Q&A > Questions on Oesteopathy
Questions' regarding Osteopathy in General
What is Osteopathy
Osteopathy is a way of treating damaged parts of the body such as muscles, ligaments, nerves and joints. When the body is balanced and efficient it will function with the minimum of wear, stress and energy and therefore reduced pain and disability. It is the aim of osteopaths to achieve the best possible balance and most of their work is carried out using their hands. A wide range of treatment methods are employed according to the age, physique and nature of the problem for each individual. Methods range from soft tissue ‘massage’ techniques to muscles and ligaments, passive stretching and traction to joints as well as manipulative separation techniques (which patients often feel as a click) to improve joint mobility.
Today there are around 3,000 osteopaths in the UK performing over 6 million patient consultations per year.
What are its roots?
Dr Andrew Taylor-Still was a medical doctor born in 1828 in Virginia USA. He trained as a doctor in a system of medicine that was fairly early in its evolution at the time. He diverted from the paths of many of his peers who were in the habit of administering the crude drugs at their disposal in heroic quantities. He sought a new method of treating illness focusing on influencing the blood supply and nervous control for bodily systems and organs. He developed this as a total system of medicine, which he thought would entirely replace conventional medical treatment.
In 1892 he started a school in Kirksville, Missouri for teaching osteopathy and from these beginnings osteopathy came to the UK. The British School of Osteopathy started in London in 1917 and over time other schools and colleges followed.
In general Dr Taylor-Still’s total system of medicine has evolved so that that most osteopaths most commonly treat spinal pain as their primary concern in addition to other musculoskeletal conditions. In addition to this a proportion of osteopaths do hold on to the traditional roots of Dr Taylor-Still more faithfully and as a result treat a wider range of conditions.
1. CONSULTATION AND TREATMENT
What should I expect from a consultation and treatment?
At the time of an initial assessment osteopaths aim to diagnose the presenting problem and gain an understanding of the underlying reasons for it. Once these reasons are appreciated it is easier to devise ways of avoiding relapses or reoccurrences. Your osteopath will share this information with you as improved understanding will enable you to play your part in getting the best from treatment. As well as involving osteopathic manipulation your treatment plan may include advice on posture, diet, lifestyle or stress, if these are contributing to your problem. Osteopaths generally compile an informal programme for your recovery so that you understand what to do in your daily life and when to return for treatment if this is needed. What to do at home, sport and leisure can greatly affect your progress and your part in this treatment is just as important as that of the osteopath. Usually treatment is pleasant and rarely painful.
The assessment itself is usually divided into 3 parts:
Firstly the osteopath will take a history of your problem as it presents and as you wish to describe it. Questions will be asked about the nature of the pain and how it affects your life and patients are sometimes surprised by the extent to which osteopaths need to know about the range and extent of activities which they perform in working and personal life. The osteopath will also need to know about wider issues relating to your present and past general health as this can be relevant to conditions which sometimes mimic mechanical pain.
Following the history it is necessary to examine you and for this it is usually necessary for you to undress to your underclothes. This is so that not only the affected area can be examined, but also so that it can be considered in relation to your posture and bodily function as a whole. Once the history and examination have been carried out the osteopath will generally have decided what is at fault and what he or she intends to do about it. This information will be shared with you and if extra investigations are required you will be informed of this.
In the largest percentage of cases the osteopath expects to move on to treatment at the time of your initial assessment. It may well be that in the case of experienced practitioners that the flow from history to examination to treatment is almost imperceptible, so that they become as one. Osteopaths will tend to work on the assumption that when you present with a problem you have come for treatment of that problem and therefore your consent is implied. If you have attended for advice only, or at any stage become unhappy in proceeding towards treatment then you should make this clear to your osteopath.
By the end of your initial consultation you should have been given a good idea as to the cause of your problem and how your osteopath intends to plan treatment, if that is what is needed. You should also have been given ideas as to what to expect when you leave the consulting room in terms of progress and when to return.
What happens when I return for follow-up treatment?
The focus of follow-up visits is the treatment itself as distinct from the diagnostic process involved in the first visit. Most often patients are asked to undress to their underclothes so that the manual treatment can be applied in accordance with the treatment plan outlined at the first visit.
At treatment visits osteopaths will ask questions regarding the progress of the patient’s pain and ability to undertake certain tasks. The strength (dose) of the treatment may be stepped up or down according to the response and techniques used may vary from one visit to another. The practitioner will make notes on each occasion so that the rate of change can be monitored carefully. The osteopath should keep the patient informed of how treatment is progressing.
Osteopaths often give patients advice on ‘do’s and don’ts’ so they can avoid factors which might hamper their progress.
How does osteopathic treatment work?
