How is Osteopathy Different from Other Forms of Manual Medicine?

I often get asked a series of great questions that go something like this: “How is osteopathy different from myofascial release, or chiropractic, craniosacral work or massage?  Is it energy medicine?  Is it deep tissue work?  Aren’t you a homeopath?”  Or they might say, “This is eastern medicine, isn’t it, like acupuncture?”

These are questions many people have before they experience a treatment themselves, so I want to answer them head-on in this article.  There are so many effective forms of manual medicine and holistic medicine mentioned below.  I want to hold some of these up side by side to osteopathy as a way of helping define what makes osteopathy the unique practice that it is.

Q: How is osteopathy different from chiropractic?

An osteopathic appointment and treatment looks quite different from a chiropractic one.  An osteopath in the U.S. is a physician, so an appointment with an osteopath will involve discussion of medical issues, possibly lab work or tests, prescriptions or other medical recommendations.  The treatments themselves are quite different as well.  An osteopathic treatment is typically longer, 20 mins – 45 mins, and involves evaluation and treatment of the whole body.  This is because the osteopath is investigating global patterns as well as local issues in the body.  The appointments are longer also because the osteopath is waiting for the patient’s body to make systemic corrections during the treatments.  For this type of change to occur in this way, patience is often required.  This type of change results in lasting and deep benefit for the patient’s body and their symptoms.  Follow up appointments are typically 1 – 2 weeks later. 

On the other hand, chiropractic appointments are shorter, and involve swift articulations of specific parts of a patient’s body – usually the vertebral column.  Often chiropractors will use instruments and tools – such as an Activator – to help get their corrections.  Chiropractic prioritizes symmetry and treatments are aimed at restoring proper alignment of the bones.  This is different from osteopathy which prioritizes proper function and motion in all aspects of the body.  A patient will see a chiropractor up to multiple times a week.

Both are useful and powerful approaches, and their histories are intertwined.  The founders of osteopathy – Andrew Taylor Still – and chiropractic – Daniel David Palmer – were contemporaries and lived close to each other for a time in Missouri during the post Civil War 1800s.  By accounts, Palmer was a student/colleague of Dr. Still.

Q: How is osteopathy different from massage, deep tissue work, or Rolfing?

In these massage, deep tissue work, and Rolfing treatments, patients typically remove most of their clothes and lie on the table.  The practitioner uses oil on the patient’s skin and uses rhythmic or repeated stroking and pressure on the soft tissue, using their finger pads, palms, knuckles or elbows.  The goal of these systems is to release strain from the soft tissue – mostly muscle and fascia – by direct pressure from the hands of the practitioner.  In the case of massage, another aim is calming the patient in the moment.  This is definitely not the aim of a Rolfing or deep tissue treatment – as many can attest to.  Rolfing is a sophisticated system that works through the soft tissue structures of the body over a series of treatments to help rebuild/reawaken the body globally, and can be very effective.

Osteopathy is quite different from these approaches.  Osteopathy does look at fascia and many soft tissues, but also addresses issues in the bones and joints directly.  An osteopath will pay attention to the particular motion at the sutures of the bones in the head, for example.  Osteopathy pays attention to fluid motions in the body as well, which includes motion of fluids between the cells and the fluid system in the head and spine.  To pay attention to all these aspects of physiology at one time, a different type of contact is applied by the osteopath that is more receptive than repetitive and forceful. 

Q: How is osteopathy different from craniosacral therapy?

The tradition of osteopathy goes back to the Civil War era in America.  Since that time there have been many developments in the field, and osteopathy itself developed different traditions within it.  One of the most consequential innovators was William Garner Sutherland who observed, in the early 1900s, specific phenomena of motion in the living human body that he went on to elucidate and codify.  This was termed osteopathy in the cranial field, and it highlighted the fluid motions and mechanics of the head and body and the way in which the body self corrects during a treatment process.  It became a major contribution to the field of osteopathy and has a rich lineage of practitioners who studied this approach to get far-reaching results in curing human ailments. 

The world of cranial osteopathy was taught to physicians, mostly D.O.s and some M.D.s  In the 1970s, however, one specific osteopath chose to take some of the cranial concepts and techniques out of the osteopathic tradition, rename it craniosacral therapy, and call it his own invention.  He went on to teach his brand to others in the health care field, including physical therapists, massage therapists, and others who wanted to learn.  He offered instruction via multi-day courses.

