using a sham technique would only be single blind

And one would assume, inherently risky?

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.

And this possibly explains some of the (mis)interpretation on the thread. Saying “Osteopaths are charlatans” (label of the practitioner) instead of “certain osteopathic techniques have no evidence base and can cause harm” (it’s the technique that matters).

I’ve seen a osteopath a few times, and they’ve helped greatly. They didn’t do anything a physio wouldn’t have done – all just massage and gentle movements, combined with some good questioning and advice that help identify the causes of the issues and ways of fixing them.

I also doubt whether the clicking and thrusting and cranial has any measurable benefit, and I’ve always thought it potentially dangerous.

And this possibly explains some of the (mis)interpretation on the thread. Saying “Osteopaths are charlatans” (label of the practitioner) instead of “certain osteopathic techniques have no evidence base and can cause harm” (it’s the technique that matters).

Thats probably air enough. they are not really practicing as osteopaths then are they? Can’t claim to be a physio without the training and registration.

But yes – its the technique not the label that counts

but physiotherapists do spinal manipulation, and ‘cracking’ too…

https://www.physio-pedia.com/Spinal_Manipulation

…I’ve seen a osteopath a few times, and they’ve helped greatly. They didn’t do anything a physio wouldn’t have done – …

Osteopathy as a field that tries to associate itself with healthcare is a sham, and thus those who choose to practice under its banner are open to scorn.

If they want to practise ‘physio techniques’ then they should become physios.

I’ve had loads of problems over the years. I’ve regularly seen two physios, an Osteo and currently a sports masseuse. They all have used very similar techniques. Only people to have tried manipulation have been the physios.

Turnerguy – if they do they are not practicing physiotherapy and could lose their registration for doing so given the proof it does not work and that its dangerous.

However see Beejs comments above – it doesn’t matter what they call themselves its the techniques that count. spinal manipulation and cracking are inneffective and dangerous – this is a fact well proven.

From the body that maintains the registration of physiotherapists

Registrant physiotherapists must:
1. be able to practise safely and effectively within their scope of practice

So if they are doing spinal manipulation and bone cracking osteopathic type they have breached this
http://www.hcpc-uk.co.uk/standards/standards-of-proficiency/physiotherapists/

The Chartered Society of Physiotherapy (CSP) is the professional, educational and trade union body for the UK’s 58,000 chartered physiotherapists, physiotherapy students and support workers.

Here’s a course they offer in Spinal Manipulation.

https://www.csp.org.uk/event/complete-manipulation-course-2-days

tj, you’ve put things in very firm boxes which don’t reflect reality: that if an osteopath isn’t doing SMT, they’re not being an osteopath, and that if a physiotherapist is using SMT, they’re either using the good type which isn’t SMT, or they’re not being a physiotherapist and risk being struck off.

You’ve made up a distinction between what a physio calls Spinal Manipulation and “osteo” SM which doesn’t exist in reality. There’s a broad range of SMT techniques and none of the descriptions in the literature talk about this “normal range of movement” you’ve decided upon. What would normal mean anyway? It’s passive or physiological.

The evidence suggests that SMT is of marginal benefit, but then so are the alternatives (drugs, exercise…). So it remains in the toolbox for many professionals, including physios, with caveats about when and when not to use it, given the possiblity of harm and probability of success.

If you go and see a physio or an osteopath with a spinal problem, there’s a good chance they’ll use some SMT techniques in their treatment, depending on their personal preference and feelings based on their background, personality and professional development.

Whoever you’re seeing, ask them about their personal approach to SMT, and if you’re not 100% sure, decide between you what’s “out of bounds” for treatment, or find someone else.

And it’s a good idea to go on recommendation, even though all recommendations are worthless because they’re just anecdotes.

Generally, if you adopt a binary, black and white position with no room for grey, you’re going to be wrong.

Dr Andrew Leaver, Senior Lecturer in Physiotherapy at the University of Sydney, points out, evidence-based practice is “not a black and white proposition”.

“True evidence-based practice is using the best available evidence that you have, and the best available evidence for any intervention is sometimes not that good,” Dr Leaver said.

“We don’t have robust clinical trials that prove the efficacy of every single thing that we do, but neither does any profession — a lot of medicine is not backed up by robust randomised controlled trials.”

I had osteo – maybe the final one – yesterday and here’s what he did for a knotted trap/neck situation

a) cracked my neck vertically, and spine between my shoulder blades

b) manipulated and massaged the knots around my trapezius

c) cracked my neck whilst lying, in a R/H direction (my issue is on the left side)

d) more massage.

