S E7: Ep 7 – FAQ: Osteopathy, what do you want to know?

Hello and welcome to the Pain Free Living Podcast.

My name's Bob Allen and my aim is to help you to live pain free.

Let's begin.

Louise a change coach and consultant.

So I work with businesses and individuals to navigate change and as part of that, I ask a lot of questions and that's why I'm here.

Louise does ask a lot of questions and today the podcast is all about questions, questions that an osteopath is likely to be asked by his or her clients.

So over to you, Louise.

What conditions do osteopaths treat?

I would love to say we treat everything.

The reality is we treat mainly muscle and joint issues.

The type of issue depends on the type of osteopath you go and see.

So for me, I treat a range of muscle and joint stuff.

Low back pain, neck pain, head headaches, sprained ankles, quite a broad range of issues.

Once you graduate, you tend to specialise more.

I tend to work more with people with complex medical issues.

So it's the kind of thing where they may have been to see three or four medical healthcare professionals, and because they work in their own little silos, nobody's actually worked out what's going on.

So coming to see somebody like myself, I will look at a full case history, I will take down all of the information and then I'll put piece together what I think is going on from that and obviously I'll talk to the person that comes in to see me and I would kind of go through my thought process and I'll say, this is what I'm going to treat.

Let's see how it goes.

If it does make a difference in one or two treatments, then we'll review and then say, okay, maybe it's not that we'll look at something else, but for me, I'm quite general.

There are other osteopaths who specialize in treating sports injuries.

Other osteopaths will specialise in treating children, et cetera, et cetera.

So it all depends on who you go and see.

Well, you've just answered about three of my questions in one there.

Oh, okay, next one.

And you didn't mention knee at all because you're always talking about knee knees.

But you didn't mention knee in that list.

No, I didn't mention knee in that list.

I treat knees too.

Yes.

Okay.

Okay, this is the classic question.

How does osteopathy differ from chiropractic or physiotherapy?

As an osteopath I specialize in looking at all of the different systems.

So it's not just muscle and joint.

It'll be whether you've had any gut issues, it'll be taking in the whole picture.

All three professions tend to look at the big picture, but we just train differently.

So as a physiotherapist, you tend to be more specific to exercise rehabilitation.

So it tends to be people post surgery, post injury, and then bringing them back to health.

And chiropractic, they are taught because every muscle and joint in the body is connected to the nervous system.

They are trained more that if the spinal column and the nerves coming out of the spine and going back into the spine are in alignment and there's no compression and there are no issues and it's all moving well, then that brings you to optimal health.

So we're all trained in a different way.

But once we get our, once we throw the training wheels away and we get out in the real world, we then tend to specialize more in different areas, tend to do lots of post grad stuff on areas of interest to us.

So for me, I, I do a lot of work with older adults.

I do a lot of work with people with a disability because those are areas of interest of mine.

Whereas like I said, others will look at doing cranial osteopathy or visceral or different branches of osteopathy.

Got you.

Okay, so big question here.

Is osteopathy evidence based?

That is a good question.

And the answer is yes and no.

So most physical therapies are actually quite difficult to do on an evidence based, using an evidence based system.

So if you're talking about medication, then you know, you'll have the 5 milligrams, 10 milligrams, whatever it is, of that medication and you'll give that to a group of people and then you'll see what the results are.

You'll also have a, a control group where you give them a sugar pill or a placebo which looks, tastes like the actual medication.

And you'll see whether the effects that you get from your group that's had the meds is the same or how it differs from the group that haven't had the medication.

You can't really do that with the physical therapy.

So although there are, there are, there are studies out there that have tried to mimic certain techniques, in my view it's, it's pretty unrealistic because if you're doing a physical therapy technique, say it's a mobilization of a shoulder joint, it means putting hands on and moving that shoulder.

Now you can't really pretend to put your hands on and move a shoulder.

You either do or you don't.

So you can't really have that control group or you do something that's kind of pretend, but it isn't because you're actually.

So that's the reason there's not a massive amount of an evidence base.

The other reason that it's not a massive evidence base is because research costs money.

Now, if you are selling a drug, the potential gains from coming up with a new drug and selling that are phenomenal are huge.

So this is why big pharmaceutical companies would much rather have something where they are going to have exclusive rights to it for however many years.

They are prepared to invest millions, if not tens or hundreds of millions in coming up with new drug because they know they can make a profit on that.

