Is osteopathy a medical science or does it have a different perspective on health, function, dis-ease and therapeutic aims and modalities?
To help people understand how osteopathy may differ to other forms of manual therapy, and also why many osteopaths seem to work differently to each other, a look at healthcare philosophy should help.
Modern science approaches understanding by looking at things objectively - research separates the object (such as a part of the body, a cell, a structure, a chemical process, a drug for example), and studies it remotely so that the research person can't influence the results (this is called reducing bias and helps improve the accuracy of what in observed in that part / object).
This has lead to many very important discoveries about how the body works and how people can be helped, and osteopaths certainly incorporate this type of knowledge into practice. However, there are limitations, especially in biology and the study of the living person - everyone is not just a collection of parts, and everything has to function together. This make the strict application of science more complex.
Often from a strict science point of view, when someone gives a treatment (whether this is prescribing a drug, or giving hands on care) the person delivering the treatment should be neutral, not 'involved' so that every practitioner can deliver the 'same' treatment, so it is unbiased and not affected by the practitioner's views (whether a doctor, surgeon or osteopath, for example). This is called working in a positivistic paradigm. But, it is known that it is virtually impossible to remove the context and interpersonal dynamics operating when someone seeks help and care from any practitioner or therapist, so healthcare is never 'neutral'. Acknowledging this requires a different paradigm - relativism.
This approach also has a tendency yo depersonalise medicine, and often people feel they are not viewed individually, nor listed to or 'heard'. This requires a shift of thought about the influence the person and their context has on their problem -and what their problem means to them, which can't be easily assessed in a strict experiment - where factors such as personal views, other diseases or problems the person have, and their social context are all deliberately 'excluded' and separated out from the thing being studied. As a result, this means the approach to experiments, research and science is not fully capturing what is relevant to an individual patient, and depersonalised medicine is giving them same thing to everyone, with mixed results. Understanding knowledge and what is relevant to the individual again requires a paradigm shift towards interpretivism - so that the individuals perspectives can be taken into account.
So, whilst many people are definitely helped by a positivistic science research approach, many require some adjustment to research efforts and needs different evidence to inform practice, as there is usually more than one way of looking at things (and this approach requires a post-positivistic paradigm at the very least).. So in order make their care individual to them, and have it delivered in a way that is supportive of them, their perspectives, social and emotional context, culture and overall health status must be considered some that something can be put together that makes care more effective for that person. This is constructivism. And when considering those other perspectives, the individuals all experience their own perspective, and have their own interpretation of events, what was said, what it means, how their view things. So, researching all that means taking an interpretivist method / approach, and it examines the phenomena that the people experience (and one approach to this study is called phenomenology)
But its also necessary to make sure that the advice and care suggested in plausible (for example someone might not be able to afford to go to a gym to get exercise, and an alternative must be considered). This is called pragmatism, and when we put all this together it means we have to take a critical reflection back over what science tells us, what the patients perspectives tell and what the context is, so that a the most inclusive consideration can be given to care solutions. This requires a critical theory / critical realism paradigm.
So, it can be seen that the strict application of science and its methods (form positivism) is not the only approach that effectively informs practice and healthcare - there is more than one 'truth' to what is needed in any given clinical situation, and for any individual patient.
There are some other factors to consider in determining how someone should be treated - and that is to do with how disease, dysfunction and changes to health occur. Basically, this can vary from 'disease comes from the outside' - such as a bacterial infection - the bacteria is to blame. But, this is also countered by ideas that if the person / their tissues are unhealthy (such as through eating a high fat diet, or having high blood pressure or being unfit, or having poor fluid drainage in the tissues) means that deep down the tissue are unhealthy from 'within' and so the bacteria can get more of a hold that in a fully healthy person. So, do you treat the bacteria or treat the person's tissues / help them with diet, exercise and tissue drainage, for example? Or both? Then there are the concepts that recognise how emotions and stress can impact on our physiology and biology, and make us weaker and less efficient as functioning humans - meaning our stressors (be they external / social to us, or part of our emotional and mental make-up) can also change the way our body's natural defences work - making us less efficient at combatting bacteria for example, or even making those defences turn against us, creating disease even without bacteria or viruses being present.
These discussions about what health is and about science, what causes disease and dysfunction, and how it should be researched, have been going on for millennia, from Socrates (e.g. the Hippocratic Oath that Doctors take), through Aristotle, to Newton, Descartes, Pasteur and many others all contributed to an understanding of health and science. A nice timeline, developed by the National Portrait Gallery
(A PICTURE OF HEALTH A timeline of pioneers in medicine, health and social reform (1840 - 1920)) is a nice summary pf some of the major milestones in more modern understandings of heath is a nice read if you are interested.
