Osteopathy is a unique philosophy and natural system of health care that emphasises the relationship between the structure of the body and the way it functions, based on the theory that disturbances in the musculoskeletal system affect other bodily parts and cause disorders that can be corrected by various manipulative techniques. Osteopathy does not simply concentrate on the problem area but aims to restore function in the body by treating the causes of imbalance and pain, focusing on how the skeleton, joints, muscles, nerves, circulation, and internal organs function as a holistic unit. To achieve this goal the Osteopathic Practitioner relies on the quality and finesse of his/her palpation, to evaluate structurally the skeletal framework and associated muscles and works with the position, mobility, and quality of the tissues. Osteopathic treatment uses skeletal mobilization and manipulation in conjunction with stretching, massage and a variety of muscle and fascia release techniques, not only to specific painful areas, but also to whole musculoskeletal and visceral systems to positively affect the body’s nervous, circulatory, lymphatic and digestive systems. The aim is to alleviate pain and dysfunction in specific joints and soft tissues (muscles, tendons, ligaments, and fascia) and also to restore integrated balance to all the systems of the body, enabling the body’s own recuperative powers to function optimally in order to provide overall good health. Osteopathy is holistic, taking a wellness approach to musculoskeletal, digestive and constitutional imbalance, considering posture, mobility, exercise, diet, lifestyle and abnormal stress as factors involved in good health, vitality and general wellbeing.
Osteopaths treat injuries of the whole musculoskeletal system including the pelvis, spine, ribs, neck, hips, legs, knees, ankles, feet, shoulders, arms, elbows, wrists and hands and even the temporomandibular joint (TMJ) for jaw misalignment. By manually correcting the imbalance of the musculoskeletal system, nerve interferences are removed, allowing the structure and the organs of the body to function normally.
Osteopaths treat all muscles and all joints of the body including the supporting tendons, ligaments, and fascia. Osteopaths also treat constitutional problems such as headaches, migraines, TMJ syndrome, constipation and other digestive disorders. Injuries and dysfunction can occur from sports such as soccer, football, basketball or skiing, incorrect lifting at work in the gym or garden, from falls off horses and bikes, from bad workstations or poor posture, simply too much time at the computer, slouching in the car or relaxing at home. Osteopaths not only treat acute injuries but many pain syndromes that Osteopaths treat are chronic in nature being cumulative result of gradual deterioration, a sum total of the above factors. Eventually, your musculoskeletal system can reach the point that triggers protective muscle guarding (muscle spasm) and joints seize and become painful. Therefore Osteopaths not only treat specific injuries but incorporate a holistic approach to better health and well-being.
The term my back is out, means that a specific vertebra or group of vertebrae are out of position or out of alignment. As vertebrae move out of alignment their range of movement becomes restricted. At this point you may notice any pain but rather notice more vague discomfort or some stiffness especially on rising or after sitting for a while. This range of movement can become so restricted that the spinal joints jam or lock. At this point you become acutely aware of pain and report “a vertebra is out ” or “I put something out in my back”. The term “my back is out” can also mean that your whole musculoskeletal system is out of alignment or out of balance and needs to be re-balanced.
Osteopathy works by correctly identifying musculoskeletal, constitutional and lifestyle imbalance then employing specific Osteopathic techniques systematically re-establishing balance. The core principles of Osteopathic philosophy are:
- The body is a unit; a person is a unit of body, mind, and spirit or soul that governs our emotional (metaphysical) and physical being.
- The body is capable of health maintenance, however any system of the body can be stuck out of balance due to injury or illness and need assistance to allow self regulating and self healing mechanisms to function normally.
- Structure and function are reciprocally interrelated.
- Rational treatment is based on an understanding of these principles: body unity, self-regulation, and the interrelationship of structure and function.
This rational treatment firstly requires obtaining a complete history followed by an examination and performing a structural analysis in order to locate the site of pain and more importantly to assess the cause of dysfunction which may be removed from the site of the pain. Emphasis is placed on obtaining a complete structural analysis to ascertain overall musculoskeletal imbalance. Spinal and muscular dysfunction occurs when the spine and pelvis are out of balance. This imbalance causes some vertebra to shift out of alignment and therefore not articulate through their normal full range of movement. Ultimately the range of movement becomes so restricted at these malfunctioning vertebrae that the spinal joints jam or lock due protective muscle guarding and associated inflammation thereby causing pain. Therefore the pain from a jammed joint may be caused by an imbalance elsewhere, usually in the pelvis but maybe in the lower limbs such as with pronated ankles. Osteopaths not only treat pain and discomfort but also take an overall or holistic approach to restoring balance to your musculoskeletal, visceral, circulatory and nervous systems as well as the impact diet, exercise and lifestyle have on these imbalances in order that that balance is maintained so that dysfunction and pain do not return.
