View source for Unsolved:Osteopathy

{{Short description|Alternative medicine emphasizing muscle and bone manipulation}}
{{Infobox alternative interventions
|  Name        = Osteopathy
|  synonyms    = 
|  Image       = Osteopathy Complete (1898) (14756710206).jpg
|  Caption     = OMT technique for the treatment of impotence in the 1898 ''Osteopathy Complete'' manual
|  ICD10       = {{ICD10PCS|7|7}}
|  ICD9        = {{ICD9proc|93.6}}
|  MeshID      = D026301
|  OPS301      = 
|  OtherCodes  = 
|  HCPCSlevel2 = 
}}

'''Osteopathy''' ({{ety|grc|''{{wikt-lang|grc|ὀστέον}}'' ({{grc-transl|ὀστέον}})|bone||''{{wikt-lang|grc|πάθος}}'' ({{grc-transl|πάθος}})|pain, suffering}}) is a pseudoscientific system of [[Medicine:Alternative medicine|alternative medicine]] that emphasizes physical manipulation of the body's [[Biology:Muscle tissue|muscle tissue]] and [[Biology:Bone|bone]]s.<ref name=SBM>{{cite web |url=https://sciencebasedmedicine.org/osteopathy-in-the-nicu-false-claims-and-false-dichotomies/ |title=Osteopathy in the NICU: False Claims and False Dichotomies |last=Snyder |first=John |year=2014 |access-date=28 March 2017 |quote=So other than a lower admissions standard and the focus on a pseudoscientific belief system, there is no difference between the two educational systems. So why should this two-tiered system even exist? It is time to rid ourselves of this pre-scientific, dual system of medical education.}}</ref><ref name=NYULangoneOMT>{{cite web |url=http://www.med.nyu.edu/content?ChunkIID=37409 |title=Osteopathic Manipulative Treatment |publisher=NYU Langone Medical Center |date=23 July 2012 |access-date=5 September 2012 |archive-url=https://web.archive.org/web/20141029115032/http://www.med.nyu.edu/content?ChunkIID=37409 |archive-date=29 October 2014 |url-status=dead}}</ref> In most countries, practitioners of osteopathy are not medically trained and are referred to as '''osteopaths'''.<ref>{{cite web |url=http://www.do-online.org/TheDO/wp-content/uploads/2010/08/Resolution301_A2010_FinalVersion.pdf |title=House of Delegates Resolution H-301 – RE: H229-A/05 Osteopath & Osteopathy – Use of the Terms |access-date=28 February 2011 |archive-url=https://web.archive.org/web/20160320141015/http://www.osteopathic.org/Pages/default.aspx |archive-date=20 March 2016 |url-status=dead}}</ref><ref>{{cite web|url=http://www.do-online.org/TheDO/?p=26191 |last1=Crosby |first1=J. |title=Promoting DOs: Words and medium change, but message stays the same |work=DO Magazine |date=3 September 2010 |archive-url=https://web.archive.org/web/20131012035325/http://www.do-online.org/TheDO/?p=26191 |archive-date=12 October 2013 |url-status=dead}}</ref><ref>{{cite web |url=http://www.osteopathic.org/inside-aoa/news-and-publications/media-center/Pages/osteopathic-style-guide.aspx |title=Style Guide for Reporting on Osteopathic Medicine |publisher=American Osteopathic Association |access-date=17 December 2012 |archive-url=https://web.archive.org/web/20130514135333/http://www.osteopathic.org/inside-aoa/news-and-publications/media-center/Pages/osteopathic-style-guide.aspx |archive-date=14 May 2013 |url-status=dead}}</ref>

'''Osteopathic manipulation''' is the core set of techniques in osteopathy.<ref name=paradox/> Parts of osteopathy, such as [[Unsolved:Craniosacral therapy|craniosacral therapy]], have been described by [[Organization:Quackwatch|Quackwatch]] as having no therapeutic value and have been labeled by them as [[Unsolved:Pseudoscience|pseudoscience]] and [[Philosophy:Quackery|quackery]].<ref>{{cite web |url=http://www.quackwatch.org/04ConsumerEducation/QA/osteo.html |title=Dubious Aspects of Osteopathy| website=quackwatch.org |access-date=29 October 2016}}</ref><ref>{{cite web |url=http://www.quackwatch.com/01QuackeryRelatedTopics/cranial.html |title=Why Cranial Therapy Is Silly |website=quackwatch.com |date=15 May 2004 |access-date=29 October 2016}}</ref> The techniques are based on an ideology created by Andrew Taylor Still (1828–1917) which posits the existence of a "myofascial continuity"—a tissue layer that "links every part of the body with every other part". Osteopaths attempt to diagnose and treat what was originally called "the osteopathic lesion", but which is now named "somatic dysfunction",<ref name=paradox/> by manipulating a person's bones and muscles. Osteopathic Manipulative Treatment (OMT) techniques are most commonly used to treat back pain and other musculoskeletal issues.<ref name=paradox>{{cite journal |doi=10.1056/NEJM199911043411910 |title=The Paradox of Osteopathy |year=1999 |last1=Howell |first1=Joel D. |journal=New England Journal of Medicine |volume=341 |issue=19 |pages=1465–8 |pmid=10547412}}</ref>{{primary source inline|date=October 2016}}<ref name=back-pain>{{cite book |vauthors=Vincent C, Furnham A |url=https://books.google.com/books?id=Q_UnQNQPJ60C&pg=PA15 |year=1997 |publisher={{wipe|John Wiley & Sons}} |isbn=978-0-471-96645-6 |page=15 |title=Manipulative Therapies: Osteopathy and Chiropractic}}</ref>

Osteopathic manipulation is still included in the curricula of osteopathic physicians or Doctors of Osteopathic Medicine (DO) training in the US. The [[Medicine:Doctor of Osteopathic Medicine|Doctor of Osteopathic Medicine]] degree, however, became a medical degree and is no longer a degree of non-medical osteopathy.

==History==
[[File:Andrew Taylor Still 1914.jpg|right|thumb|upright=0.9|Andrew Taylor Still in 1914|alt=Monochrome photograph of Andrew Taylor Still in 1914]]

The practice of osteopathy began in the United States in 1874. Osteopathy was founded by Andrew Taylor Still, a 19th-century American physician (MD), Civil War surgeon, and Kansas territorial and state legislator.<ref>{{cite web |url=http://cdm.sos.mo.gov/cdm4/document.php?CISOROOT=/atsu&CISOPTR=693&REC=1 |title=''Medical Registration for Macon County, MO as of March 27, 1874'', Missouri Digital Heritage, Secretary of State of Missouri |access-date=13 November 2011 |archive-url=https://web.archive.org/web/20131029230519/http://cdm.sos.mo.gov/cdm4/document.php?CISOROOT=%2Fatsu&CISOPTR=693&REC=1|archive-date=29 October 2013 |url-status=dead}}</ref><ref>{{cite web |url=http://cdm.sos.mo.gov/cdm4/item_viewer.php?CISOROOT=/atsu&CISOPTR=759&CISOBOX=1&REC=2 |title=Medical registration for Adair County, MO dated 28 July 1883 |publisher=Missouri Digital Heritage, Secretary of State of Missouri |access-date=27 April 2020 |archive-url=https://web.archive.org/web/20131029225308/http://cdm.sos.mo.gov/cdm4/item_viewer.php?CISOROOT=%2Fatsu&CISOPTR=759&CISOBOX=1&REC=2 |archive-date=29 October 2013 |url-status=dead}}</ref><ref>{{cite web |url=http://cdm.sos.mo.gov/cdm4/document.php?CISOROOT=/atsu&CISOPTR=685&REC=2 |title=''Six Survivors of First Free State Legislature in Kansas, Topeka Daily Capital'', Missouri's Digital Heritage, Secretary of State of Missouri |publisher=Cdm.sos.mo.gov |access-date=13 November 2011 |archive-url=https://archive.today/20120708032727/http://cdm.sos.mo.gov/cdm4/document.php?CISOROOT=/atsu&CISOPTR=685&REC=2 |archive-date=8 July 2012 |url-status=dead}}</ref><ref>{{cite web|url=http://cdm.sos.mo.gov/cdm4/document.php?CISOROOT=/atsu&CISOPTR=670&REC=1 |title=Charles E. Still (son) – Letters to Edith Mellor, DO. Missouri's Digital Heritage, Secretary of State of Missouri |publisher=Cdm.sos.mo.gov |access-date=13 November 2011 |archive-url=https://archive.today/20120707144304/http://cdm.sos.mo.gov/cdm4/document.php?CISOROOT=/atsu&CISOPTR=670&REC=1 |archive-date=7 July 2012 |url-status=dead}}</ref> He lived near Baldwin City, Kansas, during the American Civil War and it was there that he founded the practice of osteopathy.<ref>{{cite web |url=http://www.lasr.net/pages/city.php?Baldwin%20City&Kansas&City_ID=KS0301001&VA=Y&Attraction_ID=KS0301001a017 |title=Baldwin City, Kansas |quote=Among Free State leaders was Andrew T. Still, founder of osteopathy, whose theory of healing developed here.}}</ref> Still claimed that human illness was rooted in problems with the musculoskeletal system, and that osteopathic manipulations could solve these problems by harnessing the body's own self-repairing potential.<ref name=ident>{{cite journal |pmid=10179479 |year=1998 |last1=Guglielmo |first1=WJ |title=Are D.O.s losing their unique identity? |volume=75 |issue=8 |pages=200–2, 207–10, 213–4 |journal=Medical Economics}}</ref> Still's patients were forbidden from treatment by conventional medicine, as well as from other practices such as drinking alcohol.<ref name=paradox /> These practices derive from the belief, common in the early 19th century among proponents of [[Medicine:Alternative medicine|alternative medicine]], that the body's natural state tends toward health and inherently contains the capacity to battle any illness.<ref name=":0">{{Cite book |title=Osteopathic Athletic Health Care |last=McKone |first=W. Llewellyn |date=1 January 1997 |publisher=Springer US |isbn=978-0-412-59090-0|pages=1–9 |language=en |doi=10.1007/978-1-4899-3067-5_1 |chapter=History of osteopathy}}</ref> This was opposed to orthodox practitioners, who held that intervention by a physician was necessary to restore health in the patient. Still established the basis for osteopathy, and the division between alternative medicine and traditional medicine had already been a major conflict for decades.<ref>{{Cite book |title=Nature Cures: The History of Alternative Medicine in America |last=Whorton |first=James C. |publisher=[[Organization:Oxford University Press|Oxford University Press]], Inc |year=2002 |isbn=978-0-19-514071-2 |location=New York |pages=[https://archive.org/details/naturecureshisto00whor/page/8 8] |url=https://archive.org/details/naturecureshisto00whor/page/8}}</ref>

