Osteopathy

Osteopathy is a type of alternative medicine that

emphasizes physical manipulation of muscle
tissue and bones.[1][2] Practitioners of
osteopathy are referred to as osteopaths.[3][4][5]
Its name derives from Ancient Greek "bone"
(ὀστέον) and "sensitive to" or "responding to"
(-πάθεια).[6][7][8]
 Osteopathy

OMT technique for the treatment of impotence in the

1898 "Osteopathy Complete" manual

Alternative therapy

Benefits Placebo

MeSH D026301

ICD-10-PCS 7

ICD-9-CM 93.6

The UK's National Health Service says there is

"limited evidence" that osteopathy "may be
effective for some types of neck, shoulder or
lower limb pain and recovery after hip or knee
operations", but that there is no evidence that
osteopathy is effective as a treatment for health
conditions unrelated to the bones and
muscles.[9] Others have concluded that there is
insufficient evidence to suggest efficacy for
osteopathic style manipulation in treating
musculoskeletal pain.[10]

Osteopathic manipulation is the core set of

techniques in osteopathy and osteopathic
medicine.[11] Parts of osteopathy, such as cranial
therapy, have no therapeutic value and have been
labeled as pseudoscience.[12][13] The techniques
are based on an ideology created by Andrew
Taylor Still (1828–1917) which posits the
existence of a "myofascial continuity" – a tissue
layer that "links every part of the body with every
other part". Osteopaths attempt to diagnose and
treat what was originally called "the osteopathic
lesion", but which is now named "somatic
dysfunction",[11] by manipulating a person's
bones and muscles. OMT techniques are most
commonly used to treat back pain and other
musculoskeletal issues.[11][14]

In the United States, the training of osteopathic

physicians (who practice osteopathic medicine)
has become substantially similar to that of
regular physicians.[15] While osteopathic
manipulation is still included in the curricula of
osteopathic physicians, and is promoted as a
unique aspect of DO training, this has been
described as nothing more than "'extra' training
in pseudoscientific practices".[16] Osteopathic
medical schools also tend to be weaker than MD
schools with regard to research and the
understanding of scientific inquiry.[17][18][19] In
other countries, training may focus primarily on
osteopathy and does not include a standard
medical education,[20] with graduates being
referred to as "[non-physician] osteopaths". The
government policy and legal framework in which
practitioners operate vary greatly from country to
country.

History

Andrew Taylor Still in 1914

Osteopathic medicine was founded by Andrew
Taylor Still, a 19th-century American physician,
Civil War surgeon, and Kansas state and
territorial legislator.[21][22][23][24] He lived near
Baldwin City, Kansas at the time of the American
Civil War and it was there that he founded the
practice of osteopathy.[25] Still claimed that
human illness was rooted in problems with the
musculoskeletal system, and that osteopathic
manipulations could solve these problems by
harnessing the body's own self-repairing
potential.[26] Still's patients were forbidden from
treatment by conventional medicine, as well as
from other practices such as drinking alcohol.[11]
These practices derive from the belief, common
in the early 19th century among proponents of
alternative medicine (then called "irregular
medicine" or "unorthodox medicine"), that the
body's natural state tends toward health and
inherently contains the capacity to battle any
illness.[27] This was opposed to orthodox
practitioners, who held that intervention by the
physician was necessary to restore health in the
patient. At the time Still established the basis for
osteopathy, the division between irregular
medicine and regular medicine had already been
a major conflict for decades.[28]

