Pelvic floor rehabilitation in women’s health


Pelvic floor rehabilitation in women’s health 

– by Ana Aguila

Pelvic floor disorders are common in women, from young age until after menopause. Their dysfunctions include incontinence, pelvic organ prolapse, painful sexual intercourse and lower back or pelvic pain.

The pelvic floor is a diaphragm of musculature supporting the bladder, uterus and bowel, which are embraced by muscular walls. The side walls of the cavity are formed by muscles that assist hip rotation, but in pelvic floor problems, our focus is on the pelvic diaphragm. It is as a diamond shape sling of muscle attached to the pubic symphysis at the front and the coccyx and its ligaments at the back.
The main role of pelvic floor muscles is to support organs, to maintain urinary and fecal continence and to provide resistance and strength during maneouvres such as lifting. Also, well-conditioned muscles play an important role during sexual intercourse and childbirth.
Dysfunctions in the pelvic floor can be caused by childbirth, hormonal imbalance, fatigue and demanding activities such as lifting heavy weights.
Symptoms may include:

  • a sensation of a bulge or something coming down or out of the vagina, which sometimes needs to be pushed back
  • discomfort during sex
  • problems passing urine – such as slow stream, a feeling of not emptying the bladder fully, needing to urinate more often and leaking a small amount of urine when you cough, sneeze or exercise (stress incontinence)

During childbirth, the nerve that supplies the pelvic floor can be stretched or compressed and is especially at risk from with small pelvic size combined a large baby, assisted delivery and baby getting stuck. Nerve compression can be both extremely painful, and affect one of the muscles that prevents incontinence. Episiotomy during childbirth can also leave this muscle weakened and ineffective.
Prolapse of pelvic organs through the vaginal wall (pelvic organ prolapse) is common after pregnancy and childbirth due to increased abdominal pressure on the pelvic floor form the growing baby and pushing during delivery.
Muscles can repair and strengthen with training. However, before starting pelvic floor training we recommend achieving alignment and mobility of pelvis, lower back and hip joints. Once these structures are balanced, training can be established to strengthen the pelvic floor.
If you are able to perceive pelvic floor contractions and your weakness is mild, it is appropriate to start training with simple exercises.
The first exercise to help pelvic floor muscles strengthen would be simple contraction as in holding your urine in or interrupting urine flow. The contraction should be held for 5 seconds and repeated 10 times. Gradually, you will increase length of contraction from 5 seconds to 8 or 10 seconds as well as increasing repetitions to 12. It is important to avoid fatigue which is one of the factors causing urine incontinence.
However, when weakness of the pelvic floor is severe or you are not capable of contracting the pelvic floor, is advisable to use biofeedback which will help to engage the pelvic floor and train not only the muscles themselves but also helps you visualise which muscles to contract. With biofeedback you can learn about how to contract your muscles progressing onto further stages of rehabilitation.
In conclusion, an accurate physiotherapy assessment will provide you with the correct diagnosis to start rehabilitation and begin to create harmonious pelvic floor muscle stability.

1. Fonti, Y; Giordano,R; Cacciatore, A; Romano, M; La Rosa, R. (2009).Post-partum Pelvic Floor Changes. Journal of Prenatal Medicine. Volume 3(54-59)
2. Marques, A; Stothers, L; Macnab, A. (December 2010). The Status of Pelvic floor muscles training for women. CUAJ. Volume 4 (issue 6), 419-424
3. Rose Day, M; Leahy-Warren, P; Loughran, S; O’Sullivan E. Community- Dwelling Women´s Knowledge. (November 2014) British Journal of Community Nursing. Volume 19, (issue 11), 534-538.

Pilates for scoliosis, how does it help?

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Pilates for scoliosis, how does it help?

– by Chrisen Hall

Scoliosis is a sideways curvature of the spine. The severity of the curve differs from person to person and scoliosis is very common in the UK and it affects all ages. According to the NHS UK, around three to four in every 1000 children need treatment for scoliosis. The degree to which scoliosis will affect a person’s daily life depends upon how serious the curve is in their spine as everybody is very different. Scoliosis can be very mild, or significant and potentially disabling. If somebody is living with a severe scoliosis, it will affect the entire alignment of bones through the body. Not only does scoliosis impact your vertebrae, but it will also impact the structures around it. Scoliosis can shift the height of hip bones, resulting in two different leg length, it can shift the height of the shoulder blades and it can torque the rib cage, which can affect breathing.