The foundations of this divergence may be traced back to the mid-18th century when advances in [[Biology:Physiology|physiology]] began to localize the causes and nature of diseases to specific organs and tissues. Doctors began shifting their focus from the patient to the internal state of the body, resulting in an issue labeled as the problem of the "vanishing patient".<ref name=":1">{{Cite book |title=Nature Cures: The History of Alternative Medicine in America |last=Whorton |first=James C. |publisher=[[Organization:Oxford University Press|Oxford University Press]] |year=2002 |isbn=978-0-19-514071-2 |location=New York |pages=[https://archive.org/details/naturecureshisto00whor/page/15 15] |url=https://archive.org/details/naturecureshisto00whor/page/15}}</ref> A stronger movement towards experimental and scientific medicine was then developed. In the perspective of the DO physicians, the sympathy and holism that were integral to medicine in the past were left behind. Heroic medicine became the convention for treating patients, with aggressive practices like [[Unsolved:Bloodletting|bloodletting]] and prescribing chemicals such as mercury, becoming the forefront in therapeutics.<ref>{{Cite book |title=Nature Cures: The History of Alternative Medicine in America |last=Whorton |first=James C. |publisher=[[Organization:Oxford University Press|Oxford University Press]] |year=2002 |isbn=978-0-19-514071-2 |location=New York |pages=[https://archive.org/details/naturecureshisto00whor/page/4 4] |url=https://archive.org/details/naturecureshisto00whor/page/4}}</ref> Alternative medicine had its beginnings in the early 19th century, when gentler practices in comparison to heroic medicine began to emerge. As each side sought to defend its practice, a schism began to present itself in the medical marketplace, with both practitioners attempting to discredit the other. The osteopathic physicians—those who are now referred to as DO's—argued that the non-osteopathic physicians had an overly mechanistic approach to treating patients, treated the symptoms of disease instead of the original causes, and were blind to the harm they were causing their patients. Other practitioners had a similar argument, labeling osteopathic medicine as unfounded, passive, and dangerous to a disease-afflicted patient.<ref>{{Cite book |title=Natures Cures:The History of Alternative Medicine in America |last=Whorton |first=James C. |publisher=[[Organization:Oxford University Press|Oxford University Press]] |year=2002 |isbn=978-0-19-514071-2 |location=New York |pages=[https://archive.org/details/naturecureshisto00whor/page/18 18] |url=https://archive.org/details/naturecureshisto00whor/page/18}}</ref> This was the medical environment that pervaded throughout the 19th century, and the setting Still entered when he began developing his idea of osteopathy.

After experiencing the loss of his wife and three daughters to spinal meningitis and noting that the current orthodox medical system could not save them, Still may have been prompted to shape his reformist attitudes towards conventional medicine.<ref name=":2" /> Still set out to reform the orthodox medical scene and establish a practice that did not so readily resort to drugs, purgatives, and harshly invasive therapeutics to treat a person suffering from ailment,<ref name=":0" /> similar to the mindset of the irregulars in the early 19th century. Thought to have been influenced by spiritualist figures such as Andrew Jackson Davis and ideas of magnetic and electrical healing, Still began practicing manipulative procedures that intended to restore harmony in the body.<ref name=":2">{{Cite journal |last=Gevitz |first=Norman |date=1 January 2014 |title=A Degree of Difference: The Origins of Osteopathy and First Use of the "DO" Designation |journal=The Journal of the American Osteopathic Association |volume=114 |issue=1 |pages=30–40 |doi=10.7556/jaoa.2014.005 |pmid=24384971 |issn=0098-6151 |doi-access=free}}</ref> Over the course of the next twenty five years, Still attracted support for his medical philosophy that disapproved of orthodox medicine, and shaped his philosophy for osteopathy. Components included the idea that structure and function are interrelated and the importance of each piece of the body in the harmonious function of its whole.

Still sought to establish a new medical school that could produce physicians trained under this philosophy, and be prepared to compete against the orthodox physicians. He established the American School of Osteopathy on 20 May 1892, in Kirksville, Missouri, with twenty-one students in the first class.<ref>{{Cite book |last=Peter |first=Wagner |date=11 April 2011 |title=History of Osteopathy |publisher=William E. Laupus Health Sciences Library and the East Carolina University Department of Bioethics & Interdisciplinary Studies |hdl=10342/3694 |url=http://hdl.handle.net/10342/3694}}</ref> Still described the foundations of osteopathy in his book "The Philosophy and Mechanical Principles of Osteopathy" in 1892.<ref>{{Cite book |url=https://archive.org/details/philosophymechan00stil |title=The philosophy and mechanical principles of osteopathy (full text) |first=Andrew Taylor |last=Still |place=Kansas City, Mo. |publisher=Hudson-Kimberly Pub. Co. |year=1892}} This edition 1902; copyright 1892. Chapters: Preface; Introduction; I. Important Studies; II. Some Substances of the Body; III. Divisions of the Body; IV. Head, Face, and Scalp; Chapter V. The Neck; VI. The Thorax; VII. The Diaphragm; VIII. The Abdomen; IX. The Pelvis; X. Fevers; XI. Biogen; XII. Smallpox; XIII. Obesity; XIV. Ear-Wax and Its Uses; XV. Convulsions; XVI. Obstetrics. Link to read online, or download in many formats.</ref> He named his new school of medicine "osteopathy", reasoning that "the bone, [[Biology:Osteon|osteon]], was the starting point from which [he] was to ascertain the cause of pathological conditions".<ref>{{cite web |url=http://www.meridianinstitute.com/eamt/files/webster1/webcont.html#HOW%20I%20CAME%20TO%20ORIGINATE%20OSTEOPATHY |archive-url=https://web.archive.org/web/20101205145639/http://meridianinstitute.com/eamt/files/webster1/webcont.html#HOW%20I%20CAME%20TO%20ORIGINATE%20OSTEOPATHY |archive-date=5 December 2010 |website=Early American Manual Therapy |title=Concerning Osteopathy |first=George V. |last=Webster |year=1919 |url-status=dead}}</ref> He would eventually claim that he could "shake a child and stop scarlet fever, croup, diphtheria, and cure whooping cough in three days by a wring of its neck."<ref name="Carroll2015">{{cite web |title=Osteopathy |last=Carroll |first=R.T. |date=27 November 2015 |access-date=28 April 2019 |url=http://skepdic.com/osteopathy.html}}</ref>

When the state of Missouri granted the right to award the MD degree,<ref>{{cite web |url=http://www.nj.gov/highereducation/AGMEC/osteopathic_med_school_accreditation_standards.pdf |title=Commission on Osteopathic College Accreditation |publisher=State of New Jersey |url-status=dead |archive-url=https://web.archive.org/web/20080908041004/http://www.nj.gov/highereducation/AGMEC/osteopathic_med_school_accreditation_standards.pdf |archive-date=8 September 2008}}</ref> he remained dissatisfied with the limitations of conventional medicine and instead chose to retain the distinction of the [[Medicine:Doctor of Osteopathic Medicine|DO degree]].<ref>{{cite web |url=http://history.osteopathic.org/educate.shtml |title=Osteopathic Virtual Museum |access-date=13 November 2011 |url-status=dead |archive-url=https://web.archive.org/web/20120316164329/http://history.osteopathic.org/educate.shtml |archive-date=16 March 2012}}</ref> In the early 20th century, osteopaths across the United States sought to establish law that would legitimize their medical degree to the standard of the modern medic.<ref name="Booth">{{Cite book |url=https://books.google.com/books?id=tO8yAQAAMAAJ&q=legislature&pg=PR9 |title=History of Osteopathy: And Twentieth-century Medical Practice |last=Booth |first=Emmons Rutledge |date=1 January 1905 |publisher=Press of Jennings and Graham |language=en |via=[[Google Books]]}}</ref> The processes were arduous, and not without conflict. In some states, it took years for the bills to be passed. Osteopaths were often ridiculed and in some cases arrested,<ref name="Booth" /> but in each state, osteopaths managed to achieve the legal acknowledgement and action they set out to pursue. In 1898 the American Institute of Osteopathy started the ''Journal of Osteopathy'' and by that time four states recognized osteopathy as a profession.<ref>{{cite journal |title=General Notices |journal=Popular Science Monthly |date=Mar 1898 |page=710 |url=https://www.biodiversitylibrary.org/page/20879097 |access-date=14 May 2013}}</ref>

