Osteomyology

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Osteomyology (sometimes neurosteomyology) is a multi-disciplined form of alternative medicine found almost exclusively in the United Kingdom and is loosely based on aggregated ideas from other manipulation therapies, principally chiropractic and osteopathy. [1] [2] It is a results-based physical therapy tailored specifically to the needs of the individual patient. Osteomyologists have been trained in osteopathy and chiropractic, but do not require to be regulated by the General Osteopathic Council (GOsC) or the General Chiropractic Council (GCC).

Contents

Origin and philosophy

The term osteomyology was invented by an English born doctor of osteopathy, Dr Sir Alan Clemens, in 1992. This name was created the name from the joining of osteon = bone, myo = muscle and ology, a study. [3] This name was given to those who joined an informal group of qualified osteopaths and students. This group was formed to satisfy a need for 'Continuing Professional Development' (CPD) with masterclasses on technique. It was intended to allow students to learn and for the qualified to improve upon basic as well as advanced techniques. Up to that time it was felt the existing official organizations of Osteopathy and Chiropractic did not organize such training well.

In 1993 The Osteopaths Act [4] was passed followed by the Chiropractic Act 1994 [5] requiring all chiropractors and osteopaths to be registered with new governing bodies. The new acts were not universally welcomed by the grassroots of the professions. The acts protected the titles of osteopath and chiropractor to those registered with the new organisations. The techniques used by osteopaths and chiropractors are not protected by the acts and may be used by osteomyologists as long as they do not describe themselves as osteopaths or chiropractors.

Objection on the basis of requalification

Many osteomyologists were qualified under previous non-statutory schemes. The new General Osteopathic Council set a level playing field allowing application from anyone who had been practicing as an osteopath. Previous qualification, experience, clinical reasoning was to be assessed via a professional portfolio of evidence. This process was not universally popular and some osteopaths resented the requirement to re-prove their eligibility for registration. However the portfolio was required of all osteopaths including those graduating within the transitional period. Some chose not to register and some failed to fulfill the requirements and after interview and clinical assessment were refused registration. Some of those declining or failing to register became osteomyologists.

Objection on the basis of non representation

Some osteomyologists objected to the scale of fees charged by the General Osteopathic Council and claimed this did not offer them good value for money and gave this as a reason to not register. The primary purpose of a statutory registration body is to protect the public. Non registering osteopaths failed to see the value in this role. In its first creation the GOsC had the responsibility to represent and promote the profession so this claim has some merit however the promotion role was removed by legislation after the Foster Report.[ citation needed ]

First General Osteopathic Council

The first General Osteopathic council was appointed by the Department of Health. It was considered by the osteomyologists and by the Democratic Osteopathic Council, not to be representative or democratic because it had been formed initially by invitation from only one existing training school of osteopathy. There had been serious differences between this school and the others over many years over the philosophy and practice that was taught. Only later did elections take place onto the new council.

By taking on the title osteomyologist, practitioners can advertise their various spinal manipulation without being in breach of the legislation because they did not claim to be osteopaths. [6] However this means that their practice and behaviour is not subject to the Standards of Practice of either the GOsC or the GCC. The GOsC and GCC will not hear complaints about practitioners who are not registered with them so the protection offered to the patients of osteomyologists is less than that offered to osteopathic and chiropractic patients.[ citation needed ]

Claimed differences from osteopathy

The practice of osteomyology claims to be different from osteopathy because

Both osteopathy and osteomyology lack any clear definition of scope and application so these distinctions are quite arbitrary. The main difference remains that osteopathy is a statutorily regulated health profession and osteomyology is a group of like-minded professionals operating outside a statutory regulatory framework.

Alan Clemens now[ when? ] runs the Association of Osteomyologists and provides professional insurance and marketing services for members. Members of the Association designate themselves with the letters MAO (Member of the Association of Osteomyologists) after their name. Members are expected to partake in continuing training programmes and can present evidence of ongoing training in any alternative medicine. The code of conduct is made public and there is a method by which members of the public can make concerns known about members. The organisation does not publish membership figures, but their site would suggest that there are several hundred members. [7] [ verification needed ]

Efficacy

There is no reliable evidence available regarding the effectiveness or risks of treatment given by osteomyologists as a distinct practice. However, there is a wide range of evidence regarding the efficacy of the various constituent manual therapies that osteomyology draws upon.