An Osteopathic adjustment is a specific technique applied to a jammed joint in a precise manner to release the joint and at the same time re-positioning the malfunctioning bone to its correct articulating position. That is an adjustment releases a jammed displaced bone and simultaneously puts the malfunctioning bone back to its correct position. Osteopathic adjustments are also referred to as corrections or manipulations. A single adjustment should not be considered in isolation. Osteopathic adjustment has a broader, more holistic meaning. The Osteopathic treatment approach analyses not only individual vertebral misalignment but also the structural distortion of the spine, pelvis, limbs and associated muscles as a whole, to identify an overall structural imbalance that can trigger spinal dysfunction. A strategic approach is therefore taken to balance the whole musculoskeletal system often the cause of painful malfunctioning joints. By maintaining a balanced musculoskeletal system as a whole through diet, exercise, posture and lifestyle with maintenance treatment when necessary, it is less likely the joints will malfunction and jam.
The cracking sound is gas being released from the joint. Gas is produced within the joint cavity but is constantly dissipated by normal joint movement. If a joint becomes restricted in its range of movement or in some cases totally jammed, the gas is not released and gas builds up within the joint cavity causing the joint capsule to swell, irritating sensory receptors associated with the joint capsule causing it to be tender to palpate. Once the gas has been released following manipulation the joint capsule will immediately feel far less tender to touch due to the release of the built up pressure within the joint capsule.
Chiropractors and Osteopaths are both qualified and government licenced by a National Registration Board to manipulate the spine and extremities. Accordingly, manipulation is deemed extremely safe when performed by a registered Chiropractor or Osteopath. Chiropractors and Osteopaths are trained and qualified to access and diagnose soft tissue and joint restrictions resulting from injury or skeletal imbalance and to provide the appropriate drug-free treatment incorporating manipulation where necessary.
Chiropractors and Osteopaths receive 5 years training in not only how to adjust and in what precise direction but equally importantly when not to adjust. Manipulation is a highly specific, very short travel force delivered in a precise direction to a specific malfunctioning joint by highly qualified practitioners. Therefore it is impossible to adjust yourself. It is possible to stretch and twist in certain ways to achieve a “cracking” sound but this type of movement is not directed at the particular malfunctioning joint nor is it adjusting in a corrective direction. This type of “cracking” often targets the unstable joints alongside the major and totally jammed joint gradually making the adjacent area more lax and unstable and ultimately causing increased inflammation and pain.
The fact that someone requires manipulation in the first place indicates an inflamed malfunctioning joint or group of joints with associated reflex protective muscle spasm surrounding the jammed joint/joints. Therefore these malfunctioning joints may be uncomfortable to hold in the position adopted in order to correctly manipulate. Manipulation by a trained and qualified Chiropractor or Osteopath would best be described as uncomfortable for the above reasons but should not hurt. Malfunctioning inflamed joints that have become restricted in their range of movement or in the worst cases totally jammed are going to be tender to touch, partly due to inflammation and partly due to protective muscle spasm activating sensory receptors in the surrounding malfunctioning area. Preliminary massage and muscle, fascia and joint release techniques will make the restricted area less uncomfortable in the position adopted to manipulate. The actual manipulation by a skilled practitioner will be in the direction out of pain and therefore should not hurt but may be a slight shock to your system. A skilled practitioner will reassure the patient to ensure that their patient has complete trust and is relaxed and not fighting the adjustment. Practitioners are trained not proceed unless you are completely comfortable to do so.
Chiropractors and Osteopaths are government registered primary care practitioners, therefore, a referral is not necessary for treatment, nor needed to make a claim against your private health fund. However, under the Australian Government’s Enhanced Primary Care (EPC) Program a rebate is available from Medicare for a limited number of Chiropractic and Osteopathic treatments and for this a referral from your GP with the appropriate referral documentation is essential.
Chiropractors and Osteopaths complete five years full-time study, a three-year science degree followed by a two-year post-graduate master’s degree in either Chiropractic or Osteopathy. Chiropractors and Osteopaths spend twelve months under supervision in an out-patients clinic before they are eligible for registration with the Chiropractic Board of Australia or the Osteopathic Board of Australia and practitioners must obtain a Medicare number in order to practice. Some practitioners have double qualifications in both Chiropractic and Osteopathy and will have Medicare numbers for each modality. All practicing Chiropractors and Osteopaths must be registered and must complete the required ongoing education annually through approved courses and seminars to upgrade and improve their skills and to stay current with the latest scientific research to stay current to maintain their registration.
