What is osteopathic medicine?

The History of Osteopathy

Osteopathy is a medical philosophy that treats disease in the context of the whole person, taking into consideration the functions and interrelationships of all body systems as well as such factors as nutrition, environment, and psychology. The first college of osteopathic medicine was founded in Kirksville, Missouri, in 1892, by Andrew Taylor Still (1828–1917), a frontier physician and Civil War surgeon. By the opening decades of the twenty-first century, there were more than thirty colleges of osteopathic medicine across the United States.

Still was the son of the Reverend Abraham Still, a doctor as well as a minister. As a youth, Andrew often accompanied his father on house calls, where he helped with basic medical procedures. His study of medicine led to a doctorate of medicine (MD), and he was licensed in the state of Missouri.

During the Civil War and in his practice as a frontier doctor, Still became frustrated by his inability to cure patients using the available techniques. The suffering of his patients was difficult for him to tolerate. The lack of knowledge about diseases and their treatment drove him to reconsider ways to improve the lot of the ill and injured. He also suffered a great personal loss when an epidemic of spinal meningitis spread through Kansas. Three of his children died of the disease, and three others died shortly after they were born. These tragedies nearly caused Still to abandon his career, but, in spite of the fact that the practice of modern medicine was in its infancy, he was determined to find the answers that would help him conquer disease and improve the health of his patients.

After the war ended, Still spent his life studying, observing, comparing, and experimenting in the treatment of disease. His observations closely paralleled the theories that the Greek physician Hippocrates proposed two thousand years earlier. Both Still and Hippocrates encouraged the physician to concentrate on the patient, not the disease.

Still wanted to establish the first school of osteopathy at Baker University in Baldwin, Kansas. He was refused permission to do so, however, because his philosophy of medicine did not conform to the accepted medical practice of the day. He was ostracized in Kansas, and in 1874, he moved to Missouri, where he was still licensed as a doctor and was legally able to practice medicine. As an itinerant doctor, he gained fame throughout the area and was affectionately known as the “bonesetter.” It was during this time that he perfected his practice of osteopathy. Still’s reputation and popularity spread, and he soon required assistance in treating the patients who sought him out. He established the first school of osteopathic medicine in Kirksville, Missouri, as the American School of Osteopathy under the law governing scientific institutions in 1892.

In 1894, he received a new charter from the state of Missouri for an educational institution. By the authority of the charter, the school could have awarded an MD degree, but Still wanted his degree to be different and chose to award a doctor of osteopathy (DO) degree instead. During the next few years, osteopathic colleges became a trend, and at one time, thirty-seven of them existed, many of which were correspondence or diploma schools.

The American School of Osteopathy taught the art of manipulative therapy. Still and his followers believed that if they could regulate and correct malfunctions of musculoskeletal function, they could return the body to a healthful state. When possible, they also eliminated the use of drugs to treat disease. Although this approach now sounds extreme, at that time few, if any, drugs were on the market, and most had severe side effects.

At the time that Still was establishing the roots of osteopathy, many significant advances were made in medical knowledge and techniques, including germ theory, the development of antiseptic surgery, the development of anesthesia, and the reorganization of medical education. The emphasis of Still on the treatment of the entire person has taken on more importance in modern times with the development of the fields of holistic medicine and preventive care.

Science and Profession

The philosophy of osteopathic medicine suggests that a human being is an ecologically and biologically unified whole. Among its tenets are that the various body systems are joined through the nervous, endocrine, and circulatory systems and that if one region of the body is diseased, the entire body is diseased.

There are five basic premises of osteopathy. First, the unity of all body parts is a benefit that assists in the maintenance of health and the resistance to disease. Second, when the body is properly nourished and structural relationships are normal, the body is able to adapt to physiological changes that might otherwise put the body out of balance. Third, a healthy body depends on a healthy circulatory system and a nervous system that is able to conduct information to all areas of the body. Fourth, the musculoskeletal system does more than simply provide a framework for the body, and its normal function is critical to a healthy body. Fifth, it is not in the patient’s best interest for the physician to treat only one aspect of the disease; the physician must treat the entire body and mind if the patient is to be cured. In modern times, the osteopathic physician uses manipulative therapy—in which rhythmic stretching and thrusting movements are used to realign joints and muscles properly—as one of many tools to cure the patient.

