Misleading the public into fundraising for evidence free osteopathic treatments

fundraisingMany members of the public give up their time to undertake fundraising activities for the benefit of others. Indeed many charities are heavily reliant on the generous work of their fundraisers in order to carry out their charitable activities. Sometimes individuals or organisations ask people to carry out fundraising in order that they can provide healthcare. For instance, the Alder Hey Children’s Charity raises funds to carry out research, innovation and education in medical care for children. A very worthwhile cause. What about when an individual or organisation raises funds for treatments that have not been shown to be effective? That seems rather less worthwhile and potentially involves misleading the fundraisers in order to persuade them to help the cause. That seems to be the case with CORE of Clapton and their osteopathic treatments.

On the face of it, the CORE of Clapton website gives the impression of trying to benefit the community. They state “We believe everybody has the right to a pain-free life and our aim is to make osteopathy accessible to all.” Wanting to make people more pain-free can only be a good thing. However, suggesting osteopathy as the solution seems to be misguided. Osteopathy is a treatment for which there is very little evidence of effectiveness. In the case of low back pain, the “home ground” of most osteopaths, osteopathy is no longer recommended as a first-line treatment. When it comes to treatment of other conditions, the evidence for osteopathy is even weaker or in many cases non-existent. Unfortunately, the treatments being offered at CORE of Clapton don’t even align with this weak evidence base but instead use approaches that are outdated and have been shown to be ineffective.

Treatments at CORE of Clapton

There has been coverage of the types of treatments being offered at CORE of Clapton in the news recently. The treatments described in that article are far from evidence based. For instance, the NICE guidelines for low back pain and sciatica make it clear that exercise is the first line treatment and that things like osteopathy should only be offered in addition to exercise. Is there any mention of exercise in this treatment program? No. It therefore doesn’t comply with the guidelines and is not evidence based. Things get far worse than this, however. In the sixth and final session, acupuncture is used as a treatment. Now, acupuncture has been removed entirely from the latest NICE guidelines due to lack of evidence of effectiveness. The treatment being offered by CORE of Clapton clearly does not follow relevant guidelines or recent research and this can’t be in the best interest of patients.

At this point you may be wondering whether fundraising for CORE of Clapton is such a good idea after all, but there is more. The treatment approach being used came in for stiff criticism from within the osteopathic profession on twitter. There were a large number of comments including “Focusing on fixing posture and mechanical dysfunction reinforces negative beliefs and from a pain science perspective clinically ineffective” and “In some case more than clinically ineffective, but potentially harmful”. So, here is an organisation that’s asking members of the public to donate or fundraise and yet the treatments they’re offering are “clinically ineffective” or even “potentially harmful”.

As an aside, it’s good to see that some osteopaths are trying to bring about change in a profession that is closely associated with quackery. They are few in number but it’s good that they are willing to challenge the many osteopaths who are using outdated, non-evidence based treatments and frequently misleading the public into taking these inappropriate treatments.

Research at CORE of Clapton

CORE of Clapton are keen to carry out research in osteopathy. When planning to carry out research it’s important to have a good understanding of all relevant existing research so that the new research is relevant and appropriate. Unfortunately, that doesn’t seem to be the case at CORE of Clapton. First of all, the treatments described above are clearly not based on a good understanding of the latest research. The “Research” section of the website makes this lack of understanding even more obvious. For instance, it says that “NICE recommends osteopathy for sub-acute and chronic low back pain” and provides a reference to the NICE guidelines from 2009. Now, these guidelines were superseded by the version published in November 2016 which downgraded the role of osteopathy in the treatment of low back pain. So, here is an organisation that is keen to carry out “research” yet still refers to NICE guidelines that were superseded nearly 6 months ago.

Another thing that’s absolutely key when carrying out research is to minimise the risk of bias. When research is carried out it should be to test IF something works rather than to deliberately try and search for evidence that it does. The latter would be a clear case of bias and is unfortunately what happens far too frequently in most research in complementary and alternative medicine, such as osteopathy. The Research page on their website lists a number of “further positive trials”. Unfortunately, this appears to be a cherry-picked list of studies that apparently show the benefits of osteopathy. There are no trials listed that showed a negative outcome for osteopathy and the list of trials presented are far from a complete list of all research in any of the areas mentioned. There is clearly a very strong bias here towards trying to show that osteopathy works rather than genuinely researching to see IF it works.

