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A1. You must listen to patients and respect their individuality, concerns and preferences. You must be polite and considerate with patients and treat them with dignity and courtesy.

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A1. You must listen to patients and respect their individuality, concerns and preferences. You must be polite and considerate with patients and treat them with dignity and courtesy.

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My impression is that when I've been treating patients after starting my osteopathic education, I've been informing my patients of what is about to happen before conducting manual therapy. The information is given regarding the appropriate intensity, letting them know that pain is okay during treatment as long as the patient can relax, and if not, I ask them to let me know. This is both because of courtesy and professionalism, but also because the body is a unit comprised of, among others, the nervous system. If the intensity in the manual therapy is too high, this will simply result in increased sympathetic response, and the osteopathic manipulative therapy will work against greater, unnecessary resistance.

This standard is, among others, reflected in a case treating a patient with shoulder pain through my written exam paper in Osteopathic Clinical Consultations in year 2. Furthermore, before gaining consent to perform the treatment technique, I never did any High Velocity Thrust-techniques.

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B1. You must have and be able to apply sufficient and appropriate knowledge and skills to support your work as an osteopath.

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B1. You must have and be able to apply sufficient and appropriate knowledge and skills to support your work as an osteopath.

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My last practical exam gained "Excellent" grades in all except one criterion, which was the IVM component. Furthermore, I have read the Danish Clinical Practice Guidelines regarding diagnosis and treatment for musculoskeletal disorders. Even though I am still critical of not applying them blindly, some recommendations have been made solely on consensus, without any form of evidence. Moreover, these guidelines are made - no offense - by physiotherapists, who often tend to lack a holistic approach to (the active part of) treatment, which, as of today, is very evident to be more efficient. Andrew Taylor Still said: "To find health should be the object [...] Anyone can find disease". And with the current knowledge from the scientific literature today, we treat people - not diagnoses. This is why I am very aware of my gaps in knowledge and skills regarding the body's systems and functions; this will most likely be the most important step for me to step to the next level in my career.

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C1. You must be able to conduct an osteopathic patient evaluation and deliver safe, competent and appropriate osteopathic care to your patients.

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C1. You must be able to conduct an osteopathic patient evaluation and deliver safe, competent and appropriate osteopathic care to your patients.

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A client of mine came to the clinic with pain and fasciculations in both legs. Before the consultation, he visited his general practitioner, who referred him to a neurologist; however, the waiting time was a couple of months, and he wished for a second opinion on his diagnosis and cause of his systems. I conducted the subjective, neurological screening and objective examination indicating benign fasciculations and symptomatic myofascial trigger points in lower extremities, more specifically m. rectus femoris and m. gastrocnemius, predisposed mental and emotional stress, maintained by catastrophization and overuse. I informed him of my findings and let him know that I am not a professional psychologist or psychotherapist; however, sometimes talking about emotional loads can help, and if he was interested, he was more than welcome to let me know. He was, and meanwhile, I did general osteopathic treatment to decrease sympathetic activity, followed by MET of the symptomatic trigger points. I advised him to talk to his psychologist and neurologist as well and continue the treatment course with me to decrease sympathetic activity and treat the musculoskeletal issues.

Attached is a part of the anonymized medical journal.

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D1. You must act with honesty and integrity in your professional practice.

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D1. You must act with honesty and integrity in your professional practice.

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A patient of mine came to me for a free screening session of about 15 minutes. He presented with tinnitus. However, at the time, I had no experience with tinnitus at all. I told him this and informed him of the possibility of having an appointment with my colleague, whom I know has experience and skill in treating patients with tinnitus. The problem was that the waiting time for an appointment with my colleague was four weeks. I then told my patient he was welcome to have an appointment with me and that I could read up on the topic before an upcoming consultation. We agreed he could think about it and contact him via e-mail in case he had any questions.

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A2. You must work in partnership with patients, adapting your communication approach to take into account their particular needs and supporting patients in expressing to you what is important to them.

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A2. You must work in partnership with patients, adapting your communication approach to take into account their particular needs and supporting patients in expressing to you what is important to them.

