Expert reviewer, Mr Rohit Dhillon, Osteopath
Next review due November 2019

Osteopathy is a type of physical therapy that is practised in the UK by trained professionals called osteopaths. Osteopaths use their understanding of the human body; its structure and function along with touch (palpation) to investigate and find out what the cause of your problem is. Osteopaths might be able to treat you using osteopathic techniques, such as massage, joint mobilisation and manipulation, or refer you to another healthcare professional if they are better placed to treat you.

Two ladies strectching, doing yoga at the beach

What is osteopathy used for?

Osteopathy is a complementary therapy, which means it’s not part of conventional medicine, but may be used alongside it to help treat certain things. Osteopaths are known for treating problems with your muscles and joints. According to The Institute for Osteopathy (the professional association for osteopathy in the UK), osteopathy may be used to help treat the following:

  • back pain
  • pain in your ankle and foot
  • shoulder pain
  • knee pain
  • pain from arthritis
  • headache
  • neck pain
  • hip pain
  • pain in your hand or elbow, including tennis or golfers elbow

The General Osteopathic Council (GOsC) – the regulators of osteopathy practice in the UK – outline that osteopaths also treat problems with your posture due to driving or work strain. But how well osteopathy works to treat these problems isn’t fully understood.

The National Institute for Health and Care Excellence (NICE) is a public body that provides guidance on, for example, treatments, care pathways and much more to help medical experts provide the best possible care for patients. Manual therapies, such as manipulation and massage are used by osteopaths and other healthcare professionals, including physiotherapists and chiropractors. Currently, NICE only suggests considering manual therapies, along with other things such as exercise, to help treat the following:

  • lower back pain
  • osteoarthritis
  • neck pain – that has no specific cause and has lasted between four and 12 weeks

Other studies, that have looked at lots of research and evidence together, suggest that certain osteopathic techniques don’t have enough evidence behind them or aren’t effective when it comes to treating certain conditions. This includes things like:

  • excessive crying in babies (known as colic)
  • painful periods (dysmenorrhoea)

I want to see on osteopath, where can I find one?

All osteopaths in the UK should be registered with and are regulated by the General Osteopathic Council (GOsC). It's against the law for anyone to call themselves an osteopath unless they are registered with the GOsC. You can find a registered osteopath by checking the General Osteopathic Council register. Your osteopath may also display their registration certificate or the GOsC registration mark in their practice.

Most osteopaths work in the private sector either alone or in group practices. Some offer their services through the NHS, but osteopathy isn’t widely available within the NHS.

What happens during an osteopathy appointment?

Your first appointment with an osteopath will usually last around 45 minutes. To begin with, they’ll ask you what’s wrong and go through your symptoms with you. They’ll also ask about your health in general. To get a good understanding of this, they might ask you about your lifestyle, any medication you’re taking and if you are currently having any other treatment.

Your osteopath will then do a physical examination. They’ll use their hands as their tool to investigate what the problem could be. Osteopaths are trained to have a good understanding of the body’s physical structure and function. They use this knowledge to find anything that is unusual and potentially causing your symptoms.

Rohit Dhillon, an osteopath here at Bupa, says, “For the physical examination, you’ll need to remove certain pieces of clothing. This is so your osteopath can investigate and diagnose you properly. It’s a good idea to come prepared and wear something you feel comfortable changing out of – loose sports clothing such as shorts and a T-shirt is ideal. If you’re a woman, wearing a soft sports bra to your appointment is best. Your osteopath will show you where you can get changed. This may be behind a curtain or in a separate room. During your appointment, your osteopath will want to make you feel as comfortable as possible. If you would like, you can bring a friend or relative with you to the appointment.”

Your osteopath may also ask you to do certain stretches and movements as part of their assessment.

Depending on what the problem is, your osteopath may offer you more sessions to have treatment. How many sessions you’ll need, will depend on you and your individual needs.

Treatment is usually hands-on including things like massage and manipulation of your muscles and joints. But your osteopath may also give you information about things you can do yourself to help improve or maintain your own health and wellbeing. This may include things like eating a healthy diet and exercising regularly.

Your osteopath will explain your treatment to you along with its risks and benefits. If you have any questions, ask – no question is too simple or small. It’s important that you fully understand your treatment as you’ll be asked to give your consent for it to go ahead.

Sometimes your symptoms may be caused by something that cannot be treated with osteopathy. Your osteopath is trained to notice these things and should refer you to a relevant medical professional if necessary.

