Osteopathy and osteopathic manipulative treatment
Pooled trials found osteopathic treatment eased low back pain about 13 points on a 100-point scale against sham, usual care and no treatment combined. Against sham alone, a 2024 review found no difference, while the largest trial found a medium benefit. Infant and ear infection results are mixed. Brief soreness followed 2.5% of visits.
- Status
- In the US, osteopathic manipulative treatment is given by osteopathic physicians (DOs). To be licensed as an osteopathic physician, a person must graduate from an accredited US college of osteopathic medicine, pass a licensure exam sequence and complete graduate medical education, and all 50 states accept the COMLEX-USA exam for licensure [1].
- Also called
- osteopathy, osteopath, osteopathic manipulative treatment, OMT, osteopathic manipulative medicine, OMM, osteopathic manual treatment, DO, osteopathic physician, cranial osteopathy, craniosacral osteopathy, visceral manipulation, myofascial release, muscle energy technique, counterstrain
- Used for
- low back pain, neck pain, back pain in pregnancy, back pain after childbirth, infant colic, excessive crying, ear infections, otitis media, premature babies, headache, migraine, irritable bowel syndrome, fibromyalgia, general wellness
Strong several reviews agree · Moderate one review or consistent trials · Limited one or a few small studies · Untested no study in people, listed with what it rests on
Shown to help3
- StrongShown to ease low back pain by about 13 points on a 100-point scale at 3 months, in pooled trials that mixed sham, usual care, physiotherapy and no-treatment comparisons.
- ModerateShown to cut crying by about 1.3 hours a day in pooled manual therapy trials, which included chiropractic and osteopathy and mostly had parents who knew the treatment.
- ModerateShown to shorten hospital stays in premature babies by about 2.7 days when added to usual neonatal care, in five trials.
What it is used for, and what was found
Shown to help3
Low back pain, compared with a mix of sham, usual care, physiotherapy and no treatment
Shown to ease low back pain by about 13 points on a 100-point scale at 3 months, in pooled trials that mixed sham, usual care, physiotherapy and no-treatment comparisons.
Compared with sham treatment, usual medical care, physiotherapy and no treatment, pooled together [4]; control interventions the source abstract does not describe [5]; active treatment, placebo and no treatment [6]
The numbers and sources
- Effect
- At 3 months, pain fell 12.91 points more on a 100-point scale (95% CI -20.00 to -5.82) and function improved (SMD -0.36, 95% CI -0.58 to -0.14) in acute and chronic low back pain. In chronic low back pain alone, pain fell 14.93 points more (95% CI -25.18 to -4.68) [4]. A 2021 review of chronic low back pain found pain fell more than with control interventions (effect size -0.59, 95% CI -0.81 to -0.36) and function improved (-0.42) [5]. An earlier review found a smaller pain reduction (effect size -0.30, 95% CI -0.47 to -0.13) that held at short, intermediate and long-term follow-up [6].
- Population
- 15 trials, 10 in nonspecific low back pain [4]. 10 trials in chronic low back pain [5]. 6 trials with 8 comparisons [6].
- Sources
- [4], [5], [6]
- Caveats
- None of the trials in the 2021 review was judged at low risk of bias in every domain [5]. The comparisons could not be analyzed separately [4], so the pooled effect includes trials against no treatment, where patients knew they were untreated. The sham-only result is in the block above.
Infant colic and excessive crying
Shown to cut crying by about 1.3 hours a day in pooled manual therapy trials, which included chiropractic and osteopathy and mostly had parents who knew the treatment.
Compared with no physical treatment, sham treatment or a drug, depending on the trial [10]; no treatment for 3 weeks [11]
The numbers and sources
- Effect
- Manual therapy reduced crying by 1.27 hours a day (95% CI -2.19 to -0.36). Effects on sleep and parent-child relations were inconclusive, and parent-reported global improvement showed no effect [10]. In 103 infants with colic, three osteopathic treatments lowered parents' psychological stress by 3.5 points on a 0 to 10 scale more than 3 weeks without treatment (95% CI 2.6 to 4.4), with similar changes in crying time and intensity [11].
- Population
- 7 randomized trials among 19 studies of otherwise healthy crying infants [10]. 103 infants aged 1 week to 3 months in Germany [11].
- Sources
- [10], [11]
- Caveats
- The review pooled osteopathy with chiropractic and massage [10]. Crying was reported by parents, who knew whether their baby was treated in the 2025 trial [11]. Results from trials with parents blinded are on the chiropractic page.
Hospital stay in premature babies
Shown to shorten hospital stays in premature babies by about 2.7 days when added to usual neonatal care, in five trials.
