Examples of evidence for the use of Osteopathy for low back pain - 2010

There is evidence for the use of Osteopathy in the treatment of Low back pain. The most important and relevant are:-
  1. The Clinical Standards Advisory Group
  2. The Royal College of General Practitioner Guidelines
  3. The MRC Trial
  4. The National Institute of Clinical Excellence Guidelines

These and others are outlined in detail:-

There is no single, unequivocal reference that shows or proves the effectiveness of Osteopathic interventions for any particular ailment or group of ailments.

 There are, however, many publications from around the world that report trials and evaluations of Osteopathy, Chiropractic, Physiotherapy and many other types of treatment for musculoskeletal problems, especially low back pain. There are also quite a number of systematic reviews of the literature. Most of these find that the methodological quality of many of the trials reviewed is sadly lacking.

At present, there is a large scale (and methodologically sound) randomised clinical trial of low back pain treatment taking place in the UK (funded by the MRC) which includes, amongst other things, physiotherapy, chiropractic and osteopathy. The UK BEAM Trial, as it is known, will not produce and publish findings until approximately 2002 to 2004.
A recent 'review of reviews' (Bronfort 1999) reports "moderate" evidence of short-term efficacy for spinal manipulation in the treatment of both acute and chronic low back pain.

Study of 500 Patients attending an Osteopathy Practice
Pringle M., Tyreman S., p15-189 British Journal of General Practice.

This is a Naturalistic study with no attempt to control variables, only to study characteristics of patients as they presented, their experiences, diagnostic groups and outcomes. Most useful findings were that patients with 'spinal joint strain' responded best and those with spondylotic changes worst of the groups identified. Acute patients fared better than those with chronic symptoms.
Patients who had visited their GP prior to the osteopath suffered more symptoms for longer than those who consulted the osteopath first.
 
An Open Controlled Assessment of Osteopathic Manipulation in Non-Specific Low Back Pain.
Macdonald R.S., Bell C.M.J., Spine Vol 15 No 5 May 1990
A pilot trial of 100 patients were randomised between Osteopathic Treatment with management advice, and management advice only as the control. Assessment via disability questionnaire, pain analogue and activity loss analogue at predetermined intervals. Most useful findings; Osteopathic treatment showed 50% recovered at the two week period compared with 22% for the control, but the difference had reduced by the 12 week period.
 
Complementary Medicine: New Approaches to Good Practice
B.M.A. 1993 Oxford University Press
Reviews complementary health practice, regulation (which Osteopathy underwent in 1993), standards of treatment, contra-indications, calls for communication between disciplines, and audit measures. Discusses the possibility for relationships between orthodox and complementary disciplines.
 
Aswani K Fundholding Study Reveals Benefits of Osteopathy
Fundholding June 1994
Audit by questionnaire to 44 patients to evaluate their perception of pain before and after treatment along with cost benefit and patient satisfaction. Significant reduction in pain was achieved along with high cost benefit and patient satisfaction.
 
Dr Singer Meeting Patient Demand with Complementary Therapy
Fundholding Feb 1993 p20-22
Reporting the experience of fundholding General Practitioners showing high cost benefit of Osteopathy compared with the use of NSAID's and Orthopaedic referral. High patient satisfaction was reported.

MacDonald RS Dr
Osteopathic Diagnosis of Back Pain
(1988), Manual Medicine, 3: 110-113

Szmelskyj AO (1990)
The difference Between Holistic Osteopathic Practice and Manipulation
Holistic Medicine, 5 (2) 67-69

Thomas KJ (1991)
Use of Non-orthodox and Conventional Care in Britain
British Medical Journal 302 (6770) 207-210

Burns & Lyttleton (1994)
Osteopathy in General Practice
British Journal of General Practice Feb 1993 and June 284 (1994)

Osteopathy on the NHS, One Practice's Experience
Complementary Therapies in Medicine, 2:200-203

Brodin H (1987)
Inhibition-facilitating Technique For Lumbar Pain Treatment
Manual Medicine 3(1)24-26

Carruthers R (1993) Weekly Frequency of Osteopath Patient Visits
Journal of the New Zealand Register of Osteopaths 22-23

Cleary & Fox J (1994)
Menopausal Symptoms, Osteopathic Investigation, Complementary Therapies in Medicine, 2,2 181-186

Paul FA (1990)
Effects of Osteopathic Manipulation Treatment on the Heart Rate and Blood Pressure in Female Athletes.
Journal of the Australian Osteopathic Association 90 (8), 724-725

Turk Z (1987)
Mobilisation of the Cervical Spine in Chronic Headaches
Manual Medicine 3 (1) 15-17

Kirk R
Backache and its Psychosocial Influences: Implications for Osteopathic Practice
Musculoskeletal Management 2, 1 47-53 1996

Sandler S
The Management of Low Back Pain in Pregnancy
Manual Therapy 1, 4, 178-185 1996

Szmelskyj A O, Mathews S A
Study of GP to Osteopath Referral Patterns: Implications for Interprofessional Co-operation
Journal of Osteopathic Education and Clinical Practice 6,1,14-23. 1996

Anderson GBJ et al
A Comparison of Osteopathic Spinal Manipulation with Standard Care for patient With Low Back Pain
New England Journal of Medicine 1999; 341 (19)

Berger A
Osteopathy Proves Effective for Back Pain
New York Times November 16 1999 available on the Internet at www.nytimes.com/library/national/science/111699hth-back-pain.html

Vickers Zollman 1999
The Manipulative Therapies: Osteopathy and Chiropractic
British Medical Journal 1999 319: 1176-1179 (30 October)

Complementary Medicine Must be Research Led and Evidence Based
Letters British Medical Journal 2000 320:188 15 January 2000

Gunnar B J Anderson MD et al (1999)
A Comparison of Osteopathic Spinal Manipulation with Standard Care for Patients with Low Back Pain
The New England Journal of Medicine Vol 341 19 1426-1431

Dixon 1998
Alternative Therapies Rule, OK
Medical Interface Oct 98:39-41


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