FAQ - Treatment & management
When do I need a scan such as an x-ray, MRI, CT or ultrasound?
Only when it is appropriate. Much of the time, osteopaths can diagnose an injury or complaint without having to refer for a scan. We generally send patients for imaging only if a diagnosis is not clear.
When referred by an osteopath, full and partial rebates on imaging are available. The specific amount is dependant on the part of the body imaged and the type of imaging used. Rebates are also available from your local GP.
If imaging is needed, we will discuss which option is best.
Why do we experience pain?
Pain is a natural defence mechanism to signal potential danger. Pain is a perception within the brain which can be described in numerous ways such as sharp, dull, aching, shooting and throbbing.
Classically, we understand pain to result from damage to the body, such as a broken bone. However, we now understand that the extent of damage does not correlate with the degree of pain experienced. There are many examples of people injuring themselves significantly, but not experiencing pain. When Xavier was a child he fell off of a tree and broke his arm. He didn’t realise until hours later. Whilst having a bath when his mother tried to move his arm and he screamed. Conversely, there are many who have seemingly no obvious damage but experience much pain.
Therefore, the experience of pain is highly dependent on perception. However, all pain is real and valid. As osteopaths, we try to reduce people's pain levels beyond simply addressing the musculoskeletal system. We also try to take into consideration a patient’s perception of pain and life in general. This allows us to work together to help individuals develop a healthier understanding of pain and how it’s best managed.
Do osteopaths prescribe medication?
No, osteopaths do not have prescription rights.
We commonly recommend speaking to a doctor or pharmacist in relation to finding the best pain-relief options for your needs.
How may hands on treatment help?
There are great, but complicated theories behind why different types of manual therapy work. We like to simplify concepts by using analogies:
1. Imagine two ropes that normally slide past each other
2. Pulling on the ends of the ropes won’t untangle them and
may make the issue worse.
3. Untangling the ropes is achieved by use of hands to pull
apart one section at a time.
Think of your tissues as ropes. When dysfunction arises, they become tangled & painful. Manual therapy & exercise prescription aims to untangle the ropes and get them sliding pain-free again.
Of course this explanation is very simplified and doesn’t tell the full picture, but it does hopefully help you to visualise how treatment & exercises aim to get things moving again. If you would like to learn more, please contact us.
What is an adjustment? Why is there a popping sound?
An ‘adjustment’ or joint manipulation is a technique respectively known as high velocity low amplitude (HVLA) which characteristically involves a popping sound.
People often wrongly associate thrusting techniques and the subsequent noise with joint repositioning or friction between two bones (1). Instead, the noise is created due to the formation and release of a gas bubble within the synovial fluid in a joint.
Please note: this remains un-proven in vertebral synovial joints, although study has confirmed this mechanism in finger joints (2, 3).
The proposed benefits of HVLA have been studied and include:
- Alteration of pain signalling mechanisms (4)
- Increase in range of motion at restricted vertebral joints (5)
- Reduce pressure sensitivity to pain (6)
HVLA is not the only technique to offer these benefits. Other techniques that mobilise joints may create the same effects as manipulation (7). For example, Krowel et al (2010) demonstrated greater improvement in range of motion with mobilising the thoracic spine compared to HVLA in pain-free subjects.
Another main misunderstanding about HVLA is that a ‘pop’ must be heard for the technique to be effective (1). This is untrue; studies have shown that there is no link between an audible sound and outcome measures (8).
Importantly, remember that you do not have to have HVLA or any other treatment performed.
What is dry needling? How is it different to accupuncture?
Similarities between dry needling and acupuncture:
Both modalities use a needle that is thin, solid stainless steel, sterilised for single use & with straight edge. (Needles used for injections have hollow centre and jagged edge)
One of the aims for both modalities is to reduce pain occuring from injured tissues
Differences between dry needling and acupuncture:
The philisophy & approach:
Dry needling has been developed from western medicine.
