[Closed] Physio or Osteo - where to put my money

Physio - Osteopathy is pure bunkum with a zero evidence base for cure and plenty of evidence of harm

Sounds like your physio was not much better!

Physio. Maybe a sports specialist physio though?

Sports specialist physio, and one that knows backs.

Where are you based ?

North London Fossy.   I had been using Varney physio who have a good rep. I only moved because of the ever lasting treatment, yet actually the Osteo is no different in that respect - I obviously have an issue that won't be cure until I stop cycling for a while - which I'm reluctant to do.

There are good and bad physios, chiros and osteos. Aims and methods will have a lot of overlap. I had an amazing experience with an osteo who sorted a recurrent neck freeze/spasm in a single visit. I've had subsequent experiences which have been underwhelming. I've had useful and less useful physios.

Doesn't matter how they got to their field, some of this lot^ care a lot and have a huge level of interest in the body, in you, your injury, and bring a huge amount of experience and insight to each appointment. Others less so. I'd ask for personal recommendations form people local to you (ideally cyclists) who've had good experiences recovering from with similar problems, and be open minded about what they call themselves.

There is no such thing as a good osteopath. It has zero evidence base and causes a lot of harm. Pure charletans

Kryton, be open minded. Not like TJ. Go on recommendations. If someone's good, they're good. If they're a charlatan, they're a charlatan, if they cause harm, they cause harm. Try and get one from the first group.

Ned

evidence based practice! I have had osteopathy and plenty of other alternative treatments in the past so I am not closed mind. However I looked into the evidence base - you know the science adn the proof - and there is ZERO evidence that osteopathy does any good and plenty of evidence of harm.
I am trying to save the OP from wasting his money on bunkum that is proven not to work and that is proven to do harm.

No osteopath can do any good. they are all charletans

I had a bad back years ago.
NHS physio was useless, totally uninterested in helping.
I paid up for an osteopath. He fixed the acute issues, allowing me to go on and do Pilates to help fix things long term.

But hey, that's just anecdotal. He must have been a charlatan who got lucky.🙄

Another one with a lucky osteopath!

I've used both physios and an osteopath. The osteopath effectively used the same methods to ease the problems I've had in my lower back and neck as the physio did. I've tended to use him as it's easier to get an appointment, and cheaper.

A physio may be better able to advise on preventative methods to stop a recurrence.

Bedmaker - actually what happened is your back got better anyway - the osteopathy was nothing to do with it. Read the evidence base. there is no evidence of any reduction in pain or total legth of time that the pain occurs compared with not having osteopathy - What yo have there is confirmation bias

Go on - find a single proper study that shows any efficiency for osteopathy - the plural of ancedote is not evidence

Ok, seems I got it wrong.

If you were a bit further north I could recomend my Chiropractor.

However, what does your orthopaedic consultant say about it?

My physio when I broke my back treated Rugby players - she knew her stuff. I do know a very good physio/clinical director who has a tonne of research into back issues, but he is Manchester based.

Finding a good physio on recommendations.

I had recurrent neck spasms over several years which got more and more frequent, longer lasting, more painful and more debilitating. I saw a range of people, GPs at different practices, sports massage theraprists, physios, none of whom were able to help much, and the spasms continued.

I went to see an osteopath, having never seen one before and knowing next to nothing about osteopathy, who examined me, explained what he saw as the problem, treated me with subtle manipulation (not cracking - he said it's a bit of blunt instrument and he prefers to avoid it), and gave me exercises to continue with.

Due to confirmation bias, and not his knowledge and skill, or the exercises he gave me to do, I've not had a recurrence of the problem.

Anecdote is not evidence - the exercise might well have helped - the manipulation does not help at all and indeed can cause damage. But sure - your anecdote trumps loads of proper studies!

what is osteopathy, tj?

https://www.bmj.com/content/364/bmj.l689?fbclid=IwAR3h2jNYko80HT-R5HYpZDgeQQvQMMSSD7i5Cce0nV9bKMxUuiS1BGczoRc&int_source=trendmd&int_medium=cpc&int_campaign=usage-042019

A good osteopath doesn't just 'crack bones', they often know as much about musclature as a physio, but also have 4 years training on manipulation whereas a physio that does manipulation will have an awful lot less training in it.

