I understand that when you’re in pain, it can be a nervous experience seeing an osteopath or other healthcare practitioner for the first time. I hope that I can demystify it a little by explaining what happens in a typical osteopathic consultation.
What an osteopath is and how we’re trained
Osteopaths are trained to diagnose and treat problems with the bones, muscles and joints in the body. We look at the body as a whole and use hands-on treatment to help improve the way it works and relieve the symptoms people experience. In order to become an osteopath, you have to complete a degree course at university and then to practice as an osteopath, you must register with the General Osteopathic Council and carry out continued learning each year.
Osteopaths learn about axial SpA (AS) during their training and are taught to recognise the symptoms and know when someone needs to be referred for investigations. This is important, because although osteopathy is safe and beneficial for people with axial SpA (AS), they need to be formally diagnosed and under the care of a rheumatologist. Osteopaths work with other healthcare practitioners for the benefit of the patient.
What to expect from your first visit
I allow up to an hour for the first visit to allow plenty of time to discuss your symptoms, perform an examination and allow time for treatment if I think it’s appropriate. For patients with axial SpA (AS), I think it’s particularly important to allow plenty of time for discussion. When managing a condition long-term, you need to look at all aspects of your physical and emotional health and formulate a plan to approach it from all angles. It’s also essential that your osteopath understands how your condition affects you and if you have any scan reports, they can provide a good insight and help decide what hands-on treatment could be useful for you.
After the medical history, I then do a physical assessment. This usually requires you to undress down to your underwear, but I always encourage patients to wear shorts if they would be more comfortable and chaperones are always welcome to be present during appointments. It’s important to note that for patients younger than 16 years, we need a parent’s consent and a parent or guardian needs to be present for the whole session.
The physical examination usually involves:
✓ Postural assessment.
✓ Checking the movement of your joints and muscles.
✓ Orthopaedic tests, that doctors use as well.
✓ Neurological tests, such as reflexes, muscle strength and nerve sensations.
✓ General health checks, such as blood pressure and pulse.
Osteopaths won’t just assess the area where you’re experiencing pain for three reasons:
- Sometimes a problem in one area can cause ‘referred pain’ to another area.
- Particularly if a problem has been going on for a long time, you can have changes in other areas of the body that would benefit from treatment.
- It’s possible to have more than one issue at the same time, so it’s important to assess the whole body.
After the assessment, I fully explain everything that I have found and often use drawings and models to demonstrate. I think it’s essential to understand our body and how it works, especially when there’s an injury or problem. If you understand what’s going on and why, this often reduces the anxiety around the pain and you can be actively involved in the recovery process.
If I am concerned about any symptoms needing further investigations or if I feel osteopathic treatment isn’t the best treatment for you, I will always refer on to the correct person. When referring you to your GP I always write a letter to explain what I assessed and why I feel osteopathy isn’t suitable. I strive to give the best possible care for my patients and understand that sometimes that is to refer you on quickly.
I regularly get in contact with patient’s rheumatologists to make them aware that the patient has seen me for treatment. I believe that although osteopaths are more frequently private, rather than NHS, we can still work with healthcare practitioners within the NHS. With something like axial SpA (AS) it’s important to all work as a team for the benefit of the patient.
Consent is a really important part of the assessment and treatment, so I always explain what I’m going to do before I do it, why it is necessary and get your informed consent. Before starting any treatment I always ask for your consent and encourage you to ask as many questions as you wish- there’s no such thing as a silly question!
The hands-on treatment
Osteopaths are well known for their “joint clicking” (manipulations), but I do not recommend these for people with axial SpA (AS). We have lots of other techniques we can use as part of treatment, similar to other manual therapists such as physiotherapists, such as::
✓ Soft tissue massage.
✓ Muscle stretches.
✓ Muscle energy techniques (MET), using your movements to aid muscle stretches.
✓ Gentle joint movements (mobilisations).
✓ Dry needling (medical acupuncture).
✓ Sports tape.
In terms of managing axial SpA (AS) symptoms, osteopathic care is focused on reducing and managing pain, maintaining mobility and improving and maintaining the function of the body’s bones, muscles and joints.
Osteopaths work on the whole body, so although your main symptoms may be in the spine, they aim to improve how the rest of your body is functioning to reduce the strain on the spine. For example, if you have stiffness in your low back it may be difficult to pick things up from the floor. Ensuring your hips and knees are loose and the muscles strong will help you to reach down without straining your back.
Exercises following treatment are essential for patients with axial SpA (AS) to integrate the physical changes from osteopathic treatment and maintain improvements in mobility. According to the European League Against Rheumatism (EULAR), “the cornerstone of non-pharmacological treatment of patients with axial SpA is patient education and regular exercise”.
It’s essential to begin gently and then gradually increase the intensity and frequency of exercises, particularly in those who are newly diagnosed, have bone changes, have had previous steroid treatment or who have recently begun biologic therapy.
Every patient is different and needs to be assessed individually, but usually a mixture of muscle stretching and strengthening is helpful. It’s also important to perform balance exercises to reduce the risk of falls, especially in patients with bone changes in the spine or weakening of the bones (osteoporosis).
The benefits of exercise are temporary and need to be regular in order to maintain improvements and benefits. This is one reason why osteopaths work with patients to find an exercise class or routine that they enjoy, find achievable and can fit into their schedule.
I use a programme called ‘Rehab My Patient’ to create tailored exercise plans that are manageable, including photos and videos. Patients have told me it’s really helpful because they can print the exercises out and place them somewhere they will see regularly as a reminder to do the exercises, but they also have them on their phone so they can check to do them correctly when they’re at work or away from home.
Advice your osteopath can offer
My aim is to get you back to the activities you enjoy and free from pain as quickly as possible. I have the luxury of time with patients, so I can give lots of advice about exercise and lifestyle to help you stay well without the need for osteopathic treatment.
However, I feel osteopaths can play an important role in the ‘health team’ of patients with long-term conditions and be on hand when needed (no pun intended with “on hand”!)
Osteopaths may be able to advise you on:
✓ Work posture or desk set up.
✓ Driving posture.
✓ Exercise routines for your back, ribs and other joints.
✓ Teaching abdominal breathing to help rib mobility and respiratory health.
✓ Local exercise classes that may be helpful.
✓ Diet changes that may help lose weight and increase energy.
✓ Relaxation techniques.
✓ Practical tips to help if hobbies are becoming difficult to carry out.
✓ Ways to manage fatigue and pace activities.
✓ Symptoms or complications of AS to look out for (and advice on who to see if they do occur).
Top tips to make the most of your first osteopathy appointment
✓ Take a chaperone (friend or family member) if you will be more comfortable.
✓ Take copies of prescriptions, scans and most recent correspondence from GP and rheumatology teams.
✓ Take a list of symptoms, questions and concerns.
✓ Keep a symptom diary using an AS tracker app or talkingAS.
I hope this has given you an idea of what your first osteopathy session involves. Please do let me know if you have any questions! You can find a local osteopath via the General Osteopathic Council’s website.
Here’s some research evidence for physical therapy and exercises you can receive from your Osteopath to be beneficial for your AS:
Zoë Clark is an osteopath practicing in Norfolk. Zoë has worked with NASS providing guest blog posts for ASOne and spoke at the inaugural meeting of NASS, the Institute of Osteopathy and the Royal College of Chiropractors at the Norfolk and Norwich University Hospital in February 2018. Zoë has been involved in developing a survey for osteopaths and chiropractors to assess current knowledge of axial SpA (AS) and identify future beneficial projects to help reduce the delay to diagnosis and improve patient care.