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Osteopathy is a medical discipline but also a philosophy. According to my experience I found this last concept well grounded in Italy and France but completely lacking in England, where the medical aspect and the phisolophical and historical origin are rigorously separated and the latter is often rejected.  OPS B1, B2

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PRINCIPI OSTEOPATICI E STORIA DELL'OSTEOPATIA - 1° ANNO Micheli Claudia

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In a student clinic with tutors and so on the borders are in somehow already set . OPS D1, D2

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Advertising is very important as it builds an image around your role as an osteopath. While advertising our practice we need to be pragmatic and clear in what are our competences and the services that we can supply within the law. OPS D1, D3

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The relationship patient-practitioner can easy be misundertood if the patient is a friend. OPS D2, D7

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Get to know your patient keeping a professional set:

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Get to know your patient keeping a professional set:

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Get to know your patients can support your diagnostic, treatment and management choice. While we want the patient give us information about him or herself, we must be aware to not disclose critical information about ourselves. OPS A6, A7, D2, D5

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It is fundamental for the integrity of the patient-practitioner relationship and for the entire wellbeing of the patients that the practitioner in charge apply to his duty of candour. This involve that each step of a consultation must be explained and approved by the patient and all changes in our practice policy must be communicated in time to the patients. OPS D1, D3

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The duty of candour - guidance for providers

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All clinics must have a complaint policy in place. The procedure must be easily available to all patients and to the whole staff unity involved in the clinic. OPS D4

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We hope that, if you have a problem, you will use our clinic complaints procedure. However, if for any reason you feel that the clinic complaints procedure has not resolved the situation, then you may contact the GOsC, which is the governing body for osteopaths. To discuss any concerns or complaints you may have about your osteopathic treatment, please telephone the General Osteopathic Council on 020 7357 6655 Ext 224 during office hours or e-mail at regulation@osteopathy.org.uk

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Patient Complaints Procedure | ESO - European School of Osteopathy

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We hope that, if you have a problem, you will use our clinic complaints procedure. However, if for any reason you feel that the clinic complaints procedure has not resolved the situation, then you may contact the GOsC, which is the governing body for osteopaths.

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All clinics must have a privacy policy in place and it must be available to the patients in order to let them know how their data will be treated. The staff must be informed about the regulations as well in order to act in compliance with it. OPS D5

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The European School of Osteopathy (ESO) understands that privacy is very important and therefore this policy has been applied to all websites owned and maintained by the organisation. The ESO policy is to maintain and ensure that all personal information received through the site remains confidential and will only be used for internal purposes and will not be shared with third parties at any time unless permission has been provided.

Please note that our Privacy Policy may be altered or amended periodically so we do suggest that you revisit and review the Privacy Policy so that you understand and familiarise yourself with the most up-to-date version.

How We Use the Information

The personal information you provide will not be distributed amongst third parties unless permission is received from you first. The information you provide will only be used as part of a statistical audit of the site which will be for internal use only. This information will help us continuously improve the service and content provided on all the European School of Osteopathy associated websites. Any information used will not be of a nature so that you will be identified, for example, percentage of individuals who are male etc.

Information can be collected in a variety of ways some of which is the use of cookies. These are tiny bits of information which are stored on the hard drive of your computer. Browsing patterns and activity of users can be tracked by using cookies which have now become common place within the industry.

Cookies can be turned off via browsers but this may lead to restriction or possible delay of navigation of the site. You can choose not to accept cookies and delete existing cookies using your browser settings. The links below provide information on how to do this for your browser:

For browsers not listed here, please refer to the manufacturer's website.

Communications

Communication which is sent from users to us (ESO) via e-mail will be retained which will enable us to effectively respond to any enquiry thus improving the service we are able to offer to all our users.

Links to Sites

Please note that sites owned and maintained by the European School of Osteopathy may contain links to other sites and therefore we are not responsible for the content or privacy policies of these sites. We would recommend that you read and acknowledge the privacy policies of these sites as it may be different to that of the European School of Osteopathy.

Some areas of the sites owned and maintained by the European School of Osteopathy contain forums open to the public. These are heavily monitored and any inappropriate use of this service will lead to user expulsion and potential alerting of the appropriate authorities. Please be aware that information you provide in these areas becomes public information.

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The European School of Osteopathy allows users to opt out of receiving further communication from the organisation via options within each communication sent. Alternatively please send an e-mail stating your name and e-mail address to: info@eso.ac.uk.

Website Related Questions

If you do have any questions you would like to ask regarding the above policy or the website as a whole, please send an e-mail to: info@eso.ac.uk.

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Privacy Policy | ESO - European School of Osteopathy

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The European School of Osteopathy (ESO) understands that privacy is very important and therefore this policy has been applied to all websites owned and maintained by the organisation. The ESO policy is to maintain and ensure that all personal information received through the site remains confidential and will only be used for internal purposes and will not be shared with third parties at any time unless permission has been provided.

