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Osteopathy Content Supplied by NHS Choices
Introduction

Osteopathy is a way of detecting, treating and preventing health problems by moving, stretching and massaging a person's muscles and joints.

Osteopathy is based on the principle that the wellbeing of an individual depends on their bones, muscles, ligaments and connective tissue functioning smoothly together.

Osteopaths use physical manipulation, stretching and massage, with the aim of:

  • increasing the mobility of joints
  • relieving muscle tension
  • enhancing the blood supply to tissues
  • helping the body to heal

They use a range of techniques, but don't use drugs or surgery.

In the UK, osteopathy is a complementary or alternative medicine (CAM), and is different from conventional western medicine.

Although osteopaths may use some conventional medical techniques, the use of osteopathy isn't always based on scientific evidence.

Read about what happens when you visit an osteopath.

Common uses

Most people who see an osteopath do so for help with conditions that affect the muscles, bones and joints, such as:

Some osteopaths claim to be able to treat conditions not directly related to muscles, bones and joints, such as headaches, migraines, painful periods, digestive disorders, depression and excessive crying in babies (colic). However, there isn't enough evidence to suggest that osteopathy can treat these problems.

Does osteopathy work

There's good evidence that osteopathy is effective in treating persistent lower back pain. The National Institute for Health and Care Excellence (NICE) recommends it as a treatment for this condition.

There's limited evidence to suggest it may be effective for some types of neck, shoulder or lower limb pain and recovery after hip or knee operations.

There's currently no good evidence that osteopathy is effective as a treatment for health conditions unrelated to the musculoskeletal system (bones and muscles).

Read more about the evidence on osteopathy.

Accessing osteopathy

While osteopathy isn't widely available on the NHS, your GP or local clinical commissioning group (CCG) should be able to tell you whether it's available in your area.

Most people pay for osteopathy treatment privately. Treatment costs vary, but typically range from 35 to 50 for a 30-40 minute session. You don't need to be referred by your GP to see an osteopath privately. Most private health insurance providers also provide cover for osteopathic treatment.

Only people registered with the General Osteopathic Council (GOsC) are allowed to practise as or call themselves osteopaths. You can find a registered osteopath near you on the GOsC website.

Read more about how osteopathy is regulated.

What happens during osteopathy?

During your first osteopathy session, the osteopath will ask about your symptoms, general health and any other medical care you're receiving before carrying out a physical examination.

The osteopath will use their hands to find areas of weakness, tenderness, restriction or strain within your body, particularly the spine. With your consent, you'll probably need to remove some clothing from the area being examined, and you may be asked to perform simple movements.

You should then be able to discuss whether osteopathy can help treat the problem and, if so, what the treatment programme should involve.

Osteopaths are trained to identify when a patient needs to be referred to a GP or needs further tests, such as MRI scans or blood tests, to help diagnose the problem.

Osteopathic techniques

An osteopath aims to restore the normal function and stability of the joints to help the body heal itself. They use their hands to treat your body in a variety of ways, using a mixture of gentle and forceful techniques. These include:

  • massage - to release and relax muscles
  • stretching stiff joints
  • articulation - where your joints are moved through their natural range of motion
  • high-velocity thrusts - short, sharp movements to the spine, which normally produce a clicking noise similar to cracking your knuckles

These techniques aim to reduce pain, improve movement and encourage blood flow.

Osteopathy isn't usually painful, although it's not unusual to feel sore or stiff in the first few days after treatment, particularly if you're having treatment for a painful or inflamed injury. Your osteopath will explain whether you're likely to have any reactions.

If you feel any pain during or after treatment, tell your osteopath.

You may be given advice on self-help and exercise to aid your recovery and prevent symptoms returning or getting worse.

In general, the first appointment can last up to an hour or longer. Further treatments last around 30-40 minutes. Your course of treatment will depend on your symptoms. In the case of lower back pain, the National Institute for Health and Care Excellence (NICE) recommends that treatment should include up to 9 sessions over 12 weeks.

Osteopathy safety and regulation

Osteopathy is one of only two complementary and alternative medicines (CAMs) that are regulated under UK law. The other is chiropractic.

Regulation works in much the same way as regulation for medical doctors.

Regulation

By law, osteopaths must be registered with the General Osteopathic Council (GOsC).

The GOsC only accepts registration from practitioners who have a qualification in osteopathy that's recognised by the GOsC and who comply with their standards of practice.

Osteopaths are required to renew their registration each year. As part of this process, the GOsC checks to ensure they have the correct insurance, are meeting professional development requirements and remain in good health.

If you use an osteopath and they don't adhere to this standard of practice, you can complain to the GOsC. It has a duty to investigate the complaint.

The GOsC has a register of osteopaths, which you can use to find one in your local area.

Regulation aims to protect patient safety, but it doesn't mean there's scientific evidence that a treatment is effective.

What qualifications do osteopaths have

Osteopaths complete a four- or five-year honours degree programme (bachelor's or master's), which involves at least 1,000 hours of clinical training. Some osteopaths are qualified to PhD level.

Safety

Osteopathy is generally regarded as a safe treatment, although you may experience minor side effects, such as:

  • mild to moderate soreness or pain in the treatment area
  • headache
  • fatigue

These effects usually develop within a few hours of a session and typically get better on their own within a day or two.

In rare cases, serious complications have been linked to therapies involving spinal manipulation, including osteopathy. These include the tearing of an artery wall leading to a stroke, which can result in permanent disability or even death. These events usually occurred after spinal manipulation involving the neck.

These more serious complications of spinal manipulation are rare. Estimates of the rates of serious complications range widely, from one in several thousand to one in several million.

Your osteopath should explain the benefits and any potential risks associated with having treatment.

When it shouldn't be used

Osteopathy isn't recommended where there's an increased risk of damage to the spine or other bones, ligaments, joints or nerves.

Therefore, people with certain health conditions may not be able to have osteopathy. These conditions include:

Osteopathy is also not recommended if you're taking blood-thinning medicines, such as warfarin, having a course of radiotherapy or during pregnancy.

Evidence for osteopathy

To judge whether a health treatment is safe and effective, we need evidence, which is gathered by conducting fair scientific tests.

What evidence is there

Most research into techniques used in osteopathy tends to focus on general "manual therapy" techniques, such as spinal manipulation. Manual therapy techniques are used by physiotherapists and chiropractors, as well as osteopaths.

There's evidence that manual therapy performed by osteopaths is an effective treatment for persistent lower back pain. This is why guidelines from the National Institute for Health and Care Excellence (NICE) on this condition state that this can be considered as a treatment option.

NICE also recommends manual therapy as a possible treatment option for osteoarthritis, but osteopathy isn't specifically mentioned.

There's only limited or no scientific evidence to support osteopathy as an effective treatment for:

Placebo effect

When we use a treatment and feel better, this can sometimes happen because of a phenomenon called the placebo effect, and not because of the treatment itself.

This means, although many people treated by osteopaths report good results, it's not always clear how effective the treatment actually is for certain conditions.

 
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