Osteopathic approach and philosophy
Osteopathy takes a holistic approach to patient care that acknowledges psychoemotional, social, environmental and ergonomic factors1,2 that can influence pain and recovery from injury. Osteopathic physical treatment emphases the relationship between the structure of our body’s tissues and how they function. To reach a diagnosis and plan successful treatment, osteopaths assess symptomatic tissues and other related areas of the body that may influence optimal biomechanical function. Treatment includes hands-on treatment, therapeutic exercises, and patient education.
Research and Osteopathy
Osteopathy is a relatively small professional, which makes it challenging to produce a large body of research on the effectiveness of osteopathic management for every condition we treat, however, limited but growing evidence offers supports for osteopathic treatment of back pain.3–7 Targeted manual treatment techniques, such as spinal manipulation, have been most extensively researched, with modest benefit for back pain.8 An integrated treatment approach using a varied set of manual techniques and management advice, which is standard practice in osteopathy, can be of greater benefit in back pain and a number of randomised controlled trials (RCT) have found improvements in LBP after osteopathic treatment.3–7
Recent clinical trials have reported that osteopathy was more effective than placebo for chronic back pain treatment,5 more effective than standard medical care for acute LBP,3 and helpful for back pain treatment during pregnancy.4
Initial osteopathy consultations usually take between 40 to 60 minutes. The consultation includes a thorough history of your injury and pain as well as other relevant medical and health information,9 assessment of red flags (more concerning signs)10 and gaining your informed consent for examination and treatment. If a red flag is identified, patients are immediately referred to their GP for assessment, and in more urgent cases referred directly to a hospital.
Physical examination includes the following:
• observation of body structure and posture
• active and passive range of joint motion
• occupational and daily activity-oriented functional movement testing
• assessment of tissue texture, quality, and tenderness
• important orthopedic and neurological tests
Once a diagnosis has been reached after examination, osteopaths explain your condition and agree with you on an advised course of treatment. The first stage of osteopathic treatment aims to address restricted and painful areas identified in the examination. Treatment may involve soft tissue massage and stretching, therapeutic needling, articulation of joints, mobilisation of nerves, and the use of gentle contraction techniques to encourage better motion, muscle recruitment and decrease pain.11 Gentle spinal manipulation may be used for the lumbar and thoracic spine,12 but suspected intervertebral disc injury may be a contraindication in the acute stage. You may be advised to consult your general practitioner (GP) or pharmacist for appropriate short-term pain relief medications and advised to keep moving within pain limits.
An advantage of the osteopathic consultation is the time available to educate patients and discuss concerns. This will include explaining the likely causative factors and recovery timeframe, offering reassurance about variations in symptoms throughout the recovery process, and advice body use during daily activities. Most acute back and neck pain resolves without the need for ongoing treatment or surgery. You will likely be advised to be active and return to work as soon as possible,8 although we may discuss sick leave for a couple of days if the pain is severe.
Medium term (up to 6 months)
Most back pain injuries do not need treatment for more than 6-8 weeks. In the case of common recurrent factors being present, or continuing strain and re-injury, treatment may include manual therapy, with the focus being directed towards active treatment approaches, such as rehabilitation and strengthening exercises. The implementation of additional outcome measures may be helpful for identification of patients requiring psychological intervention.
Long term (years, including prevention and maintenance strategies)
In some chronic or severe injury cases, patients find benefit from periodic osteopathic treatment over the longer term, with a focus on preventative care. Osteopaths encourage patients to invest time and effort into keeping muscles strong and joints mobile, though occasional osteopathic manual treatment, ergonomic education and awareness, and exercise and conditioning.
1. Burke SR, Myers R, Zhang AL. A profile of osteopathic practice in Australia 2010–2011: a cross-sectional survey. BMC Musculoskelet Disord 2013;14:227.
2. Fryer G. Special issue: Osteopathic principles. Int J Osteopath Med 2013;16:1–2.
3. Cruser dA, Maurer D, Hensel K, Brown SK, White K, Stoll ST. A randomized, controlled trial of osteopathic manipulative treatment for acute low back pain in active duty military personnel. J Man Manip Ther 2012;20:5–15.
4. Licciardone JC, Buchanan S, Hensel KL, King HH, Fulda KG, Stoll ST. Osteopathic manipulative treatment of back pain and related symptoms during pregnancy: a randomized controlled trial. Am J Obstet Gynecol 2010;202:43–48.
5. Licciardone JC, Minotti DE, Gatchel RJ, Kearns CM, Singh KP. Osteopathic manual treatment and ultrasound therapy for chronic low back pain: a randomized controlled trial. Ann Fam Med 2013;11:122–29.
6. Vismara L, Cimolin V, Menegoni F, et al. Osteopathic manipulative treatment in obese patients with chronic low back pain: a pilot study. Man Ther 2012;17:451–55.
7. Williams NH, Wilkinson C, Russell I, et al. Randomized osteopathic manipulation study (ROMANS): pragmatic trial for spinal pain in primary care. Fam Pract 2003;20:662–69.
8. Rubinstein SM, van Middelkoop M, Assendelft WJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for chronic low-back pain: an update of a Cochrane review. Spine 2011;36:E825–46
9. Orrock P. Profile of members of the Australian Osteopathic Association: Part 1 – The practitioners. Int J Osteopath Med 2009;12:14–24.
10. Downie A, Williams CM, Henschke N, et al. Red flags to screen for malignancy and fracture in patients with low back pain: systematic review. BMJ 2013;347.
11. Degenhardt BF, Johnson JC, Hagan C. Osteopathic manipulation reduces pain and improves quality of life. Int J Osteopath Med 2013;16:e11–12.
12.Greenman PE. Principles of Manual Medicine. 3rd edn. Philadelphia: Lippincott William & Wilkins, 2003.
13. de Oliveira RF, Liebano RE, Costa LdCM, Rissato LL, Costa LOP. Immediate effects of region-specific and non-region-specific spinal manipulative therapy in patients with chronic low back pain: a randomized controlled trial. Physical Therapy 2013;93:748–56.
14. Brooks P, March L, Bogduk N, et al. Evidence-based management of acute musculoskeletal pain. Australian Acute Musculoskeletal Pain Guidelines Group. Brisbane: Australian Academic Press, 2003.