1. For each learning outcome, 1 and 2, write a maximum of 1500 words to demonstrate how your clinical experience has allowed you to fulfil these outcomes. Use Harvard referencing to support your statements.

2- For the accompanying reflections you should use the “What? So What? Now What?” model created by Rolfe et al.’s (2001)


Learning outcome 1: Reflect on and critically evaluate their osteopathic technique skills and patient management strategies.

(Guidance: By referring to a minimum of 4 individual patient cases, write an evaluation of the techniques and management strategies used. Your evaluation should be supported by evidence of reflective practice, reading and research.)

Demonstrates the ability to critically evaluate osteopathic technique and patient management strategies based on reflective practice and current evidence. This should be evidenced by referring to a minimum of 4 patients recorded in clinic log.

 Patients for task 1

Patient 1- Male 36 years old, driver (rubbish collection), presenting with right shoulder pain (GH joint).

Onset: Since January 2022

No tingling, no numbness, no radiation and no pins and needles.

Pain aggravates with abduction of arm

Relieving factors: Resting 

He described the pain as dull pain

The treatment was focused directly on mobilising the shoulder joint complex, including soft tissue techniques (STT) (cross fibre, longitudinal stretch, and inhibition) to the periscapular, rotator cuff and anterior chest muscles (subclavius, pectoralis major and minor) and articulations to the scapular, GHJ and thoracic spine (Tsp), HVT manipulation lift of for C7 – T1 and HVT AP for T2 – T 6.  After the treatment the patient 

had a good improvement on range of motion and the pain level had a significant level decreased.

Working diagnosis: a) Mild supraspinatus tendinopathy with associated upper trapezius and pec muscles hypertonicity.

   b) Muscle fatigue at upper trapezius wit associated protracted shoulders maintained by hypomobile C 7 – T1 segments and T2- T6 segments related to occupational factors.

Exercises prescribed : Door Frame exercise to stretching Pectoralis muscles.


Patient 2- Patient 53-year-old Teacher presenting with lower back pain and on the Left SI Joint.

Onset: 5 weeks ago, prior to the consultation.

There was no trauma, the pain when the patient was carrying his dog for about 1.5 miles.

No tingling, no numbness, no radiation and no pins and needles.

No Bowels movement changed, no night sweats, no fever, no Bladder changed.

Aggravating factors: Seating for long periods

Relieving Factors: Side lying and stretching.

The working diagnosis was: L5 -S1 segmental restriction with associated hamstring hypertonicity.

Treatment: HVT L5 – S1(L)

MET Gluteal muscles and lower extremities muscles (Quadriceps and Hamstrings)

Advice Exercises prescribed: Seated stretch exercise for Hamstring;

90X90 exercises for stretching lower extremities muscles and QL muscles.

Patient reported felt better range of motion after treatment with more range of motion and pain free without cramps.


Patient 3 – Female 28-year student presenting with abdominal pain and headaches that radiates through the neck and upper back.

The onset was 4 months ago prior to the day of the  consultation. The pain  starts when she was commuting abroad in holiday for about 2 months. 

The patient reported that she didn’t have any neurological symptoms such as tingling, numbness or pins and needles. Patient has done stool test and the GP said that everything was normal.

Patient mentioned that she is not drinking enough water and the urine is a bit dark and with strong smell.

The examination was: Full Abdominal examination

                                   Cervical Active and Passive Range of motion  

                                   Thoracic Active and Passive Range of motion 

On examination findings: Cervical =  Restriction C 2 – C4 

                                        Thoracic = Restriction T2 – T4 and Rotation  T4 to the Right

Palpation = Hypertonic upper trapezius, levator scapularis

Abdominal palpation= Tender on Epigastric area without distention. 

Abdominal Auscultation= Normal sounds 

Abdo Percussion = Normal 

Treatment: Traction CSP supine,

 Soft Tissue Technique Cross Fiber at  Upper trapezius Rhomboids (B) 

MET (PIR) Seated Upper Thoracic 

MET (PIR) Supine Scalene, SCM, Levator Scapularis muscles (B) 

HVT Lift of CT – T1, T4 – T8  SEGMENTS

Exercise prescribed: Door Frame exercises stretching for Pectoralis and isometric exercise for levator scapularis muscles.

