Osteopaths on the loose...

[davidrodway]

Perusing the fanciful list of conditions provided by Mojo, and the quote provided by Blue Wode, it is obvious that osteopaths in the UK are as quacky as chiropractors in the UK and USA.

Dont quite follow your reasoning there. Are you making some connection between the two quotes, or just listing them?. Hope the following deals with your point. Haven't had a chance to reply to either of those you quote yet, but -

The first quote is about osteopaths who use cranial osteopathy or treat children, which is not every osteopath or even the majority, as far as i know.

The level of evidence may be 4 or 5 , but i understand those levels, although not the best, are acceptable. But i was going to challenge on what basis he/she had decided the evidence was at this level.

Suggest you visit the Research page on the SWOS website. You should be able, shoukd you wish, to track down the references and decide for yourself which level of evidence they provide.

Regarding chiropractors - i think you should take specific claims, either by chiropractors or osteopaths - and question the specific point, Just asking "is this profession quackery" is a bit like asking "is architecture quackery", rather than "is the building standing up" - although of course there are areas such as astrology or economics where its clear the whole sorry lot is rubbish.

[davidrodway]

That search produces one result:
http://www.osteopathywales.com/index.php?searchword=EBM+research&ordering=newest& searchphrase=all&option=com_search

Clicking on the next page brings you to this:


So, at the moment, it looks like many osteopaths depend heavily on evidence level 4 or 5, does it not?

Not sure why you say that. Have you looked at the Research page? You may be right, though, but level 4 or 5 , although not the best, is regarded acceptable, i beleive.

Quite happy - well unhappy really - to admit that the amount of research is little, although accelerating. However, as a profession we are supportive of research and keen to learn the from it and incorporate the fruits of research into practice.

[davidrodway]

The immediate problem is that there is no known mechanism by which the ear is directly linked to musculo-skeletal system and so the claim that treating one can effect a therapy in the other immediately rings alarm bellsFor a direct association to be true, it would have to overturn a lot of scientific and medical evidence, which would make it an extraordinary discovery.=


I assume from what you have said that you are not a believer in subluxations and similar?[/quote]


Well I can think of two links ( do i get the Nobel prize?) -
1 Pintos ligament
2 the anterior cervical muscles (supra and infra hyoid)
Jut your head forward and try closing your jaw - how easy is that? Most of you will feel the jaw being pulled back and dificulty closing the jaw.Forward head posture is quite common and can result in altered occlusion and compression of the tmj and its intra articular disc.

Subluxations? No

[dizzyblonde]

Umm there is a sensory neurological link between the ear and the cranial nerves. This from wikipedia....

Cervical spinal nerves (C1-C4)
Further information: Cervical plexus
The first 4 cervical spinal nerves, C1 through C4, split and recombine to produce a variety of nerves that subserve the neck and back of head.
Spinal nerve C1 is called the suboccipital nerve which provides motor innervation to muscles at the base of the skull. C2 and C3 form many of the nerves of the neck, providing both sensory and motor control. These include the greater occipital nerve which provides sensation to the back of the head, the lesser occipital nerve which provides sensation to the area behind the ears, the greater auricular nerve and the lesser auricular nerve. See occipital neuralgia. The phrenic nerve arises from nerve roots C3, C4 and C5. It innervates the diaphragm, enabling breathing. If the spinal cord is transected above C3, then spontaneous breathing is not possible. See myelopathy

[davidrodway]

Umm there is a sensory neurological link between the ear and the cranial nerves. This from wikipedia....

Cervical spinal nerves (C1-C4)
Further information: Cervical plexus
The first 4 cervical spinal nerves, C1 through C4, split and recombine to produce a variety of nerves that subserve the neck and back of head.
Spinal nerve C1 is called the suboccipital nerve which provides motor innervation to muscles at the base of the skull. C2 and C3 form many of the nerves of the neck, providing both sensory and motor control. These include the greater occipital nerve which provides sensation to the back of the head, the lesser occipital nerve which provides sensation to the area behind the ears, the greater auricular nerve and the lesser auricular nerve. See occipital neuralgia. The phrenic nerve arises from nerve roots C3, C4 and C5. It innervates the diaphragm, enabling breathing. If the spinal cord is transected above C3, then spontaneous breathing is not possible. See myelopathy

Just a technical point - these are cervical spinal nerves not cranial nerves (On Old Olympus Towering Top etc), but you are right about the nerve supply. But dont forget that most of the sensory innervation to the face is by the trigeminal nerve (which is a cranial nerve of course)

[JJM]

To repeat from Blue Wode's citation

4. Evidence from well-designed non-experimental studies from more than one centre or research group.5 Opinions of respected authorities, based on clinical evidence, descriptive studies or reports of expert committees

-snip- One problem for osteopaths is there has not been the research on which to base many decisions.

