Osteopathic Medicine

Overview

What Is It?

Osteopathic medicine emphasizes the relationship between all organ systems of the body, including the musculoskeletal system (your bones and muscles) and the function of your entire body.

Osteopathic medicine is one of two fully licensed comprehensive systems of medical care in the United States. Practitioners of osteopathic medicine are identified by the letters "DO" while allopathic physicians are identified by the initials "MD." Osteopathic medicine emphasizes the relationship between all organ systems of the body, including the musculoskeletal system (your bones and muscles) and the function of your entire body.

Osteopathic physicians are licensed to prescribe medication and perform surgery. Although more than 60 percent are primary care physicians, DOs practice in all branches and specialties of medicine and have the same rights and responsibilities as MDs.

The popularity of osteopathic medicine has grown in recent years. According to the American Association of Colleges of Osteopathic Medicine, the number of graduates of colleges of osteopathic medicine more than doubled in the past decade. And the American Osteopathic Association reports that there are currently more than 77,000 DOs in this country, making up about 7 percent of all physicians.

You'll find DOs in local hospitals, private practices, community health clinics, academic medical centers and military hospitals—anywhere you expect to find a physician.

So, if DOs are fully licensed physicians, what sets them apart from MDs? It is mostly in their approach to a medical or surgical problem. The approach is rooted in their philosophy. DOs take a holistic approach to medicine; this means they focus on the total person, not just the particular symptom, illness or disease. DOs believe that all the systems in your body—including the musculoskeletal system—operate in an integrated way. Problems with one system can affect the others.

Perhaps the most significant difference between DOs and MDs is that DOs consider the role of the musculoskeletal system in relationship to symptoms and illness. They have special training in recognizing and correcting structural problems through various manual techniques called osteopathic manipulative treatment (OMT), which are used primarily for diagnosing and treating musculoskeletal problems. Given this concern with muscle and bone, it's not surprising that you will find many DOs in sports medicine and physical medicine and rehabilitation.

How It Got Started

Andrew Taylor Still, an MD, considered to be the father of osteopathic medicine, developed the discipline in 1874 after becoming disillusioned with how medicine was being practiced. A Civil War surgeon, Dr. Still was appalled by the ineffectiveness of traditional medical treatment. Later, he watched three of his children die from meningitis, despite medical treatment.

Dr. Still was particularly distressed by the use of drugs of this era. Many, such as arsenic and mercury compounds, he considered useless and even harmful. He focused on health, believing that the human body has the ability to heal itself. You could say he was an early proponent of "wellness"—now a common term among health care professionals. He identified the musculoskeletal system as an essential element of health and advocated preventive medicine, exercise and nutrition.

DOs and MDs: Many Similarities

In many ways, most DOs are almost indistinguishable from conventional MDs. The primary difference is philosophical and the types of diagnostic and treatment modalities that can be employed in medical care. Throughout their training, DOs are taught to treat the whole person. While many incorporate manipulative techniques within contemporary medical practices, you might not see a huge difference between a visit to a DO and a visit to an MD.

It's not surprising that there's so much common ground. MDs have increasingly embraced a whole-person (holistic) approach to medicine—for instance, recognizing the effect of stress on physical health. Meanwhile, DOs have embraced the diagnostic and therapeutic approaches used by MDs, including the use of medication. The vast majority of DOs will use the same medical and surgical therapies as well as medications similar to an MD.

All states license DOs, and some have separate licensing boards. In states without separate boards, DOs are licensed through the same process as MDs. Either way, all physicians (both DOs and MDs) must be approved by a state medical board exam to be licensed.

Both DOs and MDs attend three to four years of medical school, and applicants to both generally have a four-year undergraduate degree. After medical school, both DOs and MDs can choose to pursue a specialty, such as psychiatry, surgery, or obstetrics and gynecology, which involves a four- to six-year postgraduate training program.

Diagnosis

You can go to a doctor of osteopathic medicine (DO) for any condition that would lead you to seek out an allopathic MD. Finding an osteopathic physician is just as easy, but you must seek them out. Insurance companies cover visits to a DO just as they cover visits to an MD. So if you are on a health plan, look for DOs on your preferred provider list. (Medicare and Medicaid also pay for DO visits.)

You can ask for referrals from other health care professionals, or go to the American Osteopathic Association's website (www.osteopathic.org), where you will find a list of state associations that can refer you to a DO in your area.

Your visit will proceed like any other appointment with a health care professional. The doctor or an associate will take your medical history. Some advocates of osteopathic medicine say that, because of their holistic orientation, DOs may spend a bit more time with patients, probing into lifestyle issues and their relationship to the overall physical condition. The osteopathic difference is the total holistic approach to caring for a patient. Each patient's experience is what counts. But no matter how much time is spent in the DO's office, you may find a greater emphasis on your overall well-being and lifestyle than on just the complaint that brought you into the office. Once a detailed history is assessed, a physical exam is performed just like it would be in an MD's office. Of course, the nature of the exam depends on the reason for your visit.

