About Osteopathy

What is osteopathy?

Osteopathy is a primary contact and person-centred healthcare discipline that supports a whole-person approach to all aspects of health and healthy development, principally by the practice of manual (hands-on) treatment (1).

How ‘big’ is osteopathy?

There are 79,302 osteopaths in Europe. Of these 45,093 are statutorily regulated and registered osteopaths and we estimate that 34,207 osteopaths are not statutorily regulated and registered but may be registered with voluntary registering organisations (2).

What evidence is there for effectiveness and safety of osteopathy?

To date there is a growing but still limited body of evidence to support the efficacy and effectiveness of osteopathic care in chronic pain conditions (3 -5) and improving function, particularly musculoskeletal conditions such as low back and neck pain (6 – 13). The evidence is limited and inconclusive as to whether osteopathic care may benefit other health conditions, such as Irritable Bowel Syndrome (IBS), Chronic Obstructive Pulmonary Disease (COPD), primary headache, neurological diseases, thoracic pain after cardiac surgery, length of hospital stay in preterm infants, and gynaecology and obstetrics (6; 14 -22).

Importantly, osteopathy is safe. Research shows that few or no serious adverse effects are reported after osteopathic treatment (23). When adverse effects are reported, they are usually very mild and short-lived (such as stiffness, fatigue and mild headaches) (6; 24). With regard to cervical manipulation, basic research shows that the mechanical load during these manipulations cannot be considered responsible for severe complications (25 -28). Clinical research shows that serious risks are extremely rare and that the benefits of manipulative intervention for patients with neck pain, outweigh the risks (29; 30; 43)

How well qualified are osteopaths?

Most osteopaths are trained to Level 6 or Level 7 standard of education (bachelor or master level). There are 2 types of training programmes, and the type of programme completed depends on the previous education and clinical experience of the trainee. Type I training programmes are designed for those with little or no previous healthcare training who have completed a high school education or equivalent, and Type II training programmes are designed for those with previous healthcare training (1). Osteopathic practitioners practise in primary care settings (private clinics and publicly funded services), hospitals, National Health Services and secondary care services.

The ‘Regulation of the Osteopathic Profession in Europe’ report which is available from our website provides key, relevant information regarding regulation, you can download it from our Regulation page.

How accessible is osteopathy?

Osteopaths generally work in practices on their own in the private healthcare sector. Between 40-60% of osteopaths also work partly or fully part of a team. Osteopaths across the UK and central Europe are generally able to provide their patients with an osteopathic consultation within one week (31-39).

What do osteopaths do?

Osteopaths combine hands-on manual approaches (using touch and manipulation), informed by osteopathic models of care, combined with other patient management approaches (for example: patient education and reassurance, encouraging physical activity, facilitating self- management, wellbeing and lifestyle advice). Osteopaths can diagnose conditions and are skilled in triaging, knowing when to refer people to different healthcare professionals. The most common diagnostic techniques are case history taking, observation, clinical examination and testing, palpation of tenderness, structure and movement. The most common treatment techniques are articulation/mobilisation, visceral and soft tissue techniques and High Velocity Low Amplitude (HVLA) (31-39).

Who goes to see an osteopath?

People seeking osteopathic care are typically working age adults (between 18 and 65 years old) with an average age between 40 and 50 years old. Children make up about 10-25% of patients and about three quarters of these are under the age of 2. More women than men (60:40) visit an osteopath (35; 39; 40).

Osteopathic patients typically seek care for musculoskeletal complaints, such as low back, and neck pain. Osteopathic care for non-musculoskeletal conditions such as digestive complaints, headaches, respiratory conditions and gender specific health conditions occur between 1 and 15% (31-39).

What do osteopathic patients say about their care?

Osteopathy Europe is sponsoring a project to collect information from osteopathic patients about the outcomes of their osteopathic care.

By 04.07.2023, 3,347 patients from the UK and EU countries had completed questionnaires about their care. A total of 89% of these patients were very or highly satisfied with their care one week after their consultation and 91% rated their experience as good or very good. When asked about changes in their condition after osteopathic care, 81.3% reported they were either much improved or fully recovered after 6 weeks (42).