The foundations of this divergence may be

traced back to the mid-18th century, when
advances in physiology began to localize the
causes and nature of diseases to specific organs
and tissues. Doctors began shifting their focus
from the patient to the internal state of the body,
resulting in an issue labeled as the problem of
the "vanishing patient".[29] A stronger movement
towards experimental and scientific medicine
was then developed. In the perspective of the
unorthodox physicians, the sympathy and holism
that were integral to medicine in the past were
left behind. Heroic medicine became the
convention for treating patients, with aggressive
practices like bloodletting and prescribing
chemicals such as mercury, becoming the
forefront in therapeutics.[30] Alternative medicine
had its beginnings in the early 19th century,
when gentler practices in comparison to heroic
medicine began to emerge. Homeopaths,
Thomsonians, and hydropaths practiced
unconventional forms of healing that may have
had strong appeal to patients due to their more
attenuated practices.[29] As alternative medicine
grew to include more followers, orthodox
medicine continued to rebuke and seek to
invalidate the "irregulars," as termed by the
orthodox practitioners in heroic medicine. As
each side sought to defend its practice, a schism
began to present itself in the medical
marketplace, with both the irregular and regular
practitioners attempting to discredit the other.
The irregulars — those who are now referred to
as Alternative Medicine practitioners — argued
that the regulars practiced an overly mechanistic
approach to treating patients, treated the
symptoms of disease instead of the original
causes, and were blind to the harm they were
causing their patients. Regular practitioners had
a similar argument, labeling unorthodox
medicine as unfounded, passive, and dangerous
to a disease-afflicted patient.[31] This is the
medical environment that pervaded throughout
the 19th century, and this is the setting that Still
entered when he began developing his idea of
osteopathy.

After experiencing the loss of his wife and three

daughters to spinal meningitis and noting that
the current orthodox medical system could not
save them, Still may have been prompted to
shape his reformist attitudes towards
conventional medicine.[32] Still set out to reform
the orthodox medical scene and establish a
practice that did not so readily resort to drugs,
purgatives, and harshly invasive therapeutics to
treat a person suffering from ailment,[27] similar
to the mindset of the irregulars in the early 19th
century. Thought to have been influenced by
spiritualist figures such as Andrew Jackson
Davis and ideas of magnetic and electrical
healing, Still began practicing manipulative
procedures that were intended to restore
harmony in the body.[33] Over the course of the
next twenty five years, Still attracted support for
his medical philosophy that disapproved of
orthodox medicine, and shaped his philosophy
for osteopathy. Components of this philosophy
included the idea that structure and function are
interrelated and the importance of each piece of
the body in the harmonious function of its whole.

Still sought to establish a new medical school

that could produce physicians trained under this
philosophy, and be prepared to compete against
the orthodox, or allopathic, physicians. He
established the American School of Osteopathy
on 20 May 1892, in Kirksville, Missouri, with
twenty-one students in the first class.[34] Still
described the foundations of osteopathy in his
book "The Philosophy and Mechanical Principles
of Osteopathy" in 1892.[35] He named his new
school of medicine "osteopathy", reasoning that
"the bone, osteon, was the starting point from
which [he] was to ascertain the cause of
pathological conditions".[36] He would eventually
claim that he could "shake a child and stop
scarlet fever, croup, diphtheria, and cure
whooping cough in three days by a wring of its
neck."[37]

When the state of Missouri granted the right to

award the MD degree,[38] he remained
dissatisfied with the limitations of conventional
medicine and instead chose to retain the
distinction of the DO degree.[39] In the early 20th
century, osteopaths across the United States
sought to establish law that would legitimize
their medical degree to the standard of the
allopathic medic.[40] The processes were
arduous, and not without conflict. In some
states, it took years for the bills to be passed.
Osteopaths were often ridiculed and in some
cases arrested,[40] but in each state, osteopaths
managed to achieve the legal acknowledgement
and action they set out to pursue. In 1898 the
American Institute of Osteopathy started the
Journal of Osteopathy and by that time four
states recognized osteopathy as a profession.[41]

Practice

Osteopathic manipulative treatment (OMT) involves palpation

and manipulation of bones, muscles, joints, and fasciae.

