Conscious Choice: Osteopathy

June 2001

Osteopathy

What's New (and Old) in American Medicine

by Jonn Salovaara

It’s not new anymore: health-care centers continue to spring up with a variety of practitioners working together as a group — M.D.s alongside acupuncturists, massage therapists alongside psychologists, and so on. Despite the logistical and accounting difficulties, the trend continues toward a future medicine that combines American Medical Association (AMA)-approved allopathic modalities with a variety of healing therapies ranging from chiropractic to nutrition to Traditional Chinese Medicine and beyond.

Meanwhile, osteopaths, representing an older branch of American medical practice, are being recognized as practitioners of a different sort of "integrative medicine." Since the founding of osteopathy, its practitioners have integrated the best medical wisdom of the day with their own manual adjustment methods. Today, you may find an osteopath who embodies, as a single physician, a fairly wide range of complementary practices. At the very least, an osteopath will know about osteopathic manipulation techniques (OMT) in addition to standard allopathic procedures.

If you’re interested in exploring alternative or complementary modalities, but are held back by the too-frequently-correct assumption that your insurance will only pay for allopathic physicians, osteopathic treatments may be covered. Osteopaths receive training equal in length to that given to M.D.s and are fully licensed in all fifty states. They can prescribe medicine and practice surgery if surgery’s a requisite in their area of specialization. Because of their extensive training and full licensing, many insurance companies will pay for services osteopaths provide even if they won’t pay for other kinds of non-M.D. treatments.

Dr. Richard A. Feely, a Chicago osteopath who concentrates in musculo-skeletal work, offers patients not only his knowledge of allopathic medicine, not only OMT, but also Japanese scalp acupuncture, auricular therapy (needle-less ear acupuncture), and herbal medicine. I asked Dr. Feely if there was an advantage to receiving a range of treatments from an individual physician as opposed to receiving them from a group of co-practitioners. "For one thing," he said, "it’s cheaper. It’s also time-efficient." Further, as opposed to limited-license practitioners, osteopaths tend to have a broader view of treatment options; they also know when so-called alternative methods are not indicated, in emergency cases when surgery or drugs are called for at once.

Despite its advantage in this regard, according to Mary Ann Pagaduan at the American Osteopathic Association (AOA), a recent survey revealed that a huge percentage of Americans do not know what osteopathy is. This may be due in large part to the AMA’s political ascendancy during the last century. But there’s also a sort of naming problem. In terms of classical root words, osteopathy sounds like a combination of the Greek words for bone and disease.

Osteopathy is not the study of bone disease, at least not in the sense most people attach to that term. It is rather, according to author Leon Chaitow, a complete health-care system characterized by "the recognition of the importance, in the overall economy of the body, of the musculo-skeletal system, its proneness to dysfunction...and the recognition of the ability of therapy to normalize such dysfunction by one or more of a variety of manipulative techniques."

As osteopathy developed in the United States, it did incorporate allopathic methods and training. Andrew Taylor Still, the founder of osteopathy in 1874, was himself a country doctor and Civil War surgeon. At this time, as Dr. Feely reminded me, standard medical practice in the United States routinely prescribed drugs now considered to be dangerously addictive, such as heroin and cocaine. Dr. Still rejected this practice and decided to give up on the use of drugs entirely. He developed instead an understanding of the body’s ability to heal itself, when facilitated by a practitioner who would perform the manipulation techniques that he developed. He was quite successful in establishing a school of osteopathy, which he held open from the start to women and African-Americans. According to Dr. Feely, it was in the 1920s, when patent medicine gained more respectability, and on into the 1940s, when antibiotics gained so much acceptance, that some osteopaths decided to incorporate pharmaceuticals into their practice.

Osteopathy, according to Dr. Feely, has had an influence on two other "alternative" therapies. D.D. Palmer, the founder of chiropractic, experienced osteopathy as a patient for two weeks in 1899 prior to establishing his own practice of chiropractic manipulation. William Gardner Sutherland, himself an osteopath, developed an understanding of the bones in the skull and their subtle movement from which he created cranial osteopathy which was later popularized by John Upledger, also an osteopath, as cranial-sacral therapy (see sidebar).

As Karen Nichols, an osteopath in Arizona and board member at the AOA puts it, doctors of osteopathy, or D.O.s, are a kind of "M.D. plus." They not only equal M.D.s in their training; they go beyond that with their special techniques. Since most of us are familiar with the kind of treatment that M.D.s offer, the question becomes "What is that‘plus’?" What is this understanding of human disease and wellness that is special to osteopathy?

