modern principles of osteopathy

Modern_principles_of_osteopathy_version_2_05082016

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Modern Principles of Osteopathy

- Integration of Osteopathy Into General Health Care

- The International Academy of Osteopathy

- Syllabus Master Course

Authors: Luc Peeters and Grégoire Lason

© Copyright 2016: All rights reserved. IAO vzw. No part of this document may be reproduced or made public by printing, photocopying, microfilming, or by any means without the prior written permission of the publisher.


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Content

Content 2

Introduction 4

1.History 51.1.TheOsteopathicPrinciplesThatA.T.StillPublishedCanBeResumedAsFollows: 5

2.DefinitionOfOsteopathy 6

3.PrinciplesOfOsteopathy 8

4.OsteopathicViewOnDiseaseAndHealth 94.1.GeneticAbnormalities 114.2.Lifestyle 114.2.1.Nutrition 124.2.2.Smoking 154.2.3.Drugs,Alcohol 154.2.4.Stress 15

4.3.Affections 154.4.EnvironmentalAndOccupational 154.4.1.Xenooestrogens 154.4.2.Antiandrogens 164.4.3.ToxicSubstances 16

4.5.Mechanics 164.5.1.Mobility 164.5.2.DifferentFormsOfMobility 17

4.6.Posture 184.7.MentalState 184.8.ComplementaryMedicine 19

5.CompetencesOfTheOsteopathAccordingTheCanMEDModel 215.1.OsteopathicCompetence-OsteopathicExpert-ClinicalDecisionMaker 215.1.1.GenericTreatmentSkills 215.1.2.ClinicalSkills 22

5.2.Communication–Communicator 245.2.1.WithThePatient 245.2.2.WithOtherHealthWorkers 24

5.3.Collaboration–Collaborator 245.3.1.SocialHealthcare 245.3.2.Teamwork 245.3.3.ReferToAllopathicMedicine 24

5.4.KnowledgeAndScience–Schools 255.4.1.Post-GraduateCourses 255.4.2.ContributionToScience 25


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5.4.3.CriticalEvaluationOfScientificResearch 255.5.Social-HealthAdvocate 255.5.1.SocialDevelopment 255.5.2.PublicHealth 255.5.3.Insurance 25

5.6.Organisation–Manager 265.6.1.PracticeManagement 265.6.2.PatientData 265.6.3.LegalObligations 26

5.7.Professionalism–Professional 265.7.1.EffectivePatientCare 26

6.DifferencesWithExistingRelatedMedicalProfessions 276.1.DifferencesWithPhysiotherapy 276.2.DifferencesWithChiropractic 276.3.DifferencesWithClassicalAllopathicMedicine 28

7.ClinicalReasoninginOsteopathy 29

8.EvidenceBasedPractice–EBP 30

9.D-BasesOnOsteopathicMedicine 31

10.SpecificTerminology 32

11.ScientificBasisOfOsteopathy 3311.1.Mobility 3311.2.SomaticDysfunction 3311.3.Vascularisation 3311.4.Self-RegulatingMechanisms 3411.4.1.MetabolicQualityOfTheComplaintStructure 3411.4.2.Auto-ImmuneSystem 3411.4.3.SpecificOrganSystems:Examples 34

11.5.Research 35

12.SafeTechniques 36

13.Conclusion 37

14.Bibliography 38

15.ImportantLiteratureForTheFinalOralExam 45

16.OsteopathicJournals 46


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Introduction This bundle on the modern principles of osteopathy is a collection of data that must be the common knowledge for every osteopath.

This bundle is produced for the Master course in osteopathy and must be seen as a guideline for the final interview/oral exam in the Master program.

At the end of this bundle, some important references are mentioned. Read them carefully.

After studying this bundle, the graduate must be able to:

Define osteopathy and explain the principles of osteopathy to laymen and to professionals in the field of healthcare.

Explain the differences and similarities between osteopathy and other medical disciplines.

Explain the way osteopaths work in practice in respect of the patient, ethics, religion, gender, race and other medical approaches.

Explain the specific role of the osteopath in healthcare. Explain terms such as (but not limited to) somatic dysfunction, evidence based

practice, clinical reasoning, professionalism, Express an EBP opinion on lifestyle, smoking, drugs, alcohol, stress, nutrition,

environment, mental state, posture, social development, legal obligations, public health, scientific research, safety in treatment, …

Be critical to his/her own knowledge, skills and osteopathy.

The oral exam will focus on these learning goals.


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1.History Osteopathy (also called osteopathic medicine) is a specific form of manual medicine which was developed by Dr. Andrew Taylor Still, in the middle of the 1800’s in the United States of America. Dr. Still founded the first school for osteopathy (1874) and the principles and philosophy of osteopathy rapidly spread across the world. (Ref.: Cole 1987, EAMT 1906, Still 1899, Still 1902) Osteopathy is a not an iatrochemic but a vitalistic and iatromechanic medicine. Dr. Still derived its principles from these vitalistic and iatromechanic ideas. In the United States, osteopathic training runs parallel with allopathic medicine and American osteopaths enjoy the same professional opportunities as American allopathic doctors. (Ref.: American Osteopathic Association: Fact Sheet 2006) The principles and philosophy of osteopathy are added to the traditional patient-based approach. Outside of the United States, osteopaths have not been trained as doctors (osteopathic physician). Osteopathic physicians and osteopaths have shared competencies which will be discussed here. The professional profile in this document relates to the competencies of the osteopath and not the osteopathic physician. 1.1.The Osteopathic Principles That A. T. Still Published Can Be Resumed As Follows: The reciprocal nature of structure and function

One of the fundamental laws in osteopathy and nature is the following: The integrity of a structure governs the function of that structure. This implies that an impeded integrity leads to an impeded function. The opposite however is also true. A loss of function results in a loss of structure. For example: A car that has lost a wheel (loss of structural integrity) won’t drive very well (loss of function). A car that has not been driven for many years (loss of function) rusts and breaks down (loss of structure). In osteopathy we go searching for these two components and restore the structure or function of the body so that good health is assured.

The body is a biological unit, the whole is greater than the sum of its parts A second fundamental law in osteopathy is that all structures and functions in the body are interrelated. What happens to one part of the body has repercussions for the whole body. This means that osteopathy not only treats the structure and functions that are affected but also looks at the whole body system and treats it as well.

If we return to our car analogy, we can state that a punctured tire not only causes problems for the tire (the part) and wheel but inhibits the smooth driving of the car as well (function of the whole). This principle makes the osteopathic approach to patients a holistic one.

The natural auto-correction mechanism Human beings, like every other animal on earth are constantly exposed to the forces of nature. We are constantly battered by climatic changes, germs, gravity, stress, etc. Our bodies continually react, trying to find an optimal balance and remain healthy. This unique ability is called the auto-correction system.

We know from the first two principles that loss of movement and/or function, effects our whole organism. It follows then, that when we have loss of movement or function in the body, the auto-correction system is also impeded, resulting in a loss of health. By restoring mobility osteopaths take away the obstacles that impede our auto-correction system, thereby allowing it to find a new balance. The result is either a full recovery or at least an improved quality of life.


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2.Definition Of Osteopathy (Ref.: AOA 2008, Downing 1935, EAMT 1916, Kuchera & Kuchera 1994, Peeters & Lason 2005, Ward 2003) The Benchmark for Training in Osteopathy (Ref.: WHO) published by the World Health Organization - WHO in 2010 gives the following definition of osteopathy: “Osteopathy (also called osteopathic medicine) relies on manual contact for diagnosis and treatment (WHO 2008). It respects the relationship of body, mind and spirit in health and disease; it lays emphasis on the structural and functional integrity of the body and the body's intrinsic tendency for self-healing. Osteopathic practitioners use a wide variety of therapeutic manual techniques to improve physiological function and/or support homeostasis that has been altered by somatic (body framework) dysfunction, i.e. impaired or altered function of related components of the somatic system; skeletal, arthrodial and myofascial structures; and related vascular, lymphatic, and neural elements (AACOM 2002).”

CEN (European Committee for Standardization – ref.: CEN) has adopted and issued a European Standard on Osteopathic Healthcare Provision. This new standard sets a benchmark for high quality clinical practice, education, safety and ethics. (DIN EN 16686:2015-09 (E))

The definition of Osteopathy in the CEN document is: “Osteopathy is a primary contact and patient-centred healthcare discipline, that emphasizes the interrelationship of structure and function of the body, facilitates the body’s innate ability to heal itself, and supports a whole-person approach to all aspects of health and healthy development, principally by the practice of manual treatment.”