What’s worse is that the interpretation of the trials themselves is actually incorrect and clearly suffers from further bias. For instance, CORE of Clapton say that “In elderly patients hospitalised with pneumonia, treatment significantly reduced the duration of intravenous antibiotic use and length of hospital stay compared to a sham treatment.” The trial they reference doesn’t say that at all! It’s actually a negative trial and shows that osteopathy was NOT beneficial for this patient group. In the results section it clearly states “Intention-to-treat (ITT) analysis (n = 387) found no significant differences between groups”. In other words osteopathy was NOT effective. On the basis of this study, further research in this area is not warranted.

What is the chance of the “research” that’s going to be carried out at CORE of Clapton resulting in an accurate unbiased assessment of the effectiveness of osteopathy? Based on the extremely biased view presented on their website I would say “zero”. Whatever “research” does get carried out is therefore unlikely to add anything at all to our understanding of what osteopathy can and cannot treat. Any public money spent on such “research” is being wasted and could be spent better elsewhere.


A Community Interest Company (CIC) like CORE is supposed to be of benefit to the community. CORE are asking the general public to donate to them or fundraise for them because they want to improve access to osteopathy for the public and to carry out research into osteopathy. These are goals that, on the face of it, appear to be in the public interest. However, once you look more closely it’s very clear that this is not the case. The treatments offered are not evidence based and in some cases potentially harmful. The “research” that they plan to carry out is likely to be so biased as to provide no useful information on the effectiveness of osteopathy. It’s hard to imagine how this venture can benefit the community at all given the types of treatments and research being offered. Misleading the public to fundraise for something that isn’t actually going to benefit the community is unethical. Public time and money should instead be given to other organisations that provide a genuine benefit.


Cranial osteopathy: What is it and what can it treat?

craniumWhat is cranial osteopathy?

Cranial osteopathy was proposed in the 1930s by William Sutherland who believed that the bones in the skull move in a “cranial rhythm”. By manipulating this “rhythm” osteopaths believe that they can treat a range of different conditions. However, since the 1930s we have learnt a lot more about how the body works. We now know that the bones in the skull don’t move and the “cranial rhythms” proposed by William Sutherland don’t actually exist at all. Cranial osteopathy is therefore a fanciful concept based on something that doesn’t exist.

What can cranial osteopathy treat?

Some osteopaths claim to be able to treat a whole range of different conditions with cranial osteopathy. The most commonly targeted patient group is babies with osteopaths claiming to be able to treat colic, sickness, irritability, feeding difficulties, misshapen head, reflux, cerebral palsy and many others. However, there isn’t any evidence that cranial osteopathy is effective for any of these conditions. One thing that’s common to these conditions, with the exception of cerebral palsy, is that they often get better on their own. When parents take their baby to a cranial osteopath for treatment of, for example, colic and within a few days or weeks their baby has improved they assume that it is down to the osteopathic treatment. However, we know that babies outgrow colic at around 4-6 months of age. If their baby is having osteopathic treatment at this time it’s natural for the parents to assume that the colic improved due to the treatment. In reality, as cranial osteopathy is entirely fanciful, it’s much more likely that the baby simply outgrew the colic and the treatment didn’t have any effect at all.

What does the research tell us?

Most research on cranial osteopathy is of a very poor quality and tells us nothing about whether it’s effective as a treatment or not. There is one good quality trial that looked at the use of cranial osteopathy for children with cerebral palsy. The authors concluded “This trial found no statistically significant evidence that cranial osteopathy leads to sustained improvement in motor function, pain, sleep or quality of life in children aged 5-12 years with cerebral palsy nor in quality of life of their carers.” In other words, cranial osteopathy didn’t work.

The reality is that there is no evidence that cranial osteopathy is effective for ANY condition.

Is it safe?

Nobody really knows if cranial osteopathy is safe because it hasn’t been adequately studied to test its safety. The biggest risk from this kind of “treatment” is probably not the treatment itself but the potential for someone to use this when proper medical care should have been undertaken instead.


Let’s return to the questions posed in the title of this post:

Question: What is cranial osteopathy?

