Osteopathy was founded in the 1890s by Dr. Andrew Taylor, who believed that the musculoskeletal system was central to health. The primacy of the musculoskeletal system is also fundamental to chiropractic, a related health discipline. The original theory behind both approaches presumed that energy flowing through the nervous system is influenced by the supporting structure that encase and protect it—the skull and vertebral column. A defect in the musculoskeletal system was believed to alter the flow of this energy and cause disease. Correcting the defect cured the disease. Defects were thought to be misalignments—parts out of place by tiny distances. Treating misalignments became a matter of restoring the parts to their natural arrangement by adjusting them.
In other words pure bunkum!
Dislocations on the facets of the vertebrae - impossible, movement in the bones of the skull - impossible
Garbage in, Garbage out
The theory behind manipulation focuses on joints, mostly those of the vertebrae and ribs. Some believe there is a very slight offset of the joint members—a subluxation. Others believe there is a vacuum lock of the joint surfaces, similar to two suction cups stuck together. Such a condition would squeeze joint lubricant out and produce abrasion of the joint surfaces with movement. Another theory focuses on weakness of the ligaments that support the joint, allowing it freedom to get into trouble.
Some, but not all, practitioners in this field believe that the skull bones can also be manipulated. The skull is, in fact, several bones that are all moveable in infants. Whether they can be moved in adults is controversial. Other practitioners manipulate peripheral joints to relieve arthritis and similar afflictions.
Utter nonsense
Oh look - more pish from osteopathy
The osteopathic physician, however, is trained to recognize that when the body is sick, it is sick all over. A specific organ or system may become the prime focus of illness, but the effects of that illness can be felt in some degree throughout the entire body.
He developed manipulative methods (now known as osteopathic manipulative treatment) to remove these structural abnormalities to alleviate the patient’s illness. These experiences led Still to believe that diseases, as we commonly think of them, were really the result bodily malfunctions, not the cause of them.
It's utter nonsense compared to what? Because most physios are very empirical with their methods IME - they're not guided by deep (or any, in some cases) insight into the underlying physiology, they just do what they think works according to their experience, same as osteopaths.
Not that I'd ever see an osteopath, mind, I agree that the neck and back are far too fundamental to be placed in the hands of the ignorant.
I knew a cranial osteopath once. Part of our Hackney NCT group. Nice enough bloke and I'm sure he studied for ages.
Cranial osteopaths manipulate the bones of the skull to make folk feel better. Luckily bones of the skull don't move so it's unlikely he'll have done anyone much harm (whilst they got better anyway). And it will have paid his mortgage and kept him off the street, in a deep and holistic way of course.
Compared to medicine Garry. You know - real medicine based on real science.
I agree physio can be a bit empirical but at least they have a proper foundation in anatomy and physiology - rather than a totally unscientific and in some ways outright wrong training.
Any good that osteopaths and chiropractors do is probably a happy accident, achieved while ignoring the ill-conceived unscientific pish that gave birth to their beliefs and practices.
This.
Ineffective and dangerous. If osteopaths and chiropractors get something right it's because they're doing something that isn't either discipline.
I despair with people's trust in alternative medicine. Why would we bother with doctors if a handful of charlatans can do a better job?
Yoga, not an instant fix, but as kept me out of the Physios for a long time now.
Pilates might be another option - can do no harm, might do some good
I wonder what they spend 4 years studying then ?
Homeopaths can spend several years studying. What they study is complete rubbish though.
Osteo seem a bit more mixed in that they have incorporated some sensible stuff in but will be dependent on where the person learnt as too how much woo is involved.
Well thanks for the recommendations. If i strip out TJ's contribution its a close call between the other 6 posts 😉
Osteopathy is pure bunkum with a zero evidence base for cure and plenty of evidence of harm
Very much this, and include chiropractors in the 'crap that has no peer-reviewed evidence of effectiveness' pile too.
At best they are a means to separate the gullible from their money, at worst they are risking the long-term health of their punters.
But what would I know, only being a Princess Royal Spinal Injuries Centre trained link nurse?
My mother went to see an osteopath after years of getting nowhere with a bad back. He had a look at her standing up, told her to get whatever was wrong with her left foot fixed and come back if that didnt work. Didn't charge her.
Got some tiny verrucas she wasn't really aware of fixed at the gp and it sorted her back out. Didn't have to go back to the osteopath.
I'm not sure if that counts as an osteopath's treatment working or not 🤔
I recommend investigating active isolated stretching (AIS) and find a practitioner to help show you a relevant protocol.
AIS has helped me address several shoulder, hip and lower back issues.
It is based on good old common sense science that muscles work in pairs, and that to work optimally they must be free from unnecessary tension or inhibition, able to contract and relax as intended.
This was after exhausting various physios and osteos who got me nowhere - particularly with a persistent hip injury.