With some DOs, you may notice one significant difference: a focus on your body's structure in relationship to its function. The DO will assess your posture by asking you to stand, walk, sit and lie down. As you perform these tasks, the DO is observing your movements, structure of the spine and muscles and the balance of your body.

As part of osteopathic manipulative treatment (OMT), an osteopathic physician will conduct a hands-on examination. This involves evaluating your back and limbs, checking joints for pain or limited mobility and testing your muscles, tendons and ligaments for tenderness. The DO also will assess your reflexes, flexibility and muscle strength.

These techniques help your doctor detect various abnormalities, including restrictions in range-of-motion, structural irregularities and changes in tissue textures. Moreover, these techniques give an added dimension when trying to narrow down the cause of your ailment or concern. Musculoskeletal disorders sometimes mimic other conditions and, accordingly, OMT may help your DO make a more accurate diagnosis and appropriate targeted treatment.

Depending on the results of the exam, you may need other tests, including radiologic studies and/or lab studies, which the DO will order.

Women's Health

DOs have a long-standing commitment to women's health. In fact, Dr. Still was one of the first to admit women to medical school on a regular basis. Today, about half of the total enrollees in osteopathic medical schools are women.

The American College of Osteopathic Obstetricians and Gynecologists was established in 1934, nearly two decades before the allopathic American College of Obstetrics and Gynecologists. To find an osteopathic OB/GYN in your area, call 800-875-6360 or visit the website at www.acoog.org.

Treatment

Osteopathic physicians, or DOs, can be seen for almost any condition, but a visit may be especially appropriate for musculoskeletal disorders, such as:

• carpal tunnel syndrome
• back pain
• joint pain
• neck pain
• sciatica
• sports injuries

DOs may use osteopathic manipulative techniques (OMTs) to diagnose and treat these types of musculoskeletal problems.

While OMT is generally used for musculoskeletal problems, it's also used to relieve other conditions, including:

• arthritis
• migraines
• premenstrual syndrome (PMS) and menstrual pain
• allergies
• asthma
• sinus problems
• chronic fatigue syndrome
• digestive problems
• fibromyalgia

Osteopathic principles stress the body's own natural healing powers, the importance of the musculoskeletal system to the general well-being of the entire body and the interconnectedness of all the body's systems. It is a holistic approach, looking at the entire patient, not just the disorder.

DOs believe that OMT loosens lymph node congestion and increases the circulation of natural antibodies, thus boosting the immune system. OMT may also relax muscles, relieve pain, reduce stress, promote circulation, improve posture, stimulate the nervous system and increase joint mobility.

Studies are in progress to help explain how OMT works on these conditions. One possible explanation for some of OMT's benefits is that it increases circulation and the release of endorphins. Release of these endorphins could lead to an increased feeling of well-being and a higher tolerance for pain.

OMT has also been used to ease the pain of labor and delivery, in part by improving a woman's posture and by helping pregnant women use their body mechanics effectively during delivery to reduce the time they spend pushing. Moreover, OMT is drug-free, an important consideration for pregnant women.

A few DOs specialize in cranial sacral osteopathic techniques, in which OMT is applied specifically to the bones, membranes and ligaments of your skull and tailbone with gentle, rhythmic pressure to affect your entire well-being. It is often used for migraines and other forms of chronic pain. Cranial sacral therapy is not used as a primary treatment modality in bone cancer, bone or joint infection, a protruding disk or spinal-fusion surgery.

After a physical exam, your DO will decide on and develop a course of treatment with you. In most cases, it may be similar to that provided by an MD. For instance, in the case of a respiratory infection, you might receive antibiotics. But you may also receive osteopathic manipulative techniques than can improve the function of your lungs and rib cage. Your DO may also suggest an exercise program and dietary changes that can improve your particular condition. As necessary, an osteopathic physician may refer you to a different osteopathic or allopathic specialist when you need surgical or specialty care.

Depending on your condition and your DO's initial approach to health care, he or she may use some of the many OMT techniques to relieve misalignments, improve joint mobility and treat other structural problems. These techniques include soft-tissue manipulation, counter-strain, high-velocity/low-amplitude joint and spine manipulation, cranial sacral, muscle energy and many more, each of which is intended to correct misalignments of the musculoskeletal system and to relax muscles. It may feel like a massage or a chiropractic manipulation but it is distinctly different. The difference is that osteopathic medicine is a complete system of medicine, and if medications or additional medical services are needed to complement your treatment, your DO is either able to provide them to you or refer you to a specialist.