As you could imagine, this can create pain and discomfort in the body. In particular it will reduce range of motion in areas of the body which can lead to complications in traditional exercise modalities and can limit a person from exercising as freely as they want to. There are not many things that will straighten a scoliotic spine after the spine has fully matured in an adult and Pilates is perfect for reducing the pain and discomfort associated with scoliosis. Unlike traditional exercise modalities, Pilates is low impact on the joints and it works to pull and glide muscles and bones into more of a natural alignment. The Pilates Reformer machine is perfect for exercising with scoliosis, the machine supports the body and teaches you quickly how to find proper alignment without strain.

I have worked with many clients who as as a symptom of their scoliosis hold tension in their back and neck, are stiff around the thoracic (mid back) and rib cage area. My goal in developing a Pilates program for scoliotic clients is to create more symmetry throughout the body to reduce daily discomfort and improve quality of life. We will achieve this by stretching the muscles out that are excessively weak, and by strengthening the muscles that are weak due to the scoliosis condition.

How does massage help PTSD, stress and anxiety?

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How does massage help PTSD, stress and anxiety?

– by Kimberley Pledger

Post-traumatic stress disorder (PTSD) is classified as a mental health diagnosis for which the primary treatments are anti-psychotic and anti-depressant medication and talking therapies.

Despite its classification, PTSD is a prime example of the body and mind working as an integrated whole, where changes happen in tandem on a mental, physical and physiological level. In other words, PTSD exists in the mind and the body. This means that the current treatments for PTSD, based as they are on an outdated idea of a separation between the functioning of the mind and body, overlook the physical symptoms of this disorder.

Recovery from PTSD is not just about minimising or eradicating the psychological symptoms, it’s also about feeling yourself again, which means feeling in charge of your body and being able to trust it again.  This article will review the physical symptoms of PTSD and consider how touch therapy (massage), as a complement to medical and psychotherapeutic treatment, can help you regain your sense of self.

The Physical Symptoms of PTSD

There are ten physical symptoms commonly associated with PTSD so lets look at each of them in turn and consider how regular massage can help to address them.

1. Insomnia
Insomnia is itself a symptom of the hypervigilance experienced with PTSD — it stands to reason that if you’re always on guard and you never switch off then you’re going to struggle to get to sleep and stay asleep. The physiological reason you are hypervigilant is that your sympathetic nervous system is in overdrive. The sympathetic nervous system is made up of the parts of your brain and body that kick in when you’re in danger and control whether you fight back, flee or play dead. Positive touch stimulates the parasympathetic nervous system — the parts of your body and brain that are activated when you are relaxed and experiencing something that gives you pleasure. The rhythmic stroking and kneading of the body that takes place during massage activates the parasympathetic nervous system and induces a feeling of sleepiness. This feeling normally starts a short while into a massage and is accompanied by a sense of well-being which should last for several hours after the massage has finished. In fact, it is not uncommon for a person to feel the effects of a massage for a few days afterwards so you can see how regular massage could really help someone with PTSD to overcome insomnia.

2. Exhaustion
Exhaustion as a symptom of PTSD is partly the knock-on effect of insomnia, but also a result of the body being stretched to its limits because it is always on alert.  Massage deactivates the parts of the body and mind that are stimulated when under threat and effectively reverses the effects of hypervigilance. Instead of feeling wide awake and jittery you feel sleepy and calm; instead of working in overdrive your body moves into cruise control and eventually slows down into sleep. If this happens regularly it reminds the body that rest is possible and desirable so over a period of time you start to wake up feeling refreshed instead of exhausted.

3. & 4. Accelerated Heart Rate and High Blood Pressure (Hypertension)
In order to maintain the heightened state of readiness demanded by the sympathetic nervous system in a person with PTSD, the heart beats faster so it can quickly pump blood to where it is needed most — the larger muscles to get them ready for fight or flight. One of the factors in high blood pressure is an accelerated heart rate, which is why hypertension is commonly found in people with PTSD.

Massage effectively switches off the sympathetic nervous system and activates the parasympathetic so the heart slows down, breathing becomes deeper and a feeling of wellbeing spreads through the body. There have been several studies showing how regular massage can help to keep blood pressure at lower levels.

The hormone cortisol is known to be a factor in hypertension and is also evident in high levels in people with PTSD. Although it is not yet fully understood how cortisol contributes to either PTSD or high blood pressure, what is known is that cortisol levels drop following massage.

Unsettled babies and osteopathy


Unsettled babies and osteopathy 

– by Laura Wheatley, MOst, Diploma of Paediatric Osteopathy

People often ask us how osteopathy can benefit babies and wonder how our approach in treating them compares with treating adults. 

Far and away the most common symptom we see babies for is unsettled behaviour. It’s the lower back pain of the baby world if you will. And it manifests in a variety of ways – most commonly crying and irritability, trouble getting wind out (either end), vomiting and sleep disturbance.

