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Pillow Talk

Your old manky pillow needs replacing.  How do you choose a new one?

Testing pillows in a shop

So you know what kind of sleeper you are, and you’ve gone to the shop. You are sorting through pillows that fit your budget.  You’ve got a few in front of you. Which one do you choose?

It’s really important to take your time in choosing so that you avoid wasting money, or worse, sticking with a pillow that doesn’t work for you and making you sleep more poorly.

The only way to know which one to take home is to actually try them.

Here are some tips for trying pillows in a shop:

  • ​Go to a shop or department dedicated to beds and pillows.  They should be used to people trying mattresses, and so if they are, they should be very happy to let you test some pillows.
  • ​Ignore the words ‘orthopedic’ and ‘memory’ and anything that a sales person wants to introduce you to first without having spoken to you about your sleep position and preferences.
  • Knowing your sleeping style, look for the shape/lift of pillow you want and gather together a few of them.  Try both synthetic and natural fill pillows unless you already have a clear preference.
  • ​Ensure each pillow you try has a polythene bag or cover on it.  This won’t feel fantastic, but it is mean to protect both you and the next tester.  It’s a critical hygiene precaution. If you tend to get sick easily, have a few face or cleaning wipes with you in a plastic baggie and wipe off the plastic.
  • Starting with the least expensive pillow, get onto the bed and use the pillow as you would do at home. Lay there a while.  Really give it a road test!
  • If that one doesn’t work for you, try the next most expensive one in the same way.  Is it different? How? If you think it’s the filling, try the same lift and price bracket in another filling.
  • Keep going until you have a winner!  Doing it this way means you won’t be  swayed by ‘pricier is automatically better’, and you will get to test a range of pillows in a sensible way until you find the one you like best.

Testing Pillows Bought Online

​Shopping online for a pillow is tough and follows the same basic processes: but has plusses and minuses over shopping in a store for a pillow. Be sure of the return policy before you buy and test!


​You can try the pillows without a sales person breathing down your neck

You can try the pillows on your own bed

You may take more time choosing your pillow


You will have a harder time comparing pillows if you get them one at a time

It will take longer to choose a pillow unless you purchase multiple pillows for testing (up front cost is higher)

You have to do returns either way unless you get lucky on your first order!

You need to be careful that the polythene bag is not removed or damaged – again – most return policies won’t accept a pillow return if it’s been opened

Whether you decide to shop in person or online is up to you.  If you have the cash to splash (knowing you’ll get most back on the ones you return), and already have some preferences on the filling for your pillow I’d suggest to buy a few pillows with good reviews and try them out at home.

If you don’t, it’s far faster and more cost effective to go to a shop and get a pillow there.

Arthritis from Food Poisoning or Unprotected Sex?

Of course, we’ve all heard the term ‘arthritis’ but do you know about reactive arthritis and how it can affect the body? Did you know you can get arthritis from food poisoning or unprotected sex?

The term ‘reactive’ implies a response to something – in this case it is a response by  the immune system and how the body reacts to bacterial infections in the genital, gastrointestinal, and urinary systems. Although typically found in those in their 30s and 40s, it can actually affect people of all ages, primarily starting with a bowel or venereal (STI) infection. Ever wondered why your Osteopath chatted with you about travel? Or, perhaps less frequently, your intimate life?  If you show up in clinic with a peculiar or non-typical situation, there may be questions about your life that are not meant to be intrusive, but to help narrow down the possibilities of what is causing you pain.


After your infection sets in, and sometimes significantly later, inflammation can be experienced within the joints just like ordinary arthritis; this includes toes and fingers. You can also have a reaction in the soft tissues of your eyes, showing up as a ‘pinkeye’ or conjunctivitis.

Although less common, you might also experience scaly skin, ulcers in the mouth, and other symptoms linked to the common flu.

The Good News

Reactive Arthritis is usually a short term problem, provided that you get treatment. Most people recover within several months. Despite there being no specific ‘test’ your symptoms and history may lead to the typical treatments of antibiotics and non-steroidal anti-inflammatory medications. This will help reduce inflammation and pain as well as working on the infectious cause of your immune response.  Occasionally steroids may be suggested but this is often reserved for more severe or advanced symptoms.

In some cases, doctors might start to introduce other medication if the attack doesn’t show signs of stopping some months down the line. For example, a disease-modifying anti-rheumatic drug (DMARD) might be suggested but only as a last-chance effort to remove the issue. Since these will have an impact on your immune system, they won’t be advised in situations where regular treatment will do the job efficiently.

