The term osteopathy is derived from the Greek osteon (bone) and pathos (suffering), thus emphasising the importance of the body framework in abnormal body conditions. Osteopathy is based on holistic principles and the principal role of musculo-skeletal system in maintaining health or developing disease.

Holism implies integrity, interrelationship and interdependency between the body parts, the body as a whole with the environment, including all processes taking place.

Principles of osteopathy are based on the holistic concept but the exact wording is different from different sources. Generally accepted are principles developed by the osteopathic faculty committee at Kirksville College of Osteopathic Medicine in 1953:

• the body is a unit

• structure and function are reciprocally interrelated

• the body possesses self-regulatory, self-defending and self-repairing mechanisms

The role of the musculo-skeletal system

In osteopathy the musculo-skeletal system is given the primary role. Osteopaths explain it in two different ways.

Mechanists stick to biomechanics and all body derangements are explained by joint or muscle dysfunction, movement impairment or mechanical part of "osteopathic lesion" (see below). Those practitioners aim on determining mechanical alterations and normalising them.

Vitalists explain illness by impairment of normal circulation of a "vital energy", which in modern osteopathic interpretation translates as an "integrative force of the nervous and vascular system". Vitalists see their work as restoration of the free flow of the vital energy by influencing (treating) the musculo-skeletal system with it's regulation by neural reflexes, by influencing the vascular system (mainly lymphatic), or by influencing the circulation of spinal fluid (cranial osteopathy).

Somatic dysfunction

The osteopathic lesion (somatic dysfunction is the accepted term these days) is the key point of osteopathy, like subluxation in chiropractic or joint blockage in manual therapy. By somatic dysfunction Osteopaths mean a total of reversible functional (biomechanical) and reflectory changes in a lesioned motion segment.

Motion segment includes joint(s), adjacent soft tissues (ligaments, muscles, fascia, skin, connective tissue) and neuro-vascular formations, associated with each other by peculiarities of biomechanical and neural activities. For instance, the L5-S1 segment includes parts of the fifth lumbar and first sacral vertebral bodies with articular processes and the intervertebral disc, two facet joints, adjacent articular and spinal ligaments (part of the lig. flava, longitudinal, supra/interspinous and intertransversarii, ileo-lumbar ligaments), segmental muscles (intertranversarii, supra/interspinous, multifidi), skin and the rest of soft tissues adjacent to L5-S1 segment, fifth lumbar and first sacral nerve roots.

Because of segmental and autonomic innervation the motion segment is closely linked by positive and negative feedback with metameric structures, i.e. related structures of the corresponding sclerotome, dermatome, myotome and viscerotome. As a result, the clinical picture of somatic dysfunction may include a variety of local and distal features.

It is worth mentioning that the notion of a motion segment and segmental division in general have more practical and functional than abstract sense. It is practically impossible to delineate the sclerotome, viscerotome or segmental nerve roots corresponding with a certain segment.

There have been numerous attempts to find pathological changes in somatic dysfunction ending without convincing results. Researches of I.Korr (American physiologist) revealed significant changes in spinal neural reflexes patterns, corresponding with the lesioned segment, however, clinical significance of his findings needs confirming and further investigaton.

There is also an opinion that visceral pathology can be a result of somatic dysfunction in the initial stage and that osteopathic treatment is capable of preventing pathology. This opinion needs serious experimental verification and is considered today to be un-proven.

What does osteopathy do

As we can see from the description of somatic dysfunction, it is not limited to the joint and that is why osteopathic treatment is not about finding the blocked joint and "clicking it back into place". The cause of the faulty function of the motion segment may be situated in any of it's components (in the joint, muscle, ligament etc.). Therefore diagnosis and treatment are aimed at finding the key chain in the structural and functional impairment and at its correction. These key changes can include, for instance, joint locking or hypermobility, shortened muscle or trigger points in it, decreased elasticity of the fascia, painful hardening of the fibrous scar. Next is to assess relationships between neighbouring segments, between several segments in a group and relationships between distant segments that are bound functionally (for example, lumbo-sacral and thoraco-lumbar junctions).

At the end of the examination a conclusion is made about the movement pattern in the locomotor system as a whole, within functional zones and segmentally, with a logical treatment plan following.

Higher centres

Originating from the very foundations of osteopathy by A.Still, a lot of attention is paid to the role of the central nervous system and psycho-emotional state in human suffering and their role in locomotor derangements in particular. It is interesting that A.Still practiced magnetism for few years prior to founding osteopathy. He formulated the basis of osteopathic practice as being "mind, matter, motion" with mind being a separate domain along with structure and function.

It is well known that the psycho-emotional status directly affects the body. In the locomotor system it can change muscular tone, coordination, neuro-reflectory reactions, which often leads to positive or negative changes in the functional equilibrium. Many physicians still attribute such changes to hypochondria or neurosis.

Osteopaths assess the psycho-emotional state mainly intuitively according to their previous experience. As a part of treatment a correction is done in different ways depending on attitude, enthusiasm and, again, experience of the practitioner.

Today most Osteopaths practice elements of rational psychotherapy as an integral part of their treatment. This includes explanation of the possible cause and prognosis of the problem, showing ways of taking control under the situation in the light of modern science or, as in olden times, from the "twisted vertebrae" point of view. A small group of practitioners is developing the idea of the "body-oriented psychotherapy". They are talking about "reconstruction of body image", "therapeutic touch" or simply "direct suggestion with body contact".

Cranial concept and other functional techniques

The cranial concept or cranial-sacral therapy was developed by W.Sutherland in the early days of osteopathy as a continuation to A.Still's system. It postulates mobility of separate bones of the skull and rhythmic fluctuations of spinal fluid, dural membranes and the sacrum. The mechanism of fluctuations is believed to be respiratory with the frequency of 8-12 per minute and can be detected by palpation, feeling the changes in the size of the head. Treatment aims at restoring symmetrical and free excursion of the cranial bones and the sacrum.

Strain-counterstrain is the newest approach in osteopathy and was developed by L.Jones in USA in the early 70-s. The mechanism of somatic dysfunction is considered to be a breakdown in the neuromuscular network (reciprocal regulation of the muscle tone). A muscle which is shortened causes strain of the antagonist and imbalance appears. The cause is believed to be a sudden jerk or overstrain. Diagnosis is based on finding reflex "tender points" by palpation (some of them correspond with acupuncture points). During treatment tender points are monitored while putting the body and limbs into special positions where the tender point "switches off", and holding that position for 90 seconds and then slowly (which is very important!) returning the body into a neutral position again.

Positional release and myofascial release concentrate their attention on movements that increase or decrease the tension. Treatment techniques may either take the part into a direction where tension increases thus stretching tissues (direct techniques) or to the opposite direction to which tension gets less thus trying to change tone of soft tissues (indirect techniques).

Manipulations are not performed in functional techniques.