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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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During some of our seminars, we’ve received training on shared decision-making, and this article was one of the references. It provides a strong overview of how to effectively communicate with patients and highlights the importance of a collaborative process between clinician and patient when making decisions about treatment options and care. This approach also helps the clinician gain insight into the patient’s beliefs, preferences, expectations, experiences, and concerns. It’s essentially a conversation between two experts.

Throughout my osteopathy training, I’ve become much more confident in applying shared decision-making. I’ve improved in clearly explaining what I plan to do, why I’m doing it, what I can’t offer, and in listening carefully to my patient’s perspective. In my experience, this leads to more effective and successful treatment outcomes.

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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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One of the challenges I’ve always faced is explaining complex topics to patients, such as pain theory, lifestyle changes, and similar issues.

A systematic review and meta-synthesis by O’Keeffe et al. (2016) emphasized that patients benefit greatly from receiving clear explanations of their condition, supported by metaphors or analogies. This helps them not only understand their situation better but also explain it to others.

After studying both pain theory and psychology, I decided to write down a few analogies to clarify how I wanted to communicate with patients about why they experience pain. Two of those examples are included below. Doing this has made a real difference in my ability to confidently educate patients, something shown to be important in achieving good outcomes.

Going forward, whenever I find myself struggling to explain something, I plan to sit down and create analogies like these. While it takes some time, it’s been incredibly useful in practice and has long-term value, since I can reuse these explanations again and again.

1- Example:

"Pain works in such a way that all input coming into the body is sent to the brain. The brain then interprets this input and decides what you should feel and what you shouldn't. Based on memory, knowledge, and belief, the brain can turn the pain up or down.

For example, if you walk through tall grass, your brain receives input. It then communicates with various parts of itself and with your memory, things you've experienced before. If you've previously learned that tall grass isn't dangerous, you won't even notice it. But if you've heard or experienced that snakes can hide in tall grass, your brain might perceive it as a threat. This can trigger an alarm response that makes you tense up and quickly move away—and in some cases, your brain may even send out a pain signal."

2. Example

"Many factors can increase or decrease pain sensitivity and potentially trigger pain. Imagine your body as a cup. If you start filling that cup with things like lack of sleep, then add some long-term stress, followed by anxiety about your pain, and perhaps catastrophic thoughts like “what if my back gives out again?” Then, top it off with reduced physical activity, the cup starts to fill up. You might still not feel any pain. But then, one day, something small happens, and suddenly the cup overflows. That overflow can result in a lot of pain, even if the pain isn’t directly caused by a physical injury. The goal then becomes figuring out how to empty that cup again"

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What Influences Patient-Therapist Interactions in Musculoskeletal Physical Therapy? Qualitative Systematic Review and Meta-Synthesis

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Background. Musculoskeletal physical therapy involves both specific and nonspecific effects. Nonspecific variables associated with the patient, therapist,

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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 once had a case involving a 62-year-old man who came to the clinic with a neurological condition I had never treated, or even heard of, before.

His symptoms included:

Neuropathic pain described as burning and prickling

Able to walk, but typically walked on his toes

Disliked wearing shoes

Constant numbness throughout his lower extremities

No loss of muscle strength, but significant loss of balance

Inability to identify which toe was being touched when someone touched them

Still able to ride a bike

Difficulty sensing the need for a bowel movement, which had led to occasional accidents

His symptoms began four years earlier. One evening while eating, he suddenly became extremely dizzy. After about 30 seconds, the dizziness subsided, and he felt a warm, floating sensation in his right leg. The next morning, he woke up with both legs numb.

He had seen several neurologists and undergone 6 MRI scans. The only notable findings were elevated protein levels in his cerebrospinal fluid and possibly some microembolisms. Based on these, the doctors suspected lumbosacral radiculitis.

Since it was a free screening session, I didn’t have much time for a full examination. However, my findings were:

Endomorph body type

Anterior posture type

Tight calf muscles

Right SI-joint irritation

As mentioned earlier, I had no prior experience with this type of condition. He came to me hoping that I could help. I was honest with him and explained that I hadn’t encountered a case like this before and would need to consult with some of my colleagues. Since he had only booked a free screening, I told him I would get back to him after I had gathered more information.

I discussed the case with my colleagues, and they advised me that what I could offer included helping him start a gentle exercise program to stimulate the nervous system, suggesting lifestyle changes, and possibly using some manual therapy to release some tension. They also reminded me to be clear about setting expectations, that I couldn’t promise results or perform miracles, and that ultimately, he would need to do most of the work himself.

In addition, I looked into some literature, which suggested that physiotherapy, when combined with a targeted strengthening program, might be beneficial.

I called him and shared all of this with him. He appreciated my honesty and said he would think about it. I haven’t heard back from him since, but I feel I handled the situation well by consulting with colleagues, reviewing the research, and being transparent with the patient. If I encounter a similar case in the future, I would take the same approach.

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Central and Eastern European Online Library - CEE journals, documents, articles, periodicals, books available online for download, Zeitschrfitendatenbank, Online Zeitschriften, Online Zeitschriftendatenbank

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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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During my time at ESO, asking for consent has become a more natural part of my practice. In the beginning, it didn’t feel natural to ask every time I tried a new technique, unless it was an HVT or something close to an intimate area. Now, I ask almost every time, and I can see that development reflected in the feedback I’ve received from my exams from year 1 to year 3. In Denmark, when you ask for consent before performing a technique or placing your hands on a patient, most people respond as if it’s unnecessary, having already agreed to treatment at the start of the session.

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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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Before I started studying to become an osteopath, I worked as a physiotherapist. Back then, I would often ask my patients about their alcohol consumption, smoking, and diet. Occasionally, I’d try to explain why certain habits weren’t ideal, but I was usually too hesitant, worried that I might make them uncomfortable or come across as judgmental.

As a result, I didn’t put much focus on these topics.

