Silvan (00:00)
Hi, everyone. You're listening to the Silvati's podcast.

So today I'm joined by David Lintonbon, who's an experienced osteopath.

an educator and the co-author of the Handbook of Manual Medicine, which is a comprehensive guide that takes sort of readers through each body part and demonstrates clinical examination, hands-on techniques, and how we use it in osteopathic practice. So in this episode, we'll talk about the science of manual medicine, what it means to treat the body through touch, the process of writing such a detailed clinical text.

and how osteopathy continues to evolve in modern healthcare. So thank you so much for joining me again, David.

David Lintonbon DO (00:45)
Pleasure Sylvan, always a pleasure, never a chore.

Silvan (00:49)
So when we recorded our first podcast together, there were so many questions that I wanted to ask and so much positive feedback that I got from the

that time, I remember you telling me like you were writing a book and how it was in process. And I just thought, we have to get you back to talk about the book. And I've got the book with me. I have actually read it. And I have lots of questions for you.

David Lintonbon DO (01:12)
Good.

Excellent. Fire away.

Silvan (01:18)
So thinking about sort of the motivations of the Handbook of Manual Medicine, which you co-wrote with Jonathan Lawrence, talk me through the inspiration of the book. How did it come to be?

David Lintonbon DO (01:34)
Essentially, it came about roughly 20 years ago when we did the original DVD on manipulation. That was back in 2004. So really, it's evolved out of that. We wrote a whole series of ebooks thinking ebooks and that was the future and found that ebooks are okay, but

not everybody wants to read an ebook. And ⁓ doing a doing a survey on this amongst students and also practitioners and people that come to our CPD courses, 99 % of people wanted a textbook. So taking that into context, I thought, maybe ebooks are not the future after all. So we put pen to paper and basically sort of

After a lot of work and a lot of research, we came up with the Handbook of Manual Medicine last year and there we have it really in a nutshell. So it's really evolved from the DVD on manipulative techniques, the art of HVT.

Silvan (02:54)
Yeah, and you talked about sort of this is something that came into fruition. And this is a piece of work that came 20 years in the making. And it certainly feels comprehensive. It certainly feels like there was a lot of thought ⁓ and detail put into it. I'm wondering, David, you talked about, you know, talking to students and talking to other people in the field. Was there a gap that you found in like

David Lintonbon DO (03:04)
Mm-hmm.

Mm-hmm.

Silvan (03:23)
the current landscape when you were writing this that you were sort of present with.

David Lintonbon DO (03:29)
Yeah, a lot of the research we did, all right, revolved around the techniques that manual practitioners use. And, you know, doing some research on this and gaining research papers on the theory and practice and what works and what doesn't work, you know, we basically took sort of, you know, the techniques and put them down sort of in a regional format.

So looking at techniques, say, which would assist with removing or reducing headache, for instance, or TMJ pain. So we looked at the techniques that people use or solution that maybe don't use so much, and actually sort of looked at how they would assist practitioners to assist their patients. So we put it down sort of, you know, in a format that most practitioners all sort of

know, senior students could actually sort of follow the text, follow the illustrated diagrams. And actually sort of if they've got some, they've got the DVD as well, they could use that as well as another additional piece of CPD. And yeah, it took a lot of putting together, I think, you know, the book is nearly 500 pages long. So it goes into the latest theory behind

how manipulation can benefit patients. But it's not just about manipulation, it's also about how we assess and examine the patient. And as manual practitioners, using our hands is vitally important. And this is something I think that ⁓ seems to get a bit overlooked sometimes. The practice of our techniques revolves around the practitioner using their hands on a

on a daily basis. And it's the feedback we get from that and how we utilize the techniques to the benefits of our patients. Or not as the case may be because each each section itself has contraindications to the use of these techniques as well. And I think that's some vitally important part of the book itself. How you use the book and how you actually identify problems

that the techniques can help and each section and each technique itself that is listed in the book basically runs through where it is used on a regular basis and how it helps. And there are also references to pieces of research that back this up as well.

Silvan (06:17)
As an educator, and I know you've been, you know, teaching for, for a really long time yourself.

What I was struck by was the introduction of the book. You actually go into some of the history of manual medicine. And I know from when I was a student, I think that's something that isn't taught as much or not as emphasized on. And so where was the inspiration to include some of that? ⁓

David Lintonbon DO (06:30)
Yes.

Basically, from sort of history itself, these techniques have not suddenly been plucked out of the sky. A lot of people don't realize what is the background behind manual medicine. So I did a bit of research on this and I actually went to the British Library and got some of the inspiration from that.

And I can thoroughly recommend if you're doing any research itself, become a member of the British Library. I'm not plugging them for any particular reason apart from sort of, you know, it's an academic centre of excellence. You can go there and pretty much get any piece of research you require. Mind you, with AI today, maybe you don't have to. But I found some very helpful people there and, you know, was inspired sort of, you know, to dig a bit deeper into the history.

So, yeah, essentially that's where it came from. Just to give sort of, you know, the reader an idea of where these techniques have come from. You know, they're not suddenly sort of, you know, been plucked out of the air or, you know, I haven't done any of these techniques myself. I never came up with them. They were handed down to me. So it's nice to sort of, you know, maybe take a breath and, you know, look at the history of where the profession has come from.

