OSTEOPATHY

What is a DO?​

Doctors of osteopathy, or DO’s, are fully licensed physicians who practice in all areas of medicine. Emphasizing a whole-person and patient-centered approach to treatment and care, DOs are trained to listen and partner with their patients to help them get healthy and stay well. 

Dr. Andrew Taylor Still, the founder of Osteopathic Medicine, developed a hands-on approach for diagnosis and treatment utilizing the musculoskeletal system as an adjunct to traditional medical care to enhance the healing tendency of the body with any disease. Therefore, DOs receive special training in the musculoskeletal system, your body's interconnected system of nerves, muscles, and bones. By combining this knowledge with the latest advances in medical technology, they offer patients the most comprehensive care available in medicine today.

Osteopathic training includes not only the study of all branches of medicine and surgery, but also up to 500 hours of additional training in manual diagnosis and treatment. Today, there are more than 50,000 osteopathic physicians in the United States whose practices cover the entire range of specialties, such as emergency medicine, neurosurgery, cardiology, psychiatry etc. More than 65% of DO’s choose primary care specialties, such as family practice, internal medicine, obstetrics, and pediatrics, as opposed to only 25% of MD’s.

Dr. Still used the word “osteopathy” as a place to start one’s evaluation as the remainder of the anatomy is connected to give it form. It was not just about the bones but rather it was the anchor from which the remainder of the anatomy could be accessed. That was just the beginning and from there one would have additional information to assesses, understand, and seek a solution. 

​Osteopathic Manipulative Medicine:

A DO can also sub-specialize in Osteopathic Manipulative Medicine (OMM) for which Board Certification became available in 1990. For specialists in OMM, advanced training is offered by various organizations within the profession.

Osteopathy incorporates surgery and pharmaceutical agents when needed but offers a unique means of assessment and treatment where structure and function are simultaneously considered and addressed as taught by the founder of Osteopathic Medicine, A. T. Still MD, DO. Osteopathy blends both structure, matter, science and function as it relates to the art and spirit. There is a gross anatomical component and a subtle fluid component involved.

 

 

Cranial Osteopathy:

Certification for Osteopathy in the Cranial Field is provided by The Cranial Academy and is currently held by approximately 150 physicians nationwide. Those doctors who utilize Cranial Osteopathy have many hours of additional training in the various functions of the primary respiratory mechanism and its relationship to all the anatomic and physiologic systems in the living human system. This specialized training allows the Osteopathic physician to diagnose and treat disorders and diseases in ways that are unique to this method of Osteopathic Diagnosis and Treatment. Dr. Sutherland, a student of Dr. Still’s, is credited with discovering Cranial Osteopathy. He started working out his understanding of Cranial Osteopathy in 1899. After decades of study, he then shared it with the rest of the profession. 

The Origin of Osteopathy 

"Osteopathic medicine is not just something different, it's something more!"

Brief History of Osteopathic Medicine

Osteopathic Medicine is based upon a science of healing discovered by Andrew Taylor Still, MD, DO in 1874. Dr. Still based this new science upon an absolute faith in a human being’s innate capacity for self-healing and a belief that if the osteopath could remove the obstructions in the system, nature would provide the healing. It was his view that what we call disease is really just an effect of an abnormality or imbalance within a person’s body. As Dr. Still said, “Disease in an abnormal body is just as natural as is health when all the parts are in place.”

Expanded History of Osteopathic Medicine

In the U.S.A., there are two types of physicians trained and licensed to provide comprehensive medical care. They are Doctors of Osteopathy (D.O.'s) and Medical doctors (M.D.'s). Both can prescribe medications and perform surgery. Both can specialize in anesthesiology, pediatrics, internal medicine, emergency medicine, psychiatry, radiology, etc. Both must meet the necessary education and licensure requirements to practice medicine, but D.O.'s are trained to utilize the musculoskeletal system as a diagnostic & therapeutic tool in the treatment of disease along with appropriate drugs and surgery.

Theodore Roosevelt, Helen Keller, William Randolph Hearst, George Bernard Shaw, William Howard Taft, Nelson Rockefeller, and Mark Twain were aware of osteopathic medicine and advocated it.

Osteopathic medicine begins with its founder, Andrew Taylor Still, M.D. Dr. Still learned medicine through an apprenticeship with his father and attended the Kansas City College of Physicians and Surgeons and also studied at McGill University in Montreal, which was believed to be the finest medical school on the continent at the time.