Dont quite follow your reasoning there. Are you making some connection between the two quotes, or just listing them?. Hope the following deals with your point. Haven't had a chance to reply to either of those you quote yet, but -

The first quote is about osteopaths who use cranial osteopathy or treat children, which is not every osteopath or even the majority, as far as i know.

One must go with the lowest common denominator for a group. Who protects people from that group, and how is that done?

The level of evidence may be 4 or 5 , but i understand those levels, although not the best, are acceptable. But i was going to challenge on what basis he/she had decided the evidence was at this level.

We call evidence level '5' anecdote; it is not acceptable recommending treatment. It can be a basis for starting a rigorous pilot study which may then be the basis for a full-scale program. Evidence level '4' is a little better; but it depends on the number of subjects and the condition treated. It is not a substitute for an RCT. What is the level of evidence for your treatment of sinusitis?

{snip} Just asking "is this profession quackery" is a bit like asking "is architecture quackery", rather than "is the building standing up" - {snip}

I don't follow your logic here. We certainly can identify quackery and when it pervades a group they are quacks. Quackery is the pretense to medical knowledge in the absence of it.

ETA: I forgot to comment on the final part of the quote "there has not been the research on which to base many decisions." How much clearer can it be? Osteopaths are working as if they know what they are doing; but they don't.

[Blue Wode]

Regarding chiropractors - i think you should take specific claims, either by chiropractors or osteopaths - and question the specific point

The evidence for chiropractic was recently thoroughly evaluated by two impartial scientists, Simon Singh and Edzard Ernst, and the following is what they propose on page p.285 of their book, Trick or Treatment? Alternative Medicine on Trial, that all chiropractors be compelled by law to disclose to their patients:

“WARNING: This treatment carries the risk of stroke or death if spinal manipulation is applied to the neck. Elsewhere on the spine, chiropractic therapy is relatively safe. It has shown some evidence of benefit in the treatment of back pain, but conventional treatments are usually equally effective and much cheaper. In the treatment of all other conditions, chiropractic therapy is ineffective except that it might act as a placebo.”

It begs the question, why would anyone waste their money or risk their life going to a chiropractor?

As for osteopathy, we already know what they concluded about that in their book, but here’s a reminder:

The evidence that the osteopathic approach is effective for treating back pain is reasonably sound. If, however, you receive no significant benefit then be prepared to switch to physiotherapeutic exercise, which is backed by similar evidence and which can be done in groups and therefore is more cost-effective. There is no evidence to support osteopathy for the treatment of non-musculoskeletal conditions.

(Page 321)

They also said the following about osteopathy in a newspaper article last year:

In general they treat mainly musculoskeletal problems, but many also claim to treat other conditions such as asthma, ear infection and colic.

http://www.dailymail.co.uk/pages/live/articles/health/healthmain.html?in_article_id=557946&in_page_id=17 74&ICO=HEALTH&ICL=TOPART

It indicates that they don’t think that asthma, ear infections, colic, etc., are musculoskeletal in origin.

Regarding my comments,

So, at the moment, it looks like many osteopaths depend heavily on evidence level 4 or 5, does it not?

Not sure why you say that.

I'm following what the science tells us, as per Singh and Ernst. Is there any other conclusion that can be drawn?

[dizzyblonde]

Just a technical point - these are cervical spinal nerves not cranial nerves (On Old Olympus Towering Top etc), but you are right about the nerve supply. But dont forget that most of the sensory innervation to the face is by the trigeminal nerve (which is a cranial nerve of course)

Oh yes! I meant cervical not cranial. Thanks David.

[davidrodway]

JJM and Bluewode

Sorry for the delay in replying. There are also some previous posts that I have not yet had time to answer fully, but rather than delay I will try and address the more recent points.

