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Osteopathy is a philosophy and an alternative medical practice which emphasizes the interrelationship between structure and function of the body and recognizes the body's ability to heal itself; it is the role of the osteopath to facilitate that process, principally by the practice of manual and manipulative therapy. The American Osteopathic Association recommends using the terms osteopathic physician and osteopathic medicine to distinguish individuals trained in osteopathic medicine in the United States who have attained the degree of Doctor of Osteopathic Medicine (D.O.), a degree equivalent to that of Doctor of Medicine (M.D.), who practice the full scope of medicine and receive additional training in osteopathic manipulative medicine from individuals described as osteopaths who use osteopathy, the restricted-scope form of practice outside of North America. Osteopaths trained outside of the US are generally limited in practice to non-invasive manual therapies, as well as providing nutritional, postural, and other health advice. Like their American counterparts, non-US osteopaths are primary contact health care practitioners. They are usually trained at Bachelors or Masters level in the biomedical sciences and general medical diagnosis, with the addition of osteopathic techniques, but without pharmacology and surgery. Osteopathic treatment is generally considered complementary to mainstream medicine. Medical physicians may go on to qualify as an osteopath and vice-versa.
There is an international organization for individuals, the World Osteopathic Health Organization (WOHO), which permits membership by both "restricted scope manual therapist" osteopaths and "full scope of medical practice" osteopathic physicians. Similarly, there is also an international organization of organizations for national osteopathic and osteopathic medical associations, statutory regulators, and universities/medical schools offering osteopathic and osteopathic medical education, known as the Osteopathic International Alliance (OIA).
The practice of osteopathy began in the United States in 1874. The term "osteopathy" was coined by Andrew Taylor Still, MD, DO. Still was a physician and surgeon, Kansas state and territorial legislator, a free state leader, and one of the founders of Baker University, who lived near Baldwin City, Kansas at the time of the American Civil War. In Baldwin, he developed the practice of osteopathy.
Still named his new school of medicine "osteopathy," reasoning that "the bone, osteon, was the starting point from which [he] was to ascertain the cause of pathological conditions." Still founded the American School of Osteopathy (now A.T. Still University of the Health Sciences) in Kirksville, Missouri, for the teaching of osteopathy on 10 May 1892. While the state of Missouri granted the right to award the MD degree, he remained dissatisfied with the limitations of conventional medicine and instead chose to retain the distinction of the DO degree.
The osteopathic medical philosophy is defined as the concept of health care that embraces the concept of the unity of the living organism's structure (anatomy) and function (physiology). The following are the four major principles of osteopathic medicine:
These principles are not held by osteopathic physicians to be empirical laws; they serve, rather, as the underpinnings of the osteopathic philosophy on health and disease.
Osteopathic manipulative treatment (OMT in the U.S. or simply "osteopathic treatment" elsewhere) is the therapeutic application of manually guided forces by an osteopathic physician (U.S. usage) to improve physiologic function and/or support homeostasis that has been altered by somatic dysfunction. Somatic dysfunction is defined as impaired or altered function of related components of the somatic (body framework) system: skeletal, arthrodial and myofascial structures and their related vascular, lymphatic and neural elements. Acute somatic dysfunction is an immediate or short-term impairment or altered function of related components of the somatic (body) framework. It is characterized in early stages by vasodilation, oedema, tenderness, pain, and tissue contraction. It is diagnosed by history and palpatory assessment of tenderness, asymmetry of motion and relative position, restriction of motion and tissue texture change. Chronic somatic dysfunction is the impairment or altered function of related components of the somatic (body framework) system. It may be characterized by tenderness, itching, fibrosis, paresthesias, and tissue contraction.
While there are many treatment techniques, OMT methods utilized may broadly be classified as active or passive and direct or indirect in nature.
A small subdivision of UK Osteopathic practitioners, following the teachings of John Martin Littlejohn and John Wernham, are known as "classical osteopaths". They practice a style of whole or "total" body adjustment which contends that structural strains and patterns, through effects on circulation, reflexes and sensory feedback, precede pathological tissue states. This is said to be due to the downrating, for example, of arterial microcirculation or lymphatic drainage. Treatment is said to lead to successful patient outcomes in a great number of functional and pathological disorders, including infections and degenerative conditions. Traditionally, great emphasis is put on the clearance of the products of metabolism, which place a load on metabolic toxin clearance mechanisms and are said to be irritative. The approach is contentious even within osteopathy, in a similar way to cranial osteopathy. It is no longer taught at undergraduate level in the UK following the loss of GOSc accreditation by the Maidstone school, and is taught as a post graduate specialty.
