Practice Visits
Croxley Osteopathic Clinic (14.11.12)
I had the opportunity to observe Deborah Osborne-Kirby in her practice in Croxley for the afternoon. Deborah has been qualified for 11 years and uses both structural and functional techniques to treat patients. I observed Deborah in three continuations and take one new patient, which were all extremely interesting. The first gentleman had spondylo-epiphyseal dysplasia, which is a rare congenital disorder of long bone growth that results in dwafism, characteristic skeletal abnormalities, and occasionally problems with vision and hearing. He also suffers with osteoarthritis in his right proximal metatarsal phalangeal joint and scoliosis of the spine. He comes in monthly for maintenance treatment on his osteoarthritis and para-vertebral musculature to maintain adaptation to his scoliosis. Deborah used functional techniques on his ankles, knees and hips and strong soft tissue on his spinal musculature.
The next patient was an active 27 year old male who had an impact with the opposition during a football game last week to his left shoulder. It originally gave symptoms from the base of his occiput to the GH joint, however symptoms unmasked and moved to his SC joint. Deborah used a vibrating tuning fork to test for a clavicular fracture, which did not produce any symptoms thank goodness! However there was some swelling around the SC and there was a decreased range of movement, therefore Deborah focused techniques on musculature that attached around that area such as the trapezius, scalenes and SCM and advised the patient to ice the area to reduce inflammation.
The new patient was a 28 year old female who also had pain in her left shoulder however there was not an obvious reason or onset. She was getting shooting pains into her left upper extremity with occasional pins and needles. Deborah suspected she had thoracic outlet syndrome caused by tight musculature and 1st and 2nd rib involvement and treated all these areas, again using functional techniques which involved breathing techniques for the ribs. The patient was amazed that working into her shoulder brought symptoms in her hand, and felt better after treatment.
The last patient was a 56 year old female who was experiencing neck pain that limited her range of movement, particularly in rotation. She has osteoarthritis in her cervical spine and therefore her range of movement is reduced by osteophytic growth disorientation. Deborah mainly used functional technique as more vigorous articulation techniques may flare up or aggravate the symptoms further more.
I feel honoured to have had the opportunity to observe such a skilled osteopath in private practice, Deborah was so calm and sympathetic to every patient, which really put the patients at ease. I felt inspired coming away from the practice and hope to take many of Deborah's qualities into my treatments with patients.
The next patient was an active 27 year old male who had an impact with the opposition during a football game last week to his left shoulder. It originally gave symptoms from the base of his occiput to the GH joint, however symptoms unmasked and moved to his SC joint. Deborah used a vibrating tuning fork to test for a clavicular fracture, which did not produce any symptoms thank goodness! However there was some swelling around the SC and there was a decreased range of movement, therefore Deborah focused techniques on musculature that attached around that area such as the trapezius, scalenes and SCM and advised the patient to ice the area to reduce inflammation.
The new patient was a 28 year old female who also had pain in her left shoulder however there was not an obvious reason or onset. She was getting shooting pains into her left upper extremity with occasional pins and needles. Deborah suspected she had thoracic outlet syndrome caused by tight musculature and 1st and 2nd rib involvement and treated all these areas, again using functional techniques which involved breathing techniques for the ribs. The patient was amazed that working into her shoulder brought symptoms in her hand, and felt better after treatment.
The last patient was a 56 year old female who was experiencing neck pain that limited her range of movement, particularly in rotation. She has osteoarthritis in her cervical spine and therefore her range of movement is reduced by osteophytic growth disorientation. Deborah mainly used functional technique as more vigorous articulation techniques may flare up or aggravate the symptoms further more.
I feel honoured to have had the opportunity to observe such a skilled osteopath in private practice, Deborah was so calm and sympathetic to every patient, which really put the patients at ease. I felt inspired coming away from the practice and hope to take many of Deborah's qualities into my treatments with patients.
Southwick and Shoreham Osteopaths (19.12.2012)
Before starting at the BSO, I went to observe Rachel Pointon in SOS osteopaths multi-disciplinary practice to find out more about osteopathy. Despite not knowing any of the techniques or terminology, I was inspired by the way Rachel practiced and knew instantly that I wanted to become an osteopath.
Since then, I have been to observe twice in my fourth year to observe with a trained eye and to gain experience on how private practice runs. Both days of observation had busy patient lists, so I was lucky enough to see such a variety of patients. On my most recent visit, I observed 12 continuation patients being treated by Rachel, using a huge range of techniques best suited to each patient. The majority of patients presented with either shoulder, cervical spine or lumbar spine dysfunction of an acute or chronic duration.
There were two techniques that Rachel used on a patient with mid thoracic problems that I have not been taught but think they would be useful in practice. The first technique is a soft tissue technique for serratus anterior and subscapularis, which is hard to access due to the scapular overlying the musculature. The patient must be side-lying, on the side you wish to work on, and their arm must be straight and slightly extended to allow winging of the depressed scapula. This then gives access to the musculature via the medial border of the scapula. The patient also found this very theraputic and beneficial to her symptoms.