Effectiveness

In 1996, Ernst and Canter published a systematic review of the evidence base for various spinal manipulation techniques, including "chiropractors, osteopaths, physiotherapists and other healthcare providers mostly (but not exclusively) to treat musculoskeletal problems." They concluded, [8]

In conclusion, we have found no convincing evidence from systematic reviews to suggest that SM is a recommendable treatment option for any medical condition. In several areas, where there is a paucity of primary data, more rigorous clinical trials could advance our knowledge.

However, from other reviews, there is some evidence that Chiropractic practices (when compared to sham treatments) show clinically significant improvements in short-term pain relief for acute low back pain. However, when compared with conventional treatments there were no significant benefits. [9] There is some evidence that osteopathic treatment is helpful for low back pain. For other conditions, the evidence is not compelling. [10] [9]

Associated risks

Spinal manipulation is associated with frequent, mild and temporary adverse effects, [11] including new or worsening pain or stiffness in the affected region. [12] Rarely, spinal manipulation, particularly on the upper spine, can also result in complications that can lead to permanent disability or death. [11] [13] The incidence of these complications is unknown, due to rarity, high levels of under-reporting, and difficulty of linking manipulation to adverse effects such as stroke, and has been noted as a particular concern. [11]

Controversies

Osteomyology is not a statutorily regulated form of alternative medicine but due to government legislation has opted for self-regulation. To become an osteomyologist, one must have a professional qualification in any of the physical/medical disciplines and applicants have to present their professional diplomas for scrutiny also abiding by the code of practice and ethics and registering full insurance cover. Only then may they join the TAO and call themselves osteomyologist. The newly formed UK voluntary regulation body, the Complementary and Natural Healthcare Council will not play any role in the regulation of osteomyologists. [14] The Association of Osteomyologists is currently working on a framework for voluntary self-regulation for its members. [15]

The Advertising Standards Authority concluded that the Association of Osteomyologists was not a statutory or recognised health and medical professional body and merely allowed osteomyologists to share knowledge. [16]

Professional standards

The WHO states that the safety and quality of chiropractic practice depends mainly on the quality of training of the practitioner. [17] As osteomyologists are often practitioners who refuse to be subject to statutory regulation regarding training and practice, it is difficult to ensure that their standards meet minimum guidelines. The Association of Osteomyologists claim to allow membership to anyone who has "degree qualifications in one of the physical medical disciplines". [18] This is a much broader and looser requirement than the statutorily regulated profession of chiropractic. [19]

Regulatory offenses

Osteomyologists have found themselves subject to various types of regulatory investigation. The Advertising Standards Authority has taken action against practitioners, for such offenses as making untruthful and unsubstantiated claims in advertising about the extent of scientific support for the therapy, [20] or referring to serious medical conditions in their advertising. [16] [20] [21] In November 2008, the Committee of Advertising Practice issued advice about the advertising from osteomyologists warning that they should not mislead on their status or training and that if they wanted to claim to offer manipulation or chiropractic techniques they must hold suitable, relevant qualifications to undertake such therapy and robust substantiation for the efficacy of claims for the therapy. [2]

Several practitioners have been investigated by the General Osteopathic Council for advertising as osteopaths. [22] [23] The Times ran an investigation in 2004 into 'illegal chiropractors' and found many osteomyologists describing themselves as chiropractors to prospective customers. [24]

A chiropractor being investigated by the General Chiropractic Council (GCC) for multiple instances of unprofessional conduct was found by the council to have "endeavoured to evade the GCC’s jurisdiction by denying that he is a chiropractor" calling himself instead an osteomyologist. [25]

See also

Related Research Articles

<span class="mw-page-title-main">Chiropractic</span> Form of pseudoscientific alternative medicine

Chiropractic is a form of alternative medicine concerned with the diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, especially of the spine. It has esoteric origins and is based on several pseudoscientific ideas.

