Alternative and Complementary Therapies

What is Osteopathy?

© Leon Chaitow, N.D., D.O.
Editor-in-Chief, Journal of Therapeutic Bodywork; Senior lecturer,
University of Westminster, London
(Excerpted from Osteopathy: A Complete Health Care System )


If you have ever had an aching back, stiff neck, tennis elbow, 'gammy'
knee or some such affliction of the body, then the chances are that you
have sought the help of, or have been advised by someone to go to, an
osteopath for relief. If, however, you have, or have had, a more serious
health problem such as asthma, migraine headaches, angina pains,
digestive disturbances (to name but a few examples), then it has probably
not occurred to you that the condition might have some of its origins in a
dysfunction of some mechanical component of the body, the
musculo-skeletal system. You would, therefore, probably not have taken
such a problem to an osteopath practitioner. Surprising as it may seem,
many such 'illnesses' are often the end result of biomechanical changes
in the structure of the body which are amenable to osteopathic treatment.
This theme will be elaborated on in later chapters, and some of the
fascinating research that has been done in a wide range of health
problems will be detailed. At this stage, the idea of osteopathy offering
help to conditions other than the more obvious aches and pains may
seem a strange one. In order to understand the concept of osteopathy,
and what its real potentials are, it is necessary to examine its roots and
subsequent development. 

Osteopathy is a system of health care which recognizes that the
self-healing, self-regulating ability of the body is dependent upon a
number of factors, including favourable environmental conditions (internal
and external), adequate nutrition and normal structural integrity. It utilizes
generally accepted methods of diagnosis, as well as certain specialised
ones developed to facilitate accurate structural assessment. It places
special emphasis upon the importance of body mechanics, and uses
manipulative techniques to detect and correct, faulty structure and
function. 

In many people's minds, especially in the U.K., osteopathy is equated
mainly with the treatment of spinal and other joint pains and problems.
This limited care concept is largely an historical accident. As indicated
above, the osteopathic profession sees itself as being relevant to a wide
range of health problems, and not simply limited to the treatment of
musculo-skeletal derangements. Since the turn of the century, when the
first American-trained osteopaths established themselves in practice in
the U.K., they have filled a gap that existed (and to a large extent still
exists) in medical practice. Doctors tended to regard musculo-skeletal
problems as relatively unimportant, and manipulation as, at best, an
unknown quantity and, at worst, valueless. 


Side view of a normal spine
showing the natural curves.


In the U.S.A., the gradual evolution of osteopathy has been towards its
original goal of providing a complete health-care system, dealing with all
of man's ailments, and utilizing all those accepted therapeutic methods
which coincide with its belief in the necessity for treating the patient as a
whole, rather than simply treating symptoms. This concept of treating the
'whole' man deserves closer scrutiny. Disease may be stated to be the
result of a disparity between the capacities, resources and responses of
the individual, and the demands and circumstances made by his life.
Disease can be seen to be a phase in the natural history of the individual,
whose unique nature responds to his own particular environment. The
individual's inheritance, capacities, resources and demands, and,
therefore, his adaptations and responses, are unique to him. Illness, the
level of health, predispositions, resistance, responses, adaptations etc. to
all the elements of his environment, are a culmination of an individual's
life, up to that point. The apparent similarities between diseases in
different individuals, and the ability to classify diseases, are testimony to
the fact that the body can respond in only a limited number of ways to an
infinite variety of events and factors. The patient's illness should,
therefore, not be seen to be a disease, or aberration, of an organ or
process alone, but as part of an illness in his total being. The patient with
angina is not ill because of his angina, but has angina because he is ill. It
is consideration of the whole picture of the patient's uniqueness, and his
relationship with all his complex environmental factors, that provide the
background for the total health care that osteopathy seeks to offer. This,
of course, includes consideration of the largest body system, the
musculo-skeletal system. The methods of care also include its own
distinctive approach to the normalizing of musculo-skeletal dysfunction,
osteopathic manipulative therapy (O.M.T.). 

