With over 500 searches for “osteopath singapore”, it is clear the demand for osteopathy is on the rise in Singapore. In this guide, I discuss:
- What does an osteopath do?
- Is osteopath a doctor?
- What is the osteopathic lesion?
- What is the difference between an osteopath and a physiotherapist?
- How is osteopathy different from chiropractic?
Chiropractor Jesse Cai talks to osteopath Luke Kukuruzovic about his osteopathic treatment approach to getting older adult patients to exercise their pain away.
Source: Having a Bad Back – Physiotherapist, Osteopath or Chiropractor? | UFIT Clinic
There is so much confusion an osteopath vs. chiropractor that even an osteopath can get it wrong. Paul Stoenescu mistakenly suggested chiropractors heavy rely on spinal manipulations and x-rays. However, at Square One Active Recovery, we refer less than 1% of our clients for x-ray and we no longer offer chiropractic adjustment as a core service.
p.s. I spoke to Declan Halpin (UFIT Clinic Director) about the inaccuracies. He declined to make any corrections at this time.
Who are osteopaths? What is osteopathy?
Paul from UFIT Singapore clearly did not extend the courtesy to chiropractors when he made comparisons between osteopathy, chiropractic, and physiotherapist.
Even when I spoke directly to Declan, they knowingly decided to maintain their false beliefs.
It was an unpleasant experience — not going to lie — so in this blog post I will be referring to content from both osteopathic clinics in Singapore as well as research papers on osteopathy to give you a whole-picture understanding.
Update July 2020: It appears that UFIT Clinic has taken the erroneous post off their website. Thank you!
This is where things got interesting.
Both Orchard Health Clinic and UFIT Osteopathy did not share any information about what exactly is osteopathy.
While City Osteopathy and Physiotherapy also did not provide any definitions, they referred to osteopathy as a profession involved with the diagnosis, treatment, rehabilitation, and prevention of musculoskeletal disorder.
I think this works well as a definition.
It seems like osteopathy is very similar to chiropractic and physiotherapy, which comes as no surprise, since all three professions are trained specifically as experts of the musculoskeletal system.
As such, it is within all of our scope to diagnose, treat, and manage muscle and joint issues.
Is an osteopath a doctor?
In my research, I came across this term “osteopathic medicine”.
This is when things get really, really confusing. Because osteopathic medicine and osteopathy are NOT the same thing!
Here is what I found:
- Osteopathy was founded by Andrew Taylor Still
- A practitioner of osteopathy in the United States is known as an osteopathic physician because they have full practice rights (i.e. equivalent to a medical doctor)
- ALL osteopathic programs outside of the United States are NOT recognised as equivalent to formal medical training
- Osteopaths trained outside the US are NOT medical doctors
- Osteopaths in Singapore have LIMITED practice rights and CANNOT prescribe medications in Singapore
The history of osteopathy
Earlier we mentioned osteopathy was founded by Andrew Taylor Still. Let’s look further into how did osteopaths come about.
Still was particularly interested in classical Newtonian mechanics.
His approach was that an osteopath acts as an mechanic for the human body. The osteopath detects stress, strains, and deviations in a human body, and corrects them to re-establish the fine balance so healing can occur.
He proposed that every part of the body is connected (or interlinked): blood, lymph, cerebrospinal fluid, muscle, bones, nerves, organs etc.
According to him, disturbances in the flow is a deviation from health.
He termed the disturbances as “lesions” (more on this later), which can be corrected with osteopathic adjustment/manipulation – also known as osteopathic manipulative treatment.
How is osteopathy different from chiropractic?
It is quite clear there are certain parallels between traditional osteopathy and traditional chiropractic.
Essentially osteopaths believe the entire body is interlinked and obstructions – known as “osteopathic lesions” – will affect your health.
These “lesions” can be removed with a osteopathic adjustment.
In traditional chiropractic, chiropractors believe that the alignment of the spinal is the key to health.
Misalignment of the spine is also known as a chiropractic subluxation or also vertebral subluxation.
If you look further into the literature, very old school chiropractors believe subluxations interrupt the flow of “innate” which travels via the spinal cord and spinal nerves.
