Osteopathy

Definition

Osteopathy is a "whole person" philosophy of medicine, where doctors of osteopathic medicine (DOs) endorse an approach that treats the entire person, rather than a specific complaint. Attention is given to prevention, wellness, and helping the body to heal itself. Because the body is viewed as a single organism or unit, special focus is given to understanding body mechanics and the interrelationship of the body's organs and systems. A particular emphasis is placed on the musculoskeletal system. Dos may utilize physical manipulation of muscles and bones in conjunction with, or as an alternative to, conventional treatments, drug therapies, and surgery to provide complete health care.

Origins

Dr. Andrew Still developed the osteopathic approach to medicine. Still, whose father was a Methodist minister and physician, was himself a medical doctor who served as a Union surgeon during the Civil War. After the war, personal tragedy struck the Still household when three of his children died from spinal meningitis . This event angered and disillusioned him. He became dissatisfied with the state of medical knowledge and treatments available at that time. Consequently, he began an intense study of the human body to find underlying causes and cures for ailments.

Still gave great attention to anatomy. He recognized the importance of the musculoskeletal system, the body's ability for self-healing, and focused on prevention and the concept of "wellness." In an era when drug treatment was frequently dangerous and overused, and surgery often fatal, Still was able to develop alternative treatments. For example, by manipulating the ribs and spine, Still provided treatments for pneumonia . He gave attention to the lymphatic system (which filters foreign matter and removes excess fluids, proteins, and waste products from the tissues and transports them to the blood to be circulated and eliminated) and manipulating the fascia (connective tissue that is tough, but thin and elastic; it forms an uninterrupted three-dimensional network from head to foot, sheathing every muscle, bone, nerve, gland, organ, and blood vessel), allowing him to address a range of other ailments.

Still's sons learned his philosophies and techniques, but demand overwhelmed their ability to supply care. In 1892, Still founded the first college of osteopathic medicine, the American School of Osteopathy, in Kirksville, Missouri. When he died in 1917, there were more than 5,000 practicing osteopaths in the United States. Today, osteopaths are the fastest growing segment of the total population of physicians and surgeons in the United States. In 2002, there were more than 49,000 doctors of osteopathy. Osteopathy has spread outside of the United States and is now practiced in countries throughout the world.

Benefits

The osteopathic focus on prevention and wellness may help individuals to avoid illness by teaching healthy behaviors and encouraging health-promoting lifestyle changes. In addition to conventional treatments, drugs, and surgeries, DOs may offer manipulative therapies not available from their allopathic counterparts MDs). Many people seek care from an osteopath for back or neck pains, joint pains, or injuries. However, DOs may use manipulative therapies to treat a variety of ailments and conditions including arthritis, allergies, asthma, dizziness, carpal tunnel syndrome , menstrual pain , migraine headaches, sciatica , sinusitis, tinnitus (ringing in the ears), and problems in the jaw joints. Manipulative therapies may be incorporated into the treatment plan to speed recovery from various conditions, such as heart attack or disc surgery, and to address pediatric concerns, such as otitis media (ear infection ) and birth traumas. Various manipulative therapies may also be appropriate in alleviating discomforts associated with pregnancy , for example, back pain or digestive problems. Some osteopaths even feel that regular osteopathic treatments may help minimize the effects of aging on the spine and joints. Also, as noted by the American Osteopathic Association (AOA), the field of sports medicine has found particular benefit in osteopathic practitioners because of their emphasis on "the musculoskeletal system, manipulation, diet, exercise , and fitness. Many professional sports team physicians, Olympic physicians, and personal sports medicine physicians are DOs."

Description

Osteopathic medicine considers the human body to be a complex unit of interrelated parts, a unified organism. Organs and systems do not function independently and should not be treated as such. A disturbance in one part of the body affects the entire body. Illness is also impacted by many variables, such as emotions, stress , lifestyle, and environment. Therefore, illness must be addressed by taking a whole person approach to treatment. Because the body is seen as self-regulating and self-healing, the osteopath gives special attention to illness prevention and helping the body maintain or re-establish wellness.

The nervous and circulatory systems play crucial roles in maintaining the functioning of the body's organs and systems; negative body-wide effects may occur when these two major systems are not functioning optimally. Relieving blocked blood flow or nerve impulses will help the body to heal itself by promoting blood flow through affected tissues. The blood supply will be better able to deliver vital nutrients and boost the immune system, the nerve supply to the area will be improved, and systemic balance can be restored.

The musculoskeletal system is key in this effort to achieve and maintain systemic balance and health. The musculoskeletal system is comprised of the bones, tendons, muscles, tissues, nerves, and spinal column. As the body's largest system, it encompasses over 60% of body mass and can suffer mechanical disorders or amplify illness processes anywhere in the body. Therefore, structural evaluation and attention to the musculoskeletal system is central to osteopathy.

In addition to conventional care such as drug therapies and surgery, osteopaths may use a variety of manipulative procedures to help the body systems function at peak levels. These techniques are commonly referred to as Osteopathic Manipulative Treatment (OMT). OMT is a form of noninvasive, "hands-on" care used for prevention, diagnosis, and treatment to reduce pain and restore motion, as well as help the body heal itself. OMT may be used to facilitate the movement of body fluids and normal tissue functioning, and release painful joints or dysfunctional areas. These therapies take different forms depending on patient needs.

In addition to easing the pain of physical disorders, OMT appears to be helpful in some psychiatric conditions as well. A recent study performed at the College of Osteopathic Medicine in Downers Grove, IL, found that OMT as an adjunct to psychotherapy alleviated the symptoms of depression in women, as measured by the Zung Depression Scale, a standard diagnostic instrument.

ANDREW TAYLOR STILL 1828–1917

Andrew Taylor Still, the father of osteopathy, was born on August 6, 1828, in Virginia to Abram and Martha Still. Growing up on the frontier lands of Tennessee and Missouri provided the impetus for his first studies of the musculoskeletal system. Skinning squirrels and deer, Still became familiar with the relationship between bones, muscles, nerves, and veins long before he picked up an anatomy book. He later studied medicine under his doctor-preacher father and served as a Union surgeon during the Civil War.

