The way a doctor treats a patient for an illness isn't based only on technique; it's also controlled by the doctor's outlook toward both disease and the patient. This outlook is a philosophy of practice, and it's one of the key differences between osteopathic and allopathic (traditional or standard) medicine.
Allopathy focuses on the disease or condition itself. This is using the logical assumption that it's the disease that's causing the patient's suffering. The M.D. doctor locates the specific disease, targets it and treats it. If there are other conditions in the patient, they are considered incidental, at least for the moment; the actual disease is the most important matter to the doctor, and he/she focuses on that until the problem is solved.
Osteopathy takes a different approach, uses a different philosophy. To a D.O., a person's body is a single, interrelated system, not just a collection of different systems that are riding together. Each element can have an effect on everything else, and the health of the surrounding parts; and, since all these are together in one self-contained system, on the health of the whole body. Logically, then, if one part of the body-system isn't working properly, the problem can be reflected in other areas as well.
The muscles, skeleton and circulation are fundamental to the body-system's health. The skeleton provides theframe on which are hung the muscles, and the two together transport the body. The muscles, along with the skin and bones, also contain and protect the body's other organs. Nourishing all this is the blood, carried by the circulatory system. Without these three fundamentals, the body's ability to work is, at the least, impaired. This isn't to say that all disease rises from problems in the circulation or whatever; it merely emphasizes that those three areas of the body are important in the overall body-system's functioning and self-maintenance.
For the body-system is self-maintaining, under most conditions. When there's no obstruction in blood flow, no germs or viruses undermining normal function, the human body does a great job of repairing and defending itself. Consider what we have inside us: white blood cells and antibodies to fight infection, clotting agents such as platelets and other cells to begin healing wounds, the regrowth of tissue itself for repair of damage. If you're in good health, you usually stay in pretty good health.
But when an accident or infection overwhelms the normal balance, or when one part of the body-system can't do its job, the other parts will suffer. When this happens, osteopathic philosophy says that restoring the body's normal harmony and interdependence of function will relieve the condition of disease the body is going through. (It should be noted, as an important aside, that disease is considered the result of the body's problems, not the cause. If the interdependence of the body is out of whack, then the patient will exhibit the conditions of life that are commonly called "disease.") It's the D.O.'s job to discover where the problem is in the body-system, and take steps to solve it.
To find the cause of illness, D.O.s today use all of the recognized methods of medical investigation that we are familiar with, from lab tests to X-rays, to the more esoteric forms of probing: CAT scans, MRI (magnetic resonance imaging), etc. (Indeed, osteopaths at times have been pioneers in the use of such devices; the second X-ray machine west of the Mississippi River was installed at Kirksville College of Osteopathic Medicine.) They also aren't loath to use proven modern techniques and drugs to treat patients.
The technique for which D.O.s are most recognized, though, is at the root of osteopathic philosophy. Osteopathic manipulative therapy was first developed scientifically by Dr. Andrew Still in the latter 19th Century. (There is evidence that manipulation techniques similar to OMT have been used for thousands of years -- for instance, by the ancient Egyptians. Dr. Still, however, can justly receive credit for rediscovering, documenting and codifying them.) As part of examining a patient, an osteopath uses the hands to feel, or palpate, for where dysfunction is apparent. This may seem obvious; fever, swelling and tenderness can be found many times by a layperson as well as a D.O., and M.D.s often use palpation as well, such as checking the tonsils and adrenals by feeling for swelling in the throat.
A trained D.O., however, can use touch to repair, relieve or improve the body's functions as well, either by itself or as part of the overall treatment program. Both of these go hand-in-hand with osteopathy's philosophy; since a disease condition can show up in other areas of the body, touch at strategic points can give the doctor clues as to what's wrong with the patient. Logically then, if certain kinds of touch can help diagnose disease, then certain other kinds of touch (or manipulation) can help relieve disease. This technique is the hallmark of a D.O.
You'll probably see OMT most often used to relieve a muscular or skeletal problem; in fact, Dr. Still first gained fame as a "lightning bonesetter" among the patients in his practice. But problems may be only related to the muscles and bones, or include them as part of the overall situation. For instance, a nerve may be pinched in the shoulders by the way the muscles or bones are currently positioned; careful manipulation by osteopathic techniques such as counterstrain can relieve the pressure, and therefore the pain. A similar situation can be found in a simple headache. Muscle-tension headaches carry that name for just that reason; the muscles of the neck tighten, constricting blood and nerve flow to the head. Manipulation of the neck and head releases the tension on the muscles, and therefore on the nerves and blood vessels, easing or relieving the headache.
Other problems can be helped by working on the positioning of the vertebrae in the spine; because of this, D.O.s are sometimes confused with chiropractors. While there is a bit of overlap in technique, osteopaths aren't chiropractors; they practice using different philosophies of medicine. (This isn't to insult the practice of chiropractic, from which many patients have found relief for their suffering, but merely to separate the identities of the different professions.) Problems, to the D.O.'s philosophy, are located all over the body, and fixed all over the body as well. An example of this is a study of patients in a hospital in Maine with pneumonia. All of the patients received antibiotics; half of the patients received OMT, while half didn't. The ones that did recovered more quickly, and were less likely to need readmission for more treatment.
This holistic approach can't be emphasized enough; it's one of the keys on which Dr. Still based osteopathic principles, in his search for a better form of medicine than the scattershot techniques and dangerous drugs found in the 1860s and 1870s. By keying good scientific method with study and observation as to how the body worked, a new form of medicine was created that offered sensible alternatives for treatment of disease. D.O.s still practice these techniques today, and improve on them as they try to relieve the suffering of their patients.
Written with Bruce Alen Klaiss
June, 1998
An excellent site on the history of osteopathic medicine can be found at The History of Osteopathic Medicine Virtual Museum.
Even more can be explained at the sites of the American Osteopathic Association (the professional organization of D.O.s) and the American Academy of Osteopathy (the organization specializing in the study of osteopathic manipulative therapy).
Current and prospective medical students who have read this should also check out the SuccessTypes Medical E