It is not possible to separate osteopathic practice from the theories that
produced it. Osteopathy is not just a mechanistic approach to disease
but a sincere and effective system which attempts to remove the causes
of ill-health and seeks to reinforce the basic curative force which lies
within the body itself. The belief was originally expressed over a hundred
years ago by Andrew Taylor Still, the originator of Osteopathy, whose life
and work will be considered in the next chapter. The concept of many of
the causes, and therefore of the remedies, lying within the body itself,
has a long history. For as long as man has existed on earth, disease and
injury have existed with him. 

Treatment of disease was, in prehistory, assigned to practitioners of one
or another healing method. The cause of disease was ascribed, by many,
to outside forces which were thought to enter the body of the sufferer.
Treatment in such case was aimed at driving out such evil or morbid
influences. Other practitioners blamed aberrations within the body, or
soul, of the victim, for the disease process, and treatment was then
designed to normalize the causative disturbances. These two divergent
philosophies, the outside or inside cause, exists side by side for
centuries. 

In the fourth century B.C. a rational system of healing was introduced by
the great Greek physician Hippocrates. He taught that illness was often
caused by quite simple things, such as eating the wrong food or by living
in unhygienic conditions. He therefore recognized that the apparent
causes of disease could originate from external or internal factors.
However, I believed also that the body itself, through the healing efforts of
its own nature, was the means of recovery. 'It is our natures that are the
physicians of our diseases'. 

He stressed that the physician should assist the ability of the body to
overcome disease by removing causative factors, and by encouraging the
healing effort, but never to meddle with, or hinder nature's attempt towards
recovery. Thus the school of thought that followed Hippocrates' teaching
emphasized the study of health of man as a whole integrated unit;
relating the whole man to his environment. Within that framework the
causes of ill health were to be found. 

Other schools of thought, however, continued to focus attention on the
disease process itself, as an entity, largely ignoring the patient. The
history of medicine ever since has been highlighted by proponents of one
or other of these schools of thought. Through the ages we find the
theoretical battle raging, which is more important, the diseased or the
disease? It is true to say that the Hippocratic concept has been more
honoured, but the rival philosophy has been more practiced. 

Osteopathic theory and practice are firmly in line with the concepts of
Hippocrates. The patient is considered and treated as a whole. Founded
as it was in this tradition, osteopathy is patient orientated rather than
disease orientated. It has utilized structural diagnosis and manipulative
therapy as part of its philosophy and practice, and therefore as part of
total patient care, not confining it to painful conditions of the
musculo-skeletal system alone. 

In essence the original concept of osteopathy held that: 

1.Within the human body there exists a constant tendency towards
health. If this capacity is recognized, and if treatment takes its
relevance into account, then the prevention and normalization of
disease processes is enhanced. 
2.The structure of the body is reciprocally related to its function. By
this it is meant that any change in structure will alter some aspect
of function and, conversely, any alteration in function will result in
structural changes. 
3.Health is the primary area to be studied in attempting to
understand disease. 
4.The musculo-skeletal system, which incorporates the bones,
ligaments, muscles, fascia etc. forms a structure which, when
disordered, may affect the function of other parts and systems of
the body. This might be the result of irritation or abnormal
response of the nerve and/or blood supply to these other organs or
parts. 
5.The body is subject to mechanical disorder and is therefore
capable of mechanical correction. 

Discussion of these concepts will be found in the chapter dealing with
osteopathic theory. 

There is a growing awareness of the value to general health of an
integrated, mechanically sound, musculo-skeletal system. The scientific
rationale for this becomes clearer with research. Clinically, however,
osteopaths have long realized the positive effects of manipulative therapy
on health. It is necessary to keep in mind two essentially different roles
filled by Osteopathic practitioners in their work. One is that of providing
limited care to patients with joint pains and strains. The other is the total
health-care of patients, with any of the myriad ills of mankind. There is
also a further extension of osteopathic care, in areas in which no other
form of healing offers much help. This is the more recent application of
osteopathic principles and methods to the structures (bones, reciprocal
tension membranes, fluid fluctuations etc.) of the skull, especially of
infants. As will be described in the chapter on Cranial Osteopathy. These
methods, when successfully applied to such problems as cerebral palsy
and spasticity of the newborn, can produce results bordering on the
miraculous. In its limited application (joint injuries, postural stresses etc.)
osteopathy is a most effective system for the treatment of
musculo-skeletal derangements. 

