Welcome to the latest Pain Free Living podcast with your hosts Bob Allen (osteopath) and Clare Elsby (therapy coach).

In this episode, you’ll find out exactly what to expect in your first osteopathy session or therapy coaching consultation, from taking your case history to active listening, and everything in between.

Bob takes you behind the scenes of what really happens when someone walks through his clinic door. A thorough case history is at the heart of osteopathic diagnosis, and Bob explains why he gives each patient time to share their story in full.

This isn’t a quick “where does it hurt?” appointment. Instead, it’s about uncovering key details, like forgotten operations or old injuries. These are important things that are often forgotten but can completely change your treatment picture.

He explains why those one-size-fits-all YouTube exercise plans to fix your low back pain often miss the mark, and why understanding the individual always comes first.

Clare then brings the conversation online — literally. As a therapy coach, most of her sessions happen virtually, giving clients the comfort of their own curated space. She explains how a structured discovery session helps identify what’s really going on beneath the surface, when to signpost clients safely to GPs or mental health professionals, and how a professionally managed conversation differs from chatting with friends.

A major theme in this episode is active listening where space is created for you to feel genuinely heard, without interruption or judgment.

Both Clare and Bob emphasise that listening well isn’t passive; it’s the foundation for trust, accurate assessment, and meaningful change.

Whether you’re curious about seeing an osteopath for pain relief or considering therapy coaching to untangle life’s challenges, this episode demystifies the process and shows how both approaches share a common thread: understanding you.

💡 Key Takeaways

🦴 A thorough case history is the foundation of accurate diagnosis and effective treatment.

👂 Active listening helps clients feel heard and supported — and leads to better outcomes

🧠 Online therapy coaching is flexible, confidential, and surprisingly powerful.

🧾 One-size-fits-all exercise plans often fall short — personalised care matters.

🤝 Different professions, one goal: helping you move forward with clarity and confidence.

Find out more about us and stay connected

😎 Learn more about Bob’s story https://bit.ly/BobsOsteoStory

🤩 Find out more about Clare’s work https://www.clareelsby.com/

📰 Sign up for our Pain Free Living newsletter https://bit.ly/PFL_newsletter_signup

🎙️ Connect with us on socials & podcast platforms https://linktr.ee/Painfreeliving

Welcome to the Pain Free Living podcast.

It's my turn.

This is my debut opening, so please forgive me, everyone.

I'm here with Bob Allen and today this is episode three of season two.

You got that right.

Yep.

Okay.

And we're actually going to talk about what happens when you come and see either of us.

What is a session, like, what to expect.

So, Bob, what happens when someone comes to see you?

Claire?

Right.

When somebody comes to see me, they open the door.

They walk through it, they close the door.

Well, a lot of the time I close the door because I just forget.

The process is very structured and my take on it is I want people to tell me their story.

So my appointments tend to be longer than average because I want to understand who that person is and why they've walked through my door.

So.

So I get some basic contact details that we then talk about why they have come to see me.

Yes, it's because they're in pain, but there's always an underlying story behind that.

It's very rare that, yeah, I've come in to see you because my ankle hurts.

Sometimes it is.

The ones that have been in pain for a long time, they tend to have more of a story to tell.

So it's.

I don't want to say digging into that story because it's not like the Spanish Inquisition where I then pin them to the floor and say, tell me why you're here.

But it's more about conversation and seeing where it goes.

So it'll be, why are you here?

That's always my first question.

And sometimes they say it's because my leg hurts.

And sometimes they will give a little bit more.

So it's that it's taking what we call a case history, so we'll understand why they're here, what their main problem is.

We'll then take a case history.

So it will be a bit about previous injuries, what medication they're on, whether they've had any previous treatment or not.

We'll then just do like a general system check.

So we'll talk about breathing.

Do they get chest pain?

Do they have any stomach issues?

So we'll do all of that.

Do they get headaches covered, like the neuro side of things?

And then do they exercise?

Have you had any operations in the past?

Any scans that can take up to 20, 25 minutes?

If it's a long, complex case, which sometimes they are, but I like to give them the space to do that.

And then we go on to a physical examination, which is them either standing or lying, depending on how much pain they're in, get them to do certain movements, seeing if those movements trigger the pain that they've come in with, and we then go from there.

I then have a few what we call differential diagnoses.

So if it's back pain, is it sciatic nerve irritation?

Is it herniated disc?

Is it just a disc irritation?

Is it piriformis?

I just go through a list of potentials to narrow it down.

Because the key thing about osteopathy is you need to have a good understanding of what's going on before you start to treat.

And this is one of the reasons why the five best exercises for getting rid of your back pain on YouTube generally doesn't work.

