December 18, 2013
The whole issue of the International Journal of Osteopathic Medicine (Volume 16/Number1/ March 2013) was dedicated to the subject of osteopathic principles. I found this issue particularly interesting as many claim to practice osteopathy today as purely an add on to another therapy, so it is vital to have principles to support the true identity of the profession and define the distinctiveness of osteopathy. Without these principles osteopathy loses its distinctiveness and identity.
One article that I found particularly useful for my interpretation of osteopathy was written by Steven Paulus on “The Core Priciples of Osteopathic Philosophy”. He looked at components of the teachings of AT Still the founder of osteopathy to find ten distinct and unique principles.
1). Human beings function holistically in a dynamic state of connected oneness.
AT Still stated “We look at the body in health as meaning perfection and harmony, not in one part but as the whole.” The teachings of AT Still emphasized harmony, wholeness, universality, equilibrium, balance, and the interconnectedness of systems. This can be encapsulated today in the term holism.
2). The body and psyche have the ability to self-heal, or to adapt, in the presence of disease or injury. Respecting this natural law forms the foundation of all treatment.
Osteopaths recognise that the body has the ability to heal itself so aim to remove obstructions that can cause disease and support the conditions for healing allowing the body to restore equilibrium at whatever level is possible for that individual patient. Healing emerges from what is healthy rather than from what is diseased. Still emphasised this when he stated “To find health should be the object of the doctor(osteopath). Anyone can find disease.”
3). The relationship between structure and function impacts the overall health of the entire body. Structure(anatomy) and function(physiology are interconnected and inseperable in disease and health.
Osteopaths fundamentally link structure and function. Still stated “Osteopathy is that science which [helps the body] regain its normal equilibrium of structure and function.” Osteopaths need to understand the mutual linkage between structure and function as a foundation of how they see the body in health and in disease. We use this detailed knowledge of anatomy and physiology to guide us in the best way to perform osteopathic manipulative treatment. Still stated “The philosophy of manipulations is based upon an absolute knowledge of the form and function.”
4). A precise anatomic diagnosis is made using hands-on palpation of the body. Once a diagnosis is made, a patient-specific dynamic Osteopathic treatment plan may then be implemented.
The science of Osteopathy cannot exist without knowing and understanding the intricacies of anatomy. One component of holism is anatomic unity. Still said, “We know that if we ever know the whole, we must first know the parts.” By knowing anatomy we can make a more precise diagnosis. By making a precise diagnosis we are better able to apply a specific Osteopathic Manipulative Treatment. By applying a specific Osteopathic Manipulative Treatment we not only remove the focal obstructions to self-healing but also augment the local and global health of the tissues. By restoring the ability of the body to self-heal we let the natural forces of healing do the work of repair thus allowing for the restoration of holism.
5).The musculoskeletal system (bones, muscles, and connective tissues) has a unique structure and function that impacts the overall health of the entire organism. When the musculoskeletal system fails to perform normally, the entire organism may suffer a localized or generalized disorder.
Still insisted that Osteopaths have an intimate knowledge of anatomy. He commonly referred to bones as well as muscles and connective tissues emphasizing how they form a mechanical scaffolding and provide an essential portal, or handle, allowing access to other tissues and body functions. He did not end or limit his work to bones, muscles and connective tissues but he frequently used the musculoskeletal system as a starting point in his philosophy of manipulation. He also recognized that a localized anatomically specific disorder or derangement often caused distant or global problems that upset normal whole body equilibrium.
6).Structural or functional disturbances of the musculoskeletal system, as well as any of the other systems of the body are treated by the application of an individualized Osteopathic Manipulative Treatment.
Osteopathic Medicine is a system of health care that depends upon utilizing a patient specific, anatomically accurate hands-on procedure known as Osteopathic Manipulative Treatment. OMT may include mobilization of joints, soft tissue techniques and cranial and visceral mobilizations.
In addition, having a knowledge of anatomy without understanding how to effect change in the anatomy via Osteopathic Manipulation is clinically worthless. Still said it best when he declared, “A knowledge of anatomy is only a dead weight if we do not know how to apply that knowledge with successful skill.” He also said,
“What is osteopathy? It is a scientific knowledge of anatomy and physiology in the hands of a person of intelligence and skill, who can apply that knowledge to the use of man when sick or wounded by strains, shocks, falls, or mechanical derangement or injury of any kind to the body. An up-to-date osteopath must have a masterful knowledge of anatomy and physiology.”
