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1st Appointment

Your first Appointment – what to expect and £10 off your first visit

By Osteopathy

Your first Appointment- what to expect and £10 off as an Introduction in August

If you haven’t been to see Hugo before then read on to find out what to expect. And for the month of August there’s an introductory £10 reduction on the first Appointment fee. Normally £60 now £50. So you can get back to your best and make the most of the Summer!

The First Appointment- what to expect

There are typically two parts.

Part One: Typically 15-20 mins. This is when we talk about the area of your body that is hurting or preventing you doing the activity you want to do. I’ll ask you detailed questions about when it started,

1st Appointment

1st Appointment- what to expect

what makes it worse or better, the type of pain. Is it a dull ache or a burning pain? How does the pain change during the day? What history you have with previous muscle or joint pain? It is all designed to give me a short list of possible causes for your pain or restriction of movement.

General Health

So I have a good picture of your overall health I will ask questions about your general health. Such as your diet, how much water you drink, the amount of exercise you take. Any previous illnesses, accidents or operations. Any allergies you may have? Any MRI scans, X rays, CT scans etc.  If you have any of these and they are relevant to your current issue then please bring them along.

Part 2Evaluation and Treatment– Typically 40-45 mins. This is when I ask you to move and see what effect that has in terms of possible pain it may cause and how restricted a particular joint or muscle or area of the body may be. Don’t worry most of the movement should not cause pain. I may ask you to walk or even run if that is when the pain occurs. Where possible I want to see you in action, as it were, not static. Of course you may be in considerable pain just standing let alone walking and I will tailor my assessment to you so you are in the least amount of discomfort possible. This movement assessment will

Osteopath Kingston

3D functional movement and osteopathy

then segues into treatment. However the treatment may focus entirely on a specific joint movements but more often it will be a combination of movement based 3D Functional movement and hands on massage and joint mobility.

Access to Youtube channel of exercises

At the end of the session we will recap together on the movements we have been through and these will become your homework. We will either video them for you take with you or you can refer to a version of them on my Youtube channel. Patients find this a very useful too as a reference after the first session. It’s difficult to concentrate when you may be in some discomfort. We will agree if I need to see you again and what are the likely number of treatments. This will be reviewed every time I see you so there is no pressure for you to sign up to a specific number of sessions.

What you need to know before you book an appointment

  • Come in loose fitting clothes or have a change of clothes that are loose- shorts and T shirt for men, leggings and t shirt for women. What ever you feel comfortable it. If you do have back pain I may need to see your back so you may need to dress so that I can see your back easily.
  • MRI reports or x rays-if you have them and they relevant then please bring them along
  • If you book in August you will receive £10 off your first appointment
  • You can pay by credit or debit card or cash
  • You can book online or by phone
  • The treatment approach aims to reduce pain quickly, increase movement and give you the strategies to stop the pain returning. If your still unsure please read some of the reviews of my patients.
Lower back pain prevention

A Different Approach to Prevent Lower Back Pain

By Back Pain, Osteopathy, Prevention

If you suffer from recurring back pain and your current rehab exercises that work on strengthening your core don’t seem to stop your back pain from recurring then perhaps it is time to take a different approach.

For at least the last 20 years there has been a focus on advising people to strengthen their core stability muscles that in turn  will prevent back pain. However the research to support this is thin at best. Much of the research has been carried out on small non representative samples (1). When the samples are representative then whilst some short term benefits can be found no long term benefits (over 6 months) can be seen (2) in back pain prevention. Alternatively it was found that core stability rehab is no more effective than general exercise (3).

Does the following scenario sound familiar? 

I hear this quite frequently from my patients.

A patient has experienced back pain and through their physical therapist they have been given a series of cores stability exercises. Such as ‘The bridge’, the ‘1 legged bridge’, ‘the plank’, ‘superman’ etc. The patient has done them frequently and noted increased muscle tone and an ability to do the exercises for longer or more frequently. However 6-12 months later they have a recurrence of their back pain.The patients blame themselves for not doing the exercises correctly or not frequently enough. Wait for the pain to subside, perhaps receive some treatment then carry on with the same exercises.

If you can relate to this then may be it’s time to take a different approach. After all Einstein’s definition of insanity is doing the same thing over again and expecting a different outcome!

What’s the thinking behind Core stability exercises?

In essence the theory is by activating your core stability muscles such transverse obliques, rectus abdominus, pelvic floor, internal and external obliques, diaphragm you can help support the lumbar spine and so help reduce its work load. However if the research is right and there is a lack of effectiveness then perhaps we need to ask the question ‘Why can’t our backs cope with the work load in the first place?’And – “Why does it need extra support?”

An Alternative approach

I would argue that the area of your spine that is in pain is a result of it trying to cope with extra work load because other parts of the spine or body are not moving as well as they should.

