TotalMSK Musculoskeletal (MSK) Clinic FAQs

Musculoskeletal Chiropractic and Sports Massage FAQs

Why choose TotalMSK?

At TotalMSK, we specialise in the treatment of Musculoskeletal (MSK) related conditions and more specifically the treatment of work and sports-related musculoskeletal (MSK) conditions. We aim to identify the cause of any given Musculoskeletal (MSK) related condition and get you the patient out of pain and back to activity, as quickly as practicably possible. TotalMSK has extensive in-house experience covering Musculoskeletal (MSK) Conditions (including sports and work-related), Work Place Health and Safety and Mental Health in the Workplace. Many highly effective techniques are used at TotalMSK to treat a multitude of Musculoskeletal (MSK) Conditions including McTimoney Chiropractic, Advanced Sports and Remedial Massage, Dry Needling (Western Medicine Acupuncture), Gua Sha and Instrument Assisted Soft Tissue Mobilisation (IASTM). Our practitioners tailor treatments to you the patient's unique set of circumstances and besides interventions, include preventative advice covering work and none work related activities. Initial consultations always look at a number related aspects of the human body including; biological factors, social factors and psychological factors. Such factors include previous injury history, activity levels, previous conditions, stress, sleep, diet and much more. Stress within and outside of the workplace has become a major issue over time and besides having a physiological impact on the Musculoskeletal (MSK) System, can also lead to Mental Health related problems and other debilitating conditions. There are two articles on TotalMSK's blog covering the human stress response and the effects of this. Besides the expertise within TotalMSK, we also have a referral network, meaning that should a specific issue not be of a Musculoskeletal (MSK) nature, then a patient can be referred to an appropriate and suitably qualified professional.

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What's the difference between a Chiropractor, Osteopath and Physiotherapist

People often ask what the differences are between a Chiropractor, Physiotherapist and Osteopath. All three professions have a statutory regulator within the UK and have legally protected titles. Hence, it is illegal for anybody not trained and registered with the relevant regulatory body to profess to be or use the term Chiropractor, Osteopath, Physical Therapist or Physiotherapist. There are many similarities and some differences between the three professions, though all are Primary Care Health Practitioners and have to complete either a University degree or Masters level qualification. Each profession also works with diagnosing and treating Musculoskeletal related conditions. Chiropractors and Osteopaths both learn manipulative techniques as part of their training and education typically comprises of a four year full-time Masters level qualification. Physiotherapy training usually takes three years full-time and results in a degree and does not include manipulative therapy techniques as part of the course. However, some Physiotherapists then complete additional training and or a Masters and then can also use manipulative therapy techniques with patients.

Historically, Chiropractors have tended to use manipulative therapy techniques as the primary way of treating musculoskeletal-related conditions. Osteopaths have typically used a combination of manipulative therapy and soft tissue techniques. Physiotherapists, on the other hand, generally have used a combination of soft tissue techniques and prescriptive exercise. However, these days there is a considerable amount of cross-over or blurring between what practitioners might do within each profession. The fundamental differences these days probably relate to philosophy and thus how practitioners in each profession might assess and treat a specific condition. The definitions for each profession can be found below and are the actual text used on each regulators website.

General Chiropractic Council (GCC)

"Chiropractic is a health profession concerned with the diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system (bones, joints and muscles), and the effects of these disorders on the function of the nervous system and general health. There is an emphasis on manual treatments including spinal adjustment and other joint and soft-tissue manipulation."


General Osteopathic Council (GCO)

"Osteopathy is a system of diagnosis and treatment for a wide range of medical conditions. It works with the structure and function of the body, and is based on the principle that the well-being of an individual depends on the skeleton, muscles, ligaments and connective tissues functioning smoothly together."


Health and Care Professions Council (HCPC)

"Physiotherapists deal with human function and movement and help people to achieve their full physical potential. They use physical approaches to promote, maintain and restore wellbeing."


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What is McTimoney Chiropractic?

McTimoney Chiropractic is a form of Chiropractic which was developed in the UK and has been used to great effect in the treatment of patients with Musculoskeletal (MSK) conditions and for well over 50 years. The technique is very gentle and utilises precise and highly dextrous adjustments to affect change within the musculoskeletal (MSK) and nervous system. Many people in the UK choose McTimoney Chiropractic treatment as an alternative to many forms of Chiropractic and Osteopathy which use High-Velocity Low Amplitude (HVLA) adjustive techniques. The McTimoney technique rarely produces the "cracking or popping" sounds that most people associate with Chiropractic and HVLA techniques. As the McTimoney method is gentle, it is also suitable and safe to use on a wide range people, conditions and age groups.

