The 4 key principles of osteopathy

​Some of you may have been to multiple osteopaths and may have been surprised by how different your treatment has been.   It would be fair to say that osteopathy is a broad church!  If you had asked me, before I trained as an osteopath, what defined osteopaths I would probably have said, the type of treatment they offer and would probably have said specifically the use of high velocity thrusts, or, manipulations…because that was the kind of treatment I had from the osteopaths I had visited and I felt that was what was different from massage or physiotherapy.
 
But there are plenty of osteopaths who don’t use manipulations and, of course, Chiropractors use ‘adjustments’, which amount to the same thing…in fact they have probably been using them longer. 
 
What makes an osteopath, is more about how we think than any individual technique, or protocol and it is the philosophy that sets us apart from chiropractors, physiotherapists and other bodyworkers.
 
There are 4 key principles of osteopathy

1. The body is a unit.   - This is holistic medicine writ large.   Whereas we might use our diagnostic skills to try and identify which tissue is injured and which is causing symptoms, we almost never look at those in isolation.  What other tissues and postural factors are contributing to the dysfunction or are dysfunctional in response to the injury?  What effect do the patients activities, lifestyle, beliefs and social setup have that may be factors and may be helps or hindrances to healing.   When you come to most osteopaths the treatment may well be very widespread.  Your pelvis may well be treated for a neck problem, your knee pain may be due to an ankle dysfunction, your carpal tunnel syndrome may be because your pc monitor is too low and you have a scoliosis, this is not unique to osteopathy but the widespread application of this wider thinking really does set us apart 
2. The body is its own medicine chest - AT Still believed that the body contained capacity to heal itself from any disease and that our job was to remove impediments blocking that healing.  Our viewpoint has changed in the nearly 150 years since Mr Still coined the phrase and, as things stand I don't believe that the removal of musculoskeletal lesions is likely to cause cancer or other severe illnesses to reverse.  The American Osteopathic Association rephrases this as 'The body is capable of self-regulation, self-healing, and health maintenance'.  I would say this is nearer the mark.  For me the body is capable of more self-healing than we think and interventions to help improve musculoskeletal function and overall health are more powerful than we often give credit.  So, although we can't cure cancer (as far as I know) there is evidence that treatment to facilitate movement improves the bodies responses to diseases like pneumonia.  Another aspect of this is that osteopaths don't think of themselves as performing the healing change in the body rather they allow the body to heal itself.   This one is up for discussion at the moment, there is some evidence that actually the external impetus does make the change but certainly the 2 steps forward 1 step back nature of healing would suggest that any change we make need to be integrated by the body and that sometime that integration is an iterative process, so we need to understand and work with the body's own capacity to heal.
3.  Structure governs function - Actually we think of it as more reciprocal these days.  The way your body functions dictates what you can do.  A simple example is that if your muscles are too weak you can't lift something heavy but you might also think about a more complicated but common 'example.  If your shoulders are rounded then your shoulder blades tip forward, in that position your ability to open your arms out to the side is reduced because there are now bones (acromion processes) in the way, the top part of your arms is rotated inwards, so to hold your hands in a neutral position, you have to externally rotate your forearms, constantly doing that may cause the muscles that do that to be overused causing inflammation where they attach and maybe tennis elbow.  It works the other way also.  The more you use your muscles, the bigger they get, if they are pulling on bones harder, the bones get bigger.  A really good example is the skeletons of medieval archers who have much bigger, stringer bones in their arms and shoulders on the side they drew the bow.  Typically, as children function has a very big effect on structure, so the bodies we have as adults are very much laid down by the activities we undertook as children...and as we become elderly, we become proscribed in our activities by the condition of our bodies.  Putting this into practice, we can encourage change in structure by changing our activities, either by doing exercise or stopping doing something which is promoting an adverse structure, and by changing the structure of the body eg allowing shoulders to retract and arms to open out, we can increase the function. 
4. The rule of the artery is supreme.  This one is a bit contentious.  in the UK we think about it now as fluid dynamics be they blood, lymph or even the flow of blood to nerves are crucially important.  In the past it was taken to mean that arterial flow was more important than venous (which doesn't seem to hold much water as an argument). The American Osteopathic Association has completely replaced this one with 'Rational treatment is based upon an understanding of the basic principles of body unity, self-regulation, and the interrelationship of structure and function', which seems to me to be just a restating of numbers 1-3, and I think that is a shame.  Osteopathy today, as stated above does not stray much into the realms of systemic disease beyond supporting those who may suffer with it but it has a large role in treatment of peripheral nerve conditions, carpal tunnel, sciatica etcetera.  Where the nerve is trapped and painful it is usually the blood supply to that nerve which is compromised.   We should be clear with our principles that our work on joints, muscle tone and overall posture can have very real effects on nerve and blood supply and lymphatic drainage

There are plenty of other philosophical nuggets in osteopathy but these form the core..  None of them are unique, but taken together they form the basis of our values in practice

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