​Every January we see it: gyms are full, running shoes are out, and everyone’s trying something a bit new—a new class, a new running route, a heavier set of weights. It’s inspiring to see people motivated to make positive changes for their health. But sometimes that motivation comes with an unwelcome side effect: injury.
If a sprained ankle, foot pain after a long run, a sore lower back from lifting, or shoulder niggles are starting to slow you down, you’re not alone—and you don’t have to push through the pain blindly. At Oval Osteopathy and Vauxhall Village Osteopathy in Oval and Vauxhall, we help people just like you get back on track and stay on track with your New Year’s fitness goals.

Why Your Injury Matters (and Why It Can’t Wait) That satisfying deadlift personal best or first solid run of the year can feel amazing--if your body is ready for it. But back pain after lifting weights, especially deadlifts, often comes from technique issues or muscle imbalances. Deadlifts are great for strength and overall fitness—when done correctly—but can create low back strain when the movement pattern isn’t quite right.
Similarly, poor shoulder mobility during chest or shoulder presses can lead to pain around the joint, which quickly derails your upper-body training. Even something as seemingly simple as running more miles than usual can trigger conditions like plantar fasciitis or ankle sprains.
Left unmanaged, these injuries not only hurt—they discourage you. And once you start skipping workouts, old doubts can creep back in: “Maybe I’m not cut out for this.” That’s where we step in.

How Osteopathy Can Help You Recover and Stay CommittedAt both of our clinics, your treatment begins with a thorough understanding of what’s causing your discomfort—not just masking symptoms. Osteopathy works with your muscles, joints, nerves and connective tissues to support the body’s own healing mechanisms. We use hands-on approaches like joint mobility work, soft tissue techniques, and careful assessment to:

• Reduce pain and stiffness after injury
• Restore full movement and function
• Improve alignment and biomechanics so you can train smarter
• Support strength and flexibility with  exercise advice

Whether you’re dealing with a sprained ankle, foot pain like plantar fasciitis, back strain from weightlifting, or shoulder issues from pressing movements, we personalise your care so you can return to exercise confidently.

Meet Your Team   Our experienced osteopaths are here to guide you through recovery and beyond:

• Damian Moore M.Ost – Principal osteopath bringing structural expertise and supportive movement advice to every case.
• Adam Schamroth M.Ost BSc (Hons) – Combines manual techniques with personalised care tailored to active lifestyles.
• Addison Lupton M.Ost – With a broad approach including gentle & functional techniques plus sports massage skills, Addison helps you rebuild strength and confidence.

We’re passionate about helping you feel better and train better, whether you’re recovering from injury or aiming to prevent one.

Beyond Hands-On Treatment: Movement and Education  Osteopathy isn’t just about what happens on the treatment table. We also empower you with:

• Movement  and execise guidance
• Posture and mobility advice
• Strategies to prevent aches turning into setbacks

This means you’re not only healing—you’re learning how to move more efficiently so you can stay consistent with your goals.

Keep Going — Without the PainYour New Year’s resolution deserves more than a few weeks of good intentions. If pain, soreness or injury are slowing you down, come and talk to us at Oval Osteopathy or Vauxhall Village Osteopathy. With hands-on care and smart movement strategies, you can recover well and stick with your fitness goals this year.
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👉 Book an appointment with us and make this the year you move better, train smarter—and stay on track.

One of the most common questions we hear in clinic is: “How long will this take to get better?”
It’s a perfectly reasonable question — when you’re in pain, you want to know what to expect. But the honest answer is that it depends. Healing isn’t something that can be rushed or precisely scheduled. Every body — and every situation — is different.
At Oval and Vauxhall Village Osteopathy, our goal is to support natural recovery through safe, hands-on treatment and movement advice — helping you understand your body and find lasting relief from musculoskeletal pain.

Osteopathy vs Physiotherapy: Different Journeys.  While both osteopaths and physiotherapists treat musculoskeletal issues, we often see different types of patients. Physiotherapists tend to work more frequently with people recovering from major injuries or surgery, where the damage is clear and rehabilitation follows an established protocol with predictable milestones.