<span class="mw-page-title-main">Osteopathy</span> Alternative medicine emphasizing muscle and bone manipulation

Osteopathy is a type of alternative medicine that emphasizes physical manipulation of the body's muscle tissue and bones. Practitioners of osteopathy are not medically trained and are referred to as osteopaths, unlike Doctors of Osteopathic Medicine (DOs), who are licensed to practice medicine and surgery in all 50 US states. Only graduates of American osteopathic medical colleges may practice the full scope of medicine and surgery generally considered to be medicine by the general public.

<span class="mw-page-title-main">Vertebral subluxation</span> Chiropractic concept

In chiropractic, a vertebral subluxation means pressure on nerves, abnormal functions creating a lesion in some portion of the body, either in its action or makeup. Subluxations are not necessarily visible on X-rays.

<span class="mw-page-title-main">Craniosacral therapy</span> Pseudoscientific alternative medicine technique

Craniosacral therapy (CST) or cranial osteopathy is a form of alternative medicine that uses gentle touch to feel non-existent rhythmic movements of the skull's bones and supposedly adjust the immovable joints of the skull to achieve a therapeutic result. CST is a pseudoscience and its practice has been characterized as quackery. It is based on fundamental misconceptions about the anatomy and physiology of the human skull and is promoted as a cure-all for a variety of health conditions.

<span class="mw-page-title-main">History of alternative medicine</span>

The history of alternative medicine refers to the history of a group of diverse medical practices that were collectively promoted as "alternative medicine" beginning in the 1970s, to the collection of individual histories of members of that group, or to the history of western medical practices that were labeled "irregular practices" by the western medical establishment. It includes the histories of complementary medicine and of integrative medicine. "Alternative medicine" is a loosely defined and very diverse set of products, practices, and theories that are perceived by its users to have the healing effects of medicine, but do not originate from evidence gathered using the scientific method, are not part of biomedicine, or are contradicted by scientific evidence or established science. "Biomedicine" is that part of medical science that applies principles of anatomy, physics, chemistry, biology, physiology, and other natural sciences to clinical practice, using scientific methods to establish the effectiveness of that practice.

Manual therapy, or manipulative therapy, is a physical treatment primarily used by physical therapists, physiotherapists, occupational therapists to treat musculoskeletal pain and disability; it mostly includes kneading and manipulation of muscles, joint mobilization and joint manipulation. It is also used by Rolfers, massage therapists, athletic trainers, osteopaths, and physicians.

<span class="mw-page-title-main">Spinal adjustment</span>

Spinal adjustment and chiropractic adjustment are terms used by chiropractors to describe their approaches to spinal manipulation, as well as some osteopaths, who use the term adjustment. Despite anecdotal success, there is no scientific evidence that spinal adjustment is effective against disease.

<span class="mw-page-title-main">Spinal manipulation</span> Intervention performed on spinal joints

Spinal manipulation is an intervention performed on spinal articulations, synovial joints, which is asserted to be therapeutic. These articulations in the spine that are amenable to spinal manipulative therapy include the z-joints, the atlanto-occipital, atlanto-axial, lumbosacral, sacroiliac, costotransverse and costovertebral joints. National guidelines come to different conclusions with respect to spinal manipulation with some not recommending it, and others recommending a short course in those who do not improve with other treatments.

Chiropractic education trains students in chiropractic. The entry criteria, structure, teaching methodology and nature of chiropractic programs offered at chiropractic schools vary considerably around the world. Students are trained in academic areas including scopes of practice, neurology, radiology, microbiology, psychology, ethics, biology, gross anatomy, biochemistry, spinal anatomy and more. Prospective students are also usually trained in clinical nutrition, public health, pediatrics and other health or wellness related areas.

<span class="mw-page-title-main">History of chiropractic</span> History of chiropractic

The history of chiropractic began in 1895 when Daniel David Palmer of Iowa performed the first chiropractic adjustment on a partially deaf janitor, Harvey Lillard. Palmer claims to have had principles of chiropractic treatment passed along to him during a seance by a long-dead doctor named Dr. Jim Atkinson. While Lillard was working without his shirt on in Palmer's office, Lillard bent over to empty the trash can. Palmer noticed that Lillard had a vertebra out of position. He asked Lillard what happened, and Lillard replied, "I moved the wrong way, and I heard a 'pop' in my back, and that's when I lost my hearing." Palmer, who was also involved in many other natural healing philosophies, had Lillard lie face down on the floor and proceeded with the adjustment. The next day, Lillard told Palmer, "I can hear that rackets on the streets." This experience led Palmer to open a school of chiropractic two years later. Rev. Samuel H. Weed coined the word "chiropractic" by combining the Greek words cheiro (hand) and praktikos.