The body has this amazing ability to adapt and deal with reduced function in one part of the body to maintain our overall function. The spine is a key part of this.

24 interlinking segments that act liked a coiled spring. If a section of the coil stops moving then the sections above and below move more to ensure our bodies can achieve the movement we require. It’s this extra movement of muscles and joints that over time can lead to muscle fatigue and joint inflammation. These are two main symptoms of lower mechanical back pain.

Address the causes through treatment and rehab

Of all the hundreds of patients that I have seen through my practice with lower back pain the common factors are reduced mobility in the upper back and shoulders and reduced mobility in the pelvis and hips.

Coincidentally these are the two main areas of our body that we keep static for long periods of time every day of the week!

Our sedentary lifestyles reduce our mobility

It is this lack of movement in these two areas that can cause us lower back pain pain in the long term.

back pain whilst at your desk

causes of back pain

We sit at our desk, shoulders forward, fingers ready to type on our key boards, heads forward, upper back arched. Our hips flexed. Sometimes for hours at a time.

Our bodies take these inputs as a desired position and start to adapt accordingly. The body is always looking for efficiencies to reduce energy expenditure. So it reduces blood supply to muscles. Joints stop moving so nerves receive less innervation.

Muscles in our upper backs become fibrotic and joints become less mobile.

We do this day in day out for up to 8 hrs a day for months and even years! Then we go home and watch TV or use our laptops at home, or alternatively try and get the stress of our work out the system and go cycling and assume the exact same position. Or we go to the gym and contract the same muscles that were contracted at our desks (our pectorals and biceps and hip flexors)

Implications for our Lower back 

If the middle section of our spine can no longer rotate or bend forward as much as it used to do then the lower back (the lumbar spine) will have to move more to ensure that there is no reduction in functional ability and range of movement.

Likewise if we cannot rotate from the hip or our hips are flexed forwards because our hip flexors are permanently contracted from all the sitting down we do then our lower back muscles become more involved in simple daily activities such as walking and standing.

Our bodies make these adaptations without us being aware of them. Day in day out for months and years.

Then add in the role that the lower back was designed for and the wear and tear that can take place without this extra work load and you can start to see why an upper back or hip that can’t move optimally can help increase the risk of fatigue, strain and ultimately, injury in the lower spine.

How can you help?

# Change the inputs in your upper back

From a static 8 hrs. Stop every 30-45 mins and make your upper back and shoulders move. Your body will respond by increasing blood supply. Muscles will change to become more flexible. Joints and innervation inputs will increase.

Here is a simple exercise you can do at work whilst sitting down to start changing the inputs. Do it every 45-60 minutes that you are at your desk. Your colleagues might think you are mad at first but soon they will all start doing it! It really works.

# Change the inputs to our hips and pelvis

We need to reduce the tightness in our hip flexors that builds up over time as we sit at our desk, cars, TV, dinner table and on our bikes . Here is a really effective exercise to do just that.

Do it daily am and pm 10-15x. Include it into any activity warm ups and warm downs too. Especially after cycling or running.

Next we need to improve the mobility and rotation of the hip as well as activating the gluteals and hamstrings.

This exercise combines hip flexion stretches with hip rotation.  Do it am and pm 10-15x for each exercise.  These exercises should all be pain free so if you experience pain after or during then just stop and consult your professional physical therapist.

To Conclude

If you have been doing your core stability exercises and you have had no recurrence of lower back pain, then please continue but consider if you are really addressing the cause. With our increasingly sedentary lifestyles we are placing increasing work load on our lower backs due to a lack of mobility above and below in our upper backs and hips. So if you are doing core stability exercises then add hip and upper back mobility exercises into the mix. If you are not doing any exercise then start to work on hip and upper back mobility with the above exercises. The exercises should always be pain free.


(1)Stuber KJ1Bruno PSajko SHayden JAClin J Sport Med. 2014 Nov;24(6):448-56. doi: 10.1097/JSM.0000000000000081.Core stability exercises for low back pain in athletes: a systematic review of the literature.

(2) Xue-Qiang Wang,1 Jie-Jiao Zheng,2,* Zhuo-Wei Yu,2 et al. Public Library of Science. 2012; 7(12): e52082.Published online 2012 Dec 17. doi:  1371/journal.pone.0052082A Meta-Analysis of Core Stability Exercise versus General Exercise for Chronic Low Back Pain

(3)George SZ1, Childs JDTeyhen DSWu SSWright ACDugan JLRobinson MEBMC Med. 2011 Nov 29;9:128. doi: 10.1186/1741-7015-9-128.Brief psychosocial education, not core stabilization, reduced incidence of low back pain: results from the Prevention of Low Back Pain in the Military (POLM) cluster randomized trial.





Antidote to sun lounger back pain

By Back Pain, Osteopathy, Prevention

Is your back feeling bit worse after the summer? Here’s a possible antidote.

