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23rd March 2018 

Frequently asked questions

How many sessions will I need?

This varies from person to person and depends on lots of things such as what you want from treatment, how long you have had particular symptoms, what the causes are, and what your health is like generally.

People sometimes feel much better after one treatment, and if this happens we could discuss whether or not a follow up treatment would be supportive for you.

Typically, people might need a series of two or three treatments at weekly or fortnightly intervals, or occasionally it might be helpful to have a couple of treatments in a week

In my experience it is unusual for someone not to experience improvement within 2-3 sessions. If you weren't improving, then we would look at what might be interfering with your healing, and review your options.

It can sometimes be helpful to have a regular treatment every few weeks or months to support your body. We would discuss if this might be helpful for you and review your needs ongoingly.

What happens at the first session

At our first meeting I will ask about your history - including your medical history & any current symptoms you may have - to help see what is the best treatment approach for you now. I may also ask you to carry out simple movements, and do other tests to help get a sense of what is going on.
This first session usually includes treatment. Very occasionally further tests may be necessary before treatment can start. Very rarely it may be the case that osteopathic treatment is not suitable.

How do I prepare for the first session?

If you do have any medical reports it may be helpful to bring these to the first session, but dont worry if you dont have them available.

Will I need to undress for treatment?

It may be helpful to wear or bring loose clothing to wear during treatment. Sometimes it may be necessary for you to uncover relevant parts of your body to be examined, or for example to facilitate treatment with oil. However, this can usually be avoided if you are uncomfortable about it, and should the need arise you may arrange for a chaperone to be present. During treatment, most of your body will normally be covered by a towel.

Does treatment hurt?

Treatment might sometimes involve working on or near areas that are tender, but I work with sensitivity and treatment is not normally painful. I am always guided by your wishes and response to treatment.

Will I get a bad reaction to treatment?

Sometimes people might feel a little sore after treatment, as after exercise, but usually this is shortlived and fades to leave you feeling more relaxed and comfortable.
More information about possible reactions to treatment

Private health insurance

I am registered with most health insurers. You may be able to recover the cost of your treatment from your insurer. Please check with them beforehand for details.

The normal procedure is that you pay the treatment fee at the time of appointment, by cash or cheque. I then give you a receipt and you can claim the cost from your insurer.

To book or for more information call me on:
07941 531 737
or email me (email is for non urgent enquiries only)


Mindfulness and evidence based research
Mindfulness courses at The North London Buddhist Centre

Rick Hanson - Mindfulness in Action - Resources for Happiness Love and Wisdom

Click on the links below for information about electro magnetic fields and their effects on health.

Powerwatch is a small non-profit independent organisation with a central role in the UK EMF and Microwave Radiation health debate. Powerwatch works with other like-minded groups and with decision-makers in government and business, promoting policies for a safer environment. Powerwatch has been researching EMF effects on health for over 20 years, and provides information to help people understand these complex issues.
Information from EMF scientists about health issues related to cell phones, wireless devices, wireless utility meters and wireless infrastructure in neighbourhoods and
Two more useful sites with more information and practical ways of minimising the effects of electro-magnetic fields in every day life

Burgs 'Energy Fields and Modern Technology -- Part 2 - YouTube ...
Burgs, a meditation teacher, demonstrates the effects of EMF's on chakras

'Traumeel' anti inflammatory ointment and gel

Traumeel is an emerging option to nonsteroidal anti-inflammatory drugs in the management of acute musculoskeletal injuries. Traumeel has shown comparable effectiveness to NSAIDs in terms of reducing symptoms of inflammation, accelerating recovery, and improving mobility, with a favorable safety profile.
Read what the US National Library of Medicine, National Institutes of Health, has to say about 'Traumeel'

More information about Traumeel

Traumeel is available online and at various stores, including:
Helios homeopathic pharmacy
Revital, Belsize Park

Persistent pain

We all feel pain from time to time. When someone injures themselves, specific nerves recognise this as pain, which in turn triggers the body’s repair mechanism. As the problem resolves, the pain tends to improve and usually disappears within 3-6 months. This type of pain could be argued to be beneficial: if it hurts, you are likely to try and avoid doing whatever it is that has caused the pain in the future, so you are less likely to injure yourself in that way again.
Occasionally the pain continues even after tissue healing has finished. When pain continues after this point, it becomes known as persistent (or is sometimes referred to as chronic) pain. This type of pain is not beneficial and is a result of the nerves becoming over-sensitised, which means that a painful response will be triggered much more easily than normal. This can be unpleasant, but doesn’t necessarily mean that you are doing yourself any harm simply by moving. You could think of this as a sensitive car alarm that goes off in error when someone walks past.
Persistent pain is very common and effects over 14 million people in the UK alone. It often does not respond to conventional medical interventions and needs a different kind of approach, but there are many things that you can do to manage your pain yourself with the support of your osteopath, your family and loved-ones. Keeping active, performing exercises and stretches can help, learning to pace your activities so that you don’t trigger a flare-up of your pain as well as setting goals and priorities are all very important and can help you to maintain a fulfilling lifestyle.
For more information on how to manage your persistent pain, speak to your osteopath or visit

Possible reactions to osteopathic treatment - more details

What are the known common reactions to osteopathic treatment?
Reactions to any treatment can be described as positive, negative, physiological or psychological.