Osteopathy Compared
Confusion exists in both public and medical minds as to the distinction
between osteopathic and other forms of physical treatment. Because
other systems utilize manipulative methods on their approach to the
patient it is often assumed, even by apparently knowledgeable individuals,
that there really is not very much difference between osteopathy and, for
example, physiotherapy or chiropractic. Nothing could be further from the
truth, and a brief examination of some of the other systems with which
osteopathy is often confused should help to clarify the differences.
Chiropractic Osteopathy and chiropractic differ in three main areas. These
are the philosophical or theoretical aspects, the technique and the
training. Osteopathy has a basic philosophical viewpoint from which have
developed the specialized diagnostic and therapeutic measures, including
osteopathic manipulative technique. 

Chiropractic originally placed great emphasis on the idea that spinal
joints, when misplaced (subluxated), could impinge upon nerves and thus
cause disease elsewhere in the body. Chiropractors tended to focus
attention on the spinal and pelvic structures, employing elaborate x-ray
procedures in their analysis of subluxations. Treatment tended to be by
specific high velocity thrust techniques, often employing a rebound effect
from complex, sprung treatment couches. 

Over the years chiropractic has tended to take more and more interest in
joint dysfunction as related to back and neck pain, rather than in the
general treatment of ill health. A survey in Australia, Canada and the U.K.
indicated that 90 per cent of patients attending chiropractors do so for
treatment of low back and neck pain. Chiropractic techniques have also
changed over the years, to the point where many practitioners employ
similar functional and leverage techniques to osteopaths. In the same
way, many osteopaths have incorporated thrust techniques usually
associated with chiropractic. 

In the U.S.A. osteopathy has become an accepted (in law) alternative
system to orthodox medicine, employing its own unique methods as well
as what it considers useful from the orthodox system, in the treatment of
all forms of ill health. Chiropractic is more limited in its legal position, its
range of application and in its range of methods. It is certainly true to say,
though, that in treatment of neck and back conditions the difference
between the two systems has become blurred. The training of an
osteopath in the U.S.A. takes seven years and a full licence is granted to
graduates. A four year training which is undertaken to achieve a
chiropractic doctorate leads to a limited licence (no surgery, drug
prescription or the right to sign death certificates etc.) 

Historically the two professions grew out of similar roots, but they have
evolved to the point where their similarities are to be seen only in the
relatively narrow areas of pain and dysfunction in the back and neck.
Their differences become very apparent in their consideration of general
health care. 

Manipulative Therapy
This has grown out of the tradition of remedial massage and bonesetting.
Whilst utilizing techniques which resemble osteopathic manipulative
therapy and chiropractic, manipulative therapists regard their work as
being aimed at the physical normalization of joint and muscle
dysfunction, with the objective of improving mechanical function. No
attempt is made to relate the methods to broader aspects of body
function or ill health; indeed such ideas are actively discouraged by the
leaders of this profession, which sees itself as a system subsidiary to
medicine, in contrast to osteopathy which sees itself as an alternative. 

Most of the work of these therapists involves massage, with manipulation
only being used when considered absolutely necessary. There are no full
time training facilities for such practitioners who are, as a rule,
physiotherapists or masseurs drawn to these methods. Some are skillful
and competent, but their narrow view as to the value and application of
manipulation, together with their limited approach to bodily dysfunction,
distinguishes them from the osteopathic practitioner. Bonesetters
There are still some 'bonesetters' about, especially in remote rural areas.
These are, frequently, gifted healers carrying on an unwritten tradition of
learned and acquired skills which go back into prehistory. 

In England, there was for many centuries a tradition of bonesetters. Many
of these undoubtedly skilled practitioners had no formal medical training.
In the early eighteenth century a Mrs Mapp achieved a great following and
was consulted by many doctors. 

In 1867 Sir James Paget, an eminent physician, warned his fellow
doctors: 'Few of you are likely to practice without having a bonesetter for
a rival; and if he can cure a case which you have failed to cure, his fortune
will be made and yours marred.' 

