Archive for November 2019

Osteoarthritis

Osteoarthritis Of The Shoulder

Osteoarthritis (OA) is the prevalent type of arthritis and is caused by bone-on-bone contact, which causes both pain and loss of movement. This occurs when smooth cartilage surface wears away on an articulating/moving joint.

OA mainly affects joints carrying the most load, like knees and hips. However, it can affect any joint including joints around the shoulder. Cartilage doesn’t receive a direct blood supply so as a result of this, it is reliant on a process called diffusion. During this process, nutrients are absorbed by the cartilage when it’s compressed by motion.

Restriction of motion within the joint, such as injury of inflammation, can reduce or entirely cut off its supply of nutrients, this puts the tissues under threat of degeneration and injury.

When a patient requires care involving OA of the shoulder, osteopathic treatment usually aims to improve the movement of the required joints with manipulation, mobilisation, manual traction, manual massage, active release techniques, acupuncture, physical therapy modalities (such as ultrasound or electronic stim), nutritional counselling, and home-based exercises.

There are further ways to improve osteoarthritis of the shoulder:

Keep Moving: The best way to keep cartilage nourished and healthy is exercise. Many patients can improve their situation without medication, just by staying active enough.

Healthy Diet: Omega-3 fatty acids (fish oil), ginger and turmeric help aid the nutrition of the joints as they reduce inflammation however, a balance diet in general is advised.

Reduce Joint Load: Weight lose helps, changing lifestyle to make sure the affected joints are routinely active.

Sleep Well: Aiming for 9 hours of restful sleep has been proven to be the optimum for joint repair. Too much or too little sleep can have adverse effects.

Hot/Cold Packs: These can really help reduce inflammation.

Supplements: Chondroitin and glucosamine should be considered.

The more severe the case, the longer it can take to achieve a desired outcome. Hence the importance of seeking care as soon as possible, when you are experiencing shoulder pain or any other part of the body for that matter.

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Lower Back Pain

Activity Aides The Lower Back

Family doctors used to sometimes prescribe bed rest for patients with lower back pain (LBP). Today the recovery process recommends staying more active throughout the recovery stages. So what’s made this change?

In the back there are two types of muscles: the superficial muscles and the deep muscles. The superficial muscles perform movements like bending and turning. These muscles are strengthened by motion that places stress on the muscles, like rowing or push ups. The deep muscles help stabilise the spine and maintain posture. Physical activity helps keep them in shape.

Bed rest actually weakens back muscles and they begin to deteriorate. As motion stress is restarted the body will engage the superficial muscles to stabilise the back. Due to the fact these muscle are not normally used, they tire quicker and normal stamina and movement is restricted. This can put additional stress on the spine structure and other areas of the body, increasing the risk for additional musculoskeletal injuries.

Bed rest can also affect the discs that act as “shock absorbers” in the spine. In one study, researchers recruited 72 middle-aged adults and tracked their physical activity levels in the preceding years based on how many days they engaged in strenuous activity every two weeks: active (9 to 14 days), moderately active (1-8 days), or inactive (0 days). 21% were classified as active, 53% were described as moderately active, and the remainder 26% were inactive. The researchers also performed an MRI on each participant and gathered information on low back pain-related pain and disability.

The results stated that physically inactive individuals were more likely to have back pain, reduced function, loss of disc height, and fat build-up in their back muscles. The conclusion was that regular activity significantly improved function in later life and reduced lower back pain significantly.

There are very specific exercises that help strengthen the deep, low back stabilising muscles. Osteopaths frequently recommend physical activity and exercise to address an acute flair-up of LBP and to aid prevention of future episodes.

Adapted Article: credit https://www.drmatthewdunnonline.com/1607/staying-active-helps-the-lower-back/

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Carpal Tunnel Syndrome Might Be Hereditary?

Carpal Tunnel Syndrome Might Be Hereditary?

Carpal tunnel syndrome (CTS) is a problem created by compression of the median nerve that changes the nerve’s function (neuropathy), which results in pain and numbness/tingling (paresthesia) mainly on the palm-side of the wrist and hand. Hormonal changes and repetitive motions are known to increase the risk for CTS. However, it could be there is a hereditary factor involved.