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Are there any reasons why I may not be suitable for Chiropractic treatment?

This following list is not exhaustive, and other conditions can contraindicate a patient from having McTimoney Chiropractic or any of the other Musculoskeletal related treatments offered by TotalMSK practitioners. However, treatment may still be suitable for a patient and may only actually be locally contraindicated meaning that a specific area either cannot be treated or that only particular therapies may be appropriate. Global contraindications may mean that it is not currently safe to treat you the patient with a specific technique at the time, or that one should gain GP approval prior to commencing treatment. Getting GP approval tends not to be an issue, and just because it is not safe to use one type of technique, others may be entirely appropriate. Should you have any doubts or questions, then please contact a practitioner at TotalMSK, and they will be more than happy to talk you through any queries or concerns.

Typical Contraindications:-
  • Open wound, fractures or dislocations.
  • Myositis Ossifications.
  • Deep Vein Thrombosis (DVT.)
  • Varicose Veins (Local contraindication).
  • Infectious skin diseases (bacterial, fungal, viral, herpes and lymphangitis).
  • Severe Sunburn.
  • Pregnant and within the first trimester of pregnancy.
  • Tumours.
  • Cancers.
  • Haemophilia and other bleeding disorders.
  • Acute soft tissue inflammation (muscles, tendons, ligaments, organs and other underlying structures). Acute soft tissue inflammation is typically treated using R.I.C.E (Rest, Ice, Compression and Elevation) as a means of reducing inflammation and which is usually applied at the time of the initial injury.
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Are there any side effects from Chiropractic or soft tissue treatment?

One may experience some mild side effects after any Musculoskeletal (MSK) therapy treatment, such as McTimoney Chiropractic, Remedial Massage, Sports Massage, Dry Needling (DN) or Gua Sha/IASTM, which is perfectly normal. Not everybody is affected, but for those people that are the side effects typically occur within the first 12 - 48 hrs post-treatment and typically last between 48 - 72 hrs. These side effects tend to be the result of creating change within the body, which affects soft tissues, altering biomechanics/movement patterns and stimulating the bodies natural healing processes. One may or may not experience one or more of the following:-

  • Aches, soreness, tenderness or stiffness.
  • Different areas aching to those treated
  • Emotional changes.
  • Headaches.
  • Feelings of relaxation or of being invigorated.
  • Changes in sleep patterns.
  • Dizziness or nausea.
  • Spots.
  • Altered bowel movements.
  • Changes in urine output, colour or frequency.
  • Body temperature changes.

In some cases and particularly when a condition or symptoms have been long-standing (chronic) one will usually notice that symptoms can appear to be worse after the first treatment. As previously mentioned such side-effects usually lasts for up to between 48 - 72 hrs. However, patients can often notice positive or negative changes for up to seven to eight days, due to changes in biomechanics and the resulting tissue adaptions. Typically, in chronic conditions, there has been a great deal of time to enable dysfunctional tissue patterns to occur and indeed physiological changes within tissue structures. Such changes can affect the musculoskeletal (MSK) system and result in altered movement patterns, aching, pain, restricted movement, and even affect other body systems. Hence, working on these dysfunctional tissues can make things worse in the short term.

Many Musculoskeletal (MSK) therapy techniques cause some form of specific microtrauma during the treatment, and dysfunctional tissues then have to heal and adapt to these changes regarding function and biomechanics. Allowing the tissues to heal correctly is necessary if one wishes to return them to a normal or as near normal functional state. Hence, after a treatment one may notice that other regions of the body ache and not just the treated areas. It is important to remember that if the body has developed dysfunctional musculoskeletal (MSK) patterns through injury, overuse or postural fatigue, then these very dysfunctional musculoskeletal (MSK) patterns will have prevented the musculoskeletal system from operating as correctly. By treating these dysfunctional musculoskeletal (MSK) patterns, one is enabling the tissues of the body as a whole to work as intended. Dysfunctional tissues in one area will affect tissues in other areas of the body and prevent them from working correctly, such as through inactivity or overuse. Hence, these other tissues may have been inactive for an extended period and so are likely to ache when they start getting used correctly. Side effects can often be minimised by following the aftercare and home care advice provided by the therapist at the end of the treatment session. The Basic Running / Sports Injury Prevention article briefly covers tissue adaption in more detail and the principles equally apply to the prevention of and the rehabilitation of musculoskeletal (MSK) injuries in general. There is also a far more detail article about Adaption in a Musculoskeletal Context.