Osteopaths apply treatment using their hands with the patient being a passive subject. They use joint ‘manipulations’ to improve the range of motion of individual joints. The patient will often feel a ‘click’ as these ‘manipulations’ are performed. Other stretching ‘articulatory’ techniques are employed to rhythmically stretch the ligaments of a joint by manually using the patient’s limbs as levers. ‘Soft tissue’ manual techniques are another umbrella term used to describe a wide range of massage type techniques.
Osteopaths believe that their particular approach is more than a series of manipulations. The skill of blending a number of different manual techniques to improve skeletal function according to the diagnosis, the individual patient’s physique and with due regard for that individual as a whole including prevailing psycho-social factors earned through training practice and experience.
What can Osteopaths treat?
Osteopathy is best known for the treatment of spinal problems. Repeated Osteopathic Information Service surveys have shown that what most osteopaths treat most often is spinal pain which 4 out of 5 people will suffer at some stage. However, many osteopaths feel that this emphasis limits their scope of practice as they are equally concerned with the treatment of mechanical problems throughout the body and in patients of any age.
Examples include:
- Muscle and joint pains in active and developing children.
- Sports related injuries such as ‘tennis elbow’, ‘pulled hamstring’ or ‘strained ankle’.
- Muscular pain and circulation problems associated with pregnancy.
- Work related difficulties such as repetitive strain.
- Problems in later life, for example osteoarthritic hips and knees.
Less commonly there are many other problems of pain and function (such as headache, gastric pain, chest pain, gynaecological pain) which seemingly fall into the remit of medical diagnosis and treatment that, once sinister causes have been ruled out, can turn out to be referred pain of mechanical origin and these are often very satisfying for osteopaths to treat.
What is Cranial Osteopathy?
Cranial osteopathy describes a very subtle and gentle approach to the treatment of the whole body (not just the head as is implied by the name). Cranial osteopathy is not different to osteopathy, it simply recognises the importance of subtle mechanics at work within the head, and the effect that subtle mechanical strains can have on influencing the health of the whole body. Not all osteopaths are trained in the cranial approach and it is a specialised field involving considerable postgraduate study. The gentle nature of cranial treatment makes it particularly suitable for the treatment of children.
Is it safe?
Overzealous or inappropriate treatment can harm patients and the situation can be compounded if the patient has not been thoroughly assessed or ‘screened’ at the time of the initial consultation.
In the training of Osteopaths the importance of knowing what not to and when not to treat is given great emphasis.
Examples of these situations are:-
- Following major trauma where there could be structural damage
- Forceful manipulation in patients with rheumatoid arthritis.
- Patients with nerve root entrapment should receive judicious treatment
- When pain is out of proportion with the clinical findings.
- If the patient is too apprehensive or in too much pain
- Where there is known pathology such as tumour
- Severe osteoporosis
The risks are minimised in the hands of a properly trained and experienced clinician who is thorough in assessment and monitors progress carefully. At the end of an undergraduate degree programme students undertake a clinical examination which is specifically designed to assess safety and competence to practise.
Can anyone have Osteopathic treatment?
Subject to the above anyone can have osteopathic treatment. The treatment is geared to the physique of the patient as well as the problem. For example if one applied the correct level of treatment for a 75 year old frail lady to a twenty five year old 14 stone rugby player it would be ineffective. If one applied the rugby player’s treatment to the 75 year old lady she probably wouldn’t say ‘thank you’!. The treatment has to be appropriate for the situation and Osteopaths are trained in this.
Can chronic conditions be treated?
Chronic (longstanding) conditions can be assessed and treated in just the same way as acute (sudden onset more recent) conditions. It is important to realise that in chronic conditions the tissue changes such as muscle spasm and joint restriction are more established and can be resistant to change. One often expects progress to be slower in chronic conditions.
2. EFFECTIVENESS, EVIDENCE AND SIDE EFFECTS
What is the evidence that osteopathy works?
There is no single undisputed reference which demonstrates the effectiveness of osteopathic interventions for any particular group of ailments. However, there are many publications from around the World that report trials and evaluations of osteopathy and other physical treatment modalities for musculoskeletal problems especially low back pain. There are a number of systematic reviews of the literature, in particular those carried out by the Clinical Standards Advisory Group. The Royal College of General Practitioners Guidelines for the Treatment of Acute Low Back Pain is particularly helpful. These show that there are indications for the use of manipulation particularly in relation to acute low back pain, but they do also acknowledge that the methodological quality of many of the research literature is poor. There is research helpful to osteopathic practise and these fall into a number of categories.
- For the use of osteopathy for spinal pain, particularly low back pain.
- For the use of manipulation in general.
- For patient assessment, management and advice.
- For the use of treatment modalities shown to more effective than osteopathy for certain conditions.
- Research helpful to medical referrers.