And essentially that's some of the research that I found just to give it a slight potted history at the beginning. So people understand that these techniques have been around a long time. They really have. And maybe practitioners today have either refined them somewhat or maybe they just don't use them as much. And I think maybe that will inspire people to dig a bit deeper into what we do.

how far reaching these techniques can be.

Silvan (08:40)
Yeah, and I really like that you started with that because it roots the premise of the book and the premise of manual medicine in a way.

David Lintonbon DO (08:47)
Yes, yes

it does, And I think that's important, you know, I think if we understand the past we can understand the future as well.

Silvan (08:57)
Yeah. Now, when I was reading through this, I was obviously looking back at books that I used as a student. one of the things that struck me was, you know, books on osteopathy and manual techniques, you know, have existed before and will continue to exist. I continue to use them even when I'm five, six, seven years in practice.

David Lintonbon DO (09:12)
Mm-hmm. yeah.

Silvan (09:22)
what I really appreciated was a more modern take on some of the techniques in its presentation. For example, you know, previous books that I use as a student were black and white and very sort of very wordy and not clear like what clinical examination was pertaining to which photo, for example. Now your approach was very clear. It was, it was

concise and specific and that's what I appreciate and that's why I feel you took a more modern approach to the writing of it and the presentation of it. Is that something that you were conscious of?

David Lintonbon DO (09:59)
Very much so. think, going back to when I was a student, there were very few texts actually on the osteopathic approach to treatment. There were a number of very good texts, ⁓ but they were limited and they weren't backed up with research or evidence that we require today. So one of the things that really drove me to write the book itself was

One, to make it sort of as clear and concise as possible. And also, to have the relevant piece of research that shows that this technique really does benefit the patient. All right? And I've only included in the book techniques that I use myself in practice. All right? Ones that we teach to students and at CPD events. And also, to make sure that we've got the relevant piece of research with it as well. And...

That sort of, know, I think is the important aspect to match the two together. The evidence, the research, and the actual sort of theory behind the technique and how it can be used to benefit our patients.

Silvan (11:11)
That certainly comes across. Now, when I was reading this, I was also interested in how you structured the book. So you structure the book by region. And then within that, you know, you, have diagrams, you have sort of techniques and you have, like you said, contraindications and why the intention of why you would do this. What made you choose that type of approach in, in trying to structure the

David Lintonbon DO (11:26)
Mm-hmm.

That's a very good question. I know that, you know, as practitioners, we look at the body as a whole. And I think sort of, you know, it's very important to do that. That sort of, you know, makes our profession itself, you know, relatively unique. You know, how can the foot influence the TMJ, for instance. So when you do that, all right, you would then sort of, you know, look at sort of, you know, the body as a whole, but

breaking it down into its component parts, you have to look at each area accordingly. So, to make it more straightforward, when we look at, let's say for instance, the jaw, why do people get so many problems with the jaw? And why do so many people have problems treating it? Well, in the section on the TMJ, we put in there about short leg syndrome.

So we actually sort of incorporate into each region, one, the techniques that are specific for that region, but also how other areas influence that region. So we look at sort of, let's say short legs syndrome, how that results in sort of a functional scoliosis, and that can lead to an overloading of one of the TMJs. All right, and I think sort of, a lot of people,

don't realize that unless you correct short leg syndrome, if you a better word, then of course you need to look at the pelvis, the spine as a whole. And I think this is what makes us a rounded practitioner. We look at the maintaining factors and we look at the body as a whole and how one area can influence another. And I think breaking it down into regions,

but within those regions to include what can also influence those regions. And that's basically why it's organized in the way it is.

Silvan (13:48)
Yeah, and I think you do that really beautifully and you weave all those elements together. And I think that's representative of the way you practice and the way you teach. Having been a student of yours all those years ago.

David Lintonbon DO (13:50)
Thanks,

Mm-hmm.

Yes, very true. But that's part of our philosophy, isn't it? That we need to treat the body as a whole and that is really what makes our profession unique. There aren't many professions that start to incorporate other areas or they don't look at it quite as deeply as we do. For instance, one of the areas that took a lot of research was the foot.

And I've specifically put in there how sort of, know, loss of mobility in the subtalar joint can influence so many other areas of the body. Unless that joint is functioning efficiently, then patients are never really going to improve as well as they could do. All right. And I've been a victim of this myself. I've actually sort of treated many patients and you think, why aren't they getting better? And then

then the penny drops. You think, I didn't look at the subtail joint. I didn't look at other areas quite as robustly as I should have done. basically, we need to have a bit of critical feedback of ourselves. And that's another reason for having those regions and looking at the research, which is quite important. It's quite amazing when you look at the research out there, very little of it, unfortunately, is from.

know, osteopaths or sort of, you know, manual practitioners in the UK. So you do have to sort of, you know, seek far and wide. But I've done that and I've also sort of, you know, looked at other professions as well and how some of their manual techniques, you know, have maybe evolved from osteopathic techniques or maybe they have evolved themselves. But sort of, you know, they can be very useful. And I think sort of, you know, that is also highlighted in the book.

how using particular techniques on one area, as I say, the subtalar joint, and how it can influence quite greatly, you know, your overall treatment and management plans.