References

1. European committee for standardization osteopathic healthcare provision. European Standard EN 2015;16686.

2. Osteopathic International Alliance. Global review of osteopathic medicine and osteopathy 2020. 20 Oct 2022. Available from: https://oialliance.org/wp-content/uploads/2021/02/OIA_Report_2020_FINAL.pdf.

3. Franzetti, M., Dries, E., Stevens, B., Berkowitz, L., and Yao, S. C. (2021). Support for osteopathic manipulative treatment inclusion in chronic pain management guidelines: a narrative review. J. Osteopath. Med. 121, 307– 317. doi: 10.1515/jom-2019-0284

4. Licciardone, J. C., Schultz, M. J., and Amen, B. (2020). Osteopathic manipulation in the management of chronic pain: current perspectives. J. Pain Res. 13, 1839–1847. doi: 10.2147/JPR.S183170

5. Rehman, Y., Ferguson, H., Bozek, A., Blair, J., Allison, A., and Johnston, R. (2020). Osteopathic manual treatment for pain severity, functional improvement, and return to work in patients with chronic pain. J. Am. Osteopath. Assoc. 120, 888–906. doi: 10.7556/jaoa.2020.128

6. Bagagiolo D, Rosa D, Borrelli F. Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews. BMJ Open. april 2022;12(4):e053468.

7. Dal Farra, F., Risio, R. G., Vismara, L., and Bergna, A. (2021). Effectiveness of osteopathic interventions in chronic non-specific low back pain: a systematic review and meta-analysis. Complement. Ther. Med. 56:102616. doi: 10.1016/j.ctim.2020.102616

8. Franke, H., Franke, J. D., and Fryer, G. (2014). Osteopathic manipulative treatment for nonspecific low back pain: a systematic review and meta-analysis. BMC Musculoskelet. Disord. 15:286. doi: 10.1186/1471-2474-15- 286

9. Franke, H., Franke, J. D., and Fryer, G. (2015). Osteopathic manipulative treatment for chronic nonspecific neck pain: a systematic review and meta-analysis. Int. J. Osteopath. Med. 18, 255–267. doi: 10.1016/j.ijosm.2015.05.003

10. Franke, H., Franke, J. D., Belz, S., and Fryer, G. (2017). Osteopathic manipulative treatment for low back and pelvic girdle pain during and after pregnancy: a systematic review and meta-analysis. J. Bodyw. Mov. Ther. 21, 752–762. doi: 10.1016/j.jbmt.2017.05.014

11. Licciardone, J. C., Brimhall, A. K., and King, L. (2005). Osteopathic manipulative treatment for low back pain: a systematic review and meta-analysis of randomized controlled trials. BMC Musculoskelet. Disord. 6:43. doi: 10.1186/1471-2474-6-43

12. Switters, J. M., Podar, S., Perraton, L., and Machotka, Z. (2019). Is visceral manipulation beneficial for patients with low back pain? A systematic review of the literature. Int. J. Osteopath. Med. 33–34, 16–23. doi: 10.1016/j.ijosm.2019.09.002

13. Verhaeghe, N., Schepers, J., van Dun, P., and Annemans, L. (2018). Osteopathic care for spinal complaints: a systematic literature review. PLoS One 13:e0206284. doi: 10.1371/journal.pone.0206284

14. Cerritelli, F., Ruffini, N., Lacorte, E., and Vanacore, N. (2016). Osteopathic manipulative treatment in neurological diseases: systematic review of the literature. J. Neurol. Sci. 369, 333–341. doi: 10.1016/j.jns.2016.08.062

15. Cerritelli F, Consorti G, van Dun PLS, Esteves JE, Sciomachen P, Valente M, et al. (2020) The Italian Osteopathic Practitioners Estimates and RAtes (OPERA) study: How osteopaths work. PLoS ONE 15(7): e0235539. https://doi.org/10.1371/journal.pone.0235539

16. Cicchitti L, Martelli M, Cerritelli F. Chronic inflammatory disease and osteopathy: a systematic review. PLoS One. 2015 Mar 17;10(3):e0121327. doi: 10.1371/journal.pone.0121327. PMID: 25781621; PMCID: PMC4363664.