== Practice ==
[[File:Manuellterapi5.jpg|right|450px|thumb|Osteopathic manipulative treatment (OMT) involves palpation and manipulation of bones, muscles, joints, and fasciae.]]
According to the American Osteopathic Association (AOA), osteopathic manipulative treatment (OMT) is considered to be only one component of osteopathic medicine and may be used alone or in combination with [[Medicine:Pharmacotherapy|pharmacotherapy]], rehabilitation, [[Medicine:Surgery|surgery]], patient education, diet, and exercise. OMT techniques are not necessarily unique to osteopathic medicine; other disciplines, such as [[Medicine:Physical therapy|physical therapy]] or [[Unsolved:Chiropractic|chiropractic]], use similar techniques.<ref name="aacom1">{{cite web |url=http://www.aacom.org/about/osteomed/Pages/default.aspx |title=What Is Osteopathic Medicine? |publisher=Aacom.org |access-date=24 May 2012}}</ref> Indeed, many DOs do not practice OMT at all, and over time DOs in general practice less and less OMT and instead apply the common medical treatments.<ref name="pmid16585378">{{cite journal |vauthors=Gevitz N |title=Center or periphery? The future of osteopathic principles and practices |journal=J Am Osteopath Assoc |volume=106 |issue=3 |pages=122–123 |date=March 2006 |pmid=16585378 |url=https://www.aacom.org/docs/default-source/hpf-2018/2017-09_seminar/center-or-periphery.pdf?sfvrsn=73e42097_0 |format=Free full text}}</ref>

One integral tenet of osteopathy is that problems in the body's anatomy can affect its proper functioning. Another tenet is the body's innate ability to heal itself. Many of osteopathic medicine's manipulative techniques are aimed at reducing or eliminating the impediments to proper structure and function so the self-healing mechanism can assume its role in restoring a person to health.<ref>{{cite web |title=What is Osteopathic Medicine |publisher=American Association of Colleges of Osteopathic Medicine (AACOM) |access-date=17 December 2014 |url=http://www.aacom.org/become-a-doctor/about-om#aboutom}}</ref> Osteopathic medicine defines a concept of health care that embraces the concept of the unity of the living organism's structure (anatomy) and function (physiology). The AOA states that the four major principles of osteopathic medicine are the following:<ref>{{cite web |title=Statement of Healthcare Policies and Principles |url=http://www.osteopathic.org/inside-aoa/advocacy/Documents/aoa-healthpolicy-principles.pdf |publisher=American Osteopathic Association |access-date=1 July 2012 |archive-url=https://web.archive.org/web/20120611122631/http://www.osteopathic.org/inside-aoa/advocacy/Documents/aoa-healthpolicy-principles.pdf |archive-date=11 June 2012 |url-status=dead}}</ref>

# The body is an integrated unit of mind, body, and spirit.
# The body possesses [[Homeostasis|self-regulatory mechanisms]], having the inherent capacity to defend, repair, and remodel itself.
# Structure and function are reciprocally interrelated.
# Rational therapy is based on consideration of the first three principles.

These principles are not held by Doctors of Osteopathic Medicine to be [[Scientific law|empirical law]]s; they serve, rather, as the underpinnings of the osteopathic approach to health and disease.{{citation needed|date=February 2014}}

=== Muscle energy ===
{{Main|Medicine:Muscle energy technique}}
Muscle energy techniques address somatic dysfunction through stretching and muscle contraction. For example, if a person is unable to fully abduct her arm, the treating physician raises the patient's arm near the end of the patient's range of motion, also called the edge of the restrictive barrier. The patient then tries to lower her arm, while the physician provides resistance. This resistance against the patient's motion allows for [[Biology:Muscle contraction|isotonic contraction]] of the patient's muscle. Once the patient relaxes, her range of motion increases slightly. The repetition of alternating cycles of contraction and subsequent relaxation help the treated muscle improve its range of motion.<ref name=DiGiovanna_83>{{Harvnb|DiGiovanna|Schiowitz|Dowling|2005|pp=83–5}}</ref> Muscle energy techniques are contraindicated in patients with fractures, [[Medicine:Crush injury|crush injuries]], joint dislocations, joint instability, severe muscle spasms or strains, severe [[Medicine:Osteoporosis|osteoporosis]], severe whiplash injury, [[Medicine:Vertebrobasilar insufficiency|vertebrobasilar insufficiency]], severe illness, and recent surgery.

=== Counterstrain ===
{{Main|Medicine:Counterstrain}}
Counterstrain is a system of diagnosis and treatment that considers the physical dysfunction to be a continuing, inappropriate strain [[Biology:Reflex|reflex]], which is inhibited during treatment by applying a position of mild strain in the direction exactly opposite to that of the reflex.<ref name=DiGiovanna_86>{{Harvnb|DiGiovanna|Schiowitz|Dowling|2005|pp=86–8}}</ref> After a counterstrain point tender to palpation has been diagnosed,<ref name="Wong2014"/> the identified tender point is treated by the osteopathic physician who, while monitoring the tender point, positions the patient such that the point is no longer tender to palpation.<ref name="counterstrain">{{cite journal |author=Wong CK |title=Strain counterstrain: Current concepts and clinical evidence |date=February 2012 |journal=Manual Therapy |volume=17 |issue=1 |pages=2–8 |pmid=22030379 |doi=10.1016/j.math.2011.10.001}}</ref> This position is held for ninety seconds and the patient is subsequently returned to her normal posture.<ref name="Wong2014">{{cite journal |vauthors=Wong CK, Abraham T, Karimi P, Ow-Wing C |title=Strain counterstrain technique to decrease tender point palpation pain compared to control conditions: A systematic review with meta-analysis |date=April 2014 |journal=Journal of Bodywork and Movement Therapies |volume=18 |issue=2 |pages=165–73 |pmid=24725782 |doi=10.1016/j.jbmt.2013.09.010 |type=Systematic review and meta-analysis}}</ref> Most often this position of ease is usually achieved by shortening the muscle of interest.<ref name="counterstrain"/> Improvement or resolution of the tenderness at the identified counterstrain point is the desired outcome.<ref name="Wong2014"/> The use of counterstrain technique is contraindicated in patients with severe osteoporosis, pathology of the vertebral arteries, and in patients who are very ill or cannot voluntarily relax during the procedure.

=== High-velocity, low-amplitude ===
High velocity, low amplitude (HVLA) is a technique which employs a rapid, targeted, therapeutic force of brief duration that travels a short distance within the anatomic range of motion of a joint and engages the restrictive barrier in one or more places of motion to elicit release of restriction.<ref name="aacom" /> The use of HVLA is contraindicated in patients with [[Medicine:Down syndrome|Down syndrome]] due to instability of the atlantoaxial joint which may stem from [[Medicine:Ligamentous laxity|ligamentous laxity]], and in pathologic bone conditions such as [[Medicine:Bone fracture|fracture]], history of a [[Medicine:Pathologic fracture|pathologic fracture]], [[Medicine:Osteomyelitis|osteomyelitis]], osteoporosis, and severe cases of [[Medicine:Rheumatoid arthritis|rheumatoid arthritis]].<ref name="Emergency">{{cite journal |first1=Raymond J. |last1=Roberge |first2=Marc R. |last2=Roberge |title=Overcoming Barriers to the Use of Osteopathic Manipulation Techniques in the Emergency Department |journal=Western Journal of Emergency Medicine |pmid=19718381 |pmc=2729220 |url=http://escholarship.org/uc/item/31547932 |volume=10 |issue=3 |year=2009 |pages=184–9}}</ref>{{sfn|Savarese|Copabianco|Cox|2009|p=146}} HVLA is also contraindicated in patients with [[Medicine:Vascular disease|vascular disease]] such as [[Medicine:Aneurysm|aneurysm]]s, or disease of the carotid arteries or vertebral arteries.<ref name="Emergency"/> People taking [[Chemistry:Ciprofloxacin|ciprofloxacin]] or [[Medicine:Anticoagulant|anticoagulant]]s, or who have local [[Medicine:Metastasis|metastases]] should not receive HVLA.<ref name="Emergency"/>

=== Myofascial release ===
{{Main|Medicine:Myofascial release}}
''Myofascial release'' is a form of alternative treatment. The practitioners claim to treat skeletal muscle immobility and pain by relaxing contracted muscles. Palpatory feedback by the practitioner is said to be an integral part to achieving a release of myofascial tissues,<ref name="aacom">{{cite web |title=Glossary of Osteopathic Terminology, November 2011 Edition |url=http://www.aacom.org/resources/bookstore/Pages/glossary.aspx |publisher=[[Organization:American Association of Colleges of Osteopathic Medicine|AACOM]] |pages=30–31 |access-date=1 July 2012 |archive-url=https://web.archive.org/web/20120721233437/http://www.aacom.org/resources/bookstore/Pages/glossary.aspx |archive-date=21 July 2012 |url-status=dead}}</ref> accomplished by relaxing contracted muscles, increasing circulation and lymphatic drainage, and stimulating the [[Biology:Stretch reflex|stretch reflex]] of muscles and overlying fascia.<ref name=DiGiovanna_80>{{Harvnb|DiGiovanna|Schiowitz|Dowling|2005|p=80}}</ref>

Practitioners who perform myofascial release consider the fascia and its corresponding muscle to be the main targets of their procedure, but assert that other tissue may be affected as well, including other connective tissue.<ref name=DiGiovanna_80 /> Fascia is the [[Physics:Soft tissue|soft tissue]] component of the connective tissue that provides support and protection for most structures within the human body, including [[Biology:Muscle|muscle]]. This soft tissue can become restricted due to [[Medicine:Psychogenic disease|psychogenic disease]], overuse, trauma, infectious agents, or inactivity, often resulting in pain, muscle tension, and corresponding [[Medicine:Ischemia|diminished blood flow]].{{sfn|DiGiovanna|Schiowitz|Dowling|2005|pp=80–1}}

Some osteopaths search for small lumps of tissue, called "Chapman release points" as part of their diagnostic procedure.<ref>{{cite book |last1=Chila |first1=Anthony G. |title=Foundations of Osteopathic Medicine |date=2010 |publisher=Lippincott Williams & Wilkins |isbn=9780781766715 |page=568 |url=https://books.google.com/books?id=_ZR6elRmQKEC&pg=PA568 |language=en |via=[[Google Books]]}}</ref>

