Feeling worse after an osteopathy session, a phenomenon often referred to as a "healing crisis," can be perplexing and discomforting for patients who seek relief through this therapeutic approach.
While osteopathy is generally regarded as a gentle and effective treatment for musculoskeletal and other health issues, some individuals may experience increased symptoms following treatment. This lengthy discussion delves into why this can happen, including the nature of osteopathy, physiological responses, individual health conditions, psychological factors, and the overall therapeutic process.
Understanding Osteopathy
History of osteopathy: Osteopathy was a form of alternative medicine. Still, manipulation is regarded as a primary integration for back pain and is backed by the National Institute for Clinical Excellence. NICE & osteopaths in the UK have statutory regulations.
The osteopathic principles emphasise physically manipulating the body's muscle tissue and bones. Osteopathy was founded by Dr Andrew Taylor in the 19th century. Still, osteopathy is based on the principle that the well-being of an individual is dependent on your bones, muscles, ligaments, & connective tissue functioning smoothly together.
Osteopathic techniques:
Osteos use various techniques, including stretching, gentle pressure, and resistance, known as osteopathic manipulative treatment (OMT), to alleviate pain, improve mobility, and enhance circulation.
Osteopathic examination:
The osteopathic examination is much the same as any musculoskeletal therapist. It will often require that we do orthopaedic and neurological testing as well as palpation and range of motion. It should be noted for this article's main question that many of these orthopaedic tests are designed to be provocative (find discomfort). To put it simply, orthopaedic tests are intended to press on an area to evaluate your sensitivity and see if it is inflamed.
Your osteopath will also combine this provocative palpation with a motion to see how well it moves and feels for aberrant motion. This necessary exam in itself can be sore.
In a severe and chronic case of body dysfunction and pain, it's understandable that a client might feel more sore post-examination.
In our clinic based in Wimbledon, we prefer to separate examination and treatment in very severe cases. This separation is because doubling the pressure to injure the area doubles the tax on the client and can create more discomfort.
Sadly, some clients are desperate to get better and feel like rushing into a treatment session is advantageous for them, but in some cases, it might not be!
Separating the examination and treatment also helps make informed decisions about the care plan.
For instance, if a client feels tender after an examination, the follow-up treatment should be much softer because of their post-examination reaction.
We would typically gauge a high reaction as something above 5 out of 10 intensity. But don't let this put you off; it usually feels like a gym workout and is unavoidable as the same examination process would be done with physical therapy, physiotherapy, chiropractic, or GP.
Physiological Responses to Osteopathic Treatment
The primary reason some individuals feel worse after osteopathy is related to the body's physiological response to the manipulations used during treatment. These responses can include:
1. Muscle Soreness and Stiffness:
The techniques used in osteopathy, such as deep tissue massage and joint manipulation, can lead to temporary soreness and stiffness. The feeling is similar to the sensations experienced after vigorous exercise or a sports massage, and it's due to microtrauma to the muscle fibres, a normal part of the healing process. It is known as DOMS or Delayed Onset Muscle Soreness.
Clients who are not used to the gym or exercise will often have a slightly elevated anxiety response to this new type of sensation, and it can be off-putting.
We typically tell clients that a typical reaction would be slight aching post-session with an intensity of 5 out of 10 or below, and this would happen in around 40% of clients.
If a higher response than 5 out of 10, you should generally consult with your practitioner as it could mean that there are undiagnosed complexities with your spinal condition or area.
2. Release of Toxins:
Osteopathic manipulations may help release toxins in the body's tissues. This release can lead to a temporary increase in symptoms as the body processes and eliminates these substances. Symptoms such as fatigue, headache, and nausea can occur, which are commonly associated with detoxification.
3. Increased Blood Flow:
Manipulation of tissues can increase blood flow to certain areas, initially increasing inflammation as part of the healing response. This might result in temporary swelling and pain.
There is undoubtedly a predictive quality to people who may feel post-treatment soreness more than others, but there are always examples of proof of the rule.
For instance, typically, statistics tell us that women over the age of 40 who don't exercise and smoke are more likely to feel some ache post-therapy session or exercise.
However, 60% of clients feel next to nothing and instead feel great.