Osteopathy is an established and recognised system of diagnosis and treatment which lays its main emphasis on the structural and functional integrity of the body. It is distinct due to the fact that it recognises that much of the pain and disability from which we suffer stems from abnormalities in the function of the body structure as well as damage caused to it by disease. Osteopathy is a science-based healthcare profession. It emphasises the use of physical approaches in the promotion, maintenance and restoration of an individual's physical, psychological and social well-being and takes into account variations in the individual's health. One distinctive feature of osteopathic practice is that practitioners can use manipulation, mobilisation, muscle energy, visceral, cranio-sacral, fascial and other functional techniques in an integrated manner to optimise the individual's functional ability and potential and in respect of the osteopathic principles (the interrelation between structure and function and importance of a mechanical, neurological, vascular and metabolic link to the patient’s problem and the auto-correction possibilities of the patient). Osteopathy is an autonomous profession and practice. It is characterised by reflective behaviour, testing the full mobility of the entire body and systematic clinical reasoning. All in all this contributes to and underpins a problem-solving approach to patient-centred care. Osteopathic practice is supported and influenced by evidence of clinical effectiveness and practitioners may work independently or as members of the healthcare team. When assessing, managing and evaluating an individual's needs, osteopaths take into account the individual's current physical, psychological, cultural and social factors and how these influence the individual's functional ability. In practice it also takes into account the needs and


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perspectives of carers and other healthcare professionals in order to provide a coherent and holistic approach that maximises independence and function. Osteopaths work in a range of health and care settings including hospitals, in the community, private clinics and sports settings. Most work in private clinics.


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3.Principles Of Osteopathy The characteristics of osteopathy can be found in the Benchmarks for Training in Osteopathy, published by the World Health Organization (WHO). A brief summary would be: Osteopathy provides a broad range of approaches for maintaining health and managing

disease. A human is a dynamic functional unit. One’s state of health is influenced by the body, mind

and spirit. It possesses self-regulatory mechanisms and body function and structure are interrelated at all levels.

It applies current medical and scientific knowledge. Osteopathy is a patient-centred and not a disease-centred healthcare system.

Structural diagnosis and osteopathic manipulative treatment (OMT) are essential components of osteopathy.

The aim of osteopathic treatment is to promote the correct supply of blood, a correct conduction of nerve impulses, correct biomechanical function and a good metabolic state to the affected body tissues.

The aim of this document is to implement modern medical knowledge into the osteopathic principles. Osteopathy cannot be seen as an exotic approach to patients. It is an integrated part of medicine and must define its specific role in patients’ care. 5 models are described in the WHO benchmarks

1. The biomechanical structure/function relationship model: here osteopathy strives for good mechanical function and posture, particularly addressing the musculoskeletal system.

2. The respiratory/circulatory structure/function relationship model: addresses dysfunctions in the mechanics and the circulation and flow of body fluids to provide the body with oxygen and nutrients.

3. The neurological structure/function relationship model: addresses dysfunctions

of the neurological system. Spinal facilitation, the autonomic nervous system, proprioceptive functions, the activity of the nociceptors and the functioning of the neuroendocrine immune network is addressed.

4. The biosocial structure/function relationship model: this model recognizes that

environmental, socioeconomic, cultural, physiological and psychological factors can affect patient health.

5. The bioenergetic structure/function relationship model: maintaining a balance

between energy production, distribution and expenditure is essential to good health.


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4.Osteopathic View On Disease And Health The cause of disease in whatever form must be seen as a multifactorial event.

Multifactorial events of disease

Place of osteopathy within health care

Health

Functional disease

Structural disease

Genetic abnormalities Single gene inheritance Multifactorial inheritance Chromosome abnormalities Mitochondrial inheritance

Lifestyle nutricion smoking drugs, alcohol stress

Affections acquired damage viruses and bacteria systemic iatrogenic

Environmental and occupational

xenooestrogens antiandrogens toxic substances

Mechanics lost of mobility adhesions congestion

Posture gravity lost of energy

Mental state


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As a typical example we add here the osteopathic view as described by the Western University of Health Science (College of Osteopathic Medicine of the Pacific):

“When the human being is viewed in light of osteopathic principles the perception of the health-disease continuum changes. Osteopathic principles allow the osteopath to consider all aspects of the patient, not just the symptoms. The osteopath sees the integrated nature of the various organ systems and body’s capabilities for self-regulation and self-healing. These principles acknowledge the importance of the musculoskeletal system and its role in health and disease. The body, through its own regulatory mechanisms, constantly attempts to maintain itself in a state of health. At the same time, the body is subjected to various stressors which threaten this healthy state. These stressors may come from various sources and may include biological, behavioral, social, spiritual and environmental factors. The presence of somatic dysfunction may also interfere with the body’s ability to maintain health and resist illness. Under normal circumstances, the body’s own self-regulatory and self-healing mechanisms are able to counteract these stressors and thus maintain health. However, should stressors accumulate to the point where these mechanisms are overwhelmed, the body’s inherent tendency toward health is weakened. Continuation of this process over time leads to the signs and symptoms of illness. The osteopath recognizes that these signs and symptoms are not the illness itself, but are only the outward signs of the illness. The illness is the result of the stressors’ impact on the body’s systems. Treatment must be directed toward the stressors, as symptomatic treatment alone will not guarantee the restoration of health. At this stage, external resources are needed to help the patient recover from the illness. The osteopath can assist the patient by helping to reduce or eliminate the stressors, including somatic dysfunction. When this is achieved the body’s self-regulatory and self-healing capacities can regain their normal function, and the body can be restored to health. The body’s inherent regulatory mechanisms are then able, once again, to maintain this healthy condition. Thus the osteopath does not view himself or herself as a “healer”, but as one who works with the patient to facilitate that patient’s inherent tendency toward health. How does the osteopath apply OPP in the care of patients? Remember that we define osteopathic medicine as a complete system of medical care with a philosophy that combines the needs of the patient with the current practice of medicine, surgery, and obstetrics; that emphasizes the interrelationship between structure and function; and that has an appreciation of the body’s ability to heal itself. Based on this definition, osteopathic medicine defines a distinctive set of tenets which osteopaths use to formulate their approach to patient care. These tenets are:

A person is the product of dynamic interaction between body, mind, and spirit. An inherent property of this dynamic interaction is the capacity of the individual for the

maintenance of health and recovery from disease. Many forces, both intrinsic and extrinsic to the person, can challenge this inherent

capacity and contribute to the onset of illness. The musculoskeletal system significantly influences the individual’s ability to restore

this inherent capacity and therefore to resist disease processes.


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From these tenets the osteopath derives certain principles for patient care. These principles state that: 1) the patient is the focus for healthcare; 2) the patient has the primary responsibility for his or her health; and 3) an effective treatment program for patient care is founded on the above-mentioned tenets. Thus the osteopath uses a health-oriented and patient-centred philosophy to implement the principles of osteopathic medicine in the care of the patient. “ The osteopath’s goals are to:

Seek out and address the root cause(s) of disease using available evidence-based approaches.

Optimize the patient’s self-regulating and self-healing capacities. Provide an individualized patient management plan that includes emphasis on health

promotion and disease prevention. Include palpatory diagnosis and osteopathic manipulative treatment to address the

somatic component of disease the extent that it influences the well-being of the patient.

4.1.Genetic Abnormalities A genetic disorder is an illness caused by abnormalities in genes or chromosomes. It is the constitution inherited through the parents. Genetic disorders can also be very complex, multifactorial, or polygenic. This means that they are associated with the effects of multiple genes in combination with lifestyle and environmental or occupational elements. They are called acquired genetic disorders. Genetic mutations occur either randomly or due to some environmental exposure. Genetic disease or disorders can be catalogued into four groups (National Human Genome Research Institute 2010): 1. Single gene inheritance: Single gene inheritance is also called Mendelian or monogenetic inheritance. This type is caused by changes or mutations that occur in the DNA sequence of a single gene. There are more than 6,000 known single-gene disorders, which occur in about 1 out of every 200 births. Examples are cystic fibrosis, sicle cell anemia, Marfan syndrome. 2. Multifactorial inheritance: Multifactorial inheritance are also called complex or polygenic inheritance. They are caused by a combination of environmental factors and mutations in multiple genes. Examples are heart disease, high blood pressure, arthritis, cancer or obesity. 3. Chromosome abnormalities. Examples are Down syndrome or Turner syndrome. 4. Mitochondrial inheritance: This type of genetic disorder is caused by mutations in the nonchromosomal DNA of mitochondria. Examples are epilepsy or dementia. 4.2.Lifestyle Smoking, drinking, bad nutritional habits and lack of physical activity are life-style related health determinants linked to a number of major health problems, such as cancer, cardio-vascular disease and obesity. According to WHO estimates, up to 80% of cases of coronary heart disease, 90% of type 2 diabetes cases, and one-third of cancers can be avoided by increases physical activity, healthier diet and stopping smoking.


