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Osteopathy () is a type of
alternative medicine Alternative medicine is any practice that aims to achieve the healing effects of medicine despite lacking biological plausibility, testability, repeatability, or evidence from clinical trials. Complementary medicine (CM), complementary and al ...
that emphasizes physical manipulation of the body's
muscle tissue Muscle tissue (or muscular tissue) is soft tissue that makes up the different types of muscles in most animals, and give the ability of muscles to contract. Muscle tissue is formed during embryonic development, in a process known as myogenesis. ...
and
bone A bone is a rigid organ that constitutes part of the skeleton in most vertebrate animals. Bones protect the various other organs of the body, produce red and white blood cells, store minerals, provide structure and support for the body, ...
s. Practitioners of osteopathy are referred to as osteopaths. Osteopathic manipulation is the core set of techniques in osteopathy. Parts of osteopathy, such as
craniosacral therapy Craniosacral therapy (CST) or cranial osteopathy is a form of alternative therapy that uses gentle touch to palpate the synarthrodial joints of the cranium. CST is a pseudoscience and its practice has been characterized as quackery. It is bas ...
, have no therapeutic value and have been labeled as
pseudoscience Pseudoscience consists of statements, beliefs, or practices that claim to be both scientific and factual but are incompatible with the scientific method. Pseudoscience is often characterized by contradictory, exaggerated or unfalsifiable claim ...
and
quackery Quackery, often synonymous with health fraud, is the promotion of fraudulent or ignorant medical practices. A quack is a "fraudulent or ignorant pretender to medical skill" or "a person who pretends, professionally or publicly, to have skill, ...
. The techniques are based on an ideology created by
Andrew Taylor Still Andrew Taylor Still, DO (August 6, 1828 – December 12, 1917) was the founder of osteopathic medicine. He was also a physician and surgeon, author, inventor and Kansas territorial and state legislator. He was one of the founders of Baker Univer ...
(1828–1917) which posits the existence of a " myofascial continuity"—a tissue layer that "links every part of the body with every other part". Osteopaths attempt to diagnose and treat what was originally called "the osteopathic lesion", but which is now named "somatic dysfunction", by manipulating a person's bones and muscles. Osteopathic Manipulative Treatment (OMT) techniques are most commonly used to treat
back pain Back pain is pain felt in the back. It may be classified as neck pain (cervical), middle back pain (thoracic), lower back pain (lumbar) or coccydynia (tailbone or sacral pain) based on the segment affected. The lumbar area is the most common ...
and other musculoskeletal issues. Osteopathic manipulation is still included in the curricula of osteopathic physicians, not to be confused with non-physician osteopaths, and is considered a unique aspect of Doctor of Osteopathic Medicine (DO) training. The "Doctor of Osteopathic Medicine" degree, however, became a
medical degree A medical degree is a professional degree admitted to those who have passed coursework in the fields of medicine and/or surgery from an accredited medical school. Obtaining a degree in medicine allows for the recipient to continue on into special ...
and is no longer a degree of non-medical osteopathy. Because DOs in the United States attend
accredited Accreditation is the independent, third-party evaluation of a conformity assessment body (such as certification body, inspection body or laboratory) against recognised standards, conveying formal demonstration of its impartiality and competence to ...
medical schools, graduates of osteopathic medical schools may take the standard Doctor of Medicine licensing exam,
USMLE The United States Medical Licensing Examination (USMLE) is a three-step examination program for medical licensure in the United States sponsored by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME). ...
. They must additionally take the osteopathic physician-specific COMLEX medical licensing exam for the DO. DOs must attend residencies accredited by the ACGME, the
American Osteopathic Association The American Osteopathic Association (AOA) is the representative member organization for the more than 176,000 osteopathic medical doctors (D.O.s) and osteopathic medical students in the United States. The AOA is headquartered in Chicago, Illinoi ...
, and the
American Association of Colleges of Osteopathic Medicine The American Association of Colleges of Osteopathic Medicine (AACOM) is a non-profit organization that supports the 38 accredited colleges of osteopathic medicine (COMs) in the United States. These colleges are accredited to deliver instruction ...
like their MD peers to practice medicine and surgery in any specialty of medicine.


