Title:
Acknowledgements:
I would like to thank my supervisor Mr. Jonathan Edis for his interest and
guidance and Dr. Melanie Wright for her valued input into the data analysis
process. I would also like to thank Mr. Christopher Wilkes for his participation
in the pilot study and Mr. Will Podmore for his unfaltering library assistance. I
would also like to say a very special thank you to Mr. Walter Llewellyn
McKone for his inspiration, kindness and guidance.
Abstract:
Due to the tragic misdirected course Osteopathy has taken from its inception
in 1874 until present, an enquiry was conducted to ascertain the osteopathic
content of the British Journal of Osteopathy from its inception in 1960 until its
demise in 2006. Results showed a significant decrease of 0.117 osteopathic
principles per year from 1960-1984. Osteopathic principles are a direct
emergence from the osteopathic philosophy, thus results indicated uncertainty
as to the philosophic foundations of our profession. Osteopathys origin is
placed in Goethean science demarcated by its phenomenological approach to
the natural world as opposed to the Cartesian philosophy that underlies
orthodox medicine. Unfortunately, the resulting evidence based medicine
culture seems to have polarised the osteopathic profession (Leach, 2008).
However, osteopathic evidence is gained through practitioner centred
experience of metamorphosis of natural phenomena upon interacting with the
patient, thus, Dr. Stills, mind, matter and motion concept can be viewed as
an over arching principle of osteopathy supported by the very philosophy of
osteopathy. From this foundation, osteopathy should strive to gain its
deserved status in the medico-political arena as an independent school of
science, practice and research.
Introduction:
Ward et al (2003) state that viewpoints and attitudes arising from osteopathic
principles give osteopathic practitioners an important template for clinical
problem solving and patient education especially when confronted with
increasingly complex physical, psychosocial and spiritual problems affecting
individuals, and populations from a wide variety of cultures and backgrounds.
Thus, it is imperative that an osteopathic physician should mentally embrace a
set of principles when practicing osteopathy. The purpose of principles is to
trigger thought processes, which help the osteopath understand, make
decisions, and act appropriately when practicing (Kuchera & Kuchera 1994).
Indeed, Still (1910, p.28) states explicitly, when we treat diseases of the
whole system we must have a foundation or fail.
Previous Research:
principles (Gevitz 2006, see figure I). Subsequently, the Kirksville College of
Osteopathic Medicine (KCOM) reworked these in 1953 (see appendix IV)
concluding that the principles were distinctive but not the only features of
osteopathic diagnosis and treatment.
osteopathic practice. Accordingly, the authors added two principles to the list
proposed at KCOM (see appendix V). Subsequently, Dowling & Martinke (in
DiGiovanna et al, 2005) formulated nine principles (see appendix VI), of which
the first four were developed from the list proposed by KCOM in 1953, the two
produced from Sprafka et al (1981), and the remaining three were formulated
accordingly. The resulting nine principles (see appendix VI) are poised in the
KCOM curriculum, and are widely taught throughout the international
osteopathic community, and thus will be the set of principles used to conduct
this enquiry.
However Rogers et al (2002) also propose the need for the incorporation of
evidence-based guidelines into the treatment programme. Similarly, Lucas &
Moran (2007) are in favour of the addition of evidence and science as a
central principle of our tenets. However in both cases the mechanistic
scientific paradigm, that underpins the biomedical model, does not provide a
suitable philosophical framework on which to base osteopathic evaluation and
diagnosis (Green 2000) and so these authors are entirely misguided as to the
fundamentals of the osteopathic philosophy.
Method:
Ethical Approval:
Table I: A table to show the inclusion and exclusion criteria for article
selection.
Criteria
Articles
Inclusion criteria
Exclusion criteria
10
Pilot Study:
A pilot study was conducted to assess the inter reliability of the data gathering
tool (see appendix VII) in the collection of data. Thus, the author and a
second reviewer separately assessed the occurrence of the nine osteopathic
principles (see appendix VII) in five randomly selected BOJ articles (see
references II). The results showed a total of 18 principles identified between
the reviewers and 15/18 of the principles were identically selected between
the reviewers, giving an 83% agreement rate (see Table II). The 3/18 (17%)
principles, which were not agreed upon between the reviewers, presented one
error of omission by reviewer 1 in article 4 and one error of commission by
each reviewer in article 5. From the high level of agreement between the
reviewers, the pilot study was deemed validated with regard to the coding
systems credibility.
11
Table II: A table to show the results of the pilot study, conducted by the
author and a second reviewer. The principles found are numbered 1 to 9,
each number representing one of the nine principles (see appendix VI).
Article
Reviewer 2
1, 5, 9
1, 5, 9
1, 2, 3, 4, 5, 6, 7, 8, 9
1, 2, 3, 4, 5, 6, 7, 8, 9
2*
2, 4*, 6
2, 6, 8*
Total identified
16
17
12
first article from each BOJ publication was systematically selected for review.
Thus, each data set compiled from the two time periods were analysed
separately to maintain consistency. This provided a sample size of 69, giving
a credible scope of BOJ literature reviewed through the second half of the 20th
Century.
