Osteopathy

Manipulative and body-based methods
Acupressure Bodywork Bowen technique Chiropractic Craniosacral therapy Indian head massage Lomilomi Manual lymphatic drainage Massage therapy Naprapathy Osteopathic medicine Physical Therapy Rolfing Structural Integration Shiatsu Thai Massage Tui na Watsu
NCCAM classifications
Alternative Medical Systems Mind-Body Intervention Biologically Based Therapy Manipulative Methods Energy Therapy
See also
Alternative medicine Glossary of alternative medicine

Osteopathy (from Greek ὀστέον, "bone" and -πάθεια, "disease of")^[1] is a type of alternative medicine. It is an alternative medical approach emphasizing the physical manipulation of the muscle tissue and bones.^[2]

There is little evidence that osteopathy is effective in treating any medical condition^[2] other than lower back pain.^[3] In the UK, the National Institute for Health and Care Excellence lists spinal manipulation by osteopaths as one of the treatment options for persistent lower back pain.^[4] Analysis of peer-reviewed research yields little evidence that osteopathy is effective for non-musculoskeletal conditions, and limited evidence that osteopathy is an effective treatment for some types of neck pain, shoulder pain, or limb pain.^[3] According to the NYU Langone Medical Center, the fundamental reason for the lack of published research on osteopathic treatment is the inability to employ double-blind, placebo-controlled trials when studying osteopathic manipulation, since researchers are unable to blind both the practitioner and the patient.^[2]

Uniquely for the United States, osteopathic medicine there constitutes a branch of the medical profession. Practitioners of that branch of medicine are called osteopathic physicians, and are trained and certified to practice the entire scope of the modern medicine. To avoid confusion, the American Osteopathic Association and the American Association of Colleges of Osteopathic Medicine recommend using the terms osteopathic physician (U.S.-trained only) and osteopathic medicine to distinguish individuals trained in osteopathic medicine and the field they practice from osteopaths trained in manual osteopathic treatment, the restricted-scope form of osteopathy found in other countries around the world.^[5][6][7][8] In general, osteopaths trained outside of the U.S. are not physicians, are limited in practice to non-invasive manual therapies,^[5] and may provide nutritional, postural, and other health advice.

History

The practice of osteopathy began in the United States in 1874. The term "osteopathy" was coined by Andrew Taylor Still, MD, DO. Still was a physician and surgeon,^[9][10] Kansas state and territorial legislator,^[11] a free state leader,^[12] and one of the founders of Baker University,^[13] who lived near Baldwin City, Kansas at the time of the American Civil War. In Baldwin, he developed the practice of osteopathy.^[14]

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."^[15] Still founded the American School of Osteopathy (now A.T. Still University of the Health Sciences) in Kirksville, Missouri, for the teaching of osteopathy on 10 May 1892. While the state of Missouri granted the right to award the MD degree,^[16] he remained dissatisfied with the limitations of conventional medicine and instead chose to retain the distinction of the DO degree.^[17] In 1898 the American Institute of Osteopathy started the Journal of Osteopathy and by that time four states recognized osteopathy as a profession.^[18]

Techniques of osteopathic treatment

Osteopathic manipulative treatment (OMT in the U.S. or simply "osteopathic treatment" elsewhere) is the therapeutic application of manually guided forces by a practitioner, intended to improve physiologic function and/or support homeostasis that has been altered by somatic dysfunction.^[19] Somatic dysfunction is defined as impaired or altered function of related components of the somatic (body framework) system: skeletal, arthrodial and myofascial structures and their related vascular, lymphatic and neural elements. Acute somatic dysfunction is an immediate or short-term impairment or altered function of related components of the somatic (body) framework. It is characterized in early stages by vasodilation, oedema, tenderness, pain, and tissue contraction. It is diagnosed by history and palpatory assessment of tenderness, asymmetry of motion and relative position, restriction of motion and tissue texture change.^[19] Chronic somatic dysfunction is the impairment or altered function of related components of the somatic (body framework) system. It may be characterized by tenderness, itching, fibrosis, paresthesias, and tissue contraction.^[19]

