As our clinic progressively establishes its reputation in Uxbridge and surroundings, one of the most rewarding aspects of our work is when patients start referring not only friends, but also members of their own family: spouses, children and grandchildren.

In a few instances, we are now treating three successive generations of one family, which is both exciting and rewarding. Equally pleasing is when spouses begin referring each other for treatment - even if one cannot exclude the odd bit of coercion in the process…

Treating couples or families can provide great insight into some contributory or maintaining factors behind a patient’s condition. Equally, the family unit at large may be taken into account when prescribing exercise, dietary of lifestyle advice - for instance, a couple can work as an excellent emulation unit to ensure exercise and dietary changes are implemented and complied with!

Also, there is the obvious satisfaction of seeing the health of a group of people improve over a prolonged period of time, as some patients revert to the principle of regular preventive check-ups once the presenting issue has been dealt with.

However, although these referrals can only be interpreted as a vote of confidence, they also come with their own challenges and issues to consider both for the therapist and the patient.

Increased Expectations
The referred patient naturally comes with heightened expectations regardless of their presenting complaint, lifestyle, outlook and tendency to comply with exercise and occupational advice - all of which have as great an impact on the outcome as the treatment itself.

Discussing Partner’s treatment
Particularly in the case of spouse referrals, there is a natural tendency to wish to discuss the partner’s ailment(s), or to use the therapist as a more credible conduit to issue recommendations and advice - “do please tell him to ….” occasionally rings in our ears as a refrain.

The fact of the matter is that unless spouses are present at each other’s treatment sessions, each spouse is treated privately and in the strictest confidence, and only advice that the osteopath considers clinically relevant to the patient can be prescribed with integrity. The only way to find out what is going on is to ask… the spouse.

Treating Friends
Another delicate situation is the friendship that inevitably develops between the practitioner and certain patients. There are of course the obvious boundaries between therapy and friendship, such that the clinician takes over throughout examination and treatment, even if the conversation is friendly. A less obvious trap is when patients may start to mask some of their enduring symptoms so as not to offend or embarrass the practitioner. Our view on this matter is clear: friendship must never get in the way of clinical judgment and therapy, and the patient must therefore be encouraged to be as truthful and accurate about their progress - or non-progress - as possible, to secure the best possible health outcome in the shortest time-frame.

The practitioner must in turn take the utmost care to ensure that his clinical judgment, treatment and advice remain at all times as lucid and objective as possible, and are not adversely influenced by the emotion of friendship.

Patient/Parent Consent
Another interesting situation with treating several generations in a family, including the youngest, involves the occasionally delicate issue of patient consent and chaperoning.

Young children must of course always be accompanied by a parent or guardian. However, the law suggests that from 16, young people are presumed to be competent to consent for themselves - indeed, it recognises that some children under 16 are competent to make decisions about their healthcare.

All in all, our take on treating young adults chaperoned by their parents is that rather than try and operate within ambiguous and occasionally contradictory legal guidelines, it is most important to provide very clear explanations about treatment rationale and objectives, and ensure that both parent and child understand and agree at all times.

In short, treating spouses and families is a privilege and a highly rewarding experience, but it does require from both patient and practitioner the recognition and respect of some important boundaries to support the smooth and effective progress of treatment.

We spend a lot of time working with patients who have developed an injury or poor health through the stresses imposed by their occupation. There are many factors that must be considered to give a complete treatment plan.

How did the initial injury happen?
e.g. A lifting injury, picked up a large sack, forgot to bend knees and felt a twinge in the back

How are office ergonomics?
Lot’s of travel, but often need to fit into small spaces with cluttered floors… (which are occasionally on fire.)

Any dietary factors?
Excessive consumption of brandy and mince pies (nice case of raised cholesterol and liver cirrhosis)… thought about veg but always end up giving it to the reindeer.

Is stress a factor?
You try delivering gifts to every child in the world in one night and tell me how you feel!

If you have been helping Santa and are also suffering from similar aches and pains contact myself or Mathieu to book an appointment at the clinic on Uxbridge High Street (inside Fitness First).

