Different Styles of Osteopathic Treatment – Classical, Structural, Cranial, Visceral Osteopathy

When you book to see an osteopath, do you know what to expect?

Modern osteopathic training is continually evolving in response to research and development, however as the osteopath develops their skills and practice, their style of treatment will evolve to a more personalised approach influenced by the different approaches to patient care found amongst the osteopathic community.

When you visit your osteopath, the initial consultation is an information gathering session. We are looking at your posture, how you move, and your description of the condition in order to build a picture in our minds of what might be happening. The next point of diagnosis will come from laying hands on the body and moving joints passively to gather information from the affected areas. Once armed with a diagnosis, treatment goals are to restore good function to the body, but the approach can vary between osteopaths.

There are several distinct styles of osteopathic treatment and whilst some osteopaths will draw on several, others will focus essentially on one form only.

What are the different styles?

Structural Osteopathy
This is the most common approach to osteopathic treatment and is the foundation upon which modern training is based. It is where the osteopath will use manual techniques to affect the musculoskeletal system: joints are moved, muscles are stretched and in so doing the treatment effect can reach into the body and help the nervous system, blood supply or organ function.

Classical Osteopathy
Although this style involves a structural approach it is based on more traditional principles.

Osteopathy was founded in the US in 1874 by Andrew Taylor Still and then further developed by John Martin Littlejohn who also introduced osteopathy to England in 1911. They developed a system which mobilises the body in a specific manner, such that it generates an impact on the underlying physiology.

The first osteopaths were primarily healers who were concerned with treating ‘systemic illness’ such as typhoid and diphtheria, rather than the modern day osteopath who is most well known for treating back pain and sports injuries. Classical osteopathy is based on a specific routine known as the ‘body adjustment’ where the entire body is involved, and more specific treatment can be directed as appropriate. Unfortunately, this form of osteopathy is not so well understood today, and there are only a few osteopaths who use this approach exclusively.

Cranial Osteopathy
This is a more subtle approach which involves a gentle ‘hold’ of the patient to interact with more subtle energies and the body’s fluid dynamics.

Tiny physiological movements in the bones in the head and face are vital for health, and cranial osteopathy can focus on any obstructions to these microscopic movements that may have been caused by trauma or injury. Last month Mathieu explained more about this style of osteopath in his post what can a cranial osteopath treat.

Visceral Osteopathy
This approach looks at the relationship between the physical structure of the body and the organs, such as the digestive tract or respiratory system. Through the stresses imposed by poor posture, diet or lifestyle pressures, the organs can build areas of tension which can then lead to referred ‘viscero-somatic’ pain.

One example of this is the intense groin pain created by an acute kidney infection. In this case treatment over the area of pain may be ineffective whereas direct manipulation of the kidney may stimulate the healing response needed to relieve the pain.

Visceral treatment can aid movement of the digestive tract and good function of abdominal organs as well as the lungs.

Summary
Good osteopathic treatment is based on the principle that structure governs function, and vice-versa. Unlike other forms of manual therapy, all osteopaths will tend to have a “whole body”, integrated approach to assessment and treatment.

An osteopath will draw on a variety of techniques to make a change to the body in a bid to restore good function or structure. The way they interpret their findings and seek to make this change varies depending on their training, experience and technique preference of the osteopath, however, the principles that govern the reaction of the body to treatment and the healing process overall remain common to all osteopaths.

What's the difference between Osteopathy, Physiotherapy and Chiropractic?

There is a saying“if I had a pound for every time I was asked …” This is one question that many patients ask at some point during their course of treatment, and I look forward to referring them to our blog for answers from now on!

I will try to answer this without bias but please note that I am an osteopath and therefore cannot be truly objective. It is worth noting that as an aspiring health practitioner, I did consider all three, but chose osteopathy from some specific reasons that are still valid in my eyes today.

Osteopathy

is a holistic form of manual therapy, which deals with a wide range of acute, chronic and systemic disorders of the body, both musculoskeletal and visceral.

Osteopathy uses in-depth physiological and clinical knowledge, coupled with keen observation and palpatory skills. The osteopath will combine a detailed health case history with a thorough physical evaluation to diagnose the patient’s condition and treat it. The patient’s diet, work and leisure practices all inform this process.

The osteopath doesn’t treat a painful back, stomach or knee, but a body as a whole unit that is suffering an injury, and must be treated in an integrated manner to return to good balance and function: can an injured knee be treated conclusively without addressing the biomechanics of the ankle, hip, pelvis and back? The osteopath’s aim is not merely symptomatic relief, but addressing the underlying causes of the current presentation to prevent any re-occurrence.

Osteopathic treatment combines joint mobilisation – and occasionally manipulation – with work on muscles and ligament tension, as well as gentle work on visceral structures when required.

As naturopathic osteopaths, our specific bias is not merely to achieve better functional alignment of our patients’ bodies, but also to impart dietary, exercise and lifestyle advice that more generally enhance their long-term health.

More about what is ‘holistic’ osteopathy and a description of osteopathy here.

Chiropractic

The origins of Chiropractic are close to osteopathy, as the first chiropractor was a student of the founder of osteopathy. Indeed, in some instances, one would be hard-pressed to distinguish between the treatment provided by a good chiropractor and osteopath. However, a large proportion of chiropractors focus treatment on manipulation of spinal segments to normalise spinal position and effect underlying nerve roots.

Treatment plans are often based on regular manipulation for a set number of sessions in order to wholly correct a disorder. Chiropractors also often use imaging to aid diagnosis such as x-ray. These x-rays will often be conducted in the clinic as part of the course of treatment.

Physiotherapy

is the most commonly known form of ‘manual therapy’ due to its prevalence within the NHS.

Physiotherapists specialise in the rehabilitation of acute and chronic joint injury, often using a variety of prescribed exercises that the patient carries out when away from the treatment couch. Physios also use machines such as ultrasound or TENS machines to facilitate change in an injured area.

NHS Physiotherapists tend not to have diagnostic input, the diagnosis and treatment request tending to emanate from an orthopaedic surgeon, consultant rheumatologist etc.  As a result, treatment will also tend to be more specific than integrative.

Inevitably, this brief snapshot doesn’t do justice to the development of three different forms of manual therapy with their unique methods and philosophy. It merely attempts to highlight some of the key differences in clinical practice that you can expect from each – although as suggested above, the practice of some physios and chiropractors is sufficiently all encompassing as to be well aligned with osteopathic practice.

Sadly too, some osteopaths also stray into being too specific in their form of treatment, and come to rely too heavily on joint manipulation.

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