While there are many treatment techniques, OMT methods utilized may broadly be classified as active or passive and direct or indirect in nature.^[19]

• Active Method: A technique in which the person voluntarily performs an osteopathic practitioner-directed motion.
• Passive Method: Based on techniques in which the patient refrains from voluntary muscle contraction.
• Direct Method (D/DIR): An osteopathic treatment strategy by which the restrictive barrier is engaged and a final activating force is applied to correct somatic dysfunction.
• Indirect Method (I/IND): A manipulative technique where the restrictive barrier is disengaged and the dysfunctional body part is moved away from the restrictive barrier until tissue tension is equal in one or all planes and directions

Different techniques will be used depending on the somatic dysfunction/s present as well as different attributes of the individual being treated. Techniques include:^[20]

• Muscle Energy
• Counterstrain/Strain-Counterstrain
• High-Velocity, Low-Amplitude
• Myofascial Release
• Lymphatic Pump
• Ligamentous Articular Strain/Balance Ligamentous Tension
• Craniosacral
• Articulatory/Still's Technique
• Facilitated Positional Release

Effectiveness

In general, the results of randomized, controlled clinical trials have not proven osteopathy to be an effective therapy. Reviews of scientific literature produce little evidence that osteopathic manipulation is effective for the treatment of musculoskeletal pain,^[21] or for pediatric conditions.^[22]

A 2013 Cochrane Review reviewed six randomized controlled trials which investigated the effect of four types of chest physiotherapy (including OMT) as adjunctive treatments for pneumonia in adults and concluded that "based on current limited evidence, chest physiotherapy might not be recommended as routine additional treatment for pneumonia in adults."^[23]

In the United Kingdom, the National Institute for Health and Care Excellence lists spinal manipulation by osteopaths as one of the treatment options for persistent lower back pain.^[4] More research is needed to demonstrate the benefits of osteopathy. Analysis of peer-reviewed research yields evidence that osteopathy can be effective for musculoskeletal conditions particularly for some types of neck pain, shoulder pain, or limb pain.^[3] According to the NYU Langone Medical Center, the fundamental reason for the lack of published research on osteopathic treatment is the inability to employ double-blind, placebo-controlled trials when studying osteopathic manipulation, since researchers are unable to blind both the practitioner and the patient.^[2]

Osteopathy worldwide

The osteopathic profession has evolved into two branches, non-physician manual medicine osteopaths and full scope of medical practice osteopathic physicians. These groups are so distinct that in practice they function as separate professions. The regulation of non-physician manual medicine osteopaths varies greatly between jurisdictions. In Australia, the UK, and New Zealand the non-physician manual medicine osteopaths are regulated by statute and practice requires registration with the relevant regulatory authority. The Osteopathic International Alliance has a country guide with details of registration and practice rights and the International Osteopathic Association has a list of all accredited osteopathic colleges.^[24]

Several international and national organizations exist relating to osteopathic education and political advocacy. One such organization, the World Osteopathic Health Organization (WOHO),^[25] permits individual membership by both "restricted scope manual therapist" osteopaths and "full scope of medical practice" osteopathic physicians. Similarly, there is also an international organization of organizations for national osteopathic and osteopathic medical associations, statutory regulators, and universities/medical schools offering osteopathic and osteopathic medical education, known as the Osteopathic International Alliance (OIA).^[26]

The following sections describe the legal status of osteopathy and osteopathic medicine in each country listed.

Australia

In Australia, all osteopaths complete a minimum of five years university training in anatomy, physiology, pathology, general medical diagnosis and osteopathic techniques. They are also trained to perform standard medical examinations of the musculoskeletal, cardiovascular, respiratory and nervous systems.^[27][28][29] These university graduates hold either a double Bachelors or Master qualification. Osteopaths work in private practice, and the majority of private health insurance providers cover treatment performed by osteopaths.^[30] In addition, treatment performed by osteopaths is covered by the public health care system in Australia (Medicare)^[31] under the Chronic Disease Management plan.