=== Lymphatic pump treatment ===
{{main|Unsolved:Lymphatic pump}}
Lymphatic pump treatment (LPT) is a manual technique intended to encourage [[Biology:Lymph|lymph]] flow in a person's [[Biology:Lymphatic system|lymphatic system]].<ref>{{Cite journal |last1=Pierce-Talsma |first1=Stacey |last2=Cuny |first2=Lee Ann |last3=Franzini |first3=Danielle |date=1 July 2018 |title=Osteopathic Lymphatic Pump Techniques |journal=The Journal of the American Osteopathic Association |language=en |volume=118 |issue=7 |pages=e43–e44 |doi=10.7556/jaoa.2018.112 |pmid=29946678 |issn=0098-6151 |doi-access=free}}</ref> The first modern lymphatic pump technique was developed in 1920, although osteopathic physicians used various forms of lymphatic techniques as early as the late 19th century.<ref name=Origins_Lymphatics>{{cite journal |first1=Bruno J. |last1=Chikly |title=Manual Techniques Addressing the Lymphatic System: Origins and Development |journal=The Journal of the American Osteopathic Association |pmid=16314678 |url=http://www.jaoa.org/cgi/pmidlookup?view=long&pmid=16314678 |year=2005 |volume=105 |issue=10 |pages=457–64}}</ref>

Relative contraindications for the use of lymphatic pump treatments include fractures, [[Medicine:Abscess|abscess]]es or localized infections, and severe bacterial infections with [[Medicine:Fever|body temperature elevated]] higher than {{Convert|102|F|C}}.{{sfn|Savarese|Copabianco|Cox|2009|p=126}}

== Effectiveness ==
A 2005 Cochrane review of osteopathic manipulative treatment (OMT) in asthma treatment concluded that there was insufficient evidence that OMT can be used to treat asthma.<ref>{{Cite journal |doi=10.1002/14651858.CD001002.pub2 |title=Manual therapy for asthma |journal=Cochrane Database of Systematic Reviews |year=2005 |last1=Hondras |first1=Maria A. |last2=Linde |first2=Klaus |last3=Jones |first3=Arthur P. |editor1-last=Hondras |editor1-first=Maria A. |pmid=15846609 |issue=2 |pages=CD001002}}</ref>

In 2013, a [[Organization:Cochrane (organisation)|Cochrane review]] reviewed six randomized controlled trials which investigated the effect of four types of chest physiotherapy (including OMT) as adjunctive treatments for pneumonia in adults and concluded that "based on current limited evidence, chest physiotherapy might not be recommended as routine additional treatment for pneumonia in adults." Techniques investigated in the study included paraspinal inhibition, rib raising, and myofascial release. The review found that OMT did not reduce mortality and did not increase cure rate, but that OMT slightly reduced the duration of hospital stay and antibiotic use.<ref>{{Cite journal |last1=Chen |first1=Xiaomei |last2=Jiang |first2=Jiaojiao |last3=Wang |first3=Renjie |last4=Fu |first4=Hongbo |last5=Lu |first5=Jing |last6=Yang |first6=Ming |date=6 September 2022 |title=Chest physiotherapy for pneumonia in adults |journal=The Cochrane Database of Systematic Reviews |volume=2022 |issue=9 |pages=CD006338 |doi=10.1002/14651858.CD006338.pub4 |issn=1469-493X |pmc=9447368 |pmid=36066373}}</ref> A 2013 systematic review of the use of OMT for treating pediatric conditions concluded that its effectiveness was unproven.<ref name=ernst-sr>{{cite journal |doi=10.1542/peds.2012-3959 |title=Osteopathic Manipulative Treatment for Pediatric Conditions: A Systematic Review |year=2013 |last1=Posadzki |first1=P. |last2=Lee |first2=M. S. |last3=Ernst |first3=E. |journal=Pediatrics |volume=132 |pages=140–52 |pmid=23776117 |issue=1 |s2cid=5112754}}</ref>

In 2014, a [[Systematic review|systematic review]] and [[Meta-analysis|meta-analysis]] of 15 randomized controlled trials found [[Medicine:Evidence-based medicine#Levels of evidence|moderate-quality evidence]] that OMT reduces pain and improves functional status in acute and chronic nonspecific low back pain.<ref name="Franke2014">{{Cite journal |vauthors=Franke H, Franke JD, Fryer G |title=Osteopathic manipulative treatment for nonspecific low back pain: a systematic review and meta-analysis |journal=BMC Musculoskeletal Disorders |volume=15 |issue=1 |page=286 |date=August 2014 |pmid=25175885 |pmc=4159549 |doi=10.1186/1471-2474-15-286 |type=Systematic review & meta-analysis |doi-access=free}}</ref> The same analysis also found moderate-quality evidence for pain reduction for nonspecific low back pain in [[Medicine:Postpartum period|postpartum women]] and low-quality evidence for pain reduction in nonspecific low back pain in [[Medicine:Pregnancy#Signs and symptoms|pregnant women]].<ref name="Franke2014" /> A 2013 systematic review found insufficient evidence to rate osteopathic manipulation for chronic nonspecific low back pain.<ref name="chronic">{{cite journal |vauthors=Orrock PJ, Myers SP |title=Osteopathic intervention in chronic non-specific low back pain: a systematic review |journal=BMC Musculoskeletal Disorders |volume=14 |page=129 |year=2013 |pmid=23570655 |pmc=3623881 |doi=10.1186/1471-2474-14-129 |type=Systematic review |doi-access=free}}</ref> In 2011, a systematic review found no compelling evidence that osteopathic manipulation was effective for the treatment of musculoskeletal pain.<ref name="musculo-no">{{cite journal |vauthors=Posadzki P, Ernst E |title=Osteopathy for musculoskeletal pain patients: a systematic review of randomized controlled trials |journal=Clinical Rheumatology |volume=30 |issue=2 |pages=285–91 |date=February 2011 |pmid=21053038 |doi=10.1007/s10067-010-1600-6 |s2cid=20517311 |type=Systematic review}}</ref>

A 2018 systematic review found that there is no evidence for the reliability or specific efficacy of the techniques used in visceral osteopathy.<ref>{{Cite journal |doi=10.1186/s12906-018-2098-8 |title=Reliability of diagnosis and clinical efficacy of visceral osteopathy: a systematic review |journal=BMC Complementary and Alternative Medicine |year=2018 |last1=Guillaud |first1=Albin |last2=Darbois |first2=Nelly |last3=Monvoisin |first3=Richard |last4=Pinsault |first4=Nicolas |issue=2 |volume=18|page=65 |pmid=29452579 |pmc=5816506 |doi-access=free}}</ref>

''The New England Journal of Medicine''{{'}}s 4 November 1999 issue concluded that patients with chronic low back pain can be treated effectively with manipulation.<ref>{{cite web |url=https://my.clevelandclinic.org/health/treatments/9095-osteopathic-manipulation-for-low-back-pain |title=Osteopathic Manipulative Therpay & OMT Cleveland Clinic |publisher=Cleveland Clinic |access-date=27 January 2020}}</ref> The United Kingdom's National Health Service says there is "limited evidence" that osteopathy "may be effective for some types of neck, shoulder or lower limb pain and recovery after hip or knee operations", but that there is no evidence that osteopathy is effective as a treatment for health conditions unrelated to the bones and muscles.<ref name="NHS_osteopathy">{{cite web |url=http://www.nhs.uk/Conditions/Osteopathy/Pages/Introduction.aspx |title=Osteopathy – NHS Choices |date=11 October 2011 |publisher=NHS |access-date=8 January 2014}}</ref> Others have concluded that there is insufficient evidence to suggest efficacy for osteopathic style manipulation in treating musculoskeletal pain.<ref>{{cite journal |last1=Posadzki |first1=P. |last2=Ernst |first2=E. |year=2011 |title=Osteopathy for Musculoskeletal Pain |journal=Clinical Rheumatology |volume=30 |issue=2 |pages=285–91 |doi=10.1007/s10067-010-1600-6 |pmid=21053038 |s2cid=20517311}}</ref>

== Criticism ==
The American Medical Association listed DOs as "cultists" and deemed MD consultation of DOs unethical from 1923 until 1962.<ref>{{Cite book |title=The Feminine Touch: Women in Osteopathic Medicine |last=Quinn |first=Thomas A. |publisher=Truman State University Press |year=2011 |isbn=9781935503132 |pages=81–85}}</ref> MDs regarded that osteopathic treatments were rooted in "pseudoscientific dogma", and although physicians from both branches of medicine have been able to meet on common ground, tensions between the two continue.<ref name=ident/>

In 1988, Petr Skrabanek classified osteopathy as one of the "paranormal" forms of alternative medicine, commenting that it has a view of disease which had no meaning outside its own closed system.<ref name=paranormal>{{cite journal |author=Skrabanek P |title=Paranormal health claims |journal=Experientia |volume=44 |issue=4 |pages=303–9 |date=April 1988 |pmid=2834214 |type=Review |doi=10.1007/bf01961267 |s2cid=29310075}}</ref>

In a 1995 conference address, the president of the Association of American Medical Colleges, Jordan J. Cohen, pinpointed OMT as a defining difference between MDs and DOs; while he saw there was no quarrel in the appropriateness of manipulation for musculoskeletal treatment, the difficulty centered on "applying manipulative therapy to treat other systemic diseases"—at that point, Cohen maintained, "we enter the realm of skepticism on the part of the allopathic world."<ref name=ident/>

In 1998, Stephen Barrett of [[Organization:Quackwatch|Quackwatch]] said that the worth of manipulative therapy had been exaggerated and that the American Osteopathic Association (AOA) was acting unethically by failing to condemn [[Unsolved:Craniosacral therapy|craniosacral therapy]]. The article attracted a letter from the law firm representing the AOA accusing Barrett of libel and demanding an apology to avert legal action.<ref name=ident/> In response, Barrett made some slight modifications to his text, while maintaining its overall stance; he queried the AOA's reference to "the body's natural tendency toward good health", and challenged them to "provide [him] with adequate scientific evidence showing how this belief has been tested and demonstrated to be true."<ref name=ident/> Barrett has been quoted as saying, "the pseudoscience within osteopathy can't compete with the science".<ref name=ident/>