Following the war, his distrust of traditional medicine grew when three of his children died of cerebrospinal meningitis . Still decided that the medications of his day were useless and that there had to be another way.

Still studied the attributes of good health so he could understand disease. He saw the body as a complex machine that, when working properly, stayed free of disease. He turned to a drugless, manipulative therapy believing disease was caused by a failure of the human machinery to carry the fluids necessary to maintain health. He called his holistic approach osteopathy for the Greek words osteon, meaning bone, and pathos, to suffer.

Still gained a following working as an itinerant healer, and in October 1892, he opened the American School of Osteopathy in Kirksville, Missouri. Still welcomed women even as other medical schools denied them access.

As of 2000, there were 16 osteopathic medicine colleges in the United States and 35,000 practicing doctors of osteopathy. The Kirksville College of Osteopathic Medicine remains open.

Manipulative procedures may be categorized and discussed in a variety of ways. According to the American Association of Colleges of Osteopathic Medicine, the following groupings encompass some of the most commonly used procedures. Descriptions are compiled from the American Academy of Osteopathy, Leon Chaitow, N.D., DO, and others.

• Articulatory techniques. Procedures that move joints through their range of motion (articulating the joints) may be used to restore normal functioning.
• Counterstrain. This type of therapy is used to alleviate trigger points localized areas of hyperirritability in the muscles). The procedure involves first finding a body position that relieves the patient's pain. Through a process in which the patient and practitioner repeatedly use coordinated techniques of pushing (or compression), relaxing, and changing position, the trigger point is eased.
• Cranial treatment. Cranial treatments focus on the craniosacral system which consists of the brain, spinal cord, cerebrospinal fluid, dura (the membrane covering the brain and spinal cord), cranial bones, and the sacrum (triangular bone comprised of five fused vertebrae, and forming posterior section of the pelvis). Craniosacral release is a gentle technique that focuses on normalizing imbalances in the natural rhythms of this system. A light touch is used to detect and release restrictions in the system and encourage the body's own healing processes. Craniosacral therapies arose from the work of Dr. William Sutherland, a DO who developed and explored the concept that the bones of the skull allowed movement and could be manipulated to improve the system's rhythmic movements. Some DOs choose to specialize in cranial osteopathy. Craniosacral therapy is also practiced by a wide variety of health care professionals. As listed by the Upledger Institute, these practitioners include MDs, chiropractors, doctors of Oriental medicine, naturopaths, nurses, psychiatric specialists, psychologists, dentists, physical therapists, occupational therapists, acupuncturists, massage therapists, and other professional bodyworkers.
• Myofascial release treatment. Various direct or indirect treatments are applied to release fascia tissues.
• Lymphatic techniques. These techniques focus on improving lymphatic circulation, improving the ability of the lymphatic system to do its job of waste removal.
• Soft tissue techniques. Applied to tissue other than bone, these techniques use varying pressure and may stretch, roll, or knead, resulting in the relaxation or release of tissues.
• Thrust techniques. A quick, sharp thrust (which is often described as high velocity/low amplitude) to the area requiring treatment is used to force a correction, restoring normal joint function and movement. This is similar to chiropractic adjustment.

Precautions

DOs use the full range of conventional diagnostic techniques, drug therapies, treatments, and surgical interventions available to MDs. If deemed appropriate by the DO, OMT may be employed in addition to these conventional diagnoses, and treatments or may serve as an alternative to drug therapies. During the course of treatment, manipulative therapies may be interrupted or stopped if complications occur—for example, a rise in blood pressure. In some situations, the osteopath may determine that no further benefit will be gained from continuing manipulative treatment. Manipulation should not be applied in several medical conditions. As listed by Chris Belshaw, these conditions are mainly "acute infections ; fractures ; bone disease; cancer ; gross structural deformities; such severe general medical conditions as gross high blood pressure or heart attack; vascular disease, for example, thrombosis; neurological conditions with nerve damage; spinal cord damage; and severe prolapse of an intervertebral disc." Additionally, as in any area of medicine, there is the possibility of mistaken diagnosis. Patients should always discuss all medical conditions, treatments, questions, and concerns with their physicians.

Side effects

Some patients, as noted by Belshaw, may experience mild headaches following neck treatments or discomfort after back manipulation. Some flushing and bruising may appear on those with sensitive skin. These reactions may last for several hours. Such symptoms may recur as treatment continues. Symptoms may return if treatment is stopped too soon.

Research & general acceptance

Research has shown the benefits of osteopathic care in a range of ailments and through improved recovery times. In addition to many of the conditions discussed above, the American Osteopathic Healthcare Association reports ongoing research on patient recovery times, length of hospital stays, chronic pain, chlamydia infection in women, reduction of deep vein thrombosis, and fall prevention for the elderly. Osteopathic colleges have increased their attention to biomedical research opportunities for students and those who desire to pursue research careers. The AOA Board of Research encourages and supports development of scientific research in the osteopathic medical profession. The AOA has also conducted several campaigns to educate the public on osteopathy. In 2000, the AOA started a Women's Health Initiative, a three-year campaign to promote women's healthcare among osteopathic physicians and the public.

Training & certification

Training and certification for DOs exceed those of chiropractors and physical therapists, two groups to which their manipulative techniques are sometimes compared. Chiropractic training focuses on spinal manipulation only. Chiropractors typically have fewer years and types of required postgraduate training, and are more limited legally in their practice. DOs also have training and licensing well beyond that of physical therapists.

Osteopathic physicians, like their allopathic physician counterparts, are complete physicians. This means they are trained and licensed to prescribe medication and perform surgery, and qualified to render complete healthcare. DOs are fully licensed in all 50 states and the District of Columbia, to serve in the military medical corps, Veterans Administration, and Public Health Service, and are recognized by the American Medical Association as physicians. They hold the same practice rights as MDs, have passed the same or similar state licensing examinations, and practice in fully accredited hospitals. DOs can practice in all branches of medicine and surgery, and can specialize in any area, but the majority are primary care physicians.

