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.

an oldie but a goodie

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”?

@twodogs

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.

anyway, I’m out, arguing on the internet never changed anyone’s mind

What you have missed ned is that ALL spinal manipulation as practised by osteopaths and chiropractors is bad. the data is quite clear. No evidence of good, plenty evidence of harm

a physio who is doing spinal manipulation that exceeds normal movement is putting their registration at risk by using a known harmful technique. I guess the confusion is that physios will use spinal manipulation withing the normal limits of movement to stretch ligaments and muscles. An osteopath will exceed the normal limits of movements to “correct dislocations / subluxations” which apart from being baloney is harmful

So the difference between what an osteopath and a physio will do is about the normal limits of movement. An osteopath will exceed this and that is where the danger lies, a physio will not exceed the normal limits of movement thus causes no harm

Evidence based practice!

The reason I have such strong views on this is I understand the basics of medicine and I hate charlatans who prey on the credulous. Its not so bad when its crystals or homeopathy but osteopathy with is potential for serious harm needs to be countered.

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 expect the difference is that physios do spinal treatments for spinal issues rather than because you’ve got a cold.

In any case, there’s increasing pressure* within the profession for them to stop doing it, because of the risks and because it encourages and validates things like chiropractic.

(* – sorry)

Here.

https://www.physiotherapyjournal.com/article/S0031-9406(10)62622-3/abstract

you seem to be lumping all spinal manipulation together

Not me. TJ’s trying to make a distinction based on “the evidence”, and “the evidence” he links to makes no such distinction. There’s no basis for his position in there. The studies lump them all together. Where distinctions are made, there are certainly no osteo bad/ physio/good.

I’ve just been responding to TJ being a dick about the side he’s picked, trying and failing to back it up with selective reading, sloppy thinking and sloppy arguments. And whatt some guy said 130 years ago.

Anyhoo, til the next time!

As someone who cracks his neck a lot (it feels a relief when I do it plus I think it may be a ‘stim’ for me) this thread has made me realise the stroke risk. It’s going to be a hard habit to break 😣

Where distinctions are made, there are certainly no osteo bad/ physio/good.

SMT bad, whether it’s done by an osteopath, a chiropractor, a physiotherapist or a used car salesman. It’s efficacy is at best debatable, certainly when compared to other treatments, and the risk vs potential reward is too high.

I found this, from March:

https://www.bmj.com/content/364/bmj.l689

which concludes (emphasis mine), “SMT produces similar effects to recommended therapies for chronic low back pain, whereas SMT seems to be better than non-recommended interventions for improvement in function in the short term. Clinicians should inform their patients of the potential risks of adverse events associated with SMT.“

… and a ‘rapid response’ to this study here:

Rapid response to a systematic review on spinal manipulative therapy for chronic low back pain

“In conclusion, these results demonstrate no convincing evidence for the superiority of SMT over sham SMT, and a lack of clinically important benefit of SMT when compared with any other treatment. The lack of a benefit of SMT over sham therapy indicates that SMT is unlikely to have any direct benefits and observed improvements are the result of contextual and other effects. It is likely that the apparent equivalence with both ‘recommended’ and ‘non-recommended’ therapies tells us more about the disappointing effectiveness of those approaches than it does about the benefit of SMT.”

TL;DR – spines are delicate things, leave them alone.

Flippin’ heck. Go on then.

What you have missed ned is that ALL spinal manipulation as practised by osteopaths and chiropractors is bad

Can you please show me the parts I’ve missed that show this?

I’ve taken great pains to read and analyse what you’ve linked to, I’ve quoted, summarised what I’ve felt are the salient points (all of which you seem to ignored). And believe me, I’ve looked hard for evidence of the conclusion you’ve reached above, because I’d have been quite happy to hold my hands up and accept that evidence if it was there.

But I’ve not found it.

Have you?

Where is it?

The reason I have such strong views on this is I understand the basics of medicine and I hate charlatans who prey on the credulous.

Not because you love a good argument then! 😀

Ned – I gave the explanation. the differnce is physio techniques do not eceed the normal limits of movement, osteopathic does. One is safe, one is not.

A physio using osteopathic treatments is not practicing physiotherapy and is putting their registration as a physio in danger by doing so. They would have no defense in a professional misconduct hearing as they are acting outside of their training

I linked to that piece to show the evidence of harm and the lack of evidence of benefit of this technique

Evidence based practice. the evidence is clear. Osteopathic spinal manipulation techniques do no good and do harm.

