What can an osteopathic doctor do for you?

by Debra Wood, R.N.

Osteopathic Medicine Combining the age-old therapeutic powers of touch with the latest in medical technology and research, osteopathic medicine blends the best of both worlds to diagnose and treat an array of conditions, from infected toes to chronic back pain.

"Our approach utilizes everything thats good in modern medicine and modern technology," says Dr. Boyd Buser, associate dean for clinical affairs at the University of New England College of Osteopathic Medicine in Biddeford, Maine. "And it uses an additional piece during our exam and treatment that gives us more options, gives us the opportunity to be more accurate with diagnosis and, hopefully, more effective with treatment. And it focuses on the patient."

Osteopathic medicine emphasizes holistic care, respects the bodys ability to heal itself and promotes harmony as systems work together. "We step back and take a broader look," Buser says. "We try and identify if there are factors in your personal life, in your emotional health or in your environment that are contributing to the reason you came to see us. Your state of health is clearly affected by mind, body and spirit."

Osteopathic diagnostic exams include traditional medical tests and vital signs, as well as an assessment of the musculoskeletal system and how the patient moves. If they find a problem, osteopathic physicians will often employ manipulative techniques to restore normal movement.

"We use passive, thrusting-type manipulations, which people think of as popping the joints," says Buser. "We use upwards of 30 different technique approaches, depending on what we think the nature of the dysfunction is. Most do not involve popping of the joints."

Tight muscles, joint deformities and changes in connective tissues can limit movement. While chiropractors might focus on misalignment in the spine and the potential for that abnormality to interrupt nerve transmissions, osteopathic physicians hone in on how a motion restriction will alter the function of other body systems, and in particular, the movement of air and fluids.

"One of the basic principles of osteopathic medicine is that the body has mechanisms to regulate and repair itself," Buser explains. "The mechanisms will work most effectively if oxygen is being delivered to the tissues and waste products are removed from them."

For example, heres how he would treat a patient with an infected foot. In addition to prescribing an antibiotic and making sure the patient knew how to take it, he would examine the musculoskeletal system with an eye toward identifying abnormalities that would interfere with circulation to that area.

"By making sure all the circulatory channels are open, I can help provide better delivery of the antibiotic to the site," Buser says. Not all doctors of osteopathic medicine (DOs) practice manipulation. And some refer patients with complex conditions to physicians specializing in the hands-on treatment.

All 50 states license doctors of osteopathy to practice medicine with full prescription and surgical privileges. Osteopathic physicians must graduate from an American Osteopathic Association-accredited school. The four-year course of study emphasizes preventive medicine and holistic patient care. Graduates complete internships and residencies.

Most of Americas more than 43,000 osteopathic physicians provide primary care, as internists, family medicine specialists, pediatricians and gynecologists. Many practice in small towns and in underserved locales. Eighty percent of Americans are unfamiliar with osteopathic care, yet DOs provide about 10 percent of all the care rendered by physicians in the United States; the American Osteopathic Association estimates that 100 million people in the United States visit a doctor of osteopathy.

Osteopathic physicians are considered "complete" medical professionals and have similar educational preparation to medical doctors (MDs). Doctors of osteopathy can perform the same functions as a medical doctor; chiropractors receive a less broad medical education and cannot prescribe drugs or operate on patients.

Osteopathic manipulative treatment (OMT) aims to restore movement and does not usually move a joint beyond normal range of motion. Chiropracty, however, may push beyond the normal range when trying to adjust spinal alignment.

"Lets say a chiropractor and I both examine your musculoskeletal system. We both might find the same abnormalities and motion restrictions," Buser explains. "But we differ greatly in how we assess the significance of those findings in the context of your overall management. Because osteopathic care includes medications, I might prescribe something, or I might recommend OMT as another treatment option."

Little hard scientific evidence exists to prove the benefit of manipulation, but the practice is considered relatively safe. A review published in the November/December 1999 issue of the Archives of Family Medicine reported that during 15 controlled trials, not one patient experienced an adverse effect from the procedures. And the authors review of 128 articles published between 1925 and 1993 found only two cases of injury involving OMT.

A recent study reported in the New England Journal of Medicine found that patients with chronic back pain treated with OMT recovered as quickly and thoroughly as those receiving standard care. But the patients who received OMT needed less medication and less physical therapy. Prescribing fewer drugs lowers the risk of unpleasant side effects. It also saves money.

The benefits of OMT may derive from more than just the pressure exerted on muscles or joints. "When your physician is comfortable using a hands-on approach as an integral part of the examination, it builds more of a rapport and tends to ease the way for communication," Buser says. "That allows for better, [more] accurate diagnosis and treatment."

Osteopathic physicians consider activities that could contribute to your health or illness, and offer advice to prevent or treat problems. In recent years, many medical doctors have developed an added appreciation for the degree to which stress, family tensions and other issues improve or detract from health.

Manipulation is one piece of the overall diagnosis and management, Buser explains. Caring is another. "As more and more evidence accumulates [like what we saw in the New England Journal of Medicine article], youll see more people seeking out DOs. This will help them gain a better understanding of osteopathic medicine and embrace it as a viable, credible health alternative, which is really exciting!"