Recently, I realized how much I’ve grown in this area. I’ve become much more confident when discussing lifestyle changes with my patients, because I now understand how significantly these factors can influence the healing process. I explain what the Danish Health Authority recommends, and how things like alcohol, nutrition, and smoking can affect the body’s ability to recover. Patients generally respond very positively, they appreciate the information and seem motivated to make changes.

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Sundhedsstyrelsen anbefaler, at voksne over 18 år højst drikker 10 genstande om ugen. Det gælder både for kvinder og mænd.

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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 received a comment during my first-year exam that I didn’t ask for permission when I slightly pulled down my model’s pants. I’ve always made a point of asking my patients for consent, but I hadn’t considered whether they would prefer to adjust their clothing themselves. Since receiving that feedback, I’ve made it a habit to ask patients to lower their pants themselves when needed. It now feels completely natural to do so, and it would feel inappropriate not to. This small change shows respect for the patient’s dignity and reinforces a sense of trust and professionalism in the treatment room.

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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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Experience:
A patient visited the clinic due to low back pain, reflux, and heartburn. She had osteoporosis and had suffered a spinal fracture a year earlier. The pain was not located where the fracture occurred but rather around her sacroiliac (SI) joint. She had seen another colleague of mine a year ago, whom I knew. Although he had helped alleviate her symptoms, and she had not experienced heartburn for a year, she spoke poorly of him, suggesting there had been some communication issues.

After a few sessions with me, her reflux, heartburn, and back pain showed some improvement. We also discussed her stress levels and how they might relate to her heartburn. I encouraged her to begin strength training due to her osteoporosis. She started using weight machines but remained unsure about its safety and whether I truly had experience working with osteoporotic patients.

She had seen online videos from an osteoporosis expert from in Aarhus and contacted him for guidance. However, she was dissatisfied with the delayed response, which took several weeks. When he finally replied, he referred her to an osteopath he knew. A few weeks later, she visited that osteopath but was unhappy with the treatment, as it only involved dietary advice and no manual therapy. According to the osteopath’s notes, she claimed she hadn’t received much guidance from me, something I found frustrating, as I had indeed offered advice which she may not have taken seriously.

After several sessions without significant progress, I referred her to another colleague whom I believed would be a better fit. This colleague later told me that the patient had spoken positively about my treatment style and personality, though she felt there hadn’t been much improvement.

Reflection:
In this case, I dealt with a patient who openly criticized several of my colleagues. I found this frustrating and somewhat irritating, but I remained professional and did not let my emotions affect our interactions. I was particularly frustrated by her claim that I hadn’t provided any advice, which wasn’t true. It’s possible she didn’t fully absorb what I shared because I wasn’t perceived as an “osteoporosis specialist” or didn’t come across as confident enough.

Throughout my seven years as a physiotherapist, I’ve worked hard to avoid appearing uncertain, even when I have solid evidence backing my approach. In hindsight, perhaps I didn’t communicate my expertise convincingly enough. Ultimately, I referred her to another colleague—not because I couldn’t handle her critical attitude, but because I believed she might respond better and show greater compliance with someone else.

Action:
I will continue to maintain professionalism regardless of my personal feelings. This case has reminded me of the importance of sounding confident and clearly communicating that my advice is evidence-based.

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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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Throughout my osteopathic training, I’ve continuously improved my understanding and application of osteopathic principles, as well as my anatomical, physiological, and palpatory skills. The structure of the program, with annual exams, has pushed me to stay focused and has sharpened my clinical abilities. During my third-year exam, I demonstrated "good" and "excellent" knowledge, which gave me confidence in my development.

In the last exam, this summer, we will be tested specifically on medical screening and the ability to identify red flags, an essential skill when treating patients.

Once I complete my training, I look forward to continuing my professional development through further courses. I enjoy learning, and it will be a great motivation to finally choose courses based on my own interests and clinical needs. To maintain and deepen my knowledge, I plan to set aside two hours per week after graduation to study areas where I feel less confident.

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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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ERA cycles

Experience:
I treated a patient who came to me with ongoing symptoms following a motorbike accident five months earlier. He was experiencing persistent headaches and was unable to return to full-time work. He had previously seen a physiotherapist, and although manual treatment had provided some relief, his headaches continued.

There were several issues I wanted to address. He was overweight, did not engage in any regular physical activity, and was under significant stress due to conflict with his employer. His boss insisted that he either return to full-time work or go on full sick leave, which added to his stress. He consumed alcohol only occasionally, a few times per week.

I did a full examination of him, including an eye test to rule out related issues, but the result was negative.

I explained to him the potential benefits of exercise, especially following a concussion, and provided some manual treatment. I also introduced other supportive strategies, such as stress management and healthy nutrition. In our conversations about increasing physical activity, he mentioned he enjoyed mountain biking or walking and was open to using a stationary bike at home.

It was my impression that he wasn’t truly engaging with my advice. His ongoing frustration with the headaches seemed to block progress.

I discussed the case with some of my fellow students. One suggested that I should identify what resources he had available so I could meet him at a level where he could manage the changes I was trying to implement. I tried this approach as well, but it didn’t lead to any breakthrough.

Eventually, I decided to involve a colleague, an osteopath at our clinic who is specialized in concussions. I asked the patient if he would be open to being seen by this colleague while I observed, and he agreed. My goal was to see if a different approach might be more effective. The osteopath confirmed my diagnosis and provided similar advice, but he delivered it with more authority and confidence, qualities that seemed to resonate with the patient.

Afterwards, the patient told me directly that I came across as somewhat insecure, probably because I was still a student.

Reflection:
The patient’s comment affected me, but it also provided valuable insight. This experience taught me that it’s essential to understand how each patient responds best to communication. In this case, the patient needed someone who projected more authority and confidence to feel reassured and to comply with treatment recommendations. It wasn’t that my knowledge was lacking, but rather the way I presented it.