If you're talking about a physical therapy, you know the returns are going to be nowhere near the same.

It's very difficult to patent something like a joint manipulation.

It's very difficult to patent something like a shoulder mobilization.

The SODA funding 10 is, is just not there.

So that's one reason why there's this much smaller evidence base.

Having said all of that, nice.

Who will approve or disapprove of things that are used by the nhs have said that osteopathy is a valid treatment approach for cases of low back pain, short term cases of low back pain.

So although the evidence base is small, it is there and there's more evidence coming along all the time.

So yes, it is evidence based answer to that question.

And so you mentioned a minute ago around various techniques that you used, what are the key techniques that you use?

To be honest, I don't really have key techniques.

A lot depends on what the problem is.

So if it's a muscle strain, then there may be some soft tissue.

When we talk about soft tissue, we see a massage type techniques.

If it's.

There's some restriction in a joint that I want to get moving better and to help reduce some of the pain, then I might do a joint manipulation.

Yeah, it really does depend on who walks through the door because different people will get will need different techniques.

If it involves something like your tennis elbow, I'm likely to stick a needle in it.

Tennis elbow though.

Tennis elbow you didn't know you had.

Yeah, so.

So just to let you know that before we started doing the podcast, Lou was asking me a question.

I said, oh, let's just check and see if you've got tennis elbows.

Tennis actually has got tennis elbow.

So one of the things that we can, that we can do, that I would do with that is use dry needling because that worked really, really, really well for things like tennis elbow.

So yeah, it all depends on what's needed.

We haven't actually spoken about dry needling yet, have we, as one of you in one of your podcasts.

No, we haven't, but it's one of the things that I do and like I said, for certain conditions it's really effective.

Really, really effective.

I guess you've talked about stretching, soft tissue massage, manipulation, dry needling.

There's an element of, there is very much an element of hands on in the work that you do.

So I guess there's a question around chaperone and people feeling comfortable to bring a chaperone or ask for a chaperone.

So I guess, yeah, what's your take on that one?

My take on that one is if a client is under the age of 18, I would insist on a chaperone being present anyway.

If it's a female who's concerned about being treated by a male practitioner, then I would have a conversation with them and just understand why.

And if I couldn't reassure them, then I'd be happy to refer them to someone else.

Because one of the things about the treatment is that you have to be comfortable with the person that is treating you.

If you're not comfortable, then yeah, it's, you know, I'd be, I'd be very happy to refer on to female practitioners that I know.

But yes, a chaperone is absolutely fine.

I have no issues with that.

If they're under 18, then definitely bring it.

Have to have a chaperone anyway.

If they're not comfortable being in a room with a male, then I would refer to a colleague.

So yeah, okay.

You know, this massage, manipulation, dry needling, I guess some people are thinking that all sounds a bit painful.

Yeah, they probably are.

If your question is does treatment, does the treatment hurt?

The answer is no.

Dry needling, yeah, really dry needling is something that I discovered last year and one of the.

It was a three day course and we just needle the hell out of each other.

Basically I was in the position that people haven't had who haven't had it done.

I wasn't sure how it would feel.

So I did have tennis elbow, got it dry needled and haven't had a problem since.

It's that good.

But for half an hour afterwards it was uncomfortable.

Should we say it was a bit sore and one of the things that the tutor said was that if you have to dry needle a calf, then you need to warn people that it's going to be very uncomfortable for an hour or two afterwards.

So, yeah, with dry needling it can be, it can be uncomfortable initially and maybe for an hour or two afterwards, but the benefits far outweigh that discomfort.

And it will go.

If you're looking at some of the other techniques that I do, there may be a bit of discomfort.

A lot depends on how tender or sensitive people are.

So I've had people come in with acute low back pain, for example.

Now I'm not going to go in and do soft tissue on a very acute low back.

But, but what I can do is work away from that because, you know, one of our mantras is everything is connected.

So I can work on the lats, I can work on different parts of the body, but still work on the part that needs to be worked on without causing more irritation.

You may find that post treatment, there is some post treatment reaction and that's because if somebody's had, if somebody's been in pain and you start to work on the muscles and joints, whether it's direct or indirect, you're changing, you're changing the body, you're changing how, how the body sits and how it sets.

So yes, there can be some discomfort for 24 to 48 hours after treatment.

But again, risks and benefits, it, it will get better.