Osteopaths, on the other hand, often see people whose symptoms seem to have appeared “out of nowhere” — sometimes longstanding, sometimes affecting several areas of the body at once. These problems don’t always follow neat timelines, which makes setting clear expectations more challenging.

If you’re searching for an osteopath in Vauxhall or osteopathy near Oval, it’s worth knowing that osteopathic care is particularly effective for these kinds of complex, overlapping problems — the ones that don’t always fit neatly into a medical box.

Factors That Influence RecoveryThree main factors determine how much change you can expect, and how quickly:

1. What the problem is
2. How long you’ve had it
3. What else is going on in your life

You can’t cheat biology — healing takes the time it takes.
If tissues are torn or disrupted, the body must first repair them before they can safely be strengthened and conditioned again.

• Mild sprains or strains (micro-tears in ligaments, tendons, or muscles) often take a few weeks to settle.
• More severe sprains or muscle injuries may need up to 12 weeks of recovery.
• Simple fractures typically heal within 12 weeks, though more complex breaks — especially those requiring surgery — can continue to improve for up to a year.
• Herniated discs can take up to 12 weeks to resolve, provided healing proceeds naturally.
• Frozen shoulder (adhesive capsulitis) may take around 18 months to recover without intervention, though combining a steroid injection with targeted manual therapy can significantly speed this up.

A Note on Sprained Ankle Recovery. 
A common issue we see at Oval and Vauxhall Village Osteopathy is the sprained ankle. A typical recovery protocol might look like this:

• Days 1–3: Rest, ice, gentle compression, and elevation (RICE).
• Days 4–14: Begin gentle range-of-motion exercises once pain allows.
• Weeks 2–6: Gradual strengthening and balance work.
• Weeks 6–12: Return to normal activity, ensuring the ankle is strong and stable before resuming sport.

(Severe sprains may take longer and can benefit from osteopathic treatment to ensure full recovery and prevent recurrence.)

What About the Common “Everyday” Pains?   
Much of our day-to-day osteopathic work involves problems that don’t fall neatly into a traumatic injury category — non-specific low back pain, a stiff neck that appeared overnight, or discomfort your GP may have advised you to “just manage with pain relief.”
These are often very painful and disabling, yet they can be harder to predict because pain is influenced not only by tissues but also by your nervous system.
Persistent pain can actually change the way your body processes discomfort — increasing nerve sensitivity, spinal connections, and even the area of your brain dedicated to that pain. This helps explain why newer pain often responds more quickly, while longstanding pain can take longer to shift.
For an episode of acute back pain or neck stiffness not caused by trauma, we’d generally expect to see significant improvement within 2–3 weeks and around three treatments.
If there’s little change after that, it’s worth exploring what else might be influencing your recovery.

Factors That Can Slow HealingSeveral things can interfere with recovery:

• Ongoing physical strain (from work, posture, or sport)
• Emotional or psychological stress
• Lifestyle factors (such as poor sleep, diet, or general fitness)
• Undiagnosed inflammatory or autoimmune conditions

At our osteopathy clinics in Vauxhall and Oval, we look beyond symptoms to consider the whole person — lifestyle, habits, and stress levels — so treatment supports your overall wellbeing, not just your joints and muscles.

Can Osteopathy Help with Chronic Pain?
Yes — though perhaps not in the way you might think. Chronic pain can often be managed rather than “cured.” Through treatment, advice, movement, and support, many people find their pain reduces to a tolerable level, allowing them to return to normal life.
Over time, as the nervous system becomes less sensitive, pain can gradually fade further. We’re always honest about expectations — no miracle fixes, but steady, meaningful progress.
If you’re struggling with chronic back pain, shoulder tension, or longstanding musculoskeletal discomfort, osteopathic treatment can help guide your body back to balance.

And What About Postural Change?
Posture is complex. Sometimes a joint is simply “stuck”, affecting posture, and can be freed quickly with manual therapy. But many postural imbalances develop over years and involve changes in bone shape or long-term muscle shortening.

Meaningful postural change usually happens over months or years, supported by consistent work in the gym, yoga, or Pilates studio. Our role as osteopaths is to help you integrate those changes safely, reduce pain, and guide your body through the transitions that come with new movement patterns.