If you are near London the best osteopath I have been to is Xerxes at cityclinic.co.uk, I don't normally see him very often though.

He's something like £90 an hour (it is London) but his massage makes it worth it.

My ex-wife was getting migrainous headaches and he found the muscle causing it, so stopping them. A mate had issues with running and one leg/side having a lot less power than the other, he found that one as well.

I'll punt you half the fee if you are not happy... (just to spite TJ...)

All of these are probably a collection of anecdotes, but here's a summary anyway.

I'm not banging the drum for Ostepathy by the way, just objecting to TJ's black and white-ism.

I wouldn't see anyone that's going to mess with me, mess with the parts of my body that are giving me grief already without a solid collection of anecdotes from people who've coincidentally got better spontaneously after having been seen by them.

I may do that Turney Guy - worth the mention for the free Upper Back exercise sheet, but I can get to Moorgate easily.

Thats supposed to be evidence for it working Ned? from your link!

The authors concluded that “SMT is no more effective for acute low back pain than inert interventions, sham SMT or as adjunct therapy. SMT also seems to be no better than other recommended therapies.

You know what they call alternative medicine that works? Medicine!

Fossy who do you recommend in Manchester? I've a trapped nerve in my back (shoulder blade), I went to a physio last week who said I've a disc pressing against a nerve. My back feels better now (its not right though), but now my right arm aches, feel numb or I get bad pins & needles in my hand. Went to the GP who was no use. I'm not sure who I should be going to see and don't want to wasting money getting the wrong treatment.

Conclusions Spinal manipulation, particularly when performed on the upper spine, is frequently associated with mild to moderate adverse effects. It can also result in serious complications such as vertebral artery dissection followed by stroke. Currently, the incidence of such events is not known. In the interest of patient safety we should reconsider our policy towards the routine use of spinal manipulation.

The searches identified 32 case reports, four case series, two prospective series, three case-control studies and three surveys. In case reports or case series, more than 200 patients were suspected to have been seriously harmed. The most common serious adverse effects were due to vertebral artery dissections. The two prospective reports suggested that relatively mild adverse effects occur in 30% to 61% of all patients. The case-control studies suggested a causal relationship between spinal manipulation and the adverse effect. The survey data indicated that even serious adverse effects are rarely reported in the medical literature.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1905885/

Yes some osteopaths may use techniquies taken from other professions such as physio that may do some good but the spinal manipulatiion simply is proven not to do any good and is proven to do a lot of harm

As I said it's not just bone manipulation with a good osteopath - most pain is from muscles that are often in spasm for some reason.

Often the osteo can relieve the cause by manipulation as well as massage the muscles into relief.

Two more anecdotes.

A colleague at work had a brother that was an osteopath. A patient came to him who did horse dressage as a hobby, but had never been in the medals at competitions.

He manipulated her and she won bronze at the next competion as the horse did not now think she was indicating to turn to the left all the time as her hips were straight.

Another colleague at work always wore cheap suits that looked pretty iffy.

He went to the local osteo because of some pain and came back at the end of the lunch hour with his suit looking strangely much better - basicaly because he was standing straight now.

give over. Your choosing to quote that sentence alone from the document is enough evidence for me to conclude you're trolling or at the very least, not willing to engage intellectually with the subject.

But just in case: did you even read the link you posted? Only 5 of the 47 trials the study looks at involved osteopathic practitioners. I'd be interested to know which parts of that page you think should persuade me away from using a good/(lucky) osteopath.

Kryton: I sent you a PM.

Edit: posts crossed. excuse me.

Because I understand the evidence! Read the stuff about the harm. Spinal manipulation is dangerous bunkum. thats the truth. Yes an osteopath may use physio techniques as well that can do some good - but you would be better going to a physio for that

Evidence based practice. Thats the key. The evidence on spinal manipulation is clear. dangerous and does no good. Ok osteopaths are not as bad as chiropractors.

