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Therapies

osteopathy

What Is It?
How Does It Work?
What You Can Expect
Health Benefits
How To Choose a Practitioner
Cautions

References

Evidence Based Rating Scale
 

What Is It?

Osteopathy is a holistic approach to the practice of medicine. It emphasizes that all systems of the body are interrelated and that any adverse changes in one part of the body may impair the functioning of other systems or organs.

For this reason, doctors of osteopathy (D.O.s) treat the body as a whole, often focusing special attention on the musculoskeletal system (bones and muscles) in an effort to find the underlying cause of an ailment. Osteopathy also stresses preventive medicine, encouraging patients to maintain a healthy lifestyle and eat a healthy diet.

Osteopathy was first developed in 1874 by Missouri physician and surgeon Andrew Taylor Still M.D., who became disenchanted with conventional medicine after losing three of his children to spinal meningitis. Still became convinced that health and illness were largely dependent upon the soundness and mechanical functioning of the body's bones, muscles, and joints. Based on this idea, he created a new medical science, which he ultimately named osteopathy, from the Greek words osteo, meaning bone, and pathos, which means suffering or disease. In 1892, Still founded the American School of Osteopathy, now the Kirksville (Missouri) College of Osteopathic Medicine.

Today, doctors of osteopathy go through the same rigorous training as medical doctors (M.D.s). They attend four years of osteopathic medical school followed by internship, residency, and fellowship training. While they are eligible to specialize in all of the customary fields such as pediatrics, surgery, and internal medicine, a larger proportion choose family practice. An additional option is specialization in musculoskeletal alignment, known as Osteopathic Manipulative Therapy (OMT). Like M.D.s, osteopathic physicians write prescriptions and order lab tests and radiographic examinations. They are subject to board certification in their chosen specialty and are eligible for membership in the American Medical Association, although the American Osteopathic Association (AOA) is more likely to be their primary affiliation. The AOA represents more than 70,000 osteopathic physicians and is the accrediting agency for all osteopathic medical schools, hospitals, and heath care facilities. Currently in the United States, there are 26 accredited osteopathic colleges in 32 locations. The AOA has also helped to form the Bureau on International Osteopathic Medical Education and Affairs (BIOMEA) and the Osteopathic International Alliance, representing more than 65,000 osteopathic practitioners around the world.

Osteopathic Manipulative Therapies include a variety of techniques for helping to realign the musculoskeletal system, from the familiar technique that creates a sound (like popping your knuckles) to techniques that use the body’s own musculature and others that are extremely gentle. Among these, the most subtle is osteopathy in the cranial field, in which the focus of attention is on the pulsatile motion of cerebral spinal fluid and fascia. Performed by highly trained, licensed physicians (M.D.s and D.O.s) and even some dentists (D.D.S.s), this therapy was the precursor to CranioSacral Therapy, which is now practiced by a variety of other kinds of alternative practitioners.

How Does It Work?

A visit to a D.O. is very similar to a visit to an M.D. Indeed, for many disorders, the way an osteopathic physician treats a condition may be the same as a medical doctor would. There are some differences, however.

For example, if the health problem involves bones, muscles, or tendons, an osteopath may use osteopathic manipulative therapy (OMT) to encourage healing. OMT includes soft-tissue massage, rhythmic movements and stretches, articulation techniques that work the joints, and painless high-velocity thrusts. Osteopaths believe that these techniques improve nerve transmissions and enhance immunity by decreasing congestion in lymph nodes and increasing the availability of the body's natural antibodies.

OMT can relax muscles, enhance flexibility, stimulate nerves, improve posture, and increase range of motion and mobility in limbs and joints. Combined with improvements to a patient's lifestyle and eating habits, OMT promotes overall well-being.

Osteopathy should not be confused with chiropractic. Although both disciplines are based on the belief that health is rooted in the body's structure, chiropractors are trained to focus on realigning the bones and joints, while osteopaths have all the tools of a medical practice at their disposal when treating a patient.