Speaking personally, I’ve spent over a decade working on my own posture — reducing kyphosis and scoliosis, freeing a shoulder and hip that were held twisted inwards for years. Osteopathic treatment helped me at key moments when change was uncomfortable or progress stalled.
So while we don’t “correct posture” as a service, we can absolutely support you on your journey toward your best possible alignment and function.

At Oval and Vauxhall Village Osteopathy, our aim is not just to relieve pain but to help you move better, understand your body, and make confident progress toward long-term wellbeing.
Whether you’re recovering from injury, managing back or neck pain, or seeking help with postural issues, our experienced osteopaths in Oval and Vauxhall are here to help you feel and function at your best.

As osteopaths, we’re often thought of as “back specialists.” Patients frequently come to us for help with back pain, and much of our training and reputation centres on supporting the spine. But it’s worth remembering that people don’t only have backs—they have fronts too. And sometimes, it’s the front that needs attention.
Why the Front MattersThe body’s front is not just a passive surface; it contains key joints and structures that can play a major role in pain, restriction, and overall function. These include:

• The costosternal joints – where the ribs meet the breastbone (sternum).
• The sternoclavicular joints – at the front of the collarbones, vital for shoulder function.
• The pubic symphysis – the small but important joint at the front of the pelvis.

Inflammation or irritation at any of these sites can be surprisingly painful and can limit movement in the chest, shoulders, and hips. In many cases, hands-on treatment in these regions—alongside exercises and advice—can make a meaningful difference.
Sensitivities and Good PracticeOf course, treating the front of the body brings some unique challenges. The thorax, in particular, is an area where practitioners may hesitate due to the presence of breast tissue and the sensitivities around this. This is entirely understandable—but if we avoid these areas altogether, we may miss important contributors to a patient’s pain.
The key lies in:

• Clear communication – explaining what we’d like to assess or treat, why it’s relevant, and what options exist.
• Informed consent – ensuring patients are comfortable, fully understand the approach, and know they can stop at any time.
• Practical adjustments – using draping, positioning, or modified techniques to maintain dignity and ease.

Handled sensitively and professionally, treatment of the front can be safe, respectful, and effective.
A Whole-Person ApproachAs osteopaths, our strength lies in looking at the body as an integrated whole. Pain at the front can affect movement and posture at the back, just as problems at the spine can affect the front. By remembering both sides, we can give patients the most complete care possible.
So, next time you think “osteopath = back,” remember: don’t forget the front.

Sciatica is a term many of us have heard, often used to describe pain that radiates down the leg. But what exactly is sciatica? And how does it differ from other types of nerve pain?
What Is Sciatica?Technically, sciatica refers to irritation or compression of the sciatic nerve, the largest nerve in the body. This nerve originates from the lower spinal nerve roots (L4 to S3), travels through the buttocks, and runs down the back of each leg. When it’s compressed or irritated, you might feel pain, tingling, numbness, or weakness anywhere along that pathway.
However, in everyday language—even among healthcare professionals—the term sciatica is often used more broadly. It's commonly applied to any lower back or buttock pain that radiates into the outside of the thigh and sometimes further down the leg, even when the true source of the problem lies in the spinal nerve roots rather than the sciatic nerve itself.
This brings us to an important distinction:

• Sciatic nerve irritation occurs along the course of the sciatic nerve, usually in the buttock or thigh.
• Nerve root irritation (sometimes called radiculopathy) occurs at the level of the spine, often due to a disc bulge, spinal stenosis, or inflammation affecting the nerve roots as they exit the spinal canal.

Despite this difference, both conditions can produce very similar symptoms—so in practice, we often just refer to them collectively as “sciatica.”
Common SymptomsSciatica symptoms can vary in intensity and location, but they typically include:

• Sharp, burning, or shooting pain radiating from the lower back or buttock down the leg
• Numbness or tingling along the same pathway
• Muscle weakness, particularly in the leg or foot
• Pain that worsens with sitting, coughing, or certain movements

Symptoms usually affect one side of the body and may come and go or persist chronically.
What Causes Sciatica or Nerve Root Irritation?There are several ways the sciatic nerve or its roots can be irritated:

• Herniated disc: A common cause where disc material presses on a nerve root.
• Degenerative disc disease or spinal arthritis: These can narrow the spinal canal (spinal stenosis), compressing nerve roots.
• Muscle tightness: The piriformis muscle in the buttock can irritate the sciatic nerve (piriformis syndrome).  A tight hip flexor can also press on the nerve at the pelvic brim.
• Trauma or repetitive strain: Can inflame or irritate tissues surrounding the nerve.
• Postural issues and poor biomechanics: Long-term habits that put strain on the lower back and pelvis.