Lowest common denominator –
I take your point. All osteopaths have to qualify from one of the colleges recognized by the GOsC to call themselves an osteopath, so all should have the diagnostic skills and knowledge to know when to refer rather than treat the patient. “Cranial” is usually done at PG level. Thus all osteopaths are subject to the GOsC whether they use no cranial (most osteopaths), some, or only cranial (a small number).

Cranial osteopaths and cranio-sacral therapists are not the same. You cannot call yourself craial osteopath, or any sort of osteopath, unless you are on the GOSC register. However cranio-sacral therapy is, unlike osteopathy (Osteopaths Act 1993), unregulated and anyone can call themselves one. Cranio-sacral Therapy was started in the States by an osteopath called Upledger who “trained” anyone regardless of whether or not they had any training in osteopathy or medicine. That is still going on and has now spread to Britain. There is nothing the GOsC can do about it. So it is quite important to distinguish between the two.

Evidence lrevel 5 and anecdote.
Who is this “we” exactly? I am familiar with “anecdote”. With respect I think you will find anecdote and level 5 are not the same. Anecdote is just a practitioner saying ” I saw a patient , did this and that happened” .(“n=1”).Level 5 of course isn’t as good as RCT

That quote about research on the SWOSwebsite was one of my contributions and I apologise, because it obviously isn’t really clear at all. It refers to research, and research is not the same as evidence, There can be evidence to support an investigation or treatment that derives from sources other than research (although research based evidence is better) – including a consensus of experienced opinion, for example.


Some of the research relevant to osteopathy (as opposed to just evidence) is listed on the website. on its own page. Probably the biggest research project was the BEAM trial (see website again). RCTs are, as you say, the gold standard. We are still trying to work out how to do double blind trial of osteopathy (The osteopath must not know whether he is giving the right treatment or not – any suggestions as to how we do that?). Single blind trials may be possible (patient not knowing) but even those would be difficult.

The point is that osteopaths are not research averse.

One route is through clinical audit. The Osteopathic research council is currently developing a standardised audit tool that can be used by osteopaths throughout Britain to collect data.

Identify quackery –
To assess whether osteopathy for example is quackery you first have to know a little at least about how osteopaths are educated and what they do. Training is similar to medicine, except without the pharmacology, and with more concentration on subjects such as biomechanics and technique. Osteopaths use the same anatomy and physiology books – we do not have an alternative anatomy like say the acupunturists with their meridians.

Perhaps we could have a quiz to evaluate each others medical knowledge?

I would guess 95% of osteopaths treat musculo-skeletal complaints 95% of the time.True we do sometimes think “outside the box” and have a slant on things that would be different from say a GPs (see , eg, the case studies on the website).

Just another comment on the research side. Say I have a patient come in with an acute neck pain. I do my case history and examination, exclude serious pathology and decide from what I have been taught that she has a Z joint (facet joint) problem , the sort which through my and others past experience improves quickly (ie by the end of one treatment ) to soft tissue stretching and a judicious LAHVT. Am I suppose to say “Well I think I can help you but the rearch isn’t watertight so please go away. “ We have to do the research , but meanwhile we have to use what knowledge we have. I use soft tissue stretching before the LAHVT because I think it relaxes the muscles and I can therefore use much less force when doing the LAHVT. It makes sense to me, but there isn’t the research to back that up. Do I not do soft tissue stretching until the research on that is done?There are many decisions that a practitioner (including GPs and surgeons) makes throughout the day that have to be based on the best available information, even if that best is not as good as it might be a few years down the line when further research is done.

Ernst, Singh and Trick or Treatment -

First let me say that I think the BCA suing Singh is appalling and ridiculous. It’s a threat to free speech. And scientific/clinical disputes are not settled by suing people.

I am familiar with the book and some of its contents

I am not sure about what they say about “physiotherapeutic exercise”.The physios in the NHS hospitals here do not , I think, give exercises in groups, although they do give advise individual patients exercise - usually the same one regardless of what is wrong with them – a sort of modified push up to “strengthen the back muscles” (if the back muscles are weak, why don’t they fall over?)

I am not against exercise properly done – I often advise patients for example to go to Pilates (belly dancing is also good for low backs)

A lot of patients come to see us after they have tried physio without benefit.

I cant believe a “skeptic” gets their medical information from the Daily Mail!

