Your spine deserves an explanation before it gets a treatment.

Both. Start by writing to me on WhatsApp and from there we decide: you can carry on by message, or we arrange a call at a time that suits us both. By voice it is usually easier and a good deal quicker — in writing I naturally take longer to reply. The call is through WhatsApp itself, at no cost to you beyond the internet you already use.

Better to have them and not need them than to need them and not have them: if you already have some, bring them. In case of doubt they help to rule things out and to understand your history. But if you have none, do not go and arrange one just because of the appointment. For most spinal pain, routine imaging is not recommended before the person has been assessed — and the practical reason is simple: the scan does not change the direction of treatment. What guides the next step is how you respond to the stimulus being given.

No. In Portugal you can go directly to a physiotherapist. If during the assessment something is found that needs to be seen by the emergency department or by a doctor, I tell you, I explain why, and I help to arrange that referral.

I cannot give you an honest number before assessing you — and be wary of anyone who gives you a fixed number without having seen you first. What I can tell you is how it gets decided: we reassess often, and between the first and the third appointment it usually becomes clear whether there is a way forward or not. If by the end of those appointments we are not seeing changes, and if I have exhausted what I have to offer you, I tell you and point you to another route — rather than letting you carry on spending time, money and journeys out of inertia.

They do, and in relative terms I can tell you what experience shows me — without this being a prediction for your case, because there is no honest way to make one. What I call mechanical obstruction usually responds more quickly. A herniated disc tends to take longer. And spinal stenosis is, by the nature of the problem, the one that usually calls for the longest follow-up. These are different orders of magnitude, not timeframes.

No. The appointments space out as you progress, and that is the aim itself. Early on they may be closer together; then they become weekly, fortnightly, monthly — and there are situations where they end up two or three months apart, because there is no clinical sense in them being closer. The frequency follows the therapeutic need, not a package bought up front.

I use manual therapy when it helps to clear something and to open up space for movement. But understand it for what it is: a temporary facilitator, never the centre of the treatment. If the plan were only that, you would end up entirely dependent on me — and the aim here is exactly the opposite. I want you to become independent.

For a great many spinal cases it works well, and the structure is the same as the in-person appointment. There is the questioning — what happened, how it started, what makes it worse, what makes it better, what your days are like. And there is a physical examination, done at a distance: I ask you for specific movements and positions and you report back what you feel in each one, which is precisely what matters to assess. The only thing that cannot be done is manual therapy — but even myofascial work can be guided with a tennis ball, a roller or a towel you have at home. If in our initial conversation it seems to me that your case calls for in-person, I tell you before we book anything.