Osteopathy is becoming more well known in society as more people choose to seek their help for all sorts of musculoskeletal conditions ranging from back pain, neck pain or other joint or muscular pain arising from anything such as sports, posture or injury. There are actually 5431 osteopaths on the statutory state register in the UK in 2019, compared to 3239 registered chiropractors and approximately 70,000 physiotherapists. You can see why it is that physiotherapy is the well-known sister in the musculoskeletal practitioner family. However, numbers do not relate to effectiveness, experience says that the scope of practice of a practitioner is more reliable. For example, in private practice, all three professions have more time and ability to utilise skills they feel most appropriate for the patient in front of them. So, if you sought treatment from a private practitioner such as a Newcastle osteopath, what exactly would you expect?
Firstly, you can expect the initial consultation to last towards an hour in length. This is really important as it allows plenty of time to get through the process including case history taking – where you tell the osteopath about what it is you are seeking help with and your medical history; the physical examination – where we investigate what is going on with your muscles, joints and nerves; diagnose the problem – we explain for your symptoms; and finally, treatment if indicated – a referral for further investigations if warranted.
The case history taking
The information gathered during this part of the process is vital to ensure that the examination is effective and the correct diagnosis arrived at. Apart from getting a thorough picture of what is going on in your current condition, we can get lots of clues about what, why and how you have ended up in the consultation room on that day. You may think we are being pedantic asking you to describe the pain in detail, or tell us exactly what you are doing when the pain is worse or better, and I sometimes see exasperation when I want to know exactly which fingers a patient is feeling pins and needles because often they haven’t thought about the fact that not all their fingers have altered sensation, however, the importance for this is that it tells us where the nerve may be getting pinched! We also need to work out if the pain in your leg is coming from your leg or is it coming from a pinched nerve or is it coming from referred pain from trigger points, facet joints or discs for example.
Once we have all this information, we arrive at a couple or more possibilities called differential diagnosis. This means we have a pretty good idea what the diagnosis will be, but we need to confirm this through the next part of the consultation which is the physical examination.
The Physical examination
During this part of the process, it is common to remove clothing which will help facilitate the process and enable the osteopath to physically see the area in pain, as well as important factors such as the curves of your spine, the definition of muscles and the position of joints. We can also see if there is any inflammation, erythema or oedema (swelling or redness) in the affected area which might indicate something more that may need further investigation, if there has been a traumatic onset then we can check for bruising, bone integrity ruling out fractures, or joint laxity following a sprain which may need different or more conservative treatment than we would normally offer.
We also move and feel the range and quality of motion of a joint, the surrounding muscles and tissues. We can determine if the muscles or actual joint (or combination of the two!) are causing the pain. The tests we perform can gently stress various tissues such as muscles, joints, discs, ligaments, cartilage with positive results indicating which tissues are involved. Neurological testing is also completed when there is nerve involvement suspected. This means we will check the sensation, motor and reflex pathways as a minimum to confirm our thoughts as to where the nerve impingement is occurring meaning that the correct treatment can be directed to removing the impingement by encouraging movement and healing to occurring tissues which are impinging the nerve. This applies to conditions commonly known as sciatica, carpal tunnel syndrome or a pinched nerve. The key thing is to ensure that the nerve involvement in the presenting complaint is not affecting other nerves causing other symptoms which might need urgent medical attention. By the end of this part of the initial consultation, the osteopath will be able to tell you what is going on, why it might be going on and what their working diagnosis is. This then informs the treatment options.
Treatment
It is very rare that someone attends for their initial consultation and does not receive treatment. The reasons for not receiving treatment are simply that there is something more serious which needs to be looked at through a scan or x-ray, blood test or other investigation performed by a medical doctor.
The treatment you can expect from a Newcastle osteopath will be holistic, meaning that we will treat the area in which the pain exists, but also the rest of your skeleton and muscles which may be restricted or tight and contribute to the presenting complaint. For example, a leg length difference may be caused by tension in your glutes, leading to an uneven pelvis, which is the base upon which your spine sits. This can lead to compensations in your spine for the leg length difference and may present with shoulder, neck, thoracic or lower back problems. This is why working out where or why the complaint is stemming from originally is so important in getting lasting results from your presenting complaint.
You can expect treatment from an osteopath to include soft tissue work – muscles and fascia, joint mobilisation which may include manipulation of the spinal facet joints, acupuncture is often used as an adjunct to these treatments, and various other techniques which are preferred by individual osteopaths. You can expect follow-up treatment sessions from an osteopath clinic in Newcastle to last approximately 30 minutes.