The document summarizes the history and development of osteopathic medicine from its founding in the 1800s by Andrew Taylor Still to its current practice. It describes how Still was dissatisfied with conventional medicine of the time and sought to develop a scientific, natural treatment system based on manipulating the musculoskeletal system. It traces the challenges osteopathic medicine faced gaining acceptance, the expansion of its schools and practice areas over time, and how it has integrated certain conventional medical practices while retaining Still's core principles.

1. To find health should be the object of
the doctor. Anyone can find disease
--ANDREW TAYLOR STILL, MD, DO
FOUNDER OF OSEOPATHY
Joan Walton

2.  Osteopathetic medicine commenced in the
1800’s as subsidiary of “regular” medicine
 Developed by founder, Dr. Andrew Taylor Still, as
a result of dissatisfaction with medical practice
inadequacies of that era
 Still Sought a scientific based medical and
treatment system philosophy based on nature
 During this time practitioners were often
eclectic and homeopathic
 Many individuals attended to their own medical
needs
 Treatments were based on traditional
unresearched European Middle Age remedies

3.  Bleeding and leeching
 Purging and puking
 Calomel use: Pugative mercuric compound, toxic,caused
resorbed gums, loss of teeth, mouth sores, death
and disfigurement
 Surgical procedures without antisepsis
 No anesthetic use until mid 1800’s
 Limited understanding of illness and disease
 No antibiotics, no microbial cause of illness
identified until 1872
 Lack of understanding of the immune system, heart
disease and cancer
 Diagnosis and outcome predictions based on empirical
identification of illness patterns
 Medical intervention often was more dangerous than
the illness

4.  By university degree
 Early and mid 19th century M.D. education consisted
of a 4 month course of morning lectures
 A voluntary 2nd year repeated the same curriculum
 By reading medicine
 Apprenticeships sought with established alternative
pathway frontier physicians
 Completion of supervised medical and scientific
textbooks studies
 Clinical component was obtained through physician
accompanied home and office visits
 Specialty studies could be arranged with an
established experts although this was not common
practice

5.  Born in Jonesboro, Virginia, family moved west to
Missouri shortly after his birth
 Father was passionate, anti-abolitionist, slavery opposing
circuit riding physician-Methodist Minister who used
spiritual and medical treatments to attend to his “flock”
 Still’s study of anatomy began with hunting associated
butchering
 Still’s query into the relationship between the body’s
anatomy and disease process began with a childhood
headache relieved by a rope swing constructed pillow
later thought to have been comparable to cranio-sacral
therapy or myofascial release
 Had innovative mind, invented a thresher and obtained
patents for a churn and stove
 Medical training provided by father through
apprenticeship and era associated medical texts
 Family moved back to Kansas after differing opinions on
slavery between his father and church

6.  Attended a Kansas medical school, did not
complete his full course of studies.
 Began career in partnership with his father
 Practiced era specific medicine using medicine,
available treatments, obstetrics and minor
surgery
 Served the local community and the Shawnee
Indian tribe.
 Experimented with manual treatment during this
time
 Served as an officer and a Kansas militia
battalion surgeon during the Civil War.
 Lost 3 children to spinal meningitis following the
war which lead to his search for a more
enlightened practice of medicine

7.  June 22, 1874: Still defined principles of the osteopathic
philosophy and medical care practice involving hands-on treatment to
improve host disease response
 Methodist philosophy based
 viewed human beings as the highest naturally evolved life form
 sought to attain perfection through natural organism processes
Proposed that mal-positioned bones, joints, and abnormal muscle
tone levels affect circulation and nerve function allowing for
disease development opportunities
 Relieved anatomical and physiological system stress through the
use of manipulation
 increased body’s efficiency
body returned to state in which its innate self curing abilities could
restore normal physiological processes
 Promoted appropriate circulation of blood, lymph and cerebrospinal
fluid, neurotrophic substance delivery, neural impulse transmission and
respiratory efficiency
 Opposed opiate and alcohol use

8.  Still donated land and supplied timber for the original
Methodist University buildings in Baldwin, Kansas
 Ostracized and denied teaching opportunities at the
University due to a local ministers thought that his
practice was of the devil and that only Jesus had the
healing power to lay hands on the sick
 Following a period of severe illness, moved back to
Missouri, settled in Kirkville
 Set up a circuit medical practice in outlying communities
after finding a few followers
 Following increased over time
 Primary practice location established
 Practice initially labeled as “magnetic healer or lightening
bonesetter
 Settled for the traditional medical naming approach based
on central pathology and cure issues coining his practice of
medicine “Osteopathy”.