Now go on seeing as you believe that osteopaths can do good – find some evidence to back you up

I found this, from March:

keep up, we’ve been arguing about that one since tj linked to it on page 1!

Ned – its states it clearly You even quoted it

“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.

What you fail to understand is the difference – physio treatments do not exceed the normal limits of movement, osteopathic does.

A “physio” who uses osteopathic techniques by going beyond the normal limits of movement is not practicing physiotherapy as they are trained to do

I saw a shamster at a show the other day offering this:

http://www.eurotherapy.org.uk/

He even looked like the spiv out of Dad’s army which ought to be a clue. Old ladies loved it though, they were queuing up to hand their cash over.

Ned – I gave the explanation. the difference is physio techniques do not exceed the normal limits of movement, osteopathic does.

Can you show me the evidence for this difference existing in any of the studies you linked to?

The different types of SMT referred to are HVLA and LVLA. All “Low amplitude”. If there was a difference in how far the movements were pushed, there would be High Amplitude, surely? But no. No mention of any difference worth categorising in the amplitude of movements in different types of SMT used by differrent practitioners.

I’m quite happy to hold my hands up and admit if I’ve missed something, but you’ve got to help me find it!

its not in those studies. Its just basic stuff. What that study includes is people who are physiotherapists who are using techniques that are not physiotherapy. Neither HVLA and LVLA.are physiotherapy! NO spinal manipulation of that type is physiotherapy. Anything that takes it outside of normal movement is not physiotherapy.

its not in those studies. Its just basic stuff.

Righto. If that’s all you’ve got, then I’m definitely out.

There’s a good reply on that Guardian link, above:

“This piece does not, perhaps, convey adequately the fact that there is a wide range of beliefs among osteopaths. The best of them are indistinguishable form physiotherapists (indeed they may be better than that subgroup of physiotherapists who think that sticking pins into patients is a good idea). At the other extreme, there is utterly barmy “cranial ostepathy”, an entirely bogus form of treatment for which there is not a jot of evidence.”

… neatly dispelling all the anecdotal “evidence” in favour of one over another.

Ned – its in some of the stuff linked to. Thats the difference. Osteopaths can use physio techniques and some physios may use osteopathic techniques. Its the technique that matters not the label of the practitioner. Spinal manipulation that goes outside of normal range of movements is not physio.

So the study you were looking at which includes physios is physios using techniques that actually are osteopathic hence no difference found in outcomes

Osteopaths are gentler than Chiropractors

Thanks Cougar, that’s pretty much exactly what I said on page 1. And what our contributing osteopath said too.

What yo have missed again is that anecdote is not evidence! hence cougars inverted commas.

Now – the evidence of osteopathy doing good? found any yet?

It doesn’t matter who is doing the spinal manipulation – its wrong, has no evidence base and can be harmful.

Spinal manipulation as described and as the term is used in these studies is not a physiotherapy technique even tho some “physiotherapists” may use spinal manipulation.

I am a nurse. I could do a one year course in spinal manipulation and perform it on the public. However I would not be acting as a nurse if I did so!

and I suppose it is so easy to run a trial with actual spinal manipulation versus placebo spinal manipulation – how would you do the latter ?

they did sham spinal manipulation but of course you cannot do a double blind study – using a sham technique would only be single blind

so how do you obtain meaningful trial data ?

TJ where is the evidence that your evidence based information is in fact based on evidence that is evident and fulfills the evidential requirements of evidence based practice that eventually evidences to this evidence dependent forum that the specific submitted evidence fulfills the requirements of such evidence upon which we will peer review your expected evidence in the context of your non verified evidence based information around evidence based practice.

With great difficulty Turnerguy. all yo can do is look at the data you obtain, use single blind or cohort studies / longitudinal and accept the limitations of the data – like the metastudy I linked to. However whenj yo have enough data points adn the data is heavily weighted in one direct what the evidence indicates is obvious. As it is.

D Faff – my head just exploded!

Tell us all about the time you got the arm issue sorted Tj
Which evidence based practitioner did that for you again ?

The osteo I use was, up until not that long ago, employed as an osteo by the NHS at a London hospital. Confusing isn’t it!

TJ the evidence did suggest that such an outcome was likely 😉