A case history is taken which includes information of the problem that has brought you to the osteopath. Your symptoms are usually discussed in detail to find out what and where they are, how long you have had them, what you think may have caused the problem, and when that happened. The osteopath will ask about any previous treatment - what it was and whether you have had X-rays or blood tests and have you been prescribed any medication. The case history will also include details of any other medical history (past or present), and whether you are currently receiving medication or medical attention.

Next the osteopath will examine you. This usually means undressing to your underwear so that the osteopath can see how the mechanics of the body are working as your body moves. The spine is often a key part of osteopathic problems and to be able to assess this is an important part of the examination. Please discuss this with the osteopath if you feel uneasy about undressing as ways can be found to avoid this. If the problem is limited to the lower leg or ankle or hand it is often unnecessary to fully undress. However, when it is a low back or neck problem it is usually important to look at the whole spine.

During the examination various tests may be performed e.g. blood pressure may be taken and the heart listened to. Reflexes and other orthopaedic tests may also be used to assess what is wrong. Occasionally, you may be referred back to your GP or a medical specialist for further tests, if there is any doubt about the cause of your symptoms. As the examination finishes the osteopath will discuss with you the cause of the problem as he sees it and will outline what the treatment is likely to involve, or if osteopathy is appropriate. Any questions can be dealt with at this time and then your permission will be sought to proceed with the discussed treatment.

Treatment will normally involve a mixture of the following, depending on what is appropriate for the you and your condition:

• i) Soft tissue treatments: a muscle or group of muscles are massaged or stretched in order to relax them.
• ii) Articulatory treatments: a gentle mobilizing movement taking a joint through its range of motion. This could apply to parts of the spine or a shoulder or knee, for example.
• iii) Specific manipulation: Some times described as high velocity technique (HVT). This is the technique most frequently associated with osteopathy and is what can give the characteristic ‘crack’ or ‘pop’. Some patients can be alarmed by this but it is always discussed with the patient beforehand. Some momentary discomfort may be experienced but patients normally say that it is not at all painful.
• iv) Functional techniques: These could be described as a `listening’ technique. Very gentle movements of particular joints take place and patients often like this form of treatment.
• v) Cranial techniques: Again a very gentle approach to and often used in conjunction with other techniques. It recognises the subtle mechanics at work within the head that can have a profound influence on the health of the whole body. This technique is often used with babies and small children.

It is important to emphasise that you do not have to undertake any treatment you do not like or feel is not helping you.

• vi) Exercises: Specific exercises may be recommended to help or advice about exercise already being undertaken.
• vii) Advice: Other advice will often be given, both for immediate benefit (such as ice or heat, etc.) and also long term (such as posture at work or techniques to help with specific activities.)

After the treatment, you will be reassessed. Often some immediate relief is felt. However, this can be delayed for the first 24 hours and you can feel sore initially. Occasionally, it can feel quite acute for the first day. If you are unsure about what is happening it is a good idea to telephone for reassurance or some advice. When a problem has been longstanding it may take more than 3-4 treatments to produce a positive response. When you go to an osteopath for the first time it is likely that you will be asked to come back for another treatment in 3-5 days or a week depending upon the severity and chronicity of the problem. On average, a course may consist of 4-7 treatments. More chronic and difficult problems may take longer and some patients may only require the one visit.