Afterward, you may feel very relaxed. You may even experience a tingling sensation where the manipulations were performed. If you feel a little sore, don't worry—soreness can be a normal reaction. But if the pain lingers, talk to your DO.

Your DO may suggest various stretching exercises for you to do at home to further complement the OMT, as well as lifestyle changes to improve your condition long term.

If you are receiving OMT, there will be follow-up visits scheduled as needed. Otherwise, it's just like visiting any other primary health care professional—you'll visit when you are ill and come in for regular check-ups to prevent illness and promote health. Your first visit may last up to an hour; subsequent ones may last about 20 minutes, depending on the reason for your visit. The cost will be comparable with the cost of a visit to an MD, and insurance coverage is comparable as well.

Facts to Know

1. Although osteopathic medicine started out as a drug-free approach to the practice of medicine, the vast majority of doctors of osteopathic medicine are trained and licensed to be able to prescribe medication as needed.
2. By combining all other medical and surgical therapies with osteopathic manipulative treatment (OMT), doctors of osteopathic medicine (DOs) offer their patients more—a comprehensive approach to health care—because they are taught to treat the whole person, rather than just a single condition.
3. More than 60 percent of DOs select careers in primary care—such as family practice, internal medicine or pediatrics—while others practice specialties such as obstetrics and gynecology, surgery and emergency medicine. Many practice in rural and low-income areas.
4. Andrew Taylor Still, DO, MD, the father of osteopathic medicine, developed the specialty in 1874 after becoming disillusioned with the practices of allopathic (MD) medicine. He wanted to reform the practice of medicine but ended up developing a new branch of it altogether.
5. Your DO will address various lifestyle factors during diagnosis and/or treatment, such as stress, diet, exercise and posture.
6. OMT is considered extremely safe but is inadvisable for certain conditions, including bone cancer, bone or joint infection or a protruding disk.
7. One form of OMT is cranial sacral osteopathic manipulation; this approach involves OMT applied to your head and tailbone using gentle, rhythmic pressure.

Questions to Ask

Review the following Questions to Ask about osteopathic medicine so you're prepared to discuss this health care option with your health care professional.

1. What is your practice philosophy?
2. Do you practice osteopathic manipulative treatment (OMT)? For which conditions do you use this treatment?
3. What is your position on prescribing medications?
4. If I need OMT, what will be my course of treatment?
5. Are you covered by my insurance/HMO/PPO plan?
6. How would your approach to health care differ from that of a medical doctor?
7. Do you have experience treating my particular condition?
8. What lifestyle changes will I need to make?
9. Are there benefits of OMT beyond temporary pain relief?
10. Will you consult with my other health care professionals about my care, if necessary?

Key Q&A

How does osteopathic medicine differ from chiropractics?

The most obvious distinction is that chiropractors are not the legal equivalents of MDs—they can't prescribe medication or perform surgery. Although both DOs and chiropractors practice manipulation and share a philosophy that good health is tied to the body's structure, chiropractors focus almost exclusively on realigning the bones and joints. DOs focus on the interconnectedness of the entire body systems. DOs practice holistic traditional medicine and can treat a range of conditions with an array of tools.

A friend of mine had craniosacral therapy. Is that the same thing as cranial osteopathic medicine?

No. Cranial sacral osteopathic medicine is practiced by trained DOs (and some MDs); it involves gentle pressure to your head and tailbone in a directed manner to obtain desired results. Craniosacral therapy is usually practiced by physical therapists, massage therapists or other alternative health professionals who never attended medical school. It is a therapy but not a treatment, and while it may have its benefits, it has its limitations in that it is not the complete treatment of the cranial sacral regions of the body. Be sure to talk to your health care professional before pursuing it.

Organizations and Support

For information and support on Osteopathic Medicine, please see the recommended organizations listed below.

American Association of Colleges of Osteopathic Medicine (AACOM)
Website: https://www.aacom.org
Address: 5550 Friendship Blvd., Ste 310
Chevy Chase, MD 20815
Phone: 301-968-4100

American Osteopathic Association (AOA)
Website: https://www.osteopathic.org
Address: 142 E. Ontario Street
Chicago, IL 60611
Hotline: 1-800-621-1773
Phone: 312-202-8000
Email: info@osteotech.org

National Center for Complementary and Alternative Medicine
Website: https://www.nccam.nih.gov
Address: National Institutes of Health
9000 Rockville Pike
Bethesda, MD 20892
Hotline: 1-888-644-6226
Phone: 301-519-3153
Email: info@nccam.nih.gov

Texas Osteopathic Medical Association
Website: https://www.txosteo.org/
Address: Texas Osteopathic Medical Association
1415 Lavaca Street
Austin, TX 78701
Phone: 512-708-8662