The Principles And Practice Of Osteopathy

A look at the history of osteopathy and it’s practice to the present day. See how the profession has taken great strides from its humble beginnings in the US, to the respected primary healthcare profession that is practiced in the UK today.

The Founder Of Osteopathy – Andrew Taylor Still (1828-1917)

What Is Osteopathy?

For your body to work well, its structure must also work well.’ ~The General Osteopathic Council

Osteopathy is a system of Examination, Diagnosis and Treatment that uses the body’s healing resources as a means to restoring optimum levels of health.

Osteopaths aim to improve your structural integrity, balance, and health as a means to positively impacting it’s function—creating optimum conditions for improved health. Practitioners will use observations and palpation (a highly developed sense of touch) alongside combinations of stretching, massage, physical manipulation and joint mobilisations. This approach aims to restore harmony to circulation, nerves and muscular tissues—supporting the body’s capacity to resolve dysfunction and return to good health.

There are two distinct branches of Osteopathic Physicians (particularly in the US and other parts of the world), they are:

  • Doctors of Osteopathic medicine or DO’s: Osteopathic Physicians (practiced primarily in the UK),

  • Doctors of medicine or MD’s: Allopathic physicians who undergo full medical training and are concerned with an altogether different type of (medicalised) Osteopathic practice than what is seen here in the UK.

The Osteopathic Principles

The overall Osteopathic philosophy maintains the idea that the structure and function of the body is inextricably linked. The primary principles are:

  1. The Unity Of The Body: Describes the idea of the body working as an integrated functional unit (and not a sum of the parts operating independently of one another). This leads to physicians examining the person and treating the body and its symptoms as integral parts of the whole. Physicians are trained to give consideration to the context of the whole person (mind, body and spirit) in their plight to bring about the optimum states for healing to occur.

  2. The Body Has Its Own Medicine Chest: Refers to the body’s intrinsic capacity to self-regulate and heal, given the right conditions. This principle underpins the necessity for adequate circulation throughout the body (The Rule Of The Artery Supreme) coupled with sound neurological function from which to coordinate the body’s various functions. 

  3. Structure Governs Function: Describes the idea that abnormalities in either structure or function in one part of the body will likely cause an associated disharmony in another part—where tissues, organs and systems are considered to function co-dependently and harmoniously with one another. The approach of the osteopath is to facilitate optimum states for self-healing to occur, understanding that the body will overcome stress and dysfunction, and remain healthy when maintaining the optimum level of balance (and not become overwhelmed).

There is some overlap between the three main principles, yet each offers a fundamental point for consideration.

The History Of Osteopathy

Andrew Taylor Still founded osteopathy in 1874 in the United States during the American civil war. At the time, Still was a medical physician and surgeon.

Originally, Still was fascinated by machines, and whenever faced with a mechanical problem, his answer was always to devise a better approach. In the 1870’s, he patented and improved upon several inventions.

After experiencing the loss of his wife and three daughters to spinal meningitis, Still was prompted to reform orthodox medical methods (bloodletting, purgatives and other invasive interventions) and establish a new practice that worked in support of the body’s own healing systems. Still attracted support for his medical philosophy and approach over the course of twenty five years. He solidified his principles and practice (whilst also accruing a large patient base of those hearing of his revolutionary philosophy and in need of his aid) and began training small numbers of interested physicians in his osteopathic approach.

On the 20th May 1892, The American School of Osteopathy was established in Kirksville, Missouri. His first year intake consisted of twenty one students. Although the state of Missouri granted the right to award the MD degree, Still being dissatisfied with the practices of conventional medicine, opted to retain the DO degree classification. In 1898 four other states recognised Osteopathy as a profession. Still published four books during his life, they were:

  1. Autobiography of Andrew Taylor Still with a History of the Discovery and Development of the Science of Osteopathy

  2. Philosophy of Osteopathy

  3. The Philosophy and Mechanical Principles of Osteopathy

  4. Osteopathy Research and Practice

In 1913, John Martin Littlejohn—one of Still’s early students, introduced osteopathy to Britain. Litttlejohn went about setting up a standard of osteopathic science, to demonstrate its clinical benefits. The first osteopathic school was established in 1917 in the country by Littlejohn, ‘The British School of osteopathy’ where he served as the Dean of the School for 40 years. The British School of osteopathy (now the University College of Osteopathy) still exists as the leading osteopathic training establishment in the UK.

American-trained osteopaths formed a number of osteopathic associations in the late1800’s. 1925, The Osteopathic Association of Great Britain (OAGB) was founded by alumni of the British School of Osteopathy (BSO). In 1998, the British Osteopathic Association (BOA) was founded (a merger of 3 UK based Osteopathic Associations). In 2013, the transition for the BOA to become the Institute of Osteopathy (IO) began. In 2014, the transition was completed. The Institute of Osteopathy continues to support, unite, develop and promote the osteopathic profession and orchestrate improvements to public health and patient care.