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When treating patients, I sometimes send them an encrypted message with their "treatment recommendations"—not their determined plan. Furthermore, following the manual therapy, I inform them of the possible interventions they could apply at home regarding lifestyle changes or exercises, e.g., and let them choose how many and which interventions they feel are realistic to implement.

In this case, I was treating a patient who was an elite sports athlete runner who recently became a father. He came to me with hip pain during running and neck pain. Treatment consisted, among others, of load management, strengthening exercises and optimisation of recovery/the body's self-healing ability through tools to manage stress and sleep.

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A3. You must give patients the information they want or need to know in a way they can understand.

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A3. You must give patients the information they want or need to know in a way they can understand.

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I usually use the biopsychosocial model as an explanation for symptoms my clients are experiencing to emphasize that the body is a unit; I draw a cup that can be filled with biopsychosocial load. This cup has a hole in the bottom, representing the body's self-healing mechanisms. In other cases, I simply explain more specifically that the cause of symptoms is a combination of physical and mental overload. Attached is an example from one of my client's medical journals.

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A4. You must receive valid consent for all aspects of examination and treatment and record this as appropriate.

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A4. You must receive valid consent for all aspects of examination and treatment and record this as appropriate.

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Attached is an example from my year 1 examination. When reflecting, I let my patients know briefly that through my examination routine, I'll be going to touch around certain regions I'll be mentioning and look for tension and pain in most cases. I probably could improve a bit on this, as it's not every single time I do this because I think it often is implicit, however, this does not justify not doing it.

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A5. You must support patients in caring for themselves to improve and maintain their own health and wellbeing.

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A5. You must support patients in caring for themselves to improve and maintain their own health and wellbeing.

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I often send an encrypted message to my clients with their recommended active treatment plan following the appointment. In this message, I always ask them to please let me know if they have any questions at all.

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A6. You must respect your patients’ dignity and modesty.

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A6. You must respect your patients’ dignity and modesty.

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I recently had a client who came to me with tension-type headache and neck pain for at least seven years. She had tried multiple types of interventions without any improvement. She told me she separated from her husband 20 years ago. I politely let her know, that I am no psychologist nor psychotherapist; however, if she felt the need to share her thoughts and emotions, she was more than welcome to. And she did it. We gained a remarkable improvement after 6-8 weeks. We followed - partly - all of the Danish clinical guidelines, except for acupuncture and the supervision part of physical training. The current recommendations from the Danish national clinical guidelines for tension-type headache are the following:

•Manual joint mobilization techniques: Consider manual joint mobilization techniques for patients with tension-type headaches in addition to usual care (very low evidence).

•Supervised physical activity: Consider supervised physical activity for patients with tension-type headaches in addition to usual care (very low evidence).

•Psychological treatment: Consider psychological treatment in addition to standard treatment for patients who experience tension headaches that significantly limit their quality of life (very low evidence).

•Acupuncture: Consider acupuncture for patients with tension headaches in addition to usual treatment (low evidence).

•Patient education: It is good practice to consider patient education for patients with tension headaches (based on consensus - no evidence).

Despite having an improvement by applying most of the clinical guideline recommendations, which of the interventions led to the improvement remains unknown. In my opinion, the guidelines lack recommendations on interventions targeting the potential aetiology and modifiable risk factors of tension-type headache, e.g., stress, lack of sleep, general health and ergonomics.

Lastly, my aim to respect my patient's dignity and modesty is reflected in my grades from year 2 examinations in the MSK-station. I achieved a 90 % mark in "act and interact with a professional and respectful demeanor".

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B2. You must recognise and work within the limits of your training and competence.

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B2. You must recognise and work within the limits of your training and competence.