Back to research – esp on non-musculoskletal research. Ernst seems to have overlooked some. I found this when I submiited some cmments on line to Pulse. I am looking back to find the references that I found that he seemed to have missed (ignored?), hence my delay in replying. So more on that later. So don’t rely to heavily on Prof Ernst.

[Pebble]

Agreed that double blind trials are difficult, given that the mechanism of putative benefit is dubious and the operator can hardly be blinded. However, for most conditions treated there are alternatives, so it is certainly possible to do randomised trials.

Given this it is certainly reasonable to not treat conditions for which there is no evidence that osteopathy is at least as effective as proven conventional therapies.

Admitting that there are intractable conditions for which there is no known effective therapy is another important step, it is not sufficient to say that conventional therapy has failed so one must try something - even where there is no evidence. When approaching such patients enrollment into a trial is the only effective way to go, trying unregulated, un-audited, non-registry based messing may make the practicioner feel they are 'doing something' for the patient, but in reality they are simply fooling themselves and the patient.

[davidrodway]

Agreed that double blind trials are difficult, given that the mechanism of putative benefit is dubious and the operator can hardly be blinded. However, for most conditions treated there are alternatives, so it is certainly possible to do randomised trials.

Given this it is certainly reasonable to not treat conditions for which there is no evidence that osteopathy is at least as effective as proven conventional therapies.

Admitting that there are intractable conditions for which there is no known effective therapy is another important step, it is not sufficient to say that conventional therapy has failed so one must try something - even where there is no evidence. When approaching such patients enrollment into a trial is the only effective way to go, trying unregulated, un-audited, non-registry based messing may make the practicioner feel they are 'doing something' for the patient, but in reality they are simply fooling themselves and the patient.

The sort of RCTs you describe are certainly possible and some have been done Eg BEAM trial,

[davidrodway]

Agreed that double blind trials are difficult, given that the mechanism of putative benefit is dubious and the operator can hardly be blinded. However, for most conditions treated there are alternatives, so it is certainly possible to do randomised trials.

Given this it is certainly reasonable to not treat conditions for which there is no evidence that osteopathy is at least as effective as proven conventional therapies.

Admitting that there are intractable conditions for which there is no known effective therapy is another important step, it is not sufficient to say that conventional therapy has failed so one must try something - even where there is no evidence. When approaching such patients enrollment into a trial is the only effective way to go, trying unregulated, un-audited, non-registry based messing may make the practicioner feel they are 'doing something' for the patient, but in reality they are simply fooling themselves and the patient.

The sort of RCTs you describe are certainly possible and some have been done Eg BEAM trial. Dont forget also that there are other elements in the effectiveness equation - such as cost and risk of advesrse events (eg death by bleeding gut with NSAIds)

Admission of intractable conditions, yes, but not giving up on patients when there are treatments that fall outside the scope of the NHS,

Osteopathy is regulated, as I said we are introducing audit, dont understand your use of the term "non-registry". I do not do messing - I make a diagnosis based on history and examination, and further investigation such as MRI if needed, and draw up a ttt paln based on that. And if I think I cannot help - eg metastases, discitis, Parkinsons, aortic aneurysm, etc etc I refer on. Also if no real imporovement in 4 ttts, further investigation or referrral.

[davidrodway]

The parents are heavily into this woo. Unfortanately their osteopath of choice diagnosed a serious condition in my father's leg where the GP had repeatedly failed. Obviously, the osteopath could do nothing about the condition and it was left up to proper doctors and surgeons to sort out, but because the quack made the correct diagnosis he can do know wrong in the parents' eyes.[/quote]

How come the "quack" (osteopath) is the one that made the correct diagnosis ("Unfortunately" he helped your parents!).If he had not, or had treated and not refered on, the the tag might be justified, but as he did the right thing , surely that is an unfair label. Why dont you phone him and thank him for helping to preserve your parents health (or were you looking forward to some money in the will?) Perhaps better a skilled and clever "quack" than a "proper doctor" who cannot make a correct diagnosis. Or is that too skeptical?

Reminds me of a patient I saw with pulsating headache. took his bp - 170/120! Sent him straight to GP with nice letter.GP said "If youve got a headache your bp s bound to go up"! Didnt even tead the letter or take his bp. Next day pt felt v ill, went to surgery, sensible nurse took bp, so high she wouldnt let him leave. Doctor (no apology from him) finally decides to do something about the bp.


