This is an unusual post: it is by an osteopath who sent it to me for publication but insists he does not want to be named because he is still working in the profession. I think he has an interesting story to tell and therefore agreed to publishing his article, even though its author has to remain anonymous.
I graduated with an honours degree in osteopathic medicine in 2000 and remain registered as an osteopath. I am writing to help others avoid the same errant thought patterns that I developed, when assessing osteopathy.
My venture into the world of osteopathy began, as I am aware many have, with the assurance that osteopathy is far better than physiotherapy. There is an established musculoskeletal pathway in this country provided by physiotherapists and to wish to practice a therapy other than this, one must be sure that it is superior to physiotherapy in many aspects: effectiveness, remuneration, job satisfaction etc. And this belief was drummed into me ad nauseam by virtually all the osteopaths that I encountered. Despite hearing this for over 20 years, I have yet to see any evidence that it is the case.
The manipulative therapy at the heart of osteopathy should be a focus of strong suspicion. It is obvious that the cracks and pops elicited from spinal and peripheral joints are nothing more than a placebo party-trick, but it is a key feature of the treatment taught and practised by osteopaths throughout the country. In fact, the evidence appears to contradict the structural/mechanical model that underlies osteopathy. Spinal alignment, muscular and postural imbalances are seemingly not predisposing or maintaining factors for many musculoskeletal conditions, despite what continues to be taught in osteopathic colleges. It is hugely underappreciated that most of the factors deemed by osteopaths to be significant to a patient’s symptoms are prevalent in asymptomatic people.
The reality facing osteopaths is that spinal and musculoskeletal pain in general is so little understood, that you can only be confident in your ability to ‘treat’ it with osteopathic manipulative therapy by ignoring the complexity and opacity of the problem. Chronic low back pain for example, is such an obscure entity that it seems the success of one practitioner over another has little or nothing to do with their technical knowledge or ability, and more, maybe, to do with interpersonal dynamics. This makes for a frustrating and somewhat embarrassing career, given that the technical side of much of the work is a charade. I saw no objective reason to believe that I could do significantly more good for a patient than could be done with some basic exercise and possibly a massage.
When I graduated, there was widespread debate over whether dysfunction of the lumbo-sacral joints or the sacro-iliac joints was the most significant factor in back pain. Some osteopaths focused on one area, others on the other. I didn’t however perceive a difference in results from either group of practitioners, or from me, when switching between the two models. In fact, if I made no attempt to differentiate between the two, still no change. This proved true across the board – little or no change in outcome from a wide variety of approaches to the same issue. This is the nature of osteopathy; it is mostly vacuous as a form of assessment and treatment.
A common remark amongst osteopaths is that if you see ten osteopaths, you will get ten different diagnoses. This has consistently been my experience with my own symptoms, those of friends and family, and clinical observation. Good luck developing your ‘skill’ in that environment. Inter-practitioner repeatability was virtually non-existent when assessing the position and function of most joints of the body, especially the spine. If it is not repeatable (and very little in osteopathy is), then it is not science.
Confirmation bias was a huge factor in my education. ‘Successes’ were celebrated and failures ignored. We enjoyed reports from patients of how much good we had done but had practically no training in how osteopathy relates to scientific evidence. We still don’t have a decent body of research as to how it fares as a therapy compared to other approaches, or how specifically osteopathic treatment outcomes differ from the natural progression of symptoms.
Osteopathy is so far removed from mainstream medicine that it has been possible to build and maintain it on a foundation of anecdotal evidence; born of a vague perception that it must be superior to large institutionalised medicine, which is inherently inept and corrupt. There is an awareness amongst osteopaths that the evidence for osteopathy is pretty much all anecdotal but there is a faith that it will be proven effective once tested properly. Never mind the fact that anecdotal evidence is the worst form of evidence and you should not follow a system of healthcare produced by it. It is worse than no evidence, because when heeded it can lead to believing falsehoods that seem true. In osteopathy, the scientific method has largely been ignored for groupthink and indoctrination.
Osteopaths in private practice (which is most of them) encounter huge financial pressure to over-diagnose and over-treat. Most episodes of musculoskeletal pain should be viewed as a normal part of life. They are self-limiting and do not require any formal intervention. Unfortunately, people’s anxieties are perpetuated by osteopaths who pander to the worried-well, to maintain the core of their income. Best practice for the majority of people seeking help from an osteopath is reassurance and advice to stay positive and active. This doesn’t pay well, so instead patients are given a course of manual therapy and extended ‘maintenance sessions’, both of which are of little to no short-term benefit and absolutely no long-term benefit.
