Osteopathy (manipulation therapy)

Osteopathy comes from two Greek words meaning ‘bone and disease’. It is a therapy that involves manipulation of bones, muscles and connective tissue (the musculoskeletal system) to treat symptoms and illnesses. It is based on the belief that the body can be more healthy and recover from illness more quickly when the body structure is working well. Specialists trained in osteopathy (osteopaths) think that our bones and muscles are key to diagnosing and treating many disorders.

Osteopathy doesn’t involve surgery or drugs. Osteopaths use their hands to find problem areas in the body. They then treat problems by massaging and moving the relevant parts of your body. The idea is that this ‘manual therapy’ can improve your circulation, reduce swelling, ease pain and help restore movement.

Osteopathic techniques include

• Massage
• Stretching muscles, tendons and ligaments
• Moving joints rhythmically
• Muscle manipulation
• Short sharp movements called ‘high velocity thrusts’

Some osteopaths also use very gentle movements of your skull and sometimes the bone at the bottom of the spine (sacrum). This is a specialised form of treatment called cranial osteopathy or craniosacral therapy.

As well as taking a detailed medical history of your symptoms, osteopaths also take time to look at your general lifestyle, including work, diet and exercise. They want to find out any underlying reasons for your health problems. They can then offer lifestyle and exercise advice to help prevent muscle and joint problems happening again.

Most osteopaths don’t call themselves complementary therapists. They are more likely to refer to themselves as ‘primary healthcare practitioners’. Osteopathy is becoming more widely recognised by the medical profession. Many GP surgeries throughout the country provide access to osteopathy.

Some people who use osteopathy say it can help control pain, headaches and tension. They also say that it helps them relax, which improves their overall feeling of health and well being. There is no evidence to suggest that it will help treat or cure cancer.

For more information look in our section about why people with cancer use complementary therapies.

Although osteopathy is quite widely used, most of the scientific research evidence is about 'thrust techniques' for back pain. There is not much research into other gentler techniques (such as massage) that are more likely to be used for other illnesses, including cancer. But there is some evidence that massage helps with some cancer related symptoms such as lymphoedema, anxiety and tiredness. Most evidence for osteopathy in cancer care is based on reports by patients, osteopaths, and some doctors saying that it has helped. This is called anecdotal evidence.

There is now good evidence from clinical trials that spinal manipulation helps low back pain. The recent BEAM clinical trial in the UK looked at how well spinal manipulation and exercise worked for low back pain. It found that manipulation worked slightly better than the standard care provided by GPs, and a bit better again when combined with an exercise programme afterwards.

A systematic review in 2006 looked at the results from 6 studies on osteopathic spinal manipulation for low back pain and found that back pain was significantly reduced and the benefit lasted for several months.

The Cochrane Library have published reviews of spinal manipulation for asthma, chronic headaches, and period pain. Manipulation seems able to reduce the frequency of migraine and some other types of headaches. But trials have found that spinal manipulation does not help painful periods or asthma. Too few clinical trials have been done to know whether or not manipulation works for other conditions.

Because osteopathy is so widely used, and is sometimes provided by the NHS, research into its use will continue, including finding out more about long term effects and cost effectiveness. The National Council for Osteopathic Research (NCOR) was set up in 2003 to promote more research within the osteopathy profession. In 2008 they started 4 projects to find out about the safety of osteopathy and whether it causes side effects.

On your first visit, the osteopath will ask you some general questions about your health, lifestyle and medical history. These questions aim to find out what is causing your symptoms. Your osteopath may ask about

• Any muscle, joint or bone injuries you have had
• Other medical conditions, for example, diabetes, heart problems and asthma
• Where and how often you have pain or other symptoms
• How much the symptoms affect your daily life
• The type of work you do
• The amount and type of exercise you do
• The type of bed that you sleep on
• Your sleep patterns
• Your diet
• Alcohol, drugs and smoking habits

They will then examine you, which might include checking your heart rate, reflexes, and breathing pattern. They may want to contact your doctor to check that they are happy for you to go ahead and have osteopathy. There may be some situations where your doctor recommends that you don’t have osteopathy.

