Should the physician focus on the patient or the patient's disease? This debate has raged from the beginning of medical history when the Hippocratic philosophy centered on the patient and the rival Cnidian philosophy focused on the disease.

Today, only one branch of mainstream medicine follows the Hippocratic approach. It is osteopathic medicine and, currently, some 33,000 osteopathic physicians and surgeons offer the public a different dimension in medical care.

What is the osteopathic medical philosophy?
In brief, DOs, or Doctors of Osteopathic Medicine, are fully licensed and recognized physicians and surgeons who stress the unity of all body systems. They also emphasize the musculoskeletal system, holistic medicine, and proper nutrition and environmental factors. They bring a hands-on approach to medicine and view palpation and manipulation as aids to the diagnosis and treatment of various illnesses.

Osteopathic medicine was founded on the Missouri frontier in 1874. Dr. Andrew Taylor Still was an individualistic and strong willed MD who was dissatisfied with the ineffectiveness of 19th century medicine. He decried the rudimentary drugs and surgery of the day and saw many people, including his own three children, die from serious diseases. Concepts such as anesthesia, sterile surgery, antiseptics, antibiotics and x-rays were not imagined in the 1870s.

In response, Dr. Still founded a philosophy of medicine that hearkened back to Hippocrates, with its central focus on the body unit. He identified the musculoskeletal system as a key element of health. He recognized the body's capability to heal. He stressed preventative medicine, eating properly and keeping fit (which mainstream America wholeheartedly embraced in the 1970s).

He identified palpation and the human touch as vital to gaining patient confidence and providing effective medical care. And he stressed manipulation as a less intrusive form of diagnosis and treatment. Currently, many Americans seek procedures and therapies that are less invasive and less likely to escalate cost or engender side effects.

Today, DOs offer mainstream medical care ... but mainstream medical care with a difference.

Osteopathic Concept: The human body is a unified organism
Osteopathic physicians emphasize that all body systems, including the musculoskeletal system, operate in unison and disturbances in one system can alter functions of other systems. By recognizing the close relationship between body structure and organic functioning, the DO has a broader base for treating the whole patient.

Practice Application: DOs follow a holistic, common sense approach to health care delivery that views each patient in his or her entirety.
Osteopathic physicians not only recognize the interdependence of all parts of that complex machine — the human body — but also consider the patient's mental and emotional status. In addition, the DO pays attention to the relationship of the patient to his of her home environment, job and other factors that affect health.

For example, the surgical removal of a diseased gallbladder is a valuable and acceptable practice of osteopathic physicians. However, DOs believe that medicine must be more than an attempt to repair, relieve or remove the end product of disease processes. The gallbladder does not malfunction independently; its nerve and blood supply and the chemical balance of body fluids also may be implicated. Besides arresting an acute episode of illness, the DOs underlying concern is to return the patient to a state of optimum health by dealing directly with the internal conditions that caused the disease in the first place.

The holistic tradition of osteopathic medicine is reflected in the fact that a great percentage of graduating DOs enter primary care, where they view the patient as a total entity. In addition, the majority of today's osteopathic physicians practice in smaller towns and rural areas — where the need for primary health care is greatest. Even when a DO becomes a specialist, such as a neurosurgeon, cardiologist, anesthesiologist or psychiatrist, he or she still sees each patient as a whole person and stresses that illness can have its origin in another part of the body.

Osteopathic Concept: The body's musculoskeletal system is central to the patient's well being.
This system includes the bones, muscles, tendons, tissues, nerves and spinal column — about 60 percent of the body mass. The musculoskeletal framework, DOs point out, is far more that an anatomical rack on which other organs are hung. It works in concert with all other organs. It may respond properly or improperly — when a breath is drawn or body movement occurs. Besides being prone to mechanical disorders, the musculoskeletal system reflects many internal illnesses and may aggravate or accelerate the process of disease in the circulatory, lymphatic, nervous and other body systems.

Osteopathic physicians utilize all of the recognized procedures and modern technologies for prevention, diagnosis and treatment of disease, including drugs, radiation and surgery. But the DO also has another pair of tools that enable him or her to accurately diagnose areas of dysfunction and treat them effectively. These tools are his or her hands.

Practice Application: Osteopathic manipulation of the musculoskeletal system is a viable and proven technique for many hands-on diagnoses and treatments. Often, it can provide an alternative to more intrusive therapies involving drugs and/or surgery.
The osteopathic physician brings additional cognitive, diagnostic and therapeutic dimensions to the practice of medicine. Sometimes it is in the form of palpation (touch) as a diagnostic procedure to detect soft tissue changes or structural problems. The osteopathic physician also utilizes his/ her knowledge of anatomy to apply localized forces to relieve dysfunction or restrictions of motion in joints. Because musculoskeletal dysfunction can mimic other disease syndromes, osteopathic assessment and possibly manipulation is an important component in differential diagnosis, as well as means of correcting structural problems.

It has been well documented that diseases of the specific organs can produce pain in distant parts of the body. Stomach ulcers consistently cause areas of paraspinal pain and irritation just below the shoulders in the back. The radiation of pain to the loin from a diseased kidney is another typical example, as is the reflection of pain and disability to the left shoulder following heart disease. In diagnosing such diseases, DOs recognize that symptoms can be produced without actual disorder in organs to which pain has been referred.

Conversely, disturbances affecting the musculoskeletal system can cause symptoms that simulate the onset of other illnesses. Among the most common causes of recurrent tension headaches, for example, are disorders of the cervical (upper) portion of the spinal column. Consequently, properly applied manipulative treatment, particularly directed to the neck and head, often affords relief of headache symptoms when all other remedies have failed.