13
as in 1999 and 2005, articles could not be selected. Thus, in order to best
represent the part of the year each article was published in and to avoid any
confounding effects on the results, a seasonal nomenclature was formulated
for use in the data analysis (see Table III).
Table III: A table to show the Standard Nomenclature for each season.
Season
Spring
0.25
0.5
Autumn
0.75
+1
14
continual data, acted as the constant variable and the score, a set of ordinal
data, acted as the dependent variable. To deduce if a significant relationship
existed between the year of BOJ publication and the score of osteopathic
principles, a non-parametric Spearmans Correlation test was performed on
the 1960-1984 data and again on the 1987-2006 data. A 2-tailed hypothesis
and 2-tailed probability value at the 95% level (P<0.05) was selected to
account for the possibility of a positive or negative correlation occurring
between the variables.
15
Results:
16
Table IV: A table to show that the coefficients of the model were both
significant statistically at P <0.05.
Coefficient
Constant
Year (x value)
S.E.
232.621
100.511
.026
-.117
.051
.027
S.E. of
R2
R2
Estimate
0.344a
.119
.096
2.354
Score
6
5
y = -0.117x + 232.62
R2 = 0.119
4
3
2
1
0
1955
1960
1965
1970
1975
1980
1985
1990
Year
17
This retrospective model (see graph I) indicates that there was a decline in
score (i.e. number of principles) of 1.17 every decade (or 0.117 every year) in
the core texts of BOJ publications between December 1960 and December
1984.
18
Discussion:
Relevance of results:
Osteopathy in Britain has changed dramatically through the 20th Century from
its inception in 1874 to the present day. The authors attempt at philosophic
quantification of the BOJ content, in order to determine the extent of marriage
between osteopaths and their principles, reflected these changes in that there
was a significant decrease of 0.117 osteopathic principles per year in the BOJ
(or 1.17 principles per decade) between 1960 and 1984. This may have been
consequent to the great structural-mechanical period from 1920-1960
(Dummer 1988, see appendix X) which was responsible for the development
of a very mechanical bias in osteopathic diagnosis and technique, heavily
influenced by medicines advances in this period (Latey 1993c).
Consequently, barely 200 osteopaths were practicing in the UK by the mid
1960s (Latey 1993c). Thus, osteopathy suffered an eclectic degeneration that
lasted well into the middle of the century, culminating in the birth of classical
osteopathy, which emphasised single factors such as asymmetry and
vertebral joint lesions as the cause of disease. This indicated a nave
mechanistic philosophical view of linear causation, which was far from Stills
philosophy (Latey 1993c).
19
The government has been in alliance with the medical profession, as its major
source in the field of healthcare, since the 1960s following its claims to
knowledge and expertise being based on the scientific method (Green 2002).
In order to become recognised as a profession with a regulatory body,
osteopathy has had to adopt the scientific philosophy and evidence based
medicine (EBM) scientific methodology. Indeed, Cant (1996, in Edis 2001)
identified the need for osteopathy to embrace the scientific paradigm in order
to become legitimised as a profession and be accepted in the political and
medical establishment, thus another reason for the demise in principles
echoed in the results between 1960 and 1984.
Indeed, as a result of the rejection of the 1931, 1933 and 1934 Osteopath
Regulation Bills, on the grounds of a perceived lack of medical research and
the accusation that osteopathic theory was unsupported by scientific
evidence (Collins 2005), a set of osteopathic reforms were set in motion in an
attempt to conform to orthodox medicine. Reforms included BSO curriculum
changes in 1950 (see appendix IX) and conformity to a therapy founded on a
systematic body of knowledge that is accepted by the medical profession as
set out in the 1985 House of Lords debate. This conformity summated in
securing the full support of the medical profession at the Kings Fund meeting
in 1989, the culmination of which enabled the profession to gain status and
20
statutory regulation by way of the Osteopaths Act of 1993. This was a further
step towards the application of EBM into osteopathic practice, which was
expected in order to justify the latter, and of course to the great demise of our
philosophy.
The EBM culture seems to have polarised the osteopathic profession (Leach,
2008). Indeed, modern medicine is based on the process by which scientific
knowledge is acquired, which acts to minimise variables in order to make
them reproducible by others. However, osteopathy deals with many variables
in individual patients in specific non-replicable situations (Tyreman 2008a),
thus representing a body of knowledge that can only be partially captured by
scientific theory statements or assessed by scientific method. Thus, they are
based on completely different philosophies as scientific evidence per se acts
only to uncover one parameter of the bodys many differing profundities. Thus,
conventional clinical research protocols for the assessment of efficacy of most
chemical and physical therapeutic agents are ill suited for the assessment of
osteopathy (Korr, 1997). This injustice to osteopathy is seen in; The Royal
College of General Practitioners Clinical Guidelines for the Management of
Acute Low Back Pain issued in 1996, which concluded that, Manipulation
within the first 6 weeks can provide short-term improvement in pain.
