19th century.

Describes as a background reference system

Identifies a patients nature

Defines the physician mission

Establishes the basic premises of the logic of diagnosis and treatment

Osteopathic philosophy poorly understood in the general medical community due to lack of exposure

Centered on a profound respect for the inherent ability of the human being, particularly the body, to heal itself

Classical Human is identified as the trinity (mind, body and spirit)

Little writing in regard to the mind and spirit (left to the

individual)

A sick patient with sufficient recuperative power can be

structurally readjusted to assist in the return of normal

physiology

Includes surgery and obstetrics

Era consistent diet sufficient (organic in that era)

If body was working correctly it could handle any fuel

source

Dates back to the Greeks and Egyptians Mind-biochemical and emotional

Spiritual- may be the most potent but unpredictable

Body- Still’s focus-what could be seen, the relationship

between structure and function

Stills methods History taking

Observing and palpating the body

Adjusting the body parts for proper positioning and

motion to promote normal physiology

Await the body’s normal innate self-regulating powers

and healing process

Traditional Beliefs Contemporary

Sanitation and hygiene have

effectively reduced mortality and

morbidity more than any other

approach

Still’s criticism of medicine was due to lack of research, logic and validation.

Contemporary Osteopathic physicians commonly use medication although medications use is considered excessive and potentially dangerous

Immunizations is now better understood and not using immunizations can cause more mortality and morbidity than their use.

Manipulation assists in: Diminishing or eliminating pain

Improving motion

Decrease physiological and psychological stress

Assists in regaining optimal homeostatic levels

Osteopathy Includes medication, nutrition,

exercise, environmental factor considerations, genetic and molecular biology, neuroimmunology and psychology

Osteopathic concept principleso Human being is a dynamic unit

of function

o Body possesses self-regulatory self healing natured mechanisms

o Structure and function are interrelated at all levels

Traditional Contemporary

Decreased surgery rate and associated complications in the U.S. due to:

Diagnostic testing

conservative approaches

aseptic techniques

better anesthesia

micro and endoscopic surgery

Acceptable and statistically advantageous therapies

X-rays

Radiation therapy

Therapeutic laser

Still’s unifactorial illness causation description is no longer valid

Rational therapy is based on these principles. Wellness continuum

Wellness is a persons ability to handle multiple challenges without a homeostatic decompensation which interferes with normal activities

Decreasing homeostatic balance results in less of an environmental-emotional insult needed to precipitate illness

Wellness focus should be on proper nutrition, exercise, rest and stress management

Contemporary Multiple disease causes include genetic abnormality, nutritional

deficiencies, radiation damage and psychosomatic effects

Structural integrity should be maintained through tensegrity,

involving bilateral muscle tone, balance and function

The reductionalist understanding of osteopathic philosophy has

been enhanced by the chaos theory and the butterfly effect

The neuromuscular skeletal system is the largest single system

in the body; it reflects the state of the health of the other

systems

Osteopathic manipulation instruction has diminished leaving

physicians less skilled and not incorporating its use in

appropriate cases due to the incorporation of expanding

knowledge and research of the past century- which is much

broader than it was in the past

Considerations

Who is the patient

Functionally, mentally, emotionally, and spiritually and what are their physical, psychosocial and energy levels in the environment?

Where does health arise is this patient?

What is the osteopathic physicians goal?

Health, seeking the highest possible homeostatic balance and performance based on current limitations and circumstances

How is health sought in this patient?

Prevention

Illness

If patient has entered this continuum physician

must take a careful history, complete a physical

exam and form a differential diagnosis

Nueromuscular system may be used for signs

which indicate systemic problems

Diagnostic tests may be performed

Diagnosis

Treatment decisions are made based on all

factors that affect physiology and performance

Medical Standard of Care is used along with

OMT when indicated whether as a primary

treatment or as an adjunct treatment

Body systems are integrated (cardiovascular,

lymphatic, respiratory, neurologic, endocrine

and immune)

Factors affecting the patient physiology Air ,water, food, nutritional supplement, prescriptions , OTC

medication, physical forces and impacts on the system (trauma

or exercise), thought, emotions, stress, relaxation, energy

(gravity, sunlight, magnetic fields)

Illness vulnerability Host controlled via the immune system and homeostatic

mechanisms

Intervention is necessary when host control decreases and the

system downgrades into illness

Addressed along a continuum ranging from

manipulation to surgery

Approach is generally conservative

considering the body’s innate intelligence

and wisdom

Uses the least possible intervention for the

greatest result

Techniques may be combined to achieve a single treatment plan objective

Patient problem

Perception and skill of the M.D.

