What is Manual Therapy?

The needles used are sterile, solid and extremely fine and each needle is only used once. It is usual to feel a mild pricking sensation as the needle pierces the skin, and a sharp pain as the needle is engaged (twiddled) but once the needle is in position patients usually report an aching or warm sensation. It is unusual for the needles to be uncomfortable when in situ. Occasionally there is a tiny droplet of blood when the needle is removed but generally there is none. Some patients report feeling like the needle is still in after treatment – this feeling generally disappears within an hour.

Manual Therapy can be helpful throughout all stages of pregnancy. It is important that you advise me if you are or think you may be in the early stages of pregnancy. The first trimester of pregnancy (up to 12 weeks) carries a naturally high risk of miscarriage. Whilst there is no proven link between osteopathic treatment and an increase in incidence of miscarriage, osteopaths take great care when treating pregnant women and adapt their treatments appropriately. Manipulation of the lumbar spine is avoided until about 14 weeks gestation but other techniques can be used. Manual Therapy is a very safe and effective treatment for the aches, pains and discomfort of pregnancy and many women find it invaluable in the later stages when the pregnancy places tremendous strain on the body.

There are no established risks that are specific to pregnancy, and ultrasound and dry needling techniques can be safely used – with due caution – in all stages of pregnancy.

I don’t currently offer treatment for babies or small children, but I can provide contact information for therapists that do.

Yes, Manual Therapy is low risk, and the vast majority of patients find treatment helpful. About 90% of my patients are referred through word of mouth recommendation. Adverse reactions are not uncommon however and about half of people have the following effects for a couple of days after treatment, most commonly after the first or second session.

• A increase in pain or stiffness
• A mild headache
• Tiredness

Severe adverse reactions are very rare. As a Manual Therapist with a degree in Osteopathy, I am trained to screen patients to assess their suitability for treatment. I will adapt my techniques appropriately or I may decide that treatment is not suitable for the patient and in this situation will discuss other treatment options, including referring patients to other medical professionals as appropriate.

Concern is often voiced about the risk of neck manipulation causing a tear in the vertebral artery (vertebral artery dissection – a rare but serious condition that can lead to a stroke). This type of tear of the artery can be caused by serious or minor trauma and is a significant cause of strokes in patients under 45 years of age. Between 1 and 3 out of every million people who have neck manipulation are at risk of having a stroke, so the risk is real but extremely small. If you are one of the small proportion of people at risk for vertebral artery dissection, these activities also carry the same amount of risk as neck manipulation: yoga or martial arts, having your hair washed at the hairdressers, painting a ceiling, blowing your nose or turning your neck when reversing the car.

Vertebral artery dissection is also more likely if you suffer from hypertension (high blood pressure), sustain neck trauma, take oral contraceptives, suffer migraines, or as a result of other complex medical conditions. It is not always possible to identify vulnerable patients. I am trained to identify patients at high risk of a stroke and if I have any concerns, I will not perform certain neck manipulations.

If you would like to read more about possible adverse reactions to Manual Therapy, the research is published here:
Adverse Events in Manual Therapy – A Systemic Review (full report)

Sorry, I do not offer home visits. In my experience the quality of care I am able to offer is compromised and the additional expense incurred does not offer value for money to patients. If a patient is so disabled as to be unable to get to the practice, there is generally little effective treatment we can offer. However, I am always willing to give help and advice over the telephone and treatment is usually more suitable after a couple of days as the acute symptoms subside and the patient becomes a little more mobile.

Many patients are reluctant to take painkillers for fear of masking their symptoms and thus causing further trouble. However, the judicious use of analgesic, anti-inflammatory and muscle relaxant medication can often be extremely useful, especially in the acute phases of some conditions. I can advise on the suitability of appropriate ‘over-the-counter’ medication as well as other methods of easing discomfort such as the application of heat and/or cold packs, the use of pain relieving gels or gentle exercises. If prescription medications are required, I can liaise with your GP.

There is always much that a patient can do to help their condition. I will advise you if there are particular activities or exercises you should or shouldn’t do. Please ask if you have any specific activity in mind.