And what I found, what I find is as long as you tell people this may be a little bit more sore for a day or two afterwards, then they're quite happy with that.

You know, if they need to use a bit of heat on it or need to take some paracetamol because they understand that it's actually getting better, then they will put up that bit of discomfort.

But it's really, really important to let them know.

So I'm sitting here thinking, what's the difference between dry needling and acupuncture?

The difference is.

So acupuncture is part of traditional Chinese medicine.

So acupuncture is based meridians and you work through the body, there's various meridians and the acupuncture needle goes into that and it can be in there for anything from 10 to 15 to 20 minutes.

So that's more traditional Chinese medicine and acupuncture is part a branch of that.

Dry needling is the Western equivalent of that.

Some trigger points, and I haven't really got time to go into what trigger points are, but in Western medicine we tend to Work more on trigger points.

Now, some trigger points correspond with meridians in traditional Chinese medicine, but we do it for different reasons.

In acupuncture, it's about energy flow and qi and those kind of Eastern concepts.

In the west, because we're less philosophical about these things, we stick a needle into a trigger point and it.

Basically what it does is it releases.

Helps to release the muscle.

So similar techniques, but different in execution.

Tennis elbow, trigger point, for example.

Needle goes in 3, 4, 5 seconds and we take it out again.

So it's.

It's quite immediate.

Whereas with, like I said, with traditional Chinese medicine, use a lot more needles and they stay in for longer.

I'm not trained in acupuncture, so I can't give all of the detail about how it works or how you do it, but in terms of just looking at it, it's dry needling.

In, out, and it's done.

Traditional Chinese medicine, it's more.

There's more to it, there's more philosophy.

Behind it, which for some people, because I know many people do have a bit of a phobia around needles.

Yeah.

So the dry needling, it sounds like a fairly quick technique.

It is a quick technique.

Yeah.

Okay.

So I guess clients, if they're considering going to an osteopath, might be thinking, how many sessions am I going to need?

And I would be thinking, how long is a piece of string?

It depends.

For me, the average is 3 to 5.

Treatments generally resolves most problems, regardless of how long they've been there.

Sometimes where a person is where their job is quite demanding and they are constantly getting that muscle tension, those joint issues, then it can be more regular than that, or it can be more.

You know, there's one or two people I've been seeing for a few years because the problems they're getting because of the work they do are not going to resolve.

So it tends to be ongoing.

But that's a minority majority of people.

Three to five treatments is generally enough to resolve the issues.

And linked to that is.

And how often would you need to see them?

Yeah, again, it depends on how acute they are.

So typically the first couple of treatments will be within a week or two, and then the job is always to extend that time between treatments.

So the first couple of treatments might be within a couple of weeks and then extend it to three or four weeks, and then the fourth or fifth treatment may be a month or six weeks away.

And then we get to that point where you're done, you don't need to come back because One of the things that I do is I give people exercises and things that I can do in terms of self care.

So my, my approach is always to do as few treatments as possible and to give them the tools they need to go away and actually look after themselves.

Okay, so following on from that one then, is there an expectation requirement that clients will need to do exercises at home to supplement any treatment that you give?

Yes.

Yeah.

I'm a big fan of exercise as part of the rehabilitation process.

So, you know, through experience, I know that if somebody give them the right exercises to do, we'll do them.

And they will do them on a regular basis because they can see the end in sight.

They understand one of the things that people tend to be or other therapists tend to have a problem with is that they give people exercises and they don't do them.

So the ratio is something like 20% of people will do them, 80% won't.

For me, it's the other way around.

80% will, 20% may not, probably less than that.

But the reason that I get a lot of people that will stick to the exercises is because I explain what they're doing and why they're doing it.

Very rarely give more than three or four exercises to do.

They can be done at home with no equipment whatsoever.

So I just keep it as simple as possible.

And because I keep it simple, because I explain why they're doing what they're doing and because they're pretty much pain free when they're doing them, then I get a very high compliance rate.

So can osteopathy?

Because I know lots of people struggle with chronic pain.

Can osteopathy help chronic pain?

Yes, it can help chronic pain.

You're surprised at that answer, aren't you?

Yes, it can help chronic pain, mainly because it's all about understanding why the pain is there.

So as I was saying, you know, typically three to five treatments is enough where people have got chronic pain issues that are not necessarily going to go away.