As of spring 2002, the AOA lists 20 AOA-accredited colleges of osteopathic medicine. Training for DOs and MDs parallel in many ways. Osteopathic colleges, like medical schools, offer a basic, comprehensive four-year medical education. Added to this curriculum are the osteopathic philosophies and a holistic care emphasis on prevention and community care. In addition to stressing the inter-relatedness of body organs and systems, students of osteopathy are taught to consider the whole person, including lifestyle, emotional factors, and environmental factors. Training also focuses on the musculoskeletal system and manual medicine. Manipulative therapies are taught for prevention, diagnosis, and treatment, and the osteopathic principle of helping the body toward good health.

After graduation from the four-year curriculum, DOs complete a one-year rotating internship, followed by several years in a residency program, if a specialty is desired. The areas covered during the internship period ensure that each DO is first trained as a primary care physician. Over half of all DOs are primary care physicians. Conversely, MDs are more likely to be specialists.

After the formal education process, the AOA requires members to earn continuing medical education (CME) credits every three years. To further enhance postgraduate medical education, the AOA has implemented the concept of Osteopathic Postdoctoral Training Institutions (OPTIs), which reflect the osteopathic emphasis on community care. These OPTIs are community-based consortia that include at least one hospital and college of osteopathic medicine. The intention of these is to promote institutional collaboration and enhance training opportunities that reflect the settings in which many osteopaths will practice. In early 2002, a new Osteopathic Research Center opened at the University of North Texas Health Science Center in Fort Worth. The new Research Center is the result of collaboration among the American Colleges of Osteopathic Medicine, the American Osteopathic Foundation, and the American Osteopathic Association.

Many aspects of traditional osteopathic philosophy, such as advice about diet and smoking , have entered mainstream medicine to the point that the lines between DOs and MDs are blurring. In addition, the dedication of osteopaths to holistic medicine and primary care has been a great benefit to rural areas of the United States that are often underserved by mainstream practitioners.

Resources

PERIODICALS

"Osteopathic Manipulative Treatment May Benefit Patients." Health & Medicine Week (October 8, 2001).

Patrick, Stephanie. "Fort Worth Chosen for Osteopathic Center." Dallas Business Journal 25 (October 26, 2001): 10.

Shepard, Scott. "Health Philosophies on Common Ground." Cincinnati Business Courier 18 (November 9, 2001): 38.

ORGANIZATIONS

American Association of Colleges of Osteopathic Medicine. 5550 Friendship Blvd., Suite 310, Chevy Chase, MD 20815-7231. (301) 968-4100. <http://www.aacom.org>.

American Osteopathic Association. 142 E. Ontario Chicago, IL 6061. (800) 621-1773. [email protected]. <http://www.aoa-net.org>.

The Upledger Institute, Inc. 11211 Prosperity Farms Road, D-325, Palm Beach Gardens, FL 33410-3487. Educational services: (800) 233-5880. Administration: (561) 622-4334. Fax: (561) 622&-4771. [email protected]. <http://www.upledger.com>.

OTHER

HealthWorld Online. "Osteopathy." [cited October 2002]. <http://www.healthy.net/CLINIC/therapy/Osteo/Index.asp>.

The Osteopathic Homepage. <http://www.osteohome.com>.

Rebecca J. Frey, PhD

Osteopathy

2965 ■ H. FLETCHER BROWN TRUST

PNC Bank Delaware
Attn: Donald W. Davis
222 Delaware Avenue, 16th Floor
Wilmington, DE 19899
Tel: (302)429-2827
Fax: (302)429-5658
E-mail: [email protected]
To provide financial assistance to residents of Delaware who are interested in studying engineering, chemistry, medicine, dentistry, or law.
Title of Award: H. Fletcher Brown Scholarship Area, Field, or Subject: Chemistry; Dentistry; Engineering; Law; Medicine; Medicine, Osteopathic Level of Education for which Award is Granted: Graduate, Professional, Undergraduate Funds Available: The amount of the scholarship is determined by the scholarship committee and is awarded in installments over the length of study. Duration: 1 year; may be renewed if the recipient maintains a GPA of 2.5 or higher and continues to be worthy of and eligible for the award.
Eligibility Requirements: This program is open to Delaware residents who were born in Delaware, are either high school seniors entering the first year of college or college seniors entering the first year of graduate school, are of good moral character, and need financial assistance from sources outside their family. Applicants must have combined mathematics and verbal SAT scores of 1000 or higher, rank in the upper 20% of their class, and come from a family whose income is less than $75,000. Their proposed fields of study must be engineering, chemistry, medicine (for an M.D. or D.O. degree only), dentistry, or law. Finalists are interviewed. Deadline for Receipt: March of each year.

2966 ■ INDIAN HEALTH SERVICE

Attn: Scholarship Program
801 Thompson Avenue, Suite 120
Rockville, MD 20852
Tel: (301)443-6197
Fax: (301)443-6048
E-mail: [email protected]
Web Site: http://www.ihs.gov
To provide financial support to American Indian students interested in majoring in pre-medicine or pre-dentistry in college.
Title of Award: Health Professions Pregraduate Scholarship Program Area, Field, or Subject: Dentistry; Medicine; Medicine, Osteopathic Level of Education for which Award is Granted: Undergraduate Number Awarded: Varies each year. Funds Available: Awards provide a payment directly to the school for tuition and required fees; a stipend for living expenses of approximately $1,160 per month for 10 months; a lump sum to cover the costs of books, travel, and other necessary educational expenses; and up to $400 for approved tutorial costs. Duration: Up to 4 years of full-time study or up to 8 years of part-time study.
Eligibility Requirements: Applicants must be American Indians or Alaska Natives; be high school graduates or the equivalent; have the capacity to complete a health professions course of study; and be enrolled or accepted for enrollment in a baccalaureate degree program to prepare for entry into a school of medicine, osteopathy, or dentistry. Priority is given to students entering their junior or senior year; support is provided to freshmen and sophomores only if remaining funds are available. Selection is based on academic performance, work experience and community background, faculty/employer recommendations, and applicant's reasons for seeking the scholarship. Recipients must intend to serve Indian people upon completion of their professional health care education. Deadline for Receipt: February of each year.