Several large studies in the U.K. have produced evidence that demonstrates positive clinical and cost effectiveness of manipulation in the management of lower back pain, the latest being the U.K. Back pain Exercise And Manipulation (UK BEAM) trial. The physical manipulation condition of the U.K. BEAM trial involved "... a package of techniques representative of those used by the U.K. chiropractic, osteopathic, and physiotherapy professions."
In a 2005 meta-analysis and systematic review of six randomized controlled trials of osteopathic manipulative treatment (OMT) that involved blinded assessments of lower back pain in ambulatory settings, it was concluded that OMT significantly reduces low back pain, and that the level of pain reduction is greater than expected from placebo effects alone and persists for at least three months.
The NIH's National Center for Complementary and Alternative Medicine states that overall, studies have shown that spinal manipulation can provide mild to moderate relief from low-back pain and appears to be as effective as conventional medical treatments. In 2007 guidelines, the American College of Physicians and the American Pain Society include spinal manipulation as one of several treatment options for practitioners to consider using when pain does not improve with self-care. Recent research into spinal manipulation for low-back pain has begun to look at the effects of different forms of manipulation, as well as treatment duration and frequency. Studies have found that spinal manipulation provides relief from low-back pain at least over the short term (i.e., up to 3 months), and that pain-relieving effects may continue for up to 1 year. Spinal manipulation is generally a safe treatment for low-back pain. Serious complications are very rare.
Additionally, U.S. osteopathic physicians and academic researchers have conducted preliminary research to determine the efficacy of manual techniques to manage and/or co-manage conditions such as asthma and acute otitis media in children, dysmenorrhea, and pulmonary infection.
According to the U.K. National Health Service, the use of osteopathy is not always based on science, and there is no good evidence that osteopathy is effective for any health condition other than back pain and helping recovery after hip or knee operations. There is no good evidence that osteopathy is an effective treatment for asthma, painful periods, shoulder pain, headaches or migraines, sinusitis, stress or depression, even though it is sometimes used for these conditions.
The osteopathic profession has evolved into two branches, non-physician manual medicine osteopaths and full scope of medical practice osteopathic physicians. These groups are so distinct that in practice they function as separate professions. In recent years, the profession has actively attempted to enhance exchange and dialogue between them. The regulation of non-physician manual medicine osteopaths varies greatly between jurisdictions. In the Australia, the UK, and New Zealand the non-physician manual medicine osteopaths are regulated by statute and practice requires registration with the relevant regulatory authority. The Osteopathic International Alliance has a country guide with details of registration and practice rights. In certain countries such as Canada and the USA they may not provide diagnosis as this is a regulated act.[not in citation given]
The following sections describe the legal status of osteopathy and osteopathic medicine in each country listed.
Osteopaths are primary contact health professionals who, in their own practice, make independent judgments in the examination, diagnosis, treatment, prevention and care of conditions of the human body to the extent of their individual competence. Osteopaths work in private practice, and the majority of private health insurance providers cover treatment performed by osteopaths.
Three publicly funded Australian universities now offer degrees in osteopathy: RMIT University (officially The Royal Melbourne Institute of Technology), Victoria University, and Southern Cross University.
Training in osteopathic medicine is not available in Canada. U.S.-trained Doctors of Osteopathic Medicine/osteopathic physicians are licensed as full physicians with the provincial Colleges of Physicians and Surgeons. The Ontario Medicine Act 1991 states that "No person other than a member (registered with the College of Physicians & Surgeons) shall use the titles "physician" or "surgeon", a variation or abbreviation or an equivalent in another language. 1991, c. 30, s. 9 (1)." and "No person other than a member shall hold himself or herself out as a person who is qualified to practise in Ontario as a physician or surgeon or in a specialty of medicine. 1991, c. 30, s. 9 (3)." Membership in the College of Physicians and Surgeons requires that members are physicians trained in the full scope of medical practice. Similar title protection laws have been enacted in Alberta and British Columbia. The Canadian Osteopathic Association has been representing osteopathic physicians in Canada for more than 80 years and has enabled near-uniform licensing across Canada for US-trained osteopathic medical graduates.