Compared with usual neonatal care, with an osteopathic evaluation and no treatment in 3 of 5 trials [14]
The numbers and sources
- Effect
- Babies given osteopathic treatment as well as usual care left hospital 2.71 days sooner (95% CI -3.99 to -1.43) and cost less to treat. The benefit was larger in babies born earlier. No study reported adverse events linked to treatment [14].
- Population
- 1,306 preterm infants in 5 trials [14].
- Sources
- [14]
- Caveats
- Heterogeneity was moderate (I² 61%). The review used a fixed-effect model [14].
Mixed results5
Low back pain, compared with sham treatment
Mixed results: a 2024 review of sham-controlled trials found no difference in back or neck pain, while the largest trial found more people improved with treatment than with sham.
Compared with sham or placebo interventions [2]; sham osteopathic treatment [3]
The numbers and sources
- Effect
- Pooled against sham or placebo, osteopathic treatment did not change pain intensity (SMD -0.15, 95% CI -0.38 to 0.08, 7 trials, 1,173 patients) or disability (SMD -0.09, 95% CI -0.25 to 0.08, 6 trials, 1,153 patients) in neck or low back pain, and most of the 9 trials found no difference [2]. In the largest trial, people given osteopathic treatment were more likely than those given sham to have a 30% or greater drop in chronic low back pain at 12 weeks (response ratio 1.38, 95% CI 1.16 to 1.64) and a 50% or greater drop (1.41, 95% CI 1.13 to 1.76), a medium effect by Cochrane Back Review Group criteria. Back function, general health and work disability did not differ from sham [3].
- Population
- 9 trials of adults with neck or low back pain [2]. 455 adults with chronic nonspecific low back pain [3].
- Sources
- [2], [3]
- Caveats
- The 2024 review pooled neck and back pain and rated the certainty moderate to very low [2]. The practitioner cannot be blinded to giving real or sham treatment.
Low back pain in pregnancy and after childbirth
Mixed results: a review found less pain in pregnant and postpartum women, while the largest pregnancy trial found treatment no different from placebo ultrasound, with both better than usual care.
Compared with usual care only, and usual care plus placebo ultrasound [7]; control groups the source abstract does not describe [8]
The numbers and sources
- Effect
- In pregnancy, pain fell 16.65 points more (on a 100-point scale) and function improved (SMD -0.50), at moderate quality. After childbirth, pain fell 38.00 points more and function improved (SMD -2.12), at low quality [8]. In 400 women in the third trimester, 7 treatments over 9 weeks eased pain and slowed loss of back function more than usual care alone (P < .001), and results with osteopathic treatment were similar to placebo ultrasound [7].
- Population
- 5 trials in pregnancy and 3 after childbirth [8]. 400 women in their third trimester [7].
- Sources
- [8], [7]
- Caveats
- The trial authors suggest the placebo ultrasound may have been more active than intended [7].
Neck pain
Limited evidence: four small trials pooled against no treatment or sham found less neck pain, at very low quality, and a 2024 sham-only review found no difference.
Compared with no intervention or sham treatment, pooled together [9]; sham or placebo interventions [2]
The numbers and sources
- Effect
- Against no intervention or sham, osteopathic treatment lowered pain (effect size -1.57, 95% CI -2.50 to -0.65) and improved function (-1.71), with very low quality evidence for every outcome [9]. The 2024 review, which pooled neck and low back pain against sham or placebo only, found no difference in pain or disability [2].
- Population
- 5 trials, 4 pooled, of adults with nonspecific neck pain [9]. 9 trials in neck or low back pain [2].
- Sources
- [9], [2]
- Caveats
- None of the neck pain trials was judged at low risk of bias in every domain [9].
Ear infections in children
Mixed results: one trial found fewer ear infections and surgeries when treatment was added to routine care, and a trial against sham treatment found no difference.
Compared with routine pediatric care [12]; sham osteopathic treatment [13]
The numbers and sources
- Effect
- In 57 children with recurrent acute ear infections, adding osteopathic treatment to routine care led to fewer episodes (mean difference -0.14 a month, 95% CI -0.27 to 0.00), fewer surgical procedures (1 against 8) and more normal tympanograms [12]. In 90 otitis-prone children, up to five osteopathic treatments did not significantly change the risk of an ear infection over 6 months compared with sham (44% against 61%, RR 0.72, 95% CI 0.48 to 1.10) [13].
- Population
- 57 children aged 6 months to 6 years [12]. 90 children aged 12 to 60 months in Arizona [13].
- Sources
- [12], [13]
- Caveats
- Two small trials. In the first, the pediatrician was blinded but the families were not [12].
Headache, irritable bowel syndrome and other conditions
Mixed results: an overview of 27 reviews found possible relief in migraine and irritable bowel syndrome, and no relief in acute low back pain, fibromyalgia or other headaches.