According to the American Osteopathic

Association (AOA), osteopathic manipulative
treatment is considered to be only one
component of osteopathic medicine and may be
used alone or in combination with
pharmacotherapy, rehabilitation, surgery, patient
education, diet, and exercise. OMT techniques
are not necessarily unique to osteopathic
medicine; other disciplines, such as physical
therapy or chiropractic, use similar
techniques.[42]

One integral tenet of osteopathy is that problems

in the body's anatomy can affect its proper
functioning. Another tenet is the body's innate
ability to heal itself. Many of osteopathic
medicine’s manipulative techniques are aimed at
reducing or eliminating the impediments to
proper structure and function so the self-healing
mechanism can assume its role in restoring a
person to health.[43] Osteopathic medicine
defines a concept of health care that embraces
the concept of the unity of the living organism's
structure (anatomy) and function (physiology).
The American Osteopathic Association (AOA)
state that the four major principles of
osteopathic medicine are the following:[44]

1. The body is an integrated unit of mind,

body, and spirit.
2. The body possesses self-regulatory
mechanisms, having the inherent capacity
to defend, repair, and remodel itself.
3. Structure and function are reciprocally
interrelated.
4. Rational therapy is based on consideration
of the first three principles.
These principles are not held by Doctors of
Osteopathic Medicine to be empirical laws; they
serve, rather, as the underpinnings of the
osteopathic approach to health and disease.

Muscle energy

Muscle energy techniques address somatic

dysfunction through stretching and muscle
contraction. For example, if a person is unable to
fully abduct her arm, the treating physician raises
the patient's arm near the end of the patient's
range of motion, also called the edge of the
restrictive barrier. The patient then tries to lower
her arm, while the physician provides resistance.
This resistance against the patient's motion
allows for isotonic contraction of the patient's
muscle. Once the patient relaxes, her range of
motion increases slightly. The repetition of
alternating cycles of contraction and subsequent
relaxation help the treated muscle improve its
range of motion.[45] Muscle energy techniques
are contraindicated in patients with fractures,
crush injuries, dislocations, joint instability,
severe muscle spasms or strains, severe
osteoporosis, severe whiplash injury,
vertebrobasilar insufficiency, severe illness, and
recent surgery.

Counterstrain

Counterstrain is a system of diagnosis and

treatment that considers the physical
dysfunction to be a continuing, inappropriate
strain reflex, which is inhibited during treatment
by applying a position of mild strain in the
direction exactly opposite to that of the reflex.[46]
After a counterstrain point tender to palpation
has been diagnosed,[47] the identified tender
point is treated by the osteopathic physician
who, while monitoring the tender point, positions
the patient such that the point is no longer
tender to palpation.[48] This position is held for
ninety seconds and the patient is subsequently
returned to her normal posture.[47] Most often
this position of ease is usually achieved by
shortening the muscle of interest.[48]
Improvement or resolution of the tenderness at
the identified counterstrain point is the desired
outcome.[47] The use of counterstrain technique
is contraindicated in patients with severe
osteoporosis, pathology of the vertebral arteries,
and in patients who are very ill or cannot
voluntarily relax during the procedure.

High-velocity, low-amplitude

High velocity, low amplitude (HVLA) is a

technique which employs a rapid, targeted,
therapeutic force of brief duration that travels a
short distance within the anatomic range of
motion of a joint and engages the restrictive
barrier in one or more places of motion to elicit
release of restriction.[49] The use of HVLA is
contraindicated in patients with Down syndrome
due to instability of the atlantoaxial joint which
may stem from ligamentous laxity, and in
pathologic bone conditions such as fracture,
history of a pathologic fracture, osteomyelitis,
osteoporosis, and severe cases of rheumatoid
arthritis.[50][51] HVLA is also contraindicated in
patients with vascular disease such as
aneurysms, or disease of the carotid arteries or
vertebral arteries.[50] People taking ciprofloxacin
or anticoagulants, or who have local metastases
should not receive HVLA.[50]

Myofascial release

Fascia is the soft tissue component of the

connective tissue that provides support and
protection for most structures within the human
body, including muscle. This soft tissue can
become restricted due to psychogenic disease,
overuse, trauma, infectious agents, or inactivity,
often resulting in pain, muscle tension, and
corresponding diminished blood flow.[52]
Myofascial release is a form of alternative
treatment. The practitioners claim to treat
skeletal muscle immobility and pain by relaxing
contracted muscles. Palpatory feedback by the
practitioner is said to be an integral part to
achieving a release of myofascial tissues,[49]
accomplished by relaxing contracted muscles,
increasing circulation and lymphatic drainage,
and stimulating the stretch reflex of muscles and
overlying fascia.[53]