Silvan (16:11)
Yeah, and I think what you highlight there is also choosing, you know, adjunct techniques, but also choosing the correct technique. How would you like people to use the book? Like, I mean, I suppose everyone has a different approach than how they might use it, but when you sort of wrote it, how do you envisage people to use the book? Do they go through the region and then read through that? Or are there specific techniques that they remember that they want to brush up on, for example?

David Lintonbon DO (16:42)
That's a very good question. think people will use the book and some of the feedback I've got from people who've had the book now for a few months, they actually sort of come back and say, well, if I'm looking at various conditions, I'll actually sort of look at the area accordingly. And then sort of, they say, well, it's very interesting that when you look at sort of, let's say for instance, a shoulder condition and how they would go about treating that.

There is also, as I say, areas of the body that they also need to look at as well. And maybe this is more practitioners from allied therapies where maybe they would just treat a shoulder problem on its own and not look at other areas. So what people are doing now is they're looking at the region, so i.e. let's say an impingement issue, and then they use the book to use the techniques.

treat that impingement problem. But what the book tells them also is how other areas influence the shoulder. So let's say for instance, if you don't look at the thoracic spine and improve the range of movement in the thoracic spine, then of course, the shoulder is never going to truly improve as well as it should do. All right, because as we know, you know, the last few degrees of movement in the shoulder,

is dependent upon the mobility of the thoracic spine. And again, there are sort of, know, references to research which shows that if as a practitioner, you improve the range of movement in the thoracic spine, the shoulder condition will improve as well. So I think that's where it comes into tying it all together and actually sort of using sort of, you know, the region, but that region itself also shows how

Other areas can influence it as well and influence the techniques that you use.

Silvan (18:46)
Yeah, and I agree in that there's a generalizability in your writing and the way you approach the book, but there's specificity in the techniques as well. For example, if I open the page to this is one that I had earmarked when I was reading it. 277. I know very specific. I showed I did say I did read it. You know, I hate when people go on to a podcast and the pop

David Lintonbon DO (19:08)
Ha ha ha, good.

Silvan (19:14)
the person interviewing them has not read the book. So I always make sure I do. ⁓ But like on that page, you have like an L5 disc prolapse decompression technique, for example. And so yeah, and so lower back pain is prevalent in a lot of patients that come to our clinics. And what I like is you've got specificity in the types of things that you can offer or use as a technique.

David Lintonbon DO (19:24)
very common problem.

⁓ very much so.

Mm-hmm. Yes.

Silvan (19:41)
So in keeping with that sort L5 disprolapse technique that you mentioned in the book, what would your approach to a disprolapse be, for example?

David Lintonbon DO (19:45)
Mm-hmm. Yeah.

Well, ultimately, it's got to be to do with pain control. Someone's got a dysprolapse, it's going to be very uncomfortable. So first of all, you're going to have to rule out the solution that there's no cauda equina, which we talk about in the book, red flags, trying to rule out sort of anything that we can't deal with. So of course, if it is a condition that we can deal with, and the patient has got, let's say a post-tro lateral

disc prolapse to the right hand side, so we're a bit of nerve compression as well. Then we talk in the book about decompression and then using specific techniques close to the area where we can improve the mobility of the spine. So if someone's got solution to a problem with L5, they're gonna have potentially nerve root pain down one leg as well. Hopefully it's not both, that would be a red flag, so we'd probably have to refer them on.

All right, and as I say, we have to make sure that we rule out things like cauda equina. All right, that's a very, very important aspect of it. And we do talk about the red flags and contraindications as well. So going forward, if we've ruled out sort of, you know, the red flags, we carry on sort of, you know, with the treatment. One of the techniques talks about sort of decompression to L5 disc and altering the hydrostatic pressure of the disc itself.

which we've sort of used various pieces of research to back up these techniques. Then we look at sort of specificity. Why has that problem occurred in the first place? So one of the predisposing factors, let's say it's not of a traumatic onset, it could be a repetitive strain problem because other areas of the spine are restricted. All right, and what you tend to find, this is not with every case, but sort of a lot of the time,

you find there are restrictions of motion, particularly the upper lumbar, thoracolumbar region. And if we carry out sort of techniques to improve the range of movement there, then of course, sort of, you know, it takes pressure off the L5 disc, which is prolapsed. And this will sort of, you know, ease the patient's symptoms. Patient will more flexible. They'll actually sort of have less pain and they'll be more mobile.

So that specificity itself comes out very important. All right, so if we delve into the history as such, then of course, you know, there are techniques where they actually show you manipulating the area where the disc is, but I wouldn't advocate that myself. All right, particularly sort of if you're not a skilled practitioner, you could actually make things worse.

So this is where specificity comes into its own. Looking at other areas of the spine, how we can actually sort of improve their range of movement without aggravating the area of dysfunction. And I think that is emphasized in the book quite a lot. That specificity of technique itself is very important for that particular reason. Improve areas of dysfunction without aggravating the area that is inflamed.

Silvan (23:10)
Yeah. And I think that's something that such a lot of students will come across if not in clinic in their first few years of practice. And it's always one of those, shit moments. Like, what do I do?