But we all know that osteopaths earn more than physiotherapists right? Again, no clear data. In my experience of working in private multi-disciplinary practices, the flow of work heading the way of physiotherapists is far more consistent, given the long-established referral pathways from within the NHS and private medical insurance. Also, the NHS provides solid financial benefits and security that are not available in the parochial, private environments that osteopaths have to work in. Public and student perception of the likely earnings of an osteopath is remarkably high but there is a large swathe of osteopaths that never make a decent living from it. It is tragic to see otherwise intelligent people plough their money, time and effort into an alternative medicine cult. The same time and money could be spent pursuing a career that offers a net benefit to society and provides significant opportunity for personal development and progress, intellectually and financially.
The exultation of historical leading figures, derision of those questioning the status quo, veneration of tutors, delusions of grandeur and unshakable faith in the veracity of osteopathy are difficult influences to identify and navigate as a young student. Undergraduates need to be taught to think critically, both scientifically and philosophically. And this is especially crucial in the quagmire of alternative medicine; as the world is awash with misinformation about health. We should engender a clarity of thought, appropriate scepticism and strength of character that enables people to call bullshit sooner rather than later, in the face of such patent nonsense.
Numerous times I have been assured that osteopaths receive a similar level of education to doctors (albeit for a shorter duration), however, the serious academic training that occurs in actual medical schools makes this claim risible. Osteopaths mostly seem to think far too highly of their training; which is, in fact, fairly rudimentary. (Speaking as someone who has recently observed for a number of days in a leading teaching clinic in the UK.)
If you wish to study a musculoskeletal therapy, please, for the sake of your mental health, your financial income, your family and the good of the public; study physiotherapy. There is value in helping people deal with physical pain, the use of therapeutic exercise, and certain forms of manual therapy. Osteopathy, however, has nothing uniquely effective to offer and forms one of the most over-rated careers imaginable.
51 Responses to OSTEOPATHY – NOT ALL IT’S CRACKED UP TO BE
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“The manipulative therapy at the heart of osteopathy should be a focus of strong suspicion.”
He also writes that osteopathy is built on a foundation of anecdotes, something he calls “. . .the worst form of evidence.” Further “. . you should not follow a system of healthcare produced by it.”
Yet, he still practices it. He is still out there taking people’s money for sham treatments.
As worrying, is that he is anonymous. The world—and social media, in particular—is full of people like him who hide behind pseudonyms. If they have conviction in their beliefs—no matter what those beliefs are—at least have the balls to stand behind them. Otherwise, your comments are like bad science, they don’t move the needle an inch.
and what if he is preparing to start a new profession?
I see your point. But there is no shame in finally seeing the light. In fact, to me, it’s laudable. He’s showing an honesty that I admire, even if it comes a little late in the game.
And, you know, he’s admitted that he simply fell for all the hype. Once he got in and saw for himself, he did the right thing.
But, again, I see your point. The medical professional is not as forgiving as it could be.
‘Annonosteo’ is to be congratulated on his insight and forthrightness in setting down these issues. Thank you very much.
I can understand why he wants to remain anonymous – but he owes it to us to explain a few points:
1. Why did he decide to train as an osteopath in the first place, and not as a chiropractor, physiotherapist or doctor?
2.Did he really not inquire prior to training and appreciate that osteopathy is an alternative health system based on pseudo-science? Was he gulled?
3. Why did he “wish to practice a therapy other than (physiotherapy)”.
4. Was he ever aware of osteopaths eliciting the ‘cracks and pops’ by using a magicians’ gag cracker concealed in the therapists hand?
I’ve known chiropractors do this.
I should not reveal the full routine – suffice it to say Paul Daniels was one exponent of the ‘Electric Chair’ trick.
5. Is he aware that if you see 10 doctors you generally get at least 15 diagnoses?!
6. What percentage of UK osteopaths have his insight and understanding – in his opinion.
Given his current insight, I sense Annonosteo would have made a fine doctor.
Is it too late?
Thank you for your kind words Richard.