What You Can Expect

An initial visit to an osteopath typically begins with an extensive discussion of symptoms, medical history, emotional health, and lifestyle. The doctor's assessment will likely also include a complete physical exam that might involve blood work, urine analysis, or X-rays, as necessary.

A hands-on evaluation of the spine, muscles, joints, and tendons will also typically be performed. The physician will look for any dysfunction or asymmetry and note reflexes, flexibility, and muscle strength. The physician may ask the patient to walk, stand, sit, or lie down in order to note the body's form, movements, and muscle tone.

The osteopath may recommend certain changes to the diet or lifestyle, prescribe medication, or refer the patient to a specialist for different treatment. If a structural abnormality has been found, OMT may be performed by the doctor to treat the problem.

A first visit may take up to an hour, and subsequent visits are usually 20 to 30 minutes. The number of visits required will depend on the condition.

Health Benefits

Osteopathy's whole-body approach can be used to treat many conditions, but it has been shown to be especially well-suited to the treatment of back and neck pain, headache, knee problems, and joint injuries.

Moreover, osteopathy's hands-on, manipulative techniques can relax muscles, relieve pain, reduce stress, stimulate nerves, and promote blood circulation. The manipulations may also help to improve posture and increase mobility and range of motion. Not surprisingly, sports medicine is a natural outgrowth of osteopathic practice.

Specifically, osteopathy may help to:

Reduce back and neck pain. A landmark 1994 study of treatment modalities for low back pain by the Agency for Health Care Policy and Research, a division of the U.S. Department of Health and Human Services (now known as the Agency for Healthcare Research and Quality), showed that spinal manipulation can be helpful for patients with acute low back problems when used within the first month of symptoms. (1) Osteopathic physicians believe OMT provides a greater benefit and more cost-effective method of treating this condition than conventional treatment or other spinal manipulation practices, and several studies have been conducted to distinguish this difference. (2) They may also add additional physical therapy modalities such as ultrasound and diathermy to the treatment regimen.

Some research has shown that OMT may be helpful in improving back and neck pain, and in reducing the amount of conventional pain medication needed. Three major preliminary trials between the 1970s and 2000 showed that OMT seems to decrease the use of adjunctive therapies, such as medications or physical therapy. However, the studies involved small numbers of subjects. (3-5) In 2003, in the Randomized Osteopathic Manipulation Study (ROMANS) at the Wales Institute of Medical and Social Care Research, osteopathic spinal manipulation treatments significantly improved short-term physical scores and long-term psychological scores in 201 patients with neck or back pain compared to conventional care by a general practitioner. (6) A 2005 systematic review and meta-analysis of randomized controlled trials conducted by the Osteopathic Research Center in Fort Worth, Texas found six trials involving eight OMT versus control treatment comparisons. Overall, OMT was shown to significantly reduce back pain during short-, intermediate- and long-term follow-up (three months after treatment). (7) A 2008 study of 41 patients with chronic non-specific neck pain found that osteopathic treatment for 45 minutes every other week lead to significant decreases in pain intensity and improvements in quality of life compared to controls. (8) Larger studies are needed.

Between August 2006 and June 2010, researchers at the Osteopathic Research Center collected data for what will potentially be the largest randomized, controlled trial involving OMT. This phase III trial seeks to compare the efficacy of OMT and ultrasound physical therapy (UPT) to reduce pain scores in 488 subjects with chronic low back pain. Results have not yet been released. (9)

Speed healing of minor sports injuries. The professional manual adjustment and pressure applied by hand to the spine and other joints can ease pain or stiffness and improve not only posture but the function and rapid healing of joints, muscles, and nerves. Some osteopathic physicians actually specialize in sports injuries and rehabilitation. Some athletes report that manipulation can relieve muscle spasms, certain joint problems, and nerve irritation resulting from sports injuries. A 2003 study of adults 18 and older showed OMT reduced swelling and pain and improved range of motion in ankle injuries compared to controls. (10) A 2007 in vitro study showed that OMT reduced inflammation in repetitive motion strain. (11) More research in humans is needed.