Aside from being a man so binary that even his bike is a tandem, TJ is right. Straight chiro and osteo have no bearing in science, they're sham treatments. But, that's not the question we need to be asking. Rather, assuming them to be safe (which is questionable), do they have efficacy beyond placebo? Because if they do then they have merit even if we can't explain why. Unfortunately, the answer to that is "no they don't," beyond limited evidence for short-term relief from mild lower back pain.
In the UK at least, most chiropractors are what's called "mixers" (I know less about osteopathy but I'm guessing the same applies). Mixers employ other techniques such as physiotherapy alongside their core discipline, and that may well have proven efficacy, but it does then rather beg the question that if you're going for physio would you not be better seeing a qualified physiotherapist?
It is based on good old common sense science
Which is it, common sense or science? It sounds to me like the sort of thing made up by someone selling books.
Both overrated except in certain defined cases, both money spinners from cuts to the nhs. Ive not been impressed by the standards of physios in general, and I've seen many, so I don't know how good the certification is in the first place.
It is based on good old common sense science
Which is it, common sense or science? It sounds to me like the sort of thing made up by someone selling books.
Yeah fair enough that was poorly phrased. I meant well established science. You know like basic anatomy and physiology - the principals of antagonistic muscle pairings, reciprocal inhibition etc.
What’s wrong with books? I’ve spent hundreds of pounds over the years on physio, osteo appointments over the years that haven’t always helped very much. I spent £20 on an AIS book that has helped a great deal.
And anyway, much of the info is available online for free.
I’m not here to squabble. AIS has really helped me since I started doing it regularly. Just trying to share...
Some more anecdote...
Mrs Dubs used to think she had one leg shorter than the other.
Osteopath manipulated her hip and now she’s got two even length legs.
She wasn’t involved in any studies.
see an osteopath, combine with some flower based homeopathy and make sure your crystals are fully charged by bathing them in moonlight.
not big fans of vaccination either
http://www.british-institute-of-osteopathy.org/articles/vaccinations_and_immunity.aspx
Find a good sports physio. Don’t bother with a osteopath unless you want to be the best dressed dressage champion in the world.
I see this osteo as when needed and he's excellent: Dominic Eglington at the Millway Clinic in Mill Hill.
but it does then rather beg the question that if you’re going for physio would you not be better seeing a qualified physiotherapist?
All things being equal yes. I saw a Chiro on a number of occasions with good results. The treatment "made sense" in that I understood what he was trying to do and the exercises clearly built strength etc, No mumbo jumbo. He is a keen athlete himself and was clearly interested and committed to resolving my issues. The results were good.
On the other hand I have seen a number of highly qualified physios over the years, many of whom are focused more on relieving you of your cash than understanding your injury. Mixed success rate.
My advice would be to look for recommendation.
Recommendation of someone whos treatment is based on proper science.
What you describe surfer is what was said above:
In the UK at least, most chiropractors are what’s called “mixers” (I know less about osteopathy but I’m guessing the same applies). Mixers employ other techniques such as physiotherapy alongside their core discipline, and that may well have proven efficacy, but it does then rather beg the question that if you’re going for physio would you not be better seeing a qualified physiotherapist?
There is no such thing as a good osteopath. It has zero evidence base and causes a lot of harm. Pure charletans
Such a great word, 'charlatan', it always makes me think of snake oil salesmen in Victorian frock coats. I wouldn't use an osteopath or a physio who wears a frock coat, it's a dead giveaway. Next thing you know, they'll be flogging you a shepherd's hut and we all know how that ends up.
I knew TJ would start venting on this.
All I can go on is my personal experience - which is that plenty of physios (especially constrained by the NHS) are fairly useless whilst I've had a couple of outstanding chiros who have used a variety of techniques to solve problems (and I have plenty of problems caused by an ORIF procedure on a fibular spiral fracture which was was poorly realigned). Both are keen sportspeople and work with professional athletes on a regular basis.
*s****s*
I do love archaic words. I could add they are poltroons whose utterances are pure balderdash and piffle
Cheif - once again you then have someone calling themselves a chiropractor who is actually using physio to treat you. chiropractic is spinal manipulation.
Of course physio is a protected profession so you cannot call yourself one unless properly qualified and registered which is why these "mixers" don't call themselves physios even if using physio techniques.
If your problem is bike related why not take yourself and your bike to a top end cycle shop where they can analyse your riding position, bike size etc. Poor posture doing any excersize will eventually show itself as pain of some sort. IE. treat the cause not the symptoms.
"Cheif – once again you then have someone calling themselves a chiropractor who is actually using physio to treat you. chiropractic is spinal manipulation."
Except both of them do spinal manipulation to help with motor system activation, as well as using acupuncture, trigger points, massage, rehab exercises and so on.
I am an Osteopath.