1. With a sports background, I was initially drawn to physiotherapy. But virtually everyone I knew and trusted with an opinion on the area assured me that osteopathy was superior as a form of diagnosis and treatment to physiotherapy, which didn’t get to the root cause of musculoskeletal issues. They also gave the impression that chiropractic was quackery. Once I started studying, these opinions were so often and confidently asserted that it never occurred to me to question them. I didn’t have the grades for medicine.
2. Really, I was 18 and gullible.
3. As 1, plus I was assured by other osteopaths that I would earn more money.
4. No. I did hear stories of people accidentally breaking a pen in their pocket whilst performing techniques and allowing it to be perceived as a joint popping. Probably urban legend.
5. Hehe – yes. But I presume that at least some have a reasonable chance of accounting for the presenting symptoms. A diagnosis made within a postural-structural-biomechanical framework is probably wrong by definition.
6. At a guess, less than 5%. There is one high-profile person that I know of that is publicly pushing for reform but their impact seems negligible. I wonder whether a truly evidence-based approach to musculoskeletal healthcare is hard to monetise.
I’m the wrong side of 40 and have 2 young kids, so definitely too late to study medicine. But thank you for the compliment. And the new name!
For the record, I am non-practising but working in a related field, so need to maintain my registration.
Hi Anonosteo,
Just to show you are not alone with having concerns regarding MSK healthcare – have a read of this blog post by a physiotherapist
https://medium.com/@NewGrad_Physio/time-for-a-change-695ee48d73f2
All the best
Thank you.
BTW. You have a right to keep certain private info private.
PTs have led the way in research in the manual medicine field. This is especially true in the treatment of pain.
The new model is a biopsychosocial model not a mechanical model.
This has been as much as a wake up call for PTs as any other manual therapist out there.
We all need to drop the old paradigms that we picked up at college and read Explain Pain, Butler etc
Annonosteo, your further frank explanation is much appreciated, but inevitably raises more questions!
1. You seem to have received the opinions of “virtually everyone (you) knew and trusted” uncritically. How come? On what basis were they advising you “osteopathy was superior as a form of diagnosis and treatment to physiotherapy”? Evidence?
Diagnosis and treatment are in the domain of medicine (which has high entry grade requirements for very good reasons) – physiotherapy offers treatment (the clue is in the name) and osteopathy was founded as, and continues to be, an alternative health care system to that offered by the conventional professions because it is based on false, alternative, pseudo-science.
How did you choose between osteopathy and chiropractic?
Both were founded by magnetic healers, students of Paul Caster, and D.D. Palmer in fact studied A.T. Still’s osteopathy for a while before going on to found his own proprietary system which he described as “being founded on different principles to those of medicine.”
2. We are all gullible at 18, which is why it is so important to have these issues aired and appreciated by young students before they are misled and take an unwise career path.
3. If the only way to earn more is to cheat, gull, quack and mislead patients, that is to be deprecated.
4. I bet the ‘urban legend’ is based on the practice of many spinal manipulators.
I’ve seem ‘em at it – and being a magician, I know the methods!
As an orthopaedic surgeon I never got an apophyseal joint to crack, even when using a bone lever at open operation.
5. I think most medical practitioners do now recognise the strong psychological/emotional components of many presenting complaints.
6. Most interesting – and thereby lies the problem. It’s hard to see any resolution.
If ‘osteopathy’ (and ‘chiropractic’) were to be honest, practitioners would have no practice.
(Which is perhaps why they are tolerated by governments who want some form of healthcare for the population, and for employment not to fall.)
That has to be contrasted with conventional medicine whose practitioners are ethically obliged only to practice in areas in which they are competent, and to ‘move on’ when plausible reproducible research better informs their practice.
I know not all do so, but they are supposed to do so.
Not so camists – practitioners of complementary and alternative medicine.
All I ask is that patients, the public, and politicians are fully informed of these issues – not least, by following Professor Ernst’s blog. And that putative students of musculo-skeletal therapies study and qualify, if not in medicine, then in physiotherapy – setting aside anachronistic concepts of ‘liberation of vital forces’ and ‘release of innate’ (!).
(For the record: I too maintain my GMC registration for work I do outside the clinical domain – for which I am no longer licensed.)