In 1999, Joel D. Howell noted that osteopathy and medicine as practiced by MDs were becoming increasingly convergent. He suggested that this raised a paradox: "if osteopathy has become the functional equivalent of allopathy, what is the justification for its continued existence? And if there is value in therapy that is uniquely osteopathic&nbsp;&ndash; that is, based on osteopathic manipulation or other techniques&nbsp;&ndash; why should its use be limited to osteopaths?"<ref name=paradox/>

In 2004, the osteopathic physician Bryan E. Bledsoe, a professor of [[Medicine:Emergency medicine|emergency medicine]], wrote disparagingly of the "pseudoscience" at the foundation of OMT. In his view, "OMT will and should follow [[Unsolved:Homeopathy|homeopathy]], magnetic healing, [[Unsolved:Chiropractic|chiropractic]], and other outdated practices into the pages of medical history."<ref name=elephant>{{cite journal |journal=J Am Osteopath Assoc |last=Bledsoe |first=Bryan E. |year=2004 |volume=104 |issue=10 |page=407 |title=The Elephant in the Room: Does OMT Have Proved Benefit? |type=Letter |url=http://jaoa.org/Article.aspx?articleid=2092865 |}}</ref>

In 2010, [[Biography:Steven Salzberg|Steven Salzberg]] wrote that OMT was promoted as a special distinguishing element of DO training, but that it amounted to no more than "'extra' training in pseudoscientific practices."<ref name=ss>{{cite magazine |url=https://www.forbes.com/sites/sciencebiz/2010/10/27/osteopaths-versus-doctors/ |title=Osteopathic Physicians Versus Doctors |last=Salzberg |first=Steven |date=27 October 2010 |magazine={{wipe|Forbes}} |access-date=18 September 2013}}</ref> It has been suggested that osteopathic physicians may be more likely than MDs to be involved in questionable practices such as orthomolecular therapy and [[Unsolved:Homeopathy|homeopathy]].<ref name="Jarvis2000">{{cite web |title=Osteopathy's Sectarian Roots |last=Jarvis |first=W.T. |date=29 December 2000 |access-date=28 April 2019 |url=https://www.ncahf.org/articles/o-r/osteo.html |publisher=National Council Against Health Fraud}}</ref><ref name="Barrett2018">{{cite web |title=Dubious Aspects of Osteopathy |last=Barrett |first=S. |date=11 February 2018 |access-date=28 April 2019 |url=https://www.quackwatch.org/04ConsumerEducation/QA/osteo.html}}</ref>

Retired MD and {{wipe|U.S. Air Force}} flight surgeon Harriet Hall stated that DOs trained in the U.S. are Doctors of Osteopathic Medicine and are legally equivalent to MDs. "They must be distinguished from 'osteopaths', members of a less regulated or unregulated profession that is practiced in many countries. Osteopaths get inferior training that can't be compared to that of DOs."<ref>{{cite journal |last1=Hall |first1=Harriet |title=Osteopathy Then and Now |journal=Skeptic |date=2021 |volume=26 |issue=1 |pages=4–5}}</ref>

== Regulation and legal status ==
The osteopathic profession has evolved into two branches, non-physician manual medicine osteopaths and full scope of medical practice [[Medicine:Doctor of Osteopathic Medicine|osteopathic physicians]]. These groups are so distinct that in practice they function as separate professions. The regulation of non-physician manual medicine osteopaths varies greatly between jurisdictions. In Australia, Denmark, New Zealand, Switzerland, UAE and UK the non-physician manual medicine osteopaths are regulated by statute and practice requires registration with the relevant regulatory authority. The Osteopathic International Alliance has a country guide with details of registration and practice rights and the International Osteopathic Association has a list of all accredited osteopathic colleges.<ref>{{cite web |title=Directories |url=http://www.oialliance.org/directories.htm |publisher=Osteopathic International Alliance |access-date=27 July 2012 |archive-url=https://web.archive.org/web/20120626213654/http://www.oialliance.org/directories.htm |archive-date=26 June 2012 |url-status=dead}}</ref>

Several international and national organizations exist relating to osteopathic education and political advocacy. Similarly, there is also an international organization of organizations for national osteopathic and osteopathic medical associations, statutory regulators, and universities/medical schools offering osteopathic and osteopathic medical education, known as the Osteopathic International Alliance (OIA).<ref>{{cite web |url=http://www.oialliance.org/ |title=Osteopathic International Alliance |access-date=13 November 2011}}</ref>

The following sections describe the legal status of ''osteopathy'' and ''osteopathic medicine'' in each country listed.

=== Australia ===
A majority of osteopaths work in private practice, with osteopaths working within aged care, traffic and workers compensation schemes or co-located with medical practitioners. Osteopaths are not considered physicians or medical doctors in Australia, rather as allied health professionals offering private practice care. The majority of private health insurance providers cover treatment performed by osteopaths, as do many government based schemes such as veteran's affairs<ref>{{cite web |url=https://www.dva.gov.au/health-and-treatment/injury-or-health-treatments/health-services/osteopathic-services |title=Osteopathic services &#124; Department of Veterans' Affairs}}</ref> or workers compensations schemes<ref>{{cite web |url=https://www.sira.nsw.gov.au/for-service-providers/A-Z-of-service-providers/osteopaths |title=Osteopaths}}</ref><ref>{{cite web |url=http://www.oialliance.org/pdf/australia_osteopathy.pdf |title=Osteopathy in Australia |publisher=Osteopathic International Alliance |access-date=26 February 2011 |url-status=dead |archive-url=https://web.archive.org/web/20120324124423/http://www.oialliance.org/pdf/australia_osteopathy.pdf |archive-date=24 March 2012}}</ref> In addition, treatment performed by osteopaths is covered by the public healthcare system in Australia (Medicare)<ref name="Medicare Australia">{{cite web |title=Chronic Disease Management – Individual Allied Health Services under Medicare – Provider Information |url=http://www.health.gov.au/internet/main/publishing.nsf/Content/health-medicare-health_pro-gp-pdf-allied-cnt.htm |publisher=Medicare Australia}}</ref> under the Chronic Disease Management plan.

Osteopathy Australia<ref>{{cite web |title=Osteopathy Australia |url=http://www.osteopathy.org.au |publisher=Osteopathy Australia |access-date=10 July 2014}}</ref> (formerly the Australian Osteopathic Association) is a national organization representing the interests of Australian osteopaths, osteopathy as a profession in Australia, and consumers' right to access osteopathic services. Founded in 1955 in Victoria, the Australian Osteopathic Association became a national body in 1991 and became Osteopathy Australia in 2014.<ref>{{cite web |title=Allied Health Professions Australia (AHPA) |url=http://www.ahpa.com.au/ |publisher=Allied Health Professions Australia (AHPA) |access-date=10 July 2014}}</ref> and is a member of the Osteopathic International Alliance.<ref>{{cite web |title=Osteopathic International Alliance |url=http://wp.oialliance.org/ |publisher=Osteopathic International Alliance |access-date=10 July 2014 |archive-url=https://web.archive.org/web/20140626000603/http://wp.oialliance.org/ |archive-date=26 June 2014 |url-status=dead}}</ref>

The Osteopathy Board of Australia<ref>{{cite web |url=http://www.osteopathyboard.gov.au/Codes-and-Guidelines.aspx |title=Board of Australia Codes & Guidelines of the Profession |website=osteopathyboard.gov.au |url-status=dead |archive-url=https://web.archive.org/web/20110219150950/http://www.osteopathyboard.gov.au/Codes-and-Guidelines.aspx |archive-date=19 February 2011}}</ref> is part of the Australian Health Practitioner Regulation Agency which is the regulatory body for all recognized health care professions in Australia.<ref name="ahpra.gov.au">{{cite web |url=http://www.ahpra.gov.au/ |title=Australia Health Professions Regulatory Agency |access-date=13 November 2011}}</ref> The Osteopathic Board of Australia is separate from the Medical Board of Australia which is the governing body that regulates medical practitioners. Osteopaths trained internationally may be eligible for registration in Australia, dependent on their level of training and following relevant competency assessment.<ref name="ahpra.gov.au"/>

Students training to be an osteopath in Australia must study in an approved program in an accredited university.<ref>{{cite web |url=https://www.osteopathyboard.gov.au/Registration/Forms.aspx |title=Osteopathy Board of Australia - Forms |publisher=Osteopathyboard.gov.au |date=1 January 2022 |access-date=9 March 2022}}</ref> Current accredited courses are either four or five years in length.<ref>{{cite web |url=https://www.ahpra.gov.au/Accreditation/Approved-Programs-of-Study.aspx?ref=Osteopath |title=Australian Health Practitioner Regulation Agency - Approved Programs of Study |publisher=Ahpra.gov.au |access-date=9 March 2022}}</ref> To achieve accreditation universities courses must demonstrate the capabilities of graduates.<ref>{{cite web |url=https://www.osteopathyboard.gov.au/Codes-Guidelines/Capabilities-for-osteopathic-practice.aspx |title=Osteopathy Board of Australia - Capabilities for osteopathic practice |publisher=Osteopathyboard.gov.au |access-date=9 March 2022}}</ref> The capabilities are based on the CanMEDS competency framework that was developed by the Royal College of Physicians and Surgeons of Canada.

