Osteopathic Medicine

In the United States, Doctors of Osteopathic Medicine (DO’s) are fully trained physicians with schooling and licensure that equals and parallels the MD profession. Only US trained DO’s can be licensed to practice osteopathic medicine in the USA. DO’s attend their own medical schools, receive the same post-graduate training and licensure as their MD colleagues, and receive additional education in osteopathic manual medicine (OMM), a hands-on medical treatment procedure for many medical complaints, which recognizes the dynamic relationship of structure and function in health and disease.

Because DO’s can specialize in any medical specialty (e.g., surgery, cardiology, neurology, family medicine, etc.), many specialist DO’s do not utilize OMM in their medical practice, but function very similarly to their MD specialist colleagues. Some DO’s like Dr. Spector specialize in the traditional origins of the profession, Osteopathic Manual Medicine, the hands-on treatment approach that helps to change the structure of the body in order to restore more normal functioning. 

DO’s are one of the fastest growing segments of health care professionals in the United States. In 2023 there were over 148,000 osteopathic physicians and over 38,000 osteopathic medical students, with 41 colleges of osteopathic medicine (COMs) offering instruction at 66 teaching locations in 35 states. One in four U.S. medical students attended an osteopathic medical school. Both DO and MD schools offer similar, rigorous medical education, but approach the practice of medicine from distinct philosophies.

Andrew Taylor Still, MD

Osteopathic medicine was founded in 1874 by Dr. Andrew Still (1828-1917), a medical doctor who lived in Missouri. He discovered the significance of living anatomy in health and disease. Dr. Still realized that optimal health is possible only when all of the tissues and cells of the body function together in harmonious motion. Disease can have its beginnings in even a slight anatomical deviation from normal.

Dr. Still found that he had the ability to put his hands on patients, change their physiology and restore health. He named his innovative approach “Osteopathy” and began a new profession separate from his MD profession. This included his discoveries of how to use one’s hands to interact with a patient’s body and help restore more normal function to all structures, including tissues, bones, organs, arteries, cells, etc.

Today, some osteopathic physicians like Dr. Spector continue to use their hands to treat their patients in this same tradition, along with other medical modalities and an ability to apply full medical knowledge to each patient’s problem. DO’s today specialize in every field of medicine (e.g. surgery, cardiology, neurology, family medicine, etc.), and many no longer use this traditional form of osteopathic manual medicine.

Dr. Still understood that the human body is composed of many parts, but they are intimately related as a functional whole, and that the body has self-regulatory and self-healing mechanisms that can be used to help people get well. More than a hundred and fifty years ago, Dr. Still realized that the human being is more than just a physical body. He envisioned a totally new medical system that acknowledges the relationships of the body, mind, emotions and spirit.

At the age of ten, young Andrew Still suffered from frequent headaches with nausea. He constructed a rope swing between two trees, eight to ten inches off the ground. He lay down using the rope with a blanket over it for a swinging pillow. He wrote, “I lay stretched on my back, with my neck across the rope. Soon I became easy and went to sleep, got up in a little while with my headache all gone.” He continued to use this ‘treatment’ successfully every time he had a headache. 

Twenty years later Dr. Still considered his ‘rope swing treatment’ of headaches, and realized ... “I had suspended the action of the great occipital nerves, and given harmony to the flow of the arterial blood to and through the veins...I have worked from the days of a child...to obtain a more thorough knowledge of the workings of the machinery of life, in producing ease and health.”

As a practicing physician Dr. Still diligently researched and developed osteopathy. He developed a very practical way of treating people using just his hands, to change physiology and restore health.

In the late 1800s none of today's miracle drugs, such as antibiotics, were available. Dr. Still looked first to nature's own ability to heal and found a way to access this ability within the body. He saw this self-correcting potential as a cornerstone of his osteopathic philosophy. When combined with appropriate use of present day medical therapeutics, osteopathy offers a profound contribution to the practice of medicine.

Some quotes from A.T. Still, MD, founder of Osteopathic Medicine:

“To find health should be the object of the doctor. Anyone can find disease…”

“Osteopaths are the champions of natural law...”

“An Osteopath reasons from his knowledge of anatomy. He compares the work of the

abnormal body with the work of the normal body…”

“You as Osteopathic machinists can go no further than to adjust the abnormal

condition, in which you find the afflicted. Nature will do the rest...”

“Health holds dominion over the body by laws as immutable as the laws of gravity…”

“We look at the body in health as meaning perfection and harmony, not in one part,

but in the whole…”

“In Nature we look for good machines in form and action…To obtain good results we

must blend ourselves with and travel in harmony with Nature’s truths.”