David Lintonbon DO (23:25)
Yes, it is indeed. What you find is that if we've ruled out sort of red flags and we want to treat an area, all right, then of course, sort of, you know, it's very important sort of, know, that we're using our palpation skills to identify, you know, motion and motion loss elsewhere. And I think sort of that is half of the battle that if you're improving joint range of motion in

the area close to where the dysfunction and the inflammation or the dysprolapse actually is, then of course, the effects are very positive indeed because you're improving blood flow, you're improving sort of lymphatic drainage, you're actually improving mobility, so the patient feels so much better following the actual treatment itself. And as I say, that's where the specificity comes in handy.

because of course we're using our palpation skills to great effect, identifying the actual sort of area of where the disc prolapse is, all right, if we say it's L5, and then of course you're looking at other areas close by and even further afield to actually sort of influence those areas accordingly. So yeah, specificity is very important, I think, with what we do.

Silvan (24:46)
Hmm, definitely. You talked about a hands-on approach and I wanted to talk to you about, you know, the value of a hands-on approach and diagnosis. Now, you know, how important for you is that palpation technique or that palpation or that sense of touch in your diagnostic process?

David Lintonbon DO (24:56)
Uh-huh.

I think it's very important because of course this is again sort of you know what sets our profession aside from others. You've got to use sort of you know your palpation approach to identify these areas of dysfunction. Otherwise sort of you're just going to treat people in a very generic way and you know technique then becomes sort of you know just you know a whole series of well do this this and this and it becomes very prescriptive.

And I don't think that's what we are about. We are not prescriptive in our approach. Each patient is an individual. We palpate the patient accordingly, identify those structures through using our palpation skills, and then treat according to what we find. And sometimes that's a very difficult thing to actually sort of do research or evidence-based research on. So that can be a bit of a pitfall.

Silvan (26:05)
I agree and I think this is where some of our physiotherapy colleagues, for example, are very much indoctrinated in evidence-based research, whereas sometimes the techniques we use or some of the philosophy that we use isn't necessarily evidence-based but evidence-informed.

David Lintonbon DO (26:22)
That's very true.

Silvan (26:24)
And in talking about using that, know, palpation and therapeutic touch perspective that we have as osteopaths, how important is that for you to build a strong relationship or trust and rapport with the patient that you're treating?

David Lintonbon DO (26:40)
extremely important. Patients are coming to us because they have a problem, a pain. What's causing that pain? Some of it may be a traumatic onset or a repetitive strain, but some of it may be down to stressor factors. We don't know what's happening in that patient's life. There could be lots of problems either in their work or a home life or sporting activities that they do. Developing the trust of the patient.

is very, very important. So a lot of what we do, all right, is actually sort of engaging with the patient. You have a conversation with them. And through that conversation itself, it's so important for the practitioner to be able to put the patient at ease. So when you look at sort of, you know, what we do, you you can't just start sort of, you know, working on a patient. You have to sort of, you know, explain why techniques

are used, how you go about sort of examining patients so that you identify the correct techniques to use.

patients may be fearful or they may have sort of, you know, watched too much TikTok and think that sort of, you know, they're going to get thrown around the room or sort of, you know, hit on the back with a hammer and stuff like that. know, unfortunately, these things we have to counter that, you know, in this, in this day and age, you know, there's so much social media out there that obviously sort of some patients are going to think, God, is that going to happen to me? So

Gaining the trust of the patient is a very important aspect of what we do. You have to put the patients at ease. And I think the empathy that you show your patients is really sort of a reflection of how you work as a practitioner. And I think that's incredibly important. People are putting their body on your couch and they want you to help them.

That is an extremely important thing with what we do, gaining the trust of the patient through how we talk to the patient and how we respond to their particular concerns. So I think there is a section in the book really which talks about how we gain consent from the patient, how we use that consent to help that particular person by using

the correct technique accordingly.

Silvan (29:20)
And I agree, think, you know, especially being a clinical tutor as you are, think one of the things that I try and teach people or teach my students is that you have to build a rapport with the patient that comes in the room. And if you're not able to build that rapport, you know, they're coming to you in a very vulnerable state, you know, they're in pain, sometimes it's acute, sometimes it's long standing, and there's a vulnerability and a power imbalance in that room.

David Lintonbon DO (29:32)
Yes, you do.

Nah.

Absolutely.

Mm-hmm. I agree with you.

Silvan (29:51)
because you're perceived

as, you know, you're perceived as this sort of a knowledgeable practitioner. You know, you have all these things that are going to help and they're coming to you, essentially asking you for help.

David Lintonbon DO (29:57)
Mm-hmm.

Absolutely. And ⁓ obviously, most of those people we will be able to help, but there comes a point sometimes when some patients cannot be helped because our techniques may not be suitable for them. Then we have to refer the patient on and that's also a very important aspect of what we do. All right, if you identify chondrinoications or red flags, then you have to refer that patient in the right direction.

and that's an important aspect of what we do. We can't just blithely go ahead and treat people using the same techniques and the same approach week in, week out. As I say, the important aspect of what we do is to actually identify the problem and tailor our techniques according to that patient's needs. And that may change from week to week. You're constantly reviewing the situation.