Where a visit to the GP would likely result in a diagnosis of ‘colic’ or ‘reflux’ and a prescription, as osteopaths we find these diagnoses to be too broad, and commit ourselves to investigating and explaining WHY such symptoms are occurring. We feel it is our role as osteopaths to do the detective work.

We take a thorough case history including details of the pregnancy, birth and postnatal period, and listen keenly to Mum who knows her baby best and is the expert on her child. Following a head to toe examination assessing overall wellness and health, milestone attainment, joints, neuromuscular status and primitive reflexes we then put our hands very gently on the baby, and listen to what the baby’s body tells us. We are also able to pick if there are any signs of serious issues that may need referral.
We make a treatment plan tailored to the baby to unwind and resolve any tensions that may be palpable in the body and causing discomfort in some way. Treatment involves very subtle movements and light forces working with the baby’s natural physical tendency to seek balance, equilibrium and health.

To give a few examples – a baby diagnosed by the GP with reflux may have had a rapid delivery and experienced a shock on transitioning to life on the outside, tightening their diaphragm and leading to increased regurgitation or vomiting; a baby who seems colicky may have been subjected to a long and difficult labour, perhaps with forceps or ventouse intervention, and therefore be experiencing pain; and a baby with sleep disturbance may have experienced compression in an odd position in the womb and struggle to get comfortable. It’s important to add here that every baby is different and tells a their own unique story.

I must also add that currently any qualified osteopath may legally treat babies and children. At Kennington Osteopaths & Physiotherapy, we feel that expert knowledge of the specialised anatomy and physiology (and their associated problems) is essential to treating babies and children effectively and safely. Therefore both Andrea and I have completed a two-year postgraduate qualification at the Osteopathic Centre for Children.


Osteoporosis – You ARE AT RISK unless you KNOW YOU AREN’T


Osteoporosis – You ARE AT RISK unless you KNOW YOU AREN’T

Osteoporosis is really not a fun subject. But it is REALLY important that you think about it now. This has been driven home to me this year in both a personal and a professional capacity.

In 2016, the Institute of Osteopathy has teamed up with the National Osteoporosis Society to raise awareness of this very serious condition. Osteoporosis can be painless until you fall and have a fracture. If you have fragile bones and weak muscles, the recovery from fractures can be very difficult.

Half of women and a fifth of men over 50 years old are affected by bone thinning.

One in three people have undiagnosed spinal fractures that may cause no pain but will eventually lead to bone loss and spinal curvature.

My story

A beloved relative fell over in September 2016, for the first time, at the age of 78. Her balance is usually excellent, but on this occasion a large dog jumped up in excitement when she went to pat it and she stepped back and lost her balance.

She had been taking alendronic acid (a bone density drug) for several years but this didn’t prevent her from badly fracturing her pelvis and requiring pins through her femur to pull it out of her crushed hip socket (I agree its grim, but I don’t want us to shy away from the facts).

The first two weeks following her fall were excruciatingly painful and she required assistance for every single move and manoeuvre. She has now been in hospital for over six weeks, simply waiting for the fractures to slowly knit — her bones are just too fragile to stabilise surgically.

This situation breaks my heart because I know it was completely avoidable if she’d taken measures earlier in her life to improve her musculoskeletal health.

She is lucky to have a very strong community and family around her and visiting her in hospital but she is of course bored, frustrated and scared. I’m scared too. When she is allowed home she will be much more vulnerable to further falls and further fractures. We are taking serious measures to make sure she has plenty of rehabilitation from physiotherapists and physical therapists to reduce the chance she’ll lose her balance, or be too weak to prevent herself from falling.

My own wonderful grandmother died of complications related to osteoporosis. She had an increasingly hunched posture, and eventually fell, broke several ribs and died several weeks later. My mother has been reminding me for years that I have a family history of osteoporosis. This has somehow always been filed in my ‘mother banging on about medical problems’ category and therefore essentially ignorable.

As a direct consequence of her mother’s terrible death, my mother exercises frequently, is careful about her diet and has really fantastic posture. This has made it all too easy for me to ignore my own immediate family history of osteoporosis!

First, try to establish that you ARE NOT AT RISK

Here is a link to an online tool that will help you assess your fracture risk. Follow this link then select Calculation Tool tab and put in your stats.


If you’re worried you may have thinning bones, the most conclusive way of finding out is by having a Bone Density Scan. This assesses your bone density at different sites in your skeleton and can establish the risk of incurring into a stress fracture.

