Osteopathy
What is osteopathy?
Balanced information on the definition (based on the World Health Organization document), history, principles, techniques, scientific evidence, safety and regulation around the world.
On this page
- Short definition
- Who is an osteopath?
- A brief history of osteopathy
- Core principles
- The five models in osteopathy
- Osteopathic techniques
- Scientific evidence: what is known and what is not?
- Safety
- Osteopathic education and regulation around the world
- Osteopathy, physiotherapy and manual therapy: the differences
- Myths and facts
- Read on
- Sources
Short definition
Short answer
Osteopathy is an approach to diagnosis and treatment based on manual contact. It pays particular attention to the relationship between the structure and function of the body and to the organism’s capacity for self-regulation. Osteopathy does not replace medical examination and diagnosis; it is applied as a complement to modern medicine.
According to the standards for training in osteopathy published by the World Health Organization (WHO) in 2010, osteopathy is an approach to diagnosis and treatment based on manual contact. It takes into account the interrelationship of body, mind and spirit in health and disease, and pays particular attention to the structural and functional integrity of the body and to the organism’s tendency towards self-healing.
Osteopaths use a variety of manual techniques to improve physiological function or to support homeostasis that has been disturbed by somatic dysfunction. Somatic dysfunction is impaired function of the structures of the musculoskeletal system — bones, joints, muscles and fascia — and of their related vascular, lymphatic and neural elements.
The WHO document describes osteopathy as a field distinct from physiotherapy and chiropractic, although some techniques overlap. The WHO characterises osteopathy as an approach centred on the patient rather than on the disease.
Who is an osteopath?
The word “osteopath” denotes a different profession in different countries:
- In the USA, osteopathic physicians (D.O.) receive a full medical education and work in every field of medicine, including prescribing medication and performing surgery. There are around 141,000 osteopathic physicians in the USA, which is more than 11% of the country’s physicians.
- In many countries of Europe and the world, osteopaths are non-physician healthcare professionals. They do not study at a medical faculty, do not prescribe medication and do not perform surgery. They apply manual approaches mainly to complaints related to the musculoskeletal system.
- In a number of countries, physicians, physiotherapists and other healthcare professionals undertake additional training and use osteopathy within the scope of their own speciality.
A brief history of osteopathy
- 1870sThe American physician Andrew Taylor Still (1828–1917) works on a new system of treatment. In 1885 the system receives the name “osteopathy”.
- 1892Still opens the first school of osteopathy, the American School of Osteopathy, in Kirksville, Missouri, USA.
- 1917John Martin Littlejohn founds the British School of Osteopathy in London. The successor of this school is still active today.
- 1898–1939Still’s student William Garner Sutherland begins his observations on the sutures of the cranial bones and in 1939 puts forward the cranial concept (the “primary respiratory mechanism”).
- 1950s–1960sThe American osteopath Lawrence Jones develops the SCS (strain–counterstrain) technique.
- 1980sThe French osteopath and physiotherapist Jean-Pierre Barral systematises the method of visceral manipulation and teaches it from 1985 onwards.
- 1993The Osteopaths Act is passed in the United Kingdom and the General Osteopathic Council is established.
- 1999Osteopathie Schule Deutschland is founded in Hamburg.
- 2010The WHO publishes its standards document on training in osteopathy.
- 2015The European Committee for Standardization adopts the EN 16686 standard on osteopathic healthcare provision.
Core principles
The classic principles formulated in Kirksville in 1953:
- The body is a unit.
- The body possesses self-regulatory mechanisms.
- Structure and function are reciprocally interrelated.
- Rational treatment is based on an understanding of these three principles.
In 2002, a modern interpretation of these principles was proposed in the journal of the American Osteopathic Association. In that interpretation, a person is described as the product of the dynamic interaction of body, mind and spirit. It emphasises the capacity to maintain and restore health, the influence of internal and external factors on this capacity, and the role of the musculoskeletal system. The principles of treatment also include the patient being at the centre, the patient’s responsibility for their own health, and the use of evidence-based clinical guidelines.
Important note
The principle of “the body’s capacity for self-healing” is a philosophical approach. It does not mean that osteopathy can treat any disease. Reconciling traditional concepts with scientific evidence is a live topic of debate in modern osteopathy.