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A first consultation cannot be refused to anyone, however the patient can be re addressed, where possible, it we don’t feel as we could provide him the best treatment for any reason. Still, if we are the only option for this particular patient we are still supposed to provide him a good quality care. Exception can be made if the patient disrupts the balance of our practice. OPS D6

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It is in the best interest of the patients to be re address to another practitioner if for any reason we don’t feel comfortable to treat. OPS D6, D9

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I’m aware of the factors that might potentially raise issues against the reputation of the profession. Sadly this article is an exemple on how few negative events are likely to affect the whole profession. OPS D7

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Osteopathy is hugely popular in France. Despite the fact that osteopathy has never been conclusively shown to generate more good than harm, French osteopaths have somehow managed to get a reputation as trustworthy, evidence-based healthcare practitioners. They tend to treat musculoskeletal and many other issues. Visceral manipulation is oddly popular amongst French osteopaths. Now the trust of the French in osteopathy seems to have received a serious setback.

'LE PARISIEN ' has just published an article about the alleged sexual misconduct of one of the most prominent French osteopaths and director of one of the foremost schools of osteopathy in France. Here are some excerpts from the article that I translated for readers who don't speak French:

The public prosecutor's office of Grasse (Alpes-Maritimes) has opened a judicial investigation against Marc Bozzetto, the director and founder of the school of osteopathy in Valbonne, accused of rape and sexual assault.

In total, "four victims are targeted by the introductory indictment," said the prosecutor's office, stating that Marc Bozzetto had already been placed in police custody since the beginning of the proceedings. The daily paper 'Nice-Matin' has listed six complaints and published the testimony of a seventh alleged victim.

This victim claims to have been sexually assaulted in 2013, alleging that, during a professional appointment, Bozzetto had massaged her breasts and her intimate area. "He told me that everything went through my vagina and clitoris, that I had to spread my legs and let the energy flow through my clitoris. That I had to learn how to give myself pleasure on my own," she told Nice-Matin. The newspaper also recorded the testimonies of a former employee, a top-level sportswoman, an employee from the world of culture, and a former student.

"I take note that a judicial inquiry is open. To date, he has neither been summoned nor indicted," said Karine Benadava, the Parisian lawyer of the 80-year-old Bozzetto. Her client had already responded following initial accusations from students: "This is a normal feeling for women, but if all the women who work on the pelvis complain, you can't get away with it and you have to stop working as a pelvic osteopath," replied Bozzetto. In another interview, he had declared himself "furious" and unable to understand the reaction of these two students.

The school of osteopathy trains about 300 students each five years and presents itself as the first holistic osteopathy campus in France.

______________________________

Such stories of sexual misconduct of practitioners of so-called alternative medicine ( SCAM) are sadly no rarety, particularly those working in the area of manual therapy. They remind me of a case against a Devon SCAM practitioner in which I served as an expert witness many years ago. Numerous women gave witness that he ended up having his fingers in their vagina during therapy. He did not deny the fact but tried to defend himself by claiming that he was merely massaging lymph-nodes in this area. It was my task to elaborate on the plausibility of this claim. The SCAM practitioner in question was eventually sentenced to two years in prison.

It stands to reason that SCAM practitioners working in the pelvic area are at particularly high risk of going atray. The above case might be a good occasion to have a public debate in France and ask: IS VISCERAL OSTEOPATHY EVIDENCE-BASED? The answer is very clearly NO! Surely, this is a message worth noting in view of the current popularity of this ridiculous, costly, and dangerous charlatanry.

And how does one minimize the risk of sexual misconduct of SCAM professionals? The most obvious answer would be, by proper education during their training. In the case mentioned above, this might have been a problem: if the director is into sexual misconduct, what can you expect of the rest of the school? In many other cases, the problem is even greater: many SCAM practitioners have had no training at all, or no training in healthcare ethics to speak of.

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Alleged sexual misconduct serves a blow to osteopathy in France

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Osteopathy is hugely popular in France. Despite the fact that osteopathy has never been conclusively shown to generate more good than harm, French osteopaths have somehow managed to get a reputation as trustworthy, evidence-based healthcare practitioners. They tend to treat musculoskeletal and many other issues. Visceral manipulation is oddly popular amongst French osteopaths.

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To provide a clear and honest service all prices must be disclosed and available. For a good development of the business is important to keep a tidy accountability, for this an accountant might be required. OPS D8

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Corporate Transparency and Register Reform

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The handover form does not expect the patients to give consent for their data to be given to the next practitioner. Personally, I think patients should be consulted before pass the hand to another practitioner. Continuity is important and all changes might disorientate or disappoint the patient. OPS D9

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Employee and employer responsibilities: 

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Employee and employer responsibilities: 

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I consider that a good communication and a reliable relationship are essential in the picture of a multipractitioner clinic. OPS D5, D9

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Contribution of other health and care professionals:

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Contribution of other health and care professionals:

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I never had the opportunity to refer yet. I supported the possibility to see a nutritionist as a patient raised the subject. OPS D9, D10

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How to avoid my personal health to affect the patients:

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How to avoid my personal health to affect the patients:

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I’m in a new environment with three jobs and so much to learn: I’m tired and stressed, my attention towards the patient is relatively low. A colleague told me she was prioritise her sleep and well-being to be able to give her best for the studies and the patients. However with a 10K tuition fee per year not everyone can afford a chill life. OPS D11