This is why is so important to get it done if you are peri- or post-menopausal or if you identify with the risk factors for osteoporosis. The stage before becoming osteoporotic is called osteopaenia and shows a small reduction in bone density which is also visible on a bone density scan.

Being aware of it as early as possible will increase the chances for you not to even get to an osteoporotic state and to start working on it successfully addressing your diet and physical activity.

Here are some signs that you may already have osteoporosis

You may have noticed a loss of height (a sign of slow vertebral collapse caused by compression fracture), or a dowager’s hump accompanied by a bulging tummy, or breathlessness, and needing the loo frequently all caused by a change in your spinal shape.

You may have a relative with a history of osteoporosis. Long-term use of steroids can weaken bone. Poor digestion can reduce your capacity to absorb calcium and Vitamin D so inflammatory bowel disease, long term gut dysfunction, and coeliac disease can all predispose to thinning bones.

If you have established risk from a family history, or know you have osteoporosis here are the best ways to reduce your risk of fracture.

Osteoporosis – 9 ways to prevent or treat it

Load bearing exercise
Nutrition – lots of calcium (tinned fish and green veg)
Aerobic exercise
Vitamin D – to absorb the calcium (egg yolk, supplements and sunshine)
Resistance exercise
Maintaining a consistent weight (slim not skinny)
Improving your balance with stabilisation exercise
Osteopathy to treat functional anatomy of bladder / bowel
Drugs – bisphosphonates (alendronic acid)/ raloxifene / teriparatide

How can Kennington Osteopaths and Physiotherapy help?

Our new physical therapist, Mr Andrea Bartolini, has a number of treatment package options to strengthen, condition, stretch and stabilise. He is also a trained nutritionist and sports and public health so can advise you about diet as well as prescribing appropriate exercise to improve your posture and increase your bone density and reduce your risk of falling in the first place.

If you’ve already had a fall or a fracture and have been injured our phsyiotherapists and osteopaths are brilliant at rehabilitation and pain relief. You don’t have to live in pain and you don’t have to live with dysfunction. We all also offer treatment packages that offer a really cost effective way of helping you to look after yourself.

Osteoporosis – 5 signs you might have it

Loss of height
‘Dowager’s hump’
Heartburn or vomiting
Weak bladder (urge incontinence)
Family members who have (had) it

Osteoporosis – 4 symptoms that might indicate you have it

Bulging tummy (spinal fractures can reduce space in the abdomen)
Breathlessness (spinal curvature reduces lung capacity)
Back pain (spinal fractures may be extremely painful – but are sometimes painless)
Worrying about your balance (weak muscles make balancing harder)

Psychotherapy, Counselling or Talking Therapy? Part 2.


Psychotherapy, Counselling or Talking Therapy?

By Tiago Brandao

The diversification of talking therapy approaches has resulted in a number of different professionals being responsible for different aspects of mental health, which can be confusing.

To simplify:

Psychiatrists are always specialist trained doctors. In the UK (and usually around the world) they are the only professionals that are able to make a definitive diagnosis regarding their mental health (for example, schizophrenia, bipolar disorder or personality disorder). Psychiatrists are the only professionals who can prescribe medication for these conditions. Usually their focus of treatment is the physiological aspect of the mental health problem, so medication will be prescribed to alter brain chemistry to help patients manage their symptoms.

Psychologists are trained professionals that study the way that people’s minds work, including their behaviour, thoughts and physiological aspects of the brain. They can specialise in a number of different areas including but not exclusive to clinical symptoms, educational achievement, forensic studies and sports psychology. Psychologists may also provide talking therapy and tend to focus on evidence-based interventions such as CBT.

Psychotherapists and counsellors have a number of similarities and the names for their therapies are often used interchangeably. Both are trained professionals that use talking therapy to support individuals with their mental health and emotional challenges. One difference, however, is that psychotherapists have a more in-depth and extensive training, which gives them the potential to manage clients with more serious or complex psychological needs.

As I mentioned in the previous post, although each of these professionals might use different resources and techniques to support their clients, the professional relationship has been proven to be one of the most important aspects influencing the efficacy of treatment/process. Therefore, when looking for a mental health professional, make sure that you find someone that you feel comfortable with and that you feel able to build a trusting relationship with. This will be the first step of a very rewarding process.

It might also help to ensure that they are registered with one of the UK professional bodies such as BACP, UKCP, BABCP or BPS. These organisations make recommendations about the standards of training and practice for all psychotherapists and counsellors.

I offer all new clients a free 30-minute initial session so that we can get to known each other and to check that we are the right “fit”. This session offers a non-judgmental meeting with no expectations committing to counselling following this session.