Did you read the links about the damage?

Still - waste your money and risk your health if you want.

Because I understand the evidence!!

Respectfully, I'm not sure you do.

Practitioners — In 16 studies treatment was delivered by a chiropractor,28293440414445465153545566676970 in 14 by a manual or physical therapist,2730333639434748505758596364 in six by a medical manipulator or orthomanual therapist,313552566068 in five by an osteopath,3238496572 in two by a bonesetter,4271 in one by a naprapath,61 and in one by several different disciplines.73 In another study, it was unclear what type of SMT treatment was delivered or the level or skill of the treating clinicians.37 In virtually all studies, experienced clinicians or therapists delivered the treatment, with the exception of one study where treatment was delivered by a few predoctoral osteopathic fellows.49

You're dismissing as "charlatans" a group of practitioners for one set of techniques they use for treatments of one set of problems, which is the same set of techniques that is used by most other practitioners working on these problems, including your recommended lot (and 14 lots of them in this study, v. 5 osteos.

And that set of techniques:

produces similar effects to recommended therapies for chronic low back pain but results in clinically better effects for short term improvement in function compared with non-recommended therapies, sham therapy, or when added as an adjuvant therapy. Clinicians should inform their patients of the potential risks of adverse events associated with SMT.

That is the conclusion of the metastudy you linked to.

My osteo used to be a doc. She's worked wonders on an imbalance I've got in my lower back that was causing me leg pain. I have nothing more to add.

So it seems like good osteos employ techniques used by Physios and Doctors, and leave the actual osteo stuff out of it. If that's the case I'd just use a good sports physio.

"actual osteo stuff"

What's that, then?

Spinal Manipulation, the stuff that TJ has been talking about.

don't know why people think that's the be all and end all of osteopathy, or even that it's central to what they do. Maybe they're thinking of chiropracty (-ice/-ism/-ology?)

My dad and my sister used an osteopath who sorted long term back issues which going the NHS GP route had not helped with. Just lucky I guess.

There is no such thing as a good osteopath

I thought it was Chiropractors who were the real snake oil salesmen?
I've had very good responses with a couple of osteopaths on my hips.

I’ve had very good responses with a couple of osteopaths on my hips.

jeez, sometimes Xerxes struggles to get a click out of my hips but he hasn't ever had to call a colleague in to help him apply pressure !

Osteopaths are not as dangerous as chiropractors by and large that is true. However osteopathy does zero good - proven! ( apart from what they do with physio techniques and massage both of which you would be better going to someone who is actually qualified to do) Dangers still remain with osteopathy

Read the data, follow the evidence,

I too thought it was Chiropractors that were the charlatans? Still, there's no way I'd argue with TJ what with him being an expert in absolutely everything.

who is actually qualified to do)

I wonder what they spend 4 years studying then ?

Bullshit - thats what the 4 years is. They are NOT qualified physios, they are NOT qualified massage therapists. Have you ever read up on the principles behind it - its total bullshine

Here is a report of an osteopath causing a stoke. The OP has neck issues. Spinal manipulation of the neck is a direct cause of life threaten and limiting stroke. This is why I say these things so strongly - the best outcome for the OP is he has wasted his money, the worst is he is severely disabled
https://www.gerardmaloufpartners.com.au/Publication-1681-Negligent-treatment-by-osteopath-causing-stroke-results-in--24450-2c000-compensation-settlement-at-mediation.aspx

tj speaks the truth*

Any good that osteopaths and chiropractors do is probably a happy accident, achieved while ignoring the ill-conceived unscientific pish that gave birth to their beliefs and practices.