And if your medical world is divided into quacks and proper doctors, what then of those osteopaths who have gome on to train as doctors or thedoctors who have trained in osteppathy at the LCOM? Or is that a little too cofusing for you

Can you not see the difference between skepticism and blind deference to orthodoxy?

Or see below
//"Very unhelpful, arrogant," it said of a doctor. "Did not listen and cut me off, seemed much too happy to have power (and abuse it!) over suffering people."//

Many of my patients over my working life have expressed such sentiments to me, about their GP's attitude and behaviour, which has not been wholly limited to GPs; physiotherapists and hospital consultants have been just as damned bad!
I will provide you with a good example which happened to me in the first year of my self employed practice life, post grad 83'.

A late middle age lady consulted me complaining of long standing low back pain. Prior to her consultation, she asked for her GPs veiws and opinions on her attending my practice, as she wasn't getting anywhere with physio or his own 'medicine'. In no uncertain terms, he requested she stand up and turn around and upon her submissive acquiescence, he squeezed her buttock so hard it bruised and said ''there you go madam...and I won't even charge £10 for that''.
I don't have to tell you how that left both the patient and myself feeling. But, as he was an very well respected OBE decorated GP in my home town, what could we do?
Anyway, with a living to make and a patient in pain, I judiciously began to missapply the 'osteopathy' I was mistaught at the BSO to her unsuspecting body and against all the odds, she gradually got better; and the seeds were set for the mythopoeic status of 'The Osteopath to Follow' which I still enjoy today (as is the experience of us all).
The story doesn't quite end there. After sometime, that same GP began sending me patients with the advice ''you couldn't do better than to see that lad with your back...I delivered him into this world you know''!! he had been my families GP for 3 generations! What do you think to that folks?
What can we learn from all of this in light of JJs post. For me I refer to one of my best loved philosophers Michel de Montaigne who said;

...'Upon the highest throne in the world, we are seated, still, upon our arses'...

Those in power often need a kick up theirs!

[Blue Wode]

Thank you for your response, David.

Cranial osteopaths and cranio-sacral therapists are not the same.

That might be so, but at the end of the day both types of therapists are offering a treatment for which Simon Singh and Edzard Ernst say there is no convincing evidence that it is effective for any condition. Therefore, it has to follow that any osteopath who offers cranial osteopathy is contravening Section 8 of the GOsC’s Code of practice:

UNDUE INFLUENCE ON PATIENTS

You should be aware that a patient seeking healthcare may be vulnerable and open to persuasive influences.You must not exploit such a situation. This would be a serious breach of trust. Examples of this might be:

• Subjecting a patient to an investigation or treatment that is unnecessary or not in their best interest.

http://www.osteopathy.org.uk/about_gosc/4387CodesOfPractice_A_W.pdf


David Rodway wrote:

Some of the research relevant to osteopathy (as opposed to just evidence) is listed on the website. on its own page. Probably the biggest research project was the BEAM trial (see website again).

The BEAM trial estimated the effect of adding exercise classes, spinal manipulation delivered in NHS or private premises, or manipulation followed by exercise to "best care" in general practice for patients consulting with back pain. It is interesting to note what Edzard Ernst had to say about it:

Three brief comments on the excellent BEAM Trial (1). My reading of the results is that the data are compatible with a non-specific effect caused by touch: exercise has a significantly positive effect on back pain which can be enhanced by touch. If this “devil’s advocate” view is correct, the effects have little to do with spinal manipulation per se.

It would be relevant to know which of the three professional groups (chiropractors, osteopaths, physiotherapists) generated the largest effect size. This might significantly influence the referral pattern. A post-hoc analysis might answer this question.

It is regrettable that the study only monitored serious adverse effects. There is compelling data to demonstrate that minor adverse effects occur in about 50% of patients after spinal manipulation (2). If that is the case, such adverse events might also influence GP’s referrals.

1. UK BEAM Trial Team. United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care. BMJ, doi:10.1136/bmj.38282.669225.AE. BMJ 2004;19 November:1-8.
2. Stevinson C, Ernst E. Risks associated with spinal manipulation. Am J Med 2002;112:566-70.

http://www.bmj.com/cgi/eletters/bmj.38282.669225.AEv1#88126

David Rodway wrote:

Identify quackery –
To assess whether osteopathy for example is quackery you first have to know a little at least about how osteopaths are educated and what they do. Training is similar to medicine, except without the pharmacology, and with more concentration on subjects such as biomechanics and technique. Osteopaths use the same anatomy and physiology books – we do not have an alternative anatomy like say the acupuncturists with their meridians.