Advice: The patients has been advised to speak to the GP if the reflux symptoms continues and also regarding the urine smell and color changed. 

The patient has shown very good progress in her symptoms and function after two treatments. 


Patient 4- Male 73-year-old retired came for evaluation of lower back pain on the left side, that radiates through the back of his thigh.

No tingling, no pins, and needles 

Patient denies any trauma.

Onset: 5 weeks ago, prior to the day of the examination.

The patient is right-handed


Aggravating factors: Seating for long periods

Relieving Factors: Ibuprofen 1 daily

Examination: Neurological test was unremarkable

SLR = Negative 

Kemps Test + Negative

Cervical Active/ Passive Range of Motion = Full ROM

Compression test for SI joint – Negative

Palpation = Hypertonicity Lex muscles 

Lumbar Active/ Passive Range of Motion = Restriction L4, L5- S1 segments.


Treatment: Foramen Gapping side lying position

Soft Tissue Inhibition QL muscles (B) and Gluteus muscles (B).

Traction SI joint Advice: Stretching exercise seated position for Hamstring muscles 

Door frame exercise stretching for QL muscles and dorsalis muscles (B)

The patient has shown good progress in his symptoms and function after three treatments.



Learning outcome 2:

Identify contraindications to osteopathic techniques and treatment and justify their management and treatment strategies with regard to patient safety.

Guidance: Justifications should be supported by evidence of reflective practice, reading and research and discussed in relation to a minimum of 4 individual patient cases.)

Evaluates osteopathic technique, treatment, and management strategies through consideration of appropriate cautions and contraindications. Supported by current evidence. This should be evidenced by referring to a minimum of 4 patients recorded in clinic log.

Patient 1-  Female  66 years old present with right Knee pain at popliteal area. With a history of IBS  diagnosed by GP 10 years ago and is taking  Buscopan daily .

All movements aggravated symptoms, such as walking, standing and sitting(Knee Flexion)

On examination Right popliteal fossa Lump ( Fluid filled)

Working Diagnosis=  Baker’s Cyst.


Patient 2- Female 64-year-old presented for evaluation of Headache that is radiating through the neck and shoulders bilaterally and knee. The patient had a history of breast cancer surgery removed, knee replacement, Full breast reconstruction, Bulging Disc at LSP and detached Coccyx . Although Osteoarthritis on  Hands and Knee Bilaterally.

Working Diagnosis= Likely degenerative changes of cervical spine with associated upper trapezius , levator scapularis, scalene muscles hypertonicity.


Patient 3-  Male 90 years old presenting for evaluation of lower back pain (R).

The pain starts after his was doing gardening. There was no neurological symptoms.

No changes on Bowels movement or bladder.

Patient has a history of Prostate surgical intervention. The patient also suffered from benign peripheral vertigo and was unable to lay horizontal.

Also, he is Iron dependency, Diagnosed Asthma since he was 20 years old 

Has a Stent since 2018 and is taking several medications for Asthma, blood pressure and Stomach.

A working diagnosis of Right SI joint with associated gluteal hypertonicity maintained by sedentary life style and probable spondylitic changes was made.


Patient 4-  Male 56 years old present for evaluation of pain on the lateral side of the left elbow. The onset was 9 months prior to examination. Patient rated 8/10 numerical pain rating scale, described as a sharp pain.

The patient had a few treatments with a chiropractor and mentioned that didn’t decreased the symptoms. The patient has diabetes and is taking Metformin and Statin daily for Diabetes control. 

A working diagnosis of (L) Lateral epicondylitis with associated hypomobile T2 – T4 Spinal segments maintained by upper thoracic muscles hypertonicity. 

Treatment: Traction Cervical Spine Supine position

MET Levator Scap, SCM, Scalene, and upper trapezius Muscles (B)

Soft Tissue Counter Strain Brachioradialis, Pronator and adductor pollicis longus muscles (L)

Soft Tissue Cross Fiber Biceps and Brachioradialis muscles (L)

HVLA T2- T4 

Advice: ice 3 x daily on the lateral epicondyle 

Heat on the forearm muscle. 

The patient was advised to rebook in 7 days