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At work, I received a client for a free screening 15-minute-screening. When checking my calendar, I thought the client was 100 years old when looking at the birthdate. When I went to the arrival room at the clinic, I saw that the client was a baby. Despite having a very limited amount of training in paediatric care, I pretty quickly recognized the issue was torticollis upon quick subjective examination, observation and light palpation of SCM, scalenes and upper trapezius. Even though I've had two lectures on paediatric examination and treatment, one of them almost only contained information regarding the pregnant patient, and the other contained information on reflux disease and cranial techniques for babies. Despite this, I've seen and read about torticollis and informed them of my hypothesis, however also of course informed them that I had no experience in treating babies, but my colleague has and this seemed to be treatable as it seemed to be postnatally acquired since she didn't have the issue in the first couple of weeks. I recommended them to book a free screening with my colleague to be ensured she was able to help, and in the meanwhile I would recommend them to facilitate her rotation to the opposite site by e.g., holding her primarily on the opposite arm as usual and switch between the sides and place toys and stimuli to the side forcing her to decrease the torticollis. In hindsight, I should have recommended my colleague straight away to be sure I wasted no time and did no harm, despite only performing observation and light palpation.

Attached is an anonymized section from the medical journal.

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B3. You must keep your professional knowledge and skills up to date.

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B3. You must keep your professional knowledge and skills up to date.

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At the clinic where I work, we have monthly 2-3 hour education sessions on different topics. Last time, the topic was the treatment of fatty liver. Attached is the Facebook event of the session.

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B4. You must be able to analyse and reflect upon information related to your practice in order to enhance patient care.

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B4. You must be able to analyse and reflect upon information related to your practice in order to enhance patient care.

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Recently, one of my colleagues was observing one of my sessions with one of my clients. Following the session, I received feedback from my colleague. The feedback was good hands and communication. The possible improvement points were, among other things, my ability to implement the theoretical model for treatment we use at our clinic called "the body's hierarchy [of prioritized healing regarding structures in the body]". In this model, the brain and the central nervous system are prioritized first by the immune system, the cardiovascular system second (heart, lungs, etc.), internal organs (gastrointestinal system, etc.) third and musculoskeletal load fourth. Therefore, when treating pain deriving from the musculoskeletal system, loads on the systems ranked above would be treated before intervening specifically for the musculoskeletal system.

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C2. You must ensure that your patient records are comprehensive, accurate, legible and completed promptly.

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C2. You must ensure that your patient records are comprehensive, accurate, legible and completed promptly.

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When conducting the subjective examination, I conduct the medical journal at the same time. Our medical journal has a template to make sure all relevant areas are covered, however, I am still aiming to keep a red thread in the dialog so the examination does not become a questionnaire. This procedure makes sure I cover all relevant areas in the examination while also reporting it in the medical journal.

Nevertheless, recently, I've started to be more authentic with more eye contact and conversation/subjective examination at the cost of less rigorous medical journaling. However, I think implementing both and achieving a very positive patient experience is achievable. My next step is to take more time conducting the medical journal.

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C3. You must respond effectively and appropriately to requests for the production of written material and data.

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C3. You must respond effectively and appropriately to requests for the production of written material and data.

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One of my clients asked for his medical journal because his insurance company needed a copy to decide whether they would grant him more treatments covered. Our medical journal system has a safe e-mail system which makes sure to encrypt messages by sending a code to the patient's phone, which is needed to unlock the encrypted message. To send his medical journal to him, I used this function. Furthermore, this journaling system follows all General Data Protection Regulation guidelines to ensure safe data storage.

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C4. You must take action to keep patients from harm.

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C4. You must take action to keep patients from harm.

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I once had a patient who came to me three weeks following an accident in which he fell from a ladder down onto the lateral part of his shoulder. He was frequently awakened at night because of shoulder pain, and he felt his pain became worse with time since the accident. Observation only revealed a protracted and elevated shoulder girdle; however, palpation, vibration, and compression of the clavicle did not provoke pain. Palpation of the deltoid muscle and sub-subacromial space, however, provoked pain, and active mobility in all directions was very significantly decreased. My immediate thoughts were fracture, frozen shoulder, and avascular necrosis, however, I was also suspected of a possibility of a large degree of catastrophization because the mobility was that limited and he had Middle Eastern roots. I told my patient I was in doubt and told him I'd recommend a second opinion from my colleague, so my colleague came in and examined him. My colleague felt confident that my patient most likely experienced a labral tear and informed him so. Despite my colleague being so sure, I was still in doubt. Because this can be difficult to conclude specifically, I recommended my patient to call the Out-of-Hours Medical Service 1813 to go to the hospital and have a scan.

