The one factor that unites many of the varied definitions of Osteopathy in the UK is that it is a therapy that manually treats the musculoskeletal system. The scope of treatments and working practices is very large, incorporating manual and physical therapy as well as verbal advice and instruction. The interaction between patient and practitioner is varied and complex.
Improving posture and stance can play a major role in Osteopathic treatment. It is widely accepted throughout the profession that posture plays a major role in not only musculoskeletal but also visceral function. Although the former maybe disputed with current research, on occasions in clinical practice this remains true. The disturbances to circulation resulting from low diaphragm and ptosis can cause congestion. Aging and gravity can cause abdominal tone to become decreased, there is a more likelihood of drooped chest, narrow rib angle, curved forward shoulders with the head extended and forward head posture.Physiological function can be impaired; muscles and ligaments are in an abnormal state of tension and strain. A correctly poised individual expends the least amount of muscular effort, and so may have more energy and a great likelihood of experience good health. As with many aspects of osteopathy this can be used as a preventative measure.
One form of therapy commonly offered by Osteopaths is the prescription of exercise techniques, the use of which are thought to reduce the length of treatment needed and improve patient outcome. These can involve breathing and stretching routines or muscle tone, flexibility and strength exercises. One commonly used exercise is diaphragmatic breathing technique. This enables efficient usage of the entire lungs and also aids in the setting up of a pressure gradient between the abdominal and thoracic cavities. This in turn could improve drainage of blood and lymph back to the thoracic cavity from the lower extremity and abdomen. This can also be a relaxation routine helping relieve stress or can be used to improved performance. Other exercises include core stability training which can help ease lower back pain. For example, improving the function of multifidus and transversus abdominus builds muscle endurance to help maintain an upright and efficient posture. Stretch exercises to release muscle such as piriformis are used to relieve tightness. Tightness of this muscle can cause gluteal and lower extremity symptoms. Rehabilitative techniques can also be used to re-establish neuromuscular control, restore range of motion or improving flexibility while regaining muscular strength after injury. Exercises can also be given to maintain cardiovascular fitness during rehabilitation, this is especially important for professional sports people.
Most osteopaths have an extensive anatomical and physiological knowledge; the passing on of this information to patients in a way that is clear and concise may be a beneficial part of the treatment process. Advice can be given on pain management, dietary issues and lifestyle choices as well as how best to prevent further injury. It must also be considered before offering advice to patients on what information the recommendation is based. The knowledge base may vary between practitioners, but any suggestions made must be totally justifiable with a sound, logical line of reasoning.
The interaction between patient and practitioner can in itself be therapeutic. There is evidence to suggest that the verbal expression of emotion and pain can influence the perception of pain. The process may produce a subjective perception of a therapeutic effect causing the patient to feel their condition has improved. Part of this effect may be due to placebo, but it may also be due to the role of the psyche in physiological health. Studies also show that carefully selected and presented information and advice about back pain can have a positive effect on patients’ beliefs and clinical outcomes (Burton et al,1999).
Communication with other individuals on a patient’s behalf is an essential part of the role of an osteopath, whether it is with parent of minors, carers, other healthcare professionals or employers. The Importance of the social environment for patient recovery after illness has been outlined by clinical studies (Berkman et al, 1993). It has been shown that treatment of disease and maintaining health is more effective in people with interpersonal relationships and support networks. Involving others such as carers, family or partners in the treatment and rehabilitative process to gain social support outside of a clinical setting is vital. If appropriate, communication with employers over working conditions could improve patient’s health. If a part of the working environment caused injury or is hindering improvement, changing these conditions will be to a great extent beneficial to a patient.
Interaction and consultation with other health care practitioners within conventional and complementary therapy must be considered part of the process of offering the best service to maintain optimum patient outcomes and health. For this to be effective it must be recognised which form of treatment is most effective for a specific pathology or injury. Monotherapy may not be appropriate for individual patients and a more open and integrated approach to healthcare should take into account biopsychosocial factors. A working understanding of other forms of treatment available is therefore essential for precise referral of patients. The limitations of each individual practitioner’s field of knowledge must be evaluated personally. This is outlines in the Code of Practice when it states that “recognising and working within the limits of your competence” is one of the roles of the profession (Code of Practice pg 3). Constantly using reflective practice, building of knowledgebase and keeping pace with medical advances is extremely important.
There are physiological assessments that can be used to evaluate patient heath by osteopaths. Taking readings of blood pressure, heart rate or even weight are increasingly important for patient wellbeing. The use of X-rays or other forms of imaging can be used if appropriate however imaging and scans do not always explain the source of pain. Other testing such as urine testing for diabetes, saliva tests for adrenal function or blood testing for a wide spectrum of pathology and diseases can be used to gain a broader understanding of patient presentations.
To conclude, use of exercise and rehabilitative techniques, as well as advice on posture, dietary and lifestyle issues are important tools that are used by osteopaths. Building on and communicating knowledge is beneficial to both patients and practitioner. So, although manual therapy plays a huge role in osteopathic practice, there are other aspects of treatment that can be equally beneficial to patients.
Berkman L, Vaccarino V, Seeman T, (1993) ‘Gender differences in cardiovascular morbidity and mortality: The contribution of social networks and social support’ Annals of Behavioral Medicine vol 15, pg 112-118.
Burton, A. K; Waddell, G.; Tillotson, K. M; Summerton, Nick M, (1999) ‘Information and Advice to Patients With Back Pain Can Have a Positive Effect: A Randomized Controlled Trial of a Novel Educational Booklet in Primary Care’Spine: Vol 24, Issue 23 – pg 2484.
Code of practice (2005), General Osteopathic Council, London