It’s not just rubbing backs
What is osteopathy?
Sometimes, I think that I have a bit of an image problem. When I tell people that I’m an osteopath, they usually imagine me spending my days rubbing (or cracking) people’s bad backs. When people ask me “what is osteopathy?”, they expect to hear about the techniques that we use - a spinal manipulation here, a joint mobilisation there, perhaps a bit of stretching or soft tissue work. If you watched me work, it’s true that you’d see a fair bit of that (and I like to think that I do it well); but even so, it’s one of the least interesting parts of my job. As a colleague of mine once put it “a trained monkey can rub backs”.
So if that isn’t it, then what do I do? How would I sum up my role in one sentence? I help people to do the activities that matter to them.
The activity in question might be playing sport, or a musical instrument, or working a manual job. Perhaps they want to be able to walk around the shops, pick up their newborn baby, walk the dog, or play with the grandchildren in the park. We interact with the world via our actions, and being in pain limits our ability to do that.
How do I approach that in practice?
I listen. Unlike many medical professionals, I have the luxury of time with my patients. Sometimes this means that I’ll pick up on things that could easily get missed in a shorter appointment; but it also allows them to feel heard. I’m often told “it feels like you’re the first person who’s really listened to me”; for someone who might have been dealing with their pain for years, that can feel like a huge relief.
I assess. I’ll examine my patient, take them through some movements, do some testing, and then combine the results with the information they’ve told me to figure out what’s going on. Then we work out what’s the best course of action - taking into account their lifestyle, work and hobbies.
I advise and educate. I take the time to explain what’s going on in a way that my patient can understand. I’ll talk about what they can do to help themselves and to manage the problem - often just small changes to their routine, adjustments to their car seat or the pillows they sleep on. We’ll talk about their activities, and discuss what’s ok to carry on doing, and which things they should avoid. I’ll do my best to help them find ways to keep going around their injury wherever possible.
I treat. Yes, I mobilise, stretch, massage, and manipulate. I do my best to send my patient away feeling better, and able to move more easily, than they did when they came in.
I coach. I’ll pick out the exercises most likely to help with the specific problem my patient is facing, teach the movements, and give plenty of feedback as we do them. We’ll look for ways to bridge the gap between what they can do, and what they’d like to be able to do, and come up with a plan to get from one to the other.
I collaborate. Sometimes, my patient will need help from someone else. It could be that they have another medical condition (that they might or might not be aware of) and need to see their doctor. Perhaps they have an injury that may need surgery. Or it could be that they’re a high level athlete who needs me to discuss their training plan with a coach. In some cases, the best thing I can do for my patient is to act as their advocate and help them to get the care they need. When this happens, I’ll point them in the right direction, write referral letters or make phone calls if necessary.
I reassure and encourage. Being in pain, and not being able to do what we’d like, can be frustrating and demoralising. Often, I’m able to reassure patients that although they might be in a lot of pain right now, the problem is unlikely to be anything serious, and let them know roughly how long it’s likely to take to recover. Sometimes patients are pleasantly surprised to discover how much they are able to do with a bit of guidance, or to be told that a little discomfort on activity is to be expected and doesn’t mean that they’re making it worse. I aim to give people a sense of control over their pain and tools to help manage it themselves.
The hands-on manual therapy work is one aspect of what I do, but it’s just a part of a much bigger picture; and I know that there are many excellent practitioners out there who approach things in the same way. We’re not just here to rub backs.