The second technique was a seated thoracic HVT, which involved the patient interlinking their hands around the posterior neck and Rachel putting one arm around one of the patients arms and place her hand over the patients around the posterior neck. Her other hand was placed at the segment she was aiming to thrust. She then applied several levers and her thrust was a rotation thrust, which appeared to work very affectively.
I absolutely loved spending the day observing Rachel in clinic and have taken away so much from the experience. As an experienced practitioner and undergraduate examiner, Rachel has an invaluable amount of knowledge which is evident with every patient that she treats. Not only is Rachel academically and technically brilliant, her patient skills in communication and handling are to be admired. All the staff at SOS osteopaths made me feel extremely welcome and have shown me how rewarding private practice can be. I left the clinic feeling excited, upbeat and motivated to attempt the best grades I can, to ensure graduation from the BSO and to become as competent as Rachel is!
Since then, I have been to observe twice in my fourth year to observe with a trained eye and to gain experience on how private practice runs. Both days of observation had busy patient lists, so I was lucky enough to see such a variety of patients. On my most recent visit, I observed 12 continuation patients being treated by Rachel, using a huge range of techniques best suited to each patient. The majority of patients presented with either shoulder, cervical spine or lumbar spine dysfunction of an acute or chronic duration.
There were two techniques that Rachel used on a patient with mid thoracic problems that I have not been taught but think they would be useful in practice. The first technique is a soft tissue technique for serratus anterior and subscapularis, which is hard to access due to the scapular overlying the musculature. The patient must be side-lying, on the side you wish to work on, and their arm must be straight and slightly extended to allow winging of the depressed scapula. This then gives access to the musculature via the medial border of the scapula. The patient also found this very theraputic and beneficial to her symptoms.
The second technique was a seated thoracic HVT, which involved the patient interlinking their hands around the posterior neck and Rachel putting one arm around one of the patients arms and place her hand over the patients around the posterior neck. Her other hand was placed at the segment she was aiming to thrust. She then applied several levers and her thrust was a rotation thrust, which appeared to work very affectively.
I absolutely loved spending the day observing Rachel in clinic and have taken away so much from the experience. As an experienced practitioner and undergraduate examiner, Rachel has an invaluable amount of knowledge which is evident with every patient that she treats. Not only is Rachel academically and technically brilliant, her patient skills in communication and handling are to be admired. All the staff at SOS osteopaths made me feel extremely welcome and have shown me how rewarding private practice can be. I left the clinic feeling excited, upbeat and motivated to attempt the best grades I can, to ensure graduation from the BSO and to become as competent as Rachel is!
Trevor Jeffories - BSO Demonstration Clinic
I had the opportunity to observe Trevor in Demonstration clinic, whereby paying patients are treated by him and up to three students observe. I spent four afternoons observing, which were all fully booked with patients of varying presentations. Although demonstration clinic is not a private practice, as it is located within the BSO clinic, Trevor has his own version of a case history sheet and treats using different techniques that have been created and taught outside of the standard osteopathic degree. I was intrigued at how many different styles of osteopathy he used per patient, ranging from cranial to visceral and functional. Along with the more gentle approaches, he also used a lot of HVTs to achieve greater joint mobility and decreased inflammation.
I was impressed with how much technique he is able to achieve in a 30 minute consultation as he quickly moves on to another area of the body once he is satisfied with a change felt elsewhere. He appeared extremely confident yet modest in his technical ability and freely admitted to making techniques up by thinking of anatomy and making it patient lead according to his palpatory findings.
This practice observation made me realise that not one osteopathic treatment style should be adopted throughout the whole consultation but to vary it depending on the patients presentation and subjective reports. I had not thought to integrate IMS with HVTs in one treatment, yet it appeared to mould nicely together in the hollistic approach to patient symptoms and well-being. Watching Trevor run his 30 minute consultations to time has also made me appreciate the importance of time keeping to ensure completed note taking and reliability for waiting patients in a busy clinic.
I was impressed with how much technique he is able to achieve in a 30 minute consultation as he quickly moves on to another area of the body once he is satisfied with a change felt elsewhere. He appeared extremely confident yet modest in his technical ability and freely admitted to making techniques up by thinking of anatomy and making it patient lead according to his palpatory findings.
This practice observation made me realise that not one osteopathic treatment style should be adopted throughout the whole consultation but to vary it depending on the patients presentation and subjective reports. I had not thought to integrate IMS with HVTs in one treatment, yet it appeared to mould nicely together in the hollistic approach to patient symptoms and well-being. Watching Trevor run his 30 minute consultations to time has also made me appreciate the importance of time keeping to ensure completed note taking and reliability for waiting patients in a busy clinic.