Leslie R. Gass, D.O. Osteopathic Manipulative Medicine

The Osteopathy Alternative by Susan Rubenstein

The Gentle Touch of Cranial Osteopathy by Dr. Andrew Weil

Nature's Tonics By Verenda Radal

The Osteopathy Alternative by Susan Rubenstein


This unique medical approach combines conventional allopathic and more

holistic hands-on therapies.


As I lie on the table, the strains of Handel’s “Messiah” emanate from a speaker in the corner of the room. The light is low. Four outstretched fingers, tips positioned around my left eye like a crouching spider, push very gently in and out, palpating my skin almost imperceptibly. Just a typical visit to my local osteopath.


This physician is fully licensed t treat my sinus problem-congestion, headache, blurry vision-using conventional medicine. He can prescribe decongestants and painkillers. But he doesn’t.


Eight months pregnant and suffering from Bell’s Palsy, Paula DeMasi of Ridge, New York, also consulted an osteopath. A few weeks before, a neurologist had told her that because she was pregnant she wouldn’t be able to take the usual medication; until it subsided, which could take several months, she’d have to bear with the painful condition that left half her face paralyzed and contorted. The osteopath, on the other hand, gently manipulated the bones and tissues in her head and neck, and within nine days, ater three treatments, she could move her mouth freely without pain. Less than a month later she wasn’t embarrassed to have her picture taken with her newborn son.


Like many patients, DeMasi and I hadn’t heard of osteopathic medicine until we began to search for an alternative to conventional treatment. And like many, we found relief in the century-old tradition of osteopathy. Doctors of Osteopathy, commonly called D.O.s, hold a degree equivalent to that of an M.D.. They share the same privileges and may perform the same range of professional services as provided by M.D.s including diagnosing illness, prescribing drugs and performing surgery. Like M.D.s, osteopaths must complete a one year residency and pass comparable state licensure requirements. But they are also trained in manipulative treatment and diagnosis by palpation.


Most of the country’s D.O.s follow the conventional allopathic approach. Many enter the standard specialties such as pediatrics and neurology. The initials D.O. may follow their names, but they function very much like M.D.s. Others function more as holistic family physicians, however, treating everything from backaches to sore throats and gynecological problems, integrating preventive (emphasizing nutrition and fitness), allopathic (giving prescriptions) and osteopathic (using manipulation) approaches.


A smaller group, with members such as Anthony D. Capobianco, DeMasi’s doctor in Glen Cove, New York, practice a more esoteric form of osteopathy, what they term “pure” or “classical” osteopathy. These D.O.s will turn to allopathic modes only in an emergency.


Many patients, when first introduced to osteopathy, wonder which conditions it treats best. Most who go to osteopaths do so at first for relief of back and neck pain, headaches, or other musculoskeletal traumas-like those received from a car accident or sports injury. Others use osteopaths as general practitioners and receive treatment for a wide variety of ailments. With varying degrees of success, osteopathic manipulative treatments (OMT), D.O.s say, can treat such diverse problems as asthma, bronchitis, stomach problems, sciatica, ear infections and menstrual problems.


Whatever their reasons for turning to an osteopath, patients often find that their overall health improves.  Capobianco says, “A lot of people associate osteopathy with problems like lower back pain, and that’s OK, because during a treatment other parts of their body respond. The next time a patient comes in they’ll say, ‘By the way, my hayfever is better.’ They begin to understand that osteopathy is available to them for virtually anything.”


Osteopathic philosophy was developed by a nineteenth-century American frontier physician and surgeon, Andrew Taylor Still, who believed that the body has the innate ability to heal itself. He emphasized unobstructed movement, in such aspects of the body as fluids, tissues, and joints. Still felt that in both health and sickness the neuro-musculoskeletal system interacts with the rest of the body including the organs. Like the chain reaction of dominoes, when part of the structure is altered, abnormalities in other systems-the circulatory, lymph and nerves-can occur, causing disease. Capobianco describes that innate ability as “an inner wisdom which can be alled upon to provide the cure. The body is trying to heal itself, but it may need the presence of a catalyst to put that wisdom into contact with the diseased and disharmonious part.”