History

The practice of osteopathy began in the United States in 1874. Osteopathy was founded by
Andrew Taylor Still Andrew Taylor Still, DO (August 6, 1828 – December 12, 1917) was the founder of osteopathic medicine. He was also a physician and surgeon, author, inventor and Kansas territorial and state legislator. He was one of the founders of Baker Univer ...
, a 19th-century American physician (MD),
Civil War A civil war or intrastate war is a war between organized groups within the same state (or country). The aim of one side may be to take control of the country or a region, to achieve independence for a region, or to change government polici ...
surgeon, and Kansas state and territorial legislator. He lived near
Baldwin City, Kansas Baldwin City is a city in Douglas County, Kansas, United States, about south of Lawrence. As of the 2020 census, the population of the city was 4,826. The city is home to Baker University, the state's oldest four-year university. History ...
, during the
American Civil War The American Civil War (April 12, 1861 – May 26, 1865; also known by Names of the American Civil War, other names) was a civil war in the United States. It was fought between the Union (American Civil War), Union ("the North") and t ...
and it was there that he founded the practice of osteopathy. Still claimed that human illness was rooted in problems with the
musculoskeletal The human musculoskeletal system (also known as the human locomotor system, and previously the activity system) is an organ system that gives humans the ability to move using their muscular and skeletal systems. The musculoskeletal system prov ...
system, and that osteopathic manipulations could solve these problems by harnessing the body's own self-repairing potential. Still's patients were forbidden from treatment by conventional medicine, as well as from other practices such as drinking alcohol. These practices derive from the belief, common in the early 19th century among proponents of
alternative medicine Alternative medicine is any practice that aims to achieve the healing effects of medicine despite lacking biological plausibility, testability, repeatability, or evidence from clinical trials. Complementary medicine (CM), complementary and al ...
, that the body's natural state tends toward health and inherently contains the capacity to battle any illness. This was opposed to orthodox practitioners, who held that intervention by a physician was necessary to restore health in the patient. Still established the basis for osteopathy, and the division between alternative medicine and traditional medicine had already been a major conflict for decades. The foundations of this divergence may be traced back to the mid-18th century when advances in
physiology Physiology (; ) is the scientific study of functions and mechanisms in a living system. As a sub-discipline of biology, physiology focuses on how organisms, organ systems, individual organs, cells, and biomolecules carry out the chemic ...
began to localize the causes and nature of diseases to specific organs and tissues. Doctors began shifting their focus from the patient to the internal state of the body, resulting in an issue labeled as the problem of the "vanishing patient". A stronger movement towards experimental and scientific medicine was then developed. In the perspective of the DO physicians, the sympathy and holism that were integral to medicine in the past were left behind.
Heroic medicine Heroic medicine, also referred to as heroic depletion theory, was a therapeutic method advocating for rigorous treatment of bloodletting, purging, and sweating to shock the body back to health after an illness caused by a humoral imbalance. Risi ...
became the convention for treating patients, with aggressive practices like
bloodletting Bloodletting (or blood-letting) is the withdrawal of blood from a patient to prevent or cure illness and disease. Bloodletting, whether by a physician or by leeches, was based on an ancient system of medicine in which blood and other bodily f ...
and prescribing chemicals such as mercury, becoming the forefront in therapeutics. Alternative medicine had its beginnings in the early 19th century, when gentler practices in comparison to heroic medicine began to emerge. As each side sought to defend its practice, a schism began to present itself in the medical marketplace, with both practitioners attempting to discredit the other. The osteopathic physicians—those who are now referred to as DO's—argued that the allopathic physicians had an overly mechanistic approach to treating patients, treated the symptoms of disease instead of the original causes, and were blind to the harm they were causing their patients. Allopathic practitioners had a similar argument, labeling osteopathic medicine as unfounded, passive, and dangerous to a disease-afflicted patient. This is the medical environment that pervaded throughout the 19th century, and the setting Still entered when he began developing his idea of osteopathy. After experiencing the loss of his wife and three daughters to
spinal meningitis Meningitis is acute or chronic inflammation of the protective membranes covering the brain and spinal cord, collectively called the meninges. The most common symptoms are fever, headache, and neck stiffness. Other symptoms include confusi ...
and noting that the current orthodox medical system could not save them, Still may have been prompted to shape his reformist attitudes towards conventional medicine. Still set out to reform the orthodox medical scene and establish a practice that did not so readily resort to drugs,
purgatives Laxatives, purgatives, or aperients are substances that loosen stools and increase bowel movements. They are used to treat and prevent constipation. Laxatives vary as to how they work and the side effects they may have. Certain stimulant, lubr ...
, and harshly invasive therapeutics to treat a person suffering from ailment, similar to the mindset of the irregulars in the early 19th century. Thought to have been influenced by spiritualist figures such as
Andrew Jackson Davis Andrew Jackson Davis (August 11, 1826January 13, 1910) was an American Spiritualist, born in Blooming Grove, New York. Early years Davis had little education. In 1843 he heard lectures in Poughkeepsie on animal magnetism, the precursor of hyp ...
and ideas of magnetic and electrical healing, Still began practicing manipulative procedures that intended to restore harmony in the body. Over the course of the next twenty five years, Still attracted support for his medical philosophy that disapproved of orthodox medicine, and shaped his philosophy for osteopathy. Components included the idea that structure and function are interrelated and the importance of each piece of the body in the harmonious function of its whole. Still sought to establish a new medical school that could produce physicians trained under this philosophy, and be prepared to compete against the orthodox physicians. He established the American School of Osteopathy on 20 May 1892, in Kirksville, Missouri, with twenty-one students in the first class. Still described the foundations of osteopathy in his book "The Philosophy and Mechanical Principles of Osteopathy" in 1892. He named his new school of medicine "osteopathy", reasoning that "the bone, osteon, was the starting point from which ewas to ascertain the cause of pathological conditions". He would eventually claim that he could "shake a child and stop scarlet fever, croup, diphtheria, and cure whooping cough in three days by a wring of its neck." When the state of Missouri granted the right to award the MD degree, he remained dissatisfied with the limitations of conventional medicine and instead chose to retain the distinction of the DO degree. In the early 20th century, osteopaths across the United States sought to establish law that would legitimize their medical degree to the standard of the modern medic. The processes were arduous, and not without conflict. In some states, it took years for the bills to be passed. Osteopaths were often ridiculed and in some cases arrested, but in each state, osteopaths managed to achieve the legal acknowledgement and action they set out to pursue. In 1898 the American Institute of Osteopathy started the ''
Journal of Osteopathy The ''Journal of Osteopathy'' was a monthly medical journal that was first published in May 1894 in Kirksville, Missouri by the American School of Osteopathy. It was the first regular publication about the field of osteopathy. Andrew Taylor Still ...
'' and by that time four states recognized osteopathy as a profession.


Practice

According to the
American Osteopathic Association The American Osteopathic Association (AOA) is the representative member organization for the more than 176,000 osteopathic medical doctors (D.O.s) and osteopathic medical students in the United States. The AOA is headquartered in Chicago, Illinoi ...
(AOA), osteopathic manipulative treatment (OMT) is considered to be only one component of osteopathic medicine and may be used alone or in combination with
pharmacotherapy Pharmacotherapy is therapy using pharmaceutical drugs, as distinguished from therapy using surgery (surgical therapy), radiation (radiation therapy), movement (physical therapy), or other modes. Among physicians, sometimes the term ''medical ther ...
,
rehabilitation Rehabilitation or Rehab may refer to: Health * Rehabilitation (neuropsychology), therapy to regain or improve neurocognitive function that has been lost or diminished * Rehabilitation (wildlife), treatment of injured wildlife so they can be retur ...
,
surgery Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pa ...
,
patient education Patient education is a planned interactive learning process designed to support and enable expert patients to manage their life with a disease and/or optimise their health and well-being. Overview Education may be provided by any healthcare profes ...
,
diet Diet may refer to: Food * Diet (nutrition), the sum of the food consumed by an organism or group * Dieting, the deliberate selection of food to control body weight or nutrient intake ** Diet food, foods that aid in creating a diet for weight loss ...
, and
exercise Exercise is a body activity that enhances or maintains physical fitness and overall health and wellness. It is performed for various reasons, to aid growth and improve strength, develop muscles and the cardiovascular system, hone athletic ...
. OMT techniques are not necessarily unique to osteopathic medicine; other disciplines, such as
physical therapy Physical therapy (PT), also known as physiotherapy, is one of the allied health professions. It is provided by physical therapists who promote, maintain, or restore health through physical examination, diagnosis, management, prognosis, pat ...
or
chiropractic Chiropractic is a form of alternative medicine concerned with the diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, especially of the spine. It has esoteric origins and is based on several pseudosci ...
, use similar techniques. In reality many DOs do not practice OMT at all and over time DOs in general practice less and less OMT and instead apply the common medical treatments. One integral tenet of osteopathy is that problems in the body's anatomy can affect its proper functioning. Another tenet is the body's innate ability to heal itself. Many of osteopathic medicine's manipulative techniques are aimed at reducing or eliminating the impediments to proper structure and function so the self-healing mechanism can assume its role in restoring a person to health. Osteopathic medicine defines a concept of health care that embraces the concept of the unity of the living organism's structure (anatomy) and function (
physiology Physiology (; ) is the scientific study of functions and mechanisms in a living system. As a sub-discipline of biology, physiology focuses on how organisms, organ systems, individual organs, cells, and biomolecules carry out the chemic ...
). The AOA states that the four major principles of osteopathic medicine are the following: # The body is an integrated unit of mind, body, and spirit. # The body possesses self-regulatory mechanisms, having the inherent capacity to defend, repair, and remodel itself. # Structure and function are reciprocally interrelated. # Rational therapy is based on consideration of the first three principles. These principles are not held by Doctors of Osteopathic Medicine to be
empirical law Scientific laws or laws of science are statements, based on repeated experiments or observations, that describe or predict a range of natural phenomena. The term ''law'' has diverse usage in many cases (approximate, accurate, broad, or narrow) ...
s; they serve, rather, as the underpinnings of the osteopathic approach to health and disease.