17. Lanaro, D., Manzotti, A., and Lista, G. (2017). Osteopathic manipulative treatment showed reduction of length of stay and costs in preterm infants. Medicine 96:e6408. doi: 10.1097/MD.0000000000006408

18. Cicchitti L, Martelli M, Cerritelli F. Chronic inflammatory disease and osteopathy: a systematic review. PLoS One. 2015 Mar 17;10(3):e0121327. doi: 10.1371/journal.pone.0121327. PMID: 25781621; PMCID: PMC4363664.

19. Racca, V., Bordoni, B., Castiglioni, P., Modica, M., & Ferratini, M. (2017). Osteopathic manipulative treatment improves heart surgery outcomes: a randomized controlled trial. The Annals of Thoracic Surgery, 104(1), 145- 152.

20. Roncada, G. (2020). Osteopathic treatment leads to significantly greater reductions in chronic thoracic pain after CABG surgery: A randomised controlled trial. Journal of Bodywork and Movement Therapies, 24(3), 202- 211.

21. Ruffini, N., D’Alessandro, G., Cardinali, L., Frondaroli, F., and Cerritelli, F. (2016). Osteopathic manipulative treatment in gynecology and obstetrics: a systematic review. Complement. Ther. Med. 26, 72–78. doi: 10.1016/j.ctim.2016.03.005

22. Wieting, J. M., Beal, C., Roth, G. L., Gorbis, S., Dillard, L., Gilliland, D., & Rowan, J. (2013). The effect of osteopathic manipulative treatment on postoperative medical and functional recovery of coronary artery bypass graft patients. Journal of Osteopathic Medicine, 113(5), 384-393.

23. Vogel, S. Mars, M. Keeping, Sv. Barton, T. Marlin, N. Froud, R. Eldridge, S. Underwood, M. Pincus, T. Clinical Risk Osteopathy and Management Summary Report. Available at: https://www.uco.ac.uk/sites/default/files/research_supporting_docs/croam-summary-report-final%20%281%29.pdf

24. Rajendran D, Mullinger B, Fossum C, Collins P, Froud R. Monitoring self-reported adverse events: A prospective, pilot study in a UK osteopathic teaching clinic. Int J Osteopath Med. juni 2009;12(2):49–55.

25. Herzog W, Leonard TR, Symons B, Tang C, Wuest S. Vertebral artery strains during high-speed, low amplitude cervical spinal manipulation. J Electromyogr Kinesiol. oktober 2012;22(5):740–6.

26. Salem, Walid & Lenders, Cyril & Lepers, Yves & Mathieu, Jacques & Klein, Paul. (2011). Variations de longueur de l’artère vertébrale in vivo : Etude comparative entre la rotation physiologique et la position prémanipulative de la colonne cervicale.. La revue de l’Ostéopathie. 37-40.

27. Salem W, Klein P. In vivo 3D kinematics of the cervical spine segments during pre-manipulative positioning at the C4/C5 level. Man Ther. 2013;18(4):321–6.

28. Wuest S, Symons B, Leonard T, Herzog W. Preliminary Report: Biomechanics of Vertebral Artery Segments C1-C6 During Cervical Spinal Manipulation. J Manipulative Physiol Ther. mei 2010;33(4):273–8.

29. Rubinstein SM, Leboeuf-Yde C, Knol DL, de Koekkoek TE, Pfeifle CE, van Tulder MW. The Benefits Outweigh the Risks for Patients Undergoing Chiropractic Care for Neck Pain: A Prospective, Multicenter, Cohort Study. J Manipulative Physiol Ther. juli 2007;30(6):408–18.

30. Rushton, A., Carlesso, L.C., Flynn, T., Hing, W.A., Rubinstein, S.M., Vogel, S. and Kerry, R., 2023. International framework for examination of the cervical region for potential of vascular pathologies of the neck prior to musculoskeletal intervention: International IFOMPT Cervical Framework. Journal of Orthopaedic & Sports Physical Therapy, 53(1), pp.7-22.