Patients come back and say, well, I'm not feeling any better. So you think, well, maybe I've not sort of, you know, looked into this as thoroughly as I should. So therefore, sort of, know, you have to spend a bit more time looking at potential maintaining factors. And I'll go back to sort of, you know, what we do, you know, from our core philosophy of treating the body as a whole, you know, looking at other areas, which might be influencing that patient's painful area and how we can deal with it accordingly.

Silvan (31:31)
I like that you emphasize that each patient's treatment is uniquely different to suit them. I think often and you highlighted this on social media to certain extent, you know, you have a lot of content out there that is accessible to the public and to practitioners too, but also to other professions. ⁓ know, physiotherapists, chiropractors, other types of manual therapists as well. And

David Lintonbon DO (31:36)
It is. ⁓

Mm-hmm.

Silvan (31:59)
Often what I see on social media is use this routine for your back pain patients or this is the one exercise that's going to cure your shoulder pain, for example. And what you've highlighted is each patient is uniquely different. And so your treatment has to suit them.

David Lintonbon DO (32:14)
I am.

That's right. mean, it's no good giving someone a prescription of, let's say, just exercise if someone's in a massive amount of pain. If you came to see me with an acute shoulder injury and I just said, well, here's a prescription of exercise, go away and do them, you're going to look at me as if I'm mad. I've come to you because I've got this problem. I'd like to examine it and treat it accordingly.

I don't want to go away with just a prescription that is the same that you would give to the next 99 patients. It's just not on from our perspective. We just don't work that way. And how we get that across to the population as a whole is something which we've been battling with for 100 years or more.

And I think that is what we need to do as practitioners to say to potential patients that our technique is rather unique, our approach is unique, and obviously you've come to us with a condition which we will tailor our techniques to help you as a person. You can't just open a textbook and say, ah yes, page 273, right?

use that one there, that will be fine. It just doesn't work that way. Each patient has to be assessed individually and so if you know that the correct techniques have to be used accordingly. And again, reflect on what you do. That patient is not improving after two or three treatments, then you have to think about what your approach is and to look at, reflect on what you have done.

and alter your treatment plan accordingly. There's no prescription for that approach. You have to sort of treat everyone as individuals. All right, so that's how we work.

Silvan (34:27)
Absolutely. I'd like to come back to the book. writing such a comprehensive manual like this, I imagine had some challenges. Can you talk through some of the challenges that you face when writing the book?

David Lintonbon DO (34:39)
Yes.

Some of the challenges were essentially around the research. So again, sort of, you know, spending a bit of time sort of, you know, with each area. So when you look at the book, as you quite rightly said, it's broken down into the theory behind the various techniques, the manipulation approach, mobilization, MET, et cetera. So it's getting sort of, you know,

the most up-to-date pieces of research that backs up the use of these techniques. And that was a challenge. I think spending a bit of time, again, at the British Library, getting the right research paper to actually back up what you say in the book itself, not just relying on if you do this, it's going to work. Well,

You can't just say that anymore. You know, when you look at some of the old textbooks, you know, that that's what they used to say, you must do this technique and it will help this condition. Really? Well, that's not how we work today, is it? You know, times have changed and obviously getting the piece of research or evidence to back up what we do is extremely important. So that was a challenge. As I say, a lot of the the evidence and research of

how we work is not as robust as it should be. And some of it has to be borrowed from other allied professions. All right, who, let me get this correct, who are using our techniques that have been, you know, used by practitioners, you know, for many, many years, but other professions have now taken them on and considered them their own. And of course, they've now got the research.

that shows they work. all I'm doing is sharing that research to show that what we have done over the years actually sort of does work. And we do have evidence to back it up. And I think that's an important aspect as well. So that was a big challenge, getting the right piece of research, but not just the right research, know, more up to date research, know, stuff that's been done within the last, you know, five or six years.

You know, it's not easy. Not easy at all. I know what it's like. So my heart goes out there to all you students who are doing dissertations, you know, don't just use AI, go to the British Library. ⁓

Silvan (37:26)
I think, I think you're right. think when it comes to osteopaths, and this is what I appreciate about the content that you have been producing for 20 plus years, I think it's important for osteopaths to be producing content, books, videos for osteopaths, because it's so easy to go into private practice and, you know, develop your clinics and, and, know, do mentoring and things like that. That's all well and good, but who's producing the content for us?

David Lintonbon DO (37:41)
It feels... Yeah? Yes?

Silvan (37:55)
And that's what I appreciate about what you do. You know, right from when I started watching your videos on YouTube on the art of HVT videos.

David Lintonbon DO (38:03)
Yeah,

yeah. Yeah, I mean, you know, a lot of those videos themselves were basically, all right, carried out sort of, know, in such a way that if you do have the DVD, there is a section there that you can download. I know, you know, who looks at DVDs anymore, but...

If you do have the DVD, if you download it all, there is a section there which has sort of, you know, the techniques written out and research which goes with it as well. So they have been researched quite extensively. There's no doubt about that. you know, I've tried to emulate that in the book by bringing it up to date more. You know, there are aspects of it, as I say, where you've had to use allied professions that show that various

manipulation techniques in particular, do actually sort of work for a particular condition. And getting those pieces of research is very challenging. It really is. But persist with it and you you will get your fruits in the end.