Short answer: Quackery

Long answer: It’s a fanciful “treatment” based on theories that are completely at odds with our understanding of the way the human body actually works.

Question: What can cranial osteopathy treat?

Short answer: Nothing

Long answer: Nothing. At all. Ever. As it’s based on theories that are unfounded it’s unreasonable to expect it to provide any benefit to any health condition. There is also no scientific evidence to show that it works for any condition.

It’s quite surprising that more osteopaths don’t speak out against the use of cranial osteopathy. Osteopaths like to promote themselves as “healthcare professionals” but it’s going to be very hard for them to be accepted as such when they continue to allow quackery like cranial osteopathy. Cranial osteopathy is based on something that doesn’t exist, has never been shown to be effective for any condition and it’s high time it ceased to be offered as a “treatment” option.

Useful Links

If you’d like to learn more about cranial osteopathy, here are some links you might find useful:

Foundation for Paediatric Osteopathy Conference 2017: Osteopaths embracing quackery

quackeryThis weekend (8th and 9th April 2017) it’s the Foundation for Paediatric Osteopathy Conference. The osteopathy profession in the UK currently has major issues with many osteopaths making misleading claims about what they can treat in order to lure patients into their practices. I have previously highlighted that this problem also exists with some of the training being offered to osteopaths. The Foundation for Paediatric Osteopathy Conference seems to be taking this misleading training information to a whole new level. Talks at the conference include:

  • “Osteopathic Support of the Immune System in Infancy and Childhood”
  • “Special Aspects of Treating Unborn Babies”
  • “Vaccination – the Science”
  • “The Immunity Spiral – How being ill can make kids better”

You will notice that there is a focus in the above talks on medical care and treatments. In the UK, osteopaths are not licensed to practice medicine so they have no business doing anything to do with the immune system, vaccination decisions or, heaven forbid, treating unborn babies! All of these are things that should be handled by medical professionals and osteopaths shouldn’t be learning about them. With regards to the immune system, there is no evidence that any osteopathic treatment can help the immune system. “Osteopathic Support of the Immune System” is therefore a fallacy.

The talk about “Vaccination – the Science” is particularly interesting. It’s being given by Dr Jayne Donegan who, from her website, appears to be anti-vaccination. She is also a homeopath and recommends it for a range of different conditions including bruising and shock, burns and scalds and fever management. Homeopathy isn’t effective for any of these conditions, or anything else for that matter. She supports disgraced doctor Andrew Wakefield who wrongly claimed that the MMR vaccine can cause autism. Oh dear. It is well known that some alternative medicine practitioners recommend against vaccination. Might this talk result in more osteopaths becoming anti-vaccination? That can’t be a good thing for the health of their patients or the public as a whole. After the talk, the Foundation for Paediatric Osteopathy posted this on twitter “Dr Jayne Donegan inspired us about how to treat acutely ill children, and boost immunity naturally”. It’s quite incredible that osteopaths are being offered training in treating acutely ill children. Acutely ill children need proper MEDICAL help from a DOCTOR not quackery from an osteopath. They certainly don’t need their immune system “boosting naturally”.

The Foundation for Paediatric Osteopathy has recently been the subject of a complaint to the Advertising Standards Authority due to making unsubstantiated claims about the effectiveness of osteopathic treatment for babies, children and pregnant mothers. This complaint was informally resolved after they updated their website. However, they still do not comply with the guidance and continue to make misleading claims. This includes suggesting that osteopathy can help babies “recover from delivery” and treat indigestion and heart-burn in pregnant mothers. There is simply no evidence to support osteopathic treatment in these situations. They also suggest that babies would benefit from an “osteopathic check-up”. Babies receive perfectly adequate checks in the hospital after they are born and are subsequently monitored by health visitors. Osteopathy has no place in this and osteopaths are not the right people to be carrying out checks on newborn babies. By suggesting otherwise, osteopaths are blatantly misleading parents. Through their conference, the Foundation for Paediatric Osteopathy are now providing training to other osteopaths in the very things that they shouldn’t be treating and therefore spreading this misleading information more widely. Other authors have written about how osteopathy is closely linked with pseudoscience. Conferences like this suggest that osteopathy is fully embracing quackery.

