OSTEOPATHY is a comprehensive system of healing based upon a clinical philosophy that utilizes a hands-on form of manual medicine called Osteopathic Manipulative Treatment or OMT. Osteopathy was discovered and developed by a frontier physician named Andrew Taylor Still in the late 1800s. Osteopathy is not just a system of manual medicine; it is a practical and intelligent means of being with a patient in a holistic way.

Osteopathy is an applied clinical philosophy. Osteopaths are clinicians who treat patients with a wide variety of medical problems. We are taught to think Osteopathically when treating a patient. To think Osteopathically is to recognize how the body is connected in health and disconnected in the presence of disease. To think Osteopathically is a sensible way of applying the philosophy of Osteopathy in a clinical setting.

My goal in creating this document is to convey the essence of Osteopathy and consider the specifics of a historically accurate set of guiding principles that are in agreement with traditional Osteopathic philosophy as advanced by A. T. Still.

Osteopathic Philosophy

Osteopathy recognizes that the body has almost infinite possibilities. The body has the ability to self-repair and self-regulate in the presence of disease and injury. During an Osteopathic Treatment, we access the forces of self-repair through the connection made between our hands and the patient’s body. From a therapeutic point of view, Osteopathy is a method of treating disease in which the healing agents are the natural fluids and forces contained within the body itself. In essence, Osteopathic Treatment utilizes the materials and methods from life itself to do the work of healing.

Before we can effectively treat, it is imperative that an accurate diagnosis of what is wrong is made. It is not enough to just find what is diseased. Disease includes acute or chronic injuries, any illness or infectious disease, and broadly consists of disorders or disruptions of normal bodily functions. It is crucial that the cause of disease is found so that each treatment becomes precise and anatomically specific.

As originally taught in the late 1800s, Osteopathy aimed to give a new definition of the causes of disease and then offered an innovative method of treatment. Osteopathy looks at disease from a different viewpoint. From an Osteopathic perspective, many illnesses are caused by structural distortions within the musculoskeletal system, which by pressure, obstruction, or interference produces or maintains change in the natural environment of the body. Disease is maintained by a distortion of this body-wide ecosystem which then can deform the structure (anatomy) creating a vicious cycle of abnormality (a self-feeding loop of disarray leading to amplified disease). Many illnesses begin as a slight mechanical disorder, which then creates an abnormal local tissue environment, ultimately disrupting holistic equilibrium. Disease is a signal of imbalance or a lack of homeostasis.

Homeostasis is a biologic term that is defined as the ability of an organism to maintain a normal internal stability by constantly regulating its coordinated physiologic processes in the presence of environmental changes. It is the nature of a human being to keep functioning at an optimal level despite changes in the internal or external environment. Homeostasis employs a sophisticated set of feedback mechanisms to maintain this dynamic equilibrium of a self-regulating system.

A healthy body is united in a dynamic state of connected oneness. Taken as a whole, the body is greater, stronger, and more durable than any of its parts. When the body begins to function as a collection of parts, rather than an interconnected communicating whole, the entire being is adversely affected. When the body no longer functions holistically, it can lose its ability to compensate or self-regulate. Thus, the body becomes stuck, it is no longer in equilibrium, and disease dominates rather than homeostasis.

The Osteopathic Lesion

The original term for these structural distortions, mechanical disorders, disruptions of holistic equilibrium, inability to compensate or self-regulate, impaired actions, imbalances, obstructions, and abnormal local tissue environments was the Osteopathic lesion. From a historical perspective, an Osteopathic lesion (commonly referred to as “the lesion” or “lesion complex”) is simply a localized defect in structure and homeostasis, which is fundamentally a failure of biological communication. The “modern” term, somatic dysfunction, as demarcated by professional Osteopathic societies in America is, I believe, too limited in scope to fully describe the disorders of structure and homeostasis that occur in a human being. Not all lesions occur in the somatic elements (commonly thought of as bone, muscle and connective tissue). The Osteopathic lesion can be found in the non-material elements or in distortions of expression of the inherent forces of healing. Therefore, the treatment of only somatic dysfunctions is limited and does not allow for a comprehensive Osteopathic approach.

Local lesions can have global implications and larger illnesses can affect specific anatomic areas. In other words, the body can become “sick” in a specific location and then distort the entire organism. Or, the body can have a generalized illness that disrupts the localized anatomy causing secondary problems. The body is connected in health. The opposite is also true, dysfunctional structures can link up to distant areas of the body in an interrelated web of distortion that can become anatomically complex.

Sometimes an Osteopathic Treatment begins by working backwards, tracing the end point of a long thread of distortion and layered compensations that eventually leads to the originating cause.

The Issue of Pain

It is important to note that in the Osteopathic model, pain is not by itself a disease. Pain is a symptom. Pain is a signal of disorder, dysfunction, disarray, or a disturbance in homeostasis. Pain is a warning sign that has many different meanings. Often the true cause of pain is far away from the place where it hurts. Our goal as Osteopaths is to find and treat the dysfunctional connections that truly cause the pain rather than trying to relieve the symptomatic and localized expressions pain.