9.  Founded in 1892 by Still
William Smith, Scotland educated reform
minded MD traded anatomy instruction for
Still’s teaching methods
 10 student 1st year enrollment
 Lead to:
 Curricular expansion
 Enrollment expansion
 First students became professors, joined by other physicians
and college graduates
 Osteopaths bore the title of Doctor of Osteopathy, (DO) upon
graduation which changed to Doctor of Osteopathic Medicine
(DO) at the end of the 20th century

10.  The autobiography of Andrew T. Still, 1897
 The philosophy of Osteopathy, 1899
 The philosophy and Mechanical Principles of
Osteopathy, 1902
 Osteopathy, Research, and Practice, 1910
 Books revealed the continued occasional but rare
use of medication in osteopathic practice

11.  Published in Osteopathy, Research, and Practice
 Adopted by the ASO as its educational program foundation.
 Believe in sanitation and hygiene
 Opposed vaccination and serum
 Surgery used as a last resort
 Treatment not dependent of electricity, x-radiance,
hydrotherapy, or other adjuncts for treatment
 Osteopathic measures enlisted
 Friendly to other non-drug measures but believed in body
readjustment healing approach
 Applicable in all disease conditions including surgery
 Treatment measures were not in conjunction with other
methods, when other methods were used osteopathy
moved out

12.  Allopathic profession
 Established monopoly on medical training and licensure
 Still’s comparative illness treatment success spoke for itself
 Wide variety of illness treatments
 Affected cures in some “hopeless patients”
 1919 Spanish Flu pandemic revealed that patients receiving osteopathic
autonomic targeted treatments had lower morbidity and mortality rates
 The Osteopathic advantage
Special expertise in neuro-musculoskeletal conditions, including joint
pain and soft tissue injuries
 Lack of publicly available physical medicine, rehabilitation and
physical therapy
 Lead to rapid expansion of the ASO, the profession, and graduate
founded schools
 1910 Flexner report
 Carnegie Foundation sponsored comparison of all American medical
schools against the John Hopkins University School Medicine standard
 ¾ of all U.S. medical schools , including osteopathic, were closed
following criticism surrounding the report results
 6 schools remained open following this and further institutional
development of Osteopathic schools had to rely on self generated
funding

13.  Increased practice of antiseptic procedure
for surgery
 Development of sulfa and penicillin
 The use of medicine in Osteopathic practice
in conjunction with Still’s principles
 By 1928, all Osteopathic schools taught
materia medica (the part of medicine
concerned with formulation and use of
remedies or natural pharmacological
preparations) including the newly researched
and efficacious antibiotics

14.  Most were general practitioner
 No armed forces service as a physician during WWII
 Lead to many staying home and serving the patients of the physicians
who were overseas which increased growth
 Record Post war Osteopathic college enrollment
 American post-graduate training programs were not generally
available to DO’s.
 1953-AMA president received a report on the status of osteopathic
medicine indicating DO training was equivalent to M.D. training and
that as long as they were prescribing proven effective medications
their was no concern with osteopathic manipulative treatments.
 Greater osteopathic professional acceptance in the mid to late 20th
century due to:
 California government regulatory merger of the osteopathic
profession with the allopathic medical profession
 The establishment of 10 additional osteopathic medical colleges
between 1969 and 1981 followed by more in the 1990’s

15. Some state legislatures increase
osteopathic college funding after
realizing that many DO’s practiced
general medicine, especially in
underserved areas
Lead to a rapid profession expansion
 Numerous new Osteopathic medical colleges
 Increase in Osteopathic grads entering allopathic
residencies
 The movement of young osteopathic physicians
into allopathic hospitals which was previously
forbidden