Osteopathy Australia^[32] (formerly the Australian Osteopathic Association) is a national organization representing the interests of Australian osteopaths, osteopathy as a profession in Australia, and consumers' right to access osteopathic services. Originally founded in 1955 in Victoria, the Australian Osteopathic Association became a national body in 1991 and became Osteopathy Australia in 2014.^[33] and is a member of the Osteopathic International Alliance.^[34]

Osteopaths are required, by law, to maintain ongoing professional development and education every year to stay in practice. In Australia, all osteopaths are required to be government registered practitioners. If an osteopath does not appear on this register they should not practice.^[35]

The Osteopathy Board of Australia^[36] is part of the Australian Health Practitioner Regulation Agency which is the regulatory body for all recognized health care professions in Australia.^[37] The Osteopathic Board of Australia is separate from the Medical Board of Australia which is the governing body that regulates medical practitioners. Osteopaths trained internationally may be eligible for registration in Australia, dependent on their level of training and following relevant competency assessment.^[37]

Three publicly funded Australian universities now offer degrees in osteopathy: RMIT University (officially The Royal Melbourne Institute of Technology),^[38] Victoria University,^[39][40] and Southern Cross University.^[41]

Osteopathy has been practiced in Australia for over 100 years, has been a registered profession for over 35 years and has been taught in universities since the early 1980s.^[42] Today osteopathy has grown as a recognized allied health,^[31][43] primary care profession with a combination of traditional methods and modern scientific philosophies.^[44]

Canada

In Canada, the titles “osteopath” and “osteopathic physician” are protected in some provinces by the medical regulatory college for physicians and surgeons.^[45][46][47] As of 2011, there were approximately 20 U.S.-trained osteopathic physicians practicing in all of Canada.^[48] As of 2014, no training programs have been established for osteopathic physicians in Canada.^[49]

The non-physician manual practice of osteopathy is practiced in most Canadian provinces.^[50] As of 2014, manual osteopathic practice is not a government regulated health profession in any province.^[51] It is estimated that there are over 1,300 osteopathic manual practitioners in Canada, most of whom practice in Quebec and Ontario.^[49]

European Union

There is no universal regulatory authority for the practice of osteopathy or osteopathic medicine within the European Union; it is on a country by country basis. The UK's General Osteopathic Council, a regulatory body set up under the country's Osteopaths Act 1993 has issued a position paper on European regulation of osteopathy.^[52]

In Austria and Switzerland, osteopathic practitioners are MDs or physiotherapists who take additional courses in osteopathy after completing their medical training or physical therapy training.

France

Osteopathy is a governmentally recognized profession and has title protection, autorisation d'utiliser le titre d'ostéopathe.^[53] The most recent decree regarding osteopathy was enacted in 2007.^[54]

Germany

Germany has both osteopathy and osteopathic medicine. There is a difference in the osteopathic education between non-physician osteopaths, physiotherapists, and medical physicians.

Physiotherapists are a recognized health profession and can achieve a degree of "Diploma in Osteopathic Therapy (D.O.T.)." Non-physician osteopaths are not medically licensed. They have an average total of 1200 hours of training, roughly half being in manual therapy and osteopathy, with no medical specialization before they attain their degree. Non-physician osteopaths in Germany officially work under the "Heilpraktiker" law. Heilpraktiker is a separate profession within the health care system. There are many schools of Osteopathy in Germany; most are moving toward national recognition although such recognition does not currently exist.^[55] In Germany there are rules (at the country level) under which persons (non-physicians) may call themselves Osteopath.^[56]

Osteopathic physicians in Germany achieve a degree of "D.O.- DAAO" or "D.O.M.", from the DAAO and DGOM respectively. Osteopathic physicians in Germany are fully licensed with at least 6,500 hours in medical school 6 years, at least 7,000 hours in specialty training, which is 3 to 6 years, plus at least 680 hours of training in manual medicine and osteopathy before attaining their degree. German physicians who have obtained the degree designation Dr. med., and who have completed their medical education and specialty training in areas such as general practice, orthopaedics, neurology, internal medicine, etc. can earn a Diploma in Osteopathic Medicine, either a DO-DAAO from the DAAO (German-American Academy for Osteopathy), a DOM™ from the DGOM (German Society of Osteopathic Medicine), or an MDO (Medical Doctor of Osteopathy) from the DGCO (German Society for Chirotherapy and Osteopathy) if additional educational requirements are met. The additional education includes a 320-hour program in manual medicine and an additional minimum of 380 hours in osteopathic medicine, which together makes a minimum of 700 hours. The osteopathic medicine course is limited to physicians only.^[57]

