Osteopaths on the loose...

[Acleron]

CONCLUSIONS: There is some evidence that the McKenzie method is more effective than passive therapy for acute LBP; however, the magnitude of the difference suggests the absence of clinically worthwhile effects. There is limited evidence for the use of McKenzie method in chronic LBP. The effectiveness of classification-based McKenzie is yet to be established.

BTW, shall I pdf all papers in future and deliver them to your inbox or do you deem references acceptable? I'd have assumed going with the systematic reviews first was obvious....

My bolding.
Please no, if that's the best you have, the rest is not needed. Thanks for the info, I'm sure you agree that the person making the claims should supply the evidence.

[davidrodway]

Hi
Just joined. So you know who I am, I am a British osteopath, qualified from the BSO in 1979. I have recently become aware of Howard Beardmore and the BIM, and have crossed swords with him on the forum Osteopathy For All. I think he would admit that - to his great displeasure - his views, and those of a small number of osteopaths who agree with him - do not refect those of the vast majority of osteopaths in britain. He is a follower of a now deceased osteopath John Wernham, who ran a very small osteopathic college in Maidstome (not to be confused with the ESO, also in Maidstome).

If you want to get a flavour of the a more mainstream osteopathy, can I humbly suggest a visit to the site of the South wales Osteopathic Society (google osteopathy, south wales). No doubt there will be peices of this with which you might take issue, but I think it gives a better picture of the way modern day osteopaths are thinking.Better to be criticised for what you think than what you don't

[Dubious Dick]

davidrodway,

Out of interest, what is your view of cranial osteopathy for babies and young children supposedly suffering all sorts of symptoms e.g. colic etc because it is claimed, I believe, that their vertebrae are out of alignment from awkward birth?

[davidrodway]

Thats not quite the osteopathic position . I beleive it is the chirpractors view that upper cervical problems can occur during birth and can cause colic.

The "cranial" osteopathic view is different and possibly weirder. I should say that not all osteopaths use the "cranial" approach - probably the majority do not - and that even among those that do it is recognised that that traditional (Sutherland) explanation for how it works is unlikely.

"Cranial" osteopathy was originally based on the premise that there is a very small degree of movement between the sutures of the skull, even in the adult. Palpation of this movement by the osteopath and techniques to restore normal mobility are held to yeild diverse health benefits.

In babies, esp those who have undergone a difficulkt birth - eg forceps delivery - cranial osteopathy seems to have helped in some conditions, such as "colic".

There is some research (see the wensite) that appears to support this, However, it was done with the parents present in the treatment room , so of course some sort of placebo effect (on the parents and then back to the baby) cannot be ruled out.

Of "cranial" generally, I think it fair to say that the theory behind it, in my veiw at least, is very suspect, but the results are often intriguing.

I think the osteopathic profession as a whole may be struggling towards an explanation of how "cranial" osteopathy works. Osteopaths who use a lot of "cranial" claim to get impressive results - the profession is trying to get a proper research effort (see the south wales osteopathy website again) developed to see whether anecdote translates to real statistical effect. In "cranial" we may well have a real effect that as yet lacks a convincing explanation.

[Pebble]

Thats not quite the osteopathic position . I beleive it is the chirpractors view that upper cervical problems can occur during birth and can cause colic.

The "cranial" osteopathic view is different and possibly weirder. I should say that not all osteopaths use the "cranial" approach - probably the majority do not - and that even among those that do it is recognised that that traditional (Sutherland) explanation for how it works is unlikely.

"Cranial" osteopathy was originally based on the premise that there is a very small degree of movement between the sutures of the skull, even in the adult. Palpation of this movement by the osteopath and techniques to restore normal mobility are held to yeild diverse health benefits.

In babies, esp those who have undergone a difficulkt birth - eg forceps delivery - cranial osteopathy seems to have helped in some conditions, such as "colic".

There is some research (see the wensite) that appears to support this, However, it was done with the parents present in the treatment room , so of course some sort of placebo effect (on the parents and then back to the baby) cannot be ruled out.

Of "cranial" generally, I think it fair to say that the theory behind it, in my veiw at least, is very suspect, but the results are often intriguing.

I think the osteopathic profession as a whole may be struggling towards an explanation of how "cranial" osteopathy works. Osteopaths who use a lot of "cranial" claim to get impressive results - the profession is trying to get a proper research effort (see the south wales osteopathy website again) developed to see whether anecdote translates to real statistical effect. In "cranial" we may well have a real effect that as yet lacks a convincing explanation.

To claim without evidence that one is moving the cranial bones relative to one another in adults is like saying one is channelling energy from an undetectable spirit - meaningless and liable to get you labelled as a nutter.

To claim that amazing results have been obtained, without evidence, from use of any given technique especially one where there is no rational mode of action , is to behave like a snake oil sales man of old.

If you wish to be taken seriously, please provide evidence that can be discussed rather than just an opinion.

if on the other hand you feel that the behavior of cranial osteopathists is not justifiable, then let's change tack and discuss the trials of 'conventional' osteopathy for a specific range of conditions.

[imm0rtalmask]

It’s really quite worrying

[davidrodway]

I dont think i used the word "amazing".

Apparently i am not yet allowed to put on here the actual website address, but if you google osteopathy+south wales you should find the website of the south wales osteopathic society. On the websites A to Z you should find research under R, or type it into Search. You can also type in colic.

The cranial osteopath view is explained more fully on their website -try Osteopath+Sutherland Society (i am not a member)

[Pebble]

I dont think i used the word "amazing".

Apparently i am not yet allowed to put on here the actual website address, but if you google osteopathy+south wales you should find the website of the south wales osteopathic society. On the websites A to Z you should find research under R, or type it into Search. You can also type in colic.