Conditions that can increase the risk for CTS, such obesity, thyroid issues, diabetes, rheumatoid or osteoarthritis, can be genetic. In addition, surveys indicate that having a relative with CTS increases the risk that you may also develop the condition, but it’s not certain to what level genetic links are responsible versus shared lifestyles amongst family members.

Harvard professor Dr. David Ring and colleagues presented their results from 117 previously published studies to ascertain the strength of a “cause-and-effect” relationship for CTS using a scoring system that included both biological and occupational factors. Their analysis showed that genetic risk factors were twice as strong as the evidence supporting occupational risk factors, such as overuse.

Dr. Barry Simmons, chief of the Hand and Upper Extremity Service at Brigham & Women’s Hospital reported that 75-80% of CTS found in women age 50-55 is idiopathic, or caused by an unknown, further supporting genetics as the main factor. Dr. Ring states, though the evidence suggests genetics are a risk factor for CTS, there could well be epigenetic factors or environmental changes to genes based on diet or particular habits might increase a person’s risk beyond their genetic makeup. As of 2015, no epigenetic factors have been identified in idiopathic CTS.

On a positive, even if you have a genetic history of carpal tunnel syndrome, you can reduce your risk for developing CTS. By managing any conditions or activities that can increase inflammation along the course of the median nerve. Patients may consider maintaining a healthy weight, regular exercise, eating a low-inflammation diet and taking regular breaks from activities that require awkward or vibrating positions, for example.

If you are suffering CTS-related symptoms in the hand and wrist, a thorough examination by an osteopath can help with a solution and treatment plan. Contact cramosteopaths.co.uk of you need help with Carpal Tunnel Syndrome.

Article adapted from: credit https://chiro-trust.org/carpal-tunnel-syndrome/can-carpal-tunnel-syndrome-hereditary/

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Neck Pain

Cervical Traction For Neck Pain

As well as spinal manipulation, osteopaths often use other more reserved therapies to help minimise pain whilst improving function in patients with neck pain. Neck conditions including herniated discs, radiating arm pain (“radiculopathy”), facet syndromes, myofascial pain strains, or sprains, and cervical traction is one such option.

Part of the new patient examination, osteopaths may use their hands to mildly pull on the patient’s neck whilst in sitting and/or supine (lying on the back) positions. If this feels better, then cervical traction may be sanctioned either in the office, with an at-home unit, or both. However, cervical traction is not prescribed if there is instability in the spine/ligaments, vertebral artery insufficiency, rheumatoid arthritis, discitis, neoplasm, osteomyelitis, severe osteoporosis, untreated hypertension, cauda equina syndrome, severe anxiety, or myelopathy.

There are varying forms of cervical traction devices, so treatment may be performed while the patient is in a standing, sitting, lying horizontal, or inclined either prone or supine position, and the traction force can be uninterrupted or continuous vs. intermittent or pulsed. Variances including body/head weight and the associated friction against the traction table in lying down types of units, and the angle can often be varied with most types of traction units.

There are positives and negatives to varying types of traction units. Lying down traction may allow for improved relaxation vs. sitting, but due to the friction on the table, more weight may be needed. In the main, when hold times are longer (especially with sustained traction), less weight is used. Some osteopaths recommend starting at 5 lbs. (~2.67 kg) for 15 minutes with a sitting device (sustained traction) and smoothly upping the weight to maximum tolerance while keeping the time constant at 15 minutes.

There are various theories on why traction provides pain relief: it forces rest through immobilisation and by supporting the weight of the head, it separates / opens the facet joints, it improves nutrition to the joint cartilage, stretches ligaments, it reduces the pressure inside the discs, it benefits by reducing pressure on nerve roots, it improves head posture, and/or it stretches the neck muscles to increase blood flow and minimise muscle spasm.

If you have neck pain and manual traction applied to the cervical spine provides pain relief, then your osteopath may choose to introduce this therapy into your treatment plan.

Article adaptation: Credit https://www.drmatthewdunnonline.com/1615/cervical-traction-for-neck-pain/

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low back pain

Tingling in your leg?

When considering low back pain (LBP), you may imagine someone bent over rubbing the sore point on their back. Many of us have experienced low back pain at some stage in our life, so we can relate to an episode and recall how restricted we were during the acute stage of our last LBP occurrence. However, when the symptoms connected to LBP are contrasting, such as tingling or a sharp pain down one leg, it can be confusing and concerning. To best understand where these symptoms derive from, we need to look at the anatomy of the low back.

