A retired boxer walks into an osteopath's clinic with persistent sinus infection and a repeat prescription for seemingly ineffective antibiotics. After examining his head, stretching his mouth cavity and manipulating the muscles around his neck, the osteopath draws a sneeze and a giant ball of mucus. The problem is solved.
It is a true story but an atypical example of osteopathy in practice and, frankly, the type of stories they are cautious about telling. Practitioners view their work as seriously as “establishment” doctors, treating everything from back pain to recurrent headaches, post-natal complications to sports injuries.
The issues patients present themselves with are legion, and while regularly alleviated on the osteopathy table, it is a practice that lives in the shadow of scepticism, hampered by a lack of regulation and research.
On Saturday the Osteopathic Council of Ireland (OCI) will use its AGM as a launching point to lobby for statutory regulation, essential to protect and promote its field.
"We don't see any reason why we shouldn't be regulated as such given the fact that the profession has been established in other countries," says its president, Cameron Paulberg.
The OCI claims to represent the large majority of practitioners. Membership requires a recognised qualification, although these are not available in Ireland, and 1,000 hours of supervised treatment.
Osteopathy seeks to cure pain and other issues by examining the body in its entirety, as opposed to localised treatment. Practitioners view it as complementary to established medical treatment, strongly rejecting the “alternative therapy” label.
The majority of issues are musculoskeletal in nature - wide-ranging joint pain, the prevalence of which helps explain the appeal of osteopathy.
A recent report published by the Economic and Social Research Institute (ESRI) and the Health and Safety Authority (HSA), examining workplace injuries and illness between 2001 and 2014, found high levels of musculoskeletal conditions.
They accounted for 47 per cent of illnesses experienced by workers across eight sectors - including 46 per cent in health, 66 per cent in construction and 63 per cent in agriculture, forestry and fishing.
Dr Julie Ellwood, who completed her PhD in London and has been practicing in Ireland for 14 years, has noticed an increase in adolescent cases due to a relative decrease in physical activity. This can manifest itself in general joint pain.
“It’s hands on work with the musculoskeletal system - the muscles, the ligaments and the joints - and getting the framework of the body to move with as much ease as possible,” she says, stressing there is “nothing airy-fairy about it.”
Dr Ellwood says patients are often referred to other specialist care, particularly when ongoing private treatment can be expensive.
But she highlights the need for more research in her field, noting a lack of financial support. “We do work very hard to get on the evidence based ladder.”
This is a principal concern of the established medical community and one that undermines confidence in osteopathy.
Dr Mark Murphy, chair of the Irish College of General Practitioners (ICGP) says about 20 per cent of its members' 25 million annual consultations relate to musculoskeletal conditions and physiotherapy is "often the first line" of recommended treatment.
“Osteopaths may use some conventional evidence-based medical techniques, including physical massage and stretching of muscles, but there are also components of osteopathy that lack scientific evidence,” he said.
“It is very important in healthcare, that only practices which have an evidence-base are supported and advertised. Therefore patients need clarity from regulators on who are providers of safe evidence-based practices.”
This point goes back to the OCI’s determination to pursue State regulation as exists, it says, in a number of other EU countries.
Insurance is not an issue for practitioners - possibly a reflection of the apparent lack of legal actions. Stuart Gilhooly, a specialist in personal injury law, said he could not recall any such cases. Michael Boylan, another specialist, says that in 30 years he has only been involved in one action.
“The difficulty in these types of cases is that often the patient has a chronic history of neck or back pain before the visit the osteopath and it’s very difficult to attribute injury to the actions of the osteopath as opposed to the underlying medical condition,” he says.