Following the consultation, I called my patient to follow up and hear how he was doing and whether he had a scan or not, but he didn't answer, unfortunately.

In hindsight, I think I did the right thing by referring, even though just a small amount of doubt was present: "when you're in doubt, you're not in doubt".

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C5. You must ensure that your practice is safe, clean and hygienic, and complies with health and safety legislation.

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C5. You must ensure that your practice is safe, clean and hygienic, and complies with health and safety legislation.

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A pregnant patient (g1, p0 and 12/40) of mine came to the clinic with lower back pain and radiation to her right buttock and hamstrings. The pain started two weeks ago without any sudden onset. She had no pins, needles, or numbness. She had no diseases, normal estimated BMI, and didn't drink, do drugs, or smoke. She was taking folate -, iron -, and vitamin D-supplementation as recommended by the Danish Health Authority. Furthermore, she was taking omega 3 and calcium, as she didn't drink milk. She had no dizziness, and her blood pressure was normal upon examination. Because she was still in the first trimester, I did no abdominal examination and conducted a mild intensity orthopaedic examination, which indicated some degree of lumbar radiculopathy, most likely a lumbar disc protrusion/herniation. Because she was still in the first trimester and the risk of miscarriage is still increased, we only did a mild and short treatment with low intensity techniques in the form of sidelying MET of QL and inhibition of the gluteus medius.

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C6. You must be aware of your wider role as a healthcare professional to contribute to enhancing the health and wellbeing of your patients.

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C6. You must be aware of your wider role as a healthcare professional to contribute to enhancing the health and wellbeing of your patients.

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Even though our clinic already has a blood pressure monitor, it only has one to share, and it is placed in our staff room. Therefore, I've bought one myself to make sure I'm always ready to examine my blood pressure.

Until today, I've always used it in case my patients have symptoms which could be related to high blood pressure. However, I agree with these practice standards, and I probably should measure blood pressure for general health issues in most of my patients as it is a "silent killer" because patients often have asymptomatic presentations. From today on, I will do it.

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D2. You must establish and maintain clear professional boundaries with patients, and must not abuse your professional standing and the position of trust which you have as an osteopath.

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D2. You must establish and maintain clear professional boundaries with patients, and must not abuse your professional standing and the position of trust which you have as an osteopath.

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One of my clients came to me with multiple issues, among other neck pain, low back pain, bloatedness and hip pain. She's been dealing with most of these issues for many years and has seen many therapists without any long-term effect. She saw me for a 15-minute free screening and told me she was curious whether I could help her or not and followed up by "I don't want to hear I'm overweight". I told her that was fine and not the direct and sole cause of her issues. I don't know her weight or BMI, but she was overweight.

We started a treatment course and saw minor improvements during the initial follow-ups, however, more and more consultations were made, and pain was very fluctuating. Some follow-ups she felt a bit better, some follow-ups she felt worse, and some she felt no difference. Despite no clinically meaningful improvements and even some new reoccurrences of painful musculoskeletal conditions during the treatment course, she kept asking for a new appointment. After a vast amount of treatments, I told her that if no noteworthy improvement has been experienced until the upcoming appointment, I'd recommend her having a second opinion from my colleague. Nevertheless, the symptoms always seemed to always in the following consultation.

We talked about her stress levels and managed them throughout the treatment course. Last time I talked to her, she told me a lot was "going on", and she consulted with her psychologist. I haven't spoken to her since, despite trying to reach out for her via e-mail.

Looking back, I think she felt comfortable in my company and was probably too comfortable, in the way she was not comfortable seeing other therapists, maybe because she felt ashamed of her body weight.

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D3. You must be open and honest with patients, fulfilling your duty of candour.

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D3. You must be open and honest with patients, fulfilling your duty of candour.

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A 75-year-old female patient came to visit me in the clinic with subacromial shoulder pain. When she appeared at the second consultation, she told me her pain was not improving. I informed her that psychosocial factors also may contribute to a lack of recovery and/or pain levels. I asked her whether she had been stressed mentally or emotionally lately, and she said no. About a minute later, while I was treating her shoulder manually when she was seated on the table, she told me she needed a break and asked me if I could open the window. She told me she was getting hot and experienced symptoms mimicking a hot flash. She felt uncomfortable and asked for a glass of water. I immediately got her a glass of water and asked her what happened - she said she didn't know.

