Osteopathy part 1 – pseudoscience in disguise?

It’s happened many times – you may have seen it yourself. There’s a Facebook thread on the effectiveness of ‘alternative medicine’, the skeptical parties are deflecting pseudoscience left, right and centre, citing evidence, throwing facts, and then someone mentions osteopathy (or even chiropractic), and suddenly the skeptics are arguing with each other … “no, this one is science! It works!”

Many people do not think of osteopathy or chiropractic as alternative medicine, perhaps largely because you see them on the High Street in almost every town, because they are often recommended by GPs, because they seem sciencey, because they have governing bodies and training programmes, because they’re manual therapies, and because so many people use them.

Anecdotes about successful treatments are everywhere. If someone has a bad back, they’re quite likely to think of a chiropractor or an osteopath before they think of a GP or a physiotherapist. I’ve seen both a chiropractor and an osteopath myself, and I came out of each feeling more ‘balanced’ and generally … good!

Out of the two, chiropractic and osteopathy, it’s osteopathy that has the better reputation. This may be partly to do with the status of each in the United States, where chiropractors are campaigning (and failing) to achieve the status of primary care-givers, and osteopaths are already recognised as such – being just about on a par with medical doctors, and often rarely using any actual osteopathic manipulative treatment but relying on the more conventional and scientific medical practices in which they’ve also been trained.

There is a greater awareness (though still not great enough) that chiropractors were born out of non-evidenced pseudoscience and that they retain those shackles even now, in the 21st century. Most hold on to the fantasy of the ‘subluxation theory’, and quite often also hold views that promote anti-vaccination, reject the germ theory of disease, and align with various ‘Big Pharma’ conspiracy theories. It is not true of all, but generally they are more Natural News than BMJ.

Many people may be surprised to know that, in the UK, some osteopaths are not far off this mark themselves. Like chiropractic, osteopathy was born of blatant pseudoscience, and while the field has had to make some advances due to public awareness of scientific principles and stricter standards of practice, it keeps at least one foot firmly in the world of ‘complimentary and alternative medicine’ (CAM), and the actual scientific evidence for osteopathy is scant.

The originator of osteopathy was Andrew Taylor Still (1828-1917). A read of his autobiography reveals that he hated “allopathic” medicine (doctors could not save three of his family from spinal meningitis) but he was a physician of a sort. He admits he learned anatomy by desecrating the graves of dead Native Americans (“[they] never objected … their relatives knew nothing about it …”) and eventually came to the conclusion that “all the remedies necessary to health exist in the human body”, all you had to do was ‘adjust’ that body and it would heal itself – nothing else should be used.

Still believed that there was no such thing as disease, and that what we call disease is actually just the effects of a “partial or complete failure of the nerves to properly conduct the fluids of life”. He goes on to detail how his osteopathy cured colds, croup, diphtheria, pneumonia, flux, ulcerated eyes, erysipelas, asthma, and how he delivered twenty babies painlessly, stopped scarlet fever with the “shake of a child”, and whooping cough with a “wring of its neck”.

If you search Google for the websites of osteopaths (see my survey in part 2 here) you’ll see that, while the Advertising Standards Authority (ASA) has made sure many of the field’s wilder claims are no longer openly promoted, the central beliefs of A. T. Still remain at the core of the profession’s philosophy and four-year training course. Here’s a few statements from the websites of osteopaths, from around my own locality in the south-east of England, all certified members of the regulating General Osteopathic Council…

“We believe in the body’s inherent ability to heal itself, and the techniques used aim to set the best conditions for recovery.”

“Osteopaths work to restore your body to a state of balance, where possible without the use of drugs or surgery … to enhance the blood and nerve supply and to help your body’s own healing mechanisms.”

“An osteopath spends many years training to develop a very fine sense of palpation to enable them to feel and effectively listen via their hands to what is going on in the body.”

“Treatment can improve the circulation, immune and nervous system functioning along with improved digestion, breathing and energy levels … treatment has significantly improved conditions such as acid reflux, constipation, menstrual pain, sleeping problems and fatigue …”

“The entire connective tissue matrix, the largest organ of the body, is controlled by the unifying influence of water … treatment encourages tissues to release, promoting blood flow and cellular communication.”

“We work with the philosophy espoused by the founding fathers of osteopathy who understood the relationship between the physical body, the rhythmic forces within the body and the bio-energetic flow systems in and around the body.”