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Hopefully I will never need to deal with the GOsC for misconduct or lack of competences, and I will never been called to cooperate with them in any investigations. OPS D12

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The term "anatomy" refers to the anatomy of the entire system, which includes: skeletal, muscular, articular, central and peripheral nervous system, systems of vision and hearing, cardiac, pulmonary, digestive, uro-genital and gynaecologics. OPS B1, C1

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Each functional system can present pathological dysfunctions. It is very important to recognize whenever a function is disrupted to orientate our diagnosis and address an appropriate take over. OPS B1, C1

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pathophysiology
[path″o-fiz″e-ol´o-je]

the physiology of disordered function.

Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.

path·o·phys·i·ol·o·gy
(path'ō-fiz'ē-ol'ŏ-jē),

Derangement of function seen in disease; alteration in function as distinguished from structural defects.

Farlex Partner Medical Dictionary © Farlex 2012

pathophysiology
(păth′ō-fĭz′ē-ŏl′ə-jē)
n.

1. The functional changes associated with or resulting from disease or injury.

2. The scientific study of such changes. In both senses also called physiopathology.

path′o·phys′i·o·log′ic (-ə-lŏj′ĭk), path′o·phys′i·o·log′i·cal (-ĭ-kəl) adj.

The American Heritage® Medical Dictionary Copyright © 2007, 2004 by Houghton Mifflin Company. Published by Houghton Mifflin Company. All rights reserved.

path·o·phys·i·ol·o·gy
(path'ō-fiz-ē-ol'ŏ-jē)

1. The study of structural and functional changes in tissue and organs that lead to disease.

2. Derangement of function seen in disease; alteration in function as distinguished from structural defects.

Medical Dictionary for the Health Professions and Nursing © Farlex 2012

pathophysiology
The discipline concerned with the effects of disease on body function.

Collins Dictionary of Medicine © Robert M. Youngson 2004, 2005

path·o·phys·i·ol·o·gy
(path'ō-fiz-ē-ol'ŏ-jē)

Derangement of function seen in disease.

Medical Dictionary for the Dental Professions © Farlex 2012

Patient discussion about pathophysiology

Q. What is the best pathophysiology of colorectal cancer. The pathophysiology just has to be brief and concise. It also has to include nursing considerations for the patient.

A. i'm not sure i understand your question...do you mean what is the best treatment for colorectal cancer? patophysiology is the changes the tissue acquired. if you'll give me more details on what you are looking for i'll be more then happy to help you.

Q. I started to suffer from erectile dysfunction? Why is this happening and what can I do to treat it? I am a healthy 52 year old. I have hypertension but i take pills to treat it and my levels are around 130/80. except that I am at great shape. In the last few months I feel that a problem in my sex life. I want to have sex but i can't due to erectile dysfunction. What can be the reason for this? and more important what can I do?

A. get rize2 it lasts about 4 days,and all you have to do is think about sex
and you get a rock hard erection!!!!!

Q. Im a 29 yr old male that has pain after masturbation seems like the longer i go without the better I feel? Should I not masturbate at all? I have had 2 urethral scricture surguries and my doctor he seen no reason for the pain. I feel less of a man because I want to have a healthy sexual relationship with my partner. Should I quit for a long period of time like 6 months and see if the condition will go away? Do you think I may have imflamation or cause damage to urethra from masturbation? Thanks for your time

A. Hi! My guess would be that the pain you are feeling is being caused by scar tissue that has built up from the surgeries that you've had and when you ejaculate that tissue is being forced to stretch in order to allow the ejaculate to pass through the urethra.My ex Husband had something similar after his vascectomy.

More discussions about pathophysiology

This content is provided by iMedix and is subject to iMedix Terms. The Questions and Answers are not endorsed or recommended and are made available by patients, not doctors.

# data[].attributes.attachment_link.description
path″o-fiz″e-ol´o-je] the physiology of disordered function. Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved. (path'ō-fiz'ē-ol'ŏ-jē), Derangement of function seen in disease; alteration in function as distinguished from structural defects. Farlex Partner Medical Dictionary © Farlex 2012 (păth′ō-fĭz′ē-ŏl′ə-jē) n.

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The flag system is a way to identify wheter the patient is presenting biopsychosocial factors that can influence, or even be the cause, of their presenting complaint. OPS B1, B2, C4, C6

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Original Editor - The Open Physio project.

Flags can be split into two distinct categories: clinical flags and psychosocial flags.

Clinical flags are common to many areas of health - for example, red flags for musculoskeletal disorders, which are indicators of possible serious pathology such as inflammatory or neurological conditions, structural musculoskeletal damage or disorders, circulatory problems, suspected infections, tumours or systemic disease. If suspected, these require urgent further investigation and often surgical referral.

There are certain signs and symptoms that when observed in a patient's examination or history alert us to the fact that something could be seriously wrong. In the case of musculoskeletal disorders, physiotherapists are highly trained to identify or rule out red flags. If you suspect any red flags the patient must seek urgent medical attention and it is better to send the patient to A&E rather than risk any permanent, life-changing pathology.