If I, as your osteopath, suspect that you have had an infection of some kind which has led to the development of a reactive arthritis, I will immediately refer you to your GP with a letter outlining your symptoms and relevant history in order to expedite your treatment.

After treatment, you can then think about prevention and precautions to prevent further gastrointestinal and genital infections.  There are a lot of resources out there to help you.   As this is Sexual Health Awareness Week, why not check out The FPA, a leading UK sexual health charity.

Crushing Monster Headaches: Migraines and Osteopathy

What is a Migraine?

According to a recent study, around 20% of all headaches are migraines and for those who experience them often you’ll know they are more than ‘just a headache’.  

Migraine is not ‘just a headache’ but a debilitating and complex neurovascular condition.
As we now know, a migraine can occur when the head and neck blood vessels constrict. Over time, the blood flow decreases and this causes a throbbing sensation and can be the cause of migraine ‘aura’ – the strange visual and sensory symptoms that sometimes go along with or precede a migraine.  Why does this happen?  It depends on the person. Every person can have different triggers which set off migraine. Common examples are chocolate, wine, and citrus fruit as well as stress and lack of sleep.

woman with headache

The Experience of a Migraine

Symptoms of Migraine

There are many kinds of  migraine, but usual ones look like this:


  • throbbing or stabbing pain on one side of the head (but can be both sides) which lasts 4-72 hours if not treated
  • pain will be moderate to severe and will be disabling
  • attacks will be made worse by routine physical activities (work, housework)
  • attacks are made better by avoiding routine activities – a classic is laying down in a darkened room


Some people experience symptoms of ‘migraine with aura’ which means that you have the above kind of head pain within an hour of these kinds of symptoms:


  • visual symptoms like lights/lines/flickering or loss of vision in both eyes
  • pins and needles or numbness (on one side usually, but often with the above)
  • difficulty speaking

Usually the symptoms will develop over 5 minutes, or you will have several that happen one after the other for over 5 minutes, and the will last from 5 minutes to an hour. Within that time, or within the next hour, the aura will be followed by the headache pain of migraine.

How can osteopathy help with my migraines?

When people have a condition like migraine, which disrupts all aspects of a person’s life, we tend to look for all sorts of medication and home-grown treatments. However, did you know that osteopathy can actually help in the journey to prevent migraines?

If you’ve never heard the term ‘osteopathy’ previously, it’s considered ‘complementary medicine’ and helps to treat or prevent certain medical conditions affecting the joints, bones, muscles, and connective tissue. With migraine, osteopaths gently work on the head, neck and shoulders and this gentle physical work, combined with reassurance and advice as well as stress management help can really help improve your well being and reduce your migraine intensity or frequency or both.


What is an appointment like?

If you were to book with an osteopath like myself, it would be incredibly helpful to have a record of your eating and sleeping habits for as long as you can record them – including through at least 3 migraines.  This is not necessary but would be very helpful in managing treatment and advice going forward.  If you need a template for writing down these things, the Migraine Trust has an excellent set of headache diary templates.  If you’d like to do your records on your phone, there are also now excellent apps for tracking symptoms and some can even export reports for your healthcare team.

The first thing I would do is ask you questions to get a better idea of your issue. For example, you will be asked about your symptoms in great detail, about your health history, and the history of your headaches.   At first, you might be a little confused with the questioning but the I will want to get a full picture of your condition since poor posture, muscle tightness, and joint stiffness can also cause or contribute to migraines or cause other kinds of headaches which I can also help with.

After the interview you will be examined (primarily your head, neck, jaw) in active and passive movements, and I will probably conduct some tests on your coordination, vision, and take your blood pressure.

As well as helping me to decide how effective various treatments could be, this can also tell me if you need a referral. Sometimes migraine symptoms can be symptoms of other things, and this is why diagnosis is important if you’re having your first headaches.


I always try to provide treatment during a session, even though some of it will be taken up by your interview and assessment. The more prepared you are with details of your symptoms and details of any triggers you might have at your first session, the faster that part will go.


Followup sessions are entirely treatment and will be centered around your head, neck, jaw and often the upper back and collarbone area and other areas which may be involved.

Often, chronic migraines will require ongoing treatments at first but I aim to space them apart as far as possible to balance preventing attacks. In some instances, where migraine is caused more by stress or musculoskeletal problems, the impact is more rapid. Nearly everyone has more than one type of headache, so usually relief is felt immediately from at least one of those types of headache during the first few sessions.