16.  Daniel David Palmer-investigated osteopathy prior to originating
chiropratic practice
 Edith Ashmore, DO, recommended in her published 1915 manual
that student should not be taught the original Still methods of
osteopathy due to difficulty level especially in relation to high
velocity manipulative techniques.
 Ida Rolf, Rolfing founder, wrote that her techniques were learned
from a blind Osteopath which were combined with yoga to create
a systematic protocol for whole body integration.
 John Barnes-a physical therapist who studied myofacial release
at Michigan State University taught it to physical therapists
 John Epledger, DO, mixed cranial and other manipulative
techniques, taught by a Still student, William Garner Sutherland,
DO, mixing light trance work and other techniques to develop
craniosacral therapy which is generally practiced by non-physicians.
 Postgraduate programs and courses offered by Osteopathic
physicians allowed U.S. physical therapists to begin using
osteopathic techniques such as muscle energy, myofascial
release, counterstrain, and high velocity low amplitude thrust

17.  United philosophy of medicine-Developed by Andrew
Taylor Still in the last half of the 19th century.
 Describes as a background reference system
 Identifies a patients nature
 Defines the physician mission
 Establishes the basic premises of the logic of
diagnosis and treatment
 Osteopathic philosophy poorly understood in the
general medical community due to lack of exposure
 Centered on a profound respect for the inherent
ability of the human being, particularly the body, to
heal itself

18.  Classical
 Human is identified as the trinity (mind, body and spirit)
 Little writing in regard to the mind and spirit (left to the
individual)
 A sick patient with sufficient recuperative power can be
structurally readjusted to assist in the return of normal
physiology
 Includes surgery and obstetrics
 Era consistent diet sufficient (organic in that era)
 If body was working correctly it could handle any fuel
source

19.  Dates back to the Greeks and Egyptians
 Mind-biochemical and emotional
 Spiritual- may be the most potent but unpredictable
 Body- Still’s focus-what could be seen, the relationship
between structure and function
 Stills methods
 History taking
 Observing and palpating the body
 Adjusting the body parts for proper positioning and
motion to promote normal physiology
 Await the body’s normal innate self-regulating powers
and healing process

20. Traditional Beliefs Contemporary
 Sanitation and hygiene have
effectively reduced mortality and
morbidity more than any other
approach
 Still’s criticism of medicine was
due to lack of research, logic and
validation.
 Contemporary Osteopathic
physicians commonly use
medication although medications
use is considered excessive and
potentially dangerous
 Immunizations is now better
understood and not using
immunizations can cause more
mortality and morbidity than
their use.
 Manipulation assists in:
 Diminishing or eliminating pain
Improving motion
 Decrease physiological and
psychological stress
 Assists in regaining optimal
homeostatic levels
 Osteopathy
 Includes medication, nutrition,
exercise, environmental factor
considerations, genetic and
molecular biology,
neuroimmunology and psychology
 Osteopathic concept
principles
o Human being is a dynamic unit
of function
o Body possesses self-regulatory self
healing natured mechanisms
o Structure and function are
interrelated at all levels

21. Traditional Contemporary
 Decreased surgery rate and
associated complications in
the U.S. due to:
 Diagnostic testing
 conservative approaches
 aseptic techniques
 better anesthesia
 micro and endoscopic
surgery
 Acceptable and statistically
advantageous therapies
 X-rays
 Radiation therapy
 Therapeutic laser
 Still’s unifactorial illness
causation description is no
longer valid
 Rational therapy is based on
these principles.
 Wellness continuum
 Wellness is a persons
ability to handle multiple
challenges without a
homeostatic
decompensation which
interferes with normal
activities
 Decreasing homeostatic
balance results in less of
an environmental-emotional
insult needed to
precipitate illness
 Wellness focus should be
on proper nutrition,
exercise, rest and stress
management