2967 ■ INDIAN HEALTH SERVICE

Attn: Scholarship Program
801 Thompson Avenue, Suite 120
Rockville, MD 20852
Tel: (301)443-6197
Fax: (301)443-6048
E-mail: [email protected]
Web Site: http://www.ihs.gov
To provide loans-for-service to American Indian and Alaska Native students enrolled in health professions and allied health professions programs.
Title of Award: Health Professions Scholarship Program Area, Field, or Subject: Counseling/Guidance; Dental hygiene; Dentistry; Health care services; Medical assisting; Medical technology; Medicine; Medicine, Osteopathic; Nursing; Nutrition; Optometry; Pharmaceutical sciences; Physical therapy; Podiatry; Psychology; Public health; Radiology; Respiratory therapy; Social work; Level of Education for which Award is Granted: Graduate, Undergraduate Number Awarded: Varies each year. Funds Available: Awards provide a payment directly to the school for tuition and required fees; a stipend for living expenses of approximately $1,160 per month for 12 months; a lump sum to cover the costs of books, travel, and other necessary educational expenses; and up to $400 for approved tutorial costs. Upon completion of their program of study, recipients are required to provide payback service of 1 year for each year of scholarship support at the Indian Health Service, a tribal health programs, an urban Indian health program, or in private practice in a designated health professional shortage area serving a substantial number of Indians. Recipients who fail to complete their service obligation must repay all funds received (although no interest is charged). Duration: 1 year; may be renewed for up to 3 additional years.
Eligibility Requirements: This program is open to American Indians and Alaska Natives who are at least high school graduates and enrolled in a full-time study program leading to a degree in a health-related professions school within the United States. Priority is given to upper-division and graduate students. Qualifying fields of study include chemical dependency counseling (bachelor's or master's degree), clinical psychology (Ph.D. only), coding specialist (certificate), counseling psychology (Ph.D. only), dental hygiene (B.S.), dentistry (D.D.S.), diagnostic radiology technology (certificate, associate, or B.S.), dietitian (B.S.), civil or environmental engineering (B.S.), environmental health (B.S.), health care administration (B.S. or M.S.), health education (B.S. or M.S.), health records (R.H.I.T. or R.H.I.A.), injury prevention specialist (certificate), medical technology (B.S.), allopathic and osteopathic medicine, nursing (A.D.N., B.S.N., or C.R.N.A), optometry, pharmacy (B.S. or Pharm.D.), physician assistant (B.S.), physical therapy (M.S. or D.P.T.), podiatry (D.P.M.), public health (M.P.H. only), public health nutrition (master's only), social work (master's only), respiratory therapy (associate), and ultrasonography. Deadline for Receipt: February of each year.

2968 ■ PAPA OLA LOKAHI, INC.

Attn: Native Hawaiian Health Scholarship Program
345 Queen Street, Suite 706
Honolulu, HI 96813
Tel: (808)585-8944
Fax: (808)585-8081
E-mail: [email protected]
Web Site: http://www.nhhsp.org
To provide scholarship/loans to Native Hawaiians for training in the health professions in exchange for service in a federally-designated health professional shortage area (HPSA) or other facility for Native Hawaiians.
Title of Award: Native Hawaiian Health Scholarship Program Area, Field, or Subject: Dental hygiene; Dentistry; Family/Marital therapy; Health care services; Medical assisting; Medicine; Medicine, Osteopathic; Midwifery; Nursing; Nursing, Psychiatric; Psychiatry; Psychology; Public health Level of Education for which Award is Granted: Graduate, Undergraduate Number Awarded: Varies each year, depending upon the funding available. Since the program began, 151 scholars have received support. Funds Available: Full coverage of tuition and fees is paid directly to the health professional school. A stipend, current set at $1,157 per month, is paid directly to the scholar. This is a scholarship/loan program. Participants are obligated to provide full-time clinical primary health care services to populations in 1) a Native Hawaiian Health Care System, or 2) an HPSA in Hawaii, medically underserved area (MUA), or another area or facility in Hawaii designated by the U.S. Department of Health and Human Services. Participants owe 1 year of service in the National Health Service Corps for each full or partial year of support received under this program. The minimum service obligation is 2 years.
Duration: 1 year; may be renewed for up to 3 additional years.
Eligibility Requirements: Applicants must be Native Hawaiians training in allopathic or osteopathic medicine, dentistry, clinical psychology, registered nursing, nurse midwifery, psychiatric nursing, public health/community nursing, social work, dental hygiene, physician assistant, public health, marriage and family therapy, or primary care nurse practitioner. They may be studying in any state. Recipients must agree to serve in a designated health-care facility in Hawaii upon completion of training. First priority is given to former scholars who have completed their previous service obligation and are seeking another year of support. Second priority is given to applicants who appear to have characteristics that increase the probability they will continue to serve underserved Native Hawaiians after the completion of their service obligations. Deadline for Receipt: March of each year. Additional Information: This program, which began in 1991, is administered by the U.S. Health Resources and Services Administration, Bureau of Health Professions, through a contract with Papa Ola Lokahi, Inc.