The five models in osteopathy
According to the WHO document, when assessing a patient and planning treatment, osteopaths use five structure–function models, usually in combination:
| Model | What it focuses on |
|---|---|
| Biomechanical | Posture and balance, the mechanical function of joints and muscles |
| Respiratory–circulatory | The flow of body fluids, the supply of oxygen and nutrients to the tissues, the removal of waste products |
| Neurological | Facilitation of nerve impulses at the level of the spinal cord, proprioception, the autonomic nervous system, pain mechanisms |
| Biopsychosocial | Psychological, social and environmental stressors |
| Bioenergetic | The balance between the production, distribution and expenditure of energy |
Osteopathic techniques
The WHO groups the techniques according to their principle of action:
| Group | Techniques | Brief explanation |
|---|---|---|
| Direct techniques | High-velocity, low-amplitude (HVLA) techniques | A short, rapid, precise impulse to the joint at the limit of its restricted range of motion |
| Articulatory techniques | Repeated, slow, passive movement of the joint | |
| Muscle energy techniques | Alternation of the patient’s gentle muscle contraction against the therapist’s resistance with stretching | |
| General osteopathic treatment (GOT) | Rhythmic articulation of the whole body in a set sequence | |
| Indirect techniques | Functional techniques, SCS | Passive positioning of the body in a position of ease (in SCS, until the tender point diminishes, approximately 90 seconds) |
| Balancing techniques | Balanced ligamentous tension (BLT) | Holding the joint in the position where the tension of the ligaments is balanced |
| Combined techniques | Myofascial techniques, osteopathy in the cranial field, visceral techniques | Prolonged low-load stretching of fascia and muscle; gentle holds in the region of the skull and sacrum; techniques directed at the abdominal and pelvic organs and their ligaments |
| Reflex techniques | Trigger points, neuromuscular techniques | Action directed at tender points in the muscle |
| Fluid techniques | Lymphatic “pump” techniques | Rhythmic compressions on the chest, abdomen or legs |
Scientific evidence: what is known and what is not?
The effectiveness of osteopathic manipulative treatment has been studied most extensively for musculoskeletal pain. The table below is based on systematic reviews and clinical guidelines. Pain scores are given on a 100-point scale.
| Area | What the evidence shows | Source |
|---|---|---|
| Chronic non-specific low back pain | Meta-analysis of 15 randomised trials: an average pain reduction of about 13 points for up to 3 months and a small improvement in function, moderate quality of evidence. However, in trials comparing it with sham (placebo) treatment the difference was small or not detected. | Franke 2014; Nguyen 2021; Ceballos-Laita 2024 |
| Low back and pelvic pain during pregnancy | An average pain reduction of about 17 points during pregnancy, moderate quality of evidence. For the postpartum period the quality of evidence is low. | Franke 2017 |
| Neck pain | A pain reduction of about 13 points (3 trials), no significant difference in function. No superiority over sham treatment has been shown. | Franke 2015; Ceballos-Laita 2024 |
| Chronic pain | Overview of reviews: positive results for pain and function in chronic non-specific low back and neck pain and in chronic non-cancer pain. The methodological quality of the reviews is low or very low. | Bagagiolo 2022 |
| Irritable bowel syndrome | Preliminary evidence; the studies are small and the results should be interpreted with caution. | Müller 2014 |
| Headache and migraine | Low-level, preliminary evidence; there are large differences between the studies. | Cerritelli 2017; Roberti 2026 |
| Preterm infants | Conflicting: one meta-analysis found an average reduction in the length of hospital stay of 2.7 days, whereas an updated review found no effect or only a very small one (very low quality of evidence). | Lanaro 2017; Posadzki 2022 |
| Other conditions in children, including infant colic | Effectiveness has not been proven. | Posadzki 2013; Dobson 2012 |
| Cranial osteopathy | Diagnosis by cranial palpation is not reliable; there is virtually no strong evidence of effectiveness. | Guillaud 2016 |
| Visceral osteopathy | Diagnosis is not reliable; there is no reliable evidence of effectiveness. | Guillaud 2018 |
| Acute low back pain, fibromyalgia, mixed headaches, urinary symptoms, cerebral palsy | No benefit has been shown. | Zipp 2025 |
Clinical guidelines. In its guideline on low back pain, the United Kingdom’s National Institute for Health and Care Excellence (NICE) recommends considering manual therapy only as part of a treatment package that also includes exercise.
Conclusion. Osteopathic treatment may provide a small or moderate benefit for some types of musculoskeletal pain, especially in combination with exercise. For diseases of the internal organs, developmental problems in children and many other conditions, effectiveness has not been proven. Critical appraisal of the scientific literature is one of the core competencies the WHO has defined for osteopaths. At the Academy this skill is taught as a topic requiring particular attention.
