The first school of osteopathy was founded at Kirksville, Mo., in 1892. A growing number of other colleges in the United States are accredited by the American Osteopathic Association to give the required four-year course of training and to grant the degree of D.O. (Doctor of Osteopathy). These colleges give a complete course of instruction in conventional medicine as well as in osteopathic theory and practice. Osteopaths are licensed to practice medicine, including surgery and the prescription of drugs, throughout the United States. Many specialize in treating bone and muscle conditions, but about half are primary-care physicians in general medical practice.
See E. R. Booth, History of Osteopathy and Twentieth-Century Medical Practice (1924); E. H. Bean, The Spirit of Osteopathy (1956); J. M. Hoag, Osteopathic Medicine (1969).
Osteopathy is an approach to healthcare that emphasizes the role of the musculoskeletal system in health and disease. In most countries osteopathy is a form of complementary medicine, emphasizing a holistic approach and the skilled use of a range of manual and physical treatment interventions (osteopathic manipulative medicine, or OMM in the United States) in the prevention and treatment of disease. In practice, this most commonly relates to musculoskeletal problems such as back and neck pain.
Many osteopaths see their role as facilitating the body's own recuperative powers by treating musculoskeletal or somatic dysfunction. According to the American Osteopathic Association, the difference between an osteopath and an osteopathic physician is often confused. In the United States, Doctors of Osteopathic Medicine (DOs) are fully licensed medical physicians and surgeons, practicing in all clinical specialties along with their MD colleagues. Just like MDs, DOs practice the full scope of medicine.
In the United Kingdom, courses in Osteopathy have recently become integrated into the university system. Instead of receiving a Diploma in Osteopathy (DO), with or without a Diploma in Naturopathy (ND), graduates now become Bachelors of Osteopathy or Bachelors of Osteopathic Medicine, or Bachelors of Science in either Osteopathy or Osteopathic Medicine, according to the institution attended: but these degrees do not lead to prescribing rights and in this case Osteopathy and Osteopathic Medicine are synonymous. There is one "cross-over" institution, the London College of Osteopathic Medicine, which teaches osteopathy only to those already qualified in medicine. Before using the title of "osteopath," graduates have to register with the UK regulatory body by statute; the General Osteopathic Council.
Still named his new school of medicine "osteopathy," reasoning that "the bone, osteon, was the starting point from which [he] was to ascertain the cause of pathological conditions." The object of osteopathy was to "improve upon the present systems of surgery, midwifery, and the treatment of general diseases." Its scientific foundation was the discipline of anatomy. Its philosophy was based on the understanding of the integration between body, mind and spirit , the interrelatedness of structure and function, and the posited ability of the body to heal itself when mechanically sound. Osteopathic treatment emphasises comprehensive patient care with a focus on the neuromusculoskeletal system as an integral part of health and disease processes. Over time Still and his students and faculty developed a complete medical school curriculum which included a series of specialized physical treatments, now called Osteopathic Manipulative Treatment (OMT). Still founded the American School of Osteopathy (now the Andrew Taylor Still University, Kirksville College of Osteopathic Medicine) in Kirksville, Missouri, for the teaching of osteopathy on May 10, 1892. While the state of Missouri, recognizing the equivalency of the curriculum, was willing to grant him a charter for awarding the MD degree, he remained dissatisfied with the limitations of conventional medicine and instead chose to retain the distinction of the DO degree.
In the late 1800s Still taught that "dis-ease" was caused when bones were out of place and disrupted the flow of blood or the flow of nervous impulses; he therefore concluded that one could cure diseases by manipulating bones to restore the interrupted flow. Still stimulated his students to investigate these postulates. Research began in the 1890s at Kirksville and has continued there and at other osteopathic institutions ever since. The A.T. Still Research Institute was founded in 1913 and Louisa Burns, DO and others developed a rigorous series of scientific investigations of the relationships between musculoskeletal dysfunctions and health and disease. Still's critics point out that he never personally ran any controlled experiments to test his hypothesis; his supporters point out that many of Still's writings are philosophical rather than scientific in nature. He questioned the drug practices of his day and regarded surgery as a last resort.
By the 1960s, osteopathic medicine had become integrated into the American mainstream, and the reliance on manipulative therapies had fallen into less common usage. The osteopathic profession has evolved independently outside the US, where it has remained essentially a drug-free system based on manipulative techniques - a scope of practice similar to chiropractors. Chiropractic is a distinct manipulative profession that originated around 1895 in the US.
These principles are not held by osteopathic physicians to be empirical laws; they are thought to be the underpinnings of the osteopathic philosophy on health and disease.