There are many conditions which osteopaths treat and so many elements to the history taking assessment, investigation, diagnosis, management and treatment of each of these that it would be impossible to gain evidence supporting or refuting elements for every aspect of the clinical intervention. There is, however, supporting evidence for some of the decisions we make, but by no means all. The best way for osteopaths to cope with this is to have a combination of prior learning through training, reflective practise, and a continual balancing of possible benefits versus risks when applying any particular treatment. The evidence available at the time and cost effectiveness of interventions should be borne in mind.
How often is treatment needed?
It is extremely difficult to judge at the outset of treatment how much treatment will be needed for a given condition. As well as the effectiveness of treatment the compliance of patients in such things as ‘dos’, ‘don’ts’ and exercises is an important factor in optimising progress. For the management of acute spinal pain several sources indicate that an average number of treatments for acute onset low back pain would be 6. More important than judging the overall number of treatments needed is for practitioner and patient to have in mind at the outset how many treatments should be given before both should reasonably be expected to see some progress. For many conditions this would occur within 3 or 4 treatments, but longer may be required in the case of particularly severe, established or complex cases. Patients should be wary of entering into ‘open-ended’ or ’ongoing’ plans of treatment unless they have a thorough understanding of the reasons for it.
What are the possible side effects?
The most common side effect from hands on mechanical treatment is increase in pain or soreness in the first 24 to 48 hours following treatment. The balancing act which osteopaths tread is that, if treatment is pitched at too low a level it may take
many more visits to achieve an effective result, but, on the other hand, if the treatment is too strong then patients may react. A reasonable compromise is to achieve enough which may result in short term soreness as long as there is gain following on from it. Patients concerned about the level of any such reaction should initially speak to their practitioner and particularly if the level of such reaction is unacceptable or if it lasts more than 48 hours. Proper management of such side effects generally enables them to settle quickly.
There are anecdotal reports of exacerbation of conditions particularly in relation to cervical manipulation and lower lumbar disc problems. However, since the advent of statutory regulation, which enforces practitioner standards there has been no completed study which directly asks questions regarding adverse reactions. One such study in progress by the Audit Development Group is concerned with the assessment of adverse reactions up to 10,000 consultations, but the results are not known at the date of publication.
Risks are of manipulative treatment are acknowledged to be markedly reduced in the hands of properly trained and experienced practitioners following the well defined rules for when not to manipulate patients.
If I suffer an adverse reaction what should I do?
In the first instance patients suffering reactions should contact their osteopath for appropriate advice as proper management can quickly settle adverse reactions to treatment. However, patients dissatisfied with osteopathic care may seek further advice from the General Osteopathic Council which carries the Code of Conduct (published on the website www.osteopathy.co.uk) and has an ethical complaints procedure in place.(0207 357 6655)
Can I complain if I am unhappy with my treatment?
If the situation allows it you should inform your Osteopath of anything you feel to be ‘untoward’. This gives the practitioner the opportunity to clarify explain or rectify the situation. Even in the best practices miscommunication or differing expectations can be the cause for confusion which can be sorted out once the practitioner knows.
If you feel your practitioner has been in breach of his/her professional or ethical rules you should contact the General Osteopathic Council. The council has mechanisms in place to deal with such complaints sensitively and in confidence
4. TRAINING, REGULATION & CONTINUING PROFESSIONAL DEVELOPMENT
Are osteopaths regulated?
The osteopathic profession is regulated by the General Osteopathic Council whose role is to regulate, promote and develop the practise of osteopathy. This is a system of statutory self regulation under the watchful eye of the Privy Council and the Department of Health. The Osteopaths Act of Parliament was passed in 1994 and the Statutory Register became live in May 2000.
In recent years the osteopathic profession has undergone a rigorous process of individual practitioner evaluation prior to regulation re-accreditation of the providers of osteopathic education. Each practitioner has had to complete a document known as a ‘ppp’ which explores the length and depth of an osteopath’s training and the way in which he/she has worked since. Patient profiles are explored, courses attended analysed and answers to particular clinical scenarios are invited. The General Osteopathic Council has individually assessed a ‘ppp’ for each of approximately 3000 practicing osteopath. A ‘ppp’ takes approximately 40 hours to complete.
Osteopaths fulfilling the criteria of the ‘ppp’ are given full registration. A number of practitioners found to have deficiencies considered redeemable are granted a period of conditional registration subject to a period of mentored practice. In this period there is a level of supervision and training so that all standards of the ‘ppp’ are met. Osteopaths failing to meet the requirements of the ‘ppp’ are unable to continue practicing as osteopaths.
Once registered osteopaths are obliged to conform to compulsory codes of training, ethics, practise and professional behaviour for the protection of their patients. Osteopaths enjoy what is known as protection of title. This means that osteopaths which do not meet the standard and be registered with the Osteopathic Council cannot call themselves ‘Osteopath’, and can be called to account by Trading Standards.