The scope of practice for a US-trained osteopathic physician in Germany is unlimited. A foreign physician may apply for licensure with the regional medical authorities, the Health Ministry, which represents the state in which the applicant intends to work. The regional state health ministry has information regarding the types of medical providers needed in that area and therefore grants work permits to licensed physicians depending on the specialty of the foreign physician.^[57]

New Zealand

The practice of osteopathy is regulated by law, under the terms of the Health Practitioners Competence Assurance Act 2003^[58] which came into effect on 18 September 2004. Under the Act, it is a legal requirement to be registered with the Osteopathic Council of New Zealand (OCNZ),^[59] and to hold an annual practicing certificate issued by them, in order to practice as an osteopath. Each of the fifteen health professions regulated by the HPCA Act work within the "Scope of Practice" determined and published by its professional Board or Council. Osteopaths in New Zealand are not fully licensed physicians. In New Zealand, in addition to the general scope of practice, osteopaths may also hold the Scope of Practice for Osteopaths using Western Medical Acupuncture and Related Needling Techniques.^[60]

In New Zealand a course is offered at Unitec.^[61] Australasian courses consist of a bachelor's degree in clinical science (Osteopathy) followed by a master's degree. The Unitec New Zealand double degree programme is the OCNZ prescribed qualification for registration in the scope of practice: Osteopath, Australian qualifications accredited by the Australian and New Zealand Osteopathic Council are also prescribed qualifications.

Osteopaths registered and in good standing with the Australian Health Practitioner Regulation Agency – Osteopathy Board of Australian are eligible to register in New Zealand under the mutual recognition system operating between the two countries. Graduates from programs in every other country are required to complete an assessment procedure.^[62]

The scope of practice for US-trained osteopathic physicians is unlimited on an exceptions basis. Full licensure to practice medicine is awarded on an exceptions basis following a hearing before the licensing authorities in New Zealand. Both the Medical Council of New Zealand^[63] and the Osteopathic Council of New Zealand [OCNZ]^[64] regulate osteopathic physicians in New Zealand. Currently, the country has no recognized osteopathic medical schools.^[65]

United Kingdom

The practice of osteopathy has a long history in the United Kingdom. The first school of osteopathy was established in London in 1917 by John Martin Littlejohn a pupil of A.T. Still, who had been Dean of The Chicago College of Osteopathic Medicine. After many years of existing outside the mainstream of health care provision, the osteopathic profession in the UK was finally accorded formal recognition by Parliament in 1993 by the Osteopaths Act.^[66] This legislation now provides the profession of osteopathy the same legal framework of statutory self-regulation as other healthcare professions such as medicine and dentistry.

The General Osteopathic Council (GOsC) regulates the practice of osteopathy under the terms of the Osteopaths Act 1993. Under British law, an osteopath must be registered with the GOsC to practice in the United Kingdom.^[67] The General Osteopathic Council has a statutory duty to promote, develop and regulate the profession of osteopathy in the UK. It fulfills its duty to protect the interests of the public by ensuring that all osteopaths maintain high standards of safety, competence and professional conduct throughout their professional lives. In order to be registered with the General Osteopathic Council an osteopath must hold a recognized qualification that meets the standards as set out by law in the GOsC's Standard of Practice.^[68] This Act provides for "protection of title" A person who, whether expressly or implication describes himself as an osteopath, osteopathic practitioner, osteopathic physician, osteopathist, osteotherapist, or any kind of osteopath is guilty of an offence unless he is registered as an osteopath. There are currently approximately four thousand osteopaths registered in the UK.^[69]

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 Masters or Bachelors of Osteopathy, or Osteopathic Medicine, (BOst or MOst) or else Bachelors of Science (BSc) in Osteopathy or Osteopathic Medicine, according to the institution attended:^[70] in this case osteopathy and osteopathic medicine are synonymous, but these degrees do not lead to prescribing rights.