Muscle energy

Muscle energy techniques address somatic dysfunction through stretching and muscle contraction. For example, if a person is unable to fully abduct her arm, the treating physician raises the patient's arm near the end of the patient's range of motion, also called the edge of the restrictive barrier. The patient then tries to lower her arm, while the physician provides resistance. This resistance against the patient's motion allows for
isotonic contraction In an isotonic contraction, tension remains the same, whilst the muscle's length changes. Isotonic contractions differ from isokinetic contractions in that in isokinetic contractions the muscle speed remains constant. While superficially identic ...
of the patient's muscle. Once the patient relaxes, her range of motion increases slightly. The repetition of alternating cycles of contraction and subsequent relaxation help the treated muscle improve its range of motion. Muscle energy techniques are contraindicated in patients with fractures,
crush injuries A crush injury is injury by an object that causes compression of the body. This form of injury is rare in normal civilian practice, but common following a natural disaster. Other causes include industrial accidents, road traffic collisions, bui ...
,
joint dislocation A joint dislocation, also called luxation, occurs when there is an abnormal separation in the joint, where two or more bones meet.Dislocations. Lucile Packard Children’s Hospital at Stanford. Retrieved 3 March 2013 A partial dislocation is refe ...
s, joint instability, severe
muscle spasms A spasm is a sudden involuntary contraction of a muscle, a group of muscles, or a hollow organ such as the bladder. A spasmodic muscle contraction may be caused by many medical conditions, including dystonia. Most commonly, it is a muscle c ...
or strains, severe
osteoporosis Osteoporosis is a systemic skeletal disorder characterized by low bone mass, micro-architectural deterioration of bone tissue leading to bone fragility, and consequent increase in fracture risk. It is the most common reason for a broken bone a ...
, severe
whiplash injury Whiplash is a non-medical term describing a range of injuries to the neck caused by or related to a sudden distortion of the neck associated with extension, although the exact injury mechanisms remain unknown. The term "whiplash" is a colloquia ...
,
vertebrobasilar insufficiency Vertebrobasilar insufficiency (VBI) describes a temporary set of symptoms due to decreased blood flow (ischemia) in the posterior circulation of the brain. The posterior circulation supplies the medulla, pons, midbrain, cerebellum and (in 70-8 ...
, severe illness, and recent surgery.


Counterstrain

Counterstrain is a system of diagnosis and treatment that considers the physical dysfunction to be a continuing, inappropriate strain
reflex In biology, a reflex, or reflex action, is an involuntary, unplanned sequence or action and nearly instantaneous response to a stimulus. Reflexes are found with varying levels of complexity in organisms with a nervous system. A reflex occurs ...
, which is inhibited during treatment by applying a position of mild strain in the direction exactly opposite to that of the reflex. After a counterstrain point tender to palpation has been diagnosed, the identified tender point is treated by the osteopathic physician who, while monitoring the tender point, positions the patient such that the point is no longer tender to palpation. This position is held for ninety seconds and the patient is subsequently returned to her normal posture. Most often this position of ease is usually achieved by shortening the muscle of interest. Improvement or resolution of the tenderness at the identified counterstrain point is the desired outcome. The use of counterstrain technique is contraindicated in patients with severe osteoporosis, pathology of the
vertebral arteries The vertebral arteries are major arteries of the neck. Typically, the vertebral arteries originate from the subclavian arteries. Each vessel courses superiorly along each side of the neck, merging within the skull to form the single, midline ...
, and in patients who are very ill or cannot voluntarily relax during the procedure.