Difficulty achieving the desired outcome

Technique aims

joint surface opposition

muscle and connective tissue tension imbalances

promote vascular and lymphatic flow

modulate autonomic nervous tone

most affect > 1 system

Techniques types

Direct

Indirect

Direct-confronts motion restriction, body part is taken directly towards the restricted motion

Indirect-body part is taken in the direction of ease of motion after proper positioning. Uses activating forces to induce changes in muscle and connective tissue length and tone, central, peripheral and ANS tone (activation level); joint surface opposition and motion; or vascular lymphatic function

Goals

Tissue relaxation

Increase physiological motion

Decrease pain

Optimization of homeostasis

Soft tissue and lymphatic treatment Direct method

Still developed

Focus is on altering tone and length of muscle and connective tissue

Relaxes muscle and connective tissue

Decreases and removes tissue tension and impediments to arterial flow

Alters ANS tone

Alters lymphatics

High velocity low-amplitude thrust Direct method

Engages restrictive barrier through body positioning

Thrust is short distance (low amplitude) and rapid (velocity)

Joint position, muscle tension levels, and neural and vascular adjustments are reset through gapping the articulation by 1/8 inch or less

Articulatory technique

Still developed

Takes the treated body part to the end of it’s

restricted ROM gently and repetitively

Repetitive motion directly diminishes the

restrictive barrier

Multiple planes of motion are treated at one

time

Used for individual joints or regions

Includes the Still technique and Facilitated

positional release

Muscle energy technique Direct treatment

Developed by Fred Mitchell Sr. D.O.

Muscle energy means that the patient uses their own energy through directed muscular cooperation with the physician

Uses reflexive muscle tension changes

Allows dysfunctionally shortened muscles to lengthen, lengthen muscles to shorten, strengthens weak muscles and relaxes hypertonic muscles

May use traction, reciprocal inhibition, cross-extensor reflexes or oculocervical reflexes

Counterstrain Passive positional technique

Dysfunctional joint or tissue is placed in a relaxed position

Position is maintained for 90 seconds

Inappropriate strain reflex is inhibited by application

Diagnosis is by palpation of tenderness mapped by system originator which indicates inappropriate neurological balance

May be use with positional, movement or tissue texture abnormalities

Ideal for postsurgical patients that may not be tolerant of articulatory techniques

Myofascial release

Performed by lengthening the contracted tissue

(direct myofascial release) or shortening it (

indirect myofascial release.

Allows the nervous and respiratory systems to

facilitate changes

Uses 2 physiological processes

Creep

Hysteresis

Compression, traction, torsion, respiratory

cooperation or a combination of these may

facilitate treatment

Osteopathy in the Cranial Field Developed by William G. Sutherland, D.O.

Uses direct and indirect procedures

Works with the body’s inherent rhythmic motions

Commonly use as a treatment for headaches, temporomandibular joint dysfunction syndrome

Used in infants for treatment of cranial nerve compression

Used for otitis media

Focus on skull and sacrum at dura matter attachments but can be used throughout the body

Variant technique called Craniosacral therapy is not medically licensed

Visceral techniques Addresses viscera imbalances

Includes stretching and balancing techniques related to ligamentous attachments

May involve inherent visceral motion

Determined by physiology

Organizes thought, seeking understanding of the entire organism

Allows for concurrent reductionistic analysis

Reassembles parts into the individuals totality

Uses standard orthopedic and neurological exam to diagnose somatic dysfunction Tissue palpation

Muscle and joint motion testing

MS system used as an access point for diagnostic information based on muscle tension, fluid distribution and autonomic activity levels

Visceral problems may be revealed through neurological reflex interaction

Somatic dysfunction

Not tissue damage

A disorder of the body’s programming for length, tension, mobility affecting joint surface apposition, tissue fluid flow efficiency and neurological balance

Expands the standard medical differential diagnosis

Uses more specific information

Four somatic dysfunction diagnosis criteria TART

T-tissue texture abnormalities

A-static or positional asymmetry

R- motion restriction

T- tenderness

Reflex relationships may also be included

Treatment based on knowledge of structure

and function

In restrictive MS problems with high tone, aim is

to decrease tone and increase motion

In visceral dysfunction, aim is lowering muscle

tone and sympathetic nervous system tone

thereby enhancing adaptability and homeostatic

balance

May or may not require the use of surgery and

medication

May be primary treatment or as an adjunct

2 levels

Macroscopic- abnormal pressure on joints, nerves

and blood vessels may over time cause tissue

change

Local dysfunction can lead to global dysfunction

Microscopic-cellular physiology depends on

fluid flow

Flow impedance of the internal fluid system (CV

system) can lead to decreased functioning of cells,

tissues, organs, and entire systems, causing increased

disease vulnerability

Manipulation decreases or eliminates pain

Adjusts involved structures toward an

adaptability level of the body’s tensegrity

system

A system characterized by a discontinuous set of

compression elements (struts) that are held

together and/or moved, by a continuous

tensional network

e.g. muscular system erecting the human frame

Manipulation assist the body in functioning at

an optimal level, enhancing healing abilities

If body’s functioning level is severely restricted the sole use of manipulation may not be effective

Additional use of medication, surgery and direct psychosocial interventions may be indicated

2 possible scenarios when manipulation alone may not be effective When preventative medicine or manipulation alone

would be ineffective in attaining the goal of health

When the speed is of the essence

Osteopathic physician failure to use manipulative techniques ignores the main premise of osteopathic medicine in that the elimination of structural physiologic function impediments assist the body’s innate self-healing capabilities

Micozzi, M.(2011) Osteopathic Medicine,

Fundamentals of Complementary and

Alternative Medicine, 4th edition, pp.232-

247, Saunders, St. Louis, Missouri