A recent article published in IJOM asked: what’s wrong with osteopathy? Nothing that a shake-up in education, representation and political direction in osteopathy in the UK wouldn’t fix.
Going back to the onset of professionalism in the late 1990’s and 2000’s as the GOsC event horizon came nearer, there has been a purposeful drive by people representing the profession to grow closer to the mainstream paradigm of what it means to be evidence-based.
If one goes back to the history of the evolution of science, back to the 1700’s and emergent Cartesian dynamics, there has been a loss of the balanced representation of what constitutes knowledge and truth in practice. When group leaders’ and organisations’ actions are considered (social group theory and communities of practice theories are examined) one can see that people who hold positions of power that wish to be accepted into a hierarchy and to join a new community of mainstream healthcare practice, become hugely enmeshed in their new communities values and norms.
This has, I (and others) feel, led to an abandonment of extant and traditional osteopathic practice, then and now. As with long-standing expert witnesses, people who hold roles of responsibility often become trapped in a paradigm of their own desires for identity and recognition in new communities (the NHS being a very powerful one), and the outcomes for their previous community seem unimportant in the light of being accepted as leaders of a profession of health-role providers, with courses designed to enable students to have role migration (ie away from osteopathy) built into their education under the guise of progress.
With a long-standing agenda of dismissing palpation (through studies with flawed methodology, using poor methods, badly trained and under-experienced practitioners, and exploring static palpation what motion and dynamic testing are representative of practice (not static dynamics – which are drawn from other manual professions) we are told that palpation is unreliable. This at a time when physiotherapy research is acknowledging that inter-rater reliability is more than acceptable when trained practitioners are used. Indeed it is poor practice that research is done without training. Yet, we are told we should accept such palpatory outcomes as evidence that osteopathic practice is flawed and outdated.
We are told that osteopathy is a biomedical science as we are trained in anatomy and that the profession needs informing about patient-centred and patient-oriented care, and the holistic nature of care of the person in their situation and circumstance, This might be necessary for psychology and other manual professions but it has never been absent from osteopathic practice. It seems an ignorance of what constitutes osteopathy might be more important to dispel than a claim that osteopaths are not patient-centred.
Perhaps this is what students are now taught, which is a shame. There are drives in research debates where operator-driven ideals and models are to be dispensed with, whilst on the same hand research indicates that models are not fixed, are an aid to contemplating personalised individual care, and that practitioners who are informed by a model have a better patient interaction than those who don’t. We are told that osteopaths who look at spinal motion are ignorant of the evidence that movement is nuanced, networked, variable and can be repatterned and that all osteopaths are doing is chasing an ideal posture that does not exist – thereby being operator-led, which is bad for patients.
In fact, osteopaths who work in traditional and classical approaches have always understood that the principle of osteopathy is adjustment towards the nearest most effective dynamic for that person at that time. This is what adjustment is, not HVT. We are led to believe that studies that do not measure muscle action potential correctly are better than Korr’s and Denslow’s works -.and so therefore this ‘disapproved’ the osteopathic lesion story, when in fact this is a constant conversation that no one has proved, (or disproved) even if the methods of analysis that could capture it are still in development.
We are led to believe that one can equate static spinal palpation of joints with the practice of the body adjustment, and that all classical methods are simply walking up and down twisted spines with meaningless anecdotes to flexion, rotation and side bending. We are told that postural models are inappropriate, whilst at the same time many osteopathic authors are trying to find workarounds to this dialogue, ‘redefining’ the postural model to recreate a dynamic analysis of physiological relevance – bringing in vestibular, automatic and arousal networks, where this was always part of the early dynamic.
We are also supposedly not meant to spot that if we have an (en)active inference with patients that this means we are inter-subjective and have to explore our own phenomenological perspectives when understanding how ‘we’ as in the ‘individual practitioner’ can help any individual patient. Whilst tissue states have a clinical utility, they also speak to so much more, and this is completely ignored. We are told that subjectivity doesn’t count and that only what can be counted ‘counts’.
We are told that the pubis has nothing to do with lumbopelvic support and that osteopaths have no place touching the ventral body, nor looking at pelvic levels. We are told that it is inappropriate to work on women’s health issues as examining these sensitive areas is not an acceptable practice, or it is to be frowned upon. Given half the profession is female how on earth is this acceptable? What are the rights of our patients who are women to have an understanding of their health needs denigrated in this way? Why, when other manual professions are exploring physiological organ work and multimodal exploration of respiration, gynaecology, urology, lymphatic and immune work is this driven from our curriculums?
There are many such omissions and glaring misrepresentations of practice in the drive for medical and reductionist community acceptance. This is not what osteopaths wanted, nor are the vast majority of the profession convinced. We know that there is an alternative model to truth, and that there can be more than one ‘science’ – one where ‘whole’ is understood, and that the indivisible nature of us all means we can’t objectify the patient, our place, and our actions. Where complex black box experimentation with N=1 analysis is necessary, and that whilst some measurement always has its place, there are other truths that can guide OSTEOPATHIC practice.
I do hope a revolution can still be possible in osteopathy, by osteopaths, where the actual practice of osteopathy becomes valued, and not lost in a rush to fill NHS vacancies and to become accepted into a medical practice that does not meet all the health needs nor the needs of the public – and is not the paradigm that osteopathy was created in and lives in.
Don’t let a small group of the profession continue to trap you in insecurity, ignorance and fear. You went into this profession wanting to explore osteopathy, and it is still there – you just may need to look beyond your modern exposure to find it.
With love, and lots of spade work.