Should osteopaths provide an exercise program? (Part 2)

weight-trainingThis is a follow up to one of my previous posts: Should osteopaths provide an exercise program? This generated some interesting discussions on twitter with some osteopaths accepting that exercise programming isn’t something they are routinely taught and others claiming that osteopaths are well placed to offer an exercise program. One of the points made is that it’s the skill and experience of the individual therapist that really matters. That’s a valid point as, within any profession, some people are more skilled and experienced in a particular area than others. However, this presents something of a practical problem. It is difficult for many members of the general public to assess the training and qualifications of a professional offering an exercise program. It’s therefore important to have some guidance available so that members of the public are not misled into being given an exercise program by someone who lacks the qualifications and expertise to provide it. This post provides some clarification on whether osteopaths are well placed to provide an exercise program or not.

The National Council for Osteopathic Research (NCOR) produced a report that profiles day-to-day osteopathic practice. This report identifies the different types of treatments used by osteopaths in their first and subsequent appointments with patients. Less than 1 in 4 appointments involved exercise. In contrast, nearly 3 in 4 appointments involved articulation and a similar number involved soft tissue treatment. Approximately 1 in 3 appointments involved HVLA thrust. Osteopaths therefore used manual therapy (hands on) techniques much more than they used exercise. When someone practices a particular skill or technique frequently they usually become better at it. As most osteopaths use manual therapy more than exercise it is therefore very likely that they are also more skilled in manual therapy than exercise. It is also not clear what proportion of those appointments that did include exercise actually resulted in a suitable personalised exercise program.

Elsewhere in the report it is stated that “A high proportion of osteopaths have documented that they are recommending exercise to patients. Little work has been undertaken in this area which is not formally taught in all osteopathic educational institutions.” and “Investigation of the exercise regimes/advice being offered by osteopaths would be a helpful area of investigation. The inclusion of exercise in the management of patients is notably present in many clinical guidelines. It is important that the advice and recommendations by osteopaths are not only evidence based but appropriate and effective for patients.” The National Council for Osteopathic Research (NCOR) therefore recognises that there is a lack of evidence of the suitability and effectiveness of exercise advice provided by osteopaths.

You may be wondering why osteopaths are suddenly taking such an interest in exercise. That’s because osteopathy is no longer considered to be a first-line treatment for low back pain or sciatica. Treating “bad backs” is what osteopaths are known for and makes up a significant proportion of the patients seen by most osteopaths. The new NICE guidelines therefore put the businesses of many osteopaths, and potentially the profession as a whole, under threat. Osteopaths are therefore trying to tackle this issue by adding exercise programming to the services they offer. Most osteopaths don’t receive training in exercise nor do they use it routinely as part of their current practice. It therefore seems unrealistic to expect that they can suddenly become skilled in providing an exercise program to their patients. In the February / March edition of The Osteopath, the NCOR suggest that osteopaths could form a working relationship with a local exercise or movement specialist as a means of providing an exercise program to their patients. In that situation, wouldn’t the patient be better off just seeing the exercise specialist and not bothering with the osteopath at all?

Whilst it may be possible to find an individual osteopath who has taken specialist training in exercise programming and uses it regularly as part of their practice it is quite clear that these individuals are not commonly found within osteopathy. Osteopaths are primarily manual therapists and use mostly manual therapy techniques. The suggestion that osteopaths are well suited to help someone get started with an exercise program, teach the exercises correctly and progress the exercise program is therefore misleading. Most osteopaths lack the skills or experience to do this. If you need help with an exercise program please make sure you see someone who is suitably qualified in this field. As I made clear in my previous post on this subject it is physiotherapists who are more routinely trained in exercise programming rather than osteopaths.

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