2969 ■ TEXAS HIGHER EDUCATION COORDINATING BOARD

Attn: Hinson-Hazlewood College Student Loan Program
1200 East Anderson Lane
P.O. Box 12788, Capitol Station
Austin, TX 78711-2788
Tel: (512)427-6340
Free: 800-242-3062
Fax: (512)427-6423
E-mail: [email protected]
Web Site: http://www.hhloans.com
To provide educational loans to students in Texas in health-related degree programs.
Title of Award: Hinson-Hazlewood Health Education Loan Program Area, Field, or Subject: Dentistry; Health care services; Medicine; Medicine, Osteopathic; Nursing; Optometry; Pharmaceutical sciences; Podiatry; Public health; Veterinary science and medicine Level of Education for which Award is Granted: Four Year College, Graduate Number Awarded: Varies each year. Funds Available: The maximum annual loan is $12,500 for pharmacy, nursing, allied health, and public health students; or $20,000 for medicine, dentistry, optometry, osteopathy, podiatry, or veterinary medicine students. The origination fee is 3%. After a grace period of 9 months, repayment must be completed within 25 years at a minimum monthly payment of $50. The current interest rate is 5.25% which begins to accrue immediately, even while the student is in school. Duration: 1 year; may be renewed up to 3 additional years. The maximum total loan is $50,000 for pharmacy, nursing, allied health, and public health students or $80,000 for medicine, dentistry, optometry, osteopathy, podiatry, or veterinary medicine students.
Eligibility Requirements: This program is open to students who qualify as Texas residents and meet the academic requirements of a public or private college or university in the state. Applicants must be enrolled at least half time in a course of study leading to 1) a doctoral degree in medicine, dentistry, optometry, osteopathy, podiatry, or veterinary medicine; 2) a bachelor's or master's degree in pharmacy; 3) a graduate or equivalent degree in public health; or 4) an associate, bachelor's, or graduate degree in nursing or allied health fields. They must be able to demonstrate financial need and enroll full time. U.S. citizenship is required. Additional Information: Applications must be submitted through the financial aid office at the college or university attended. This program is part of the Hinton-Hazelwood College Student Loan Program (HHCSLP).

2970 ■ WASHINGTON HIGHER EDUCATION COORDINATING BOARD

917 Lakeridge Way
P.O. Box 43430
Olympia, WA 98504-3430
Tel: (360)753-7844
Fax: (360)753-7808
E-mail: [email protected]
Web Site: http://www.hecb.wa.gov/financialaid/other/health.asp
To provide scholarship/loans for primary care health professional education to students who agree to work in designated areas of Washington.
Title of Award: Washington State Health Professional Scholarship Program Area, Field, or Subject: Dental hygiene; Dentistry; Medicine; Medicine, Osteopathic; Midwifery; Nursing; Pharmaceutical sciences Level of Education for which Award is Granted: Graduate, Undergraduate Number Awarded: Varies each year. Funds Available: The stipend is intended to cover eligible expenses: tuition, books, equipment, fees, and room and board. This is a scholarship/loan program. Recipients who fail to complete the course of study are required to repay the amount received, plus a penalty and interest. Scholars who fail to serve in health professional shortage areas in Washington are required to repay the scholarship, with penalty plus interest. The interest rate on the repayments is 8% for the first 4 years and 10% for the fifth year. Duration: Up to 5 years.
Eligibility Requirements: Applicants must be enrolled or accepted for enrollment in an accredited program leading to eligibility for licensure in Washington State in a designated health profession. They must agree to practice in Washington for 3 to 5 years following graduation, but they do not need to be Washington residents or to attend an educational institution in the state. Currently, there are no geographic restrictions for registered nurses or practical nurses. For other primary care health professionals (M.D., D.O., N.D., P.A., N.P., C.N.M., L.M.), dental care professionals (D.D.S., R.D.H.), and pharmacists, service must be in designated areas of the state. State correctional facilities, state mental health facilities, community and migrant health centers, and any other facility with more than 40% of its caseload consisting of Medicaid and sliding fee patients also qualify. Deadline for Receipt: April of each year.

2971 ■ WESTERN INTERSTATE COMMISSION FOR HIGHER EDUCATION

Attn: Student Exchange Programs
3035 Center Green Drive
P.O. Box 9752
Boulder, CO 80301-9752
Tel: (303)541-0210
Fax: (303)541-0291
E-mail: [email protected]
Web Site: http://www.wiche.edu/sep/psep
To underwrite some of the cost of out-of-state professional schooling for students in selected western states.
Title of Award: Professional Student Exchange Program Area, Field, or Subject: Architecture; Dentistry; Library and archival sciences; Medical assisting; Medicine; Medicine, Osteopathic; Nursing; Occupational therapy; Optometry; Pharmaceutical sciences; Physical therapy; Podiatry; Public health; Veterinary science and medicine Level of Education for which Award is Granted: Graduate, Undergraduate Number Awarded: Varies each year. Funds Available: The assistance consists of reduced levels of tuition, usually resident tuition in public institutions or reduced standard tuition at private schools. The home state pays a support fee to the admitting school to help cover the cost of the recipient's education. Duration: 1 year; may be renewed.
Eligibility Requirements: This program is open to residents of 13 western states who are interested in pursuing professional study at selected out-of-state institutions, usually because those fields of study are not available in their home states. The eligible programs, and the states whose residents are eligible, presently include: 1) architecture (master's degree), for residents of Wyoming, to study at designated institutions in Arizona. California, Colorado, Idaho, Montana, New Mexico, Oregon, Utah, or Washington); 2) dentistry, for residents of Alaska, Arizona, Hawaii, Montana, New Mexico, North Dakota, and Wyoming, to study at designated institutions in Arizona, California, Colorado, Nevada, Oregon, or Washington; 3) library studies (master's degree), for residents of New Mexico and Wyoming, to study at designated institutions in Arizona, California, Hawaii, or Washington; 4) medicine, for residents of Montana and Wyoming, to study at designated institutions in Arizona, California, Colorado, Hawaii, Nevada, New Mexico, North Dakota, Oregon, or Utah; 5) nursing (graduate degree), for residents of Wyoming, to study at designated institutions in California, Hawaii, North Dakota, or Oregon; 6) occupational therapy (bachelors' or master's degree), for residents of Alaska, Arizona, Hawaii, Montana, and Wyoming, to study at designated institutions in Arizona, California, Idaho, New Mexico, North Dakota, Oregon, Utah, or Washington; 7) optometry, for residents of Alaska, Arizona, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, North Dakota, Utah, Washington, and Wyoming, to study at designated institutions in California or Oregon; 8) osteopathic medicine, for residents of Arizona, Montana, New Mexico, Washington, and Wyoming, to study at
designated institutions in Arizona or California; 9) pharmacy, for residents of Alaska, Hawaii, and Nevada, to study at designated institutions in Arizona, California, Colorado, Idaho, Montana, New Mexico, North Dakota, Oregon, Utah, Washington, or Wyoming; 10) physical therapy (master's or doctoral degree), for residents of Alaska, Hawaii, and Wyoming, to study at designated institutions in Arizona, California, Colorado, Idaho, Montana, New Mexico, North Dakota, Oregon, Utah, or Washington; 11) physician assistant, for residents of Alaska, Arizona, Nevada, and Wyoming, to study at designated institutions in Arizona, California, Colorado, Idaho, Oregon, Utah, or Washington; 12) podiatry, for residents of Alaska, Montana, New Mexico, Utah, and Wyoming, to study at a designated institution in California; 13) public health, for residents of Montana and New Mexico, to study at designated institutions in California, Colorado, or Washington; and 14) veterinary medicine, for residents of Arizona, Hawaii, Montana, Nevada, New Mexico, North Dakota, Utah, and Wyoming, to study at designated institutions in California, Colorado, Oregon, or Washington. The financial status of the applicants is not considered. Interested students must apply for admission and for PSEP assistance directly from the institution of their choice. They must be certified by their state of residence to become an exchange student and be seeking enrollment at the first professional degree level. Deadline for Receipt: In most states, the deadline for receiving completed applications for certification is in October. After obtaining certification, students must still apply to the school of their choice, which also sets its own deadline.