1. Butler AC, Chapman JE, Forman EM & Beck AT (2006). The empirical status of cognitive-behavioral therapy: a review of meta-analyses. Clin Psychol Rev. Jan 26(1):17-31. Epub 2005 Sep 30.
2. Lambert MJ & Barley DE. (2001) Research summary on the therapeutic relationship and psychotherapy outcome. Psychotherapy: Theory, Research, Practice, Training Vol 38(4), 357-361.

Psychotherapy, Counselling or Talking Therapy?


Psychotherapy, counselling or talking therapy?

– by Tiago Brandao

Counselling and Psychotherapy are two of the many names that can be used to refer to different types of “talking therapy”. The idea of using talking therapy was first identified by Sigmund Freud in the early 20th century, when he sought to cure his patients’ physical ailments using dialogue.

As technology and scientific methods improved, research disproved some of Freud’s original findings and uncovered new links between the body and the brain. This led to the development and diversification of a number of theories and diaglogue-based approaches, each with its own strengths.

Currently, psychotherapy and counselling can be divided in three broad approaches:

  • Psychodynamic psychotherapy evolved from Freud’s original work. It tends to focus on the unconscious processes of the human mind and the impact these have on interpersonal relationships. Research has demonstrated that psychodynamic psychotherapy is effective over years of practice or treatment. It tends to be a long process with regular sessions of therapy taking place over years.
  • Cognitive Behavioural Therapy (CBT) focuses on changing the individual’s thoughts (“cognitions”) and behaviours. CBT has been shown to have a beneficial impact on the person’s general sense of wellbeing. It also provides the individual with a number of tools to use to continue the therapeutic process once the therapy sessions come to an end. Cognitive behavioural therapy is the main approach used by the NHS. 70% of the population has shown improvements in their mental health following treatment(1). CBT tends to be a short intervention (around 8-12 sessions). Some professionals have questioned whether benefits are maintained into the long-term with CBT – it is seen by some as a short-term fix.
  • Person-centred approaches focus on an individual’s ability to self-heal and provide a safe space to do so. These approaches, which utilise flexibility and warmth, tend to be attractive as they respect they make allowances for each person’s rate of development whilst providing the challenge and the support concurrently.

Gestalt Therapy is a person-centred approach that focuses on an individual’s ability to adapt – using the relationship between therapist and client creatively and compassionately to support the person to realise their full potential. In the 21st century, most healthcare professionals aspire to make their care and treatment person-centred. Because of the highly individual nature of Gestalt Therapy and other person-centred approaches, research methods are still being developed to measure the active ingredients of the therapy and their outcomes. Person-centred therapies tend to be a middle length approach compared with psychodynamic psychotherapy and cognitive behavioural therapy, but allow for each person’s development, from months to years.

The brain, the mind, human behaviour and the study of relationships are challenging to study as isolating the variables that affect someone’s development requires enormous research resources. It is, as all others sciences, a never ending process of new discoveries and development.

Research has identified that the most important aspect of psychotherapy or counselling is the relationship between a person and their therapist, known as the therapeutic relationship(2).  The more positive and trusting the relationship a person has with their therapist the more successful the therapeutic process.

When looking for a therapist, it is essential that you find someone that you feel comfortable with and that you are willing to build a trusting relationship with, as research shows this will have a significant impact on your development and capacity to achieve your potential.

For this reason, I offer an initial 30-minute session free of charge. This session allows us to get to know each other, and decide whether we can work together successfully.


1. Butler AC, Chapman JE, Forman EM & Beck AT (2006). The empirical status of cognitive-behavioral therapy: a review of meta-analyses. Clin Psychol Rev. Jan 26(1):17-31. Epub 2005 Sep 30.

2. Lambert MJ & Barley DE. (2001) Research summary on the therapeutic relationship and psychotherapy outcome. Psychotherapy: Theory, Research, Practice, Training Vol 38(4), 357-361.

Manipulative approach for physiotherapists.


Manipulative approach for physiotherapists.

Kennington Osteopaths and Physiotherapy has now developed a training side of the practice, offering interesting courses and talks.

This course is an invaluable opportunity for physiotherapists to learn, improve and practice manipulation techniques. Physiotherapists will learn how to apply effective and reliable manipulative treatment techniques in their daily clinical practice for a variety of musculoskeletal conditions. The course is very “hands-on” in nature and you will have the opportunity to practice with full 1-2-1 support.

The aim of this 4-day course is to enable physiotherapists to safely apply spinal structural manipulation techniques to the thoracic, lumbar and cervical spine. The course is divided into two weekends. The first weekend will introduce you to the general concepts of manipulation. You will then focus on thoracic and lumbar spine manual therapy techniques, their clinical relevance and application to major musculoskeletal conditions.

