This episode is entitled ‘what happens in an online consultation for low back pain or sciatica?’. In it you will learn why online consultations have been proven to be as effective as in person, how to choose a provider of online consultations for low back pain/sciatica. And where many providers will fail you, what to look out for and what our process involves.
Before I dive into the topic, these are questions that have been posed by people like you. People who have lower back pain and/or sciatica and they want an answer. So send in your questions. You can reach us on Twitter, Facebook, or just email us firstname.lastname@example.org and we will answer your question.
Why online consultations have been proven to be as effective as in-person
Now this may surprise you if you’re someone who’s used to having manual therapy. I have been an osteopath for nearly 30 years, so I’m used to dishing out manual therapy. But the evidence is that manual therapy is very effective in the short term or is effective in helping people with recent onset lower back pain. It’s not quite so good at helping those with long-term pain.
The other thing is that when you see someone who is a manual therapist, they feel, and I can testify to this, that they have to put their hands on you. Now that could be a good thing- the laying on of hands and all the different techniques that involves. It may help you to feel better in a briefer period of time. However, it does take up time. Time that could arguably be better spent explaining to you exactly what’s wrong with you and helping to co-create a plan. That’s what we’re all into these days, co-creating a plan. With our expertise helping you to create in essence, a plan for recovery and a plan for prevention.
So online consultations afford us that opportunity, to focus entirely on the information that we impart and the negotiation of a plan of action. It is estimated, in the research that, that is why online consultations have been proven to be as effective as in-person. Because we spend all of our time discussing your problem and coming up with a credible plan of action for the long-term.
How to choose a provider of online consultations for back pain or sciatica
I used to take great pride in saying, and have said hundreds of times, to clients over the years that I treat headaches to sprained ankles and everything in between. That was true. And to some extent it still is. We still have people who come to us with a range of different problems. However, a phrase that springs to mind for me is “Jack of all trades, master of none”. If your clinician/therapist can help you with pretty much any problem, then I would question how good they are at any one of those individual problems. My recommendation would be that you look for someone who is specialising in the problem that you have.
You’ll definitely want to look for someone who has experience of doing online consultations. Who has a framework in place to support you. Which brings me onto my next point..
Where many providers will fail you
Lots of clinicians may be able to help you understand your problem. But the key thing, and I think in my experience where a lot of us fall down and we did for many years of our clinical practice, is supporting you outside the treatment room. So besides the consultation (explaining to you exactly what’s going on and helping co-create a plan), the key thing I think you need is support in executing that plan. What we’re often looking for you to do, is to start up some new habits, whether that be some exercises to do, or sitting differently, moving around differently, or simply taking breaks more often.
These are establishing new habits and habit change is difficult. You may also need to cut out some habits- doing less of certain things or doing them completely differently. And this is the absolutely crucial piece, that in order to change habits you need, (or the vast majority of us need) and benefit from, support outside the consultation.
What happens in an online consultation for low back pain and sciatica?
Firstly, you need to book an appointment (you can book online or you can call us on 0131-221-1415 [from the UK] or 0044-131-221-1415 [international]). When you make that appointment, you will receive a text or email from us. In that email is an embedded link to an online form. We ask you to fill in this pretty extensive online form so that we understand a lot about your problem, and the extent of it, before we even see you or consult with you online.
It’s really important that we get that data up front. It helps to bring some structure to the consultation and it also helps to give us a baseline. Included in that form, for instance, is what we call a validated questionnaire, the Roland Morris disability questionnaire, which is specific for lower back problems. It’s a 24 item questionnaire. In which you tick whichever sentences of those 24 apply to you. For example, these can be questions or statements such as ‘I struggle to get out of the chair’, ‘it’s difficult for me to roll over in bed’, ‘I can’t go to work’, ‘I find I am moody and irritable around others’. We total them up which gives you a disability rating. This tells us how badly your pain is impacting your life and it gives us specific things that we know you’re struggling with.
These are what we call activities of daily living; getting out of the chair, being able to walk a distance, being able to go to work. From the statements you tick we know immediately what you are struggling with. We then know areas that we can focus on both within the online consultation and subsequently.