Dear Anonosteo, i had 10 years very intense training in cranial osteopathy that cost me a hugh amount of money. Nevertheless when i discovered the frauds and tricks in this kind of widespread pseudoscience i abandoned it in 2009 and continued to work simply as a physiotherapist that i am since 1995. Since 2013 i have been collecting all available reasonable against osteopathy and you are invited to have a look at my blog: http://relaxman-redaktion.blogspot.com
I also brought in court several colleagues who promoted osteopathy illegitimate. That also cost me a lot of money. Best regards Volker H. Richter
…all available reasonable knowledge…
I can’t speak for UK osteopaths but here in Australia we have started dropping parts of our
University courses in order to move towards a more evidence-based practise. I remember at Uni 15 years ago thinking ‘we’ll that’s clearly unlikely or utter nonsense’ and made a decision that I won’t be practising certain philosophies being taught. Talking to my fellow osteopaths I know they had similar thoughts. I tell a vast majority of my patients that there’s not much wrong with them. I tell them the best they’ll get from my treatments is temporary pain relief. Despite that I see nearly 60 patients every week. I explain if they want to reduce or get rid of their pain they need to improve lifestyle and posture habits and commit to regular exercise. I try to convince them their pain is mostly a normal reaction to their behaviour in the light of the state of their health and fitness. Chronic pain is a different kettle of fish. Too often Osteopathy is judged by the treatments and not the practise of the osteopath.
so, what sort of manual treatment does an ‘evidence-based’ osteopath administer, and for which conditions?
Dear Anonosteo, thank you so much for writing this insightful testimony.
I live in Canada and I’ve been looking into osteopathy for a while, as it’s increasingly popular here and osteopaths are about to join a professional Order (i.e. becoming licensed healthcare professionals). Meanwhile, pysiotherapists are losing a lot of ground, as osteopaths are taking over. Physiotherapy Is relegated to severe cases only, eg. car accidents.
Two quick questions:
1) How much of an osteopath’s work is evidence-based in your opinion, or makes any kind of sense? Osteopaths in Canada do some physical therapy, that’s why I’m asking.
2) In your opinion, what are the most importants things we should say to the public regarding osteopathy that would allow them to see the reality behind it?
Thanks again!
Thanks for your comments Olivier!
Interesting to hear about the situation in Canada.
1) I am inclined to think that none of that which is distinctly ‘osteopathic’ is evidence-based. That’s not to say that there isn’t evidence that physical therapy is of some benefit when combined with exercise.
2) That body shape/posture/structure/biomechanics are unlikely causes of pain. To quote Eyal Lederman: ‘…research findings in the last three decades have challenged the plausibility of the Structural Model and imply that the role of osteopathy in supporting health and recovery needs to be reconsidered.’
That generally, the body (and especially spine) is not fragile and in the vast majority of cases of musculoskeletal discomfort, doesn’t require an expert to fix it for you.
Best wishes.
Hi Olivier,
Living in Qc, I can relate to the testimony offered by Anonosteo.
To attempt to answer your questions
1) None of it is evidence based. Not any “classical” osteopathy at least. Most manual therapy isn’t evidence based, and the little that might be is not at all at level of the claims that are made. This would include physiotherapy, although they have a head significant head start in relevant research.
2) That’s a loaded question. Much has been said about chiros, homeopathy, acupuncture, etc. Even you actively participate in educating the public, to the best of your ability! Have you figured out the best way to make the public see the reality behind any of these topics? Do you have a reliable success rate? Most professionals who undergo the 4000+ hours of education in osteo don’t see it. It’s a lot to ask the public to make that call, even though it’s a worthy endeavor.
That said, the case made by the CDM on medical malpractice concerning one of our most revered osteopathic institutions didn’t bat an eye. It was all a hyperbolic media wash-out that only nurtured the cause for a certain group to promote the need of a professional order. The more optimistic bunch say that when osteo will see the day in Uni, the research needed to justify its claims in an academic milieu will set things straight.
I believe it’s wishful thinking. The process in all the involved bureaucracy is a slow and tedious one. Even physios have a very hard time getting on board with painscience, neurobiology and the biopsychosocial model event though it’s all been around for 20+ years, pushing forward.
Anyway, as an osteopath, massage therapist and personal trainer, I’m also looking for ways to educate the public about this but I’m also very cautious about not being too confrontational. People want to feel better, whether its scientifically right or just bullshit and they’re willing to believe anyone, as long as they receive a convincing story.