The General Osteopathic Council (GOsC) was established in 1997 following the Osteopaths Act 1993. Their primary aim is to provide regulation of the profession, and protect the public. It produced the first Statutory Register of Osteopaths in 2000.

Osteopathic Treatment

‘Patients seek treatment for a wide variety of conditions, including back pain, changes to posture in pregnancy, postural problems caused by driving or work strain, the pain of arthritis and minor sports injuries.’ ~The General Osteopath Council

©The Osteopathic Council: Manipulative Treatment Of The Neck

Qualified osteopaths are required to have a minimum of Degree Level Training and must be Registered with the GOsC in order to practice. Registered osteopaths must apply annually to renew their licence to practice. The GOsC serve as the governing body, regulating the profession, setting and enforcing high standards of practice as well as investigating any potential misconduct and removing those practitioners deemed unfit to practice from the register. It is a criminal offence to use the title of ‘osteopath’ without first being registered with the GOsC.

Osteopathic patients include people of a broad range of ages, from the very young to the elderly, as well as falling into a wide range of other categories such as, manual workers, office workers, students, pregnant women, sports enthusiasts and professionals. A list of Registered Osteopaths can be found using the ‘Find An Osteopath’ page on the GOsC’s website.

An initial appointment will usually consist of both a consultation and treatment. During the consultation, the case history and details of any signs and symptoms will be logged. A physical examination will usually follow, where the patient is likely to be asked to remove some clothing (some patients opt to change into a pair of shorts and a vest in order for the practitioner to make a full assessment). 

The practitioner will typically carry out a standing ‘active’ examination, where the patient is asked to perform a range of ‘active’ movements in order to assess the quality and range of movement. This is typically followed by a ‘passive’ examination (in a suitable position, often on a hydraulic treatment couch), where the practitioner may take one or more of the patient’s joints through a series of supported movements to further evaluate the quality and range of movement. Further clinical examinations such as; neurological, respiratory, blood pressure or other clinical testing may also be performed.

Over 30,000 people every day visit an osteopath suffering from a variety of conditions including neck or back pain, joint or muscular pain, sports injuries, recurring headaches and more.‘ ~The Institute of Osteopathy (March 2020)

A Typical Treatment will normally include a range of physical manipulation techniques such as High Velocity Thrusts (characterised by an associated ‘clicking’ or ‘popping sound’), Joint Mobilisations, Massage and Stretching. Some practitioners may incorporate the use of Cranial Osteopathic Techniques (in varying measures). Cranial osteopathic techniques are known for their subtle approach, and are used as an effective modality of treatment for highly reactive or sensitive patients and conditions. It is often the preferred approach in the treatment of young babies and children due to its gentle nature. Practitioners may also offer additional advice in relation to lifestyle, posture, exercise regime and diet in order to prevent the recurrence of symptoms. 

Depending on the history, practitioner findings and severity of the condition, further recommendations may also be made. The osteopath may go on to make referrals to other healthcare professionals before continuing treatment. Treatments can vary in price with appointments durations averaging from 30 minutes to 1 hour.

Cranial Osteopathy and Craniosacral Therapy

 ‘All the various modern approaches to Craniosacral Therapy have their roots in the work of William Garner Sutherland (1873-1954). In the late 1970s another American osteopath, John Upledger, began to teach cranial work to non-osteopaths, and coined the name ‘Craniosacral Therapy’. In the 1980s Thomas Attlee and Franklyn Sills began teaching Craniosacral Therapy in the UK, mainly to non-osteopaths.’ ~The Craniosacral Therapy Association

William Garner Sutherland D.O (1873-1954) was an American osteopath and a student of Andrew Taylor Still. Although he discovered, developed and taught what he termed ‘Osteopathy in the Cranial Field’ during the early part of the 1900’s, he made it clear that the cranial understanding and approach was merely an extension of Still’s science of osteopathy.

Sutherland discovered the subtle palpable movement within the bones of the cranium and realised their intrinsic relationship to the rhythmic fluid expression and movement throughout the cranium and other tissues of the body. At this time, cranial sutures were said to be fused and unable to move in adulthood, but he understood that a given structure was designed in a way to fulfil a specified set of functions. He embarked upon years of detailed study of the bones of the skull and nervous system—even carrying out experimentation on the bones of his own head—restricting the movement of specific cranial bones and detailing their symptomatic outcomes. He named his discovery ‘The Primary Respiratory Mechanism’, one of fundamental physiological importance.