Osteopaths seem to be continuously trying to widen their scope of practice, presumably to increase their income. However, by trying to move into areas that they have no skills and for which their treatments are not effective they are putting their own income ahead of the needs of patients. This is a dangerous game and in the long-term can only be harmful to the reputation of the profession.

UK Health Centre: Misleading information about osteopathy, chiropractic, homeopathy and acupuncture all on one site

The UK Health Centre website says that it provides “Access to Health and Medical Information on the Internet”. However, this is not a site that just provides information. It has an appointment booking service and the focus seems to be primarily on providing information that encourages people to make bookings for private treatment. Unfortunately, the information is therefore somewhat biased and in some cases very misleading. Some of the information on the site is actually of a good quality and provides evidence based advice. One example of this would be the information on vaccines. The area where the advice is much more misleading is alternative medicine. This includes osteopathy, chiropractic, acupuncture, homeopathy and herbal remedies. Mixing this misleading information about alternative treatments with more accurate information about conventional medical treatments is likely to cause confusion for the general public and could result in them opting to take treatments that are completely unsuitable.


The UK Health Centre website promotes osteopathy as a treatment for a wide range of medical conditions including:

  • Whiplash
  • Asthma and chest problems
  • Diabetes
  • Long term illness
  • Stress
  • Depression
  • Tiredness
  • Osteoporosis
  • IBS
  • Glue ear
  • Infections
  • Insomnia
  • Growing pains
  • Dysmenorrhoea (period pains)
  • Issues specifically related to pregnancy (such as morning sickness, wounds from childbirth)
  • Common infant problems (including colic, colds and teething pain)
  • Conditions arising from oxygen deprivation during birth
  • Monitoring baby’s growth and development
  • General poor health

Osteopathy has not been shown to be effective for any of these conditions and therefore advertising such treatments breaches advertising regulations. It is in conflict with the guidance provided by the General Osteopathic Council (regulatory body for osteopathy in the UK), the Advertising Standards Authority and the Committee of Advertising Practice (http://www.osteopathy.org.uk/news-and-resources/document-library/practice-guidance/gosc-asa-cap-letter-to-osteopaths/ and https://www.asa.org.uk/asset/44783612-C34B-4084-9B8A7036F01C43D7/ ). This misleading information could result in someone booking an appointment with an osteopath when their treatments are completely unsuitable. Some of the conditions on the list, such as asthma, are serious medical conditions that should only be handled by a suitably qualified MEDICAL professional and definitely not an osteopath.


Although less outrageous than the treatment claims made for osteopathy, the information provided about chiropractic is also misleading. The site suggests that chiropractic treatment can improve the immune system, provide a solution to fertility problems and also to treat asthma. None of these claims can be substantiated and this information is therefore misleading. Elsewhere it says “The National Institute for Health and Clinical Excellence (NICE) support the use of chiropractic for treatment of acute lower back pain as they have analysed the results of studies that prove its effectiveness in this area.” Actually, the recent NICE guidelines have downgraded the role of chiropractic in treatment of low back pain due to a lack of evidence for its effectiveness.

Besides treatment for specific medical conditions, the site has other misleading information about chiropractic such as “It is considered most beneficial to undergo chiropractic treatments on a regular basis in order to prevent future damage to the skeleton.” Wow! There is no evidence to suggest that chiropractic is suitable as a preventative treatment. Furthermore, suggesting that not having such treatment might result in “future damage to the skeleton” is blatant and unsubstantiated scaremongering to try and get people to take treatments.

Interestingly, they do highlight risks of chiropractic: http://www.healthcentre.org.uk/chiropractors/chiropractors-safety.html . What’s rather puzzling is that the site doesn’t consider similar risks of osteopathy even though many of the same risks apply to both.


The UK Health Centre website recommends acupuncture or acupressure for a range of different conditions including:

  • Tooth pain
  • Other pain
  • Muscle tightness
  • Nausea
  • Erectile dysfunction
  • Bronchitis
  • Anxiety
  • Stress
  • Drug use / alcoholism
  • Overeating
  • Fertility
  • Conditions during pregnancy including tiredness, anxiety, tenderness in the breasts, varicose veins, induction of labour, to correct foetal position

Acupuncture hasn’t been shown to be effective for any of these conditions and claiming otherwise is misleading. This also conflicts with the Advertising Standards Authority guidelines for acupuncture.