Dr. Still was a community leader. He was a representative in the Kansas State Legislator to keep Kansas one of the free states. He worked with Abraham Lincoln's presidential campaign and served in the Ninth Cavalry as a major and surgeon.

It was only when Dr. Still's three children (two born to him and his wife, the third adopted) died of spinal meningitis, did he begin to look for methods to improve the practice of medicine. He began with a study of anatomy as he believed this to be the only true science of his day. Many accepted medical practices of Dr. Still's time would be considered unacceptable by today's standards and it was for this reason that he desired a science based more on reason and less on speculation. Many of the practices employed at the time we know now were not helpful to the patient and were in some instances harmful (i.e., the use of mercurial compounds, bloodletting, etc.) His contribution to medicine was the development of a logical and effective means of improving abnormalities within the musculoskeletal system and thereby enhance the physiologic response of the body to disease. He did not say that the musculoskeletal system was the sole cause of disease, but correcting the problems there would favorably influence the body to return to health and decrease recovery time. This was unlike the claim made by D.D. Palmer, a businessman, claiming to have discovered musculoskeletal manipulation under the name chiropractic in 1895, well after Dr. Still's practice and then establishment of the American School of Osteopathy in 1892. D.D. Palmer declared that 95% of all diseases were due to subluxated vertebrae.

Although Dr. Still's incorporation of musculoskeletal manipulation in his practice brought skepticism at first, his ability to get results, where other established physicians did not, brought him much popularity. Dr. Still's petition to teach and explain his findings at Baker University in Baldwin, Kansas was rejected. The decision was a painful one since his family had donated land for the institution and then helped build it. Nevertheless, Dr. Still's respectability continued to grow. Due to numerous requests, he began the establishment of "The American School of Osteopathy" in 1892 chartered by the State of Missouri which allowed it to grant the M.D. degree. Dr. Still insisted on granting the D.O. degree instead in order to distinguish its graduates from other practicing physicians of the time. The term Osteopathy also served as a reminder to the fact that the position of the bones served as a general starting point of diagnosing the musculoskeletal problems but involved the careful evaluation of related soft tissue structures as well. Dr. Still declared the school open to all regardless of race and gender and had three women in his first class.

The school from the beginning was considered to be an institution embracing all of the arts and sciences of medicine. It was gauged to improve the practice of medicine as the charter issued to the school indicated and read in part: "To establish a college of osteopathy the design of which is to improve the present system of surgery, obstetrics, and treatment of disease generally and place the same on a more rational and scientific basis and to impart information from the medical profession and to grant and confer such honors and degrees as are usually granted and conferred by reputable medical colleges; to issue diplomas and testimony of the same to all students graduating from said school under the seal of the corporation with the signature of each member of the faculty and of the president of the college."

During Dr. Still's stay in Kirksville, Missouri, not only was the American School of Osteopathy established, but Kirksville also grew in size to accommodate the ever increasing student body and growing practice. The train depot was very busy, new hotels were being built, and patients who could not be housed in hotels for lack of space were housed in boarding houses or private residences within easy reach. A representative from the infirmary was at the train station all day and night for outpatients needing assistance. Kirksville's population went from 3,510 in 1892 to 5,966 in 1900.

So what happened to osteopathic medicine from the 1900's to the mid 1980's? Although osteopathic manipulative medicine is older than the more well-known chiropractic school, the general public knows little if anything about it and how much it differs from other forms of manipulation. It is also interesting to note that osteopathic manipulative medicine (OMT) is now more commonly used to treat musculoskeletal pain. In the past, it was used regularly on patients after surgery and those with pneumonias and asthmatics to decrease recovery time and improve the management of the disease along with appropriate medical and surgical treatments.

Presently, chiropractic is more commonly associated with manipulation even though the field was pioneered and developed by osteopathic physicians in the United States. Additionally, the knowledge base, philosophy, and employment of manipulation by D.O.'s has been applied at a more refined level. Why then is manipulation more commonly associated with chiropractors? A study of the history behind osteopathic medicine and chiropractic can explain this. I will quote from Dr. Hildreth, a former student in the first class of Osteopathy and whose parents were acquainted with Dr. Still's early work in 1875, well before the establishment of the School of Osteopathy.