The fame of Herbert Barker, an unqualified bonesetter, was so great that
he was eventually knighted for his services. He was hounded by orthodox
medicine and all contact between Barker and doctors was forbidden on
pain of expulsion from the profession; this, despite his continual stream of
successful cases. In his old age Barker demonstrated his techniques to a
group of orthopaedic surgeons in London, a final admission of his genius. 

Manipulation, as practiced by bonesetters, was a relatively simple matter
of pushing or pulling restricted joints, to achieve ease of movement.
Sometimes great force was used and frequently damage was caused by
excessive violence. The difference between such methods and their total
lack of any coherent or systematic use differentiates them from
osteopathy. 

Massage
Massage has a long history, but not until the nineteenth century was a
systematic approach developed by P. H. Ling in Sweden. A school of
medical gymnastics was founded, and this promoted the use of 'scientific'
massage. Many variations exist. Some methods are remedial, being
aimed at the restoration of function lost during surgery or because of
enforced bed-rest (accidents, strokes etc.), or through advancing age.
Other methods are used to encourage function in birth injuries or
disease-damaged (polio) patients. Massage techniques are also used in
gaining general relaxation and circulatory improvements. 

Osteopaths utilize specialized soft-tissue techniques which bear a
superficial resemblance to massage. Both deal with the soft tissues. The
osteopath is either preparing the area for subsequent manipulation or
dealing reflexly with problems distant from the area being treated. The
U.K. trained osteopath might use a system developed in England known
as neuro-muscular technique. In the U.S.A a similar deep soft tissue
method was developed by the late Ida Rolf. Both these method have
some similarities with the specialized German method of connective
tissue massage (Bindesgewebsmassage) which uses deep finger and
thumb strokes to achieve local and reflex effects Rolfing aims at releasing
deep tissue contractions and thus encouraging postural and structural
reintegration, and psychological 'release' from emotions which are tied
into muscular stress patterns. Neuro-muscular technique, rolfing and
connective tissue massage are all specialized soft tissue methods,
bearing little in common with what is normally, thought of as massage. 

Physiotherapy
In orthodox medicine the remedial gymnast and masseur of old has been
replaced by the physiotherapist of today. This profession is an adjunct of
the dominant medical system, and it incorporates a variety of modalities
such as exercise, massage and manipulation. Traction and some forms
of hydrotherapy also form part of the physiotherapist's methods. In other
words anything that can usefully be employed in treating the physical
body, to enhance its function, or to minimize its dysfunction especially as
related to the muscles and joints, is incorporate' into physiotherapy.
There are, of course, other rehabilitative aspects and therapeutic ones
(such as encouraging normality after injury or surgery, and assisting in
respiratory function in asthmatics.) 

In the main, however, physiotherapists deal with the vast range of
rheumatic diseases with the modalities outlined. Their use of
manipulation tends to be confined to a limited range of specific
techniques which are applied to the neck and low back areas. The
techniques employed are usually direct action ones where joints are
forced through a range of motion. Doctors of physical medicine and
orthopaedic surgeons tend to limit their sphere of interest to the
mechanics and pathology of the musculo-skeletal system. This is a large
and vital area, but from the osteopathic viewpoint it is important, not only
in itself, but because of the ramifications that dysfunction in any of its
constituent parts may have on the overall economy of the body and on
specific organs and functions. 

As we shall see in the unfolding of the history and current practice of
osteopathy, as important as manipulative methods and specialized
osteopathic diagnostic methods are to the science of osteopathy, it has
always been recognized that care of the 'whole' man requires the
integration and use of all methods and measures which contribute to
well-being. This was made clear in the charter of the first College of
Osteopathy in 1892. The aim then was stated to be 'To establish a
college of osteopathy, the design of which is to improve our present
system of surgery, obstetrics and treatment of diseases generally, and to
place the same on a more scientific and rational basis and to impart
knowledge to the medical profession'. A reforming role was seen as being
the essential part osteopathic medicine would play. The subsequent
history and the success of the profession especially in the country of its
birth, against extraordinary odds, is fascinating. Before we touch on this,
however, a man of extraordinary vision deserves our attention; Andrew
Taylor Still. 

© Leon Chaitow, N.D., D.O.