Practitioners who perform myofascial release

consider the fascia and its corresponding
muscle to be the main targets of their procedure,
but assert that other tissue may be affected as
well, including other connective tissue.[53]

Some osteopaths search for small lumps of

tissue, called "Chapman release points" as part
of their diagnostic procedure.[54]

Lymphatic pump treatment

Lymphatic pump treatment (LPT) is a manual

technique intended to encourage lymph flow in a
person's lymphatic system.[55] The first modern
lymphatic pump technique was developed in
1920, although osteopathic physicians used
various forms of lymphatic techniques as early
as the late 19th century.[56]

Relative contraindications for the use of

lymphatic pump treatments include fractures,
abscesses or localized infections, and severe
bacterial infections with body temperature
elevated higher than 102 °F (39 °C).[57]

E�ectiveness
In 2014, a systematic review and meta-analysis
of 15 randomized controlled trials found
moderate-quality evidence that OMT reduces
pain and improves functional status in acute and
chronic nonspecific low back pain.[58] The same
analysis also found moderate-quality evidence
for pain reduction for nonspecific low back pain
in postpartum women and low-quality evidence
for pain reduction in nonspecific low back pain in
pregnant women.[58] A 2013 systematic review
found insufficient evidence to rate osteopathic
manipulation for chronic nonspecific low back
pain.[59] In 2011, a systematic review found no
compelling evidence that osteopathic
manipulation was effective for the treatment of
musculoskeletal pain.[60]

In 2013, a Cochrane Review reviewed six

randomized controlled trials which investigated
the effect of four types of chest physiotherapy
(including OMT) as adjunctive treatments for
pneumonia in adults and concluded that "based
on current limited evidence, chest physiotherapy
might not be recommended as routine additional
treatment for pneumonia in adults." Techniques
investigated in the study included paraspinal
inhibition, rib raising, and myofascial release.
The review found that OMT did not reduce
mortality and did not increase cure rate, but that
OMT slightly reduced the duration of hospital
stay and antibiotic use.[61] A 2013 systematic
review of the use of OMT for treating pediatric
conditions concluded that its effectiveness was
unproven.[62]

A 2005 Cochrane Review of OMT in asthma

treatment concluded that there was insufficient
evidence that OMT can be used to treat
asthma.[63]

A 2018 systematic review found that there is no

evidence for the reliability or specific efficacy of
the techniques used in visceral osteopathy.[64]

Criticism
The AMA listed D.O.s as "cultists" and deemed
M.D. consultation of D.O.s unethical from 1923
until 1962.[65] M.D.s regarded that osteopathic
treatments were rooted in "pseudoscientific
dogma", and although physicians from both
branches of medicine have been able to meet on
common ground, tensions between the two
continue.[26]

In 1988, Petr Skrabanek classified osteopathy as

one of the "paranormal" forms of alternative
medicine, commenting that it has a view of
disease which had no meaning outside its own
closed system.[66]

In a 1995 conference address, the president of

the Association of American Medical Colleges,
Jordan J. Cohen, pinpointed OMT as a defining
difference between M.D.s and D.O.s; while he
saw there was no quarrel in the appropriateness
of manipulation for musculoskeletal treatment,
the difficulty centered on "applying manipulative
therapy to treat other systemic diseases" – at
that point, Cohen maintained, "we enter the
realm of skepticism on the part of the allopathic
world."[26]

In 1998 Stephen Barrett of Quackwatch said that

the worth of manipulative therapy had been
exaggerated and that the American Osteopathic
Association (AOA) was acting unethically by
failing to condemn craniosacral therapy. The
article attracted a letter from the law firm
representing the AOA accusing Barrett of libel
and demanding an apology to avert legal
action.[26] In response Barrett made some slight
modifications to his text, while maintaining its
overall stance; he queried the AOA's reference to
"the body's natural tendency toward good health"
and challenged them to "provide [him] with
adequate scientific evidence showing how this
belief has been tested and demonstrated to be
true."[26] Barrett has been quoted as saying "the
pseudoscience within osteopathy can't compete
with the science".[26]

In 1999, Joel D. Howell noted that osteopathy

and medicine as practiced by M.D.s were
becoming increasingly convergent. He
suggested that this raised a paradox: "if
osteopathy has become the functional
equivalent of allopathy, what is the justification
for its continued existence? And if there is value
in therapy that is uniquely osteopathic – that is,
based on osteopathic manipulation or other
techniques – why should its use be limited to
osteopaths?"[11]

In 2004, the osteopathic physician Bryan E.