The techniques D.O.s use to restore harmony range from subtle palpations that promote movement of bodily fluids (blood, lymph, cerebrospinal) to more assertive manipulations that move muscles, joints and connective tissue. Quite often a combination of techniques is used.


While examining DeMasi, Capobianco says he felt restricted motion in cranial bones and the vertebrae of the neck. Tissues in the area were retaining fluid. Through gentle manipulation on both tempromandibular joints (where the jaw connects to the ear bone), the base of her head, her temples, and the area of her neck where he felt tissue abnormalities, he worked to decrease fluid buildup and re-establish motion. “Most of it was very relaxing,” notes DeMasi, describing a technique which she says feels as if the doctor is rhythmically pressing on the area at the base of the skull. Slightly uncomfortable, she adds, was when he “pulled up on the bottom of my jaw.”


Some 29,000 osteopathic physicians provide health care to about 25 million Americans, according to the American Osteopathic Association in Chicago, yet few people have any concept of what an osteopathic physician does.


“Osteopathy-is that a disease?” That comment from a receptionist at the American Medical Association reveals the prevailing ignorance. The AMA has no policy statement on osteopathy, but, according to the American Osteopathic Association, it recognizes D.O.s as full-practice physicians. And although most medical doctors still don’t actively promote it, osteopathic manipulative care has found acceptance in conventional medical publications.


A study presented in 1975 in a National Institutes of Health publication showed that osteopathic manipulative treatment may increase the lung capacities of patients with chronic obstructive lung disorders. A recent article in Patient Care: The Practical Journal for Primary Care Physicians affirmed that OMT is “appropriate and useful.”


For example, manipulation may be used to treat a patient with angina pain. Barabra Briner, a D.O. in Okemos, Michigan, who combines OMT with conventional techniques, says, “You are not taking away the organic problems. If the patient has a blockage in one of the coronary vessels, you’re not changing that, but you’re changing the somatic (the body’s total physical condition) component.” She explains that the problem in the blood vessel affects the sympathetic nervous system and leads to muscle tightness. By breaking into that cycle with manipulation, “you decrease the frequency and severity of the angina.”


Those with a more esoteric understanding say that osteopathy goes beyond merely affecting the musculoskeletal components of disease. “Pure osteopathy,” says Capobianco, “goes back to the original idea of using manipulation for every organic, visceral, and structural problem, be it schizophrenia, asthma, colitis, or whatever.” These doctors are a part of the growing group, estimated at 5 to 10 percent of the nation’s total, who treat their patients only with osteopathic manipulative treatments developed by Still and later expanded by his student William Gardiner Sutherland, D.O..


No matter what a D.O.s particular orientation, all learn that there is no invisible force field separating one body system from another. “We’re trained to sense the origins of disease in altered tissue or motion caused by trauma, be it physical, emotional, gross or microscopic, “ says Capobianco. In effect, that lower back pain you’ve had for the last few years might have originated with the bum on your head you got when the training wheels came off your first bicycle. And according to some patients and osteopathic physicians, if a bump was ever there a D.O. will find it.


East West Health Advisory board member Christiane Northrup, an MD and co-president of the American Holistic Medical Association, in Raleigh, North Carolina, says that the first time an osteopathic physician examined her he found a head injury that had occurred when she fell out of a jeep at age eleven. “Then he got down to my right knee and asked, “What happened here?” My body was still trying to compensate for this injury that happened in college when I fell while jogging.” She remembers thinking, “If that’s all still in my body and he can feel it. I’m signing up.”


Although the treatments they offer have been compared to massage, chiropractic, and other bodyworks, many D.O.s bristle at the suggestion that there are similarities. Most important, they point out, D.O.s posses the educational background-medical and surgical training and a year-long hospital residency-that allows them to practice medicine.