To have the treatment you will usually need to take off your clothes down to your underwear. Your osteopath might give you a gown to wear. They will then use their hands to stretch, massage and improve movement in your spine, joints and muscles. Sometimes they use a rapid ‘thrust’ type action, which can cause a ‘popping’ sound due to the sudden change of pressure in the joint space. This might sound alarming, but it shouldn’t be painful.

Most treatment sessions last about 30 to 45 minutes. Tell the osteopath if you are in any discomfort or want them to stop. Most osteopaths suggest that you have between 3 to 6 sessions to get the most benefit. Your osteopath may suggest exercises that you can do at home to help prevent further problems.

Using osteopathy is generally safe. For a couple of days afterwards you may

• Feel slight soreness in the treated area
• Have a slight headache
• Feel tired

If these symptoms don’t go away you should contact your osteopath for advice.

There have been some concerns about the possible risk of having a stroke because of manipulation to your neck. Between 1 and 3 out of every million people who have neck manipulation are at risk of having a stroke. But if you are at high risk of stroke, your osteopath will follow strict guidelines about the kind of neck manipulation they can and can’t do. It may also help to know that spinal manipulation for neck pain seems to be much safer than taking non steroidal anti-inflammatory drugs, according to a research review.

If you have cancer it is important that you let your cancer specialist know before you have osteopathy. Let your osteopath know that you have cancer too. In most cases it will be OK for you to go ahead. But most doctors and osteopaths wouldn’t recommend using any forceful techniques, such as the ‘high velocity thrust’ technique for people who have

• Any type of bone cancer (primary bone cancer or secondary bone cancer)
• Cancer involving the bone marrow such as leukaemia, myeloma or lymphoma
• Osteoporosis
• Broken bones or fractures
• Inflammatory joint disease such as arthritis
• Infections
• Bleeding disorders, such as haemophilia
• Multiple sclerosis

You also shouldn’t use osteopathy during a course of radiotherapy, or if you are taking drugs to help thin your blood (anticoagulants), or if you are between 8 and 12 weeks pregnant. Your doctor may recommend other situations where you shouldn't have osteopathy (such as during a course of chemotherapy), so always ask them before having treatment.

If you have osteopathy privately, it will usually cost between £25 and £50 for a session. Your first appointment will cost more (between £30 and £60) because it generally takes longer. Some GPs can refer people for osteopathic treatment on the NHS, although this varies between primary care trusts. The General Osteopathic Council website has more information on osteopathy and the NHS.

If you have private health insurance your policy might cover osteopathy. Your policy provider will advise you.

It is most important that your osteopath is properly trained and qualified. The best way to find a reliable one is to

• Go to the General Osteopathic Council website and use their ‘find an osteopath’ search - or phone them and ask for a list of osteopaths in your area
• Before having treatment, ask the osteopath how many years of training they've had, how long they've been practising and if they have treated people with cancer before

There is general information about finding a reliable therapist in our about complementary therapies section.

The professional body that regulates osteopaths is the General Osteopathic Council (GOC). By law osteopaths have to register with this organisation in order to call themselves osteopaths. This means that they have to meet the correct set of standards for training, professional behaviour and skills. And they must have insurance. The GOC website has information on their code of practice. There are about 4,000 osteopaths registered with the General Osteopathic Council.

General Osteopathic Council
Osteopathy House
176 Tower Bridge Road
London
SE1 3LU
Phone 020 7357 6655
Email: info@osteopathy.org.uk
Website: www.osteopathy.org.uk

Other osteopathy organisations include

British Osteopathic Association
3 Park Terrace
Manor Road
Luton
LU1 3HN
Phone: O1582 488455
Email: boa@osteopathy.org
Website: www.osteopathy.org

National Council for Osteopathic Research (NCOR)
Based at the Clinical Research Centre for Health Professions
Aldro Building
University of Brighton
49, Darley Road
Eastbourne
East Sussex
BN20 7UR
Phone: 01273 643766
Website: www.ncor.org.uk