If you have ever had an aching back, stiff neck, tennis elbow, ‘gammy’ knee or some such affliction of the body, then the chances are that you have sought the help of, or have been advised by someone to go to, an osteopath for relief. If, however, you have, or have had, a more serious health problem such as asthma, migraine headaches, angina pains, digestive disturbances (to name but a few examples), then it has probably not occurred to you that the condition might have some of its origins in a dysfunction of some mechanical component of the body, the musculo-skeletal system. You would, therefore, probably not have taken such a problem to an osteopath practitioner. Surprising as it may seem, many such ‘illnesses’ are often the end result of biomechanical changes in the structure of the body which are amenable to osteopathic treatment. This theme will be elaborated on in later chapters, and some of the fascinating research that has been done in a wide range of health problems will be detailed. At this stage, the idea of osteopathy offering help to conditions other than the more obvious aches and pains may seem a strange one. In order to understand the concept of osteopathy, and what its real potentials are, it is necessary to examine its roots and subsequent development.
Osteopathy is a system of health care which recognizes that the self-healing, self-regulating ability of the body is dependent upon a number of factors, including favourable environmental conditions (internal and external), adequate nutrition and normal structural integrity. It utilizes generally accepted methods of diagnosis, as well as certain specialised ones developed to facilitate accurate structural assessment. It places special emphasis upon the importance of body mechanics, and uses manipulative techniques to detect and correct, faulty structure and function.
In many people’s minds, especially in the U.K., osteopathy is equated mainly with the treatment of spinal and other joint pains and problems. This limited care concept is largely an historical accident. As indicated above, the osteopathic profession sees itself as being relevant to a wide range of health problems, and not simply limited to the treatment of musculo-skeletal derangements.
Since the turn of the century, when the first American-trained osteopaths established themselves in practice in the U.K., they have filled a gap that existed (and to a large extent still exists) in medical practice. Doctors tended to regard musculo-skeletal problems as relatively unimportant, and manipulation as, at best, an unknown quantity and, at worst, valueless.
Side view of a normal spine showing the natural curves.
In the U.S.A., the gradual evolution of osteopathy has been towards its original goal of providing a complete health-care system, dealing with all of man’s ailments, and utilizing all those accepted therapeutic methods which coincide with its belief in the necessity for treating the patient as a whole, rather than simply treating symptoms. This concept of treating the ‘whole’ man deserves closer scrutiny. Disease may be stated to be the result of a disparity between the capacities, resources and responses of the individual, and the demands and circumstances made by his life. Disease can be seen to be a phase in the natural history of the individual, whose unique nature responds to his own particular environment. The individual’s inheritance, capacities, resources and demands, and, therefore, his adaptations and responses, are unique to him. Illness, the level of health, predispositions, resistance, responses, adaptations etc. to all the elements of his environment, are a culmination of an individual’s life, up to that point. The apparent similarities between diseases in different individuals, and the ability to classify diseases, are testimony to the fact that the body can respond in only a limited number of ways to an infinite variety of events and factors. The patient’s illness should, therefore, not be seen to be a disease, or aberration, of an organ or process alone, but as part of an illness in his total being. The patient with angina is not ill because of his angina, but has angina because he is ill. It is consideration of the whole picture of the patient’s uniqueness, and his relationship with all his complex environmental factors, that provide the background for the total health care that osteopathy seeks to offer. This, of course, includes consideration of the largest body system, the musculo-skeletal system. The methods of care also include its own distinctive approach to the normalizing of musculo-skeletal dysfunction, osteopathic manipulative therapy (O.M.T.).
It is not possible to separate osteopathic practice from the theories that produced it. Osteopathy is not just a mechanistic approach to disease but a sincere and effective system which attempts to remove the causes of ill-health and seeks to reinforce the basic curative force which lies within the body itself. The belief was originally expressed over a hundred years ago by Andrew Taylor Still, the originator of Osteopathy, whose life and work will be considered in the next chapter. The concept of many of the causes, and therefore of the remedies, lying within the body itself, has a long history. For as long as man has existed on earth, disease and injury have existed with him.