Your two questions are way too broad. It’s slightly unfair to attempt a significant answer, especially when I’ve read post after post, year after year of ongoing polemics and disagreements between professionals, let alone laymen on the legitimacy of manual therapy.
If it talks like a quack, walks like a quack and quacks like a quack – it’s a quack!
You’d do best to duck out of having anything to do with it.
Oh dear Edzard have you fallen to such depths that you have to pretend to be sharing on behalf of an anonymous osteopath when in reality it is yourself of one of your cronies that has written this drivel.
No Osteopath, that has been working for 20 odd years, would supposedly stoop to such a level to a) claim that (scuse the pun) its not all its cracked up to be and b) be continuing to practise in the profession.
Let’s say for arguement’s sake that it actually was an osteopath that had written this. He/She obviously does not understand and has never understood, for the 20 years he/she has worked, the concepts, principles and models that are used to successfully treat someone. If he/she cannot determine the difference between a lumbar-sacral issue or an ilio-sacral dysfucntion then I’m not surprised he has had such a hard time in practice and has basically had to pretend to be doing a good job, therefore yes purely himself pandering to the needs of those in pain but not actually fixing anything. Guilty of doing bugger-all I strongly believe, and not taking any responsibility for their own ineffectiveness and instead taking it out on those nearest and dearest in his own profession.
The notion that all accounts of successful treatment are purely anecdotal are ludicrous – please widen your field of research and if anything just look at the research works of Kapandji, Kuchera amongst others (if you need to remain purely structural and understand what the hell you are doing), if you need further more recent research to show effectiveness and true stats of osteopathic treatment I will be MORE than happy to provide.
To declare that the level of knowledge of undergraduates is below par when they themselves cannot seem to determine the root cause of symptoms presenting is basically laughable so should really be struck off the list of complaints as they should certainly be looking at themselves in the mirror to decide who has less knowledge.
by the way, what year of undergraduate is being mentioned? because if its a 1st or 2nd year then no, they are only just really starting to understand their base of knowledge.
Actually this is all rather boring because i go back to my original point of whether this is actually written by an osteopath because grammatically noone would put themselves in the third person as much as this supposed Osteopath has in this ‘admission of guilt’
Low Edzard, painfully low.
the one who is low here is the one who accuses me of hiding behind an anonymous.
you must be blind, deluded, stupid or all of this to think I wrote the post myself.
None of your suggestions on my state of mind or character are correct. I am very clear in what I am saying and find it utterly disturbing that this has even been posted by you in the first place. You really do have a mountain of a chip on your shoulder.
When you decide to try and support your claims of ineffectiveness of osteopathy you constantly omit relevant current research to remain biased. Wasn’t this one of the reasons you were fired from your university position many moons ago? For your biased and deluded opinion.
And your ‘papers’ that you have written constantly omit relevant CRUCIAL data and you have been shown to be categorically wrong in many of your apparently educated opinions. So i stand by what I say, just admit it Ernst.
I think you should stop posting lies:
I tend to quote systematic reviews which, by definition, do not omit relevant research.
I was not fired from my Exeter post; in fact, I am still emeritus professor of the uni Exeter.
you really need to calm down and stop lying.
I’m calm, thank you for your concern, not needed.
You quote SOME data from systematic reviews, not all, therefore omitting specific data because it doesnt support your flaky theory which results in flawed opinion. You need to do better more substantial research, it will disappoint you as you will find that your vitriolic towards the osteopathic profession has been a waste of time which could have been better spent on enjoying your retirement , possibly even getting some therapy for your bizarre anger issues that you take out on different primary health care practitioners (yes primary health care not alternative medicine). Live a little Ernst, maybe go and have a session of effective Osteopathy (unlike whatever it is that anonymous osteopath does) might help you relax a little
thank you for trying to teach me my business.
and thanks also for tacitly admitting that you have been lying (fired from Exeter).
I didnt tacitly admit anything, just forgot to add it to my reply, thanks for reminding me. You were asked to leave, its not a secret.
And its nice you sent me a link of further nonsense spouted by yourself, its a shame you cant take responsibility for the very accurate fact that your work is wrong. You have to feel that it is the masses that are incorrect. Carry on with your cute vitriol if it makes you feel warm and fuzzy inside.
thank you for re-writing my very own past; it has just one flaw: you continue to lie!
you could, of course, read it all up here:
https://www.amazon.co.uk/Scientist-Wonderland-Searching-Finding-Trouble/dp/1845407776
but you probably won’t, as you are not interested in the truth.