“Even before the first osteopathic treatment, the doctor has handled cardiac codes, delivered babies, and has assisted in major surgery. Unless you study medicine and surgery, there will be important and dangerous limitations,” says Capobianco.

According to Dr. Charles Steiner of the New Jersey School of Osteopathic medicine in Stratford, even though some chiropractic techniques may be similar chiropractors focus on the spine while D.O.s study soft tissue, muscles, ligaments, and tendons, and not just vertebral movement.

Patricia Ausman, D.O., from Hempstead, New York, who refers patient back and forth with Richard Statler, a Huntington, New York, chiropractor says that the differences in some techniques may be subtle. In describing one instance where they compared maneuvers, Ausman saysm “My counterstrain technique is just me positioning a limb and holding it. He put movement into it, which makes it different.”


Traditionally, chiropractic is oriented more toward manipulating specific vertebrae. Briner says, “I think D.O.s have many more techniques available to them. There are some very good chiropractors, but I think that, by and large, osteopathic physicians are trained to look at the whole person. So someone may come in with a headache, and we may end up treating a short leg problem as well as perhaps a flat foot. We’re looking at the whole person, whether the malady is some distance away from the primary problem or is and organic problem.”


Explaining his understanding of the differences between osteopathy and chiropractic, Capobianco emphasizes what some other osteopaths would say only off the record-that chiropractors sometimes use too much force. “The spine is not to be hammered into an x-ray, picture perfect, normal position, because we’re all unique.”


Statler, who has added other disciplines, including nutrition and exercise, to his adjustments, disagrees with these criticisms, noting that he also stress the concepts that the body has the innate ability to heal itself, and a therapist should look at a patient holistically, not just concentrating one the area of complaint.


“Chiropractors who are philosophically based, “ he says, “recognize that you get in there, you mobilize the segments that aren’t working like they should, and you let the body find what’s right for it. The way you do that is, rather than looking for normal alignment, you try to normalize joint play at each of the segmental levels. When the bone can move where it is best suited to move, it’s going to seek out that natural balance. It may not be textbook perfect.”

Observing an ostepath and a chiropractor at work may reveal the biggest differences. Whereas manipulative osteopaths use their hands, chiropractors may be more technologically oriented. In addition to spinal manipulations, they may use ultrasound, motorized traction machines and heating pads. Manipulative osteopaths spend at least a half hour to forty minutes with each patient. A chiropractor may see a patient initially for that long, but often subsequent maintenance visits can last but five or ten minutes.


Osteopaths may be limited in the number of patients they see in one day, because they treat one at a time. A chiropractor may have two or three patients in examining rooms at once: while one is being treated, another might be on a traction machine.


The biggest dissimilarity exists among chiropractors and those osteopaths who practice “cranial osteopathy” because fully sanctioned cranial study is not open to chiropractors or other practitioners without a medical degree.


At the core of pure osteopathy is this “cranial concept,” the ability according to Capobianco, “to sense the cranial rhythmic impulse.” Developed by Sutherland, it stresses the importance of movement within the twenty-nine bones of the skull; the rhythmic movement of spinal fluid through the brain, central nervous system, and body tissues; and the ability of the sacrum, between the pelvic bones, to move in sync with everything else. Use of the technique is not limited to “pure” osteopaths; some D.O.s, who integrate allopathic and osteopathic modes also use it. Some who use the method say that it goes beyond treating the musculoskeletal components of diseases and can be used for hypoglycemia, pneumonia, heart disease, and other maladies.


During a treatment it may not be obvious to an onlooker that the doctor using cranial manipulation is doing anything. The patient often is supine on the examination table, the doctor apparently only holding the patient’s head. Some patients report feeling of fluid motion within their bodies and a feeling fo the doctor’s fingertips as having melted into them. Patients often report feelings of emotional release and serenity. Osteopathy in the cranial field, as the Sutherland method is called, is subtle, says John H. Harkal, D.O.. As long as the osteopath is “working with the tissues, you won’t feel it,” he says. “If he works against the tissues you become much more aware of what he is doing.” Harkal goes on, “He’s monitoring and cooperating and using a directive effort. Sometimes you are directing the bones of the skull or pelvis, sometimes you are directing the fluid. But the bottom line is, the fluids are making the changes.”