If like many of us this Summer involved long car drives, traffic jams, some cycling and may be some sun lounger action then your hip flexors could now be tighter than normal. These muscles help us bend forwards at the hip. But tighter Hip flexors and in particular Psoas and Iliopsoas can lead to lower back pain.


Tight Psoas can cause back pain

Tight Psoas causes reduced movement in lumbar spine

If you have been sitting for long periods of time either in the car, on your bike or with your feet up on a sun lounger (lucky you!) or at your desk (not so lucky!) then your hip flexors become tighter.

This would normally cause your body to lean forwards. However your body adapts to ensure you are standing up straight by contracting your postural muscles in your lumbar spine (lower back). This can lead to greater pressure on your lower vertebrae and the associated facet joints as the muscles attached to them tighten up. The extra work load on the postural muscles can lead to strains and spasms. Back pain!

How to help Yourself

The antidote to this is to start a concerted exercise to stretch these hip flexor muscles out from their contracted state. As you can see from the image below the Psoas originates from the lumbar vertebrae in the lower back and connects to inside of the femur (thigh bone).

Tight psoas can be a cause of back pain

Psoas helps flex hips

So any exercise must work the muscles fibres that run vertically and those that go at an angle to attach to the femur. This exercise does just that and so is very effective.





The Hip Flexor exercise

The key to this exercise is that it is what’s termed dynamic. It is a movement rather than a static stretch. Research has shown that the body responds better to dynamic movement based exercise designed to increase range of movement than static stretches. It makes sense. Our bodies were designed to move not hold static poses and so our muscles are designed to adapt to movement.

Important points to note

At no point in the exercise is the stretch held as a static stretch

Your hips move forward to dynamically stretch the vertical muscles fibres

Your arm comes up and you bend to the side to dynamically stretch the muscle fibres that attach into your femur.

Do not arch your back in an attempt to gain a greater ‘stretch’ sensation.  This can make the muscles in your lower back even tighter and put more pressure on the lumbar vertebrae. Just push forward with your hips.

Repeat the movement 10-15x am and pm daily for best results. Incorporate it into exercise warm up and warm downs too.

It should be a pain free exercise. If you experience pain just stop and contact your Osteopath or other professional physical therapist.

For more information on this exercise and how Hugo can help you return you to your personal best call  0208 226 3767.

The role of Gluteals in Back Pain or running a PB

By Back Pain, Osteopathy, Prevention


From  Back Pain to running a PB – effective Gluteals are an important factor

If you suffer from back pain , even infrequently, or you’re aiming for a personal best for your next race or training harder for your chosen sport whether it be running, rugby, football, tennis, swimming, cycling, skiing or golf.. the strength and effectiveness of your Gluteals will be a factor. Read More

Knee Pain? The problem could be above and below

By Osteopathy

A female patient, 26yrs old, recently came to the practice with pain underneath her left knee cap. It also clicked occasionally and was much worse after the gym or running and walking up the stairs. It had been getting progressively worse for the last 6 months.

On examination the patient’s knee had no obvious mechanical injury to her ligaments. There were signs of a little wear and tear. However what was obvious was that the patient significantly pronated on her left foot and her left pelvis was anteriorly rotated.

The diagnosis was patella femoral syndrome.


This involved articulation and manipulation to the foot , the fibula head and the SIJ and lumbars to address the rotation. Sports massage to the muscles inserting at the knee including gastrocnemius, hamstrings, tfl, itb and quads and a recommendation to purchase orthotics to help her pronation.
The patient was also given therapeutic exercises to strengthen her core stability, relax and stretch her ilio-psoas and so reduce her pelvic tilt.
After two treatments the patient reported a complete cessation of pain. She had also ordered the orthotics.


Now I recognise that not every patient will respond in the same way but this global approach to the patient’s knee pain, combining osteopathy with remedial  and sports massage and therapeutic exercise is a typical example of how I treat. And for this patient it was very effective at addressing her problem.  Long term she will need to use her orthotics and maintain her therapeutic exercises. But now the management of her pronation and potential future knee trouble is within her own control.

How osteopathy can help patients with Arthritis

By Arthritis, Osteopathy


Rheumatoid arthritis
Patients can suffer from either Rheumatoid arthritis or osteoarthritis. The two conditions are quite different. The first is an auto immune response where the body evokes an inflammatory response in a joint. The synovial membranes within the joint are attacked by the body’s own white cells (antibodies) and they become inflamed, red , swollen. The bone starts to degenerate. Joints tend to be affected bilaterally. That is to say on both left and right. Eg both hands or knees, elbows etc.
Treatment includes drugs to reduce the body’s immune response – steroids are given at the beginning. This can help but as the disease progresses stronger drugs are employed such as methotrexate or cyclosprorin.

Read More