Dear “Imnotstupid “,
two comments:
1. Thank you for putting a smile on my face, I indeed find it very funny that you accuse one of the most well-known and outspoken critics of CAM therapies of hiding his opinion behind an anonymous post on HIS OWN blog 🙂
2. For your own anonymous posts, you definitely chose the wrong pseudonym
A patronizing tone, caustic comments, a know-it-all attitude, arrogance, overstatement, unfounded accusations, anonymity. . . any or all of these tell me a writer/speaker has weak arguments and is not to be taken seriously.
Enough said. Next, please.
Patronizing? When we have had to put up for too long with the pathetic tactics that ernst pulls to tell us what we are doing in our profession and claim wrong-doing. Not a know it all, but certainly know a bloody site more than the ones condoning the profession here. Caustic, no, irritated yes. Overstatement? The only overstatement is by Ernst’s contemptuous accusations towards osteopathy. Unfounded accusations? No I’m afraid not, dear (yes that was me being patronising now – try and see the difference)
stop foaming from the mouth and read this:
https://edzardernst.com/2012/12/ad-hominem-attacks-are-signs-of-victories-of-reason-over-unreason/
‘Osteopathy’ was invented by a disgruntled magnetic healer who failed to follow his father into the medical profession, and then sought to justify what he was up to by making assertions for which he had no evidence.
And no plausible, reproducible evidence has been adduced since to suggest osteopathy, chiropractic or physiotherapy have any substantial beneficial differences.
So please Mr Imnotstupid, answer the most critical questions I posed Anonosteo (above) and which he has courteously answered:
How did you choose between osteopathy and chiropractic?
Both were founded by magnetic healers, students of Paul Caster.
Just what do you perceive to be the difference?
And why did you not first qualify as a doctor, before studying osteopathy as a post-grad?
Thank you for enlightening us.
Hi Notstupid
Please take my anonymous word for it that the post is genuine!
My concern is that there isn’t good research to show that osteopathic manipulative therapy (a structural model) fares better than any other system of manipulative therapy when it comes to low back pain. What does osteopathy have to offer that has been shown to be uniquely effective?
Further, as I said above, it seems that there is good evidence to show that postural/structural/biomechanical factors are not generally predisposing and maintaining factors in back pain. Which helps to explain why, in my experience, it makes no difference to treatment outcome to differentiate between lumbo-sacral and sacro-illiac dysfunction. I didn’t have a hard time in practice. I just noticed that if you don’t apply the osteopathic structural model, your treatment outcomes remain the same as those who use it rigidly.
he will think that I am the author!
I have to agree. It’s amusing. It’s like watching a child tell stories. You know it’s all made up but you listen anyway because of the smile it brings to your face.
I don’t know who Steve Maraboli is, bult I have to agree with what he said about haters:
“I don’t worry about the haters… They are just angry because the truth I speak contradicts the lie they live.”
Yup.
@Imnotstupid
You mentioned “the research works of Kapandji, Kuchera amongst others” as examples of non-anecdotal evidence of the efficacy of osteopathy and offered to provide “more recent research to show effectiveness and true stats of osteopathic treatment”.
I’d certainly appreciate your providing references to some recent research that demonstrates efficacy of osteopathic manipulations. The references should of course be to studies that are authentically scientific in design and robust in their findings.
I looked up Kapandji and Kuchera (each plus ‘osteopathy’ as a Google search). If it’s IA Kapandji you mean, he’s clearly a prolific author of books (mostly called Physiology of the joints and published in several volumes). On Medline, he shows up as the author of 17 publications, none of which is a study of the efficacy of osteopathic manipulations.
Where Kuchera is concerned, there appear to be two Kucheras linked with osteopathy, W.A. and M.L. Conveniently they are co-authors of a couple of books on osteopathy. A Medline search reveals a total of 14 papers by WA or ML Kuchera. Three of these (all authored by ML and not WA Kuchera) are described as ‘pilot studies’ of efficacy of osteopathic manipulations (in cervical hysteresis, paediatric otitis media and females with multiple sclerosis). From the abstracts, one can easily deduce that none of these studies come anywhere remotely close to providing serious evidence of the efficacy of osteopathic manipulative therapy.