*on this subject 🙂

Osteopathy was founded in the 1890s by Dr. Andrew Taylor, who believed that the musculoskeletal system was central to health. The primacy of the musculoskeletal system is also fundamental to chiropractic, a related health discipline. The original theory behind both approaches presumed that energy flowing through the nervous system is influenced by the supporting structure that encase and protect it—the skull and vertebral column. A defect in the musculoskeletal system was believed to alter the flow of this energy and cause disease. Correcting the defect cured the disease. Defects were thought to be misalignments—parts out of place by tiny distances. Treating misalignments became a matter of restoring the parts to their natural arrangement by adjusting them.

In other words pure bunkum!

Dislocations on the facets of the vertebrae - impossible, movement in the bones of the skull - impossible

Garbage in, Garbage out

The theory behind manipulation focuses on joints, mostly those of the vertebrae and ribs. Some believe there is a very slight offset of the joint members—a subluxation. Others believe there is a vacuum lock of the joint surfaces, similar to two suction cups stuck together. Such a condition would squeeze joint lubricant out and produce abrasion of the joint surfaces with movement. Another theory focuses on weakness of the ligaments that support the joint, allowing it freedom to get into trouble.

Some, but not all, practitioners in this field believe that the skull bones can also be manipulated. The skull is, in fact, several bones that are all moveable in infants. Whether they can be moved in adults is controversial. Other practitioners manipulate peripheral joints to relieve arthritis and similar afflictions.

Utter nonsense

Oh look - more pish from osteopathy

The osteopathic physician, however, is trained to recognize that when the body is sick, it is sick all over. A specific organ or system may become the prime focus of illness, but the effects of that illness can be felt in some degree throughout the entire body.

He developed manipulative methods (now known as osteopathic manipulative treatment) to remove these structural abnormalities to alleviate the patient’s illness. These experiences led Still to believe that diseases, as we commonly think of them, were really the result bodily malfunctions, not the cause of them.

It's utter nonsense compared to what? Because most physios are very empirical with their methods IME - they're not guided by deep (or any, in some cases) insight into the underlying physiology, they just do what they think works according to their experience, same as osteopaths.

Not that I'd ever see an osteopath, mind, I agree that the neck and back are far too fundamental to be placed in the hands of the ignorant.

I knew a cranial osteopath once. Part of our Hackney NCT group. Nice enough bloke and I'm sure he studied for ages.

Cranial osteopaths manipulate the bones of the skull to make folk feel better. Luckily bones of the skull don't move so it's unlikely he'll have done anyone much harm (whilst they got better anyway). And it will have paid his mortgage and kept him off the street, in a deep and holistic way of course.

Compared to medicine Garry. You know - real medicine based on real science.

I agree physio can be a bit empirical but at least they have a proper foundation in anatomy and physiology - rather than a totally unscientific and in some ways outright wrong training.

Any good that osteopaths and chiropractors do is probably a happy accident, achieved while ignoring the ill-conceived unscientific pish that gave birth to their beliefs and practices.

This.

Ineffective and dangerous. If osteopaths and chiropractors get something right it's because they're doing something that isn't either discipline.

I despair with people's trust in alternative medicine. Why would we bother with doctors if a handful of charlatans can do a better job?

Yoga, not an instant fix, but as kept me out of the Physios for a long time now.

Pilates might be another option - can do no harm, might do some good

I wonder what they spend 4 years studying then ?

Homeopaths can spend several years studying. What they study is complete rubbish though.

Osteo seem a bit more mixed in that they have incorporated some sensible stuff in but will be dependent on where the person learnt as too how much woo is involved.

Well thanks for the recommendations.  If i strip out TJ's contribution its a close call between the other 6 posts 😉

Osteopathy is pure bunkum with a zero evidence base for cure and plenty of evidence of harm

Very much this, and include chiropractors in the 'crap that has no peer-reviewed evidence of effectiveness' pile too.

At best they are a means to separate the gullible from their money, at worst they are risking the long-term health of their punters.

But what would I know, only being a Princess Royal Spinal Injuries Centre trained link nurse?

My mother went to see an osteopath after years of getting nowhere with a bad back. He had a look at her standing up, told her to get whatever was wrong with her left foot fixed and come back if that didnt work. Didn't charge her.