Recently, orange flags were added to the spectrum, and represent the equivalent of red flags for mental health and psychological problems - alerting the clinician to serious problems that could be psychiatric in nature, and therefore require referral to a specialist in that field, rather than following the normal course of management for mild mental health conditions such as anxiety<. Orange flags can include excessively high levels of distress, major personality disorders, post-traumatic stress disorders, drug and alcohol abuse/addictions or clinical depression.

Psychosocial flags allow us to identify aspects of the person, their problem and their social context, and how those factors affect the recovery and return-to-work process. The concept was introduced in 1997 by Kendall et al and looked at factors that identified patients who were at risk of developing chronic disability, and did not recover as was expected for their condition.

Psychosocial flags enable us to work from a biopsychosocial model and give a framework for assessment and planning. These flags are not a diagnosis or a symptom, but an indication that someone may not recover as expected, and may need additional support to return to work. These flags are often referred to as obstacles to recovery. Psychosocial factors determine outcomes such as activity levels and participation and work, but appear to be less relevant to the reporting of symptoms.

Below is a table with some examples of a flag colour, the nature of the flag and examples of clinical signs to look for on assessment:

Red

Signs of serious pathology

Cauda equina syndrome, fracture, tumour, unremitting night pain, sudden weight loss of 10pounds over 3 months, bladder & bowel incontinence, previous history of cancer, saddle anaesthesia,

Orange

Psychiatric symptoms

Clinical depression, personality disorder

Yellow

Beliefs, appraisals and judgements

Unhelpful beliefs about pain: indication of injury as uncontrollable or likely to worsen.
Expectations of poor treatment outcome, delayed return to work.

Emotional Responses

Distress not meeting criteria for diagnosis of mental disorder.
Worry, fears, anxiety.

Pain behaviour (including pain and coping strategies)

Avoidance of activities due to expectations of pain and possible reinjury.
Over-reliance on passive treatments.

Blue

Perceptions about the relationship between work and health

Belief that work is too onerous and likely to cause further injury.
Belief that workplace supervisor and workmates are unsupportive.

Black

System or contextual obstacles

Legislation restricting options for return to work.
Conflict with insurance staff over injury claim.
Overly solicitous family and health care providers.
Heavy work, with little opportunity to modify duties.

Psychosocial flags have been subdivided over the years to reflect the different interactions that can affect recovery. As a result, they are now referred to as yellow, blue and black flags. Briefly, yellow flags cover the features of the person which affect how they manage their situation with regard to thoughts, feelings and behaviours. Blue flags concern the workplace and the employee's perceptions of health and work. And black flags are about the context and environment in which that person functions, which includes other people, systems and policies. Black flags can block or limit the helpful activity of healthcare providers and workplace support.

Screening for orange flags is performed by asking questions regarding clinical depression or other personality disorders. Screening for clinical depression is completed with the Patient Health Questionnaire-2 (PHQ-2). The purpose of the PHQ-2 is not to diagnose depression, but rather screen for it in a "first-step" approach.

Patient Health Questionnaire-2

Over the past 2 weeks, how often have you been bothered by any of the following problems?

1. Little interest or pleasure in doing things

2. Feeling down, depressed or hopeless

Answers: 0-Not at all, 1-Several days, 2-More than half the days, 3-Nearly every day

Scoring: 0 points for "Not at all" answer, 1 point for "several days", 2 points for "more than half the days", and 3 points for "nearly every day. The cutoff score for screening purposes is 3. If the individual scores >3, continue with the PHQ-9 for further assessment of depression.

Obstacles that can be classed as yellow flags include many aspects of thoughts, feelings and behaviours. Some common examples include:

Catastrophising - thinking the worst

Finding painful experiences unbearable, reporting extreme pain disproportionate to the condition

Having unhelpful beliefs about pain and work - for instance, 'if I go back to work my pain will get worse'

Becoming preoccupied with health, over-anxious, distressed and low in mood

Fear of movement and of re-injury

Uncertainty about what the future holds

Changes in behaviour or recurring behaviours

Expecting other people or interventions to solve the problems (being passive in the process) and serial visits to various practitioners for help with no improvement.

Blue flags can be considered in terms of the employee and the workplace. The employee often has fears and misconceptions about work and health based on their own previous experiences or those of others in the company they work for, or stories from the neighbours. Blue flags can include:

Concerns about whether the person is able to meet the demands of the job

Low job satisfaction

Little or poor support at work

A perception that the job is very stressful

An accommodating approach in the workplace to providing altered duties or modified work options to facilitate a return to work

Poor communication between employer and employee.

There is some overlap between blue and black flags, but they can be primarily distinguished by the black flags being those that are outside the immediate control of the employee and/or the team trying to facilitate the return to work. Black flags include:

Misunderstandings among those involved

Financial issues and/or claims procedures

Sensationalist media reports

Family and friends with strong unhelpful beliefs influencing the employee

Social isolation and becoming disconnected from the workforce

Poor or unhelpful company policies. Often company policies can take two forms: either there is no policy or inadequate policy surrounding sickness absence management and return to work, or there is rigid management of absence within a disciplinary policy system that does not allow sufficient flexibility to deal with genuine injury and illness rehabilitation needs.