Action:
Moving forward, I will focus on adjusting my communication style based on the individual in front of me. I will work on projecting more confidence and authority, even as a student, to improve my ability to engage patients and gain their trust.

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Exercise is Medicine for Concussion : Current Sports Medicine Reports

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level of exercise intensity, raising arterial carbon dioxide (PaCO2) levels. Elevated PaCO2 increases cerebral blood flow (CBF) out of proportion to exercise intensity, which is associated with symptoms that limit exercise performance. Thus, elevated exercise PaCO2 may signal incomplete recovery from SRC. This article reviews recent observational and experimental data and presents the evidence that subthreshold aerobic exercise normalizes the cerebrovascular physiological dysfunction and is “medicine” for patients with concussion and persistent postconcussive symptoms (PPCS). It discusses the systematic evaluation of exercise tolerance after concussion using the Buffalo Concussion Treadmill Test (BCTT) and reviews the utility of the Buffalo Concussion Bike Test (BCBT), the data from which are used to establish an individualized heart rate “dose” of subthreshold exercise to safely speed recovery, which also may work in the acute recovery phase after SRC with the potential to reduce the incidence of PPCS. Evaluation and treatment approaches based on the physiology of concussion suggest that exercise is medicine for concussion, potentially adding a new dimension to concussion care to help safely speed recovery and prevent PPCS in some patients.…

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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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Because I am currently in training, I make it a priority to keep my skills up to date by attending a new course every month, and I plan to continue taking additional courses after completing my osteopathic education. Additionally, when I encounter a patient with a condition I am not fully confident in managing, I actively engage in self-directed learning and hands-on practice to stay sharp in my clinical skills.

For example, I once had a patient who came in for a free screening, not for treatment, but for case history taking and examination. Based on my assessment, I concluded that she would benefit from fascial drainage. Before her treatment session, I reviewed the lecture on fascial drainage from our GOT seminar, which we had recorded and practiced the technique several times on a family member. I also revised the relevant lymphatic anatomy. As a result, I felt more confident, and the treatment was successful.

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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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I often reflect on how I can improve my clinical practice, including when a patient cancels an appointment and does not reschedule. To support both my development and their care, I usually follow up with an email after about a month to check in on how they are doing.

I write this:

Hi ....

I hope you're doing well!

I'm reaching out to check in on how you're doing and to follow up on whether you need a new appointment after the recent cancellation.

Please feel free to let me know, and don't hesitate to reach out if you have any questions.

You can book a new appointment using the following link:

....

Best regards

Fortunately, most patients respond and explain that they have simply been too busy. Some do not reply, while others provide feedback or mention that they have chosen to try a different treatment approach.

For those who do not book a follow-up appointment, I take the time to review their case history and reflect on the treatment I provided, our communication, and what I could have done differently to improve their experience and outcome.

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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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I was interested in starting to treat babies, but after the lessons we had at ESO, I didn’t feel fully competent. To build my confidence and ensure I could provide safe and effective care, I decided to take an additional course focused on taking a detailed case history and performing thorough examinations on infants. The course emphasized how to identify red flags and carry out comprehensive assessments. As a result, I now feel more confident in developing a working diagnosis and safer when treating babies.

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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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Due to the standards set by the physiotherapy profession, I have always been aware of the importance of taking a thorough case history. However, in the past, I would occasionally forget to ask for certain details and had to follow up at the next appointment. To improve this, I now use a structured template, which helps ensure I consistently collect all the necessary information.

My case history taking has developed significantly during my time at ESO. I have become much more specific and detail-oriented in my approach. I also follow the guidelines set by the Danish Patient Safety Authority, which outline the essential elements that must be included in a case history and how to document them properly when working as an osteopath.

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Når du arbejder som osteopat, skal du dokumentere dine behandlinger i den sundhedsfaglige journal. Journalføring er vigtig, fordi den sikrer den faglige kommunikation mellem dig og dine sundhedsfaglige kolleger om den enkelte patients sundhed og dokumentation af dit arbejde.

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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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I am using the ERA cycle for reflection.

Experience:
I treated a 22-year-old female patient who presented with radiating pain in her left leg, specifically along the posterior side, extending all the way down to her foot. She also reported some pain in the groin area. The symptoms began suddenly while she was mopping the floor. Initially, the pain was present in both legs, and she was unable to move due to its intensity.

She did not report any loss of strength or sensory disturbances. The pain improved when she lay on her stomach and worsened with prolonged sitting. She described the pain as a constant, pulsing sensation that only subsided when lying in the prone position. Her pain intensity was rated at 7–8 on the Numeric Rating Scale (NRS) at onset and 6 upon arrival at the clinic.

She had previously consulted a medical doctor who prescribed paracetamol and ibuprofen, but these provided no relief.

The patient was a law student and worked in an office setting. She also reported having chronic headaches following a concussion sustained eight years ago.

Based on her symptoms—radiating posterior leg pain, worsening with sitting, and relief in the prone position—I suspected a possible lumbar disc herniation and conducted a thorough examination.

Active Range of Motion (ROM):

Flexion: Reduced

Extension: Reduced

Side Bending: Reduced bilaterally

Rotation: Within normal limits

Neurological Examination:

Muscle Strength: Slightly reduced in the psoas, quadriceps femoris, hamstrings, and gluteus maximus

Reflexes: Normal

Sensibility: Reduced in the anterior thigh, shin, hamstring, and calf on the left side

Orthopedic/Neurodynamic Tests:

SLUMP Test: Positive

Straight Leg Raise (SLR): Positive on the left, though not worsened by neck flexion

FABER Test: Positive on the left

Ilium Compression & Separation Tests: Negative (no provocation)

Thigh Thrust Test: Negative, but she had difficulty performing a pelvic lift, making it challenging to position my hand under the sacrum

Palpation & Soft Tissue Findings:

Psoas and piriformis were tender and tight

Unable to perform a reliable "rising thumb test" due to her limited ability to flex

Visceral Screening:

Notable tension around the sigmoid colon

I saw the patient for three appointments. During these sessions, I focused on releasing muscular tension, addressing visceral restrictions, and improving overall mobility. I also introduced McKenzie exercises and provided guidance on healthy lifestyle habits to support healing, as well as strategies for pain management.

