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Ed Bennett: What is osteopathic medicine and how do osteopathic physicians differ from conventional medical doctors?
Dr. Theresa A. Cyr: Osteopathic medicine is a form of medical care that treats disease or dysfunction within the context of the entire body. In other words, it treats the whole person, not just specific symptoms or illnesses, and focuses on the promotion of health and wellness.
Osteopathic physicians, or doctors of osteopathy (DOs), are trained in both allopathic and osteopathic medicine. Although all DOs are trained in osteopathic manipulation in medical school (and some receive additional training in it), only a small percentage actually use it in their clinical practices. The rest treat or manage their patient’s condition primarily by utilizing the standard protocols available to allopathic physicians – medication, surgery, and therapy (physical therapy, occupational therapy, etc.) – or referring their patient to a specialist.
Although a DO may follow the same course of action as an MD, there is one very particular area where they are different: the DO is also focused, through their training and philosophy, to find the root cause of the body’s dysfunction. By identifying and eliminating the root cause, the DO believes, the outward manifestation (i.e., symptoms) will resolve over time and either will not recur or will not be as debilitating for the patient.
Dr. Andrew Taylor Still, the discoverer of osteopathic medicine, understood that all the systems of the body are interrelated and dependent on each other for proper functioning. This philosophy is integral to the practice of osteopathic medicine. Today, DOs generally subscribe to four main tenets, based on Still’s views, which have been expressed as follows: First, the body is a unit, and the person is a unit of body, mind, and spirit. Second, the body is capable of self-regulation, self-healing, and health maintenance. Third, structure and function are reciprocally interrelated. And, finally, rational treatment is based upon an understanding of the basic principles of body unity, self-regulation, and the interrelationship of structure and function.
Patients most often identify the use of osteopathic manipulation as what differentiates DOs from MDs. However, that is not the whole story. More important is the philosophy of osteopathy based on the four tenets. Basically, whether the DO is practicing clinical osteopathy or allopathic medicine, this philosophy is at the core of their approach to patient care.
EB: Would you speak more about Dr. Still’s background and philosophy?
TC: Dr. Still was born in Virginia in 1828. Following in the footsteps of his minister-physician father, he became a physician and, later, a hospital steward and scout surgeon in the Union Army during the Civil War. After the war – and after three of his children died from spinal meningitis – he lost faith in many of the orthodox medical practices of the day and dedicated himself to finding better ways to treat disease, eventually coming to the conclusion that the musculoskeletal system was vitally important to the health of the body.
He integrated the manipulation of the musculoskeletal system into his practice and became known as the “lightning bonesetter.” His approach to treatment was different from that of the mainstream physicians of his time. He treated the patient’s illness or condition in the context of the whole person. A specific diagnosis might require different treatments in various individuals because their systems as a whole were operating differently.
Although he wasn’t fully accepted by his peers, Dr. Still’s results were truly exceptional. Patients would come from many miles away, often traveling for days, to see him for conditions that other doctors did not or could not treat effectively. In 1892, Dr. Still founded the first school of osteopathic medicine, in Kirksville, Missouri, in order to teach his students this philosophy and approach to medicine. The school, now called the Kirksville College of Osteopathic Medicine (KCOM), is still located in Kirksville.
EB: Is there any difference between American-trained DOs and foreign-trained osteopaths? Are they all medical doctors?
TC: Osteopathic physicians trained in the United States are fully licensed to practice medicine in all 50 states and can practice in any specialty. Foreign-trained osteopaths may be medical doctors, depending on the country in which they received their training. In Russia, for example, you have to be an MD first, and then you go to osteopathic school. In many other countries – Spain, England, France, and Canada, to name a few – most of the osteopaths are not medical doctors and do not practice medicine. They may practice osteopathic manipulation exclusively.
EB: What is osteopathic manipulation?
TC: Osteopathic manipulation is a hands-on treatment modality that may be used by the DO as part of patient care. The osteopath, using their hands, treats what is called somatic dysfunction in the body. For example, if a vertebra is slightly out of place, we consider that to be a somatic dysfunction. However, you can have a somatic dysfunction in any part of the body. It’s basically any problem where the body is out of balance.
In osteopathic medicine, we look at a somatic dysfunction as a target for correction within the context of the whole person. For DOs who practice it, osteopathic manipulation is often a primary modality to try to bring balance to the body and to treat symptoms, with a focus on minimizing the need for medication or more invasive interventions, such as surgery.