Individual Health Conditions
A patient's health can significantly influence their response to osteopathic treatment. Individuals with chronic conditions, such as fibromyalgia or arthritis, may experience flare-ups after treatments due to the body's heightened sensitivity to any form of manipulation or pressure.
Capacity to heal
Typically, we summed up through the word Stress, which indicates they might be under more Physical, Emotional, or Chemical Stress.
Physical stresses:
These might be working long hours, say 14 hours a day behind a computer and not having a perfect set-up for that workspace or indeed someone that's got a hip or knee complaint or indeed anything in the lower limb that stands, meaning the same area is under extreme pressures and navigating their capacity to heal.
Chemical stresses:
We often see it in the clinic as the prominent colds/viruses and deficient people.
This could be anaemia (lack of red blood cells) around the female period or diet deficiency like iron or B12, which is quite common in the UK.
Furthermore, mass magnesium and vitamin D3 deficiencies are widespread within the UK's typical diet. These are vital micronutrients required for healing. Without these aches post, osteopathic treatment may last longer than usual.
Interestingly, we are now also seeing fad diets such as the Vegan diet, where people also come in believing that they're making healthy choices but instead are using products that are not supplying what they think they're supplying. This is seen in the case of organic milk alternatives (soya, nut, oat, etc.) that need to be fortified with the correct micronutrients (B12 and Calcium), or it may mean that they haven't been supplemented in the case of veganism with B12 tablets.
Emotional Stress / Psychological Factors:
The psychological state of a patient can also impact their experience after an osteopathic session.
Anxiety, Stress, and a patient's expectations of immediate relief can alter their perception of pain and discomfort following treatment.
Moreover, if patients are apprehensive about the treatment, they may tense their muscles and resist manipulations, leading to increased soreness afterwards.
In such a case, informed consent and having someone else at your examination are crucial. This time, the second pair of eyes/ears ensures that there are reasonable justifications for all the unknowns and that the anxiety levels can dissipate.
Most of the time, we can manage this accurate expectation of experience and education about the process we're going through and what we are likely to feel at each key stage of a treatment plan.
Therapeutic/Healing Process and Adjustment Period
Osteopathy is not a quick fix, and healing and muscle adaption takes 4-6 weeks physiologically for a typical complaint. However, osteopathy is part of a broader therapeutic process that aims at holistic healing and muscle re-structuring. As your body adjusts, if there was some discomfort post-session early on in the treatment plan, there is likely to be less and less as you progress.
This osteopathic healing process may require several sessions (10 sessions of musculoskeletal care is average for most complaints (some people, therefore, will take six sessions to recover from the pain cycle and some 15 sessions, but with periodic improvements seen throughout the treatment plan).
Feeling worse initially can be part of an adjustment period where the body learns to self-regulate and heal:
1. Adaptation: The body may take time to adapt to the changes osteopathy introduces if underlying chronic conditions or misalignments exist.
At our Wimbledon-based osteopathic clinic, we take postal photos at the start of care. This helps us objectify how bad your alignment might be. This aims not only to track your adaption results from osteopathic treatment. However, we also do this picture analysis as a prognosis check. Clients with good posture alignment will tend to recover quicker and have no post-treatment discomfort. However, clients with terrible posture results/ are very wonky and will tend to feel more achy.
2. Rebound Effects: In some cases, patients may experience a rebound effect where symptoms temporarily worsen as the body's homeostatic mechanisms attempt to restore balance.
3. Emotional Release: Some osteopathic manipulations can trigger an emotional release. This can be unsettling but is considered part of addressing the body-wide impacts of physical and emotional Stress.
Conclusion
Feeling worse after osteopathy, though counterintuitive, can be seen as a sign that the body is responding to treatment. This response is not universal but occurs in some individuals depending on the factors discussed.
Patients are encouraged to communicate openly with their osteopath about any post-treatment discomfort partially when it is either 5/10 or above in intensity or just driving some undesirable anxiety, as this can provide valuable information that may help adjust future treatments.#
Understanding that these symptoms are typically temporary and often a part of the healing process can help patients manage their expectations and commit to the therapeutic journey.
Over time (ask osteopath about your prognosis timeline for decent expectation management), with the proper adjustments and continued treatment, the benefits of osteopathy often outweigh the initial discomfort, leading to better health and improved quality of life.
Please feel free to contact the Wimbledon Clinic Osteopathy Centre on 02085403389 or