Since the patient was in the middle of an exam period and needed to sit for extended periods, I gave ergonomic advice tailored to her situation.

After three treatments, the only noticeable improvement was that she was able to sit cross-legged and reported minimal symptom relief. At the third session, I advised her to contact me after three days if there was no further improvement. When she did, and her symptoms persisted, I informed her that I would write to her doctor and explained what I intended to include in the referral.

Referral Letter to Doctor (Revised):

Dear [Doctor's Name],

I have treated ...... over the course of three appointments for low back pain with radiating symptoms in the left leg. Unfortunately, her symptoms have shown little improvement despite treatment.

Presenting Symptoms:

Pulsating, radiating pain down the posterior left leg to the foot

Limited response to paracetamol and ibuprofen

Symptoms aggravated by coughing, sneezing, and prolonged sitting

Pain relieved when lying on her stomach

No reported loss of strength or sensation during daily activities

Clinical Findings:

Active Flexion: Provokes radiating pain

Extension: Slight improvement in symptoms

SLUMP and Straight Leg Raise tests: Positive on the left side

Muscle Strength: Reduced in the psoas, quadriceps, hamstrings, gluteus maximus and medius (left)

Sensory Changes: Reduced sensation in the anterior thigh, shin, posterior thigh, and calf (left)

Treatment Provided:

Manual therapy for muscle tension

McKenzie-based exercises

Pain education and ergonomic advice

Given the persistence of her symptoms, positive neurological signs, and lack of treatment response, I recommend further evaluation, including consideration of an MRI scan, to rule out a possible lumbar disc herniation.

Best regards,

When the patient visited her doctor, she was initially told to simply continue with the current treatment plan. However, the following day, she received a call from the same doctor, who had since discussed the case with a colleague who had also read my referral. Based on that conversation, the doctor agreed that an MRI was appropriate. Three weeks later, the MRI was performed and revealed a herniated disc at the L4/L5 and L5/S1 levels.

Reflection:
I was proud of how I managed this case. I initially focused on conservative treatment, but based on the patient's symptoms and lack of improvement, I strongly felt that further diagnostic clarification was necessary. I communicated this clearly and specifically in my referral to the doctor, which ultimately led to the correct diagnosis being made.

Earlier in my physiotherapy career, I worked in a clinic where my supervisor dedicated an hour each week to reviewing cases with me. She would go through my patient records and any letters to doctors. She had attended a course on professional correspondence and was highly detail-oriented when it came to writing to medical professionals. That experience helped shape my communication skills.

I have also been taught that physiotherapists should avoid directly requesting imaging, as it may raise unrealistic expectations in the patient and can be perceived as overstepping by the referring physician. In this case, I tried to be respectful while still making my clinical concerns clear.

Action:
After sending this referral, I revisited the Danish physiotherapy standards for communication with medical doctors. I learned that we should avoid using profession-specific terminology, such as "McKenzie" as it may not be familiar to doctors and could lead to miscommunication. This was a mistake I made in my letter. Going forward, I will be more mindful of using universally understood clinical language in interprofessional communication to ensure clarity and professionalism.

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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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Fortunately, I have never been in a situation where I needed to contact child welfare services. An abuser would most likely avoid having their child assessed by a physiotherapist or osteopath. However, if such a case were to arise and I had any suspicions, I am aware of the proper reporting procedures and where to submit a concern (via the link).

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Hvis du er bekymret for et barn, skal du underrette kommunen

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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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I started a new job a year ago at a clinic where the treatment pillows did not have removable pillowcases. At my previous clinic, we used pillows with washable covers, which made it easier to maintain hygiene. I brought this to my employer’s attention and asked whether it would be possible to get a pillow that could be sanitized. I also offered to purchase one myself if necessary. This was well received, and within a few weeks, I received a new sanitizable pillow, along with additional ones for the other treatment rooms.

Being able to sanitize both the pillow and the treatment couch allows me to demonstrate to my patients that I take hygiene seriously and adhere to high cleanliness standards.

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The Importance of Cleaning in Healthcare: Meeting CQC Standards

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Cleaning in Healthcare: Meeting CQC Standards The concerning aggression of hospital acquired infections which are a direct result of lack of proper sanitation and cleanliness practices in hospitals has raised alarms within the healthcare community in the last decade. A study proved that an enhanced cleaning experiment in healthcare institutions in the United Kingdom led Explore the crucial role of cleaning in healthcare and how it helps meet CQC standards. Learn about The LCS’s expert services that ensure patient safety and compliance with healthcare cleanliness regulations. Discover our commitment to excellence in healthcare cleaning.

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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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I’ve become much more confident when advising my patients about health issues like smoking, alcohol, diet, etc. That’s because I can now explain in more detail how these things affect the body. At the same time, we have to be careful not to point fingers or make them feel bad. My most important job is to motivate them to live a healthier life. I usually refer to the recommendations from the Danish Health Authority ("Sundhedsstyrelsen") to support my advice.

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På denne side kan du blandt andet finde information om alkohol, rygestop, kost og motion.

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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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There are clear guidelines for professional conduct and ethical behavior in both the Danish and English clinical frameworks. These rules are well-grounded and serve to protect both the patient and the therapist. In Denmark, the title “Osteopath” is protected, and you cannot legally use it without authorization. When patients ask if I am an osteopath, I always clarify that I am a physiotherapist currently training to become an osteopath. I believe this reflects my respect for the title and the profession.