Improve airflow in asthma. Osteopathic manipulative therapy has been studied in patients with asthma. Osteopathic physicians try to minimize symptoms of asthma by improving the mobility of the thoracic cage, thereby allowing better airflow in and out of the lungs. A randomized controlled trial of 90 pediatric asthmatics found that osteopathic manipulation improved their peak airflow readings from 7 liters to 9 liters per minute. (12) However, a 2005 Cochrane Database review of studies involving manual therapies like osteopathic in 156 patients found insufficient evidence to support or refute the use of manual therapy for patients with asthma. (13) More research is needed.

Treat fibromyalgia. Preliminary evidence indicates that OMT may be useful in treating the chronic muscle aches of fibromyalgia. In a small 2002 study of 24 female patients with fibromyalgia, patients were assigned to one of four groups: manipulation group, manipulation and teaching group, moist heat group or control group (no additional treatment other than current medication). The OMT group showed beneficial effects during assessments of pain thresholds, pain ratings, quality of of life, and depression  scores compared to other treatment groups and controls, indicating that OMT combined with standard medical care was more efficacious in treating fibromyalgia than standard care alone. (14) More research is needed.

Boost immunity. The use of OMT may theoretically shorten the course of respiratory infections, such as Type A (H1N1) Influenza 2009, and improve pulmonary function in Chronic Obstructive Pulmonary Disease (COPD) by improving blood flow and lymphatic drainage in the lungs as well as by decreasing restrictions in rib motion and improving ventilatory capacity. (15-17) In a 2008 study of 35 patients age 65 and older with COPD, patients receiving OMT showed significant improvements in pulmonary function parameters (air flow, airway resistance, reserve volume, total lung capacity, etc.) and reported breathing better after receiving treatment. (18) However, research is limited. More research is needed.

How To Choose a Practitioner

Choose a D.O. with the same scrutiny as an M.D. Make sure the doctor selected is licensed and board-certified in the designated field. Not all D.O.s offer OMT as part of their treatment approach, so patients looking for this type of therapy should be sure to ask about it when making an appointment. Patients can also search the American Academy of Osteopathy website at http://www.academyofosteopathy.org/ or the Osteopathic Cranial Academy at http://www.cranialacademy.com/ to find a physician that offers the desired services. Osteopathic continuing medical education courses are also open to M.D.s, so while they may not also be licensed as a D.O., some M.D.s may be skilled in osteopathic treatment.

Insurance coverage for D.O.s and M.D.s is identical.

Cautions

Strenuous joint manipulation should not be painful but can result in minor aches that last a day or two.

Patients with a history of bone and joint related problems such as osteoporosis, fractures, severe joint Inflammation, spinal fusion,  bone cancer, etc. should mention these conditions to a physician before undergoing osteopathic treatment so that therapy techniques can be adapted so as to not exacerbate the condition. 

