One Leap Forwards or Two Steps Apart
Originally published in Osteopathy Today Feb 2012
This article follows on from the “The Brain, the Mind and the Osteopath” published in Osteopathy Today, April 2011, highlighting the diversity of practitioners within the UK Osteopathic profession. This first article stressed the need for cohesion, respect and understanding within the profession so that the profession might stand united and strengthened, rather than weakened, by its diversity. This diversity was attributed to different mindsets and a preponderance of the left and right hemispheres of the brain to dominate, within individuals and within groups.
This second article serves to highlight and develop some of the points made previously, placing emphasis on osteopathic philosophy. It proposes that to practice osteopathic medicine in its intended format requires a change in mindset from that typically accepted in modern, conventional western society and medicine. This author questions whether the original intended format of practising osteopathic medicine is the most effective. Producing effective practitioners should be the most important remit for the UK osteopathic colleges as the osteopathic profession cannot expect to survive if they do not.
This is a proposal that the cranial osteopathic approach, whether embraced in practice or not, provides the schools with an excellent teaching tool for bringing about that vital change of mindset in their undergraduate students.
The Osteopathic Profession
The osteopathic profession has two main groups that are currently diverging, rather than converging. The allopathic biomechanical aspect of structural osteopathy, currently the focus of our undergraduate programmes, is pushing forward scientifically in allegiance with the chiropractors, the physiotherapists and the medics. This seems to be having an almost polarising effect on the cranial osteopaths where the biodynamic aspect of cranial osteopathy is becoming more and more energetically biased, less and less tangible and more in allegiance with the healers – to the observer, at least.
The Bell Curve, cited in my previous article as hypothetically representing the mindset of the osteopathic profession, is gradually turning upside down!
This second article serves to highlight and develop some of the points made previously, placing emphasis on osteopathic philosophy. It proposes that to practice osteopathic medicine in its intended format requires a change in mindset from that typically accepted in modern, conventional western society and medicine. This author questions whether the original intended format of practising osteopathic medicine is the most effective. Producing effective practitioners should be the most important remit for the UK osteopathic colleges as the osteopathic profession cannot expect to survive if they do not.
This is a proposal that the cranial osteopathic approach, whether embraced in practice or not, provides the schools with an excellent teaching tool for bringing about that vital change of mindset in their undergraduate students.
The Osteopathic Profession
The osteopathic profession has two main groups that are currently diverging, rather than converging. The allopathic biomechanical aspect of structural osteopathy, currently the focus of our undergraduate programmes, is pushing forward scientifically in allegiance with the chiropractors, the physiotherapists and the medics. This seems to be having an almost polarising effect on the cranial osteopaths where the biodynamic aspect of cranial osteopathy is becoming more and more energetically biased, less and less tangible and more in allegiance with the healers – to the observer, at least.
The Bell Curve, cited in my previous article as hypothetically representing the mindset of the osteopathic profession, is gradually turning upside down!
It seems that individuals are being directed towards using one or other of the hemispheres but not both. This author questions whether the diverging groups are potentially leaving “Osteopathy” behind?
True strength comes from using both ways of thinking; see the whole picture, analyse the detail, understand it, rationalise it and then move back to the whole picture.
The profession has two choices to make. The first is to continue to diverge, separate and potentially lose osteopathy. The second is to form a working allegiance and reclaim osteopathy for what it is – a philosophy of health.
True strength comes from using both ways of thinking; see the whole picture, analyse the detail, understand it, rationalise it and then move back to the whole picture.
The profession has two choices to make. The first is to continue to diverge, separate and potentially lose osteopathy. The second is to form a working allegiance and reclaim osteopathy for what it is – a philosophy of health.
Osteopathic Philosophy
Osteopathic philosophy revolves around motion - voluntary and involuntary motion - representing health. A practitioner will apply osteopathic techniques to restore motion where it is absent. By restoring motion the intention is to initiate or remove obstructions to the patients’ inherent self regulating and self healing mechanisms which subsequently take charge. This, in itself, takes a form of blind faith where the osteopath cannot predict, understand or control the outcome of the treatment.
In an aim to restore motion the osteopaths works to provide a functional midline around which paired lateral structures can express health in motion. That midline can be represented by the spine; the spine, cranial base and sacrum; the cranial and spinal dural membrane; and/or the energetic midline.
The choice of the individual osteopathic practitioner is at what level he directs his attention and his tools of trade. He may use the more direct or the more indirect techniques to effect a functional change.
