The pains for which I refer you to a doctor first

Osteopathy treats functional disorders: a joint that has lost its mobility, a muscle that will not relax, a posture that overloads an area. It does not treat an infection, a fracture, a tumour or an inflammation of medical origin. The first job of a consultation, before any treatment, is therefore to check that your pain really falls within my field. When it does not, I tell you, and I refer you on.

The list that follows is not there to worry you. The great majority of the pains I see at the practice are not on it. It is there so that you know when not to wait for an osteopathy appointment.

The signs that apply to every pain

• Fever together with the pain, especially with back or joint pain.
• Night pain that wakes you and that no position relieves.
• Unexplained weight loss, unusual tiredness, night sweats.
• History of cancer and a new pain, even a moderate one.
• Recent trauma: a fall, an accident, a blow, with sharp pain or inability to move.
• Pain that increases week after week despite rest.

In these cases, I do not treat before a medical opinion, even if the pain looks like ordinary low back pain.

The back and the pelvis

Sciatica, I treat. Sciatica with loss of strength in the foot, loss of sensation between the thighs or around the seat area, new urinary or bowel problems: that is an emergency, straight to the emergency department without coming through the practice. Low back pain in someone over 50 on long-term cortisone treatment, or with known osteoporosis, also deserves an X-ray before any manipulation. Low back pain that runs forward, towards the belly or the groin, can come from an organ, not from the spine.

The neck and the head

A stiff neck after an awkward movement, I treat. A stiff neck with fever and headache, a sudden headache “like never before”, dizziness, vision or speech problems, weakness in an arm or a leg, neck pain after a road accident: that is not for me, and it must not wait. I never manipulate the neck without a precise interview on these points.

Pains that mimic mechanical pain

Pain between the shoulder blades can come from the heart, the stomach or the gallbladder. Pain in the left shoulder on exertion, a point in the back with breathlessness, abdominal pain radiating to the back with nausea: I send you to a doctor, sometimes to 15 (the French medical emergency number) or 112, before anything else. It is rare, but it is exactly what a clinical examination is for.

The knee, the ankle, the tendon

A knee that hurts on the bike because the saddle is low, I adjust. A knee that is swollen, that locks or gives way, especially after a twist, needs a medical examination and often imaging: meniscus, ligament, cartilage. A tendon that has snapped suddenly, with immediate loss of function, may be ruptured. An ankle that can no longer bear weight after a sprain justifies an X-ray before anything else.

Children, teenagers, pregnant women

In a sporty teenager, low back pain that has lasted for months with a marked arch in the lower back can be a weakness of a vertebra, to be checked by imaging before working on the area. A child who limps or has hip pain with fever needs to see a paediatrician the same day. During pregnancy, contractions, bleeding or abdominal pain are not reasons to see an osteopath: that is your midwife or your maternity unit.

What I actually do

At every first consultation, I spend a quarter of an hour on your history, your treatments and the story of the pain, then I examine. If a warning sign appears, I explain it to you simply, I do not treat the area, and I tell you who to go to: your GP, a specialist, the emergency department, or 15 (the French medical emergency number) or 112 if there is serious doubt. If you already have imaging or a report, bring them, it saves me sending you away for nothing.

Outside these situations, osteopathy has its full place: back pain, neck pain, sciatica, tendinopathies, cyclists’ pain. And if you are unsure, a call to 06 13 66 09 55 is enough: I tell you in two minutes whether the appointment is worth it.