Motion: The Key to diagnosis and treatment

“We know life only by the motion of material bodies…The processes of life must be kept in motion.”      ~  Dr. A. T. Still

Osteopathic Philosophy understands that the natural motion within the body's structure has a relationship to the body’s ability to function. Our main goal is to restore normal motion within the body, and therefore restore normal function. We recognize and work with several types of motion in the body, and have many ways of interfacing with tissues with our hands. Some of these forms of motion were discovered within the osteopathic profession.

For the body to function well, all the structures of the body must move “as Nature ordered.” In osteopathic medical school, we study medical anatomy and physiology in detail, along with many other topics, such as pathology, biochemistry, etc. In addition to the basics, we understand from a medical point of view how all the intricate parts of our bodies are constructed and work to do the job they are meant to do (function). We are trained to understand how each part of the body must move naturally in order to have ideal function. The interrelationships in the body (which are many!) all become a part of the incredibly intricate understanding of the life and ongoing connecting functions that go on inside our bodies. This includes relationships not only from head to toe, but inside out and between systems (e.g. nerve and artery interactions with organ functions, etc.). When we put our hands on patients, we develop a fine ability to feel these things, and, combined with our medical knowledge, learn to “sense” or “read” how your body is working, and where things may not be moving or working as well as they could.

Osteopathic Treatment restores motion, improves vitality, and brings about a higher state of function. Because the focus is on health and the individual, rather than only on the disease, patients with virtually any condition may benefit.

Dr. Still understood that the human body is composed of many parts, but they are intimately related as a functional whole, and that the body has self-regulatory and self-healing mechanisms that can be used to help people get well.

The many types of motion in the body include the obvious movements we can control (such as our muscles and bones moving in our necks, backs, arms and legs), some involuntary movements such as the heart beating, blood and lymphatic fluids moving and circulating, respiratory breathing (voluntary and involuntary) involving lungs moving air as they expand and contract with the diaphragm and ribs moving, and some more subtle internal movements that we may not be aware of, but which are nevertheless necessary for health to be maintained. Dr. Sutherland, an osteopathic physician, discovered a very important form of motion called primary respiration, which exists in every cell and tissue of the body, and is key to good function and health. See section on “Cranial Osteopathy” for more details on this. We are trained to feel and work with all these types of motion.

Osteopathy recognizes that good motion of all cells and tissues is necessary for good function.  

There are many ways that Dr. Spector uses her hands to treat the body. Osteopathy includes various methods of interacting with the body tissues.  Some methods are experienced by the patient as more “physical”, where body parts are actively moved, such as high velocity/low amplitude (commonly experienced as cracking or popping), muscle energy (a mild form of contraction and stretching) and visceral manipulation. Other methods are more subtle, where internal mechanisms are utilized and the outer body does not have to be moved very much, such as cranial osteopathy, biodynamics of cranial osteopathy, myofascial release and percussion machine treatment. All forms of osteopathic manipulative medicine apply the same principles and are focused on achieving the same results.

Dr. Spector always individualizes her osteopathic treatments by what each patient and their tissues need and may use a variety of osteopathic approaches. However, cranial osteopathy is a large focus of her treatments and these methods are particularly subtle and gentle, yet extremely effective.

Philosophical Foundations of Osteopathy

Although osteopathy employs the practice of manual medicine, it is not just a set of techniques. It is a philosophy and a science based on the application of sound principles. These principles, although initially conceived during the late nineteenth century by Dr. Andrew Taylor Still, the founder of osteopathy, have been consistently validated by scientific research (see http://cranialacademy.org/research/ ).

The philosophy and science of osteopathy is based upon the following four principles:

1. Structure and Function are interrelated.

From the smallest cell to the largest bone, all of anatomy is alive and in constant dynamic, rhythmic motion. Blood flows, lymphatics drain and cerebral spinal fluid fluctuates. The heart beats and the ribcage expands and contracts with each respiration. Each and every organ gently moves as it functions. Each and every structure has its own inherent rhythmic activity. This is the living anatomy that osteopathic physicians feel with their hands. When this motion becomes impaired, the tissues will not function as they were intended. As a result of this altered motion, symptoms develop, and disease may even occur. Dr. Still described this process in the following way, “Disease is the result of anatomical abnormalities followed by physiologic discord.”