Got some tiny verrucas she wasn't really aware of fixed at the gp and it sorted her back out. Didn't have to go back to the osteopath.

I'm not sure if that counts as an osteopath's treatment working or not 🤔

I recommend investigating active isolated stretching (AIS) and find a practitioner to help show you a relevant protocol.

AIS has helped me address several shoulder, hip and lower back issues.

It is based on good old common sense science that muscles work in pairs, and that to work optimally they must be free from unnecessary tension or inhibition, able to contract and relax as intended.

This was after exhausting various physios and osteos who got me nowhere - particularly with a persistent hip injury.

Aside from being a man so binary that even his bike is a tandem, TJ is right. Straight chiro and osteo have no bearing in science, they're sham treatments. But, that's not the question we need to be asking. Rather, assuming them to be safe (which is questionable), do they have efficacy beyond placebo? Because if they do then they have merit even if we can't explain why. Unfortunately, the answer to that is "no they don't," beyond limited evidence for short-term relief from mild lower back pain.

In the UK at least, most chiropractors are what's called "mixers" (I know less about osteopathy but I'm guessing the same applies). Mixers employ other techniques such as physiotherapy alongside their core discipline, and that may well have proven efficacy, but it does then rather beg the question that if you're going for physio would you not be better seeing a qualified physiotherapist?

It is based on good old common sense science

Which is it, common sense or science? It sounds to me like the sort of thing made up by someone selling books.

Both overrated except in certain defined cases, both money spinners from cuts to the nhs. Ive not been impressed by the standards of physios in general, and I've seen many, so I don't know how good the certification is in the first place.

It is based on good old common sense science

Which is it, common sense or science? It sounds to me like the sort of thing made up by someone selling books.

Yeah fair enough that was poorly phrased. I meant well established science. You know like basic anatomy and physiology - the principals of antagonistic muscle pairings, reciprocal inhibition etc.

What’s wrong with books? I’ve spent hundreds of pounds over the years on physio, osteo appointments over the years that haven’t always helped very much. I spent £20 on an AIS book that has helped a great deal.

And anyway, much of the info is available online for free.

I’m not here to squabble. AIS has really helped me since I started doing it regularly. Just trying to share...

Some more anecdote...

Mrs Dubs used to think she had one leg shorter than the other.

Osteopath manipulated her hip and now she’s got two even length legs.

She wasn’t involved in any studies.

see an osteopath, combine with some flower based homeopathy and make sure your crystals are fully charged by bathing them in moonlight.

not big fans of vaccination either

http://www.british-institute-of-osteopathy.org/articles/vaccinations_and_immunity.aspx

Find a good sports physio. Don’t bother with a osteopath unless you want to be the best dressed dressage champion in the world.

I see this osteo as when needed and he's excellent: Dominic Eglington at the Millway Clinic in Mill Hill.

but it does then rather beg the question that if you’re going for physio would you not be better seeing a qualified physiotherapist?

All things being equal yes. I saw a Chiro on a number of occasions with good results. The treatment "made sense" in that I understood what he was trying to do and the exercises clearly built strength etc, No mumbo jumbo. He is a keen athlete himself and was clearly interested and committed to resolving my issues. The results were good.
On the other hand I have seen a number of highly qualified physios over the years, many of whom are focused more on relieving you of your cash than understanding your injury. Mixed success rate.

My advice would be to look for recommendation.

Recommendation of someone whos treatment is based on proper science.
What you describe surfer is what was said above:

In the UK at least, most chiropractors are what’s called “mixers” (I know less about osteopathy but I’m guessing the same applies). Mixers employ other techniques such as physiotherapy alongside their core discipline, and that may well have proven efficacy, but it does then rather beg the question that if you’re going for physio would you not be better seeing a qualified physiotherapist?

There is no such thing as a good osteopath. It has zero evidence base and causes a lot of harm. Pure charletans

Such a great word, 'charlatan', it always makes me think of snake oil salesmen in Victorian frock coats. I wouldn't use an osteopath or a physio who wears a frock coat, it's a dead giveaway. Next thing you know, they'll be flogging you a shepherd's hut and we all know how that ends up.