Oftentimes, patients and other types of doctors equate osteopathic manipulation with the treatment of bones. But, in actuality, osteopathic manipulation is indicated for treatment of any and all ailments, as it is supportive to the body and helps restore homeostasis and balance. It is based, in part, on the concept of myofascial continuity, in which the fascia links every part of the body with every other part.
EB: Would you explain what the fascia is?
TC: The fascia is connective tissue that is located throughout your body. It covers – and sometimes penetrates – your muscles and organs. It’s basically what gives you form and shape. A lot of people think their skin holds them together, but really it’s the fascia underneath the skin that holds them together. It’s flexible and strong. Without it, we wouldn’t function.
Your fascia supports your blood supply, nerve supply, and lymphatic supply, and fascial dysfunctions can negatively affect all of these. For example, if the fascia is strained or twisted, it can interfere with the lymphatic return, resulting in swelling in the ankles, arms, or other parts of the body. Problems with the fascia can cause pain that may baffle some physicians. They’ll say, “I don’t know why you’re hurting because everything looks fine.”
If you have ever skinned a chicken prior to cooking it, you’ve probably noticed this white filmy stuff between the skin and the muscle. It wrinkles up and piles on top of itself, and people pull it off and throw it away. That is the fascia. It may appear to have no form, but it does have function
When I was in medical school, a DO came into our anatomy lab and pointed out the fascia to us. This was unusual because, in most anatomy labs, the students are told, “You just peel that off,” and they throw it into a bucket at the end of the table. They are not told it actually has a purpose. But in an osteopathic school, someone will likely point out that the fascia is very important.
EB: What might a patient typically expect when they go to an osteopathic appointment?
TC: In my practice, I begin with a full history and physical examination. After the initial evaluation, I will ask the patient to lie on the treatment table. Then, I begin to treat the patient by placing my hands on them. I create a meaningful contact, sometimes firmly to move tissue or bones and sometimes using a lighter touch so that the patient may not even feel my hands on their body.
I continue evaluating during the treatment, and what I find may change its direction or focus. Based on evaluation, all ear infections are not treated the same way. All gut issues are not treated the same way, even if the symptoms are the same. Even chronic disease – such as diabetes or hypertension – is not always treated the same way. Whatever the initial diagnosis, once I put my hands on a patient, I may find I need to focus on something else going on in the body, because it is more important at that moment.
EB: What kinds of health problems are treated with osteopathy?
TC: Anything and everything. Obviously, we treat conditions where people are experiencing pain or have had a trauma. We treat people with concussions and people who have been in car accidents and have complaints of neck, back, or joint pain. If there is acute whiplash, we wait for the body to settle down a little bit before touching the injured area, but we treat other parts of the body. Based on the initial evaluation, sometimes we can treat immediately and sometimes we need to wait. But if a person has been in a car accident, I treat them within the first 24 hours, if possible. That doesn’t mean that I am using forceful manipulation on them. Usually, it’s manipulation to support and gently realign parts of the body.
Patients come in with a variety of disorders, and whatever comes in we treat. We treat the person. Sometimes people think, “This is a problem for an osteopath, but that isn’t.” For example, some do not consider carpal tunnel to be a problem that an osteopathic physician can treat, but clearly it is. It’s a musculoskeletal issue. But our practice isn’t limited to musculoskeletal issues. It fully encompasses metabolic and autoimmune issues and problems with the nervous system.
With the exception of an acute emergency, we treat everything in our clinical practice. There’s really nothing that osteopathy doesn’t have a hand in, short of stopping someone from bleeding or intubating them in an emergency setting. And osteopathic manipulation can be used in an emergency situation as well. There are DOs who are emergency room physicians and use osteopathic manipulation and employ their osteopathic philosophy in their everyday work. Certainly, in the emergency room, you can use osteopathic manipulation to treat musculoskeletal issues such as acute back pain, as well as headache, asthma, and other breathing problems.
EB: What can osteopathy do for a person with head trauma?
TC: With head trauma, we take care of the patient’s needs as one would in a traditional emergency room setting. We don’t manipulate the head immediately after a trauma, but sometimes we can settle the system down by treating other areas of the body. Later, there is more that we can do.