The primary respiratory mechanism describes the Involuntary Mechanism of movement carried through the organs, tissues and Membranous System of the body. This membranous (or connective) tissue forms a thin yet strong interconnected covering over the body’s organs, muscles, tendons, bones and joints. The membranous system synchronises all of the body’s respective parts through its extensive linking and reciprocal flow of motion. Physical stresses, strain and tension can interfere with the fluidity and ease of this movement expression, most of which can be palpated or felt by the osteopath.

Cranial osteopaths will observe, palpate and treat a wide range of complaints (using a highly specialised touch), releasing areas of restriction, block, tension, congestion and strain, to reinstate optimum conditions for health and wellbeing. They are able to pick up on subtle changes in shape, tension, stress and strain reflected through this subtle involuntary expression anywhere on the body. However, the typical ‘Cranial and Sacral’ (top and tail) contact points are often the preferred start point. Their centralised location, relationship to the 26 Cranial bones, spinal column and direct connection to a large amount of the body’s soft tissues are a major vantage point. It is a Highly Specialised technique used as a discipline all on its own or in tandem with structural osteopathic techniques. Cranial osteopaths offer a gentle yet effective approach where practitioners palpate various areas of the body, including the spine, tailbone and head to assess the condition and relationship between the functioning parts. Treatment consists of applying gentle pressure to encourage the release of stress and strain whilst adhering to its core osteopathic principles. Although the approach appears to differ significantly from the more well known structural osteopathic approach, the aims and principles of treatment remain the same.

Due to its gentle application, cranial osteopathy has become popularised (and heavily associated) with the treatment of babies, infants and young children. However, its use is equally effective in the treatment of older children, adults and the elderly. Some osteopaths prefer to work using predominantly cranial osteopathic techniques. They may also choose to focus their practice in one or more specialised areas such as; sports injuries, visceral complaints (internal organs), paediatrics or treatment of the elderly.  Some practitioners choose to combine the cranial approach with structural techniques while others may choose not to incorporate the technique into their practice at all.

Craniosacral therapy works in a similar way to Cranial Osteopathy — the main difference being the depth of study and duration of time involved in obtaining a qualification. Cranial osteopaths undergo four years training at degree level (and are considered primary healthcare professionals), whereas craniosacral therapists require just two years of training in order to achieve a diploma status. Craniosacral therapy has its roots in osteopathy but works solely via the ‘Cranio-Sacral System’, whereas osteopathy has a more extensive framework. Patients may find differences in the way that osteopathy and craniosacral therapist practice (depending on the training and experience of practitioner seen). It is advised that patients carry out additional research to understand more about the training, approach and experience of individual therapists. Practitioner websites will often detail training and experience, while also providing indicators to areas of special interest and professional approach. Referrals from friends and family members can be useful.

Cranial Osteopathic Treatment

Mechanical problems can occur as a result of unresolved trauma or accumulating tension. If left untreated, the negative impacts can build over time, causing the body struggle in its attempt to cope. Cranial osteopathy is a Safe, Gentle and Effective Approach to treating both adults and children for a wide range of complaints. Children are treated for symptoms of irritability, feeding difficulties, disturbed sleep and resolving the stressful effects of a difficult birth. Babies are frequently brought in for a mechanical check following a traumatic delivery. In older children and adults, cranial osteopathy is often used to treat a variety of symptoms including stress, malaise, fatigue, head and face pain and general ill health.

Osteopaths will carry out an Assessment and Palpate areas of imbalance and dysfunction and gently reduce the level of strain to restore optimum balance and greater ease. The cranial approach works complementary to many other treatment modalities. Experiences vary from person to person and can depend on the level of sensitivity. Typically, patients may drift in and out of sleep, while others describe a range of sensations, these may include:

  • Changes felt in and around the symptomatic area
  • Emotional release or ease
  • Physical relaxation or lightness
  • Greater sense of awareness 
  • A range of physical sensations (as the body makes adjustments)
  • Increased feelings of groundedness
  • A desire to rest, sleep or slowdown following the treatment
Cranial osteopathy is generally reported to be a soothing experience.


Overtime, Osteopathy has made significant gains in its regulation, status, credibility and uptake by the public.

The parliamentary Osteopaths Act passed in 1993, saw the profession gain mainstream status. Osteopathy has since become increasing available on the NHS, with GP referrals becoming commonplace and osteopaths making new alliances with many other primary health care providers.

As the profession continues to gain in visibility and patient numbers rise, the future of osteopathy looks bright.

Kelly Mckay – Registered Osteopath

Osteopath and Integrative Life Coach serving the central London area:

Upper Street Islington ▪️ Highbury ▪️ Holloway ▪️ Angel ▪️Clerkenwell ▪️Highgate ▪️Hackney ▪️Haringey ▪️Camden ▪️Online Life Coaching also available.