A 2018 large scale study, representing a response rate of 49.1% of the profession indicated the average age of the participants was 38.0 years, with 58.1% being female and the majority holding a Bachelor or higher degree qualification for osteopathy. The study also estimated a total of 3.9 million patients consulted osteopaths every year in Australia. Most osteopaths work in referral relationships with a range of other health services, managing patients primarily with musculoskeletal disorders.<ref>A workforce survey of Australian osteopathy: analysis of a nationally representative sample of osteopaths from the Osteopathy Research and Innovation Network (ORION) project, Adams et al. BMC Health Services Research (2018) 18:352 https://doi.org/10.1186/s12913-018-3158-y</ref>

=== Canada ===
In Canada, the titles "osteopath" and "osteopathic physician" are protected in some provinces by the medical regulatory college for physicians and surgeons.<ref>{{cite web |url=http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_91m30_e.htm |title=Ontario Medicine Act – Restricted Titles, Section 9 |publisher=Province of Ontario, Canada |access-date=13 November 2011}}</ref><ref>{{cite web|url=http://www.bclaws.ca/EPLibraries/bclaws_new/document/ID/freeside/19_416_2008 |title=''British Columbia Medical Practitioners Act,'' Section 40 Registration of Osteopaths |date=1 June 2009 |access-date=13 November 2011}}</ref><ref>{{cite web |url=http://www.canlii.org/ab/laws/sta/m-11/20060310/whole.html |title=''Alberta Medical Profession Act,'' Sections 3 and 18 |access-date=13 November 2011}}</ref> As of 2011, there were approximately 20 U.S.-trained osteopathic physicians, all of which held a [[Medicine:Doctor of Osteopathic Medicine|Doctor of Osteopathic Medicine]] degree, practicing in all of Canada.<ref>{{cite magazine |url=http://thedo.osteopathic.org/?p=80661 |title=MSUCOM pilot program targets Canadian students for training |magazine=The DO |access-date=3 May 2014 |archive-url=https://web.archive.org/web/20140424064948/http://thedo.osteopathic.org/?p=80661 |archive-date=24 April 2014 |url-status=dead}}</ref> As of 2014, no training programs have been established for osteopathic physicians in Canada.<ref name="Who Provides Osteopathy">{{cite web |url=http://osteopathyontario.org/about-osteopathy/who-provides-osteopathy/ |title=Who Provides Osteopathy? |publisher=Ontario Association of Osteopathic Manual Practitioners |access-date=28 April 2014 |archive-url=https://web.archive.org/web/20140424130524/http://osteopathyontario.org/about-osteopathy/who-provides-osteopathy/ |archive-date=24 April 2014 |url-status=dead}}</ref>

The non-physician manual practice of osteopathy is practiced in most Canadian provinces.<ref>{{cite web |url=http://www.osteopathy.ca/provinces.html |title=Who is an Osteopath in Canada? |publisher=Canadian Federation of Osteopaths |access-date=3 May 2014 |archive-url=https://web.archive.org/web/20140425000229/http://www.osteopathy.ca/provinces.html |archive-date=25 April 2014 |url-status=dead}}</ref> As of 2014, manual osteopathic practice is not a government-regulated health profession in any province,<ref>{{cite web |url=http://osteopathyontario.org/our-association/regulation/ |title=Regulation |publisher=Ontario Association of Osteopathic Manual Practitioners |access-date=28 April 2014 |archive-url=https://web.archive.org/web/20140424160356/http://osteopathyontario.org/our-association/regulation/ |archive-date=24 April 2014 |url-status=dead}}</ref> and those interested in pursuing osteopathic studies must register in private osteopathy schools.<ref name="Allard_2011" /> It is estimated that there are over 1,300 osteopathic manual practitioners in Canada, most of whom practice in Quebec and Ontario.<ref name="Who Provides Osteopathy"/> Some sources indicate that there are between 1,000 and 1,200 osteopaths practicing in the province of Quebec, and although this number might seem quite elevated, many osteopathy clinics are adding patients on waiting lists due to a shortage of osteopaths in the province.<ref name="Allard_2011" />

==== Quebec ====
Beginning in 2009, Université Laval in Quebec City was working with the ''Collège d'études ostéopathiques'' in {{wipe|Montreal}} on a project to implement a professional osteopathy program consisting of a bachelor's degree followed by a professional master's degree in osteopathy as manual therapy.<ref name="Allard_2011" /> However, due to the many doubts concerning the scientific credibility of osteopathy from the university's faculty of medicine, the program developers decided to abandon the project in 2011, after {{fract|2|1|2}} years of discussion, planning, and preparation for the program implementation.<ref name="Allard_2011">{{cite news |last1=Allard |first1=Marc |title=L'Université Laval ferme la porte à l'ostéopathie |trans-title=Université Laval closes the door to osteopathy |url=http://www.lapresse.ca/le-soleil/actualites/education/201110/02/01-4453561-luniversite-laval-ferme-la-porte-a-losteopathie.php |access-date=12 May 2015 |work=Le Soleil |date=3 October 2011 |language=fr}}</ref> There was some controversy with the final decision of the university's committee regarding the continuous undergraduate and professional graduate program in osteopathy because the Commission of studies, which is in charge of evaluating new training programs offered by the university, had judged that the program had its place at Université Laval before receiving the unfavourable support decision from the faculty of medicine.<ref name="Allard_2011" /> Had the program been implemented, Université Laval would have been the first university institution in Quebec to offer a professional program in osteopathy as a manual therapy.<ref name="Allard_2011" />

=== Egypt and the Middle East ===
Hesham Khalil introduced osteopathy in the Middle East at a local physical therapy conference in Cairo, Egypt in 2005 with a lecture titled "The global Osteopathic Concept / Holistic approach in Somatic Dysfunction". Since then he has toured the Middle East to introduce osteopathy in other Middle Eastern and North African countries, including Sudan, Jordan, Saudi Arabia, Qatar, UAE, Kuwait and Oman.
In December 2007 the first Workshop on Global osteopathic approach was held at the Nasser Institute Hospital for Research and Treatment, sponsored by the Faculty of Physical Therapy, University of Cairo, Egypt.<ref>{{cite web |url=http://egyptianpt.blogspot.com/2007/10/26-osteopathy.html |title=Osteopathy |first=Mohamed |last=Rizk |year=2007 |publisher=Physical Therapists of Egypt Blog |access-date=30 July 2014}}</ref> On 6 August 2010, the Egyptian Osteopathic Society (OsteoEgypt) was founded. OsteoEgypt promotes a two-tier model of osteopathy in Egypt and the Middle East. The event was timed to coincide with the birthday of A.T. Still.<ref>{{cite web |url=http://osteoegypt.org/about-us/history/ |title=The History of the Egyptian Osteopathic Society |first=Hesham |last=Khalil |year=2014 |publisher=OsteoEgypt |access-date=26 July 2014}}</ref><ref>{{cite web |url=http://digital.ahram.org.eg/Community.aspx?Serial=1515679 |script-title=ar:هشام خليل: الاستيوباثي علاج يستهدف العرض وليس المرض |title=hisham khalil: aliastiubathiu eilaj yastahdif aleard walays almarad |trans-title=Hisham Khalil: Osteopathy is a treatment that targets the symptom, not the disease |year=2014 |publisher=alahram newspaper |access-date=30 July 2014 |archive-url=https://web.archive.org/web/20140808053426/http://digital.ahram.org.eg/Community.aspx?Serial=1515679 |archive-date=8 August 2014 |url-status=dead}}</ref>{{Primary source inline|date=July 2014}}

=== European Union ===
There is no European regulatory authority for the practice of osteopathy or osteopathic medicine within the European Union; each country has its own rules. The UK's General Osteopathic Council, a regulatory body set up under the country's Osteopaths Act 1993, issued a position paper on European regulation of osteopathy in 2005.<ref>{{cite web |url=http://www.epha.org/a/1673 |url-status=usurped |archive-url=https://web.archive.org/web/20110719152522/http://www.epha.org/a/1673 |archive-date=19 July 2011 |title=Position Statement on the draft Services Directive |website=General Osteopathic Council (GOsC) |date=21 February 2005}}</ref>

==== Belgium ====
Since the early 1970s, osteopaths have been practicing in Belgium, during which time several attempts have been made to obtain an official status of health care profession.{{Citation needed|date=September 2019}} In 1999, a law was voted (the 'Colla-Law'<ref>{{cite web |title=Pratiques non-conventionnelles |url=https://www.health.belgium.be/fr/sante/professions-de-sante/pratiques-non-conventionnelles |website=Service Public Fédéral - Santé publique |date=27 January 2016}}</ref>) providing a legal framework for osteopathy, amongst three other non-conventional medical professions.
In 2011, the former Belgian Minister Onkelinx set up the Chambers for Non-Conventional Medicines and the Joint Commission provided for in the "Colla-law" (1999). Their goal was to discuss and reach an agreement between the various medical professions to rule on these practices. In February 2014, only one practice, homeopathy, received its recognition. The others, including osteopathy, remain unresolved.<ref>{{cite web |title=Développement de l'Ostéopathie en Belgique |language=fr |trans-title=Development of Osteopathy in Belgium |url=http://osteopathie.be/fr/osteopathie-je-suis-patient/organisation-belgique/ |website=osteopathie.be |access-date=11 November 2017}}</ref>

==== Finland ====
Osteopathy has been a recognized health profession since 1994 in Finland. It is regulated by law along with chiropractors and naprapaths. These professions require at least a four-year education.<ref>{{Cite web |last=Oy |first=Edita Publishing |title=FINLEX ® - Ajantasainen lainsäädäntö: Asetus terveydenhuollon ammattihenkilöistä 564/1994 |trans-title=FINLEX ® - Current legislation: Decree on healthcare professionals 564/1994 |url=https://www.finlex.fi/fi/laki/ajantasa/1994/19940564 |access-date=2 October 2022 |website=www.finlex.fi |language=fi}}</ref> Currently there are three osteopathic schools in Finland, one which is public and two private ones.<ref>{{Cite journal |last1=Hopeapuu |first1=Elessar |last2=Ulvinen |first2=Anssi |date=15 June 2022 |title=Mitä osteopatia on? Osa 1: Osteopatia Suomessa |trans-title=What is osteopathy? Part 1: Osteopathy in Finland |url=https://journal.fi/kuntoutus/article/view/120025 |journal=Kuntoutus |language=fi |volume=45 |issue=2 |pages=39–46 |doi=10.37451/kuntoutus.120025 |s2cid=250039659 |issn=2489-7604}}</ref>

