MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

What is osteopathy?

That’s a straightforward question; and it’s one that I am being asked regularly. Embarrassingly, I am not sure I know the optimal answer. A dictionary definition states that osteopathy is ‘a system of medical practice based on a theory that diseases are due chiefly to loss of structural integrity which can be restored by manipulation of the parts supplemented by therapeutic measures (such as use of drugs or surgery).‘ And in my most recent book, I defined it as ‘a manual therapy involving manipulation of the spine and other joints as well as mobilization of soft tissues‘. However, I am aware of the fact that these definitions are not optimal. Therefore, I was pleased to find a short article entitled ‘What is osteopathy?’; it was published on the website of the London-based UNIVERSITY COLLEGE OF OSTEOPATHY (UCO).

The UCU has a proud history of ~100 years and a mission stating that they want to continually provide the highest quality education and research for all and the very best care, for each patient, on every occasion. Surely, they must know what osteopathy is.

Here is how they define it:

Osteopathy is a person-centred manual therapy that aims to enable patients to respond and adapt to changing circumstances and to live well.

At the UCO, we believe that osteopathy has the potential to help people change their lives – not only by searching for ways to manage disease, but also by helping patients to discover ways to enhance and maintain their own health and wellbeing.

A core principle of osteopathy is that wellbeing is dependent on how each person is able to function and adapt to changes in physical capability and their environment. Osteopaths are often described as treating the individual rather than the condition: when treating a patient they consider the symptom or injury alongside other biological, physiological and social factors which may be contributing to it.

Osteopaths work to ensure the best possible care for their patients, aiding their recovery and supporting them to help manage their conditions through a range of approaches, including physical manipulation of the musculoskeletal system and education and advice on exercise, diet and lifestyle.

END OF QUOTE

Let’s analyse this text bit by bit:

  1. … a person-centred manual therapy that aims to enable patients to respond and adapt to changing circumstances and to live well. Sorry, but this sounds like a platitude to me. It could apply to any quackery on the planet: Homeopathy is a person-centred manual therapy that aims to enable patients to respond and adapt to changing circumstances and to live well. Faith healing is a person-centred manual therapy that aims to enable patients to respond and adapt to changing circumstances and to live well. Chiropractic is a person-centred manual therapy that aims to enable patients to respond and adapt to changing circumstances and to live well. etc., etc.
  2. … we believe that osteopathy has the potential to help people change their lives – not only by searching for ways to manage disease, but also by helping patients to discover ways to enhance and maintain their own health and wellbeing. Of course, they believe that. Homeopaths, faith healers, chiropractors believe the same about their bogus treatments. But medicine should have more to offer than mere belief.
  3. … wellbeing is dependent on how each person is able to function and adapt to changes in physical capability and their environment. Yes, perhaps. But this statement is too broad to amount to more than a platitude.
  4. Osteopaths are often described as treating the individual rather than the condition: when treating a patient they consider the symptom or injury alongside other biological, physiological and social factors which may be contributing to it. Really? I thought that all great clinicians can be described as treating the individual rather than the condition: when treating a patient they consider the symptom or injury alongside other biological, physiological and social factors which may be contributing to it. (‘The good physician treats the disease; the great physician treats the patient who has the disease.’ [William Osler], ‘Reductionism is a dirty word, and a kind of ‘holistier than thou’ self-righteousness has become fashionable.’ [Richard Dawkins])
  5. Osteopaths work to ensure the best possible care for their patients, aiding their recovery and supporting them to help manage their conditions through a range of approaches… What is this supposed to mean? Do non-osteopaths work to ensure the worst possible care for their patients, obstructing their recovery and preventing them to help manage their conditions through a range of approaches? In my view, this sentence is just plain stupid.

What have we learnt from this excursion?

Mainly two things, I think:

  1. Osteopaths and even the UCO seems unable to provide a decent definition of osteopathy. The reason for this odd phenomenon might be that it is not easy to define nonsense.
  2. Osteopaths, like other SCAM-practitioners, may not be all that good at logical thinking, but – by Jove! – they are excellent at touting fallacies.

25 Responses to What is osteopathy?

  • Of course, in the USA. They have achieved near-equivalence with MDs. But I don’t really understand why the DO qualification still exists.

    In the UK osteopaths seem to be more like physiotherapists with an added layer of philosophical nonsense. It becomes hard to draw firm lines when physiotherapists add on nonsensical therapies like acupuncture to their offering.

  • I think that it’s a mistake to talk about osteopathy in general. They vary greatly. At one end of the spectrum are those who sell nonsense like craniosacral osteopathy, and claim to cure diseases. At the other end there are some who appreciate evidence, and practice in a way that’s indistinguishable from the best physiotherapists (i.e. no acupuncture).

    If you want an example of a sensible osteopath, check my interview with Rosi Sexton https://www.youtube.com/watch?v=7R-d1KP_6lg&lc=UgyERW0h9TWQd984_Kl4AaABAg
    If you want an example of the daft end of the spectrum, check http://www.dcscience.net/2011/03/26/cranial-osteopathy-at-the-royal-london-hospital-for-integrated-medicine-and-inaction-by-dr-gill-gaskin/

    It’s true that the evidence base for all manual therapies (including physiotherapy) is pretty thin but the best physios and osteopaths appreciate that, and do what they can.

    • Hi David,

      Did you ask Rosi Sexton why she didn’t train to be a physiotherapist? if not why didn’t you ask her?

      What approach and techniques / treatments make an osteopath ‘sensible’ or evidence based in your opinion?