Approximately half of all manual therapy patients experience some mild to moderate short-lived reaction to treatment. These can include, for example, a temporary increase in pain, aching after treatment, or post-treatment fatigue.

In a study of osteopathy patients, 10-20% patients reported an increase in pain or symptoms, however, 42% of those went on to make clinically significant improvements compared to base line9. Most muscle soreness, aching and headache post treatment resolved within 24 hours.

Many patients who attend for osteopathic treatment take non-steroidal anti-inflammatory drugs (NSAIDs) to help with their symptoms. Approximately 1 in 10 people who take NSAIDs on a daily basis experience persistent headaches (

Who is most likely to experience these common reactions?
Mild to moderate treatment reactions are more frequently reported by females after their first appointment1.

Treatment reactions can result from a range of manual therapy techniques and an increase in intensity of symptoms does not appear to be related to high velocity thrust (HVT) techniques4. They appear to be more common after a patient’s first treatment, and in patients presenting with multiple sites of pain4.

What about other, more serious treatment reactions?
Symptoms that last for more than a few days that do not require medical treatment, such as increased pain or troublesome numbness or tingling are considered to be moderate treatment reactions. These types of reactions are uncommon and are estimated to occur in 1% of patients.

Reactions to treatment are serious if they require emergency medical care, or cause long term damage; they may be irreversible. Examples are stroke, nerve damage, muscular weakness, bowel and bladder weakness, or death. These would be described as a patient incident.

The best estimate for the frequency of patient incidents in osteopathy are 1 in 36,079 osteopathic treatments; these are not all associated with spinal manipulation4.

How often do serious treatment reactions occur?
Treatment reactions can be experienced from any form of treatment whether that is medication, surgery, or non-invasive manual therapies like osteopathy. The evidence that we have suggests that patient incidents do occur in manual therapy, including osteopathy, but they are very rare; the causal link is unclear also. The following table gives some best estimates for risk relating to spinal manipulation:

The best estimates available for serious patient incidents following manipulation are:
1 per 100,000 to 1,000,000 manipulations or
0.1 (less than one) to 1 in 100,000 manipulations1 to 10 people per 1,000,000 manipulations
1 per 50,000 to 100,000 patients
1 to 2 per 100,000 patients10 to 20 per 1,000,000 patients

Major cerebrovascular insult incidents, accidents following cervical spine manipulation:
1:120,000 – 1:1,666,666
0.06 to 0.83:100,0000.6 to 8.33:1,000,000

Lumbar disc herniation following manipulation:

Cauda Equina:
<1:3.7 million – 1:100million

How does this compare to the risks associated with day-to-day activities?

Stroke can occur with accidental impacts, during sport and leisure activities.

Risks in day-to-day life that could be compared with the risk of serious events following osteopathic treatment are:

Death from surgery to the neck
1 person in around 145 operations
Death by road traffic accident
1 person per 20,000 people in any one year
Death from long-term (years) using anti-inflammatory painkillers for osteoarthritis
1 person per 1,000 people
First time stroke
1 person per 1,000 people in the general population in any one year
Spontaneous strokes
0.03-5 person per 100,000 people in the general population over one year

Estimated risk of serious adverse event (death) over 1 year for:
Non-steroidal anti-inflammatory drugs (NSAIDs for osteoarthritis)
Course of manipulative treatment
The risk of having an adverse event with manual therapy (HVT) is less than taking medication (NSAIDs, diclofenac and amitriptyline)1

What can serious treatment reaction/patient incidents include?
Information gathered from the CROaM study identified a range of different treatment reactions and incidents. These included:

Central neurological symptoms e.g. stroke.
Peripheral neurological symptoms e.g. disc prolapse and sciatic pain.
Non-specific musculoskeletal symptoms e.g. spasm.
Symptoms related to underlying pathology e.g. fracture due to undiagnosed metastases.
Fractures e.g. rib fracture.
Unallocated e.g. worsening of low back symptoms, which led to 3 days hospitalisation4.

1. Carnes D, Mars T, Mullinger B, Underwood M. Adverse events in manual therapy: a systematic review. 2009. Available at:

4. Vogel S, Mars T, Keeping S, Barton T, Marlin N, Froud R, Eldridge S, Underwood M, Pincus T. Clinical Risk Osteopathy and Management Scientific Report: The CROaM Study. 2013. Available at

9. Licciardone, J., S. Stoll, et al. (2003). “Osteopathic manipulative treatment for chronic low back pain: A randomized controlled trial.” Spine 28(13): 1355-62.

10. UK BEAM Trial team (2004). “United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care.” Bmj 329(7479): 1377.

11. Licciardone, J., A. Brimhall, et al. (2005). “Osteopathic manipulative treatment for low back pain: A systematic review and meta-analysis of randomsied controlled trials.” BioMedCentral Musculoskeletal Disorders 6: 43.

12. Gross, A., J. Miller, et al. (2010). “Manipulation or mobilisation for neck pain: a Cochrane Review.” Man Ther 15(4): 315-33.

National Health Service Resources

Please click the link for National Health Service Resources

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Sue Step Osteopath,
Registered with The General Osteopathic Council,
Member of the Institute of Osteopathy.
Cranial and Structural, Mindfulness based approach, North London Islington & Camden areas