Silvan (39:14)
Yeah, I'm wondering, there any moments when you were writing the book or realizations or aha moments, I suppose, when you were writing the book? Because, you know, with anything you write, you talked about some of the challenges, what were some of the insights that you gained from it as well?

David Lintonbon DO (39:35)
I think the main insights were, all right, where, I say, other allied professions are using these techniques. And if you trace those techniques back, they were used by the likes of Little John and so on and so forth. And you can trace them back to their days. other insights as well, again, how we have actually

you know, use other professions techniques and incorporated them into our own. One thing was the Mills procedure on the radial head. All right, I looked into this in more detail and actually sort of, even though it is an osteopathic technique, it was actually sort of really used quite extensively by an orthopaedic physician back in the 20s and 30s called Supercival Mills. And that's where the

The name comes from, the Mills technique itself, comes from this gentleman who was using this technique, as I say, nearly a hundred years ago, but he wasn't an osteopath, he was actually an orthopaedic physician. So there we are, history itself, did he get that from an osteopath? Maybe he had an elbow problem when he was writing his notes and went to see an osteopath and didn't want to talk about it because it wasn't a done thing in the day.

All right. And obviously, sort of, you know, came away and thought, hey, that technique really works. I'll start using it on my patients. And then obviously, him being a magnanimous person, sort of, you know, decided, well, maybe we'll call it the Mills technique. And it's got nothing to do with osteopathy. It's funny how these things come about.

Silvan (41:22)
That's what I love about the profession is we borrow and we also lend. And we do that without ego.

David Lintonbon DO (41:26)
We do, correct.

Yeah, absolutely. And I think that's a very important aspect of what we do. You know, as I say, you know, it's a very fluid profession that we have. And obviously, sort of, you know, those techniques that we use and utilize a lot, you know, can be extremely helpful. But sort of, know, as I say, you know, there's a lot of toing and froing between sort of, you know, various allied professions. And I think sort of, you know, that can be very helpful.

you know, one technique might actually sort of trump another and you think to yourself, well, that's got to be quite useful and you do learn as you go along. So maybe we need a bit more sort of interaction with other alloyed professions. You know, there's a lot of information out there. Well, one thing that sort of struck me about when I was doing a bit of history and research was finding about the bones setters of old.

And these people were sort of, you know, just learning techniques which were handed down sort of, you know, from a parent, usually from their father. And, you know, they've utilized these techniques to great effect, sort of, know, for hundreds of years. But, you know, the origins of them are lost in the midst of time. So how many these techniques could have been sort of, you know, maybe sort of saved or used or...

actually sort of researched into. Some of them we won't know because they're just lost in the midst of time. that's what I'm saying. Another reason for writing the book is to actually sort of put down stuff that, you know, future generations may be able to put to really good use.

Silvan (43:08)
that's the importance of the content that you create like this. Absolutely. Now you co-authored the book with Jonathan Lawrence. I'm wondering how that collaboration between the two of you came about. Did each of you focus on different chapters or did you share it combined together?

David Lintonbon DO (43:10)
Mm-hmm. Yep.

Correct.

⁓ Basically, Jonathan, I've known him a long time. He was a graduate of the ESO, at the same time I graduated from the old BSO as such. he's really taken his whole practice life down a very craniosequential route. And in doing so, he's become one of the country's foremost educators in craniosequential techniques.

He's also sort of, know, very good at sort of, you know, the structural side and we were actually collaborated on a number of projects over the years. And he reviewed, I think, the art of HVT. I think he's one of the first people to review the art of HVT video, stroke DVD, all right, back in the day. And yes, I think sort of collaborating with Jonathan has been very helpful because

his section on of, know, train your sacral techniques, you know, actually sort of gives the practitioner a much more rounded approach to treatment. And by including that in there, I think sort of, it helps practitioners to see and even sort of, know, senior students to look at sort of, you know, the other spectrum of our profession. So utilizing again, using the right tool to carry out the job.

And the craniosacral aspect itself is a highly important aspect of what we do. again, sort of, you know, doing some collaboration and finding sort of, you know, relevant research to look into the use of the techniques accordingly, particularly from that approach. So it's a very valuable chapter that Jonathan has written on sort of, you know, that craniosacral approach. And again, sort of, you know, this is something that sort of

that most practitioners need to look at, there's not just one approach, you can't just use one technique. You've got to utilize various approaches to become a more rounded practitioner. So that's why I collaborated with Jonathan to put that chapter in there. So it shows that if you can't use the structural approach,

there is an alternative and that alternative is a very useful one, all right, so if you know which our profession uses, you know, to ⁓ help with many people. And again, I think sort of, know, if you just use one approach, you know, you're not gonna really help that many people.

Silvan (46:14)
Yeah, and I really love the collaboration between the two of you and how well it complemented each other.

David Lintonbon DO (46:17)
Thank you.

Yes, yes, I think it does.

It needs to be in there because it's a very valuable part of the profession as a whole. When you think about it, that technique itself has been around for quite some time and obviously it's helped many, many people. But again, the actual evidence and research is not as robust perhaps as we would like it.