Osteopathic Treatment as an Expression
of Osteopathic Philosophy

We utilize the bones, muscles and connective tissues as dependable landmarks to locate and define disease and they are used in treatment as levers and handles to secure motion and restore normal function. The musculoskeletal system provides a reliable window into the body’s complex relationships. We also connect with “non-material” (non-physical) elements that are the forces of self-repair accessed during a treatment. These non-material forces also shape the insidious compensations found in dysfunction or diagnostically are perceptually decreased.

Dr. Still classified his perceptual fields between what he called the “material and non-material” and the “visible and the invisible.” The material field is composed of biomechanical elements, palpable anatomy, and physical forces that can be measured in the human body. Every Osteopath works with the material through the musculoskeletal system using the principles of biomechanics and by having a thorough understanding of applied anatomy. Material education forms the overt foundation of every Osteopathic school.

His use of “non-material” and “invisible” was defined as having no physical substance or not consisting of matter. His definition of non-material and invisible refers to the metaphysical aspects of what it means to be a human being. The non-material is based upon subtle function or inherent forces rather than physical anatomic structure. It represents a field or matrix that is not palpable but can be perceived by what I call other-sensory perceptions. These subtle inherent forces of healing include the rhythmic tides discussed in Cranial Osteopathy, and the non-rhythmic dynamic forces such as the “Potency of the Tide” and “The Health.”

Osteopathic Treatment is Simple

What makes Osteopathy different than other healing arts is that the Osteopath does not utilize disease as a reference point, but actively engages what is healthy and vital as the therapeutic organization for healing. Healing emerges from the Health in the body not from the disease.

Osteopathic Treatment is really very simple.

• First we identify the subtle forces of what are healthy in the body.

• Through the diagnostic process we find the lesion.

• By using Osteopathic Manipulation we match the power behind
  what is healthy with the dysfunction.

• Finally, we consciously let nature do the real work of healing.

This simple formula is applied when offering subtle treatments, like Cranial Osteopathy, and is also utilized when performing more physical treatments, like direct myofascial release or muscle energy. This fundamental philosophic approach transforms a technique into an interconnected holistic event.

The Inspiration Behind an Osteopathic Treatment

For me, Osteopathic Treatment is a comprehensive approach to health care. I capitalize the ‘T’ in Treatment to note this word as a distinctive term. Osteopathic Treatment implies the inseparable interrelationship between Osteopathic philosophy, palpation and perceptual skills, and Osteopathic Manipulation. Together these three components form the heart and soul of what it means to be an Osteopath.

There is another aspect of Osteopathic philosophy that has never been recorded in the written literature and is passed down from teacher to student over four generations of Osteopaths. It is not a technique and it is not a defined principle. Palpatory and perceptual skills form the other Osteopathic system and is the third leg of the proverbial three legged stool of Osteopathy. Osteopathic philosophy and Osteopathic Manipulation cannot stand alone without the stability provided by these palpatory and perceptual skills. The finely tuned palpatory and perceptual training of an Osteopath allows for us to make an anatomically specific diagnosis and to engage the Health and the “unnamed forces of healing.” It is difficult to even call this process a principle of Osteopathy, but the perceptual training that occurs in developing an accomplished Osteopath is inextricably linked to being able to apply the practical clinical philosophy of Osteopathy. We learn basic palpatory skills in Osteopathic medical school but we earn more complex and subtle perceptual skills from the transmission of an unwritten “secret language” from our teachers in a hand-to-hand form of communication that can be traced back to the first Osteopath—Andrew Taylor Still.

Introducing the Guiding Principles of Osteopathic Philosophy

I have extensively scrutinized all of Still’s written works. I have studied his life and times. I have explored the writings of each of his closest students in order to gain an idea of how they prioritized Osteopathic philosophy. I have also researched 19th century medicine to attempt to understand the context from which Still’s ideas emerged. I consider myself an Osteopathic historian and translator of the work of A. T. Still.

I believe that to define, or at the very least adequately describe, Osteopathic philosophy we must connect to the traditional roots and values taught by the founder of Osteopathy.

Listed below are the key guiding principles of traditional Osteopathic philosophy as taught by A. T. Still. I have attempted to stay historically accurate and at the same time provide a concise illustration of his ideas that form the foundation of our work as Osteopaths in the 21st century.

These guiding principles form broad categories of Osteopathic philosophy and provide a list of most common values that motivates every Osteopath. I have then interpreted his teachings and made them more understandable.

• As human beings we are part of the Natural World. The term “Nature” is a broad representation of the inherent forces of healing contained within the human body and psyche. Nature refers to the therapeutic processes that self-regulate, sustain physiologic order, allow for moment-to-moment adjustments, and guide the body toward harmony and healthy adaptation.