Manual (non-medical) osteopathy is not a regulated profession in Canada. The Canadian Manual Osteopathy Examining Board (CMOEB) aims to "establish and maintain uniform high standards of excellence in the manual osteopathy profession and education, primarily but not exclusively by preparing and administering to qualified applicants examinations of superior quality . . . and to advance the manual osteopathy profession when in the best interests of manual osteopathy testing". Manual osteopaths who pass exams administered by the CMOEB are permitted to join the International Osteopathic Association (IOA) and receive a certificate of registration.
The first self-identified college of manual (non-medical) osteopathy in Canada opened in 1981. There are now 7 manual osteopathy colleges in Canada, teaching in Halifax, Montreal, Quebec City, Toronto, Hamilton, Vancouver, Ottawa, London, Winnipeg, Calgary and Edmonton.
There is no universal regulatory authority for the practice of osteopathy or osteopathic medicine within the European Union; it is on a country by country basis. The UK's General Osteopathic Council, a regulatory body set up under the country's Osteopaths Act 1993 has issued a position paper on European regulation of osteopathy.
Germany has both osteopathy and osteopathic medicine. There is a difference in the osteopathic education between non-physician osteopaths, physiotherapists, and medical physicians.
Physiotherapists are a recognized health profession and can achieve a degree of "Diploma in Osteopathic Therapy (D.O.T.)." Non-physician osteopaths are not medically licensed. They have an average total of 1200 hours of training, roughly half being in manual therapy and osteopathy, with no medical specialization before they attain their degree. Non-physician osteopaths in Germany officially work under the "Heilpraktiker" law. Heilpraktiker is a separate profession within the health care system. There are many schools of Osteopathy in Germany; most are moving toward national recognition although such recognition does not currently exist. In Germany there are rules (at the country level) under which persons (non-physicians) may call themselves Osteopath.
Osteopathic physicians in Germany achieve a degree of "D.O.- DAAO" or "D.O.M.", from the DAAO and DGOM respectively. Osteopathic physicians in Germany are fully licensed with at least 6,500 hours in medical school 6 years, at least 7,000 hours in specialty training, which is 3 to 6 years, plus at least 680 hours of training in manual medicine and osteopathy before attaining their degree. German physicians who have obtained the degree designation Dr. med., and who have completed their medical education and specialty training in areas such as general practise, orthopaedics, neurology, internal medicine, etc. can earn a Diploma in Osteopathic Medicine, either a DO-DAAO from the DAAO (German-American Academy for Osteopathy), a DOM™ from the DGOM (German Society of Osteopathic Medicine), or an MDO (Medical Doctor of Osteopathy) from the DGCO (German Society for Chirotherapy and Osteopathy) if additional educational requirements are met. The additional education includes a 320-hour program in manual medicine and an additional minimum of 380 hours in osteopathic medicine, which together makes a minimum of 700 hours. The osteopathic medicine course is limited to physicians only.
The scope of practise for a US-trained osteopathic physician in Germany is unlimited. A foreign physician may apply for licensure with the regional medical authorities, the Health Ministry, which represents the state in which the applicant intends to work. The regional state health ministry has information regarding the types of medical providers needed in that area and therefore grants work permits to licensed physicians depending on the specialty of the foreign physician.
The practice of osteopathy is regulated by law, under the terms of the Health Practitioners Competence Assurance Act 2003 which came into effect on 18 September 2004. Under the Act, it is a legal requirement to be registered with the Osteopathic Council of New Zealand [OCNZ], and to hold an annual practicing certificate issued by them, in order to practice as an osteopath. Each of the thirteen healthcare professions regulated by the HPCA Act works within the "Scope of Practise" determined and published by its professional Council. Osteopaths in New Zealand are not fully licensed physicians. In New Zealand, in addition to the general scope of practice, osteopaths may also hold the Scope of Practice for Osteopaths using Western Medical Acupuncture and Related Needling Techniques.
In New Zealand a course is offered at Unitec. Australasian courses consist of a bachelor's degree in clinical science (Osteopathy) followed by a master's degree. The Unitec New Zealand double degree programme is the OCNZ prescribed qualification for registration in the scope of practice: Osteopath, Australian qualifications accredited by the Australian and New Zealand Osteopathic Council are also prescribed qualifications.