Osteopathy, as a discipline, is not rocket science and it’s not magic – although one cannot say the same for the underlying natural bio-logical forces at work!
The Undergraduate Programme
The approach taken by an osteopath will be based on how he is informed.
A UK Osteopathic undergraduate will leave college with an excellent knowledge of the biomechanics of the musculoskeletal system (minus the cranium), a solid and necessary back ground medical education and 4 years training in direct techniques. There are peripheral subjects and some of the UK colleges provide an optional introductory module in Cranial and Visceral Osteopathy and the use of indirect techniques. This provides a “taster” for those who may want to embark on further postgraduate studies at great cost to themselves in terms of time and money. The postgraduate courses on offer are of high standard and are comprehensive but are way beyond the financial or time reach of many.
The Limitations
Two major problems evolve with this current system.
The first problem is that many osteopaths who claim to practise cranially have not completed a full educational programme in this field. There will be gaps in their knowledge base and skill. Some have completed the extensive 9/10 modular Sutherland Cranial College course over years, others may have done a 5-day introductory course, maybe some courses with the Rollin Becker Institute and there are those that have done no courses whatsoever. This author has worked alongside structural osteopaths who teach at schools and represent the profession politically, who freely admit to accepting patients asking for cranial osteopathy even though they have not attended any cranial osteopathic courses at all!
The outcome of this situation is that these practitioners will be ineffective and negligent. This impacts negatively on the cranial osteopathic profession and, in turn, on the whole osteopathic profession. This author had to explain this situation recently to a GP patient of hers. The doctor and her extensive family have been so impressed with cranial osteopathy over the decades that she had decided that she wanted to retrain as an osteopath specifically to practice cranially. There is no satisfactory pathway in the UK unless she wants to embark solely on the structural route first. She was utterly horrified to hear that all the post graduate courses are voluntary and not a prerequisite for practising cranially.
The second problem with the offer of an introductory cranial course in the current undergraduate training is those who favour the structural and allopathic route, as a rule, don’t sign up and, if they do, they dismiss the cranial concept before they have given it a chance. It doesn’t help that the subject is often institutionally denigrated in some of the undergraduate colleges. As a result ther is a whole section of the profession who are dismissive of another whole section of osteopathy but they are normally totally uninformed and inexperienced in the field that they dismiss.
Abroad and the UK
At the Vienna School of Osteopathy, representative of many other European osteopathic schools, students have a 13 module cranial osteopathic course ( in excess of 200 contact hours), running alongside their structural and visceral training. This author teaches the first 10 modules and has had her fair share of Alpha males, medical consultants, national sportsmen and women – all structurally and allopathically biased – who profess, charmingly or rudely, that they have no interest or belief in this course in 1st and even 2nd year. They resist it with all their might and often don’t get to grips with the impact of the training until the 3rd or 4th year.
They have all eventually graduated aware of involuntary motion, the inherent healing mechanism and how we can interact with it and initiate a therapeutic response. This initiation is sometimes with the most minimal of intervention, effecting a small change in an area perhaps distal to the symptomatic area. They start to understand, as well, that this initiation of a therapeutic response is all that is required.
This represents a huge transition in their mind set.
In this author’s opinion, many of the European trained osteopaths are leaving the UK trained osteopaths trailing way behind in their breadth of thought and their finesse of treatment. The European schools look to the UK for validation criteria and experience in achieving registration (i.e. politically) but at ground level, European osteopaths have been known to frown upon the UK osteopaths for their limited approach.
The Inherent Self Healing and Self Regulating Mechanism
This mind set change does not come about by being informed alone. It is through experience we start to trust in some “thing” more powerful and intelligent than a manipulative practitioner (cranial or structural) can ever impose on his patient through his own will. The gaining of that experience, the experience of having this form of blind faith in the patients’ inherent self regulating and self healing mechanism (a complex biochemical/bio kinetic/biophysical mechanism), even though one cannot understand, control or predict how it will respond, needs to start at undergraduate level.
It is impossible to practice an osteopathic philosophy of health - structural, cranial or visceral - without it.
Are Osteopaths effective practitioners?
This author worries that in the attempts to conform to what the public expect of the profession and in trying to give themselves the competitive edge by comparing themselves with others (e.g. diagnostic labelling, proof that osteopaths can treat certain conditions, factualising everything, rationalising what they do and how it works.... ) they actually lose what makes osteopathy effective.
Busy practices evolve from effective treatments. An established and respected profession requires first and foremost that their members be successful at what they do, above being able to explain what it is they are trying to do and justifying their ability to do so.