In private practice, patients often pay for their treatment themselves. This means they are typically very aware of the value they receive and expect treatment that is truly necessary, not more, not less. I don’t believe our patients are naïve; they can often sense if your intentions are not genuine. That’s why I always work with my patients’ best interests in mind. When they feel this sincerity, they are more likely to trust that everything I do is to support their health, not to fulfill my own agenda.

I’ve occasionally heard the suggestion that to maintain a busy schedule, you should see each patient at least five times. While I do agree that a longer course of treatment can sometimes provide a more holistic outcome, especially if it includes lifestyle guidance or long-term support, I don’t believe in a fixed minimum number of sessions. In many cases, I’ve seen patients significantly improve after just one or two sessions, especially when they’re motivated and responsive to advice. What matters most is that we identify and address the root cause of the problem and give patients the tools they need, however many sessions it takes.

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Danske Osteopater - Forening for Osteopater i Danmark

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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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Experience:
Early in my osteopathic training, I treated a friend of my boss. While they weren’t close, they knew each other through a triathlon club. The patient was very involved in triathlons and came to see me occasionally for a knee issue. He was about 15 years older than me. My boss had once mentioned that he was quite lonely and had been unsuccessful in his attempts to find a partner. Apparently, he would often try to flirt with new women in the triathlon club, but without much success. One day, my boss told me that this patient had said he wished I didn’t have a boyfriend, because he had developed a fondness for me.

During appointments, he would often show me pictures of his aquarium and invite me to come see it. After I casually mentioned once that I had been swimming, he asked if I wanted to go swim training with him. I politely declined, saying I preferred to swim alone, and repeatedly made excuses when he brought up the aquarium visits.

Reflection:
I always maintained a professional attitude and didn’t feel uncomfortable, just slightly irritated by the constant invitations. Since I had discussed the situation with my boss and knew the patient’s background, I understood that he was likely just lonely and looking for company. He never behaved inappropriately, but clearly wanted to spend time with me outside the clinic.

However, had I not been aware of his general behavior or had I felt uncomfortable in any way, I would have considered referring him to a colleague, perhaps mentioning that a colleague might be better suited to treat his specific issue. Alternatively, I could have made it clear that I don’t see patients outside of work, though that felt a little complicated since my boss regularly treated and socialized with others from the same club.

Action:
Throughout my time as a physiotherapist, I’ve been in a relationship , and it’s rare that a patient has given me inappropriate attention. I always aim to remain professional, but I recognize that I sometimes avoid direct confrontation and could become better at setting firmer boundaries when needed. If a similar situation arises in the future, I plan to politely redirect the patient to a colleague and emphasize the importance of them receiving the best care. Reflecting on this experience has helped me feel better prepared to handle such interactions in the future.

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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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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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Fortunately, I haven’t received any complaints in my seven years of practice. I believe that good communication, clear expectation management, thorough explanations and consent are essential in preventing misunderstandings and dissatisfaction. However, if I were to receive a complaint in the future, I know it would be my responsibility to inform the patient of their rights and guide them on how to file a formal complaint. The link above directs patients to the appropriate platform for submitting a complaint in Denmark.

I did experience a situation once where a colleague, who was a newly qualified physiotherapist, had a patient who called our boss to complain. The patient had expected manual therapy but was only given exercises, which didn’t meet his expectations. To resolve the situation, our boss offered the patient a follow-up appointment with me, free of charge and covered by the clinic.

When I saw the patient, I made sure to clearly discuss his expectations before beginning the treatment. Fortunately, he was very pleased with the session and continued seeing me until his issue was resolved.

In situations like this, I think it’s important to remain neutral and professional. It’s essential to support your colleague by explaining their clinical reasoning while also actively listening to the patient and validating their concerns. Creating that balance helps maintain trust on both sides and fosters a respectful and solution-focused outcome. If it was me who got a complaint, this is how I would like my colleagueto act.

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Der er forskellige klagemuligheder inden for sundhedsvæsenet. Nedenfor kan du se, hvilke klager Styrelsen for Patientklager og tilknyttede nævn håndterer.

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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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At my workplace, I’m part of a concussion team where we receive ongoing training on how to manage patients with concussions. During one of our courses, we discussed what information should be shared with insurance companies when they request access to a patient’s medical records. As highlighted in the relevant professional standards: "Disclose only the information you need to, for example, does the recipient need to see the patient’s entire medical history?"

Our instructor, a colleague and osteopath who leads the course, advised that we should redact any information that is not directly relevant to the claim. For example, if a patient has a history of ADHD or anxiety, that information should be crossed out, as it could potentially be used by the insurance company to argue that the patient’s symptoms are not related to the concussion.

Initially, I was unsure about this approach. On one hand, patients are aware that much of what they share is documented, and they consent to us forwarding their records to the insurance company. I also felt that we should be able to trust that insurers will evaluate the case fairly. However, following this discussion, I now take a more cautious approach.

Whenever an insurance company requests a medical report, I carefully review the entire journal and redact details that are unrelated to the case, for example, issues concerning bowel function or hormonal imbalances. I now recognize that this protects the patient’s interests and ensures that only pertinent clinical information is shared.

At my job, we use a highly secure system that ensures patient records are stored properly. I am confident that it meets all GDPR requirements. In general, I take confidentiality very seriously and always ask for my patients’ consent if I need to discuss their case with a colleague for professional input.

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Appropriate technical and organizational measures

As mentioned under the heading " What are your obligations?", the controller must ensure that data protection is handled through "appropriate technical and organizational measures".

What "appropriate" is, is in particular up to an assessment of the risks that processing entails for data subjects and, where appropriate, an impact assessment on data protection. You must also be able to demonstrate that you have taken measures that meet the requirements of the data protection rules.

As a contribution to this assessment, different standards and guidance texts can help you finding tools as well as generic lists of potential threats and measures:

However, compliance with or certification in accordance with one of the standards or guidelines mentioned above does not mean that The General Data Protection Regulation has been complied with.