An initial Osteopathic session lasts for 40 to 50 minutes depending on the complexity of your problem. On arrival, you will be asked to fill out a form with your relevant details if you haven’t already done so on-line. Once you are with the Osteopath a full history is taken of your condition, your presenting symptoms and any signs or triggers that you have noticed which can be of great help in understanding the background to your problem. So that the Osteopath can examine you and then subsequently treat you, you may be asked to remove some of your clothing (women are provided with a clean hospital gown).
The Osteopath then performs a full and thorough structural examination, may do various orthopedic or neurological tests and examines any x-rays or reports that you may have with you. It may be necessary in some severe or complex cases to have x-rays taken before proceeding with treatment if you don’t already have them. Once the Osteopath is satisfied with the examination and investigation he/she will formulate a diagnosis and describe your particular condition to you and together decide on a treatment plan that best suits your circumstances. In most cases, treatment can commence in the initial visit.
Treatment involves an emphasis on a thorough soft tissue work up involving extensive therapeutic massage of knotted muscles employing various Osteopathic release techniques of muscles, fascia and ligaments so that protective guarding of joints can be subdued enabling jammed joints to be released more easily and more gently. Fundamental to the Osteopathic approach is to balance the musculoskeletal system, especially the pelvis while mobilizing any restricted painful joints spinal and peripheral joints so that once balanced your body can continue to heal. Based on your response to treatment in your initial visit the Osteopath will suggest the ideal time for any follow-up visits, if required, as well as give you advice on what you can and can’t to get the most out of treatment.
Most patients presenting with a painful stiff back are immediately surprised how much better they feel immediately following initial treatment, however very severe cases where the protective muscle guarding is extremely strong only slight or even no improvement immediately may be noticed due to the severity of the inflammation. Furthermore any treatment of a rigid severely inflamed back, even though structural correction may be achieved, inflammation may be initially worsened. The structural corrections however will ultimately decrease this inflammatory response after 24-48 hours. The majority of patients immediately following treatment notice much more freedom of movement and less pain moving.
Over the next few hours, some retightening of muscles will occur as the released muscles commence to protect the mobile but still inflamed joints. Extreme care must be taken especially during the first 48 hours following adjustments not to shock these inflamed joints and not to trigger protective muscle guarding to recommence sending the muscles into spasm. All movement needs to be slow and considered while the joint and muscle inflammation subsides. Avoid all lifting and bending tasks and particularly avoid rapid jerky movements and extreme twisting. Most patients report that after the second day they feel the best results as the inflammation subsides. As inflammation and protective muscle guarding subsides gradually activity levels can be increased. If the pelvis and spine are not yet fully balanced following the initial treatment a follow-up visit after a few days is required so that correction and balancing can be continued and to prevent deterioration and possibly losing much of the ground achieved in the first visit. Your Osteopath will advise you on when it would be best to follow up. The type and severity of back problems differ so the timing of follow-up visits is very important in limiting deterioration between visits and therefore minimising the number of visits required to correct your problem. With each visit as your pelvis, spine and muscles become more balanced regression between visits slows and the time interval between visits can slowly be extended and activity and exercise can be gradually increased.
Every patient and every injury are different. The patient profile: age, occupation, lifestyle, physical status, weight, exercise, sports and other activities will have an impact on recovery as well preexisting conditions such as poor posture, spinal degeneration, arthritis, abnormalities, previous injuries and the severity of the problem. The aim is to get you out of pain as quickly as possible and in most cases, this is achieved within a few treatments. Three factors that adversely affect recovery time are abnormal stress, how long you have had the problem before you seek treatment, and following the advice given to you by your treating practitioner while recovering. Seeking treatment early before your nervous system protective muscle spasm response is programmed too strongly cannot be emphasized enough. Once protective muscle spasm becomes too strong recovery progress is slowed requiring more treatment to break the cycle of pain. A stitch in time saves nine. Finally, stress is a factor in all disease. Stress tightens all skeletal muscles and can render a tight out of balance back tighter and more out of balance requiring more treatment to correct.
Exercise and strenuous activity are strongly advised against immediately following treatment. The length of time required to avoid such activity will vary from patient to patient according to type and severity of the injury as well as the acute or chronic nature of the complaint.