It is used by trained practitioners, with a focus on the
Acupuncture exists within eastern medicine traditions
(such as traditional Chinese medicine). It is based on a
complex system of assessment, diagnosis and treatment.
The location & intention of needle insertion:
Dry needling - in areas of myofascial pain or dysfunction
to alter the pain mechanism
Acupuncture - according to the meridian system in order
to redirect Qi (energy flow)
How may prescribed exercises help?
Prescribed exercises may help in various ways. Provided are some examples and analogies to help you understand:
Fraying rope: consider how frayed rope loses its strength and integrity. Prescribed exercises are akin to splicing the rope back together. The exercises may stress the damaged (or frayed) tissue in a safe fashion, so that the tissues can heal and repair appropriately.
Unbalanced pulley system: when one side of a pulley system is exerting too much force, issues with balance occurs. This happens much the same in the body. One side may be much stronger than the other. Prescribed exercises may help to create balance.
Missing tent poles: a tent needs equal tension to stay erect. If tent just one tent pole is missing the entire structure loses its integrity. Our body may lose integrity/stability when core strength is lost. Prescribed exercises may help to regain this stability.
Broken hips: 30% of people over 65 years of age fall at least once every year. This is a major cause of hip fracture, which often leads to mortality. Exercises may help to improve coordination and balance, and prevent falls from occuring.
Pain avoidance: when pain is present for a long period of time, people tend to avoid particular movements or activities that previously resulted in pain. Prescribed exercises may allow for a safe and progressive return of these movements or activities.
At Prom Country Osteo, we try to ensure that the exercises we prescribe are well-considered. When deciding which exercises to give patients, we think about what exercises have most evidence, which ones suit our patients current circumstances, we find out what our patients enjoy doing and then try to tailor our advice to these factors.
What is yoga? What is pilates? Do I need them?
Pilates involves specific and targeted exercises that aim to build body awareness, muscular strength and correct movement patterns. It is a popular method used to build core and spinal strength.
Yoga is a philosophy involving the practice of controlled and specific movements, breathing exercises and meditation. It is often perceived as an activity to stretch and improve flexibility, however it offers other benefits to the body and mind.
There are many types of yoga & pilates & knowing what type to do can be confusing. In reality, anyone can do yoga or pilates, as long as the type of practice suits the individual. We are happy to make a recommendation about whether to do either of them based on your individual needs & preferences.
How frequently do we recommend seeing patients?
The following is a general guide:
1. When symptoms are acute: treatment is organised more frequently, such
as twice per week until patients are able to get by their day without significant
2. When symptoms are non-acute: generally, we recommend weekly to fortnightly
treatment until symptoms settle.
3. Once symptoms have settled: consults are progressively spaced further apart.
The focus at this stage is on fully addressing the root cause/s of the problem and
preventing it from coming back.
Everyone presents and responds to osteopathic treatment uniquely. Therefore, we always reassess progress at each consult & tailor the frequency of treatment to your individual needs. You are included in the decision-making process.
What are the risks to treatment?
Osteopathy is generally considered a safe form of health service.
However, we need to make you are aware of the risks associated with an osteopathic consult before deciding to receive it.
Osteopaths are trained health-professionals. We use our best clinical judgement to limit foreseeable risk to patients from treatment and openly discuss these risks.
There is risk associated with the examination, treatment & management we provide. Risk is relative to your individual circumstances & your particular consult.
Common risks to treatment include, but is not limited to:
Aggravation/making an injury worse
Feeling tired, fatigued
Numbness or tingling
Serious risks to treatment are incredibly rare. There is a lack of evidence to conclude figures. Despite the rarity, these risks are believed to exist. Therefore, we need to make you aware of them. They include:
Nerve root or spinal cord injury
Pneumothorax (punctured lung)
Worsening of disc herniations
Stroke & arterial dissections
If you request, we can provide detailed information on studies about these risks, including proposed figures on likelihood, & discuss this information relative to your particular circumstances.