The problem with measuring osteopathy

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