It's all about teaching them how to.

Well, it's all about making sure they understand why the pain is there and then treating the problem, but also, also giving them tools to help treat, to help manage the problem as well.

A lot of the time where people have chronic pain and it seems, and it's just there forever is because they don't understand why the pain is there or what, what's happening.

So I found, I found that the more people understand why they're in pain in the first place, the better they are at managing Their pain issues.

So yeah, a lot of it is just about explanation and giving them things that they can do to help themselves.

So are there any risks or side effects from osteopathy?

Yeah, I mean in terms of side effects, the main one is what we call post treatment reaction.

So it's once you start to change somebody's body, once you start to move mobilized joints, then yeah, you can get what we call post treatment reaction that can last 24 to 48 hours and then it resolves.

So yes, there can be some reaction afterwards.

The other thing about osteopathy is that, well, not osteopathy but the other thing about physical therapy generally is that you want to do enough treatment to make a difference but not too much, that it goes the other way and then can cause more problems.

Sometimes it happens, but not very often.

And like I said, as long as I warn people that there may be post treatment reaction and it may last 24, 48 hours or maybe longer, depending on the person, then they're generally quite happy to accept the fact that yes, it may ache a bit more afterwards.

So my penultimate question is you mentioned earlier that your specialism is or your specialisms are working with older people or people living with disabilities.

Yep.

What then are probably the most common things that you see?

That is a good question.

I still see a lot of back pain.

I still see a lot of neck and shoulder pain, a few knees.

Hint, she was pointing at a knee room.

A few knees.

I interestingly, a lot of knees I see are not knee problems.

They're ankle or foot related problems.

And the knees just sore because it's the joint in the between the two longest bones in the body.

So I do see a lot of, I do see knees, but yeah, mainly low back, neck and shoulders.

What about you haven't mentioned a lot arms or do you see many arms?

Not that many.

Interestingly I do see a few tennis elbow, but not that many.

It's mainly neck, mainly head, neck, shoulders.

Okay, so my final question then is if there is somebody that is thinking about going to see an osteopath, why should they come and see you?

Because I'm really good at what I do.

Serious answer.

Yeah, you're definitely passionate about what you do.

Oh thank you.

I am passionate about what I do.

But also like I said, I tend to work really, really well with people with complex, complex long standing problems.

I was talking to somebody on the phone today who has had back pain, pain in the thighs, et cetera for the last 10 years and we kind of Did a little bit of case history stuff, and I think I know what the problem is.

And this particular problem, I think it's a hip flexor problem.

Oh, no.

When I see him on Thursday.

But this is a com.

What I found is quite a common problem, but very few people actually look at it.

And it can be a cause of low back pain, it can be a cause of hip or groin pain.

It can cause a lot of different issues, but A, it's relatively easy to diagnose, and B, it's relatively easy to treat, but a lot of people just don't think to look.

And so I.

So I.

I can get quite good results from people that have fairly complex medical problems or a long history of muscle and joint issues, but they've never actually got to the bottom of them.

Right.

Because people make assumptions about what it is and then they get better for, you know, a while, a month, couple of months, but then the pain comes back.

I tend not to get that because if.

If I treat someone and they go away and the pain comes back, then I will look at something else because one of the things we know, and a great topic for a podcast, is that where you feel the pain is not necessarily where the pain is coming from.

So, yeah, I.

People should come to see me.

If they have.

Actually, if they have simple muscle and joint problems, I can treat those.

If they have more complex muscle and joint problems that they've had for a while and not got a solution to, then I can generally resolve.

Either I'll resolve it or I can refer on to somebody who can.

So it sounds like whilst you obviously enjoy seeing the more simple things, you enjoy a bit of a challenge in working out, getting to the bottom of.

What I mean, to be honest, that is.

That is my bread and butter.

I.

I love the complex stuff.

So anybody out there who's got a complex issue?

Yeah, you know, I'm perfectly happy to have a conversation with them.

If I think I can help, I will.

If I don't think I can, I'll refer them to somebody who I think will be able to give them more support.

Great.

Thank you, Bob.

I've exhausted all my questions.

Really?

Yeah, my Q and A on my.

Well, my Q and A for common questions for an osteopath.

So thank you.

Thank you.

Okay, we've come to the end of the episode.

Hope you enjoyed it, hope you learned a few things and please tell all your friends like and subscribe and I'll see you next time.