The second weekend will focus on the cervical spine and the treatment of its most common conditions through manipulative techniques as well as their application to the physiotherapist’s clinical role and setting. The course will conclude with a holistic view of how manipulation techniques can be effectively integrated in physiotherapy rehabilitation protocols.

The tutors are both trained physiotherapists and qualified osteopaths and they have mastered the ability to integrate osteopathic techniques within physiotherapy clinical settings. This course is an unique opportunity for all physiotherapists to develop a stronger clinical practice and maximise the rehabilitation goals for their patients.

The course has a limited availability of 14 participants to guarantee optimal support and 1-2-1 attention to exact and correct spinal manual techniques. Each weekend can be booked separately, but priority will be given to students that can commit to the whole course.

On completion of this course you will be able to:
Understand the principles of the manipulative approach and develop insight into the clinical reasoning behind it.
Identify and assess spinal dysfunctions through a thorough examination process and carry out effective vertebral segment tests to corroborate your findings.
Perform accurate, safe and effective high velocity thrusts and soft tissue techniques to the cervical, thoracic and lumbar spine within a clinical environment.
Be able to differentiate between the need for a soft tissue or high velocity thrust technique to ensure your patients receive the best treatment for them.
Recognise red flags and confidently select a treatment approach based on your clinical findings.

We suggest reviewing spinal anatomy before the course to prepare for the practical “hands on” workshop with a refreshed knowledge.

Participants must have undergraduate training in physiotherapy and must be registered with the HCPC health and care professions council or equivalent (if overseas participant).
Participants must have professional liability insurance covering the techniques taught on the course. We reserve the right to ask for proof of this to ensure eligibility.
Participants that are, or may be, pregnant when attending any courses with a practical component should let us know in advance by email.


1st weekend 15th/16th of October 2016
2nd weekend 5th/6th November 2016


£260 per weekend, £500 if both weekends are booked together.
A deposit of £150 will be required to secure your place.


The course will be held at Kennington Osteopaths and Physiotherapy,
2/4 Cleaver Street, SE11 4DP, London.

Light refreshment will be provided throughout the day, lunch is not included. There are several cafes very close to the clinic.


“Excellent organisation and wealth of knowledge of both tutors” L., London.

“Great presentation skills – full of knowledge” J. London.

“lots of flexibility and enough time to practice” T.,Manchester.

“Both tutors are very observant and able to offer advice regarding techquines” C. London.

“The course was great!!” M., London.




– by Lorna Rose

What is osteoarthritis?

Osteoarthritis is the most common type of arthritis, it is a clinical syndrome characterised by joint pain accompanied by varying degrees of functional limitation and reduced quality of life. The most common peripheral joints to be affected are the knees, hips and small joints of the hand. Structural changes to joints can happen without any symptoms at all. It is usually when people are unable to compensate for these changes that they start to become symptomatic. Joints are particularly vulnerable to developing osteoarthritis if they’ve been injured in the past or if the normal healthy movement has been disrupted.

There are various ways of managing osteoarthritis, both pharmacological and non-pharmacological, to understand the role that manual therapy can play it is useful to know what changes happen within an osteoarthritic joint:

Osteoarthritis is characterised pathologically by localised loss of cartilage, remodelling of adjacent bone and associated inflammation. Loss of cartilage leads to reduced space between the boney surfaces of the joint, initially this can lead to increased mobility but as the joint capsule contracts and the surrounding muscles shorten, mobility is reduced.

What can osteopaths do?

One of the main objectives for us when treating an osteoarthritic joint is to maximise the mobility of the joint. We do this by gently moving the joint within a pain-free range and by stretching surrounding muscles. The benefits of this are reinforced by doing exercises at home.

Joint cartilage relies on compression and decompression to access nutrients from the synovial fluid contained within the joint capsule. This is one of the reasons exercise is so important for osteoarthritic joints. By passively moving the joint during treatment, we’re helping to coat the cartilage with fluid and changing the pressure by gently stretching the joint.

My experience of treating patients with osteoarthritis

Lots of my patients suffering with osteoarthritis have found treatment really benefitted them and helped to minimise the impact of the condition on their day to day activities. Of course there are limits to what can be achieved through conservative management of osteoarthritis. On those occasions I would encourage patients to communicate with their GP to discuss other options, including steroid injections and joint replacements if indicated. However, having witnessed the benefits of osteopathic treatment for patients with osteoarthritis I think it is definitely worth seeing what can be achieved through osteopathic treatment first.

What is the difference between an osteopath and a physiotherapist?


What is the difference between an osteopath and a physiotherapist?