Osteopathic Concept: The body has a natural tendency toward health, as well as the capacity to resist disease and to heal itself.
The body's own healing power, vis medicatrix naturae, is a main principle of osteopathic medicine and a basic condition of all diagnosis and treatment. Therefore, osteopathic practice is designed to support, stimulate and, in some instances, initiate the body's trend toward health.

Practice Application: In addition to treating specific health problems, the DOs goal is to help every patient function at his or her highest level of efficiency.

There is a fundamental concern with preventive medicine, proper nutrition and keeping a patient fit.

DOs pioneered the concept "wellness" 100 years ago. In today's terms, personal health risks — such as smoking, high blood pressure, excessive cholesterol levels, stress and other lifestyle factors — are evaluated for each individual. In coordination with appropriate medical treatments, the osteopathic physician acts as a teacher and guide to help patients take more responsibility for their own being and change unhealthy patterns.

Sports medicine also is a natural outgrowth of osteopathic practice, which focuses on the musculoskeletal system, manipulation, diet, exercise and fitness. Many professional sports team physicians, Olympic physicians and personal sports medicine physicians are DOs.

Osteopathic Concept: The osteopathic profession cooperates with all other branches of medical science.
However, it maintains its professional independence in order to sustain and develop osteopathic medicine as a unique and comprehensive system of health care.

Practice Application: Osteopathic medicine plays a distinctive role in the nation's health care delivery system.
DOs hold the same unlimited practice rights as MDs in all 50 states; they serve as commissioned officers in the medical corps of all armed forces, plus the Veterans Administration and Public Health Service and they are recognized by the AMA as full practice physicians.

DOs admit and treat patients in both osteopathic and allopathic (MD) hospitals and clinics. Many DOs and MDs word as colleagues in a range of medical settings, and patient referrals between the two professions are common. Many MDs utilize DOs as personal physicians, especially for the philosophical concepts and manipulation. Participation in federal Medicare and Medicaid programs is also on the equal basis.

Although osteopathic medicine represents only five percent of the US physician population, it is a fast growing segment of the health care field. The number of osteopathic medical colleges has more that tripled since 1975.

By combining unique osteopathic principles with traditional diagnostic and therapeutic procedures, DOs offer a balanced system of health care to both prevent and cure disease. In fact, the osteopathic approach is philosophically the only true system of preventive medicine.

And by treating the whole person, not just the disease, the DO actively seeks to improve the quality of life of each patient.

The American Academy of Osteopathy is ready to answer your questions about the profession and its special contributions to US health care.

An Overview of Osteopathic Manipulation Techniques
The spectrum of osteopathic manipulation techniques focus on the principal that body structure and function are dependent on one another. When structure is altered via the musculoskeletal system, abnormalities occur in other body systems. This, in turn, can produce restriction of motion, tenderness, tissue changes and asymmetry (somatic dysfunction).

Following are some of the manipulation procedures most commonly used by osteopathic physicians to diagnose and treat somatic dysfunctions:

Hands-On Contact

The value of the placing of hands on a patient is universally acknowledged by health professionals. This essential component of the doctor patient relationship has a great deal to do with the patient's well being. whether he or she suffers from a cold or a terminal disease. When the DO examines a patient by auscultation of the chest or palpation of the abdomen or spine, the treatment already has begun.

Soft-Tissue Technique

This procedure is commonly applied to the musculature surrounding the spine. and consists of a rhythmic stretching. deep pressure and traction. Its purpose is to move excess tissue fluids (edema) and to relax hypertonic muscles and myofascial (fibrous tissue) layers associated with somatic dysfunction.

Myofascial Release

This procedure is designed to treat primarily the myofascial structures. In the use of direct myofascial release treatment (MRT) a restrictive barrier is engaged for the myofascial tissues; the tissue is loaded with a constant force until release occurs. In treating with indirect MRT the dysfunctional tissues are guided along a path of least resistance until free movement is achieved.

Cranial Osteopathy

Cranial osteopathy is a specific approach within the osteopathic concept. It influences the structure and fluid surrounding the central nervous system. creating an impact on the total body and initiating the body's inherent capacity to heal itself. Fascial connections throughout the body are contiguous with the lining around the central nervous system. including the aura and other structures. Practitioners of cranial osteopathy utilize a manual approach to accomplish these goals within the practice of osteopathic medicine.

Lymphatic Technique

This manual procedure is designed to promote circulation of the Iymphatic fluids and can be wed to treat various difficulties. One technique is pressure applied with the physician's hands to the supine patient's upper anterior chest wall. When the force is applied to the chest reaches its maximum on expiration, the physician's hands are removed suddenly. This increases negative pressure of the chest to assist the body's respiratory mechanism to move Iymphatic fluids.

Thrust Technique

In this form of manipulation, the physician applies a high velocity/low amplitude thrust to restore specific joint motion. With such a technique, the joint regains its normal range of motion and resets neural reflexes. The procedure reduces and/or completely nullifies the physical signs of somatic dysfunction: tissue changes, asymmetry, restriction of motion and tenderness.

Muscle Energy Technique

In this manual technique the patient is directed to use 0a or her muscles from a precise position and in a specific direction against counter force applied by the physician. The purpose is to restore motion, decrease muscle/tissue changes and modify asymmetry of somatic dysfunction.

Counterstrain

The counterstrain technique is a manual procedure in which the patient is moved passively away from the restricted motion barrier, towards the position of greatest comfort. As this point, passive, asymptomatic strain is induced.