Either way, the proposed solution is a chiropractic adjustment, whihc is supposed to remove subluxations and — by extension — give you good health.
No wonder people are confused between chiropractors and osteopaths.
Not only does our scope of practice overlap, both professions also have very similar origins/traditional beliefs.
N.B. I do not subscribe to the chiropractic subluxation dogma.
Osteopathic lesion – philosophy or dogma?
“Yet, osteopathic manual practitioners, like most musculoskeletal therapists are still educated using outdated, biomedical dualistic concepts that link structure with symptoms, conflating the understanding of nociception and pain.”
A paper published in July 2020 examined the impact of the osteopathic lesion on people in pain. The lead author, Monica Noy, is a Canadian osteopath.
The paper explained that the osteopathic lesion, from an osteopathy perspective, is a disruption of tissues, but one that is non-visible and with NO demonstrable pathology or injury.
I.e. there’s something wrong with you but you can’t see it and cannot measure or find it with any form of established medical testing.
The only way you can find it is true “skilled” osteopathic palpation.
I.e. only an osteopath can touch your body to find one. Nobody else can.
This is a total recipe for snake oil right?
Remember, these are the words of an osteopath!
With that, it should come as no surprise that such narratives are not helpful for patients who are living in pain.
As a pain patient yourself, you probably worry about your symptoms and you most likely have seek treatment from various therapists who promise to resolve them.
It is possible that osteopaths use the osteopathic lesion as an explanation for your symptoms because there are no apparent root causes. Again, chiropractors are just as guilty of this with the “vertebral subluxation complex” BS.
When pain patients are misled to believe that a “lesion” or a “subluxation” is causing their pain, it becomes a problem. They think there’s something — that cannot be seen or measured beyond the special hands of the practitioner — is the cause of their pain and they become forever dependent on that provider.
Imagine your back was to hurt again in the future.
Instead of keeping active, which is the first-line clinical recommendation for back pain, you may end up doing nothing and continuing to live in pain until you have a chance to see your osteopath or chiropractor again.
This is dependency-healthcare.
It’s really no different from being dependent on unnecessary medication!
What does an osteopath do?
I found this study published in 2013 which profiled 54 osteopaths in Australia.
The study found these are the main treatment modalities used by osteopaths:
• Soft tissue therapy (20%)
• Muscle energy technique (15%)
• Manipulative techniques (14%) and education/advice (12%)
Muscle energy technique is almost comparable to a clinician-facilitated resisted range of motion exercises.
Honestly, so very similar chiropractors in terms of choice of modalities. Of course most chiropractors in Singapore would offer only manipulation despite being trained in a wider variety of techniques.
I realised exercise or rehabilitation was not included in the list. That I found surprising.
Either way, very different from what we do at Square One since we do 100% exercise and 100% education/advice. I.e. all of our clients will receive both of that as treatment. Very occasionally, less than 1% will we utilise manual treatments like chiropractic adjustments or IASTM.
Source: The Osteopathic Centre
Do osteopaths do massage?
Yes, osteopaths do do massage.
City Osteopathy and Physiotherapy
- Yes, they offer on “hands on therapy” which should include massage.
- No mention of exercise. However, their physiotherapy did mention the use of exercise as a form of treatment.
- Yes. They also offer shockwave, ultrasound, spinal traction, manual technique, dry needling, kinesiotaping
- Yes. Like Orchard Health, they also offer manual therapy, soft tissue manipulation and massage, stretching, spinal manipulation, and craniosacral therapy.
- They mention about providing exercise recommendation.
None of the three clinics seem to offer unique osteopathic techniques. The general osteopathic treatment seem to revolve around manipulation, soft tissue therapy, and electrotherapy.
What we think of osteopathic treatments in Singapore?
This is by no means a comprehensive review of what Singapore osteopaths as treatments. I am sure if you look up the big chiropractic players, what they offer is drastically different from what we do at Square One.
It is interesting to note that passive modalities seem to be the overarching treatment approach. Exercise, when mentioned, seem to be more of a footnote rather than a core therapy.