Is this really the best kind of evidence you can offer? Your comments amount to rants against Edzard Ernst and his integrity. Which would be fine if they were backed up by something substantive. Please do provide the evidence you promise, so readers of this blog can judge for themselves whether you are a sensible source of realistic scientific evidence or merely exhaling hot air.
@I’mknownasstupid: me thinks the lady doth protest too much…it’s apparent to all of us your inanity could only mean one thing; you are a Chiropractor! Telling us “you are not stupid” (we’d not be able to tell otherwise), defending random bone-cracking as healthcare and casting aspirations toward science and logic gives you the trifecta! No need to hide yourself, counseling, proper medication and a few months of exercise Rid you of many of the symptoms.
The lastest review i have seen concluded…
” The comparative effectiveness studies reported
outcomes for varied health conditions and the majority (n ¼ 6) demonstrated a high risk of bias. The
economic evaluations included a range of analyses and considerable differences in the quality of
reporting were evident. Despite some positive findings, published comparative effectiveness and health
economic studies in OMT are of insufficient quality and quantity to inform policy and practice. High
quality, well-designed, research that aligns with international best practice is greatly needed to build a
pragmatic evidence base for OMT.”
https://www.google.com/url?sa=t&source=web&rct=j&url=http://www.quotidianosanita.it/allegati/allegato1318297.pdf&ved=2ahUKEwjelL-WvMjeAhVFzoMKHVKeC24QFjAJegQICRAB&usg=AOvVaw0nqIbtmDrzmxqLGObQZ0VQ&cshid=1541806372750
I am an American physical therapist who studied for five years at the Canadian College of osteopathy.
I love both professions and use both in my practice.
It does not make sense to compare osteopathy with physical therapy.
Osteopathy is a manual therapy
Physical therapy includes manual therapy as well as therapeutic exercise, postural work, ergonomic training and so on.
Most patients need more than manual therapy to get better. But manual therapy can be a valuable component. But it can only go so far, proven or unproven.
Thank you for comparing osteopathy with physical therapy.
But why did you study osteopathy in the first place?
Hi Richard – I am an osteopath. I doubt that I have the wherewithal, time and resources to respond to every question and heckle on this post – either current or arising from my words – so I will apologise in advance. I would pick up the baton to your question “Why study osteopathy in the first place?”? (Deirdre – please chip in. My input is a contribution rather than a hijack of yours).
Richard, I considered being a GP or surgeon, but neither pharmacology nor surgery are my path. GPs must work to desperately tight time limits, and I know that I can’t offer my best in those circumstances. I’d have found that stressful and dissatisfying. Surgery – just not my thing, but I applaud you that it is yours.
I considered physiotherapy as a profession. I don’t know how things are nowadays, but in the UK in the 80s, the GP determined the patient’s diagnosis, and typically instructed the physiotherapist as to treatment. Physiotherapists felt – and indeed were – quite disempowered and felt varying degrees of frustration due to the loss of autonomy. I recall being told that the Professions Supplementary to Medicine Act (1960) had much to do with this. You may know much more about this than I. Certainly our UK physio colleagues are welcome to support or correct my recollection.
A friend suggested osteopathy to me, and I researched this – as much as a 20-something year old might, weighing in with a complete career sidestep, loss of income from dropping the career path I had embarked upon, etc. I saw in osteopathy a profession that allowed for:
* Time with each patient or client. (I currently offer 40-minute sessions, which works well),
* Time allowed to question, to listen, to determine if the case falls within my scope, and to offer advice or direction,
* Time to obtain informed consent, time to examine, time to consider differential diagnoses and a working diagnosis,
* Time – with consent – to treat. (Treatment may compromise any of a combination of hands-on techniques, lifestyle advice, simple ergonomic advice, simple stretches and exercise. Referral on to another practitioner. Etc.)
* Most importantly, time to care.
Thirty-plus years on, I’d say I was right about this.
I am working under heavy deadlines for the next few weeks, but if I can respond to your further questions, I will. BW.
@Joyaa
I must say I chuckled to read the substance of your post; that your choice of osteopathy allows you, above all, time to deal with patients in the way you feel they deserve and “most importantly, time to care”. Then you go on to say you’re “working under heavy deadlines for the next few weeks” and doubt you may not have the time to respond to follow-ups of your comments. Ironic or what?