On a personal note, if this author treats the disease and not the patient she finds her powers of manipulation to be extremely limited no matter how much she understands that disease and the science behind it. If she treats the patient and not the disease she finds her powers of manipulation to be well beyond her expectation. She has to practice an osteopathic philosophy alongside her informed but background knowledge.
Summary
If the UK osteopathic profession embrace a compulsory and complete modular programme in cranial osteopathy into the undergraduate programme it would put a halt to the two divisions of osteopathy as they continue to diversify and singularly exercise their hemisphere of choice.
In this highly competitive world osteopaths must make sure that the undergraduates have been given ALL the tools. They should not be limited by being only able to work with voluntary motion and, seemingly to be convinced that they can treat only musculoskeletal complaints. If the profession diversify the training, their scope of practice and effectiveness could increase dramatically. If osteopaths are all educated in all fields of osteopathy there would be respect and cohesion along with diversity.
Strength, as a profession, would rest in the unusual capability of using both hemispheres of the brain in assessment, treatment and management of patients when applying a unique philosophy of health. The impact of working with the PRM could become better and more widely understood.
The choice of whether to converge is in the hands of the UK Osteopathic colleges and their controllers. It can only occur if the cranial osteopathic profession have an agreed consensus that this is a good way forward for them and one that they would choose. It could be influenced by demand from students, recent graduates frustrated by lack of work, from the post graduate students of the SCC and the Roland Becker Institute reeling from the cost of it all.
It will take a huge shift in attitude which may or may not happen.
If the two divisions agree that they should work to converge rather than diverge then, in anticipation, the cranial osteopaths will have to question themselves as a profession, identify their strengths and weaknesses and move forwards in a way that works for the osteopathic profession as a whole. This will be the content of my next article directed towards the cranial osteopathic profession.
One leap forward or two steps apart?
Osteopathic philosophy revolves around motion - voluntary and involuntary motion - representing health. A practitioner will apply osteopathic techniques to restore motion where it is absent. By restoring motion the intention is to initiate or remove obstructions to the patients’ inherent self regulating and self healing mechanisms which subsequently take charge. This, in itself, takes a form of blind faith where the osteopath cannot predict, understand or control the outcome of the treatment.
In an aim to restore motion the osteopaths works to provide a functional midline around which paired lateral structures can express health in motion. That midline can be represented by the spine; the spine, cranial base and sacrum; the cranial and spinal dural membrane; and/or the energetic midline.
The choice of the individual osteopathic practitioner is at what level he directs his attention and his tools of trade. He may use the more direct or the more indirect techniques to effect a functional change.
Osteopathy, as a discipline, is not rocket science and it’s not magic – although one cannot say the same for the underlying natural bio-logical forces at work!
The Undergraduate Programme
The approach taken by an osteopath will be based on how he is informed.
A UK Osteopathic undergraduate will leave college with an excellent knowledge of the biomechanics of the musculoskeletal system (minus the cranium), a solid and necessary back ground medical education and 4 years training in direct techniques. There are peripheral subjects and some of the UK colleges provide an optional introductory module in Cranial and Visceral Osteopathy and the use of indirect techniques. This provides a “taster” for those who may want to embark on further postgraduate studies at great cost to themselves in terms of time and money. The postgraduate courses on offer are of high standard and are comprehensive but are way beyond the financial or time reach of many.
The Limitations
Two major problems evolve with this current system.
The first problem is that many osteopaths who claim to practise cranially have not completed a full educational programme in this field. There will be gaps in their knowledge base and skill. Some have completed the extensive 9/10 modular Sutherland Cranial College course over years, others may have done a 5-day introductory course, maybe some courses with the Rollin Becker Institute and there are those that have done no courses whatsoever. This author has worked alongside structural osteopaths who teach at schools and represent the profession politically, who freely admit to accepting patients asking for cranial osteopathy even though they have not attended any cranial osteopathic courses at all!
The outcome of this situation is that these practitioners will be ineffective and negligent. This impacts negatively on the cranial osteopathic profession and, in turn, on the whole osteopathic profession. This author had to explain this situation recently to a GP patient of hers. The doctor and her extensive family have been so impressed with cranial osteopathy over the decades that she had decided that she wanted to retrain as an osteopath specifically to practice cranially. There is no satisfactory pathway in the UK unless she wants to embark solely on the structural route first. She was utterly horrified to hear that all the post graduate courses are voluntary and not a prerequisite for practising cranially.