Joint manipulation is a type of passive movement of a skeletal joint. It is usually aimed at one or more 'target' synovial joints with the aim of achieving a therapeutic effect.

Manipulation under anesthesia (MUA) or fibrosis release procedures is a multidisciplinary, chronic pain-related manual therapy modality which is used for the purpose of improving articular and soft tissue movement. This is accomplished by way of a combination of controlled joint mobilization/manipulation and myofascial release techniques. MUA is used by osteopathic/orthopedic physicians, chiropractors and specially trained physicians. It aims to break up adhesions on or around spinal joints or extremity joints to which a restricted range of motion can be painful and limit function. Failed attempts at other standard conservative treatment methods, over a sufficient time-frame, is one of the principal patient qualifiers.

Chiropractors use their version of spinal manipulation as their primary treatment method, with non-chiropractic use of spinal manipulation gaining more study and attention in mainstream medicine in the 1980s. There is no evidence that chiropractic spinal adjustments are effective for any medical condition, with the possible exception of treatment for lower back pain. The safety of manipulation, particularly on the cervical spine has been debated. Adverse results, including strokes and deaths, are rare.

Throughout its history, chiropractic has been the subject of internal and external controversy and criticism. According to magnetic healer Daniel D. Palmer, the founder of chiropractic, "vertebral subluxation" was the sole cause of all diseases and manipulation was the cure for all disease. A 2003 profession-wide survey found "most chiropractors still hold views of Innate Intelligence and of the cause and cure of disease consistent with those of the Palmers". A critical evaluation stated "Chiropractic is rooted in mystical concepts. This led to an internal conflict within the chiropractic profession, which continues today." Chiropractors, including D.D. Palmer, were jailed for practicing medicine without a license. D.D. Palmer considered establishing chiropractic as a religion to resolve this problem. For most of its existence, chiropractic has battled with mainstream medicine, sustained by antiscientific and pseudoscientific ideas such as vertebral subluxation.

<span class="mw-page-title-main">Veterinary chiropractic</span>

Veterinary chiropractic, also known as animal chiropractic, is the practice of spinal manipulation or manual therapy for animals. Veterinary chiropractors typically treat horses, racing greyhounds, and pets. Veterinary chiropractic is a fast-developing field that is complementary to the conventional approach. Veterinary chiropractic is considered a controversial method due to limited evidence that exists on the efficacy of osteopathic or chiropractic methods in equine therapy. There is limited evidence supporting the effectiveness of spinal manipulation or mobilization for equine pain management, and the efficacy of specific equine manual therapy techniques is mostly anecdotal.

Because of the uncertain nature of various alternative therapies and the wide variety of claims different practitioners make, alternative medicine has been a source of vigorous debate, even over the definition of "alternative medicine". Dietary supplements, their ingredients, safety, and claims, are a continual source of controversy. In some cases, political issues, mainstream medicine and alternative medicine all collide, such as in cases where synthetic drugs are legal but the herbal sources of the same active chemical are banned.

<span class="mw-page-title-main">Friends of Science in Medicine</span> Australian association which supports science-based medicine

The Friends of Science In Medicine (FSM) is an Australian association which supports evidence-based medicine and strongly opposes the promotion and practice of unsubstantiated therapies that lack a scientifically plausible rationale. They accomplish this by publicly raising their concerns either through direct correspondence or through media outlets. FSM was established in December 2011 by Loretta Marron, John Dwyer, Alastair MacLennan, Rob Morrison and Marcello Costa, a group of Australian biomedical scientists and clinical academics.

Primary spine practitioners are health care professionals who are specially trained to provide primary care for patients with spinal disease.

Various organizations of practicing chiropractors have outlined formal codes of professional ethics. Actual practice has revealed a wide range of behaviors which may or may not conform to these standards.