What do they have to do to keep up their skills and knowledge?
As the process of regulating the profession was completed in May 2000 the assessment of all practitioners on the register is current. In order to maintain these standards from this date onwards a system of Continuing Professional Development is being developed and this will be mandatory in order to maintain registration. It is in the interests of each practitioner to continually update their skills and when questioned they should be able to give evidence of this.
The focus of the General Osteopathic Council’s attention up to the opening of the statutory register on 5/5/2000 has been to ensure the standards of osteopaths registered and those of the osteopathic schools educating future practitioners. Now this has happened the production of an ongoing programme to ensure that osteopaths maintain their standards is not far away.
What does training involve?
Students train through a degree programme run by schools having ‘recognised qualification’ status. A list of schools which have been awarded this status is held by The General Osteopathic Council (0207 357 6655)
Osteopathic involves knowledge of basic medical sciences such as anatomy physiology and biochemistry, a grounding in medical knowledge such as pathology, neurology and orthopaedics and a focus on manipulation and clinical skills. Professionalism, ethics research and radiology are included in a long list of other subjects.
Are there specialisms within Osteopathy?
Many osteopaths have special areas of interest in which they may be highly trained and experienced. Examples are sports injuries, cranial osteopathy, treatment of children. The Osteopathic Council does not have a register of special interests but it does help patients to identify such practitioners.
5 PRACTICAL MATTERS
How much will a session cost?
Osteopathic fees can vary considerably according to geographical location, experience of the osteopath and the extent of the facilities provided and administrative back up. A range between £25 to £50 is the norm and some osteopaths charge more for the first consultation.
How long will a session last?
Osteopaths vary in the length of time they spend with their patients according to their style of practice and experience. Sessions may last anywhere between 20 to 40 minutes, but patients should recognise that time is not always the best judge of the quality of what is being achieved. For instance practitioners early in their career will often need more time to achieve what an established and experienced clinician can.
Where can I find osteopathy at reduced rates?
Most osteopaths will endeavour to provide osteopathy for as wide a range of patients as possible. Osteopaths are aware of the need to provide treatment for patients who have difficult financial circumstances and most cater for this eventuality in some way. Some osteopaths will publish reduced rates for particular groups of patients, but many will assess them on individual need. The best advice is to find the osteopath which suits you best and then enquire as to the possibilities at that practice.
What should I ask before visiting an Osteopath?
It is important for patients to feel comfortable with the decision to visit any particular practitioner.
Helpful questions to ask might include:-
- Is the osteopath registered
- How many years in practise and is this full or part time
- Registration with major health insurance companies
- Fees for first and subsequent visits
- Will the osteopath speak to the patient prior to the consultation
- Is the osteopath involved in any teaching or other professional activity.
It may be helpful to visit the premises. This could be achieved by attending personally to book the appointment. Seeking three or four rather than a single recommendation would be a strength as would asking a local general practitioner.
Do osteopaths make home visits?
Most practices will offer a domiciliary service when it is needed. Most will acknowledge it is most cost effective for the patient to come to the practice if at all possible. It is less expensive in terms of practitioner time, and with adjustable treatment tables and other equipment very often the treatment is more effective.
Will the practitioner discuss my condition with my GP?
If it is necessary, or an appropriate professional courtesy to liase with a General Practitioner or any other health professional then an osteopath would be expected to ask your permission first.
Can my Gp refer me to an osteopath?
Many Gp’s refer patients to Osteopaths either by informally suggesting this route or by formal referral letter. The Osteopaths’ act was welcomed by the General Medical Council and attitudes towards osteopaths have changed enormously in recent years
Will a practitioner have access to my medical records?
An osteopath will not generally have access to your medical records and certainly cannot do this without your written consent. With the appropriate consent access to other medical information can be helpful particularly X-ray, MRI and imaging reports and indeed the films themselves.
Is it covered by health insurance?
Osteopathy is now covered by most health insurance companies. However, the extent and conditions of cover varies enormously and best advice is to contact your health insurer prior to treatment. BUPA and PPP carry a list of practitioners having ‘specialist status’ which requires at least 5 years full-time experience and references from peers, general practitioners and consultants. The extent of cover varies considerably, from a fixed amount to a number of visits and will carry a variable excess.
What other services can osteopaths provide?
Off work certificates, liaison with your employer, medico-legal reports, VDU work station assessments , accessing X-rays, MRI and bone density scans are all common in osteopathic practice.
Where can I find out more?
Helpful osteopathic information can be obtained from:
General Osteopathic Council
Osteopathy House
176 Tower Bridge Road
London
SE1 3LU
Tel 020 7357 6655
www.osteopathy.org.uk
British Osteopathic Association
275 Borough High Street
London
SE1 1JE
Tel 020 7407 0222
www.bso.ac.uk |
