The Whole Body
After working for a couple of years as a yoga and Pilates teacher, the physicality of the work started to take its toll, and I sought out professional help, both to correct and prevent. I've been seeing osteopath Guy Gold on and off for about 2 years, and not only is he an excellent osteopath and my body feels good in his care, he's also a positive with a great sense of humour, and a generally lovely person to spend time with. I asked him to explain a little more about osteopathy and what's involved.
What is osteopathy and how does it work?
Osteopathy is a system of healing which realigns the musculoskeletal system to allow the body to heal itself. Our specialisation is within the musculoskeletal framework, but it’s very holistic in its approach, so we’re treating people not conditions and a lot of osteopaths would have concurrently studied naturopathy, which I also studied. Naturopathy is effectively the definition of holistic health, in that we look at the mental, spiritual, emotional, physical and biochemical bodies. The osteopathic part is the musculoskeletal system. So we don’t get people better, we just give people’s bodies a nudge to getting themselves better.
What’s the difference between osteopathy and physiotherapy?
I’ll bring in chiropractics as well, because that’s something else that patients often ask about. We’re all equally good, we’re all specialists within the musculoskeletal field. Physios tend to (and there’s a lot of overlap here, which is important to highlight), but physios tend to provide more remedial exercises – stretching, strengthening and tend to be a bit more hands off and more prescriptive. Chiropractors tend to work more centrally along the spine – they do work peripherally as well, but principally they’re working on the spinal column and the nerve supply to other areas of the body. So their techniques tend to be more manipulations – clicking, popping and so on, but again, there’s often overlap and osteopaths generally are working more with the cardiovascular system and people’s entire body, so whilst we use spinal manipulations and advise people on exercises and so on, we also do lots of massage techniques and stretching techniques. A lot of our work is increasing blood supply to tight areas where there’s no sort of movement and reduced “life”, if you like. But all of them are well placed to treat people suffering from musculoskeletal pain and it’s really down to patient choice. They’re all equally good, just coming in from slightly different angles and slightly different philosophies behind them.
Who can benefit from osteopathy treatments?
I think anyone can. Again, having trained as a naturopath, my approach is very holistic - thus we’re into prevention rather than cure. So typically, I’ll treat from infants to very elderly patients. This week, my youngest patient was four and my eldest patient was ninety-three. In my opinion, I think everyone benefits from osteopathy.
The majority of patients that present to me are patients presenting with pain, ranging from mild discomfort to literally crawling in on their hands and knees in agony. I also treat world-class sports people and they’re in ludicrously good physical shape and they come in for preventative work – so a good osteopath is skilled at kindly observing a patient’s body, reading their body and ascertaining areas of “stuckness”, or restriction that can be freed to enable less stress on other areas. So, for example, someone with a painful knee, you’ll want to look at all of the joints of the lower limbs – so the feet, the ankles, the knee and the articulations of the knee, the hips, the pelvis and the lower back – that’ll be very typical – because it’s all very well and good looking at the knee, but you want to make sure it’s housed in a functioning lower limb and attached to a well-functioning body, in a person that you can guide on what they should and shouldn’t be doing to help to stay well and keep well.
I often see patients who present without pain, or who have been in pain, and want to stay out of pain, and I might see them a few times a year as a preventative measure; it’s less uncomfortable for the patient and they’ll need less treatment across a year; because I’m not curing people, I’m helping people’s bodies to realign so that they can heal themselves and sometimes, with someone who presents for example with arthritis, we can’t impact arthritis in terms of curing it or improving it, but we can help an individual’s body manage it a lot better. And in that respect, there’s often good hope. Some of my patients, for example, might be advised that they need a hip replacement because they’ve got very marked osteoarthritis in the hip and I can help make them more comfortable despite the fact they’ve got that – that means they might not need to be suffering quite as much as they might be in the lead up to requiring surgery.
How will someone usually feel following treatment?
AMAZING! (laughs). The majority of people find it really beneficial. A lot of what we do as osteopaths is education and support. The first and most important job as an osteopath is accurate diagnosis. The most important clinical decision I have to make is “is this patient safe for treatment?” and if they’re not, then where should they be? That’s where osteopathy stands alone in some complimentary medical fields in that we’re primary healthcare practitioners - you go through the same diagnostic triage that a doctor would. We’re not doctors, but we do go through the same triage, so in a typical working week I normally recommend, on average, one or two patients to seek out further scans, or go to the doctor or the hospital. People present things as extreme as broken backs, which is an extreme contraindication for treatment, so in those instances I refer them to get the appropriate checks or treatments before I commence treatment.