If you would like help with your headaches or migraines, please book in a session to see me.

** Any new, sudden, debilitating head pain, particularly with other symptoms, should always be seen by your GP **

Get an appointment today

Same day appointments are often available, and cash and cards are accepted.

Book Online and quote #MAW5 and get £5 off your session.

Get to the Point – Injection Therapies

Tendinopathies are not uncommon and are often a consequence of overuse or degeneration/wear and tear.  Tendinopathy pain can interfere with everyday life depending on what tendon is involved, and so a lot of research has been done to look at what is special about different tendinopathies and how they are most effectively treated.

A huge range of options for tendinopathy treatment are given to patients, but what do we really know about how effective they are and how they work?

Steroid Injections

This kind of anti inflammatory injection is the mainstay of injection treatments for tendinopathy, despite the fact that most tendinopathies have no inflammation. Weird huh?  They are not sure why this is but early on the injection may help with exercise and manual treatment because it reduces pain in the area – but given there is no inflammation to actually affect, there is a possibility that injection therapy has more of a placebo effect in the longer term and is not as effective as other options.  Steroid injections, if delivered inside the tendon, can actually weaken the tendon for several weeks, which is when people are most likely to be getting treatment and exercise.

Steriods can be more effective in bursitis and tendonitis, where inflammation is a key part of the condition. For example, some tendonitis in the hands can be virtually cured in over 80% of people.  However, 9% of tendinopathy recipients can develop tendon atrophy – that means instead of getting better, it gets worse.

Platelet Rich Plasma Injections

Platelet Rich Plasma (PRP) injections are relatively new. The platelets within the injection are rich in tissue repair protein simulators.  The idea behind these injections is that they will promote tendon tissue growth if injected into a broken down tendon but there has not been enough done to know how large an injection is best, how many would be needed, or if there is a dose dependent response (ie the more you deliver, the more repair, so you might deliver more to a more damaged tendon).  There just isn’t the evidence yet.

Hyaluraonic Acid Injections

Hyaluronic injections have been shown to help with osteoarthritis.  The idea behind these injections is that they would help with “gliding and sliding” for a tendon much in the same way they help with osteoarthritic joints.  These injections are still being studied.

Other injections

There are other injection types – injecting irritants to stimulate blood flow for example. We know that healthy tendons are not supposed to have high blood flow – and those which are painful have higher blood flow.  It’s still unknown if this kind of injection type will actually help (though in other tissues more perfusion is generally a good thing!)  These are all classic examples of how ‘it should make sense’ hasn’t actually proven itself out in reality.

If you’re unsure of injection therapies, why not try osteopathy?  Exercise, manual therapy and other guidance does help people with tendinopathy pain.


Come here, lay down, and get excited

Osteopaths aren’t nosy – it might seem so because it’s often important for us to know how happy you are in your bed.  Not getting good sleep is bad for your body, bad for your mind, and bad for your emotional health.

Sleeping habits and sleep quality can significantly affect your ability to recover from pain and injury and so I’ll often ask you about how you sleep, what positions you find comfortable, and what your mattress is like. It’s important for us both to have insight into what happens to your body during that one full third of the day (or more – or less).

Quality comfortable sleep on a good mattress is a key indicator of your health and wellbeing and can affect your body both directly and indirectly.  Poor sleep or sleeping on an uncomfortable or poor surface is a key contributor to back, neck and shoulder pain.  Sometimes you just know you need a new mattress but aren’t sure where to start.

Choosing a mattress can be very daunting.  There are so many of them, and they range vastly in terms of not just size but quality. And then there is your budget to consider.  This is a real practicality, but needs to be balanced with getting a good and healthy amount of sleep.

Did you know....
….that 48% of Londoners get inadequate sleep?

….that a third of us only get 5 to 6 hours of sleep a night?

….and that only 22% of Britons get adequate sleep, which experts say is between 7 and 9 hours ?

Do I really need one? I’d rather spend that money on a holiday!

Me too!

How might you know if you need a new mattress? Is it over 7 years old? Does it sag?  Can you feel the springs even when you put a topper on it? Do you and your partner roll toward one another in your sleep? Does it creak or crackle or smell damp?  You give your mattress an MOT but honestly if you get bad sleep because you’re not comfortable and you’ve already tried a topper, it might just need replacing.

I just went through this process with my son, and we got to make a little game of it.  It’s a big purchase, so try to have fun with it!