Among D.O.s who use the cranial method is Viola Fryman of La Jolla, California’s Osteopathic Center for Children. Fryman says, “We get children with recurrent ear infections that started when they were six months old and have gone on for years. Parents are sick of the merry-go-round of antibiotics and ear infections. When we begin to address the structural problem, which may have originated at birth, the ear infections become progressively less frequent.” Last year, DeMasi took her baby, Paul, for treatment of ear infections that had recurred twice a month for a year. “After three treatments, his ears were OK,” she reports. “He hasn’t had an ear infection since. We’re very happy and kind of amazed too.”


The cranial method is Capobianco’s primary mode of treatment. He believes that it goes beyond making changes on the structural level to making deeper emotional and possibly even spiritual changes. “Pure osteopathy is setting the stage for transformation,” he says, “It is allowing motion to manifest. In pure osteopathy, pushing is blasphemy. But most people have a problem ‘getting’ osteopathy. It’s much easier to say, ‘We push here and stimulate this to happen, and therefore the pressure is off the artery.’ That’s all true, but there’s a possibility of listening to the innate wisdom present in all patients.”


The process of listening feels great to patients of cranial method practitioners-“like magic,” as Northrup puts it. “Afterwards I can hardly get off the table,” she says. “He changes the way the cerebrospinal fluid flows, that’s definite.” Northrup visits a Maine osteopath four times a year for “tune-ups.”


Within the field of osteopathy there is some discord over how much allopathic medicine should be incorporated. To different degrees, D.O.s see the ability to integrate manipulation with other modes as an advantage. “A complete osteopath will use everything known,k but address ti from an anatomic and physiological as opposed to a biochemical basis which is what most allopathic medicine does,” says Harkal. Briner, a board trustee of the American Academy of Osteopathy says that sometimes a short-term pharmacological approach “seems necessary to facilitate a treatment or response.” Seiner adds that “treatment is integrated in the sense that the manipulative procedures are used whenever they are appropriate, just as penicillin is used where it’s appropriate.


That kind of integration doesn’t always jibe with the beliefs of some more classical osteopaths. And some argue that in their fight to be recognized by the conventional medical establishment, too much of the art of osteopathy has been lost. They view osteopathy not so much as a profession, but as a calling with a philosophical and even spiritual orientation that A.T. Still would be proud of.


To those with the more esoteric viewpoint, osteopathy is an art and a science passed like a torch from one generation to another through mentors. In his 1950 self-published Doctor A.T. Still in the Living, Robert E. Truhlar, D.O., wrote that many of the older successful osteopaths had a “spiritual concept.”  The book is a collection of philosophical, religious, and scientific adages culled from Still’s writings, and in its preface Truhlar says, “These capsules of wisdom and knowledge must be preserved fro those who come after us. They are the guideposts of the osteopathic way of life.


Within the holistic medical community, pure osteopathy is in general highly regarded, although there is not widespread awareness of it. The American Association of Naturopathic Physicians in Seattle tends to recommend its own physicians, but president Cathy Rogers says that because of osteopathy’s roots in looking at health in a non-allopathic manner, the association regards pure osteopathy as an acceptable form of treatment.


Probably the biggest controversy in the relationship between osteopaths and the holistic medical community is the use of osteopathic cranial techniques by body-workers not trained in Sutherland’s methods. The Sutherland Cranial Teaching Foundation and the Cranial Academy, postgraduate nonprofit institutions, will teach the method only to osteopaths, medical doctors, and dentists. Bur around the nation, similar cranial-sacral methods are being taught by a few D.O.s, MDs, nurses and other bodyworkers for a fee to laypeople and health care professionals without medical degrees. “We do not approve of this, “ says Harakal. “Their training is incomplete on an anatomical or physiological basis or has been modified. We have concerns not only about the qualifications of those taking such instruction but also about those who are instructors.” Adds Capobianco, “Osteopathy in the cranial field is not a separate therapy as many are deceived to believe. It’s an expansion of the osteopathic concept. Full medical, surgical and clinic experience is needed to administer it properly.”