About a week later, I received a message through the contact form on our webpage, saying she needed to talk to me about the treatment because she felt sick after the treatment. Straight away, I was worried, but at the time, I only did manual therapy of the shoulder and the neck of a mild level of intensity, so it was very doubtful that my treatment could have harmed her. Nonetheless, I recognized it could have been a possibility, and I messaged her back, letting her know that I was very sorry if in any way I did any harm to her and asked her to please let me know if I could help in any way. She e-mailed me back and told me that it wasn't my fault she has been to the psychologist since the last appointment and most likely experienced an untreated mental trauma in the form of her husband passing away two years ago.

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D4. You must have a policy in place to manage patient complaints, and respond quickly and appropriately to any that arise.

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D4. You must have a policy in place to manage patient complaints, and respond quickly and appropriately to any that arise.

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A 99-year-old patient of mine came to the practice for a 15-minute free screening with knee pain, interested in knowing whether I could help her or not to improve her pain and walking. She acted surprisingly well-functioning both physically and cognitively despite her age. I examined her knee and came to a working diagnosis indicating symptomatic left knee osteoarthritis. I told her I likely would be able to help to some degree, despite the age-related condition, however, I could not promise her improvement. I informed her that part of the management plan would consist of advice on optimizing the body's ability to heal and recover, exercises, and manual therapy, but I greatly focused on exercises in the beginning. She told me she already had tried exercises, to which I asked which exercises she had tried and which technique, frequency, intensity, and volume they were performed with. She told me she couldn't remember, but she had them on her computer. I informed her that most patients with symptomatic knee OA see improvements in pain when exercising, as long as the exercises have the right technique and dosage. I informed her of the price and told her that if she was interested, we could start the treatment right away. She hesitated a bit and said, "Okay, yes, let's do it". With a limited amount of time left (20-25 min.) - in the context of her age - I chose to walk her through the exercises properly in regards to technique and dosage and let her try them. No manual therapy or advice was given other than three exercises due to my considerations regarding gaining the most effectiveness with the least amount of time available. We then agreed to an initial follow-up the following week. She then said goodbye and walked out of the treatment room, to which I also said goodbye and let her know I'd send the bill to her cell phone in a text message. She then asked what the price was, and I repeated the price. She seemed a bit surprised and then asked me to help her pay the bill on the phone. I tried, but it did not seem to function, so she ended up paying cash, and we said goodbye on a friendly note.

A week later, I received the e-mail as attached. She cancelled the follow-up and told me she felt cheated because she had a free screening, she did not know when the screening ended, and she said she declined to do any exercises and receive any information about the treatment price. She ended the mail by telling me she wanted a refund. I did not doubt at all that I informed her about the price, and she agreed to start treatment, including exercises. I got a feeling of confusion, irritation, and injustice and found myself ruminating for many hours regarding what I should do about it, and I wanted to avoid a bad review anywhere online (and in public). In the end, I found myself spending a lot of time ruminating about this issue but also not deciding the issue. Based on this and the benefit of the doubt - she did ask for the price as she walked out - I chose to give her a refund and a polite apology for the possible misunderstanding.

When reflecting, I think this is a unique situation in every case; however, if the same thing happened again, I would choose the same option.

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D5. You must respect your patients’ rights to privacy and confidentiality, and maintain and protect patient information effectively.

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D5. You must respect your patients’ rights to privacy and confidentiality, and maintain and protect patient information effectively.

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The medical journal system at our clinic follows the General Data Protection Regulation.

Furthermore, I always ask my patients for psychosocial factors through questions like: "Do you like your work?", "How's everything at home?", "How's your relationship with your partner?", "How are your kids doing?". If my patient is emotionally loaded, I let them know I am no psychologist nor psychotherapist; however, often, it may help to get some frustrations off their chest by letting someone know. If they are interested and feel comfortable doing so, they are more than welcome to talk to me about their issues, and I inform them about my duty of confidentiality.