While we will endeavour to keep the clinic open throughout the holiday season for anyone who has hurt themselves by lifting their over plumped turkey out of the oven(!), we will obviously be closing for a few days.

The clinic will be closed from Wednesday 24th to Friday 26th December, and also on Thursday 1st January 2009.

We will be available on the morning of the 31st for any urgent osteopathic appointments as well.

Have a fantastic Christmas break and good fortune in 2009, with best wishes from the osteopathic team at Bridge to Health.

Let me start this entry by clarifying that it is not meant as a guilt trip, and is no diatribe against your choices over the Christmas period…

“you must forego all pleasures and only eat sprouts for your Christmas dinner!” -

I’m no hypocrite, Christmas is an important time for celebration and reflection where we should get together with family and friends, take stock of the year gone and look onwards to the New Year and its new challenges. However we should note that during this time our health usually takes quite a hit and as always, prevention is better than cure. Some planning around this time should prevent the worst effects.

Start at full power

If our health is going to take a hit, it’s better to start at full strength so right now take extra vigilance in your lifestyle choices. Fend away potential illness by the most effective way we know, a healthy immune system.

• Boost your immune system with a good balanced diet, ensuring plenty of fresh ingredients, at this time of year we have a wide array of fantastic, earthy vegetables full of vitamins and minerals such as squash, parsnips, and the wide variety of greens which are in season now.
• Supplementing your diet can also help this but not as a replacement for good nutrition. There are several powerful immune boosters such as echinacea, propolis and the most effective, vitamin C.
• If you do feel you are ‘coming down’ with an illness, my personal cure is always fresh chilli and garlic (and plenty of it), although probably not before the Christmas party or you might clear a wide space on the dance floor…

During party season

If I suggest you drink less at the Christmas party, are you going to listen? If not, then at least minimise the damage you cause (both to your body and your reputation at the office).

• You need to maintain good hydration, so if you know you’re going out that evening drink plenty of fluids throughout the day and most definitely at the end of the night before bed.
• Make sure you eat a full meal before you start drinking and try to stick to one type of drink.
• The following day, get back to extra good habits, good food, plenty of fluids and some light exercise.

Into the New Year

By now we’ve drunk too much, eaten our body weight in mince pies and the body feels like it’s running on crude oil, not high-octane performance fuel. Most people have started a new year with a pang of regret about the previous couple of weeks, but that can’t be changed by then, so how do we get the body back up to full steam, and fast?

The body needs to flush out all the toxins you’ve been kindly storing and the lymphatic system will be working overtime.

• Some light exercise such as walking will provide the muscular pumping needed to clear the waste, preferably in the good fresh air, rather than up and down the Uxbridge high street, and this can also be effectively boosted by treatment aimed at stimulating your lymphatics and clearing the waste - see our January special health offer!

Back to diet, whatever you goals are for your dietary intake now is a good time to critically evaluate and improve your nutritional habits. “You are what you eat” so in order to maintain a healthy weight, a strong immune system and an active lifestyle, you must give the body the nutrients it needs and deserves. Improve your habits now!

As I said before, this is no lecture, I will be enjoying a healthy dollop of brandy butter on my Christmas pud! To be frank, this period of rest and indulgence is incredibly important and does bring with it some valuable benefits to health, but be aware of your body’s needs throughout and you will be able to start the New Year at full speed.

The dominant attitude towards health today is a curative, reactive one.

Indeed, we will sit and work all day hunched back in our chair staring at a computer screen, eat our ready-meal dinner (following on from our snack lunch sat at the desk), then slouch into a settee and watch the evening news and film, putting off exercising and losing weight until tomorrow or next week… and if anything goes wrong, we only need to pay a visit to our GP, who will prescribe a few pills and get us back in the saddle - fast!

Yet why are we spending so much time damaging rather than nurturing our health? And as the damage is often gradually done over a long period of time, how can we expect our doctors to instantly assess and “fix the problem” in the space of a five minute consultation?

As holistic osteopaths, we aspire to embody and share a very different health model.

