I am in a hotel room in East Lansing, Michigan, a small town in the Midwestern US that seems to be in hibernation. The most obvious reason is that school is out – Michigan State University is the lifeblood of this place, and the 47,000 students who flock here to study, party and watch football – not necessarily in that order – are mostly gone. Another kind of slumber has taken hold of the place, one that sadly might be longer-term. Home to many factories in the auto industry, the economic downturn feels more like a gaping wound in these parts. Things will likely get worse as the indebted state government, the city’s biggest employer, has adopted days off without pay as an alternative to layoffs.

I am here to learn some Osteopathy. This is the modern name for a profession dedicated to manual manipulation, whose heartland is in the Midwestern US but whose roots are centuries old and spread throughout the world. It was popularized in this country by Andrew Taylor Still, the son of a preacher who abandoned medicine when three of his children died of meningitis. He developed a reputation as the ‘lightning bonesetter’ of Kirksville, Missouri and founded a school there in 1892. With a handful of teachers, he taught a generation of osteopaths who spread out across the nation.

Osteopathy is one of a handful of alternative healing professions whose dealings with orthodox medicine make for interesting reading. The DOs – Osteopathic Medicine in America by Norman Gevitz is an authoritative work about this interesting part of medical history in North America. The author focuses a great deal on the osteopaths’ struggle for legitimacy in the face of pressure, lobbying and opposition from the American Medical Association. The AMA successfully tackled the threat posed by the homeopaths and the eclectics, but somehow the DOs managed to become recognized as equivalent to MDs in the US, and can enter residency training programs to become neurosurgeons and cardiologists.

Canada has very few osteopaths. The Canadian College of Osteopathy was established here in 1982, but its graduates do not enjoy nearly the same recognition or legitimacy as some of the other manual practitioners. Chiropractors specialize in only one type of manual technique, the high-velocity, low-amplitude ‘adjustment’ that we all recognize as a cracking of the bones. They can be found all across the country, they are licensed and regulated and their services are often reimbursed by insurers. The same can be said for massage therapists and physiotherapists, but Canadian osteopaths are not nearly so well organized.

That is a shame, because this stuff works. There is very good evidence that manual medicine effectively treats many painful disorders. There are millions of people suffering with musculoskeletal pain around the world who could benefit from this simple, safe and cost-effective healing art. Many are considered invalid, unable to work, on permanent disability, labeled as sufferers of ‘chronic pain’, but many might return to the ranks of the healthy and functional if they could get proper treatment.

One of the key differences between osteopathy and the other disciplines is that the practitioner identifies and treats many lesions at the same visit, and a keen eye can recognize a few key lesions that create spreading patterns of dysfunction throughout the body. Another is that the focus is not on the bones – or the muscles – but rather on both. The various techniques, with names like muscle energy, myofascial, functional and mobilization with impulse, make for an impressive toolkit.

The notion of a healing energy or lifeforce within the body that can be enhanced by a wise clinician is centuries old, with roots in Ayurveda and Traditional Chinese Medicine, but while eastern healing traditions embrace massage, they do not specifically mention the manipulation of bones, joints, ligaments or tendons. A few ‘bonesetters’ gained wide renown for impressive cures in England. One example is Sally Mapp, who called herself Crazy Sal and garnered enough attention during her itinerant wanderings that her ‘admirable cures’ were described in the Gentleman’s Quarterly in 1736. Some have even interpreted the writings of Galen and Hippocrates as evidence that they practiced manual medicine two thousand years ago.

Physicians, including specialists, are not currently taught how to treat musculoskeletal pain using effective manual techniques. If it is not a fracture, a dislocation or something that can be seen on an MRI, it is referred to physiotherapists or left to the tincture of time. This leaves the vast majority of people with pain without a solution. What they really need is not pain killers, sleeping pills, anti-inflammatories, counseling or anti-depressants. They need to be cured, and most people who know about manual medicine and can afford to pay for it find it there. It certainly does not fix everything – nothing does – but sometimes all that is needed is a skilled pair of hands.

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