21
22
Thus, a divide between what is taught and what is applied in the education
system may exist whereby the osteopathic philosophy is taught in theory but
not practiced with regard to the diagnostic and treatment thought processes
when interacting with the patient which is regrettably currently being reasoned
with a philosophy of unity in multiplicity as is so in orthodox medicine whereby
treatment approaches and management plans are sought with a set diagnosis
taking absolutely no account of the phenomena before them which they are a
witness to and thus being external to the experience of the practitioner-patient
interaction, but instead bombarding them with orthopaedic tests in set
parameters. Indeed, McKone, (2004) states that the idea of separateness is
fundamental to differential diagnosis, specific techniques to specific tissues,
23
Stills Influences:
24
25
Thus, this Cartesian philosophy is useful in building a box, but not in treating a
patient. Indeed, Tucker (1919, in McKone 2001) states, we think of
mathematics as existing in nature, since every quality of nature is definable
ultimately in terms of mathematics. But nothing could be further from the truth.
There is and can be no true mathematics in nature for the simple and perfect
reason that there are no uniform units in nature. No leaf is just like any other
leaf, no wave like any other wave. Indeed there is no human like any other
human.
26
27
Both Still and Goethe had phenomenological approaches towards man and
nature respectively and viewed the human being as the most exact instrument
to be studied, instead of creating instruments that distort our encounter with
the natural phenomena in their environment (McKone, 2001). This holistic
paradigm is non-external, and so allows the observer to become part of the
experience witnessed, whereby a total relationship to the surroundings is
achieved where no abstracted elements are considered (McKone, 2001).
28
The link between Goethe and Still: Multiplicity in Unity, (McConnell, 1935).
At this late date many seem to forget that a basic discovery of Dr. Still was the fact of
immunity... The osteopathic approach is so fundamentally different from that of any other
method,In attempting to set aright a disordered mechanism, innumerable facts,
representative of multiform forces, are enlistedThe whole living structure (not just the
backbone) which embraces function, or vice versa, is something more than just the sum of
the parts; and the sum of the parts is not confined to one class of tissue, e.g.
bonesWhere we, as osteopathic physicians, are negligent is in not giving sufficient time
and thought in reading, interpreting and analysing the body hieroglyphsThese signs
(are) comprehensively written throughout the tissuesOne partially misleading
procedure is that we too readily seek the mathematical coordinates of the osseous lesion
as a sort of standard indexoverlooking the very environic forces which make the
segmental and organic changes possibleThe environic forces, acting through the media
of the soft tissues by way of circulating fluidsare those which should be primarily
attacked in order to resolve the pathologyThe practical everyday problem resolves itself
into what the individual measure of the particular case is. It is not a composite collective
one, but composite and unified, with multiplicity in unity. This is exactly what makes
osteopathy successful. Now, it is right in the functional strains and stresses of tissues that
there is a world, individually so, of detectable differences. Each ones difference should be
sought, exposed and unravelled. This is what art should do. Herein rests the difference
between mediocrity and skill. No two treatments can be, or at least should be, the same;
for the impacts of environing forces necessarily vary.
Figure II: The link between Goethes science and its influence on Stills
philosophy, embodied in the statement, multiplicity in unity (McConnell,
1935).
29
30
31
32
Description
treatment
1
Thus, the practitioner must think of the patient out into its environment, and
develop the sense of active absence when treating. Indeed, Still and Goethe
wanted us to bathe in the phenomenon and open our senses to receive the
environment into our consciousness (McKone, 2001) as all beings dwell in the
33
34
Thus mans body is a form given by celestial life to the terrestrial life
that is reduced back from the living matter to a man, world, or being,
with form of a being given by the celestial forces acting on living matter
whilst in the living state of matter, so fine that the atoms blend and
become a unit, or melt and become one being or body of living matter,
with quality equal to all qualities of life, wisdom, and material
substances, never to return to their original state, either as matter or
life.
Figure V: (Still, 1902, p.225), Stills description of Life in Matter as a dynamic
continuum manifesting itself in mind, matter and/or motion.
Relevance to Treatment:
35
our observations to his internal structures, but to the outer world in which he is
placed and his interactions with it (see Figure VI).
Man, nature and his social milieu, are the trinity
of medicine, and the three are indeed one.
To the true physician there is no solid medium,
but only motion and amorphous Man.
Figure VI: The concept of mans interaction with the environment (Milne,
1956).
Thus, mind, matter and motion can be viewed as an over arching principle of
osteopathy supported by the very philosophy of osteopathy i.e. that
osteopathy is a science that is primarily concerned with the Lebenswelt, Lifeworld (McKone, 2001). Indeed, Kuchera & Kuchera (1994) state that there
needs to be some method of understanding life, in order to have positive
health, the dilemma to which is answered in this over-arching principle.
Lost direction: Finding our Foundation: The reason why the adult no
longer wonders (as does a child) is not because he has solved the riddle of
life, but because he has grown accustomed to the laws governing his world
picturehe who has reached the stage where he no longer wonders about
anything, merely demonstrates that he has lost the art of reflective reasoning.