Osteopathy

Definition

Osteopathy is a system and philosophy of health care that separated from traditional (allopathic) medical practice about a century ago. It places emphasis on the musculoskeletal system, hence the name—osteo refers to bone and path refers to disease. Osteopaths also believe strongly in the healing power of the body and do their best to facilitate that strength. During this century, the disciplines of osteopathy and allopathic medicine have been converging.

Purpose

Osteopathy shares many of the same goals as traditional medicine, but places greater emphasis on the relationship between the organs and the musculoskeletal system as well as on treating the whole individual rather than just the disease.

Precautions

Pain is the chief reason patients seek musculoskeletal treatment. Pain is a symptom, not a disease by itself. Of critical importance is first to determine the cause of the pain. Cancers, brain or spinal cord disease, and many other causes may be lying beneath this symptom. Once it is clear that the pain is originating in the musculoskeletal system, treatment that includes manipulation is appropriate.

Description

History

Osteopathy was founded in the 1890s by Dr. Andrew Taylor, who believed that the musculoskeletal system was central to health. The primacy of the musculoskeletal system is also fundamental to chiropractic, a related health discipline. The original theory behind both approaches presumed that energy flowing through the nervous system is influenced by the supporting structure that encase and protect it—the skull and vertebral column. A defect in the musculoskeletal system was believed to alter the flow of this energy and cause disease. Correcting the defect cured the disease. Defects were thought to be misalignments—parts out of place by tiny distances. Treating misalignments became a matter of restoring the parts to their natural arrangement by adjusting them.

As medical science advanced, defining causes of disease and discovering cures, schools of osteopathy adopted modern science, incorporated it into their curriculum, and redefined their original theory of disease in light of these discoveries. Near the middle of the 20th century the equivalance of medical education between osteopathy and allopathic medicine was recognized, and the D.O. degree (Doctor of Osteopathy) was granted official parity with the M.D. (Doctor of Medicine) degree. Physicians could adopt either set of initials.

However, osteopaths have continued their emphasis on the musculoskeletal system and their traditional focus on "whole person" medicine. As of 1998, osteopaths constitute 5.5% of American physicians, approximately 45,000. They provide 100 million patient visits a year. From its origins in the United States, osteopathy has spread to countries all over the world.

Practice

Osteopaths, chiropractors, and physical therapists are the experts in manipulations (adjustments). The place of manipulation in medical care is far from settled, but millions of patients find relief from it. Particularly backs, but also necks, command most of the attention of the musculoskeletal community. This community includes orthopedic surgeons, osteopaths, general and family physicians, orthopedic physicians, chiropractors, physical therapists, massage therapists, specialists in orthotics and prosthetics, and even some dentists and podiatrists. Many types of headaches also originate in the musculoskeletal system. Studies comparing different methods of treating musculoskeletal back, head, and neck pain have not reached a consensus, in spite of the huge numbers of people that suffer from it.

The theory behind manipulation focuses on joints, mostly those of the vertebrae and ribs. Some believe there is a very slight offset of the joint members—a subluxation. Others believe there is a vacuum lock of the joint surfaces, similar to two suction cups stuck together. Such a condition would squeeze joint lubricant out and produce abrasion of the joint surfaces with movement. Another theory focuses on weakness of the ligaments that support the joint, allowing it freedom to get into trouble. Everyone agrees that the result produces pain, that pain produces muscle spasms and cramps, which further aggravates the pain.

Some, but not all, practitioners in this field believe that the skull bones can also be manipulated. The skull is, in fact, several bones that are all moveable in infants. Whether they can be moved in adults is controversial. Other practitioners manipulate peripheral joints to relieve arthritis and similar afflictions.

Manipulation returns the joint to its normal configuration. There are several approaches. Techniques vary among practitioners more than between disciplines. Muscle relaxation of some degree is often required for the manipulation to be successful. This can be done with heat or medication. Muscles can also be induced to relax by gentle but persistent stretching. The manipulation is most often done by a short, fast motion called a thrust, precisely in the right direction. A satisfying "pop" is evidence of success. Others prefer steady force until relaxation permits movement.

Return of the joint to its normal status may be only the first step in treating these disorders. There is a reason for the initial event. It may be a fall, a stumble, or a mild impact, in which case the manipulation is a cure. On the other hand, there may be a postural misalignment (such as a short leg), a limp, or a stretched ligament that permits the joint to slip back into dysfunction. Tension, as well as pain, for emotional reasons causes muscles to tighten. If the pain has been present for any length of time, there will also be muscle deterioration. The osteopathic approach to the whole person takes all these factors into account in returning the patient to a state of health.