==== France ====
''Osteopathy'' is a governmentally recognized profession and has title protection, {{lang|fr|autorisation d'utiliser le titre d'ostéopathe}}.<ref>{{cite web |url=http://www.legifrance.gouv.fr/affichTexte.do;jsessionid=E2C6AF0F427389ECA418BB4307239596.tpdjo08v_3?cidTexte=JORFTEXT000000227015&idArticle=&dateTexte=20090604 |title=Article 75, Public Health Law(2002) |language=fr |access-date=13 November 2011}}</ref> The most recent decree regarding osteopathy was enacted in 2014.<ref>{{Cite web |url=https://www.legifrance.gouv.fr/loda/id/JORFTEXT000029449275 |title=Décret n° 2014-1043 du 12 septembre 2014 relatif à l'agrément des établissements de formation en ostéopathie - Légifrance |language=fr |date=2014}}</ref><ref>{{cite web |url=http://www.legifrance.gouv.fr/eli/decret/2014/12/12/2014-1505/jo/texte |title=Décret n° 2014-1505 du 12 décembre 2014 relatif à la formation en ostéopathie - Legifrance |language=fr |trans-title=Decree No. 2014-1505 of December 12, 2014 relating to training in osteopathy - Legifrance |website=legifrance.gouv.fr |date=2014}}</ref><ref>{{Cite web |url=https://www.legifrance.gouv.fr/loda/id/JORFTEXT000029574545 |title=Arrêté du 29 septembre 2014 relatif à l'agrément des établissements de formation en ostéopathie - Légifrance |language=fr |date=2014}}</ref><ref>{{cite web |url=http://www.legifrance.gouv.fr/eli/arrete/2014/12/12/AFSH1426478A/jo/texte |title=Arrêté du 12 décembre 2014 relatif à la formation en ostéopathie - Legifrance |language=fr |trans-title=Order of 12 December 2014 relating to training in osteopathy - Legifrance |website=legifrance.gouv.fr |date=2014}}</ref><ref>{{cite web |url=http://www.legifrance.gouv.fr/eli/arrete/2014/12/12/AFSH1426479A/jo/texte |title=Arrêté du 12 décembre 2014 relatif aux dispenses d'enseignement susceptibles d'être accordées en vue de la préparation au diplôme permettant d'user du titre d'ostéopathe - Legifrance |language=fr |trans-title=Order of 12 December 2014 relating to teaching exemptions likely to be granted with a view to preparing for the diploma allowing the use of the title of osteopath - Legifrance |website=legifrance.gouv.fr |date=2014}}</ref><ref>{{cite web |url=http://www.sante.gouv.fr/fichiers/bo/2014/14-11/ste_20140011_0000_0098.pdf |title=Legifrance |language=fr |date=2014}}</ref>

==== Germany ====
Germany has both ''osteopathy'' and ''osteopathic medicine''. There is a difference in the osteopathic education between non-physician osteopaths, physiotherapists, and medical physicians.

Physiotherapists are a recognized health profession and can achieve a degree of "Diploma in Osteopathic Therapy (D.O.T.)". Non-physician ''osteopaths'' are not medically licensed. They have an average total of 1200 hours of training, roughly half being in manual therapy and osteopathy, with no medical specialization before they attain their degree. Non-physician osteopaths in Germany officially work under the "[[Medicine:Heilpraktiker|Heilpraktiker]]" law. Heilpraktiker is a separate profession within the health care system. There are many schools of osteopathy in Germany; most are moving toward national recognition although such recognition does not currently exist.<ref>{{cite web |url=http://www.oialliance.org/pdf/germany_osteopathy.pdf |title=Osteopathy in Germany |website=Osteopathic International Alliance |access-date=26 February 2011 |url-status=dead |archive-url=https://web.archive.org/web/20130602132251/http://www.oialliance.org/pdf/germany_osteopathy.pdf |archive-date=2 June 2013}}</ref> In Germany, there are state level rules governing which persons (non-physicians) may call themselves osteopaths.<ref>{{cite web |title=Verordnung einer Weiterbildungs- und Prüfungsordnung im Bereich der Osteopathie- Hessen |language=de |trans-title=Regulation of further training and examination regulations in the field of osteopathy- Hessen |url=http://www.rv.hessenrecht.hessen.de/jportal/portal/page/bshesprod.psml?pid=Dokumentanzeige&showdoccase=1&js_peid=Trefferliste&documentnumber=1&numberofresults=37&fromdoctodoc=yes&doc.id=jlr-OsteoWeitBiPrOHErahmen%3Ajuris-lr00&doc.part=X&doc.price=0.0&doc.hl=1}}</ref>

==== Portugal ====
Osteopathy is a governmentally recognized health profession and the title of Osteopath is protected by Law (Act 45/2003, of 22 October, and Act 71/2013, of 2 September). Currently there are eight faculties that teach the four-year degree course of osteopathy (BSc Hon in Osteopathy).<ref>{{cite web |url=http://www.parlamento.pt/ActividadeParlamentar/Paginas/DetalheIniciativa.aspx?BID=40568 |title=Iniciativa - Atividade Parlamentar e Processo Legislativo |website=parlamento.pt}}</ref>

=== India ===
Sri Sri University offers BSc and MSc Osteopathy programmes.<ref>{{cite web |title=Faculty of Health and Wellness |website=Sri Sri University |access-date=14 June 2021 |url=https://srisriuniversity.edu.in/faculty-of-health-and-wellness/}}</ref>

=== New Zealand ===
The practice of osteopathy is regulated by law, under the terms of the Health Practitioners Competence Assurance Act 2003<ref>{{cite web |url=http://www.legislation.govt.nz/act/public/2003/0048/latest/whole.html |title=Health Practitioners Competence Assurance Act 2003 No 48 (as at 1 August 2011), Public Act – New Zealand Legislation |year=2011 |access-date=18 November 2011}}</ref> which came into effect on 18 September 2004. Under the act, it is a legal requirement to be registered with the Osteopathic Council of New Zealand (OCNZ),<ref>{{cite web |url=http://www.osteopathiccouncil.org.nz/ |title=Home |website=osteopathiccouncil.org.nz}}</ref> and to hold an annual practicing certificate issued by them, in order to practice as an osteopath. Each of the fifteen health professions regulated by the HPCA act work within the "Scope of Practice" determined and published by its professional board or council. Osteopaths in New Zealand are not fully licensed physicians. In New Zealand, in addition to the general scope of practice, osteopaths may also hold the Scope of Practice for Osteopaths using western medical acupuncture and related needling techniques.<ref>{{cite web |url=http://online.gazette.govt.nz/MSOS118/On-Line/NZGazette.nsf/6cee7698a9bbc7cfcc256d510059ed0b/56863e2945a2e287cc25763c004d1a9b?OpenDocument |archive-url=https://archive.today/20120720032743/http://online.gazette.govt.nz/MSOS118/On-Line/NZGazette.nsf/6cee7698a9bbc7cfcc256d510059ed0b/56863e2945a2e287cc25763c004d1a9b?OpenDocument |url-status=dead |archive-date=20 July 2012 |title=The Department of Internal Affairs: New Zealand Gazette – The New Zealand Gazette |access-date=13 November 2011}}</ref>

In New Zealand a course is offered at the Unitec Institute of Technology (Unitec).<ref>{{cite web |url=http://www.unitec.ac.nz/?C7B4901F-385F-44F0-B37B-609CE4CC0E1E |title=Master of Osteopathy courses, postgraduate study for a masters degree |access-date=26 January 2009 |publisher=Unitec |quote=The Master of Osteopathy is the only New Zealand-based programme that enables you to register with the Osteopathic Council of New Zealand, and to enter practice as an osteopath in New Zealand.}}</ref> Australasian courses consist of a bachelor's degree in clinical science (osteopathy) followed by a master's degree. The Unitec double degree programme is the OCNZ prescribed qualification for registration in the scope of practice: Australian qualifications accredited by the Australian and New Zealand Osteopathic Council are also prescribed qualifications.

Osteopaths registered and in good standing with the Australian Health Practitioner Regulation Agency – Osteopathy Board of Australian are eligible to register in New Zealand under the mutual recognition system operating between the two countries. Graduates from programs in every other country are required to complete an assessment procedure.<ref>{{cite web |url=http://www.oialliance.org/pdf/newzealand_osteopathy.pdf |title=Osteopathy in New Zealand |website=Osteopathic International Alliance |access-date=26 February 2011 |url-status=dead |archive-url=https://web.archive.org/web/20130602130203/http://www.oialliance.org/pdf/newzealand_osteopathy.pdf |archive-date=2 June 2013}}</ref>

The scope of practice for US-trained ''osteopathic physicians'' is unlimited on an ''exceptions'' basis. Full licensure to practice medicine is awarded on an exceptions basis following a hearing before the licensing authorities in New Zealand. Both the Medical Council of New Zealand<ref>{{cite web |author=Medical Council of New Zealand |url=http://www.mcnz.org.nz/ |title=Medical Council of New Zealand |access-date=13 November 2011}}</ref> and the OCNZ<ref>{{cite web |url=http://www.osteopathiccouncil.org.nz/ |title=Osteopathic Council of New Zealand |date=19 February 2009 |access-date=13 November 2011}}</ref> regulate osteopathic physicians in New Zealand. Currently, the country has no recognized osteopathic medical schools.<ref>{{cite web |url=http://www.oialliance.org/pdf/newzealand_om.pdf |title=Osteopathic Medicine in New Zealand |website=Osteopathic International Alliance |access-date=26 February 2011 |url-status=dead |archive-url=https://web.archive.org/web/20130602130524/http://www.oialliance.org/pdf/newzealand_om.pdf |archive-date=2 June 2013}}</ref>

=== United Kingdom ===
The first school of osteopathy was established in London in 1917 by John Martin Littlejohn, a pupil of A.T. Still, who had been Dean of the [[Organization:Chicago College of Osteopathic Medicine|Chicago College of Osteopathic Medicine]]. After many years of existing outside the mainstream of health care provision, the osteopathic profession in the UK was accorded formal recognition by Parliament in 1993 by the Osteopaths Act.<ref>{{cite web |url=https://www.legislation.gov.uk/ukpga/1993/21/contents |title=Osteopaths Act 1993}} Link to both original act and latest revision.</ref> This legislation now provides the profession of osteopathy the same legal framework of statutory self-regulation as other healthcare professions such as medicine and dentistry. This Act provides for "protection of title". A person who expressly or implicitly describes themself as an osteopath, osteopathic practitioner, osteopathic physician, osteopathist, osteotherapist, or any kind of osteopath is guilty of an offence unless they are registered as an osteopath.