Treatment of disease was, in prehistory, assigned to practitioners of one or another healing method. The cause of disease was ascribed, by many, to outside forces which were thought to enter the body of the sufferer. Treatment in such case was aimed at driving out such evil or morbid influences. Other practitioners blamed aberrations within the body, or soul, of the victim, for the disease process, and treatment was then designed to normalize the causative disturbances. These two divergent philosophies, the outside or inside cause, exists side by side for centuries.
In the fourth century B.C. a rational system of healing was introduced by the great Greek physician Hippocrates. He taught that illness was often caused by quite simple things, such as eating the wrong food or by living in unhygienic conditions. He therefore recognized that the apparent causes of disease could originate from external or internal factors. However, I believed also that the body itself, through the healing efforts of its own nature, was the means of recovery. ‘It is our natures that are the physicians of our diseases’.
He stressed that the physician should assist the ability of the body to overcome disease by removing causative factors, and by encouraging the healing effort, but never to meddle with, or hinder nature’s attempt towards recovery. Thus the school of thought that followed Hippocrates’ teaching emphasized the study of health of man as a whole integrated unit; relating the whole man to his environment. Within that framework the causes of ill health were to be found.
Other schools of thought, however, continued to focus attention on the disease process itself, as an entity, largely ignoring the patient. The history of medicine ever since has been highlighted by proponents of one or other of these schools of thought. Through the ages we find the theoretical battle raging, which is more important, the diseased or the disease? It is true to say that the Hippocratic concept has been more honoured, but the rival philosophy has been more practiced.
Osteopathic theory and practice are firmly in line with the concepts of Hippocrates. The patient is considered and treated as a whole. Founded as it was in this tradition, osteopathy is patient orientated rather than disease orientated. It has utilized structural diagnosis and manipulative therapy as part of its philosophy and practice, and therefore as part of total patient care, not confining it to painful conditions of the musculo-skeletal system alone.
In essence the original concept of osteopathy held that:
- Within the human body there exists a constant tendency towards health. If this capacity is recognized, and if treatment takes its relevance into account, then the prevention and normalization of disease processes is enhanced.
- The structure of the body is reciprocally related to its function. By this it is meant that any change in structure will alter some aspect of function and, conversely, any alteration in function will result in structural changes.
- Health is the primary area to be studied in attempting to understand disease.
- The musculo-skeletal system, which incorporates the bones, ligaments, muscles, fascia etc. forms a structure which, when disordered, may affect the function of other parts and systems of the body. This might be the result of irritation or abnormal response of the nerve and/or blood supply to these other organs or parts.
- The body is subject to mechanical disorder and is therefore capable of mechanical correction.
Discussion of these concepts will be found in the chapter dealing with osteopathic theory.
There is a growing awareness of the value to general health of an integrated, mechanically sound, musculo-skeletal system. The scientific rationale for this becomes clearer with research. Clinically, however, osteopaths have long realized the positive effects of manipulative therapy on health. It is necessary to keep in mind two essentially different roles filled by Osteopathic practitioners in their work. One is that of providing limited care to patients with joint pains and strains. The other is the total health-care of patients, with any of the myriad ills of mankind. There is also a further extension of osteopathic care, in areas in which no other form of healing offers much help. This is the more recent application of osteopathic principles and methods to the structures (bones, reciprocal tension membranes, fluid fluctuations etc.) of the skull, especially of infants. As will be described in the chapter on Cranial Osteopathy. These methods, when successfully applied to such problems as cerebral palsy and spasticity of the newborn, can produce results bordering on the miraculous. In its limited application (joint injuries, postural stresses etc.) osteopathy is a most effective system for the treatment of musculo-skeletal derangements.
