Existing evidence

There is good quality evidence supporting the beneficial effects of manipulation for back pain. NICE recommends osteopathy for sub-acute and chronic low back pain, and the risk of experiencing serious adverse reaction to osteopathic treatment is very small.1

Osteopathic care was found to provides a cost-effective, efficient service, with high patient satisfaction rates and referral safety2. Many further positive trials at the bottom of the page.


Areas for future study



Migraine occurs in 15% of the UK adult population with three quarters of people affected reporting disability and the cost to the economy may exceed £1.5 billion per annum. Osteopathy has been shown to reduce frequency and intensity of migraine and reduce the psychological burden that migraines impose.


Chronic Pelvic Pain

In the UK some £158 million is spent on the management of pelvic pain and over a third of women worldwide report experiencing period pains that regularly impact on their ability to work or study. Several osteopathic techniques exist for treating pelvic pain and dysmenorrhoea, primarily aimed at improving mobility of the pelvis, ligamentous tension and blood flow to the area.

Young woman in pain

Painful diabetic neuropathy

The number of people with diabetes in the UK has risen from 1.4 million to 2.9 million with diabetes prevalence estimated to rise to 4 million by 2025. One third of diabetics suffer from excruciating nerve pain in their feet and, anecdotally, osteopathy has been effective in improving circulation to the feet and reducing pain levels.



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Research | Access | Mentoring


Further positive trials:


  • In acute low back pain (LBP), return to work time was reduced when osteopathy was included alongside GP and physiotherapy services. In addition, a primary care osteopathy clinic improved short-term physical and longer term psychological outcomes, at little extra cost to normal GP care. 3,4
  • For chronic LBP, osteopathy significantly reduced pain when compared to ultrasound, reduced the amount of prescription drugs taken and led to greater patient satisfaction.5
  • The difference in outcome between patients being treated with group exercise, physiotherapy or osteopathy in a hospital setting was greater for osteopathy than both physiotherapy and exercise groups.6
  • In pregnancy, treatment slows or halts the deterioration of back-specific functioning during the third trimester of pregnancy.7 Another study has found evidence that pregnant patients who received osteopathic care experienced improved outcomes in labour and delivery compared to those who did not.8
  • There is ample evidence of the effect of manual therapy in the treatment of neck pain, shoulder pain and lower limb pain.9
  • In a small pilot trial, preventative osteopathic treatment in elderly nursing home residents led to fewer hospitalisations and decreased medication usage with only a fortnightly treatment regime.10
  • In elderly patients hospitalised with pneumonia, treatment significantly reduced the duration of intravenous antibiotic use and length of hospital stay compared to a sham treatment.11
  • Shoulder function in elderly patients with chronic pain and reduced functional ability was considerably improved with osteopathy.12
  • In patients with severe chronic obstructive airways disease (emphysema/chronic bronchitis) osteopathy plus pulmonary rehab significantly improved lung function and exercise tolerance as opposed to rehab alone.13
  • Finally, paving the way for an integrated psychological and osteopathic service, The British School of Osteopathy (BSO) was recently awarded a significant Department of Health ‘Innovation’ grant of £256,000 over three years to develop a new service called OsteoMAP. This integrates a form of mindfulness with ‘hands on’ osteopathic treatment with the aim of helping people with chronic pain lead more fulfilling lives, despite on-going symptoms.14


  1. National Institute for Health and Care Excellence (NICE), 2009, Low back pain: Early management of persistent non-specific low back pain (
  2. The UK Back Pain Exercise and Manipulation (BEAM) Randomised Trial:, 2004 (
  3. Williams et al, 2003, Randomized osteopathic manipulation study (ROMANS): pragmatic trial for spinal pain in primary care. Family Practice. 2003;20, 662-9.
  4. Gurry et al, 2004, Rapid access treatment facility for acute low back pain based in the primary care setting, Journal of Orthopaedic Medicine; 2004;26(1): pp.13‐19.
  5. Licciardone et al, 2013, Osteopathic Manual Treatment and Ultrasound Therapy for Chronic Low Back Pain: A Randomized Controlled Trial, Ann Fam Med; Vol. 11(2): pp.122-129.
  6. Chown et al. A prospective study of patients with chronic back pain randomised to group exercise, physiotherapy or osteopathy. Physiotherapy. 2008;94:21-28.
  7. Licciardone et al, 2009, Osteopathic manipulative treatment of back pain and related symptoms during pregnancy: a randomized controlled trial, American Journal of Obstetrics and Gynecology; Vol 202(1): pp.43.e1–43.e8.
  8. King et al, 2003, Osteopathic manipulative treatment in prenatal care: a retrospective case control design study, J Am Osteopath Assoc; Vol. 103(12): 577-582.
  9. Bronfort et al, 2010, Effectiveness of manual therapies: the UK evidence report, J Chiror Osteopat, 25;18:3
  10. Snider et al, 2012, Preventative Osteopathic Manipulative Treatment and the Elderly Nursing Home Resident: A Pilot Study, J Am Osteopath Assoc; Vol 112(8): pp. 489-501.
  11. Noll et al, 2010, Efficacy of osteopathic manipulation as an adjunctive treatment for hospitalized patients with pneumonia: a randomized controlled trial, Osteopath Med Prim Care; 4(2): Published online Mar 19, 2010. doi: 1186/1750-4732-4-2.
  12. Knebl et al, 2002, Improving functional ability in the elderly via the Spencer technique, an osteopathic manipulative treatment: a randomized, controlled trial. J Am Osteopath Assoc. 2002; 102(7): 387-396.
  13. Zanotti et al, 2012, Osteopathic manipulative treatment effectiveness in severe chronic obstructive pulmonary disease: a pilot study. Complement Ther Med. 2012;20(1-2):16-22.
  14. Abbey & Nanke, 2014, Developing OsteoMAP: A new programme to expand the scope of care for patients with persistent pain, Bone Joint J; Vol. 96-B no. SUPP 4 44 (