Bledsoe, a professor of emergency medicine,
wrote disparagingly of the "pseudoscience" at
the foundation of OMT. In his view, "OMT will and
should follow homeopathy, magnetic healing,
chiropractic, and other outdated practices into
the pages of medical history."[67]

In 2010, Steven Salzberg wrote that OMT was

promoted as a special distinguishing element of
DO training, but that it amounted to no more than
"'extra' training in pseudoscientific practices."[16]
It has been suggested that osteopathic
physicians may be more likely than regular MDs
to be involved in questionable practices such as
orthomolecular therapy and homeopathy.[68][69]

Regulation and legal status

The osteopathic profession has evolved into two
branches, non-physician manual medicine
osteopaths and full scope of medical practice
osteopathic physicians. These groups are so
distinct that in practice they function as separate
professions. The regulation of non-physician
manual medicine osteopaths varies greatly
between jurisdictions. In Australia, the UK, and
New Zealand the non-physician manual medicine
osteopaths are regulated by statute and practice
requires registration with the relevant regulatory
authority. The Osteopathic International Alliance
has a country guide with details of registration
and practice rights and the International
Osteopathic Association has a list of all
accredited osteopathic colleges.[70]

Several international and national organizations

exist relating to osteopathic education and
political advocacy. Similarly, there is also an
international organization of organizations for
national osteopathic and osteopathic medical
associations, statutory regulators, and
universities/medical schools offering
osteopathic and osteopathic medical education,
known as the Osteopathic International Alliance
(OIA).[71]

The following sections describe the legal status

of osteopathy and osteopathic medicine in each
country listed.

Australia

Osteopaths work in private practice, and the

majority of private health insurance providers
cover treatment performed by osteopaths.[72] In
addition, treatment performed by osteopaths is
covered by the public healthcare system in
Australia (Medicare)[73] under the Chronic
Disease Management plan.

Osteopaths in Australia undertake a minimum of

five years' university training in anatomy,
physiology, pathology, general medical diagnosis
and osteopathic techniques to be eligible to
practice.[74]

Osteopathy Australia[75] (formerly the Australian

Osteopathic Association) is a national
organization representing the interests of
Australian osteopaths, osteopathy as a
profession in Australia, and consumers' right to
access osteopathic services. Founded in 1955 in
Victoria, the Australian Osteopathic Association
became a national body in 1991 and became
Osteopathy Australia in 2014.[76] and is a
member of the Osteopathic International
Alliance.[77]
The Osteopathy Board of Australia[78] is part of
the Australian Health Practitioner Regulation
Agency which is the regulatory body for all
recognized health care professions in
Australia.[74] The Osteopathic Board of Australia
is separate from the Medical Board of Australia
which is the governing body that regulates
medical practitioners. Osteopaths trained
internationally may be eligible for registration in
Australia, dependent on their level of training and
following relevant competency assessment.[74]

Canada

In Canada, the titles "osteopath" and

"osteopathic physician" are protected in some
provinces by the medical regulatory college for
physicians and surgeons.[79][80][81] As of 2011,
there were approximately 20 U.S.-trained
osteopathic physicians, all of which held a
Doctor of Osteopathic Medicine degree,
practicing in all of Canada.[82] As of 2014, no
training programs have been established for
osteopathic physicians in Canada.[83]