Confusion exists in both public and medical minds as to the distinction between osteopathic and other forms of physical treatment. Because other systems utilize manipulative methods on their approach to the patient it is often assumed, even by apparently knowledgeable individuals, that there really is not very much difference between osteopathy and, for example, physiotherapy or chiropractic. Nothing could be further from the truth, and a brief examination of some of the other systems with which osteopathy is often confused should help to clarify the differences.
Osteopathy and chiropractic differ in three main areas. These are the philosophical or theoretical aspects, the technique and the training. Osteopathy has a basic philosophical viewpoint from which have developed the specialized diagnostic and therapeutic measures, including osteopathic manipulative technique.
Chiropractic originally placed great emphasis on the idea that spinal joints, when misplaced (subluxated), could impinge upon nerves and thus cause disease elsewhere in the body. Chiropractors tended to focus attention on the spinal and pelvic structures, employing elaborate x-ray procedures in their analysis of subluxations. Treatment tended to be by specific high velocity thrust techniques, often employing a rebound effect from complex, sprung treatment couches.
Over the years chiropractic has tended to take more and more interest in joint dysfunction as related to back and neck pain, rather than in the general treatment of ill health. A survey in Australia, Canada and the U.K. indicated that 90 per cent of patients attending chiropractors do so for treatment of low back and neck pain. Chiropractic techniques have also changed over the years, to the point where many practitioners employ similar functional and leverage techniques to osteopaths. In the same way, many osteopaths have incorporated thrust techniques usually associated with chiropractic.
In the U.S.A. osteopathy has become an accepted (in law) alternative system to orthodox medicine, employing its own unique methods as well as what it considers useful from the orthodox system, in the treatment of all forms of ill health. Chiropractic is more limited in its legal position, its range of application and in its range of methods. It is certainly true to say, though, that in treatment of neck and back conditions the difference between the two systems has become blurred. The training of an osteopath in the U.S.A. takes seven years and a full licence is granted to graduates. A four year training which is undertaken to achieve a chiropractic doctorate leads to a limited licence (no surgery, drug prescription or the right to sign death certificates etc.)
Historically the two professions grew out of similar roots, but they have evolved to the point where their similarities are to be seen only in the relatively narrow areas of pain and dysfunction in the back and neck. Their differences become very apparent in their consideration of general health care.
This has grown out of the tradition of remedial massage and bonesetting. Whilst utilizing techniques which resemble osteopathic manipulative therapy and chiropractic, manipulative therapists regard their work as being aimed at the physical normalization of joint and muscle dysfunction, with the objective of improving mechanical function. No attempt is made to relate the methods to broader aspects of body function or ill health; indeed such ideas are actively discouraged by the leaders of this profession, which sees itself as a system subsidiary to medicine, in contrast to osteopathy which sees itself as an alternative.
Most of the work of these therapists involves massage, with manipulation only being used when considered absolutely necessary. There are no full time training facilities for such practitioners who are, as a rule, physiotherapists or masseurs drawn to these methods. Some are skillful and competent, but their narrow view as to the value and application of manipulation, together with their limited approach to bodily dysfunction, distinguishes them from the osteopathic practitioner.
There are still some ‘bonesetters’ about, especially in remote rural areas. These are, frequently, gifted healers carrying on an unwritten tradition of learned and acquired skills which go back into prehistory.
In England, there was for many centuries a tradition of bonesetters. Many of these undoubtedly skilled practitioners had no formal medical training. In the early eighteenth century a Mrs Mapp achieved a great following and was consulted by many doctors.
In 1867 Sir James Paget, an eminent physician, warned his fellow doctors: ‘Few of you are likely to practice without having a bonesetter for a rival; and if he can cure a case which you have failed to cure, his fortune will be made and yours marred.’