How We Can Help.  A multi-modal, personalized approach can offer significant relief and long-term improvement:

• Osteopathic Manipulative Therapy (OMT)OMT uses gentle, hands-on techniques to improve spinal mobility, relieve muscle tension, and restore proper alignment. By reducing mechanical strain on the nerve roots and surrounding tissues, OMT can help reduce inflammation and improve nerve function.
• Exercise and RehabilitationTargeted exercises strengthen the core, improve spinal stability, and promote flexibility in the hips and legs. A tailored rehab program also retrains posture and movement patterns to prevent recurrence. For many patients, this is key to long-term recovery.
• Medical acupuncture can help by reducing muscle spasm, improving blood flow, and calming nerve irritation. It can be particularly helpful when used alongside manual therapy and exercise.

When to Watch for Red FlagsWhile most cases of sciatica are treatable with conservative care, certain signs may indicate a more serious underlying condition. Seek immediate medical attention if you experience:

• Loss of bladder or bowel control
• Significant weakness in the leg or foot
• Numbness in the saddle area (around the inner thighs or buttocks)
• Unexplained weight loss or fever
• Pain following significant trauma or injury

These symptoms may suggest conditions like cauda equina syndrome, spinal infection, or a tumor—and require urgent evaluation.  We would recommend attenting your local accident and emergency unit  immediately .
 
In Summary
Sciatica is a common condition that can significantly affect quality of life, whether it stems from the sciatic nerve itself or the spinal nerve roots. Fortunately, with a combination of osteopathic manipulative therapy, personalized exercise, and medical acupuncture, we can often reduce symptoms, restore function, and prevent recurrence. If you're experiencing leg pain or nerve-related symptoms, don’t wait—early assessment and treatment can make all the difference.

Have you ever diligently stretched and exercised, hoping to ease your back or rib discomfort, only to find little or no relief? You’re not alone—and here’s a biomechanical reason for that. Let’s talk about something I like to call the “locking nut” effect—a concept that can explain why some restrictions in your spine or ribs just don’t budge, no matter how committed you are to stretching or moving.

What Is the Locking Nut Effect?
Imagine trying to unscrew a tight bolt that's held in place by two locking nuts—one tightening from above, and one from below. No matter how hard you twist from one end, the other nut keeps everything fixed in place.

Now apply that idea to your spine and ribs. In some people, spinal joints become restricted at different levels but in opposite directions. Or perhaps a rib joint moves one way while the spine it attaches to is restricted the other way. The result? A system of forces working against each other. Trying to stretch or mobilize one restriction ends up tightening the opposing one—like trying to loosen one nut while the other just digs in tighter.

Why Stretching and Exercise Might Not HelpStretching is often helpful for general mobility. But when your body is caught in a locking nut pattern:

• Stretching the spine may actually increase tension in the ribs.
• Mobilizing the ribs might worsen a spinal restriction.
• Untwisting one segment is actually  tightening another
• Your efforts can feel like you’re making progress… until the pain snaps right back—or doesn’t improve at all.

This is because you can’t isolate the restricted joints enough through stretching alone. Your body’s interconnected system resists isolated movement in this locked configuration.

How Osteopaths Can Help
This is where osteopathic treatment can make the difference.
Osteopaths are trained to palpate (feel) and identify these opposing restrictions. More importantly, we can use precise manual techniques and biomechanical leverage to:

• Isolate specific joints that are locked.
• Work around the compensatory patterns.
• Release each restricted segment individually—something stretching cannot do.

By addressing each “nut” in the locking nut setup, we can help restore balanced movement and relieve the dysfunctional tension that’s causing your discomfort.