It then goes on to say that effectiveness of acupuncture for some conditions is in a “grey area”. Conditions that it puts into this category include depression, neck pain, stroke, sciatica, tinnitus, asthma, addictions (substance abuse). However, there is no such thing as a “grey area” in treatment effectiveness. Either a treatment has been proven to work or it hasn’t – in this case it hasn’t and suggesting otherwise is misleading.

Like osteopathy, some of the items on the list are serious medical conditions that should only be handled by a suitably qualified MEDICAL professional and definitely not treated with acupuncture.


The site suggests that homeopathy is an effective treatment for hay fever (http://www.healthcentre.org.uk/allergies/hay-fever-homeopathy.html ) and snoring (http://www.healthcentre.org.uk/sleep-disorders/snoring-natural-alternative-homeopathic.html ). It then goes on to say that homeopathy is the most suitable treatment during pregnancy (http://www.healthcentre.org.uk/sleep-disorders/snoring-natural-alternative-homeopathic.html ). None of these claims are backed by any sort of evidence and are misleading the general public into potentially taking a treatment that is completely ineffective.

Herbal Remedies

The UK Health Centre website suggests that herbal remedies are effective for allergies, menopause, erectile dysfunction, skin tags and sleep problems. There is no evidence to back up these claims and they are therefore misleading the general public.

Actions Taken and Next Steps

I contacted UK Health Centre in November 2016 to ask them to amend the misleading content on their site. In the first instance I opted to focus on the content about osteopathy to see if they would be willing to correct their site. If they responded positively I then planned to tackle the other issues. Here is the e-mail I sent:

“I’m following up on the information provided about osteopathy on your website. A number of the claims made about osteopathy on your site do not have evidence to support them and are therefore misleading prospective patients and the general public. Furthermore, making these kinds of claims breaches advertising regulations and is in conflict with the guidance provided by the General Osteopathic Council (regulatory body for osteopathy in the UK), the Advertising Standards Authority and the Committee of Advertising Practice. See this link for the guidance they provided to osteopaths: http://www.osteopathy.org.uk/news-and-resources/document-library/practice-guidance/gosc-asa-cap-letter-to-osteopaths/ Many of the pages on your site breach these guidelines and provide misleading advice. This includes references to treatment for whiplash, asthma and chest problems, stress, depression, tiredness, osteoporosis, IBS, glue ear, infections, growing pains, common infant problems and “general poor health”. Furthermore, your site suggests that preventative osteopathic treatment is appropriate and that “osteopathy can provide health benefits to most people”. However, there is no evidence to support either of these claims and therefore your site is misleading prospective patients and the general public.

Could you please remove all of your misleading articles about osteopathy from your website or amend them to make it clear what osteopathy can / cannot actually treat? I look forward to hearing from you.”

I received no response so sent a follow up in December 2016. Again there was no response. The information they provide is misleading the general public and has the potential to cause people to take unsuitable treatments. As such, the information on this site represents a risk to the public. I have therefore reported UK Health Centre to the Advertising Standards Authority (ASA). It will be interesting to see the outcome of this.

Osteopathy and Chiropractic: Are they as safe as we’re led to believe?

risksUK osteopaths and chiropractors often claim that their treatments are “very safe”. However, there is a paucity of evidence to back up these claims and any practitioner who claims this is therefore misleading patients and the general public. A recent study suggests that the potential for long-term harm from the types of treatments provided by osteopaths and chiropractors may be significantly higher than previously thought.

This study looked at the adverse effects experienced by students after having manual techniques performed on them as part of their orthopaedic manual physical therapy training. The questionnaire was completed by 1640 respondents spread over 22 countries. This survey highlighted more people suffering longer-term adverse effects from treatments than have previously been reported. The treatments that caused most of the adverse effects were manipulation and mobilisation, treatments that are used frequently by osteopaths and chiropractors. The two key areas highlighted were major adverse effects and moderate adverse effects.