High-velocity, low-amplitude

High velocity, low amplitude (HVLA) is a technique which employs a rapid, targeted, therapeutic force of brief duration that travels a short distance within the anatomic range of motion of a joint and engages the restrictive barrier in one or more places of motion to elicit release of restriction. The use of HVLA is contraindicated in patients with
Down syndrome Down syndrome or Down's syndrome, also known as trisomy 21, is a genetic disorder caused by the presence of all or part of a third copy of chromosome 21. It is usually associated with physical growth delays, mild to moderate intellectual d ...
due to instability of the
atlantoaxial joint The atlanto-axial joint is a joint in the upper part of the neck between the atlas bone and the axis bone, which are the first and second cervical vertebrae. It is a pivot joint. Structure The atlanto-axial joint is a joint between the atlas ...
which may stem from
ligamentous laxity Ligamentous laxity, or ligament laxity, is a cause of chronic body pain characterized by loose ligaments. When this condition affects joints in the entire body, it is called ''generalized joint hypermobility'', which occurs in about ten percent ...
, and in pathologic bone conditions such as
fracture Fracture is the separation of an object or material into two or more pieces under the action of stress. The fracture of a solid usually occurs due to the development of certain displacement discontinuity surfaces within the solid. If a displ ...
, history of a
pathologic fracture A pathologic fracture is a bone fracture caused by weakness of the bone structure that leads to decrease mechanical resistance to normal mechanical loads. This process is most commonly due to osteoporosis, but may also be due to other pathologies ...
,
osteomyelitis Osteomyelitis (OM) is an infection of bone. Symptoms may include pain in a specific bone with overlying redness, fever, and weakness. The long bones of the arms and legs are most commonly involved in children e.g. the femur and humerus, while the ...
, osteoporosis, and severe cases of
rheumatoid arthritis Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects joints. It typically results in warm, swollen, and painful joints. Pain and stiffness often worsen following rest. Most commonly, the wrist and hands are inv ...
. HVLA is also contraindicated in patients with
vascular disease Vascular disease is a class of diseases of the blood vessels – the arteries and veins of the circulatory system of the body. Vascular disease is a subgroup of cardiovascular disease. Disorders in this vast network of blood vessels can cause a ...
such as
aneurysm An aneurysm is an outward bulging, likened to a bubble or balloon, caused by a localized, abnormal, weak spot on a blood vessel wall. Aneurysms may be a result of a hereditary condition or an acquired disease. Aneurysms can also be a nidus ( ...
s, or disease of the
carotid arteries In anatomy, the left and right common carotid arteries (carotids) (Entry "carotid"
in
People taking
ciprofloxacin Ciprofloxacin is a fluoroquinolone antibiotic used to treat a number of bacterial infections. This includes bone and joint infections, intra abdominal infections, certain types of infectious diarrhea, respiratory tract infections, skin i ...
or
anticoagulant Anticoagulants, commonly known as blood thinners, are chemical substances that prevent or reduce coagulation of blood, prolonging the clotting time. Some of them occur naturally in blood-eating animals such as leeches and mosquitoes, where t ...
s, or who have local
metastases Metastasis is a pathogenic agent's spread from an initial or primary site to a different or secondary site within the host's body; the term is typically used when referring to metastasis by a cancerous tumor. The newly pathological sites, the ...
should not receive HVLA.


Myofascial release

''Myofascial release'' is a form of alternative treatment. The practitioners claim to treat skeletal muscle immobility and pain by relaxing contracted muscles. Palpatory feedback by the practitioner is said to be an integral part to achieving a release of myofascial tissues, accomplished by relaxing contracted muscles, increasing circulation and lymphatic drainage, and stimulating the
stretch reflex The stretch reflex (myotatic reflex), or more accurately "muscle stretch reflex", is a muscle contraction in response to stretching within the muscle. The reflex functions to maintain the muscle at a constant length. The term deep tendon reflex is ...
of muscles and overlying
fascia A fascia (; plural fasciae or fascias; adjective fascial; from Latin: "band") is a band or sheet of connective tissue, primarily collagen, beneath the skin that attaches to, stabilizes, encloses, and separates muscles and other internal organs ...
. Practitioners who perform myofascial release consider the fascia and its corresponding muscle to be the main targets of their procedure, but assert that other tissue may be affected as well, including other connective tissue. Fascia is the
soft tissue Soft tissue is all the tissue in the body that is not hardened by the processes of ossification or calcification such as bones and teeth. Soft tissue connects, surrounds or supports internal organs and bones, and includes muscle, tendons, ...
component of the
connective tissue Connective tissue is one of the four primary types of animal tissue, along with epithelial tissue, muscle tissue, and nervous tissue. It develops from the mesenchyme derived from the mesoderm the middle embryonic germ layer. Connective tiss ...
that provides support and protection for most structures within the human body, including
muscle Skeletal muscles (commonly referred to as muscles) are organs of the vertebrate muscular system and typically are attached by tendons to bones of a skeleton. The muscle cells of skeletal muscles are much longer than in the other types of mus ...
. This soft tissue can become restricted due to
psychogenic disease Classified as a "conversion disorder" by the DSM-IV, a psychogenic disease is a disease in which mental stressors cause physical symptoms of different diseases. The manifestation of physical symptoms without biologically identifiable causes results ...
, overuse, trauma, infectious agents, or inactivity, often resulting in pain, muscle tension, and corresponding diminished blood flow. Some osteopaths search for small lumps of tissue, called "Chapman release points" as part of their diagnostic procedure.


Lymphatic pump treatment

Lymphatic pump treatment (LPT) is a manual technique intended to encourage
lymph Lymph (from Latin, , meaning "water") is the fluid that flows through the lymphatic system, a system composed of lymph vessels (channels) and intervening lymph nodes whose function, like the venous system, is to return fluid from the tissues ...
flow in a person's
lymphatic system The lymphatic system, or lymphoid system, is an organ system in vertebrates that is part of the immune system, and complementary to the circulatory system. It consists of a large network of lymphatic vessels, lymph nodes, lymphatic or lymphoid ...
. The first modern lymphatic pump technique was developed in 1920, although osteopathic physicians used various forms of lymphatic techniques as early as the late 19th century. Relative contraindications for the use of lymphatic pump treatments include fractures,
abscess An abscess is a collection of pus that has built up within the tissue of the body. Signs and symptoms of abscesses include redness, pain, warmth, and swelling. The swelling may feel fluid-filled when pressed. The area of redness often extends ...
es or localized infections, and severe bacterial infections with body temperature elevated higher than .


