Osteopathy

What is it?

Osteopathy is the name given to a form of physical treatment whereby the body is seen as a functioning whole, where each body system and its component parts contribute to a functioning whole. Diagnosis and treatment is therefore to do with seeing the functional and structural relationships between body systems and helping to correct them.

The emphasis is on the physical manipulation of body tissues including all body soft tissues, bones, joints, the nervous system and the fluidic systems circulation, lymphatics and cerebro-spinal fluid to affect the better functioning of the whole body i.e. through the musculo-skeletal system we believe we can influence all body systems and functions either directly or indirectly. We often use the word "syntegrity" to describe the functional whole of the body.

Osteopaths belief that when the body is restored to optimal functioning it promotes the innate healing powers of the body to restore itself to better health, and maintain good health. Osteopaths see their role as one of assisting the body to restore that good function. Often osteopaths work with naturopathic ideas of nutrition to assist this process.

The osteopathic system is therefore holistic and can be part of any medical system where treatment of both primary cause, secondary complications and promotion of well-being are important.

There are a range of techniques available to osteopaths which make our work compatible with most other forms of bodywork.

In its classical form oseopathy is primarily a physical based treatment. However, it is a holistic treatment in that it recognises that people live in a world where personal issues and problems can impact on them physically. Cranial osteopathy is a distinct part of osteopathy and has a more implicit role in the treatment of emotional issues and trauma.

Who developed it?

Osteopathy was developed by Andrew Stills, an American physician, around the turn of the nineteenth century. He was a doctor in mid-west America in an era where medics did not have the full pharmacy of powerful drugs that western doctors have today. Instead he had to depend on his extensive knowledge of how the body functioned to address the health needs of the people he administered to. He developed a range of physical interventions as a profound method of primary healthcare.

In America, osteopathy is taught as part of orthodox medicine and trainee MDs can elect to become Osteopathic Doctors. In the UK and Europe there has been an historical divorce between conventional medicine and osteopathic medicine. It is not always possible to access this therapy within public health systems although GPs are increasingly open to refer patients privately and some have trained as osteopaths.

What conditions is it good for treating?

This is a difficult issue to discuss as it requires some understanding of the different forms of evidence that can be currently allowed into the discussion by the Advertising Standards Agency and the reader would need to refer to both our section on EVIDENCE BASE and the general DISCLAIMER in this website.

What we can say here is that traditionally osteopathy has been used for a wide-range of musculo-skeletal conditions particularly low back pain (LBP) and that its application is used to address issues of functionality in the body.

What is the evidence base that supports its effectiveness?

Osteopathic medicine has a rich archive of material cataloguing its use in a range of Medical conditions. Recently the UK National Institute for Clinical Excellence (NICE - the Government watch-dog on evidence based medical treatments within the National Health Service (NHS)) gave approval for osteopathy as a treatment for non-specific low back pain. Historically osteopathy has been used to address a wide range of clinical conditions from influenza and respiratory conditions to gynaecological, reproductive and gastro-intestinal health.

There is more international research going on much of which is chronicled in journals like the 'International Journal of Osteopathic Medicine' (IJOM) which tries to delineate the research issues and methodology for evaluating osteopathic practice.

In the UK the National Council for Osteopathic Research (NCOR) is attempting to standardise osteopathic data collection so that a national picture of activities and practice can be built up.

What are the risks and benefits?

There is always a balance between risk and benefit in any medical treatment. Osteopathy is no exception and there must always be informed choice about the likely gain or harm involved with any proposed intervention. Your osteopath should discuss this before any treatment begins and make sure that you understand any implications for the proposed treatment and seek your consent before commencing treatment. Also if there are any unforeseen consequences of treatment these should be notified to your osteopath immediately so that remedial action can be taken if needed.

Most treatment effects are about normal treatment reactions as body tissues have been manipulated e.g. breaking down old fibrotic material, chronic muscle spasm, or sometimes under-used muscles might be recruited which could be give rise to muscle soreness as after a new work-out routine. In all cases treatment should be matched to patients tolerance for discomfort and ability to understand the sensations caused.

The gains from these treatments are pain reduction, greater movement and functionality and prevention of further deterioration from a previously affected musculo-skeletal condition. Often patients feel relieved that their painful conditions are treatable and can be helped. Where there is a body-mind component to the pain this can help lift secondary depression caused by physical pain.

The osteopathic profession (www.GOsC.org.uk ) regularly reviews the data on risks and benefits. The current consensus is that there is most concern over high velocity thrust manipulations to the neck, which have been associated with the risk of vascular damage in the neck and subsequent stroke.

Professional osteopathic opinion is dividied over the use of the technique. However, at TSHP we do not use it. This technique aside, for the vast majority of people the risk of an osteopathic treatment for the neck is less than the risk of having your hair washed at the hairdressers with your neck in a prolonged backward bending position.

A current update on risks in osteopathy can be found in the September 2010 edition of the International Journal of Osteopathic Medicine (www.elsevier.co/ijos ).

Are there any side effects from the treatment?

As above most side effects are mild and are caused by tissue reactions from manipulation or mobilisation of joints, and are readily remedied in the context of a professional treatment plan.

If there are any reactions outwith normal tissue reactions this would be a relative contra-indication to further treatment; and unless there was a clear clinical rationale for such an adverse affect a second relevant professional opinion would be sought.

How many sessions does it need?

This will depend on the complexity and chronicity of the presenting case. Normally conditions should respond to between 6 to 10 sessions.

Acute episodes will respond better after the initial inflammatory phase is reduced.

With musculo-skeletal problems acquired from a life-time of postural, occupational, or life-style habits treatment might last longer and patients might need to think in terms of maintenance work, much like that devoted to treasured personal items and effects.

How long do sessions need to be?

The initial session involves taking the case-history and the first treatment this usually takes about an hour, Follow-up treatments are between 30 and 40 minutes.

Treatment is usually on a one-to-one basis.

How many practitioners need to be available?

Treatment is normally with one osteopath.

Does it need follow-up support? If so, what, how often and by whom?

Again this will depend on the complexity and chronicity of the presenting case. Sometimes conditions are one-off episodes; sometimes they are acute episodes of chronic conditions; sometimes treatments are more for prevention; sometimes the aim of the treatment is to consolidate treatment gains; and sometimes the aim is maintenance of good functionality as a precaution or support for people whose occupation or leisure activity impose particular stresses on their bodies.

Sometimes a practitioner may refer patients to other therapists if they feel that additional input would be useful e.g a naturopath, personal trainer, medical herbalist, homeopath, psychotherapist, or counsellor etc.

How does it work as a self-care tool?

Like all good therapies there is a large component of education and guidance in the therapy to support the treatment, protect against further injury and develop good postural habits.

Principles of osteopathy can be taught as part of self-care to individuals and to groups

What is the best way for teaching the self-care techniques?

Either one to one within a session or in self-help groups. We have run several successful small groups for specific conditions like chronic fatigue, multiple sclerosis and degenerative joint conditions etc.

Where can Osteopathy methods be accessed?

Through TSHP in Merseyside. A central register of qualified osteopaths can be found at www.GOsC.org.uk

Locally Osteopaths are listed in Yellow Pages