(Planck, in McKone, 2001).
36
37
The Principle to Progress: Our science is young, but the laws that govern
life are as old as the hours of all ages (Still 1902 p.62).
Due to the fact that the osteopathic principles are a direct emergence from the
osteopathic philosophy, the author proposes a medium to which the osteopath
can embrace, understand and apply the osteopathic principles in reasoning as
a philosopher of osteopathy, in order to practice as Stills science and
philosophy of osteopathy intended, by instilling the phenomenological
Goethean inspired paradigm, which understands truth as a fluid and
convertible entity, into ones cognition and utility. In order to achieve this goal,
an overruling principle could translate as follows (see Figure VII),
An osteopath must aim to so truly embed the concept of multiplicity in
unity in his or her mental realms when, coming into knowledge of the
natural world and reasoning at all times, whether it be in the educational or
practical realms of diagnosis, research &/or osteopathic practice, whereby
the practitioner-patient system should come into a state of active absence in
order to become part of a shared experience witnessed with the patient, out
into the dynamic multiform and multifunctional spatio-temporal processes
we call the environment, thus forming a total relationship to natural
phenomena as they interchange between mind, matter and motion and thus,
achieving the evidence and rewards of philosophising, and practicing the
science of osteopathy as a healing art in treatment of dysfunctions and
diseases.
Figure VII: An attempt by the author to reintroduce the osteopathic
philosophy into the osteopath by way of an overarching principle.
38
A Unified Osteopathic Future: Give me the age of God and I will give you
the age of osteopathy. (Still, in Essig-Beaty, 2008).
39
Figure VIII: The Osteopathic Oath (adapted from Clapp 1949). In bold are
the phrases that highlight the undertones of the osteopathic philosophy and
our duties as practitioners to be philosophers of our science and practice.
Future Research:
With regard to this enquiry, it would be of interest to research the BOJ for its
content of mechanical principles, thus gauging the extent of the Cartesian
Philosophys influence in the osteopathic community through time. From the
results here, a subsequent increase of Cartesian-Newtonian thought process
and philosophy would be expected through the 20th Century. However, it is
thought that time would be better spent in promoting the osteopathic
philosophy to the curriculum and wider international community due to the fact
that as Dubos (1977) states, very few know of its (Goethean approach)
existence. However, we now know of our truly bracing and novel
philosophical platform which provides the endowment of reasoning skills, with
regard to health and disease, so that we can now confidently apply the art of
osteopathic science in practice, and so here rests our osteopathic identity.
.
Future Osteopathic Research With Regard to Evidence Based Medicine:
EBM hierarchy of evidence is short sighted and ranks evidence not according
to effectiveness but according to study method, (Bluhm 2005, in Fryer 2008).
This author clearly understands the essence of osteopathy. Indeed Avis &
Freshwater (2006, in Fryer 2008) agree that EBM undermines the role of
40
clinical judgement and individual expertise. Similarly, Leach (2008) states that
evidence from random controlled trials are limited, not adequately reflecting
osteopathic practice. However, pragmatic randomised trials where one health
service model is compared to another to assess the package of care, as was
done in the BEAM (UK BEAM Trial team, 2004) and ROMANS (Williams et al
2003) trials represent better methodologies to reflect the efficacy of
osteopathy in the EBM arena (the better of two evils). However, true
osteopathic research would consist of practitioner-patient views directly
representative of the natural world and experience reports of those natural
phenomena interactions and case reports/studies on the many differing
patterns of the body in space and time all of which Still (1910) describes in his
book, Osteopathy: Research & Practice.
Weaknesses of Research:
Keeping in mind that only two issues per year were reviewed in the
BOJ, it is difficult to make any fully claimable conclusions or
assumptions based on the data from sampled issues (Riese, 2000).
Publication bias was a factor as the BOJ was the only journal to be
reviewed and so the results cannot be extrapolated to the contents of
other osteopathic publications. However, although the results were
obtained from only one journal source, and may not be representative
of all osteopathic literature, the lack of reinforcement of osteopathic
41
The editors decision to use articles from the same author on a regular
basis may have biased the BOJ content i.e. Dove, Smith, Barrett,
Miller. However this is also a valuable factor in determining osteopathy
at the time.
Conclusion:
42
43
References I:
Bagust, J., Chen, Y., & Kerkut, G., A. (1993) Spread of the dorsal root
reflex in an isolated preparation of hamster spinal cord. Experimental
Physiology 78:799-809.
44
45
Essig-Beatty, D., R. (2008) Fire on the Prairie: The Life and Times of
Andrew Taylor Still, Founder of Osteopathic Medicine by Comeaux, Z.
(2007). IJOM. 11:69-70.
46
Gould, S., J. (1987) Times Arrow, Times Cycle: Myth and Metaphor in
the Discovery of Geological Time. Harvard University Press, London.
47
Lucas, N., P. & Moran, W., R. (2007) Is there a place for science in the
definition of osteopathy? IJOM. 10:85-87.