      • That’s one thing that I’d intended to ask, but didn’t get round to it. I’ve always imagined that it was to do with the availability of part-time courses -remember that this was her 5th degree. I’ll let you know if I get a definite answer.

        The techniques used by osteopaths seem to be much the same as for physios. The results for low back pain (for example) come out much the same for all manipulative therapies. Of course this could mean that none of them work very well. Being “evidence-based” means being aware of that. It means knowing what the evidence is and being able to assess its quality (something that we discussed in the interview). It isn’t only manipulative therapies that lack good evidence. The same can be said of vast areas of medicine. And for even bigger areas, there are no very effective treatments. Like, for example, low back pain.

  • A different view?

    http://jaoa.org/article.aspx?articleid=2093117

    As with the DO respondents, most of the MD respondents (89.6%) indicated that they believed OMT is at least somewhat effective in treating somatic dysfunction, while far fewer of the MDs (15.5%) supported the effectiveness of OMT for treating patients with systemic illness.

    Most of the MD respondents expressed interest in learning to perform OMT (20.3% very interested, 50.6% somewhat interested). In addition, 42.6% of the MD respondents supported incorporation of OMT training into the allopathic medical school curricula, with only 13.9% opposed. The MDs indicated support in similar proportions (43.7%) for incorporation of OMT training into allopathic residency training programs. Approximately 80% percent of the participating MDs indicated their interest in receiving OMT training as part of CME. Finally, 68.2% of MD respondents expressed their support for AOA certification of MDs who demonstrate proficiency in the use of OMT. Such certification was opposed by 5.2% of the MDs.

  • Your view is myopic and I doubt you’ve witnessed an osteopath practice in the real world. Osteopathy is just another tool a physician uses to heal the entire individual. A DO is free to choose to use or not use those principles in their practice. A DO is not going to treat your ribs when you’re having a heart attack. A DO will address your sacral imbalance and short leg before ordering X-rays, injections, and pain pills.
    It’s not a sham, it’s being a well-rounded physician and using all tools available to them. The arrogance of your article is ridiculous.

  • Here’s one for you DC. Just follow the instructions:

    http://bfy.tw/LXvc

  • The reason the UCO is vague is simple: It’s in its members’ best interests. If they made what they do understandable, far more people would see the nonsense for what it is.

  • how are patients supposed to distinguish between the two ends of the spectrum ?. It is up to the therapists belonging to the therapies to clean up their house from within !!! STOP allowing patients to be taken advantage of !!!

    • If that question is addressed to me, I agree that it’s hard for patients to distinguish one end of the spectrum from the other, especially if the patient has not got much medical knowledge and isn’t accustomed to critical evaluation of claims.

      My suggestions would be (1) avoid totally anyone who offers acupuncture (which is disproved) or craniosacral therapy (which is mystical baloney), and (2) beware of anyone who claims to cure anything. If it sounds too good to be true, it probably is.

      It’s always worth googling the technique or the person whom you’re trying to assess, including the word ‘quack’ in the search string. That will often reveal critical assessments which may otherwise be missed.

      • Hi David,

        Thanks for you reply above. I was just wondering what are your thoughts on dry needling?

        I think it is the same as acupuncture and therefore should not be viewed as an appropriate treatment for any condition

        • In addition “dry needling” is more painful and more hazardous than the original version. It is a rebranding of acupuncture claimed by its proponents to be a modern western therapy form different from the fantasy based, ineffective “eastern” one.
          The effect is supposed to be local due to microtrauma to internal “myofascial trigger points” that is supposed to elicit a biological repair response and or endorfins or other ostentatiously selected but unproven mediators. As usual with any branch of alternative medicine, there are studies purporting to corroborate it but collective evidence is not corroborating any efficacy.

      • My friend, Dr. Harriet “SkepDoc” Hall, offers similar advice: Always find out what the other side is saying before making a decision.

        Of course, even then, you cannot be sure as even the most valid remedies have critics (e.g., vaccines—despite overwhelming evidence as to their efficacy, antivaxxers persist). But at least if you’ve explored both sides, you are making a better, more informed decision. We can only hope that common sense then prevails. As we all know, it doesn’t always.

  • Anything that sells … That’s America, nothing goes on without religion, Oh Lord! There is no need for evidence neither in politics nor in medicine in post-modern, post-factual times…
    http://jaoa.org/article.aspx?articleid=2093846

  • The question: “What is osteopathy?” can best be answered by answering the question: “What is it that osteopaths do that cannot be done, or is not done, by chiropractors, physiotherapists, nurses or doctors?”
    Simple.

    We know what chiropractors do that nobody else does – they release ‘innate intelligence’ by ‘adjusting subluxations’, but UCO should not be so coy – the students they wish to attract to their college need to know why they should study osteopathy and not chiropractic, physiotherapy or medicine.

    If UCO cannot identify its USP it should close – on the grounds that intending students cannot know what it is they will be studying and cannot give proper consent to pay the fees (or have them paid in some cases).

    And by the way, the UCO web site states AT Still was a “physician and surgeon”. He was not. He was a ‘magnetic healer’ and ‘lightening bone setter’ trained by Paul Custer (as was D D Palmer), who became a hospital steward in the Union Army. Of course, for marketing purposes he styled himself as “Dr”, but then so does practically everyone who wants to create the impression they are members of a well regarded healthcare profession.

  • I agree that it’s a pity that manipulative therapies have been split between physiotherapists, osteopaths and chiropractors (though I’d barely include chiropractors because they are almost universally dishonest woo-sellers). The important split, though, is between those who understand evidence and those who don’t. The fact that so many physiotherapists sell acupuncture shows that (mis)understanding evidence is not a prerogative of any branch of the manipulative industry.

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