It’s interesting what Rose Shapiro has to say about osteopaths in the ‘Bad Backs’ chapter of her book, Suckers: How Alternative Medicine Makes Fools Of Us All:

“The UK’s 5,000 or so osteopaths require no scientific medical training and so are more firmly established in the ‘alternative’ camp. Very few are MDs and many combine osteopathy with dubious practices such as naturopathy and cranial osteopathy.

And Singh and Ernst say the following on page 321 of their book, Trick or Treatment? Alternative Medicine on Trial:

In the UK, osteopaths are regulated by statute but considered to be complementary/alternative practitioners.

David Rodway wrote:

Just another comment on the research side. Say I have a patient come in with an acute neck pain. I do my case history and examination, exclude serious pathology and decide from what I have been taught that she has a Z joint (facet joint) problem , the sort which through my and others past experience improves quickly (ie by the end of one treatment) to soft tissue stretching and a judicious LAHVT. Am I suppose to say “Well I think I can help you but the research isn’t watertight so please go away.” We have to do the research , but meanwhile we have to use what knowledge we have. I use soft tissue stretching before the LAHVT because I think it relaxes the muscles and I can therefore use much less force when doing the LAHVT. It makes sense to me, but there isn’t the research to back that up. Do I not do soft tissue stretching until the research on that is done?

Those are quite worrying comments when you consider what Dr Mark Crislip had to say recently on the subject of chiropractic neck manipulation and stroke:

If you want to increase the chance of injury from relatively minor trauma, have the person relax. If the muscles are relaxed because the person is not expecting the trauma, the chance of injury goes up. It is why whiplash can occur after minor injuries (4). Chiropractors often have their patients relax just before the coup de grace, I mean manipulation, helping to maximize the chance of injury despite having less force applied to the neck than a noose and gravity.

http://www.sciencebasedmedicine.org/?p=170

And Dr Harriet Hall made similar comments a few days ago:

The unspoken implication is that the stroke would have happened anyway even if the patient hadn’t seen a chiropractor, and that chiropractic manipulation is no more traumatic than watching airplanes. That’s clearly wrong, because more force is exerted when a chiropractor rapidly twists a relaxed neck than when someone extends his own neck to look at the sky. When someone turns his neck himself, his muscles actively stabilize the neck and protect it from injury.

http://www.sciencebasedmedicine.org/?p=362

David Rodway wrote:

There are many decisions that a practitioner (including GPs and surgeons) makes throughout the day that have to be based on the best available information, even if that best is not as good as it might be a few years down the line when further research is done.

But the best available information on treating neck pain is to use exercise:

Spinal manipulation for neck pain is a treatment with unknown benefits and unknown harm. Because of this and the fact that serious risks are on record, a responsible risk–benefit assessment cannot ignore the risks and cannot come out in favour of spinal manipulation.

Remember the supreme law in medicine: first do no harm. Other therapies for neck pain exist, e.g. exercise, which are supported by at least as good evidence for benefit and which are at the same time free of significant risks.

The inescapable recommendation based on the best evidence available today is to use exercise rather than spinal manipulation as a treatment for neck pain.

http://www.medicinescomplete.com/journals/fact/current/fact0902a06d01.htm

David Rodway wrote:

I cant believe a “skeptic” gets their medical information from the Daily Mail!

That fact that it was the Daily Mail is irrelevant since it was Simon Singh and Edzard Ernst who wrote the piece. Indeed, on checking their information source, I discovered that the osteopathy section was lifted, unedited, from page 321 of their book, Trick or Treatment? Alternative Medicine on Trial.

David Rodway wrote:

…don’t rely too heavily on Prof Ernst.

Why not? Isn’t he likely to be more impartial than researchers who are osteopaths? What reason would Ernst have to mislead health-care professionals on scientific research?

