Longer Out Than In: Five Years of Osteopathy

This week I realised something that stopped me for a moment. I’ve now been practising as an osteopath for longer than I spent at university studying to become one. Four years of study, and now almost five years of practice.

It feels like a tipping point. For most of my career, uni was the bigger part of my story. Now the treatment room is. So I’ve been reflecting on what’s changed, and what I’ve learned since I walked out of Southern Cross University with a degree and a head full of anatomy.

Uni gave me the map

University gave me something I’m still grateful for: a kind of 3D render of the human body in my head. Every muscle, joint, nerve and vessel, mapped out and labelled. That model is the scaffold I still use every day. It’s the launch point for everything else.

These days I’m not discovering new parts of the body. What keeps growing is my understanding of how those parts relate to each other: how a problem in one place shows up somewhere else, and how the whole system adapts around it.

No one presents like the textbook

The thing uni couldn’t prepare me for was the sheer variability between people. Textbooks and research papers create the impression that a condition presents in a particular way. In reality, almost nothing presents exactly the way you expect.

Early on there’s a temptation to treat the odd details as noise and set them aside. What I’ve learned is that you have to get comfortable with variability before you can see through it. Underneath all the unusual bits, there are patterns, but you only find them once you’ve seen enough people to know what “normal variation” actually looks like.

The whole person is what’s real

In Anatomy Trains, Tom Myers writes that the only thing that is real is the whole, and that every division we make, including the ones in his own book, is purely conceptual.

I think that’s the central argument of osteopathy. The shoulder, the lower back, the jaw: these are useful labels, but they aren’t what walks into my room. A whole person does. To get good at this job, you have to understand how the parts work together toward that whole.

Listening is part of the assessment

The conversation at the start of a consult isn’t a formality. It’s part of the assessment, and often the most important part.

Patients tell me things all the time that they don’t think matter. A throwaway comment about their work, their sleep, something that happened years ago. They mention it as if it’s nothing, but sometimes that detail is the key to the whole case. It can tell me exactly what I’ve been looking for about why they’re in pain.

That’s one of the best things about this job. I get to sit with people for an hour at a time and actually talk with them. I learn clinical lessons from patients every day, and plenty of life lessons too, about their work, their fields, their families. It’s a genuinely beautiful part of what I do.

Evidence tells you about averages; patients are individuals

When I graduated, I was sure I’d treat purely structurally. I believed research would dictate every decision I made, and if I’m honest, I looked down a bit on practitioners who used cranial techniques or some of the more “esoteric” forms of osteopathy and manual therapy.

Five years later, I use many of the techniques I once said I never would. Not because I’ve stopped valuing evidence, but because I understand its limits better. Research tells us about averages across groups of people. It can’t tell me everything about the individual lying on my table. Evidence informs my clinical decisions; it can’t make all of them for me. Those decisions need someone with clinical experience who is paying close attention to the person in front of them.

Realising how far I’ve come

Earlier this year I saw a patient with a very unusual headache presentation, sudden and intense across the brow, unlike the typical patterns you read about. The case ended up being fairly straightforward to work through.

What stuck with me wasn’t the case itself; it was how I felt during it. Looking back afterward, I realised that new-graduate me would have been overwhelmed. I might not have known where to start. This time I felt calm, curious and clear about how to approach it. That was the moment I really noticed how much five years had changed me.

More than clinical

These five years have been a lot. I started a business. I became a father. I’ve changed as a person as much as a practitioner, and I don’t think those two things are separate. Becoming more patient, more comfortable with uncertainty and more interested in people has made me a better osteopath.

Five years in

I hope that when you come in to see us, you feel that your care is well considered: that you’re being listened to as a whole person, not as a sore back or a stiff neck, and that the approach is shaped by evidence, experience, and you.

I’m looking forward to seeing what the next five years teach me.