Interview With Our Osteopath – Sebastian Hicks

sebastian hicks at his theraphy room

Small steps create a ripple of change, and when we see some positive changes then it becomes much easier

How long did it take for you to qualify?

The osteopathy training was five years, and before that I was at Middlesex University, where I completed a BSc in Sports Rehabilitation and Injury Prevention.

Where do you practise?

I’ve been self-employed for ten years, previously working in community health centres, gym chains including LA Fitness and Virgin Active, and sports clubs. Most recently I’ve been working at private physiotherapy clinics throughout London providing a range of services including osteopathy, massage and exercise therapy for chronic pain patients. I work two days at an interdisciplinary clinic very close to the Royal Free Hospital in North London (SF Studios).

The rest of the week I work from central London at the Osteopathic Association Clinic, and I also provide home visits for those patients less able to move. I also have access to gym space close to Baker Street for patients who require more movement-based intervention.

What’s your main therapy/ modality?

Osteopathy and movement coaching. I find it very effective to combine “couch based” passive intervention with physical movement. I’ve found that by combining a hands-on approach with movement and exercise coaching I’m able to facilitate strong and positive outcomes.

There are clearly times when it is more appropriate to place emphasis on one modality over the other, and this is where the assessment and all relevant health information gathered are very important. Having said all of this, my approach is very much about engaging the patient towards implementation of a therapeutic movement program, rather than a prolonged series of couch-based interventions.

Within any therapeutic movement program, I will often do hands-on techniques to  facilitate an improvement in a joint range of movement (ROM). This approach of mobilisation through active movement is very beneficial for creating a lasting change, as the central nervous system responds very differently to intervention whether it is carried out actively (movement) or passively (couch-based). Both these approaches are powerful tools and should be implemented appropriately, based on a complete medical history and understanding of the patient and their current status.

Following the AFMCP-UK course in London a couple of years ago, I’ve been able to build upon a more solid knowledge base in relation to the functional medicine approach to healthcare and how this can work alongside osteopathy and movement coaching as positive modalities in patient care.

I discovered throughout the course that the approaches and philosophies of FM and osteopathy are very closely aligned, and although most of the time the methods perhaps differ, the concept and importance placed on a team ethos and an integrated, multi-faceted approach are heavily ingrained in both fields. There are clear difficulties in how we as physical therapists and movement coaches apply lifestyle advice with regards to not flooding patients with information and overwhelming them, especially when they present with an acute MSK problem (like a low back disc injury), that is likely to be their primary concern.

I have taken the approach of encouraging (where appropriate) patients to implement mini “movement snacks” throughout the day, and I’ve found that with this, there has been an increasing willingness and enthusiasm in wanting to learn more about how their lifestyle can impact their health. Exposing the “dangers” of long-term sitting to patients has made me sound like a broken record, however it’s a message I’ll continue to expose!

I’ve found being able to refer to specialists in nutrition and other fields to help optimise patient care very useful and this just reinforces the importance of having a network of like-minded coaches and professionals so we can all provide advice and aid each other in being able to provide the best input possible. I’m always open to meeting and engaging with nutritional therapists and other healthcare professionals and look forward to continuing education.

Why did you become a practitioner?

I’ve always enjoyed working with people and have been involved with sport and exercise for many years. The approach and philosophy of osteopathic medicine is one which really got my interest, especially having been treated by a practitioner when working in sport.

Having been a qualified osteopath for more than five years now, it’s a great profession and I’m very happy. Trying to create a small ripple of change in the patients we see gives the greatest joy, but it’s the human nature of the work we do which is the real draw. As with anything to do with the human body, its complex! But this complexity is what makes every day different. I stay humble and appreciate the human body always knows best (although sometimes needs a little nudge) and try to keep on learning.

How long have you been in practice?

I started working at 16 as a lifeguard at my local leisure centre, from there I trained with the YMCA to get my gym instructor qualifications. It was while working on the gym floor I first became exposed to the GP exercise referral system. The kind of patients that we were seeing had complex health conditions that often required simple strategies to help them get back in control of their health. Obviously, diet and stress are key factors in the overall picture of good health, but at that stage our training was very much about educating patients in the community about how to exercise and move safely.

This passion for movement education has stuck with me to this day and is a consistent element in how I address the health of the patients I see. I am a big advocate of high- intensity training in terms of both the physiological and psychological benefits, however I do feel that the dangers of HIIT training have not been widely enough exposed. I have many examples where I have had to explain to clients that the body must be robust enough both structurally and physiologically to cope with this form of training (when done properly). 

