MATT BRABNER OSTEOPATHY

YOUR FIRST APPOINTMENT

I am often asked what ACTUALLY happens when I see a patient for the first time. So, here is a description of what I do when I first meet a patient. I won’t go into detail on osteopathic principles, or compare what I do to chiropractors, massage therapists or physiotherapists, but share how I normally work so you can get a sense of what usually happens.

THE DURATION

Your first appointment will normally last 45-60 minutes, with the majority of time spent listening to you, a hands on examination and discussing treatment options. Treatment itself is usually 15-20 minutes depending on your symptoms.

THE LISTENING PART

This is the most important part of our first meeting. I will spend time asking about the pain that is your main concern, but will also listen to how you use your body in your daily life and what stresses and strains you may be under. The key to whether osteopathy may be able to help you (or not) is gaining an understanding of your overall health, and recent changes or symptoms you may have noticed, plus any previous injuries or health problems. Some questions say seem unconnected, but be assured the they are relevant, even if you think I am a bit odd for asking about bowel movements when you have a bad back!

THE EXAMINATION

This will always involve looking at you standing and asking you to move your body to assess your overall posture. After that, a hands on examination of the main areas of pain plus any areas I feel may be contributing to your problem. This may involve asking you to move in certain ways yourself, moving against my resistance or helping you through certain ranges of movement.

Depending on your symptoms and main site(s) of pain it may be necessary to do a more detailed check of a body system or area. This is most commonly a neurological exam, taking your blood pressure and/or listening to your heart or lungs. I will explain what the tests involve, the reason for them and ensure you are happy to proceed before conducting these examinations.

THE WORKING DIAGNOSIS

After the examination and any tests I will explain what I think is the most likely diagnosis based on your health history, symptoms and the examination. This ‘working diagnosis’ can sometimes be clear but can often involve a number of factors. In either case I will explain what I feel we may be able to do to address your symptoms and their root causes, and give an estimate of how long healing may take. It may be at this stage that I suggest a referral to another healthcare provider if I feel there are elements that osteopathy may not be suitable for, or discuss how we could help to manage some more persistent symptoms rather than totally remove them.

THE TREATMENT

• Soft tissue – this will involve stretching, applying pressure and/or moving certain muscles, similar to a deep tissue or sports massage
• Articulation – this is the active movement of joints and this can be done either very locally or more broadly and dynamically
• Resisted movement – often treatment may involve some work from you, activating certain muscles as I resist their normal movement
• Manipulation – this is where a quick, short movement applied to a joint (usually in your spine) can result in a pop or click, and this requires your full consent so we will discuss this as an option if I feel it may be beneficial

THE ADVICE

A key player in your recovery is you, so I will always spend time discussing what you can work on to adjust relevant parts of your daily life to help recovery. We can also discuss ‘first aid’ such as ice vs heat, rest vs movement etc.

A short exercise program is usually beneficial to continue and develop your body’s healing process. I will usually talk through and demonstrate a few suitable exercises you can do and send a handy sheet with detailed guidance.

WHAT HAPPENS NEXT…

As part of your working diagnosis we will discuss how many further appointments may be needed. It is normally ideal to have at least one more, 1-2 weeks later, so we can check on progress and how exercises are going. If I feel it will take a while to fully recover I will talk through my best estimate on how many appointments may be needed, but we will always review progress and adjust this as necessary at each subsequent appointment.

Often we get to the point where just a maintenance treatment may be necessary every 2-3 months. I can also suggest support from colleagues who can offer massage, pilates, yoga or physiotherapy that may be beneficial as part of your recovery and to try to reduce the likelihood of the problem recurring.

On some occasions, if we are not making progress as expected, or I feel there are some symptoms that are outside my remit or area of expertise, I can refer you to a GP to discuss further investigations. For example if we agree a scan or X-Ray may be beneficial.

IN SUMMARY

My aim is to make you feel as comfortable as possible and ensure you understand all elements of your working diagnosis and treatment plan. If at any point you have a question or feel bamboozled with information please do say. And lastly, strange as it may seem, I don’t wish you to feel you have to see me too much. I believe that although treatment can be important at the start of your body’s healing process, we shift responsibility towards you as the symptoms diminish.

So, that’s an ‘average’ first appointment, many are different but I hope this gives a sense of how I work.