I knew TJ would start venting on this.

All I can go on is my personal experience - which is that plenty of physios (especially constrained by the NHS) are fairly useless whilst I've had a couple of outstanding chiros who have used a variety of techniques to solve problems (and I have plenty of problems caused by an ORIF procedure on a fibular spiral fracture which was was poorly realigned). Both are keen sportspeople and work with professional athletes on a regular basis.

*s****s*

I do love archaic words. I could add they are poltroons whose utterances are pure balderdash and piffle

Cheif - once again you then have someone calling themselves a chiropractor who is actually using physio to treat you. chiropractic is spinal manipulation.

Of course physio is a protected profession so you cannot call yourself one unless properly qualified and registered which is why these "mixers" don't call themselves physios even if using physio techniques.

If your problem is bike related why not take yourself and your bike to a top end cycle shop where they can analyse your riding position, bike size etc. Poor posture doing any excersize will eventually show itself as pain of some sort. IE. treat the cause not the symptoms.

"Cheif – once again you then have someone calling themselves a chiropractor who is actually using physio to treat you. chiropractic is spinal manipulation."

Except both of them do spinal manipulation to help with motor system activation, as well as using acupuncture, trigger points, massage, rehab exercises and so on.

I am an Osteopath.
Nedrapier is right, there are wide variations in the knowledge and technical ability of osteopaths, chiropractors & physios. Some individuals in each profession are money-grabbing charlatans, most are just trying to help.
Outcomes of treatment are affected by the diagnosis, the treatment itself, the interaction between the patient and therapist and the circumstances of the patent - hence the rise of the biopsychosocial model of healthcare.

My suggestion to the op is that he goes to see someone recommended by his peers who he feels he can get on with & trusts. He should be given a plausible explanation of his symptoms and their cause, a treatment plan, including the risks of treatment and no treatment, treated (if he agrees), given manageable exercises to do at home and advised how to change the use of his body. If the problem is curable and things do not change in a reasonable time (2-4 appointments) either he should be reassessed or go elsewhere. It may be that the previous spinal injuries mean that the best outcome is managing the symptoms, but that should be discussed.

Shoulder stabilisation exercises & hip mobility sound like areas worth looking at.

Please bear in mind that by virtue of disagreeing with tj I am, by definition, almost certainly biased, ignorant & wrong.....

what's your opionion on neck manipultion in infants?

Ok

I don't want to be too rude given an actual osteopath has been brave enough to raise his head but I would like to hear the reasons why there is NO evidence for spinal manipulation doing anything other than some minor short term pain relief and the fact that there are many many documented cases of harm caused by it from minor to major

I would also like to here the basis for osteopathic treatment seeing as I have never heard anything that makes any sense at all.

I have had osteopathic and chiropractic treatment in the past. Now I know more I never will again

tj, If you have a problem with your spine, and you go and see a physio about it, what to you expect them to do? Breathe on it?

If you're struggling to think, have a read of the links below, particularly the "... back pain treatment" sections

https://www.local-physio.co.uk/articles/middle-back-pain/middle-back-pain/
https://www.local-physio.co.uk/articles/upper-back-pain/upper-back-pain/

If you're not so good with reading, the first picture on this page will give you a clue:

https://www.local-physio.co.uk/articles/general/what-is-physiotherapy/

I imagine you'll run screaming for the hills.

Evience based practice is what I want - and the evidence on osteopathy is clear. NO significant positve benefits and risk of harm is high.

NO physio who wants to keep their registration will use spinal manipulation as performed by osteopaths due to that pesky old thing EVIDENCE BASED PRACTICE.

That picture does not show ostoepathic based spinal manipulation. It shows stretching. A very differnt thing. What those links show is that you do not understand the differnce between what physios do and what osteopaths do. Physios have scientific training and base what they do upon the evidence.

Evidence based practice!