48
Rogers, F. J., DAlonzo, G. E., Glover, J., C., Korr, I., M., Osborn, G.
G., Patterson, M., M., Seffinger, M., A., Taylor, T., E. and Willard, F.
(2002) Proposed tenets of osteopathic medicine and principles for
patient care. JAOA. 102(2):63-65.
49
Shelhamer, J., H., Levine, S. J., Wu, T., et al (1995) NIH conference.
Airway inflammation. Annals of Internal Medicine123:288-304.
50
Teitelbaum, H., S., Bunn, W., E., Brown, S., A., and Burchett, A., W.
(2003) Osteopathic Medical Education: Renaissance of Rhetoric?
JAOA. 103(10):489-490.
UK BEAM Trial Team. (2004). United Kingdom back pain exercise and
manipulation (UK BEAM) randomised trial: effectiveness of physical
treatments for back pain in primary care. Br Med J. 329:1377
Ward, R. C., Sefinger, M. A., King, H., Jones, J. M., Rogers, F. J. and
Patterson, M. M. (2003). Foundations for Osteopathic Medicine.
Chapter 1. 2nd Ed. Lippincott Williams & Wilkins. Philadelphia.
51
Williams, N., H., Wilkinson, C., Russel, I., Edwards, R., T., Hibbs, R.,
Linck, P., et al. (2003). Randomized osteopathic manipulation study
(ROMANS): pragmatic trial for spinal pain in primary care. Fam Pract.
20:662-9.
52
References II: Article references for the pilot study selected at random from
the BOJ:
53
References III: BOJ article references (n=69) from which data was gathered
and subsequently used for data analysis: (Note that between reference 41
and 42 the BOJ ceased publications from December 1984 until November
1987).
54
10. Crawford, D., A., H. (1965) Dupuytrens contracture. BOJ. 2(8): 1-6.
11. Hewitt, P., M. (1966) Cervical Spondylosis. BOJ. 3(1): 2-5.
12. Jackson. P., A. (1966) The sacral base plane. BOJ. 3(2): 2-11.
13. Dove, C., I. (1967) A history of the Osteopathic Vertebral Lesion. BOJ.
3(3): 2-17.
14. Crawford, D., A., H. (1967) An investigation into the number of
practicing osteopaths in the United Kingdom. BOJ. 3(4): 1-13.
15. Chapman, A., E. & Troup, J., D., G. (1968) Training for heavy manual
work. BOJ. 4(1): 2-10.
16. Barrett, J. (1969) The frozen shoulder. BOJ. 4(2): 2-4.
17. Barrett, J. (1969) A study of inversion of the foot. BOJ. 4(3): 1-6.
18. Tyrie, M. (1970) Head Pain. BOJ. 4(4): 2-13.
19. Stoddard, A. (1971) Spinal Osteochondritis. BOJ. 5(1): 2-9.
20. Smith, A., E. (1971) Osteopathic Diagnosis. BOJ. 5(2): 2-8.
21. Smith, A., E. (1972) Osteopathic Diagnosis- Standing Examination.
BOJ. 5(3): 2-7.
22. Smith, A., E. (1972) Osteopathic Diagnosis- Sitting Examination. BOJ.
5(4): 2-8.
23. Smith, A., E. (1973) Osteopathic Diagnosis. BOJ. 6(1): 2-9.
24. Stoddard, A. (1973) Mechanics of the Spine. BOJ. 6(2): 3-10.
25. Leahy, J. (1974) Georgia D.O wins suit to use M.D suffix. BOJ. 7(1): 37.
26. Middleton, H., C. (1974) Osteopathic Diagnosis and treatment
prescription. BOJ. 7(2): 4-12.
55
27. Michigan C.O.M Advanced study group (1975) The piriformis muscle
syndrome. BOJ. 8(1): 3-12.
28. Burton, A., K. (1975) The need for Osteopathic Research. BOJ. 8(2): 39.
29. Salter, D., C. (1976) Some aspects of the prognostic detection of
referred clinical signs. BOJ. 9(1): 3-26.
30. Stoddard, A. (1977) Acute Spinal Pain. BOJ. 10(1): 3-9.
31. Good, A., B. (1978) Spinal joint blocking. BOJ. 11(1): 4-19.
32. Smith, C. (1978) Treatment approaches for the Frozen Shoulder
Syndrome. BOJ. 11(2): 3-8.
33. Droz-Georget, J., H. (1980) High-Velocity Thrust and Pathophysiology
of segmental dysfunction. BOJ. 12(1): 2-17.
34. Miller, R. (1980) Intercosto-Brachial Nerve neuralgia. BOJ. 12(2): 4-13.
35. Burton, A., K. (1981) Sitting; Theoretical Consideration of the problem
and potential solutions. BOJ. 13(1): 2-21.
36. Barker, M., E. (1982) Back pain in general practice: A practical
classification. BOJ. 14(1): 1-7.
37. Mason, G., N., G. (1982) Factors predisposing towards injury in rugby
football. BOJ. 14(2): 77-82.