For example, taking a deep breath may be difficult if the ribs, diaphragm or parts of the spine do not move well. When breathing is impaired, lymphatic drainage (necessary for clearing congestion and inflammation) will also be impaired. This may lead to the development of asthma or respiratory infections.

A dramatic example of how well osteopathic physicians understand the importance of the structure and function relationship is the influenza epidemic of 1917-1918. Approximately 30,000,000 people died worldwide. In the U.S., osteopathic physicians treated their patients with osteopathic manipulation and were quite successful in decreasing mortality from the disease. In fact, while hospitals run by MD’s reported a 30 to 40 percent mortality rate, osteopathic hospitals reported a mortality rate of less than one percent.

2. The Body is a Single Dynamic Unit of Function

There are many unifying systems within the body. The circulatory system supplies blood to every tissue and organ. The nervous system connects and integrates all of the body’s functions. A third unifying system is comprised of a connective tissue matrix called fascia. The fascia is a continuous sheath of living tissue that connects the body front to back, head to toe. It surrounds every muscle, organ, nerve and blood vessel. A primary function of this fascial system is to support, lubricate and transport electrical signals and cells, including immune cells, to other parts of the body. Thus, the circulatory system, the nervous system and the fascia all help to organize the body into a unified continuous whole. No single part exists independent of the whole. When even a small part of the body does not function optimally, the entire person is affected.

Consider the circulatory system. Dr. Still stated, “The rule of artery and vein is universal in all living beings, and the osteopath must know that and abide by its rulings, or he will not succeed as a healer.” Dr. Still used these words to describe the essential need for optimal fluid exchange. When blood and other fluids flow freely, the tissues can perform their physiologic functions without interference. When injury or disease occurs, the result can be a twisting or compression of all tissues, including the circulatory system. The blood and fluid flow becomes obstructed and areas of the body may become under-nourished and vulnerable. This effect may be a significant factor in causing disease. It is similar to trying to water a garden with a kinked hose. The water will not flow properly and the garden will not receive its proper nutrition.

Understanding this concept of functional unity allows osteopathic physicians to diagnose and treat their patients as a functional whole. This explains why an osteopathic physician may treat an area that is fairly distant from the area of pain or injury.

3. The Body Possesses Self-Regulatory and Self-Healing Mechanisms

The human body is always working to maintain a state of balanced function. For example, blood pressure, blood sugar and the heart rate are actively kept within a normal range. When there is a laceration or tear in the tissues, a physician can assist by cleaning the wound and bringing the edges together, but healing occurs by the action of inherent forces and processes within the body.

Dr. Still stated, “All the remedies necessary to health exist in the human body.” He understood that within the tissues, there is an inherent wisdom, a wise all-knowing restorative force, an intelligence within every cell that keeps the body well. When a state of discord arises, this healing force acts to restore functional balance and harmony. Sometimes the body’s self-healing forces can be impaired or impeded by disease or structural imbalance. The osteopathic physician is trained to augment these intrinsic mechanisms to help the body to better and more quickly heal itself.

4. Rational Treatment is Based on Applying These Principles

Osteopathic treatment applies these principles with a sound and thorough knowledge of anatomy and physiology. An osteopathic medical approach to treatment typically integrates osteopathic manipulation to restore structural freedom in the tissues, enhance fluid flow throughout the body, and creates the optimal setting for healing to occur.

Osteopathic Manual Medicine (OMM) is a gentle yet very effective hands-on treatment for many medical conditions, including, but not limited to, injuries and musculoskeletal complaints. It is often an answer to problems that have not responded to conventional medical, surgical or other therapeutic treatments. Osteopathic manual medicine can improve the function of all body systems through addressing motion in structural components of the body. In the US, it is only practiced by osteopathic physicians (DO’s), who are physicians equal in training and licensure to MD’s, and by MD’s who are qualified. Osteopathic medical training, perspective and practice differ greatly from other hands-on treatment professions, such as physical therapy, massage therapy, chiropractic, etc.

The goal of treatment is to restore healthy function, whether that be in the nervous system, the GI, respiratory, circulatory or musculoskeletal system, or any other system or area of the body. Your body has an amazing ability to change and function more easily. There are vital mechanisms of external and inherent motion in all of us that are capable of being accessed and utilized during osteopathic treatment by a skilled DO to help restore health. DO’s develop a very fine sense of touch, and, combined with their medical knowledge, are able to understand and treat many medical complaints in a unique way. We work in restoring the body’s natural abilities to strive toward health and homeostasis. W. G. Sutherland, DO, founder of Osteopathy in the Cranial Field, describes Dr. Spector’s fundamental osteopathic approach well, saying: "Allow physiologic function within to manifest its own unerring potency rather than apply a blind force from without."