So how do we go about assessing for psychosocial flags? The literature recommends an early intervention and stepped approach to common health problems. It is believed that psychosocial factors start to become increasingly important between two and six weeks of onset of the problem, and assessment can begin during this period.

A stepped approach means using an assessment tool as appropriate for the needs of the employee - for instance, starting by asking some key questions and undertaking a screening questionnaire, and then making further in-depth assessment where indicated by these processes.

There are several useful methods for assessing flags:

Of the way the employee behaves, interacts with others, and talks about their condition and work.

These will give you an idea for the flags that may be present. Useful questions (from Tackling MSDs, Kendall & Burton 2009) include:

What do you think has caused the problem?

What do you expect is going to happen?

How are you coping with things?

Is it getting you down?

When do you think you'll get back to work?

What can be done at work to help?

A number of screening questionnaires exist that can help to identify flags in more detail. It should be remembered, however, that questionnaires are just one part of the overall assessment process and should be used alongside other methods. A useful one for back pain is the Acute Low Back Pain Screening Questionnaire, which includes sections on Pain Management, Anxiety Levels, Beliefs about Work and Activity Level. Other questionnaires exist for measurement of Fear Avoidance, Fear of Movement and Self-efficacy, and may be a useful addition where indicated.

If the methods above have confirmed the presence of flags, then the structured interview is the next step in getting more information about particular issues and flags. An acronym has been developed to help remember which areas to ask more about: ABCDEFW.

Attitudes/Beliefs - What does the patient think to be the problem and do they have a positive or negative attitude to the pain and potential treatment?

Behaviour - Has the patient changed their behaviour to the pain? Have they reduced activity or compensating for certain movements. Early signs of catastrophising and fear-avoidance?

Compensation - Are they awaiting a claim due to a potential accident? Is this placing unnecessary stress on their life? .

Diagnosis/Treatment - Has the language that has been used had an effect on patient thoughts? Have they had previous treatment for the pain before, and was there a conflicting diagnosis? This could cause the patient to over-think the issue, leading to catastrophising and fear-avoidance.

Emotions - Does the patient have any underlying emotional issues that could lead to an increased potential for chronic pain? Collect a thorough background on their psychological history.

Family - How are the patient's family reacting to their injury? Are they being under-supportive or over-supportive, both of which can effect the patient's concept of their pain

Work - Are they currently off work? Financial issues could potentially arise? What are the patient's thoughts about their working environment?

In addition, the conclusion of researchers and working group members at the 'Decade of the Flags' conference in 2008 suggests that there are seven key workplace factors that are important to include in screening, and give some sample questions:

1. Heavy physical demands: Are you concerned that the physical demands of your job might delay your return to work?

2. Inability to modify work: Do you expect your work could be modified temporarily so you could return to work sooner?

3. Stressful work demands: Are there stressful elements to your job that might be difficult when you first return to work?

4. Lack of workplace social support: What kind of response do you expect from co-workers and supervisors when you return?

5. Job dissatisfaction: Is this a job you would recommend to a friend?

6. Poor expectation of recovery and return to work: Are you concerned that returning to your work may be difficult given your current circumstances?

7. Fear of re-injury: Are you worried about any repeat episodes of (back) pain once you return to work?

An excellent additional method of assessing flags. Whether an informal visit or a more structured one for ergonomic assessment, a wealth of information can be gathered when you are familiar with the flags system and what to look out for.

1. Kendall NA, Linton SJ, Main CJ. Guide to Assessing Psychosocial Yellow Flags in Acute Low Back Pain: Risk Factors for Long-Term Disability and Work Loss. Wellington, New Zealand: Accident Rehabilitation and Compensation Insurance Corporation of New Zealand and the National Health Committee; 1997.

2. Nicholas MK1, Linton SJ, Watson PJ, Main CJ; "Decade of the Flags" Working Group. Early identification and management of psychological risk factors ("yellow flags") in patients with low back pain: a reappraisal. Phys Ther. 2011 May;91(5):737-53. doi: 10.2522/ptj.20100224. Epub 2011 Mar 30.

1. Main CJ, Phillips CJ, Watson PJ. Secondary prevention in health-care and occupational settings in musculoskeletal conditions focusing on low back pain. In: Schultz IZ, Gatchel RJ, eds. Handbook of Complex Occupational Disability Claims: Early Risk Identification, Intervention and Prevention. New York, NY: Kluwer Academic/Plenum; 2005:387-404.

2. Main CJ, Sullivan MJ, Watson PJ. Risk identification and screening. In: Main CJ, Sullivan MJ, Watson PJ, eds. Pain Management: Practical Applications of the Biopsychosocial Perspective in Clinical and Occupational Settings. Edinburgh, Scotland: Churchill Livingstone Elsevier; 2008:97-134.