38. Sandler, S., E. (1983) The physiology of Soft Tissue Massage. BOJ.
15(1): 1-7.
39. Dyer, C., D. (1983) Visco-elastic insoles in long distance walking. BOJ.
15(2): 79-83.
40. Burton, A., K. (1984) A pilot study of electromyography and office chair
design. BOJ. 16(1): 1-5.
56
41. Miller, R. (1984) The prone sleepers spine. BOJ. 16(2): 61-68.
57
58
65. Carnell, L., Nicholls, B. and Gibbons, P. (2002) A study of the referral
patterns of General Practitioners to Osteopaths, Chiropractors and
Physiotherapists in Victoria. BOJ. 24: 6-12.
66. Swain, C. (2002) An Investigation into the different usage of
Osteopathic Terminology. BOJ. 25: 5-12.
67. Climent, G. & Goss-Sampson, M. (2003) Quiet Stance: The act of
Standing Upright, a literature review with implications for Osteopathic
Practice. BOJ. 26: 6-11.
68. West, C. (2004) An Investigation into backpack habits and back pain in
14-year-old schoolchildren. BOJ. 27: 6-14.
69. Edwards, D. (2006) The General Osteopathic Council Standard of
Proficiency-a consumers perspective. BOJ. 28: 7-16.
59
Appendix I: A table to show the keywords used in this study and their
respective definitions.
Key words
Definitions
Philosophy
Osteopathic
philosophy
Principle
Osteopathic
principle
60
Osteopathy
Osteopath
Concept
Value
61
Appendix II: Literature Search: A table to show the databases searched for
research into the principles of osteopathy.
Database
Key words
Number of articles
found
Science Direct
2,231
OstMed
318
Psych Info
20
Highwire Press
412
PubMed
1,523
62
Health
I. Health is a natural state of harmony.
II. The human body is a perfect machine created for health and activity.
III. A healthy state exists as long as there is normal flow of body fluids and
nerve activity.
Disease
IV. Disease is an effect of underlying, often multifactorial causes.
V. Illness is often caused by mechanical impediments to normal flow of
body fluids and nerve activity.
VI. Environmental, social, mental and behavioural factors contribute to the
aetiology of disease and illness.
Patient Care
VII. The human body provides all the chemicals necessary for the needs of
its tissues and organs.
VIII. Removal of mechanical impediments allows optimal body fluid flow,
nerve function, and restoration of health.
IX. Environmental, cultural, social, mental and behavioural factors need to
be addressed as part of any management plan.
63
64
Appendix IV: The four osteopathic principles adapted from, The Special
Committee on Osteopathic Principles and Osteopathic Technic, KCOM,
1953.
65
66
Osteopathic
Foundations
Principles
I. The body is a
unit.
67
Still (1902 p.33) aptly demarcates the essence of this principle in the
function are
interrelated.
68
Still (1908) studied the nature of health, illness and disease, and
possesses self-
concluded that, God had certainly placed all the principles of motion,
regulatory
life and all its remedies to be used in sickness within the material
mechanisms.
house in which the spirit of life dwells. The bodys self- regulating
systems constantly monitor the functioning of the whole body through
feedback mechanisms, which maintain homeostasis in concert with
the environment. The theorised mechanisms include firstly, the
neurocrine signalling system which functions by way of neurons
within the CNS. Secondly, the endocrine system which consists of
several organs including, the thyroid and parathyroid glands, the
heart, striated muscle, skin, adipose tissue, the stomach and
duodenum, the liver and pancreas, the kidneys, adrenal glands,
testes, ovaries, placenta, and uterus (Cartesian thought process)
which are all integrated by the release of their respective hormones in
order to regulate processes including growth, metabolism,
development of puberty, tissue function and mood (Collier et al 2006).
Thirdly, the neuro-endocrine system processes that integrate
peripheral and central information with regard to a particular sub
system. It consists of the hypothalamus, pineal body, anterior,
posterior and intermediate pituitary lobes which themselves constitute
neurones that synthesise and secrete particular hormones which
encompasses the CNSs capacity to launch the first in a long
sequence of cellular events that control an endocrine sub system of
communication and thus acts as an autonomous pulse generator.
Fourthly, paracrine signalling systems function to secrete signalling
molecules that act on target cells which reside near to the signal
releasing cell and thus auto regulate sub systems. Fifthly, autocrine
systems act to release chemical messengers, which bind and act on
69
the same cell of release and finally, intracrine systems are those
cells, which release signalling molecules that act within a cell. Thus,
the Cartesian model theorises that the body is a dynamic array of
fluctuating micro systems, which are conducted and harmonised by
the bodys self- regulating mechanisms.
IV. The body
has the
the bodys self- healing capacity. Still, (1910 p. 36) avowed that each
inherent
capacity to
defend and
thus indicating that within the body are found all the necessary
repair itself.