Compared with no treatment, sham treatment or other non-osteopathic treatment [16]
The numbers and sources
- Effect
- Osteopathic treatment may relieve symptoms in adults with migraine and irritable bowel syndrome. It did not appear to relieve acute nonspecific low back pain, fibromyalgia, headaches of various causes, lower urinary tract symptoms in women, or cerebral palsy in children. Evidence for vertigo, COPD, high blood pressure and gynecological complaints was insufficient [16]. An earlier overview rated the evidence for children's conditions, headache and irritable bowel syndrome limited and inconclusive [17].
- Population
- 27 systematic reviews covering nine indications [16]. 9 reviews with 55 trials and 3,740 participants [17].
- Sources
- [16], [17]
- Caveats
- Included reviews were rated low or critically low in quality [17], and the trials were heterogeneous and partly of poor quality [16].
Not shown to help1
Cranial osteopathy
Not shown to rest on a reliable diagnosis or to have strong trial evidence. A review found examiners did not agree and rigorous efficacy trials were almost non-existent.
Compared with control conditions in randomized or crossover trials, which the review abstract does not describe [15]
The numbers and sources
- Effect
- Studies comparing two examiners, or one examiner on two occasions, found the diagnostic procedures of cranial osteopathy unreliable in many ways. Of 14 efficacy trials, 2 were at high risk of bias, 9 had major doubts about bias and 3 were at low risk, and those 3 did not consider other explanations such as a nonspecific effect of treatment [15].
- Population
- 9 reliability studies and 14 efficacy trials across many conditions [15].
- Sources
- [15]
- Caveats
- The review included only studies in English or French with open full text [15].
Protocols studied
The largest back pain trial gave 6 sessions over 8 weeks from osteopathic physicians [3], and the pregnancy trial 7 sessions over 9 weeks from board-certified specialists [7]. The infant colic trial gave 3 sessions a week apart [11]. The sham-controlled ear infection trial offered up to five treatments over 3 months, including cranial techniques [13]. Trials pooled under osteopathy included general osteopathic treatment, myofascial release, craniosacral treatment and visceral manipulation [5]. Comparison treatments included sham osteopathic treatment and placebo ultrasound [3][7]. Spinal manipulation, which osteopaths also give, is covered on the chiropractic page, including its reported link to neck artery tears.
Risks
Reported risks1
Pain or discomfort after treatment
Shown at 2.5% of office visits, mostly as pain or discomfort, in patients asked right after treatment. Safety outcomes did not differ from sham in the largest back pain trial.
The numbers and sources
- How common
- Common: between 1 in 100 and 1 in 10 people.
- Effect
- Patients felt worse or much worse right after treatment at 45 of 1,847 visits, an adverse event rate of 2.5% (95% CI 1.3% to 4.7%). Pain or discomfort was the most common type (0.9%). Women reported adverse events more often than men (OR 13.9) [18]. In the largest back pain trial, safety outcomes did not differ between osteopathic treatment and sham [3]. Most systematic reviews reported no adverse events [17].
- Population
- 884 patients at 1,847 visits [18]. 455 adults [3]. 9 systematic reviews [17].
- Sources
- [18], [3], [17]
- Caveats
- Effects were recorded before patients left the office, so later effects were not captured [18].
Checked, no increase found1
Adverse events in infants
Not shown to raise adverse events in infants: 7 mild events per 1,000 infants treated, against 110 per 1,000 untreated, in a review of manual therapy.
The numbers and sources
- How common
- Uncommon: between 1 in 1,000 and 1 in 100 people.
- Effect
- Seven non-serious adverse events were reported per 1,000 infants given manual therapy (n = 1,308) and 110 per 1,000 among those not given it [10]. No trial in premature babies reported an adverse event linked to osteopathic treatment [14].
- Population
- 1,308 infants given manual therapy [10]. 1,306 premature babies [14].
- Sources
- [10], [14]
- Caveats
- The review pooled osteopathy with chiropractic and massage, and reporting of harms was inconsistent [10]. Serious harms after high-velocity spinal thrusts in infants are covered on the chiropractic page.
Claims tested and not found
- That osteopathic treatment eases neck or low back pain more than sham. Pain and disability did not differ from sham or placebo in a 2024 review of 7 trials [2].
- That osteopathic treatment prevents ear infections in otitis-prone children. Risk did not differ from sham treatment in 90 children [13].
- That cranial osteopathy rests on a reliable diagnosis. Examiners did not agree in reliability studies [15].
- That osteopathic treatment helps back pain in pregnancy beyond placebo. Results were similar to placebo ultrasound in 400 women [7].