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4.2.1.Nutrition The World Health Organization – WHO (http://www.who.int/nutrition/topics/en/ ) recommends 5 Keys to healthy nutrition: Breastfeed babies and young children

From birth to 6 months of age, feed babies exclusively with breast milk (i.e. give them no other food or drink), and feed them "on demand" (i.e. often as they want, day and night). At 6 months of age, introduce a variety of safe and nutritious foods to complement breastfeeding, and continue to breastfeed until babies are 2 years of age or beyond. Do not add salt or sugars to foods for babies and young children. Why?On its own, breast milk provides all the nutrients and fluids that babies need for their first 6 months of healthy growth and development. Exclusively breastfed babies have better resistance against common childhood illnesses such as diarrhoea, respiratory infections and ear infections. In later life, those who were breastfed as infants are less likely to become overweight or obese, or to suffer from noncommunicable diseases, such as diabetes, heart disease and stroke. Eat a variety of foods

Eat a combination of different foods, including staple foods (e.g. cereals such as wheat, barley, rye, maize or rice, or starchy tubers or roots such as potato, yam, taro or cassava), legumes (e.g. lentils, beans), vegetables, fruit and foods from animals sources (e.g. meat, fish, eggs and milk). Why?Eating a variety of whole (i.e. unprocessed) and fresh foods every day helps children and adults to obtain the right amounts of essential nutrients. It also helps them to avoid a diet that is high in sugars, fats and salt, which can lead to unhealthy weight gain (i.e. overweight and obesity) and noncommunicable diseases. Eating a healthy, balanced diet is especially important for young children's and development; it also helps older people to have healthier and more active lives.


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Eat plenty of vegetables and fruit

Eat a wide variety of vegetables and fruit. For snacks, choose raw vegetables and fresh fruit, rather than foods that are high in sugars, fats or salt. Avoid overcooking vegetables and fruit as this can lead to the loss of important vitamins When using canned or dried vegetables and fruit, choose varieties without added salt and sugars. Why?Vegetables and fruit are important sources of vitamins, minerals, dietary fibre, plant protein and antioxidants. People whose diets are rich in vegetables and fruit have a significantly lower risk of obesity, heart disease, stroke, diabetes and certain types of cancer. Eat moderate amounts of fats and oils

Use unsaturated vegetable oils (e.g. olive, soy, sunflower or corn oil) rather than animals fats or oils high in saturated fats (e.g. butter, ghee, lard, coconut and palm oil). Choose white meat (e.g. poultry) and fish, which are generally low in fats, in preference to red meat. Eat only limited amounts of processed meats because these are high in fat and salt. Where possible, opt for low-fat or reduced'fat versions of milk and dairy products. Avoid processed, baked and fried foods that contain industrially produced trans-fat. Why?Fats and oils are concentrated sources of energy, and eating too much fat, particularly the wrong kinds of fat, can be harmful to health. For example, people who eat too much saturated fat and trans-fat are at higher risk of heart disease and stroke. Trans-fat may occur naturally in certain meat and milk products, but the industrially produced trans-fat (e.g. partially hydrogenated oils) present in various processed foods is the main source.


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Eat less salt and sugars

When cooking and preparing foods, limit the amount of salt and high-sodium condiments (e.g. soy sauce and fish sauce). Avoid foods (e.g. snacks), that are high in salt and sugars. Limit intake of soft drinks or soda and other drinks that are high in sugars (e.g. fruit juices, cordials and syrups, flavoured milks and yogurt drinks). Choose fresh fruits instead of sweet snacks such as cookies, cakes and chocolate. Why?People whose diets are high in sodium (including salt) have a greater risk of high blood pressure, which can increase their risk of heart disease and stroke. Similarly, those whose diets are high in sugars have a greater risk of becoming overweight or obese, and an increased risk of tooth decay. People who reduce the amount of sugars in their diet may also reduce their risk of noncommunicable diseases such as heart disease and stroke. Malnutrition refers to insufficient, excessive, or imbalanced consumption of nutrients. It is one of the major health risks of our time. Normal nutrition can also be illustrated by the United States Department of Agriculture USDA Food Pyramid.

Food Pyramid


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The World Health Organization cites malnutrition as the gravest single threat to the world's public health. A diet low in energy-dense foods that are high in saturated fats and sugars, and abundant in fruit and vegetables, together with an active lifestyle are among the key measures to combat chronic disease recommended in an independent Expert Report prepared for two UN agencies (WHO technical report series 2003). 4.2.2.Smoking Tobacco use is one of the biggest public health threats the world has ever faced. It kills more than five million people a year. This is an average of one person every six seconds – and accounts for one in 10 adult deaths. Up to half of current users will eventually die of a tobacco-related disease (WHO fact sheet 2016). 4.2.3.Drugs, Alcohol (Ref.: WHO, drugs 2012, WHO, alcohol)

"Alcohol and illicit drugs are harming millions of people in many ways, from becoming dependent on such substances to causing a range of other health problems, such as injuries, cardiovascular diseases, HIV and hepatitis C or cancers," says Dr Shekhar Saxena, director of WHO's Department of Mental Health and Substance Abuse. 4.2.4.Stress (Ref.: NIH, WHO-Stress, APA)

Stress is the emotional and physical strain caused by our response to pressure from the outside world. Common stress reactions include tension, irritability, inability to concentrate, and a variety of physical symptoms that include headache and a fast heartbeat. It's almost impossible to live without some stress. And most of us wouldn't want to, because it gives life some spice and excitement. But if stress gets out of control, it may harm your health, your relationships, and your enjoyment of life. Living in a constant fight and flight situation charges the heart, increases bloodflow to muscles and brain up to 400 %, digestion diminishes, muscle tension increases, breathing increases. Stress can cause chronic fatigue, digestive upsets, headaches, and back pain. Chronic stress causes immunity insufficiency and high blood pressure. 4.3.Affections Aquired damage, virus and microbial infections, systemic disease and iatrogenic disorders will affect human health. Iatrogenic disease is the result of diagnostic and therapeutic procedures undertaken on a patient. With the multitude of drugs prescribed to a single patient adverse drug reactions are bound to occur. The Physician should take suitable steps to detect and manage them (Krishnan & Kasthuri 2005). 4.4.Environmental And Occupational 4.4.1.Xenooestrogens Xenooestrogens are widely used industrially made compounds such as PCB, BPA and Phthalates. They are chemically different from human oestrogens but they have oestrogenic effects on living organisms. Because these xenooestrogens come into the environment through pesticides, herbicides, plastic and because they are widely used in medication, cosmetics and