In SummaryI
​f you’ve been stuck in a cycle of persistent tension or pain despite your best stretching efforts, it may be time to look beyond exercise. The “locking nut” effect is a classic example of how mechanical restrictions can block progress—and how osteopathic treatment can unlock what stretching can’t.
Want to know if this applies to you? Reach out to an osteopath near you—we're here to help you move freely again.

Last week The Guardian (hardly the UK's most sensationalist newspaper) ran a couple of articles 
here  and here based on this paper 

Analgesic effects of non-surgical and non-interventional treatments for low back pain: a systematic review and meta-analysis of placebo-controlled randomised trials

Here's a link, click on the PDF symbol to download

The Guardian take-home, and indeed  the headline of one of the articles is 'only  10% of non-surgical  interventions provide pain-relief', but is this what  the  research paper says?  Spoiler, no it doesn't

The paper is a systematic review of randomised controlled trials comparing individual treatments with a sham or placebo (a sham treatment is not quite the same as a placebo but the idea is  that it mimics the treatment being tested but tries to exclude the supposed active element).  The group had previously undertaken this activity in 2008 and this was an update so the paper aimed to find and add all of the published research since 2008  that met its inclusion and quality criteria.  Papers that didn't quite meet the gold standard would be included but marked down.

Providing sham treatments for manual therapies is difficult  and double blinding (ensuring that neither the practitioner nor patient know whether they are in the active or sham group) is very difficult and so out of the c6500  new studies since this group's previous  version of this paper only c170  met the grade for inclusion 

These papers tended to cluster around interventions  for which a sham or placebo can more easily be contrived such as analgesic drugs and  meridian point acupuncture

There was enough evidence to say that 5  interventions were likely beneficial (they include  spinal manipulation and  massage)  ​

And so, despite  16 years having elapsed since the last systematic review , actually the take home was that there was still  not enough evidence to say how effective  most interventions were

In the UK, osteopaths hold a distinctive position in the healthcare system. As primary care practitioners, they are expected to have the medical knowledge necessary to identify serious health conditions that may present as simple musculoskeletal issues. This responsibility requires a deep understanding of human anatomy, physiology, and biomechanics, ensuring that diagnoses are credible and that referrals are made appropriately. This level of expertise sets osteopaths apart from bodyworkers like massage therapists, whose scope typically does not involve diagnostic responsibilities.
Osteopaths also stand out because of their hands-on approach to treatment, which they share with chiropractors but contrasts with the often exercise-focused methods of many UK physiotherapists. However, unlike many chiropractors, osteopaths heavily rely on touch not only for treatment but also as a key part of their assessment process. They constantly evaluate tissue health with their hands, allowing for an iterative treatment approach that adapts to the body's responses. In this way, osteopaths blend diagnostic precision with a tactile, responsive style of care, positioning them uniquely between the medical and manual therapy worlds.

Osteopathy is a holistic healthcare approach, focusing on the musculoskeletal system and its relationship with overall health and using touch to assess tissue health and function and usually also to provide treatment.  By addressing structural imbalances and improving movement, osteopaths aim to enhance the body's natural ability to heal.  Within those parameters though diagnosis and treatment approaches can vary widely  and it is important that you choose an osteopath who will give you the care you are expecting .  

​Below, we highlight the various types of osteopathy, with the emphasis on   structural osteopathy, currently the cornerstone of care at our practice.

1. Structural Osteopathy Structural osteopathy is central to what we do. This approach targets the body’s structural components, including muscles, bones, and joints, to alleviate pain and improve mobility. Techniques we use include:

• Soft tissue work: Releasing tension in muscles and fascia.  Techniques may include    stretching, massage, medical acupuncture or inhibition to trigger points and muscle energy techniques
• Joint articulation    and manipulation: Restoring range of motion and reducing discomfort.  Articulation techniques are repetitive, aiming to gradually increase range of motion, manipulations are usually fast movements  delivered with an impulse that  override inappropriate muscular guarding and are often accompanied by an audible pop or click.  Other techniques may include functional technique or balance ligamentous tension where the aim is to find and support a position  where the joint can unlock itself
• Exercise prescription:   We will ask you about your exercise regime and where relevant will  provide you with exercises to  help your recovery
  
• Lifestyle advice: Exercise  for your whole body and as part of your usual routine is more important than rehabilitation exercises and we will try and advise on what would suit you and adaptations you can make .    We're not here to nag you about smoking, drinking or diet are here to support you  with small nudges!
  