So, to answer the question, in the first instance, hopefully people feel reassured by accurate diagnosis so we can know exactly what it is that’s causing a patient’s pain in order to treat the patient safely and effectively. And in the absence of feeling confident in our diagnosis, a good osteopath wouldn’t treat, because a) it’s dangerous, and b) we’re effectively trying to guess a patient better which again is dangerous, inappropriate and ill-advised. In that light, I think the first thing that people often feel is reassured that they are listened to and heard, taken seriously, examined thoroughly and respectfully, that they’re communicated to clearly about what it is that’s going on, what can be done and what can’t be done … given additional advice and modalities as a supportive benefit to moving back to optimum health and wellbeing, and being taken seriously. I always ask if there are any questions or concerns, if people want any further explanation about what I’ve observed, so I think that’s a really important starting point – establishing a really diligent, clear, supportive framework.
And once we start treatment, it really depends on what they present with – there’s different extremes. One patient might just have cricked their neck that morning, we might be able to unclick it and suddenly they feel amazing, and it’s really striking – from agony to feeling brilliant. But that can really vary depending on what it is, how long it’s been there before and how much better I feel we can get that person.
It’s quite a hard question to answer apart from that first part which I think is really important. Normally people feel a bit more spacious, softer, a bit less uncomfortable, a bit more fluid, better quality and quantity and range of motion. On a broader level, in realigning the body, untwisting twisted areas and freeing up stuck areas and helping guide a patient to tighten up loose areas, they can feel like their psyche is housed in a better soma, so the mind’s housed in a better body and quite often you’ll get a sense of someone being more in their midline, more grounded, more relaxed … softer broader breath. Just a kind of more embodied sense. Their sense of wellbeing – there’s a marked broader sense when you observe a patient having done a treatment.
You can also get patients who, because we’re moving blood around already inflamed areas (say for example, there’s a very tight knot that’s inflamed, painful and tender) – by breaking it down, we’re bringing good blood in, so oxygen, nutrients, the ability to drain toxins away – but in bringing in good blood, so bringing inflammation into an already inflamed area – it’s effectively creating more inflammation, so you can be a bit more tender, and in releasing the waste products through metabolism such as lactic acid, that can cause irritation to the surrounding tissue. An osteopathic treatment reaction can be quite common – where someone feels a bit sore, tender, worked on, moved about, for 24 (possibly 48) hours and then that will settle and they’ll tend to feel much better. There can be a slight apparent worsening before they then feel improved.
And in very rare situations, someone might not react well. Obviously, we’re bound by the Hippocratic Oath, and we only treat if we feel that we can genuinely benefit someone. But sometimes it isn’t for everyone. Ideally, you think you can positively impact someone’s health and well-being, you draw up a prognosis, perhaps they need 4-6 treatments and if they’re not following that trajectory that you hope, a good osteopath will review, reconsider, perhaps in confidence talk to an osteopathic colleague, get a second opinion, bring in a doctor, get further investigations. It’s really important that as an osteopath you’re regulating a person’s care and ensuring (kind of auditing, really) that they’re getting better at the rate you anticipate, and if they’re not, you want to look at why not: have you got the diagnosis right? do you need to do further examination? A good osteopath will review the patient’s notes regularly and really think about each individual’s care between sessions. I’ve always got a file of patients that I’m keeping a particularly keen eye on.
What should someone should look for in a practitioner?
Qualified (laughs) … qualified, insured, and registered with a governing body.
Seriously, a good osteopath will be present, aware, engaged, intelligent, thoughtful, considerate, respectful, very diligent, and have a continued commitment to their profession in that they’re doing regular professional development. It’s called an osteopathic practice, and we’re always learning. Our patients are often our teachers, but it’s really important that we continue to develop our skill set and highlight areas of weakness that we can improve. They need to be safe, they need to be kind, they need to listen, be respectful. Stop if a patient is uncomfortable. It’s such a broad question, but an osteopath should be holistic; we’re treating people not conditions. They have to be boundaried, and deeply courteous and respectful to the patients in their care. It’s a significant privilege and honour to be able to do this.
What’s the best thing that happened in the treatment room?
Awww …. it happens every day. Frankly, I feel quite moved by the work I do, not because of what it is, but because it’s inescapably honest, real, humbling – it offers an amazing opportunity for patients to open up, in the strictest of confidence. There are very tender moments, human to human, and there’s a really depth-y human resonance that occurs. Being an osteopath offers an amazing opportunity for … it’s hard to put into words. It’s just extraordinarily humbling. I’ve heard the most remarkable stories of humankind in here – from horrific to amazing to tragic to beautiful. It’s just very real. And it’s a total privilege.
Guy Gold practices Osteopathy in London with his associates at triyoga in Camden and Soho.