Related
Sources
- American Association of Colleges of Osteopathic Medicine. Medical Board Examinations and Licensure. 2026. https://www.aacom.org/become-a-doctor/succeed-in-medical-school/board-examinations-and-licensure
- Ceballos-Laita L, Jiménez-Del-Barrio S, Carrasco-Uribarren A, et al. Is Osteopathic Manipulative Treatment Clinically Superior to Sham or Placebo for Patients with Neck or Low-Back Pain? A Systematic Review with Meta-Analysis. Diseases. 2024. https://doi.org/10.3390/diseases12110287
- Licciardone JC, Minotti DE, Gatchel RJ, et al. Osteopathic manual treatment and ultrasound therapy for chronic low back pain: a randomized controlled trial. Annals of Family Medicine. 2013. https://doi.org/10.1370/afm.1468
- Franke H, Franke JD, Fryer G. Osteopathic manipulative treatment for nonspecific low back pain: a systematic review and meta-analysis. BMC Musculoskeletal Disorders. 2014. https://doi.org/10.1186/1471-2474-15-286
- Dal Farra F, Risio RG, Vismara L, Bergna A. Effectiveness of osteopathic interventions in chronic non-specific low back pain: a systematic review and meta-analysis. Complementary Therapies in Medicine. 2021. https://doi.org/10.1016/j.ctim.2020.102616
- Licciardone JC, Brimhall AK, King LN. Osteopathic manipulative treatment for low back pain: a systematic review and meta-analysis of randomized controlled trials. BMC Musculoskeletal Disorders. 2005. https://doi.org/10.1186/1471-2474-6-43
- Hensel KL, Buchanan S, Brown SK, et al. Pregnancy Research on Osteopathic Manipulation Optimizing Treatment Effects: the PROMOTE study. American Journal of Obstetrics and Gynecology. 2015. https://doi.org/10.1016/j.ajog.2014.07.043
- Franke H, Franke JD, Belz S, Fryer G. Osteopathic manipulative treatment for low back and pelvic girdle pain during and after pregnancy: a systematic review and meta-analysis. Journal of Bodywork and Movement Therapies. 2017. https://doi.org/10.1016/j.jbmt.2017.05.014
- Dal Farra F, Buffone F, Risio RG, et al. Effectiveness of osteopathic interventions in patients with non-specific neck pain: a systematic review and meta-analysis. Complementary Therapies in Clinical Practice. 2022. https://doi.org/10.1016/j.ctcp.2022.101655
- Carnes D, Plunkett A, Ellwood J, Miles C. Manual therapy for unsettled, distressed and excessively crying infants: a systematic review and meta-analyses. BMJ Open. 2018. https://doi.org/10.1136/bmjopen-2017-019040
- Schwerla F, Zimmer M, Göpfert J, et al. Osteopathic treatment of infants with infantile colic/excessive crying: a prospective, multicentric, randomized controlled trial and nested observational trial. BMC Pediatrics. 2025. https://doi.org/10.1186/s12887-025-05413-1
- Mills MV, Henley CE, Barnes LL, et al. The use of osteopathic manipulative treatment as adjuvant therapy in children with recurrent acute otitis media. Archives of Pediatrics & Adolescent Medicine. 2003. https://doi.org/10.1001/archpedi.157.9.861
- Wahl RA, Aldous MB, Worden KA, Grant KL. Echinacea purpurea and osteopathic manipulative treatment in children with recurrent otitis media: a randomized controlled trial. BMC Complementary and Alternative Medicine. 2008. https://doi.org/10.1186/1472-6882-8-56
- Lanaro D, Ruffini N, Manzotti A, Lista G. Osteopathic manipulative treatment showed reduction of length of stay and costs in preterm infants: a systematic review and meta-analysis. Medicine. 2017. https://doi.org/10.1097/md.0000000000006408
- Guillaud A, Darbois N, Monvoisin R, Pinsault N. Reliability of Diagnosis and Clinical Efficacy of Cranial Osteopathy: A Systematic Review. PLOS ONE. 2016. https://doi.org/10.1371/journal.pone.0167823
- Zipp CR, Semlitsch T, Tögel G, et al. An overview of systematic reviews on the efficacy and safety of osteopathic techniques. Journal of Bodywork and Movement Therapies. 2025. https://doi.org/10.1016/j.jbmt.2025.03.018
- Bagagiolo D, Rosa D, Borrelli F. Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews. BMJ Open. 2022. https://doi.org/10.1136/bmjopen-2021-053468
- Degenhardt BF, Johnson JC, Brooks WJ, Norman L. Characterizing Adverse Events Reported Immediately After Osteopathic Manipulative Treatment. Journal of the American Osteopathic Association. 2018. https://doi.org/10.7556/jaoa.2018.033