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Why do I have to have an initial Chiropractic consultation?

The initial Chiropractic consultation is a requirement of being treated for many reasons. The process is partially used to establish if you would benefit by having a specific Musculoskeletal (MSK) Therapy treatment (Chiropractic, Sports and Remedial Massage, Dry Needling, Gua Sha or IASTM). More importantly, the consultation is used to establish if it is safe to treat you based on your presenting symptoms or condition(s). If it is unsafe to provide care for you, then you will be referred to a suitably qualified medical practitioner for further investigations and or treatment. The consultation is also to ensure that you get the best individualised treatment concerning your unique personal history. Your background information will be unique to you regarding medical, emotional, physical and lifestyle aspects, often referred to as BioPsychoSocial factors. One can view overall health from multiple constructs such as Physical, Mental, Emotional, Social, Environmental and Spiritual, with each part affecting the next. Hence, your treatment plan needs to take account of your unique history. Finally, the consultation is a requirement of regulated health professions, professional associations and also insurance companies. All suitably qualified practitioners will conduct initial consultations and keep patient record card information. If a therapist or practitioner is not doing this, then they may not be trained, registered with a professional association and certainly in breach of their insurance requirements and be a risk to you the patient's health.

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Why may I have to undergo more than one Initial Chiropractic consultation?

Once somebody has undergone an initial Chiropractic consultation, then one does not usually have to experience the same process again. However, there are circumstances where it may be necessary and is viewed as best practice by the Chiropractic regulator and professional associations. For example, if a patient has not been seen or treated by a specific chiropractor or anybody working for the same said clinic in a six-month given period. In essence, a considerable amount can happen within six months (injuries, changes in medication, other aspects of health etc.) and a regular appointment will not provide ample time to gather any additional details. An accident or other severe trauma may also mean that a patient has to undergo another initial consultation process. Besides being viewed as "best practice", the initial consultation process is designed to protect you the patient and ensure that you receive the most appropriate treatment.

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Can Chiropractors treat children?

Yes. If the child is under the age of 16 then written permission is required from either a parent or guardian, before providing any treatment. One can give written parental consent during the initial consultation process. Also, a responsible adult should attend and be present while the child/patient is receiving treatment. These measures are viewed as best practice by professional associations and health profession regulators.

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Can I have treatment if another therapist or professional is already treating me?

Yes. However, you should speak with your existing therapist or professional before seeking further treatment, which is partially out of courtesy. The main reason to talk with your current therapist or professional is to ensure that the work that they do does not become adversely affected by the work that TotalMSK's practitioner is going to perform. Some types of therapy can work well together, and others can be counterproductive.

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How many treatments am I likely to need?

On average our practitioner's have found that the majority of patients only need between three and five treatments to resolve the vast majority of Musculoskeletal (MSK) related conditions. The three to five treatment figure includes the initial consultation and typically applies to one particular problem. Hence, if somebody has multiple ailments, then on average it may take 3-5 treatments to resolve each one. That said, some patient's have only required a few treatments for a specific condition, but everybody is different. The number of sessions needed can depend on a wide range of factors, as can the frequency of any maintenance treatment:-

  • Injury History
  • Age
  • Gender
  • Chronicity of Condition(s)
  • Following aftercare advice
  • Other relevant conditions
  • The number of individual conditions
  • Diet and lifestyle

Many patients also find maintenance treatments to be highly beneficial. The frequency of any such maintenance treatments can also vary from anything from 4-6 weeks to a few months. Our practitioners have found that the combination of techniques used at TotalMSK tends to result in better patient outcomes and a quicker symptom resolution.

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What does holistic mean?

The word Holism originates from ancient Greek and means, (entire, total, all or whole). The concept of holism and its relation to health and wellbeing has existed since ancient times. Prominent historical figures who have advocated such an approach to health include Hippocrates and Galen.

Holistic health is a philosophy or approach to medical care which views the whole as more than the sum of the parts. The holistic approach also aims to look at the complexed relationship between mind, body and soul and which in turn affects the end treatment. This type of approach to health has only really started being integrated and gaining significant support in mainstream health in the last 30 years. Today an individualised treatment approach is being advocated in many parts of mainstream medicine. Historically, general medicine has applied a particular treatment for a specific condition, and this has taken minimal account of individual differences. However, there have always been questions as to why two individuals with similar ailments could undergo the same treatment and yet have differing outcomes. Taking a holistic approach about how to treat the patient is certainly making a difference in mainstream medicine.