Read more: Manual therapy for low back pain · Osteopathy and children
Safety
Mild reactions are common. Adverse reactions immediately after osteopathic treatment were recorded in about 2.5% of visits — mainly pain and discomfort (Degenhardt 2018). According to a review of manual therapy, mild or moderate, short-lived reactions (pain, fatigue) occur in about 41% of patients in observational studies and in about 22% in randomised trials (Carnes 2010).
Serious complications are rare but possible. Serious events have been described mainly after manipulation of the neck and in patients with an undiagnosed disease. The American Heart Association recommends that patients be informed of the statistical association between neck manipulation and dissection of the cervical arteries (Biller 2014).
Contraindications
The WHO document lists, for example, the following contraindications for direct techniques:
- bleeding disorders or anticoagulant use without monitoring of blood coagulation;
- diseases that weaken bone, tendon, ligament or joint (metastatic, metabolic, rheumatoid);
- in the area to be treated: aortic aneurysm, open wound or recent surgery, acute head injury, cerebral haemorrhage or acute ischaemia, suspected vascular anomaly, acute abdominal pain, acute disc herniation with progressive neurological signs, cauda equina syndrome, tumour, bone infection;
- additionally for manipulation (HVLA): acute fracture, unstable bone or joint, site of surgical fixation, haematoma, abscess.
A contraindication in one area or for one technique does not necessarily rule out working in another area or with another technique. Only a trained professional can make this decision.
Red flags
In the presence of the following signs, osteopathic treatment should be postponed and the patient referred urgently to a physician:
- severe pain following trauma;
- fever, unexplained weight loss, a history of cancer;
- pain that does not ease at rest or at night and is getting worse;
- progressive weakness or numbness in the limbs;
- disturbance of urination or defecation, loss of sensation in the perineal area;
- neck pain accompanied by dizziness, double vision, speech or swallowing difficulty, sudden severe headache;
- acute abdominal pain.
The International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) has developed separate clinical frameworks for screening for serious disease of the spine and for risks related to the vessels of the neck.
Conclusion
Before osteopathic treatment, a medical diagnosis and a check for red flags are essential. The radiology and differential diagnosis modules in the Academy’s programme serve precisely this purpose.
Osteopathic education and regulation around the world
The WHO education standards
The WHO describes two models of training:
- Type I — for people with no prior medical training who have completed secondary school: usually 4 years of full-time study, about 4,200 hours, including at least 1,000 hours of supervised clinical practice.
- Type II — for professionals who already have training in healthcare: the aims and content are the same, the duration is adapted to the student’s prior education, usually about 1,000 hours. Graduates must demonstrate the same competencies as Type I graduates.
The WHO document defines 12 core competencies for osteopaths. These include differential diagnosis and treatment planning, palpation and clinical skills, physical examination, interpretation of imaging and laboratory results, thorough knowledge of indications and contraindications, and critical appraisal of the scientific literature.
The European standard
EN 16686:2015 is the European standard on osteopathic healthcare provision, its facilities, education and professional ethics. This standard is voluntary: it is not a law, it does not accredit schools and it does not grant a licence to practise.
Regulation around the world
According to the 2025 report of the Osteopathic International Alliance (OIA), the title of osteopath is protected by law, or osteopathy is recognised as a healthcare profession, in around 15–16 countries. Osteopathic physicians, meanwhile, can practise in 57 countries.
| Country | Status |
|---|---|
| United Kingdom | Regulated by the 1993 Act; only those registered with the General Osteopathic Council may use the title “osteopath”. |
| France | The title “osteopath” is protected by a 2002 law; training lasts 5 years. |
| Switzerland | Independent practice requires a master’s degree in osteopathy from a university of applied sciences. |
| Finland | “Osteopath” is a protected title; at least 4 years of approved training is required. |
| Italy | Osteopathy was recognised as a healthcare profession by a 2018 law. |
| Germany | Osteopathy is not regulated as a separate profession. According to case law, only physicians and holders of a Heilpraktiker licence may practise it independently; physiotherapists may do so on a physician’s referral. |
| Türkiye | In the 2014 regulation on traditional and complementary medicine practices, osteopathy is included in the list of these practices. Under the regulation, these practices are carried out by certified physicians in authorised institutions. |
| USA | Osteopathic physicians (D.O.) have the full rights of physicians. |
| Azerbaijan | In Azerbaijan, the legal status of osteopathy as a separate specialty has not yet been defined. The work of specialists who have trained in osteopathy abroad is therefore assessed within the framework of their existing medical specialties, the rules for admission to professional practice and the relevant licence. Private medical practice is regulated by the Law “On Private Medical Practice”: it requires higher or secondary medical education, attestation and a special permit (licence) for the relevant type of activity. If osteopathy is recognised as a separate specialty in the future, separate requirements may also be set for it. |
Key conclusion
Whether any osteopathy diploma is recognised for professional practice depends on the legislation of each country. The WHO standards are recommendations for education, not an international licence.