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cattle breeding, the world population suffers more and more under these xenooestrogens (Korach & Kenneth 1998). Xenooestrogens have an influence on the reproduction. Endometriosis and lost of fertility in both men and women are known effects. They also play a role in the oncogenesis (Darbre 2006, Darbre et al 2004, Buterin et al 2006, Pugazhendhi et al 2007, Safe 2004). Breast developpement in children and in men with metabolic syndrome are consequences of xenooestrogen environmental intake. Several chronic disease such as arthritis, Myalgic encephalomyelitis – ME or Post-Viral Fatigue Syndrome - PFS tend to stand under the influence of this slow toxic intake. Phytooestrogens or dietary oestrogens as they appear in different food such as soya have the same oestrogen effect when taken in too high quantities. 4.4.2.Antiandrogens Antiandrogens are hormone receptor antagonists. They inhibit hormonal functions and are used as treatment for example prostate cancer. They are also found in dioxin and pesticides. Anti-androgenic drugs have many potential side effects including nausea, diarrhea and sexual problems. Long-term treatment also may cause osteoporosis. 4.4.3.Toxic Substances All substances are potentially toxic. Some are toxic when ingested in abnormally large quantities, for example, common salt and water. Others such as caffeine and certain other alkaloids are toxic in moderate amount. We refer here to toxins such as Trypsin inhibitors, Phytohemagglutinins, Goitrogens, Cyanogenic glucosides. These toxins enter our food in abnormal ways (pesticides). Toxins can have negative influences on our health such as allergies, food intolerance, inhibition of digestive enzymes, goiter, thiamine deficiency and neurological or hematological manifestations. The main responsibility lies here with the community, government and environmental policies. 4.5.Mechanics 4.5.1.Mobility The motions that a person makes are usually attributed to the musculoskeletal system. In osteopathy every motion of one structure relative to an adjacent structure is considered as an articulation. In this context the viscera are in intimate contact with each other and also with certain musculoskeletal structures, creating a specific biomechanical relationship that must remain perfectly mobile. Classical medicine also recognizes that an immobile organ functions poorly. However, this fact is usually only considered as a diagnostic tool and does not result in any type of manual treatment. Osteopathy has a clear role to play in this situation. Manual evaluation of mobility loss and the identification of retractions of visceral ligaments are standard skills for a well trained osteopath. As well as the visceral mobility, the osteopath will also evaluate any visceral congestion, the tone of the organs and the circulation (arterial, venous and lymphatic). The repair or optimization of visceral mobility, neurology (afferent and efferent) and circulation of the organs provides positive influence not only for the function of those organs but for the entire function of the body.


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Every pathological condition will result in a visceral fixation. The organ lost the ability to move freely within the cavity. If the body cannot adapt to this new situation, a functional disorder will develop which will in turn (if the adaption is inadequate) become a structural disorder. The treatment involves stimulating the organ so that it regains its primitive physiological mobility. The osteopath works on every mobile component of the body - whether the most simple or the most complex motion. The isolated manipulation of a vertebra or an organ is only of relative importance. This is not only treatment but it is a way to access the body’s system so as to stimulate the organism to autocorrect. The basic concept of visceral osteopathy is the fact that a healthy organ requires optimal mobility, optimal nervous conduction and optimal circulatory supply. 4.5.2.Different Forms Of Mobility 4.5.2.1.Musculosceletal Mobility These are the most well known motions. The striped muscles move the bones under central nervous system control. Larger motions are the result of combined small motions in multiple joints. These larger motions result in a passive mobilization of the organs and of all other body structures. 4.5.2.2.Visceral Mobility The motions in the visceral system are not under central nervous system control but autonomic nervous system control. This means that the free will of the individual has no influence upon this mobility. There are different motions in this category: motions under influence of the diaphragm, motions under influence of the heart beat, motions of the gastro-intestinal system (peristalsis) under influence of the neurovegetative and hormonal systems. 4.5.2.3.The Diaphragm The motions of the diaphragm are well known and described. Most specifically the influence of the diaphragm upon the lungs has been well studied. It should not be forgotten, however, that the motions of the diaphragm not only effect the lungs but also all the surrounding organs. The abdominal and thoracic organs also follow the diaphragm and important parts of their function even depends upon this mobility. The liver will drain its portal blood into the inferior vena cava more during inhalation while this flow reduces during exhalation. It is clear that an optimal function of the diaphragm is essential for an optimal function of the surrounding organs. The diaphragm moves up and down approximately 25.000 times per day. During inhalation thoracic decompression and abdominal compression occurs while during exhalation thoracic compression and abdominal decompression occurs (West 1990). The mobility of the organs under influence of the diaphragm were first appreciated after 1980 and much remains to be learnt. Radiologists recognize the mobility of the kidneys, pancreas and other organs. Research has also been done in recent years related to radiation therapy so as to improve the accuracy of the treatment. Correlations have been found between visceral complaints and the poor mobility of that organ. This also applies to the organs of the upper abdomen. While the sigmoid colon, caecum and pelvic organs are not under direct mechanical influence of the diaphragm these organs benefit from an optimal function of the diaphragm as it has an essential effect upon general venous flow. Furthermore, the motions of the diaphragm do not only move the organs up and down but will also alter the angles of certain organs. For example, the angle between duodenum I and II and the angle at the junction between duodenum IV and the jejunum.


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4.5.2.4.The Heart The heart beats approximately 100.000 times per day. This provides a mechanical action upon the surrounding organs such as the lungs, oesophagus and diaphragm. 4.5.2.5.Peristalsis Peristalsis occurs in the hollow organs. It is an ingenious intrinsic motion that is controlled by the autonomic nervous system and by the hormonal system that allows transport and mixing of the gut contents. Some organs have an intrinsic neurological system, which regulates the peristaltic function. The sinus node of the heart and the Meissner plexus and Auerbach plexus (Schutte 1964) in the digestive system are examples. 4.5.2.6.Lost Of Mobility Somatic dysfunctions: a somatic dysfunction is an altered function of somatic related components (skeleton, joints, myofascial structures) and their vascular, lymphatic and neurologicval elements. A somatic dysfunction can be diagnosed with manual methods because the altered muscle structure, capsular and ligamentary structures and the periostal sensibility can be palpated. The neurological relation between sclerotom, dermatom, myotom, angiotom and viscerotom is proven and is used daily in medical diagnosis, often under the name ‘referred pain’. Differentiating between viscerosomatic, somatovisceral, viscerovisceral and somatosomatic relations is important. This indicates that the origin of the pain is not always to be found at the pain location. This is the reason why osteopaths palpate and test tissue quality, mobility and pain in different body areas related to the pain location in a mechanical, vascular, neurological or metabolic way. 4.5.2.7.Adhesions An adhesion is a band of scar tissue that binds 2 parts of body tissue together. They should remain separate. Adhesions may appear as thin sheets of tissue or as thick fibrous bands. The causes for adhesions are multiple: Surgery Inflammation that heals leaves adhesion

4.5.2.8.Congestion Congestive organs take-up more space than a normal organ due to the increased internal pressure. This increase in pressure (permanent in case of congestion) will chronically press the serosae together causing adhesion. This congestion also impinges the surrounding small blood vessels which causes retraction of the supporting connective tissue, leading to further adhesion and mobility loss. 4.6.Posture Posture is the way humans counter gravity when standing on their feet. A good posture means that little energy is used to stand upright. Good posture reduces energy lost, diminishes the risk for injuries and abnormal load bearing components. 4.7.Mental State The ability to enjoy life is essential to good mental health.


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It has been long known that some people handle stress better than others. This means that a genetic or constitutional factor is present. The characteristic of "resilience" is shared by those who cope well with stress. Balance in life, meaning spending time socially versus spending time alone as well as flexibility, meaning as well emotionally as cognitive flexibility versus expectations is important for mental health. Mental healthy people experience a range of emotions and allow themselves to express these feelings. Using your own potentials is also very important in mental health as well as the ability to form healthy relationships with others. 4.8.Complementary Medicine Every medical discipline is complementary to all the other medical disciplines. Health and disease are multifactorial. Good health demand a good constitution (genetic quality), a healthy lifestyle and nutrition, a healthy environment, a good functioning defence system against germs, mobile structures and an optimal posture. It must be clear that not all these factors are always of equal importance. Chromosome abnormalities can’t be treated. Single gene inheritance can be treated to extend life or to improve quality of life but cannot be cured. Life threatening germs must be treated with medication even when this induces iatrogenic factors ore side-effects. Disease cannot just be seen as a sum of factors since several of the factors will enforce other factors. This is very well known in for example the metabolic syndrome where the high Body Mass Index – BMI, raised triglycerides, reduced HDL cholesterol, raised blood pressure and raised fasting plasma glucose as well as a family history are all factors that enforce each other with different coefficients. Genetic engineers map our DNA trying to understand the functioning, the interaction of chromosomes and genes and the interaction with other proteins. This way they try to find cures for diseases with major genetic impact. Viruses and bacteria’s are treated with medication. Environmental health risks are dealt with by governments and laws. Blocked vertebrae are manipulated. Every specialist sees his/her own specialty as very important. There is little doubt that all these specialists are indeed very important although every specialist should be aware of the interaction and enforcement of all the other factors that influence health or disease. Cancer for example can have an genetic origin, a lifestyle and nutritional origin, an environmental origin and even a viral origin. These different causing factors enforce each other. A mechanical cause for low back pain will be much easier to treat by manipulation in a patient with a healthy lifestyle, a good constitution and no disease present. If however this patient with low back pain caused by a mechanical factor also has a poor constitution, a poor lifestyle and malnutrition, manipulation will not be the solution for his cure. An tissue inflammation that causes a low back pain will be difficult to cure with anti-inflammatory medication when the region suffers from lost of mobility, poor blood supply or pH disbalance.