Again and again it is emphasised that osteopathic techniques restore the body to its ‘natural balance’ allowing it to ‘heal itself’ – this is the essence of osteopathy (also, by the way, of naturopathy), and the theory is not backed up by science. Alongside such phrases as ‘holistic’ and ‘individual’ treatment, there’s enough vagueness in the language that a fairly sizeable cartload of pseudoscientific claims can be ushered in through the door.

In addition, while a few practices offer osteopathy alone, the majority also provide some other form of unproven alternative therapy, such as acupuncture, homeopathy, naturopathy, reflexology, reiki and applied kinesiology, to name a few, giving you some idea of an osteopath’s general mindset. Babies and animals are often singled out as specialisms of the osteopath, and the more brazen practitioners will blithely claim that their musculoskeletal manipulations can treat ailments such as eczema, asthma, colic and irritable bowel syndrome.

The subtext (not always very sub) is clear – many osteopaths see themselves as natural healers, travelling a different road to that of the General Practitioner, Physiotherapist and mainstream medicine, getting to the real cause of illness rather than just applying drugs to the symptom. The red flags of pseudoscience are definitely aflutter within the profession’s territory.

I’ve no doubt that a good bone and tissue massage, plus a great deal of personal attention, can do wonders for any patient (indeed I’ve experienced this myself, and it has its place), and there’s some (not strong) evidence that manual therapy may have some benefit in the case of lower back pain. But that’s as much as the NHS will admit to (“osteopathy is a complimentary or alternative medicine … [and] isn’t always based on scientific evidence”) and the National Institute for Health and Care Excellence (NICE) no longer recommends massage and manipulation as a first step in treating back pain due to the poor quality of supporting evidence.

Of course the anecdotes of many will say different – even my own experience was somewhat positive in the short term (longer term, the best thing for my back has been an increase in exercise, just what NICE does now recommend, and a lot cheaper too). But the trouble with anecdote in relation to osteopathy is that it’s prone to so many obscuring factors: confusing correlation with causation, regression to the mean, the self-limitation or natural remission of the condition, placebo effect, short-term relief of symptoms but not cure, misdiagnosis by an osteo-biased practitioner, and even, sometimes, a bit of self-delusion due to the financial and emotional investment of the patient.

There are a couple of more controversial aspects of treatment given by the majority of mainstream osteopaths that are worth looking at in a little more detail: spinal manipulation and cranial osteopathy.

Spinal manipulation at the neck involves the practitioner giving a sudden twist of the patient’s head to one side. I’ve had this done, and it was not a pleasant experience. The question is, however, does its supposed benefit far outweigh any risk? There’s no clear-cut answer, but there is a growing chorus of scientific voices who think the technique may increase the risk of vertebrobasilar stroke, and a number of cases have been highlighted. Part of the problem is that some of these strokes may not happen until some time after the manipulation, a matter of weeks even, and so the correlation, if present, may not be obvious.

Cranial osteopathy is a technique whereby the practitioner uses their hands to feel the skull for ‘rhythmic pulsations’ where they can then detect and release ‘restrictions’ using very light pressure. The alleged danger comes not in the physicality of the technique itself, but in the ailments it claims to be able to treat, and the lack of plausible science to back the theory and its outcomes (not to mention the taking of money for such a thing). It is especially controversial as it is often highlighted as a technique that can (and in some cases, should) be used on very young babies.

There is no doubt that osteopathy exists at the shallow end of the pseudoscientific spectrum, at its best inhabiting much of the same arena as its more practical cousin, physiotherapy, at its worst still clinging onto the full philosophy of its quack founder, A. T. Still, while also giving credence to a whole host of non-effective alternative medicine systems that accompany many practices, legitimised by the seemingly scientific glow of a Masters Osteopathy certificate on the clinic wall.

I’ll end with a quote from a GP I once saw, who was telling me about his new baby daughter’s problem with colic: “My wife and I took her to see an osteopath. Complete quackery, but we were desperate!”. Well, he said it, not me.

Part 2 – a survey of 100 osteopath websites – can be read here.

Notes: please see the links in the article above for sources and extra information. See also:

Edzard Ernst on Osteopathy
Skeptic Barista: Osteopaths: Talking a good game
Vic Skeptics: Does Osteopathy work? Is it Scientific?
Good Thinking Investigates: Osteopathy
Quackwatch: Dubious aspects of Osteopathy
RationalWiki: Osteopathy
David Colquhoun: Cranial Osteopathy at the Royal London Hospital for Integrated Medicine

Note 2: this article was posted at the beginning of International Osteopathic Healthcare Week (17-23 April 2016).

• chiropractic
• osteopathy
• science