• A. T. Still spoke of the “unnamed forces of healing,” which are generated from Nature and he generically referred to them as the Attributes of Life. They are the subtle forces of Nature that every Osteopath works with to assist a patient in their processes of healing.

• The most accessible of the Attributes of Life is “the Health.” Health is perfection and harmony. Health is an expression of holism. Health is a distinctive biologic matrix within a living being that interfaces with every aspect of structure, function, and the totality of all psychologic processes. Health, not disease, is the true reference point for every Osteopathic Treatment. Healing is derived from what is healthy in each individual.

• Holism, in the Osteopathic sense, was traditionally called: connected oneness, harmony, united in form and function, or the whole being, the whole person, and the whole body. The goal of an Osteopathic Treatment is to help the patient achieve harmony or connected oneness—or what we now call holism.

• The concept of Normal permeates Osteopathic philosophy at nearly every level. To truly understand diseaseor the abnormalwe must first have the many experiences of what is normal, or healthy and holistic. Normal is synonymous with Health and holism and it is also the anatomic and physiologic normal found during a physical examination or in the tangible measurements found in laboratory tests, x-ray exams, or other objective studies.

• The study of anatomy is a priority in the practice of Osteopathy. The development of a successful and skilled Osteopath requires a lifelong commitment to increasing our anatomic knowledge. Appreciating the applied anatomy of a patient’s structure allows for greater specificity in treatment and therefore an increased likelihood of positive outcome for the patient. When I treat, I “see” the patient’s unique anatomy with my hands. The normal anatomy and the contrasted dysfunctional version of anatomy comes alive in my hands allowing me to offer a specific and unique treatment for every patient.

• Restoration of motion is elemental to an Osteopathic Treatment. We use our hands to find anatomically specific areas of restriction in the tissues and in the non-material elements. We apply a patient-specific Osteopathic Treatment to help restore motion so that Nature can then do the true work of healing. The restoration of motion allows for the self-healing mechanisms to perform the necessary correction and re-establish normal function and anatomic relationships.

• The equilibrium of structure and function is a key principle in the clinical philosophy of Osteopathy. Structure, or anatomy, and function, or physiology are interrelated and inseparable. Function relates to how the body works through the vehicle of structure. When structure, especially the skeletal and myofascial systems are distorted, then normal physical function is altered creating the earliest context for disease.

• The body is a living machine motivated by the forces of Nature. Many of the principles of physics that govern inanimate machines can be applied to a biologic model. The musculoskeletal systemwhich includes bones, muscles, and connective tissues—has an intimate impact on the functioning of the entire human being, including the body and the psyche. Addressing these biomechanical imbalances in the tissues by utilizing Osteopathic Manipulation, we can normalize distorted anatomic relationships and restore optimal function.

• Before an effective Osteopathic Treatment can be offered and accurate diagnosis must be made. Identifying the true cause, or causes, of a problem is indispensable. Effects are symptoms. Osteopathy is a health care system based upon treating the cause rather than only attempting to address symptoms. Pain is only a symptom and is not a disease. To only treat pain is to apply therapies to effects and not to arrive at the origins of what is causing pain. Often the cause is distant from the symptoms. Frequently the originating cause initiates an interconnected web of dysfunctional compensations that create disabling disease. Osteopathic Treatment addresses the complicated organization of disease by linking the compensations and removing the obstructions to healing.

• Osteopathic clinical philosophy is applied by the use of Osteopathic Manipulative Treatment to restore unobstructed flow of all fluids in the body (blood, lymph, cerebrospinal fluid, and extracellular fluid); to resolve the fascial strains that distort skeletal and muscle function; to help coordinate the normal functioning of the nervous system; to directly treat the dysfunctions found in the viscera and to indirectly treat it via neurologic reflex mechanisms; and finally, to utilize the bones as the doorway to treating both superficial and deep structures within the living human body.

• Finally, Osteopathy for me is a way of Life. The Foundation Stone upon which Osteopathy stands is conforming to and working with the Divinity present in each and every human being. Respect for the Unknowable and the Infinite guides every Osteopathic Treatment. Each Osteopath practices their unique, and personal, expression of spirituality and interweaves it within the totality of Osteopathic patient care.

In Conclusion

It is difficult to provide a concise definition of Osteopathy. A. T. Still did not organize the philosophy of Osteopathy into a neat package. He alternated between being very specific and quite vague in his written works. His direct students each heard a different aspect of his teaching and also did not organize his complex principles of treatment into a systematic treatise.

Over the past 100 years many individuals and organizations have attempted to arrange Osteopathic philosophy into a simple and brief statement. This effort, often by committee, has unfortunately created definitions that are overly simplified to the point of being ineffective and are historically inaccurate.

Osteopathic philosophy is multifaceted interconnected set of biologic principles that cannot be defined in just a few sentences. Osteopathic philosophy intelligently directs the techniques used in Osteopathic Manipulation, transforming what appears to be a manual procedure into a magnificent therapeutic event.