Osteopathic physicians and allopathic physicians have much in common. Both are members of the health care community who are fully trained physicians, who have taken a prescribed amount of undergraduate work, and who have received four years of training in a medical school. After completing medical school, osteopathic physicians take a one-year rotating internship in hospitals with approved intern training programs. They may then enter a medical specialty program which may require a three- to four-year residency program.

Both allopathic and osteopathic medical programs use scientifically accepted methods of diagnosis and treatment. In the United States, the graduates of these programs are licensed by the same state medical boards and can practice in all phases of medicine in all states.

Admission to a college of osteopathic medicine in the United States requires a minimum of three years of preprofessional education in an accredited college or university. Virtually all students in osteopathic school, however, have been awarded undergraduate degrees. Many osteopathic students were science majors in undergraduate school, but all areas of study are represented. Most schools require a minimum of two semesters of study in biology, physics, and inorganic and organic chemistry. Students are also required to take the Medical College Admission Test (MCAT), submit letters of recommendation, and demonstrate an understanding of osteopathic medicine.

During the first two years in a college of osteopathic medicine, students receive basic science and preclinical instruction in a classroom or laboratory environment. Students are required to take courses in anatomy, biochemistry, physiology, pharmacology, pathology, and microbiology.

Schools are organized along one of two lines. They teach either by discipline or by system. In a discipline curriculum, the student concentrates on one subject at a time, such as biochemistry or physiology. In those programs with a curriculum that is organized by system, the student will study one organ system from the perspective of various basic science disciplines. For example, when studying the circulatory system, the student would concentrate on the anatomy, biochemistry, physiology, and pathology of the blood vessels and heart before moving on to another system.

Most students of osteopathy are required to take the first part of an examination prepared by the National Board of Osteopathic Medical Examiners near the end of their second year. At the end of the second year or in the third year, the student concentrates on clinical instruction. Students of osteopathy may do clinical rotations in teaching hospitals, community hospitals, or physicians’ offices in both urban and rural areas. Clinical instruction is designed to give the student experience in the diagnosis and treatment of a patient’s symptoms. Students also attend seminars and conferences that are more specialized and that emphasize the disease process and the healing process.

The second part of the national boards is taken during the last year, and the third part is taken after the student has received the DO degree. After completion of the degree, the student participates in a one-year rotating internship in an approved hospital prior to selection of a residency program. Approximately 70 percent of all doctors of osteopathy enter one of the primary care specialties, including general practice, general internal medicine, obstetrics/gynecology, and pediatrics.

Diagnostic and Treatment Techniques

Osteopathic medicine stresses the interdependence of structure and function. The application of manipulative therapy, and in particular joint mobilization, has been a hallmark of osteopathic medicine since its inception. Osteopathic physicians recognize human beings as complex biomechanical, biophysical, and biochemical organisms. They believe that structural disturbances can have wide-ranging effects that may spread to interconnecting systems. The biologic foundations of osteopathic medicine are based in the concepts of holism, homeostasis, unity of the body, environmental influences, and health-versus-disease.

Holism suggests that humans are whole beings that are not resolvable into component parts and that each “whole” is more than the sum of its parts. This premise can also be extended to mean that people are not isolated units—they are a part of their surroundings and thus are a part of their environment and the universe. The increased tendency toward specialization in health care would seem to be in conflict with this principle. Osteopathic medicine suggests a need to increase the number of generalists or primary care physicians to ensure adequate care of the whole person. It further requires time to know and understand the patient as a person in his or her own environment.

The concept of body unity suggests that the normal healthy body contains all the elements necessary to maintain optimum function. Osteopathic physicians would argue that when disease alters body function, there is adequate flexibility within the system to compensate for change and to return the body to a state of wellness. This concept is similar to the principle of general physiology known as homeostasis.

Homeostasis recognizes the fact that essential body functions such as acidity of the blood, body temperature, and blood pressure are maintained within relatively narrow limits. It is not unusual for these parameters to drift slightly from the norm, but they must be quickly and efficiently returned to normal if the body is to survive. Deviations that cannot be readjusted quickly lead to poor body function and even death. Therefore, the body expends much time and energy in maintaining homeostasis, which prevents changes in the environment from having a significant effect on body function.