Osteopaths should be clinically up to date in their knowledge of anatomy and physiology, and for this reason both the General Osteopathic Council in the UK and the Society for the Promotion of Manual Practice Osteopathy in BC insist that their members undertake continued professional development each year. A foundation of these skills should be a detailed osteopathic education as detailed in the World Health Organizations benchmarks for osteopathy.
7).The goal of an Osteopathic Manipulative Treatment is to restore the natural ability to self-heal—or to creatively compensate—by augmenting the local and global health of the body and by removing obstructions to proper blood flow, fluid flow, or nerve function allowing for the restoration of motion.
Built in to Still’s teachings is the Osteopaths experience of “normal.” Still emphasized that, “An Osteopath reasons from his knowledge of anatomy. He compares the work of the abnormal body with the work of the normal body.” As Osteopaths, to practically understand what is abnormal we must have an intimate knowledge of normal structure and function. For us to know clinical normal requires patience, a devotion to practice, and a dedication to learning the unique anatomy and physiology found in diverse clinical situations.
An Osteopathic intervention has three key components.
A). We make a detailed anatomic diagnosis while monitoring the vitality of the tissues.
B). We apply a tissue-specific and patient-specific Osteopathic Manipulative Treatment while also attending to the non-material milieu.
C). We let the body do the true work of healing. The body does the repair, renovation, restoration of motion, and creative compensation. We as Osteopaths only assist the body by removing the impediments to the full expression of holism and help to promote the conditions that augment the therapeutic processes. Still taught that, “Harmony only dwells where obstructions do not exist.”
8).Osteopathy is a health care system based upon finding and treating the causes of a disease or injury rather than only attempting to address symptoms. Pain is a symptom, not a disease. If pain is exclusively treated, and there is a failure to arrive at the origins of what is causing pain, then the therapeutic actions are limited. The causes of pain are often distant from the symptoms.
Still said it best when he declared, “I want it understood that I look upon the treating of effects as being as unwarranted as it would be for the fireman of a city to fight the smoke and pay no attention to the cause that produces it.” Effects (smoke) are symptoms. Addressing the cause (fire) is the goal of Osteopathic Treatment. Pain is a common effect. Some of the time, effect/smoke/pain overlap with the cause/fire and when we treat the pain we treat the cause. Most of the time, the effect/smoke/pain is distant from the cause and Osteopathic philosophy demands that we find this distant cause and address the dysfunction that creates the diseased reaction.
9).There are two distinct and interrelated ways of perceiving during Osteopathic diagnosis and treatment. The material field is tangible and contains the biomechanical elements that are formed by the palpable anatomy and physical functions that are objective and can be measured. The non-material field is invisible and refers to the subjective bioenergetic elements that underlie the material form. The non-material field is the expression of subtle functions or inherent forces. The material and non-material fields coexist simultaneously and are unified in a dynamic state of connected oneness.
Veiled within Still writings is a key perceptual distinction that helps to guide Osteopathic diagnosis and treatment. Still delineated two perceptual access portals which he referred to as the “visible and invisible,” and the “material and immaterial” The material field is the visible, tangible, objective, and measurable. It includes the physical elements contained in anatomy and the physiologic functions that are quantifiable. Coexisting with the material elements is the non-material field, which is invisible, intangible, subjective, and is not measurable. It includes the attributes of Nature that vivify the structure. Still reveals more concerning the non-material when he states,
“Does Nature have a finer matter that is invisible and that moves all that is visible to us? Life surely is a very finely prepared substance, which is the all-moving force of Nature, or that force that moves all nature from worlds to atoms. It seems to be a substance that contains all the principles of construction and motion, with the power to endow that which it constructs with the attributes necessary to the objects it has formulated from matter and sent forth as a living being.”
To efficiently access the non-material we use our hands to intelligently make physical contact with the patient’s body. “All the principles of motion, life, and all its remedies to be used in sickness [are found] inside of the human body. [They are] placed…somewhere in the structure… As Osteopaths, we access the invisible that moves all that is visible through our connection with the structure.
Essential to A.T. Still’s Osteopathic approach are the clinically practical principles of accessing the body as a material mechanic and concomitantly connecting with the “vital qualities of Nature.”
10).The foundation stone of the Osteopathic system of health care is based upon trusting the unnamed forces of healing, which are concordant with Nature. Each Osteopath cultivates a personal self-reflective practice and draws upon this inner work to provide an intimately interconnected Osteopathic Treatment.
Still was intentionally vague regarding the details of his personal approach to spirituality but he was clear that his students would be better Osteopaths if we recognized that something greater influences the therapeutic actions initiated with our Osteopathic interventions.
Reference International Journal of Osteopathic Medicine Vol 16/Number 1/ March 2013
The Core Principles of Osteopathic Philosophy by S. Paulus