Osteopathy concentrates as much on why there is a problem in the muscles and joints as on the problem itself explains Anne Woodham

Osteopathy - from the Greek osteon ('bone') and pathos ('suffering') - was developed in the late 19th century by an American army doctor, Dr Andrew Taylor Still, after his wife and three children died from meningitis. He believed that when the body was correctly adjusted, there would be less strain on the muscles and joints, all the systems would function smoothly and the body could heal itself naturally.

Still founded the American School of Osteopathy in 1892, and in 1917 his pupil, Dr John Martin Littlejohn, founded the British School of Osteopathy. Despite early opposition from the medical establishment, osteopathy remained popular and is now accepted in orthodox medicine. Osteopaths were licensed to practise as conventional doctors in the US in 1972 and the first British state register of osteopaths opened in 1999.

How does it work?
Osteopaths use touch and manipulation to diagnose and treat problems caused by misalignments of the muscles, bones, joints, ligaments and connective tissue that make up the musculo-skeletal system. In a healthy body, this framework supports and protects the organs, helping all body systems - nerves, circulation, digestion and hormones - to function at their best.

Physical and emotional stress, injury and poor posture can have a negative effect on the musculo-skeletal system. Pain creates muscle tension, which in turn creates more pain. Osteopathic techniques that range from soothing massage to high velocity mobilisation of joints help ease muscle tension, improve mobility and promote self-healing processes.

Osteopathy is a holistic approach, regarding your way of life and your mental and emotional state as important influences on total well-being. An osteopath will be as concerned about why a problem has arisen as with the problem itself. For example, is your back pain due to a lifetime of lifting heavy loads the wrong way?

Specialisations include cranial osteopathy, developed by an American osteopath, Dr William Garner Sutherland, in the 1930s. Practitioners use delicate touch around the skull and lower spine to ease tension believed to disturb the flow of cerebrospinal fluid. Cranial osteopathy is believed to be particularly successful for babies and young children and in treating problems following trauma and injury.

What can I expect?
After taking a thorough medical history, an osteopath asks about lifestyle and emotional health and carries out standard medical tests. You will probably be asked to undress to your underwear so that the osteopath can see as much of your body as possible, and to stand, sit and lie down on a special treatment table to study the way you hold yourself and move.

The osteopath will also ask you to bend this way and that while feeling your spine. Years of experience sensitise their fingers, so that by palpating (feeling) tissues, muscles and joints, and by testing temperature, tone, shape and response to movement, they can detect problem areas.

Treatment is tailored to individual needs. It may consist simply of massage and stretching techniques, or it may involve manipulation of the joints, taking limbs through their full range of movement. An abrupt high-velocity thrust, though painless, can cause the joint to 'click'. You may be positioned in such a way that tension from areas of strain or injury is released spontaneously. 'Muscle energy techniques' involve working against resistance provided by the practitioner in order to release tension.

What is it good for?
Osteopathy can help with back and neck pain, joint pain, sports injuries, frozen shoulder, sciatica, PMS and menstrual pain, headaches, insomnia, depression and digestive disorders. Cranial osteopathy is used to treat colic, sleeplessness and glue ear in children.

Although there is a lot of research into osteopathy, much of it is not of a high standard, and osteopaths accept that more clinical trials are needed. Some studies show that osteopathic manipulation can improve recovery time for lower back pain. In 1994, the UK Clinical Standards Advisory Group recommended manipulation for NHS patients with acute back pain and advised GPs to liase more closely with osteopaths, chiropractors and physiotherapists.

What to watch out for
If you have osteoporosis or inflammation, infections, tumours, circulatory problems or a recent fracture, an osteopath may decide not to use manipulation. Avoid vigorous manipulation if you have badly prolapsed (slipped) discs.

How much does it cost?
The first consultation usually lasts 30-60 minutes; subsequent sessions may be 20-30 minutes. Fees vary according to location, but expect to pay £20-£40 plus for the initial consultation.

How can I find it?
General Osteopathic Council and Osteopathic Information Service
(osteopaths must pass a professional assessment to qualify for the state register)
Osteopathy House, 176 Tower Bridge Road, London SE1 3LU
Tel 020 7357 6655 ext. 242
www.osteopathy.org.uk

Osteopathy and chiropractic are often confused because both treatments involve manipulation of the body. Chiropractic was developed by an osteopath, Daniel D Palmer, and tends to be more mechanistic in its approach, with emphasis on the spine as the major support structure. Any misalignments in the spine can affect the whole body.

What's the difference between osteopathy and chiropractic?
Osteopaths take a more holistic approach and will explore a patient's lifestyle, habits, mental and emotional health to find reasons for musculo-skeletal problems. Poor posture in childhood, for example, could lead to later back problems.

While chiropractors tend to make more use of X-rays, osteopaths traditionally use more soft tissue manipulation and less high velocity thrusts, but in actual practice the distinction is becoming blurred. Some chiropractors work more like osteopaths, and some osteopaths more like chiropractors.