Osteopathy: Minor Orthopedics or Holistic Primary Care?

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Permalink Reply by Clement Rhein on June 18, 2008 at 2:57pm

Back to the roots, back to the roots, back to the roots! :-)

Still was a doctor, and patients came to him as they would go see their doctor. Patient go see their doctor for "all manner of health and disease". However, he treated them with osteopathy, not conventional medicine. that means that osteopathy CAN treat all manner of health and disease.

For me, the limiting factor is how the practitioner interprets osteopathy - the difference in thinking/belief generates the ability.

I think osteopathy can treat the whole system (I know I do, or try to), but the fact that we are primarily body workers/musculoskeletal therapist blurs this.

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Permalink Reply by James on June 18, 2008 at 3:02pm

As someone completely new to all of this and due to start my studies in September, my beginner's question would be this:
Can osteopathic treatment be successful and long-lasting without treating the whole system? Is the holistic element in fact the reason why it works so well and why patients don't have to keep returning month after month?

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Permalink Reply by Clement Rhein on June 18, 2008 at 5:01pm

Ah, but that's another question. Because some patients do return month after month to see their osteopath (try the ESO clinic ;-)). I think, Jamesey, that you're talking about "treating the cause, not the symptoms". If you treat the cause of the problem then the problem should not come back. If you treat the symptoms then things should get better but may well come back.

Here, i think the question is more about the complaints that patients come in with - musculoskeletal (back pain) or "organic"/"systemic" (abdominal pain, asthma, hypertension...).

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Permalink Reply by Nancy on June 18, 2008 at 9:53pm

Interesting debate, Jody (and one which I will follow....I have lots to say but little time to say it in). I like your post - hopefully it will entice some of the lurkers on the forum join in.

I agree with Clement, there are far more limitations to practitioners than to osteopathy itself.

Jody, if you don't mind I'd like to question a couple of your statements - clarifying them might also enhance this debate. Firstly, is it possible to "go back to our roots"? Our roots came at a time when medicine was very different. Also, the training of osteopaths included surgery and other aspects of healthcare/patient management which today we see as "medicine" not "osteopathy" (at least the UK trained osteopaths do). Are you suggesting that we reintroduce this into the osteopathic training? Or is osteopathy more the philosophy than the tools? Can it be completly "holistic" and "back to our roots" without these tools in our kit-bag.

You also said that we are "arguably best at dealing with" musculoskeletal problems. Are we? Do you mean “best” compared to our attempts at something which is not musculoskeletal or best compared to other practitioners attempts at treating musculoskeletal problems. If it's the first, I'm not sure that this is true of my practice - orthopaedic/musculoskeletal-type pain presentations are not where my expertise as an osteopathy lie. If it's the second then I think we would be arrogant as a profession to claim this - many other professions do also address similar problems with documented success.

This leads me to an important factor to consider in this debate. We need to think about osteopathy in the long-term. "sticking to musculoskeletal problems" makes us very acceptable to other healthcare practitioners. I think this is perhaps what we have seen over the past few decades and I believe that this has brought us great advantage in terms of regulation and recognition. However, I'm increasingly beginning to wonder whether as a profession (since others also treat some groups of our patients very effectively) we need to consider what makes us different/distinct from other professions. If this were business and we were talking about long-term survival of an individual business, we’d look to market the thing we do best which is NOT offered by other businesses. Offering a safe, effective non-pharmaceutical treatment of non-/orthopaedic/musculoskeletal problems could be a major selling point.

Also, osteopathy across the world is a "broad church". The WHO's efforts to include a broad spectrum of "osteopathy" in their definition is very encouraging. If a part of the profession looks at restricting practice in the a part of osteopathy which they do not practice, they are effectively safeguarding their own job whilst telling someone else they can't practice. I'm not prepared to tell anyone that they interpret osteopathy incorrectly...isn't there scope for the profession to embrace both those who "go back to their roots" (however they interpret "roots") and those who prefer to "stick to" the so-called minor orthopaedics? Do we need to have a battle? In this context, battles only happen when people arrogantly proclaim their opinion as more valuble than others'.