The video consultation will last approximately 40 minutes. Which gives you a good chance to describe your problem and for us to ask you further questions to fill in the blanks. If it seems appropriate, we will ask you to step back from the camera and go through a few movements. This helps to add to the picture. We may ask you to poke and prod at your own back and other relevant bits of you. The evidence is that actually people are quite good at articulating, “Oh yeah, I found a tight bit here…”.
So although to some extent we’re hamstrung in that we can’t put our hands on you in an online consultation. We can still gain a lot of information about how you’re moving and how tight different bits of you are. This put together with the information that you provided in your online form helps us to come up with an evaluation of your problem. And that evaluation is very different to what we would have used 10/15 years ago. The science has moved along a lot and if you listen to previous episodes of this podcast, you’ll understand that.
(Particularly I would encourage you to listen to episodes one to six, which are our foundation episodes, which will really help you to understand our rationale, our way of thinking about lower back pain and sciatica and how to relieve and prevent it. Especially if you haven’t already listened to episodes one to six because they will give you enormous value and help you straight away.)
From our evaluation we will put a label on your problem. We will then send you resources to address that specific type of lower back or sciatic problem. As well as information on the specific activities of daily living that you’re struggling with and we will coach you via your digital devices.
This is the support piece. So we have an app that we use that helps to remind you to do the things you’ve committed to do and to nudge you to stop doing the things that you think are bad for you. And that is an absolutely crucial piece in the puzzle. As I mentioned, this is where a lot of providers will fall down- supporting you beyond the consultation.
So we have a huge amount of content both on the podcast as well as in written format and video format to help you to more fully understand beyond the consultation. Although we will explain things within the consultation, there’s often a lot to go through. So we have all those resources that you can tap into after the consultation.
Prevention, not just relief
You’ll get a lot of value from your first consultation, and your pain may well improve. But your lower back pain or sciatica is unlikely to resolve after just one consultation. We have found, through experience, that it takes at least three consultations to make a big impact. That’s because it takes time and part of our focus is to coach you not just outside the consultation but in subsequent consultations. It gives you the opportunity to come back to us and say, I’m still struggling with X or Y. That’s where obviously we can provide personalised tailored advice and information that goes beyond the prerecorded stuff that we will have sent you after that first consultation.
We’re very much encouraging you to think about this in the long-term, not just the relief of your problem, but the prevention of it as well. And if we’re going to achieve that, that takes time. So we have packages where you can commit. The evidence is, if you make a financial commitment, so book and pay for three appointments upfront, that people stick to our co-created plan and have much better outcomes.
However there’s nothing wrong with pay as you go and we’re more than happy to help under any circumstance. But our advice and recommendation to you is that you pay for a package, a minimum of three, and that goes up to much higher volumes depending how long you’ve had your problem. Because in essence, the longer you’ve had a problem, usually the longer it takes to fix. You can have a look at our pricing grid and the different scales of commitment that we would recommend you make in order to make a long-term solution for your problem.
What happens in an online consultation for low back pain or sciatica?
So there we have it, ‘what happens in an online consultation for low back pain or sciatica?’ After making the booking for your online consultation you will be sent a link to an in depth questionnaire. This will guide the structure of our online consultation, with you filling in the blanks and, if appropriate, doing some movements and feeling for tight bits. Very importantly we will coach you outside the consultation, which is absolutely crucial if you are going to be successful in making the changes that you need to make.
Why do you need to make those changes? Because the vast majority of lower back and sciatic problems are lifestyle related. They’re all about what you do. They’re not due to a shortage of pills. You know, it wasn’t a lack of pills that caused your pain. It was your habits, the different things that you do day to day. And we will help you to understand all of that more fully within the consultation and beyond it in all the different content that we send you.
You can in the meantime also use our chat bot to work out which exercises are best for the relief of your back pain. It’s been programmed by me, so I can guarantee the process is a sound one. And we’ll even send you the exercises in an ebook, PDF format, which is entirely based on the content of the answers that you provide to that chat bot. Don’t forget to listen to our foundation podcast episodes before we virtually meet. I look forward to it!