Effectiveness

A 2005 Cochrane review of osteopathic manipulative treatment (OMT) in asthma treatment concluded that there was insufficient evidence that OMT can be used to treat asthma. In 2013, a
Cochrane review Cochrane (previously known as the Cochrane Collaboration) is a British international charitable organisation formed to organise medical research findings to facilitate evidence-based choices about health interventions involving health professi ...
reviewed six randomized controlled trials which investigated the effect of four types of chest physiotherapy (including OMT) as adjunctive treatments for pneumonia in adults and concluded that "based on current limited evidence, chest physiotherapy might not be recommended as routine additional treatment for pneumonia in adults." Techniques investigated in the study included paraspinal inhibition, rib raising, and myofascial release. The review found that OMT did not reduce mortality and did not increase cure rate, but that OMT slightly reduced the duration of hospital stay and antibiotic use. A 2013 systematic review of the use of OMT for treating pediatric conditions concluded that its effectiveness was unproven. In 2014, a
systematic review A systematic review is a scholarly synthesis of the evidence on a clearly presented topic using critical methods to identify, define and assess research on the topic. A systematic review extracts and interprets data from published studies on t ...
and
meta-analysis A meta-analysis is a statistical analysis that combines the results of multiple scientific studies. Meta-analyses can be performed when there are multiple scientific studies addressing the same question, with each individual study reporting m ...
of 15 randomized controlled trials found moderate-quality evidence that OMT reduces pain and improves functional status in acute and chronic nonspecific
low back pain Low back pain (LBP) or lumbago is a common disorder involving the muscles, nerves, and bones of the back, in between the lower edge of the ribs and the lower fold of the buttocks. Pain can vary from a dull constant ache to a sudden sharp feel ...
. The same analysis also found moderate-quality evidence for pain reduction for nonspecific low back pain in postpartum women and low-quality evidence for pain reduction in nonspecific low back pain in
pregnant women Pregnancy is the time during which one or more offspring develops ( gestates) inside a woman's uterus (womb). A multiple pregnancy involves more than one offspring, such as with twins. Pregnancy usually occurs by sexual intercourse, but ca ...
. A 2013 systematic review found insufficient evidence to rate osteopathic manipulation for chronic nonspecific low back pain. In 2011, a systematic review found no compelling evidence that osteopathic manipulation was effective for the treatment of musculoskeletal pain. A 2018 systematic review found that there is no evidence for the reliability or specific efficacy of the techniques used in visceral osteopathy. ''The New England Journal of Medicine''s 4 November 1999 issue concluded that patients with chronic low back pain can be treated effectively with manipulation. The United Kingdom's
National Health Service The National Health Service (NHS) is the umbrella term for the publicly funded healthcare systems of the United Kingdom (UK). Since 1948, they have been funded out of general taxation. There are three systems which are referred to using the " ...
says there is "limited evidence" that osteopathy "may be effective for some types of neck, shoulder or lower limb pain and recovery after hip or knee operations", but that there is no evidence that osteopathy is effective as a treatment for health conditions unrelated to the bones and muscles. Others have concluded that there is insufficient evidence to suggest efficacy for osteopathic style manipulation in treating musculoskeletal pain.


Criticism

The American Medical Association listed DOs as "cultists" and deemed MD consultation of DOs unethical from 1923 until 1962. MDs regarded that osteopathic treatments were rooted in "pseudoscientific dogma", and although physicians from both branches of medicine have been able to meet on common ground, tensions between the two continue. In 1988, Petr Skrabanek classified osteopathy as one of the "paranormal" forms of alternative medicine, commenting that it has a view of disease which had no meaning outside its own closed system. In a 1995 conference address, the president of the
Association of American Medical Colleges The Association of American Medical Colleges (AAMC) is a nonprofit organization based in Washington, D.C. that was established in 1876. It represents medical school A medical school is a tertiary educational institution, or part of such an i ...
, Jordan J. Cohen, pinpointed OMT as a defining difference between MDs and DOs; while he saw there was no quarrel in the appropriateness of manipulation for musculoskeletal treatment, the difficulty centered on "applying manipulative therapy to treat other systemic diseases"—at that point, Cohen maintained, "we enter the realm of skepticism on the part of the allopathic world." In 1998,
Stephen Barrett Stephen Joel Barrett (; born 1933) is an American retired psychiatrist, author, co-founder of the National Council Against Health Fraud (NCAHF), and the webmaster of Quackwatch. He runs a number of websites dealing with quackery and health frau ...
of
Quackwatch Quackwatch is a United States-based website, self-described as a "network of people" founded by Stephen Barrett, which aims to "combat health-related frauds, myths, fads, fallacies, and misconduct" and to focus on "quackery-related information th ...
said that the worth of manipulative therapy had been exaggerated and that the
American Osteopathic Association The American Osteopathic Association (AOA) is the representative member organization for the more than 176,000 osteopathic medical doctors (D.O.s) and osteopathic medical students in the United States. The AOA is headquartered in Chicago, Illinoi ...
(AOA) was acting unethically by failing to condemn
craniosacral therapy Craniosacral therapy (CST) or cranial osteopathy is a form of alternative therapy that uses gentle touch to palpate the synarthrodial joints of the cranium. CST is a pseudoscience and its practice has been characterized as quackery. It is bas ...
. The article attracted a letter from the law firm representing the AOA accusing Barrett of libel and demanding an apology to avert legal action. In response, Barrett made some slight modifications to his text, while maintaining its overall stance; he queried the AOA's reference to "the body's natural tendency toward good health", and challenged them to "provide imwith adequate scientific evidence showing how this belief has been tested and demonstrated to be true." Barrett has been quoted as saying, "the pseudoscience within osteopathy can't compete with the science". In 1999, Joel D. Howell noted that osteopathy and medicine as practiced by MDs were becoming increasingly convergent. He suggested that this raised a paradox: "if osteopathy has become the functional equivalent of allopathy, what is the justification for its continued existence? And if there is value in therapy that is uniquely osteopathic – that is, based on osteopathic manipulation or other techniques – why should its use be limited to osteopaths?" In 2004, the osteopathic physician Bryan E. Bledsoe, a professor of
emergency medicine Emergency medicine is the Medical specialty, medical speciality concerned with the care of illnesses or Injury, injuries requiring immediate medical attention. Emergency physicians (often called “ER doctors” in the United States) continuous ...
, wrote disparagingly of the "pseudoscience" at the foundation of OMT. In his view, "OMT will and should follow
homeopathy Homeopathy or homoeopathy is a pseudoscientific system of alternative medicine. It was conceived in 1796 by the German physician Samuel Hahnemann. Its practitioners, called homeopaths, believe that a substance that causes symptoms of a d ...
, magnetic healing,
chiropractic Chiropractic is a form of alternative medicine concerned with the diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, especially of the spine. It has esoteric origins and is based on several pseudosci ...
, and other outdated practices into the pages of medical history." In 2010, Steven Salzberg wrote that OMT was promoted as a special distinguishing element of DO training, but that it amounted to no more than "'extra' training in pseudoscientific practices." It has been suggested that osteopathic physicians may be more likely than MDs to be involved in questionable practices such as
orthomolecular therapy Orthomolecular medicine is a form of alternative medicine that aims to maintain human health through nutritional supplementation. The concept builds on the idea of an optimal nutritional environment in the body and suggests that diseases reflect ...
and
homeopathy Homeopathy or homoeopathy is a pseudoscientific system of alternative medicine. It was conceived in 1796 by the German physician Samuel Hahnemann. Its practitioners, called homeopaths, believe that a substance that causes symptoms of a d ...
. Retired MD and
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flight surgeon A flight surgeon is a military medical officer practicing in the clinical field of aviation medicine. Although the term "flight surgery" is considered improper by purists, it may occasionally be encountered. Flight surgeons are physicians ( M ...
Harriet Hall Harriet A. Hall (born July 2, 1945) is a U.S. retired family physician, former U.S. Air Force flight surgeon and skeptic who writes about alternative medicine and quackery for '' Skeptic'' and ''Skeptical Inquirer''. She writes under the name ...
stated that DOs trained in the U.S. are Doctors of Osteopathic Medicine and are legally equivalent to MDs. "They must be distinguished from 'osteopaths', members of a less regulated or unregulated profession that is practiced in many countries. Osteopaths get inferior training that can't be compared to that of DOs."