Certain tools that may contribute to the protection of personal data may be referred to as Privacy Enhancing Technologies because the protection of privacy and the protection of personal data are linked.

Achieving the objectives of personal data protection requires a professional, structured and systematic approach, and especially in large and medium-sized organizations, it also requires the focus and support of management.

As IT projects often are complex and with many participants, it is typically helpful if a project model that ensures sufficient time and resources at the right times in the timetable is used, for example for identifying legal requirements, risk assessment/impact assessment and implementation of data protection through design and default settings.

Safety of processing

An important part of the "protection of personal data" deals with processing security.

As a data controller or processor, you are responsible for protecting the personal data against unauthorized or unlawful processing and from accidental loss, destruction or damage, by means of appropriate technical and organizational measures.

For example, if personal data come in unauthorized persons possession, is changed, damaged or lost, it may infringe with the rights of individuals. Therefore, you must ensure the confidentiality, availability and integrity of personal data.

How to handle personal data

The use and handling of personal data must take place reassuringly and with an appropriate level of security and privacy protection. The level of security must reflect the actual risk of data being stolen, lost, damaged or processed illegally.

If the risk is likely to be high, the processing of personal data must not be initiated until an impact assessment on data protection and, where appropriate, consultation with the Danish Data Protection Agency has been carried out.

When IT solutions are designed and developed, data protection must be considered from the outset, and default settings must ensure that only the personal data necessary for the purpose of processing are processed.

If things go wrong and you become aware of a personal data breach as a data controller, you must notify the Danish Data Protection Agency without undue delay and, in some cases, to the persons whose data are affected by the security breach. Processors who become aware of a data breach must inform the controller without undue delay.

You can report security breaches here.

Protection of personal data from cradle to grave

The development, purchase, adaptation, testing, use, maintenance and settlement of an IT system are all phases where you, as a data controller or processor, have the opportunity to influence the protection of personal data.

During phases such as development, procurement and adaptation, data protection must be incorporated into the design and default settings.

Security tests are particularly relevant for new IT systems and for changes in existing IT systems, but here we are not talking about user tests where you primarily test for intended functionality. Security tests are primarily about finding out how the confidentiality, integrity or accessibility of personal data can be adversely affected. It is typically a test of the effect of the measures - whether they work as intended and whether they are adequate. These tests typically require specific expertise and tools, such as:

Test of bypassing login (including issues such as 'brute force' attacks, session management, issuance of new log-in, single-sign-on).

Tests for inaccessibility, e.g. through congestion attacks or the exploitation of vulnerabilities.

Vulnerabilities tests for e.g. a web application.

Code review of e.g. an app for smartphone.

Penetration tests on e.g. network equipment and servers.

Other relevant security tests may be about whether users can be tricked into handing out a personal password to an IT system. Testing of the physical protection of personal data may be about testing e.g. burglary protection, alarm systems, emergency power and fire extinguishing equipment.

In relation to the maintenance/settlement/disposal of IT equipment, the protection of personal data is about the effective deletion of this information from equipment that is no longer used.

During the period when the IT system is used for the processing of personal data (ordinary operation), you must also consider the protection of personal data. The established protection may cease to be sufficient because the processing of personal data, and the context in which it occurs, usually changes over time. However, even if the processing or context does not change, new threats arise which will enable the measures already in place to cease to be sufficient.

In order to maintain a certain level of protection of personal data confidentiality, integrity and accessibility, the data controller/processor is responsible for regularly testing, assessing and evaluating the effectiveness of the existing technical and organizational measures. This applies to all the measures at all stages from cradle to grave.

Ransomware is an example of a relatively new threat that has caused some data controllers to take new actions. The same applies to physical security in relation to the protection of personal data, where, for example, the threat of rising water and flooding changes with the climate.

Defense in depth with IT security

"Defense in depth" is an old military term, but it is also used in IT security because many of the same challenges arise when it comes to protecting data from malicious attacks as well as from deliberate or unconscious abuse. It is a recognition of the fact that effective data protection cannot be achieved by a single measure.

A firewall does not provide full protection because it may be bypassed due to a vulnerability in the software, a necessary network opening has been established through the firewall or because malicious software has entered via a USB-connected device, or for any other reason. However, if a firewall is bypassed it should not mean that the personal data on a company's internal network are completely unprotected.

The aforementioned technical and organizational measures must therefore constitute several layers which together provide adequate protection for personal data. Various measures reduce or eliminate different risks, and therefore each of them increases the protection.

More help

Finding the right level of security can be a complex task. Regardless of whether you have expertise in this area or not, it can be helpful if you apply already established standards to guide you through the process. In addition, the Danish Data Protection Agency advises on issues within the Data Protection Regulation and the Data Protection Act.

Trade associations and the like have the possibility of drawing up and approving codes of conduct as a useful tool, especially for small and medium-sized enterprises, to help protect personal data. You can read the Danish Data Protection Agency's guidelines on GDPR codes of conduct here.

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The data controller or processor is obliged to assess the risks involved in processing personal data and implement appropriate technical and organizational security measures to mitigate those risks.

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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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Experience:
I had a patient who presented with back pain and informed me during the consultation that he was HIV-positive but on medication. I asked whether he experienced any side effects from the medication, which he denied. He appeared in good health, with a healthy skin tone and no visible signs of illness.

When he shared his diagnosis, I felt a moment of internal worry. However, I recalled that well-medicated HIV-positive individuals have a very low risk of transmitting the virus. I was mindful not to make him feel discriminated against, so I chose not to wear gloves during the treatment.

Discreetly, while he wasn’t looking, I checked my hands thoroughly for any open wounds, there were none. I also carefully examined his skin during treatment to ensure there were no lesions or areas of concern. After the appointment, I looked up the transmission risk again to reassure myself, and what I found confirmed my understanding.