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D6. You must treat patients fairly and recognise diversity and individual values. You must comply with equality and anti-discrimination law.

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D6. You must treat patients fairly and recognise diversity and individual values. You must comply with equality and anti-discrimination law.

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A patient of mine informed me that she had a mastectomy conducted, changing her gender from female to male. To this, I regained my professional attitude and maintained focus on the complaints he presented to the clinic.

I feel I dealt with this properly and didn't start discussing any beliefs or politics, but kept focus on the issue itself without forgetting treating the person as a whole. This may, to some degree, be supported by the fact that he returned half a year later to me with another complaint.

In the future, I think this will be the right approach. However, I am not bothered to any degree about which sexual preferences my clients have nor which gender they prefer to be. So if they open up a discussion, I think I might optimize treatment and relation to the patient while keeping a professional distance by asking questions regarding their social situation and trying to put myself in their situation.

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D7. You must uphold the reputation of the profession at all times through your conduct, in and out of the workplace.

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D7. You must uphold the reputation of the profession at all times through your conduct, in and out of the workplace.

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My clean criminal record is attached.

Furthermore, during my osteopathic education, I've experienced a lot of likely and less likely hypotheses coming from colleagues regarding patient examination and treatment, which sometimes frustrates me. It is possible to see both bad and skillful osteopaths, but this is possible in any industry. Over time, I have acknowledged that there are different opinions on this topic. When speaking to people outside the osteopathic environment, I am always very mindful of speaking positively about osteopathy.

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D8. You must be honest and trustworthy in your professional and personal financial dealings.

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D8. You must be honest and trustworthy in your professional and personal financial dealings.

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Often, after a treatment session, I provide a recommendation regarding the treatment plan. At the same time, I allow my patients to book the follow-up appointment by themself online in case they want to utilize this solution, providing them the opportunity to reflect on their preferences, as documented in the attached section of one of my patient's medical journal.

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D9. You must support colleagues and cooperate with them to enhance patient care.

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D9. You must support colleagues and cooperate with them to enhance patient care.

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A client with tinnitus came to the clinic one day for a free 15-minute screening with me. I told him I'd recommend him having a free screening with my colleague who has experience with treating tinnitus.

My reflections on my handover are that despite not being completely confident in what next step was or should be for my client, I was completely honest in the way I provided him with possibilities, and I included shared decision-making in the process. I think honesty and authenticity are more important than the delivery itself. If this approach is applied, I think delivery will improve with experience and time - the opposite will probably not be the case. So, in the future, I will focus on maintaining honesty and authenticity.

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D10. You must consider the contributions of other health and care professionals, to optimise patient care.

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D10. You must consider the contributions of other health and care professionals, to optimise patient care.

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At the moment, I am treating a patient with a lot of symptoms deriving from the muscles in her lower extremities. It is associated with pronounced muscular atrophy and deficits in muscular strength and endurance. I, among other interventions, advised her to do strengthening exercises. To ensure proper treatment effects, I recommended her consult with a dietitian to reach a calorie surplus and optimal protein intake.

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D11. You must ensure that any problems with your own health do not affect your patients. You must not rely on your own assessment of the risk to patients.

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D11. You must ensure that any problems with your own health do not affect your patients. You must not rely on your own assessment of the risk to patients.

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A few months ago, I was sick with a cold. I felt able to go to work and push through if necessary; however, because of courtesy to my patients, I rescheduled them for a new appointment in the next week.

Furthermore, I have taken out an insurance policy (attached) that offers sick pay. When reflecting on it, this is beneficial to decrease any inclination to go to work despite being sick to any degree, because to be honest, earlier in my career, I have attended work despite being a bit sick with a cold now and then.

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A7. You must make sure your beliefs and values do not prejudice your patients’ care.

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A7. You must make sure your beliefs and values do not prejudice your patients’ care.