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Although the most common cause for stomach ulcer is “helico bacter pilori”, the antibiotic treatment will give poor results when the orthosympathic segment T6-T9 is blocked following a trauma. Treatment of high blood pressure with medication will be much more difficult when the patient doesn’t take care of his/her nutrition or when the patient doesn’t do sport or when there are intrathoracic retractions which inhibit the good functioning of the heart muscle.

There is prove that osteopathy is beneficial in the treatment of several affections such as low back pain, fibrmyalgia, carpal tunnel syndrome, respiratory disfunctions, otitis media, constipation, Tension Type Headache, Posture Assymetry in Children, Malocclusion, Pneumonia, Irritable Bowel Syndrome, Chronic Prostatitis, Shoulder Pain, Lower Urinary Tract in Women Dysfunctions, Pregnacy Optimalization, etc… (Alvizatos 2006, Andersson et al 1999, Andresen et al 2012, Bledsoe 2004, Brugman et al 2010, Bube et al 2010, Crow & Gorodinsky 2009, Cuccia et al 2010, Degenhart & Kuchera 2006, Fischer 2009, Fryer et al 2005, Gibson et al 1985, Goldstein et al 2010, Franke & Hösele, 2013, Hallas et al 2009, Hensel et al 2015, Hoehler et al 1981, Howard & Drysdale 2006, King et al 2003, Kirk et al 2005, Licciardone 2001, Licciardone et al 2003, Licciardone 2004, Licciardone et al 2005, Licciardone et al 2005, Licciardone 2007, Licciardone et al 2010,Marx et al 2009, Müller et al 2014, Nemett et al 2007, Overberger et al 2009, Philippi et al 2006, McReynolds & Sheridan 2005, Smithermann et al 2007, Norton 2009, Sandhouse et al 2010, Schabert & Crow 2009)


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5.Competences Of The Osteopath According The CanMED Model 5.1. Osteopathic Competence - Osteopathic Expert - Clinical Decision Maker 5.1.1. Generic Treatment Skills

5.1.1.1. Osteopathic Principles the osteopath knows the osteopathic principles, can express them and can apply these principles in complex patient examination and treatment situations.

5.1.1.2. Osteopathic Diagnosis the osteopath is able (on the basis of their knowledge) to take a case history of the patient and to make a functional osteopathic diagnosis that relates to the patient’s complaint. He/she is also capable of making an exclusion diagnosis and can refer the patient to allopathic medicine. Functional osteopathic diagnosis is different from allopathic diagnosis. Functional osteopathic diagnosis concerns the manual detection of somatic dysfunctions that disturb or modify the patients’ self-regulating mechanisms. (Stochkendahl et al 2006) Allopathic diagnosis is tracing the presence of sickness using all possible means. However, the osteopath can consult relevant clinical tests such as x-rays, scanner reports and lab results to guarantee the safety of the patient and make a referral if necessary.

5.1.1.3. Recognizing Contraindications the osteopath is capable of making a differential diagnosis in order to exclude patients from osteopathic treatment or osteopathic techniques and to refer them to allopathic medicine.

5.1.1.4. Treatment by closely consulting the functional osteopathic diagnosis, the osteopath is able to offer an efficient and above all safe osteopathic treatment which respect osteopathic principles.

5.1.1.5. Advice by closely consulting the functional osteopathic diagnosis and osteopathic treatment, the osteopath is able to advise the patient on nutrition, behaviour and lifestyle to improve their health.

5.1.1.6. Critical Evaluation And Follow-Up the osteopath is capable of evaluating his/her treatment results and if necessary adapt the osteopathic treatment or refer the patient.


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5.1.2. Clinical Skills

5.1.2.1. Case History And Clinical Examination the osteopath can independently record a thorough case history, understand the impact of the patient’s complaints on general health and pain and recognize complaints which must be referred to allopathic medicine. The osteopath recognizes the complaint structure. The osteopath has the professional skills to use general manual examination techniques (topographic and diagnostic palpation, provocation tests, mobility tests) and to use these specifically (Bush & Vorro 2009) for detecting tissue changes, distinguishing normal tissues from abnormal tissues and linking findings with the somatic dysfunctions observed. Therefore the osteopath is trained in topographic and diagnostic palpation and mechanical test skills. The osteopath recognizes contraindications for osteopathic treatment and can refer the patient when necessary.

5.1.2.2. Manipulation the osteopath possesses the professional skills for applying manipulative techniques (HVLA: high velocity/low amplitude treatment) in a safe and effective manner. He/she has the competence to adapt the manipulative techniques according to age, gender and the current situation of the patient. The osteopath recognizes contraindications for the application of manipulations. Manipulation is used on all possible musculoskeletal regions to restore normal biomechanical mobility for the restoration of vascularisation and neurological conduction as well for restoring somatic dysfunctions. Both short and long lever techniques are used depending on the lesions found. Manipulations can also restore body posture. (Bronfort et al 2001, Bronfort et al 2004, Bronfort et al 2008, Bronfort et al 2010, Cecchi et al 2010, de Almeida et al 2010, Du et al 2010, Gross et al 2010, Liu et al 2010, Passmore et al 2010, Taylor & Murphy 2010)

5.1.2.3. Mobilization the osteopath possesses the professional skills to apply mobilization techniques in a safe and effective manner. He/she has the competence to adapt the mobilization techniques according to the age, gender and current situation of the patient. The osteopath recognizes contraindications for the application of mobilizations. Mobilization is used on all possible body regions to restore normal biomechanical mobility, to restore vascularisation and neurological conduction as well as to restore somatic dysfunctions. Both short and long lever techniques are used depending on the lesions found. (Gross et al 2010)

5.1.2.4. Muscle Energy Techniques (MET) (Mitchel et al 1997) the osteopath possesses the professional skills to apply MET techniques in a safe and effective manner. He/she has the competence to adapt the MET techniques according to the age, gender and current situation of the patient. The osteopath recognizes contraindications for the application of MET. MET is used on all possible muscular regions to restore normal biomechanical mobility, to restore vascularisation and neurological conduction as well as to restore somatic dysfunctions. Muscle Energy Techniques tend to stretch muscles, re-enforce muscles and correct muscle tone and trophicity. (Ref.: Burns & Wells 2006)

5.1.2.5. Spontaneous Release Techniques (SRT) (Jones 2004) the osteopath possesses the professional skills to apply SRT techniques in a safe and effective manner. He/she has the competence to adapt the SRT techniques according to the age, gender and present situation of the patient. The osteopath recognizes contraindications for the


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application of SRT. SRT is used on all possible musculoskeletal regions to restore normal biomechanical mobility, to restore vascularisation and neurological conduction as well as to restore somatic dysfunctions. SRT techniques are developed by L.Jones, osteopath. Through the monitoring of pain points with palpation and bringing the joints in relaxed positions, the aim of the technique is to make these pain points disappear.

5.1.2.6. Visceral Mobilization And Drainage the osteopath possesses the professional skills to apply visceral mobilizations and drainage techniques in a safe and effective manner. He/she has the competence to adapt the visceral mobilizations and drainage techniques according to the age, gender and present situation of the patient. The osteopath recognizes contraindications for the application of visceral mobilizations and drainage techniques. Visceral mobilizations and drainage techniques are used on all possible visceral regions to restore normal biomechanical mobility, to restore vascularisation and neurological conduction as well as to restore somatic dysfunctions. Visceral techniques include techniques on the respiratory diaphragm.

