How to Train an Osteopath

Tensegrity Sculpture in Downtown Denver

Today I finished teaching for the semester at the Rocky Vista Osteopathic Medical school where I’m an Assistant Professor. I teach first-year medical students and the final exam is a pass fail test called “competency testing” where they diagnose and treat each other while the other faculty and I observe. For the students, it’s a nerve racking experience. For me, it’s an osteopathic marathon. 

Many of you see students in the clinic. You may wonder who they are and how they got there. Perhaps you are not sure what really makes D.O.s different from M.D.s, especially if you have not had an osteopathic treatment. So here’s a little story on how an Osteopath is born. 

First, we take a bright college student who took a lot of tests and did well enough to get into medical school. Then we teach them how to feel and think. 

Here’s what we taught the students at Rocky Vista in their first year in the department of Osteopathic Principles and Practice: 

1. How to feel
   First we teach students how to feel the layers of the body. To represent different tissues we use corn starch and plastic wrap between layers of sheets. By the end of their first lab, the students can feel the difference between the vein, artery and nerve next to each other in the crease of a partner’s elbow. 
2. Functional anatomy
   Typically in med school we learn origin and insertions of all muscles, ligaments, tendons and then name nerves, veins, arteries and bones galore. The founder of Osteopathic Medicine, A.T. Still, D.O., said the three legged stool of Osteopathy is “anatomy anatomy anatomy”. This year, before the students had their traditional anatomy dissection class, we started teaching functional movement-based anatomy. Instead of focusing on how the hip bone connects to the knee bone, we asked students to think: what muscles would need to fire (and which you’d need to relax) to complete the action of pulling your knee to touch your nose? 
3. Techniques
   We group treatments into direct and indirect techniques. For example, imagine a patient who woke up in the morning with a kink in her neck and she can’t look over your left shoulder without excruciating pain. In a direct technique you as the doctor asks the patient to turn your her right to the edge where it is sensitive but not too painful. From there you either help the patient stretch through that pain barrier little by little with the right muscles (using the “muscle energy” technique), or you have her quickly move through the barrier with a specific vector to help the misalignment re-align (we call that the “high velocity low amplitude” technique - this is the one that you may be familiar with from chiropractic). Indirect techniques go into the “direction of ease”, one of my favorite concepts in Osteopathic medicine. In the example, you would move your neck all the way to the right, the way it likes to go, and relax completely. Magically (or so it seems—it’s actually related to muscle, brain and nerve physiology) this slowly allows the tight muscles and fascial on the left to reset and the barrier transforms. Indirect techniques we taught this year are termed counter strain or myofascial release techniques.  
4. Tensegrity
   This is a concept I taught this past month. It comes from architecture and engineering and has been applied to biological systems by Donald Ingber MD, PhD and other scientists. This is a concept that illustrates the amazing connectivity of our bodies. It’s not just a saying that we are all connected—it’s actually true! By observing the cellular cytoskeleton that defines a cell’s internal structure, we see that chemical conduction and gene expression itself can be influenced by the environment that surrounds. Translate that to the continuous tension and discontinuous compression systems of the body between fascia, bones and ligaments and suddenly the impact of a sprained ankle on the downstream effect of shoulder pain makes sense. 

Today, after ten short months in the classroom, the students amazed me. Competency testing can be challenging for the students who internalize the idea that they must be perfect at everything (like I did in med school) or for the ones that blow off true osteopathy. But under the layers of nerves were students who were really feeling and changing the physiology of their classmates. Bones moved, ligaments relaxed, muscles that were too tight let go. Next year the students will learn advanced techniques and start treating more and more clinically. This year we helped them to build a foundation. 

It’s true, only about 20% of the students will graduate as Osteopaths and go on to use the manual skills they have learned. But in their 4th year I can tell they still have their placatory skills. I know they will be better surgeons because they can feel still feel fascia and understand functional anatomy. They ask deep questions when taking a medical history because they understand that looking at the whole person is part of what our founder, A.T. Still D.O., called “a rational approach to treatment”.

I wish more of our Doctors of Osteopathy (D.O.s) could keep these skills honed through training and clinical practice. It is a clinical skill like any other that some are innately good at and others have to practice a lot to do well. I wish our medical system fostered the students to keep looking at the body this way. That is why you see students in our office on rotation. We want to teach them to look at people always as a good doctor will and see not just body - but mind and spirit. Dr Lisa is my “adopted D.O.” colleague—and friend—because she sees the whole person in context of their life. She considers stress, nutrition and exercise in her approach. A Doctor certainly doesn’t need to be a D.O. to think holistically. ​

Thanks for being a part of teaching every day you let a medical student tag along with your visit. You can always say “no, not today”. When it is ok to say yes, know that you are part of shaping a future Osteopath who might one day write a blog that incorporates all of our tenets without even realizing it until the end. It was the tenets of Osteopathic Medicine that attracted me to the profession when I was 19. Nearly 20 years later I believe in Osteopathy even more than ever.  Congratulations future Osteopaths of 2021. Welcome to second year.

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The Tenets of Osteopathic Medicine

The Tenets of Osteopathic Medicine express the underlying philosophy of osteopathic medicine and were approved by the AOA House of Delegates as policy.​

1. The body is a unit; the person is a unit of body, mind, and spirit.
2. The body is capable of self-regulation, self-healing, and health maintenance.
3. Structure and function are reciprocally interrelated.
4. Rational treatment is based upon an understanding of the basic principles of body unity, self-regulation, and the interrelationship of structure and function.