The non-physician manual practice of

osteopathy is practiced in most Canadian
provinces.[84] As of 2014, manual osteopathic
practice is not a government-regulated health
profession in any province,[85] and those
interested in pursuing osteopathic studies must
register in private osteopathy schools.[86] It is
estimated that there are over 1,300 osteopathic
manual practitioners in Canada, most of whom
practice in Quebec and Ontario.[83] Some
sources indicate that there are between 1,000
and 1,200 osteopaths practicing in the province
of Quebec, and although this number might
seem quite elevated, many osteopathy clinics
are adding patients on waiting lists due to a
shortage of osteopaths in the province.[86]

Quebec

Beginning in 2009, Université Laval in Quebec

City was working with the Collège d'études
ostéopathiques in Montreal on a project to
implement a professional osteopathy program
consisting of a bachelor's degree followed by a
professional master's degree in osteopathy as
manual therapy.[86] However, due to the many
doubts concerning the scientific credibility of
osteopathy from the university's faculty of
medicine, the program developers decided to
abandon the project in 2011, after 21⁄2 years of
discussion, planning, and preparation for the
program implementation.[86] There was some
controversy with the final decision of the
university's committee regarding the continuous
undergraduate and professional graduate
program in osteopathy because the Commission
of studies, which is in charge of evaluating new
training programs offered by the university, had
judged that the program had its place at
Université Laval before receiving the
unfavourable support decision from the faculty
of medicine.[86] Had the program been
implemented, Université Laval would have been
the first university institution in Quebec to offer a
professional program in osteopathy as a manual
therapy.[86]

European Union

There is no universal regulatory authority for the

practice of osteopathy or osteopathic medicine
within the European Union; it is on a country-by-
country basis. The UK's General Osteopathic
Council, a regulatory body set up under the
country's Osteopaths Act 1993, has issued a
position paper on European regulation of
osteopathy.[87]

France

Osteopathy is a governmentally recognized

profession and has title protection, autorisation
d'utiliser le titre d'ostéopathe.[88] The most recent
decree regarding osteopathy was enacted in
2014.[89][90][91][92][93][94]

Belgium
Since the early 1970's, osteopaths have been
practicing in Belgium, during which time several
attempts have been made to obtain an official
status of health care profession. In 1999, a law
was passed (the 'Colla-Law'[95]) providing a legal
framework for osteopathy, amongst three other
non-conventional medical professions, to
develop into an independent medical profession
in its own right. In 2011, the Belgian Minister
Onkelinx created and established the Chambers
for Non-Conventional Medicines and the Joint
Commission provided for in the "Colla-law"
(1999). The Chamber for Osteopathy has been
active since then. Their goal is to discuss and
reach an agreement between the various
medical bodies to rule on these practices. In
February 2014, only one practice, homeopathy,
received its recognition. The others, including
osteopathy, remain unresolved.[96] Since 2014,
the majority of the professional osteopathic
associations have joined together under the
name UPOB - BVBO (Union Professionelle des
Osteopathes de Belgique - Belgische Vereniging
van Belgische Osteopaten - Professional Union
of Belgian Osteopaths) in order to consolidate
the image and united vision of osteopathy (± 900
osteopaths). This merger also resulted in the
creation of a website[97] which represents all
aspects of osteopathy in Belgium. Its aim is to
offer Belgians a base of information about
osteopathy, to provide access to a national
emergency care service as well as to
osteopathic care facilities for the less fortunate.
It also serves as a directory for osteopaths who
practice osteopathy exclusively. Lastly, the
website serves as a platform to support actions
working towards the recognition of osteopathy.

Germany

Germany has both osteopathy and osteopathic

medicine. There is a difference in the osteopathic
education between non-physician osteopaths,
physiotherapists, and medical physicians.