Osteopaths registered and in good standing with the Australian Health Practitioner Regulation Agency – Osteopathy Board of Australian are eligible to register in New Zealand under the mutual recognition system operating between the two countries. Graduates from programs in every other country are required to complete an assessment procedure.
The scope of practice for US-trained osteopathic physicians is unlimited on an exceptions basis. Full licensure to practice medicine is awarded on an exceptions basis following a hearing before the licensing authorities in New Zealand. Both the Medical Council of New Zealand and the Osteopathic Council of New Zealand [OCNZ] regulate osteopathic physicians in New Zealand. Currently, the country has no recognized osteopathic medical schools.
The practice of osteopathy has a long history in the UK. The first school of osteopathy was established in London in 1917 by John Martin Littlejohn, Ph.D., M.D., D.O., a pupil of A.T. Still, who had been Dean of The Chicago College of Osteopathic Medicine. After many years of existing outside the mainstream of health care provision, the osteopathic profession in the UK was finally accorded formal recognition by Parliament in 1993 by the Osteopaths Act. This legislation now provides the profession of osteopathy the same legal framework of statutory self-regulation as other healthcare professions such as medicine and dentistry.
The General Osteopathic Council (GOsC) regulates the practice of osteopathy under the terms of the Osteopaths Act 1993. A person cannot practise unless they register with the GOsC. The General Osteopathic Council has a statutory duty to promote, develop and regulate the profession of osteopathy in the UK. It fulfils its duty to protect the interests of the public by ensuring that all osteopaths maintain high standards of safety, competence and professional conduct throughout their professional lives. In order to be registered with the General Osteopathic Council an osteopath must hold a recognized qualification that meets the standards as set out by law in the GOsC's Standard of Practice. This Act provides for "protection of title" A person who, whether expressly or implication describes himself as an osteopath, osteopathic practitioner, osteopathic physician, osteopathist, osteotherapist, or any kind of osteopath is guilty of an offence unless he is registered as an osteopath. There are currently approximately four thousand osteopaths registered in the UK.
In the United Kingdom, courses in Osteopathy have recently become integrated into the university system. Instead of receiving a Diploma in Osteopathy (DO), with or without a Diploma in Naturopathy (ND), graduates now become Masters or Bachelors of Osteopathy, or Osteopathic Medicine, (BOst or MOst) or else Bachelors of Science (BSc) in Osteopathy or Osteopathic Medicine, according to the institution attended: in this case osteopathy and osteopathic medicine are synonymous, but these degrees do not lead to prescribing rights.
The recognition of osteopathy also means that doctors can now refer patients to osteopaths for treatment with the transfer of clinical responsibility rather than simply delegating the responsibility for care, as is the case with other healthcare professionals. It may or may not be a covered benefit under the National Health Service depending on where in the UK you may live.
Osteopathic medicine is regulated by the General Osteopathic Council (GOsC) under the terms of the Osteopaths Act 1993 and statement from the GMC. The London College of Osteopathic Medicine, teaches osteopathy only to those who are already physicians.
Foreign-trained osteopathic physicians, who are registered with the GMC and GOsC, hold both a full medical practise and osteopathic license. Each applicant will have to pass the Professional and Linguistic Assessment Board test (PLAB) and work for one supervised year in the National Health Service (NHS). Following that year, the applicants will be able to apply for full registration (unsupervised practice or private practice). If the physician is already a specialist, postgraduate training will need to be separately recognized by the Postgraduate Medical Education and Training Board (PMETB).
Licensure or registration of non-physician osteopaths is not permitted anywhere in the United States. European style osteopaths are prohibited from calling themselves osteopaths. They are referred to as osteopathic manual practitioners. A.T. Still's American School of Osteopathy, now known as A.T. Still University, was chartered by the state of Missouri to award the M.D. degree, but chose to offer the D.O. degree instead.
Osteopathic medicine in the United States has always meant a physician trained in and entitled to the full scope of medical practice. Osteopathy or osteopath as written in some U.S. state and federal laws refers only to osteopathic medicine or osteopathic physicians, respectively. With the increased internationalization of the profession, these older terms have fallen out of favor as generally accepted use due to the confusion they may cause.