Cervical manipulation, commonly known as neck manipulation, is a procedure involving adjustment of the upper seven vertebrae of the spinal column. This procedure is most often utilized by chiropractors, as well as osteopathic physicians who practice osteopathic manipulation. This type of manipulation may increase the risk of stroke and other issues, with studies suggesting the relationship is causative.

References

  1. Randi, James (1997). An Encyclopedia of Claims, Frauds, and Hoaxes of the Occult and Supernatural. Saint Martin's Press Inc. ISBN   0-312-15119-5.
  2. 1 2 Committee of Advertising Practice , AdviceOnline: Ailments, Treatments and Therapies: Osteomyology Archived 27 November 2008 at the Wayback Machine 21 November 2008
  3. "The Philosophy of Osteomyology". Archived from the original on 6 October 2008. Retrieved 21 May 2008.
  4. The Osteopaths Act 1993 http://www.legislation.gov.uk/ukpga/1993/21/contents
  5. Chiropractic Act http://www.legislation.gov.uk/ukpga/1994/17/contents
  6. Julie Stone; Joan Matthews (1997). Complementary Medicine and the Law. Oxford University Press. p. 152. ISBN   0-19-825971-9.
  7. "Directory of Osteomyologists". Archived from the original on 1 April 2008. Retrieved 21 May 2008.
  8. Ernst E, Canter PH (2006). "A systematic review of systematic reviews of spinal manipulation". J R Soc Med. 99 (7): 192–6. doi:10.1177/014107680609900418. PMC   1420782 . PMID   16574972. Archived from the original on 16 May 2008. Retrieved 21 May 2008.
  9. 1 2 Ernst, Pittler, Wider (2006). The Desktop Guide to Complementary and Alternative Medicine. Elsevier. pp. 313, 343. ISBN   0-7234-3383-6.{{cite book}}: CS1 maint: multiple names: authors list (link)
  10. "Piriformis Stretch" . Retrieved 18 July 2018.
  11. 1 2 3 Ernst E (2007). "Adverse effects of spinal manipulation: a systematic review". J R Soc Med. 100 (7): 330–8. doi:10.1177/014107680710000716. PMC   1905885 . PMID   17606755.
  12. Thiel HW, Bolton JE, Docherty S, Portlock JC (2007). "Safety of chiropractic manipulation of the cervical spine: a prospective national survey" (PDF). Spine. 32 (21): 2375–8. doi:10.1097/BRS.0b013e3181557bb1. PMID   17906581. S2CID   42353750.
  13. Vohra S, Johnston BC, Cramer K, Humphreys K (2007). "Adverse events associated with pediatric spinal manipulation: a systematic review". Pediatrics. 119 (1): e275–83. doi:10.1542/peds.2006-1392. PMID   17178922. S2CID   43683198.
  14. Complementary and Natural Healthcare Council (CNHC)
  15. "Osteomyology Voluntary Self Regulation (VSR) Working Group". Archived from the original on 6 October 2008. Retrieved 21 May 2008.
  16. 1 2 ASA Adjudications: Optimum Health Centres Archived 27 May 2009 at the Wayback Machine 18 September 2008
  17. WHO guidelines on basic training and safety in chiropractic
  18. "The Association of Osteomyologists". Archived from the original on 9 July 2008. Retrieved 21 May 2008.
  19. "GCC: Recognised qualifications". Archived from the original on 30 August 2013. Retrieved 7 July 2008.
  20. 1 2 ASA Adjudications: Optimum Health Centres Archived 15 March 2008 at the Wayback Machine 19 December 2007
  21. ASA Adjudications: Ideal Spine Centre Archived 30 April 2008 at the Wayback Machine 20 February 2008
  22. Watchdogs to launch hotline to vet medics; Patients can check The Sunday Herald 25 July 2004
  23. `Osteopath' fined £1,000 [ permanent dead link ]Cotswold journal 18 May 2006
  24. Back off: Handle with care The Times 17 January 2004
  25. Notice of Findings by the Professional Conduct Committee of the General Chiropractic Council Archived 19 July 2011 at the Wayback Machine 22 January 2007

Further reading