• Posture:  This is a tricky one.  Significant postural change is usually a very long term objective and requires a 7 day a week commitment but we can support you as you  make those changes yourself and can advise on such issues as desk/work setup and provide some linited advice on orthotics, wrist splints etc 
  

Structural osteopathy is particularly effective for resolving and managing conditions such as:

• Back and neck pain.
• Joint injuries, including sprains.
• Sports-related injuries and performance optimization.

At our practice, we prioritize individualized care, tailoring treatment plans to each patient’s unique needs.

2. Cranial Osteopathy Cranial osteopathy is a gentle technique focusing on the subtle movements of the skull and its influence on the central nervous system. It is often used for:

• Chronic headaches or migraines.
• Stress-related tension.
• Pediatric care

We don't curently offer cranial osteopathy

3. Visceral Osteopathy Visceral osteopathy addresses the body’s internal organs and their connections to the musculoskeletal system. 
We don't currently offer visceral osteopathy

4. Classical Osteopathy Classical osteopathy builds on the foundational principles of osteopathy as developed by its founder, Andrew Taylor Still. It emphasizes treating the whole body as a connected unit, focusing on balance and harmony. Practitioners use a combination of structural techniques and rhythmic movements to:

• Encourage the body’s self-healing mechanisms.
• Address a wide range of systemic issues.
• Enhance overall vitality and wellness.

This approach is holistic and comprehensive.  Although we don't  currently have any  classically trained osteopaths we do tend towards a very holistic approach in our treatment and we may treat more boradly than some other osteopaths

5. Paediatric Osteopathy   Paediatric osteopathy is designed for infants, children, and adolescents, addressing their unique developmental needs. 
We don't currently offer paediatric osteopathy

Why Structural Osteopathy is key at our clinic,
structural osteopathy is our primary focus because it offers practical, effective solutions for a wide range of musculoskeletal conditions. By restoring the body’s structural balance, we help patients reduce pain, improve movement, and enjoy a better quality of life.

So how do we justify our approach as cost effective?  

a drug may contain multiple ingredients and  testing those ingredients in isolation may not give you many clues regarding the drug's effectiveness, moreover, if the drug has been designed specifically for that patient, it may not tell you how well that combination will work for another patient, in addition there is the placebo effect

Is it time to recognise that the placebo as a reference against which to measure non-chemical interventions is nonsense?  When we try and break down a complex and unique intervention into individual elements so that they can be tested against someone having ostensibly a similar experience minus that intervention that becomes so artificial it is pseudoscience and importantly disregards the nature of osteopathy.  Osteopathy is not defined by 'cracking' joints or by craniosacral therapy or by any particular technique.  It is not the same thing to everyone...which makes things very difficult...but it is not about the techniques used, at least not at a granular level.

Without looking up the latest agreed definition (which probably comes from the US where they do both more..and less... as osteopaths than the UK tradition)  I would say that at its heart osteopathy is about using non-pharmaceutical techniques to treat people with dysfunctions that are  largely (but not exclusively) musculoskeletal.    A T Still the originator of osteopathy created it in response to the deaths of three of his children from meninigitis and saw it as a full system of medicine in opposition to the brutal heroic medicine practiced at the time and believed that a body free of osteopathic lesions would be a body that could resist disease in all its forms.  There are many possible applications for osteopathy and the boundaries of what it is appropriate to say we treat are contentious...so lets start with the basics...musculoskeletal issues.