Regulation and legal status

The osteopathic profession has evolved into two branches, non-physician manual medicine osteopaths and full scope of medical practice
osteopathic physicians Doctor of Osteopathic Medicine (DO or D.O., or in Australia DO USA) is a medical degree conferred by the 38 osteopathic medical schools in the United States. DO and Doctor of Medicine (MD) degrees are equivalent: a DO graduate may become licen ...
. These groups are so distinct that in practice they function as separate professions. The regulation of non-physician manual medicine osteopaths varies greatly between jurisdictions. In Australia, Denmark, New Zealand, Switzerland, UAE and UK the non-physician manual medicine osteopaths are regulated by statute and practice requires registration with the relevant regulatory authority. The Osteopathic International Alliance has a country guide with details of registration and practice rights and the International Osteopathic Association has a list of all accredited osteopathic colleges. Several international and national organizations exist relating to osteopathic education and political advocacy. Similarly, there is also an international organization of organizations for national osteopathic and osteopathic medical associations, statutory regulators, and universities/medical schools offering osteopathic and osteopathic medical education, known as the Osteopathic International Alliance (OIA). The following sections describe the legal status of ''osteopathy'' and ''osteopathic medicine'' in each country listed.


Australia

A majority of osteopaths work in private practice, with osteopaths working within aged care, traffic and workers compensation schemes or co-located with medical practitioners. Osteopaths are not considered physicians or medical doctors in Australia, rather as allied health professionals offering private practice care. The majority of private health insurance providers cover treatment performed by osteopaths, as do many government based schemes such as veteran's affairs or workers compensations schemes In addition, treatment performed by osteopaths is covered by the public healthcare system in Australia ( Medicare) under the Chronic Disease Management plan. Osteopathy Australia (formerly the Australian Osteopathic Association) is a national organization representing the interests of Australian osteopaths, osteopathy as a profession in Australia, and consumers' right to access osteopathic services. Founded in 1955 in Victoria, the Australian Osteopathic Association became a national body in 1991 and became Osteopathy Australia in 2014. and is a member of the Osteopathic International Alliance. The Osteopathy Board of Australia is part of the
Australian Health Practitioner Regulation Agency The Australian Health Practitioner Regulation Agency (AHPRA), infrequently spelt as the Australian Health Practitioners Regulation Agency is a statutory authority founded in 2010 which is responsible, in collaboration with the ''Medical Board of ...
which is the regulatory body for all recognized health care professions in Australia. The Osteopathic Board of Australia is separate from the Medical Board of Australia which is the governing body that regulates medical practitioners. Osteopaths trained internationally may be eligible for registration in Australia, dependent on their level of training and following relevant competency assessment. Students training to be an osteopath in Australia must study in an approved program in an accredited university. Current accredited courses are either four or five years in length. To achieve accreditation universities courses must demonstrate the capabilities of graduates. The capabilities are based on the CanMEDS competency framework that was developed by the Royal College of Physicians and Surgeons of Canada. A 2018 large scale study, representing a response rate of 49.1% of the profession indicated the average age of the participants was 38.0 years, with 58.1% being female and the majority holding a Bachelor or higher degree qualification for osteopathy. The study also estimated a total of 3.9 million patients consulted osteopaths every year in Australia. Most osteopaths work in referral relationships with a range of other health services, managing patients primarily with musculoskeletal disorders.


Canada

In Canada, the titles "osteopath" and "osteopathic physician" are protected in some provinces by the medical regulatory college for physicians and surgeons. As of 2011, there were approximately 20 U.S.-trained osteopathic physicians, all of which held a
Doctor of Osteopathic Medicine Doctor of Osteopathic Medicine (DO or D.O., or in Australia DO USA) is a medical degree conferred by the 38 osteopathic medical schools in the United States. DO and Doctor of Medicine (MD) degrees are equivalent: a DO graduate may become lice ...
degree, practicing in all of Canada. As of 2014, no training programs have been established for osteopathic physicians in Canada. The non-physician manual practice of osteopathy is practiced in most Canadian provinces. As of 2014, manual osteopathic practice is not a government-regulated health profession in any province, and those interested in pursuing osteopathic studies must register in private osteopathy schools. It is estimated that there are over 1,300 osteopathic manual practitioners in Canada, most of whom practice in Quebec and Ontario. Some sources indicate that there are between 1,000 and 1,200 osteopaths practicing in the province of Quebec, and although this number might seem quite elevated, many osteopathy clinics are adding patients on waiting lists due to a shortage of osteopaths in the province.