[davidrodway]

Dear Bluewode

Glad to see that you have visited the SWOS and GOsC websites

Nice point about “cranial” and the GOsC Code. I think that the response would be (But why not ask the GOsC directly?) that, if challenged, the “cranial” osteopath would say that they believe (and they really will) that what they are doing is in the patients best interests. They will no doubt point to a long long list of very satisfied patients. Anecdotal of course, but, were a complaint made against them on this point, they would be able to call on many patients who would be more than happy to testify that they or their child had been helped enormously where others - perhaps even non –cranial osteopaths - had failed.
And they would trot out of course “Lack of evidence is not evidence of lack” or however it goes.
Nonetheless, a challenge to “cranial” along these lines would be very interesting. It could happen.
BEAM (only one of course of the list of research on the website). Ernst says it is his reading of it. So I assume there are others that vary. Interestingly he says (I think) that he thinks that touch enhances the benefits of exercise . Or is it exercise enhances the benefits of touch. Are we talking, all touch, any touch, touch by osteopaths, touch by physios? Is touch by osteopaths better than touch by physios.? A lot of the benefit of osteopathy is because of touch - that is the point. Doesn’t mean that just getting your husband/wife to toch you is going to be as beneficial for your health/pain as an osteopaths touch (although it might be)
Certainly agree with Ernst it’s a pity that the osteros/chiro/physio interventions were not split. Why were they not?. If it can now be done at this late stage I would be v interested to see the results
Shapiro – not familiar with this name I admit. But on osteopathic education her facts as quoted here are totally totally wrong. Even when I trained 30 years ago we used the standard anat and physiological and clinical methods texts (Greys, Guyton, Hutchinson, Apleys etc) and were taught by doctors and surgeons, saw dissections etc. Didn’t do stats then but they do now. All my training was osteopathic under grad and PG If using an opthalmoscope for example or using the hypotheco-deductive method of diagnosis (as used by the medics) isn’t scientific, I don’t know what is. On this point I am adamant – I was there and I know what was and is taught and how. Will be contacting her to see where her information come from

What next?
Neck treatment. Not sure of the source of your neck exercise is best quote. What neck exercises anyway?
Osteopaths have a range of manual techniques of which LAHVT (low amplitude high velocity thrust ) is just one. It works well, I find , in the acute neck as in slept awkwardly a few days ago and cannot move neck to one side without pain since. The patient cannot “Exercise” the neck even if they wanted to - it is usually too painful for active movement in at least 2 directions. TTT usually gives relief and increased mobility by the end of the treatment.
Whiplash is so devastating not just because the subject is (sometimes) relaxed. There are several other factors.
If the patients muscles were not relaxed, that would be a contra-indication to LAHVT ( the practitioner would eitjher have to use too much force or just “bounce off”). Bear in mind also that chiropractic and osteopathic LAHVTs are done differently – chiropractors often use plinths with flaps that give way under the patients neck sc they apply a sideways karate chop style thrust to the neck.

We are still told, however, before using a n LAHVT to the patients upper cervical spine to advise them of possible risks (again see website) and ask their explicit permission to proceed. Never been a recorded case of stroke through an osteopaths LAHVT as far as I know, but we still have to ask them.

I should also add that before an LAHVT we will test eg auscultate for carotid bruit. Also the history may point against LAHVT – eg drop attacks, clotting disorders – in which case no LAHVT is done
Ernst – not decrying him completely, just saying he is not the sole authority. For example (without looking it up again ) I think there was something in that advice he gave in the Daily Mail about making sure that the osteopath would not use vigorous treatment if the patient told them they had cancer, bone infection, clotting disorders and some others. This implies he does not realise that an osteopath will know not to use certain techniques if these conditions are present.The osteopath actually will be making enquiry during the history about these conditions – and not just asking the patient about conditions the patient knows they have, but also asking about symptoms that may indicate those conditions – eg “ are you on Warfarin, do you bruise easily”!. See for example on the SWOS website under “Spinal Cancer”. Not only would the osteopath not be using certain techniques in those conditions, they probably would not be treating them at all! Eg – osteomyelitis – the osteopath will refer on . Point is, why doesn’t Ernst know that is what is what we do? Should he not visit a few osteopathic colleges?. He can come to my practice if he likes and watch me work.

Ernst impartial – trouble is he doesn’t do research of his own as far as I know. And he has overlooked some that has been done (references to folllow as I said before)

Who should do research –If osteopaths do it the results are “biased”, if we do not do it we are criticised for not doing our own research If we use other peoples results we are “piggy backing”. Cant win .l I think osteopaths and non-osteopaths should do the research and then the studies stand on their own merits.
Sorry about the numerous typos. Too knackered now to correct them