Profound changes in physiology (the way the body functions or works inside) commonly occur from OMM because of the very specific nature and focus of osteopathic medical training and care. Yet patients experience these treatments as very comfortable and relaxing. They are often pleasantly surprised at how much better they feel with such gentle treatment. OMM is safe, appropriate and effective for all ages, from newborns into the older years.

Training in Osteopathic principles and practice is part of every osteopathic medical school curriculum. After learning this unique understanding of how the body tissues and cells move and function, DO medical students are trained in a variety of methods of using their hands to diagnose and treat patients. There are many osteopathic methods which apply and utilize the same principles, using our hands to interface with body tissues and change physiology and function.

Osteopathic methods vary from very direct ways of positioning and actively moving the patient’s body during a treatment, to more subtle, gentle ways of holding areas and accessing deeper mechanisms within the body. Dr. Spector utilizes all methods of Osteopathic Manual Medicine, listening to each patient’s body to determine what is needed. However, her main method of practice and expertise is Osteopathic Cranial Manipulative Medicine (OCMM), also known as  Cranial Osteopathy  (see next section for details), including Robert Fulford DO’s Percussion Osteopathy,  Eliott Blackman DO’s embryological approach to Cranial Osteopathy and James Jealous DO’s.  Traditional/Biodynamics of Osteopathy in the Cranial Field. Osteopathic approaches of Fascial release, Muscle energy, Counterstrain, Lymphatic mobility, Gentle thrust approaches and other osteopathic procedures are also used as indicated. Dr. Spector considers Cranial Osteopathy to be the most refined method of Osteopathic Manual Medicine, requiring greater knowledge, palpatory skills and expertise, and working with a very specific, refined and powerful mechanism in the body, yielding effective systemic results.

Cranial Osteopathy, also referred to as Osteopathic Cranial Manipulative Medicine (OCMM), is an expansion of the general principles of osteopathy, with a system of diagnosis and treatment of the body by an osteopathic physician using the primary respiratory mechanism and balanced membranous tension. It includes a special understanding of the nervous system. This primary respiratory mechanism was first discovered and identified in the cranium (head) by Dr. William G. Sutherland, an osteopathic physician, in the 1930’s. He then realized this movement occurs in every cell and tissue of the body. The osteopathic concept of the existence and function of primary respiration was then expanded to include the whole body, and this is how cranial osteopathy is practiced today. DO’s who wish to practice Cranial Osteopathy train extensively through post-graduate studies.  Dr. Spector is an active senior faculty member of the Osteopathic Cranial Academy, teaching physicians, medical students and dentists Osteopathy in the Cranial Field since 1991.

Physicians who practice Cranial Osteopathy recognize that primary respiration guides the function of every cell of the body. The Primary Respiratory Mechanism is not restricted to the cranium, spinal cord, dura and sacrum. Osteopathic physicians do not separate the body into individual parts, but treat the body as a whole. When working on any one part, the physician is in contact with all parts. So when you hear the term “Cranial Osteopathy”, realize that although an osteopathic physician practicing cranial osteopathy has a very particular expertise in treating problems and injuries involving the cranium, this type of treatment is not restricted to treating only the cranium, but indeed involves treating the whole body. For this reason, the depth of knowledge acquired with a comprehensive medical education is essential when treating with Cranial Osteopathy.

Primary respiration is an involuntary type of movement that exists in every cell and tissue.  It is a type of rhythmic, alternating expansion and contraction that orchestrates our beginning development as an embryo and continues to guide functioning as long as we live.  It can be engaged to begin a therapeutic process and help restore more normal functioning, especially when we have experienced some trauma or illness and have trouble recovering.

One of the reasons Dr. Spector’s treatments are so gentle is that her hands are helping the patient’s Primary Respiratory Mechanism to do much of the work.  So she does not need to push and prod and force things to change.  This remarkable way of utilizing the body’s inherent forces has a track record of often producing remarkable results.

It is important to know that Cranial Osteopathy is NOT the same as “Craniosacral Therapy”, differing in training, principles and in practice. Craniosacral Therapy is a system of simple techniques usually taught to non-physicians such as massage therapists or physical therapists, requiring minimal to no previous education or training. 

(see  http://cranialacademy.org/patients/faq/ for more details).