Quebec

Beginning in 2009,
Université Laval Université Laval is a public research university in Quebec City, Quebec, Canada. The university was founded by royal charter issued by Queen Victoria in 1852, with roots in the founding of the Séminaire de Québec in 1663 by François de Montm ...
in
Quebec City Quebec City ( or ; french: Ville de Québec), officially Québec (), is the capital city of the Canadian province of Quebec. As of July 2021, the city had a population of 549,459, and the metropolitan area had a population of 839,311. It is t ...
was working with the '' Collège d'études ostéopathiques'' in
Montreal Montreal ( ; officially Montréal, ) is the second-most populous city in Canada and most populous city in the Canadian province of Quebec. Founded in 1642 as '' Ville-Marie'', or "City of Mary", it is named after Mount Royal, the triple- ...
on a project to implement a professional osteopathy program consisting of a
bachelor's degree A bachelor's degree (from Middle Latin ''baccalaureus'') or baccalaureate (from Modern Latin ''baccalaureatus'') is an undergraduate academic degree awarded by colleges and universities upon completion of a course of study lasting three to si ...
followed by a professional
master's degree A master's degree (from Latin ) is an academic degree awarded by universities or colleges upon completion of a course of study demonstrating mastery or a high-order overview of a specific field of study or area of professional practice.
in osteopathy as manual therapy. However, due to the many doubts concerning the scientific credibility of osteopathy from the university's
faculty of medicine A medical school is a tertiary educational institution, or part of such an institution, that teaches medicine, and awards a professional degree for physicians. Such medical degrees include the Bachelor of Medicine, Bachelor of Surgery (MBBS, M ...
, the program developers decided to abandon the project in 2011, after years of discussion, planning, and preparation for the program implementation. There was some controversy with the final decision of the university's committee regarding the continuous undergraduate and professional graduate program in osteopathy because the Commission of studies, which is in charge of evaluating new training programs offered by the university, had judged that the program had its place at Université Laval before receiving the unfavourable support decision from the faculty of medicine. Had the program been implemented, Université Laval would have been the first university institution in Quebec to offer a professional program in osteopathy as a manual therapy.


Egypt and the Middle East

Hesham Khalil introduced osteopathy in the Middle East at a local physical therapy conference in Cairo, Egypt in 2005 with a lecture titled "The global Osteopathic Concept / Holistic approach in Somatic Dysfunction". Since then he has toured the Middle East to introduce osteopathy in other Middle Eastern and North African countries, including Sudan, Jordan, Saudi Arabia, Qatar, UAE, Kuwait and Oman. In December 2007 the first Workshop on Global osteopathic approach was held at the Nasser Institute Hospital for Research and Treatment, sponsored by the Faculty of Physical Therapy, University of Cairo, Egypt. On 6 August 2010, the Egyptian Osteopathic Society (OsteoEgypt) was founded. OsteoEgypt promotes a two-tier model of osteopathy in Egypt and the Middle East. The event was timed to coincide with the birthday of A.T. Still.


European Union

There is no European regulatory authority for the practice of osteopathy or osteopathic medicine within the European Union; each country has its own rules. The UK's General Osteopathic Council, a regulatory body set up under the country's Osteopaths Act 1993, issued a position paper on European regulation of osteopathy in 2005.


Belgium

Since the early 1970s, osteopaths have been practicing in Belgium, during which time several attempts have been made to obtain an official status of health care profession. In 1999, a law was voted (the 'Colla-Law') providing a legal framework for osteopathy, amongst three other non-conventional medical professions. In 2011, the former Belgian Minister Onkelinx set up the Chambers for Non-Conventional Medicines and the Joint Commission provided for in the "Colla-law" (1999). Their goal was to discuss and reach an agreement between the various medical professions to rule on these practices. In February 2014, only one practice, homeopathy, received its recognition. The others, including osteopathy, remain unresolved. Since 2014, the majority of the professional osteopathic associations have joined together under the name of UPOB - BVBO (Union Professionelle des Osteopathes de Belgique - Belgische Vereniging van Belgische Osteopaten - Professional Union of Belgian Osteopaths) in order to strengthen the image and vision of osteopathy (± 900 osteopaths). This unification also led in the creation of a website which represents all aspects of osteopathy in Belgium. Its aim is to offer Belgians a base of information about osteopathy, to provide access to a national on-call emergency service as well as to osteopathic care facilities for the less fortunates. The site has also a search engine giving access to all osteopaths who exclusively practice osteopathy. Lastly, the website serves as a platform to support actions working towards the recognition of osteopathy. In 2020, they changed their name to osteopathie.be


Finland

Osteopathy has been a recognized health profession since 1994 in Finland. It is regulated by law along with chiropractors and naprapaths. These professions require at least a four-year education. Currently there are three osteopathic schools in Finland, one which is public and two private ones.


France

''Osteopathy'' is a governmentally recognized profession and has title protection, . The most recent decree regarding osteopathy was enacted in 2014.


Germany

Germany has both ''osteopathy'' and ''osteopathic medicine''. There is a difference in the osteopathic education between non-physician osteopaths, physiotherapists, and medical physicians. Physiotherapists are a recognized health profession and can achieve a degree of "Diploma in Osteopathic Therapy (D.O.T.)". Non-physician ''osteopaths'' are not medically licensed. They have an average total of 1200 hours of training, roughly half being in manual therapy and osteopathy, with no medical specialization before they attain their degree. Non-physician osteopaths in Germany officially work under the "
Heilpraktiker ''Heilpraktiker'' ("healing practitioner") is a naturopathic profession in Germany. It is recognized as an alternative and complementary health care profession by German law. Profession in Germany ''Heilpraktiker'', or non-medical healing prac ...
" law. Heilpraktiker is a separate profession within the health care system. There are many schools of osteopathy in Germany; most are moving toward national recognition although such recognition does not currently exist. In Germany, there are state level rules governing which persons (non-physicians) may call themselves osteopaths.


Portugal

Osteopathy is a governmentally recognized health profession and the title of Osteopath is protected by Law (Act 45/2003, of 22 October, and Act 71/2013, of 2 September). Currently there are eight faculties that teach the four-year degree course of osteopathy (BSc Hon in Osteopathy).


India

Sri Sri University offers BSc and MSc Osteopathy programmes.