For starters, we view the human body as nothing short of a miracle of design and execution, a true gift well worth nurturing and protecting from birth into advanced decades of age.

We also know from clinical experience and practice that the body naturally tends towards health rather than disease, and has an amazing ability to self repair and right itself if allowed to.

In effect, our view is that the best form of fighting disease is not a curative pill, but the preventive approach of attending to all the conditions underpinning excellent, long term health.

The underlying conditions of health are rather more wide-ranging than consuming the “five portions of fruit and veg” a day and walking for half an hour three times a week - which sadly most of us fail to do.

We are interested in promoting health as resting on:

• an alkaline, rather than acid-forming, diet ensuring that the right balance of food groups, vitamins and minerals is fulfilled;
• enough of the right source of fluids;
• a balanced exercise schedule, combining cardiovascular health, flexibility and muscle tone;
• minimising exposure to toxins, in very practical ways;
• postural awareness, work ergonomics and workplace exercise routines that tend to prevent workplace injuries
• good breathing awareness and practice;
• good sleep;
• the regular practice of relaxation and meditation routines

Six months ago, we encompassed these thoughts and recommendations into a short workshop called “ten tips to avoid the osteopath” and have been delivering it since in a wide range of settings - health spas, companies, old peoples’ homes, sheltered accommodation, clubs - in an attempt to promote a more positive, empowered approach to health in the community.

If you are interested in this workshop either personally or on behalf of a company or organisation (as well as personal consultations we also offer a range of structured services for employers: health workshops, ergonomic assessments and on-site osteopathic treatment) please contact Mathieu at the clinic on 01895 2000 50.

When you book to see an osteopath, do you know what to expect?

Modern osteopathic training is continually evolving in response to research and development, however as the osteopath develops their skills and practice, their style of treatment will evolve to a more personalised approach influenced by the different approaches to patient care found amongst the osteopathic community.

When you visit your osteopath, the initial consultation is an information gathering session. We are looking at your posture, how you move, and your description of the condition in order to build a picture in our minds of what might be happening. The next point of diagnosis will come from laying hands on the body and moving joints passively to gather information from the affected areas. Once armed with a diagnosis, treatment goals are to restore good function to the body, but the approach can vary between osteopaths.

There are several distinct styles of osteopathic treatment and whilst some osteopaths will draw on several, others will focus essentially on one form only.

What are the different styles?

Structural Osteopathy
This is the most common approach to osteopathic treatment and is the foundation upon which modern training is based. It is where the osteopath will use manual techniques to affect the musculoskeletal system: joints are moved, muscles are stretched and in so doing the treatment effect can reach into the body and help the nervous system, blood supply or organ function.

Classical Osteopathy
Although this style involves a structural approach it is based on more traditional principles.

Osteopathy was founded in the US in 1874 by Andrew Taylor Still and then further developed by John Martin Littlejohn who also introduced osteopathy to England in 1911. They developed a system which mobilises the body in a specific manner, such that it generates an impact on the underlying physiology.

The first osteopaths were primarily healers who were concerned with treating ’systemic illness’ such as typhoid and diphtheria, rather than the modern day osteopath who is most well known for treating back pain and sports injuries. Classical osteopathy is based on a specific routine known as the ‘body adjustment’ where the entire body is involved, and more specific treatment can be directed as appropriate. Unfortunately, this form of osteopathy is not so well understood today, and there are only a few osteopaths who use this approach exclusively.

Cranial Osteopathy
This is a more subtle approach which involves a gentle ‘hold’ of the patient to interact with more subtle energies and the body’s fluid dynamics.

Tiny physiological movements in the bones in the head and face are vital for health, and cranial osteopathy can focus on any obstructions to these microscopic movements that may have been caused by trauma or injury. Last month Mathieu explained more about this style of osteopath in his post what can a cranial osteopath treat.

Visceral Osteopathy
This approach looks at the relationship between the physical structure of the body and the organs, such as the digestive tract or respiratory system. Through the stresses imposed by poor posture, diet or lifestyle pressures, the organs can build areas of tension which can then lead to referred ‘viscero-somatic’ pain.

