Osteopathy: Empathize With the Essence of Man.

By Sander Kales, D.O.-MRO, M.Sc.

Definition Osteopathy.
According to the founder, AT Still, the definition of osteopathy is that Osteo means bone and Pathos stands for illness or suffering in general (1874). He is quoted: "The merging of these two concepts is inspired by the Indians who merged two tribal names". Later new interpretations were added. Osteo is bone and in the 19th century this was seen as the essence of man because it was the only thing that was left of him. Pathos is empathy (see empathy). Merged this means "empathising with the essence of man" (McKone, 2001).
According to the professional competency profile (BCS-1) in the Netherlands osteopathic manual medicine is an examination and treatment.
Osteopathy is a philosophy, a science and an art.

The osteopathic philosophy is about
A. Health and illness
B. Process
C. Three general principles

A. Illness and health are two aspects of development. The death of brain cells is required for the growth. The loss of memory is needed to get new impressions. Also, for the immune system disease is a conditioning for a better immune system. When the path of disease to health (or vice versa) is put on a scale of 0 (ill) to 10 (healthy), then regular medicine is engaged in the domain of disease (0-3), in the domain functional subclinical symptoms (4-7) osteopathy is engaged and things like yoga, Pilates, fitness in the spa are on the wellness end of the scale (8-10).

B. Process
In recognizing symptoms, functional symptoms and disease it is about placing the processes and patterns in time. Health care providers are accustomed to looking for the symptoms (what do I have) and causality (how I got it) of a patient. Causality is the way the brains organize experiences. Causality cannot be seen, it comes from the subjective experience (Fenomenon) and not from the world (noumenon). Therefore, the effect cannot be distinguished from the source, because it comprises both. For osteopathic clinical reasoning this means that the genesis of the neck problems in its totality is important, not the neck problem 'in itself' and not 'the cause'. In the identification of disease and dysfunction the osteopathic clinical reasoning is important. This reasoning is based on the general principles.
The recognition of the originality of the patient (why do I have this now), depends on the patient history and knowledge of physical, psychological and emotional development. The world of matter (eg. A fist) thus conceals the whole (the hand) and the process (the fisting of the hand). If we apply this reasoning to recognize symptoms and disease, this allows the processes, patterns and thus to understand the information that is stored in the symptom.

Osteopathy as a science.
In today's academic world, the latest development is that Evidence Based Medicine (EBM) moves in the direction of Outcome-Based Medicine (CBM). Osteopathy takes causes into consideration, making use of these two approaches. Fundamental research is used for hypothesis formation and experimental studies to evaluate the final result. INSERM has published a paper in 2012 in which the current experimental studies summarized in Osteopathy and geëvaluereerd (Falissard 2012).
The physical aspect of osteopathy is based on medicine and is approached in a scientific manner. Aspects of human functioning such as cytology (1), histology (1) anatomy (1), physiology (2 and 3) fluid dynamics (2), endocrinology (3), immunology (3), biophysics (3), neurology (4 ), and psychology (5) are the foundation on which osteopathic thinking is based. However, this will be considered from an osteopathic or health perspective, and not from an allopathic or illness perspective. A systems model is a mental image of a disease or functional complaint. A model can be tested, in contrast to a paradigm (faith structure).

In regular care, there is a progressive differentiation: cardiology, internal medicine, endocrinology, etc. Developmental Systems Theory (DST) not only provides the before mentioned "Model thinking", but also the connection between the different models, where the psycho neuro-immunology is an example of (Oyama, 2001). This connection between the different models is comparable with the general principle: the body is a unit. Therefore DST is important in osteopathic thinking.

According to the Dutch Association of General Practitioners (NVH) 40% visited their GP with somatic insufficiently explained physical complaints (SOLK). Because of the three general principles and the Ecop model osteopathy is suitable for assessing functional complaints. She works in this domain and thus osteopathy is a part of functional medicine.

The Osteopath goes beyond the complaint and the elimination of symptom:
- He identifies disease and assesses the primary disease.
- He identifies the functional "sub clinical" complaints, called dysfunction, and places them in time.
- He uses evidence-based guidelines and basic research in treating the dysfunction.
- He analyzes the factors affecting the life of the patient's disease so that health can be improved, and the body can heal itself.

Osteopathic authors base their treatment hypotheses on fundamental research and not yet on experimental studies, when they describe empirical techniques in the current osteopathic literature (Georges Finet 2013) (Barral).
If basic research changes the hypothesis that the treatment strategy is based on changes, while the effectiveness has not been studied.
An example of this is the fundamental investigation into the "glymphatic system" (Iliff, Wang et al, 2012). Because the researchers had used a smaller marker than the dye that was used in previous studies, they found that the drainage of CSF is also via the para vascular place in the parenchyma. This shows that the earlier hypothesis in osteopathy of liquor drainage, only via the arachnoid villi and the venous system is incorrect.