I was a year at the physio prior with sports massage and dry needling and I’ve been 8 months with the osteo   Both have said it’s a chronic issue and I need to stop cycling for 6months to a year to resolve it, or face continual remedial efforts at undoing the damage from riding and races

The both seem “right”, the results are slightly not as good with the Osteo in terms of short term pain relief.  Who to stick with – no idea…

People are getting aerated about this aren’t they!
A few points:
Risk – my annual professional indemnity insurance is circa £270, this means that the chance of me needing it is low. There are risks associated with all interventions, ask a surgeon or anaesthetist what there premiums are.
Treatment – when I trained the definition of osteopathic treatment was ‘treatment provided by an osteopath’. You need to be competent in using your chosen technique, but it is not limited to HVLA manipulation. I use various techniques, including (occasionally) HVLA thrusts, probably the most useful element of what I do in the longer term is offer advice about how to help recovery and reduce the chance of recurrence in the future. Different patients get different treatment, dependent on the nature of their problem and what is appropriate and safe for that individual.
Manipulation – there were pictures in the library where I trained of a chap called Cyriax (a physio IIRC) doing the kind of manipulation described by tj, it was universally felt to be unacceptable then. We were taught that the correct way to manipulate was to create tension using a variety of levers and apply pressure within the physiological range of the joint. Not just ‘take it as far as it can go & then force it further’.
@Kryton53 you are asking the symptomatic area to do more than it can manage, you need to alter what you are asking it to do &/or make it more able to cope with the demands placed on it. Looking at a combination of your strength, flexibility and movement patterns should help.

Guys – there is NO evidence base for spinal manipulation – none at all.

Go on – two osteos have poked their heads above the parapet. I thank you for that.

Your quote about evidence practice is irrelevant – the evidence for spinal manipulation is very clear.

So let me see the evidence for it working because all the evidence I have seen works one way only – its does no good and its dangerous. and given conditions of registration for spinal manipulation then any registerd physiotherapist using it does indeed risk being struck off – as I would if I used nursing treatments from 100 years ago which are proven to have no use and to be harmful

I linked to a major meta study earlier that shows spinal manipulation does no significant good and can do significant harm. given that is the best evidence we have then how can anyone no matter their label perform this?

OK – hint taken!

Nope! This is bigger than SMT!

Seriously, honestly, you are too binary, TJ. There is something in your personality which leads you into black and white answers and doesn’t let you out again.

You seem to feel so comfortable about having made a decision, and so uncomfortable about the possibility of reconsidering that decision that you’re not able to take on new information. You’re literally blind to it.

The studies you linked to do not conclude what you think they do. Physiotherapists use SMT in much the same way as osteos. It’s not universally condemned.

The news that the official body for education and registration for physiotherapists offers courses in SMT seems to have made no impact whatsoever to your belief that it’s counter to the central tenets of physiotherapy, and that practitioners can be thrown off for using it. How can that be?

Allow yourself the faintest glimmer that you might be wrong and try and read through the thread again and the links again with an open mind. Seek out passages and indicators which show you might be wrong, rather than skimming for the odd sentence which says what you want it to say.

And in life generally, allow yourself the space to believe that there might be truth in a different perspective. You’ll learn more. You might find it liberating. You’ll certainly have fewer multipage tj-dominated arguments on here.

NOpe Ned( sorry Drac – direct question to me)

The point is no matter who does it spinal manipulation ( even the osto above agrees) has no significant benefits and causes minor harm frequently and major harm occasionally

The studies I linked to show this conclusively.

Therefore this is not a treatment anyone should be using.

BTW – the body the osteo above linked to is NOT the registration body

It really is that simple and that black and white. The fact that some physios may use it does not validate it, it invalidates those physios. It is counter to the central tenets of scientific medicine.

The facts are simple and black and white. spinal manipulation is proven to do no significant good and often causes harm. thats the science

If I or a doctor was using some treatment with no scientific basis, proven to do no good, proven to do harm then rightly we would be stuck off.

You’re right TJ, physios register with the HCPC, the CSP is the professional, educational and trade union body for the UK’s 58,000 chartered physiotherapists, physiotherapy students and support workers. Sloppy typing on my part.

As such, they’ve got plenty of advice on registration with the HCPC, and yet they’re still advertising courses by physios, for physios on SMT.

All these evidence based practitioners, the ones you like, all reading the same evidence and coming to a different conclusion to you? That’s odd, isn’t it? But no glimmer of doubt in your mind?

You’re right that there’s evidence of only marginal benefit from SMT, and you’re right that there’s evidence of some harm. What you’re missing is the context that no other recommended treatments are much better, while carrying their own risk of harm, and that the risk from SMT is acceptable if care is taken and caution used about when and when not to use it and how and how not to use it based on the patient and the symptomatic areas.

That’s why evidence based practitioners use it where appropriate, promote its use, teach it and learn it. Because they understand the evidence.

@nick1c thanks for your last few sentences of advice.  With similar results for both I’ve decided to return to the physio after my Hols, and prior to winter training.  The basis of this is that when I’ve asked my Osteo for exercises he’s provided a few stretches but seems reluctant to give advice.  During physio we tried quite a few things which aggregated the issue so we stopped

I don’t have a great core, and have a bad posture so my intention is to walk into the physio with a dictat of treating the problem but providing me with some relevant winter exercises in association with my Coach to do as you say.