5.1.2.7. Craniosacral Techniques (Becker 2001, Bering 1962, Enzman 1991, Ferguson 1991, Ferre 1991, Greenman 1995, Greitz 1992 & 1993, Heisev 1993, Hubbart 1971, Jaslow 1992, Kimmer 1961, Magoun 1979, Moskalenko et al 1980 & 2003, Nelson 2001 & 2002, Retzlav 1975, Sergueef 2001 & 2002, Sutherland 1939, Upledger 1971) the osteopath possesses the professional skills to apply craniosacral techniques in a safe and effective manner. He/she has the competence to adapt the craniosacral techniques according to the age, gender and present situation of the patient. The osteopath recognizes contraindications for the application of craniosacral techniques. Craniosacral mobilizations and drainage techniques are used on all possible cranial regions to restore normal biomechanical mobility, to restore vascularisation and neurological conduction as well as to restore somatic dysfunctions. Craniosacral tests and techniques were developed by W.G. Sutherland. They are very soft and gentle mobilization techniques of the scull sutures and structures in the high cervical region and temporomandibular region. The aim is to restore mobility, vascularisation and neurological conduction. They often affect the neurovegetative balance of the patient.

5.1.2.8. Fascial Techniques the osteopath possesses the professional skills to apply fascial techniques in a safe and effective way. He/she has the competence to adapt the fascial techniques according to the age, gender and present situation of the patient. The osteopath recognizes contraindications for the application of fascial techniques. Fascial mobilizations and stretch techniques are used on all possible body regions to restore normal biomechanical mobility, vascularisation and neurological conduction as well as to restore somatic dysfunctions.


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5.2. Communication – Communicator

5.2.1. With The Patient

the osteopath possesses the professional skills to develop a professional relationship with the patient. The osteopath is able to explain to the patient what osteopathy is, what the principles are and can even explain the osteopathic findings to the patient. The osteopath is able to objectively explain the treatment options, taking in account the ethnic, religious and intellectual background of the patient. The osteopath can ask relevant questions, follow-up questions and open and closed questions. He/she can listen and extract the relevant information from conversations with patients. The osteopath understands and uses verbal and non-verbal communication. The osteopath deals with patient data confidentially.

5.2.2. With Other Health Workers

the osteopath is able to report the case history results, the osteopathic findings and the treatment and treatment choice to other healthcare workers both orally and in writing and using medical language. The osteopath strives for communication and cooperation with other healthcare workers, especially allopathic doctors and he/she is conscious of the position of the osteopath in the healthcare system. The osteopath knows the limitations of his/her osteopathic interventions. The osteopath can inform the patient on how other healthcare workers can help in the restoration of health. The osteopath is reliable, ethically and discretely handles patient data and maintains appointments and agreements. The osteopath knows the consequences of his/her osteopathic interventions and can correlate this to allopathic medicine treatments.

5.3. Collaboration – Collaborator

5.3.1. Social Healthcare

the osteopath contributes to the debate concerning social healthcare. He/she is prepared to take up any advisory or collaborative role within the social healthcare system.

5.3.2. Teamwork

the osteopath is prepared for multidisciplinary actions and cooperation with other medical professions. The osteopath is able to work in team, colleagues who use the same osteopathic principles and also with other healthcare workers who work who work with the principles of evidence and consensus-based medicine.

5.3.3. Refer To Allopathic Medicine

the osteopath is aware of the different disciplines within the healthcare sector. He/she sees the role of the General Practitioner as the central person who guards the patient’s medical file and will always report to the patients’ General Practitioner. The osteopath knows and recognizes the limitations of osteopathy, is able to infer these limitations about the patient and can adequately refer the patient if necessary.


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5.4. Knowledge And Science – Schools

5.4.1. Post-Graduate Courses

the osteopath respects that the osteopathy profession requires “continuous study (lifelong learning)”. He/she is responsible for maintaining his/her knowledge and competences at the highest possible level.

5.4.2. Contribution To Science

the osteopath cooperates in effective and quality research. He/she is capable of evaluating the necessity, relevance and need for scientific research. He/she is prepared to assist with training students in osteopathy (clinical work). The osteopath is capable of performing scientific research, set up a study design, formulate a hypothesis, doing appropriate literature search and publish in peer review journals.

5.4.3. Critical Evaluation Of Scientific Research

the osteopath has an understanding of the principles of statistics and mathematics for evaluating statistical reports and understanding and implementing scientific research articles. He/she is competent to interpret research results and to apply the conclusions in the daily osteopathic thinking and practice.

5.5. Social - Health Advocate

5.5.1. Social Development

the osteopath is capable of following relevant medical and osteopathic publications and applying the outcomes to daily osteopathic thinking and practice. He/she is a member of the professional organization.

5.5.2. Public Health

in his/her practice, the osteopath recognizes situations that could endanger general public health and he/she knows how, when and where to report this.

5.5.3. Insurance

the osteopath knows the professional insurance laws. He/she can correctly interpret data from insurance reports concerning the patient’s health. The osteopath has taken out a good insurance policy for his/her osteopathic interventions.


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5.6. Organisation – Manager

5.6.1. Practice Management

the osteopath organizes people, means and information within his/her own practice to guarantee continuous and efficient osteopathic patients’ care.

5.6.2. Patient Data

the osteopath knows and applies data protection laws, in particular the protection of patient data. He/she records the patients’ data in a structured way and where possible in a digital file.

5.6.3. Legal Obligations

the osteopath respects local laws and general laws as laws that concern the practice of osteopathy. He/she is always prepared to provide insight into practice data (to authorities) in as far as this does not damage patient confidentiality. The osteopath fulfils his/her obligations towards the financial authorities. The osteopath also follows the rules and guidelines drawn up by the legal professional organization.

5.7. Professionalism – Professional

5.7.1. Effective Patient Care

the osteopath is capable of making an independent and specific contribution (based on the osteopathic principles) towards the improvement of the quality of life and the well-being of the patient. The osteopath works in a patient-centred manner and is aware of his/her responsibilities towards the patient, colleagues, other healthcare workers and public health. The osteopath works independently and can contextualise and evaluate his/her role in the patients’ care. The osteopath has a critical insight into his/her own possibilities and limitations. In this context the osteopath can also interpret scientific articles and implement the outcomes in daily osteopathic thinking and practice. The osteopath works with well-determined aims and searches for solutions in an independent way. The osteopath knows and implements laws and regulations which are currently in force such as the ethical code, patient confidentiality, the professional code and code of conduct.


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6. Differences With Existing Related Medical Professions 6.1. Differences With Physiotherapy

Osteopathy uses specific and authentic basic principles which are different from physiotherapy or manual medicine.

osteopathy doesn’t treat illnesses. It optimizes patients health to stimulate self-regulating physiological processes (immunity, repair, anti-inflammatory). Physiotherapy is directed towards revalidation, exercising and supporting the allopathic concept. Manual therapy is directed towards only musculoskeletal complaints and examines and treats strain and stresses in joints with local techniques.

Osteopathy sees the importance of the somatic dysfunction as possible cause of complaints and tends to treat the somatic dysfunction to alter neurological, mechanical and vascular components in the complaint area.

Osteopathy is not working with revalidation such as physiotherapy, osteopathy doesn’t perform massage and exercise therapy which are specific to physiotherapy.

Osteopathy doesn’t use equipment nor electrical or mechanical. This is done in physiotherapy.

The treatment frequency of osteopathy is maximum once per week to give the patients body the time to use its self-regulating forces. Physiotherapy and manual therapy treat more often.

The principles of mobility examination and mobilizations in physiotherapy is based on mobility amplitude while in osteopathy it is more based on the biomechanical correctness of the movement.

Osteopathy considers the whole patient (holistic) to solve complaints and problems that alter health of the patient. Therefore not only the complaint area is considered in osteopathy but also relevant other body regions. Physiotherapy and manual therapy treats locally.

Physiotherapy and manual therapy are limited to complaints of the musculoskeletal system where as osteopathy also treats complaint af other body systems such as the gastrointestinal complaints, urogenital complaints, respiration complaint and vascular complaints. Osteopathy considers the interactions of different body regions such as the musculoskeletal, visceral and craniosacral system.

Osteopathy sees prevention as very important. patients can visit osteopaths like they do with dentists with the aim of preventing the occurrence of somatic dysfunctions and associated complaints.

Mixture of physio- and osteopathy praxis is not possible, both disciplines have different concepts and must be seen as different.

Physiotherapy and manual therapy have treatment procedures for most affections. Osteopathy adapts each treatment to the specific demands of the patient.

6.2. Differences With Chiropractic Osteopathy considers the somatic dysfunctions in the patient and treats them in all

possible regions and tomes. Osteopathy treats through manipulation, mobilization MET, drainages, visceral techniques, fascial techniques and craniosacral techniques while chiropraxis is concentrated on the manipulations of the spine.

