Osteopathy

What is it? Osteopathy is a system of treatment used primarily for musculoskeletal problems where the osteopath uses massage, manipulation, stretching and other phyical techniques. NB Osteopathy is not the same as American osteopathic medicine, despite the fact that providers of that are also sometimes referred to as "osteopaths" in America.

Does it work? It very much depends what the root of your problem is plus some other variables that seem not to have been identified yet (see the section on evidence). In particular, trials have looked at its efficacy for low back pain.
I couldn't make up my mind whether it worked for me. As a solution for my problems it at most lasted a few months and I sometimes got worse for a few days after treatment (even with exceedingly gentle treatment). This happens sometimes with osteopathy, and is not considered a problem (I agree with that, I think it's only a problem if you get worse for a few weeks or months or if you are consistently worse after it with no subsequent sign of improvement to beyond the state you were in to start with). I also often felt marvellous (for me) for an hour or so after treatment. My problem was that beyond the occasional marvellous hour, it wasn't clear whether I got better than I would have been without treatment or whether time would have healed me anyhow. For some people, it will hopefully be more obvious than it is for me.

Who does it work for? People with musculoskeletal problems, including postural problems. Trials have focused on people with low back pain. See above and the section on evidence.

Who doesn't it work for? There's no evidence that it works for anything that isn't a musculoskeletal problem. According to NHS Choices, some osteopaths claim to be able to treat things other than musculoskeletal problems, such as headaches, migraines, painful periods, digestive disorders and depression, but there isn't enough evidence to support this. If you have one of these and want to try an osteopath anyway, I recommend setting yourself a target before your first visit for the minimum you're hoping to achieve by when and at what cost for it to be worth the money. If it doesn't improve you to the minimum level you need, then stop. If the osteopath says you will need more treatment than you were hoping for it to work, work out what minimum result you would need to see for that to be worth it and if you don't achieve it, stop.

Where can I get it? Personal recommendation is always good. Alternatively, the Institute of Osteopathy has a website you can use to find one. Osteopaths are regulated by statute in the UK.

How much does it cost? According to the General Osteopathic Council, fees typically range from £35 to £50 for a 30 minute session. I have typically been recommended to have courses of weekly sessions - I think generally about 6-8 - followed by less frequent follow-up sessions to keep my body working right (e.g. every 6 weeks). I'm not sure how typical that is, but I have the suspicion that it is rare to be recommended only a single session. Your osteopath may want to see you for longer for your first visit when they assess your problems (and charge more for that session).

Is there a cheap/free version? In some areas you may be able to get osteopathic treatment on the NHS. If you have health insurance, that may cover it. Otherwise, as far as I'm aware, no, there's no cheap or free version.

Does the individual practitioner matter? I think so, as the osteopath's decisions on how to treat you will be based on their only personal knowledge and experience. As with most other jobs requiring a skill, it seems likely that some will be better than others, but I don't have any personal experience where I could say "osteopath A was definitely better than osteopath B".

Is there any evidence for it? Yes, but it's a bit mixed. Some trials show positive results, others show no improvment beyond the placebo effect. Also, some trials don't differentiate between osteopathy and other manipulation treatments, such as chiropractic and physiotherapy. I found the trials referenced in this section in this 2013 pdf from the National Council for Osteopathic Research.

No better than placebo:
A meta-analysis of 39 randomised controlled trials showed spinal manipulative therapy (which includes but is not limited to osteopathic manipulation) had no statistically or clinically significant advantage over general practitioner care, analgesics, physical therapy, exercises or back school. Results for patients with chronic low-back pain were similar. Radiation of pain, study quality, profession of manipulator, and use of manipulation alone or in combination with other therapies did not affect these results. Looking specifically at osteopathy, a randomised controlled trial of 91 participants and a 1985 controlled comparison of osteopathic manipulation with other treatment showed no clear benefit to osteopathy above placebo.

Better than placebo:
One small (40-patient) single-blind randomised controlled trial tested osteopathic manipulation against a control treatment known to work (chemonucleolysis) for patients with sciatica/symptomatic lumbar disc hermiation. Patients reported a 12-month outcome that was equivalent to chemonucleolysis, but showed a significant improvement compared to it in pain and disability in the first few weeks

A randomised trial known as UK BEAM looked at the impact of exercise, manipulation, and manipulation followed by exercise, each together with best GP care compared to GP care alone on chronic low back pain. After 3 months, they found an improvement with just exercise, a slightly greater improvement with manipulation and an even greater improvment still with manipulation and exercise. But "manipulation" here means a package of techniques representative of those used by the UK chiropractic, osteopathic, and physiotherapy professions, where the manipulation was applied by either a phyiotherapist, an osteopath or a chiropractor, so although this does speak in favour of osteopathy as one of the manipulation techniques involved, it doesn't differntiate it from physiotherapy or chiropractic. Also,  you couldn't tell in advance who was going to benefit.
This randomised controlled trial showed that an osteopathic manual treatment regimen met or exceeded the Cochrane Back Review Group criterion for a medium effect size in relieving chronic low back pain.
Are there any negative side effects? It's not cheap and you can have an adverse reaction to it. This study shows that headache, stiffness, discomfort and fatigue were quite common after manipulation (it didn't look at osteopathic manipulation specifically). However, it also noted that they were usually mild and short-lived. My own personal experience is that I sometimes feel worse immediately after or for a few days after osteopathy, but I've never felt worse for longer than that (and I have a particularly fragile body). Please note that I have always explained to osteopaths that I'm unusually fragile because of hypermobility syndrome and then they've left out any techniques they thought weren't gentle enough for me.

Anything else worth knowing? It's drug-free, which is great. My experience is that if your level of fitness (including in particular muscles) is poor, they will sometimes ask you to do exercises that you can do at home as part of your treatment.

Was it worth the money? I'm not sure if it was for me. I'm glad I tried it, but I'm not convinced it was a particularly good fit to my problems. The evidence suggests to me that it may create an improvement for some people, but not for everyone, and unfortunately you can't currently predict in advance if that will be you. I'd say that doesn't mean you shouldn't try it at all, but you need to think about what would represent a level of success worth the money to you.

Have you tried osteopathy? Was it successful for you? What signs did you recognise that by?