Physiotherapists are a recognized health

profession and can achieve a degree of "Diploma
in Osteopathic Therapy (D.O.T.)". Non-physician
osteopaths are not medically licensed. They have
an average total of 1200 hours of training,
roughly half being in manual therapy and
osteopathy, with no medical specialization
before they attain their degree. Non-physician
osteopaths in Germany officially work under the
"Heilpraktiker" law. Heilpraktiker is a separate
profession within the health care system. There
are many schools of osteopathy in Germany;
most are moving toward national recognition
although such recognition does not currently
exist.[98] In Germany, there are rules (at the
country level) under which persons (non-
physicians) may call themselves osteopaths.[99]

New Zealand

The practice of osteopathy is regulated by law,

under the terms of the Health Practitioners
Competence Assurance Act 2003[100] which
came into effect on 18 September 2004. Under
the Act, it is a legal requirement to be registered
with the Osteopathic Council of New Zealand
(OCNZ),[101] and to hold an annual practicing
certificate issued by them, in order to practice as
an osteopath. Each of the fifteen health
professions regulated by the HPCA Act work
within the "Scope of Practice" determined and
published by its professional Board or Council.
Osteopaths in New Zealand are not fully licensed
physicians. In New Zealand, in addition to the
general scope of practice, osteopaths may also
hold the Scope of Practice for Osteopaths using
Western Medical Acupuncture and Related
Needling Techniques.[102]

In New Zealand a course is offered at Unitec.[103]

Australasian courses consist of a bachelor's
degree in clinical science (osteopathy) followed
by a master's degree. The Unitec double degree
programme is the OCNZ prescribed qualification
for registration in the scope of practice:
Osteopath, Australian qualifications accredited
by the Australian and New Zealand Osteopathic
Council are also prescribed qualifications.

Osteopaths registered and in good standing with

the Australian Health Practitioner Regulation
Agency – Osteopathy Board of Australian are
eligible to register in New Zealand under the
mutual recognition system operating between
the two countries. Graduates from programs in
every other country are required to complete an
assessment procedure.[104]

The scope of practice for US-trained osteopathic

physicians is unlimited on an exceptions basis.
Full licensure to practice medicine is awarded on
an exceptions basis following a hearing before
the licensing authorities in New Zealand. Both
the Medical Council of New Zealand[105] and the
Osteopathic Council of New Zealand [OCNZ][106]
regulate osteopathic physicians in New Zealand.
Currently, the country has no recognized
osteopathic medical schools.[107]

Portugal
Osteopathy is a governmentally recognized
health profession and the title of Osteopath is
protected by Law (Act 45/2003, of 22 October,
and Act 71/2013, of 2 September). Currently
there are three faculties that teach the four-year
degree course of osteopathy (BSc Hon in
Osteopathy).[108]

United Kingdom

The practice of osteopathy has a long history in

the United Kingdom. The first school of
osteopathy was established in London in 1917
by John Martin Littlejohn, a pupil of A.T. Still, who
had been Dean of the Chicago College of
Osteopathic Medicine. After many years of
existing outside the mainstream of health care
provision, the osteopathic profession in the UK
was accorded formal recognition by Parliament
in 1993 by the Osteopaths Act.[109] This
legislation now provides the profession of
osteopathy the same legal framework of
statutory self-regulation as other healthcare
professions such as medicine and dentistry.

The General Osteopathic Council (GOsC)

regulates the practice of osteopathy under the
terms of the Osteopaths Act 1993. Under British
law, an osteopath must be registered with the
GOsC to practice in the United Kingdom.[110] The
General Osteopathic Council has a statutory duty
to promote, develop and regulate the profession
of osteopathy in the UK. It fulfills its duty to
protect the interests of the public by ensuring
that all osteopaths maintain high standards of
safety, competence and professional conduct
throughout their professional lives. In order to be
registered with the General Osteopathic Council
an osteopath must hold a recognized
qualification that meets the standards as set out
by law in the GOsC's Standard of Practice.[111]
This Act provides for "protection of title" A
person who, whether expressly or implicitly
describes him- or herself as an osteopath,
osteopathic practitioner, osteopathic physician,
osteopathist, osteotherapist, or any kind of
osteopath is guilty of an offence unless they are
registered as an osteopath. There are currently
more than five thousand osteopaths registered
in the UK.[112]

Osteopathic medicine is regulated by the General

Osteopathic Council, (GOsC) under the terms of
the Osteopaths Act 1993 and statement from
the GMC. Practising osteopaths will usually have
a B.S. or M.Sc. in osteopathy. Accelerated
courses leading to accreditation are available for
those with a medical degree and
physiotherapists.[113] The London College of
Osteopathic Medicine,[114] teaches osteopathy
only to those who are already physicians.