The General Osteopathic Council (GOsC) regulates the practice of osteopathy under the terms of the Act. Under British law, an osteopath must be registered with the GOsC to practice in the United Kingdom.<ref>{{cite web |url=http://www.osteopathy.org.uk/information/about-osteopathy/ |title=About osteopathy |publisher=General Osteopathic Council |access-date=7 March 2013}}</ref> More than 5,300 osteopaths were registered in the UK as of 2021.<ref>{{cite web |url=http://www.osteopathy.org.uk/training-and-registration/ |title=Training and registering |work=Osteopathy |publisher=General Osteopathic Council |access-date=14 June 2021}}</ref> The General Osteopathic Council has a statutory duty to promote, develop and regulate the profession of osteopathy in the UK. Its duty is to protect the interests of the public by ensuring that all osteopaths maintain high standards of safety, competence and professional conduct throughout their professional lives. In order to be registered with the General Osteopathic Council an osteopath must hold a recognized qualification that meets the standards as set out by law in the GOsC's Standard of Practice.<ref name="osteopathy.org.uk">{{cite web |title=Standards of education and training - General Osteopathic Council |website=General Osteopathic Council |access-date=14 June 2021 |url=https://www.osteopathy.org.uk/standards/standards-of-education-and-training/}}</ref>

Osteopathic medicine is regulated by the General Osteopathic Council, (GOsC) under the terms of the Osteopaths Act 1993 and statement from the GMC. Practising osteopaths will usually have a BS or MSc in osteopathy. Accelerated courses leading to accreditation are available for those with a medical degree and physiotherapists.<ref>{{cite web |url=http://www.osteopathy.org.uk/training-and-registration/becoming-an-osteopath/ |title=Becoming an osteopath |website=General Osteopathic Council |access-date=25 September 2016}}</ref> The London College of Osteopathic Medicine<ref>{{cite web |url=http://www.lcom.org.uk/ |title=London College of Osteopathic Medicine |access-date=13 November 2011}}</ref> teaches osteopathy only to those who are already physicians.

=== United States ===
An ''osteopathic physician'' in the United States is a physician trained in the full scope of medical practice, with a degree of [[Medicine:Doctor of Osteopathic Medicine|Doctor of Osteopathic Medicine]] (DO).<ref>{{cite web |url=http://www.ama-assn.org/ama1/pub/upload/mm/40/physician.pdf |title=Medicine |publisher=American Medical Association |access-date=20 March 2013}}</ref><ref name="Harrisons">{{cite book |first1=Dennis L. |last1=Kasper |first2=Eugene |last2=Braunwald |first3=Anthony S. |last3=Fauci |first4=Stephen L. |last4=Hauser |first5=Dan L. |last5=Longo |first6=J. Larry |last6=Jameson |first7=Kurt J. |last7=Isselbacher |chapter-url=http://accessmedicine.com/content.aspx?aID=9106846 |chapter=Chapter 10. Complementary and Alternative Medicine |archive-url=https://web.archive.org/web/20131224095507/http://accessmedicine.com/content.aspx?aID=9106846 |archive-date=24 December 2013 |title=Harrison's Principles of Internal Medicine |edition=16th |date=2005 |publisher=McGraw-Hill}}</ref><ref>{{cite web |url=http://www.ncmedboard.org/faqs/list/category/consumer_info#what_is_a_doctor_of_osteopathic_medicine_do |title=Consumer Info FAQs |publisher=North Carolina Medical Board |access-date=20 March 2013}}</ref><ref>{{cite web |url=https://www.nlm.nih.gov/medlineplus/ency/article/002020.htm |title=Doctor of Osteopathic medicine |author=MedlinePlus |year=2012 |publisher=U.S. National Library of Medicine |access-date=25 October 2012}}</ref> With the increased internationalization of osteopathy, the American Osteopathic Association (AOA) recommended in 2010 that the older terms ''osteopathy'' and ''osteopath'' be reserved for "informal or historical discussions and for referring to previously named entities in the profession and foreign-trained osteopaths", and replaced in the US by ''osteopathic medicine'' and ''osteopathic physician''.<ref>{{cite web |url=http://www.do-online.org/TheDO/?p=24181 |title=AOA House reasserts preferred terms ''osteopathic physician'', ''osteopathic medicine'' |date=4 August 2010 |last=Schierhorn |first=Carolyn |website=The DO |archive-url=https://web.archive.org/web/20131006043533/http://www.do-online.org/TheDO/?p=24181 |archive-date=6 October 2013 |url-status=dead}}</ref><ref>{{cite web |url=http://www.do-online.org/TheDO/?p=26191 |title=Promoting DOs: Words, medium change, but message stays the same |date=3 September 2010 |last=Croby |first=John B. Crosby |website=The DO |archive-url=https://web.archive.org/web/20131012035325/http://www.do-online.org/TheDO/?p=26191 |archive-date=12 October 2013 |url-status=dead}}</ref> The [[Organization:American Association of Colleges of Osteopathic Medicine|American Association of Colleges of Osteopathic Medicine]] made a similar recommendation.<ref>{{cite web |url=http://www.osteopathic.org/inside-aoa/about/leadership/aoa-policy-search/Documents/H315-A2015-OSTEOPATH-AND-OSTEOPATHY-USE-OF-THE-TERM.pdf |title=H315-A/15 Osteopath and Osteopathy - Use of the Term |year=2015 |website=American Osteopathic Association |access-date=5 April 2018 |archive-url=https://web.archive.org/web/20180406225809/http://www.osteopathic.org/inside-aoa/about/leadership/aoa-policy-search/Documents/H315-A2015-OSTEOPATH-AND-OSTEOPATHY-USE-OF-THE-TERM.pdf |archive-date=6 April 2018 |url-status=dead}}</ref>

Those trained only in manual osteopathic treatment, generally to relieve muscular and skeletal conditions, are referred to as osteopaths,<ref>{{cite web |title=Osteopath |url=https://dictionary.cambridge.org/dictionary/english/osteopath|website=dictionary.cambridge.org |publisher={{wipe|Cambridge University Press}} |access-date=4 August 2017}}</ref> and are not permitted to use the title DO in the United States{{citation needed|date=March 2017}} to avoid confusion with osteopathic physicians.<ref name=SBM/>

== See also ==
* [[Medicine:Doctor of Osteopathic Medicine|Doctor of Osteopathic Medicine]]
* List of medical schools in the United States
* List of osteopathic colleges
* Osteopathic medicine in the United States
* [[Medicine:Spinal manipulation|Spinal manipulation]]

== References ==
{{reflist}}

== Further reading ==
* American Association of Colleges of Osteopathic Medicine (2011); ''[http://www.aacom.org/resources/bookstore/Documents/GOT2011ed.pdf Glossary of Osteopathic Terminology] {{Webarchive|url=https://web.archive.org/web/20131002131413/http://www.aacom.org/resources/bookstore/Documents/GOT2011ed.pdf |date=2 October 2013}}''.
* {{cite book |last=Collins |first=Martin |title=Osteopathy in Britain: The First Hundred Years |year=2005 |publisher=Martin Collins |location=London |isbn=978-1-4196-0784-4}}
* {{cite web |author=Crislip M |title=Pump it up: osteopathic manipulation and influenza |url=http://www.sciencebasedmedicine.org/pump-it-up-osteopathic-manipulation-and-influenza/ |date=4 October 2013 |publisher=Science-based Medicine |access-date=7 February 2014}}
* {{cite book |last1=DiGiovanna |first1=Eileen |last2=Schiowitz |first2=S |last3=Dowling |first3=DD |year=2005 |title=An Osteopathic Approach to Diagnosis and Treatment |edition=3rd |publisher=Lippincott Williams & Wilkins |location=Philadelphia |isbn=978-0-7817-4293-1}}
* {{cite book |last1=Savarese |first1=Robert G. |last2=Copabianco |first2=John D. |last3=Cox |first3=James J. |title=OMT review |year=2009 |publisher=Robert G. Savarese |isbn=978-0967009018}}
* {{cite book |last=Smith |first=J.C. |title=Pseudoscience and Extraordinary Claims of the Paranormal: A Critical Thinker's Toolkit |entry=Manipulative and Body-based Practices |url=https://books.google.com/books?id=ojd1sdVUydwC&pg=PA342 |year=2009 |publisher={{wipe|John Wiley & Sons}} |isbn=978-1-4443-1013-9 |page=342 |via=[[Google Books]]}}
* {{cite book |last=Stone |first=Caroline |title=Science in the Art of Osteopathy: Osteopathic Principles and Practice |year=2002 |publisher=Nelson Thornes |location=Cheltenham, UK |isbn=978-0-7487-3328-6}}
* {{cite book |last=Ward |first=Robert C. |title=Foundations for Osteopathic Medicine |year=2002 |publisher=Lippincott Williams & Wilkins |location=Philadelphia |isbn=0-7817-3497-5 |edition=2nd}}

== External links ==


[[Category:Alternative medicine]]
[[Category:Manual therapy]]
[[Category:Pseudoscience]]

{{Sourceattribution|Osteopathy}}