70
adaptability is
disrupted, or
when
environmental
that overcome the bodys defences. Still (1902 p.28) succinctly states,
changes
If the fish should change place with the bird, it would surely die and
overcome the
bodys capacity
for self-
Suppose we should move the heart up to the cranial cavity and the
maintenance,
brain down to the place now occupied by the liver, and the liver to the
disease may
position of the lungs, and placed the lungs on the sacrum; what would
ensue.
VI. Movement of
Perfect health is the natural result of pure blood (Still, 1902, p.52).
body fluids is
This principle is often quoted as the widely accepted idiom, the rule
essential to the
maintenance of
health.
71
of life (Still, 1899) and states that it is the highest known element
contained in the human body. Furthermore, Still conveyed that the
flow of body fluids was under the control of the nerves that innervated
the blood vessel walls and the heart, thus, healthy tissue is tissue in
which the blood circulation and nerve force are correlated (Littlejohn,
in Wernham, 1996). Of equal importance, Still (1902) states that,
blood must not be allowed to flow to the part by wild motion. Its flow
must be gentle to suit the demands of nutrition; otherwise we lose
the benefits of the nutritive nerves. Thus, vessel circulation must be
unobstructed, otherwise inadequate flow, tissue anoxia and injurious
metabolites may permit and disease may prevail, with tissue atrophy
as an end product of mechanical derangement. Still elucidates,
Abdominal tumours only form when some channel of drainage is shut
off to remove a growth of any organ in the abdomen, we must line
up the body in good form for the appropriation of the arterial blood by
the organ to which it was sent out by the heart, then fix all the vessels
of drainage, turn the nerves loose and the work will be done (Still
1902 p35).
VII. The
The lungs move, thus you find motor nerves; they have feeling, thus
nervous system
the sensory nerves; they grow by nutrition, thus the nutrient nerves.
plays a crucial
They move by will or without it; thus they have a voluntary and
part in
controlling the
body.
72
2001. p. 38).
Stone (1999) explains that adaptive neural processing occurs when
increased summative and temporal nociceptive afferents entering the
dorsal horn at a named segment following injury induce inter-neuronal
plasticity whereby excess excitatory or inhibitory synapses are
synthesised leading to sensitisation or depression at that SC segment
thus directly influencing segmental reflex activity with regard to the
segmental efferents in addition to amending ascending signals.
Ascending pathways can thus become reinforced and consequent
higher centre adaptation occurs such that descending influences on
segmental cord activity summates at a few SC levels to adversely
affect the segmental efferents to the end tissue. Thus, sympathetic
vasomotor efferents to a named angiotome may be modified by
dysfunction in a related segment within the MS system through a
somato-visceral reflex. Sammut & Searle-Barnes (1998) state that
this may be observed clinically as increased skin temperature locally,
moisture, tenderness and/or oedema.
In addition to Korrs 1967 evidence of the neurotrophic functions of
nerves on their target tissues (American Academy of Osteopathy,
1979), dorsal root reflexes exist whereby neurogenic inflammation is
the result of retrograde inflammatory mediator signals from the
afferent fibre to the tissue where the noxious stimulus originated from
(Bagust et al, 1993, in Stone 1999) and thus may be the mechanism
underlying visceral dysfunctions such as asthma (Shelhamer et al
1995, in Stone 1999) and irritable bowel syndrome (Accarino et al
1995, in Stone 1999). Furthermore, Stone (1999) states that afferent
fibres conveying information from an injured somatic structure may in
addition to causing neurogenic inflammation in somatic tissues may
also trigger visceral cell bodies through shared connections to cause
neurogenic inflammation in the segmentally related organ, which is
termed neurogenic switching (Meggs, 1993).
VIII. There are
Korr (in Kuchera & Kuchera 1994) highlights that the majority of the
somatic
efferent output and afferent input from and to the CNS is directed to
73
components to
only are
the CNS is very much occupied with motion (Korr 1987). Indeed,
manifestations
of disease but
that contribute
to maintenance
of the diseased
state.
74
treatment is
the rock of reason (Still 1910) in order to rationalise from the effect to
based on the
previous
principles.
the cause. When you fully comprehend and travel by the laws of
reason, confusion will be a stranger in all your combats with disease.
(Still, 1910 p. 39). In every patient encounter, the osteopath filters the
results obtained from the patients history, physical examination and
any other tests through the philosophic lens formed by the principles
of osteopathy. If the philosophy is used to integrate the basic science
information and clinical experiences, the patient will receive
osteopathic care (Kuchera & Kuchera 1994).
Palpation identifies dysfunctional areas in the guise of tissue
changes, treatment results in restoring the relationship between the
patient with its environment with minimal intervention in conjunction
with the principles in mind to correlate body structures in order to
affect their functions and so facilitate the bodys inherent healing
mechanisms through the medium of newly adapted techniques,
advice on diet regulation and/or environmental modifications. When
you have adjusted the human body to the degree of absolute
perfection, all parts in place, none excepted, then perfect health is
your answer. Nature has no apology to offer. It does the work if you
know how to line up the parts; then food and rest are all that is
required (Still 1910, p.25).
