Spinal manipulation is but one potential element of the osteopathic treatment package, which also includes guidance on lifestyle, diet and exercise.

A large proportion of patients visit osteopaths for help with back pain including low back pain, neck pain and headaches. All recent scientific research suggests that back pain:

-- is rarely a simple problem.
-- is influenced by psychological and social factors.
-- requires treatment tailored to the patient's needs.

Research is a high priority within the osteopathic profession and new research is always welcomed by the General Osteopathic Council (GOsC). However, this is a review of research dating back to 2000 and provides no new findings itself. Further, the paper fails to draw on more recent studies. As such, the review is extremely limited, and certainly not helpful to patients or healthcare professionals when making generalisations about osteopathic practice.

Contrary to Professor Ernst's statement that "� regulation serves as a substitute for research �" the National Council for Osteopathic Research (NCOR) was set up in 2003, following the establishment of the Statutory Register of Osteopaths in 2000. NCOR's remit is to co-ordinate and develop the evidence-base for osteopathy.

A spokesperson for NCOR said, "A substantial amount of research has been carried out in the last few years, most notably a Medical Research Council (MRC) funded trial on spinal manipulation and exercise therapy for low back pain (UK BEAM trial 2004 - www.osteopathy/media/prdetails.php?id=24). This important study provides good evidence to support spinal manipulation for low back pain, particularly when combined with exercise guidance - typical osteopathic management. This suggests that Professor Ernst is out of date with this review."

In summary, the research design/methodology is not a recognised systematic review, it is limited in terms of scientific value, and the data presented does not support the conclusions made.

This article is in response to:
'Spinal Manipulation doesn't work for any condition, new research finds' Ernst E., Canter P. A systematic review of systematic reviews of spinal manipulation. J R Soc Med 2006;99:189-193

About Osteopathy

-- Osteopathy uses many of the diagnostic procedures involved in conventional medical assessment and diagnosis. Its main strength lies in the unique way the patient is assessed holistically from a mechanical, functional and postural standpoint. Treatment is aimed at improving mobility and/or reducing inflammation by using gentle manual osteopathic techniques on joints, muscles and ligaments.

-- Patients are given positive advice, related to their lifestyle, about how they use their body. Age is no barrier to osteopathy since each patient is assessed individually and treatment is gentle.

-- Osteopaths treat a wide range of conditions, including changes to posture in pregnancy; babies with colic or sleeplessness, repetitive strain injury, postural problems caused by driving or work strain, glue ear in children, the pain of arthritis and sports injuries, amongst others.

Growing public awareness of osteopathy

-- Statutory self-regulation of the profession has raised public awareness of and confidence in osteopathy.

-- There has been a 25% growth in demand since 1996.

-- The GOsC undertakes a rolling programme of public awareness monitoring & clinical auditing.

-- A better understanding has generated a surge in media interest.

A Growing profession

-- Currently there are 3740 osteopaths on the UK Register - 90% of whom practise in the UK.

-- Growing profession with 250 new graduates every year.

-- An increasing number of universities are registering an interest in establishing osteopathic training institutions. Osteopathic training

-- To date, 8 Osteopathic Training Institutions have been awarded Recognised Qualification Status by the Privy Council.

-- Osteopathic training comprises four to five-year BSc Honours degree programmes, majoring in anatomy / physiology / neuro-anatomy / pathology.

Research

-- The National Council of Osteopathic Research (NCOR) is an independent body, whose remit is to encourage and develop a research culture within the field of osteopathy.

-- Founded in 2003, NCOR consists of representatives from the GOsC, the osteopathic educational institutions, the British Osteopathic Association, the NHS and private practitioners.

-- NCOR is chaired by Professor Ann Moore, Director of the Clinical Research Centre for Health Professions at the University of Brighton.

-- For further information visit the NCOR website at: ncor.

The Statutory Register of Osteopaths

-- Osteopaths are statutorily regulated health professionals and form an integral part of primary care teams.

-- The General Osteopathic Council (GOsC) regulates, promotes and develops the osteopathic profession, maintaining a Statutory Register of those entitled to practise osteopathy in the United Kingdom.

-- Only practitioners meeting the highest standards of safety and competency are eligible for registration. Proof of good health, good character and professional indemnity insurance cover is also a requirement.

-- It is an offence for anyone to describe themselves as an osteopath and practise as such, unless registered with the GOsC. The public can, therefore, be confident in visiting a registered osteopath that they will experience safe and competent treatment from a practitioner who adheres to a strict Code of practice:

-- "13. (1) The General Osteopathic Council shall from time to time determine the standard of proficiency which, in its opinion, is required for the competent and safe practice of osteopath" (Osteopaths Act 1993).

-- Copies of Standard 2000 (S2K) are available from the GOsC on 020 7357 6655.

-- "Any patient consulting an osteopath is entitled to a high standard of care. The register of osteopaths exists so that members of the public can identify those who have demonstrated their ability to practise to the required standards" (extract from the GOsC 'Code of practice', GOsC, 2005).

-- Copies of the Code of Practice are available from the GOsC on 020 7357 6655.

-- The 2006 Statutory Register of Osteopaths provides a geographical index of all practising osteopaths, and is available to healthcare providers and the general public. Printed copies are available from the GOsC. A current and searchable listing of osteopaths is available on the GOsC website: osteopathy.

The General Osteopathic Council The General Osteopathic Council (GOsC) exists to protect patients by promoting excellence in osteopathic care. The GOsC regulates, develops and promotes the profession of osteopathy by:

-- Maintaining the definitive Register of those who have satisfied the GOsC that they can practise osteopathy safely and competently.

-- Defining and maintaining high standards of education, training and clinical practice.

-- Guiding osteopaths in standards of professional practice.

-- Dealing promptly and effectively with osteopaths whose competence or fitness to practise is called into question.

-- Promoting and developing the profession and practise of osteopathy.

General Osteopathic Council (GOsC)
Osteopathy House
176 Tower Bridge Road
London, SE1 3LU
Tel: 020 7357 6655 x226
Fax: 020 7357 0011
osteopathy