Dr. Sutherland and Osteopathy in the Cranial Field

William Garner Sutherland, DO (1873-1954), discovered, developed and taught Cranial Osteopathy in the early to mid-1900s. Dr. Sutherland referred to his discovery as “Osteopathy in the Cranial Field” (OCF). He never failed to emphasize that the Cranial Concept was only an extension of, not separate from, Dr. Still's science of osteopathy. Dr. Sutherland was the first to perceive a subtle palpable movement within the bones of the cranium. He went on to discover the continuity of this rhythmic fluid movement throughout all tissues of the body. While a student at the American School of Osteopathy in 1899, Dr. Sutherland pondered the fine details of a separated or “disarticulated” skull. He wondered about the function of this complex architecture. Dr. Still taught that every structure exists because it performs a particular function. While looking at a temporal bone, a flash of inspiration struck Dr. Sutherland: “Beveled like the gills of a fish, indicating respiratory motion for an articular mechanism.”

Anatomy textbooks stated that the cranial sutures were fused and unable to move in adulthood. Dr. Sutherland thought his inspiration to be absurd and resisted the notion that the skull bones could move. This idea consumed him and became the motivation for his singular, detailed and prolonged study of skulls, and experimentation upon his own head. Over many years of intense study, Dr. Sutherland came to discover a previously unrecognized phenomenon. The anatomy had been described by others, but it took the unique genius of Dr. Sutherland to put it all together. He named his discovery “The Primary Respiratory Mechanism” and recognized this phenomenon as life's purest and most vital expression. As data is gathered throughout the medical and scientific disciplines, the fundamental genius of Dr. Sutherland's observations becomes ever more validated. In time, this Cranial Concept may become regarded as one of the most important discoveries in human physiology.

The Primary Respiratory Mechanism

PRIMARY RESPIRATION is a normal, inherent, involuntary physiological mechanism that exists in ALL parts of the body, and relates to the health or stagnation of health in the area.

In his own unique and very elegant style, Dr. Sutherland had identified the same self-healing mechanism discovered by Dr. Still. He named this collection of findings the Primary Respiratory Mechanism:

Primary - It is a system that comes “first.” It underlies all of life's processes and gives dynamism, form and substance to all of anatomy and physiology, driving all functions of the body.

Respiratory - It is the spark that gives rise to the breath as it moves through the tissues. It is the foundation of metabolism. It enables the exchange of gases and other substances between compartments of the body.

Mechanism - It manifests as a specific motion of the body, a system composed of many parts that work together to create a whole, greater than the sum of the parts.

The Primary Respiratory Mechanism has five basic components:

1.  The inherent rhythmic motion of the brain and spinal cord.

2.  The fluctuation of the cerebrospinal fluid (CSF) that bathes and nourishes the brain and spinal cord.

3.  The shifting tensions of the membranous envelope (dura mater) surrounding the brain and spinal cord. This entire membranous structure acts as a unit and is called a "Reciprocal Tension Membrane."

4.  The inherent rhythmic motion of the cranial bones.

5.  The involuntary motion of the sacrum (tailbone) between the ilia (pelvic bones).

As the lungs breathe and the heart beats with a rhythmic alternating expansion and contraction, the central nervous system (CNS) also has its own involuntary rhythmic motion of expansion and contraction. Dr. Sutherland described this inherent activity of the CNS as a respiratory motion with “inhalation” and “exhalation” phases. The hands of a skilled osteopathic physician connect directly with the primary respiratory mechanism to bring about a therapeutic response. Primary respiration is the guiding principle; it is the inherent intelligence within. This Primary Respiratory Motion actually expresses itself through every cell of the body, influencing all body functions. Physicians trained in Cranial Osteopathy can place their hands on any part of the patient to perceive and influence this important mechanism.

"Osteopathy is a science with possibilities as great as the magnitude of the heavens. It is a science dealing with the natural forces of the body. We work as osteopaths with the traditional principle in mind that the tendency in the patient’s body is always toward the normal. There is much to discover in the science of osteopathy by working with the forces within that manifest the healing processes. These forces within the patient are greater than any blind force that can safely be brought to bear from without."               

                                                                                    ~ William Garner Sutherland, DO

“There is no way you can make the…cranial and sacral mechanism a separate entity from the total body physiology…

Every single time we touch that patient, whether we choose to do it in relation to one tiny joint in the finger or whether we grab a hold of a whole leg, we have to start tuning into this involuntary, physiological mechanism…

Every single individual cell residing within the fluids in which it is being made, is being flexed and extended, externally and internally rotated 8 to 12 times a minute.”

                                                                                                ~ Rollin Becker, DO