One example of this is the intense groin pain created by an acute kidney infection. In this case treatment over the area of pain may be ineffective whereas direct manipulation of the kidney may stimulate the healing response needed to relieve the pain.

Visceral treatment can aid movement of the digestive tract and good function of abdominal organs as well as the lungs.

Summary
Good osteopathic treatment is based on the principle that structure governs function, and vice-versa. Unlike other forms of manual therapy, all osteopaths will tend to have a “whole body”, integrated approach to assessment and treatment.

An osteopath will draw on a variety of techniques to make a change to the body in a bid to restore good function or structure. The way they interpret their findings and seek to make this change varies depending on their training, experience and technique preference of the osteopath, however, the principles that govern the reaction of the body to treatment and the healing process overall remain common to all osteopaths.

There is a saying“if I had a pound for every time I was asked …” This is one question that many patients ask at some point during their course of treatment, and I look forward to referring them to our blog for answers from now on!

I will try to answer this without bias but please note that I am an osteopath and therefore cannot be truly objective. It is worth noting that as an aspiring health practitioner, I did consider all three, but chose osteopathy from some specific reasons that are still valid in my eyes today.

Osteopathy

is a holistic form of manual therapy, which deals with a wide range of acute, chronic and systemic disorders of the body, both musculoskeletal and visceral.

Osteopathy uses in-depth physiological and clinical knowledge, coupled with keen observation and palpatory skills. The osteopath will combine a detailed health case history with a thorough physical evaluation to diagnose the patient’s condition and treat it. The patient’s diet, work and leisure practices all inform this process.

The osteopath doesn’t treat a painful back, stomach or knee, but a body as a whole unit that is suffering an injury, and must be treated in an integrated manner to return to good balance and function: can an injured knee be treated conclusively without addressing the biomechanics of the ankle, hip, pelvis and back? The osteopath’s aim is not merely symptomatic relief, but addressing the underlying causes of the current presentation to prevent any re-occurrence.

Osteopathic treatment combines joint mobilisation - and occasionally manipulation - with work on muscles and ligament tension, as well as gentle work on visceral structures when required.

As naturopathic osteopaths, our specific bias is not merely to achieve better functional alignment of our patients’ bodies, but also to impart dietary, exercise and lifestyle advice that more generally enhance their long-term health.

More about what is ‘holistic’ osteopathy and a description of osteopathy here.

Chiropractic

The origins of Chiropractic are close to osteopathy, as the first chiropractor was a student of the founder of osteopathy. Indeed, in some instances, one would be hard-pressed to distinguish between the treatment provided by a good chiropractor and osteopath. However, a large proportion of chiropractors focus treatment on manipulation of spinal segments to normalise spinal position and effect underlying nerve roots.

Treatment plans are often based on regular manipulation for a set number of sessions in order to wholly correct a disorder. Chiropractors also often use imaging to aid diagnosis such as x-ray. These x-rays will often be conducted in the clinic as part of the course of treatment.

Physiotherapy

is the most commonly known form of ‘manual therapy’ due to its prevalence within the NHS.

Physiotherapists specialise in the rehabilitation of acute and chronic joint injury, often using a variety of prescribed exercises that the patient carries out when away from the treatment couch. Physios also use machines such as ultrasound or TENS machines to facilitate change in an injured area.

NHS Physiotherapists tend not to have diagnostic input, the diagnosis and treatment request tending to emanate from an orthopaedic surgeon, consultant rheumatologist etc.  As a result, treatment will also tend to be more specific than integrative.

Inevitably, this brief snapshot doesn’t do justice to the development of three different forms of manual therapy with their unique methods and philosophy. It merely attempts to highlight some of the key differences in clinical practice that you can expect from each - although as suggested above, the practice of some physios and chiropractors is sufficiently all encompassing as to be well aligned with osteopathic practice.

Sadly too, some osteopaths also stray into being too specific in their form of treatment, and come to rely too heavily on joint manipulation.