22.  Contemporary
 Multiple disease causes include genetic abnormality, nutritional
deficiencies, radiation damage and psychosomatic effects
 Structural integrity should be maintained through tensegrity,
involving bilateral muscle tone, balance and function
 The reductionalist understanding of osteopathic philosophy has
been enhanced by the chaos theory and the butterfly effect
 The neuromuscular skeletal system is the largest single system
in the body; it reflects the state of the health of the other
systems
 Osteopathic manipulation instruction has diminished leaving
physicians less skilled and not incorporating its use in
appropriate cases due to the incorporation of expanding
knowledge and research of the past century- which is much
broader than it was in the past

23.  Considerations
 Who is the patient
 Functionally, mentally, emotionally, and spiritually
and what are their physical, psychosocial and energy
levels in the environment?
 Where does health arise is this patient?
 What is the osteopathic physicians goal?
 Health, seeking the highest possible homeostatic
balance and performance based on current limitations
and circumstances
 How is health sought in this patient?
 Prevention

24.  Illness
 If patient has entered this continuum physician
must take a careful history, complete a physical
exam and form a differential diagnosis
 Nueromuscular system may be used for signs
which indicate systemic problems
 Diagnostic tests may be performed
 Diagnosis
Treatment decisions are made based on all
factors that affect physiology and performance
 Medical Standard of Care is used along with
OMT when indicated whether as a primary
treatment or as an adjunct treatment

25.  Body systems are integrated (cardiovascular,
lymphatic, respiratory, neurologic, endocrine
and immune)
 Factors affecting the patient physiology
 Air ,water, food, nutritional supplement, prescriptions , OTC
medication, physical forces and impacts on the system (trauma
or exercise), thought, emotions, stress, relaxation, energy
(gravity, sunlight, magnetic fields)
 Illness vulnerability
 Host controlled via the immune system and homeostatic
mechanisms
 Intervention is necessary when host control decreases and the
system downgrades into illness

26.  Addressed along a continuum ranging from
manipulation to surgery
 Approach is generally conservative
considering the body’s innate intelligence
and wisdom
 Uses the least possible intervention for the
greatest result

27.  Techniques may be combined to achieve a single treatment plan objective
 Patient problem
 Perception and skill of the M.D.
 Difficulty achieving the desired outcome
 Technique aims
 joint surface opposition
 muscle and connective tissue tension imbalances
 promote vascular and lymphatic flow
 modulate autonomic nervous tone
 most affect > 1 system
 Techniques types
 Direct
 Indirect
 Direct-confronts motion restriction, body part is taken directly towards the
restricted motion
 Indirect-body part is taken in the direction of ease of motion after proper
positioning. Uses activating forces to induce changes in muscle and connective
tissue length and tone, central, peripheral and ANS tone (activation level); joint
surface opposition and motion; or vascular lymphatic function
 Goals
 Tissue relaxation
 Increase physiological motion
 Decrease pain
 Optimization of homeostasis

28.  Soft tissue and lymphatic treatment
 Direct method
 Still developed
 Focus is on altering tone and length of muscle and
connective tissue
 Relaxes muscle and connective tissue
 Decreases and removes tissue tension and impediments
to arterial flow
 Alters ANS tone
 Alters lymphatics
 High velocity low-amplitude thrust
 Direct method
 Engages restrictive barrier through body positioning
 Thrust is short distance (low amplitude) and rapid
(velocity)
 Joint position, muscle tension levels, and neural and
vascular adjustments are reset through gapping the
articulation by 1/8 inch or less

29.  Articulatory technique
 Still developed
 Takes the treated body part to the end of it’s
restricted ROM gently and repetitively
 Repetitive motion directly diminishes the
restrictive barrier
 Multiple planes of motion are treated at one
time
 Used for individual joints or regions
 Includes the Still technique and Facilitated
positional release

30.  Muscle energy technique
 Direct treatment
 Developed by Fred Mitchell Sr. D.O.
 Muscle energy means that the patient uses their
own energy through directed muscular
cooperation with the physician
 Uses reflexive muscle tension changes
 Allows dysfunctionally shortened muscles to
lengthen, lengthen muscles to shorten,
strengthens weak muscles and relaxes hypertonic
muscles
 May use traction, reciprocal inhibition, cross-extensor
reflexes or oculocervical reflexes