Reflection:
Although the session went smoothly, I felt a lingering sense of worry afterwards. I discussed the situation with a doctor in my family, who reassured me that there was no reason to be concerned. He asked why I didn’t simply wear gloves, pointing out that in hospital settings, it is standard for healthcare professionals to use gloves during patient examinations.

The reason I chose not to use gloves was because I was concerned the patient might feel singled out or discriminated against, and I didn’t want to risk damaging the therapeutic relationship. I also feared he might perceive me as judgmental or distant.

However, I realized that this internal conflict consumed mental energy during and after the session. In the future, I will prioritize my mental comfort and safety by wearing gloves in similar situations. I also plan to ask patients with HIV more specifically about their current health status and viral load, so I can be fully informed and confident in my approach. This example, reinforces my belief that I treat all patients equally and always do my best to ensure they feel comfortable and respected

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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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According to the Danish Patient Safety Authority’s authorisation register, there are currently 352 authorised osteopaths in Denmark, compared to 24,770 physiotherapists. Osteopaths therefore represent only a small proportion (1.42%) of this healthcare segment, even though their work often overlaps. This limited number contributes to a high demand for osteopaths, and the holistic approach they offer is highly valued, both by patients and by my physiotherapy colleagues.

As a general practitioner recently said, “You osteopaths are the last hope when people have tried everything else.”

I was raised to treat others with respect, and being part of a profession that commands such respect only motivates me more to do good work, work that I can be proud of.

In Denmark, healthcare professionals with authorisation are bound by regulations concerning how they conduct themselves in interactions with patients. Standard D7 in the Gosc specifically addresses how to preserve the integrity and reputation of the osteopathic profession. The answer lies in strictly following both the legal requirements set out for the profession and adhering to the moral standards expected of all healthcare professionals (the referrence).

Confidentiality, particularly regarding the information patients share during their case history, is a critical aspect of maintaining professional respect. As osteopaths, we depend on patients feeling safe and comfortable enough to share everything, so we can make an accurate diagnosis. Therefore, clear, respectful, and empathetic communication is essential in building and maintaining trust with patients.

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Hvad vil det sige at være autoriseret sundhedsperson? Med en autorisation har du bevis for, at du må arbejde som autoriseret sundhedsperson og kalde dig en bestemt titel. En autorisation får du på baggrund af en gennemført uddannelse. Der følger en række rettigheder og pligter med, når du bliver autoriseret sundhedsperson.

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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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As previously mentioned, there are relatively few osteopaths in Denmark and a high demand for treatment, which makes it easy to maintain a good income. This could tempt some to charge high fees. The average consultation fee in Denmark is at a level where I feel fairly compensated.

Due to the high demand, some osteopaths set their prices quite high simply because they can. However, I believe we need to be careful not to raise fees so much that it becomes unaffordable for many. Everyone, regardless of their financial situation, should have a fair chance to receive help from an osteopath. According to the World Health Organization (WHO), financial barriers are a significant cause of health inequality, which highlights the importance of keeping osteopathic care accessible and affordable for all.

It’s important to make sure patients are fully aware of the cost of treatment before anything begins. At my clinic, we offer free screenings. This means the patient comes in, we have a conversation, and I do a quick examination to assess what we can and can’t help with.

I’ve heard from a couple of fellow students and colleagues who unfortunately, ended up in awkward situations, after doing a screening, they started treatment and maybe without being clear of the cost, and then sent an invoice. The patients thought it was all part of the free screening and ended up feeling misled.

Luckily, I’ve never had that issue. I think that’s because, right from the start of the screening, I explain that we’ll talk first, then I’ll do a short exam, and finally give them an idea of what I’ve found and whether I think treatment could help. At the end, if I have time for treatment the same day, I clearly say: “If you’d like to start treatment now, the cost is X otherwise, you’re welcome to go home and think about it.”

Most patients choose to start treatment right away, but by being upfront like this, everyone’s clear on the costs, and expectations are aligned.

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Fact sheet on Universal health coverage (UHC): key facts, what is UHC, benefits of implementing UHC and WHO response

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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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When I hand over a patient to a colleague, I always ask the patient for permission to share relevant information verbally, and they usually agree. If we're unable to speak directly, I write a brief note in the patient’s journal entry for the day my colleague is seeing them. That way, they can also read my notes in the medical record.

Our journal system is secure, and I have full confidence in it.

A growing issue is that criminals are now using AI to get around security systems, which means we all need to stay updated on how these breaches can happen. But even simple things matter, like logging out when you step away from your computer and never sharing your password. It’s also crucial that all staff are aware of the risks of clicking on links in emails that may look harmless but can actually infect the system or open it up to misuse.

When writing emails to patients, I always ensure that no sensitive patient information is included. If such information is necessary, I use what we refer to as "secure email". Additionally, when patients send their insurance documents by email, I make sure to delete the message after reviewing it.

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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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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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Fortunately, I don’t get sick very often, but when I do, I take it seriously to avoid infecting my patients. On the few occasions I’ve felt unwell, I’ve chosen to call in sick, even if my symptoms were mild. This is especially important to me because I treat vulnerable groups such as elderly patients, pregnant women, and babies. I would feel extremely embarrassed if I had passed something on to a patient and they came back the following week to tell me they’d become ill. I’ve probably become even more cautious about this since the COVID-19 pandemic.

I haven’t experienced mental health issues, but I do notice that I become quite stressed during exam periods. Over the years, while training to become an osteopath, I’ve learned to reduce my working hours during these times. It’s important to me that I am not exhausted when seeing patients, so I can give them my full attention and energy. During our first-year exams, I didn’t take any days off and studied through the weekends, which I later regretted. Now, I allow myself more space when I need it, knowing it’s only for a limited period. This helps me protect my mental well-being and ensures I can stay fully present and professional in my work.