The cranial osteopath view is explained more fully on their website -try Osteopath+Sutherland Society (i am not a member)

You are right you wrote "impressive" but it would be truly amazing if the results were impressive.

The cranial osteopaths opinion of themselves is of no interest, the published research or the published reviews based on analysis of the evidence is - for example:

http://www.pubmedcentral.nih.gov/art...medid=16762070

"This treatment regime lacks a biologically plausible mechanism, shows no diagnostic reliability, and offers little hope that any direct clinical effect will ever be shown. In spite of almost uniformly negative research findings, "cranial" methods remain popular with many practitioners and patients."

[davidrodway]

Sorry, perhaps I wasnt clear enough.

The website I refer to in my second paragraph is that of the South Wales Osteopatic Society. There is a page on there relating to Research in osteopathy in general. and allied subjects - some of it carried out by osteopaths , some by others. It is not a website about "cranial", although there are some references to it.

The website mentioned in the last paragraph is purely cranial. I have not visited it recently - they may well have objective research on there.

[Blue Wode]

Hello David, and welcome to the UK Skeptics forum.

British scientists, Simon Singh and Edzard Ernst, devote a page (305) of their book, Trick or Treatment? Alternative Medicine on Trial, to craniosacral therapy/cranial osteopathy (they don’t differentiate between the two). They say that despite the brevity of the section, they have rigorously examined the scientific evidence for and against it in order to reach their conclusions:

The little research that exists fails to demonstrate the craniosacral therapy is effective in treating any condition. Moreover, therapists struggle to give consistent diagnoses for the same patient, probably because they are attempting to detect a non-existent phenomenon. Mothers bringing their children to a therapist are sometimes impressed by the positive reaction. This is likely to be a relaxation response caused by the gentle touch and calming manner of the therapist, but these effects are usually short-lived. There are no conceivable risks, but if severely ill children are treated with craniosacral therapy instead of an effective treatment, the approach becomes life threatening.

Conclusion
There is no convincing evidence to demonstrate that craniosacral therapy is effective for any condition. Prolonged treatment series are expensive and unnecessary.

And for osteopathy, on p321, they conclude:

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.

BTW, here’s your link to the South Wales Osteopathic Society:
http://www.osteopathywales.com/

Some of the information on its index page seems to be inconsistent with Singh and Ernst’s findings:

Osteopaths use hands-on manual techniques to treat patients with a wide variety of conditions arising from or affected by the musculo-skeletal system.

These conditions can include…tinnitus, sinusitis…irritable bowel syndrome, glue ear, colic...

Would you please post the link to the General Osteopathic Council’s Code of Practice so that we can see what it says about osteopaths’ provision of care and evidence. Thanks.

[Neuromuscular Therapist]

You can find the General Osteopathic Council's website at www.osteopathy.org.uk

Practice guidelines are posted down the bottom of the first page.

[filippo lippi]

Waves at our sometime resident hit and run friend of the homeopath!

I've a bit of sinus trouble at the moment, what neck muscles should I be massaging to cure myself?

[Blue Wode]

You can find the General Osteopathic Council's website at www.osteopathy.org.uk

Practice guidelines are posted down the bottom of the first page.

Thank you for that, Neuro.

Having read through the General Osteopathic Council’s Code of Practice, it mentions the word ‘evidence’ only once, and that’s in the section addressing insolvency. The closest reference to evidence-based practice seems to be in section 8:

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

Not very impressive. All in all, it seems that ‘anything goes’ as long as there’s anecdotal evidence for it.

[Mojo]

Osteopaths use hands-on manual techniques to treat patients with a wide variety of conditions arising from or affected by the musculo-skeletal system.

These conditions can include…tinnitus, sinusitis…irritable bowel syndrome, glue ear, colic...

Would you please post the link to the General Osteopathic Council’s Code of Practice so that we can see what it says about osteopaths’ provision of care and evidence. Thanks.

The most relevant part of the Code of Practice is probably:

PRACTICE INFORMATION

122.All advertising must be legal, decent, honest and truthful and must conform to the current guidance, such as the British Code of Advertising Practice.

The relevant section of the CAP code is probably 50.1:

50.1 Medical and scientific claims made about beauty and health-related products should be backed by evidence, where appropriate consisting of trials conducted on people. Where relevant, the rules will also relate to claims for products for animals. Substantiation will be assessed by the ASA on the basis of the available scientific knowledge.

“Claims” of cures, as interpreted by the ASA, generally seems to include implied claims of cure such as “can be used to treat” etc.

OTOH, there are some claims made on the COsC website which might have some bearing on whether the GOsC thinks the above claims are acceptable:

Many common problems suffered by babies and children can be treated effectively with osteopathy.

Problems often suffered by babies:

• crying and irritability, especially when lying down.
• feeding difficulties
• sickness, colic and wind
• sleep disturbances.

Problems often suffered by older childern:

• musculo-skeletal problems
• susceptibility to infections and a depleted immune system
• ear infection, sometimes with a loss of hearing and 'glue ear'
• sinus and dental problems, with a constantly blocked or runny nose
• behavioural problems and learning difficulties, including poor concentration, fidgeting, difficulty in sitting and hyperactivity.
• headache, other aches and pains.
• asthma and vulnerability to chest infections.

Osteopathy can also help children suffering from cerebral palsy or Down's Syndrome.

[davidrodway]

Any criticisms of the General Osteopathic Council, please address to them. The Code of Practice, Fitness to Practice, was subject to a much detailed criticism by osteopaths when it came out a few years ago (with no effect).


EBM - please look up on the south wales osteopathic society website - search for EBM and Research

Other points/ questions I will address when I have some time.

Silly question - what does WOO stand for?

David