Osteopathic refers to a branch of medicine built on the idea that the body’s structure and function are deeply connected, and that the body has a built-in ability to heal itself. In practice, it most often describes a type of physician called a Doctor of Osteopathic Medicine (DO), who completes medical training similar to a traditional MD but with additional coursework in hands-on diagnosis and treatment of the musculoskeletal system. There are more than 207,000 osteopathic physicians and medical students in the United States today.
The Philosophy Behind Osteopathic Medicine
Osteopathic medicine rests on four core principles, formally recognized by the American Osteopathic Association. First, the body is a unit, meaning a person’s physical health, mental state, and overall well-being are interconnected rather than separate systems. Second, the body is capable of self-regulation and self-healing. Third, structure and function influence each other: if a joint, muscle, or bone is out of alignment, the surrounding tissues and organs can be affected, and vice versa. Fourth, effective treatment should account for all three of these ideas together rather than focusing on symptoms in isolation.
These principles trace back to Andrew Taylor Still, a physician in the mid-1800s who grew frustrated with the medical practices of his era and developed osteopathy as an alternative framework. Still emphasized logical thinking, careful diagnosis, and understanding the body’s own healing mechanisms. Over the following century, osteopathic medicine evolved into a fully modern medical discipline while retaining that philosophical foundation.
What DOs Actually Do
A DO is a fully licensed physician. DOs diagnose illnesses, order tests and imaging, prescribe medications, and perform surgery, the same scope of practice as an MD in all 50 states. About 55% of DOs work in primary care, while 45% practice in non-primary care specialties like cardiology, orthopedics, or emergency medicine.
The practical difference is that DOs receive additional training in osteopathic manipulative treatment (OMT), a set of hands-on techniques used to diagnose and treat problems in the muscles, joints, and connective tissues. Not every DO uses OMT regularly in practice. Some rely on it heavily, while others practice in ways that are functionally identical to their MD counterparts, depending on their specialty.
Osteopathic Manipulative Treatment
OMT encompasses several distinct techniques, each targeting the body differently:
- High-velocity low-amplitude (HVLA): A quick, targeted thrust applied to a joint to release a restriction and restore mobility. This is the technique most people associate with a “popping” adjustment, and it’s also used by chiropractors.
- Muscle energy: The patient actively pushes against the physician’s resistance in a specific direction. This engages the muscles around a restricted area, helping them relax and lengthen so the joint can move more freely.
- Myofascial release: The physician applies gentle, sustained pressure to the fascia, the connective tissue that wraps around muscles and organs. The goal is to release tightness and improve blood flow to the area.
Other techniques include lymphatic manipulation, rib raising, and diaphragm work. A DO might use one technique or combine several in a single visit, depending on what they find during a physical exam.
A meta-analysis of randomized controlled trials found that OMT significantly reduces low back pain, with effects that are greater than what would be expected from placebo alone and that persist for at least three months. Pain reductions held up across short, intermediate, and long-term follow-up periods, and the results were consistent across studies conducted in both the United States and the United Kingdom.
DO Training Compared to MD Training
Both DOs and MDs complete four years of medical school followed by residency training in their chosen specialty. The core curriculum, covering anatomy, pharmacology, pathology, and clinical rotations, is comparable. The key addition for DO students is a series of courses in osteopathic principles and practices that run throughout all four years, covering the philosophy, diagnostic techniques, and hands-on skills specific to osteopathic medicine.
For licensing, DO students must pass the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA). Many also choose to take the United States Medical Licensing Examination (USMLE), which is the standard exam for MD graduates. Both exams are recognized by all state medical licensing boards, and the Accreditation Council for Graduate Medical Education accepts either exam for residency applications. In practical terms, this means DOs and MDs compete for the same residency positions and practice side by side in the same hospitals.
International Recognition
One important distinction: outside the United States, “osteopath” often refers to a non-physician practitioner who performs manual therapy but cannot prescribe medications or perform surgery. This has historically created confusion for American-trained DOs seeking to practice abroad.
That changed significantly in November 2023, when the International Association of Medical Regulatory Authorities passed a resolution recognizing U.S.-trained DOs as fully licensed physicians equivalent to MDs in 47 member countries. The resolution was supported by the Federation of State Medical Boards and the Association of Medical Councils of Africa. This means DOs now have a much smoother path to licensure in dozens of countries where their credentials were previously difficult to translate.
How to Know If Your Doctor Is a DO
The letters after your doctor’s name tell you their degree. “MD” stands for Doctor of Medicine, while “DO” stands for Doctor of Osteopathic Medicine. Both appear on a physician’s credentials, business card, and office signage. In most clinical settings, the experience of seeing a DO is indistinguishable from seeing an MD. You’ll receive the same evidence-based treatments, the same prescriptions, and the same referrals. The difference is that a DO may also incorporate hands-on assessment of your musculoskeletal system into a routine visit, or offer OMT as part of a treatment plan for conditions like back pain, headaches, or joint stiffness.
With the osteopathic profession growing by more than 158,000 physicians since records began in 1935, DOs now represent a substantial and expanding share of the physician workforce. If you’ve seen a doctor in the U.S. recently, there’s a reasonable chance they were one.