Modified and perhaps more subtle versions of HIIT I think are often the way forward, rather than blinkered high-intensity training sessions, which can predispose very significant health risks and soft tissue injuries! There must be a bespoke approach to the needs of each and every individual seeking advice and input.

Who or what has been the main influence/inspiration on your practice?

The work and approach of Frank Forencich is great. It’s all about promotion of a movement culture which promotes health based upon an understanding of our evolutionary history. What I like about his approach is that it’s not all about climbing trees and hurdling rocks! It very much creates an understanding and introduction of how to implement good movement practice applicable to everyday life.

A couple of his books I recommend are Exuberant Animal – the power of health, play and joyful movement and Beautiful Practice – a whole life approach to health, performance and the human predicament. Other good reads include the Biology of Belief, by Bruce Lipton, and probably most importantly the Oxford Clinical Medicine & A&P manuals for the foundation of basic knowledge which they provide.

What conditions or types of client do you see most of?

Primarily we see a wide range of musculoskeletal problems, ranging from post-orthopaedic rehabilitation, ankle sprains and many cases of low back pain, both acute and chronic.

Since I’ve been in practice, I’ve been more aware of the increasing number of presentations where the ability to formulate a working diagnosis is far less clear cut.

Examples include patients presenting with a multitude of symptoms, making a treatment intervention far more complex. This is where I feel the benefits of osteopathy come in to play. The psychological elements of patients’ lives are creating a huge impact on how their body perceives pain and responds to treatment, hence an understanding of how to approach this side of a patient’s presentation is very important.

What is the most challenging type of symptoms/illness/ problem that you get presented with?

When I first qualified, I was seeing a lot of sports injuries, from ankle sprains to ACL rehabilitation. However, over the past few years, although we still see those “weekend warrior” athletes, there has been a jump in the number of patients presenting with symptoms of which the functional health professional will be very familiar, including increased anxiety, bowel issues, episodic headaches with inability to focus – I believe that’s known as “brain fog”! This has created a challenge for myself and many of my colleagues who are trained in physical therapy, as our traditional protocol for assessment would find it very difficult to address these concerns. My interest has really grown in getting more of an understanding of how to help patients who present with MSK pain with the additional symptoms I mentioned above as an example.

What one thing is essential to you in your practice?

Smiles and a positive mindset. Creating and nurturing the human aspect of healing is so important when we apply skin to skin contact with our patients.

Listening to their story and letting them express their journey can be a very positive place to start a therapeutic intervention. Understanding patients (not just the disease/Illness) and applying an appropriate treatment strategy is the simple philosophy I work with, and one which runs throughout our clinic.

Why do you do what you do?

Because working with the human body keeps every day different! I love the day-to-day interaction and learning about the many factors which can contribute to how and why a patient presents to a clinic. It is never as straightforward as the manual tells you. The complexity of the human body and how it works often requires thinking and an approach which considers a wide range of factors which can contribute to health. Weaving my way through this web is often one of intrigue, surprises and very often a great learning. Most importantly though, it’s fun, and fulfilment and enjoyment at work can only have a positive effect on the people whom we see face to face.

If money, time and effort were no object, what one thing would you change about your practice or integrative healthcare in general?

I would heavily advocate mass involvement of hands-on therapy and a far greater emphasis on exercise and movement education to our NHS.

I’m passionate about wanting to expose the benefits of these tools to add strings to the bow of the NHS to allow it to do its job of critical care and life-saving work. To see the burden of chronic disease crippling the services is sad to see, especially when the work and research that is being done in the field of functional health and complementary medicine can do so much to help. I’d set up huge clinics or Functional Health Centres next door to the hospitals, with nutritional therapists, physical therapists, GPs, chefs, fitness coaches, psychotherapists, massage therapists and CBT/ NLP coaches. I’d like to think these would go some way to easing the burden on our medics!

What piece of advice would you give to newly-qualified practitioners who are just setting up a business?

Gather your own research, read lots and network with other professionals; most importantly however, try to establish your own ethos, methods and approach.

Just as each of our patients are biochemically different, each practitioner has individual traits and methods, despite perhaps having been trained under the same organisation. Harness your strengths to best help the people you see.

What is the biggest challenge you face as a practitioner?

From an osteopathic perspective one of the biggest challenges has been working in isolation. It has been great to work with a superb team at the clinic I’m at now two days per week and it really helps having like-minded healthcare practitioners to be able to bounce information off and collaborate with and refer to.

There is a range of CPD options open now covering a huge range of topics, and I’ve found this to be particularly helpful, too. Meeting other healthcare practitioners from different professions helps open your field of vision and can put a new perspective on how you perhaps move forward with your own goals in mind.

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