Side-effects of osteopathy

Osteopathy involves hands-on manual treatments – from light massage to manually moving or manipulating specific joints. Because of this it’s understandable that your muscles may be stiff or sore after treatment. You’ll usually notice this around 24 hours after your treatment, but it should ease off after a couple of days. Your pain may increase temporarily after treatment and you may even have some bruising. About half of all patients who have manual therapy get these mild to moderate side-effects, but they don’t usually last long.

Complications of osteopathy

Complications are the more serious effects that can happen during or after your treatment. Some manual treatments have been known to cause serious problems; however, in general the chance of this happening is very low. For more information about complications talk to your osteopath.

Below are two of the most serious complications, which can happen if your osteopath does more forceful movement and manipulation of your spine.

  • Stroke – this can happen if one of the large blood vessels (arteries) in your neck tears. This is known as cervical artery dissection (CAD).
  • Lumbar disc herniation (commonly referred to as a slipped disc). Disc herniation is when the inside part of one of the discs that sits between the vertebrae of your spine ruptures through its outer ring. The rupture can compress and irritate the nerves in your spine. If this happens in the lower (lumbar) part of your spine and affects a group of nerves called the cauda equina, it can lead to cauda equina syndrome. If you have cauda equina syndrome, you might have pain in your lower back and trouble feeling or moving your lower body, your bladder or bowel might not work properly and you might find it hard to have sex.

Frequently asked questions

  • There's no fixed price for osteopathy treatment. How much it costs will likely depend on where the osteopathy practice is and your osteopath’s experience. On average, an initial consultation with your osteopath costs around £48. Any sessions you have after this cost £42 on average.

  • Yes, osteopaths do offer treatment to children. They are trained to treat children during their degree and some osteopaths choose to focus on and forge their career specifically in paediatric osteopathy. But again, how well it works is uncertain. For some conditions such as excessive crying in babies (colic), there isn’t enough evidence to show that it works. If your child does have osteopathy, the techniques used will be very gentle. Older children and teenagers can have osteopathy too.

  • The Institute for Osteopathy suggests that osteopathy can help to improve sporting performance, treat sports injuries and reduce the risk of them happening. Although people see their osteopath to prevent and treat sport-related injuries, this isn’t well supported by scientific evidence.

    Using osteopathic techniques such as manual therapy to prevent and treat sports injuries is usually based on people’s own told experience of seeing their osteopath and is based on individual expert opinion. But it isn’t necessarily standard practice.

    What the evidence says

    Here we have looked at some of the evidence around using osteopathic techniques to treat certain sport-related injuries.

    Groin pain

    Groin pain is common in athletes who do sports, such as football or hockey, where you have to change direction quickly. One particular study showed that the time it takes to get back to sport after groin pain is shorter with treatment that includes manual therapy, compared to therapy with specific exercises alone.

    This looks positive, but it’s important to remember that this is just one study. Lots of studies that point to the same conclusion would be much more reliable than one study on its own. To add to this, the majority of studies, in a review of lots of studies that looked at the best treatment options for groin pain, weren’t of very good quality and therefore not that reliable.

    Sprained ankle

    A sprained ankle is a common sports injury. You are more at risk of a sprained ankle if you do contact sports, or sports such as sprinting, hurdles or long jump where you have to spring into action quickly. There is some evidence to show that manual therapy helps to treat sprained ankle. However, the evidence is very weak and the positive effects are only seen for a short while after treatment.

    Fractured ankle

    Ankle fractures are less common in sport, but aren’t unheard of. In one very small study, manual therapy with exercise improved the range of movement in the ankle compared to exercise alone after a fracture. However, this is a very small study, which doesn’t represent what the effects of this treatment would be in the majority of people with a fractured ankle. There also wasn’t any improvement in how well the ankle actually functioned overall after this treatment. Another larger (and therefore more representative) study showed that manual therapy didn’t increase the range of movement, or improve how well the ankle functioned any more so than treatment with specific exercises alone.

    Overall, more research is needed to find out if osteopathic techniques work to treat certain sports injuries.

    What we do know is that warming-up before sport, using the correct techniques and making sure you cool down after sport can help to prevent injury.  For more information on preventing injury, take a look at the following pages:

    If you do get a sports injury, it’s important to see your doctor or physiotherapist for advice. They’ll usually advise you to follow the PRICE procedure and avoid HARM. Take a look at the infographics below for more information.

    An image describing the acronym PRICE 

    An image describing the acronym HARM 

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  • Reviewed by Laura Blanks, Specialist Health Editor, Bupa Health Content Team, November 2016
    Expert reviewer, Mr Rohit Dhillon, Osteopath
    Next review due November 2019

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