New Zealand

The practice of osteopathy is regulated by law, under the terms of the Health Practitioners Competence Assurance Act 2003 which came into effect on 18 September 2004. Under the act, it is a legal requirement to be registered with the Osteopathic Council of New Zealand (OCNZ), and to hold an annual practicing certificate issued by them, in order to practice as an osteopath. Each of the fifteen health professions regulated by the HPCA act work within the "Scope of Practice" determined and published by its professional board or council. Osteopaths in New Zealand are not fully licensed physicians. In New Zealand, in addition to the general scope of practice, osteopaths may also hold the Scope of Practice for Osteopaths using western medical acupuncture and related needling techniques. In New Zealand a course is offered at the
Unitec Institute of Technology Unitec Institute of Technology (Māori: Te Whare Wānanga o Wairaka) is the largest institute of technology in Auckland, New Zealand. 16,844 students study programmes from certificate to postgraduate degree level (levels 1 to 9) across a range of ...
(Unitec). Australasian courses consist of a bachelor's degree in clinical science (osteopathy) followed by a master's degree. The Unitec double degree programme is the OCNZ prescribed qualification for registration in the scope of practice: Australian qualifications accredited by the Australian and New Zealand Osteopathic Council are also prescribed qualifications. Osteopaths registered and in good standing with the Australian Health Practitioner Regulation Agency – Osteopathy Board of Australian are eligible to register in New Zealand under the mutual recognition system operating between the two countries. Graduates from programs in every other country are required to complete an assessment procedure. The scope of practice for US-trained ''osteopathic physicians'' is unlimited on an ''exceptions'' basis. Full licensure to practice medicine is awarded on an exceptions basis following a hearing before the licensing authorities in New Zealand. Both the Medical Council of New Zealand and the OCNZ regulate osteopathic physicians in New Zealand. Currently, the country has no recognized osteopathic medical schools.


United Kingdom

The first school of osteopathy was established in London in 1917 by John Martin Littlejohn, a pupil of A.T. Still, who had been Dean of the
Chicago College of Osteopathic Medicine (''City in a Garden''); I Will , image_map = , map_caption = Interactive Map of Chicago , coordinates = , coordinates_footnotes = , subdivision_type = Country , subdivision_name ...
. After many years of existing outside the mainstream of health care provision, the osteopathic profession in the UK was accorded formal recognition by Parliament in 1993 by the Osteopaths Act. This legislation now provides the profession of osteopathy the same legal framework of statutory self-regulation as other healthcare professions such as medicine and dentistry. This Act provides for "protection of title". A person who expressly or implicitly describes themself as an osteopath, osteopathic practitioner, osteopathic physician, osteopathist, osteotherapist, or any kind of osteopath is guilty of an offence unless they are registered as an osteopath. The
General Osteopathic Council The General Osteopathic Council (GOsC) is the regulator of the practice of osteopathy in the United Kingdom. The GOsC was established in 1997 following the Osteopaths Act 1993 to 'provide for the regulation of the profession of osteopathy' with th ...
(GOsC) regulates the practice of osteopathy under the terms of the Act. Under British law, an osteopath must be registered with the GOsC to practice in the United Kingdom. More than 5,300 osteopaths were registered in the UK as of 2021. The General Osteopathic Council has a statutory duty to promote, develop and regulate the profession of osteopathy in the UK. Its duty is to protect the interests of the public by ensuring that all osteopaths maintain high standards of safety, competence and professional conduct throughout their professional lives. In order to be registered with the General Osteopathic Council an osteopath must hold a recognized qualification that meets the standards as set out by law in the GOsC's Standard of Practice. Osteopathic medicine is regulated by the General Osteopathic Council, (GOsC) under the terms of the Osteopaths Act 1993 and statement from the GMC. Practising osteopaths will usually have a BS or MSc in osteopathy. Accelerated courses leading to accreditation are available for those with a medical degree and physiotherapists. The London College of Osteopathic Medicine teaches osteopathy only to those who are already physicians.


United States

An ''osteopathic physician'' in the United States is a physician trained in the full scope of medical practice, with a degree of
Doctor of Osteopathic Medicine Doctor of Osteopathic Medicine (DO or D.O., or in Australia DO USA) is a medical degree conferred by the 38 osteopathic medical schools in the United States. DO and Doctor of Medicine (MD) degrees are equivalent: a DO graduate may become lice ...
(DO).Dennis L. Kasper, Eugene Braunwald, Anthony S. Fauci, Stephen L. Hauser, Dan L. Longo, J. Larry Jameson, and Kurt J. Isselbacher, Eds.
Chapter 10. Complementary and Alternative Medicine
'' Harrison's Principles of Internal Medicine, 16th Ed. 2005. McGraw-Hill.
With the increased internationalization of osteopathy, the
American Osteopathic Association The American Osteopathic Association (AOA) is the representative member organization for the more than 176,000 osteopathic medical doctors (D.O.s) and osteopathic medical students in the United States. The AOA is headquartered in Chicago, Illinoi ...
(AOA) recommended in 2010 that the older terms ''osteopathy'' and ''osteopath'' be reserved for "informal or historical discussions and for referring to previously named entities in the profession and foreign-trained osteopaths", and replaced in the US by ''osteopathic medicine'' and ''osteopathic physician''. The
American Association of Colleges of Osteopathic Medicine The American Association of Colleges of Osteopathic Medicine (AACOM) is a non-profit organization that supports the 38 accredited colleges of osteopathic medicine (COMs) in the United States. These colleges are accredited to deliver instruction ...
made a similar recommendation. Those trained only in manual osteopathic treatment, generally to relieve muscular and skeletal conditions, are referred to as osteopaths, and are not permitted to use the title DO in the United States to avoid confusion with osteopathic physicians.


See also

*
Reiki is a Japanese form of energy healing, a type of alternative medicine. Reiki practitioners use a technique called ''palm healing'' or ''hands-on healing'' through which a " universal energy" is said to be transferred through the palms of the ...
*
Doctor of Osteopathic Medicine Doctor of Osteopathic Medicine (DO or D.O., or in Australia DO USA) is a medical degree conferred by the 38 osteopathic medical schools in the United States. DO and Doctor of Medicine (MD) degrees are equivalent: a DO graduate may become lice ...
*
List of medical schools in the United States This list of medical schools in the United States includes current and developing academic institutions which award the Doctor of Medicine (MD), or the Doctor of Osteopathic Medicine (DO) a professional level of education, either of which is requ ...
* List of osteopathic colleges *
Osteopathic medicine in the United States Osteopathic medicine is a branch of the medical profession in the United States that promotes the practice of allopathic medicine with a set of philosophy and principles set by its earlier form, osteopathy. Osteopathic physicians (DOs) are licen ...
*
Spinal manipulation Spinal manipulation is an intervention performed on spinal articulations, synovial joints, which is asserted to be therapeutic. These articulations in the spine that are amenable to spinal manipulative therapy include the z-joints, the atlanto ...


References


Further reading

* American Association of Colleges of Osteopathic Medicine (2011);
Glossary of Osteopathic Terminology
'. * * * * * * *


External links

* {{Authority control Alternative medicine Manual therapy Osteopathic medicine * Pseudoscience