Osteopathy, physiotherapy and manual therapy: the differences
| Criterion | Osteopathy | Physiotherapy | Manual therapy |
|---|---|---|---|
| Main focus | The body viewed as a whole system, the relationship between structure and function | Restoration of movement and function, therapeutic exercise | Manual treatment of joints and soft tissues |
| Main tools | Manual assessment and a variety of manual techniques | Exercise therapy, manual techniques, physical agents, patient education | Mobilisation, manipulation, soft tissue techniques |
| Education | Depending on the country, a separate degree programme or additional training for healthcare professionals | University education | Usually an additional specialisation for physiotherapists and physicians |
These fields are not mutually exclusive. Osteopathy is most often studied as an additional specialisation that extends the knowledge and skills of a healthcare professional — a physician or a physiotherapist.
Myths and facts
Myth“Osteopathy cures any disease.”
FactThe effectiveness of osteopathy has mainly been studied for some types of musculoskeletal pain. For many other conditions the evidence is insufficient or no benefit has been shown.
Myth“An osteopath replaces a physician.”
FactThe osteopathic approach does not replace medical examination and diagnosis. If there are signs of serious disease, the patient must be referred to a physician.
Myth“Osteopathy has no side effects.”
FactMild and short-lived reactions are common. Serious complications are rare but possible.
Myth“An osteopath puts organs back in their anatomical place.”
FactThere is no scientific evidence to support this idea.
Myth“The movement of the cranial bones and the cranial rhythm can be felt precisely by hand.”
FactStudies testing the reliability of cranial palpation show that this form of diagnosis is not reliable.
Myth“‘Releasing’ fascia by hand breaks adhesions in the tissue.”
FactMechanically changing dense fascia would require a force many times greater than can be applied by hand. The “release” felt by the therapist is related to other mechanisms, probably the response of the nervous system.
Myth“Osteopathy can be learnt in a course lasting a few weeks.”
FactThe WHO standards require long-term education that also includes supervised clinical practice.
Read on
- The 4-year osteopathy programme
- Curriculum: 40 modules in 4 years
- Knowledge base: evidence-based articles
Sources
- World Health Organization (2010). Benchmarks for training in osteopathy. ISBN 978-92-4-159966-5. who.int (opens in a new window)
- Rogers F. J. et al. (2002). Proposed tenets of osteopathic medicine. J Am Osteopath Assoc, 102(2):63–65. PMID 11866391. PubMed: 11866391 (opens in a new window)
- Zegarra-Parodi R. et al. (2022). Tradition and the evidence-based approach in osteopathy. Healthcare. DOI: 10.3390/healthcare11010010 (opens in a new window)
- American Association of Colleges of Osteopathic Medicine — about osteopathic medicine aacom.org (opens in a new window)
- A. T. Still University — the history of osteopathy atsu.edu (opens in a new window)
- Health Sciences University — successor to the British School of Osteopathy hsu.ac.uk (opens in a new window)
- Barral Institute — about Jean-Pierre Barral barralinstitute.com (opens in a new window)
- United Kingdom: Osteopaths Act 1993, section 32. legislation.gov.uk (opens in a new window)
- EN 16686:2015. Osteopathic healthcare provision (European standard). sis.se (opens in a new window)
- Osteopathic International Alliance (2026). Global report: executive summary (2025 data). oialliance.org (opens in a new window)
- Switzerland: Federal Act on Health Professions. fedlex.admin.ch (opens in a new window)
- Finland: Decree No. 564/1994. finlex.fi (opens in a new window)
- Italy: Presidential Decree No. 131/2021. normattiva.it (opens in a new window)
- Germany: judgment of the Düsseldorf Higher Regional Court of 8 September 2015 (I-20 U 236/13). nrwe.justiz.nrw.de (opens in a new window)