The recognition of osteopathy also means that doctors can now refer patients to osteopaths for treatment with the transfer of clinical responsibility rather than simply delegating the responsibility for care, as is the case with other healthcare professionals. It may or may not be a covered benefit under the National Health Service depending on where in the UK you may live.^[71]

Osteopathic medicine is regulated by the General Osteopathic Council (GOsC) under the terms of the Osteopaths Act 1993 and statement from the GMC. The London College of Osteopathic Medicine,^[72] teaches osteopathy only to those who are already physicians.

Foreign-trained osteopathic physicians, who are registered with the GMC and GOsC, hold both a full medical practice and osteopathic license. Each applicant will have to pass the Professional and Linguistic Assessment Board test (PLAB) and work for one supervised year in the National Health Service (NHS). Following that year, the applicants will be able to apply for full registration (unsupervised practice or private practice). If the physician is already a specialist, postgraduate training will need to be separately recognized by the GMC.^[73]

United States

Licensure or registration of non-physician osteopaths is not permitted anywhere in the United States. European style osteopaths are prohibited from calling themselves osteopaths. In contrast, osteopathic physicians earn the degree of Doctor of Osteopathic Medicine (D.O.), a degree equivalent, though different in certain aspects, to that of Doctor of Medicine (M.D.).^{[74][75][76][77]}

Osteopathic medicine in the United States has always meant a physician trained in and entitled to the full scope of medical practice. Osteopathy or osteopath as written in some U.S. state and federal laws refers only to osteopathic medicine or osteopathic physicians, respectively.^[78] With the increased internationalization of the profession, these older terms have fallen out of favor as generally accepted use due to the confusion they may cause.^[79][80]

Egypt and the Middle East

Hesham Khalil introduced Osteopathy in the Middle East at a local physical therapy conference in Cairo, Egypt in 2005 with a lecture titled “The global Osteopathic Concept / Holistic approach in Somatic Dysfunction”. Since then he has toured the Middle East to introduce osteopathy in other Middle Eastern & North African countries including: Sudan, Jordan, Saudi Arabia, Qatar, UAE, Kuwait and Oman. In December 2007 the first Workshop on Global osteopathic approach was held at the Nasser Institute Hospital for Research and Treatment, sponsored by the Faculty of Physical Therapy, University of Cairo, Egypt.^[81] On August 6, 2010, the Egyptian Osteopathic Society (OsteoEgypt) was founded. OsteoEgypt promotes a two tier model of osteopathy in Egypt and the Middle East. The event was timed to coincide with the birthday of the founder of Osteopathic Medicine A. T. Still.^[82][83]

See also

• List of medical schools in the United States
• List of osteopathic colleges

References

Further reading

• Collins, Martin (2005). Osteopathy in Britain: the First Hundred Years. London: Martin Collins. ISBN 1-4196-0784-7. 
• DiGiovanna, Eileen; Schiowitz, S; Dowling, DD (2005). An Osteopathic Approach to Diagnosis and Treatment (3rd ed.). Philadelphia, PA: Lippincott Williams and Wilkins. ISBN 0-7817-4293-5. 
• Stone, Caroline (2002). Science in the Art of Osteopathy: Osteopathic Principles and Practice. Cheltenham, UK: Nelson Thornes. ISBN 0-7487-3328-0. 

Osteopathic medicine (ICD-10-PCS 7) General Osteopathic medicine in the United States Osteopathic medicine in Canada Treatments Articulatory technique Balanced ligamentous tension Chapman reflex points Counterstrain Cranial Lymphatic pump Muscle energy technique Myofascial release Paraspinal inhibition Soft tissue technique Somatic dysfunction Education List of osteopathic medical schools Doctor of Osteopathic Medicine Accrediting Commission Licensing COMLEX NBOME Organizations AOA COA AACOM Student Council Specialty Boards Specialty colleges Directors and Medical Educators American Academy of Osteopathy People List of osteopathic physicians Andrew Taylor Still S. S. Still Media The DO The Journal of the American Osteopathic Association Osteopathic Family Physician History History California merger Flexner Report Osteopathic medicine