3. Kendall NA, Linton SJ, Main CJ. Guide to Assessing Psychosocial Yellow Flags in Acute Low Back Pain: Risk Factors for Long-Term Disability and Work Loss. Wellington, New Zealand: Accident Rehabilitation and Compensation Insurance Corporation of New Zealand and the National Health Committee; 1997.

4. Leerar,P. Boissonnault,W. Domholdt,E. Roddey,T. Documentation of Red Flags by Physical Therapists for Patients with Low Back Pain.J Man Manip Ther. 2007; 15(1): 42-49.

5. Nicholas MK1, Linton SJ, Watson PJ, Main CJ; "Decade of the Flags" Working Group. Early identification and management of psychological risk factors ("yellow flags") in patients with low back pain: a reappraisal.fckLRPhys Ther. 2011 May;91(5):737-53. doi: 10.2522/ptj.20100224. Epub 2011 Mar 30.

6. Kroenke K, Spitzer RL, Williams JB. The Patient Health Questionnaire-2: validity of a two-item depression screener. Med Care. 2003 Nov;41(11):1284-92.

7. Hurley DA, Dusoir TE, McDonough SM, Moore AP, Baxter GD. How effective is the acute low back pain screening questionnaire for predicting 1-year follow-up in patients with low back pain? Clin J Pain. 2001 Sep;17(3):256-63.

8. Carsten Oliver Schmidt , T. Kohlmann, M. Pfingsten, G. Lindena, U. Marnitz, K. Pfeifer, J. F. Chenot. Construct and predictive validity of the German Örebro questionnaire short form for psychosocial risk factor screening of patients with low back pain. European Spine Journal, First online: 27 August 2015.

9. Felipe Ribeiro Cabral Fagundes , Leonardo Oliveira Pena Costa, Fernanda Ferreira Fuhro, Ana Carolina Tacollini Manzoni, Naiane Teixeira Bastos de Oliveira, Cristina Maria Nunes Cabral. Örebro Questionnaire: short and long forms of the Brazilian-Portuguese version. Quality of Life Research, November 2015, Volume 24, Issue 11, pp 2777-2788

10. Felipe Ribeiro Cabral Fagundes , Leonardo Oliveira Pena Costa, Fernanda Ferreira Fuhro, Ana Carolina Tacollini Manzoni, Naiane Teixeira Bastos de Oliveira, Cristina Maria Nunes Cabral. Örebro Questionnaire: short and long forms of the Brazilian-Portuguese version. Quality of Life Research, November 2015, Volume 24, Issue 11, pp 2777-2788

11. Shaw, W.S., van der Windt, D. A, Main, C.J., Loisel, P., Linton, S.J., Decade of the Flags Working Group. 2008. Early patient screening and intervention to address individual level Occupational Factors ("Blue Flags") in Back Disability. J Occ Rehab. Published online 12/12/08. Springer Science & Business Media. LLC 2008.

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Original Editor - The Open Physio project. Flags can be split into two distinct categories: clinical flags and psychosocial flags. Clinical flags are common to many areas of health - for example, red flags for musculoskeletal disorders, which are indicators of possible serious pathology such as inflammatory or neurological conditions, structural musculoskeletal damage or disorders, circulatory problems, suspected infections, tumours or systemic disease.

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I struggle to understand the notion of integrate scientific and medical findings within an osteopathic consultation. I also find hard to make the right choice of clinical tests and to interpret the findings. OPS B1, C1

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Once you know the biomechanics and the physiology of an healthy body it will be easier to recognize when the organism presents a pathological process. OPS B1, B2, C1

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I find this book extremely helpful to improve my palpatory skills of the musculoskeletal system. For what concern the visceral anatomy and palpatory trianing I suggest to rely on an anatomy atlas and on the books written by Barral. OPS B1, B2, C1

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I've got the tendency to make of a small alteration a big catastrophe. This attitude often leads me to panic in front of any kind of unexpected event or unresolved doubt. I do try and apply many different way of dealing with it, luckily one day I will find a way that suits me and that I can use as general rule. OPS B2, B4

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Using this as a symbmolical representation: being an osteopath means use my own body to perform an adequate assessment and an appropriate treatment. Thereby it is of main importance to take care and protect my body in first instance. This is fundamental for the delivery of a safety treatment for me and the patient. OPS B1, D11

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This involve being aware of our competences and being able to address the patients for them to achieve the best quality information they need. OPS B2, B3, B4

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This was a CPD on femal genital mutilation which the English government require as mandatory for all health professions. I found it extremely interesting and very appropriate to the population differences in the country. OPS B2, B3

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The English government funded the creation of an interactive CPD course on radicalism, this choice was probably led by the events happened in France in the last 6 years. OPS B2, B3

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A first aid course should be part of the training of everyone and it should be retaken regularly. The ESO kindly organised this course for me and other new students. OPS B2, B3

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Critical appraisal and reflection on own practice:

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Critical appraisal and reflection on own practice:

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I do reflect a lot on my own practice: my communication skills to establish a trustworth relationship with the patient, the reasoning that leads me to the choice of the assessment to do, the managing plan and treatment approach when possible. All these information are in an on-going developmental process in my head thanks to the discussion with my peers, my tutors and my patients. OPS B2, B4