The theory underlying cranial osteopathy is rejected by many physicians. It is believed by most modern osteopathic physicians working within the cranial field, that the spheno-basilar symphysis (a large joint in the skull base) ossifies (turn to bone). Cranial osteopathic teaching refers to movement remaining within the thin bone of the sutures, and that flexibility within living bone occurs, in contrast to dried specimen bones. Research suggests that examiners are unable to measure craniosacral motion reliably, as indicated by a lack of interrater agreement among examiners.The authors of this research suggest that this "measurement error may be sufficiently large to render many clinical decisions potentially erroneous".
No scientific links have been found between this mechanism and health/disease. Some osteopathic physicians believe that healing dysfunctional cranial rhythmic impulses enhances cerebral spinal fluid flow to peripheral nerves, thereby enhancing metabolic outflow and nutrition inflow.
Craniosacral therapy is based on the same principles but the practitioners have not attended medical school and are therefore not osteopathic medical physicians. Chiropractor and osteopathic physician, M B Dejarnette further developed craniopathic techniques inside of a complete Chiropractic system known as Sacro-Occipital Technique or simply "SOT
Practitioners contend that visceral osteopathy relieves imbalances and restrictions in the interconnections between the motion of all the organs and structures of the body--namely, nerves, blood vessels, and fascial compartments. During the 1940s, osteopaths like H V Hoover and M D Young built on the work of Andrew Taylor Still to create this method of assessment and manipulation. The efficacy and basis of this treatment remains controversial even within the osteopathic profession.
In Europe, commonwealth countries and elsewhere, osteopaths rely on non-surgical, non-pharmaceutical approaches, and see themselves as a complete school of manual medicine or NMS specialists, complementary to most mainstream medical practices. Commonwealth osteopathic students may spend up to ten times as many hours training in osteopathic diagnosis and technique as their American counterparts. Because of this specialization, they have traditionally remained as an alternative to mainstream healthcare alongside naturopaths and chiropractors. In commonwealth countries, osteopaths have also had to compete with physiotherapists, many of whom have integrated manipulative therapy into their practice. Nevertheless, osteopathy is growing in size in many countries of the Commonwealth and Europe.
Many UK osteopaths are also naturopaths, with one osteopathic college offering a dual training in osteopathy & naturopathy (the British College of Osteopathic Medicine) and another offering a post-graduate programme (the College of Osteopaths).
In 2005 the General Medical Council of Great Britain announced that U.S.-trained DOs would be accepted for full medical practice rights in the United Kingdom. This decision was an important departure from the United Kingdom's long-standing tradition of exclusively manual, or "traditional" osteopathy.
There are currently 550 in the country, all practicing under provincial associations. Canadian osteopaths with the DOMP title do not have prescribing rights.
In the UK, since the Osteopaths Act, osteopathy has been a recognised profession. Some doctors within the country's National Health Service recognise osteopathy as a therapy and refer patients to its practitioners when other forms of treatment are not successful or are considered inappropriate - but the NHS will not usually pay for any treatment.
However, a meta-analysis of six randomized controlled trials of OMT that involved blinded assessments of lower back pain in ambulatory settings found from computerized bibliographic searches of MEDLINE, EMBASE, MANTIS, OSTMED, and the Cochrane Central Register of Controlled Trials, found that OMT significantly reduces lower back pain. It also concluded that the level of pain reduction is greater than expected from placebo effects alone and persists for at least three months.
Another study, which aimed to identify cellular mechanisms at work during OMM, was published in the Journal of American Osteopathic Association in December 2007. Data from the present study suggest that fibroblast proliferation and expression/secretion of proinflammatory and anti-inflammatory interleukins may contribute to the clinical efficacy of indirect osteopathic manipulative techniques.
The practice of osteopathy in the cranial field is considered even by some within the field as lacking scientific evidence. One meta-analysis from the British Columbia Office of Health Technology Assessment (BCOHTA) concluded that although some of the central tenets of craniosacral therapy are supported by convincing evidence, "this systematic review found there is insufficient scientific evidence to recommend craniosacral therapy to patients, practitioners or third party payers for any clinical condition."
As with all medical treatments, manipulative and manual therapies carry inherent risks of injury. Direct, forceful techniques are more likely than indirect techniques to cause injury. 'Neck cracking', i.e. cervical high-velocity low-amplitude thrusting, has received particular attention in the popular media because of a risk of arterial occlusion and consequently of stroke. Although the existing data cannot provide a conclusive estimate of the cervical artery dissection risk researchers have stated that a stroke risk of about 1.3 per 100 000 chiropractic visits for individuals aged under 45 years, with a 95% confidence interval of 0.5–16.7 per 100 000 is a theoretically unbiased estimate. Although this data primarily concerns chiropractic visits, both osteopaths and chiropractors may practice cervical manipulations.