United States

Those trained only in manual osteopathic

treatment, generally to relieve muscular and
skeletal conditions, are referred to as
osteopaths.[115] These non-physician
practitioners are not permitted to use the title
D.O. in the United States. This is to avoid
confusion with osteopathic physicians who are
medical doctors trained and certified to practice
in the branch of scientific medicine called
osteopathic medicine.[1]

The American Osteopathic Association and the

American Association of Colleges of
Osteopathic Medicine recommend using the
terms osteopathic physician (U.S.-trained only)
and osteopathic medicine in reference to
osteopathic medicine as practiced in the United
States.[116] Osteopathic physicians earn the
degree of Doctor of Osteopathic Medicine (D.O.).
[117][118][119][120]

Osteopathic medicine in the United States has

always meant a physician trained in and entitled
to the full scope of medical practice. Osteopathy
or osteopath as written in some U.S. state and
federal laws refers only to osteopathic medicine
or osteopathic physicians, respectively. With the
increased internationalization of the profession,
these older terms have fallen out of favor as
generally accepted use due to the confusion they
may cause.[121][122]

Egypt and the Middle East

Hesham Khalil introduced osteopathy in the

Middle East at a local physical therapy
conference in Cairo, Egypt in 2005 with a lecture
titled "The global Osteopathic Concept / Holistic
approach in Somatic Dysfunction". Since then he
has toured the Middle East to introduce
osteopathy in other Middle Eastern and North
African countries, including Sudan, Jordan, Saudi
Arabia, Qatar, UAE, Kuwait and Oman. In
December 2007 the first Workshop on Global
osteopathic approach was held at the Nasser
Institute Hospital for Research and Treatment,
sponsored by the Faculty of Physical Therapy,
University of Cairo, Egypt.[123] On 6 August 2010,
the Egyptian Osteopathic Society (OsteoEgypt)
was founded. OsteoEgypt promotes a two-tier
model of osteopathy in Egypt and the Middle
East. The event was timed to coincide with the
birthday of A.T. Still.[124][125]

India

Sri Sri University is the first university in India to

offer M.Sc in Osteopathy programme by
following the benchmarks defined by the World
Health Organisation for training in
Osteopathy.[126]

See also
Chiropractic
Doctor of Osteopathic Medicine
List of medical schools in the United States
List of osteopathic colleges
Osteopathic medicine in the United States
Spinal manipulation

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Further reading
American Association of Colleges of
Osteopathic Medicine (2011); Glossary of
Osteopathic Terminology .
Collins, Martin (2005). Osteopathy in Britain:
The First Hundred Years. London: Martin
Collins. ISBN 978-1-4196-0784-4.
Crislip M (4 October 2013). "Pump it up:
osteopathic manipulation and influenza" .
Science-based Medicine. Retrieved 7 February
2014.
DiGiovanna, Eileen; Schiowitz, S; Dowling, DD
(2005). An Osteopathic Approach to Diagnosis
 and Treatment (3rd ed.). Philadelphia:
Lippincott, Williams and Wilkins.
ISBN 978-0-7817-4293-1.
Savarese, Robert G.; Copabianco, John D.; Cox,
James J. (2009). OMT review.
ISBN 978-0967009018.
Smith JC (2009). "Manipulative and Body-
based Practices". Pseudoscience and
Extraordinary Claims of the Paranormal: A
Critical Thinker's Toolkit . John Wiley & Sons.
p. 342. ISBN 978-1-4443-1013-9.
Stone, Caroline (2002). Science in the Art of
Osteopathy: Osteopathic Principles and
Practice. Cheltenham, UK: Nelson Thornes.
ISBN 978-0-7487-3328-6.
Ward, Robert C. (2002). Foundations for
Osteopathic Medicine (2nd ed.). Philadelphia:
Lippincott Williams & Wilkins.
ISBN 0-7817-3497-5.

External links
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