31.  Counterstrain
 Passive positional technique
 Dysfunctional joint or tissue is placed in a
relaxed position
 Position is maintained for 90 seconds
 Inappropriate strain reflex is inhibited by
application
 Diagnosis is by palpation of tenderness mapped
by system originator which indicates
inappropriate neurological balance
 May be use with positional, movement or tissue
texture abnormalities
 Ideal for postsurgical patients that may not be
tolerant of articulatory techniques

32.  Myofascial release
 Performed by lengthening the contracted tissue
(direct myofascial release) or shortening it (
indirect myofascial release.
 Allows the nervous and respiratory systems to
facilitate changes
 Uses 2 physiological processes
 Creep
 Hysteresis
 Compression, traction, torsion, respiratory
cooperation or a combination of these may
facilitate treatment

33.  Osteopathy in the Cranial Field
 Developed by William G. Sutherland, D.O.
 Uses direct and indirect procedures
 Works with the body’s inherent rhythmic motions
 Commonly use as a treatment for headaches,
temporomandibular joint dysfunction syndrome
 Used in infants for treatment of cranial nerve compression
 Used for otitis media
 Focus on skull and sacrum at dura matter attachments but can
be used throughout the body
 Variant technique called Craniosacral therapy is not medically
licensed
 Visceral techniques
 Addresses viscera imbalances
 Includes stretching and balancing techniques related to
ligamentous attachments
 May involve inherent visceral motion

34.  Determined by physiology
 Organizes thought, seeking understanding of the
entire organism
 Allows for concurrent reductionistic analysis
 Reassembles parts into the individuals totality
 Uses standard orthopedic and neurological exam
to diagnose somatic dysfunction
 Tissue palpation
 Muscle and joint motion testing
 MS system used as an access point for diagnostic
information based on muscle tension, fluid
distribution and autonomic activity levels
 Visceral problems may be revealed through
neurological reflex interaction

35.  Somatic dysfunction
 Not tissue damage
 A disorder of the body’s programming for length,
tension, mobility affecting joint surface apposition,
tissue fluid flow efficiency and neurological balance
 Expands the standard medical differential diagnosis
 Uses more specific information
 Four somatic dysfunction diagnosis criteria
 TART
 T-tissue texture abnormalities
 A-static or positional asymmetry
 R- motion restriction
 T- tenderness
 Reflex relationships may also be included

36.  Treatment based on knowledge of structure
and function
 In restrictive MS problems with high tone, aim is
to decrease tone and increase motion
 In visceral dysfunction, aim is lowering muscle
tone and sympathetic nervous system tone
thereby enhancing adaptability and homeostatic
balance
 May or may not require the use of surgery and
medication
 May be primary treatment or as an adjunct

37.  2 levels
 Macroscopic- abnormal pressure on joints, nerves
and blood vessels may over time cause tissue
change
 Local dysfunction can lead to global dysfunction
 Microscopic-cellular physiology depends on
fluid flow
 Flow impedance of the internal fluid system (CV
system) can lead to decreased functioning of cells,
tissues, organs, and entire systems, causing increased
disease vulnerability

38.  Manipulation decreases or eliminates pain
 Adjusts involved structures toward an
adaptability level of the body’s tensegrity
system
 A system characterized by a discontinuous set of
compression elements (struts) that are held
together and/or moved, by a continuous
tensional network
 e.g. muscular system erecting the human frame
 Manipulation assist the body in functioning at
an optimal level, enhancing healing abilities

39.  If body’s functioning level is severely restricted
the sole use of manipulation may not be
effective
 Additional use of medication, surgery and direct
psychosocial interventions may be indicated
 2 possible scenarios when manipulation alone
may not be effective
 When preventative medicine or manipulation alone
would be ineffective in attaining the goal of health
 When the speed is of the essence
 Osteopathic physician failure to use
manipulative techniques ignores the main
premise of osteopathic medicine in that the
elimination of structural physiologic function
impediments assist the body’s innate self-healing
capabilities

40.  Micozzi, M.(2011) Osteopathic Medicine,
Fundamentals of Complementary and
Alternative Medicine, 4th edition, pp.232-
247, Saunders, St. Louis, Missouri