Based on this knowledge, the hypothesis about drainage in the Cranio Sacral system must be re-evaluated. Instead of focusing on the statements of the assumptions (which, incidentally, much more leads to be like sync dog rosen that are long mobile connections between dura and musculature at the height of the occiput) there should be focused on the effectiveness of the techniques.

Classically the treatment techniques were divided into parietal, visceral and cranio-sacral techniques. This subdivision is by region. The structures that are treated, however, can be summarized in the above five models. As an example the biomechanical model through the fascia, both parietal, visceral as cranial be treated. Neurogenic, autonomic nervous system may also apply to all three. However, the symptomatic approach is still the language of patients and physicians. They want to know if we can help with a specific complaint / symptom.
For example, osteopathy can help with my digestive problem ??
The functional complaints top 10, according to the directive SOLK (NVH): generic low
back pain, neck pain, sleep problems, fatigue, upset stomach, irritable bowel syndrome, headaches, dizziness, anxiety and restlessness. These are the complaints that are within the osteopathic domain.

conclusion:
Studies have been done, not all of them methodologically sound, but it's a start. The last 10-15 years, more and more studies done in Osteopathy. There is also an increase of Osteopathic doing masters and even PhD. There are several research centers in the world (CORE, NCOR, etc.). In the Netherlands there's Foundation Research in Osteopathy (swoo.nl) which is working on more support from the profession.

Osteopathy as an art.
The osteopathic contact can be divided into the exteroceptive contact between the patient and the osteopath and interoceptive contact the osteopath has with himself.
The qualities that we can palpate exteroceptief:
1. Mechanical (motility)
2. Rhythm and Heat (circulation)
3. Vitality (innervation and metabolic)

During the exteroceptive contact, an exchange takes place through various phenomena. Brainwaves (Stevens 2010) and heart rhythms (McCraty 1996) have been proven to synchronize during the contact. Besides these physical qualities that are palpated, there is also the "mental" aspect during palpation of the other. In osteopathy the body is seen as an expression of the subconscious.
The person is the context in which the "spirit" finds its expression. So the body which is palpated has a 'mental-spiritual' side. The philosopher Whitehead said: "There are no two substances body-mind, but experience has two aspects: physically and mentally."

Whith interoceptive contact the inner world of the osteopath plays a role. Michael Shea emphasizes the development of an inner "resting" state during treatment (Shea, 2008). It should be considered that through supervision / peer review and biofeedback it is made clear what this "rest" state is and than what the content of the interoception is. Therefore an open balanced attitude is a prerequisite for observing the impression that the patient has on the osteopath, so it can be properly interpreted.
Subjectivity further calls for a development of one's own observations, so that a reproducible reference system can be developed. Nothing is greater than self-knowledge. This permits the osteopath to maintain distance and proximity and to let go of judgmental thoughts so openness arises for what is there. Therefore, the patient-osteopathy relationship is a collaboration system that promotes the health of the patient. Things like intuition and palpation are examined in relation to the inner world of the osteopath (McNeill, 2013).
The sense of touch is developed by the feedback obtained. Is it really the intestine or ligament that is felt? The feedback in the past was obtained by X-ray or ultrasound. For "hand-workers" the anatomy, histology, physiology and psychology of the nervous system act as a navigation system during palpation.

It can be concluded that during the osteopathic contact more will be observed than just the mechanical, physical, but that these things should be distinguished in the phenomenological experience of the osteopath and the existential á priori aspect of perception. Both must be reproducible and verifiable. Therefore, the name Osteopathy can be questioned, which literally means disease of the bone. The name empathize with the essence of the human being from the functional medicine would be more appropriate.

the Future
Problems for osteopathy are the recognition of the profession, which should be by the BIG register. To join this, first one needs  to develop a NVAO accredited full-time training. Furthermore, the experimental research will also be extended.
Furthermore, anyone can learn the techniques ("skills") and do "osteo therapy", such as craniosacral therapists, visceral techniques by manual therapists, etc. However, the clinical reasoning and competencies are more complicated and require more study so that the osteopathic medicine, and most importantly the clinical reasoning must be based on adequate knowledge of anatomy, physiology, histology and cytology.
Future directions for osteopathy are increasing the basic medical knowledge. Than the clinical reasoning should take place from an osteopathic conceptual framework, ie how health is defined and what are functional problems (tired, stiff, pain, etc.)? Additionally an osteopath as first-line worker must master sufficient knowledge of the pathology to distinguish the red and yellow, the green flags.

In Summary:

The osteopathic philosophy has phenomenological, empirical and process aspects. There are three principles of osteopathy: unity, process of structure and function and self-healing / health.
The science of osteopathy is still in its infancy. Clinical reasoning is based on the statement of five models: biomechanical, circulation / respiration, metabolic, neurological and biopsychosocial.
The art of osteopathy lies in a refinement of feeling, extero- as well intero-ceptief.

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