Andrea Rippe (BOst, MSc Paed Ost) is a registered osteopath and Pietro Susini (BSc Phys, MSc Ost) is a registered osteopath and a physiotherapist. This is not the most frequently asked question (which is,” what is the difference between an osteopath and a chiropractor” – see below!), but it is the question we are most qualified to answer.


Osteopaths train longer at 4 years (full time). Physiotherapists train for 3 years (full time). WHY?


UK physiotherapists train with and work within the NHS. On graduation, we work as part of a team like an apprentice to get you back on your feet after surgery or injury. We are given a diagnosis by the consultant or GP and use an evidence-tested protocol to rehabilitate you. So we don’t do the clinical diagnostic work when we first see you.

Osteopaths are alternative (trained outside the NHS) therapists. We start practising as independent clinicians on day one after graduation. To ensure your safety, we need to be able to make a diagnosis before we decide to treat you. Making a diagnosis means differentiating between the likelihood of your back pain or shoulder pain being caused by a muscle strain, a joint strain, osteoporotic fracture, or cancer, for example. Obviously, we would treat you for the first two conditions, and refer you back to the NHS or a private clinic for exploration of the second two conditions. The extra year of study gives us the clinical tools to decide whether it is appropriate and safe to treat you as soon as we’ve registered.

REHABILITATION vs PAIN MANAGEMENTWhat is the difference between an osteopath and a physiotherapist

Physiotherapists rehabilitate you after surgery or injury – often brilliantly. If you’ve had a stroke and lost the ability to walk, we can follow a protocol to train you muscle by muscle. Physiotherapy worked for Andrea’s grandfather after a stroke so he could continue to live at home. And physiotherapy did this for her father after both hip replacements, allowing him to climb stiles again when out birdwatching. These excellent protocols can be adapted uniquely to your body, ability and stage of recovery.

Osteopaths don’t use treatment protocols. We could work out how to rehabilitate you from first principles, but it would probably be quicker and more effective to see a physio for post-op rehab. We use your case history and clinical examination to diagnose the cause of your pain or stiffness and we use our hands to relieve pain and improve flexibility so that your body heals quicker with fewer compensations and side effects.


A physiotherapist could, in theory, rehabilitate you without touching you, completely successfully (although most would probably use their hands at some point.) By visually assessing your muscle weakness or dysfunctional movement pattern we could prescribe and instruct you how to perform the appropriate exercises. With modifications at each session – adapted to your increasing ability – your performance can be restored and amplified.

It would be unthinkable for an osteopath not to touch you. Manual therapy is the osteopath’s primary tool for relieving pain, reducing stiffness and restoring function, be it to a muscle, joint, limb or spine.


Physios are frequently accused of reductionism and osteopaths lauded as holistic. We believe these labels are confusing and wrong. Teaching someone to walk after a stroke or hip replacement is hardly reductionist. Intervening to give someone their quality of life back is a truly holistic goal. Restoring the ability to bend and straighten a replacement knee joint is without doubt reductionist and also vital to the owner of the knee!

Some osteopaths could easily fall into a reductionist approach to back pain and simply manipulate spinal joints to restore flexibility without addressing the cause of the stiffness. A more holistic osteopath would explore and address their patient’s lifestyle, medical history and state of mind for insight into the causes of the stiffness.


We’re going to go out on a limb here, but broadly, for rehabilitation post-operatively or following serious sports injuries, you are better off with a physiotherapist.

For acute, subacute and chronic spinal pain, you are better off with an osteopath.

If you’d prefer to be given an exercise programme to do at home, its probably a physio (unless your osteopath has a sports / exercise background.) If you have a horror of touch or hate the idea of having to dress down to your underwear for examination, its physiotherapy. (Although you can wear shorts and t-shirt for osteopathic examination, we really prefer to see the contours of your muscles and spinal curves to help our diagnosis).

When you have tension headache, knots in your muscles, tired, aching neck or shoulder, sciatica, back stiffness, its osteopathy. If you feel like you just need to be pulled and stretched and pummelled, it’s osteopathy!


Again, this is a little controversial but, possibly not! The difference in length of training makes less and less difference as therapists gain more experience. Let’s take the example of frozen shoulder. Your physiotherapist will prescribe a protocol of training exercises for you to increase your shoulder movement day by day. We know this work – there is plenty of research to demonstrate that this is a faster route to mobility than ‘wait and see’.

An osteopath might investigate whether you had a) adhesive capsulitis – an immune system reaction to stress or trauma; b) a rotator cuff muscle strain that they could treat manually; c) other shoulder muscle strain that they could treat manually; or d) nerve impingement causing weakness of the arm muscles (and masquerading as frozen shoulder). Senior and independent physiotherapists would also go through this thought process.