31. Alvarez G, Roura S, Cerritelli F, Esteves JE, Verbeeck J, van Dun PLS (2020) The Spanish Osteopathic Practitioners Estimates and RAtes (OPERA) study: A cross-sectional survey. PLoS ONE 15(6): e0234713. https://doi.org/10.1371/journal.pone.0234713

32. Cerritelli F, van Dun PLS, Esteves JE, Consorti G, Sciomachen P, Lacorte E, Vanacore N; OPERA-IT Group. The Italian Osteopathic Practitioners Estimates and RAtes (OPERA) study: A cross sectional survey. PLoS One. 2019 Jan 25;14(1):e0211353. doi: 10.1371/journal.pone.0211353. PMID: 30682169; PMCID: PMC6347434.

33. Dornieden, R. Exploration of the characteristics of German osteopaths and osteopathic physicians—Survey development and implementation. Ph.D. Thesis, University of Bedfordshire, Luton, UK, 30 January 2019. Available online: https://uobrep.openrepository.com/handle/10547/623987

34. Ellwood J, Carnes D, An international profile of the practice of osteopaths: a systematic review of surveys, International Journal of Osteopathic Medicine, https://doi.org/10.1016/ j.ijosm.2021.03.007.

35. Plunkett A, Fawkes C, Carnes D (2022) Osteopathic practice in the United Kingdom: A retrospective analysis of practice data. PLoS ONE 17(7): e0270806. https://doi.org/10.1371/journal. pone.0270806

36. Rui José Santiago, Alexandre Nunes, Jorge Eduardo Esteves, Francesco Cerritelli, Johan Verbeeck, Sónia Lopes, Manuel Paquete, Patrick van Dun, The Portuguese Osteopathic Practitioners Estimates and RAtes (OPERA): A cross-sectional survey, International Journal of Osteopathic Medicine, 2022,ISSN 1746-0689, https://doi.org/10.1016/j.ijosm.2022.04.002.

37. van Dun PLS, Verbeeck J, Arcuri L, Esteves JE, Cerritelli F. The Profile of Belgian Osteopaths: A Cross-Sectional Survey. Healthcare. 2022a; 10(11):2136. https://doi.org/10.3390/healthcare10112136

38. van Dun PLS, Arcuri L, Verbeeck J, Esteves JE, Cerritelli F (2022b) The Austrian Osteopathic Practitioners Estimates and RAtes (OPERA): A cross-sectional survey. PLoS ONE 17(11): e0278041. https://doi.org/10.1371/journal.pone.0278041

39. Vaucher P, Macdonald M, Carnes D. The role of osteopathy in the Swiss primary health care system: a practice review. BMJ Open. 2018 Sep 1;8(8):e023770. doi: 10.1136/bmjopen-2018-023770. PMID: 30173163; PMCID: PMC6120650.

40. Alvarez Bustins G, López Plaza PV, Carvajal SR. Profile of osteopathic practice in Spain: results from a standardized data collection study. BMC Complement Altern Med. 2018 Apr 11;18(1):129. doi: 10.1186/s12906- 018-2190-0. PMID: 29642901; PMCID: PMC5896131.

41. Morin C, Aubin A. Primary reasons for osteopathic consultation: a prospective survey in Quebec. PLoS One. 2014 Sep 3;9(9):e106259. doi: 10.1371/journal.pone.0106259. Erratum in: PLoS One. 2015;10(3):e0121180. PMID: 25184204; PMCID: PMC4153609.

42. Fawkes C, Carnes D. Patient reported outcomes in a large cohort of patients receiving osteopathic care in the United Kingdom. PLoS One. 2021 Apr 16;16(4):e0249719. doi: 10.1371/journal.pone.0249719. PMID: 33861778; PMCID: PMC8051759.

43. Whedon, J.M., Petersen, C.L., Schoellkopf, W.J., Haldeman, S., MacKenzie, T.A. and Lurie, J.D., 2023. The association between cervical artery dissection and spinal manipulation among US adults. European Spine Journal, pp.1-8.

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