A few years ago, I treated one young man who was in the US Marines. He was in danger of not being allowed to reenlist because he had vertigo and couldn’t perform his work duties. As part of his job, he had to look at a panel on a helicopter, and every time he looked up, he would develop vertigo. Everything would spin, and he would get nauseated and vomit. He also had painful ocular migraines that would last for 15 to 30 minutes and would disable him.
Two and a half years before I met him, he had been in an accident in which his skull was fractured in three places. However, when he first returned to duty after his hospitalization, he didn’t have the vertigo. It developed over the next few weeks and eventually became so intense that it interrupted his work. He came to me because he had been through all the allopathic treatments, and his doctors had said, “You should be fine now. There’s nothing more we can do.” They had put him on medications, but the side effects of the drugs had been intolerable to him, so he stopped taking them. The medications did not help his symptoms.
I treated him with osteopathic manipulation – primarily osteopathy in the cranial field. During the first treatment, he reported that his symptoms had improved, and he soon told me that he was 100 percent better. Unfortunately, he reinjured himself by hitting his head on the floor while wrestling with his buddies, and his vertigo returned. But over the course of a few treatments, his vertigo and his ocular migraines resolved completely, and he was able to return to full duty and then reenlist. It’s been nine years since I initially saw him in my office, and he is still doing well, with no headaches or vertigo.
EB: You mentioned that his vertigo didn’t begin immediately after the accident. Is it common to have a delayed reaction such as this?
TC: Yes. In fact, sometimes we will find problems that are rooted in traumas that took place decades before the patient walked into our office. A person may adapt to their situation after the trauma and function well enough until there is another trauma on top of that or an illness that causes their body to decompensate. Then, they need to have all these things addressed.
In the case of this young Marine, it appeared that the formation of scar tissue while the temporal bone was healing may have caused the vertigo. I think it’s often the development of scar tissue that causes problems later. The purpose of scar tissue is usually to stabilize the injured area. As the body heals, it tries to rebuild the areas that have been injured. If those areas are not brought back into balance, the body will compensate and adapt as best it can. Sometimes that’s enough, and we don’t notice any symptoms, and sometimes we develop problems because the body hasn’t been able to get back into balance.
One thing that can happen when we have scar tissue is that it can compress structures that aren’t supposed to be compressed, such as nerves, blood vessels, or lymphatic tissue. If we can free up the area through osteopathic manipulation, it may get better blood flow and the scar tissue may remodel in a more physiologic or useful way.
EB: What is cranial osteopathy? Is it an integral part of regular osteopathic practice or is it more of a specialty?
TC: Well, it’s an integral part of my practice, but not all osteopathic physicians who treat with osteopathic manipulation employ it. Those who have chosen to do so have received specialty training in osteopathy in the cranial field. They work with the bones of the skull, the coverings of the brain, and the central nervous system to treat dysfunction and improve health in the context of the whole person.
Incidentally, most DOs refer to cranial work as cranial osteopathy or osteopathy in the cranial field. They reserve the term craniosacral therapy for non-physicians, who may practice something slightly different than what we do, although it has its roots in the work of an osteopathic physician, William Garland Sutherland, who was trained by Dr. Still.
Dr. Sutherland realized that the bones of the skull had sutures where they came together, so there was always the ability for the bones to move. He applied the principles of osteopathic manipulation to the cranium, and developed osteopathy in the cranial field over several decades.
EB: Do children generally respond better than adults to that type of treatment, since their skulls haven’t fully developed yet?
TC: Not necessarily. I think all patients respond well to it. But children – even infants – generally respond very well to cranial work.
In fact, I think all babies should be evaluated—and treated, if it’s deemed necessary – as soon as possible after birth. This is particularly critical if they were delivered by forceps or suction. However, even those who undergo normal vaginal deliveries should be evaluated. Sometimes, even during a “normal” birth, the baby is not properly lined up. If the birth position isn’t optimal, the bones of the skull may overlap in a way that is also not optimal, and certain bodily systems may not work as well as they should.
When a child is born, the occiput – the bone that the brain stem goes through, at the base of the skull – is in four pieces. Later, it will fuse into one piece. At birth, there can be impingement upon the cranial nerves that run between these little bones and the adjacent temporal bones. If there is more pressure on one side of the head than the other during the birth process, the nerves on one side could get compressed by these bones. If the bones don’t shift into proper alignment because of muscle tension or some other reason, the child may have nursing problems, such as spitting up, not latching on properly, or not swallowing properly. They may have tongue thrust or breathing issues. These problems can frequently be corrected by a physician who has been well trained in cranial osteopathy.