Step 1: Set your budget for the size mattress you need. Unfortunately decent mattresses aren’t cheap BUT you also don’t need to pay a fortune.  In looking around I wouldn’t consider any single size matress under £150 – but set your low budget end as high as you can afford to give yourself a guide.  I’d try to find the least expensive model that’s comfortable for you…then check the next one down in price.  You might end up pleasantly surprised.

Step 2: Get an idea of the kind of mattress you want.  There are sprung mattresses, pocket sprung mattresses (each spring has a wrapper of softness on it), foam mattresses and memory foam mattresses – all widely available. If your second cousin’s crystal healer says you need to get a yak hair filled mattress, your hunt might take you a while.

Generally, sprung mattresses without any tufting at the top are the cheapest and least comfortable.

A good tip: if you can feel the springs, don’t buy it.

More springs are generally better, so an ideal sprung mattress would be a pocket sprung one with a higher number of springs and some kind of tufted top (so you don’t feel those springs!)

At the other end of the price spectrum is a full memory foam mattress.  These mattresses can be amazing but beware of low quality foam being sold as if it were ‘the real deal’.  Not all the foam is high quality, and so will feel super for a while after sleeping on a pokey rock of a mattress…but it won’t last.  The better the foam density the higher the cost. I looked at them a few years back for my king size bed and we are talking in the thousands of pounds here.

If you want to look at memory foam, a quality mattress will have a density rating on the label. It is suggested that you choose one with a rating of 80kg as a minimum – which is supportive but will mould to you once it warms up to your body.  Beware: they will cost a minor fortune!

A superb compromise is a pocket sprung mattress with a small layer of memory foam.  Even better, a pocket sprung mattress with a foam layer and cotton tufting (to keep you cool in summer – foam can be toasty).  My mattress is a pocket sprung with a 2.5cm layer of foam, and a cotton tufted top.  On top of that I have a duck topper (which I can take off and wash as needed).

Step 3.  Get into your comfy clothes….maybe not your pj’s…..but this is where it gets fun. Pick a mattress shop and give yourself (and your partner) lots of time.  If you’re worried about pressure, leave your credit card at home.  Ask to see mattresses in the type you prefer and within your budget.  You may want to ‘test drive’ them right there!  Any good shop will let you try the mattress (plastic cover on!).  Lay on them for a long time, in all your sleeping positions.  Be sure to do it together as well as seperately to check if you roll toward one another because of the mattress.  Check mattresses labelled through the range of soft through firm.  Most people will prefer a medium to firm mattress as soft may not be supportive enough for people with pain.

Step 4. Go away and think about it. Don’t buy on the spur of the moment if you’re conflicted.  Once you take the plastic off you can’t return it.  (This is particularly true if you order a mattress online!) They may even offer you a deal to keep you from buying elsewhere.

Step 5.  Pay the little extra for delivery and placement, especially if it’s a big mattress. It will be heavy, and you don’t want to do your back in (but if you do I’m here of course!)

Checking out mattresses can be fun – spend some time on it before you buy it and many restful hours in it afterward…good sleep is an investment in terms of both your wallet and your body!

5 Real Reasons to NOT see me as your osteopath

Will it be a good match? What are they like? Will it really help? There are a lot of legitimate reasons people don’t book in to see me.  I understand that making a first appointment with someone new can be difficult.  I’m here to help!

The first one is a biggie!

You don’t know what an osteopath is

Sometimes people don’t know what an osteopath is or does, and so this makes them hesitant.  This is, thankfully, a very easy one to fix! An osteopath is a regulated healthcare professional who works primarily with their hands to help with all kinds of aches and pains.  We are trained to triage your problem and refer you if treatment is not appropriate for you.  And with me you can book online and get a free 10 minute phone chat or a 15 minute meet and greet to get to know me and how I work before deciding to book a paid session.

You don’t want gentle treatment

My approach to osteopathy is gentle and rythmic, and whatever your personally developed treatment will be it will take into account your biology, your emotional state and the history of your pain. Everyone is an individual. Also – if you are wondering – I don’t do heavy ‘cracking’ and I don’t ‘crack necks’.  All of your treatment must be with your complete consent and we discuss a plan before hand and all along the way to be sure you’re comfortable with how it is going.

You don’t want treatment quickly

It might sound strange but sometimes people want to wait a while before becoming better. Sometimes people who come to see me have waited years.  Sometimes they are waiting for a physio appointment on the NHS. Making an appointment with me is easy once they decide – appointments are often available the same day.