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Case history taking expectation in France and in England are shockingly different. In France we were required to manage the case history in 15 minutes, here half an hour is a good timing plus between 7 and 15 minutes spent discussing with the tutor. I'm not surprised that the first consultation is 1h20 and still short. OPS A4, C1, C2

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We had quite a lot of courses about red flags and differential diagnosis in France, I did not understand any of them and now I feel as I really should. Luckily they don’t expect us to formulate an appropriate working diagnosis in the first months of clinic, but they will by the end of the year. My objective now is to go through all the courses again and try to make a sense of them while juggling between lectures, clinic, three jobs and stay mentally and physically sane. OPS C1, C2, C4

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5-A Contre indications absolues et relatives à la prise en charge ostéopathique immédiate

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The treatment and management plan should be based on the working diagnosis, the best available evidences, the patient’s values and preferences and my own skills – I started planning it putting together techniques I learned in France, it does not seem to be accepted here though so I’m getting more and more into raw local articulation, with the one I'm not comfortable as I find too short focussed.
My objective is:
- get to plan a treatment I'm comfortable with
- remember to re test post-treatment
- consider possible adverse reactions to treatment for the ones I should inform the patient
OPS C1, C2

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Choose what information record might be critical, health-related information need to be recorded. However during the conversation with the patients other information might come up about their lifestyle and what they like to do. OPS C2, C3

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The ESO has put in place a system called: C-POMS. Through the one we can anonymously report children and vulnerable adults to the clinic head departement.

Other autorities and services are surely put in place by other local institutions. I think it is appropriate when working in a clinic to have a list of services to contact in the case we doubt the safety of a patient. OPS C4, D5, D10

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Considering hygiene in clinic and at school, I'm concerned about laying carpet everywhere. It is a great locus for dirt and mold to build up. I know it is vacuumed every evening, however the only way to get a carpet properly clean is to use a carpet washing machine, great fun to bring upstairs !
Safety wise, the treatment couch fixed with screw screwed upward don't reassure me. OPS C5

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Workplace health and safety standards NHS

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Where to place myself in the health care system?

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Where to place myself in the health care system?

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Depending on the country, osteopaths cover different roles in the health care system. OPS B2, C6

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Osteopathy is a way of detecting, treating and preventing health problems by moving, stretching and massaging a person's muscles and joints.
Osteopathy is based on the principle that the wellbeing of an individual depends on their bones, muscles, ligaments and connective tissue functioning smoothly together.

Osteopaths use physical manipulation, stretching and massage with the aim of:

increasing the mobility of joints

relieving muscle tension

reducing pain

enhancing the blood supply to tissues

helping the body to heal

They use a range of techniques, but not medicines or surgery.

In the UK, osteopathy is a health profession regulated by UK law.

Read about how osteopathy is performed.

When it's used

Most people who see an osteopath do so for help with conditions that affect the muscles, bones and joints, such as:

lower back pain

uncomplicated neck pain (as opposed to neck pain after an injury such as whiplash)

shoulder pain and elbow pain (for example, tennis elbow)

problems with the pelvis, hips and legs

sports injuries

muscle and joint pain associated with driving, work or pregnancy

If you're pregnant, make sure you seek advice from a GP or midwife about your symptoms before you see an osteopath. You should also make sure you see an osteopath who specialises in muscle or joint pain during pregnancy.

Effectiveness of osteopathy

Most research into techniques used in osteopathy tends to focus on general "manual therapy" techniques, such as spinal manipulation. Manual therapy techniques are used by physiotherapists and chiropractors, as well as osteopaths.

The National Institute for Health and Care Excellence (NICE) guidelines on managing lower back pain and sciatica recommend manual therapy alongside exercise as a treatment option.

NICE also recommends manual therapy as a possible treatment option for osteoarthritis, although osteopathy is not specifically mentioned.

There's some evidence to suggest that osteopathy may be effective for some types of neck, shoulder or lower-limb pain, some types of headache, and recovery after hip or knee operations.

There's only limited or no scientific evidence that it's an effective treatment for conditions unrelated to the bones and muscles (musculoskeletal system), including:

Accessing osteopathy

Osteopathy is available in some areas on the NHS. Your GP or local integrated care board (ICB) should be able to tell you whether it's available in your area.

Most people pay for osteopathy treatment privately. Treatment costs vary, but typically range from £40 to £55 for a 30- to 40-minute session.

You do not need to be referred by your GP to see an osteopath privately. Most private health insurance providers also provide cover for osteopathic treatment.

Only people registered with the General Osteopathic Council (GOsC) are allowed to practise as or call themselves osteopaths.

You can find a nearby registered osteopath on the GOsC website.

Read more about how osteopathy is regulated.

Page last reviewed: 09 August 2021
Next review due: 09 August 2024

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Osteopathy is a way of detecting, treating and preventing health problems by moving, stretching and massaging a person's muscles and joints. Osteopathy is based on the principle that the wellbeing of an individual depends on their bones, muscles, ligaments and connective tissue functioning smoothly together.

