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. We specialise in the assessment, treatment and rehabilitation of work and sports-related musculoskeletal (MSK) conditions. We aim to identify the root cause of symptoms and get you the patient out of pain and back to activity, as quickly as 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. Our practitioners work very differently to many others within the Chiropractic profession. Not only do we work purely from a musculoskeletal perspective, but our practitioners have extensive training in multiple advanced soft-tissue techniques too. In our experience and opinion, such a mix of training allows our practitioners to treat a wider variety of conditions effectively.

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 multiple 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 significant 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 three articles on TotalMSK's blog covering the human stress response and the effects of this. Besides the expertise within TotalMSK, we also have a professional 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. Other noticeable differences are:-

Treatment plans/frequency

Treatment plans rarely require more than one treatment in any given week period. Hence, patients are never expected to agree to three treatments per week for weeks to months. However, there are exceptions in acute cases or when there has been a setback due to re-irritation of symptoms. In such cases, it may have been necessary to provide two treatments within a given week. (See how many treatments am I likely to need).

Discounted treatment plans

We do not offer discounted treatment plans to patients who sign up to large blocks of weekly treatments, extending over months. The simple reason for this is that to date; our patients have never needed multiple weekly treatments or over such extended periods. Hence, you will not find TotalMSK offering discounted treatments on large voucher type websites.

MSK Chiropractic Treatments

Our treatments are typically 30 minutes in duration and yet a similar cost to other far shorter treatments of between 8 and 20 minutes. The reason for this is due to the way our practitioners work with a combination of treatment methods. The combination of McTimoney Chiropractic and advanced soft-tissue techniques has proved to be highly effective. However, to effectively treat in such a fashion requires time, and this is not feasible in a much shorter treatment window.

Professional Memberships and Registrations

All of our practitioners hold registrations and professional memberships with relevant voluntary and statutory regulators. Primary healthcare practitioners all have statutory regulators, which have legal requirements. Such requirements govern; continuing professional development, codes of conduct, the scope of practice, insurance requirements, criminal records, etc. Unlike, Primary healthcare practitioners, there are no legal regulators for many soft-tissue and other related professions. Regulators help protect the public, even voluntary based ones. Hence, if somebody is not registered even in a voluntarily regulated industry, then one should ask why not? There are associated costs with meeting yearly registration requirements for practitioners, but it helps to reassure the public. Other requirements of registration help ensure that practitioners are kept up-to-date with recent research.

Vanity Awards ("Award Winning Chiropractors")

Unlike a disappointing trend within the Chiropractic profession, to become "Award Winning Chiropractors" our primary aim is improving the lives of our patients. The vanity awards trend does not seem to apply to other primary healthcare professions as yet and just a minority of Chiropractors. Such awards rarely appear to be Professionally related either, based on our previous experience of being contacted about winning such an award. The award in question was in a minimal category, and the category was so narrow that it was clear that one would win the award. To get the award, one would have to pay to attend an overpriced and ticketed black-tie gala type event. There were also various paid options around publicity packages too. Receiving such an award would have been morally and ethically questionable and misleading to the general public. Hence, it is always worth checking why an award was given, by who and for what? If members of the public feel that a particular award is misleading, then one should report the matter to the Advertising Standards Agency (ASA) and even the General Chiropractic Council (GCC).

The "Chiropractic Subluxation"

As Musculoskeletal Chiropractors, we do not treat the "mythical Chiropractic Subluxation" or subluxations. There has never been any evidence for such a historical concept, which in essence is viewed as the "root of all disease". There are a small minority of chiropractors who claim to treat subluxations and thus falsely believe they can treat all disease. Historically (late 1800's), the chiropractic subluxation was thought to interfere with the nervous system and thus the bodies natural ability to heal itself (innate ability to heal). Hence, in theory, treating subluxations could remove barriers to the body's innate ability to heal itself from the disease. Conveniently, only Chiropractors could treat such "subluxations" and therefore disease, eliminating the need for any other form of medication. Clearly, nonsense even if the body does have the innate ability to heal itself given the right environment to do so. That environment might be the hospital, medications from the GP, or a visit too a "non-subluxation" based Chiropractor etc.

