Personalised Clinical Direction

How involved I stay in your treatment is your choice.

When surgery is not the immediate answer, the usual next step is a referral to a pain specialist, physiotherapist, osteopath or other clinician.

For most patients that is entirely appropriate and it is all that is needed. But it does mean that the person who reviewed your imaging and worked out what is driving your symptoms steps out at the point where that understanding becomes most useful. Your therapist receives a letter. They begin work. And if things are not progressing, there is no straightforward route back to me.

Where treatment is likely to run over months, or where the target is not obvious, that gap is often where the result is lost.

Below are three levels of involvement. The first is included for every patient. The other two are for cases where more is genuinely useful — and I will tell you honestly which I think applies to you.

Your clinic letter

After your consultation I write to you, your GP and, where relevant, your therapist.

The letter sets out your diagnosis, what I believe is causing your symptoms, what the imaging shows, and what the treatment should be aimed at.

For most patients this is ample. A good physiotherapist or osteopath can work perfectly well from a clear letter, and where that is the case I will say so rather than suggest you need anything more.

INCLUDED AS STANDARD

No charge

Scan explanation video

A recorded video in which I take you through your own imaging on screen — what each finding means, which one is responsible for your symptoms, and what treatment needs to be directed at.
It is yours to keep. You can watch it again when the consultation has faded, share it with your family, and send it to your therapist — now, or to a different therapist in two years’ time.

Where this helps. Where the imaging is complex, where more than one thing is going on, or where your therapist would benefit from seeing what I am seeing rather than reading a description of it.
Most patients find the greater value is simply understanding their own spine properly for the first time.

£200

Direct clinical liaison

Everything in the scan explanation video, plus:

A discussion with your therapist. I speak to them directly and go through your imaging with them in a dedicated video meeting, so that we are looking at the same scan, understand the same mechanism, and are agreed on the same target before your first session. I also make clear what is safe to load and how hard you can be pushed — which is frequently the thing that changes a programme most.

Three months of access. You can contact me during that period with a question or a concern. So can your therapist. If you are not progressing as expected, they do not have to guess — they can ask.

A written plan setting out what treatment is aimed at and an agreed point at which we review whether it is working.

Where this helps. Where treatment will run over months, where previous therapy has failed, where you live at a distance from me, or where the rehabilitation is the thing that will decide your outcome.

£500

How to decide

You do not need to. I will tell you at the end of your consultation which I think is appropriate, and for most patients it is the letter alone. If I think more would make a material difference to your result, I will say so and explain why. If I do not, I will tell you that too — I would rather you spent nothing than spent money on something you did not need.

A note on independence

I have no financial arrangement with any physiotherapist, osteopath or other practitioner I recommend, and I receive nothing for referring to them. If you do not have a therapist, I will help you find the right one for your particular problem. If you already have someone and I do not think they are well suited to it, I will tell you honestly and help you find someone who is.

Where this applies

Personalised clinical direction is most useful where rehabilitation is a significant part of the treatment and the target is specific.

Lumbar spinal stenosis

where the programme needs to work with the mechanism rather than against it.

Vertebrogenic back pain

where treatment opens a limited window and what happens inside it determines the result.

Cervical myelopathy

where the spinal cord is compressed but your function is stable and surgery can potentially be avoided, but close clinical monitoring is advisable.

Spondylolisthesis and segmental instability, managed non-operatively or conditioned ahead of planned surgery.

Recovery after spinal surgery, where rehabilitation is complex or the case was technically demanding.

These options are offered following a consultation, once I have reviewed your imaging and established your diagnosis.

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