Osteopathy : A History of Vision and Innovation

Osteopathy originated in the Midwestern United States with Andrew Taylor Still (1828-1917), a man ahead of his time, who was both an anti-slavery activist and an advocate of women's rights. He learned his first medical skills empirically from his father, Abram Still, a Missouri physician and Methodist minister. As an itinerant practitioner, Andrew Taylor Still quickly realized that the modern medicine of the day was not always effective and could sometimes aggravate health problems. His experience as a military surgeon during the American Civil War also led him to observe lower infant mortality rates in areas deprived of physicians.

In 1865, after losing three of his own children to cerebrospinal meningitis, he was confronted with the impotence of the conventional therapies of the time. He continued to practice allopathic medicine, while deepening his knowledge of how the human body works. His training at the Kansas College of Medicine and Surgery left him dissatisfied with the quality of teaching, and he did not complete his medical studies. However, in 1874, at the age of 46, he had an epiphany while examining a child with dysentery. He noticed that the child's back was warm and not very mobile, while his belly was cold. By using his hands to treat these areas, he was able to bring relief to the young patient. This led him to continue his research and clinical practice, based on observation and experimentation.

Despite the harsh judgment of his fellow doctors and the lack of support from the Church, Andrew Taylor Still believed in his ability to heal with his hands. In 1892, he founded the first college of osteopathy in Kirksville, Missouri, and began training his own children. Thus, osteopathy was born and passed on. This manual therapy is based on meticulous observation of how the various structures of the human body function.

After several years of expansion of this new discipline, Andrew Taylor Still stopped practicing conventional medicine. He wrote several books setting out the principles and philosophy of osteopathy, as well as his autobiography. After his death in 1917, many successors perpetuated the discipline. The first of these was Dr. John Martin Littlejohn, a Scotsman who completed his medical studies in the USA and became a fervent believer in osteopathy after being cured by Andrew Taylor Still.

In France, the forerunner of osteopathy was Robert Lavezzari (1866-1977), who was trained by an Andrew Taylor Still pupil, Florence Cat. He founded the Société française d'ostéopathie and worked closely with American practitioners to introduce the cranial technique to France. A physiotherapist, Paul Gény (deceased 1996), then structured the training of professionals by creating the École française d'ostéopathie.the École française d'ostéopathie, which later became the École européenne d'ostéopathie. Over the years, numerous osteopathic schools and colleges have sprung up, mainly attended by physiotherapists seeking to broaden their skills. This has sometimes led to concerns that the philosophy of osteopathy is being diluted.

To address this concern, some advocated the independence of the discipline, which led to the creation of the French Register of Osteopaths in 1981. In March 2002, the Kouchner law authorized the practice of osteopathy without being a doctor. Today, twenty-three osteopathic training schools are recognized by the public authorities.

The different principles

Osteopathy is a manual therapeutic approach aimed at resolving mobility restrictions affecting various body structures, such as joints, tissues, ligaments and muscles. It is based on a holistic understanding of the body, seeing it as an interconnected whole, unlike traditional Western medicine, which focuses more on individual organs. The body, including the psychological aspect, is seen as part of its environment, whether ecological, cultural, familial or occupational.

Structure influences function, which means that if a body structure is affected, its functionality may be impaired. Osteopaths are particularly interested in bone structure and skeletal mobility, as loss of mobility can lead to dysfunction of the nervous, muscular or circulatory systems. For example, a joint problem can have repercussions on visceral or nervous functions. For example, restricted mobility in the spinal column can cause digestive problems or compress a nerve, affecting the transmission of nerve signals. In addition, a rigid joint can lead to excessive tension in the surrounding muscles and ligaments.

Osteopathy aims to eliminate these mobility restrictions, allowing the body to return to its natural balance. Body fluids, such as arterial blood, play a crucial role in the proper functioning of the body, and the osteopath ensures that their circulation is not impeded by mobility restrictions. This ties in with the concept of self-healing, where once restrictions are eliminated through appropriate manual techniques, the body can use its resources to function properly.

During an osteopathic consultation, the practitioner begins by asking questions to understand the patient's symptoms, medical history, lifestyle habits and habitual postures. He then observes the patient's posture and palpates to detect areas of tension or restricted mobility. The osteopath uses a variety of manual techniques, including structural, functional, visceral, myotensive, fascial and cranial, to restore mobility and relieve symptoms.

The various manual approaches in osteopathy

They require mobilization and palpation gestures that are gentle and painless. Although there is a wide range of manual techniques, we can identify six main categories, each of which can be subdivided into several specific methods :

1. Structural techniques : These aim to free a joint using rapid, low-amplitude movements. These manoeuvres can sometimes produce a slight cracking sound. It's important to note that this sound doesn't come from the bones themselves, but from the release of gas bubbles in the synovial fluid, which acts as a joint lubricant. It's similar to the sound you hear when you crack your knuckles.

2. Functional techniques : These are based on gentle, slow movements that help relax the muscles and tissues surrounding a blocked joint.

3. Visceral techniques : These are used when normal organ mobility is compromised, often following surgery, childbirth or illness. The osteopath intervenes manually to restore the organs' natural mobility.

4. Myotensive (or muscle energy) techniques : In this method, the practitioner encourages the patient to contract a muscle against resistance, eventually causing muscle structures to relax. This helps to correct dysfunctions or mobility restrictions.

5. Fascial techniques : The osteopath applies gentle pressure to specific areas of the body, manually identifying blockages in the tissues and fascias, the membranes that envelop muscles and organs. The aim of this approach is to restore mobility to these areas, enabling tissues to breathe more easily.

These different methods are applied according to the patient's specific needs and the results of the osteopath's initial assessment.

The different applications of osteopathy

Osteopathy does not claim to cure all ailments, and in some cases an osteopath may recommend that the patient consult an allopathic physician when the pathology falls within the scope of conventional medicine. However, osteopathy has proved effective in relieving a wide range of ailments.

Here are just some of the common indications for which osteopathy can be beneficial :

• Vertigo,

• Headaches, migraine, facial neuralgia, cervicobrachial neuralgia, sciatica, cruralgia (damage to the crural nerve).

• Gastrointestinal disorders such as hiatal hernia, gastritis, constipation, colitis, bloating.

• Respiratory problems such as dyspnea, rhinitis and sinusitis.

• Gynaecological pain and disorders.

• Back pain, including lumbago, dorsalgia, cervicalgia, intercostal pain, joint pain in upper limbs (wrists, elbows, shoulders) and lower limbs (ankles, knees, hips), as well as tendonitis and sprains.

• Management of anxiety, stress, spasmophilia and insomnia.

Scientific evidence also supports the efficacy of osteopathy in certain specific conditions :

• Migraines : a meta-analysis published in the Journal of Pain Research in 2017 showed that osteopathic manual techniques could provide relief for migraine sufferers.

• Anxiety linked to chronic pain : An American study published in Health Psychology Open in 2018 found that osteopathy could be an effective remedy for alleviating symptoms associated with chronic pain, including anxiety, depression and low self-confidence.

• Spinal pain : An Inserm evaluation suggested that osteopathy could potentially offer effective solutions for spinal pain.

• Pain inhibition : A study in Madrid showed that osteopathic spinal manipulation stimulated the secretion of neurotensin, oxytocin and cortisol, biomarkers contributing to pain inhibition.

• Tendonitis : A study published in The Journal of Orthopaedic and Sports Physical Therapy in 2015 suggested that osteopathy could be beneficial in cases of rotator cuff (shoulder) tendonitis."