Whilst I said that osteopathy is not the sum of the techniques used I think it is useful to think about they might constitute:

• soft-tissue techniques (to work on muscles etc, perhaps massage, MET, stretches)
• articulation (repeated and gently increasing movements through a joint's range of motion)
• techniques applied to joints and muscles (functional, strain-counterstrain, Still techniques perhaps medical acupuncture)
• exercise prescription
• lifestyle advice
• referal to other specialists
• retraining concious  thinking about health beliefs (it is safe to move, I am not my pain)
• retraining the nervous system to allow movement (subconcious it is safe to move)
• manipulations/high velocity thrusts ('cracking' joints to overide inappropriate guarding)
• cranial osteopathy / involuntary motion / craniosacral
• pharmaceutical intervention  - only applicable to osteopaths who are also medcal doctors, few in the UK, nearly all in the US

All bar the last three are fairly uncontentious within our community and would to a greater or lesser extent be part of the armoury of most osteopaths.   There are; however, schisms about the last three, such that I would argue adherents to each provide a subtantially different service to those who don't, so whilst I don't believe in testing different techniques separately I do think there is some mileage in testing the major types of osteopath separately .

I want to separate out pharmaceutical intervention.  It doesn't form much of UK practice whereas it is almost ubiquitous in the US.  It is not part of the uniqueness of osteopathy even if at some time it would be useful to understand how effective co-treatment could be.

Cranial osteopaths and those who use lots of manipulations are almost mutually exclusive, both eyeing the other with a degree of suspicion and in the middle there are osteopaths who may use little or none of either and can sometimes be quite sniffy about both

Where I am heading with this is that it would be useful to classify osteopaths into different cohorts, in order to assess their effectiveness for patients with particular and that perhaps the faultlines broadly fall into three categories

1. Those who often use manipulations and rarely use cranial osteopathy
2. Those who often use cranial osteopathy and rarely use manipulations
3. Those who rarely use either

These could be worked up into statements about the type osteopathy we practice and osteopaths could be encouraged to choose the statement that best suits them.

Then, part two,  we need to work out what they are treating, and in this we should avoid over medicalisation.  Luckily this is already happening.  Diagaoses such as non-specific low back pain are more honest than trying to pin the cause on a particular structure or tissue, at least when there has been no trauma 

Thirdly there are different cohorts of patients, do we split them by age, lifestyle factors, health beliefs, chronicity, co-morbitities etc

It's a pretty complicated matrix but in my opinion if we want to truly test how effective an osteopathic approach to treatment is then that is what we need to work towards , in the meantime my fear is that a less granular approach risks throwing the baby out with the bathwater and that would be a terrible shame...and not evidence based medicine

Osteopathy, when performed at least moderately competently is reactive, not prescriptive.  The osteopath is constantly monitoring the structure, the tissue on whch they are working feeling for a return to normality, or the sense that no further change will be forthcoming, the technique, used by the practitioner to achieve the change may well be constantly changing fractionally in response to the perceived needs of the patient's body.

Moreover osteopathy tends to treat very widely, both physically, 'the knee may have a strain of the medial collateral ligament but is that because there is a problem with foot and ankle mechanics and that is causing a gait pattern thatcauses that or is preventing it from healing...is that also then causing an assymetry in the back which may be leading to other problems?'...and beyond, 'is this patient cycling and reinforcing this bad pattern, have they recently split up with their partner and sleeping on the sofa and the poor sleep is affecting their recovery?' (note I am not saying we do the work of counsellors but we do provide a listening ear).

This creates a problem.  How do we measure the effectiveness of interventions so that we can compare and understand what works and what doesn't?  Our interventions are complex and multifaceted.  What is the active ingredient in osteopathy and what is placebo?  How do we determine which part of our treatment is effective and which part is a waste of our time and the patient's, insurance company or NHS's money?

It is made all the more complicated by the fact that osteopathy is a broad church.   There are some osteopaths who only use very gentle techniques such as functional techiques and cranial osteopathy, others including me prefer, where it is safe to put some force through a joint or work on it persistantly until it starts moving.  I've had effective treatments from both modalities but I've also had patients who have had multiple 'gentle' treatments to no effect and have improved massively from one treatment using more direct techniques.  Is that down to the previous osteopath's personal competence, the general effectveness of those 'gentle' techniques or just a mismatch between that patient's need and the type of treatment they got...That may include some element of 'placebo' as they felt like I was doing something, whereas they were not convinced the other treatment did.   (I do treat more gently when the patient doesn't want or isn't appropriate for a direct approach...and sometimes refer when I tihnk they would be better suited elsewhere).

So how do we measure osteopathy?   More on that next time