Osteopathic  Practice Framework

 

This document is largely made up of things I have stolen from other people – notably Peter Buxton’s excellent article in OT some years ago which predicted precisely the problem the GOsC now faces.  I have stolen ideas and words from many other people and documents as well, and I make no claims for originality in any of the following.

The following is not complete: it is not intended to be a finished article, merely some ideas to form a basis for discussion.  It is intended to give some idea of one way that an alternatice framework could be structured.

1. Principles

Osteopathy is an approach to healthcare that is centred on the patient rather than the disease and that seeks to facilitate a return to health.  To understand osteopathic practice it is necessary to recognise the principles on which it is based:

1.1 The body has intrinsic systems of maintenance and repair

At the core of Osteopathy is the understanding that our bodies have intrinsic systems of maintenance and repair, which normally enable a return to health and full function following an insult.  The body also has some ability to adapt and compensate for dysfunction, but where the systems of maintenance and repair are impeded to a degree that exceeds the body’s capacity to adapt, health will be impaired.

The intention of the osteopath is to enhance the intrinsic health-maintaining and health-restoring capabilities of the individual person. This involves the consideration of a broad range of factors to identify and resolve the causes of impaired health with emphasis on the patient rather than their disease.

1.2 The body is an indivisible unit

Although it is customary to consider the body in terms of “systems” and “regions”, for convenience in teaching and study, no system or region of the body can exist in isolation and the body functions as an indivisible whole.  Impaired function in any part of the body will cause effects elsewhere.

The underlying cause of symptoms may be remote from the site of the symptoms themselves.  Similarly, it is possible for a therapeutic intervention to produce effects remote to the site of its application.

1.3 Rational approach to clinical reasoning based on science

Osteopathy is based on scientific discovery, especially in the fields of Anatomy and Physiology.  Osteopathic assessment is based on rational, critical clinical reasoning to apply knowledge in an integrated and informed manner. 

As scientific knowledge develops, so osteopathic practice is bound to change and develop, even though its principles remain the same.

1.4 The individual is unique

Every patient is a unique individual; the specific path from health to illness is unique to the individual and the instance.  The path of returning to health will also be unique to the individual and will be influenced by a wide range of factors which will combine and interact in a way that is also unique to the individual.

Osteopathic treatment and management of a patient’s health is tailored to the needs and circumstances of that particular individual.

1.5 Relationship between structure and function

Structure and function are inseparably related.

The selection of the specific intervention in osteopathic treatment is informed by an appreciation of the relationship between the functional and structural changes in the patient.

1.6 Importance of Movement

Movement is one of the characteristics of life.  It is essential for the efficient working of the body’s inherent maintenance and repair mechanisms and thus to health.

A principal aim of osteopathic treatment is to improve mobility: both the mobility of individual joints and also the overall mobility of the patient.

1.7 Importance of the neuro-endocrine control systems

The body’s intrinsic mechanisms of maintenance and repair are influenced by the neuro-endocrine control systems.

Interventions that influence the neuro-endocrine control systems may affect the body’s intrinsic systems of maintenance and repair.

1.8 Importance of vascular and lymphatic flow

Tissue health is dependent on adequate vascular and lymphatic flow.

Interventions intended to improve vascular and/or lymphatic flow can form a significant part of the osteopathic treatment approach.

1.9 Importance of the axial skeleton

The axial skeleton links the head and extremities and contains the pathways of neurological control. 

Poor spinal function may cause effects throughout the body, and dysfunction in peripheral areas may cause effects in spinal function.

1.10 Manual mediation of investigation and treatment

Use of the hands in both assessment and treatment is a characteristic of Osteopathy.

While adjunctive methods may be used by some osteopaths, the primary methods of osteopathic treatment are manual and applied mainly through the musculoskeletal system.

1.11 Respect for patients’ rights and values

The patient is an individual person who is entitled to respect and personal dignity.  They are entitled to their own values and opinions; these form an essential part of the individual person and are taken into consideration within the assessment and treatment.  Osteopathy aims to put patients in charge of their own health and enable them to assist their own recovery to and maintenance of health as far as possible.

The osteopath works in partnership with the patient to identify the factors contributing to impaired health and the measures that will enable the patient to take responsibility for their own return to health.

