You might substitute ‘structure and function’ as ‘anatomy and physiology’ here. I see the structure being the muscles, ligaments, tendons, fascia, blood vessels, organs etc of the body and their function that has the potential to maintain the biology or chemistry of the body. The structure, being the architecture that contains our fluid dynamics, with the function being the biochemical maintenance of it. Blood and lymph plus other bodily fluids need to be carried around in the best way possible so that their ‘function’, to remove the products of respiration, exchange gases, carry away dead cells etc can work as best possible to maintain health and ultimately the structure of the body as it constantly renews itself, and allow its function to be as good as possible. Osteopathy attempts to improve and or maintain this process, so that the body has reduced pain, reduced dysfunction, improved function and overall better health is felt by the patient. This feeling can be felt by the patient as feeling les pain, better breathing, improved range of motion in their joints and the ability to do what they want to do as their own personal fluid dynamics are optimised through OMT.

As an osteopath, the body is considered an interconnected unit with no part working in isolation, this is in a structural and functional way. Strained or torn ankle joint ligaments can affect ankle mechanics, ascending forces and have an influence on other anatomical structures above; such as the knee and or hip, pelvis, lumbar spine etc. Therefore all injuries must at least be considered as being possibly related to another injury, pain or dysfunction. It may be that they are discounted quickly, but they must at least be considered as part of a holistic analysis of the patients presenting symptoms, complaints or previous diagnosis by another practitioner.

Functionally a bad infection or other disease process in one part of the body can affect the whole body and its ability to function normally. A pharmaceutical drug being ingested, injected or released from within may affect bodily functions and cause changes elsewhere in the body. If this is identified, it may be that an alternative medication or approach to the patient’s original need for the intervention is found. In one patient, after the case history, I believed that a new IUD resulted in the patient having a dysfunction resulting in pain, the subsequent changing of the patient’s birth/hormone control method, resulted in those side effects not being present any more.

This is probably one of the more esoteric beliefs in Osteopathy, especially given the wording ‘medicine chest’, but it is fundamental to our understanding of healing. A medicine chest would have been something more common in the late 19^th century, in rural USA, and refers to a collection of supplements, herbal remedies etc that would have been administered or applied to patients. In those times this practice would have been based on beliefs and experience, for first aid or other medicinal purposes, not scientific research. Remember the first patented pharmaceutical drug was aspirin, by Bayer in 1899, before that doctors and pharmacist always had a bit of artistic license, in their prescriptive medicinal approach to patients.

What I believe as an osteopath is that the body wants to work towards healing i.e. has it’s ‘own medicine chest’, reduce pain and work towards the removal of dysfunctions. This is also given the right environmental, nutritional, psychological etc factors. Stress, poor diet, a lack of hope in their ability to recover from an injury, are all likely to negatively infringe upon that patient’s situation or stasis, and impair their ability to improve the sitiation. With reduced stress hormones, good sleep, diet and other health positive factors in place, I believe the body wants to heal itself based on my experience, and OMT can be part of that equation. Osteopathy compliments the healing process by allowing proper fluid dynamics such hormonal communication, lymphatic drainage or nutritional bathing of body parts for example. This is by attempting to correct any bodily fluid motility to and from a tissue, organ, nerve root or muscle etc of the body, where a disease process might be occurring.

The expression ‘rule of the artery…’ is clearly dated but refers to a belief of osteopaths that blood flow to and from an organ, tissue, nerve root, muscle or any part of the body where fluid perfusion takes place, will be negatively affected by a reduced circulation. With time and the greater understanding of lymph, the idea of lymphatic drainage has been included in this principle.

Given the right internal and external environment for the human body, its health maintenance could be thought of as the carrying of good things to one place and bad things to another, possibly for exchange, alteration or other processes that are essential to survival. Osteopathy appreciates this and attempts through physical therapy, to improve these processes. We believe we can effect CSF, blood, lymph and other bodily fluid flow in a positive way to reduce pain and or dysfunction, and improve the body’s health.

The last tenet or principle of osteopathy’s philosophy is, in my opinion, with regard to the therapeutic relationship between the practitioner and patient. A patient will likely come to us with pain, dysfunction or the need for an understanding regarding their body and problems they are having with t, and in attempting to live life as they wish. This might be doing physical activity, a hobby, working at a desk bound job etc where they are struggling due to pain, worry, dysfunction or another problem that is preventing them from expressing themselves in life as they wish too. Our job is to help that person live life as they wish. By using our ‘osteopathic sieve’, during the taking of a case history, we will attempt to take as much information from the patient as possible, to understand them in the time and space they occupy in front of us. This includes their age, job, marital status, regular activities undertaken, if they have children or not, how old the children are etc. Before we get onto understanding the location, duration, progression, nature of, daily pattern etc of the pain or dysfunction they are presenting with. We will also want to know about their medical history, medications past and present, previous diagnoses, imaging or other tests performed and results gained. Once this information is gained a timeline analysis is considered as the information is placed upon it. The timeline comparison and analysis using the necessary data gained from a holistic case history is taken, with osteopathic philosophy as the basis of my thinking. The idea is to fully understand the person being consulted as they are at that moment, when diagnosing, possibly treating or referring and ultimately helping or managing their condition.

This form of human analytical appraisal was taught to me by an osteopathic hero of mine from university, one of my lecturers and I believe it has served me well. They used to teach their class three times in a row, as the academic year was split into three, to fit into the room used for their class. Once I missed the start of my class and knew they would be teaching it again afterwards, so stayed for the next lecture. The teaching principles were the same but the class was totally different, it was fascinating, so I stayed for the third one as well. Brilliant teacher and osteopath, I really wanted to worked for them after graduation, alas it was not meant to be. Luckily I was able to use the teaching and learn from others I found along the way. Am still learning!

After talking to and understanding the patient as best possible, during the osteopathic consultation, it is likely that ideas or hypotheses regarding what is causing the patient’s problem will start being formulating in the head. The next job is to test these ideas. A full physical examination: including observation, palpation, muscle energy, strength or reflex testing etc will be carried out to try and find the tissue causing symptoms plus potential maintaining factors or other issues that may impede the patients recovery. At this stage a crucial decision whether to treat, refer or do both for a patient must be made. With no ‘red flags’ found in either the case history or physical examination, it might be that we treat but need to get another practitioner involved. This might be to rule things out or possibly stop the pain coming back in the future. It might be that osteopathy can get rid of the immediate problem, but it will likely return without the intervention of another person using their specialised skills to confirm, help with or change the diagnosis plus treatment plan.

The osteopath is there to help people find a path upon which a problem can be removed, where hope was lost, it might be found again at the start of the path to healing. Whether the healing is helped by the osteopath directly, in conjunction with someone else using other skills, or by the other completely. Ultimately answers to questions regarding complicated pain or dysfunctions will try to be found so that health and healing occur for the benefit of the patient.

A caveat: osteopathy is not going to get rid of cancer, an acute urinary tract or sinus infections etc, but we might spot them and refer to an allopathic doctor for treatment. In my career to date, I have sent two patients to the doctor after finding unusual things following a case history and palpating their bodies, unfortunately cancers have been diagnosed, many other times they were given the all clear. Colleagues of mine have reported having similar experiences. Urinary tract or sinus infections can manifest as pelvic pain and headaches. The careful taking of a holistic case history to understand the genesis of the patient’s pain, can allow osteopaths to decide to treat or send to the doctor for a potential pharmaceutical intervention, that will lead to quick relief of pain and suffering. Our goal is to stop patients suffering.