Controversies may also exist in the examination room. Without a basic understanding and the experience of osteopathy, a patient may not believe that the osteopath can feel what other practitioners need an x-ray to tell them. Also, osteopathic manipulative treatment means a commitment of time, both for the treatment itself, which can last from half an hour to more than an hour, and for the curative process, which can take longer than the response time for prescription medications. “This isn’t Burger King. You don’t just drive up, get your hamburger, and drive away,” says Capobianco.

But in the long run, as little Paul De Masi’s parents point out, patients save both time and money. “Between the constant trips to the pediatrician and the antibiotics, it was costing me a fortune,” says Paul’s father, Bernard. According to Paula DeMasi, there is one commodity that can’t be measured in dollars: sleep.


DOs say that their practices grow by “word of mouth,” not through advertising. “It’s not the kind of thing you discuss around the water cooler at work,” says a patient. “If I go to my doctor for pneumonia, people expect me to come back saying he gave me antibiotics, not that he set the stage for my body’s innate wisdom to heal itself. But I do plant the seed. I drop hints. That’s how I ended up going, and it’s important to pass it on.”


“Osteopathy to me is a very sacred science,” Still wrote. “It is sacred because it is a healing power through all Nature.” Classical osteopaths, following the original precepts set down by Still, believe that we have the power within to heal ourselves. That belief, passed down for more than a century through the hands of osteopaths, gives us the option to step off the beaten path of conventional medicine and on to a road where our own innate wisdom is waiting for us.

December 1990/East West 45-49



The Gentle Touch of Cranial Osteopathy by Dr. Andrew Weil


Andrew Weil, MD, noted integrative physician and author, has written numerous times on the benefits of Osteopathic Manipulative Medicine. In fact, Chapter 2 of his early best-seller “Spontaneous Healing” was on his training from Robert Fulford, D.O., a world-renowned Traditional Osteopath. Below is and excerpt from his newsletter, and a link to his website (www.drweilselfhealing.com).


In the early 1970s, I met a remarkable osteopathic physician named Robert Fulford here in Tucson. Dr. Fulford was a leading practitioner of cranial osteopathy, a healing method in which gentle pressure is applied with the hands to the head and other areas of the body. One of several osteopathic manipulation techniques, it’s based on the idea that the central nervous system (including the brain and spinal cord) has subtle, rhythmic pulsations that are key to health, and can be detected and regulated by a skilled practitioner.


I still consider Dr. Fulford (who died in 1997 at the age of 91) the most effective clinician and healer I’ve ever known. He relied upon hands-on manipulation alone to treat a variety of diseases and gave no drugs. Dr. Fulford had great success using cranial osteopathy for many problems that hadn’t responded to conventional medicine. For instance, he was often able to permanently end cycles of recurrent ear ineftions in children with a single session of treatment.


Practitioners of cranial osteopathy use their hands to gently free up restrictions in the movement of cranial bones and to stimulate the flow of the cerebrospinal fluid, which bathes the surfaces of the brain and the spinal cord. According to Dr. Fulford, distortions in the natural rhythms of the central nervous system may result from trauma of all sorts: birth trauma, childhood injuries, car accidents, even psychological trauma. Because the nervous system regulates all other organs, any impairment in its function could affect your health.


For decades, mainstream medicine dismissed the notion that the cranial bones could move, an idea first put forth in the late 1930s by osteopath William Sutherland. However, researchers at Michigan State University’s College of Osteopathic Medicine confirmed Sutherland’s theory in the 1970s by showing cranial motion in x-ray movies of living skulls.


