What is Osteopathic Manual Therapy?
Definition and Description
The word Osteopathy is derived from two Greek words meaning bone and dysfunction. The founder of Osteopathy, Dr Andrew Taylor Still, chose this name to highlight how the structure of the skeleton is vital in correct function of the body’s systems, and that misalignment of bones can cause dysfunction. Dr Still established the first Osteopathic College in 1892 in Kirksville, Missouri, since then Osteopathy has spread around the world. After his death in 1917 Osteopathy split into two branches. One branch merged with and became an allopathic medical degree, it is only possible to study this form of Osteopathy in the U.S.A. graduates are called osteopathic physicians. The other branch remained separate from mainstream medicine and established itself in Europe, these practitioners are called Osteopaths. However, in Alberta the word Osteopath is reserved for the exclusive use of US train osteopathic physicians. For the sake of clarity this page will endeavor to make this distinction even more clear by referring to the former branch as osteopathic physicians and the latter branch as osteopathic manual therapists.
Osteopathic manual therapy focuses on the assessment, diagnosis and treatment of disorders of the body’s structure, whether it is related to the pelvis, peripheral joints, visceral organs, nervous systems, venous system or spine. Osteopathic manual therapists use manipulations to the joints or organs and gentle oscillatory movements to correct biomechanical dysfunctions that are related to neuromusculoskeletal complaints. In addition to this they will also provide advice regarding exercises, diet and lifestyle to augment the bodies own healing capabilities . By restoring proper mechanics to an area the osteopathic manual therapists allows the normal flow of fluids and improves function which will help to reduce pain and normal activity for that patient.
Concept and Principles
Osteopathic manual therapists believe that abnormal functioning of one area of the body can cause symptoms to present elsewhere in the body, the theory of ‘Tensegrity’. When the body is balanced there is no excessive stress anywhere in the body, but when the body becomes out of balance this can be amplified to other areas. Osteopathic manual therapists regard the whole of the body as greater than a collection of all its parts. They acknowledge the body’s inherent ability to heal itself and seek to support that process by removing any obstacles that impede it. In order for this to happen osteopathic manual therapists specialize in individualized patients management, which includes educating the patient about their particular condition and how they can adjust their lifestyle to allow themselves the best possible chance recovery or optimal management.
Education of Osteopathic Manual Therapists
In Canada osteopathic manual therapists undertake a minimum of 4 years after having already completed a degree in a health related area.
Biological health sciences (anatomy, histology, physiology, kinesiology, pathology, neurology etc) Medical Diagnosis (differential diagnosis, symptomatolgy, dermatology orthopedics and manual skill) Comprehensive clinical training (1500 supervised clinical hours)
Regulation and Third Party Payment
Osteopathic manual therapy in Canada is undergoing a growth phase at present with a push for federal wide regulation. Nearly all provinces have an association that is a member of the Canadian Federation of Osteopathy. Only fully qualified osteopathic manual therapists can become members of these provincial bodies. They provide training, support and best practice guidelines for all member therapists.
The cost of osteopathic manual therapy may be covered by private health insurance plans but some patients must pay the full cost of treatment. Osteopathic manual therapy is not covered by Alberta Health.
Effectiveness and Cost Effectiveness
Osteopathic manual therapy as well has other manipulation therapies has been proven to be effective in the treatment of lower back pain(1), but may also be effective in treating disorders of the cervical and thoracic spine, peripheral joint pain and visceral disorders. Common complaints treated are work or sport related injures, headaches and whiplash, the effects of joint degeneration, especially in the elderly. Osteopathic manual therapists will generally treat with their hands and not use machines, however treatment choice is down to the individual practitioner.
Studies on effectiveness and cost effectiveness of osteopathic manual therapists care have concluded that treatment for lower back pain is more affective than conventional treatment and could provide a significant cost saving to health care systems if it became the treatment of choice for management of lower back pain(2). Due to the individualized nature of the treatment large scale randomized control trials are difficult to implement for osteopathic manual therapy. Any lack of evidence of efficacy should not be taken as evidence of lack of efficacy. Osteopathic literature overflows with remarkable case studies in which this form of care has had far greater therapeutic results than the allopathic medicine of the time.
Safety Issues and Contraindications
Osteopathic manual therapists are trained to give a careful screening of every patient so as to limit any complications from osteopathic care. In most cases if osteopathic manual therapy is not suitable the patient will be referred back to their primary care physician. Some osteopathic therapists who hold other qualifications in physiotherapy or chiropractic may perform spinal thrusts. Recently there has been some media coverage of upper cervical spinal high velocity low amplitude thrust (HVT) can leading to stroke like symptoms. The incidence is 1/million and only likely to occur in a patient with a pre-existing illness(3). These therapists, in addition to their osteopathic training, would have to be a member of a regulated body such as physiotherapy or Chiropractic to use HVTs. Due to the extensive medical history that a osteopathic manual therapist takes on the initial consultation it is unlikely that an HVT would be used for a person that presents any type of risk, there are many other techniques that can be used its place. To put this in context death rate attributed to NSAID and aspirin use has been shown to be between 21 and 24.8 cases/million people, respectively. Up to one-third of all NSAID/aspirin deaths can be attributed to low-dose use(4).
Osteopathic manual therapists are in a position to refer when they feel a patient would benefit from a more allopathic medical approach. The following conditions are generally considered to be a cause for referral; this list is by no means exhaustive.
- Inflammatory arthritis, including seronegative arthropathies.
- Fractures or dislocation
- Infections of bones or joints
- Acute spinal cord compression (cauda equina syndrome)
- Un-diagnosed bleeding from any orifice.
- Suspect undiagnosed endocrine disorders.
The following are two definitions put forward by the Australian and British Osteopathic Associations respectively.
‘Osteopathy is a ‘whole body’ system of manual therapy, based on unique bio mechanical principles, which uses a wide range of techniques to treat musculo-skeletal problems and other functional disorders of the body.’ Australian Osteopathic Association.
‘Osteopathy is an established system of clinical diagnosis and manual treatment in which a caring approach to the patient and attention to the individual needs are of the primary importance. In particular, it is concerned with the inter-relationship between the structure of the body and the way in which it function and is therefore and appropriate form of therapy for many problems affection the neuro-musculo-skeletal systems’ British Osteopathic Association
- W.J. Assendelft, et al., ‘Spinal Manipulative Therapy for Low Back Pain: A Meta-Analysis of Effectiveness Relative to Other Therapies,’ Annals of Internal Medicine 138 (2003), pp. 871-81
- UK BEAM Trial Team. UK back pain exercise and manipulation (UK BEAM) trial—national randomised trial of physical treatments for back pain in primary care: objectives, design and intervention. BMC Health Serv Res 2003;3: 16.
- E.L. Hurwitz, et al., ‘Manipulation and Mobilization of the Cervical Spine: A Systemic Review of the Literature.’ Spine 21, no. 15 (1996), pp.1746-59
- A. Lanas, et al. ‘A nationwide study of mortality associated with hospital admission due to severe gastrointestinal events and those associated with nonsteroidal anti-inflammatory drug use.’ Am J Gastroenterology. 100(8) (2005), pp.1685-93.