Theories of disease have ranged from the Four Humors, Miasmas, Supernatural theories, Terrain theory, Toxicology, Germ theory, Microcirculation theories, Bioelectrical theories, Metaphysical theories, Genetic theories, Vitalism theories, Eastern and Chinese, Indigenous and Traditional cultural theories, and more.
So where does Osteopathy fit into all this, and what concepts does it have for health and disease? (Please see the separate blog posts on the history of osteopathy and its founder Andrew Taylor Still, and the concepts of health and principles of osteopathic practice).
Osteopathy derives from a mix of cultures and contexts, which blends spiritual, physiological, physical and natural medical approaches as an alternative to the healthcare practices of the early American era in the 1800-1850's and onwards. For a detailed blog on the osteopathic philosophical traditions, try this website by Registered Osteopath Walter Mckone He explains the tradition of osteopathic healthcare is related to the branch of science and enquiry that links Goethe to the founder of Osteopathy, A.T.Still, and reaches forwards into knowledge and methodology for research and understanding which is phenomenological and uses intuitive dynamics as well as utilising some scientific / western medical approaches. In placing osteopathy as part of a longer tradition that was sidestepped somewhat by western medical approaches (from Descartes onwards) it means that osteopaths value the contributions of the practitioner as vital in negotiating and determining what help to offer a person and how to engage and interact with them in a hands on manner.
Specfically it is not possible to separate the osteopath from the hands on care given and each osteopath even if feeling and touching the same person will interpret that person differently. The two - practitioner and patient together are a meeting point for a therapeutic approach that that practitioner perceives within the persons tissues as a way of supporting that persons health, physiology, emotions and function. R=This means that many osteopaths may focus on differing elements from wtihin the presentating persons tissues - and there is a common understanding that many phenomena in the patietns body may be detectable, and the ostoepath evaluates which way and which ones they themsleves can interact with. So, whilst tests such as using a reflex hammer, or taking an xray or ultrasouns, or listgening to the heart may show the same things regardless of who is doing the test, when one puts hands on, from an osteopathic perspective, each practitioner is only able to intract in a way guided by the phenomena as they see it in that patient.
So, this means it is expected that each osteopath hands on will vary, and as it is a social practice of healthcare - the interaction between the two individuals - patient and practitioner make a unique combination - so each osteopathic interaction cannot be replicated by another practitioner - as that makes a new social group - and those two people will interact on different levels and in different ways. This makes the practice of osteopathy a practitioner-centred approach, as the skills and perceptions of the individual practitioner are key to how they can interact with a person - the practitioner cannot be separated from the practice.
But, the health care that osteopaths give are not just arbitrary, and up to the whims of the practitioner - all osteopaths work according to the principles which are to help support the natural healing processes in the persons body, to help them self-regulate, and to find any barriers to function and health expression that may reside in their body.
Osteopaths can also interact by discussing understanding the patient experience, their expectations, their social and work contexts, give exercises, nutrition advice, referral advise for emotional or mental issues if required,. In this way osteopaths respect a patient focused practice, whilst enactive and negotiating case based on the practitioner perceived interpretation of that persons body / mind / spirit.
Osteopaths have an extensive training in general medical anatomy, physiology, pathology, neuroscience, understanding of the endocrine and immune systems and so ae aware of screening for factors that may require investigating by medical or other health professionals. But, they view all of these as a whole, and approach care based on the function of all the parts together, not separated out into discrete parts.
Osteopaths strive not to separate out their understanding into systems, eg viewing the muscles as separate from the organs or the blood vessels - they take a a whole approach - where the whole is more than the sum of the parts, and where if you hold one part, you can see all the other parts within that one contact. This is like a hologram, and is a different thing from integrative medicine, which seeks to combine things.
Working with a concept of the whole means utilising a different philosophical approach to diagnosis and therapy than traditional western medicine. Osteopaths therefore combine an understanding of western medical approaches, to screen out pathology and significant trauma, but then they bring their own perspectives based on osteopathic principles into how that person can be helped.
If you explore the other blog posts / information sections on the website you can see how this may be relevant in a wide variety of clinical presentations, and the information will help you gain insight into how osteopaths view various problems, and how they might approach helping in different situations.
Please note that not all the osteopathic ideas an concepts discussed on this website are fully evidenced or researched, but it is hoped that by sharing the conceptual framework for osteopathic practice patient and other health professionals can get a better understanding of what osteopaths are seeking to contribute - to the theory of health and healthcare, as well as to the support of individual patients.
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