The philosophy of osteopathic medicine presents the position that musculoskeletal function is important in the maintenance of homeostasis. If this system is “out of line” or in any way unhealthy, the body will have a more difficult time maintaining homeostasis. It further argues that a healthy musculoskeletal system is necessary for a healthy immune system and that an unhealthy immune system can interfere with homeostasis.

The osteopathic physician emphasizes the role of the environment in health. There is general agreement that a healthy environment contributes to a healthy body. However, a healthy environment here refers not only to the working and living environment of the patient, but also to all associates and family members who are directly involved with the patient.

The concept of health-versus-disease is central to the philosophy of osteopathic medicine. The osteopathic physician is not as concerned with the treatment of the disease as with the cause of the disease and the methods that can be used to prevent its continuation or recurrence. The concept of health implies that all components of the body are functioning as a unit and that all are contributing to the maintenance of homeostasis. Consequently, properly functioning circulatory, nervous, and endocrine systems are required. Disease, on the other hand, is present when cells do not receive appropriate circulation and/or nervous or endocrine regulation, causing a breakdown in the immune system or impairment of the adaptative mechanisms.

Although there are many similarities between allopathic and osteopathic physicians, some distinctions can be made. While the allopathic physician’s philosophy emphasizes the value of the type of intervention used, the osteopathic physician stresses the importance of the body’s ability to heal itself. Osteopathic medicine recognizes the musculoskeletal system as an important factor in the body’s efforts to resist and overcome illness and disease. The major factor that separates osteopathic medicine from allopathic medicine is manipulative treatment, which is often called biomechanics. Osteopathic manipulative treatment is used in conjunction with other practices to provide the body with the means to cure itself.

Perspective and Prospects

In 1894, when Andrew Taylor Still opened the first osteopathic medical school in Kirksville, Missouri, the medical community was skeptical of the methods of the osteopathic physician. Although Missouri was the first state to recognize an osteopathic medical school, there was resistance to licensing the graduates. In 1896, Vermont was the first state to enact legislation legalizing the licensing of osteopathy. Licensing in Missouri followed in 1897. By 1924, thirty-eight states had legally recognized osteopathy. In 1897, the American Osteopathic Association was formed to establish professional standards of practice. Its objectives were to promote the public health and to maintain high standards of medical education in osteopathic colleges.

Members of the American Medical Association (AMA) were not as accepting of osteopathic physicians as was the general public. When World War I broke out, some allopathic physicians claimed that the osteopaths were insufficiently trained for military service. Although there was widespread disagreement across the country, these allopathic physicians were successful, and the osteopathic physicians were kept at home. This situation ultimately proved to be to the benefit of osteopathy: While allopaths were serving in foreign countries, health care in the United States was left to osteopaths.

In 1923, the AMA continued its efforts to limit the practice of osteopathic physicians by declaring that it was unethical for MDs to consult with DOs. In 1938, MDs were forbidden to engage in any professional relationship with DOs.

Acceptance of osteopathic physicians finally came in 1967, when the AMA voted to negotiate for the merger of the two professions. The American Osteopathic Association was not interested in such a merger, but allopaths and osteopaths were allowed to work side by side in hospitals, community health clinics, and offices throughout the United States.

In the United States in 2013, there were more than 73,000 osteopathic physicians across the nation. The education of osteopathic physicians is expected to have an increasingly important role in the United States as people continue to emphasize preventive and family medicine. In efforts to cut costs and to improve the availability of health care, the government and health care insurance providers have stressed the need for primary care—an area that has always been important to the osteopathic physician.

Two monthly journals are available in libraries throughout the United States: the Journal of the American Osteopathic Association and The DO These journals contain research studies from osteopathic physicians as well as articles regarding the profession and the education of its students.

Bibliography

Chila, Anthony G., ed. Foundations of Osteopathic Medicine. 3rd ed. Philadelphia: Wolters, 2011. Print.

Lederman, Eyal. Fundamentals of Manual Therapy: Physiology, Neurology, and Psychology. New York: Churchill Livingstone, 1997. Print.

McKone, Walter Llewellyn. Osteopathic Medicine: Philosophy, Principles and Practice. Malden: Blackwell, 2001. Print.

Nicholas, Alexander S., and Evan A. Nichols. Atlas of Osteopathic Techniques. 2nd ed. Philadelphia: Wolters, 2012. Print.

Still, Andrew T. Philosophy of Osteopathy. Kirksville: Author, 1899. Print.