But I have done quite a bit of research in there along with Jonathan and we've found some very interesting pieces of research that have been done but unfortunately not much of it has been done by our own profession but it's been other people looking at it from afar. And obviously they've used various techniques to show that these techniques do help a lot of people and that's the whole aspect of it.

you know, you're there to use that technique to help your patients. You can't just use one approach, you know, as I say, if your techniques are not, if your approach needs to be reviewed, or you need to sort of, you know, critically reflect what you're doing yourself, then sort of, you know, if you don't have a broad spectrum of techniques, you know, you're not going to help that many people.

Silvan (47:43)
Yeah, I agree. And in thinking about sort of the broader perspective of osteopathy today, where do you see osteopathy in the in the current health care landscape now? So I know me personally coming from an NHS background, for example, and lots of people and my colleagues in private practice, where do you see osteopathy fitting in? Or does it need to fit in?

David Lintonbon DO (47:50)
Mm-hmm.

Mm-hmm.

That's a very good question actually. think sort of, you know, getting osteopathy into an NHS background itself. I myself worked with a GP's practice in North London for 15 years. that sort of, you know, that collaboration between sort of, you know, the manual approach to the treatment of various musculoskeletal conditions was very important.

and those GPs could see the benefits that it had. So, where do we go as a profession into the future? It's a very difficult question, isn't it? The number of potential students coming into the profession has dropped in recent years. It would be nice if someone could do a documentary on osteopathy in the UK.

you know, play it on solution and Netflix perhaps, you know, we, we've never really had, alright, so if you know, a champion of someone who could actually sort of say, well, this profession has been around a long time, you know, maybe we need to sort of, you know, as I say, carry out a piece of research, or an in depth documentary into the history of the profession, how it's developed and where it's going to go and our place today.

There's never been a greater need than now for the use of what we do. It's just a shame that even though the country's population has grown, that we're not getting enough people into the profession to actually train and help the general public. And I think the profession as a whole needs to have a serious think of how it's going to go.

One thing that of, you know, that does concern me is this unveiling of a three year BSE in osteopathic technique or osteopathy as a profession. I don't think it's sufficient. And I really sort of, you know, don't think it's a good idea. You know, our training has always been four years.

Why sort of, know, try and make it sort of, you know, three, why try and squeeze it all into that space? Is it merely sort of, you know, just to try and sort of, you know, attract people in, but then if you're only getting people to train over a three year period, you know, what are those practitioners going to be like? I don't care how people try and dress it up. I don't think it's sufficient. So that's one part of the future that sort of,

Silvan (50:58)
Hmm.

David Lintonbon DO (51:04)
that really I don't like myself. I think, you know, maybe we're shooting ourselves in the foot there. Trying to of, you know, bend the profession just to fit in a particular slot. It's not really where we've come from.

Silvan (51:20)
I think that's an interesting perspective, especially coming from someone as experienced as you. And if we look into sort of our European counterparts, you know, some of their training is four to five years, for example.

David Lintonbon DO (51:29)
Yes,

I agree. So why are we dumbing down things here when other countries and other notable universities and the like are actually saying, no, it's four, maybe five years are required. So that does concern me somewhat.

Silvan (51:54)
Yeah, and I think it still boggles me in 2025 that we're still trying to gain recognition or acceptance from the public and raise awareness for a profession that has been around for hundreds of years. ⁓ And so the fact that we're still continuing to have this conversation frustrates me.

David Lintonbon DO (52:17)
Well, I don't think there's any easy answer to that one, so I think...

Silvan (52:21)
Yeah.

David Lintonbon DO (52:24)
you know, like I said earlier, I think it needs somebody, you'll have work, we should get together and create a documentary of the history of the profession. Just to say in the UK, know, where it's come from, you know, there's a long history in the UK. I know, I know it's stemmed from America, from Andrew Taylor still, but you know, the history of the profession in the UK, you know, is just

I don't think anybody has ever done a documentary on how the profession has evolved in the UK. A lot of it just boils down to money, doesn't it? At the end of the day, there's nobody really pushing the profession in the way it should go. And I can say that with my hand on my heart, because at the end of the day,

Silvan (53:01)
Yeah.

David Lintonbon DO (53:22)
I don't think the profession is as well known today as it probably was 40 years ago. There's no change in the number of people who understand what osteopathy does, maybe a small amount. But certainly, you could take 100 people in the street and I think maybe 90 % wouldn't have a clue what the word osteopathy even means, let alone does.

And I think that's a sad reflection of our profession as a whole really is.

Silvan (53:59)
Yeah, and I what I really appreciate in talking to you is you have that basis to understand what the landscape has looked like for a number of years from before and and how it's looking now and and one thing you touched upon is, know, the dropping in student numbers and things like that. And I know, like from a personal perspective, you know, where I'm teaching currently is going to be closing down very soon. And so there is this sense of of of of.

David Lintonbon DO (54:08)
Mm-hmm.

in

Silvan (54:27)
frustration but of sorrow that institutions are closing and what that would mean and the ramifications of that on student numbers, the profession, how we move forward and so forth.

