Toby Pollard-Smith, Osteopath

24/03/2026

I had an interesting chat with a patient recently.

They had presented with low back pain, and when they moved and when I examined them, there was very little movement in places where there should be.

We did some work, and a week later, the patient said how unstable they had felt since.

"FABULOUS", I said and thought.

"Eh? No! It was weird...", said the patient.

We had a positive chat from this point, in which we talked about how the body is meant to move. It is fluid. The patient had described the week before how stiff they felt , and how walking, in particular, felt harder than it should be.

By tackling some of this stiffness, we had asked the body to work a little harder again. The "hard" skeleton gets moved around by "soft" tissues. But when we increase the amount of movement potential, our "control" system has more work to do, telling the "soft" system where to put the "hard" skeleton, and when to get it in place.

The "precipice of instability" as we suddenly termed it, was an opportunity for change. Better movement potential, but more planning and prediction required. These are changes that need to be introduced slowly and steadily, but with a playful mentality. Enjoy the extra movement, and allow the software to update.

23/02/2026

Seven years ago, I started a company with two others. It was meant to be a digital solution for back pain, one that could fill the gap between NHS/public healthcare and private healthcare. Skip the waiting list, avoid the big bills. We had plans to cover the whole body, make it iterative, build a community.

Sadly, it never took off, we just couldn't get it to sell.
There was interest, there were compliments, but we didn't make a strong enough business proposition to warrant further attempts at development.
Not to mention, AI has started to impress - although I'm not convinced it will ever replace good medics.

As I have been reflecting on the ups and downs, the lessons learnt, I came back to one of the phrases we used a lot in our content: "Patients who know more do better".
We had three pillars of content: education, advice, and rehab. All delivered in videos, and I think those education mini-lessons stand up to scrutiny.

My current clinical work is not what it was several years ago. I know more, I do better. The process of making the content in this project made me stop and think. So I realise that these words, my ambition for comprehension, my ongoing curiosity have helped shape me where I am now. And will continue to shape me going forwards.

20/01/2026

There is rarely one single cause for anything, let alone back pain, which is what I see the most of.

❌ Back pain is NOT solely caused by weak core muscles.
❌ Not is it only down to your sitting posture, your mattress, you car, your tight-ish hamstrings, the weather, inflation...

I'd rather spend my time with my patients talking about what is in front of us, and constructing a path forwards, than sit and remonstrate about all the uncontrollable factors that might (or might not!) have led to where we are.

For one thing, the list of commonly supposed causes for back pain is often full of myths and fallacies.
Furthermore, when we start to apportion blame, we start to develop fear and distrust, sometimes of healthy activities, such as lifting weights or playing sport.

We can even develop false narratives of being fragile or incapable of doing daily tasks since we have falsely associated them with the onset of our pain. Association is not causation.

These are important conversations. Attitudes and beliefs predict behaviour. Behaviour change is at the root of good outcomes. I will continue to challenge the attitudes and beliefs of my patients, as I want them to have the best outcomes possible.

06/01/2026

I have a lot of time for Joanne Elphinston.
Her principles and the space she allows for differing threads of thinking to integrate, has helped make me the practitioner I am. She said to me that her courses are not meant to be educational, but transformative. I didn't really understand at the time, but I do now.

Her recent newsletter tackled the topic of evidence based medicine (EBM), which as an osteopath, not a physiotherapist, is a topic of regular debate. Looking back at the birth of EBM, it was never meant to be "practice only what the evidence says". I think those that do are painting themselves into a corner.

Joanne's quotation, in the image, sums it up. Everything we do has to fit the patient in front of us. Not just be a representation of quantitative data.

Another voice I remember is Danny Orchard, who was a tutor at the BSO. He always said that we should know guidelines, but most importantly so we recognise when we are working outside of them, and use that as an opportunity to reflect on how we got to that place.

To paraphrase Captain Jack Sparrow: I like to know guidelines and evidence. And I like to wave at them as they pass by.

Thank you Joanne, and thank you Danny. Jack Sparrow too.
Onwards.

15/12/2025

📣 Ultrasound Therapy!

Now listen... Is it a cure for everything?
❌ No!
I remember that as a young/professional dancer, when I was injured, the treatment I received featured a LOT of ultrasound. I pointed to where it hurt, and the area got ultrasound. Sometimes laser as well.

Nowadays, the industry has accepted that Ultrasound plays a more limited role. I will use it for:
✔️ Tendon injuries
✔️ Ligament injuries
✔️ Swollen joints..amongst some other things. Essentially, it is a gentle, passive treatment, with no side effects.

I use it quite often , and I can now offer it as well.

If you have any questions, please feel free to reach out!

08/12/2025

Medical acronyms. Here are some I use - perhaps not all conventional 😬

SIN - this is a useful clinical acronym.
🔥 S for severity - Is the patient in agony? Is their condition serious? Good to stop and think.
📈 I is for Irritability - Different to simply thinking about how bad the pain is, but instead, does it come and go unpredictably, or is it a steady burn. More unpredictable conditions score higher for irritability, and this will dictate how we might manage them.
⚡️ N is for Nature - What tissue is damaged? Is it a bone injury? Is it a muscle injury? Is it a problem with the nervous system? Again, thinking about these can really help chose the optimal treatment plan.

EITR - we all know what this means...
🐘 The Elephant in the Room.
The thing that no one really wants to discuss, but needs to be discussed.
In some recent cases, this has meant cancer, MS, or other serious neurological conditions.