The second problem with the offer of an introductory cranial course in the current undergraduate training is those who favour the structural and allopathic route, as a rule, don’t sign up and, if they do, they dismiss the cranial concept before they have given it a chance. It doesn’t help that the subject is often institutionally denigrated in some of the undergraduate colleges. As a result ther is a whole section of the profession who are dismissive of another whole section of osteopathy but they are normally totally uninformed and inexperienced in the field that they dismiss.
Abroad and the UK
At the Vienna School of Osteopathy, representative of many other European osteopathic schools, students have a 13 module cranial osteopathic course ( in excess of 200 contact hours), running alongside their structural and visceral training. This author teaches the first 10 modules and has had her fair share of Alpha males, medical consultants, national sportsmen and women – all structurally and allopathically biased – who profess, charmingly or rudely, that they have no interest or belief in this course in 1st and even 2nd year. They resist it with all their might and often don’t get to grips with the impact of the training until the 3rd or 4th year.
They have all eventually graduated aware of involuntary motion, the inherent healing mechanism and how we can interact with it and initiate a therapeutic response. This initiation is sometimes with the most minimal of intervention, effecting a small change in an area perhaps distal to the symptomatic area. They start to understand, as well, that this initiation of a therapeutic response is all that is required.
This represents a huge transition in their mind set.
In this author’s opinion, many of the European trained osteopaths are leaving the UK trained osteopaths trailing way behind in their breadth of thought and their finesse of treatment. The European schools look to the UK for validation criteria and experience in achieving registration (i.e. politically) but at ground level, European osteopaths have been known to frown upon the UK osteopaths for their limited approach.
The Inherent Self Healing and Self Regulating Mechanism
This mind set change does not come about by being informed alone. It is through experience we start to trust in some “thing” more powerful and intelligent than a manipulative practitioner (cranial or structural) can ever impose on his patient through his own will. The gaining of that experience, the experience of having this form of blind faith in the patients’ inherent self regulating and self healing mechanism (a complex biochemical/bio kinetic/biophysical mechanism), even though one cannot understand, control or predict how it will respond, needs to start at undergraduate level.
It is impossible to practice an osteopathic philosophy of health - structural, cranial or visceral - without it.
Are Osteopaths effective practitioners?
This author worries that in the attempts to conform to what the public expect of the profession and in trying to give themselves the competitive edge by comparing themselves with others (e.g. diagnostic labelling, proof that osteopaths can treat certain conditions, factualising everything, rationalising what they do and how it works.... ) they actually lose what makes osteopathy effective.
Busy practices evolve from effective treatments. An established and respected profession requires first and foremost that their members be successful at what they do, above being able to explain what it is they are trying to do and justifying their ability to do so.
On a personal note, if this author treats the disease and not the patient she finds her powers of manipulation to be extremely limited no matter how much she understands that disease and the science behind it. If she treats the patient and not the disease she finds her powers of manipulation to be well beyond her expectation. She has to practice an osteopathic philosophy alongside her informed but background knowledge.
Summary
If the UK osteopathic profession embrace a compulsory and complete modular programme in cranial osteopathy into the undergraduate programme it would put a halt to the two divisions of osteopathy as they continue to diversify and singularly exercise their hemisphere of choice.
In this highly competitive world osteopaths must make sure that the undergraduates have been given ALL the tools. They should not be limited by being only able to work with voluntary motion and, seemingly to be convinced that they can treat only musculoskeletal complaints. If the profession diversify the training, their scope of practice and effectiveness could increase dramatically. If osteopaths are all educated in all fields of osteopathy there would be respect and cohesion along with diversity.
Strength, as a profession, would rest in the unusual capability of using both hemispheres of the brain in assessment, treatment and management of patients when applying a unique philosophy of health. The impact of working with the PRM could become better and more widely understood.
The choice of whether to converge is in the hands of the UK Osteopathic colleges and their controllers. It can only occur if the cranial osteopathic profession have an agreed consensus that this is a good way forward for them and one that they would choose. It could be influenced by demand from students, recent graduates frustrated by lack of work, from the post graduate students of the SCC and the Roland Becker Institute reeling from the cost of it all.
It will take a huge shift in attitude which may or may not happen.
If the two divisions agree that they should work to converge rather than diverge then, in anticipation, the cranial osteopaths will have to question themselves as a profession, identify their strengths and weaknesses and move forwards in a way that works for the osteopathic profession as a whole. This will be the content of my next article directed towards the cranial osteopathic profession.
One leap forward or two steps apart?
