There is a wide range of treatment options for chronic pain available in Singapore today. Should you go to a chiropractor, a physiotherapist, or an osteopath? Today we discuss who are osteopaths and what is osteopathy.

Who are the osteopathic clinics in Singapore?

City Osteopathy & Physiotherapy and Orchard Health Clinic are probably the biggest players in the Singapore market with the UFIT Clinic coming closely behind.

What is Osteopathy or Osteopathic Manipulative Medicine in Singapore?

We are not really sure so we decided to look up the definition of osteopathy from osteopathic clinic websites for answers.

This is where things get interesting because both Orchard Health Clinic and UFIT Clinic don’t actually have any information to what osteopathy is. We are not sure why that is the case.

City Osteopathy and Physiotherapy didn’t specifically define what osteopathy is as well. They did, however, refer to it as a profession involved with the diagnosis, treatment, rehabilitation, and prevention of musculoskeletal disorder. We think this works as a definition.

Sounds pretty much like chiropractic and physiotherapy, which is no surprise, since all three professions are trained specifically as experts of the musculoskeletal system. As such, it is within our scope to diagnose, treat, and manage muscle and joint issues.

Osteopaths are not osteopathic physicians

While I was doing my research into osteopathy, I came across this term “osteopathic medicine”. This is when things get really, really confusing.

In essence, 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. This means they have practice rights – in both medicine and surgery – equivalent to a medical doctor.

The biggest difference is that osteopathic physicians are trained in manual medicine or manipulative therapy.

N.B. ALL osteopathic programs outside of the United States are NOT recognised as equivalent to the American Doctor of Osteopathic Medicine degrees. I.e. Osteopaths trained outside the US are not recognised as osteopathic physicians. Osteopathic medical schools in the US are structured similarly to allopathic medical schools where students are trained in internal medicine, surgery, family medicine, and to prescribe medications.

Osteopaths, however, have LIMITED practice rights. These are osteopathic practitioners (not physicians) trained in countries such as Australia, Britain or New Zealand.

The history of osteopathy

Earlier we mentioned osteopathy was founded by Andrew Taylor Still. He 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”, which can be corrected by osteopathic adjustment/manipulation – also known as osteopathic manipulative treatment.

osteopath, osteopathic medicine, singapore, chiropractorOsteopathy vs. 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. Chiropractic adjustments are supposed to remove subluxations and – by extension – give you good health.

No wonder people are confused between chiropractors and osteopaths. Our scope of practice is very similar and both professions have very similar origins/traditional beliefs.

N.B. We do not subscribe to the chiropractic subluxation garbage.

What treatments do osteopaths offer?

City Osteopathy and Physiotherapy

  • It’s not clear from their osteopathy page but they did mention the use on hands on therapy. There’s no mention of exercise. However, their physiotherapy did mention the use of exercise as a form of treatment.

Orchard Health

  • Their offering seem to be focused on passive care – shockwave, ultrasound, spinal traction, manual technique, dry needling, kinesiotaping. They do offer rehabilitation in the form of pre- and post-operative care. Not sure if they utilise rehabilitation for non-surgical patients though.

UFIT Clinic

  • Also focused on passive treatments such as manual therapy, soft tissue manipulation and massage, stretching, spinal manipulation, and craniosacral therapy. They did also 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.

We decided to dig deeper into it and see what does studies say about osteopathic treatments.

Study: A profile of osteopathic practice in Australia 2010–2011: a cross sectional survey

 

osteopath, osteopathic medicine, chiropractor, singapore
Not strictly a muscle energy technique example but can look similar to this for neck treatment.

We 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.

What we think of osteopathic treatments in Singapore?

singapore chiropractor, shoulder pain, sports chirporactor, exercise therapy
Singapore #1 Tennis Player Roy Hobbs receiving dry needling treatment for his shoulder pain from chiropractor Jesse Cai

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 did offer very similar treatment approaches to the three clinics previously, we 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, we 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 think in 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 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.

It some countries such as 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.

Should I see a chiropractor or an osteopath or a physiotherapist?

 

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Jesse Cai, the first chiropractor in Singapore to introduce a 100% active care approach to treating musculoskeletal care. This means you get better results, faster.

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.

p.s. There are actually research supporting chiropractors are spinal care experts. We are more evidence-based than physiotherapists and medical doctors. Surprise, surprise. There’s a large scale paper that showed that chiropractors deliver results superior to physiotherapists when it comes to low back pain. We blogged about it twice at lower back pain treatment and 6 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, ostepaths in Singapore practise osteopathy. Not osteopathic medicine.

Come visit us. Our chiropractic clinic is 2-minute walk from Pinnacle @ Duxton and Spottiswoode Park. To come from Tanjong Pagar, take a scroll down the scenic Duxton Plains Park.