"At the opening of the second class in the fall of 1893, a man by the name of Strothers, who had been a member of the first class in the fall and winter before and who had been practicing a little in Davenport, Iowa during the summer of 1893, returned to Kirksville for further study. There came with him a man who said his name was Palmer. This was a person probably in his 50's who was very large, a heavyset man with a dark brown beard. He came to Kirksville, it was said, to take treatment from Dr. Still. Dr. Still's daughter, Blanche now Mrs. George M. Laughlin, told me that this man, Palmer, was not only treated by her father, but also sat at the family table upon the invitation of the old doctor. She told me that as many as eighteen places would be laid at Dr. Still's table at that time and some of the most prominent people who were being treated by Dr. Still would eat with him. Palmer took treatments from Dr. Still for a few weeks. He also talked with Dr. Still's students and was treated by many of them. When we next heard of him he had "discovered" a method of treating disease by the hands which he called chiropractic. My first experience with the method taught by Palmer in Davenport was a demonstration given by Dr. C.E. Achorn, then of Boston, at our American Osteopathic Association Convention in 1900 at Chattanooga, Tennessee. Dr. Achorn had come to Kirksville in an early day and studied osteopathy. He had graduated from a Northern School in Minneapolis. He also visited Davenport and witnessed a type of adjustment treatment there which was called chiropractic. Dr. Achorn showed that the Palmer method was along the lines practiced by Dr. Still for a number of years before opening his school in 1892 in Kirksville, only it was a very crude and very poor imitation of the type of manipulative therapy Dr. Still practiced. There has been much discussion as to whom the credit should be given for the discovery and use of adjustment in the cure of disease. There is no question in the minds of those osteopathic physicians who were associated with Dr. Still and who knew his theory of the development and growth of Osteopathy is where the credit belongs. Dr. Still was using manipulative methods for the alleviation of pain and suffering years before the man from Davenport was ever heard of. Hence, to Dr. Still alone belongs the credit for the discovery of adjustment of physical defects as the basis for the cure of disease."

At the turn of the century chiropractors were being sued for practicing Osteopathy without a license. Through the court system they contested that their ideas and application of manipulation was different from osteopathic physicians. With this kind of argument, they were able to continue to practice limited to manipulation under the chiropractic heading. In fact, D.D. Palmer, in 1906, was convicted of practicing medicine without a license and was sentenced to six months in jail. During his incarceration, his school was taken over by B.J. Palmer, his son. Upon D.D.'s release, B.J. managed to keep his father out of the school. Bitter feelings remained between the two. In August of 1913, D.D., while marching in a parade, was hit from behind by an automobile driven by B.J. A law suit against B.J. soon followed and D.D. Palmer died a few months later. Under B.J., the school grew by sensational advertising, a practice he encouraged his followers to emulate. Correspondence courses and the selling of diplomas was not uncommon in those days. It was said that Palmer explained to a local newspaper the "School back at Davenport is established on a business and not a professional basis". "It is a business where we manufacture chiropractors". "A course in salesmanship goes along with your training". "We teach them the idea and then show them how to sell it". These were some of the maneuvers and events that placed manipulation in association with chiropractors in the eye of the public. Additionally, and almost simultaneously, there was a de-emphasis of manipulative treatment in patient management among osteopathic physicians. This decline of manipulative treatment among D.O.'s began after the 1930's. In order to improve osteopathic physician graduates' chances of becoming eligible and passing unlimited licensure examinations, many full-time non-D.O. teachers were hired. Basic science instruction improved at the cost of adequate integration of osteopathic principles into the lectures. Also, physical modalities, such as spinalators, did not require the continued presence of physicians. The development of drug therapies, which included antibiotics, analgesics, anti-inflammatory agents, muscle relaxers and tranquilizers from 1935 to 1960 further decreased the need for lengthy osteopathic manipulative procedures in the management of patient care. As a result of these various events, it was not surprising to see that musculoskeletal manipulation became more closely associated with chiropractors.

To quote from Medical Economics May 15, 1989, "Having experienced both chiropractic and allopathic medicine, I have decided the most valuable degree is one I don't have: D.O. I find it hard to believe that doctors of osteopathy haven't already taken over responsibilities for primary care. To my way of thinking they have it all: pharmacology, surgery, and manipulation." L.D. Gilley, M.D., D.C.

So what can we say from all of this?

OSTEOPATHIC MEDICINE IS NOT SOMETHING DIFFERENT - IT IS SOMETHING MORE!