Associated with joint muscular dysfunction are inflammation, pain and protective muscle guarding or muscle spasm. Muscle guarding is designed to protect an injured or area from further damage and is mediated by the nervous system. The longer and worse the complaint the more entrenched within the nervous system this reflex muscle guarding becomes. During the period of recovery immediately following treatment any shock to the system can reignite the muscle protection response, restricting joint movement such that the joint can once again lock or jam.
For at least two weeks following an initial treatment gentle and predictable, rhythmical movements that don’t shock recovering joints and muscles are recommended such as walking, Ti Chi, movement style yoga and possibly swimming and elliptical cross training (as long as shoulders are not a part of the injury profile). After follow-up treatments within a treatment programme or following a maintenance treatment, 48 hours of only movement based exercise is recommended. To be avoided for the same period of time are all strenuous activities, heavy lifting, forward bending tasks such as rowing, gardening, raking, sweeping, vacuuming and making beds and rapid jerky movements involving sudden changes in direction such as squash, soccer, touch, table tennis, netball, basketball and volleyball to mention a few. As inflammation subsides and as the reflex protective mechanisms programmed into your nervous system subdue activity levels and exercise can gradually be increased.
Chiropractic and Osteopathic treatments are perfectly safe for kids. The rough and tumble of kids growing up, playing sport, climbing, jumping, wrestling with one another and generally trying new things can lead to spinal strains or pelvic imbalance just like adults. Kids have the same muscles and bones as adults, just smaller. Like adults, kids are subject to the same laws of physics, therefore, they too can suffer injury and their musculoskeletal system can be stuck out of balance. Because children are smaller and far more subtle than adults, Chiropractic, and Osteopathic treatment techniques accordingly are more gently performed. Being so subtle kids are far easier to manipulate therefore requiring far less force and respond more quickly to treatment.
A wide spectrum of Chiropractic and Osteopathic techniques are available to choose from enabling versatility, therefore Osteopathic treatment is suitable for all ages. With elderly patients an emphasis on soft tissue techniques, stretching, counter force, joint articulation and mobilisation can be employed with remarkable results to ease the pain of aging and arthritic joints and re-establish pain-free movement.
Osteopathic treatment is definitely suitable during pregnancy. As pelvic ligaments become lax during pregnancy due to hormone changes and due to postural changes from the developing baby, the pelvis, and lower spine can more easily shift out of alignment. Gentle Osteopathic techniques to re-align and mobilise the pelvis, hips and lower back can relieve pregnancy-related aches and pains and set pregnant women up for a better childbirth.
All three professions treat musculoskeletal pain and dysfunction. The professions differ in their diagnostic and philosophical approach to correcting painful conditions. Chiropractic is described as the art, science, and philosophy that emphasizes the relationship between the vertebrae of the spine and the nervous system in disease. That by manipulating vertebrae alone can nervous energy can be restored. Where Chiropractic considers bony impingement as the cause of disease, Physiotherapy considers muscle imbalance as the cause and is described as the treatment of a disease or an injury of the muscles or joints with massage, exercise, heat and electrotherapy. Osteopathy differs in that it takes a more holistic integrated approach looking at the musculoskeletal system as whole, that muscles and bones work together at the joints integrated by the nervous system and that the musculoskeletal system as a whole needs to be in balance so that the nervous system can function correctly. When the musculoskeletal system is out of balance muscle and joint dysfunction will result causing inflammation and pain and adversely affect spinal nerves passing out of the spine between each vertebrae to innervate the rest of your body. The Osteopathic approach considers that the muscles and bones through the nervous system work together, that it is not a system of bones independent of muscles and that it is not a system of muscles independent of bones. By working on all three aspects at the same time, the muscles, joints and thereby the nervous system can maximum results be achieved and balance restored in order that self regulating and self healing mechanisms can operate optimally so that your body can continue to heal.
