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what is it?
Osteopaths diagnose problems and use their hands to treat by manipulating the muscles, bones, joints, ligaments and connective tissue that comprise the musculo-skeletal system. This framework is designed to support and protect the organs and body systems, but misalignments or imbalances that develop in it can affect the nervous system and trigger all sorts of ailments.
Osteopaths use a variety of techniques to re-align the musculo-skeletal framework, ease muscle tension and restore the body's natural self-healing abilities. These include massage to relax stiff muscles, stretching to mobilise joints, manipulation and high velocity thrusts to restore easy movement.
An American army doctor, Dr Andrew Taylor Still, developed osteopathy (the term comes from the ancient Greek osteon, 'bone', and pathos, 'suffering') in the mid 19th century. According to Still, body systems and self-healing processes would function smoothly when there was less strain on muscles and joints. His pupil, Dr John Martin Littlejohn, founded the British School of Osteopathy in 1917. Osteopaths were licensed to practise as conventional doctors in the US in 1972. In the UK the profession was not state-regulated until 1993 and the register of practitioners opened in 1999.
The House of Lords Select Committee on complementary and alternative medicine in 2000 placed osteopathy in the top five therapies in terms of regulation, education and research. Many GPs now refer patients to osteopaths for musculo-skeletal problems, especially low back pain.
Although distinctions between osteopathy and chiropractic are blurring, osteopaths are less likely to use X-rays for diagnosis, and focus more on 'soft tissue' techniques rather than high-velocity thrusts.
what it's supposed to do
Physical and emotional stress, injury and poor posture can adversely affect the musculo-skeletal system and establish a vicious circle of pain-muscle tension-pain. Pain messages passed to the brain can result in far reaching physical and emotional effects. Osteopathic manipulation aims to relax muscle tensions at the seat of the problem.
Conditions said to benefit include back and neck pain, arthritic joint pain, sciatica, sports injuries and repetitive strain injury, headaches, insomnia, depression, menstrual pain, digestive disorders and asthma. Cranial osteopathy is claimed to be particularly successful in relieving colic, glue ear and recurrent infections in children and headaches and migraine in adults. The research to back these claims up has yet to be done.
what happens
At the first appointment, usually about 30-60 minutes, the osteopath takes a detailed medical history, asks about your symptoms, lifestyle and emotional health and carries out standard medical tests. The holistic approach means the osteopath is as concerned about the cause of a problem as its effects. For example, is back pain due to poor posture brought on by sitting in a poorly designed chair?
You'll be asked to remove some of your clothing and carry out a series of movements so that the practitioner can assess your mobility, both by observation and by feeling (palpating) your spine, muscles and joints. Depending on the problem, treatment may consist simply of massage and stretching techniques or may include muscle resistance techniques to release tension and joint manipulation, including high-velocity thrusts that, although painless, can cause the joint to 'click'. You'll also be given exercises to do at home. Most osteopaths expect some treatment benefit within three to six sessions. They are trained to recognise when osteopathy won't help a problem and when to refer you to a doctor.
Not all osteopaths use direct manipulation in their treatments. For example, indirect techniques — light touching and gentle joint positioning to relieve tension and restore balance — are often used with children and elderly people. Cranial osteopathy is one example. It is thought that head injury or the infant's passage through the birth canal can displace the cranial bones that surround the brain, creating disturbances in the rhythmic pulse of the cerebrospinal fluid that practitioners claim to detect by touch. Delicate manipulation of the cranial bones to restore this rhythm is said to relieve tension and improve blood circulation and drainage of lymph and sinus fluids in the head.
what's the evidence?
A number of trials have shown that manipulation can benefit low back pain, but very few have specified the type of manipulation, although osteopathy is often included among several approaches. A 1992 American review of trials of osteopathic and chiropractic spinal manipulation concluded that cases of acute back pain could be relieved, but there was less evidence for chronic back pain. In 1994, the UK Clinical Standards Advisory Group recommended manipulation for NHS patients with acute back pain and advised GPs to liaise more closely with osteopaths, chiropractors and physiotherapists trained in manipulation.
precautions
Go to the safety first section of 'before you start' for some general precautions to take into account when considering a complementary therapy.
- Manipulation should be avoided if you have severe osteoporosis, joint inflammation, bone infections, tumours, circulatory problems or a recent fracture.
- Vigorous manipulation should be avoided if you have badly prolapsed (slipped) discs.
how to find a practitioner
The Osteopathy Act was passed in 1993 to protect the public from untrained and unauthorised practitioners. No one can now call themselves an osteopath unless they are registered with the new professional regulatory body, the General Osteopathic Council. This also sets educational and training standards, maintains codes of ethics and practice, professional insurance and complaints and disciplinary procedures. A period of time was allowed for those who had previously called themselves osteopaths to pass a professional assessment and the first British state register of osteopaths opened in 1999.
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(July 2002)
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