The current situation
First, the positive. In limited areas, there is good quality evidence to show evidence of osteopathy. In particular, for back pain, the BEAM trials concluded that osteopathy was a cost-effective, efficient service, with high patient satisfaction rates and referral safety. It is also one of the therapies recommended for chronic low back pain in NICE guidelines.
Where do we go from here?
As most private clinics are small or single-practitioner clinics very few have the time or funds to do clinical audits and research. As such, most research is performed at the universities. This means that evidence often comes from the findings of research undertaken by final year students rather than experienced osteopaths. Furthermore, treatment efficacy research is actively discouraged as beyond the scope of undergraduate study.
As more professions such as physiotherapy and medicine are beginning to use osteopathic techniques such as spinal manipulation, and as these professions have larger funding bodies, the research undertaken that use these techniques is often executed by them rather than osteopaths. Comparing the effect of treatment by an osteopath that has honed this skill for at least four years to a physiotherapist who has only done a short introductory course may well affect the outcomes of such studies.
One area of opposition to osteopathy is based on the lack of randomised controlled trials (RCTs). Considering the substantial costs involved in undertaking large RCTs, the lack of large osteopathic practices to provide the patients for such research, and the lack of funding available it is unclear where the evidence base can come from to cement osteopathy as an integral part of the nation’s healthcare. Similarly, no longitudinal research into the preventative effects of osteopathy has been done.
Other areas to investigate
Medically-unexplained symptoms (MUS) are an increasing issue in today’s NHS. This label is often given to patients who present with collections of symptoms yet with no obvious pathological cause, such as chest pain in the absence of cardiac anomalies. The number of patients with MUS presenting to primary care (and taking up a large proportion of GP and secondary care appointments), means there is an urgent need to find a resolution for this epidemic.1
Anecdotally, osteopathy is used to treating patients with this type of condition due to its history of incorporating the biopsychosocial model of healthcare, long before mainstream medicine. This means that the patient is never considered out of the context of their circumstances and as such osteopathic treatment, addressing the patient rather than a condition, has tremendous potential.
Highlighting osteopathy’s potential to treat complex, drug-resistant conditions, ongoing research into the effects of treatment on the immune system has early promising results. Lymphatic ‘pumping’ techniques applied to the chest and abdomen appear to release stores of white blood cells from the spleen and gut that enter the general circulation. This is a technique used for over a century by osteopaths to treat flu and general health problems and recent animal models of pneumonia, cancer and HIV have all been shown to be directly affected by these techniques.2
Burton, 2003, Beyond somatisation: a review of the understanding and treatment of medically unexplained physical symptoms (MUPS), Br J General Practice; Vol 23(488): 231-239.
Hodges, 2012, Osteopathic lymphatic pump techniques to enhance immunity and treat pneumonia, International Journal of Osteopathic Medicine; Vol 15(1): 13-21.