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Hard to forget and painful to remember, my first patient ever as a practitioner at the ESO Student Clinic: middle age woman presenting LBP in a very acute phase. OPS A1, A2, C1

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Communicate effectively in a non-native language can be very challenging. Many are the synonyms and the slang terms used in everyday language, likewise several are the accents developed in each part of the country. OPS A1, A2

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An effective communication is very impmortant to understand what are the priorities of your patients and to explain him what are yours, in case you are concerned by any of his symptoms. OPS A1, A3, C1

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When listening to your patient many are the information that may touch the surface. Assumptions are easy to do and it’s important we don’t make our choices on unfounded opinions. OPS A1, A2, A6, A7, D2

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Time is very difficult to manage properly, although it is fundamental to let things fit in your daily schedule. OPS A1, A3

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Gain the patient's trust is not granted and it is fundamental for the construction of a reliable relationship. OPS A1, A2, A4, A6, A7, D3, D5, D6, D8

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Adapting communication while speaking a foreign language:

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Adapting communication while speaking a foreign language:

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When speaking your own language you often don't know technical terms before getting into a specific area of study. It is different though when you go abroad continuing your study: the technical language is there, the "everyday" synonyms aren't. OPS A2

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In order to give the patients a first insight of what to expect from the consultation a document is given to them and they are required to read and sign it before start the session. OPS A3

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It is important to always record the consent gathered during the case history, this is the reason why the form we use in clinic has two section for consent record only. OPS A3, A4, A6, C2

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The first patient of a colleague’s of mine was an Italian lady speaking no English, how she managed to get an appointment I don’t know.

Being in this group for only the introduction week I could assist him during the case history translating within the patient and the practitioner, even if my English vocabulary was very thin at that moment. The lady has been addressed to an Italian student in the year above, in order to get the most from the consultation without spending time translating. OPS A2, A3

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First arrived in England to me it was obvious that a patient would have need to undress at the osteopath’s and that they would have brought shorts of leggins if they were not comfortable in being in their underwear. I also gave for granted that an osteopath, as per called “manual therapist”, will need to touch the patient. OPS A4, A6, A7

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There are two forms of consent in a clinical setting: oral and written.

For both the patients need to understand what you are proposing them, what it involves, pros and cons and what their options are.

Whether a patient’s comprehension is altered or they are younger than the “consent age” allowed by the law – which change from country to country – the consent must be taken by the parent, guardian or carer of the patient. This must be recorded and the person in charge of the patient must be legally approved. OPS A4

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The form the patient sign in first instance once arrived at the clinic include the option of whether give consent for the patient’s information to be used for research purposes. OPS A4

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The record of the patients' notes is a difficult process that requires practice. OPS A4, C2

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Supporting patients in caring for themselves:

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Supporting patients in caring for themselves:

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I don’t feel competent in giving lifestyle or exercise advice at the moment. I’m starting to see exercises as a very interesting and effective tool beside treatment but I’m still very sceptic on it as it is a new concept to me and I considered it out of an osteopath competences until now. I do feel as we cross the border between osteopaths and physiotherapists and it seems to be only a way to increase the gap in acceptance and respect among different health professions. OPS A5, C4, C6

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What to do while the patient gets undressed?

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What to do while the patient gets undressed?

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Modesty is all a concept in each country and depends on culture, education and personal values. OPS A4, A6

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I’m quite surprised by myself how I enjoy treating whoever enters that door, I mainly see adults and elderlies and I don’t have a preference. I’m also curious about the patient background however I feel as sometimes it may bias the treatment due to contrasts in opinions and ideologies.  OPS A7

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A patient as a friend or a friend as a patient:

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A patient as a friend or a friend as a patient:

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It is interesting to remark how different is the boarder setting from patient to patient. OPS A7, D2

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Set well defined professional borders might help in desisting the patient to development dependency to the practitioner and/or to the treatment. OPS A7, D2, D3

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Istituto della Enciclopedia Italiana fondata da Giovanni Treccani S.p.A., 1980-in activity. Treccani il Vocabolario della Lingua Italiana.

Gilroy, Anne M., MacPherson, Brian R., Ross, Lawrence M., Gaudio. Prometheus Atlante di Anatomia, Second Edition.
The Free Dictionary, 2021 | Pathophysiology, Available at: https://www.thefreedictionary.com/pathophysiology [Accessed: February 13, 2021]
Stuart Ira Fox. Human physiology, Ninth Edition.
Andrew Biel. Trail Guide to the Body, Third Edition.
NHS, 2021 | Osteopathy, Available at: https://www.nhs.uk/conditions/osteopathy/ [Accessed: May 17, 2021]
ESO, 2021 | Patient Feedback & Complaints procesure, Available at: https://www.eso.ac.uk/eso-clinic/feedback/patients-complaints-procedure/ [Accessed: April 23, 2021]
ESO, 2021 | Privacy Policy, Available at: https://www.eso.ac.uk/privacy-policy/ [Accessed:  3 March 2021]
Edward Ernst, 2021. Alleged Sexual misconduct serves a blow to osteopathy in France.