It works for some people, but every case of back pain is different.

Every case of back pain is different.

There are certain things that will work generally, but there's a lot that don't.

One of the things I have to be very mindful of is that when people are no longer in pain from a particular injury that happened 20 years ago, they don't talk about it.

And I have had one client, you know, we've gone through the case history, we've been talking about what's going on, what hurts, what doesn't, that sort of thing.

You know, building the picture, building the story.

So we did that.

Any operations?

Any scans, Any X rays?

No.

So he took his shirt off.

Massive scar down the center of his chest because he'd had a heart operation a few years ago, wasn't causing the problem now, didn't even think to mention it.

So we have to be very careful about.

That was a nice easy one, because that was obvious.

But, you know, times in conversation where we're just talking and they go.

And they all say something and you go, oh, hang on a minute.

Right, so you have had a knee replacement or, you know, because if it's not causing pain, people just don't think to mention it.

And they don't think we need to know, but actually we need to know everything because the more we know, the more we can work out.

Oh, okay.

That pain you had, in fact, somebody quite recently, they were getting hip pain, a lot of hip pain.

They had had a fall nine months ago and they didn't.

And that had kind of recovered.

It's still a bit achy, but that kind of recovered, but they were getting quite severe pain from the hip.

So we.

We went through that and.

Okay, so then once I knew that they had a fall, and once I knew that they actually caused quite a Lot of damage to the hip, which they'd not remembered because it was less of a problem.

So we started treating the hip and that was what we needed to do to resolve what the issues were.

So we have to be very careful about getting as complete a picture as we can.

And what about you, Claire?

What about yourself?

What happens if I come to see you?

What would you do?

Well, first of all, you wouldn't come to see me, you'd log on.

Most of my clients I see online, which, when I first started doing this, I was a bit skeptical about that.

But because my training started in the pandemic, it was all online.

And I do have some face to face clients, but actually I think I'm being really surprised at how well online works.

And you can get a really good feeling for somebody just even through a screen.

So the first thing would be that someone would sign on.

And the other reason I do online or I find it works really well, is the individual can create, curate their own space.

So bearing in mind our conversations are confidential, they can make themselves a cup of tea, they can get themselves settled.

And we always.

I tend to start with a check in just to see how people are feeling when they're sitting there.

But the first session is generally a discovery session.

So this is where I'm really listening to them, trying to get, like you say, the background as to why the story, if you like, without getting too involved in the story, but gleaning the, the language and understanding what, really listening to what they're saying so that then I can decide and effectively signpost them.

So either it's something that I feel confident dealing with or it's something that actually either it might be that I think their gp, I need to go and see their gp, or it could be that I feel that actually something going on in the background which is much bigger and is overshadowing everything.

And without that being dealt with, any work that I would do comes to nothing, really.

So that's where I would refer them to a network where I've got a psychotherapist and a psychiatrist or counselor, whichever I feel is more appropriate.

But if I feel I'm sort of in the right place to deal with them also that session is where I explain how I work.

So one of the big things about a coaching session, which is very similar to a therapy session, is that it's a professionally managed conversation.

So it's very different to a conversation you might have with friends or work colleagues, because what you.

We all know that when we have a conversation with friends, they know you, so they've probably got a lot of advice to give you.

They know your history, they, they know what's going on for you and they're probably not listening to everything you're actually saying because they're almost wanting to jump in with their reply and just tell you what to do.

The other thing is that conversation might not be 100% confidential.

Can you actually rely on that?

But they're not going to go and tell anyone.

Also with me, I guess I've been trained that there is no judgment from me and that's because I've been trained to not bring my own biases, my own, you know, we've all got stuff going on.

So I've got, I'm constantly thinking in this intercession, is this something that's bringing something out for me or is this the client?

So again there is no judgment for me.

So we're talking about a confidential safe space where anything that's said is not repeated.

There is a slight caveat to that.

If I felt the person was at harm to themselves or to anybody else then I would have to speak up on that.

But it is a confidential safe space.

As I say there is no judgment.

My job is to professionally listen to that person.

So it's quite often in society these days that we're not listened to.

Yeah, I was going to say this is a topic that we are going to come back to on active listening.

But yeah, sorry, carry on.

So, yeah, so I adopt it is known as active listening but that's what I do.

And it's just about the client feeling that they've been heard and quite often that is a really good start in a relationship is for the person, the individual to feel.

Yeah, I feel that I've been listened to probably first time in a long time and it's about building that rapport and it's about building that relationship and then it's about inviting the person to bring whatever it is that's bothering them.

And I never know from session to session what someone's going to bring.