Again, exercise is the first-line treatment approach for lower back pain and it gives you results as long as three years later – WITHOUT maintenance care. We blogged about that specific study in Why We Choose Exercise.
While Square One previously offered very similar treatments to the three clinics previously, I have moved on from them to embrace best evidence care.
Everyone seems to claim to be offering the best treatment, or an unique approach, or evidence based care that is backed by the latest research. Is it though?
While browsing the websites, I didn’t see any references to any scientific studies to support their osteopathic treatment approach.
To our best knowledge, the current recommendation for musculoskeletal pain is active recovery through exercise.
Manual therapy, dry needling, electrotherapies such as ultrasound and shockwave should only be used as an adjunctive (accessory) treatment to best evidence practice.
You can check out the paper published earlier this year: 11 best practice recommendations for care in musculoskeletal pain.
Difference between chiropractors and osteopaths
Based on what we have seen so far, there is very little difference between a chiropractor and osteopath Singapore.
While some chiropractors would claim to be spinal experts, it does seem that osteopaths are trained to treat spinal conditions as well.
Traditional chiropractors in Singapore do subscribe to the believe that chiropractic is about correcting spinal misalignment in the nervous system. This misalignment is also known as the chiropractic subluxation. Their belief is that subluxation interferes with the body’s ability to heal and causes health problems. However, no research has been able to support this.
Modern chiropractors no longer operate within that framework.
Both chiropractors and osteopaths are not medical doctors. The “doctor” title is a professional courtesy as a result of the United States education system. Chiropractors and osteopaths would graduate from a doctor of chiropractic or doctor of osteopathy program respectively.
Both chiropractors and osteopaths are part of the health service system. It would be fair to say we are primary care clinicians when it comes to musculoskeletal health. We work in health care setting to help people with their back pain, neck pain, or other muscle and joint disorders. Including sports injuries.
It should be noted that Singapore osteopaths are not osteopathic physicians.
There also seems to be some misconception that osteopathy and physiotherapy are related. We do hear terms like “osteopathy physiotherapy” or “osteopaths physiotherapists” every so often but they are not the same.
In Singapore, both chiropractors and osteopaths are not regulated. As such, we are both considered alternative medicine.
In countries were chiropractic and osteopathy is regulated, such as Australia, both professionals are considered allied health providers in their conventional medical system.
Source: Infinity Chiropractic, Elements Wellness Group
Osteo-chiropractic is by far the most confusing thing I came across in my research. It would look like the spa originally had a chiropractor offering chiropractic services. Osteopath Jan-Mark Smith replaced (?) him and the spa started offering osteo-chiropractic services.
Is osteopathy better than physiotherapy?
Most clinics and practitioners in Singapore try very hard to carve a unique niche for their own profession.
Chiropractors claim to be spinal experts even though both osteopaths and physiotherapists are trained to provide the same spinal care.
Osteopaths may claim to look at the whole body and provide a more holistic approach to your health compared to chiropractors who only look at the spine. Most of these are false claims.
Read more: Six things an orthopaedic surgeon got wrong
When it comes to treating patients, the scope of practice between a chiropractor, an osteopath, and a physiotherapist is minimal. (With the exception of in-patient care for physiotherapists.)
At the end of the day, it’s not about which health care professional you are choosing to see. Instead, it is about who you see specifically and the capacity of him or her to help you achieve the goals you are after.
Square One is committed to delivering superior musculoskeletal care that is backed by the latest research. Unlike most of our competitors, we provide high quality references to support our treatment approach.
We are also 100% evidence based. In doing so, we are happy to remove and add treatment options to your recovery based on what works and what doesn’t.
In our efforts to stay up to date with best clinical practice guidelines, we offer exercise and active care as our main therapy now. We stopped providing passive treatments such as chiropractic adjustments, soft tissue therapy, IASTM, and even dry needling six months ago.
Because, to us, your results matter.
Remember, osteopaths in Singapore practise osteopathy. Not osteopathic medicine.
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*We do not offer short-term pain solutions such as chiropractic adjustments, dry needling, or any form of soft tissue therapy.