© Springer International Publishing Switzerland 2014Donata Villani and Maria Vittoria Meraviglia (eds.)Positional Plagiocephaly10.1007/978-3-319-06118-4_7
7. Osteopathic Considerations in Positional Plagiocephaly
German School of Osteopathy (OSD), Hamburg, Germany
Osteopathic European Academic Network (OsEAN), Vienna, Austria
International Osteopathic Centre, Milan, Italy
7.1 Introducing Osteopathic Manual Medicine
Osteopathy, also called osteopathic medicine, was developed as an alternative system of medicine in the middle of the nineteenth century by Dr. Andrew Taylor Still in the United States. A. T. Still also founded the first school (American School of Osteopathy in Kirksville, Missouri) starting in 1892, something that in over 100 years has become a profession, represented in almost every corner of the world.
From his earliest beginnings as a frontier doctor, A.T. Still searched for a drugless alternative to the medical practices of his days, eventually developing his own system of medical treatment – what he termed “osteopathic manipulation.”
In earlier years, osteopathic practitioners were primarily generalists and used manipulation extensively . In more recent years, a trend toward specialization and adoption of a more mainstream approach to medicine has led to a declining emphasis on the manual approach in training and practice especially in the United States where osteopathy has the same legal status as orthodox medicine (in the United States, osteopaths are called “osteopathic physicians”). Europe (where osteopaths are simply called “osteopaths” in order to distinguish them from the medically trained practitioner), on the other hand, managed to keep osteopathic medicine separated from mainstream medicine, still emphasizing the manual approach. Considered one of the complementary and alternative medicines (CAM), unfortunately the profession is not recognized in all European countries yet, although the number of practitioners is constantly growing and an increasing number of universities in different European countries are offering osteopathic degrees on a full-time basis as well as on a part-time basis for those who already hold a previous degree in health-care disciplines).
Osteopathic medicine found historically a successful place in treating systemic dysfunctions and illnesses. Nowadays, osteopathy is more confined, at least in Europe, to the treatment of musculoskeletal disorders. Interviewed experts on historical literature refer to the osteopathic intervention not primarily related to musculoskeletal disorders or dysfunctions (Summers D, April 2011, Curator International Centre for Osteopathic History, Kirksville Missouri, personal communication). But as modern medical technologies and pharmaceutics (e.g., incredible advances in surgical methods and antibiotics) represent a faster and more effective way in treating most diseases (especially infective ones), osteopathy can be considered today more as a coadjuvant to orthodox intervention in the treatment of many chronic diseases, besides its strengths in the neuromusculoskeletal system, which certainly represents an important area of action, as modern lifestyles (like a lack in physical exercise) are unfortunately having a rather bad impact on our body, with very well-known major impacts on health systems.
A very important issue regarding manipulative medicine, in particular osteopathy, is a lack of scientific evidence. Nowadays, evidence-based medicine (EBM) plays a crucial role in medicine and therapeutics. But the problem concerning osteopathy not being evidence based was already an issue discussed a century ago, when osteopathy tried to gain recognition in front of the English Parliament and British medical societies .
How does osteopathy work and how can osteopathic manipulative treatment have an effect on a systemic disease or musculoskeletal disorders? Up to date in fact there are neither adequate nor scientific evidence-based answers to these questions. Even surveys carried out recently on the effects of osteopathy and other disciplines on, for example, asthma and other non-musculoskeletal conditions, have inconclusive evidence of effectiveness . Applied to pediatric conditions, the situation does not change much as shown by a very recent systematic review . It has to be highlighted that systematic reviews of the literature actually did not evaluate a great number of clinical trials to start with (and certainly not all conditions), as one of the major problems the osteopathic profession has always faced is a lack of financial funding, in order to conduce proper clinical research.
Osteopathy and osteopathic philosophy rely on five models applied to diagnosis and treatment, recognized by the World Health Organization (WHO) in 2006 as “a unique osteopathic contribution to world health care” . It is worth mentioning at this stage that osteopathy gained a partial official recognition from the WHO in 2010, after the organization published the so-called benchmarks on osteopathy and is now undergoing a European standardization process through the European Committee for Standardization (CEN).
7.2 A Brief Overview of the Five Osteopathic Models
7.2.1 The Biomechanical Model
This model looks at the human body from a mechanical and structural point of view. Posture and general biomechanics play a fundamental role in understanding how the body is functioning, emphasizing the structure-function interrelationship. The concept of somatic dysfunction (SD)1 is a crucial component of this (and the neurological) model. Somatic dysfunction, which can be diagnosed and treated manually by definition, is an important clinical factor, although the somatic dysfunction does not differ osteopathic medicine from conventional medicine in its conceptual approach. Somatic dysfunction is, namely, listed in the International Classification of Diseases (ICD-10) and is therefore making the biomechanical model a very “orthodox” model. From a mechanical point of view, osteopaths are particularly interested in observing and feeling how the human body is functioning and pick up changes that are signs of dysfunction, making the International Classification of Function (ICF)2 a truly fundamental item in the general osteopathic approach to the patient.
7.2.2 The Respiratory-Circulatory Model
This model regards fluid mechanics as an important key in maintaining health. All fluids have to be considered, starting from the blood, the lymphatic system, and even the cerebrospinal fluid. This model represents a keystone of osteopathy, as the founder of the discipline was particularly interested in understanding fluid mechanics, probably influenced by Virchow’s “cellular pathology,” which was spreading across the United States at the end of the nineteenth century. Osteopathic manipulation (as well as other types of manual therapies) is very likely to have a major effect on fluid dynamics and drainage, and certain techniques also appear to be very effective on the lymphatic system and consequently on the immune system, as recently investigated .
7.2.3 The Metabolic Energy Model
This model focuses on the energy expenditure of the organism. Osteopathic medicine addresses metabolic functions, by interacting with the autonomic nervous system and endocrine system. Inflammation processes play a fundamental role, as manual treatment means acting on the extracellular matrix and the ground regulation and possibly enhancing fluid mechanics in order to encourage natural healing mechanisms. But the idea is very simple: if a body functions better and easier, it will have enough resources to maintain its homeostatic regulatory characteristics. And the osteopathic approach will try to support these.
7.2.4 The Neurological Model
This model regards sensory, proprioceptive impulses and neural integration as another key factor in order to maintain health. Manual approaches will have an effect on neural feedback mechanisms, especially in terms of pain pathways, and pain mechanisms. The main aim of treatment here is to restore proper neurological processes, which could be disrupted by trauma or disease. Inflammatory processes and their associated nociceptive mechanisms play a crucial role, as these will inevitably change anatomical structures and functions, something that to a certain extend can be assessed and treated manually.
7.2.5 The Behavioral Model
This model, probably the most modern of the five, considers psychosocial and environmental factors in treatment. The therapeutic setting, the understanding of these factors in relation to someone’s health problems, becomes a crucial part of the whole patient-practitioner relationship. In the past, surveys have shown how osteopathic physicians are more keen on considering social and psychological factors, showing a more patient-centered attitude toward clinical cases . Although the definition of health has not been changed since 1946 (which has been the cause of much debate), the importance of adding environmental, social, and psychological factors in order to define not only the absence of disease, pain, and injury to define a status of well-being or general health is undisputable.