While connected genetically, the two approaches represent separate lineages, modes of learning, and actual content.  Training to be an osteopath takes a minimum of seven years of study, which includes medical school and residency.  Getting certified in craniosacral therapy involves a different route, taking a much shorter amount of time and having different requirements and study priorities.  The cranial concept in osteopathy is taught within a specific framework – alongside an array of other techniques and approaches in the osteopathic tradition, and against the backdrop of learning anatomy and pathology in a medical context.  It is often taught later on in training once a student has built a library of certain palpatory experience over years.  Both disciplines, while occupying separate lanes, share the intention of perceiving those specific subtle phenomena in the human body – set forth in the cranial concept – for therapeutic benefit.

Q: Is osteopathy energy medicine?

If you were to sit in on any osteopathic course around the world that teaches traditional osteopathy – whether in the medical school setting or as offered privately by osteopathic organizations – you would see variations on 3 main themes.  #1 Study of human anatomy in detail #2 Practice of how to palpate and observe that anatomy in a living patient  #3 Practice of how to work with that anatomy – i.e. approaches or techniques – in order to get the body to respond and change and improve its condition.

To answer the above question accurately, the person inquiring would have to define what they mean by “energy medicine.”  Nothing in traditional osteopathic curricula would likely fit the criteria of what most people would say is “energy medicine.”  However, there are many aspects of living human anatomy and physiology that can be perceived by the skilled osteopath, and these can be subtle and imperceptible to a person who does not have experience perceiving them.  A patient consequently may be surprised if the osteopath does subtle corrections and causes them to feel so much better.  They may wonder if the osteopath is working with “energy.” 

Q: Is osteopathy eastern medicine or homeopathy?

This question comes up consistently I think because people tend to associate holistic medicine that doesn’t involve pharmaceuticals with eastern philosophies or the term homeopathy.  You may be surprised to learn that osteopathy is an American medicine born and raised in the midwest United States in the 1800s, not long after the Civil War.  The frontier physician A.T. Still watched three of his children die from meningitis while under the care of the best physicians in his area, and saw that many of the medical practices at the time were doing more harm than good.  He became inspired to understand for himself how to most effectively treat disease and improve health.  After dedicating much of his life to this project, what he discovered was an approach to treating the body with his hands based on precise palpatory sense and detailed knowledge of human anatomy – this he called osteopathy.  The first osteopathic school was opened in Kirksville, Missouri in 1892. 

The manual medicine he developed became quite a sensation at the time, causing many people over the country to flock to Missouri for treatments, and it garnered the respect of Bertrand Russel, Theodore Roosevelt, Mark Twain, the Rockefellers, and many other prominent figures. 

While osteopathy is geographically about as far from “the east” as you can get, it remains an open topic what commonalities there are philosophically speaking between osteopathy and many other forms of medicine around the world that are privy to the direct observation of functional anatomy in the human body. 

Homeopathy, on the other hand, is an entirely different approach to health unto itself.  It involves the use of remedies in the form of little dissolvable spheres placed in the mouth or under the tongue that are prepared with specific elements from the natural world.  The remedies are prescribed based on a detailed account of specific details in the patient’s history.

Q: What distinguishes osteopathy from the other manual therapies?

The main feature that distinguishes osteopathy is it’s ability to handle, all at one time, so many aspects of living anatomy and physiology simultaneously.  An osteopath is trained to evaluate and treat the ligaments, fascia, and muscles, as well as the skeletal system, that includes misaligned joints and strains through bones themselves.  An osteopath will also spend time addressing the multitude of fluid motions in the body that have high diagnostic and therapeutic value.  In particular, the osteopath has expertise in treatment of the head, that complex area of anatomy and function that most manual therapies do not address in detail.  The osteopathic tradition has an entire science dedicated to treatment of the bones of the head, and the structures and motions within the cranium and face.

In order to perceive all these phenomena at once, there is a specific quality of contact that the osteopath applies with the hands on the patient that is the signature of an osteopathic treatment.  In this contact there is as much listening by palpation as doing of techniques.  When this relationship of listening with the hands is established between the physician and the patient, it creates the environment in which the patient’s body is able to self correct and unwind deep strains and stresses – another hallmark of osteopathic treatment.

If the patient’s issue is in the fascia, the osteopath can perform a myofascial release approach.  If the issue is in the joint, he can perform an articulatory adjustment, or a balanced ligamentous technique. If there is derangement in the fluid system, he can apply the cranial concept.  This is what makes osteopathy unique.  It is a tradition of evaluating this full scope of motion and structure in the human body, and then applying the most reasonable and effective treatment approach.  When this quality of perception is operating with knowledge of anatomy and physiology on the part of the physician, this is the recipe for osteopathy.