The majority of patients require 3-6 treatment sessions. Every patient responds differently, therefore I will discuss with you the anticipated course of treatment, your prognosis and realistic expectations for recovery. In some cases where the problems being addressed cannot be expected to resolve (old injuries, structural changes) it may be recommended that treatment is given at regular intervals on a long-term basis to maintain the function and keep symptoms at bay as far as possible.

Most people initially feel easier after treatment. It is not unusual to then experience a treatment reaction and become more uncomfortable as the day goes on. This usually happens after the first or second treatment. The discomfort may last for a couple of days and is usually easily controlled. I will advise you on post-treatment self-help to minimise this reaction. If you are concerned about how things feel after a treatment, please get in touch.

The primary aim of your initial consultation is to establish what is wrong and whether Manual Therapy is a safe and appropriate treatment for you. Providing there are no contraindications, I will normally treat you on your first visit, with your consent.

It is not necessary to advise your GP, though you are welcome to let them know. As a Manual Therapist, with a degree in Osteopathy, I have been trained to assess patients. Occasionally I may need to contact your GP about aspects of your health and medical history. I will always obtain your consent before contacting your GP or other medical personnel.

You are welcome to bring a companion with you. Please be aware that they will become party to all conversation during the appointment. Anyone under the age of 16 should be accompanied at all times by a parent or appointed guardian.

Treatment using Manual Therapy involves both observation and palpation, therefore you will probably be asked to undress to your underwear but it is not compulsory. If you prefer not to undress to underwear, please bring suitable alternative clothing (eg shorts and a sleeveless t-shirt). Your privacy will be respected at all times.

Please bring details of any prescribed medication or supplements you are taking. If you have any recent relevant X-rays, scans or medical reports please bring these with you. Also bring any orthotics, braces or supports you use.

Your first appointment takes approximately 60 minutes, but I always allow for up to an hour. As part of your first visit, I need to obtain a full case history to ensure you receive the appropriate treatment.  Subsequent visits take approximately 30 minutes.

It may be possible to claim for a course of treatment but you should check in advance with your insurance company before your appointment, in order to confirm the available level of cover and whether you will need to have a referral from your GP or a specialist to make a claim. I will provide you with a receipt, and you can submit this directly to your private healthcare provider.

Osteopathy and chiropractic share a common origin and although the two disciplines are superficially similar, they have quite different underlying philosophies. However, in practical terms osteopathy, chiropractic and also physiotherapy (a branch of conventional medicine) treat the same sort of musculoskeletal conditions. There is considerable overlap between the working styles of practitioners from the three different disciplines, and also considerable variation between practitioners within the same discipline.

Broadly speaking the initial consultations will be similar with practitioners from all three disciplines, involving a detailed case history, physical examination of the patient, their standing posture and the way they move, and a series of clinical tests to aid diagnosis and to help establish that the patient is suitable for treatment. The nature of the treatments are rather different:

Osteopathic treatment is usually made up of massage of the soft tissues, stretches and rhythmical movements of the joints, and short corrective manipulations of the joints of the spine and/or the limbs (causing the pops and crunches for which we are known). Treatments with an osteopath are generally about half an hour duration and patients are usually seen approximately weekly in the initial phase of treatment.

Treatments with a chiropractor are usually shorter – 10 or 15 minutes – and comprise mainly spinal adjustments (pops and crunches again). Chiropractors generally see their patients more often – twice or three times a week in the initial stages.

Physiotherapy treatment tends to be more based around exercise therapy, self help and rehabilitation. Many physios with a special interest in musculoskeletal medicine will also have studied manipulative techniques (more pops and crunches). Physio treatments in the private sector tend to be at approximately weekly intervals.

However the distinction is not clear-cut as every practitioner works differently. All practitioners will prescribe exercises to help in your recovery and you may be also be offered other treatment such as acupuncture or offered taping, supports, insoles, supplements etc if your practitioner feels it may be of help.

All these treatment approaches have been shown to be safe and effective and it can sometimes be difficult for patients to decide which treatment to choose. Often it is best to talk to your friends – who do they see? And make sure that when you do go to see someone, that you feel comfortable with them, feel listened to, cared for and that you like them as a person.