The treatment frequency of osteopathy is maximum once per week to give the patients body the time to use its self-regulating forces. Chiropracters treats more often.


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An osteopathic treatment has minimum 30 minutes while chiropractors work only minutes with the patient.

6.3. Differences With Classical Allopathic Medicine Osteopathy considers the somatic dysfunctions in the patient and treats them in all

possible regions and tomes. Osteopathy treats through manipulation, mobilization MET, drainages, visceral techniques, fascial techniques and craniosacral techniques. Classical medicine knows the somatic dysfunction and it is sometimes used in medical diagnosis but classical medicine never uses this in treatments.

Osteopathy has a specific functional osteopathic diagnosis, based on the search for somatic dysfunction and lost of mobility. Classical medicine diagnoses disease and treats disease.

Osteopathy only uses manual techniques to test and treat the patients’ complaints. Osteopathy sees the general practitioner as the central figure in the patients’ dossier. Although they examine and treat independently, osteopaths report to the general

practitioner to keep the patients’ file up-to-date. Osteopathy is not in competition with classical medicine. Pure functional complaints can be treated by osteopaths. In the case of structural

problems osteopathy is complementary to classical medicine. Osteopathy doesn’t work life saving as classical medicine does. Osteopaths do not prescribe medication and don’t perform surgery.


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7. Clinical Reasoning in Osteopathy Clinical reasoning refers to the thinking and decision-making processes that are used in clinical practice. Clinical reasoning is a process in which the therapist, interacting with the patient and others (such as family members or others providing care), helps patients structure meaning, goals, and health management strategies based on clinical data, patient choices, and professional judgment and knowledge.

See video: https://www.youtube.com/watch?v=EXxPk2U0uPI&feature=youtu.be

Clinical reasoning in osteopathy is comparable with clinical reasoning in allopathic medicine. However, osteopaths don’t stop when the disease is determined or when the complaint structure is found.

Osteopaths also continue reasoning towards possible causes why the concerned complaint structure doesn’t heal as it should or why the disease doesn’t react on allopathic treatment sufficiently.

In this context all possible dysfunctions are considered on musculoskeletal, visceral, craniosacral, fascial, emotional, psychological, even social level.

In this context, osteopathy responds to the most modern psychosocial/behavioural or biopsychosocial model.

Biopsychosocial model


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8. Evidence Based Practice – EBP Evidence-based practice is the integration of best research evidence with clinical expertise and patient values. (Sackett 2000).

See video: https://www.youtube.com/watch?v=qwDqPMbpgvw

Osteopathy is based on EBP, meaning that osteopathic examination and treatment is not only based on clinical expertise but as well on best research evidence and patients’ values.

EBP


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9. D-Bases On Osteopathic Medicine Osteopathic Research Web is a collaboration of the Wiener Schule für Osteopathie

and some other schools in Europe, especially the British School of Osteopathy and the British College of Osteopathic Medicine.

OSTMED. DR (Osteopathic Medicine Digital Repository) When funding for OSTMED® ended in 2003 those interested in osteopathic research and scholarship were concerned about the future of collecting, disseminating and having Internet access to the osteopathic literature. VCOM and its partner, VTLS, Inc., conceived the idea of a digital library and submitted a proposal to the American Osteopathic Association (AOA) and he American Academy of Colleges of Osteopathic Medicine (AACOM) which was approved by March 2006. OSTMED.DR® was created using VTLS. solution, VITAL, a digital repository and management system that is designed to simplify the development of digital collections and provide seamless online search and retrieval of information.

The Clinical Research Database of the American Association of Colleges of Osteopathic Medicine (AACOM).


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10. Specific Terminology HVLA: high velocity/low amplitude treatment. Iatrochemistry: the study of chemistry in relation to the physiology, pathology, and treatment of disease. Iatromechanical: describing a school of thought that maintained that physiology and pathology could be explained in terms of physics. Lesion: loss of mobility. OMT: Osteopathic Manipulative Techniques. Not only manipulations (HVLA) but all manual osteopathic techniques are included. Somatic dysfunction: a somatic dysfunction is a disturbed or modified function of somatic related components (skeleton, joints and myofasciale structures) and their vascular, lymphatic and neurological elements. A somatic dysfunction can be traced with manual methods because the modified muscle structure, capsules, ligamentary structures and raised periostal sensibility can be palpated. The neurological relation between sclerotom, dermatom, myotom, angiotom and viscerotom has been proven and is used in traditional medicine, frequently under the name “referred pain”. This interaction between the body areas is differentiated in traditional medicine as viscerosomatic, somatovisceral, viscerovisceral and somatosomatic relations. In other words this means that the cause of a complaint is not always in the complaint region but can be in different related body areas. This is the reason why the osteopath frequently checks body structures (with palpation, provocation tests and mobility tests) away from the complaint structure but neurological, vascular, mechanical or metabolic related. If mobility, neurological and vascular situation can be improved in the related structures, one also sees that the complaint structure improves. Glossary: to find all specific osteopathic terminology. http://www.osteopathic.org/search/Pages/results.aspx?k=glossary (Ref.: Glossary of Osteopathic Terminology 2015) Vitalistic: The theory or doctrine that life processes arise from or contain a nonmaterial vital principle and cannot be explained entirely as physical and chemical phenomena.


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11. Scientific Basis Of Osteopathy Osteopathy is based on the basic medical sciences (anatomy, physiology, neurology, biomechanics, biochemistry, pathology). These fundamental medical sciences are applied in case history, examination and osteopathic treatment. Relations between the treated body regions and the complaint area are explained by known interactions in the allopathic medicine: neurological, vascular and mechanic. 11.1. Mobility Osteopathy understands that a disturbed mobility in single joints can bring soft tissues like muscles, capsules, ligaments under stress. This stress can be stretch, trophical changements, bad circulation). Disturbed mechanics means in osteopathy that the normal axis of mobility are not followed. This can be the origin of:

overstretch of soft tissues, bad vascularisation in retractive soft tissues, cartilage disformation by changes in the axis of mobility….arthrosis, degeneration.

The disturbed mechanics in a joint often finds its origin in dysfunctions in other joints, further away. FE a foot that doesn’t follow the correct biomechanics in walking because of a blockage (after inversion trauma) can influence the mechanics of the lower back and cause complaints and degeneration. (Ref.: Fairbank et al 1984, Häkkinen 2005, Schulte et al 2005) 11.2. Somatic Dysfunction a somatic dysfunction is a disturbed or modified function of somatic related components (skeleton, joints and myofasciale structures) and their vascular, lymphatic and neurological elements. A somatic dysfunction can be traced with manual methods because the modified muscle structure, capsules, ligamentary structures and raised periostal sensibility can be palpated. The neurological relation between sclerotom, dermatom, myotom, angiotom and viscerotom has been proven and is used in traditional medicine, frequently under the name “referred pain”. This interaction between the body areas is differentiated in traditional medicine as viscerosomatic, somatovisceral, viscerovisceral and somatosomatic relations. In other words this means that the cause of a complaint is not always in the complaint region but can be in different related body areas. This is the reason why the osteopath frequently checks body structures (with palpation, provocation tests and mobility tests) away from the complaint structure but neurological, vascular, mechanical or metabolic related. If mobility, neurological and vascular situation can be improved in the related structures, one also sees that the complaint structure improves. 11.3. Vascularisation In allopathic medicine, disturbed circulation is also recognized as possible cause of complaints. Ischemic pain, migraine and lots of other affections are caused by circulatory problems. When the osteopath can alter the tone of the arteries, the drainage through veins and lymph vessels through treatment of the segmental elements, the complaint structure will have a better vascularisation. In allopathic medicine the same is done through medication. (Ref.: Karason & Drysdale 2003, Knott et al 2005)


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11.4. Self-Regulating Mechanisms Under self-regulating mechanisms osteopaths understand: 11.4.1. Metabolic Quality Of The Complaint Structure When the osteopath alters the mechanical, vascular and neurological qualities of the complaint structure, local metabolism will improve and this raises the chances for healing. 11.4.2. Auto-Immune System White bloodcells and enzymes that circulate in the blood: the quality of these products depend of the quality (vascular, mechanic, neurological and metabolic) of the producing organs and organ systems (bone marrow for example) and of the quality of the circulatory system that brings the products where needed. It is obvious that osteopathy doensn’t have any influence on hereditary disease. Osteopathy can have influence on the aspecific immunity but not on the specific immunity. 11.4.3. Specific Organ Systems: Examples

11.4.3.1. Surrenal Glands The optimal functioning of these organs demands a good functioning of the related segment. Also a good vascularisation and good nutricion are important in this context to deliver for example cortisol.

