The Guardian published an article last Sunday questioning the rationale behind osteopathy and whether there is any evidence that it works to improve or ‘cure’ patients from their ills. To clarify before we start, I don’t agree with it. It wasn’t particularly well written, or remotely balanced as an article with no opinions from osteopaths or chiropractors but plenty of opinions from other professions who often consider osteopathy and chiropractic to be competition (this isn’t really our view however, osteopathy is a niche between surgery, physiotherapy and chiropractic). However, I do agree that any medical field should be able to justify what it does and the way in which it approaches how patients are cared for.
If you want to read it, here is the link, but in summary, it suggests that osteopathy is a luxury when most likely, all injuries get better by themselves, or at least, the brain just switches off the pain. Glorified quotes include:
“In the 120 years since chiropractic and osteopathy were invented, there is no convincing evidence that either works” David Colquhoun, a pharmacologist
“Manipulation is not appropriate in the neck at all – it can occasionally cause stroke. There is definite risk of harm” Philip Sell, spinal surgeon
However, there is a growing amount of evidence that shows that osteopathy does improve symptoms on a long and short term basis for several areas of the body. The National Council For Osteopathic Research (NCOR) are very good at this tracking. They have a work in progress compilation about al the good quality research that has been done in the area of osteopathy and they regularly update it. We have a copy of it on our website here if anyone is interested, but in summary:
Lower Back Pain: There is good quality evidence, in the form of systematic reviews and randomised controlled trials, showing that spinal manipulation is effective in treating low-back pain. Once systematic review by Licciardone and colleagues looked specifically at osteopathic treatment for low back pain and found that it significantly reduces lower back pain.
Neck Pain: There IS evidence for manual therapy (manipulation – cervical and thoracic, mobilisation and myofascial techniques) for the treatment of non-specific neck pain, especially when combine with exercises.
Headache: There IS evidence that spinal manipulation may be effective in treating tension-type headache and cervicogenic headache; there is evidence to suggest that some manual therapies, including spinal manipulation, may be more effective that some pharmaceutical drugs in the prophylactic treatment of migraine. Spinal manipulation appears to be superior to massage for cervicogenic headaches.
Shoulder Pain: There IS a fair level of evidence for manual and manipulative therapy combined with multimodal exercise therapy for rotate cuff injuries. disorders and/or diseases and frozen shoulder (when utilising proprioceptive exercises). There is also a fair level of evidence for so tissue or myofascial treatments for soft tissue disorders of the shoulder. There is limited evidence for high velocity low amplitude manipulation with soft tissue release and exercise for minor neurogenic shoulder pain. There is insufficient evidence for the treatment of osteoarthritis of the shoulder.
Low-Limb pain: There IS fair evidence to support the use of manipulative therapy, combined with multimodal or exercise therapy for knee osteoarthritis, patellofemoral pain syndrome and ankle inversion sprain.
There is limited evidence for its use in hip osteoathritis, plantar fasciitis, metatarsalgia and halls limits/rigidus.
Scoliosis: The efficacy of manual therapy in adolescent idiopathic scoliosis is inconclusive due to lack of good quality research.
Now to talk about the risk of STROKE. We will not shy away from it because it is a well trodden road for any osteopath who used spinal manipulation on their patients. Again, NCOR has collated evidence of stroke and other serious treatment reactions but please find the table below. Comforting reading for any patient!
How often do serious treatment reactions occur?
Treatment reactions can be experienced from any form of treatment whether that is medication, surgery, or non-invasive manual therapies like osteopathy. The evidence that we have suggests that patient incidents do occur in manual therapy, including osteopathy, but they are very rare; the causal link is unclear also. The following table gives some best estimates for risk relating to spinal manipulation:
|The best estimates available for serious patient incidents following manipulation are:|
|1 per 100,000 to 1,000,000 manipulations or||0.1 (less than one) to 1 in 100,000 manipulations1 to 10 people per 1,000,000 manipulations|
|1 per 50,000 to 100,000 patients||1 to 2 per 100,000 patients10 to 20 per 1,000,000 patients|
|Major cerebrovascular insult incidents, accidents following cervical spine manipulation:|
|1:120,000 – 1:1,666,666||0.06 to 0.83:100,0000.6 to 8.33:1,000,000|
|Lumbar disc herniation following manipulation:|
|<1:3.7 million – 1:100million|
How does this compare to the risks associated with day-to-day activities?
Stroke can occur with accidental impacts, during sport and leisure activities.
Risks in day-to-day life that could be compared with the risk of serious events following osteopathic treatment are:
|Death from surgery to the neck||1 person in around 145 operations|
|Death by road traffic accident||1 person per 20,000 people in any one year|
|Death from long-term (years) using anti-inflammatory painkillers for osteoarthritis||1 person per 1,000 people|
|First time stroke||1 person per 1,000 people in the general population in any one year|
|Spontaneous strokes||0.03-5 person per 100,000 people in the general population over one year|
Some patients have indicated that they don’t like this type of comparative information. It is provided for information purposes should you require it for your patients.
|Estimated risk of serious adverse event (death) over 1 year for:|
|Non-steroidal anti-inflammatory drugs (NSAIDs for osteoarthritis)||Course of manipulative treatment|
|The risk of having an adverse event with manual therapy (HVT) is less than taking medication (NSAIDs, diclofenac and amitriptyline)1|
A word on research in the manual medicine field (aka osteopathy, physiotherapy, chiropractic, etc.). It is very difficult to conduct gold standard research whereby a double blind trial is performed. Easy if you are taking a pill – you can give the placebo group a pill, but take a patient who is either getting treatment or not and the group who don’t get treatment are very much area they aren’t getting treatment. Not so blind now is it?
Now, considering almost every person on our newsletter list has been to see us in a professional capacity, I imagine there are plenty of our patients who will attest that we helped you feel and move better, reached a new PB or managed to walk down the isle limp and crutch free.
If you agree with us that osteopathy is an evidence based and effective medicine and you are struggling with any aspect of your health, get yourself booked for your osteopathy session here, now!