Still (1902, p28) explains, the practical osteopath must be very
exacting in adjusting the system. He must know that he has done his
work right in all particulars, in that the forms, great and small, all
through the body, must be infinitely correct, with the object in view,
that the necessary fuel and nutriment of life that is now in the hands
of Deity may be adjusted to the degree of perfection that it was when
it received the first breath of individualized life. We do hope to
understand the forms and functions of the parts of the human body to
75
76
Osteopathic
Accepted Phraseology
Present
principle
The body is a
unit
Body unity
Structure and
function are
interrelated
The body
possesses
self- regulatory
functions
77
mechanisms
the inherent
repair itself
capacity to
defend and
repair itself
When normal
adaptability is
disrupted, or
when
environmental
changes
overcome the
bodys capacity
Still (1910)
78
for self-
maintenance,
disease may
ensue
Movement of
body fluids is
maintenance of health
essential to the
maintenance of
health
must be unobstructed
The nervous
system plays a
crucial part in
controlling the
2
3
79
body
There are
somatic
components to
disease that
diseased state
manifestations
of disease but
disease state
that contribute
to maintenance
of the diseased
state
80
Rational
treatment is
based on the
principles
previous
principles
81
82
Appendix VIII: A table to show the article number reviewed (see references
III, for article references 1-69), the year of its publication, the season it was
published in, the designated season code, the resulting year to be used for
data analysis and the score of osteopathic principles assigned by the author.
Article
Full Year
Season
Score
1,960 Winter
1.00
1961.00
1,961 Summer
0.50
1961.50
1,961 Winter
1.00
1962.00
1,962 Autumn
0.75
1962.75
1,962 Winter
1.00
1963.00
1,963 Summer
0.50
1963.50
1,963 Winter
1.00
1964.00
1,964 Summer
0.50
1964.50
10
1,965 Summer
0.50
1965.50
1,965 Winter
1.00
1966.00
12
1,966 Summer
0.50
1966.50
11
1,966 Winter
1.00
1967.00
14
1,967 Summer
0.50
1967.50
13
1,967 Winter
1.00
1968.00
15
1,968 Spring
0.25
1968.25
16
1,969 Winter
1.00
1970.00
17
1,969 Winter
1.00
1970.00
83
18
1,970 Summer
0.50
1970.50
19
1,971 Spring
0.25
1971.25
20
1,971 Autumn
0.75
1971.75
22
1,972 Autumn
0.75
1972.75
21
1,972 Winter
1.00
1973.00
23
1,973 Spring
0.25
1973.25
24
1,973 Summer
0.50
1973.50
25
1,974 Spring
0.25
1974.25
26
1,974 Summer
0.50
1974.50
27
1,975 Spring
0.25
1975.25
28
1,975 Winter
1.00
1976.00
29
1,976 Summer
0.50
1976.50
30
1,977 Spring
0.25
1977.25
31
1,978 Spring
0.25
1978.25
32
1,978 Winter
1.00
1979.00
33
1,980 Spring
0.25
1980.25
34
1,980 Winter
1.00
1981.00
35
1,981 Winter
1.00
1982.00
36
1,982 Summer
0.50
1982.50
37
1,982 Winter
1.00
1983.00
38
1,983 Summer
0.50
1983.50
39
1,983 Winter
1.00
1984.00
40
1,984 Summer
0.50
1984.50
41
1,984 Winter
1.00
1985.00
84
42
1,987 Summer
0.50
1987.50
43
1,988 Summer
0.50
1988.50
44
1,989 Summer
0.50
1989.50
45
1,990 Summer
0.50
1990.50
46
1,990 Summer
0.50
1990.50
47
1,991 Summer
0.50
1991.50
48
1,991 Summer
0.50
1991.50
49
1,992 Summer
0.50
1992.50
50
1,992 Summer
0.50
1992.50
51
1,993 Summer
0.50
1993.50
52
1,993 Summer
0.50
1993.50
53
1,993 Summer
0.50
1993.50
54
1,994 Summer
0.50
1994.50
55
1,994 Summer
0.50
1994.50
56
1,995 Summer
0.50
1995.50
57
1,995 Summer
0.50
1995.50
58
1,995 Summer
0.50
1995.50
59
1,996 Summer
0.50
1996.50
60
1,996 Summer
0.50
1996.50
61
1,997 Summer
0.50
1997.50
62
1,998 Summer
0.50
1998.50
63
2,000 Summer
0.50
2000.50
64
2,001 Summer
0.50
2001.50
65
2,002 Summer
0.50
2002.50
85
66
2,002 Summer
0.50
2002.50
67
2,003 Summer
0.50
2003.50
68
2,004 Summer
0.50
2004.50
69
2,006 Summer
0.50
2006.50
86
Year
Event
1931,
1933,
1934.
1936
1938
1950
1966
1971
1976
1977
1983
87
1985
House of Lords debate outlined the criteria for Health Care practitioners to
fulfil in order to gain statutory recognition.
1986
1989
1993
88
Evolutionary State
Description
of Osteopathy
1.
2.
3.
4.
89