Nedrapier is right, there are wide variations in the knowledge and technical ability of osteopaths, chiropractors & physios. Some individuals in each profession are money-grabbing charlatans, most are just trying to help.
Outcomes of treatment are affected by the diagnosis, the treatment itself, the interaction between the patient and therapist and the circumstances of the patent - hence the rise of the biopsychosocial model of healthcare.
My suggestion to the op is that he goes to see someone recommended by his peers who he feels he can get on with & trusts. He should be given a plausible explanation of his symptoms and their cause, a treatment plan, including the risks of treatment and no treatment, treated (if he agrees), given manageable exercises to do at home and advised how to change the use of his body. If the problem is curable and things do not change in a reasonable time (2-4 appointments) either he should be reassessed or go elsewhere. It may be that the previous spinal injuries mean that the best outcome is managing the symptoms, but that should be discussed.
Shoulder stabilisation exercises & hip mobility sound like areas worth looking at.
Please bear in mind that by virtue of disagreeing with tj I am, by definition, almost certainly biased, ignorant & wrong.....
what's your opionion on neck manipultion in infants?
Ok
I don't want to be too rude given an actual osteopath has been brave enough to raise his head but I would like to hear the reasons why there is NO evidence for spinal manipulation doing anything other than some minor short term pain relief and the fact that there are many many documented cases of harm caused by it from minor to major
I would also like to here the basis for osteopathic treatment seeing as I have never heard anything that makes any sense at all.
I have had osteopathic and chiropractic treatment in the past. Now I know more I never will again
tj, If you have a problem with your spine, and you go and see a physio about it, what to you expect them to do? Breathe on it?
If you're struggling to think, have a read of the links below, particularly the "... back pain treatment" sections
https://www.local-physio.co.uk/articles/middle-back-pain/middle-back-pain/
https://www.local-physio.co.uk/articles/upper-back-pain/upper-back-pain/
If you're not so good with reading, the first picture on this page will give you a clue:
https://www.local-physio.co.uk/articles/general/what-is-physiotherapy/
I imagine you'll run screaming for the hills.
Evience based practice is what I want - and the evidence on osteopathy is clear. NO significant positve benefits and risk of harm is high.
NO physio who wants to keep their registration will use spinal manipulation as performed by osteopaths due to that pesky old thing EVIDENCE BASED PRACTICE.
That picture does not show ostoepathic based spinal manipulation. It shows stretching. A very differnt thing. What those links show is that you do not understand the differnce between what physios do and what osteopaths do. Physios have scientific training and base what they do upon the evidence.
Evidence based practice!
What those links show is that you do not understand the difference between what physios do and what osteopaths do
I'm not even sure what definition of "spinal manipulation" you're working with. Have got your own one which you're not sharing?
You seem to have a very specific bee in your bonnet about osteopaths and spinal manipulation, but in two pages of ranting you've not been able to describe what it is.
You've not been able to show me or tell me what the difference is between the spinal manipulation you think is good and the spinal manipulation you think is bad, other than the spelling of the person that's doing it. I show you a picture of a physio doing spinal manipulation on a website which says physios treat back pain with spinal manipulation and you tell me that it's not spinal manipulation.
You keep talking about the evidence and how well you understand it, but doesn't appear you've even read what you posted. You linked to a metastudy which reviewed studies on the effectiveness of spinal manipulation, which included more studies of physios than osteos but did not choose to distingiush between them. Why not, if the treatments are so very different?
You linked to a study about the adverse effects of spinal manipulation, which describes spinal manipulation generally, irrespective of who's doing it.
Spinal manipulation or adjustment is a manual treatment where a vertebral joint is passively moved between the normal range of motion and the limits of its normal integrity, though a universally accepted definition does not seem to exist. It is occasionally used by osteopaths, physiotherapists and physicians, and it is the hallmark treatment of chiropractors
The case studies are broken down into only 2 groups: adverse events after spinal manipulation performed by 1) chiropractors, 2) non-chiropractors.
which bits of these studies did you read?
Just repeating "evidence based practice" in capitals and with exclamation marks doesn't help to explain your reasoning. If anything, it suggests that maybe there isn't any.
Its very simple.
Evidence based practice is doing what the evidence states works. As there is no evidence for any form of spinal manipulation doing anything significant in the way of good and plenty of evidence of it doing harm, evidence based practise means you do not do spinal manipulation!
I am using spinal manipulation to mean the type of manipulation that osteopaths adn chiropractors use - where they take the sp[-inal joints beyond the normal range of movements. What some physions will do is move the joints to the normal range of movements in order to stretch tight muscles and or ligaments. A very diffeernt thing
Why am I so adamant about this - its because osteopathy does no good, cost a lot of money and often does harm. I am hoping to prevent people being injured by it and wasting their money on claptrap.