That’s where Chaitow’s statement about the musculo-skeletal system comes in. Osteopathy is practiced under the assumption that the "structure" of the body is a key component in understanding illness. It’s not just aches, strains, and injuries to that structure — to the back, to leg muscles, to joints — that concern osteopaths, although they do treat patients with these complaints. Osteopaths believe that other illnesses, including digestive, breathing, and headache problems, may be traced to a disruption in the body’s structure. Sometimes, a current problem may be traced to a disruption of the body’s structure that occurred years earlier.

In addition to knowing everything an M.D. knows, D.O.s also learn a variety of manipulative techniques based in this thinking about the body’s structure. According to Nichols, these techniques include but are not limited to "soft tissue techniques," which one handbook describes as a form of pressure and massage on muscles and ligaments, and "muscle energy techniques" in which the patient is asked to contract a muscle or group of muscles while the practitioner is gently opposing them. One introductory handbook lists eleven different types of manipulative techniques, from adjustment techniques on the spine and other joints in the body to relief of compression through pulling and stretching an appropriate area. Dr. Feely, atypical in that he specializes in musculo-skeletal disorders while most D.O.s are primary care physicians, uses a "high velocity thrust" with 70 percent of his patients; he also uses isometric-muscle energy procedures, and articulatory methods that gently guide the joints.

Dr. Feely uses cranial osteopathy with 96 percent of his patients. This procedure, originated by osteopath William G. Sutherland and later modified into cranial-sacral therapy, is based on the idea that cerebrospinal fluid is produced and absorbed in a certain rhythm which may be disturbed by trauma or repetitive stresses to the body. Sutherland noticed that the bones of the skull are beveled like the gills of a fish and as a result this rhythm of the fluid beneath those bones was christened the primary respiratory mechanism, even though it is not respiration in the sense of oxygen entering through the lungs. Cranial osteopathy, in which the osteopath palpates the cerebrospinal fluid, is designed to restore that rhythm when it has been disrupted by trauma or stress.

All of these techniques are subsidiary to the philosophy of osteopathy, that the body will be able to heal itself when restrictions are removed, Dr. Feely reminds me. This philosophy of healing, he says, is the primary key to osteopathy. The various techniques are ways of putting into practice the fundamental principle that "structure and function are reciprocally related." In other words, bad body structure will lead to bad function and bad function will lead to bad structure in the body.

Dr. Feely allowed me to observe his appointments with two different patients, one of whom is suffering from a chronic uncontrollable shaking in her right arm, the other of whom has suffered a kind of vertigo since his car was hit from behind in an auto accident. I spoke with both and found that each one is pleased with osteopathy and hopeful of good results. The accident survivor has come to osteopathy in part because he prefers it to the prospect of drug treatments offered by M.D.s . The fact that he travels almost weekly from the East Coast to Chicago to receive treatments is testimony to the power of osteopathy as practiced by Dr. Feely. The woman with the arm problem says her condition is "better than when it started." She emphasizes that osteopaths "seem to be more open" to trying a variety of techniques.

Indeed, osteopaths, with their comprehensive medical training, are in a position to use a combination of approaches. Those who specialize in musculo-skeletal problems are more likely to use OMT. Others use OMT techniques in conjunction with allopathic stand-bys. Dr. Nichols offers the example of a patient with pneumonia who might be treated with both antibiotics and a manipulative technique that will help the antibiotic to work better. Osteopaths who are primary care physicians may find that they are using allopathic approaches to illness almost exclusively. While some writers worry that practitioners may be relying too heavily on allopathic techniques, Nichols notes that "osteopathic medicine has always bridged the gap" between specifically osteopathic techniques and conventional allopathic approaches.

If you are looking for an osteopath with an integrated-medicine outlook, you may want to start with the American Academy of Osteopaths. This is the organization of osteopaths who focus on using OMT in their practices. The broader organization of osteopaths is the AOA, which has a directory of osteopaths by zip code connected to its Web site. When you find the right osteopath, you may discover that what’s old is new: a holistic approach that satisfies your health care needs — without sacrificing the benefits of allopathic medicine.

Resources:

Dr. Richard A. Feely, D.O., 312-266-8565, Chicago and Olympia Fields, IL

American Academy of Osteopathy, Indianapolis, IN, 317-879-1881

American Osteopathic Association, Chicago, IL, 800-621-1773

The AOA Web site includes information about schools of osteopathy nationwide; in the Chicago area, the Chicago College of Osteopathic Medicine is now part of Midwestern University in Downers Grove, IL., www.midwestern.edu.

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