David Lintonbon DO (54:40)
unfortunately, sort of, you know, that that that is the case that, you know, various aspects are going to contract. And as a result of that, sort of, you know, you have to sort of think, well, you know, what's going to happen to the profession sort of, you know, in years to come. And when you look at that, when when institutions, know, ⁓ are going to close, you know,

it saddens me quite greatly. When you look back when I was a student, there were two main colleges that were highly respected, the British School of Osteopathy. That college now has lost that title and maybe has lost its direction. And as you say, our beloved British College of Osteopathic Medicine is now also

scheduled to close, which is a great loss to the profession. You know, these institutions have been around a long time and it will be a terrible shame to see them go and you know, it does sadden me quite a lot. ⁓

Silvan (55:55)
Yeah. On a brighter note then, you talked about the intention of the book or the audience of the book being students. I wonder who else might benefit from the book.

David Lintonbon DO (55:58)
That's a good idea.

Mm-hmm.

Well, of course, you know, lot of students will benefit from the book. There's no doubt about that. But if you've been a practitioner for many years, you know, you might want to brush up on some things. Or if you're going to look around, sort of, you know, some critical reflection of your own approach, or you're trying to gain a bit bit of CPD in itself, then of course, you can look at the book sort of, you know, to enhance what you do. So the book itself is

is out there for people to dive into whatever aspect of it they want to use. And again, if a lot of people, when they've been doing something for a long time, they get a bit stuck in a rut, and maybe they want to get out of that rut and look at other areas of the profession, or maybe think, ⁓ I haven't used this technique for a long time, wonder why.

Or it might sort of, you know, just jog their memory into, you know, basically looking at sort of, you know, areas that they need to brush up on as such, or maybe sort of, you know, just alter what they're doing. So it could be very helpful from that perspective, just to widen your approach and remember where your roots come from.

Silvan (57:30)
I agree and the book certainly reminded me of techniques that I was taught by you and by other people at BCom, which I haven't used for a while. It was so handy to then look through the book rather than try and dig up notes from like five years ago, which God knows where those are now. And that was really helpful. It was a concise guide, I would say.

David Lintonbon DO (57:35)
Yeah.

Yeah. Yeah.

Yes. Yeah. Concise guide is what it's all about. mean, you know, even the size of the book, we did it at 85 because of course, it's to put in your pocket. Well, not quite your pocket, but it's easy to carry around, you know, you can get out of the tube and have a read, you know, if you've got somebody who's at 84, you're going to pull that out on the tube and have a read through? Maybe not. You know, so it's portable. I think that's the key word. It's portable.

you know, you can take it to your clinic, can take it sort of, you know, take it on the bus or the train and you know, you can gin up on something before you get to an exam, for instance, or, or maybe sort of, know, before you get to clinic, you know, you can have a browse through and think, yeah, what do do with that shoulder issue? What do I, no, I'll have a look. Just have a quick read on the chapter. And you know, just, just, just 10 minutes will bring you back sort of feeling, ⁓ yes, that's what we need to use.

So yeah, it's portable, easy, concise, and a cool solution. It's got the techniques that you can utilize pretty much, know, straight away.

Silvan (59:00)
Now, David, where can people buy the book? Where can they find the book?

David Lintonbon DO (59:05)
Well, they can pop along to BCom. We've got them there in the library. But you can buy online through our website, which ⁓ I think you're gonna put a link to at the end. yeah, buying it from our online shop is easier. Then we can post it direct to your clinic or to your address. Yeah, so.

Silvan (59:27)
Yeah, I'll certainly put the link in the description box just for those people who are listening. For those people who are listening and not watching, what's the website called?

David Lintonbon DO (59:30)
in the link below. ⁓

The website's called sort of Integrated Manual Medicine CPD UK or IMM CPD UK. All right. And if you go to that sort of, you know, just go to the shop and it's in the shop so you can purchase it online. Yeah.

Silvan (59:56)
Wonderful. David, thank you so much for spending the last hour and talking to me about the book. I have to say, I thoroughly enjoyed reading it. I think it's so important, like I said, for osteopaths to be producing content for our profession. And you have done that consistently over the last 20, 30 years.

David Lintonbon DO (59:59)
⁓ it's been a pleasure.

Thank you.

Yes. Yes.

Yeah, I think that's what we've got to do to try and sort of, you know, get our approach across to not just sort of, you know, allied professions, but to general populace really. That's the thing. Yeah.

Silvan (1:00:32)
Yeah, and inspire

the next generation of osteopaths that are coming through.

David Lintonbon DO (1:00:36)
do hope so, that's the thing.

Silvan (1:00:38)
you so much, David, and thank you for producing this. ⁓ I look forward to what you're coming up with next, because I know you've always got something planned.

David Lintonbon DO (1:00:42)
My pleasure.

Yes, yes, that's right. You know, it's there will be something maybe I'll do a follow up book. So we should think now there we're talking so if there's any documentary makers out there listening, you know, think about sort of, you know, Sylvan and Iself, we, we got, we got something planned. Yeah, I think a documentary on the history of osteopathy in the UK would be

Silvan (1:00:56)
and the documentary.

David Lintonbon DO (1:01:16)
Absolutely enthralling. I really do.

Silvan (1:01:21)
Thanks so much David.

David Lintonbon DO (1:01:22)
It's an absolute pleasure Sylvan. Thank you so much again