With regards to major adverse effects, participants in the survey were asked To your knowledge, have any of your fellow students experienced a major adverse effect (e.g. stroke, death or permanent neurological damage) directly resulting from a technique performed on them during their manual therapy training?” If these types of therapies are really “very safe” then you would expect nothing other than ZERO positive responses to this question. In actual fact 3.3% of respondents reported knowing of a fellow student experiencing a major adverse event (stroke, death or permanent neurological damage). Let’s just reflect on this for a moment. 3.3% on the face of it seems like a pretty small number. However, when you consider the severity of the effect: stroke, death or permanent neurological damage, anything other than 0% is a cause for concern. This certainly isn’t what you would expect from a treatment that is described as “very safe”. As the paper states, it’s not possible to quantify the absolute number of major adverse events from this data as we don’t know if some of the respondents are referring to the same cases. However, what this study does tell us is that some people do suffer very serious harm from the types of treatments provided by osteopaths and chiropractors. It is therefore unreasonable for any osteopath or chiropractor to claim that their treatments are “very safe” unless they can provide evidence to back up this claim. (I’m not aware of any such evidence.)

Looking at moderate adverse effects, 6.7% of respondents reported still experiencing adverse effects from the treatment they had during their training. The most common effects were chronic or recurrent neck pain, headache and low back pain. In the vast majority of cases these adverse effects were reported after manipulation or mobilisation, exactly the treatments that are used frequently by osteopaths and chiropractors. Most osteopaths and chiropractors don’t even highlight these risks to patients and instead (if they even talk about risks at all) only mention the mild transient risks of tiredness, temporary increase in pain or stiffness that typically last less than 48 hours. The frequency with which the participants in this study reported long-term effects highlights the potential for much greater harm from chiropractic or osteopathic treatment. In this study, 1 in 15 people treated suffered long-term problems due to the treatment.

Osteopaths and chiropractors will undoubtedly argue that this study was based on treatments carried out by students during their training and does not reflect the risks to patients being treated by someone with many years’ experience. That may be true, although these were postgraduate students developing their skills to an advanced level not undergraduates just starting out. In any case, what this study does do is make it clear that these treatments are NOT inherently safe. It’s possible that the risks from being treated by an experienced practitioner will be lower than in this study but the fact that these serious risks do exist cannot be ignored. Furthermore, how does an osteopath or chiropractor gain their many years of experience? By treating patients, of course. Therefore, some patients are going to be treated by someone who has just graduated or is only very early in their career. In this situation it seems likely that the risks of treatments will be closer to the figures quoted here which are far higher than most osteopaths or chiropractors are willing to admit.

This is an important study that highlights the potential for the types of treatments used by osteopaths and chiropractors to cause long-term damage to patients, in some cases including stroke, death or permanent neurological damage. Given the lack of effectiveness of these treatments for the most often treated patient group (low back pain) it’s important to consider whether the risks involved actually justify the use of the treatment at all. If a drug was developed that provided no or small benefits to patients and carried risks of long-term harm including the possibility of stroke, death or permanent neurological damage it would not get licensed. It’s therefore puzzling why these types of treatments are allowed to be offered at all.

UK Osteopaths advising on choice of medication: A potential risk to patients

medicationUK osteopaths are not medically trained and are not licensed to prescribe medication. You wouldn’t therefore expect an osteopath to advise patients on choice of medication. However, that’s exactly what they are being trained to do. On 17th March, the British School of Osteopathy are running a training course “Pain and Pharmacology”. Within the description of this course it states “This course will give delegates the opportunity to increase their knowledge and confidence of pharmacology and pain control medication. The course will discuss assessing and treating patients with poorly controlled pain, with advice and education on safe and effective pain control medication selection.”

It seems quite ridiculous (and potentially dangerous) for an osteopath to provide advice to patients on choosing medication as they are not qualified to do so. If an osteopath is asked about medication by one of their patients they should refer them to a suitably qualified MEDICAL professional – usually their GP.

Much like their recent interest in exercise, osteopaths yet again seem to be trying to offer services that are outside of their expertise. The core treatments provided by osteopaths are no longer considered to be first-line treatments for many of their patients. This recent move to try to widen their services appears to be a desperate attempt by a profession to justify its existence. Osteopaths should be sticking to their core treatments in which they have expertise. After all, what really matters is improving care for patients. An osteopath advising on choice of medication is completely inappropriate and can’t be in the patient’s best interest. If you need advice on choice of medication, are concerned about side effects or need other medical advice please see your GP. Do not place your health at risk by taking advice from an osteopath.


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.