It’s a shame that, when you were a 20-something year old and you researched osteopathy, you never elected to read the autobiography of its founder, Andrew Still. The book is entitled Autobiography of Andrew T. Still: With a History of the Discovery and Development of the Science of Osteopathy, Together With an Account of the … School of Osteopathy and is still (no pun intended) available from Amazon UK. It’s a pretty hilarious read, and you just might have been deterred from your chosen career.
I’m with you Frank – the irony isn’t lost on me either! My time constraints are entirely self-imposed, and are due to my striving to metamorphose from a position that is heavily clinical to one that comprises some primary research. The morphing from caterpillar to butterfly is neither painless nor financially easy, as I am sure you will appreciate. Thanks for your time.
Hi Joyaa just chipping in to say that it appears that currently in the UK GP’s refer patients with joint pain etc to physiotherapists before deciding whether a consultant referral is necessary. I also know that some GP’s refer to chiropractors and osteopaths.
Way back in the 1960’s I had my first appointment with an osteopath – I was having X-rays /tests at hospital and getting no results,; a friend recommended her osteopath relative. He happened to have a very well known teaching osteopath with him; they instructed me to walk ahead of them (at this point I had no faith and indeed thought it odd) but they saw the issue, made the adjustment and I was pain and symptom free and reduced the burden on the NHS.
Thanks for chipping in, Angela. Yes – I understand that some osteopaths (and presumably chiropractors) work within the NHS, just as many physiotherapists work privately.
Imagery is of limited value in some musculoskeletal conditions, not least because the false positives they show that can cause a great deal of unnecessary worry and send us all down the wrong path. I am glad that you had a good experience with your osteopath.
As far as I’m ware, the proportion of osteopaths working in the NHS is low and the number of chiros is virtually zero.
I applied for Physiotherapy but unfortunately didn’t get the grades to study as the requirements were extremely high at the time due to free funding, since they have been lowered.
I decided to go for Osteo as felt pressured to do something.
Now in my final year… i realize, weather you study Osteo or physio it’s the same fucking thing. You have this knowledge of the human body it’s up to you what to do with it.
I personally prescribe exercise as a primary treatment, some would say “like a physio”. I couldn’t give a shit what labels are.
I have sat through many parts of the course and thought it was complete horseshit, And not the biggest fan of manual therapy techniques which I use sparingly. As a combat sports athlete I appreciate the benefit of soft tissue techniques however.
I don’t prescribe to the structure-function dogma and I stay up to date on the research. I would still like to, in the future further my education with Kinesiology or Physiotherapy to really see what both sides are like.
In my school (UCO) all the theory is EXACTLY the same you would learn in Physio. You learn anatomy as you would find in Netters or Grays, you learn Neurology from lecturers who have neuroscience degrees, nutrition from lecturers with nutrition science degrees. The only part you refer to as Quackery is the technique aspect (which is the manual therapy).
We also learn about embryology and pathophysiology, again taught by highly qualified teachers. So the theory is sound and science based. It’s just the manual therapy is thrown in too.
What an absolutely absurd piece of fake news. Author must of been looking for a new way to discredit Osteopathy. Must of been watching the US election results runs !
Please conjugate the verb “of”.
? Lol. Conjugation will throw him off.
The Chinese may have given us some rather dubious medical practices and unreliable research, but they certainly have the right idea when it comes to verbs, since they don’t conjugate them at all.
I am an osteopath. The training I received was really great and I know for a fact that I have far better “hands on palpatory skills” than most any MD. I think when osteopathic treatment is done well it has an amazing ability to instantly reduce musculoskeletal pain.
This comment from Angela is pertinent: ” (at this point I had no faith and indeed thought it odd) but they saw the issue, made the adjustment and I was pain and symptom free and reduced the burden on the NHS.”
That said, I (and many of my classmates) expressed appropriate skepticism for claims that OTM can help treat a variety of purely medical conditions like hypertension, COPD, etc. etc. The studies just don’t show those claimed benefits. But it always gets thrown in there as some kind of “sacred cow” we are supposed to accept.
The other problem: there is a great variety in the ability of osteopaths to really do manipulative treatments well. Some are great, some definitely not. Many of the best no longer practice a full spectrum of medicine. They confine themselves to straight osteopathic manipulative treatment and many are booked up far in advance. I suspect the anonymous poster was someone with little or no real ability.
Great article to read. Thank you for this.