Osteopathy is a system and philosophy of health care that separated from traditional (allopathic) medical practice about a century ago. Osteopathy sharesmany of the same goals as traditional medicine, but places greater emphasis on the relationship between the organs and the musculoskeletal system.Osteopaths strongly believe in the healing power of the body and try to takeadvantage of that strength. They believe in treating the whole individual rather than just the disease.

Osteopathy was founded in the 1890s by Dr. Andrew Taylor, who believed that the musculoskeletal system was central to health. Chiropractic, a related health discipline, also emphasizes the importance of the musculoskeletal system. The original theory behind both approaches presumed that energy flowing through the nervous system is influenced by the supporting structure that encases and protects 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 adjustingthem.

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. Since the middle of the 20th century, the Doctor of Osteopathy (D.O.) degree has been considered equivalent to the doctor of medicine (M.D.) degree. However, osteopaths have continued their emphasis on the musculoskeletal system and their traditional focus on "whole person" medicine. As of 1998,osteopaths constituted 5.5% of American physicians, approximately 45,000. From its origins in the United States, osteopathy has spread to countries all over the world.

Osteopaths, chiropractors, and physical therapists all practice manipulations(adjustments). Back and neck pain are the main reasons patients come to these specialists for manipulation. The place of manipulation in medical care isfar from settled, but millions of patients find relief from it.

When a patient comes to an osteopath with pain, the first step is to determine the cause of the pain. It is important to rule out serious conditions suchas cancer and brain or spinal cord disease. Once it is clear that the pain isoriginating in the musculoskeletal system, manipulation may be appropriate.

Techniques for manipulation vary among practitioners. Most try to get the muscles to relax first. This can be done with heat, medication, or 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" isevidence of success. Others practitioners use steady force until relaxation permits movement.

Returning the joint to its normal position may be only the first step. If a misalignment is due to a short leg, for example, a patient may need a lift inone shoe. Longstanding pain may have caused muscle deterioration. In that case, additional methods of physical therapy may be necesssary to rebuild muscles, correct posture and change habits that the patient developed to compensatefor the pain. Patients may also be given medicines to relieve muscle spasmsand pain.

Manipulation has rarely caused problems. Once in a while too forceful a thrust has damaged structures in the neck and caused serious damage. The most common adverse event, though, is misdiagnosis. Cancers have been missed and serious back problems that could have been corrected by surgery have been ignoreduntil spinal nerves have been permanently damaged.

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