So go on. Find a reputable study that shows osteopathic spinal manipulation does any good. a proper peer reviewed study like the ones I linked to that show no significant evidence of good adn a lot of ecvidence of harm.
A while ago I had back pain for around 3 years on and off,it wasn't too bad just a really dull ache.Anyway I met a newly qualified osteopath in the pub through a mate who had just set up his own practice.I had one session with him which he asked loads of questions then massage then at the end manipulation(cracking my back)technique,two days later I had severe sciatica which lasted 3 months due to slipped disc.And four years on my back still flares up in pain more than it did before that appointment.I may be wrong and I did feel bad about it but I blamed him for causing my slipped disc so I wouldn't see a chiropractor or osteopath again.
Yup - you are one of the many people injured by an osteopath.
Thanks Twodogs, good read.
As always we have to ask ourselves if "alternative medicine" is effective and safe, why on earth is it an "alternative medicine". Why isn't it just "medicine"?
I love this part.
perhaps most damning – and surprising for anybody who has paid for the treatment – is that nobody can explain how manipulation would theoretically work, even the practitioners. Matthew Bennett, the president of the British Chiropractic Association (BCA), says that one explanation they’re working on is that a physical force through the spine removes stiffness, though it is unclear what causes this “stiffness” or, therefore, how a physical force might remove it. Another is that it changes the body’s perception of pain. “We’ve spent 100 years or more going through various other hypotheses,” he says, “but those seem to be the ones where most of the encouraging work is going on.”
Over 100 years of cracking bones and all the President of the BCA can do is shrug, when pushed on how it's supposed to work.
Quackery dressed up in quasi-scientific clothing. Anyone who admits to being one of these charlatans should be ashamed.
OK, I'll try but I don't think it's going to do any good. You've not shown any inclination to get to grips with what I've written before.
You might recognise these.
Here's a study that looks in depth into the adverse effects of spinal manipulation but does not seek to make any distinction between the type of spinal manipulation done by osteopaths and the type of of spinal manipulation done by physiotherapists. You would think if there was a distinction, especially one as directly correlated to harm as you believe there is, one would be made. But no.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1905885/
And here's a metastudy, combining and summarising the results of 74 individual studies looking into the benefits of spinal manipulation (or SMT - Spinal Manipulative therapy). This metastudy does refer to different practitioners and different types of SMT.
16 of the 74 studies involved chiros
14 involved physios
5 involved osteos
The types of SMT it identified are:
high velocity, low amplitude (HVLA) thrust SMT,
low velocity, low amplitude (LVLA) passive movement techniques
and a mixture of both (HVLA manipulation and LVLA mobilisation)
I'm going to take a liberty and assume in TJ World HVLA is Bad, and LVLA is Good. And because the bad kind is so very very bad, good in combination with bad can only be bad.
So, which types of practitioner used what kind?
Chiros: 7% Good, 93% Bad
Physios: 43% Good, 57% Bad
Osteos: 60% Good, 40% Bad
The results make no distinction between the benefits or harms of HV versus LV therapies, which is odd if one was so obviously fine and one was so harmful.
Taken as a whole, it concluded that "SMT [in general - no distinction for type or practitioner] results in a modest, average clinical effect at best"
and in summing up the harm: "The body of evidence, which includes data from large, prospective observational studies of SMT[again - no distinction for type or practitioner] , suggests that benign adverse events are common and serious adverse events are rare. The incidence and causal relations with serious adverse events are difficult to establish, in part due to inherent methodological limitations of the included studies. Importantly, predictors of these events are unclear. Given this, clinicians should ensure that patients are fully informed of potential risks before treatment." Which is fair enough and no-one's suggested otherwise.
How, given the above, do you arrive at such a strongly held opinion that a) there is a special type of Osteo SMT, b) that this type is universally bad, and c) the type of SMT that Physios do can be recommended without hesitation?
I suspect the answer is because you're tj, and that I won't have much motivation to reply again.
sorry to read about your injury, dannymite. Must have been especially annoying to be injured by someone who was supposed to be sorting you out.
@Ned
from article I linked:
"Philip Sell, an NHS spinal surgeon, says that “manipulation is not appropriate in the neck at all – it can occasionally cause stroke. There’s a definite risk of harm and it is not recommended.” As Singh concluded in his article that led to the lawsuit with the BCA, “if spinal manipulation were a drug with such serious adverse effects and so little demonstrable benefit, then it would almost certainly have been taken off the market”.
Surprisingly, Sell isn’t completely dismissive of chiropractic or osteopathy for people with low-back pain, for which he says there is probably no harm. He concedes that there’s little evidence that spinal manipulation works, and that there’s little reason to think that it would, but adds: “What they do with their hands isn’t particularly important, it’s what they end up saying to the person that might help them manage pain better and keep active.”
you seem to be lumping all spinal manipulation together - for lower back pain, probably no harm, but little evidence for any benefit.