Well, quite a lot, according to Oliver Thomson and Andrew MacMillan. This tantalizingly titled paper, published in IJOM1, has been doing the rounds on Twitter/X in 2023 and I have been looking forward to reading it.
Even as a patient, before considering becoming an osteopath myself, I was confused about what osteopathy was and how it worked. I left college still not quite clear what it is we were meant to be and do. However, despite its flaws and internal contradictions, I remain absolutely certain that 1) osteopathy is a great force for good in the world, 2) we’d all be happier and healthier if we had more of it, and 3) I really wouldn’t want to live in a world without osteopathy. Frankly, I care about its survival, if only because I know it works better for me as a patient than anything else, and, as Thomson and Macmillan point out, its future strength and even survival still does not seem assured despite its professional, regulated status.
So, as I seem unable to read a paper unless I have decided to write a blog on it, I really had to resurrect osteofm.com in order to make myself read this. You can find a truncated version of the paper here. If you are an osteopath you can get access to the full paper through the research journal page on the 0-zone area of the GOSC website.
The authors identify 5 problem areas, which I have attempted to summarize as bluntly as the paper’s title:
- Weak theoretical basis
- The problem
- the basis for osteopathy came from the work of one man (Still) who regarded pain or disease as resulting from structural or physiological abnormalities which could be put right by the osteopath. It treats the body as a faulty machine. This does not really align with the current “patient as person with life context” model of therapeutics, and does not really reflect how many osteopaths that I know actually practise.
- the determination to keep alive the essence of this impressive man, who was clearly a transformational and original thinker, means we might be trying to fit what we do today into a19th century American Midwest mindset
- What do they think we should do?
- apply a little more self-criticism to what we do, and embrace concepts from outside osteopathy (they mention phenomenology and dispositionalism which place much more focus on the patient as an individual person with a life which is relevant to their condition)
- they believe this will “develop” rather than “diminish” osteopathy and bring it more into line with contemporary healthcare models
- The problem
- Biomedicalism
- a couple of striking contradictions are outlined here
- osteopaths have a “rigidly obsessive commitment” to human physical form and structure, which goes back to the time of Still. They quote him: “You begin with anatomy, you end with anatomy, a knowledge of anatomy is all you need”. However we also take pride in claiming to take a “whole person approach”. I.e. it’s not just anatomy at all
- the authors believe that osteopaths are always looking for dysfunction, or deviations from the norm (although we also claim to be always looking for the “health”). I clearly remember the first time I was a model for osteopathic standing examination – I had come in that day thinking my body was basically OK, and went home, somewhat crushed, with flat feet, a winged scapula, hyperlordosis, numerous asymmetries and tight muscles, a possible leg length discrepancy, somatic dysfunctions in my thoracic spine and hypertonic suboccipitals. What a wreck!
- What do they think we should do?
- more of the biopsychosocial model, less of the posturo-structuro-biomechanical focus. Being somewhat better at the former than the latter, I am all in favour of this.
- a couple of striking contradictions are outlined here
- Monointerventionism
- the problem
- osteopaths largely rely on touch, or manual therapy, as their one modality (although this is on the decline in the USA, apparently). The authors believe that this ignores the complexity of modern healthcare.
- They also believe that manual therapy treatments only have modest effects.
- What do they think we should do?
- they are not saying we should totally stop hands-on treatment, but they just think we should stop relying on it so heavily and start looking at other approaches which take the person and their individual situation into account more
- the problem
- Default practitioner-centredness
- the problem
- while osteopaths say they are patient-centred, the way they work is actually quite practitioner-centred. The osteopath “knows things” about the patient’s body and as a result “does things” to their body. This could be seen as quite paternalistic.
- What do they think we should do?
- focus more on the therapeutic relationship in which they are not the omniscient being who knows exactly what the patient’s body needs, but in which they are more “person-centred” and share those decisions about treatment with the patient
- the problem
- Predilection for implausible mechanisms
- the problem
- the theories of osteopathy are “overly complicated, convoluted and often unfalsifiable” and derive from the experiences, interpretations and observations of a small number of individuals. Many require a “suspension of critical thinking”. Amongst examples they give are the redirection of cerebrospinal fluid and manipulation of the heart and pericardium.
- what they think we should do
- we should be willing to discard those theories that don’t seem plausible and be open to alternative explanations and theories
- the problem
The authors conclude with something of a call to arms. If we don’t address these very fundamental problems, they say, or at least make them “less wrong”, there is a “major threat to the development, unity and legitimacy of osteopathy as a healthcare profession.”
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This blog has been written by me and only me without the help of Chat GPT, Bing, Grok or any other artificial mind. However I did just accept an invitation from some type of artificial mind to generate an excerpt of approximately 50 words describing this post, and was astonished to find it was pretty good and actually better than the one I had planned. Slippery slope, guys…
Here it is – an auto-generated summary of this blog post not written by me
This blog post delves into the challenges faced by osteopathy according to the perspectives of Thomson and Macmillan. It highlights issues such as a weak theoretical basis, reliance on manual therapy, practitioner-centredness, and implausible mechanisms. The authors urge for critical self-reflection and embracing concepts from outside osteopathy to ensure the profession’s development and legitimacy.
Thanks for reading this – I have a long list of blogs I’ve been wanting to write and am hoping I have time to do more!
What’s wrong with osteopathy?