Another area of research and which also takes a more holistic view of the individual is the biopsychosocial model. This model stems from "social cognitive theory" and dates back to the late 1970s, though it is gaining much interest from a mainstream medical perspective. The model looks at how biological, psychological and social factors affect health and well being and thus has implications for treatment. In essence, a problem in one of these areas can lead to problems in the others and vice versa. Hence, as with the holistic approach, it is better to look at the whole rather than just the individual parts. A criticism of the biopsychosocial model is that it is an oversimplification of human health. Other models or constructs of health have sort to expand on the initial ideas of the biopsychosocial model and can include; Physical, Mental, Emotional, Social, Environmental and Spiritual. Each of these central aspects of health may further be subdivided, and there is still a lack of consensus on the exact main areas. Some models also include Financial health.

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What is Holistic/Swedish Massage?

Holistic/Swedish massage is a traditional form of massage which uses many methods to either relax or to stimulate the body, depending on the desired effect. The techniques used include; effleurage, petrissage, frictions, tapotement, vibrations, joint mobilisation and holding.

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Is Massage likely to hurt?

Massage is not usually painful provided that the tissues have been warmed up, and one applies the techniques correctly. However, deep tissue massage techniques can sometimes cause considerable pain, though this pain is tolerable and patients often refer to this pain as “good pain”. Correctly used deep tissue techniques should not cause any actual tissue damage (bruising). However, such forms of treatment are designed to produce some microtrauma to congested tissues. It is often necessary to break down fibrous adhesions within dysfunctional tissues. Treatment aims to restore normal or as near normal tissue function.

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What is Sports Massage?

Sports Massage uses a mix of Holistic / Swedish massage techniques, combined with deep tissue massage. The deep tissues massage techniques are designed to improve the suppleness and flexibility of muscles, the underlying tissues and the joints. Sports massage usually applied before activity (pre-event) or after exercise (post-event).Further details about Sports Massage can be found here.

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What is Remedial Massage?

Remedial massage therapists tend to treat specific soft tissue related injuries and which have resulted in dysfunctional tissues. Tissues can become dysfunctional due to injury, misuse, overuse, habitual behaviour or specific medical conditions. Remedial massage therapists frequently use a combination of superficial and deep tissue therapy techniques to relieve symptoms of tension, pain, restricted movement. Remedial massage techniques are also used to treat fascia, muscles, tendons, ligaments and joint structures which make up the Musculoskeletal (MSK) system. More advanced qualified therapists will have also undergone training in some soft tissue techniques with origins in Osteopathy.Further details about Remedial Massage can be found here.

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What is Dry Needling or Western Medicine Acupuncture?

Dry Needling, Western Medicine Acupuncture or Medical Acupuncture is a form of Acupuncture, which is used purely in the treatment of Myofascial Trigger points (TrPs). The technique involves inserting fine monofilament needles into active trigger points to relieve muscle tension and pain. The method can be very effective and works particularly well on muscles that are hard to treat with other forms of treatment. Dry Needling can prove very useful in the treatment of various types of headaches, including migraines, depending on the underlying cause of such an ailment. Dry Needling can also be extremely good at treating musculoskeletal (MSK) related Jaw Pain and Tempromandibular Joint (TMJ) Syndrome. Other soft tissue techniques can be applied to treat such conditions, and some of these can prove to be particularly uncomfortable. Although Dry Needling can sometimes prove uncomfortable, it can be far less unpleasant than other soft tissue treatments for deep muscles of the Jaw. Further details on Dry Needling can be found here Dry Needling

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What is Gua Sha or Instrument Assisted Soft Tissue Mobilisation (IASTM)?

Instrument Assisted Soft Tissue Mobilisation (IASTM), and some other registered trademark techniques have their origins in deep tissue massage and the ancient art of Gua Sha. Hence, having a thorough knowledge of anatomy, deep tissue massage and Gua Sha can prove extremely relevant when administering Instrument Assisted Soft Tissue Mobilisation techniques, of which there are many. Further details on Gua Sha and IASTM can be found here Gua Sha and IASTM

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Chiropractic and Massage Registrations

All of our practitioner's hold relevant professional industry registrations and or memberships. Our principal Chiropractor Terry Davis MSMA holds additional memberships and registrations for Massage Therapy with the Complementary & Natural Health Council (CHNC) and is BTEC Level 5 Clinical Sports and Remedial Massage Therapy qualified and holds professional membership with the Sports Massage Association (SMA):-

Chiropractic and Massage RegistrationsSports Massage Association (SMA)General Chiropractic CouncilComplementary & Natural Health Council