Osteopathy and osteopathic manipulative treatment (Still)

Domain X · Body, movement, breath & physical · Andrew Taylor Still · 1874 · Kirksville, Missouri

What it is

Osteopathy is a manual-therapy system developed by Andrew Taylor Still, a US physician and surgeon, in the mid-1800s. He founded the first independent school of osteopathy in 1892. That school was the American School of Osteopathy in Kirksville, Missouri. Some secondary sources date the origin of…

Format

• Information and valid consent. The osteopath explains risks, benefits and alternatives and records the discussion.
• Phase C, alongside. Process body experiences in sessions, watch for adverse effects and boundary issues, and keep the two roles distinct.

Who practises it, and how they are trained or regulated

• Session count and length. No standard number of sessions appears in the regulatory sources, and practice varies. Ask the osteopath for their planned number of sessions and their review point.
• Phase A, consider. Identify a musculoskeletal complaint that is within accepted scope (see section 4.1). Ask whether medical assessment has already happened.
• Phase B, refer and prepare. Give the client information on regulation and title. Prepare a client with a trauma history for touch, and agree a plan for sharing information.

Evidence status, as the guide reports it

• NICE change relevant to psychotherapists. The July 2026 NG59 update deleted the recommendations on cognitive-behavioural psychological therapy and on combined physical-psychological programmes for low back pain. The guideline gives retracted evidence as part of the reason. Psychotherapy for a…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Does it use a device, heat, cold, water or a physical procedure? Has a medical professional checked that it is safe for you?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• see 4.1.11.
• parental exhaustion driving the search for a fix; safeguarding concerns.
• any account of touch that was not explained or was sexualised. Go to 4.1.9.
• self-blame; minimising ("maybe it was a technique"); retraumatisation symptoms.
• the client attributing a new symptom to a "healing crisis" or being told to push through it.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.