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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. All three professions are Primary Care Health Practitioners and have to complete either a University degree or Masters level qualification. Each occupation 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. The degree does not include training in manipulative therapy techniques (HVLA). Physiotherapists can complete further 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 have tended to use 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 occupation 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 significant 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" sound 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 comprehensive range of 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. The list also covers other musculoskeletal related treatments offered by TotalMSK practitioners. However, treatment may still be suitable for a patient and may only actually be locally contraindicated. Local contraindications mean 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. There may be occasions where one may need to gain GP approval before commencing treatment. Getting GP approval tends not to be an issue. 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. Our practitioners will be more than happy to talk you through any queries or concerns.

Typical types of Contraindications may include:-
  • 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.
  • Pregnancy 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 of 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 usually 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 typically last 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 differences 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 create microtrauma during the treatment. 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 as a near-normal functional state. Hence, after treatment, one may notice other regions of the body aching and not just the treated areas. Also, dysfunctional movement patterns can develop over time due to "lack of use, misuse, overuse and abuse" (Leon Chaitow, Osteopath). Such changes, will impact multiple other tissues and create change in these too, especially in chronic cases. By treating these dysfunctional musculoskeletal (MSK) patterns, one is enabling the tissues of the body as a whole to work as intended. 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. The principles equally apply to the prevention of and the rehabilitation of musculoskeletal (MSK) injuries in general. There is also a far more detailed article about 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 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. Primarily, it is to establish if it would be safe to treat you the patient and if Chiropractic care would be suitable. 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 for 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 into account 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 there are good reasons for concern.

It is vitally important to be completely open and honest during the initial and confidential consultation process. Practitioners will be interested in all aspects of health, even if the patient does not view them as relevant. In essence, there are a vast number of possible variables affecting how and why symptoms may have occurred. Such variables may include medications, habits, previous injuries, operations, diet, stress, other medical conditions, existing on-going treatments etc. Each variable is like a small piece of a giant jigsaw puzzle. Hence, the more a practitioner understands regarding a patient's unique health circumstances, the better they can help. There is also an aspect of patient safety, as certain existing conditions or medications may contraindicate some methods of treatment. There are usually multiple ways to achieve the patient's desired end outcome via a combination of suitable techniques. There may be a contraindication for one method and not another, with patient safety being paramount.

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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, including, injuries, changes in medications etc. A regular appointment will not provide ample time to gather any additional details needed to assess and treat safely. 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. In some cases, differing therapies may be counterproductive or not advised in conjunction with Chiropractic care. In other cases, therapists can work effectively with other disciplines to achieve an overall common patient goal. However, various professionals/therapists need to coordinate treatment in such cases.

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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
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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Why bother with Chiropractic maintenance treatment?

The simple answer is because our bodies are constantly adapting to various forces, such as gravity daily. Forces impart loads on our entire musculoskeletal system. Our tissues will "adapt" to these forces over time, and one may typically notice these changes as restricted movement, tension, pain or a combination of symptoms. The article on "adaption" goes into far more detail. Many patients find maintenance treatments to be highly beneficial at countering some of the adaptions caused by the day-to-day stresses and strains of modern-day life. The frequency of any such maintenance treatments can also vary from anything from 4-6 weeks to a few months.

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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 undoubtedly 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. A criticism of the biopsychosocial model is that it is an oversimplification of human health. Other models or constructs of health have sought 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. The article on "Biotensegrity" explains in further detail the importance of the holistic view of 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). Further details about such techniques can be found here.

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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. A sports massage is 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 Temporomandibular 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. One can find further details about Dry Needling 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. Further details on Gua Sha and IASTM can be found here Gua Sha and IASTM.

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