References 

1. Bigos S, Bowyer O, Braen G, Brown K, Deyo R, Haldeman S, et al. Acute Low Back Problems in Adults. Clinical Practice Guideline 14. Rockville, Md: AHCPR Publication No. 95-0642. Agency for Health Care Policy and Research, Public Health Service, US Department of Health and Human Services; December 1994.
2. Licciardone, JC. The unique role of osteopathic physicians in treating patients with low back pain. J AM Osteopath Assoc.  2004 Nov;104(22):13-18.
3. Andersson GB, Lucente T, Davis AM, Kappler RE, Lipton JA, Leurgans S. A comparison of osteopathic spinal manipulation with standard care for patients with low back pain. N Engl J Med.1999; 341:1426 -1431.
4. Hoehler FK, Tobis JS, Buerger AA. Spinal manipulation for low back pain. JAMA.1981; 245:1835 -1838.
5. Licciardone JC, Stoll ST, Fulda KG, Russo DP, Siu J, WinnW, et al. Osteopathic manipulative treatment for chronic low back pain: a randomized controlled trial. Spine.2003; 28:1355 -1362.
6. Williams NH, Wilkinson C, Russell I, et al. Randomized osteopathic manipulation study (ROMANS): pragmatic trial for spinal pain in primary care. Farm Pract. 2003 Dec;20(6):662-9.
7. Licciardone JC, Brimhall AK, King LN. Osteopathic manipulative treatment for low back pain: a systematic review and meta-analysis of randomized controlled trials. BMC Musculoskelet Disord. 2005 Aug 4;6:43.
8. Schweria F, Bischoff A, Nurnberger A, et al. Osteopathic treatment of patients with chronic non-specific neck pain: a randomized controlled trial of efficacy. Forsch Komplementmed. 2008 Jun;15(3):138-45.
9. Licciardone JC, King HH, Hensel KL, Williams DG. OSTEOPAThic Health outcomes In Chronic low back pain: the OSTEOPATHIC Trial. Osteopath Med Prim Care. 2008 Apr 25;2:5.
10. Eisenhart AW, Gaeta TJ, Yens DP. Osteopathic manipulative treatment in the emergency department for patients with acute ankle injuries. J Am Osteopath Assoc. 2003 Sep;103(9):417-21.
11. Meltzer KR, Standley PR Modeled repetitive motion strain and indirect osteopathic manipulative techniques in regulation of human fibroblast proliferation and interleukin secretion. J Am Osteopath Assoc. 2007 Dec;107(12):527-36
12. Guiney PA, Chou R, Vianna A, Lovenheim J. Effects of osteopathic manipulative treatment on pediatric patients with asthma: A randomized controlled trial. JAOA. 2005;105:7-11.
13. Hondras MA, Linde K, Jones AP. Manual therapy for asthma. Cochrane Database Syst Rev. 2005 Apr 18;(2):CD001002.
14. Gamber RG, Shores JH, Russo DP, et al. Osteopathic manipulative treatment in conjunction with medication relieves pain associated with fibromyalgia syndrome: results of a randomized clinical pilot project. J Am Osteopath Assoc. 2002 Jun;102(6):321-5.
15. Riley GW. Osteopathic Success in the Treatment of Influenza and Pneumonia. American Osteopathic Association – Chicago Session. July 1919. J Am Osteopath Assoc. August 1919.
16. Riley GW. Osteopathic Success in the Treatment of Influenza and Pneumonia. American Osteopathic Association – Chicago Session. July 1919. J Am Osteopath Assoc. August 1919. Special Reprint J Am Osteopath Assoc. May 2000;100(5).
17. Murray DR, Irwin M, Reardon CA, et al. "Sympathetic and immune interactions during dynamic exercise. Mediation via a beta 2 – adrenergic-dependent mechanism." Circulation. 1992;86(1):203.
18. Noll DR, Degenhardt BF, Johnson JC, Burt SA. Immediate effects of osteopathic manipulative treatment in elderly patients with chronic obstructive pulmonary disease. J Am Osteopath Assoc. 2008 May;108(5):251-9.

Evidence Based Rating Scale

The Evidence Based Rating Scale is a tool that helps consumers translate the findings of medical research studies and what our clinical advisors have found to be efficacious in their personal practice into a visual and easy to interpret format. This tool is meant to simplify the information on supplements and therapies that demonstrate promise in the treatment of certain conditions.

 

Condition

Rating

Explanation

 

Asthma

   

In one study, osteopathic manipulation improved peak air flow readings in children. (12, 13)

Back pain  
Several small studies and meta-analyses of small studies indicate efficacy in reducing pain. Larger studies are needed to confirm or refute efficacy. (1-9)
Bronchitis  
Preliminary studies indicate potential efficacy to shorten the duration of infection. More research is needed. (15-17)
 

Fibromyalgia  
Preliminary evidence indicates potential efficacy. More research is needed. (14)
Neck pain  
Date Published: 04/19/2005
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