So I like an it fit like, you know, I'm a boring dancer and I liken it to that.

I just don't know what's going to happen on the floor.

So I've got to be prepared for whatever they bring.

And I've learned that actually me preparing for hours beforehand for a session just doesn't work.

So what I do is after the session I make sure that I do a proper follow up.

I send through an email, I Summarize everything.

But then again it depends on who I'm dealing with.

So I'm a neurodiverse inclusive coach.

So if the person will just not deal with a log email, then we'll find another way to communicate that sort of blade got by information.

So that is really a session.

So there's nothing to do with a coach.

There's no coat unless the person's got one and lounging on it while they're talking to me on screen.

But no, it's very much, it's a curated, professionally managed conversation.

Yeah.

And it's interesting that you talk about online coaching because in the pandemic when all the clinics closed down and I had to get a proper job for a while.

We'll talk about that another time.

But I did do a few online sessions.

I went through a big battle in my head about can I do osteopathy online?

Because I'm not doing hands on.

And that's kind of what people expect.

But actually I'd got enough experience just having a conversation with someone and just, just having them face to face and I'd occasionally get them to do a few movements just to see what had happened, what things hurt and what didn't.

But I did a few online appointments that worked really, really well.

I think a lot of it is because there's that bank of experience in that.

Okay, somebody's got shoulder pain.

Well, I know that there's certain movements I will get them to do if they do that and that hurts.

Okay, so that's long headed bicep, tendonitis or whatever it is.

But yeah, online can work really, really well.

And something else I found as well is that it's something that piggybacks on what you were saying is that people like to feel heard now in the nhs, in the medical profession generally they, you know, there are some consultants that are brilliant because I took my dad to a consultant and he was absolutely fantastic.

Sometimes the consultant will talk to me and not me dad because he's 95 and he's a little bit confused about stuff.

But this guy talked to my dad and if he needed any kind of confirmation he talked to me.

But otherwise it was totally focused on my dad.

And that's unfortunately that's not as common as it should be because some consultants will just, or GPS also will just talk at people rather than engaging a conversation with them.

I understand gps have very, and consultants very little time.

Very rushed.

We need to get this, this, this, this and this done and they will just throw everything out the downside of that is you then get people who don't feel they've been listened to, who don't feel.

Who feel they've been dealt with rather than listened to.

And if that's how they feel, they tend to respond less well to a treatment.

So I know again from experience that when people come to see me and I listen and exactly what you're saying about active listening, I'll listen to understand rather than listen to respond.

Because a lot of the time there's a lot of people that listen to respond without actually considering what they've just been told.

And I think that is.

That is something that's really important, that people feel listened to and heard.

Yeah, absolutely.

I mean, I'm sure it's the same with you, where people are talking to me once they begin to trust me, like some very vulnerable.

They're being very vulnerable in that space.

And, you know, the worst thing I could do is to not listen, interrupt them and, you know, not really respond to them and show them that I'm not listening.

So, yeah, I make some promises and I make the promises that I make is that I, you know, I won't interrupt them and I provide a safe and confidential space and there is no judgment.

So I think people.

Clients appreciate that.

I think so, yeah.

And like I said, although we come at things from different angles, I think our approaches are very similar in that, yes, we get the story, we listen, we respond appropriately, and then we're just here to support the client.

I think one of the things as well is I know that you give out exercise sheets and all that stuff to help, whereas my role, again, which is why it's different from friends and family, is I'm not there to give advice in my.

My belief is that the person knows themselves the best and they've actually got bit.

Like a client mentioned in a previous episode about walking around in a private bag of fog.

Once he'd worked it out, he was good to go.

And that's what I feel, is that people, once they've been unlocked, if you like, then you know, they can make their own decisions.

And also that empowers them.

If I was to sit there and say, I think you should do this, or da, da d. You know, they're going to walk away feeling a bit like that doctor's appointment or that consultant's.

Appointment, they've been done, they've been dealt.

They've been dealt with.

Yes, exactly.

So, yeah, yeah, so there you go.

Two different approaches.

Well, actually similar approaches, totally different areas, but yeah, that's why we work.

So are we done?

Is that it for this episode?

I think.

I think we are.

We exhausted that time topic.

I think we've covered pretty much everything on that one.

So that's the end of episode three.

If you go and see a therapy coach or an osteopath or physical therapist, generally, because we all work in a very similar way, then that is how a session should take place in the next world.

We're going to talk about a few do's and don'ts.

So just to give you a few pointers on you are going to see a therapist, give you some ideas about good practice and not so good practice.

So hope you enjoyed that one.

We will see you at the next one.

Bye for now.