- Türkiye: Regulation on Traditional and Complementary Medicine Practices (Official Gazette, 27 October 2014). resmigazete.gov.tr (opens in a new window)
- Law of the Republic of Azerbaijan “On Private Medical Practice” (30 December 1999, No. 789-IQ). sehiyye.gov.az (opens in a new window)
- NICE NG59 (2016, with 2026 amendments). Low back pain and sciatica: assessment and management. nice.org.uk (opens in a new window)
- Franke H. et al. (2014). Osteopathic manipulative treatment for non-specific low back pain: a systematic review and meta-analysis. BMC Musculoskelet Disord. DOI: 10.1186/1471-2474-15-286 (opens in a new window)
- Franke H. et al. (2017). Osteopathic treatment for low back and pelvic pain during and after pregnancy. J Bodyw Mov Ther. DOI: 10.1016/j.jbmt.2017.05.014 (opens in a new window)
- Franke H. et al. (2015). Osteopathic treatment for non-specific neck pain. Int J Osteopath Med, 18(4):255–267. DOI: 10.1016/j.ijosm.2015.05.003 (opens in a new window)
- Nguyen C. et al. (2021). Osteopathic treatment compared with sham treatment for chronic low back pain: a randomised trial. JAMA Intern Med. DOI: 10.1001/jamainternmed.2021.0005 (opens in a new window)
- Ceballos-Laita L. et al. (2024). Osteopathic treatment compared with sham treatment: a meta-analysis. Diseases. DOI: 10.3390/diseases12110287 (opens in a new window)
- Bagagiolo D. et al. (2022). Effectiveness and safety of osteopathic manipulative treatment: an overview of systematic reviews. BMJ Open. DOI: 10.1136/bmjopen-2021-053468 (opens in a new window)
- Müller A. et al. (2014). Osteopathic treatment for irritable bowel syndrome: a systematic review. J Am Osteopath Assoc. DOI: 10.7556/jaoa.2014.098 (opens in a new window)
- Cerritelli F. et al. (2017). Osteopathic treatment for headache: a systematic review. J Pain Res. DOI: 10.2147/JPR.S130501 (opens in a new window)
- Roberti et al. (2026). Osteopathic treatment for migraine: a meta-analysis. J Osteopath Med. DOI: 10.1515/jom-2025-0234 (opens in a new window)
- Lanaro D. et al. (2017). Osteopathic treatment in preterm infants: a meta-analysis. Medicine (Baltimore). DOI: 10.1097/MD.0000000000006408 (opens in a new window)
- Posadzki P. et al. (2022). Osteopathic treatment in preterm infants: an updated review. J Clin Med. DOI: 10.3390/jcm11154455 (opens in a new window)
- Posadzki P. et al. (2013). Osteopathic treatment in children: a systematic review. Pediatrics. DOI: 10.1542/peds.2012-3959 (opens in a new window)
- Dobson D. et al. (2012). Manipulative therapies for infantile colic. Cochrane review. DOI: 10.1002/14651858.CD004796.pub2 (opens in a new window)
- Guillaud A. et al. (2016). Reliability of diagnosis and clinical efficacy in cranial osteopathy: a systematic review. PLoS One. DOI: 10.1371/journal.pone.0167823 (opens in a new window)
- Guillaud A. et al. (2018). Reliability of diagnosis and clinical efficacy in visceral osteopathy: a systematic review. BMC Complement Altern Med. DOI: 10.1186/s12906-018-2098-8 (opens in a new window)
- Zipp et al. (2025). An overview of systematic reviews on osteopathy. J Bodyw Mov Ther. DOI: 10.1016/j.jbmt.2025.03.018 (opens in a new window)
- Degenhardt B. F. et al. (2018). Adverse reactions after osteopathic treatment. J Am Osteopath Assoc. DOI: 10.7556/jaoa.2018.033 (opens in a new window)
- Carnes D. et al. (2010). Adverse events in manual therapy: a systematic review. Man Ther. DOI: 10.1016/j.math.2009.12.006 (opens in a new window)
- Biller J. et al. (2014). Cervical arterial dissection and cervical manipulation: a statement of the American Heart Association. Stroke. DOI: 10.1161/STR.0000000000000016 (opens in a new window)
- Finucane L. M. et al. (2020). Recognising serious pathology of the spine: the IFOMPT framework. J Orthop Sports Phys Ther. DOI: 10.2519/jospt.2020.9971 (opens in a new window)
- Rushton A. et al. (2023). Assessing cervical vascular risk before manual therapy: the IFOMPT framework. J Orthop Sports Phys Ther. DOI: 10.2519/jospt.2022.11147 (opens in a new window)