For you, the outcome may well be the same for both styles of treatment, particularly if the diagnosis was, indeed, adhesive capsulitis. But if the osteopath concluded that rotator cuff muscle spasm was the cause of the restriction and they could get a finger onto your subscapularis (rotator cuff) muscle under your shoulder blade and use pressure and stretch to make it relax, you might gain a few extra degrees of movement much more quickly (making your physio exercises much more effective).


Yes and no. Some osteopaths work within the NHS alongside musculoskeletal teams, notably at Queens Medical Centre in Nottingham. The osteopaths there work with orthopaedic consultants and senior physiotherapists. In the past, some osteopathic clinics received ‘Any Qualified Provider’ status to treat musculoskeletal complaints in their health authority. Since austerity economics, patients have less choice about whether they see an osteo or physio.

Many osteopaths treat doctors and their children. But GPs can’t refer their patients to osteopaths. This is because by referring NHS patients to NHS physiotherapists GPs can ensure that there is equal access to care for all patients. As explained above, osteopaths usually work outside the NHS as private practitioners.

Therefore, it seems to us that access to physiotherapy rather than osteopathy is an economic and political decision rather than a clinical one.


Yes, they all do. At Kennington Osteopaths and Physiotherapy, we offer both osteopathy and physiotherapy with health insurers including BUPA, AXA, Aviva, Nuffield Health, WPA and many, many more.


Both osteopaths and independent physiotherapists examine you to help them make the correct diagnosis. This can range from watching you walk, to testing your sciatic nerve function, evaluating your tendon reflexes, measuring blood pressure, exploring your ankle, knee or back, inspect your fingernails for signs of cancer, heart problems or pernicious anaemia, and a host of other interesting things.

At Kennington Osteopaths & Physiotherapy, because osteopaths don’t have direct access to blood testing, an MRI machine or an x-ray, we rely heavily on evidence-based clinical tests. We will refer you to your GP, or a private centre if you prefer, for MRI, x-ray or blood tests if necessary.


We like your questioning!

In the UK, physiotherapists must be registered with the HCPC (Healthcare Professions Council), the regulatory body that oversees many allied health professions such as nurses, midwives and podiatrists. This means they have demonstrated that they are educated to an appropriate clinical level, have indemnity insurance and stay up to date with their training. No one can pretend to be a physiotherapist.

Only osteopaths can call themselves osteopaths. We are proud that our title became protected by the Osteopaths’ Act in 1993. We’re not sure why, but we pay a lot more to our registrar the General Osteopathic Council (around £650 per year) than physiotherapists pay to the HCPC (we think this may be a result economies of scale at HCPC). We also have to prove we are insured, are of good character, have no criminal record and are maintaining our clinical training (we must demonstrate we’ve spent at least 30 hours per year studying — the same as physios). YAY!


Generally, physiotherapists within the public healthcare system, cover the role of mechanics of the human body, employing a range of vitally important rehab skills ranging from neurological and musculoskeletal, to cardiovascular and respiratory physiotherapy, returning patients to good health after chronic disease and injury.

In the USA, osteopaths are called family doctors with prescribing rights, the ability to carry our minor surgery and all the things that your GP does. Some UK osteopaths consider themselves to be bloodless surgeons, as they work to alter internal tensions around the spine, pelvis and skull to restore normal function to tissues like discs, joints and organs.


Chiropractors tend to follow an alignment theory in their approach to any musculoskeletal condition. This anatomy-based model drives their manipulative practice, which is often characterised by manipulation (joint cracking).

Chiropractors have specialised tables to make joint manipulation easier and quicker so treatment is on average slightly shorter (often 20 minutes).

Although all osteopaths are trained to manipulate joints, they are much more likely to incorporate other manual techniques in their practice. Some will undergo prolonged training using the cranio-sacral model of manipulation and visceral manipulation in addition to the baseline musculoskeletal techniques.

Osteopaths use standard treatment tables, and we commonly treat muscles as well as manipulating joints (in fact, we might only massage, stretch or activate muscles that are in spasm and their functionally adjacent tissues during a treatment). This means our treatments are slightly longer on average (often 30 minutes).

We hope this clears things up a little. We also really hope that other osteopaths and physiotherapists (or chiropractors!) don’t feel misrepresented by this blog.

Because we all train in different colleges but operate in the same market, it can be easy to be disparaging about our therapeutic cousins! At Kennington Osteopaths & Physiotherapy we believe that offering a mix of skills and specialities offers our clients the absolute best of all worlds.