1.12 Professional independence and compatibility with congruent practitioners

Osteopathy is an independent system of primary contact healthcare.  Osteopaths practice autonomously, taking full clinical responsibility for the care of their patients, and will co-operate with and refer to other healthcare practitioners where this is appropriate.

Respect for and co-operation with other healthcare professionals, as appropriate for each patient, is an intrinsic part of being an autonomous healthcare professional.

2. Osteopathic Practice

Because Osteopathy centred on the patient, every aspect of assessment and treatment is tailored to the individual, and every consultation will be different.  Osteopaths use a very wide range of treatment approaches, depending on their specific training and experience and it would therefore be misleading to describe a “typical” consultation.  The osteopathic approach used will depend on the individual patient and the osteopath’s clinical judgement.  The individual osteopath must be able to recognise limitations in their competence and practice accordingly.

Despite its wide range, there are certain common factors in all osteopathic practice:

2.1 Comprehensive clinical history

A detailed clinical history and a more detailed osteopathic history, as relevant to the presenting complaint and its impact on the patient’s lifestyle, are taken.

2.2 Physical assessment

The clinical examination process might include (as appropriate):

-          observation of active movements;

-          assessment of passive movements (normally using manual methods);

-          assessment of tissue tone (normally using manual methods);

-          standard clinical examination methods as indicated.

2.3 Development of a logical, clinically reasoned working hypothesis

Based on the findings of the history and examination the osteopath will develop a working hypothesis based on differential diagnosis principles using a logical clinically reasoned approach. 

A principal factor in the history-taking and physical assessment is the need to establish whether it is safe and appropriate for the osteopath to treat the patient.  This may necessitate a very wide-ranging history and examination that includes many aspects that may not appear immediately relevant to the patient.

From the overall assessment of the patient, and on the basis of the osteopath’s working hypothesis, a management strategy is constructed.  This may include a treatment plan or referral, as necessary. An osteopathic treatment plan may include lifestyle advice concerning exercise, diet and nutrition, stress management and coping strategies.

2.4 Manually applied assessment and treatment methods

The use of manual methods of assessment and treatment is a characteristic of Osteopathy, and the critically applied use of the sense of touch (palpation) and proprioception are fundamental to osteopathic methods.  Osteopaths acquire highly developed palpatory and proprioceptive skills that are normally used both in assessing joint movement and tissue tone and also in manually applied treatment methods.

Some osteopaths may also use adjunctive (non-manual) treatment methods such as acupuncture, dry-needling, ultrasound or electrotherapies.

3. Advice for patients

3.1 The osteopathic approach

The osteopathic approach to healthcare is based on the fact that the body has its own ways of fighting disease and repairing injuries.  Normally this works well and we recover from illness or injury, but sometimes it needs help.  So osteopaths set out to find things that may be stopping your body from healing itself.  If we can do something about those things, then your body may be able to return to health as it does normally.

We believe the different parts of the body work together to keep the body healthy.  That means that all the parts of the body affect each other to some degree, so when there is a problem in one part of the body, the underlying cause may be somewhere else.  So osteopaths don’t just look at the area that is causing you problems.  We will look much wider to see if we can spot anything that could be stopping your body from healing itself.

3.2 Your first appointment

Osteopathy is centred on you, the patient.  You are a unique individual and we need to build up a picture of you as a complete person.  Your health also depends upon factors such as diet, exercise and what is happening in your life.   So first we need to listen to what is troubling you, but then we may need to ask lots of questions to find out about:

·         The way it affects you – when it causes you most problems, what makes it worse, and other things like that.

·         Things that have happened to you in the past that may affect the way you are now – and that may be all the way back to when you were a child.

·         The kinds of things you usually do – so we can build up a picture of how you use your body.

 

Once we have found out about your history, we normally need to examine you to see how your body is working.  We usually look at your posture and how you move your body.  We may also assess what happens when we move it for you and see what hurts, where and when.  Using touch we may also find the points which are sensitive or tight, and this helps us to identify what is going on.

Using the sense of touch is an important part of Osteopathy; the highly developed sense of touch is known medically as palpation.  Osteopaths normally use their hands a lot, both in assessing patients and in treating them, and we gain highly developed palpation skills which help us to get as much information as we can about the way your body is working.

Our clinical examination may also include taking measurements such as your blood pressure, feeling your pulse and checking your reflexes.  If necessary, we may refer you for clinical tests, such as x-rays.