In the front of the spine, the part mainly on the inside of our body, we have the large vertebral bodies and shock absorbing discs that support about 80% of our bodyweight. At the opposing side of each vertebrae you’ll find the spinous and transverse processes that are connected to the muscles and ligaments in the back, to the spine. Between the vertebral body and these processes are the tiny bone parts called the pedicles. Where the nerves exit the spine, the length of the pedicle partially controls the size of the holes.

When the pedicles are short, the exiting nerves can be compressed due to the narrowed opening; this is known as foraminal spinal stenosis. This compression generally happens as we age, when osteoarthritis and/or degenerative disc disease progressively crowds these “foramen” where the nerves exit the spine.

Likewise, short pedicles can narrow the “central canal” where the spinal cord travels up and down the spine from the brain. As we get older, the effects of the narrow canal plus disc bulging, osteoarthritic spurs, and/or thickening or calcification of ligaments can result in “central spinal stenosis.” The indicators linked with spinal stenosis include difficulty walking due to a gradual increase in tingling, heavy, crampy, achy and/or sore feeling in one or both legs. The tingling in the legs associated with spinal stenosis is called “neurogenic claudication” and must be segmented from “vascular claudication”, which feels similar but is caused from lack of blood flow to the leg(s) instead of to the nerve.

When we are younger, tingling in the legs can be caused by either a bulging or herniated lumbar disc or it can be referred pain from a joint – usually a facet or sacroiliac joint. The main difference in issues between nerve vs. joint leg tingling sensation is that nerve pinching from a deranged disc is found in a specific area in the leg, such as the inside or outside of the foot. So, the tingling can be identified pretty much exactly in the leg. Tingling from a joint is often named as a deep, “inside the leg,” generalised aching and tingling that can affect the whole leg and/or foot, however it’s harder to describe by the patient as it’s less specific in its whereabouts.

Osteopathic management of all these conditions offers a non-invasive, sufficient form of non-drug, non-surgical care and is the recommended in LBP guidelines as an option when treating these issues.

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Low Back Pain and Nerve Flossing

A patient can feel severe discomfort when the sciatic nerve is pinched or pressed. A tingling feeling, a lack of sensation, deadness, and even frailty in the hip, buttock and leg can be symptoms witnessed. For under 60-year olds, the customary cause of sciatica is a herniated disc.

For older adults, the most likely source of sciatica is spinal stenosis which is a narrowing of the openings of the spine the nerves travel through, and spondylolisthesis, which is when one vertebra slides forward on the neighbouring vertebra.

The sciatic nerve is made up of five nerve roots that exit the spine in the lower back. They then merge into one nerve that travels through the buttock and down to the leg. At the back of the knee, the nerve divides into two nerves. These two nerves are the tibial and common peroneal, that travel into the inner and outer lower leg and foot.

In most instances, a nerve root moves freely in and out of the spine through holes located between each vertebra. Tthese are known as intervertebral foramen (IVF). Exercises such as hamstring stretches or kicking a rugby ball create resistance within the sciatic nerve and pull the nerve roots out of the IVFs. Likewise, when we stand upright and stare at our toes, this pulls the spinal cord upward and the nerve roots move into the IVFs.

When undertaking management of sciatica, osteopaths will make use of an approach named nerve flossing. Similarly, with flossing teeth, the forward and backwards movement of the dental floss is theoretically the same move as the back and forth motion of the five nerve roots, that combine into the sciatic nerve. To draw the nerve roots out of the IVF, extend the head and neck skyward and then bend the foot/ankle skyward in addition (toes toward the nose). To flex the nerve back into the IVF, aim the foot/ankle down while the head/neck flexes progressively (chin to chest). Replicate several times as long as pain or other symptoms are not exacerbated. The concept underlying this is to relieve the nerve root by minimising sticking in the IVF.

Nerve flossing is generally conducted by an osteopath to ensure it is well tolerated and safeguarded, so that the patient can carry out the movement at home multiple times a day. Studies suggest that this method helps minimise stress on the sciatic nerve whilst pulling on the hamstrings, which are invariably tight in patients with low back pain.

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