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Early symptoms of the common cold include sore throat, runny nose and coughing.

What are the symptoms of the common cold?

Common cold symptoms typically appear in stages. The common cold stages include early, active and late.

Stage 1: Early (Days 1 to 3)

Within one to three days of picking up a cold virus, you may notice a tickle in your throat. About half of all people with colds report a tickly or sore throat as their first symptom. Other common cold symptoms you may experience during this early stage include:

Stage 2: Active (Days 4 to 7)

Symptoms typically worsen or peak during this stage. In addition to the symptoms in stage 1, you may experience:

Stage 3: Late (Days 8 to 10)

Colds usually begin to wind down during this stage. You may be free and clear at this point. But some symptoms can persist. Some people develop a nagging cough that can last up to two months after a respiratory infection.

If your symptoms get worse and/or your fever returns, make a trip to a healthcare provider. You may have developed another infection or a complication, such as bronchitis, sinusitis or pneumonia.

What are the symptoms of the common cold in babies?

Symptoms of colds in babies may include:

Runny nose (the discharge may start clear; later, it becomes thicker and may be gray, yellow or green).

Sneezing.

Fever of 101 to 102 degrees Fahrenheit (38.3 to 38.9 degrees Celsius).

Loss of appetite.

Increased drooling because of sore throat and difficulty swallowing.

Cough.

Irritability.

Slightly swollen glands.

How do cold symptoms differ from more severe infections in babies and children?

If your child has any of the following symptoms, call their healthcare provider. These symptoms could mean that your child has something more serious than a cold:

Fever in an infant 2 months or younger.

Difficulty breathing (especially if your baby's or child's nostrils widen with each breath).

Fast or labored breathing.

Ribs showing with each breath.

Not eating or drinking, which could mean dehydration.

Excessive crankiness or sleepiness.

A cough that lasts more than 3 weeks.

Your baby seems to be getting sicker.

What causes the common cold?

Rhinoviruses cause up to 50% of common colds. There are more than 100 different rhinoviruses. But other types of viruses, such as coronaviruses, can also cause colds. More than 200 different viruses can cause a cold.

Is the common cold contagious?

Yes. Colds spread easily from person to person. For you to become infected, the virus has to get to one of your mucous membranes - the moist lining of your nostrils, eyes or mouth. That happens when you touch a surface or breathe moist air that contains the cold virus.

For example, when a person who's sick sneezes or coughs, they launch droplets of fluid containing the cold virus into the air. If you breathe in those droplets, the cold virus takes root in your nose. You can also leave virus particles on surfaces you touch when you're sick. If someone else touches those surfaces and then touches their nostrils, eyes or mouth, the virus can get in.

How long is the common cold contagious?

You can be contagious for up to two weeks, even spreading a cold a day or two before you have symptoms. But you're most contagious when your symptoms are at their worst - usually the first three days you feel sick.

What is the common cold incubation period?

The incubation period is the time between when you're infected and when your symptoms first appear. The common cold incubation period is between 12 hours and three days after exposure to the virus.

Why do children and babies get more colds?

The common cold in children and babies occurs more often because they haven't been exposed to as many viruses as adults. Their immune systems have to learn how to recognize and fight new germs.

Before turning 2 years old, a baby can get as many as eight to 10 colds a year. By the time you become an adult, you've had many colds. It's easier for your immune system to identify and attack similar viruses.

In addition, children are in close contact with other children. Kids typically don't cover their coughs and sneezes or wash their hands before touching their faces - steps that prevent the virus from spreading.

Cold viruses can live on objects for several hours. Babies often pick up objects that other babies have touched. If a baby touches something that has cold germs on it, then touches their mouth, eyes or nose, the germs can infect them.

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Common Cold: Symptoms, Cold vs. Flu, Treatment

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The common cold is an upper respiratory infection that affects your nose, throat, sinuses and windpipe. Colds usually go away on their own within a week to 10 days.

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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 truly enjoy my work, but as a self-employed healthcare professional, it’s difficult not to worry about the possibility of making mistakes. I strive to avoid the kinds of errors highlighted by the GOsC and would be very surprised if I were to make one.

In Denmark, we have a system similar to the GOsC in the UK: The Danish Patient Safety Authority, which manages complaints or incidents of malpractice. If a practitioner becomes involved in such a case, there are clear rules on how to act and deadlines for responding. For example, it states that "You must report incidents you have been involved in yourself, as well as incidents involving other healthcare professionals that you become aware of," along with clear instructions on how to do so.

Overall, I do my best to follow all relevant regulations. If my physical or mental health were ever to compromise my ability to treat patients properly, I feel confident I would take a sick leave. So far, I’ve only taken time off to avoid passing on infections to patients.

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Hvad vil det sige at være autoriseret sundhedsperson? Med en autorisation har du bevis for, at du må arbejde som autoriseret sundhedsperson og kalde dig en bestemt titel. En autorisation får du på baggrund af en gennemført uddannelse. Der følger en række rettigheder og pligter med, når du bliver autoriseret sundhedsperson.

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For my third-year exam, we were asked to give a PowerPoint presentation on a clinical case that incorporated the themes of sport, pain, and psychology. I chose to present a case involving a 31-year-old basketball player. Following my presentation, I had a very insightful discussion with my examiner about how to support her return to sport more effectively, and how osteopathic principles can contribute to this process.

As a physiotherapist, I have experience working in a sports clinic and have rehabilitated many young athletes. I’m experienced in using exercise-based strategies to support their return to sport. However, this conversation with my examiner encouraged me to shift my focus toward the specific contributions osteopathy can make in these cases.

Since then, I have paid more attention to aspects such as improving circulation, evaluating the patient’s available resources (both physical and emotional), understanding how they use their body in their specific sport, and identifying old habits and compensatory patterns. I also focus more on joint mobilization to help patients move more efficiently and optimally within their sport.