What is osteopathy exactly?
I still take a deep breath every time someone asks me what osteopaths do. I’ve never been able to formulate a standard answer, because I find osteopathy is hard to explain even to myself. I think I try to make people feel better. Using my hands and my brain. Usually because they’re in pain, or uncomfortable, or their function is affected by tension or strain. I use feeling too. I listen to them, try to be there for them, helping them to find their own way through whatever complexity or struggle is going on in their life, although I don’t venture into counselling territory. But the great general public usually sum us up as either “bones” or “backs”. Sometimes I just nod in agreement. It’s easier that way. I know that I’m not the only person who emerged from college confused about exactly what osteopathy is and what I was meant to be doing. And I discovered this week a fascinating new(ish) piece of research from the ESO which helps identify some of the different ideas we have about what we do.
This paper by the ESO’s Hannah Kasiri-Mantini and Phil Bright is ostensibly an exploration into osteopathic educators’ attitudes towards osteopathic principles and how to apply them. It is published by the Journal of Manual Therapy and I’d recommend you read it, even if just for their collection of interesting quotes, while access is free – that is, till February 23 2016. Members of the GOsC will always be able to find it via the o-Zone. It will give you a contemporary snapshot of the diverse views and opinions which make up our profession. The authors interviewed nine osteopathic educators, from different colleges and countries, and uncovered an internal conflict within our profession. It would be too much to call it a schism, but they sound to me like they are ringing an early warning bell, with their language of rifts, divides and polarisation.
And the problem is?
The problem stated is that to “remain as a respected healthcare profession” we need to clarify how OP (osteopathic principles) apply in clinical practice. So the principles need work – clarifying, reformulating, changing in some way – but this carries with it the mildly alarming statement that this might be 1) impossible or 2) divisive for the profession. The imminent demise of osteopathy has been predicted since its inception, but somehow there is life in it which has kept it going. We might be at yet another critical juncture.
What are OP (osteopathic principles) anyway?
I think we had a course when I was an undergraduate called osteopathic principles. I don’t know what I was expecting, but it wasn’t what we got. Someone called Irvin Korr was mentionned quite a bit, and the facilitated segment, and the viscero-somatic reflex, and we pondered on the relationship between structure and function. We also did really interesting courses in psychosomatics and psychology, but these fitted into the naturopathic triad more easily than the principles of osteopathy. Oh, and we learnt a lot of manual techniques. But this study illuminates the principles by drawing attention to the Kirksville Tenets.
I had never heard the phrase “Kirksville Tenets” till I read this paper, although their content is not unfamiliar, but apparently they consitute to some extent the principles of osteopathy. I have obviously been missing something though, because the subjects in this study were well-acquainted with them. Sounding a bit like a midwestern folk group (The Kirksville Tenets perform live tonight at the Grand Ole Opry!) , or even having overtones of religiosity, these were agreed in 1953, at a kind of summit meeting. (They are an update of a previous version whch was agreed in the 1920s.) Here they are:
|“The human being is a dynamic unit of function”|
|“The body possesses self-regulatory mechanisms that are self-healing in nature.”|
|“Structure and function are interrelated at all levels.”|
|“Rational treatment is based on these principles.”|
Elsewhere I have seen them stated in a different form. In a JAOA editorial from 2006; “the body is a unit, and the person represents a combination of body, mind and spirit”; a considerably more expanded statement which is critically distinct from the one above and implies a whole different scope for osteopathy.
Are osteopaths using the OP? Well, some are.
There is considerable difference over how and whether osteopaths are using these in practice. (Although the GOsC states we are meant to.) Some find them too nebulous, anachronistic and fluid (i.e.vague, out of date and changeable) to mean anything and don’t understand how they relate to clinical practice. Others are very keen on them and think they ARE osteopathy and feel guided by them the whole time. I have a tenet which guides me. I look for the health and not the disease. It sounds woolly, and comes from a famous Still quote, but is something that I feel I can apply in a philosophical, personal and a very direct practical way. I can’t even remember how I came to embrace this concept so completely, or even whether it is widely used in osteopathy. I feel it differentiates our model from the medical model and other manual therapy disciplines (for now…).
Different attitudes to OP represent two polarized concepts of osteopathy
So back to the big question: is osteopathy a philosophy? Or a manual therapy with an osteopathic philosophical background? The study indicates that osteopaths might be split into two camps with regard to the OP.
Dangerous to give them names, but chances are if you think osteopathy is at heart a philosophy, you probably think OP are essential, you think osteopathy goes deeper than science has yet understood, you think osteopathy has a very distinct identity, and you think the science should follow on from the philosophy. You probably see osteopathy as superior to the other manual therapy disciplines, and maybe find it hard to communicate your understanding of OP to the other camp. You probably think that abandoning traditional OP will weaken osteopathic identity and bring the risk that osteopathy loses its niche in healthcare. You would see a merge of manual therapy disciplines as the death of osteopathy’s distinct skills and approaches.
If you think osteopathy is primarily a manual therapy with a philosophical background, you probably think OP are an anachronism, and our clinging to them is a hindrance to forward movement. You might be influenced by your involvement with research. You might think that the other camp are more interested in how they would LIKE to define themselves, at the cost of patient satisfaction. You probably want osteopaths to think more critically, and consider if they are really doing what they claim to be doing, and you probably like evidence-based medicine. You might think that a merging of manual therapy disciplines would be a positive move in that we could all retain and share what we are good at, and emerge as a kind of super-skilled manual therapy profession.
So, what to do?
So do you identify with one camp? Or is this talk of division overstated? And assuming we all want to remain “osteopaths”, how are we all going to move forward, if we have such different notions of what we do? In two separate streams, or by finding a way to merge? There might only be nine osteopaths in this study, but they reflect pretty accurately the different views amongst osteopaths I am in touch with. A timely and revealing piece of research.