The word Osteopathy was coined by a medical doctor Dr. Andrew Taylor Still in about 1874 however the history of this treatment approach dates back thousands of years. Chinese writing dating back 2,700 BC refer to manipulation of muscles and the spine as a healing art. Hippocrates in the fifth century BC and Galen (131-202), both practiced and wrote about it. Similar procedures were used in ancient Egypt, Babylon, Syria, Tibet, and by the Aztecs and Incas in Central and South America. During the Middle Ages practice of manipulation became known as bone setting performed mainly by medical doctors. The early 19th century saw a rise in patent medicine. It is well to remember that the first drug to be manufactured was aspirin in 1899 by Bayer. Prior to that medical doctors had a more diverse role than today, dispensing herbal remedies and plant drugs such as foxglove (1785) and morphine (1803), mineral drugs including large doses of heavy metals, as well as tending cuts and abrasions, stitching wounds, setting broken bones and performing bone setting. In Hollywood Westerns doctors are often referred to “sore bones”. Although some remedies were sold by doctors of medicine, most were sold by lay people with little or no warnings, and often with questionable claims. The addictive sometimes toxic effects of some remedies especially morphine and mercury based cures lead to the rise of less dangerous alternatives such as homeopathy, eclectic medicine, Thomsonian Physiomedicalism and of course osteopathic and chiropractic medicine. In the mid-19th century as Charles Darwin published “the Origin of Species” and Louis Pasteur’s germ theory began to replace the metaphysical causes of disease, the search for invisible microbes required the world to embrace scientific method as a way to discover the causes of disease. This was a period of great change, of discovery and enlightenment.
In settling America it is not surprising that the rough and tumble injuries that the early settlers encountered required hands on remedies. Following the American Civil War licencing of health care all but vanished, new medical schools flourished. Paget (1866) describes inconsistency among bone setters in his lecture “Cases that Bone Setters Cure”. The first attempt to describe bone setters manipulation systematically was Hood, a medical doctor in his lecture “On Bone Setting” 1871. Uniformity was needed and unhappy with the way that other doctors prescribed medicines of the day such as mercury and lead to excess an American physician Dr. Andrew Taylor Still sought a more holistic approach and in 1874 established a system of manipulative treatment which he called Osteopathy. Dr. Still believed that the conventional medical system lacked credible efficiency and treated the effects rather than causes of disease, commonly with medicines of the day, such as arsenic, castor oil, whisky, opium and large doses of toxic heavy metals such as lead and mercury. These heroic doses and unsanitary surgical procedures caused more deaths than cures. Dr. Still had studied machines in his earlier life and he considered that the muscles and bones of the body worked together like a machine. He rejected the idea that germs alone cause disease, rather that diseases were more common when bones moved out of place and disrupted the flow of blood and the flow of nervous impulses, making the body more susceptible to disease. He, therefore concluded, that by manipulating to restore the interrupted flow, the body could better cure its own disease. In 1892 Dr. Still founded the first Osteopathic college in Kirksville, Missouri.
In 1886 Daniel David Palmer a teacher, grocer, and magnetic healer opened his office of magnetic healing curing people with magnetic hands. Accounts differ as to how D.D. Palmer started manipulating. Palmer himself claims that in 1895 a partially deaf janitor Harvey Lillard was working in his office with his shirt off and noticed a lump on Lillard’s back and applied pressure to it which restored Lillard’s hearing. Lillard’s daughter Vadeenia Lillard Simons said that her father was telling a joke outside Palmer’s office, at the punch-line Palmer slapped Lillard on the back with a book that he was carrying and that the next day Lillard noticed that his hearing had improved. Initially, Palmer denied being trained by Osteopathic medicine founder Dr. A.T. Still, however, in 1899 he admitted that some years earlier he studied Osteopathy. D.D. Palmer’s first description and underlying philosophy of Chiropractic is strikingly similar to Andrew Still’s principles of Osteopathy described two decades earlier. Both described the body as a “machine” whose parts could be manipulated to produce a drug-less cure. Both professed the use of spinal manipulation on joint dysfunction to improve health. Palmer called this lesion a subluxation which caused nerve impingement and, consistent with his magnetic healing philosophy, took a laying on of the hand’s approach manipulating the spine without first releasing the muscles. In contrast, Dr. Still considered any lesion also involved tight muscles as an integral cause of skeletal dysfunction. This, in turn, affected the nervous system and accordingly incorporated muscle release techniques as prerequisites to manipulation, as both were a part of one system. Nevertheless, Palmer started to experiment with manipulation to which he coined the word Chiropractic and added manipulation to his teachings. In 1896 more than twenty years after Dr. Andrew Still described Osteopathy D.D. Palmer opened Palmer School of Chiropractic in Davenport, Iowa only teaching spinal manipulation. D.D. Palmer’s son B.J. Palmer assumed control of Palmer School in 1906 and seriously considered declaring Chiropractic a religion as many Chiropractic leaders at the time invoked religious imagery but he decided against it. B.J. Palmer quoted “….chiropractic was founded on a business, not a professional basis. We manufacture chiropractors. We teach them the idea then we show them how to sell it”. Chiropractors of the time took a very evangelical approach in sharp contrast to science-based Osteopathy.