KISS
🤪 Keep it Simple, Stupid!
Sometimes, and especially with complex cases, a simple plan is the best way forward. Then it can be modified, iterated, updated, refined.

HWB
This one just saves me time.
Hot Water Bottle 🤣
Perhaps one of the best interventions, with few side effects!

Osteopathy in Ascot and Fleet
Details in my Linktree!

13/11/2025

Researchers have found a miraculous way to reduce back pain. A seated salsa. Really?

👍🏻 I don't disagree at all with getting people to move more - it's absolutely key
👎🏻 Should this be framed as a way to avoid getting out of your chair?
🤯 Is this a "miracle movement"? Please...

I sense AI writing at work here.
33 vertebrae?
Only if you count the bones that are fused into our sacrum and coccyx.
Let’s stick with trying to get people to move the 24 that can move!

Lower back pain is a chronic condition that affects hundreds of millions of people around the world. A simple exercise could be a big help.

06/11/2025

Such kind comments from a patient who has been through his fair share of injuries!

We had an interesting session the other day, where, besides some treatment, we talked about the influence of the nervous system on bodywide systems, and how people can vary in their awareness of injury and dysfunction.

I've still got a lot of learning to do - not sure about the "top of my game bit", but I can promise that I have come a long way in my 11 years of practice.

Onwards and upwards, and thank you for the eggs 🥚

05/11/2025

"These are a few of my favourite things..."

I like to feel comfortable in clinic, and in private practice, we have the luxury of making ourselves comfortable.

So, at Hartwood Health, when I had the chance to make a space for me to work in, I was able to add the things that would make me feel at home, calm, and comfortable. And I genuinely feel that these things lead to me doing a slightly better job.

1. Lighting 💡
I have a bit of a lamp fe**sh, and I HATE fluorescent tube lighting. I typically walk into the clinic, turn the tubes off, and turn the lamps on.

2. Pot Plants 🪴
A bit of life in the clinic, right?

3. Music 🎵
Besides providing a screen of noise for privacy, I don't like silence. And I don't like radio - I can't quite cope with the talking, and the compressed sound. My taste in music might not be everyone's cup of tea, but I try to have some variety, and occasionally mix it up.

4. Coffee ☕️
It's almost a superstition that I feel I can't start a shift without a coffee. And the caffeine keeps me sharp. I think this makes for better decision-making, so it will keep flowing!

What do you like around you when you're working?
What gets you in the zone, or knocks you out of it?

29/10/2025

A problem I think about in osteopathy is the tendency for too many people to work in "silos". Isolated, working alone. I don't think it's healthy.

If we're all busy trying to earn money by seeing patient after patient after patient, and we don't have the time, freedom or network to surface, breathe, and talk to other colleagues, what is there to prevent us from spiralling off into weird corners?

I find myself guilty of this at times. The pressure of self-employment, increasing costs of living, keeping a list alive. But I do my best to read things, watch lectures online, and generally pester other practitioners when we have the time to chat about cases.

In the future, I would like to mentor more, teach students, offer guidance to others at earlier stages of their careers. Let's see what happens!

21/07/2025

It's getting to holiday time.

When a patient in the middle of a case tells me they're off on holiday, I always think to myself, "Well, this could go either way!".

Sometimes, a holiday is just what a person needs.
It's all about rest and relaxation for some. Time away from targets, pressure, perhaps away from certain people 🤭.
For others, it gives more time to be active, whether that's swimming, walking, hitting the gym, or whatever else is on offer.
Indeed, not being tied to a desk appears to help many people.

Sometimes, however, holidays can be a negative for a person in pain. Wrestling with heavy luggage, an uncomfortable bed, the wrong pillow.
Not being in a regular routine can sometimes compromise a person's recovery.

I hope all my patients have good holidays, but we don't know until we see them on the other side.

16/06/2025

Good communication is paramount in healthcare, but some factors can sway what we say and how we interpret what we hear.

A particularly hazardous area, in my opinion, is with the mostly better person, who has perhaps had several sessions.
They typically ask about future sessions and whether they should keep coming back in to "stop it happening again".

In the past, I have tried to be confident and assertive, telling my patients that we have achieved our goals. I have considered their progress, added on a few more weeks of recovery, and deduced that there might be nothing for me to do by the time of the next appointment. So they don't need it. Save your time, save your energy. Let me get on with seeing someone else who needs it more.

I have also met plenty of new patients, and I notice how often I hear a story of "failed therapy". This person was seeing someone previously, and they were making progress, only to be told that "there was nothing else to do" or that "they couldn't help anymore".

It leads me to wonder whether we're exploring the same conversation from different sides and hearing different motives.

The person being a clinician wants to be effective, efficient, and not waste anyone's time or money. I've done my work, and you're mostly better; I don't see the value in another session.

In contrast, the person who is a patient is still in pain and is worried that things will not clear up completely. They don't want to live like this forever and are desperate to prevent a relapse.

One person is trying to be confident.
One person may be putting on a brave face, but underneath is scared.

Over the years, I have started to recognise these moments, and I do my best to navigate them carefully.

We can debate the merits of "maintenance" treatment. I think that in many cases, people who choose to embark on a course of "maintenance" sessions are actually after a little more companionship on their road to recovery.

There are numerous opportunities in these after-the-event sessions to explore the nature of the injury in greater detail, consider what might have predisposed or contributed to it, and learn how best to cope in the future.

When the person who has been a patient truly starts to feel independent, confident, and empowered, they will most likely stop attending their "maintenance" appointments. And they will tell their friends that they know someone who can help others. Someone who sticks by their patients, listens, cares, guides, and educates.