WHO and the European Standard
Although international bodies such as the World Health Organization (WHO) and the European Committee for Standardization (CEN) recognise osteopathy as an independent healthcare discipline with its own professional competencies, the situation in Spain is very different. Osteopathy is currently not regulated as an independent healthcare profession and is included within the scope of physiotherapy under Order CIN/2135/2008 of 3 July. This legislation prevents a clear definition of its scope of practice, the establishment of specific educational requirements, and the protection of the professional title of osteopath. Furthermore, initiatives such as the Ministry of Health’s 2018 Plan for the Protection of Health Against Pseudotherapies have contributed to a distorted perception of the profession, classifying osteopathy as a pseudotherapy while disregarding the positions of both the WHO and CEN. In response, the Spanish Federation of Osteopaths (FOE) has repeatedly submitted extensive documentation and scientific evidence to the Ministry supporting the healthcare nature of osteopathy and its evidence-informed practice. In summary, the lack of regulatory recognition in Spain contradicts the position of international organisations, which support osteopathy as a distinct healthcare discipline with its own standards of quality and safety.
According to the document “WHO Benchmarks for Training in Osteopathy”, published by the WHO in 2010, osteopathy (also referred to as osteopathic medicine): “Relies on manual contact for diagnosis and treatment. It respects the relationship of body, mind and spirit in health and disease; places emphasis on the structural and functional integrity of the body and the body’s intrinsic tendency for self-healing. Practitioners use a wide variety of therapeutic manual techniques to improve physiological function and/or support homeostasis that has been altered by somatic dysfunction (impaired or altered function of related components of the somatic system: skeletal, arthrodial and myofascial structures, and related vascular, lymphatic and neural elements).”
According to the WHO: “The practice of osteopathy is distinct from other health-care professions that use manual techniques, such as physiotherapy or chiropractic, although some techniques and interventions may be shared.”
At the end of 2015, the European Standard EN 16686:2015 on Osteopathic Healthcare Provision was published. Its adoption was officially announced in the Spanish Official State Gazette (BOE) on 21 January 2016. The standard was developed by the European Committee for Standardization (CEN), which at the time included representatives from 34 countries, through the CEN/TC 414 “Services of Osteopathy” committee. The standard specifies requirements and recommendations relating to healthcare provision, facilities and equipment, education and training, and the ethical framework for good osteopathic practice.
The standard states that: “osteopathy is a first-contact, patient-centred healthcare discipline that emphasises the interrelationship between structure and function of the body, facilitates the body’s innate ability to heal itself, and promotes a holistic approach to all aspects of health and healthy development through the practice of manual treatment. Patients choosing osteopathic care must be assured of the quality and standard of healthcare they receive”.
It further specifies that: “the practice of osteopathy uses osteopathic, medical and scientific knowledge to apply osteopathic principles to the diagnosis and treatment of patients”, the standard also highlights that: “scientific rigour and evidence-based practice” are important components of osteopathy. In addition, it defines osteopathy as:
“an independent healthcare discipline” and states that it is: “based on principles derived from human physiology, anatomy and embryology, as well as other biomedical sciences”.