A Safe and Effective Technique

In my experience, cranial osteopathy is extremely useful for a wide range of problems. Besides ear infections, I’ve seen it benefit asthma, sleep disorders, migraines, Meniere’s disease and TMJ syndrome. It may also be helpful with pediatric conditions such as colic, attention-deficity/hyperactivity disorder (ADHD), and even learning disabilities. Because of its gentle nature, cranial osteopathy is generally quiet safe.


At our Integrative Medicine Clinic at the University of Arizona, we often refer patients to osteopathic physicians (DOs) trained in cranial osteopathy, including Tuscon-based osteopath Theresa Cisler, who studied with D.r Fulford. We’re also collaborating on a new study at the NIH-funded Pediatric Center for Complementary and Alternative Medicine here at the university on cranial osteopathy and Echinacea to break cycles of recurrent ear infections in children.


During a typical cranial-osteopathy session with a DO trained in the technique, you may be asked about your history of injuries and the circumstances of your birth, in addition to the usual questions about your symptoms, medical history, and lifestyle habits. As part of the physical exam, the practitioner may move your limbs and feel your spine, rib cage, and cranium to check for areas of restricted motion. Treatment includes gentle hands-on manipulation of the cranial bones and the sacrum 99tailbone), as well as other restricted areas of the body. The practitioner may use other osteopathic manipulation techniques as well, for example to relax muscles around the joints and spine.


The overall effect of a treatment session is calming, says Dr. Cisler. During the session, some patients report feeling a pleasant tingling sensation throughout the body as the nervous system begins to function more smoothly. The initial visit may last 45 minutes to an hour, and any subsequent visits may last about 30 minutes. Check with your health plan to see if it covers osteopathic manipulation.


All osteopathic physicians are trained in manipulative medicine, but only a minority use manipulation as a primary treatment. Most of these practitioners have training in cranial osteopathy. A very small number of MDs and dentists also have training in this technique. I’m pleased that the number of DOs who practice cranial osteopathy is on the rise.


Some massage therapists and physical therapists practice what’s called craniosacral therapy. Their training isn’t as comprehensive as that of DOs, who as physicians can diagnose and treat the full spectrum of health conditions.





  Nature’s Tonics By Verenda Radal


Too little attention has been paid to the necessity of rest as a conserver of force, as means of maintaining health and consequently happiness: too little has been said on the subject of vacations. The truth of this is impressed upon us daily by the army of tired faces; faces stamped with tension and anxiety. Hurry and worry are more fatal than disease.


The true physician teaches men, women and children how to combine activity with rest, how to conserve energy while spending it. He teaches that we are foolishly the slaves of our possessions, and that besides a definite aim in life we should have a hobby which we may ride for freedom, relaxation, and possibly other useful ends. There would be fewer chronic invalids, fewer cases of melancholia and neurasthesia if people as a whole took more vacation and fewer hypothetical tonics. Real tonics are drawn from the vast storehouses of Nature-from sunshine, pure air, exercise, healthful food, and sleep. Ella Adelia Fletcher has expressed so beautifully the influence of Nature upon our imagination, and says in her book “The Philosophy of Rest”:


            “Get away into the woods where the trees will talk to you, or down on the sands by the seashore where every incoming wave will whisper messages of throbbing vitality of which you are a part. A delicious sense of freedom, an intoxicating calm will steal over you, wooing your soul to expand.”


You are not dual, your soul is the only one there is! This intimate companionship with self thus enjoyed may enable you to discover hitherto unsuspected talents. Every moment of intimacy with yourself is fraught with deepest significance and will return to you hundredfold treasure, in ways you wot not, of health, strength, and enlarged ability.


What has the world been made so beautiful for, if not to minister to some need of man? To lift him out of his petty environment-into the secrets of everlasting hills.


By Verena Radal, D.O.. Reprinted from the “Osteopathic Magazine, Nature’s Way to the Health” 1925

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