You don’t want a simple way to look after yourself after your treatment

I don’t sell products, supplements or equipment.  And most of the time my advice is that you don’t need anything costly or complicated to help you get well! My advice is practical (so it’s easy to do), it builds on itself (so you find success with your programme and don’t get overwhelmed), and most importantly – it really works to help people.

You don’t want good value

My treatments are really good value. Compared to many others, you get longer session times at less cost because I work from a residential clinic.  You also always get self care advice with the aim of spreading your sessions as far as possible and preventing your problem from returning once it is gone.  And when you sign up to my Facebook Page, you’ll be first to know about deals and offers.


Can you think of any other reasons to not see me? I’d be more than happy to discuss them with you.


So if you’ve changed your mind and want to book in to see me, I’d be more than happy to help. It’s time! Book now and get your pain sorted.



High Hamstring Tendinopathy

This is an update on an article originally written in May 2014

Running downhill?  Sprints?  New to interval training?  Got a pain in your backside?

Is it pretty much ‘on the spot’, and in one place? Does it hurt when you get out of bed?  Does it hurt when you stretch? Does the pain get better after a while?  Is it painful to drive?   It might be high (proximal) hamstring tendinopathy.

What is high / proximal hamstring tendinopathy?

There are three hamstring muscles, and they all attach in the same place: at the ischial tuberosity (the base of your sitting bones).

Proximal hamstring tendinopathy is like an overuse syndrome of the hamstring tendon, and the pain of proximal hamstring tendinopathy is swelling at the point where the tendon attaches to the bone.

The ’cause’ is often a lack of balance between the load placed upon the tendon and the tendon’s capacity to manage that load, and a mismatch is often created when people jump back into training after a break, suddenly increase the frequency or intensity of training, have a forward leaning gait when running, or have started doing hill sprints.

What can I do about it?

You first need a proper diagnosis from a clinician like myself.  Gluteal pain can have many causes and we want to be sure we are addressing the correct source of the pain.

You’ll be given some load testing to check the tendon in different levels of strain, and then I can advise a course of action to get you back to action!

Generally speaking, work will not happen directly on the tendon – we don’t want to irritate it.  Work around the area can be done to help minimize contributing factors.  The main contributor to this problem, however, is overload and less than ideal gait in running or both.

The first part of rehab advice is this:

  • No stretching (yes that’s right!)
  • Avoid prolonged sitting
  • Relative Rest
  • Isometrics for the pain

Isometric exercise with minimal hip flexion will be the start, and this should help reduce your pain making sitting, bending, driving and walking easier.

We will then move into helping the tendon learn to increase its load capacity so that it can gradually withstand the strain you want to put through it.  This will happen through a series of 3 progressive loading exercise sets.  You’ll get re-tested at intervals to check how the tendon is coping with its demands and to determine if it’s ready to take the next progression.

What if it hurts to do the exercise?

Don’t be afraid of a little discomfort – it’s normal! Anything on a zero (no pain) to 10 (most pain ever) scale within the range of 0 to 3 is safe to experience during or up to 48 hours afterward. For some 4-5 is acceptable though we’d watch that more carefully.  If you’re at those levels during or within 48 hours, it’s generally safe to continue or to progress.  If you are feeling anything over a 5 out of 10, that is a sign that for some reason the progression is too much, too soon. We can discuss how to back up and keep you moving forward in your rehab without stopping activity.

What about my return to running?

First of all, the same pain threshold guidance applies. There are two areas to focus on when returning to running training:

First we look at running gait, and second we look at training factors.

It is advisable to work with a running coach or have an experienced clinician watch you running.  Why?

Small changes in your running gait can reduce strain on your proximal hamstring tendon.  Three main changes can be made, in order (not all at once, and you may not need them all) – one is a change in cadence in order to shorten your stride, the second is running ‘taller’ and the last is changing your pelvic tilt slightly.  An experienced coach or therapist can watch you and give you cues to help guide your running re-training.

Lastly, getting back to sport progressions involve looking at three factors: volume of training, frequency of training and intensity of training.  Changing volume is easier than changing frequency which is easier than training intensity.  So extend your runs or training sessions before you increase the numbers of times you train per week.  And then up your intensity as a last progression factor.  Make hills sprints the last thing you add back to your training routine (if you did those!) as this places the highest load on the tendon.

Always see a qualified professional for diagnosis and support in your recovery.