OK, I'm off my soap-box now....I’m not really argumentative or picking on Jody, I’m just hoping to encourage more debate.
Nancy

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Permalink Reply by Jody Jakob on June 19, 2008 at 8:29am

Hi Nancy!!
Great thoughtful reply.
I think you put the question into perspective. The problem that some osteopaths see is that in order to get recognition we are selling our soul to the devil....so to speak. We are forgetting what does make us distinctive and concentrating on minor orthopedic problems rather than really looking at the patient as a whole.
I think Still has been greatly misunderstoon mostly by modern osteopaths who see him as something of an embarrassment.
But if you look closely at the Stillian philosophy you will see that the Old Doctor was really interested in treating the whole patient by helping the movement of fluids throughout the body...and not only by banging things into place.
....
I agree with you that ostepathy can be a broad church that encompasses both views. And I believe that there does not have to be a battle..... but there is a battle because if we want to be even more recognized the powers that be will ask us to restrict our practice even more so that we become almost the same as a good physio or a good medic!!!
In the states the osteo's were recognized in exchange for giving up most of there principles!!! Hence the rise of Chiros.....
Are we in Europe headed the same way??

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Permalink Reply by Suzie Morgan on June 19, 2008 at 9:00am

I hope not.
I've just finished my first year at the BSO and although I know I still have a great deal to learn, the impression that I have got is that Osteopathy is going through a real crisis of confidence here in the U.K. It dosn't seam to think it has enough going for it to stand on it's own two feet seperate from the conventional system of health care. It wants to hang out with the popular kids in the play ground.

I worry that in getting through it's identity crisis, it's in danger of throwing the baby out with the bath water.
The way I see it we already have plenty in the conventional health care system doing as much as they can for paitents within thier own philosphy. If we allie ourself too closely with them, we arn't adding anything to health care, we are just doing more of the same.
I would prefere to be in a profession thats capable of thinking outside of the box and can add to what we already have.

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Permalink Reply by Nancy on June 19, 2008 at 7:42pm

Hi Suzie
I don't really think that there is a crisis of confidence in the real world of osteopathy. In reality, some osteopaths get quite worked up (maybe too much and this creating a certian amount of fear) about the politics of osteopathy and it's schisms, but most just carry on doing what they do well without really caring what may or may not be going on being the scenes (perhaps this is too much of a "head in the sand" approach).

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Permalink Reply by Jody Jakob on June 20, 2008 at 5:52am

Hi Nancy.....I can't afgree with you about no crisis of confidence.....I think there is. And because of that the powers that be are in the process of restricting osteopathic practice to the lowest common, acceptable to the government and the medical world, donominators.
There are highly successful osteopaths who are not concerned with this. But there are a mass of young graduates looking for jobs or starting practices who do not know which way to turn in order to be successful.

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Permalink Reply by Suzie Morgan on June 20, 2008 at 10:20am

It's interesting what you said about the real world of osteopathy mostly going about it's buissness and not really caring what may or may not be going on. That may explain why the BSO have highlighted this for us as new Osteopaths. Lots of 'you are the future and this will be your debate' stuff, but flippancy aside I found that I really do care and so do alot of my fellow students.
I can't see that limiting what Osteopathy can do, so as to fit within a majority veiw of health care is anything other then a lack of confidence. Lack of confidence towards each others chosen form of practice, how we should define ourself in a text book and wether we should stand with in or with out mainstream medicine and all it's restictions.
It would seam that we are all in agreement about osteopathy being a broad church(like that expression) and there should be room for all within.
My impressions are a little vauge though, and are limited to what I've been told at college and have read. I'm interested to know what the actual current situation is, not just give my impression. It's why I was excited to jump in on this debate.
Suzie

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Permalink Reply by Clement Rhein on June 20, 2008 at 11:25am

Perhaps, the strive to get more and more recognized is to make osteopathy for efficient (regarding patient management) and more available to people.
For example, being able to request medical investigation e.g an x-ray, without going through the GP (did I dream that or it's going to happen? I don't remember).
And being able to work in hospitals and treat within the NHS.

The problem being that objectivity is lacking. I think this means clarifying/reducing the definition of osteopathy (with evidence!) and therefore restricting our freedom of practice.

I think it would be amazing to be merged with the health care system and so so bloody beneficial for patients, if we didn't lose our freedom to practice offcourse (use whatever approach we want, treat whatever complaint we feel capable in treating...). This seems to be going back and forth.
For me, the biggest barrier is power-profit. Osteopathy gets people better, for good! "What? No drugs?! No more amazingly great profit by slowly making people more and more unhealthy?"

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Permalink Reply by Kuno on June 24, 2008 at 1:40pm

I can't see the point in training as an osteopath then working as a physiotherapist.

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Permalink Reply by Clement Rhein on June 25, 2008 at 12:22pm

Well, there's no point really, except have the potential of osteopathy, and therefore to do more that physiotherapy and so they may change their practice later in their life. They just missed to osteopathic concept. Perhaps the studies where too soon for them to be able to perceive the concept. Perhaps osteopathy is not for them, and they would have even enjoyed much more a physio course...

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