I allow an extra 30 minutes for your first visit...Why? To ask you questions.
I'll be asking you all about the issue that has brought you to me and also about your health in general. Why is that?
1. To make sure your issue is appropriate for osteopathic treatment today
Osteopathy started out as a form of medicine for all systems of the body...but I am trained to use osteopathy to help patients with mechanical musculoskeletal problems, and whilst I am very happy to support patients who have other conditions, I don't purport to treat those conditions, so it is my responsibility to refer patients outside my remit. Many systemic conditions present with musculoskeletal symptoms and the case history I take is designed to detect these, so if you are complaining of low back ache and I seem interested in whether you have problems urinating I am thinking about the possibility of a kidney problem or prostate cancer that has metastasised to the lumbar spine. If you are a woman and I am asking about your periods then I might be wondering if you have fibroids. There are few absolute barriers to treatment but an example might be someone with calf pain and the history tells you it started after they returned from holiday...a quick look and very gentle touch to confirm that there is a pulsatile mass and straight off to A&E to investigate for Deep Vein Thrombosis.
2. To determine what forms of treatment are appropriate
If you have had a lifetime of steroid use, or long term anorexia, or a series of broken bones for relatively small knocks, I need to know because it suggests you may have lower than normal bone density. If you have low bone density, I will use more gentle treatment, even if it means results take a bit longer. If you have problems which suggest you might have some cardiovascular disease then I will be even more careful when treating your upper neck, I don't want to run the (tiny) risk of breaking off an atherosclerotic plaque.
3. To identify what the problem is.
By asking you questions about how the problem occurred, how it then progressed, what aggravates it or relieves it, where it hurts and the nature of the pain, I am usually able to work out what is likely to be wrong before I even start to examine you. The examination is designed to add weight to the diagnosis. I don't have X-ray or MRI eyes, or access to nerve block injections so my diagnosis is provisional and the strongest piece of evidence for what is wrong with you is usually the case history. I'll give you an example. A man, in otherwise good health, walks in with low back ache. The pain is worse for movement, especially extension and rotation, standing is painful but sitting not so much, no pain into the legs. The injury occurred in the gym 2 days ago when he bent over a little and felt it go, he was in instant pain and couldn't straighten up, the pain has got a bit better since.
The injury had a clear onset and was as a result of movement. It is also aggravated by particular movements and the man is otherwise in good health, this tells me that the problem is almost certainly musculoskeletal and mechanical in origin. I think it very unlikely it is a herniated disc since the injury happened at partial flexion, not full, the pain was instant rather than taking several hours to develop, no pain into the legs (disc bulges often press on the peripheral nerves, which, in this area, innervate the legs), pain in all ranges of motion, not just flexion, pain not worse for sitting (or all weight-bearing activities) and starting to recover within a couple of days. All of these point me away from a disc injury. I also doubt it is a muscular or ligamentous tear as it didn't occur when under heavy load, so I am thinking that it is likely to be a facet joint injury, some further testing and I am able to confidently estimate recovery time and i can use this knowledge to inform the treatment I use
4. To get to know you
I could send you a health questionnaire and save time and room hire fees. I don't because sometimes I get additional information about a person, that they wouldn't put on a form. Our health, or otherwise, is determined, not just by our physical presence or absence of dysfunction but also our psychological state, our social relationships and our lifestyles. This isn't airy-fairy. If you are stressed you pump out cortisol. Cortisol is designed to keep you keep you ready to fight or flight, this process reduced the resources available to repair injuries. If you have just changed job and the seat is uncomfortable. If you have a 2 year old who is heavy but demands to be carried. Whether you smoke, drink too much, eat poorly, or are a paragon of virtue. All of this information is important to me and is difficult to get from a questionnaire.
Just as importantly though, it is a chance to get to know me a little too...it is an ice-breaker. It is uncomfortable enough, for many, to undress to their underwear for examination. At least this way we are not quite strangers by that stage,
Damian is the principal osteopath at Vauxhall Village Osteopathy and Oval Osteopathy