Traditionally, osteopathy, or osteopathic medicine, is based on the belief that most diseases are related to problems in the musculoskeletal system and that structure and function of the body are related. The musculoskeletal system is made up of nerves, muscles, and bones, all of which are interconnected and form the body's structure. Today, osteopathy is much like conventional medicine although many osteopathic physicians maintain the historical focus of structural health.

Osteopathy was founded in 1874 by Andrew Taylor Still. Still was a Missouri physician who had become frustrated with the ineffective nature of available remedies. He believed that the doctor's role in fighting disease was to restore the body's proper musculoskeletal function. Still founded the American School of Osteopathy in Missouri in 1892. The school taught manual manipulation, nutrition, and lifestyle modifications rather than surgery and drug therapies.

The American Osteopathic Association was formed in 1901 to regulate the profession. In 1962, doctors of osteopathy (D.O.s) were recognized for full practice rights in all 50 states (provided they obtain a license in any given state). By 1973, the California Medical Association invited D.O.s to join and become voting members.

Today, D.O.s get the same basic training as medical doctors (M.D.s), but they also learn manipulation (hands-on adjustments of muscles, bones, and ligaments) and use this along with more conventional medical treatments. Most D.O.s are primary care practitioners, specializing in family medicine, internal medicine, obstetrics/gynecology, or pediatrics.

D.O.s practice in all specialties of medicine ranging from emergency medicine and cardiovascular surgery to psychiatry and geriatrics. D.O.s trained in various specialty areas take a whole patient (holistic) approach. Although osteopathic manipulations were once used to treat all forms of disease, now they are considered useful mostly for musculoskeletal conditions (such as back pain).

Andrew Taylor Still believed that every disease or illness began with structural problems in the spine. Long nerves connect the spine to various organs in the body. According to Still, when there is a problem with the spine, the nerves send abnormal signals to the body's organs. Still called these spinal problems "osteopathic lesions" (osteo for bone and pathic for diseased), and created osteopathic manipulation techniques (OMTs) to treat them. These treatments, he believed, would return the nerves to their normal function and allow blood to flow freely throughout the circulatory system. With structure restored, the body's own natural healing powers would be able to restore full health.

Osteopathy also pioneered the techniques that have become known as craniosacral therapy, which is now practiced in different disciplines. Craniosacral therapy is the gentle manipulation of the bones of the skull to restore balance to the whole body.

A visit to a D.O. is much like a visit to your family doctor. The D.O. will ask you questions about your medical history, physical condition, and lifestyle. However, the physical exam of your bones, joints, muscles, ligaments, and tendons will be more extensive than with your family doctor. During the physical, the D.O. may:

• Look at your posture, spine, and balance
• Check your joints, muscles, tendons, and ligaments
• Use his hands to manipulate your back, legs, or arms

They may also measure changes in your skin temperature and sweat gland activity. If needed, the D.O. will order X-rays and laboratory tests. When the results are in, the D.O. will make a diagnosis and set up a treatment plan for you that may include prescription medications.

For problems involving the bones, muscles, tendons, tissues, or spine, many D.O.s use OMTs. There are two categories of OMT procedures: direct and indirect. In direct OMT, "problem," or "tight" tissues are moved (by the D.O., the person being treated, or both) toward the areas of tightness. In indirect OMT, the D.O. pushes the "tight" tissues away, in the opposite direction of the muscle's resistance. The D.O. holds the tissues in this position until the tight muscle relaxes.

Most osteopathic doctors use many of the medical and surgical treatments used by medical doctors. OMTs are used to treat a variety of health problems, both musculoskeletal and nonmusculoskeletal. The best scientific evidence shows that OMTs are most effective for back and neck pain. In fact, you may be able to reduce the amount of pain medication you are taking for back pain if you receive OMTs as part of your therapy.

Some preliminary evidence also shows that OMTs may be helpful for:

• Low back pain
• Ankle injuries
• Asthma
• Fibromyalgia
• Tennis elbow
• Neck pain
• Chronic obstructive pulmonary disease (COPD)
• Recovery after surgery
• Menstrual pain
• Depression
• Irritable bowel syndrome (IBS)
• Pregnancy and labor

You should avoid osteopathic manipulation if you have a broken bone or dislocation, bone cancer, a bone or joint infection, damaged ligaments, rheumatoid arthritis of the neck, or osteoporosis. Osteopathic manipulation is not recommended for people who recently underwent joint surgery or for people taking an anticoagulant (blood thinning) medication, such as aspirin or warfarin (Coumadin).

Shortly after an OMT treatment you might feel an increase in pain, slight headache, or fatigue. These side effects are temporary, and generally disappear within 4 to 24 hours. More seriously, stroke and spinal injury have been reported following manipulation of the neck. This complication is extremely rare.

Locate a licensed D.O. in your area who has been trained in one of the medical schools or teaching hospitals approved by the American Osteopathic Association (AOA): www.osteopathic.org

For additional information or referrals, see:

• American Academy of Osteopathy: www.academyofosteopathy.org
• American College of Osteopathic Family Physicians: www.acofp.org

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