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 – hands-on 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 that 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," Mr. 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 team physicians for professional athletes.
But in Canada, the Doctor of Osteopathy, or DO, is a rarity, with only 20 licensed to practise medicine.
Mr. Jacob said he was attracted to the original philosophy espoused by physician Andrew Taylor Still, who founded the American School of Osteopathy in Kirksville, Mo., in 1894.
Dr. Still focused on the musculoskeletal system, believing that pain and illness evident in one part of the human body was related to or had its origins in connected tissues, ligaments, bones and joints.
He advocated manipulation techniques, many of which are now incorporated into modern physiotherapy, as an alternative or supplement to therapies such as medication or surgery.
Ted Findlay, a Calgary family practitioner who is president of the Canadian Osteopathic Association, says osteopathic 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 pain.
He recently saw a 70-year-old woman with spinal stenosis – the final stages of deterioration of the discs in the vertebrae, which leads to painful pressure on nerve roots.
One option would be surgery on her spine, but Dr. Findlay first prescribes manual therapy and lifestyle changes. "It might delay the day she faces surgery," he says. "My experience is that a good 30 to 40 per cent of patients will benefit from the manual therapy."
During the treatment, the patient will lie on a table similar to those used by physiotherapists and chiropractors and Dr. 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 took away the osteopathic physicians' ability to prescribe medication, the Canadian connection withered.
That's going to change, predicts William Strampel, 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," he says. "You had a great out-migration of osteopathic physicians to the United States."
By 2015, when Mr. Jacob and others are expected to graduate, a steady influx will begin going in the other direction, according to Dr. Strampel. "What we do is realign patients using muscle energy techniques that let the body move itself back in place."
He notes there are already courses in Canada for osteopathic practitioners, but 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," Annette Bourdon said in an e-mail. "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."
Dr. 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, 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. It's not rocket science. It's all connected."
Dr. Findlay worked with Dr. Strampel in an initial attempt to create Canada's first College of Osteopathic Medicine for physicians through Sarnia's Lambton College.
But, he says, the project wasn't approved by Ontario's Ministry of Training, Colleges and Universities.