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One of my current clients came to me with substantial muscular atrophy in both lower extremities associated with pain and hypertonicity in m. quadriceps, hamstring muscles and triceps surae for many years. She is retired and doesn't feel stressed. My recommended treatment plan was to do exercises, aim to sleep a minimum of 7 hours, and a protein intake of a minimum of 1.6 grams of protein per kilogram of body weight per day. However, despite this, she told me she was only going to implement the exercises. The way she told me was a bit intense, and I was sensing a bit of shame covered in realism, and therefore I told her it was completely fine for now as structure governs function, and I would expect her to improve even though.

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D12. You must inform the GOsC as soon as is practicable of any significant information regarding your conduct and competence, cooperate with any requests for information or investigation and comply with all regulatory requirements.

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D12. You must inform the GOsC as soon as is practicable of any significant information regarding your conduct and competence, cooperate with any requests for information or investigation and comply with all regulatory requirements.

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I have a clean criminal record, my medical journalling system follows all General Data Protection Regulations (www.easyme.dk) and the Danish Patient Safety Authority has visited our clinic not too long ago and concluded "No issues of significance to patient safety". My values ​​in life include honesty and treating others as I would like to be treated. Therefore, this is no issue for now and I don't think this is going be an issue in the future, if I continue to practice, among others, these life values.

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Case treating a client with women's health issues 

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Case treating a client with women's health issues 

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I recently treated a pregnant client (g1, p0 and 14/40) of mine who was in the second trimester. Thus, she just passed the first trimester, in which the risk of miscarriage is dramatically increased, however, she was also a bit early in relation til low back and hip pain, which usualy starts around week 18-20. She came with lateral hip pain without radiation. However, she also felt fatigue and headache most of the time. I asked her whether she had her blood pressure measured at her doctor, to which she answered yes, but there never seemed to be a problem. We measured her blood pressure, which was 100/63, which is not too low but in the lower end and could explain her symptoms of fatigue and headache. I then asked whether she was taking iron supplements as recommended by the Danish Health Authorities, to which she answered no. I then explained to her that her dizziness, fatigue and headache could be due to anemia, which could be caused by, among other things, iron deficiency.

Then, we proceeded to examine her lower hip pain and found a working diagnosis of gluteal tendinopathy. We managed load, and I gave her a strengthening exercise with a certain dosage and advised her to take iron supplements as advised by the Danish Health Authorities and make sure to follow the remaining recommendations by them. Furthermore, I advised her to see her doctor an extra time to ensure safety.

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On 29th of September 2024, I became a father to our firstborn son. During the first three months, he suffered quite a bit from bloating, which is most common from week 3 until 3 months of age. As an intervention, my girlfriend and I have frequently been applying osteopathic manipulative treatment to him when bloating was present with great success. The time from onset to effect when using the intervention was short, and the effect size was typically large. If he tensed up during treatment, we'd always stop and decrease the intensity until he was able to relax during treatment. He never cried; however, if this were the case, we would stop manual therapy and try to solve the cause as quickly as possible. This is further supported by the attached evidence in a meta-analysis indicating a positive effect on gastrointestinal disorders in infants.

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Case treating a client with a long term condition

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Case treating a client with a long term condition

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During 4th year in osteopathic education, I made a poster on patients with chronic tension-type headache, containing evidence-based examination, treatment and reflections on recommendations from the clinical guidelines in Denmark.

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Case treating a client with issue related to sports

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Case treating a client with issue related to sports

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One of my clients was an elite cross fitter who came to me with multiple issues, however, primarily bilateral shoulder pain lasting multiple years. My working diagnosis was subacromial pain syndrome, associated with biceps brachii tendinopathy and hypertonicity of all rotator cuff muscles. She was living very healthy; no drinking, no smoking, healthy eating, lots of vegetables, lots of protein, no weight loss recently, and slept as a baby. However, her weekly exercise schedule was literally:

Crossfit: Every day: 1 time per day; 1-2 hours per session. Soccer: 2 x per week. Weightlifting 2 x per week. Calisthenics 1 x per week with son.

Competes 3-4 times per year in elite level CrossFit.

Thus, my recommendation was to decrease the amount of exercise, especially exercises in the bar, pull ups, muscle ups, rowing, etc. - exercises which loaded the biceps brachii and rotator cuff the most. After a month we gained considerable improvement in her pain levels.