The fame of Herbert Barker, an unqualified bonesetter, was so great that he was eventually knighted for his services. He was hounded by orthodox medicine and all contact between Barker and doctors was forbidden on pain of expulsion from the profession; this, despite his continual stream of successful cases. In his old age Barker demonstrated his techniques to a group of orthopaedic surgeons in London, a final admission of his genius.
Manipulation, as practiced by bonesetters, was a relatively simple matter of pushing or pulling restricted joints, to achieve ease of movement. Sometimes great force was used and frequently damage was caused by excessive violence. The difference between such methods and their total lack of any coherent or systematic use differentiates them from osteopathy.
Massage has a long history, but not until the nineteenth century was a systematic approach developed by P. H. Ling in Sweden. A school of medical gymnastics was founded, and this promoted the use of ‘scientific’ massage. Many variations exist. Some methods are remedial, being aimed at the restoration of function lost during surgery or because of enforced bed-rest (accidents, strokes etc.), or through advancing age. Other methods are used to encourage function in birth injuries or disease-damaged (polio) patients. Massage techniques are also used in gaining general relaxation and circulatory improvements.
Osteopaths utilize specialized soft-tissue techniques which bear a superficial resemblance to massage. Both deal with the soft tissues. The osteopath is either preparing the area for subsequent manipulation or dealing reflexly with problems distant from the area being treated. The U.K. trained osteopath might use a system developed in England known as neuro-muscular technique. In the U.S.A a similar deep soft tissue method was developed by the late Ida Rolf. Both these method have some similarities with the specialized German method of connective tissue massage (Bindesgewebsmassage) which uses deep finger and thumb strokes to achieve local and reflex effects Rolfing aims at releasing deep tissue contractions and thus encouraging postural and structural reintegration, and psychological ‘release’ from emotions which are tied into muscular stress patterns. Neuro-muscular technique, rolfing and connective tissue massage are all specialized soft tissue methods, bearing little in common with what is normally, thought of as massage.
In orthodox medicine the remedial gymnast and masseur of old has been replaced by the physiotherapist of today. This profession is an adjunct of the dominant medical system, and it incorporates a variety of modalities such as exercise, massage and manipulation. Traction and some forms of hydrotherapy also form part of the physiotherapist’s methods. In other words anything that can usefully be employed in treating the physical body, to enhance its function, or to minimize its dysfunction especially as related to the muscles and joints, is incorporate’ into physiotherapy. There are, of course, other rehabilitative aspects and therapeutic ones (such as encouraging normality after injury or surgery, and assisting in respiratory function in asthmatics.)
In the main, however, physiotherapists deal with the vast range of rheumatic diseases with the modalities outlined. Their use of manipulation tends to be confined to a limited range of specific techniques which are applied to the neck and low back areas. The techniques employed are usually direct action ones where joints are forced through a range of motion.
Doctors of physical medicine and orthopaedic surgeons tend to limit their sphere of interest to the mechanics and pathology of the musculo-skeletal system. This is a large and vital area, but from the osteopathic viewpoint it is important, not only in itself, but because of the ramifications that dysfunction in any of its constituent parts may have on the overall economy of the body and on specific organs and functions.
As we shall see in the unfolding of the history and current practice of osteopathy, as important as manipulative methods and specialized osteopathic diagnostic methods are to the science of osteopathy, it has always been recognized that care of the ‘whole’ man requires the integration and use of all methods and measures which contribute to well-being. This was made clear in the charter of the first College of Osteopathy in 1892. The aim then was stated to be ‘To establish a college of osteopathy, the design of which is to improve our present system of surgery, obstetrics and treatment of diseases generally, and to place the same on a more scientific and rational basis and to impart knowledge to the medical profession’. A reforming role was seen as being the essential part osteopathic medicine would play. The subsequent history and the success of the profession especially in the country of its birth, against extraordinary odds, is fascinating. Before we touch on this, however, a man of extraordinary vision deserves our attention; Andrew Taylor Still.