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What is osteopathy and how does it compare against chiropractic and physiotherapy?

My name is Christopher Diciolla and I’d like to introduce you to or maybe reacquaint you with osteopathy, as well as answer two of the most frequent questions I get asked. To introduce myself first, I am a French osteopath practising since 2013 and I have a diploma in osteopathy obtained after a 6-year training course in France. It is accredited by the French Ministry of Health and follows (and in some areas surpasses) the benchmark for training in osteopathy provided by the World Health Organization1. I have been practising in Bahrain for over 5 years.

Osteopathy (also called osteopathic medicine) was founded by American physician Andrew Taylor Still in 1874. At this time in the Midwest of America, relatively to today, there was a lack of medical knowledge and treatment options were limited. This led Andrew Taylor Still to develop a simple yet revolutionary theory that still holds true to date: the body has an intrinsic tendency for self-healing and that with an adequate understanding of anatomy and the physiological mechanisms at work behind the healing process one could accelerate it or free-up any obstacle that would prevent it from functioning correctly. For this, one must fully grasp the relationship between the structure and the function. Ultimately, osteopathic practitioners will manually diagnose and treat the mechanical cause (the structure) of the patient’s pain or functional disorder through a wide variety of methods and techniques to improve the overall physiological function and physiological balance (homeostasis) of the body (the function).

These mechanical causes are also what is referred to as “somatic dysfunctions” that are an impaired or altered function of the musculoskeletal and fascial system, for example in the ligaments, muscle, tendon, fascia, skull, or visceral (organs). These will negatively affect the nerve and blood supply as well as lymphatic drainage that would normally allow for a healthy environment.

Osteopathic healthcare includes osteopathic manual therapy, typically called “osteopathic manipulative treatment” that will address the above “somatic dysfunctions”; and combined with advice, for example on posture, ergonomics, diet, physical activity, or counselling. Osteopathic healthcare however, is not the be-all and end-all; it must be combined with other treatments. The place of osteopathic medicine in an integrated care environment is particularly interesting and useful given the benefits the patient receives.

Osteopathy is often classified as an alternative medicine but it is of course impossible for a manual therapy to replace today’s medical practice with its progress since 1874. This non-invasive therapy truly is complementary to other treatments in order for the patient to recover quicker. Conventional medicine may however, be a victim of its success when actors tend to be more removed from the patient relying on lab tests and computerised readouts. This may leave the patient in need of sympathy and bedside manner that treats them as a human being rather than a number. Osteopathy can clearly grow and contribute in such an environment bringing more empathy to healthcare.

This holistic approach to patient care and healing is based on the concept that a human being is a dynamic functional unit, that the human body and its different systems should be viewed together as interrelated and able to self-regulate and self-heal.

So why is osteopathy called osteopathy? It has led to many misconceptions that “osteopaths treats bones” – as you may have understood, osteopaths don’t really treat bones! Although some manipulative techniques will address the bone tissue itself, they mostly treat everything around them (the ligaments, muscle, tendon, fascia, skull, or visceral (organs)). They may, however, use the bones as levers to treat these structures.

What is the difference between osteopathy and chiropractic?

This is probably the most common question I get asked and it is one that I struggle to answer succinctly. This is because despite there being similarities in certain techniques and interventions employed, there are distinct differences in each one’s philosophies and therefore methods.

A friend chiropractor likes it when I briefly answer to say “Chiropractors are amazing…” unfortunately he conveniently forgets to hear the next part “…but osteopaths are better”.

Chiropractic was founded by David Palmer in 1895, over two decades after osteopathy, and some would say therefore as an offshoot from osteopathy. Chiropractors will mostly focus on spinal manipulation and soft tissue massage. The concept is that a vertebral “subluxation”, also known as a vertebral misalignment, will cause bony nerve pressure that will not only lead to problems in the surrounding muscle and tissue but will also affect other areas of the body that are supplied by this nerve. For example, if your 5th thoracic vertebra is misaligned you may suffer from functional disorders to your stomach.

This is true to an extent but the osteopathic concept goes beyond that. The disturbed vertebral segment will cause physiological changes locally that will affect the autonomic nerves and alter the blood supply to the tissue this segment supplies (the ligaments, muscle, tendon, fascia, skull, organs). The osteopath will also actually physically address these different tissues as discussed previously through an array of specific manipulative techniques.

These differing concepts will of course require different approaches. Chiropractors typically use short sharp thrusts; focusing on the spine and other joints of the body. Osteopaths will usually have a subtler approach to the spine as well as all the types of tissues anywhere in the body.

The chiropractor’s approach will generally only require them to see a patient in 10 to 15 minutes as opposed to the osteopath who will need longer (a minimum of 30 minutes) to apply their broader methods. It is also common practice for a chiropractor to see you several times a week totalling dozens of sessions at a time. An osteopath should rarely see you more than once a week and will classically see you on a monthly basis for continued treatment for chronic conditions or preventive measure.

I think it is fair to say that osteopathy has a more comprehensive approach to patient health in that it utilises a wider variety of methods and techniques that can be applied beyond the joints of the spine and the body.

In truth, there are as many ways of practising osteopathy and chiropractic as there are osteopaths and chiropractors. In fact, some chiropractors are embracing some principles such as cranial motion, visceral motility, and fascia release to include in their approach, in the same way that some osteopaths are leaving these behind for a less energetic and time consuming session.

What is the difference between osteopathy and physiotherapy?

From a historical and practical point of view, if osteopathy and chiropractic are brothers then physiotherapy is a cousin. Although physiotherapy is a manual therapy it doesn’t have a specific philosophy; it is more a medical auxiliary. Most commonly, a patient would see a physiotherapist only after being referred by a physician to perform the prescribed treatment. Some physiotherapists, however, will have more autonomy and be able to evaluate, diagnose and decide of a treatment plan for a patient as a first-line professional. The physiotherapy treatments will gravitate around exercise programs for rehabilitation for post-surgery, strokes, sports injuries etc. They will often use tools such as ultrasound machines, laser therapy, shock-wave therapy, traction machines, heat packs, cold packs etc.

Some reasons of visit overlap between physiotherapy and osteopathy, such as back pain, sports injuries, tendinitis, joint pains etc. Generally speaking, physiotherapists will have a more symptomatic approach to these ailments, using localised methods to help the patient heal, as opposed to a more holistic view of the patient’s health as osteopaths would. This creates an opportunity for osteopaths to work hand in hand with physiotherapists to optimise the healing process and quicken the patient’s journey to good health.

Christopher DICIOLLA, Osteopath

1Benchmarks for Training in Osteopathy – World Health Organization http://apps.who.int/medicinedocs/documents/s17555en/s17555en.pdf

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