Under the spotlight: osteopathy

Osteopathy has become a conventional alternative medicine and is even available on the NHS. Arthritis Digest reviews the evidence

‘Have you tried an osteopath?’ is a common question, but how many of us actually know what they are, what they do or how to find the right one? We’ve checked out the science, spoken to an expert and found some true stories for readers to digest.

What is osteopathy?

Osteopathy specialises in the diagnosis, management, treatment and prevention of musculoskeletal and other related disorders. It includes a range of techniques that include soft tissue massage, articulation and mobilisation and spinal manipulation. Other approaches may also be used if they are relevant to the symptoms reported, the area of the body treated and an individual’s preference (such as acupuncture). 

“Treatment aims to achieve a range of outcomes including the reduction of pain and improvement in functional mobility – for example by optimising the range of movement in joints,” explains Dr Dawn Carnes, director of the National Council for Osteopathic Research.

An osteopath will also advise people about the best ways to reduce inflammatory changes or stiffness in daily life, based on the latest scientific findings.

Osteopathy is available within the NHS but provision varies across the UK, so depending on where you live you may be able to access it.

“Some Clinical Commissioning Groups are contracting osteopaths, chiropractors and physiotherapists to deliver neck and back pain services through the Any Qualified Provider system,” outlines Dr Carnes. “Some osteopaths are registered with the NHS as a qualified provider so in these cases patients can be referred by their GP to an osteopath and the NHS will meet the cost of treatment.”

Osteopathy and arthritis

Many people who go to osteopaths with musculoskeletal symptoms actually have osteoarthritic issues. In these cases, treatment focuses on reducing pain and increasing mobility on an individual level, ie there is no “one size fits all” agenda.

“This is achieved by using a ‘package of care’, which normally includes manual treatment, discussion and advice relating to self-management and appropriate exercises,” Dr Carnes explains. “The osteopath will tailor treatment to the extent, severity and re-activeness of the arthritis and the needs and wishes of each individual patient.”

For those who have rheumatoid arthritis, some techniques are not used on the neck because of the bone and ligamentous changes in this area. And treatment is not administered to actively inflamed joints.

Side effects

A range of studies have looked at reactions to treatment that can be associated with osteopathic care and the evidence suggests that serious problems are rare.  

“Recent research carried out in 2013 that looked specifically at osteopathic practice found that the most frequent reaction that occurred in around 20% of patients was an immediate short-term increase in pain/symptom intensity,” says Dr Carnes. “Other reactions included stiffness, fatigue and headache; these are normally short-term reactions that resolve within 48 hours and were felt by affected patients to be acceptable and well managed.”

Osteopaths are trained to be vigilant about known risk factors and presenting symptoms that contra-indicate treatment, and aim to identify these from thorough case history taking.

The process

Initial appointments take around an hour, during which time the osteopath will ask questions about the problem and record information about any other medical care, medication and medical history. Then you will be examined so expect to remove some of your clothing (a gown or towel will be provided). Ask a family member or friend to accompany you if you are uncomfortable.

The osteopath will ask you to make simple movements and stretches to observe your posture and mobility and will examine the health of the joints, tissues and ligaments using their hands and a highly developed sense of touch called palpation.

A full explanation of the diagnosis and treatment plan will be outlined, and if for any reason you are deemed unsuitable for osteopathic care, the osteopath will refer you to a GP or another healthcare professional.

Treatment involves skilled manipulation of the spine and joints and massage of soft tissues.

“The choice of techniques for a particular patient is based on a range of factors including their age, general health, the suspected cause of their symptoms and the patient’s preference,” says Dr Carnes. “Ultimately treatment choice is based upon discussion between the patient and the osteopath consulted.”

The osteopath should explain what they are doing and ask your permission to treat you. You should feel able to ask questions and voice concerns at any stage. Benefits and any risks of their recommendations will be outlined along with the likely number of sessions needed.

And advice on self-help measures and exercises that will aid recovery and prevent worsening of symptoms should be given.

Because of the physical nature of the treatment, it is not unusual to sometimes feel sore in the first 24–48 hours after treatment.

Cost and choice

If you aren’t lucky enough to receive osteopathy through the NHS – or tap into health insurance – expect to pay £35 to £50 for a 30-minute session. Price varies depending on the experience of the osteopath and the location of the clinic.

If cost is a concern, another option is to visit an osteopathic training school where students are supervised by qualified osteopaths.

Generally, however, the first point to consider when looking for an osteopath is that he or she is registered with the General Osteopathic Council, the regulatory body for osteopathy.

“Individual osteopathic practices should be able to provide information about the osteopath, the clinic, what the treatment involves, payment methods and anything else you might want to know in advance of your first visit,” advises Dr Carne.

Many people prefer word of mouth recommendations, so ask friends and family if they have visited an osteopath recently, what kind of experience they had and the outcome. It could be the decision that makes all the difference to your quality of life.

Further information

The General Osteopathic Council, visit www.osteopathy.org.uk or tel  020 7357 6655. 

Recent support for osteopathy:

• Osteopathy is a recommended treatment in European Guidelines (2004) for the management of chronic and acute non-specific low back pain.
• The National Institute for Health and Clinical Effectiveness in the UK recommends a course of up to nine sessions of manual therapy for the treatment of persisting low back pain (NICE 2009).
• Three large studies compared spinal manipulation for low back pain with other treatments and showed positive effects (UK BEAM Trial Team, British Medical Journal 2004; Licciardone JC et al, BMC Musculoskeletal Disorders 2005; von Heymann WJ et al, Spine  2013.
• Review studies have shown that manual therapies are helpful for neck and low back pain (Furlan AD et al, Evidence Based Complementary Alternative Medicine 2012; Vincent K et al, Joint Bone Spine 2012.

Jane Streetly, 51 years old, interpreter

“I have been going to a brilliant osteopath in London for about two years, roughly six times a year – since I hurt my back on a trampoline. She fixed that but has helped with other things too. Apparently one leg is slightly longer than other and that has affected my posture causing other back problems. I have had some vertebra compression and sciatic pain as a result… she has shown me a great exercise for that which is easy to do and brings immediate relief.

“By helping to correct my posture (through some hands on work but very little manipulation and via some simple exercises that I try to do daily) I find I am standing a lot better and get almost no back pain at work, which I frequently used to get. She also helped with tennis elbow.

“I have found osteopathy is helpful for specific complaints, general maintenance and posture – all necessary as you get older.

“She was recommended highly to me. I would be wary of finding someone via an advertisement; you don’t want to mess around with your back.”

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Paul Walton, 68 years old, solicitor

“Being tall, I experienced lower back pain for a long time, but monthly visits to an osteopath in Liverpool for over 20 years have been a great help and actually eliminated the problem. Since then I have had sporadic middle back pain and neck pain, which the osteopath sorts out for me using manipulation.

“We get our cars serviced regularly, even when there’s nothing obviously wrong with them, so we should get our bodies seen to too.

“As well as manipulation, my osteopath gives me advice about my posture, breathing and exercises. He was highly recommended to me, I like his attitude and he’s effective – it works. From time to time I have tried other osteopaths who are more conveniently located, but haven’t found anyone else as good.”

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Zoe Hewetson, 52 years old, conference interpreter

“I visited a cranial osteopath about eight times over a period of three months because of headaches and a stiff neck and shoulders. The osteopath always focused on my head, neck and shoulders, and did help a little to begin with but not as much as I had hoped. Some lingering tendonitis was sorted out, but she didn’t get rid of the headaches.

“It is very important to find the right person for you. You need to trust the practitioner and feel they are committed and interested; the right osteopath can work wonders.”