Adapted and updated from original post on 14th May 2014

2016 Patient Survey Results

Part of my Continuing Professional Development requirements include reflecting upon the feedback of patients. This year I conducted a patient satisfaction survey, delivered online through a link within my newsletter.

Here are the results of my survey:

Overwhelmingly patients felt that the care I provide is good value.  I pride myself on longer appointments compared to others, which translates into longer treatment times and more time for explanation of self care advice and take- home exercise.  I am able to offer this at relatively low (for London!) cost because of having a residential based clinic.

All patients felt that the clinic was clean and welcoming, either agreeing or strongly agreeing with the statement.  As an added bonus, the clinic feels fresher as well!  One comment of feedback early on provided the last bit of inspiration I needed to do some redecorating.  Many patients were on holiday for Easter so I decided to close and redecorate the entire front clinic room.  So it’s clean, welcoming and also with a fresh lick of paint!

The majority of patients strongly agreed or agreed with the statement that I provide self care advice that is easy to apply.  A very small number (7%) were neutral, with no negatives.  This is good reminder to me that sometimes less can be more, and I will strive to provide only the most impactful advice particularly when self care could be complicated.

One of the realities of working with a variety of people with a variety of conditions is that sometimes I simply can’t help everyone.  I always try to provide help and care if appropriate, and clinically responsible referral when I’m not the best person to care for someone.  The majority of patients strongly agreed or agreed that they got better after seeing me, with 7% feeling more neutral.

Every respondent said that they would recommend me to friends or colleagues (including those who felt neutral about if they got better).

More feedback next time!

NICE guidelines revision for low back pain and sciatica

The National Institute of Clinical Excellence sets standards for medical assessment and treatment excellence in the UK.  NICE regularly reviews treatments for a wide variety of conditions and provides guidance for all healthcare professionals which should be followed unless otherwise justified. They recently released treatment guidance and a summary for back pain with or without sciatica in people over the age of 16.  The full guidance is available at the link however it is nearly 800 pages long!

Please note this guidance is for mechanical types of back pain with or without sciatica (as opposed to inflammatory rheumatic conditions).  My mini-summary is below.

Treatments given a GREEN LIGHT Treatments given a RED LIGHT
(this means that these are highly evidenced approaches and healthcare providers should be using them within our abilities and training) (this means we have to justify more heavily doing these things and ensure that a large group of others use them and have had sound justification and also would agree with our use of these techniques)
Objective assessments of psychosocial risk factors associated with low back pain Belts, braces, orthotics, shoes with rocking soles
Exercise prescription Traction (manual and presumably inversion)
Certain medications (see your GP, who must also be informed by this guidance) Certain medications (see your GP, who also must be informed by this guidance)
Manual therapy alongside exercise (but not on its own) Acupuncture, ultrasound, TENS machines
Combined support including both manual therapy as well as psychological supports such as CBT Spinal injections, fusions (in some cases), disc replacements
Support in getting back to work and doing daily activities Disc replacement
Injection/Surgical interventions for people who aren’t responding Routine imaging

What does this mean for your treatment from an osteopath ?

Previous guidelines suggested certain professions for back pain treatment, however NICE recognised that professionals with varying credentials are often qualified to perform approved treatments.  This is reflected in the newest guidance which is focussed exclusively on treatments that help and those that do not.  Within one’s remit of training, clinicians should offer ‘green light’ treatments and should not offer ‘red light’ treatments without justification and peer support.

Osteopathy is a profession which focusses on the whole person in treatment, and so this guidance is welcome news to patients of osteopaths. Assessment of psychosocial risk factors using quick tools like the START BACK tool, tailored exercise, manual therapy, referrals to CBT as well as daily living and return-to-work advice can be offered.

Why is getting an Xray or MRI for low back and neck pain a bad idea?

This is the single best video I’ve ever seen on why ‘routine imaging’ is a bad idea.

Did you know that nearly every study done on back and neck pain imaging shows us what is found in an Xray and MRI has no relationship to the pain people feel?

They show that upwards of 98% of people have arthritis in their neck – and most have no pain. They show that up to a third of people under 30 — with no pain — have disc prolapses. Incidental findings are often a reason we don’t do routine imaging – it’s not helpful. In fact, it can be harmful.

What is most fascinating about this: if you tell people who aren’t in pain about these ‘incidental’ findings, they may start to develop abnormal movement patterns, fear avoidant behaviours and ultimately – pain. And if you tell people with pain the details of what was found in their XRay or MRI, they tend to do worse and are more likely to develop ongoing pain than if you focus on their functional daily needs during treatment.


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