Other repairs may be needed. A short leg is thought by some to be a subluxation in the pelvis that may be manipulated back into position. Other short legs may require a lift in one shoe. Long-standing pain requires additional methods of physical therapy to rehabilitate muscles, correct posture, and extinguish habits that arose to compensate for the pain. Medications that relieve muscle spasm and pain are usually part of the treatment. Psychological problems may need attention and medication.

Risks

Manipulation has rarely caused problems. Once in a while too forceful a thrust has damaged structures in the neck and caused serious problems. The most common adverse event, though, is misdiagnosis. Cancers have been missed; surgical back disease has been ignored until spinal nerves have been permanently damaged.

Normal results

Many patients find that one or a series of manipulations cures long-standing pain. Other patients need repeated treatments. Some do not respond at all. It is always a good idea to reassess any treatment that is not producing the expected results.

Resources

ORGANIZATIONS

American Association of Colleges of Osteopathic Medicine. 5550 Friendship Blvd., Suite 310, Chevy Chase, MD 20815-7231. (301) 968-4100. 〈http://www.aacom.org〉.

American Osteopathic Association. 〈[email protected]〉 〈http://www.am-osteo-assn.org〉.

KEY TERMS

Orthotics— Mechanical devices that assist function.

Prosthetics— Mechanical devices that replace missing body parts.

Osteopathy

Definition

Osteopathy is a system and philosophy of health care that separated from traditional (allopathic) medical practice about a century ago. It places emphasis on the musculoskeletal system, hence the name—osteo refers to bone and path refers to disease. Osteopaths also believe strongly in the healing power of the body and do their best to facilitate that strength. During this century, the disciplines of osteopathy and allopathic medicine have been converging.

Purpose

Osteopathy shares many of the same goals as traditional medicine, but places greater emphasis on the relationship between the organs and the musculoskeletal system as well as on treating the whole individual rather than just the disease.

Precautions

Pain is the chief reason patients seek musculoskeletal treatment. Pain is a symptom, not a disease by itself. Of critical importance is first to determine the cause of the pain. Cancers, brain or spinal cord disease, and many other causes may be lying beneath this symptom. Once it is clear that the pain is originating in the musculoskeletal system, treatment that includes manipulation is appropriate.

Description

History

Osteopathy was founded in the 1890s by Dr. Andrew Taylor, who believed that the musculoskeletal system was central to health. The primacy of the musculoskeletal system is also fundamental to chiropractic , a related health discipline. The original theory behind both approaches presumed that energy flowing through the nervous system is influenced by the supporting structure that encase and protect it—the skull and vertebral column. A defect in the musculoskeletal system was believed to alter the flow of this energy and cause disease. Correcting the defect cured the disease. Defects were thought to be misalignments—parts out of place by tiny distances. Treating misalignments became a matter of restoring the parts to their natural arrangement by adjusting them.

As medical science advanced, defining causes of disease and discovering cures, schools of osteopathy adopted modern science, incorporated it into their curriculum, and redefined their original theory of disease in light of these discoveries. Near the middle of the 20th century the equivalance of medical education between osteopathy and allopathic medicine was recognized, and the D.O. degree (Doctor of Osteopathy ) was granted official parity with the M.D. (Doctor of Medicine) degree. Physicians could adopt either set of initials.

However, osteopaths have continued their emphasis on the musculoskeletal system and their traditional focus on “whole person” medicine. As of 1998, osteopaths constitute 5.5% of American physicians, approximately 45,000. They provide 100 million patient visits a year. From its origins in the United States, osteopathy has spread to countries all over the world.

Practice

Osteopaths, chiropractors, and physical therapists are the experts in manipulations (adjustments). The place of manipulation in medical care is far from settled, but millions of patients find relief from it. Particularly backs, but also necks, command most of the attention of the musculoskeletal community. This community includes orthopedic surgeons, osteopaths, general and family physicians, orthopedic physicians, chiropractors, physical therapists, massage therapists, specialists in orthotics and prosthetics, and even some dentists and podiatrists. Many types of headaches also originate in the musculoskeletal system. Studies comparing different methods of treating musculoskeletal back, head, and neck pain have not reached a consensus, in spite of the huge numbers of people that suffer from it.

The theory behind manipulation focuses on joints, mostly those of the vertebrae and ribs. Some believe there is a very slight offset of the joint members—a subluxation. Others believe there is a vacuum lock of the joint surfaces, similar to two suction cups stuck together. Such a condition would squeeze joint lubricant out and produce abrasion of the joint surfaces with movement. Another theory focuses on weakness of the ligaments that support the joint, allowing it freedom to get into trouble. Everyone agrees that the result produces pain, that pain produces muscle spasms and cramps, which further aggravates the pain.

Some, but not all, practitioners in this field believe that the skull bones can also be manipulated. The skull is, in fact, several bones that are all moveable in infants. Whether they can be moved in adults is controversial. Other practitioners manipulate peripheral joints to relieve arthritis and similar afflictions.

Manipulation returns the joint to its normal configuration. There are several approaches. Techniques vary among practitioners more than between disciplines. Muscle relaxation of some degree is often required for the manipulation to be successful. This can be done with heat or medication. Muscles can also be induced to relax by gentle but persistent stretching. The manipulation is most often done by a short, fast motion called a thrust, precisely in the right direction. A satisfying “pop” is evidence of success. Others prefer steady force until relaxation permits movement.

Return of the joint to its normal status may be only the first step in treating these disorders. There is a reason for the initial event. It may be a fall, a stumble, or a mild impact, in which case the manipulation is a cure. On the other hand, there may be a postural misalignment (such as a short leg), a limp, or a stretched ligament that permits the joint to slip back into dysfunction. Tension, as well as pain, for emotional reasons causes muscles to tighten. If the pain has been present for any length of time, there will also be muscle deterioration. The osteopathic approach to the whole person takes all these factors into account in returning the patient to a state of health.

KEY TERMS

Orthotics —Mechanical devices that assist function.

Prosthetics —Mechanical devices that replace missing body parts.