EB: Would you talk about your experiences in treating autistic children?
TC: This is an important question due to the increasing prevalence of autism. We’re going to be in deep trouble unless we can treat these children and help them function better as part of society.
I’ve treated a number of children who are on the autism spectrum, and I’ve found that cranial osteopathy is essential in helping them improve their functioning. The other essential thing is for these children to have a really clean diet. Most of them have the best results when they’re on a gluten-free and dairy-free diet, although not all of them need to be both gluten- and dairy-free. The autistic children I’ve treated have dysfunctional digestive tracts, and when we can improve their digestion and absorption of nutrients, their brains and bodies start to work better.
EB: Does the practice of osteopathic medicine frequently include nutritional counseling?
TC: I don’t know if most osteopathic physicians include nutritional counseling in the treatment of their patients, but I do. When I was in osteopathic medical school, it was emphasized that we should eat a good diet. Certainly, in specialties such as family medicine, a doctor should and often will educate their patients on the benefits of proper nutrition.
I stress the importance of eating “real” food, not the processed or modified foods that comprise so much of today’s diet. I tell every one of my patients – or if the patient is a child, I tell their parents – that they must eat real food if they desire optimal performance and health. Also, proper nutrition will improve healing, so it is imperative to have good nutrition. We’re designed to eat foods that are relatively simple and not highly processed.
EB: How do people know what foods are right for them and what they should avoid?
TC: If you get symptoms such as a headache, nausea, stomach pain, heartburn, diarrhea, or constipation after eating, you’ve probably eaten something that’s not good for you. Most of us eat multiple things in each meal, so it can be hard to tell what is good for us and what is not. I often recommend that patients keep a food and symptom diary detailing what happens after they eat. If they keep a diary, we can usually pinpoint one or more problems in their nutritional regimen.
Different people have problems with different foods. One person might get migraines from eating certain nuts, and another might get them from eating bell peppers or tomatoes. But when people get sick, they don’t tend to think, “It may have been something I ate.” We’re not trained that way. Usually, in allopathic medicine, if you get a headache, you’re just told to take a pill.
EB: Have you noticed any recent trend in DOs using the more traditional hands-on osteopathic methods as opposed to allopathic medicine?
TC: Yes. There seems to be a growing number of DOs who are returning to their roots and using osteopathic manipulation in their practice. Many students entering osteopathic medical school today are very interested in the difference between MDs and DOs and are seeking a more complete way of treating their patients, including using osteopathic manipulative techniques. They are enthusiastic about the idea of having these “tools” in their toolbox and using osteopathic treatment to improve the health of the body, perhaps avoiding the use of drugs or surgery. They understand that it’s safer and less invasive, in most circumstances, to use osteopathic treatment initially to see if we can help the body resolve the problem itself.
Likewise, a growing segment of the population is becoming aware of the overuse and sometimes unnecessary use of pharmaceutical intervention or medications. These patients would like to have education in their treatment plan regarding possible lifestyle or dietary changes that they can adapt to help improve their health, rather than “just taking a pill.”
EB: How would a prospective patient find a traditional DO?
TC: Most traditional DOs who practice clinical osteopathy or osteopathic manipulation have a private medical practice. A good way to find one is to get a referral from someone who has seen or knows them. You can also get a referral from one of the osteopathic medical associations, such as the American Academy of Osteopathy (AAO) or the Osteopathic Cranial Academy (OCA). Their websites have extensive information on their members, including their clinical specialties and whether or not they currently practice clinical osteopathy or osteopathic manipulation.
Theresa A. Cyr, DO, Diplomate-AIHM, is a graduate of Touro University College of Osteopathic Medicine-California (TUCOM) and completed family practice residency at Via Christi Riverside, Wichita, KS. She is board certified in family medicine and osteopathic manipulative treatment. Dr. Cyr is a member of the board of directors and part of the academic faculty for the Osteopathic Cranial Academy (OCA) and the Osteopathic Center for Children (OCC). Her private practice is located at the Osteopathic Center San Diego (OCSD) with osteopathic medical associates. She has been in practice in San Diego since July 2005. Her website is www.drcyr.com.
Ed Bennett is president of the Price-Pottenger Board of Directors and editor in chief of the Price-Pottenger Journal of Health and Healing.
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Published in the Price-Pottenger Journal of Health and Healing
Fall 2016 | Volume 40, Number 3
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