"Exclusive tissue": paediatrics, sports, cranial, what about osteopathy specialties?

Some osteopaths choose to focus their practice on babies, others focus their knowledge on the treatment of athletes, or still others on the psychosomatic approach of their patients.

However, it is true that, by definition, osteopathy requires us to have no restrictions on our ability to manage all types of patients. Indeed, its holistic aspect dictated by one of its founding principles, “The unity of the human body”,[1] requires the osteopath not only to understand the interdependent nature of the different systems and tissues of the body, but also to be able to act on each of these if the patient’s condition warrants it. So it’s out of the question not to take care of a depressive patient, since “I specialize in sports” or to give up the muscular aspect since “I only practice the cranial[2]”.

But can we really be blamed for having an affinity for one area more than another? I do not believe, in a natural way, we will tend to develop our experience in the areas that stimulate our interest the most. So if sport is part of your daily routine, when a patient consults you for tendonitis, it is likely that in the evening you will dive into a book looking for every detail of the tendon that caused this pain in your patient, so that the next time you are confronted with this tendonitis, you will understand all the ins and outs.

And why would you do more for tendinitis (see: tendon anatomy video) than for another pathology? Well since the intelligent Being that we are likes to make connections. However, if you have an interest in sports, you will make many more connections between your daily life and tendonitis, than between your daily life and a digestive pathology for example.

  • You will better understand the patient’s pain, because you will link it to the pain of tendonitis that you yourself have already had.
  • You will understand your patient in his desire to continue the practice of sport despite the pain, since your brain will associate this desire with that you have already experienced yourself.
  • You’re going to want to cure this patient maybe more than another, why? Because we naturally seek recognition from people who look like us, people who live in the same environment as us. In sociology, this is called our “community of reference”, a subject addressed by Rosenberg’s work[3].

In short, unless you are dutifully and perpetually fighting your natural reflexes, you will tend to develop more skills in the areas that arouse your interest than in others. This lack of competence in a specific area will result in the satisfaction of patients who correspond to the latter, so they will tend to come back more than others and advise other patients who are likely to have similar needs. That’s it, your patient is naturally oriented towards what you like to do.

At first glance, and if osteopathy is respected in the strict sense, each osteo must be able to treat or redirect all patients, regardless of their pathology. Indeed, just like a general practitioner, we are first-line therapists and just like a general practitioner, the patient should not ask whether Mr. X would be more suited to a knee problem or Mr. Y to a concern for digestion. The environment of alternative therapies is already a sacred terminology folklore between physiotherapists, osteopaths and pure osteopaths… it would not add a little more complexity with specialties.

However, in fact, it would be hypocrisy to claim that all osteos are equal in all areas. From the orientation of schools – where the emphasis is sometimes placed on one technique more than another – to the personal affinities of each practitioner, there can be a world between two osteopathic practices. Would you have been consulting Rollin Becker, (heir to Sutherland’s teachings and practising almost exclusively the cranial) as you would see Patrick Tépé the osteopath of the Toulouse Stadium? No, the same goes for anatomical areas, let’s be honest, not everyone is able to manage atM (jaw joint) in the same way, and when the concern exceeds my skills, I am the first to be happy to be able to redirect my patient to an osteo that I know will be able to help much more than I do.

So what are the solutions. Well the first thing to do is certainly to ask the question. To allow everyone to be a specialist, on his plate, on his website, on his Google page, is to implicitly believe in the eyes of the general public that a non-specialist osteopath has less legitimacy to take charge of the specialty in question. So it’s not trivial, it’s sort of a truncated freedom that serves some and serves others. However, it is also necessary to take into account the interest that the patient finds in these second lines, it allows him to be sure to set foot in a practice that corresponds to his needs. For these reasons I think that on the operational level each osteopath must keep a sufficiently broad base of practice to be able to take care of all patients at all times. It is a work and a personal commitment that is a minimum for our role as a first-line practitioner to continue. Secondly, with regard to the ethical or legal aspect, there is certainly no perfect solution at all levels, however I think that a balance is possible among the proposals: the following from the most restrictive to the most flexible.

  • The mention of “affinities” is allowed on your site, your presentations, but neither on your Google statement nor on your plate.
  • The mention of “affinities” is allowed on all media, but not on the plate.
  • The mention of “specialties” is allowed on the plates only if you justify the corresponding university degree.
  • The mention of “specialties” is allowed on the plates only if you justify a post-graduate training or not.
  • There are no restrictions on “specialties” (current situation).

Here are some proposals among others and each will certainly have his preference on where the cursor should be placed. The whole thing is at a minimum that a rule is established and that it is the same for everyone, in France at least. As far as Europe is concerned, there are many things that need to be addressed before we consider the issue.

Find my article on the treatment of babies HERE.

[1] The concept of globality in osteopathy: Marie Eckert https://www.furet.com/media/pdf/feuilletage/9/7/8/2/8/0/4/1/9782804171599.pdf

[2] Passport definition of “cranial” https://www.passeportsante.net/en/Therapies/Guide/Fiche.aspx?doc-therapie_craniosacrale_th::text-This%20th%C3%A9rapie%20tr%C3%A8s%20douce%20a,structures%20anatomicals%20 they’re 20thferment.

More information on the “cranial” :d beginning of Chapter 5 Treatment of the B.A.-BA of Cranial Osteopathy https://www.elsevier.com/fr-fr/connect/kine-osteo/losteopathie-cranienne-en-pratique

[3] Go to Section 49: https://journals.openedition.org/teth/667

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