Other repairs may be needed. A short leg is thought by some to be a subluxation in the pelvis that may be manipulated back into position. Other short legs may require a lift in one shoe. Long-standing pain requires additional methods of physical therapy to rehabilitate muscles, correct posture, and extinguish habits that arose to compensate for the pain. Medications that relieve muscle spasm and pain are usually part of the treatment. Psychological problems may need attention and medication.

Risks

Manipulation has rarely caused problems. Once in a while too forceful a thrust has damaged structures in the neck and caused serious problems. The most common adverse event, though, is misdiagnosis. Cancers have been missed; surgical back disease has been ignored until spinal nerves have been permanently damaged.

Results

Many patients find that one or a series of manipulations cures long-standing pain. Other patients need repeated treatments. Some do not respond at all. It is always a good idea to reassess any treatment that is not producing the expected results.

Resources

ORGANIZATIONS

American Association of Colleges of Osteopathic Medicine. 5550 Friendship Blvd., Suite 310, Chevy Chase, MD 20815-7231. (301) 968-4100. http://www.aacom.org.

American Osteopathic Association. [email protected] http://www.am-osteo-assn.org.

J. Ricker Polsdorfer MD

osteopathy first developed from the 1870s onwards in America, under the initial inspiration and guidance of Andrew Taylor Still (1828–1917), who claimed to have discovered a revolutionary new system of healing and an associated therapeutic philosophy. These were based upon two related principal elements; that the healthy body already contained all the relevant capacities for maintaining itself, and that it thus did not need the drug-based remedies of the day. These views at that time were not original, but they were combined with Still's description of ‘osteopathic lesions’. These lesions, unless treated through his system of manual manipulation, were said to disturb the necessary internal balances of the body. Their occurrence became the controversial cornerstone of a distinctive osteopathic pathology. They were thought to be morbid alterations in tissue: muscular, osseous, visceral, ligamentous, or a combination of some or all of those in individual cases. In particular, osteopathic lesions were linked to inadequate articulation of the various parts of the musculo-skeletal system, particularly regarding the condition of the spinal vertebrae. In Still's view, improper articulation produced a disposition to various types of disease, by affecting the neurological system and the circulation of blood and body fluids which were essential to good health.

The social context of the latter decades of nineteenth-century rural America provided a supportive background for Still's beliefs and his related therapeutic evangelism. He was an ‘untrained’ medical practitioner by modern standards, but, as was common in his day, learnt medicine through apprenticeship to his father. He was in practice for many years in Missouri before becoming increasingly interested in bone setting in the 1870s in Kirksville. This was an ancient craft, and the prevailing medical ridicule of it had recently been brought into question. The distinguished London surgeon, Sir James Paget, had published an article, ‘On the Cases that Bone Setters Cure’ in the British Medical Journal. This was followed by Wharton Hood's book On Bone Setting (1871), published in Britain and America. Hood, a general practitioner, was interested in the movements of flexion and extension, combined with external pressure, used by bone setters for back injuries. As Gevitz, a noted historian of osteopathy, points out, at that time Still may have picked up and refined elements of practice which existed in his environment. At this historical point many of the more drastic drug and surgical remedies of conventional doctors did not inspire public confidence, and Still with his ‘new’ methods worked within a tradition of bone setting which was at least familiar to his rural patients. His mechanical theory of health and disease, of aligned and misaligned parts, akin almost to malfunctions of farm machinery, dovetailed nicely with the cultural beliefs of Still's patients.

However, this period was only the starting point of osteopathy's subsequent growth as a rival and different system of practice to medicine in the twentieth century. Still founded a school in 1892 in Kirkville, Missouri, and from this a small group of graduates went on in 1911 to found the British Osteopathy Association. In both countries decades of medical professional opposition to osteopathy followed, but these disagreements had very different outcomes in the two countries, both for medicine and for osteopathy. In the American case, conflict has led eventually to a kind of integration: a movement by practitioners from their initial adherence to Still's beliefs to broadly accepting those of orthodox medicine. Indeed, by the turn of the century the first osteopathic colleges were already teaching some of the medical pharmacopoeia of the day, and gradually pharmacology was brought into osteopathic education and practice. By the 1960s all restrictions on osteopathy as a one-time marginal cult were disappearing, leading to eligibility for medical residencies, and appointment to hospital medical staffs and to positions in the military and public health services. In this gradual process of absorbing and sharing of notions of scientific practice with orthodox medical practitioners, American osteopathic practitioners made manipulation a part rather than the core of their practice.

In Britain and its Commonwealth, professional developments between the two groups have been somewhat different, reflecting in turn their varying social and legal contexts. In Britain osteopaths sought in the 1920s and 30s to secure from the Government the right to practise as independent but different medical practitioners. Eventually this pressure led in 1935 to a Parliamentary Select Committee enquiry into their case, conducted adversarially between two different systems of philosophy and treatment. Eight hundred leading allopathic medical and biological scientists asserted that osteopathy disputed the very basis of modern medical and surgical practice, and that in particular osteopathic lesions could not be affirmed by any objective scientific scrutiny. The osteopaths were not successful in their case for licensing or state registration. Thus they practised under marginalized conditions outside of the National Health Service for forty years after its inception in 1948. By the early 1990s, however, much had changed. Osteopaths had practised successfully for decades as private practitioners; back problems were a major cause of absence from work and were recalcitrant to conventional treatments, and furthermore medical and public attitudes had changed. British osteopaths now presented themselves as complementary practitioners specializing in biomechanics and the manipulation of the musculo-skeletal system. Although extensively trained in basic medical sciences, they did not claim the wider competence of conventionally trained doctors regarding treatment as in earlier decades. In 1993 osteopaths in Britain gained state registration and formal recognition, not so much as an adjusted part of medicine as in America, but as skilled colleagues, akin to physiotherapists, specializing in rather than diminishing the role of manipulation in the treatments they offered.

Gerry Larkin

Bibliography

Gevitz, N. (1982). The D.O.'s: osteopathic medicine in America. John Hopkins University Press, Baltimore.
Wardell, W. (1994). Alternative medicine in the United States. Social Science and Medicine, 38 (8), 1061–8.