Medical student Chris Jacob will soon learn to place his hands on patients and subtly manipulate bone and muscle in hope of relieving pain and hastening their recovery.
He's among 15 Canadians learning osteopathy ????? manual manipulation of the body to promote healing ????? as part of a pilot project at the College of Osteopathic Medicine at Michigan State University.
"This practice treats the patient as a whole being, rather than focusing on the symptoms and trying to solve what the immediate problem is," says the 24-year-old from Whitby, Ont., who applied for the program rather than less expensive Canadian medical schools.
The Canadians are paying about $40,000 each in annual tuition for a program some advocates of osteopathy hope will renew a form of medicine that has struggled to find its place in Canada.
"We essentially will be some of the pioneers to make doctors of osteopathic medicine as popular in Canada as they are in America," Jacob said in an interview.
In the United States, about 70,000 osteopathic physicians ????? who are fully qualified to practise regular medicine ????? quietly blend into the medical system, doing jobs ranging from primary-care physicians in inner cities to serving as team physicians for professional athletes.
However, in Canada the Doctor of Osteopathy, or DO, is a rarity ????? with only 20 licensed to practise medicine.
Jacob said he was attracted to the original philosophy espoused by Dr. Andrew Taylor Still, who founded the American School of Osteopathy in Kirksville, Mo., in 1894.
The Missouri physician focused on the musculoskeletal system, believing that pain and illness evident in one part of the human body had its origins or relationships to connected tissues, ligaments, bones and joints.
He advocated manual manipulation techniques ????? many of them now incorporated into modern physiotherapy ????? as an alternative or supplement to therapies such as medication or surgery.
Dr. Ted Findlay, a Calgary family practitioner who is president of the Canadian Osteopathic Association, says osteopathic manual manipulation is a key feature of his practice.
The 52-year-old doctor spends a portion of each day treating biomechanical problems such as neck and lower-back problems.
For example, he recently saw a 70-year-old woman with spinal stenosis ????? the final stages of deterioration of the discs in the vertebrae leading to painful pressure on nerve roots.
One option would be surgery on her spine, but Findlay first prescribes manual therapy and lifestyle changes for the patient.
"It might delay the day she faces surgery. ... My experience is that a good 30 to 40 per cent of patients will benefit from the manual therapy," he said.
During the treatment, she will lie on a table similar to one used by a physiotherapist or chiropractor and Findlay will use her legs as a lever to induce bending which helps increase the space between the vertebrae for the nerve roots.
It's been a long road to bring these ideas and practices back to the medical profession in Canada, he said.
In the early days of the movement, it grew rapidly throughout the country. By the mid-1920s, there were more than 200 American-trained osteopathic physicians in Ontario alone.
However, when the Ontario government removed the osteopathic physicians' ability to prescribe medication, the Canadian connection withered to today's scattered few.
That's going to change, predicts William Strampel, the dean of the College of Osteopathic Medicine at Michigan State University.
"In the 1920s there were probably more osteopathic physicians in Canada than in Michigan or the United States. You had a great out-migration of osteopathic physicians to the United States," he said.
By 2015, when Jacob and others are expected to graduate, a steady influx will begin going the other direction due to Michigan's training program, said Strampel.
"What we do is realign patients using muscle energy techniques that let the body move itself back in place," Strampel said in an interview.
Strampel notes there are already courses in Canada for osteopathic practitioners, who learn the manual manipulation techniques.
However, he says the U.S. program differs in that it is part of a full medical training.
A spokeswoman for the Canadian Chiropractic Association, which uses different forms of manual therapy, says her profession will welcome the new doctors.
"The Canadian Chiropractic Association supports patient choice and welcomes well-trained health-care providers," said Annette Bourdon in an email.
"At present in Canada, many practitioners with less rigorous training hold themselves out to be osteopaths and offer their services to the Canadian public. Graduates of a Michigan State University program can help to raise the standards of osteopathic care here and educate the public on what to expect in terms of practitioner qualifications."
Strampel argues that the osteopathic doctors are among the best-trained physicians in the world as a result of the added knowledge.
Even on matters as simple as a sprained ankle, their approach may differ from conventional medicine, he says.
While a medical doctor may prescribe taping, icing and elevation, Strampel says an osteopathic doctor will consider the next connected bone joint ????? the head of the fibula in the knee.
"I would look at your knee because nine times out of 10 you're going to upset the fibular bone at the knee and if I don't correct that your ankle will take a week longer to heal up," he said.
"It's not rocket science. It's all connected."
Findlay says that when osteopathic physicians work on a patient's body they often discover symptoms as they work.
He gives the example of a patient he recently was working with to manage fibromyalgia syndrome.
"I found evidence of a thyroid nodule that I sent for biopsy, and the results are unfortunately malignant," he said.
Findlay initially worked with Strampel in an initial attempt to create Canada's first College of Osteopathic Medicine for physicians through distance education based at Sarnia's Lambton College.
However, he says the project wasn't approved by Ontario's Ministry of Training, Colleges and Universities.
Strampel said the resistance prompted him to create the 25 spots for qualified Canadians at his college ????? one of 31 colleges that produces osteopathic physicians in the U.S.
?? The Canadian Press, 2011