11.4.3.2. Intestines The resistance against external aggression (through nutricion) of the digestive system is determined for a great part by the functioning of the “Peyers patches”, the lymphatic system in the wall of the intestines. A good lymphatic drainage, a good mobility of the intestines, a good elasticity of the intestines, good innervations by the intrinsic system and the neurovegetative system are influenced by the osteopath by means of mobilizations, stretching, segmental treatment, drainage of the venous and lymphatic system and through nutricional advices.

11.4.3.3. The Neurovegetative System (Para-Orthosympathetic, Intrinsic System) An optimal functioning of the neurovegetative is absolutely necessary to function as well metabolically as psychologically. The ortho- and parasympathetic segments are kept mobile by the osteopath and the circulation is optimized as well arterial, venous and lymphatic. Patients with a disturbed neurovegetative balance are more vulnerable for complaints and sense more pain.

11.4.3.4. Blood Forming Organs (For Example Bone Marrow, Spleen, Lymphoid Tissue) Good mobility, normal soft tissue tractions to bone and a good circulation contribute to the normal functioning of the bone marrow. A good lymphatic circulation contributes to a better resistance. An optimal functioning of the spleen and a normal lifestyle contribute to a good blood formation.


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11.5. Research The American Osteopathic Association (AOA) keeps a research handbook (Ref. AOA Research Handbook 2007). The effectiveness of osteopathy is amongst other research proven by Alvizatos 2006, Andersson et al 1999, Andresen et al 2012, Bledsoe 2004, Brugman et al 2010, Bube et al 2010, Crow & Gorodinsky 2009, Cuccia et al 2010, Degenhart & Kuchera 2006, Fischer 2009, Franke et al 2013, Fryer et al 2005, Gibson et al 1985, Goldstein 2010, Hallas et al 2009, Hoehler et al 1981, Howard & Drysdale 2006, King et al 2003, Kirk et al 2005, Licciardone 2001, Licciardone et al 2003, Licciardone 2004, Licciardone et al 2005, Licciardone et al 2005, Licciardone 2007, Licciardone et al 2010, Müller et al 2014, Marx et al 2009, Nemett et al 2007, Overberger et al 2009, Philippi et al 2006, McReynolds & Sheridan 2005, Norton 2009, Sandhouse et al 2010, Schabert & Crow 2009, Smithermann et al 2007.


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12. Safe Techniques Osteopaths use techniques that are adapted to the lesions found, to the age, gender and health status of the patient. The safety of osteopathic treatment and techniques is for example proven by Cramer 2010.


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13. Conclusion Osteopathy must be pure, A. T. Still said but modern osteopathy must define clearly her specialism in mechanical (musculoskeletal, visceral and craniosacral) and postural dysfunctions in relation to other health threatening factors. Osteopathy must play an important role in the health of patients by being the specialist in mechanical and postural disorders as well on the musculoskeletal, the visceral as the craniosacral level. Not only to treat mechanical dominant problems but also as a complementary treatment in other disease mechanisms. Osteopaths distinct themselves from other healthcare workers with their mechanical approach. Despite this mechanical approach they must be well aware of the multifactorial aspect of disease just as other health care workers must see the important mechanical factor that can influence disease. Understanding the multifactorial cause of disease and taking that in account when treating a patient is an holistic approach.


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14. Bibliography 1. Alvizatos J., Lamaro J. & fryer G. 2006 The effect of osteopathic treatment on people

with sub-chronic and chronic neck pain: A pilot study. IJOM Volume 9 Issue 1 page 27. 2. American Association of Colleges of Osteopathic Medicine. Glossary of Osteopathic

Terminology. (http://www.aacom.org, revised 2002). 3. American Osteopathic Association: Fact Sheet. Chicago 2006 -

http://www.osteopathic.org/pdf/ost_factsheet00.pdf. 4. Andersson G.B., Lucente T., Davis A.M., Kappler R.E., Lipton J.A. & Leurgans S: A

comparison of osteopathic spinal manipulation with standard care for patients with low back pain. New Engl. J. Med.1999, 341: 1426-1431.

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111. Still A.T.: The Philosophy en Mechanical Principles of Osteopathy, The American Academy of Osteopathy. 1902.

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116. Trowbridge C. Andrew Taylor Still 1828-1917, 1st ed. Kirksville, MO: the Thomas Jefferson University Press, 1991.

117. Upledger J., Karni Z.: 1979 Mechano-electric patterns during craniosacral osteopathic diagnosis and treatment. Journal of the American Osteopathic Association 78 (July): 782-791.

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Geneva 2003. 124. WHO Fact sheet: http://www.who.int/mediacentre/factsheets/fs339/en/ 125. WHO. Atlas 2010: First global report on substance use disorders launched.

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15. Important Literature For The Final Oral Exam Still A.T.: The Philosophy of Osteopathy, The American Academy of

Osteopathy.1899. Still A.T.: The Philosophy en Mechanical Principles of Osteopathy, The American

Academy of Osteopathy. 1902. WHO Benchmarks:

http://apps.who.int/medicinedocs/documents/s17555en/s17555en.pdf Glossary of Osteopathic Terminology:

http://www.aacom.org/resources/Documents/Downloads/GOT2009ed.pdf Principles of Osteopathy:

http://www.meridianinstitute.com/eamt/files/tasker/taskcont.htm


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16. Osteopathic Journals International Journal of Osteopathic Medicine (IJOM) is a peer-reviewed journal that

provides for the publication of high quality research articles and review papers that are as broad as the many disciplines that influence and underpin the practice of osteopathic medicine. Particular emphasis is given to basic science research, clinical epidemiology and health social science in relation to osteopathy and neuromusculoskeletal medicine.

Journal of the American Osteopathic Association (JAOA) is the official scientific publication of the American Osteopathic Association, as well as the primier scholarly, peer-reviewed publication of the osteopathic medical profession.

Osteopathic Medicine and Primary Care (OMPC) is an open access, peer-reviewed online journal that encompasses all aspects of family medicine, internal medicine, pediatrics, and obstetrics and gynecology. The journal also covers health service and public health research that addresses primary care issues.

Osteopathy Today (OT) is a full colour monthly newspaper for osteopaths of the British Osteopathic Association, published ten times per year.

La revue ApoStill est l'organe de communication essentiel de l'Académie d'Ostéopathie de France destiné à faire connaître tous les travaux pouvant servir l'objet de l'association.

La Revue de l'Ostéopathie: une revue scientifique, internationale et francophone dédiée à la recherche en ostéopathie vient de voir le jour. Les rédacteurs en chef sont bien connus des ostéopathes puisqu’ils ont œuvré durant plusieurs années au sein de l’académie d’ostéopathie de France. Robert Meslé et Laurent Stubbe nous proposent une revue tournée vers l’avenir. Si Apostill s’est orienté pendant des années à retracer le chemin parcouru par l’ostéopathie depuis sa création et nous rappeler les fondements de cette profession, la revue de l’ostéopathie fait le choix de la recherche scientifique et de l’évaluation de l’efficacité de l’ostéopathie.

Osteopathische Medizin spiegelt den ganzheitlichen Ansatz der Osteopathie wieder und beleuchtet alle akademisch-wissenschaftlichen, medizinischen, geschichtlichen und philosophischen Aspekte des osteopathischen Spektrums.

DO - Deutsche Zeitschrift für Osteopathie ist ein unabhängiges Magazin für Praktiker. Chiropractic & Osteopathy (previously Australasian Chiropractic and Osteopathy,

COCA) is an international open access journal without charge to authors during this time. Readers should note that on January 1, 2011 the journal’s name will change to Chiropractic & Manual Therapies.

Osteopatía Científica (Scientific Osteopathy) publicación cuatrimestral (3 números al año), avalada por la escuela de Osteópatas de Madrid (EOM) y por la Scientific European Federation of Osteopaths (SEFO), se constituye como el vehículo de divulgación de los avances científicos y técnicos y trasmisor de conocimientos de alto valor científico entre los profesionales de la osteopatía.

modern principles of osteopathy

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