The nhs and Osteopathy
The NHS and Osteopathy
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 believe their treatments allow the body to heal itself. They use a range of techniques but do not use drugs or surgery.
Most people who see an osteopath do so for help with back pain, neck pain, shoulder pain or other problems related to muscles and joints. Some osteopaths also claim to treat a wide range of health conditions, including asthma, digestive problems and period pain.
Outside the US, osteopathy is a complementary or alternative medicine (CAM), and is different from conventional western medicine. Osteopaths may use some conventional medical techniques, but the use of osteopathy is not always based on science.
Read more about the common uses for osteopathy and what happens when you visit an osteopath.
Does osteopathy work?
There is good evidence that osteopathy is effective for the treatment of persistent lower back pain. The National Institute for Health and Care Excellence (NICE) recommends it as a treatment for this condition.
There is 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 is no good evidence that osteopathy is effective as a treatment for health conditions unrelated to the musculoskeletal system (bones and muscles).
Osteopathy is not widely available on the NHS. Your GP or local clinical commissioning group (CCG) can usually tell you whether it is 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 do not need to be referred by your GP to see an osteopath privately.
Only people registered with the General Osteopathic Council (GOsC) are allowed to practise or call themselves osteopaths. You can find a registered osteopath near you on the GOsC website.
Evidence for osteopathy
To judge whether a health treatment is safe and effective, we need evidence. Evidence on a treatment is gathered by conducting fair scientific tests of the treatment.
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 is not always clear how effective the treatment actually is for certain conditions.
Conditions commonly treated with osteopathy
Osteopathy is most commonly used to treat conditions that affect the muscles, bones and joints.
These conditions include:
lower back pain
problems with the pelvis, hips and legs
problems with posture caused by driving, work or pregnancy
Some osteopaths may also 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 is not enough evidence to suggest osteopathy can treat these problems.
NICE recommended uses
The National Institute for Health and Care Excellence (NICE) provides guidelines to the NHS on the use of treatments and care of patients.
Currently, NICE recommends that osteopathy can be considered as a treatment option for persistent lower back pain.
What happens during osteopathy?
During your first osteopathy session, the osteopath will ask you about your symptoms and your general health 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. You will 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.
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
It is claimed that these techniques reduce pain, improve movement and encourage blood flow.
Osteopathy is not usually painful, although there may be some discomfort if you’re having treatment for a painful or inflamed injury. If you feel any pain during treatment, tell your osteopath immediately.
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 nine sessions over 12 weeks.
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.
However, there is some good 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 this can be considered as a treatment option.
NICE also recommends manual therapy as a possible treatment option for osteoarthritis, but osteopathy is not specifically mentioned.
There is no good evidence that osteopathy is an effective treatment for:
excessive crying in babies (colic)
the abnormal curvature of the spine to the sides (scoliosis)
sinusitis (inflammation of the sinuses)
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.
This regulation works in much the same way as regulation for medical doctors.
Under the terms of the Osteopaths Act 1993, only people registered with the General Osteopathic Council (GOsC) can practise osteopathy and call themselves osteopaths.
The GOsC will only accept registration from practitioners who have a qualification in osteopathy that is recognised by the GOsC and who comply with their standards of practice.
If you use an osteopath and they do not 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 does not mean there is scientific evidence that a treatment is effective.
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
These effects usually develop within a few hours of a session and typically get better on their own within a day or two.
Serious complications that have been linked to therapies involving spinal manipulation – including osteopathy – include 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.
Osteopathy is not recommended where there is 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:
acute inflammatory conditions
blood clotting disorders such as haemophilia
Osteopathy is also not recommended if you are taking blood-thinning medicines, such as warfarin.